scholarly journals Aortic root longitudinal strain by speckle-tracking echocardiography predicts progressive aortic root dilation in Marfan syndrome patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Guala ◽  
MI Pons ◽  
A Ruiz-Munoz ◽  
L Dux-Santoy ◽  
L Madrenas ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Aortic Root ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Aortic Surgery ◽  
Root Diameter ◽  
Aortic Diseases ◽  
Severe Aortic Regurgitation

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Science, Innovation and Universities; Instituto de Salud Carlos III Introduction In Marfan syndrome (MFS) patients reduced longitudinal strain of the ascending aorta (AAo) as measured by applying feature-tracking on cine cardiac magnetic resonance (CMR) images predicts aortic root dilation and aortic events during the follow-up. Speckle-tracking is well established for cardiac deformation assessment but proximal aorta applications are challenging due to limited wall thickness and substantial cardiac motion. Moreover, echocardiography is widely used in the clinical assessment aortic diseases. Purpose We aimed to test a speckle-tracking tool for root longitudinal strain analysis in terms of comparison with CMR-derived AAo longitudinal strain and reproducibility and as predictor of dilation in MFS patients. Methods Thirty-five MFS patients diagnosed by original GHENT criteria, with maximum aortic root diameter of 45 mm and free from previous aortic dissection or cardiac/aortic surgery and non-severe aortic regurgitation were consecutive enrolled and followed-up. CMR and echocardiography were performed less than 2 months apart. Baseline and final aortic root diameter were measured on CMR images. To quantify aortic root cyclic elongation by echocardiography, two regions of interests were manually created covering both walls in a parasternal long-axis view and tracked along the cardiac cycle (Figure 1). Longitudinal strain was computed as the average of maximum increase in relative distance of several sub-regions covering both walls. CMR-derived AAo longitudinal strain was available in 29 patients. Intra-observer reproducibility was tested in 15 patients via intraclass correlation coefficient (ICC) for single-rater absolute agreement. Results Aortic root longitudinal strain by echocardiography was mildly related to CMR-derived AAo longitudinal strain (R = 0.27) and was larger compared to CMR-derived values (16.2 ± 6.0 vs 11.3 ± 4.3). Reproducibility was high, with ICC of 0.811, R = 0.802, p < 0.001. After a mean follow up of 76 ± 13 months, aortic root diameter grew in 20 patients with a rate of 0.29± 0.24 mm/year. Overall mean growth-rate was 0.87 ± 0.33 mm/year. In multivariable analysis corrected for age and baseline aortic root diameter, baseline longitudinal strain by echocardiography was independently and inversely related to progressive dilation (p = 0.033). Conclusions The measurement of aortic root longitudinal strain by speckle-tracking echocardiography is feasible. Aortic root longitudinal strain is an independent predictor of progressive dilation in MFS patients. This may permit the improvement of risk-stratification in aortic diseases in large scale studies. Abstract Figure 1

Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome

2019 ◽  
Vol 40 (25) ◽  
pp. 2047-2055 ◽  
Author(s):  
Andrea Guala ◽  
Gisela Teixidó-Tura ◽  
Jose Rodríguez-Palomares ◽  
Aroa Ruiz-Muñoz ◽  
Lydia Dux-Santoy ◽  
...  
Keyword(s):  
Growth Rate ◽  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Aortic Root ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Root Diameter ◽  
Demographic Characteristics ◽  
Dilation Rate

Abstract Aims Life expectancy in Marfan syndrome patients has improved thanks to the early detection of aortic dilation and prophylactic aortic root surgery. Current international clinical guidelines support the use of aortic root diameter as a predictor of complications. However, other imaging markers are needed to improve risk stratification. This study aim to ascertain whether proximal aorta longitudinal and circumferential strain and distensibility assessed by cardiac magnetic resonance (CMR) predict the aortic root dilation rate and aortic events in Marfan syndrome. Methods and results One hundred and seventeen Marfan patients with no previous aortic dissection, cardiac/aortic surgery, or moderate/severe aortic regurgitation were prospectively included in a multicentre protocol of clinical and imaging follow-up. At baseline, CMR was performed and proximal aorta longitudinal strain and ascending aorta circumferential strain and distensibility were obtained. During follow-up (85.7 [75.0–93.2] months), the annual growth rate of aortic root diameter was 0.62 ± 0.65 mm/year. Fifteen patients underwent elective surgical aortic root replacement and four presented aortic dissection. Once corrected for baseline clinical and demographic characteristics and aortic root diameter, proximal aorta longitudinal strain, but not circumferential strain and distensibility, was an independent predictor of the aortic root diameter growth rate (P = 0.001, P = 0.823, and P = 0.997, respectively), z-score growth rate (P = 0.013, P = 0.672, and P = 0.680, respectively), and aortic events (P = 0.023, P = 0.096, and P = 0.237, respectively). Conclusion Proximal aorta longitudinal strain is independently related to the aortic root dilation rate and aortic events in addition to aortic root diameter, clinical risk factors, and demographic characteristics in Marfan syndrome patients.

