Early Detection of Cardiac Systolic Functional Impairment and Correlation with NT-ProBNP Change in AL Amyloidosis by Cardiac Lateral Wall Tissue Doppler S Wave.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2814-2814
Author(s):  
Marna de Cruz ◽  
Babita Pawarova ◽  
Helen Lachmann ◽  
Julian Gillmore ◽  
Simon Gibbs ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Systolic Function ◽  
Prognostic Significance ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
S Wave ◽  
International Consensus ◽  
2D Strain ◽  
The Mean ◽  
Significant Change

Abstract Abstract 2814 Poster Board II-790 N-terminal fragment of brain natriuretic peptide is a cardiac biomarker that has prognostic significance in amyloidosis and NT-ProBNP can rapidly change after completion of chemotherapy. We and others who have previously reported such changes in NT-ProBNP to be of prognostic significance but there was no cardiac “progression” or “improvement” according to the international amyloidosis consensus criteria (Gertz et al 2005) in the majority - making this finding difficult to explain. We now report subtle changes in left ventricular systolic function using lateral wall tissue Doppler as a new robust and reproducible parameter correlating well with such changes in NT-ProBNP. Patients with cardiac amyloidosis as defined by the international consensus criteria who had good renal function (creatinine clearance >30ml/min), received chemotherapy and had a significant change in NT-ProBNP after chemotherapy were identified from the database of the UK National Amyloidosis Centre. A significant change in NT-ProBNP was defined as minimum rise or fall of 30% over the baseline pre-treatment value. Ninty seven patients with identified. All analysis was repeated on stored off line data on EchoPAC” in accordance with British Society of Echocardiography guidelines with special focus on ejection fraction (EF) (Biplane Simpson's method), longitudinal 2D strain, lateral TDI S wave (Tissue Doppler Imaging) and mean left ventricular wall thickness. At baseline the mean EF was 59%, mean LV wall thickness 13mm and mean TDI S wave velocity 0.07m/sec. 76/97 (78%) patients showed a significant increase in the NT-proBNP levels and 21/97 (22%) showed a significant a decrease. There was a significant correlation between the free light chain (FLC) level and NT-ProBNP at diagnosis (correlation coefficient 0.322; p <0.001). NT-ProBNP decreased from median 444 to 144 pMol/L (p=0.021) among patients who had a complete FLC response. There was also good correlation between the NT-ProBNP level with interventricular septal and left ventricular posterior wall thickness (spearman correlation coefficient 0.55, significance 0.01) at baseline. None of the patients had cardiac progression or improvement by echocardiography according to the international consensus criteria . In both groups of patients (increase or decrease in NT-ProBNP), there was no significant change in the LV wall thickness. In patients with a decrease in the NT-proBNP, there was no significant increase in the ejection fraction or longitudinal 2-D strain in the evaluable cases. But there was a significant improvement in the mean lateral TDI S wave (a marker of longitudinal LV systolic function) from 0.07 m/s to 0.08m/s (p=0.02) suggesting improvement in systolic function. In patients with an increase in the NT-ProBNP, there was a significant decrease in the mean EF from 60% to 56% (p=0.032). The longitudinal 2D strain also decreased significantly by mean of 10% (-13.9% to -12.6%; p=0.009) and the lateral TDI S wave also showed significant worsening with a decline from 0.09m/sec to 0.07m/sec (p <0.001). NT-ProBNP changes after chemotherapy have remained difficult to explain. The international consensus criteria for cardiac progression or improvement by echocardiography - a 2 mm change in the LV wall thickness or 20% change in EF - are relatively insensitive and the clinical criteria (change in NYHA class by 2) are not robust or reproducible to detect cardiac improvement or progression. Lateral TDI S wave is a robust and reproducible parameter that correlates well with both an increase and decrease drop in NT-ProBNP levels. This suggests that there are subtle changes to the left ventricular systolic function which correlate well with change in NT-ProBNP and are of prognostic significance. These changes in systolic function occur well before any substantial diastolic functional change or change in wall thickness. This interesting finding needs further validation in larger groups and if confirmed should be considered for incorporation in the consensus criteria for cardiac progression or improvement. Disclosures: No relevant conflicts of interest to declare.

scholarly journals B-Lines on Chest Ultrasound Predicts Elevated Left Ventricular Diastolic Pressures

