scholarly journals P905 Value of global longitudinal strain (GLS) in the short term prognosis of geriatric patients with asymptomatic severe aortic stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Ramos Sanchez ◽  
M Quezada ◽  
A Garcia ◽  
R Ayala ◽  
C Herrera ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Geriatric Patients ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Event Free Survival ◽  
Short Term ◽  
Free Survival ◽  
Global Population

Abstract Funding Acknowledgements VII Convocatoria del Banco de Santander and Alfonso X el Sabio University. Background Detection of symptoms in geriatric population with aortic stenosis (AS) is challenging, especially when they associate other comorbidities or frailty. Left ventricular global longitudinal strain (GLS) occurs before left ventricular ejection fraction impairment and could be useful for risk stratification and management of these patients. Purpose We sought to analyze the usefulness of GLS for predicting major cardiovascular adverse events (MACEs) in geriatric patients with asymptomatic severe AS. Material and Methods: Prospective study on 54 patients older than 70 years old with severe asymptomatic AS. Patient evaluation included biochemistry tests, electrocardiogram and echocardiography. We use a GLS cut-off point of 18% to dichotomize patients. Outcomes were defined as the composite of MACEs – occurrence of death from any cause, hospitalization for heart failure, appearance of symptoms or change in treatment. Results The mean age was 83.2 ± 7.1, with 60.4% of women. 24.5% showed atrial fibrillation. At 6 months of follow-up, 33% of patients reached the endpoint: 5.6% CHF, 11.1% death, 3.7% symptoms without changes in management and 13% were referred to an invasive treatment. The event-free survival rate at 6 months for the global population was 83%. 41.5 % of the subjects had GLS < 18%. Kaplan Meier analysis showed that the probability of freedom from MACEs was not significant in patients with lower GLS (Log Rank p = 0.39). In the multivariate analysis only AVA was an inverse predictor of events (AVA) HR 0.05 (95% CI 0.007- 0.471, p < 0.05). Conclusions The value of GLS was not a predictor of short term events in geriatric patients. Only assessment of AVA was an independent marker of MACES and in this kind of subjects. Charasteristics of the global population Global N = 53 (%) GLS ≥ 18 N = 31 (58.5%) GLS < 18 N = 22 (41.5%) (p) HBP 42 (79.2) 27 (87.1) 19 (82.6) 0.09 Atrial fibrillation 13 (24.5) 6 (19.4) 7 (31.8) 0.29 CVD 6 (11.3) 1 (3.2) 5 (22.7) 0.02 LVEF: Normal >50% 48 (92) 31 (100) 17 (77.2) 0.05 Peak velocity 3.72 ± 0.72 3.81 ± 0.71 3.60 ± 0.74 0.315 Mean gradient 34.01 ± 14.06 35.61 ± 13.54 32.09 ± 15.07 0.29 Integral ratio 0.25 ± 0.08 0.26 ± 0.09 0.25 ± 0.08 0.83 AVA 0.8 ± 0.26 0.78 ± 0.27 0.83 ± 0.26 0.651 Indexed AVA 0.48 ± 0.16 0.48 ± 0.17 0.48 ± 0.16 0.9 AVA Aortic valve area; CVD: cerebro vascular disease; HBP: High blood presure; LVEF: left ventricule ejection fraction. Abstract P905 Figure. Kapplan-Meier event-free survival curves

1227 Risk stratification of patients with asymptomatic moderate mitral regurgitation: the prognostic value of left atrial strain

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Cameli ◽  
M C Pastore ◽  
F M Righini ◽  
G E Mandoli ◽  
F D"ascenzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Mitral Regurgitation ◽  
Risk Stratification ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Event Free Survival ◽  
Free Survival

