Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.348
S. San, RE Ravis, TL Tessonier, M. Philip, F. Lavagna, GN Norscini, L. Oliver, F. Arregle, HM Martel, TO Torras, RS Renard, A. Ambrosi, Cac Casalta, D. Drancourt, G. Habib
Type of funding sources: None. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is commonly used for the diagnosis of infective endocarditis (IE), but its prognostic value remains unknown. This study sought to assess the prognostic value of 18F-FDG PET/CT in prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE). This study prospectively included 173 consecutive patients (109 PVE and 64 NVE) with definite left-sided IE who had an 18F-FDG PET/CT and were followed-up for 1 year. The primary endpoint was a composite of major cardiac events: death, recurrence of IE, acute cardiac failure, nonscheduled hospitalization for cardiovascular indication, and new embolic event. 18F-FDG PET/CT was positive in 100 (58%) patients, 83% (n = 90 of 109) in the PVE, and 16% (n = 10 of 64) in the NVE group. At a mean follow-up of 225 days (interquartile range: 199 to 251 days), the primary endpoint occurred in 94 (54%) patients: 63 (58%) in the PVE group and 31 (48%) in the NVE group. In the PVE group, positive 18F-FDG PET/CT was significantly associated with a higher rate of primary endpoint (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.1 to 6.7; p = 0.04). Moderate to intense 18F-FDG valvular uptake was also associated with worse outcome (HR: 2.3; 95% CI: 1.3 to 4.5; p = 0.03) and to new embolic events in PVE (HR: 7.5; 95% CI: 1.24 to 45.2; p = 0.03) and in NVE (HR: 8.8; 95% CI: 1.1 to 69.5; p = 0.02). In the NVE group, 18F-FDG PET/CT was not associated with occurrence of the primary endpoint CONCLUSIONS: In addition to its good diagnostic performance, 18F-FDG PET/CT is predictive of major cardiac events in PVE and new embolic events within the first year following IE. Primary Endpoint Occurrence: Univariate and Multivariate Analysis in PVE Univariate HR (95% CI) p Value Multivariate HR (95% CI) p Value Renal insufficiency at admission 2.16 (1.00-4.68) 0.05 CRP >100 mg/l 2.46 (1.04-5.89) 0.02 1.90 (1.10-3.40) 0.03 Staphylococcus aureus 2.70 (1.10-6.55) 0.03 Severe valvular regurgitation 2.55 (1.01-6.41) 0.05 1.20 (0.70-2.10) 0.68 Echographic complications 1.15 (0.54-2.46) 0.72 Vegetation length >10 mm 2.53 (1.19-4.60) 0.03 Positive 18F-FDG PET/CT 3.74 (1.30-10.80) 0.02 2.70 (1.10-6.70) 0.04 Moderate to intense 18FDG valvular uptake 2.70 (1.20-6.30) 0.02 2.30 (1.30-4.50) 0.03 Abstract Figure.
{"title":"Prognostic value of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography in infective endocarditis","authors":"S. San, RE Ravis, TL Tessonier, M. Philip, F. Lavagna, GN Norscini, L. Oliver, F. Arregle, HM Martel, TO Torras, RS Renard, A. Ambrosi, Cac Casalta, D. Drancourt, G. Habib","doi":"10.1093/EHJCI/JEAA356.348","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.348","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is commonly used for the diagnosis of infective endocarditis (IE), but its prognostic value remains unknown.\u0000 \u0000 \u0000 \u0000 This study sought to assess the prognostic value of 18F-FDG PET/CT in prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE).\u0000 \u0000 \u0000 \u0000 This study prospectively included 173 consecutive patients (109 PVE and 64 NVE) with definite left-sided IE who had an 18F-FDG PET/CT and were followed-up for 1 year. The primary endpoint was a composite of major cardiac events: death, recurrence of IE, acute cardiac failure, nonscheduled hospitalization for cardiovascular indication, and new embolic event.\u0000 \u0000 \u0000 \u0000 18F-FDG PET/CT was positive in 100 (58%) patients, 83% (n = 90 of 109) in the PVE, and 16% (n = 10 of 64) in the NVE group. At a mean follow-up of 225 days (interquartile range: 199 to 251 days), the primary endpoint occurred in 94 (54%) patients: 63 (58%) in the PVE group and 31 (48%) in the NVE group. In the PVE group, positive 18F-FDG PET/CT was significantly associated with a higher rate of primary endpoint (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.1 to 6.7; p = 0.04). Moderate to intense 18F-FDG valvular uptake was also associated with worse outcome (HR: 2.3; 95% CI: 1.3 to 4.5; p = 0.03) and to new embolic events in PVE (HR: 7.5; 95% CI: 1.24 to 45.2; p = 0.03) and in NVE (HR: 8.8; 95% CI: 1.1 to 69.5; p = 0.02). In the NVE group, 18F-FDG PET/CT was not associated with occurrence of the primary endpoint CONCLUSIONS: In addition to its good diagnostic performance, 18F-FDG PET/CT is predictive of major cardiac events in PVE and new embolic events within the first year following IE.\u0000 Primary Endpoint Occurrence: Univariate and Multivariate Analysis in PVE Univariate HR (95% CI) p Value Multivariate HR (95% CI) p Value Renal insufficiency at admission 2.16 (1.00-4.68) 0.05 CRP >100 mg/l 2.46 (1.04-5.89) 0.02 1.90 (1.10-3.40) 0.03 Staphylococcus aureus 2.70 (1.10-6.55) 0.03 Severe valvular regurgitation 2.55 (1.01-6.41) 0.05 1.20 (0.70-2.10) 0.68 Echographic complications 1.15 (0.54-2.46) 0.72 Vegetation length >10 mm 2.53 (1.19-4.60) 0.03 Positive 18F-FDG PET/CT 3.74 (1.30-10.80) 0.02 2.70 (1.10-6.70) 0.04 Moderate to intense 18FDG valvular uptake 2.70 (1.20-6.30) 0.02 2.30 (1.30-4.50) 0.03 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73540838","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/JEAA356.115
Y. Ohara, Y. Yoshimura, Y. Fukuoka, K. Tanioka, K. Yamamoto
Type of funding sources: None. Elevated left ventricular (LV) filling pressures are the main physiologic consequence of LV diastolic dysfunction. Left atrial (LA) strain was recently found useful to predict elevated LV filling pressures noninvasively. However, there are few reports on the role of LA strain when predicting LV filling pressure in patients with coronary artery disease (CAD). The aim of this study was to explore the correlation between LA strain and LV end-diastolic pressure (LVEDP) in patients with CAD and preserved LV ejection fraction. Fifty-four patients with stable CAD were enrolled. Global atrial longitudinal strain was measured by averaging all atrial segments. Resorvoir (S-LAs), conduit (S-LAe), and contractile (S-LAa) phase strain were obtained. LVEDP was invasively obtained by left heart catheterization. Patients were divided into two groups: elevated LVEDP group (LVEDP > 15mmHg group: n = 23) and normal LVEDP group (LVEDP ≤ 15mmHg group: n = 31). Elevated LVEDP group showed significantly decreased S-LAs and S-LAa (S-LAs: 21.3 ± 7.2% vs. 27.5 ± 7.8%, p < 0.005; S-LAa: 9.7 ± 3.3% vs. 14.6 ± 3.4%, p < 0.0001). However, E/Ea and S-LAe were not significantly different between the two groups. LVEDP significantly correlated with S-LAa (r=-0.596, p < 0.0001) and S-LAs (r=-0.431, p < 0.001). Receiver operating characteristics curve analysis showed that S-LAa could predict elevated LVEDP (AUC = 0.84) and a cut-off value of S-LAa < 11.6% was able to most accurately identify patients with elevated LVEDP. LA strain, especially S-LAa, provided additional diagnostic value for the noninvasive assessment of LV filling pressure in CAD patients with preserved LV ejection fraction.
