Detection Of Subclinical Systolic Dysfunction Research Articles

Targeting Left Ventricular Mechanics In Patients With Pheochromocytoma/Paraganglioma: An Updated Meta-analysis.

Numerous studies targeting left ventricular (LV) systolic function by measuring LV ejection fraction (LVEF) in patients with pheochromocytoma and paraganglioma (PPGL) either failed to reveal any impairment of this parameter or found a super-normal systolic function compared to essential hypertensives or normotensive controls. To provide an updated piece of information on LV systolic dysfunction in the PPGL setting, we performed a meta-analysis of speckle tracking echocardiography (STE) studies investigating LV mechanics via global longitudinal strain (GLS), a more sensitive index of LV systolic function than LVEF. A computerized search was performed using PubMed, OVID, EMBASE, and Cochrane library databases from inception until September 30, 2022. Full articles reporting data on LV GLS and LVEF in patients with PPGL and controls were considered suitable. A total of 252 patients with PPGL and 187 controls were included in 6 studies. LV GLS was worse in the pooled PPGL group than in the control group (-17.3 ± 1.2 vs. -20.0 ± 0.6) with a standard means difference (SMD) of 1.13 ± 0.36 confidence interval (CI: 0.43-1.84, P = 0.002), whereas this was not the case for LVEF (67.3 ± 1.9 and 66.4 ± 1.6%, respectively), SMD: 0.12 ± 0.03, (CI: -0.41/0.65, P = 0.66). A meta-regression analysis in PPGL patients showed an inverse relationship between adrenergic activity and GLS (P < 0.0001). Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the PPGL setting can be revealed by STE; therefore, STE implementation in the workup of patients with PPGL may improve the detection of subclinical systolic dysfunction.

Hemodynamic force analysis is not ready for clinical trials on HFpEF

Hemodynamic force analysis has been proposed as a novel tool for early detection of subclinical systolic dysfunction in heart failure with preserved ejection fraction (HFpEF). Here we investigated the ability of hemodynamic forces to discriminate between healthy subjects and heart failure patients with varying degrees of systolic dysfunction. We studied 34 controls, 16 HFpEF patients, and 25 heart failure patients with mid-range (HFmrEF) or reduced ejection fraction (HFrEF) using cardiac magnetic resonance with acquisition of cine images and 4D flow at 1.5 T. The Navier–Stokes equation was used to compute global left ventricular hemodynamic forces over the entire cardiac cycle. Forces were analyzed for systole, diastole, and the entire heartbeat, with and without normalization to left ventricular volume. Volume-normalized hemodynamic forces demonstrated significant positive correlation with EF (r2 = 0.47, p < 0.0001) and were found significantly lower in heart failure with reduced ejection fraction compared to controls (p < 0.0001 for systole and diastole). No difference was seen between controls and HFpEF (p > 0.34). Non-normalized forces displayed no differences between controls and HFpEF (p > 0.24 for all analyses) and did not correlate with EF (p = 0.36). Left ventricular hemodynamic force analysis, whether indexed to LV volumes or not, is not ready for clinical trials on HFpEF assessment.

Interrelation of cognitive impairments and structural and functional features of the left ventricle of the heart in patients with hypertension

Objective — to study morphofunctional changes in the left ventricle in patients with arterial hypertension with cognitive impairment. Materials and methods. Examinations involved 76 patients with stage II arterial hypertension, and 12 practically healthy persons aged (51.55 ± 0.86) and (54.25 ± 2.74) years, respectively. To assess cognitive function, the Montreal Evaluation Scale (MoCA-test) was used. Patients were divided into 2 groups: the first included 40 subjects without cognitive impairment, the second group consisted from 36 patients with cognitive impairment (according to the ­MoCA-test). The structural and functional state of the heart was investigated based on the echocardiography data with evaluation of cardiac contractile function with method of speckle tracking echocardiography. Results and discussion. In all patients with arterial hypertension, regardless of the presence of cognitive impairment, the structural and functional parameters of the left ventricular myocardium according to echocardiography significantly differed from those of the control group. All patients had a preserved ejection fraction (60 ± 2.4) and (58 ± 3.2) % and left ventricular hypertrophy. There were no significant differences between the groups in the studied parameters in patients with arterial hypertension. The correlation between the expression of the left ventricular myocardial mass index and the sum of the MOCA-test scores in patients with arterial hypertension with cognitive impairment (r = – 0.31, p < 0.05) was revealed. According to speckle tracking echocardiography longitudinal deformation of the left ventricle in patients with arterial hypertension was reduced by 60 % of patients of the 1st group and by 91.7 % of patients of the second group and significantly differed both in the intergroup comparison and with the control group. A correlation was found between the index of the total longitudinal deformation of the left ventricle and the presence of cognitive impairment (r = – 0.44, p < 0.01). Conclusions. Decrease in the left ventricular function in the longitudinal direction is associated with cognitive impairment in patients with grade II and III arterial hypertension in addition to the presence of the left ventricular hypertrophy. The use of speckle tracking echocardiography can help in the early detection of subclinical systolic dysfunction of the left ventricle in patients with hypertension with a higher risk of developing cognitive impairment.

