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Lisi M, Luisi GA, Pastore MC, Mandoli GE, Benfari G, Ilardi F, Malagoli A, Sperlongano S, Henein MY, Cameli M, D'Andrea A. New perspectives in the echocardiographic hemodynamics multiparametric assessment of patients with heart failure. Heart Fail Rev 2024:10.1007/s10741-024-10398-7. [PMID: 38507022 DOI: 10.1007/s10741-024-10398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
International Guidelines consider left ventricular ejection fraction (LVEF) as an important parameter to categorize patients with heart failure (HF) and to define recommended treatments in clinical practice. However, LVEF has some technical and clinical limitations, being derived from geometric assumptions and is unable to evaluate intrinsic myocardial function and LV filling pressure (LVFP). Moreover, it has been shown to fail to predict clinical outcome in patients with end-stage HF. The analysis of LV antegrade flow derived from pulsed-wave Doppler (stroke volume index, stroke distance, cardiac output, and cardiac index) and non-invasive evaluation of LVFP have demonstrated some advantages and prognostic implications in HF patients. Speckle tracking echocardiography (STE) is able to unmask intrinsic myocardial systolic dysfunction in HF patients, particularly in those with LV preserved EF, hence allowing analysis of LV, right ventricular and left atrial (LA) intrinsic myocardial function (global peak atrial LS, (PALS)). Global PALS has been proven a reliable index of LVFP which could fill the gaps "gray zone" in the previous Guidelines algorithm for the assessment of LV diastolic dysfunction and LVFP, being added to the latest European Association of Cardiovascular Imaging Consensus document for the use of multimodality imaging in evaluating HFpEF. The aim of this review is to highlight the importance of the hemodynamics multiparametric approach of assessing myocardial function (from LVFP to stroke volume) in patients with HF, thus overcoming the limitations of LVEF.
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Affiliation(s)
- Matteo Lisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy.
| | - Giovanni Andrea Luisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy
- Mediterranea Cardiocentro, 80122, Naples, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, Baggiovara, Italy
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Matteo Cameli
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014, Nocera Inferiore, SA, Italy
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Diomede D, Terazzi E, Diomede N, Alcidi G, Pugliese R, Ioannoni S, Romano M, Granatiero M, Di Terlizzi V, Correale M, Di Biase M, Brunetti ND, Iacoviello M. Relationship between the strain measures of left atrial function and heart failure worsening. Echocardiography 2023; 40:942-951. [PMID: 37503767 DOI: 10.1111/echo.15659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/02/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Two-dimensional speckle tracking evaluation (2D-STE) is a useful tool to evaluate the complexity of atrial function by the analysis of the different phases of atrial deformation and by the combination with Doppler measurements of diastolic function. AIM OF THE STUDY To evaluate the role of the left atrial (LA) strain parameters to predict worsening chronic heart failure (CHF). METHODS We enrolled outpatients affected by CHF referred to our heart failure unit. Each patient underwent a medical visit, an electrocardiogram (ECG), and an echocardiographic examination. LA function was assessed by 2D-STE. The three phases of LA strain, that is, the reservoir (LAr), the conduit (LAcd), and the contraction (LAct)-were evaluated. Moreover, the ratio between E and LAr (E/LAr) and those between LAr and septal (LAr/Ees), lateral (LAr/Eel), and septal-lateral (LAr/Eem) E/e' were measured. During follow-up, the events related to worsening of heart failure were evaluated. RESULTS Two hundred eleven patients were enrolled. During a mean follow-up of 14 ± 7 months, 37 patients showed at least one event related to heart failure worsening. At univariate Cox regression analysis, LAr, LAcd, LAct, E/LAr, LAr/Ees, LAr/Eel, and LAr/Eem were all associated with events related to heart failure worsening, but at multivariate regression analyses, only LAr (Hazard Ratio, HR: .95; 95% Confidence Interval, CI: .92-.99; p: .031), LAct (HR: 1.06; 95% CI: 1.01-1.12; p: .027), E/LAr (HR: 1.10; 95%CI: 1.0-1.16; p < .001), LAr/Ees (HR: .57; 95% CI: .37-.87; p: .010), and LAr/Eem (HR: .71; 95% CI: .53-.96; p: .026) remained significantly associated with the events. Finally, in a predictive model including the other relevant echocardiographic parameters LAr < 18%, LAct > -10.0%, LAr/Ees < 1.28, and E/LAr > 3.70 were associated with a statistically significant overall net reclassification improvement. CONCLUSIONS In CHF patients, the measure of the LA reservoir and contraction by 2D-STE is independently associated with heart failure worsening, but the accuracy in predicting the events is even greater when the reservoir is combined with the Doppler measures of diastolic function.
