scholarly journals P313 Prognostic value of automated measurement of mitral annular displacement by speckle-tracking echocardiography in asymptomatic aortic stenosis patients with preserved left ventricular ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Hozumi ◽  
I Teraguchi ◽  
K Takemoto ◽  
S Fujita ◽  
T Wada ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Speckle Tracking ◽  
Prognostic Value ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Study Population

Abstract Background Management of patients with asymptomatic severe aortic stenosis (AS) and preserved left ventricular (LV) ejection fraction (EF) remains controversial. Recent studies have shown prognostic value of decreased LV global longitudinal strain in AS patients with preserved LVEF. Tissue-tracking mitral annular displacement (TMAD) in single apical four-chamber view (AP4) by speckle-tracking echocardiography provides automated rapid assessment of LV longitudinal deformation (Figure). This simple method may be useful for the prediction of cardiac events in asymptomatic severe AS patients with preserved LVEF. Purpose The purpose of this study was to examine the value of TMAD to predict cardiac events in asymptomatic severe AS patients with preserved LVEF. Methods The study population consisted of 103 patients with severe AS and preserved LVEF [aortic velocity >4m/s or aortic valve area (AVA) <1.0 cm², LVEF >50%]. After exclusion of 56 patients who met the exclusion criteria (symptomatic, atrial fibrillation, significant mitral valve diseases, history of cardiac surgery, short follow-up period <120 days, and inadequate echocardiographic images), the final study population consisted of 47 patients. Using TMAD analysis software (QLAB 10.5, Philips), the base-to-apex displacement of automatically defined mid-point of mitral annular line in AP4 was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated . We investigated the occurrence of the cardiac events including appearance of symptoms, decreased LVEF (< 50%), and cardiac death. Results %TMAD was successfully and quickly evaluated in 44 (94%) of 47 patients. During a follow-up, the cardiac events developed in 16 (36%) of 44 patients. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 1.9 vs 12.1 ± 2.6%, p= 0.002). There were no significant differences in the other parameters including age, LVEF, aortic velocity, AVA, tricuspid regurgitation pressure gradient, early diastolic /atrial filling velocity (E/A), early diastolic velocity of the mitral valve annulus (e’) and E/e’ between the patients with and without the cardiac events. Receiver operating characteristic analysis revealed that area under the curve of %TMAD was 0.81 for the cardiac events. Kaplan-Meier analysis showed %TMAD (cut-off: 11.9) provides a significant difference in the cardiac events (hazard ratio 14.8, 95% CI, 2.75-79.3; p= 0.002). Conclusions The present results suggest that automated TMAD measurement by speckle-tracking echocardiography may be useful to predict cardiac events in asymptomatic severe AS patients with preserved LVEF. Abstract P313 Figure

P91 Prognostic value of tissue-tracking mitral annular displacement by speckle-tracking echocardiography in asymptomatic patients with aortic stenosis with preserved left ventricular ejection fraction

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
I Teraguchi ◽  
T Hozumi ◽  
H Emori ◽  
K Takemoto ◽  
N Maniwa ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Longitudinal Deformation ◽  
Cardiac Events ◽  
Tissue Tracking

