scholarly journals The prognostic value of left ventricular mechanical dyssynchrony in predicting incident atrial fibrillation and ischemic stroke in the general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Saed Alhakak ◽  
S.R Biering-Sorensen ◽  
R Mogelvang ◽  
G.B Jensen ◽  
P Schnohr ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
General Population ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Composite Outcome ◽  
Prognostic Information ◽  
Left Ventricular Mechanical Dyssynchrony ◽  
Multivariable Adjustment ◽  
Incremental Prognostic Information

Abstract Background Left ventricular mechanical dyssynchrony (LVMD) is a predictor of many cardiovascular outcomes including ventricular arrhythmias. However, the prognostic value of LVMD in predicting incident atrial fibrillation (AF) in participants from the general population is currently unknown. Purpose The aim of this study was to investigate if LVMD can be used to predict AF and ischemic stroke in the general population. Methods A total of 1282 participants (mean age 57±16 years, 42% male) from the general population underwent a health examination including two-dimensional speckle tracking echocardiography. LVMD was calculated as the standard deviation of the regional time-to-peak strain from the three apical views. The primary endpoint was incident AF at follow-up. All participants with known AF and prior stroke at baseline were excluded (n=84). The secondary endpoint consisted of the composite of AF and ischemic stroke. Results During a median follow-up of 16 years, 148 participants (12%) were diagnosed with incident AF and 88 (7%) experienced an ischemic stroke, resulting in 236 (19%) experiencing the composite outcome. The risk of AF increased incrementally with increasing tertile of LVMD, being approximately 2-fold higher in the 3rd tertile as compared to the 1st tertile (HR 1.79; 95% CI (1.22–2.63), p=0.003; figure). LVMD was a univariable predictor of AF with 7% increased risk per 10ms increase in LVMD (per 10ms: HR 1.07; 95% CI (1.03–1.12), p<0.001). The association remained significant even after multivariable adjustment for age, sex, body mass index, hypertension, diabetes, previous ischemic heart disease, systolic blood pressure, diastolic blood pressure, heart rate, smoking, plasma proBNP, left ventricular ejection fraction <50%, global longitudinal strain, left atrial volume index (LAVI) and E/e' (per 10ms increase: HR 1.06; 95% CI (1.01–1.12), p=0.018). LVMD was also a univariable predictor of the composite outcome of AF and ischemic stroke (per 10ms increase: HR 1.07; 95% CI (1.04–1.11), p<0.001). After multivariable adjustment for the same clinical and echocardiographic parameters, LVMD remained an independent predictor of the composite outcome (per 10ms: HR 1.07; 95% CI (1.03–1.11), p=0.001). Additionally, LVMD provided incremental prognostic information with regard to predicting AF as assessed by a significant increase in the net reclassification improvement (NRI) index beyond the CHARGE-AF score (continuous NRI, 0.300; 95% CI, 0.022–0.503). Furthermore, LVMD provided additional incremental prognostic information, when added to both the CHARGE-AF score and the LAVI (continuous NRI, 0.269; 95% CI, 0.004–0.499). Conclusion In a low risk general population, LVMD provides novel prognostic information on the long-term risk of AF and ischemic stroke. In addition, LVMD provides incremental prognostic information beyond the CHARGE-AF score and LAVI in predicting AF in the general population. Funding Acknowledgement Type of funding source: None

2138Usefulness of left atrial strain for predicting incident atrial fibrillation and ischemic stroke in the general population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Saed Alhakak ◽  
S R Biering-Sorensen ◽  
R Mogelvang ◽  
D Modin ◽  
G B Jensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
General Population ◽  
Left Atrial ◽  
Prognostic Value ◽  
Volume Index ◽  
Composite Outcome ◽  
Prognostic Information ◽  
Incremental Prognostic Information

