scholarly journals P914 Changes of echocardiographic parameters in primary mitral regurgitation and determinants of symptom: an assessment from the Asian valve registry data

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Amano ◽  
C Izumi ◽  
Y J Kim ◽  
S J Park ◽  
S W Park ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Volume Index ◽  
P Value ◽  
Actual Measurement ◽  
Determinant Factors ◽  
Lv Mass ◽  
Echocardiographic Parameters

Abstract [Background]Clinicians often have a difficulty in determining the presence of mitral regurgitation (MR)-relatedsymptoms because of subjectivity.However, there are few actual measurement data for echocardiographic left ventricular (LV) and left atrial (LA) size related to the severity of MR and the relationship between MR-related symptoms and these echocardiographic parameters. [Purpose] The purpose of this study was to clarify actual values for echocardiographic parameters related to severity of MR and determinant factors of MR-related symptoms. [Methods] Among patients enrolled in the Asian Valve Registry, we investigated 778 consecutive patients with primary MR showing sinus rhythm. Symptoms were determined by NYHA (≤ II or ≥ III). [Results]MR severity was mild in 106, moderate in 285, and severe in 387 patients. LA volume index, LV end-diastolic diameter, and LV mass index increased with increasing MR grade [LA volume index: 47.9 (mild), 56.2 (moderate), and 64.9 ml/m2(severe) (p < 0.001), LV end-diastolic diameter: 51.2, 54.5, 58.1 mm (p < 0.001), and LV mass index: 101, 109, 123 g/m2(p < 0.001)]. Regarding moderate and severe MR, 70 patients (10.4%) were symptomatic. Table shows multivariable analysis for being symptomatic in moderate and severe MR patients. LV mass index (p = 0.040), ejection fraction (p < 0.001), female gender (p = 0.004), and heart rate (p = 0.007) were independent factors for MR-related symptoms. [Conclusions] LV and LA parameters on echocardiography worsened as MR severity progressed. Larger LV mass index and lower ejection fraction were independent determinant factors for MR-related symptoms. We should also pay attention to LV hypertrophy in patients with primary MR. Determinant factors for mitral regurgita Model 1 Model 2 OR (95% CI) P-value OR (95% CI) P-value Age, per 1-y increment 1.03 (1.00-1.05) 0.035 1.02 (0.99-1.05) 0.053 Sex (female) 2.23 (1.20-4.16) 0.011 2.28 (1.31-3.98) 0.004 Hear rate, per 1 bpm increment 1.03 (1.00-1.05) 0.025 1.03 (1.01-1.05) 0.007 LVDs index, per 1 mm increment 0.99 (0.90-1.09) 0.90 EF, per 1% increment 0.95 (0.92-0.99) 0.019 0.96 (0.93-0.98) <0.001 LV mass index, per 10 g/m2increment 1.12 (1.01-1.25) 0.033 1.09 (1.005-1.18) 0.040 LA volume index, per 10 mL/m2increment 0.96 (0.90-1.03) 0.23 E wave, per 1cm/s increment 1.81 (0.70-4.66) 0.23 TR pressure gradient >40 mmHg 2.11 (0.97-4.57) 0.057 Hypertention 1.40 (0.75-2.63) 0.29

Prognostic value of global longitudinal layer specific strain for patients with heart failure with reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Johnsen ◽  
M Sengeloev ◽  
P Joergensen ◽  
N Bruun ◽  
D Modin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Volume Index ◽  
Funding Source ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Echocardiographic Parameters

