Prognostic utility of routine assessment of left ventricular global longitudinal strain and peak atrial reservoir strain in stable heart disease patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.I Bolog ◽  
M Dumitrescu ◽  
E Pacuraru ◽  
F Romanoschi ◽  
A Rapa
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Acute Coronary Syndromes ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Coronary Syndromes ◽  
Routine Assessment

Abstract Background Left ventricular ejection fraction above 40% is a poor predictor of cardiac outcomes. Strain imaging seems to add incremental prognostic value in various heart conditions. Purpose The aim of the study is to investigate whether assessment of both left ventricular global longitudinal strain (LVGLS) and peak atrial reservoir strain (PARS) in routine daily practice is useful in predicting cardiac events. Methods We prospectively enrolled 300 patients (212 men, mean age 64.8±10.9 years old) with stable cardiac disease, referred for echocardiographic examination and eligible for strain imaging. Conventional and speckle tracking 2D rest echocardiography were performed and clinical variables were recorded. We excluded patients with acute coronary syndromes, severe valvular disease, cardiomyopathies, arrhythmia and class IV NYHA. Results During a median follow up of 30 months, there were 111 cardiac events (CE) recorded including: 7 cardiac deaths (CD), 25 acute coronary syndromes (ACS), 45 hospitalisations for worsening heart failure (WHF), 23 episodes of atrial fibrillation (AF), 11 stroke (S). Average EF, LVGLS and PARS in patients with CE were significantly lower than in patients without CE (55.8±8.4%, −17.3±3.9% and 16.3±9.8% vs. 60.4±8.4%, −20.1±3.7% and 28.4±8.2%; p<0.05, p<0.01, p<0.01). In univariate analysis, lower LVGLS, respectively lower PARS were associated with a higher risk of cardiac events [Hazard Ratio (HR)1.26; 95% CI (confidence interval): 1.08–1.34; p<0.01 per 1% decrease, respectively HR 1.38; 95% CI: 1.16–1.42; p<0.01 per 1% decrease]. On multivariate analysis this association was independent after adjustment for age, gender, hypertension, diabetes, ejection fraction, left atrial indexed volume. Lower LVGLS was a better predictor of a composite of ACS and CD (HR 1.38 per 1% decrease 95% CI: 1.16–1.48; p<0.01). Lower PARS had a stronger association with AF, S and WHF (HR 1.49 per 1% decrease 95% CI: 1.19–1.58; p<0.01). In a model defined by depressed LVGLS (more positive than −18%) adding lower PALS, with a cut off point of 20%, significantly improved prediction of CE (C-statistic increased from 0.68 to 0.83, p<0.001). Conclusions Left ventricular global longitudinal strain and peak atrial reservoir strain are independent predictors of cardiac events patients with stable heart disease. Acute coronary syndromes and death were better predicted by depressed LVGLS and onset of atrial fibrillation, stroke and worsening heart failure were better predicted by lower PARS. Routine assessment of both parameters improves significantly prediction of cardiac events and helps clinical decision making. Funding Acknowledgement Type of funding source: None

scholarly journals Prognostic implications of longitudinal strain in hypertensive patients

