scholarly journals The effects of doxorubicin on left and right atrial mechanics in patients with lymphoma

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Vahabi ◽  
E Kharati-Koopaei ◽  
M Stewart ◽  
H Hancock ◽  
M Norouzi ◽  
...  
Keyword(s):  
Strain Rate ◽  
Left Atrial ◽  
Left Ventricular ◽  
Right Atrial ◽  
Lv Function ◽  
Compensatory Mechanism ◽  
Research Association ◽  
Anthracycline Cardiotoxicity ◽  
Diastolic Strain Rate ◽  
Significant Change

Abstract Background Despite the associated dose-dependent cardiotoxicity, anthracyclines continue to form the backbone of modern chemotherapy regimens. Speckle Tracking Echocardiography (STE) has been a popular method of quantifying cardiac function but most studies have focused on left ventricular function. Research into the effects of anthracyclines on left atrial (LA) and right atrial (RA) function continues to be neglected. Purpose To investigate the effects of doxorubicin, a commonly used anthracycline, on both the LA and RA systolic and diastolic strain and strain-rate parameters in two groups of patients with lymphoma: Group 1 (G1) with a conventional drop in ejection fraction (EF <53%), and Group 2 (G2) without. Methods We retrospectively studied 46 patients treated for lymphoma between 2015 and 2018; G1 (n=12) and G2 (n=34). Echocardiograms performed at baseline (T0), mid-chemotherapy (T1), and post-chemotherapy (T2), were analysed by using offline vendor-independent software (TomTec, 2D Cardiac Performance Analysis). Using 2D STE, LA and RA reservoir, conduit and contractile strains, systolic and diastolic strain-rates were measured. Multi-level longitudinal model was used for statistical analysis.This study was ethically approved by the Health Research Association (REC Reference 18/SS/0139). Results Median age was 64 years (IQR 51–74 years) in G1, and 65 years (IQR 57–73 years) in G2. In G1, there was no significant change in LA reservoir strain with time, however a significant decline with an average mean difference of −7.52 was seen between T0 to T2 (p=0.016) in G2. LA conduit strain did not significantly change in either group with incremental doses of doxorubicin. However, LA contraction strain was seen to significantly increase in G1 between T1 to T2 (p=0.045) with an average change of 7.23. LA peak systolic strain rate, and late diastolic strain rate did not show any significant change with time in both groups. Yet, a significant increase was seen in LA early diastolic strain rate between T0 to T2 (p=0.017) in G1 but not G2. No significant changes were seen in the RA strain parameters in both groups. Conclusion In patient with a reduction in LV function, a significant change was noted in the left atrial contraction strain and early diastolic strain rate with incremental doses of doxorubicin. These changes shows the close relationship between the LA and LV, and the importance of LA in providing a compensatory mechanism for a decline in LV function secondary to anthracycline cardiotoxicity. Funding Acknowledgement Type of funding source: None

scholarly journals P1394 Left atrial strain as a tool to explore disturbed system biology involving cerebral cognition in diabetes: A sub study of the European multicenter MOPEAD project

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S K Saha ◽  
A Kiotsekoglou ◽  
A Borysenko ◽  
A Gopal ◽  
S C Govind
Keyword(s):  
Type 2 Diabetes ◽  
Strain Rate ◽  
Left Atrial ◽  
System Biology ◽  
Left Ventricular ◽  
Lv Function ◽  
Right Ventricular Free Wall ◽  
Lv Dysfunction ◽  
Strain And Strain Rate

