scholarly journals 434 Feasibility and reproducibility of parameters of cardiac function and dimension by transthoracic echocardiography in obesity patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Snelder ◽  
J O Younge ◽  
J E Van Velzen ◽  
J A Akkerhuis ◽  
F Zijlstra ◽  
...  

Abstract Background Cardiac disease occurs more frequently in obesity patients. Imaging by transthoracic echocardiography (TTE) can be limited due to poor acoustic windows. An increase of the number of obesity patients who need to undergo TTE is expected. Purpose The aim of this study was to evaluate the feasibility, test-retest variability and inter- and intra-observer variability of parameters of cardiac function and dimension by TTE in obesity patients as compared to non-obese controls. Methods 100 obesity patients (BMI≥35kg/m2) and 50 non-obese controls (BMI < 30kg/m2) without known cardiovascular disease were prospectively enrolled and underwent an echocardiogram. Feasibility of echocardiographic parameters was assessed by categorizing the image quality and by evaluating the availability of the echocardiographic parameters. Intra-observer reproducibility was assessed by one observer on the same echocardiographic loop in 50 patients. A second observer assessed interobserver reproducibility in these patients. In 37 obesity patients and 17 non-obese controls images were obtained by two physicians to investigate test-retest variability. Results Image quality was excellent in 11% of the obesity patients as compared to 60% of the non-obese controls. Nevertheless, apart from global longitudinal strain (GLS), all investigated parameters of cardiac function and dimension were available in both groups (Table). GLS was obtainable in 93% of obesity patients versus 98% of non-obese controls (p = 0.20). For the vast majority of parameters inter- and intra-observer variability was comparable between obesity patients and non-obese controls. There were no significant differences between obesity patients and non-obese controls regarding the test-retest variability (Table). Conclusion Although non-obese controls on average had better echocardiographic image quality than obesity patients, feasibility of assessment of a broad variety of parameters of cardiac function and dimension was excellent in obesity patients and there were no important differences regarding variability of measurements. Echocardiographic parameters Available obesity patients (n = 100) Available non-obese controls (n-50) Intra-observer variability obese (n = 50) Intra-observer variability non-obese (n = 25) Inter-observer variability obese (n = 50) Interobeserver variability non-obese (n = 25) Test-retest variability obese (n = 37) Test-rest variability non-obese(n= 17) IVSd 100% 100% 10.6 ± 6.3 6.8 ± 6.3* 10.8 ± 6.9 8.5 ± 4.5 11.1 ± 9.0 10.1 ± 6.4 LVEDD 100% 100% 5.4 ± 4.7 6.7 ± 5.3 5.5 ± 3.7 5.5 ± 3.3 6.7 ± 5.1 6.1 ± 5.2 PWd 100% 100% 12.4 ± 9.0 13.7 ± 9.6 11.5 ± 9.7 9.7 ± 6.7 12.4 ± 9.4 9.8 ± 6.4 E/A ratio 100% 100% 5.9 ± 9.6 2.1 ± 3.0 4.9 ± 5.0 3.8 ± 3.4 8.9 ± 5.7 8.5 ± 5.7 LA-volume index 100% 100% 12.3 ± 7.8 8.7 ± 6.5 11.0 ± 6.9 9.2 ± 4.8 13.6 ± 11.8 10.1 ± 6.3 GLS 93% 98% 6.8 ± 5.2 5.6 ± 4.6 6.4 ± 4.9 5.6 ± 4.6 8.8 ± 7.6 6.9 ± 5.3 Selection of various echocardiographic parameters. *p < 0.05

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Joaquin Duarte Ow ◽  
Mohamad Hemu ◽  
Anel Yakupovich ◽  
Parva Bhatt ◽  
Hannah Gaddam ◽  
...  

