P316 A feasible and accurate method for the assessment of early ventricular dysfunction in children with kawasaki disease: result from the MyoWoRK (myocardial work related to kawasaki disease) study

Abstract Funding Acknowledgements EACVI Training Grant Introduction Kawasaki disease (KD) is an acute vasculitis of unknown etiology. It is associated with high morbidity and mortality due to the development of coronary artery aneurysms and myocardial dysfunction. Purpose The aim of this study was to evaluate sensitivity and specificity of left ventricular (LV) pressure–strain loop (PSL) area, which reflects regional myocardial work and metabolic demand, in predicting subtle myocardial abnormalities in KD patients with coronaries aneurisms. Methods A total of 88 patients (59 male, age 8.95 ± 4.95 years) were included in our study. Among the children admitted in our institution with a diagnosis of KD during the study time frame, 42 patients (KDg) (29 male) with coronary artery dilatation (Z-score >2.5) were selected. These cases were compared with 46 (30 male) age-matched controls (CTRg). Classical echocardiographic parameters of LV systolic function were normal in both groups, while global longitudinal strain (GLS) was decreased in 6 KD patients. Global work index (GWI) was calculated as the area of the LV PSL. From GWI, it was estimated also Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE). We also made a subgroup analysis between KD patients with normal GLS (> -19 %) and control patients. Results Despite normal LV systolic function by routine echocardiography, compared to controls, KD patients had lower GWI (1448 ± 382 mmHg% in KDg vs 1751 ± 263] mmHg% in CTRg, p = 0.00003), GCW (1904 ± 390 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p= 0.0004) and GWE (94 ± 5 % in KDg vs 96 ± 2 % in CTRg, p= 0.01). There was not significant difference in GWW between the KDg and CTRg. When KD patients with normal GLS were analysed separately, they preserved a significant difference in GWI, GCW and GWE in comparison with controls (GWI: 1490 ± 347 mmHg% in KDg vs 1751 ± 263 mmHg% in CTRg, p = 0.0002; GCW: 1972 ± 321 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p = 0.004; GWE: 95 ± 3 in KDg vs 96 ± 2 % in CTRg, p= 0.04). No association was found between GWI, GCW, GWW, GWE and number or dimension of the involved aneurysmatic coronaries. Conclusions The estimation of myocardial work by PSL is a novel tool for the evaluation of patients with KD. GWI, GCW and GWE were significantly reduced in KD patients with dilated coronaries. In KD patients with normal GLS, estimation of GWI, GCW and GWE may be a sensitive indicator of myocardial dysfunction and an adjuvant criterion to avoid delayed diagnosis of KD. Abstract P316 Figure. Myocardial work in KD and CTR.

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Abstract 14432: Myocardial Work in Stage I and II Hypertensive Patients

Circulation ◽

10.1161/circ.142.suppl_3.14432 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Akshar Jaglan ◽

Sarah Roemer ◽

Ana C Perez Moreno ◽

Bijoy K Khandheria

Keyword(s):

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Deformation Analysis ◽

Hypertensive Patients ◽

Reduced Ejection Fraction ◽

Work Index ◽

Significant Difference ◽

Global Work ◽

Lv Systolic Function

Introduction: Myocardial work is a novel parameter that can be used in a clinic setting to assess left ventricular (LV) pressures and deformation. This study sought to distinguish patterns of global myocardial work index in hypertensive vs. non-hypertensive patients. Methods: Fifty (25 male, mean age 60±14 years) hypertensive patients and 15 (7 male, mean age 38±12 years) control patients underwent transthoracic echocardiography at rest. Hypertensive patients were divided into stage 1 (26 patients) and stage 2 (24 patients) based on the 2017 American College of Cardiology guidelines. We excluded patients with suboptimal image quality for myocardial deformation analysis, reduced ejection fraction (EF), valvular heart disease, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were estimated from LV pressure strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using a noninvasive brachial artery cuff. Results: Global longitudinal strain (GLS) and EF were preserved between the two groups with no statistically significant difference whereas there was a statistically significant difference in the GWI (p<0.01), GCW (p=0.03), GWW (p<0.01), and GWE (p=0.03) (Figure and Table). Conclusions: Myocardial work gives us a closer look at the relationship between LV pressure and contractility in settings of increased load dependency whereas LVEF and GLS cannot. We show how myocardial work is an advanced assessment of LV systolic function in hypertensive patients.

