scholarly journals Impact of BMI z-score On Left Ventricular Mechanics in a Pediatric Population

2021 ◽  
Author(s):  
Justine Paysal ◽  
Etienne Merlin ◽  
Emmanuelle Rochette ◽  
Daniel Terral ◽  
Stephane Nottin
Keyword(s):  
Pediatric Population ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Female Adolescents ◽  
Lv Function ◽  
Z Score ◽  
Ventricular Mechanics ◽  
Lv Mass ◽  
Left Ventricular Mechanics ◽  
Longitudinal Strains

Abstract Background: Adolescent weight disorders ranging from anorexia nervosa (AN) to obesity (OB) can impact the heart by causing opposite alterations in its morphology, suggesting a direct impact of BMI on the heart. Cardiac function is relatively preserved as assessed by standard ultrasound methods. However, few studies have used speckle-tracking echocardiography (STE), which can detect subtle alterations of left ventricular (LV) function by evaluating deformations. The aim of this study was to assess the link between BMI z-score of female adolescents and myocardial function. Methods: Ninety-one female adolescents comprising 26 AN patient (age 14.6 ± 1.9 y), 28 OB patients (age 13.2 ± 1.4 y), and 37 controls (age 14.0 ± 2.0 y) underwent STE to assess LV morphology and myocardial regional deformations. Findings: The BMI z-score of our population ranged from −4.6 to 5.2. LV morphological remodeling was significantly and positively correlated with BMI z-score (R² = 0.456, p < 0.0001 for LV mass). Global longitudinal strain (LS) and regional LS recorded at the mid and apical levels were significantly correlated with BMI z-score (R² = 0.196, p = 0.0001 and R² = 0.274, p < 0.0001 respectively for apical and medial LS). Circumferential strains and twisting mechanics were not correlated with BMI z-score. Fibrinogen and SBP were the main variables explaining the alteration of longitudinal strains. Conclusion: A impact of BMI z-score on LV mechanics was observed especially on medial and apical LS. Neither circumferential nor twisting mechanics were altered by BMI z-score in female adolescents.

Abstract 12952: Global Longitudinal Strain is Simple, Effective & Sensitive Assessment of Cardiac Chamber Function in Patients With Acute-phase Myocarditis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shaun Khanna ◽  
Aditya Bhat ◽  
Henry H Chen ◽  
Kennith Gu ◽  
Gary Gan ◽  
...  
Keyword(s):  
Acute Phase ◽  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Disease Process ◽  
Left Ventricular ◽  
Lv Function ◽  
Lv Mass ◽  
Echocardiographic Parameters ◽  
Cardiac Therapy

Introduction: Myocarditis is an inflammatory disease process with growing clinical relevance in the current COVID-19 pandemic. Acute-phase myocarditis is known to result in subclinical changes in left ventricular (LV) function despite normal LV ejection fraction (LVEF), as assessed by myocardial deformation indices. The presence of right ventricular (RV) and left atrial (LA) subclinical dysfunction however has not been well described in current literature. Hypothesis: Myocarditis patients have subclinical impairment of LV, RV and LA function as assessed by global longitudinal strain (GLS) on speckle tracking echocardiography. Methods: Consecutive patients with clinical diagnosis of myocarditis admitted to our institution during 2013-2018 were assessed (n=76). Patients who did not meet appropriate diagnostic criteria (n=14), had impaired LVEF or prior cardiac disease (n=8) or poor transthoracic echocardiogram images (n=14) were excluded from analysis. Clinical and echocardiographic parameters were compared to age- , gender- and risk factor- matched controls. GLS was performed by two independent observers using vendor independent software (TomTec Arena, Germany v4.6). Results: The final cohort consisted 40 patients with myocarditis (age 44.3±16.7, 60% male) and 40 matched controls (44.5±16.6, 60% male). No significant differences in baseline clinical characteristics were observed between groups. No differences in LVEF, indexed LV mass, RV fractional area change, indexed LA volume or TR pressure gradient (p>0.05 for all) were demonstrated between the two groups. Patients with myocarditis had a lower mean LV strain (GLS%: -16.4±2.9 vs -19.7±2.7, p=0.0001), a lower mean RV Free Wall Strain (FWS) (GLS%: -22.1±4.1 vs -26.2±6.9, p=0.03) and a lower mean LA reservoir strain (GLS%: 27.5±4.6 vs. 33.7±6.3, p<0.0001) when compared to controls. Conclusions: Our results demonstrate the presence of significant subclinical global myocardial dysfunction despite normal traditional echocardiographic indices, in patients with acute-phase myocarditis. Routine assessment of GLS may identify such patients for early targeted cardiac therapy.

