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  • Ovid Technologies (Wolters Kluwer Health)  (6)
  • 2015-2019  (6)
  • 1
    Online Resource
    Online Resource
    Abstract 14303: Low Global Longitudinal Strain in Ischemic Cardiomyopathy Patients at Baseline is Associated With Ventricular Arrhythmias After Cardiac Resynchronization Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Heart failure (HF) patients have an increased risk for ventricular arrhythmias (VA) and in particular patients with ischemic cardiomyopathy (ICM) have a worse prognosis after cardiac resynchronization therapy with defibrillator (CRT-D) compared with non-ischemic patients. Hypothesis: We hypothesize that global longitudinal strain (GLS) at baseline has the ability to identify ICM patients at higher risk for VA after CRT-D. Methods: We prospectively studied 175 consecutive HF patients implanted with CRT-D from a single center. All of them had class II-IV HF symptoms, LV ejection fraction (≤35%), QRS≥120 ms. GLS was measured from the three standard apical views and presented as absolute values. Outcome event was defined as VA (anti-tachycardia pacing or appropriate shock) after CRT in the first 2 years of follow-up. Results: Of 175 patients aged 65±11 years, 135 (77%) were male and 115 (66%) had ICM. They suffered 34 (19%) VA events over 2 years. Mean GLS of the population was 8.1±3.0. GLS ( 〈 6.5%) was associated with VA events after CRT-D with a sensitivity of 70% and specificity of 56%. A cutoff of GLS 〈 6.5% was associated with greater VA events in the ICM patients with HR 2.92 (95% confidence interval 1.48 to 5.77, p=0.002). A similar significant association of GLS was not seen in the non ICM patients (p=0.12). Conclusions: Low GLS ( 〈 6.5% in absolute values) in ICM patients is associated with increased risk for VA after CRT-D and might represent more extensive myocardial scarring and has prognostic implications.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.14303
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 2
    Online Resource
    Online Resource
    Characterization of Right Ventricular Remodeling in Pulmonary Hypertension Associated With Patient Outcomes by 3-Dimensional Wall Motion Tracking Echocardiography
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation: Cardiovascular Imaging Vol. 8, No. 6 ( 2015-06)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 6 ( 2015-06)
    Abstract: Adverse right ventricular (RV) remodeling has significant prognostic and therapeutic implications to patients with pulmonary hypertension (PH). However, differentiating RV adaption from adverse remodeling associated with poor outcomes is difficult. We hypothesized that novel 3-dimensional (3D) wall motion tracking echocardiography can differentiate morphological features of RV adaption from adverse remodeling heralding an unfavorable short-term prognosis in patients with PH. Methods and Results— We studied 112 subjects: 92 patients with PH and 20 normal controls with 3D wall motion tracking for RV end-systolic volume index (ESVi), RV ejection fraction (EF), and RV global area strain. Patients with PH also had invasive hemodynamic measurements. Pressure–volume relations classified patients with PH into 3 groups, such as RV adapted, RV adapted–remodeled, and RV adverse–remodeled. The predefined combined end point was PH-related hospitalization, death, or lung surgery (lung transplantation or pulmonary endarterectomy) during 6 months. The 92 patients with PH had significantly larger RV volumes, lower RVEF and global area strain than normal controls as expected. Patients with PH classified as RV adapted (ESVi, ≤ 72 mL/m 2 ) had a more favorable clinical outcome than those classified as RV adapted–remodeled (ESVi, 73–113 mL/m 2 ) or RV adverse–remodeled (ESVi, ≥ 114 mL/m 2 ): hazard ratio, 0.15; 95% confidence intervals, 0.07 to 0.39; P 〈 0.0001. RV adverse–remodeled patients (ESVi, ≥ 114 mL/m 2 ) had worse short-term outcome than the RV adapted–remodeled patients: hazard ratio, 2.2; 95% confidence interval, 0.91 to 5.39; P =0.04. Conclusions— Quantitative 3D echocardiography in patients with PH demonstrated morphological subsets of RV adaption and remodeling associated with clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.114.003176
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 3
    Online Resource
    Online Resource
