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  • 1
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    Recovery of cardiac function following COVID ‐19 –  ECHOVID ‐19: a prospective longitudinal cohort study
    Wiley ; 2021
    In:  European Journal of Heart Failure Vol. 23, No. 11 ( 2021-11), p. 1903-1912
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    In: European Journal of Heart Failure, Wiley, Vol. 23, No. 11 ( 2021-11), p. 1903-1912
    Abstract: The degree of cardiovascular sequelae following COVID‐19 remains unknown. The aim of this study was to investigate whether cardiac function recovers following COVID‐19. Methods and results A consecutive sample of patients hospitalized with COVID‐19 was prospectively included in this longitudinal study. All patients underwent an echocardiographic examination during hospitalization and 2 months later. All participants were successfully matched 1:1 with COVID‐19‐free controls by age and sex. A total of 91 patients were included (mean age 63 ± 12 years, 59% male). A median of 77 days (interquartile range: 72–92) passed between the two examinations. Right ventricular (RV) function improved following resolution of COVID‐19: tricuspid annular plane systolic excursion (TAPSE) (2.28 ± 0.40 cm vs. 2.11 ± 0.38 cm, P   〈  0.001) and RV longitudinal strain (RVLS) (25.3 ± 5.5% vs. 19.9 ± 5.8%, P   〈  0.001). In contrast, left ventricular (LV) systolic function assessed by global longitudinal strain (GLS) did not significantly improve (17.4 ± 2.9% vs. 17.6 ± 3.3%, P  = 0.6). N‐terminal pro‐B‐type natriuretic peptide decreased between the two examinations [177.6 (80.3–408.0) ng/L vs. 11.7 (5.7–24.0) ng/L, P   〈  0.001]. None of the participants had elevated troponins at follow‐up compared to 18 (27.7%) during hospitalization. Recovered COVID‐19 patients had significantly lower GLS (17.4 ± 2.9% vs. 18.8 ± 2.9%, P   〈  0.001 and adjusted P  = 0.004), TAPSE (2.28 ± 0.40 cm vs. 2.67 ± 0.44 cm, P   〈  0.001 and adjusted P   〈  0.001), and RVLS (25.3 ± 5.5% vs. 26.6 ± 5.8%, P  = 0.50 and adjusted P   〈  0.001) compared to matched controls. Conclusion Acute COVID‐19 affected negatively RV function and cardiac biomarkers but recovered following resolution of COVID‐19. In contrast, the observed reduced LV function during acute COVID‐19 did not improve post‐COVID‐19. Compared to the matched controls, both LV and RV function remained impaired.
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Issue
    URL: Article
    DOI: 10.1002/ejhf.v23.11
    DOI: 10.1002/ejhf.2347
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 2
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    Layer‐specific global longitudinal strain and the risk of heart failure and cardiovascular mortality in the general population: the Copenhagen City Heart Study
    Wiley ; 2021
    In:  European Journal of Heart Failure Vol. 23, No. 11 ( 2021-11), p. 1819-1827
    Details
    In: European Journal of Heart Failure, Wiley, Vol. 23, No. 11 ( 2021-11), p. 1819-1827
    Abstract: Layer‐specific global longitudinal strain (GLS) has been demonstrated to predict outcome in various patient cohorts. However, little is known regarding the prognostic value of layer‐specific GLS in the general population and whether different layers entail differential prognostic information. The aim of the present study was to investigate the prognostic value of whole wall (GLS WW ), endomyocardial (GLS Endo ), and epimyocardial (GLS Epi ) GLS in the general population. Methods and results A total of 4013 citizens were included in the present study. All 4013 had two‐dimensional speckle tracking echocardiography performed and analysed. Outcome was a composite endpoint of incident heart failure and/or cardiovascular death. Mean age was 56 years and 57% were female. During a median follow‐up time of 3.5 years, 133 participants (3.3%) reached the composite outcome. Sex modified the relationship between all GLS parameters and outcome. In sex‐stratified analysis, no GLS parameter remained significant predictors of outcome in females. In contrast, GLS WW [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.02–1.31, per 1% decrease] and GLS Epi (HR 1.19, 95% CI 1.04–1.38, per 1% decrease) remained as significant predictors of outcome in males after multivariable adjustment (including demographic, clinical, biochemistry, and echocardiographic parameters). Lastly, only in males did GLS parameters provide incremental prognostic information to general population risk models. Conclusions In the general population, sex modifies the prognostic value of GLS resulting in GLS Epi being the only layer‐specific prognosticator in males, while no GLS parameter provides independent prognostic information in females.
