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He J, Yang ZX, Zhang WL, Zhang HZ, Zhu M. Evaluation of Left Ventricular Function in Patients With Severe Aortic Stenosis Utilizing Automated Cardiac Motion Quantitation Techniques. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:939-945. [PMID: 38521696 DOI: 10.1016/j.ultrasmedbio.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The objective of this study is to explore the patterns of alteration in left ventricular systolic function among patients with severe aortic stenosis (SAS) through the application of automatic myocardial motion quantification (aCMQ) techniques. Furthermore, we seek to ascertain dependable quantitative markers for the assessment of impaired left ventricular function in patients with SAS and an ejection fraction (EF) ≥ 60%. METHODS Seventy patients who underwent echocardiography and received a diagnosis of severe aortic stenosis (SAS) in the hospital from November 2021 to August 2022 were selected for the SAS group and categorized into three subgroups based on ejection fraction (EF)-SAS group with EF ≥ 60%, SAS group with EF ranging from 50% to 59%, and SAS group with EF < 50%. Concurrently, 30 healthy individuals were recruited at the hospital during the same timeframe to serve as the control group. Participants from both groups underwent standard transthoracic echocardiography to assess conventional echocardiographic parameters. Dynamic images were examined using automatic myocardial motion quantification (aCMQ) software to derive longitudinal peak strain (LPS) parameters, which were then subjected to statistical analysis. RESULTS In comparison to the control group participants, the measurements of ascending aorta diameter (AoD), left atrium diameter (LAD), interventricular septal end diastolic thickness (IVSd), left ventricular posterior wall end diastolic thickness (LVPWd), peak systolic velocity (Vmax), and mean pressure gradient (MPG) were significantly higher in the SAS groups (p < 0.05). When compared to participants in the SAS group with an EF ≥ 60%, the values of IVSd, LVPWd, Vmax, and MPG in the SAS group with EF ranging from 50% to 59% were significantly elevated (p < 0.05). Similarly, left ventricular end-diastolic diameter (LVEDD), the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e'), and the ratio of early to late diastolic mitral inflow velocities (E/A) in the SAS group with EF < 50% were significantly elevated (p < 0.05). The absolute values of longitudinal peak strain (LPS) in the SAS groups were significantly lower in comparison to those in the control group (p < 0.05). Furthermore, all measurements of left ventricular global longitudinal systolic peak strain (GLPS) showed a positive correlation with MPG, a moderate negative correlation with aortic valve area index (AVAI), and a moderate positive correlation with E/A. CONCLUSIONS Patients with SAS and an EF < 50% exhibited the most profound impairment in left ventricular myocardial function. Utilizing the aCMQ technique enables the precise and quantitative evaluation of the severity of impaired left ventricular systolic function in patients within the SAS group with an EF ≥ 60%.
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Affiliation(s)
- Jing He
- Department of Cardiovascular Ultrasonography, Central Hospital Affiliated To Shandong First Medical University, Jinan, China
| | - Zi-Xin Yang
- Shandong First Medical University (Shandong Academy Of Medical Sciences), Jinan, China
| | - Wen-Long Zhang
- Department of Cardiac Surgery, Shandong First Medical University Affiliated Provincial Hospital, Jinan, China
| | - Hai-Zhou Zhang
- Department of Cardiac Surgery, Shandong First Medical University Affiliated Provincial Hospital, Jinan, China
| | - Mei Zhu
- Department of Ultrasonography, Shandong First Medical University Affiliated Provincial Hospital, Jinan, China.
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Rezaeian N, Hosseini L, Samiei N, Azimian M, Rashidinejad A, Toloueitabar Y, Mehdi Hemmati Komasi M, Shayan L, Asadian S. Aortic Valve Area and Strain Measurements by Cardiac MRI and Transthoracic Echocardiography in Severe Aortic Stenosis with Normal Left Ventricular Function. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:370-378. [PMID: 37456208 PMCID: PMC10349161 DOI: 10.30476/ijms.2022.94552.2590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/17/2022] [Accepted: 07/10/2022] [Indexed: 07/18/2023]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) is the recommended imaging technique for the evaluation of patients with aortic stenosis (AS). However, in cases with inconclusive findings, cardiac magnetic resonance (CMR) planimetry is used to grade AS severity. This study aimed to compare the results derived from TTE and CMR in patients with severe AS with normal left ventricular (LV) function. METHODS In a prospective study, 20 patients with severe AS were recruited and data derived from TTE and CMR modalities were compared with the archived records of 28 age- and sex-matched healthy controls. The data included aortic valve area (AVA), MRI-derived biventricular global strains, and TTE-derived global longitudinal strain (GLS). SPSS software was used to analyze the data with independent samples t test, intraclass correlation coefficient (ICC), and Pearson correlation. P<0.05 was considered statistically significant. RESULTS An excellent agreement was found in AVA values derived from CMR and TTE with an average ICC of 0.932 (95% CI=0.829-0.973). There was a significant difference in LV-GLS, LV global radial strain (GRS), right ventricular (RV) GRS, and RV global circumferential strain between the groups. A good correlation was found between CMR- and TTE-derived GLS with an average ICC of 0.721 (95% C=0.255-0.896). The mean aortic valve pressure gradient in TTE had a significant inverse linear correlation with LV-GRS in CMR (r=-0.537). All P values were <0.05. CONCLUSION There was a good agreement between AVA and strain values derived from cardiac MRI and TTE. The myocardial strain was impaired in patients with severe AS and normal LV function and correlated with disease severity.
