scholarly journals Prognostic value of fast semi-automated left atrial long-axis strain analysis in hypertrophic cardiomyopathy

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Fuyao Yang ◽  
Lili Wang ◽  
Jie Wang ◽  
Lutong Pu ◽  
Yuanwei Xu ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Adverse Events ◽  
Left Atrial ◽  
Prognostic Value ◽  
Cox Regression ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Volume Index ◽  
Cox Regression Analysis ◽  
Long Axis Strain

Abstract Background The prognostic value of left atrial (LA) size and function in hypertrophic cardiomyopathy (HCM) is well recognized, but LA function is difficult to routinely analyze. Fast LA long-axis strain (LA-LAS) analysis is a novel technique to assess LA function on cine cardiovascular magnetic resonance (CMR). We aimed to assess the association between fast LA-LAS and adverse clinical outcomes in patients with HCM. Methods 359 HCM patients and 100 healthy controls underwent routine CMR imaging. Fast LA-LAS was analyzed by automatically tracking the length between the midpoint of posterior LA wall and the left atrioventricular junction based on standard 2- and 4-chamber balanced steady-state free precession cine-CMR. Three strain parameters including reservoir strain (εs), conduit strain (εe), and active strain (εa) were assessed. The endpoint was set as composite adverse events including cardiovascular death, resuscitated cardiac arrest, sudden cardiac death aborted by appropriate implantable cardioverter-defibrillator discharge, and hospital admission related to heart failure. Results During an average follow-up of 40.9 months, 59 patients (19.7%) reached endpoints. LA strains were correlated with LA diameter, LA volume index (LAVI) and LA empty fraction (LAEF) (all p < 0.05). In the stepwise multivariate Cox regression analysis, εs and εe (hazard ratio, 0.94 and 0.89; p = 0.019 and 0.006, respectively) emerged as independent predictors of the composite adverse events. Fast LA εs and LA εe are stronger prognostic factors than LA size, LAVI and the presence of left ventricular late gadolinium enhancement. Conclusions Fast LA reservoir and conduit strains are independently associated with adverse outcomes in HCM.

scholarly journals Thigh intramuscular fat predicts the prognosis in patients in non-ischemic cardiomyopathy with reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yoshida ◽  
A Shibata ◽  
A Tanihata ◽  
H Hayashi ◽  
Y Ichikawa ◽  
...  
Keyword(s):  
Adverse Events ◽  
Ischemic Cardiomyopathy ◽  
Cox Regression ◽  
Intramuscular Fat ◽  
Left Ventricular ◽  
Skeletal Muscle Atrophy ◽  
Measured Quantity ◽  
Ectopic Fat ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Abstract Background Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia is drawing attention. Furthermore, the importance of not only muscle mass but also intramuscular fat (IMF) has been pointed out. However, there is a lack of consensus on the implications of ectopic fat for the prognosis in patients with non-ischemic cardiomyopathy. Purpose We investigated whether ectopic fat in the thigh affects the prognosis with non-ischemic cardiomyopathy. Methods We recruited 105 patients who were diagnosed with non-ischemic cardiomyopathy by cardiac catheterization and echocardiographic date between September 2017 and November 2019. Finally 73 patients with reduced EF (EF 40% or less) enrolled in this prospective study. Functional status was evaluated by using cardiopulmonary exercise test at baseline. All patients were measured quantity of epicardial fat and thigh IMF percentage (%IMF) using computed tomography scan. Demographic, laboratory and echocardiographic date were collected from the patients' medical records. Clinical endpoints were unexpected readmission. Results During the follow-up period 18 patients had adverse events. The %IMF was significantly higher in the group with adverse events than without (5.57±5.70 and 3.02±2.44%, respectively; p&lt;0.01). Spearman correlation coefficient analysis showed a modest correlation between %IMF and lower limb extension strength (Spearman r=−0.280; p=0.0315), but there was no significant correlation between %IMF and exercise tolerance such as anaerobic threshold and peak oxygen uptake. Patients were divided into 2 groups according to the median values of %IMF. Kaplan-Meier analysis demonstrated that events were significantly higher in the high %IMF group (log-rank p=0.033). Multivariate Cox regression analysis adjusted for left ventricular end-diastolic diameter and peak ventricular oxygen consumption found %IMF as an independent factor of adverse events (hazard ratio 1.545; 95% confidential interval 1.151–2.087; p=0.004). Conclusions In non-ischemic cardiomyopathy patients with reduced EF, %IMF may have important adverse consequences such as increased cardiac-related events. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

