Abstract 16650: Segmental and Global Longitudinal Strain Differences Between Children With Paediatric Inflammatory Multisystem Syndrome Temporally Associated With Sars-cov-2 Pandemic and Kawasaki Disease: Preliminary Data From an Ongoing Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Enrico Piccinelli ◽  
jethro herberg ◽  
Heechan Kang ◽  
alain fraisse ◽  
Sylvia Krupickova ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Preliminary Data ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Differences ◽  
Myocardial Damage ◽  
Segmental Analysis ◽  
Significant Difference ◽  
Royal Brompton Hospital ◽  
Normal Lvef

Introduction: The paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and Kawasaki disease (KD) have overlapping features. This study aimed to describe the strain segmental analysis among both entities. Methods: Retrospective review of strain segmental analysis within 4 weeks of presentation of symptoms among children diagnosed with PIMS-TS between April and June 2020 and a historic cohort of typical KD from the Royal Brompton Hospital, London. Results: We included 33 PIMS-TS patients (23 males, 69.7%) at a mean age of 8 ± 4,9 years old and 45 KD patients (31 males, 68,9%) at a mean age of 5,8 ± 4,5 years old. PIMS-TS patients were older at presentation (p = 0.038). Left ventricle ejection fraction (LVEF) was normal in both groups (63,3% vs 63,5%; p= 0,89), 4/33 PIMS-TS children (12,1%) had coronary arteries abnormalities (CAA), whereas 100% of KD cohort had CAA. Both groups had a normal global longitudinal strain (GLS), but in PIMS-TS it was significantly reduced compared to the KD group (-20% vs -22%; p=0,008). Basal segments were the most affected in PIMS-TS with significant difference in the basal anterior and anterolateral strain compared to KD (respectively -18,2% vs -23,4%; p < 0,001 and - 16,7% vs -22,7%; p < 0,001). PIMS-TS had a greater anterior, anterolateral and posterior segments involvement with a significant reduction in the anterolateral mid-wall longitudinal strain (-18,3% vs -22%; p=0,002). Apical segments were less involved, with a significant difference only in the septal and inferior apical strain (respectively p=0.001 and p=0,032). Conclusions: These preliminary data showed that after 4 weeks from the onset of symptoms, all PIMS-TS patients had a normal LVEF but they had a significant reduction in GLS and different segmental involvement compared to KD cohort. We hypothesize that these findings may be related to direct myocardial damage in PIMS-TS rather than caused by coronaries perfusion abnormalities.

scholarly journals Segmental and global longitudinal strain differences between children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 pandemic and Kawasaki disease

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Piccinelli ◽  
J Herberg ◽  
H Kang ◽  
A Fraisse ◽  
S Krupickova ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Differences ◽  
Myocardial Damage ◽  
Segmental Analysis ◽  
Funding Sources ◽  
Significant Difference ◽  
Royal Brompton Hospital ◽  
Normal Lvef

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  The paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and Kawasaki disease (KD) have overlapping features. This study aimed to describe the strain segmental analysis among both entities. Methods Retrospective review of strain segmental analysis within 4 weeks of presentation of symptoms among children diagnosed with PIMS-TS between April and June 2020 and a historic cohort of typical KD from the Royal Brompton Hospital, London. Results We included 33 PIMS-TS patients (23 males, 69.7%) at a mean age of 8 ± 4,9 years old and 45 KD patients (31 males, 68,9%) at a mean age of 5,8 ± 4,5 years old. PIMS-TS patients were older at presentation (p = 0.038). Left ventricle ejection fraction (LVEF) was normal in both groups (63,3% vs 63,5%; p= 0,89), 4/33 PIMS-TS children (12,1%) had coronary arteries abnormalities (CAA), whereas 100% of KD cohort had CAA. Both groups had a normal global longitudinal strain (GLS),but in PIMS-TS it was significantly reduced compared to the KD group (-20% vs -22%; p = 0,008). Basal segments were the most affected in PIMS-TS with significant difference in the basal anterior and anterolateral strain compared to KD (respectively -18,2% vs -23,4%; p &lt; 0,001 and - 16,7% vs -22,7%; p &lt; 0,001). PIMS-TS had a greater anterior, anterolateral and posterior segments involvement with a significant reduction in the anterolateral mid-wall longitudinal strain (-18,3% vs -22%; p = 0,002). Apical segments were less involved, with significant difference only in the septal and inferior apical strain (respectively p = 0.001 and p = 0,032). Conclusions  These preliminary data showed that after 4 weeks from the onset of symptoms, all PIMS-TS patients had a normal LVEF but they had a significant reduction in GLS and different segmental involvement compared to KD cohort. We hypothesize that these findings may be related to direct myocardial damage in PIMS-TS rather than caused by coronaries perfusion abnormalities. Abstract Figure. Bull"s eye

