Abstract 828: Serum Midkine Predicts Cardiac Events in Chronic Heart Failure Patients

Midkine (MK), a heparin-binding growth factor, has various functions such as migration of inflammatory cell and anti-apoptotic effect. Invasion of inflammatory cells and cardiomyocyte apoptosis are involved in development and progression of heart failure (HF). However, relationship between MK and HF has not been previously examined. Therefore, we examined clinical significance of serum MK levels to determine the prognosis of HF patients. Serum levels of MK were measured at admission in 216 consecutive patients hospitalized for chronic HF and 60 control subjects. Patients were prospectively followed during a median follow-up period of 658 days with the end points of cardiac death and progressive HF requiring re-hospitalization. Serum concentrations of MK were significantly higher in patients with HF than in controls and increased as NYHA functional class rose (fig 1 ). There were 74 cardiac events, including 30 cardiac deaths and 44 re-hospitalization for HF during follow-up period. Patients with cardiac events had significantly higher concentrations of MK than those without cardiac events (539 ± 57 pg/ml vs. 331 ± 17 pg/ml, P < 0.01). Patients were divided into 4 groups based on midkine levels. Risk of cardiac events increased as MK levels rose (fig 2 ). In addition, the Cox multivariate hazard analysis showed that MK was an independent predictor of cardiac events (hazard ratio 1.280, 95% CI 1.027–1.578, P<0.05). Serum MK level is increased in HF patients, and MK is a novel marker for risk stratifying chronic HF patients. Figure 1. Serum Midkine Levels in Study Population Figure 2. Quartile Analysis of Serum Midkine Levels and Relative Risk for All Cardiac Events

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P687Is sacubitril/valsartan useful in patients with cancer and heart failure? Data from HF-COH Spanish multicenter registry

European Heart Journal ◽

10.1093/eurheartj/ehz747.0292 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Martin Garcia ◽

C Mitroi ◽

M Chaparro ◽

P Moliner ◽

A Martinez-Monzonis ◽

...

Keyword(s):

Heart Failure ◽

Cancer Therapy ◽

Ejection Fraction ◽

Arterial Pressure ◽

Creatinine Clearance ◽

Serum Levels ◽

Left Ventricular ◽

Functional Class ◽

Multicenter Registry

Abstract Current guidelines recommend sacubitril/valsartan (S/V) for patients (p.) with heart failure and reduced left ventricular ejection fraction (LVEF) but there is lack of evidence of its efficacy and safety in p. with cancer and heart failure. Our aim was to analyze the potential benefit of S/V in specific cardio-oncology clinics. Methods We performed a retrospective multicenter registry (HF-COH) in six Spanish hospitals with cardio-oncology clinics including all p. treated with S/V. Clinical and echocardiographic data, NYHA functional class, type of neoplasms and anti-tumoral treatment were described. Median follow-up was 7.2 [7.9] months. Results Sixty-one p. were included (median age was 64 [21] years old; 64%women, 43% hypertensive, 54% dyslipidemics and 28% diabetics). Most of p. (97%) had cancer therapy related cardiac dysfunction (CTRD) with a median time from anti-cancer therapy to CTRD of 40 [132] months. Breast (46%) and hematological (38%) cancers were the most frequent neoplasms, 31% of p. had metastatic disease and 71% had been treated with anthracyclines. In 5% S/V was initiated at CTRCD diagnosis while in 95% S/V was started to improve clinical status in p. already treated with ACE inhibitors or ARBs. 87% were on beta-blocker therapy and 74% on mineralocorticoid receptor antagonists.Maximal S/V titration dose was achieved in 8.2% of p. (24/26mg: 43%; 49/51mg: 33%) S/V was discontinued in 4 p. (reasons: 2 hypotension; 1: renal failure; 1: pruritus) Baseline NT-proBNP levels, functional class, and LVEF improved at the end of follow-up in p. who continued with S/V (all p values ≤0.01). No statistical differences were found in creatinine clearance or potassium serum levels. Table Patient parameters before and after S/V Before S/V After S/V P value LVEF (%) 33 [7] 39.5 [15] <0.001 Creatinine (mg/dl) 0.9 [0.4] 0.9 [0.5] 0.15 Creatinine clearance (ml/min) 73 [30] 75 [37] 0.22 Potassium serum levels (mg/dl) 4.5 [0.5] 4.5 [0.6] 0.42 Systolic arterial pressure (mmHg) 116 [23] 112 [27] 0.025 Diastolic arterial pressure (mmHg) 70 [13] 68 [10] 0.498 NT-proBNP (pg/ml) 1831 [3132] 842 [1919] 0.007 NYHA 2.2±0.6 1.6±0.62 <0.001 Values are median [interquartile range] or mean ± standard derivation; S/V: sacubitril-valsartan; LVEF: left ventricle ejection fraction. Conclusions Our experience suggests that S/V is well tolerated and improves functional class and left ventricular function parameters in patients with CTRCD.

