scholarly journals 101 Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Hubert ◽  
V Le Rolle ◽  
E Galli ◽  
A Hernandez ◽  
E Donal
Keyword(s):  
Diastolic Function ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Volume Index ◽  
P Value ◽  
Volume Strain ◽  
Left Atrial Volume Index ◽  
Loop Area ◽  
Lv Volume ◽  
Automatic Tool

Abstract AIM This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE). METHOD 17 patients with proved cardiac amyloidosis and 18 patients with heart failure with preserved ejection fraction (HFpEF) were compared to 19 controls, from a local database. All TTE were performed using Vivid E95 ultrasound system (General Electrics Healthcare, Horten, Norway). The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel A) RESULTS (Table 1): LVEF was similar between all groups whereas global longitudinal strain was significantly lower in amyloidosis group than controls (-14.4 vs -20.5%; p < 0.001). HFpEF and amyloidosis groups had a worse diastolic function than controls with a greater left atrial volume index , a faster tricuspid regurgitation, a greater E/e’ ratio with a p < 0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in HFpEF and amyloidosis group than controls (72 vs 36 vs 120.0 %.mL, respectively, p < 0.0001) with an intermediate profile of HFpEF(Figure 1, panel B, HFpEF in green). This area was better correlated with mean e’ (r = 0.650, p < 0.001) than all other indices. CONCLUSION LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function. Main echocardiographic results Controls n = 19 HFpEF n = 18 Amyloidosis n = 17 p-value LVEDV (mL) 105 ± 15 103 ± 30 95 ± 93 0.476 LVEF (%) 65 ± 5 62 ± 7 62 ± 7 0.196 GLS (%) -20.5 ± 1.8 -18.4 ± 4.3 -14.4 ± 3.8 <0.0001 LAVi (ml.m-2) 22 ± 5 51 ± 14 51 ± 22 <0.0001 E/A ratio 2.1 ± 0.4 1.2 ± 0.7 1.7 ± 1.0 0.005 Mitral E/Ea average 5.9 ± 1.4 13.7 ± 5.8 17.3 ± 5.4 <0.0001 Vmax TR (m/s) 2.0 ± 0.3 3.1 ± 0.4 2.7 ± 0.5 <0.0001 V-S loop area (ml.%) 120 ± 54 72 ± 45 37 ± 21 <0.0001 Abstract 101 Figure 1

P1486Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Hubert ◽  
V Le Rolle ◽  
E Galli ◽  
A Hernandez ◽  
E Donal
Keyword(s):  
Left Atrial ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Atrial Volume ◽  
Volume Strain ◽  
Left Atrial Volume Index ◽  
Loop Area ◽  
Lv Volume

Abstract Aim This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE). The proposed method was evaluated on a typical model of left ventricular (LV) diastolic dysfunction: the cardiac amyloidosis. Method 18 patients with proved cardiac amyloidosis were compared to 19 controls, from a local database. All TTE were performed using Vivid E9 or E95 ultrasound system. The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel B) Results (Table 1): LVEF was similar between both groups whereas global longitudinal strain was significantly lower in amyloidosis group (−14.4 vs −20.5%; p<0.001). Amyloidosis group had a worse diastolic function with a greater left atrial volume index (51 vs 22ml/m2), a faster tricuspid regurgitation (2.7 vs 2.0 m/s), a greater E/e' ratio (17.3 vs 5.9) with a p<0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in amyloidosis group (36.5 vs 120.0%.mL). This area was better correlated with mean e' with r=0.734 (p<0.001) than all other indices (Figure 1, panel A). Table 1 Amyloidosis (N=18) Controls (N=19) p Global strain-volume loop area (%.mL) 36.5±21.3 120.0±54.2 <0.001 Global longitudinal strain (%) −14.4±3.8 −20.5±1.8 <0.001 Left ventricular ejection fraction (%) 62±7 65±5 0.08 Left atrial volume index (ml/m2) 51±22 22±5 <0.001 E/A 1.72±0.97 2.07±0.45 0.17 Mean e' 5.5±1.3 14.4±2.8 <0.001 Mean E/e' 17.3±5.4 5.9±1.4 <0.001 Tricuspid regurgitation velocity (m/s) 2.7±3.8 2.0±0.3 <0.001 Figure 1 Conclusion LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function. Future applications will concern the integration of LV volume-strain loop area as novel feature in machine-learning approach.