    Differentiating Electromechanical From Non–Electrical Substrates of Mechanical Discoordination to Identify Responders to Cardiac Resynchronization Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation: Cardiovascular Imaging Vol. 8, No. 9 ( 2015-09)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 9 ( 2015-09)
    Abstract: Left ventricular (LV) mechanical discoordination, often referred to as dyssynchrony, is often observed in patients with heart failure regardless of QRS duration. We hypothesized that different myocardial substrates for LV mechanical discoordination exist from (1) electromechanical activation delay, (2) regional differences in contractility, or (3) regional scar and that we could differentiate electromechanical substrates responsive to cardiac resynchronization therapy (CRT) from unresponsive non–electrical substrates. Methods and Results— First, we used computer simulations to characterize mechanical discoordination patterns arising from electromechanical and non–electrical substrates and accordingly devise the novel systolic stretch index (SSI), as the sum of posterolateral systolic prestretch and septal systolic rebound stretch. Second, 191 patients with heart failure (QRS duration ≥120 ms; LV ejection fraction ≤35%) had baseline SSI quantified by automated echocardiographic radial strain analysis. Patients with SSI≥9.7% had significantly less heart failure hospitalizations or deaths 2 years after CRT (hazard ratio, 0.32; 95% confidence interval, 0.19–0.53; P 〈 0.001) and less deaths, transplants, or LV assist devices (hazard ratio, 0.28; 95% confidence interval, 0.15–0.55; P 〈 0.001). Furthermore, in a subgroup of 113 patients with intermediate electrocardiographic criteria (QRS duration of 120–149 ms or non–left bundle branch block), SSI≥9.7% was independently associated with significantly less heart failure hospitalizations or deaths (hazard ratio, 0.41; 95% confidence interval, 0.23–0.79; P =0.004) and less deaths, transplants, or LV assist devices (hazard ratio, 0.27; 95% confidence interval, 0.12–0.60; P =0.001). Conclusions— Computer simulations differentiated patterns of LV mechanical discoordination caused by electromechanical substrates responsive to CRT from those related to regional hypocontractility or scar unresponsive to CRT. The novel SSI identified patients who benefited more favorably from CRT, including those with intermediate electrocardiographic criteria, where CRT response is less certain by ECG alone.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.115.003744
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 4
    Online Resource
    Online Resource
    Right Ventricular Function in Peripartum Cardiomyopathy at Presentation Is Associated With Subsequent Left Ventricular Recovery and Clinical Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation: Heart Failure Vol. 9, No. 5 ( 2016-05)
    Details
    In: Circulation: Heart Failure, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 5 ( 2016-05)
    Abstract: Peripartum cardiomyopathy has variable disease progression and left ventricular (LV) recovery. We hypothesized that baseline right ventricular (RV) size and function are associated with LV recovery and outcome. Methods and Results— Investigations of Pregnancy-Associated Cardiomyopathy was a prospective 30-center study of 100 peripartum cardiomyopathy women with LV ejection fraction (LVEF) 〈 45% within 13 weeks after delivery. Baseline RV function was assessed by echocardiographic end-diastolic area, end-systolic area, fractional area change, tricuspid annular plane excursion, and RV speckle-tracking longitudinal strain. LV recovery was defined as LVEF of ≥50% at 1 year, persistent severe LV dysfunction as LVEF of ≤35%, and major events as death, transplant, or LV assist device implantation. RV measurements were feasible for 90 of the 96 patients (94%) with echocardiograms available. Mean baseline LVEF was 36±9%. RV fractional area change was 〈 35% in 38% of patients. Of 84 patients with 1-year follow-up data, 63 (75%) had LV recovery and 11 (13%) had LVEF of ≤35% or a major event (4 LV assist devices and 2 deaths). Tricuspid annular plane excursion and RV strain did not predict outcome. Baseline RV fractional area change by multivariable analysis was independently associated with subsequent LV recovery and clinical outcome. Conclusions— Peripartum cardiomyopathy patients had a high incidence of LV recovery, but a significant minority had persistent LV dysfunction or a major clinical event by 1 year. RV function per echocardiographic fractional area change at presentation was associated with subsequent LV recovery and clinical outcomes and thus is prognostically important.
