1
|
Espe E, Stokke MK. Editorial for "MRI Assessment of Myocardial Deformation for Risk Stratification of Major Arrhythmic Events in Patients with Non-Ischemic Cardiomyopathy Eligible for Primary Prevention Implantable Cardioverter Defibrillators". J Magn Reson Imaging 2024. [PMID: 38358060 DOI: 10.1002/jmri.29300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
- Emil Espe
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Nikoo MH, Zarrabi M, Moaref A, Razeghian-Jahromi I. Global Longitudinal Strain May Be the One that Appropriately Identifies Candidates of ICD Implantation. Cardiol Res Pract 2024; 2024:2214072. [PMID: 38264236 PMCID: PMC10805553 DOI: 10.1155/2024/2214072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/20/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) significantly contributes to an elevated risk of sudden cardiac death. Primary prevention is implemented by using an implantable cardioverter defibrillator (ICD). However, all of the HCM patients do not really need ICD therapy. Providing a superior index for ICD indication compared with the current indices like ejection fraction is essential to differentiate high-risk patients efficiently. The present study assessed the potential of global longitudinal strain (GLS) for the differentiation of HCM patients based on their need for ICD shocks. Patients with HCM were considered in four defined centers between March and June 2021. Those with previous ICD implantation or current candidates for ICD therapy were included in the study. Participants were subjected to speckle-tracking echocardiography, and GLS as well as some other echocardiographic parameters were recorded. Afterwards, data from implanted ICDs were extracted. Patients who received ICD shocks (appropriate) due to ventricular tachycardia (VT)/ventricular fibrillation (VF) were categorized in group A. The remaining patients were constituted group B who received inappropriate shocks, i.e., other than VT/VF. Overall, 34 patients were found eligible to participate with a mean age of 62 ± 16.1 years including 64.7% of males. Among a variety of echocardiographic parameters, GLS was the sole one that was significantly higher in group A compared with that in group B. Our findings revealed that only GLS could predict fatal arrhythmias. To substantiate, the odds of VT were raised by 43% with a single increase in GLS unit. GLS showed the highest accuracy for ICD indication among HCM patients and, therefore, could be a solid and early criterion to predict the incidence of life-threatening arrhythmias. In this regard, identifying appropriate HCM patients with respect to their need for ICD therapy is feasible.
Collapse
Affiliation(s)
- Mohammad Hossein Nikoo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Zarrabi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Moaref
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | |
Collapse
|
3
|
Dutton LC, Spalla I, Seo J, Silva J, Novo Matos J. Aortic annular plane systolic excursion in cats with hypertrophic cardiomyopathy. J Vet Intern Med 2024; 38:61-70. [PMID: 38038190 PMCID: PMC10800187 DOI: 10.1111/jvim.16962] [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: 06/14/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Impairment of left ventricular (LV) longitudinal function is an early marker of systolic dysfunction in hypertrophic cardiomyopathy (HCM). Aortic annular plane systolic excursion (AAPSE) is a measure of LV longitudinal function in people that has not been evaluated in cats. HYPOTHESIS Aortic annular plane systolic excursion is lower in cats with HCM compared to control cats, and cats in stage C have the lowest AAPSE. ANIMALS One hundred seventy-five cats: 60 normal, 61 HCM stage B and 54 HCM stage C cats. MATERIALS Multicenter retrospective case-control study. Electronic medical records from 4 referral hospitals were reviewed for cats diagnosed with HCM and normal cats. HCM was defined as LV wall thickness ≥6 mm and normal cats ≤5 mm. M-mode bisecting the aorta in right parasternal short-axis view was used to measure AAPSE. RESULTS Aortic annular plane systolic excursion was lower in HCM cats compared to normal cats (3.9 ± 0.9 mm versus 4.6 ± 0.9 mm, P < .001) and was lowest in HCM stage C (2.4 ± 0.6 mm, P < .001). An AAPSE <2.9 mm gave a sensitivity of 83% (95% CI 71%-91%) and specificity of 92% (95% CI 82%-97%) to differentiate HCM stage C from stage B. AAPSE correlated with mitral annular plane systolic excursion (r = .6 [.4-.7], P < .001), and atrial fractional shortening (r = .6 [.5-.7], P < .001), but showed no correlation with LV fractional shortening. CONCLUSIONS AND CLINICAL IMPORTANCE Aortic annular plane systolic excursion is an easily acquired echocardiographic variable and might be a new measurement of LV systolic performance in cats with HCM.
Collapse
Affiliation(s)
- Luke C Dutton
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Joonbum Seo
- Animal Referral Centre, Auckland, New Zealand
| | - Joel Silva
- North Downs Specialist Referrals, The Friesian Buildings 3 & 4, Bletchingley, Surrey, UK
| | - Jose Novo Matos
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
4
|
Gardner MM, Wang Y, Himebauch AS, Conlon TW, Graham K, Morgan RW, Feng R, Berg RA, Yehya N, Mercer-Rosa L, Topjian AA. Impaired echocardiographic left ventricular global longitudinal strain after pediatric cardiac arrest children is associated with mortality. Resuscitation 2023; 191:109936. [PMID: 37574003 PMCID: PMC10802989 DOI: 10.1016/j.resuscitation.2023.109936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/17/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Global longitudinal strain (GLS) is an echocardiographic method to identify left ventricular (LV) dysfunction after cardiac arrest that is less sensitive to loading conditions. We aimed to identify the frequency of impaired GLS following pediatric cardiac arrest, and its association with hospital mortality. METHODS This is a retrospective single-center cohort study of children <18 years of age treated in the pediatric intensive care unit (PICU) after in- or out-of-hospital cardiac arrest (IHCA and OHCA), with echocardiogram performed within 24 hours of initiation of post-arrest PICU care between 2013 and 2020. Patients with congenital heart disease, post-arrest extracorporeal support, or inability to measure GLS were excluded. Echocardiographic LV ejection fraction (EF) and shortening fraction (SF) were abstracted from the chart. GLS was measured post hoc; impaired strain was defined as LV GLS ≥ 2 SD worse than age-dependent normative values. Demographics and pre-arrest, arrest, and post-arrest characteristics were compared between subjects with normal versus impaired GLS. Correlation between GLS, SF and EF were calculated with Pearson comparison. Logistic regression tested the association of GLS with mortality. Area under the receiver operator curve (AUROC) was calculated for discriminative utility of GLS, EF, and SF with mortality. RESULTS GLS was measured in 124 subjects; impaired GLS was present in 46 (37.1%). Subjects with impaired GLS were older (median 7.9 vs. 1.9 years, p < 0.001), more likely to have ventricular tachycardia/fibrillation as initial rhythm (19.6% versus 3.8%, p = 0.017) and had higher peak troponin levels in the first 24 hours post-arrest (median 2.5 vs. 0.5, p = 0.002). There were no differences between arrest location or CPR duration by GLS groups. Subjects with impaired GLS compared to normal GLS had lower median EF (42.6% versus 62.3%) and median SF (23.3% versus 36.6%), all p < 0.001, with strong inverse correlation between GLS and EF (rho -0.76, p < 0.001) and SF (rho -0.71, p < 0.001). Patients with impaired GLS had higher rates of mortality (60% vs. 32%, p = 0.009). GLS was associated with mortality when controlling for age and initial rhythm [aOR 1.17 per 1% increase in GLS (95% CI 1.09-1.26), p < 0.001]. GLS, EF and SF had similar discrimination for mortality: GLS AUROC 0.69 (95% CI 0.60-0.79); EF AUROC 0.71 (95% CI 0.58-0.88); SF AUROC 0.71 (95% CI 0.61-0.82), p = 0.101. CONCLUSIONS Impaired LV function as measured by GLS after pediatric cardiac arrest is associated with hospital mortality. GLS is a novel complementary metric to traditional post-arrest echocardiography that correlates strongly with EF and SF and is associated with mortality. Future large prospective studies of post-cardiac arrest care should investigate the prognostic utilities of GLS, alongside SF and EF.
Collapse
Affiliation(s)
- Monique M Gardner
- Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
| | - Yan Wang
- Division of Cardiology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Adam S Himebauch
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Thomas W Conlon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Kathryn Graham
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Ryan W Morgan
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Rui Feng
- Department of Biostatistics and Epidemiology, the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Robert A Berg
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Nadir Yehya
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Alexis A Topjian
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, United States
| |
Collapse
|
5
|
Ha KE, Choi K, Lee H, Gwak S, Kim K, Cho I, Hong G, Ha J, Shim CY. Effects of septal myectomy on left atrial and left ventricular function in obstructive hypertrophic cardiomyopathy. ESC Heart Fail 2023; 10:2939-2947. [PMID: 37483012 PMCID: PMC10567661 DOI: 10.1002/ehf2.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023] Open
Abstract
AIMS Mechanical function of the left atrium (LA) and the left ventricle (LV) has been demonstrated to be a prognostic factor in patients with hypertrophic cardiomyopathy (HCM). We explore whether myocardial mechanical function can be improved by septal reduction therapy in symptomatic obstructive HCM. METHODS AND RESULTS Among 65 patients who underwent septal myectomy for symptomatic obstructive HCM from 2006 to 2022, 44 were analysed after excluding those who underwent simultaneous valve repair or replacement or maze operation. LA and LV functional variables including LA strain and LV global longitudinal strain were evaluated by two-dimensional and speckle-tracking echocardiography and compared before and 1 year after surgery. After septal myectomy, LA volume index (58.1 ± 18.3 vs. 45.3 ± 14.6 mL/m2 , P = 0.001) decreased significantly. As LV end-systolic dimension increased after surgery, the LV ejection fraction decreased (73.8 ± 6.7 vs. 62.9 ± 8.3%, P < 0.001). LA strain (24.4 ± 9.3 vs. 30.5 ± 13.6%, P = 0.004) improved after septal myectomy, but LV global longitudinal strain deteriorated (-12.6 ± 3.6 vs. -11.6 ± 4.3%, P = 0.033), mainly related to worsening non-septal longitudinal strain (-14.4 ± 4.3 vs. -10.9 ± 8.4%, P = 0.005). CONCLUSIONS As haemodynamic loads due to LV outflow tract obstruction was relieved through surgical septal reduction therapy in patients with symptomatic obstructive HCM, there was a significant reduction in LA volume and restoration of LA mechanical dysfunction. However, LV mechanical dysfunction deteriorated even after surgical septal reduction therapy.
Collapse
Affiliation(s)
- Kyung Eun Ha
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulKorea
| | - Kang‐Un Choi
- Department of Internal Medicine, Division of CardiologyYeoungnam University College of MedicineDaeguKorea
| | - Hee‐Jung Lee
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulKorea
| | - Seo‐Yeon Gwak
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulKorea
| | - Kyu Kim
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulKorea
| | - Iksung Cho
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulKorea
| | - Geu‐Ru Hong
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulKorea
| | - Jong‐Won Ha
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulKorea
| | - Chi Young Shim
- Division of CardiologySeverance Cardiovascular Hospital, Yonsei University College of MedicineSeoulKorea
| |
Collapse
|
6
|
Peters M, Jan MF, Ashraf M, Sanders H, Roemer S, Schweitzer M, Adefisoye J, Galazka P, Jain R, Jahangir A, Khandheria B, Tajik AJ. Myocardial Work in Apical Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2023; 36:1043-1054.e3. [PMID: 37406714 DOI: 10.1016/j.echo.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Pressure-strain loop analysis is a novel echocardiographic technique to calculate myocardial work indices that has not been applied to patients with apical hypertrophic cardiomyopathy (ApHCM). We hypothesized that myocardial work indices differ between patients with ApHCM and those with non-ApHCM. This study aimed to (1) evaluate myocardial work indices in patients with ApHCM compared with those with non-ApHCM, (2) describe associations with relevant clinical variables, and (3) examine associations with significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging. METHODS We retrospectively identified 48 patients with ApHCM and 69 with non-ApHCM who had measurements of global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. We evaluated available cardiac magnetic resonance imaging data on 34 patients with ApHCM and 51 with non-ApHCM. Multivariable regression models correcting for traditional cardiac risk factors were used to evaluate the associations of myocardial work indices with relevant clinical variables. RESULTS Median GLS (-11% vs -18%, P < .001), GWI (966 mm Hg% vs 1803 mm Hg%, P < .001), and GCW (1,050 mm Hg% vs 1,988 mm Hg%, P < .001) were significantly impaired in patients with ApHCM compared with those with non-ApHCM. Increasing N-terminal pro b-type natriuretic peptide, abnormal ultrasensitive troponin, and increasing maximal left ventricular wall thickness were significantly associated with reduced GWI and GCW in patients with ApHCM (P < .05). Global constructive work had only modest accuracy (area under the curve [AUC] = 0.70) to predict LGE in patients with ApHCM. However, in patients with non-ApHCM, GLS was the strongest predictor of LGE (AUC = 0.91), with a -17% cutoff yielding 81% sensitivity and 80% specificity. CONCLUSION Myocardial work indices are significantly impaired in patients with ApHCM compared to those with non-ApHCM and correlate with important clinical variables. Global longitudinal strain, GWI, and GCW are more strongly predictive of fibrosis in patients with non-ApHCM than ApHCM.
