P5002The impact of diabetes mellitus on global longitudinal strain of patients with acute heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Kwak ◽  
I.-C Hwang ◽  
J.-J Park ◽  
J.-H Park ◽  
G.-Y Cho ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Propensity Score ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
P Value ◽  
Matched Cohort ◽  
Entire Cohort ◽  
The Impact

Abstract Introduction Diabetes mellitus (DM) aggravates the clinical features and the prognosis of heart failure (HF) patients. However, the impact of DM on the ventricular systolic function of HF patients is not well delineated. Purpose The present study aimed to investigate the impact of DM on HF, regarding the systolic function presented by the global longitudinal strain (GLS). Methods In 4312 patients with acute HF, left ventricle (LV) and right ventricle (RV) GLS were acquired by speckle-tracking echocardiography. HF patients with DM were compared to those without DM from the entire cohort (n=4312), as well as the propensity-score matched cohort (n=3034). Results Our cohort consisted of 1750 DM patients (40.6%). Both LV-GLS and LVEF were significantly lower within the patients with DM (10.1±4.8% vs. 11.3±5.1%, p<0.001 for LV-GLS; 39.1±15.5% vs. 41.7±15.6%, p<0.001 for LVEF) in the entire cohort. In the propensity-score matched cohort, LV-GLS was significantly reduced in the patients with DM compared to those without DM (10.2±4.9% vs. 10.9±5.0%, p<0.001), even with the matched LVEF (Table 1). Decreased LV-GLS in the DM patients was consistently identified in both subgroups of preserved EF and reduced EF (Table 1). Although RV-GLS was slightly lower in the patients with DM from the matched cohort, it was not significant in neither the preserved EF nor the reduced EF subgroup. When comparing the adverse outcome in the propensity-score matched cohort, the survival of patients with DM was significantly lower (Figure 1-A, 1-B), except for the preserved EF group (Figure 1-C). Comparison between heart failure patients with and without diabetes in the matched cohort Matched cohort p-value HFrEF (matched) p-value HFpEF (matched) p-value No-DM (n=1517) DM (n=1517) No-DM (n=823) DM (n=801) No-DM (n=652) DM (n=669) Age, years 71±14 71±11 0.962 69±14 70±11 0.305 75±11 74±10 0.061 Ischemic heart disease, n (%) 545 (35) 575 (37) 0.275 375 (36) 402 (39) 0.238 150 (34) 147 (34) 0.945 GFR, mL/min/1.73m2 56±27 55±27 0.282 58±28 56±27 0.253 54±27 54±26 1.000 HbA1C, % 5.7±0.4 7.3±1.4 <0.001 5.7±0.4 7.3±1.4 <0.001 5.7±0.4 7.2±1.4 <0.001 LV ejection fraction, % 39±15 39±15 0.871 31±9 31±10 0.99 59±5 59±6 0.279 LV-GLS, % 10.9±5.0 10.2±4.9 <0.001 9.1±3.8 8.3±3.6 <0.001 15.5±4.5 14.9±4.5 0.036 RV-GLS, % 13.1±6.5 12.7±6.2 0.045 12.1±6.2 11.8±5.9 0.188 15.6±6.5 15.0±6.4 0.157 Figure 1. Outcome by DM status Conclusions DM is associated with the impaired LV systolic function presented by GLS in HF patients, even with the adjustment of LVEF. The result indicates that GLS is a more sensitive marker of systolic function than LVEF, in terms of the DM status among the HF patients.

scholarly journals Left ventricular function in rheumatoid arthritis during anti-TNF-α treatment: a speckle tracking prospective echocardiographic study

2016 ◽  
Vol 84 (1-2) ◽  
Author(s):  
Enrico Vizzardi ◽  
Ilaria Cavazzana ◽  
Franco Franceschini ◽  
Ivano Bonadei ◽  
Edoardo Sciatti ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Tnf Α ◽  
One Year