P1821Proximal aorta longitudinal but not circumferential strain predicts aortic events and aortic root dilation rate in marfan syndrome patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Guala ◽  
G Teixido Tura ◽  
J F Rodriguez-Palomares ◽  
A Ruiz Munoz ◽  
C Granato ◽  
...  
Keyword(s):  
Growth Rate ◽  
Marfan Syndrome ◽  
Aortic Root ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Aortic Diameter ◽  
Diameter Growth ◽  
Z Score ◽  
Aortic Dissections

Abstract Background The most common cardiovascular complications in Marfan syndrome (MFS) are aortic root dilation and type A aortic dissections. Elective aortic root surgery is indicated when maximum aortic diameter is larger than a defined threshold or in the case of fast-progressing dilation. However, maximum aortic diameter is limited for the prediction of aortic events. Indeed, a large international registry of acute aortic syndromes reported that as much as 40% of aortic dissections happen with maximum aortic diameter lower than 50 mm. Consequently, there is a need for new, non-invasive biomarkers to improve the prediction of aortic complications. Purpose The aim of the present study was to assess if proximal aorta circumferential and longitudinal strain and ascending aorta distensibility were associated with progressive aortic dilation and incidence of aortic events in Marfan syndrome patients. Methods Eighty seven Marfan syndrome patients free from previous cardiac/aortic surgery or dissection, were prospectively included in a multicenter follow-up. Patients were diagnosed by original Ghent criteria. Proximal aorta longitudinal and circumferential strain and distensibility were computed from baseline cine CMR images by means of feature-tracking. The predictive capacity of each stiffness biomarkers was separately tested with multivariable linear regression analysis (aortic growth) and with Cox logistic regression analysis (aortic events), both corrected for clinical and demographic variables, including baseline maximum aortic diameter. Results During a follow-up of 81.6±17 months, mean diameter growth-rate was 0.65±0.67 mm/year and z-score growth rate was 0.07±0.13 / year. Elective aortic root replacement was performed in 11 patients while two patients presented type A aortic dissection.Baseline proximal aorta longitudinal strain was independently related to diameter growth-rate (p=0.001), z-score growth-rate (p=0.018) and aortic events (p=0.018). Conversely, neither circumferential strain nor distensibility were independent predictors of diameter growth-rate (p=0.385 and p=0.381, respectively), z-score growth-rate (p=0.515 and p=0.484, respectively) and aortic events (p=0.064 and p=0.205, respectively). Conclusions Proximal aorta longitudinal strain predicts aortic root dilation and major aortic events in Marfan syndrome patients beyond aortic root diameter and clinical and demographic characteristics. Acknowledgement/Funding ISCIII PI14/0106, La Maratό de TV3 (20151330) and CIBERCV. Guala A. FP7/People n° 267128

scholarly journals Early detection of subclinical left ventricular dysfunction after breast cancer radiation therapy using speckle-tracking echocardiography: association between cardiac exposure and longitudinal strain reduction (BACCARAT study)

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Valentin Walker ◽  
Olivier Lairez ◽  
Olivier Fondard ◽  
Atul Pathak ◽  
Baptiste Pinel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Radiation Doses ◽  
Lv Dysfunction