Collapse
Affiliation(s)
- Matthew Peters
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Muddasir Ashraf
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Heather Sanders
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - McKenzie Schweitzer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - James Adefisoye
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Patrycja Galazka
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Bijoy Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin.
| |
Collapse
|
7
|
Rodriguez Garcia M, Schmeckpeper J, Landim-Vieira M, Coscarella IL, Fang X, Ma W, Spran PA, Yuan S, Qi L, Kahmini AR, Shoemaker MB, Atkinson JB, Kekenes-Huskey PM, Irving TC, Chase PB, Knollmann BC, Pinto JR. Disruption of Z-Disc Function Promotes Mechanical Dysfunction in Human Myocardium: Evidence for a Dual Myofilament Modulatory Role by Alpha-Actinin 2. Int J Mol Sci 2023; 24:14572. [PMID: 37834023 PMCID: PMC10572656 DOI: 10.3390/ijms241914572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
The ACTN2 gene encodes α-actinin 2, located in the Z-disc of the sarcomeres in striated muscle. In this study, we sought to investigate the effects of an ACTN2 missense variant of unknown significance (p.A868T) on cardiac muscle structure and function. Left ventricular free wall samples were obtained at the time of cardiac transplantation from a heart failure patient with the ACTN2 A868T heterozygous variant. This variant is in the EF 3-4 domain known to interact with titin and α-actinin. At the ultrastructural level, ACTN2 A868T cardiac samples presented small structural changes in cardiomyocytes when compared to healthy donor samples. However, contractile mechanics of permeabilized ACTN2 A868T variant cardiac tissue displayed higher myofilament Ca2+ sensitivity of isometric force, reduced sinusoidal stiffness, and faster rates of tension redevelopment at all Ca2+ levels. Small-angle X-ray diffraction indicated increased separation between thick and thin filaments, possibly contributing to changes in muscle kinetics. Molecular dynamics simulations indicated that while the mutation does not significantly impact the structure of α-actinin on its own, it likely alters the conformation associated with titin binding. Our results can be explained by two Z-disc mediated communication pathways: one pathway that involves α-actinin's interaction with actin, affecting thin filament regulation, and the other pathway that involves α-actinin's interaction with titin, affecting thick filament activation. This work establishes the role of α-actinin 2 in modulating cross-bridge kinetics and force development in the human myocardium as well as how it can be involved in the development of cardiac disease.
Collapse
Affiliation(s)
| | - Jeffrey Schmeckpeper
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | | | - Xuan Fang
- Department of Cell & Molecular Physiology, Loyola University, Chicago, IL 60660, USA
| | - Weikang Ma
- BioCAT, Department of Biological Sciences, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - Payton A. Spran
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA
| | - Shengyao Yuan
- BioCAT, Department of Biological Sciences, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - Lin Qi
- BioCAT, Department of Biological Sciences, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - Aida Rahimi Kahmini
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA;
| | - M. Benjamin Shoemaker
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - James B. Atkinson
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Thomas C. Irving
- BioCAT, Department of Biological Sciences, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - Prescott Bryant Chase
- Department of Biological Science, Florida State University, Tallahassee, FL 32306, USA
| | - Björn C. Knollmann
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jose Renato Pinto
- Biomedical Sciences, Florida State University, Tallahassee, FL 32306, USA
| |
Collapse
|
8
|
Hu X, Bao Y, Zhu Y, Zheng K, Zhang J, Zhou W, Deng Y, Liu Y. Predicting Left Ventricular Myocardial Fibrosis in Patients with Hypertrophic Cardiomyopathy by Speckle Tracking Automated Functional Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1309-1317. [PMID: 36863952 DOI: 10.1016/j.ultrasmedbio.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/25/2022] [Accepted: 01/24/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The study was performed to explore the predictive value of multiple strain parameters for myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) by using speckle tracking automated functional imaging (AFI). METHODS A total of 61 patients diagnosed with HCM were finally enrolled in this study. All patients completed transthoracic echocardiography and cardiac magnetic resonance late gadolinium enhancement (LGE) within 1 month. Twenty age- and sex-matched healthy participants were included as the control group. Multiple parameters, including segmental longitudinal strain (LS), global longitudinal strain (GLS), post-systolic index and peak strain dispersion, were automatically analyzed by AFI. RESULTS A total of 1458 myocardial segments were analyzed according to the left ventricular 18-segment model. Among the 1098 segments from HCM patients, segments with LGE had a lower absolute value of segmental LS than those without LGE (p < 0.05). The cutoff values of segmental LS for predicting positive LGE in the basal, intermediate and apical regions were -12.5%, -11.5% and -14.5%, respectively. GLS could predict significant myocardial fibrosis (≥2 positive LGE segments) at a cutoff value of -16.5% with a sensitivity of 80.9% and specificity of 76.5%. As an independent predictor of significant myocardial fibrosis, GLS was substantially associated with the severity of myocardial fibrosis and 5 years sudden cardiac death risk score in HCM patients. CONCLUSION Speckle tracking AFI could efficiently identify left ventricular myocardial fibrosis in patients with HCM by multiple parameters. GLS predicted significant myocardial fibrosis at a cutoff value of -16.5%, which may indicate the adverse clinical outcomes in HCM patients.
Collapse
Affiliation(s)
- Xin Hu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuwei Bao
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kangchao Zheng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
9
|
She J, Zhao S, Chen Y, Zeng M, Jin H. Detecting Regional Fibrosis in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac Magnetic Resonance. Acad Radiol 2023; 30:230-238. [PMID: 35469720 DOI: 10.1016/j.acra.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES The value of myocardial strain for reflecting fibrosis in patients with hypertrophic cardiomyopathy (HCM) on cardiac magnetic resonance (CMR) has not been definite. We aim to explore whether there are underlying non-contrast parameters to evaluate myocardial fibrosis and screen which may be the best. MATERIALS AND METHODS We retrospectively included 127 HCM patients (89 men; average age 46.6 ± 15.6 years) and 30 healthy controls (20 men; average age 52.0 ± 13.2 years) who have undergone late gadolinium enhancement (LGE) CMR. Next, 127 HCM patients were divided randomly into two sets including training cohort and validation cohort. Strain and imaging parameters were measured and analyzed statistically. RESULTS Based on univariate and multivariate analysis, segmental circumferential strain (SCS) (p < 0.001) and maximal wall thickness (MWT) (p < 0.001) may differentiate myocardial segments with or without LGE as significant biomarkers for both sets. The area under the curve (AUC) was 0.803 (95% CI 0.785-0.820) for SCS and 0.777 (95% CI 0.759-0.795) for MWT to identify myocardial fibrosis. When combining SCS >-13.9% and MWT >16.4mm, the specificity of the model (AUC = 0.779; 95% CI 0.760-0.796) achieved the highest 93.9%, with a sensitivity of 61.8%. CONCLUSION Strain analysis in HCM holds promise for myocardial fibrosis detection and SCS is the best strain parameter based on CMR. Nevertheless, the model of combining SCS and MWT could achieve the highest specificity for fibrotic diagnosis.
Collapse
Affiliation(s)
- Jiaqi She
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China
| | - Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China.
| |
Collapse
|
10
|
Qin L, Zhu S, Liu P, Zhu L, Chen C, Gu S, Yang W, Zhou M, Yan F. Additional prognostic values of strain and strain rate over late gadolinium enhancement in hypertrophic cardiomyopathy patients. Int J Cardiol 2023; 370:427-434. [PMID: 36332750 DOI: 10.1016/j.ijcard.2022.10.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) has some shortcomings in the risk stratification in hypertrophic cardiomyopathy (HCM). Myocardial strain/strain rate (SR) can be acquired from unenhanced cardiovascular magnetic resonance (CMR) images and detect cardiac dysfunction sensitively. The present study aimed to evaluate the additional prognostic values of myocardial strain/SR beyond LGE for the risk stratification in patients with HCM. METHODS 293 patients with HCM who underwent CMR were enrolled in this prospective study. LGE/left ventricular (LV) mass, LV global strain, and SR were acquired based on CMR. Also, conventional clinical, echocardiography, and CMR parameters and established risk factors for HCM were evaluated. RESULTS 14/293 patients had major adverse cardiovascular events (MACEs) during the median follow-up of 15.0 months, including eight all-cause deaths, four resuscitated cardiac arrests and two cardiac transplantations. Peak systolic (PS)-global longitudinal SR (GLSR) was independently associated with MACEs (hazard ratio: 15.297, P < 0.001) after adjusting for conventional clinical characteristics, echocardiography, and CMR parameters. The model constructed by conventional variables plus PS-GLSR had significantly stronger predictive ability than the model constructed by conventional variables plus LGE/LV mass (C-statistic: 0.850 vs 0.708, P = 0.030). The addition of PS-GLSR to the conventional model also significantly improved the sensitivity (92.9% vs 71.4%) and specificity (71.0% vs 57.3%), and lowered false positives (81 patients vs 119 patients) compared to the addition of LGE/LV mass. CONCLUSION LV PS-GLSR derived from CMR has the potential to be a novel biomarker for risk stratification of HCM and provide additional prognostic value over LGE/LV mass.
Collapse
Affiliation(s)
- Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siqi Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chihua Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengjia Gu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mi Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
11
|
Molecular Approaches and Echocardiographic Deformation Imaging in Detecting Myocardial Fibrosis. Int J Mol Sci 2022; 23:ijms231810944. [PMID: 36142856 PMCID: PMC9501415 DOI: 10.3390/ijms231810944] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 12/25/2022] Open
Abstract
The pathological remodeling of myocardial tissue is the main cause of heart diseases. Several processes are involved in the onset of heart failure, and the comprehension of the mechanisms underlying the pathological phenotype deserves special attention to find novel procedures to identify the site of injury and develop novel strategies, as well as molecular druggable pathways, to counteract the high degree of morbidity associated with it. Myocardial fibrosis (MF) is recognized as a critical trigger for disruption of heart functionality due to the excessive accumulation of extracellular matrix proteins, in response to an injury. Its diagnosis remains focalized on invasive techniques, such as endomyocardial biopsy (EMB), or may be noninvasively detected by cardiac magnetic resonance imaging (CMRI). The detection of MF by non-canonical markers remains a challenge in clinical practice. During the last two decades, two-dimensional (2D) speckle tracking echocardiography (STE) has emerged as a new non-invasive imaging modality, able to detect myocardial tissue abnormalities without specifying the causes of the underlying histopathological changes. In this review, we highlighted the clinical utility of 2D-STE deformation imaging for tissue characterization, and its main technical limitations and criticisms. Moreover, we focalized on the importance of coupling 2D-STE examination with the molecular approaches in the clinical decision-making processes, in particular when the 2D-STE does not reflect myocardial dysfunction directly. We also attempted to examine the roles of epigenetic markers of MF and hypothesized microRNA-based mechanisms aiming to understand how they match with the clinical utility of echocardiographic deformation imaging for tissue characterization and MF assessment.
Collapse
|
12
|
Hu S, Mi L, Fu J, Ma W, Ni J, Zhang Z, Li B, Guan G, Wang J, Zhao N. Model Embraced Electromechanical Coupling Time for Estimation of Heart Failure in Patients With Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2022; 9:895035. [PMID: 35800170 PMCID: PMC9254680 DOI: 10.3389/fcvm.2022.895035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to establish a model embraced electromechanical coupling time (EMC-T) and assess the value of the model for the prediction of heart failure (HF) in patients with hypertrophic cardiomyopathy (HCM). Materials and Methods Data on 82 patients with HCM at Shaanxi Provincial People’s Hospital between February 2019 and November 2021 were collected and then formed the training dataset (n = 82). Data were used to screen predictors of HF using univariate and multivariate analyses. Predictors were implemented to discover the optimal cut-off value, were incorporated into a model, and shown as a nomogram. The cumulative HF curve was calculated using the Kaplan–Meier method. Additionally, patients with HCM at other hospitals collected from March 2019 to March 2021 formed the validation dataset. The model’s performance was confirmed both in training and validation sets. Results During a median of 22.91 months, 19 (13.38%) patients experienced HF. Cox analysis showed that EMC-T courses in the lateral wall, myoglobin, PR interval, and left atrial volume index were independent predictors of HF in patients with HCM. Five factors were incorporated into the model and shown as a nomogram. Stratification of patients into two risk subgroups by applying risk score (<230.65, ≥230.65) allowed significant distinction between Kaplan–Meier curves for cumulative incidence of HF events. In training dataset, the model had an AUC of 0.948 (95% CI: 0.885–1.000, p < 0.001) and achieved a good C-index of 0.918 (95% CI: 0.867–0.969). In validation dataset, the model had an AUC of 0.991 (95% CI: 0.848–1.000, p < 0.001) and achieved a strong C-index of 0.941 (95% CI: 0.923–1.000). Calibration plots showed high agreement between predicted and observed outcomes in both two datasets. Conclusion We established and validated a novel model incorporating electromechanical coupling time courses for predicting HF in patients with HCM.
Collapse
Affiliation(s)
- Su Hu
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China.,Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Lan Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianli Fu
- Department of Cardiovascular Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Wangxia Ma
- Department of Cardiovascular Medicine, Zhouzhi County Hospital, Xi'an, China
| | - Jingsong Ni
- Department of Cardiovascular Medicine, Huazhou District People's Hospital, Weinan, China
| | - Zhenxia Zhang
- Department of Cardiovascular Medicine, Pucheng County Hospital, Weinan, China
| | - Botao Li
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Gongchang Guan
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Junkui Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Na Zhao
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| |
Collapse
|
13
|
Nagueh SF, Phelan D, Abraham T, Armour A, Desai MY, Dragulescu A, Gilliland Y, Lester SJ, Maldonado Y, Mohiddin S, Nieman K, Sperry BW, Woo A. Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertrophic Cardiomyopathy: An Update from the American Society of Echocardiography, in Collaboration with the American Society of Nuclear Cardiology, the Society for Cardiovascular Magnetic Resonance, and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2022; 35:533-569. [PMID: 35659037 DOI: 10.1016/j.echo.2022.03.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is defined by the presence of left ventricular hypertrophy in the absence of other potentially causative cardiac, systemic, syndromic, or metabolic diseases. Symptoms can be related to a range of pathophysiologic mechanisms including left ventricular outflow tract obstruction with or without significant mitral regurgitation, diastolic dysfunction with heart failure with preserved and heart failure with reduced ejection fraction, autonomic dysfunction, ischemia, and arrhythmias. Appropriate understanding and utilization of multimodality imaging is fundamental to accurate diagnosis as well as longitudinal care of patients with HCM. Resting and stress imaging provide comprehensive and complementary information to help clarify mechanism(s) responsible for symptoms such that appropriate and timely treatment strategies may be implemented. Advanced imaging is relied upon to guide certain treatment options including septal reduction therapy and mitral valve repair. Using both clinical and imaging parameters, enhanced algorithms for sudden cardiac death risk stratification facilitate selection of HCM patients most likely to benefit from implantable cardioverter-defibrillators.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Saidi Mohiddin
- Inherited/Acquired Myocardial Diseases, Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Koen Nieman
- Cardiovascular Medicine and Radiology (CV Imaging), Stanford University Medical Center, CA
| | - Brett W Sperry
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Anna Woo
- Toronto General Hospital, Toronto, Canada
| |
Collapse
|
14
|
Klettas D, Georgiopoulos G, Rizvi Q, Oikonomou D, Magkas N, Bhuva AN, Manisty C, Captur G, Aimo A, Nihoyannopoulos P. Echocardiographic and Cardiac Magnetic Resonance Imaging-Derived Strains in Relation to Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 171:132-139. [PMID: 35305784 DOI: 10.1016/j.amjcard.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/01/2022]
Abstract
We compared speckle tracking echocardiography (STE) and feature tracking cardiovascular magnetic resonance (FT-CMR) in patients with hypertrophic cardiomyopathy (HC) with a varying extent of fibrosis as defined by late gadolinium enhancement to look at the level of agreement between methods and their ability to relate those to myocardial fibrosis. At 2 reference centers, 79 patients with HC and 16 volunteers (the control group) underwent STE and CMR with late gadolinium enhancement and FT-CMR. Patients were classified into 3 categories: no detectable, limited, and extensive fibrosis. Global longitudinal strain (GLS) and global radial strain (GRS) were derived using FT-CMR and STE. STE-derived GRS was decreased in all HC categories compared with the control group (p <0.001), whereas FT-CMR GRS was reduced only in patients with HC with fibrosis (p <0.05). Reduced STE-derived GLS was associated with extensive fibrosis (p <0.05) and a value less than -15.2% identified those with extensive fibrosis (sensitivity 79%, specificity 92%, area under the curve 0.863, 95% confidence interval [CI] 0.76 to 0.97, p <0.001). Inter-modality agreement was moderate for STE versus CMR-GLS (overall population intra-class correlation coefficient = 0.615, 95% CI 0.42 to 0.75, p <0.001; patients with HC 0.63, 0.42 to 0.76, p <0.001) and GRS (overall population intra-class correlation coefficient = 0.601, 95% CI 0.397 to 0.735, p <0.001). A low level of agreement for GRS was seen between methods in patients with HC. In conclusion, strain indexes measured using echocardiography and CMR are reduced in patients with HC compared with the control group and correlate well with the burden of myocardial fibrosis. Reduced STE-GLS can identify patients with extensive fibrosis, but whether there is an added value for risk stratification for sudden cardiac death remains to be determined.