<p><strong>Aim</strong>. Rheumatoid arthritis (RA) shows a high risk for cardiovascular disease, including heart failure. Although TNF-α has been implicated in the pathogenesis of myocardial remodelling, TNF-α inhibition did not show any efficacy in patients with advanced heart failure and should be contraindicated in RA with cardiac complications. We aimed to assess global left ventricular (LV) systolic function using global longitudinal strain (GLS) as a measure of myocardial deformation, in a group of RA patients before and during anti-TNF-α treatment. <strong>Methods</strong>. 13 patients (female:male 7:6) affected by RA were prospectively followed for one year during anti TNF-α treatment. Every subject underwent echocardiography before starting anti-TNF-α drugs and after one year of treatment, to evaluate LV ejection fraction (EF), telediastolic diameter, telediastolic volume and global longitudinal strain (GLS) that was calculated using 2D speckle tracking as the mean GLS from three standard apical views (2, 3 and 4 -chambers). The patients showed a mean age of 43 years at RA onset (SD: 13) and a mean follow-up of 7.3 years (SD: 4.8). Steroid and methotrexate were used in 84.6% and 100%, respectively, in association with etanercept (6 cases), adalimumab (4 cases) and infliximab (3 cases). <strong>Results</strong>. Patients globally showed a normal EF before and after one year of treatment (mean: 65% and 65.7%, respectively). GLS did not differ before or after anti-TNF-α treatment (mean: -15.8% and -16.7%, respectively). <strong>Conclusion</strong>. Anti-TNF-α treatment did not significantly modify myocardial contractility after 12 months.</p><p> </p><p> </p>

scholarly journals Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Shetty ◽  
H Malik ◽  
A Abbas ◽  
Y Ying ◽  
W Aronow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Kidney Injury ◽  
Matched Cohort ◽  
Hospital Outcomes ◽  
Increased Risk ◽  
The Impact

Abstract Background Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions. Purpose We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity. Methods Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Results Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p&lt;0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days. Conclusions In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was &gt;2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. Funding Acknowledgement Type of funding source: None

scholarly journals Sex-Specific Impact of Diabetes Mellitus on Left Ventricular Systolic Function and Prognosis in Heart Failure

2020 ◽  
Author(s):  
Soongu Kwak ◽  
In-Chang Hwang ◽  
Jin Joo Park ◽  
Jae-Hyeong Park ◽  
Jun-Bean Park ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Structural Equation ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Equation Model ◽  
Sem Analysis ◽  
Left Ventricular ◽  
Main Driver

Abstract Background: Diabetes mellitus (DM) aggravates the clinical features and outcomes of heart failure (HF). However, the sex-specific cardiovascular consequence of DM in HF patients remains unclear. We aimed to investigate the sex differences in associations of DM with echocardiographic phenotypes and clinical outcomes of HF.Methods: We studied 4,180 patients admitted for acute HF between 2009 and 2016 (median follow-up, 31.7 months), whose left ventricular global longitudinal strain (LV-GLS) data were available. Patients were compared by sex and DM. Structural equation model (SEM) analysis was performed to evaluate the moderating effects of two causal paths, via ischemic heart disease (IHD) and LV-GLS, linking DM with mortality by sex. Results: Among 1,431 patients with HF and DM (34.2%), women had more preserved LV systolic function, whereas men had more ischemic etiology. Compared to non-diabetic women, diabetic women had lower LV-GLS (11.3% versus 10.1%, p<0.001), but the difference was attenuated within men (9.7% versus 9.2%, p=0.014). In Cox analyses, DM was an independent predictor for higher mortality in both women and men, with a statistically insignificant but higher relative risk in women than men (adjusted hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.15-1.59 for women versus HR 1.24, 95% CI 1.07-1.44 for men, p for interaction=0.669). Restricted cubic spline curves showed that LV-GLS consistently declined, and mortality increased in women as hyperglycemia became more severe, but these trends were not evident in men. In SEM analysis, the main driver from DM to mortality differed by sex; men had a stronger effect via IHD than LV-GLS, whereas effect mediating LV-GLS was the only predominant path in women.Conclusions: DM increases the mortality risk in HF irrespective of sex. However, the main driver leading to mortality differed by sex, suggesting the importance of sex-specific strategies for HF management.

