Assessment of Left Ventricular Systolic Function Using Echocardiography in Patients With Preserved Ejection Fraction and Elevated Diastolic Pressures

Dokainish, Hisham; Sengupta, Ranjita; Pillai, Manu; Bobek, Jaromir; Lakkis, Nasser

doi:10.1016/j.amjcard.2008.02.070

Cited by 50 publications

(33 citation statements)

References 19 publications

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“…Indeed, early studies in select patients with heart failure with preserved EF suggest significant impairments in myocardial contractile function measured by strain imaging. 21,22 The sensitivity of these measures to alterations in deformation has resulted in their application, in both animal and human studies, to a variety of pathological conditions characterized by myocardial dysfunction despite preserved EF, including asymptomatic carriers of hypertrophic cardiomyopathy sarcomeric mutations, 23 Fabry's disease, 24 myocardial steatosis, 25,26 and rodent models of Duchenne muscular dystrophy. 27 Perhaps because of their less load-dependent nature, these measures have also proven informative in the setting of valvular heart disease in which alterations in loading conditions make EF a less reliable measure of contractile function, including severe aortic stenosis, 28 aortic regurgitation, 29 and mitral regurgitation.…”

Section: Deformation Imaging As a Measure Of LV Function Detection Ofmentioning

confidence: 99%

Myocardial Deformation Imaging

2012

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M yocardial deformation imaging is a novel echocardiographic method for assessment of global and regional myocardial function. As this technology has evolved, it has been applied to an increasing number of research questions, and the number of publications incorporating deformation imaging has grown in parallel.Although not yet sufficiently vetted for routine clinical use, these methods offer the long-term potential for more complete, accurate, and reproducible assessment of myocardial function. What Is Myocardial Deformation Imaging?Evaluation of contractile function with echocardiography has traditionally been limited to volume-based assessment of ejection fraction (EF) and assessment of regional wall motion or visual estimation of regional thickening. These methods have suffered from lack of reproducibility and standardization and are generally considered to be extremely sensitive to loading conditions. These limitations have led to an interest in techniques that provide more objective and reproducible measures of contractile function.During systole, the ventricular myocardium simultaneously shortens in the longitudinal and circumferential planes and thickens in the radial plane, with reciprocal changes in diastole ( Figure). Deformation imaging, in the broadest sense, allows for more direct assessment of myocardial muscle shortening and lengthening throughout the cardiac cycle by assessing regional myocardial strain and strain rate. Strain is defined as the change in length of a segment of myocardium relative to its resting length and is expressed as a percentage; strain rate is the rate of this deformation. Longitudinal and circumferential shortening results in negative strain values, whereas radial thickening results in a positive strain value. Previously, assessment of myocardial strain could be performed with the use of sonomicrometry crystals, which can only be performed experimentally 1 or with magnetic resonance imaging-based myocardial tagging, 2,3 which is limited by relatively low temporal resolution and the limited availability and expense of cardiac magnetic resonance imaging. Extension of these techniques to echocardiography has allowed for substantially greater utility in a broader range of patients.Myocardial deformation imaging with echocardiography can be performed with the use of either tissue Doppler-based or 2-dimensional speckle tracking-based methods. Doppler methods, developed initially, utilize the velocity gradient present along the length of the left ventricle (LV) to calculate strain rate, which is then integrated to derive strain. This technique suffers from limitations similar to those of traditional Doppler because it can only accurately assess deformation in the plane incident with the ultrasound beam and requires prospective acquisition of dedicated images at high frame rate. B-mode speckle tracking, sometimes referred to as feature tracking, utilizes the movement of the coherent ultrasound backscatter speckle pattern within B-mode echocardiographic images to assess myocardial...

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Section: Deformation Imaging As a Measure Of LV Function Detection Ofmentioning

confidence: 99%

Myocardial Deformation Imaging

2012

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“…Several investigators have suggested that patients with HFPSF do not necessary have normal S function. 35,36 Our present result may have implications for the optimal medical therapy for patients with HFPSF. As mentioned, limited data are available with respect to the medical treatment of the HFPSF patients.…”

Section: Figmentioning

confidence: 91%

Elevated E/E' Predicts Prognosis in Congestive Heart Failure Patients With Preserved Systolic Function

Okura

Kubo

Asawa

et al. 2009

Circ J

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Background Although approximately 50% of heart failure patients are reported as heart failure with preserved left ventricular systolic function (HFPSF), echocardiographic prognostic predictors have not been well investigated. Recently, the tissue Doppler-derived index, the ratio of the early transmitral flow velocity and the early mitral annular velocity (E/E'), was reported as useful in predicting prognosis of patients with heart diseases. The purpose of this study was to investigate whether E/E' predicts prognosis in HFPSF. Methods and Results A total of 50 patients with HFPSF (ejection fraction >50%) were consecutively enrolled and studied. Echocardiographic examination was performed on admission and repeated after optimized medical therapy. Cardiac events were defined as death and unplanned hospitalization because of congestive heart failure. Cardiac event-free survival curves from patients with E/E' >15 and E/E' ≤15 at baseline did not differ. On the other hand, patients with E/E' >15 after medical therapy showed significantly lower cardiac event-free survival than patients with E/E' ≤15 (log-rank, P=0.005). By multivariate logistic regression analysis, E/E' >15 after medical therapy was the only independent predictor of cardiac events (P=0.037, risk ratio=6.1, 95% confidence interval: 1.12-33.3) in patients with HFPSF. Conclusions Elevated E/E' after optimized medical therapy may be useful in predicting cardiac events in patients with HFPSF. (Circ J 2009; 73: 86 -91)

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“…Previous studies have shown a correlation between increasing LV mass with increasing LVDD and filling pressure. 29 The average E/e ratio, an indicator of LA pressure, was increased in patients with native kidneys than in those without. Numerous studies have shown a correlation of the E/e ratio with adverse events after acute myocardial infarction, hypertensive cardiomyopathy, and ESRD.…”

Section: 28mentioning

confidence: 99%