Collapse
Affiliation(s)
- Dimitrios Klettas
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom; First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Qaima Rizvi
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom
| | | | - Nikolaos Magkas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece
| | - Anish N Bhuva
- Department of Cardiovascular Imaging, Barts Heart Center, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Center, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Gabriella Captur
- Royal Free London, National Health Service Foundation Trust, London, United Kingdom; University College London Medical Research Council Unit for Lifelong Health and Aging, University College London, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Alberto Aimo
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy; Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Petros Nihoyannopoulos
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom; First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece.
| |
Collapse
|
15
|
Usefulness of Longitudinal Strain Adjusted to Regional Thickness in Hypertrophic Cardiomyopathy. J Clin Med 2022; 11:jcm11082089. [PMID: 35456183 PMCID: PMC9024891 DOI: 10.3390/jcm11082089] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
Background. We assessed the usefulness of a longitudinal strain adjusted to regional thickness in hypertrophic cardiomyopathy (HCM). Indeed, with conventional software, the width of the region of interest (ROI) is the same over the entire myocardial wall, wherein the software analyzes only partially the left ventricular (LV) hypertrophic segments. Methods. We included 110 patients: 55 patients with HCM (HCM group) and 55 healthy subjects (age- and sex-matched control group). The global longitudinal strain (GLS) and regional strain for each of the 17 segments was calculated with standard software (for two groups) and with software adjusted to the myocardial wall thickness (for the HCM group). Results. GLS was significantly decreased in the HCM group compared to the control group (−15.1 ± 4.8% versus −20.5 ± 4.3%, p < 0.0001). In the HCM group, GLS (standard method versus adjusted to thickness) measurements were not significantly different (p = 0.34). Interestingly, the regional strain adjusted to thickness was significantly lower than the standard strain in the hypertrophic segments, especially in the basal inferoseptal segment (p = 0.0002), median inferoseptal segment (p < 0.001) and median anteroseptal segment (p = 0.02). The strain adjusted to thickness was still significantly lower in the most hypertrophic segments (≥20 mm) (−3.7 ± 3%, versus −5.9 ± 4.4%, p = 0.049 in the basal inferoseptal segment and −5.7 ± 3.5% versus −8.3 ± 4.5%, p = 0.0007 in the median inferoseptal segment). In the segments with significant myocardial fibrosis, the longitudinal strain adjusted to thickness was significantly lower than the conventional strain (−8.3 ± 3.3% versus −11.4 ± 4.5%, p = 0.002). The analysis of the strain adjusted to thickness had a better feasibility (97.5% versus 99%, p = 0.01). Conclusions. The analysis of a longitudinal strain adjusted to regional thickness is feasible in HCM and allows a better evaluation of myocardial deformation, especially in the most LV hypertrophic segments.
Collapse
|
16
|
Mazzutti G, Pivatto Júnior F, Costa GOM, Foppa M, Biolo A, Santos ABS. Right ventricular function during trastuzumab therapy for breast cancer. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:779-787. [PMID: 34783929 DOI: 10.1007/s10554-021-02470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
Cardiotoxicity (CDT) is the main adverse effect related to trastuzumab (TTZ). The role of the right ventricle (RV) in this context is not clear. We aimed to evaluate the longitudinal changes in RV function during TTZ therapy and to determine RV function changes associated with subclinical CDT. Breast cancer patients underwent echocardiograms at the beginning of TTZ treatment (Exam 1) and every 3 months during the first year (Exams 2, 3, and 4). Subclinical CDT was defined as ≥ 12% relative reduction of left ventricle global longitudinal strain (LV GLS). Twenty-five women (52.1 ± 13.1 y-o) were included. We found a decrease in LV ejection fraction between the first and fourth exams (Ex1: 64.1% ± 4.9 vs Ex4: 60.9% ± 4.9, p = 0.003) and the LV GLS gradually decreased during follow-up (Ex1: - 20.6% ± 2.0; Ex2: - 19.4% ± 2.1; Ex3: - 19.2% ± 1.8; Ex4: - 19.0% ± 2.1, all p < 0.05). RV GLS changed from baseline to 3 month and to 6 month (Ex1: - 23.9% ± 1.6; Ex2: - 22.5% ± 2.1; Ex3: - 22.5% ± 2.3, all p < 0.05), and the RV Fractional Area Change was lower in the third exam (Ex1: 44.3% ± 6.6 vs Ex3: 39.9% ± 6.0, p = 0.004). We found subclinical CDT in 13 patients (52%); worsening in RV parameters did not differ between those with and without subclinical CDT. In this sample, the RV function decreased during TTZ therapy and the decrease was not associated to the observed LV cardiotoxicity.
Collapse
Affiliation(s)
- Géris Mazzutti
- Cardiology Division, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Room 2061, Porto Alegre, RS, 90035-903, Brazil.
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Fernando Pivatto Júnior
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Murilo Foppa
- Cardiology Division, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Room 2061, Porto Alegre, RS, 90035-903, Brazil
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Andreia Biolo
- Cardiology Division, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Room 2061, Porto Alegre, RS, 90035-903, Brazil
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Angela Barreto Santiago Santos
- Cardiology Division, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Room 2061, Porto Alegre, RS, 90035-903, Brazil
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| |
Collapse
|
17
|
Myocardial early systolic lengthening predicts mid-term outcomes in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2021; 38:161-168. [PMID: 34846619 DOI: 10.1007/s10554-021-02484-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
In this study, we investigated whether early systolic lengthening (ESL) which reflects subclinical ischemia and other echocardiographic and clinic parameters predict primary outcome [appropriate ICD shock, cardiovascular mortality and ventricular tachycardia (VT) or fibrillation] in patients with hypertrophic cardiomyopathy (HCM). 202 Patients with HCM (68% male, mean age 48 ± 13.9 years) were included in the study. Patients' clinical, electrocardiographic, 2D classic and speckle tracking echocardiography (STE) data were collected. ESL was defined as time from onset of the Q wave on ECG (onset of the R wave if the Q wave was absent) to maximum myocardial systolic lengthening. Patients were divided into two groups as occurrence or absence of primary outcome during 5 years follow up. During the follow-up period of 5 years (mean follow-up duration, 45.9 ± 10.8 months), 31 patients (15%) developed primary outcome [appropriate ICD shock 22 (11%), cardiovascular death 6 (3%), VT/VF 3(1.5%)]. Higher HCM Risk SCD score, longer ESL, and decreased global longitudinal peak strain (GLPS) were observed in patients with primary outcome. A Cox regression analysis, ESL, GLPS and HCM Risk SCD score were found to be independent predictors of occurrence of primary outcome. In ROC curve analysis, ESL > 53.5 msn could discriminate between groups with and without a primary outcome (AUC 0.768, 80% sensitivity and 60% specificity, CI 95% 0.666-0.871). ESL were found to be predictive for primary outcome in patients with HCM. Readily measurable ESL could be helpful to distinguish patients at high risk who could optimally benefit from ICD therapy.
Collapse
|
18
|
Cui H, Schaff HV, Nishimura RA, Geske JB, Dearani JA, Newman DB, Ommen SR. Preoperative left ventricular longitudinal strain predicts outcome of septal myectomy for obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01414-8. [PMID: 34763894 DOI: 10.1016/j.jtcvs.2021.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this study was to determine the characteristics of longitudinal strain and its effect on outcomes in patients with obstructive hypertrophic cardiomyopathy (HCM) who underwent septal myectomy. METHODS We reviewed patients with obstructive HCM who underwent septal myectomy at our clinic from 2007 to 2016. Data of those who had strain echocardiography within 6 months before isolated myectomy were analyzed. RESULTS The median age of the 857 patients studied was 55 (interquartile range [IQR], 44-63) years, and 451 (52.6%) were male. Left ventricular ejection fraction was 71% (IQR, 67%-74%), and the resting peak outflow tract gradient was 58 (IQR, 27-85) mm Hg. The median global longitudinal strain (GLS) was -14.6% (IQR, -12.0% to -17.3%). Regional longitudinal strain was nonuniform as reflected by more normal values in apical segments and more abnormal in basal segments. Moreover, GLS correlated poorly with ejection fraction and outflow tract gradient. In 64 patients who had postoperative strain echocardiography, GLS was comparable before and after septal myectomy, but regional strain was more uniform after myectomy. Over a follow-up of 8.3 (IQR, 6.5-10.3) years, when patients were equally stratified according to GLS (cutoff, -14.64%), the group with worse GLS had significantly poorer survival compared with the better GLS group (P = .002). Left ventricular ejection fraction had no association with survival. CONCLUSIONS Left ventricular longitudinal strain is nonuniform and might be significantly reduced in patients with obstructive HCM. Septal myectomy does not impair GLS but is associated with more uniform regional strains. Most importantly, reduced GLS preoperatively is strongly and independently associated with increased all-cause mortality after septal myectomy for obstructive HCM.
Collapse
Affiliation(s)
- Hao Cui
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Darrell B Newman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| |
Collapse
|
19
|
Lee HJ, Kim HK, Lee SC, Kim J, Park JB, Hwang IC, Choi YJ, Lee SP, Chang SA, Lee W, Park EA, Cho GY, Kim YJ. Supplementary role of left ventricular global longitudinal strain for predicting sudden cardiac death in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 23:1108-1116. [PMID: 34542591 DOI: 10.1093/ehjci/jeab187] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS We investigated the prognostic role of left ventricular global longitudinal strain (LV-GLS) and its incremental value to established risk models for predicting sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS LV-GLS was measured with vendor-independent software at a core laboratory in a cohort of 835 patients with HCM (aged 56.3 ± 12.2 years) followed-up for a median of 6.4 years. The primary endpoint was SCD events, including appropriate defibrillator therapy, within 5 years after the initial evaluation. The secondary endpoint was a composite of SCD events, heart failure admission, heart transplantation, and all-cause mortality. Twenty (2.4%) and 85 (10.2%) patients experienced the primary and secondary endpoints, respectively. Lower absolute LV-GLS quartiles, especially those worse than the median (-15.0%), were associated with progressively higher SCD event rates (P = 0.004). LV-GLS was associated with an increased risk for the primary endpoint, independent of the LV ejection fraction, apical aneurysm, and 2014 European Society of Cardiology (ESC) risk score [adjusted hazard ratio (aHR) 1.14, 95% confidence interval (CI) 1.02-1.28] or 2011 American College of Cardiology/American Heart Association (ACC/AHA) risk factors (aHR 1.18, 95% CI 1.05-1.32). LV-GLS was also associated with a higher risk for the composite secondary endpoint (aHR 1.06, 95% CI 1.01-1.12). The addition of LV-GLS enhanced the performance of the ESC risk score (C-statistic 0.756 vs. 0.842, P = 0.007) and the 2011 ACC/AHA risk factor strategy (C-statistic 0.743 vs. 0.814, P = 0.007) for predicting SCD. CONCLUSION LV-GLS is an important prognosticator in patients with HCM and provides additional information to established risk stratification strategies for predicting SCD.