Abstract Background Breast cancer (BC) radiotherapy (RT) can induce cardiotoxicity, with adverse events often observed many years after BC RT. Subclinical left ventricular (LV) dysfunction can be detected early after BC RT with global longitudinal strain (GLS) measurement based on 2D speckle-tracking echocardiography. This 6-month follow-up analysis from the BACCARAT prospective study aimed to investigate the association between cardiac radiation doses and subclinical LV dysfunction based on GLS reduction. Methods The patient study group consisted of 79 BC patients (64 left-sided BC, 15 right-sided BC) treated with RT without chemotherapy. Echocardiographic parameters, including GLS, were measured before RT and 6 months post-RT. The association between subclinical LV dysfunction, defined as GLS reduction > 10%, and radiation doses to whole heart and the LV were performed based on logistic regressions. Non-radiation factors associated with subclinical LV dysfunction including age, BMI, hypertension, hypercholesterolemia and endocrine therapy were considered for multivariate analyses. Results A mean decrease of 6% in GLS was observed (− 15.1% ± 3.2% at 6 months vs. − 16.1% ± 2.7% before RT, p = 0.01). For left-sided patients, mean heart and LV doses were 3.1 ± 1.3 Gy and 6.7 ± 3.4 Gy respectively. For right-sided patients, mean heart dose was 0.7 ± 0.5 Gy and median LV dose was 0.1 Gy. Associations between GLS reduction > 10% (37 patients) and mean doses to the heart and the LV as well as the V20 were observed in univariate analysis (Odds Ratio = 1.37[1.01–1.86], p = 0.04 for Dmean Heart; OR = 1.14 [1.01–1.28], p = 0.03 for Dmean LV; OR = 1.08 [1.01–1.14], p = 0.02 for LV V20). In multivariate analysis, these associations did not remain significant after adjustment for non-radiation factors. Further exploratory analysis allowed identifying a subgroup of patients (LV V20 > 15%) for whom a significant association with subclinical LV dysfunction was found (adjusted OR = 3.97 [1.01–15.70], p = 0.048). Conclusions This analysis indicated that subclinical LV dysfunction defined as a GLS decrease > 10% is associated with cardiac doses, but adjustment for non-radiation factors such as endocrine therapy lead to no longer statistically significant relationships. However, LV dosimetry may be promising to identify high-risk subpopulations. Larger and longer follow-up studies are required to further investigate these associations. Trial registration ClinicalTrials.gov: NCT02605512, Registered 6 November 2015 - Retrospectively registered

P1476Global longitudinal strain assessed by 2-D speckle tracking echocardiography identifies myocardial viability and predicts LV function and remodeling after acute MI with systolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Ben Driss ◽  
C Ben Driss Lepage ◽  
A Sfaxi ◽  
M Hakim ◽  
J Y Tabet ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Myocardial Viability ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Dysfunction ◽  
Lv Remodeling ◽  
Acute Mi ◽  
Lge Cmr

Abstract Aims To assess whether two-dimensional speckle-tracking echocardiography (2D-STE) could (1) identify myocardial viability in comparison with late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR); (2) predict global left ventricular (LV) functional recovery and remodeling and (3) assess prognosis after acute myocardial infarction (MI) with LV systolic dysfunction. Methods Seventy one first STEMI patients with LVEF ≤45%, treated with acute percutaneous coronary intervention, underwent 2D-echocardiography for 2D-STE analysis and LGE CMR between 2 and 45 days after STEMI. Segments were defined as viable when transmural LGE extension was <50% and non viable when transmural LGE extension was ≥50%. At 8-month follow-up, transthoracic echocardiography was repeated to determine global LV functional recovery (increase in LVEF ≥5%) and LV remodeling (increase in end-systolic volume >15%) (n=30) and clinical outcomes were obtained (n=46). Results Global longitudinal strain (GLS) was lower in non viable than in viable infarct segments (−6.6±6.1% vs −10.3±5.9%, p<0.0001) and in viable infarct segments than in normal segments (−10.3±5.9% vs −14.5±6.4%, p<0.0001). GLS >−12% had sensitivity of 78% and specificity of 69% to identify non viable segments (area under the curve (AUC), 0.79; 95% confidence interval (CI), 0.77–0.81, p<0.0001). GLS >−11.3% had sensitivity of 53% and specificity of 100% to predict the absence of global functional improvement (AUC=0.73 (CI: 0.55–0.87) p=0.01) at 8-month follow-up. GLS <−12.5% predicted the absence of adverse LV remodeling at 8-month follow-up with a sensitivity of 100% and a specificity of 54% (AUC=0.83 (CI: 0.66–0.94) p<0.0001). GLS >−11.5% was associated with a poor prognosis. Conclusions In patients with recent first acute MI with LV systolic dysfunction, GLS assessed by 2D-STE: (1) is able to identify non viable segments in comparison with LGE CMR, (2) allows prediction of LV global functional recovery and LV remodeling at 8-month follow-up and (3) provides strong prognostic information, independently of LVEF.

