Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.174
T Kaneko, Y Kuroda, H Yoshikawa, S Uchiyama, Y Nagata, Y Matsushita, M Hiki, T Minamino, K Takahashi, H Daida, N Kagiyama
Abstract Funding Acknowledgements Type of funding sources: None. Background Although lung ultrasound has been reported to be a portable, cost-effective, and accurate method to detect pneumonia, it has not been widely used because of the difficulty in its interpretation. Purpose We aimed to investigate the effectiveness of a novel artificial intelligence-based automated pneumonia detection method using point-of-care lung ultrasound (AI-POCUS) for the coronavirus disease 2019 (COVID-19). Methods We enrolled consecutive patients admitted with COVID-19 who underwent computed tomography (CT) in August and September 2021. A 12-zone AI-POCUS was performed by a novice observer using a pocket-size device within 24 h of the CT scan. Fifteen control subjects were also scanned. Additionally, the accuracy of the simplified 8-zone scan excluding the dorsal chest, was assessed. More than three B-lines detected in one lung zone were considered zone-level positive, and the presence of positive AI-POCUS in any lung zone was considered patient-level positive. The sample size calculation was not performed given the retrospective all-comer nature of the study. Results A total of 577 lung zones from 56 subjects (59.4 ± 14.8 years, 23% female) were evaluated using AI-POCUS. The mean number of days from disease onset was 9, and 14% of patients were under mechanical ventilation. The CT-validated pneumonia was seen in 71.4% of patients at total 577 lung zones (53.3%). The 12-zone AI-POCUS for detecting CT-validated pneumonia in the patient-level showed the accuracy of 94.5% (85.1% – 98.1%), sensitivity of 92.3% (79.7% – 97.3%), specificity of 100% (80.6% – 100%), positive predictive value of 95.0% (89.6% − 97.7%), and Kappa of 0.33 (0.27 – 0.40). When simplified with 8-zone scan, the accuracy, sensitivity, and sensitivity were 83.9% (72.2% – 91.3%), 77.5% (62.5% – 87.7%), and 100% (80.6% – 100%), respectively. The zone-level accuracy, sensitivity, and specificity of AI-POCUS were 65.3% (61.4% – 69.1%), 37.2% (32.0% – 42.7%), and 97.8 % (95.2% – 99.0%), respectively. Conclusion AI-POCUS using the novel pocket-size ultrasound system showed excellent agreement with CT-validated COVID-19 pneumonia, even when used by a novice observer.
{"title":"Artificial intelligence-based point-of-care lung ultrasound for screening Covid-19 pneumoniae: comparison with CT scans","authors":"T Kaneko, Y Kuroda, H Yoshikawa, S Uchiyama, Y Nagata, Y Matsushita, M Hiki, T Minamino, K Takahashi, H Daida, N Kagiyama","doi":"10.1093/ehjci/jead119.174","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.174","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Although lung ultrasound has been reported to be a portable, cost-effective, and accurate method to detect pneumonia, it has not been widely used because of the difficulty in its interpretation. Purpose We aimed to investigate the effectiveness of a novel artificial intelligence-based automated pneumonia detection method using point-of-care lung ultrasound (AI-POCUS) for the coronavirus disease 2019 (COVID-19). Methods We enrolled consecutive patients admitted with COVID-19 who underwent computed tomography (CT) in August and September 2021. A 12-zone AI-POCUS was performed by a novice observer using a pocket-size device within 24 h of the CT scan. Fifteen control subjects were also scanned. Additionally, the accuracy of the simplified 8-zone scan excluding the dorsal chest, was assessed. More than three B-lines detected in one lung zone were considered zone-level positive, and the presence of positive AI-POCUS in any lung zone was considered patient-level positive. The sample size calculation was not performed given the retrospective all-comer nature of the study. Results A total of 577 lung zones from 56 subjects (59.4 ± 14.8 years, 23% female) were evaluated using AI-POCUS. The mean number of days from disease onset was 9, and 14% of patients were under mechanical ventilation. The CT-validated pneumonia was seen in 71.4% of patients at total 577 lung zones (53.3%). The 12-zone AI-POCUS for detecting CT-validated pneumonia in the patient-level showed the accuracy of 94.5% (85.1% – 98.1%), sensitivity of 92.3% (79.7% – 97.3%), specificity of 100% (80.6% – 100%), positive predictive value of 95.0% (89.6% − 97.7%), and Kappa of 0.33 (0.27 – 0.40). When simplified with 8-zone scan, the accuracy, sensitivity, and sensitivity were 83.9% (72.2% – 91.3%), 77.5% (62.5% – 87.7%), and 100% (80.6% – 100%), respectively. The zone-level accuracy, sensitivity, and specificity of AI-POCUS were 65.3% (61.4% – 69.1%), 37.2% (32.0% – 42.7%), and 97.8 % (95.2% – 99.0%), respectively. Conclusion AI-POCUS using the novel pocket-size ultrasound system showed excellent agreement with CT-validated COVID-19 pneumonia, even when used by a novice observer.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.068
C Dellino, E Cozza, F Amato, M Savo, G De Conti, D Galzerano, G Tarantini, C Tessari, R Motta, G Gerosa, S Iliceto, V Pergola
Abstract Funding Acknowledgements Type of funding sources: None. Background Heart transplanted patients are usually monitored with invasive diagnostic techniques for detecting cardiac allograft vasculopathy (CAV). However coronary CT angiography (CCTA) is a new promising tool in the initial stages of CAV bringing clinical and economical benefits. Purpose 1) assess the non-inferiority of CCTA in comparison to coronary angiography (CA), in terms of radiation and contrast dose, costs, hospitalization hours, complications and diagnostic accuracy; 2) analyse the different role of immunological and non-immunological risk factors predicting CAV in patients undergoing CCTA; 3) Investigate the rule of coronary inflammation through the pericoronary-fat-attenuation-index (pFAI) at CCTA in the progression of CAV. Methods 179 heart transplanted patients were retrospectively analysed: 78 performed a CCTA and 101 performed a CA between March 2021 and May 2022. Results CCTA and CA showed similar radiation doses (8.47 [1.46–30] versus 8.15 [1.38–87.34]; p = 0.796) and rate of complications (0 (0%) vs 3 (3%); p = 0,258). CCTA in comparison with CA required less hours of hospitalization (0.5 hours versus 23.7 12.31 hours; p<0.001), lower costs (120 euros versus 2800 euros; p<0.001) and less contrast agent (60.4 8.7 ml versus 95.68 47.6ml; p<0.001). Diagnostic accuracy was similar between CCTA and CA (95% vs 100%; p = 0,169). Among the non immunological risk factors for CAV, only smoking showed a statistically significance in predicting CAV (p = 0.015). Among immunological risk factors, TNF was the only independent predictor in the progression of CAV (HR 8.23; IC 95% 1.47–45.81; p = 0.019). There were no statistically correlation between pFAI at CCTA either as a continuous variable or as a categorical variable (>-70.1HU) and the progression of CAV (p = NS). Conclusions CCTA is similar to CA in terms of radiation dose and rate of complications and is superior in terms of hospitalization hours, costs and contrast agent injected. Diagnostic accurancy was equivalent between CCTA and CA. TNF was the only independent predictor in the progression of CAV. Pericoronary inflammation assessed by pFAI at CCTA was not associated with the progression of CAV.
