Longitudinal strain in patients with severe aortic regurgitation: superiority to ejection fraction for detection of myocardial dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.C Reil ◽  
G.-H Reil ◽  
N Necker ◽  
J Borer ◽  
H.H Sievers ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Aortic Regurgitation ◽  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Stroke Work ◽  
Indication For Surgery ◽  
Severe Aortic Regurgitation ◽  
Normal Lvef

Abstract Objectives The aim of the study was to analyse LV systolic function and mechanical energetics in asymptomatic patients with severe aortic regurgitation (AR) to seek a new hemodynamic concept for timing for surgery. Background Current guidelines suggest surgery for patients with severe AR including clinical symptoms, subnormal LV ejection fraction (EF), or markedly abnormal left ventricular dimensions. However, the optimal measure to detect intrinsic myocardial systolic dysfunction in the presence of normal LVEF remains elusive. Methods Strain and echo-derived single beat pressure-volume analyses were performed in cohorts with severe AR without indication for surgery (ARNS; LVEDD <70mm, EF >50%, n=41), with indication for surgery (ARS; n=19) and in healthy, age-matched controls (C; n=20). Additionally, end-systolic elastance (Ees=LV contractility), stroke work (SW) and total energy (PVA) were calculated. Results Patients with ARNS demonstrated significant depression of LV contractility vs. C: Ees (1.5mmHg/ml ±0.7 vs. 2.25mmHg/ml ±0.7; p<0.001), despite comparable ejection fractions (EF: 0.56±0.05 vs. 0.60±0.07; p=0.10). Accordingly, global longitudinal strain (GLS) was decreased (−16.0±2.5% vs. −21.5±2%; p<0.001), end-diastolic volume markedly enlarged (236ml ±90 vs. 136ml ±30; p<0.001), as were PVA and SW indicating waste of energy. The correlation of GLS vs. Ees was good (r=−0.68; p<0.001). Results of ARS-patients were consistently worse. Conclusion Patients with severe AR and normal LVEF showed depressed LV contractility and waste of energy when assessed by Ees and GLS, both correlating well with each other. Hence, GLS may outperform LV dimensions for predicting timing for surgery and clinical outcomes in AR patients. Funding Acknowledgement Type of funding source: None

scholarly journals Reduced left ventricular contractility, increased diastolic operant stiffness and high energetic expenditure in patients with severe aortic regurgitation without indication for surgery

2020 ◽  
Vol 32 (1) ◽  
pp. 29-38
Author(s):  
Jan-Christian Reil ◽  
Gert-Hinrich Reil ◽  
Nora Hecker ◽  
Vasco Sequeira ◽  
Jeffrey S. Borer ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Stroke Work ◽  
Ventricular Contractility ◽  
Indication For Surgery ◽  
Severe Aortic Regurgitation ◽  
End Diastolic Volume ◽  
Systolic And Diastolic Function ◽  
Mild Hypertensive

Abstract OBJECTIVES Recent mortality studies showed worse prognosis in patients (ARNS) with severe aortic regurgitation and preserved ejection fraction (EF) not fulfilling the criteria of current guidelines for surgery. The aim of our study was to analyse left ventricular (LV) systolic and diastolic function and mechanical energetics to find haemodynamic explanations for the reduced prognosis of these patients and to seek a new concept for surgery. METHODS Global longitudinal strain (GLS) and echo-based single-beat pressure–volume analyses were performed in patients with ARNS (LV end-diastolic diameter <70 mm, EF >50%, GLS > −19% n = 41), with indication for surgery (ARS; n = 19) and in mild hypertensive controls (C; n = 20). Additionally, end-systolic elastance (LV contractility), stroke work and total energy (pressure–volume area) were calculated. RESULTS ARNS demonstrated significantly depressed LV contractility versus C: end-systolic elastance (1.58 ± 0.7 vs 2.54 ± 0.8 mmHg/ml; P < 0.001), despite identical EF (EF: 59 ± 6% vs 59 ± 7%). Accordingly, GLS was decreased [−15.7 ± 2.7% (n = 31) vs −21.2 ± 2.4%; P < 0.001], end-diastolic volume (236 ± 90 vs 136 ± 30 ml; P < 0.001) and diastolic operant stiffness were markedly enlarged, as were pressure–volume area and stroke work, indicating waste of energy. The correlation of GLS versus end-systolic elastance was good (r = −0.66; P < 0.001). ARNS and ARS patients demonstrated similar haemodynamic disorders, whereas only GLS was worse in ARS. CONCLUSIONS ARNS patients almost matched the ARS patients in their haemodynamic and energetic deterioration, thereby explaining poor prognosis reported in literature. GLS has been shown to be a reliable surrogate for LV contractility, possibly overestimating contractility due to exhausted preload reserve in aortic regurgitation patients. GLS may outperform conventional echo parameters to predict more precisely the timing of surgery.

