Early changes in left ventricular myocardial function by 2D speckle tracking layer-specific technique in neonates with hyperbilirubinemia

Effect of phototherapy on cardiac function in full term neonates with unconjugated hyperbilirubinemia

BACKGROUND

Phototherapy of jaundiced neonates has several cardiovascular effects. We investigated the effect of phototherapy on cardiac function in jaundiced full-term neonates using two-dimensional speckle tracking echocardiography (2D-STE).

METHODS

This cohort study was conducted on 40 full term neonates with unconjugated hyperbilirubinemia who needed phototherapy as the patient group and 40 healthy neonates of matched gestational age, age, and sex served as the control group. Conventional echocardiography, tissue Doppler, and 2D-STE were performed before and 24 h after phototherapy. Serum troponin T, serum bilirubin levels, systolic and diastolic blood pressure, and heart rate (HR) were measured also before and after phototherapy.

RESULTS

Systolic and diastolic blood pressure significantly decreased in the patient group after phototherapy compared to their levels before phototherapy. On the contrary, HR significantly increased after phototherapy in the patient group. However, serum cardiac troponin showed non-significant change after phototherapy. After phototherapy, all conventional and tissue Doppler parameters showed non-significant change. While 2D- left ventricular global longtudinal strain (2D-LVGLS) obtained by STE significantly decreased after phototherapy. There was a significant negative correlation between 2D-LV GLS and both duration and number of phototherapy units and both are good predictors for 2D-LVGLS.

CONCLUSION

Phototherapy may cause myocardial dysfunction that is correlated with the duration and number of phototherapy units.

IMPACT

Phototherapy of jaundiced neonates has many cardiovascular effects such as decrease in blood pressure and stroke volume. However, the effect of phototherapy on cardiac function in neonates has not been fully investigated yet. We investigated, for the first time, the effect of phototherapy on cardiac function in jaundiced full term neonates using two-dimensional speckle tracking echocardiography (2D-STE). Phototherapy may cause myocardial dysfunction that is correlated with the duration and number of phototherapy unit. Cardiac shield may be needed during phototherapy.

Feasibility and reproducibility of cardiovascular magnetic resonance-feature tracking for quantitative right atrial function in dilated cardiomyopathy patients

Background

The importance of right heart assessment in dilated cardiomyopathy (DCM) is increasingly recognized. The development of cardiovascular magnetic resonance-feature tracking (CMR-FT) has provided a novel approach to quantify myocardial deformation and evaluate cardiac function. In this study, we aimed to evaluate the feasibility and reproducibility of CMR-FT for the quantitative derivation of right atrial (RA) strain and strain rate (SR) in patients with DCM.

Methods

A total of 68 DCM patients (84% male; aged 50.6±13.2 years) and 58 healthy controls (81% male; aged 48.4±11.2 years) were retrospectively enrolled from September 2018 to August 2022 at the First Affiliated Hospital of Zhejiang Chinese Medical University and Shenzhen Clinical Medical College of Guangzhou University of Chinese Medicine. RA reservoir, conduit, and booster strain (εs, εe, and εa) and peak positive, peak early negative, and peak late negative SR (SRs, SRe, and SRa) were measured using CMR-FT and compared between 2 groups using Student's t-test. Intra- and inter-observer reproducibility was evaluated using intraclass correlation coefficients (ICC) and Bland-Altman plots.

Results

Compared to healthy controls, DCM patients showed significantly lower RA strain (εs: 19.7%±9.0% vs. 44.4%±9.7%; εe: 7.9%±5.3% vs. 25.8%±8.6%; εa: 11.8%±6.2% vs. 18.6%±5.1%, all P<0.001) and SR (SRs: 1.17±0.48 vs. 1.92±0.62 s-1; SRe: -0.85±0.56 vs. -1.94±0.63 s-1; SRa: -1.39±0.71 vs. -2.01±0.65 s-1, all P<0.001). There was no significant difference in RA maximum volume index between the 2 groups. Simple linear regression analysis demonstrated a significant correlation between N-terminal B-type natriuretic peptide (NT-proBNP), RA emptying fraction passive (RAEF passive), and RA εe [(NT-proBNP and εe): r=-0.48, P<0.001, 95% confidence interval (CI): -0.64 to -0.26; and (RAEF passive and εe): r=0.41, P=0.001, 95% CI: 0.22 to 0.56, respectively] in DCM patients. Intra- and inter-observer reproducibility was excellent (all ICCs >0.85) for RA deformation measurements.