{"title":"Coronary CT angiography a new promising tool in Heart transplanted patients: from clinical and economical benefits to coronary inflammation detection","authors":"C Dellino, E Cozza, F Amato, M Savo, G De Conti, D Galzerano, G Tarantini, C Tessari, R Motta, G Gerosa, S Iliceto, V Pergola","doi":"10.1093/ehjci/jead119.068","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.068","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Heart transplanted patients are usually monitored with invasive diagnostic techniques for detecting cardiac allograft vasculopathy (CAV). However coronary CT angiography (CCTA) is a new promising tool in the initial stages of CAV bringing clinical and economical benefits. Purpose 1) assess the non-inferiority of CCTA in comparison to coronary angiography (CA), in terms of radiation and contrast dose, costs, hospitalization hours, complications and diagnostic accuracy; 2) analyse the different role of immunological and non-immunological risk factors predicting CAV in patients undergoing CCTA; 3) Investigate the rule of coronary inflammation through the pericoronary-fat-attenuation-index (pFAI) at CCTA in the progression of CAV. Methods 179 heart transplanted patients were retrospectively analysed: 78 performed a CCTA and 101 performed a CA between March 2021 and May 2022. Results CCTA and CA showed similar radiation doses (8.47 [1.46–30] versus 8.15 [1.38–87.34]; p = 0.796) and rate of complications (0 (0%) vs 3 (3%); p = 0,258). CCTA in comparison with CA required less hours of hospitalization (0.5 hours versus 23.7 12.31 hours; p&lt;0.001), lower costs (120 euros versus 2800 euros; p&lt;0.001) and less contrast agent (60.4 8.7 ml versus 95.68 47.6ml; p&lt;0.001). Diagnostic accuracy was similar between CCTA and CA (95% vs 100%; p = 0,169). Among the non immunological risk factors for CAV, only smoking showed a statistically significance in predicting CAV (p = 0.015). Among immunological risk factors, TNF was the only independent predictor in the progression of CAV (HR 8.23; IC 95% 1.47–45.81; p = 0.019). There were no statistically correlation between pFAI at CCTA either as a continuous variable or as a categorical variable (&gt;-70.1HU) and the progression of CAV (p = NS). Conclusions CCTA is similar to CA in terms of radiation dose and rate of complications and is superior in terms of hospitalization hours, costs and contrast agent injected. Diagnostic accurancy was equivalent between CCTA and CA. TNF was the only independent predictor in the progression of CAV. Pericoronary inflammation assessed by pFAI at CCTA was not associated with the progression of CAV.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.061
A Al Wazzan, M Taconne, V Le Rolle, M Inngjerdingen Forsaa, K Hermann Haugaa, E Galli, A Hernandez, T Edvardsen, E Donal
Abstract Funding Acknowledgements Type of funding sources: None. Background The excess mortality in hypertrophic cardiomyopathy (HCM) patients is mainly attributed to the occurrence of sudden cardiac death (SCD). The prediction of ventricular arrhythmias remains challenging and could be improved. Purpose This study evaluated the added predictive value of a machine learning-based model combining clinical and conventional imaging parameters with information from left ventricular strain analysis to predict SCD in patients with HCM. Methods A total of 434 HCM patients (65% men, mean age 56 years) were retrospectively included from two referral centers from two different countries and followed longitudinally (mean duration 6 years). Strain parameters were automatically extracted from the left ventricle longitudinal strain segmental curves of each patient and included in a Ridge Regression model alongside conventional clinical and imaging data. The composite endpoint included sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy, aborted cardiac arrest, or sudden cardiac death. Results 34 patients (7.8%) met the endpoint with an incidence of ventricular arrhythmias of 0.9%/years. Among the 18 most discriminating parameters, 7 were derived from left ventricle longitudinal strain segmental curves analysis (figure 1). After n=200 rounds of cross-validation, the final model showed superior predictive performance compared to conventional models with a mean area under the curve (AUC) of 0.83 ± 0.8 compared with an AUC of 0.56 and 0.61 for the 2014 ESC risk score and the 2020 AHA/ACC model, respectively. Conclusion A machine learning model including automatically extracted left ventricular strain-derived parameters was superior in the prediction of sustained ventricular arrhythmias and SCD in patients with HCM compared to existing models. A machine learning model including left ventricle longitudinal strain analysis could improve SCD risk stratification in HCM patients.
