Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy

Saito, Makoto; Okayama, Hideki; Yoshii, Toshitaka; Higashi, Haruhiko; Morioka, Hiroshi; Hiasa, Go; Sumimoto, Takumi; Inaba, Shinji; Nishimura, Kazuhisa; Inoue, Kentaro; Ogimoto, Akiyoshi; Shigematsu, Yuji; Hamada, Mareomi; Higaki, Jitsuo

doi:10.1093/ejechocard/jer318

Cited by 167 publications

(105 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is more suited to detect subtle changes of LV function than LVEF, which mainly depends on radial and circumferential deformation caused by mid-myocardial and epicardial fibers [17,20]. GLPS is affected by the composition of the interstitial myocardium including the extent of myocardial fibrosis [30] and was shown to be a robust and independent predictor for allcause mortality in patients with severe CKD and impaired LV function [31]. Furthermore, GLPS assessed after KTX was shown to be a prognostic marker for CV events [32].…”

Section: Discussionmentioning

confidence: 99%

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Hewing

Dehn

Staeck

et al. 2016

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Cardiac changes observed in chronic kidney disease patients are of multifactorial origin including chronic uremia, hemodynamics or inflammation. Restoration of renal function by kidney transplantation (KTX) may reverse cardiac changes. Novel echocardiographic methods such as speckle tracking echocardiography (STE) allow early and sensitive detection of subtle changes of cardiac parameters. We evaluated changes of cardiac structure and function after KTX by advanced echocardiographic modalities. Methods: Thirty-one KTX recipients (female n=11) were evaluated by medical examination, laboratory testing and echocardiography before and after KTX (median follow-up 19 months). Left ventricular (LV) and right ventricular (RV) diameters and function were assessed by echocardiographic standard parameters. Longitudinal 2D strain of the LV (GLPS) and left atrium (LA) was determined by 2D STE. Results: After KTX, median serum creatinine level was 1.3 mg/dl (IQR, 1.2-1.5). Systolic blood pressure decreased significantly after KTX. Echocardiography showed a significant reduction in LV end-diastolic septal and posterior wall thickness and LV mass index after KTX, which was accompanied by an improvement of GLPS. There were no relevant changes in parameters of LA (reservoir, conduit or contractile) function, LV diastolic or RV function after KTX. Conclusion: LV hypertrophy reversed after successful KTX and was accompanied by an improvement in longitudinal LV function as assessed by STE. Diastolic function and STE-derived LA function parameters did not change significantly after KTX.

show abstract

Section: Discussionmentioning

confidence: 99%

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Hewing

Dehn

Staeck

et al. 2016

Kidney Blood Press Res

View full text Add to dashboard Cite

show abstract

“…50 Fibrosis severity detected via late gadolinium enhancement correlates significantly with STE-assessed strain parameters in patients with hypertrophic cardiomyopathy and Fabry disease. 19,20,23 However, in patients with higher-stage CKD and those with ESRD, gadolinium is contraindicated because of the risk of nephrogenic systemic fibrosis. 51 The earlier detection of myocardial fibrosis in UC using STE compared with standard echocardiographic readouts can thus possibly be used for interventional trials in patients with CKD and ESRD.…”

Section: Discussionmentioning

confidence: 99%

“…STE has been used to gain further insight into the pathophysiology of cardiac ischemia and infarction, and several primary diseases of the myocardium, such as hypertrophic or diabetic cardiomyopathy. [16][17][18] It has recently been appreciated that STE can also be used to identify areas of myocardial fibrosis, [19][20][21][22][23][24] one of the hallmarks of UC. This prompted us to evaluate in an animal study whether STE can detect early changes of left ventricular function and correlates with histologically determined severity of myocardial fibrosis in rat models of UC.…”

