scholarly journals Comparison of the capability of risk stratification evaluation between two- and three-dimensional speckle-tracking strain in pre-capillary pulmonary hypertension

2019 ◽  
Vol 9 (4) ◽  
pp. 204589401989452 ◽  
Author(s):  
Bing-Yang Liu ◽  
Wei-Chun Wu ◽  
Qi-Xian Zeng ◽  
Zhi-Hong Liu ◽  
Li-Li Niu ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
High Risk ◽  
Risk Stratification ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Risk Group ◽  
Three Dimensional ◽  
High Risk Group ◽  
Two Dimensional

To investigate and compare the value of right ventricular longitudinal strain detected by two-dimensional and three-dimensional speckle-tracking echocardiography in risk stratification evaluation in pre-capillary pulmonary hypertension. We consecutively screened 66 patients diagnosed with pre-capillary pulmonary hypertension in our center. According to the risk assessment recommended by 2015 European Society of Cardiology Guidelines, all participants were classified into low- and intermediate-high-risk group. Two-dimensional and three-dimensional strains were measured using off-line softwares (GE EchoPAC version 201 and TomTec, 4D RV Function 2.0). Fifty-seven pre-capillary pulmonary hypertension patients (average 35 years old, 18 males and 39 females) were finally enrolled in our study, 32 (56.1%) were classified in low-risk group, while 25 (43.9%) were in the intermediate-high-risk group. Clinical data associated with disease severity, such as N-terminal pro-brain natriuretic peptide ( r = 0.574, P < 0.001), peak oxygen consumption ( r = –0.484, P < 0.001), and 6-min walking distance ( r = –0.356, P = 0.008) were significantly correlated with two-dimensional right ventricular longitudinal strain; while the correlations with three-dimensional right ventricular longitudinal strain were weaker. Receiver operating characteristic curves for the detection of intermediate-high risk stratification showed two-dimensional right ventricular longitudinal strain had the best predictive capacity (area under curve, 0.82, 95% CI: 0.71–0.93, P < 0.001). Univariate and Multivariate Logistic regression analyses identified two-dimensional right ventricular longitudinal strain as an independent predictor (OR: 1.42, 95% CI: 1.18–1.71, P < 0.001) of intermediate-high risk stratification in this cohort of pre-capillary pulmonary hypertension patients, the predictive capacity retained (OR: 1.45, 95% CI: 1.18–1.78, P < 0.001) after adjusted by age, gender, and body mass index, while three-dimensional speckle-tracking echocardiography parameters were not. In conclusion, when used for the detection of intermediate-high risk stratification in pre-capillary pulmonary hypertension, two-dimensional right ventricular longitudinal strain was better than three-dimensional right ventricular longitudinal strain.

scholarly journals Right Ventricular Myocardial Adaptation Assessed by Two-Dimensional Speckle Tracking Echocardiography in Canine Models of Chronic Pulmonary Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Yunosuke Yuchi ◽  
Ryohei Suzuki ◽  
Haruka Kanno ◽  
Takahiro Teshima ◽  
Hirotaka Matsumoto ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Myocardial Contractility ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Chronic Phase ◽  
Two Dimensional ◽  
Canine Models

Background: Pulmonary hypertension (PH) is a life-threatening disease in dogs characterized by an increase in pulmonary arterial pressure (PAP) and/or pulmonary vascular resistance. Right ventricle adapts to its pressure overload through various right ventricular (RV) compensative mechanisms: adaptive and maladaptive remodeling. The former is characterized by concentric hypertrophy and increased compensatory myocardial contractility, whereas the latter is distinguished by eccentric hypertrophy associated with impaired myocardial function.Objectives: To evaluate the RV adaptation associated with the increase of PAP using two-dimensional speckle tracking echocardiography.Animals: Seven experimentally induced PH models.Methods: Dogs were anesthetized and then a pulmonary artery catheter was placed via the right jugular vein. Canine models of PH were induced by the repeated injection of microspheres through the catheter and monitored pulmonary artery pressure. Dogs were performed echocardiography and hemodynamic measurements in a conscious state when baseline and systolic PAP (sPAP) rose to 30, 40, 50 mmHg, and chronic phase. The chronic phase was defined that the sPAP was maintained at 50 mmHg or more for 4 weeks without injection of microspheres.Results: Pulmonary artery to aortic diameter ratio, RV area, end-diastolic RV wall thickness, and RV myocardial performance index were significantly increased in the chronic phase compared with that in the baseline. Tricuspid annular plane systolic excursion was significantly decreased in the chronic phase compared with that in the baseline. The RV longitudinal strain was significantly decreased in the sPAP30 phase, increased in the sPAP40 and sPAP50 phases, and decreased in the chronic phase.Conclusions: Changes in two-dimensional speckle tracking echocardiography-derived RV longitudinal strain might reflect the intrinsic RV myocardial contractility during the PH progression, which could not be detected by conventional echocardiographic parameters.

scholarly journals Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 5-12 ◽  
Author(s):  
Dominique N van Dongen ◽  
Rudolf T Tolsma ◽  
Marion J Fokkert ◽  
Erik A Badings ◽  
Aize van der Sluis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
St Elevation

Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group ( p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group ( p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk ( p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.

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 Adnexal mass risk assessment: a multivariate index assay for malignancy risk stratification

2019 ◽  
Vol 15 (33) ◽  
pp. 3783-3795
Author(s):  
Zhen Zhang ◽  
Rowan G Bullock ◽  
Herbert Fritsche
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Stratification ◽  
Predictive Value ◽  
Adnexal Mass ◽  
Clinical Performance ◽  
Risk Group ◽  
High Risk Group ◽  
Adnexal Masses ◽  
Immediate Surgery

Aims: Adnexal mass risk assessment (AMRA) stratifies patients with adnexal masses, identifying the relatively small number of malignancies from benigns which might take a ‘watchful waiting’ approach. Methods: AMRA uses seven biomarkers and derived from women with adnexal masses scheduled for surgery. Estimated clinical performance was calculated using fixed prevalence. Results: At 5% prevalence, the high-risk group, 7.9% total, captured 75.9% of invasive malignancies at a positive predictive value of 35.8%. High risk/intermediate risk combined had a sensitivity of 89.7 and 95.6% for pre- and post-menopausal cancers, respectively. The low-risk group, 67.8% total, had an negative predictive value of 99.0%. Conclusion: With highly differentiating risk stratification capability across histological subtypes and stages, AMRA is potentially applicable to patients with adnexal masses to assist deciding whether immediate surgery is recommended.

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