scholarly journals Diverse Adiposity and Atrio-Ventricular Dysfunction across Obesity Phenotypes: Implication of Epicardial Fat Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 408
Author(s):  
Yau-Huei Lai ◽  
Lawrence Yu-min Liu ◽  
Kuo-Tzu Sung ◽  
Jui-Peng Tsai ◽  
Wen-Hung Huang ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Ventricular Dysfunction ◽  
Global Longitudinal Strain ◽  
Normal Weight ◽  
Net Reclassification Improvement ◽  
Specific Effects ◽  
Lv Mass ◽  
Metabolically Healthy ◽  
Atrial Functions

Obesity has been conceptualized as a highly heterogeneous condition. We aim to investigate chamber-specific effects of obesity on the heart and relevant outcomes. A total of 2944 symptom-free individuals (age: 47.5 ± 10.0 years), free of known cardiovascular diseases were classified into four categories based on body mass index (BMI) (as normal-weight (NW) vs. overweight/obese (O)) and metabolic status (metabolically-healthy (MH) vs. unhealthy (MU)). Epicardial adipose thickness (EAT) using echocardiography method. Speckle-tracking based atrio-ventricular (LA/LV) deformations including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS) were also analyzed. MUNW had higher cardiometabolic risks and more impaired diastolic and GLS/PALS than MHNW phenotype. Both MHO and MUO phenotypes exhibited worst atrial functions. Greater EAT was independently associated with worse GLS and PALS after correcting for various anthropometrics, LV mass and LA volume, respectively, with unfavorable LA effects from EAT being more pronounced in the NW phenotypes (both p interactions < 0.05). During a median follow-up period of 5.3 years, BMI/EAT improved the reclassification for atrial fibrillation (AF) incidence (p for net reclassification improvement < 0.05) mainly in the NW phenotypes (p interaction < 0.001). Categorization of clinical obesity phenotypes based on excessive visceral adiposity likely provides increment prognostic impacts on atrial dysfunction, particularly in non-obese phenotypes.

scholarly journals The impact of left atrial strain parameters on systolic and diastolic improvement following TAVI

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Vattay ◽  
A I Nagy ◽  
A Apor ◽  
M Kolossvary ◽  
A Manouras ◽  
...  
Keyword(s):  
Left Atrial ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Term Survival ◽  
Lv Mass ◽  
Reverse Remodelling ◽  
The Impact

Abstract Introduction Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and has been shown to improve long term survival. Data on the prognostic value of left atrial (LA) strain following TAVI are scarce. LA strain – a surrogate of LV filling pressure - can aid the early detection of diastolic dysfunction and correlates with the extent of fibrosis in atrial remodelling. Purpose In this multimodality study, we aimed to evaluate the prognostic value of LA function measured before hospital discharge following TAVI and to further elucidate its association with LV and LA reverse remodelling. Methods In this prospective single center study, we investigated 90 patients (mean age 78.5 years, 46.7% female) with severe, symptomatic aortic stenosis (AS) who underwent transthoracic echocardiography immediately after TAVI and 6 months later. LA and LV global longitudinal strain parameters were obtained by speckle tracking echocardiography. CT angiography (CTA) was performed for pre-TAVI planning and repeated at 6 months follow-up. LV mass values were derived from the serial CTA images. We defined LV reverse remodelling as reduction of myocardial mass quantified on CTA and as an improvement of LV global longitudinal strain (GLS). LA reverse remodelling was assessed based on the peak reservoir strain values (LAGS). The association of LA and LV global strain parameters, LA stiffness, systolic and diastolic functional parameters and LV mass based reverse remodelling were analysed using Pearson correlation coefficient and linear regression models. Results The mean LAGS and LVGLS values were 17.7% and 15.3% at discharge and 20.2% and 16.6% at follow-up, respectively (p=0.024, p&lt;0.001). LA and LV strain values improved in 60.6% and 74.5% of all patients. Reduced LAGS (&lt;20%) was found in 66.7% of all patients at baseline. LA strain at discharge correlated significantly with diastolic parameters (E wave, E/e', LAVI, all p&lt;0.05). Atrial reverse remodelling based on LAGS change correlated with LVGLS change (p&lt;0.01, standardized β=0.53) and LAGS at discharge (p=0.012, standardized β=−0.30). LAGS correlated with the extent of morphological LV remodelling based on LV mass reduction (p=0.002, coeff: 0.36). Elevated LA stiffness at discharge (upper tercile) leads to substantially lower LAGS at 6 months versus patients with lower LA stiffness value (1. and 2. tercile): 16.4±10.0 vs 21.9±9.8, p=0.042. Conclusion Patients with reduced LAGS immediately after TAVI showed a larger extent of LV reverse remodelling during follow up. On the other hand, increased LA stiffness at discharge was consistent with irreversible LA damage as demonstrated by a lack of improvement in LA function. FUNDunding Acknowledgement Type of funding sources: None.