scholarly journals Assessment of immediate effects of percutaneous balloon mitral valvuloplasty on right ventricular and pulmonary functions in severe rheumatic mitral stenosis patients using speckle tracking echocardiography and spirometry

2020 ◽  
Vol 12 (4) ◽  
pp. 280-285
Author(s):  
Praveen Kumar Reddy Sakkuru ◽  
Vanajakshamma Velam ◽  
Rajasekhar Durgaprasad ◽  
Narendra Chanda ◽  
Raja Naga Mahesh Maddala ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Pulmonary Function ◽  
Right Ventricular ◽  
Strain Rate ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Pulmonary Functions ◽  
The Mean

Introduction: The current study was sought to assess the immediate effect of percutaneous balloonmitral valvuloplasty (PBMV) on right ventricular (RV) and pulmonary functions using speckle tracking echocardiography (STE) and spirometry respectively. Methods: Two-dimensional speckle tracking and doppler studies for strain and strain rate imaging of RV were performed before PBMV, after 48h and 15 days of PBMV using echocardiography and spirometry. Mitral valve area, peak and mean mitral valve transannular pressure gradients, late filling velocities,Wilkins score, Systolic pulmonary artery pressure, TAPSE, RV end-diastolic and end-systolic areas,RV fractional area change and Tei index were measured. Results: There was a significant rise in peak RV global longitudinal strain (GLS) from baseline to48h post PBMV and at 15 days post PBMV. Segmental RV strain at basal septum, mid septum,apical septum and basal RV free wall showed considerable improvement from baseline to 48h post PBMV and 15 days post PBMV. RV longitudinal strain rate parameters did not show significant improvement after PBMV and remained low at follow-up. Post PBMV all patients showed restrictive features on pulmonary function test. The mean FEV1 (% predicted), mean FVC (% predicted), mean PEFR improved from baseline to 48h PBMV and 15 days post PBMV. Though the mean FEV1/FVC increased post PBMV at 15 days follow-up, but it was statistically insignificant. Conclusion: RV performance in MS was decreased mainly due to increase in RV after load which improves after PBMV. Patients with severe MS have impaired pulmonary function which is of restrictive type and successful PBMV improves pulmonary function.

P1820New parameters for the evaluation of mechanic and elastic properties of the aortic root in Marfan Syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Torres Sanabria ◽  
E Garcia Izquierdo Jaen ◽  
V Monivas Palomero ◽  
A Forteza Gil ◽  
S Navarro Rico ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Aortic Root ◽  
Speckle Tracking ◽  
Aortic Stiffness ◽  
Aortic Wall ◽  
Aortic Distensibility ◽  
Root Diameter ◽  
Stiffness Index ◽  
Wall Displacement ◽  
Aortic Strain

Abstract Background Elastic properties of the thoracic aorta in patients with Marfan Syndrome (MS) have already been evaluated with classic echocardiographic parameters. In the latest years the use of Speckle-Tracking (STE) ecocardiography has been widely extended. Our aim is to describe and provide new parameters of aortic deformation measured by STE in patients with MS. Methods 95 unoperated adult patients with MS and 32 healthy controls were prospectively enrolled. We measured classic parameters of the aortic root using 2D echocardiography. We calculated the posterior aortic wall systolic excursion at the sinuses of Valsalva and ascending aorta using M Mode in TDI colour; with ST 2D ecocardiography we measured the aortic strain at the sinuses of Valsalva (SV) and the anterior and posterior aortic wall displacement at the SV. Aortic distensibility was calculated using the formula: 1000 * (Ds − Dd)/Dd * 1/(Ps − Pd) in mmHg–1 (Ds: systolic and Dd: diastolic diameters, Ps systolic and Pd diastolic blood pressure). Aortic stiffness index was calculated as Ln((Ps/Pd)/(Ds-Dd)/Dd)). Results As shown in the table bellow, patients with MS had lower aortic strain, aortic anterior and posterior wall displacement and impaired aortic distensibility and stiffness index compared to healthy controls. We found a strong negative linear correlation between aortic root diameter at the SV and aortic root strain (r=−0.56, figure 1). Results of statistical analysis MS (n=95) Controls (n=32) p Age (years) 32.84±12.35 32.41±7.98 0.85 Aortic root diameter at the sinuses of Valsalva (mm) 38.82±5.35 30.92±3.65 <0.001 Aortic root strain (%) 4.66±2.45 9.19±2.49 <0.001 Anterior aortic wall displacement STE (mm) 10.39±3.64 13.10±2.26 <0.001 Posterior aortic wall displacement STE (mm) 9.02±2.87 11.04±1.82 <0.001 Aortic distensibility 0.98±0.46 1.37±0.72 0.01 Aortic stiffness index 3.74±0.43 3.47±0.51 0.01 MS = Marfan Syndrome; STE = Speckle Tracking Ecocardiography. Figure 1. Dispersion plot Conclusions Our results suggest that aortic deformation and displacement obtained by STE echocardiography is impaired in MS, showing a reduced distensibility and an increased stiffness of the aortic wall, with a strong negative correlation between aortic root dilation and aortic strain. All these parameters may be useful as additional tools for the diagnosis and follow-up of Marfan patients, and could be useful to to improve the echocardiographic evaluation of the aortic root.