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Affiliation(s)
- Nahid Rezaeian
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Hosseini
- Department of Echocardiography, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valves Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Azimian
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rashidinejad
- Department of Interventional Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Toloueitabar
- Department of Cardiac Surgery, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Leila Shayan
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Asadian
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Normative healthy reference values for global and segmental 3D principal and geometry dependent strain from cine cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2023; 39:115-134. [PMID: 36598686 DOI: 10.1007/s10554-022-02693-x] [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: 03/14/2022] [Accepted: 07/03/2022] [Indexed: 01/07/2023]
Abstract
3-Dimensional (3D) myocardial deformation analysis (3D-MDA) enables novel descriptions of geometry-independent principal strain (PS). Applied to routine 2D cine cardiovascular magnetic resonance (CMR), this provides unique measures of myocardial biomechanics for disease diagnosis and prognostication. However, healthy reference values remain undefined. This study describes age- and sex-stratified reference values from CMR-based 3D-MDA, including 3D PS. One hundred healthy volunteers were prospectively recruited following institutional ethics approval and underwent CMR imaging. 3D-MDA was performed using validated software. Age- and sex-stratified global and segmental strain measures were derived for conventional geometry-dependent [circumferential (CS), longitudinal (LS), and radial (RS)] and geometry-independent [minimum (minPS) and maximum principal (maxPS)] directions of deformation. Layer-specific contraction angle interactions were determined using local minPS vectors. The average age was 43 ± 15 years and 55% were women. Strain measures were higher in women versus men. 3D PS-based assessment of maximum tissue shortening (minPS) and maximum tissue thickening (maxPS) were greater than corresponding geometry-dependent markers of LS and RS, consistent with improved representation of local tissue deformations. Global maxPS amplitude best discriminated both age and sex. Segmental analyses showed greater strain amplitudes in apical segments. Transmural PS contraction angles were higher in females and showed a heterogeneous distribution across segments. In this study we provided age and sex-based reference values for 3D strain from CMR imaging, demonstrating improved capacity for 3D PS to document maximal local tissue deformations and to discriminate age and sex phenotypes. Novel markers of layer-specific strain angles from 3D PS were also described.
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Zhang H, Xie JJ, Li RJ, Wang YL, Niu BR, Song L, Li J, Yang Y. Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation. World J Clin Cases 2022; 10:1806-1814. [PMID: 35317147 PMCID: PMC8891760 DOI: 10.12998/wjcc.v10.i6.1806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although transcatheter aortic valve implantation (TAVI) is a safe and effective treatment for aortic stenosis, it still carries some risks, such as valve leaks, stroke, and even death. The left ventricular global longitudinal strain (LVGLS) measurement may be useful for the prediction of adverse events during this operation.
AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.
METHODS In this study, 61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography. Before surgery, data on left ventricular ejection fraction (LVEF) and LVGLS were collected separately following balloon expansion and stent implantation. Difference in values of LVGLS and LVEF during preoperative balloon expansion (pre-ex), preoperative stent implantation (pre-im) and balloon expansion-stent implantation (ex-im) were also examined. Adverse events were defined as perioperative death, cardiac rupture, heart arrest, moderate or severe perivalvular leakage, significant mitral regurgitation during TAVI, perioperative moderate or severe mitral regurgitation, perioperative left ventricular outflow tract obstruction, reoperation, and acute heart failure.
RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS, but not with difference in pre-ex LVEF. There were significant differences between pre-LVGLS and ex-LVGLS, and between pre-LVGLS and im-LVGLS (P = 0.037 and P = 0.020, respectively). However, differences in LVEF were not significant (P = 0.358, P = 0.254); however differences in pre-ex LVGLS were associated with pre-LVGLS (P = 0.045). Compared to LVEF, LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period. Moreover, the differences in LVGLS were associated with the occurrence of perioperative adverse events, and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery. Furthermore, LVGLS is useful to predict changes in cardiac function during TAVI.
CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.
