scholarly journals Image-Based Modelling of Cardiac Mechanics

2021 ◽  
Vol 24 (2) ◽  
pp. 98-103
Author(s):  
Mais Odai Al-Saffar ◽  
Ziad T. Al-Dahhan ◽  
Rafid B. Al-taweel
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Cardiac Mechanics ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Mechanics ◽  
2D Echocardiography

The main objective of this study was to model the left ventricle (LV) based on 2D echocardiography imaging technique to assess the cardiac mechanics for group of patients affected by heart failure. A prospective study has been made at Ibn Al-Bitar center for cardiac surgery, for 13 patients with heart failure (HF), 9 patients were males (69%) and 4 females (31%). The mean age was 54±7 years. Those patients were supposed to undergo a CRT-D (Cardiac Resynchronization Therapy Defibrillator) implant as they didn’t respond to drug therapy. Before CRT-D implantation, 2D echocardiography was performed for all the patients, to model the left ventricle and to measure indices that were used to evaluate cardiac mechanics which are LV pressure, wall stresses, global longitudinal strain, and cardiac output. After 3-months of follow-up, 2D echocardiography was re-assessed and the left ventricular mechanics has been re-measured. Post CRT-D implantation, significant improvement in the cardiac mechanics was observed in 54% of the patients which were called responders (patients that respond to CRT-D device) and the other patients were called non-responders. It has been seen that, the circumferential wall stresses were decreased in responder’s group while increased or remain unchanged in non-responders. Global longitudinal strain for the responder’s group were increased while remain unchanged in the non-responders. So, patients were divided into responders and non-responders, based on improvement of the cardiac mechanics after 3-moths of follow up. It has been concluded that the modelling of the left ventricle based on images obtained from 2D echocardiography imaging techniques, was an important computational tool that was used to enhance understanding and support the evaluation, surgical guidance and treatment management of basic biophysics underlying cardiac mechanics.

scholarly journals Cardiac mechanics as predictors of left ventricular reverse remodelling in patients with dilated non-ischemic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Ferrandez ◽  
F Islas ◽  
A Travieso ◽  
J Diz-Diaz ◽  
A Restrepo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Cardiomyopathy ◽  
Multimodality Imaging ◽  
Global Longitudinal Strain ◽  
Cardiac Mechanics ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Imaging Parameters ◽  
Reverse Remodelling

Abstract Background and purpose The appearance of left ventricular reverse remodelling (LVRR) is associated with a better prognosis in patients with dilated non-ischemic cardiomyopathy (DCM). Our aim was to identify cardiac imaging parameters, including speckle tracking by transthoracic echocardiography (TTE) and feature tracking by CMR, associated with LVRR in a prospective cohort of patients with DCM. Methods From 2014 to 2021, 182 patients with DCM and left ventricle ejection fraction (LVEF) <40% were prospectively evaluated in our hospital. LVRR was defined as an increase in LVEF ≥10 points or absolute LVEF ≥50%, associated with a reduction in left ventricular end- diastolic diameter ≥10%. Patients underwent multimodality imaging evaluation including CMR with a 1.5 Tesla scanner, and TTE. Cardiac mechanics, including global longitudinal strain (GLS), strain rate (SR) and mechanical dispersion (MD) were measured. Results Median age of our cohort was 62.3 (14.4) years, and 67.7% were male. Most patients (>90%) were treated with beta-blockers or RASS blockers, and 67% with mineralocorticoid receptor antagonists. 30% had cardiac resynchronization therapy (CRT) and 37% had ICD as primary prevention. Mean LVEF was 31.3%. During a mean follow-up period of 35.9 (35.4) months, 38.3% of patients had LVRR. Age and gender distribution were similar in both groups. Regarding cardiovascular risk factors and pharmacological treatment, no differences were found between patients with and without LVRR. Baseline CRT therapy was not associated with LVRR (22.6% vs 34.7%; p=0.249). However, there was a trend towards higher LVRR in those who received CRT during follow-up 18.8% vs 0%; p=0.069). Patients who experienced LVRR had lower basal LVEF (23.4% vs 29%; p<0.008), as well as poorer RV function, including lower RVEF (40.5% vs 51%; p=0.006) and lower TAPSE (16 mm vs 19 mm; p=0.021). Regarding cardiac mechanics, those patients with lower GLS (−9% vs −12%; p=0.001), and higher MD (73 mm vs 55 mm; p=0,050) had LVRR more frequently during follow-up. The presence of a left bundle branch block (LBBB) contraction pattern by strain was associated with higher rate of LVRR (83.3% vs 30.4%; p=0.011). The burden of fibrosis measured by LGE with CMR was not associated with LVRR (14% vs 12%; p=NS). Patients with LVRR had a lower cardiovascular mortality (3.3 vs 14.3%; p=0.117), lower mortality due to heart failure (0% vs 12.2%; p=0.046), less heart failure hospitalizations (20% vs 46.9%; p=0.016), and a lower incidence of ventricular tachyarrhythmias (3.3% vs 18.4%; p=0.051). Conclusions LVRR in patients with DCM receiving optimized medical therapy is associated with a better prognosis. Imaging parameters, including a lower basal LVEF, RVEF, GLS and higher MD, as well as LBBB echo pattern, were associated with a higher frequency of LVRR, and might help to identify patients who could benefit from CRT/and may be helpful to stratify patients's risk. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Sakaguchi ◽  
A Yamada ◽  
M Hoshino ◽  
K Takada ◽  
N Hoshino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Stable Condition ◽  
Left Ventricular ◽  
Operating Characteristics ◽  
Cardiac Events

