A STUDY ON GLOBAL LONGITUDINAL STRAIN IN PREDICTING PACING INDUCED LEFT VENTRICULAR DYSFUNCTION OVER TIME IN POST PERMANENT PACEMAKER PATIENTS

OBJECTIVE:The goal of this study is to predict the long term LV function in RV apical paced patients. BACKGROUND:We have used the GLS measured by 2D STE, as a tool to predict the patients who are at high risk of developing pacing induced LV dysfunction (PIVD) or pacing induced cardiomyopathy (PCMP). METHOD: A prospective study conducted in the cardiology department of Government Rajaji Hospital, Madurai, including 47 patients of AV block or sinus node dysfunction with preserved ejection fraction undergoing RV apical pacing. This study population was followed up with serial trans thoracic 2D echocardiography with GLS by STE for a period of 12 months for the development of PIVD (PCMP). RESULTS: Of the study population, 42.5% (n=20) developed PIVD at 12 months and these patients had a signicant fall in their GLS values at one month post pacing. (GLS -16.94% vs -17.60%; p=0.02). CONCLUSION: GLS, a novel echocardiographic parameter can be used as a tool in predicting the decline in ejection fraction following pacemaker implantation with potential to predict the development of PIVD. GLS at one month post pacing had a high predictive accuracy for identifying those who developed PIVD later in the follow up.

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Application of the current HFA-ESC consensus guidelines on diagnosis of heart failure with preserved ejection fraction to a population referred for echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.038 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Liang ◽

R Hearse-Morgan ◽

S Fairbairn ◽

Y Ismail ◽

AK Nightingale

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Diastolic Function ◽

Global Longitudinal Strain ◽

Diagnostic Algorithm ◽

Left Ventricular ◽

Lv Function ◽

Preserved Ejection Fraction ◽

Consensus Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The recent Heart Failure Association (HFA) of the European Society of Cardiology (ESC) consensus guidelines on diagnosis of heart failure with preserved ejection fraction (HFpEF) have developed a simple diagnostic algorithm for clinical use. PURPOSE To assess whether echocardiogram (echo) parameters needed to assess diastolic function are routinely collected in patients referred for assessment of heart failure symptoms. METHODS Retrospective analysis of echo referrals in January 2020 were assessed for parameters of diastolic function as per step 2 of the HF-PEFF diagnostic algorithm. Echo images and clinical reports were reviewed. Electronic records were utilised to obtain clinical history, blood results (NT-proBNP) and demographic data. RESULTS 1330 patients underwent an echo in our department during January 2020. 83 patients were referred with symptoms of heart failure without prior history of cardiac disease; 20 patients found to have impaired left ventricular (LV) function were excluded from analysis. Of the 63 patients with possible HFpEF, HF-PEFF score was low in 18, intermediate in 33 and high in 12. Median age was 68 years (range 32 to 97 years); 25% had a BMI >30. There was a high prevalence of hypertension (52%), diabetes (19%) and atrial fibrillation (40%) (cf. Table 1). Body surface area (BSA) was documented in 65% of echo reports. Most echo parameters were recorded with the exception of global longitudinal strain (GLS) and indexed LV mass (cf. image 1). NT-proBNP was recorded in only 20 patients (31.7%). 12 patients with an intermediate HF-PEFF score could have been re-categorised to a high score depending on GLS and NT-proBNP (which were not recorded). CONCLUSION More than three quarters of echoes acquired in our department obtained the relevant parameters to assess diastolic function. The addition of BSA, and inclusion of NT-proBNP, and GLS would have been additive to a third of ‘intermediate’ patients to determine definite HFpEF. Our study demonstrates that the current HFA-ESC diagnostic algorithm and HF-PEFF scoring system are easy to use, highly relevant and applicable to current clinical practice. Age >70 years 29 (46.0%) Obesity (BMI >30) 16 (25.4%) Diabetes 12 (19%) Hypertension 33 (52.4%) Atrial Fibrillation 25 (39.7%) ECG abnormalities 18 (28.5%) Table 1. Prevalence of Clinical Risk Factors Abstract Figure. Image 1. HFPEFF score & echo parameters

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P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.459 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

F Sahiti ◽

C Morbach ◽

C Henneges ◽

M Hanke ◽

R Ludwig ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Future Research ◽

Lv Function ◽

Acutely Decompensated Heart Failure

Abstract OnBehalf AHF Registry Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF <40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF). Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates. Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF <40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table). Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF. Abstract P803 Figure.

