Echocardiographic evaluation of the failing heart

2015 ◽  
Vol 25 (S2) ◽  
pp. 87-93 ◽  
Author(s):  
Anitha Parthiban ◽  
Girish Shirali
Keyword(s):  
Heart Failure ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Univentricular Heart ◽  
Echocardiographic Evaluation ◽  
Wide Range ◽  
Primary Test ◽  
Prognostic Importance ◽  
The Common

AbstractHeart failure in children can result from a wide range of aetiologies and can manifest in systolic and/or diastolic dysfunction. Echocardiography is the primary test for the diagnosis and follow-up of children with heart failure. In this article, we critically review standard echocardiographic measurements that have been shown to have prognostic importance in children with various types of heart failure. Each of the common forms of cardiomyopathy that is encountered in childhood – dilated, hypertrophic, restrictive, left ventricular non-compaction, and arrhythmogenic right ventricular cardiomyopathy – is discussed separately. Special attention is paid to the failing right ventricle, both in the systemic and in the sub-pulmonary position, to the failing univentricular heart, and to the assessment of diastolic function in children.

3D is a feasible and more reproducible method than 2D echocardiography for in-training echocardiographers to follow-up patients with heart failure with reduced ejection fraction

2020 ◽  
Author(s):  
Sorina Baldea Mihaila ◽  
Andreea E Velcea ◽  
Roxana C Rimbas ◽  
Anca Andronic ◽  
Lavinia Matei ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Imaging Method ◽  
Reduced Ejection Fraction ◽  
Expert User ◽  
Wide Range ◽  
Patients With Heart Failure ◽  
Reproducible Method

Abstract Background: Left ventricular volumes (LVVs) and ejection fraction (LVEF) are key elements for the evaluation and follow-up of patients with heart failure with reduced ejection fraction (HFrEF). Therefore, a feasible and reproducible imaging method to be used by both experienced and in-training echocardiographers is mandatory. Aims: To establish if, in a large echo lab, echocardiographers in-training provide feasible and more reproducible results for the evaluation of patients with HFrEF, when using three-dimensional (3DE) vs. two-dimensional echocardiography (2DE). Methods: 60 patients with HFrEF (46 males, age 58±17) underwent standard transthoracic 2D acquisitions and 3D multi-beat full-volumes of the LV. One expert-user in echocardiography (Expert), and 3 echocardiographers with different levels of training in 2DE (Beginner, Medium, and Advanced) measured the 2D LVVs and LVEFs on the same consecutive images of patients with HFrEF. Afterward, the Expert performed a one-month training in 3DE analysis of the users, and both the Expert and trainees measured the 3D LVVs and LVEF of the same patients. Measurements provided by the Expert and all trainees in echo where compared.Results: 6 patients were excluded from the study due to a poor image quality. Mean end-diastolic LVV of the remaining 54 patients was 214±75 ml with 2DE, and 233±77 ml with 3DE. Mean LVEF was 35±10% with 2DE, and 33±10% with 3DE.When compared with the Expert user, the trainees showed acceptable reproducibility of the 2DE measurements, according to their level of expertise in 2DE (ICCs ranging from 0.75 to 0.94). However, after the short training in 3DE, they provided feasible and more reproducible measurements of the 3D LVVs and LVEF than with 2DE (ICCs ranging from 0.89 to 0.97).Conclusions: 3DE is a feasible, fast-learning, and more reproducible method for the assessment of LVVs and LVEF than 2DE, regardless of the basic level of expertise in 2DE of the trainees in echocardiography. In echo labs with a wide range of experience of the staff, 3DE might be a more accurate method for the follow-up of patients with HFrEF.

