Abstract 1882: Use of Speckle Tracking to Quantify Global LV Function: A Comparison with 2D and 3D Echo and Magnetic Resonance Imaging

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Joseph K Brown ◽  
Thomas H Marwick
Keyword(s):  
Ejection Fraction ◽  
Speckle Tracking ◽  
Clinical Decision Making ◽  
Global Longitudinal Strain ◽  
Clinical Decision ◽  
Lv Function ◽  
Endocardial Border ◽  
3D Echo ◽  
2D And 3D ◽  
Better Than

Background: Ejection fraction (EF) plays a prominent role in clinical decision making but this calculation is time-consuming and dependent on load and geometry. A simple and quick technique for assessing global LV function would be useful. We sought to evaluate the robustness of global longitudinal strain (GLS) for assessment of LV function in comparison to Simpsons biplane ejection-fraction (2D-EF), 3D ejection fraction (3D-EF) and MRI ejection fraction (MRI-EF). We further investigated the automated measures of EF (auto-EF) from wall tracking. Methods: 2D and 3D echo and MRI measurement of EF were performed in 53 pts with previous infarction. GLS was measured by offline speckle-tracking in the apical 4C and 2C views. Abnormal curves were excluded on the basis of visual assessment. Auto-EF was calculated using the method of discs, using the traced endocardial border to establish end-diastolic and end-systolic volumes. Results: Average global TQ (tracking quality) was 1.14±0.22, permitting reliable derivation of strain from all segments. GLS showed a significant linear correlation with MRI-EF, similar to that between 3D-EF and MRI and better than that between 2D-EF and MRI and automated EF and MRI (Table ). Of 26 pts with a normal MRI-EF (≥50%), 85% had GLS within normal limits and 81% had normal 3D-EF, but significantly fewer were recognized as normal by 2D-EF (Table ). In pts with ≤5 abnormal segments, 3D-EF was the most accurate modality for assessing global LV function, while GLS was better than 2D-EF and auto-EF. In pts with >5 abnormal segments, GLS was the most accurate modality of quantifying global LV function against MRI-EF (r = −0.83, p <0.0001), comparatively better than 3D-EF against MRI-EF (r = 0.75, p <0.0001). Conclusion: GLS is an effective method of quantifying global LV function. In pts with >5 abnormal segments, GLS offered the best correlation with MRI-EF, reflecting the benefit of a geometry independent and site-specific parameter.

Glycogen storage cardiomyopathy (PRKAG2): diagnostic findings of standard and advanced echocardiography techniques

2020 ◽  
Author(s):  
José Luiz Barros Pena ◽  
Wander Costa Santos ◽  
Maria Helena Albernaz Siqueira ◽  
Isaac Hermes Sampaio ◽  
Isabel Cristina Gomes Moura ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Global Longitudinal Strain ◽  
Radial Strain ◽  
Glycogen Storage ◽  
Left Ventricular ◽  
Strain Pattern ◽  
Normal Limits ◽  
3D Echo ◽  
Bull's Eye ◽  
2D And 3D

Abstract Aims  Describe the findings obtained using standard echocardiography (Echo) and deformation indices (2D and 3D speckle tracking strain) in patients (Pts) with PRKAG2 cardiomyopathy. Seek to identify any peculiar characteristics and possible strain patterns that may distinguish this condition from other causes of left ventricular hypertrophy (LVH). Methods and results  Thirty Pts with genetically proven PRKAG2 (R302Q and H401Q), 16 (53.3%) male, mean age 39.1± 15.4 years old, were examined using standard, speckle tracking (STE), and 3D Echo. Pacemaker (PM) had been implanted in 12 (40%) Pts with a mean age of 38.1 ± 13 years. Hypertrophy was found in varying degrees in 18 (86%) Pts. Seven Pts (24%) presented 3D ejection fraction (EF) below normal limits. Diastolic function was abnormal in 17 (63%) Pts. Global longitudinal strain (GLS) on 2D measured −16.4% ± 5.3%. GLS measured −13.2% ± 4.8%, global radial strain 40.8% ± 13.8%, global circumferential strain (GCS) −16.1% ± 4.4%, and global area strain −26.1% ± 6.7% by 3D Echo offline analyses. Pts with PM presented lower EF and GCS compared with those without PM. EF/GLS measured 3.65 ± 1.00. In the bull's eye map, a strain pattern similar to stripes in 18 (60%) Pts was identified, which might be a differentiating signal among LVH. Conclusion  Echocardiography is a valuable tool in detecting diffuse and focal myocardial abnormalities in PRKAG2 cardiomyopathy. The deformation indices are especially revealing because they may help distinguish this rare infiltrative disease, thereby favouring early diagnosis, enhanced treatment, and improved outcome.

