scholarly journals Left ventricular function in rheumatoid arthritis during anti-TNF-α treatment: a speckle tracking prospective echocardiographic study

2016 ◽  
Vol 84 (1-2) ◽  
Author(s):  
Enrico Vizzardi ◽  
Ilaria Cavazzana ◽  
Franco Franceschini ◽  
Ivano Bonadei ◽  
Edoardo Sciatti ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Tnf Α ◽  
One Year

<p><strong>Aim</strong>. Rheumatoid arthritis (RA) shows a high risk for cardiovascular disease, including heart failure. Although TNF-α has been implicated in the pathogenesis of myocardial remodelling, TNF-α inhibition did not show any efficacy in patients with advanced heart failure and should be contraindicated in RA with cardiac complications. We aimed to assess global left ventricular (LV) systolic function using global longitudinal strain (GLS) as a measure of myocardial deformation, in a group of RA patients before and during anti-TNF-α treatment. <strong>Methods</strong>. 13 patients (female:male 7:6) affected by RA were prospectively followed for one year during anti TNF-α treatment. Every subject underwent echocardiography before starting anti-TNF-α drugs and after one year of treatment, to evaluate LV ejection fraction (EF), telediastolic diameter, telediastolic volume and global longitudinal strain (GLS) that was calculated using 2D speckle tracking as the mean GLS from three standard apical views (2, 3 and 4 -chambers). The patients showed a mean age of 43 years at RA onset (SD: 13) and a mean follow-up of 7.3 years (SD: 4.8). Steroid and methotrexate were used in 84.6% and 100%, respectively, in association with etanercept (6 cases), adalimumab (4 cases) and infliximab (3 cases). <strong>Results</strong>. Patients globally showed a normal EF before and after one year of treatment (mean: 65% and 65.7%, respectively). GLS did not differ before or after anti-TNF-α treatment (mean: -15.8% and -16.7%, respectively). <strong>Conclusion</strong>. Anti-TNF-α treatment did not significantly modify myocardial contractility after 12 months.</p><p> </p><p> </p>

scholarly journals Left ventricular systolic function impairment in children after balloon valvuloplasty for congenital aortic stenosis assessed by 2D speckle tracking echocardiography

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248862
Author(s):  
Krzysztof Godlewski ◽  
Paweł Dryżek ◽  
Elżbieta Sadurska ◽  
Bożena Werner
Keyword(s):  
Strain Rate ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Strain And Strain Rate ◽  
Eccentric Hypertrophy

Aims The aim of the study was to evaluate left ventricular (LV) remodeling and systolic function using two-dimensional speckle tracking echocardiographic (2D STE) imaging in children at a long-term (more than 36 months, 107.5±57.8 months) after balloon valvuloplasty for aortic stenosis (BAV). Methods and results 40 patients (mean age 9,68 years, 75% male) after BAV and 62 control subjects matched to the age and heart rate were prospectively evaluated. The 2D STE assessment of LV longitudinal and circumferential strain and strain rate was performed. Left ventricular eccentric hypertrophy (LVEH) was diagnosed in 75% of patients in the study group. Left ventricular ejection fraction (LVEF) was normal in all patients. In study group, global longitudinal strain (GLS), global longitudinal strain rate (GLSr) were significantly lower compared with the controls: GLS (-19.7±2.22% vs. -22.3±1.5%, P< 0.001), GLSr (-0.89±0.15/s vs. -1.04 ±0.12/s, P < 0.001). Regional (basal, middle and apical segments) strain and strain rate were also lower compared with control group. Global circumferential strain (GCS), global circumferential strain rate (GCSr) as well as regional (basal, middle and apical segments) strain and strain rate were normal. Multivariable logistic regression analysis included: instantaneous peak systolic Doppler gradient across aortic valve (PGmax), grade of aortic regurgitation (AR), left ventricular mass index (LVMI), left ventricular relative wall thickness (LVRWT), left ventricular end-diastolic diameter (LVEDd), peak systolic mitral annular velocity of the septal and lateral corner (S’spt, S’lat), LVEF before BAV and time after BAV and showed that the only predictor of reduced GLS was LV eccentric hypertrophy [odds ratio 6.9; (95% CI: 1.37–12.5), P = 0.045]. Conclusion Patients at long-term observation after BAV present the subclinical LV systolic impairment, which is associated with the presence of its remodeling. Longitudinal deformation is the most sensitive marker of LV systolic impairment in this group of patients.