4093Beyond global longitudinal strain: early impairment of apical function after antracyclines therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Manganaro ◽  
L Longobardo ◽  
M Cusma' Piccione ◽  
A Bava ◽  
R Costantino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Troponin I ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Interventricular Septum ◽  
P Value ◽  
Apical Segment ◽  
Regional Strain

Abstract Purpose To confirm GLS diagnostic sensitivity as parameter for the evaluation of LV systolic function in women with breast cancer who underwent chemotherapy including anthracyclines and to identify a pattern of decreased 2D speckle tracking regional longitudinal strain through the analysis of polar maps obtained with AFI technology. Methods We enrolled 60 female patients (age with 56.5±12 years) with breast cancer before the beginning of chemotherapy. The study protocol included clinical examination, ECG with QTc calculation, lab test (BNP and troponin I) and echocardiography with TDI and speckle tracking analysis (STI), that were performed before the beginning of the chemotherapy (basal) and after 3, 6 and 12 months. Echocardiography evaluation included the following parameters: LV end-diastolic and end-systolic volumes, LV ejection fraction (EF), average TDI S' at the mitral annulus, Global Longitudinal Strain (GLS), regional longitudinal strain, E/A ratio, E/E' ratio and sPAP. For each patient we analyzed the bull's eye maps before the beginning of the therapy (basal value) and when GLS showed the lowest values during the FU (FU value), to identify the pattern of regional longitudinal strain alterations. We compared basal and FU strain values for each of the 17 LV segments and the difference between them (delta) was calculated according to the formula [(FU LS –basal LS, (%)]. Results During the FU, systolic blood pressure, systolic pulse pressure and BNP values increased from the basal assessment to the 3 and 6 months FU. Similarly, a progressive worsening of GLS values has been observed (basal −20.4±2.6%, 3 months FU −18.2±2.5%, 6 months FU −17.7±2.9, 12 months FU −17.6±3, p value <0.001). Through the analysis of polar maps, we observed that regional strain values worsened significantly in all the LV segments but the most evident impairment was reported in the apical cap (−22.8±3.9 vs −17.1±3.8; p<0.001, Δ=−5,78%) and in the apical segment of the anterior interventricular septum (−23.4±4.5 vs −17±6.3; p<0.001, Δ=−6,2%), as reported in Figure. Conclusion GLS is able to identify LV systolic dysfunction that EF is not able to detect. However, since that it describes the global function of LV, GLS could result as normal (18–20%) when strain impairment of some LV segments is counterbalanced by the compensatory strain increase of other segments, determining an misdiagnosis of myocardial damage. Regional strain and particularly the Δ-strain, seem to suggest that anthracyclines induce a damage more evident in the apical cap and in the apical segment of the interventricular septum and this pattern could be typical in these patients. Thus, polar maps analysis could be provide additional information about cardiac damage in this population.

scholarly journals Systolic Aortic Root Motion and Angle as novel indices of Left Ventricular Systolic Function

2020 ◽  
Author(s):  
ghada m soltan ◽  
ahmed m el kersh ◽  
nevien e sami ◽  
ghadeer m yehia ◽  
mahmoud ali soliman
Keyword(s):  
Aortic Root ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
P Value ◽  
Ventricular Systolic Function ◽  
Global Left Ventricular ◽  
Motion Amplitude

Abstract Background Aortic root motion was used only as a surrogate parameter of global left ventricular systolic function depending on its direct proportion to cardiac output. We hypothesize that aortic root motion angle and aortic root motion amplitude may overcome many limitations of EF calculation by M mode and two dimensional methods and are easier and reproducible.Objective The aim of this study is to asses systolic aortic root motion measured by M mode and aortic root motion angle as novel indices of global left ventricular systolic function.Patients and methods one hundred patients were enrolled in this study and divided into four groups: according to their age (above and below 60 years) and EF (above and below50%). They were subjected to full history taking, careful clinical examination, and conventional echo-Doppler study .Systolic aortic root motion obtained from long axis parasternal view by M-mode echo guided by 2D echo, and aortic root motion angle was traced off line and mathematically measured. Also global logitudinal strain (GLS) and global longitudinal strain rate (GLSR) from apical 4,3 and 2 chamber views were measured offline.Results Statistical analysis of collected data show that there are significant differences between control groups and patient groups in aortic root motion angle (t= 16.9 and p value <0.001, and in aortic root motion amplitude (t= 20.1 and p value <0.001). Aortic root motion (cm) and aortic root motion angle have significant positive correlation with EF(Mm), EF(2D), Fs, global longitudinal strain(GLS) and global Strain rate . The best cutoff value of aortic root motion angle was 19.5 degree, with sensitivity of 93.9%, specificity of 96.1.Aortic root motion angle >19.5 predicts systolic function >50% and that<19.5 predicts systolic function <50% The best cutoff value of aortic root SAM was 8.5 mm. An aortic root SAM of ˂ 8.5 mm predicts an LVEF of ˂ 50% with sensitivity of 95.9%, specificity of 96.1%.Conclusion The amplitude of systolic aortic root motion (SARM) by (M-mode) and aortic root motion angle are well- correlated with the EF and GLS and could be considered as novel indices of global left ventricular systolic function with high accuracy and reproducibility .