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Affiliation(s)
- Han Zhang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jin-Jie Xie
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Rong-Juan Li
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yue-Li Wang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Bao-Rong Niu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Li Song
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jing Li
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Ya Yang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Tsugu T, Nagatomo Y, Dulgheru R, Lancellotti P. Layer-specific longitudinal strain predicts left ventricular maximum wall thickness in patients with hypertrophic cardiomyopathy. Echocardiography 2021; 38:1149-1156. [PMID: 34028870 DOI: 10.1111/echo.15125] [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: 03/21/2021] [Accepted: 05/09/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS The aim of this study was (a) to clarify the detailed mechanisms of structural and functional abnormalities of myocardial tissue in hypertrophic cardiomyopathy (HCM) using layer-specific strain (LSS) and compare it with healthy subjects (b) to investigate the diagnostic accuracy of LSS for HCM. METHODS AND RESULTS Forty-one patients with HCM and preserved left ventricular ejection fraction (LVEF; 66% male, 52 ± 18 years, LVEF 62.9% ± 3.7%) and 41 controls matched for age and sex (66% male, 52 ± 20 years, LVEF 63.5% ± 8.2%) underwent 2D-speckle tracking echocardiography. Absolute values of LSS were globally lower and the ratio of endocardial/epicardial layer (End/Epi ratio) was higher in HCM. LSS gradually increased from the epicardial toward the endocardial layer at all chamber views and at all levels of the LV. LSS and End/Epi ratio at the apex were higher than those at the middle or basal level of the LV. End/Epi ratio was correlated with LV maximal wall thickness both controls (r = .35, P = .03) and HCM (r = .81, P < .001). End/Epi ratio was an independent factor associated with LV maximal wall thickness (β = 0.96, P < .001). A higher End/Epi ratio (≥1.31) was associated with diagnostic criteria for HCM (sensitivity 98%, specificity 95%, area under the curve 0.99, P < .001). CONCLUSION LSS has the potential for unraveling the mechanism of impaired LV wall motion in HCM and to accurately detect HCM.
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Affiliation(s)
- Toshimitsu Tsugu
- Departments of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, University of Liège Hospital, Liège, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Raluca Dulgheru
- Departments of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, University of Liège Hospital, Liège, Belgium
| | - Patrizio Lancellotti
- Departments of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, University of Liège Hospital, Liège, Belgium
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Ananthapadmanabhan S, Vo G, Nguyen T, Dimitri H, Otton J. Direct comparison of multilayer left ventricular global longitudinal strain using CMR feature tracking and speckle tracking echocardiography. BMC Cardiovasc Disord 2021; 21:107. [PMID: 33607946 PMCID: PMC7893897 DOI: 10.1186/s12872-021-01916-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background Cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) are well-established strain imaging modalities. Multilayer strain measurement permits independent assessment of endocardial and epicardial strain. This novel and layer specific approach to evaluating myocardial deformation parameters may provide greater insight into cardiac contractility when compared to whole-layer strain analysis. The aim of this study is to validate CMR-FT as a tool for multilayer strain analysis by providing a direct comparison between multilayer global longitudinal strain (GLS) values between CMR-FT and STE. Methods We studied 100 patients who had an acute myocardial infarction (AMI), who underwent CMR imaging and echocardiogram at baseline and follow-up (48 ± 13 days). Dedicated tissue tracking software was used to analyse single- and multi-layer GLS values for CMR-FT and STE. Results Correlation coefficients for CMR-FT and STE were 0.685, 0.687, and 0.660 for endocardial, epicardial, and whole-layer GLS respectively (all p < 0.001). Bland Altman analysis showed good inter-modality agreement with minimal bias. The absolute limits of agreement in our study were 6.4, 5.9, and 5.5 for endocardial, whole-layer, and epicardial GLS respectively. Absolute biases were 1.79, 0.80, and 0.98 respectively. Intraclass correlation coefficient (ICC) values showed moderate agreement with values of 0.626, 0.632, and 0.671 respectively (all p < 0.001). Conclusion There is good inter-modality agreement between CMR-FT and STE for whole-layer, endocardial, and epicardial GLS, and although values should not be used interchangeably our study demonstrates that CMR-FT is a viable imaging modality for multilayer strain
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Affiliation(s)
| | - Giau Vo
- Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia.,Cardiology Department, Liverpool Hospital, Liverpool, Sydney, 2170, Australia
| | - Tuan Nguyen
- Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia.,Cardiology Department, Liverpool Hospital, Liverpool, Sydney, 2170, Australia
| | - Hany Dimitri
- Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia.,Cardiology Department, Liverpool Hospital, Liverpool, Sydney, 2170, Australia
| | - James Otton
- Faculty of Medicine, University of New South Wales, Sydney, 2052, Australia.,Cardiology Department, Liverpool Hospital, Liverpool, Sydney, 2170, Australia
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Tsugu T, Postolache A, Dulgheru R, Sugimoto T, Tridetti J, Nguyen Trung ML, Piette C, Moonen M, Manganaro R, Ilardi F, Chitroceanu AM, Sperlongano S, Go YY, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez T, de la Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, van de Veire N, Von Bardeleben RS, Vinereanu D, Zamorano JL, Rosca M, Calin A, Magne J, Cosyns B, Galli E, Donal E, Santoro C, Galderisi M, Badano LP, Lang RM, Lancellotti P. Echocardiographic reference ranges for normal left ventricular layer-specific strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2020; 21:896-905. [PMID: 32259844 DOI: 10.1093/ehjci/jeaa050] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 10/16/2023] Open
