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Yehia A, Zaki A, Sadaka M, Azeem AMAE. Incremental prognostic value of speckle tracking echocardiography and early follow-up echo assessment in predicting left ventricular recovery after reperfusion for ST-segment elevation myocardial infarction (STEMI). Echocardiography 2024; 41:e15725. [PMID: 38078679 DOI: 10.1111/echo.15725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/02/2023] [Accepted: 11/26/2023] [Indexed: 01/30/2024] Open
Abstract
PURPOSE Up to 50% of patients do not achieve significant left ventricular ejection fraction (LVEF) recovery after primary percutaneous intervention (PPCI) for STEMI. We aimed to identify the echocardiographic predictors for LVEF recovery and assess the value of early follow-up echocardiography (Echo) in risk assessment of post-myocardial infarction (MI) patients. METHODS One hundred one STEMI patients undergoing PPCI were enrolled provided EF below 50%. Baseline echocardiography assessed LVEF, volumes, wall motion score index (WMSI), global longitudinal strain (GLS), global circumferential strain (GCS), and E/e'. Follow-up echocardiography after 6 weeks reassessed left ventricular volumes, LVEF and GLS.GCS was not assessed at follow up. Patients were classified into recovery and non-recovery groups. Predictors of LVEF recovery and major adverse cardiovascular events (MACE) at 6 months were analysed. RESULTS The mean change of EF was 8.04 ± 3.32% in group I versus -.39 ± 5.09 % in group II (p < .001). Recovered patients had better baseline GLS, baseline GCS, E/e', and follow-up GLS. Multivariate regression analysis revealed E/e', GCS, and follow-up GLS after 6 weeks to be strong independent predictors for LVEF recovery. Composite MACE was considerably higher in group II (32.7% vs. 4.1%, p < .001) mainly driven by higher heart failure hospitalisation Multivariate regression analysis revealed baseline GLS, E/e', and ejection fraction (EF) percentage recovery as strong independent predictors for MACE. CONCLUSIONS Multiparametric echocardiographic approach incorporating LVEF, strain parameters, and diastolic function could allow early optimal risk stratification after STEMI treated with PPCI. Follow-up GLS and LVEF percentage change are the strongest predictors for early LV recovery and long term clinical outcome, respectively.
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Affiliation(s)
- Ahmed Yehia
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr Zaki
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Sadaka
- Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Rumbinaite E, Karuzas A, Verikas D, Jonauskiene I, Gustiene O, Mamedov A, Jankauskiene L, Benetis R, Zaliunas R, Vaskelyte JJ. Value of myocardial deformation parameters for detecting significant coronary artery disease. J Cardiovasc Thorac Res 2022; 14:180-190. [PMID: 36398054 PMCID: PMC9617060 DOI: 10.34172/jcvtr.2022.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: The study aimed to evaluate the diagnostic value of global and regional myocardial deformation parameters derived from two-dimensional speckle-tracking echocardiography to detect functionally significant coronary artery stenosis.
Methods: Dobutamine stress echocardiography and cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) were performed on 145 patients with a moderate and high probability of coronary artery disease (CAD) and LVEF≥55%. Significant CAD was defined as>50% stenosis of the left main stem,>70% stenosis in a major coronary vessel, or in the presence of intermediate stenosis (50-69%) validated as hemodynamically significant by CMRMPI. Patients were divided in two groups: non-pathological (48.3%) vs pathological (51.7%), according to CAG and CMR-MPI results. Afterwards, off-line speckle-tracking analysis was performed to analyse myocardial deformation parameters. Results: There were no differences in myocardial deformation parameters at rest between groups, except global longitudinal strain (GLS) and global radial strain (GRS) were significantly lower in the CAD (+) group: -21.3±2.2 vs.-16.3±2.3 (P<0.001) and 39.7±23.2 vs. 24.5±15.8 (P<0.001). GLS and regional longitudinal strain rate (SR) had the highest diagnostic value at high dobutamine dose with AUC of 0.902 and 0.878, respectively. At early recovery, GLS was also found to be the best myocardial deformation parameter with a sensitivity of 78%, specificity 67%, AUC 0.824. Conclusion: Global and regional myocardial deformation parameters are highly sensitive and specific in detecting functionally significant CAD. The combination of deformation parameters and WMA provides an incremental diagnostic value for patients with a moderate and high probability of CAD, especially the combination with regional longitudinal SR.
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Affiliation(s)
- Egle Rumbinaite
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arnas Karuzas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dovydas Verikas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ieva Jonauskiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Olivija Gustiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arslan Mamedov
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Loreta Jankauskiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jolanta Justina Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Transmural difference in myocardial damage assessed by layer-specific strain analysis in patients with ST elevation myocardial infarction. Sci Rep 2020; 10:11104. [PMID: 32632236 PMCID: PMC7338453 DOI: 10.1038/s41598-020-68043-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/15/2020] [Indexed: 01/26/2023] Open
Abstract
We performed layer-specific strain analysis with speckle-tracking echocardiography to investigate the transmural difference of myocardial damage as the predicting factor for the viability of damaged myocardium in patients with ST segment elevation myocardial infarction (STEMI). We analysed patients with acute STEMI who had undergone primary percutaneous coronary intervention and echocardiography within 24 h from the intervention and 2 months after the event. Segmental strains of the left ventricular (LV) endocardium, myocardium, epicardium, and strain gradient (SG) between the endocardium and epicardium were evaluated. In 34 patients, 112 akinetic/dyskinetic and 94 hypokinetic segments were observed among 612 segments of the LV at baseline, and 65 akinetic/dyskinetic segments had viability. In our study, layer-specific strains were gradually deteriorated by their wall motion. SG was augmented in the hypokinetic segments where inhomogeneous wall motion impairment was progressed. SG in the akinetic/dyskinetic segments was different between the viable and non-viable myocardium and was maintained in viable segments. We therefore believe that significantly reduced SG is indicative of irreversible transmural damage in the acute stage of STEMI and can be suitably used as a parameter for predicting myocardial viability.
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Mangion K, Carrick D, Clerfond G, Rush C, McComb C, Oldroyd KG, Petrie MC, Eteiba H, Lindsay M, McEntegart M, Hood S, Watkins S, Davie A, Auger DA, Zhong X, Epstein FH, Haig CE, Berry C. Predictors of segmental myocardial functional recovery in patients after an acute ST-Elevation myocardial infarction. Eur J Radiol 2019; 112:121-129. [PMID: 30777200 PMCID: PMC6390173 DOI: 10.1016/j.ejrad.2019.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 01/28/2023]
Abstract
Objective We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial function. Methods Two hundred and sixty-one patients (mean age 59 years, 73% male) underwent MRI 2 days post-ST elevation myocardial infarction (STEMI) and 241 (92%) underwent repeat imaging 6 months later. The MRI protocol included cine, 2D-cine DENSE, T2 mapping and late enhancement. Wall motion scoring was assessed by 2-blinded observers and adjudicated by a third. (WMS: 1=normal, 2=hypokinetic, 3=akinetic, 4=dyskinetic). WMS improvement was defined as a decrease in WMS ≥ 1, and normalization where WMS = 1 on follow-up. Segmental circumferential strain was derived utilizing DENSE and feature-tracking. A generalized linear mixed model with random effect of subject was constructed and used to account for repeated sampling when investigating predictors of segmental myocardial improvement or normalization Results At baseline and follow-up, 1416 segments had evaluable data for all parameters. Circumferential strain by DENSE (p < 0.001) and feature-tracking (p < 0.001), extent of oedema (p < 0.001), infarct size (p < 0.001), and microvascular obstruction (p < 0.001) were associates of both improvement and normalization of WMS. Circumferential strain provided incremental predictive value even after accounting for infarct size, extent of oedema and microvascular obstruction, for segmental improvement (DENSE: odds ratio, 95% confidence intervals: 1.08 per −1% peak strain, 1.05–1.12, p < 0.001, feature-tracking: odds ratio, 95% confidence intervals: 1.05 per −1% peak strain, 1.03–1.07, p < 0.001) and segmental normalization (DENSE: 1.08 per −1% peak strain, 1.04–1.12, p < 0.001, feature-tracking: 1.06 per −1% peak strain, 1.04–1.08, p < 0.001). Conclusions Circumferential strain provides incremental prognostic value over segmental infarct size in patients post STEMI for predicting segmental improvement or normalization by wall-motion scoring.
