scholarly journals 1032 Evaluation viability in patients with ventricular dysfunction by 2D speckle tracking echocardiography: the impact of low dose dobutamine. A meta-analysis of prospective trials

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Ballo ◽  
F Doghman ◽  
A Saraste ◽  
J Knuuti
Keyword(s):  
Myocardial Viability ◽  
Speckle Tracking ◽  
Low Dose ◽  
Speckle Tracking Echocardiography ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
2D Speckle Tracking ◽  
Prospective Trials ◽  
The Impact

Abstract Background 2D-Speckle tracking echocardiography (2DSTE) has been used for the assessment of myocardial viability in patients with artery disease and left ventricular (LV) dysfunction. Aim The purpose of this analysis was to evaluate the diagnostic accuracy of 2DSTE using longitudinal (LS) and rest circumferential strain (CS) in this setting with or without low dose dobutamine (LDD) infusion. Methods A systematic review of MEDLINE, Cochrane, and Embase for all the prospective trials using 2DSTE to assess myocardial viability until January 2019 was done. Studies that utilized 2DSTE before coronary revascularisation and used the wall motion evaluation in the long term after the revascularisation as a reference were included. A standard approach of meta-analysis for diagnostic tests and a bivariate analysis of sensitivity, specificity, positive likelihood ratio(+LR), and negative likelihood (-LR) were performed. In addition, direct comparison analysis was done to only studies that compared the tests in the same patients. Results A total of 24 studies of 2DSTE evaluating myocardial viability with 1173 patients (mean age 66 years, 72% male, and mean left ventricular ejection fraction was 45%) fulfilled the inclusion criteria. Eight studies used LS, 8 studies used CS, 4 studies used LS with LDD, and 4 studies used CS with LDD. LS and CS with LDD provided higher +LR ( 4.2 and 4, respectively) as well as a best specificity when compared with LS and CS (81% CI: 65- 92% vs 68% CI: 60- 75%, p = 0.04, and 81% CI: 64-91% vs 66% CI: 59-72%, p= 0.02, respectively) for predicting improved segmental LV contractile function after revascularization. The sensitivities of different 2DSTE tests for detection the viability were not statistically different. The direct comparison of the studies with the same patients yielded similar results. Conclusions Using LDD with LS and CS analysis significantly improve specificity of the tests. Therefore, the use of a low dose of the dobutamine can be recommended to improve the accuracy of the 2DSTE for detection of viable myocardium following myocardial infarction. Abstract 1032 Figure. Summary ROC Curves

scholarly journals Atrial Strain in Atrial Fibrillation Patients: A 2D Speckle Tracking Echocardiography Study

2019 ◽  
Vol 16 (5) ◽  
pp. 7-18
Author(s):  
Maria-Luiza Toplicianu ◽  
Ioan Tiberiu Nanea
Keyword(s):  
Atrial Fibrillation ◽  
Speckle Tracking ◽  
Predictive Power ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
2D Speckle Tracking ◽  
Study Population ◽  
Atrial Strain

AbstractObjectives. In this study we tried to determine the values of the left atrial (LA) strain in patients with atrial fibrillation (AF) and set a parameter that could be a predictor of sinus rhythm (SR) maintenance.Study population. We included 60 patients with left ventricular ejection fraction (LVEF) ≥50% - 33 (55%) of them were known to have in their personal history AF (newly diagnosed, paroxysmal and persistent) and they were examined at SR. The second group was represented by 27 (45%) patients that were examined in AF. Using two dimensional speckle tracking echocardiography (2D STE) it was quantified the strain of the 3 functions that characterize the physiology of the LA - reservoir, conduct and pump in the apical sections, mentioning that the pump was absent in patients examined in AF.Results. The average of the reservoir (R%) for all sections had a significantly higher value in patients with SR (20,2±6,225%) compared to patients examined in AF (6,505±2,66%): P<0.001. With the help of the logistic regression model was observed that only systolic LA strain had the highest predictive power of maintenance of SR. The cutt off value of ≥13,25% of the R% has a sensitivity (Se) and a specificity (Sp) of 90,9%, respectively 100% for maintenance of SR.Conclusions. In the present study, after analyzing all the parameters that were associated between the 2 groups, it was found that only R %, as the only variable, has the highest predictor power for maintenance of SR.