Collapse
Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Sang Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam 13620, Korea
| | - You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam 13620, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| |
Collapse
|
20
|
Zhang Y, Yan WF, Jiang L, Shen MT, Li Y, Huang S, Shi K, Yang ZG. Aggravation of functional mitral regurgitation on left ventricle stiffness in type 2 diabetes mellitus patients evaluated by CMR tissue tracking. Cardiovasc Diabetol 2021; 20:158. [PMID: 34332579 PMCID: PMC8325822 DOI: 10.1186/s12933-021-01354-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Functional mitral regurgitation (FMR) is one of the most common heart valve diseases in diabetes and may increase left ventricular (LV) preload and aggravate myocardial stiffness. This study aimed to investigate the aggravation of FMR on the deterioration of LV strain in type 2 diabetes mellitus (T2DM) patients and explore the independent indicators of LV peak strain (PS). MATERIALS AND METHODS In total, 157 T2DM patients (59 patients with and 98 without FMR) and 52 age- and sex-matched healthy control volunteers were included and underwent cardiac magnetic resonance examination. T2DM with FMR patients were divided into T2DM patients with mild (n = 21), moderate (n = 19) and severe (n = 19) regurgitation. LV function and global strain parameters were compared among groups. Multivariate analysis was used to identify the independent indicators of LV PS. RESULTS The T2DM with FMR had lower LV strain parameters in radial, circumferential and longitudinal direction than both the normal and the T2DM without FMR (all P < 0.05). The mild had mainly decreased peak diastolic strain rate (PDSR) compared to the normal. The moderate had decreased peak systolic strain rate (PSSR) compared to the normal and PDSR compared to the mild and the normal. The severe FMR group had decreased PDSR and PSSR compared to the mild and the normal (all P < 0.05). Multiple linear regression showed that the regurgitation degree was independent associated with radial (β = - 0.272), circumferential (β = - 0.412) and longitudinal (β = - 0.347) PS; the months with diabetes was independently associated with radial (β = - 0.299) and longitudinal (β = - 0.347) PS in T2DM with FMR. CONCLUSION FMR may aggravate the deterioration of LV stiffness in T2DM patients, resulting in decline of LV strain and function. The regurgitation degree and months with diabetes were independently correlated with LV global PS in T2DM with FMR.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
21
|
Comprehensive Echocardiography of Left Atrium and Left Ventricle Using Modern Techniques Helps in Better Revealing Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2021; 11:diagnostics11071288. [PMID: 34359371 PMCID: PMC8304227 DOI: 10.3390/diagnostics11071288] [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] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is an important arrhythmia in hypertrophic cardiomyopathy (HCM). We aimed to explore whether a complex evaluation of the left ventricle (LV) using modern echocardiography techniques, additionally to the left atrium (LA) boosts the probability of AF diagnosis. Standard echocardiography, 2D and 3D speckle tracking, were performed for LA and LV evaluation in HCM patients and healthy volunteers. Of 128 initially qualified HCM patients, 60 fulfilled included criteria, from which 43 had a history of AF, and 17 were without AF. LA volume index and peak strain, LV ejection fraction, and strains were significant predictors of AF. In addition, 2D global longitudinal strain (GLS) for LV at cut off -16% turned out to be the most accurate predictor of AF (OR 48.00 [95% CI 2.68-859.36], p = 0.001), whereas the combination of LA peak strain ≤ 22% and LV GLS ≥ -16% had the highest discriminatory power (OR 76.36 [95% CI 4.13-1411.36], p = 0.001). AF in HCM patients seems to be LA as well as LV disease. Revealing lower strain for LV, in addition to lower LA strain, may have an important impact on accurate characteristics of HCM patients with AF history.
Collapse
|
22
|
Rowin EJ, Maron BJ, Wells S, Burrows A, Firely C, Koethe B, Patel AR, Maron MS. Usefulness of Global Longitudinal Strain to Predict Heart Failure Progression in Patients With Nonobstructive Hypertrophic Cardiomyopathy. Am J Cardiol 2021; 151:86-92. [PMID: 34167691 DOI: 10.1016/j.amjcard.2021.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 01/26/2023]
Abstract
While predicting prognosis to anticipate adverse disease course has long been an aspiration in hypertrophic cardiomyopathy (HC), reliable markers of progressive and unrelenting heart failure symptoms in the absence of obstruction are not well characterized. We sought to evaluate markers of systolic function, including the role of global longitudinal strain (GLS), to identify nonobstructive HC patients at risk for future heart failure. A cohort of 296 consecutive nonobstructive HC patients (42 ± 18years; 75% male) with NYHA class I/II symptoms and preserved systolic function at study entry (EF: 65 ± 6%), were followed for progressive heart failure symptoms (increase in ≥ 1 NYHA functional class) and/or development of systolic dysfunction (EF < 50%). Over median follow-up of 4 ± 3 years, 35 study patients (10%) experienced new heart failure events, including 31 with progressive symptoms and 4 who developed systolic dysfunction. Abnormal GLS < 16% was associated with a 5-fold increase in risk for heart failure compared to GLS > 18% (p < 0.001). GLS remained an independent predictor of heart failure even after adjustment for other relevant disease variables including EF (OR 1.23, p = 0.005). However, notably, when GLS and EF were combined, the prediction of heart failure for individual patients was enhanced (net reclassification improvement 0.55; p = 0.002). Together, GLS < 16% and EF 50% to 59% were associated with a 12.5-fold greater risk for heart failure versus patients with GLS > 18% and EF ≥ 60%, who were at the lowest risk. In conclusion, in nonobstructive HC with no or mild symptoms and preserved EF, abnormal GLS is a strong independent predictor for subsequent development of progressive heart failure symptoms and/or systolic dysfunction. Furthermore, the greatest power in predicting outcome in nonobstructive HC is achieved by combining GLS with EF to identify HC patients at the highest risk for heart failure progression and systolic dysfunction.
Collapse
|
23
|
Baudry G, Mansencal N, Reynaud A, Richard P, Dubourg O, Komajda M, Isnard R, Réant P, Charron P. Global and regional echocardiographic strain to assess the early phase of hypertrophic cardiomyopathy due to sarcomeric mutations. Eur Heart J Cardiovasc Imaging 2021; 21:291-298. [PMID: 31056691 DOI: 10.1093/ehjci/jez084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 01/24/2023] Open
Abstract
AIMS Hypertrophic cardiomyopathy (HCM) is a genetic disease with delayed cardiac expression. Our objective was to characterize left ventricular (LV) myocardial strain by two-dimensional echocardiography in sarcomeric mutation carriers before the hypertrophic stage. METHODS AND RESULTS We studied 140 adults [derivation cohort (n = 79), validation cohort (n = 61)]. The derivation cohort comprised 38 confirmed HCM patients with hypertrophy (LVH+/Gen+), 20 mutation carriers without LV hypertrophy (LVH-/Gen+), and 21 healthy controls. LV global longitudinal strain was not different in LVH-/Gen+ compared with controls [20.6%, interquartile (IQ): 18.3/24.2 vs. 22.9%, IQ: 20.9/26.8] but was reduced in LVH+/Gen+ patients (14.1%, IQ: 11.8/18.5, P < 0.001). Regional peak longitudinal strain was significantly decreased in LVH-/Gen+ when compared with controls in four segments: basal anteroseptal (BAS) wall (P = 0.018), basal inferoseptal wall (P = 0.047), basal inferior wall (P = 0.006), and mid anteroseptal wall (P = 0.022). Receiver operating characteristic analysis identified that BAS strain <16.5% had a sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV, NPV) of 57%, 90%, 82%, and 67%, respectively, to differentiate LVH-/G+ patients from controls. Similarly, the accuracy of a ratio between basal inferoseptal/basal anterolateral (BIS/BAL) strain <0.76 was 73%, 92%, 82%, and 64%, respectively (Se/Sp/PPV/NPV). In the validation cohort, the accuracy of BAS and BIS/BAL was 39%/93%/87%/57% and 55%/96%/95%/64% (Se/Sp/PPV/NPV), respectively, to differentiate the LVH-/Gen+ group from controls. CONCLUSION Regional longitudinal strain, but not global strain, was significantly reduced at the early stage of HCM before LV hypertrophy. This suggests that the inclusion of strain (BAS < 16.5%; BIS/BAL < 0.76) in the evaluation of HCM relatives would help identify mutation carriers and early LV abnormalities.
Collapse
Affiliation(s)
- Guillaume Baudry
- APHP, Centre de référence pour les maladies cardiaques héréditaires, Hôpital Pitié-Salpêtrière, 47 bvd de l'hôpital, 75013 Paris, France.,HCL, Service Insuffisance cardiaque, Hôpital Louis Pradel, 59 Boulevard Pinel, 69500 Bron, France
| | - Nicolas Mansencal
- APHP, Service de Cardiologie, CHU Ambroise Paré, 9 av Charles de Gaulle, 92100 Boulogne Billancourt, France.,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94800 Villejuif, France
| | - Amelie Reynaud
- Université de Bordeaux, CHU de Bordeaux, Service de cardiologie, Bordeaux, 33600 Pessac, France
| | - Pascale Richard
- APHP, UF Cardiogénétique et Myogénétique, Service de Biochimie Métabolique, Hôpitaux Universitaires de la Pitié-Salpêtrière-Charles Foix, 47 Bvd de l'Hôpital, 75013 Paris, France
| | - Olivier Dubourg
- APHP, Service de Cardiologie, CHU Ambroise Paré, 9 av Charles de Gaulle, 92100 Boulogne Billancourt, France.,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94800 Villejuif, France
| | - Michel Komajda
- APHP, Centre de référence pour les maladies cardiaques héréditaires, Hôpital Pitié-Salpêtrière, 47 bvd de l'hôpital, 75013 Paris, France.,Service de Cardiologie, Hôpital Saint Joseph, 75014 Paris, France
| | - Richard Isnard
- APHP, Centre de référence pour les maladies cardiaques héréditaires, Hôpital Pitié-Salpêtrière, 47 bvd de l'hôpital, 75013 Paris, France.,Sorbonne Université, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, 91 bvd de l'hôpital, 75013 Paris, France
| | - Patricia Réant
- Université de Bordeaux, CHU de Bordeaux, Service de cardiologie, Bordeaux, 33600 Pessac, France
| | - Philippe Charron
- APHP, Centre de référence pour les maladies cardiaques héréditaires, Hôpital Pitié-Salpêtrière, 47 bvd de l'hôpital, 75013 Paris, France.,Sorbonne Université, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, 91 bvd de l'hôpital, 75013 Paris, France
| |
Collapse
|
24
|
Left and Right Myocardial Functionality Assessed by Two-Dimensional Speckle-Tracking Echocardiography in Cats with Restrictive Cardiomyopathy. Animals (Basel) 2021; 11:ani11061578. [PMID: 34071192 PMCID: PMC8226601 DOI: 10.3390/ani11061578] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary The endomyocardial form of restrictive cardiomyopathy, a primary disorder of the myocardium, is one of the diseases with poor prognosis in cats. While two-dimensional speckle-tracking echocardiography has been known to identify myocardial deformations, its function relative to cats with the endomyocardial form of restrictive cardiomyopathy has yet to be characterized. We hypothesized that both the left and right myocardial functional abnormalities may occur in cats with the endomyocardial form of restrictive cardiomyopathy, causing this disease pathophysiology and clinical status. In the current study, cats were assessed for layer-specific myocardial function (whole, endocardial, and epicardial) in the left ventricular longitudinal and circumferential directions, and right ventricular longitudinal direction, via two-dimensional speckle-tracking echocardiography. Our study indicated that cats with restrictive cardiomyopathy have reduced left ventricular myocardial function. Notably, left ventricular systolic circumferential endocardial strain and circumferential endocardial-to-epicardial strain ratio were lower in cats with restrictive cardiomyopathy. Furthermore, some right ventricular myocardial deformations were also differerent in cats with restrictive cardiomyopathy. Myocardial function assessed by two-dimensional speckle-tracking echocardiography could reveal left and right myocardial dysfunction. Abstract The endomyocardial form of restrictive cardiomyopathy (EMF-RCM), a primary disorder of the myocardium, is one of the diseases with poor prognosis in cats. We hypothesized that both the left and right myocardial functional abnormalities may occur in cats with EMF-RCM, causing this disease pathophysiology and clinical status. Out of the 25 animals included in this study, 10 were client-owned cats with EMF-RCM, and 15 were healthy cats. In this study, cats were assessed for layer-specific myocardial function (whole, endocardial, and epicardial) in the left ventricular longitudinal and circumferential directions, and right ventricular longitudinal direction, via two-dimensional speckle-tracking echocardiography (2D-STE). Cats with EMF-RCM had depressed left ventricular myocardial deformations both in systole (whole longitudinal strain, epicardial longitudinal strain, and endocardial circumferential strain) and diastole (early and late diastolic longitudinal strain rates, and late diastolic circumferential strain rate) compared to controls. Furthermore, some right ventricular myocardial deformations (systolic longitudinal strain in epicardial layers, and endocardial-to-epicardial strain ratio) were significantly differerent in cats with EMF-RCM. Myocardial function assessed by 2D-STE could reveal left and right myocardial dysfunction.
Collapse
|
25
|
Fahmy AS, Rowin EJ, Manning WJ, Maron MS, Nezafat R. Machine Learning for Predicting Heart Failure Progression in Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2021; 8:647857. [PMID: 34055932 PMCID: PMC8155292 DOI: 10.3389/fcvm.2021.647857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Development of advanced heart failure (HF) symptoms is the most common adverse pathway in hypertrophic cardiomyopathy (HCM) patients. Currently, there is a limited ability to identify HCM patients at risk of HF. Objectives: In this study, we present a machine learning (ML)-based model to identify individual HCM patients who are at high risk of developing advanced HF symptoms. Methods: From a consecutive cohort of HCM patients evaluated at the Tufts HCM Institute from 2001 to 2018, we extracted a set of 64 potential risk factors measured at baseline. Only patients with New York Heart Association (NYHA) functional class I/II and LV ejection fraction (LVEF) by echocardiography >35% were included. The study cohort (n = 1,427 patients) was split into three disjoint subsets: development (50%), model selection (10%), and independent validation (40%). The least absolute shrinkage and selection operator was used to select the most influential clinical variables. An ensemble of ML classifiers, including logistic regression, was used to identify patients with high risk of developing a HF outcome. Study outcomes were defined as progression to NYHA class III/IV, drop in LVEF below 35%, septal reduction procedure, and/or heart transplantation. Results: During a mean follow-up of 4.7 ± 3.7 years, advanced HF occurred in 283 (20% out of 1,427) patients. The model features included patients' sex, NYHA class (I or II), HCM type (i.e., obstructive or not), LV wall thickness, LVEF, presence of HF symptoms (e.g., dyspnea, presyncope), comorbidities (atrial fibrillation, hypertension, mitral regurgitation, and systolic anterior motion), and type of cardiac medications. The developed risk stratification model showed strong differentiation power to identify patients at advanced HF risk in the testing dataset (c-statistics = 0.81; 95% confidence interval [CI]: 0.76, 0.86). The model allowed correct identification of high-risk patients with accuracy 74% (CI: 0.70, 0.78), sensitivity 80% (CI: 0.77, 0.83), and specificity 72% (CI: 0.68, 0.76). The model performance was comparable among different sex and age groups. Conclusions: A 5-year risk prediction of progressive HF in HCM patients can be accurately estimated using ML analysis of patients' clinical and imaging parameters. A set of 17 clinical and imaging variables were identified as the most important predictors of progressive HF in HCM.