mentioning

confidence: 99%

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Kramann¹,

Erpenbeck²,

Schneider

et al. 2014

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Cardiovascular mortality is high in ESRD, partly driven by sudden cardiac death and recurrent heart failure due to uremic cardiomyopathy. We investigated whether speckle-tracking echocardiography is superior to routine echocardiography in early detection of uremic cardiomyopathy in animal models and whether it predicts cardiovascular mortality in patients undergoing dialysis. Using speckle-tracking echocardiography in two rat models of uremic cardiomyopathy soon (4-6 weeks) after induction of kidney disease, we observed that global radial and circumferential strain parameters decreased significantly in both models compared with controls, whereas standard echocardiographic readouts, including fractional shortening and cardiac output, remained unchanged. Furthermore, strain parameters showed better correlations with histologic hallmarks of uremic cardiomyopathy. We then assessed echocardiographic and clinical characteristics in 171 dialysis patients. During the 2.5-year follow-up period, ejection fraction and various strain parameters were significant risk factors for cardiovascular mortality (primary end point) in a multivariate Cox model (ejection fraction hazard ratio [HR], 0.97 [95% confidence interval (95% CI), 0.95 to 0.99; P=0.012]; peak global longitudinal strain HR, 1.17 [95% CI, 1.07 to 1.28; P,0.001]; peak systolic and late diastolic longitudinal strain rates HRs, 4.7 [95% CI, 1.23 to 17.64; P=0.023] and 0.25 [95% CI, 0.08 to 0.79; P=0.02], respectively). Multivariate Cox regression analysis revealed circumferential early diastolic strain rate, among others, as an independent risk factor for all-cause mortality (secondary end point; HR, 0.43; 95% CI, 0.25 to 0.74; P=0.002). Together, these data support speckle tracking as a postprocessing echocardiographic technique to detect uremic cardiomyopathy and predict cardiovascular mortality in ESRD.

show abstract

“…Global longitudinal strain (GLS) analysis is known to be of higher prognostic value than LVEF in various cardiomyopathies [6][7][8][9][10]. Moreover, few studies suggest that it should be a good prognostic indicator in HCM patients [11]. In addition to contraction abnormalities, LV regional strain abnormalities are partially related to the degree of hypertrophy [12,13].…”

Section: Introductionmentioning

confidence: 99%

Clinical and imaging description of the Maron subtypes of hypertrophic cardiomyopathy

Réant¹,

Donal

Schnell

et al. 2014

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

Longitudinal strain analysis enables early detection of left ventricular (LV) contraction abnormalities in patients with preserved ejection fraction. Hypertrophic cardiomyopathy (HCM) is associated with low values of regional and global longitudinal myocardial deformations. In addition to contraction abnormalities, LV regional strain abnormalities are partially related to the degree of hypertrophy. This study sought to describe global longitudinal strain (GLS) in HCM patients as categorized using the Maron's classification. Complete echocardiography examinations, including GLS analysis, were performed in consecutive HCM patients followed up in two French HCM-clinics. A total of 271 patients (mean age 49 ± 16yrs; 71 % male) were evaluated. In this population, the most frequently classified hypertrophy pattern was Type II (47 %), following the Maron's classification. Type III was characterized by a higher degree of LV hypertrophy in terms of mass and maximal wall thickness, and was more frequently obstructive at rest, with lower GLS values (-15.3 ± 3.9 %, p = 0.016), higher E/E' ratio (13.4 ± 6.7, p < 0.001), and a more frequently inadequate blood pressure response to exercise (30 %, p = 0.04) compared to other patterns. The variable that correlated best with GLS was LV mass index (r = 0.49, p < 0.01), while GLS did not significantly correlate with left ventricular outflow tract obstruction. This study demonstrated that the Type III HCM pattern presented with lower GLS, which was partially related to higher LV mass index, more elevated LV filling pressures, and a more frequently inadequate blood pressure response to exercise, in comparison with other patterns categorized using the Maron's classification.

show abstract

Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy

Abstract: These results suggest that global 2D strain might provide useful information on myocardial fibrosis and cardiac events in HCM patients with normal chamber function.

Cited by 167 publications

References 44 publications

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Clinical and imaging description of the Maron subtypes of hypertrophic cardiomyopathy

Contact Info

Product

Resources

About