Follow-up Of Left Ventricular Function Research Articles

Effect of Experience and Training on the Concordance and Precision of Strain Measurements

ObjectivesThis study sought to show the degree to which experience and training affect the precision and validity of global longitudinal strain (GLS) measurement and to evaluate the variability of strain measurement after feedback. BackgroundThe application of GLS for the detection of subclinical dysfunction has been recommended in an expert consensus document and is being used with increasing frequency. The role of experience in the precision and validity of GLS measurement is unknown, as is the efficacy of training. MethodsFifty-eight readers, divided into 4 groups on the basis of their experience with GLS, calculated GLS from speckle strain analysis of 9 cases with various degrees of image quality. Intraclass correlation coefficients (ICCs), mean difference, SD, and coefficient of variation (CV) were compared against the measurements of a reference group that had experience with >1,000 cases of strain measurement. Individualized feedback was distributed, and repeat measurements were performed by 40 readers. Comparisons with the baseline variation provided information about whether feedback was effective. ResultsThe ICC for GLS was significantly greater than that for ejection fraction regardless of image quality. Experience with strain measurement affected the concordance in strain values among the readers; the group with the highest level of experience showed significantly better ICC than those with no experience, although the ICC of the inexperienced readers was still very good (0.996 vs. 0.975; p = 0.0002). As experience increased, the mean difference, SD, and CV became significantly smaller. The CV of segmental strain analysis showed significant improvement after training, regardless of experience. ConclusionsThe favorable interobserver agreement of GLS makes it more attractive than ejection fraction for follow-up of left ventricular function by multiple observers. Although experience is important, the precision of GLS was high for all groups. Training appears to be of most value for the assessment of segmental strain.

A prospective comparison of cardiac magnetic resonance imaging and radionuclide ventriculography in the assessment of cardiac function in patients treated with anthracycline-based chemotherapy

To compare cardiac MRI and radionuclide ventriculography (RVG) in cardiac monitoring during anthracycline (doxorubicin)-based chemotherapy. We studied 10 previously untreated adult non-Hodgkin lymphoma patients. Left ventricular ejection fraction (LVEF) was assessed by MRI and RVG simultaneously. In addition, left ventricular (LV) and left atrial size were determined by MRI. Both MRI and RVG measurements were determined at baseline and then repeated after eight cycles of CHOP chemotherapy (cumulative doxorubicin dose of 400 mg/m²). Power calculations were made on the basis of reproducibility measurements. Clinical heart failure was not observed in any patient during the study. MRI detected a statistically significant increase in LV end-diastolic volume (128 ± 39 vs. 151 ± 46 ml, P<0.05) and LV mass (119 ± 32 vs. 146 ± 49 g, P<0.05) after doxorubicin therapy but no change in LVEF (46 ± 8 vs. 47 ± 11%, P=NS) or left atrial area. A significant LVEF reduction compared with baseline was observed by RVG (61 ± 10 vs. 50 ± 6%, P<0.01). On average, MRI resulted in 7 ± 10% lower LVEF values compared with RVG. RVG seems to be a valuable and repeatable tool in detecting early, subclinical deterioration in cardiac function and is the method of choice in the follow-up of LV function during anthracycline-based chemotherapy. Whether LV volumetric and mass changes found in MRI could predict later significant permanent cardiac damage should be evaluated in larger studies with long-term follow-up.

Role of echocardiography in cancer care

For cancer therapy survivors, regular echocardiographic follow-up of left ventricular function is considered part of standard care. Metastases of tumors on the pericardium and myocardium as well as cardiac structure and function can be assessed using echocardiography. This review focuses on current and developing echocardiographic modalities for the assessment of cardiac structure and function in the cancer patient, delineates the echocardiographic diagnosis of cardiac amyloidosis, and discusses the echocardiographic features of cardiac masses including those associated with the hypercoagulable state of cancer.

