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Impaired Global Right Ventricular Longitudinal Strain Predicts Long-Term Adverse Outcomes in Patients with Pulmonary Arterial Hypertension.

Jae Hyeong PARK ; Margaret M PARK ; Samar FARHA ; Jacqueline SHARP ; Erika LUNDGRIN ; Suzy COMHAIR ; Wai Hong TANG ; Serpil C ERZURUM ; James D THOMAS

Journal of Cardiovascular Ultrasound.2015;23(2):91-99. doi:10.4250/jcu.2015.23.2.91

BACKGROUND: New 2-dimensional strain echocardiography enables quantification of right ventricular (RV) mechanics by assessing global longitudinal strain of RV (GLSRV) in patients with pulmonary arterial hypertension (PAH). However, the prognostic significance of impaired GLSRV is unclear in these patients. METHODS: Comprehensive echocardiography was performed in 51 consecutive PAH patients without atrial fibrillation (40 females, 48 +/- 14 years old) with long-term follow-up. GLSRV was measured with off-line with velocity vector imaging (VVI, Siemens Medical System, Mountain View, CA, USA). RESULTS: GLSRV showed significant correlation with RV fractional area change (r = -0.606, p < 0.001), tricuspid annular plane systolic excursion (r = -0.579, p < 0.001), and RV Tei index (r = 0.590, p < 0.001). It showed significant correlations with pulmonary vascular resistance (r = 0.469, p = 0.001) and B-natriuretic peptide concentration (r = 0.351, p = 0.012). During a clinical followup time (45 +/- 15 months), 20 patients experienced one or more adverse events (12 death, 2 lung transplantation, and 15 heart failure hospitalization). After multivariate analysis, age [hazard ratio (HR) = 2.343, p = 0.040] and GLSRV (HR = 2.122, p = 0.040) were associated with adverse clinical events. Age (HR = 3.200, p = 0.016) and GLSRV (HR = 2.090, p = 0.042) were also significant predictors of death. Impaired GLSRV (> or = -15.5%) was associated with lower event-free survival (HR = 4.906, p = 0.001) and increased mortality (HR = 8.842, p = 0.005). CONCLUSION: GLSRV by VVI showed significant correlations with conventional echocardiographic parameters indicating RV systolic function. Lower GLSRV (> or = -15.5%) was significantly associated with presence of adverse clinical events and deaths in PAH patients.
Atrial Fibrillation ; Disease-Free Survival ; Echocardiography ; Female ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension* ; Lung Transplantation ; Mechanics ; Mortality ; Multivariate Analysis ; Vascular Resistance

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Excessive Weight and Obesity Are Associated to Intra-Ventricular Asynchrony: Pilot Study.

Nydia AVILA-VANZZINI ; Cyntia Zulema MACHAIN LEYVA ; Luis Eduardo RODRIGUEZ CASTELLANOS ; Jose Antonio ARIAS GODINEZ ; Maria Eugenia RUIZ ESPARZA ; Hector HERRERA BELLO

Journal of Cardiovascular Ultrasound.2015;23(2):86-90. doi:10.4250/jcu.2015.23.2.86

BACKGROUND: Excessive weight and obesity (EwO) are independent factors in the development of heart failure; they lead to a state of myocardiopathy via inflammatory and hormonal mechanisms. If excessively accumulated, epicardial fat favors a proinflammatory state. Ventricular asynchrony is a marker of heart failure progression and has been poorly studied in EwO. The objective was evaluate the relation between epicardial fat, body mass index (BMI) and mechanical synchrony measured by echocardiography, in healthy individuals with EwO. METHODS: We included 55 healthy individuals between the ages of 18 and 35, 17 had a BMI < 25 kg/m2 (30.9%) and 38 had a BMI > 25 kg/m2 (EwO group) (69.09%), anthropometric measurements, transthoracic echocardiogram and synchrony evaluation were obtained. RESULTS: Left atrial volume, telediastolic and telesystolic left ventricular volumes and the baseline volume of the right ventricle were greater in the EwO group (20 mL/m2 vs. 15 mL/m2, p = 0.001; 106 mL vs. 82 mL, p = 0.0149 vs. 32 mL, p = 0.001 and 34 mm vs. 31 mm, p = 0.02, respectively). The Yu index also correlated with epicardial fat, r = 0.53, p < 0.01, whereby the greater the amount of epicardial fat, the greater the dispersion timing of ventricular activation. The systolic synchrony index also correlated with the BMI, p = 0.01. CONCLUSION: Mechanical intraventricular asynchrony is associated to EwO and the amount of epicardial fat; hence, asynchrony may be one more factor leading to heart failure in EwO individuals.
Body Mass Index ; Cardiomyopathies ; Echocardiography ; Heart Failure ; Heart Ventricles ; Obesity* ; Pilot Projects*

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Left Ventricular Strain as Predictor of Chronic Aortic Regurgitation.

