scholarly journals Left ventricular longitudinal shortening at cardiac base as a determinant of left atrial reservoir function in cardiac amyloidosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Inoue ◽  
Y Nakao ◽  
M Saito ◽  
M Kinoshita ◽  
R Higaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Male Gender ◽  
Hazard Ratio ◽  
Heart Failure Hospitalization ◽  
Reservoir Function ◽  
Lv Ejection Fraction

Abstract Objective To investigate a mechanistic determinant of left atrial (LA) reservoir function in patients presenting left ventricular (LV) hypertrophy, and clarify diagnostic and prognostic values of LA reservoir strain in patients with cardiac amyloidosis (CA). Methods Three-hundred sixty patients (median age: 68 years, male gender: 65%) with left ventricular hypertrophy (LVH) assessed by echocardiography were retrospectively included. The LVH etiologies were diagnosed by any of biopsy, cardiac magnetic resonance imaging or 99mTc-PYP scintigraphy. LV segmental longitudinal strain was estimated from apical three views, and LA reservoir strain was measured from an apical 4-chamber view. Results The LVH etiologies were confirmed with CA in 81 patients, hypertensive heart disease in 87 patients, hypertrophic cardiomyopathy in 143 patients, and miscellaneous disorders in 49 patients. The median (25th, 75th percentile) value of LV ejection fraction was 59% (48–67). LV basal longitudinal strain and LA reservoir strain were significantly reduced in patients with CA compared with those with other etiologies; LV basal strain: 5.4% (3.9–8.7) vs. 11.9% (9.3–14.6), LA reservoir strain: 9.2% (6.3–12.3) vs. 17.5% (11.3–24.1), p<0.01 respectively. LV basal strain was significantly correlated with LA reservoir strain in patients with CA (r=0.57, p<0.01) and in those with other etiologies (r=0.45, p<0.01). The area under the receiver-operating characteristic curves of LA reservoir strain and E/e' (0.78 and 0.74) to identify CA etiology were significantly larger than that of LA volume index (0.62) (p<0.01). During the follow-up period (median 2.9 years), 53 patients experienced heart failure hospitalization. The Cox regression model including age, gender, LV ejection fraction, E/e' and LA reservoir strain showed that male gender (hazard ratio: 0.46, p=0.03), E/e' (hazard ratio: 1.04, p<0.01) and LA reservoir strain (hazard ratio: 0.94, p<0.01) independently predicted heart failure hospitalization. Conclusions The decrease of LV longitudinal shortening at cardiac base could worsen LA reservoir function especially in patients with CA. LA reservoir strain might be an alternative measure to identify CA etiology and have a predictive value of heart failure hospitalization in patients with LV hypertrophy. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals P177 Left atrial strain in patients with cardiac amyloidosis. Relationship to left atrial amyloid deposition focusing on prognosis

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
K Misumi ◽  
H Miura ◽  
Y Morita ◽  
H Amano ◽  
H I Ueda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
Amyloid Fibrils ◽  
Prognostic Significance ◽  
Amyloid Deposit ◽  
Heart Failure Hospitalization ◽  
Left Atrial Strain ◽  
Atrial Strain

Abstract Background  In cardiac amyloidosis (CA), the left atrium (LA) is frequently infiltrated by the amyloid fibrils. It is currently known that LA strain is a marker of LA function and prognosis in many cardiac diseases, however its significance in CA remains unknown.  Purpose  Our aim was to investigate correlation between LA strain measured by Cardiovascular Magnetic Resonance (CMR) and amyloid deposit in LA, and also evaluate the LA strain on the prognostic significance.  Methods and results  Of 74 consecutive patients with biopsy-proven CA, we analyzed 42 patients (age 72 ± 10 years; 76 % males) with contrast-enhanced CMR, and examined LA late gadolinium enhancement (LGE) and CMR derived LA strain using feature tracking method. Of the 42 patients, 29 patients (69 %) was transthyretin cardiac amyloidosis (ATTR-CA) in the majority. We divided these 42 patients into two groups according to the CMR measured peak atrial longitudinal strain (PALS) (> = or < median); high-strain (> = 6.67 %, n = 21) and low-strain (＜ 6.67 %, n = 21) and compared the patient’s characteristics, blood test data, echocardiography and CMR parameters. There were no significant differences between two groups in these parameters but in the extent of LA-LGE (54 % vs 80 %, p = 0.008). The PALS correlated with the extent of LA-LGE (ρ= 0.50, p = 0.001). In multivariate analysis including LVEF, E/e’ and BNP, LA-LGE was an independent determinant of PALS. During three-year follow up, the LA strain significantly related to heart failure hospitalization in the ATTR-CA patients (p = 0.036)(Figure).  Conclusions  In CA patients, CMR measured LA longitudinal strain correlates with the LA-LGE. It also provides useful information for poor prognosis of patients with ATTR-CA. Abstract P177 Figure. Heart failure hospitalization in ATTR-CA

scholarly journals Higher Acceleration/Ejection Time Ratio Predicts Impaired Outcome in Aortic Valve Stenosis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Eigir Einarsen ◽  
Dana Cramariuc ◽  
Edda Bahlmann ◽  
Helga Midtbo ◽  
John B. Chambers ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Aortic Valve Stenosis ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Heart Failure Hospitalization ◽  
Ejection Time

