Detection Of Left Ventricular Systolic Dysfunction Research Articles

Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease

BACKGROUND Peripheral vascular disease (PVD) is a common complication of type 2 diabetes mellitus (T2DM). Patients with T2DM have twice the risk of PVD as nondiabetic patients. AIM To evaluate left ventricular (LV) systolic function by layer-specific global longitudinal strain (GLS) and peak strain dispersion (PSD) in T2DM patients with and without PVD. METHODS Sixty-five T2DM patients without PVD, 57 T2DM patients with PVD and 63 normal controls were enrolled in the study. Layer-specific GLS [GLS of the epimyocardium (GLSepi), GLS of the middle myocardium (GLSmid) and GLS of the endocardium (GLSendo)] and PSD were calculated. Receiver operating characteristic (ROC) analysis was performed to calculate the sensitivity and specificity of LV systolic dysfunction in T2DM patients with PVD. We calculated Pearson’s correlation coefficients between biochemical data, echocardiographic characteristics, and layer-specific GLS and PSD. RESULTS There were significant differences in GLSepi, GLSmid and GLSendo between normal controls, T2DM patients without PVD and T2DM patients with PVD (P < 0.001). Trend tests revealed a ranking of normal controls > T2DM patients without PVD > T2DM patients with PVD in the absolute value of GLS (P < 0.001). PSD differed significantly between the three groups, and the trend ranking was as follows: normal controls < T2DM patients without PVD < T2DM patients with PVD (P < 0.001). ROC analysis revealed that the combination of layer-specific GLS and PSD had high diagnostic efficiency for detecting LV systolic dysfunction in T2DM patients with PVD. Low-density lipoprotein cholesterol was positively correlated with GLSepi, GLSmid and PSD (P < 0.05), while LV ejection fraction was negatively correlated with GLSepi, GLSmid and GLSendo in T2DM patients with PVD (P < 0.01). CONCLUSION PVD may aggravate the deterioration of LV systolic dysfunction in T2DM patients. Layer-specific GLS and PSD can be used to detect LV systolic dysfunction accurately and conveniently in T2DM patients with or without PVD.

Artificial Intelligence Applied to Cardiomyopathies: Is It Time for Clinical Application?

Artificial intelligence (AI) techniques have the potential to remarkably change the practice of cardiology in order to improve and optimize outcomes in heart failure and specifically cardiomyopathies, offering us novel tools to interpret data and make clinical decisions. The aim of this review is to describe the contemporary state of AI and digital health applied to cardiomyopathies as well as to define a potential pivotal role of its application by physicians in clinical practice. Many studies have been undertaken in recent years on cardiomyopathy screening especially using AI-enhanced electrocardiography (ECG). Even with mild left ventricular (LV) dysfunction, AI-ECG screening for amyloidosis, hypertrophic cardiomyopathy, or dilated cardiomyopathy is now feasible. Introduction of AI-ECG in routine clinical care has resulted in higher detection of LV systolic dysfunction; however, clinical research on a broader scale with diverse populations is necessary and ongoing. In the area of cardiac-imaging, AI automatically assesses the thickness and characteristics of myocardium to differentiate cardiomyopathies, but research on its prognostic capability has yet to be conducted. AI is also being applied to cardiomyopathy genomics, especially to predict pathogenicity of variants and identify whether these variants are clinically actionable. While the implementation of AI in the diagnosis and treatment of cardiomyopathies is still in its infancy, an ever-growing clinical research strategy will ascertain the clinical utility of these AI tools to help improve diagnosis of and outcomes in cardiomyopathies. We also need to standardize the tools used to monitor the performance of AI-based systems which can then be used to expedite decision-making and rectify any hidden biases. Given its potential important role in clinical practice, healthcare providers need to familiarize themselves with the promise and limitations of this technology.

Deep learning analysis of resting electrocardiograms for the detection of myocardial dysfunction, hypertrophy, and ischaemia: a systematic review.

