Left Ventricular Strain and Rotation in Patients with Dilated Cardiomyopathy and Severe Systolic Dysfunction

Cardiology ◽  
2019 ◽  
Vol 145 (1) ◽  
pp. 1-12
Author(s):  
Elena Kinova ◽  
Desislava Somleva-Todorova ◽  
Assen Goudev
Keyword(s):  
Dilated Cardiomyopathy ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Class Iii ◽  
Roc Curve Analysis ◽  
Mitral Annulus Velocity

Introduction: In dilated cardiomyopathy (DCM) left ventricular (LV) strain and twist are significantly decreased. However, the rate of attenuation has not been investigated well in patients with varying degrees of systolic dysfunction. Aim: The present study aimed to investigate the relationship between LV deformational and rotational mechanics and conventional and tissue Doppler imaging (TDI) parameters, and to search for a constellation of findings distinguishing patients with severe systolic dysfunction (SSD) in DCM. Methods: Fifty-two patients with heart failure NYHA class III–IV and ejection fraction (EF) ≤45% were prospectively enrolled (mean age 61.8 ± 13.4 years; 36 males, 69%). Severe systolic LV dysfunction was considered as EF <30%. Echocardiography with 2D-speckle tracking analysis was performed. Results: The relationships of global longitudinal strain (GLS) with EF, circumferential strain at mid-level (CSmid), and systolic medial mitral annulus velocity were strong (r = –0.53, 0.67, and –0.56, respectively, p < 0.0001 for all). A good correlation was found between CSmid and EF (r = –0.50, p < 0.0001). There were weak correlations between basal endocardial rotation (BRendo) and EF and CSmid. Multiple regression analysis found GLS (p < 0.0001) and BRendo (p = 0.04) to be predictors of the change of EF. In ROC curve analysis, the cut-off values of GLS –7.2% (AUC 0.81, p < 0.0001), CSmid –7.5% (AUC 0.76, p = 0.002), and BRendo –2.43° (AUC 0.68, p = 0.03) identified SSD. Conclusions: Parameters of LV mechanics were related to conventional and TDI systolic parameters in patients with DCM. The degree of alterations of LV longitudinal and circumferential deformation and basal rotation may identify patients with SSD and a higher risk, and may help in therapeutic decision making.

Abstract 1601: Comprehensive Evaluation of the Left Ventricular Systolic and Diastolic Synchronicity in 160 “Completely” Healthy Normal Volunteers Using Tissue Doppler Echocardiography

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hyung-Kwan Kim ◽  
Keun-Ho Park ◽  
Suna-A Chang ◽  
Jin-Shik Park ◽  
Hyun-Jae Kang ◽  
...  
Keyword(s):  
Age Groups ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Specific Reference ◽  
Reference Ranges ◽  
Normal Ranges ◽  
Mitral Annulus Velocity

Background Growing use of the left ventricular(LV) systolic(LVSIsys) and diastolic synchronicity indexes(LVSIdia) in selecting potential responders to cardiac resynchronization therapy(CRT) has created a need for normative reference values. This study was performed to determine reference ranges for tissue Doppler imaging-derived LVSIsys and LVSIdia, and to assess their relationships to age and conventional parameters reflecting LV systolic and diastolic functions. Methods and Results We recruited 160 completely healthy volunteers (45±13yrs, 104 men) free of any systemic or cardiovascular disease. Maximal difference and SD of time to peak systolic and early diastolic velocities for LVSIsys and LVSIdia were measured using 6- and 12-segment models. Table and Figure represent normal ranges. Aging was not found to significantly change LVSIsys, whereas LVSIdia progressively and consistently increased with age. Significant correlations were observed between LVSIdia and parameters representing LV diastolic function, i.e. early mitral inflow velocity and its deceleration time, and early mitral annulus velocity. A physiologic rise in LV mass/Ht 2.7 showed a weak, but significant correlation with LVSIdia( r = 0.15 to 0.22), but not with LVSIsys. On multivariate analysis, age-dependent increase in LVSIdia was confirmed. Conclusions Age-specific reference ranges for LVSIsys and LVSIdia are presented here. LVSIsys remain stable throughout age groups, whereas LVSIdia progressively increases with age. These data given here will be useful for defining abnormal LV synchronous contraction and relaxation, and help better select patients likely to respond favorably to CRT.

