scholarly journals The Effect of Anti-TNF Therapy on Cardiac Function in Rheumatoid Arthritis: An Observational Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3145
Author(s):  
Milad Baniaamam ◽  
M. Louis Handoko ◽  
Rabia Agca ◽  
Sjoerd C. Heslinga ◽  
Thelma C. Konings ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiac Function ◽  
Global Longitudinal Strain ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Inflammatory State ◽  
History Of

Congestive heart failure (CHF) is the second most prevalent cause of death in rheumatoid arthritis (RA). The systemic inflammatory state in RA patients is deemed responsible for this finding. Anti-inflammatory treatment with anti-tumor necrosis factor (anti-TNF) therapy decreases CV risk and subsequently might improve the cardiac function by lowering the overall inflammatory state. This study investigated the effect of anti-TNF on the cardiac function in RA patients. Fifty one RA patients were included, of which thirty three completed follow-up. Included patients were >18 years, had moderate–high disease activity and no history of cardiac disease. Patients were assessed at baseline and after six months of anti-TNF treatment. Patients underwent conventional Speckle tracking and tissue Doppler echocardiography in combination with clinical and laboratory assessments at baseline and follow-up. The left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed no changes during follow-up, LVEF 63% (±9) to 62% (±8) p = 0.097 and GLS −20 (±4) to −20 (±3) p = 0.79, respectively. Furthermore, E/e’ nor E/A changed significantly between baseline and follow-up, respectively 8 (7–9) and 8 (7–9) p = 0.17 and 1.1 (±0.4) and 1.1 (±0.4) p = 0.94. Follow-up NT-proBNP decreased with 23%, from 89 ng/L (47–142) to 69 ng/L (42–155), p = 0.10. Regression analysis revealed no association between change in inflammatory variables and cardiac function. Echocardiography showed no effect of anti-TNF treatment on the cardiac function in RA patients with low prevalence of cardiac dysfunction. Moreover, NT-proBNP decreased, possibly indicating (subtle) improvement of the cardiac function.

P3118CMR Fast-SENC intramyocardial LV & RV segmental strain detects cardiotoxicity during oncology treatment and impact of cardioprotection therapy before echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Steen ◽  
M Montenbruck ◽  
P Wuelfing ◽  
S Esch ◽  
A K Schwarz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Therapy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lower Sensitivity ◽  
Pharmacological Agents ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background The incidence of cardiotoxicity during cancer therapy is underestimated due to limitations of current diagnostic tests. Current biomarkers (BNP, NT-pro-BNP, hs-Troponin, etc.) and imaging calculations (e.g. echocardiography) such as left ventricular ejection fraction (LVEF) are currently included in the guidelines to designate cardiotoxicity during cancer therapy. Unfortunately, these diagnostics identify systemic damage in symptomatic patients after the heart is unable to compensate for regional dysfunction. Fast-SENC segmental intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) test that regionally detects subclinical intramyocardial dysfunction in 1 heartbeat. Methods This single center, prospective Prefect Study was used to evaluate cardiotoxicity and the impact of cardioprotective therapy in Breast Cancer and Lymphoma patients (NCT03543228). fSENC was acquired with a 1.5T MRI and processed with the software to quantify intramyocardial strain. Segmental strain was measured in three short axis scans (basal, midventricular, apical) with 16 LV/6 RV longitudinal segments & three long axis scans (2-, 3-, 4-chamber) with 21 LV/5 RV circumferential segments. fSENC CMR was performed before chemotherapy, during and after anthracycline/taxane therapy, at 1 year follow-up, and as needed in between designated follow-up periods. Cardioprotective therapy was offered to patients meeting the definition of cardiotoxicity by the ESC Guidelines on Cardiotoxicity and/or ESMO Clinical Practice Guidelines or those observing a substantial decline in cardiac function. Results Two hundred eight (208) CMRs were performed in fifty-two (52) patients (44 female). Patients had an average (± stdev) age of 53 (15) yrs, BMI of 26 (5) kg/m2; 77% had breast cancer, 23% had Lymphoma. fSENC CMRs required 11 (2) min total exam time. The % of normal fSENC (segmental stain <−17%) with a threshold of 65% showed a sensitivity of 87% and specificity of 89% in detecting cardiotoxicity while echocardiography GLS with a threshold of −17% observed a sensitivity of 20% and specificity of 88%. Figure 1 shows receiver operating characteristic curves for fSENC based on the percent of normal myocardium, and echocardiography global longitudinal strain (GLS) respectively. Global fSENC had substantially lower sensitivity than segmental fSENC despite having higher accuracy than the other global metrics. Figure 1 Conclusion Segmental fSENC intramyocardial strain detects subclinical dysfunction due to cardiotoxic response of chemotherapy before other biomarkers and imaging modalities. The ability to detect the subclinical cardiotoxicity of chemotherapy agents, or other pharmacological agents that cause or worsen heart failure, enables proactive prescription of cardioprotective medications to avoid tissue remodeling that precedes systemic cardiac dysfunction and worsening of global measures such as LVEF and current biomarkers.

