scholarly journals Global Longitudinal Strain Analysis Using Cardiac MRI in Aortic Stenosis: Comparison with Left Ventricular Remodeling, Myocardial Fibrosis, and 2-year Clinical Outcomes

2019 ◽  
Vol 1 (4) ◽  
pp. e190027 ◽  
Author(s):  
Nicholas B. Spath ◽  
Miquel Gomez ◽  
Russell J. Everett ◽  
Scott Semple ◽  
Calvin W. L. Chin ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Clinical Outcomes ◽  
Myocardial Fibrosis ◽  
Cardiac Mri ◽  
Longitudinal Strain ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Left Ventricular

scholarly journals P323 Early measurement of left ventricular global longitudinal strain and mechanical dispersion predict left ventricular remodeling at 5 year follow up after STEMI: pilot study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A I Scarlatescu ◽  
S Onciul ◽  
D Zamfir ◽  
A Pascal ◽  
M Dorobantu
Keyword(s):  
Longitudinal Strain ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Mechanical Dispersion ◽  
Global Strain ◽  
Lv Remodeling ◽  
Adverse Remodeling

Abstract Funding Acknowledgements This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF. Background Left ventricule (LV) function plays an important role in the pathophysiology of decompensation after acute ST elevation myocardial infarction (STEMI). LV remodeling (LVR) after STEMI is associated with development of heart failure, predicting poor clinical outcome therefore its identification is of clinical importance to set up preventive strategies. Prediction of the left ventricular remodeling (LVR) after STEMI in patients treated by primary PCI is challenging. Purpose Finding an echocardiographic parameter that can predict left ventricular remodeling in time after STEMI. Materials and methods In this prospective study we included 30 consecutive patients, median age 60 (37-79), 76% male, with STEMI treated by primary PCI. We performed conventional 2D transthoracic echocardiography for all included patients. In addition to conventional parameters we measured LV global longitudinal strain (GLS) and LV mechanical dispersion using 2D speckle tracking imaging technique. For morphological and functional analysis of LV we used 3D echocardiography (volumes, LVEF) considering its superiority in assessment of LV. All measurements were performed at baseline (up to 7 days after STEMI) and at 5 year follow up. LVR was defined as an increase of over 15% of the LV end diastolic volume (LVEDV) in time, at 5 years after the STEMI. Results We obtained significant differences in time (up to 7 days after STEMI vs at 5 years) between 3D LVEF (46,48 vs 51,68, p = 0.002), LVEDV (97,12 vs 107,76, p = 0.000), 2D global strain (-11.76 vs - 14,1, p = 0.00), and mechanical dispersion (65,06 vs 57,66, p = 0.00) in all patients. LV remodeling at 5 years (15% increase in LVEDV) was observed in 36,6% of the included patients. At 5 years follow up, LVEDV mean value in the remodeling group was 130 ml and in the no remodeling group 90,21 ml (p = 0.002), 3D LVEF was 48,18 vs 54,42 (p = 0.05), global strain was - 12,33 vs -15,35 (p = 0.02) and LV mechanical dispersion 66,27 vs 55,55 (p = 0.05). Therefore patients with LV remodeling in time had lower LVEF, lower global strain and higher LV mechanical dispersion at baseline. Using ROC analysis we identified two cut off values, one of -11.55 for global LV strain measured at baseline (Sb 81.8%, Sp 77%, AUC 0.776, CI 95%, p = 0.022) and the other one of 63.7 for LV mechanical dispersion at admission (Sb 72,7%, Sp 62%, AUC 0.734, p 0.05) to discriminate between patients with or without LV adverse remodeling at 5 years after STEMI. We also found, using regression analysis, that GLS and LV mechanical dispersion are able to predict LV remodeling in time. Conclusion Global longitudinal strain and left ventricular mechanical dispersion measured in the acute phase can predict which patient is likely to undergo LV remodeling at 5 years after STEMI. GLS and LV dispersion could be used as predictors for future LV adverse remodeling after STEMI. Larger scale studies are needed to validate these findings.

Abstract 12576: Impact of Insulin Resistance on Left Ventricular Remodeling in Patients With a First-Time ST Elevation Acute Myocardial Infarction Without Overt Diabetes Mellitus

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Noriaki Iwahashi ◽  
Masaomi Gohbara ◽  
shunsuke Kataoka ◽  
Eiichi Akiyama ◽  
Nobuhiko Maejima ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Insulin Resistance ◽  
Longitudinal Strain ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
St Elevation ◽  
First Time