Collapse
Affiliation(s)
- Ahmed S Fahmy
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Ethan J Rowin
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA, United States
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.,Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Martin S Maron
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA, United States
| | - Reza Nezafat
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
26
|
The predictive value of left ventricular and left atrial mechanics for atrial fibrillation and heart failure in hypertrophic cardiomyopathy: a prospective cohort study. Int J Cardiovasc Imaging 2021; 37:2679-2690. [PMID: 33818698 DOI: 10.1007/s10554-021-02232-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
Atrial fibrillation (AF) and heart failure (HF) represent clinical turning points, altering the natural history of HCM and influencing long-term outcome of the disease. The aim of this study was to evaluate the ability of left ventricular (LV) and left atrial (LA) myocardial deformation parameters to predict new-onset AF and HF outcomes in patients with HCM. This was a prospective study that included HCM patients without severe valvular heart disease, prior myocardial infarction or history of AF. The study sample consisted of 250 patients (mean age 50.8 ± 15.8, 67.2% male). Two-dimensional (2D) speckle tracking deformation parameters including global longitudinal strain (GLS), radial strain, circumferential strain, LA reservoir strain (LAεres), LA conduit strain (LAεcon) and LA booster strain(LAεboost) were examined. During a mean follow-up of 2.5 ± 1.2 years, 44 patients developed new-onset AF. All the LV and LA deformation parameters were significant univariate predictors of AF. GLS and LAεres had the highest C statistic among the LV and LA functional indices. In multivariable analysis, only LAεres remained an independent predictor of the arrhythmia (HR 0.91, 95% CI 0.85-0.98, p: 0.008). Similarly, GLS and LAεres had the highest predictive value among the 2D speckle tracking parameters for HF outcomes. LAεres remained an independent predictor after adjusting for significant covariates. GLS and LAεres demonstrated high predictive value for the development of AF and HF in HCM. LAεres was the only independent predictor of both outcomes.Clinical trial registration: ClinicalTrials.gov identifier: NCT04112511.
Collapse
|
27
|
CMR feature tracking strain patterns and their association with circulating cardiac biomarkers in patients with hypertrophic cardiomyopathy. Clin Res Cardiol 2021; 110:1757-1769. [PMID: 33779809 PMCID: PMC8563550 DOI: 10.1007/s00392-021-01848-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
Aims CMR feature tracking strain (CMR-FT) provides prognostic information. However, there is a paucity of data in hypertrophic cardiomyopathy (HCM). We sought to analyze global CMR-FT parameters in all four cardiac chambers and to assess associations with NT-proBNP and cardiac troponin T (hsTnT) in patients with HCM. Methods This retrospective study included 144 HCM patients and 16 healthy controls with CMR at 1.5 T. Analyses were performed on standard steady-state free precession cine (SSFP) CMR data using a commercially available software. Global left ventricular (LV) strain was assessed as longitudinal (LVLAX-GLS), circumferential (LVLAX-GCS) and radial strain (LVLAX-GRS) on long -axis (LAX) and as LVSAX-GCS and LVSAX-GRS on short- axis (SAX). Right ventricular (RV-GLS), left atrial (LA-GLS) and right atrial (RA-GLS) strain were assessed on LAX. Results We found LVLAX-GLS [− 18.9 (− 22.0, − 16.0), − 23.5 (− 25.5, − 22.0) %, p = 0.0001), LVSAX-GRS [86.8 (65.9–115.5), 119.6 (91.3–143.7) %, p = 0.001] and LALAX-GLS [LA2CH-GLS 29.2 (19.1–37.7), LA2CH-GLS 38.2 (34.3–47.1) %, p = 0.0036; LA4CH-GLS 22.4 (14.6–30.7) vs. LA4CH-GLS 33.4 (28.4–37.3) %, p = 0.0033] to be impaired in HCM compared to healthy controls despite normal LVEF. Furthermore, LV and LA strain parameters were impaired in HCM with elevated NT-proBNP and/or hsTnT, despite preserved LVEF compared to HCM with normal biomarker levels. There was a moderate correlation of LV and LA CMR-FT with levels of NT-proBNP and hsTnT. Conclusion CMR-FT reveals LV and LA dysfunction in HCM despite normal LVEF. The association between impaired LV strain and elevated NT-proBNP and hsTnT indicates a link between unapparent functional abnormalities and disease severity in HCM. Graphic abstract
Typical CMR-FT findings in patients with hypertrophic cardiomyopathy![]()
Collapse
|
28
|
Dohy Z, Szabo L, Toth A, Czimbalmos C, Horvath R, Horvath V, Suhai FI, Geller L, Merkely B, Vago H. Prognostic significance of cardiac magnetic resonance-based markers in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2021; 37:2027-2036. [PMID: 33555536 PMCID: PMC8255255 DOI: 10.1007/s10554-021-02165-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/08/2020] [Indexed: 12/26/2022]
Abstract
The prognosis of patients with hypertrophic cardiomyopathy (HCM) varies greatly. Cardiac magnetic resonance (CMR) is the gold standard method for assessing left ventricular (LV) mass and volumes. Myocardial fibrosis can be noninvasively detected using CMR. Moreover, feature-tracking (FT) strain analysis provides information about LV deformation. We aimed to investigate the prognostic significance of standard CMR parameters, myocardial fibrosis, and LV strain parameters in HCM patients. We investigated 187 HCM patients who underwent CMR with late gadolinium enhancement and were followed up. LV mass (LVM) was evaluated with the exclusion and inclusion of the trabeculae and papillary muscles (TPM). Global LV strain parameters and mechanical dispersion (MD) were calculated. Myocardial fibrosis was quantified. The combined endpoint of our study was all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapy. The arrhythmia endpoint was malignant ventricular arrhythmias and appropriate ICD therapy. The LVM index (LVMi) was an independent CMR predictor of the combined endpoint independent of the quantification method (p < 0.01). The univariate predictors of the combined endpoint were LVMi, global longitudinal (GLS) and radial strain and longitudinal MD (MDL). The univariate predictors of arrhythmia events included LVMi and myocardial fibrosis. More pronounced LV hypertrophy was associated with impaired GLS and increased MDL. More extensive myocardial fibrosis correlated with impaired GLS (p < 0.001). LVMi was an independent CMR predictor of major events, and myocardial fibrosis predicted arrhythmia events in HCM patients. FT strain analysis provided additional information for risk stratification in HCM patients.
Collapse
Affiliation(s)
- Zsofia Dohy
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Liliana Szabo
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Attila Toth
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Csilla Czimbalmos
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Rebeka Horvath
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Viktor Horvath
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Ferenc Imre Suhai
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Laszlo Geller
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, Budapest, 1122, Hungary.
| |
Collapse
|
29
|
Myocardial Mechanics Parameters That Predict Left Ventricular Outflow Tract Obstruction in Patients With Hypertrophic Cardiomyopathy: A Cardiovascular Magnetic Resonance Feature Tracking Analysis. J Comput Assist Tomogr 2021; 45:65-72. [PMID: 32168083 DOI: 10.1097/rct.0000000000000977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify left ventricular (LV) myocardial mechanics predictors of LV outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomyopathy (HCM). METHODS Thirty-nine adults with HCM and 21 controls underwent cardiovascular magnetic resonance. The feature tracking (FT) analysis results of HCM patients with and without LVOTO and controls were compared. RESULTS Global radial strain measured on the short-axis slice (GRS-SAX) (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.15; P < 0.01), global longitudinal strain measured on the long-axis slice (GLS-LAX) (OR, 1.81; 95% CI, 1.21-2.73; P < 0.01) and GRS measured on the long-axis slice (GRS-LAX) (OR, 1.07; 95% CI, 1.01-1.13; P = 0.02) were independent predictors of LVOTO. The combination of GRS-SAX plus GLS-LAX and GRS-LAX showed great discriminatory power for identifying LVOTO with an area under the receiver operating characteristic curve value of 0.91 (95% CI: 0.81-1.00). CONCLUSIONS In adult HCM patients, GRS-SAX, GLS-LAX, and GRS-LAX were independent predictors of LVOTO. The combination of GRS-SAX plus GLS-LAX and GRS-LAX showed great discriminatory power for identifying LVOTO.
Collapse
|
30
|
Espinola-Zavaleta N, Antonio-Villa NE, Briseño-Diaz N, Oregel-Camacho D, Camacho-Camacho G, Keirns C, Alexanderson-Rosas E. Left ventricular and atrial global strain evaluation within subtypes of ventricular remodeling. Echocardiography 2021; 38:280-288. [PMID: 33484595 DOI: 10.1111/echo.14981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/08/2020] [Accepted: 01/09/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy is associated with poor prognosis and adverse events. Left ventricular and left atrial global strain and left atrial reservoir strain (LV-GS; LA-GS; LA-RS) could be used as markers for myocardial function in different ventricular remodeling forms. This study aimed to evaluate LV-GS and LA-GS scores in different ventricular remodeling variants and identify risk factors for myocardial dysfunction. METHODS AND RESULTS This cross-sectional study was divided into four groups of ventricular remodeling: normal geometry, eccentric hypertrophy (EH), concentric hypertrophy (CH), and concentric remodeling (CR). Strain analysis was obtained using standardized protocols. We included 121 subjects, 33 with previous myocardial infarction (MI). We found that EH had the lowest LV-GS and CH, the lowest LA-GS, and LA-RS. Atrial and ventricular dysfunction was present in 40 (33%) and 14 (11.5%) subjects, respectively. Smoking, male sex, and previous MI were associated with LV dysfunction and smoking and dyslipidemia with LA dysfunction; EH was closely associated with LV dysfunction and CH with LA dysfunction. CONCLUSIONS We conclude that different ventricular geometry types had echocardiographic profiles associated with different risk factors for dysfunction assessed by strain. The assessment of ventricular remodeling by global strain could be used as a complementary tool in the echocardiographic evaluation of ventricular and atrial function.
Collapse
Affiliation(s)
- Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.,Department of Echocardiography, ABC Medical Center, I.A.P, Mexico City, Mexico
| | | | - Nidia Briseño-Diaz
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.,Academic Unit of Medicine, Autonomous University of Nayarit, Tepic-Nayarit, Mexico.,Inter-Institutional Program for Promoting Research and Postgraduate Studies in the Pacific (Dolphin), Mexico City, Mexico
| | - Diego Oregel-Camacho
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.,Inter-Institutional Program for Promoting Research and Postgraduate Studies in the Pacific (Dolphin), Mexico City, Mexico
| | - Gyselle Camacho-Camacho
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.,Benemerita Autonomous University of Puebla, School of Medicine, Puebla, Mexico
| | - Candace Keirns
- International Medical Interpreters Association, Boston, MA, USA
| | - Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.,Department of Physiology, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| |
Collapse
|
31
|
Tanaka H. Efficacy of echocardiography for differential diagnosis of left ventricular hypertrophy: special focus on speckle-tracking longitudinal strain. J Echocardiogr 2021; 19:71-79. [PMID: 33460030 PMCID: PMC8154763 DOI: 10.1007/s12574-020-00508-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
Left ventricular (LV) hypertrophy (LVH) is a frequent imaging finding in daily clinical practice, and its presence is associated with poor outcomes and ventricular arrhythmias. It is commonly detected in athletes, arterial hypertension, aortic stenosis, hypertrophic cardiomyopathy, cardiac amyloidosis, Fabry disease, or Friedreich’s ataxia. Echocardiography plays an important role in detecting LVH and underlying causes in current clinical practice. While echocardiography is essential for the quantification and early detection of LV structural findings for various cardiovascular diseases, it has been reported that speckle-tracking echocardiographic parameters are also useful for the detection of early LV structural abnormalities. In particular, global longitudinal strain (GLS) assessed by two-dimensional speckle-tracking echocardiography is reportedly a sensitive marker for early subtle abnormalities of LV myocardial performance, helpful for the prediction of outcomes for various cardiac diseases, and superior to conventional echocardiographic indices. GLS is determined as the averaged peak longitudinal strain of 18 LV segments from standard apical views and can be assessed as a polar plot. This polar plot longitudinal strain mapping offers an intuitive visual overview of the global and regional LV longitudinal myocardial function status of various cardiomyopathies with LVH. This mapping is clinically practicable and the plot patterns obtainable as the result of further development of this technique for clinical practice provide clues to the etiology of cardiomyopathies. This article reviews the efficacy of echocardiography for differential diagnosis of LVH, with a special focus on the utility of speckle-tracking longitudinal strain.
Collapse
Affiliation(s)
- Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| |
Collapse
|
32
|
Gong FF, Nishtala A, Chow K, Jafari L, Azizuddin A, Ramirez H, Chuzi S, Akhter N. Inter-vendor variability and reproducibility of subcostal left ventricular longitudinal strain. Int J Cardiovasc Imaging 2021; 37:1669-1678. [PMID: 33454895 DOI: 10.1007/s10554-020-02152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022]
Abstract
Left ventricular longitudinal strain (LVLS) performed using subcostal windows is a novel alternative for patients who require strain imaging but have poor apical windows. We investigated the reproducibility and inter-vendor variability of subcostal LVLS. One hundred and twenty-four echocardiographic studies were analysed from 73 women with early stage HER2-positive breast cancer. Speckle tracking strain was performed offline using EchoPAC and TomTec on subcostal 4-chamber and 3-chamber views to obtain subcostal 4-chamber (SC4_LS) and 3-chamber (SC3_LS) LVLS which was then averaged (SCav_LS). Reproducibility of subcostal single chamber and averaged LVLS were assessed. Measurements between platforms were compared. Strain was reported in absolute magnitude. EchoPAC measurements of SC3_LS (20.5 ± 2.4% vs. 21.2 ± 2.5%, p = 0.002) and SCav_LS (20.9 ± 2.1% vs. 21.2 ± 2.1%, p = 0.02) were lower than TomTec measurements while SC4_LS was similar (21.3 ± 2.7% vs. 21.3 ± 2.5%, p = 0.94). Mean differences between EchoPAC and TomTec were ≤ 0.6% strain units for all subcostal LVLS measurements; SCav_LS showed the narrowest limits of agreement (LOA) (mean difference - 0.3%, LOA - 3.2 to 2.6%). EchoPAC and TomTec measurements of SCav_LS showed good correlation (r = 0.76, p < 0.001). Intra-observer and inter-observer analysis showed good reproducibility. Inter-observer variability was lower than inter-vendor variability; SCav_LS was most reproducible: inter-observer relative mean error was 3.6% for EchoPAC and 4.3% for TomTec and inter-observer LOA were ± 2.1% for EchoPAC and ± 2.6% for TomTec. Averaged subcostal LVLS was highly reproducible with inter-observer variability comparable to GLS. Inter-vendor differences in averaged subcostal LVLS were small but statistically significant.