Abstract Background Novel echocardiographic software allows for layer-specific evaluation of myocardial deformation by 2-dimensional speckle tracking echocardiography. Endocardial, epicardial- and whole wall global longitudinal strain (GLS) may be superior to conventional echocardiographic parameters in predicting all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Purpose The purpose of this study was to investigate the prognostic value of endocardial-, epicardial- and whole wall GLS in patients with HFrEF in relation to all-cause mortality. Methods We included and analyzed transthoracic echocardiographic examinations from 1,015 patients with HFrEF. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained. A p value in a 2-sided test <0.05 was considered statistically significant. Cox proportional hazards regression models were constructed, and both univariable and multivariable hazard ratios (HRs) were calculated. Results During a median follow-up time of 40 months, 171 patients (16.8%) died. A lower endocardial (HR 1.17; 95% CI (1.11–1.23), per 1% decrease, p<0.001), epicardial (HR 1.20; 95% CI (1.13–1.27), per 1% decrease, p<0.001), and whole wall (HR 1.20; 95% CI (1.14–1.27), per 1% decrease, p<0.001) GLS were all associated with higher risk of death (Figure 1). Both endocardial (HR 1.12; 95% CI (1.01–1.23), p=0.027), epicardial (HR 1.13; 95% CI (1.01–1.26), p=0.040) and whole wall (HR 1.13; 95% CI (1.01–1.27), p=0.030) GLS remained independent predictors of mortality in the multivariable models after adjusting for significant clinical parameters (age, sex, total cholesterol, mean arterial pressure, heart rate, ischemic cardiomyopathy, percutaneous transluminal coronary angioplasty and diabetes) and conventional echocardiographic parameters (left ventricular (LV) ejection fraction, LV mass index, left atrial volume index, deceleration time, E/e', E-velocity, E/A ratio and tricuspid annular plane systolic excursion). No other echocardiographic parameters remained an independent predictors after adjusting. Furthermore, endocardial, epicardial and whole wall GLS had the highest C-statistics of all the echocardiographic parameters. Conclusion Endocardial, epicardial and whole wall GLS are independent predictors of all-cause mortality in patients with HFrEF. Furthermore, endocardial, epicardial and whole wall GLS were superior prognosticators of all-cause mortality compared with all other echocardiographic parameters. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Herlev and Gentofte Hospital

scholarly journals P353 Structural, functional, and electromechanical alterations in patients with paroxysmal atrial fibrillation compared to healthy controls

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Trivedi ◽  
L Stefani ◽  
P Brown ◽  
E Kizana ◽  
S Kumar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Inverse Correlation ◽  
Left Ventricular ◽  
P Value ◽  
Healthy Controls ◽  
Systolic Volume ◽  
Mechanical Dispersion ◽  
Lv Mass ◽  
Echocardiographic Parameters

Abstract Background and Methods We sought to evaluate the clinical and echocardiographic differences between healthy controls and paroxysmal atrial fibrillation (AF) patients. Clinical and echocardiographic parameters (performed in sinus rhythm) in 46 paroxysmal AF patients were compared with a departmental database of 83 health controls. Results AF patients were older and had increased body size (Table 1). 39/46 (84%) of AF patients had hypertension and 23/46 (50%) had diabetes mellitus. AF patients had increased left ventricular (LV) mass, and reduced diastolic function (lower e’ and increased E/e’ ratio) when compared to healthy controls. Left atrial (LA) volumes were significantly increased in the AF group. All strain parameters – reservoir, conduit, and contractile strain – were impaired in AF patients compared to controls. LA mechanical dispersion (MD) was significantly increased in AF patients. A ratio of indexed LA volume/LA reservoir strain was significantly higher in AF patients over controls. The duration of AF had an inverse correlation with LA reservoir strain (Fig 1) (r=–0.78; p < 0.001). Conclusions Compared to healthy controls, patients with paroxysmal AF have significant structural, functional and electromechanical alterations. LA strain is significantly impaired in paroxysmal AF and correlates with AF duration. Table 1. Echocardiographic parameters Parameter Controls (mean ± SD) AF patients (mean ± SD) P value Age (years) 48 ± 18 58 ± 14 0.001 Body surface area (m2) 1.9 ± 0.2 2 ± 0.2 0.014 LV mass (g) 178 ± 48 223 ± 68 <0.001 Average e’ velocity (cms-1) 10.3 ±2.7 8.1 ± 2.2 <0.001 E/e’ 7.4 ± 1.9 9.3 ± 3.4 0.001 Indexed LA end systolic volume (ml/m2) 27.2 ± 7.1 39.0 ± 11.6 <0.001 LA ejection fraction 55.2 ± 10.4 48.5 ± 14.0 0.007 LA functional index 43.7 ± 14.6 29.8 ± 14.3 <0.001 LA reservoir strain (%) 34.3 ± 6.8 27.9± 8.1 <0.001 LA conduit strain (%) 18.4 ± 6.2 13.5 ± 4.7 <0.001 LA contractile strain (%) 15.9 ± 3.9 14.4 ± 5.5 0.007 LA mechanical dispersion (ms) 25.8 ± 9.6 30.9 ± 11.6 0.018 Indexed LA volume / Reservoir strain ratio 0.8 ± 0.3 1.6 ± 0.9 <0.001 LV = left ventricular; LA = left atrium; SD = standard deviation Abstract P353 Figure. Fig 1. AF duration vs. Reservoir strain

