LV Strain Rate Research Articles

Myocardial strain assessment in the human fetus by cardiac MRI using Doppler ultrasound gating and feature tracking

ObjectivesAssessment of myocardial strain by feature tracking magnetic resonance imaging (FT-MRI) in human fetuses with and without congenital heart disease (CHD) using cardiac Doppler ultrasound (DUS) gating.MethodsA total of 43 human fetuses (gestational age 28–41 weeks) underwent dynamic cardiac MRI at 3 T. Cine balanced steady-state free-precession imaging was performed using fetal cardiac DUS gating. FT-MRI was analyzed using dedicated post-processing software. Endo- and epicardial contours were manually delineated from fetal cardiac 4-chamber views, followed by automated propagation to calculate global longitudinal strain (GLS) of the left (LV) and right ventricle (RV), LV radial strain, and LV strain rate.ResultsStrain assessment was successful in 38/43 fetuses (88%); 23 of them had postnatally confirmed diagnosis of CHD (e.g., coarctation, transposition of great arteries) and 15 were heart healthy. Five fetuses were excluded due to reduced image quality. In fetuses with CHD compared to healthy controls, median LV GLS (− 13.2% vs. − 18.9%; p < 0.007), RV GLS (− 7.9% vs. − 16.2%; p < 0.006), and LV strain rate (1.4 s−1 vs. 1.6 s−1; p < 0.003) were significantly higher (i.e., less negative). LV radial strain was without a statistically significant difference (20.7% vs. 22.6%; p = 0.1). Bivariate discriminant analysis for LV GLS and RV GLS revealed a sensitivity of 67% and specificity of 93% to differentiate between fetuses with CHD and healthy fetuses.ConclusionMyocardial strain was successfully assessed in the human fetus, performing dynamic fetal cardiac MRI with DUS gating. Our study indicates that strain parameters may allow for differentiation between fetuses with and without CHD.Clinical relevance statementMyocardial strain analysis by cardiac MRI with Doppler ultrasound gating and feature tracking may provide a new diagnostic approach for evaluation of fetal cardiac function in congenital heart disease.Key Points• MRI myocardial strain analysis has not been performed in human fetuses so far.• Myocardial strain was assessed in human fetuses using cardiac MRI with Doppler ultrasound gating.• MRI myocardial strain may provide a new diagnostic approach to evaluate fetal cardiac function.

Abstract 15552: Augmentation of Right Ventricular Strain Dynamics During Direct Mechanical Ventricular Actuation

Introduction: Available forms of mechanical circulatory support are associated with significant complications related to blood contact. Direct cardiac compression (DCC) devices avoid blood contact but may impair diastolic function. This derogatory effect of DCC devices may be related to a negative impact on RV function. Direct mechanical ventricular actuation (DMVA) uniquely augments LV diastolic function. The purpose of this study was to evaluate DMVA’s effect on RV function. Methods: Ischemic heart failure (HF) was induced using 5 mins of ventricular fibrillation (VF) circulatory arrest in large mature canines (n=9). Hearts were defibrillated and DMVA applied for 15 mins. VF circulatory arrest was subsequently re-induced for 5 mins to generate progressive HF. The experimental protocol was continued for 3 hrs. Intracardiac echocardiography was used to quantify longitudinal strain and peak strain rates in the RV and LV using speckle-tracking algorithms. Two-way ANOVA with Tukey HSD tests were used to evaluate statistical differences in strain metrics (baseline vs. HF vs. DMVA support and LV vs. RV). Results: DMVA increased RV fractional area change (DMVA: 0.282 ± 0.011, Mean ± SEM) relative to either baseline (0.221 ± 0.15, p=0.004) or HF (0.170 ± 0.006, p&lt;0.001). DMVA statistically significantly augmented all RV strain metrics relative to either baseline or HF (Table). Additionally, all DMVA strain metrics were statistically significantly greater in the RV than the LV (LV strain: 18.8 ± 0.5 %, p&lt;0.001, LV strain rate: systolic, -1.46 ± 0.04 1/s, p&lt;0.001, diastolic, 1.51 ± 0.04 1/s, p&lt;0.001). Conclusions: DMVA substantially improved RV strain dynamics compared to baseline or HF in this model. During DMVA support, strain dynamics in the RV were amplified more than the LV. This RV augmentation is important to achieving balanced biventricular DMVA support. Enhanced diastolic RV and LV augmentation during DMVA remains highly unique when compared to any other devices.