scholarly journals Assessment of left ventricular mechanics in right ventricular overload using in silico rat models

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
H Martinez-Navarro ◽  
E K S Espe ◽  
O O Odeigah ◽  
I Sjaastad ◽  
J Sundnes
Keyword(s):  
Cardiac Function ◽  
Circumferential Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
Public Institution ◽  
Lv Function ◽  
Passive Stiffness ◽  
Ventricular Mechanics ◽  
Longitudinal Strains ◽  
Rv Function

Abstract Background To preserve cardiac function in overload conditions, the RV adapts by developing muscular hypertrophy through progressive tissue remodelling. This process may lead to a vicious cycle with detrimental effects on RV diastolic and systolic function, as seen in pulmonary arterial hypertension (PAH) patients [1]. However, how RV overload affects LV function and remodelling remains an open question [2]. Computational models of cardiac physiology offer an opportunity for investigating mechanisms difficult or impossible to analyse otherwise due to the existence of overlapping factors and technical limitations. Aim This study aims to assess the acute effects of RV overload and increased myocardial passive stiffness on the LV mechanical properties in an anatomically-based computational model of healthy rat heart. Methods A computational simulation pipeline of cardiac mechanics based on the Holzapfel-Ogden model has been implemented using MR images from a healthy rat. Whereas LV function was modelled realistically using catheter measurements conducted on the same subject than the MR imaging, RV function was based on representative literature values for healthy and PAH rats with RV overload. The following cases were defined (Fig. 1): CTRL, with normal RV function; PAH1, with 30% increase in RV ESV (end-systolic volume) and 15% increase in RV ESP (end-systolic pressure) in comparison to CTRL; and PAH2, with 60% increase in RV ESV and 30% increase in RV ESP compared to CTRL. The cardiac cycle was simulated for all cases whilst fitting the experimentally measured LV pressure and volume values from a healthy rat, which allowed quantifying the effects of RV overload on LV function. Results The increase of average circumferential strain in the LV correlated with the degree of RV overload simulated (CTRL: −8.7%, PAH1: −8.9%, PAH2: −9.2%), whilst average radial (CTRL: 35.2%, PAH1: 34.8%, PAH2: 30.3%) and longitudinal strains decreased (CTRL: −7.7%, PAH1: −7.4%, PAH2: −6.6%), as seen in Fig.2. However, regional differences in strain were significant: under RV overload conditions, circumferential strain increased in the septum (−3.5% difference in PAH2 vs. CTRL) but lower values were observed in the lateral wall (+1.7% difference in PAH2 vs. CTRL). Cardiac function of case PAH2 was simulated also with increased myocardial passive stiffness (2.67 kPa instead of 1.34 kPa) which presented a mild strain increase in the mid LV ventricle in comparison to PAH2 with normal stiffness (circumferential strain: −0.8%, radial strain: +0.5%, longitudinal strain: −0.2%). Conclusion Our study provides mechanistic evidence on how RV overload and increased passive myocardial stiffness causes a redistribution of strain and fibre stress in the LV, which may play a significant role in LV remodelling and function. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): K.G. Jebsen Center for Cardiac Research Figure 1. Pressure – volume loops  Figure 2. Mean mid-LV strains

Effects of acute lung injury and anesthesia on left ventricular mechanics

1986 ◽  
Vol 251 (6) ◽  
pp. H1195-H1204 ◽  
Author(s):  
D. E. Hansen ◽  
K. M. Borow ◽  
A. Neumann ◽  
R. M. Lang ◽  
A. M. Fujii ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Mechanics ◽  
Wide Range ◽  
Left Ventricular Mechanics ◽  
Anesthetized Dogs ◽  
Time Dependent Effect