scholarly journals 665 Longitudinal strain impairment in organic mitral regurgitation: look beyond the valve

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giovanni Diana ◽  
Laura Manfredonia ◽  
Monica Filice ◽  
Emanuele Ravenna ◽  
Francesca Graziani ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Lv Dysfunction ◽  
Lv Mass ◽  
Significant Difference ◽  
Lv Ejection Fraction

Abstract Aims Global longitudinal strain (GLS) is a hallmark of cardiac damage in mitral regurgitation (MR). GLS > −18% in patients with severe organic MR (OMR) and normal LV ejection fraction (LVEF) is an independent predictor of postoperative LV dysfunction. While it is known that GLS is impaired in less than severe functional ischaemic MR (FMR), the value of GLS in less than severe OMR is not known. We aimed to determine prevalence and determinants of any GLS impairment in OMR, in comparison to FMR. Methods We retrospectively evaluated 51 consecutive patients (33 OMR and 18 FMR) with mild-to-moderate, moderate and moderate-to-severe MR (Table*). Overall, GLS was higher in OMR than FMR (17.9±4.5 vs. 10.3±5.3, P<0.001), with rate of impairment of 45% in OMR and 89% in FMR (P= 0.0024). Results However, no significant difference was found in GLS between mild-to-moderate, moderate and moderate-to-severe MR patients within OMR (17.7±4.7 vs. 16.9±3.9 vs. 22.4±3, respectively, P>0.05), as well as FMR (9.8±6.6 vs. 10.7±5.3 vs. 10.4±5.3, respectively, P>0.05) groups. GLS correlated directly with left ventricular (LV) ejection fraction (EF) in both OMR (r=0.69, P<0.001) and FMR (r=0.90, P<0.001), and inversely with LV mass indexed for body surface area (LVMi) in both OMR (r = −0.50, P=0.005) and FMR (r = −0.48, P=0.042). While correlation with LVEF was better for FMR than OMR (Z − 1.95, P=0.026), correlation with LVMi was similar for OMR and FMR groups (Z − 0.082, P>0.05). Conclusions In patients with OMR, GLS may be reduced, despite normal LVEF, in less than severe MR. Prevalence and degree of GLS impairment in OMR is less than in FMR. In OMR, as well as in FMR, GLS impairment is independent of entity of MR, but rather correlates with LVMi, maybe reflecting impact of myocardial fibrosis derived by increased LVMi on GLS.

MO712EVALUATION OF VOLUME OVERLOAD STATUS MARKERS IN PERITONEAL DIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
João Carvão ◽  
Adriana Fernandes ◽  
Rita Veríssimo ◽  
Rita Calça ◽  
Ana Rita Martins ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ejection Fraction ◽  
Multivariable Analysis ◽  
Volume Overload ◽  
Left Ventricular ◽  
Hydration Status ◽  
Dialysis Patients ◽  
Multifrequency Bioimpedance ◽  
Lv Mass ◽  
Lv Ejection Fraction

