Subendocardial dysfunction in patients with chronic severe aortic regurgitation and preserved ejection fraction detected with speckle-tracking strain imaging and transmural myocardial strain profile

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.

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Non‐severe aortic regurgitation increases short‐term mortality in acute heart failure with preserved ejection fraction

ESC Heart Failure ◽

10.1002/ehf2.12983 ◽

2020 ◽

Vol 7 (6) ◽

pp. 3901-3909

Author(s):

Tamila Abdurashidova ◽

Pierre Monney ◽

Georgios Tzimas ◽

Nisha Soborun ◽

Julien Regamey ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Aortic Regurgitation ◽

Acute Heart Failure ◽

Preserved Ejection Fraction ◽

Short Term ◽

Severe Aortic Regurgitation ◽

Short Term Mortality

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Prognostic value of 3D area strain in moderate or severe aortic regurgitation with preserved ejection fraction

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2021.01.018 ◽

2021 ◽

Author(s):

Laura Morán Fernández ◽

Eduardo Casas Rojo ◽

Ana García Martín ◽

José Luis Moya Mur ◽

Covadonga Fernández Golfin ◽

...

Keyword(s):

Ejection Fraction ◽

Aortic Regurgitation ◽

Prognostic Value ◽

Preserved Ejection Fraction ◽

Severe Aortic Regurgitation ◽

Area Strain

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Frequency and Magnitude of Subclinical Systolic Dysfunction by Strain Imaging in Heart Failure With Preserved Ejection Fraction

Case Medical Research ◽

10.31525/ct1-nct04163861 ◽

2019 ◽

Author(s):

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Systolic Dysfunction ◽

Strain Imaging ◽

Preserved Ejection Fraction

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Predictive values of multiple non-invasive markers for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction

Scientific Reports ◽

10.1038/s41598-021-83678-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yumin Li ◽

Jia Liu ◽

Yukun Cao ◽

Xiaoyu Han ◽

Guozhu Shao ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Ejection Fraction ◽

Myocardial Fibrosis ◽

Troponin I ◽

Myocardial Strain ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Predictive Values ◽

Non Invasive ◽

Potential Biomarker

AbstractMyocardial fibrosis assessed by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) is associated with cardiovascular outcomes in hypertrophic cardiomyopathy (HCM) patients, but little is known about the utility of non-invasive markers for detecting LGE. This study aims to explore the association between cardiac-specific biomarkers, CMR myocardial strain, left ventricular (LV) hypertrophy and LGE in HCM patients with preserved ejection fraction (EF) and investigate the predictive values of these indexes for LGE. We recruited 33 healthy volunteers and 86 HCM patients with preserved EF to undergo contrast-enhanced CMR examinations. In total, 48 of 86 HCM patients had the presence of LGE. The LGE-positive patients had significant higher serum high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro b-type natriuretic peptide (Nt-proBNP) levels and lower global longitudinal (GLS) and circumferential (GCS) strains than the LGE-negative group. The LGE% was independently associated with the Nt-proBNP levels, GCS, LV end-diastolic maximum wall thickness (MWT) and beta-blocker treatment. In the receiver operating characteristic curve analysis, the combined parameters of Nt-proBNP ≥ 108.00 pg/mL and MWT ≥ 17.30 mm had good diagnostic performance for LGE, with a specificity of 81.25% and sensitivity of 70.00%. These data indicate that serum Nt-proBNP is a potential biomarker associated with LGE% and, combined with MWT, were useful for identifying myocardial fibrosis in HCM patients with preserved EF. Additionally, LV GCS may be a more sensitive indicator for reflecting the presence of myocardial fibrosis than GLS.

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Significance of the echocardiographic evaluation of left atrial myocardial strain for early diagnosis of heart failure with preserved ejection fraction

Kardiologiia ◽

10.18087/cardio.2021.8.n1418 ◽

2021 ◽

Vol 61 (8) ◽

pp. 68-75

Author(s):

E. K. Serezhina ◽

A. G. Obrezan

Keyword(s):

Heart Failure ◽

Early Diagnosis ◽

Ejection Fraction ◽

Left Atrial ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Myocardial Strain ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Echocardiographic Evaluation

This systematic review is based on 19 studies from Elsevier, PubMed, Embase, and Scopus databases, which were found by the following keywords: LA strain (left atrial strain), STE (speckle tracking echocardiography), HF (heart failure), and HFpEF (heart failure with preserved ejection fraction). The review focuses on results and conclusions of studies on using the 2D echocardiographic evaluation of left atrial (LA) myocardial strain for early diagnosis of HFpEF in routine clinical practice. Analysis of the studies included into this review showed a significant decline of all LA functions in patients with HFpEF. Also, multiple studies have reported associations between decreased indexes of LA strain and old age, atrial fibrillation, left ventricular hypertrophy, left and right ventricular systolic dysfunction, and LV diastolic dysfunction. Thus, the review indicates significant possibilities of using indexes of LA strain in evaluation of early stages of both systolic and diastolic myocardial dysfunction. Notably, LA functional systolic and diastolic indexes are not sufficiently studied despite their growing significance for diagnosis and prognosis of patients with HFpEF. For this reason, in addition to existing models for risk stratification in this disease, including clinical characteristics and/or echocardiographic data, future studies should focus on these parameters.

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