scholarly journals Left ventricular mechanical dispersion in a general population: Data from the Akershus Cardiac Examination 1950 study

2019 ◽  
Author(s):  
Erika N Aagaard ◽  
Brede Kvisvik ◽  
Mohammad O Pervez ◽  
Magnus N Lyngbakken ◽  
Trygve Berge ◽  
...  
Keyword(s):  
General Population ◽  
Global Longitudinal Strain ◽  
Population Data ◽  
Left Ventricular ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Clinical Model ◽  
Mechanical Dispersion ◽  
Obesity And Diabetes ◽  
Increased Risk

Abstract Aims Increased left ventricular mechanical dispersion by 2D speckle tracking echocardiography predicts ventricular arrhythmias in ischaemic heart disease and heart failure. However, little is known about mechanical dispersion in the general population. We aimed to study mechanical dispersion in the general population and in diseases associated with increased risk of cardiovascular disease. Methods and results The present cross-sectional study consists of 2529 subjects born in 1950 included in the Akershus Cardiac Examination (ACE) 1950 study. Global longitudinal strain (GLS) was assessed from 17 strain segments, and mechanical dispersion calculated as the standard deviation of contraction duration of all segments. The cohort was divided according to the median value of mechanical dispersion, and multivariable linear regression models were performed with mechanical dispersion as the dependent variable. The prevalence of coronary artery disease (CAD), hypertension, obesity, and diabetes (P < 0.01 for all) was significantly higher in subjects with supra-median mechanical dispersion. In a multivariable clinical model, CAD (B = 7.05), hypertension (B = 4.15; both P < 0.001), diabetes (B = 3.39), and obesity (B = 1.89; both P < 0.05) were independently associated with increasing mechanical dispersion. When echocardiographic indices were added to the multivariable model, CAD (B = 4.38; P < 0.01) and hypertension (B = 2.86; P < 0.001) remained significant in addition to peak early diastolic tissue velocity e’ (B = −2.00), GLS (B = 1.68), and ejection fraction (B = 0.22; P < 0.001 for all). Conclusion In a general middle-aged population, prevalent CAD and hypertension were associated with increasing mechanical dispersion, possibly indicating elevated risk of fatal arrhythmias and sudden cardiac death. Albeit weaker, systolic and diastolic dysfunction, were also associated with increasing mechanical dispersion.

The utility of strain imaging in the cardiac surveillance of bone marrow transplant patients

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319359
Author(s):  
Tejas Deshmukh ◽  
Peter Emerson ◽  
Paul Geenty ◽  
Shehane Mahendran ◽  
Luke Stefani ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Global Longitudinal Strain ◽  
Group Versus ◽  
Marrow Transplant ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Right Ventricular Free Wall ◽  
Cross Sectional ◽  
Allogenic Bone ◽  
Transplant Patients

ObjectiveTo evaluate the utility of two-dimensional multiplanar speckle tracking strain to assess for cardiotoxicity post allogenic bone marrow transplantation (BMT) for haematological conditions.MethodsCross-sectional study of 120 consecutive patients post-BMT (80 pretreated with anthracyclines (BMT+AC), 40 BMT alone) recruited from a late effects haematology clinic, compared with 80 healthy controls, as part of a long-term cardiotoxicity surveillance study (mean duration from BMT to transthoracic echocardiogram 6±6 years). Left ventricular global longitudinal strain (LV GLS), global circumferential strain (LV GCS) and right ventricular free wall strain (RV FWS) were compared with traditionl parameters of function including LV ejection fraction (LVEF) and RV fractional area change.ResultsLV GLS (−17.7±3.0% vs −20.2±1.9%), LV GCS (−14.7±3.5% vs −20.4±2.1%) and RV FWS (−22.6±4.7% vs −28.0±3.8%) were all significantly (p=0.001) reduced in BMT+AC versus controls, while only LV GCS (−15.9±3.5% vs −20.4±2.1%) and RV FWS (−23.9±3.5% vs −28.0±3.8%) were significantly (p=0.001) reduced in BMT group versus controls. Even in patients with LVEF >53%, ~75% of patients in both BMT groups demonstrated a reduction in GCS.ConclusionMultiplanar strain identifies a greater number of BMT patients with subclinical LV dysfunction rather than by GLS alone, and should be evaluated as part of post-BMT patient surveillence. Reduction in GCS is possibly due to effects of preconditioning, and is not fully explained by AC exposure.