Abstract Purposes We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission. Methods We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (> 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events. Results Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p < 0.0001, log-rank). Conclusion A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.

Heart failure: risk stratification and follow-up

2016 ◽  
Author(s):  
Marie Moonen ◽  
Nico Van de Veire ◽  
Erwan Donal
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Heart Failure Patients ◽  
Reverse Remodelling ◽  
Lv Ejection Fraction

An increasing number of two- and three-dimensional echocardiographic, Doppler, and speckle imaging-derived parameters and values can be related to prognosis in heart failure with left ventricular (LV) systolic dysfunction. This chapter discusses both conventional and new indices, including their advantages and potential limitations. There is increasing evidence for the use of new indices, including three-dimensional LV ejection fraction and global longitudinal strain. The follow-up and monitoring of heart failure patients using two-dimensional transthoracic echocardiography is also discussed in this chapter, including how to estimate the LV filling pressures and quantify LV reverse remodelling.

scholarly journals Predictors of left ventricular remodelling in patients after active myocarditis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Koziel ◽  
J Boidol ◽  
J Klys ◽  
K Miszalski-Jamka ◽  
Z Kalarus ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Longitudinal Strain ◽  
Cox Regression ◽  
Troponin T ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
Mechanical Dispersion

Abstract Background Myocarditis may be a challenging diagnosis because of diversity of clinical presentations. Thus, the clinical course and ventricular remodelling in this disease seems to be unpredictable. Aims To assess predictors of left ventricular remodelling in patients after active myocarditis. Methods Database from a high-volume, tertiary cardiology center was analysed to identify patients with active myocarditis, based on clinical presentation and ≥1 diagnostic criteria from different categories (including electrocardiography/ holter, elevated troponin T/I levels, functional or structural abnormalities on cardiac imaging or tissue characterization by cardiac magnetic resonance) between 2016 and 2019. Left ventricle global longitudinal strain (GLS), mechanical dispersion (standard deviation of time to peak longitudinal strain derived from all left ventricle segments in 3 apical views) were calculated. Response (left ventricular positive remodeling measured by transthoracic echocardiography) was defined as end-systolic volume (ESV) reduction ≥15% from a baseline value or end-diastolic volume (EDV) reduction ≥15%. Results 61 consecutive patients were enrolled. The median follow-up was 1.4 years (range: 0.3–4.0). During entire follow-up period mortality rate in patients was 1.6%. Multivariate Cox regression model including significant baseline differences as covariates reported that QRS durations (HR 1.31, 95% CI 1.17–1.57, P=0.049) and mechanical dispersion (HR 1.03, 95% CI 1.01–1.07, P=0.036) were independently associated with left ventricular positive remodelling with ESV reduction. Mechanical dispersion (HR 1.04, 95% CI 1.02–1.06, P=0.040) was independently associated with left ventricular positive remodelling with EDV reduction. Conclusions Mechanical dispersion and QRS duration are independent predictors of left ventricular remodelling in patients after active myocarditis. Funding Acknowledgement Type of funding source: None

scholarly journals CORELATION OF GLOBAL LONGITUDINAL STRAIN (GLS) – LEFT VENTRICLE AND SOLUBLE SUPRESSION OF TUMORGENICITY 2 (sST2) IN ACUTE HEART FAILURE WITH SYSTOLIC DYSFUNCTION