scholarly journals P818 Association between baseline left ventricular longitudinal strain and follow-up left ventricular ejection fraction in patients with dilated cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I H Jung ◽  
Y S Byun ◽  
J H Park
Keyword(s):  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Lv Function ◽  
Ventricular Ejection Fraction

Abstract Funding Acknowledgements no Background Left ventricular global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction. The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LV reverse remodeling (LVRR) in DCM patients with sinus rhythm and also investigate the relationship between baseline LV GLS and follow-up LVEF. Methods We enrolled patients with DCM who had been initially diagnosed, evaluated, and followed at our institute. Results During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45) within 14.7 ± 10.0 months of medical therapy. The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9% and was not different from the value of 27.1 ± 7.4% (p = 0.49) of those who did not recover. There was a moderate and highly significant correlation between baseline LV GLS and follow-up LVEF (r = 0.717; p &lt;0.001). Conclusion There was a significant correlation between baseline LV GLS and follow-up LVEF in this population. Baseline Follow-up Difference (95% CI) p-value All patients (n = 160) LVEDDI, mm/m2 35.6 ± 6.6 35.6 ± 6.6 -2.7 (-3.4 to -2.0) &lt;0.001 LVESDI, mm/m2 30.3 ± 6.1 26.6 ± 6.6 -3.7 (-4.6 to -2.8) &lt;0.001 LVEDVI, mL/m2 95.0 ± 30.7 74.3 ± 30.2 -20.7 (-25.6 to -15.8) &lt;0.001 LVESVI, mL/m2 70.0 ± 24.8 50.2 ± 26.8 -19.8 (-24.2 to -15.4) &lt;0.001 LVEF, % 26.8 ± 7.5 33.9 ± 12.6 7.2 (5.2 to 9.2) &lt;0.001 LV GLS (-%) 9.2 ± 3.1 11.0 ± 4.8 1.8 (1.3 to 2.2) &lt;0.001 Patients without LVRR (n = 115) LVEDDI, mm/m2 34.9 ± 6.8 34.1 ± 6.8 -0.8 (-1.3 to -0.3) 0.002 LVESDI, mm/m2 29.5 ± 6.1 28.4 ± 6.4 -1.4 (-1.8 to -0.4) 0.002 LVEDVI, mL/m2 92.0 ± 30.5 83.4 ± 29.8 -8.6 (-12.4 to -4.8) &lt;0.001 LVESVI, mL/m2 67.1 ± 24.4 59.5 ± 25.3 -7.6 (-10.9 to -4.3) &lt;0.001 LVEF, % 27.1 ± 7.4 27.8 ± 7.4 0.7 (-0.2 to 1.6) 0.126 LV GLS (-%) 8.2 ± 2.9 8.7 ± 3.2 0.5 (0.7 to 3.6) &lt;0.001 Patients with LVRR (n = 45) LVEDDI, mm/m2 37.4 ± 5.5 29.8 ± 5.2 -7.5 (-9.1 to -6.0) &lt;0.001 LVESDI, mm/m2 32.2 ± 5.7 21.9 ± 4.4 -10.3 (-11.9 to -8.6) &lt;0.001 LVEDVI, mL/m2 102.7 ± 30.2 51.1 ± 15.0 -51.7 (-61.6 to -41.7) &lt;0.001 LVESVI, mL/m2 77.3 ± 24.5 26.4 ± 11.3 -50.9 (-58.8 to -43.1) &lt;0.001 LVEF, % 26.1 ± 7.9 49.4 ± 9.5 23.9 (20.4 to 27.5) &lt;0.001 LV GLS (-%) 11.9 ± 1.6 16.9 ± 2.7 5.1 (4.2 to 5.9) &lt;0.001 Baseline and Follow-up LV Functional Echocardiographic Data Abstract P818 Figure.