Sun Hee PARK ; Young Ae YANG ; Kyu Yeon KIM ; Sang Mi PARK ; Hong Nyun KIM ; Jae Hee KIM ; Se Yong JANG ; Myung Hwan BAE ; Jang Hoon LEE ; Dong Heon YANG

Journal of Cardiovascular Ultrasound.2015;23(2):78-85. doi:10.4250/jcu.2015.23.2.78

BACKGROUND: It is not well known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic aortic regurgitation (AR). The purpose of this study was to investigate whether global longitudinal strain measured by two-dimensional speckle-tracking echocardiography could predict long-term outcome in patients with chronic AR. METHODS: This is a single center non-randomized retrospective observational study. The patients with chronic AR from January 2002 to December 2012 were retrospectively enrolled. Following patients were excluded; combined other significant valvular disease, previous heart surgery, aortic disease, congenital heart disease, acute AR and young age under 18 years old. Finally, 60 patients were analyzed and the LV global strain rate was measured on apical four chamber image (GS-4CH). RESULTS: During 64 months follow-up duration, 16 patients (26.7%) were deceased and 38 patients (63.3%) underwent aortic valve replacement (AVR). Deceased group was older (69 years old vs. 51 years old, p < 0.001) and had lower longitudinal strain (-12.05 +/- 3.72% vs. -15.66 +/- 4.35%, p = 0.005). Kaplan-Meier survival curve stratified by GS-4CH showed a trend of different event rate (log rank p = 0.001). On multivariate analysis by cox proportional hazard model adjusting for age, sex, body surface area, history of atrial fibrillation, blood urea nitrogen, LV dilatation, LV ejection fraction and AVR, decreased GS-4CH proved to be an independent predictor of mortality in patients with chronic AR (hazard ratio 1.313, 95% confidence interval 1.010-1.706, p = 0.042). CONCLUSION: GS-4CH may be a useful predictor of mortality in patient with chronic AR.
Aortic Diseases ; Aortic Valve ; Aortic Valve Insufficiency* ; Atrial Fibrillation ; Blood Urea Nitrogen ; Body Surface Area ; Dilatation ; Echocardiography ; Follow-Up Studies ; Heart Defects, Congenital ; Humans ; Mortality ; Multivariate Analysis ; Observational Study ; Proportional Hazards Models ; Retrospective Studies ; Thoracic Surgery

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Prevalence of Congenital Heart Disease and Pulmonary Hypertension in Down's Syndrome: An Echocardiographic Study.

Nilda ESPINOLA-ZAVALETA ; Maria Elena SOTO ; Angel ROMERO-GONZALEZ ; Lidia Del Carmen GOMEZ-PUENTE ; Luis MUNOZ-CASTELLANOS ; Aasha S GOPAL ; Candace KEIRNS ; Eulo LUPI-HERRERA

Journal of Cardiovascular Ultrasound.2015;23(2):72-77. doi:10.4250/jcu.2015.23.2.72

BACKGROUND: Down's syndrome (DS) is a genetic anomaly, which undergoes increased morbidity and mortality when associated with congenital heart disease (CHD). The aims of the study were to determine the prevalence of CHD and pulmonary hypertension (PH) in DS. METHODS: One hundred twenty-seven patients with DS living in Mexico City were evaluated by physical exam, electrocardiogram and echocardiogram. RESULTS: CHD was found in 40%. In 80% (n = 102) PH was present [systolic pulmonary artery pressure (SPAP) of 47 +/- 19 mm Hg and mean pulmonary artery pressure (MPAP) of 32 +/- 11 mm Hg]. Patients with CHD and PH were classified as having 1) no shunt (n = 18) with SPAP of 37 +/- 9 mm Hg and MPAP of 25 +/- 6 mm Hg and 2) with shunt (n = 26) with PASP of 57 +/- 29 mm Hg and MPAP of 38 +/- 19 mm Hg (p < or = 0.001). In those without CHD or with CHD without shunt (n = 76), SPAP was 37 +/- 19 mm Hg and the MPAP 25 +/- 6 mm Hg. The prevalence of PH in DS was 5.9% at one year and 15% at 10 years. The odds ratio of PH in DS with CHD was 7.3 vs. 3 without CHD. CONCLUSION: DS has a high prevalence of CHD and PH. PH prevalence increases when it is associated with CHD. The pathophysiology of PH in DS without CHD should be studied in the near future. Echocardiography is an indispensible tool for evaluation of DS.
Down Syndrome* ; Echocardiography* ; Electrocardiography ; Heart Defects, Congenital* ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Mexico ; Mortality ; Odds Ratio ; Prevalence* ; Pulmonary Artery

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Down Syndrome in Moderate Altitude Residents: Are There Unique Features?.

