scholarly journals 105 Impact of global left ventricular afterload and transaortic gradient on myocardial work in patients with aortic stenosis and preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Ilardi ◽  
R E Dulgheru ◽  
S Marchetta ◽  
S Cimino ◽  
M Cicenia ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Stroke Volume ◽  
Speckle Tracking ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Control Group ◽  
Aortic Valve Area ◽  
Global Work

Abstract Funding Acknowledgements Dr. Ilardi is supported by a research grant from Cardiopath PhD program. Background Myocardial work (MW) is a new parameter that derives from myocardial strain and provides an incremental value to myocardial function, incorporating measurement of deformation and load. To date, little is known about the changes in MW related to AS severity and arterial compliance. Purpose We investigated the effect of severity of AS, valvulo-arterial impedance (Zva) and stroke volume in patients with AS and preserved LV ejection fraction (EF). Methods 283 patients (60% males, mean age 71 ± 12 years old) with varying grades of AS and LVEF≥50% were enrolled. Exclusion criteria were more than mild associated cardiac valve lesion, left bundle branch block, and suboptimal quality of speckle-tracking image analysis. The control group included 50 patients matched for age and sex. Clinical, demographic and resting echocardiographic data were recorded, including quantification of 2D global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Results Patients with AS had higher systolic (p = 0.017) and diastolic arterial pressure (p = 0.007), increased LV wall thickness, mass index (p < 0.001) and volumes (p = 0.045) compared to controls. Greater indexed left atrial volume, E/e’ and trans-tricuspid gradient were also observed in the AS group (p < 0.001). As expected, speckle tracking analysis revealed significant lower GLS in AS than in control group (18.7 ± 3.2 vs 20.7 ± 2.1%, p < 0.001). Conversely, increased values of GCW and GWI (respectively 2965 ± 647 vs 2360 ± 353 mmHg%, and 2535 ± 559 vs 2005 ± 302 mmHg%, p < 0.001) were observed in patients with AS. Besides, GWW was significantly increased in AS vs controls (147 ± 108 vs 90 ± 49 mmHg%, p = 0.001), with no changes in terms of GWE (95 ± 4 vs 96 ± 2%, p = 0.110). When patients were stratified according to the AS severity, the analysis of variance revealed that GCW, GWI and GWW significantly increased with higher transaortic mean gradient and lower aortic valve area (p < 0.001). Also Zva demonstrated to impact on CGW (p = 0.040) and GWW (p < 0.001), with increased values in presence of increased global LV afterload (Zva > 4.5 mmHg/ml/m2). Conversely, patients with low-flow AS (stroke volume index < 35 ml/m2) showed lowers values of GCW (p = 0.014) and GWI (p = 0.001) compared to normal flow AS, but increased GWW (p = 0.041) and reduced GWE (93 ± 7 vs 95 ± 4%, p = 0.010). At multivariable analysis, mean gradient (p < 0.001), Zva (p = 0.038), systolic blood pressure (p < 0.001) and GLS (p < 0.001) were independently associated with GWI and GCW, while only GLS was associated with GWW. Conclusion In patients with AS and preserved LVEF, GLS reduction is accompanied by an increase of GCW, GWI and GWW, without affecting the GWE. These MW modifications seem to be mainly correlated to the severity of AS and increased global LV afterload.

P3369Impact of global left ventricular afterload, aortic stenosis severity and left ventricular hypertrophy on global myocardial work

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Ilardi ◽  
S Marchetta ◽  
R E Dulgheru ◽  
S Cimino ◽  
G D'Amico ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Stroke Volume ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Low Flow ◽  
Control Group ◽  
Aortic Valve Area ◽  
Global Work ◽  
Valve Area