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Abstract 1701: Soluble Receptor for Advanced Glycation End Products (RAGE) is a Prognostic Factor for Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_357-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Yo Koyama ◽

Yasuchika Takeishi ◽

Takeshi Niizeki ◽

Satoshi Suzuki ◽

Tatsuro Kitahara ◽

...

Keyword(s):

Heart Failure ◽

Prognostic Factor ◽

Hazard Analysis ◽

Functional Class ◽

Proportional Hazard ◽

Cardiac Events ◽

Cox Proportional Hazard ◽

Soluble Rage ◽

Glycation End Products ◽

Patients With Heart Failure

Background: It is known that oxidative stress is increased in patients with heart failure. Advanced glycation end products (AGE) are generated nonenzymatically by glycation and oxidation of proteins. We have recently reported that serum level AGE is an independent prognostic factor for heart failure. Receptor for AGE (RAGE) has a secretory isoform of the receptor protein, termed soluble RAGE. In the present study, we measured serum soluble RAGE levels in patients with heart failure. Methods: Serum soluble RAGE level was measured in 160 patients with heart failure and 40 control subjects. Patients were prospectively followed with endpoints of cardiac death or re-hospitalization. Results: Serum soluble RAGE level was increased with advancing NYHA functional class (figure 1 ). We determined the cut-off value of serum soluble RAGE level to predict cardiac events from ROC curve analysis as 1220 pg/ml (sensitivity 0.60, specificity 0.69). As shown in figure 2 , high serum soluble RAGE groups (>1220 pg/ml) had a significantly lower cardiac event-free rate (P = 0.0004) than low serum soluble RAGE groups (≥ 1220 pg/ml). In the univariate Cox proportional hazard analysis, serum soluble RAGE, age, NYHA functional class, creatinine, B-type natriuretic peptide (BNP), left ventricular end-diastolic diameter (LVEDD) were significantly associated with cardiac events. In the multivariate Cox proportional hazard analysis, serum soluble RAGE and plasma BNP were independent risk factors for cardiac events (soluble RAGE: HR 2.22, 95% CI 1.08 - 4.53, P = 0.029; BNP: HR 2.86, 95% CI 1.11 - 7.37, P = 0.029). Conclusions: Serum soluble RAGE level is a novel independent prognostic factor for heart failure.

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P4537Impact of body composition analysis on prediction of short-term readmission events in heart failure: muscle wasting vs. obesity

European Heart Journal ◽

10.1093/eurheartj/ehz745.0928 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Ohori ◽

T Yano ◽

S Katano ◽

S Honma ◽

K Shimomura ◽

...

Keyword(s):