Chi Young SHIM

Journal of Cardiovascular Ultrasound.2015;23(2):70-71. doi:10.4250/jcu.2015.23.2.70

No abstract available.
Altitude* ; Down Syndrome*

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Aortic Stenosis: Changing Disease Concepts.

Nina RASHEDI ; Catherine M OTTO

Journal of Cardiovascular Ultrasound.2015;23(2):59-69. doi:10.4250/jcu.2015.23.2.59

Aortic stenosis (AS) occurs in almost 10% of adults over age 80 years with a mortality about 50% at 2 years unless outflow obstruction is relieved by aortic valve replacement (AVR). Development of AS is associated with anatomic, clinical and genetic risk factors including a bicuspid valve in 50%; clinical factors that include older age, hypertension, smoking, diabetes and elevated serum lipoprotein(a) [Lp(a)] levels; and genetic factors such as a polymorphism in the Lp(a) locus. Early stages of AS are characterized by focal areas of leaflet thickening and calcification. The rate of hemodynamic progression is variable but eventual severe AS is inevitable once even mild valve obstruction is present. There is no specific medical therapy to prevent leaflet calcification. Basic principles of medical therapy for asymptomatic AS are patient education, periodic echocardiographic and clinical monitoring, standard cardiac risk factor evaluation and modification and treatment of hypertension or other comorbid conditions. When severe AS is present, a careful evaluation for symptoms is needed, often with an exercise test to document symptom status and cardiac reserve. In symptomatic patients with severe AS, AVR improves survival and relieves symptoms. In asymptomatic patients with severe AS, AVR also is appropriate if ejection fraction is < 50%, disease progression is rapid or AS is very severe (aortic velocity > 5 m/s). The choice of surgical or transcatheter AVR depends on the estimated surgical risk plus other factors such as frailty, other organ system disease and procedural specific impediments.
Adult ; Aortic Valve ; Aortic Valve Stenosis* ; Disease Progression ; Echocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension ; Lipoprotein(a) ; Mitral Valve ; Mortality ; Patient Education as Topic ; Risk Factors ; Smoke ; Smoking

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The Value of Elastic Modulus Index as a Novel Surrogate Marker for Cardiovascular Risk Stratification by Dimensional Speckle-Tracking Carotid Ultrasonography.

Ji Hyun YOON ; In Jeong CHO ; Hyuk Jae CHANG ; Ji Min SUNG ; Jinyong LEE ; Hojin RYOO ; Chi Young SHIM ; Geu Ru HONG ; Namsik CHUNG

Journal of Cardiovascular Ultrasound.2016;24(3):215-222. doi:10.4250/jcu.2016.24.3.215

BACKGROUND: Carotid intima media thickness (CIMT) and the presence of carotid plaque have been used for risk stratification of cardiovascular disease (CVD). To date, however, the association between multi-directional functional properties of carotid artery and CVD has not been fully elucidated. We sought to explore the multi-directional mechanics of the carotid artery in relation to cardiovascular risk. METHODS: Four hundred one patients who underwent carotid ultrasound were enrolled between January 2010 and April 2013. A high risk of CVD was defined as more than 20% of 10-year risk based on the Framingham risk score. Using a speckle-tracking technique, the longitudinal and radial movements were analyzed in the B-mode images. Peak longitudinal and radial displacements, strain and strain rate were also measured. Beta stiffness and elastic modulus index were calculated from the radial measurements. RESULTS: Of the overall sample, 13% (52) of patients comprised the high-risk group. In multivariate logistic regression, CIMT and elastic modulus index were independently associated with a high-risk of CVD {odds ratio (OR): 1.810 [95% confidence interval (CI) 1.249–2.622] and OR: 1.767 (95% CI: 1.177–2.652); p = 0.002, 0.006, respectively}. The combination of CIMT and elastic modulus index correlated with a high-risk of CVD more so than CIMT alone. CONCLUSION: The elastic modulus index of the carotid artery might serve as a novel surrogate marker of high-risk CVD. Measurement of the multi-directional mechanics of the carotid artery using the speckle tracking technique has potential for providing further information over conventional B-mode ultrasound for stratification of CVD risk.
Biomarkers* ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Intima-Media Thickness ; Elastic Modulus* ; Humans ; Logistic Models ; Mechanics ; Ultrasonography*

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Diastolic Dyssynchrony in Acute ST Segment Elevation Myocardial Infarction and Relationship with Functional Recovery of Left Ventricle.