Abstract Background and Aims N-terminal fragment of B-type natriuretic peptide (NT-proBNP) can reflect changes in hydration status and may help the nephrologist to estimate it. Fluid volume overload is a major concern in dialysis patients, and it is associated with increased cardiovascular risk and death. This study evaluated the relationship between serum NT-proBNP levels and left ventricular (LV) dysfunction and extra-cellular excess water in peritoneal dialysis patients. Method We conducted a cross-sectional study of 60 peritoneal dialysis (PD) patients. Incident and prevalent patients were included. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. A multifrequency bioimpedance (BIA) analyzer was used. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also analysed. Results A total of 60 patients were evaluated (male 60% (n=36), mean age was 55,8 ± 15,3 years, BMI 25.9 ± 3.9 kg/m2 and 31.7% (n=19) had diabetes mellitus (DM). Median PD vintage was 21 months, automated PD 30%, 8.3% (n=5) were anuric and 10% (n=6) were overhydrated. The median serum NT-proBNP level was 1071 pg/mL. LV mass index and LV ejection fraction were 129.0 ± 51.1 g/m2 and 62.8 ± 13.0%, respectively. The median excess volume overload was 0.9L. Serum NT-proBNP levels correlated positively with, diabetes (r=0.27, p=0.04), isquemic cardiopathy (r=0.37, p=0.01), LV mass index (r=0.48, p=0.001) and extracellular water (r=0.31, p=0.02) and negatively with LV ejection fraction (r= -0.81, p=0.01). In a multivariable analysis, in a model adjusted to time in DP, diabetes, residual diuresis, isquemic cardiopathy and left ventricle mass index, NT-proBNP > 1600 pg/mL was associated with patient overhidratation (exp (B) 1,44, 95% CI 0,15-2.73). No statistical difference was observed considering nutritional parameters, peritoneal transport, dialysis efficacy and NT-proBNP. Conclusion In this population, higher levels of NT-proBNP were associated with overhydration status and left ventricular dysfunction. Therefore, BIA and NT-proBNP may be complementary to clinical evaluation of PD patients. BIA results can be affected by malnutrition with loss of cell mass according to some studies. In our population NT-proBNP is not affected by nutritional status and therefore can also be used as a congestive marker in malnourished patients. Longitudinal application of BIA could be a useful clinical tool to evaluate adequacy in PD patients.

Left ventricular end-systolic stress-volume index ratio in aortic and mitral regurgitation with normal ejection fraction

1990 ◽  
Vol 120 (4) ◽  
pp. 892-901 ◽  
Author(s):  
Makoto Nakagawa ◽  
Kunio Shirato ◽  
Tadasu Ohyama ◽  
Masahito Sakuma ◽  
Tamotsu Takishima
Keyword(s):  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Volume Index ◽  
Normal Ejection Fraction ◽  
Index Ratio

scholarly journals Differential left ventricular and left atrial remodelling in heart failure with preserved ejection fraction patients with and without diabetes

2019 ◽  
Vol 10 ◽  
pp. 204201881986159 ◽  
Author(s):  
Gaurav S. Gulsin ◽  
Prathap Kanagala ◽  
Daniel C. S. Chan ◽  
Adrian S. H. Cheng ◽  
Lavanya Athithan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Markers Of Inflammation ◽  
Lv Mass ◽  
Mass Volume

Background: Attempts to characterize cardiac structure in heart failure with preserved ejection fraction (HFpEF) in people with type 2 diabetes (T2D) have yielded inconsistent findings. We aimed to determine whether patients with HFpEF and T2D have a distinct pattern of cardiac remodelling compared with those without diabetes and whether remodelling was related to circulating markers of inflammation and fibrosis and clinical outcomes. Methods: We recruited 140 patients with HFpEF (75 with T2D and 65 without). Participants underwent comprehensive cardiovascular phenotyping, including echocardiography, cardiac magnetic resonance imaging and plasma biomarker profiling. Results: Patients with T2D were younger (age 70 ± 9 versus 75 ± 9y, p = 0.002), with evidence of more left ventricular (LV) concentric remodelling (LV mass/volume ratio 0.72 ± 0.15 versus 0.62 ± 0.16, p = 0.024) and smaller indexed left atrial (LA) volumes (maximal LA volume index 48 ± 20 versus 59 ± 29 ml/m2, p = 0.004) than those without diabetes. Plasma biomarkers of inflammation and extracellular matrix remodelling were elevated in those with T2D. Overall, there were 45 hospitalizations for HF and 22 deaths over a median follow-up period of 47 months [interquartile range (IQR) 38–54]. There was no difference in the primary composite endpoint of hospitalization for HF and mortality between groups. On multivariable Cox regression analysis, age, prior HF hospitalization, history of pulmonary disease and LV mass/volume were independent predictors of the primary endpoint. Conclusions: Patients with HFpEF and T2D have increased concentric LV remodelling, smaller LA volumes and evidence of increased systemic inflammation compared with those without diabetes. This suggests the underlying pathophysiology for the development of HFpEF is different in patients with and without T2D. ClinicalTrials.gov identifier: NCT03050593.