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
N Taleb Bendiab ◽  
S Benkhedda ◽  
A Meziane Tani ◽  
L Henaoui
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Lv Function ◽  
Cardiac Events ◽  
Hypertensive Patients ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Tlemcen Introduction Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular (LV) pressure overload, and, in turn, changes in cardiac geometry and LV hypertrophy (LVH). Early impairment of LV function, detected by a reduced GLS, is associated with long-lasting, uncontrolled HBP, overweight, related metabolic changes, and is more pronounced in patients with LVH. This decline in longitudinal function may be a determining factor in the occurrence of cardiovascular complications and therefore an increase in cardiovascular morbidity and mortality. Purpose : This study sought to investigate the associations of left ventricular (LV) strain and its serial change with major adverse cardiac events  in hypertensive patients. Methods We retrospectively studied 400 asymptomatic patients with hypertension of which, 182 patients had abnormal global longitudinal strain(GLS) and 218 patients had normal GLS, between 2016 and 2019. Global longitudinal strain (GLS) was measured using speckle tracking. Patients were followed for  admission because of heart failure, myocardial infarction, atrial fibrillation and strokes, over median of 4 years. At the start of study, all patients had preserved LV ejection fraction. Résultats :  The control of patients noted 25 cases (6.25%) of attacks of heart failure in the arm hypertension with low GLS against only 4 cases (1%) in the arm hypertension + normal GLS (P <0.001). The same, 19 ( 4.75%) hypertensive patients with low GLS had a stroke compared to only 5 (1.25%) hypertensive patients with normal GLS. A significant difference in the incidence of onset of acute coronary syndromes was also noted in the hypertension arm with abnormal GLS (P = 0.002). As for rhythmic complications, 26 (6.5%) hypertensive patients with  abnormal GLS developed atrial fibrillation compared to only 9 (2.25%) hypertensive patients with normal GLS (P <0.0001). Conclusion :  GLS and its deterioration are associated with cardiovascular complications in asymptomatic hypertensive heart disease. Although LVEF will remain a cornerstone of LV function assessment, the addition of GLS enables detailed phenotyping and improved risk assessment and is a tool for present and future therapeutic advancement. A risk score incorporating strain was useful for predicting risk of cardiac events.

scholarly journals P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Sakaguchi ◽  
A Yamada ◽  
M Hoshino ◽  
K Takada ◽  
N Hoshino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Stable Condition ◽  
Left Ventricular ◽  
Operating Characteristics ◽  
Cardiac Events

Abstract Purposes We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission. Methods We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (> 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events. Results Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p < 0.0001, log-rank). Conclusion A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.

Abstract 11749: Prognostic Value of Left Ventricular Global Longitudinal Strain and Ejection Fraction in Patients With Non-ischemic and Ischemic Heart Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tetsuari Onishi ◽  
Yasue Tsukishiro ◽  
Hiroya Kawai
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Ischemic Heart Disease ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Lv Function

Background: Both Left ventricular (LV) global longitudinal strain (GLS) and LV ejection fraction (LVEF) are useful parameters for assessment of LV function. The aim of this study is to confirm the prognostic value of them in patients with non-ischemic and ischemic heart disease. Methods: We studied 179 patients (DCM group: Age 61±15 years, 70 females, LVEF 33±9%) with non-ischemic dilated cardiomyopathy and heart failure symptom, and 97 patients (MI group: Age 66±13 years, 18 females, LVEF 45±7%) who were successfully treated with percutaneous coronary intervention for acute anteroseptal myocardial infarction. Echocardiography was used for LV GLS derived from 2D speckle-tracking method and LVEF with modified Simpson’s method. Outcome was assessed according to death and re-hospitalization with heart failure in the follow-up period. Results: 40 patients in DCM group and 10 patients in MI group experienced at least one event. In these 2 groups, significant differences in GLS and LVEF were found between patients with and without cardiac events (p<0.05). Kaplan-Meier analysis showed patients with worse GLS had an unfavorable outcome in both DCM and MI groups (p<0.05), but LVEF did not associated with outcome. Conclusion: LV GLS has the potential to predict the outcome with higher sensitivity than LVEF in patients with heart disease regardless of ischemic etiology.

Abstract 20577: Combination of Global Longitudinal Strain and Sympathetic Nervous Dysfunction Predicts Cardiac Events in Patients With Non-Ischemic Dilated Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Misato Chimura ◽  
Tetsuari Onishi ◽  
Hiroya Kawai ◽  
Shinishiro Yamada ◽  
Yoshinori Yasaka
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Dilated Cardiomyopathy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Nervous Activity ◽  
Left Ventricular ◽  
Sympathetic Nervous Activity ◽  
Cardiac Events ◽  
Sympathetic Nervous

