Preserved Cerebral Oxygenation with Worsening Global Myocardial Strain during Pediatric Chronic Hemodialysis

2021 ◽  
pp. ASN.2021020193
Author(s):  
Alexandra Idrovo ◽  
Ricardo Pignatelli ◽  
Robert Loar ◽  
Asela Nieuwsma ◽  
Jessica Geer ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Blood Volume ◽  
Volume Change ◽  
Pediatric Patients ◽  
Cerebral Oxygenation ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Chronic Hemodialysis ◽  
Intermittent Hemodialysis ◽  
Pediatric Hemodialysis

Background Cerebral and myocardial hypoperfusion occur during hemodialysis in adults. Pediatric patients receiving chronic hemodialysis have fewer cardiovascular risk factors, yet cardiovascular morbidity remains prominent. Methods We conducted a prospective observational study of pediatric patients receiving chronic hemodialysis to investigate whether intermittent hemodialysis is associated with adverse end organ effects in the heart or with cerebral oxygenation (regional O2 saturation [rSO2]). We assessed intradialytic cardiovascular function and rSO2, using noninvasive echocardiography to determine myocardial strain and continuous noninvasive nearinfrared spectroscopy for rSO2. We measured changes in blood volume and central venous oxygen saturation (mCVO2) were pre-, mid-, and post-hemodialysis. Results The study included 15 patients (median age, 12 years; median hemodialysis vintage 13.2 [9, 24] months were included. Patients were asymptomatic. The rSO2 did not change during hemodialysis, whereas mCVO2 decreased significantly, from 73% to 64.8 %. Global longitudinal strain of the myocardium worsened significantly by mid-hemodialysis and persisted post-hemodialysis. The ejection fraction remained normal. Lower systolic blood pressure and faster blood volume change were associated with worsening myocardial strain; only blood volume change was significant in multivariate analysis (β coefficient, -0.3; 95% confidence interval [95% CI], −0.38 to −0.21; P=0.0001). Blood volume change was also associated with a significant decrease in mCVO2 (β coefficient 0.42; 95% CI, 0.07 to 0.76; P=0.001). Access, age, hemodialysis vintage, and ultrafiltration volume were not associated with worsening strain. Conclusion s Unchanged rSO2 suggested that cerebral oxygenation was maintained during hemodialysis. However, despite maintained ejection fraction, intradialytic myocardial strain worsened in pediatric hemodialysis and was associated with blood volume change. The effect of hemodialysis on individual organ perfusion in pediatric versus adult patients receiving hemodialysis might differ.

scholarly journals Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ke Shi ◽  
Meng-Xi Yang ◽  
Shan Huang ◽  
Wei-Feng Yan ◽  
Wen-Lei Qian ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Estrogen Deficiency ◽  
Cine Mri ◽  
Contractile Dysfunction ◽  
Preserved Ejection Fraction

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with sex-specific pathophysiology. Estrogen deficiency is believed to be responsible for the development of HFpEF in women. However, estrogen deficiency does not seem to be completely responsible for the differences in HFpEF prevalence between sexes. While diabetes mellitus (DM) frequently coexists with HFpEF in women and is associated with worse outcomes, the changes in myocardial contractility among women with HFpEF and the DM phenotype is yet unknown. Therefore, we aimed to investigate sex-related differences in left ventricular (LV) contractility dysfunction in HFpEF comorbid with DM. Methods A total of 224 patients who underwent cardiac cine MRI were included in this study. Sex-specific differences in LV structure and function in the context of DM were determined. LV systolic strains (global longitudinal strain [GLS], circumferential strain [GCS] and radial strain [GRS]) were measured using cine MRI. The determinants of impaired myocardial strain for women and men were assessed. Results The prevalence of DM did not differ between sexes (p > 0.05). Despite a similar LV ejection fraction, women with DM demonstrated a greater LV mass index than women without DM (p = 0.023). The prevalence of LV geometry patterns by sex did not differ in the non-DM subgroup, but there was a trend toward a more abnormal LV geometry in women with DM (p = 0.072). The magnitudes of systolic strains were similar between sexes in the non-DM group (p > 0.05). Nevertheless, in the DM subgroup, there was significant impairment in women in systolic strains compared with men (p < 0.05). In the multivariable analysis, DM was associated with impaired systolic strains in women (GLS [β = 0.26; p = 0.007], GCS [β = 0.31; p < 0.001], and GRS [β = −0.24; p = 0.016]), whereas obesity and coronary artery disease were associated with impaired systolic strains in men (p < 0.05). Conclusions Women with DM demonstrated greater LV contractile dysfunction, which indicates that women with HFpEF comorbid with DM have a high-risk phenotype of cardiac failure that may require more aggressive and personalized medical treatment.