Heart Failure ◽

Body Composition ◽

Muscle Wasting ◽

Functional Class ◽

Composition Analysis ◽

Class Iii ◽

Cardiac Events ◽

Short Term ◽

Readmission Rates

Abstract Background Obesity, defined as higher body mass index (BMI), is associated with better prognosis in patients with chronic heart failure (CHF), though the presence of obesity is a risk factor of development of CHF (Obesity paradox). On the other hand, muscle wasting, i.e. reduction in skeletal muscle mass, is frequently observed in CHF, leading to lower exercise capacity and poor cardiovascular outcome. Purpose The aim of this study was to examine whether analysis of body composition improves prediction of short-term readmission rates in patients with CHF. Methods We retrospectively analyzed data for 167 consecutive HF patients who were admitted to our institute for management of HF and received a Dual-energy X-ray absorptiometry (DEXA) scan. Muscle wasting was defined as DEXA-measured appendicular skeletal muscle mass index <7.0 kg/m2 in male and <5.4 kg/m2 in female according to the Asian Working Group for Sarcopenia criteria. Obesity was defined according to the criteria by the use of DEXA-measured percent body fat mass: >25% in male, >30% in female. The primary endpoint was readmission due to cardiac events including worsening heart failure, arrhythmia, and cardiopulmonary arrest during a 180-days follow-up period after discharge. Results The mean age of the patients was 74±13 years and 46% of them were male. The mean BMI was 21.8±3.8 kg/m2. Forty-seven percent of the patients were classified as NYHA functional class III. The most frequent etiology of HF was cardiomyopathy (30%), followed by ischemic heart disease (27%) and valvular heart disease (27%). The prevalence of muscle wasting and that of obesity were 69% and 59%, respectively. Patients with muscle wasting had lower BMI level, higher prevalence of NYHA functional class III and diabetes mellitus compared with those without muscle wasting. On the other hand, patients with obesity had higher prevalence of hypertension and dyslipidemia, higher level of BMI, fasting plasma insulin and triglyceride, and lower level of HDL-cholesterol compared with those without obesity. During the follow-up period, 34 patients (19%) were re-hospitalized due to cardiac events. Kaplan-Meier survival curves showed that patients with obesity had a significantly lower readmission rate during a 180-days follow-up period than did the patients without obesity (14.3% vs. 29.0%, Log-Rank test, p<0.01). There was no difference in readmission rates between patients with and without muscle wasting (20.0% vs. 21.2%, p=0.88). In multivariate Cox regression analyses adjusted for age, sex, diabetes, and renal function, obesity was independently associated with lower readmission rates (hazard ratio 0.45, 95% confidence interval 0.22–0.93). However, the association between obesity and readmission rate was lost after the adjustment for NT-proBNP levels. Conclusion Body composition analysis by DEXA enables to find CHF patients with increased fat mass who have lower risk of short-term readmission.

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BNP-guided therapy optimizes the timing of discharge and the medium term risk stratification in patients admitted for congestive heart failure

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2007.448 ◽

2016 ◽

Vol 68 (3) ◽

Cited By ~ 1

Author(s):

Roberto Valle ◽

Nadia Aspromonte ◽

Emanuele Carbonieri ◽

Giorgio De Michele ◽

Giuseppe Di Tano ◽

...

Keyword(s):

Heart Failure ◽

Initial Treatment ◽

Left Ventricular ◽

Functional Class ◽

Left Ventricular Ejection ◽

Cardiac Events ◽

Medium Term ◽

Ventricular Ejection Fraction ◽

Risk Of Death

most important cause of hospitalizations and is associated with high cost. Despite a consistent body of data demonstrating the benefits of drug therapy in HF, persistently high rates of readmission, especially within six months of discharge, continue to be documented. Neurohormonal activation characterizes the disease; plasma brain natriuretic peptide (BNP), is correlated with the severity of left ventricular dysfunction and relates to outcome. Objective: The aim of the study was to evaluate if plasma levels of BNP would provide an index to guide drug treatment and to predict medium-term prognosis in HF patients (pts) after hospital discharge. Methods and Results: We evaluated 200 consecutive pts (age 77±10 (35–96) years, 49% male versus 51% female) hospitalized for HF (DRG 127). Standard echocardiography was performed and left ventricular systolic/diastolic function was assessed; plasma BNP levels were measured with a rapid point-of-care assay (Triage BNP Test, Biosite Inc, San Diego, CA) on days 1 and after initial treatment. Using a cut-off of 240 pg/ml and/or changes in plasma BNP (days 2-3 after admission), 2 groups were identified: the low BNP group-responders (n= 68, BNP 30% reduction) and the high BNP group-non responders (n = 132, BNP >= 240 pg/ml and/or < 30% reduction). The high BNP group showed a different pattern of clinical variables according to the severity of the disease New York Heart Association (NYHA) functional class, left ventricular ejection fraction, ischemic etiology and age. A sustained elevation of plasma BNP (> 240 pg/mL) indicated the presence of a clinical unstable condition requiring further intervention whereas pts with low BNP values were discharged after 24 hours. During a mean follow-up period of 3 months, there were 62 cardiac events, including 15 cardiac deaths, 22 readmissions for worsening heart failure and 25 clinical decompensation requiring diuretic treatment. The incidence of clinical events was significantly greater in pts with higher levels of BNP (admission and discharge) than in those with lower levels (42% vs. 10%) and plasma values > 500 pg/ml identified a subgroup at high risk of death. Conclusions: The influence of BNP in the clinical course and prognosis of patients hospitalized for HF has not been studied. After initial treatment pts need to be risk stratified by means of the BNP test, to guide further management and to identify subjects with poor prognosis. An aggressive therapeutic and follow-up strategy may be justified for pts with high BNP levels and/or no changes after hospital admission for worsening HF. The changes in plasma BNP level at discharge were significantly related to cardiac events.