Abstract P121: Left Atrial Function Predicts Heart Failure Hospitalization in Patients with Stable Coronary Artery Disease and Normal Ejection Fraction: Data from the Heart and Soul Study

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Christine C Welles ◽  
Ivy Ku ◽  
Mary A Whooley ◽  
Nelson B Schiller ◽  
Mintu P Turakhia
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Atrial Function ◽  
Left Atrial Function ◽  
Left Ventricular Ejection ◽  
Normal Ejection Fraction ◽  
Wide Range

Background: Half of all hospitalizations for heart failure (HF) occur in patients with normal ejection fraction (EF). Because left atrial (LA) function contributes up to thirty percent of left ventricular stroke volume, we hypothesized that LA function would predict HF hospitalization in subjects with normal EF. Methods: We performed resting transthoracic echocardiography in 855 patients with stable coronary heart disease (CHD) and normal EF (≥ 50%). We calculated left atrial functional index (LAFI) as [(LAEF x LVOT VTI)/(LAESVI)], where LAEF = LA emptying fraction, LAESVI = LA end-systolic volume indexed to body surface area, and LVOT VTI = left ventricular outflow tract velocity time integral. LAEF was defined as (LAESV-LAEDV)/LAESV). We used Cox proportional hazards models to evaluate LAFI as a predictor of HF hospitalization during a median follow-up of 7.9 years. Results: LAFI was normally distributed with a mean of 42.3 ± 18.6 units. During 5621 person-years of follow-up, 106 subjects had a HF hospitalization. Rates of HF hospitalization were inversely proportional to quartile of LAFI: Q1 (0.5-29.2): 47 per 10 person-years; Q2 (29.3-40.8): 18; Q3 (40.8-53.4): 9.5; Q4 (53.4-160): 5.3 (p<0.001). Patients with LAFI in the lowest quartile had over 8 times the risk of HF compared with those with LAFI in the highest quartile (HR 8.7, 95%CI 4.2-18.2; p<0.001). Each standard deviation decrease in LAFI was associated with an over 2-fold greater risk of HF (HR 2.6, 95% CI, 2.1-3.3, p<0.001). After adjustment for age, sex, body mass index, history of heart failure, prior revascularization, creatinine, atrial fibrillation, diastolic dysfunction, left ventricular mass index, left ventricular ejection fraction, and inducible ischemia, participants with LAFI in the lowest quartile still had over 4 times the risk of HF compared with those in the lowest quartile (HR 4.7, 95% CI, 1.7-12.5; p=0.002). Conclusions: Reduced left atrial function strongly predicts HF hospitalization in subjects with CHD and normal EF, even after adjustment for a wide range of clinical and echocardiographic covariates. These findings suggest that LA failure plays an important role in HF and may represent a potential target for preventative or therapeutic efforts.

scholarly journals POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY I (F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION?

EP Europace ◽  
2016 ◽  
Vol 18 (suppl 2) ◽  
pp. ii36-ii47
Author(s):  
T. Philippsen ◽  
M. Orini ◽  
C.A. Martin ◽  
E. Volkova ◽  
J.O.M. Ormerod ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Hypertrophic Cardiomyopathy ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Day Case ◽  
Single Centre ◽  
Subcutaneous Icd

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

scholarly journals Zebrafish Models to Study New Pathways in Tauopathies

2021 ◽  
Vol 22 (9) ◽  
pp. 4626
Author(s):  
Clément Barbereau ◽  
Nicolas Cubedo ◽  
Tangui Maurice ◽  
Mireille Rossel
Keyword(s):  
Cognitive Deficits ◽  
Tau Protein ◽  
Common Point ◽  
Transgenic Models ◽  
Synaptic Loss ◽  
Wide Range ◽  
Transgenic Lines ◽  
Functional Consequences ◽  
The Common

Tauopathies represent a vast family of neurodegenerative diseases, the most well-known of which is Alzheimer’s disease. The symptoms observed in patients include cognitive deficits and locomotor problems and can lead ultimately to dementia. The common point found in all these pathologies is the accumulation in neural and/or glial cells of abnormal forms of Tau protein, leading to its aggregation and neurofibrillary tangles. Zebrafish transgenic models have been generated with different overexpression strategies of human Tau protein. These transgenic lines have made it possible to highlight Tau interacting factors or factors which may limit the neurotoxicity induced by mutations and hyperphosphorylation of the Tau protein in neurons. Several studies have tested neuroprotective pharmacological approaches. On few-days-old larvae, modulation of various signaling or degradation pathways reversed the deleterious effects of Tau mutations, mainly hTauP301L and hTauA152T. Live imaging and live tracking techniques as well as behavioral follow-up enable the analysis of the wide range of Tau-related phenotypes from synaptic loss to cognitive functional consequences.