Traditional left ventricular (LV) function curves are frequently depressed in patients with acute lung injury. Similar findings in pentobarbital sodium-anesthetized dogs with oleic acid lung injury (OALI) have been observed. To test the hypothesis that acute OALI produces a significant injury to the heart, the LV mechanics of pentobarbital-anesthetized dogs with (n = 6) and without (n = 6) OALI were evaluated. End-systolic force-length and force-velocity relations determined echocardiographically during afterload manipulation with sodium nitroprusside demonstrated a marked deterioration in LV shortening characteristics over 90 min in both groups of pentobarbital-anesthetized dogs. In contrast, LV mechanics studied using the same protocol in fentanyl-anesthetized dogs were unchanged in both the injured (n = 6) and noninjured (n = 6) lung groups. Comparisons with data acquired over a wide range of LV afterload from six conscious, instrumented dogs showed that LV contractile state was normal to slightly increased with fentanyl and markedly depressed with pentobarbital. Diastolic properties, as assessed by end-diastolic pressure-dimension relations, were essentially unchanged in all anesthetized animals. We conclude that OALI has no effect on LV systolic or diastolic mechanics; the LV dysfunction attributed to OALI in previous studies is due to an acute, severe cardiomyopathy induced by pentobarbital; and unlike pentobarbital, anesthesia with fentanyl has no discernible time-dependent effect on LV mechanics. These findings have important implications for future studies of canine cardiovascular physiology employing anesthetized animal preparations.

scholarly journals Differential Changes of Left Ventricular Myocardial Deformation in Three-vessel Critical Stenosis CAD Patients with and without Diabetes: A Two-dimensional Speckle-tracking Echocardiography-based Study.

2021 ◽  
Author(s):  
luying jiang ◽  
jingbo liu ◽  
zhenjia yang ◽  
li wang ◽  
houjuan zuo
Keyword(s):  
Glucose Control ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Control Level ◽  
Left Ventricular ◽  
Lv Function ◽  
Two Dimensional ◽  
Longitudinal Strains

Abstract BackgroundThough the presence of three-vessel disease (3VD) coronary artery disease (CAD) among patients with type 2 diabetes mellitus (T2DM) is relatively common, very limited data is regarding their left ventricular (LV) function. The purpose of our study is to assess the LV function in 3VD patients with T2DM by two-dimensional speckle tracking echocardiography (2-D STE).MethodsHundred-three consecutive patients with confirmed 3VD CAD were enrolled and divided into two groups, 53 patients with DM and 50 patients without DM. The control group was composed of 30 age- and sex-matched healthy individuals. Echocardiography was performed at baseline before coronary angiography. The 2-D STE was used to measure LV global longitudinal strain (GLS) and segmental peak systolic longitudinal strains (PSLSs).ResultBy standard echocardiogram, there is no significant difference between 3VD-DM and 3VD-non-DM groups. Strains measured by 2-D STE showed that the 3VD-DM patients have significantly lower global longitudinal strain (GLS) than the 3VD-non-DM patients (15.87 ± 2.51 vs.17.56 ± 2.72, P < 0.05). Further, in the 3VD-DM groups, the duration of the DM and glucose control level were investigated. Our results showed that GLS of the duration of DM≥5 of 3VD was significantly lower than that in 3VD patients with duration of DM<5, especially in global PSLS (14.25 ± 2.31 vs. 16.65 ± 1.96, P=0.007), mid PSLS (14.08 ± 3.72 vs. 16.51 ± 2.15，P=0.017), and apical PSLS (15.26 ± 3.28 vs.18.44 ±4.36，p=0.049). However, the results of the glucose control level showed no difference on GLS between the 3VD patients with HbA1c ≥ 7% and HbA1c < 7%.ConclusionsGlobal and segmental peak systolic longitudinal strains (PSLSs) are significantly lower in 3VD-DM patients than in the patients with 3VD only. The duration of diabetes is an important factor cause the decrease GLS in 3VD-DM patients. However, the glucose control level has limited influence on LV function in 3VD patients.

scholarly journals Pregnancy-related changes in Doppler gradients and left ventricular mechanics in women with subvalvular or valvular aortic stenosis.

2021 ◽  
Author(s):  
Soohyun Chang ◽  
Parm Khakh ◽  
Mikyla Janzen ◽  
Marla Kiess ◽  
Valerie Rychel ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Control Group ◽  
Ventricular Mechanics ◽  
Healthy Pregnancy ◽  
Echocardiographic Evaluation ◽  
Left Ventricular Mechanics ◽  
Valvular Aortic Stenosis ◽  
The Relationship

Background: The aim of our study was to characterize echocardiographic changes during pregnancy in women with known LVOT obstruction or AS compared to the healthy pregnancy controls, and to assess the relationship with pregnancy outcomes. Methods: We retrospectively studied 34 pregnant patients with congenital LVOT obstruction or AS with healthy age-matched pregnant controls. Patients with other significant valvular lesions, structural heart disease (LVEF <40%), or prior valve surgery were excluded. All LVOTO/AS patients underwent a minimum of 2 consecutive echocardiograms between 1 year pre-conception up to 1 year postpartum, with at least 2 studies during the pregnancy. Comprehensive echocardiographic evaluation was performed including speckle-tracking LV global longitudinal strain. Results: A total of 83 echocardiograms from the study group and 34 echocardiograms from the control group were evaluated. Over the range of LVOTO/AS, a significantly greater increase in the AV gradients and LV and LA volumes were observed as compared with the controls. In the sub-group of LVOTO/AS pregnant women with > moderate (n=8) vs.

