scholarly journals Idiopathic Atrial Flutter Associated with Dilated Cardiomyopathy in a Preterm Newborn: A Case Report

2021 ◽  
pp. 1-4
Author(s):  
Nitin Unde ◽  
Mahmoud ElHalik ◽  
Arif Faquih
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Case Report ◽  
Dilated Cardiomyopathy ◽  
Atrial Flutter ◽  
Structural Heart Disease ◽  
Oral Medications ◽  
Reversible Condition ◽  
Tachycardia Induced Cardiomyopathy

<b><i>Background:</i></b> Arrhythmias in neonates are uncommon and usually affect newborns with a normal heart or associated with structural heart disease. Meanwhile, one uncommon type of supraventricular arrhythmias is atrial flutter (AF), which is reentry mechanisms in the atrium. The AF may result in heart failure or even death, but the majority of its cases have revealed favorable prognosis in the event of early prenatal diagnosis and immediate treatment [J Am Coll Cardiol. 2006;48:1040–6, Semin Fetal Neonatal Med. 2006;11:182–90, and Arch Argent Pediatr. 2007;105:427–35]. A persistent tachyarrhythmia can progress to a state of cardiac dysfunction known as tachycardia-induced cardiomyopathy. While this may be a rare cause of dilated cardiomyopathy and heart failure in children, the condition is usually reversible and should be considered in newborn and infants [Europace. 2011;14(4):466–473]. <b><i>Case Report:</i></b> A preterm 33+1-week male newborn with birth weight 2,790 g was delivered through cesarean section. The baby presented with tachycardia after birth associated with respiratory distress. The physical examination showed heart rate &#x3e;220/min, and ECG showed “saw tooth pattern” after intravenous adenosine boluses confirming diagnosis of AF (2-3:1). The heart rate reverted to sinus rhythm after synchronized cardioversion. Due to poor LV myocardial performance with dilated chambers, the baby received intravenous milrinone, followed by oral captopril. The baby was discharged on oral medications in perfect clinical condition, and follow-up showed no recurrence AF with improved cardiac function. <b><i>Conclusion:</i></b> Despite the rare occurrence, AF should be considered in differential diagnosis of newborn arrhythmia and diagnosed after intravenous adenosine injection. In few cases, AF can be associated with dilated cardiomyopathy which is a reversible condition.

scholarly journals SAT-470 When The Heart Can’t Clap To The Thyroid’s Beat

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Aditi Thakkar ◽  
Maria Camila Trejo-Parades ◽  
Anantha Sriharsha Madgula ◽  
Margaret Stevenson
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Tachycardia Induced Cardiomyopathy

Abstract Hyperthyroidism is associated with multiple cardiac pathologies including dilated cardiomyopathy, isolated right ventricular heart failure, and atrial fibrillation (AF). Long standing untreated hyperthyroidism in conjunction with AF can cause severe dilated cardiomyopathy with reduced ejection fraction that is completely reversible with treatment. We present the case of a previously healthy male who presented with florid congestive heart failure (CHF) as an initial presentation for hyperthyroidism. A 37-year-old male presented to the emergency department with progressively worsening dyspnea on exertion and lower extremity edema for one month. His heart rate was noted to be 172 bpm and an EKG was done that showed AF. He was clinically noted to be in heart failure and was admitted for further management. He was started on metoprolol with good heart rate control and was started on furosemide for diuresis. A transthoracic echocardiogram was done and showed severe global hypokinesis with left ventricular ejection fraction reduced to 20% along with bi-atrial enlargement and dilated left ventricular cavity. Ischemic cardiomyopathy was ruled out with left heart catheterization. A TSH level was checked as a part of workup for non-ischemic cardiomyopathy and atrial fibrillation and was markedly reduced to &lt;0.01mIU/L with free T4 of 1.49ng/dL and free T3 of 6.7ng/dL. A diagnosis of hyperthyroid cardiomyopathy with concomitant tachycardia induced cardiomyopathy was made. Autoimmune workup was negative for anti-thyroid-peroxidase and anti-thyroid-stimulating antibodies. Ultrasound of his thyroid gland revealed multiple thyroid nodules concerning for toxic multinodular goiter. He was started on methimazole and discharged after volume optimization with diuresis to closely follow up with endocrinology and cardiology for further management. CHF can be the primary presentation in about 6% of patients with hyperthyroidism. T3 is the main thyroid hormone that binds to cardiomyocytes. It increases the expression of beta-adrenergic receptors on cardiomyocytes and subsequently increases heart rate and contractility. T3 can also cause atrial arrhythmias such as AF by decreasing the parasympathetic tone. Concomitant AF and hyperthyroidism can cause reduced ejection fraction due to tachycardia induced cardiomyopathy and dilated cardiomyopathy. Treatment mainly is with beta-blockers that slow down the heart as well decrease serum T3 levels by blocking 5-monodeiodinase which converts T4 to T3. Our patient was started on beta-blocker and methimazole with good reduction in heart rate and improvement of symptoms. Recovery of cardiac function will be assessed with longitudinal follow up. As hyperthyroidism is one of the few causes of CHF that is completely reversible, clinicians must maintain low degree of suspicion in patients with new onset heart failure especially when associated with AF.