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Affiliation(s)
- Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Guillaume Clerfond
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Christie McComb
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Mark C Petrie
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Los Angeles, CA, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Caroline E Haig
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.
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Scharrenbroich J, Hamada S, Keszei A, Schröder J, Napp A, Almalla M, Becker M, Altiok E. Use of two-dimensional speckle tracking echocardiography to predict cardiac events: Comparison of patients with acute myocardial infarction and chronic coronary artery disease. Clin Cardiol 2018; 41:111-118. [PMID: 29359809 DOI: 10.1002/clc.22860] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Two-dimensional speckle strain (2D STE) echocardiography can aid in the prognosis of acute myocardial infarction (AMI) and chronic coronary artery disease (CAD). HYPOTHESIS Differences occur in the prediction of cardiac events using 2D STE in AMI vs CAD patients. METHODS In this prospective study, 94 patients with a first AMI and successful revascularization, and 137 patients with stable CAD after complete revascularization were included. In all patients, we performed echocardiography and myocardial deformation analysis for layer-specific global circumferential strain (GCS) and longitudinal strain. Receiver operating characteristic (ROC) curve analysis was used to predict the presence of a cardiac event using strain values and baseline characteristics in different regression models. RESULTS Patients were followed for 3.6 ± 0.8 years. Strain parameters in AMI and CAD patients were significantly different with respect to the occurrence of a cardiac event. Frequency of diabetes and hypertension was associated with the presence of a cardiac event in CAD patients. Furthermore, in CAD patients, ROC analysis demonstrated that the addition of endocardial GCS to baseline characteristics and ejection fraction to a regression model significantly improved the prediction of cardiac events (area under curve = 0.86, cutoff value: 20%, sensitivity: 79%, specificity: 84%). In contrast, the addition of strain parameters in AMI patients did not increase the prediction power for cardiac events. CONCLUSIONS Global strain parameters by 2D STE may be useful for the prediction of cardiac events in patients with CAD but add no supplemental information to baseline characteristic and ejection fraction in patients with AMI.
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Affiliation(s)
- Jörg Scharrenbroich
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Sandra Hamada
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Andras Keszei
- Department of Medical Statistics, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Jörg Schröder
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Andreas Napp
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Michael Becker
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Ertunc Altiok
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
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Ross Agner BF, Katz MG, Williams ZR, Dixen U, Jensen GB, Schwarz KQ. Left Ventricular Systolic Function Assessed by Global Longitudinal Strain is Impaired in Atrial Fibrillation Compared to Sinus Rhythm. J Atr Fibrillation 2017; 10:1437. [PMID: 29487674 DOI: 10.4022/jafib.1437] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/19/2017] [Accepted: 10/14/2017] [Indexed: 01/19/2023]
Abstract
Background Atrial fibrillation (AF) is the most common aberrant cardiac arrhythmia. Many AF patients present with symptoms of dyspnea and fatigue, but have normal left ventricular ejection fraction (LVEF). Purpose To determine the reproducibility of measurements of global longitudinal strain (GLS) and strain rate in patients with AF and examine if the arrhythmia is associated with abnormal LV strain and strain rate independent of age, sex, heart rate, LVEF and LV mass. We hypothesized that AF independently reduces ventricular systolic performance. Methods The study was conducted as a retrospective analysis of images from 150 randomly selected patients with AF compared to an equal number of subjects with sinus rhythm (SR) matched for age, sex, heart rate, LVEF and LV mass. Half of the patients had normal LVEF (LVEF > 50%) and half had reduced LVEF (LVEF < 50%). GLS and strain rate were measured in each group, as were quantitative LV volumes and standard systolic and diastolic parameters. Results: GLS was significantly impaired in patients with AF compared to subjects with SR, both in the overall population (-12.25 ± 4.1% vs. -16.13 ± 4.7%, p<0.0001), in patients with normal LVEF (-14.41 ± 3.9% vs. -19.42 ± 3.1%, p<0.0001) and in patients with reduced LVEF (-10.10 ± 3.1% vs. -12.85 ± 3.5%, p<0.0001).Linear regression and Bland Altman analyses demonstrated good intraobserver and interobserver agreement for measurements of GLS and strain rate parameters even in patients with AF.
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Affiliation(s)
- Bue F Ross Agner
- Hvidovre University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Michael G Katz
- Hvidovre University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Zachary R Williams
- University of Rochester Medical Center, Department of Cardiology, Rochester, New York, USA
| | - Ulrik Dixen
- University of Rochester Medical Center, Department of Cardiology, Rochester, New York, USA
| | - Gorm B Jensen
- Hvidovre University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Karl Q Schwarz
- Hvidovre University Hospital, Department of Cardiology, Copenhagen, Denmark
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Biering-Sørensen T, Jensen JS, Pedersen SH, Galatius S, Fritz-Hansen T, Bech J, Olsen FJ, Mogelvang R. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction. PLoS One 2016; 11:e0158280. [PMID: 27348525 PMCID: PMC4922592 DOI: 10.1371/journal.pone.0158280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/13/2016] [Indexed: 11/19/2022] Open
Abstract
Background Global longitudinal systolic strain (GLS) has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI). The aim of this study was to evaluate the prognostic value of regional longitudinal myocardial deformation in comparison to GLS, conventional echocardiography and clinical information. Method In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All patients were examined by tissue Doppler imaging (TDI) and two-dimensional strain echocardiography (2DSE). Results During a median-follow-up of 5.3 (IQR 2.5–6.1) years the primary endpoint (death, heart failure or a new MI) was reached by 145 (38.9%) patients. After adjustment for significant confounders (including conventional echocardiographic parameters) and culprit lesion, reduced longitudinal performance in the anterior septal and inferior myocardial regions (but not GLS) remained independent predictors of the combined outcome. Furthermore, inferior myocardial longitudinal deformation provided incremental prognostic information to clinical and conventional echocardiographic information (Harrell's c-statistics: 0.63 vs. 0.67, p = 0.032). In addition, impaired longitudinal deformation outside the culprit lesion perfusion region was significantly associated with an adverse outcome (p<0.05 for all deformation parameters). Conclusion Regional longitudinal myocardial deformation measures, regardless if determined by TDI or 2DSE, are superior prognosticators to GLS. In addition, impaired longitudinal deformation in the inferior myocardial segment provides prognostic information over and above clinical and conventional echocardiographic risk factors. Furthermore, impaired longitudinal deformation outside the culprit lesion perfusion region seems to be a paramount marker of adverse outcome.