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Affiliation(s)
- Davide Diomede
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Erica Terazzi
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Nicolangelo Diomede
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gianmarco Alcidi
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Rosanna Pugliese
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sara Ioannoni
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Romano
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Michele Granatiero
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vito Di Terlizzi
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Michele Correale
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Matteo Di Biase
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Natale Daniele Brunetti
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Massimo Iacoviello
- School of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
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Sannino A, Delgado V. Left Atrial Reservoir Strain and Machine Learning: Augmenting Clinical Care in Heart Failure Patients. Circ Cardiovasc Imaging 2023; 16:e015154. [PMID: 36752110 DOI: 10.1161/circimaging.123.015154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Anna Sannino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (A.S.).,Cardiac Imaging Core Laboratory, Baylor Scott & White Research Institute, Plano, TX (A.S.)
| | - Victoria Delgado
- Hospital University German Trias y Pujol, Badalona, Spain (V.D.)
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Faggiano A, Avallone C, Gentile D, Provenzale G, Toriello F, Merlo M, Sinagra G, Carugo S. Echocardiographic Advances in Dilated Cardiomyopathy. J Clin Med 2021; 10:5518. [PMID: 34884220 DOI: 10.3390/jcm10235518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 12/29/2022] Open
Abstract
Although the overall survival of patients with dilated cardiomyopathy (DCM) has improved significantly in the last decades, a non-negligible proportion of DCM patients still shows an unfavorable prognosis. DCM patients not only need imaging techniques that are effective in diagnosis, but also suitable for long-term follow-up with frequent re-evaluations. The exponential growth of echocardiography’s technology and performance in recent years has resulted in improved diagnostic accuracy, stratification, management and follow-up of patients with DCM. This review summarizes some new developments in echocardiography and their promising applications in DCM. Although nowadays cardiac magnetic resonance (CMR) remains the gold standard technique in DCM, the echocardiographic advances and novelties proposed in the manuscript, if properly integrated into clinical practice, could bring echocardiography closer to CMR in terms of accuracy and may certify ultrasound as the technique of choice in the follow-up of DCM patients. The application in DCM patients of novel echocardiographic techniques represents an interesting emergent research area for scholars in the near future.
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Affiliation(s)
- Brian D Hoit
- Departments of Medicine, Physiology, and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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Arques S, Quennelle F, Roux E. Accuracy of peak mitral e-wave velocity in the diagnosis of heart failure with preserved ejection fraction in older patients with acute dyspnea. Ann Cardiol Angeiol (Paris) 2021; 70:281-285. [PMID: 34130805 DOI: 10.1016/j.ancard.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The diagnosis of heart failure with preserved ejection fraction is characterized by its complexity, especially for physicians without great experience in comprehensive transthoracic Doppler echocardiography. Peak mitral E-wave (E) velocity has been successfully correlated to invasive left ventricular diastolic pressures in patients with structural heart disease. The aim of the study was to address the accuracy of E in the diagnosis of heart failure with preserved ejection fraction in elderly patients with acute dyspnea. METHODS This prospective study included 29 consecutive patients ≥70 years of age with heart failure with preserved ejection fraction and acute dyspnea and 29 controls ≥70 years of age. The final diagnosis was supported by the 2016 ASE/EACVI recommendations. RESULTS Mean age of the overall population was 85±7 years. E was strongly correlated with left atrial volume index (r=0.72, P<0.001) and with peak velocity of tricuspid regurgitation (r=0.77, P<0.001). E >85cm/s was 90% sensitive and 93% specific in the diagnosis of heart failure with preserved ejection fraction (AUC, 0.95). E/e' (0.95) and E/(e'xs') (0.92) did not perform better. CONCLUSION E/e' and E/(e'xs') provide essential diagnostic and prognostic information in heart failure with preserved ejection fraction and deserve to be included in every report of comprehensive transthoracic Doppler echocardiography. E velocity is a very simple and user-friendly parameter that can be used for the sole diagnostic purpose in elderly patients with acute dyspnea by operators without great deal of experience, such as cardiologists without formal training, emergency physicians, intensive care anesthetists, internists and geriatricians.
