scholarly journals P366 Role of mechanical dispersion in the prediction of heart failure admissions in dilated non ischemic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Travieso Gonzalez ◽  
M Ferrandez Escarabajal ◽  
F Islas ◽  
M Luaces ◽  
L Perez De Isla ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
Mechanical Dispersion ◽  
End Diastolic Volume ◽  
2D Speckle Tracking ◽  
Baseline Characteristics

Abstract Introduction Non ischemic dilated cardiomyopathy (DCM) is a disease with poor prognosis and limited therapeutic options. Several echocardiographic measures attempt to provide good estimators of the risk of heart failure (HF) admissions. Purpose To assess the potential additional value of mechanical dispersion (MD) compared to global longitudinal strain (GLS) in the prediction of outcomes in DCM. Methods 74 patients with DCM and left ventricle ejection fraction (LVEF) of less than 50% were prospectively evaluated from 2015 to 2019. MD and GLS were blindly measured using 2D speckle tracking echocardiography. Hospital admissions due to worsening HF were examined. Results Mean LVEF was 29.4%, and median follow-up time was 14 months. Baseline characteristics are shown in Table 1. Patients with high MD, defined as >67 ms, showed a significantly higher risk of admissions due to HF (50.5% vs 22.0%, p = 0.026), even when adjusted with LVEF and end-diastolic volume in multivariable analysis, with a hazard ratio of 2.6 (95% confidence interval 1.1-6.1) (Figure). No differences in the use of cardiac resynchronization therapy and implantable cardioverter defibrillator were observed in both groups. This cut off value had a Sensitivity of 52.2% and Specificity of 76.5%. Despite significant correlation between MD and GLS (R = 0.36, p = 0.002), a GLS of less than -10% was not significantly associated with higher incidence of HF admissions in this population (40.6% vs 23.8%, p = 0.229). Conclusion Mechanical dispersion, measured by 2D speckle tracking echocardiography, predicts HF admissions more accurately than global longitudinal strain in patients with non-ischemic DCM. Table 1 Mech. Disp <67 ms (n = 50) Mech. Disp ≥67 ms (n = 24) p Age 62.2 (±2.2) 64.6 (±3.0) 0.538 Female sex 13 (26.0%) 10 (41.7%) 0.173 NYHA class III-IV 4 (8.5%) 3 (13.6%) 0.882 CRT 23 (46.0%) 12 (50.0%) 0.747 ICD 27 (54.0%) 17 (70.0%) 0.167 QRS duration (ms) 144.2 (±8.6) 152.7 (±7.9) 0.496 NTproBNP (pg/ml) 4495 (±964) 4488 (±1529) 0.997 LVEF (%) 29.9 (±1.1) 28.6 (±1.7) 0.520 LVEDV (ml/m2) 93.0 (±5.6) 95.2 (±5.8) 0.802 Table 1: baseline characteristics in population with MD <67 ms or ≥ MS. Data is shown as N(%) or Mean(±SD). CRT: cardiac resynchronization therapy. ICD: implantable cardioverter defibrillator. LVEDV: LV end-diastolic volume. Abstract P366 Figure

scholarly journals New capabilities in assessing the left ventricular contractility by two-dimensional speckle tracking echocardiography

2020 ◽  
Vol 35 (3) ◽  
pp. 79-85
Author(s):  
V. E. Oleynikov ◽  
Yu. G. Smirnov ◽  
V. A. Galimskaya ◽  
E. A. Gundarev ◽  
N. V. Burko
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Two Dimensional ◽  
Ventricular Contractility ◽  
Resynchronization Therapy ◽  
Clinical Implementation

This work reviews the reasons why the characteristics of left ventricular (LV) contractility, in particular, and 2D speckle echocardiography-based peak rates of global longitudinal strain (GLS), are not widely used in clinical practice. Authors present the analysis of new indicators proposed for the assessment ofLVcontractile function based on longitudinal strain taking into account the involvement of individual segments. The authors show that the assessment of myocardial work indicators characterizing the relationships between contractile and pump functions is a promising approach for the study ofLVcontractile function. The analysis of postsystolic strain index (PSI) is presented to illustrate its clinical implementation in the studies of viable myocardium in ischemic conditions and evaluating the effectiveness of cardiac resynchronization therapy (CRT).