Left ventricular myocardial work in patients with secondary mitral regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Yedidya ◽  
R.P Lustosa ◽  
F Fortuni ◽  
P Van Der Bijl ◽  
F Namazi ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Blood Pressure Measurement ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Work Efficiency ◽  
Constructive Work ◽  
Secondary Mitral Regurgitation

Abstract Background Assessment of left ventricular (LV) function in patients with secondary mitral regurgitation (SMR) remains challenging because LV ejection fraction (LVEF) reflects changes in LV volume without taking into account the direction of the blood flow. LV global longitudinal strain better reflects active LV myocardial deformation but does not incorporate afterload. LV myocardial work derived from pressure-strain loops integrates speckle tracking echocardiography with non-invasive blood pressure measurement. Purpose To evaluate LV myocardial work components to better characterize LV function in patients with SMR. Methods 378 patients (72% men, median age 68 [range 60 to 74 years]) with various grades of SMR were retrospectively analysed. LV myocardial constructive work, wasted work and work efficiency were measured with speckle tracking echocardiography. Results 145 patients had mild SMR, 130 moderate SMR and 103 severe SMR. Patients with severe SMR had larger LV volumes, lower LVEF and more impaired LV GLS (Table 1). While LV constructive work was more impaired in patients with severe SMR, wasted work was lower as compared to mild SMR (Table 1). Consequently, patients with severe SMR had better myocardial work efficiency than patients with mild MR. This could reflect, the regurgitant volume which is pumped into a low pressure chamber (the left atrium) resulting in less myocardial wasted work and preservation of myocardial efficiency. Conclusion In patients with severe SMR, LVEF, LV GLS and myocardial constructive work are more impaired when compared to mild SMR. However, myocardial wasted work is lower, resulting in higher better LV myocardial work efficiency. Funding Acknowledgement Type of funding source: None

scholarly journals Application of the current HFA-ESC consensus guidelines on diagnosis of heart failure with preserved ejection fraction to a population referred for echocardiography

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Liang ◽  
R Hearse-Morgan ◽  
S Fairbairn ◽  
Y Ismail ◽  
AK Nightingale
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Global Longitudinal Strain ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Lv Function ◽  
Preserved Ejection Fraction ◽  
Consensus Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The recent Heart Failure Association (HFA) of the European Society of Cardiology (ESC) consensus guidelines on diagnosis of heart failure with preserved ejection fraction (HFpEF) have developed a simple diagnostic algorithm for clinical use. PURPOSE To assess whether echocardiogram (echo) parameters needed to assess diastolic function are routinely collected in patients referred for assessment of heart failure symptoms. METHODS Retrospective analysis of echo referrals in January 2020 were assessed for parameters of diastolic function as per step 2 of the HF-PEFF diagnostic algorithm.  Echo images and clinical reports were reviewed. Electronic records were utilised to obtain clinical history, blood results (NT-proBNP) and demographic data. RESULTS 1330 patients underwent an echo in our department during January 2020. 83 patients were referred with symptoms of heart failure without prior history of cardiac disease; 20 patients found to have impaired left ventricular (LV) function were excluded from analysis. Of the 63 patients with possible HFpEF, HF-PEFF score was low in 18, intermediate in 33 and high in 12. Median age was 68 years (range 32 to 97 years); 25% had a BMI &gt;30. There was a high prevalence of hypertension (52%), diabetes (19%) and atrial fibrillation (40%) (cf. Table 1). Body surface area (BSA) was documented in 65% of echo reports. Most echo parameters were recorded with the exception of global longitudinal strain (GLS) and indexed LV mass (cf. image 1). NT-proBNP was recorded in only 20 patients (31.7%). 12 patients with an intermediate HF-PEFF score could have been re-categorised to a high score depending on GLS and NT-proBNP (which were not recorded). CONCLUSION More than three quarters of echoes acquired in our department obtained the relevant parameters to assess diastolic function. The addition of BSA, and inclusion of NT-proBNP, and GLS would have been additive to a third of ‘intermediate’ patients to determine definite HFpEF. Our study demonstrates that the current HFA-ESC diagnostic algorithm and HF-PEFF scoring system are easy to use, highly relevant and applicable to current clinical practice. Age &gt;70 years 29 (46.0%) Obesity (BMI &gt;30) 16 (25.4%) Diabetes 12 (19%) Hypertension 33 (52.4%) Atrial Fibrillation 25 (39.7%) ECG abnormalities 18 (28.5%) Table 1. Prevalence of Clinical Risk Factors Abstract Figure. Image 1. HFPEFF score & echo parameters

scholarly journals Clinical Measurement of Sit-to-Stand Performance in People With Balance Disorders: Validity of Data for the Five-Times-Sit-to-Stand Test

