European Journal of Echocardiography最新文献

{"title":"Assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis","authors":"I Leo, J Sabatino, A Strangio, G Canino, C Critelli, F Troilo, M Maglione, G Loliva, L R Romano, C Indolfi, S De Rosa","doi":"10.1093/ehjci/jead119.427","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.427","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of intracardiac flows has acquired increasing significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have demonstrated abnormalities in cardiac function, which are related to pathological intracardiac vortical flows. This study investigates the additional information provided by quantifying intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods One hundred twenty patients with severe AS (65 females – 54%), 60 patients with concentric remodelling (VR) (7 females – 12%) and 100 healthy controls (CTRL) (32 females – 32%) were prospectively enrolled to undergo a non-invasive evaluation of intracardiac flow dynamics. Echocardiographic assessments were performed, and apical three chamber views were recorded by means of MyLab™ X8 Platform. The HyperDoppler software adapted to an Esaote echo-scanner without contrast injection was used to assess vortex properties in all the patients. Results Vortex depth, vortex length, vortex intensity and vortex area were all significantly increased in SAo compared to CTRL (p<0.001, p = 0.003, p<0.001 and p = 0,049, respectively). Only vortex depth and vortex intensity (p<0.001 and p = 0.013, respectively) were significantly increased in SAo compared with VR. The mean energy dissipation of SAo group was significantly increased compared to control group (p<0.001) and VR (p = 0.002). Finally, the ROC Curve, generated to assess the capability of vortex depth to discriminate patients with and without severe aortic stenosis, showed an AUC of 0.751 (cutoff value ≥ 0.354; sensitivity, 73%; specificity, 73%). Conclusions There is a significant change of vortex localization, vorticity and energy parameters in patients with Sao. In particular, vortex depth, vortex intensity and energy dissipation are all significantly increased in SAo compared to CTRL and vortex depth can independently differentiate patients with SAo to those with only concentric remodelling and to CTRLs with high accuracy. These findings indicate that the assessment of intracardiac flow dynamics may provide complementary information to standard echocardiography, helping to distinguish within the heterogeneous population of patients with severe AS.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking multi-organ treatment response in systemic AL amyloidosis with cardiac magnetic resonance derived extracellular volume mapping","authors":"A Ioannou, R K Patel, Y Razvi, A Martinez-Naharro, A Porcari, L Venneri, D Hutt, H Lachmann, A Wechalekar, H Lachmann, P N Hawkins, J D Gillmore, M Fontana","doi":"10.1093/ehjci/jead119.004","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.004","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Systemic light-chain (AL) amyloidosis commonly involves the liver, spleen and heart. Cardiac magnetic resonance (CMR) with extracellular volume (ECV) mapping has demonstrated accuracy in measuring cardiac, hepatic and splenic amyloid infiltration. Purpose We sought to: (1) assess the association between baseline multi-organ ECVs and prognosis (2) assess the multi-organ response to treatment using ECV mapping, and (3) assess the association between multi-organ treatment response and prognosis. Methods We identified 351 patients with a confirmed diagnosis of systemic AL amyloidosis who underwent baseline serum amyloid P component (SAP) scintigraphy and CMR at diagnosis, of which 171 had follow-up imaging. We also recruited 20 healthy volunteers who underwent CMR with ECV mapping, without corresponding SAP scintigraphy, to allow calculation of the ECV normal ranges. Results At diagnosis, ECV mapping demonstrated that 304(86.7%) had cardiac involvement, 114(32.5%) significant hepatic involvement and 147(41.9%) significant splenic involvement. Baseline myocardial and liver ECV independently predict mortality (myocardial: HR=1.05,95CI%[1.03–1.07],P<0.001; liver: HR=1.03,95%CI[1.01–1.05],P<0.001). Liver and spleen ECV correlated with amyloid load assessed by SAP scintigraphy (R=0.751,P<0.001; R=0.765,P<0.001, respectively). Serial multi-organ ECV measurements accurately tracked treatment response as validated against serial SAP scintigraphy (the current reference standard). Multi-organ ECV regression was observed as early as 6-months in patients with a good haematological response (liver=15%, spleen=15%, heart=5%). The remaining patients with a good haematological response had stable liver and spleen ECVs, but 20% had cardiac progression. By 12-months more patients with a good haematological response demonstrated cardiac regression (liver=30%, spleen=36%, heart=32%), and this trend was maintained at 24-months. Multi-variable analysis adjusting for haematological response, change in myocardial, liver and spleen ECV