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Abnormal myocardial work in children with Kawasaki disease

Scientific Reports ◽

10.1038/s41598-021-86933-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jolanda Sabatino ◽

Nunzia Borrelli ◽

Alain Fraisse ◽

Jethro Herberg ◽

Elena Karagadova ◽

...

Keyword(s):

Kawasaki Disease ◽

Systolic Function ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

High Morbidity ◽

Additional Group ◽

Constructive Work ◽

Lv Systolic Function ◽

Normal Lvef

AbstractKawasaki disease (KD) can be associated with high morbidity and mortality due to coronary artery aneurysms formation and myocardial dysfunction. Aim of this study was to evaluate the diagnostic performance of non-invasive myocardial work in predicting subtle myocardial abnormalities in Kawasaki disease (KD) children with coronary dilatation (CADL). A total of 100 patients (age 8.7 ± 5 years) were included: 45 children with KD and CADL (KD/CADL) (Z-score > 2.5), 45 age-matched controls (CTRL) and, finally, an additional group of 10 children with KD in absence of coronary dilatation (KD group). Left ventricular (LV) systolic function and global longitudinal strain (GLS) were assessed. Global myocardial work index (MWI) was calculated as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Despite normal LV systolic function by routine echocardiography, KD/CADL patients had lower MWI (1433.2 ± 375.8 mmHg% vs 1752.2 ± 265.7 mmHg%, p < 0.001), MCW (1885.5 ± 384.2 mmHg% vs 2175.9 ± 292.4 mmHg%, p = 0.001) and MWE (994.0 ± 4.8% vs 95.9 ± 2.0%, p = 0.030) compared to CTRL. Furthermore, MWI was significantly reduced in children belonging to the KD group in comparison with controls (KD: 1498.3 ± 361.7 mmHg%; KD vs CTRL p = 0.028) and was comparable between KD/CADL and KD groups (KD/CADL vs KD p = 0.896). Moreover, KD/CADL patients with normal GLS (n = 38) preserved significant differences in MWI and MCW in comparison with CTRL. MWI, MCW and MWE were significantly reduced in KD children despite normal LVEF and normal GLS. These abnormalities seems independent from CADL. Thus, in KD with normal LVEF and normal GLS, estimation of MWI may be a more sensitive indicator of myocardial dysfunction.

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CORONARY ARTERY DISEASE

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.02.2894 ◽

2009 ◽

Vol 16 (02) ◽

pp. 192-197

Author(s):

FIDA MUHAMMAD ◽

Nadeem Hayat Mallick, ◽

ABDUL REHMAN ABID ◽

AJAZ AHMAD ◽

Shahid Imran

Keyword(s):

Coronary Artery Disease ◽

Risk Factor ◽

Coronary Artery ◽

Clinical Presentation ◽

Systolic Function ◽

Left Ventricular ◽

Premature Coronary Artery Disease ◽

Common Risk Factor ◽

Artery Disease ◽

Lv Systolic Function

Objectives: This study was designed to evaluate the pattern of clinical presentation, risk factors and angiographic findingsin young males presenting with acute myocardial infarction (AMI).Materials and methodsThis cross-sectional descriptive study wasconducted at the Cardiology Department, Punjab Institute of Cardiology, Lahore from May 2005 till February 2006. After fulfilling the inclusioncriteria 200 male patients <40 years with coronary artery disease (CAD) were studied. Results: Mean age of the study population was31.5±9.2 years with an age range of 31 to 40 years. Most common risk factor was smoking present in 60% patients. Family history ofischemic heart disease (IHD) was present in 44.5% patients, hyperlipidemia in 35.5% patients, hypertension in 25.5% and diabetes mellitusin 17.5% of patients.Common mode of clinical presentation was AMI 42.5% patients. Left anterior descending (LAD) was diseased in 73.5%,followed by Left Circumflex (LCx) 51% and Right Coronary Artery (RCA) in 39% patients. Left Main Stem (LMS) disease occurred in 9.5%patients. Good left ventricular (LV) systolic function was observed in 38%, moderate LV systolic function in 34% and poor LV systolic functionin 14.5% patients. Conclusion: Patients with premature coronary artery disease have unheralded acute onset of symptoms. Smoking isthe most common risk factor. Young patients have single vessel CAD with frequent involvement of LAD and commonly have good leftventricular systolic function.