Beta-receptor desensitization after a multistage ultralong distance exercise in the desert?

Abstract Background Although cardiac function has been largely investigated during ultra-endurance exercise, few studies addressed to multi-stage endurance race. Methods Serial echocardiographic assessment of cardiac function was performed in male healthy subjects during the 2014 Marathon des Sables before the race (T1), at the second (T2) and fifth (T3) arrival (236 km) then after 48h recovery. Analysis were performed by 2 sonographers blind for the results of the other and the time of measure. Results Among the 20 athletes, 18 completed the study (mean age 42.4, median 42). RR intervals and (Left ventricular End Diastolic Volume (Simpson) (LVEDV) changed during the race and were correlated (r2 = 0.539, p&amp;lt;0.001); afterload approched by Left Ventricular Meridional Wall Stress (LVMWS) did not change. LV Global Longitudinal Peak Strain (PS) and subepicardial (Epi) PS did not vary. Subendocardial (Endo) LV.PS was lower at T2 /T1, concomitant to a (non-significant) drop in LVEDV; LV strain rate (SR) was lower at T4. RR and LVEDV were higher at T3 than at T2, and higher at T4 compared to T1 and T2. As preload conditions changed during the race, we studied the response of PS and SR to the change in preload (Starling mechanism). EndoPS/LVEDV, LVPS/LVEDV and SR/LVEDV did not change during the race but were lower after recovery. Conclusions 48h after a multistage ultralong duration exercise, we observed a drop in heart rate and contractility response to preload. The evolution of these parameters could be explained by a beta-receptors desensitization. These data need to be confirmed by other studies. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne ARS Bourgogne Franche Comté Evolution of parameters

Left atrial strain rate during atrial contraction predicts raised pulmonary capillary wedge pressure: evidence for left atrio-ventricular interaction

This study aimed to assess the relationship between different LA strain components and PCWP as well as to the relationship with other established methods. We studied 144 symptomatic patients, age 63 ± 14 years, 54 males, using conventional transthoracic echocardiography protocols, including LA and LV myocardial deformation from speckle tracking technique investigations along with simultaneous right heart catheterization (RHC) using established techniques. From RHC, pulmonary artery pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were measured and pulmonary vascular resistance (PVR) calculated. LA strain rate during atrial contraction (LASRa) was the strongest correlate with PCWP (r2 = − 0.40, p < 0.001), over and above both LASR during LV systole (LASRs) and LA longitudinal strain during ventricular systole (LASs) (r2 = 0.21 and 0.19, respectively, p < 0.001 for both). The correlation between LASRa and PCWP was stronger in patients with post-capillary PH compared to pre-capillary PH (r2 = 0.21 vs. r2 = 0.02, respectively). The strongest relationship between LASRa and PCWP was in patients with enlarged LA volume > 34 ml/m2 (r2 = 0.60, p < 0.001). In all patients LASRa < = 0.9 1/s was 88% accurate in predicting LA pressure > 15 mmHg which was superior to recently proposed uni- and multi-variable models. LASR during atrial contraction is the strongest predictor of PCWP, particularly in patients with post-capillary PH and with dilated LA cavity. Furthermore, it proved superior to recently proposed uni- and multi-variable based algorithms. Its close relationship with LV strain rate counterpart reflects important left heart chamber interaction in patients with raised LA pressure.

Beta-receptor desensitization evoked by a multistage ultralong distance exercise in the desert?