2019 ◽  
Vol 39 (4) ◽  
Author(s):  
Herlina Yulidia ◽  
Muhammad Aminuddin ◽  
Budi S Pikir
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Acute Heart Failure ◽  
Longitudinal Strain ◽  
Significant Positive Correlation ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Soluble St2 ◽  
Positive Correlation

Background  :  Assessment of  left  ventricular  function  in  patients with   acute heart failure is important for prognostication, determination of treatment plan, for decisions related to  expensive device therapies and for assessing response  to treatment. Echocardiography is the "gold standard" of assessing left ventricular function, and in establishing a diagnosis of heart failure. Left ventricular Global Longitudinal Strain (GLS) assessed through Speckle Tracking Echocardiography (STE) is currently considered sensitive in assessing left ventricular motion, by analyzing multidimensional myocardial deformation . s ST2 used to be correlated with stretch miocard and inhibid ligand of IL-33 wich also inhibit the cardioprotectve effect. Objective : To prove the positive correlation between GLS-left ventricle with soluble ST2. Methods  :  This  is  a  correlational  study  with  cosecutive   sampling   technique. Thirty subjects participate in this reseach and each subject underwent echocardiography and  GLS-left  ventricle  and  soluble ST2 blood examination. The correlation between GLS-left ventricle and soluble ST2  were  evaluated using Spearman correlation test. Results : There is a strong, significant, positive correlation between the GLS-left ventricle with soluble ST2 (r = 0.99 and p =  0.0001). Conclusion : There is a  strong,  significant,  positive  correlation  between  the  GLS- left ventricle with soluble ST2. Keywords :  acute  heart  failure,   systolic   dysfunction,   global  longitudinal  strain, soluble ST2.

scholarly journals Sacubitril/Valsartan Induces Global Cardiac Reverse Remodeling in Long-Lasting Heart Failure with Reduced Ejection Fraction: Standard and Advanced Echocardiographic Evidences

2020 ◽  
Vol 9 (4) ◽  
pp. 906 ◽  
Author(s):  
Matteo Castrichini ◽  
Paolo Manca ◽  
Vincenzo Nuzzi ◽  
Giulia Barbati ◽  
Antonio De Luca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Prognostic Impact ◽  
Reduced Ejection Fraction

Sacubitril/valsartan reduces mortality in heart failure with reduced ejection fraction (HFrEF) patients, partially due to cardiac reverse remodeling (RR). Little is known about the RR rate in long-lasting HFrEF and the evolution of advanced echocardiographic parameters, despite their known prognostic impact in this setting. We sought to evaluate the rates of left ventricle (LV) and left atrial (LA) RR through standard and advanced echocardiographic imaging in a cohort of HFrEF patients, after the introduction of sacubitril/valsartan. A multi-parametric standard and advanced echocardiographic evaluation was performed at the moment of introduction of sacubitril/valsartan and at 3 to 18 months subsequent follow-up. LVRR was defined as an increase in the LV ejection fraction ≥10 points associated with a decrease ≥10% in indexed LV end-diastolic diameter; LARR was defined as a decrease >15% in the left atrium end-systolic volume. We analyzed 77 patients (65 ± 11 years old, 78% males, 40% ischemic etiology) with 76 (28–165) months since HFrEF diagnosis. After a median follow-up of 9 (interquartile range 6–14) months from the beginning of sacubitril/valsartan, LVRR occurred in 20 patients (26%) and LARR in 33 patients (43%). Moreover, left ventricular global longitudinal strain (LVGLS) improved from −8.3 ± 4% to −12 ± 4.7% (p < 0.001), total left atrial emptying fraction (TLAEF) from 28.2 ± 14.4% to 32.6 ± 13.7% (p = 0.01) and peak atrial longitudinal strain (PALS) from 10.3 ± 6.9% to 13.7 ± 7.6% (p < 0.001). In HFrEF patients, despite a long history of the disease, the introduction of sacubitril/valsartan provides a rapid global (i.e., LV and LA) RR in >25% of cases, both at standard and advanced echocardiographic evaluations.