Abstract Introduction Assessment of cardiac function after treatment for breast cancer relies on interval evaluation of ventricular function through echocardiography. Women who undergo mastectomy more frequently choose to undergo breast reconstruction with implant. This could impede assessment of cardiac function in those with left-sided implant. We aimed to examine whether left-sided breast reconstruction with tissue expanders (TE) affect echo image acquisition and quality, possibly affecting clinical decision-making. Methods A retrospective case-control study was conducted in 190 female breast cancer patients who had undergone breast reconstruction with TE at an urban academic center. Echocardiographic technical assessment and image quality were respectively classified as excellent/good or adequate/technically difficult by technicians; and excellent/good or adequate/poor by 2 board-certified cardiologist readers. Likelihood ratio was used to test multivariate associations between image quality and left-sided TE. Results We identified 32 women (81.3% white; mean age 48 years) with left-sided/bilateral TE, and 158 right-sided/no TE (76.6% white, mean age 57 years). In multivariable analyses, we found a statistically significant difference in technician-assessed difficulty in image acquisition between cases and controls (p = 0.01); but no differences in physician-assessed image quality between cases and controls (p = 0.09, Pearson’s r = 0.467). Conclusions Left-sided breast TE appears to affect the technical difficulty of echo image acquisition, but not physician-assessed echo image quality. This likely means that echo technicians absorb most of the impediments associated with imaging patients with breast TE such that the presence of TE has no bearing on downstream clinical decision-making associated with echo image quality.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Kawakami ◽  
S Ramkumar ◽  
F Pathan ◽  
L Wright ◽  
T H Marwick

Abstract Background Although LV hypertrophy and dysfunction are associated with atrial fibrillation (AF), AF often occurs in the absence of LV hypertrophy or reduced ejection fraction. The effect of subclinical LV dysfunction on AF has not been fully studied. Purpose We sought the association between subclinical LV dysfunction (measured with global longitudinal strain, GLS) and new-onset AF. Methods This observational study evaluated 531 consecutive patients (median age, 67 years [interquartile range, 56 to 78]; 56% male), without a history of AF who underwent strain echocardiography after cryptogenic stroke. The CHARGE-AF score was used to calculate the 5-year risk of developing AF. Standard echocardiographic parameters were measured, and speckle-tracking was used to measure LA (reservoir strain, pump strain, and conduit strain) and LV strain (GLS). A strain analysis was conducted using a dedicated software package, using R-R gating. The baseline clinical and echocardiographic parameters of the patients who developed AF and those who did not were compared. Results Over 2.5 years of follow-up, 61 patients (11%) had new-onset AF. Patients who developed AF were older, had a higher CHARGE-AF score, larger LA volume, worse LA strain, and worse GLS than those who did not. Areas under the receiver-operating curve for GLS (0.84) was comparable to CHARGE-AF (0.79), LA pump strain (0.83), and LA reservoir strain (0.85). In the nested Cox models, GLS demonstrated an independent and incremental predictive value over the clinical and LA parameters (Figure). Moreover, adding GLS to the combined clinical and LA parameters model resulted in a significantly improved reclassification (net reclassification improvement, 0.32; p=0.016). Importantly, the predictive value of GLS was confirmed in patients with abnormal LA volumes (LA volume index≥34ml/m2) but not in patients with normal LA volumes. Figure 1 Conclusion GLS is associated with new-onset AF, especially in patients with abnormal LA volumes. This effect is independent of and incremental to the clinical and LA parameters.


2020 ◽  
Vol 27 (10) ◽  
pp. 561-570
Author(s):  
Atanaska Elenkova ◽  
Rabhat Shabani ◽  
Elena Kinova ◽  
Vladimir Vasilev ◽  
Assen Goudev ◽  
...  