Conclusions

CMR-FT is a promising, noninvasive approach for the quantitative assessment of RA phasic function in patients with DCM. DCM patients exhibit impaired RA reservoir, conduit, and booster pump function prior to visible RA enlargement.

Assessing the early prognosis of heart failure after acute myocardial infarction using left ventricular pressure-strain loop: a prospective randomized controlled clinical study

Background

The left ventricular pressure-strain loop (LV-PSL) technique, which is noninvasive and independent of pressure load, is more sensitive than is left ventricular speckle tracking imaging in detecting subtle changes in myocardial function. This study evaluated the improvement in cardiac function after application of LV-PSL in patients with heart failure with reduced ejection fraction (HFrEF) after acute myocardial infarction (MI) treated with sacubitril/valsartan plus dapagliflozin as compared to treatment with sacubitril/valsartan monotherapy.

Methods

This prospective, multicenter, open-label study recruited 60 MI survivors with HFrEF between March 2021 and June 2022. The patients were randomly assigned in 1:1 groups, as stratified by center. Patients were randomly categorized into either an observation group [n=30; conventional treatment + 100 mg (49/51 mg) of sacubitril/valsartan, + 10 mg of dapagliflozin] or a control group [n=30; conventional treatment + 100 mg (49/51 mg) of sacubitril/valsartan]. Patients were assessed at three time points: 1 month after discharge (T1), 3 months after discharge (T3), and 6 months after discharge (T6). Two-dimensional ultrasound images were routinely collected, two-dimensional speckle tracking imaging was applied to calculate the left ventricular global longitudinal strain (LV-GLS) rate for both groups, and LV-PSL analysis was used for the assessment of myocardial work, including global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. The results at the three follow-up visits were compared with the predischarge results (baseline, T0).

Results

Compared with the values at T0, the LV-GLS and left ventricular myocardial work index (LVMWI) values increased in both the observation and control groups at T1, T3, and T6, with GWI and GCW showing significantly greater improvement in the observation group at T6 (GWI: 1,204±336 vs. 987±417 mmHg%, P=0.03; GCW: 1,401±348 vs. 1,206±356 mmHg%, P=0.04). Survival analysis revealed that the overall incidence of major adverse cardiovascular events (MACEs) in the observation group was significantly lower than that in the control group (P=0.03). In a multivariate logistic regression analysis including GCW, GWI, GLS, and left ventricular eject fraction (LVEF), GCW emerged as the only independent predictor of occurrence of MACEs (odds ratio =1.08; 95% CI: 0.63-0.93; P<0.001).

Conclusions

Sacubitril/valsartan and dapagliflozin combination therapy led to a moderate improvement of cardiac function in patients with post-MI heart failure (P-MI-HF) compared to treatment with sacubitril/valsartan alone. Moreover, LV-PSL analysis can be used to assess the early prognosis of patients with P-MI-HF.

Association between epicardial adipose tissue and myocardial work by non-invasive left ventricular pressure-strain loop in people with suspected metabolic syndrome

Given the inconsistent results on the prognostic significance of epicardial adipose tissue (EAT), the purpose of the present study was to investigate the association of EAT thickness and myocardial work by non-invasive left ventricular pressure-strain loop in people with suspected metabolic syndrome (MS). A total of 194 participants imaged with echocardiography were evaluated. In accordance with the median EAT thickness, MS patients fell into thin EAT group and thick EAT group. Conventional echocardiographic parameters, global longitudinal strain (GLS) and the global myocardial work parameters obtained by pressure-strain loop analysis, comprising the global work index (GWI), global work efficiency (GWE), global constructive work (GCW) and global wasted work (GWW) were compared between the two groups. In comparison with the thin EAT group, thick EAT group achieved significantly higher values in interventricular septal thickness, end-diastolic left ventricular posterior wall thickness, left ventricular mass index and GWW (p < 0.05). while the absolute value of GLS, GWI, GCW, and GWE were notably lower in the thick EAT group (p < 0.001). EAT thickness showed a significant correlation with GWI and GCW (r = - 0.328, p = 0.001; r = - 0.253, p = 0.012), and also independently correlated with GWI and GCW in the multivariate regression analysis (β = - 0.310, p = 0.001; β = - 0.199, p = 0.049). EAT thickness is associated with left ventricular myocardial function in subjects with suspected metabolic syndrome, independently of other risk factors. Further studies are supposed to ensure the causal associations and related mechanisms.