Abstract Background Left atrial (LA) enlargement is an established independent predictor of incident atrial fibrillation (AF). However, the prognostic value of left atrial peak reservoir strain (LA RS) in predicting incident AF in participants from the general population is currently unknown. It is our hypothesis that decreased LA RS can reveal early atrial dysfunction. Purpose The aim of this study was to investigate if LA RS can be used to predict AF and ischemic stroke in the general population. Methods A total of 405 participants (mean age 56±16 years, 41% male) from the general population underwent a health examination including two-dimensional speckle tracking echocardiography of the LA. LA RS was calculated as the average from the three apical views. The primary endpoint was incident AF at follow-up. All participants with known AF and prior stroke at baseline were excluded (n=54). The secondary endpoint consisted of the composite of AF and ischemic stroke. Results During a median follow-up of 16 years (interquartile range, 13.6–16.2 years), 36 participants (9%) were diagnosed with incident AF and 30 (7%) experienced an ischemic stroke, resulting in 66 (16%) experiencing the composite outcome. The risk of AF increased incrementally with decreasing tertile of LA RS, being approximately 10-fold higher in the 1st tertile as compared to the 3rd tertile (HR 9.82; 95% CI (2.95–32.63), p<0.001; figure). LA RS was a univariable predictor of AF with 41% increased risk per 5% decrease in LA RS (per 5% decrease: HR 1.41; 95% CI (1.18–1.67), p<0.001). However, the prognostic value of LA RS was modified by age (p=0.002 for interaction). After adjusting for clinical and echocardiographic parameters the LA RS predicted AF in participants aged <65 years (per 5% decrease: HR 1.86; 95% CI (1.20–2.90), p=0.006). In contrast, LA RS did not predict AF in participants aged >65 years (per 5% decrease: HR 0.95; 95% CI (0.73–1.23), p=0.69). LA RS was also a univariable predictor of the composite outcome of AF and ischemic stroke (per 5% decrease: HR 1.29; 95% CI (1.14–1.46), p<0.001). After multivariable adjustment the LA RS predicted AF and ischemic stroke in participants aged <65 years (per 5% decrease: HR 1.33; 95% CI (1.03–1.72), p=0.030). Furthermore, LA RS provided incremental prognostic information over the left atrial volume index (LAVI) with regard to predicting AF (Harrell's C-statistics 0.69 vs. 0.75, p=0.044) and the composite of AF and ischemic stroke (Harrell's C-statistics 0.59 vs. 0.66, p=0.027) in participants from the general population. Conclusion In a low risk general population, the LA RS provides novel prognostic information on the long-term risk of AF and ischemic stroke, especially in participants aged <65 years. In addition, LA RS provides incremental prognostic information over the LAVI in predicting AF and ischemic stroke in the general population.

scholarly journals Unsupervised machine learning generated clusters of left ventricular strain curves identifies patients in risk of heart failure and cardiovascular death following acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.O Simonsen ◽  
K.G Skaarup ◽  
K Djernaes ◽  
D Modin ◽  
M.C.H Lassen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Cycle ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Prognostic Information ◽  
Deformation Curves ◽  
Incremental Prognostic Information ◽  
Score Risk

Abstract Background Today myocardial deformation, also known as strain, is assessed by the global longitudinal strain (GLS) which only provides information about the maximal deformation during systole. Hence, a lot of information obtained from different patterns of deformation curves might be undiscovered. Unsupervised Machine leaning (uML) is capable of identifying similar patterns of deformation curves. Identifying different phenotypical patterns from myocardial deformation curves might provide insights into the pathophysiological development of cardiac disease and entail useful prognostic information. Purpose To investigate whether uML can group specific patterns of myocardial deformation curves which provide prognostic information on heart failure and/or cardiovascular death (HF/CVD) following ST-segment elevation myocardial infarction (STEMI). Methods A total of 319 STEMI patients had an echocardiogram performed at median 2 days after primary percutaneous coronary intervention (pPCI). Speckle tracking echocardiography analysis divided the left ventricle into 18 segments. Standardisation of the cardiac cycle was done using linear interpolation and complete strain data (mean of all segments) as function of time throughout the cardiac cycle was used as input for the uML algorithm. Clusters were identified using a K-means cluster analysis algorithm. Primary endpoint was the composite of heart failure (HF) and/or cardiovascular death (CVD). Median follow-up time was 1423 days (IQR: 91; 1660). Results Mean age was 62 years, 75% were male and 130 (41%) suffered incident HF/CVD during follow-up. The uML algorithm grouped patients into three clusters containing 97, 104, and 118 patients respectively. GLS curves of the three clusters are illustrated in the Figure 1. Incidence of HF/CVD increased significantly from cluster 1 through 3 (24% vs. 39% vs. 60%, P&lt;0.001). In multivariable Cox regressions adjusting for the variables in the score risk chart model all three clusters were significantly associated with future HF/CVD (Figure 1). Cluster models provided significant incremental prognostic information when comparing C-statistics (0.64 vs. 0.62, p=0.029) Conclusion Unsupervised Machine Learning clusters of left ventricular deformation curves identifies patients in risk of HF/CVD following STEMI treated with pPCI, and provides incremental prognostic information to the score risk chart model. Figure 1. GLS curves of the three clusters Funding Acknowledgement Type of funding source: None

scholarly journals 1234 The cardiac isovolumetric contraction time is an independent predictor of cardiovascular morbidity in the general population

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Saed Alhakak ◽  
R Mogelvang ◽  
G B Jensen ◽  
G Gislason ◽  
T Biering-Sorensen
Keyword(s):  
General Population ◽  
Cardiovascular Morbidity ◽  
Left Ventricular Ejection ◽  
Contraction Time ◽  
Composite Outcome ◽  
Prognostic Information ◽  
Time Intervals ◽  
Cardiac Time Intervals ◽  
Ventricular Ejection Time ◽  
Multivariable Adjustment