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Issue
    URL: Article
    DOI: 10.1002/ejhf.v23.11
    DOI: 10.1002/ejhf.2315
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 3
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    Abstract 12868: Normal Values and Reference Ranges for Left Atrial Strain by Speckle Tracking Echocardiography: The Copenhagen City Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Background: In current literature, left atrial (LA) function assessed by 2D speckle tracking echocardiography (2DSTE) has shown increasing clinical and prognostic significance. We sought to establish age- and sex-based normative values of LA strain measures in the general population and to assess the diagnostic and prognostic yield of the prediction intervals (PI) in relation to baseline and future atrial fibrillation (AF). Methods: We performed 2DSTE in members of the general population included in the 5 th round of the Copenhagen City Heart Study. We determined normative values of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and left atrial conduit strain (LACS) based on age and sex in 1,757 healthy participants. In a secondary analysis, 3,657 participants, regardless of health status, were included to assess the diagnostic and prognostic value of the established reference values. Results: In the healthy cohort, median age was 46 years (IQR: 33, 57), 62% were female. Median normative values of PALS, PACS, and LACS in the healthy participants were 39.1% (PI: 22.7-67.4%), 15.5% (PI: 6.3-28.0%), and 23.5% (PI: 8.6-44.8%), respectively. We observed higher values and reference limits of PALS and LACS in females compared to males, while no differences were observed for PACS. Across four different age categories, all three LA strain parameters differed significantly in both females and males. PALS and LACS decreased, while PACS increased with advancing age (Figure 1). The lower reference limits of all three LA strain parameters showed high specificity (range 96-98%) in relation to baseline and future AF, implying a low risk of AF in participants with LA strain above the lower prediction interval in their respective sex and age group. Conclusion: We report normal values for LA strain measures stratified by sex and age. The established lower reference limits showed high specificity regarding baseline and future AF diagnosis.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.12868
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 4
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    Abstract 12827: The Prognostic Value of Peak Mitral Annulus Systolic Velocity in Relation to Incident Heart Failure in the General Population - The Copenhagen City Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Peak mitral annulus systolic velocity (s’) measured by color tissue Doppler echocardiography can be used to evaluate longitudinal systolic function of the left ventricle (LV). The prognostic value of s’ has previously been documented in patients with ischemic heart disease and heart failure (HF). We sought to investigate the prognostic value of s’ in association with incident HF in the general population with low cardiovascular risk. Methods: This prospective cohort consists of participants from the 5th Copenhagen City Heart Study. All participants had echocardiography performed. Exclusion criteria were prevalent HF, prevalent atrial fibrillation and inadequate image quality for s’ assessment. Multivariable Cox regression models adjusted for; sex, age, smoking-status, diabetes, ischemic heart disease, hypertension, heart rate, left atrial volume index and E/e’, were used to assess the association between s’ and HF. Results: Of 4,110 participants included (mean age 56 years ± 17.4 year, 56.8% female), 90 (2.2%) developed HF during a median follow-up of 5.4 years, [IQR: 4.4-6.3]. The mean s’ was 6.05 cm/s ± 1.2. Following multivariable adjustment, decreasing s’ remained significantly associated with HF (HR 1.60 (95% CI: 1.24; 2.07 p 〈 0.001) per 1 cm/s decrease) (Figure). An optimal cut-off value for s’ was calculated to be 5.9 cm/s. Participants with s’ below this cut-off had a 3-fold increased risk of HF (HR 3.15 (95% CI: 1.97; 5.03 p 〈 0.001). In participants with s’ ≥ 5.9 cm/s, the incidence rate of HF was 2.1 per 1000 person-years (95% CI: 1.39; 3.09) and 6.5 per 1000 person-years (95% CI: 5.13; 8.31) when s’ 〈 5.9 cm/s. The cut-off value had a sensitivity of 73.3% (95% CI: 63; 82.1), a specificity of 54.0 (95% CI: 52.4; 55.6), and a negative predictive value of 98.9% (95% CI: 98.4; 99.3). Conclusion: In the general population, s’ is an independent prognosticator for the development of HF. Figure. The assocation between s’ and HF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.12827
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 5
