scholarly journals The Importance of Calibration Method in Determining the Association between Central Blood Pressure with Left Ventricular and Left Atrial Strain.

2021 ◽  
Author(s):  
Satish Ramkumar ◽  
Hong Yang ◽  
Mark Nolan ◽  
Tomoko Negishi ◽  
James E Sharman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Myocardial Strain ◽  
Strain Analysis ◽  
Calibration Method ◽  
Left Ventricular ◽  
Central Blood Pressure ◽  
Lv Function ◽  
Left Atrial Strain ◽  
Calibration Methods ◽  
Atrial Strain

Abstract PurposeAfterload is an important determinant of left ventricular(LV) and atrial(LA) function, including myocardial strain. Central blood pressure(CBP) is the major component of cardiac afterload and independently associated with cardiovascular risk. However, the optimal means of calibrating CBP is unclear - standard CBP assessment uses systolic(SBP) and diastolic blood pressure(DBP) from brachial waveforms, but calibration with mean pressure(MAP) and DBP purports to be more accurate. Therefore, we sought to determine which CBP is best associated with LA and LV strain.MethodsCBP was measured using both standard and MAP based calibration methods in 546 participants(age 70.7±4.7 years, 45% male) with risk factors for heart failure. Echocardiography was performed in all patients and strain analysis conducted to assess LA/LV function. The associations of CBP with LA and LV strain were assessed using linear regression. ResultsMAP-derived CSBP(150±20mmHg) was higher than standard CSBP(128±15mmHg) and brachial SBP(140±17mmHg, p<0.001), whereas DBPs were similar(84±10, 83±10, and 82±10 mmHg). MAP-derived CSBP was not independently associated with LV strain(p>0.05), however was independently associated with LA reservoir strain(p<0.05). Brachial and central DBP were more strongly associated with LA reservoir/conduit and LV strain than brachial and central SBP. LA pump strain was not independently associated with any SBP or DBP parameter(p>0.05). MAP-derived CBP was more accurate in identifying patients with abnormal LA and LV strain than brachial SBP and standard CBP calibration. ConclusionCBP calibrated using MAP and DBP may be more accurate in identifying patients with abnormal LA and LV function than standard brachial calibration methods.

P5253Does regional myocardial strain by cardiac magnetic resonance feature tracking reflect scar in ischemic heart disease?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Stathogiannis ◽  
V Mor-Avi ◽  
R Lang ◽  
A R Patel
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Feature Tracking ◽  
Circumferential Strain ◽  
Myocardial Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Lv Function ◽  
Regional Strain ◽  
The Relationship

Abstract Background Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) is the gold standard for detection of myocardial scar. We hypothesized that CMR Feature Tracking (FT)-derived regional myocardial strain may reflect the presence of scar and could thus potentially be used instead of LGE imaging. Purpose The aim of this study was to determine the relationship between FT-derived regional myocardial strain and LGE in patients with coronary artery disease (CAD). Methods Seventy-five patients with CAD and typical ischemic LGE patterns on CMR (1.5T) were included (mean age 60±12 years, 70% males). Myocardial strain analysis and LGE identification were performed using dedicated commercial software. Scar was defined by presence of LGE in the same area of the myocardium in both short- and long-axis views. Peak systolic regional longitudinal and circumferential strain (RLS, RCS) values were calculated in the region of interest corresponding to the LGE area and also in a non-LGE myocardial region as a reference in each patient. These comparisons were repeated for a subgroup of 36 patients with left ventricular (LV) ejection fraction (EF) <40% to determine whether the relationship between strain and LGE holds in the presence of reduced LV function, when strain measurements may be altered as a reflection of reduced LVEF itself. Results Both global longitudinal and circumferential strain values were abnormal (−12.8±5.1% and −11.4±4.1%, respectively), reflecting LV dysfunction in this CAD cohort (EF = 40±16%). The magnitude of both RLS and RCS was significantly reduced in areas of LGE, compared to those without LGE: RLS −10.0±5.8% versus −20.4±7.5% (p<0.001); RCS −10.1±5.3±% versus −18.9±7.5%, respectively (p<0.001). Same pattern was noted in the reduced EF subgroup: RLS −8.0±4.7% versus −16.9±6.6% (p<0.001), RCS −7.7±4.3±% versus −16.0±7.9%, respectively (p<0.001). The figure depicts 2 representative cases in long and short axis views, LGE detection and concomitant regional strain analysis. LGE and regional strain analysis. Conclusion Reduced magnitude of regional longitudinal and circumferential strain by CMR-FT correlates with presence of LGE. Pending further validation, this finding may constitute the basis for detection of scar without contrast enhanced imaging, and would result in reduced cost, scan time and risk associated with gadolinium. Acknowledgement/Funding ARP: Research support (software) from Neosoft and Philips