Abstract
AIMS To obtain the normal range for 2D echocardiographic (2DE) measurements of left ventricular (LV) layer-specific strain from a large group of healthy volunteers of both genders over a wide range of ages. METHODS AND RESULTS A total of 287 (109 men, mean age: 46 ± 14 years) healthy subjects were enrolled at 22 collaborating institutions of the EACVI Normal Reference Ranges for Echocardiography (NORRE) study. Layer-specific strain was analysed from the apical two-, three-, and four-chamber views using 2DE software. The lowest values of layer-specific strain calculated as ±1.96 standard deviations from the mean were -15.0% in men and -15.6% in women for epicardial strain, -16.8% and -17.7% for mid-myocardial strain, and -18.7% and -19.9% for endocardial strain, respectively. Basal-epicardial and mid-myocardial strain decreased with age in women (epicardial; P = 0.008, mid-myocardial; P = 0.003) and correlated with age (epicardial; r = -0.20, P = 0.007, mid-myocardial; r = -0.21, P = 0.006, endocardial; r = -0.23, P = 0.002), whereas apical-epicardial, mid-myocardial strain increased with the age in women (epicardial; P = 0.006, mid-myocardial; P = 0.03) and correlated with age (epicardial; r = 0.16, P = 0.04). End/Epi ratio at the apex was higher than at the middle and basal levels of LV in men (apex; 1.6 ± 0.2, middle; 1.2 ± 0.1, base 1.1 ± 0.1) and women (apex; 1.6 ± 0.1, middle; 1.1 ± 0.1, base 1.2 ± 0.1). CONCLUSION The NORRE study provides useful 2DE reference ranges for novel indices of layer-specific strain.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Adriana Postolache
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
| | - Raluca Dulgheru
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
| | - Tadafumi Sugimoto
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
- Clinical Laboratory, Mie University Hospital, Mie, Japan
| | - Julien Tridetti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
| | - Mai-Linh Nguyen Trung
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
| | - Caroline Piette
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
| | - Marie Moonen
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
| | - Roberta Manganaro
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Federica Ilardi
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Alexandra Maria Chitroceanu
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
- Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Simona Sperlongano
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Yun Yun Go
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - George Kacharava
- Department of the Cardiology, Tbilisi Institute of Medicine (TIM), 16 Tsintsadze, 0160 Tbilisi, Georgia
| | | | - Daniele Barone
- Laboratory of Cardiovascular Ecography, Department of Cardiology, S. Andrea Hospital, La Spezia, Italy
| | - Monica Baroni
- Laboratorio Di Ecocardiografia Adulti, Fondazione Toscana "G.Monasterio" - Ospedale Del Cuore, Massa, Italy
| | - Nuno Cardim
- Hospital da Luz, Echocardiography Laboratory, Lisbon, Portugal
| | | | - Krasimira Hristova
- Department of Noninvasive Functional Diagnostic and Imaging, University National Heart Hospital, Sofia, Bulgaria
| | - Teresa Lopez
- Cardiology Department, La Paz Hospital, IdiPAz, Ciber, Madrid, Spain
| | - Gonzalo de la Morena
- Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022328, Bucharest, Romania
| | | | - Tolga Ozyigit
- VKV Amerikan Hastanesi, Kardiyoloji Bölümü, Istanbul, Turkey
| | | | | | - Ralph Stephan Von Bardeleben
- Emergency Medical Department Cardiology, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dragos Vinereanu
- Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Jose Luis Zamorano
- Department of Cardiology, University Alcala, Hospital Ramón y Cajal, Madrid, Spain
| | - Monica Rosca
- University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022328, Bucharest, Romania
| | - Andreea Calin
- University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022328, Bucharest, Romania
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042 France
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, GEIST, 2, rue Marcland, 87000 Limoges, France
| | - Bernard Cosyns
- CHVZ (Centrum voor Hart en Vaatziekten) - Universitair ziekenhuis Brussel; and ICMI (In Vivo Cellular and Molecular Imaging) laboratory, 101 Laarbeeklaan, 1090b Brussels, Belgium
| | - Elena Galli
- Service de Cardiologie, INSERM 1414, CHU Pontchaillou - and- LTSI, Université de Rennes 1 - INSERM, UMR 1099, Rennes, France
| | - Erwan Donal
- Service de Cardiologie, INSERM 1414, CHU Pontchaillou - and- LTSI, Université de Rennes 1 - INSERM, UMR 1099, Rennes, France
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Luigi P Badano
- Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italy
- Anthea Hospital, Bari, Italy
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Rimbaş RC, Mihăilă-Baldea S, Magda LŞ, Vişoiu SI, Muraru D, Vinereanu D. New Myocardial Deformation by 2D Multi-layer Speckle-Tracking Analysis in Healthy Patients: Normal Reference Values and Their Physiologic Determinants. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:818-827. [PMID: 31918859 DOI: 10.1016/j.ultrasmedbio.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/19/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
There are limited data regarding intrinsic changes of the left (LV) and right ventricular (RV) deformation assessed layer-by-layer. We designed a prospective multi-centric study, using a new multi-layer 2D-speckle-tracking-echo (MSTE). We investigated the impact of different physiologic parameters on layer-specific LV/RV myocardial deformation and synchrony, in a large group of healty subjects. 151 subjects were feasible for MSTE, divided in 4 groups: <40 yrs, 41 to 50 yrs, 51 to 60, and >61 yrs. We found a significant higher LV dyssynchrony index with age. In all groups, an endo-epicardial gradient was present in longitudinal LV/RV and circumferential deformation, with higher values in endocardial layer (p<0.001). There were no differences in deformation with age in all layers. We provided normal reference values for a new index of LV dyssynchrony, and also for RV longitudinal, LV circumferential and longitudinal layer-specific deformation, which can be further used when assessing subclinical dysfunction in myocardial diseases.