2005 ◽  
Vol 85 (10) ◽  
pp. 1034-1045 ◽  
Author(s):  
Susan L Whitney ◽  
Diane M Wrisley ◽  
Gregory F Marchetti ◽  
Michael A Gee ◽  
Mark S Redfern ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Balance Disorders ◽  
Stand Test ◽  
Balance Confidence ◽  
Sit To Stand ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Confidence Scale ◽  
Better Than

Abstract Background and Purpose. People with balance disorders are characterized as having difficulty with transitional movements, such as the sit-to-stand movement. A valid and feasible tool is needed to help clinicians quantify the ability of people with balance disorders to perform transitional movements. The purpose of this study was to describe the concurrent and discriminative validity of data obtained with the Five-Times-Sit-to-Stand Test (FTSST). The FTSST was compared with the Activities-specific Balance Confidence Scale (ABC) and the Dynamic Gait Index (DGI). Subjects and Methods. Eighty-one subjects without balance disorders and 93 subjects with balance disorders were recruited for the study. Each subject was asked to stand from a 43-cm-high chair 5 times as quickly as possible. The ABC and DGI scores were recorded. Results. Subjects with balance disorders performed the FTSST more slowly than subjects without balance disorders. Discriminant analysis demonstrated that the FTSST correctly identified 65% of subjects with balance dysfunction, the ABC identified 80%, and the DGI identified 78%. The ability of the FTSST to identify subjects with balance dysfunction was better for subjects younger than 60 years of age (81%). Discussion and Conclusion. The FTSST displays discriminative and concurrent validity properties that make this test potentially useful in clinical decision making, although overall the ABC and the DGI are better than the FTSST at discriminating between subjects with and subjects without balance disorders.

Abstract 13101: Assessment of Left Ventricular Myocardial Fibrosis Using Two-dimensional and Three-dimensional Speckle Tracking Echocardiography in Patients With End-stage Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mingxing XIE ◽  
TiAN Fangyan ◽  
Li Yuman
Keyword(s):  
Myocardial Fibrosis ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Radial Strain ◽  
Surrogate Marker ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
End Stage ◽  
2D And 3D

Background: Previous studies showed that 2-dimensional speckle-tracking echocardiography (2D-STE) correlates with the extent of left ventricular(LV)myocardial fibrosis (MF). However, the utility of 3D-STE in predicting LV MF remains unknown. We aimed to identify which LV strain assessed by 2D- and 3D-STE is the most reliable parameter to predict LV MF in patients with end-stage HF. Methods: 105 patients with end-stage HF undergoing heart transplantation were enrolled in our study. LV global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) were measured by 2D- and 3D-STE. LV ejection fraction (EF) was determined by 3D-STE.The degree of MF was quantified by using Masson trichrome stain in LV myocardial samples. The study population was divided into 3 groups according to the degree of MF on histology (mild, moderate, and severe MF). Results: Patients with severe MF had lower 2D-STE, 3D-STE, and LVEF compared with those with mild and moderate MF. LV MF strongly correlated with 3D-LVGLS (r =0.73; P < 0.001), modestly with 3D-LVGRS (r =0.53; P< 0.001), weakly with 2D-LVGLS (r =0.49, P<0.001), 3D-LVGCS(r = 0.37, P <0.01), and LVEF (r =-0.46, P<0.001), but did not correlated with 2D-LVGCS and 2D-LVGRS. 3D-LVGLS correlated best with the degree of MF (r = 0.73 vs 0.37~0.53; P<0.05) compared with other 2D- and 3D-STE, and LVEF. 3D-LVGLS had the highest accuracy for detecting severe MF (area under the curve 0.90 VS 0.62~0.80; P< 0.05) compared with the 2D- and 3D-STE, and LVEF. Stepwise multivariate analysis showed that 3D-LVGLS (β=0.79, p < 0.001) was the only independent predictor of the degree of MF. Conclusion: 3D-LVGLS may be an ideal surrogate marker for LV MF in patients with end-stage HF.

scholarly journals P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Sahiti ◽  
C Morbach ◽  
C Henneges ◽  
M Hanke ◽  
R Ludwig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Future Research ◽  
Lv Function ◽  
Acutely Decompensated Heart Failure

Abstract OnBehalf AHF Registry Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF &lt;40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF). Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates. Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF &lt;40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table). Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF. Abstract P803 Figure.