scholarly journals P818 Association between baseline left ventricular longitudinal strain and follow-up left ventricular ejection fraction in patients with dilated cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I H Jung ◽  
Y S Byun ◽  
J H Park
Keyword(s):  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Lv Function ◽  
Ventricular Ejection Fraction

Abstract Funding Acknowledgements no Background Left ventricular global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction. The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LV reverse remodeling (LVRR) in DCM patients with sinus rhythm and also investigate the relationship between baseline LV GLS and follow-up LVEF. Methods We enrolled patients with DCM who had been initially diagnosed, evaluated, and followed at our institute. Results During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45) within 14.7 ± 10.0 months of medical therapy. The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9% and was not different from the value of 27.1 ± 7.4% (p = 0.49) of those who did not recover. There was a moderate and highly significant correlation between baseline LV GLS and follow-up LVEF (r = 0.717; p <0.001). Conclusion There was a significant correlation between baseline LV GLS and follow-up LVEF in this population. Baseline Follow-up Difference (95% CI) p-value All patients (n = 160) LVEDDI, mm/m2 35.6 ± 6.6 35.6 ± 6.6 -2.7 (-3.4 to -2.0) <0.001 LVESDI, mm/m2 30.3 ± 6.1 26.6 ± 6.6 -3.7 (-4.6 to -2.8) <0.001 LVEDVI, mL/m2 95.0 ± 30.7 74.3 ± 30.2 -20.7 (-25.6 to -15.8) <0.001 LVESVI, mL/m2 70.0 ± 24.8 50.2 ± 26.8 -19.8 (-24.2 to -15.4) <0.001 LVEF, % 26.8 ± 7.5 33.9 ± 12.6 7.2 (5.2 to 9.2) <0.001 LV GLS (-%) 9.2 ± 3.1 11.0 ± 4.8 1.8 (1.3 to 2.2) <0.001 Patients without LVRR (n = 115) LVEDDI, mm/m2 34.9 ± 6.8 34.1 ± 6.8 -0.8 (-1.3 to -0.3) 0.002 LVESDI, mm/m2 29.5 ± 6.1 28.4 ± 6.4 -1.4 (-1.8 to -0.4) 0.002 LVEDVI, mL/m2 92.0 ± 30.5 83.4 ± 29.8 -8.6 (-12.4 to -4.8) <0.001 LVESVI, mL/m2 67.1 ± 24.4 59.5 ± 25.3 -7.6 (-10.9 to -4.3) <0.001 LVEF, % 27.1 ± 7.4 27.8 ± 7.4 0.7 (-0.2 to 1.6) 0.126 LV GLS (-%) 8.2 ± 2.9 8.7 ± 3.2 0.5 (0.7 to 3.6) <0.001 Patients with LVRR (n = 45) LVEDDI, mm/m2 37.4 ± 5.5 29.8 ± 5.2 -7.5 (-9.1 to -6.0) <0.001 LVESDI, mm/m2 32.2 ± 5.7 21.9 ± 4.4 -10.3 (-11.9 to -8.6) <0.001 LVEDVI, mL/m2 102.7 ± 30.2 51.1 ± 15.0 -51.7 (-61.6 to -41.7) <0.001 LVESVI, mL/m2 77.3 ± 24.5 26.4 ± 11.3 -50.9 (-58.8 to -43.1) <0.001 LVEF, % 26.1 ± 7.9 49.4 ± 9.5 23.9 (20.4 to 27.5) <0.001 LV GLS (-%) 11.9 ± 1.6 16.9 ± 2.7 5.1 (4.2 to 5.9) <0.001 Baseline and Follow-up LV Functional Echocardiographic Data Abstract P818 Figure.

scholarly journals Beneficial effect of angiotensin converter enzyme inhibitors on left ventricular deformation in patients with hematologic malignancies after bone marrow transplantation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
I Ikonomidis ◽  
K Katogiannis ◽  
M Stamouli ◽  
G Makavos ◽  
A Frogoudaki ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Ejection Fraction ◽  
Marrow Transplantation ◽  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Hematologic Malignancies ◽  
Left Ventricular