Abstract Funding Acknowledgements EU GRANT OnBehalf MOPEAD STUDY GROUP Background Although the 2D speckle tracking software (2DSTE-SW) has been irrevocably proved to be useful for quantification of left ventricular (LV) function, the same SW has also been used successfully in a plethora of cardiac illnesses using left atrial (LA) strain and strain rate, even in the absence of a dedicated LA SW. LA peak longitudinal strain during ventricular systole (LA-Reservoir strain%; LA-Res S), and strain rate during early (LA-SRE) and late (LA-SRA) phases constitute respectively the reservoir (LA-RS%), conduit, and booster pump functions of this chamber. The role of this dynamic function has not been investigated to assess cerebral cognition in type 2 diabetes (DM). Methods We enrolled thirty-nine subjects with DM and mild LV dysfunction (76 ± 5 years, 25 F) in the EU- funded MOPEAD (Models of Patient Engagement for Alzheimer’s Disease) project. Fifteen of them underwent standard echocardiography and 2DSTE. We assessed cerebral cognition using the standard MMSE (Mini-Mental Stage Examination) score: we considered a score of less than 28 as a surrogate of mild cognitive impairment (MCI+). Besides LA-Res strain, LA-SRE, LA-SRA, LV-GLS and right ventricular free wall strain (RV-FWS) were also computed (RV-FWS). Routine biochemistry included, among other, HbA1c and NT-proBNP. Results Mean values of the 2D STE measures were LVGLS: 14± 3%, LAVI: 36± 21 ml/m2, LA -RS: 18 ±8 %, LA-SRE: 0.6± 0.3, and LA-SRA: 1.6± 0.4. RV FWS was 20± 5 %. HbA1c was 58 ± 16 mmol/mol. LVEF was 53± 7%. There was no difference in theses variable between MCI+ and those with normal cognition (MCI-). However, in the regression model, LA-Res S had the strongest association with MCI (P < 0.01) (Fig), with excellent strength of association ( R2 = 0.8). LA-SRE, indexed LA volume, and NT-proBNP were not retained by the model (p > 0.05). Conclusion LA reservoir strain may emerge as a useful tool to explore disturbed system biology involving extracardiac organ such as the brain in older adults with type 2 diabetes, in the background of mild LV dysfunction. Abstract P1394 Figure. Fig.Regression analysis

scholarly journals Subclinical Impairment of Left Ventricular Function in Young Obese Women: Contributions of Polycystic Ovary Disease and Insulin Resistance

2008 ◽  
Vol 93 (10) ◽  
pp. 3748-3754 ◽  
Author(s):  
Wojciech Kosmala ◽  
Trisha M. O'Moore-Sullivan ◽  
Rafal Plaksej ◽  
Justyna Kuliczkowska-Plaksej ◽  
Monika Przewlocka-Kosmala ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Strain Rate ◽  
Young Women ◽  
Polycystic Ovary ◽  
Left Ventricular ◽  
Lv Function ◽  
Peak Strain ◽  
Fasting Insulin ◽  
Obese Women ◽  
Diastolic Strain Rate

Context: Obesity and insulin resistance (IR) may produce disturbances of left ventricular (LV) function. Obese women with polycystic ovary syndrome (PCO), characterized by hormonal and metabolic abnormalities, are thought to be at particularly increased cardiovascular risk. Objectives: We sought to determine the influence of IR on LV function in obese young women with and without PCO and without other comorbidities. Design: This was a cross-sectional study. Setting: The study was performed at a university hospital. Patients: A total of 150 women aged younger than 40 yr with a body mass index (BMI) of 30 kg/m2 or more was classified into three groups: with both PCO and IR, without PCO and with IR, and without either PCO or IR. Main Outcome Measures: Tissue Doppler-derived myocardial velocities, strain-rate and strain, and metabolic and hormonal measurements were calculated. Results: Subclinical impairment of LV systolic and diastolic function as indicated by lower peak strain (P < 0.001), peak systolic strain rate (P < 0.001), peak early diastolic strain rate (P < 0.001), and peak early diastolic velocity (P < 0.01) was demonstrated in both groups with IR. IR subjects with and without PCO did not differ in any LV function indices. Strain was independently associated with fasting insulin (β = −0.39; P < 0.001), urinary albumin excretion (UAE) (β = −0.36; P < 0.001), and BMI (β = −0.22; P < 0.03), and peak early diastolic strain rate was associated with UAE (β = −0.35; P < 0.001), fasting insulin (β = −0.24; P < 0.02), BMI (β = −0.23; P < 0.02), and SHBG (β = 0.20; P < 0.04). Conclusions: In obese young women, fasting insulin, BMI, SHBG, and UAE are independent correlates of impaired LV performance. The contribution of PCO to LV function abnormalities is linked to IR, but not to other hormonal aberrations associated with this condition.