Abstract 18294: Left Ventricular Systolic Dysfunction Early After Resuscitation From Cardiac Arrest is Associated With Shockable Arrest Rhythm

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jacob C Jentzer ◽  
Hussein Abu-Daya ◽  
Asher Shafton ◽  
Meshe Chonde ◽  
Didier Chalhoub ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Troponin I ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Mitral Annulus Velocity ◽  
Fractional Shortening

Introduction: Left ventricular systolic dysfunction (LVSD) is common after resuscitation from cardiac arrest (CA). The association of echocardiographic LVSD with cardiac rhythm during CA is not well described. Hypothesis: Patients with a shockable rhythm (VT/VF) will have a greater degree of LVSD by echocardiography after CA. Methods: Prospective registry of patients resuscitated from CA underwent transthoracic echocardiography (TTE) within 24 hours after CA. We determined 2D measurements, LVEF, spectral Doppler of mitral inflow and LV outflow, systolic and diastolic tissue Doppler of the mitral annulus velocity, and tricuspid plane annular excursion (TAPSE). We collected data on in-hospital mortality as well as vasopressor doses and troponin I levels. TTE parameters and clinical characteristics were compared between patients with a shockable (VT/VF) arrest rhythm and a non-shockable (asystole/PEA) arrest rhythm and between survivors and non-survivors using t-tests and ANOVA. Results: Of the 55 patients, the 23 (42%) with shockable CA rhythms had significantly higher LV end-systolic dimension (4.1cm vs. 3.3cm, p = 0.0073), lower LV fractional shortening (0.15 vs. 0.28, p <0.0001), and lower LVEF both by visual estimate (36.2% vs. 52.3%, p = 0.0012) and by Simpson’s biplane method (37.5% vs. 52.3%, p = 0.0506). Other measured TTE parameters did not differ between groups, including TAPSE (shockable 1.53 vs. non-shockable 1.82, p = 0.1731). Admission and peak 24 hour vasopressor requirements did not differ between groups. Peak troponin levels were higher (22.26 vs. 3.88, p = 0.0198) in patients with shockable CA rhythms, but admission troponin levels were no different (0.88 vs. 0.51, p = 0.1527). TTE parameters did not differ between survivors and non-survivors (visual LVEF 47.0% vs. 44.2%, p = 0.5968; LV fractional shortening 0.19 vs. 0.25, p = 0.0916). Conclusions: Patients with shockable CA rhythms have more severe LVSD on 24 hour echocardiography despite similar vasopressor requirements and admission troponin levels. Echocardiographic parameters at 24 hours did not predict in-hospital mortality. Early echocardiography after CA appears more useful for differentiating primary CA rhythm than for predicting mortality.

scholarly journals 85 Diuretics trajectories in dilated cardiomyopathy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo Nuzzi ◽  
Antonio Cannatà ◽  
Paolo Manca ◽  
Caterina Gregorio ◽  
Giulia Barbati ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Nyha Class ◽  
Diuretic Therapy ◽  
Left Ventricular ◽  
Equivalent Dose ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
Kaplan Meier