Basics of Tissue Doppler Revisited

Tissue Doppler imaging (TDI) records velocities of myocardial tissue. Routinely longitudinal velocities of medial and lateral mitral annulus and lateral tricuspid annulus are evaluated in apical four chamber view. Commonly recorded waves include isovolumic contraction wave, systolic wave, isovolumic relaxation wave, early diastolic wave, and late diastolic wave. TDI is useful in detection of subclinical systolic dysfunction and early diastolic dysfunction. It is useful in differentiating athlete's heart from hypertrophic cardiomyopathy and pericardial constriction from restrictive cardiomyopathy.

Abstract 11322: Detection of Subclinical Left Ventricular Systolic Dysfunction by Real-Time 3D Speckle Tracking Echocardiography in Patients With Myocardial Bridge of Left Anterior Descending Coronary Artery

Background: To understand the impact of myocardial bridge (MB) on left ventricle (LV) function, we evaluate the myocardial function in patients with MB of the left anterior descending coronary artery (LAD), using real-time 3-dimensional speckle tracking echocardiography (RT3D-STE). Methods: The LAD MB was diagnosed by coronary angiography in 82 patients. According to the percentage of systolic compression (SC), patients were divided into 3 groups: SC &lt;50% defined as Group I (n=24), SC 50%-75% as Group II (n=28), and SC &gt;75% as Group III (n=30). Thirty age and gender matched normal subjects were studied as controls. The traditional echocardiography was performed, and LV deformation was estimated by RT3D-STE. Results: The LV ejection fraction was normal in patients with LAD MB. However, the peak longitudinal (LS) and area strain (AS) of the LAD territory were significantly reduced in Group II and III when compared with controls and Group I (p&lt;0.05). The peak circumferential (CS) and radial strain (RS) were significantly reduced only in Group III (p&lt;0.05) (Table). Furthermore, the amplitude of strain variables were significantly reduced in patients with symptom than those without (AS: 17.7±6.4 vs. 25.3±8.4%; LS:-13.0±1.9 vs. -16.2±2.5%; CS:-15.4±3.3 vs. 18.9±3.0 %; RS: 36.6±3.8 vs. 49.4±2.7%; all p&lt;0.0001). The severity of LAD compression correlated the best with with AS at LAD territory (r=–0.90, p&lt;0.0001), although it was also significant in conventional strain variables (LS: r =–0.79, CS: r =–0.69, RS: r =–0.64, all p &lt;0.0001). Conclusions: Despite apparently normal ejection fraction, myocardial strain is abnormal in the LAD territory which had MB. Such abnormality is more pronounced in patients with progressively more severe MB and in those with symptoms. Furthermore, the area strain by RT3D-STE appeared to be most accurate in detection of subclinical systolic dysfunction in patients with LAD MB than conventional 2D strain parameters.

The feasibility and utilization of tissue doppler imaging, longitudinal and circumferential strain and strain rate in the diagnostic accuracy for heart failure with preserved ejection fraction

Background: Though Tissue Doppler imaging (TDI) is a sensitive tool in identifying diastolic dysfunction, recent myocardial deformation imaging including longitudinal and circumferential strain and strain rate enabled early detection of subclinical systolic dysfunction. Head-to-head comparison and optimal cut-off by these measures for preserved ejection fraction heart failure (HFpEF) remained elusive. Methods: Echocardiography was performed in 2 groups of hospitalized patients: 1) 64 with HFpEF (EF ≥50%); 2) 240 without clinical evidence of HF. TDI-based mitral annulus systolic (S') and early diastolic (E') velocities were measured as well as global longitudinal (GLS) and circumferential strain (GCS), systolic (S SR)/diastolic strain rate (E SR) from 3 apical views by Echo system. The diagnostic accuracy and optimal cut-off for these parameters were compared. Results: For all HFpEF patients, the sensitivity, specificity, and area under ROC curve (AUROC) for GLS were 68.8%, 86.7%, and 0.85, respectively (Table), with an optimal cut-off set at -16.4%. Longitudinal S SR also had good AUROC (0.74) in HFpEF, while circumferential E' SR was most sensitive (93.7%). The highest positive predictive value and negative predictive value were achieved by GLS (57.9%) and E CSR (92.5%), respectively. Abbreviations: GLS, global longitudinal strain; S LSR, systolic longitudinal strain rate; E LSR, diastolic longitudinal strain rate; GCS, global circumferential strain; S CSR, systolic circumferential strain rate; E CSR, diastolic circumferential strain rate; LFS, longitudinal fractional shortening; PPV, positive predictive value; NPV, negative predictive value. Conclusion: Deformation-based imaging using global longitudinal strain remains a sensitive clinical indicator for identifying subclinical systolic dysfunction in HFpEF, which is more accurate than TDI in our study.