demonstrated that haematological response, change in myocardial ECV (HR=1.11, 95%CI[1.02–1.19], P=0.011) and liver ECV (HR=1.06, 95%CI[1.01–1.11], P=0.015) remained independent predictors of prognosis at 6-months. Conclusions Multi-organ ECV quantification accurately tracks treatment response, and demonstrates different rates of organ regression, with the liver and spleen regressing more rapidly than the heart. A good haematological response alone is likely to induce visceral organ stabilisation/regression, but may not be sufficient to induce myocardial stabilisation/regression. Liver and myocardial ECV at diagnosis and changes in ECV at 6-months independently predict mortality. ECV mapping offers a comprehensive multi-organ assessment of treatment response and accurate prognostication.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning model including left ventricular strain analysis for sudden cardiac death prediction in hypertrophic cardiomyopathy","authors":"A Al Wazzan, M Taconne, V Le Rolle, M Inngjerdingen Forsaa, K Hermann Haugaa, E Galli, A Hernandez, T Edvardsen, E Donal","doi":"10.1093/ehjci/jead119.061","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.061","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background The excess mortality in hypertrophic cardiomyopathy (HCM) patients is mainly attributed to the occurrence of sudden cardiac death (SCD). The prediction of ventricular arrhythmias remains challenging and could be improved. Purpose This study evaluated the added predictive value of a machine learning-based model combining clinical and conventional imaging parameters with information from left ventricular strain analysis to predict SCD in patients with HCM. Methods A total of 434 HCM patients (65% men, mean age 56 years) were retrospectively included from two referral centers from two different countries and followed longitudinally (mean duration 6 years). Strain parameters were automatically extracted from the left ventricle longitudinal strain segmental curves of each patient and included in a Ridge Regression model alongside conventional clinical and imaging data. The composite endpoint included sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy, aborted cardiac arrest, or sudden cardiac death. Results 34 patients (7.8%) met the endpoint with an incidence of ventricular arrhythmias of 0.9%/years. Among the 18 most discriminating parameters, 7 were derived from left ventricle longitudinal strain segmental curves analysis (figure 1). After n=200 rounds of cross-validation, the final model showed superior predictive performance compared to conventional models with a mean area under the curve (AUC) of 0.83 ± 0.8 compared with an AUC of 0.56 and 0.61 for the 2014 ESC risk score and the 2020 AHA/ACC model, respectively. Conclusion A machine learning model including automatically extracted left ventricular strain-derived parameters was superior in the prediction of sustained ventricular arrhythmias and SCD in patients with HCM compared to existing models. A machine learning model including left ventricle longitudinal strain analysis could improve SCD risk stratification in HCM patients.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac magnetic resonance features associated with the risk of cardiac arrest in patients with acute myocardial infarction","authors":"E Szabo, T Benedek, I Kovacs, N Rat, L Bordi, Z S Parajko, A Rosca, T Mihaila, B Ion, I Benedek","doi":"10.1093/ehjci/jead119.386","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.386","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number NR. 164 / 26 / 10.01.2023. Background Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). The role of different factors related to the site and severity of coronary occlusion in the pathogenesis of AMI-related cardiac arrest is still under investigation. The aim of the study was to investigate the association between (1) different cardiac magnetic resonance (CMR) features associated with the location and severity of the myocardial injury, and (2) the risk of CA accompanying an AMI. Methods In total, 54 patients AMI undergoing post-AMI CMR imaging with delayed gadolinium enhancement were enrolled in the study. The study lot was divided into 2 groups: group 1–8 patients who survived a CA in the acute phase of AMI and group 2–46 patients, matched for age and gender, with AMI but without CA. In all patients, infarct mass, the proportion of high transmural extent, and scar mass at different myocardial segments were calculated using the QMap software (Medis BV). Results Compared to patients without CA, those with CA had a significantly higher infarct mass (47.9 +/- 38 g versus 23.3 g, p = 0.03), infarct mass % (26.9 +/ 17.3% vs 15.1 +/- 8.6 %, p = 0.02), and a higher degree of transmurality (29.28 +/- 20.2 % vs 14.1 +/- 9.2 %, p = 0.01). Location of myocardial injury at the level of latero-apical, anterolateral, and bazal anterior segments seemed to be more frequently associated with the risk of CA in the acute phase of AMI: infarct mass 33.9 +/- 30.6 g in group 1 vs 13.6 +/- 17.3 g in group 2, p = 0.02 for the latero-apical segment, 26.5 +/- 29.0 g in group 1 vs 8.9 +/- 12.8 g in group 2, p = 0.02 for the anterolateral segment, and 20.1 +/- 21.5 g in group 1 vs 7.8 +/- 14.7 g in group 2, p = 0.02 for anterobazal segment. Conclusions Myocardial mas, high transmural extent at CMR imaging, and a large myocardial injury identified by CMR at the level of the anterior and lateral ventricular segments seems to be associated with an increased risk of CA in the acute phase of AMI.