scholarly journals Assessment of global longitudinal strain and plasma natriuretic peptide in patients with asymptomatic left ventricular dysfunction

Kardiologiia ◽  
2021 ◽  
Vol 61 (10) ◽  
pp. 53-60
Author(s):  
Ganchimeg Ulziisaikhan ◽  
Mungun-Ulzii Khurelbaatar ◽  
Chingerel Khorloo ◽  
Naranchimeg Sodovsuren ◽  
Altaisaikhan Khasag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Roc Curve ◽  
Longitudinal Strain ◽  
Troponin I ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Systolic Function

Objective    The purpose of this study was to investigate the association between global longitudinal strain (GLS) and plasma NT-proBNP for predicting left ventricular (LV) performance in asymptomatic patients after acute myocardial infarction (AMI).Material and methods    We prospectively included patients with diagnosis of AMI without clinical signs and symptoms of heart failure (HF) and followed these patients for 6 mos. Baseline echocardiography was performed at admission, and follow-up echocardiography was performed after 6 mos. A normal GLS was defined as having an absolute value of ≥16 %. According to the baseline GLS, participants were divided into two groups and compared. In all participants, blood samples of plasma NT-proBNP were obtained at admission, before discharge, and 6 mo after discharge.Results    The study population was consisted of 98 participants, of which 80 (81.6 %) were males, and the mean age was 56.0±9.3 years. Baseline echocardiography showed that most of the participants (60, 61.2 %) had abnormal GLS<16 %, whereas 38 (38.8 %) participants had normal or borderline GLS ≥16 %. Compared with the normal GLS group, participants with abnormal GLS had higher GRACE score, higher troponin I concentration, lower systolic blood pressure, lower mean LV ejection fraction, and decreased LV diastolic function. At 6‑mo follow-up, only LV systolic function remained significantly different between the two groups. Compared to baseline, there was a significant improvement of GLS in the abnormal GLS group at 6‑mo follow-up (p=0.04). Prevalence of complications after AMI was significantly higher in this group. There were significant differences between baseline and discharge NT-proBNP concentrations between the two groups (p<0.05). In the abnormal GLS group, there were significant correlations between baseline and discharge NT-proBNP concentrations with baseline LV systolic function. Discharge NT-proBNP concentration also correlated significantly with 6‑mo follow-up GLS. For determining the effect of baseline GLS abnormality, the areas under the ROC curve for baseline and discharge NT-proBNP concentrations were 0.73 (95 % CI 0.60–0.85, p=0.001) and 0.77 (95 % CI 0.66–0.87, p<0.001), respectively. Regarding early prediction of follow-up GLS abnormality, the area under the ROC curve for discharge NT-proBNP concentration was significantly higher 0.70 (95 % CI 0.55–0.84, p=0.016). The optimum cut-off value of discharge NT-pro-BNP was 688.5 pg / ml, with 72.4 % sensitivity and 65.4 % specificity to predict 6‑mon GLS abnormality following acute myocardial infarction.Conclusion    The main finding of this study is that impaired LV GLS is associated with elevated plasma concentrations of NT-proBNP in post-AMI patients. Pre-discharge NT-proBNP concentration combined with impaired initial GLS could predict worsening LV systolic function over time in asymptomatic post-AMI patients.

scholarly journals Prognostic impact of non-improvement of global longitudinal strain in patients with revascularized acute myocardial infarction

2021 ◽  
Author(s):  
Jan Erik Otterstad ◽  
Ingvild Billehaug Norum ◽  
Vidar Ruddox ◽  
An Chau Maria Le ◽  
Bjørn Bendz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Longitudinal Strain ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Ventricular Ejection Fraction