资金来源类型:无。左室充盈压力升高是左室舒张功能障碍的主要生理后果。最近发现左心房(LA)应变可用于无创预测左室充盈压力升高。然而，关于LA应变在预测冠心病(CAD)患者左室充盈压中的作用的报道很少。本研究的目的是探讨冠心病患者左室舒张末压(LVEDP)与左室射血分数的相关性。54例稳定型CAD患者入组。通过平均所有心房段来测量总体心房纵向应变。得到了溶质相应变(S-LAs)、导管相应变(S-LAe)和收缩相应变(S-LAa)。左心导管有创性获得LVEDP。患者分为两组:LVEDP升高组(LVEDP > 15mmHg组:n = 23)和LVEDP正常组(LVEDP≤15mmHg组:n = 31)。LVEDP升高组S-LAs和S-LAa显著降低(S-LAs: 21.3±7.2% vs 27.5±7.8%，p < 0.005;S-LAa: 9.7±3.3% vs. 14.6±3.4%，p < 0.0001)。E/Ea和S-LAe在两组间差异无统计学意义。LVEDP与S-LAa (r=-0.596, p < 0.0001)、S-LAs (r=-0.431, p < 0.001)显著相关。受试者工作特征曲线分析显示，S-LAa能够预测LVEDP升高(AUC = 0.84)， S-LAa < 11.6%的临界值能够最准确地识别LVEDP升高患者。LA应变，特别是S-LAa，为保留左室射血分数的CAD患者无创评估左室充盈压力提供了额外的诊断价值。
{"title":"Correlation of left atrial strain with left ventricular end-diastolic pressure in patients with coronary artery disease and preserved left ventricular ejection faction","authors":"Y. Ohara, Y. Yoshimura, Y. Fukuoka, K. Tanioka, K. Yamamoto","doi":"10.1093/EHJCI/JEAA356.115","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.115","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Elevated left ventricular (LV) filling pressures are the main physiologic consequence of LV diastolic dysfunction. Left atrial (LA) strain was recently found useful to predict elevated LV filling pressures noninvasively. However, there are few reports on the role of LA strain when predicting LV filling pressure in patients with coronary artery disease (CAD). The aim of this study was to explore the correlation between LA strain and LV end-diastolic pressure (LVEDP) in patients with CAD and preserved LV ejection fraction.\u0000 \u0000 \u0000 \u0000 Fifty-four patients with stable CAD were enrolled. Global atrial longitudinal strain was measured by averaging all atrial segments. Resorvoir (S-LAs), conduit (S-LAe), and contractile (S-LAa) phase strain were obtained. LVEDP was invasively obtained by left heart catheterization.\u0000 \u0000 \u0000 \u0000 Patients were divided into two groups: elevated LVEDP group (LVEDP > 15mmHg group: n = 23) and normal LVEDP group (LVEDP ≤ 15mmHg group: n = 31). Elevated LVEDP group showed significantly decreased S-LAs and S-LAa (S-LAs: 21.3 ± 7.2% vs. 27.5 ± 7.8%, p < 0.005; S-LAa: 9.7 ± 3.3% vs. 14.6 ± 3.4%, p < 0.0001). However, E/Ea and S-LAe were not significantly different between the two groups. LVEDP significantly correlated with S-LAa (r=-0.596, p < 0.0001) and S-LAs (r=-0.431, p < 0.001). Receiver operating characteristics curve analysis showed that S-LAa could predict elevated LVEDP (AUC = 0.84) and a cut-off value of S-LAa < 11.6% was able to most accurately identify patients with elevated LVEDP.\u0000 \u0000 \u0000 \u0000 LA strain, especially S-LAa, provided additional diagnostic value for the noninvasive assessment of LV filling pressure in CAD patients with preserved LV ejection fraction.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76720917","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/JEAA356.241
G. Kalykakis, A. Antonopoulos, T. Pitsariotis, P. Siogkas, T. Exarchos, Pavlos Kafouris, R. Liga, A. Giannopoulos, A. Scolte, P. Kaufmann, O. Parodi, J. Knuuti, D. Fotiadis, D. Neglia, C. Anagnostopoulos
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported in part from European Regional Development Fund, Operational Programme “Competitiveness, Entrepreneurship and Innovation 2014-2020 (EPAnEK)”, titled: The Greek Research Infrastructure for Personalized Medicine (pMED-GR) , no. GR 5002802 ,and by Greece and the European Union (European Social Fund-ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning 2014-2020» in the context of the project “Assessment of coronary atherosclerosis: a new complete, anatomo-functional, morphological and biomechanical approach”, Project no. 504776 EVINCI-SMARTOOL Background/Objectives: The relationship between biomechanical characteristics of a coronary lesion with myocardial blood flow has not been studied. We investigated the relationship between local endothelial shear stress (ESS) and computed tomography coronary angiography (CTCA)-derived anatomical and plaque characteristics data with impaired vasodilating capability assessed by positron emission tomography myocardial perfusion imaging (PET-MPI). A total of 92 coronary vessels of 53 patients who have undergone both CTCA and PET-MPI with 15O-water or 13N-ammonia were analysed. PET was considered abnormal when > 1 contiguous segments showed both stress Myocardial Blood Flow (MBF) ≤2.3mL/g/min and Myocardial Flow Reserve (MFR) ≤2.5 for 15O-water or <1.79 mL/g/min and ≤2.0 for 13N-ammonia respectively. CTCA images were used to assess stenosis severity, lesion specific total plaque volume (PV), non-calcified PV and calcified PV as well as plaque phenotype. ESS was calculated for the full length of a lesion (total), as well as in the proximal, minimum lumen area and distal lesion segments. ESS was weakly correlated with total PV (rho = 0.273, p = 0.008), non-calcified PV (rho = 0.247, p = 0.017) and the volume of necrotic core (rho = 0.242, p = 0.02). ESS increased progressively with stenosis severity (p ≤ 0.001). ΕSS was also higher in functionally significant vs. non-significant lesions (10.4 [8.04-54.4] Pa vs. 3.9 [2.32-7.29] Pa, p ≤0.001). Addition of ESS to stenosis severity improved prediction (Δ[AUC]:0.113, 95% CI: 0.055 to 0.171, p = 0.0001) of functionally significant lesions. There is a weak positive association between lesion-specific ESS and plaque volume. ESS increases progressively with stenosis severity and is higher in functionally significant lesions by PET-MPI. The addition of ESS to CTCA-anatomical information improves prediction of an abnormal PET-MPI result.