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Affiliation(s)
- Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sune H. Pedersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jan Bech
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Na HM, Cho GY, Lee JM, Cha MJ, Yoon YE, Lee SP, Kim HK, Kim YJ, Sohn DW. Echocardiographic Predictors for Left Ventricular Remodeling after Acute ST Elevation Myocardial Infarction with Low Risk Group: Speckle Tracking Analysis. J Cardiovasc Ultrasound 2016; 24:128-34. [PMID: 27358705 PMCID: PMC4925390 DOI: 10.4250/jcu.2016.24.2.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/21/2016] [Accepted: 05/10/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND We sought to assess echocardiographic predictors of left ventricular (LV) adverse remodeling after successfully reperfused acute ST elevation myocardial infarction (STEMI). LV remodeling is commonly found in STEMI patients and it may suggest adverse outcome in acute myocardial infarction. We sought to identify whether 2D strain and torsion be independent parameters for prediction of LV adverse remodeling. METHODS We investigated 208 patients with low-risk STEMI patients who had follow up echocardiography at 6 or more months. After clinical assessments, all patients received revascularization according to current guideline. LV remodeling was defined as > 20% increase in end-diastolic volume (EDV) at follow up. RESULTS During the follow-up (11.9 ± 5.3 months), 53 patients (25.5%) showed LV remodeling. In univariate analysis, EDV, end-systolic volume, deceleration time (DT), CK-MB, and global longitudinal strain (GLS) were associated with LV remodeling. In multivariate analysis, EDV [hazard ratio (HR): 0.922, 95% confidence interval (CI): 0.897-0.948, p< 0.001], GLS (HR 0.842, 95% CI: 0.728-0.974, p = 0.020), DT (HR: 0.989, 95% CI: 0.980-0.998, p = 0.023) and CK-MB (HR: 1.003, 95% CI: 1.000-1.005, p = 0.033) independently predicted LV remodeling. However, global circumferential strain, net twist, and twist or untwist rate were not associated with remodeling. CONCLUSION Of various parameters of speckle strain, only GLS predicted adverse remodeling in STEMI patients.
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Affiliation(s)
- Hyun-Min Na
- College of Medicine, Seoul National University, Seoul, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Myung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Myung-Jin Cha
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yeonyee E Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung-Pyo Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Kwan Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Dae-Won Sohn
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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Loutfi M, Ashour S, El-Sharkawy E, El-Fawal S, El-Touny K. Identification of High-Risk Patients with Non-ST Segment Elevation Myocardial Infarction using Strain Doppler Echocardiography: Correlation with Cardiac Magnetic Resonance Imaging. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:51-9. [PMID: 27199575 PMCID: PMC4863927 DOI: 10.4137/cmc.s35734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Assessment of left ventricular (LV) function is important for decision-making and risk stratification in patients with acute coronary syndrome. Many patients with non-ST segment elevation myocardial infarction (NSTEMI) have substantial infarction, but these patients often do not reveal clinical signs of instability, and they rarely fulfill criteria for acute revascularization therapy. AIM This study evaluated the potential of strain Doppler echocardiography analysis for the assessment of LV infarct size when compared with standard two-dimensional echo and cardiac magnetic resonance (CMR) data. METHODS Thirty patients with NSTEMI were examined using echocardiography after hospitalization for 1.8 ± 1.1 days for the assessment of left ventricular ejection fraction, wall motion score index (WMSI), and LV global longitudinal strain (GLS). Infarct size was assessed using delayed enhancement CMR 6.97 ± 3.2 days after admission as a percentage of total myocardial volume. RESULTS GLS was performed in 30 patients, and 82.9% of the LV segments were accepted for GLS analysis. Comparisons between patients with a complete set of GLS and standard echo, GLS and CMR were performed. The linear relationship demonstrated moderately strong and significant associations between GLS and ejection fraction (EF) as determined using standard echo (r = 0.452, P = 0.012), WMSI (r = 0.462, P = 0.010), and the gold standard CMR-determined EF (r = 0.57, P < 0.001). Receiver operating characteristic curves were used to analyze the ability of GLS to evaluate infarct size. GLS was the best predictor of infarct size in a multivariate linear regression analysis (β = 1.51, P = 0.027). WMSI >1.125 and a GLS cutoff value of -11.29% identified patients with substantial infarction (≥12% of total myocardial volume measured using CMR) with accuracies of 76.7% and 80%, respectively. However, GLS remained the only independent predictor in a multivariate logistic regression analysis to identify an infarct size ≥12%. CONCLUSION GLS is a good predictor of infarct size in NSTEMI, and it may serve as a tool in conjunction with risk stratification scores for the selection of high-risk NSTEMI patients.
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Affiliation(s)
- Mohamed Loutfi
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sanaa Ashour
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman El-Sharkawy
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sara El-Fawal
- Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Karim El-Touny
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Chen R, Zhu M, Sahn DJ, Ashraf M. Non-Invasive Evaluation of Heart Function with Four-Dimensional Echocardiography. PLoS One 2016; 11:e0154996. [PMID: 27144844 PMCID: PMC4856388 DOI: 10.1371/journal.pone.0154996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 04/23/2016] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study is to assess the accuracy and feasibility of left ventricular systolic function determined by four-dimensional echocardiography (4DE). Methods Latex balloons were sewn into the left ventricle (LV) of 20 freshly harvested pig hearts which were then passively driven by a pulsatile pump apparatus. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and left ventricular ejection fraction (LVEF) derived from 4DEand two-dimensional echocardiography (2DE)-derived LVEF were quantified at different stroke volumes (SV) 30–70 ml and correlated with sonomicrometry data. Results In all comparisons, GLS, GCS, GAS, 2DE-LVEF, and 4DE-LVEF demonstrated strong correlations with sonomicrometry data (r = 0.77, r = 0.89, r = 0.79, r = 0.93, r = 0.96, all P <0.001). Bland-Altman analyses showed slight overestimations of echo-derived GLS, GCS, 2DE-LVEF and 3DE-LVEF over sonomicrometry values (bias = 2.88, bias = 3.99, bias = 3.37, bias = 2.78, respectively). Furthermore, there is better agreement between GCS, 4D LVEF and sonomicrometry values compared with GLS and 2D LVEF. Conclusion Four-dimensional echocardiography accurately assesses LV function. GCS derived by 4DE is a potential alternative parameter to quantify LV systolic function.
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Affiliation(s)
- Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, United States of America
| | - Meihua Zhu
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, United States of America
| | - David J. Sahn
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, United States of America
| | - Muhammad Ashraf
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, United States of America
- * E-mail:
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Fan L, Yao J, Yang C, Wu Z, Xu D, Tang D. Material stiffness parameters as potential predictors of presence of left ventricle myocardial infarction: 3D echo-based computational modeling study. Biomed Eng Online 2016; 15:34. [PMID: 27044441 PMCID: PMC4820947 DOI: 10.1186/s12938-016-0151-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/29/2016] [Indexed: 01/18/2023] Open
Abstract
Background Ventricle material properties are difficult to obtain under in vivo conditions and are not readily available in the current literature. It is also desirable to have an initial determination if a patient had an infarction based on echo data before more expensive examinations are recommended. A noninvasive echo-based modeling approach and a predictive method were introduced to determine left ventricle material parameters and differentiate patients with recent myocardial infarction (MI) from those without. Methods Echo data were obtained from 10 patients, 5 with MI (Infarct Group) and 5 without (Non-Infarcted Group). Echo-based patient-specific computational left ventricle (LV) models were constructed to quantify LV material properties. All patients were treated equally in the modeling process without using MI information. Systolic and diastolic material parameter values in the Mooney-Rivlin models were adjusted to match echo volume data. The equivalent Young’s modulus (YM) values were obtained for each material stress–strain curve by linear fitting for easy comparison. Predictive logistic regression analysis was used to identify the best parameters for infract prediction. Results The LV end-systole material stiffness (ES-YMf) was the best single predictor among the 12 individual parameters with an area under the receiver operating characteristic (ROC) curve of 0.9841. LV wall thickness (WT), material stiffness in fiber direction at end-systole (ES-YMf) and material stiffness variation (∆YMf) had positive correlations with LV ejection fraction with correlation coefficients r = 0.8125, 0.9495 and 0.9619, respectively. The best combination of parameters WT + ∆YMf was the best over-all predictor with an area under the ROC curve of 0.9951. Conclusion Computational modeling and material stiffness parameters may be used as a potential tool to suggest if a patient had infarction based on echo data. Large-scale clinical studies are needed to validate these preliminary findings.
