Correspondence of Myocardial Strain with Torrent-Guasp’s Theory. Contributions of New Echocardiographic Parameters

Background: Strain, assessed by speckle tracking echocardiography, may be used to evaluate left ventricular mechanics and could establish reference values together with new indices of myocardial function. Objective: The aim of this study was to demonstrate the correspondence of echocardiographic strain values with TorrentGuasp’s single band theory. Methods: A prospective observational study was conducted in 54 healthy volunteers. The three apical projections were used to determine longitudinal strain. Radial strain, circumferential strain and rotation were assessed in transverse planes at the level of the mitral valve, the papillary muscles and the apex. Results: Mean age was 52±10.1 years. Global left ventricular longitudinal strain was -20.8%±2.4%. Postsystolic longitudinal strain mainly affects interventricular septal segments. Radial strain was 36.5%±10.7%, with basal values prevailing over apical ones, extending its duration to the early phase of diastole. Circumferential strain was -20.8%±3.8%, with larger values towards the apex. Twist was 18.4°±6°, torsion 2.2°±0.8°/cm and the torsion index (twist/mitral annular plane systolic excursion) 13.1°±4.4°/cm. The combined strain index includes the “strain product” (-387°±147° × %), and the “strain index” (-0.9°±0.3°/%) calculated as twist × longitudinal strain and twist/longitudinal strain, respectively. Conclusions: New strain parameters may be useful in the study of ventricular mechanics. The anatomical arrangement described by the myocardial band theory is echocardiographically supported by the presence of larger radial strain at the basal-medial level (prevalence of transverse fibers), while the variable arrangement of oblique fibers are responsible for longitudinal strain, circumferential strain and ventricular torsion.Introducción y objetivos. El Strain, o Deformación, evaluado mediante ecocardiografía Speckle Tracking, puede utilizarse para estudiar la mecánica del ventrículo izquierdo. El objetivo fue demostrar la correspondencia de los valores ecocardiográficos con la teoría de la banda única de Torrent-Guasp. Métodos. Estudio prospectivo observacional de 54 voluntarios sanos. Se utilizaron las tres proyecciones apicales para determinar el Strain Longitudinal (SL). El Strain Radial (SR), Circunferencial (SC) y la rotación se determinaron en planos transversales a nivel de válvula mitral, músculos papilares, y ápex. Resultados. Edad media 52,5±10,1 años. El SL global del ventrículo izquierdo fue -20,8±2,4%. Una Deformación Postsistólica en el SL afecta fundamentalmente a segmentos del septo interventricular. El SR fue 36,5±10,7%, con valores basales predominantes sobre los apicales, extendiendo su duración hasta la protodiástole. El SC fue -20,8±3,8%, con valores mayores hacia el ápex. El Giro o Twist fue 18,4±6º, la Torsión 2,2±0,8º/cm y el Índice de Torsión (Giro/excursión sistólica del anillo mitral o MAPSE) 13,1±4,4º/cm. El Índice Combinado de Deformación incluye el “Producto de Deformación” (-387±147 º x %), y el “Índice de Deformación” (-0,9±0,3 º/%) calculados como Giro x SL y Giro/SL, respectivamente. Conclusión: Nuevos parámetros de Deformación pueden ser útiles en el estudio de la mecánica ventricular. La disposición anatómica descrita por la teoría de la banda miocárdica se ve apoyada ecocardiográficamente por la presencia de mayor Strain Radial a nivel basal-medial (predominio de fibras transversales), mientras que la disposición variable de las fibras oblicuas son las responsables del Strain Longitudinal, Circunferencial y Torsión ventricular

Long-term prognosis of chronic kidney disease in non-ST elevation acute coronary syndrome treated with invasive strategy

Background and aim: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTE-ACS). However, the information available on this specific population is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTE-ACS managed with invasive strategy. Methods: We conduct a prospective registry of patients with NSTE-ACS and coronary angiography. CKD was defined as a glomerular filtration rate <60 ml/min/1.73 m2. The composite primary end-point was cardiac death and non-fatal cardiovascular readmission. We estimated the cumulative probability and hazard rate (HR) of combined primary end-point at 3 years according to the presence or absence of CKD. Results: We included 248 patients with mean age of 66.9 years, 25% women. CKD was present at baseline in 67 patients (27%). Patients with CKD were older (74.9 vs. 63.9 years; p < 0.0001) with more prevalence of hypertension (89.6 vs. 66.3%; p < 0.0001), diabetes (53.7 vs. 35.9%; p = 0.011), history of heart failure (13.4 vs. 3.9%; p = 0.006) and anemia (47.8 vs. 16%; p < 0.0001). No differences in the extent of coronary artery disease. CKD was associated with higher cumulative probability (49.3 vs. 28.2%; log-rank p = 0.001) and HR of the primary combined end-point (HR: 1.94; 95% CI: 1.12–3.27; p = 0.012). CKD was an independent predictor of adverse cardiovascular outcomes at 3 years (HR: 1.66; 95% CI: 1.05–2.61; p = 0.03). Conclusions: In NSTE-ACS patients treated with invasive strategy, CKD is associated independently with an increased risk of adverse cardiovascular outcomes at 3 years