Imaging-Based Risk Stratification for Recurrence Risk in Women with a History of Peripartum Cardiomyopathy

2021 ◽  
Author(s):  
Marwan Ma'ayeh ◽  
Jeremy A. Slivnick ◽  
Monique E. McKiever ◽  
Zachary D. Garrett ◽  
Woobeen Lim ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Recurrence Risk ◽  
Left Ventricular ◽  
Subsequent Pregnancy ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Recurrence ◽  
Key Points ◽  
History Of

Objective Peripartum cardiomyopathy (PPCM) affects 1:1,000 U.S. pregnancies, and while many recover from the disease, the risk of recurrence in subsequent pregnancy (SSP) is high. This study aims to evaluate the utility of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) to predict the risk of recurrence of PPCM in SSP. Study Design We retrospectively evaluated outcomes in women with a history of PPCM and SSP at a large-volume cardioobstetrics program (2008–2019). Results There were 18 women who had incident PPCM and pursued SSP. Of 24 pregnancies in these women, 8 (33%) were complicated by the development of recurrent PPCM. LVEF ≥ 52% or GLS ≤ −16 was associated with a low risk of recurrent PPCM. Conclusion Approximately one-third of women with PPCM developed recurrent PPCM in SSP. LVEF and GLS on prepregnancy echocardiography may predict the risk of recurrence. Additional studies evaluating risk for recurrence are required to better understand which women are the safest to consider SSP. Key Points

Anthracycline associated cardiotoxicity in a sub-Saharan African population - tertiary care experience

2020 ◽  
Author(s):  
Joseph Odunga Abuodha ◽  
Asim Jamal Shaikh ◽  
Jasmit Shah ◽  
Mohamed Jeilan ◽  
Anders Barasa
Keyword(s):  
Cardiac Dysfunction ◽  
Standard Dose ◽  
Global Longitudinal Strain ◽  
Tertiary Care ◽  
Left Ventricular ◽  
African Population ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Sub Saharan

Abstract Background Anthracyclines are associated with irreversible cardiotoxicity, with changes in echocardiographic parameters preceding clinically manifest cardiac dysfunction. We sought to evaluate the incidence of early cardiac dysfunction post anthracyclines, and associated clinical, echocardiographic and treatment parameters in a sub-Saharan African population. Methods Cancer patients aged ≥18years at anthracycline initiation with archived baseline echocardiograms, underwent repeat echocardiographic assessment. Cases (with cardiac dysfunction) had (1) >15% relative decline from baseline in global longitudinal strain (GLS), or (2) a decline in left ventricular ejection fraction (LVEF) from baseline to <53% with either (i) symptoms (assessed by the Duke Activity Status Index at follow-up echocardiogram) and LVEF decline by >5 to ≤10%, or (ii) LVEF decline >10% regardless of symptoms. Comparisons in clinical, echocardiographic and treatment parameters were made with controls (no cardiac dysfunction). Results Among 141 patients (mean age, 47.7years ± 11.2, Africans 95%, females 85.1%, breast cancer 82%), 39 (27.7%) had cardiac dysfunciton at a mean inter-echocardiogram interval of 14.9months ± 14.3, mean cumulative anthracycline dose of 244.7mg/m 2 ± 72.2, and mean DASI score was 50.0 ± 13.3. Mean cardiotoxic doxorubicin equivalence dose was 236.7mg/m 2 ± 57.4 for cases and 217.3 ± 61.9 for controls [p = 0.033, OR = 1.00 (95% CI: 0.99 - 1.01)]. The assessed clinical, echocardiographic and treatment parameters were not associated with cardiac dysfunction. Conclusion Incidence of early cardiac dysfunction after standard dose anthracyclines in an adult Sub-Saharan population is 27.7% at a mean follow-up of 14.9 months post anthracycline. Routine pre- and post-exposure cardiac assessment should be considered.