2017 ◽  
pp. 1-7
Author(s):  
Maadarani O ◽  
Bitar Z ◽  
Almeri K
Keyword(s):  
Pulmonary Edema ◽  
Predictive Value ◽  
Lung Ultrasound ◽  
Systolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Acute Pulmonary Edema ◽  
Chest Ultrasound ◽  
Highly Sensitive ◽  
The Mean

Background: Echocardiography and lung ultrasound are important tests for assessing left ventricular function in patients presented to the emergency department with acute pulmonary edema. Chest ultrasound is becoming an important tool in diagnosing acute pulmonary edema. Aim: To investigate the relationship between the B profile on ultrasound chest and Spectral tissue Doppler echocardiography (E/e’ ratio) in patients presented with the suspicion of acute pulmonary edema. Methods: This paper reports a prospective observational study of 61 consecutive patients, which was presented with symptoms and signs of pulmonary edema and B - profile detected by echocardiography with a 5 MHz curvilinear probe. Critical care physicians trained in ultrasound examination performed echocardiography and chest ultrasounds. Results: Sixty-one participants were included in the study. Forty-seven of the 61 patients had a B-profile and 14 patients had an A profile. The mean E/e’ level in the patients with B-profile was 20.8, compared with the mean level in the patients with an A-profile of 8.2 (CI = 0.33-0.82). The distribution in the two groups differed significantly (p=0.003). Based on the value of E/e’, the sensitivity and specificity were determined; the sensitivity of B profile on ultrasound was 92% (95% confidence interval (CI) = 0.812-0.968), and the specificity was 91% (CI =0.623-0.98). The positive predictive value of the B-profile was 97% (CI=0.889-0.996), and the negative predictive value was 71% (CI=0.454-0.883). The systolic function in the subjects with a B-profile was below 50% in 74.3% of the subjects and normal in 25.7% of the subjects. All the subjects with B profile and systolic function > 50% had elevated ProBNP and E/e’ > 15. An A-profile subjects had systolic function > 55%. Conclusions: Detecting the B-profile in lung ultrasound is highly sensitive and specific for elevated left ventricular diastolic pressures regardless of the systolic function of the left ventricle which may help in diagnosing pulmonary edema.

Athlete's heart in prepubertal male swimmers

2006 ◽  
Vol 16 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Canan Ayabakan ◽  
Figen Akalin ◽  
Sami Mengütay ◽  
Birol Çotuk ◽  
İlhan Odabaş ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Wall Thickness ◽  
Structural Changes ◽  
Systolic Function ◽  
Posterior Wall ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Cardiac Response ◽  
Control Group

To determine the cardiac response to intensive endurance training during prepuberty, we studied 22 male prebubertal swimmers who had been trained for at least 3 years, with a mean of 3.91 years and a standard deviation of 1.10 years, and 8 hours per week, the mean being 10.0 hours and the standard deviation 1.7 hours. The control group consisted of 21 boys of similar age, height and weight (p is more than 0.05 for all), who were not participating regularly in sporting activities. Left ventricular dimensions and systolic function were examined with M-Mode; velocities and durations of transmitral flow were measured with pulsed wave Doppler; and tissue Doppler velocities and durations were measured with pulsed wave tissue Doppler echocardiography. We determined the regional velocities of the lateral mitral annulus in four-chamber position, the left ventricular posterolateral wall, and the midseptum in long-axis position. Interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass and relative wall thickness were increased in swimmers (p is less than 0.05). All the tissue Doppler measurements were similar in both groups, except the septal isovolumic relaxation time. We observed that the left ventricular wall thickness had increased concentrically in prepubertal swimmers compared to controls, without a significant change in the left ventricular diastolic diameter. This finding is contrary to the previous studies on adult swimmers. Whether the structural changes observed in our study reflect the unique cardiac adaptation of the hearts of children to exercise will only be disclosed by longitudinal studies of prepubertal athletes.