scholarly journals usefulness of the electrocardiogram and cardiac magnetic resonance to differentiate tachycardia induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Vera Sainz ◽  
A Cecconi ◽  
P Martinez-Vives ◽  
MJ Olivera ◽  
S Hernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
High Rate ◽  
Left Ventricular Ejection ◽  
Qrs Duration ◽  
Tachycardia Induced Cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background In patients admitted for heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and a concomitant high-rate supraventricular tachyarrhythmia (SVT) it is challenging to predict LVEF recovery after heart rate control and distinguish tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DC). The role of cardiac magnetic resonance (CMR) and the electrocardiogram (ECG) in this setting remains unsettled. Methods Forty-three consecutive patients admitted for HF due to high-rate SVT and LVEF &lt;50% undergoing CMR in the acute phase were retrospectively included. Those who had LVEF &gt;50% at follow up were classified as TIC and those with LVEF &lt;50% were classified as DC. Clinical, laboratory, CMR and ECG findings were analyzed to predict LVEF recovery. Results Twenty-five (58%) patients were classified as TIC. Patients with DC had wider QRS (121.2 ± 26 vs 97.7 ± 17.35 ms; p = 0.003). On CRM the TIC group presented with higher LVEF (33.4 ± 11 vs 26.9 ± 6.4% p = 0.019) whereas late gadolinium enhancement (LGE) was more frequent in DC group (61 vs 16% p = 0.004). On multivariate analysis, QRS duration ≥100 ms (p = 0.027), LVEF &lt; 40% on CMR (p = 0.047) and presence of LGE (p = 0.03) were identified as independent predictors of lack of LVEF recovery. Furthermore, during clinical follow-up (median 60 months) DC patients were admitted more frequently for HF (44% vs 0%; p &lt; 0.001) than TIC patients (Figure 1). Conclusion In patients with reduced LVEF admitted for HF due to high-rate SVT, QRS duration ≥100 ms, LVEF &lt;40% on CMR and presence of LGE are independently associated with lack of LVEF recovery and worse clinical outcome.

scholarly journals Tachicardia-induced cardiomyopathy. Case report

2021 ◽  
Vol 93 (4) ◽  
pp. 465-469
Author(s):  
Maria R. Atabegashvili ◽  
Dmitry Yu. Shchekochikhin ◽  
Grigory A. Gromyko ◽  
Ekaterina S. Pershina ◽  
Alexandra A. Bogdanova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Catheter Ablation ◽  
Left Ventricle ◽  
Sinus Rhythm ◽  
Atrial Flutter ◽  
Treatment Strategy ◽  
Rare Case ◽  
Clinical Case ◽  
Tachycardia Induced Cardiomyopathy

The tachycardia-induced cardiomyopathy is a rare case of reversible heart failure and left ventricle disfunction. The diagnostic approach and treatment strategy are described in this article. Also the clinical case of heart failure compensation in the patient with left ventricle dilatation and atrial flutter after the reverse to sinus rhythm is after catheter ablation presented.