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Affiliation(s)
- S Arques
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs Gastine, 13400 Aubagne, France.
| | - F Quennelle
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs Gastine, 13400 Aubagne, France
| | - E Roux
- Structure de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs Gastine, 13400 Aubagne, France
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Bytyçi I, D’Agostino A, Bajraktari G, Lindqvist P, Dini FL, Henein MY. Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction: The impact of diabetes. Clin Physiol Funct Imaging 2021; 41:208-216. [PMID: 33342025 PMCID: PMC7898664 DOI: 10.1111/cpf.12688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/10/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between diabetes mellitus (DM) and left atrial (LA) remodelling in a group of patients with heart failure and reduced ejection fraction (HFrEF), and their combined impact on cardiac events (CE). METHODS This study included 136 consecutive HFrEF patients (65 ± 11 years), 36 had DM, and 86 had increased LA stiffness (LASt). All patients underwent complete conventional and tissue Doppler echocardiographic measurements were made including LA volumes and function. LASt was calculated using the formula: LASt = E/e' ratio / PALS. RESULTS At 55 ± 37 months follow-up, free survival from CE was 69% in patients without DM and 44.4% in those with DM (p < .0001). The CE free survival was lower in patients with increased LASt compared to normal LASt, (50 versus. 80%, p < .001), irrespective of the presence of DM (27 versus. 71%, p < .001).The best cut-off value of LASt for predicting CE in the group as a whole was ≥ 0.82% [81% sensitivity, 72% specificity and AUC 0.82 (p < .001)]. LASt ≥ 0.82% also predicted CE in no DM patients [78% sensitivity, 71% specificity and AUC 0.80 (p < .001)] and was a stronger predictor in DM patients [85% sensitivity, 71% specificity and AUC = 0.847 (p < .001)]. CONCLUSION High LA stiffness is associated with poor clinical outcome in patients with HFrEF. Diabetes has an additional incremental value in determining clinical outcome in those patients.
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Affiliation(s)
- Ibadete Bytyçi
- Institute of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
- Clinic of CardiologyUniversity Clinical Centre of Kosovo, and Universi CollegePrishtinaKosovo
| | | | - Gani Bajraktari
- Institute of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
- Clinic of CardiologyUniversity Clinical Centre of Kosovo, and Universi CollegePrishtinaKosovo
| | - Per Lindqvist
- Faculty of MedicineDepartment of Surgical and Perioperative SciencesClinical PhysiologyUmeå UniversityUmeåSweden
| | - Frank L. Dini
- Institute of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
- Cardiac, Thoracic and Vascular DepartmentUniversity of PisaPisaItaly
| | - Michael Y. Henein
- Institute of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
- Molecular and Clinic Research InstituteSt George UniversityBrunel UniversityLondonUK
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Ahmeti A, Bytyçi FS, Bielecka-Dabrowa A, Bytyçi I, Henein MY. Prognostic value of left atrial volume index in acute coronary syndrome: A systematic review and meta-analysis. Clin Physiol Funct Imaging 2021; 41:128-135. [PMID: 33372377 PMCID: PMC7898886 DOI: 10.1111/cpf.12689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023]
Abstract
Background In the absence of mitral valve disease, increased left atrial volume (LAV) is a marker of diastolic dysfunction and long‐standing elevated left ventricle (LV) pressure. The aim of this study was to assess the role of increased baseline LAV in predicting clinical outcome of patients presenting with acute coronary syndrome (ACS). Methods We systematically searched all electronic databases up to September 2020 in order to select clinical trials and observational studies, which assessed the predictive role of LAV indexed (LAVI) on clinical outcome in patients with ACS. Primary clinical endpoints were as follows: major adverse cardiac events (MACE), all‐cause mortality and hospitalization. Secondary endpoints were in‐hospital complications. Results A total of 2,705 patients from 11 cohort studies with a mean follow‐up 18.7 ± 9.8 months were included in the metaanalysis. Patients with low LAVI had low risk for MACE (15.9% vs. 33.7%; p < .01), long‐term all‐cause mortality (9.14% vs. 18.1%; p < .01), short‐term mortality (3.31% vs. 9.38%; p = .02) and lower hospitalization rate (11.6% vs. 25.5%; p < .01) compared to patients with increased LAVI. Atrial fibrillation and cardiogenic shock as in‐hospital events were lower (p < .05 for all) in patients with low LAVI but ventricular fibrillation/tachycardia was not different between groups (p = .14). Conclusion Increased LAVI is an independent predictor of outcome in patients with ACS. Thus, assessment of LA index in these patients is important for better risk stratification and guidance towards optimum clinical management.