Surgical Treatment of Left Ventricular Aneurysms: A Comparison of Long-term Follow-up of Left Ventricular Function for Classic Aneurysmectomy and Endoaneurysmorrhaphy Techniques

Myocardial infarction may be complicated by the formation of a left ventricular (LV) aneurysm that distorts the normal elliptical geometry of the ventricle to produce a dilated spherical ventricle with limited contractile and filling capacities. One of the consequences is congestive heart failure, which may be refractory to medical therapy and require surgical treatment. The aim of this study was to evaluate LV function in the late term following repair of LV aneurysm. Ninety-seven patients underwent repair of postinfarctional LV aneurysms. Sixty-one patients (62.9%) underwent classic aneurysmectomy, and 36 patients (37.1%) had endoaneurysmorrhaphy. The mean age (+/-SD) of the 87 men (89.7%) and 10 women was 55.98 +/- 8.59 years. Coronary surgery was performed in 82 patients (84.5%), with a mean of 1.34 +/- 0.77 grafts/patient. The mean preoperative ejection fraction (EF) was 39.74% +/- 8.79% (classic, 39.92% +/- 8.90%; endoaneurysmorrhaphy, 39.43% +/- 8.61%; difference not statistically significant [NS]). Fifty-five patients (56.7%) had angina of Canadian Cardiovascular Society class III to IV (classic, 55.7%; endoaneurysmorrhaphy, 58.3%; NS), 31 patients (31.9%) were in New York Heart Association (NYHA) class III to IV (classic, 31.1%; endoaneurysmorrhaphy, 33.3%; NS), and the mean preoperative NYHA functional class was 2.88 +/- 0.74 (classic, 2.83 +/- 0.77; endoaneurysmorrhaphy, 2.97 +/- 0.71; NS). The mortality rate at <30 days was 9.8% (n = 6) in the classic aneurysmectomy group and 2.7% (n = 1) in the endoaneurysmorrhaphy group. Long-term follow-up was available for 80 of these patients. During a mean follow-up of 79.3 +/- 37.6 months (range, 6-156 months), 14 patients (17.5%) died of a cardiac-related cause (classic, 8 patients [16.6%]; endoaneurysmorrhaphy, 6 patients [18.7%]; NS). The cardiac-related survival rate was 82.5%. In the first year, at 5 years, and at 10 years, the survival rates of the patients who underwent classical aneurysmectomy were 98.8%, 93.5%, and 76.1%, respectively, and the rates for patients who underwent endoaneurysmorrhaphy were 100%, 93.0%, 71.2%, respectively (P = .2). In the follow-up patient population, the mean preoperative EF was 40.21% +/- 9.44% in the classic aneurysmectomy group and 39.34% +/- 8.61% in the endoaneurysmorrhaphy group. Postoperatively, mean EFs increased to 44.24% +/- 9.50% and 43.80% +/- 8.81%, respectively, at the last follow-up. NYHA functional class changed from 2.79 +/- 0.77 preoperatively to 1.60 +/- 0.73 postoperatively in the classic aneurysmectomy group and from 2.97 +/- 0.71 preoperatively to 1.34 +/- 0.54 postoperatively in the endoaneurysmorrhaphy group. There was no significant difference in hospital readmissions for cardiac causes (classic, 27.1%; endoaneurysmorrhaphy, 31.2%). LV aneurysm can be repaired with acceptable surgical risk. Surgical treatment of LV aneurysm is associated with an improvement in long-term survival and symptoms.