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Heart T2* for Prediction of Cardiac Complications in Well-Treated TM Patients

Blood ◽

10.1182/blood.v118.21.1089.1089 ◽

2011 ◽

Vol 118 (21) ◽

pp. 1089-1089

Author(s):

Alessia Pepe ◽

Antonella Meloni ◽

Giuseppe Rossi ◽

Paolo Cianciulli ◽

Anna Spasiano ◽

...

Keyword(s):

Heart Failure ◽

Chelation Therapy ◽

Conflicts Of Interest ◽

Large Cohort ◽

Patient Specific ◽

Cardiac Complications ◽

Cardiac Events ◽

Increased Risk ◽

Study Population

Abstract Abstract 1089 Introduction: T2* Magnetic Resonance Imaging (MRI) technique allows noninvasive quantification of organ-specific iron burden, playing a key role in the management of thalassemia major (TM) patients. There are few data on the incidence of heart failure and arrhythmias in TM patients according to baseline T2* values. The aim of this study was to establish prospectively the risk of cardiac complications in a large cohort of well-treated TM patients. Methods: We considered 527 TM patients (252 males, mean age 30±9) for who clinical data relative to a period of 5 years after the first MRI were collected in a central data base. At time of the first scan mean ferritin levels were1653±1559 ng/l, global heart was 27±13 ms, and excellent/good level of compliance were present in the 96% of the study population. Results: At 5 years of follow-up, we recorded 24 cardiac events: 4 episodes of cardiac failure, 15 of arrhythmia, 1 of pulmonary hypertension and 4 of other cardiac complications. The majority of these events (21/24) happened within the first 24 months subsequent to the MRI, so we considered this follow-up period. At the first MRI scan, in patients with cardiac complications the global heart T2* was 22.5 ±12.4 ms. In comparison with global heart T2* values ≥20 ms, there was not a significantly increased risk of cardiac complications associated with global heart T2* values <20 ms (HR= 2.028 P=0.09) (see figure). In the heart failure patients the global heart T2* was 19±12 ms. In comparison with global heart T2* values ≥20 ms, there was not a significantly increased risk of heart failure associated with global heart T2* values <20 ms (HR=1.9 P=0.524) or <10 ms (HR=2.6 P=0.443). In the arrhythmic patients the global heart T2* was 25±13 ms. In comparison with global heart T2* values ≥20 ms, there was not a significantly increased risk of arrhythmia associated with global heart T2* values <20 ms (HR=2.1 P=0.179) or <10 ms (HR=0.8 P=0.824). During the follow up changes in the chelation therapy (type and/or dose-frequencies) were found in > 25% of the study population. Conclusion: We detected very few cardiac events, almost all concentrated in the first 24 months. In a large cohort of well-treated TM patients heart T2* lost its power in predicting cardiac events probably due to a patient-specific adjustment of the chelation therapy MRI-guided. Disclosures: No relevant conflicts of interest to declare.

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THE EFFECT OF BETA-BLOCKERS ON A COURSE OF CHRONIC HEART FAILURE IN PATIENTS WITH A LOW TRIIODOTHYRONINE SYNDROME

Wiadomości Lekarskie ◽

10.36740/wlek202007118 ◽

2020 ◽

Vol 73 (7) ◽

pp. 1402-1409

Author(s):

Sergiy M. Pyvovar ◽

Iurii S. Rudyk ◽

Mykola P. Kopytsya ◽

Tetiana V. Lozyk ◽

Valentina Ir. Galchinskaya ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Opposite Effect ◽