scholarly journals Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in ebstein anomaly

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Devara ◽  
M Iftikhar ◽  
A Goda ◽  
L Shaik ◽  
R Katta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Clinical Implications ◽  
Ebstein Anomaly ◽  
Free Survival ◽  
Lv Dysfunction ◽  
Lv Systolic Function

Abstract Background Certain factors such as left ventricular (LV) geometry and loading conditions affect the validity and reliability of LV ejection fraction (LVEF) as a true measure of LV contractility. LV global longitudinal strain (LVGLS) is less sensitive to these factors, and it has superior prognostic performance in patients with acquired heart disease. The purpose of this study was to determine the clinical implications of using LVGLS (instead of LVEF) as the measure of LV systolic function in adults with Ebstein anomaly given the inherent abnormalities of LV geometry and preload in this population. Methods Retrospective cohort study of 673 adults with Ebstein anomaly (2003–2018). We hypothesized that LVGLS had a stronger correlation with heart failure indices and transplant-free survival compared to LVEF. Results Compared to LVEF, LVGLS had stronger correlations with cardiac index (r=0.46 vs r=0.21, p=0.007), glomerular filtration rate (r=0.57 vs r=0.19, p&lt;0.001), and NT-proBNP (r=−0.64 vs r=−0.41, p=0.01). Of 673 patients, 514 (76%) had normal LV systolic function (LVGLSNormal-LVEFNormal), 87 (13%) had subclinical LV dysfunction (LVGLSLow-LVEFNormal) and 66 (10%) had overt LV dysfunction (LVGLSLow-LVEFLow). Compared to the overt LV dysfunction group, the subclinical LV dysfunction group had similar 10-year transplant-free survival (64% vs 63%, p=0.6), but were less likely to be on heart failure therapy (12% vs 82%, p&lt;0.001). LVGLS (but not LVEF) was the independent predictor of transplant-free survival Conclusions LVGLS provided more robust risk stratification and prognostication than LVEF in patients with Ebstein anomaly, and patients with low LVGLS had reduced transplant-free survival regardless of LVEF. The use of LVGLS (rather than LVEF) as the measure of LV systolic function has important clinical implications with regards to initiation of medical and surgical therapies. FUNDunding Acknowledgement Type of funding sources: None.

P4377Use of LV Deformation Imaging to predict long term Heart Failure Risk in high risk patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Haji ◽  
T Marwick ◽  
C Neil ◽  
S Stewart ◽  
M Carrington ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
P Value ◽  
Ageing Population ◽  
Patients At Risk