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Affiliation(s)
- Artan Ahmeti
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.,Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | | | | | - Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.,Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Molecular and Clinic Research Institute, St George University, London, UK.,Brunel University, London, UK
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Lindqvist P, Henein M. Left atrial strain rate during atrial contraction predicts raised pulmonary capillary wedge pressure: evidence for left atrio-ventricular interaction. Int J Cardiovasc Imaging 2021; 37:1529-1538. [PMID: 33392878 PMCID: PMC8105232 DOI: 10.1007/s10554-020-02126-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/29/2020] [Indexed: 10/29/2022]
Abstract
This study aimed to assess the relationship between different LA strain components and PCWP as well as to the relationship with other established methods. We studied 144 symptomatic patients, age 63 ± 14 years, 54 males, using conventional transthoracic echocardiography protocols, including LA and LV myocardial deformation from speckle tracking technique investigations along with simultaneous right heart catheterization (RHC) using established techniques. From RHC, pulmonary artery pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were measured and pulmonary vascular resistance (PVR) calculated. LA strain rate during atrial contraction (LASRa) was the strongest correlate with PCWP (r2 = - 0.40, p < 0.001), over and above both LASR during LV systole (LASRs) and LA longitudinal strain during ventricular systole (LASs) (r2 = 0.21 and 0.19, respectively, p < 0.001 for both). The correlation between LASRa and PCWP was stronger in patients with post-capillary PH compared to pre-capillary PH (r2 = 0.21 vs. r2 = 0.02, respectively). The strongest relationship between LASRa and PCWP was in patients with enlarged LA volume > 34 ml/m2 (r2 = 0.60, p < 0.001). In all patients LASRa < = 0.9 1/s was 88% accurate in predicting LA pressure > 15 mmHg which was superior to recently proposed uni- and multi-variable models. LASR during atrial contraction is the strongest predictor of PCWP, particularly in patients with post-capillary PH and with dilated LA cavity. Furthermore, it proved superior to recently proposed uni- and multi-variable based algorithms. Its close relationship with LV strain rate counterpart reflects important left heart chamber interaction in patients with raised LA pressure.
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Affiliation(s)
- Per Lindqvist
- Department of Surgical and Perioperative Sciences and Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Thomas L, Muraru D, Popescu BA, Sitges M, Rosca M, Pedrizzetti G, Henein MY, Donal E, Badano LP. Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice. J Am Soc Echocardiogr 2020; 33:934-952. [DOI: 10.1016/j.echo.2020.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/05/2023]
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Henein MY, Lindqvist P. Diastolic function assessment by echocardiography: A practical manual for clinical use and future applications. Echocardiography 2020; 37:1908-1918. [PMID: 32426907 DOI: 10.1111/echo.14698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/10/2023] Open
Abstract
Diastole is an important component of the cardiac cycle, during which time optimum filling of the ventricle determines physiological stroke volume ejected in the succeeding systole. Many factors contribute to optimum ventricular filling including venous return, left atrial filling from the pulmonary circulation, and emptying into the left ventricle. Left ventricular filling is also impacted by the cavity emptying function and also its synchronous function which may suppress early diastolic filling in severe cases of dyssynchrony. Sub-optimum LA emptying increases cavity pressure, causes enlarged left atrium, unstable myocardial function, and hence atrial arrhythmia, even atrial fibrillation. Patients with clear signs of raised left atrial pressure are usually symptomatic with exertional breathlessness. Doppler echocardiography is an ideal noninvasive investigation for diagnosing raised left atrial pressure as well as following treatment for heart failure. Spectral Doppler based increased E/A, shortened E-wave deceleration time, increased E/e', and prolonged atrial flow reversal in the pulmonary veins are all signs of raised left atrial pressure. Left atrial reduced myocardial strain is another correlate of raised cavity pressure (>15 mm Hg). In patients with inconclusive signs of raised left atrial pressure at rest, exercise/stress echocardiography or simply passive leg lifting should identify those with stiff left ventricular which suffers raised filling pressures with increased venous return.
