Hemodynamics and Clinical Implications of Occult Left Ventricular Dysfunction in Adults Undergoing Ebstein Anomaly Repair

Background: Left ventricular global longitudinal strain (LVGLS) can detect early phases of LV systolic dysfunction, but its application has not been studied in Ebstein anomaly. We hypothesized that LVGLS can detect early phases of LV systolic dysfunction and that patients with occult LV systolic dysfunction will have worse hemodynamics, end-organ dysfunction, and suboptimal postoperative LV reverse remodeling after tricuspid valve surgery in comparison to patients with normal LV systolic function. Methods: In this retrospective cohort study, 371 Ebstein patients that underwent tricuspid valve surgery were divided into 3 groups: normal LV systolic function (normal LVGLS and LV ejection fraction; n=244, 77%), occult LV systolic dysfunction (abnormal LVGLS with normal LV ejection fraction; n=44, 14%), and overt LV systolic dysfunction (abnormal LVGLS and LV ejection fraction; n=27, 9%). Results: Compared with the normal LV function group, the occult group had smaller LV volume and cardiac output (2.1±0.4 versus 2.9±0.6 L/min per m 2 , P <0.001), worse end-organ dysfunction (glomerular filtration rate, 78±14 versus 91±18 mL/min per 1.73 m 2 , P =0.01), and suboptimal postoperative LV reverse remodeling. Although both the occult and overt groups had a similar degree of end-organ dysfunction (glomerular filtration rate, 78±14 versus 82±16 mL/min per 1.73 m 2 , P =0.3), the occult group was less likely to be on heart failure therapy (48% versus 96%, P <0.001). Conclusions: Abnormal LVGLS was associated with suboptimal postoperative LV reverse remodeling. These data suggest that LVGLS can potentially be used for risk stratification and provides a foundation for further studies to determine whether optimal heart failure therapy or tricuspid valve intervention can improve outcomes for LV systolic dysfunction in patients with Ebstein anomaly.

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Non-Invasive Assessment of Left Ventricle Ejection Fraction: Where Do We Stand?

Journal of Personalized Medicine ◽

10.3390/jpm11111153 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1153

Author(s):

Alessandra Scatteia ◽

Angelo Silverio ◽

Roberto Padalino ◽

Francesco De Stefano ◽

Raffaella America ◽

...

Keyword(s):

Clinical Practice ◽

Ejection Fraction ◽

Systolic Function ◽

Left Ventricular ◽

Left Ventricle Ejection Fraction ◽

Advantages And Disadvantages ◽

Non Invasive ◽

Lv Ejection Fraction ◽

Lv Systolic Function ◽

Invasive Evaluation

The left ventricular (LV) ejection fraction (EF) is the preferred parameter applied for the non-invasive evaluation of LV systolic function in clinical practice. It has a well-recognized and extensive role in the clinical management of numerous cardiac conditions. Many imaging modalities are currently available for the non-invasive assessment of LVEF. The aim of this review is to describe their relative advantages and disadvantages, proposing a hierarchical application of the different imaging tests available for LVEF evaluation based on the level of accuracy/reproducibility clinically required.

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Left ventricular systolic function

Practical Perioperative Transoesophageal Echocardiography ◽

10.1093/med/9780198759089.003.0006 ◽

2018 ◽

Author(s):

David Sidebotham ◽

Alan Merry ◽

Malcolm Legget ◽

Gavin Wright

Keyword(s):

Ejection Fraction ◽

Systolic Function ◽

Acute Myocarditis ◽

Systolic Dysfunction ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Strain Rate Imaging ◽