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Affiliation(s)
- Roxana Cristina Rimbaş
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
| | - Sorina Mihăilă-Baldea
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; Department of Cardiac, Thoracic and Vascular Science, University of Padua, Italy
| | - Lucia Ştefania Magda
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | | | - Denisa Muraru
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neurologic and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Dragoş Vinereanu
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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9
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Spath NB, Gomez M, Everett RJ, Semple S, Chin CWL, White AC, Japp AG, Newby DE, Dweck MR. Global Longitudinal Strain Analysis Using Cardiac MRI in Aortic Stenosis: Comparison with Left Ventricular Remodeling, Myocardial Fibrosis, and 2-year Clinical Outcomes. Radiol Cardiothorac Imaging 2019; 1:e190027. [PMID: 33778518 DOI: 10.1148/ryct.2019190027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 12/20/2022]
Abstract
Purpose To use global longitudinal strain (GLS) as a marker of left ventricular decompensation in aortic stenosis and to investigate the relationship of GLS measured with cardiac MRI with markers of myocardial fibrosis, symptom development, remodeling, and clinical outcomes. Materials and Methods Patients with aortic stenosis and healthy control subjects were assessed. GLS was assessed by using cardiac MRI feature tracking, diffuse fibrosis by T1 mapping, and replacement fibrosis using late gadolinium enhancement. Follow-up was prospective for the primary endpoint of all-cause mortality. Results GLS was reduced in aortic stenosis (n = 159) compared with control subjects (n = 41) (-17.6% ± 3.1 [standard deviation] vs -18.9% ± 2.6, P = .02). GLS demonstrated weak associations with aortic stenosis severity (Vmax; r = 0.24, P = .0005) but showed moderate correlation with T1 mapping measures of myocardial fibrosis (eg, indexed extracellular volume [iECV]; r = 0.43, P < .0001). Moreover, GLS was reduced in patients with midwall fibrosis compared with control subjects (P < .001), although values were similar to those of patients with myocardial infarction (P = .25). In adjusted analyses, GLS was associated with total myocardial fibrosis burden (iECV) and ejection fraction (both P < .001). GLS offered poor discrimination between disease states, inability to distinguish between control subjects and patients (area under the curve [AUC], 0.60), presence or absence of fibrosis (AUC, 0.63), or symptomatic severity (left ventricular decompensation AUC, 0.64). At follow-up (median, 1466 days), 21 patients died. GLS did not independently predict clinical outcomes. Conclusion GLS correlates with established markers of myocardial fibrosis. However, widespread utility of single GLS measurements may be limited by overlap between disease states and its inability to predict clinical outcomes beyond current established markers.© RSNA, 2019Supplemental material is available for this article.
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Affiliation(s)
- Nicholas B Spath
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Miquel Gomez
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Russell J Everett
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Scott Semple
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Calvin W L Chin
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Audrey C White
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Alan G Japp
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - David E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
| | - Marc R Dweck
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 47 Little France Crescent, Edinburgh EH16 4SB, Scotland (N.B.S., R.J.E., S.S., A.C.W., A.G.J., D.E.N., M.R.D.); Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain (M.G.); Department of Cardiovascular Science, National Heart Center, Singapore (C.W.L.C.); and Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland (A.G.J., D.E.N., M.R.D.)
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10
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Ilardi F, Marchetta S, Martinez C, Sprynger M, Ancion A, Manganaro R, Sugimoto T, Tsugu T, Postolache A, Piette C, Cicenia M, Esposito G, Galderisi M, Oury C, Dulgheru R, Lancellotti P. Impact of aortic stenosis on layer-specific longitudinal strain: relationship with symptoms and outcome. Eur Heart J Cardiovasc Imaging 2019; 21:408-416. [DOI: 10.1093/ehjci/jez215] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
Aims
The present study sought to assess the impact of aortic stenosis (AS) on myocardial function as assessed by layer-specific longitudinal strain (LS) and its relationship with symptoms and outcome.
Methods and results
We compared 211 patients (56% males, mean age 73 ± 12 years) with severe AS and left ventricular ejection fraction (LVEF) ≥50% (114 symptomatic, 97 asymptomatic) with 50 controls matched for age and sex. LS was assessed from endocardium, mid-myocardium, and epicardium by 2D speckle-tracking echocardiography. Despite similar LVEF, multilayer strain values were significantly lower in symptomatic patients, compared to asymptomatic and controls [global LS: 17.9 ± 3.4 vs. 19.1 ± 3.1 vs. 20.7 ± 2.1%; endocardial LS: 20.1 ± 4.9 vs. 21.7 ± 4.2 vs. 23.4 ± 2.5%; epicardial LS: 15.8 ± 3.1 vs. 16.8 ± 2.8 vs. 18.3 ± 1.8%; P < 0.001 for all]. On multivariable logistic regression analysis, endocardial LS was independently associated to symptoms (P = 0.012), together with indexed left atrial volume (P = 0.006) and LV concentric remodelling (P = 0.044). During a mean follow-up of 22 months, 33 patients died of a cardiovascular event. On multivariable Cox-regression analysis, age (P = 0.029), brain natriuretic peptide values (P = 0.003), LV mass index (P = 0.0065), LV end-systolic volume (P = 0.012), and endocardial LS (P = 0.0057) emerged as independently associated with cardiovascular death. The best endocardial LS values associated with outcome was 20.6% (sensitivity 70%, specificity 52%, area under the curve = 0.626, P = 0.022). Endocardial LS (19.1 ± 3.3 vs. 20.7 ± 3.3, P = 0.02) but not epicardial LS (15.2 ± 2.8 vs. 15.9 ± 2.5, P = 0.104) also predicted the outcome in patients who were initially asymptomatic.