Early change in left atrial and left ventricular strain predicts sinus rhythm maintenance after cardioversion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kupczynska ◽  
D Miskowiec ◽  
B Michalski ◽  
L Szyda ◽  
K Wierzbowska-Drabik ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Recurrence Risk ◽  
Left Ventricular ◽  
Mechanical Function ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) impairs mechanical function of the heart, especially atria and restoration of sinus rhythm (SR) leads to improvement of mechanics. The predicting role of changes in strain parameters for AF recurrence is not established yet. Purpose To analyse changes in left atrial (LA) and left ventricular (LV) mechanical function after conversion to SR and their prognostic values for AF recurrence during 24 months follow-up. Methods Prospective study involved 59 patients after successful electrical cardioversion (EC) because of nonvalvular AF (mean age 65±4 years, 47% female). Speckle tracking analysis (STE) was applied to calculate longitudinal strain of LV and LA before EC and within 24 hours after restoration of SR and additionally total left heart strain (TS) defined as a sum of absolute peak LV and LA strain. We calculated change in strain between AF and SR analyses expressed as delta (Δ). During follow-up we noticed AF recurrence in 42 (71%) patients, most of them (93%) during 1st year after EC. Median time of AF recurrence was 3 months. Results We noticed significant immediate post-EC improvement in peak LA longitudinal strain (PALS) and LV global longitudinal strain (LVGLS) (table). Unlike CHA2DS2-VASc score, strain parameters were predictors of AF recurrence. Every 1% increment in ΔLVGLS was related with 13% increase in AF recurrence risk (p=0.02) and every 1% increment in ΔPALS and ΔTS were related with 9% decrease in AF recurrence risk (p=0.007 and p=0.0014, respectively). Multivariate analysis revealed ΔTS as a strongest predictor with 9% decrease in AF risk per every 1% increment. The criterion of ΔTS ≤7.5% allows to predict AF recurrence with 81% sensitivity and 63% specificity. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR and these absolute changes in LVGLS as well as PALS can predict AF recurrence, with optimal stratification by novel parameter - TS. Funding Acknowledgement Type of funding source: None

scholarly journals The value of regional myocardial function assessment in patients with acute myocarditis at baseline and mid term follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Boidol ◽  
M Koziel ◽  
K Miszalski-Jamka ◽  
J Klys ◽  
Z Kalarus ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Ventricular Remodeling ◽  
Clinical Course ◽  
Troponin T ◽  
Global Longitudinal Strain ◽  
Cardiac Resynchronization ◽  
Global Improvement ◽  
Myocardial Disease ◽  
Mechanical Dispersion

