Myocardial viability as integral part of the diagnostic and therapeutic approach to ischemic heart failure

Cardiolog

Diagnostic and prognostic roles of echocardiography and cardiac magnetic resonance

Cardiolog

Multimodality imaging:Bird's eye view from the European Society of Cardiology Congress 2019 Paris, August 31st-September 4th, 2019

At the European Society of Cardiology (ESC) congress of this year 2019, held in Paris from August 31st to September 4th, 4509 abstracts were presented. Of those, 414 (9%) belonged to an imaging category. Experts in echocardiography (VD), nuclear imaging (AS), cardiac computed tomography (CT) (MD) and cardiovascular magnetic resonance (CMR) (CBD), have selected the abstracts in their areas of expertise that were of most interest to them and are summarized in this bird's eye view from this ESC meeting. These abstracts were integrated by one of the Editors of the Journal (JB).Cardiolog

Effect of Bi-Atrial Size and Function in Patients With Paroxysmal or Permanent Atrial Fibrillation

Atrial fibrillation (AF) remains the most common arrhythmia in clinical practice. The choice between a rate-control and rhythm-control strategy depends on various factors, including the anatomical and functional substrate. This study investigates the anatomical and functional characteristics of both atria in patients with AF and explores the potential therapeutic implications. From an ongoing registry of patients with paroxysmal or permanent AF, those who underwent cardiac computed tomography (CCT) were included. Left atrial (LA) and right atrial (RA) sizes were measured on CCT, whereas bi-atrial function was quantified with speckle tracking strain echocardiography. The mean LA volume index was 41.6 ± 5.6 ml/m2, and the mean RA volume index was 71.0 ± 21.6 ml/m2. Mean LA reservoir strain was 24.3 ± 15.1%, compared with the mean RA reservoir strain of 21.6 ± 13.2%. Patients with smaller LA volumes had higher LA reservoir strain values than those with larger LA volumes (24.6% [interquartile range (IQR) 15.8 to 35.8] vs 16.5% [IQR 11.2 to 25.0], p 2 vs 36.9 [IQR 30.1 to 47.1] ml/m2, p = 0.025) compared with paroxysmal AF. Patients with permanent AF had more impaired LA reservoir strain (15.5% [IQR 11.6 to 22.7] vs 26.9% [IQR 17.4 to 35.6], p <0.001) compared with paroxysmal AF. Similar trends were observed in the RA. In conclusion, atrial substrate characterization by CCT and speckle tracking strain echocardiography may have therapeutic implications, especially for choosing between a rate-control and rhythm-control strategy

Prognostic implications of left ventricular global longitudinal strain in heart failure patients with narrow QRS complex treated with cardiac resynchronization therapy: a subanalysis of the randomized EchoCRT trial

Aim: Left ventricular (LV) global longitudinal strain (GLS) reflects LV systolic function and correlates inversely with the extent of LV myocardial scar and fibrosis. The present subanalysis of the Echocardiography Guided CRT trial investigated the prognostic value of LV GLS in patients with narrow QRS complex. Methods and results: Left ventricular (LV) global longitudinal strain (GLS) was measured on the apical 2-, 4- and 3-chamber views using speckle tracking analysis. Measurement of baseline LV GLS was feasible in 755 patients (374 with cardiac resynchronization therapy (CRT)-ON and 381 with CRT-OFF). The median value of LV GLS in the overall population was 7.9%, interquartile range 6.2–10.1%. After a mean follow-up period of 19.4 months, 95 patients in the CRT-OFF group and 111 in the CRT-ON group reached the combined primary endpoint of all-cause mortality and heart failure hospitalization. Each 1% absolute unit decrease in LV GLS was independently associated with 11% increase in the risk to reach the primary endpoint (Hazard ratio 1.11; 95% confidence interval 95% 1.04–1.17, P &lt; 0.001), after adjusting for ischaemic cardiomyopathy and randomization treatment among other clinically relevant variables. When categorizing patients according to quartiles of LV GLS, the primary endpoint occurred more frequently in patients in the lowest quartile (&lt;6.2%) treated with CRT-ON vs. CRT-OFF (45.6% vs. 28.7%, P = 0.009) whereas, no differences were observed in patients with LV GLS ≥6.2% treated with CRT-OFF vs. CRT-ON (23.7% vs. 24.5%, respectively; P  = 0.62). Conclusion: Low LV GLS is associated with poor outcome in heart failure patients with QRS width &lt;130 ms, independent of randomization to CRT or not. Importantly, in the group of patients with the lowest LV GLS quartile, CRT may have a detrimental effect on clinical outcomes

Valvular heart disease: shifting the focus to the myocardium

Adverse cardiac remodelling is the main determinant of patient prognosis in degenerative valvular heart disease (VHD). However, to give an indication for valvular intervention, current guidelines include parameters of cardiac chamber dilatation or function which are subject to variability, do not directly reflect myocardial structural changes, and, more importantly, seem to be not sensitive enough in depicting early signs of myocardial dysfunction before irreversible myocardial damage has occurred. To avoid irreversible myocardial dysfunction, novel biomarkers are advocated to help refining indications for intervention and risk stratification. Advanced echocardiographic modalities, including strain analysis, and magnetic resonance imaging have shown to be promising in providing new tools to depict the important switch from adaptive to maladaptive myocardial changes in response to severe VHD. This review, therefore, summarizes the current available evidence on the role of these new imaging biomarkers in degenerative VHD, aiming at shifting the clinical perspective from a valve-centred to a myocardium-focused approach for patient management and therapeutic decision-making

Impact of valvular heart disease on activities of daily living of nonagenarians: the leiden 85-plus study a population based study

<p>Abstract</p> <p>Background</p> <p>Data on the prevalence of valvular heart disease in very old individuals are scarce and based mostly on in-hospital series. In addition, the potential detrimental effect of valvular heart disease on the activities of daily living is unknown. The present study evaluated the prevalence of significant valvular heart disease and the impact of valvular heart disease on the activities of daily living in community dwelling nonagenarians. Nested within the Leiden 85-plus study, a population based follow-up study of the oldest old, a sample of 81 nonagenarians was recruited.</p> <p>Methods</p> <p>The left ventricular (LV) dimensions, function and the presence and severity of heart valvular disease were evaluated by echocardiography. Significant valvular heart disease included any mitral or aortic stenosis severity, moderate or severe mitral regurgitation, moderate or severe aortic regurgitation and moderate or severe tricuspid regurgitation. Activities of daily living were assessed using the Groningen Activity Restriction Scale (GARS).</p> <p>Results</p> <p>LV cavity diameters (end-diastolic diameter 47 ± 8 mm, end-systolic diameter 30 ± 8 mm) and systolic LV function (LV ejection fraction 66 ± 13%) were within normal for the majority of the participants. Significant valvular disease was present in 57 (70%) individuals, with mitral regurgitation and aortic regurgitation as the most frequent valve diseases (49% and 28% respectively). The GARS score between individuals with and without significant valvular heart disease was similar (36.2 ± 9.2 vs. 34.4 ± 13.2, p = 0.5).</p> <p>Conclusions</p> <p>Nonagenarian, outpatient individuals have a high prevalence of significant valvular heart disease. However, no relation was observed between the presence of significant valvular heart disease and the ability to perform activities of daily living.</p

The year in cardiology 2017: imaging

Cardiolog

The year in cardiology: imaging The year in cardiology 2019

No abstract available