Changes in speckle-tracking-derived mechanical dispersion index are associated with 30-day readmissions in acute heart failure

The aim of the study was to develop a score scale for assessing the high risk of establishing chronic heart failure with preserved ejection fraction (HFpEF), based on echocardiography (EchoCG) evidence.Materials and methods. A clinical and instrumental study of 175 patients, of which 108 (61.7%) women and 67 (38.3%) men, aged 71 [64; 78] years was performed in the 1st City Clinical Hospital in Minsk in 2017–2018. In order to validate the score scale for assessing the risk of HFpEF establishment in 2019–2020 a reproductive clinical and instrumental study of 129 patients was performed at the Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, of which 55 (42.6%) were men and 74 (57.4%) women aged 65 [58; 70] years. Inclusion criteria: sinus rhythm, essential arterial hypertension, chronic coronary heart disease: atherosclerotic heart disease, past myocardial infarction of left ventricle (LV), after which at least six months have passed, necessary to stabilize the structural and functional parameters of the LV, HFpEF, informed consent of the patient. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or prosthetics, congenital heart defects, acute and chronic diseases of the kidneys, lungs. EchoCG was performed on ultrasound machines Siemens Acuson S1000 (Germany) and Vivid E9 (GE Healthcare, USA).Results. The developed scale for assessing the risk of establishing HFpEF in a patient with sinus rhythm including the criteria: LV diastolic dysfunction type II – 47 points, deceleration time of peak E of the transmitral blood flow DTE ≤171 ms – 25 points, the speed of early diastolic movement of the septal part of the mitral fibrous ring e'septal ≤7 cm/s – 25 points, LV early diastolic filling index E/е'septal >7.72 – 20 points, index of the end-systolic volume of the left atrium >34.3 ml/m2 – 24 points, has high diagnostic reliability (AUC 0.96, sensitivity (S) 96.6%, specificity (Sp) 83.2%) and reproducibility of results in an examination cohort of patients (AUC 0.99, S 98.8%, Sp 98.0%). A total score > 45 indicates a high probability of HFpEF. If the total score is ≤45, it is recommended to perform 2D Speckle Tracking EchoCG. The leading patho-functional mechanisms for the development of HFpEF are a decrease of LV global systolic longitudinal strain GLSAVG > −18.9% (S 94.9%, Sp 98.0%), GLS of the right ventricle (RV) > −19.9% (S 76.5%, Sp 88.5%), mechanical dispersion with LV mechanical dispersion index > 54.69 ms (S 70.7%, Sp 90.2%), RV mechanical dispersion index > 50.29 msec (S 78.1%, Sp 73.9%) and ventricular dyssynergy with LV global post systolic index >5.59% (S 82.6%, Sp 87.5%), RV global post systolic index > 2.17% (S 84.5%, Sp 69.9%).Conclusions. The use of the developed scale will improve the efficiency of ultrasound imaging of HFpEF.

Download Full-text

P1381 The utility of left ventricle deformation in patients with myocarditis with midle-range and preserved ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.814 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

G Krljanac ◽

I Veljic ◽

A Ristic ◽

R Maksimovic ◽

I Milinkovic ◽

...

Keyword(s):