scholarly journals Global Longitudinal Strain at Rest as an Independent Predictor of Mortality in Liver Transplant Candidates: A Retrospective Clinical Study

2020 ◽  
Vol 9 (8) ◽  
pp. 2616
Author(s):  
Mare Mechelinck ◽  
Bianca Hartmann ◽  
Sandra Hamada ◽  
Michael Becker ◽  
Anne Andert ◽  
...  
Keyword(s):  
Liver Disease ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Retrospective Clinical Study ◽  
Transplant Candidates

Speckle tracking echocardiography enables the detection of subclinical left ventricular dysfunction at rest in many heart diseases and potentially in severe liver diseases. It could also possibly serve as a predictor for survival. In this study, 117 patients evaluated for liver transplantation in a single center between May 2010 and April 2016 with normal left ventricular ejection fraction were included according to clinical characteristics of their liver disease: (1) compensated (n = 29), (2) clinically significant portal hypertension (n = 49), and (3) decompensated (n = 39). Standard echocardiography and speckle tracking echocardiography were performed at rest and during dobutamine stress. Follow-up amounted to three years to evaluate survival and major cardiac events. Altogether 67% (78/117) of the patients were transplanted and 32% (31/96 patients) died during the three-year follow-up period. Global longitudinal strain (GLS) at rest was significantly increased (became more negative) with the severity of liver disease (p < 0.001), but reached comparable values in all groups during peak stress. Low (less negative) GLS values at rest (male: >−17/female: >−18%) could predict patient survival in a multivariate Cox regression analysis (p = 0.002). GLS proved valuable in identifying transplant candidates with latent systolic dysfunction.

scholarly journals Long-term outcome of patients with Marfan syndrome with previous aortic surgery but native aortic roots

2020 ◽  
Vol 58 (6) ◽  
pp. 1289-1295
Author(s):  
Selim Mosbahi ◽  
Murat Yildiz ◽  
Paul-Philipp Heinisch ◽  
Bettina Langhammer ◽  
Silvan Jungi ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Aortic Root ◽  
Aortic Surgery ◽  
Current Data ◽  
Aortic Root Replacement ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Aortic Interventions

Abstract OBJECTIVES The goal of this study was to report the long-term outcomes of patients with Marfan syndrome who had aortic surgery on any aortic segment except for the replacement of the aortic root itself. METHODS An observational retrospective single-centre study was conducted with 115 Marfan syndrome patients who underwent 189 major aortic interventions from 1995 until 2018. Patients without aortic root replacement were identified and aortic root growth was analysed over time. RESULTS Eleven of 115 patients (9.5%) did not have aortic root replacement during a follow-up of 10.5 [standard deviation (SD) 5.7] years and a mean age at last follow-up of 53.9 (SD 13.4) years. Patients without root replacement did not suffer less frequently from any type of acute aortic dissection (type A 27% vs 25%, P = 0.999; type B 36% vs 25%, P = 0.474). Patients with native aortic roots did not undergo fewer aortic interventions than those with aortic root replacement [12/11, mean 1.09 (SD 0.54) operations/patient vs 177/104, mean 1.7 (SD 1.3); P = 0.128]. Progression of the aortic root dimension was 0.5 (SD 0.3) mm/year in the group of patients with native aortic roots. CONCLUSIONS Current data suggest that 10% of patients with Marfan syndrome with previous aortic surgery will be free from aortic root replacement until the sixth decade of life.

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