BackgroundAtrial fibrillation (AFib) exists more frequently in patients with aortic stenosis (AS) than in patients without, and AFib may be a sign of progressive deterioration of AS. Echocardiographic assessment of AS in sinus rhythm is well documented, however, little is known about AFib in AS since such patients often are excluded from clinical echocardiographic trials.AimThe purpose of this study was to assess the prognostic importance of AFib in AS.MethodsThe study was designed as a single-center case-control study. Patients with AS and AFib were enrolled as cases (n = 103) and subsequently matched to controls (103 patients with AS but sinus rhythm). Cases and controls were matched according to age, gender and severity of AS. Primary outcome was all cause mortality and follow-up was 100% complete.ResultsCompared to controls the group with AFib had lower mean ejection fraction (42% vs. 49%; p < 0.001) and stroke volume (47 mL vs. 55 mL; p = 0.004), but higher heart rate (81 bpm vs. 68 bpm; p < 0.001) and no significant difference with regard to cardiac output (3.8 L vs. 4.0 L; p = 0.29). Accordingly, aortic jet velocity and gradients were significantly lower in AFib compared to controls but there were no differences (p = 0.38) in aortic valve area calculated by the continuity equation. During a median follow-up of 2.3 years (IQR: 1.2-3.6), 70 (34%) patients with AS died: 42 patients with AFib and 28 patients with sinus rhythm (p < 0.02). After adjusting for echocardiographic significant differences, AFib remained an independent predictor of mortality (HR 2.72 (95% CI: 1.12–6.61), p < 0.03). There was no significant interaction (p = 0.62) between AFib and AS on the risk of mortality, indicating that AFib predicted bad outcome regardless of the severity of AS.ConclusionsAFib is an independent risk factor in patients with AS and the prognostic impact of AFib seems to be the same despite the severity of AS.
Rationale & Objective
Left ventricular (LV) mass (LVM) is a predictor of cardiovascular morbidity and mortality and commonly calculated using 1-dimensional (1D) echocardiographic methods. These methods are vulnerable to small measurement errors and LVM may wrongly change according to changes in LV volume (LVV). Less commonly used 2-dimensional (2D) methods can accommodate to the changes in LVV and may be a better alternative among patients receiving hemodialysis (HD) with large fluid fluctuations.
Study Design
Observational study.
Setting & Participants
Patients with end-stage kidney disease receiving HD.
Exposure
One HD session.
Analytical Approach
Transthoracic echocardiography was performed right before and after HD. LVM was calculated using 1D (Devereux, Penn, and Teichholz) and 2D methods (truncated ellipsoid and area-length).
Outcomes
Significant differences in LVM after HD.
Results
We compared dimensions, LVV and LVM, in 53 patients (mean age, 63 ± 15 years; 66% men). For each 1-L increase in ultrafiltration volume (UFV), LV internal diameter decreased 1.1 mm (95% CI, 0.5-1.7 mm;
P
= 0.001). Patients were divided into 2 groups by the median UFV of 1.6 L. Patients with UFV > 1.6 L had significant smaller LVV and LV internal diameter after HD. LVM calculated using 1D methods decreased according to changes in LVV. Conversely, LVM calculated using 2D methods was not significantly different after HD. No significant change in differences between diastolic − systolic myocardial thickness or LVM as assessed using 1D and 2D methods was observed before and after HD, indicating that LVM remained constant despite HD.
Limitations
We did not use contrast enhancement, 3-dimensional methods, or cardiac magnetic resonance.
Conclusions
LVM calculated using 2D methods, truncated ellipsoid and area-length, is less affected by fluctuations in fluid and LVV, in contrast to 1D methods. Complementary LVM calculation using 2D methods is encouraged, especially in patients with large fluid fluctuations in which increased LVM using a 1D method has been detected.
Purpose
Increased left ventricular mass (LVM) is a strong independent predictor for adverse cardiovascular events, but conventional echocardiographic methods used to assess and monitor individuals are limited by poor reproducibility and accuracy. We aimed to develop an echocardiographic method for LVM-quantification that is simple, reproducible and accurate.
Methods
The novel method adds the mean wall thickness to the left ventricular end-diastolic volume acquired using the biplane model of discs. The mean wall thickness is acquired from the parasternal short axis view. Cardiac assessment was performed using echocardiography followed immediately by cardiac magnetic resonance in 85 subjects with different left ventricular geometries, ranging from patients with various cardiac disorders (n=41) to individuals without known cardiac disorders (n=44). We compared the novel two-dimensional (2D) method to various conventional one-dimensional (1D) and 2D methods as well as three-dimensional (3D) echocardiography.
Results
The novel method had better reproducibility in intra-examiner (coefficients of variation (CV) 9% vs. 11-14%) and inter-examiner analysis (CV 9% vs. 10-20%) than the other methods. Accuracy of the novel method was similar to 3D (mean difference±95% limits of agreement, CV): Novel: 2±50g,15% vs. 3D: 2±51g, 16%; and better than the 1D-method by Devereux (7±76g, 23%).
Conclusion
The novel 2D-based method for LVM-quantification had better reproducibility than the other echocardiographic methods. Accuracy was similar to 3D and better than conventional methods. As endocardial tracings using the biplane model forms part of the standard echocardiographic protocol, the novel method can easily be integrated into any echocardiographic software, without substantially increasing analysis time.
BackgroundGlobal longitudinal strain (GLS) is a predictor of outcome after cardiac surgery. If integrated into clinical decision‐making and timing of surgery, it is important to evaluate the feasibility, reproducibility, and variation of GLS in this selection of patients, where poor image quality and nontraceable segments are frequent.Methods and resultsTwo‐dimensional strain analysis was performed on 250 patients planned to undergo open‐heart surgery. Intra‐ and inter‐examiner retest variability was assessed in 50 consecutive patients. All myocardial segments were traceable in 119 patients, and GLS of those served as a reference in comparison with alternative strain models with nontraceable segments. Global longitudinal strain estimation by the recommended method of a maximum of one nontraceable segment per view was only feasible in 64% of cases (mean GLS −16%). Reproducibility was moderate (intra‐observer coefficient of variation [CV] 8%; inter‐observer CV 10%) and variation of GLS showed bias ± 95% limits of agreement (LOA) of 0.6 ± 1.1 (P < .05). Accepting three nontraceable segments in total increased feasibility to 77% with similar reproducibility (intra‐observer CV 8%; inter‐observer CV 11%) and variation (bias ± LOA: 0.6 ± 1.3, P < .05). A model with a maximum of one apical, one mid, and one basal nontraceable segment increased feasibility to 72% with similar reproducibility (intra‐observer CV 8%; inter‐observer CV 10%) and variation (bias ± LOA: 0.4 ± 1.2, P < .05).ConclusionGlobal longitudinal strain estimation in patients prior to cardiac surgery is challenged by moderate feasibility, retest variation as well as variation in cases of nontraceable segments. We suggest alternative strain models with improved feasibility without compromising reproducibility and variation.
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