{"title":"Machine learning model including left ventricular strain analysis for sudden cardiac death prediction in hypertrophic cardiomyopathy","authors":"A Al Wazzan, M Taconne, V Le Rolle, M Inngjerdingen Forsaa, K Hermann Haugaa, E Galli, A Hernandez, T Edvardsen, E Donal","doi":"10.1093/ehjci/jead119.061","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.061","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background The excess mortality in hypertrophic cardiomyopathy (HCM) patients is mainly attributed to the occurrence of sudden cardiac death (SCD). The prediction of ventricular arrhythmias remains challenging and could be improved. Purpose This study evaluated the added predictive value of a machine learning-based model combining clinical and conventional imaging parameters with information from left ventricular strain analysis to predict SCD in patients with HCM. Methods A total of 434 HCM patients (65% men, mean age 56 years) were retrospectively included from two referral centers from two different countries and followed longitudinally (mean duration 6 years). Strain parameters were automatically extracted from the left ventricle longitudinal strain segmental curves of each patient and included in a Ridge Regression model alongside conventional clinical and imaging data. The composite endpoint included sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy, aborted cardiac arrest, or sudden cardiac death. Results 34 patients (7.8%) met the endpoint with an incidence of ventricular arrhythmias of 0.9%/years. Among the 18 most discriminating parameters, 7 were derived from left ventricle longitudinal strain segmental curves analysis (figure 1). After n=200 rounds of cross-validation, the final model showed superior predictive performance compared to conventional models with a mean area under the curve (AUC) of 0.83 ± 0.8 compared with an AUC of 0.56 and 0.61 for the 2014 ESC risk score and the 2020 AHA/ACC model, respectively. Conclusion A machine learning model including automatically extracted left ventricular strain-derived parameters was superior in the prediction of sustained ventricular arrhythmias and SCD in patients with HCM compared to existing models. A machine learning model including left ventricle longitudinal strain analysis could improve SCD risk stratification in HCM patients.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.386
E Szabo, T Benedek, I Kovacs, N Rat, L Bordi, Z S Parajko, A Rosca, T Mihaila, B Ion, I Benedek
Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number NR. 164 / 26 / 10.01.2023. Background Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). The role of different factors related to the site and severity of coronary occlusion in the pathogenesis of AMI-related cardiac arrest is still under investigation. The aim of the study was to investigate the association between (1) different cardiac magnetic resonance (CMR) features associated with the location and severity of the myocardial injury, and (2) the risk of CA accompanying an AMI. Methods In total, 54 patients AMI undergoing post-AMI CMR imaging with delayed gadolinium enhancement were enrolled in the study. The study lot was divided into 2 groups: group 1–8 patients who survived a CA in the acute phase of AMI and group 2–46 patients, matched for age and gender, with AMI but without CA. In all patients, infarct mass, the proportion of high transmural extent, and scar mass at different myocardial segments were calculated using the QMap software (Medis BV). Results Compared to patients without CA, those with CA had a significantly higher infarct mass (47.9 +/- 38 g versus 23.3 g, p = 0.03), infarct mass % (26.9 +/ 17.3% vs 15.1 +/- 8.6 %, p = 0.02), and a higher degree of transmurality (29.28 +/- 20.2 % vs 14.1 +/- 9.2 %, p = 0.01). Location of myocardial injury at the level of latero-apical, anterolateral, and bazal anterior segments seemed to be more frequently associated with the risk of CA in the acute phase of AMI: infarct mass 33.9 +/- 30.6 g in group 1 vs 13.6 +/- 17.3 g in group 2, p = 0.02 for the latero-apical segment, 26.5 +/- 29.0 g in group 1 vs 8.9 +/- 12.8 g in group 2, p = 0.02 for the anterolateral segment, and 20.1 +/- 21.5 g in group 1 vs 7.8 +/- 14.7 g in group 2, p = 0.02 for anterobazal segment. Conclusions Myocardial mas, high transmural extent at CMR imaging, and a large myocardial injury identified by CMR at the level of the anterior and lateral ventricular segments seems to be associated with an increased risk of CA in the acute phase of AMI.
{"title":"Cardiac magnetic resonance features associated with the risk of cardiac arrest in patients with acute myocardial infarction","authors":"E Szabo, T Benedek, I Kovacs, N Rat, L Bordi, Z S Parajko, A Rosca, T Mihaila, B Ion, I Benedek","doi":"10.1093/ehjci/jead119.386","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.386","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number NR. 164 / 26 / 10.01.2023. Background Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). The role of different factors related to the site and severity of coronary occlusion in the pathogenesis of AMI-related cardiac arrest is still under investigation. The aim of the study was to investigate the association between (1) different cardiac magnetic resonance (CMR) features associated with the location and severity of the myocardial injury, and (2) the risk of CA accompanying an AMI. Methods In total, 54 patients AMI undergoing post-AMI CMR imaging with delayed gadolinium enhancement were enrolled in the study. The study lot was divided into 2 groups: group 1–8 patients who survived a CA in the acute phase of AMI and group 2–46 patients, matched for age and gender, with AMI but without CA. In all patients, infarct mass, the proportion of high transmural extent, and scar mass at different myocardial segments were calculated using the QMap software (Medis BV). Results Compared to patients without CA, those with CA had a significantly higher infarct mass (47.9 +/- 38 g versus 23.3 g, p = 0.03), infarct mass % (26.9 +/ 17.3% vs 15.1 +/- 8.6 %, p = 0.02), and a higher degree of transmurality (29.28 +/- 20.2 % vs 14.1 +/- 9.2 %, p = 0.01). Location of myocardial injury at the level of latero-apical, anterolateral, and bazal anterior segments seemed to be more frequently associated with the risk of CA in the acute phase of AMI: infarct mass 33.9 +/- 30.6 g in group 1 vs 13.6 +/- 17.3 g in group 2, p = 0.02 for the latero-apical segment, 26.5 +/- 29.0 g in group 1 vs 8.9 +/- 12.8 g in group 2, p = 0.02 for the anterolateral segment, and 20.1 +/- 21.5 g in group 1 vs 7.8 +/- 14.7 g in group 2, p = 0.02 for anterobazal segment. Conclusions Myocardial mas, high transmural extent at CMR imaging, and a large myocardial injury identified by CMR at the level of the anterior and lateral ventricular segments seems to be associated with an increased risk of CA in the acute phase of AMI.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.088
M Tomaselli, V Cannone, L P Badano, D N Radu, E Curti, F P Perelli, F Heilbron, M Gavazzoni, V Rella, G Oliverio, S Caravita, C Baratto, G Parati, F M Brasca, D Muraru
Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, associated with elevated risks of cardiovascular events and death. The assessment of left atrial (LA) mechanics has been reported to refine AF risk prediction, however it does not completely predict AF relapse. The potential added role of right atrial (RA) function in this setting is unknown. Purpose This study sought to evaluate the added value of RA longitudinal reservoir strain (RARS), on top of LA longitudinal reservoir strain (LARS) analysis, for the prediction of AF recurrence after electrical cardioversion (ECV). Methods We retrospectively studied 132 consecutive adult patients (men 55%, 72±10 years) with persistent AF undergoing ECV in hospital setting. Exclusion criteria were: pregnancy, previous cardiac surgery, pacemaker or implantable cardioverter defibrillator, severe valvular regurgitation/stenosis, ventricular systolic dysfunction, poor apical acoustic window, unsuccessful ECV, early recurrent AF and lack of follow-up. LA and RA size and function were analyzed by conventional 2D and speckle-tracking echocardiography before ECV. The endpoint was AF recurrence. Results After a total follow-up of 12 months, 63 patients (48%) showed AF recurrence. Both LA and RA reservoir strain were significantly lower in patients experiencing AF recurrence than in patients with persistent sinus rhythm (LARS 10±6 vs 13±7%, RARS 14±10 vs 20±9 %, respectively, p<0.001 for both). By receiving operating curve (ROC) analysis, the best cut-offs associated to AF recurrence after ECV were 15% for RARS [AUC 0.77 (95%CI 0.69–0.84), p<0.0001] and 10% for LARS [AUC 0.69 (95%IC 0.60–0.77), p<0.0001]. Kaplan-Meier curves showed that patients with both LARS≤10% and RARS ≤15% had a significant risk for AF recurrences (log-rank, p<0.001) (Figure 1). However, at multivariable Cox regression, RARS [HR 3.26, 95%CI (1.73–6.13), p< 0.001] was the only parameter independently associated with the AF recurrence. RARS provided incremental prognostic value over LARS, LA and RA volumes concerning the prediction of AF relapse after ECV (Figure 2). Conclusions RARS was independently associated with AF recurrence after ECV and provided an incremental prognostic value over LARS. This study highlights the importance of assessing the functional remodeling of both RA and LA in patients with persistent AF. Figure 1. Atrial fibrillation recurrence freedom according to left and right atrial reservoir longitudinal strain. Kaplan-Meier plots of patients grouped according to the threshold levels of left (left panel) and right (right panel) values of reservoir longitudinal strain identified by the Receiver Operating Curve analyses.
{"title":"Incremental value of right atrial strain analysis to predict atrial fibrillation recurrence after electrical cardioversion","authors":"M Tomaselli, V Cannone, L P Badano, D N Radu, E Curti, F P Perelli, F Heilbron, M Gavazzoni, V Rella, G Oliverio, S Caravita, C Baratto, G Parati, F M Brasca, D Muraru","doi":"10.1093/ehjci/jead119.088","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.088","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, associated with elevated risks of cardiovascular events and death. The assessment of left atrial (LA) mechanics has been reported to refine AF risk prediction, however it does not completely predict AF relapse. The potential added role of right atrial (RA) function in this setting is unknown. Purpose This study sought to evaluate the added value of RA longitudinal reservoir strain (RARS), on top of LA longitudinal reservoir strain (LARS) analysis, for the prediction of AF recurrence after electrical cardioversion (ECV). Methods We retrospectively studied 132 consecutive adult patients (men 55%, 72±10 years) with persistent AF undergoing ECV in hospital setting. Exclusion criteria were: pregnancy, previous cardiac surgery, pacemaker or implantable cardioverter defibrillator, severe valvular regurgitation/stenosis, ventricular systolic dysfunction, poor apical acoustic window, unsuccessful ECV, early recurrent AF and lack of follow-up. LA and RA size and function were analyzed by conventional 2D and speckle-tracking echocardiography before ECV. The endpoint was AF recurrence. Results After a total follow-up of 12 months, 63 patients (48%) showed AF recurrence. Both LA and RA reservoir strain were significantly lower in patients experiencing AF recurrence than in patients with persistent sinus rhythm (LARS 10±6 vs 13±7%, RARS 14±10 vs 20±9 %, respectively, p&lt;0.001 for both). By receiving operating curve (ROC) analysis, the best cut-offs associated to AF recurrence after ECV were 15% for RARS [AUC 0.77 (95%CI 0.69–0.84), p&lt;0.0001] and 10% for LARS [AUC 0.69 (95%IC 0.60–0.77), p&lt;0.0001]. Kaplan-Meier curves showed that patients with both LARS≤10% and RARS ≤15% had a significant risk for AF recurrences (log-rank, p&lt;0.001) (Figure 1). However, at multivariable Cox regression, RARS [HR 3.26, 95%CI (1.73–6.13), p&lt; 0.001] was the only parameter independently associated with the AF recurrence. RARS provided incremental prognostic value over LARS, LA and RA volumes concerning the prediction of AF relapse after ECV (Figure 2). Conclusions RARS was independently associated with AF recurrence after ECV and provided an incremental prognostic value over LARS. This study highlights the importance of assessing the functional remodeling of both RA and LA in patients with persistent AF. Figure 1. Atrial fibrillation recurrence freedom according to left and right atrial reservoir longitudinal strain. Kaplan-Meier plots of patients grouped according to the threshold levels of left (left panel) and right (right panel) values of reservoir longitudinal strain identified by the Receiver Operating Curve analyses.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.022
A Schulz, T Lange, R Evertz, J T Kowallick, G Hasenfuss, S J Backhaus, A Schuster
Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): DZHK Background Heart failure with preserved ejection fraction (HFpEF) has been observed to have a twice as high prevalence in women compared to men.(1,2) While predisposing risk factors are quite similar between the sexes(2,3), this study aimed to identify sex-specific pathophysiological features in HFpEF using state-of-the-art diagnostic approaches. Methods 75 Patients with exertional dyspnea, preserved ejection fraction (EF ≥ 50%) and signs of diastolic dysfunction on echocardiography were prospectively recruited in the HFpEF-Stress Trial. Patients underwent right heart catheterization (RHC), echocardiographic and cardiovascular magnetic resonance (CMR) imaging at rest and during exercise stress. HFpEF was defined according to pulmonary capillary wedge pressure in RHC (rest ≥ 15mmHg, stress ≥ 25mmHg), below these thresholds patients were classified as non-cardiac dyspnea (NCD). Results Main results are displayed in Figure 1. Compared to men, women with HFpEF revealed lower right ventricular (RV)-stroke volumes during exercise stress (f 38.1 vs. m 50.4 ml/m2 BSA; p = 0.011) but not with NCD. This was accompanied by a decreasing left atrial (LA) EF in women but not men comparing resting to exercise conditions (f −2.7 vs. m 2.5%, p = 0.020) and an impaired left ventricular (LV) filling (f 35.5 vs. m 44.2 ml/m2 BSA, p = 0.017) in women with HFpEF during exercise stress. These sex-specific differences were not present in NCD. The exercise-induced decrease in LA EF emerged as a predictor for HFpEF in women (OR 13.67 95% CIs: 3.03 – 62.14, p<0.001) with high diagnostic accuracy (AUC 0.83 95% CIs: 0.7–0.95). Conclusion Women with HFpEF demonstrate sex-specific functional alterations of RV, LA, and LV function during exercise-stress. The biventricular impairment suggests a complex interplay of both sides of the heart during the progression of HFpEF in women. This unique pathophysiology represents a sex-specific diagnostic target, which may allow early identification of women with HFpEF for future individualized therapeutic approaches.
