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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 (English)In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 112, no 11, 1778-1784 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 112, no 11, 1778-1784 p.
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-85092DOI: 10.1016/j.amjcard.2013.07.046ISI: 000327685900013OAI: oai:DiVA.org:umu-85092DiVA: diva2:691771
Available from: 2014-01-28 Created: 2014-01-28 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Mechanical and histological disturbances in advanced heart failure and cardiac transplantation
Open this publication in new window or tab >>Mechanical and histological disturbances in advanced heart failure and cardiac transplantation
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2016. 99 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1862
Keyword
Advanced heart failure, heart transplantation, speckle tracking echocardiography, left ventricular function, right ventricular function, left ventricular fibrosis, left ventricular filling pressure, atrial strain
National Category
Cardiac and Cardiovascular Systems
Research subject
Cariology
Identifiers
urn:nbn:se:umu:diva-127295 (URN)978-91-7601-609-1 (ISBN)
Public defence
2016-11-30, E04, Målpunkt R-1, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2016-11-09 Created: 2016-11-05 Last updated: 2016-11-21Bibliographically approved

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Henein, Michael

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