Non-invasive assessment of left ventricular myocardial work in healthy subjects with echocardiography

2020 ◽  
Vol 1 (14) ◽  
pp. 45-52
Author(s):  
M. N. Alekhin ◽  
S. I. Ivanov ◽  
A. I. Stepanova
Keyword(s):  
Blood Pressure ◽  
Healthy Subjects ◽  
Global Longitudinal Strain ◽  
Negative Relationship ◽  
Left Ventricular ◽  
Healthy Individuals ◽  
Men And Women ◽  
Mean Values ◽  
Non Invasive ◽  
Constructive Work

Purpose: to evaluate the left ventricular (LV) echocardiographic indices of myocardial work using the LV pressure-strain loops method in healthy individuals.Material and methods. The study included 50 healthy subjects (28 men, mean age: 44 ± 14 years). The inclusion criteria were the absence of any cardiovascular diseases and diabetes mellitus. After calculating global longitudinal strain (GLS) from speckle-tracking Echo and inserting values of brachial artery cuff blood pressure (BP), the vendor-specific module constructed non-invasive LV pressure-strain loops. The following parameters were calculated: global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE).Results. The lowest values of GWI in men and women were 1382 mmHg% and 1821 mmHg%, the highest values were 2875 mmHg% and 2589 mmHg%, mean values were 2056 ± 326 mmHg% and 2109 ± 200 mmHg%, respectively. Mean values of GCW were 2292 ± 329 mmHg% in men and 2304 ± 211 mmHg% in women. The median and the highest value of GWW were 66 mmHg% and 313 mmHg% in men and 79,5 mmHg% and 172 mmHg% in women, respectively. The lowest value of GWE were 89% in men and 91% in women. GWI was significantly and naturally correlated only with systolic BP (r = 0,30, р = 0,03) and GLS (r = -0,72, р < 0,001). GCW was significantly correlated with systolic BP (r = 0,36, р = 0,01) and GLS (r = -0,72, р < 0,001) too, however, the negative relationship with the age of the patients was found (r = -0,27, р = 0,04). LV myocardial work indices did not significantly differ between men and women. Coefficients of variation for GWI, GCW and GWE did not exceed 10%, which is typical for good reproducible indices.Conclusion. The study presents values of the echocardiographic LV myocardial work indices, obtained with help of the LV pressure-strain loops method in healthy individuals. The natural correlation of LV myocardial work indices with strain and blood pressure was demonstrated, as well as a dependence on the age of the subjects and good reproducibility.

scholarly journals P322 Dynamic changes of left ventricular cardiac mechanics in takotsubo syndrome: a preliminary study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Prota ◽  
M Bellino ◽  
M Pucci ◽  
D Ferraioli ◽  
I Radano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Adverse Events ◽  
Cardiac Mechanics ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Dynamic Changes ◽  
Non Invasive ◽  
Constructive Work

Abstract Background Takotsubo syndrome (TTS) is a transient left ventricular (LV) heart failure due to a reversible systolic dysfunction, usually recovering within days or weeks. Purpose To assess the dynamic changes of LV cardiac mechanics in a small cohort of TTS patients through the estimation of myocardial work, a newly developed non-invasive approach which allows correction of global longitudinal strain (GLS) for systolic blood pressure. Methods Twenty-four patients (mean age, 63.8 ± 8.4 yy; all female) with TTS diagnosis were retrospectively enrolled. Data from transthoracic two-dimensional and speckle-tracking echocardiography on admission and at 3 months follow-up were collected. Global myocardial work index (GWI, mmHg%) was calculated as the area of the LV pressure (LVP)-strain loop, where LVP was estimated noninvasively using a standard waveform fitted to valvular events and scaled to systolic blood pressure. From GWI we also assessed: global constructive work (GCW, mmHg%: work performed during shortening in systole + negative work during lenghtening in isovolumetric relaxation, IVR), global wasted work (GWW, mmHg%: negative workperformed by a segment during lengthening in systole + work performed during shortening in IVR) and global work efficiency (GWE, %: constructive work divided by the sum of constructive and wasted work). Baseline demographic and clinical features, including in-hospital adverse events as acute heart failure, cardiogenic shock and cardiac death, were also assessed. Results On overall population, a reduced ejection fraction (EF) and GLS were detected at hospital admission, with a substantial improvement at discharge and at follow-up (from 41.7 ± 8.3% to 54.5 ± 6.5% to 60.2 ± 4.6% for EF and from -11.7 ± 4.5% to -16.2 ± 4.2 to -21.3 ± 2.8% for GLS, respectively). Similarly, global MWI and MWE both showed a positive trend during the hospital course and at follow-up: MWI increased from 1048.8 ± 580.5 to 1522.4 ± 695.4 to 2021.1 ± 388.6 mmHg% and MWE from 78.7 ± 10.2 to 91.1 ± 4.6 to 94.5 ± 3.8 %. Increasing in MWE has been obtained through an improvement of GCW (from 1195.9 ± 537.2 to 1651.3 ± 700.3 to 2316.8 ± 490.6 mmHg%) and a contemporary decreasing in GWW (from 237.9 ± 137.2 to 106 ± 37.2 to 131.8 ± 150.8 mmHg%). In-hospital adverse events occurred in 8 (50%) patients. Of note, despite EF and GLS at admission showed no significant differences, patients experiencing in-hospital adverse events showed lower value of acute MWI (725.6 ± 289.6 vs 1371.9 ± 632.1 mmHg%; p= 0.02) and MWE (73.6 ± 3.4 vs 83.8 ± 12.4%; p= 0.04) compared to patients without in-hospital complications. Conclusion Non-invasive assessment of myocardial work through echocardiographic strain-based technique could be useful to demonstrate the peculiar dynamic changes of cardiac mechanics and for a better risk stratification in TTS patients. Abstract P322 Figure.