Abstract 20072: Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain and Late Gadolinium Enhancement in Patients with Dilated Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Misato Chimura ◽  
Tetsuari Onishi ◽  
Hiroya Kawai ◽  
Shinishiro Yamada ◽  
Yoshinori Yasaka
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Incremental Prognostic Value

Introduction: Reduced left ventricular (LV) global longitudinal strain (GLS) by two-dimensional speckle-tracking (2DST) echocardiography and late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) have been reported to be associated with unfavorable outcome in patient with heart failure (HF). We investigated to assess these 2 markers as prognostic parameters over conventional HF markers in patients with dilated cardiomyopathy (DCM). METHODS: We studied consecutive 179 DCM patients (Age 61±15 years, 121 males, LV ejection fraction (LVEF) 33±9%, NYHA class I: n= 0; II: n=71; III: n=107; IV: n=1) who underwent CMR and echocardiography with conventional assessment including LV end-diastolic and end-systolic volume (LVEDV, LVESV), LVEF and mitral regurgitation grade (MR), and with 2DST analysis of GLS. Brain natriuretic peptide (BNP) was measured. Outcome was assessed according to death and hospitalization with heart failure in the follow-up period for 3.8±2.5 years. RESULTS: There were 7 cardiac deaths and 40 HF hospitalizations in the follow-up period. Univariate Cox proportional hazard regression analysis showed NYHA class, systolic blood pressure, diastolic blood pressure, BNP, LVEDV, LVESV, LVEF, MR, GLS and positive LGE were significantly associated with outcome. Multivariate Cox proportional hazards regression analysis revealed GLS and positive LGE (p<0.05 for both) were independent predictors of outcome. Dividing all 179 patients into 4 groups with the median of GLS (-8.3%) and the presence or absence of LGE, Kaplan-Meier analysis showed worse GLS predicted adverse events in patients with and without LGE (p<0.05 for both). GLS and LGE provide additional benefit over conventional parameters (Age, NYHA class, LVEF and BNP). CONCLUSIONS: Risk stratification with LGE and GLS is useful to predict long-term outcome in DCM patients. These 2 markers provide incremental prognostic value to conventional HF markers.

Abstract 2435: The Role of Myocardial Longitudinal Strain in Monitoring Subclinical Heart Failure in Survivors of Childhood Cancer

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Annelies M Mavinkurve-Groothuis ◽  
Jacqueline Groot-Loonen ◽  
Louise Bellersen ◽  
Ton Feuth ◽  
Jos P Bokkerink ◽  
...  
Keyword(s):  
Heart Failure ◽  
Childhood Cancer ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Strain And Strain Rate ◽  
Survivors Of Childhood Cancer

Objectives: Previous studies have demonstrated that myocardial longitudinal strain and strain rate is decreased in asymptomatic patients treated with anthracyclines. In this study, the relation between global myocardial longitudinal strain, conventional echocardiographic parameters, NT-pro-BNP levels, cumulative anthracycline dosage and follow up duration was investigated in a large group of asymptomatic long term survivors of childhood cancer. Methods: 79 asymptomatic survivors (45% children) underwent a detailed echocardiographic examination for obtaining conventional parameters and global myocardial longitudinal strain values in 4-chamber view. In addition to this, we collected blood samples for NT-pro-BNP estimation. Results: the survivors had a mean age of 20 years (range: 6 –37 years), a mean follow up duration of 14 years (range 5–27 years) and a mean cumulative anthracycline dose of 240 mg/m 2 (range 50 –524 mg/m 2 ). Reduced global myocardial longitudinal strain was significantly related to an EF<55% (p<0.001) and to reduced left ventricular posterior wall thickness in diastole indexed by body surface area (LVPWd/BSA) (p<0.003). Reduced myocardial global longitudinal strain was not related to abnormal NT-pro-BNP levels, follow up duration and cumulative anthracycline dosage. Conclusion: reduced global myocardial longitudinal strain is related to subclinical heart failure, e.g. abnormal EF and reduced LVPWd/BSA in asymptomatic survivors of childhood cancer. The role of myocardial strain in the early detection of anthracycline-induced cardiotoxicity needs to be explored by further longitudinal prospective studies.

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