资金来源类型:基金会。研究背景:研究发现，保留射血分数的心力衰竭(HFpEF)在女性中的患病率是男性的两倍(1,2)。虽然男女之间的易感危险因素非常相似(2,3)，但本研究旨在利用最先进的诊断方法确定HFpEF的性别特异性病理生理特征。方法前瞻性地招募75例运动呼吸困难、保留射血分数(EF≥50%)和超声心动图舒张功能不全的患者参加hfpef -应激试验。患者在休息和运动应激时接受右心导管(RHC)、超声心动图和心血管磁共振(CMR)成像。HFpEF是根据RHC的肺毛细血管楔压(休息≥15mmHg，应激≥25mmHg)来定义的，低于这些阈值的患者被归类为非心源性呼吸困难(NCD)。主要结果如图1所示。与男性相比，患有HFpEF的女性在运动应激时显示右室(RV)卒中容量较低(f 38.1 vs m 50.4 ml/m2 BSA;p = 0.011)，但与NCD无关。与静息条件和运动条件相比，女性左房(LA) EF下降，而男性没有(f - 2.7 vs. m - 2.5%， p = 0.020)，运动应激下HFpEF女性左室(LV)充盈受损(f 35.5 vs. m - 44.2 ml/m2 BSA, p = 0.017)。这些性别特异性差异在非传染性疾病中不存在。运动引起的LA EF下降是女性HFpEF的预测因子(OR 13.67 95% ci: 3.03 - 62.14, p<0.001)，诊断准确性高(AUC 0.83 95% ci: 0.7-0.95)。结论HFpEF女性在运动应激时右室、左室和左室功能发生了性别特异性的改变。双心室损伤提示在女性HFpEF的进展过程中，心脏两侧的复杂相互作用。这种独特的病理生理学代表了一种性别特异性的诊断靶点，这可能允许早期识别患有HFpEF的女性，以便将来采用个性化的治疗方法。
{"title":"Sex-specific impairment of cardiac functional reserve in HFpEF: insights from the HFpEF-Stress trial","authors":"A Schulz, T Lange, R Evertz, J T Kowallick, G Hasenfuss, S J Backhaus, A Schuster","doi":"10.1093/ehjci/jead119.022","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.022","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): DZHK Background Heart failure with preserved ejection fraction (HFpEF) has been observed to have a twice as high prevalence in women compared to men.(1,2) While predisposing risk factors are quite similar between the sexes(2,3), this study aimed to identify sex-specific pathophysiological features in HFpEF using state-of-the-art diagnostic approaches. Methods 75 Patients with exertional dyspnea, preserved ejection fraction (EF ≥ 50%) and signs of diastolic dysfunction on echocardiography were prospectively recruited in the HFpEF-Stress Trial. Patients underwent right heart catheterization (RHC), echocardiographic and cardiovascular magnetic resonance (CMR) imaging at rest and during exercise stress. HFpEF was defined according to pulmonary capillary wedge pressure in RHC (rest ≥ 15mmHg, stress ≥ 25mmHg), below these thresholds patients were classified as non-cardiac dyspnea (NCD). Results Main results are displayed in Figure 1. Compared to men, women with HFpEF revealed lower right ventricular (RV)-stroke volumes during exercise stress (f 38.1 vs. m 50.4 ml/m2 BSA; p = 0.011) but not with NCD. This was accompanied by a decreasing left atrial (LA) EF in women but not men comparing resting to exercise conditions (f −2.7 vs. m 2.5%, p = 0.020) and an impaired left ventricular (LV) filling (f 35.5 vs. m 44.2 ml/m2 BSA, p = 0.017) in women with HFpEF during exercise stress. These sex-specific differences were not present in NCD. The exercise-induced decrease in LA EF emerged as a predictor for HFpEF in women (OR 13.67 95% CIs: 3.03 – 62.14, p&lt;0.001) with high diagnostic accuracy (AUC 0.83 95% CIs: 0.7–0.95). Conclusion Women with HFpEF demonstrate sex-specific functional alterations of RV, LA, and LV function during exercise-stress. The biventricular impairment suggests a complex interplay of both sides of the heart during the progression of HFpEF in women. This unique pathophysiology represents a sex-specific diagnostic target, which may allow early identification of women with HFpEF for future individualized therapeutic approaches.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.248
M Arslan, O Ozden, K Ohtaroglu Tokdil, A Barutcu
Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary artery disease is a major public health problem. Early diagnosis and treatment of coronary artery disease is crucial. There is a need for a practical, reliable and cost-effective non-invasive imaging tool. We aimed to evaluate the rest ischemia with speckle tracking echocardiography (STE) compare to the two methods in patients who were scheduled coronary angiography according to the stress tests. Methods We included fifty patients with stable angina pectoris who were scheduled for conventional coronary angiography after the stress tests in our study. Speckle tracking echocardiography was performed just before coronary angiography. The association of 2 parameters with coronary artery disease was investigated and compared. Results Among 50 patients recruited for the study, 38 of them had severe CAD (>50%), whereas 12 patients had non-significant CAD. Post systolic shortening (PSS) was significantly related with CAD (p<0.0001). The relationship of PLS with the area at risk was found to be statistically insignificant but global longitudinal strain (GLS) was significantly lower in patients with severe CAD (p = 0.011). Conclusion PSS may detect coronary ischemia in patients with stable coronary artery disease and it is more sensitive and specific in patients with stable CAD. PSS is a very useful, practical and easy applicable non invasive tool for the detection of severe coronary artery disease at rest.
