scholarly journals Non-Invasive Assessment of Left Ventricle Ejection Fraction: Where Do We Stand?

2021 ◽  
Vol 11 (11) ◽  
pp. 1153
Author(s):  
Alessandra Scatteia ◽  
Angelo Silverio ◽  
Roberto Padalino ◽  
Francesco De Stefano ◽  
Raffaella America ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricle Ejection Fraction ◽  
Advantages And Disadvantages ◽  
Non Invasive ◽  
Lv Ejection Fraction ◽  
Lv Systolic Function ◽  
Invasive Evaluation

The left ventricular (LV) ejection fraction (EF) is the preferred parameter applied for the non-invasive evaluation of LV systolic function in clinical practice. It has a well-recognized and extensive role in the clinical management of numerous cardiac conditions. Many imaging modalities are currently available for the non-invasive assessment of LVEF. The aim of this review is to describe their relative advantages and disadvantages, proposing a hierarchical application of the different imaging tests available for LVEF evaluation based on the level of accuracy/reproducibility clinically required.

scholarly journals Non-invasive Myocardial Work Index Contributes to Early Identification of Impaired Left Ventricular Myocardial Function in Uremic Patients With Preserved Left Ventricular Ejection Fraction

2021 ◽  
Author(s):  
Huizhen Zhu ◽  
Yanan Li ◽  
Cunying Cui ◽  
Danqing Huang ◽  
Yuanyuan Liu ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Sensitivity And Specificity ◽  
Myocardial Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Non Invasive ◽  
Work Index ◽  
Uremic Patients ◽  
Global Work ◽  
Lv Systolic Function

Abstract BackgroundCardiac damage is the leading cause of death in uremic patients. This study aimed to evaluate the application of non-invasive myocardial work index (NIMWI) by echocardiography in assessing the left ventricular (LV) systolic function in uremic patients.MethodsTwenty-six uremic patients and twenty-seven age- and sex-matched healthy volunteers were enrolled in the study. Except for the conventional echocardiographic parameters, the LV myocardial work (MW) parameters including GWI (myocardial global work index), GCW (global constructive work), GWW (global wasted work), and GWE (global work efficiency) were calculated in study participants. Differences in MW parameters between the uremic and normal groups were compared by independent-sample t-test. Receiver operating characteristic (ROC) curves were constructed for MW parameters to detect abnormal LV systolic function in uremic patients.ResultsCompared with the normal group, GWW was significantly increased and GWE decreased in the uremic group (P< 0.05). Area under the curve (AUC) for GWE by the ROC analysis was 0.966. The best threshold, sensitivity and specificity values of GWE to detect abnormality of LV systolic function in uremic patients were 92.5%, 0.89 and 0.96 respectively. ConclusionsNIMWI may be applied to assess the global MW of uremic patients. The presence of reduced GWE can help identify impaired left ventricular myocardial function in uremic patients with preserved LV ejection fraction with a high sensitivity and specificity.

scholarly journals Hemodynamics and Clinical Implications of Occult Left Ventricular Dysfunction in Adults Undergoing Ebstein Anomaly Repair

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Alexander C. Egbe ◽  
William R. Miranda ◽  
Joseph A. Dearani ◽  
Heidi M. Connolly
Keyword(s):  
Ejection Fraction ◽  
Organ Dysfunction ◽  
Tricuspid Valve ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Ebstein Anomaly ◽  
Lv Ejection Fraction ◽  
Lv Systolic Function