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Affiliation(s)
- Longling Fan
- Department of Mathematics, Southeast University, Nanjing, 210096, China
| | - Jing Yao
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Chun Yang
- Network Technology Research Institute, China United Network Communications Co., Ltd., Beijing, 100048, China.,Mathematical Sciences Department, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Zheyang Wu
- Mathematical Sciences Department, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Di Xu
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Dalin Tang
- Department of Mathematics, Southeast University, Nanjing, 210096, China. .,Mathematical Sciences Department, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA.
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Wang N, Hung CL, Shin SH, Claggett B, Skali H, Thune JJ, Køber L, Shah A, McMurray JJ, Pfeffer MA, Solomon SD. Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction. Eur Heart J 2015; 37:466-72. [DOI: 10.1093/eurheartj/ehv558] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 09/29/2015] [Indexed: 11/12/2022] Open
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Fan L, Yao J, Yang C, Tang D, Xu D. Infarcted Left Ventricles Have Stiffer Material Properties and Lower Stiffness Variation: Three-Dimensional Echo-Based Modeling to Quantify In Vivo Ventricle Material Properties. J Biomech Eng 2015; 137:081005. [PMID: 25994130 DOI: 10.1115/1.4030668] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Indexed: 11/08/2022]
Abstract
Methods to quantify ventricle material properties noninvasively using in vivo data are of great important in clinical applications. An ultrasound echo-based computational modeling approach was proposed to quantify left ventricle (LV) material properties, curvature, and stress/strain conditions and find differences between normal LV and LV with infarct. Echo image data were acquired from five patients with myocardial infarction (I-Group) and five healthy volunteers as control (H-Group). Finite element models were constructed to obtain ventricle stress and strain conditions. Material stiffening and softening were used to model ventricle active contraction and relaxation. Systolic and diastolic material parameter values were obtained by adjusting the models to match echo volume data. Young's modulus (YM) value was obtained for each material stress-strain curve for easy comparison. LV wall thickness, circumferential and longitudinal curvatures (C- and L-curvature), material parameter values, and stress/strain values were recorded for analysis. Using the mean value of H-Group as the base value, at end-diastole, I-Group mean YM value for the fiber direction stress-strain curve was 54% stiffer than that of H-Group (136.24 kPa versus 88.68 kPa). At end-systole, the mean YM values from the two groups were similar (175.84 kPa versus 200.2 kPa). More interestingly, H-Group end-systole mean YM was 126% higher that its end-diastole value, while I-Group end-systole mean YM was only 29% higher that its end-diastole value. This indicated that H-Group had much greater systole-diastole material stiffness variations. At beginning-of-ejection (BE), LV ejection fraction (LVEF) showed positive correlation with C-curvature, stress, and strain, and negative correlation with LV volume, respectively. At beginning-of-filling (BF), LVEF showed positive correlation with C-curvature and strain, but negative correlation with stress and LV volume, respectively. Using averaged values of two groups at BE, I-Group stress, strain, and wall thickness were 32%, 29%, and 18% lower (thinner), respectively, compared to those of H-Group. L-curvature from I-Group was 61% higher than that from H-Group. Difference in C-curvature between the two groups was not statistically significant. Our results indicated that our modeling approach has the potential to determine in vivo ventricle material properties, which in turn could lead to methods to infer presence of infarct from LV contractibility and material stiffness variations. Quantitative differences in LV volume, curvatures, stress, strain, and wall thickness between the two groups were provided.
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Left ventricular global longitudinal systolic strain predicts adverse remodeling and subsequent cardiac events in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2015; 31:575-84. [DOI: 10.1007/s10554-015-0593-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
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15
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Lebeau R, Sas G, El Rayes M, Serban A, Moustafa S, Essadiqi B, DiLorenzo M, Souliere V, Beaulieu Y, Sauve C, Amyot R, Serri K. Left ventricular ejection fraction assessment by non-cardiologists from transverse views using a simplified wall motion score index. Echo Res Pract 2015; 2:1-8. [PMID: 26693310 PMCID: PMC4676426 DOI: 10.1530/erp-14-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/06/2015] [Indexed: 11/08/2022] Open
Abstract
For the non-cardiologist emergency physician and intensivist, performing an accurate estimation of left ventricular ejection fraction (LVEF) is essential for the management of critically ill patients, such as patients presenting with shock, severe respiratory distress or chest pain. Our objective was to develop a semi-quantitative method to improve visual LVEF evaluation. A group of 12 sets of transthoracic echocardiograms with LVEF in the range of 18–64% were interpreted by 17 experienced observers (PRO) and 103 untrained observers or novices (NOV), without previous training in echocardiography. They were asked to assess LVEF by two different methods: i) visual estimation (VIS) by analysing the three classical left ventricle (LV) short-axis views (basal, midventricular and apical short-axis LV section) and ii) semi-quantitative evaluation (base, mid and apex (BMA)) of the same three short-axis views. The results for each of these two methods for both groups (PRO and NOV) were compared with LVEF obtained by radionuclide angiography. The semi-quantitative method (BMA) improved estimation of LVEF by PRO for moderate LV dysfunction (LVEF 30–49%) and normal LVEF. The visual estimate was better for lower LVEF (<30%). In the NOV group, the semi-quantitative method was better than than the visual one in the normal group and in half of the subjects in the moderate LV dysfunction (LVEF 30–49%) group. The visual estimate was better for the lower LVEF (ejection fraction <30%) group. In conclusion, semi-quantitative evaluation of LVEF gives an overall better assessment than VIS for PRO and untrained observers.
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Affiliation(s)
- Real Lebeau
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Georgetta Sas
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Malak El Rayes
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Alexandrina Serban
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Sherif Moustafa
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Btissama Essadiqi
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Maria DiLorenzo
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Vicky Souliere
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Yanick Beaulieu
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Claude Sauve
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Robert Amyot
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
| | - Karim Serri
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal , 5400 Boulevard Gouin Ouest, Montréal, Quebec , Canada H4J-1C5
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Use of Three-Dimensional Speckle-Tracking Echocardiography for Quantitative Assessment of Global Left Ventricular Function: A Comparative Study to Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2014; 27:285-91. [DOI: 10.1016/j.echo.2013.11.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Indexed: 11/18/2022]
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Kümler T, Gislason GH, Køber L, Torp-Pedersen C. Persistence of the prognostic importance of left ventricular systolic function and heart failure after myocardial infarction: 17-year follow-up of the TRACE register. Eur J Heart Fail 2014; 12:805-11. [DOI: 10.1093/eurjhf/hfq071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas Kümler
- Department of Cardiology; Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 2900 Hellerup Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology; Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 2900 Hellerup Denmark
| | - Lars Køber
- Department of Cardiology B 2141; Copenhagen University Hospital Rigshospitalet; Blegdamsvej 9 2100 Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology; Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 2900 Hellerup Denmark
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18
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Joyce E, Hoogslag GE, Leong DP, Debonnaire P, Katsanos S, Boden H, Schalij MJ, Marsan NA, Bax JJ, Delgado V. Association between left ventricular global longitudinal strain and adverse left ventricular dilatation after ST-segment-elevation myocardial infarction. Circ Cardiovasc Imaging 2013; 7:74-81. [PMID: 24186962 DOI: 10.1161/circimaging.113.000982] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Myocardial infarct size is a major determinant of left ventricular (LV) remodeling after ST-segment-elevation myocardial infarction. We evaluated whether LV global longitudinal strain (GLS), proposed as a novel marker of infarct size, is associated with 3- and 6-month LV dilatation after ST-segment-elevation myocardial infarction. METHODS AND RESULTS In the first ST-segment-elevation myocardial infarction patients treated with primary percutaneous coronary intervention, baseline LVGLS was measured with 2-dimensional speckle-tracking echocardiography. Patients were dichotomized according to median value. The independent relationship between GLS groups and LV end-diastolic volume at 3 and 6 months (adjusted for clinical and echocardiographic variables) was assessed. The final study population comprised 1041 patients (60±12 years; 76% men). Median LVGLS was -15.0%. Patients with baseline LVGLS>-15.0% exhibited greater LV dilatation at 3 and 6 months compared with patients with GLS≤-15.0% (LV end-diastolic volume 123±44 versus 106±36 mL and 121±43 versus 102±34 mL, respectively; global group-time interaction P<0.001). This association retained the same statistical significance after adjustment for various relevant demographic, clinical, and echocardiographic characteristics. Further, net reclassification improvement index demonstrated significant incremental value of LVGLS for prediction of LV end-diastolic volume increase (0.14 [95% confidence interval, 0.00034-0.29]; P=0.04). CONCLUSIONS LVGLS before discharge after ST-segment-elevation myocardial infarction is independently associated with LV dilatation at follow-up.