Abstract Background In asymptomatic moderate mitral regurgitation (MR), the criteria for risk stratification are still uncertain. Therefore, in these patients, optimal time of surgery remains controversial. Purpose Our aim was to compare left atrial (LA) strain to other echocardiographic parameters for the prediction of cardiovascular (CV) events in patients with asymptomatic moderate MR. Methods 401 patients with primary degenerative asymptomatic moderate MR was enrolled and prospectively followed for the development of CV events (i.e. atrial fibrillation, stroke/transient ischemic attack, acute heart failure, CV death). Patients with history of atrial fibrillation, myocardial infarction, heart failure, cardiac surgery or heart transplantation, severe MR, mitral valve surgery during follow-up were excluded. Results During a mean follow up of 3.4 ± 2 years, of the 326 patients eligible (mean age 65 ± 9 years), 122 patients had 149 new events. There were no significative differences in mean age and sex, clinical and therapeutic characteristics between the two groups. The event-group presented reduced global peak atrial longitudinal strain (PALS), LA emptying fraction, LV strain at baseline, and larger LA volume indexed (p <0.0001). Receiver operating characteristics curves proved the greatest predictive performance for global PALS < 35% (AUC 0.88). Bland-Altman analysis demonstrated good intra- and inter-observer agreement and Kaplan Meier analysis showed a graded association between PALS and event-free-survival. Conclusions Speckle tracking echocardiography could provide a useful index, global PALS, to estimate LA function in patients with asymptomatic moderate MR in order to optimize surgical timing before the development of irreversible myocardial dysfunction. Echo-data of our study population Variable No CV events (n = 204) CV events (n = 122) LV ejection fraction (%) 59 ± 9 58 ± 10 LV global longitudinal strain (%) - 18.5 ± 3.4 -17.6 ± 3.6* LA volume indexed (ml/m2) 32.5 ± 6.7 36.4 ± 7.1* LA emptying fraction (%) 68 ± 13 62 ± 15* Mitral E/A ratio 0.94 ± 0.14 0.95 ± 0.16 Mitral E/E’ ratio 11.2 ± 6.5 12.4 ± 7.1 Mitral regurgitant fraction (%) 38.9 ± 8.1 39.1 ± 9.4 End regurgitation orifice area (cm2) 0.34 ± 0.05 0.34 ± 0.06 Global PALS (%) 32.5 ± 8.5 19.7 ± 8.1* *Significative variation between groups. Cardiovascular, CV; Left atrial, LA; Left ventricular, LV; Peak atrial longitudinal strain, PALS Abstract 1227 Figure. Event-free survival according to PALS

Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Philabout ◽  
L Soulat-Dufour ◽  
I Benhamou-Tarallo ◽  
S Lang ◽  
S Ederhy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cardiac Rhythm ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Chamber ◽  
Deformation Imaging ◽  
And Function

Abstract Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p<0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p<0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p<0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure). Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

P1783Prognostic implications of significant tricuspid regurgitation in patients with atrial fibrillation in the absence of left-sided heart disease or pulmonary hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M F Dietz ◽  
E A Prihadi ◽  
P Van Der Bijl ◽  
N Ajmone Marsan ◽  
V Delgado ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Tricuspid Regurgitation ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Event Free Survival ◽  
Free Survival ◽  
Rv Function

Abstract Background Tricuspid regurgitation (TR) can be caused by atrial fibrillation (AF) in the absence of left-sided heart disease or pulmonary hypertension. The prognostic impact of AF-TR has not been investigated. Purpose The aim of this study was to investigate the prognostic significance of TR in AF patients who do not show left-sided heart disease, pulmonary hypertension or primary structural abnormalities. Methods A total of 63 AF patients with moderate and severe TR were identified and matched by age and gender to 116 patients with AF without significant TR, resulting in a total study population of 179 patients (mean age 71±7 years, 59% male). As per design of the study, patients with primary TR, significant (moderate or severe) aortic and/or mitral valve disease, previous valvular surgery, congenital heart disease, left ventricular ejection fraction <50%, systolic pulmonary artery pressure >40mmHg, pacemaker or implantable cardioverter defibrillator leads in situ were excluded as well as patients with AF de novo. Patients were followed for the combined endpoint of all-cause mortality, hospitalization for heart failure and stroke. Results Patients with AF-TR had more often paroxysmal AF as compared to patients without TR (60% vs. 43%, p=0.028). In addition, right atrial volumes and the tricuspid annulus diameter (TAD) were significantly larger in patients with AF-TR compared to their counterparts (p<0.001 for all). Furthermore, tricuspid annular plane systolic excursion was significantly lower in patients with AF-TR (17±5 mm vs. 21±6 mm, p<0.001). During follow-up (median 62 [32–95] months) 55 events for the combined endpoint occurred. One- and 5-year event-free survival rates for patients with TR were 71% and 53%, compared to 92% and 85% for patients without TR, respectively (Log rank Chi-Square p<0.001; Figure). In the multivariable Cox proportional hazard model adjusted for age, gender, NYHA functional class >2, renal function, right ventricular (RV) function and TAD, the presence of significant TR was independently associated with the combined endpoint (HR, 2.495; 95% CI, 1.167–5.335; p=0.018), while RV function was not (HR, 1.026; 95% CI, 0.971–1.085; p=0.364). Figure 1. Kaplan-Meier curves Conclusion In the absence of left-sided heart disease and pulmonary hypertension, significant TR is independently associated with worse event-free survival in patients with AF.