The aim of this review was to assess the evidence for deep learning (DL) analysis of resting electrocardiograms (ECGs) to predict structural cardiac pathologies such as left ventricular (LV) systolic dysfunction, myocardial hypertrophy, and ischaemic heart disease. A systematic literature search was conducted to identify published original articles on end-to-end DL analysis of resting ECG signals for the detection of structural cardiac pathologies. Studies were excluded if the ECG was acquired by ambulatory, stress, intracardiac, or implantable devices, and if the pathology of interest was arrhythmic in nature. After duplicate reviewers screened search results, 12 articles met the inclusion criteria and were included. Three articles used DL to detect LV systolic dysfunction, achieving an area under the curve (AUC) of 0.89–0.93 and an accuracy of 98%. One study used DL to detect LV hypertrophy, achieving an AUC of 0.87 and an accuracy of 87%. Six articles used DL to detect acute myocardial infarction, achieving an AUC of 0.88–1.00 and an accuracy of 83–99.9%. Two articles used DL to detect stable ischaemic heart disease, achieving an accuracy of 95–99.9%. Deep learning models, particularly those that used convolutional neural networks, outperformed rules-based models and other machine learning models. Deep learning is a promising technique to analyse resting ECG signals for the detection of structural cardiac pathologies, which has clinical applicability for more effective screening of asymptomatic populations and expedited diagnostic work-up of symptomatic patients at risk for cardiovascular disease.

Preoperative Point-of-Care Assessment of Left Ventricular Systolic Dysfunction With Transthoracic Echocardiography.

Left ventricular (LV) systolic dysfunction is an acknowledged perioperative risk factor and should be identified before surgery. Conventional echocardiographic assessment of LV ejection fraction (LVEF) obtained by biplane LV volumes is the gold standard to detect LV systolic dysfunction. However, this modality needs extensive training and is time consuming. Hence, a feasible point-of-care screening method for this purpose is warranted. The aim of this study was to evaluate 3 point-of-care echocardiographic methods for identification of LV systolic dysfunction in comparison with biplane LVEF. One hundred elective surgical patients, with a mean age of 63 ± 12 years and body mass index of 27 ± 4 kg/m2, were consecutively enrolled in this prospective observational study. Transthoracic echocardiography was conducted 1-2 hours before surgery. LVEF was obtained by automatic two-dimensional (2D) biplane ejection fraction (EF) software. We evaluated if Tissue Doppler Imaging peak systolic myocardial velocities (TDISm), anatomic M-mode E-point septal separation (EPSS), and conventional M-mode mitral annular plane systolic excursion (MAPSE) could discriminate LV systolic dysfunction (LVEF <50%) by calculating accuracy, efficiency, correlation, positive (PPV) respective negative predictive (NPV) values, and area under the receiver operating characteristic curve (AUROC) for each point-of-care method. LVEF<50% was identified in 22% (21 of 94) of patients. To discriminate an LVEF <50%, AUROC for TDISm (mean <8 cm/s) was 0.73 (95% confidence interval [CI], 0.62-0.84; P < .001), with a PPV of 47% and an NPV of 90%. EPSS with a cutoff value of >6 mm had an AUROC 0.89 (95% CI, 0.80-0.98; P < .001), with a PPV of 67% and an NPV of 96%. MAPSE (mean <12 mm) had an AUROC 0.80 (95% CI, 0.70-0.90; P < 0.001) with a PPV of 57% and an NPV of 98%. All 3 point-of-care methods performed reasonably well to discriminate patients with LVEF <50%. The clinician may choose the most suitable method according to praxis and observer experience.

Value of Speckle Tracking Echocardiography as a Predictor of the Deleterious Effect of Right Ventricular Pacing on Left Ventricular Function

Background: Pacemaker-induced cardiomyopathy (PICM) is reported in different articles but with variable incidence. Aim: The aim of the study is to determine the validity of speckle tracking echocardiography as a predictor of the deleterious effect of right ventricular (RV) pacing on left ventricular (LV) function, using two-dimensional guided global and segmental longitudinal strain. Materials and Methods: Fifty patients with conventional indications for permanent pacemaker implantation were studied; they were classified to Group A (37 = 74%) patients who didn't show a significant reduction of ejection fraction (EF) (&gt;10%) and Group B (13 = 26%) represent patients who showed a significant reduction of EF. Group C constituted 25 healthy persons (control group). We defined PICM when EF is reduced &gt;10%. Results: The incidence of pacemaker-induced ventricular dysfunction was 26%. Statistical analysis revealed that left atrial volume index (LAVI), global longitudinal strain (GLS), native-QRS duration, and ischemic heart disease were significant predictors of reduction of LV function, however, on multivariate regression analysis, only the LAVI and GLS were independent predictors of reduction of LVEF after permanent pacing. Conclusions: Speckle tracking echocardiography is a new, unique and evolving tool to assess the myocardial deformation which can detect LV systolic dysfunction much earlier than can be reflected in LVEF. The importance of defining predictors is to predict whom patient will be at risk for the deleterious effect of RV pacing on LV function, and who will need observation with possible upgrading to biventricular pacing.