scholarly journals Global Left Atrial Longitudinal Strain Using 3-Beat Method Improves Risk Prediction of Stroke Over Conventional Echocardiography in Atrial Fibrillation

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Jo-Nan Liao ◽  
Tze-Fan Chao ◽  
Jen-Yuan Kuo ◽  
Kuo-Tzu Sung ◽  
Jui-Peng Tsai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Strain Rate ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Diastolic Strain Rate ◽  
Longitudinal Strains ◽  
Conventional Echocardiography

Background: Atrial fibrillation (AF) is associated with a risk of ischemic stroke, and functional myocardial imaging has offered novel insights on its pathophysiology and prognosis, but its use in AF-related stroke remains limited. We aimed to evaluate the feasibility of left atrial (LA) deformations and its prognostic values of ischemic stroke in a large-scale AF population. Methods: Peak atrial longitudinal strain (LA strain), left ventricular strain (global longitudinal strain), LA strain rate (LA SR) at reservoir (LA longitudinal systolic strain rate), and early diastolic conduit (LA longitudinal early diastolic strain rate) phases were analyzed using 2-dimensional speckle tracking echocardiography. Consecutive 3-beat averaged values of strain and SR were used. The clinical end point was ischemic stroke. Results: Among 1457 AF participants, the mean LA strain, LA longitudinal systolic strain rate, and LA longitudinal early diastolic strain rate values were 12.9±4.8%, 0.80±0.28 s − 1 , and −1.17±0.46 s − 1 , respectively. There were strong positive linear relationships of 3-beat average with index-beat analysis (R=0.94, 0.94, and 0.94 for LA strain, LA longitudinal systolic strain rate, and LA longitudinal early diastolic strain rate, respectively; all P <0.001). Multivariate Cox regression models incorporating conventional echocardiography parameters demonstrated LA strain and SRs to be independent prognosticators of ischemic stroke during a median follow-up of 37.6 months. Utilization of LA strain further provided incremental value over CHA 2 DS 2 -VASc scoring ( C statistics, 0.78–0.81; P =0.006) for ischemic stroke. Overall, the prognostic performances of LA deformations were attenuated after adding global longitudinal strains in models. Conclusions: LA deformations by the 3-beat method are feasible and reproducible during AF. LA strain provided additional prognostic implication over clinical information and conventional echocardiographic measures for ischemic stroke in the AF population but not incremental to global longitudinal strains.

Ventricular and atrial mechanics and their interaction in patients with congenital scoliosis without clinical heart failure

2014 ◽  
Vol 25 (5) ◽  
pp. 976-983
Author(s):  
Shujuan Li ◽  
Junlin Yang ◽  
Ling Zhu ◽  
Yuese Lin ◽  
Xuandi Li ◽  
...  
Keyword(s):  
Strain Rate ◽  
Left Atrial ◽  
Congenital Scoliosis ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Diastolic Strain Rate ◽  
Positive Strain ◽  
Cobb’S Angle ◽  
Clinical Heart Failure ◽  
Left Atrial Mechanics

AbstractObjectives: This study sought to evaluate left ventricular, right ventricular, and left atrial mechanics and their interactions in patients with congenital scoliosis without clinical heart failure.Methods: A total of 23 patients with a median age of 14 years and a median Cobb’s angle of 61° were studied. Ventricular and atrial myocardial deformation was measured using speckle tracking echocardiography. The results of the patients were compared with 22 controls.Results: Compared with controls, the patients had a significantly greater annular a velocity (p=0.04) and lower e/a ratio (p=0.03); the left ventricular deformation significantly decreased in radial global (p=0.04) and segmental systolic strain and early diastolic strain rate (p=0.03); the left atrial deformation showed a significantly lower positive strain (p=0.02), greater negative strain (p=0.01), and active contractile strain rate (p=0.01). For the patients, the Cobb’s angle was negatively correlated with the left ventricular global radial systolic strain (r=−0.65, p=0.001), left atrial positive strain (r=−0.68, p<0.001), and the left atrial negative strain was positively correlated with the left ventricular circumferential late diastolic strain rate (r=0.46, p=0.01). The left atrial conduit strain rate was positively correlated with the left ventricular circumferential early diastolic strain rate (r=0.42, p=0.03). The left atrial active contractile strain rate was positively correlated with the left ventricular longitudinal late diastolic strain rate (r=−0.4, p=0.03).Conclusions:Impaired left ventricular and altered left atrial mechanics occur relatively early in patients with congenital scoliosis, and are correlated with the severity of their scoliosis. Our findings provide evidence of preclinical heart dysfunction in patients with this disorder.