Background: Left ventricular global longitudinal strain (LVGLS) can detect early phases of LV systolic dysfunction, but its application has not been studied in Ebstein anomaly. We hypothesized that LVGLS can detect early phases of LV systolic dysfunction and that patients with occult LV systolic dysfunction will have worse hemodynamics, end-organ dysfunction, and suboptimal postoperative LV reverse remodeling after tricuspid valve surgery in comparison to patients with normal LV systolic function. Methods: In this retrospective cohort study, 371 Ebstein patients that underwent tricuspid valve surgery were divided into 3 groups: normal LV systolic function (normal LVGLS and LV ejection fraction; n=244, 77%), occult LV systolic dysfunction (abnormal LVGLS with normal LV ejection fraction; n=44, 14%), and overt LV systolic dysfunction (abnormal LVGLS and LV ejection fraction; n=27, 9%). Results: Compared with the normal LV function group, the occult group had smaller LV volume and cardiac output (2.1±0.4 versus 2.9±0.6 L/min per m 2 , P <0.001), worse end-organ dysfunction (glomerular filtration rate, 78±14 versus 91±18 mL/min per 1.73 m 2 , P =0.01), and suboptimal postoperative LV reverse remodeling. Although both the occult and overt groups had a similar degree of end-organ dysfunction (glomerular filtration rate, 78±14 versus 82±16 mL/min per 1.73 m 2 , P =0.3), the occult group was less likely to be on heart failure therapy (48% versus 96%, P <0.001). Conclusions: Abnormal LVGLS was associated with suboptimal postoperative LV reverse remodeling. These data suggest that LVGLS can potentially be used for risk stratification and provides a foundation for further studies to determine whether optimal heart failure therapy or tricuspid valve intervention can improve outcomes for LV systolic dysfunction in patients with Ebstein anomaly.

scholarly journals Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice

2021 ◽  
Vol 10 (19) ◽  
pp. 4521
Author(s):  
Federica Ilardi ◽  
Antonello D’Andrea ◽  
Flavio D’Ascenzi ◽  
Francesco Bandera ◽  
Giovanni Benfari ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Current Knowledge ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
New Method ◽  
Added Value ◽  
Non Invasive ◽  
Potential Applications ◽  
Lv Systolic Function

Left ventricular (LV) global longitudinal strain (GLS) has established itself in the last decade as a reliable, more objective method for the evaluation of LV systolic function, able to detect subtle abnormalities in LV contraction even in the presence of preserved ejection fraction (EF). However, recent studies have demonstrated that GLS, similar to LV EF, has important load dependency. Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative tool for myocardial function assessment. This new method, incorporating measurement of strain and LV pressure, has shown to overcome GLS and LV EF limitations and provide a loading-independent evaluation of myocardial performance. The presence of a commercially available echocardiographic software for the non-invasive MW calculation has allowed the application of this new method in different settings. This review sought to provide an overview on the current knowledge of non-invasive MW estimation, showing its potential applications and possible added value in clinical practice.

Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis

2016 ◽  
Vol 76 (2) ◽  
pp. 371-376 ◽  
Author(s):  
Helga Midtbø ◽  
Anne Grete Semb ◽  
Knut Matre ◽  
Tore K Kvien ◽  
Eva Gerdts
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Ejection Fraction ◽  
Disease Activity ◽  
Cardiovascular Risk Factors ◽  
Myocardial Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Ejection Fraction ◽  
Lv Systolic Function

ObjectivesDisease activity has emerged as a new, independent risk factor for cardiovascular disease in patients with rheumatoid arthritis (RA). We tested if disease activity in RA was associated with lower left ventricular (LV) systolic function independent of traditional cardiovascular risk factors.MethodsEchocardiographic assessment was performed in 78 patients with RA having low, moderate or high disease activity (Simplified Disease Activity Index (SDAI) >3.3), 41 patients in remission (SDAI ≤3.3) and 46 controls, all without known cardiac disease. LV systolic function was assessed by biplane Simpson ejection fraction, stress-corrected midwall shortening (scMWS) and global longitudinal strain (GLS).ResultsPatients with active RA had higher prevalence of hypertension and diabetes compared with patients in remission and controls (both p<0.05). LV ejection fraction (endocardial function) was normal in all three groups, while mean scMWS and GLS (myocardial function) were reduced in patients with RA with active disease compared with patients with RA in remission (95±18% vs 105±17% and −18.9±3.1% vs −20.6±3.5%, respectively, both p<0.01). Patients with RA in remission had similar scMWS and GLS as the controls. In multivariable analyses, having active RA was associated with lower GLS (β=0.21) and scMWS (β=−0.22, both p<0.05), both reflecting lower LV systolic myocardial function, independent of cardiovascular risk factors and LV ejection fraction. Classification of RA disease activity by other disease activity composite scores yielded similar results.ConclusionsActive RA is associated with lower LV systolic myocardial function despite normal ejection fraction and independent of traditional cardiovascular risk factors.