Abstract Background   Management of asymptomatic severe aortic stenosis (AS) patients with preserved left ventricular (LV) ejection fraction (EF) remains controversial. Recent studies using have shown that decreased LV longitudinal deformation assessed by global longitudinal strain analysis can predict adverse cardiac events in AS patients with preserved EF. Tissue-tracking mitral annular displacement (TMAD) by speckle-tracking echocardiography provides rapid and simple assessment of LV longitudinal deformation even when the acoustic window is poor (Fig.1). Purpose  The purpose of this study was to examine the value of TMAD to predict occurrence of the cardiac events in asymptomatic severe AS patients with preserved EF. Methods   We studied 103 patients with severe AS and preserved EF [aortic velocity >4m/s or aortic valve area (AVA) <1.0 cm2, EF >50%]in whom TMAD was measured, and a total of 44 patients were included in the final data setaccording to the exclusion criteria. Using TMAD analysis software, the base-to-apex displacement of automatically defined mid-point of mitral annular line in four-chamber view was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated (Fig.1). We investigated the association between %TMAD and the cardiac events including implementation of hospitalization due to heart failure, decreased EF (< 50%), aortic valve replacement or transcatheter aortic valve implantation due to appearance of symptoms and cardiac death,  Results  In all the final study patients, %TMAD was successfully and quickly (within 10 seconds) evaluated. During a follow-up, the cardiac events developed in 16 (36%) of 44 patients. Tableshows echocardiographic parameters in patients with and without the cardiac events. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 0.6 vs 12.1 ± 0.4%, p= 0.002). The other parameters were not involved in the event occurrence; age, LV mass index, EF, aortic velocity, AVA, tricuspid regurgitation pressure gradient (TR-PG), early diastolic /atrial filling velocity (E/A), early diastolic velocity of the mitral valve annulus (e’) and E/e’. In multiple variable analysis, %TMAD was an independentpredictor of the cardiac events (HR; 12.1, p= 0.001). ROC analysis revealed that the area under the curve of %TMAD was 0.81 for the cardiac events. Kaplan-Meier analysis showed %TMAD (cut-off: 11.9) provides a significant difference in the cardiac event (Fig. 2). Conclusions.  The present results suggests that TMAD easily and rapidly estimated by speckle-tracking echocardiography can be used as a simple method to predict occurrence of the cardiac events in asymptomatic severe AS patients with preserved EF. Abstract P91 Figure 1,2 and Table

Clinical significance of energy loss index in patients with low-gradient severe aortic stenosis and preserved ejection fraction

2020 ◽  
Vol 21 (6) ◽  
pp. 608-615 ◽  
Author(s):  
Alexandre Altes ◽  
Anne Ringle ◽  
Yohann Bohbot ◽  
Océane Bouchot ◽  
Ludovic Appert ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Cardiac Mortality ◽  
Cardiac Events ◽  
Loss Index

Abstract Aims  We hypothesized that among patients with low-gradient severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), reclassification of AS severity as moderate by pressure recovery adjusted indexed aortic valve area (AVAi) = energy loss index (ELI), may identify a subgroup of patients with a better outcome. Methods and results  Three hundred and seventy-nine patients with low-gradient AS (defined by AVAi ≤ 0.6 cm2/m2 and mean aortic pressure gradient < 40 mmHg) and preserved LVEF ≥50% were studied. Reclassification as moderate AS by ELI was defined as AVAi ≤0.6 cm2/m2 but with an ELI >0.6 cm2/m2. Cardiac events [cardiac mortality and/or need for aortic valve replacement (AVR)] during follow-up were studied. One hundred and forty-eight patients (39%) were reclassified as moderate AS by ELI. Reclassification as moderate AS was independently associated with decreased body surface area, normal flow status, decreased left ventricular mass index, and left atrial volume index (all P < 0.05). After adjustment for variables of prognostic interest, reclassification as moderate AS by ELI was associated with a considerable reduction of risk of cardiac events {adjusted hazard ratio (HR) 0.49 [95% confidence interval (CI) 0.33–0.72]; P < 0.001}, need for AVR [adjusted HR 0.52 (95% CI 0.34–0.81); P = 0.004], and cardiac mortality [adjusted HR 0.46 (95% CI 0.22–0.98); P = 0.044]. Conclusion  In patients with low-gradient severe AS and preserved LVEF, calculation of ELI permits to reclassify almost 40% of patients as having moderate AS. These reclassified patients have a considerable reduction of the risk of cardiac events during follow-up. Calculation of ELI is useful for decision-making in patients with low-gradient severe AS and preserved ejection fraction.