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Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting

10.21203/rs.2.20921/v3 ◽

2020 ◽

Author(s):

Lan-Ting Zhao ◽

Lu Liu ◽

Ping-Ping Meng ◽

Yong-Huai Wang ◽

Meng Li ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Circumferential Strain ◽

Systolic Function ◽

Artery Bypass ◽

Radial Strain ◽

Left Ventricular ◽

Bypass Grafting ◽

Sphericity Index ◽

Lv Systolic Function

Abstract Background: Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG. Methods: Intraoperative transesophageal echocardiography was performed in 27 patients during elective off-pump beating heart CABG 5 minutes before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously. Results: LV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P<0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P<0.001). The LV volumes and LVEF remained unchanged. Conclusions: Pericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG.

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Value of quantitative analysis of left ventricular systolic function in patients on maintenance hemodialysis based on myocardial work technique

10.21203/rs.3.rs-40062/v3 ◽

2021 ◽

Author(s):

Chang Liu ◽

Yi-Ping Feng ◽

Zi-Ning Yan ◽

Li Fan ◽

Yi-Fei Rui ◽

...

Keyword(s):

Quantitative Analysis ◽

Left Ventricular Hypertrophy ◽

Receiver Operating Characteristic ◽

Ventricular Hypertrophy ◽

Operating Characteristic ◽

Systolic Function ◽

Left Ventricular ◽

Maintenance Hemodialysis ◽

Global Work ◽

Lv Systolic Function

Abstract Background: This study aimed to determine the left ventricular (LV) systolic function in patients on maintenance hemodialysis (MHD) using the myocardial work (MW) technique and investigate the clinical value of the MW technique for the quantitative analysis of left ventricular (LV) systolic function in MHD patients with left ventricular hypertrophy (LVH).Methods: A total of 68 MHD patients and 35 controls were registered in this study. The MHD patients were divided into the non-left ventricular hypertrophy (NLVH) group (n=35) and the LVH group (n=33) according to the LV mass index (LVMI). MW was used to generate the LV global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), and global wasted work (GWW), global work efficiency (GWE). GLS and the MW parameters (GWI, GCW, GWW, GWE) were compared between groups and the correlations between these parameters and the LV ejection fraction (LVEF) in the LVH group were examined. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of MW parameters and GLS for the assessment of LV systolic dysfunction in MHD with LVH patients.Results: The LVH group had significantly lower GWE, GWI, GCW, and GLS but higher GWW than the control and NLVH groups. Compared with the control group, the NLVH group had significantly lower GWE and GLS and higher GWW, but no significant differences in GWI, GCW were observed between these two groups. The LVEF was negatively correlated with GWW in MHD patients, but positively correlated with GWI, GWE, and GCW in the LVH group. Receiver operating characteristic curve (ROC) analysis revealed that GWE, GWW, GWI, and GCW had appreciable area under the curve (AUC), sensitivity, and specificity for evaluating LV function in LVH patients on MHD. Conclusion: The MW parameters can quantitatively represent the LV myocardial work in MHD patients. Thus, the technique provides a new method for the quantitative evaluation of LV systolic function in MHD with LVH patients.

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Value of quantitative analysis of left ventricular systolic function in patients on maintenance hemodialysis based on myocardial work technique

10.21203/rs.3.rs-40062/v2 ◽

2020 ◽

Author(s):

Chang Liu ◽

Yi-Ping Feng ◽

Zi-Ning Yan ◽

Li Fan ◽

Yi-Fei Rui ◽

...