scholarly journals Prognostic value of D-dimer for adverse outcomes in patients with infective endocarditis: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying-Wen Lin ◽  
Mei Jiang ◽  
Xue-biao Wei ◽  
Jie-leng Huang ◽  
Zedazhong Su ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Infective Endocarditis ◽  
Adverse Events ◽  
Prognostic Value ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Large Sample Size ◽  
Cox Regression Analysis ◽  
D Dimer

Abstract Background Increased D-dimer levels have been shown to correlate with adverse outcomes in various clinical conditions. However, few studies with a large sample size have been performed thus far to evaluate the prognostic value of D-dimer in patients with infective endocarditis (IE). Methods 613 patients with IE were included in the study and categorized into two groups according to the cut-off of D-dimer determined by receiver operating characteristic (ROC) curve analysis for in-hospital death: > 3.5 mg/L (n = 89) and ≤ 3.5 mg/L (n = 524). Multivariable regression analysis was used to determine the association of D-dimer with in-hospital adverse events and six-month death. Results In-hospital death (22.5% vs. 7.3%), embolism (33.7% vs 18.2%), and stroke (29.2% vs 15.8%) were significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L. Multivariable analysis showed that D-dimer was an independent risk factor for in-hospital adverse events (odds ratio = 1.11, 95% CI 1.03–1.19, P = 0.005). In addition, the Kaplan–Meier curve showed that the cumulative 6-month mortality was significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L (log-rank test = 39.19, P < 0.0001). Multivariable Cox regression analysis showed that D-dimer remained a significant predictor for six-month death (HR 1.11, 95% CI 1.05–1.18, P < 0.001). Conclusions D-dimer is a reliable prognostic biomarker that independently associated with in-hospital adverse events and six-month mortality in patients with IE.

Abstract 2284: Non-invasively Determined Ventricular Elastance as a predictor of cardiovascular mortality in Patients With acute myocardial infarction and Preserved ejection fraction: Data from Infarction Prognosis Study (IPS) registry

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sung Ai Kim ◽  
Jong-Won Ha ◽  
Hyeon Chang Kim ◽  
Sungha Park ◽  
Eui-Young Choi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Left Ventricular ◽  
Volume Index ◽  
Rank Test ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Acute Mi

Background : Previous studies of the prognosis of myocardial infarction (MI) have focused primarily on patients with left ventricular (LV) systolic dysfunction. Little is known about the prognosis of patients with MI and preserved ejection fraction (EF), which is increasing. Since the ratio of mitral inflow (E) and annular velocity (E′) to stroke volume (E/E′/SV) has been reported as an index of diastolic elastance (Ed), we hypothesized that Ed has prognostic implication in patients with acute MI and preserved EF. Method : Between May 2005 and January 2007, a total of 421 patients with acute MI were prospectively enrolled in Infarction Prognosis Study (IPS) registry. Among 358 patients who had comprehensive echocardiographic study, 42 patients with significant valvular heart disease or coexisted cardiomyopathy and 50 patients with decreased EF (<40%) were excluded. This left a total of 266 patients, who constituted the study population. The primary end-point was cardiovascular mortality. Results : Median follow-up duration was 12 months. Of 266 patients, cardiovascular death occurred in 11 (4.1%) patients. Age (p< 0.001), LA volume index (p=0.001), the severity of diastolic dysfunction (grade ≥ 2, p=0.04), Ed (p=0.003) were univariate predictors of cardiovascular mortality. However, in multivariate Cox regression analysis, age (p=0.008, HR; 1.14, 95% CI; 1.03–1.25) and Ed (p=0.009, HR; 1.72, 95% CI; 1.14 –2.58) were found to be independent predictors for cardiovascular mortality in patients with acute MI and preserved EF. Cut-off value of Ed for cardiovascular mortality determined by Kaplan-Meier method (p<0.001 by log-rank test) and ROC curve (AUC 0.87, sensitivity 90%, specificity 74%) was 0.25. Conclusion : Non-invasively determined ventricular diastolic elastance is a novel and powerful independent predictor of cardiovascular mortality in patients with acute MI and preserved EF.