Myocardial work in Stage 1 and 2 hypertensive patients

2021 ◽  
Author(s):  
Akshar Jaglan ◽  
Sarah Roemer ◽  
Ana Cristina Perez Moreno ◽  
Bijoy K Khandheria
Keyword(s):  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Non Invasive ◽  
Significant Difference ◽  
Lv Ejection Fraction ◽  
Global Work ◽  
Stage 1

Abstract Aims Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. Methods and results Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure–strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P &lt; 0.001), and GWW (P &lt; 0.001). Conclusion Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.

scholarly journals 1187 Evaluation of left and right ventricular functions with 3D speckle tracking in patients with mitral stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O Seckin ◽  
S Unlu ◽  
G Tacoy
Keyword(s):  
Right Ventricular ◽  
Mitral Stenosis ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Control Group ◽  
Free Wall ◽  
Significant Difference

Abstract Background The function of both ventricles have been suggested to be affected in patients with mitral stenosis. In this study, it was aimed to investigate deformation properties of right (RV) and left ventricles (LV) in mild and moderate rheumatic mitral stenosis (MS) patients with three-dimensional speckle tracking echocardiography (3D-STE). Methods A total of 60 patients were included in the study (20 patients with mild MS diagnosis, 20 patients with moderate MS diagnosis and 20 healthy volunteers). Three-dimensional echocardiography datasets were obtained for both ventricles in all patients. An example for RV assessment is shown in Figure 1. LV global longitudinal strain (GLS), LV torsion, RV free wall (FW) LS and interventricular septal (IVS) LS measurements were analyzed. Results The LV ejection fraction (EF), RV fractional area change and tricuspid annular plane systolic excursion values were statistically similar and in the normal range. The LV GLS measurements were significantly different among the groups by being highest in the control group and least in the moderate stenosis group (ANOVA,p &lt; 0.001) (Table 1). Patients with MS showed higher torsional values, correlated with MS severity (ANOVA,p &lt; 0.001) (Table 1). IVS LS, RVFW LS values obtained by RV analysis also differed significantly among groups. The FW-GLS values only showed significant difference between the control group and moderate MS group (Table 1). Conclusion Patients with mitral stenosis showed lower LV-GLS and higher LV torsion values. Although the LV GLS is affected; the LV EF was detected to be normal due to increase in LV torsion. RV deformation indices showed signıficant decrease in correlation with the severity of the mitral stenosis. In conclusion, our data suggest that subclinical LV and RV systolic dysfunction is present in mild-moderate MS patients and this dysfunction can be detected by 3D-STE. Table 1 Parameters Control group Mild MS Moderate MS P LV GLS (%) 23.3 ± 2.08 18.9 ± 1.3 17.5 ± 1.8 &lt;0.001 LV torsion 1.5 ± 0.6 2.1 ± 0.6 2.6 ± 0.5 &lt;0.001 IVS LS (%) 23 ± 3.0% 20 ± 2.6 17.1 ± 2.9 &lt;0.001 RV FW LS (%) 25.4 ± 5 22.7 ± 3.2 21.1 ± 4.8 &lt;0.001 FW; free-wall, GLS; global longitudinal strain, IVS; interventricular septum, LV; left ventricular, RV; right ventricular Abstract 1187 Figure 1

scholarly journals Abnormal left ventricular global longitudinal strain by speckle tracking echocardiography in COVID-19 patients