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Variability in echocardiography and MRI for detection of cancer therapy cardiotoxicity

Heart ◽

10.1136/heartjnl-2019-316297 ◽

2020 ◽

Vol 106 (11) ◽

pp. 817-823 ◽

Cited By ~ 7

Author(s):

James Lambert ◽

Mariana Lamacie ◽

Babitha Thampinathan ◽

Mustafa A Altaha ◽

Maryam Esmaeilzadeh ◽

...

Keyword(s):

Healthy Volunteers ◽

Temporal Variability ◽

Global Longitudinal Strain ◽

Cancer Therapeutics ◽

Temporal Changes ◽

Left Ventricular ◽

Lv Function ◽

Intraobserver Variability ◽

2D Echocardiography ◽

The Mean

ObjectivesTo compare variability of echocardiographic and cardiovascular magnetic resonance (CMR) measured left ventricular (LV) function parameters and their relationship to cancer therapeutics-related cardiac dysfunction (CTRCD).MethodsWe prospectively recruited 60 participants (age: 49.8±11.6 years), 30 women with human epidermal growth factor receptor 2-positive breast cancer (15 with CTRCD and 15 without CTRCD) and 30 healthy volunteers. Patients were treated with anthracyclines and trastuzumab. Participants underwent three serial CMR (1.5T) and echocardiography studies at ~3-month intervals. Cine-CMR for LV ejection fraction (LVEF), myocardial tagging for global longitudinal strain (GLS) and global circumferential strain (GCS), two-dimensional (2D) echocardiography for strain and LVEF and three-dimensional (3D) echocardiography for LVEF measurements were obtained. Temporal, interobserver and intraobserver variability were calculated as the coefficient of variation and as the SE of the measurement (SEM). Minimal detected difference (MDD) was defined as 2xSEM.ResultsPatients with CTRCD demonstrated larger mean temporal changes in all parameters compared with those without: 2D-LVEF: 4.6% versus 2.8%; 3D-LVEF: 5.2% vs 2.3%; CMR-LVEF: 6.6% versus 2.7%; 2D-GLS: 1.9% versus 0.7%, 2D-GCS: 2.5% versus 2.2%; CMR-GCS: 2.7% versus 1.6%; and CMR-GLS: 2.1% versus 1.4%, with overlap in 95% CI for 2D-LVEF, 2D-GCS, CMR-GLS and CMR-GCS. The respective mean temporal variability/MDD in healthy volunteers were 3.3%/6.5%, 1.8%/3.7%, 2.2%/4.4%, 0.8%/1.5%, 1.9%/3.7%, 1.8%/3.6% and 1.4%/2.8%. Although the mean temporal variability in healthy volunteers was lower than the mean temporal changes in CTRCD, at the individual level, 2D-GLS, 3D-LVEF and CMR-LVEF had the least overlap. 2D-GLS and CMR-LVEF had the lowest interobserver/intraobserver variabilities.ConclusionTemporal changes in 3D-LVEF, 2D-GLS and CMR LVEF in patients with CTRCD had the least overlap with the variability in healthy volunteers; however, 2D-GLS appears to be the most suitable for clinical application in individual patients.

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

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.470 ◽

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 <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) <0.001 LVESDI, mm/m2 30.3 ± 6.1 26.6 ± 6.6 -3.7 (-4.6 to -2.8) <0.001 LVEDVI, mL/m2 95.0 ± 30.7 74.3 ± 30.2 -20.7 (-25.6 to -15.8) <0.001 LVESVI, mL/m2 70.0 ± 24.8 50.2 ± 26.8 -19.8 (-24.2 to -15.4) <0.001 LVEF, % 26.8 ± 7.5 33.9 ± 12.6 7.2 (5.2 to 9.2) <0.001 LV GLS (-%) 9.2 ± 3.1 11.0 ± 4.8 1.8 (1.3 to 2.2) <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) <0.001 LVESVI, mL/m2 67.1 ± 24.4 59.5 ± 25.3 -7.6 (-10.9 to -4.3) <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) <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) <0.001 LVESDI, mm/m2 32.2 ± 5.7 21.9 ± 4.4 -10.3 (-11.9 to -8.6) <0.001 LVEDVI, mL/m2 102.7 ± 30.2 51.1 ± 15.0 -51.7 (-61.6 to -41.7) <0.001 LVESVI, mL/m2 77.3 ± 24.5 26.4 ± 11.3 -50.9 (-58.8 to -43.1) <0.001 LVEF, % 26.1 ± 7.9 49.4 ± 9.5 23.9 (20.4 to 27.5) <0.001 LV GLS (-%) 11.9 ± 1.6 16.9 ± 2.7 5.1 (4.2 to 5.9) <0.001 Baseline and Follow-up LV Functional Echocardiographic Data Abstract P818 Figure.