AbstractGlobal longitudinal strain (GLS) is a more sensitive prognostic factor than left ventricular ejection fraction (LVEF) in various cardiac diseases. Little is known about the clinical impact of GLS changes after acute myocardial infarction (AMI). The present study aimed to explore if non-improvement of GLS after 3 months was associated with higher risk of subsequent composite cardiovascular events (CCVE). Patients with AMI were consecutively included at a secondary care center in Norway between April 2016 and July 2018 within 4 days following percutaneous coronary intervention. Echocardiography was performed at baseline and after 3 months. Patients were categorized with non-improvement (0 to − 100%) or improvement (0 to 100%) in GLS relative to the baseline value. Among 214 patients with mean age 65 (± 10) years and mean LVEF 50% (± 8) at baseline, 50 (23%) had non-improvement (GLS: − 16.0% (± 3.7) to − 14.2% (± 3.6)) and 164 (77%) had improvement (GLS: − 14.0% (± 3.0) to − 16.9% (± 3.0%)). During a mean follow-up of 3.3 years (95% CI 3.2 to 3.4) 77 CCVE occurred in 52 patients. In adjusted Cox regression analyses, baseline GLS was associated with all recurrent CCVE (HR 1.1, 95% CI 1.0 to 1.2, p < 0.001) whereas non-improvement versus improvement over 3 months follow-up was not. Baseline GLS was significantly associated with the number of CCVE in revascularized AMI patients whereas non-improvement of GLS after 3 months was not. Further large-scale studies are needed before repeated GLS measurements may be recommended in clinical practice.Trial registration: Current Research information system in Norway (CRISTIN). Id: 506563

Impact of baseline feature tracking multi-detector row computed tomography-derived left ventricular global longitudinal strain on left ventricular functional recovery in TAVI patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Gegenava ◽  
P Bijl ◽  
M Vollema ◽  
F Kley ◽  
A Weger ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Functional Recovery ◽  
Feature Tracking ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Systolic Function

Abstract Background Advances in left ventricular (LV) analysis with dynamic multi-detector row computed tomography (MDCT) permit measurement of LV global longitudinal strain (GLS) and have shown their impact on risk stratification of patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Purpose To evaluate the influence of baseline feature tracking (FT) MDCT- derived LV GLS on LV functional recovery in severe AS patients undergoing TAVI. Methods A total of 194 patients with severe AS (50% male, 80±7 years) with dynamic MDCT data allowing LV GLS measurement with a novel FT algorithm and having complete echocardiography evaluation at baseline, at 3–6 months and at 1 year follow-up were evaluated. FT MDCT-derived LV GLS was measured at baseline and the study population was divided according to a cut-off value of MDCT LV GLS −14% (≤−14% [more preserved LV systolic function] vs. &gt;−14% [more impaired LV systolic function]). Results Transthoracic echocardiography (TTE)-derived Left ventricular ejection fraction (LVEF) increased over time in both groups: in patients with preserved and reduced MDCT LV GLS, and reached a higher value in patients with preserved MDCT LV GLS (52±7% at baseline, 55±7% at 3–6 months, 58±7% at 1 year follow-up vs. 43±10% at baseline, 49±10% at 3–6 months, 53±11% at 1 year follow-up; p=0.016) (Figure 1). TTE-derived LV GLS also showed greater improvement for patients with preserved MDCT LV GLS (−17±3% at baseline, −18±3% at 3–6 months, −20±3% at 1 year follow-up vs. −12±3% at baseline, −15±3% at 3–6 months, −16±3% at 1 year follow-up; p=0.027) (Figure 1). Conclusions In severe AS patients treated with TAVI, LV function improves significantly at 3–6 and at 12 months' follow-up and shows superior recovery in patients with more preserved baseline MDCT LV GLS, suggesting that MDCT-derived LV GLS has an important impact on LV functional recovery after TAVI. Funding Acknowledgement Type of funding source: None

scholarly journals Echocardiographic global longitudinal strain is associated with infarct size assessed by cardiac magnetic resonance in acute myocardial infarction

2019 ◽  
Vol 6 (4) ◽  
pp. 81-89
Author(s):  
Gowsini Joseph ◽  
Tomas Zaremba ◽  
Martin Berg Johansen ◽  
Sarah Ekeloef ◽  
Einar Heiberg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Longitudinal Strain ◽  
Early Stage ◽  
Global Longitudinal Strain ◽  
Apical Part ◽  
Left Ventricular ◽  
Percent Increase ◽  
Study Population