Conclusion
In patients with severe AS, LS impairment involves all myocardial layers and is more prominent in the advanced phases of the disease, when the symptoms occur. In this setting, the endocardial LS is independently associated with symptoms and patient outcome.
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Affiliation(s)
- Federica Ilardi
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
- Department of Advanced Biomedical Sciences, University Federico II of Via S. Pansini, 5, 80131 Naples, Naples, Italy
| | - Stella Marchetta
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Christophe Martinez
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Muriel Sprynger
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Arnaud Ancion
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Roberta Manganaro
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Tadafumi Sugimoto
- Department of Clinical Laboratory, Mie University Hospital, Mie, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Toshimitsu Tsugu
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
- Department of Cardiology, School of Medicine, Keio University, Tokyo, 160-8582, Japan
| | - Adriana Postolache
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Caroline Piette
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Marianna Cicenia
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II of Via S. Pansini, 5, 80131 Naples, Naples, Italy
| | - Maurizo Galderisi
- Department of Advanced Biomedical Sciences, University Federico II of Via S. Pansini, 5, 80131 Naples, Naples, Italy
| | - Cécile Oury
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Raluca Dulgheru
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
- Gruppo Villa Maria Care and Research, Via Camillo Rosalba, 35, 70124 Bari BA, Italy
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11
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Tadic M, Cuspidi C, Pencic B, Ivanovic B, Grassi G, Kocijancic V, Celic V. The impact of arterial hypertension on left ventricular strain in patients with aortic stenosis and preserved ejection fraction. J Hypertens 2019; 37:747-753. [PMID: 30817456 DOI: 10.1097/hjh.0000000000001963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The influence of arterial hypertension on aortic stenosis severity is still controversial. The aim of this study was to evaluate the influence of hypertension on LV strain in patients with moderate and severe aortic stenosis. METHODS This cross-sectional study included 115 patients with moderate and severe aortic stenosis and preserved LV ejection fraction (>50%) and 89 age-matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. Aortic stenosis patients were divided into normotensive and hypertensive groups. RESULTS There was no significant difference in LV ejection fraction between hypertensive and normotensive aortic stenosis patients. LV mass index gradually increased with the grade of aortic stenosis. LV global longitudinal strain, as well as endocardial and epicardial longitudinal strains, was significantly lower in hypertensive patients with severe aortic stenosis than in their normotensive counterparts. There was no significant difference in LV global circumferential strain between normotensive and hypertensive patients with severe aortic stenosis. Among patients with moderate aortic stenosis, there was no difference in global longitudinal strain between normotensives and hypertensive patients, whereas circumferential was significantly lower in hypertensive patients. LV radial strain was reduced in patients with severe aortic stenosis than in control subjects. SBP and mean aortic valve gradient were associated with LV global longitudinal and circumferential strains in aortic stenosis patients independently of LV mass index, LVEF, age and BMI. CONCLUSION Hypertension had additional significant negative influence on LV mechanics in patients with significant aortic stenosis. Blood pressure was associated with LV global longitudinal and circumferential strains in aortic stenosis patients independently of main clinical and demographic characteristics.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center 'Dr Dragisa Misovic - Dedinje,' Heroja Milana Tepica, Belgrade, Serbia
| | - Cesare Cuspidi
- University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza, Meda, Italy
| | - Biljana Pencic
- Department of Cardiology, University Clinical Hospital Center 'Dr Dragisa Misovic - Dedinje,' Heroja Milana Tepica, Belgrade, Serbia
| | - Branislava Ivanovic
- Clinical Centre of Serbia, Cardiology Clinic, Koste Todorovica, Belgrade, Serbia
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
| | - Vesna Kocijancic
- Department of Cardiology, University Clinical Hospital Center 'Dr Dragisa Misovic - Dedinje,' Heroja Milana Tepica, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center 'Dr Dragisa Misovic - Dedinje,' Heroja Milana Tepica, Belgrade, Serbia
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12
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Shiino K, Yamada A, Scalia GM, Putrino A, Chamberlain R, Poon K, Walters DL, Chan J. Early Changes of Myocardial Function After Transcatheter Aortic Valve Implantation Using Multilayer Strain Speckle Tracking Echocardiography. Am J Cardiol 2019; 123:956-960. [PMID: 30594290 DOI: 10.1016/j.amjcard.2018.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective therapeutic option for severe symptomatic aortic valve stenosis (AS) with intermediate or high surgical risk. The purpose of this study was to examine the effects of TAVI on left ventricular (LV) mechanics using multilayer global longitudinal strain (GLS) by 2D speckle-tracking echocardiography. A total of 119 patients (mean age 83 ± 7.0 years, male 54%) with severe symptomatic AS and normal LV ejection fraction (LVEF) underwent echocardiography at baseline and 1 month after TAVI. Global longitudinal strain was measured from the endocardial layer (GLSendo), mid-ventricular layer (GLSmyo), epicardial layer (GLSepi) and full thickness of myocardium (GLSwhole). There was significant improvement in all 3 layers of GLS after TAVI compared with baseline, but there was no significant change in LVEF. The relative % increment in GLS in each layer strain were 11.2 ± 23.4% (GLSendo), 13.4 ± 33.0% (GLSmyo) and 18.0 ± 46.6% (GLSepi) with significant difference between GLSendo and GLSepi (p < 0.05). In conclusion, multilayer GLS is more sensitive than conventional LVEF to detect early improvement in LV systolic function after TAVI in patients with severe AS. There is a disproportional improvement in different layers with least improvement in the endocardium. Multilayer strain analysis may provide new insights into understanding mechanics of AS.