scholarly journals P1768 The value of global longitudinal strain in non-alcoholic steatohepatitis-associated cirrhosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Y Dimitroglou ◽  
C Aggeli ◽  
A Alexopoulou ◽  
T Alexopoulos ◽  
A Nitsa ◽  
...  
Keyword(s):  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Alcoholic Steatohepatitis ◽  
Mitral Annular Velocity ◽  
Cirrhotic Patients

Abstract Introduction Non-alcoholic steatohepatitis (NASH) in patients with metabolic syndrome is a common cause of cirrhosis and has been associated with increased cardiovascular mortality. In patients with liver cirrhosis systolic or diastolic dysfunction can be observed and is independent of the cirrhosis etiology. Only few studies using newer echocardiography indices such as Global Longitudinal Strain (GLS) have been published in cirrhotic patients. Purpose To evaluate GLS in patients with NASH cirrhosis when compared to other etiologies. Methods A total of consecutive 36 cirrhotic patients aged 18-70 were included in our study. Standard speckle-tracking software was used for offline analysis of standard apical views and GLS was calculated. Stroke Volume Index (SVI) was calculated with the Simpson method and a standard 2D, Doppler and Tissue Doppler examination was performed in all patients. Results Median age of the study population was 58 (IQR 50-64) years, 78% were male and 17% had ascites. Cirrhosis was considered decompensated in 21 (58%) of patients. The 28%, 42% and 19% had NASH-associated, alcoholic and viral etiology of cirrhosis, respectively. Median ejection fraction (EF) was 60% (IQR: 57%; 65%) and GLS was -21.1% (-19.7%; -23.1%) in the total population. Absolute value of GLS was lower in patients with NASH cirrhosis compared to other etiologies (p = 0.009) (figure 1). EF, SVI, left atrial volume index (LAVI), E/e’ ratio and mitral annular velocity (e’) did not differ significantly between those with NASH associated cirrhosis and the rest. GLS values were significantly correlated with EF (r=-0.588, p = 0.002), SVI (r=-0.469, p = 0.016) and BNP levels (r=-0.571, p = 0.007), but not with age, left ventricular end diastolic volume, left atrial volume index, E/e’, mitral annular velocity and blood pressure. According to a multivariable linear regression model, NASH etiology [B = 2.1 (0.6; 3.7), p = 0.008)] and EF (per 10% increase) [B=-1.7 (-3.3; -0.2), p = 0.03)] were the only independent factors associated with GLS values in cirrhotic patients. Conclusions GLS values are within normal limits in cirrhotic patients but seem to be affected in patients with NASH associated cirrhosis. Further studies are needed to assess the prognostic implications of this finding. Abstract P1768 Figure 1

scholarly journals Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 850
Author(s):  
Martina Setti ◽  
Giovanni Benfari ◽  
Donato Mele ◽  
Andrea Rossi ◽  
Piercarlo Ballo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Function ◽  
Valsalva Maneuver ◽  
Left Atrial Volume ◽  
Structural Heart Disease ◽  
Volume Index ◽  
Left Atrial Volume Index ◽  
American Society ◽  
Current Guidelines ◽  
Care Study

Background: Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number. Methods: We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a’-ratio (LAVi/a’) over indeterminate grading was assessed. Results: The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a’, with the latter being the single most effective parameter. Conclusion: Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a’ emerges as a simple and effective approach to this aim.

scholarly journals The effect of spironolactone on diastolic function in haemodialysis patients

