LA Mechanics in Decompensated Heart Failure: Insights From Strain Echocardiography With Invasive Hemodynamics

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.     

La obesidad central es el componente clave en la asociación del síndrome metabólico con el deterioro del strain longitudinal global del ventrículo izquierdo

Introduction and objectives

Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MS and impaired left ventricular global longitudinal strain (GLS) and the role of each MS criteria in this association.

Role of Left Atrial Reservoir Strain Rate in Left Atrial Remodeling in Severe Mitral Regurgitation

Background

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.

Left Atrial Strain Determinants During the Cardiac Phases

ObjectivesThe present study investigated the determinants of left atrial (LA) strain in all phases of the cardiac cycle.BackgroundLA strain by speckle-tracking echocardiography allows the assessment of LA function in each phase of the cardiac cycle. However, its determinants and its relation with left ventricular (LV) function have not yet been fully described.MethodsThe authors performed a retrospective analysis in 127 patients with different cardiovascular pathologies. Using 2-dimensional speckle tracking in 4- and 2-chamber apical views we derived both LA and LV strain curves. Strain–strain loops were reconstructed using LV strain and the corresponding, synchronized LA strain data. Linear regressions were calculated for the entire strain–strain loop as well as for the 3 phases of the cardiac cycle (systole, and early and late diastole). The association between LA strain parameters and LV systolic and diastolic parameters was studied. The prediction of cardiovascular events was evaluated for both measured and predicted LA strain and other parameters.ResultsLA and LV strain curves presented excellent correlations with an R² > 0.90 for the cardiac cycle, and R² > 0.97 for its phases. Moreover, the ratios of LV/LA maximal volumes and the slopes of the LA-LV strain–strain loops of the individual patients correlated well (R² = 0.75). In each phase of the cardiac cycle, LA strain parameters correlated well with the corresponding LV strain and the LV-LA volume ratio (R² > 0.78). No significant difference in predictive ability of cardiovascular events or atrial fibrillation between the measured and predicted LA strain was observed (P > 0.05 for both).ConclusionsIn the absence of abnormal LA/LV volume exchange, LA strain is, to a large extent, determined by LV strain and further modulated by the ratio of LV and LA volumes. Nonetheless, measuring LA strain is of high clinical interest because it integrates several parameters into a single, robust, and reproducible measurement.     

三维斑点追踪成像技术对单纯性肥胖儿童左心室收缩功能的评价及其与外周动脉弹性相关性的前瞻性研究北大核心CSCD

目的应用三维斑点追踪成像技术评价单纯性肥胖儿童左心室收缩功能,并探讨其与外周动脉弹性的相关性。方法采用随机结合方便抽样的方法,获取研究样本。将样本分为3组:肥胖组(23例)、超重组(21例)和正常组(24例)。采用三维斑点追踪成像技术测量左心室整体长轴应变(global longitudinal strain,GLS)、整体径向应变(global radial strain,GRS)及整体环向应变(global circumferential strain,GCS),全自动动脉硬化测试仪测量踝臂指数(ankle brachial index,ABI)、脉搏波传导速度(brachial ankle pulse wave velocity,baPWV)。比较3组各参数的差异性并探讨三维斑点追踪各参数与ABI、baPWV的相关性。结果肥胖组与正常组左心室GLS、GRS、GCS差异无统计学意义(P>0.05)。超重组左心室GLS高于正常组[(-24±7)vs(-19±12),P<0.05]。肥胖组ABI(1.00±0.09)、超重组ABI(1.09±0.13)均低于正常组(2.25±0.13)(P<0.05);肥胖组baPWV高于正常组[(978±109)vs(905±22),P<0.05]。肥胖儿童左心室GLS与baPWV呈正相关(r=0.516,P<0.05),与ABI无相关性(P>0.05);左心室GCS、GRS与ABI、baPWV无相关性(P>0.05)。结论单纯性肥胖儿童左心室收缩功能和外周动脉弹性发生不同程度的改变且二者有一定的相关性。     

3-Dimensional Versus 2-Dimensional STE for Right Ventricular Myocardial Fibrosis in Patients With End-Stage Heart Failure