scholarly journals 621 Anemia and its impact on clinical, echocardiographic parameters and prognosis in patients with severe aortic stenosis and normal left ventricular ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Beladan ◽  
A Calin ◽  
A D Mateescu ◽  
M Rosca ◽  
R Enache ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Nyha Class ◽  
Left Ventricular ◽  
Volume Index ◽  
All Cause Mortality ◽  
Echocardiographic Parameters ◽  
Study Population

Abstract Background Anemia is common in patients (pts) with severe aortic stenosis (AS). Untreated anemia and severe AS are individually associated with the development of heart failure, however data regarding the potential detrimental effect of anemia on left ventricular (LV) function and prognosis in pts with severe AS are controversial. Aim To investigate the impact of anemia on clinical status, echocardiographic parameters and prognosis in pts with severe AS and preserved LV ejection fraction (LVEF). Methods Consecutive patients with severe AS (aortic valve area [AVA] index ≤ 0.6 cm2/m2) and preserved LVEF (>50%) referred to our echocardiography laboratory were prospectively screened. All patients underwent complete clinical examination and comprehensive echocardiography, including speckle tracking-derived measurements of LV and left atrial (LA) strain. Baseline clinical variables included NYHA class, cardiac risk factors, haemoglobin (Hb) level and glomerular filtration rates (GFR, by MDRD formula). The definition of anemia was based on gender-specific cut-off values, as recommended by the WHO (Hb <13.0 g/dL for men, <12.0 g/dL for women). Patients with more than mild aortic regurgitation or mitral valve disease, atrial fibrillation or cardiac pacemakers were excluded. Results The study population included 264 patients (pts) (66 ± 11 yrs, 147 men). Anemia was present in 64 pts (24%). Aortic valve replacement (AVR) was performed in 151 pts. Dividing the study population into 2 groups, according to the presence/absence of anemia, no significant differences were found between groups regarding: age (p = 0.09), body surface area (p = 0.6), LVEF (62 ± 7 vs 63 ± 6%, p = 0.2), LV Global Longitudinal Strain (-15.2 ± 4 vs -14.7 ± 3 %, p = 0.4), LV mass index (p = 0.9), mean aortic gradient (p = 0.2) and indexed AVA (0.40 ± 0.09 vs 0.39 ± 0.09 cm2/m2, p = 0.6), or presence of significant coronary artery disease (p = 0.9). Compared to pts with normal Hb level, in pts with anemia NYHA class (p = 0.03), brain natriuretic peptide values (p = 0.004), lateral E/e’(16.2 ± 6.9 vs 13.7 ± 6.3, p = 0.01) and average E/e" ratio (15.9 ± 5.9 vs 14.1 ± 5.3, p = 0.03), LA volume index (54.3 ± 16.9 vs 45.0 ± 12.1 ml/m2, p < 0.001), and systolic pulmonary artery pressure (38 ± 13 vs 33 ± 8, p = 0.009) were all significantly higher. During a 3–years follow-up 47 pts died. Age, NYHA class, BNP serum level, baseline anemia, LA volume index and systolic pulmonary pressure were associated with all-cause mortality in the whole study group (p < 0.03 for all). In the group of pts who underwent AVR, NYHA class was the only independent predictor of all-cause mortality. Conclusions In our study including pts with severe AS and preserved LVEF, patients with baseline anemia presented worse functional status and LV diastolic dysfunction and increased 3-year all-cause mortality compared to those with normal Hb levels. However, in pts who underwent surgical AVR, there was no impact of baseline anemia on 3-year survival.