Keyword(s):

Quantitative Analysis ◽

Left Ventricular Hypertrophy ◽

Receiver Operating Characteristic ◽

Ventricular Hypertrophy ◽

Operating Characteristic ◽

Systolic Function ◽

Left Ventricular ◽

Maintenance Hemodialysis ◽

Global Work ◽

Lv Systolic Function

Abstract Background: To detect the left ventricular (LV) systolic function in maintenance hemodialysis (MHD) patients by using myocardial work (MW) technique. And investigated the clinical value of the MW technique for the quantitative analysis of left ventricular (LV) systolic function in MHD patients with left ventricular hypertrophy (LVH).Methods: A total of 58 MHD patients and 29 normal subjects were registered in this study. The MHD patients were divided into the non-left ventricular hypertrophy (NLVH) group (n=32) and the LVH group (n=26) according to the LV myocardial index (LVMI). MW was used to generated the LV global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE. GLS and the MW parameters (GWI, GCW, GWW, GWE) were compared between groups and the correlations between these parameters and the LV ejection fraction (LVEF) in the LVH group were examined. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of MW parameters and GLS for the assessment of LV systolic dysfunction in MHD patients with LVH.Results: The LVH group had significantly lower GWE, GWI, GCW, and GLS but higher GWW than the control and NLVH groups. Compared with the control group, the NLVH group had significantly lower GWE and GLS and higher GWW, but no significant differences in GWI, GCW were observed between these two groups. The LVEF was negatively correlated with GWW in MHD patients, but positively correlated with GWI, GWE, and GCW in the LVH group. Receiver operating characteristic curve (ROC) analysis revealed that GWE, GWW, GWI, and GCW had appreciable area under the curve (AUC), sensitivity, and specificity for evaluating LV function in LVH patients. Conclusion: MW parameters can be effectively used to evaluate the LV systolic function in MHD patients with or without LVH.

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The Effect of Regular Physical Activity on the Left Ventricle Systolic Function in Patients With Chronic Coronary Artery Disease

Physiological Research ◽

10.33549/physiolres.932162 ◽

2011 ◽

pp. 869-875

Author(s):

R. PANOVSKÝ ◽

P. KUKLA ◽

R. JANČÁR ◽

J. MELUZÍN ◽

J. JANČÍK ◽

...

Keyword(s):

Physical Activity ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Systolic Function ◽

Left Ventricular ◽

Maximal Load ◽

Significant Difference ◽

Left Ventricle Systolic Function ◽

Artery Disease

The purpose of this study was to assess the influence of aerobic training on the left ventricular (LV) systolic function. Thirty patients with stable coronary artery disease, who had participated in the conducted 3-month physical training, were retrospectively divided into 2 cohorts. While patients in the cohort I (n=14) had continued training individually for 12 months, patients in the cohort II (n=16) had stopped training after finishing the conducted program. Rest and stress dobutamine/atropine echocardiography was performed in all patients before the training program and 1 year later. The peak systolic velocities of mitral annulus (Sa) were assessed by tissue Doppler imaging for individual LV walls. In addition, to determine global LV systolic longitudinal function, the four-site mean systolic velocity was calculated (Sa glob). According to the blood supply, left ventricular walls were divided into 5 groups: A- walls supplied by nonstenotic artery; B- walls supplied by coronary artery with stenosis ≤ 50 %; C- walls supplied by coronary artery with stenosis 51-70 %; D- walls with stenosis of supplying artery 71-99 %; and E- walls with totally occluded supplying artery. In global systolic function, the follow-up values of Sa glob in cohort I were improved by 0.23±0.36 as compared with baseline values at rest, and by 1.26±0.65 cm/s at the maximal load, while the values of Sa glob in cohort II were diminished by 0.53±0.22 (p=NS), and by 1.25±0.45 cm/s (p<0.05), respectively. Concerning the resting regional function, the only significant difference between cohorts in follow-up changes was found in walls E: 0.37±0.60 versus –1.76±0.40 cm/s (p<0.05). At the maximal load, the significant difference was found only in walls A (0.16±0.84 versus –2.67±0.87 cm/s; p<0.05). Patients with regular 12-month physical activity improved their global left ventricle systolic function mainly due to improvement of contractility in walls supplied by a totally occluded coronary artery.