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Hellenic society of lipidiology, atherosclerosis and cardiovascular disease Background/Introduction:  Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of cardiotoxic treatment. Patients and methods 60 patients age 46,3 ± 12,9 years old, 19 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation, were randomized to receive 2,5 mg enalapril bid daily or placebo. We measured at baseline, before transplantation, and after three months: i) Global Longitudinal Strain of left ventricle (LV) (GLS), ii) LV Epicardial Strain (GLSepi), iii) LV Endocardial Strain (GLSendo), by speckle tracking imaging, iv) LV End Diastolic ,End Systolic Volume and Ejection Fraction (LVEF). Results   The two treatment groups had similar age, sex atherosclerotic risk factors and cardiotoxic medication before and after bone marrow transplantation. Compared to baseline, patients treated with enalapril did not show a deterioration of LV GLS and GLSepi [ p = 0,540 and p = 0,422)], Conversely, patients treated with placebo group, presented a significant impairment of LV GLS and GLSepi [p = 0,041 and p = 0,028)] three months after bone marrow  transplantation. No significant changes were found in LVEF after treatment with enalapril ( p = 0,692) or the placebo ( p = 0,892). Table 1 Conclusions   Treatment with enalapril prevented deterioration of myocardial deformation three months after bone marrow transplantation Table 1 group baseline 3 months follow-up p Longitudinal strain apical 4 chambers view placebo -20.56 ± 2.55 -19.46 ± 2.59 0.154 enalapril -20.41 ± 3.31 -19.70 ± 3.70 0.433 Longitudinal strain apical 2 chambers view placebo -20.5 ± 1.97 -16.11 ± 10.38 0.149 enalapril -20.30 ± 3.90 -20.00 ± 3.82 0.763 Longitudinal strain apical 3 chambers view placebo -19.55 ± 2.36 -18.55 ± 2.43 0.197 enalapril -20.01 ± 4.09 -19.26 ± 3.68 0.489 Global Longitudinal Strain placebo -20.19 ± 1.76 -18.96 ± 2.08 0.041 enalapril -20.24 ± 3.58 -19.66 ± 3.65 0.540 Average Global Epicardial Strain placebo -17.82 ± 1.45 -16.60 ± 1.68 0.028 enalapril -17.84 ± 3.09 -17.16 ± 3.20 0.422 Average Global Endocardial Strain placebo -23.03 ± 2.15 -21.96 ± 2.56 0.181 enalapril -23.07 ± 4.19 -23.60 ± 4.17 0.666 EF (Simpon’s method) placebo 59.46 ± 6.59 59.69 ± 6.79 0.892 enalapril 58.65 ± 7.63 59.45 ± 9.28 0.692 Left ventricular parameters during 3 months of follow-up.

Abstract 4691: Endomyocardial Dysfunction in Patients with Severe Aortic Regurgitation and Preserved Ejection Fraction: A Speckle Tracking Echocardiographic Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yoshihiro Seo ◽  
Tomoko Ishizu ◽  
Noriko Iida ◽  
Tomoko Machino ◽  
Ryou Kawamura ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Aortic Regurgitation ◽  
Speckle Tracking ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Separate Analysis ◽  
Ventricular Ejection Fraction ◽  
Severe Aortic Regurgitation ◽  
Control Subjects

Potential myocardial dysfunction may be present in patients with significant aortic regurgitation (AR) and preserved left ventricular ejection fraction (LVEF). Newly developed software for speckle tracking imaging (STI) allows separate analysis of endo- and epimyocardial strain. The aim of this study was to assess the relationship between endo- and epimyocardial radial strain (RS) distribution and AR severity in identifying the potential myocardial dysfunction in patients with significant AR and LVEF>50%, and its correlation with postoperative LV function. We studied 47 patients with AR and 26 control subjects. Degree of AR was classified according to standard echocardiographic criteria as moderate in 16 and severe in 23 patients. STI was analyzed with the new software (Toshiba Medical Systems, Tokyo, Japan). For STI analysis, an endocardial and epicardial border line were each manually traced at end-systole on a short-axis B-mode image at the mid-ventricular level; peak RS of total, endomyocardium, and epicardium were automatically calculated. Endomyocardial RS was reduced in patients with severe AR compared to control subjects and patients with moderate AR (Figure ). Postoperative changes in LVEF were well correlated with the ratio of baseline endomyocardial RS to epimyocardial RS (n=21, r=−0.69, p<0.001). Endomyocardial RS was reduced in patients with severe AR. Assessment of STI-derived RS distribution may be useful to identify potential myocardial dysfunction and postoperative LV functional deterioration in patients with severe AR and preserved EF.