External validation of a heart failure risk prediction model in a remote monitoring cohort submitted to cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Cardoso ◽  
M Coutinho ◽  
G Portugal ◽  
A Valentim ◽  
A.S Delgado ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
High Risk ◽  
Remote Monitoring ◽  
Hospital Admissions ◽  
External Validation ◽  
Left Ventricular Ejection ◽  
National Database ◽  
Failure Risk

Abstract Background Patients (P) submitted to cardiac ressynchronization therapy (CRT) are at high risk of heart failure (HF) events during follow-up. Continuous analysis of various physiological parameters, as reported by remote monitoring (RM), can contribute to point out incident HF admissions. Tailored evaluation, including multi-parameter modelling, may further increase the accuracy of such algorithms. Purpose Independent external validation of a commercially available algorithm (“Heart Failure Risk Status” HFRS, Medtronic, MN USA) in a cohort submitted to CRT implantation in a tertiary center. Methods Consecutive P submitted to CRT implantation between January 2013 and September 2019 who had regular RM transmissions were included. The HFRS algorithm includes OptiVol (Medtronic Plc., MN, USA), patient activity, night heart rate (NHR), heart rate variability (HRV), percentage of CRT pacing, atrial tachycardia/atrial fibrillation (AT/AF) burden, ventricular rate during AT/AF (VRAF), and detected arrhythmia episodes/therapy delivered. P were classified as low, medium or high risk. Hospital admissions were systematically assessed by use of a national database (“Plataforma de Dados de Saúde”). Accuracy of the HFRS algorithm was evaluated by random effects logistic regression for the outcome of unplanned hospital admission for HF in the 30 days following each transmission episode. Results 1108 transmissions of 35 CRT P, corresponding to 94 patient-years were assessed. Mean follow-up was 2.7 yrs. At implant, age was 67.6±9.8 yrs, left ventricular ejection fraction 28±7.8%, BNP 156.6±292.8 and NYHA class &gt;II in 46% of the P. Hospital admissions for HF were observed within 30 days in 9 transmissions. Stepwise increase in HFRS was significantly associated with higher risk of HF admission (odds ratio 12.7, CI 3.2–51.5). HFRS had good discrimination for HF events with receiving-operator curve AUC 0.812. Conclusions HFRS was significantly associated with incident HF admissions in a high-risk cohort. Prospective use of this algorithm may help guide HF therapy in CRT recipients. Funding Acknowledgement Type of funding source: None

Long-term follow-up of cardiac resynchronization therapy patients with non-ischemic dilated cardiomyopathy assessed by radionuclide angiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Valzania ◽  
R Bonfiglioli ◽  
F Fallani ◽  
J Frisoni ◽  
M Biffi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Dilated Cardiomyopathy ◽  
Radionuclide Angiography ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Long Term Follow Up ◽  
Non Ischemic Dilated Cardiomyopathy ◽  
Lv Ejection Fraction