Left ventricular functions in patients with beta-thalassemia major: a speckle tracking imaging study

Objectives To assess left ventricular (LV) functions in patients with beta-thalassemia major (β-TM) on regular blood transfusion (without cardiac manifestations) by speckle tracking echocardiography and correlate the findings with serum ferritin levels of these patients. Background Patients with β-TM have extravasal hemolysis and ineffective erythropoiesis, resulting in severe anemia. Thus, they require regular blood transfusions, which results in iron overload. Patients with thalassemia absorb more iron than normal individuals. Iron overload results in iron deposition in a variety of parenchymal tissues including the heart leading to ventricular systolic and diastolic dysfunctions. Iron-mediated cardiomyopathy is the main cause of death in patients with thalassemia. Early detection of cardiac abnormalities is important as aggressive chelation therapy may improve prognosis in these patients. Patients and methods A total of 50 patients with β-TM on regular blood transfusion for more than or equal to 4 years and 25 sex-matched and age-matched controls were included. The laboratory parameters measured were blood hemoglobin and ferritin, which were measured 2 h before doing echocardiography with Doppler imaging and speckle tracking analysis. Results There were no significant differences in LV ejection fraction and fractional shortening between the groups by conventional echocardiography. However, by using speckle tracking echocardiography, systolic strain and strain rate of the LV walls were significantly lower in patients with thalassemia. Conclusion Patients with thalassemia have regional systolic dysfunction in the LV walls, even if they do not have overt heart failure. Strain imaging is more helpful than conventional echocardiography in early detection of LV systolic dysfunction in patients with thalassemia.

Left ventricular assessment in patients with systemic light chain amyloidosis: a 3-dimensional speckle tracking transthoracic echocardiographic study.

Cardiac involvement in systemic light chain (AL) amyloidosis carries a poor prognosis mainly through involvement of the left ventricular (LV) myocardium. Despite its limitations, two-dimensional transthoracic echocardiography (2D-TTE) remains the main tool used for the assessment of LV systolic function in AL patients. We hypothesize that 3D-TTE coupled with speckle tracking imaging allows earlier detection of LV systolic dysfunction than 2D-TTE in AL amyloidosis. We prospectively studied 71 subjects including 58 patients with confirmed AL amyloidosis (mean age 66 ± 10years, 60% male) and 21 healthy control (mean age 64 ± 7years, 48% male) from 2011 to 2014at the University Hospital of Limoges. The AL patients were divided into three groups according to Mayo Clinic (MC) staging and all subjects underwent 2D-TTE and 3D-TTE at the same setting. Using 2D-TTE, there was no significant difference in LV ejection fraction (EF) between the groups [LVEF = 63 ± 7% (control), 59 ± 6% (MC stage I), 60 ± 8% (MC stage II) and 57 ± 14% (MC stage III) (p = 0.24)]. In contrast, 3D-TTE demonstrated significantly worse LV systolic function in stage II and III patients using 3D-LVEF [MC II and III 45 ± 8% and 39 ± 12% vs. control 53 ± 8% (p < 0.0001)], global longitudinal strain (GLS) [MC II and III - 11 ± 4% and - 8 ± 3% vs. control - 15 ± 3% (p < 0.0001)] and global radial strain (GRS) [MC II and III 14 ± 9% and 10 ± 8% vs. control 25 ± 10% (p < 0.0001)]. Furthermore, MC III patients had significantly worse global circumferential strain and area tracking [- 17 ± 6% and - 25 ± 8% vs. - 24 ± 7% and - 36 ± 7% for control (p < 0.0001)]. Additionally, MC I had significantly better 3D GLS, GRS and global strain (- 15 ± 3%, 25 ± 10% and 28 ± 12%) than MC II (- 11 ± 4%, 14 ± 9% and 16 ± 10%) and MC III patients (- 8 ± 3%, 10 ± 8% and 12 ± 8%), respectively. Despite an apparently preserved LVEF by 2D-TTE, AL patients in MC stage II and III demonstrate evidence of LV systolic dysfunction by 3D imaging using LVEF and strain analysis. Worse LV involvement by AL amyloidosis was associated with more impaired 3D-TTE LV systolic parameters.