P3540The predictive value of global longitudinal strain in patients with heart failure mid-range ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Wei-Ting ◽  
C T Liao ◽  
Z C Chen
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Predictive Values

Abstract Background Heart failure with mid-range ejection fraction (HFmrEF) was defined as the typical symptoms of HF with a left ventricular ejection fraction (LVEF) of 41% to 49%. However, till now the progression of LV function and the subsequent prognosis remains largely unknown. Speckle tracking echocardiography (STE) is a novel method to detect the early myocardial dysfunction and has been used to differentiate the outcomes of different phenotypes of cardiovascular diseases. Purpose Herein, we aim to investigate the application of STE in HFmrEF and its predictive values. Methods Retrospectively, we collected the medical records and echocardiography imaging of 250 patients diagnosed as HFmrEF during 2014 to 2018. LV longitudinal strain at diagnosis was evaluated and compared with the changes of LV during the follow-up period. Also, mortality and major adverse cardiovascular events (MACE) including myocardial infarction, heart failure requiring admission were recorded. Results Our result indicated that a reduced LV longitudinal strain at baseline was significantly associated with a subsequent declined LVEF beneath 40%. Also, the lower strain a baseline implied the higher mortality and MACE. Using −12% as the cut-off value LV strain presented the most significant impact on the prognosis compared with the other echocardiographic parameters in the logistic regression Regarding the guideline directed medications, blockers of renin-angiotensin-aldosterone system most significantly improved the cardiac remodeling compared with the others. Conclusion STE can predict the subsequent changes of LVEF and the cardiovascular outcomes in patients with HFmrEF.

scholarly journals Left ventricular global longitudinal strain in identifying subclinical myocardial dysfunction among patients hospitalized with COVID-19

2021 ◽  
Vol 32 ◽  
pp. 100719
Author(s):  
Hezzy Shmueli ◽  
Maulin Shah ◽  
Joseph E. Ebinger ◽  
Long-Co Nguyen ◽  
Fernando Chernomordik ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular

scholarly journals Atrial and Ventricular Structural and Functional Alterations in Obese Children

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 562
Author(s):  
Rima Šileikienė ◽  
Karolina Adamonytė ◽  
Aristida Ziutelienė ◽  
Eglė Ramanauskienė ◽  
Jolanta Justina Vaškelytė
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
Z Score ◽  
Obese Children ◽  
2D Speckle Tracking

Background and objectives: Childhood obesity has reached epidemic levels in the world. Obesity in children is defined as a body mass index (BMI) equal to or above the 95th percentile for age and sex. The aim of this study was to determine early changes in cardiac structure and function in obese children by comparing them with their nonobese peers, using echocardiography methods. Materials and methods: The study enrolled 35 obese and 37 age-matched nonobese children. Standardized 2-dimensional (2D), pulsed wave tissue Doppler, and 2D speckle tracking echocardiography were performed. The z-score BMI and lipid metabolism were assessed in all children. Results: Obese children (aged 13.51 ± 2.15 years; 20 boys; BMI z-score of 0.88 ± 0.63) were characterized by enlarged ventricular and atrial volumes, a thicker left ventricular posterior wall, and increased left ventricular mass. Decreased LV and RV systolic and diastolic function was found in obese children. Atrial peak negative (contraction) strain (−2.05% ± 2.17% vs. −4.87% ± 2.97%, p < 0.001), LV and RV global longitudinal strain (−13.3% ± 2.88% vs. −16.87% ± 3.39%; −12.51% ± 10.09% vs. −21.51% ± 7.42%, p < 0.001), and LV global circumferential strain (−17.0 ± 2.7% vs. −19.5 ± 2.9%, p < 0.001) were reduced in obese children. LV torsion (17.94° ± 2.07° vs. 12.45° ± 3.94°, p < 0.001) and normalized torsion (2.49 ± 0.4°/cm vs. 1.86 ± 0.61°/cm, p = 0.001) were greater in obese than nonobese children. A significant inverse correlation was found between LV and RV global longitudinal strain and BMI (r = −0.526, p < 0.01; r = −0.434, p < 0.01) and total cholesterol (r = −0.417, p < 0.01). Multivariate analysis revealed that the BMI z-score was independently related to LV and RV global longitudinal strain as well as LV circumferential and radial strain. Conclusion: 2D speckle tracking echocardiography is beneficial in the early detection of regional LV systolic and diastolic dysfunctions, with preserved ejection fraction as well as additional RV and atrial involvement, in obese children. Obesity may negatively influence atrial and ventricular function, as measured by 2D speckle tracking echocardiography. Obese children, though they are apparently healthy, may have subclinical myocardial dysfunction.

Myocardial work in Stage 1 and 2 hypertensive patients

2021 ◽  
Author(s):  
Akshar Jaglan ◽  
Sarah Roemer ◽  
Ana Cristina Perez Moreno ◽  
Bijoy K Khandheria
Keyword(s):  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Non Invasive ◽  
Significant Difference ◽  
Lv Ejection Fraction ◽  
Global Work ◽  
Stage 1

Abstract Aims Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. Methods and results Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure–strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P &lt; 0.001), and GWW (P &lt; 0.001). Conclusion Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.

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