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Evaluation of Cardiac Scan in Diagnosing Coronary-artery Disease

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666200530211415 ◽

2020 ◽

Vol 16 (8) ◽

pp. 1022-1028

Author(s):

Zubaida Butaish ◽

Masheal Alajmi ◽

Arouba Elahi ◽

Saeed M. Bafaraj

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Systolic Function ◽

Imaging Techniques ◽

Cost Effective ◽

Left Ventricular ◽

Diastolic Filling ◽

Study Results ◽

Artery Disease ◽

Lv Systolic Function

Background: With the evaluation of focal epicardial coronary stenosis and non-obstructive atherosclerosis, the cardiac scans play a significant role in diagnosing coronary artery disease (CAD). Moreover, the advancements in the imaging techniques leading to improved risk assessment and timely therapies help in early diagnosis of CAD with greater accuracy. Aims: To evaluate the role of cardiac scan in diagnosing CAD. Methods: Recruited 100 individuals without any history of CAD that refers to the assessment of suspected angina, conducted the prospective study. Electrocardiogram (ECG) findings assisted in the evaluation of left bundle branch blockage, abnormalities of ST-segment, and pathological Q waves. Results: The results depicted negative N.M findings among 38 respondents; whereas, ischemia and myocardial infarctions were diagnosed in 26% and 19% of the respondents, respectively. The majority of the males (59) were positive in contrast to 37 females with positive results. Similarly, 24 respondents were presented with mild dilated left atria (LA), 37 respondents suffered from impaired relaxation pattern of left ventricular (LV) diastolic filling; while, 40 of the respondents had normal global LV systolic function. Conclusion: The study results have concluded that non-invasive, low-risk, and cost-effective technique like ECG is an important beneficial advancement in the diagnosis of CAD.

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Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting

10.21203/rs.2.20921/v1 ◽

2020 ◽

Author(s):

Lu Liu ◽

Ping-Ping Meng ◽

Yong-Huai Wang ◽

Meng Li ◽

Jun Yang ◽

...

Keyword(s):

Coronary Artery ◽

Circumferential Strain ◽

Systolic Function ◽

Artery Bypass ◽

Radial Strain ◽

Left Ventricular ◽

Syntax Score ◽

Bypass Grafting ◽

Sphericity Index ◽

Lv Systolic Function

Abstract Background: Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG. Methods: Intraoperative transesophageal echocardiography was performed in 27 patients during elective CABG 5 minutes before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously. Results: LV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P<0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P<0.001). The LV volumes and LVEF remained unchanged. The SYNTAX score was an independent predictor of reduction of GLS by >15% immediately after pericardial incision (P<0.001). Conclusions: Pericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG, especially in those with a lower SYNTAX score.

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Impact of Bi-ventricular systolic function on mortality in patients with sepsis and septic shock

Kosuyolu Heart Journal ◽

10.51645/khj.2021.m120 ◽

2021 ◽

Author(s):

Elif Tükenmez Tigen ◽

Alper Kepez ◽

Murat Sünbül ◽

Beste Özben ◽

Buket Ertürk Şengel ◽

...

Keyword(s):

Septic Shock ◽

Hospital Mortality ◽

Systolic Function ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Survivor Group ◽

Significant Difference ◽

Echocardiographic Examination ◽

Sepsis And Septic Shock

Objectives: We aimed to evaluate left ventricular (LV) and right ventricular (RV) systolic performance in patients with sepsis or septic shock and possible functional alteration on in-hospital mortality. Patients and Methods: Thirty-seven consecutive patients with the diagnosis of sepsis or septic shock were included in the study. All patients underwent comprehensive transthoracic echocardiographic examination. Data of patients discharged from the intensive care unit was compared with data of patients who died in the hospital. Results: Fifteen patients (40.5%) survived, while 22 patients were died in the hospital (59.5%). A significant difference was detected between survivor and non-survivor groups regarding before discharge or death level of inflammatory markers such as CRP (p=0.05) and procalcitonin (p=0.03) besides BNP (p=0.01) and SOFA (p=0.009) score. There were two patients (5.4%) with EF value less than %50 in the study population. Eight patients (21.6%) displayed hypokinesia on the apical segment, and four patients (10.8%) had TAPSE values below 17 mm. One patient (6.6%) in the survivor group, but seven patients (31.8%) in the non-survivor group had apical hypokinesia with a trend towards significance (p=0.068). One patient in the survivor group (6.6%) and three patients (13.6%) in the non-survivor group had RV systolic dysfunction (p: 0.51). Conclusion: We found a much lower rate of LV and RV systolic dysfunction in patients with sepsis or septic shock compared with previous studies. None of the myocardial dysfunction types was associated with in-hospital mortality. Apical hypokinesia was also more prevalent in non-survivors despite borderline significance.

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