Introduction: It has been reported that sympathetic nervous dysfunction by 123I-metaiodobenzylguanidine (MIBG) is associated with worse outcome in dilated cardiomyopathy (DCM) patients. However, the association between sympathetic nervous function and myocardial strain is not established. Hypothesis: Global longitudinal strain (GLS) by two-dimensional speckle-tracking echocardiography (2DSTE) is correlated with sympathetic nervous activity, and stratifies DCM patients at risk for cardiac events with a combination of sympathetic nervous activity. Methods: We studied 71 patients who had admitted to a cardiology department with heart failure at the initial visit (age 61±13 years, 45 males, LV ejection fraction (EF) 30±8 %). All patients underwent MIBG imaging for the delayed heart to mediastinum ratio (H/M), and echocardiography with conventional assessment including left atrial volume (LAV), LV end-diastolic and end-systolic volume (LVEDV, LVESV), LVEF, mitral regurgitation grade (MR), early transmitral flow to atrial contraction (E/A) and with 2DSTE analysis for GLS expressed with an absolute value. Cardiac events were assessed according to death and hospitalization with heart failure. Results: There were 21 cardiac events in the follow-up period for 4.9±2.3 years. Univariate regression analysis showed LAV, LVEDV, LVESV, LVEF, MR, E/A and GLS had a significant correlation with delayed H/M (all p < 0.05). Multivariate regression analysis revealed that GLS was an independent predictor of delayed H/M. Dividing all patients into 4 groups by the median of GLS in patients with delayed H/M >1.6 or≤1.6, the combination of the worse delayed H/M and the worse GLS was significantly associated with cardiac events (p=0.03). Conclusions: Left ventricular GLS is significantly correlated with delayed H/M and can be useful to stratify the risk in DCM patients with a combination of delayed H/M.

Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Philabout ◽  
L Soulat-Dufour ◽  
I Benhamou-Tarallo ◽  
S Lang ◽  
S Ederhy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cardiac Rhythm ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Chamber ◽  
Deformation Imaging ◽  
And Function

Abstract Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p&lt;0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p&lt;0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p&lt;0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure). Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

scholarly journals Application of the current HFA-ESC consensus guidelines on diagnosis of heart failure with preserved ejection fraction to a population referred for echocardiography

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Liang ◽  
R Hearse-Morgan ◽  
S Fairbairn ◽  
Y Ismail ◽  
AK Nightingale
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Global Longitudinal Strain ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Lv Function ◽  
Preserved Ejection Fraction ◽  
Consensus Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The recent Heart Failure Association (HFA) of the European Society of Cardiology (ESC) consensus guidelines on diagnosis of heart failure with preserved ejection fraction (HFpEF) have developed a simple diagnostic algorithm for clinical use. PURPOSE To assess whether echocardiogram (echo) parameters needed to assess diastolic function are routinely collected in patients referred for assessment of heart failure symptoms. METHODS Retrospective analysis of echo referrals in January 2020 were assessed for parameters of diastolic function as per step 2 of the HF-PEFF diagnostic algorithm.  Echo images and clinical reports were reviewed. Electronic records were utilised to obtain clinical history, blood results (NT-proBNP) and demographic data. RESULTS 1330 patients underwent an echo in our department during January 2020. 83 patients were referred with symptoms of heart failure without prior history of cardiac disease; 20 patients found to have impaired left ventricular (LV) function were excluded from analysis. Of the 63 patients with possible HFpEF, HF-PEFF score was low in 18, intermediate in 33 and high in 12. Median age was 68 years (range 32 to 97 years); 25% had a BMI &gt;30. There was a high prevalence of hypertension (52%), diabetes (19%) and atrial fibrillation (40%) (cf. Table 1). Body surface area (BSA) was documented in 65% of echo reports. Most echo parameters were recorded with the exception of global longitudinal strain (GLS) and indexed LV mass (cf. image 1). NT-proBNP was recorded in only 20 patients (31.7%). 12 patients with an intermediate HF-PEFF score could have been re-categorised to a high score depending on GLS and NT-proBNP (which were not recorded). CONCLUSION More than three quarters of echoes acquired in our department obtained the relevant parameters to assess diastolic function. The addition of BSA, and inclusion of NT-proBNP, and GLS would have been additive to a third of ‘intermediate’ patients to determine definite HFpEF. Our study demonstrates that the current HFA-ESC diagnostic algorithm and HF-PEFF scoring system are easy to use, highly relevant and applicable to current clinical practice. Age &gt;70 years 29 (46.0%) Obesity (BMI &gt;30) 16 (25.4%) Diabetes 12 (19%) Hypertension 33 (52.4%) Atrial Fibrillation 25 (39.7%) ECG abnormalities 18 (28.5%) Table 1. Prevalence of Clinical Risk Factors Abstract Figure. Image 1. HFPEFF score & echo parameters