Abstract Background Color Tissue Doppler imaging (TDI) M-mode through the mitral leaflet is an easy and precise method to obtain the cardiac time intervals including the isovolumic contraction time (IVCT), the isovolumic relaxation time (IVRT) and the left ventricular ejection time (ET). The myocardial performance index (MPI) is defined as [(IVCT + IVRT)/ET]). It is our hypothesis that the duration of the cardiac time intervals can reveal early cardiac dysfunction. Purpose Our aim was to investigate if the cardiac time intervals can be used to predict cardiovascular morbidity in the general population. Methods A total of 1,915 participants from the general population (mean age 58 ± 16 years, 42% male) underwent a general health examination including TDI echocardiography. The IVCT, IVRT and ET were measured. The primary endpoint was the composite of ischemic heart disease (IHD), heart failure (HF) and atrial fibrillation (AF). Participants with previous IHD, prevalent HF and AF were excluded (n = 336). Results During a median follow-up time of 11 years, 277 (17.5%) participants reached the composite endpoint. Assessing the association between IVCT and the composite outcome, the risk of IHD, HF and AF increased with 20% per 10ms increase in IVCT (per 10 ms increase: HR 1.20; 95% CI (1.11-1.30), p &lt; 0.001; figure). The association remained significant even after multivariable adjustment for clinical and echocardiographic parameters (per 10ms increase: HR 1.11; 95% CI (1.01-1.22), p = 0.037). IVRT, LVET and MPI were significant predictors of the composite outcome in unadjusted analysis (p &lt; 0.001 for all). However, none remained significant after multivariable adjustment. Additionally, the IVCT provided incremental prognostic information, as assessed by a significant increase in the net reclassification improvement (NRI) index, beyond the SCORE risk chart (continuous NRI, 0.266; 95% CI, 0.093-0.386) and the ACC/AHA Pooled Cohort Equation (continuous NRI, 0.252; 95% CI, 0.078-0.371). Conclusion In a low risk general population, the IVCT provides novel and independent prognostic information on the long-term risk of cardiovascular morbidity. Abstract 1234 Figure.

Abstract 2816: Assessment Of Left Ventricular Mechanical Dyssynchrony With Radial Strain By Speckle-tracking Best Predicts Response To Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Victoria Delgado ◽  
Claudia Ypenburg ◽  
Laurens F Tops ◽  
Sjoerd A Mollema ◽  
Nina Ajmone Marsan ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Radial Strain ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Speckle Tracking Imaging ◽  
Resynchronization Therapy ◽  
Left Ventricular Mechanical Dyssynchrony

Background: Recently, 2-dimensional strain by speckle tracking imaging has emerged as a new technology for assessment of myocardial deformation in three dimensions: radial, circumferential and longitudinal. The current study evaluates which type of deformation study can best identify left ventricular mechanical dyssynchrony (LVMD) and predicts response to cardiac resynchronization therapy (CRT). Methods: One-hundred fifty-two consecutive patients underwent echocardiographic study before implantation of the CRT device and at 6 months follow-up. Radial (RS) and circumferential (CS) strains were applied to midventricular short axis views; difference in time to peak systolic strain value between anteroseptal-to-posterior walls was used to study LVMD. Longitudinal strain (LS) was applied to apical 4-chamber views and LVMD was calculated as the difference between basal septum-to-basal lateral walls. Patients with a decrease of LV end-systolic volume ≥15% at 6 months follow-up were considered responders. Results: After 6 months of CRT, 85 pts (56%) showed response to CRT. Compared to non-responders, responders had significant more LVMD when it was assessed by RS (212±146 ms vs. 127±108 ms; p<0.001), whereas there were no differences with neither CS nor LS (Table ). With RS, the optimal cut-off value to predict response to CRT was identified at a time-difference value of ≥130 ms yielding a sensitivity of 83% and a specificity of 71%. Conclusions: Radial strain by speckle-tracking imaging is a useful tool to assess LVMD and best predicts echocardiographic response to CRT. Left Ventricular Mechanical Dyssynchrony assessed by radial, circumferential and longitudinal strain

Usefulness of left atrial strain for predicting incident atrial fibrillation and ischaemic stroke in the general population

2020 ◽  
Author(s):  
Alia Saed Alhakak ◽  
Sofie Reumert Biering-Sørensen ◽  
Rasmus Møgelvang ◽  
Daniel Modin ◽  
Gorm Boje Jensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Ischaemic Stroke ◽  
Left Atrial ◽  
Prognostic Value ◽  
Secondary Endpoint ◽  
Health Examination ◽  
Prognostic Information ◽  
Multivariable Adjustment