Galectin-3 is inversely associated with cardiorespiratory fitness in the general population

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Haid ◽  
M Bahls ◽  
M Doerr ◽  
S Felix ◽  
S Zylla ◽  
...  
Keyword(s):  
General Population ◽  
Oxygen Uptake ◽  
Cardiorespiratory Fitness ◽  
Extreme Values ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Linear Regression Models ◽  
Ventricular Ejection Fraction ◽  
Galectin 3

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Low cardiorespiratory fitness (CRF) is associated with high mortality and morbidity. Galectin-3 (Gal-3) is a prognostic biomarker for fibrosis, different cancers, renal impairment and, in particular, for heart failure. Further, higher Gal-3 levels are associated with increased cardiovascular mortality. Whether Gal-3 is related with the protective effects of a high CRF is unclear. Purpose The present study examined the relation between Gal-3 and CRF as determined by body weight adjusted peak oxygen uptake (VO2peak/kg), oxygen uptake at the anaerobic threshold (VO2@AT) and maximal workload (Wmax). Methods We used data of the population-based Study of Health in Pomerania (SHIP-TREND) from Northeast Germany. A total of n = 1,483 participants with a median age of 49 (IQR: 39 – 59 years, male 48%) were included in the analysis. CRF parameters were measured using standardized cardiopulmonary exercise testing on a bicycle ergometer. Plasma galectin-3 concentrations were determined using a quantitative sandwich enzyme immunoassay. Individuals with left ventricular ejection fraction &lt; 40%, previous myocardial infarction, atrial fibrillation, chronic lung disease, severe renal disease (eGFR &lt; 30 ml/min/mm2), a history of cancer, and extreme values for Gal-3 were excluded. Linear regression models adjusted for age, sex and lean mass were used to analyze the association between Gal-3 and CRF. Results A one ml/min/kg greater VO2peak was related to a 0.32 ng/ml (95% confidence interval [CI] -0.45 to -0.18, p &lt;.001) lower Gal-3. Further, a one Watt larger power output was also associated with a 1.32 ng/ml (95% CI -2.10 to – 0.54, p &lt;.001) lesser Gal-3. VO2@AT was not related to Gal-3 (β: -3.31 95% CI -8.68 to 2.05, p = .23). Conclusions In the general population Gal-3 is inversely associated with CRF. Further studies should investigate whether lower Gal-3, beyond its importance as a biomarker for heart disease, may even play a role in the protective effect of the CRF.

Circumferential deformation in diagnosis and risk assessment of patients with left ventricular non-compaction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Anwer ◽  
P.S Heiniger ◽  
S Rogler ◽  
D Cassani ◽  
L Rebellius ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Strong Association ◽  
Global Longitudinal Strain ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Deformation Analysis ◽  
Funding Source ◽  
Apical Rotation ◽  
Increased Risk

Abstract Introduction Echocardiography-based deformation analysis is used for studying left ventricular (LV) mechanics and have an emerging role in the diagnosis of cardiomyopathies. Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterised by a two-layered LV myocardium with prominent trabeculae separated by deep recesses perfused from the LV cavity. Left ventricular hypertrabeculation (LVHT) may be difficult to differentiate from LVNC. In this study, we aim to develop a diagnostic algorithm based on the circumferential deformation (CD) of LVNC, LVHT and controls; and find their associations with LVNC outcomes. Methods We compared 45 LVNC patients, 45 LVHT individuals, and 45 matched healthy controls. LVNC was diagnosed according to current echocardiographic criteria. LVHT was defined as presence of three or more trabeculae in the LV apex visualised in both parasternal short axis and apical views. Controls had a normal echocardiographic examination and no evidence of cardiovascular disease. Strain analysis was performed using TomTec Image-Arena (version 4.6). Results Receiver observer characteristics curve (ROC) analyses revealed that GCS &lt;22.3% differentiated LVNC from control or LVHT. In individuals with global circumferential strain (GCS) below 22.3%, an apical peak circumferential strain (PCS) cut-off value of 18.4% differentiated LVNC [&lt;18.4%] and LVHT [≥18.4%] (fig. 1). An independent echocardiographer (Table 1) performed blind validation of diagnosis on 32 subjects from each group. Combined endpoint of cardiovascular events in LVNC (CVE) is described in figure 2. Multi-variate regression analyses have shown that GCS was associated with 11-fold increased risk of CVE independent of LVEF and NC:C ratio, while global longitudinal strain (GLS) displayed only 2-fold increased risk. Regional basal and apical peak circumferential or longitudinal strain, left ventricular twist, basal-apical rotation ratio have shown significant associations (Fig. 3). Conclusions A diagnostic algorithm with GCS and aPCS (threshold value 18.4%) differentiates LVNC from LVHT and control with very high sensitivity and specificity independent of additional echocardiographic or clinical information. Circumferential strain derived parameters exhibit a very strong association with outcomes independent of LVEF and NC:C ratio. Absence of CVE in LVHT provides further evidence on the distinct nature of LVNC and LVHT. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): 2018 research grant from the Swiss Heart Foundation