scholarly journals Global longitudinal strain in chronic asymptomatic aortic regurgitation: systematic review

2020 ◽  
Vol 7 (3) ◽  
pp. 39-48
Author(s):  
Diana deCampos ◽  
Rogério Teixeira ◽  
Carolina Saleiro ◽  
Ana Botelho ◽  
Lino Gonçalves
Keyword(s):  
Systematic Review ◽  
Disease Progression ◽  
Aortic Regurgitation ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Ventricular Mechanics ◽  
Left Ventricular Mechanics ◽  
Long Time ◽  
Chronic Aortic Regurgitation

Chronic aortic regurgitation (AR) patients typically remain asymptomatic for a long time. Left ventricular mechanics, namely global longitudinal strain (GLS), has been associated with outcomes in AR patients. The authors conducted a systematic review to summarize and appraise GLS impact on mortality, the need for aortic valve replacement (AVR) and disease progression in AR patients. A literature search was performed using these key terms ‘aortic regurgitation’ and ‘longitudinal strain’ looking at all randomized and nonrandomized studies conducted on chronic aortic regurgitation. The search yielded six observational studies published from 2011 and 2018 with a total of 1571 patients with moderate to severe chronic AR. Only two studies included all-cause mortality as their endpoint. The other studies looked at the association between GLS with AVR and disease progression. The mean follow-up period was 4.2 years. We noted a great variability of clinical, methodological and/or statistical origin. Thus, meta-analytic portion of our study was limited. Despite a relevant heterogeneity, an impaired GLS was associated with adverse cardiac outcomes. Left ventricular GLS may offer incremental value in risk stratification and decision-making.

scholarly journals Oxidative Stress State Is Associated with Left Ventricular Mechanics Changes, Measured by Speckle Tracking in Essential Hypertensive Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Luis Antonio Moreno-Ruíz ◽  
David Ibarra-Quevedo ◽  
Erika Rodríguez-Martínez ◽  
Perla D. Maldonado ◽  
Benito Sarabia-Ortega ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Stress State ◽  
Diastolic Pressure ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Sod Activity ◽  
Hypertensive Patients ◽  
Oxidized Proteins ◽  
Ventricular Mechanics ◽  
Left Ventricular Mechanics

The oxidative stress state is characterized by an increase in oxygen reactive species that overwhelms the antioxidant defense; we do not know if these pathological changes are correlated with alterations in left ventricular mechanics. The aim was correlating the oxidative stress state with the left ventricular global longitudinal strain (GLS) and the left ventricular end diastolic pressure (LVEDP). Twenty-five patients with essential hypertension and 25 controls paired by age and gender were studied. All of the participants were subjected to echocardiography and biochemical determination of oxidative stress markers. The hypertensive patients, compared with control subjects, had significantly (p<0.05) higher levels of oxidized proteins (5.03±1.05versus4.06±0.63 nmol/mg), lower levels of extracellular superoxide dismutase (EC-SOD) activity (0.045±0.02versus0.082±0.02 U/mg), higher LVEDP (16.2±4.5versus11.3±1.6 mm Hg), and lower GLS (−12% versus −16%). Both groups had preserved ejection fraction and the results showed a positive correlation of oxidized proteins with GLS (r=0.386,p=0.006) and LVEDP (r=0.389,p=0.005); we also found a negative correlation of EC-SOD activity with GLS (r=-0.404,p=0.004) and LVEDP (r=-0.347,p=0.014).