Abstract 13086: Left Atrial Function in Adult With Normally Functioning Bicuspid Aortic Valves

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mingxing XIE ◽  
Deng Wenhui ◽  
Wang Jing
Keyword(s):  
Blood Pressure ◽  
Left Atrial ◽  
Clinical History ◽  
Stiffness Index ◽  
Lv Function ◽  
Sinus Of Valsalva ◽  
Left Atrial Strain ◽  
History Of ◽  
Atrial Strain ◽  
Left Atrial Dysfunction

Background: Bicuspid aortic valve is a complicated and heterogeneous disease that has aroused great interest in recent years. Traditionally the greatest attention during a routine echocardiography is paid to the function of the ventricles and aortopathy, much less is known about dysfunction the left atrium. The objective of this study was to characterize left atrial strain (LAS) and functions by two-dimensional speckle tracking echocardiography in adult BAV with normally functioning, and interrogate the risk factors. Methods: This is a prospective cohort study of 52 patients (age 40.23±11.29 years) and 33 healthy volunteers (aged 39.12±12.74 years) were recruited. All subjects included in both groups were in sinus rhythm and no clinical history of cardiovascular diseases. We mainly assessed left atrial reservoir, pump, and conduit function using 2D STE, then determined relationships among indices of segmental aortic stiffening, BAV cusp fusion pattern, LV diastolic function indices and LA deformation. Results: Without adjustment, the indices of LA functions in patients with BAV were significantly decreased compared with controls (LAS 49.41 ± 11.14 vs 59.48 ± 9.53, p<0.001, LAEF 71.56 ± 6.57 vs 76.36 ± 5.72, p=0.001; LAS-passive 29.43 ± 9.42 vs 36.67 ± 9.60, p=0.001, LAEF-passive 43.72 ± 10.78 vs 49.58 ± 6.80, p=0.003). However, after adjustment on age, gender, systolic blood pressure, diastolic blood pressure, BSA ,only the LAS was lowering (p<0.001). With or without adjustment, the ascending aorta of patients with BAV were still stiffer at each segment compared with controls. As parameters of LV diastolic functions, the E/e’ ratio (p=0.01) and e’ value (p=0.01) were significantly altered. The LA volume were increased in BAV patients (59.33 ± 19.12 vs 46.10 ± 9.73). In patients with BAV, LA functions, LV functions and segmental aortic stiffness were not influenced by the Sivere valve types. In multiple regression analysis, the stiffness at the sinus of Valsalva were independently correlated with LAS (adjust R 2 = 0.82, β = -0.33, p<0.001). Conclusion: Left atrial dysfunction is common in adult BAV with normally functioning. LA dysfunction is associated with stiffness index at the sinus of Valsalva, and is independent of LV function.