scholarly journals Estimation of myocardial work – a new concept of non-invasive left ventricular systolic function assessment

2021 ◽  
Vol 28 (1) ◽  
pp. 56-65
Author(s):  
M.Yu. Kolesnyk
Keyword(s):  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Non Invasive ◽  
Lv Systolic Function

Assessment of left ventricular (LV) systolic function is a mandatory component of cardiovascular diseases diagnostics. In clinical practice, the main parameters are the ejection fraction and LV global longitudinal strain. Both parameters have a number of limitations, including dependence on afterload. This review describes a new technique for non-invasive assessment of global and segmental myocardial contractility based on the calculation of myocardial work by analyzing pressure-strain curves. The main advantage of the technique is the ability to take into account the afterload conditions by the traditional measurement of blood pressure on the brachial artery. The characteristics of the key parameters of the methodology (global work index, global constructive work, global effective and wasted work) as well as their normative values are presented. The stages of the analysis and the limitations of the method are described separately. The results of the main pilot studies of myocardial work parameters in various cardiovascular diseases are presented. Possibilities of the technique for characterizing LV segmental function in left bundle branch block, selection of patients for cardiac resynchronization therapy with subsequent response assessment are presented. The diagnostic and prognostic value of the parameters of myocardial work in arterial hypertension, acute and chronic forms of ischemic heart disease, hypertrophic and dilated cardiomyopathy, chronic heart failure are analyzed. The possibilities of the technique in assessing the effectiveness of therapy in patients with heart failure are described. Potential advantages of the parameters of myocardial work over other markers of LV systolic function, such as ejection fraction and global longitudinal strain, have been determined. The review is illustrated with clinical examples of the use of the technique for various cardiovascular diseases from our own practice.

Myocardial work in Stage 1 and 2 hypertensive patients

2021 ◽  
Author(s):  
Akshar Jaglan ◽  
Sarah Roemer ◽  
Ana Cristina Perez Moreno ◽  
Bijoy K Khandheria
Keyword(s):  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Non Invasive ◽  
Significant Difference ◽  
Lv Ejection Fraction ◽  
Global Work ◽  
Stage 1

Abstract Aims Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. Methods and results Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure–strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P &lt; 0.001), and GWW (P &lt; 0.001). Conclusion Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.

Abstract 1962: Quantification of Longitudinal Right Ventricular Systolic Function and Its Coupling to Left Ventricular Global Function Using Speckle-Tracking Strain Imaging in Patients with Old Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kaoru Dohi ◽  
Katsuya Onishi ◽  
Shinya Kato ◽  
Takeshi Takamura ◽  
Naoki Fujimoto ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Speckle Tracking ◽  
Systolic Function ◽  
Strain Imaging ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Lv Ejection Fraction ◽  
Rv Function ◽  
Global Peak