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Affiliation(s)
- Emer Joyce
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Shalbaf A, Behnam H, Alizade-Sani Z, Shojaifard M. Automatic classification of left ventricular regional wall motion abnormalities in echocardiography images using nonrigid image registration. J Digit Imaging 2013; 26:909-19. [PMID: 23359089 PMCID: PMC3782595 DOI: 10.1007/s10278-012-9543-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Identification and classification of left ventricular (LV) regional wall motion (RWM) abnormalities on echocardiograms has fundamental clinical importance for various cardiovascular disease assessments especially in ischemia. In clinical practice, this evaluation is still performed visually which is highly dependent on training and experience of the echocardiographers and therefore suffers from significant interobserver and intraobserver variability. This paper presents a new automatic technique, based on nonrigid image registration for classifying the RWM of LV in a three-point scale. In this algorithm, we register all images of one cycle of heart to a reference image (end-diastolic image) using a hierarchical parametric model. This model is based on an affine transformation for modeling the global LV motion and a B-spline free-form deformation transformation for modeling the local LV deformation. We consider image registration as a multiresolution optimization problem. Finally, a new regional quantitative index based on resultant parameters of the hierarchical transformation model is proposed for classifying RWM in a three-point scale. The results obtained by our method are quantitatively evaluated to those obtained by two experienced echocardiographers visually as gold standard on ten healthy volunteers and 14 patients (two apical views) and resulted in an absolute agreement of 83 % and a relative agreement of 99 %. Therefore, this diagnostic system can be used as a useful tool as well as reference visual assessment to classify RWM abnormalities in clinical evaluation.
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Affiliation(s)
- Ahmad Shalbaf
- />Department of Biomedical Engineering, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Hamid Behnam
- />Department of Biomedical Engineering, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Zahra Alizade-Sani
- />Rajaie Cardiovascular Medical & Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Shojaifard
- />Rajaie Cardiovascular Medical & Research Center, Tehran University of Medical Science, Tehran, Iran
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Munk K, Andersen NH, Terkelsen CJ, Bibby BM, Johnsen SP, Bøtker HE, Nielsen TT, Poulsen SH. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention. J Am Soc Echocardiogr 2012; 25:644-51. [PMID: 22406163 DOI: 10.1016/j.echo.2012.02.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Left ventricular systolic function is a key determinant of outcome after ST-segment elevation myocardial infarction (STEMI). The aim of this study was to study speckle-tracking global longitudinal strain (GLS) for early risk evaluation in STEMI and compare it with left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and end-systolic volume index (ESVI). METHODS Five-hundred seventy-six patients underwent echocardiography ≤24 hours after primary percutaneous coronary intervention for STEMI. The end point was the composite of death, hospitalization with reinfarction, congestive heart failure, or stroke. Associations with outcome were assessed by multivariate Cox regression with adjustment for clinical parameters. Hazard ratios (HRs) for events within the first year are reported per absolute percentage GLS increase. RESULTS During a median follow-up period of 24 months, 162 patients experienced at least one event. GLS was associated with the composite end point (adjusted HR, 1.20; 95% confidence interval [CI], 1.12-1.29) and also when controlling for LVEF (adjusted HR, 1.17; 95% CI, 1.07-1.29) and ESVI (adjusted HR, 1.18; 95% CI, 1.08-1.28). Although WMSI was significantly associated with outcome beyond any association accounted for by GLS, a borderline significant association was found after controlling for WMSI (adjusted HR for GLS, 1.10; 95% CI, 1.00-1.21). When GLS or WMSI was known, there was no significant association between LVEF or ESVI and outcome. CONCLUSIONS In a large population of patients with STEMI, GLS and WMSI were comparable and both superior for early risk assessment compared with volume-based left ventricular function indicators such as LVEF and ESVI. Compared with WMSI, the advantage of GLS is the provision of a semiautomated quantitative measure.
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Affiliation(s)
- Kim Munk
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
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Fischer-Rasokat U, Honold J, Seeger FH, Fichtlscherer S, Schächinger V, Dimmeler S, Zeiher AM, Assmus B. Early remodeling processes as predictors of diastolic function 5 years after reperfused acute myocardial infarction and intracoronary progenitor cell application. Clin Res Cardiol 2011; 101:209-16. [DOI: 10.1007/s00392-011-0382-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 11/09/2011] [Indexed: 11/30/2022]
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Lønborg J, Vejlstrup N, Kelbæk H, Bøtker HE, Kim WY, Mathiasen AB, Jørgensen E, Helqvist S, Saunamäki K, Clemmensen P, Holmvang L, Thuesen L, Krusell LR, Jensen JS, Køber L, Treiman M, Holst JJ, Engstrøm T. Exenatide reduces reperfusion injury in patients with ST-segment elevation myocardial infarction. Eur Heart J 2011; 33:1491-9. [PMID: 21920963 DOI: 10.1093/eurheartj/ehr309] [Citation(s) in RCA: 416] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Exenatide, a glucagon-like-peptide-1 analogue, increases myocardial salvage in experimental settings with coronary occlusion and subsequent reperfusion. We evaluated the cardioprotective effect of exenatide at the time of reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS A total of 172 patients with STEMI and Thrombolysis in Myocardial Infarction flow 0/1 were randomly assigned to exenatide or placebo (saline) intravenously. Study treatment was commenced 15 min before intervention and maintained for 6 h after the procedure. The primary endpoint was salvage index calculated from myocardial area at risk (AAR), measured in the acute phase, and final infarct size measured 90 ± 21 days after pPCI by cardiac magnetic resonance (CMR). In 105 patients evaluated with CMR, a significantly larger salvage index was found in the exenatide group than in the placebo group (0.71 ± 0.13 vs. 0.62 ± 0.16; P= 0.003). Infarct size in relation to AAR was also smaller in the exenatide group (0.30 ± 0.15 vs. 0.39 ± 0.15; P= 0.003). In a regression analysis, there was a significant correlation between the infarct size and the AAR for both treatment groups and an analysis of covariance showed that datapoints in the exenatide group lay significantly lower than for the placebo group (P= 0.011). There was a trend towards smaller absolute infarct size in the exenatide group (13 ± 9 vs. 17 ± 14 g; P= 0.11). No difference was observed in left ventricular function or 30-day clinical events. No adverse effects of exenatide were observed. CONCLUSION In patients with STEMI undergoing pPCI, administration of exenatide at the time of reperfusion increases myocardial salvage.
