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Bigdelu L, Alimi H, Poorzand H, Ghaderi F, Afshar S, Rafighdoost AH, Baradaran Rahimi V. Relationship between New York functional class and duke activity status index with the severity of mitral valve stenosis and echocardiographic parameters: is left atrial strain a better predictor? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1115-1122. [PMID: 38589678 DOI: 10.1007/s10554-024-03082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/09/2024] [Indexed: 04/10/2024]
Abstract
Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r = - 0.73) and MVA (r = - 0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r = - 0.62), LAV (r = - 0.65), LAVI (r = - 0.56), E (r = - 0.46), A (r = - 0.3), and PAP (r = - 0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.
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Affiliation(s)
- Leila Bigdelu
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoorak Poorzand
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Ghaderi
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Afshar
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hossein Rafighdoost
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
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Anwar AM. Potential Diagnostic and Prognostic Values of Left Atrial Strain in Valvular Heart Disease. J Cardiovasc Echogr 2024; 34:41-49. [PMID: 39086705 PMCID: PMC11288298 DOI: 10.4103/jcecho.jcecho_9_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/25/2024] [Accepted: 04/24/2024] [Indexed: 08/02/2024] Open
Abstract
There has been increasing evidence supporting the importance of left atrial (LA) functional analysis and measurement in various physiologic and pathologic cardiovascular conditions due to its high diagnostic and prognostic values. Assessment of LA strain (LAS) has emerged as an early marker of subclinical LA dysfunction. Using speckle-tracking echocardiography, LAS can be measured in all phases of LA function (reservoir, conduit, and booster pump). In valvular heart disease (VHD), surgical and nonsurgical interventions should be performed before irreversible left ventricular (LV) and/or LA myocardial dysfunction. The current guidelines recommended using LV strain as a parameter for early detection and timely intervention. Currently, many published data have shown the diagnostic and prognostic values of LAS in VHD, which is encouraging to integrate LAS during echo assessment. In this review, we aim to collect the current data about the clinical utility of LAS changes in risk stratification, predicting outcome, and guiding the time of intervention in VHD. The review summarized these data according to the type of valve pathologies.
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Affiliation(s)
- Ashraf Mohammed Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Dedeoğlu R, Bornaun H, Dedeoglu S. Left atrial and left ventricular strain dynamics with echocardiography in asymptomatic children with mitral regurgitation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:633-641. [PMID: 38315318 DOI: 10.1007/s10554-023-03033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/08/2023] [Indexed: 02/07/2024]
Abstract
Left atrial (LA) dilatation is a strong predictor of cardiovascular morbidity and mortality. Strain parameters evaluating LA functions have gained importance in assessing cardiovascular health. This study aimed to investigate the relationship between LA and left ventricular (LV) strain, using speckle-tracking echocardiography, and assess the impact of vena contracta on LV functioning in asymptomatic children with mitral regurgitation. We evaluated 45 asymptomatic mitral regurgitation patients, categorized as mild, moderate, and severe. LV strain was significantly lower in the moderate group (-17.8 ± 3.7%) and further reduced in the severe group (16 ± 2.1%) compared to the reference group (20.5 ± 6.2%). Conversely, LA reservoir strain was higher in the severe and moderate groups (38 ± 12.9% and 40.7 ± 9.5%, respectively) compared to the controls (31.3 ± 7.5%; p < 0.0001). The severe group also displayed a milder depression of contraction (12.2%) compared to the moderate group (13 ± 7.2%). In the moderate and severe groups, LV strain correlated significantly with vena contracta (r=-0.858; p = 0.04), with vena contracta emerging as the only independent predictor for LV longitudinal strain. ROC curve analysis indicated a cut-off value > 5.65 mm for vena contracta, which had a positive predictive value of 75% for predicting LV function impairment. In conclusion, this study emphasizes the significance of assessing LA and ventricular strain in asymptomatic children with mitral regurgitation. Furthermore, vena contracta with diameters greater than 5.6 mm may alert clinicians to the possibility of LV function impairment. These findings offer valuable insights for the follow-up and management of paediatric patients with mitral regurgitation, enabling early detection of potential complications and improved patient outcomes.
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Affiliation(s)
- Reyhan Dedeoğlu
- Department of Pediatric Cardiology, İstanbul University-Cerrahpaşa Cerrahpaşa Medical School, Istanbul, Turkey.
| | - Helen Bornaun
- Department of Pediatric Cardiology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Savas Dedeoglu
- Department of Pediatrics, Uskudar University Medical Faculty, Istanbul, Turkey
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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Foppa M, Santos ABS. Percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with atrial dysfunction. Opening the valve…and a window of opportunity. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1499-1500. [PMID: 38819546 DOI: 10.1007/s10554-022-02548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Murilo Foppa
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio grande do Sul, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brasil.