Abstract Background Myocardial work (MW) is an innovative tool, that derives from myocardial strain with the advantage to incorporate measurement of deformation and load. Therefore, it could be useful in conditions of increased afterload, such as aortic stenosis (AS). To date, little is known about the changes in MW related to AS severity, left ventricle (LV) geometry and arterial compliance. Purpose We investigated the effect of valvulo-arterial impedance (Zva), stroke volume and LV hypertrophy in patients with AS and preserved LV ejection fraction (EF). Methods We retrospectively analyzed 283 patients (60% males, mean age 71±12 years old) with AS (aortic valve area ≤1.5 cm2) and LVEF≥50%. Exclusion criteria were more than mild associated cardiac valve lesion, left bundle branch block, and suboptimal quality of speckle-tracking image analysis. The control group included 50 patients matched for age and sex. Clinical, demographic and resting echocardiographic data were recorded, including quantification of 2D global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Results Patients with AS had higher systolic (p=0.017) and diastolic arterial pressure (p=0.007), increased LV wall thickness, mass index (p<0.001) and volumes (p=0.045) compared to controls. Greater indexed left atrial volume, E/e' and trans-tricuspid gradient were also observed in the AS group (p<0.001). As expected, speckle tracking analysis revealed significant lower GLS in AS than in control group (18.7±3.2 vs 20.7±2.1%, p<0.001). Conversely, increased values of GCW and GWI (respectively 2965±647 vs 2360±353 mmHg%, and 2535±559 vs 2005±302 mmHg%, p<0.001) were observed in patients with AS. Besides, GWW was significantly increased in AS vs controls (147±108 vs 90±49 mmHg%, p=0.001), with no changes in terms of GWE (95±4 vs 96±2%, p=0.110). When patients were stratified according to the AS severity, the analysis of variance revealed that GCW, GWI and GWW significantly increased with higher transaortic mean gradient and lower aortic valve area (p<0.001). Also Zva demonstrated to impact on CGW (p=0.040) and GWW (p<0.001), with increased values in presence of increased global LV afterload (Zva>4.5 mmHg/ml/m2). Conversely, patients with low-flow AS (stroke volume index <35 ml/m2) showed lowers values of GCW (p=0.014) and GWI (p=0.001) compared to normal flow AS, but increased GWW (p=0.041) and reduced GWE (93±7 vs 95±4%, p=0.010). Finally, LV geometry didn't influence significantly GCW and GWE, only an increase of GWW was observed in patients with eccentric hypertrophy (p=0.031). Conclusion In patients with AS and preserved LVEF, GLS reduction is accompanied by an increase of GCW, GWI and GWW, without affecting the GWE. These modifications seem to be correlated to the severity of AS, low-flow state and increased global LV afterload but not on the grade of LV hypertrophy.

scholarly journals Use of passive leg rise as an add-on to dobutamine in patients with paradoxical low-flow, low-gradient aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Buffle ◽  
A Papadis ◽  
C Seiler ◽  
S F De Marchi
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Low Ejection Fraction ◽  
Valve Area

Abstract Background Dobutamine has been proposed for the assessment of low-flow, low-gradient aortic stenosis (LFLGAS). However, in 1/3 of patients, no increase in stroke volume index can be achieved by Dobutamine, thus hampering its diagnostic value. This study evaluated the manoeuvre of cardiac preload augmentation by passive leg rise (PLR) alone or on top of Dobutamine to increase stroke volume index (SVI) in patients with LFLGAS, particularly in paradoxical LFLGAS. Methods We examined 50 patients with LFLGAS. Patients were assigned to the paradoxical LFLGAS (Paradox) group if left ventricular ejection fraction (LVEF) was ≥50% (n=29) and to the LFLGAS with low ejection fraction (LEF) group if LVEF was &lt;50% (n=21). A modified Dobutamine stress echocardiography was performed in all patients with the following 4 steps: Rest, PLR alone, maximal Dobutamine infusion rate alone (Dmax) and Dobutamine plus PLR (Dmax + PLR). Three SVI measurement methods were used: first the left ventricular outflow tract velocity time integral (LVOT VTI) method, second the 2D Simpson's method, and third the 3D method. The corresponding aortic valve area (AVA) was obtained by the continuity equation. The increase of those values compared to measurements at rest was calculated and compared between the 3 stress steps. Results In the paradoxical LFLGAS group, delta SVI with Dmax assessed by both Simpson's (depicted in the figures) and 3D method was lowest compared to PLR and Dmax + PLR. PLR alone yielded an equally high delta SVI as Dmax + PLR in Simpson's and 3D, and was at least as high as Dmax across all methods. Dobutamine alone yielded the lowest delta transaortic aortic valve VTI. The highest delta aortic valve area resulted for Dmax + PLR. In the LEF group, the three stress steps yielded an equally high delta SVI with Simpson's method. Dmax never yielded a higher delta SVI than PLR alone. The yielded delta SVI was the highest for Dmax + PLR for both LVOT VTI and 3d method, although the difference was overall not as strong as in the Paradox group. Conclusions In patients with paradoxical LFLGAS, Dobutamine alone is inadequate for testing the potential of aortic valve opening augmentation. Instead, PLR alone or the addition of PLR plus Dobutamine should be used for that purpose. In low LVEF, adding PLR to Dobutamine also seems useful although its diagnostic added value is less evident than in the Paradox group. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Gottfried und Julia Bangerter-Rhyner-Foundation Paradox group Low ejection fraction group

