Subtle Left Ventricular Systolic Dysfunction Research Articles

Myocardial deformation imaging unmasks subtle left ventricular systolic dysfunction in asymptomatic and treatment-naïve HIV patients.

Patients infected by the human immunodeficiency virus (HIV) and receiving highly active antiretroviral therapy have a higher incidence of cardiovascular disease than healthy subjects, but little is known about cardiac function in asymptomatic and treatment-naïve patients. We sought to study cardiac function in asymptomatic HIV-infected, treatment-naïve patients. We studied 41 HIV-infected and treatment-naïve patients and 20 age- and sex-matched healthy controls. Patients with cardiac symptoms, history of cardiac disease or NT-proBNP >100pg/mL were excluded. We addressed cardiac function using standard echocardiography along with tissue Doppler (TDI) measurements, including strain/strain rate assessment. Standard echocardiographic parameters did not differ between groups, except for transmitral E wave velocity (64.8±14cm/s in HIV vs 76.1±10cm/s in controls, p=0.002). In contrast, TDI mitral and tricuspid annulus s velocity and all strain/strain rate measurements were significantly lower in HIV patients: s lateral, 10.2±2.4/11.3±0.7, p=0.011; s septal, 8.1±1.6/8.7±0.8, p=0.045; s tricuspid, 13.4±2.3/14.9±1.3, p=0.002; strain/strain rate, septal (strain/strain rate, 15.1±5.7/-0.9±0.3, 25.3±1.7/-1.9±0.2, p<0.001), anterior (16.7±3/-1.0±0.1, 26.7±1.7/-1.9±0.2, p<0.001), lateral (16.0±6/-1.0±0.1, 27.5±1.8/-2.2±0.3, p<0.001) and posterior (15.2±5.8/-1.0±0.2, 26.2±1.8/-2.2±0.3, p<0.001) left ventricular wall. HIV infection itself is accompanied by subclinical systolic dysfunction, not apparent to standard echocardiography that can be unmasked though using sensitive echocardiographic techniques.

Evaluation of Human Immunodeficiency Virus Infection‐Related Left Ventricular Systolic Dysfunction by Tissue Doppler Strain Echocardiography

Cardiovascular involvement causes significant morbidity and mortality among patients with human immunodeficiency virus (HIV) infection. Since the introduction of highly active antiretroviral treatment (HAART), subtle changes in left ventricular (LV) function, which may be clinically silent, have become more pronounced in HIV patients. Echocardiographic strain imaging (SI) may detect subclinical myocardial dysfunction at an earlier stage compared with conventional echocardiography. The aim of this study was to evaluate tissue Doppler-derived LV strain and strain rate (SR) along with conventional measures of LV function in asymptomatic, stable adult HIV patients on HAART. Twenty-one patients with HIV infection (mean age: 37.8 ± 11.9 years, 11 males) who had no cardiovascular complaints and 27 healthy volunteers (mean age: 40.9 ± 5.8 years, 14 males) were enrolled. Traditional parameters including LV ejection fraction (EF) were measured along with tissue velocity imaging (TVI) and tissue Doppler SI parameters using transthoracic echocardiography. The mean duration of HIV infection was 30.8 ± 25.1 (3-120) months. The mean LVEF in HIV group was within normal limits but lower than controls (64.5% ± 10.2% vs. 72.2% ± 6.4%, P = 0.003). There were no differences in other major traditional measures, as well as TVI parameters between groups. LV systolic strain and SR parameters were impaired indicating subtle LV systolic dysfunction in HIV group. No difference in diastolic function was observed between groups. Left ventricular systolic strain parameters may be utilized to demonstrate subtle LV systolic dysfunction in asymptomatic HIV patients.

Evaluation of Myocardial Deformation in Patients with Sickle Cell Disease and Preserved Ejection Fraction Using Three‐Dimensional Speckle Tracking Echocardiography

Sickle cell disease (SCD) is a hemoglobinopathy that affects one in 500 African Americans. Although it is well established that patients with SCD have left ventricular (LV) diastolic dysfunction, it is not clear whether they have subtle LV systolic dysfunction despite preserved ejection fraction (EF). We used three-dimensional speckle tracking echocardiography (3DSTE) to assess changes in both systolic and diastolic LV function in SCD. Transthoracic real time 3D images were obtained (Philips iE33) in 56 subjects, including 28 stable outpatients with SCD (age 33 ± 7 years) and 28 normal controls (age 35 ± 9 years). 3DSTE was performed using prototype software (4DLV Analysis, TomTec) to obtain LV volume and deformation time curves, from which indices of systolic and diastolic LV function were calculated. In SCD patients, 3DSTE-derived LV filling parameters were significantly different from normal controls, reflecting an increase in both rapid and atrial filling volumes and prolonged active relaxation, depicted by a decrease in filling volume fractions at fixed times and an increase in rapid filling duration. Global LV systolic function was not only preserved but increased compared to controls, as reflected by significantly increased global longitudinal strain. Importantly, twist angle and torsion as well as radial and circumferential components of 3D strain were similar in both groups. 3DSTE was able to confirm diastolic dysfunction, as expected in some patients with SCD. However, 3DSTE strain analysis did not reveal any changes in LV systolic function. These findings provide novel insight into the pathophysiology of the cardiovascular complications of SCD.

Feasibility of detecting early left ventricular systolic dysfunction using global area strain: a novel index derived from three-dimensional speckle-tracking echocardiography

Area strain (AS), derived from three-dimensional speckle-tracking echocardiography (3D-STE), is a novel parameter integrating longitudinal and circumferential deformation. We sought to evaluate the ability of global AS to detect early left ventricular (LV) systolic dysfunction in patients with risk factors for heart failure (HF). Standard echocardiography and 3D-STE were performed in 160 subjects with or without HF. Three-dimensional speckle-tracking echocardiography was measured with reliable tracking quality in 137 (86%) of the 160 subjects initially enrolled in this study: 30 healthy volunteers, 29, 37, 26, and 15 patients with Stage A, B, C, and D HF, respectively. Global strain values were automatically calculated by 3D wall motion tracking (3D-WMT) software. Although global longitudinal strain (LS), circumferential strain (CS), radial strain (RS), and LV ejection fraction (LVEF) showed the downward trend from normal controls to patients with Stage D HF, the difference did not reach statistical significance between normal controls and patients with Stage A HF. In contrast, we observed the progressive decrease in global AS from normal to Stage A HF to Stage D HF (P< 0.05). In addition, global AS showed an excellent correlation with LVEF, global LS and CS. The optimal cut-off value for global AS, to detect LV dysfunction (Simpson's rule-based LVEF <50%), was -29.23% at a sensitivity of 86.3% and at a specificity of 88.4%. Global AS is a sensitive and reproducible parameter to detect early and subtle LV systolic dysfunction, showing greater feasibility than other conventional strain parameters.