scholarly journals The value of regional myocardial function assessment in patients with acute myocarditis at baseline and mid term follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Boidol ◽  
M Koziel ◽  
K Miszalski-Jamka ◽  
J Klys ◽  
Z Kalarus ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Ventricular Remodeling ◽  
Clinical Course ◽  
Troponin T ◽  
Global Longitudinal Strain ◽  
Cardiac Resynchronization ◽  
Global Improvement ◽  
Myocardial Disease ◽  
Mechanical Dispersion

Abstract Background The clinical course and ventricular remodeling in inflammatory myocardial disease could be unpredictable. No single functional parameter has been confirmed as a powerful predictor of clinical course and functional recovery assessment in patients with acute inflammatory myocardial disease. Purpose The aim of the study was to assess the mechanical properties of the myocardium in patients with active myocarditis at baseline and follow-up. Methods Database from a high volume, tertiary cardiology center was analysed to identify patients with active myocarditis, based on clinical presentation and ≥1 diagnostic criteria from different categories (including electrocardiography/holter, elevated troponin T/I levels, functional or structural abnormalities on cardiac imaging or tissue characterization by cardiac magnetic resonance) between 2016 and 2019. Conventional and speckle tracking echocardiography including global longitudinal strain (GLS) mechanical dispersion (MD) was completed at baseline and at 17±13 months follow-up. MD was calculated as a standard deviation of time to peak longitudinal strain derived from all left ventricle segments in 3 apical views. Results 61 consecutive patients [50 M, 11F, end-diastolic volume 212±84 ml, end-systolic volume 130±90ml, ejection fraction (EF) 42±16%] were enrolled. During the entire follow-up 1 patient died at early observation. Implantable cardioverter-defibrillator was implanted in 5 patients (primary prevention 4, secondary 1), cardiac resynchronization therapy pacemaker in 1 patient. Despite of significant global improvement (EF 42±16% vs 52±10%, p<0.001) the limited regional improvement was noticed (GLS 14±6% vs 15±4%, p = NS; MD 47±18 ms vs 45±20 ms, p=NS) in all patients at 17±13 months follow-up. There was a strong negative association between GLS and MD at baseline (Figure 1), and slightly weaker at follow-up (R=0.47, Pearson's correlation). Moreover, the GLS correlated well the change of MD in each individual patient. Conclusions Mechanical dispersion and global longitudinal strain may serve as an additional markers of myocardial damage and potential predictive markers in non ischemic cardiomyopathy patients with proven inflammatory origin. Funding Acknowledgement Type of funding source: None

scholarly journals Atrial and Ventricular Structural and Functional Alterations in Obese Children

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 562
Author(s):  
Rima Šileikienė ◽  
Karolina Adamonytė ◽  
Aristida Ziutelienė ◽  
Eglė Ramanauskienė ◽  
Jolanta Justina Vaškelytė
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
Z Score ◽  
Obese Children ◽  
2D Speckle Tracking