scholarly journals Assessment of aortic and mitral annuli dynamics during the cardiac cycle using speckle tracking echocardiography

2014 ◽  
Vol 1 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Wenjuan Bai ◽  
Hui Li ◽  
Hong Tang ◽  
Qing Zhang ◽  
Ye Zhu ◽  
...  
Keyword(s):  
Left Ventricular Function ◽  
Ventricular Function ◽  
Speckle Tracking ◽  
Cardiac Cycle ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Healthy Adults ◽  
Aortic Annulus ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

The aims of this study were i) to evaluate mitral and aortic annuli excursion, and aortomitral angle (AMA) during the cardiac cycle in healthy adults using two-dimensional speckle tracking echocardiography, ii) to assess two annuli dynamics and coupling behaviors as an integral, and iii) to detect the relation between two annuli and left ventricular ejection fraction (LVEF). A total of 74 healthy adults underwent transthoracic echocardiography. In the parasternal long-axis view, a number of points were extracted, including right coronary aortic annular, aortomitral fibrous junction, and posterior mitral annular points. The annuli excursion and AMA were measured using a speckle tracking-derived software during the cardiac cycle. During the isovolumic contraction and the isovolumic relaxation phase, annuli excursion and AMA remain stable for a short time. During the systole, annuli excursion increased sharply to the maximum, while AMA narrowed quickly to the minimum value. During the diastole, there are three patterns of decrease in annuli excursion and AMA expansion in different phases. The annuli excursion of three points correlates well with the LVEF (right coronary aortic annulus excursion, r=0.71, P<0.05; non-coronary aortic annulus excursion, r=0.70, P<0.05; posterior mitral annulus excursion, r=0.82, P<0.05). Moreover, there are positive correlations between annuli excursion and the variation of AMA (r=0.60, P<0.05). The annuli excursion and AMA have various regular patterns in healthy adults. The interactions of mitral and aortic annuli correlate with the left ventricular function. Our findings may have relevance to the evaluation of left ventricular function and presurgical planning of patients with valvular diseases.

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 2391: Impact of Therapies for Anemia on Outcomes in Patients with Heart Failure in Randomized Clinical Trials

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Howard M Julien ◽  
Preetika Muthukrishnan ◽  
Eldrin F Lewis
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Ejection Fraction ◽  
Serum Creatinine ◽  
Exercise Capacity ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
The Impact

Anemia is common in heart failure (HF) patients and has been well-established as a risk factor for increased risk of HF hospitalization and mortality. Treatment with erythropoietin stimulating agents (ESA) has increased hemoglobin, but outcomes trials are limited and use of ESA has been controversial given disparate results in other populations. This meta-analysis aimed to evaluate the impact of ESA and iron on outcomes in HF patients. A systematic review of four databases was conducted in April 2008 (n = 95 unique trials). Analysis inclusion criteria included randomized controlled trial to ESA/iron with clinically defined HF, yielding 10 eligible trials published between 6/01–3/08. Data was independently extracted and cross-checked for accuracy and reliability (2 investigators). A total of 768 subjects (421 treated and 338 controls) are included (Characteristics in Table 1 ). Randomization to ESA produced a significant improvement in exercise capacity 0.39 standard units [95% CI 0.1– 0.6, p = 0.001], a 5.72% [95% CI 1.2–10.3, p = 0.014] increase in left ventricle ejection fraction and a 0.23 mg/dL [95% CI 0.4 – 0.1 p = 0.001] reduction in serum creatinine. There was no difference in all-cause mortality - RR 0.79 [95% CI 0.49, 1.26, p = 0.320]. Trends were noted in reduced hospitalization rates, decreased brain natriuretic peptide, and improved quality of life. Meta-analysis of randomized studies of treatment of anemia in HF patients suggests significant benefit in exercise capacity, left ventricular ejection fraction, and serum creatinine. There does not appear to be excess mortality with ESA/iron treatment. Despite favorable findings, definitive randomized clinical trials are needed to assess the role of this treatment modality in HF management. Table 1. Baseline Patient and Study Characteristics

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