Cardiomyopathy is a frequent complication of pheochromocytoma, and echocardiography is the most accessible method for its evaluation. The objective of this study was to assess the clinical significance of classical and novel echocardiographic parameters of cardiac function in 24 patients with pheochromocytomas (PPGL) compared to 24 subjects with essential hypertension (EH). Fourteen PPGL patients were reassessed after successful surgery. Left ventricular hypertrophy was four times more prevalent in patients with PPGL vs EH (75% vs 17%; P = 0.00005). Left ventricular mass index (LVMi) significantly correlated with urine metanephrine (MN) (rs = 0.452, P = 0.00127) and normetanephrine (NMN) (rs = 0.484, P = 0.00049). Ejection fraction (EF) and endocardial fractional shortening (EFS) were normal in all participants and did not correlate with urine metanephrines. Global longitudinal strain (GLS) was significantly lower in PPGL compared to EH group (−16.54 ± 1.83 vs −19.43 ± 2.19; P < 0.00001) and revealed a moderate significant positive correlations with age (rs = 0.489; P = 0.015), LVMi (rs = 0.576, P < 0.0001), MN (rs = 0.502, P = 0.00028) and NMN (rs = 0.580, P < 0.0001). Relative wall thickness (RWT) showed a strong positive correlation with urine MN (rs = 0.559, P < 0.0001) and NMN (rs = 0.689, P < 0.00001). Markedly decreased LVMi (118.2 ± 26.9 vs 102.9 ± 22.3; P = 0.007) and significant improvement in GLS (−16.64 ± 1.49 vs −19.57 ± 1.28; P < 0.001) was observed after surgery. ΔGLS depended significantly on the follow-up duration. In conclusion, classical echocardiographic parameters usually used for assessment of systolic cardiac function are not reliable tests in pheochromocytoma patients. Instead, GLS seems to be a better predictor for the severity and the reversibility of catecholamine-induced myocardial function damage in these subjects. RWT should be measured routinely as an early indicator of cardiac remodeling.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Neha Bansal ◽  
Nadia Ovchinsky ◽  
Jacqueline M Lamour ◽  
Debora Kogan-Liberman ◽  
Trang Nguyen ◽  
...  

Introduction: Cirrhotic cardiomyopathy is a hemodynamic complication of cirrhosis resulting in cardiac dysfunction. It remains poorly characterized in children. Our aim was to assess cardiac function using speckle tracking echocardiography (STE), a marker of subclinical cardiac dysfunction, in patients undergoing liver transplant (LT) and correlate it with their post-operative (op) clinical course. Methods: This is a retrospective study of pre-LT echocardiograms performed on pediatric patients (pts) with cirrhosis at a single tertiary care center who received a LT. Demographic clinical and echocardiographic data was collected and STE was performed by a single observer using TomTec system. Descriptive data was expressed as mean (SD) and number (%). The relationship between clinical data and echocardiographic variables was assessed using Pearson correlation coefficient. Significance was set at P value < 0.05. Results: Twenty-three pts underwent LT between 03/2013-12/2019 with median age 7.5 (IQR 0.1, 17) years and 31 % with biliary atresia. Five patients were listed as status 1A/1B. Their mean natural pediatric/model end-stage lived disease (PELD/MELD) score was 15. Their pre-LT echocardiogram showed normal left ventricular (LV) ejection fraction and normal right ventricular (RV) fractional area change. Tricuspid annular plane systolic excursion (TAPSE) was abnormal in 50% of pts. While LV global longitudinal strain (GLS) (23 ± 3%) and LV circumferential strain (27 ± 4%) were normal, RV GLS was abnormal in 65% of pts (22 ± 3%). There was no correlation between echocardiographic parameters and post-operative LT course (length of stay, duration of mechanical ventilation, surgical complications). Conclusions: Children undergoing liver transplant have RV dysfunction as evidenced by abnormal TAPSE and RV GLS on speckle tracking echocardiography. Echocardiographic parameters do not correlate with the immediate post-LT clinical status.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Branco Mano ◽  
L Moura Branco ◽  
S Aguiar Rosa ◽  
A Agapito ◽  
A T Timoteo ◽  
...  