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incremental value of right atrial strain analysis to predict atrial fibrillation recurrence after electrical cardioversion","authors":"M Tomaselli, V Cannone, L P Badano, D N Radu, E Curti, F P Perelli, F Heilbron, M Gavazzoni, V Rella, G Oliverio, S Caravita, C Baratto, G Parati, F M Brasca, D Muraru","doi":"10.1093/ehjci/jead119.088","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.088","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, associated with elevated risks of cardiovascular events and death. The assessment of left atrial (LA) mechanics has been reported to refine AF risk prediction, however it does not completely predict AF relapse. The potential added role of right atrial (RA) function in this setting is unknown. Purpose This study sought to evaluate the added value of RA longitudinal reservoir strain (RARS), on top of LA longitudinal reservoir strain (LARS) analysis, for the prediction of AF recurrence after electrical cardioversion (ECV). Methods We retrospectively studied 132 consecutive adult patients (men 55%, 72±10 years) with persistent AF undergoing ECV in hospital setting. Exclusion criteria were: pregnancy, previous cardiac surgery, pacemaker or implantable cardioverter defibrillator, severe valvular regurgitation/stenosis, ventricular systolic dysfunction, poor apical acoustic window, unsuccessful ECV, early recurrent AF and lack of follow-up. LA and RA size and function were analyzed by conventional 2D and speckle-tracking echocardiography before ECV. The endpoint was AF recurrence. Results After a total follow-up of 12 months, 63 patients (48%) showed AF recurrence. Both LA and RA reservoir strain were significantly lower in patients experiencing AF recurrence than in patients with persistent sinus rhythm (LARS 10±6 vs 13±7%, RARS 14±10 vs 20±9 %, respectively, p<0.001 for both). By receiving operating curve (ROC) analysis, the best cut-offs associated to AF recurrence after ECV were 15% for RARS [AUC 0.77 (95%CI 0.69–0.84), p<0.0001] and 10% for LARS [AUC 0.69 (95%IC 0.60–0.77), p<0.0001]. Kaplan-Meier curves showed that patients with both LARS≤10% and RARS ≤15% had a significant risk for AF recurrences (log-rank, p<0.001) (Figure 1). However, at multivariable Cox regression, RARS [HR 3.26, 95%CI (1.73–6.13), p< 0.001] was the only parameter independently associated with the AF recurrence. RARS provided incremental prognostic value over LARS, LA and RA volumes concerning the prediction of AF relapse after ECV (Figure 2). Conclusions RARS was independently associated with AF recurrence after ECV and provided an incremental prognostic value over LARS. This study highlights the importance of assessing the functional remodeling of both RA and LA in patients with persistent AF. Figure 1. Atrial fibrillation recurrence freedom according to left and right atrial reservoir longitudinal strain. Kaplan-Meier plots of patients grouped according to the threshold levels of left (left panel) and right (right panel) values of reservoir longitudinal strain identified by the Receiver Operating Curve analyses.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific impairment of cardiac functional reserve in HFpEF: insights from the HFpEF-Stress trial","authors":"A Schulz, T Lange, R Evertz, J T Kowallick, G Hasenfuss, S J Backhaus, A Schuster","doi":"10.1093/ehjci/jead119.022","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.022","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): DZHK Background Heart failure with preserved ejection fraction (HFpEF) has been observed to have a twice as high prevalence in women compared to men.(1,2) While predisposing risk factors are quite similar between the sexes(2,3), this study aimed to identify sex-specific pathophysiological features in HFpEF using state-of-the-art diagnostic approaches. Methods 75 Patients with exertional dyspnea, preserved ejection fraction (EF ≥ 50%) and signs of diastolic dysfunction on echocardiography were prospectively recruited in the HFpEF-Stress Trial. Patients underwent right heart catheterization (RHC), echocardiographic and cardiovascular magnetic resonance (CMR) imaging at rest and during exercise stress. HFpEF was defined according to pulmonary capillary wedge pressure in RHC (rest ≥ 15mmHg, stress ≥ 25mmHg), below these thresholds patients were classified as non-cardiac dyspnea (NCD). Results Main results are displayed in Figure 1. Compared to men, women with HFpEF revealed lower right ventricular (RV)-stroke volumes during exercise stress (f 38.1 vs. m 50.4 ml/m2 BSA; p = 0.011) but