Collapse
Affiliation(s)
- Fei Fei Gong
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Arvind Nishtala
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Kimberly Chow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lua Jafari
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Asra Azizuddin
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Haydee Ramirez
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Sarah Chuzi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Nausheen Akhter
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA.
| |
Collapse
|
33
|
Wabich E, Dorniak K, Zienciuk-Krajka A, Nowak R, Raczak G, Daniłowicz-Szymanowicz L. Segmental longitudinal strain as the most accurate predictor of the patchy pattern late gadolinium enhancement in hypertrophic cardiomyopathy. J Cardiol 2020; 77:475-481. [PMID: 33246844 DOI: 10.1016/j.jjcc.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prognostic value of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) has been well-established. Although cardiac magnetic resonance (CMR) is the method of choice in its revealing as the presence of late gadolinium enhancement (LGE), this technique still has limited availability in daily clinical practice. Two-dimensional speckle tracking echocardiography (2D STE) seems to be helpful in verification which HCM patient has the highest probability of LGE presence and hence needs to be qualified to CMR. While the majority of HCM patients have a patchy pattern of myocardial fibrosis, the aim of this study was to evaluate whether segmental rather than global longitudinal strain is more accurate in the identification of the presence of LGE. METHODS Forty-six HCM patients had transthoracic echocardiography and CMR imaging performed. Each patient had global longitudinal strain and rotation parameters calculated, as well as segmental analyses for wall thickness, longitudinal strain, and LGE presence based on 736 segments of the left ventricle (LV). The presence of LGE in CMR was confirmed on a per-segment basis, which was similar to LV segments in the echocardiographic examination. All patients were divided into two groups according to the CMR result: LGE (+) and LGE (-). RESULTS Receiver-operating characteristic analyses identified peak global longitudinal strain and peak twisting velocity with the cut-off values -14.4% and 116°/s respectively as the accurate predictors of LGE presence in CMR, whereas segmental longitudinal strain of -12.5% cut-off value had the highest area under the curve value (87.4%, confidence interval 84.5-90.3%), with 93.7% sensitivity, 86.5% negative predictive value, and 55% specificity. CONCLUSIONS Segmental longitudinal strain with the cut-off value of -12.5% has the highest discriminatory power for LGE presence and seems to be more adequate than global speckle tracking parameters in identification of HCM patients with strong indications for CMR for more accurate risk stratification.
Collapse
Affiliation(s)
- Elżbieta Wabich
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7 St., 80-211 Gdansk, Poland
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Zienciuk-Krajka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7 St., 80-211 Gdansk, Poland
| | - Radosław Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7 St., 80-211 Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7 St., 80-211 Gdansk, Poland
| | | |
Collapse
|
34
|
She JQ, Guo JJ, Yu YF, Zhao SH, Chen YY, Ge MY, Zeng MS, Jin H. Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac MR Tissue Tracking. J Magn Reson Imaging 2020; 53:51-60. [PMID: 32798304 DOI: 10.1002/jmri.27307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Myocardial strain for assessment of hypertrophic cardiomyopathy (HCM) is of importance and may play a role in identifying obstruction in HCM patients. PURPOSE To evaluate the utility of myocardial strain for detecting left ventricular (LV) outflow tract (LVOT) obstruction in HCM patients based on magnetic resonance tissue tracking. STUDY TYPE Retrospective. POPULATION In all, 44 adult HCM patients with LVOT obstruction and 108 adult HCM patients without LVOT obstruction. FIELD STRENGTH/SEQUENCE 1.5 T; Steady-state free-precession cine sequence; phase-sensitive inversion-prepared segmented gradient echo sequence for late gadolinium enhancement (LGE) imaging. ASSESSMENT Strain parameters including the local and global levels of LV myocardium and the subtraction (Sub) of myocardial strain variables between interventricular septal segments (IVSS) and noninterventricular septal segments (NIVSS) were measured for differentiating HCM with obstruction from nonobstruction. Average and maximum LV wall thickness (Average and Maximum LVWT) were also analyzed. STATISTICAL TESTS Univariate and multivariate logistic regression analysis, area under the receiver operating characteristic (ROC) curve (AUC), intraclass correlation coefficient. RESULTS In multivariate analysis, Average LVWT, Maximum LVWT, and the subtraction of radial peak strain (Sub Radial PS) between NIVSS and IVSS were independently associated with LVOT obstruction. The AUCs were 0.731, 0.840, and 0.890 for Average LVWT, Maximum LVWT, and Sub Radial PS, respectively. Sub Radial PS (cutoff value: 8.1%) demonstrated the highest sensitivity of 75.0% and a high specificity of 87.9% for identifying LVOT; Maximum LVWT (cutoff value: 22.9 mm) showed good sensitivity (72.7%) and specificity (83.3%). Combining Maximum LVWT >22.9 mm and Sub Radial PS > 8.1% achieved a better diagnostic performance (specificity 95.4%, sensitivity 70.5%). DATA CONCLUSION Combining Maximum LVWT >22.9 mm and Sub Radial PS >8.1% holds promise for objectively evaluating LVOT obstruction in HCM patients with very high specificity and acceptable sensitivity. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- Jia-Qi She
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Jia-Jun Guo
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yun-Fei Yu
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shi-Hai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yin-Yin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Mei-Ying Ge
- Department of Radiology, The 5th People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| |
Collapse
|
35
|
Hassan S, Barrett CJ, Crossman DJ. Imaging tools for assessment of myocardial fibrosis in humans: the need for greater detail. Biophys Rev 2020; 12:969-987. [PMID: 32705483 PMCID: PMC7429810 DOI: 10.1007/s12551-020-00738-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
Myocardial fibrosis is recognized as a key pathological process in the development of cardiac disease and a target for future therapeutics. Despite this recognition, the assessment of fibrosis is not a part of routine clinical practice. This is primarily due to the difficulties in obtaining an accurate assessment of fibrosis non-invasively. Moreover, there is a clear discrepancy between the understandings of myocardial fibrosis clinically where fibrosis is predominately studied with comparatively low-resolution medical imaging technologies like MRI compared with the basic science laboratories where fibrosis can be visualized invasively with high resolution using molecularly specific fluorescence microscopes at the microscopic and nanoscopic scales. In this article, we will first review current medical imaging technologies for assessing fibrosis including echo and MRI. We will then highlight the need for greater microscopic and nanoscopic analysis of human tissue and how this can be addressed through greater utilization of human tissue available through endomyocardial biopsies and cardiac surgeries. We will then describe the relatively new field of molecular imaging that promises to translate research findings to the clinical practice by non-invasively monitoring the molecular signature of fibrosis in patients.
Collapse
Affiliation(s)
- Summer Hassan
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Carolyn J Barrett
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - David J Crossman
- Department of Physiology, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
36
|
Hiemstra YL, van der Bijl P, El Mahdiui M, Bax JJ, Delgado V, Marsan NA. Myocardial Work in Nonobstructive Hypertrophic Cardiomyopathy: Implications for Outcome. J Am Soc Echocardiogr 2020; 33:1201-1208. [PMID: 32680744 DOI: 10.1016/j.echo.2020.05.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Noninvasive left ventricular (LV) pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate LV function, integrating longitudinal strain by speckle-tracking analysis and sphygmomanometrically measured blood pressure to estimate myocardial work. The aims of this study were (1) to describe global and segmental myocardial work in patients with hypertrophic cardiomyopathy (HCM), (2) to assess the correlation between myocardial work and other echocardiographic parameters, and (3) to evaluate the association of myocardial work with adverse outcomes. METHODS One hundred ten patients with nonobstructive HCM (mean age, 55 ± 15 years; 66% men), with different phenotypes (apical, concentric, and septal hypertrophy), and 35 age- and sex-matched healthy control subjects were included. The following myocardial work indices were included: myocardial work index, constructive work (CW), wasted work, and cardiac efficiency. The combined end point included all-cause mortality, heart transplantation, heart failure hospitalization, aborted sudden cardiac death, and appropriate implantable cardioverter-defibrillator therapy. RESULTS Mean global CW (1,722 ± 602 vs 2,274 ± 574 mm Hg%, P < .001), global cardiac efficiency (93% [89%-95%] vs 96% [96%-97%], P < .001), and global MWI (1,534 ± 551 vs 1,929 ± 473 mm Hg%) were significantly reduced, while global wasted work (104 mm Hg% [66-137 mm Hg%] vs 71 mm Hg% [49-92 mm Hg%], P < .001) was increased in patients with HCM compared with control subjects. Segmental impairment in CW colocalized with maximal wall thickness (HCM phenotype), and global CW correlated with LV wall thickness (r = -0.41, P < .001), diastolic function (r = -0.27, P = .001), and QRS duration (r = -0.28, P = .001). Patients with global CW > 1,730 mm Hg% (the median value) experienced better event-free survival than those with global CW < 1,730 mm Hg% (P < .001). CONCLUSIONS Myocardial work, assessed noninvasively using echocardiography and blood pressure measurement, is reduced in patients with nonobstructive HCM; it correlates with maximum LV wall thickness and is significantly associated with a worse long-term outcome.
Collapse
Affiliation(s)
- Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
37
|
Implications of the complex biology and micro-environment of cardiac sarcomeres in the use of high affinity troponin antibodies as serum biomarkers for cardiac disorders. J Mol Cell Cardiol 2020; 143:145-158. [PMID: 32442660 PMCID: PMC7235571 DOI: 10.1016/j.yjmcc.2020.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023]
Abstract
Cardiac troponin I (cTnI), the inhibitory-unit, and cardiac troponin T (cTnT), the tropomyosin-binding unit together with the Ca-binding unit (cTnC) of the hetero-trimeric troponin complex signal activation of the sarcomeres of the adult cardiac myocyte. The unique structure and heart myocyte restricted expression of cTnI and cTnT led to their worldwide use as biomarkers for acute myocardial infarction (AMI) beginning more than 30 years ago. Over these years, high sensitivity antibodies (hs-cTnI and hs-cTnT) have been developed. Together with careful determination of history, physical examination, and EKG, determination of serum levels using hs-cTnI and hs-cTnT permits risk stratification of patients presenting in the Emergency Department (ED) with chest pain. With the ability to determine serum levels of these troponins with high sensitivity came the question of whether such measurements may be of diagnostic and prognostic value in conditions beyond AMI. Moreover, the finding of elevated serum troponins in physiological states such as exercise and pathological states where cardiac myocytes may be affected requires understanding of how troponins may be released into the blood and whether such release may be benign. We consider these questions by relating membrane stability to the complex biology of troponin with emphasis on its sensitivity to the chemo-mechanical and micro-environment of the cardiac myocyte. We also consider the role determinations of serum troponins play in the precise phenotyping in personalized and precision medicine approaches to promote cardiac health. Serum levels of cardiac TnI and cardiac TnT permit stratification of patients with chest pain. Release of troponins into blood involves not only frank necrosis but also programmed necroptosis. Genome wide analysis of serum troponin levels in the general population may be prognostic about cardiovascular health. Significant levels of serum troponins with exhaustive exercise may not be benign. Troponin in serum can lead to important data related to personalized and precision medicine.
Collapse
|
38
|
Zacchigna S, Paldino A, Falcão-Pires I, Daskalopoulos EP, Dal Ferro M, Vodret S, Lesizza P, Cannatà A, Miranda-Silva D, Lourenço AP, Pinamonti B, Sinagra G, Weinberger F, Eschenhagen T, Carrier L, Kehat I, Tocchetti CG, Russo M, Ghigo A, Cimino J, Hirsch E, Dawson D, Ciccarelli M, Oliveti M, Linke WA, Cuijpers I, Heymans S, Hamdani N, de Boer M, Duncker DJ, Kuster D, van der Velden J, Beauloye C, Bertrand L, Mayr M, Giacca M, Leuschner F, Backs J, Thum T. Towards standardization of echocardiography for the evaluation of left ventricular function in adult rodents: a position paper of the ESC Working Group on Myocardial Function. Cardiovasc Res 2020; 117:43-59. [PMID: 32365197 DOI: 10.1093/cvr/cvaa110] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/28/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
Echocardiography is a reliable and reproducible method to assess non-invasively cardiac function in clinical and experimental research. Significant progress in the development of echocardiographic equipment and transducers has led to the successful translation of this methodology from humans to rodents, allowing for the scoring of disease severity and progression, testing of new drugs, and monitoring cardiac function in genetically modified or pharmacologically treated animals. However, as yet, there is no standardization in the procedure to acquire echocardiographic measurements in small animals. This position paper focuses on the appropriate acquisition and analysis of echocardiographic parameters in adult mice and rats, and provides reference values, representative images, and videos for the accurate and reproducible quantification of left ventricular function in healthy and pathological conditions.