BackgroundLongitudinal strain of the right ventricular (RV) free wall (RVFWLS) assessed by 2-dimensional (2D) speckle-tracking echocardiography (STE) has been recently demonstrated to correlate with the extent of RV myocardial fibrosis (MF). However, the value of 3-dimensional (3D) STE–derived strain parameters in predicting RV MF has not been investigated in patients with end-stage heart failure (HF).ObjectivesThis study aimed to determine which RV strain parameter assessed by 2D-STE and 3D-STE was the most reliable parameter for predicting RV MF in patients with end-stage HF against histological confirmation of MF.MethodsA total of 105 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in our study. The conventional RV function parameters, 2D-RVFWLS, and 3D-RVFWLS were obtained in these patients. The degree of MF was quantified by Masson trichrome staining in RV myocardial samples. The study population was divided into 3 groups according to the degree of MF on histology.ResultsPatients with severe MF had lower 3D-RVFWLS, 2D-RVFWLS, and conventional parameters of RV function compared with those with mild and moderate MF. RV MF strongly correlated with 3D-RVFWLS (r = ?0.72; p < 0.001), modestly with 2D-RVFWLS (r = ?0.53; p < 0.001), and weakly with conventional RV function parameters (r = ?0.21 to ?0.49; p < 0.01). 3D-RVFWLS correlated best with the degree of MF (r = ?0.72 vs. ?0.21 to ?0.53; p < 0.05) compared with 2D-RVFWLS and conventional RV function parameters. 3D-RVFWLS had the highest accuracy for detecting severe MF (area under the receiver-operating characteristic curve: 0.90 vs. 0.24–0.80; p < 0.05) compared with 2D-RVFWLS and conventional RV parameters. The model with 3D-RVFWLS (R² = 0.63; p < 0.001) was better in predicting the degree of RV MF than that with 2D-RVFWLS (R² = 0.54; p < 0.001).Conclusions3D-RVFWLS may be the most robust echocardiographic measure for predicting the extent of RV MF in patients with end-stage HF.     

Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: A two-dimensional speckle-tracking echocardiographic study

Hypertension and obesity each are well known to result in heart failure with preserved ejection fraction. Therefore, it is clinically important to clarify the mechanisms of further deterioration of left atrial (LA)-left ventricular (LV) interaction in asymptomatic patients with obesity in the presence of hypertension. Data on conventional and two-dimensional speckle-tracking echocardiography (2DSTE) were obtained from 134 asymptomatic hypertensive patients. The study sample was divided into two groups: non-obese (n = 80; body mass index [BMI] <25 kg/m²] and obese (n = 54; BMI ≥25 kg/m²). The end-diastolic LV diameter, ratio of early transmitral flow to mitral annular motion velocity (E/e’), peak systolic LV circumferential strain rate, and E/e’/peak systolic LA strain (S-LAs) were greater in the obese group. Among the significantly correlated variables with BMI and E/e’/S-LAs in univariate analyses, multivariate analyses revealed that BMI is independently associated with end-diastolic LV diameter and peak systolic LV radial strain in all hypertensive patients, and that age, systolic blood pressure, relative LV wall thickness, peak systolic mitral annular motion velocity (s’), peak systolic LV radial strain, and peak early diastolic LV longitudinal strain rate are identified as independent predictors related to E/e’/S-LAs in the obese patients, whereas only s’ contributes to the E/e’/S-LAs in the non-obese patients. Impaired LA-LV interaction was accelerated with obesity in the presence of hypertension. Assessment of the LA and LV function using 2DSTE provided additional information to the negative effects of cardiovascular risk factors on the LA and LV function in patients without clinical symptoms.     

三维斑点追踪结合多巴酚丁胺负荷超声诊断非ST段抬高性急性冠脉综合征的价值

目的应用三维斑点追踪技术（3D-STE）结合多巴酚丁胺负荷超声（DSE）评估非ST 段抬高性急性冠脉综合征
（NSTE-ACS）患者左室心肌形变,探讨其诊断价值及意义。方法49例初诊NSTE-ACS的患者行DSE和冠脉造影。多巴酚丁
胺初始剂量5 μg·kg-1·min-1,间隔3 min剂量加倍,峰值剂量20 μg·kg-1·min-1。应用3D-STE对静息和峰值负荷时实时三维图像
进行分析,获取左室收缩期心内膜下心肌整体长轴应变（GLS）,整体环向应变（GCS）,灌注区长轴应变（TLS）,灌注区环向应变
（TCS）等参数。比较分析DSE前后常规超声、3D-STE参数及其变化,应用ROC曲线评价各参数对NSTE-ACS的诊断价值。结
果患者均完成负荷试验,3D-STE参数具有满意重复性。静息状态下,NSTE-ACS患者与非NSTE-ACS患者相比,左室心肌形
变功能明显减低,以环向功能减低更为显著（P<0.05）,各参数ROC曲线比较无明显差异（P>0.05）。峰值负荷时,两组间左室形
变功能的差异进一步增大（P值均小于0.01）,峰值负荷参数诊断价值明显增加。各参数ROC曲线比较中,峰值负荷TLS和TCS
诊断NSTE-ACS 价值最高。结论3D-STE 结合小剂量DSE是安全有效的NSTE-ACS 无创检查和诊断方法,DSE明显增加
3D-STE诊断价值。