Abstract
Accurate surgical timing for significant primary mitral regurgitation (PMR) still remains an issue despite of several ways of left ventricular (LV) hidden disfunction detection, including ...LV global longitudinal strain (GLS). Since novel modalities such as myocardial work (MW) or area strain (AS) are currently available we assumed that they might predict surgical timing beyond known parameters.
Methods
58 patients (31 female) 63±8 years, asymptomatic and with pulmonary systolic pressure (PSP) ≤45 mmHg on exercise echo test (ET), with PMR, in sinus rhythm, with ejection fraction (EF) ≥65% and GLS <−19.5% were enrolled into the study along with 23 healthy subjects matched by age and sex and followed up for 1 year. Comprehensive echocardiography (EchoCG) was performed with offline analysis including MW and AS by one experienced specialist. GW index (GWI) 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 (GWW) aa energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency (GWE) as the percentage ratio of constructive work to the sum of constructive work and wasted work were obtained by the dedicated software.
Results
13 (22%) patients with PMR became symptomatic or increase PSP >50 mmHg on ET in 1 year follow up. EF, GLS, AS and GWI did not differ between symptomatic patients and those who remained asymptomatic during follow up, however these patients had significantly lower values of GCW, and higher values of GWW (EF 68.3±6.1% vs 69.2±6.5%, p=NS; GLS –22.4±2.3% vs 23.1±3.2%, p=NS, GWI 2452±161 mmHg% vs 2479±147 mmHg%, p=NS; GCW 1875±119 mmHg% vs 2321±124 mmHg%, p<0.01; GWW 118±9 mmHg% vs 88±7 mmHg%, p<0.03; GWE 93±8% vs 96±9%, p=NS; AS −32.5±5.4% vs −34.3±6.1%, p=NS;). Patients with subsequent symptoms development had significantly lower values of GCW and higher values of GWW. Among all parameters GCW was the predictor of MR clinical course worsening (AUC 0.769).
Conclusion
MR GCW is able to predict clinical course of patients with PMR beyond known conventional parameters.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): City Hall resources
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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