13 research outputs found
Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure
Objectives: The aim of this study was to investigate whether echocardiographic
assessment of myocardial work is a predictor of outcome in advanced heart failure.
Background: Global work index (GWI) and global constructive work (GCW) are
calculated bymeans of speckle tracking, blood pressuremeasurement, and a normalized
reference curve. Their prognostic value in advanced heart failure is unknown.
Methods: Cardiopulmonary exercise testing and echocardiography with assessment
of GWI and GCW was performed in patients with advanced heart failure caused by
ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up
repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular
assist device, or heart transplantation.
Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The
mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was
1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean
GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI
as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p
= 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months
(IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight
underwent transplantation, and 19 underwent implantation of a left ventricular assist
device. In themultivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI
(hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as
GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as
independent predictors of the endpoint. The cut-off value for predicting the outcome was
455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and
530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%).
Conclusions: GWI and GCW are powerful predictors of outcome in patients with
advanced heart failure
Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure
Objectives: The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in advanced heart failure.Background: Global work index (GWI) and global constructive work (GCW) are calculated by means of speckle tracking, blood pressure measurement, and a normalized reference curve. Their prognostic value in advanced heart failure is unknown.Methods: Cardiopulmonary exercise testing and echocardiography with assessment of GWI and GCW was performed in patients with advanced heart failure caused by ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular assist device, or heart transplantation.Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was 1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p = 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months (IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight underwent transplantation, and 19 underwent implantation of a left ventricular assist device. In the multivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI (hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as independent predictors of the endpoint. The cut-off value for predicting the outcome was 455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and 530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%).Conclusions: GWI and GCW are powerful predictors of outcome in patients with advanced heart failure
Cardiac remodeling in patients with centrifugal left ventricular assist devices assessed by serial echocardiography
Aim: The aim of the study was to characterize the remodeling process in a large cohort of patients supported with a centrifugal left ventricular assist device (cfLVAD) by standardized serial echocardiography. Methods and Results: From 3/2018 all cfLVAD patients underwent transthoracic echocardiography at 6 and 12 months after implantation using a standardized protocol. A total of 512 echocardiograms were reviewed (216 preoperative, 156 at 6 months, 140 at 12 months). While on cfLVAD support, left ventricular (LV) diameter decreased (p 64% of the patients at 6 months and in 66% at 12 months. Moderate aortic regurgitation (AR) was rare with 3.8% at 6 months but increased with the duration of cfLVAD support (8.5% at 12 months). We found no significant difference in echocardiographic parameters between patients supported with a HeartWare HVAD™ or a HeartMate 3™ device. Conclusion: LVAD therapy can lead to reverse LV remodeling and improvement of MR and TR. However, right ventricular function does not improve and prevalence of AR progressively increases during mechanical support
Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure
Objectives: The aim of this study was to investigate whether echocardiographic
assessment of myocardial work is a predictor of outcome in advanced heart failure.
Background: Global work index (GWI) and global constructive work (GCW) are
calculated bymeans of speckle tracking, blood pressuremeasurement, and a normalized
reference curve. Their prognostic value in advanced heart failure is unknown.
Methods: Cardiopulmonary exercise testing and echocardiography with assessment
of GWI and GCW was performed in patients with advanced heart failure caused by
ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up
repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular
assist device, or heart transplantation.
Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The
mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was
1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean
GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI
as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p
= 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months
(IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight
underwent transplantation, and 19 underwent implantation of a left ventricular assist
device. In themultivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI
(hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as
GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as
independent predictors of the endpoint. The cut-off value for predicting the outcome was
455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and
530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%).
Conclusions: GWI and GCW are powerful predictors of outcome in patients with
advanced heart failure
Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure
Objectives: The aim of this study was to investigate whether echocardiographic
assessment of myocardial work is a predictor of outcome in advanced heart failure.
Background: Global work index (GWI) and global constructive work (GCW) are
calculated bymeans of speckle tracking, blood pressuremeasurement, and a normalized
reference curve. Their prognostic value in advanced heart failure is unknown.
