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Mechanical and histological disturbances in advanced heart failure and cardiac transplantation
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.ORCID-id: 0000-0003-3872-8964
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The general purpose of this thesis is to establish capability and accuracy of speckle tracking echocardiography (STE) in assessing left atrial (LA), left ventricular (LV) and right ventricular (RV) function and their correlation with myocardial fibrosis, filling pressure and clinical outcomes in advanced heart failure (HF) patients before and after heart transplantation (HT).

I demonstrated that HT recipients had impaired LV twist dynamics in the form of reduced rotation twist angle and untwist rate but time to peak twist was not different from the age matched controls and other cardiac surgical patients.

With a longitudinal study conducted on patients with refractory HF, the best prognostic power has been shown by RV strain analysis. Among the indexes of LV function, the LV ejection fraction (LVEF) demonstrated the lowest diagnostic accuracy; instead LV global circumferential strain (GCS) showed a better sensitivity and specificity than LV global longitudinal strain (GLS).

When analyzing the relationship between different severity of myocardial fibrosis and LV cavity function, the strongest function parameter that correlated with severity of myocardial fibrosis was GLS. In contrast, none of diastolic LV function or even measures of exercise capacity correlated with myocardial fibrosis.

In patients with end-stage HF, global peak atrial longitudinal strain (PALS), an index of atrial reservoir function was dependent by pulmonary capillary wedge pressure (PCWP) and LV fibrosis, but not influenced by LV systolic function. Results from this study confirm previous evidence of correlation between impaired global PALS and increased PCWP.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University , 2016. , s. 99
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1862
Nyckelord [en]
Advanced heart failure, heart transplantation, speckle tracking echocardiography, left ventricular function, right ventricular function, left ventricular fibrosis, left ventricular filling pressure, atrial strain
Nationell ämneskategori
Kardiologi
Forskningsämne
kariologi
Identifikatorer
URN: urn:nbn:se:umu:diva-127295ISBN: 978-91-7601-609-1 (tryckt)OAI: oai:DiVA.org:umu-127295DiVA, id: diva2:1044716
Disputation
2016-11-30, E04, Målpunkt R-1, Norrlands Universitetssjukhus, Umeå, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2016-11-09 Skapad: 2016-11-05 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Delarbeten
1. Left ventricular twist in clinically stable heart transplantation recipients: a speckle tracking echocardiography study
Öppna denna publikation i ny flik eller fönster >>Left ventricular twist in clinically stable heart transplantation recipients: a speckle tracking echocardiography study
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2013 (Engelska)Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 1, s. 357-361Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND AND AIM: Cavity twist is an integral part of LV function and its pattern in transplanted hearts is not well known. This study aimed at exploring LV twist in clinically stable heart transplant (HT) recipients with no evidence for rejection.

METHODS: We studied 32 HT patients (54±24months after HT), 34 other cardiac surgery (CS) patients and compared them with 35 health controls using speckle tracking echocardiography, measuring peak twist angle, time-to-peak twist, and untwist rate.

RESULTS: LV twist angle was smaller in the HT group (6.2±3.3°) in comparison with the CS group and controls (13.2±3.5° and 13.1±4.5°, respectively; p<0.0001 for all) and untwist rate was reduced (HT group: -74±30°/s; CS group: -118±43°/s; controls: -116±39°/s; p<0.0001 for all). Time-to-peak twist was not different between groups. Time after HT was the main independent predictor of both LV twist angle and untwist rate (β=0.8, p<0.0001).

CONCLUSION: Though clinically stable, LV twist dynamics are significantly impaired in HT recipients, even in comparison with patients who underwent other cardiac surgery.

