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Nardi F, Pino PG, De Luca L, Riccio C, Cipriani M, Corda M, Francese GM, Gabrielli D, Oliva F, Gulizia MM, Colivicchi F. ANMCO position paper: 2022 focused update of appropriate use criteria for multimodality imaging: aortic valve disease. Eur Heart J Suppl 2022; 24:C289-C297. [PMID: 35602253 PMCID: PMC9117909 DOI: 10.1093/eurheartj/suac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This document addresses the evaluation of the Appropriate Use Criteria (AUC) of multimodality imaging in the diagnosis and management of aortic valve disease. The goal of this AUC document is to provide a comprehensive resource for multimodality imaging in the context of aortic valve disease, encompassing multiple imaging modalities. Clinical scenarios are developed in a simple way to illustrate patient presentations encountered in everyday practice.
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Affiliation(s)
- Federico Nardi
- Cardiology Department, Ospedale Santo Spirito, Via Giolitti 2, Casale Monferrato 15033, AL, Italy
| | - Paolo Giuseppe Pino
- Consultant Cardiologist of the Echo-Lab, Ospedale Santo Spirito, Casale Monferrato, AL, Italy
| | - Leonardo De Luca
- Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Carmine Riccio
- Cardio-Vascular Department, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | - Manlio Cipriani
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Corda
- Cardiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Giuseppina Maura Francese
- Cardiology Department, Ospedale Garibaldi-Nesima-Azienda Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | - Domenico Gabrielli
- Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Fabrizio Oliva
- Unit of Intensive Cardiological Care, Cardiology 1-Hemodynamics, Cardiothoracovascular Department "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima-Azienda Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy.,Fondazione per il Tuo cuore-Heart Care Foundation, Firenze, Italy
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Ilardi F, Postolache A, Dulgheru R, Trung MLN, de Marneffe N, Sugimoto T, Go YY, Oury C, Esposito G, Lancellotti P. Prognostic Value of Non-Invasive Global Myocardial Work in Asymptomatic Aortic Stenosis. J Clin Med 2022; 11:jcm11061555. [PMID: 35329881 PMCID: PMC8953091 DOI: 10.3390/jcm11061555] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/20/2022] [Accepted: 03/09/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to evaluate the modification of non-invasive myocardial work (MW) indices related to aortic stenosis (AS) stages of cardiac damage and their prognostic value. The echocardiographic and outcome data of 170 patients, with asymptomatic moderate-to-severe AS and left ventricular ejection fraction (LVEF) ≥ 50%, and 50 age- and sex-comparable healthy controls were analysed. Primary endpoints were the occurrence of all-cause and cardiovascular death. Increased values of the global work index (GWI), global constructive work (GCW), and global wasted work (GWW) were observed in AS patients compared to controls (GWI: 2528 ± 521 vs. 2005 ± 302 mmHg%, GCW: 2948 ± 598 vs. 2360 ± 353 mmHg%, p < 0.001; GWW: 139 ± 90 vs. 90 ± 49 mmHg%, p = 0.005), with no changes in the global work efficiency. When patients were stratified according to the stages of cardiac damage, the GWI showed lower values in Stage 3−4 as compared to Stage 0 and Stage 2 (p = 0.024). During a mean follow-up of 30 months, 27 patients died. In multivariable Cox-regression analysis, adjusted for confounders, GWI (HR: 0.998, CI: 0.997−1.000; p = 0.034) and GCW (HR:0.998, CI: 0.997−0.999; p = 0.003) were significantly associated with excess mortality. When used as categorical variables, a GWI ≤ 1951 mmHg% and a GCW ≤ 2475 mmHg% accurately predicted all-cause and cardiovascular death at 4-year follow-up. In conclusion, in asymptomatic patients with moderate-to-severe AS, reduced values of GWI and GCW are associated with increased mortality. Therefore, the evaluation of MW indices may allow for a better identification of asymptomatic patients with moderate to severe AS and preserved LVEF whom are at increased risk of worse prognosis during follow-up.