scholarly journals New Indicators of Myocardial Work in Healthy Individuals

2021 ◽  
Vol 17 (5) ◽  
pp. 712-718
Author(s):  
V. E. Oleynikov ◽  
A. V. Babina ◽  
V. A. Galimskaya ◽  
A. V. Golubeva ◽  
K. N. Makarova ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Radial Deformation ◽  
Strong Positive Correlation ◽  
Work Efficiency ◽  
Healthy Individuals ◽  
Average Value ◽  
Work Index ◽  
Constructive Work ◽  
Global Work

Aim. To study in healthy individuals the gender and age characteristics of left ventricular (LV) myocardial work indicators, their correlations with global LV deformity indicators and echocardiographic parameters characterizing LV systolic and diastolic functions.Materials and methods. 70 Healthy individuals (n=70; 34 men and 36 women; aged 39.3±8.9 years) were included in the study. The echocardiographic examination determined the standard parameters and indicators of myocardial work: global work efficiency (GWE), global constructive work (GCW), global wasted work (GWW), global myocardial work index (GWI); as well as the myocardium deformation characteristics: global longitudinal deformation (GLS), global radial deformation (GRS) and global circular deformation (GCS). Spearman's correlation coefficient was used to investigate the relationship between parameters. A correlation was considered weak at r≤0.3, moderate at 0.3<r<0.7, and strong at r≥0.7.Results. The average value of global work efficiency (GWE) in men was 97% (96; 98), in women – 98% (97; 98). Global constructive work (GCW) in men was 2343.8±350.4 mm Hg%, in women – 2362.2±343.8 mm Hg%. The average value of global wasted work (GWW) in men was 46 mm Hg% (27; 75), in women – 44 mm Hg% (33; 55.5). The global myocardial work index (GWI) in men was 2069.9±356.4 mm Hg%, in women – 2055.7±339.9 mm Hg%. No significant differences were found in the comparative analysis of performance indicators. The analysis of correlations found that the myocardial work indicators didn't have significant correlations with age. Ejection fraction was moderately correlated with GWI (r=0.45) and GCW (r=0.49). Global longitudinal strain was strongly correlated with GWI (r=0.77) and GCW (r=0.77). Global radial strain correlated moderately directly with GWI (r=0.4) and GCW (r=0.4). Global circular strain was moderately correlated with GCW (r=0.35). A strong negative correlation was found between the GWE indicator and the post systolic contraction index (PSI) (r=-0.85). At the same time, PSI and GWW had a strong positive correlation (r=0.85).Conclusion. Indicators of LV myocardial work in healthy individuals do not have gender differences. The efficiency of the work of the myocardium depends primarily on the deformation of the LV, while the constructive work is determined by the volume characteristics. The wasted work indicator depends on the number of segments that peak in the post-systolic period.

scholarly journals P1559 3D echocardiography improves the agreement between left ventricular and right ventricular stroke volumes in healthy individuals