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Affiliation(s)
- Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Per Lindqvist
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
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Bytyçi I, Dini FL, Bajraktari A, Pugliese NR, D’Agostino A, Bajraktari G, Lindqvist P, Henein MY. Speckle Tracking-Derived Left Atrial Stiffness Predicts Clinical Outcome in Heart Failure Patients with Reduced to Mid-Range Ejection Fraction. J Clin Med 2020; 9:jcm9051244. [PMID: 32344825 PMCID: PMC7287788 DOI: 10.3390/jcm9051244] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM Left atrial stiffness (LASt) is an important marker of cardiac function, especially in patients with heart failure (HF); it explains symptoms on the basis of pressure transfer to the pulmonary circulation. The aim of this study was to evaluate the relationship between LASt and cardiac events (CE) in HF patients with reduced to mid-range ejection fraction. METHODS The study included 215 consecutive ambulatory HF patients with ejection fraction (EF) < 50% (162 HF reduced EF and 53 HF mid-range EF) of mean age 66 ± 11 years and 24.4% females. Peak LA strain (PALS) was measured by speckle tracking echocardiography and E/e' recorded from the apical four-chamber view. Non-invasive LASt was calculated using the equation: LASt = E/e' ratio/PALS. Documented cardiac events (CE) were HF hospitalization and cardiac death. RESULTS During a median follow up of 41 ± 34 months, 65 patients (30%) had CE. In multivariate analysis model, only raised LV filling pressure (E/e') (OR = 0.292, (95% CI 0.099 to 0.859), p = 0.02), peak pulmonary artery pressure (PAP) (OR = 1.050 (1.009 to 1.094), p = 0.01), PALS (OR = 0.932 (0.873 to 0.994), p = 0.02) and LASt (OR = 3.781 (1.144 to 5.122), p = 0.001) independently predicted CE. LASt ≥ 0.76% was the most powerful predictor of CE, with 80% sensitivity and 73% specificity (AUC 0.82, CI = 0.73 to 0.87, p < 0.001) followed by PALS ≤ 16%, with 74% sensitivity and 72% specificity (AUC 0.77, CI = 0.71 to 0.84, p < 0.001). These results were consistent irrespective of EF (p < 0.05). CONCLUSION In this cohort of ambulatory HFrEF and HFmrEF patients, LASt proved the most powerful predictor of clinical outcome.
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Affiliation(s)
- Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
- Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, Kosovo
| | - Frank L. Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy; (F.L.D.); (N.R.P.); (A.D.)
| | - Artan Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
| | - Nicola Riccardo Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy; (F.L.D.); (N.R.P.); (A.D.)
| | - Andreina D’Agostino
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy; (F.L.D.); (N.R.P.); (A.D.)
| | - Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
- Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, Kosovo
| | - Per Lindqvist
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
- Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, 90187 Umeå, Sweden
| | - Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
- Molecular and Clinic Research Institute, St George University, London SW17 0QT, UK
- Institute of Fluid Dynamics, Brunel University, London UB8 3PH, UK
- Correspondence: ; Tel.: +46-90-785-14-31
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Bytyçi I, Bajraktari G, Lindqvist P, Henein MY. Improved Left Atrial Function in CRT Responders: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E298. [PMID: 31973068 PMCID: PMC7074461 DOI: 10.3390/jcm9020298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/05/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) is associated with reverse left atrial (LA) remodeling. The aim of this meta-analysis was to assess the relationship between clinical response to CRT and LA function changes. We conducted a systematic search of all electronic databases up to September 2019 which identified 488 patients from seven studies. At (mean) 6 months follow-up, LA systolic strain and emptying fraction (EF) were increased in CRT responders, with a -5.70% weighted mean difference (WMD) [95% confidence interval (CI) -8.37 to -3.04, p < 0.001 and a WMD of -8.98% [CI -15.1 to -2.84, p = 0.004], compared to non-responders. The increase in LA strain was associated with a fall in left ventricle (LV) end-systolic volume (LVESV) r = -0.56 (CI -0.68 to -0.40, p < 0.001) and an increase in the LV ejection fraction (LVEF) r = 0.58 (CI 0.42 to 0.69, p < 0.001). The increase in LA EF correlated with the fall in LVESV r = -0.51 (CI -0.63 to -0.36, p < 0.001) and the increase in the LVEF r = 0.48 (CI 0.33 to 0.61, p = 0.002). The increase in LA strain correlated with the increase in the LA EF, r = 0.57 (CI 0.43 to 0.70, p < 0.001). Thus, the improvement of LA function in CRT responders reflects LA reverse remodeling and is related to its ventricular counterpart.
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Affiliation(s)
- Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (G.B.); (P.L.)
- Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, Kosovo
| | - Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (G.B.); (P.L.)
- Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, Kosovo
| | - Per Lindqvist
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (G.B.); (P.L.)
- Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, 90187 Umeå, Sweden
| | - Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (G.B.); (P.L.)
- Molecular and Clinic Research Institute, St George University, London SW17 0QT, UK
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Henein MY, Mondillo S, Cameli M. Left atrial function. Anatol J Cardiol 2019; 22:52-3. [PMID: 31375644 DOI: 10.14744/AnatolJCardiol.2019.31036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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