2020 ◽  
Author(s):  
Lori B Croft ◽  
Parasuram Krishnamoorthy ◽  
Richard Ro ◽  
Malcolm Anastasius ◽  
Wenli Zhao ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Healthy Population ◽  
Significant Difference ◽  
The Mean ◽  
Lv Ejection Fraction ◽  
Prognostic Implications

COVID-19 infection can affect the cardiovascular system. We sought to determine if left ventricular global longitudinal strain (LVGLS) is affected by COVID-19 and if this has prognostic implications. Materials & methods: Retrospective study, with LVGLS was measured in 58 COVID-19 patients. Patients discharged were compared with those who died. Results: The mean LV ejection fraction (LVEF) and LVGLS for the cohort was 52.1 and -12.9 ± 4.0%, respectively. Among 30 patients with preserved LVEF(>50%), LVGLS was -15.7 ± 2.8%, which is lower than the reference mean LVGLS for a normal, healthy population. There was no significant difference in LVGLS or LVEF when comparing patients who survived to discharge or died. Conclusion: LVGLS was reduced in COVID-19 patients, although not significantly lower in those who died compared with survivors.

scholarly journals Speckle-tracking during dipyridamole stress echocardiography in the detection of myocardial ischemia in patients with suspected coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Moderato ◽  
G Pastorini ◽  
D Lazzeroni ◽  
A Monello ◽  
G Rusticali ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Model Average ◽  
Significant Difference ◽  
Artery Disease ◽  
Dipyridamole Stress Echocardiography ◽  
Dipyridamole Stress

Abstract Background The aim of this study was to investigate the incremental value of global longitudinal strain (GLS), postsystolic strain index (PSI) and prestretch (PSE) by automated function imaging with respect to wall motion (WM) and coronary flow reserve (CFR) for the diagnosis of significant coronary artery disease (CAD) during dipyridamole stress echocardiography. Methods We retrospectibely enrolled 227 patients with known or suspected CAD, approaching our echo lab to perform a DSE; all patient underwent coronary angiography within 1 month for clinical reasons. Obstructive CAD was defined as the evidence of &gt;70% stenosis during coronary angiogram. Obstructive CAD was detected in 143 (63%) patients, while 84 (37%) had no significant CAD. Global longitudinal strain, PSI and PSE were measured at rest and peak of the stress (after 6 minutes of 0,84mg/kg of dipyridamole infusion). Results Patient with CAD showed a significantly lower GLS at rest (−16.9±4.2 vs −18.6±3.4; p&lt;0.01) and peak (14.9±3.8 vs −21.50±3.3; p&lt;0.01) Figure A; the behavior of GLS was opposite, in patient with CAD showed an increase while in patient without CAD a significant decrease after dipyridamole infusion. There was also a significant difference between groups for Delta PSI (PSIpeak − PSIrest) and Delta PSE (PSEpeak − PSErest), respectively 126±145 vs −40±97, (p&lt;0.01) and 108±163 vs −41±106 (p&lt;0.01) Figure C. ROC analyses produced a statistically valid model: Average GLS at peak (p 0.001; AUC=0.906, cut-off value −18%, sensitivity 83% and specificity 82%); on the basis of these results, we compared WM and myocardial deformation analysis and GLS was superior to CFR LAD, Delta EF, Delta ESV and Delta WMI (Figure B). Conclusions GLS, PSE and PSI show an opposite response to dipyridamole, in patients with CAD in patient without CAD and show much higher sensitivity and specificity compared to the conventional parameters like WMI, EF and CFR in detecting CAD Funding Acknowledgement Type of funding source: None

scholarly journals Derangements in Coronary Calcium Score and Left Ventricular Global Longitudinal Strain in Patients Post Left Breast Radiotherapy