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A P Pilalidou ◽  
V K Kantartzi ◽  
C A Adamopoulos ◽  
L Z Zitiridou ◽  
M D Dimtsa ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Left Ventricular ◽  
Absolute Difference ◽  
P Value ◽  
Healthy Individuals ◽  
Mean Absolute Difference ◽  
Mean Values ◽  
Intracardiac Shunt ◽  
The Mean ◽  
The Difference

Abstract Funding Acknowledgements None Background/Introduction: Calculation of the LV and RV stroke volumes (SV) with the volumetric method can be useful for assessment of valvular regurgitant volumes and intracardiac shunt ratios. However, this method often yields significant differences between the estimated LV and RV SV even in healthy subjects. We hypothesized that this discrepancy can be largely due to the assumption of LV and RV outflow tract circularity which forms the basis of 2D derived areas. Purpose To assess if the use of 3D transoesophageal (TOE) derived LVOT and RVOT areas can improve the agreement between LV and RV stroke volumes using the volumetric approach in healthy subjects with no valvular abnormality or intracardiac shunt. Methods We studied 20 patients (9 Males, age: 51 ± 19 y) submitted to TOE for various reasons, who had normal cardiac anatomy and function and good quality 3D TOE LVOT and RVOT data. Two dimensional TOE measurements of the LVOT and RVOT diameters were made in a zoomed mid oesophageal long axis and short axis view respectively; using these measurements 2D TOE LVOT and RVOT derived areas were calculated assuming circularity. In a similar way, we calculated the 2D LVOT and RVOT areas using data from transthoracic echo (TTE) for each patient. Offline analysis of the 3D TOE data allowed direct planimetry of the LVOT and RVOT areas devoid of any geometric assumptions. Finally, calculation of the 2D TTE, 2D TOE and 3D TOE LV and RV stroke volumes were performed for each patient based on the acquired data. The difference between LV and RV stroke volume (which theoretically should be around zero) for each technique and for each patient was also calculated. Results The mean LV and RV SV for the whole cohort, did not differ significantly within each method: 2D-TTE. However, the mean absolute difference between LV and RV stoke volumes for each technique was significantly lower with the use of 3D TOE compared to both 2D TTE and 2D TOE. Mean values and dispersion of absolute differences for each method are shown in Figure 1. Conclusions Compared to 2D, use of direct 3D TOE RVOT and LVOT planimetry yielded significantly less difference between RV and LV stroke volumes in healthy individuals. This finding can have potential clinical implications for more accurate assessment of valvular regurgitant volumes or intracardiac shunts. The mean absolute difference LV-RV Absolute mean defference between LV and RV 95%ΔΕ F(2.38) p-value TTE 2D 18,65 ± 11,72 (13,2-24,1) 8.63 0.001 TOE 2D 13,45 ± 12,44 (7,6-19.3) 8.63 0.001 TOE 3D 6,45 ± 3,62 (4,8-8,1) 8.63 0.001 Abstract P1559 Figure. Bland Altaman Analysis

scholarly journals Impact of diastolic blood pressure on speckle tracking derived myocardial work components in a population of normotensive and untreated hypertensive patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Lembo ◽  
C Santoro ◽  
O Casciano ◽  
V Capone ◽  
T Fedele ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Healthy Subjects ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Newly Diagnosed ◽  
Hypertensive Patients ◽  
Constructive Work ◽  
Study Population ◽  
Global Work