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Left Ventricular Function Assessment by Strain Analysis in Patients with Severe Aortic Stenosis with Preserved Ejection Fraction Undergoing Aortic Valve Replacement – A Prospective Longitudinal Study at a Tertiary Health Care Centre of South India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/446 ◽

2021 ◽

Vol 8 (27) ◽

pp. 2405-2411

Author(s):

Syed Waleem Pasha ◽

Narasimha D. Pai ◽

Padmanabha Kamath ◽

Ramanatha L. Kamath ◽

Francis N.P. Monteiro

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Ejection Fraction ◽

Aortic Valve Replacement ◽

Strain Rate ◽

Valve Replacement ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Study Population

BACKGROUND Aortic stenosis (AS) is the most common, single, native valvular heart disease in adult population. The purpose of this study was to detect abnormalities in global longitudinal strain (GLS) and strain rate using 2D - STI in patients with severe AS and preserved left ventricular ejection fraction (LVEF). The effect of aortic valve replacement (AVR) on changes in strain parameters 30 days after surgery was also analysed. METHODS A total number of 60 patients aged more than 18 years with aortic valve disease scheduled for surgical aortic valve replacement admitted in Department of Cardiology, KMC hospital Mangalore, were included over a period of 18 months from January 2017 to June 2018. RESULTS A total of 60 patients with severe AS, defined by an aortic valve area of < 1 cm², mean transaortic pressure gradient ( P) of > 40 mmHg and maximum aortic velocity (Vmax) of > 4 m/sec were studied. Mean age of the study population was 63.5 years. 60 % of the population were males and 40 % being females. Most common risk factor present in the study population was diabetes mellitus (DM). 83% of the patients in the study population had at least one symptom. Most common symptom with which the patients presented was exertional dyspnoea. All patients had normal left ventricle (LV) cavity dimensions and LVEF prior to surgery with diastolic dysfunction being present in all patients. The LV ejection fraction is not significantly altered. The aortic valve area calculated by continuity equation has significantly increased post AVR with a significant reduction in transaortic peak and means pressure gradients. Mean global longitudinal strain (GLS) improved from -15.1 % to - 16.9 % (P < 0.001) and longitudinal strain rate improved from -0.8 to -0.9/s (P < 0.001). CONCLUSIONS Global longitudinal strain and strain rate can be adequately measured by 2D speckle-tracking imaging and can be used to detect subtle changes of myocardial function in patients with severe AS with preserved LVEF. KEYWORDS Aortic Stenosis, Exertional Dyspnoea, Global Longitudinal Strain, Transaortic Pressure Gradient, Ventricular Hypertrophy

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Abstract 11749: Prognostic Value of Left Ventricular Global Longitudinal Strain and Ejection Fraction in Patients With Non-ischemic and Ischemic Heart Disease

Circulation ◽

10.1161/circ.132.suppl_3.11749 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Tetsuari Onishi ◽

Yasue Tsukishiro ◽

Hiroya Kawai

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Ejection Fraction ◽

Ischemic Heart Disease ◽

Prognostic Value ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Ischemic Heart ◽

Lv Function

Background: Both Left ventricular (LV) global longitudinal strain (GLS) and LV ejection fraction (LVEF) are useful parameters for assessment of LV function. The aim of this study is to confirm the prognostic value of them in patients with non-ischemic and ischemic heart disease. Methods: We studied 179 patients (DCM group: Age 61±15 years, 70 females, LVEF 33±9%) with non-ischemic dilated cardiomyopathy and heart failure symptom, and 97 patients (MI group: Age 66±13 years, 18 females, LVEF 45±7%) who were successfully treated with percutaneous coronary intervention for acute anteroseptal myocardial infarction. Echocardiography was used for LV GLS derived from 2D speckle-tracking method and LVEF with modified Simpson’s method. Outcome was assessed according to death and re-hospitalization with heart failure in the follow-up period. Results: 40 patients in DCM group and 10 patients in MI group experienced at least one event. In these 2 groups, significant differences in GLS and LVEF were found between patients with and without cardiac events (p<0.05). Kaplan-Meier analysis showed patients with worse GLS had an unfavorable outcome in both DCM and MI groups (p<0.05), but LVEF did not associated with outcome. Conclusion: LV GLS has the potential to predict the outcome with higher sensitivity than LVEF in patients with heart disease regardless of ischemic etiology.