Background: Acceleration time (AT)/ejection time (ET) ratio is a marker of aortic valve stenosis (AS) severity and predicts outcome in moderate-severe AS. Methods: We explored the association of increased AT/ET ratio on prognosis in 1530 asymptomatic patients with presumably mild-moderate AS, normal ejection fraction, and without known diabetes or cardiovascular disease. Patients were part of the SEAS study (Simvastatin Ezetimibe Aortic Stenosis). Patients were grouped according to the optimal AT/ET ratio threshold to predict cardiovascular death and heart failure hospitalization. Low-gradient severe AS was identified as combined valve area ≤1.0 cm 2 and mean gradient <40 mm Hg. Outcome was assessed in Cox regression analyses, and results are reported as hazard ratio and 95% CI. Results: Higher AT/ET ratio was significantly associated with lower systolic blood pressure, lower left ventricular ejection fraction, lower stress-corrected midwall shortening, low flow, and with higher left ventricular mass and higher peak aortic jet velocity. AT/ET ratio ≥0.32 provided the optimal cutoff for predicting incident cardiovascular death and heart failure hospitalization in the total study sample. In patients with low-gradient severe AS, this threshold was >0.32. AT/ET ratio ≥0.32 had a 79% higher risk of cardiovascular death and heart failure hospitalization (hazard ratio, 1.79 [95% CI, 1.20–2.68]). In patients with low-gradient severe AS, AT/ET ratio >0.32 was associated with a 2-fold higher risk of cardiovascular death and heart failure hospitalization (hazard ratio, 2.15 [95% CI, 1.22–3.77]). Conclusions: In asymptomatic nonsevere AS and low-gradient severe AS, higher AT/ET ratio was associated with increased cardiovascular morbidity and mortality. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00092677.

scholarly journals P1288 Male gender and left atrial volume index predict non valvular atrial fibrillation recurrence. The NeAfi echo registry

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Sorrentino ◽  
V Capone ◽  
L Esposito ◽  
F Lo Iudice ◽  
A M De Roberto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Male Gender ◽  
Volume Index ◽  
Significant Information ◽  
Af Recurrence

Abstract Background In non-valvular atrial fibrillation (AF) patients, risk stratification scores such as CHA2DS2VASc and HASBLED allow the prediction of thromboembolic and bleeding risks, respectively. However, no risk score for the prediction of AF recurrence has been yet validated. Purpose To evaluate the mayor anthropometric and echocardiographic determinants of AF recurrence in non-valvular paroxysmal AF patients at 1 year follow-up. Methods Among 395 consecutive adult patients with non valvular AF enrolled in the Neapolitan Atrial Fibrillation (NeAfi) Echo registry, 177 (F/M = 87/90, age = 66.5± 11.9 years) had paroxismal AF and underwent 1-year follow-up. Fifteen patients had AF recurrence. Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc and HASBLED scores were calculated. At baseline, patients underwent a comprehensive echo-Doppler exam, including quantification of left atrial (LA) size measurements, peak atrial longitudinal strain (PALS) and left ventricular (LV) global longitudinal strain (GLS). Binary logistic regression analysis was used to establish a mathematical model of the relationship between the variables and AF recurrence. The covariates for regression analysis were chosen as potential confounding factors based on their significance in independent T test analyses for continuous variables of chi-square for dichotomous variables, or on their biological plausibility. Results AF recurrence was higher in male than in female patients (14.4 vs 2.3%, p = 0.008). Patients with AF recurrence had similar body mass index, systolic and diastolic BP and heart rate compared to those without. The two groups were similar for LV end-systolic and end-diastolic volumes, ejection fraction, LV mass index, diastolic indexes, pulmonary artery systolic pressure and GLS. LA diameter (p = 0.235) and PALS (p = 0.375) were also similar between the two groups, whereas LA volume index (LAVi) was greater in patients experiencing AF recurrence (45.5 ± 15.7 vs. 36.7 ± 10.4 ml/m², p = 0.003). Binomial multiple regression analysis model explained 25% (Nagelkerke R²) of the variance in AF recurrence and correctly classified 95.0% of cases. Males were 8.9 times more likely to exhibit AF recurrence than females (p = 0.04). Greater LAVi was associated with an increased likelihood of exhibiting AF recurrence (OR = 1.07, p = 0.03), whereas CHA2DS2VASc &gt;1 in men and &gt;2 in women, HASBLED &gt;3 and greater LA diameter or lower PALS did not add significant information to the model. Conclusions Male gender and, with a lower extent, LAVi appear to be major determinants of AF recurrence in non-valvular paroxysmal AF. The quantification of PALS does not seem to add valuable information in the prediction of recurrent AF.