not with NCD. This was accompanied by a decreasing left atrial (LA) EF in women but not men comparing resting to exercise conditions (f −2.7 vs. m 2.5%, p = 0.020) and an impaired left ventricular (LV) filling (f 35.5 vs. m 44.2 ml/m2 BSA, p = 0.017) in women with HFpEF during exercise stress. These sex-specific differences were not present in NCD. The exercise-induced decrease in LA EF emerged as a predictor for HFpEF in women (OR 13.67 95% CIs: 3.03 – 62.14, p<0.001) with high diagnostic accuracy (AUC 0.83 95% CIs: 0.7–0.95). Conclusion Women with HFpEF demonstrate sex-specific functional alterations of RV, LA, and LV function during exercise-stress. The biventricular impairment suggests a complex interplay of both sides of the heart during the progression of HFpEF in women. This unique pathophysiology represents a sex-specific diagnostic target, which may allow early identification of women with HFpEF for future individualized therapeutic approaches.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing of Peak Longitudinal strain and Post Systolic Shortening in detecting ischemia at rest in stable coronary artery disease: an angiography verified study","authors":"M Arslan, O Ozden, K Ohtaroglu Tokdil, A Barutcu","doi":"10.1093/ehjci/jead119.248","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.248","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary artery disease is a major public health problem. Early diagnosis and treatment of coronary artery disease is crucial. There is a need for a practical, reliable and cost-effective non-invasive imaging tool. We aimed to evaluate the rest ischemia with speckle tracking echocardiography (STE) compare to the two methods in patients who were scheduled coronary angiography according to the stress tests. Methods We included fifty patients with stable angina pectoris who were scheduled for conventional coronary angiography after the stress tests in our study. Speckle tracking echocardiography was performed just before coronary angiography. The association of 2 parameters with coronary artery disease was investigated and compared. Results Among 50 patients recruited for the study, 38 of them had severe CAD (>50%), whereas 12 patients had non-significant CAD. Post systolic shortening (PSS) was significantly related with CAD (p<0.0001). The relationship of PLS with the area at risk was found to be statistically insignificant but global longitudinal strain (GLS) was significantly lower in patients with severe CAD (p = 0.011). Conclusion PSS may detect coronary ischemia in patients with stable coronary artery disease and it is more sensitive and specific in patients with stable CAD. PSS is a very useful, practical and easy applicable non invasive tool for the detection of severe coronary artery disease at rest.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of post-operative left ventricular dysfunction in degenerative mitral regurgitation","authors":"A Althunayyan, S Alborikan, S Badiani, K Wong, R Uppal, N Patel, P Petersen, G Lloyd, S Bhattacharyya","doi":"10.1093/ehjci/jead119.170","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.170","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Saudi Arabian Cultural Bureau. Background Chronic degenerative mitral regurgitation leads to volume overload causing left ventricular (LV) enlargement and eventually LV impairment. Current guidelines determining thresholds for intervention are based on LV diameters and ejection fraction. There is sparse data examining the value of LV volumes and newer markers of LV performance on outcomes of surgery in mitral valve prolapse. Purpose Identify the best markers of LV impairment after mitral valve surgery. Methods Prospective, observational study of patients with mitral valve prolapse undergoing mitral valve surgery. Pre-operative LV diameters, volumes, ejection fraction (LVEF), global longitudinal strain (GLS) and myocardial work measured. Post-operative LV impairment defined as LVEF < 50% at 1 year post-surgery. Results Eighty-seven patients included. 13% developed post-operative LV impairment. Patients with post-operative LV dysfunction showed significantly larger indexed LV end-systolic diameters (LVESD), volumes (LVESV), lower LVEF and more abnormal GLS than patients without post-operative LV dysfunction. In multivariate analysis, indexed LVESV (Odds ratio 1.11 (95% CI 1.01 – 1.23), p = 0.039) and GLS (odds ratio 1.46 (95% CI 1 – 2.14), p = 0.054) were the only independent predictors of post-operative LV dysfunction. The optimal cut-off of 36.3 ml/m2 for indexed LVESV had a sensitivity of 82% and specificity of 78% for detection of post-operative LV impairment. Conclusion Post-operative LV impairment is common. Indexed LV volumes (36.3ml/m2) provided the best marker of post-operative LV impairment.