Phasic left atrial strain analysis to discriminate cardiac amyloidosis in patients with unclear thick heart pathology

2020 ◽  
Author(s):  
Anna Brand ◽  
David Frumkin ◽  
Anne Hübscher ◽  
Henryk Dreger ◽  
Karl Stangl ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Left Atrial ◽  
Cardiac Amyloidosis ◽  
Area Under The Curve ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Wall Thickening ◽  
Left Atrial Strain ◽  
Heart Pathology ◽  
Atrial Strain

Abstract Aims  Traditional echocardiographic parameters for the assessment of suspected cardiac amyloidosis (CA) are of limited diagnostic accuracy. We sought to explore differences and the discriminative value of phasic left atrial strain (LAS) reductions and of regional longitudinal left ventricular (LV) strain alterations (relative apical sparing; RELAPS) in CA and other causes of LV wall thickening (LVH). Methods and results  We included 54 patients with unclear LVH (mean septal diastolic wall thickness 17.8 ± 3.5 mm); CA was bioptically confirmed in 35 patients (8 mATTR, 6 wtATTR, 20 AL, and 1 AA amyloidosis) and LVH in 19 subjects. We analysed RELAPS as well as LA reservoir (LASr), conduit (LAScd), and contraction strain (LASct) using 2D speckle tracking echocardiography (EchoPAC software, GE). RELAPS was higher (1.37 ± 0.94 vs. 0.86 ± 0.29, P &lt; 0.007), whereas atrial mechanics were significantly reduced in CA (LASr, LAScd, and LASct: 9.7 ± 5.2%, −6.5 ± 3.5%, and −5.0 ± 4.1% in CA; and 22.7 ± 7.8%, −13.9 ± 5.2%, and −13.0 ± 5.5% in LVH, respectively; P &lt; 0.001 each). With an area under the curve (AUC) of 0.91 [95% confidence interval (CI) 0.82–0.99], LASr showed a higher diagnostic accuracy in discriminating CA than RELAPS (AUC 0.74, 95% CI 0.59–0.88). LASr and LAScd remained significantly associated with CA in a multivariate regression model. Conclusion  Phasic LAS was significantly reduced in patients with CA and showed a higher diagnostic accuracy in discriminating CA than RELAPS. The additional assessment of phasic LAS may be useful to rule in the possible diagnosis of CA in patients with unclear LVH.

P4372Left atrial strain: a potential marker of early diastolic dysfunction in patients with Marfan syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Garcia-Izquierdo Jaen ◽  
S Mingo Santos ◽  
M Torres Sanabria ◽  
V Monivas Palomero ◽  
S Moreno Casado ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ejection Fraction ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Left Atrial Strain ◽  
Strain And Strain Rate ◽  
Atrial Strain