Burak TURAN ; Tolga DAŞLI ; Ayhan ERKOL ; Ismail ERDEN ; Yelda BAŞARAN

Journal of Cardiovascular Ultrasound.2016;24(3):208-214. doi:10.4250/jcu.2016.24.3.208

BACKGROUND: Incidence of diastolic dyssynchrony (DD) and its impact on functional recovery of left ventricle (LV) after ST segment elevation myocardial infarction (STEMI) is not known. METHODS: Consecutive patients with STEMI who underwent successful revascularization were prospectively enrolled. Echocardiography with tissue Doppler imaging was performed within 48 hours of admission and at 6 months. LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), ejection fraction (EF), and left atrial volume index (LAVI) were calculated. Diastolic delay was calculated from onset of QRS complex to peak of E wave in tissue Doppler image and presented as maximal temporal difference between peak early diastolic velocity of 6 basal segments of LV (TeDiff). Study patients were compared with demographically matched control group. RESULTS: Forty eight consecutive patients (55 ± 10 years, 88% male) and 24 controls (56 ± 6 years, 88% male) were included. TeDiff was higher in STEMI than in controls (35.9 ± 19.9 ms vs. 26.3 ± 6.8 ms, p = 0.025). Presence of DD was higher in STEMI than controls (58% vs. 33%, p = 0.046) according to calculated cut-off value (≥ 29 ms). There was no correlation between TeDiff and change in EDVI, ESVI, and LAVI at 6 months, however TeDiff and change in EF at 6 months was positively correlated (r = 0.328, p = 0.023). Patients with baseline DD experienced remodeling less frequently compared to patients without baseline DD (11% vs. 38%, p = 0.040) during follow-up. CONCLUSION: STEMI disrupts diastolic synchronicity of LV. However, DD during acute phase of STEMI is associated with better recovery of LV thereafter. This suggests that DD is associated with peri-infarct stunned myocardium that is salvaged with primary intervention as well as infarct size.
Echocardiography ; Follow-Up Studies ; Heart Ventricles* ; Humans ; Incidence ; Myocardial Infarction* ; Myocardial Stunning ; Prospective Studies

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Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement.

Jeong Yoon JANG ; Jeong Sook SEO ; Byung Joo SUN ; Dae Hee KIM ; Jong Min SONG ; Duk Hyun KANG ; Jae Kwan SONG

Journal of Cardiovascular Ultrasound.2016;24(3):201-207. doi:10.4250/jcu.2016.24.3.201

BACKGROUND: Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvular stenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload on LV hypertrophy (LVH) before and after aortic valve replacement (AVR). METHODS: The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (Z(VA)) and LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH. RESULTS: Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm². Z(VA) was 5.9 ± 1.9 mm Hg/mL/m² and showed a stronger correlation (β = 0.601, p < 0.001) with pre-AVR LVMI/LVEDVI than indexed AVA (β = 0.061, p = 0.19), transvalvular peak velocity (β = 0.211, p < 0.001). During a median follow-up of 3.5 years, patients had a 18.8 ± 10.4% decrease in the LV geometry index with a decrease in SAC from 1.20 ± 0.48 to 1.00 ± 0.38 mL/m²/mm Hg (p < 0.001). Pre-AVR LV ejection fraction (r = 0.284, p < 0.001) and Z(VA) (r = 0.523, p < 0.001) were independent factors associated with LVH regression in 322 patients with follow-up duration >1 year after AVR. CONCLUSION: Z(VA) is a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, which should be incorporated in routine evaluation of AS.
Aortic Valve ; Aortic Valve Stenosis* ; Cohort Studies ; Compliance ; Constriction, Pathologic ; Echocardiography ; Electric Impedance* ; Follow-Up Studies ; Heart Ventricles ; Hemodynamics ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Retrospective Studies

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Assessing Right Ventricular Function: The Role of Echocardiography in a Murine Model of Pulmonary Hypertension.

Kyung Hee KIM

Journal of Cardiovascular Ultrasound.2016;24(3):199-200. doi:10.4250/jcu.2016.24.3.199

No abstract available.
Echocardiography* ; Hypertension, Pulmonary* ; Ventricular Function, Right*

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