    Type of Medium: Online Resource
    ISSN: 1941-3289 , 1941-3297
    URL: Article
    DOI: 10.1161/CIRCHEARTFAILURE.115.002756
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2428100-1
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  • 5
    Online Resource
    Online Resource
    Abstract 13532: Diastolic Function at Presentation Has Independent Prognostic Value in Patients With Peripartum Cardiomyopathy
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Background: Peripartum cardiomyopathy (PPCM) is a rare disease with variable but potentially devastating consequences. The prognostic importance of alterations in LV diastolic function is unclear. Methods: Pregnancy Associated Cardiomyopathy cohort was a prospective study of 100 PPCM women from 30 centers presenting with LV ejection fraction (EF) 〈 45% within 2 months of delivery. Baseline data were mitral inflow E-wave, A-wave, E/A ratio, E deceleration time (DT), tissue Doppler septal and lateral annular velocities and biplane LA volume index. There were 90 PPCM patients and 21 female controls (8 healthy postpartum and 13 non-pregnant) with diastolic data. LV recovery was defined as LVEF ≥ 50% at 1 year. Outcome events were predefined as death, heart transplant or LV assist device (LVAD). Results: PPCM patients were aged 30±6 years with EF 35±9% at presentation. At 1 year, 84 patients had follow-up data: 63 patients (75%) had LV recovery (EF ≥50%) and 11 patients (13%) had either LVEF ≤35% or a major event (4 LVADs and 2 deaths). Elevated filling pressures (E/A≥2 and DT 〈 150ms) were present in 57% at baseline and persisted in 11% at last echo, p 〈 0.0001. Abnormalities in baseline diastolic function were associated with clinical outcomes and lack of LV recovery: area under the ROC curve (AUC) for E/A 0.78, p=0.0002, AUC for DT 0.82, p 〈 0.0001, AUC for LA volume index 0.79, p 〈 0.0001. Diastolic measures were also predictive of persistent severe LV dysfunction (EF ≤35%) or unfavorable events: E/A, p 〈 0.0001; DT, p 〈 0.0001, and LA volume index, p=0.0001. By multivariate analysis, baseline diastolic function was independently associated with subsequent lack of LV recovery or unfavorable events (Table). Conclusions: In PPCM patients, echo-Doppler measures of diastolic function at presentation provide important prognostic information regarding LV recovery and clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.13532
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 6
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    Online Resource
    Additive Prognostic Value of Echocardiographic Global Longitudinal and Global Circumferential Strain to Electrocardiographic Criteria in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation: Cardiovascular Imaging Vol. 9, No. 6 ( 2016-06)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 6 ( 2016-06)
    Abstract: Response to cardiac resynchronization therapy is most favorable in patients with heart failure with QRS duration ≥150 ms and left bundle branch block and less predictable in those with QRS width 120 to 149 ms or non–left bundle branch block. Methods and Results— We studied 205 patients with heart failure referred for cardiac resynchronization therapy with QRS ≥120 ms and ejection fraction ≤35%. We tested the hypothesis that contractile function using speckle-tracking echocardiographic global circumferential strain (GCS) from 2 short-axis views and global longitudinal strain (GLS) from 3 apical views add prognostic value to electrocardiographic criteria. There were 112 patients (55%) with GLS 〉 −9% and 136 patients (66%) with GCS 〉 −9%. During 4 years, 81 patients reached the combined primary end point (death, circulatory support, or transplant) and 120 reached the secondary end point (heart failure hospitalization or death). Both GLS 〉 −9% and GCS 〉 −9% were associated with increased risk of unfavorable events as follows: for the primary end point (hazard ratio=2.91; 95% confidence interval, 1.88–4.49; P 〈 0.001) and (hazard ratio=3.73; 95% confidence interval, 2.39–5.82; P 〈 0.001) for the secondary end point (hazard ratio=2.10; 95% confidence interval, 1.45–3.05; P 〈 0.001) and (hazard ratio=3.25; 95% confidence interval, 2.23–4.75; P 〈 0.001). In a prespecified subgroup of 120 patients with QRS 120 to 149 ms or non–left bundle branch block, significant associations of baseline GLS and GCS and outcomes remained: P =0.014 and P =0.002 for the primary end point and P =0.049 and P =0.001 for the secondary end point. Global strain measures had additive prognostic value to routine clinical or electrocardiographic parameters ( P 〈 0.001). Conclusions— Baseline GCS and GLS were significantly associated with long-term outcome after cardiac resynchronization therapy and had additive prognostic value to routine clinical and electrocardiographic selection criteria for cardiac resynchronization therapy.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.115.004241
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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