P2614Comparison of global longitudinal strain and ejection fraction in correlation to NT-proBNP in ischemic and non-ischemic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Ablasser ◽  
D Von Lewinski ◽  
E Kolesnik ◽  
M Gangl ◽  
L Kattnig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Abstract Background In chronic heart failure (CHF) NT-proBNP and left ventricular ejection fraction (LVEF) by echocardiography are standard diagnostic as well as follow-up markers and are known to correlate with prognosis. Speckle-tracking echocardiography is a more recent technique to quantify myocardial deformation as a measurement of left ventricular function with potential benefits over LVEF. Purpose The purpose of this investigation was to analyse the cross-sectional relationship between 2D speckle tracking-derived global longitudinal strain (GLS) and NT-proBNP plasma levels in a prospective cohort of ischemic and non-ischemic CHF patients. Methods We enrolled 205 patients with chronic heart failure. Major inclusion criteria were age over 18 years, stable disease with absence of unplanned hospitalization or change in medication or device therapy in the previous month or major surgery in the previous 3 months. CHF treatment had to be according to the recommendations of the ESC CHF guidelines 2016 and LVEF had to be below 50%. Patient history, physical examination and an extensive echocardiography exam were performed. Lab results included NT-proBNP. Manual longitudinal strain was calculated using EchoPAC (General Electric Medical Systems, Horten, Norway) by a single and blinded examiner. LVEF was measured using Simpson's biplane method. Results 205 patients included in the study. The baseline characteristics included mean age 65.0 years and 75% male. Mean GLS was −9.6% (SD ±4.5%) and median NT-proBNP 1269.5 (IQR 379.5–2759.5) ng/ml. The CHF aetiology was 70.0% ischemic vs 30.0% non-ischemic. There was a significant negative correlation between GLS and NT-proBNP (Pearson r=0.239, p=0.029), this was not significant for LVEF and NT-proBNP (Pearson r=0.149, p=0.228).In a multivariate regression analysis adjusted for age, sex, NYHA classification and HF aetiology, GLS remained significantly correlated with NT-proBNP (adjusted beta-coefficient= 0.289, p=0.011). Furthermore, in contrast to LVEF, GLS showed a significant correlation to NT-proBNP in patients with ischemic (Pearson r=0.266, p=0.049) as well as non-ischemic aetiology of heart failure (Pearson r=0.434, p=0.034). Conclusion Global longitudinal strain, not LVEF, was significantly correlated with NT-proBNP in patients with CHF, independently of age, sex, symptoms or heart failure aetiology. This shows that speckle-tracking might be superior to LVEF for the assessment of left ventricular function in CHF.

scholarly journals Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction

2016 ◽  
Vol 10 ◽  
pp. CMC.S38407 ◽  
Author(s):  
Amal Mohamed Ayoub ◽  
Viola William Keddeas ◽  
Yasmin Abdelrazek Ali ◽  
Reham Atef El Okl
Keyword(s):  
Ejection Fraction ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Control Group ◽  
Hypertensive Patients

Background Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. Methods We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). Results There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson's method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. Conclusion 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention.

scholarly journals Effect of adrenalectomy on remission of subclinical left ventricular dysfunction in patients with pheochromocytoma: a speckle-tracking echocardiography study

2021 ◽  
Author(s):  
Jan Kvasnička ◽  
Ondřej Petrák ◽  
Tomas Zelinka ◽  
Judita Klímová ◽  
Barbora Kološová ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Dysfunction ◽  
Echocardiographic Examination ◽  
Recent Diagnosis ◽  
One Year ◽  
Lower Magnitude

Background: Pheochromocytomas (PHEO) are tumours with the ability to produce, metabolize and secrete catecholamines. Catecholamines overproduction leads to the decrease of longitudinal function of the left ventricle (LV) measured by speckle tracking echocardiography. Patients with PHEO have lower magnitude of global longitudinal strain (GLS) than patients with essential hypertension. GLS normalization is expected after resolution of catecholamine overproduction. Methods: Twenty-four patients (14 females and 10 males) with recent diagnosis of PHEO have been examined before and one year after adrenalectomy. An echocardiographic examination including speckle tracking analysis with the evaluation of GLS and regional longitudinal strain (LS) in defined groups of LV segments (basal, mid-ventricular and apical) was performed. Results: One year after adrenalectomy magnitude of GLS increased (−14.3 ± 1.8 to −17.7 ± 1.6 %; p < 0.001). When evaluating the regional LS, the most significant increase in the differences was evident in apical segment compared to mid-ventricular and basal segments of LV (-5.4 ± 5.0 vs. -1.9 ± 2.7 vs.-1.6 ± 3.8; p < 0.01). Conclusions: In patients with PHEO, adrenalectomy leads to an improvement of subclinical LV dysfunction represented by increasing magnitude of GLS, which is the most noticeable in apical segments of LV.

scholarly journals Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in ebstein anomaly