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    Abstract 13088: Peak Systolic Strain Rate is Associated With Incident Heart Failure in the General Population - The Copenhagen City Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Peak systolic strain rate (SrS) reflecting the maximal acceleration of the systolic deformation during systole derived from speckle tracking echocardiography has been demonstrated to be a significant predictor of cardiovascular outcomes in patients with myocardial infarction. However, the prognostic utility of SrS in individuals with low cardiovascular risk is unknown. Hypothesis: We hypothesized that SrS was associated with incident heart failure (HF) in the general population. Methods: The 5th Copenhagen City Heart Study is a prospective cohort study. All participants had echocardiography performed. Exclusion criteria were prevalent HF and inadequate image quality for SrS assessment. The multivariable Cox model included variables from the Atherosclerosis Risk In Communities (ARIC) HF risk score and left ventricular ejection fraction. Results: A total of 4,013 participants were included in the final study sample. The mean age was 56 years and 2,290 (57.1%) were female. The mean SrS was 1.11 s -1 . During a median follow-up of 5.4 years, 101 participants (3%) developed HF. In multivariable analysis, decreasing SrS was significantly associated with HF (HR 1.32 (95% CI: 1.12; 1.56) p= 0.001) per s -1 decrease) (Figure). The optimal cutoff value of SrS 〈 1.028 s -1 was linked to a 4-fold risk of HF (HR 4.38 (95% CI: 2.92; 6.56). Incidence rate of HF was 2.4 per 1000 person-years (95% CI: 1.77; 3.36) when SrS ≥ 1.028 and 10.7 per 1000 person-years (95% CI: 8.35; 13.63) when SrS 〈 1.028. The cutoff had a sensitivity of 63.4% (95% CI: 53.2; 72.7), a specificity of 72.1% (95% CI: 70.6; 73.5), and a negative predictive value of 98.7% (95% CI: 98.2; 99.1). Finally, SrS added incremental value to the ARIC HF risk score with a net reclassification index of 0.264 (95% CI: 0.086; 0.415). Conclusions: SrS was significantly associated with the development of HF in the general population and provided incremental value to the ARIC HF risk score.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.13088
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 6
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    Abstract 14179: Unsupervised Machine Learning on Myocardial Deformation Curves Identifies Specific Clusters of People at Risk of Heart Failure - The Copenhagen City Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background Peak global longitudinal strain is recognized as a powerful predictor of heart failure (HF). However, whether the entire strain curve add important prognostic information regarding risk of HF remains unknown. We aimed to investigate whether patterns of myocardial deformation identified through unsupervised machine learning (uML) entailed additional information regarding risk of HF. Methods Longitudinal strain curves from 3,710 subjects from the general population without prevalent HF were clustered by similarity using uML based on strain curves alone. The grouped clusters were then compared by incidence rate of HF and in multivariable COX models. Results Mean age was 56 years and 43% were male. During a median follow-up of 5.3 years, 92 subjects (2.5%) developed HF. The uML algorithm generated a hierarchical clustering tree (Figure 1) and 10 different clusters. Generally, with increasing incidence of HF, strain curves displayed a smaller reduction of strain from peak-GLS to the maximal curvature during the early filling relative to the size of their peak-GLS (Figure 1 and 2): We called this value early diastolic strain to peak-GLS (EDS to peak-GLS). One exception was cluster 9. In multivariable Cox regression, cluster 9 was significantly associated with increased incidence of HF when compared to cluster 3,4 and 5 [For cluster 3: HR 6.6, 95%CI: 1.5;29.0, p = 0.013] even though the subjects of cluster 9 were younger (40 years), displayed healthier clinical baseline characteristics, and only had slightly reduced Peak-GLS. The mean strain curve of the lateral basal segment of cluster 9 displayed an early systolic lengthening followed by a late and reduced contraction specifically related to the basal lateral segment (Figure 3). Conclusion uML could identify clusters with high incidence of HF based on strain curves alone. The algorithm identified unknown strain patterns beyond peak-GLS presumably related to increased risk of HF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.14179
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 7
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    Abstract 12009: Normal Values and Reference Ranges for Left Atrial Coupling Index: The Copenhagen City Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Left atrial volumetric/mechanical coupling index (LACi) has shown increasing clinical and prognostic utility. LACi is a proposed echocardiographic measurement combining information regarding LA size and function in one measure with no established reference values. The aim of the present study was to establish sex-based normative values and a reference range for LACi in the general population. Methods: The present study included healthy participants from the 5th Copenhagen City Heart Study (2011-2015). Participants were considered healthy when free off heart failure, atrial fibrillation, diabetes, hypertension, ischemic heart disease, valvular heart diseases and use of heart medication. All participants were examined with echocardiography. LACi was calculated as the ratio of LA maximal volume index and a’ (peak myocardial velocity of the left ventricle at the septal base in late diastole). Reference values were defined based on prediction intervals (PI) between 2.5% and 97.5%. Results: Among 1,939 participants, mean age was 46 ± 16 years, and 61% were female. Median LACi was 2.5 [95% PI (1.16-4.97)]. We observed higher normative values and reference limits of LACi for females than for males (median 2.5 [95% PI (1.19-5.03)] vs 2.4 [95%PI (1.11- 4.73)], p=0.002) (Figure 1). LACi decreased significantly across age categories for all, and when categorized according to sex. In multivariate linear regression models, younger age (beta=-0.230), female sex (b=-0.081), lower BMI (b=-0.067) and high physical activity (reference: no physical activity during leisure time) (b=0.196) were all significantly associated with higher LACi. Conclusions: We report normative reference values and ranges for LACi in a healthy general population and stratified by sex. LACi was higher in females and decreased with age.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.12009