{"title":"CCTA-derived functional and morphological features and their comparative performance in predicting impaired coronary vasodilatation by PET-myocardial perfusion imaging","authors":"G. Kalykakis, A. Antonopoulos, T. Pitsariotis, P. Siogkas, T. Exarchos, Pavlos Kafouris, R. Liga, A. Giannopoulos, A. Scolte, P. Kaufmann, O. Parodi, J. Knuuti, D. Fotiadis, D. Neglia, C. Anagnostopoulos","doi":"10.1093/EHJCI/JEAA356.241","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.241","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported in part from European Regional Development Fund, Operational Programme “Competitiveness, Entrepreneurship and Innovation 2014-2020 (EPAnEK)”, titled: The Greek Research Infrastructure for Personalized Medicine (pMED-GR) , no. GR 5002802 ,and by Greece and the European Union (European Social Fund-ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning 2014-2020» in the context of the project “Assessment of coronary atherosclerosis: a new complete, anatomo-functional, morphological and biomechanical approach”, Project no. 504776\u0000 \u0000 \u0000 \u0000 EVINCI-SMARTOOL\u0000 Background/Objectives: The relationship between biomechanical characteristics of a coronary lesion with myocardial blood flow has not been studied. We investigated the relationship between local endothelial shear stress (ESS) and computed tomography coronary angiography (CTCA)-derived anatomical and plaque characteristics data with impaired vasodilating capability assessed by positron emission tomography myocardial perfusion imaging (PET-MPI).\u0000 \u0000 \u0000 \u0000 A total of 92 coronary vessels of 53 patients who have undergone both CTCA and PET-MPI with 15O-water or 13N-ammonia were analysed. PET was considered abnormal when > 1 contiguous segments showed both stress Myocardial Blood Flow (MBF) ≤2.3mL/g/min and Myocardial Flow Reserve (MFR) ≤2.5 for 15O-water or <1.79 mL/g/min and ≤2.0 for 13N-ammonia respectively. CTCA images were used to assess stenosis severity, lesion specific total plaque volume (PV), non-calcified PV and calcified PV as well as plaque phenotype. ESS was calculated for the full length of a lesion (total), as well as in the proximal, minimum lumen area and distal lesion segments.\u0000 \u0000 \u0000 \u0000 ESS was weakly correlated with total PV (rho = 0.273, p = 0.008), non-calcified PV (rho = 0.247, p = 0.017) and the volume of necrotic core (rho = 0.242, p = 0.02). ESS increased progressively with stenosis severity (p ≤ 0.001). ΕSS was also higher in functionally significant vs. non-significant lesions (10.4 [8.04-54.4] Pa vs. 3.9 [2.32-7.29] Pa, p ≤0.001). Addition of ESS to stenosis severity improved prediction (Δ[AUC]:0.113, 95% CI: 0.055 to 0.171, p = 0.0001) of functionally significant lesions.\u0000 \u0000 \u0000 \u0000 There is a weak positive association between lesion-specific ESS and plaque volume. ESS increases progressively with stenosis severity and is higher in functionally significant lesions by PET-MPI. The addition of ESS to CTCA-anatomical information improves prediction of an abnormal PET-MPI result.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76850671","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/JEAA356.129
F. Luciano, C. Santoro, V. Capone, O. Casciano, M. Canonico, T. Fedele, SO Silvia Orefice, L. Fiorillo, R. Esposito
Type of funding sources: None. Sacubitril/valsartan has shown the ability in reducing the risk of death and of hospitalization in patients with HF (heart failure) and is recommended in patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite conventional therapies. Strain imaging derived myocardial work (MW) is an emerging tool for the evaluation of left ventricular (LV) mechanics by incorporating both systolic deformation and afterload burden in the analysis. To evaluate in a prospective fashion the impact of sacubitril/valsartan therapy in HF patients on MW derived parameters in relation with standard echocardiographic indices. We recruited thirteen HF patients with indication to sacubitril/valsartan therapy according to current guidelines. Sacubitril/valsartan therapy titrated at the maximum tolerated dose. A comprehensive echo-Doppler exam, including speckle tracking derived assessment of global longitudinal strain (GLS) (in absolute value), was performed before and after a three months therapy with sacubitril/valsartan. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were calculated according to standardized procedures. Patients with more than mild aortic and mitral stenosis and/or regurgitation were excluded. Other exclusion criteria included permanent and/or persistent atrial fibrillation and inadequate echo images. The 13 patients (M/F = 11/2, age: 57 ± 8.2 years, aetiology: idiopathic in 3 patients, ischaemic in 7 patients and chemotherapy related cardiotoxicity in 3 patients, NYHA Class: II in 7 and III in 6 patients). All patients tolerated sacubitril/valsartan therapy. After the three months therapy an improvement of LVEF (from 32.3 ± 2% to 36.2± 6%, p = 0.015), GLS (from 9.8 ± 1% to 11.6 ± 2%, p = 0.019), GWI (from 845.0 ± 175.0 mmHg% to 1091.6 ± 336.8 mmHg%, p = 0.003), GCW (from 993.4± 211.6 mmHg% to 1262.7 ± 404 mmHg%, p = 0.002) and GWE (from 77 ± 11% to 81 ± 10%, p = 0.002) was observed, without significant changes in GWW (from 190 ± 121 mmHg% to 211 ± 145 mmHg%, p = 0.307). We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.66, p = 0.014). This relation remained significant even after adjusting for the extent of systolic blood pressure reduction (r = 0.54, p = 0.033). Three months sacubitril/valsartan therapy significantly improves standard and advanced indices of LV systolic function. This improvement is due to the increase of constructive work more than to the reduction of wasted work and the increase of LVEF can be predicted by the global constructive work levels at baseline. MW assessment may help to understand the mechanisms underlying the sacubitril/valsartan therapy efficacy in HF patients. Abstract Figure.
资金来源类型:无。Sacubitril/缬沙坦已显示出降低HF(心力衰竭)患者死亡和住院风险的能力，并被推荐用于射血分数降低(HFrEF)的心力衰竭患者，尽管常规治疗仍有症状。应变成像衍生心肌功(MW)是一种评估左心室(LV)力学的新兴工具，它在分析中结合了收缩变形和后负荷负荷。前瞻性评价苏比利/缬沙坦治疗HF患者对与标准超声心动图指标相关的MW衍生参数的影响。我们招募了13名心衰患者，根据目前的指南，有苏比里尔/缬沙坦治疗的适应症。萨奎比利/缬沙坦治疗以最大耐受剂量滴定。在使用苏比里尔/缬沙坦治疗3个月前后，进行了全面的超声多普勒检查，包括斑点跟踪得出的全球纵向应变(GLS)(绝对值)评估。按照标准化程序计算了MW的全局工作指数(GWI)、全局建设工作(GCW)、全局浪费工作(GWW)和全局工作效率(GWE)等参数。排除有轻度以上主动脉瓣和二尖瓣狭窄和/或反流的患者。其他排除标准包括永久性和/或持续性房颤和不充分的回声图像。13例患者(M/F = 11/2，年龄:57±8.2岁，病因:特发性3例，缺血性7例，化疗相关心脏毒性3例，NYHA分级:II级7例，III级6例)。所有患者耐受sacubitril/缬沙坦治疗。LVEF三个月治疗后有所改善(从32.3±2%到36.2±6%,p = 0.015), gl(9.8±1%至11.6±2%,p = 0.019),描述(从845.0±175.0毫米汞柱1091.6±336.8 mmHg % %, p = 0.003), GCW(从993.4±211.6毫米汞柱1262.7±404毫米汞柱% %,p = 0.002)和GWE(77±11%至81±10%,p = 0.002)观察,没有重大变化GWW(190±121 mmHg % 211±145 mmHg %, p = 0.307)。我们还发现LVEF改善程度与GCW基线值呈正相关(r = 0.66, p = 0.014)。即使在调整收缩压降低的程度后，这种关系仍然显著(r = 0.54, p = 0.033)。舒比利/缬沙坦治疗3个月可显著改善左室收缩功能的标准和高级指标。这种改善是由于建设性工作的增加，而不是由于浪费工作的减少，LVEF的增加可以通过基线的全球建设性工作水平来预测。MW评估可能有助于了解苏比里尔/缬沙坦治疗HF患者疗效的机制。抽象的图。