Abstract Background Arterial hypertension deeply influences left ventricular (LV) mechanics and global longitudinal strain (GLS). The effect of blood pressure (BP), in particular systolic BP burden, on speckle tracking derived myocardial work (MW) was demonstrated in both hypertensive and healthy subjects. Purpose Aim of our study was to evaluate the impact of diastolic BP (DBP) on MW components in a population of newly-diagnosed, never treated hypertensive patients and healthy subjects. Methods The study population included 105 newly-diagnosed, never treated hypertensive patients (M/F= 62/43; age=46.1±13.0 years, BP=145.1±10/89.8±7.4 mmHg), and 105 healthy normotensive subjects (BP=121.6±9.8/73.7±7.4mmHg), matched for age and sex. All participants underwent standard echo exam, including GLS evaluation (in absolute value). Cuff BP was employed as a surrogate of LV peak pressure for the assessment of global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. The study population was divided into two groups according to DBP threshold of normalcy defined by 2018 ESH/ESC guidelines: the first group including individuals with normal DBP (n=135, DBP&lt;90mmHg) and the second group including patients with abnormal DBP (n=75, DBP ≥90 mmHg). Results The two groups were comparable for sex prevalence, age and heart rate. Body mass index (BMI), systolic and mean BP were higher in the group with abnormal DBP (all p&lt;0.0001). Among echo data, no significant intergroup difference was found in LV mass index, relative wall thickness, ejection fraction and diastolic parameters. GLS was lower in patients with abnormal DBP (20.4±1.9 vs. 22.1±2.1%, p&lt;0.0001). GWI (2443.0±403.1 vs. 2277.3±359.6 mmHg%, p&lt;0.002), GCW (2733.5±406.0 vs. 2556.9±405.6 mmHg%, p=0.003) and GWW (112.8±84.4 vs. 76.8±45.1 mmHg%, p&lt;0.0001) were significantly higher in patients with abnormal DBP, whereas GWE (95.3±2.8 vs. 96.2±1.7%, p&lt;0.002) was lower in this group. In the pooled population, DBP was positively related to GWI, GCW (both r=0.30, p&lt;0.0001) and GWW (r=0.26, p&lt;0.0001), while negatively correlated with GLS (r=−0.37, p&lt;0.0001) and GWE (r=−0.21, p&lt;0.002). By separate multiple linear regression analyses, GWI (β=0.45, p&lt;0.0001), GCW (β=0.47, p&lt;0.0001), GWW (β=0.20, p=0.007) and GWE (β=−0.15, p&lt;0.05) were all independently associated with DBP, after adjusting for male sex, age, BMI, heart rate, GLS and E/e' ratio. Conclusions In a population of untreated hypertensive patients and healthy subjects, increased DBP affects longitudinal function and MW. In particular, elevated diastolic BP induces an increase of wasted work which is only partially balanced by the increased constructive work, thus provoking a clear reduced efficiency of myocardial mechanics. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Association Between Echocardiographic Non-invasive Myocardial Work Indices and Myocardial Fibrosis in Patients With Dilated Cardiomyopathy

2021 ◽  
Vol 8 ◽  
Author(s):  
Cunying Cui ◽  
Yanan Li ◽  
Yuanyuan Liu ◽  
Danqing Huang ◽  
Yanbin Hu ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Myocardial Fibrosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Qualitative Assessment ◽  
Operating Characteristics ◽  
Systolic Volume ◽  
Non Invasive ◽  
Constructive Work ◽  
Global Work

Objectives: To analyze the association between global myocardial work indices evaluated by non-invasive left ventricular (LV) pressure-strain loop (PSL) and LV myocardial fibrosis in patients with dilated cardiomyopathy (DCM).Methods: A total of 57 patients with DCM were included in this prospective study. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global longitudinal strain (GLS) were measured using LVPSL. LV volumes and LV ejection fraction (LVEF) were evaluated using cardiac magnetic resonance imaging (CMRI), LV myocardial fibrosis was estimated at CMRI by qualitative assessment of late gadolinium enhancement (LGE). According to the CMRI, the studied population was divided into two groups, namely: patients without LGE (LGE-) and patients with LGE (LGE+).Results: The LGE+ group presented with increased age, LV end systolic volume (LVESV) index and reduced GWI, GCW, GWE, GLS, CMRI-derived LVEF (LVEFCMRI), the differences between the two groups were statistically significant (P &lt; 0.05). After correcting for age and LVESV index, LVEFCMRI, GLS, GWI, GCW, and GWE retained independent associations with LV myocardial fibrosis. According to receiver operating characteristics (ROC) analysis, LVEFCMRI, and GCW showed larger AUC and higher accuracy, sensitivity, and specificity than GLS, the accuracy of predicting LV myocardial fibrosis ranged from high to low as: LVEFCMRI, GCW, GWE, GWI, and GLS.Conclusions: LVEFCMRI, GWI, GCW, GWE, and GLS remained significant predictors of LV myocardial fibrosis. LVEFCMRI, and GCW appeared to better predict LV myocardial fibrosis compared with GLS.

scholarly journals Does age at aortic coarctation repair have an impact on left ventricle size and function?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Cardoso Torres ◽  
CX Resende ◽  
PG Diogo ◽  
P Araujo ◽  
RA Pinto ◽  
...  
Keyword(s):  
Aortic Coarctation ◽  
Surgical Repair ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Negative Relationship ◽  
Late Complications ◽  
Left Ventricular ◽  
Funding Sources ◽  
The Mean ◽  
Clinical Records