scholarly journals Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction

2016 ◽  
Vol 10 ◽  
pp. CMC.S38407 ◽  
Author(s):  
Amal Mohamed Ayoub ◽  
Viola William Keddeas ◽  
Yasmin Abdelrazek Ali ◽  
Reham Atef El Okl
Keyword(s):  
Ejection Fraction ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Control Group ◽  
Hypertensive Patients

Background Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. Methods We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). Results There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson's method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. Conclusion 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention.

Ejection dynamics and valve kinetics in patients with low-gradient severe aortic stenosis with preserved ejection fraction. Comparison between normal and low-flow

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Migliore ◽  
M.E Adaniya ◽  
M.A Barranco ◽  
S Gonzalez ◽  
G Miramont
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Severe Aortic Stenosis ◽  
Aortic Flow ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Preserved Ejection Fraction

Abstract Background Studies of ejection dynamics in severe aortic stenosis and prosthetic valve obstruction had demonstrated a delay in aortic valve opening. Purpose The aim of this study was to compare and evaluate ejection dynamics and valve kinetics in patients with severe aortic stenosis with preserved ejection fraction with normal and low flow. Methods 83 patients (age average 68±11 years) with severe aortic stenosis (aortic valve area &lt;1cm2) and preserved ejection fraction (≥50%) were studied with Doppler echocardiography and included prospectively. The ratio of aortic valve area measured at mid-deceleration and mid-acceleration (Md/Ma) were calculated using velocity of left ventricular outflow tract and aortic transvalvular velocity in continuity equation as an index of valvular kinetics. A ratio of Md/Ma &gt;1 indicate delay in opening of aortic valve. Assessment of ejection dynamics was evaluated with acceleration time (AT), ejection time (ET) and the ratio AT/ET estimated from aortic Doppler velocities profiles. Aortic flow was calculated as stroke volume/ET. According to stroke volume index and mean gradient patients were classified in 3 groups: normal-flow, low-gradient (NFLG) 25 patients, low-flow, low-gradient (LFLG) 28 patients and normal-flow, high-gradient (HG) 30 patients. Analysis of the variance and coefficient of correlation “r” were used for statistical evaluation. A p value &lt;0.05 was considered significant. Results There was no significant difference among the 3 groups with regard to ratio Md/Ma: NFLG 1.29±0.38, LFLG 1.22±0.26 and HG 1.23±0.45, NS. No difference was found in AT in the 3 groups, but ET was shorter in LFLG (310±30 ms) in comparison with NFLG (345±32 ms) and HG (361±31 ms), p&lt;0.01. Ratio AT/ET occurred in early systole in NFLG (0.27±0.07) compared with LFLG (0.32±0.07) and HG (0.39±0.07), p&lt;0.01. As expected, flow was decreased in LFLG (163±20 ml/s, p&lt;0.001) compared with NFLG (217±13 ml/s) and HG (233±44 ml/s). There was no correlation among AT/ET and aortic flow or stroke volume index. Conclusions There were not differences among the groups with regard to kinetic of the valve evaluated by mean of ratio Md/Ma. According to ratio AT/ET, aortic valve takes less time to open in NFLG compared with LFLG and HG independent of aortic flow suggesting a different ejection dynamics pattern in this group. Funding Acknowledgement Type of funding source: None

Abstract P137: Nonspecific ST-T Change In Electrocardiogram Was Associated With A Reduced Constructive Myocardial Work In Hypertensive Patients With Preserved Ejection Fraction

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Joji Ishikawa ◽  
Saori Nakamura ◽  
Ayumi Toba ◽  
Masashi Miyawaki ◽  
Ruri Shimizu ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Work Efficiency ◽  
Ventricular Ejection Fraction ◽  
Hypertensive Patients ◽  
Constructive Work ◽  
Global Work