Assessment of left ventricular functions and its correlation to the severity of liver cirrhosis caused by hepatitis C virus by different echocardiography modalities (two-dimensional speckle-tracking echocardiography study)

Background Cardiovascular abnormalities are associated with liver cirrhosis observed especially under conditions of stress, so it is important to evaluate the cardiovascular function in every patient with cirrhosis. The Child–Pugh scoring system is the most commonly used clinical method for classifying liver cirrhosis. Tissue Doppler imaging and Two-dimensional speckle-tracking echocardiography (2D-STE) are newer imaging modalities able to accurately quantify left ventricular (LV) systolic function.Aim To assess LV functions in patients with chronic liver cirrhosis caused by hepatitis C virus by different echo modalities and correlate the results with the severity of cirrhosis based on Child–Pugh score.Material and methods A prospective study was done in the Echocardiography Unit, Cardiology Department, Al-Zahraa University Hospital, during a period of one year, including 75 participants, with 45 cirrhotic patients and 30 healthy individuals. For all patients, 2D-STE of the LV was measured. Then the patients with liver cirrhosis were divided into three subgroups according to Child–Pugh score, and LV functions were evaluated with conventional echo, tissue Doppler imaging (TDI), and STE.Results By conventional echo, the LV systolic function increased in the diseased group (P=0.004) but decreased when using TDI and STE. Then the patient group was divided into three subgroups based on the Child–Pugh score. By conventional echo parameters, there were normal LV dimensions in the three groups but increased in class C with lowered systolic function by using 2D-STE. Conventionally, LV diastolic dysfunction was diagnosed in 30% but in 75% when using TDI. There is a correlation between severity of liver cirrhosis and LV systolic dysfunction when measured only by 2D-speckle tracking.Conclusion The 2D-STE is considered a useful tool for early detection of LV systolic dysfunction especially in asymptomatic patients with viral liver cirrhosis. The LV diastolic dysfunction occurs earlier in cirrhotic patients. There is correlation between the extent of severity of liver cirrhosis and LV systolic dysfunction.

Correlations of left ventricular systolic function indices with aortic root systolic excursion (ARSE): A cross-sectional echocardiographic study.

BackgroundHeart failure (HF), is a major public health issue globally. Echocardiography is cost–effective in the diagnosis in expert hands. This study was conducted to estimate the usefulness of Aortic Root Systolic Excursion (ARSE) as a simple and accurate measure to estimate Left Ventricular (LV) function.MethodsThis was a cross-sectional echocardiographic study among adults aged ≥ 18 years, with or without heart failure, in sinus rhythm, and with no LV out–let obstruction. We studied the correlations of ARSE with some selected indices of LV Systolic Functions. We determined optimal cut–offs of ARSE in detecting LV dysfunction. We generated a simple regression equation to best estimate LV ejection fraction according to the modified Simpson method.ResultsOverall 213 echocardiograms were included from 106 males (49.8%), with mean age of the participants being 52.4 (SD: 18.3) years. The rate of LV systolic dysfunction was highest with Teicholz method (17.4%) and lowest with MAPSE method (5.2%). ARSE correlated with the LV functions. This was highest for the Simpson method (r = 0.619, p<0.001), and lowest for the ITV method (r = 0.319, p<0.001). Optimal cut-offs to detect LV systolic dysfunction was ≈ 6.6 mm. For an LV ejection fraction < 55%, the sensitivity was 82.9%, and the specificity was 97.2%, with an AUROC of 91.6%.The logarithmic regression equation was best in predicting LV ejection fraction (AUC: 60.2%), followed by the power model (AUC: 56.7%), and the linear model (AUC: 53.6%).ConclusionARSE correlated well with LV systolic function. The cut–off ≤ 6.5 mm suggest LV systolic dysfunction. LV Ejection Fraction was best estimated with the generic equation: LVEF (%) = 29 x In [ARSE].

Assessment of Subclinical Myocardial Changes in Non-Alcoholic Fatty Liver Disease: A Case-Control Study Using Speckle Tracking Echocardiography.

Considering the association between cardiac abnormalities and non-alcoholic fatty liver disease (NAFLD), the present study aimed to evaluate the relationship between biopsy-proven NAFLD and functional echocardiographic parameters, including left ventricular (LV) global longitudinal strain (GLS) in asymptomatic individuals. Thirty asymptomatic patients with liver biopsy-proven NAFLD and the same number with no evidence of fatty liver in ultrasonography were enrolled in the study as cases and controls, respectively. The measured echocardiographic parameters included LV ejection fraction (LVEF), LV end-systolic and end-diastolic dimensions (ESD, EDD), LV end-systolic and end-diastolic volumes (ESV, EDV), E/e' ratio (early-diastolic mitral inflow velocity/early-diastolic myocardial velocity), E/A ratio (early-diastolic mitral inflow velocity/late-diastolic mitral inflow velocity), and GLS. Data were analyzed using the SPSS statistical software (version 18.0) by performing the independent t test, Chi-square, and non-parametric Mann-Whitney U tests. P values <0.05 were considered statistically significant. A significant difference in ESD (32.1±1.4 mm vs. 34±1.8 mm), EDD (41.9±1.7 mm vs. 45.2±3.1 mm), and E/e' ratio (8.4±0.8 vs. 7.4±1.2) was detected among individuals with NAFLD compared with those without NAFLD (P<0.001 for the first two parameters and P=0.002 for the last one). GLS was also significantly lower in NAFLD patients than in controls, but within normal levels (19.3%±2.0 vs. 21.2%±1.4, P<0.001). The findings support the presence of subclinical cardiovascular structural and functional changes in patients affected by NAFLD. It also indicates that the use of GLS is more sensitive than LVEF for the detection of LV systolic dysfunction in NAFLD patients.