INFLUENCE OF RISK FACTORS FOR CARDIOVASCULAR DISEASES, HISTORY OF CARDIOVASCULAR DISEASES, AND STRUCTURAL AND FUNCTIONAL STATE OF THE HEART ON 3-YEAR SURVIVAL IN PERSONS 95 YEARS AND OLDER

2021 ◽  
pp. 727-733
Author(s):  
К.А. Ерусланова ◽  
А.В. Лузина ◽  
Ю.С. Онучина ◽  
В.С. Остапенко ◽  
Н.В. Шарашкина ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
History Of ◽  
The Right

В последние годы появляется все больше работ, посвященных снижению воздействия классических факторов риска, негативно сказывающихся на выживаемости с возрастом. Целью исследования была оценка влияния сердечно-сосудистых заболеваний, их факторов риска и структурно-функциональных характеристик сердца на трехлетнюю выживаемость лиц 95 лет и старше. В исследовании участвовали 69 пациентов 95 лет и старше (98±1,9 года), из них 61 (88,4 %) женщина и 8 (11,6 %) мужчин. Через 3 года были получены данные о статусе жизни участников: 25 (36,2 %) были живы и 44 (63,8 %) умерли. По результатам проведенного однофакторного регрессионного анализа было определено, что факторы риска и анамнез сердечно-сосудистых заболеваний не ассоциированы с трехлетней выживаемостью. Однако в трехлетнем периоде риск смерти увеличивался в 3 раза при снижении ДАД <75 мм рт. ст., в 7,8 раза - при снижении ФВ ЛЖ <62 % и в 4,9 раза - при увеличении конечного диастолического размера правого желудочка >2,9 см. In recent years, more and more works have appeared that with age, classic risk factors that negatively affect the prognosis (cardiovascular diseases) lose their influence on life expectancy. The study aimed to assess the influence of cardiovascular diseases and their risk factors and structural and functional characteristics of the heart on three-year survival in people 95 years and older. The study involved 69 patients 95 years and older (98±1,9 years), 61 (88,4 %) were women. After 36 months, data were obtained on the participants’ status of life: 25 (36,2 %) were alive, and 44 (63,8 %) died. Based on the regression analysis results, it was determined that risk factors and history of cardiovascular diseases were not associated with 3-year survival. With a 3-year follow-up, the risk of death increases three times with a decrease in diastolic blood pressure less than 75 mm/Hg, 7,8 times with a decrease in left ventricular ejection fraction below 62 %, and 4,9 times with an increase in the end-diastolic size of the right ventricle by more than 2,9 cm.

Prognostic significance of longitudinal strain in dilated cardiomyopathy with recovered ejection fraction

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319504
Author(s):  
Marco Merlo ◽  
Marco Masè ◽  
Andrew Perry ◽  
Eluisa La Franca ◽  
Elena Deych ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death

ObjectivePatients with non-ischaemic dilated cardiomyopathy (NICM) may experience a normalisation in left ventricular ejection fraction (LVEF). Although this correlates with improved prognosis, it does not correspond to a normalisation in the risk of death during follow-up. Currently, there are no tools to risk stratify this population. We tested the hypothesis that absolute global longitudinal strain (aGLS) is associated with mortality in patients with NICM and recovered ejection fraction (LVEF).MethodsWe designed a retrospective, international, longitudinal cohort study enrolling patients with NICM with LVEF <40% improved to the normal range (>50%). We studied the relationship between aGLS measured at the time of the first recording of a normalised LVEF and all-cause mortality during follow-up. We considered aGLS >18% as normal and aGLS ≥16% as of potential prognostic value.Results206 patients met inclusion criteria. Median age was 53.5 years (IQR 44.3–62.8) and 56.6% were males. LVEF at diagnosis was 32.0% (IQR 24.0–38.8). LVEF at the time of recovery was 55.0% (IQR 51.7–60.0). aGLS at the time of LVEF recovery was 13.6%±3.9%. 166 (80%) and 141 (68%) patients had aGLS ≤18% and <16%, respectively. During a follow-up of 5.5±2.8 years, 35 patients (17%) died. aGLS at the time of first recording of a recovered LVEF correlated with mortality during follow-up (HR 0.90, 95% CI 0.91 to 0.99, p=0.048 in adjusted Cox model). No deaths were observed in patients with normal aGLS (>18%). In unadjusted Kaplan-Meier survival analysis, aGLS <16% was associated with higher mortality during follow-up (31 deaths (22%) in patients with GLS <16% vs 4 deaths (6.2%) in patients with GLS ≥16%, HR 3.2, 95% CI 1.1 to 9, p=0.03).ConclusionsIn patients with NICM and normalised LVEF, an impaired aGLS at the time of LVEF recovery is frequent and associated with worse outcomes.