Abstract 15734: Left Atrial Reservoir Strain as a Novel Prognostic Marker in Biopsy-proven Light-chain Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Peter Huntjens ◽  
Kathleen Zhang ◽  
Yuko Soyama ◽  
Maria Karmpalioti ◽  
Daniel Lenihan ◽  
...  
Keyword(s):  
Light Chain ◽  
Left Atrial ◽  
Prognostic Value ◽  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Imaging ◽  
Left Ventricular ◽  
Lv Function ◽  
Al Amyloidosis

Introduction: Light chain cardiac amyloidosis (AL) has a variable but usually poor prognosis. Left ventricular (LV) function measures including LV strain imaging for global longitudinal strain (GLS) have shown clinically prognostic value in AL. However, the utility of novel left atrial (LA) strain imaging and its associations with LV disease remains unclear. Hypothesis: LA strain is of additive prognostic value to GLS in AL. Methods: We included 99 consecutive patients with AL. Cardiac amyloidosis either confirmed by endocardial biopsy (25%) or by non-cardiac tissue biopsy and imaging data supportive of cardiac amyloidosis. Peak LA reservoir strain was calculated as an average of peak longitudinal strain from apical 2- and 4-chamber views. GLS and apical sparing ratio were assessed using the 3 standard apical views. All-cause mortality was tracked over a median of 5 years. Results: Echocardiographic GLS and peak longitudinal LA strain were feasible in 96 (97%) and 86 (87%) of patients, respectively. There were 48 AL patients who died during follow-up. Patients with low GLS (GLS < median; 10.3% absolute values) had worse prognosis than patients with high GLS group (p<0.001). Although peak longitudinal LA strain was correlated with GLS (R=0.65 p<0.001), peak longitudinal LA strain had additive prognostic value. AL patients with low GLS and low Peak LA strain (<13.4%) had a 8.3-fold increase in mortality risk in comparison to patients with high GLS (95% confidence interval: 3.84-18.03; p<0.001). Multivariable analysis showed peak longitudinal LA strain was significantly and independently associated with survival after adjusting for clinical and echocardiographic covariates (p<0.01). Conclusions: Peak longitudinal LA strain was additive to LV GLS in predicting prognosis in patients with biopsy confirmed AL amyloidosis. LA strain imaging has potential clinical utility in patients with AL cardiac amyloidosis.

Detection of Left Atrial Myopathy Using Artificial Intelligence–Enabled Electrocardiography

2021 ◽  
Author(s):  
Frederik H. Verbrugge ◽  
Yogesh N.V. Reddy ◽  
Zachi I. Attia ◽  
Paul A. Friedman ◽  
Peter A. Noseworthy ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Preserved Ejection Fraction ◽  
Ecg Analysis ◽  
Patients With Heart Failure

Background: Left atrial (LA) myopathy is common in patients with heart failure and preserved ejection fraction and leads to the development of atrial fibrillation (AF). We investigated whether the likelihood of LA remodeling, LA dysfunction, altered hemodynamics, and risk for incident AF could be identified from a single 12-lead ECG using a novel artificial intelligence (AI)-enabled ECG analysis. Methods: Patients with heart failure and preserved ejection fraction (n=613) underwent AI-enabled ECG analysis, echocardiography, and cardiac catheterization. Individuals were grouped by AI-enabled ECG probability of contemporaneous AF, taken as an indicator of underlying LA myopathy. Results: Structural heart disease was more severe in patients with higher AI-probability of AF, with more left ventricular hypertrophy, larger LA volumes, and lower LA reservoir and booster strain. Cardiac filling pressures and pulmonary artery pressures were higher in patients with higher AI-probability, while cardiac output reserve was more impaired during exercise. Among patients with sinus rhythm and no prior AF, each 10% increase in AI-probability was associated with a 31% greater risk of developing new-onset AF (hazard ratio, 1.31 [95% CI, 1.20–1.42]; P <0.001). In the population as a whole, each 10% increase in AI-probability was associated with a 12% greater risk of death (hazard ratio, 1.12 [95% CI, 1.08–1.17]; P <0.001) during long-term follow-up, which was no longer significant after adjustments for baseline characteristics. Conclusions: A novel AI-enabled score derived from a single 12-lead ECG identifies the presence of underlying LA myopathy in patients with heart failure and preserved ejection fraction as evidenced by structural, functional, and hemodynamic abnormalities, as well as long-term risk for incident AF. Further research is required to determine the role of the AI-enabled ECG in the evaluation and care of patients with heart failure and preserved ejection fraction.