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P4134Impaired left ventricular systolic function in alcohol abusers expressed by both 3D calculated ejection fraction and longitudinal strain by AFI

European Heart Journal ◽

10.1093/eurheartj/ehz745.0706 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Hamala ◽

J D Kasprzak ◽

P Lipiec ◽

K Wierzbowska-Drabik

Keyword(s):

Alcohol Abuse ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Harmful Effect ◽

Left Ventricular ◽

Control Group ◽

Lv Function ◽

Alcohol Abusers

Abstract Aim Despite knowledge regarding the existence of alcohol cardiomyopathy the exact impact of alcohol abuse in consecutive subject is poorly examined. We aimed to evaluate the left ventricle (LV) function in chronic abusers group and compared classical and novel echocardiography parameters in alcohol abusers (ALC) and control group (C). Methods We compared 75 adults (mean age 48±12, 60 male) without other overt heart disease, coronary artery disease excluded, but with alcohol abuse history: average alcohol intake 32 alcohol unit per week (AUW) with control group consisted of 40 subjects without history of excessive drinking, abstinents or drinking ≤8 AUW (mean age 50±4, 16 men). One unit was defined as 10 grams of pure etanol. All patients underwent TTE examination including ejection fraction (EF) calculation with 3D and longitudinal strain assessment by AFI method. Results ALC group showed LV systolic dysfunction expressed as EF 48±14 vs 60±9%, global longitudinal strain (AFI GLS) −15.6±6.6 vs −18.7±3.4; p<0.0001 and p 0.0064, respectively. On the other hand the LV and left atrial diameters as well as diastolic function were similar in both groups, indicating on relatively low advancement of heart remodeling. ALC vs Control group comparison ALC N75 C N40 p value Age 48±12 50±4 ns BMI 24±6 28±6 0.0009 LVd 48±13 47±4 ns LVs 34±15 32±4 ns LA 38±9 38±3 ns EF 48±14 60±9 <0.0001 E/A 1.1±0.6 1.1±0.3 ns E' lateral 10.6±3.9 10.6±2.9 ns AFI 2ch −15.9±6.9 −18.8±4.8 0.0143 AFI 3ch −15.9±6.9 −18.9±3.6 0.0116 AFI 4ch −15.2±7.1 −18.6±3.5 0.0053 AFI GLS −15.6±6.6 −18.7±3.4 0.0064 Conclusions Chronic alcohol abuse revealed harmful effect on LV systolic function which can be assessed quantitatively by both decreased EF and absolute values of myocardial longitudinal strain. This systolic function impairment seems to anticipate the overt remodelling of the heart.

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Echocardiographic Evaluation of LV Function in Patients with Tachyarrhythmia and Reduced Left Ventricular Function in Response to Rhythm Restoration

Journal of Clinical Medicine ◽

10.3390/jcm10163706 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3706

Author(s):

Christian Schach ◽

Thomas Körtl ◽

Rolf Wachter ◽

Lars S. Maier ◽

Samuel Sossalla

Keyword(s):

Heart Rate ◽

Ejection Fraction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Left Ventricular Geometry ◽

Lv Function ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Systolic Volume

Aims: Tachyarrhythmia due to atrial fibrillation (AF) is often associated with reduced left ventricular (LV) function and has been proposed to cause arrhythmia-induced cardiomyopathy (AIC). However, the precise diagnostics of AIC and reversibility after rhythm restoration are poorly understood. Our aim was to investigate systolic LV function in tachycardic AF and to evaluate the direct effect of rhythm restoration. Methods: We prospectively studied 24 patients (71% male, age 65 ± 9 years) with tachycardic AF and newly diagnosed reduced left ventricular ejection fraction (LVEF). Just before and immediately after electrical cardioversion (ECV), transthoracic echocardiography was performed. Geometric as well as functional data were assessed. Results: Patients presented with a heart rate (HR) of 117.4 ± 21.6/min and a 2D-/3D-LVEF of 32 ± 9/31 ± 8%. ECV to sinus rhythm normalized HR to 77 ± 11/min with an increase of 2D-/3D-LVEF to 37 ± 9/37 ± 10% (p < 0.01 vs. baseline, each). Left ventricular geometry changed with an increase of end-diastolic volume (LVEDV) while end-systolic volume (LVESV) remained unchanged. Parameters concerning myocardial deformation (global longitudinal strain (GLS), strain rate (SR)) decreased whereas the RR interval-corrected GLS (GLSc) remained unchanged. In a simple linear regression model, GLS correlated with 2D- and 3D-LVEF not only before (pre) ECV, but also after (post) ECV. We demonstrate that the increase of LVEF and GLS (ratios pre/post) correlates with the change of HR (ΔHR; R2 = 0.20, 0.33 and 0.32, p < 0.05 each), whereas ratios of GLSc and SR do not significantly correlate with HR (R2 = 0.03 and 0.01, p = n.s. each). Conclusion: In patients with tachyarrhythmia and reduced ejection fraction, ECV leads to immediate improvement in EF and GLS while HR-corrected LV contractility remains unchanged. This suggests that the immediate effects of rhythm restoration are mostly related to changes in left ventricular volume, but not to an acute improvement of heart-rate independent contractility.