P2741Predictors of subtle left ventricular systolic dysfunction after treatment of coarctation of the aorta

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Saber Hafez ◽  
D Adel Ezzeldin ◽  
Y Abdel Razek Esmail ◽  
H Mohamed Attia ◽  
A Mahmoud Roshdy ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Systolic Dysfunction ◽  
Coarctation Of The Aorta ◽  
Left Ventricular ◽  
Aortic Flow ◽  
Abdominal Aortic ◽  
Lv Ejection Fraction

Abstract Background With the advent of the term “Heart Failure with Preserved Ejection Fraction - HFpEF”, more and more evidence has emerged supporting the importance of Speckle Tracking Echocardiography in measurement of Left ventricular (LV) Strain to assess subtle myocardial systolic dysfunction in such patients. Aim: To assess Global Longitudinal stain (GLS) of the LV in patients with Coarctation of the Aorta (CoA) after surgical or percutaneous treatment and predict the variables affecting the occurrence of subtle myocardial dysfunction in these patients. Patients and methods This was a cross sectional observational study that included 77 patients who presented to Ain Shams University hospital for follow up post treatment of Coarctation of the Aorta. All of these patients underwent intervention (surgical or catheter based) in the period between January 2005 and December 2017 and aged between 15 and 40 years at the time of the study. The patients underwent a detailed transthoracic echocardiogram, including Speckle Tracking using Phillips Q Lab version 7.1 software. All patients had normal systolic functions as measured by LV ejection fraction using Modified Simpsons' method. Correlations between variables were studied using “Independent paired T test and Chi square test”. Results The mean follow up duration was 13.19±3 years. The least accepted GLS value using the Phillips Q Lab version 7.1 software was −16.4%. Accordingly, the study group was divided into two groups (Normal GLS and Abnormal GLS). Nineteen patients had a low GLS, representing 24% of the study population. There was no age nor sex predilection between the two groups. Age at first intervention correlated positively with GLS (p=0.01), meaning that earlier intervention lead to better LV strain as the GLS is a negative value. Patients with Bicuspid Aortic Valve and those having Left ventricular Hypertrophy had significantly lower GLS (p=0.001). Patients with continuous abdominal Aortic flow had significantly lower GLS as compared to patients with pulsatile flow (p=0.005) (see figure). The occurrence of complications, e.g. stent fracture or recoarctation caused a significant reduction in GLS (p=0.012). Type of intervention, Order of interventions and age at second and third interventions did not significantly affect the GLS. CoA dimensions by MSCT and presence of Hypertension both before and after treatment did not affect the GLS. Effect of Aortic flow on GLS Conclusions Although most patients post CoA repair have normal LV ejection fraction, a good proportion of them have impaired LV global longitudinal strain and are thus prone to HFpEF. Earlier age at intervention, absence of complications and LV hypertrophy, as well as presence of pulsatile Abdominal Aortic flow lead to better LV performance as measured by GLS. LV strain derived from Speckle Tracking Echocardiography should be an integral part of follow up of CoA patients after repair. Acknowledgement/Funding None

scholarly journals Determinants and prognostic value of echocardiographic first-phase ejection fraction in aortic stenosis

Heart ◽  
2020 ◽  
Vol 106 (16) ◽  
pp. 1236-1243 ◽  
Author(s):  
Rong Bing ◽  
Haotian Gu ◽  
Calvin Chin ◽  
Lingyun Fang ◽  
Audrey White ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
Prognostic Value ◽  
Independent Predictor ◽  
Clinical Care ◽  
Systolic Dysfunction ◽  
Extracellular Volume ◽  
Left Ventricular