Segmental Wall Motion ◽

Complications Of Myocardial Infarction ◽

Lv Systolic Function

Chapter 6 is subdivided into three sections: global LV systolic function, regional LV systolic function, and cardiomyopathies. In Section 1, commonly used indices of global systolic function, such as fractional area change and ejection fraction, are reviewed, along with their limitations related to oesophageal imaging. The relationship between stroke volume and ejection fraction is explored. Newer techniques such as quantitative 3D imaging and strain-rate imaging are described. In Section 2, the causes of regional systolic dysfunction are reviewed, along with the different aetiologies of real and apparent segmental wall motion abnormalities. Complications of myocardial infarction such as mitral regurgitation, true and false LV aneurysms, and ventricular septal rupture are also dealt with in this section. Section 3 provides an overview of the echocardiographic findings associated with various cardiomyopathies: dilated, hypertrophic, restrictive, acute myocarditis, LV non-compaction, and Takotsubo.

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Catheter Ablation of Atrial Fibrillation in Patients With Functional Mitral Regurgitation and Left Ventricular Systolic Dysfunction

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.596491 ◽

2020 ◽

Vol 7 ◽

Author(s):

Jin-Tao Wu ◽

Junaid A. B. Zaman ◽

H. Yakup Yakupoglu ◽

Boyalla Vennela ◽

Cantor Emily ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Mitral Regurgitation ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Function ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

Reverse Remodeling ◽

Lv Systolic Function

Background: The efficacy of catheter ablation for atrial fibrillation (AF) in patients with functional mitral regurgitation (MR) and left ventricular (LV) systolic dysfunction (LVSD) is not known. The aim of the study is to determine the efficacy of catheter ablation for AF in patients with functional MR and LVSD, and to validate its effects on the severity of MR and cardiac reverse remodeling.Methods: We performed a retrospective study of 54 patients with functional MR who underwent AF ablation, including 21 (38.9%) with LVSD and 33 (61.1%) with normal LV systolic function (LVF). The primary outcomes evaluated were freedom from recurrent atrial tachyarrhythmia (ATa), severity of MR, and left atrial (LA) and LV remodeling.Results: During a mean follow-up of 20.7 ± 16.8 months, freedom from recurrent ATa was not significantly different between patients with LVSD and those with normal LVF after the first ablation (P = 0.301) and after multiple ablations (P = 0.728). Multivariable predictors of recurrent ATa were AF duration [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.01–1.25; P = 0.039), previous stroke (HR 5.28, 95% CI 1.46–19.14; P = 0.011), and estimated glomerular filtration rate (HR 0.97, 95% CI 0.95–0.99; P = 0.012). Compared with baseline, there was a significant reduction in severity of MR (P = 0.007), LA size (P < 0.001) and LV end-systolic dimension (P = 0.008), and improvement in the LV ejection fraction (P = 0.001) after restoring sinus rhythm in patients with LVSD.Conclusion: Catheter ablation is a valid option for the treatment of AF in patients with functional MR and LVSD, even though multiple procedures may be required.

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Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-209223 ◽

2016 ◽

Vol 76 (2) ◽

pp. 371-376 ◽

Cited By ~ 20

Author(s):