Beta Blockers ◽

Thyroid Stimulating Hormone ◽

Functional Class ◽

Left Heart ◽

Follow Up Study ◽

Serum T3

The aim: The aim is to study the effect of β-ABs in patients with LT3S on the course of HF. Materials and methods: 354 patients with HF on a background of post-infarction cardiosclerosis were included in the 2-yeared follow-up study. LT3S was diagnosed at 89 (25.1%) patients. The levels of thyroid-stimulating hormone, free T3f and T4f, and reversible T3 were determined. The echocardioscopy was performed. Results: Patients with HF in combination with LT3S have a heavier functional class by NYHA, greater dilatation of the left heart cavities, less myocardial contractility, a higher frequency of atrial fibrillation and re-hospitalization. The use of β-ABs in patients with HF without LT3S leads to a likely decrease in hospitalization frequency, while in patients with LT3S it has an opposite effect. The frequency of rehospitalization increases with an excess of β-ABs dose > 5 mg (equivalent to bisoprolol). At these patients a decrease in serum T3 level and negative dynamics of parameters of intracardiac hemodynamics are observed. Conclusions: The use of β-ABs in patients with LT3S leads to an increase in re-hospitalization at a dose over 5.0 mg (equivalent to bisoprolol). In these patients there is a decrease in serum T3, an increase in T4 level; and the ejection fraction decrease; and heart cavities size increase.

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Prognostic Value of Combination of Cardiac Troponin T and B-Type Natriuretic Peptide after Initiation of Treatment in Patients with Chronic Heart Failure

Clinical Chemistry ◽

10.1373/clinchem.2003.021311 ◽

2003 ◽

Vol 49 (12) ◽

pp. 2020-2026 ◽

Cited By ~ 66

Author(s):

Junnichi Ishii ◽

Wei Cui ◽

Fumihiko Kitagawa ◽

Takahiro Kuno ◽

Yuu Nakamura ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cardiac Troponin ◽

Troponin T ◽

Myocardial Damage ◽

Left Ventricular ◽

Functional Class ◽

Cardiac Troponin T ◽

Cardiac Events ◽

Nyha Functional Class

Abstract Background: Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment. Methods: We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years). Results: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) μg/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 μg/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P <0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P <0.001). cTnT >0.01 μg/L and/or BNP >160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates. Conclusion: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.

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Predicting mortality for patients with heart failure beyond oxygen consumption: a prognostic risk score

Journal of Applied Physiology ◽

10.1152/japplphysiol.00326.2021 ◽

2021 ◽

Author(s):

Hanaa Shafiek ◽

Andres Grau ◽

Jaume Pons ◽

Pere Pericas ◽

Xavier Rossello ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Risk Score ◽

Cardiac Transplantation ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Evaluation ◽

Cardiac Events ◽

Ventricular Ejection Fraction

Background: Cardiopulmonary exercise test (CPET) is a crucial tool for the functional evaluation of cardiac patients. We hypothesized that VO2 max and VE/VCO2 slope are not the only parameters of CPET able to predict major cardiac events (mortality or cardiac transplantation urgently or elective). Objectives: We aimed to identify the best CPET predictors of major cardiac events in patients with severe chronic heart failure and to propose an integrated score that could be applied for their prognostic evaluation. Methods: We evaluated 140 patients with chronic heart failure who underwent CPET between 2011 and 2019. Major cardiac events were evaluated during follow-up. Univariate and multivariate logistic regression analysis were applied to study the predictive value of different clinical, echocardiographic and CPET parameters in relation to the major cardiac events. A score was generated and c-statistic was used for the comparisons. Results: Thirty-nine patients (27.9%) died or underwent cardiac transplantation over a median follow-up of 48 months. Five parameters (maximal workload, breathing reserve, left ventricular ejection fraction, diastolic dysfunction and non-idiopathic cardiomyopathy) were used to generate a risk score that had better risk discrimination than NYHA dyspnea scale, VO2 max, VE/VCO2 slope > 35 alone, and combined VO2 max and VE/VCO2 slope (p= 0.009, 0.004, < 0.001 and 0.005 respectively) in predicting major cardiac events. Conclusions: A composite score of CPET and clinical/echocardiographic data is more reliable than the single use of VO2max or combined with VE/VCO2 slope to predict major cardiac events.

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Abstract 19314: Impact of Body Mass Index on Clinical Outcomes in Complex Adult Congenital Heart Disease

Circulation ◽

10.1161/circ.130.suppl_2.19314 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Norihisa Toh ◽

Ines Uribe Morales ◽

Zakariya Albinmousa ◽

Tariq Saifullah ◽

Rachael Hatton ◽

...

