Abstract
Left atrial (LA) dimensions, wall composition and function strongly depend on left ventricular (LV) diastolic function and impaired in patients with preclinical diastolic disfunction (PDD), ...which increases the likelihood of atrial fibrillation (AF) occurrence. LA longitudinal strain (LALS) is a sensitive parameter of subclinical myocardial changes and its reduction might be predictive for AF.
Methods
168 patients (90 female) 68±9 years with arterial hypertension in sinus rhythm with preserved systolic function (LVEF>50%) and PDD and without renal or valvular disease and 45 age and sex matched healthy controls were followed up for 2 years. PDD was diagnosed at stress echocardiography (SE) if E/e' ≥13, transmittal E wave deceleration time reduction >50ms, systolic pulmonary artery pressure (sPAP) >30 mmHg, and patients remained asymptomatic. LALS was measured by speckle tracking echocardiography as average value of two basal segments in 4 chamber view along with LA end-systolic volume index (LAVi), LA EF, LV mass index (LVMi), and LVLS. 72 hours Holter monitoring was performed every 6 months.
Results
Patients with PDD had larger LAVi, less LALS, higher LVLS and bigger LVMi compared with controls (LAVi 30.5±4.9 ml/m2 vs 23.1±4.8 ml/m2, p<0.001; LALS 34.7±6.9% vs 45±4.3%, p<0.001; LVLS –17.4±2.4% vs –20.8±2.1%, p<0.002; LVMi 81.8±12.3 g/m2 vs 68±9.2 g/m2, p<0.001). AF was registered in 42 (25%) patients with PDD. LAVi, LVLS and LVMi did not significantly differ in PDD patients with or without incidents of AF however LALS was significantly less in patients with AF (26.8±7.5% vs 37.2±8.1%, p<0.01). Multivariate analysis defined LALS as an independent predictor of AF development (OR=2.4; 95% CI=2.41–5.96; p<0.01) with the cut-off value of 28.9%.
Conclusion
LA peak reservoir LS is an independent predictor of AF development in patients with PDD.
Abstract
Mitral regurgitation (MR) leads to subclinical changes that often cannot be detected by low sensitive conventional parameters and early predictors of deterioration could suggest a better ...timing for intervention.
Methods
We follow up 175 asymptomatic patients 56±13 years (79 female) with severe primary MR in sinus rhythm and without diabetes mellitus and renal disease for 2 years. Global longitudinal strain (LS) of left ventricle (LVGLS), right ventricular (RV) free wall LS (RVLS), and left atrial (LA) peak reservoir LS as average of two basal segments in 4 chamber view were measured by speckle tracking along with indexes of LV end-systolic and end-diastolic volumes, LV ejection fraction (EF), left atrial end-systolic volume index (LAVi) every 6 months. Normal reference values of LS were obtained from age and sex matched 40 healthy controls.
Results
Patients with MR had higher LV ejection fraction (EF), LVGLS, LALS and lower values of RVLS compared with controls (EF 67.4±5% vs 59.3±4%, p<0.05; LVGLS –25.2±2.3% vs –21.2±1.9%, p<0.03; LALS 46.2±5.1% vs 42.4±3.7%, p<0.04; RVLS –23.4±5.1% vs –27.3±2.8%, p<0.03). 53 (30%) patients developed symptoms at exercise during follow up. Symptomatic patients at baseline had higher values of RVLS compared with patients who remained asymptomatic during follow up without significant differences in EF, LVGLS, LALS (RVLS –21.4±2.6% vs –25.8±3.2%, p<0.02; EF 66.8±2.4% vs 68.1±3.1%, p>0.05; LVGLS –24.8±2.1% vs –25.3±2.3%, p>0.05; LALS 45.7±4.1% vs 46.5±4.4%, p>0.05). RVLS correlated with LAVi (r=0.53, p<0.01) and LALS (r=0.57, p<0.01). Regression analysis defined RVLS as an independent predictor of symptoms development (OR=3.2; 95% CI=1.37–7.63; p<0.01).
Conclusion
RV longitudinal strain predicts symptoms in patients with chronic primary mitral regurgitation.
Abstract
Preclinical diastolic disfunction (PDD) often progresses to heart failure and distinct clinical predictors for this transformation are yet to be defined. Since deterioration of longitudinal ...strain (LS) can occur before the changes of more conventional parameters, we assumed that right ventricular free wall longitudinal strain (RVLS) might start deteriorating before the pulmonary hypertension can be established.