2020 ◽  
Author(s):  
Tochi Okwuosa ◽  
Andres Palomo ◽  
Thelma Dangana ◽  
Anel Yakupovich ◽  
Sanjib Basu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Longitudinal Strain ◽  
Meta Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Screening Methods ◽  
Breast Radiotherapy ◽  
Goodness Of Fit Test ◽  
Significant Difference ◽  
Historical Controls

Abstract Background Radiotherapy is a common treatment for breast cancer, with unintended long-term CV consequences; and no consensus on adequate CV screening methods to prevent future events. We aimed to assess the use of coronary artery calcium (CAC) and left ventricular global longitudinal strain (GLS) to identify those at risk for CVD due to radiotherapy. Methods Using data from an urban cancer registry, we enrolled 17 women (mean age 62 years) with left-sided breast cancer from 1999-2003, treated with radiotherapy. Agatston CAC score was measured by CT scan; and GLS by echocardiography. Logistic regression was used to compare study CAC scores with historical controls using age- and race-matched (Multi-Ethnic Study of Atherosclerosis) MESA CAC calculator [derived from MESA cohort from 6 US communities, free of clinical CVD at baseline (2000-2002) https://www.mesa-nhlbi.org ]; and GLS with historical controls from prior meta-analysis with defined normal GLS values ( Yingchoncharoen et al). Results The Hosmer-Lemeshow goodness of fit test reported a significant lack of fit (p < 0.02) compared with the expected probability of non-zero CAC in the historical controls from MESA. The mean GLS of -20.6% (95% CI: -21.50%, -19.79%), and was not statistically different when compared with the average of the historical controls. However, there was a significant difference of GLS compared to the meta-analysis using a one-sample T test with P=0.03. Conclusion We found that women post left sided breast radiotherapy had higher CAC presence without significant difference in mean GLS, compared with historical controls from the MESA database and prior GLS meta-analysis.

scholarly journals 665 Longitudinal strain impairment in organic mitral regurgitation: look beyond the valve

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giovanni Diana ◽  
Laura Manfredonia ◽  
Monica Filice ◽  
Emanuele Ravenna ◽  
Francesca Graziani ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Lv Dysfunction ◽  
Lv Mass ◽  
Significant Difference ◽  
Lv Ejection Fraction

Abstract Aims Global longitudinal strain (GLS) is a hallmark of cardiac damage in mitral regurgitation (MR). GLS &gt; −18% in patients with severe organic MR (OMR) and normal LV ejection fraction (LVEF) is an independent predictor of postoperative LV dysfunction. While it is known that GLS is impaired in less than severe functional ischaemic MR (FMR), the value of GLS in less than severe OMR is not known. We aimed to determine prevalence and determinants of any GLS impairment in OMR, in comparison to FMR. Methods We retrospectively evaluated 51 consecutive patients (33 OMR and 18 FMR) with mild-to-moderate, moderate and moderate-to-severe MR (Table*). Overall, GLS was higher in OMR than FMR (17.9±4.5 vs. 10.3±5.3, P&lt;0.001), with rate of impairment of 45% in OMR and 89% in FMR (P= 0.0024). Results However, no significant difference was found in GLS between mild-to-moderate, moderate and moderate-to-severe MR patients within OMR (17.7±4.7 vs. 16.9±3.9 vs. 22.4±3, respectively, P&gt;0.05), as well as FMR (9.8±6.6 vs. 10.7±5.3 vs. 10.4±5.3, respectively, P&gt;0.05) groups. GLS correlated directly with left ventricular (LV) ejection fraction (EF) in both OMR (r=0.69, P&lt;0.001) and FMR (r=0.90, P&lt;0.001), and inversely with LV mass indexed for body surface area (LVMi) in both OMR (r = −0.50, P=0.005) and FMR (r = −0.48, P=0.042). While correlation with LVEF was better for FMR than OMR (Z − 1.95, P=0.026), correlation with LVMi was similar for OMR and FMR groups (Z − 0.082, P&gt;0.05). Conclusions In patients with OMR, GLS may be reduced, despite normal LVEF, in less than severe MR. Prevalence and degree of GLS impairment in OMR is less than in FMR. In OMR, as well as in FMR, GLS impairment is independent of entity of MR, but rather correlates with LVMi, maybe reflecting impact of myocardial fibrosis derived by increased LVMi on GLS.