Abstract Aims Diuretics in heart failure (HF) are commended to relieve symptoms at lowest dosage effective. Dilated cardiomyopathy (DCM) is a particular HF setting with several variables that may influence disease trajectory. We aimed to assess the long-term use of diuretics in DCM, the possibility of withdrawal and to explore the prognostic correlations. Methods and results All consecutive DCM patients enrolled from 1990 to 2018 were considered eligible. All the patients had available the information about the furosemide-equivalent dose at baseline and at follow-up evaluation within 24 months. Patients were categorized in stable (diuretic dose variation &lt;50%), increasers (diuretics dose increase ≥50% or initiation of diuretic therapy), and decreasers (diuretics dose decrease ≥50% or never prescribed diuretics in the 24-months observation period). The prognostic role of the diuretics trajectory group was assessed with Kaplan Meier analysis and with a time-dependent multivariable model. The outcome measure was a composite of all-cause death/heart transplantation/HF hospitalization (ACD/HTx/HFH). 908 patients were included [mean age 50 ± 16, 70% male sex, 24% NYHA class III or IV, mean left ventricular ejection fraction (LVEF) 31 ± 9%, 66% treated with diuretics at baseline]. The furosemide-equivalent dose at enrolment had a linear association with the risk of outcome. Compared to other groups, decreaser patients were younger, had less HF symptoms, higher LVEF and more dilated left atrium. Decreasers had a lower prescription rate of diuretics and less frequent indication to renin-angiotensin inhibitors and mineralocorticoid receptors antagonists. Over a median follow-up of 122 (62–195) months decreasers had the lowest incidence of outcome, followed by stable, while increasers had the worst outcome (P &lt; 0.001). After adjustment for other prognosticators, compared to stable patients, decreasers had a reduced risk of ACD/HTx/HFH [HR: 0.497 (95% CI: 0.337–0.731)] while increasers had the highest risk of adverse outcome [HR: 2.027 (95% CI: 1.254–3.276)]. Similarly, amongst patients taking diuretics at baseline, the diuretics withdrawal was in independent outcome predictor. The only multivariable predictors of diuretics withdrawal were younger age and lower furosemide-equivalent dose at enrolment. Conclusions In DCM patients the diuretics dose at baseline is a strong prognosticator. Diuretics dose reduction or its withdrawal provides a prognostic benefit on hard outcome. Diuretics tapering in selected patients should be considered in the short-term follow-up to improve DCM prognosis.

Long-term outcomes and left ventricular diastolic function of sarcomere mutation-positive and mutation-negative patients with hypertrophic cardiomyopathy: a prospective cohort study

2020 ◽  
Author(s):  
Ching-Yu Julius Chen ◽  
Mao-Yuan Marine Su ◽  
Ying-Chieh Liao ◽  
Fu-Lan Chang ◽  
Cho-Kai Wu ◽  
...  
Keyword(s):  
New York ◽  
Hypertrophic Cardiomyopathy ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Heart Association ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Ventricular Ejection Fraction

Abstract Aims Hypertrophic cardiomyopathy (HCM) is an inheritable disease that leads to sudden cardiac death and heart failure (HF). Sarcomere mutations (SMs) have been associated with HF. However, the differences in ventricular function between SM-positive and SM-negative HCM patients are poorly characterized. Methods and results  Of the prospectively enrolled 374 unrelated HCM patients in Taiwan, 115 patients underwent both 91 cardiomyopathy-related gene screening and cardiovascular magnetic resonance (45.6 ± 10.6 years old, 76.5% were male). Forty pathogenic/likely pathogenic mutations were identified in 52 patients by next-generation sequencing. The SM-positive group were younger at first cardiovascular event (P = 0.04) and progression to diastolic HF (P = 0.02) with higher N-terminal pro-brain natriuretic peptide (NT-proBNP) [New York Heart Association (NYHA) Class III/IV symptoms with left ventricular ejection fraction &gt; 55%] than the SM-negative group (P &lt; 0.001). SM-positive patients had a greater extent of late gadolinium enhancement (P = 0.01), larger left atrial diameter (P = 0.03), higher normalized peak filling rate (PFR) and PFR ratio, and a greater reduction in global longitudinal strain than SM-negative patients (all P ≤ 0.01). During mean lifelong follow-up time (49.2 ± 15.6 years), SM-positive was a predictor of earlier HF (NYHA Class III/IV symptoms) after multivariate adjustment (hazard ratio 3.5; 95% confidence interval 1.3–9.7; P = 0.015). Conclusion SM-positive HCM patients had a higher extent of myocardial fibrosis and more severe ventricular diastolic dysfunction than those without, which may contribute to earlier onset of advanced HF, suggesting the importance of close surveillance and early treatment throughout life.

scholarly journals Right ventricular free wall strain in acutely decompensated heart failure patients with ischemic and non-ischemic cardiomyopathy

2021 ◽  
Author(s):  
Dino Mirić ◽  
Ana Barac ◽  
Vesna Čapkun ◽  
Darija Baković Kramarić
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Laboratory Evaluation ◽  
Lv Function ◽  
Free Wall ◽  
Class Iii

