scholarly journals Time course of left atrial reverse remodelling after mitral valve surgery and the impact of left ventricular global longitudinal strain in patients with chronic severe mitral regurgitation

2016 ◽  
Vol 23 (6) ◽  
pp. 876-882 ◽  
Author(s):  
Peter Chipeta ◽  
Chi Young Shim ◽  
Geu-Ru Hong ◽  
Darae Kim ◽  
In Jeong Cho ◽  
...  
Keyword(s):  
Left Atrial ◽  
Longitudinal Strain ◽  
Time Course ◽  
Global Longitudinal Strain ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Severe Mitral Regurgitation ◽  
Reverse Remodelling ◽  
The Impact

scholarly journals The impact of left atrial strain parameters on systolic and diastolic improvement following TAVI

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Vattay ◽  
A I Nagy ◽  
A Apor ◽  
M Kolossvary ◽  
A Manouras ◽  
...  
Keyword(s):  
Left Atrial ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Term Survival ◽  
Lv Mass ◽  
Reverse Remodelling ◽  
The Impact

Abstract Introduction Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and has been shown to improve long term survival. Data on the prognostic value of left atrial (LA) strain following TAVI are scarce. LA strain – a surrogate of LV filling pressure - can aid the early detection of diastolic dysfunction and correlates with the extent of fibrosis in atrial remodelling. Purpose In this multimodality study, we aimed to evaluate the prognostic value of LA function measured before hospital discharge following TAVI and to further elucidate its association with LV and LA reverse remodelling. Methods In this prospective single center study, we investigated 90 patients (mean age 78.5 years, 46.7% female) with severe, symptomatic aortic stenosis (AS) who underwent transthoracic echocardiography immediately after TAVI and 6 months later. LA and LV global longitudinal strain parameters were obtained by speckle tracking echocardiography. CT angiography (CTA) was performed for pre-TAVI planning and repeated at 6 months follow-up. LV mass values were derived from the serial CTA images. We defined LV reverse remodelling as reduction of myocardial mass quantified on CTA and as an improvement of LV global longitudinal strain (GLS). LA reverse remodelling was assessed based on the peak reservoir strain values (LAGS). The association of LA and LV global strain parameters, LA stiffness, systolic and diastolic functional parameters and LV mass based reverse remodelling were analysed using Pearson correlation coefficient and linear regression models. Results The mean LAGS and LVGLS values were 17.7% and 15.3% at discharge and 20.2% and 16.6% at follow-up, respectively (p=0.024, p<0.001). LA and LV strain values improved in 60.6% and 74.5% of all patients. Reduced LAGS (<20%) was found in 66.7% of all patients at baseline. LA strain at discharge correlated significantly with diastolic parameters (E wave, E/e', LAVI, all p<0.05). Atrial reverse remodelling based on LAGS change correlated with LVGLS change (p<0.01, standardized β=0.53) and LAGS at discharge (p=0.012, standardized β=−0.30). LAGS correlated with the extent of morphological LV remodelling based on LV mass reduction (p=0.002, coeff: 0.36). Elevated LA stiffness at discharge (upper tercile) leads to substantially lower LAGS at 6 months versus patients with lower LA stiffness value (1. and 2. tercile): 16.4±10.0 vs 21.9±9.8, p=0.042. Conclusion Patients with reduced LAGS immediately after TAVI showed a larger extent of LV reverse remodelling during follow up. On the other hand, increased LA stiffness at discharge was consistent with irreversible LA damage as demonstrated by a lack of improvement in LA function. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 18515: Forward Flow Ejection Fraction as a Major Determinant of Outcome in Organic Mitral Regurgitation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marlène Dupuis ◽  
Marie-Annick Clavel ◽  
Haïfa Mahjoub ◽  
Kim O’Connor ◽  
Mario Sénéchal ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Cardiac Events

Introduction: The optimal timing of mitral valve (MV) surgery in patients with organic mitral regurgitation (OMR) is controversial. The objective of this study was to determine independent predictors of cardiac events in patients with OMR and no triggers for mitral valve surgery. Hypothesis: We hypothesized that forward LV ejection fraction (LVEF) calculated by the Dumesnil’s method (i.e. stroke volume measured in LV outflow tract divided by left ventricular end diastolic volume) is superior to the LVEF measured by the biplane Simpson’s method. Methods: Two hundred seventy eight patients with OMR (i.e. severity grade ≥1/4) and Doppler echocardiography exam at least 6 months before MV surgery or death were included. Clinical and echocardiographic data of 278 patients with OMR were analyzed retrospectively. The study end-point was the composite of death or need for mitral valve surgery. Results: During a mean follow-up of 5.4 ± 3.2 years, there were 147 (53%) events: 96 (35%) mitral surgeries and 66 (24%) deaths. There was no difference in the Simpson LVEF (65 ± 6% vs 65 ± 4%; p=0.86) and global longitudinal strain (-21.18 ± 3.26 % vs -21.26 ± 2.44 %; p=0.86) between patients who had an event versus those who were event-free during follow-up. However, LVEF calculated by Dumesnil’s method at baseline was lower in the event-group (47 ± 15%vs 59 ± 15%; p<0.0001) compared to the non-event group. After adjustment for age, sex, Charlson’s probability, coronary artery disease, ACE inhibitors, β-blockers, diuretics, AF and MR grade, forward LVEF by Dumesnil’s method remained an independent predictor of the occurrence of cardiac events (adjusted hazard ratio: 1.09, 95% interval confidence: 1.02-1.17; p=0.01). Conclusion: This study shows that the forward LVEF calculated by the Dumesnil’s method is superior to the standard LVEF or to longitudinal strain to predict outcomes in OMR. These results could help to improve risk stratification of patients with OMR and thereby individualized the treatment’s strategy. Further prospective studies are needed to confirm these findings.