LV replacement fibrosis in aortic stenosis: prevalence and relation to LV remodelling and function

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Sa Mendes ◽  
J Abecasis ◽  
A Ferreira ◽  
R Ribeiras ◽  
C Saraiva ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Low Flow ◽  
Lv Function ◽  
Aortic Valve Area ◽  
High Gradient ◽  
Lv Mass ◽  
Replacement Fibrosis

Abstract Background Progressive myocardial fibrosis takes part in left ventricular (LV) remodeling in aortic stenosis (AS) and drives the transition from hypertrophy to heart failure. Replacement fibrosis may be characterized by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). Aim To assess the prevalence and association between LGE and indexes of LV function in patients with severe aortic stenosis. Methods We prospectively studied 53 consecutive patients (age: 71±8 years [min. 51–max. 84], 54.7% men) with severe symptomatic AS, referred for surgical aortic valve replacement with no previous history of ischemic cardiomyopathy. Aortic valve mean gradient was 54.6 mmHg [IQR 46.6–63.2] and aortic valve area 0.74cm2 [IQR 0.61–0.89]; all patients with high gradient, 4 with low-flow. CMR with tissue characterization (T1 mapping, LGE and extracellular volume by ECV quantification – using 5SD from remote myocardium as signal intensity cut-off), was performed before surgery. AS severity indexes, LV mass, systolic and diastolic LV function indexes including global longitudinal strain (GLS) and torsion were compared in both groups of patients, with and without LGE. Results Mid-wall LGE was present in 36 patients (67.9%) with a median fraction of 6.0% [IQR 4.9–12.7%] of LV mass. Native T1 value and ECV were within normal ranges (median values: 1047ms [IQR 1028–1084]; 22% [IQR 18–25], respectively). Median CMR LV ejection fraction and mass were 64.5% [IQR 51.3–70.8%] (11 patients with reduced EF) and 76.5g/m2 [IQR 57.4–94.8g/m2], respectively. Median GLS was −13.9% [IQR −11.4 to −17.0%] and torsion was 24.2° [IQR 19.8–32.5°]. Patients with LGE had significantly higher LV mass (87.1g/m2 vs 63.3 g/m2, p=0.001), worse GLS (−14.4% vs −16.9%, p=0.041) and higher NT-proBNP values (1333.7ng/mL vs 559.9ng/mL, p=0.004) (Figure). Conclusions Non-ischemic LGE is common in this group of patients with severe symptomatic high gradient aortic stenosis. As it is more prevalent in patients with more pronounced LVH, lower longitudinal deformation and higher NT-proBNP values, it probably represents a more advanced stage of the disease. Funding Acknowledgement Type of funding source: None

Urine Albumin to Creatinine Ratio and Echocardiographic Left Ventricular Structure and Function in Patients with Essential Hypertension

2011 ◽  
Vol 9 (2) ◽  
pp. 90 ◽  
Author(s):  
Rohola Hemmati ◽  
Mojgan Gharipour ◽  
Hasan Shemirani ◽  
Alireza Khosravi ◽  
Elham Khosravi ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Lv Function ◽  
Creatinine Ratio ◽  
Uncomplicated Hypertension ◽  
Urine Albumin ◽  
Lv Dysfunction ◽  
Mitral Annulus Velocity ◽  
Lv Mass

Background:Appearance of microalbuminuria, particularly in patients with hypertension, might be associated with a higher prevalence of left ventricular (LV) dysfunction and geometric abnormalities. This study was undertaken to determine whether high urine albumin to creatinine ratio (UACR) as a sensitive marker for microalbuminuria can be associated with LV hypertrophy (LVH) and systolic and diastolic LV dysfunction.Methods:The study population consisted of 125 consecutive patients with essential uncomplicated hypertension. Urine albumin and creatinine concentration was determined by standard methods. LVH was defined as a LV mass index >100 g/m2 of body surface area in women and >130 g/m2 in men. Echocardiographic LV systolic and diastolic parameters were measured.Results:The prevalence of microalbuminuria in patients with essential hypertension was 5.6 %. UACR was significantly no different in patients with LVH than in patients with normal LV geometry (21.26 ± 31.55 versus 17.80 ± 24.52 mg/mmol). No significant correlation was found between UACR measurement and systolic and diastolic function parameters, including early to late diastolic peak velocity (E/A) ratio (R=-0.192, p=0.038), early diastolic peak velocity to early mitral annulus velocity (E/E') ratio (R=-0.025, p=0.794), LV ejection fraction (R=0.008, p=0.929), and LV mass (R=-0.132, p=0.154). According to the receiver operator characteristic (ROC) curve analysis, UACR measurement was not an acceptable indicator of LVH with areas under the ROC curves 0.514 (95 % confidence interval 0.394–0.634). The optimal cut-off value for UACR for predicting LVH was identified at 9.4, yielding a sensitivity of 51.6 % and a specificity of 48.3 %.Conclusion:In patients with uncomplicated essential hypertension, abnormal systolic and diastolic LV function and geometry cannot be effectively predicted by the appearance of microalbuminuria.

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