P2455Global peak left atrial longitudinal strain - a good predictor of left atrial appendage thrombus in patients in sinus rhythm with heart failure and very low left ventricular ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Zandecki ◽  
J Kurzawski ◽  
A Janion-Sadowska ◽  
M Sadowski
Keyword(s):  
Heart Failure ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Gini Index ◽  
Longitudinal Strain ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Atrial Appendage Thrombus ◽  
Ventricular Ejection Fraction

Abstract The aim of this study was to determine if various clinical and transthoracic echocardiography data including left atrial strain analysis could predict the presence of left atrial appendage thrombus (LAAT) in heart failure (HF) patients with very low left ventricular ejection fraction (LVEF), sinus rhythm at presentation and no history of atrial fibrillation or any other established indication for anticoagulation. Material and methods Sixty-seven patients with HF, LVEF <25%, sinus rhythm and not anticoagulated were included. Transesophageal echocardiography was performed in all patients to allow detection of LAAT. Results LAAT was found in 21 (31.3%) patients. Global peak left atrial longitudinal strain (PALS) was the best predictor of LAAT presence in univariate logistic regression analysis (Gini index 0.65, AUC 0.83) – data for other variables are presented in the Table 1. In the multivariate model after the inclusion of global PALS no other available variable could significantly improve it. The global PALS value of 8% was a good discriminator of LAAT presence with OR 26.2 (95% CI 6.8–103) if global PALS was <8% at p<0.001. Table 1. Univariable models for potential risk factors for LAAT incidence in the study population OR (95% CI) p-value Gini index Age 1.01 (0.96–1.06) 0.71 0.02 Heart rate 0.99 (0.94–1.03) 0.57 0 Body surface area 0.66 (0.03–12.45) 0.78 0.03 Ischaemic HF etiology 2.11 (0.73–6.07) 0.17 0.18 Hypertension 1.10 (0.39–3.09) 0.86 0.02 Diabetes 0.59 (0.18–1.89) 0.37 0.11 Chronic kidney disease 1.29 (0.46–3.65) 0.63 0.06 Prior stroke or TIA (transient ischemic attack) 1.75 (0.35–8.63) 0.49 0.06 LA diameter 0.96 (0.3–3.03) 0.94 0.02 LAVI (LA volume index) 1.06 (1.01–1.11) 0.01 0.46 LVEF 0.99 (0.87–1.12) 0.88 0.07 E/A 1.28 (0.79–2.09) 0.31 0.1 E/e' 0.98 (0.91–1.04) 0.44 0.15 Global PALS 0.43 (0.29–0.64) <0.001 0.65 Global PACS (peak atrial contraction strain) 1.42 (0.91–2.21) 0.13 0.27 Conclusions LAAT has been a relatively common finding in this group of HF patients and PALS has shown prognostic potential in LAAT identification.

scholarly journals Left atrial strain and outcome in heart failure with preserved ejection fraction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
N Bekki ◽  
H Hayama ◽  
R Nagai ◽  
W Miyake ◽  
J Yamamoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Imaging System ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Strain Measurements

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) function is impaired in heart failure with preserved ejection fraction (HFpEF). However, the association between LA longitudinal strain and heart failure (HF) events in patients with HFpEF is still unknown. We evaluated whether LA strain measurements would be useful to predict hospitalizations for worsening HF in this study. Methods This study included 121 patients (Male 73, Female 48) with HFpEF who had echocardiogram at our institute (Age = 76 ± 14y, Left ventricular ejection fraction; LVEF = 63 ± 8%). Patients with atrial fibrillation were excluded. LA longitudinal strain was measured by speckle-tracking echocardiography, using TOMTEC imaging system. The endpoints were hospitalizations for worsening HF. Results During follow-up period of 319 ± 269 days, 33 patients (27%) experienced hospitalizations for worsening HF. LA strain was markedly lower in patients with HF events at 11.3 ± 5.6, whereas LA strain was higher at 20.3 ± 10.1 in patients without HF events. Kaplan-Meier analysis demonstrated a significant separation of survival curves stratified by median value of LA strain (Figure). Conclusions LA dysfunction in HFpEF is associated with a higher risk of HF hospitalization, and LA strain measurements would be useful to predict HF events. Abstract Figure

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