Helga Midtbø ◽

Anne Grete Semb ◽

Knut Matre ◽

Tore K Kvien ◽

Eva Gerdts

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Ejection Fraction ◽

Disease Activity ◽

Cardiovascular Risk Factors ◽

Myocardial Function ◽

Systolic Function ◽

Left Ventricular ◽

Lv Ejection Fraction ◽

Lv Systolic Function

ObjectivesDisease activity has emerged as a new, independent risk factor for cardiovascular disease in patients with rheumatoid arthritis (RA). We tested if disease activity in RA was associated with lower left ventricular (LV) systolic function independent of traditional cardiovascular risk factors.MethodsEchocardiographic assessment was performed in 78 patients with RA having low, moderate or high disease activity (Simplified Disease Activity Index (SDAI) >3.3), 41 patients in remission (SDAI ≤3.3) and 46 controls, all without known cardiac disease. LV systolic function was assessed by biplane Simpson ejection fraction, stress-corrected midwall shortening (scMWS) and global longitudinal strain (GLS).ResultsPatients with active RA had higher prevalence of hypertension and diabetes compared with patients in remission and controls (both p<0.05). LV ejection fraction (endocardial function) was normal in all three groups, while mean scMWS and GLS (myocardial function) were reduced in patients with RA with active disease compared with patients with RA in remission (95±18% vs 105±17% and −18.9±3.1% vs −20.6±3.5%, respectively, both p<0.01). Patients with RA in remission had similar scMWS and GLS as the controls. In multivariable analyses, having active RA was associated with lower GLS (β=0.21) and scMWS (β=−0.22, both p<0.05), both reflecting lower LV systolic myocardial function, independent of cardiovascular risk factors and LV ejection fraction. Classification of RA disease activity by other disease activity composite scores yielded similar results.ConclusionsActive RA is associated with lower LV systolic myocardial function despite normal ejection fraction and independent of traditional cardiovascular risk factors.

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P315 Prevalence of left ventricular systolic and diastolic dysfunction in patients with chronic kidney disease and preserved left ventricular ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.168 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

O V Tereshina ◽

O A Germanova ◽

L A Rogozina ◽

I L Davydkin

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Ejection Fraction ◽

Diastolic Function ◽

Circumferential Strain ◽

Systolic Function ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ckd Stage ◽

Lv Systolic Function

Abstract BACKGROUND Presence of heart failure (HF) is associated with poor outcome in patients with chronic kidney disease (CKD), although Left ventricular (LV) systolic function is often preserved in them. However, CKD patients may have HF symptoms with preserved LVEF. Myocardial Deformation Imaging is more accurate for detecting LV systolic dysfunction. The aim of this study was to evaluate global longitudinal (GLS) and circumferential strain (GCS) in patients with renal function impairment. METHODS Overall, 67 patients (40% men, mean age 45 ± 12 years) with CKD stage 3-4 were studied. All patients had an LV ejection fraction ≥50%. We performed echocardiography including speckle-tracking (STE) measurement of LV GLS and LV GCS and as well as assessment of diastolic function. RESULTS Despite preserved LVEF, impaired LV GLS (<18%) was observed in all patients. The mean value of GLS was 14,1 ± 1,5. This finding indicates that systolic dysfunction in CKD started from compromise LV longitudinal function. However, the GCS parameter was in the normal range – 22,7 ± 1,8. Thereby preserved LVEF was compensated by normal or slightly increase circumferential strain. Impaired diastolic function was observed in 18% of patients including 8% patients with increased left ventricle filling pressure (stage II-III). CONCLUSION The prevalence of impaired LV GLS despite preserved LVEF in patients with CKD stage 3-4 is high, which proved that renal disease is associated with early and subclinical impairment of LV systolic function. Impaired diastolic function was not so common among them. Assessment of it is not always so easy and reliable using current recommendation. Thus, STE can be recommended for early detection impairment of LV function.

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Central and obstructive apneas prevalence in heart failure with reduced, mid-range and preserved ejection fraction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1170 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Borrelli ◽