The aim of this study was to investigate if there was an association between infarct size (IS) measured by cardiac magnetic resonance (CMR) and echocardiographic global longitudinal strain (GLS) in the early stage of acute myocardial infarction in patients with preserved left ventricular ejection fraction (LVEF). Patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were assessed with CMR and transthoracic echocardiogram within 1 week of hospital admission. Two-dimensional speckle tracking was performed using a semi-automatic algorithm (EchoPac, GE Healthcare). Longitudinal strain curves were generated in a 17-segment model covering the entire left ventricular myocardium. GLS was calculated automatically. LVEF was measured by auto-LVEF in EchoPac. IS was measured by late gadolinium enhancement CMR in short-axis views covering the left ventricle. The study population consisted of 49 patients (age 60.4 ± 9.7 years; 92% male). The study population had preserved echocardiographic LVEF with a mean of 45.8 ± 8.7%. For each percent increase of IS, we found an impairment in GLS by 1.59% (95% CI 0.57–2.61), P = 0.02, after adjustment for sex, age and LVEF. No significant association between IS and echocardiographic LVEF was found: −0.25 (95% CI: −0.61 to 0.11), P = 0.51. At the segmental level, the strongest association between IS and longitudinal strain was found in the apical part of the LV: impairment of 1.69% (95% CI: 1.14–2.23), P < 0.001, for each percent increase in IS. In conclusion, GLS was significantly associated with IS in the early stage of acute myocardial infarction in patients with preserved LVEF, and this association was strongest in the apical part of the LV. No association between IS and LVEF was found.

scholarly journals Value of 3-dimensional speckle tracking echocardiography in the prediction of cardiovascular events in patients with hypertension complicated by acute myocardial infarction: a long-term follow-up study

2021 ◽  
Author(s):  
Xiaoyan Chen ◽  
Qingmei Yang ◽  
Jianxiu Fang ◽  
Haifeng Guo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Events ◽  
Global Longitudinal Strain ◽  
Three Dimensional ◽  
Radial Strain ◽  
Left Ventricular ◽  
Structural Function ◽  
3 Dimensional

Background Patients with hypertension complicated by acute myocardial infarction (AMI) have a poor prognosis. Identification of powerful predictors of recurring cardiovascular events (RCEs) is very important. This study sought to evaluate the predictive value of three-dimensional (3D) strain parameters for RCEs in patients with hypertension complicated by AMI. Methods We successfully followed up 62 patients with hypertension and AMI. Participants underwent three-dimensional echocardiography before, one week after, and one month after percutaneous coronary intervention (PCI). Left ventricular (LV) structural function parameters and three-dimensional strain parameters (3-dimensional global longitudinal strain (3D-GLS), 3-dimensional global circumferential strain (3D-GCS), 3-dimensional global radial strain (3D-GRS), and 3-dimensional global area strain (3D-GAS)) were acquired. We used a Cox model to determine the relationships between these parameters and RCEs. Results During follow-up (41.27±20.45 months), 20 patients (32.8%) had RCEs, which were independently predicted one month after PCI by 3D-GLS (HR: 1.481, 95%CI: 1.202-1.824) and 3D-GAS (HR: 1.254, 95%CI: 1.093-1.440). The optimal 3D-GLS and 3D-GAS cutoffs for predicting cardiac events were >-12.5% [area under the receiver operating characteristic curve (AUC) 0.736, 95%CI 0.611-0.862, P=0.003)] and >20.5% (AUC 0.685, 95%CI 0.551-0.818, P=0.020), respectively. Using logistic regression analysis, we constructed joint predictor=(3D-GLS)+(3D-GAS)×0.303/0.558, and its cutoff point was -22.36% (AUC 0.829, 95%CI 0.722-0.937, P<0.001). Conclusions 3D-GLS and 3D-GAS assessed one month after PCI can predict RCEs in patients with hypertension complicated by AMI. Additionally, the predicted value of (3D-GLS)+ (3D-GAS)×0.303/0.558 was higher than the predicted value of either parameter alone.