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Affiliation(s)
- Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
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Three-dimensional speckle tracking echocardiography for automatic assessment of global and regional left ventricular function based on area strain. J Am Soc Echocardiogr 2011; 24:314-21. [PMID: 21338866 DOI: 10.1016/j.echo.2011.01.014] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We evaluated the ability of a novel automatic index based on area strain to reliably quantify global and regional left ventricular (LV) function and accurately identify wall motion (WM) abnormalities using three-dimensional speckle tracking echocardiography. METHODS A total of 140 consecutive patients underwent two- and three-dimensional echocardiography. Segmental WM assessment by area strain was compared with visual assessment of two-dimensional images by two experienced echocardiographers. For global LV function assessment, area strain was validated against LV ejection fraction (EF) and wall motion score index (WMSI). Observer reliability was assessed in all patients, whereas test-retest reliability was evaluated in a subgroup of 50 randomly selected patients. Normal reference values of area strain were determined in 56 healthy subjects. RESULTS Agreement of WM scores between area strain and visual assessment was found in 94% of normal, 55% of hypokinetic, and 91% of akinetic segments (κ-coefficient 0.88). Sensitivity, specificity, and accuracy of area strain to distinguish abnormal segments from normal segments were 91%, 96%, and 94%, respectively. In regard to global LV function assessment, area strain was highly correlated with EF and WMSI (r = 0.91 and 0.88, respectively). Observer and test-retest reliability of area strain for quantitative assessment of global and regional LV function were good to excellent (all intraclass correlation coefficients ≥0.77). Intraobserver and interobserver reliability of semiquantitative segmental WM analysis by area strain (κ-coefficients 0.87 and 0.73) were comparable to visual assessment by experienced echocardiographers (0.85 and 0.69, respectively). CONCLUSION Area strain represents a promising novel automatic index that may provide an accurate and reproducible alternative to current echocardiographic standards for quantitative assessment of global and regional LV function. Area strain seems to adequately identify regional wall motion abnormalities compared with the clinical standard of visual assessment by experienced echocardiographers.
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Grover S, Leong DP, Selvanayagam JB. Evaluation of left ventricular function using cardiac magnetic resonance imaging. J Nucl Cardiol 2011; 18:351-65. [PMID: 21234827 DOI: 10.1007/s12350-010-9334-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Suchi Grover
- Department of Cardiology, Flinders Medical Centre, Bedford Park, SA 5042, Australia
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Hung CL, Verma A, Uno H, Shin SH, Bourgoun M, Hassanein AH, McMurray JJ, Velazquez EJ, Kober L, Pfeffer MA, Solomon SD. Longitudinal and circumferential strain rate, left ventricular remodeling, and prognosis after myocardial infarction. J Am Coll Cardiol 2011; 56:1812-22. [PMID: 21087709 DOI: 10.1016/j.jacc.2010.06.044] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We sought to investigate the clinical prognostic value of longitudinal and circumferential strain (S) and strain rate (SR) in patients after high-risk myocardial infarction (MI). BACKGROUND Left ventricular (LV) contractile performance after MI is an important predictor of long-term outcome. Tissue deformation imaging might more closely reflect myocardial contractility than traditional measures of systolic functions. METHODS The VALIANT (Valsartan in Acute Myocardial Infarction Trial) Echo study enrolled 603 patients with LV dysfunction, heart failure, or both 5 days after MI. We measured global peak longitudinal S and systolic SR (SRs) from apical 4- and 2-chamber views and global circumferential S and SRs from parasternal short-axis view with speckle tracking software (Velocity Vector Imaging, Siemens, Inc., Mountain View, California). We related global S and SRs to LV remodeling at 20-month follow-up and to clinical outcomes. RESULTS Both longitudinal (mean: -5.1 ± 1.6 100/ms) and circumferential SRs (mean: -8.0 ± 2.8 100/ms) were predictive of death or hospital stay for heart failure (hazard ratio: 2.4, 95% confidence interval [CI]: 2.0 to 3.1, p < 0.001; hazard ratio: 1.3, 95% CI: 1.2 to 1.4, p < 0.001, respectively) after adjustment for clinical covariates by Cox proportional hazards, and longitudinal SRs further improved in predicting 18-month survivor on a model based on clinical and standard echocardiographic measures (increase in area under the receiver-operator characteristic curve: 0.13, p = 0.009). With multivariable logistic regression, circumferential SRs, but not longitudinal SRs, was strongly predictive of remodeling (odds ratio: 1.3, 95% CI: 1.1 to 1.4, p < 0.001). CONCLUSIONS Both longitudinal and circumferential SRs were independent predictors of outcomes after MI, whereas only circumferential SRs was predictive of remodeling, suggesting that preserved circumferential function might serve to restrain ventricular enlargement after MI.
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Affiliation(s)
- Chung-Lieh Hung
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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26
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Flachskampf FA, Schmid M, Rost C, Achenbach S, DeMaria AN, Daniel WG. Cardiac imaging after myocardial infarction. Eur Heart J 2010; 32:272-83. [PMID: 21163851 DOI: 10.1093/eurheartj/ehq446] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
After myocardial infarction, optimal clinical management depends critically on cardiac imaging. Remodelling and heart failure, presence of inducible ischaemia, presence of dysfunctional viable myocardium, future risk of adverse events including risk of ventricular arrhythmias, need for anticoagulation, and other questions should be addressed by cardiac imaging. Strengths and weaknesses, recent developments, choice, and timing of the different non-invasive techniques are reviewed for this frequent clinical scenario.
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Affiliation(s)
- Frank A Flachskampf
- Uppsala University, Akademiska sjukhuset, Ingång 40, plan 5, 75185 Uppsala, Sweden.
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27
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Munk K, Andersen NH, Nielsen SS, Bibby BM, Bøtker HE, Nielsen TT, Poulsen SH. Global longitudinal strain by speckle tracking for infarct size estimation. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:156-65. [PMID: 21131657 DOI: 10.1093/ejechocard/jeq168] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS To assess the utility of speckle tracking global longitudinal systolic strain (GLS) compared with traditional echocardiographic indices including left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and end-systolic volume index (ESVI), in estimating the infarct size (IS) following a ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS The study includes 227 patients with STEMI and day 1 and day 30 echocardiograms, and myocardial perfusion imaging (MPI) only at day 30 to assess IS. IS was modelled by linear regression with echocardiographic parameters using MPI as reference. Resulting echocardiographic IS estimates were compared by ratios of standard deviations of model residuals (RSD). To estimate the resultant day 30 IS 1 day after a STEMI, GLS was more precise than LVEF (RSD: 0.91, P = 0.014) and ESVI (RSD: 0.88, P = 0.002), and comparable with WMSI (RSD 0.99, P = 0.86). To estimate IS from a day 30 echocardiogram, GLS was comparable with LVEF (RSD: 0.98, P = 0.68) and ESVI (RSD: 1.04, P = 0.40), but WMSI was more precise (RSD: 0.89, P = 0.006). Multiple linear regression revealed that on day 1 after STEMI, GLS significantly complemented the standard parameters separately (P-values all models <0.001) or combined [multivariable model: GLS (P = 0.001), WMSI (P = 0.03), LVEF (P = 0.40)]. On day 30, GLS significantly complemented LVEF and ESVI, but when WMSI was in the model, GLS's association with IS was not significant. CONCLUSION On day 1 after revascularization for STEMI, GLS contains additional information about final IS compared with standard echocardiographic systolic function indices. Studies are needed to clarify whether this has prognostic implications.