P Sciarrone ◽

F Gentile ◽

N Ghionzoli ◽

G Mirizzi ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Function ◽

Systolic Dysfunction ◽

Cardiopulmonary Exercise Testing ◽

Left Ventricular ◽

Apnea Hypopnea Index ◽

Preserved Ejection Fraction ◽

2D Echocardiography

Abstract Background Central apneas (CA) and obstructive apneas (OA) are highly prevalent in heart failure (HF) both with reduced and preserved systolic function. However, a comprehensive evaluation of apnea prevalence across HF according to ejection fraction (i.e HF with patients with reduced, mid-range and preserved ejection fraction- HFrEf, HFmrEF and HFpEF, respectively) throughout the 24 hours has never been done before. Materials and methods 700 HF patients were prospectively enrolled and then divided according to left ventricular EF (408 HFrEF, 117 HFmrEF, 175 HFpEF). All patients underwent a thorough evaluation including: 2D echocardiography; 24-h Holter-ECG monitoring; cardiopulmonary exercise testing; neuro-hormonal assessment and 24-h cardiorespiratory monitoring. Results In the whole population, prevalence of normal breathing (NB), CA and OA at daytime was 40%, 51%, and 9%, respectively, while at nighttime 15%, 55%, and 30%, respectively. When stratified according to left ventricular EF, CA prevalence decreased from HFrEF to HFmrEF and HFpEF: (daytime CA: 57% vs. 43% vs. 42%, respectively, p=0.001; nighttime CA: 66% vs. 48% vs. 34%, respectively, p<0.0001), while OA prevalence increased (daytime OA: 5% vs. 8% vs. 18%, respectively, p<0.0001; nighttime OA: 20 vs. 29 vs. 53%, respectively, p<0.0001). When assessing moderte-severe apneas, defined with an apnea/hypopnea index >15 events/hour, prevalence of CA was again higher in HFrEF than HFmrEF and HFpEF both at daytime (daytime moderate-severe CA: 28% vs. 19% and 23%, respectively, p<0.05) and at nighttime (nighttime moderate-severe CA: 50% vs. 39% and 28%, respectively, p<0.05). Conversely, moderate-severe OA decreased from HFrEF to HFmrEF to HFpEF both at daytime (daytime moderate-severe OA: 1% vs. 3% and 8%, respectively, p<0.05) and nighttime (noghttime moderate-severe OA: 10% vs. 11% and 30%, respectively, p<0.05). Conclusions Daytime and nighttime apneas, both central and obstructive in nature, are highly prevalent in HF regardless of EF. Across the whole spectrum of HF, CA prevalence increases and OA decreases as left ventricular systolic dysfunction progresses, both during daytime and nighttime. Funding Acknowledgement Type of funding source: None

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Correlation between hemoglobin level and left ventricular systolic functions and dimensions in children with chronic severe anemia

Paediatrica Indonesiana ◽

10.14238/pi51.2.2011.79-83 ◽

2011 ◽

Vol 51 (2) ◽

pp. 79

Author(s):

Erlina Masniari Napitupulu ◽

Fera Wahyuni ◽

Tina Christina L. Tobing ◽

Muhammad Ali ◽

Bidasari Lubis

Keyword(s):

Systolic Function ◽

Pearson Correlation ◽

Systolic Dysfunction ◽

Univariate Analysis ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Lv Function ◽

Severe Anemia ◽

Cross Sectional ◽

Lv Systolic Function

Background Chronic severe anemia is a connnon disease. Cardiac output may increase when the hemoglobin (Hb) level decreases to < 7 g/dL for 3 months or more. Alteration of left ventricular (LV) function occurs frequently in children 'With chronic severe anemia, in the {onn of concentric LV hypertrophy, LV dilatation with or v.ithout LV hypertrophy, or systolic dysfunction. Objective To examine the correlation between Hb level and alteration of LV systolic function in children with chronic severe anemia. Methods We conducted a cross-sectional study in Adam Malik Hospital from October to December 2009. Subjects were chronic severely anemic children. Left ventricular systolic function (ejection fraction/EF, fractional shortening/FS) and dimensions (left ventricular end diastolic diameter/LVEDD and left ventricular end systolic diameter/LVESD) were measured using Hitachi EUB 5500 echocardiography unit. Univariate analysis and Pearson correlation were performed.Results Thirty children were enrolled in the study. The mean of age was 113.5 months (SD 53.24). Hb values ranged from 2.1 to 6.9 g/dL with mean value of 4.6 g/dL (SD 1.44). Mean duration of anemia was 3.9 months (SD 0.70). Chronic severe anemia was not associated \\lith decreased LV systolic function [EF 62.2% (SD 9.16), r =0.296, P=0.112; FS 33.8% (SD 7.26), r =0.115, P=0.545], nor LV dimension changes [LVEDD 40.2 mm (SD 6.85), r = -0.192, P=0.308; LVESD 26.2 mm (SD 4.98), r=-0.266, P=0.156]. Conclusion There was no correlation between Hb level in chronically anemic children and changes in LV systolic function or dimension.