Use of Speckle Tracking Echocardiography to Assess Left Ventricular Systolic Function in Patients with Surgically Repaired Tetralogy of Fallot: Global and Segmental Assessment.

Patients with repaired Tetralogy of Fallot (rToF) can have significant right and left ventricular dysfunction which can impact clinical outcome. Conventional echocardiographic evaluation using ejection fraction can be limited in detecting early stages of deteriorating left ventricular (LV) systolic function. Speckle-tracking echocardiography (STE) provides a promising emerging tool for early detection of LV systolic dysfunction. The aim of this cross-sectional study is to evaluate the left ventricular global and regional function using STE in rToF patients with preserved left ventricular ejection fraction to detect early signs of LV dysfunction. The study is a retrospective review of the medical records and transthoracic echocardiograms of rTOF patients who were seen in the pediatric cardiology clinic at our institution from August 2016 till May 2018. The rTOF group was compared with a matched healthy control group. Offline strain analysis of TTE studies was completed in each subject according to mode set by the American Society of Echocardiography. Twenty-two patients with rTOF and 22 age-matched controls (rTOF 18.7 ± 6years and control 14.6 ± 9.6 years, P value 0.19) were included during the study period. The rTOF group consisted of 12 males and 10 females, whereas the control group consisted of 15 males and 7 females. There was no significant difference in terms of LV ejection fraction using both 2-chamber as well as 4-chamber views. Global LV longitudinal strain was significantly lower in the rTOF group compared with the control group (rTOF - 15.92 ± 3.16 vs control - 22.79 ± 2.45, P value 0.00). All 17 segments showed significantly lower longitudinal strains in rTOF group compared with the control group. Global circumferential left ventricle strain was significantly lower in the rTOF patients compared with the control group (- 17.24 ± 5.86 vs - 22.74 ± 3.99, P value 0.001). 13 out of 16 segments had lower circumferential strains in the rTOF patients compared with controls. Asymptomatic surgically repaired TOF patients exhibited abnormal segmental and global left ventricle longitudinal and circumferential strains despite having normal left ventricle ejection fraction. Our findings suggest subclinical damage to the left ventricle systolic function post-surgical repair of TOF. 2-D speckle-tracking echocardiography may be used as a valuable method in the early recognition of left myocardial systolic function impairment in patients after TOF repair. The application of this method to guide clinical decision and management of rTOF patients such as earlier pulmonary valve replacement or risk stratification for sudden cardiac death needs further investigation.

Prevalence of left ventricular systolic dysfunction in pre-dialysis and dialysis patients with preserved left ventricular ejection fraction.

Patients with chronic kidney disease (CKD) have an excess of cardiovascular morbidity and mortality, with heart failure (HF) being particularly frequent. Reduced left ventricular ejection fraction (LVEF) defines left ventricular (LV) systolic dysfunction and is associated with poor prognosis. However, CKD patients may have HF symptoms with preserved LVEF. In this subgroup of patients, two-dimensional speckle tracking echocardiography can detect LV systolic dysfunction by analysing LV myocardial deformation. The present study evaluated the prevalence of impaired LV global longitudinal strain (GLS) in CKD patients with preserved LVEF and its prognostic consequences. Overall, 200 pre-dialysis and dialysis patients (65% men, mean age 60 ± 14 years) with CKD stage 3b-5 and preserved LVEF (≥50%) were evaluated. Left ventricular systolic dysfunction despite preserved LVEF was defined by LV GLS ≤15.2% (cut-off value derived from two standard deviations below the mean value of individuals without structural heart disease). Impaired LV GLS (≤15.2%) despite preserved LVEF was observed in 32% of patients. During a median follow-up of 33 months (interquartile range 17-62 months), 47% of patients underwent renal transplantation, 9% were admitted with HF, and 28% died. Patients with LV GLS ≤15.2% showed significantly worse cumulative event-free survival rates of the combined endpoint of HF hospitalization and all-cause mortality compared to patients with LV GLS >15.2% (log-rank P = 0.018). The prevalence of impaired LV GLS despite preserved LVEF in pre-dialysis and dialysis patients is relatively high. Patients with preserved LVEF but impaired LV GLS have an increased risk of HF hospitalization and all-cause mortality.