P2738Prognosis of the systemic right ventricle further refined: a role for myocardial strain analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O I Woudstra ◽  
A C Van Dissel ◽  
T Van Der Bom ◽  
H A C M De Bruin - Bon ◽  
J P Van Melle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Predictive Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Prospective Trial ◽  
Free Survival ◽  
Systemic Right Ventricle

Abstract Background Predicting heart failure in patients a with systemic right ventricle (sRV) due to transposition of the great arteries (TGA) is difficult. Strain parameters are easily available and detect early myocardial damage. Purpose To determine the value of strain parameters compared to cardiovascular magnetic resonance (CMR) derived parameters as predictors for heart failure-free survival in patients with an sRV. Methods In participants of a multicenter prospective trial, global longitudinal strain (GLS) was assessed on echocardiography using speckle tracking. Cox regression was used to determine the association of sRV GLS and postsystolic shortening, defined as >20% of myocardial contraction appearing after aortic valve closure, with the combined endpoint of progression of heart failure and death, compared to CMR derived parameters. Results Echocardiograms of 61/88 participants could be analyzed (age 34±11 years, 66% male, 34% congenitally corrected TGA). Mean GLS was −13.5±2.9% and 13 (21%) patients had postsystolic shortening. During 8 [7–9] years, 15 (23%) patients met the composite endpoint. sRV ejection fraction (mean 39±9%, HR=0.93/% [95% CI 0.87–0.99]), sRV end systolic volume (mean 80±31 ml/m2, HR=1.19 per 10ml/m2 [95% CI 1.01–1.40]), GLS (HR=1.25/% [95% CI 1.01–1.54]) and postsystolic shortening (HR=4.10 [95% CI 1.48–11.37]) were all associated with heart failure-free survival in univariable analysis. Optimal cut-offs for sRV ejection fraction and GLS were 30% and −10.5%, respectively, with comparable predictive value for heart failure-free survival (iAUC=0.66 and iAUC=0.68). Patients with both decreased strain (>−10.5%) and decreased RVEF (<30%) were at highest risk for heart failure and death (HR=19.83 [95% CI 4.92–80.01], iAUC=0.73). Predicted heart failure-free survival Conclusion The predictive value of global longitudinal strain is comparable to CMR derived ejection fraction. Patients with both low ejection fraction and low myocardial strain are at highest risk of heart failure and death. These easily available parameters should be integrated in future risk prediction scores and can be used in the clinic to guide follow-up intensity. Acknowledgement/Funding This work was supported by the Dutch Heart Foundation [CVON 2014-18 project CONCOR-genes]

scholarly journals Myocardial Strain and Association With Clinical Outcomes in Danon Disease: A Model for Monitoring Progression of Genetic Cardiomyopathies

2021 ◽  
Author(s):  
Quan M. Bui ◽  
Kimberly N. Hong ◽  
Megan Kraushaar ◽  
Gary S. Ma ◽  
Michela Brambatti ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Clinical Outcomes ◽  
False Positive Rate ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Composite Outcome ◽  
Characteristic Analysis ◽  
Danon Disease ◽  
Positive Rate

Background Myocardial strain can identify subclinical left ventricular dysfunction in various cardiac diseases, but its association with clinical outcomes in genetic cardiomyopathies remains unknown. Herein, we assessed myocardial strain in patients with Danon disease (DD), a rare X‐linked autophagic disorder that causes severe cardiac manifestations. Methods and Results Echocardiographic images were reviewed and used to calculate myocardial strain from a retrospective, international registry of patients with DD. Regression analyses were performed to evaluate for an association of global longitudinal strain (GLS) and ejection fraction with the composite outcome (death, ventricular assist device, heart transplantation, and implantable cardioverter defibrillator for secondary prevention). A total of 22 patients with DD (male 14 [63.6%], median age 16.5 years) had sufficient echocardiograms for analysis. Absolute GLS was reduced with a mean of 12.2% with an apical‐sparing pattern observed. Univariable regression for GLS and composite outcome showed an odds ratio of 1.32 (95% CI, 1.02–1.71) with P =0.03. For receiver operating characteristic analysis, the areas under the curve for GLS and ejection fraction were 0.810 ( P =0.02) and 0.605 ( P =0.44), respectively. An absolute GLS cutoff of 10.0% yielded a true positive rate of 85.7% and false positive rate of 13.3%. Conclusions In this cohort of patients with DD, GLS may be a useful assessment of myocardial function and may predict clinical outcomes. This study highlights the potential use of myocardial strain phenotyping to monitor disease progression and potentially to predict clinical outcomes in DD and other genetic cardiomyopathies.

scholarly journals P307 Trajectories of Myocardial Strain Across the Spectrum of Aortic Stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Alfuhied ◽  
M Alfarih ◽  
P Kumar M ◽  
G Captur ◽  
P Nihoyannopoulos
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Circumferential Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
P Value ◽  
Global Circumferential Strain ◽  
Significant Difference

