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- Lisi, Matteo, et al.
(författare)
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Right ventricular longitudinal deformation correlates closely with right ventricular myocardial fibrosis in patients with end-stage heart failure
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34, s. 780-780
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Right ventricular (RV) longitudinal strain (LS) plays a key role in the evaluation of its systolic performance and clinical outcomein patients with refractory heart failure (HF). This study sought to determine the value of RVLS for prediction of RV myocardial fibrosis inpatients with severe HF undergoing heart transplantation (HTx).Methods: The cohort we studied consists of 24 patients with severe systolic HF (left ventricular ejection fraction ≤ 25%; NYHA class IV) referred between 2009 and 2013 for a simultaneous right heartcatheterization and echocardiographic evaluation before HTx.RVLS by Speckle Tracking Echocardiography (STE) was used to assess free-wall RVLS, global cavity RVLS (including all segments in the apical 4 chamber view and right atrial LS (RALS), RV fractional area change (RVFAC), RV sphericity index (RVSI) and tricuspid annular plane systolic excursion (TAPSE) were also measured. All patients underwent HTx 12±34 days afterwards. From the explanted hearts a 1 x 0,5 cmmyocardial sample of the RV lateral free wall was obtained and stainedwith hematoxylin-eosin and Masson's trichrome. The ratio of the fibrotic area to the total surface area of each section was used to estimate the extent of RV myocardial fibrosis (percentage) as (fibrotis area-total area) x 100.Results: A good correlation was found between the extent of RVmyocardial fibrosis and free-wall RVLS (r=0.72; p<0.0001), global RVLS (r=0.49; p<0.0001), RVSI (r=0.47; p<0.0001), and RALS (r= -0.46; p=0.005), with a poorer correlation with TAPSE (r= -0.32; p=0.01) and RVFAC (r= -0.25; p=ns). Of these indeces, free-wall RVLS had the strongest diagnostic accuracy for detecting severe RV myocardialfibrosis (AUC = 0.87).Conclusions: In late stage HF patients, right ventricular free wallmyocardial deformation is the best functional measure that correlateswith the extent of myocardial fibrosis. These findings should have clinical implications when interpreting other RV measurements.
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- D'Ascenzi, F., et al.
(författare)
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Left atrial remodeling in patients undergoing transcatheter aortic valve implantation : a speckle tracking prospective study
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:Supplement: 1, s. 338-338
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Aortic Stenosis (AS) results in several Left Ventricular (LV) disturbances as well as progressive Left Atrial (LA) enlargement and dysfunction. Transcatheter Aortic Valve Implantation (TAVI) reverses LV remodelling and improves overall systolic function but its effect on LA function remains undetermined. The aim of this prospective study was toinvestigate the effects of TAVI on LA structure and function.Material and methods: We studied thirty-two patients with severe symptomatic AS and high surgical risk who underwent TAVI, using standard and 2-dimensional speckle-tracking echocardiography before, at 40-day and at 3-month follow-up.Results: Following TAVI, mean transvalvular gradient reduced (p<0.001). Both LA mean area index and LA mean volume index decreased at 40-day (16.2±6.4 vs. 12.5±2.9 cm2/m2, and 47.3±12.0 vs. 42.8±12.5 mL/m2, respectively, p<0.05) and values remained unchanged at 3 months. The reduction of LA size was accompanied by a significant increase in global PALS (14.4±3.9% vs. 19.1±4.7%, p<0.001) and global PACS (8.4±2.5% vs. 11.0±4.1%, p<0.05) at 3-month. After the procedure, LA stiffness measurements decreased and became significant at 3-month follow up (p<0.001). Pre-procedural trans-aortic mean gradient and pre-procedural LA volume were identified as predictors of global PALSincrease (p<0.0001) while the delta drop in trans-aortic mean gradient as predictors of LA volume index reduction 3 months after TAVI (p<0.0001).Conclusion: TAVI is associated with significant recovery of LA structure and function suggesting a reverse cavity remodelling. Such functional recovery is determined by the severity of pre-procedural valve stenosis.
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- Lisi, Matteo, et al.
(författare)
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Mitral annular longitudinal function preservation after mitral valve repair : the MARTE study
- 2012
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Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 157:2, s. 212-215
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In patients with chronic mitral regurgitation (MR), undergoing surgical mitral valve repair, current Guidelines only recommend standard echocardiographic indices i.e. left ventricular (LV) ejection fraction (EF), and LV end-systolic and end-diastolic diameters as preoperative variables. However LV EF is often preserved until advanced stages of the valve disease. Aim of this study was to evaluate changes in LV systolic longitudinal function, 3months after mitral valve repair in patients with chronic degenerative MR and normal preoperative EF.METHODS: We measured M-mode mitral lateral annulus systolic excursion (MAPSE) and Tissue Doppler (TD) peak systolic annular velocity (S(m)) in 31 patients with moderate to severe MR and normal EF (59.9±4.7%) candidates for mitral valve repair, preoperatively and 3months after surgery.RESULTS: After mitral valve repair, S(m) increased from 7.8±1.4 to 9.6±2.2cm/s (p<0.0001) and MAPSE increased from 1.33±0.26 to 1.55±0.25cm (p=0.0013). EF decreased from 59.9±4.7 to 51.3±5.9% (p<0.0001). As expected, LV diameters and volumes, wall thicknesses, midwall fractional shortening (mFS), and left atrial (LA) size were all reduced after surgery.CONCLUSIONS: This study suggests that assessment of LV long axis systolic velocity and amplitude of excursion by echocardiography is more sensitive than simple determination of EF for revealing the beneficial impact of MR surgery on overall systolic function.
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- Lisi, Matteo, 1982-, et al.
(författare)
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Severity of aortic stenosis predicts early post-operative normalization of left atrial size and function detected by myocardial strain
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 167:4, s. 1450-1455
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Aortic stenosis (AS) causes significant disturbances in left ventricular (LV) and left atrial (LA) function irrespective of the extent of myocardial hypertrophy which associates the increased afterload. We hypothesize that aortic valve replacement (AVR) and removal of LV outflow tract obstruction should result in LA size and function recovery, even partial, and were set to study this in a group of patients with AVR for AS.METHODS: Peak atrial longitudinal strain (PALS) was evaluated in 43 patients with severe isolated AS and normal EF (56.6±3.8%) and no obstructive coronary artery disease candidates for AVR, pre-operatively and then 40days and 3months after surgery. Results were compared with those from 34 age- and gender-matched healthy controls.RESULTS: LVEF remained unchanged and LV mass regressed after AVR. Global PALS was reduced pre-operatively and increased 40days after surgery (p=0.002) and showed only a slight further increase at 3months follow-up (p<0.0001). Indexed LA volume was increased before surgery, but significantly fell 40days after surgery (p<0.0001) and showed only a slight further reduction after 3months (p<0.0001). Trans-aortic mean gradient change after surgery was the only independent predictor of the recovery of LA size and function.CONCLUSIONS: AVR reverses LA abnormalities and regains normal atrial function, a behavior which is directly related to the severity of pre-operative LV outflow tract obstruction. Early identification of LA size enlargement and functional disturbances might contribute to better patient's recruitment for AVR.
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