scholarly journals Left Ventricular Global Longitudinal Strain Is Associated With Long-Term Outcomes in Moderate Aortic Stenosis

2020 ◽  
Vol 13 (4) ◽  
Author(s):  
Dan Zhu ◽  
Saki Ito ◽  
William R. Miranda ◽  
Vuyisile T. Nkomo ◽  
Sorin V. Pislaru ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Long Term Outcomes

P1485Left atrial reservoir function is associated with major adverse cardiac events in patients undergoing transarterial valve implantation for isolated severe aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Weber ◽  
F Petillo ◽  
S Pollack ◽  
G Petrossian ◽  
N Robinson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Independent Predictor ◽  
Global Longitudinal Strain ◽  
Free Wall ◽  
Valve Implantation

Abstract Background Left atrial (LA) reservoir function as measured by LA global longitudinal strain (LAGS) is an independent predictor of left ventricular (LV) performance and has prognostic value. Purpose To evaluate by speckle tracking echocardiography (STE), LAGS and other myocardial deformation indices changes after transarterial valve implantation (TAVI) for severe isolated aortic stenosis (AS) in relation to the outcome measures. Methods Of 995 pts who underwent TAVI at our Institution between 2017–18, 120 (age = 82.8±7.7 years, 74% female, AVAi = 0.37±0.09 cm2/m2, LVEF = 61.6±11.3%, no > than 2+ mitral or aortic regurgitation, all in NSR) underwent 2-D echocardiography and STE, pre (21±34 days) and post (16±27 days) TAVI. LAGS was measured at QRS onset, and LV global longitudinal strain (LVGS) and RV free wall strain were recorded. The velocity index = peak vel LVOT/AV. Phillips IE 33 scanners (frame rates 60–80 Hz) were used and one observer analyzed data on QLAB software. The median follow-up was 208 days (range 20–763). The outcome variable was a composite of death, atrial fibrillation and hospitalization for heart failure (MACE). Univariate and multivariable logistic regression were used to determine independent predictors of LA, LV and RV free wall global strain changes (covariates; age, sex, BSA, LVEF, systolic blood pressure, LA volume index) and, separately, for predictors of MACE (covariates; age, sex, AVA index, LVEF and E/e'). Intra- and interclass correlation coefficients (ICC) were calculated. Results The intra- and inter-observer ICC was 0.70–0.90 and 0.90–0.95, respectively. In the absence of LA volume change, LAGS improved post TAVI in 54% of pts. Overall, mean change was 2.2±11.6% (95% CI; 0.05, 4.3) and it was significantly associated in multivariable analysis with RV free wall strain (OR=2.7, 95% CI; 1.2, 6), velocity index (OR=0.4, 95% CI; 0.2, 1), LVEF (OR= 0.3, 95% CI; 0.2, 0.8) and LVGS (OR=3.8, 95% CI; 1.4, 10), yielding together an AUC of 0.90. LVGS improved in 64% of pts by −2.8±7.5%, (95% CI: −4.2, −1.5) and the velocity index independently predicted the LVGS change (OR = 0.6; 95% CI: 0.4, 0.9). The other deformation indices did not significantly change. At follow-up, there were 6 hospitalizations for heart failure, 5 atrial fibrillation events and 6 deaths. At multivariable logistic regression analysis, post TAVI LAGS was the only variable independently predicting MACE (OR (in units of 1%) = 0.90, 95% CI; 0.82, 0.98), estimating that a 1% increase in post-LAGS decreases the likelihood of MACE by 10%. Conclusions 1. There was no relationship between LA systolic volume and LAGS change after TAVI. 2. Within a month after the procedure, LAGS improves in less than half of pts and is directly associated with both ventricles systolic function and AS severity. 3. At a median of 9 months after TAVI, post procedural LAGS is an independent predictor of MACE and could be used in the risk stratification of such pts.

3224Incremental benefit of left ventricular global longitudinal strain over clinical and left atrial parameters for predicting new-onset atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Kawakami ◽  
S Ramkumar ◽  
F Pathan ◽  
L Wright ◽  
T H Marwick
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Receiver Operating Curve ◽  
Lv Dysfunction ◽  
Echocardiographic Parameters ◽  
New Onset

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.

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