Aims. Right ventricular (RV) dysfunction is a predictor of adverse outcomes among patients with HF with reduced ejection fraction (HFrEF) however, differences in RV parameters in HFrEF patients with ischemic (ICM) and non-ischemic cardiomyopathies (NICM) are not well understood. We investigated echocardiographic characteristics, including RV strain, in patients with acute decompensated heart failure (ADHF) and compared patients with ICM and NICM etiology. Methods. Consecutive patients who presented with ADHF and NYHA class III-IV were prospectively enrolled if they had LVEF <40% and history of ICM or NICM. All patients underwent clinical exam, laboratory evaluation and 2-D echocardiographic assessment of the left ventricular (LV) and RV function, LV and RV global longitudinal strain (LVGLS, RVGLS), and RV free wall strain (RVfwLS). Results. Of 84 patients, 44 had ICM and 40 NICM. The groups had similar blood pressure, NT-proBNP, and echocardiographic parameters of LV function including LVGLS. Absolute RVGLS values were lower than RVfwLS values in both groups. Patients with NICM had significantly lower RVfwLS, but not RVGLS, compared to patients with ICM (-13% to -17%, P=0.006). Similar differences in RVfwLS were seen in patients in NYHA class III (NICM vs ICM: -13% and -17%, respectively, 95% CI: -8.5 to -0.5) and NYHA class IV (NICM vs ICM: -13.8% and -17%, respectively, 95% CI: -6.4 to -0.59). Conclusion. Among patients hospitalized with ADHF, patients with nonischemic etiology compared with the patients with ICM, have worse RV dysfunction measured by RVfwLS, despite similar extent of LV impairment and the same functional limitation class.

Abstract 4855: Influence of Left Ventricular End Diastolic Diameter Index on Clinical Outcomes with Cardiac Resynchronization: Insights from the COMPANION Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Teresa De Marco ◽  
Byron Lee ◽  
JoAnn Lindenfeld ◽  
Leslie A Saxon ◽  
John Boehmer ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Ventricular Remodeling ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Pharmacologic Therapy ◽  
Class Iii ◽  
Event Driven

Background: Although cardiac resynchronization therapy (CRT) has been shown to slow the progression of heart failure (HF), it has not been well described whether the baseline severity of ventricular remodeling influences clinical outcomes. Methods: The COMPANION study database was analyzed retrospectively. This study randomized patients (pts) with NYHA Class III/IV HF, wide QRS, and systolic dysfunction to optimal pharmacologic therapy (OPT) alone or to OPT plus CRT either with (CRT-D) or without a defibrillator (CRT-P). For this analysis both CRT arms were combined. Ventricular remodeling was measured as left ventricular end diastolic dimension indexed by body surface area (LVEDDI). Data were stratified around the median value: LVEDDI≥ 35 mm/m 2 and < 35 mm/m 2 . CRT was compared to OPT for each cohort using functional outcomes at six months [exercise capacity, quality of life, functional status, and the Clinical Composite Endpoint] as well as event-driven outcomes [all-cause mortality alone and in combination with cause-specific hospitalization]. Results: Baseline LVEDDI data were available for 1260 pts. Pts in the larger LVEDDI cohort were characterized at baseline with wider QRS, lower EF, and a greater proportion of non-ischemic, female, and NYHA Class IV. Clinical outcomes are summarized below: Conclusion: In the COMPANION study, both cohorts demonstrated significant benefit in functional outcomes with CRT when compared to OPT. However, significant improvement in event-driven outcomes were seen only in the population with larger baseline LVEDDI. A prospective study is needed to confirm that LVEDDI can predict potential for improvement with CRT.