{"title":"Comparing of Peak Longitudinal strain and Post Systolic Shortening in detecting ischemia at rest in stable coronary artery disease: an angiography verified study","authors":"M Arslan, O Ozden, K Ohtaroglu Tokdil, A Barutcu","doi":"10.1093/ehjci/jead119.248","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.248","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary artery disease is a major public health problem. Early diagnosis and treatment of coronary artery disease is crucial. There is a need for a practical, reliable and cost-effective non-invasive imaging tool. We aimed to evaluate the rest ischemia with speckle tracking echocardiography (STE) compare to the two methods in patients who were scheduled coronary angiography according to the stress tests. Methods We included fifty patients with stable angina pectoris who were scheduled for conventional coronary angiography after the stress tests in our study. Speckle tracking echocardiography was performed just before coronary angiography. The association of 2 parameters with coronary artery disease was investigated and compared. Results Among 50 patients recruited for the study, 38 of them had severe CAD (&gt;50%), whereas 12 patients had non-significant CAD. Post systolic shortening (PSS) was significantly related with CAD (p&lt;0.0001). The relationship of PLS with the area at risk was found to be statistically insignificant but global longitudinal strain (GLS) was significantly lower in patients with severe CAD (p = 0.011). Conclusion PSS may detect coronary ischemia in patients with stable coronary artery disease and it is more sensitive and specific in patients with stable CAD. PSS is a very useful, practical and easy applicable non invasive tool for the detection of severe coronary artery disease at rest.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.170
A Althunayyan, S Alborikan, S Badiani, K Wong, R Uppal, N Patel, P Petersen, G Lloyd, S Bhattacharyya
Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Saudi Arabian Cultural Bureau. Background Chronic degenerative mitral regurgitation leads to volume overload causing left ventricular (LV) enlargement and eventually LV impairment. Current guidelines determining thresholds for intervention are based on LV diameters and ejection fraction. There is sparse data examining the value of LV volumes and newer markers of LV performance on outcomes of surgery in mitral valve prolapse. Purpose Identify the best markers of LV impairment after mitral valve surgery. Methods Prospective, observational study of patients with mitral valve prolapse undergoing mitral valve surgery. Pre-operative LV diameters, volumes, ejection fraction (LVEF), global longitudinal strain (GLS) and myocardial work measured. Post-operative LV impairment defined as LVEF < 50% at 1 year post-surgery. Results Eighty-seven patients included. 13% developed post-operative LV impairment. Patients with post-operative LV dysfunction showed significantly larger indexed LV end-systolic diameters (LVESD), volumes (LVESV), lower LVEF and more abnormal GLS than patients without post-operative LV dysfunction. In multivariate analysis, indexed LVESV (Odds ratio 1.11 (95% CI 1.01 – 1.23), p = 0.039) and GLS (odds ratio 1.46 (95% CI 1 – 2.14), p = 0.054) were the only independent predictors of post-operative LV dysfunction. The optimal cut-off of 36.3 ml/m2 for indexed LVESV had a sensitivity of 82% and specificity of 78% for detection of post-operative LV impairment. Conclusion Post-operative LV impairment is common. Indexed LV volumes (36.3ml/m2) provided the best marker of post-operative LV impairment.
资金来源类型:私人资助和/或赞助。主要资金来源:沙特阿拉伯文化局。背景:慢性退行性二尖瓣反流导致容量超载，导致左室(LV)增大，最终导致左室损伤。目前确定干预阈值的指南是基于左室直径和射血分数。关于二尖瓣脱垂手术结果的左室容积和新的左室表现指标的价值研究数据很少。目的确定二尖瓣手术后左室损伤的最佳标志。方法对二尖瓣脱垂患者行二尖瓣手术进行前瞻性观察研究。测量术前左室直径、体积、射血分数(LVEF)、总纵应变(GLS)和心肌功。术后左室损伤定义为LVEF <50%在术后1年。结果纳入87例患者。13%的患者术后出现左室损伤。与无术后左室功能障碍的患者相比，术后左室收缩末直径(LVESD)、容积(LVESV)、LVEF (LVEF)和GLS异常明显增大。在多因素分析中，指数LVESV(优势比1.11 (95% CI 1.01 - 1.23)， p = 0.039)和GLS(优势比1.46 (95% CI 1 - 2.14)， p = 0.054)是术后左室功能障碍的唯一独立预测因子。指标LVESV的最佳临界值为36.3 ml/m2，检测术后LV损伤的敏感性为82%，特异性为78%。结论术后左室损伤较为常见。指标型左室容积(36.3ml/m2)是判断术后左室损伤的最佳指标。