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13
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Huang MS, Lee WH, Tsai HR, Liu YW, Liu PY, Tsai WC. Value of layer-specific strain distribution patterns in hypertrophied myocardium from different etiologies. Int J Cardiol 2019; 281:69-75. [PMID: 30711265 DOI: 10.1016/j.ijcard.2019.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/20/2018] [Accepted: 01/10/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Intrinsic myocardial mechanics might have different patterns because of the different etiologies of myocardial hypertrophy. We used layer-specific strain to compare those with aortic stenosis (AS) and hypertrophic cardiomyopathy (HCM) and examined the differences in strain distribution pattern and for their clinical implications. METHODS Comprehensive echocardiography was done in 3 groups: 129 with moderate-to-severe AS, 172 consecutive patients with HCM, and 58 healthy controls. Left ventricle (LV) layer-specific deformation parameters were obtained using two-dimensional speckle tracking echocardiography. The transmural strain gradient was defined as the strain difference between subendocardial and subepicardial myocardium. Both diseased groups were further divided based on the median value of transmural strain gradient for the hemodynamics correlation. RESULTS Compared with the HCM group, the AS group had more preserved transmural longitudinal strain gradient (4.49 ± 1.3% vs. 3.61 ± 1.2%, p < 0.001), which was not significantly different from that of the healthy controls (4.49 ± 1.3% vs. 4.54 ± 1.0%, p = 0.975). And only in AS group the transmural circumferential strain correlated with myocardium mass index (r = -0.237, p = 0.008), and the hemodynamic profiles (LV ejection fraction and LA pressure) were correlated well with transmural strain gradient, in that the lower subgroup had a significantly lower LV ejection fraction and higher average E/E'. CONCLUSIONS Myocardium hypertrophy from different etiology resulted in different layer-specific strain distribution pattern. The loss of an adequate transmural strain gradient correlated with hemodynamics and might reflect intrinsic myocardial dysfunction.
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Affiliation(s)
- Mu-Shiang Huang
- Division of Cardiology, Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Taiwan; Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Wen-Huang Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Huey-Ru Tsai
- Division of Cardiology, Department of Internal Medicine, Madou Sin-Lau Hospital, Tainan, Taiwan
| | - Yen-Wen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Ping-Yen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Wei-Chuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan.
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14
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Funabashi N, Takaoka H, Ozawa K, Kamata T, Uehara M, Komuro I, Kobayashi Y. Quantitative Differentiation of LV Myocardium with and without Layer-Specific Fibrosis Using MRI in Hypertrophic Cardiomyopathy and Layer-Specific Strain TTE Analysis. Int Heart J 2018; 59:523-530. [PMID: 29743413 DOI: 10.1536/ihj.17-208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To achieve further risk stratification in hypertrophic cardiomyopathy (HCM) patients, we localized and quantified layer-specific LVM fibrosis on MRI in HCM patients using regional layer-specific peak longitudinal strain (PLS) and peak circumferential strain (PCS) in LV myocardium (LVM) on speckle tracking transthoracic echocardiography (TTE). A total of 18 HCM patients (14 males; 58 ± 17 years) underwent 1.5T-MRI and TTE. PLS and PCS in each layer of the LVM (endocardium, epicardium, and whole-layer myocardium) were calculated for 17 AHA-defined lesions. MRI assessment showed that fibrosis was classified as endocardial, epicardial, or whole-layer (= either or both of these). Regional PLS was smaller in fibrotic endocardial lesions than in non-fibrotic endocardial lesions (P = 0.004). To detect LV endocardial lesions with fibrosis, ROC curves of regional PLS revealed an area under the curve (AUC) of 0.609 and a best cut-off point of 13.5%, with sensitivity of 65.3% and specificity of 54.3%. Regional PLS was also smaller in fibrotic epicardial lesions than in non-fibrotic epicardial lesions (P < 0.001). To detect LV epicardial lesions with fibrosis, ROC curves of PLS revealed an AUC of 0.684 and a best cut-off point of 9.5%, with sensitivity of 73.5% and specificity of 55.5%. Using whole-layer myocardium analysis, PLS was smaller in fibrotic lesions than in non-fibrotic lesions (P < 0.001). To detect whole-layer LV lesions with fibrosis, ROC curves of regional PLS revealed an AUC of 0.674 and a best cut-off point of 12.5%, with sensitivity of 79.0% and specificity of 50.7%. There were no significant differences in PCS of LV myocardium (endocardium, epicardium, and whole-layer) between fibrotic and non-fibrotic lesions. Quantitative regional PLS but not PCS in LV endocardium, epicardium, and whole-layer myocardium provides useful non-invasive information for layer-specific localization of fibrosis in HCM patients.