ObjectiveFirst-phase ejection fraction (EF1) is a novel measure of early left ventricular systolic dysfunction. We investigated determinants of EF1 and its prognostic value in aortic stenosis.MethodsEF1 was measured retrospectively in participants of an echocardiography/cardiovascular magnetic resonance cohort study which recruited patients with aortic stenosis (peak aortic velocity of ≥2 m/s) between 2012 and 2014. Linear regression models were constructed to examine variables associated with EF1. Cox proportional hazards were used to determine the prognostic power of EF1 for aortic valve replacement (AVR, performed as part of clinical care in accordance with international guidelines) or death.ResultsTotal follow-up of the 149 participants (69.8% male, 70 (65–76) years, mean gradient 33 (21–42) mm Hg) was 238 029 person-days. Sixty-seven participants (45%) had a low baseline EF1 (<25%) despite normal ejection fraction (67% (62%–71%)). Patients with low EF1 had more severe aortic stenosis (mean gradient 39 (34–45) mm Hg vs 24 (16–35) mm Hg, p<0.001) and more myocardial fibrosis (indexed extracellular volume (iECV) (24.2 (19.6–28.7) mL/m2 vs 20.6 (16.8–24.3) mL/m2, p=0.002; late gadolinium enhancement (LGE) prevalence 52% vs 20%, p<0.001). Zva, iECV and infarct LGE were independent predictors of EF1. EF1 improved post-AVR (n=57 with post-AVR EF1 available, baseline 16 (12–24) vs follow-up 27% (22%–31%); p<0.001). Low baseline EF1 was an independent predictor of AVR/death (HR 5.6, 95% CI 3.4 to 9.4), driven by AVR.ConclusionEF1 quantifies early, potentially reversible systolic dysfunction in aortic stenosis, is associated with global afterload and myocardial fibrosis, and is an independent predictor of AVR.

Abstract 18515: Forward Flow Ejection Fraction as a Major Determinant of Outcome in Organic Mitral Regurgitation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marlène Dupuis ◽  
Marie-Annick Clavel ◽  
Haïfa Mahjoub ◽  
Kim O’Connor ◽  
Mario Sénéchal ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Cardiac Events

Introduction: The optimal timing of mitral valve (MV) surgery in patients with organic mitral regurgitation (OMR) is controversial. The objective of this study was to determine independent predictors of cardiac events in patients with OMR and no triggers for mitral valve surgery. Hypothesis: We hypothesized that forward LV ejection fraction (LVEF) calculated by the Dumesnil’s method (i.e. stroke volume measured in LV outflow tract divided by left ventricular end diastolic volume) is superior to the LVEF measured by the biplane Simpson’s method. Methods: Two hundred seventy eight patients with OMR (i.e. severity grade ≥1/4) and Doppler echocardiography exam at least 6 months before MV surgery or death were included. Clinical and echocardiographic data of 278 patients with OMR were analyzed retrospectively. The study end-point was the composite of death or need for mitral valve surgery. Results: During a mean follow-up of 5.4 ± 3.2 years, there were 147 (53%) events: 96 (35%) mitral surgeries and 66 (24%) deaths. There was no difference in the Simpson LVEF (65 ± 6% vs 65 ± 4%; p=0.86) and global longitudinal strain (-21.18 ± 3.26 % vs -21.26 ± 2.44 %; p=0.86) between patients who had an event versus those who were event-free during follow-up. However, LVEF calculated by Dumesnil’s method at baseline was lower in the event-group (47 ± 15%vs 59 ± 15%; p<0.0001) compared to the non-event group. After adjustment for age, sex, Charlson’s probability, coronary artery disease, ACE inhibitors, β-blockers, diuretics, AF and MR grade, forward LVEF by Dumesnil’s method remained an independent predictor of the occurrence of cardiac events (adjusted hazard ratio: 1.09, 95% interval confidence: 1.02-1.17; p=0.01). Conclusion: This study shows that the forward LVEF calculated by the Dumesnil’s method is superior to the standard LVEF or to longitudinal strain to predict outcomes in OMR. These results could help to improve risk stratification of patients with OMR and thereby individualized the treatment’s strategy. Further prospective studies are needed to confirm these findings.

Sign in / Sign up

Export Citation Format

Share Document