Abnormal Myocardial Strain Indices in Children Receiving Anthracycline Chemotherapy

Anthracycline chemotherapy (AC) is associated with impaired left ventricular (LV) systolic function. LV ejection fraction (EF %) obtained by two-dimensional echocardiography is the current gold standard for detection and monitoring of LV systolic function. However, dependence on LVEF has been shown to be unreliable due to its inherent limitations. Speckle tracking echocardiography (STE) measures myocardial strain and is a sensitive method to detect LV systolic dysfunction with demonstrated utility in such detection in adult and pediatric cohort studies. Compare myocardial strain indices derived by STE with LVEF to detect ACT-induced LV systolic dysfunction. Prospective, cross-sectional measurements of LV myocardial strain indices derived from STE with LVEF. Pediatric cohort of 25 patients (pts): 17 females, eight males with a mean age 9.8±5.8years, who received anthracyclines (AC); median cumulative dose ≥150±124.4mg/m(2), range 60-450mg/m(2) showing normal LV end-diastolic diameter (mm) and normal LVEF (≥55%) underwent STE to obtain LV myocardial strain indices: strain and strain rate. The inter- and intraobserver variability for the strain indices was 5%. Fifteen of 25 pts (60%) showed abnormal global longitudinal peak systolic strain (GLPSS) and 19/25 pts (76%) showed abnormal peak circumferential strain (PCS) compared to age-matched controls (p=0.005). In contrast, no significant differences was observed in either indices with the dose of AC. Likewise, no significant changes in the systolic or diastolic strain rate were noted with the dose of AC (r (2)=0.0076 for peak E, r (2)=0.072 for peak A, p=NS). GLPSS and PCS were diminished and, however, correlated poorly with the cumulative dose of AC. These observations indicate an early onset of LV systolic dysfunction by the strain indices in pts who continue to show a normal LVEF implying presence of occult LV systolic dysfunction. These novel strain indices may assist in early detection of LV systolic dysfunction with implications for monitoring and prevention of AC-induced LV systolic dysfunction.

The predictive value of non-invasive cardiac output at rest in discharged heart failure patients

Risk stratification in patients suffering from chronic congestive heart failure (CHF) is based on a variety of clinical and laboratory variables. Indeed, several prognostic parameters have been identified, including age, New York Heart Association (NYHA) class, renal function, comorbidity such as atrial fibrillation, diabetes mellitus and ischemic heart disease [ [1] Swedberg K. Cleland J. Dargie H. et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur. Heart J. 2005; 26: 1115-1140 Crossref PubMed Scopus (246) Google Scholar ]. In acute decompensated heart failure (ADHF) episodes, the degree of renal dysfunction and arterial hypotension easily stratified patients with worst clinical outcome [ [2] Fonarow G.C. Adams K.F. Abraham W.T. Yancy C.W. Boscardin W.J. for the ADHERE Scientific Advisory Committee Risk stratification for in-hospital mortality in acutely decompensated heart failure. JAMA. 2005; 293: 572-580 Crossref PubMed Scopus (1308) Google Scholar ]. A single determination of Brain Natriuretic Peptide (BNP) plasma level represents a reliable risk stratification procedure and its increase is considered a sensitive diagnostic marker of left ventricular dysfunction [ 3 Boland D.G. Abraham W.T. Natriuretic peptides in heart failure. Congest. Heart Fail. 1998; 4: 23-33 Google Scholar , 4 McDonagh T.A. Robb S.D. Murdoch D.R. et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet. 1998; 351: 9-13 Abstract Full Text Full Text PDF PubMed Scopus (909) Google Scholar ] having a clear prognostic relevance in predicting cardiovascular events in congestive heart failure (CHF) patients [ 5 Maisel A.S. Krishnaswamy P. Nowak R.M. et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N. Engl. J. Med. 2002; 347: 161-167 Crossref PubMed Scopus (2785) Google Scholar , 6 Berger R. Huelsman M. Strecker K. et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation. 2002; 105: 2392-2397 Crossref PubMed Scopus (616) Google Scholar , 7 Feola M. Aspromonte N. Canali C. et al. Prognostic value of plasma brain natriuretic peptide, urea nitrogen and creatinine in outpatients >70 years of age with heart failure. Am. J. Cardiol. 2005; 96: 705-709 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar ]. In discharged HF patients both right or left ventricular function proved to play a prognostic role [ 8 Kamath S.A. Drazner M.H. Tasissa G. Rogers J.G. Stevenson L.W. Yancy C.W. Correlation of impedance cardiography with invasive hemodynamic measurements in patients with advanced heart failure: the Bioimpedance CardioGraphy (BIG) Substudy of the ESCAPE Trial. Am. Heart J. 2009; 158: 217-223 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 9 Zornoff L.A.M. Skali H. Pfeffer M.A. et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J. Am. Coll. Cardiol. 2002; 39: 1450-1455 Abstract Full Text Full Text PDF PubMed Scopus (366) Google Scholar ]. In particular, in HF patients developed after an MI each reduction of 5% in right ventricular function correlated with a 16% increased in mortality [ [9] Zornoff L.A.M. Skali H. Pfeffer M.A. et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J. Am. Coll. Cardiol. 2002; 39: 1450-1455 Abstract Full Text Full Text PDF PubMed Scopus (366) Google Scholar ]. In the substudy of the ESCAPE trial, the invasive measurement of pulmonary wedge pressure was significantly associated with death at 6-month follow-up [ [8] Kamath S.A. Drazner M.H. Tasissa G. Rogers J.G. Stevenson L.W. Yancy C.W. Correlation of impedance cardiography with invasive hemodynamic measurements in patients with advanced heart failure: the Bioimpedance CardioGraphy (BIG) Substudy of the ESCAPE Trial. Am. Heart J. 2009; 158: 217-223 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar ].