scholarly journals Aggravation of functional mitral regurgitation on left ventricle stiffness in type 2 diabetes mellitus patients evaluated by CMR tissue tracking

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yi Zhang ◽  
Wei-feng Yan ◽  
Li Jiang ◽  
Meng-ting Shen ◽  
Yuan Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mitral Regurgitation ◽  
Strain Rate ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Lv Function ◽  
Peak Strain

Abstract Background Functional mitral regurgitation (FMR) is one of the most common heart valve diseases in diabetes and may increase left ventricular (LV) preload and aggravate myocardial stiffness. This study aimed to investigate the aggravation of FMR on the deterioration of LV strain in type 2 diabetes mellitus (T2DM) patients and explore the independent indicators of LV peak strain (PS). Materials and methods In total, 157 T2DM patients (59 patients with and 98 without FMR) and 52 age- and sex-matched healthy control volunteers were included and underwent cardiac magnetic resonance examination. T2DM with FMR patients were divided into T2DM patients with mild (n = 21), moderate (n = 19) and severe (n = 19) regurgitation. LV function and global strain parameters were compared among groups. Multivariate analysis was used to identify the independent indicators of LV PS. Results The T2DM with FMR had lower LV strain parameters in radial, circumferential and longitudinal direction than both the normal and the T2DM without FMR (all P < 0.05). The mild had mainly decreased peak diastolic strain rate (PDSR) compared to the normal. The moderate had decreased peak systolic strain rate (PSSR) compared to the normal and PDSR compared to the mild and the normal. The severe FMR group had decreased PDSR and PSSR compared to the mild and the normal (all P < 0.05). Multiple linear regression showed that the regurgitation degree was independent associated with radial (β = − 0.272), circumferential (β = − 0.412) and longitudinal (β = − 0.347) PS; the months with diabetes was independently associated with radial (β = − 0.299) and longitudinal (β = − 0.347) PS in T2DM with FMR. Conclusion FMR may aggravate the deterioration of LV stiffness in T2DM patients, resulting in decline of LV strain and function. The regurgitation degree and months with diabetes were independently correlated with LV global PS in T2DM with FMR.

scholarly journals Association between Reduced estimated Glomerular Filtration Rate and Cardiac Structure and Function in Patients with Essential Hypertension

2021 ◽  
Author(s):  
Liying Mu ◽  
Lu Chen ◽  
juan du ◽  
Hua Jiang ◽  
Caixia Guo ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Left Atrial ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Left Ventricular ◽  
Structure And Function ◽  
Right Atrial ◽  
Cardiac Structure ◽  
Cardiac Structure And Function ◽  
And Function