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Devara ◽  
M Iftikhar ◽  
A Goda ◽  
L Shaik ◽  
R Katta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Clinical Implications ◽  
Ebstein Anomaly ◽  
Free Survival ◽  
Lv Dysfunction ◽  
Lv Systolic Function

Abstract Background Certain factors such as left ventricular (LV) geometry and loading conditions affect the validity and reliability of LV ejection fraction (LVEF) as a true measure of LV contractility. LV global longitudinal strain (LVGLS) is less sensitive to these factors, and it has superior prognostic performance in patients with acquired heart disease. The purpose of this study was to determine the clinical implications of using LVGLS (instead of LVEF) as the measure of LV systolic function in adults with Ebstein anomaly given the inherent abnormalities of LV geometry and preload in this population. Methods Retrospective cohort study of 673 adults with Ebstein anomaly (2003–2018). We hypothesized that LVGLS had a stronger correlation with heart failure indices and transplant-free survival compared to LVEF. Results Compared to LVEF, LVGLS had stronger correlations with cardiac index (r=0.46 vs r=0.21, p=0.007), glomerular filtration rate (r=0.57 vs r=0.19, p&lt;0.001), and NT-proBNP (r=−0.64 vs r=−0.41, p=0.01). Of 673 patients, 514 (76%) had normal LV systolic function (LVGLSNormal-LVEFNormal), 87 (13%) had subclinical LV dysfunction (LVGLSLow-LVEFNormal) and 66 (10%) had overt LV dysfunction (LVGLSLow-LVEFLow). Compared to the overt LV dysfunction group, the subclinical LV dysfunction group had similar 10-year transplant-free survival (64% vs 63%, p=0.6), but were less likely to be on heart failure therapy (12% vs 82%, p&lt;0.001). LVGLS (but not LVEF) was the independent predictor of transplant-free survival Conclusions LVGLS provided more robust risk stratification and prognostication than LVEF in patients with Ebstein anomaly, and patients with low LVGLS had reduced transplant-free survival regardless of LVEF. The use of LVGLS (rather than LVEF) as the measure of LV systolic function has important clinical implications with regards to initiation of medical and surgical therapies. FUNDunding Acknowledgement Type of funding sources: None.

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.

scholarly journals 270 Prediction of congestive state and prognosis in acute and chronic heart failure: the association between NT-proBNP and left atrial strain

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Maria Concetta Pastore ◽  
Giulia Elena Mandoli ◽  
Nicolò Ghionzoli ◽  
Flavio D’Ascenzi ◽  
Luna Cavigli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Linear Regression Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Study Cohort ◽  
Phone Calls

Abstract Aims In acute and chronic heart failure (HF), the relief of congestion is one of the pivotal elements to improve patient’s quality of life and prognosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of cardiovascular (CV) congestion in HF, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography is emerging as an index of left ventricular (LV) filling pressure and prognosis in HF, however, its role as a marker of congestion should be further elucidated. The aim of our study was to determine the association between NT-proBNP and PALS in patients acute and chronic HF. Methods and results Patients hospitalized for de-novo or recurrent acute HF and patients with chronic HF referred to our echo-labs for follow-up evaluation were included in this retrospective study. Patients with missing data, previous cardiac surgery, heart transplant and/or left ventricular assist device implantation, non-feasible speckle tracking analysis were excluded. Clinical characteristics, laboratory examinations, transthoracic echocardiography data were collected. Speckle tracking analysis was performed offline on the echocardiographic records. Follow up data were obtained via electronical records or phone-calls. The primary clinical endpoint was a combination of all-cause death and HF hospitalization. The overall study cohort included 388 patients (172 with chronic HF and 216 with chronic HF). Mean age was 65 ± 12, 37% were female. Most patients had reduced LV systolic function (mean LV ejection fraction = 30 ± 10%; mean LV global longitudinal strain = −8.3 ± 3.9%). Patients with acute HF presented higher values of NT-proBNP than those with chronic HF [median (interquartile range) = 6039 (2989–13 535) pg/ml vs. 544 (200–1533) pg/ml] and lower global PALS =10.4 (6.3–16.45)% vs. 15.6 (10.6–21)%. Global PALS showed a significant inverse correlation with NT-proBNP both in acute and chronic HF (all P &lt; 0.001) and to be a significant predictor of NT-proBNP with linear regression analysis (R2 = 0.2; P &lt; 0.001). During a median follow-up of 1 year, 98 patients reached the combined endpoint (49 all-cause deaths, 16 CV deaths, 62 HF hospitalizations). With ROC curves, both NT-proBNP and global PALS showed to be good predictors of the combined endpoint (AUC = 0.87and 0.82, respectively, Figure 1). Conclusions Global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management in these patients. Both global PALS and NT-proBNP confirmed to be accurate prognostic markers in HF.

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