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identify cause of heart failure of unknown aetiology using cardiac magnetic resonance - a 10-year observational study","authors":"N. Ojrzyńska, M. Marczak, Ł. Mazurkiewicz, J. Petryka-Mazurkiewicz, Barbara Miłosz-Wieczorek, J. Grzybowski, M. Śpiewak","doi":"10.1093/EHJCI/JEAA356.253","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.253","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Heart failure (HF) is a clinical syndrome caused by structural or functional cardiac abnormality and is diagnosed on the basis of typical symptoms. It is associated with significant morbidity and mortality and affects more than 25 million people worldwide.\u0000 HF of unknown aetiology is managed with symptomatic treatment. Patients with reduced (HFrEF) or mid-reduced ejection fraction (HFmrEF) and no clear cause of systolic dysfunction are usually classified as having DCM. In HFpEF group ejection fraction is preserved but diastolic dysfunction is present leading to HF symptoms.\u0000 \u0000 \u0000 \u0000 The aim of this study was to investigate the clinical significance of cardiac magnetic resonance (CMR) imaging to identify heart failure (HF) aetiology.\u0000 \u0000 \u0000 \u0000 We retrospectively reviewed all medical charts of patients referred for CMR due to heart failure of unknown aetiology admitted to our hospital between 2008 and 2017. Only patients with no specific pre-CMR initial diagnosis were included. Patients with suspicion of any specific disease leading to HF were excluded. If a referring physician suspected myocarditis, cardiomyopathy, previous myocardial infarction or advanced stable coronary disease (based on clinical signs and symptoms, the patient’s and family history or all pre-CMR studies), these patients were omitted from our analysis. Thus, we included only patients whose diagnostic work-up did not reveal suspicion of any specific cardiac disease leading to HF.\u0000 \u0000 \u0000 \u0000 The study sample consisted of 243 patients (173 (71.2%) male, mean age 44.0 ± 14.2%). All patients underwent contrast-enhanced CMR. Late gadolinium enhancement (LGE) was detected in 74.9% cases. Cardiomyopathies comprised the main aetiology (174 cases, 71.6%), in particular dilated cardiomyopathy (143 patients, 58.8%). 17 patients (7.0%) were diagnosed with myocarditis and in 24 patients (9.9%) CMR-based diagnosis was ambiguous – pointing out myocarditis or dilated cardiomyopathy. In 23 cases (9.5%) CMR indicated the presence of prior infarction undetected by pre-CMR testing. In five patients (2.1%) valvular disease was revealed as the sole cause of HF.\u0000 We analysed the change in patients’ management guided by the CMR results defined as change of treatment and/or necessity of further tests leading to therapeutic consequences. Change of pre-CMR diagnosis occurred in 94 patients (38.7%) and was judged crucial in 41 patients (16,9%).\u0000 As crucial we adjudicated the diagnosis associated with a need immediately further investigation and treatment changing, as follows: newly diagnosed amyloidosis, ischaemic heart disease or complex advanced valvular disease and cardiomyopathies other than dilated, hypertrophic and restrictive.\u0000 \u0000 \u0000 \u0000 Our study strongly suggests that cardiac magnetic resonance imaging is a valuable tool for determining the aetiology of heart failure and impacts patients\" management.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"2014 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73545336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac magnetic resonance derived global longitudinal strain outperforms established functional parameters in prognostication after ST-elevation myocardial infarction","authors":"M. Holzknecht, M. Reindl, C. Tiller, I. Lechner, T. Hornung, D. Plappert, G. Klug, S. Reinstadler, A. Bauer, B. Metzler, A. Mayr","doi":"10.1093/EHJCI/JEAA356.268","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.268","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Although left ventricular ejection fraction (LVEF) is recommended for left ventricular (LV) systolic function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI), its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far.\u0000 \u0000 \u0000 \u0000 We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in acute STEMI patients.\u0000 \u0000 \u0000 \u0000 This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2-4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure.\u0000 \u0000 \u0000 \u0000 During a follow-up of 21 [IQR: 12-50] months, 40 (10%) patients experienced MACE. Patients with MACE showed significantly lower LVEF (49% vs. 53%, p = 0.005) and MAPSE (7.9 mm vs. 9.1 mm, p = 0.001), as well as higher GLS values (-10.2% vs. -12.3 %, p < 0.001). GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63-0.79; p < 0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58-0.75; p = 0.001) and LVEF (AUC: 0.64, 95% CI 0.54-0.73; p = 0.005). After multivariable analysis, GLS emerged as independent predictor of MACE (HR: 1.22, 95% CI 1.11-1.35; p < 0.001). Of note, GLS remained associated with MACE (p < 0.001) even after adjustment for infarct size and microvascular obstruction.\u0000 \u0000 \u0000 \u0000 CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75777171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}