P1951Serial left ventricular global longitudinal strain and mortality in patients with Takotsubo cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Isaza ◽  
A Alashi ◽  
J Faulx ◽  
Z B Popovic ◽  
V Menon ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Takotsubo Cardiomyopathy ◽  
Longitudinal Strain ◽  
Troponin I ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Rank Statistic ◽  
Benign Condition ◽  
Kaplan Meier

Abstract Background Recent studies on Takotsubo cardiomyopathy (TC) have challenged the common conception that it is a relatively benign condition with functional recovery observed in the majority of cases. However, it is important to recognize that overt functional recovery might not reflect the true regional recovery, which might have an adverse impact on survival. Objective We sought to assess baseline and follow-up left ventricular function characteristics and their impact on longer-term mortality in patients presenting with documented Takotsubo cardiomyopathy (TC) at a tertiary centre. Methods 339 patients (66±14 years, 88% women) presented to our centre between 2006 and 2018 with acute anginal symptoms and were subsequently diagnosed with TC following clinical and angiographic evaluation. All patients returned for a follow-up evaluation including transthoracic echocardiography (TTE). Baseline and follow-up (3–6 months after TC diagnosis) LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS using velocity vector imaging) were recorded on TTE. The primary endpoint was longer-term mortality. Results Hypertension, dyslipidaemia, and diabetes were present in 71%, 56%, and 26% of patients. Baseline mean troponin I peak, LVEF and LV-GLS were 0.9±7 ng/ml, 36±9%, and 11±3%; respectively. 94% had baseline LVEF<50%, 272 (80%) had apical ballooning, and 94% had LV-GLS worse than −18%. No patient had angiographically obstructive coronary artery disease. At 3–6 months follow-up, mean LVEF, and LV-GLS improved to 57±9% and 16±3%, respectively. 87% of patients had LVEF >50%, but in 70% LV-GLS remained worse than −18%. After 3.3±3 years, 72 patients (21%) died. On multivariable Cox survival analysis (adjusted for age, gender, baseline troponin peak and follow up LVEF), follow up LV-GLS was independently associated with longer-term mortality (hazard ratio 1.12 [95% confidence interval 1.05, 1.20], p<0.001). Significantly more patients with follow up LV-GLS worse than −18% died vs. those with LV-GLS better than −18% (57/237 [24%] vs. 15/102 [15%], log-rank statistic p-value 0.01, Kaplan-Meier figure 1). Kaplan-Meier curve of freedom from death Conclusions In this large single-centre study of patients with documented TC (majority women), 87% recovered LVEF at 3–6 months, but in 70% LV-GLS remained worse than −18%, which was independently associated with higher longer-term mortality.

scholarly journals Significance of left ventricular global longitudinal strain assessment in patients with preserved ejection fraction after acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Luvsansuren ◽  
S Chimed
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Clinical Heart Failure