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Adults with repaired aortic coarctation (CoA) require lifelong follow-up due to late complications, including left ventricular (LV) myocardial dysfunction. Age at the time of CoA repair is an important prognostic factor in these patients (pts). Purpose To evaluate LV size, ejection fraction (EF) and global longitudinal strain (GLS) values using 2D speckle tracking echocardiography (STE) in a population of adult pts with repaired CoA and to assess the relationship between these echocardiographic parameters and age at the time of CoA repair. Methods Retrospective analysis of adult pts with repaired CoA, followed in a Grown Up Congenital Heart Disease Centre. Pts with hemodynamically significant concomitant cardiac lesions were ruled out. Epidemiologic and clinical data were obtained from clinical records. Transthoracic echocardiograms were reviewed in order to assess GLS using 2DSTE (Echopac Software, GE). Results The study population consisted of 63 pts (61.9% male), with a mean age of 35.3 years at the time of the echocardiographic evaluation. The mean age at the time of the CoA repair was 117 months (95% CI 89.8-144.1 months). Surgical repair was performed in 46 pts (73%): resection with subclavian artery flap aortoplasty (n = 21); patch aortoplasty (n = 15) and head-to-head anastomosis (n = 10). In 10 pts there was no data regarding the type of surgical repair. Seven pts (11.1%) were submitted to percutaneous intervention (6 with aortic stent implantation and 1 with balloon aortic angioplasty). Mean LVEF was 63.4% (CI 95% 55.6 – 71.2%) and mean LV end-diastolic diameter (LVEDD) was 50mm (CI 95% 43-57mm). Mean GLS was - 17.3 (CI 95% 14.8- 19.8), which is inferior to the mean normal values reported for the software used. Age at the time of CoA repair had a statistically significant positive linear relationship with LVEDD (r= 0.282; p= 0.026) and a linear negative relationship with both GLS (r= -0,29; p= 0.022) and LVEF (r= -0.33; p= 0.05). Conclusion Older age at the time of CoA repair was associated with increased LVEDD and decreased GLS and LVEF. Also, GLS may be an important tool for the identification of subclinical LV dysfunction in adult pts with repaired CoA.

Myocardial work analysis in screening of familial dilated cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Triantafyllou ◽  
R Monteiro ◽  
A Protonotarios ◽  
T Gossios ◽  
P Elliott ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dilated Cardiomyopathy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
Work Efficiency ◽  
Work Analysis ◽  
Significant Difference ◽  
Global Work

Abstract Introduction Early detection of affected family relatives of patients with dilated cardiomyopathy (DCM) is essential in order to guide follow up, outcomes and initiate early treatment. Myocardial work analysis is a novel method which integrated strain imaging and blood pressure and has the potential to identify patients with subclinical disease. Purpose We analysed myocardial work in family relatives of DCM patients with positive genotype but negative phenotype in order to identify whether myocardial work can identify early changes. Methods Seventy-four family relatives of DCM patients attending for screening were examined. All individuals were asymptomatic with either positive (45/74, G+) or negative (29/74, G-) genotype and no echocardiographic evidence of left ventricular dilatation or systolic impairment. Non-invasive myocardial work analysis using two-dimensional (2D) speckle tracking echocardiography was analysed. Global longitudinal strain (GLS) was measured by the same vendor specific software used for myocardial work analysis. Left ventricular (LV) ejection fraction (EF) was measured with the Simpson's biplane method. The peak systolic arm cuff blood pressure (BP) measurement at the time of echocardiography was used for the myocardial work study. Results In total we included 74 individuals (37±15 years old, 50.7% women) with mean systolic and diastolic BP of 121.3±14 and 73.2±10 mmHg respectively, mean EF was 58±5% and mean GLS at 18.4±2.5%. G+ individuals had pathogenic and very likely pathogenic mutations in 8 different genes (TTN, BAG3, DSP, FLNC, LMNA, DMD, RBM20, TPM1). There was no difference in age, systemic hypertension, diabetes or medical treatment between the 2 groups. No significant difference was found among G+ and G- individuals in mean systolic and diastolic BP (121.2±14.7 vs 121.2±15.2 mmHg), mean EF (57.3±5 vs 59.1±4%), GLS (−18.2±1.5 vs −18.6±2.9%), mean global work index (1818±403 vs 1928±295 mmHg%) and global constructive work (2192±464 vs 2260±318 mmHg%). However, we found significant reduction of the global work efficiency (GWE) with a GWE of 94.4±2.7% in the G+ versus 95.9±1.6% in the G- individuals (p 0.02). Moreover, the global wasted work (GWW) was increased in the G+ with a GWW of 111±58 mmHg% versus 82±41 mmHg% in the G- individuals (p 0.03). Conclusion DCM gene carriers show, early on, decreased myocardial work efficiency and increased wasted work compared to unaffected family members, which appears to be earlier than other parameters such as EF and GLS. Myocardial work analysis could potentially recognize individuals showing early cardiac involvement and guide closer follow up and early initiation of treatment. Funding Acknowledgement Type of funding source: None