{"title":"Usefulness of myocardial work assessment for the understanding of mechanisms underlying sacubitril/valsartan efficacy in patients with heart failure and reduced ejection fraction","authors":"F. Luciano, C. Santoro, V. Capone, O. Casciano, M. Canonico, T. Fedele, SO Silvia Orefice, L. Fiorillo, R. Esposito","doi":"10.1093/EHJCI/JEAA356.129","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.129","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Sacubitril/valsartan has shown the ability in reducing the risk of death and of hospitalization in patients with HF (heart failure) and is recommended in patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite conventional therapies. Strain imaging derived myocardial work (MW) is an emerging tool for the evaluation of left ventricular (LV) mechanics by incorporating both systolic deformation and afterload burden in the analysis.\u0000 \u0000 \u0000 \u0000 To evaluate in a prospective fashion the impact of sacubitril/valsartan therapy in HF patients on MW derived parameters in relation with standard echocardiographic indices.\u0000 \u0000 \u0000 \u0000 We recruited thirteen HF patients with indication to sacubitril/valsartan therapy according to current guidelines. Sacubitril/valsartan therapy titrated at the maximum tolerated dose. A comprehensive echo-Doppler exam, including speckle tracking derived assessment of global longitudinal strain (GLS) (in absolute value), was performed before and after a three months therapy with sacubitril/valsartan. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were calculated according to standardized procedures. Patients with more than mild aortic and mitral stenosis and/or regurgitation were excluded. Other exclusion criteria included permanent and/or persistent atrial fibrillation and inadequate echo images.\u0000 \u0000 \u0000 \u0000 The 13 patients (M/F = 11/2, age: 57 ± 8.2 years, aetiology: idiopathic in 3 patients, ischaemic in 7 patients and chemotherapy related cardiotoxicity in 3 patients, NYHA Class: II in 7 and III in 6 patients). All patients tolerated sacubitril/valsartan therapy. After the three months therapy an improvement of LVEF (from 32.3 ± 2% to 36.2± 6%, p = 0.015), GLS (from 9.8 ± 1% to 11.6 ± 2%, p = 0.019), GWI (from 845.0 ± 175.0 mmHg% to 1091.6 ± 336.8 mmHg%, p = 0.003), GCW (from 993.4± 211.6 mmHg% to 1262.7 ± 404 mmHg%, p = 0.002) and GWE (from 77 ± 11% to 81 ± 10%, p = 0.002) was observed, without significant changes in GWW (from 190 ± 121 mmHg% to 211 ± 145 mmHg%, p = 0.307). We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.66, p = 0.014). This relation remained significant even after adjusting for the extent of systolic blood pressure reduction (r = 0.54, p = 0.033).\u0000 \u0000 \u0000 \u0000 Three months sacubitril/valsartan therapy significantly improves standard and advanced indices of LV systolic function. This improvement is due to the increase of constructive work more than to the reduction of wasted work and the increase of LVEF can be predicted by the global constructive work levels at baseline. MW assessment may help to understand the mechanisms underlying the sacubitril/valsartan therapy efficacy in HF patients.\u0000 Abstract Figure.\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":"78090574","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/JEAA356.373
M. F. Oliveira, Marta Oliveira, R. Costa, A. Frias, I. Silveira, S. Cabral, Myrna Serapião dos Santos, S. Torres, Amanda Maria Sena Reis
Type of funding sources: None. Although the perceived prognosis of patients with precapillary pulmonary hypertension (PH) is poor, the natural history of this condition is very heterogeneous. In this study we sought to identify predictors of poor outcomes which could help refine prognosis. We studied consecutive patients referred to our centre from 12/2016 to 11/2018 with confirmed precapillary PH. A range of clinical, laboratory, echocardiographic and right heart catheterization (RHC) data variables were collected to assess predictors of survival. Outcome was defined as mortality from any cause. Of the 80 included patients, 51 (64%) were female and mean age was 60.5 ± 16.0 years. The majority of patients (45%) had pulmonary arterial hypertension (group 1) and 41% were chronic thromboembolic pulmonary hypertensive disease patients (group 4). During a median follow-up of 18.7 [IQR 12.3 – 26.7] months, 10 patients (12.5%) died. New York Heart Association (NYHA) functional class (HR 19.4 [95% CI 2.56 - 147.5], p = 0.004) was the strongest predictor of mortality, whereas higher haemoglobin (HR 0.70 [0.49 - 0.99], p= 0.047) and 6-minute walking distance (6MWD) expressed as percentage of predicted (HR 0.96 [0.93 - 0.99], p = 0.004) were associated with better survival overall. Echocardiographic parameters such as eccentricity index (HR 3.35 (95% CI 1.11 - 10.0), p = 0.031), short pulmonary acceleration time (HR 0.98 [95% CI 0.96 - 0.99], p = 0.008), the presence of moderate to severe tricuspid regurgitation (HR 6.46 [95% CI 1.67 - 25.0], p = 0.007) and pericardial effusion (HR 3.86 [95% CI 1.12 - 13.4], p = 0.033) were also associated with death. Traditional right ventricular function parameters such as fractional area change, tricuspid annular plane systolic excursion (TAPSE) and S velocity of the lateral annular tricuspid annulus did not predict mortality in these patients. Invasive pressures and pulmonary vascular resistance measured by RHC were also not associated with mortality. In multivariable analysis, NYHA functional class was the only independent predictor of mortality in patients with precapillary PH (HR 14.5 [95% CI 2.3 - 146.8], p = 0.006). Eccentricity index, short pulmonary acceleration time, moderate to severe tricuspid regurgitation and pericardial effusion were associated with poor survival. Functional class was the strongest independent predictor of mortality in precapillary PH patients. These parameters may help stratify the risk of death in this heterogenous population.
资金来源类型:无。虽然毛细血管前肺动脉高压(PH)患者的预后很差，但这种疾病的自然病史是非常不同的。在这项研究中，我们试图确定不良预后的预测因素，以帮助改善预后。我们研究了2016年12月至2018年11月期间到我们中心就诊的连续患者，这些患者确认了毛细前ph值。收集了一系列临床、实验室、超声心动图和右心导管(RHC)数据变量，以评估生存预测因素。结果定义为任何原因导致的死亡率。80例患者中，女性51例(64%)，平均年龄60.5±16.0岁。大多数患者(45%)为肺动脉高压(第1组)，41%为慢性血栓栓塞性肺动脉高压(第4组)。在18.7 [IQR 12.3 - 26.7]个月的中位随访期间，10例患者(12.5%)死亡。纽约心脏协会(NYHA)功能分类(HR 19.4 [95% CI 2.56 - 147.5]， p= 0.004)是死亡率的最强预测因子，而较高的血红蛋白(HR 0.70 [0.49 - 0.99]， p= 0.047)和6分钟步行距离(6MWD)以预测百分比表示(HR 0.96 [0.93 - 0.99]， p= 0.004)总体上与较好的生存率相关。超声心动图参数如偏心率指数(HR 3.35 (95% CI 1.11 - 10.0)， p = 0.031)，短肺加速时间(HR 0.98 [95% CI 0.96 - 0.99]， p = 0.008)，存在中度至重度三尖瓣反流(HR 6.46 [95% CI 1.67 - 25.0]， p = 0.007)和心包积液(HR 3.86 [95% CI 1.12 - 13.4]， p = 0.033)也与死亡相关。传统的右心室功能参数，如分数面积变化，三尖瓣环平面收缩偏移(TAPSE)和三尖瓣环外侧环S速度不能预测这些患者的死亡率。RHC测量的侵入性压力和肺血管阻力也与死亡率无关。在多变量分析中，NYHA功能分级是毛细前PH患者死亡率的唯一独立预测因子(HR 14.5 [95% CI 2.3 - 146.8]， p = 0.006)。偏心率指数、肺加速时间短、中度至重度三尖瓣反流和心包积液与生存率低相关。功能分级是毛细前PH患者死亡率最强的独立预测因子。这些参数可能有助于对这一异质性人群的死亡风险进行分层。