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Affiliation(s)
- Federica Ilardi
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini, 5, 80131 Napoli, Italy;
| | - Adriana Postolache
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
| | - Raluca Dulgheru
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
| | - Mai-Linh Nguyen Trung
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
| | - Nils de Marneffe
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
| | - Tadafumi Sugimoto
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
- Clinical Laboratory, Mie University Hospital, Tsu 514-8507, Japan
| | - Yun Yun Go
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore 169609, Singapore
| | - Cécile Oury
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini, 5, 80131 Napoli, Italy;
| | - Patrizio Lancellotti
- Department of Cardiology and Radiology, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege University Hospital, 4000 Liege, Belgium; (F.I.); (A.P.); (R.D.); (M.-L.N.T.); (N.d.M.); (T.S.); (Y.Y.G.); (C.O.)
- Gruppo Villa Maria Care and Research, Anthea Hospital, 70124 Bari, Italy
- Correspondence: ; Tel.: +32-4-366-71-94
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lin J, Gao L, He J, Liu M, Cai Y, Niu L, Zhao Y, Li X, Wang J, Wu W, Zhu Z, Wang H. Comparison of Myocardial Layer-Specific Strain and Global Myocardial Work Efficiency During Treadmill Exercise Stress in Detecting Significant Coronary Artery Disease. Front Cardiovasc Med 2022; 8:786943. [PMID: 35111825 PMCID: PMC8801497 DOI: 10.3389/fcvm.2021.786943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background Myocardial layer-specific strain can identify myocardial ischemia. Global myocardial work efficiency (GWE) based on non-invasive left ventricular (LV) pressure-strain loops is a novel parameter to determine LV function considering afterload. The study aimed to compare the diagnostic value of GWE and myocardial layer-specific strain during treadmill exercise stress testing to detect significant coronary artery disease (CAD) with normal baseline wall motion. Methods Eighty-nine patients who referred for coronary angiography due to suspected of CAD were included. Forty patients with severe coronary artery stenosis were diagnosed with significant CAD, and 49 were defined as non-significant CAD. Stress echocardiography was performed 24 h before angiography. Layer-specific longitudinal strains were assessed from the endocardium, mid-myocardium, and epicardium by 2D speckle-tracking echocardiography. Binary logistic regression analyses were performed to evaluate the association between significant CAD and echocardiographic parameters. A receiver operating characteristic curve was used to assess the capability of layer-specific strain and GWE to diagnose significant CAD. Results Patients with significant CAD had the worse function in all three myocardial layers at peak exercise compared with those with non-significant CAD when assessed with global longitudinal strain (GLS). At the peak exercise and recovery periods, GWE was lower in patients with significant CAD than in patients with non-significant CAD. In multivariable binary logistic regression analysis, peak endocardial GLS (OR: 1.35, p = 0.006) and peak GWE (OR: 0.76, p = 0.001) were associated with significant CAD. Receiver operating characteristic curves showed peak GWE to be superior to mid-myocardial, epicardial, and endocardial GLS in identifying significant CAD. Further, adding peak GWE to endocardial GLS could improve diagnostic capabilities. Conclusions Both GWE and endocardial GLS contribute to improving the diagnostic performance of exercise stress echocardiography. Furthermore, adding peak GWE to peak endocardial GLS provides incremental diagnostic value during a non-invasive screening of significant CAD before radioactive or invasive examinations.
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Affiliation(s)
- Jingru Lin
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijian Gao
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia He
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyi Liu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqi Cai
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lili Niu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Zhao
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoni Li
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Weichun Wu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Weichun Wu
| | - Zhenhui Zhu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Zhenhui Zhu
| | - Hao Wang
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Hao Wang
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Le TT, Huang W, Singh GK, Toh DF, Ewe SH, Tang HC, Loo G, Bryant JA, Ang B, Tay ELW, Soo WM, Yip JWL, Oon YY, Gong L, Lunaria JB, Yong QW, Lee EM, Yeo PSD, Chai SC, Goh PP, Ling LF, Ong HY, Richards AM, Delgado V, Bax JJ, Ding ZP, Ling LH, Chin CWL. Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis. Front Cardiovasc Med 2021; 8:750016. [PMID: 34859068 PMCID: PMC8631398 DOI: 10.3389/fcvm.2021.750016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
Aims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on cardiovascular magnetic resonance (CMR) and validate the prognostic value of LV-GLS thresholds associated with fibrosis. Methods and results: LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57 ± 10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71 ± 12 years; 58% males; NYHA functional class I–II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, and myocardial infarction. In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74 [0.66–0.83]; P < 0.001) and calibration (Hosmer-Lemeshow χ2 = 6.37; P = 0.605) for replacement fibrosis. In the outcome cohort, 47 events occurred over 16 [3.3, 42.2] months. Patients with LV-GLS > −15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS < −21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P < 0.001). LV-GLS offered independent prognostic value over clinical variables, AS severity and echocardiographic LV mass and E/e′. Conclusion: LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF.