- Postgraduate studies Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
| | - Angela Barreto Santiago Santos
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio grande do Sul, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brasil
- Postgraduate studies Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Evaluation of left atrial reservoir function and sphericity index in patients with mitral valve disease: a cardiac magnetic resonance imaging study. Int J Cardiovasc Imaging 2022; 38:2425-2435. [DOI: 10.1007/s10554-022-02654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/20/2022] [Indexed: 11/05/2022]
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Marques-Alves P, Ferreira JA, Freitas AA, Almeida JP, Baptista R, Castro G, Martins R, Donato P, Ferreira MJ, Gonçalves L. Atrial Mechanics in Hypertrophic Cardiomyopathy: Discriminating between Ventricular Hypertrophy and Fibrosis. Arq Bras Cardiol 2022; 118:77-87. [PMID: 35195213 PMCID: PMC8959060 DOI: 10.36660/abc.20200890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. OBJECTIVES We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. METHODS Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p<0.05. RESULTS Mean LV ejection fraction was not different between the groups. The E/e' ratio was impaired in the HCM group and preserved in the control group. LA mechanics was significantly reduced in HCM, compared to the HTN group. LA strain rate in reservoir (LASRr) and in contractile (LASRct) phases were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in reservoir phase (LASr) (AUC 0.76). LASRr and LASR-ct had high specificity (89% and 91%, respectively) and LASr had sensitivity of 80%. A decrease in 2.79% of LA strain rate in conduit phase (LASRcd) predicted an increase of 1cm in LGE extension (r2=0.42, β 2.79, p=0.027). CONCLUSIONS LASRr and LASRct were the best discriminators for LVH secondary to HCM. LASRcd predicted the degree of LV fibrosis assessed by CMR. These findings suggest that LA mechanics is a potential predictor of disease severity in HCM.
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Affiliation(s)
- Patrícia Marques-Alves
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
- Faculdade de MedicinaUniversidade de CoimbraCoimbraPortugal Faculdade de Medicina , Universidade de Coimbra , Coimbra – Portugal
| | - João André Ferreira
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
| | - André Azul Freitas
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
| | - José Paulo Almeida
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
| | - Rui Baptista
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
- Instituto de Investigação Clínica e Biomédica de CoimbraUniversidade de CoimbraCoimbraPortugal ICBR Instituto de Investigação Clínica e Biomédica de Coimbra , Universidade de Coimbra , Coimbra – Portugal
- Faculdade de MedicinaUniversidade de CoimbraCoimbraPortugal Faculdade de Medicina , Universidade de Coimbra , Coimbra – Portugal
| | - Graça Castro
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
| | - Rui Martins
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
| | - Paulo Donato
- Faculdade de MedicinaUniversidade de CoimbraCoimbraPortugal Faculdade de Medicina , Universidade de Coimbra , Coimbra – Portugal
- Departamento de RadiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Radiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
| | - Maria João Ferreira
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
- Instituto de Investigação Clínica e Biomédica de CoimbraUniversidade de CoimbraCoimbraPortugal ICBR Instituto de Investigação Clínica e Biomédica de Coimbra , Universidade de Coimbra , Coimbra – Portugal
- Faculdade de MedicinaUniversidade de CoimbraCoimbraPortugal Faculdade de Medicina , Universidade de Coimbra , Coimbra – Portugal
| | - Lino Gonçalves
- Departamento de CardiologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra – Portugal
- Instituto de Investigação Clínica e Biomédica de CoimbraUniversidade de CoimbraCoimbraPortugal ICBR Instituto de Investigação Clínica e Biomédica de Coimbra , Universidade de Coimbra , Coimbra – Portugal
- Faculdade de MedicinaUniversidade de CoimbraCoimbraPortugal Faculdade de Medicina , Universidade de Coimbra , Coimbra – Portugal
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Latado L, de Melo RMV, Mistro S, Latado AL, do Nascimento HF, Lira YM, de Oliveira NFC, Galindo YDS, Viana T, Passos LCS. Cost-Effectiveness Analysis of Evolocumab Therapy in Patients at High Risk of Cardiovascular Events in the Context of the Brazilian Unified Health System. Arq Bras Cardiol 2021; 117:988-996. [PMID: 34817008 PMCID: PMC8682111 DOI: 10.36660/abc.20200690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/23/2020] [Accepted: 12/02/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. OBJECTIVES We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. METHODS Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p<0.05. RESULTS Mean LV ejection fraction was not different between the groups. The E/e' ratio was impaired in the HCM group and preserved in the control group. LA mechanics was significantly reduced in HCM, compared to the HTN group. LA strain rate in reservoir (LASRr) and in contractile (LASRct) phases were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in reservoir phase (LASr) (AUC 0.76). LASRr and LASR-ct had high specificity (89% and 91%, respectively) and LASr had sensitivity of 80%. A decrease in 2.79% of LA strain rate in conduit phase (LASRcd) predicted an increase of 1cm in LGE extension (r2=0.42, β 2.79, p=0.027). CONCLUSIONS LASRr and LASRct were the best discriminators for LVH secondary to HCM. LASRcd predicted the degree of LV fibrosis assessed by CMR. These findings suggest that LA mechanics is a potential predictor of disease severity in HCM.