scholarly journals Usefulness of NT-proBNP in the Follow-Up of Patients after Myocardial Infarction

2016 ◽  
Vol 35 (2) ◽  
pp. 158-165 ◽  
Author(s):  
Mina Radosavljevic-Radovanovic ◽  
Nebojsa Radovanovic ◽  
Zorana Vasiljevic ◽  
Jelena Marinkovic ◽  
Predrag Mitrovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Value ◽  
Cox Regression ◽  
Clinical Chemistry ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Cut Points ◽  
One Year

SummaryBackground:Since serial analyses of NT-proBNP in patients with acute coronary syndromes have shown that levels measured during a chronic, later phase are a better predictor of prognosis and indicator of left ventricular function than the levels measured during an acute phase, we sought to assess the association of NT-proBNP, measured 6 months after acute myocardial infarction (AMI), with traditional risk factors, characteristics of in-hospital and early postinfarction course, as well as its prognostic value and optimal cut-points in the ensuing 1-year follow-up.Methods:Fasting venous blood samples were drawn from 100 ambulatory patients and NT-proBNP concentrations in lithium-heparin plasma were determined using a one-step enzyme immunoassay based on the »sandwich« principle on a Dimension RxL clinical chemistry system (DADE Behring-Siemens). Patients were followed-up for the next 1 year, for the occurrence of new cardiac events.Results:Median (IQR) level of NT-proBNP was 521 (335–1095) pg/mL. Highest values were mostly associated with cardiac events during the first 6 months after AMI. Negative association with reperfusion therapy for index infarction confirmed its long-term beneficial effect. In the next one-year follow-up of stable patients, multivariate Cox regression analysis revealed the independent prognostic value of NT-proBNP for new-onset heart failure prediction (p=0.014), as well as for new coronary events prediction (p=0.035). Calculation of the AUCs revealed the optimal NT-proBNP cut-points of 800 pg/mL and 516 pg/mL, respectively.Conclusions:NT-proBNP values 6 months after AMI are mainly associated with the characteristics of early infarction and postinfarction course and can predict new cardiac events in the next one-year follow-up.

Abstract 12980: Impaired Left Atrial Function is Associated With Increased Rehospitalisation in Patients With Non-valvular Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aditya Bhat ◽  
Henry H Chen ◽  
Shaun Khanna ◽  
Gary Gan ◽  
Sumreen Nawaz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Left Ventricular ◽  
Volume Index ◽  
Primary Study ◽  
Tertiary Referral Centre ◽  
Cardiovascular Comorbidities ◽  
And Function

Introduction: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice with a high clinical and economic burden, largely driven through hospital admissions. Left atrial (LA) size and function have been shown to be powerful predictors of cardiovascular disease. We evaluated the relationship between LA function and AF rehospitalisation. Hypothesis: Impaired LA is a predictor of AF rehospitalisation. Methods: Consecutive patients admitted to a tertiary referral centre (Jan 2013 - Dec 2017) with a diagnosis of non-valvular AF and who underwent transthoracic echocardiogram during their index admission were evaluated for the primary study outcome of AF rehospitalisation. Results: Of the 665 patients (68±14 years, 52% men), 72.2% had paroxysmal AF, 23.4% had persistent AF and 4.4% had permanent AF. The cohort had high cardiovascular comorbidities (33% IHD, 29% HF and 10% previous stroke/TIA). Over a follow-up period of 33 ± 21 months, 253 (38%) patients were rehospitalised for AF. Impaired eGFR (p=0.03), persistent/permanent AF (p=0.05) and indices of LA size and function [see Kaplan Meier curves; LA volume index (LAVI), p<0.01; LA emptying fraction (LAEF), p=0.01; LA expansion index (LAEI), p=0.02; LA function index (LAFI), p<0.01] predicted AF rehospitalisation. Parameters of left ventricular size and function were not predictive of the primary outcome. Multivariable Cox regression models revealed that LAEF (HR 1.58, 95%CI 1.06 to 2.35, p<0.01), LAFI (HR 2.02, 95%CI 1.34 to 3.04, p<0.01) and LAEI (HR 1.58, 95%CI 1.06 to 2.34, p=0.03) were independent predictors of AF rehospitalisation. Conclusions: Impaired LA function is a predictor of AF rehospitalisation.