Abstract Background While the beneficial effects of cardiac resynchronization therapy (CRT) have been widely investigated soon after CRT implantation, relatively few data are available on long-term clinical outcomes of CRT recipients. Aim To investigate long-term outcomes of CRT patients with non-ischemic dilated cardiomyopathy stratified as responders and non-responders according to radionuclide angiography. Methods Consecutive heart failure patients with non-ischemic dilated cardiomyopathy undergoing CRT implantation at our University Hospital between 2007 and 2013 were enrolled. All patients were assessed with equilibrium Tc99 radionuclide angiography at baseline and after 3 months of CRT. Left ventricular (LV) ejection fraction was computed on the basis of relative end-diastolic and end-systolic counts, and intraventricular dyssynchrony was derived by Fourier phase analysis. Response to CRT was defined by an absolute increase in LV ejection fraction (LVEF) ≥5% at 3-month follow-up. Clinical outcome was assessed after 10 years through hospital records review. Results Forty-seven patients (83% men, 63±11 years) were included in the study. At 3 months, 25 (53%) patients were identified as CRT responders according to LVEF increase (from 26±8 to 38±12%, p&lt;0.001). In these patients, LV dyssynchrony decreased from 59±30° to 29±18° (p&lt;0.001). Twenty-two (47%) patients were defined as non-responders. No significant changes in LVEF and LV dyssynchrony (50±30° vs. 38±19°, p=0.07) were observed in non-responders. At long-term follow-up (11±2 years), all-cause and cardiac mortality rates were 24% and 12% in responders vs. 32% and 27% in non-responders, respectively (p=ns). Heart transplantation was performed in 3 patients. One (4%) patient among CRT responders compared with 6 (27%) patients among non-responders died of worsening heart failure (p=0.03). Conclusions Although late overall mortality of non-ischemic CRT recipients was not significantly different between mid-term responders and non-responders, CRT responders were at lower risk of worsening heart failure death. Funding Acknowledgement Type of funding source: None

Heart rate as a marker of relapse during withdrawal of heart failure therapy in patients with recovered dilated cardiomyopathy: an analysis from TRED-HF

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Halliday ◽  
A Vazir ◽  
R Owen ◽  
J Gregson ◽  
R Wassall ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Function ◽  
Dilated Cardiomyopathy ◽  
Funding Source ◽  
End Point ◽  
Therapy Withdrawal ◽  
The Mean ◽  
Withdrawal Of Therapy ◽  
Continue Therapy

Abstract Introduction In TRED-HF, 40% of patients with recovered dilated cardiomyopathy (DCM) relapsed in the short-term during phased withdrawal of drug therapy. Non-invasive markers of relapse may be used to monitor patients who wish a trial of therapy withdrawal and provide insights into the pathophysiological drivers of relapse. Purpose To investigate the relationship between changes in heart rate (HR) and relapse amongst patients with recovered DCM undergoing therapy withdrawal in TRED-HF. Methods Patients with recovered DCM were randomised to phased withdrawal of therapy or to continue therapy for 6 months. After 6 months of continued therapy, those in the control arm underwent withdrawal of therapy in a single arm crossover phase. HR was measured at each study visit. Mean HR and 95% confidence intervals (CI) were calculated at baseline, 45 days after baseline, 45 days prior to the end of the study or relapse and at the end of the study or relapse. Patients were stratified by treatment arm and the occurrence of the primary relapse end-point. Heart rate at follow-up was compared amongst patients who had therapy withdrawn and relapsed versus those who had therapy withdrawn and did not. ANCOVA was used to adjust for differences in HR at baseline between the two groups. Results Of 51 patients randomised, 26 were assigned to continue therapy and 25 to withdraw therapy. In the randomised and cross-over phases, 20 patients met the primary relapse end-point; one patient withdrew from the study and one patient completed follow-up in the control arm but did not enter the cross-over phase. Mean HR (standard deviation) at baseline and follow-up for (i) patients in the control arm was 69.9 (9.8) & 65.9 (9.1) respectively; (ii) for those who had therapy withdrawn and did not relapse was 64.6 (10.7) & 74.7 (10.4) respectively; and (iii) for those who had therapy withdrawn and relapsed was 68.3 (11.3) & 86.1 (11.8) respectively [all beats per minute]. The mean change in HR between the penultimate visit and the final visit for those who had therapy withdrawn and did not relapse was −2.4 (9.7) compared to 3.1 (15.5) for those who relapsed. After adjusting for differences in HR at baseline, the mean difference in HR measured at follow-up between patients who underwent therapy withdrawal and did, and did not relapse was 10.4bpm (95% CI 4.0–16.8; p=0.002) (Figure 1 & Table 1). Conclusion(s) A larger increase in HR may be a simple and effective marker of relapse for patients with recovered DCM who have insisted on a trial of therapy withdrawal. Whether HR control is crucial to the maintenance of remission amongst patients with improved cardiac function, or is simply a marker of deteriorating cardiac function, warrants further investigation. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation

scholarly journals Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001425
Author(s):  
Marc Meller Søndergaard ◽  
Johannes Riis ◽  
Karoline Willum Bodker ◽  
Steen Møller Hansen ◽  
Jesper Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Heart Rate ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Pr Interval ◽  
Qrs Duration ◽  
The Impact