Few studies addressed to the evolution of cardiac function during a multistage ultra-long duration exercise (MULDE). Serial echocardiographic assessment of cardiac function was performed in male healthy subjects during the 2014 Marathon des Sables before the race (T1), at the second (T2) and fifth (T3) arrival (236 km) then after 48 h recovery. Analysis were performed by 2 sonographers blind for the results of the other and the time of measure. Statistical analysis was performed using ANOVA-RM to compare the evolution of the different parameters. Among the 20 athletes, 18 completed the study (mean age 42.4, median 42). RR intervals and (Left ventricular End Diastolic Volume (Simpson) (LVEDV) changed during the race and were correlated (r2 = 0.539, P < 0.001); afterload approached by Left Ventricular Meridional Wall Stress (LVMWS) did not change. LV Global Longitudinal Peak Strain (PS) and subepicardial (Epi) PS did not vary. Subendocardial (Endo) LV.PS was lower at T2/T1, concomitant to a (non-significant) drop in LVEDV; LV strain rate (SR) was lower at T4. RR and LVEDV were higher at T3 than at T2, and higher at T4 compared to T1 and T2. As preload conditions changed during the race, we studied the response of PS and SR to the change in preload (Starling mechanism). EndoPS/LVEDV, LVPS/LVEDV and SR/LVEDV did not change during the race but were lower after recovery ( Table 1 ). 48 h after a MULDE, we observed a drop in heart rate and contractility response to preload. The evolution of these parameters could be explained by a beta-receptors desensitization. These data need to be confirmed by other studies.

Can Doppler echocardiography estimate raised pulmonary capillary wedge pressure provoked by passive leg lifting in suspected heart failure?

Non-invasive estimation of left ventricular filling pressure (LVFP) during stress is important for explaining exertional symptoms in patients with heart failure (HF). The aim of this study was to evaluate ability of Doppler echocardiographic measures of elevated LVFP with passive leg lifting (PLL) in patients with suspected HF. Twenty-nine patients with clinical signs of HF who underwent simultaneous Doppler echocardiography and right heart catheterization (RHC) at rest and during PLL were consecutively investigated. Seventeen patients had normal PCWP (≤15mmHg) at rest and during PLL and 12 with normal PCWP at rest but >15mmHg with PLL. Conventional echo and 2D strain were used to assess early diastolic blood flow velocity (E), LV strain rate during early diastole (LVSRe), left atrial SR during atrial contraction (LASRa) and myocardial tissue Doppler velocities to assess lateral e' and further calculate E/e' and E/LVSRe and their relationship with PCWP, at rest and during PLL. Resting LAVI (β=0·45, P=0·009) and LASRa (β=-0·51, P=0·004) were independently related to PCWP during PLL. Also, LASRa (β=-0·77, P<0·001), E/e' (β=0·40, P=0·04) and E/LVSRe (β=0·47, P=0·021) during PLL correlated with PCWP during PLL. Multiple regression analysis identified E/LVSRe (β=0·46, P=0·001) and LASRa (β=-0·58, P=0·002) during PLL as being independently associated with PCWP during PLL. Left atrial volume and myocardial contraction (LASRa) at rest both predict unstable LV filling pressures measured as raised PCWP when provoked by PLL. Furthermore, LASRa at PLL seems to have the strongest association to PCWP during PLL.

Cardiac magnetic resonance characteristics in young survivors of aborted sudden cardiac death