scholarly journals Differential left ventricular and left atrial remodelling in heart failure with preserved ejection fraction patients with and without diabetes

2019 ◽  
Vol 10 ◽  
pp. 204201881986159 ◽  
Author(s):  
Gaurav S. Gulsin ◽  
Prathap Kanagala ◽  
Daniel C. S. Chan ◽  
Adrian S. H. Cheng ◽  
Lavanya Athithan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Markers Of Inflammation ◽  
Lv Mass ◽  
Mass Volume

Background: Attempts to characterize cardiac structure in heart failure with preserved ejection fraction (HFpEF) in people with type 2 diabetes (T2D) have yielded inconsistent findings. We aimed to determine whether patients with HFpEF and T2D have a distinct pattern of cardiac remodelling compared with those without diabetes and whether remodelling was related to circulating markers of inflammation and fibrosis and clinical outcomes. Methods: We recruited 140 patients with HFpEF (75 with T2D and 65 without). Participants underwent comprehensive cardiovascular phenotyping, including echocardiography, cardiac magnetic resonance imaging and plasma biomarker profiling. Results: Patients with T2D were younger (age 70 ± 9 versus 75 ± 9y, p = 0.002), with evidence of more left ventricular (LV) concentric remodelling (LV mass/volume ratio 0.72 ± 0.15 versus 0.62 ± 0.16, p = 0.024) and smaller indexed left atrial (LA) volumes (maximal LA volume index 48 ± 20 versus 59 ± 29 ml/m2, p = 0.004) than those without diabetes. Plasma biomarkers of inflammation and extracellular matrix remodelling were elevated in those with T2D. Overall, there were 45 hospitalizations for HF and 22 deaths over a median follow-up period of 47 months [interquartile range (IQR) 38–54]. There was no difference in the primary composite endpoint of hospitalization for HF and mortality between groups. On multivariable Cox regression analysis, age, prior HF hospitalization, history of pulmonary disease and LV mass/volume were independent predictors of the primary endpoint. Conclusions: Patients with HFpEF and T2D have increased concentric LV remodelling, smaller LA volumes and evidence of increased systemic inflammation compared with those without diabetes. This suggests the underlying pathophysiology for the development of HFpEF is different in patients with and without T2D. ClinicalTrials.gov identifier: NCT03050593.

scholarly journals P301 The prognostic value of preoperative left atrial volume after surgical aortic valve replacement in patients with isolated severe aortic stenosis and preserved left ventricular ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A D Mateescu ◽  
A Calin ◽  
M Rosca ◽  
C C Beladan ◽  
R Enache ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Atrial ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Volume Index ◽  
Surgical Aortic Valve Replacement ◽  
All Cause Mortality