2021 ◽  
Author(s):  
T. Hauser ◽  
◽  
V. Dornberger ◽  
U. Malzahn ◽  
S. J. Grebe ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Left Atrial Volume Index ◽  
Maintenance Haemodialysis ◽  
Significant Difference

AbstractHeart failure with preserved ejection fraction (HFpEF) is highly prevalent in patients on maintenance haemodialysis (HD) and lacks effective treatment. We investigated the effect of spironolactone on cardiac structure and function with a specific focus on diastolic function parameters. The MiREnDa trial examined the effect of 50 mg spironolactone once daily versus placebo on left ventricular mass index (LVMi) among 97 HD patients during 40 weeks of treatment. In this echocardiographic substudy, diastolic function was assessed using predefined structural and functional parameters including E/e’. Changes in the frequency of HFpEF were analysed using the comprehensive ‘HFA-PEFF score’. Complete echocardiographic assessment was available in 65 individuals (59.5 ± 13.0 years, 21.5% female) with preserved left ventricular ejection fraction (LVEF > 50%). At baseline, mean E/e’ was 15.2 ± 7.8 and 37 (56.9%) patients fulfilled the criteria of HFpEF according to the HFA-PEFF score. There was no significant difference in mean change of E/e’ between the spironolactone group and the placebo group (+ 0.93 ± 5.39 vs. + 1.52 ± 5.94, p = 0.68) or in mean change of left atrial volume index (LAVi) (1.9 ± 12.3 ml/m2 vs. 1.7 ± 14.1 ml/m2, p = 0.89). Furthermore, spironolactone had no significant effect on mean change in LVMi (+ 0.8 ± 14.2 g/m2 vs. + 2.7 ± 15.9 g/m2; p = 0.72) or NT-proBNP (p = 0.96). Treatment with spironolactone did not alter HFA-PEFF score class compared with placebo (p = 0.63). Treatment with 50 mg of spironolactone for 40 weeks had no significant effect on diastolic function parameters in HD patients.The trial has been registered at clinicaltrials.gov (NCT01691053; first posted Sep. 24, 2012).

Abstract 14622: Longitudinal Changes in Left Ventricular Diastolic Function in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Li Zhao ◽  
Brian Claggett ◽  
Kunihiro Matsushita ◽  
Dalane W Kitzman ◽  
Aaron R Folsom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Diastolic Function ◽  
Left Atrial Volume ◽  
Late Life ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Atrial Volume Index ◽  
Longitudinal Changes ◽  
Aric Study

Introduction: Diastolic dysfunction is a potent risk factor for heart failure (HF). However, there is limited data regarding longitudinal changes of diastolic function in the very old, who are at the highest risk for HF. Methods: We studied 2,559 community-based elderly participants in the prospective ARIC study who underwent protocol echocardiography, were in sinus rhythm at study Visits 5 (2011-2013) and 7 (2018-2019), and did not have an interval myocardial infarction. The primary diastolic measures were Tissue Doppler e’, E/e’ ratio, and left atrial volume index (LAVi). Results: Mean age at Visit 5 was 74±4 years, 59% were women, and 25% black. At Visit 5, mean e’ was 5.8±1.4 cm/s, E/e’ 11.8±3.6, and LAVi 24.3±6.7 ml/m 2 . Over a mean of 6.5±3.1 years, e’ decreased by 0.6±1.4 cm/s, E/e’ increased by 3.1±4.5, and LAVi increased by 1.4±7.7 ml/m 2 . Using validated ARIC-based cut-points, there was significant increase in the proportion of participants with abnormal e’ (18% at Visit 5 to 34 % at Visit 7), E/e’ (20% vs 46%), LAVi (17% vs 25%; all p<0.01), and in the number of abnormal diastolic measures ( Figure ). Compared to participants free of cardiovascular (CV) risk factors or CV diseases (n=237), those with CV risk factors or diseases at Visit 5 (n=2,210) demonstrated greater increases in E/e’ (2.3±3.9 vs 3.1±4.5 respectively; p=0.006) and LAVi (0.0±7.0 vs 1.5±7.7 ml/m 2 ; p=0.008) while increases in E/e’ (5.0±5.1; p<0.001) and LAVi (4.6±8.7 ml/m 2 ; p<0.001) were the most prominent in those who developed HF between Visits 5 and 7 (n=60). Conclusions: Diastolic function progressively worsens over 6.5 years in late life, particularly among persons with CV risk factors. Further studies are necessary to determine if risk factor prevention or control will mitigate these changes.