Collapse
Affiliation(s)
- Serena Zacchigna
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy.,International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Alessia Paldino
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Evangelos P Daskalopoulos
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels
| | - Matteo Dal Ferro
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Simone Vodret
- International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Pierluigi Lesizza
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Antonio Cannatà
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Daniela Miranda-Silva
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André P Lourenço
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bruno Pinamonti
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Gianfranco Sinagra
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Florian Weinberger
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Thomas Eschenhagen
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Lucie Carrier
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Izhak Kehat
- Department of Physiology, Biophysics and System Biology, The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | - Michele Russo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - James Cimino
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Emilio Hirsch
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Dana Dawson
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | | | | | - Wolfgang A Linke
- Institute of Physiology 2, University of Muenster, Muenster, Germany
| | - Ilona Cuijpers
- Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Center of Molecular and Vascular Biology (CMVB), KU Leuven, Leuven, Belgium
| | - Stephane Heymans
- Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Center of Molecular and Vascular Biology (CMVB), KU Leuven, Leuven, Belgium
| | - Nazha Hamdani
- Department of Molecular and Experimental Cardiology, Division Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Martine de Boer
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diederik Kuster
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Christophe Beauloye
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels.,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luc Bertrand
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels
| | - Manuel Mayr
- King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Mauro Giacca
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy.,International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy.,King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Florian Leuschner
- Institute of Experimental Cardiology, Department of Cardiology, Angiology & Pulmology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, Department of Cardiology, Angiology & Pulmology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Thomas Thum
- Institute for Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.,REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany
| |
Collapse
|
39
|
Beaumont AJ, Grace FM, Richards JC, Campbell AK, Sculthorpe NF. Aerobic Training Protects Cardiac Function During Advancing Age: A Meta-Analysis of Four Decades of Controlled Studies. Sports Med 2020; 49:199-219. [PMID: 30374946 PMCID: PMC6513799 DOI: 10.1007/s40279-018-1004-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background In contrast to younger athletes, there is comparatively less literature examining cardiac structure and function in older athletes. However, a progressive accumulation of studies during the past four decades offers a body of literature worthy of systematic scrutiny. Objectives We conducted a systematic review, meta-analysis and meta-regression of controlled echocardiography studies comparing left ventricular (LV) structure and function in aerobically trained older athletes (> 45 years) with age-matched untrained controls, in addition to investigating the influence of chronological age. Methods Electronic databases were searched from inception to January 2018 before conducting a random-effects meta-analysis to calculate pooled differences in means, effect size and 95% confidence intervals (CIs). Study heterogeneity was reported using Cochran’s Q and I2 statistic. Results Overall, 32 studies (644 athletes; 582 controls) were included. Athletes had greater LV end-diastolic diameter (3.65 mm, 95% CI 2.66–4.64), interventricular septal thickness (1.23 mm, 95% CI 0.85–1.60), posterior wall thickness (1.20 mm, 95% CI 0.83–1.56), LV mass (72 g, 95% CI 46–98), LV mass index (28.17 g·m2, 95% CI 19.84–36.49) and stroke volume (13.59 mL, 95% CI 7.20–19.98) (all p < 0.01). Athletes had superior global diastolic function [ratio of early (E) to late (A) mitral inflow velocity (E/A) 0.18, 95% CI 0.13–0.24, p < 0.01; ratio of early (e′) to late (a′) diastolic annular tissue velocity (e′/a′) 0.23, 95% CI 0.06–0.40, p = 0.01], lower A (−8.20 cm·s−1, 95% CI −11.90 to −4.51, p < 0.01) and a′ (−0.72 cm·s−1, 95% CI −1.31 to −0.12, p = 0.02), and more rapid e′ (0.96 cm·s−1, 95% CI 0.05–1.86, p = 0.04). Meta-regression for chronological age identified that athlete–control differences, in the main, are maintained during advancing age. Conclusions Athletic older men have larger cardiac dimensions and enjoy more favourable cardiac function than healthy, non-athletic counterparts. Notably, the athlete groups maintain these effects during chronological ageing. Electronic supplementary material The online version of this article (10.1007/s40279-018-1004-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alexander J Beaumont
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK
| | - Fergal M Grace
- Human Movement and Sports Science Group, Faculty of Health, Federation University Australia, Ballarat, VIC, Australia
| | - Joanna C Richards
- School of Sport Science and Physical Activity, Institute of Sport and Physical Activity Research, University of Bedfordshire, Bedford, UK
| | - Amy K Campbell
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK
| | - Nicholas F Sculthorpe
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK.
| |
Collapse
|
40
|
Chowdhury SAK, Warren CM, Simon JN, Ryba DM, Batra A, Varga P, Kranias EG, Tardiff JC, Solaro RJ, Wolska BM. Modifications of Sarcoplasmic Reticulum Function Prevent Progression of Sarcomere-Linked Hypertrophic Cardiomyopathy Despite a Persistent Increase in Myofilament Calcium Response. Front Physiol 2020; 11:107. [PMID: 32210830 PMCID: PMC7075858 DOI: 10.3389/fphys.2020.00107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/30/2020] [Indexed: 01/12/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disorder caused by mutations in different genes mainly encoding myofilament proteins and therefore called a “disease of the sarcomere.” Despite the discovery of sarcomere protein mutations linked to HCM almost 30 years ago, the cellular mechanisms responsible for the development of this disease are not completely understood and likely vary among different mutations. Moreover, despite many efforts to develop effective treatments for HCM, these have largely been unsuccessful, and more studies are needed to better understand the cellular mechanisms of the disease. In experiments reported here, we investigated a mouse model expressing the mutant cTnT-R92Q, which is linked to HCM and induces an increase in myofilament Ca2+ sensitivity and diastolic dysfunction. We found that early correction of the diastolic dysfunction by phospholamban knockout (PLNKO) was able to prevent the development of the HCM phenotype in troponin T (TnT)-R92Q transgenic (TG) mice. Four groups of mice in FVB/N background were generated and used for the experiments: (1) non-transgenic (NTG)/PLN mice, which express wild-type TnT and normal level of PLN; (2) NTG/PLNKO mice, which express wild-type TnT and no PLN; (3) TG/PLN mice, which express TnT-R92Q and normal level of PLN; (4) TG/PLNKO mice, which express TnT-R92Q and no PLN. Cardiac function was determined using both standard echocardiographic parameters and speckle tracking strain measurements. We found that both atrial morphology and diastolic function were altered in TG/PLN mice but normal in TG/PLNKO mice. Histological analysis showed a disarray of myocytes and increased collagen deposition only in TG/PLN hearts. We also observed increased Ca2+/calmodulin-dependent protein kinase II (CaMKII) phosphorylation only in TG/PLN hearts but not in TG/PLNKO hearts. The rescue of the HCM phenotype was not associated with differences in myofilament Ca2+ sensitivity between TG/PLN and TG/PLNKO mice. Moreover, compared to standard systolic echo parameters, such as ejection fraction (EF), speckle strain measurements provided a more sensitive approach to detect early systolic dysfunction in TG/PLN mice. In summary, our results indicate that targeting diastolic dysfunction through altering Ca2+ fluxes with no change in myofilament response to Ca2+ was able to prevent the development of the HCM phenotype and should be considered as a potential additional treatment for HCM patients.
Collapse
Affiliation(s)
- Shamim A K Chowdhury
- Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Chad M Warren
- Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Jillian N Simon
- Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - David M Ryba
- Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Ashley Batra
- Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Peter Varga
- Department of Pediatrics, Section of Cardiology, University of Illinois at Chicago, Chicago, IL, United States
| | - Evangelia G Kranias
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States
| | - Jil C Tardiff
- Department of Medicine, Division of Cardiology, The University of Arizona, Tucson, AZ, United States
| | - R John Solaro
- Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Beata M Wolska
- Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
41
|
Suzuki R, Mochizuki Y, Yuchi Y, Yasumura Y, Saito T, Teshima T, Matsumoto H, Koyama H. Assessment of myocardial function in obstructive hypertrophic cardiomyopathy cats with and without response to medical treatment by carvedilol. BMC Vet Res 2019; 15:376. [PMID: 31660967 PMCID: PMC6819392 DOI: 10.1186/s12917-019-2141-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 10/14/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Inconsistency of treatment response in cats with obstructive hypertrophic cardiomyopathy is well recognized. We hypothesized that the difference in response to beta-blockers may be caused by myocardial functional abnormalities. This study was designed to compare myocardial function in cats with obstructive hypertrophic cardiomyopathy with and without response to beta-blockers. Twenty-one, client-owned, hypertrophic cardiomyopathy cats treated with carvedilol were analyzed. After carvedilol treatment, cats with decreased left ventricular outflow tract velocity were categorized as responders (n = 10); those exhibiting no response (no decrease in the left ventricular outflow tract velocity) were categorized as non-responders (n = 11). The cats were examined using layer-specific assessment of the myocardial function (whole, endocardial, and epicardial layers) longitudinally and circumferentially by two-dimensional speckle-tracking echocardiography, before and after carvedilol treatment. RESULTS The non-responder cats had a significantly higher age, end-diastolic left ventricular posterior-wall thickness, peak velocity of left ventricular outflow tract, and dose of carvedilol than the responders (p = 0.04, p < 0.01, p < 0.01, and p < 0.01, respectively). The circumferential strain in the epicardial layer was lower and circumferential endocardial to epicardial strain ratio was higher in non-responders than responders (p < 0.001 and p = 0.006). According to the multivariate analysis, circumferential strain in the epicardial layer was the only independent correlate of treatment response with carvedilol. CONCLUSIONS Myocardial function, assessed by two-dimensional speckle-tracking echocardiography, differed in cats with hypertrophic cardiomyopathy with and without response to beta-blockers. The determination of layer-specific myocardial function may facilitate detailed pathophysiologic assessment and treatment response in cats with hypertrophic cardiomyopathy.
Collapse
Affiliation(s)
- Ryohei Suzuki
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8602, Japan.
| | - Yohei Mochizuki
- Faculty of Veterinary Medicine, Okayama University of Science, 1-3 Ikoinooka, Imabari-shi, Ehime, 794-8555, Japan
| | - Yunosuke Yuchi
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8602, Japan
| | - Yuyo Yasumura
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8602, Japan
| | - Takahiro Saito
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8602, Japan
| | - Takahiro Teshima
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8602, Japan
| | - Hirotaka Matsumoto
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8602, Japan
| | - Hidekazu Koyama
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo, 180-8602, Japan
| |
Collapse
|
42
|
Sugahara M, Kagiyama N, Hasselberg NE, Blauwet LA, Briller J, Cooper L, Fett JD, Hsich E, Wells G, McNamara D, Gorcsan J. Global Left Ventricular Strain at Presentation Is Associated with Subsequent Recovery in Patients with Peripartum Cardiomyopathy. J Am Soc Echocardiogr 2019; 32:1565-1573. [PMID: 31563436 DOI: 10.1016/j.echo.2019.07.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a serious complication of pregnancy associated with variable degrees of left ventricular (LV) recovery. The aim of this study was to test the hypothesis that global LV strain at presentation has prognostic value in patients with PPCM. METHODS One hundred patients with PPCM aged 30 ± 6 years were enrolled in the multicenter Investigation in Pregnancy Associated Cardiomyopathy study along with 21 normal female control subjects. Speckle-tracking global longitudinal strain (GLS) and global circumferential strain (GCS) analysis was performed. The predefined primary combined outcome variable was death, transplantation, LV assist device implantation, or evidence of persistent LV dysfunction (LV ejection fraction [LVEF] < 50%) at 1 year. RESULTS GLS measurement was feasible in 110 subjects: 89 of 90 patients with PPCM (99%) with echocardiographic data and all 21 control subjects. Of 84 patients (94%) with 1-year follow-up, 21 (25%) had unfavorable primary outcomes: four LV assist device placements, two deaths, and 15 patients with persistent LV dysfunction. GLS at presentation with a cutoff of 10.6% (absolute value) was specifically associated with the subsequent primary outcome with 75% sensitivity and 95% specificity. GCS at presentation with a cutoff of 10.1% was associated with the primary outcome with 78% sensitivity and 84% specificity. GLS and GCS remained significantly associated with outcomes after adjusting for LVEF (GLS odds ratio, 2.07; P < .001; GCS odds ratio, 1.37; P = .005). GLS was significantly additive to LVEF (C statistic = 0.76-0.91, net reclassification improvement = 1.32, P < .001). CONCLUSIONS GLS and GCS in patients with PPCM at presentation were associated with subsequent clinical outcomes, including death, LV assist device implantation, and evidence of persistent LV dysfunction. Strain measures may add prognostic information over LVEF for risk stratification.
Collapse
Affiliation(s)
- Masataka Sugahara
- School of Medicine, Unversity of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nobuyuki Kagiyama
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Nina E Hasselberg
- School of Medicine, Unversity of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lori A Blauwet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Joan Briller
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Leslie Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - James D Fett
- School of Medicine, Unversity of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eileen Hsich
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Gretchen Wells
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Dennis McNamara
- School of Medicine, Unversity of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Gorcsan
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | |
Collapse
|
43
|
Trivedi SJ, Altman M, Stanton T, Thomas L. Echocardiographic Strain in Clinical Practice. Heart Lung Circ 2019; 28:1320-1330. [DOI: 10.1016/j.hlc.2019.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 01/07/2023]
|
44
|
Sperry BW, Sato K, Phelan D, Grimm R, Desai MY, Hanna M, Jaber WA, Popović ZB. Regional Variability in Longitudinal Strain Across Vendors in Patients With Cardiomyopathy Due to Increased Left Ventricular Wall Thickness. Circ Cardiovasc Imaging 2019; 12:e008973. [PMID: 31412719 DOI: 10.1161/circimaging.119.008973] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cardiomyopathies with increased left ventricular wall thickness such as cardiac amyloidosis, septal hypertrophic cardiomyopathy (HCM), and apical HCM exhibit characteristic regional longitudinal strain (LS) patterns. However, between-vendor agreement of segmental and regional LS has not been tested in these diseases. We sought to assess LS values among vendors in specific cardiomyopathies that exhibit regional strain variation: cardiac amyloidosis, septal HCM, and apical HCM. METHODS This was a prospective, cross-sectional study of 69 patients (18 amyloidosis, 30 septal HCM, 6 apical HCM, and 15 controls) who underwent clinically indicated outpatient echocardiography at the Cleveland Clinic. Peak systolic segmental, regional (basal, mid, and apical), and global LS were evaluated using GE (EchoPAC), Siemens (Velocity Vector Imaging), and Phillips (QLab) systems in the same imaging session. Between-vendor, differences were analyzed using correlation coefficients, Bland Altman plots, and a mixed model. RESULTS Global LS was highly correlated among the 3 software packages and most abnormal in patients with amyloidosis (P<0.001). Regional LS analysis demonstrated that QLab software tended to produce more negative LS values, driven by differences in apical strains. EchoPAC had the greatest ability to discriminate patients with amyloidosis using regional strain values (area under the curve, 0.932) as compared with Velocity Vector Imaging and QLab (P<0.001). CONCLUSIONS Global and regional variations in LS exist between-vendors in patients with cardiomyopathies with increased left ventricular wall thickness (amyloidosis, septal HCM, and apical HCM). It is important to be aware of these differences for diagnosis, prognosis, and serial examinations in these conditions.