Early detection of asymptomatic left ventricular systolic dysfunction in hypertensive patients

Background: Hypertension is a potent risk factor for congestive heart failure (CHF). Development of overt CHF may be preceded by a phase of asymptomatic left venrticular systolic dysfunction. The aim of this study was early detection of alteration in left ventricular systolic function. Methods: 120 hypertensive patients, with preserved ejection fraction (EF), were divided in three groups according LVDD: normal (n=40), abnormal relaxation (Grade I, n=37) and pseudonormal (Grade II, n=43). Left atrial volume index (LAVI), left ventricular mass index (LVMI), left ventricular dimensions and volume inexes (LVEDV/BSA and LVESV/BSA) and EF were estimated by echocardiography. We measured coresponding velocities from tissue Doppler at the level of the septal mitral annulus (Em, Am, Sm), including E/Em and tissue Doppler myocardial performance index (tMPI). The same measurements were repeated after three years. Results: Close correlations were found between Sm and EF (r=0.349; p=0.0009), LVMI (r= -0.222; p=0.015), LVEDV/BSA (r =-0.317; p=0.0004) and LVESV/BSA (r =-0.472; p=0.0005). Levels of LVEDV/BSA (89.3 vs 103.8 vs 101.7; p=0.009), LVESV/BSA (34.0 vs 42.9 vs 44.0; p=0.0004), LVMI (104.3 vs 112.5 vs 123.0; p=0.0004), LAVI (32.0 vs 35.5 vs 44.5; p=0.0001) and MPI (61.7 vs 72.1 vs 76.3; p=0.036) progressively increased from the normal group through LVDD Grade I and II groups. Significantly different values of EF (63 vs 61 vs 59; p=0.003) and Sm (0.074 vs 0.067 vs 0.059; p=0.003) were obtained between groups too, but with progressively decrease from the normal group through LVDD Grade I and II groups. General linear model for repeated measures showed increase of LVEDV/BSA (F=50.009; p<0.001), LVESV/BSA (F=34.258; p<0.001), LVMI (F=27.648; p<0.001), LAVI (F=17.083; p<0.001) and tMPI (F=35.842; p<0.001) during three years, with significant time difference, but withot significant difference between groups, these parameters enarged in all groups almost at the same manner. Sm also significantly changed during three years with significant time difference (F=128.24; p<0.001) and with significant difference between groups (F=4.597; p< 0,012), Sm decrease in all groups, but most expressed in LVDD Grade II group. Conclusion: Left ventriculae EF was not sensitive indicator for the detection of subclinical systolic dysfunction, but decrease of Sm appeared as the first sign of systolic abnormalities following established diastolic dysfunction and was the clear reflection of LV remodeling process. This suggests that Sm may aid in the identification of patients at high risk for development of CHF who need preventive treatment.

THE CLINICAL USEFULNESS AND UTILIZATION OF TISSUE DOPPLER IMAGING, LONGITUDINAL AND CIRCUMFERENTIAL STRAIN AND STRAIN RATE IN THE DIAGNOSTIC ACCURACY FOR DIFFERENT PHENOTYPES OF HEART FAILURE

Tissue Doppler imaging (TDI) is a sensitive tool in identifying diastolic dysfunction. Recent progresses in myocardial deformation imaging has enabled early detection of subclinical systolic dysfunction. Head-to-head comparison and optimal cut-off by these measures for different heart failure

P371 Early detection of subclinical systolic dysfunction in hypertensive left ventricular hypertrophy by two-dimensional speckle tracking: the importance of radial strain

P371 Early detection of subclinical systolic dysfunction in hypertensive left ventricular hypertrophy by two-dimensional speckle tracking: the importance of radial strain