4091Mechanical dispersion by speckle tracking echocardiography in fabry disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T F Cianciulli ◽  
M C Saccheri ◽  
A M Risolo ◽  
J A Lax ◽  
R J Mendez ◽  
...  
Keyword(s):  
Fabry Disease ◽  
Speckle Tracking ◽  
Heart Diseases ◽  
Systolic Dysfunction ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Peak Strain ◽  
Cross Sectional ◽  
Mechanical Dispersion ◽  
Group I

Abstract Background Fabry disease is a rare X-linked storage disorder caused by a deficiency of the lysosomal enzyme α-galactosidase A and generally causes multi-organ dysfunction. Heart disease is the main cause of death, due to severe left ventricular (LV) systolic dysfunction and sudden death. In several heart diseases, the LV systolic dysfunction and ventricular arrhythmias are associated with mechanical dispersion (MD). The presence of MD in patients with FD has not been studied yet. In this cross-sectional study, we investigated the prevalence of MD in patients with FD. Methods Complete echocardiographic and speckle tracking echocardiographic (STE) data were collected. MD is an index of inter-segmental discoordination of contraction which has been used to quantify LV dyssynchrony and was defined as the standard deviation (SD) of time to peak negative strain in 17 left ventricular segments. Patients were divided into two groups according to whether or not they had left ventricular hypertrophy (LVH). MD was defined as an SD >49 msec. Results We studied 108 patients with FD, 24 patients (22%) were excluded due to inadequate imaging quality or presence of comorbidities, so the final study population consisted of 84 patients (mean age 33.3±14.6 years, 60.7% women). LVH in FD appears at older ages than in patients without LVH (48±12.5 y/o vs 27.8±11.1 y/o, p<0.0001). Patients with FD without LVH (Group I) showed normal global longitudinal peak strain (GLPS) (21.2±2.5%) and no MD (32.7±8.8 msec). In Group II (n=23) patients with FD with LVH, 17 (73.9%) had MD >49 msec prolonged mechanical dispersion (73.3±20.7 msec) and reduced GLPS (13.6±4.0%). MD was more pronounced in Fabry patients with LVH than in patients without LVH (63.4±24.7 msec vs. 32.7±8.8 msec, p<0.0001). GLPS was lower in Fabry patients with LVH than in patients without LVH (15.3±4.7% vs 21.2±2.5%, p<0.0001). Figure 1 Conclusions To our knowledge, this is the first study to demonstrate the prevalence of mechanical dispersion in patients with FD. Mechanical dispersion was seen in 73.9% of patients with FD with LVH. This dyssynchrony should be taken into account in patients who develop heart failure or life-threatening ventricular tachyarrhythmias.

scholarly journals TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population

2021 ◽  
Vol 10 (13) ◽  
pp. 2907
Author(s):  
Alba Martínez-Escudé ◽  
Guillem Pera ◽  
Anna Costa-Garrido ◽  
Lluís Rodríguez ◽  
Ingrid Arteaga ◽  
...  
Keyword(s):  
Risk Factor ◽  
Liver Fibrosis ◽  
General Population ◽  
Transient Elastography ◽  
Atherogenic Dyslipidemia ◽  
Control Group ◽  
Cross Sectional ◽  
Alcoholic Fatty Liver ◽  
Increased Risk ◽  
Tsh Levels

Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis. The aim of this study is to investigate the relationship between thyroid stimulating hormone (TSH) levels, NAFLD, and liver fibrosis in the general population. A descriptive cross-sectional study was performed in subjects aged 18–75 years randomly selected from primary care centers between 2012 and 2016. Each subject underwent clinical evaluation, physical examination, blood tests and transient elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with NAFLD and fibrosis. We included 2452 subjects (54 ± 12 years; 61% female). Subjects with TSH ≥ 2.5 μIU/mL were significantly associated with obesity, atherogenic dyslipidemia, metabolic syndrome (MetS), hypertransaminasemia and altered cholesterol and triglycerides. The prevalence of NAFLD and liver fibrosis was significantly higher in subjects with TSH ≥ 2.5 (μIU/mL). We found a 1.5 times increased risk of NAFLD, 1.8 and 2.3 times increased risk of liver fibrosis for cut-off points of ≥ 8.0 kPa and ≥ 9.2 kPa, respectively, in subjects with TSH ≥ 2.5 μIU/mL compared with TSH < 2.5 μIU/mL (control group), independent of the presence of MetS. These findings remained significant when stratifying TSH, with values ≥ 10 μIU/mL.