Abstract Background Although heart disease in haemoglobinopathy have dramatically reduced with modern therapy, cardiac complications are still a leading cause of morbimortality. It became essential to detect cardiac complications in early stages in order to provide specific therapy and to improve prognosis. Transthoracic echocardiography (TTE) has a paramount role in this field. Purpose To evaluate cardiac function in haemoglobinopathy patients and to correlate echocardiographic parameters with haematological determinants. Methods Retrospective analysis of haemoglobinopathy patients (pts) referred to a tertiary centre for cardiac evaluation and transthoracic echocardiography. Epidemiological, clinical, laboratory and echocardiographic data were analysed. Comparations between echocardiographic data and haemoglobin and serum ferritin levels were performed (independent T test). P value &lt;0.05 was considered statistically significant. Results 55 pts were included: 58% female, mean age 37.9 ± 10.9 years, 85% with sickle cell disease, 13% (N = 7) with previous thromboembolic event and 20% (N = 11) with documented hemosiderosis. 36% (N = 20) were symptomatic (9 pts with palpitations, 6 pts with thoracic pain and 5 pts with exertion dyspnea – New York Heart Association class II). The mean haemoglobin level was 8.96 ± 1.91 g/dL and serum ferritin 1335.5 ± 2452 ng/mL. All patients had preserved left and right ventricular systolic function (TAPSE 27.1 ± 4.9mm) The mean left ventricular (LV) end-diastolic diameter indexed to body surface area (female 32.2 ± 4.7mm/m2; male: 31.2 ± 4.0mm/m2) and LV mass index (female 105.6 ± 31.4g/m2; male: 134.7 ± 97.3g/m2) were increased in both genders, although interventricular septum thickness was in the superior normal range (mean 9.3 ± 1.6mm). Left atrium enlargement was also present (29.9 ± 8.4mm/m2). The mean global ratio between early mitral inflow velocity and mean (septal and lateral) mitral annular early diastolic velocity (E/e") was 7.5 ±2.3, and 12 pts (21.8%) had impairment of LV diastolic function. Global longitudinal strain (GLS) was assessed in 35 pts, with a mean value of 19.6 ± 2.9%. 40% (14 pts) had GLS &gt; -18%, being the septal wall the most frequently affected. Pulmonary hypertension was rare (3 pts), with mean arterial pulmonary pressure of 27.7 ± 7.0mmHg. An agreement was found between serum ferritin levels and GLS impairment defined as GLS &gt; -18% (2649ng/ml vs 549ng/ml, p = 0.04). Pts with diastolic dysfunction had a trend to higher serum ferritin levels (2753ng/ml vs 1001ng/ml, p = 0.06). The haemoglobin levels did not correlate with echocardiographic parameters. Conclusion In the study population of haemoglobinopathy pts, mainly constituted by cardiac asymptomatic individuals, LV diastolic dysfunction and LV global longitudinal strain were impaired in 22% and 40%, respectively. These echocardiographic parameters revealed to be related to serum ferritin levels.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Orstad ◽  
K Steine ◽  
T Nerdrum

Abstract Background It is recommended that breast cancer patients should undergo cardiac follow-up during chemotherapy, with clinical assessment and echocardiogram. Standard measurements are robust and reproducible, but novel echocardiography methods as global longitudinal strain (GLS) and three-dimensional (3D) echocardiography are recommended due to their superior sensitivity. These methods require high-quality images. Breast cancer surgery may lead to reduced echocardiographic image quality in this population, in addition to age, obesity and smoking. Purpose We wanted to explore the feasibility of standard and novel echo methods in an unselected breast cancer population. Methods The present study included consecutive, unselected patients referred to baseline echocardiogram at the cardio oncology outpatient clinic in a large university hospital prior to start of adjuvant chemotherapy. Data on surgery, smoking habits, age and body mass index were collected. Feasibility was defined as the presence or absence to carry out meaningful measurements of left ventricular (LV) systolic function, from standard mitral annular plane systolic excursion (MAPSE) and two-dimensional LV ejection fraction (EF), to novel GLS and 3D LVEF. Multivariable logistic regression was performed to assess the impact of relevant variables on image quality. Results 116 female patients were included. 21 % of these patients had insufficient images for novel analyses. Left sided breast implant (OR 5,77; P 0,04), age (OR 3,89; P 0,02) and daily smoking (OR 3,57; P 0,03) were found to be independently associated with insufficient image quality. Standard analyses like two-dimensional EF and MAPSE were obtainable in 99 and 97 % of the examinations, respectively. Conclusion One of five in a postoperative breast cancer population cannot undergo follow-up using novel, sensitive echocardiographic measurements. Standard measurements, however, are obtainable in almost all patients. It is therefore important that these measurements are included in cardiac follow-up during chemotherapy.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Q Bui ◽  
G Ma ◽  
M Kraushaar ◽  
V Escobedo ◽  
B Le ◽  
...  