Surgical therapy for heart failure

2018 ◽  
pp. 157-174
Author(s):  
Stephen Westaby
Keyword(s):  
Heart Failure ◽  
Dilated Cardiomyopathy ◽  
Acute Coronary Syndromes ◽  
Symptomatic Relief ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
End Stage ◽  
Age Range

Congestive heart failure affects 23 million people worldwide, and is the final pathway for many diseases that affect the myocardium. Successful intervention in acute coronary syndromes together with improved management of idiopathic dilated cardiomyopathy and dysrhythmia provide an ever-increasing number of advanced heart failure patients spread over a wide age range. In Western countries, coronary artery disease is responsible for about 70% of patients with idiopathic dilated cardiomyopathy and valvular heart disease accounting for 15%. Since 10% of patients older than 65 years suffer systolic left ventricular dysfunction, the numbers with heart failure will double within the next 25 years. For end-stage patients, cardiac transplantation provides the benchmark for increased longevity and symptomatic relief. However, the vast majority of patients are over 65 years of age or are referred with established comorbidity, which precludes transplantation.

scholarly journals P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Sahiti ◽  
C Morbach ◽  
C Henneges ◽  
M Hanke ◽  
R Ludwig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Future Research ◽  
Lv Function ◽  
Acutely Decompensated Heart Failure

Abstract OnBehalf AHF Registry Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF &lt;40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF). Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates. Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF &lt;40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table). Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF. Abstract P803 Figure.

P624The prognostic value of myocardial deformation in patients with congenital aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R W J Van Grootel ◽  
A T Van Den Hoven ◽  
D Bowen ◽  
T Ris ◽  
J W Roos-Hesselink ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Stenosis ◽  
Prognostic Value ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Congenital Aortic Stenosis

Abstract Background Congenital aortic stenosis (AoS) is associated with significant mortality and morbidity but predictors for clinical outcome are scarce. Strain analysis provides a robust and reproducible method for early detection of left ventricular (LV) dysfunction, which might be of prognostic value. Therefore we aimed to assess the prognostic value of LV global longitudinal strain (GLS) and global longitudinal early diastolic strain rate (GLSre) with regard to cardiovascular events. Methods This prospective study, included clinically stable patients with congenital AoS between 2011–2013. LV GLS and GLSre was performed in the apical 4, 3 and 2-chamber views using Tomtec software. The endpoint was a composite of death, heart failure, hospitalization, arrhythmia, thrombo-embolic events and re-intervention. Results In total 138 patients were included (33 [26–43] years, 86 (62%) male), NYHA class I: 134 (97%). Mean LV GLS was −15.3±3.2%, GLSre 0.66±0.18 s–1. Both correlated with NT-proBNP, LV volumes and ejection fraction (strongest LV GLS with LV EF: r −0.539, p<0.001, strongest LV GLSre with age: r −0.376 p<0.001). During median follow-up of 5.9 [5.5–6.2] years, the endpoint occurred in 53 (38%) patients: 4 patients died, 9 developed heart failure, 22 arrhythmias, 8 thrombo-embolic events and 35 re-interventions. Both LV GLS (standardized HR (sHR 0.62 (95% CI 0.47–0.81) and GLSre (sHR 0.62 (95% CI 0.47–0.83) were associated with the endpoint. Additional multivariable analysis showed that both GLS and GLSre were associated independent of left atrial volume, NT-proBNP and prior re-interventions. Figure 1 Conclusion Left ventricular GLS and GLSre are reduced in adult patients with congenital AoS. Both markers are associated with adverse cardiac events and have clear clinical relevance Acknowledgement/Funding Erasmus Thorax Foundation

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