Background: Nonspecific ST-T change in electrocardiogram can be observed in hypertensive heart disease with preserved left ventricular ejection fraction (LVEF); however, the relationship between nonspecific ST-T change and global myocardial work in echocardiography was unclear. Methods: We evaluated global longitudinal strain (GLS), GWI (global work index), GCW (global constructive work), GWW (global wasted work), GWE (global work efficiency), using offline analyzing system (View Pal, GE) in 196 hypertensive patients with preserved LVEF (>50%). Nonspecific ST-T change and major ST-T change (depression of ST in V5 lead >1mV) was also evaluated in electrocardiogram. Results: Mean age was 79.3±8.2 years (men 37.8%). Compared with patients with no ST-T change, those with nonspecific and major ST-change had a smaller absolute value of GLS (-20±3, -18±4, -14±5%, P<0.001) and had smaller constructive work load [GWI (2140±488, 1915±472, 1523±776 mmHg%, P<0.001), GCW (2410±514, 2165±471, 1694±784 mmHg%, P<0.01)]. Additionally, those with nonspecific and major ST-T change had an increased wasted myocardial work [GWW (87±61, 109±58, 138±71 mmHg%, P<0.001)], and this resulted in reduction of myocardial work efficiency [GWE (95±4,93±3,87±12%,P<0.001)]. Even after adjustment for age, sex, diabetes, dyslipidemia, EF, LV mass index, relative wall thickness, parameters of diastolic function (E/A, E/e’, left atrial volume index, tricuspid valve regurgitant flow velocity), and electrocardiogram LVH of Cornell product and Sokolow-Lyon voltage, the patients with nonspecific ST-T change had a significantly smaller LV global constructive work. [GWI (2243±41 vs. 1998±96 mmHg%, P=0.025), GCW (2501±45 vs. 2210±105 mmHg%, P=0.015)]. Conclusion: In hypertensive patients with preserved LVEF, nonspecific ST-T change in electrocardiogram was associated with a reduced constructive work in LV.

scholarly journals P775 Assessment of left ventricular function in patients with atrial fibrillation using real time triplain speckle tracking in comparison with 2D speckle tracking

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
HASAN Ali Al-Farhan ◽  
T A Sulaiman
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Real Time ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Control Group ◽  
And Control

Abstract Background Atrial fibrillation (AF) is one of the most common cardiovascular diseases in the world, can cause many structural and functional cardiac abnormalities, one of them is left ventricular (LV) systolic dysfunction which may not be detected by conventional echocardiographic parameters (CEP) and need to use a modality of real time triplain (3P) speckle tracking strain for early detection and improvement of prognosis Purpose Assessment of LV systolic function in AF patients with normal ejection fraction (EF) using 3P speckle-tracking strain and its role as early predictor of subclinical dysfunction Methods A case-control study was conducted at Baghdad Heart Center, Baghdad Medical City since July 2017 to July 2018, including patients with AF and control group. The CEP (EF, diastolic function, mitral annular plane systolic excursion) and speckle tracking longitudinal strain were done for the patients by 3P in comparison with two dimension (2D) Results The study included two groups. First group: 100 patients with AF, mean age (48 ± 12.2) ranging between (25-81), (48%) men, (52%) women. Second group: 100 control patients with mean age (46.4 ± 13.1) ranging between (20-84), (58%) men, (42%) women. 3P method showed more easy and accurate in comparison with 2D method in patients with AF. Applying cut off value of (-17.5%), it was found that 71% of AF patients had undetected LV systolic dysfunction even with preserved EF. Global longitudinal strain was reduced significantly in those with AF group and reduced mitral annular plane systolic excursion Conclusion(s) Real time triplain speckle tracking can be dependable which is easy, useful, and more accurate in comparison with 2D method in assessment of LV function in patients with AF. 3P method is a useful tool in the early detection of subtle LV systolic dysfunction in AF patients with preserved EF and in whom more aggressive interventions could have a significant impact on prognosis. 3P vs 2D in Patients with AF and Control Average GLS by 3P % Average GLS by 2D % p-value No. Mean± SD No. Mean± SD AF group EF &lt; 52 % 29 -11.23± 3.89 29 -12.05± 3.84 0.01 EF ≥53 % 71 -13.30± 2.55 71 -14.20± 2.64 0.001 Control group EF &lt; 52 % 2 -21.15± 4.45 2 -20.20± 1.84 0.6 EF ≥53 % 98 -19.14± 1.49 98 -19.91± 1.66 0.001 3P, real time triplain; 2D, two dimension; AF, atrial fibrillation; GLS, global longitudinal strain; SD, standard deviation; EF, ejection fraction

Right ventricular myocardial work in patients with HFrEF

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.C Butcher ◽  
F Fortuni ◽  
J.M Montero ◽  
N Ajmone Marsan ◽  
V Delgado ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
The Novel ◽  
Global Work

