Abstract
The aim of this study was to assess longitudinal systolic function and mechanical synchrony parameters derived from advanced speckle tracking echocardiography (STE) and to determine their correlation with N-terminal prohormone of brain natriuretic peptide (NT-proBNP). Their influence on heart failure (HF) outcomes at a one-year follow-up, not clarified in previous studies, was also examined. Advanced STE was performed from August 2009 to January 2012 in 103 chronic HF patients at the University Kebangsaan Malaysia Medical Center to assess their longitudinal systolic function and synchrony parameters; NT-proBNP blood measurement was taken at the same time. Longitudinal cardiac velocity; strain; strain rate; displacement; intraventricular mechanical dyssynchrony based on the standard deviation (SD) of time to peak systolic strain rate (Tsr-SD); displacement, and antero-septal to posterior (AS-P) delay were associated with cardiac events. In multivariate analysis, NT-proBNP and AS-P delay were identified as independent predictors for cardiac events. Significant correlations were found between NT-proBNP and longitudinal velocity; displacement; strain; strain rate, and ejection fraction. Log NT-proBNP levels correlated moderately with the SD of time to peak displacement and to peak strain, and there was a small correlation with maximal differences and SD of time to peak velocity. A multiple linear analysis revealed that NT-proBNP levels significantly correlated to age, ejection fraction and velocity. Advanced STE is a promising technique which accelerates the clinical application of the quantification of myocardial function and synchrony. STE parameters and NT-proBNP have the ability to identify patients at higher risk of death and hospitalisation.
Highlights
Advances in Knowledge - This is the first study of its kind in Malaysia and the Middle East that uses multiple parameters derived from the advanced twodimensional strain tool speckle tracking echocardiography (STE) supplemented by N-terminal prohormone of brain natriuretic peptide to predict cardiac events
Simple linear regression analysis was performed between log NT-proBNP levels as a dependent parameter and age and other independent parameters of cardiac function and left ventricular (LV) intraventricular mechanical dyssynchrony indices derived from advanced STE
The advanced 2D-strain tool STE is a promising technique which is accelerating the clinical application of the quantification of myocardial velocity and deformation
Summary
Advances in Knowledge - This is the first study of its kind in Malaysia and the Middle East that uses multiple parameters derived from the advanced twodimensional strain tool speckle tracking echocardiography (STE) supplemented by N-terminal prohormone of brain natriuretic peptide to predict cardiac events. - STE is breaking new ground in heart failure (HF) monitoring and therapy so that treatment can be administrated earlier to high-risk patients as part of a HF management programme. The prognosis for patients with HF remains poor.[1,2] One possibility to improve HF management would be early detection and treatment of left ventricular (LV) dysfunction, which has traditionally been evaluated as left ventricular ejection fraction (LVEF) and LV endsystolic volume, both regarded as the simplest and most widely used parameters for global assessment of LV function.[3] Recently, new echocardiographic techniques have been introduced to evaluate myocardial mechanics. Tissue Doppler imaging (TDI) and two-dimensional (2D) speckle tracking echocardiography (STE) allow more objective quantification of myocardial mechanics in the form of tissue velocities, displacement, strain, strain rate and mechanical dyssynchrony assessment
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