Keyword(s):

Heart Failure ◽

Body Mass Index ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Adult Congenital Heart Disease ◽

Cardiac Events ◽

Increased Risk ◽

Adult Congenital

Background: Obesity can adversely affect most organ systems and increases the risk of comorbidities likely to be of consequence for patients with complex adult congenital heart disease (ACHD). Conversely, several studies have demonstrated that low body mass index (BMI) is a risk factor for heart failure and adverse outcomes after cardiac surgery. However, there are currently no data regarding the impact of BMI in ACHD. Methods: We examined the charts of 87 randomly selected, complex ACHD patients whose first visit to our institution was at 18-22 years old. Patients were categorized according to BMI at initial visit: underweight (BMI < 18.5 kg/m 2 ), normal (BMI 18.5 - 24.9 kg/m 2 ), overweight/obese (BMI ≥ 25 kg/m 2 ). Events occurring during follow-up were recorded. Data was censured on 1/1/2014. Cardiac events were defined as a composite of cardiac death, heart transplantation or admission for heart failure. Results: The cohort included patients with the following diagnoses: tetralogy of Fallot n=31, Mustard n=28, Fontan n=17, ccTGA n=9 and aortic coarctation n=2. The median (IQR) duration of follow-up was 8.7 (4.2 - 1.8) years. See table for distribution and outcomes by BMI category. Cardiac events occurred in 17/87 patients. After adjustment for age, sex, and underlying disease, the underweight group had increased risk of cardiac events (HR=12.9, 95% CI: 2.8-61.5, p < 0.05). Kaplan-Meier curves demonstrate the poorer prognosis of underweight patients (Figure). Conclusions: Underweight was associated with increased risk of late cardiac events in ACHD patients. We were unable to demonstrate significant overweight/obesity impact.

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Abstract 12421: Single Beat Simultaneous Left Atrioventricular Strain-Volume Analysis Using Speckle Tracking Echocardiography

Circulation ◽

10.1161/circ.130.suppl_2.12421 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Alaa M Omar ◽

Mohamed A Abdel-Rahman ◽

Zaid H Sabe-Eleish ◽

Osama Rifaie ◽

Gianni Pedrizzetti ◽

...

Keyword(s):

Heart Failure ◽

Speckle Tracking ◽

Heart Function ◽

Cardiac Mechanics ◽

Structural Heart Disease ◽

Left Heart ◽

Cardiac Events ◽

Structural Shape ◽

Heart Volume

Introduction: Assessment of cardiac mechanics in relation to left atrial (LA) and ventricular (LV) structural (shape and volume) changes represent a foundation for assessing cardiac remodeling in heart failure (HF) patients. We tested the feasibility of assessing simultaneous LA and LV volumes and deformation within an index cardiac cycle as a marker of total left heart structural and functional remodeling in HF. Methods: Echocardiography was performed in total 101 patients, which included 77 patients with HF (50 had normal EF (HFNEF) and 27 had reduced EF (HFREF)) and 24 young subjects with no structural heart disease (controls) (table 1). Two-dimensional speckle tracking was performed in apical 2- and 4- chamber views for simultaneous measurement of LV and LA volumes and deformation. Peak longitudinal average atrio-ventricular strain (AVS) and early diastolic strain rate (AVSR-E), in addition to the total left heart volume (TLV) during LV systole and diastole (TLVsystole, TLVdiastole), were measured. Occurrence of major adverse cardiac events (MACE) was defined during follow up. Results: In comparison with younger controls, patient with HF showed higher TLV and nearly 50% reduction in AVS and AVSR-E (table 1). These differences persisted even after adjusting for age. During a median follow up of 7 months, MACE occurred in 15 patients (5 hospitalization for heart failure, 1 cerebrovascular stroke, and 9 cardiac deaths). AVS and AVSR-E were predictors for MACE after adjusting for age (HR=0.9, 95% CI: 0.81 to 0.99, p=0.038; HR= 0.14, 95% CI: 0.02 to 0.89, p=0.037; respectively). AVS and AVSR-E had similar diagnostic values in predicting MACE (AUC= 0.77 and 0.79; p=0.001 and <0.001 respectively), with higher event free survival seen for AV-S>14.5%, and AVSR-E>0.92 s-1 (Figure 1). Conclusion: Single beat combined assessments of LA-LV strain and strain rates may be useful integrated markers of total left heart function.

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