The right heart in cardiac amyloidosis: a comparison between subtypes and with other genetic and non-genetic causes of left ventricular hypertrophy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Palmiero ◽  
M Rubino ◽  
E Monda ◽  
M Caiazza ◽  
M.G Trinchillo ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Cardiac Amyloidosis ◽  
Ventricular Hypertrophy ◽  
Systolic Function ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
S Wave ◽  
Roc Curve Analysis ◽  
Right Heart ◽  
Attr Amyloidosis

Abstract Background Right chambers involvement is common in cardiac amyloidosis (CA) but has been ever compared to control groups. Purpose Aim of this study is to compare right heart involvement between CA subgroups (AL vs. ATTR amyloidosis) and between CA and other forms of genetic and non-genetic left ventricular hypertrophy. Methods We enrolled 25 patients with CA (10 pts with AL and 15 pts with wild type ATTR amyloidosis) and 75 patients with LVH (25 HCM pts; 25 HypCMP pts; 25 AS pts). Beside routine echocardiographic measurements, we analysed right chambers dimensions and classical and novel parameters for right ventricular (RV) function [TAPSE (Tricuspid Anulus Plane Systolic Excursion), St (S' wave at RV TDI), global and free-wall strain]. Results ATTR group showed higher right dimensions compared to AL, without differences in RV systolic parameters (see table). CA patients, compared to LVH group, showed no differences in right dimensions. RV systolic parameters were significantly reduced while diastolic Doppler parameters were higher (E/E' 21.7±9.0 vs. 11.2±5.0; p&lt;0.0001). At ROC curve analysis TAPSE showed the best ability in discriminating CA among other forms of LVH (AUC 0.936; 95% CI: 0.879–0.993; p&lt;0.0001), with a sensibility of 94.7% and specificity of 87.3% for a cut-off value of 19.5 mm. At Kaplan-Meier estimation CA patients showed a significantly higher cardiovascular mortality compared to LVH group (9/25 deaths vs. none). At multivariate analysis TAPSE was the only independent prognostic factor (β 1.324; 95% IC: 1.086–1.614; p&lt;0.006). Discussion CA group showed a significantly impaired RV systolic function with higher pulmonary pressures compared to LVH group. TAPSE proved to be the only able to discriminate CA among genetic and non-genetic forms of LVH and also to have prognostic significance. Funding Acknowledgement Type of funding source: None

Subclinical impact of diabetes and hypertention on left ventricular function

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Maaroufi ◽  
S Abouradi ◽  
H Zahidi ◽  
H Choukrani ◽  
R Habbal
Keyword(s):  
Sex Ratio ◽  
Systolic Function ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Lv Function ◽  
Diabetic Patients ◽  
Systolic Performance ◽  
The Mean ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Assessment of longitudinal left ventricular (LV) function has a major clinical significance for the early detection of contractile LV dysfonction. The measurement of the MAPSE (Mitral annular plane systolic excursion) and the systolic peak velocity of the edge of the mitral ring (Sm) allow an accurate assessment of longitudinal systolic performance Objective The aim of this study was to compare the impact of isolated type 2 diabetes and the coexistence of hypertension and diabetes on LV longitudinal systolic performance. Patients and Methods The study included 170 diabetic patients, of whom 85 had both hypertension and diabetes, and 50 controls. The systolic mitral annulus (Sm) velocity by tissue Doppler and the Mitral annular plane systolic excursion (MAPSE) by M mode were measured in all subjects. Results The mean age was 52.8 ± 15 years with a sex ratio M / F 0.23 in diabetic patients, and a mean age 60.8 ± 8 years with a sex ratio M / F 0.45 in control subjects. The mean MAPSE value was reduced in diabetics (11.5 ± 2.6 mm) and even more in hypertensive diabetics (10.5 ± 3.0 mm) compared to controls (16.1 ± 2.4 mm ) (p = 0.02). Similar results were found for Sm (controls, 12.4 ± 2.5 cm / s; diabetics, 9.0 ± "3.3 cm / s; diabetic hypertensive, 7.3 ± 2.0 cm) (p = 0.04). Conclusions diabetics present a depression of the LV longitudinal systolic indices compared to healthy controls; the coexistence of diabetes and hypertension results in further impairment of LV longitudinal systolic function in an additive manner.