{"title":"Determinants of post-operative left ventricular dysfunction in degenerative mitral regurgitation","authors":"A Althunayyan, S Alborikan, S Badiani, K Wong, R Uppal, N Patel, P Petersen, G Lloyd, S Bhattacharyya","doi":"10.1093/ehjci/jead119.170","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.170","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Saudi Arabian Cultural Bureau. Background Chronic degenerative mitral regurgitation leads to volume overload causing left ventricular (LV) enlargement and eventually LV impairment. Current guidelines determining thresholds for intervention are based on LV diameters and ejection fraction. There is sparse data examining the value of LV volumes and newer markers of LV performance on outcomes of surgery in mitral valve prolapse. Purpose Identify the best markers of LV impairment after mitral valve surgery. Methods Prospective, observational study of patients with mitral valve prolapse undergoing mitral valve surgery. Pre-operative LV diameters, volumes, ejection fraction (LVEF), global longitudinal strain (GLS) and myocardial work measured. Post-operative LV impairment defined as LVEF &lt; 50% at 1 year post-surgery. Results Eighty-seven patients included. 13% developed post-operative LV impairment. Patients with post-operative LV dysfunction showed significantly larger indexed LV end-systolic diameters (LVESD), volumes (LVESV), lower LVEF and more abnormal GLS than patients without post-operative LV dysfunction. In multivariate analysis, indexed LVESV (Odds ratio 1.11 (95% CI 1.01 – 1.23), p = 0.039) and GLS (odds ratio 1.46 (95% CI 1 – 2.14), p = 0.054) were the only independent predictors of post-operative LV dysfunction. The optimal cut-off of 36.3 ml/m2 for indexed LVESV had a sensitivity of 82% and specificity of 78% for detection of post-operative LV impairment. Conclusion Post-operative LV impairment is common. Indexed LV volumes (36.3ml/m2) provided the best marker of post-operative LV impairment.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.253
N. Ojrzyńska, M. Marczak, Ł. Mazurkiewicz, J. Petryka-Mazurkiewicz, Barbara Miłosz-Wieczorek, J. Grzybowski, M. Śpiewak
Type of funding sources: None. Heart failure (HF) is a clinical syndrome caused by structural or functional cardiac abnormality and is diagnosed on the basis of typical symptoms. It is associated with significant morbidity and mortality and affects more than 25 million people worldwide. HF of unknown aetiology is managed with symptomatic treatment. Patients with reduced (HFrEF) or mid-reduced ejection fraction (HFmrEF) and no clear cause of systolic dysfunction are usually classified as having DCM. In HFpEF group ejection fraction is preserved but diastolic dysfunction is present leading to HF symptoms. The aim of this study was to investigate the clinical significance of cardiac magnetic resonance (CMR) imaging to identify heart failure (HF) aetiology. We retrospectively reviewed all medical charts of patients referred for CMR due to heart failure of unknown aetiology admitted to our hospital between 2008 and 2017. Only patients with no specific pre-CMR initial diagnosis were included. Patients with suspicion of any specific disease leading to HF were excluded. If a referring physician suspected myocarditis, cardiomyopathy, previous myocardial infarction or advanced stable coronary disease (based on clinical signs and symptoms, the patient’s and family history or all pre-CMR studies), these patients were omitted from our analysis. Thus, we included only patients whose diagnostic work-up did not reveal suspicion of any specific cardiac disease leading to HF. The study sample consisted of 243 patients (173 (71.2%) male, mean age 44.0 ± 14.2%). All patients underwent contrast-enhanced CMR. Late gadolinium enhancement (LGE) was detected in 74.9% cases. Cardiomyopathies comprised the main aetiology (174 cases, 71.6%), in particular dilated cardiomyopathy (143 patients, 58.8%). 17 patients (7.0%) were diagnosed with myocarditis and in 24 patients (9.9%) CMR-based diagnosis was ambiguous – pointing out myocarditis or dilated cardiomyopathy. In 23 cases (9.5%) CMR indicated the presence of prior infarction undetected by pre-CMR testing. In five patients (2.1%) valvular disease was revealed as the sole cause of HF. We analysed the change in patients’ management guided by the CMR results defined as change of treatment and/or necessity of further tests leading to therapeutic consequences. Change of pre-CMR diagnosis occurred in 94 patients (38.7%) and was judged crucial in 41 patients (16,9%). As crucial we adjudicated the diagnosis associated with a need immediately further investigation and treatment changing, as follows: newly diagnosed amyloidosis, ischaemic heart disease or complex advanced valvular disease and cardiomyopathies other than dilated, hypertrophic and restrictive. Our study strongly suggests that cardiac magnetic resonance imaging is a valuable tool for determining the aetiology of heart failure and impacts patients" management. Abstract Figure.