{"title":"Predictors of survival in patients with precapillary pulmonary hypertension","authors":"M. F. Oliveira, Marta Oliveira, R. Costa, A. Frias, I. Silveira, S. Cabral, Myrna Serapião dos Santos, S. Torres, Amanda Maria Sena Reis","doi":"10.1093/EHJCI/JEAA356.373","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.373","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Although the perceived prognosis of patients with precapillary pulmonary hypertension (PH) is poor, the natural history of this condition is very heterogeneous. In this study we sought to identify predictors of poor outcomes which could help refine prognosis.\u0000 \u0000 \u0000 \u0000 We studied consecutive patients referred to our centre from 12/2016 to 11/2018 with confirmed precapillary PH. A range of clinical, laboratory, echocardiographic and right heart catheterization (RHC) data variables were collected to assess predictors of survival. Outcome was defined as mortality from any cause.\u0000 \u0000 \u0000 \u0000 Of the 80 included patients, 51 (64%) were female and mean age was 60.5 ± 16.0 years. The majority of patients (45%) had pulmonary arterial hypertension (group 1) and 41% were chronic thromboembolic pulmonary hypertensive disease patients (group 4). During a median follow-up of 18.7 [IQR 12.3 – 26.7] months, 10 patients (12.5%) died. New York Heart Association (NYHA) functional class (HR 19.4 [95% CI 2.56 - 147.5], p = 0.004) was the strongest predictor of mortality, whereas higher haemoglobin (HR 0.70 [0.49 - 0.99], p= 0.047) and 6-minute walking distance (6MWD) expressed as percentage of predicted (HR 0.96 [0.93 - 0.99], p = 0.004) were associated with better survival overall. Echocardiographic parameters such as eccentricity index (HR 3.35 (95% CI 1.11 - 10.0), p = 0.031), short pulmonary acceleration time (HR 0.98 [95% CI 0.96 - 0.99], p = 0.008), the presence of moderate to severe tricuspid regurgitation (HR 6.46 [95% CI 1.67 - 25.0], p = 0.007) and pericardial effusion (HR 3.86 [95% CI 1.12 - 13.4], p = 0.033) were also associated with death. Traditional right ventricular function parameters such as fractional area change, tricuspid annular plane systolic excursion (TAPSE) and S velocity of the lateral annular tricuspid annulus did not predict mortality in these patients. Invasive pressures and pulmonary vascular resistance measured by RHC were also not associated with mortality. In multivariable analysis, NYHA functional class was the only independent predictor of mortality in patients with precapillary PH (HR 14.5 [95% CI 2.3 - 146.8], p = 0.006).\u0000 \u0000 \u0000 \u0000 Eccentricity index, short pulmonary acceleration time, moderate to severe tricuspid regurgitation and pericardial effusion were associated with poor survival. Functional class was the strongest independent predictor of mortality in precapillary PH patients. These parameters may help stratify the risk of death in this heterogenous population.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75056515","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/JEAA356.313
S. Mathai, J. Sehmi, D. Auger, C L Heureux, N. Keenan
Type of funding sources: None. Takotsubo cardiomyopathy remains an elusive entity to diagnose, especially with increasing time following the initial clinical event. Patients are often referred for cardiac MR, but when performed on a convalescent patient, the conventional CMR exam can be normal. However CMR elevated native T1 values on mapping may persist, aiding diagnosis. We sought to review a series of confirmed Takotsubo cases to evaluate which CMR features were most helpful in making a diagnosis. We reviewed 2 years of CMR exams in our institution and identified 14 patients with a confirmed diagnosis of Takotsubo cardiomyopathy after a read of all clinical data by two consultant cardiologists. All of the 14 patients had a troponin positive cardiac event, unobstructed coronary arteries on invasive angiography and echocardiographic evidence of apical hypo/akinesia (or basal, in the non-apical variants) at the time of presentation. All CMR exams were performed at 1.5T. All included functional assessment, T1 mapping and late gadolinium enhancement(LGE). Some exams also included T2 mapping and STIR. All patients were female. The time interval between presentation and CMR exam varied from 24 hours to 2 years. 2 of the scans showed evidence of non-apical Takotsubo cardiomyopathy. At the time of CMR, only 7 patients(50%) had a residual regional wall motion abnormality, but 13 patients(93%) had a region of elevated native T1 (>1 myocardial segment). High signal was identified on STIR in 6(43%) and elevated native T2 in 10(71%). Of interest, we identified small areas of patchy LGE in 2 patients(14%). Increased native T1 signal may be the only residual cardiac MRI marker of previous Takotsubo cardiomyopathy, persisting for months after the initial cardiac event, even after resolution of regional wall motion abnormalities and recovery of the left ventricular function. T1 mapping should be performed in CMR exams for Takotsubo cardiomyopathy to improve diagnostic yield. Abstract Figure. CMR in convalescent Takotsubo
{"title":"Role of T1 mapping in identification of convalescent Takotsubo cardiomyopathy","authors":"S. Mathai, J. Sehmi, D. Auger, C L Heureux, N. Keenan","doi":"10.1093/EHJCI/JEAA356.313","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.313","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Takotsubo cardiomyopathy remains an elusive entity to diagnose, especially with increasing time following the initial clinical event. Patients are often referred for cardiac MR, but when performed on a convalescent patient, the conventional CMR exam can be normal. However CMR elevated native T1 values on mapping may persist, aiding diagnosis.\u0000 \u0000 \u0000 \u0000 We sought to review a series of confirmed Takotsubo cases to evaluate which CMR features were most helpful in making a diagnosis.\u0000 \u0000 \u0000 \u0000 We reviewed 2 years of CMR exams in our institution and identified 14 patients with a confirmed diagnosis of Takotsubo cardiomyopathy after a read of all clinical data by two consultant cardiologists. All of the 14 patients had a troponin positive cardiac event, unobstructed coronary arteries on invasive angiography and echocardiographic evidence of apical hypo/akinesia (or basal, in the non-apical variants) at the time of presentation. All CMR exams were performed at 1.5T. All included functional assessment, T1 mapping and late gadolinium enhancement(LGE). Some exams also included T2 mapping and STIR.\u0000 \u0000 \u0000 \u0000 All patients were female. The time interval between presentation and CMR exam varied from 24 hours to 2 years. 2 of the scans showed evidence of non-apical Takotsubo cardiomyopathy. At the time of CMR, only 7 patients(50%) had a residual regional wall motion abnormality, but 13 patients(93%) had a region of elevated native T1 (>1 myocardial segment). High signal was identified on STIR in 6(43%) and elevated native T2 in 10(71%). Of interest, we identified small areas of patchy LGE in 2 patients(14%).\u0000 \u0000 \u0000 \u0000 Increased native T1 signal may be the only residual cardiac MRI marker of previous Takotsubo cardiomyopathy, persisting for months after the initial cardiac event, even after resolution of regional wall motion abnormalities and recovery of the left ventricular function. T1 mapping should be performed in CMR exams for Takotsubo cardiomyopathy to improve diagnostic yield.\u0000 Abstract Figure. CMR in convalescent Takotsubo\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78451690","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/JEAA356.359