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Affiliation(s)
- Kim Munk
- Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.
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28
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Reant P, Dijos M, Donal E, Mignot A, Ritter P, Bordachar P, Dos Santos P, Leclercq C, Roudaut R, Habib G, Lafitte S. Systolic time intervals as simple echocardiographic parameters of left ventricular systolic performance: correlation with ejection fraction and longitudinal two-dimensional strain. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:834-44. [PMID: 20660604 DOI: 10.1093/ejechocard/jeq084] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Conventionally, the evaluation of left ventricular (LV) systolic function is based on ejection fraction assessment, which may be supplemented by other echocardiographic techniques, such as tissue Doppler imaging, 3D evaluation, and speckle tracking strains. However, these imaging modalities have a high technicity and are time-consuming, while being associated with reproducibility limitations. In this context, the usefulness of simpler measurements such as systolic time intervals (STI) by pulsed Doppler echocardiography must be emphasized. METHODS AND RESULTS In this multicentre study, left ventricular ejection fraction (LVEF), dP/dt(max), LV stroke volume, myocardial longitudinal deformation, aortic pre-ejectional period (PEP, ms), and left ventricular ejection time (LVET, ms) were prospectively investigated and compared in 134 consecutive heart failure (HF) patients and 43 control subjects. Feasibility of STI measurements was 100%. Intra-observer reproducibility was 98% for PEP, 96% for LVET, 87% for LVEF, and 93% for global longitudinal strain (GLS). By subgroup analyses, with increasingly altered LVEF or GLS, PEP significantly increased, whereas significantly LVET decreased, resulting in a significantly increased PEP/LVET ratio (P < 0.001). In the HF patients group, a correlation between LVEF and PEP/LVET was found, with r = 0.55 (y = -0.0083x + 0.75, P < 0.001). Based on receiver operating curve analyses, the area under the curve was 0.91 for PEP/LVET > 0.43, which allowed us to detect LVEF < 35% with a sensitivity of 87%, and a specificity of 84%. CONCLUSION STI can be easily and accurately measured in clinical practice, and may be used for detecting alterations in LV systolic function. Moreover, this method is likely to have potential applications in the management of HF patients.
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Affiliation(s)
- Patricia Reant
- Département de Cardiologie, CHU de Bordeaux, Université de Bordeaux, CIC-0005, Inserm U828, Plateforme Technologique d'Innovation Biomédicale, Bordeaux-Pessac, France.
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29
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Shin SH, Hung CL, Uno H, Hassanein AH, Verma A, Bourgoun M, Køber L, Ghali JK, Velazquez EJ, Califf RM, Pfeffer MA, Solomon SD. Mechanical dyssynchrony after myocardial infarction in patients with left ventricular dysfunction, heart failure, or both. Circulation 2010; 121:1096-103. [PMID: 20176989 DOI: 10.1161/circulationaha.109.863795] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mechanical dyssynchrony is considered an independent predictor for adverse cardiovascular outcomes in patients with heart failure. However, its importance as a risk factor after myocardial infarction is not well defined. METHODS AND RESULTS We examined the influence of mechanical dyssynchrony on outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction who were enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) echocardiography study. B-mode speckle tracking with velocity vector imaging was used to assess ventricular synchrony in 381 patients who had image quality sufficient for analysis. Time to regional peak velocity and time to strain rate were measured among 12 left ventricular segments from the apical 4- and 2- chamber views, and the SDs between all 12 segments were used as a measure of dyssynchrony. The relationships between the SD of time to regional peak velocity and strain rate and clinical outcome of death or heart failure were assessed. In a multivariate Cox model adjusted for clinical and echocardiographic variables, the SD of time to peak velocity (hazard ratio per 10 ms, 1.10; 95% confidence interval, 1.02 to 1.18; P=0.010) and the SD of time to strain rate (hazard ratio per 10 ms, 1.16; 95% confidence interval, 1.06 to 1.27; P=0.001) were independent predictors of death or heart failure. CONCLUSIONS Left ventricular dyssynchrony is independently associated with increased risk of death or heart failure after myocardial infarction, suggesting that contractile pattern may play a role in post-myocardial infarction prognosis.
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Affiliation(s)
- Sung-Hee Shin
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA
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30
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Lønborg J, Kelbaek H, Vejlstrup N, Jørgensen E, Helqvist S, Saunamäki K, Clemmensen P, Holmvang L, Treiman M, Jensen JS, Engstrøm T. Cardioprotective effects of ischemic postconditioning in patients treated with primary percutaneous coronary intervention, evaluated by magnetic resonance. Circ Cardiovasc Interv 2010; 3:34-41. [PMID: 20118154 DOI: 10.1161/circinterventions.109.905521] [Citation(s) in RCA: 199] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postconditioning has been suggested to reduce myocardial damage during primary percutaneous coronary intervention (PPCI) in patients with ST-segment-elevation myocardial infarction. However, because clinical experience is limited, we examined the cardioprotective effects of postconditioning, using cardiac MRI in patients treated with PPCI. METHODS AND RESULTS One hundred eighteen patients with ST-segment-elevation myocardial infarction referred for PPCI were randomly assigned to have either conventional PPCI or PPCI with postconditioning. Postconditioning was performed immediately after obtained reperfusion with 4 balloon occlusions, each lasting 30 seconds, followed by 30 seconds of reperfusion. The primary end point was myocardial salvage after 3 months as judged by delayed enhancement cardiac MRI. We found a 19% relative reduction of infarct size in the postconditioning group (51+/-16% of total area at risk versus 63+/-17%, P<0.01), corresponding to a 31% increase in salvage ratio. The number of patients developing heart failure was significantly fewer in the postconditioning group (27% versus 46%, P=0.048). No significant evidence of interaction between the impact of postconditioning and the location of the culprit lesion or size of the myocardium at risk was detected (P=0.21 and P=0.71). CONCLUSIONS Mechanical postconditioning reduces infarct size in patients with ST-segment-elevation myocardial infarction treated with PPCI. The impact of mechanical postconditioning seems to be independent of the size of myocardium at risk. CLINICAL TRIAL REGISTRATION- URL http://www.clinicaltrials.gov. Unique Identifier: NCT00507156.
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Affiliation(s)
- Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
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31
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Liel-Cohen N, Tsadok Y, Beeri R, Lysyansky P, Agmon Y, Feinberg MS, Fehske W, Gilon D, Hay I, Kuperstein R, Leitman M, Deutsch L, Rosenmann D, Sagie A, Shimoni S, Vaturi M, Friedman Z, Blondheim DS. A New Tool for Automatic Assessment of Segmental Wall Motion Based on Longitudinal 2D Strain. Circ Cardiovasc Imaging 2010; 3:47-53. [DOI: 10.1161/circimaging.108.841874] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Identification and quantification of segmental left ventricular wall motion abnormalities on echocardiograms is of paramount clinical importance but is still performed by a subjective visual method. We constructed an automatic tool for assessment of wall motion based on longitudinal strain.