PurposeWe aimed to identify and assess cardiac abnormalities by cardiovascular magnetic resonance (CMR) in a non-ischaemic aborted sudden cardiac death (SCD) population and to establish possible predictors of SCD. MethodsThirty-six consecutive SCD survivors [median age 37.6 years (IQR 24.1-43.2), 31% female] with no previous cardiac history or evidence of ischaemic heart disease underwent CMR on day 6 (IQR 4-10) after admission. Data on ventricular volumes and the extent of late gadolinium enhancement (LGE) were collected. Systolic strain analysis was performed using feature tracking software. ResultsLeft ventricular (LV) and right ventricular (RV) indexed diastolic volumes were 92.9 ± 28.4 ml/m2 and 94.1 ± 29 ml/m2, respectively. LV ejection fraction (EF) and RV EF were 56.8 ± 10.7% and 53.7 ± 10.7%, respectively. Global peak endocardial longitudinal, circumferential, and radial strain were −17.9 ± 4.28%, −23.2 ± 5.8%, and 32.8 ± 10.6%, respectively. Compared to normal range, global longitudinal endocardial strain, longitudinal epicardial strain, circumferential endocardial strain, radial strain, and circumferential endocardial strain rate were impaired. Median volume of LGE was 0.25% (IQR 0.12-1.12) of the LV myocardium with highest prevalence in the inferolateral wall. Patients with cardiomyopathy diagnosis (n = 16) had lower LV strain rate compared to patients without cardiomyopathy (n = 20). ConclusionsCMR findings in young patients with aborted SCD due to non-ischaemic heart disease seem to be minor. Although only present in small amounts, LGE appears to have a predilection towards the inferolateral wall in this population.

Intra- and inter-observer reproducibility of global and regional magnetic resonance feature tracking derived strain parameters of the left and right ventricle

ObjectivesTo investigate the reproducibility of regional and global strain and strain rate (SR) parameters of both ventricles and to determine sample sizes for all investigated strain and SR parameters in order to generate a practical reference for future studies. Materials and methodsThe study population consisted of 20 healthy individuals and 20 patients with acute myocarditis. Cine sequences in three horizontal long axis views and a stack of short axis views covering the entire left and right ventricle (LV, RV) were retrospectively analysed using a dedicated feature tracking (FT) software algorithm (TOMTEC). For intra-observer analysis, one observer analysed CMR images of all patients and volunteers twice. For inter-observer analysis, three additional blinded observers analysed the same datasets once. Intra- and inter-observer reproducibility were tested in all patients and controls using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation. ResultsIntra-observer reproducibility of global LV strain and SR parameters was excellent (range of ICCs: 0.81–1.00), the only exception being global radial SR with a poor reproducibility (ICC 0.23). On a regional level, basal and midventricular strain and SR parameters were more reproducible when compared to apical parameters. Inter-observer reproducibility of all LV parameters was slightly lower than intra-observer reproducibility, yet still good to excellent for all global and regional longitudinal and circumferential strain and SR parameters (range of ICCs: 0.66–0.93). Similar to the LV, all global RV longitudinal and circumferential strain and SR parameters showed an excellent reproducibility, (range of ICCs: 0.75–0.97). Radial strain and SR parameters were less reproducible in the LV as well as in the RV when compared to circumferential or longitudinal parameters. ConclusionCMR FT using the TOMTEC algorithm is highly reproducible in health and disease in both, the LV and RV on a global and regional level. The only exceptions are radial strain and SR parameters, which should be used with caution within clinical studies. The sample sizes estimated on the basis of the present study might serve as a reference during the planning of future FT studies.

Abstract 12623: Complementary Role of Exercise Performance and Right Heart Metrics to the Validated MAGGIC score: Insights From a Network Analysis