scholarly journals 1230 The atrial stiffness index in hypertensive women with indeterminate diastolic function

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Y Kolesnyk ◽  
M V Sokolova
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Normal Function ◽  
Stiffness Index ◽  
Additional Parameter ◽  
Deformation Curves ◽  
Additional Information ◽  
Significant Difference

Abstract Background Despite new 2016 ASE/EACVI guidelines on diastolic function (DF), there is still significant amount of patients with indeterminate results. The left atrial (LA) longitudinal strain could provide additional information in case of inconclusive results. Recenty, a new LA stiffness index was proposed as ratio between E/e" and LA global longitudinal strain (GLS). The purpose of this study was to test the diagnostic utility of LA stiffness index in hypertensive women with inderterminate DF. Methods The study enrolled 100 postmenopausal women (mean age 57 ± 4 years) with uncomplicated arterial hypertension, divided into 3 groups (normal DF, indeterminate DF, diastolic dysfunction). The DF was assessed with both 2009 and 2016 ASE/EACVI algorithms. LA longitudinal strain was measured as peak of deformation curves with R-wave variant of ECG triggering. The LA GLS was measured by averaging 12 segmental values. The atrial stiffness index was calculated as E/e" ratio to LA GLS. Results The prevalence of indeterminate DF was higher with assessment by 2016 algorithm (53 % vs 38 %). The E/e" ratio was significantly increased in patients with indeterminate DF compared to normal function (Table). LA GLS was decreased only in patients with inconclusive resuts by 2009 algorithm. LA stiffness index was increased gradually according to diastolic abnormalities severity. The significant difference between three groups was only found with categorization of patients by 2016 algorithm. Conclusions The novel LA stiffness index could be additional parameter of DF assessment in case of indeterminate results. However, it needs further validation in simultaneous echo-invasive studies. LA mechanics in diastolic dysfucntion Parameter Normal diastolic function Indeterminate function Diastolic dysfunction p 2009 guidelines Prevalence, % 31 38 31 E/e" ratio 8,07 (7,36-9,6) 9,91 (8,44-11,6)* 11 (10,52-13)*^ p &lt; 0,0001 LA GLS, % 34,8 (30,2-39,9) 30,8 (26,5-34,9)* 28,9 (24,2-36)* p = 0,028 LA stiffness index 0,24 (0,18-0,31) 0,32 (0,27-0,39)* 0,37 (0,31-0,46)* p &lt; 0,0001 2016 guidelines Prevalence, % 40 53 7 E/e" ratio 8,8 (7,74-10,1) 10 (8,6-11,7)* 14 (12-14,9)*^ p &lt; 0,0001 LA GLS, % 34,2 (28,4-39,1) 30,8 (26,5-34,8) 29,6 (25,1-37,8) p = 0,18 LA stiffness index 0,27 (0,2-0,34) 0,33 (0,27-0,4)* 0,47 (0,38-0,59)*^ p = 0,001 The values are given as median and interquartile range. * - compared to normal function ^ - compared to indeterminate result

Segmentally impaired left ventricular longitudinal strain: a new predictive diagnostic parameter for asymptomatic patients with severe aortic stenosis and preserved ejection fraction

Perfusion ◽  
2021 ◽  
pp. 026765912199599
Author(s):  
Peggy M Kostakou ◽  
Elsie S Tryfou ◽  
Vassilios S Kostopoulos ◽  
Lambros I Markos ◽  
Dimitrios S Damaskos ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Average Strain ◽  
Asymptomatic Patients ◽  
Significant Difference