Impact of Obstructive Sleep Apnea on the Global Myocardial Performance Beyond Obesity

We aimed to assess the impact of obstructive sleep apnea (OSA) on the left ventricular (LV) function independent of obesity using the myocardial performance index (Tei index) and the global longitudinal LV strain (GLS) and its reversibility after surgery. Twenty-five newly diagnosed OSA patients, normal weight (n = 15) and obese (body mass index [BMI] ≥ 25; n = 20) controls without OSA were enrolled and underwent transthoracic echocardiographic evaluation. The OSA and obese groups had a significantly comparable increased BMI and LV chamber dimension, prolonged isovolumic relaxation time, reduced early mitral filling velocity, and increased late mitral filling velocity and Tei index as compared to the normal weight group. However, GLS was significantly reduced only in the OSA group (-16.5 ± 1.9%) as compared to the normal weight group (-20.6 ± 2.0%, P < 0.001) and obese group (-19.1 ± 2.5%, P < 0.001). As a treatment, 13 of 25 patients underwent surgical modification, and the follow-up echocardiogram revealed significantly improved Tei index and GLS as compared to baseline (0.37 ± 0.06 and -18.9 ± 3.3% vs. 0.42 ± 0.04 and -16.3 ± 2.4%, P = 0.006 and 0.031, respectively), which was comparable to the obese controls. A reduction in the apnea-hypopnea index had a significant effect on the improvement in the GLS (r = 0.73, P < 0.001). LV systolic and diastolic function significantly deteriorated in the patients with OSA beyond obesity, and an improvement in the LV function was observed within 6 months after the surgical modification. GLS is considered to be one of the parameters that can be used in the early detection of LV systolic dysfunction in patients with OSA and a normal ejection fraction.

Early prediction of left ventricular systolic dysfunction in patients of asymptomatic chronic severe rheumatic mitral regurgitation using tissue Doppler and strain rate imaging

AimsIdentification of subclinical left ventricular (LV) dysfunction in patients with rheumatic mitral regurgitation (MR) facilitates optimal surgical results and better postoperative LV function. This study is designed to assess the role of tissue Doppler and strain rate (SR) imaging in early detection of LV systolic dysfunction in patients with asymptomatic chronic severe MR. Methods and resultsPatients were studied under four groups. Group I: Normal subject (n = 25). Group II: Patients with chronic severe MR with ejection fraction (EF) > 60% and end-systolic dimension (ESD) ≤ 40 mm (n=23). Group III: Patients with chronic severe MR with EF ≥ 60% and ESD 41–50 mm (n = 27). Group IV: Patients with chronic severe MR with EF < 60% with any ESDs (n = 25). With decrease in EF and increase in ESD there was decrease in systolic velocity and increased in precontraction time and contraction time was noted. The tissue Doppler systolic indices between groups were statistically significant P < 0.05 and showed significant correlation value r = 0.45 between groups. Strain (S) and SR significantly decreased with decrease in EF and increase in ESD P < 0.05, r = 0.45 between different groups. ConclusionOur study showed significant correlation between tissue Doppler systolic indices and SR imaging with EF and ESD.