scholarly journals Concordance and Discordance of Echocardiographic Parameters Recommended for Assessing the Severity of Mitral Regurgitation

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Seth Uretsky ◽  
Lillian Aldaia ◽  
Leo Marcoff ◽  
Konstantinos Koulogiannis ◽  
Edgar Argulian ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Regurgitant Volume ◽  
Orifice Area ◽  
Vena Contracta ◽  
Echocardiographic Parameters ◽  
American Society ◽  
Regurgitant Orifice Area

Background: The American College of Cardiology/American Heart Association and American Society of Echocardiography guidelines recommend assessing several echocardiographic parameters when evaluating mitral regurgitation (MR) severity. These parameters can be discordant, making the assessment of MR challenging. The degree to which echocardiographic parameters of MR severity are concordant is not well studied. Methods: We enrolled 159 patients in a prospective multicenter study. Eight parameters were included in this analysis: proximal isovelocity surface area (PISA)–derived regurgitant volume, PISA-derived effective regurgitant orifice area, vena contracta, color Doppler jet/left atrial area, left atrial volume index, left ventricular end-diastolic volume index, peak E wave, and the presence of pulmonary vein systolic reversal. Each echocardiographic parameter was determined to represent severe or nonsevere MR according to the American Society of Echocardiography guidelines. A concordance score was calculated as so that a higher score reflects greater concordance. There was no discordance when all the echocardiographic parameters agreed and high discordance when 3 or 4 parameters were discordant. Results: The mean concordance score was 75±14% for the entire cohort. There were 9 (6%) patients with complete agreement of all parameters and 61 (38%) with high discordance. There was greater discordance in patients with severe MR but no difference between primary versus secondary or central versus eccentric jets. There was an improvement in concordance when only considering PISA-based regurgitant volume, PISA-based effective regurgitant orifice area, and vena contracta with agreement in 68% of patients. Conclusions: There was limited concordance between the echocardiographic parameters of MR severity, and the discordance was worse with more severe MR. Concordance improved when considering only 3 quantitative measures of vena contracta and PISA-based effective regurgitant orifice area and regurgitant volume. These findings highlight the challenges facing echocardiographers when assessing the severity of MR and emphasize the difficulty of using an integrated approach that incorporates multiple components. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04038879.

Abstract 14958: Global Longitudinal Strain is a Superior Predictor of All-cause Mortality Compared to Left Ventricular Ejection Fraction in Male Patients with Heart Failure and Without Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Morten Sengeløv ◽  
Tor Biering-Sørensen ◽  
Peter Godsk Jørgensen ◽  
Niels Eske Bruun ◽  
Thomas Fritz-Hansen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Global Strain ◽  
Echocardiographic Parameters

Object: Myocardial strain deformation analysis (global strain) may be superior to left ventricular ejection fraction (LVEF) in predicting all-cause mortality in patients with heart failure. Methods: In this retrospective study transthoracic echocardiographic examinations were retrieved from Gentofte Hospital heart failure clinic’s database in 1061 patients. The echocardiographic images were subsequently analyzed and conventional echocardiographic parameters and strain data were obtained. Results: During a median follow-up of 40 months 177 (16.7 %) patient died. Mean LVEF was 23.7 % and mean global strain was -8.12.884 (83.3%) were patients alive at follow-up and mean LVEF was 28.2 % while mean global strain was -9.86 %. The risk of dying increased with decreasing tertile of global strain being approximately three times higher for the patients in the lower tertile compared to the highest tertile (1. tertile vs 3. tertile HR: 3.38 95% CI: 2.3 [[Unable to Display Character: &#8211;]] 5.1), p-value: 0.001. Many of the conventional echocardiographic parameters proved to be predictors of mortality. Global strain remained an independent predictor of mortality in cox proportional-hazards models after adjusting for age, gender, BMI, total cholesterol, heart rate, atrial fibrillation, non-independent diabetes mellitus and conventional echocardiographic parameters (p-value: 0.014, 95% CI: 1.04 [[Unable to Display Character: &#8211;]] 1.37) while ejection fraction proved to be insignificant adjusted for aforementioned characteristics (p-value: 0.81, 95% CI: 0.96 [[Unable to Display Character: &#8211;]] 1.05 Atrial fibrillation modified the relationship between GLS and mortality (p for interaction = 0.023). HR 1.08 (CI 0.97 to 1.19, p=0.150) and HR 1.22 (CI 1.15 to 1.29, p<0.001) per 10 % decrease in GLS for patients with and without atrial fibrillation, respectively. Gender also modified the relationship between mean GLS and mortality (p for interaction = 0.047); HR 1.23 (CI 1.16 to 1.30, p<0.001) and HR 1.09 (CI 0.99 to 1.20, p=0.083) per 10 % decrease in GLS for men and women, respectively. Conclusion: In male patients with systolic heart failure and without atrial fibrillation global strain is an independent predictor of all-cause mortality. Furthermore, global strain proved to be a superior prognosticator when compared to left ventricular ejection fraction.