Abstract Background The clinical course and ventricular remodeling in inflammatory myocardial disease could be unpredictable. No single functional parameter has been confirmed as a powerful predictor of clinical course and functional recovery assessment in patients with acute inflammatory myocardial disease. Purpose The aim of the study was to assess the mechanical properties of the myocardium in patients with active myocarditis at baseline and follow-up. Methods Database from a high volume, tertiary cardiology center was analysed to identify patients with active myocarditis, based on clinical presentation and ≥1 diagnostic criteria from different categories (including electrocardiography/holter, elevated troponin T/I levels, functional or structural abnormalities on cardiac imaging or tissue characterization by cardiac magnetic resonance) between 2016 and 2019. Conventional and speckle tracking echocardiography including global longitudinal strain (GLS) mechanical dispersion (MD) was completed at baseline and at 17±13 months follow-up. MD was calculated as a standard deviation of time to peak longitudinal strain derived from all left ventricle segments in 3 apical views. Results 61 consecutive patients [50 M, 11F, end-diastolic volume 212±84 ml, end-systolic volume 130±90ml, ejection fraction (EF) 42±16%] were enrolled. During the entire follow-up 1 patient died at early observation. Implantable cardioverter-defibrillator was implanted in 5 patients (primary prevention 4, secondary 1), cardiac resynchronization therapy pacemaker in 1 patient. Despite of significant global improvement (EF 42±16% vs 52±10%, p&lt;0.001) the limited regional improvement was noticed (GLS 14±6% vs 15±4%, p = NS; MD 47±18 ms vs 45±20 ms, p=NS) in all patients at 17±13 months follow-up. There was a strong negative association between GLS and MD at baseline (Figure 1), and slightly weaker at follow-up (R=0.47, Pearson's correlation). Moreover, the GLS correlated well the change of MD in each individual patient. Conclusions Mechanical dispersion and global longitudinal strain may serve as an additional markers of myocardial damage and potential predictive markers in non ischemic cardiomyopathy patients with proven inflammatory origin. Funding Acknowledgement Type of funding source: None

Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Philabout ◽  
L Soulat-Dufour ◽  
I Benhamou-Tarallo ◽  
S Lang ◽  
S Ederhy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Cardiac Rhythm ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Chamber ◽  
Deformation Imaging ◽  
And Function

Abstract Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p&lt;0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p&lt;0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p&lt;0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure). Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

Global longitudinal strain predicts outcome in chronic heart failure across American Heart Association stages: results from the MyoVasc study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.O Troebs ◽  
A Zitz ◽  
S Schwuchow-Thonke ◽  
A Schulz ◽  
M.W Heidorn ◽  
...  
Keyword(s):  
American Heart Association ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
American Heart ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Heart Association ◽  
Increased Risk ◽  
Systolic And Diastolic Function

Abstract Background Global longitudinal strain (GLS) demonstrated a superior prognostic value over left ventricular ejection fraction (LVEF) in acute heart failure (HF). Its prognostic value across American Heart Association (AHA) stages of HF – especially under considering of conventional echocardiographic measures of systolic and diastolic function – has not yet been comprehensively evaluated. Purpose To evaluate the prognostic value of GLS for HF-specific outcome across AHA HF stages A to D. Methods Data from the MyoVasc-Study (n=3,289) were analysed. Comprehensive clinical phenotyping was performed during a five-hour investigation in a dedicated study centre. GLS was measured offline utilizing QLab 9.0.1 (PHILIPS, Germany) in participants presenting with sinus rhythm during echocardiography. Worsening of HF (comprising transition from asymptomatic to symptomatic HF, HF hospitalization, and cardiac death) was assessed during a structured follow-up with subsequent validation and adjudication of endpoints. AHA stages were defined according to current guidelines. Results Complete information on GLS was available in 2,400 participants of whom 2,186 categorized to AHA stage A to D were available for analysis. Overall, 434 individuals were classified as AHA stage A, 629 as stage B and 1,123 as stage C/D. Mean GLS increased across AHA stages of HF: it was lowest in stage A (−19.44±3.15%), −18.01±3.46% in stage B and highest in AHA stage C/D (−15.52±4.64%, P for trend &lt;0.0001). During a follow-up period of 3.0 [1.3/4.0] years, GLS denoted an increased risk for worsening of HF after adjustment for age and sex (hazard ratio, HRGLS [per standard deviation (SD)] 1.97 [95% confidence interval 1.73/2.23], P&lt;0.0001) in multivariable Cox regression analysis. After additional adjustment for cardiovascular risk factors, clinical profile, LVEF and E/E' ratio, GLS was the strongest echocardiographic predictor of worsening of HF (HRGLS [per SD] 1.47 [1.20/1.80], P=0.0002) in comparison to LVEF (HRLVEF [per SD] 1.23 [1.02/1.48], P=0.031) and E/E' ratio (HRE/E' [per SD] 1.12 [0.99/1.26], P=0.083). Interestingly, when stratifying for AHA stages, GLS denoted a similar increased risk for worsening of HF in individuals classified as AHA stage A/B (HRGLS [per SD] 1.63 [1.02/2.61], P=0.039) and in those classified as AHA stage C/D (HRGLS [per SD] 1.95 [1.65/2.29], P&lt;0.0001) after adjustment for age and sex. For further evaluation, Cox regression models with interaction analysis indicated no significant interaction for (i) AHA stage A/B vs C/D (P=0.83) and (ii) NYHA functional class &lt;II vs ≥II in individuals classified as AHA stage C/D (P=0.12). Conclusions GLS demonstrated a higher predictive value for worsening of HF than conventional echocardiographic measures of systolic and diastolic function. Interestingly, GLS indicated an increased risk for worsening of HF across AHA stages highlighting its potential value to advance risk prediction in chronic HF. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK), Center for Translational Vascular Biology (CTVB) of the University Medical Center of the Johannes Gutenberg-University Mainz