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Affiliation(s)
- Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Weiting Huang
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Desiree-Faye Toh
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - See Hooi Ewe
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Hak Chaw Tang
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Germaine Loo
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Jennifer A Bryant
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Briana Ang
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Edgar Lik-Wui Tay
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Asian Heart and Vascular Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Wern Miin Soo
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
| | - James Wei-Luen Yip
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore
| | - Yen Yee Oon
- Department of Cardiology, Sarawak Heart Centre, Sarawak, Kota Samarahan, Malaysia
| | - Lingli Gong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Josephien B Lunaria
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Quek Wei Yong
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Evelyn Min Lee
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Poh Shuan Daniel Yeo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore.,Apex Heart Clinic, Gleneagles Hospital, Singapore, Singapore
| | - Siang Chew Chai
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Ping Ping Goh
- Asian Heart and Vascular Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Lee Fong Ling
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Hean Yee Ong
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Arthur Mark Richards
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Christchurch, Christchurch, New Zealand
| | - Victoria Delgado
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart and Lung Centre, Leiden University, Leiden, Netherlands
| | - Zee Pin Ding
- Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Lieng-Hsi Ling
- Department of Cardiology, National University Heart Center Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, Singapore
| | - Calvin W L Chin
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore.,Cardiovascular ACP, Duke-NUS Medical School Singapore, Singapore, Singapore.,Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
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Weise Valdés E, Barth P, Piran M, Laser KT, Burchert W, Körperich H. Left-Ventricular Reference Myocardial Strain Assessed by Cardiovascular Magnetic Resonance Feature Tracking and fSENC-Impact of Temporal Resolution and Cardiac Muscle Mass. Front Cardiovasc Med 2021; 8:764496. [PMID: 34796219 PMCID: PMC8593240 DOI: 10.3389/fcvm.2021.764496] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: Cardiac strain parameters are increasingly measured to overcome shortcomings of ejection fraction. For broad clinical use, this study provides reference values for the two strain assessment methods feature tracking (FT) and fast strain-encoded (fSENC) cardiovascular magnetic resonance (CMR) imaging, including the child/adolescent group and systematically evaluates the influence of temporal resolution and muscle mass on strain. Methods and Results: Global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain values in 181 participants (54% women, 11–70 years) without cardiac illness were assessed with FT (CVI42® software). GLS and GCS were also analyzed using fSENC (MyoStrain® software) in a subgroup of 84 participants (60% women). Fourteen patients suffering hypertrophic cardiomyopathy (HCM) were examined with both techniques. CMR examinations were done on a 3.0T MR-system. FT-GLS, FT-GCS, and FT-GRS were −16.9 ± 1.8%, −19.2 ± 2.1% and 34.2 ± 6.1%. fSENC-GLS was higher at −20.3 ± 1.8% (p < 0.001). fSENC-GCS was comparable at−19.7 ± 1.8% (p = 0.06). All values were lower in men (p < 0.001). Cardiac muscle mass correlated (p < 0.001) with FT-GLS (r = 0.433), FT-GCS (r = 0.483) as well as FT-GRS (r = −0.464) and acts as partial mediator for sex differences. FT-GCS, FT-GRS and fSENC-GLS correlated weakly with age. FT strain values were significantly lower at lower cine temporal resolutions, represented by heart rates (r = −0.301, −0.379, 0.385) and 28 or 45 cardiac phases per cardiac cycle (0.3–1.9% differences). All values were lower in HCM patients than in matched controls (p < 0.01). Cut-off values were −15.0% (FT-GLS), −19.3% (FT-GCS), 32.7% (FT-GRS), −17.2% (fSENC-GLS), and −17.7% (fSENC-GCS). Conclusion: The analysis of reference values highlights the influence of gender, temporal resolution, cardiac muscle mass and age on myocardial strain values.
