Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction

Shah, Sanjiv J.; Anand, Inder S.; Sweitzer, Nancy K.; Claggett, Brian; Liu, Li; Pitt, Bertram; Pfeffer, Marc A.; Solomon, Scott D.; Shah, Amil M.

doi:10.1002/ejhf.789

Cited by 35 publications

(11 citation statements)

References 42 publications

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“…In HFpEF patients, LV mechanical dyssynchrony has been suggested to contribute to an impairment of longitudinal systolic and diastolic LV function and to be associated with higher LV-filling pressures and worse clinical status in terms of NYHA functional class [ 145 ]. On the other hand, a post hoc analysis of the TOPCAT trial has shown that LV mechanical dyssynchrony is not associated with outcomes of HFpEF patients [ 146 ]. Targeting LV dyssynchrony by implantation of a CRT device is currently subject of ongoing studies, which will help to better understand its relevance for the therapy of HFpEF patients (NCT03338374, NCT02145351).…”

Section: Treatment Of Hfpefmentioning

confidence: 99%

Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future

et al. 2020

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In contrast to the wealth of proven therapies for heart failure with reduced ejection fraction (HFrEF), therapeutic efforts in the past have failed to improve outcomes in heart failure with preserved ejection fraction (HFpEF). Moreover, to this day, diagnosis of HFpEF remains controversial. However, there is growing appreciation that HFpEF represents a heterogeneous syndrome with various phenotypes and comorbidities which are hardly to differentiate solely by LVEF and might benefit from individually tailored approaches. These hypotheses are supported by the recently presented PARAGON-HF trial. Although treatment with LCZ696 did not result in a significantly lower rate of total hospitalizations for heart failure and death from cardiovascular causes among HFpEF patients, subanalyses suggest beneficial effects in female patients and those with an LVEF between 45 and 57%. In the future, prospective randomized trials should focus on dedicated, well-defined subgroups based on various information such as clinical characteristics, biomarker levels, and imaging modalities. These could clarify the role of LCZ696 in selected individuals. Furthermore, sodium-glucose cotransporter-2 inhibitors have just proven efficient in HFrEF patients and are currently also studied in large prospective clinical trials enrolling HFpEF patients. In addition, several novel disease-modifying drugs that pursue different strategies such as targeting cardiac inflammation and fibrosis have delivered preliminary optimistic results and are subject of further research. Moreover, innovative device therapies may enhance management of HFpEF, but need prospective adequately powered clinical trials to confirm safety and efficacy regarding clinical outcomes. This review highlights the past, present, and future therapeutic approaches in HFpEF.

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Section: Treatment Of Hfpefmentioning

confidence: 99%

Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future

et al. 2020

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“…Left ventricular electrical dys‐synchrony is a strong prognostic marker of adverse outcomes in heart failure with reduced EF . With STE, LV mechanical dys‐synchrony can be detected as peak systolic dispersion (PSD), calculated as the standard deviation of the time to peak strain of the 18 segments, divided by the RR interval . Studies have shown that strain‐derived mechanical dys‐synchrony abnormalities are independently associated with LVEF changes over time in regard to idiopathic dilated cardiomyopathy, as well as the occurrence of ventricular tachycardia after myocardial infarction (MI) …”

Section: Introductionmentioning

confidence: 99%

The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

Liu

et al. 2019

Echocardiography

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Purpose The primary aim of this study was to evaluate early changes in cardiac function after anthracycline therapy with layer‐specific speckle‐tracking echocardiography (STE) and mechanical dys‐synchrony. Methods A total of 78 breast cancer patients (ranging 31~72 years) exposed to anthracycline treatment were recruited in this study. All patients received both conventional two‐dimensional speckle‐tracking echocardiographs at baseline, as well as after the completion of 2 and 4 cycles of the regimen. Layer‐specific longitudinal strain (LS) and circumferential strain (CS) of the 3 myocardial layers (endocardium, mid‐myocardium, and epicardium) were automatically measured. Peak systolic dispersion (PSD) was defined as the standard deviation of the time to peak strain of the 18 segments, divided by the RR interval. Results There were no significant differences in conventional echocardiographic parameters during treatment (all P > .05). Peak endocardium CS at basal level decreased significantly after 2 and 4 cycles compared with baseline (both P = .001), while PSD significantly increased in that same period versus baseline (both P = .000). Endocardium and mid‐myocardium LS, peak mid‐myocardium and epicardium CS at the basal level, peak CS of all three layers at the papillary level, and peak endocardium and mid‐myocardium CS at the apical level all significantly decreased after 4 cycles, compared with baseline and 2 cycles (all P = .000). Conclusion This study showed that myocardial deformation impairment occurred as early as 2 cycles after anthracycline chemotherapy. Endocardium CS at the basal level and left ventricular dys‐synchrony index PSD were the initial cardiac abnormalities in anthracycline‐treated breast cancer patients.

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“…Biering‐Sørensen et al conducted a study on 3445 patients with HF and preserved EF, and they reported MD in 12% of the patients. However, MD did not predict poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

Mechanical dispersion in Fabry disease assessed with speckle tracking echocardiography

et al. 2020

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Background Fabry disease (FD) is a rare X‐linked storage disorder caused by deficiency of the lysosomal enzyme α‐galactosidase A, and it typically causes multiorgan dysfunction. The main cause of death is heart disease resulting from left ventricular (LV) diastolic dysfunction, LV systolic dysfunction, severe LV hypertrophy (LVH), and sudden death. In several cardiac disorders, LV systolic dysfunction and ventricular arrhythmias are associated with mechanical dispersion (MD). MD has until now not been studied in patients with FD. Objective To investigate the prevalence of MD in patients with FD. Methods Complete echocardiographic data and speckle tracking echocardiographic data were collected. MD is an index of inter‐segmental discoordination of contraction and is defined as the standard deviation (SD) of the time‐to‐peak longitudinal negative strain in 17 LV segments with a value >49 milliseconds. Patients with FD were divided into the following 2 groups: group I (patients with FD but no LVH, n = 64) and group II (patients with FD and LVH, n = 25). These groups were compared with a group of healthy subjects (group III, n = 50). Parametric variables were expressed as mean ± SD, and nonparametric variables were expressed as median and inter‐quartile range. A P value <.05 was considered significant. Results A total of 113 patients with FD were included in this study. Of these, 24 (21%) were excluded because of poor imaging quality or presence of comorbidities, and the final study population consisted of 89 patients (mean age of 33.5 ± 14.5 years, 64% female). Group II patients were older than group I patients (46 ± 13 years vs 27 ± 11 years, P < .0001). There was no difference in LV ejection fraction between the 3 groups. There was also no difference in MD between groups I and III (32.4 ms [26‐39] vs 32 ms [26‐39]). In group II, the MD in 19 patients (76%) was 56 ms (39‐80). Conclusions To the best of our knowledge, this is the first study to assess the prevalence of MD in patients with FD. MD was observed in 76% of patients with FD and LVH. The use of MD in strain echocardiography may be beneficial in the assessment of patients with FD who develop heart failure.

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Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction

Cited by 35 publications

References 42 publications

Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future

Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future

The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

Mechanical dispersion in Fabry disease assessed with speckle tracking echocardiography

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