Abstract Background/Introduction Previous studies using conventional echocardiographic measurements have reported subclinical left diastolic dysfunction in patients with Marfan syndrome (MFS). Left atrial strain (LAS) has been shown to be an accurate predictor of left ventricular diastolic dysfunction. However, there is no evidence regarding the use of LAS in MFS. Purpose To assess feasibility of LAS and compare LAS derived measurements along with traditional diastolic parameters in MFS patients vs healthy controls. Methods 46 MFS patients (normal LV ejection fraction, no previous cardiovascular surgery, no significant valvular regurgitation) vs. 20 healthy controls (age and sex-matched). We performed LAS analysis using 2D speckle-tracking (QLAB 10, Philips). LA strain was determined as the average value of the longitudinal deformation (7 segments) in the apical 4-chamber view (RR gating). Results LAS analysis was feasible in 40 MFS patients (87%). All participants had normal diastolic function according to current guidelines (ASE/EACVI 2016). MFS patients showed lower TDI e' velocities and higher average E/e' ratio, but still within normal range. Similarly, LVEF was normal but slightly reduced in MFS patients. LA strain and strain rate parameters during reservoir and conduit phase were significantly impaired in MFS patients compared to controls. MFS vs controls MFS patients (n=40) Controls (n=20) p MFS patients (n=40) Controls (n=20) p Age 33.8±12.4 34.4±8.3 0.846 Septal e' (cm/s) 9.7±2.5 11.7±2.3 0.006 Male (%) 24 (60%) 12 (60%) 1.000 Average E/e' ratio 6.8±1.5 5.5±1.1 0.002 SBP (mmHg) 120.3±12.4 120.1±9.4 0.969 TR velocity (cm/s) 208.6±21.4 201.6±22.9 0.390 DBP (mmHg) 72.0±10.1 67.1±6.2 0.069 LAVi (ml/m2) 23.5±7.1 25.5±4.8 0.260 Aortic root (mm) 40.3±4.6 31.7±3.7 <0.001 LASr (%) 32.6±8.8 43.0±8.3 <0.001 LVEF (%) 60.9±5.6 64.2±4.2 0.022 LAScd (%) −20.1±8.0 −29.4±5.5 <0.001 E-wave (cm/s) 74.6±16.5 76.7±16.5 0.651 LASct (%) −12.8±6.1 −13.6±5.2 0.622 A-wave (cm/s) 55.2±10.9 52.0±12.8 0.327 LASRr 2.02±0.49 2.31±0.43 0.030 E/A ratio 1.4±0.4 1.5±0.4 0.287 LASRcd −2.22±0.61 −3.07±0.68 <0.001 Lateral e' (cm/s) 13.0±3.6 16.3±3.3 0.002 LASRct −2.24±0.90 −2.35±0.75 0.600 SBP: Systolic blood pressure. DBP: Diastolic blood pressure. LVEF: Left ventricular ejection fraction. LAVi: Left atrial volume index. LAS: Left atrial strain. LASR: Left atrial strain rate. (r): Reservoir. (cd): Conduit. (ct): Contraction. Example of LA strain and strain rate Conclusion MFS patients showed a subtle impairment in diastolic function compared to controls. Although further evidence is needed, LAS derived parameters could be early markers of diastolic dysfunction in this group of patients. Acknowledgement/Funding Programa de Actividades de I+D de la Comunidad de Madrid

scholarly journals Left ventricular myocardial deformation assessment in asymptomatic patients with recently diagnosed sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Roman Panovský ◽  
Martina Doubková ◽  
Mary Luz Mojica-Pisciotti ◽  
Tomáš Holeček ◽  
Jan Máchal ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Demographic Data ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Radial Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Lv Function ◽  
Asymptomatic Patients

Abstract Background Sarcoidosis is a systemic granulomatous disease affecting different organs including the heart. Myocardial strain analysis could potentially detect the early stages of cardiac dysfunction in sarcoidosis patients. The present study aims to assess the use of cardiac magnetic resonance (CMR) strain analysis using feature tracking (FT) in the detection of early cardiac involvement in asymptomatic patients with sarcoidosis. Methods One hundred and thirteen CMR studies of patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis without pre-existing known cardiovascular disease were included in the study and analysed using FT and compared to 22 age and gender-matched controls. Global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) of the left ventricle (LV) were measured. Results The sarcoidosis patients did not significantly differ from the controls in basic demographic data and had normal global and regional systolic LV function—LV ejection fraction (EF) 66 ± 7% vs 65 ± 5% in the controls (p = NS). No statistically significant differences were found in all strain parameters between patients and controls: GLS (− 13.9 ± 3.1 vs. − 14.2 ± 2.5), GCS (− 23.4 ± 4.0 vs. − 22.2 ± 2.9) and GRS (53.4 ± 13.5 vs. 51.2 ± 13.6%) (p = NS). Conclusion Patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis had normal myocardial deformation measured by CMR-FT derived global strain

scholarly journals Left ventricular strain and left atrial strain are impaired during hemodialysis in children

2021 ◽  
Author(s):  
Tam T. Doan ◽  
Poyyapakkam Srivaths ◽  
Asela Liu ◽  
J. Kevin Wilkes ◽  
Alexandra Idrovo ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Ventricular ◽  
Left Atrial Strain ◽  
Left Ventricular Strain ◽  
Atrial Strain
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