Association of Myocardial Energetic Efficiency with Circumferential and Longitudinal Left Ventricular Myocardial Function in Subjects with Increased Body Mass Index (the FATCOR Study)

Mancusi, Costantino; Midtbø, Helga; Luca, Nicola De; Halland, Hilde; Simone, Giovanni de; Gerdts, Eva

doi:10.3390/jcm10081581

Cited by 12 publications

(25 citation statements)

References 34 publications

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“…Whether MEEi identifies LV myocardial dysfunction comparable with global longitudinal strain could not be tested in the present study since data on global longitudinal strain was not available in the dataset. However, Mancusi et al 33 recently demonstrated in a study of 480 obese subjects that both global longitudinal strain and midwall shortening decreased in parallel with lower MEEi.…”

Section: Discussionmentioning

confidence: 96%

Low myocardial energetic efficiency is associated with increased mortality in aortic stenosis

et al. 2021

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ObjectivesIn hypertension, low myocardial energetic efficiency (MEEi) has been documented as an integrated marker of metabolic and left ventricular (LV) myocardial dysfunction. We tested the predictive performance of MEEi in initially asymptomatic aortic stenosis (AS) patients free from diabetes and known cardiovascular disease.MethodsData from 1703 patients with mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study followed for 4.3 years was used. MEE was calculated from Doppler stroke volume/([heart rate/60]) and indexed to LV mass (MEEi). The threshold value for MEEi associated with increased mortality was identified in generalised additive model with smoothing splines. Covariables of MEEi were identified in logistic regression analysis. Outcome was assessed in Cox regression analysis and reported as HR and 95% CI.ResultsMEEi <0.34 mL/s per gram was associated with increased cardiovascular mortality (n=80) (HR 2.53 (95% CI 1.50 to 4.28)) and all-cause mortality (n=155) (HR 1.74 (95% CI 1.20 to 2.52)) (both p<0.01). The association was independent of confounders of low MEEI (<0.34 mL/s per gram) identified in multivariable logistic regression analysis, including more severe AS, higher body mass index, lower LV midwall shortening and ejection fraction and presence of hypertension. Comparison of the Cox models with and without MEEi among the covariables demonstrated that MEEi significantly improved the prognostic yield (both p<0.01).ConclusionsIn patients with initially asymptomatic AS, low MEEi was associated with clustering of cardiometabolic risk factors, lower LV myocardial function and subsequent increased mortality during 4.3 years follow-up, independent of known prognosticators.Trial registration numberNCT00092677.

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Section: Discussionmentioning

confidence: 96%

Low myocardial energetic efficiency is associated with increased mortality in aortic stenosis

et al. 2021

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“…The fat-associated CV dysfunction (FATCOR) study explored the association of MEEi with LV systolic circumferential and longitudinal myocardial function in 480 subjects with increased body mass index (BMI), without known CV disease (mean age 47 ± 9 years, 61% women, 63% obese, 74% with hypertension). Patients with lower MEEi values were more frequently men with obesity, hypertension, dyslipidemia, and a higher insulin resistance index (all p for trend < 0.05) [ 4 ]. The lower MEEi quartile (< 0.41 mL/s per g) was associated with lower circumferential and longitudinal LV myocardial function assessed by midwall fractional shortening (MFS) and global longitudinal strain (GLS), independent of cardiometabolic factors [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…MEE can be defined as the ratio between the external systolic work and the total amount of energy produced by cardiomyocytes, estimated by the rate pressure product, which is an indirect measure of MVO2 [ 2 , 3 , 4 , 5 ]. LV MEE was estimated as the ratio between SW and MVO2 [ 2 , 3 , 4 , 5 ], SW as the product SBP × SV (mmHg × mL), and MVO2 using the “double product” (DP) of SBP in mmHg × HR, as the time of cardiac cycle (CC) by the following formula: CC = HR/60 in seconds (HR/60). Thus, MEE (mL/s) was calculated as follow: SBP × SV/SBP × HR = SV/HR, where HR was expressed in seconds (HR/60) [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, although MEE can be quantified by dual-sided heart catheterization and selective catheterization of the coronary sinus, its widespread clinical applications have been limited by the need of invasive measurements requiring complex calculations [ 1 ]. In this regard, the availability of a surrogate measure of MEE based on a non-invasive echocardiographic approach allows more extensive clinical applications [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Indeed, strong evidence exists supporting the role of non-invasively derived indexed MEE (MEEi) in predicting cardiovascular (CV) clinical outcomes, with altered values associated with CV risk factors/disease such as insulin resistance and diabetes, hypertension, obesity, heart failure with preserved ejection fraction (HFpEF) [ 2 , 3 , 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…In this regard, the availability of a surrogate measure of MEE based on a non-invasive echocardiographic approach allows more extensive clinical applications [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Indeed, strong evidence exists supporting the role of non-invasively derived indexed MEE (MEEi) in predicting cardiovascular (CV) clinical outcomes, with altered values associated with CV risk factors/disease such as insulin resistance and diabetes, hypertension, obesity, heart failure with preserved ejection fraction (HFpEF) [ 2 , 3 , 4 , 5 , 6 , 7 ]. Therefore, the aim of the present study was to explore the full range of MEE and MEEi values (as calculated by standard transthoracic Doppler echocardiography (TTE)) in a large cohort of healthy subjects, evaluating clinical and echocardiographic correlates.…”