scholarly journals Feature-tracking cardiac magnetic resonance left ventricular global longitudinal strain improves 6 months after kidney transplantation associated with reverse remodeling, not myocardial tissue characteristics

2021 ◽  
Author(s):  
Maurício Fregonesi Barbosa ◽  
Mariana Moraes Contti ◽  
Luis Gustavo Modelli de Andrade ◽  
Alejandra del Carmen Villanueva Mauricio ◽  
Sergio Marrone Ribeiro ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cardiac Magnetic Resonance ◽  
Feature Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Myocardial Tissue ◽  
Tissue Characteristics

AbstractTo determine whether left ventricular (LV) global longitudinal strain (GLS) measured by feature-tracking (FT) cardiac magnetic resonance (CMR) improves after kidney transplantation (KT) and to analyze associations between LV GLS, reverse remodeling and myocardial tissue characteristics. This is a prospective single-center cohort study of kidney transplant recipients who underwent two CMR examinations in a 3T scanner, including cines, tagging, T1 and T2 mapping. The baseline exam was done up to 10 days after transplantation and the follow-up after 6 months. Age and sex-matched healthy controls were also studied for comparison. A total of 44 patients [mean age 50 ± 11 years-old, 27 (61.4%) male] completed the two CMR exams. LV GLS improved from − 13.4% ± 3.0 at baseline to − 15.2% ± 2.7 at follow-up (p < 0.001), but remained impaired when compared with controls (− 17.7% ± 1.5, p = 0.007). We observed significant correlation between improvement in LV GLS with reductions of left ventricular mass index (r = 0.356, p = 0.018). Improvement in LV GLS paralleled improvements in LV stroke volume index (r = − 0.429, p = 0.004), ejection fraction (r = − 0.408, p = 0.006), global circumferential strain (r = 0.420, p = 0.004) and global radial strain (r = − 0.530, p = 0.002). There were no significant correlations between LV GLS, native T1 or T2 measurements (p > 0.05). In this study, we demonstrated that LV GLS measured by FT-CMR improves 6 months after KT in association with reverse remodeling, but not native T1 or T2 measurements.

Global Longitudinal Strain to Predict Pacing Induced Ventricular Dysfunction

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Noran Khalil ◽  
Medhat Ashmawy ◽  
Ayman El Saied ◽  
Samia Sharaf El Din ◽  
Yasser El Barbary
Keyword(s):  
Longitudinal Strain ◽  
Ventricular Dysfunction ◽  
Global Longitudinal Strain

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 Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Anna Calleja ◽  
Frédéric Poulin ◽  
Ciril Khorolsky ◽  
Masoud Shariat ◽  
Philippe L. Bedard ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Therapy ◽  
Right Ventricular ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Breast Cancer Patients ◽  
Lv Dysfunction ◽  
Her2 Breast Cancer

Background. Right ventricular (RV) dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined.Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity.Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline) who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF), RV fractional area change (RV FAC), and peak systolic longitudinal strain (for both LV and RV) were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls.Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years) RV FAC was significantly lower (42 ± 7 versus 47 ± 6%,P=0.01) compared to controls. RV dysfunction defined by global longitudinal strain (GLS < −20.3%) was seen in 40% (n=12). During follow-up in 16 out of 30 patients (23 ± 15 months), there was persistent LV dysfunction (EF < 55%) in 69% (n=11). Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant.Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

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