scholarly journals Myocardial work: a new way to predict fibrosis in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Valentim Goncalves ◽  
S Aguiar Rosa ◽  
L Moura Branco ◽  
A Galrinho ◽  
A Fiarresga ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Global Longitudinal Strain ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Information ◽  
Ventricular Ejection Fraction ◽  
Significant Fibrosis ◽  
Constructive Work ◽  
Global Work

Abstract Aims Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) adds prognostic information in patients with hypertrophic cardiomyopathy (HCM). Whether Myocardial work (MW), a new parameter on transthoracic echocardiographic (TTE), can predict significant fibrosis in HCM patients is unknown. Methods Single-centre evaluation of consecutively recruited HCM patients in which TTE and CMR were performed. MW and related indices were calculated from global longitudinal strain (GLS) and from estimated left ventricular pressure curves. The extent of LGE was quantitatively assessed. LGE ≥15% was chosen to define significant fibrosis. Logistic regression analysis was used to find the variables associated with LGE ≥15% and cut-off values were determined. Results Among the thirty-two patients analysed mean age was 57±16 years, 18 (56%) were male patients and the mean left ventricular ejection fraction by TTE was 67±8%. Global constructive work (GCW), global work index and GLS were significant predictors of LGE ≥15%. A cut-off ≤1550 mmHg% of GCW was able to predict significant fibrosis with a sensitivity of 92% and a specificity of 79%, while the best cut-off for GLS (&gt;−15%) had a sensitivity of 86% and a specificity of 72%. Conclusion GCW was the best parameter to predict significant left ventricular myocardial fibrosis in CMR, suggesting its utility in patients who may not be able to have a CMR study. Myocardial Work and LGE in CMR in HCM Funding Acknowledgement Type of funding source: None

Left ventricular myocardial work in patients with secondary mitral regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Yedidya ◽  
R.P Lustosa ◽  
F Fortuni ◽  
P Van Der Bijl ◽  
F Namazi ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Blood Pressure Measurement ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Work Efficiency ◽  
Constructive Work ◽  
Secondary Mitral Regurgitation

Abstract Background Assessment of left ventricular (LV) function in patients with secondary mitral regurgitation (SMR) remains challenging because LV ejection fraction (LVEF) reflects changes in LV volume without taking into account the direction of the blood flow. LV global longitudinal strain better reflects active LV myocardial deformation but does not incorporate afterload. LV myocardial work derived from pressure-strain loops integrates speckle tracking echocardiography with non-invasive blood pressure measurement. Purpose To evaluate LV myocardial work components to better characterize LV function in patients with SMR. Methods 378 patients (72% men, median age 68 [range 60 to 74 years]) with various grades of SMR were retrospectively analysed. LV myocardial constructive work, wasted work and work efficiency were measured with speckle tracking echocardiography. Results 145 patients had mild SMR, 130 moderate SMR and 103 severe SMR. Patients with severe SMR had larger LV volumes, lower LVEF and more impaired LV GLS (Table 1). While LV constructive work was more impaired in patients with severe SMR, wasted work was lower as compared to mild SMR (Table 1). Consequently, patients with severe SMR had better myocardial work efficiency than patients with mild MR. This could reflect, the regurgitant volume which is pumped into a low pressure chamber (the left atrium) resulting in less myocardial wasted work and preservation of myocardial efficiency. Conclusion In patients with severe SMR, LVEF, LV GLS and myocardial constructive work are more impaired when compared to mild SMR. However, myocardial wasted work is lower, resulting in higher better LV myocardial work efficiency. Funding Acknowledgement Type of funding source: None

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