The importance of comorbidities for long-term outcome after aortic valve intervention in patients with preserved left ventricular ejection fraction, a nation-wide register study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Thilen ◽  
S James ◽  
L Lindhagen ◽  
E Stahle ◽  
C Christersson
Keyword(s):  
Postoperative Outcome ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Outcome ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome ◽  
Cardiovascular Comorbidities ◽  
History Of

Abstract Background In Aortic stenosis (AS) cardiovascular comorbidities as well as left ventricular ejection fraction (LVEF) have an impact on postoperative outcome among patients undergoing aortic valve replacement (AVR). The prevalence of heart failure (HF) based on LVEF in patients with severe AS varies. Lately HF with preserved LVEF has gained more attention. The aim is to describe the prevalence and prognostic impact of cardiovascular comorbidities, including HF, in relation to LVEF before AVR in a national cohort of patients with AS. Methods Patients &gt;18 years, undergoing AVR due to AS 2008–2014 were identified in the national register for heart diseases, SWEDEHEART. Preoperative LVEF and comorbidities were collected from the register and enriched with data from national patient registries. The outcome events were all cause mortality and hospitalization for HF as the main diagnosis. The cohort was separated by preoperative LVEF status; preserved (&gt;50%) or reduced (≤50%). Outcome events were analysed by Cox regression. Results 10406 patients, median age 73 (18–96) years whereof 3817 (36.7%) women, were included with a median follow-up of 35 months. In the cohort 15.9%, 73.9% and 10.2% received a mechanical, surgical biological and trans-catheter biological valve prosthesis, respectively. Preserved LVEF was present in 7512 (72.2%). Comorbidities were more frequent in the group with reduced LVEF (p&lt;0.001). Irrespective of LVEF HF influenced outcome negatively (see table). Conclusion In patients planned for AVR a history of HF irrespective of LVEF worsen postoperative prognosis and a history of HF seems at least as important as LVEF when predicting long-term outcome. When stratifying patients for AVR with preserved LVEF, comorbidities such as HF and atrial fibrillation should be highlighted, and further research to identify risk factors for a negative postoperative outcome in this group seems important in optimizing the follow-up after AVR. Funding Acknowledgement Type of funding source: None

Pre-operative heart failure worsens outcome after aortic valve replacement irrespective of left ventricular ejection fraction

2021 ◽  
Author(s):  
Maria Thilén ◽  
Stefan James ◽  
Elisabeth Ståhle ◽  
Lars Lindhagen ◽  
Christina Christersson
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
History Of

Abstract Aims Left ventricular ejection fraction (LVEF) affects the outcome of aortic valve replacement (AVR) in aortic stenosis (AS). The study aim was to investigate the prognostic importance of concomitant cardiovascular disease in relation to pre-operative LVEF. Methods and results All adult patients undergoing AVR due to AS 2008–14 in a national register for heart diseases were included. All-cause mortality and hospitalization for heart failure during follow-up after AVR, stratified by preserved or reduced LVEF (≤50%), were derived from national patient registers and analysed by Cox regression. During the study period, 10 406 patients, median age 73 years, a median follow-up of 35 months were identified. Preserved LVEF was present in 7512 (72.2%). Among them, 647 (8.6%) had a history of heart failure (HF) and 1099 (14.6%) atrial fibrillation (AF) before the intervention. Pre-operative HF was associated with higher mortality irrespective of preserved or reduced LVEF: hazard ratio (HR) 1.64 [95% confidence interval (CI) 1.35–1.99] and 1.58 (95% CI 1.30–1.92). Prior AF was associated with a higher risk of mortality in patients with preserved but not in those with reduced LVEF: HR 1.62 (95% CI 1.36–1.92) and 1.05 (95% CI 0.86–1.28). Irrespective of LVEF, pre-operative HF and AF were associated with an increased risk of post-operative heart failure hospitalization. Conclusion In patients planned for AVR, a history of HF or AF, irrespective of LVEF, worsens the post-operative prognosis. Heart failure and AF can be seen as markers of myocardial fibrosis not necessarily discovered by LVEF and the merely use of it, besides symptoms, for the timing of AVR seems suboptimal.