Abstract Introduction Optimal timing of intervention in aortic stenosis (AS) is key. Left ventricular deformation parameters are sensitive markers of myocardial wellbeing in AS, but data is sparse so strain does not currently feature in the clinical decision-making process governing timing of AS intervention. We explore the trajectory of myocardial strain in AS of varying severity to potentially identify the most sensitive periods for valve intervention. Methods 50 patients from across the spectrum of isolated AS were prospectively recruited: mild AS n = 10; moderate AS n = 10; and severe AS n = 30 of which n = 10 in each of 3 ejection fraction (EF) groups: EF &gt; 50%, EF = 40-49% and EF &lt; 35%. Longitudinal, circumferential, and radial strain were measured by speckle tracking echocardiography (STE) using TomTec software. Results Strain parameters and EF were not significantly different between mild and moderate AS groups but almost all parameters (except for global circumferential strain (GCS)) showed significant deterioration with progression to severe AS, even in spite of preserved EF (&gt;50%; Table1). In patients with severe AS, strain parameters showed no significant differences between hearts with EF &gt; 50% and EF 40-49%, but they continued to deteriorate significantly (p &lt; 0.05) as hearts transitioned from 40-49% to &lt;35% (Figure 1, a&b). Conclusion The heart can maintain its deformation and global systolic function throughout mild and moderate AS but strain deteriorates significantly in severe AS, irrespective of EF. Tracking the precise timings of strain deterioration in severe AS could help refine optimal timings of AS intervention. LVEF and strain in varying AS severity Left ventricle ejection fraction and strain values in varying severity of AS Mild (n = 10) Moderate (n = 10) Severe (n = 10) P-value Mean (SD) Mean (SD) Mean (SD) EF (%) 65.4 (6.1) 65.8 (9.0) 60.4 (3.6)*§ 0.15 GLS (%) -14.2 (2.1) -13.6 (2.3) -11.8 (2.9)* 0.09 GCS (%) -30.3 (9.1) -31.0 (11.4) -26.5 (8.2) 0.55 GRS (%) 55.9 (15.5) 52.6 (24.0) 35.9 (13.5)*§ 0.05 EF: ejection fraction; GLS: global longitudinal strain; GCS: global circumferential strain; GRS: global radial strain; SD: standard deviation. Severe (n = 10): Severe AS with preserved EF &gt;50%. P-value: ANOVA-single factor; comparison in-between groups was performed using unpaired t-test (parametric) and Mann Whitney test (non-parametric). *significant difference P &lt; 0.05 mild vs severe. §significant difference P &lt; 0.05 moderate vs severe. Abstract P307 Figure.

Faster rate of blood volume change in pediatric hemodialysis patients impairs cardiac index

2016 ◽  
Vol 32 (2) ◽  
pp. 341-345 ◽  
Author(s):  
Jessica J. Geer ◽  
Shweta Shah ◽  
Eric Williams ◽  
Ayse Akcan Arikan ◽  
Poyyapakkam Srivaths
Keyword(s):  
Cardiac Index ◽  
Blood Volume ◽  
Volume Change ◽  
Hemodialysis Patients ◽  
Pediatric Hemodialysis

scholarly journals Predictive values of multiple non-invasive markers for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yumin Li ◽  
Jia Liu ◽  
Yukun Cao ◽  
Xiaoyu Han ◽  
Guozhu Shao ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
Troponin I ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Predictive Values ◽  
Non Invasive ◽  
Potential Biomarker

AbstractMyocardial fibrosis assessed by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) is associated with cardiovascular outcomes in hypertrophic cardiomyopathy (HCM) patients, but little is known about the utility of non-invasive markers for detecting LGE. This study aims to explore the association between cardiac-specific biomarkers, CMR myocardial strain, left ventricular (LV) hypertrophy and LGE in HCM patients with preserved ejection fraction (EF) and investigate the predictive values of these indexes for LGE. We recruited 33 healthy volunteers and 86 HCM patients with preserved EF to undergo contrast-enhanced CMR examinations. In total, 48 of 86 HCM patients had the presence of LGE. The LGE-positive patients had significant higher serum high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro b-type natriuretic peptide (Nt-proBNP) levels and lower global longitudinal (GLS) and circumferential (GCS) strains than the LGE-negative group. The LGE% was independently associated with the Nt-proBNP levels, GCS, LV end-diastolic maximum wall thickness (MWT) and beta-blocker treatment. In the receiver operating characteristic curve analysis, the combined parameters of Nt-proBNP ≥ 108.00 pg/mL and MWT ≥ 17.30 mm had good diagnostic performance for LGE, with a specificity of 81.25% and sensitivity of 70.00%. These data indicate that serum Nt-proBNP is a potential biomarker associated with LGE% and, combined with MWT, were useful for identifying myocardial fibrosis in HCM patients with preserved EF. Additionally, LV GCS may be a more sensitive indicator for reflecting the presence of myocardial fibrosis than GLS.

scholarly journals Pharmacokinetics of Vancomycin in Pediatric Patients Receiving Intermittent Hemodialysis or Hemodiafiltration

2021 ◽  
Vol 6 (4) ◽  
pp. 1003-1014
Author(s):  
Erin Chung ◽  
James A. Tjon ◽  
Rosaleen M. Nemec ◽  
Nadya Nalli ◽  
Elizabeth A. Harvey ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Intermittent Hemodialysis
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