Backgrounds: Insulin resistance (IR) has been reported to be associated with worse prognosis in patients with coronary artery disease. However, the role of IR in patients with acute myocardial infarction(AMI) remains unclear. Therefore, we explored the impact of IR on left ventricular remodeling (LVR) after ST elevation AMI (STEMI) without overt DM. Methods: One hundred seventy patients with a first-time ST elevation AMI (STEMI) who underwent reperfusion within 12 hours were enrolled in this study. Patients had no history of diabetes mellitus prior to their first STEMI. We examined echocardiography results 24 hours after PCI and 12 months later. We measured global longitudinal strain using 3D speckle tracking echocardiography (4D LV Analysis, TOMTEC, Germany). We calculated 3D global longitudinal strain(3D-GLS) as the parameter of accurate systolic function free from tethering effect. Infarct size was defined using Tc99m-sestamibi as the area of <50% uptake at 2 weeks. We checked HOMA-R at 2 weeks. The absolute difference of the LV end-diastolic volume (ΔLVEDV) after 12 months was calculated as a parameter of LVR. We excluded the patients with CKD (eGFR <30ml/min/1.73m2) and the high fasting glucose level (>140mg/dl). Results: Infarct size (r2=0.30, p=0.03) and HOMA-R (r2=0.50, p=0.018) had a good association with ΔLVEDV. There was a significant relationship between HOMA-R andΔLVEDV (r2=0.096, p=0.0007). Multiple regression analysis showed that HOMA-R was the strongest predictor of ΔLVEDV, followed by 3D-GLS (Table). Conclusions: Insulin resistance was the strongest predictor for the degree of LV remodeling in patients with a first STEM without overt DM.

scholarly journals Echocardiographic global longitudinal strain as a marker of myocardial fibrosis predicts outcomes in aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Chin ◽  
T T Le ◽  
G Singh ◽  
J Yip ◽  
S C Chai ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Confidence Interval ◽  
Myocardial Fibrosis ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Derivation Cohort ◽  
Replacement Fibrosis

Abstract Background Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) reflects intrinsic myocardial function, influenced by interstitial abnormalities. Cardiovascular magnetic resonance (CMR) detects myocardial fibrosis non-invasively, but it is limited for widespread use. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on CMR and validate the prognostic value of LV-GLS thresholds associated with fibrosis. Methods LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57±10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR for replacement myocardial fibrosis. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71±12 years; 58% males; NYHA functional class I-II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, myocardial infarction and cerebrovascular events. Results In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74; 95% confidence interval: 0.66–0.83; P&lt;0.001) and calibration (Hosmer-Lemeshow X2=6.37; P=0.605) for replacement fibrosis. In the outcome cohort, 52 events occurred over 16 [3.1, 42.0] months of follow-up. Patients with LV-GLS &gt;−15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS &lt;−21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P&lt;0.001; Figure 1). Furthermore, LV-GLS offered independent prognostic value over clinical variables, AS severity, echocardiographic LVEF and E/e' (hazard ratio 1.18; 95% confidence interval: 1.07 to 1.30; P=0.001). Conclusions LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF (Figure 2). FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council Figure 1 Figure 2

scholarly journals 1677 Global longitudinal strain during dobutamine stress echocardiography can predict left ventricular remodeling after anterior wall acute myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Onishi ◽  
K Iwakura ◽  
A Okamura ◽  
Y Koyama ◽  
K Inoue ◽  
...  
Keyword(s):  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Low Dose ◽  
Ventricular Remodeling ◽  
Dobutamine Stress Echocardiography ◽  
Left Ventricular Remodeling ◽  
Global Longitudinal Strain ◽  
Dobutamine Stress ◽  
Anterior Wall ◽  
Left Ventricular

Abstract Background Although dobutamine stress echocardiography (DSE) at the early stage of acute myocardial infarction (AMI) is useful for the prediction of functional and clinical prognosis, the interpretation requires expertise. In this study, we sought to investigate if global longitudinal strain (GLS) during DSE after AMI can predict left ventricular remodeling (LVR). Methods Consecutive 30 patients with anterior wall AMI (18 male, age = 58 ± 13 years) were performed DSE 3 days after AMI. GLS was calculated as an averaged value of peak longitudinal strain in the apical 4- and 2-chamber views at baseline echocardiography, low-dose DSE (10 μg/kg/min) using available software (QLAB, Philips Medical Systems). Left ventricular remodeling (LVR) was defined as an echocardiographically determined increase in both EDVI and ESVI of 20% or more from baseline to the 6 month follow-up echocardiography. Results 12 patients (40%) evolved with LVR. The change in GLS during low-dose DSE was significantly different between the remodeling and non-remodeling group (8 ± 5% v.s. 27 ± 20%, p &lt; 0.05). Interestingly, it predicted LVR with sensitivity of 88%, specificity of 92% at the cut-off value of 12% (Area under the curve = 0.94, p &lt; 0.0001). Conclusion The change in GLS during low-dose DSE can be used as a predictor for the LVR after AMI. This observation has promise for clinical applications. Abstract 1677 Figure.

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