Abstract Background Left atrial (LA) volume is an important cardiovascular prognostic marker. However, data regarding the prognostic value of LA volume in severe AS patients (pts) after surgical aortic valve replacement (AVR) are scarce. Moreover, the predictive role of LA function in AS pts after AVR has not yet been studied. Our study aimed to assess the relationship of LA volume index (LAVi) and function with outcome, in terms of mortality, in severe AS pts who underwent surgical AVR. Methods A total of 360 consecutive pts with isolated severe AS (aortic valve area index ≤ 0.6 cm2/m2) referred to our echocardiography laboratory were prospectively screened. Two hundred and seventeen pts with preserved left ventricular (LV) ejection fraction (≥50%) and in sinus rhythm were enrolled. All patients underwent a baseline comprehensive echocardiogram, including speckle tracking analysis of both LV and LA strain. Symptomatic pts (142 pts, 65%) that were subject to AVR were followed for a median period of 4 years (IQR 3-6 years). The endpoint was all-cause mortality after AVR. The last update of the survival status was obtained in January 2019. Outcome data were available in 116 severe AS pts that underwent AVR (mean age 63 ± 10 yrs, 56% men), who formed the final study population. Results Seventeen (14%) pts died during follow-up. No significant differences were found between nonsurvivors and survivors after AVR in terms of age and cardiovascular risk factors. Nonsurvivors had higher BNP plasma values (p=.04) at baseline compared with surviving pts. Survivors and nonsurvivors alike exhibited similar preoperative AS severity and LV systolic function parameters (ejection fraction and global longitudinal strain). Moreover, there were no significant differences between the two groups regarding baseline valvuloarterial impedance, average E/e’ ratio, and LA longitudinal deformation parameters. Nonsurvivors had a tendency toward higher LV mass index (p=.08). Nonsurvivors had higher preoperative LA volume index (LAVi)(50 ± 12 vs. 44 ± 10 ml/m2, p=.003). In a multivariable Cox regression analysis adjusted for age, LAVi emerged as the only independent predictor for death in our population study (HR 1.06, 95% CI 1.01-1.11, p=.02). A cut-off value for LAVi derived from ROC curve analysis was used to construct Kaplan-Meier survival curves. A value of 43 ml/m2 for LAVi predicted all-cause mortality after AVR in severe AS pts with 71% sensitivity and 54% specificity. Conclusions In our study, preoperative LAVi predicted death in severe AS pts after surgical AVR. LAVi assessment may improve preoperative risk stratification in patients with severe AS, however further larger prospective studies are needed. Abstract P301 Figure.

scholarly journals Prevalence and prognostic value of various types of right ventricular dysfunction in mechanically ventilated septic patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hongmin Zhang ◽  
Wei Huang ◽  
Qing Zhang ◽  
Xiukai Chen ◽  
Xiaoting Wang ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Venous Pressure ◽  
Left Ventricular ◽  
Prognostic Information ◽  
Mechanically Ventilated ◽  
Cox Regression Analysis ◽  
Mechanical Ventilation Duration

Abstract Introduction Right ventricle (RV) dilation in combination with elevated central venous pressure (CVP), which is a state of RV congestion, is seen as a sign of RV failure (RVF). On the other hand, RV systolic function is usually assessed by tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). This study aimed to investigate the prevalence and prognostic value of RVF and RV systolic dysfunction (RVSD) in septic patients. Methods Mechanically ventilated sepsis and septic shock patients were included. We collected haemodynamic and echocardiographic parameters as well as prognostic information including mechanical ventilation duration, length of ICU stay and 30-day mortality. RVF was defined as a right and left ventricular end-diastolic area ratio ≥ 0.6 in combination with CVP ≥ 8 mmHg. RVSD was defined as TAPSE < 16 mm or FAC < 35%. Results A total of 215 patients were enrolled in this study, and the patients were divided into 4 groups: patients with normal RV function (normal, n = 101), patients with RVF but without RVSD (RVF only, n = 38), patients with RVSD but without RVF (RVSD only, n = 44), and patients with combined RVF–RVSD (RVF/RVSD, n = 32). The RVF/RVSD group and RVSD only group had a lower cardiac index than the RVF only group and normal groups (p < 0.05). At 30 days after ICU admission, 50.0% of patients had died in the RVF/RVSD group, which was much higher than the mortality in the RVF only group (13.2%) and normal group (13.9%) (p < 0.05). In a Cox regression analysis, the presence of RVF/RVSD was independently associated with 30-day mortality (HR 3.004, 95% CI:1.370–6.587, p = 0.006). In contrast, neither the presence of RVF only nor the presence of RVSD only was associated with 30-day mortality (HR 0.951, 95% CI:0.305–2.960, p = 0.931; HR 1.912, 95% CI:0.853–4.287, p = 0.116, respectively). Conclusion The presence of combined RVF–RVSD was associated with 30-day mortality in mechanically ventilated septic patients. Additional studies are needed to confirm and expand this finding.

Sign in / Sign up

Export Citation Format

Share Document