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Abstract 1962: Quantification of Longitudinal Right Ventricular Systolic Function and Its Coupling to Left Ventricular Global Function Using Speckle-Tracking Strain Imaging in Patients with Old Myocardial Infarction

Circulation ◽

10.1161/circ.116.suppl_16.ii_423 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Kaoru Dohi ◽

Katsuya Onishi ◽

Shinya Kato ◽

Takeshi Takamura ◽

Naoki Fujimoto ◽

...

Keyword(s):

Ejection Fraction ◽

Speckle Tracking ◽

Systolic Function ◽

Strain Imaging ◽

Left Ventricular ◽

Systolic Strain ◽

Peak Systolic Strain ◽

Lv Ejection Fraction ◽

Rv Function ◽

Global Peak

Background: We tested the hypothesis that speckle-tracking strain imaging can quantify longitudinal right ventricular (RV) function and its association with left ventricular (LV) function in patients with myocardial infarction (MI). Methods: To quantify longitudinal RV function, 39 patients with old MI (OMI: LV ejection fraction 17 – 77 %, 45 ±16 %) and 29 age matched normal controls (Control: LV ejection fraction 65 ± 5 %) were studied with echocardiography. Longitudinal RV global peak systolic strain was assessed from apical four-chamber view using speckle-tracking imaging (EchoPAC, GE Electronic). RV fractional area change was also analyzed. Results: Longitudinal RV global peak systolic strain was significantly impaired in OMI compared to Control (−18 ± 5* and −25 ± 4 %, *p < 0.05 vs. Control) whereas RV fractional area change failed to discriminate from normal to impaired RV function (OMI: 48 ± 11 vs. Control: 52 ± 6 %, p = NS). When divided OMI into three groups regarding to plasma BNP level (Group A: BNP < 100 pg/ml; n = 14, Group B: 100 pg/ml ≤ BNP < 500 pg/ml; n = 14, and Group C; BNP ≥ 500 pg/ml; n = 11), Group A had no significant relations between longitudinal RV global peak systolic strain and LV ejection fraction (y = −0.07x − 11, r = 0.30, p = NS) whereas those were significantly correlated in Group B (y = −0.18x − 11, r = 0.59*, *p < 0.05). Furthermore, the strongest correlation between longitudinal RV global peak systolic strain and LV ejection fraction was observed in Group C (y = −0.58x + 5, r = 0.90*, *p < 0.05). Conclusion: Speckle tracking strain imaging quantified longitudinal RV global systolic function and exhibited its BNP-related dependency to LV systolic function in patents with OMI.

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Progression of Left Ventricular Myocardial Dysfunction in Systemic Sclerosis: A Speckle-tracking Strain Echocardiography Study

The Journal of Rheumatology ◽

10.3899/jrheum.171207 ◽

2019 ◽

Vol 46 (4) ◽

pp. 405-415 ◽

Cited By ~ 4

Author(s):

Suzanne E. van Wijngaarden ◽

Samira Ben Said-Bouyeri ◽

Maarten K. Ninaber ◽

Tom W.J. Huizinga ◽

Martin J. Schalij ◽

...

Keyword(s):

Muscle Weakness ◽

Speckle Tracking ◽

Systolic Function ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Proximal Muscle Weakness ◽