Abstract 15706: Association of Blood Pressure Level With Left Atrial Size and Function in Adolescents (SHIP AHOY)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Edem Binka ◽  
Cedric Manlhiot ◽  
Elaine M Urbina ◽  
Tarek ALSAIED ◽  
Tammy M Brady
Keyword(s):  
Blood Pressure ◽  
Left Atrial ◽  
Global Longitudinal Strain ◽  
Blood Pressure Level ◽  
Left Ventricular ◽  
Z Score ◽  
Linear Regression Models ◽  
Cvd Risk ◽  
Strain And Strain Rate ◽  
And Function

Introduction: Left atrial (LA) enlargement and dysfunction are risk factors for stroke, atrial fibrillation and death in adults, and are associated with hypertension (HTN). In children, left ventricular hypertrophy is the most common manifestation of cardiac-specific organ damage in those with HTN, but gaps in knowledge remain regarding the association of HTN with LA size and function. Hypothesis: Increasing blood pressure (BP) is associated with increased LA volume and abnormal LA strain in children. Methods: Echocardiographic images of youth, aged 11 to 18 yrs from 5 clinical sites were obtained. LA strain and strain rate were analyzed using 2-D speckle tracking imaging with R-R gating in the apical 4 and 2-chamber views and averages of both views were used. Subjects were grouped by SBP as low-risk (L; <80th %ile), mid-risk (M; 80-<90th %ile), or high-risk, (H;≥90th %ile). Linear regression models were used to determine the association between BP z-score and LA size and function adjusting for age, sex, race and ethnicity. Results: N=347 youth (median age 15.7 yrs) 60% (n=208) male and 40% (n=139) non-white were included. BP groups differed by age (L&H<M) and BMI (L<M&H). BP groups did not differ by LA size and strain but differed by left ventricular mass index (H>L), stroke volume (M&H<L), peak global longitudinal strain (L>H), mitral E/e’ (H>L) and pulse wave velocity (H>L), each indicating worse CVD risk in the H vs. L group (Table). Multivariable analyses revealed DBP z-score to be independently associated with LA conduit strain (beta 0.73, 95% CI 0.01, 1.45, p<0.05). No other LA size or function variables were associated with BP. Conclusions: Greater BP is associated with increased CVD risk among youth as assessed by non-invasive measurements of CV structure and function. DBP is independently associated with LA conduit strain, a finding associated with CV events in adults. Future studies to determine the long-term association of abnormal DBP with LA strain are needed.

scholarly journals Maternal overweight and its relation with child’s anthropometric indices

2021 ◽  
Vol 21 (2) ◽  
pp. 379-388
Author(s):  
Marcela Martins Soares ◽  
Leidjaira Lopes Juvanhol ◽  
Andreia Queiroz Ribeiro ◽  
Patrícia Feliciano Pereira ◽  
Sylvia C. C. Franceschini ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Cross Sectional Study ◽  
Linear Regression Models ◽  
Maternal Weight ◽  
Anthropometric Indices ◽  
Cross Sectional ◽  
Increased Risk ◽  
Waist To Height Ratio ◽  
Maternal Overweight

Abstract Objectives: to investigate the relation between maternal overweight and child’s anthropometric indices, identifying the interaction with the child's age. Methods: a cross-sectional study with mothers and their children under 2 years old. The mothers’ body mass index (BMI), waist-to-hip ratio and waist-to-height ratio was calculated. In children, we calculated height/age (H/A), body mass index/age (BMI/A), weight/height (W/H) and weight/age (W/A) indices. The means of the anthropometric indices of children with excess weight and maternal cardiometabolic risk were compared. Mothers and children’s anthropometric indices were correlated. Linear regression models were proposed. We investigated the child's age interaction with anthropometric variables of the dyad. Results: the means of BMI/A and W/H were higher in children of overweight mothers and the means of BMI/A, W/H and W/A were higher when mothers had increased risk for cardiometabolic diseases. There was an association of maternal weight and height with the W/A index; maternal BMI with W/H; maternal height with H/A; maternal weight, BMI and waist circumference with BMI/A. The children's age did not interact with the assessed parameters. Conclusion: children under 2 years of age, whose mothers are overweight, tend to show changes in weight, regardless of age.