Left Ventricular Diastolic Dysfunction — Early Cardiac Impairment in Patients with Polymyositis/Dermatomyositis: A Tissue Doppler Imaging Study

2013 ◽  
Vol 40 (9) ◽  
pp. 1572-1577 ◽  
Author(s):  
Zhang Lu ◽  
Qiao Wei ◽  
Zu Ning ◽  
Zhao Qian-Zi ◽  
Shu Xiao-Ming ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diastolic Dysfunction ◽  
Late Onset ◽  
Mitral Annulus ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Mitral Annulus Velocity ◽  
Significant Difference ◽  
Ventricular Diastolic Dysfunction

Objective.To investigate early cardiac involvement in patients with polymyositis/dermatomyositis (PM/DM), and to evaluate the risk factors for early cardiac impairment.Methods.The study population included 46 patients with PM/DM who did not have overt cardiovascular manifestations and 21 age- and sex-matched healthy controls. Traditional echocardiography and tissue Doppler imaging (TDI) were used to evaluate cardiac function in both groups. Clinical characteristics were recorded. Multivariate logistics regression analysis was applied to investigate risk factors for early cardiac impairment in patients with PM/DM.Results.No significant difference was found between patients and controls by traditional echocardiography. However, compared to controls, PM/DM patients had a significantly lower ratio of early diastolic mitral annulus velocity to late diastolic mitral annulus velocity (Em/Am; 1.23 ± 0.52, 1.79 ± 0.37, respectively; t = −4.485, p < 0.001) and a higher ratio of peak early diastolic transmitral flow velocity to Em (E/Em; 8.26 ± 2.57, 6.76 ± 1.17; t = 3.287, p < 0.05) as found by TDI measurements. There was no significant difference between the TDI variables of patients with PM and DM. The multivariate regression analysis showed that female sex (OR 11.044, 95% CI 1.066–114.357, p = 0.044), late onset (OR 1.157, 95% CI 1.047–1.278, p = 0.004), and duration of disease (OR 1.060, 95% CI 1.008–1.115, p = 0.023) were risk factors for abnormal left ventricular filling pressures.Conclusion.TDI is useful for detecting early cardiac impairment in patients with PM/DM. Left ventricular diastolic dysfunction is an early feature of cardiac involvement. Female sex, late onset, and long course of disease are 3 independent risk factors for predicting left ventricular diastolic dysfunction in patients with PM/DM.

scholarly journals Predictive value of global longitudinal strain and geometry of left ventricle in patients with noncompaction cardiomyopathy

2021 ◽  
Vol 26 (11) ◽  
pp. 4622
Author(s):  
S. M. Komissarova ◽  
O. V. Krasko ◽  
N. M. Rineyskaya ◽  
A. A. Efimova
Keyword(s):  
Risk Factors ◽  
Cardiac Mri ◽  
Longitudinal Strain ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Class Iii ◽  
Noncompaction Cardiomyopathy ◽  
Sphericity Index

Aim. To assess the prognostic role of a decrease in longitudinal strain and an increase in the left ventricular sphericity index as predictors of NYHA class III heart failure (HF) progression, requiring hospitalization in a cohort of patients with noncompaction cardiomyopathy (NCM) in combination with dilated cardiomyopathy (DCM).Material and methods. We examined 90 patients with a combination of NCM and DCM aged 18 to 72 years (median age, 41 years; men — 73; women — 17), who, in addition to conventional echocardiographic and magnetic resonance imaging (MRI) characteristics, were studied for two-dimensional strain and global longitudinal strain (GLS) parameters and left ventricular sphericity index (SI) using cardiac MRI. The endpoints included NYHA class III HF progression, requiring hospitalization.Results. During the follow-up period (median follow-up, 36 (6; 152) months) in 59 of 90 (65,5%) patients with NCM in combination with DCM, symptoms progressed to NYHA class III HF, requiring hospitalization. Multivariate analysis showed following independent risk factors for HF-related hospitalization: a decrease in GLS <10% (hazard ratio (HR), 5,1; 95% confidence interval (CI), 1,6-16,7, p<0,007) and an increase in SI >0,5 (HR, 9,0; 95% CI, 2,2-37,8, p<0,003) .The 3-year event-free survival rate for patients with one risk factor (GLS, %<10 and SI <0,5; GLS, %>10 and SI >0,5) was 79,2±16,9% and 64,4±24,6%, respectively, while for the group with two risk factors (GLS, %<10 and SI>0,5) — 12,3%.Conclusion. Global longitudinal strain characteristics according to 2D Strain echocardiography and SI according to cardiac MRI are associated with adverse events in NCM and DCM combination and can be used to identify patients with a high risk of HF progression to NYHA class III, requiring hospitalization.

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