scholarly journals Hemodynamic Effects of Permanent His Bundle Pacing Compared to Right Ventricular Pacing Assessed by Two-Dimensional Speckle-Tracking Echocardiography

2021 ◽  
Vol 18 (21) ◽  
pp. 11721
Author(s):  
Jedrzej Michalik ◽  
Alicja Dabrowska-Kugacka ◽  
Katarzyna Kosmalska ◽  
Roman Moroz ◽  
Adrian Kot ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Left Atrial Volume Index ◽  
His Bundle ◽  
Conduction Disorders ◽  
2D Speckle Tracking

We compared the effects of right ventricular (RVP; n = 26) and His bundle (HBP; n = 24) pacing in patients with atrioventricular conduction disorders and preserved LVEF. Postoperatively (1D), and after six months (6M), the patients underwent global longitudinal strain (GLS) and peak systolic dispersion (PSD) evaluation with 2D speckle-tracking echocardiography, assessment of left atrial volume index (LAVI) and QRS duration (QRSd), and sensing/pacing parameter testing. The RVP threshold was lower than the HBP threshold at 1D (0.65 ± 0.13 vs. 1.05 ± 0.20 V, p < 0.001), and then it remained stable, while the HBP threshold increased at 6M (1.05 ± 0.20 vs. 1.31 ± 0.30 V, p < 0.001). The RVP R-wave was higher than the HBP R-wave at 1D (11.52 ± 2.99 vs. 4.82 ± 1.41 mV, p < 0.001). The RVP R-wave also remained stable, while the HBP R-wave decreased at 6M (4.82 ± 1.41 vs. 4.50 ± 1.09 mV, p < 0.02). RVP QRSd was longer than HBP QRSd at 6M (145.0 ± 11.1 vs. 112.3 ± 9.3 ms, p < 0.001). The absolute value of RVP GLS decreased at 6M (16.32 ± 2.57 vs. 14.03 ± 3.78%, p < 0.001), and HBP GLS remained stable. Simultaneously, RVP PSD increased (72.53 ± 24.15 vs. 88.33 ± 30.51 ms, p < 0.001) and HBP PSD decreased (96.28 ± 33.99 vs. 84.95 ± 28.98 ms, p < 0.001) after 6 months. RVP LAVI increased (26.73 ± 5.7 vs. 28.40 ± 6.4 mL/m2, p < 0.05), while HBP LAVI decreased at 6M (30.03 ± 7.8 vs. 28.73 ± 8.7 mL/m2, p < 0.01). These results confirm that HBP does not disrupt ventricular synchrony and provides advantages over RVP.

Serum uric acid possibly associated with abnormal left ventricular diastolic function in healthy individuals

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.W Liu ◽  
C.M Tu
Keyword(s):  
Uric Acid ◽  
Diastolic Function ◽  
Serum Uric Acid ◽  
Elevated Serum ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Funding Source ◽  
Healthy Individuals ◽  
Left Atrial Volume Index