scholarly journals Left ventricular and left atrial deformation imaging early after pPCI: does diabetes mellitus make any difference?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
D Trifunovic Zamaklar ◽  
G Krljanac ◽  
M Asanin ◽  
L Savic-Spasic ◽  
J Vratonjic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Strain Rate ◽  
Myocardial Function ◽  
Radial Strain ◽  
Left Ventricular ◽  
Deformation Analysis ◽  
Syntax Score ◽  
Deformation Imaging ◽  
Early Diastole

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf PREDICT-VT More extensive coronary atherosclerosis in diabetes mellitu (DM) induces poorer clinical outcomes after STEMI, but there are data suggesting that impaired myocardial function in DM, even independently from epicardial coronary lesions severity, might have detrimental effect, predominately on heart failure development in DM. Aim the current study is a sub-study of PREDICT-VT study (NCT03263949), aimed to analyse LV and LA function using myocardial deformation imaging based on speckle tracking echocardiography after pPCI in STEMI patients with and without DM. Methods in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and analysis of LV rotation mechanic. Results from 242 patients who completed 1 year follow up, 48 (20%) had DM. Pts with DM were older (60 ± 1,01 vs 57 ± 10; p = 0.067) and had insignificantly higher SYNTAX score (18.5 ± 9.2 vs 15.8 ± 9.8, p = 0.118) . However, diabetics had more severely impaired EF (44.2 ± 8.6 vs 49.2 ± 9.8, p = 0.001), E/A ratio (0.78 ± 0.33 vs 0.90 ± 0.34; p = 0.036) and MAPSE (1.18 ± 0.32 vs 1.32 ± 0.33; p = 0.001).  Global LV LS on all layers (endo: -13.6 ± 4.0 vs-16.2 ± 4.7; mid: -11.9 ± 3.5 vs -14.1 ± 4.1; epi: -10.4 ± 3.1 vs -12.3 ± 3.6; p &lt; 0.005 for all) was impaired in DM patients, as well as longitudinal systolic SR (-0.71 ± 0.23 vs -0.84 ± 0.24; p = 0.001) and SR during early diastole (0.65 ± 0.26 vs 0.83 ± 0.33, p &lt; 0.001). Patients with DM had more pronounced longitudinal posts-systolic shortening throughout LV wall (endo: 21.4 ± 16.1 vs 13.7 ± 13.3, p = 0.005; mid: 21.9 ± 16.1 vs 14.3 ± 13.1, p = 0.006; epi: 22.4 ± 16.5 vs 15.3 ± 13.7, p = 0.010) and higher LV mechanical dispersion (MDI: 71.3 ± 38.3 vs 59.0 ± 18.9, p = 0.037). LA strain was significantly impaired in DM patients (18.9 ± 7.7 vs 22.6 ± 10.0, p = 0.011) and even more profoundly LA strain rate during early diastole (-0.73 ± 0.48 vs -1.00 ±0.58, p = 0.002). Patients with DM also had more impaired LV global (15.7 ± 9.1 vs 19.8 ± 10.4, p = 0.013) radial strain, global LV circumferencial strain, especially at the mid-wall level (-13.9 ± 4.2 vs -16.0 ± 4.3, p = 0.005) and impaired circumferential SR E (1.25± 0.44 vs 1.49 ± 0.46, p = 0.003). End-systolic rotation of the LV apex was more impaired in DM (4.7 ± 5.1 vs 6.8 ± 5.5, p= 0.022). During 1 year follow-up heart failure and all-cause mortality tend to be higher among DM pts (46.7% vs 35.2%, p = 0.153). Conclusion STEMI patients with DM have more severely impaired LV systolic and diastolic function estimated both by traditional parameter and advanced echo techniques. These results might, at least partially, explain why outcomes after STEMI in DM might be poorer, even in the absence of more complex angiographic findings, pointing to the significance of impaired myocardial function DM itself.

scholarly journals Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pankaj Garg ◽  
Hosamadin Assadi ◽  
Rachel Jones ◽  
Wei Bin Chan ◽  
Peter Metherall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Native T1 ◽  
Lv Mass ◽  
All Cause Mortality ◽  
Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

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