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Affiliation(s)
- Nobusada Funabashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Koya Ozawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Tomoko Kamata
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
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15
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Funabashi N, Takaoka H, Ozawa K, Uehara M, Komuro I, Kobayashi Y. 2D speckle-tracking TTE-based quantitative classification of left ventricular myocardium in patients with hypertrophic cardiomyopathy by the presence or the absence of fibrosis and/or hypertrophy. Heart Vessels 2018; 33:1046-1051. [PMID: 29569032 DOI: 10.1007/s00380-018-1155-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/16/2018] [Indexed: 01/02/2023]
Abstract
We used peak longitudinal strain (PLS) on TTE in HCM patients to differentiate LV myocardium (LVM) into the following 4 groups: group 1-no fibrosis or hypertrophy (≥ 13 mm), group 2-no fibrosis but hypertrophy evident, group 3-fibrosis present but without hypertrophy, and group 4-both fibrosis and hypertrophy. Seventeen HCM patients (13 males, 56 ± 16 years) underwent both 1.5 T CMR and TTE. On TTE, PLS (absolute values) for each LVM segment from 17 AHA-defined lesions was calculated. Of 289 LVM lesions, the numbers in each group, 1-4, were 156, 53, 39, and 41, respectively. PLS for LVM segments in group 1 (13.6 ± 6.4%) were significantly greater than those in group 2 (8.5 ± 4.9%, P < 0.001), group 3 (10.4 ± 5.0%, P = 0.006), and group 4 (7.1 ± 4.4%, P < 0.001). PLS for LVM segments in group 3 was significantly greater than those in group 4 (P = 0.016). However, significant differences in PLS in LVM between groups 2 and 3, and between 2 and 4 were not observed. Using regional PLS, we demonstrate successful differentiation of LVM in HCM patients for group 1 (LVM with zero fibrosis or hypertrophy) from LVM belonging to groups 2-4 and we also demonstrate successful differentiation of LVM with fibrosis present but without hypertrophy from LVM with both fibrosis and hypertrophy. However, it is not possible to differentiate between LVM with no fibrosis but hypertrophy evident and those with fibrosis present but without hypertrophy and also between LVM with no fibrosis but hypertrophy evident and those with both fibrosis and hypertrophy. Our findings have significant implications for the management of HCM patients.
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Affiliation(s)
- Nobusada Funabashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Koya Ozawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Differential Myocardial Fibre Involvement by Strain Analysis in Patients With Aortic Stenosis. Heart Lung Circ 2017; 27:1357-1367. [PMID: 28966113 DOI: 10.1016/j.hlc.2017.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/28/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular heart disease and can result in left ventricular (LV) systolic impairment. LV myocardial fibres are organised in layers: the subendocardial layer is orientated longitudinally and the subepicardial layer circumferentially. We hypothesised that there is differential involvement of myocardial fibres in patients with aortic stenosis. METHODS We performed multi-directional, multi-layered systolic strain analysis in 70 patients (aged 72±10.7years) with varying grades of AS severity (mean gradient 32.3±20mmHg, aortic valve area 1.1±0.6cm2) and in 30 controls. Clinical, demographic and resting echocardiographic data were recorded. Left ventricular subendocardial and subepicardial systolic strains were measured in the longitudinal, radial and circumferential axes. RESULTS Systolic subendocardial strain was significantly higher than subepicardial strain in all three axes in patients and in controls. There were significant differences in longitudinal, but not in circumferential and radial strain, or left ventricular ejection fraction (LVEF), between patient groups. Aortic valve mean gradient (MG) and valve area (AVA) correlated better with subendocardial longitudinal strain (r=0.548, p<0.001; r=-0.54, p<0.001 respectively) than with subepicardial longitudinal strain (r=0.496, p<0.001, r=-0.544, p<0.001 respectively). Correlations between circumferential and radial strain and MG or AVA were poor. CONCLUSIONS There was differential impairment in LV systolic strain in all three cardiac axes in patients with AS. Left ventricular longitudinal strain impairment was proportional to AS severity. Subendocardial longitudinal strain correlated better with AS severity than subepicardial longitudinal strain while correlations between circumferential and radial strain and AS severity were weak.
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17
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Inter- and intraobserver consistency in LV myocardial strain measurement using a novel multi-layer technique in patients with severe aortic stenosis and preserved LV ejection fraction. Int J Cardiol 2017; 228:687-693. [DOI: 10.1016/j.ijcard.2016.11.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/06/2016] [Indexed: 11/18/2022]
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