Abstract Background The increasing prevalence of heart failure (HF), due to hypertension, ischaemic heart disease, diabetes, obesity, and ageing population demands identification of at-risk subgroup whom we could target on prevention strategies. In a same cohort of patients at risk of HF (70% with CAD), 13% developed new HF hospitalization or death over 4.3 years of follow-up, however, disease management program did not confer any benefit to outcome and LV ejection fraction (EF) was not predictive of progression to HF. Better risk stratification strategies are needed. In this study, we sought whether advanced echo measure on deformation, global longitudinal strain (GLS) would predict HF admission over a long term follow up and thereby define an at-risk group. Aim: To determine which of the LV morphology, function and deformation parameters, best predict new HF admission or HF death in pts at risk but without prior dx of HF. Method Echocardiograms (including measurement of LV, size, function, morphology and deformation) were obtained in 431 inpatients (mean age 65±11, 72% male) at risk of HF. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured offline (EchoPac, GE). Long term (9 years) follow up data were obtained via data linkage. Results 63 pts (15%) reached the end-point of HF admission or HF death. LV deformation showed a univariable association with outcome (Table). In multivariable analysis, including known significant predictors of outcome (age, sex, BMI, diabetes, hypertension), GLS less than 18 remained an independent predictor (Table), in addition to age and DM at baseline. EF and LV mass were not predictors of heart failure. HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Age 1.1 (1–1.1) <0.01 1.1 (1–1.1) 0.04 1 (1–1.1) 0.04 Sex 1.0 (0.6–1.7) 0.9 0.8 (0.4–1.8) 0.6 0.8 (0.4–1.8) 0.6 BMI 1.0 (1–1.1) 0.05 1 (0.9–1.1) 0.7 1 (0.9–1.1) 0.7 DM 2.6 (1.6–4.3) <0.01 2.7 (1.4–5.3) <0.01 2.7 (1.4–5.2) 0.04 LVMI 1.0 (1.0–1.0) <0.01 1 (0.9–1.0) 0.7 1 (0.99–1.0) 0.7 Impaired EF, % 1.0 (0.9–1.0) <0.01 1 (0.9–1.0) 0.16 0.97 (0.94–1.0) 0.04 Diastolic dysfunction 2.3 (1.4–3.7) <0.01 0.8 (0.3–1.7) 0.5 0.7 (0.3–1.7) 0.5 GLS 1.3 (1.4–1.2) <0.01 1.1 (1–1.2) 0.07 GLS <18 5.3 (2.8–10.2) <0.01 2.3 (1.1–5.1) 0.04 Conclusion GLS <18 is independently associated with increasing new onset heart failure admission and HF mortality in patients at risk of HF.

Abstract 11751: Beneficial Impact of Dipeptidyl-peptidase-4 inhibitors on Mortality of Patients With Hospitalized Heart Failure Patients With Diabetes Mellitus

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Akihiko Sato ◽  
Akiomi Yoshihisa ◽  
Yuki Kanno ◽  
Mai Takiguchi ◽  
Shunsuke Miura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Propensity Score ◽  
Experimental Studies ◽  
Rank Test ◽  
Matched Cohort ◽  
Cardiac Mortality ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
All Cause Mortality

Background: Heart failure (HF) and diabetes mellitus (DM) often co-exist. Treatment of DM in patients with HF is challenging since some therapies for DM are contraindicated in HF. Although previous experimental studies have reported that DPP-4 inhibitors improve cardiovascular function, it still remains unclear whether DPP-4 inhibition improves mortality of HF patients with DM. Therefore, we examined impacts of the DPP-4 inhibition on mortality in hospitalized HF patients using propensity score matching. Methods and Results: We performed prospective observational study regarding to hospitalized HF. Out of 1011 original HF patients cohort, 112 patients were treated with DPP-4 inhibitors. Propensity score for treatment with DPP-4 inhibitors were estimated for each patient by logistic regression with clinically relevant baseline variables including age, estimated GFR, HbA1c, usages of α-glucosidase inhibitor, sulphonylurea, biguanide and insulin. The propensity matched cohort 1:1 was assessed based on propensity scores (DPP-4 inhibitors, n = 82 and non-DPP-4 inhibitors, n = 82). Kaplan-Meier analysis demonstrated that cardiac and all-cause mortality was significantly lower in the DPP-4 inhibitor group than in the non-DPP-4 inhibitor group (cardiac mortality: 7.3% vs. 23.2%, P=0.006; all-cause mortality: 17.1% vs. 42.7%, P=0.002, by a log-rank test) in the propensity matched cohort. In the multivariable Cox proportional hazard analyses, after adjusting for other potential confounding factors, the use of DPP-4 inhibitors was an independent predictor of cardiac and all-cause mortality (cardiac mortality: HR 0.322, 95% CI 0.127-0.819, P = 0.017; all-cause mortality: HR 0.517, 95% CI 0.273-0.978, P = 0.042) in HF patients with DM. Conclusions: Our data suggest that DPP-4 inhibitors may improve cardiac and all-cause mortality in patients with HF and DM.

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