Ort, förlag, år, upplaga, sidor
Elsevier, 2013
Nyckelord
LV function, torsion, heart transplantation, echocardiography, speckle tracking
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:umu:diva-63833 (URN)10.1016/j.ijcard.2012.09.042 (DOI)000325409800068 ()23031285 (PubMedID)
Tillgänglig från: 2013-01-08 Skapad: 2013-01-08 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
2. Comparison of Right Versus Left Ventricular Strain Analysis as a Predictor of Outcome in Patients With Systolic Heart Failure Referred for Heart Transplantation
Öppna denna publikation i ny flik eller fönster >>Comparison of Right Versus Left Ventricular Strain Analysis as a Predictor of Outcome in Patients With Systolic Heart Failure Referred for Heart Transplantation
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2013 (Engelska)Ingår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 112, nr 11, s. 1778-1784Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The aim of the present study was to explore the relation between right ventricular (RV) and left ventricular (LV) echocardiographic parameters with clinical outcome in patients with advanced heart failure referred for cardiac transplantation. Ninety-eight consecutive patients with advanced systolic heart failure, referred for cardiac transplant evaluation, were enrolled. All patients were prospectively followed for the development of new outcome events, which included hospitalization for acute heart failure, cardiovascular death, heart transplantation, intra-aortic balloon pump implantation, and ventricular assist device implantation. Conventional transthoracic echocardiography was performed in all subjects. RV longitudinal strain (RVLS) by speckle-tracking echocardiography was assessed by averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). LV global longitudinal and global circumferential strains were also calculated. Of the 98 subjects at baseline, 46 had 67 new events during a mean follow-up of 1.5 +/- 0.9 years. Free-wall RVLS, global RVLS, N-terminal fragment of the prohormone brain natriuretic peptide, RV fractional area change, and LV end-diastolic volume were independently predictive of combined outcomes (all p<0.0001). The overall performance for the prediction of cardiovascular events was greatest for free-wall RVLS (area under the curve free-wall RVLS: 0.87; global RVLS: 0.67; RV fractional area change: 0.60; N-terminal fragment of the prohormone brain natriuretic peptide, 0.62; global circumferential strain: 0.55; global longitudinal strain: 0.35; and LV ejection fraction: 0.26). Free-wall RVLS showed the highest adjusted hazards ratio. A graded association between the grade of RV dysfunction and the risk of cardiovascular events was only evident for free-wall RVLS and global RVLS. In conclusion, in patients referred for heart transplantation, RVLS is a stronger predictor of outcome than LV longitudinal strain and other conventional parameters, providing a stronger prognostic stratification.

Ort, förlag, år, upplaga, sidor
Elsevier, 2013
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:umu:diva-85092 (URN)10.1016/j.amjcard.2013.07.046 (DOI)000327685900013 ()
Tillgänglig från: 2014-01-28 Skapad: 2014-01-28 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
3. Left Ventricular Deformation and Myocardial Fibrosis in Patients With Advanced Heart Failure Requiring Transplantation
Öppna denna publikation i ny flik eller fönster >>Left Ventricular Deformation and Myocardial Fibrosis in Patients With Advanced Heart Failure Requiring Transplantation
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2016 (Engelska)Ingår i: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 22, nr 11, s. 901-907Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

PURPOSE: To evaluate potential relationships between different components of left ventricular (LV) function and histopathological evidence for myocardial fibrosis in patients undergoing heart transplantation.

METHODS: The study population included patients with advanced heart failure, referred for an echocardiographic examination before heart transplantation. Traditional LV function measurements and global longitudinal strain (GLS) by speckle tracking echocardiography, averaging all LV segments in 4-, 2-, and 3-chamber views were obtained in all subjects. LV tissue samples were obtained from all patients who underwent heart transplantation. Myocardial fibrosis was assessed using Masson's staining.

RESULTS: Of 106 patients referred for cardiac transplantation, 47 underwent cardiac transplantation and were enrolled in the study. LV myocardial fibrosis and its grade strongly correlated with GLS (r = 0.75, P = .0001), modestly with global circumferential strain and LV torsion (r = 0.61, P = .001 and r = 0.52, P = .01, respectively) and weakly with mitral S' wave (r = -0.41; P = .01) and mitral annular plane systolic excursion (r = -0.35; P = .05) but did not correlate with LV ejection fraction (r = -0.12; P = NS). GLS had the strongest accuracy for detecting LV fibrosis (area under the curve, 0.92). None of the echo parameters correlated with patient's exercise capacity.

CONCLUSION: Global longitudinal strain is the most accurate LV global function measure that correlates with the extent of myocardial fibrosis in patients with advanced systolic HF requiring heart transplantation.

Nyckelord
Advanced cardiac failure, heart transplantation, LV fibrosis, echocardiography, speckle tracking, LV strain
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:umu:diva-119479 (URN)10.1016/j.cardfail.2016.02.012 (DOI)000388059200009 ()26952240 (PubMedID)
Tillgänglig från: 2016-04-20 Skapad: 2016-04-20 Senast uppdaterad: 2018-06-07Bibliografiskt granskad
4. Structure and functional predictors of left atrial pressure inpatients with end-stage heart failure
Öppna denna publikation i ny flik eller fönster >>Structure and functional predictors of left atrial pressure inpatients with end-stage heart failure
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(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Kardiologi
Forskningsämne
kardiologi
Identifikatorer
urn:nbn:se:umu:diva-127266 (URN)
Tillgänglig från: 2016-11-03 Skapad: 2016-11-03 Senast uppdaterad: 2018-06-09

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