Abstract 3356: Does Severe Obesity Cause Progressive Impairment of Left Ventricular Systolic Function?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Theophilus Owan ◽  
Kimberly Morley ◽  
Travis G Ault ◽  
Ronny Jiji ◽  
Nathaniel Hall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Entire Group ◽  
Obese Patients ◽  
Cross Sectional ◽  
Increased Risk ◽  
Severely Obese ◽  
The Mean

Background: Obesity is associated with an increased risk of developing heart failure. Based on cross sectional studies, it has been hypothesized that the duration of obesity is the key factor leading to impaired cardiac function. However, longitudinal data to confirm this hypothesis are not available. Methods: We prospectively studied 62 severely obese patients at baseline, 2 and 5 years after randomization to nonsurgical therapy (NonSurg, n = 25) or Rouxen-Y gastric bypass surgery (GBS, n = 37). Echocardiography was used to measure left ventricular (LV) size and ejection fraction (EF). Results: At enrollment, the mean BMI was 46±9 and the mean age was 47±11 years (range 25– 66). GBS subjects lost 96± 26 vs. 6±18 lbs at 2 years and 78±42 vs. 17±42 lbs at 5 years compared to NonSurg (p<0.0001 for both). At baseline LVEF was not different between GBS and nonsurg (67±9 vs. 64±8%) and it did not change at 2 years (64±9 vs. 63±9%) or 5 years (63±9 vs. 63±10%). LV diastolic dimension did not change over time in control (4.3±1.0 vs. 4.2±0.6 vs. 4.5±0.3) or GBS patients (4.4±0.6 vs. 4.3±0.7 vs. 4.4±0.4). Stratifying the entire group by quartiles of age or duration of obesity (quartile 1 avg duration = 16 years, quartile 4 average duration = 56 years), we found no evidence of time-dependent changes in LV size or function. Conclusion: In this, prospective study of severely obese patients we found no evidence of progressive changes in LV size or EF over a period of 5 years. Moreover, we find no relationship between age or duration of obesity and LV size or LVEF. These data argue strongly that other factors such as the development of coronary disease are the most likely causes of heart failure in obese patients.

Abstract 16215: Ventricular Dyssynchrony is Associated With Arrhythmic Mitral Prolapse Prior to Chamber Remodeling

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dimosthenis Pandis ◽  
Marc Miller ◽  
Ahmed El-Eshmawi ◽  
Ioulia A Grapsa ◽  
Percy Boateng ◽  
...  
Keyword(s):  
At Risk ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Study Cohort ◽  
Ventricular Ectopy ◽  
Myocardial Mechanics ◽  
Ventricular Dyssynchrony ◽  
Mechanical Dispersion ◽  
The Mean

Introduction: Asymptomatic patients on active surveillance for degenerative mitral regurgitation are at risk of ventricular arrhythmia and sudden death. Hypothesis: Abnormal myocardial mechanics may precede ventricular remodeling and may help identify at-risk patients. Methods: Multi-directional myocardial mechanics and LV dyssynchrony were assessed in 204 consecutive patients awaiting surgical mitral repair for severe degenerative MR in a quaternary mitral reference center. Results: The mean age was 58 ±12.5 years and 40% were females. The mean EF was 63% ± 6% and 92% had compensated LV function (EF>60% and LVESD<4cm) and only 24% had elevated LV filling pressures (E/e'≥13). Indexed LV wall stress-to-LVEDD, relative wall thickness and indexed LV mass-to-BSA were similar amongst males-females, although males had higher mean blood pressure (94 Vs. 90, P=0.02) . The peak global longitudinal strain (GLS) was -25.2% ± 3.3% and the mid-ventricular circumferential and radial strains were -33.5%±6.7% and 56%±25% respectively. Ventricular ectopy was present in 24.5% of patients and only 17% had atrial fibrillation (Afib) despite the significantly dilated left atria (mean LAVi 70±26.6 ml/m 2 ). The median LV mechanical dispersion was 40msec (IQR 30.7-56.5) but increased significantly with ventricular ectopy (65msec, P<0.01) and further influenced by concomitant Afib (p=0.001 for 2-factor interaction). Diastolic LV function did not correlate with dispersion (r=0.02 and 0.01 for E/A and E/e', P=NS) but was associated with the duration of LV diastolic filling (mean 502±140msec; r=0.2, P=0.004). Interpapillary radial strain delay was noted in the study cohort (mean delay 52.8msec, range 0-335msec) while intepapillary activation delay was manifested with concomitant ventricular ectopy (mean time-to-peak LS delay 57.5±48msec). Conclusions: Left ventricular dyssynchrony manifested by increased mechanical dispersion and imbalanced interpapillary mechanics are observed prior to overt chamber remodeling in significant degenerative MR and is associated with ventricular ectopy. Further studies are needed to assess the related clinical implications and potential impact on risk stratification in this patient group.

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