Cardiac Effects of Dexamethasone in Very Low Birth Weight Infants

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 818-821 ◽  
Author(s):  
Andrew S. Bensky ◽  
Jamanadas M. Kothadia ◽  
Wesley Covitz
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Wall Thickness ◽  
Very Low Birth Weight ◽  
Systolic Function ◽  
Left Ventricular ◽  
Low Birth Weight Infants ◽  
Cardiac Effects ◽  
Significant Prolongation ◽  
Lv Mass

Objective. To characterize the cardiac effects of dexamethasone in very low birth weight infants. Design. Prospective, randomized, placebo-controlled, double-blind trial. Enrolled subjects were randomized to receive either a 42-day tapering course of dexamethasone or a saline placebo. Echocardiographic measurements were obtained on days 0, 7, 14, 28, and 42. Subjects. Thirteen infants received dexamethasone and 13 a saline placebo. The two groups were similar in birth weight, gestational age, age at enrollment, and sex/race composition. Results. Patients receiving dexamethasone had a significantly larger increase in septal thickness on days 7, 14, and 28 and left ventricle (LV) posterior wall thickness on day 14. A significantly lower left ventricular enddiastolic dimension in the dexamethasone group was initially noted on day 7 and persisted until day 42. With the reduced left ventricular end-diastolic dimension, no significant differences in LV mass were noted, despite the increased wall thickness. No differences in LV systolic function, as assessed by area shortening, were seen. Assessment of diastolic function showed a significant increase in the atrial portion of mitral inflow in dexamethasone patients on day 14, as well as a significant prolongation in isovolumic relaxation time on days 7, 14, and 28. Conclusions. Infants receiving dexamethasone developed evidence for impaired LV filling with a larger increase in wall thickness but no increase in LV mass, asymmetric septal hypertrophy, or augmented systolic function. This suggests that alterations in left ventricular filling play an important role in the development of hypertrophy seen with dexamethasone administration.

scholarly journals P797 Assessment of right ventricular systolic function with 3D echocardiography following cardiac resynchronization therapy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Jenei ◽  
E Papp ◽  
M Clemens ◽  
Z Csanadi
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Systolic Function ◽  
Left Ventricular ◽  
3D Echocardiography ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
S Wave ◽  
Ventricular Systolic Function ◽  
Significant Difference

Abstract Background In approximately 30-40% of cases, the left ventricular systolic function does not improve following cardiac resynchronization therapy (CRT; non-responders). Currently, the role of right ventricular (RV) systolic function is not yet completely clear in the background. Our aim was to assess the RV systolic function with 3D echocardiography in CRT patients. Methods We selected 19 patients who received CRT in our department between May and June 2017, and whose 1-year follow-up data were available. We characterized several 2D parameters of RV systolic function, such as RV free wall strain (RV GLSFW), annular s’ wave velocity (TDI s), tricuspid annulus plane systolic excursion (TAPSE), RV fractional area change (RV FAC). A number of 3D parameters were also assessed, such as RV ejection fraction (EF), end-diastolic (EDV) and end-systolic (ESV) volumes, using a dedicated RV analysis software. Moreover, we measured the LV EF and considered the patients "responder", when the LV EF improved with at least 10% after CRT implantation. Results From 19 patients, 12 was identified as responders (R) and 7 as non-responders (NR). No significant difference was seen in the mean age of patients in the two groups (NR: 68 ± 6 year; R: 67 ± 9 year, p = 0.76), however, the proportion of male individuals was higher in the NR group (8/12 vs. 1/7). The RV EF was higher in the R group (41 ± 8% vs.29 ± 10%; p = 0.012), while the EDV or ESV did not differ between the two groups. The RV GLSFW (–21.2 ± 7% vs.–13.9 ± 7%, p = 0.045) and the TAPSE (16.8 ± 5 mm vs.11.4 ± 3 mm, P = 0.03) values were significantly different between the two groups. Based on logistic regression analysis, the RV EF was an independent predictor of non-respondence. Conclusions The lower RV EF indicates non-respondence to CRT, however, it is not associated with RV dilation, i.e.adverse remodelling. These results suggest mechanical abnormality of RV function in the background of impaired EF.

scholarly journals The impact of obesity on left ventricular mass and left ventricular systolic function in children

2016 ◽  
Vol 45 (4) ◽  
pp. 171
Author(s):  
Ria Nova ◽  
Bambang Madiyono ◽  
Sudigdo Sastroasmoro ◽  
Damayanti R Sjarif
Keyword(s):  
Wall Thickness ◽  
Systolic Function ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Internal Diameter ◽  
Obese Children ◽  
Normal Children ◽  
Posterior Wall Thickness ◽  
Lv Mass ◽  
Lv Systolic Function