Two-dimensional speckle tracking of the left ventricle in patients with systemic sclerosis for an early detection of myocardial involvement

Myocardial involvement is associated with poor prognosis in patients with systemic sclerosis (SSc). Two-dimensional speckle-tracking echocardiography (STE) is a powerful novel modality for the assessment of subclinical cardiac left ventricular (LV) dysfunction that, so far, has not been investigated in SSc patients. The aim of this study was to evaluate deformation analyses derived from STE for early detection of LV systolic dysfunction in patients with SSc having preserved left ventricular ejection fraction (LVEF). Twenty-two patients with SSc (57.1 ± 13.3 years, LVEF 64 ± 3.1%, mean time of 5.4 ± 4.6 years from diagnosis) and 22 gender- and age-matched healthy subjects (57.4 ± 14.0 years, LVEF 65 ± 2.7%) underwent echocardiography with STE to assess global and regional LV function. The global longitudinal 2D peak systolic strain (PSS) of the left ventricle was significantly lower in the SSc group compared with controls: -19.0 ± 2.4 vs. -21.1 ± 2.5% (P = 0.008). This was mainly driven by a reduced strain in the basal segments. Strain in the medial segments and in the apex did not differ significantly. In addition, there was a significant difference between both groups regarding the global longitudinal PSS rate of the left ventricle (-1.19 ± 0.18 vs. -1.43 ± 0.26 s(-1), P = 0.001). LV deformation analysis by STE is a sensitive method to detect early LV systolic impairment primarily in the basal segments in patients with SSc having preserved LVEF.

Functional analysis by 64-slice CT scanning: prediction of left ventricular dysfunction together with reduction in radiation exposure?

Functional analysis by 64-slice CT scanning: prediction of left ventricular dysfunction together with reduction in radiation exposure?

Noninvasive Detection of Left-Ventricular Systolic Dysfunction by Acoustic Cardiography in Atrial Fibrillation

Objectives. Assessment of left ventricular (LV) systolic function in patients with atrial fibrillation can be difficult. Acoustic cardiography provides several parameters for quantifying LV systolic function. We evaluated the ability of acoustic cardiography to detect LV systolic dysfunction in patients with and without atrial fibrillation. Design. We studied 194 patients who underwent acoustic cardiography and cardiac catheterization including measurement of angiographic ejection fraction (EF) and maximum LV dP/dt. LV systolic dysfunction was defined as LV maximum dP/dt <1600 mmHg/s. Acoustic cardiographic parameters included electromechanical activation time (EMAT) and the systolic dysfunction index (SDI). Results. Acoustic cardiography detected systolic dysfunction with high specificity and moderate sensitivity with similar performance to EF (sensitivity/specificity without afib: EMAT 30/96, SDI 40/90, EF at 35% 30/96; sensitivity/specificity with afib: EMAT 64/82, SDI 59/100, EF at 35% 45/82). Conclusions. Acoustic cardiography can be used for diagnosis of LV systolic dysfunction in atrial fibrillation.

Early Detection of Left Ventricular Dysfunction with Strain Imaging in Thalassemia Patients

Iron-mediated cardiomyopathy is the main cause of death in thalassemia patients. Early detection of cardiac abnormalities is important as aggressive chelation therapy may improve prognosis in these patients. The aim of this study is to evaluate left ventricular (LV) functions by tissue velocity imaging (TVI) and strain imaging (SI) in thalassemia patients without overt heart failure. At total of 32 patients with beta-thalassemia major (mean age: 24.2+/-8.0 y, 22 male) and 25 healthy controls (mean age: 22.8+/-2.1 y, 20 male) were included. Conventional echocardiography, TVI, and SI were performed on all subjects. Tissue velocity imaging and SI measures included peak systolic, early and late diastolic myocardial velocities, peak systolic strain and strain rate, and early and late diastolic strain rate at the basal segments of the LV lateral and septal walls. There were no significant differences in LV ejection fraction and fractional shortening between the groups. However, systolic myocardial velocity of the lateral wall and systolic strain and strain rate of the septal and lateral walls were significantly lower in thalassemia patients. There was a significant negative correlation between LV mass index and systolic myocardial velocity of the lateral wall (r = - 0.29, P = .045) and septal systolic strain (r = - 0.45, P < .001). Thalassemia patients have regional systolic dysfunction in the LV lateral and septal walls, even if they do not have overt heart failure. Strain imaging is helpful in early detection of LV systolic dysfunction in thalassemia patients.