880 Short- and long-term follow-up of left-ventricular function after surgical treatment of mitral valve for chronic regurgitation

s S111 880 Shortand long-term follow-up of left-ventricular function after surgical treatment of mitral valve for chronic regurgitation. A. Klisiewicz 1, P. Leszek 2, P. Michalek 3, J. Korewicki 2, P. Hoffman 3 . 1Institute of Cardiology, Congenital Heart Disease Department, Warsaw, Poland; 2Institute of Cardiology, Heart Failure Department, Warsaw, Poland; 3Institute of Cardiology, Congenital Heart Disease Department, Warsaw, Poland Background: There are ambiguous data concerning late LV remodeling following mitral valve surgery due to chronic regurgitation (MR). Methods: We performed serial echocardiographic evaluation of 35 consecutive patients prior and following surgical treatment of mitral valve for chronic regurgitation. Studies were performed 1 week before operation (I), then at 1 week (II) and 9 – 13 months (III) (mean 11 months) after surgery. End-diastolic and systolic diameters (LVEDD and LVESD) and left atrial (LA) size were recorded from parasternal longaxis view, and ejection fraction (EF) was calculated by Teicholtz formula. Statistical significance of achieved values was assessed. Materials: The study group consisted of 35 patients (25 males, 10 females, age 63±9 yrs) All pts were symptomatic due to the significant MR: NYHA II (n = 8), III (n = 25), IV (n = 2). All subjects had excluded coronary artery disease by coronary angiogram. 30 patients underwent successful mitral valve replacement without preservation of subvalvular apparatus and 5 mitral valve repair. Results: Echo – Doppler examination before procedure discovered isolated significant MR (4+) with left ventricular dilatation (LVEDD 6.6cm±0.3, LVESD 4.3cm±0.8, left atrial enlargement (6.0 cm±1.1), and pulmonary hypertension (systolic PAP 46 mmHg ± 16). Changes of assessed parameters obtained in consecutive examinations are depicted in table 1. All changes were independent of age, LV size, EF or NYHA status.

Long-term left ventricular echocardiographic follow-up of SHR and WKY rats: effects of hypertension and age

Long-term follow-up of left ventricular (LV) function using echocardiography has not been reported and, in this study, was carried out in normotensive (WKY) rats and spontaneously hypertensive rats (SHR). In 10 WKY rats and SHR, LV diastolic and systolic diameter (LVEDD and LVSD), shortening fraction (SF), and weight (LVW) were determined at 8, 15, 20, 35, and 80 wk of age. The ratio of early to late mitral flow and mitral annulus velocity (VE/VA and Em/Am), isovolumic relaxation time (IVRT), deceleration time of the E wave (DTE), Tei index, and mitral flow propagation velocity (Vp) were measured. No difference in LVEDD was found between SHR and WKY rats; however, LVEDD was increased at 80 wk in both strains. SF decreased slightly in old WKY rats. LVW progressively increased from 20 to 80 wk in both strains and was greater in SHR. VE/VA and Em/Am decreased at 80 wk in WKY rats. LV relaxation (IVRT, Tei index, and Vp) was progressively impaired in SHR compared with WKY rats. LV compliance (DTE) was altered in old SHR. Echocardiography permitted a long follow-up of LV function in SHR and WKY rats. Ventricular relaxation was impaired early in the life of SHR and progressed with aging. Furthermore, LV compliance was altered, but systolic function remained unchanged, in old SHR. In contrast, relaxation and SF were only slightly altered in old WKY rats, suggesting that pressure-related changes in LV function were the dominant features in the SHR.

Echocardiography in infants with anomalous origin of the left coronary artery

Echocardiograms were performed on four infants with anomalous origin of the left coronary artery from the pulmonary artery. Common features included (1) a large, dilated, poorly contractile left ventricle, (2) posterior position of the mitral valve, (3) an abnormal pattern of septal motion with exaggerated septal excursion, (4) decreased excursion and delayed onset of posterior left ventricular wall contraction, and (5) an enlarged left atrium. These findings in infants are similar to those seen in adult patients with coronary artery disease. Septal motion was similar to the pattern described in adults with left bundle branch block. The characteristic echocardiographic features described are useful in both the diagnosis and the follow-up of left ventricular function of patients with anomalous origin of the left coronary artery from the pulmonary artery.