Background and objectives: Childhood obesity has reached epidemic levels in the world. Obesity in children is defined as a body mass index (BMI) equal to or above the 95th percentile for age and sex. The aim of this study was to determine early changes in cardiac structure and function in obese children by comparing them with their nonobese peers, using echocardiography methods. Materials and methods: The study enrolled 35 obese and 37 age-matched nonobese children. Standardized 2-dimensional (2D), pulsed wave tissue Doppler, and 2D speckle tracking echocardiography were performed. The z-score BMI and lipid metabolism were assessed in all children. Results: Obese children (aged 13.51 ± 2.15 years; 20 boys; BMI z-score of 0.88 ± 0.63) were characterized by enlarged ventricular and atrial volumes, a thicker left ventricular posterior wall, and increased left ventricular mass. Decreased LV and RV systolic and diastolic function was found in obese children. Atrial peak negative (contraction) strain (−2.05% ± 2.17% vs. −4.87% ± 2.97%, p < 0.001), LV and RV global longitudinal strain (−13.3% ± 2.88% vs. −16.87% ± 3.39%; −12.51% ± 10.09% vs. −21.51% ± 7.42%, p < 0.001), and LV global circumferential strain (−17.0 ± 2.7% vs. −19.5 ± 2.9%, p < 0.001) were reduced in obese children. LV torsion (17.94° ± 2.07° vs. 12.45° ± 3.94°, p < 0.001) and normalized torsion (2.49 ± 0.4°/cm vs. 1.86 ± 0.61°/cm, p = 0.001) were greater in obese than nonobese children. A significant inverse correlation was found between LV and RV global longitudinal strain and BMI (r = −0.526, p < 0.01; r = −0.434, p < 0.01) and total cholesterol (r = −0.417, p < 0.01). Multivariate analysis revealed that the BMI z-score was independently related to LV and RV global longitudinal strain as well as LV circumferential and radial strain. Conclusion: 2D speckle tracking echocardiography is beneficial in the early detection of regional LV systolic and diastolic dysfunctions, with preserved ejection fraction as well as additional RV and atrial involvement, in obese children. Obesity may negatively influence atrial and ventricular function, as measured by 2D speckle tracking echocardiography. Obese children, though they are apparently healthy, may have subclinical myocardial dysfunction.

Abstract 2819: Identification and Characterization of Super-Responders to Cardiac Resynchronization Therapy: An Echocardiographic Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Amira Zaroui ◽  
Patricia Reant ◽  
Erwan Donal ◽  
Aude Mignot ◽  
Pierre Bordachar ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
End Systolic Volume

In some patients, cardiac resynchronization therapy (CRT) has been recently shown to induce a spectacular effect on left ventricular (LV) function and inverted remodeling with nearby normalization of LV contraction. Objectives: To analyze and characterize super-responders (CRTSR) by echocardiography before CRT. 186 patients have been investigated before and 6 months after implantation of a CRT device with conventional indication according to ESC guidelines. Echocardiographies including measurements of LV dimensions, and contraction by 2-dimensional strain, and pressure assessment, mitral valve analysis were performed at baseline and at 6 months in an independent core-center lab. CRTSR were defined as a reduction of end-systolic volume of at least 15% and an ejection fraction (EF)>50% and were compared to normal responder patients (CRTNo, patients with a reduction of end-systolic volume of at least 15% but an EF <50%). 17/186 patients (9.1%) were identified as CRTSR, only 2 with ischemic cardiomyopathy (p<0.01). No difference was observed regarding NYHA status, EKG duration or EF between CRTSR and CRTNo at baseline. CRTSR presented with significant lower end-diastolic and end-systolic diameters (64±9mm vs 73±9mm (p<0.01) and 53±7.4mm vs 63±8.4mm (p<0.01), respectively), and end-diastolic and end-systolic volumes 161±44ml vs 210±76ml (p<0.02) and 123±43ml vs 163±69ml (p<0.01)) as well as a higher LV dP/dt max (714±251mmHg.s −1 vs 527±188 mmHg.s −1 (p<0.05)). Regarding strain analysis, CRTSR had significantly higher longitudinal values than CRTNo (−12.8±3% vs −9±2.6%, p<0.001) whereas no difference was observed for other components (p ns). Global longitudinal strain obtained by ROC curves was identified as the best parameter for predicting CRTSR with a cut-off value of −11% (Se=80%, Spe=87%, AUC=0.89, p<0.002) and was confirmed as an independent predictor by the logistic regression (RR: 21.3, p<0.0001). In a large multicenter study, CRT super-responders (EF>50%) were observed in 9% of the population and were associated with less-depressed LV function as determined by strain analysis. Global longitudinal strain appears to be the best predictor of CRTSR.

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