Patients with stage 3 and stage 4 CKD demonstrate alterations in LV GLS, LVMI, E/e′, LAVI, and LASr but had normal LVEF. Each of these parameters was evaluated using reported normal values as a cutoff (normal indicated as green) in the figure. Left atrial reservoir strain was the strongest predictor of death and MACE and the only echocardiographic parameter that predicted adverse events.
Assessment of left ventricular systolic function has a central role in the evaluation of cardiac disease. Accurate assessment is essential to guide management and prognosis. Numerous echocardiographic techniques are used in the assessment, each with its own advantages and disadvantages. This review is based on a literature search of the PubMed, MEDLINE, EMBASE, and Scopus databases from inception through December 30, 2017, using the terms strain echocardiography, tissue Doppler strain, and speckle-tracking echocardiography. We provide the internist with a contemporary overview of current echocardiographic techniques used in the evaluation of left ventricular systolic function. In particular, we focus on the role of speckle-tracking echocardiography, including its utility in the detection of subclinical left ventricular dysfunction and the associated prognostic implications. 相似文献
ObjectivesThe aim of this study was to assess the effect of congestion and decongestive therapy on left atrial (LA) mechanics and to determine the relationship between LA improvement after decongestive therapy and clinical outcome in immediate or chronic heart failure with reduced ejection fraction (HFrEF).BackgroundLA mechanics are affected by volume/pressure overload in decompensated HFrEF.MethodsA total of 31 patients with HFrEF and immediate heart failure (age 64 ± 15 years, 74% male, left ventricular ejection fraction 20 ± 12%) underwent serial echocardiography during decongestive therapy with simultaneous hemodynamic monitoring. LA function was assessed by strain (rate) imaging. Patients were re-evaluated 6 weeks after discharge and prospectively followed up for the composite endpoint of heart failure readmission and all-cause mortality.ResultsLA reservoir function was markedly reduced at baseline and improved with decongestion (peak atrial longitudinal strain from 6.4 ± 2.2% to 8.8 ± 3.0% and strain rate from 0.29 ± 0.11 s–1 to 0.38 ± 0.13 s–1), independent of changes in left ventricular global longitudinal strain, LA end-diastolic volume, and mitral regurgitation severity (p < 0.001). Both measures continued to rise at 6 weeks (up to 13.4 ± 6.1% and 0.50 ± 0.19 s–1, respectively; p < 0.001). LA pump strain rate only increased 6 weeks after discharge (–0.25 ± 0.12 s–1 to –0.55 ± 0.29 s–1; p < 0.010). Changes in LA mechanics correlated with changes in wedge pressure (r = –0.61; p < 0.001). Lower peak atrial longitudinal strain values after decongestion were associated with increased risk for the composite endpoint of heart failure and mortality (p < 0.019).ConclusionsLA reservoir and booster function, while severely impaired during immediate decompensation, significantly improve during and after decongestive therapy. Poor LA reservoir function after decongestion is associated with worse outcome. 相似文献
Impaired left atrial (LA) reservoir deformation has been found to be associated with poor functional capacity and outcomes in severe chronic mitral regurgitation (MR). Among patients with primary MR (valve incompetence due to mitral valve pathology), we focus on Carpentier II classification (prolapse or flail mitral valve) and aim to investigate determinants for decreased LA reservoir deformation and its impact on LA remodeling in severe MR.
Methods
Among 159 consecutive patients with severe chronic Carpentier II MR (left ventricular ejection fraction ≥ 60%), 55 underwent follow-up echocardiography, which was compared with their baseline study. We used the change of LA volume index as the rapidity of LA remodeling, LA eccentricity index as LA sphericity, and peak LA reservoir strain as well as reservoir strain rate (LASRR) derived from two-dimensional speckle-tracking echocardiography as LA reservoir function.
Results
Older age, elongated left atrium, increased LA volume index, as well as reduced left ventricular global longitudinal strain and LA ejection fraction all linked to a poor baseline LASRR (all p < 0.001). A second echocardiography during a mean follow-up of 15.3 ± 8.3 months revealed an enlarged left atrium (increased interval change of LA volume index; p < 0.001). In multivariate analysis, only the difference between the baseline and follow-up LASRR values (△LASRR; odds ratio (OR) 0.037, 95% confidence interval (CI) 0.003–0.496, p = 0.013) predicted accelerated LA remodeling. A poor baseline LASRR was significantly associated with its profound deterioration during the follow-up period (β = ?0.424, p = 0.002).
Conclusion
In severe chronic Carpentier II MR, a reduced follow-up LASRR predicted future accelerated LA remodeling. Patients with a poor baseline LASRR are at a higher risk of its deterioration. 相似文献
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