Heart Failure ◽

Speckle Tracking ◽

Systolic Function ◽

Acute Myocarditis ◽

Deformation Analysis ◽

Mechanical Dispersion ◽

Middle Range ◽

Myocardial Deformation Imaging ◽

Lv Systolic Function ◽

Insight Into

Abstract Background Predicting malignant ventricular arrhythmias and heart failure in patients (pts) with acute myocarditis and middle-range and preserved EF is challenge Aim: to define whether quantification of myocardial mechanics in early, acute phase of myocarditis offers more information to predict six months outcome of patients.Methods: In the 36 consecutive pts with myocarditis, middle age 32.86 ± 12.04yr, 75% males, echocardiography exam was done 1-3 day of diseases, including conventional parameters and comprehensive speckle tracking LV deformation analysis with longitudinal (L), circumferential (C) strain (S;%), strain rate (SR, 1/sec) and rotational LV mechanics. Results: The most patients were present as infarct-like myocarditis (80.56%), the others patients were present as heart failure-like (11.11%) and arrhythmia-like myocarditis (8.33%). At admission 27 (90%) pts had chest pain, 20 (66.7%) pts had ECG changes, 15 (50%) pts had symptoms of heart failure, 5 (16.7%) pts had arrhythmias. Amount of edema and fibrosis assessed by cardiovascular magnetic resonance (CMR) and echo correlate significantly. Classical and conventional parameters of LV systolic function, and deformation were not significantly different between groups. However, mechanical dispersion index (IMD) of global LS and systolic S were significantly different between groups (p < 0.05). Conclusion: Myocardial deformation imaging, like speckle tracking echocardiography, offers deeper insight into complex mechanical abnormalities during not only LV contraction but LV relaxation in longitudinal directions in patients with acute myocarditis. Infarct-like Arrhythmia-like Heart failure-like p EF (%) 57.5 ± 5.42 54.7 ± 12.9 58.3 ± 6.8 NS GLS endo (%) -20.8 ± 2.59 -19.78 ± 2.27 -17.36 ± 5.65 NS GLS (mid (%) -18.31 ± 2.4 -17.31 ± 1.52 -15.3 ± 5.10 NS GLS epi (%) -16.15 ± 2.28 -15.20 ± 0.92 -13.55 ± 4.68 NS IMD LS (ms) 37.04 ± 7.71 33.04 ± 6.58 60.75 ± 38.56 0.008 CS endo (%) -26.39 ± 6.93 -21.59 ± 3.88 -25.17 ± 6.48 NS CS mid (%) -17.32 ± 6.77 -13.03 ± 2.07 -15.95 ± 4.41 NS CS epi (%) -10.99 ± 6.89 -7.13 ± 0.72 -9.53 ± 2.73 NS IMD CS (ms) 47.69 ± 8.86 41.43 ± 23.92 41.01 ± 20.51 NS IMD SL peak S* 12.27 (21) 13.96 (4) 20.28 (84) 0.042 *Median and range values are presented.

Download Full-text

2D Speckle Tracking echocardiography in the prognostication of left ventricle diastolic dysfunction

Medical Visualization ◽

10.24835/1607-0763-2020-3-76-87 ◽

2020 ◽

Vol 24 (3) ◽

pp. 76-87

Author(s):

O. M. Zherko ◽

E. I. Shkrebneva

Keyword(s):

Left Ventricle ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Type Ii ◽

Dispersion Index ◽

Time To Peak ◽

Mechanical Dispersion ◽

Peak Longitudinal Strain ◽

2D Speckle Tracking

The aim of the study: to develop prediction comprehensive criteria for the diastolic dysfunction (DD) of the left ventricle (LV) according to 2D Speckle Tracking echocardiography (STE).Materials and methods. A clinical and instrumental study of 91 patients aged 64.0 was performed [58.0; 70.0] years in the Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology in 2019. Criteria for inclusion: sinus rhythm, essential arterial hypertension, chronic coronary artery disease, previous left myocardial infarction, after which at least six months have passed to stabilize the LV structural and functional parameters, chronic heart failure, patient informed consent. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or prosthetics, congenital heart defects, acute and chronic diseases of the kidneys, lungs. Transthoracic echocardiography and STE was performed on ultrasound machine Vivid E9 (GE Healthcare, USA).Results. The leading functional anomalies, interconnected in the development of LV DD, are decline of the LV longitudinal diastolic, regional and global systolic strain, LV mechanical dispersion and dyssynergy. Correlations between LV DD type II and the mechanical dispersion index (r = 0.69, p < 0.001), delta of LV time to peak longitudinal deformation (r = 0.66, p < 0.001), LV global post-systolic index (r = 0.58, p < 0.001), GLSAVG (r = 0.63, p < 0.001) were established. LV DD is characterized by early diastolic longitudinal strain E of the LV basal lateral segment > −6.75%, LV basal septal segment > −5.22%, early and late diastolic longitudinal strain ratio E/A of the LV basal lateral segment ≤0.91, basal-septal segment ≤0.69. LV DD type I is characterized by an LV mechanical dispersion index >49.34 ms, LV delta time to peak longitudinal strain >157 ms. Prognostic values for LV DD type II are LV mechanical dispersion index >49.34 ms, delta time to peak longitudinal strain is >136 ms, global post-systolic index >6.24%, mechanical dyssynergy index >4.60%, global LV peak longitudinal displacement ≤9.88 mm, GLSAVG > −18.5% (sensitivity 88.2%, specificity 83.3%).Conclusions. The use of the developed STE prediction value in practical public health will increase the efficiency of diagnosis of LV DD.

Download Full-text