scholarly journals P1779 Myocardial work is a predictor of exercise tolerance in patients with dilated cardiomyopathy and left ventricular dyssynchrony

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Galli ◽  
F Schrub ◽  
F Schnell ◽  
A Hubert ◽  
E Donal
Keyword(s):  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Exercise Performance ◽  
Exercise Tolerance ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Ventricular Dyssynchrony ◽  
P Value ◽  
Heterogeneous Distribution ◽  
Lv Dyssynchrony

Abstract Background the assessment of myocardial work (MW) by pressure-strain loops is a recently introduced tool for the assessment of myocardial performance. Aim of the present study is to evaluate the relationship between myocardial work and exercise tolerance in patients with dilated cardiomyopathy (DCM) Methods 51 patients with DCM (mean age 57 ± 13 years, left entricular ejection fraction : 32 ± 9%) underwent cardiopulmonary exercise test (CPET) to assess exercise performance. Trans-thoracic echocardiography (TTE) was performed CPET. The following indices of myocardial work (MW) were measured regionally and globally: constructive work (CW), wasted work (WW), and work efficiency (WE). Left ventricular (LV) dyssynchrony (DYS) was defined by the presence of septal flash or apical rocking at TTE. Results LV-DYS was observed in 16 (31%) patients and associated with lower LV ejection fraction (LVEF), GLS, global and septal WE, and higher global and septal WW (Table 1). In patients with LV-DYS, septal WE was the only predictor of exercise peak VO2max at multivariable analysis (Figure 1), whereas LVEF (β=0.47, p = 0.05) and age (β=-0.42, 47, p= 0.04) were predictors of exercise capacity in patients without LV-DYS. Conclusions In patients with DCM, LV-DYS is associated with an heterogeneous distribution of myocardial work. Septal WE is the best predictor of exercise performance in these patients. Table 1 All n = 51 No-dyssynchrony n = 35 (69%) LV-Dyssynchrony n = 16 (31%) p-value LVEF, % 32 ± 9 34 ± 10 28 ± 7 0.04 GLS, % -12 ± 3 -13 ± 3 -10 ± 3 0.001 GCW, mmHg% 1325 ± 398 1342 ± 354 1287 ± 491 0.65 GWW, mmHg% 201 ± 147 154 ± 95 304 ±191 &lt;0.0001 GWE, % 85 ± 9 88 ± 7 78 ±10 &lt;0.0001 CWsept, mmHg% 1172 ± 459 1274 ± 398 949 ± 516 0.017 CWlat, mmHg% 1518 471 1472 ± 386 1620 ± 622 0.30 WWsept, mmHg% 283 ± 275 174 ± 98 522 ±376 &lt;0.0001 WWlat, mmHg% 135 ± 88 117 ± 81 176 ± 92 0.02 WEsept, % 78 ± 16 84 ± 9 62± 18* &lt;0.0001 WElat, % 90 ± 7 91 ± 7 88 ± 7 0.16 Abstract P1779 Figure.

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