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 8
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    Abstract 11595: Applying Machine Learning on Myocardial Deformation Parameters for Identifying Subjects in High Risk of Heart Failure: The Copenhagen City Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background Recently, speckle tracking echocardiography (STE) and tissue doppler imaging (TDI) has gained increasing traction as a non-invasive tissue characterisation method within cardiology. But until now many patterns from the strain and TDI curves remain uninvestigated. In this work we applied supervised machine learning (ML) to identify unknown pathophysiological drivers of heart failure (HF) in the general population. Methods A total of 2383 subjects from the general population (Mean age 55.9 years ± 17.3, male 42%) underwent STE, TDI, and clinical examination. We applied an ensemble decision tree and a logistic regression model to investigate unknown speckle tracking parameters and to predict the endpoint: Occurrence of HF within five years. The ML models were evaluated with 20-fold cross-validation to provide a clear split between training and validation data. Results The median follow up-time was 5.41 years (ICR 4.49 - 6.28). 88 subjects (3.7%) developed HF within 5 years.We identified 4 new echocardiographic characteristics that improved the prediction of HF: 1. Peak systolic strain rate (SRs), 2. Strain at AVC, 3. Accumulated systolic strain/HR, 4. TDI Peak LV Diastolic Acceleration(Figure 1 and Figure 2). The model combining both novel strain- and TDI parameters as well as conventional echo parameters and clinical features performed significantly better than a model based on clinical features alone (AUC echocardiographic and clinical parameters vs. clinical parameters = 0.88/0.84, p = 0.04). An ensemble decision tree model predicted the outcome reasonably well with a precision of 24% at a sensitivity of 50%. Conclusion Adding novel echocardiographic parameters to a clinical ML model for prediction of HF improved the prognostic performance significantly. We identified 4 new parameters relevant for prediction of HF and found that peak systolic strain rate (SRs) was the most important predictor.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.11595
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 9
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    Abstract 9893: The Associations Between Layer-Specific Global Circumferential Strain Parameters and Incident Heart Failure: The Copenhagen City Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Global circumferential strain (GCS) has been demonstrated to be sensitive marker of early cardiac pathology compared to conventional echocardiographic measurements. Improvement in speckle tracking echocardiography has introduced layer-specific quantification of GCS. This study investigated the differences in the prognostic value of endomyocardial (GCS Endo ) and epimyocardial (GCS Epi ) GCS regarding incident HF (heart failure) in the general population. Methods: The prospective cohort study included randomly invited individuals from the general population. All participants were examined with echocardiography. Exclusion criteria were prevalent HF at baseline, non-sinus rhythm during echocardiography and inadequate image quality for speckle tracking analysis. Cox proportional hazard regression models were utilized to assess associations between GCS Endo and GCS Epi with incident HF. A multivariable model was created, which included left ventricular (LV) ejection fraction, LV mass index, and the variables from the ARIC HF risk score. Results: A total of 2874 individuals were included in the study sample. Mean age was 53 years ± 18 years and 40% were males. Mean GCS Endo and GCS Epi were 31.9 ± 5.3% and 14.3 ± 4.0% respectively. During a follow-up period of 5.4 years (IQR: 4.5; 6.3) 52 suffered incident HF. The cumulative incidence of HF according to the medians of layer-specific GCS is illustrated in Figure 1. In multivariable Cox regressions, GCS Endo remained significantly associated with HF (HR = 1.06 95%CI: [1.00; 1.12], per 1 % decrease), while GCS Epi did not (HR = 1.01 95%CI: [0.94; 1.10], per 1 % decrease). The same pattern was observed when only adjusting for age and sex. Additionally, GCS Endo provided significantly higher Harrel’s C-statistics as compared to GCS Epi (0.68 95%CI[0.58; 0.77] vs 0.60 95%CI[0.50; 0.69] ). Conclusions: In the general population, GCS Endo is independently associated with incident HF while GCS Epi is not.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.9893
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 10
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    RECOVERY OF CARDIAC FUNCTION FOLLOWING COVID-19 INFECTION: ECHOVID-19 - A LONGITUDINAL COHORT STUDY
    Elsevier BV ; 2021
    In:  Journal of the American College of Cardiology Vol. 77, No. 18 ( 2021-05), p. 3035-
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 77, No. 18 ( 2021-05), p. 3035-
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/S0735-1097(21)04390-4
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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