Background: We tested the hypothesis that speckle-tracking strain imaging can quantify longitudinal right ventricular (RV) function and its association with left ventricular (LV) function in patients with myocardial infarction (MI). Methods: To quantify longitudinal RV function, 39 patients with old MI (OMI: LV ejection fraction 17 – 77 %, 45 ±16 %) and 29 age matched normal controls (Control: LV ejection fraction 65 ± 5 %) were studied with echocardiography. Longitudinal RV global peak systolic strain was assessed from apical four-chamber view using speckle-tracking imaging (EchoPAC, GE Electronic). RV fractional area change was also analyzed. Results: Longitudinal RV global peak systolic strain was significantly impaired in OMI compared to Control (−18 ± 5* and −25 ± 4 %, *p < 0.05 vs. Control) whereas RV fractional area change failed to discriminate from normal to impaired RV function (OMI: 48 ± 11 vs. Control: 52 ± 6 %, p = NS). When divided OMI into three groups regarding to plasma BNP level (Group A: BNP < 100 pg/ml; n = 14, Group B: 100 pg/ml ≤ BNP < 500 pg/ml; n = 14, and Group C; BNP ≥ 500 pg/ml; n = 11), Group A had no significant relations between longitudinal RV global peak systolic strain and LV ejection fraction (y = −0.07x − 11, r = 0.30, p = NS) whereas those were significantly correlated in Group B (y = −0.18x − 11, r = 0.59*, *p < 0.05). Furthermore, the strongest correlation between longitudinal RV global peak systolic strain and LV ejection fraction was observed in Group C (y = −0.58x + 5, r = 0.90*, *p < 0.05). Conclusion: Speckle tracking strain imaging quantified longitudinal RV global systolic function and exhibited its BNP-related dependency to LV systolic function in patents with OMI.

The impact of endurance exercise training on left ventricular systolic mechanics

2008 ◽  
Vol 295 (3) ◽  
pp. H1109-H1116 ◽  
Author(s):  
Aaron L. Baggish ◽  
Kibar Yared ◽  
Francis Wang ◽  
Rory B. Weiner ◽  
Adolph M. Hutter ◽  
...  
Keyword(s):  
Exercise Training ◽  
Ejection Fraction ◽  
Endurance Exercise ◽  
Systolic Function ◽  
Radial Strain ◽  
Left Ventricular ◽  
Functional Changes ◽  
Endurance Exercise Training ◽  
Lv Systolic Function ◽  
The Impact

Although exercise training-induced changes in left ventricular (LV) structure are well characterized, adaptive functional changes are incompletely understood. Detailed echocardiographic assessment of LV systolic function was performed on 20 competitive rowers (10 males and 10 females) before and after endurance exercise training (EET; 90 days, 10.7 ± 1.1 h/wk). Structural changes included LV dilation (end-diastolic volume = 128 ± 25 vs. 144 ± 28 ml, P < 0.001), right ventricular (RV) dilation (end-diastolic area = 2,850 ± 550 vs. 3,260 ± 530 mm2, P < 0.001), and LV hypertrophy (mass = 227 ± 51 vs. 256 ± 56 g, P < 0.001). Although LV ejection fraction was unchanged (62 ± 3% vs. 60 ± 3%, P = not significant), all direct measures of LV systolic function were altered. Peak systolic tissue velocities increased significantly (basal lateral S′Δ = 0.9 ± 0.6 cm/s, P = 0.004; and basal septal S′Δ = 0.8 ± 0.4 cm/s, P = 0.008). Radial strain increased similarly in all segments, whereas longitudinal strain increased with a base-to-apex gradient. In contrast, circumferential strain (CS) increased in the LV free wall but decreased in regions adjacent to the RV. Reductions in septal CS correlated strongly with changes in RV structure (ΔRV end-diastolic area vs. ΔLV septal CS; r2 = 0.898, P < 0.001) and function (Δpeak RV systolic velocity vs. ΔLV septal CS, r2 = 0.697, P < 0.001). EET leads to significant changes in LV systolic function with regional heterogeneity that may be secondary to concomitant RV adaptation. These changes are not detected by conventional measurements such as ejection fraction.

