Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Helse Nord Background The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS. Purpose The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures. Methods In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months. Results Pre- and postoperative values were septal e´; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e´ 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e´19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds according to the cut-off values of the table increased prediction of NT-proBNP levels ≥ 500 ng/L with substantially increased specificity (>85%). Conclusion Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6-12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Abstract Table Cut-off values for high ProBNP Abstract Figure. Examples for diastolic parameters in AS
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Helse Nord HNF1458-19 Background Definition of normal ranges of myocardial segmental deformation are important in clinical studies and routine echocardiographic practice. It is known that artefacts hamper segmental strain and strain rate (S/SR) analysis. Purpose This study is based on a new approach for artefact detection. We intended to investigate to what degree different types of artefacts and their localization bias the result of measurements and to establish corrected normal ranges for segmental S/SR parameters. Methods The study is based on a collaboration project between the Russian cross-sectional study "Know your heart" and the Norwegian "Tromso-7" study. From 2207 participants we identified 840 individuals (511 females and 329 males, age range 40-79) with normal cardiac function by excluding left ventricular ejection fraction <50%, moderate or severe valvular heart disease, LV- dilatation, pulmonary hypertension, Q-waves and bundle branch block signs on ECG, high blood pressure, history of heart attack, use of antihypertensive drugs or high level of NT-proBNP. End-systolic longitudinal epi- myo- and endocardial strain and peak systolic SR and diastolic SR E and SR A were assessed for the calculation of segmental normal ranges. In addition to noise and foreshortening artefacts, we introduced a concept of "curve artefact" which can be defined as unphysiological strain curve shapes. Panel A of the figure shows examples of these curve artefacts, A: diastolic mismatch B: blunted curve, and C: floating curve. All strain curves were assessed for the presence of one of these unphysiological shapes and 2D images were visually assessed for the presence of noise, reverberations, or missing parts of the myocardium. Results The bar-chart for segmental strain demonstrates significantly reduced strain values at the presence of curve artefacts and increased strain at the presence of foreshortening. Normal ranges for basal septal, basal, medial, and apical segments excluding segments with artefacts and foreshortening are displayed in the table. The presence of curve artefacts matched the presence of noise or other 2D image artefacts in 88% of cases. Conclusions Strain artefacts result in systematically reduced peak-strain values. Thus, the detection and exclusion of curve artefacts seem to be an important measure for the correct interpretation of strain curves for a definition of normalcy and pathology. The selection of artefact-free strain curves reveals high strain and SR gradients increasing from epi to endocardial position and basal-septal towards apical segments. Abstract Figure. normal range Abstract Figure. artefacts
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