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Affiliation(s)
- Elena Weise Valdés
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Peter Barth
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Misagh Piran
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kai Thorsten Laser
- Center for Congenital Heart Defects, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Wolfgang Burchert
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2021; 10:jcm10194563. [PMID: 34640580 PMCID: PMC8509290 DOI: 10.3390/jcm10194563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Aims: We sought to assess the impact of the extent of cardiac damage on survival among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). (2) Methods: A staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-days after TAVI. The primary endpoint of the study was all-cause mortality at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis, and re-hospitalization for all causes. (3) Results: At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-days after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p = 0.08). No differences were found in secondary endpoints. (4) Conclusions: TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline significantly affects the risk of mortality at 1-year after the procedure.
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Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice. J Clin Med 2021; 10:jcm10194521. [PMID: 34640537 PMCID: PMC8509621 DOI: 10.3390/jcm10194521] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022] Open
Abstract
Left ventricular (LV) global longitudinal strain (GLS) has established itself in the last decade as a reliable, more objective method for the evaluation of LV systolic function, able to detect subtle abnormalities in LV contraction even in the presence of preserved ejection fraction (EF). However, recent studies have demonstrated that GLS, similar to LV EF, has important load dependency. Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative tool for myocardial function assessment. This new method, incorporating measurement of strain and LV pressure, has shown to overcome GLS and LV EF limitations and provide a loading-independent evaluation of myocardial performance. The presence of a commercially available echocardiographic software for the non-invasive MW calculation has allowed the application of this new method in different settings. This review sought to provide an overview on the current knowledge of non-invasive MW estimation, showing its potential applications and possible added value in clinical practice.
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Michalski B, Dweck MR, Marsan NA, Cameli M, D'Andrea A, Carvalho RF, Holte E, Podlesnikar T, Manka R, Haugaa KH. The evaluation of aortic stenosis, how the new guidelines are implemented across Europe: a survey by EACVI. Eur Heart J Cardiovasc Imaging 2021; 21:357-362. [PMID: 32196100 DOI: 10.1093/ehjci/jeaa009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/11/2020] [Indexed: 12/27/2022] Open
Abstract
Aortic stenosis (AS) is the most prevalent valvular disease in developed countries, with a prevalence that is set to expand further with an ageing population. The most recent guidelines on valvular heart disease published by the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery, aim to standardize the diagnosis and management of valvular heart diseases. The imaging criteria of the current guidelines are mostly based on EACVI Recommendations, with an appropriate diagnostic workflow being of major importance, to ensure streamlined and efficient patient assessment and accurate diagnoses and decisions regarding the timing of surgery. The EACVI Scientific Initiatives Committee, therefore, created a survey on the imaging assessment of patient with AS to investigate the diagnostic patient pathways used in different centres across Europe. In particular, we conducted this survey to better understand the use and access of advanced imaging techniques in AS including 3D transthoracic echocardiography and 3D transoesophageal echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance.