Nazir, M. Yazdani, Jane Draper, Russell Franks, S. Lam, S. Plein, S. Kapetanakis, A. Young, A. Chiribiri
Type of funding sources: Public Institution(s). Main funding source(s): National Insitute for Health Research Background There is clinical and prognostic evidence for global longitudinal strain (GLS) and circumferential strain (GCS). A range of techniques exist: 2-dimensional echocardiography (2Decho), 3-dimensional echocardiography (3Decho) and Cardiovascular Magnetic Resonance (CMR). Purpose To investigate inter-study repeatability and inter-method comparison of GLS and GCS techniques. Methods rescan 2Decho, 3Decho, 1.5T Siemens CMR (Cine imaging and Displacement encoding with stimulated echoes [DENSE]), 3T Siemens CMR (Cine Imaging and DENSE) and 3T Philips CMR (Tagging and Fast strain-encoding [fSENC]) imaging. Strain was quantified for 2Decho (EchoPAC), 3Decho (TomTec), Feature tracking (FT) for cine imaging (CircleCVI), CIM (University of Auckland) for DENSE and Tag, and Myostrain (Myocardial solutions) for fSENC. Results 20(6F) volunteers, mean age 33 ± 7 years, mean LVEF 62 ± 4%. All GLS and GCS methods had excellent inter-study agreement (ICC > 0.75) with coefficient of variation (CoV) between 4-8% (Table 1). Median and IQR are presented in Figure 1. Friedman’s test revealed statistically significant inter-method differences for GLS (χ2 = 66.4,p < 0.0001) and GCS (χ2 = 50.9,p < 0.0001). Post hoc analysis using Dunn’s test with Bonferroni correction demonstrated significant differences: -GLS: 2Decho vs DENSE 1.5T (p = 0.001) and Myostrain 3T (p = 0.0116); 3Decho vs FT 3T (p = 0.049) and DENSE 1.5T (p < 0.0001); FT 1.5T vs DENSE 1.5T (p = 0.001) and Myostrain 3T (p = 0.01); FT 3T vs Myostrain 3T (p < 0.0001); DENSE 1.5T vs Tag 3T (p = 0.0008) and Myostrain 3T (p < 0.0001); Tag 3T vs Myostrain (p = 0.02). -GCS: 3Decho vs DENSE 1.5T (P = 0.0005), FT 1.5T (p < 0.001), FT 3T (P < 0.001) and Myostrain (p = 0.003); FT 1.5T vs Tag 3T (p = 0.001), FT 3T vs Myostrain 3T (p = 0.04). There is excellent interstudy agreement for GLS and GCS methods. However, there are important inter-method differences in absolute values, that need to be considered for clinical application as a surveillance method and longitudinal studies. Table 1 Acquisiton Post processing GLS CoV(%) GLS ICC GCS CoV(%) GCS ICC 2DEcho EchoPAC 4.88 0.80 - - 3DEcho TomTec 4.77 0.86 3.97 0.85 Siemens 1.5T cine FT CircleCVI 8.30 0.79 6.00 0.85 Siemens 3T cine FT CircleCVI 6.21 0.89 4.76 0.94 Philips 3T Tag CIM 6.15 0.89 5.86 0.88 Siemens 1.5T DENSE CIM 4.36 0.90 4.65 0.89 Philips 3T fSENC Myostrain 8.45 0.81 4.06 0.90 Interstudy agreement for the different GLS and GCS methods. Abstract Figure 1
资金来源类型:公共机构。背景全球纵向应变(GLS)和周向应变(GCS)有临床和预后证据。存在一系列技术:二维超声心动图(2Decho)，三维超声心动图(3Decho)和心血管磁共振(CMR)。目的探讨GLS和GCS技术的研究间重复性和方法间比较。方法重新扫描2Decho、3Decho、1.5T Siemens CMR (Cine imaging and Displacement encoding with stimulation echos [DENSE])、3T Siemens CMR (Cine imaging and DENSE)和3T Philips CMR (Tagging and Fast strain encoding [fSENC])成像。2Decho (EchoPAC)、3Decho (TomTec)对菌株进行量化，Feature tracking (FT)用于电影成像(CircleCVI)， CIM(奥克兰大学)用于DENSE和Tag, Myostrain(心肌溶液)用于fSENC。结果20例(6F)志愿者，平均年龄33±7岁，平均LVEF 62±4%。所有GLS和GCS方法均具有良好的研究间一致性(ICC > 0.75)，变异系数(CoV)在4-8%之间(表1)。中位数和IQR如图1所示。弗里德曼检验显示，GLS (χ2 = 66.4,p < 0.0001)和GCS (χ2 = 50.9,p < 0.0001)的方法间差异具有统计学意义。采用Dunn 's检验和Bonferroni校正的事后分析显示了显著差异:-GLS: 2Decho vs DENSE 1.5T (p = 0.001)和Myostrain 3T (p = 0.0116);3Decho vs FT 3T (p = 0.049)和DENSE 1.5T (p < 0.0001);ft1.5 t vs DENSE 1.5T (p = 0.001)和Myostrain 3T (p = 0.01);ft3t vs Myostrain 3T (p < 0.0001);DENSE 1.5T vs Tag 3T (p = 0.0008)和Myostrain 3T (p < 0.0001);Tag 3T vs Myostrain (p = 0.02)。-GCS: 3Decho vs DENSE 1.5T (P = 0.0005)， ft1.5 t (P < 0.001)， ft3t (P < 0.001)和Myostrain (P = 0.003);ft1.5 t vs Tag 3T (p = 0.001)， ft3t vs Myostrain 3T (p = 0.04)。GLS和GCS方法有很好的相互研究一致性。然而，不同方法之间在绝对值上存在重要的差异，作为一种监测方法和纵向研究，在临床应用时需要考虑到这一点。表1采集后处理GLS CoV(%) GLS ICC GCS CoV(%) GCS ICC 2DEcho EchoPAC 4.88 0.80 - - 3DEcho TomTec 4.77 0.86 3.97 0.85 Siemens 1.5T cine FT CircleCVI 8.30 0.79 6.00 0.85 Siemens 3T cine FT CircleCVI 6.21 0.89 4.76 0.94 Philips 3T Tag CIM 6.15 0.89 5.86 0.88 Siemens 1.5T DENSE CIM 4.36 0.90 4.65 0.89 Philips 3T fSENC Myostrain 8.45 0.81 4.06 0.90不同GLS和GCS方法的相互研究协议。摘要图1
{"title":"The strain-7 study: multimodal, multivendor, multifield strength, scan:rescan comparison of global longitudinal and circumferential strain in healthy volunteers","authors":"Nazir, M. Yazdani, Jane Draper, Russell Franks, S. Lam, S. Plein, S. Kapetanakis, A. Young, A. Chiribiri","doi":"10.1093/EHJCI/JEAA356.359","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.359","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public Institution(s). Main funding source(s): National Insitute for Health Research\u0000 Background\u0000 There is clinical and prognostic evidence for global longitudinal strain (GLS) and circumferential strain (GCS). A range of techniques exist: 2-dimensional echocardiography (2Decho), 3-dimensional echocardiography (3Decho) and Cardiovascular Magnetic Resonance (CMR).\u0000 Purpose\u0000 To investigate inter-study repeatability and inter-method comparison of GLS and GCS techniques.\u0000 Methods\u0000 \u0000 \u0000 \u0000 rescan 2Decho, 3Decho, 1.5T Siemens CMR (Cine imaging and Displacement encoding with stimulated echoes [DENSE]), 3T Siemens CMR (Cine Imaging and DENSE) and 3T Philips CMR (Tagging and Fast strain-encoding [fSENC]) imaging. Strain was quantified for 2Decho (EchoPAC), 3Decho (TomTec), Feature tracking (FT) for cine imaging (CircleCVI), CIM (University of Auckland) for DENSE and Tag, and Myostrain (Myocardial solutions) for fSENC.\u0000 Results\u0000 20(6F) volunteers, mean age 33 ± 7 years, mean LVEF 62 ± 4%. All GLS and GCS methods had excellent inter-study agreement (ICC > 0.75) with coefficient of variation (CoV) between 4-8% (Table 1). Median and IQR are presented in Figure 1.\u0000 Friedman’s test revealed statistically significant inter-method differences for GLS (χ2 = 66.4,p < 0.0001) and GCS (χ2 = 50.9,p < 0.0001). Post hoc analysis using Dunn’s test with Bonferroni correction demonstrated significant differences:\u0000 -GLS: 2Decho vs DENSE 1.5T (p = 0.001) and Myostrain 3T (p = 0.0116); 3Decho vs FT 3T (p = 0.049) and DENSE 1.5T (p < 0.0001); FT 1.5T vs DENSE 1.5T (p = 0.001) and Myostrain 3T (p = 0.01); FT 3T vs Myostrain 3T (p < 0.0001); DENSE 1.5T vs Tag 3T (p = 0.0008) and Myostrain 3T (p < 0.0001); Tag 3T vs Myostrain (p = 0.02).\u0000 -GCS: 3Decho vs DENSE 1.5T (P = 0.0005), FT 1.5T (p < 0.001), FT 3T (P < 0.001) and Myostrain (p = 0.003); FT 1.5T vs Tag 3T (p = 0.001), FT 3T vs Myostrain 3T (p = 0.04).\u0000 \u0000 \u0000 \u0000 There is excellent interstudy agreement for GLS and GCS methods. However, there are important inter-method differences in absolute values, that need to be considered for clinical application as a surveillance method and longitudinal studies.\u0000 Table 1 Acquisiton Post processing GLS CoV(%) GLS ICC GCS CoV(%) GCS ICC 2DEcho EchoPAC 4.88 0.80 - - 3DEcho TomTec 4.77 0.86 3.97 0.85 Siemens 1.5T cine FT CircleCVI 8.30 0.79 6.00 0.85 Siemens 3T cine FT CircleCVI 6.21 0.89 4.76 0.94 Philips 3T Tag CIM 6.15 0.89 5.86 0.88 Siemens 1.5T DENSE CIM 4.36 0.90 4.65 0.89 Philips 3T fSENC Myostrain 8.45 0.81 4.06 0.90 Interstudy agreement for the different GLS and GCS methods. Abstract Figure 1\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"185 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75529306","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/JEAA356.107