Collapse
Affiliation(s)
- Brett W Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P).,Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO (B.W.S.)
| | - Kimi Sato
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Richard Grimm
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| |
Collapse
|
45
|
Hiemstra YL, Debonnaire P, Bootsma M, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Prevalence and Prognostic Implications of Right Ventricular Dysfunction in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2019; 124:604-612. [PMID: 31204037 DOI: 10.1016/j.amjcard.2019.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/28/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022]
Abstract
Right ventricular (RV) dysfunction is a well-known prognostic factor in several cardiac diseases. However, the prevalence of RV dysfunction in hypertrophic cardiomyopathy (HC) is unclear and its prognostic value is unknown. This study aims at addressing these issues assessing RV function with speckle tracking echocardiography. In 267 HC patients (52 ± 15 years, 68% male), standard and advanced echocardiographic measurements of RV function were performed including RV 4-chamber longitudinal strain (RV4CLS) and RV free wall longitudinal strain (RVFWLS). The primary end point was all-cause mortality and heart failure development. RV dysfunction was observed in 9% of patients based on tricuspid annular plane systolic excursion (≤17 mm), 5% based on fractional area change (<35%), 23% based on RVFWLS ≥-19%, 39% based on RVFWLS ≥-23%, and 55% based on RV4CLS ≥-20%. In total 59 (22%) patients reached the primary end point during a median follow-up of 6.7 (interquartile range 4.2 to 9.8) years. Kaplan-Meier survival curve showed a significant worse survival free of the end point for patients with impaired RV4CLS ≥-20% versus patients with preserved RV4CLS <-20% (log-rank 7.0, p = 0.008) and for patients with impaired RVFWLS ≥-19% versus patients with preserved RVFWLS <-19% (log-rank 4.4, p = 0.037). Multivariable Cox regression analysis showed that E/E' (hazards ratio [HR] 2.26 [1.30 to 3.92], p = 0.004), left ventricular global longitudinal strain LV GLS (HR 1.08 (1.01 to 1.17), p = 0.034) and RV4CLS (HR 1.08 (1.02 to 1.15), p = 0.007) were independently associated with the primary end point. In conclusion, RV dysfunction as measured by longitudinal strain is relatively frequent in HC patients. Impaired RV4CLS is - together with LV GLS and E/E' - associated with adverse outcome, which may indicate a more severe form of HC.
Collapse
Affiliation(s)
- Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philippe Debonnaire
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
46
|
Yang F, Wang J, Li Y, Li W, Xu Y, Wan K, Sun J, Han Y, Chen Y. The prognostic value of biventricular long axis strain using standard cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Int J Cardiol 2019; 294:43-49. [PMID: 31405582 DOI: 10.1016/j.ijcard.2019.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Long axis strain (LAS) is a parameter derived from standard cardiovascular magnetic resonance imaging. However, the prognostic value of biventricular LAS in hypertrophic cardiomyopathy (HCM) is unknown. METHODS Patients with HCM (n = 384) and healthy volunteers (n = 150) were included in the study. Left ventricular (LV)-LAS was defined as the percentage change in the length measured from the epicardial border of the LV apex to the midpoint of a line connecting the mitral annulus at end-systole and end-diastole. Right ventricular (RV)-LAS represented the percentage change of length between epicardial border of the LV apex to the midpoint of a line connecting the tricuspid annulus at end-systole and end-diastole. The primary endpoint was a combination of all-cause death and sudden cardiac death aborted by appropriate implantable cardioverter-defibrillator discharge and cardiopulmonary resuscitation after syncope. The secondary endpoint was a combination of the primary endpoint and hospitalization for congestive heart failure. RESULTS Twenty-nine patients (7.6%) achieved the primary endpoint, and the secondary endpoint occurred in 66 (17.2%) patients. In multivariate Cox regression analysis, RV-LAS was an independent prognostic factor for the primary (hazard ratio (HR), 1.13) and secondary (HR, 1.11) endpoints. In the subgroup of patients with a normal RV ejection fraction (EF) (>45.0%, n = 345), impaired RV-LAS was associated with adverse outcomes and might add incremental prognostic value to RVEF and tricuspid annular plane systolic excursion (TAPSE) (p < 0.01). CONCLUSIONS RV-LAS is an independent predictor of adverse prognosis in HCM in addition to RVEF and TAPSE.
Collapse
Affiliation(s)
- Fuyao Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuancheng Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, PA, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China; Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| |
Collapse
|
47
|
Kobayashi Y, Moneghetti KJ, Bouajila S, Stolfo D, Finocchiaro G, Kuznetsova T, Liang D, Schnittger I, Ashley E, Wheeler M, Haddad F. Time based versus strain based myocardial performance indices in hypertrophic cardiomyopathy, the merging role of left atrial strain. Eur Heart J Cardiovasc Imaging 2019; 20:334-342. [PMID: 30060097 DOI: 10.1093/ehjci/jey097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/28/2018] [Accepted: 06/21/2018] [Indexed: 11/15/2022] Open
Abstract
AIMS The myocardial performance index (MPI) is a time-based index of global myocardial performance. In this study, we sought to compare the prognostic value of the MPI with other strain and remodelling indices in hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS We enrolled 126 patients with HCM and 50 age- and sex-matched controls. Along with traditional echocardiographic assessment, MPI, left ventricular global longitudinal strain (LVGLS), E/e' ratio, and total left atrial (LA) global strain (LAS) were also measured. Time-based MPI was calculated from flow or tissue-based pulse wave Doppler (PWD and TDI) as the (isovolumic-relaxation and contraction time)/systolic-time. We used hierarchical clustering and network analysis to better visualize the relationship between parameters. The primary endpoint was the composite of all-cause death, heart transplantation, left ventricular assist device implantation, and clinical worsening. Left ventricular outflow tract (LVOT) obstruction was present in 56% of patients. Compared with controls, patients with HCM had worse LVGLS (-14.0 ± 3.4% vs. -19.6 ± 1.5%), higher E/e' (12.9 ± 7.2 vs. 6.1 ± 1.5), LA volume index (LAVI) (36.4 ± 13.8 ml/m2 vs. 25.6 ± 6.7 ml/m2), and MPI (0.55 ± 0.17 vs. 0.40 ± 0.11 for PWD and 0.59 ± 0.22 vs. 0.46 ± 0.09 for TDI) (all P < 0.001). During a median follow-up of 55 months, 47 endpoints occurred. PWD or TDI-based MPI was not associated with outcome, while LAVI, LAS, LVGLS, and E/e' were (all P < 0.01). On multivariable analysis, LVOT obstruction (P < 0.001), LAS (P < 0.001), and E/e' (P = 0.02) were retained as independent associates. They were in different clusters suggesting complemental relationship between them. CONCLUSION Time-based index is less predictive of outcome than strain or tissue Doppler indices. LAS may be a promising prognostic marker in HCM.
Collapse
Affiliation(s)
- Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Sara Bouajila
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Davide Stolfo
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Gherardo Finocchiaro
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Tatiana Kuznetsova
- Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA.,KU Leuven Department of Cardiovascular Sciences, Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Leuven, Belgium
| | - David Liang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Matthew Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| |
Collapse
|
48
|
Spalla I, Boswood A, Connolly DJ, Luis Fuentes V. Speckle tracking echocardiography in cats with preclinical hypertrophic cardiomyopathy. J Vet Intern Med 2019; 33:1232-1241. [PMID: 30993757 PMCID: PMC6524080 DOI: 10.1111/jvim.15495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Cats with hypertrophic cardiomyopathy (HCM) have decreased left ventricular (LV) longitudinal deformation detected by mitral annular plane systolic excursion (MAPSE) and speckle tracking echocardiography. People with preclinical HCM have decreased systolic LV longitudinal and radial strain (S) and strain rate (SR), with preserved circumferential S and SR. Hypothesis/Objectives Cats with preclinical HCM have decreased systolic LV deformation compared to normal cats. Animals Seventy‐three client‐owned cats with (n = 37) and without (n = 36) preclinical HCM. Methods Retrospective echocardiographic study. Left and right ventricular longitudinal S and SR, LV radial and circumferential S and SR were calculated by STE. Left ventricular mass was also calculated. Correlation between STE variables and LV hypertrophy was determined and receiver‐operating characteristic (ROC) curves were plotted for prediction of HCM. Results Cats with HCM had smaller absolute longitudinal S (−14.8 ± 3.3% vs −19.7 ± 2.7%, P < .001), longitudinal SR (−2.36 ± 0.62 vs −2.95 ± 0.68 second−1, P < .001), radial S (46.2 ± 21.3% vs 66.7 ± 17.6%, P < .001), and radial SR (5.60 ± 2.08 vs 6.67 ± 1.8 second−1, P < .001) compared to healthy controls. No difference was observed for circumferential S and SR. Cats with HCM had greater LV mass (13.2 ± 3.7 g vs 8.6 ± 2.7 g, P < .001). The ROC with the greatest area under the curve (AUC) for the identification of HCM (0.974) was plotted from a logistic regression equation combining LV mass, MAPSE at the free wall, and LV internal diameter in diastole (LVIDd). Conclusions and clinical importance Cats with preclinical HCM have decreased long axis and radial deformation. Decreased longitudinal deformation and decreased LVIDd are factors that would support a diagnosis of HCM.
Collapse
Affiliation(s)
- Ilaria Spalla
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Adrian Boswood
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - David J Connolly
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Virginia Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| |
Collapse
|
49
|
Cirino RHD, Scola RH, Ducci RDP, Camarozano AC, Kay CSK, Lorenzoni PJ, Werneck LC, Carmes ER, da Cunha CLP. Evaluation of Left-Sided Heart Chambers With Novel Echocardiographic Techniques in Men With Duchenne or Becker Muscular Dystrophy. Am J Cardiol 2019; 123:972-978. [PMID: 30638960 DOI: 10.1016/j.amjcard.2018.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 12/18/2022]
Abstract
Left ventricular systolic dysfunction (LVSD) is a common finding in patients with Duchenne (DMD) and Becker (BMD) muscular dystrophies. Novel echocardiographic techniques have been used for the detection of LVSD in several heart diseases. We aim to compare cardiac anatomic and functional data studied by three-dimensional (3DE) and two-dimensional (2DE) echocardiography and to analyze the myocardial strain for the detection of early LVSD in DMD and BMD patients. We performed a cross-sectional study of 46 DMD and 14 BMD patients. We measured left atrium volume and left ventricle volumes and ejection fraction using 3DE and 2DE techniques. Myocardial strain analysis was derived from global longitudinal strain (GLS) measurements. GLS was measured by 2DE with the speckle tracking technique. The correlation between 3DE and 2DE for the measurement of left atrium volume as well as left ventricle diastolic and systolic volumes was strong. 2DE presented larger left atrium and left ventricle volumes. Left ventricle ejection fraction was similar between the two techniques. Myocardial strain analysis was able to detect early LVSD in 50.0% of DMD patients and in 9.1% of BMD patients. In conclusion, two-dimensional echocardiography appears to be a good alternative for the anatomical and functional evaluation of the left heart chambers in DMD and BMD patients. Myocardial strain analysis detects early LVSD in a sizable portion of patients with dystrophinopathies.
Collapse
Affiliation(s)
| | - Rosana Herminia Scola
- Neuromuscular Service, Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Renata Dal-Prá Ducci
- Neuromuscular Service, Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil; Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Ana Cristina Camarozano
- Cardiology Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Claudia Suemi Kamoi Kay
- Neuromuscular Service, Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Paulo José Lorenzoni
- Neuromuscular Service, Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil; Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Lineu Cesar Werneck
- Neuromuscular Service, Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Eliane Ribeiro Carmes
- Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | | |
Collapse
|
50
|
Five-year prognostic significance of global longitudinal strain in individuals with a hypertrophic cardiomyopathy gene mutation without hypertrophic changes. Neth Heart J 2019; 27:117-126. [PMID: 30680638 PMCID: PMC6393574 DOI: 10.1007/s12471-019-1226-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Previous studies have reported that global longitudinal strain (GLS) is reduced in patients with hypertrophic cardiomyopathy (HCM) while left ventricular ejection fraction (LVEF) is normal. Our aim was to assess GLS in individuals with HCM mutations without hypertrophic changes and to determine its prognostic value for the development of HCM. Methods and results This retrospective case-control and cohort study included 120 HCM mutation carriers and 110 controls. GLS and LVEF were assessed with Tomtec Imaging software. Age, gender, and body surface area were similar in mutation carriers and controls. Compared to controls, mutation carriers had a higher maximal wall thickness (9 ± 2 vs 8 ± 2 mm, p < 0.001), higher LVEF (60 ± 5 vs 58 ± 4%, p < 0.001) and higher GLS (−21.4 ± 2.3% vs −20.3 ± 2.2%, p < 0.001). The GLS difference was observed in the mid-left ventricle (−21.5 ± 2.5% vs −19.9 ± 2.5%, p < 0.001) and the apex (−24.1 ± 3.5% vs −22.1 ± 3.4%, p < 0.001), but not in the base of the left ventricle (−20.0 ± 3.3% vs −20.0 ± 2.6%, p = 0.9). Echocardiographic follow-up was performed in 80 mutation carriers. During 5.6 ± 2.9 years’ follow-up, 13 (16%) mutation carriers developed HCM. Cox regression analysis showed age (hazard ratio (HR) 1.08, p = 0.01), pathological Q wave (HR 8.56; p = 0.01), and maximal wall thickness (HR 1.94; p = 0.01) to be independent predictors of the development of HCM. GLS was not predictive of the development of HCM (HR 0.78, p = 0.07). Conclusion GLS is increased in HCM mutation carriers without hypertrophic changes. GLS was of no clear prognostic value for the development of HCM during follow-up, in contrast to age, pathological Q waves and maximal wall thickness. Electronic supplementary material The online version of this article (10.1007/s12471-019-1226-5) contains supplementary material, which is available to authorized users.
Collapse
|