Are there any subclinical myocardial dysfunctions in subjects with aortic valve sclerosis? A 3D-speckle tracking echocardiography study

Changes in the structure and function of the left ventricle in patients with gout: A study based on three-dimensional speckle tracking echocardiography

PURPOSE

Studies have shown that gout can increase the risk of cardiovascular disease. Three-dimensional speckle-tracking echocardiography (3D-STE), a sensitive imaging technology, enables the detection of subtle myocardial dysfunctions. Our aim is to evaluate the left ventricular (LV) functions in patients with gout using 3D-STE.

METHODS

80 subjects: 40 with gout and 40 as normal controls were involved. We obtained and analyzed these parameters from the dynamic images of a 3D full-volume dataset: global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), Twist, 16-segmental time-to-peak longitudinal strain (TTP) and systolic dyssynchrony index (SDI)besides other relevant parameters.

RESULTS

Compared with the normal group, gout patients were more likely to have left ventricular remodeling. The patients with gout showed decreased Em, increased E/Em and larger volume index of the left atrium (LAVI) indicating reduced diastolic function. The peak GLS (-17.42 ± 2.02 vs. -22.40 ± 2.57, P < 0.001), GCS (-27.04 ± 3.75 vs. -34.85 ± 4.99, P < 0.001), GRS (38.22 ± 4.28 vs. 46.15 ± 5.17, P < 0.001), and Twist (15.18 ± 5.45 vs. 19.02 ± 5.29, P = 0.015) were significantly lower in patients with gout than in healthy participants. The SDI (5.57 ± 1.46 vs. 4.91 ± 1.19, P = 0.016) was significantly increased in patients with gout compared with normal controls. There was no significant between-group difference in TTP (P = 0.43). The systolic GLS, GRS and GCS peak values increased gradually from the base to the apex, with the lowest values in the basal segment in patients with gout. Receiver-operating characteristic curve analysis revealed among these strains GLS has the largest area under the curve (AUC: 0.93, P < 0.001), the cutoff value of -18.97% with a sensitivity and specificity of 80.0% and 92.0%, respectively, for differentiating two groups. A multivariate linear regression analysis shows that the relationship between gout and strain parameters including GLS, GRS, and GCS is statistically significant (P < 0.001).

CONCLUSION

Although patients with gout having a normal ejection fraction, structural remodeling of the left ventricle and subclinical LV deformation may occur. 3D-STE can detect subtle cardiac dysfunctions in patients with gout at an early stage.

Early Diagnosis of Abnormal Left Ventricular Systolic Functions of Rare Pathogenic Titin Mutation Gene Carriers in FHCM by Three-Dimensional Speckle Tracking Echocardiography Combined with Gene Detection

OBJECTIVE

This study aimed to explore the early diagnosis of abnormal left ventricular systolic function of rare pathogenic titin (TTN) mutation gene carriers in familial hypertrophic cardiomyopathy (FHCM) by three-dimensional speckle tracking echocardiography (3D-STE) combined with gene detection.

METHODS

Eighteen members of a Hui nationality family in Ningxia province of China were enrolled in this study in July 2019. The proband was tested with high-throughput sequencing of gene detection technology to detect the whole exome, and the mutation locus of pathogenic TTN gene was analyzed. According to the result, 16 subjects were divided into two groups: carrier group (n = 4) and noncarrier group (n = 12). Related indicators from 2DE were obtained, and myocardial strain indicators from 3D-STE were analyzed by postprocessing software of Tomtec. Strain indicators included global longitudinal strain (GLS), global circumference strain (GCS), global radial strain (GRS), regional longitudinal strain (RLS), regional circumference strain (RCS), and regional radial strain (RRS). All those indicators were compared between the two groups, and a receiver operating characteristic (ROC) curve was used for further analysis.

RESULTS

There were 4 subjects diagnosed as asymptomatic TTN gene carriers with the mutation locus of Val135643Ile. Compared with the noncarrier group, GLS and partial RLS were significantly reduced in the carrier group. The ROC curve shows that GLS has the largest AUC, and its sensitivity was better than LVPWD and specificity was better than IVSD and LVMI obtained from 2DE in the carrier group.

CONCLUSIONS

There were 4 subjects diagnosed as asymptomatic TTN gene carriers with the mutation locus of Val135643Ile, and their GLS and partial RLS were significantly reduced; GLS had the better sensitivity and specificity than LVPWD, IVSD, and LVMI.

Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis

Aims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on cardiovascular magnetic resonance (CMR) and validate the prognostic value of LV-GLS thresholds associated with fibrosis.

Methods and results: LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57 ± 10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71 ± 12 years; 58% males; NYHA functional class I–II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, and myocardial infarction. In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74 [0.66–0.83]; P < 0.001) and calibration (Hosmer-Lemeshow χ² = 6.37; P = 0.605) for replacement fibrosis. In the outcome cohort, 47 events occurred over 16 [3.3, 42.2] months. Patients with LV-GLS > −15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS < −21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P < 0.001). LV-GLS offered independent prognostic value over clinical variables, AS severity and echocardiographic LV mass and E/e′.

Conclusion: LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF.

Impact of sigmoid septum on periprocedural outcomes following transcatheter aortic valve implantation using current-generation valves

The role of sigmoid septum (SS) observed using preprocedural transthoracic echocardiography (TTE) in patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown. This study aimed to compare clinical outcomes of TAVI using the current-generation transcatheter heart valves in patients with and without SS. We divided 140 consecutive patients, excluding four patients who underwent pacemaker implantation before TAVI, into two groups (those with and without SS) and compared the periprocedural outcomes, including new pacemaker implantation, within 30 days post-TAVI. Thirty-five patients (25%; 32 female patients) had SS before TAVI. The body surface area and aortic annulus area measured using computed tomography were significantly smaller in patients with SS than in those without SS (1.40 m² vs. 1.48 m², P = 0.03; and 372 mm² vs. 409 mm², P < 0.01; respectively). Device success was achieved in all patients with SS. Postprocedural TTE on 30 days post-TAVI showed no significant differences in the valvular hemodynamics between patients with and without SS. No severe prosthesis-patient mismatch was noted on TTE, although the transcatheter heart valve size tended to be smaller in patients with SS. Within 30 days of the TAVI, three (8.6%) and eight (7.6%) patients with and without SS, respectively, had new pacemaker implantation (P = 0.86). The presence of SS was not associated with periprocedural outcomes following TAVI in patients without pre-existing pacemakers. No specific assessment or treatment strategy is required for the TAVI in patients with SS using the current-generation devices.