AimLeft bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data.Methods and resultsUsing ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment.ConclusionProlonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.

scholarly journals Catecholaminergic polymorphic ventricular tachycardia complicated by dilated cardiomyopathy: a case report

2020 ◽  
Author(s):  
Granitz Christina ◽  
Jirak Peter ◽  
Strohmer Bernhard ◽  
Pölzl Gerhard
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Dilated Cardiomyopathy ◽  
Sinus Bradycardia ◽  
Clinical Care ◽  
Structural Heart Disease ◽  
Catecholaminergic Polymorphic Ventricular Tachycardia ◽  
Polymorphic Ventricular Tachycardia ◽  
Myocardial Inflammation ◽  
As Stress

Abstract Background  Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe genetic arrhythmogenic disorder characterized by adrenergically induced ventricular tachycardia manifesting as stress-induced syncope and sudden cardiac death. While CPVT is not associated with dilated cardiomyopathy (DCM) in most cases, the combination of both disease entities poses a major diagnostic and therapeutic challenge. Case summary  We present the case of a young woman with CPVT. The clinical course since childhood was characterized by repetitive episodes of exercise-induced ventricular arrhythmias and a brady-tachy syndrome due to rapid paroxysmal atrial fibrillation and sinus bradycardia. Medical treatment included propranolol and flecainide until echocardiography showed a dilated left ventricle with severely depressed ejection fraction when the patient was 32 years old. Cardiac magnetic resonance imaging revealed non-specific late gadolinium enhancement. Myocardial inflammation, however, was excluded by subsequent endomyocardial biopsy. Genetic analysis confirmed a mutation in the cardiac ryanodine receptor but no pathogenetic variant associated with DCM. Guideline-directed medical therapy for HFrEF was limited due to symptomatic hypotension. Over the next months, the patient developed progressive heart failure symptoms that were finally managed by heart transplantation. Discussion  Management in patients with CPVT and DCM is challenging, as Class I antiarrhythmic drugs are not recommended in structural heart disease and prophylactic internal cardioverter-defibrillator implantation without adjuvant antiarrhythmic therapy can be detrimental. Regular echocardiographic screening for DCM is recommendable in patients with CPVT. A multidisciplinary team of heart failure specialists, electrophysiologists, geneticists, and imaging specialists is needed to collaborate in the delivery of clinical care.

scholarly journals Heart rate turbulence in healthy dogs and dogs with dilated cardiomyopathy

2012 ◽  
Vol 15 (3) ◽  
pp. 469-475 ◽  
Author(s):  
A. Noszczyk-Nowak
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Dilated Cardiomyopathy ◽  
Autonomic Neuropathy ◽  
Regression Line ◽  
Reference Value ◽  
Control Group ◽  
Heart Rate Turbulence ◽  
Percentage Difference ◽  
Healthy Dogs