Proximal Muscle ◽

Lv Ejection Fraction ◽

Lv Diastolic Dysfunction ◽

Echocardiographic Speckle Tracking

Objective.Cardiac involvement is a main cause of mortality in systemic sclerosis (SSc). Its detection remains challenging using conventional echocardiography and little is known about its potential progression. This study assessed changes in cardiac performance over time in a prospective cohort of patients with SSc, including echocardiographic speckle-tracking strain analysis.Methods.The study included 234 patients with SSc [196 women, age 52 ± 14 yrs, 165 limited SSc, time since diagnosis 5.2 yrs, interquartile range (IQR) 2.9–11.3]. Clinical variables, laboratory tests, pulmonary function tests, and echocardiographic measures were recorded at baseline and followup (median 2.3 yrs, IQR 1.3–3.9). Additionally, left ventricular (LV) systolic function was assessed with global longitudinal strain (GLS) by echocardiographic speckle-tracking analysis.Results.At followup, GLS had significantly worsened (−21% ± 2 vs −19% ± 2, p < 0.001) while LV ejection fraction had not changed (62% ± 7 vs 61% ± 8, p = 0.124). In particular, 39 patients showed a significant deterioration of GLS as defined by a ≥ 15% decrease, which was accompanied by a concomitant worsening of proximal muscle weakness, lung fibrosis, renal function, LV diastolic function, and right ventricular systolic function. Baseline variables associated with ≥ 15% deterioration in GLS were proximal muscle weakness (OR 3.437, 95% CI 1.13–10.43, p = 0.020), decreased DLCO (OR 3.621, 95% CI 1.25–10.51, p = 0.049), and LV diastolic dysfunction (OR 2.378, 95% CI 1.07–5.27, p = 0.033).Conclusion.In patients with SSc, progression of LV systolic dysfunction was demonstrated by GLS but not by LV ejection fraction. Proximal muscle weakness, DLCO, and LV diastolic dysfunction may identify patients at risk for progressive LV systolic dysfunction and in need of closer cardiac monitoring.

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The impact of endurance exercise training on left ventricular systolic mechanics

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00395.2008 ◽

2008 ◽

Vol 295 (3) ◽

pp. H1109-H1116 ◽

Cited By ~ 84

Author(s):

Aaron L. Baggish ◽

Kibar Yared ◽

Francis Wang ◽

Rory B. Weiner ◽

Adolph M. Hutter ◽

...

Keyword(s):

Exercise Training ◽

Ejection Fraction ◽

Endurance Exercise ◽

Systolic Function ◽

Radial Strain ◽

Left Ventricular ◽

Functional Changes ◽

Endurance Exercise Training ◽

Lv Systolic Function ◽

The Impact

Although exercise training-induced changes in left ventricular (LV) structure are well characterized, adaptive functional changes are incompletely understood. Detailed echocardiographic assessment of LV systolic function was performed on 20 competitive rowers (10 males and 10 females) before and after endurance exercise training (EET; 90 days, 10.7 ± 1.1 h/wk). Structural changes included LV dilation (end-diastolic volume = 128 ± 25 vs. 144 ± 28 ml, P < 0.001), right ventricular (RV) dilation (end-diastolic area = 2,850 ± 550 vs. 3,260 ± 530 mm2, P < 0.001), and LV hypertrophy (mass = 227 ± 51 vs. 256 ± 56 g, P < 0.001). Although LV ejection fraction was unchanged (62 ± 3% vs. 60 ± 3%, P = not significant), all direct measures of LV systolic function were altered. Peak systolic tissue velocities increased significantly (basal lateral S′Δ = 0.9 ± 0.6 cm/s, P = 0.004; and basal septal S′Δ = 0.8 ± 0.4 cm/s, P = 0.008). Radial strain increased similarly in all segments, whereas longitudinal strain increased with a base-to-apex gradient. In contrast, circumferential strain (CS) increased in the LV free wall but decreased in regions adjacent to the RV. Reductions in septal CS correlated strongly with changes in RV structure (ΔRV end-diastolic area vs. ΔLV septal CS; r2 = 0.898, P < 0.001) and function (Δpeak RV systolic velocity vs. ΔLV septal CS, r2 = 0.697, P < 0.001). EET leads to significant changes in LV systolic function with regional heterogeneity that may be secondary to concomitant RV adaptation. These changes are not detected by conventional measurements such as ejection fraction.

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