Background: Risk stratification in heart failure can be completed with established risk scores. However, right heart metrics, deformation imaging and the cardiopulmonary response to exercise have not been routinely incorporated. We investigated the interaction and incremental prognostic value of novel echocardiographic metrics and exercise performance in a consecutive cohort of patients with dilated cardiomyopathy (DCM). Methods: The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score was applied to 208 ambulatory patients with DCM (age 47 ± 13 years) who had undergone echocardiography in conjunction with cardiopulmonary exercise testing. Patients were followed for the composite end point of death, heart transplant, left ventricular device implantation and hospitalization for acute heart failure. Partial correlation network analysis was used to assess interaction between variables. Cox proportional hazard models identified independent predictors of outcome. Results: Mean LVEF and LV GLS were 33 ± 13 % and -10.6 ± 4.4 % respectively. Among echocardiographic variables, LVEF and LV GLS and LV strain rate were strongly related (r = -0.89, and -0.86, respectively, p &lt; 0.01). Age, sex, BMI, LV GLS and RV GLS explained 56% of the variance in peak VO 2 . Over a median follow up of 5.3 years, 60 events occurred including 16 deaths. MAGGIC scores were normally distributed (Figure 1, left) and log rank testing showed significant differences in survival. Cox proportional hazards identified MAGGIC score (1.78 [1.27-2.50], p &lt;0.01), peak VO 2 (HR 0.40 [0.24-0.84], p&lt;0.01) and right atrial volume indexed (RAVI) (HR 1.10 [1.02-1.19], p = 0.01) as independently associated with outcome. In combination these variables were incremental in prognostic value compared to MAGGIC score alone ( x 2 = 65 vs 42, p &lt;0.01, Figure 1, right). Conclusion: In patients with DCM exercise performance and RAVI provide incremental prognostic value when combined with the validated MAGGIC score.

Abstract 11961: Impact of Left Ventricular Systolic Stress on Contractility in Hypertension Assessed by One-beat Three-dimensional Speckle Tracking Echocardiography With High Volume Rates

Background: Left ventricular hypertrophy (LVH) is known as compensative mechanism of LV against pressure overload to reduce LV stress and maintain systolic performance. However, the relationship between LV systolic stress and strain or torsion that reflects contractility assessed by 3-dimensional speckle tracking echocardiography with high volume rates (3D-STE) has not been examined. We sought to evaluate the impact of LV systolic stress on LV contractility in hypertension (HTN). Methods: A total of 162 subjects {131 HTN patients and 31 controls (age 65±12)} were enrolled. HTN were divided into 3 groups: 47 HTN patients without LVH (age 67±12), 47 HTN patients with LVH (age 70±11) and 37 patients with hypertensive heart failure (HHF) (age 74±15). We examined LV longitudinal, circumferential and radial peak strain, LV strain rate at systole (SR) and LV torsion by 3D-STE with 70-80vps. LV systolic stress was calculated as LV end systolic radius x systolic blood pressure / thickness. Results: LV strain and SR in 3 directions and torsion decreased in HHF (longitudinal strain; control: -19±3, HTN without LVH: -18±4, HTN with LVH: -17±4, HHF: -13±4*. Torsion; 1.4±0.2, 1.4±0.3, 1.5±0.3, 1.2±0.2* °/cm, *p&lt;0.05 vs control) associated with increased systolic stress (129±24, 141±36, 143±40, 164±51* mmHg). There was correlation between LV systolic stress and longitudinal, radial and circumferential peak strain (r=0.18, p=0.024, r=-0.22, p=0.005 and r=0.18, p=0.021, respectively) and between LV stress and LV radial SR (r=-0.1.9, p=0.018) in total subjects. There was not a significant correlation between LV systolic stress and strain or SR in 3 directions in controls. Significant correlation was found between LV stress and circumferential strain or torsion in HHF (r=0.43, r=-0.34, p&lt;0.05), but not between LV stress and longitudinal or radial strain in HHF. Conclusion: Reduction of LV contractility assessed by LV strain, SR-S and torsion was associated with LV stress. In HHF only circumferential strain and torsion were decreased associated with increased LV stress, suggesting that the beginning of reduction in circumferential strain and torsion after deterioration of longitudinal and radial contractility due to increased systolic stress may be responsible for HHF.