Abstract Heart rate turbulence (HRT) is modulated by the baroreceptor reflex and it was suggested that it could be used as a measure of autonomic dysfunction. Impaired HRT is of a significant prognostic value in humans after myocardial infarction, suffering from dilated cardiomyopathy and patients with heart failure. So far no studies were performed assessing the importance of HRT in dogs. The aim of this study was to prospectively evaluate the HRT turbulence onset (TO) and the turbulence slope (TS) in healthy dogs and in dogs with DCM and to compare the HRT in dogs with DCM that died during the first 30 days of observation and dogs with DCM that survived the first 30 days after the HRT analysis. The current study was aimed at determining reference value of the TO and TS of HRT in healthy dogs (control group) and dogs with dilated cardiomyopathy (DCM group). The tests were carried out on 30 healthy dogs and 30 dogs with DCM composed of Boxers, Doberman pinschers and Great Danes, of different sexes and body weights from 22 to 72 kg, aged between 1.5 and 11.5 years, submitted to the 24-hour Holter monitoring. HRT parameters were calculated using an HolCard software algorithm. TO is a percentage difference between the heart rate immediately following ventricular premature complex (VPC) and the heart rate immediately preceding VPC. TS corresponds to the steepest slope of the linear regression line for each sequence of five consecutive normal intervals in the local tachogram. The average TO in healthy dogs was determined as -13.55 ± 11.12%, TS was 21.33 ± 9.66 ms/RR. TO in dogs with DCM was determined as - 2.61 ± 2.1% and TS was 6.15 ± 3.86 ms/RR. Parameters of HRT were statistically significantly decreased (p<0.01) in dogs with DCM. HRT TO and TS were statistically significantly decreased in dogs with DCM. Dogs with DCM that survived more than 30 days of observation had HRT statistically significantly decreased in comparison to dogs with DCM that died after the 30’th day of observation. Decreased HRT parameters in dogs with DCM suggest an autonomic neuropathy which principally consists of the withdrawal of the cardiac parasympathetic tone. The more the autonomic neuropathy is advanced the faster the death of the dog with DCM might occur, with no correlation with the level of the heart failure.

Abstract 12421: Single Beat Simultaneous Left Atrioventricular Strain-Volume Analysis Using Speckle Tracking Echocardiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Alaa M Omar ◽  
Mohamed A Abdel-Rahman ◽  
Zaid H Sabe-Eleish ◽  
Osama Rifaie ◽  
Gianni Pedrizzetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Speckle Tracking ◽  
Heart Function ◽  
Cardiac Mechanics ◽  
Structural Heart Disease ◽  
Left Heart ◽  
Cardiac Events ◽  
Structural Shape ◽  
Heart Volume

Introduction: Assessment of cardiac mechanics in relation to left atrial (LA) and ventricular (LV) structural (shape and volume) changes represent a foundation for assessing cardiac remodeling in heart failure (HF) patients. We tested the feasibility of assessing simultaneous LA and LV volumes and deformation within an index cardiac cycle as a marker of total left heart structural and functional remodeling in HF. Methods: Echocardiography was performed in total 101 patients, which included 77 patients with HF (50 had normal EF (HFNEF) and 27 had reduced EF (HFREF)) and 24 young subjects with no structural heart disease (controls) (table 1). Two-dimensional speckle tracking was performed in apical 2- and 4- chamber views for simultaneous measurement of LV and LA volumes and deformation. Peak longitudinal average atrio-ventricular strain (AVS) and early diastolic strain rate (AVSR-E), in addition to the total left heart volume (TLV) during LV systole and diastole (TLVsystole, TLVdiastole), were measured. Occurrence of major adverse cardiac events (MACE) was defined during follow up. Results: In comparison with younger controls, patient with HF showed higher TLV and nearly 50% reduction in AVS and AVSR-E (table 1). These differences persisted even after adjusting for age. During a median follow up of 7 months, MACE occurred in 15 patients (5 hospitalization for heart failure, 1 cerebrovascular stroke, and 9 cardiac deaths). AVS and AVSR-E were predictors for MACE after adjusting for age (HR=0.9, 95% CI: 0.81 to 0.99, p=0.038; HR= 0.14, 95% CI: 0.02 to 0.89, p=0.037; respectively). AVS and AVSR-E had similar diagnostic values in predicting MACE (AUC= 0.77 and 0.79; p=0.001 and <0.001 respectively), with higher event free survival seen for AV-S>14.5%, and AVSR-E>0.92 s-1 (Figure 1). Conclusion: Single beat combined assessments of LA-LV strain and strain rates may be useful integrated markers of total left heart function.

Sign in / Sign up

Export Citation Format

Share Document