Abstract Aims Left atrial enlargement predicts incident atrial fibrillation (AF). However, the prognostic value of peak atrial longitudinal strain (PALS) for predicting incident AF in participants from the general population is currently unknown. Our aim was to investigate if PALS can be used to predict AF and ischaemic stroke in the general population. Methods and results A total of 400 participants from the general population underwent a health examination, including two-dimensional speckle tracking echocardiography of the left atrium. The primary endpoint was incident AF at follow-up. All participants with known AF and prior stroke at baseline were excluded (n = 54). The secondary endpoint consisted of the composite of AF and ischaemic stroke. During a median follow-up of 16 years, 36 participants (9%) were diagnosed with incident AF and 30 (7%) experienced an ischaemic stroke, resulting in 66 (16%) experiencing the composite outcome. PALS was a univariable predictor of AF [per 5% decrease: hazard ratio (HR) 1.42; 95% confidence interval (CI) (1.19–1.69), P &lt; 0.001]. However, the prognostic value of PALS was modified by age (P = 0.002 for interaction). After multivariable adjustment PALS predicted AF in participants aged &lt;65 years [per 5% decrease: HR 1.46; 95% CI (1.06–2.02), P = 0.021]. In contrast, PALS did not predict AF in participants aged ≥65 years after multivariable adjustment [per 5% decrease: HR 1.05; 95% CI (0.81–1.35), P = 0.72]. PALS also predicted the secondary endpoint in participants aged &lt;65 years and the association remained significant after multivariable adjustment. Conclusion In a low-risk general population, PALS provides novel prognostic information on the long-term risk of AF and ischaemic stroke in participants aged &lt;65 years.

P2442Myocardial performance index predicts mortality in people with obstructive lung function from the general population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Andersen ◽  
R Moegelvang ◽  
P Schnohr ◽  
P Lange ◽  
D Modin ◽  
...  
Keyword(s):  
Heart Disease ◽  
Lung Function ◽  
General Population ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Normal Lung ◽  
Prognostic Information ◽  
Normal Lung Function ◽  
All Cause Mortality ◽  
Incremental Prognostic Information

Abstract Background Forced expiratory volume in one second (FEV1) is a significant predictor of mortality in patients with obstructive lung function (OL). Whether echocardiography can be used to identify patients at high risk, and whether it provides incremental prognostic information on mortality in patients with OL, remains unknown. Methods In a large, low-risk general population study, 1873 participants underwent a health examination with spirometry and echocardiography, including tissue Doppler imaging (TDI). The myocardial performance index (MPI) was calculated as the sum of the isovolumic contraction time (IVCT) and the isovolumic relaxation time (IVRT) divided by the left ventricle ejection time (LVET). Spirometry included measurements of (FEV1) and the forced vital capacity (FVC). OL was defined as FEV1/FVC <0.70. The primary endpoint was all-cause mortality. Results The mean age was 59±16 years, 57% were women, 43% had hypertension, 11% had diabetes, and 6% had ischemic heart disease. Of the 1873 included participants, 288 (15%) were classified as having OL at baseline. During follow up (median 13.7 years (IQR 13.2–16.2)), 584 (31%) persons died, hereof 178 (62%) in the subgroup of participants with OL and 406 (26%) in the subgroup of participants with normal lung function. OL was associated with presence of left ventricular hypertrophy (higher left ventricular mass index), impaired diastolic function (lower E, higher A, lower E/A ratio, longer deceleration time, lower e' and higher E/e'), lower global longitudinal strain, and higher MPI. In unadjusted analysis, higher MPI was associated with all-cause mortality for participants with OL (HR=1.18 (1.11–1.26), p<0.001, per 0.1 increase) and for participants with normal lung function (HR=1.42 (1.34–1.50), p<0.001, per 0.1 increase). The predictive value of MPI was significantly modified by the presence of obstructive lung function (p<0.001). After multivariable adjustment for age, sex, FEV1/FVC, heart rate, systolic blood pressure, smoking status, body mass index (BMI), hypertension, diabetes, ischemic heart disease, ischemic stroke and heart failure at baseline, MPI remained an independent predictor of all-cause mortality (HR=1.19 (1.06–1.34), p=0.004, per 0.1 increase) for participants with OL but not for participants with normal lung function (HR=1.02 (0.94–1.11), p=0.598, per 0.1 increase). When adding the MPI to the updated Age, Dyspnea and Obstruction (ADO) index, MPI provided incremental prognostic information beyond the updated ADO index, as determined from a significant increase in the Harrell's C-statistics (0.785 to 0.792, p=0.003). Conclusion Presence of OL is associated with subtle impairment of left ventricular systolic function, impaired left ventricular diastolic function, and higher MPI. MPI is an independent predictor of mortality in people with OL and provides incremental prognostic information regarding all-cause mortality in this population. Acknowledgement/Funding Herlev & Gentofte University Hospital PhD fund

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