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Affiliation(s)
- Luiza Latado
- Universidade Federal da BahiaFaculdade de MedicinaSalvadorBABrasilUniversidade Federal da Bahia - Faculdade de Medicina, Salvador, BA – Brasil
| | - Rodrigo Morel Vieira de Melo
- Universidade Federal da BahiaFaculdade de MedicinaSalvadorBABrasilUniversidade Federal da Bahia - Faculdade de Medicina, Salvador, BA – Brasil
- Hospital Ana NeryServiço de CardiologiaSalvadorBABrasilHospital Ana Nery - Serviço de Cardiologia, Salvador, BA – Brasil
| | - Sóstenes Mistro
- Universidade Federal da BahiaPrograma de Pós-Graduação em Saúde ColetivaInstituto Multidisciplinar em SaúdeVitória da ConquistaBABrasilUniversidade Federal da Bahia. Instituto Multidisciplinar em Saúde - Programa de Pós-Graduação em Saúde Coletiva, Vitória da Conquista, BA - Brasil
| | - Adriana Lopes Latado
- Universidade Federal da BahiaFaculdade de MedicinaSalvadorBABrasilUniversidade Federal da Bahia - Faculdade de Medicina, Salvador, BA – Brasil
| | - Harrison Floriano do Nascimento
- Hospital Universitário Professor Edgard SantosPesquisa e Inovação TecnológicaSalvadorBABrasilHospital Universitário Professor Edgard Santos - Pesquisa e Inovação Tecnológica, Salvador, BA – Brasil
| | - Yasmin Menezes Lira
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBABrasilEscola Bahiana de Medicina e Saúde Pública, Salvador, BA – Brasil
| | | | - Yuri de Santana Galindo
- Universidade Federal da BahiaFaculdade de MedicinaSalvadorBABrasilUniversidade Federal da Bahia - Faculdade de Medicina, Salvador, BA – Brasil
| | - Tainá Viana
- Hospital Ana NeryServiço de CardiologiaSalvadorBABrasilHospital Ana Nery - Serviço de Cardiologia, Salvador, BA – Brasil
| | - Luiz Carlos Santana Passos
- Universidade Federal da BahiaFaculdade de MedicinaSalvadorBABrasilUniversidade Federal da Bahia - Faculdade de Medicina, Salvador, BA – Brasil
- Hospital Ana NeryServiço de CardiologiaSalvadorBABrasilHospital Ana Nery - Serviço de Cardiologia, Salvador, BA – Brasil
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Pastore MC, Mandoli GE, Dokollari A, Bisleri G, D'Ascenzi F, Santoro C, Miglioranza MH, Focardi M, Cavigli L, Patti G, Valente S, Mondillo S, Cameli M. Speckle tracking echocardiography in primary mitral regurgitation: should we reconsider the time for intervention? Heart Fail Rev 2021; 27:1247-1260. [PMID: 33829389 PMCID: PMC9197800 DOI: 10.1007/s10741-021-10100-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
Thanks to the improvement in mitral regurgitation (MR) diagnostic and therapeutic management, with the introduction of minimally invasive techniques which have considerably reduced the individual surgical risk, the optimization of the timing for MR “open” or percutaneous surgical treatment has become a main concern which has highly raised scientific interest. In fact, the current indications for intervention in MR, especially in asymptomatic patients, rely on echocardiographic criteria with high severity cut-offs that are fulfilled only when not only mitral valve apparatus but also the cardiac chambers’ structure and function are severely impaired, which results in poor benefits for post-operative clinical outcome. This led to the need of new indices to redefine the optimal surgical timing in these patients. Speckle tracking echocardiography provides early markers of cardiac dysfunction due to subtle myocardial impairment; therefore, it could offer pivotal information in this setting. In fact, left ventricular and left atrial strains have already shown evidence about their usefulness in recognizing MR impact not only on symptoms and quality of life but also on cardiovascular events and new-onset atrial fibrillation in these patients. Moreover, right ventricular strain could be used to identify those patients with advanced cardiac damage and different grades of right ventricular dysfunction, which entails higher risks for cardiac surgery that could overweigh surgical benefits. This review aims to describe the importance of reconsidering the timing of intervention in MR and to analyze the potential additive value of speckle tracking echocardiography in this clinical setting.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy. .,Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | | | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | | | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Giuseppe Patti
- Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
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