Introduction: This study aims to investigate the correlation between severe aortic stenosis (sAS) and impairment of left ventricular global longitudinal strain (LVGLS) in particular segments, using two-dimensional speckle tracking echocardiography in patients with sAS and normal ejection fraction of left ventricle (LVEF). Methods: The study included 53 consecutive patients with asymptomatic sAS and preserved LVEF. The regional longitudinal systolic LV wall strain was evaluated at the area opposite of the aorta as the median strain value of the basal, middle, and apical segments of the lateral and posterior walls and was compared to the average strain value of the interventricular septum (IVS) at the same views. Results: LVGLS was decreased and was not statistically different between three- and four-chamber views (−12.5 ± 3.6 vs −11.4 ± 5.5%, p = 0.2). The average strain values of the lateral and posterior walls were statistically reduced compared to the average value of the IVS (lateral vs IVS: −7.8 ± 3.7 vs −10 ± 5.3%, p = 0.005, posterior vs IVS: −7.7 ± 4.2 vs −10.3 ± 3.8%, p < 0.0001). There was no significant difference between lateral and posterior walls (−7.8 ± 3.7 vs −7.7 ± 4.2%, p = 0.9). Conclusions: The strain of lateral and posterior walls of left ventricle, which lay just opposite to the aortic valve seem to be more reduced compared to other walls in patients with sAS and preserved LVEF possibly due to their anatomical position. This impairment seems to be the reason of the overall LVGLS reduction. Regional strain could be used as an extra tool for the estimation of the severity of AS as well as for prognostic information in asymptomatic patients.

Longitudinal strain in patients with severe aortic regurgitation: superiority to ejection fraction for detection of myocardial dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.C Reil ◽  
G.-H Reil ◽  
N Necker ◽  
J Borer ◽  
H.H Sievers ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Aortic Regurgitation ◽  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Stroke Work ◽  
Indication For Surgery ◽  
Severe Aortic Regurgitation ◽  
Normal Lvef

Abstract Objectives The aim of the study was to analyse LV systolic function and mechanical energetics in asymptomatic patients with severe aortic regurgitation (AR) to seek a new hemodynamic concept for timing for surgery. Background Current guidelines suggest surgery for patients with severe AR including clinical symptoms, subnormal LV ejection fraction (EF), or markedly abnormal left ventricular dimensions. However, the optimal measure to detect intrinsic myocardial systolic dysfunction in the presence of normal LVEF remains elusive. Methods Strain and echo-derived single beat pressure-volume analyses were performed in cohorts with severe AR without indication for surgery (ARNS; LVEDD &lt;70mm, EF &gt;50%, n=41), with indication for surgery (ARS; n=19) and in healthy, age-matched controls (C; n=20). Additionally, end-systolic elastance (Ees=LV contractility), stroke work (SW) and total energy (PVA) were calculated. Results Patients with ARNS demonstrated significant depression of LV contractility vs. C: Ees (1.5mmHg/ml ±0.7 vs. 2.25mmHg/ml ±0.7; p&lt;0.001), despite comparable ejection fractions (EF: 0.56±0.05 vs. 0.60±0.07; p=0.10). Accordingly, global longitudinal strain (GLS) was decreased (−16.0±2.5% vs. −21.5±2%; p&lt;0.001), end-diastolic volume markedly enlarged (236ml ±90 vs. 136ml ±30; p&lt;0.001), as were PVA and SW indicating waste of energy. The correlation of GLS vs. Ees was good (r=−0.68; p&lt;0.001). Results of ARS-patients were consistently worse. Conclusion Patients with severe AR and normal LVEF showed depressed LV contractility and waste of energy when assessed by Ees and GLS, both correlating well with each other. Hence, GLS may outperform LV dimensions for predicting timing for surgery and clinical outcomes in AR patients. Funding Acknowledgement Type of funding source: None

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