Objectives To investigate the relationship between small reductions in estimated glomerular filtration rate (eGFR) and cardiac structure and function in patients with essential hypertension. Methods The study group included 565 patients with essential hypertensive. eGFR was calculated by EPI equation and cardiac structure and function were assessed using echocardiography. The participants were divided into three groups: eGFR ≥90 mL/min /1.73 m2, 60-89 mL/min/1.73 m2, and 30-59 mL/min /1.73 m2. Pearson correlation analysis and multiple stepwise linear regression analysis were performed to evaluate associations between eGFR and echocardiogram parameters. Results Compared with patients with eGFR ≥ 90 mL/min/ 1.73 m2, those with eGFR 60-89 mL/min/ 1.73 m2 and 30-59 mL/min/ 1.73 m2 had higher left ventricular end-diastolic diameter (LVEDD) (p=0.019), mitral valve E wave (p=0.004), left atrial diameter (LAD) (p=0.001), right atrial diameter (RAD) (p=0.001), right ventricular diameter (RVD) (p=0.001) and lower left ventricular ejection fraction (LVEF) (p=0.01). After further adjustment for traditional cardiovascular risk factors including systolic and diastolic blood pressure, BMI, diabetes, dyslipidemia and smoking, eGFR was still associated with LVEF (p＜0.001), LAD (p＜0.001) and RAD (p=0.003). Conclusion Among patients with essential hypertension, even mildly reduced renal function is independently associated with greater cardiac remodeling, indicated by left atrial and right atrial enlargement, and worse left ventricular systolic function.

scholarly journals Do left atrial strain and strain rate reflect intrinsic atrial function, or are they determined by left ventricular function?

2015 ◽  
pp. 539-548 ◽  
Author(s):  
Andrei Dumitru Margulescu ◽  
Emma Rees ◽  
Rose-Marie Coulson ◽  
Aled D. Rees ◽  
Dragos Vinereanu ◽  
...  
Keyword(s):  
Left Ventricular Function ◽  
Strain Rate ◽  
Ventricular Function ◽  
Left Atrial ◽  
Left Ventricular ◽  
Atrial Function ◽  
Left Atrial Strain ◽  
Strain And Strain Rate ◽  
Atrial Strain

P1484Exploring the grey zone of E/e' ratio: does left atrial strain help?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L F Cerrito ◽  
R M Inciardi ◽  
G Benfari ◽  
C Bergamini ◽  
F L Ribichini ◽  
...  
Keyword(s):  
Left Atrial ◽  
Diagnostic Algorithm ◽  
Roc Curves ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Right Atrial ◽  
Deformation Analysis ◽  
Systolic Pulmonary Artery Pressure ◽  
Grey Zone ◽  
Left Atrial Strain

Abstract Background The combination of early trans-mitral inflow and mitral annular tissue Doppler velocities (E/e' ratio) is widely applied to noninvasively estimate left ventricular (LV) filling pressures. However E/e' ratio has a significant gray zone that restrict its accuracy and left atrial (LA) deformation analysis by speckle tracking echocardiography (STE) was recently proposed as an alternative approach to estimate LV filling pressures, but the clinical application of LA strain in the subgroup of patients with E/E' between 8 and 14 has been under-investigated. Aims This study aimed to analyze the role of LA longitudinal function by STE (PALS) to estimate intra-cardiac pressures as assessed by systolic pulmonary artery pressure (sPAP), measured by Doppler, specifically in patients with an E/e' ratio >8 and ≤14. Methods We enrolled 142 consecutive, non-selected patients, referred to our echocardiography laboratory for a comprehensive transthoracic echocardiography. Exclusion criteria were: organic mitral valve disease or prosthesis and presence of disease possibly associated with pre-capillary pulmonary hypertension. Particular care was used for accurate measurement of maximal tricuspid regurgitation velocity and of right atrial pressure and consequently sPAP estimation. PALS values were obtained by averaging all segments, and by separately averaging segments measured in the 4-chamber and 2-chamber views. Results Seventy-four patients (52% of total) showed an E/e' ratio >8 and ≤14, with the following characteristics: mean age 65.5±11.9 years, LVEF 54.5±11.2, E/e' 11.2±1.9, sPAP 33±7 mmHg, PALS 31.6±11.7%. A negative correlation between PALS and sPAP was found (r=−0.55, p<0.0001). From receiver operating characteristic (ROC) curves, PALS demonstrated a high diagnostic accuracy (AUC 0.78 (95% CI: 66%–90%)); the cutoff value of 23% showed an excellent specificity of 90% with a sensibility of 60%, to predict sPAP higher than 35 mmHg. Correlation between sPAP and PALS Conclusions LA function measured by STE is a simple parameter able to predict increased intra-cardiac pressure even in the intermediate E/E' group. This parameters might help in improving the diagnostic algorithm of diastolic function.

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