Abstract Background Danon Disease (DD) is a rare X-linked autophagic disorder due to mutations in the Lysosomal Associated Membrane Protein 2 (LAMP-2) gene and causes severe cardiac manifestations. Measurement of longitudinal strain (LS) has been shown to provide diagnostic insights into different etiologies of hypertrophic cardiomyopathies compared to conventional echocardiographic parameters. Purpose The aim of this study was to describe the pattern of global and regional LS in DD. Methods A retrospective, international registry, using medical records provided by patients, was formed to describe the natural history of DD. Complete echocardiogram images were available for review and LS was analyzed globally and regionally (basal, mid, apex). Results A total of eighteen DD patients (male 72%, mean age 17.2±10 years) had sufficient quality echocardiographic images for both traditional and myocardial strain evaluation. Notable traditional echocardiographic parameters included a mean EF of 60±11%, LV mass index 200±159 g/m2, intraventricular septal diameter 17.7±10.3 mm, LV posterior wall diameter 16.1±7.7 mm, LA volume index 21.9±13 mL/m2. Global longitudinal strain was reduced with a mean of −12.1±4.9% with an observed regional strain gradient: apex (−16.6±6.6%), mid (−10.9±4.7%) and basal (−9.2±4.5%). Bull's eye plot patterns reflected an apical sparing pattern that was similar to that described in cardiac amyloidosis. Conclusion In this DD cohort, we describe for the first time a strain pattern characterized by reduction in global longitudinal strain with apical sparing, which was originally pathognomonic for cardiac amyloidosis. This strain pattern in conjunction with a paradoxically normal LA volume may discriminate patients with DD from other hypertrophic conditions. Funding Acknowledgement Type of funding source: None


2017 ◽  
Vol 52 (2) ◽  
pp. 196-199
Author(s):  
Michelle E Colpitts ◽  
Rachel C Phillion ◽  
Marcin Malinowski ◽  
Rhonda A Coleman ◽  
Lou A Mitchell ◽  
...  

Transthoracic echocardiography (TTE) is a valuable non-invasive imaging research technique. In ovine models of cardiac disease, restraint for TTE often involves sedation even with currently available restraint equipment; our goal was to determine the feasibility of using a commercial restraint device, commonly known as the sheep chair, in minimizing animal stress and the need for sedation while achieving a complete TTE examination. A total of 10 healthy adult Dorset sheep were restrained in a sheep chair for TTE and observed for signs of stress. No animals displayed overt evidence of stress and none required sedation. While individual anatomic variation existed, image quality was sufficient to determine cardiac function. These observations suggest that a sheep chair is a useful aid in minimizing the need for sedation to acquire a full TTE study in ovine subjects.


2021 ◽  
Vol 11 ◽  
Author(s):  
Savannah V. Wooten ◽  
Stefan Moestl ◽  
Phil Chilibeck ◽  
José Ramón Alvero Cruz ◽  
Uwe Mittag ◽  
...  

BackgroundCardiac function and morphology are known to differ between men and women. Sex differences seen with echocardiography have not been studied systematically in masters athletes.PurposeTo evaluate sex differences in cardiac structure, function and left ventricular (LV) systolic global longitudinal strain among masters athletes.MethodsThis cross-sectional study comprises of 163 masters athletes (M = 109, 60 ± 12 years; F = 55, 57 ± 12 years, range 36–91 years) who participated at the 23rd World Masters Athletics Championship held in Málaga, Spain. All athletes underwent state-of-the-art echocardiography including cardiac function, morphology, strain and hemodynamic assessment.ResultsLeft ventricular mass was higher in male than in female athletes (174 ± 44 vs. 141 ± 36 g, p &lt; 0.01) due to greater end-diastolic intraventricular septal, LV posterior wall and LV basal diameter. However, LV mass index did not differ between the groups. End-diastolic LV volume and right ventricular area, both indexed to body-surface-area, were greater in men than in women (52.8 ± 11.0 vs. 46.1 ± 8.5 ml/m2, p &lt; 0.01, 9.5 ± 2.4 vs. 8.1 ± 1.7 cm2/m2, p &lt; 0.01). In contrast, women had higher LV systolic global longitudinal strain (-20.2 ± 2.6 vs. -18.8 ± 2.6%, p &lt; 0.01) and LV outflow tract flow velocity (75.1 ± 11.1 vs. 71.2 ± 11.1 cm/s, p = 0.04). Systolic and diastolic blood pressure, LV ejection fraction, and stroke volume index were not different between sexes.ConclusionCardiac sex differences are present even among masters athletes. Lifelong exercise training does not appear to exasperate morphological difference to a point of cardiac risk or dysfunction in both male and female athletes.


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