Background Obesity causes cardiovascular disturbances. Theincidence of cardiovascular disease is higher even in mildly obesepatients than in lean subjects.Objectives The purpose of this study was to compare left ven-tricular (LV) mass, LV internal dimensions, and LV systolic func-tion between obese and normal children; and to determine the as-sociation of the degree of obesity with LV mass and LV systolicfunction.Methods This cross-sectional study was conducted on elemen-tary school students in Jakarta from February to April 2003. Wemeasured the subjects’ body weight and height, and performedlipid profile and echocardiography examinations. Measurementsof LV mass, LV internal dimensions with regard to septum thick-ness, LV internal diameter, and LV posterior wall thickness; andLV systolic function as indicated by shortening fraction and ejec-tion fraction, were performed echocardiographically. The differ-ences in measurements between obese and normal children aswell as between obese children with and without lipid abnormalitywere analyzed. The correlation between the degree of obesity withLV size and systolic function was determined.Results Twenty-eight normal children and 62 obese children wereenrolled in the study. Mean LV mass was 35.7 (SD 5.16) g/cm 3 inobese children versus 24.0 (SD 3.80) g/cm 3 in normal children(P<0.0001). Mean septum thickness was 0.8 (SD 0.14) mm inobese children versus 0.6 (SD 7.90) mm in normal children (P<0.0001). Mean posterior wall thickness was 0.9 (SD 0.14) mm inobese children versus 0.6 (SD 9.97) mm in normal children(P<0.0001). Mean LV internal diameter was 4.0 (SD 0.34) mm inobese children versus 3.9 (SD 0.29) mm in normal children(P=0.300). There was strong correlation between the degree ofobesity and LV mass (r=0.838, P<0.0001). LV systolic function(shortening fraction) was 37.1 (SD 4.20) percent in obese childrenversus 35.8 (SD 4.99) percent in normal children (P=0.19). Ejec-tion fraction was 67.4 (SD 5.32) percent in obese children versus65.5 (SD 6.29) percent in normal children (P=0.13). There wasweak correlation between LV systolic function and the degree ofobesity (shortening fraction r=0.219, P=0.038; ejection fractionr=0.239, P=0.023).Conclusions Obese children had significantly greater LV mass,septum thickness, and posterior wall thickness than normal chil-Backgrounddren. Such significant difference was absent for LV internal diam-eter and measures of LV systolic function. There was no signifi-cant difference in LV mass and LV systolic function between obesechildren with or without abnormality of lipid profile. A strong corre-lation exists between the degree of obesity and LV mass, but thecorrelation between degree of obesity and LV systolic function wasweak

scholarly journals Comparison of left ventricular systolic function by 2D speckle-tracking echocardiography between normal pregnant women and pregnant women with preeclampsia

2019 ◽  
Vol 11 (4) ◽  
pp. 309-313
Author(s):  
Atoosa Mostafavi ◽  
Yaser Tase Zar ◽  
Farahnaz Nikdoust ◽  
Seyed Abdolhossein Tabatabaei
Keyword(s):  
Pregnant Women ◽  
Speckle Tracking ◽  
Circumferential Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
2D Speckle Tracking ◽  
The Mean ◽  
The Right

Introduction: In light of previous studies reporting the significant effects of preeclampsia on cardiac dimensions, we sought to evaluate changes in the left ventricular (LV) systolic and diastolic functions in patients with preeclampsia with a view to investigating changes in cardiac strain. <br /> Methods: This cross-sectional study evaluated healthy pregnant women and pregnant women suffering from preeclampsia who were referred to our hospital for routine healthcare services. LV strain was measured by 2D speckle-tracking echocardiography. <br /> Results: Compared with the healthy group, echocardiography in the group with preeclampsia showed a significant increase in the LV end-diastolic diameter (47.43 ± 4.94 mm vs 44.84 ± 4.30 mm; P = 0.008), the LV end-systolic diameter (31.16 ± 33.3 mm vs 29.20 ± 3.75 mm; P = 0.008), and the right ventricular diameter (27.93 ± 1.71 mm vs 24.53 ± 23.3; P = 0.001). The mean global longitudinal strain was -18.69 ± 2.8 in the group with preeclampsia and -19.39 ± 3.49 in the healthy group, with the difference not constituting statistical significance (P = 0.164). The mean global circumferential strain in the groups with and without preeclampsia was -20.4 ± 12.4 and -22.68 ± 5.50, respectively, which was significantly lower in the preeclampsia group (P = 0.028).<br /> Conclusion: The development of preeclampsia was associated with an increase in the right and left ventricular diameters, as well as a decrease in the ventricular systolic function, demonstrated by a decline in global circumferential strain.

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