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Affiliation(s)
- Blazej Michalski
- Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, 91-347 Lodz, Poland
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Policlinico Le Scotte, Viale Bracci 16, 53100 Siena, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I_ Hospital, Viala San Francesco 84014 Nocera Inferiore (Salerno), Luigi Vanvitelli University, Italy
| | - Ricardo Fontes Carvalho
- Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Espen Holte
- Clinic of Cardiology, St. Olavs Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, Postboks 8905, 7491 Trondheim, Norway
| | - Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.,Department of Cardiology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000 Ljubljana, Slovenia
| | | | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway
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Binder RK, Dweck M, Prendergast B. The year in cardiology: valvular heart disease. Eur Heart J 2021; 41:912-920. [PMID: 31901941 DOI: 10.1093/eurheartj/ehz948] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/23/2019] [Accepted: 12/24/2019] [Indexed: 01/01/2023] Open
Abstract
Abstract
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Affiliation(s)
- Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, Wels, Austria
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital and Cleveland Clinic, London, UK
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11
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Cimino S, Monosilio S, Luongo F, Neccia M, Birtolo LI, Salvi N, Filomena D, Mancone M, Fedele F, Agati L, Maestrini V. Myocardial contractility recovery following acute pressure unloading after transcatheter aortic valve intervention (TAVI) in patients with severe aortic stenosis and different left ventricular geometry: a multilayer longitudinal strain echocardiographicanalysis. Int J Cardiovasc Imaging 2021; 37:965-970. [PMID: 33251555 PMCID: PMC7969538 DOI: 10.1007/s10554-020-02074-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022]
Abstract
Aim of the present study was to describe the left ventricular longitudinal strain (LS) in all myocardial layers in patients with severe aortic stenosis (AS), preserved left ventricular ejection fraction (LVEF) in different LV geometry and to compare LS analysis before and early after acute LV unloading provided by transcatheter aortic valve implantation (TAVI). 68 patients were enrolled. LS was measured from the endocardial layer (Endo-LS), epicardial layer (Epi-LS) and full thickness of myocardium (Transmural-LS) before and after TAVI. Patients were divided in two groups accordingly with relative wall thickness (RWT): concentric LV hypertrophy (cLVH) vs eccentric LV hypertrophy (eLVH). Less impaired values of LS at baseline were observed, in all layers, in patients with cLVHas compared to patients with eLVH (Endo-LS was - 13.2 ± 2 vs - 11.1±3 %, p = 0.041; Epi-LS was - 11.8 ± 1.8 vs - 9.9 ± 3 %, p = 0.043; Transmural-LS was - 12.3 ± 1.8 vs - 10.49 ± 3.3 %, p = 0.02, respectively). A significant improvement in endocardial LS (Endo-LS) after TAVI was detected only in cLVH(- 13 ± 2 vs - 14 ± 2, p = 0.011). Our findings documented that concentric LVH had better basal strain function and showed a better myocardial recovery after TAVI compared to eLVH.
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Affiliation(s)
- Sara Cimino
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy.
| | - Sara Monosilio
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Federico Luongo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Matteo Neccia
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Lucia Ilaria Birtolo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Nicolò Salvi
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Domenico Filomena
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Luciano Agati
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
| | - Viviana Maestrini
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric, Science "Sapienza" University of Rome, Policlinico Umberto I, Rome Viale del Policlinico 155, 00161, Roma, Italy
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Accuracy of global and regional longitudinal strain at peak of dobutamine stress echocardiography to detect significant coronary artery disease. Int J Cardiovasc Imaging 2021; 37:1321-1331. [PMID: 33433744 PMCID: PMC7801788 DOI: 10.1007/s10554-020-02121-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/24/2020] [Indexed: 11/11/2022]
Abstract
Dobutamine stress echocardiography (DSE) is sensitive but subjective diagnostic tool to detect inducible ischemia. Nowadays, speckle tracking allows an objective quantification of regional wall function. We aimed to investigate the feasibility and accuracy of global (GLS) and regional longitudinal strain (RLS) during DSE to detect significant coronary stenosis (SCS). We conducted a prospective observational multicenter study including patients undergoing DSE for suspected SCS. 50 patients with positive DSE underwent coronary angiography. Besides visual regional wall motion score index (WMSI), GLS and RLS were determined at rest and at peak stress by Automated Function Imaging. DSE GLS feasibility was 96%. Among 35 patients with SCS, 12 patients were affected by multivessel disease, 18 had stenosis of left anterior descending artery (LAD), 18 of left circumflex (LCX) and 15 of right coronary artery (RCA). At peak stress, both GLS reduction (p = 0.037) and WMSI worsening (p = 0.04) showed significant agreement with coronary angiography for detecting SCS. When single lesion was considered, peak stress GLS and LAD RLS were lower in the obstructed LAD regions than in normo-perfused territories (17.4 ± 5.5 vs. 20.5 ± 4.4%, p = 0.03; 17.1 ± 7.6 vs. 21.6 ± 5.5%, p < 0.02, respectively). Furthermore, the addition of RLS to regional WMSI was able to improve accuracy in LAD SCS prediction (AUC 0.68, p = 0.037). Conversely, in presence of LCX or RCA SCS, LS was less accurate than WMSI at peak stress. In conclusion, DSE strain analysis is feasible and may improve prediction of LAD SCS, whereas regional WMSI assessment performs better in presence of SCS of LCX and RCA.
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