Abstract 11808: Association Between Left Ventricular Properties in Patients With Hypertension and the Incidence of Paroxysmal Atrial Fibrillation: Three-Dimensional Speckle Tracking Echocardiographic Study

Background: Hypertension (HTN) is one of the major causes of atrial fibrillation (AF), since it is usually accompanied by left atrial (LA) remodeling due to pressure and/or volume (LAV) overload. We examined the relationship between ventricular (LV) geometry or LV properties in HTN and the incidence of paroxysmal AF (PAF) using novel, one-beat, automated, 3-dimensional speckle tacking echocardiography (3D-STE) with high volume rates. Methods: Patients with HTN (n=107, age 69±7) and controls (n=60, age 69±9) were prospectively enrolled. HTN patients were divided into 5 groups according to LV geometry and the presence of hypertensive heat failure (HHF) {normal geometry (n=25), concentric remodeling (n=20), concentric hypertrophy (LVH) (n=24), eccentric LVH (n=21) and HHF (n=17)}. Isovolumic relaxation time (IVRT) was measured by Doppler echo. We evaluated LV ejection fraction (EF), E/e’, pulmonary capillary wedge pressure (PCWP), Tau, LV diastolic stress, LV strain and LV myocardial stiffness in sinus rhythm. PCWP was estimated as 10.7- 12.4 x log (LA active emptying function / minimum LAV) as we reported. Tau was calculated as IVRT / (ln 0.9 x systolic blood pressure - ln PCWP). LV diastolic stress was calculated as LV radius at end diastole x PCWP / thickness. LV strain rate (SR) during IVR, as an index of relaxation, and LV strain were measured by the 3D-STE with volume rates of 50-80vps. LV myocardial stiffness was estimated as LV stress / LV strain. Results: LVEF was reduced only in HHF compared with controls (56±7 vs. 67±6%). Conclusion: LVEF in HHF was decreased but still remained within the normal range, whereas diastolic properties in eccentric LVH and HHF were reduced compared with control. The incidence of PAF significantly increased in eccentric LVH and HHF associated with the impairment of LV relaxation and stiffness and increased LV stress. This suggests that the target of treatment to reduce the incidence of PAF in HTN must be diastolic function.

Beta blockers or combination of beta blocker with ivabradine better alters the course of heart failure with reduced ejection fraction when the target heart rate is achieved

β-blockers (BB) and ivabradine (I) has been shown to be beneficial in heart failure with reduced EF (HFREF). The main benefit of I derives from heart rate reduction (HRR), whereas BB have broader spectrum of action. We conducted this study to evaluate whether HRR plays a major role in the treatment of HFREF in pts on standard therapy. Methods: 180 pts (55 female) 62±9 years with postinfarction HFREF (EF≤35%) on standard therapy with ACEI/ARB, spironolacton, loop diuretics and in sinus rhythm were randomized to two groups to receive nebivolol (N) titrated up to the achievement of the target HRR (THRR) <70 BPM or I titrated to 10mg BID in order to achieve THRR. THRR were achieved in 43 N tolerated pts, and 56 pts on I and the rest received the combination of N and I on order to reach THRR. All pts on N alone and the same number of pts on I or N+I were selected for the study and comprised 3 groups. EchoCG indexes of LV EDV, ESV and LAV, septal E/Em, mean longitudinal LV strain rate (LSR), Tei index (TI) as IVCT+IVRT/ET, as well as the total ischemic burden (TIB) as a total time of ST segment depressions ≥ 1 mm and ≥1 min duration and HRV as a standard deviation of normal RR intervals (SDNN) were measured by 24-hour ECG monitoring at baseline, 90 and 180 days follow up. Results: After 90 days follow up all parameters were similar between groups but significantly improved at the same degree within each group compared with baseline (p < 0.05). After 180 days follow up LV remodeling was better altered, contractility, SDNN parameters significantly improved at the same degree in N and N+I groups compared with I without differences between N and N+I, TIB did not differ between groups (ESVI: N 59.7±7.4 ml/m2 vs N+I 60.5±7.6 ml/m2 vs I 69.8±7.9* ml/m2, *p<0.05; EDVI: N 95.8±9.4 ml/m2 vs N+I 93.4±9.2 ml/m2 vs I 109.4±9.8* ml/m2, *p<0.05; TI: N 0.76±0.24 vs N+I 0.73±0.22 vs I 0.89±0.28*, *p < 0.05; E/Em: N 11.4±4.1 vs N+I 11.1±4.5 vs I 14.8±5.2*, *p < 0.05; TIB: N 35±13 min vs N+I 34±10 min vs I 33±9 min, p=NS; SDNN: N 103.04±15 ms vs N+I 104.06±16 ms vs I 126±18*ms, *p<0.05; LSR: N 1.59±0.16 vs N+I 1.54±0.14, 1.30±0.12*, *p < 0.05). Both N and I were well tolerated by pts throughout follow up. Conclusion: BB or in case of intolerance their combination with I to further reduce HR are more beneficial than reduction of HR at the same degree solely with I. Additional properties of BB are of importance and neurohormonal modulation with HR reduction better alters the course of HF.