Section: Introductionmentioning

confidence: 99%

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Physiologic Range of Myocardial Mechano-Energetic Efficiency among Healthy Subjects: Impact of Gender and Age

Ferrara

Capone

Cademartiri

et al. 2022

JPM

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Background: Myocardial mechano-energetic efficiency (MEE) is the capability of the left ventricle (LV) to convert the chemical energy obtained from the cardiac oxidative metabolism into mechanical work. The aim of present study was to establish normal non-invasive MEE and MEEi reference values. Methods: In total, 1168 healthy subjects underwent physical examinations, clinical assessment, and standardized transthoracic echocardiographic (TTE) examination. MEE was obtained by TTE as the ratio between stroke volume (SV) and heart rate (HR): MEE = SV/HR [HR expressed in seconds (HR/60)]. Because MEE is highly related to left ventricular mass (LVM), MEE was then divided by LVM with the purpose of obtaining an estimate of energetic expenditure per unit of myocardial mass (i.e., indexed MEE, MEEi, mL/s/g). Results: The mean values of MEE and MEEi in the overall population were 61.09 ± 18.19 mL/s; 0.45 ± 0.14, respectively. In a multivariable analysis, gender, body surface area (BSA), diastolic blood pressure, left atrial volume indexed to BSA, E/e’ and tricuspid annular plane systolic excursion (TAPSE) were the independent variables associated with MEE, while age, gender, BSA and TAPSE were the independent variables associated with MEEi. Conclusions: The knowledge of age- and gender-based MEE and MEEi normal values may improve the global assessment of LV cardiac mechanics and serve as a reference to identify phenotypes at high risk of cardiovascular events.

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Low mechano‐energetic efficiency is associated with future left ventricular systolic dysfunction in hypertensives

et al. 2022

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AimsIn a hypertensive population with optimal blood pressure control with a long-term follow-up, we aimed at analysing possible predictors of left ventricular (LV) ejection fraction (LVEF) reduction, including indexed mechano-energetic efficiency (MEEi), a well-recognized echo-derived parameter of LV performance. Methods and resultsThe study population included 5673 hypertensive patients from the Campania Salute Network with a long-term follow-up, normal baseline LVEF (≥50%), and no prevalent cardiovascular (CV) disease. Patients developing LVEF impairment (LVEF < 50% or a reduction of at least 10 percentage points compared with baseline) were compared with patients with persistently normal LVEF. Optimal blood pressure control was achieved in about 80% of patients. Patients who experienced LVEF reduction were 2.41% during a long-term follow-up (mean duration 5.6 ± 3.9 years). At baseline, they were older (59.46 ± 11.58 vs. 53.40 ± 11.41, P < 0.0001) and showed higher LV mass index (53.3 ± 12.83 vs. 47.56 ± 9.58, P < 0.0001), left atrial (LA) volume index (14.4 ± 4.2 vs. 13.1 ± 2.8, P < 0.0001) and carotid intima-media thickness (1.99 ± 0.86 vs. 1.61 ± 0.73, P < 0.0001), lower MEEi (0.32 ± 0.08 vs. 0.34 ± 0.07, P = 0.037), and higher prevalence of CV events during follow-up (13.9% vs. 3%, P < 0.0001) compared with patients with persistently normal LVEF. A logistic regression analysis, performed after running univariate analyses and selecting parameters significantly associated with LVEF reduction, showed that having a CV event [odds ratio (OR) 7.57, P < 0.0001], being in the lowest MEEi quartile (OR 2.43, P = 0.003), and having a larger LA volume index (OR 1.08, P = 0.028) were all parameters independently associated with the development of LV systolic dysfunction. A further logistic regression model, performed by excluding patients experiencing CV events, demonstrated that the lowest MEEi quartile was independently associated with the evolution towards LVEF reduction (OR 2.35, P = 0.004), despite significant impact of LA volume index (OR 1.08, P = 0.023) and antiplatelet therapy (OR 1.89, P < 0.01). Receiver operating characteristic curves showed that the model including MEEi had higher accuracy than the model without MEEi in predicting LVEF reduction (areas under the curve 0.68 vs. 0.63, P = 0.046). Conclusions Lower values of MEEi at baseline identify hypertensive patients more liable to develop LVEF reduction. In hypertensive setting, MEEi evaluation improves risk stratification for development of LV systolic dysfunction during long-term follow-up.

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Association of Myocardial Energetic Efficiency with Circumferential and Longitudinal Left Ventricular Myocardial Function in Subjects with Increased Body Mass Index (the FATCOR Study)

Cited by 12 publications

References 34 publications

Low myocardial energetic efficiency is associated with increased mortality in aortic stenosis

Low myocardial energetic efficiency is associated with increased mortality in aortic stenosis

Physiologic Range of Myocardial Mechano-Energetic Efficiency among Healthy Subjects: Impact of Gender and Age

Low mechano‐energetic efficiency is associated with future left ventricular systolic dysfunction in hypertensives

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