Early change in left atrial and left ventricular strain predicts sinus rhythm maintenance after cardioversion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kupczynska ◽  
D Miskowiec ◽  
B Michalski ◽  
L Szyda ◽  
K Wierzbowska-Drabik ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Recurrence Risk ◽  
Left Ventricular ◽  
Mechanical Function ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) impairs mechanical function of the heart, especially atria and restoration of sinus rhythm (SR) leads to improvement of mechanics. The predicting role of changes in strain parameters for AF recurrence is not established yet. Purpose To analyse changes in left atrial (LA) and left ventricular (LV) mechanical function after conversion to SR and their prognostic values for AF recurrence during 24 months follow-up. Methods Prospective study involved 59 patients after successful electrical cardioversion (EC) because of nonvalvular AF (mean age 65±4 years, 47% female). Speckle tracking analysis (STE) was applied to calculate longitudinal strain of LV and LA before EC and within 24 hours after restoration of SR and additionally total left heart strain (TS) defined as a sum of absolute peak LV and LA strain. We calculated change in strain between AF and SR analyses expressed as delta (Δ). During follow-up we noticed AF recurrence in 42 (71%) patients, most of them (93%) during 1st year after EC. Median time of AF recurrence was 3 months. Results We noticed significant immediate post-EC improvement in peak LA longitudinal strain (PALS) and LV global longitudinal strain (LVGLS) (table). Unlike CHA2DS2-VASc score, strain parameters were predictors of AF recurrence. Every 1% increment in ΔLVGLS was related with 13% increase in AF recurrence risk (p=0.02) and every 1% increment in ΔPALS and ΔTS were related with 9% decrease in AF recurrence risk (p=0.007 and p=0.0014, respectively). Multivariate analysis revealed ΔTS as a strongest predictor with 9% decrease in AF risk per every 1% increment. The criterion of ΔTS ≤7.5% allows to predict AF recurrence with 81% sensitivity and 63% specificity. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR and these absolute changes in LVGLS as well as PALS can predict AF recurrence, with optimal stratification by novel parameter - TS. Funding Acknowledgement Type of funding source: None

Abstract 15160: Atrioventricular and Ventricular Functional Interdependence in the Community

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yuriko Yoshida ◽  
Koki Nakanishi ◽  
Masao Daimon ◽  
Jumpei Ishiwata ◽  
Naoko Sawada ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Preventive Strategies ◽  
Lv Dysfunction ◽  
Functional Remodeling ◽  
Integral Role

Introduction: Left atrial (LA) and right ventricular (RV) performance play an integral role in the pathophysiology and prognosis of heart failure (HF). However, the alteration of atrioventricular and ventricular functional interdependence in a preclinical setting is unclear. We aimed to investigate the association between LA/RV functional remodeling and subclinical left ventricular (LV) dysfunction. Methods: LV global longitudinal strain (LVGLS), RV free wall longitudinal strain (RVLS) and LA reservoir strain were assessed by speckle-tracking echocardiography in 1,080 participants (600 men; 62±12 years) without cardiac disease. Results: A hundred and forty-three participants (13.2%) had an abnormal LVGLS (>-18.6%). LA reservoir strain and RVLS were significantly decreased in abnormal LVGLS group compared with normal LVGLS group (both p<0.001). LA and RV dysfunction (LA reservoir strain < 31.4% and RVLS > -19.2%) were present in 18.9% and 19.6% of participants with abnormal LVGLS, respectively (Figure). Decreased LVGLS was significantly associated with worse LA reservoir strain and RVLS (standardized β=-0.20 and 0.11 respectively, both p<0.01) independent of cardiovascular risk factors, pertinent biomarkers and LV geometry and diastolic dysfunction. Conclusions: In the general population without overt cardiac disease, approximately 20% subjects with impaired LVGLS exhibited LA/RV dysfunction, and LVGLS was independently associated with both LA and RV strain. Our findings may provide valuable insights for a better understanding of HF pathophysiology and possibly preventive strategies.

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.

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