Efficacy, Safety, and Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction

This study sought to investigate the efficacy and safety of catheter ablation for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFPEF). AF is a precipitating factor for clinical deterioration of HFPEF. Catheter ablation for AF was performed in a consecutive 74 patients with compensated HFPEF (left ventricular [LV] ejection fraction >50%). AF-free probability after catheter ablation and factors relating to maintenance of sinus rhythm were investigated. LV strain and strain rate were assessed by echocardiography at baseline and over 12 months after ablation. During a 34 ± 16-month follow-up period, single- and multiple-procedure drug-free success rates were 27% (n = 20) and 45% (n = 33), respectively. Multiple procedures and pharmaceutically assisted success rate was 73% (n = 54). No major complications occurred during follow-up. Multivariate Cox regression analyses revealed that AF type (other than long-standing persistent AF) and lack of hypertension were independently associated with maintenance of sinus rhythm (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.03 to 3.17, p = 0.04; HR: 0.49, 95% CI: 0.24 to 0.96, p = 0.04, respectively). LV systolic indices (LV ejection fraction, LV strain/strain rate at systole) and diastolic indices (E/E', ratio of LV strain rate at diastole with early transmitral flow) were improved only in patients maintaining sinus rhythm at follow-up. Our results suggest that AF can be effectively and safely treated with a composite of repeat procedures and pharmaceuticals in patients with HFPEF. However, the current study was a single-arm analysis; therefore, larger randomized control studies are needed to verify the benefit of AF ablation in this cohort.

Subclinical Left Ventricular Dysfunction in Asymptomatic Chronic Mitral Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging-Based Study

The optimal timing of the surgery in asymptomatic severe mitral regurgitation (MR) remains a challenge. The aim of the study is to evaluate the subclinical changes in LV longitudinal functions by using a novel strain imaging technique; velocity vector imaging (VVI); in patients with chronic MR. We studied 54 patients with asymptomatic, nonischemic, chronic MR (56.8 ± 9 years and 56% male) and 30 healthy controls (55 ± 6.5 years and 55% male) with normal ejection fraction. Patients with MR were analyzed in tertiles according to their regurgitant volumes (RV) and regurgitant fractions (RF): mild MR (RV < 30 mL, RF < 30% n = 7), moderate MR (RV: 30-59 mL, RF = 30-50%; n = 29), and severe MR (RV > 60 mL, RF ≥ 50%; n = 18). Conventional echocardiography and VVI-based strain imaging were performed to analyze LV functions. LV longitudinal peak systolic strain and strain rate (SRs) were significantly impaired in moderate and severe MR patients. Changes in LV longitudinal deformation were more significant in patients with severe MR. All deformation parameters showed a marked negative correlation with RV (LV Strain r =-0.583, P = 0.0001; LV SR r =-0.408, P = 0.002, respectively). LV long-axis functions are important markers of LV contractility in MR patients. Novel echocardiographic techniques may provide additional data on subclinical changes in the LV and give way to the optimal timing for the surgery in severe MR patients.