H. B. D. Bon, A. Wilde, A. Amin, J. N. T. Sande, M. Ree, P. Postema, B. Bouma
Type of funding sources: None. An aberrant DPP6 mutation haplotype on chromosome 7 is associated with familial idiopathic ventricular fibrillation in severely affected Dutch families with numerous cases of sudden cardiac death (SCD) So far, no clinical parameters could be linked to predict SCD risk other than this genetic predisposition. In various other cardiac disease, global longitudinal strain (GLS) and mechanical dispersion (MD), both markers of left ventricular (LV) dysfunction, are predictive tools for patients at risk for ventricular arrhythmias (VA) and SCD. The goal of the current study was to investigate whether LV dysfunction, detected by GLS and MD, is present in patients with DPP6 haplotype. DPP6 risk-haplotype carriers with sufficient echocardiographic images were included as cases (n = 31, 15 males mean age 41 ± 11 years) and individuals evaluated during cascade screening who were tested but appeared not to be affected as controls (n = 14, 7 males, mean age 39 ± 12 years). Echocardiographic bi-plane ejection fraction (LVEF), GLS and MD of the left ventricular were determined. LVEF was similar between DPP6 cases (57.3%) and controls (60.5%, p = 0.07). In contrast, the GLS of the LV (-18.0%) of DPP6 cases was significant lower compared to controls (-21.1%, p < 0.0001). MD in DPP6 cases (43.4ms) was significantly higher than in controls (26.7ms, p < 0.0001). DPP6 risk- haplotype carriers have similar LVEF, but significant lower LV-GLS and higher mechanical dispersion than controls. These findings can be used for clinical discrimination. Whether these markers can be used for prediction of clinical events has to be determined after a longer follow up. echocardiographic characteristics controls DPP6 p-value LVEF (%) 60.5 57.3 0.07 GLS LV (%) -21.2 -18.0 0.0001 MD ( ms) 26.7 43.4 0.0001
{"title":"Patients with a DPP6 risk- haplotype for familial idiopathic ventricular fibrillation have normal left systolic function but abnormal deformation","authors":"H. B. D. Bon, A. Wilde, A. Amin, J. N. T. Sande, M. Ree, P. Postema, B. Bouma","doi":"10.1093/EHJCI/JEAA356.107","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.107","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 An aberrant DPP6 mutation haplotype on chromosome 7 is associated with familial idiopathic ventricular fibrillation in severely affected Dutch families with numerous cases of sudden cardiac death (SCD) So far, no clinical parameters could be linked to predict SCD risk other than this genetic predisposition. In various other cardiac disease, global longitudinal strain (GLS) and mechanical dispersion (MD), both markers of left ventricular (LV) dysfunction, are predictive tools for patients at risk for ventricular arrhythmias (VA) and SCD. The goal of the current study was to investigate whether LV dysfunction, detected by GLS and MD, is present in patients with DPP6 haplotype.\u0000 \u0000 \u0000 \u0000 DPP6 risk-haplotype carriers with sufficient echocardiographic images were included as cases (n = 31, 15 males mean age 41 ± 11 years) and individuals evaluated during cascade screening who were tested but appeared not to be affected as controls (n = 14, 7 males, mean age 39 ± 12 years). Echocardiographic bi-plane ejection fraction (LVEF), GLS and MD of the left ventricular were determined.\u0000 \u0000 \u0000 \u0000 LVEF was similar between DPP6 cases (57.3%) and controls (60.5%, p = 0.07). In contrast, the GLS of the LV (-18.0%) of DPP6 cases was significant lower compared to controls (-21.1%, p < 0.0001). MD in DPP6 cases (43.4ms) was significantly higher than in controls (26.7ms, p < 0.0001).\u0000 \u0000 \u0000 \u0000 DPP6 risk- haplotype carriers have similar LVEF, but significant lower LV-GLS and higher mechanical dispersion than controls. These findings can be used for clinical discrimination. Whether these markers can be used for prediction of clinical events has to be determined after a longer follow up.\u0000 echocardiographic characteristics controls DPP6 p-value LVEF (%) 60.5 57.3 0.07 GLS LV (%) -21.2 -18.0 0.0001 MD ( ms) 26.7 43.4 0.0001\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74583989","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/JEAA356.032
O. Sletten, J. Aalen, E. Remme, H. Izci, J. Duchenne, C. K. Larsen, E. Hopp, E. Galli, P. A. Sirnes, E. Kongsgård, E. Donal, J. Voigt, O. Smiseth, H. Skulstad
Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association Septal dysfunction is a main feature of left bundle branch block (LBBB), and increasing wall stress is a proposed mechanism of heart failure development in LBBB patients. To try to reveal the pathophysiologic pathway from dyssynchrony to heart failure, we investigated the relationship between septal and left ventricular (LV) lateral wall stress in patients with LBBB. Increased septal wall stress causes septal dysfunction in LBBB. We included 24 LBBB-patients (65 ± 11 years, 11 males) with LV ejection fraction (EF) ranging from 18 to 67%, and 8 healthy controls (58 ± 10 years, 4 males). Wall stress was calculated at peak LV pressure (LVP) according to the law of La Place ([LVP x radius]/[wall thickness]). Wall thickness was measured using M-mode, and regional curvature was measured in mid-ventricular shortaxis from 2D echocardiographic images. We used a previously validated non-invasive method to estimate LVP from brachial blood pressure and adjusted for valvular events. Myocardial scar was ruled out by late gadolinium enhancement cardiac magnetic resonance imaging. Wall stress was significantly higher in septum than LV lateral wall at peak LVP (48 ± 12 vs 37 ± 11 kPa, p < 0.01) in LBBB patients, while no difference was seen in the controls (Figure A). In patients, septal wall thickening showed a strong correlation with LVEF (r = 0.77, p < 0.01) (Figure B). Similar correlation was not significant for the LV lateral wall (r = 0.13, NS). Attenuation of septal wall thickening in LBBB-patients correlated well with increasing septal wall stress (r=-0.60, p < 0.01). Wall thickening and stress did not correlate in the LV lateral wall (r=-0.14, NS). Increased septal wall stress is associated with reduced systolic thickening in patients with LBBB. Septal wall thickening, in contrast to LV lateral wall thickening, was correlated to global LV function. These findings suggest that septal remodeling which could have normalized septal wall stress, was not achieved and heart failure may develop. Abstract Figure.