Abstract Background Right ventricular myocardial work (RVMW) is a novel method of non-invasively quantifying right ventricular (RV) systolic function. Through the use of speckle tracking echocardiography-derived RV pressure-strain loops, RVMW provides a quantitative evaluation of afterload-dependent RV systolic function. Purpose To investigate RVMW in patients with heart failure and reduced ejection fraction (HFrEF) and compare to that of patients without cardiovascular disease (CVD) and a structurally and functionally normal heart. Methods Noninvasive analysis of RVMW was performed in 23 HFrEF patients and 23 patients without cardiovascular or structural heart disease. The novel indices of RV global constructive work (RVGCW), RV global work index (RVGWI), RV wasted work (RVWW) and RV global work efficiency (RVGWE) were analysed utilizing proprietary software originally developed for the assessment of left ventricular myocardial work by speckle tracking echocardiography. Parameters of RVMW were then compared between the two patient groups. Results The HFrEF group had lower left ventricular (LV) ejection fraction (18.7% [±6.7] vs 60.1% [±4.6], p&lt;0.0001), LV global longitudinal strain (−3.6% [±1.6] vs −20.4% [±2.1), p&lt;0.0001) and RV global longitudinal strain (−10.0% [±4.2] vs −22.0% [±3.1], p&lt;0.0001) when compared to those with no CVD. Estimated pulmonary artery systolic pressure (42.5mm Hg [±12] vs 22.5mm Hg [±3.7], p&lt;0.0001) and estimated right atrial pressure (8mm Hg (5 to 15) vs 5mm Hg (5 to 5), p&lt;0.0001) were significantly higher in the HFrEF group. RVGWI (259.7mmHg% [±135.0] vs 385.3mmHg% [±103.1], p=0.001), RVGWW (83.7mmHg% [±58.6] vs 14.5mmHg% [8.5 to 20.5], p&lt;0.0001) and RVGWE (77.2% [11.4] vs 95.5% [93.5 to 97], p&lt;0.0001) were significantly lower in the HFrEF group when compared to those without CVD. There was no statistically significant difference in RVGCW between the two groups (353.5mmHg% [±118.4] vs 417.2 [±102.1], p=0.057). Conclusion The novel parameters of RVGWI, RVGWW and RVGWE were significantly reduced in patients with HFrEF when compared to those without CVD. Further exploration of the clinical role and prognostic value of these afterload dependent parameters of RV systolic function is warranted. Funding Acknowledgement Type of funding source: None

scholarly journals Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Agata Popielarz-Grygalewicz ◽  
Jakub S. Gąsior ◽  
Aleksandra Konwicka ◽  
Paweł Grygalewicz ◽  
Maria Stelmachowska-Banaś ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Healthy Volunteers ◽  
Global Longitudinal Strain ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Group ◽  
Glucose Metabolism Disorders ◽  
Acromegalic Cardiomyopathy ◽  
The Right

To determine whether the echocardiographic presentation allows for diagnosis of acromegalic cardiomyopathy. 140 patients with acromegaly underwent echocardiography as part of routine diagnostics. The results were compared with the control group comprising of 52 age- and sex-matched healthy volunteers. Patients with acromegaly presented with higher BMI, prevalence of arterial hypertension, and glucose metabolism disorders (i.e., diabetes and/or prediabetes). In patients with acromegaly, the following findings were detected: increased left atrial volume index, increased interventricular septum thickness, increased posterior wall thickness, and increased left ventricular mass index, accompanied by reduced diastolic function measured by the following parameters: E’med., E/E’, and E/A. Additionally, they presented with abnormal right ventricular systolic pressure. All patients had normal systolic function measured by ejection fraction. However, the values of global longitudinal strain were slightly lower in patients than in the control group; the difference was statistically significant. There were no statistically significant differences in the size of the right and left ventricle, thickness of the right ventricular free wall, and indexed diameter of the ascending aorta between patients with acromegaly and healthy volunteers. None of 140 patients presented systolic dysfunction, which is the last phase of the so-called acromegalic cardiomyopathy. Some abnormal echocardiographic parameters found in acromegalic patients may be caused by concomitant diseases and not elevated levels of GH or IGF-1 alone. The potential role of demographic parameters like age, sex, and/or BMI requires further research.