scholarly journals Comparison of two methods to predict CRT-response

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Hubert ◽  
A Galard ◽  
V Le Rolle ◽  
E Galli ◽  
A Hernandez ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Systolic Volume ◽  
Pressure Estimation ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital university of Rennes INSERM - LTSI Background Non-invasive estimation of myocardial work by trans-thoracic echocardiography is a novel tool to analyze myocardial contraction efficiency during systole. Two methods are described, on using Left ventricular (LV) strain and a LV pressure estimation, and another with only LV strain integrals. The present study analyzes their utility in prediction of CRT-response. Methods and results: 243 patients implanted by a CRT according to current recommendations were retrospectively included in hospital university of Rennes. All patients had a complete trans-thoracic echocardiography at implantation and at 6-moths follow-up. Responders were defined as having a 15% decrease in indexed LV end-systolic volume at follow-up compared to baseline. Baseline characteristics are described in table 1. 25.1% were non-responders. In this group, there were more men, more ischemic cardiomyopathies with more dilated LV. Strain signals ware analyzed only in the most informative loop, the apical 4 cavities. Myocardial work estimation with LV pressure estimation was previously described. The 3 different integral of strain signal were represented in figure 1. According to ROC curves, myocardial work (particularly wasted work in septal wall with AUC = 0.718 ± 0.04) estimated with LV pressure estimation is better than strain integrals to predict LV positive remodeling (best AUC 0.631 ± 0.040) after CRT-implantation. Conclusion Left ventricular pressure estimation give useful information on top of strain curves for prediction for CRT-response. Table 1 Responders n = 182 Non-responders n = 61 Men (%) 109 (59.9%) 52 (85%) Ischemic cardiomyopathy (%) 42 (23.1%) 34 (55.7%) LVEF (%) 28 ± 6 28 ± 7 GLS (%) -9 ± 3 -7 ± 3 LVEDD (mm) 62 ± 8 67 ± 7 LVEDVi (ml/m2) 85 ± 34 88 ± 30 LVEF Left ventricular ejection fraction; GLS: global longitudinal strain; LVEDD: left ventricular end-diastolic diameter; LVEDVi: left ventricular end diastolic volume index Abstract Figure 1

scholarly journals Usefulness of non-invasive myocardial work to predict left ventricular recovery and acute complications after acute anterior myocardial infarction treated by primary angioplasty

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Meimoun ◽  
S Abdani ◽  
M Gannem ◽  
V Stracchi ◽  
F Elmkies ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Global Longitudinal Strain ◽  
Primary Angioplasty ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anterior Myocardial Infarction ◽  
Ventricular Ejection Fraction ◽  
Non Invasive ◽  
2D Strain

Abstract Background Predicting left ventricular (LV) recovery after acute ST-elevation myocardial infarction (STEMI) is challenging and of prognostic importance. Objective To evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LV recovery and in-hospital complications after STEMI. Methods Ninety-three consecutive patients with anterior STEMI (mean age, 59±12 years) treated by primary angioplasty underwent transthoracic echocardiography (TTE) within 24–48 hours after angioplasty and a median of 92 days at follow-up. MW is derived from the non-invasive strain-pressure loop obtained from the 2D strain data, integrating in its calculation the non-invasive brachial arterial pressure. Segmental LV recovery was defined as a normalization of segmental wall motion abnormalities of the affected segments and global recovery as an absolute improvement of left ventricular ejection fraction (LVEF) greater than 5% in patients with baseline LVEF &lt;50%. In-hospital complications were defined as a composite of death, reinfarction, heart failure, and LV apical thrombus. Results 1642 segments were studied and MW was impaired in infarct segments, more severely in no recovery versus recovery segments (MW index, constructive MW, MW efficiency, all, p&lt;0.01). Furthermore, global MW was significantly correlated to acute and follow-up LVEF and global longitudinal strain (GLS) (all, p&lt;0.01). Constructive MW was the best indice to predict segmental (p&lt;0.01 versus MW index, MW efficiency, and wasted work), and global recovery (p&lt;0.05 versus GLS) with an independent association (all, p&lt;0.01). Moreover, global constructive MW was independently associated to in-hospital complications which occurred in 18 patients (p&lt;0.01). Conclusion In patients with anterior STEMI treated by primary angioplasty, acute constructive MW is an independent predictor of segmental and global LV recovery, as well as in-hospital complications. Funding Acknowledgement Type of funding source: None

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