Left ventricular long-axis changes in early diastole and systole: impact of systolic function on diastole

2002 ◽  
Vol 102 (5) ◽  
pp. 515-522 ◽  
Author(s):  
Gabriel W. YIP ◽  
Yan ZHANG ◽  
Peggy Y. TAN ◽  
Mei WANG ◽  
Pik-Yuk HO ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Peak Velocity ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Early Diastole ◽  
Non Linear ◽  
Lv Ejection Fraction

Impaired long-axis motion is a sensitive marker of systolic myocardial dysfunction, but no data are available that relate long-axis changes in systole with those in diastole, particularly in subjects with diastolic dysfunction and a ‘normal’ left ventricular (LV) ejection fraction. A total of 311 subjects (including 105 normal healthy volunteers) aged 20-89 years with variable degrees of systolic function (LV ejection fraction range 0.15-0.84) and diastolic function were studied using tissue Doppler echocardiography and M-mode echocardiography to determine mean mitral annular amplitude and peak velocity in systole and early and late diastole. The LV systolic mitral annular amplitude (SLAX, where LAX is long-axis amplitude) and peak velocity (Sm) correlated well with the respective early diastolic components (ELAX and Em) and late diastolic (atrial) components (ALAX and Am). A non-linear equation fitted better than a linear relationship (non-linear model: SLAX against ELAX, r2 = 0.67; Sm against Em, r2 = 0.60; SLAX against ALAX and Sm against Am, r2 = 0.42). After adjusting for age, sex and heart rate, linear relationships of early diastolic (ELAX, r2 = 0.70; Em, r2 = 0.60) and late diastolic (ALAX, r2 = 0.61; Am, r2 = 0.64) long-axis amplitudes and velocities with the respective values for SLAX and Sm were found, even in those subjects with apparently ‘isolated’ diastolic dysfunction. Long-axis changes in systole or diastole did not correlate with Doppler mitral velocities. We conclude that ventricular long-axis changes in early diastole are closely related to systolic function, even in subjects with diastolic dysfunction. ‘Pure’ or isolated diastolic dysfunction is uncommon.

scholarly journals Non-invasive intraventricular pressure differences estimated with cardiac MRI in subjects without heart failure and with heart failure with reduced and preserved ejection fraction

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001088 ◽  
Author(s):  
Francisco Londono-Hoyos ◽  
Patrick Segers ◽  
Zeba Hashmath ◽  
Garrett Oldland ◽  
Maheshwara Reddy Koppula ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Spatiotemporal Pattern ◽  
Intraventricular Pressure ◽  
Preserved Ejection Fraction ◽  
Non Invasive ◽  
Echocardiographic Parameters

ObjectiveNon-invasive assessment of left ventricular (LV) diastolic and systolic function is important to better understand physiological abnormalities in heart failure (HF). The spatiotemporal pattern of LV blood flow velocities during systole and diastole can be used to estimate intraventricular pressure differences (IVPDs). We aimed to demonstrate the feasibility of an MRI-based method to calculate systolic and diastolic IVPDs in subjects without heart failure (No-HF), and with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).MethodsWe studied 159 subjects without HF, 47 subjects with HFrEF and 32 subjects with HFpEF. Diastolic and systolic intraventricular flow was measured using two-dimensional in-plane phase-contrast MRI. The Euler equation was solved to compute IVPDs in diastole (mitral base to apex) and systole (apex to LV outflow tract).ResultsSubjects with HFpEF demonstrated a higher magnitude of the early diastolic reversal of IVPDs (−1.30 mm Hg) compared with the No-HF group (−0.78 mm Hg) and the HFrEF group (−0.75 mm Hg; analysis of variance p=0.01). These differences persisted after adjustment for clinical variables, Doppler-echocardiographic parameters of diastolic filling and measures of LV structure (No-HF=−0.72; HFrEF=−0.87; HFpEF=−1.52 mm Hg; p=0.006). No significant differences in systolic IVPDs were found in adjusted models. IVPD parameters demonstrated only weak correlations with standard Doppler-echocardiographic parameters.ConclusionsOur findings suggest distinct patterns of systolic and diastolic IVPDs in HFpEF and HFrEF, implying differences in the nature of diastolic dysfunction between the HF subtypes.

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