Abstract Background Depression of left ventricular function is common phenomenon after acute myocardial infarction and it's often associated with poor prognosis. However, substantial portion of patients with acute myocardial infarction had normal left ventricular function by assessment of left ventricular ejection fraction. Purpose In this study, we examined role of left ventricular global longitudinal strain assessment in patients who had normal ejection fraction after acute myocardial infarction. Methods We choose patients with acute myocardial infarction who were successfully treated with primary percutaneous coronary intervention (PCI). All of those patients had normal ejection fraction (EF≥55%) in routine echocardiographic examination within 3 days after acute myocardial infarction. Two dimensional speckle tracking echocardiography was used to assess left ventricular global longitudinal strain. Based on existence of newly onset clinical signs (pulmonary edema, lung crackles, peripherial edema etc.) of heart failure patients divided into case and control group. Patients who had other etiology or previous heart failure were excluded. Results A total of 153 patients with AMI were selected and newly onset heart failure is occurred in 20 patients. Left ventricular global strain was significantly different between patients with clinical heart failure and patients without clinical heart failure (−11.1±1.85% vs. −16.6±3.38%, p&lt;0.001). After adjustment of possible predictors of impaired left ventricular function such as, age, gender, hypertension, diabetes, previous coronary artery disease, cardiac troponin, mitral inflow EA ratio, deceleration time, left ventricular end diastolic volume, ejection fraction, mitral annulus EE' ratio and wall motion score index, global longitudinal strain was independent predictor of clinical heart failure (odds ratio 1.79, 95% CI 1.22–2.65, p=0.003). Adding global longitudinal strain into above mentioned predictors of clinical heart failure after acute myocardial infarction is associated with significantly increased c-statistic (0.93, 95% CI 0.87–0.99 vs. 0.97, 95% CI 0.94–0.99, p&lt;0.001). Conclusion Left ventricular global longitudinal strain is independently associated with clinical heart failure in patients with preserved ejection fraction after acute myocardial infarction. Adding global longitudinal strain parameter into screening model may increase rate of precise determination of clinical heart failure after acute myocardial infarction. Funding Acknowledgement Type of funding source: None

Abstract 3339: Effects of Atorvastatin 10 mg versus 40 mg in Eight Months Follow-up Coronary Flow Reserve and Clinical Events in Patients with Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Soon Jun Hong ◽  
Seung Cheol Choi ◽  
Jong Il Choi ◽  
Hyung Joon Joo ◽  
Seung Yong Shin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Systolic Function ◽  
Left Ventricular ◽  
Clinical Events ◽  
Flow Reserve ◽  
Cd34 Cells

Background: Circulating bone marrow-derived stem cells are capable of homing to sites of myocardial infarction and endothelial disruption, thereby restoring myocardial function and microvascular integrity after acute myocardial infarction. We compared the effects of atorvastatin 10 mg versus 40 mg in follow-up clinical events and in restoring coronary flow reserve (CFR) during the 8 months follow-up in patients with acute myocardial infarction. Methods: CFR, which is reflective of the integrity of coronary microvasculature, was measured by using intracoronary Doppler wire in 102 consecutive patients with acute myocardial infarction 5 days after the successful primary coronary intervention with sirolimus-eluting stents. Stented patients were randomly assigned to either atorvastatin 10 mg (ATOR10, n=52) or atorvastatin 40 mg (ATOR40, n=50). All patients received aspirin and clopidogrel. Clinical events such as death, myocardial infarction, and target lesion revascularization (TLR) were compared during the 8-month follow-up. Results: CFR increased significantly in both groups during the 8 months follow-up (1.9 ± 0.6 at baseline vs. 2.6 ± 0.7 at follow-up in the ATOR10, p<0.05; 1.9 ± 0.7 at baseline vs. 2.9 ± 0.8 at follow-up in the ATOR40, p<0.05). The changes from baseline in CFR was greater in the ATOR40 Group compared with the ATOR10 Group (1.0 ± 0.8 vs. 0.7 ± 0.6, p<0.05, respectively). The numbers of CD34+ and CXCR4+ cells were significantly greater in the ATOR40 Group compared with the ATOR10 Group (13 ± 10 vs. 6 ± 6, p<0.05, respectively for CD34 cells and 15 ± 14 vs. 10 ± 9, p<0.05, respectively for CXCR4+ cells per 1uL). Clinical events such as death (0 patient in the ATOR10 vs. 2 patients in the ATOR40, p=0.247), myocardial infarction (2 patients in the ATOR10 vs. 1 patient in the ATOR40, p=0.557), and TLR (2 patients in the ATOR10 vs. 2 patients in the ATOR40, p=0.692) demonstrated no significant differences during the follow-up. Conclusion: The increases from baseline in CFR, CD34+ cells and CXCR4+ cells were significantly greater in the ATOR40 Group compared with the ATOR10 Group. However, the improvement in left ventricular systolic function and the rate of clinical events revealed no significant differences between the 2 groups.

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