Methods: Cardiopulmonary exercise testing and echocardiography with assessment
of GWI and GCW was performed in patients with advanced heart failure caused by
ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up
repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular
assist device, or heart transplantation.
Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The
mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was
1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean
GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI
as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p
= 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months
(IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight
underwent transplantation, and 19 underwent implantation of a left ventricular assist
device. In themultivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI
(hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as
GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as
independent predictors of the endpoint. The cut-off value for predicting the outcome was
455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and
530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%).
Conclusions: GWI and GCW are powerful predictors of outcome in patients with
advanced heart failure
Echocardiographic assessment of mitral regurgitation : discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness
The echocardiographic assessment of mitral valve regurgitation (MR) by characterizing specific morphological features and grading its severity is still challenging. Analysis of MR etiology is necessary to clarify the underlying pathological mechanism of the valvular defect. Severity of mitral regurgitation is often quantified based on semi-quantitative parameters. However, incongruent findings and/or interpretations of regurgitation severity are frequently observed. This proposal seeks to offer practical support to overcome these obstacles by offering a standardized workflow, an easy means to identify non-severe mitral regurgitation, and by focusing on the quantitative approach with calculation of the individual regurgitant fraction. This work also indicates main methodological problems of semi-quantitative parameters when evaluating MR severity and offers appropriateness criteria for their use. It addresses the diagnostic importance of left-ventricular wall thickness, left-ventricular and left atrial volumes in relation to disease progression, and disease-related complaints to improve interpretation of echocardiographic findings. Finally, it highlights the conditions influencing the MR dynamics during echocardiographic examination. These considerations allow a reproducible, verifiable, and transparent in-depth echocardiographic evaluation of MR patients ensuring consistent haemodynamic plausibility of echocardiographic results
Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation
Background: Despite the risk for complications, allograft surveillance after orthotopic heart transplantation (OHT) is performed by cardiac catheterization and biopsies. We investigated the diagnostic and prognostic value of a TDI-derived systolic wall motion analysis of the posterobasal wall of the left ventricle (Sm) as a screening modality in OHT aftercare. Methods: We examined data of 210 eligible patients who underwent OHT between 2010 and 2020. Forty-four patients who had died within the initial hospital stay were excluded. For 166 patients, baseline and follow-up data were analyzed. The mean age at OHT was 46.2 (±11.4) years; 76.5% were male. Results: Within the observational period, 22 (13.3%) patients died. In total, 170 episodes of acute cellular or humoral rejections occurred (84 ISHLT1R; 13 ISHLT2R; 8 ISHLT3R; 65 AMR), and 29 catheterizations revealed cardiac allograft vasculopathy (5 CAV1; 4 CAV2; 20 CAV3). Individual Sm radial/longitudinal remained stable within the follow-up period (11.5 ± 2.2 cm/s; 10.9 ± 2.1 cm/s). Patients with acute rejections and CAV3 showed significant Sm radial/longitudinal reductions (AMR1: 1.6 ± 1.9 cm/s, confidence interval (CI) 0.77–0.243, p < 0.001; 1.8 ± 2.0 cm/s, CI 0.92–0.267, p < 0.001. ISHLT1R: 1.7 ± 1.8 cm/s, CI 1.32–2.08, p < 0.001; 2.0 ± 1.6 cm/s, CI 1.66–2.34, p < 0.001. CAV3: 1.3 ± 2.5 cm/s, CI 0.23–2.43, p < 0.017; 1.4 ± 2.8 cm/s, CI 0.21–2.66, p < 0.021). Lower Sm was associated with a threefold increase in all-cause mortality (hazard ratio (HR) 3.24, CI 1.2–8.76, p = 0.020; HR 2.92, CI 1.19–7.18, p = 0.019). Overall, Sm-triggered surveillance led to 0.75 invasive diagnostics per patient post-OHT year. Conclusions: Sm remained stable in the post-OHT course. Reductions indicated ISHLT1R, AMR1 and CAV3 and were associated with higher all-cause mortality. Sm-triggered surveillance may be referred to as a safe, high-yield screening modality in OHT aftercare.ISSN:2075-172