{"title":"Identify cause of heart failure of unknown aetiology using cardiac magnetic resonance - a 10-year observational study","authors":"N. Ojrzyńska, M. Marczak, Ł. Mazurkiewicz, J. Petryka-Mazurkiewicz, Barbara Miłosz-Wieczorek, J. Grzybowski, M. Śpiewak","doi":"10.1093/EHJCI/JEAA356.253","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.253","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Heart failure (HF) is a clinical syndrome caused by structural or functional cardiac abnormality and is diagnosed on the basis of typical symptoms. It is associated with significant morbidity and mortality and affects more than 25 million people worldwide.\u0000 HF of unknown aetiology is managed with symptomatic treatment. Patients with reduced (HFrEF) or mid-reduced ejection fraction (HFmrEF) and no clear cause of systolic dysfunction are usually classified as having DCM. In HFpEF group ejection fraction is preserved but diastolic dysfunction is present leading to HF symptoms.\u0000 \u0000 \u0000 \u0000 The aim of this study was to investigate the clinical significance of cardiac magnetic resonance (CMR) imaging to identify heart failure (HF) aetiology.\u0000 \u0000 \u0000 \u0000 We retrospectively reviewed all medical charts of patients referred for CMR due to heart failure of unknown aetiology admitted to our hospital between 2008 and 2017. Only patients with no specific pre-CMR initial diagnosis were included. Patients with suspicion of any specific disease leading to HF were excluded. If a referring physician suspected myocarditis, cardiomyopathy, previous myocardial infarction or advanced stable coronary disease (based on clinical signs and symptoms, the patient’s and family history or all pre-CMR studies), these patients were omitted from our analysis. Thus, we included only patients whose diagnostic work-up did not reveal suspicion of any specific cardiac disease leading to HF.\u0000 \u0000 \u0000 \u0000 The study sample consisted of 243 patients (173 (71.2%) male, mean age 44.0 ± 14.2%). All patients underwent contrast-enhanced CMR. Late gadolinium enhancement (LGE) was detected in 74.9% cases. Cardiomyopathies comprised the main aetiology (174 cases, 71.6%), in particular dilated cardiomyopathy (143 patients, 58.8%). 17 patients (7.0%) were diagnosed with myocarditis and in 24 patients (9.9%) CMR-based diagnosis was ambiguous – pointing out myocarditis or dilated cardiomyopathy. In 23 cases (9.5%) CMR indicated the presence of prior infarction undetected by pre-CMR testing. In five patients (2.1%) valvular disease was revealed as the sole cause of HF.\u0000 We analysed the change in patients’ management guided by the CMR results defined as change of treatment and/or necessity of further tests leading to therapeutic consequences. Change of pre-CMR diagnosis occurred in 94 patients (38.7%) and was judged crucial in 41 patients (16,9%).\u0000 As crucial we adjudicated the diagnosis associated with a need immediately further investigation and treatment changing, as follows: newly diagnosed amyloidosis, ischaemic heart disease or complex advanced valvular disease and cardiomyopathies other than dilated, hypertrophic and restrictive.\u0000 \u0000 \u0000 \u0000 Our study strongly suggests that cardiac magnetic resonance imaging is a valuable tool for determining the aetiology of heart failure and impacts patients\" management.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"2014 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73545336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.268
M. Holzknecht, M. Reindl, C. Tiller, I. Lechner, T. Hornung, D. Plappert, G. Klug, S. Reinstadler, A. Bauer, B. Metzler, A. Mayr
Type of funding sources: None. Although left ventricular ejection fraction (LVEF) is recommended for left ventricular (LV) systolic function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI), its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far. We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in acute STEMI patients. This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2-4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure. During a follow-up of 21 [IQR: 12-50] months, 40 (10%) patients experienced MACE. Patients with MACE showed significantly lower LVEF (49% vs. 53%, p = 0.005) and MAPSE (7.9 mm vs. 9.1 mm, p = 0.001), as well as higher GLS values (-10.2% vs. -12.3 %, p < 0.001). GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63-0.79; p < 0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58-0.75; p = 0.001) and LVEF (AUC: 0.64, 95% CI 0.54-0.73; p = 0.005). After multivariable analysis, GLS emerged as independent predictor of MACE (HR: 1.22, 95% CI 1.11-1.35; p < 0.001). Of note, GLS remained associated with MACE (p < 0.001) even after adjustment for infarct size and microvascular obstruction. CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage.
资金来源类型:无。虽然左室射血分数(LVEF)被推荐用于st段抬高型心肌梗死(STEMI)患者的左室(LV)收缩功能评估和风险分层，但其预后价值有限。其他左室功能的测量，如总纵向应变(GLS)和二尖瓣环平面收缩位移(MAPSE)可能提供stemi后的额外预后信息。然而，目前还缺乏比较这些参数预测STEMI后硬临床事件的综合研究。我们旨在探讨心脏磁共振(CMR)成像LVEF、MAPSE和GLS对急性STEMI患者预后的比较价值。这项观察性研究纳入了407例连续接受经皮冠状动脉介入治疗(PCI)的急性STEMI患者。PCI后3[四分位间距(IQR): 2-4]天进行全面CMR检查，以确定LVEF、GLS和MAPSE以及心肌梗死特征。主要终点是MACE的发生，MACE定义为死亡、再梗死和充血性心力衰竭的复合。随访21个月[IQR: 12-50]， 40例(10%)患者出现MACE。MACE患者的LVEF (49% vs. 53%， p = 0.005)和MAPSE (7.9 mm vs. 9.1 mm, p = 0.001)显著降低，GLS值较高(-10.2% vs. - 12.3%， p < 0.001)。GLS表现出最高的预后价值，曲线下面积(AUC)为0.71 (95% CI 0.63-0.79;p < 0.001)，与MAPSE相比(AUC: 0.67, 95% CI 0.58-0.75;p = 0.001)和LVEF (AUC: 0.64, 95% CI 0.54-0.73;p = 0.005)。多变量分析后，GLS成为MACE的独立预测因子(HR: 1.22, 95% CI 1.11-1.35;p < 0.001)。值得注意的是，即使在调整梗死面积和微血管阻塞后，GLS仍与MACE相关(p < 0.001)。cmr衍生的GLS是急性STEMI后MACE的强大且独立的预测因子，具有LVEF和心肌损伤参数的附加预后有效性。
{"title":"Cardiac magnetic resonance derived global longitudinal strain outperforms established functional parameters in prognostication after ST-elevation myocardial infarction","authors":"M. Holzknecht, M. Reindl, C. Tiller, I. Lechner, T. Hornung, D. Plappert, G. Klug, S. Reinstadler, A. Bauer, B. Metzler, A. Mayr","doi":"10.1093/EHJCI/JEAA356.268","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.268","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Although left ventricular ejection fraction (LVEF) is recommended for left ventricular (LV) systolic function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI), its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far.\u0000 \u0000 \u0000 \u0000 We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in acute STEMI patients.\u0000 \u0000 \u0000 \u0000 This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2-4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure.\u0000 \u0000 \u0000 \u0000 During a follow-up of 21 [IQR: 12-50] months, 40 (10%) patients experienced MACE. Patients with MACE showed significantly lower LVEF (49% vs. 53%, p = 0.005) and MAPSE (7.9 mm vs. 9.1 mm, p = 0.001), as well as higher GLS values (-10.2% vs. -12.3 %, p < 0.001). GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63-0.79; p < 0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58-0.75; p = 0.001) and LVEF (AUC: 0.64, 95% CI 0.54-0.73; p = 0.005). After multivariable analysis, GLS emerged as independent predictor of MACE (HR: 1.22, 95% CI 1.11-1.35; p < 0.001). Of note, GLS remained associated with MACE (p < 0.001) even after adjustment for infarct size and microvascular obstruction.\u0000 \u0000 \u0000 \u0000 CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75777171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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