Methods
We followed up 243 patients (143 female) 67±9 years with PDD for 3 years. All patients had an impaired relaxation or pseudo normal transmitral patterns and E/e' 8–13 at rest, normal NT-proBNP values, and systolic pulmonary artery pressure (sPAP) ≤30 mm Hg. PDD was diagnosed by stress echocardiography (SE) if E/e' ≥13, transmittal E wave deceleration time reduction >50ms, systolic pulmonary artery pressure (sPAP) <30 mmHg, and patients remained asymptomatic during SE. RVLS as average of RV free wall 3 segments values, left atrial peak reservoir LS (LALS) as average of two LA basal segments in four chamber view and left ventricular peak systolic global LS (LVGLS) were measured by speckle tracking (ST). ST and SE was performed with 6 months intervals. 35 healthy subject served as controls.
Results
Patients with PDD had higher RVLS, LVGLS, and lower LALS compared with controls (RVLS –23.2±4.2% vs –27.3±5.1%, p<0.001; LVGLS –17.8±5.2% vs –21.9±2.8%, p<0.001; LALS 39.7±3.7% vs 44.1±4.9%, p<0.002). 76 (31.3%) patients developed sPAP increase >30 mmHg at rest or SE during follow up of which 34 (44.7%) had dyspnea. Patients with increased sPAP had higher RVLS and lower LALS values at baseline compared with the rest of PDD patients without significant differences in other parameters (RVLS –17.9±2.8% vs –24.8±3.6%, p<0.002; LALS 37.7±2.3% vs 41.5±3.6%, p<0.003; LVGLS –17.4±4.8% vs –18.2±5.1%, p>0.05). Both LALS and RVLS correlated with LA end diastolic volume index (LALS r=0.51, p<0.01; RVLS r=0.54, p<0.01). Additionally RVLS was an independent predictor of sPAP rise (OR=2.7; 95% CI=2.43–6.92; p<0.01).
Conclusion
RVLS is an independent predictor of sPAP increase in patients with PDD.
Abstract
Background
Despite advances in treatment of heart failure with preserved ejection fraction (HFpEF) its management remains challenging. SGLT2 inhibitors benefits across the full range of ...ejection fraction, and sacubitril/valsartan benefits up to the lower end of preserved EF <57% implies that in some patients with HFpEF some pathophysiological mechanisms of HFrEF might co-exist, and some subset of HFpEF patients might benefit from proven treatment of HFrEF, particularly those with EF deterioration over time. We aimed to found out predictors of EF deterioration in HFpEF patients assuming that we can start treating them earlier with therapies of HFrEF, preventing further deterioration.
Methods
We studied 215 patients (63% women) 73±8 years with HFpEF. All patients had records of comorbidity Charlson index (CI), glomerular filtration rate (GFR). Echocardiography (EchoCG) was performed with offline analysis, including calculations of myocardial work (MW), global longitudinal (LS), radial (RS), circumferential (SS) and area strain (AS) by one experienced specialist. GW index was obtained from pressure-strain loops derived from speckle tracking analysis multiplied by brachial systolic blood pressure. Global constructive work (GCW) as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, global wasted work as energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency as the percentage ratio of constructive work to the sum of constructive work and wasted work were obtained. RS, SS and AS were calculated in 3D by dedicated software. Patients followed up for 3 years.
Results
5 patients developed myocardial infarction and were excluded from the study. Baseline EF was higher in women (61,2±3,1 vs 56,4±2,7; P<0.002), in patients >70 years (62,4±2,1 vs 57,1±2,3; p<0.005), and with end-diastolic volume index <60 ml/m2 (56,1±3,2 vs 63,4±2,3; p<0.001). Overall decline in EF compare to baseline was −7.3±1.6%, p<0.01. Reduction in EF was more prominent in patients >70 years (−6,9±1,8 vs −5,7±1,7; P<0,002), and in patients with coronary artery disease (CAD) (−7,2±1,9 vs −5,8±1,6; P<0,001) and did not relate to sex, LV size, CI, and GFR. During follow up 58 (27%) patients had EF <50%. We observed significant worsening in AS (−27.9±8.5% vs −24.7±5.3%, p<0.003), LS (−19.7±2.4% vs −17.1±1.6%, p<0.005), and GCW (GCW 2378±117 vs 2107±102 mmHg%, p<0.002). Patients with EF <50% at the end of the study had significantly less AS and GCW baseline values compared with patients with EF>50% (22.4±7.2% vs −27.6±8.1%, p<0.002; 2081±92 vs 2489±127 mmHg%, p<0.001). GCW was the predictor of EF deterioration (area under curve 0,875).
Conclusion
GCW predicts reduction of EF in patients with HFpEF which may help earlier identify the subset of HFpEF patients who may benefit from proven therapies for HFrEF and prevent upcoming deterioration.
Funding Acknowledgement
Type of funding sources: None.
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