Myocardial work in Stage 1 and 2 hypertensive patients

2021 ◽  
Author(s):  
Akshar Jaglan ◽  
Sarah Roemer ◽  
Ana Cristina Perez Moreno ◽  
Bijoy K Khandheria
Keyword(s):  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Non Invasive ◽  
Significant Difference ◽  
Lv Ejection Fraction ◽  
Global Work ◽  
Stage 1

Abstract Aims Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. Methods and results Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure–strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P &lt; 0.001), and GWW (P &lt; 0.001). Conclusion Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.

scholarly journals Ultrasound assessment of heart remodelling affected by therapeutic hypothermia and MSC on myocardial infarction model

2020 ◽  
Vol 28 (3) ◽  
pp. 222-240
Author(s):  
M. O. Chyzh ◽  
A. O. Manchenko ◽  
A. V. Trofimova ◽  
I. V. Belochkina
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Therapeutic Hypothermia ◽  
Left Coronary Artery ◽  
Left Ventricular ◽  
Control Group ◽  
Normal Range ◽  
Allogeneic Mscs

Background. Late seeking medical advice, limited number of cardiac surgery hospitals and conservative treatment, which does not seem to be always efficacious, trigger the search for new, more effective mode therapy of acute myocardial infarction (MI). Recently, mesenchymal stromal cells (MSCs) have come into sharp focus of scientists due to the prospects for clinical use. On the other hand, multicenter studies have proved that therapeutic hypothermia (TH) has neuro- and cardioprotective effects, and it is administered as one of the urgent methods in providing primary health care. Purpose. Providing and analyzing ultrasonography (US) of rat hearts with experimental MI in order to determine the nature of heart remodelling under combined use of TH and introducing allogeneic MSCs. Materials and methods. The study involved 90 outbred white rats weighing 240–270 g. Myocardial infarction was reproduced by ligating the descending branch of the left coronary artery on the border of the upper and middle third of the vessel. Therapeutic hypothermia was performed in a cold chamber, 60 minutes long. The local skin temperature of the neck area was maintained at +4 оC, while the rectal and tympanic temperature decreased to + 25 оC. A suspension of allogeneic cryopreserved MSCs of the placenta with a concentration of 1.2 × × 106 cells/ml was administered once intravenously through v. saphena magna. Heart sonography was carried out by means of «Сономед 500» («СПЕКТРОМЕД», Russia) ultrasound scanner in B- and M-mode using a linear sensor 7.5L38 with frequency of 7.5 MHz. Results and discussion. The control group with experimental MI showed significantly suppressed function of the left ventricle (LV). It resulted in decreasing stroke volume (SV) and cardiac output (CO) and on the whole indicated reduced ejection fraction (EF) to 46.04 %, that was 35 % less than the corresponding normal range. According to the values of relative wall thickness (RWT) and left ventricular mass (LVM) on day 7 and day 30 after ligating the left coronary artery, LV remodelling was proceeding via eccentric mode of LV alteration. Therapeutic hypothermia was not able to completely stop the pathophysiological processes associated with coronary ligation. EF was not significantly different from the control group, and was 51.08 ± ± 2.68 %. On day 7 of the experiment, heart remodelling in this group was proceeding according to the normal geometry model, and on day 30 – according to the eccentric model. In spite of the volume overload causing post-infarction extension of the left ventricular cavity, in the group with applying MSCs, on day 7 there was a compensatory increase of the stroke volume, 1.8 times over compared to the group with normal range values and 2.3 over compared to the control group. The ejection fraction was 17 % less than the normal range, but statistically significantly higher than the corresponding indicator of the control group of this observation period. Heart remodelling after applying allogeneic MSCs associated with MI at all stages of observation was proceeding by eccentric LV hypertrophy. Аfter therapeutic hypothermia and applying MSCs associated with experimental myocardial infarction on day 7 and day 30, the group recorded the best values of echo params of LV anatomical structures, indicating no dilatation along with occuring moderate myocardial hypertrophy. The ejection fraction showed the best outcome, i. e. 58.78 %, while LV remodelling was minimal, occurring according to normal heart geometry. Conclusions. Applying echocardiography in rats is a very informative diagnosis method which makes it possible to describe the type of structural and functional remodelling of the myocardium associated infarction at early and late observation stages. The ultrasound study showed that the closest to the normal range was the group of animals exposed to therapeutic hypothermia and MSC transplantation. According to LVM and RWT values, in the rats of that group on day 7 and day 30 of the experiment, LV remodelling was characterized by normal geometry.

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