资金来源类型:公共机构。主要资金来源:挪威健康协会(Norwegian Health Association):室间隔功能障碍是左束支传导阻滞(LBBB)的主要特征，而壁应力增加是LBBB患者心力衰竭发展的一种机制。为了揭示从非同步化到心力衰竭的病理生理途径，我们研究了LBBB患者中隔和左室(LV)外壁应力之间的关系。室间隔壁压力增加导致LBBB的室间隔功能障碍。我们纳入24例左室射血分数(EF)在18% ~ 67%之间的lbbb患者(65±11岁，11名男性)和8名健康对照(58±10岁，4名男性)。根据La Place定律([LVP x半径]/[壁厚])计算峰值低压压力(LVP)时的壁应力。使用m模式测量壁厚，并通过二维超声心动图测量中心室短性的区域曲率。我们使用了一种先前验证过的非侵入性方法，通过肱血压来估计LVP，并根据瓣膜事件进行调整。晚期钆增强心脏磁共振成像排除心肌瘢痕。LBBB患者在LVP峰值时，室间隔壁应力明显高于左室侧壁(48±12 kPa vs 37±11 kPa, p < 0.01)，而对照组无差异(图A)。在患者中，室间隔壁增厚与LVEF有很强的相关性(r = 0.77, p < 0.01)(图B)，相似的相关性在左室侧壁无显著性(r = 0.13, NS)。lbbb患者室间隔壁增厚的减弱与室间隔壁应力的增加有良好的相关性(r=-0.60, p < 0.01)。左室侧壁壁增厚与应力无相关性(r=-0.14, NS)。在LBBB患者中，室间隔壁压力增加与收缩增厚减少有关。与左室侧壁增厚相比，室间隔壁增厚与左室整体功能相关。这些结果表明，可以使室间隔壁应力正常化的室间隔重塑没有实现，可能会发生心力衰竭。抽象的图。
{"title":"Elevated septal wall stress - a driver of left ventricular dysfunction in left bundle branch block?","authors":"O. Sletten, J. Aalen, E. Remme, H. Izci, J. Duchenne, C. K. Larsen, E. Hopp, E. Galli, P. A. Sirnes, E. Kongsgård, E. Donal, J. Voigt, O. Smiseth, H. Skulstad","doi":"10.1093/EHJCI/JEAA356.032","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.032","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association\u0000 \u0000 \u0000 \u0000 Septal dysfunction is a main feature of left bundle branch block (LBBB), and increasing wall stress is a proposed mechanism of heart failure development in LBBB patients. To try to reveal the pathophysiologic pathway from dyssynchrony to heart failure, we investigated the relationship between septal and left ventricular (LV) lateral wall stress in patients with LBBB.\u0000 \u0000 \u0000 \u0000 Increased septal wall stress causes septal dysfunction in LBBB.\u0000 \u0000 \u0000 \u0000 We included 24 LBBB-patients (65 ± 11 years, 11 males) with LV ejection fraction (EF) ranging from 18 to 67%, and 8 healthy controls (58 ± 10 years, 4 males). Wall stress was calculated at peak LV pressure (LVP) according to the law of La Place ([LVP x radius]/[wall thickness]). Wall thickness was measured using M-mode, and regional curvature was measured in mid-ventricular shortaxis from 2D echocardiographic images. We used a previously validated non-invasive method to estimate LVP from brachial blood pressure and adjusted for valvular events. Myocardial scar was ruled out by late gadolinium enhancement cardiac magnetic resonance imaging.\u0000 \u0000 \u0000 \u0000 Wall stress was significantly higher in septum than LV lateral wall at peak LVP (48 ± 12 vs 37 ± 11 kPa, p < 0.01) in LBBB patients, while no difference was seen in the controls (Figure A). In patients, septal wall thickening showed a strong correlation with LVEF (r = 0.77, p < 0.01) (Figure B). Similar correlation was not significant for the LV lateral wall (r = 0.13, NS). Attenuation of septal wall thickening in LBBB-patients correlated well with increasing septal wall stress (r=-0.60, p < 0.01). Wall thickening and stress did not correlate in the LV lateral wall (r=-0.14, NS).\u0000 \u0000 \u0000 \u0000 Increased septal wall stress is associated with reduced systolic thickening in patients with LBBB. Septal wall thickening, in contrast to LV lateral wall thickening, was correlated to global LV function. These findings suggest that septal remodeling which could have normalized septal wall stress, was not achieved and heart failure may develop.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79349193","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/JEAA356.223
M. Hol, Vincent L. Aengevaeren, A. Mosterd, T. Eijsvogels, B. Velthuis
Type of funding sources: None. Background A previous study reported a high prevalence (21%) of clinically relevant aortic dilatation (≥40 mm) in competitive veteran runners and rowers. It is uncertain whether this also applies to middle-aged sportsmen performing other sporting disciplines. Purpose To relate aortic dimensions to sporting disciplines in middle-aged sportsmen. Methods Middle-aged sportsmen, ≥45 years of age, underwent coronary CT angiography. Aortic size was measured at the sinus of Valsalva (cusp-cusp) and the ascending aorta (at the height of the pulmonary trunk). Dominant sporting discipline was categorized as running, cycling or other. Analysis of variance was used to compare baseline characteristics and aortic dimensions across sporting disciplines. Multivariable linear regression was used to adjust for baseline characteristics. Results A total of 260 sportsmen (mean age 55.1 ± 6.4 years; 64 runners, 75 cyclists and 121 other sporting disciplines) were included (Table). Clinically relevant aortic dilatation was found in 5.0% (n = 13). Aortic size or presence of aortic dilatation did not differ across sporting disciplines. Ascending aorta and aortic root size were significantly related to age, body surface area, diastolic blood pressure and exercise tolerance, but not sporting disciplines. Conclusions We found clinically relevant aortic dilatation in 5% of middle-aged sportsmen. Aortic size was not different between sporting disciplines. Aortic size may be more related to level of exercise performance rather than sporting discipline. Running (n = 64) Cycling (n = 75) Other (n = 121) p value Participant characteristics Age, yrs 54.6 ± 6.4 56.1 ± 6.8 54.8 ± 6.2 0.30 Systolic BP, mmHg 129 ± 12 128 ± 13 129 ± 12 0.95 Diastolic BP, mmHg 80 ± 8 79 ± 8 80 ± 9 0.32 Body surface area, m2 2.03 ± 0.14 2.02 ± 0.15 2.07 ± 0.15 0.08 Exercise tolerance, Watt 310 ± 42* 329 ± 47 307 ± 48 0.003 Aortic dimensions Ascending aorta maximum diameter, mm 32.5 ± 3.1 33.0 ± 3.8 32.5 ± 3.6 0.64 SoV mean diameter, mm 34.3 ± 2.8 34.1 ± 2.8 33.7 ± 3.2 0.46 SoV, NCC-RCC diameter, mm 34.2 ± 2.9 34.0 ± 2.9 33.7 ± 3.4 0.61 Any aortic diameter ≥40 mm, n (%) 3 (4.7) 2 (2.7) 8 (6.6) 0.46 Values are mean SD or n (%). *significantly different from cycling and other. BP = blood pressure; SoV = sinus of Valsalva; NCC = non-coronary cusp; RCC = right coronary cusp
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