Abstract Background Elevated serum uric acid (SUA) is reportedly associated with the traditional left ventricular diastolic dysfunction (LVDD). Purpose We aimed to investigate the association between SUA and the contemporarily defined LV diastolic function (LVDF). Methods We prospectively enrolled healthy individuals who underwent echocardiography to evaluate electrocardiographic abnormalities at the health exam between 1st Jan 2018 and 31th Dec 2019. The evaluation for LVDF includes four criteria: (1) septal E' velocity &lt;7 cm/s or lateral E' &lt;10 cm/s. (2) average E/e' ≥14, (3) left atrial volume index (LAVI) &gt;34 ml/m2, (4) tricuspid regurgitation (TR) velocity &gt;2.8 m/s. The study interest were the presence of the LVDF criteria for each or combined. Results The study consisted of 275 healthy individuals (89% male) with the mean age of 32.9±7.6 years and SUA of 6.1±1.3 mg/dl. The hyperuricemic (N=77) vs. normouricemic (N=198) groups had greater ratio of septal e' &lt;7 (18.2% vs. 5.6%, P=0.002), lateral e' &lt;10 (26% vs. 10.8%, P=0.003), the composite of septal e' &lt;7 or lateral e' &lt;10 (31.6% vs. 13.3%, P=0.001), and average E/e' &gt;14 (3.9% vs. 0%, P=0.021). SUA remained significantly associated with septal e' &lt;7 cm/s (adjusted HR: 1.704, 95% CI: 1.093–2.655, P=0.019) and the presence of any LVDF criteria (adjusted HR: 1.342, 95% CI: 1.044–1.724, P=0.022); Trends toward significant association were found between SUA and average E/e' &gt;14 (adjusted HR: 1.330, 95% CI: 0.981–1.804, P=0.066) and between SUA and lateral e' &lt;10cm/s (adjusted HR: 1.342, 95% CI: 0.970–1.857, P=0.076). Conclusions Elevated SUA was associated with abnormal LVDF in the healthy individuals with normal kidney function. Maintaining SUA level within a normal limit may prevent from the development of abnormal LVDF and LVH. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Tri-service General Hospital, Songshan branch

Essential hypertension worsens left ventricular contractility in systemic sclerosis

2021 ◽  
pp. jrheum.200873
Author(s):  
Valentina Mercurio ◽  
Alicia M. Hinze ◽  
Laura K. Hummers ◽  
Fredrick M. Wigley ◽  
Ami A. Shah ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Cardiovascular Risk ◽  
Systemic Sclerosis ◽  
Diastolic Function ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Groups ◽  
Normal Lvef

Objective Primary cardiac involvement in systemic sclerosis (SSc) is prevalent and morbid, however the influence of traditional cardiovascular risk factors such as essential hypertension (HTN) are unclear. In the present study, we sought to understand the effects of HTN on left ventricular (LV) contractility in SSc patients using echocardiographic speckle-derived global longitudinal strain (GLS). Methods 56 SSc patients with HTN (SSc+HTN+) and 82 SSc patients without HTN (SSc+ HTN-) were compared with 40 non-SSc controls with HTN (SSc-HTN+) and 40 non-SSc controls without HTN (SSc-HTN-), matched by age and sex. All HTN patients were on stable antihypertensive therapies. Echocardiographic measures included LV ejection fraction (LVEF), left atrial volume index (LAVi), and LV diastolic function. LV contractility was assessed by GLS, averaged across the 18 LV segments. Results SSc patients had diminished GLS regardless of HTN status when compared to both control groups despite normal LVEF, p<0.001. SSc+HTN+ had the highest prevalence of diastolic dysfunction with significantly higher septal E/e’, a marker of LV filling pressures (p<0.05), as well as the largest reduction in GLS compared to SSc+HTN- and both control groups. Conclusion Speckle-derived strain revealed diminished LV contractility in SSc patients despite normal LVEF. SSc+HTN+ had more prominent reductions in GLS associated with evidence of LV remodeling and worsened diastolic function. Our findings demonstrate the presence of subclinical LV contractile dysfunction in SSc that is further exacerbated by concomitant HTN, thereby identifying HTN as an important modifiable cardiovascular risk factor that should be managed aggressively in this at-risk population.

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