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Association Between Left Ventricular Mechanical Deformation and Myocardial Fibrosis in Nonischemic Cardiomyopathy

Journal of the American Heart Association ◽

10.1161/jaha.120.016797 ◽

2020 ◽

Vol 9 (19) ◽

Author(s):

Ibolya Csecs ◽

Farhad Pashakhanloo ◽

Amanda Paskavitz ◽

Jihye Jang ◽

Talal Al‐Otaibi ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Ejection Fraction ◽

Global Longitudinal Strain ◽

Mechanical Deformation ◽

Left Ventricular ◽

Lv Function ◽

Nonischemic Cardiomyopathy ◽

Deformation Parameters ◽

Lv Ejection Fraction

Background In patients with nonischemic cardiomyopathy, nonischemic fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is related to adverse cardiovascular outcomes. However, its relationship with left ventricular (LV) mechanical deformation parameters remains unclear. We sought to investigate the association between LV mechanics and the presence, location, and extent of fibrosis in patients with nonischemic cardiomyopathy. Methods and Results We retrospectively identified 239 patients with nonischemic cardiomyopathy (67% male; 55±14 years) referred for a clinical cardiovascular magnetic resonance. LGE was present in 109 patients (46%), most commonly (n=52; 22%) in the septum. LV deformation parameters did not differentiate between LGE‐positive and LGE‐negative groups. Global longitudinal, radial, and circumferential strains, twist and torsion showed no association with extent of fibrosis. Patients with septal fibrosis had a more depressed LV ejection fraction (30±12% versus 35±14%; P =0.032) and more impaired global circumferential strain (−7.9±3.5% versus −9.7±4.4%; P =0.045) and global radial strain (10.7±5.2% versus 13.3±7.7%; P =0.023) than patients without septal LGE. Global longitudinal strain was similar in both groups. While patients with septal‐only LGE (n=28) and free wall–only LGE (n=32) had similar fibrosis burden, the septal‐only LGE group had more impaired LV ejection fraction and global circumferential, longitudinal, and radial strains (all P <0.05). Conclusions There is no association between LV mechanical deformation parameters and presence or extent of fibrosis in patients with nonischemic cardiomyopathy. Septal LGE was associated with poor global LV function, more impaired global circumferential and radial strains, and more impaired global strain rates.

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Early Right Ventricular Apical Pacing-Induced Gene Expression Alterations Are Associated with Deterioration of Left Ventricular Systolic Function

Disease Markers ◽

10.1155/2017/8405196 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Haiyan Xu ◽

Xiongwei Xie ◽

Jiangjin Li ◽

Yuanyuan Zhang ◽

Changsong Xu ◽

...

Keyword(s):

Energy Metabolism ◽

Right Ventricular ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Pacemaker Implantation ◽

Right Ventricular Outflow Tract ◽

Left Ventricular ◽

Lv Function ◽

High Dose ◽

Mrna Levels

The chronic high-dose right ventricular apical (RVA) pacing may have deleterious effects on left ventricular (LV) systolic function. We hypothesized that the expression changes of genes regulating cardiomyocyte energy metabolism and contractility were associated with deterioration of LV function in patients who underwent chronic RVA pacing. Sixty patients with complete atrioventricular block and preserved ejection fraction (EF) who underwent pacemaker implantation were randomly assigned to either RVA pacing (n=30) group or right ventricular outflow tract (RVOT) pacing (n=30) group. The mRNA levels of OPA1 and SERCA2a were significantly lower in the RVA pacing group at 1 month’s follow-up (both p<0.001). Early changes in the expression of selected genes OPA1 and SERCA2a were associated with deterioration in global longitudinal strain (GLS) that became apparent months later (p=0.002 and p=0.026, resp.) The altered expressions of genes that regulate cardiomyocyte energy metabolism and contractility measured in the peripheral blood at one month following pacemaker implantation were associated with subsequent deterioration in LV dyssynchrony and function in patients with preserved LVEF, who underwent RVA pacing.

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