2139Left atrial dysfunction assessed by strain correlates with symptoms and severity of aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Santoro ◽  
A Pardo ◽  
R Hinojar ◽  
A Garcia ◽  
L Salido ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Speckle Tracking ◽  
Global Longitudinal Strain ◽  
Control Group ◽  
Lv Function ◽  
Functional Changes ◽  
Lv Dysfunction ◽  
Significant Difference ◽  
Atrial Strain ◽  
And Function

Abstract Background Aortic stenosis (AS) results in high pressure afterload causing detrimental effect especially on the left chambers. Structural and functional changes of the left ventricle (LV) usually corresponds to concomitant remodelling of the left atrium (LA). However, how this pressure afterload specifically affects LA function and whether the study of LA function could help in stratifying patients with different degree of AS it is not known. Purpose We aim to evaluate the differences in LA and LV function according different degree of AS by standard and speckle tracking echocardiographic. Methods From January 2016 to May 2018 we recruited 135 patients referring to our echo-lab with diagnosis of AS (mean age 79.5±4.4; 60/55% female). We divided this population according to AS severity in patients with moderate AS, severe asymptomatic and severe symptomatic AS and matched with 35 control group with no aortic stenosis (n=45, mean age: 77.6±4.5). All patients underwent standard and 2-dimensional speckle tracking echocardiography computing global longitudinal strain (GLS) of LV and peak atrial strain of LA (PALS). Results In all patients PALS was a good predictor of E/e' ratio after correction for LV EF and age (p<0.001, β: −0.48). LVEF and GLS progressively decreased together with worsening of AS degree, as well as parameters of geometry and function of LA (Table1). By excluding patients with LV dysfunction the reduction gradient of parameters of LA geometry and function was still present. However, when severe symptomatic with asymptomatic severe AS are compared, no difference in E/e' ratio was found while both GLS and PALS were significantly reduced (both p<0.0001). Variables Overall population (180) Control (45) Moderate AS (45) Severe asympt AS (45) Severe sympt. AS (45) p LVEF 65.0±11.1 67.7±5.6 69.4±8.5 66.1±10.7 59.5±13.5 0.0001 GLS −20.4±4.1 −23.1±2.4 −21.5±2.9 −21.4±3.2 −17.1±4.3 0.0001 LA vol index 41.6±21.5 28.2±10.4 40.1±19.7 39.8±16.7 52.3±24.9 0.0001 LA strain 23.6±10.9 30.8±10.3 27.8±9.2 24.4±9.7 15.2±7.1 0.0001 LA reservoir 46.4±15.9 51.9±11.5 53.0±15.0 48.3±14.1 37.2±16.1 0.0001 Ee' ratio 14.8±7.0 9.6±2.7 13.7±6.3 15.4±6.2 19.3±7.2 0.0001 Conclusions LA function seems to progressively decrease according to the degree of AS, independently from LV function. Significant difference was found between parameters of LA remodelling and dysfunction between symptomatic and asymptomatic AS patients. The assessment of LA function by strain may help stratify the patients with AS, identifying those who need intensive medical/surgical treatment.

scholarly journals 1312. Division Divided: Using Debate as an Educational Tool to Teach Evidence-Based Clinical Decision-Making

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S401-S401
Author(s):  
Jennifer O Spicer ◽  
Varun K Phadke
Keyword(s):  
Critical Thinking ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Faculty Members ◽  
Case Conference ◽  
Multiple Choice Questions ◽  
Innovative Teaching ◽  
Attitudes And Practices ◽  
The Impact ◽  
Better Than

Abstract Background In medical education, there has been a push to implement innovative teaching techniques that encourage critical thinking rather than just knowledge dissemination. Debate promotes critical thinking by challenging individuals to consider alternate viewpoints, which could make it an ideal format to review the evidence relevant to common clinical dilemmas in infectious diseases (ID). We describe a pilot of one such debate format in our ID fellowship program. Methods We reviewed literature regarding the effectiveness of ceftriaxone for outpatient antibiotic therapy (OPAT) in methicillin-susceptible Staphylococcus aureus (MSSA) osteoarticular infections. The evidence was presented as a structured debate in place of our weekly case conference. Pre- and post-session surveys containing multiple choice questions and Likert items were administered to assess the impact of the debate on attendees’ knowledge, attitudes, and practices on this topic along with their attitudes toward the debate format. Differences between pre- and post-session surveys were analyzed using paired t-tests and McNemar’s test. Results At the first debate 33 residents, fellows, and faculty members were present, and 24 (73%) completed both the pre- and post-session surveys. Attendees demonstrated significant improvement between the pre- and post-session knowledge questions, which covered the following topics: study design of articles supporting ceftriaxone use (31% vs. 62%, P = 0.008), appropriate method to assess ceftriaxone susceptibility (64% vs. 100%, P = 0.004), and whether the inoculum effect applies to ceftriaxone (35% vs. 77%, P = 0.003). After the debate, attendees were more willing to use ceftriaxone (P = 0.001) and felt more familiar with the literature (P &lt; 0.001). The post-session survey showed that individuals both enjoyed the format and found it effective (Figure 1). Most individuals stated that they were either extremely likely (85%) or likely (8%) to attend if this format was used again. Written comments included “strongly recommend continuing this format” and “much better than regular case conference with more discussion and critical thinking.” Conclusion Debate appears to be an effective and enjoyable format to teach clinical controversies in ID. Disclosures All authors: No reported disclosures.

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