Methods and Results—
Echocardiograms of 105 patients (3 apical views) were blindly analyzed by 12 experienced readers. Visual segmental scores (VSS) and peak systolic longitudinal strain were assigned to each of 18 segments per patient. Ranges of peak systolic longitudinal strain that best fit VSS (by receiver operating characteristic analysis) were used to generate automatic segmental scores (ASS). Comparisons of ASS and VSS were performed on 1952 analyzable segments. There was agreement of wall motion scores between both methods in 89.6% of normal, 39.5% of hypokinetic, and 69.4% of akinetic segments. Correlation between methods was
r
=0.63 (
P
<0.0001). Interobserver and intraobserver reliability using interclass correlation for scoring segmental wall motion into 3 scores by ASS was 0.82 and 0.83 and by VSS 0.70 and 0.69, respectively. Compared with VSS (majority rule), ASS had a sensitivity, specificity, and accuracy of 87%, 85%, and 86%, respectively. ASS and VSS had similar success rates for correct identification of wall motion abnormalities in territories supplied by culprit arteries. VSS had greater specificity and positive predictive values, whereas ASS had higher sensitivity and negative predictive values for identifying the culprit artery.
Conclusions—
Automatic quantification of wall motion on echocardiograms by this tool performs as well as visual analysis by experienced echocardiographers, with a greater reliability and similar agreement to angiographic findings.
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Affiliation(s)
- Noah Liel-Cohen
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Yossi Tsadok
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Ronen Beeri
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Peter Lysyansky
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Yoram Agmon
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Micha S. Feinberg
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Wolfgang Fehske
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Dan Gilon
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Ilan Hay
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Rafael Kuperstein
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Marina Leitman
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Lisa Deutsch
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - David Rosenmann
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Alik Sagie
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Sarah Shimoni
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Mordehay Vaturi
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Zvi Friedman
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - David S. Blondheim
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
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Quantitative assessment of left ventricular systolic wall thickening using multidetector computed tomography. Eur J Radiol 2009; 72:92-7. [DOI: 10.1016/j.ejrad.2008.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 06/06/2008] [Accepted: 06/30/2008] [Indexed: 11/17/2022]
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33
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Joffe SW, Ferrara J, Chalian A, Tighe DA, Aurigemma GP, Goldberg RJ. Are ejection fraction measurements by echocardiography and left ventriculography equivalent? Am Heart J 2009; 158:496-502. [PMID: 19699876 PMCID: PMC4562011 DOI: 10.1016/j.ahj.2009.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 06/05/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (EF) is an important parameter in the diagnosis and treatment of patients with coronary heart disease. Previous studies comparing echocardiography and contrast left ventriculography (CVG) for the measurement of EF have shown considerable variation in results, yet, in clinical practice, EF measurements are used interchangeably. The purpose of this study was to assess the concordance between echocardiography and CVG for the determination of EF in routine clinical practice and to identify factors associated with variation in test results. METHODS We reviewed the medical records of 5,385 patients hospitalized for acute myocardial infarction between 1997 and 2005 as part of a community-based surveillance project. Of these, 741 patients had EF measurements recorded by both echocardiography and CVG during hospitalization. RESULTS While good correlation (r = 0.73) and no systematic bias were noted between the measurement of EF by echocardiogram compared to CVG, there was wide variation between the 2 methods for any given patient. In approximately one third of patients with acute myocardial infarction, the measurement of EF by echocardiography and CVG differed by >10 points, while in approximately 1 in 20 patients, EF measurements by echocardiography and CVG differed by >20 points. The number of days between tests to measure EF, level of EF, temporal order of EF testing, and patient-related factors made only a minor contribution to the variation in test results. CONCLUSIONS Our results demonstrate that, in routine clinical practice, EF determinations obtained by echocardiography and CVG may vary widely, with potentially important clinical implications.
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Affiliation(s)
- Samuel W Joffe
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
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Ghersin E, Abadi S, Yalonetsky S, Engel A, Lessick J. Clinical evaluation of a fully automated model-based algorithm to calculate left ventricular volumes and ejection fraction using multidetector computed tomography. ACTA ACUST UNITED AC 2009; 11:43-51. [DOI: 10.1080/17482940802588317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Left Ventricular Function Can Reliably be Assessed From Dual-Source CT Using ECG-Gated Tube Current Modulation. Invest Radiol 2009; 44:384-9. [DOI: 10.1097/rli.0b013e3181a4d874] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pattern and Impact of Altered Regional Myocardial Excursion on Global Ventricular Performance After First-Time Acute Anterior Wall Myocardial Infarction by Real-Time Three-Dimensional Echocardiography. INT J GERONTOL 2008. [DOI: 10.1016/s1873-9598(09)70008-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Arruda-Olson AM, Pellikka PA, Bursi F, Jaffe AS, Santrach PJ, Kors JA, Killian JM, Weston SA, Roger VL. Left ventricular function and heart failure in myocardial infarction: impact of the new definition in the community. Am Heart J 2008; 156:810-5. [PMID: 19061692 DOI: 10.1016/j.ahj.2008.06.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate ventricular function and the occurrence of heart failure (HF) among persons with myocardial infarction (MI) meeting only troponin criteria compared to persons meeting creatine kinase and its MB fraction (CK-MB) criteria. BACKGROUND The 2000 American College of Cardiology/European Society of Cardiology MI definition enabled identification of MIs meeting only troponin-based criteria. Data on ventricular function and HF among these are lacking. METHODS Between November 2002 and May 2006, we prospectively identified 835 persons with MI in the community using standardized criteria including cardiac pain, electrocardiogram, and biomarkers. Troponin and CK-MB were prospectively measured in all; each patient was classified according to the criteria met. RESULTS We performed echocardiograms (median of 1 day post-MI) in 482 patients (age 68+/-15 years; 45% women); 363 patients met CK-MB criteria, whereas 119 met only troponin criteria. The latter had lower wall motion score index (1.3+/-0.4 vs 1.5+/-0.5 for CK-MB; P<.01). Diastolic dysfunction was similar in both groups. After 1 year of follow up, 142 patients developed post-MI HF. Patients meeting only troponin criteria had a lower risk of HF after adjustment for age, sex, comorbidity (hazard ratio 0.56, 95% confidence interval 0.37-0.85, P<.01), which persisted after further adjustments for systolic or diastolic function. CONCLUSIONS In the community, the prospective application of the new MI definition identifies patients meeting only troponin criteria with better systolic function than cases meeting CK-MB criteria. Such MIs have a lower risk of subsequent HF. These findings are important for risk stratification in clinical practice.
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Relation Between Global Left Ventricular Longitudinal Strain Assessed with Novel Automated Function Imaging and Biplane Left Ventricular Ejection Fraction in Patients with Coronary Artery Disease. J Am Soc Echocardiogr 2008; 21:1244-50. [PMID: 18992675 DOI: 10.1016/j.echo.2008.08.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Indexed: 11/22/2022]
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Shapiro MD, Guarraia DL, Moloo J, Cury RC. Evaluation of acute coronary syndromes by cardiac magnetic resonance imaging. Top Magn Reson Imaging 2008; 19:25-32. [PMID: 18690158 DOI: 10.1097/rmr.0b013e31816fd81d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The use of cardiovascular magnetic resonance (CMR) imaging for the evaluation of patients with acute chest pain and acute coronary syndromes has great potential. The strength of CMR relies on its ability to provide information on anatomy, physiology, and function in a single scanning session in a noninvasive manner without the need for iodinated contrast, radiation, or the need to undergo invasive procedures. Specifically, with regard to imaging patients with acute chest pain and/or myocardial infarction (MI), CMR has the ability to qualitatively and quantitatively evaluate global and regional right and left ventricular systolic functions, myocardial edema, myocardial perfusion, and myocardial infarct size and transmurality/viability. This review will focus on CMR imaging for the following applications: (1) imaging for the evaluation of ventricular function and infarct size in patients with acute chest pain and/or acute MI, (2) for triage and prognosis of patients presenting to the emergency department with acute chest pain, (3) for evaluating patients after sustaining an acute MI, and (4) for stem cell research.
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Affiliation(s)
- Michael D Shapiro
- Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
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