Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure

Wang, Jianwen; Khoury, Dirar S.; Yue, Yong; Torre‐Amione, Guillermo; Nagueh, Sherif F.

doi:10.1093/eurheartj/ehn141

Cited by 390 publications

(360 citation statements)

References 23 publications

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“…In this study, the echocardiographic parameters did not differ between the mortality group and the survival group, except for GLS. In the nondialysis population, GLS is proved as a more reliable and sensitive parameter for representing LV systolic function in patients with cardiomyopathies, advanced-stage CKD, or HF with preserved LVEF (11,12,(27)(28)(29)(30). Less negative GLS is also proved as a powerful predictor of all-cause mortality in the general population (9), and is reported to be useful in the preclinical diagnosis of a number of other cardiomyopathies, including diabetes, hypertrophic cardiomyopathy, and amyloidosis (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Liu¹,

Sung

et al. 2013

Clinical Journal of the American Society of Nephrology

101

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SummaryBackground and objectives Little is known about the optimal echocardiographic parameters for risk stratification in stable dialysis patients with preserved left ventricular ejection fraction (LVEF) (ejection fraction $50%). Left ventricular (LV) global peak systolic longitudinal strain (GLS) is the ratio of the maximal change in myocardial longitudinal length in systole to the original length and reliably and accurately assesses LV function. During systole, LV myocardium in the longitudinal direction shortens and GLS is represented by a negative value. The more negative value of GLS, the better the LV function is. This study hypothesized that subtle abnormalities of GLS are associated with an adverse prognosis.Design, setting, participants, & measurements This prospective study collected clinical and echocardiographic data (including GLS) from 88 stable hemodialysis patients (mean age 67.0611.2 years; 35% men) with preserved LVEF. These patients were enrolled from December 2008 to January 2009 and were followed-up for 25.669.9 months. The primary outcome was all-cause mortality. Multivariate Cox regression analysis was used to investigate risk factors for mortality.Results The mortality group (n=24) had lower albumin levels, less negative GLS, and higher prevalence of coronary artery disease and diabetes mellitus than the survival group. Using a GLS cutoff value of 215%, the less negative GLS group (GLS $215%) had a higher mortality rate. Cox regression analyses revealed that lower albumin level (hazard ratio, 0.16; 95% confidence interval, 0.05 to 0.53; P=0.003) and less negative GLS (hazard ratio, 3.57; 95% confidence interval, 1.41 to 9.04; P=0.01) were independent predictors of all-cause mortality. Furthermore, less negative GLS was associated with a higher cardiovascular death rate.Conclusions Less negative GLS is predictive of poor prognosis among stable hemodialysis patients with preserved LVEF.

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Section: Discussionmentioning

confidence: 99%

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Liu¹,

Sung

et al. 2013

Clinical Journal of the American Society of Nephrology

101

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“…Abnormalities in each of these components have been identified in HFpEF with blunted exercise-induced increases in preload, blunted increases in ejection fraction, contractility and regional systolic function, impaired chronotropic reserve (i.e. chronotropic incompetence) and attenuated exercise-mediated vasodilatation being documented in several studies [15,16,18,41,42,[44][45][46][47]50,64,[92][93][94][95]. Recent studies have also reported increased prevalence of diastolic dyssynchrony in patients with HFpEF [96][97][98].…”

Section: Global Cardiovascular Reserve Dysfunctionmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction

Čulić

2017

N Engl J Med

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Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies.

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“…Whereas HFpEF is almost as common as heart failure with reduced ejection fraction, HFpEF has proven relatively refractory to treatment in a number of randomized clinical trials,13, 14, 15 underscoring the importance of efforts to better understand its pathophysiology. Interestingly, HFpEF has been related to both reduced GLS and increased aortic stiffness in a number of prior studies 3, 7, 16, 17, 18, 19, 20. Furthermore, both HFpEF and aortic stiffness are prevalent in older individuals, particularly women,16, 17 suggesting possible pathophysiologic links between aortic stiffness and subclinical alterations in LV systolic function that may promote the development of HFpEF in susceptible individuals.…”

Section: Introductionmentioning

confidence: 96%

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Bell

McCabe

Larson

et al. 2017

JAHA

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BackgroundAortic stiffness impairs optimal ventricular–vascular coupling and left ventricular systolic function, particularly in the long axis. Left ventricular global longitudinal strain (GLS) has recently emerged as a sensitive measure of early cardiac dysfunction. In this study, we investigated the relation between aortic stiffness and GLS in a large community‐based sample.Methods and ResultsIn 2495 participants (age 39–90 years, 57% women) of the Framingham Offspring and Omni cohorts, free of cardiovascular disease, we performed tonometry to measure arterial hemodynamics and echocardiography to assess cardiac function. Aortic stiffness was evaluated as carotid–femoral pulse wave velocity and as characteristic impedance, and GLS was calculated using speckle tracking–based measurements. In multivariable analyses adjusting for age, sex, height, systolic blood pressure, augmentation index, left ventricular structure, and additional cardiovascular risk factors, increased carotid–femoral pulse wave velocity (B±SE: 0.122±0.030% strain per SD, P<0.0001) and characteristic impedance (0.090±0.029, P=0.002) were both associated with worse GLS. We observed effect modification by sex on the relation between characteristic impedance and GLS (P=0.004); in sex‐stratified multivariable analyses, the relation between greater characteristic impedance and worse GLS persisted in women (0.145±0.039, P=0.0003) but not in men (P=0.73).ConclusionsMultiple measures of increased aortic stiffness were cross‐sectionally associated with worse GLS after adjusting for hemodynamic variables. Parallel reductions in left ventricular long axis shortening and proximal aortic longitudinal strain in individuals with a stiffened proximal aorta, from direct mechanical ventricular‐vascular coupling, offers an alternative explanation for the observed relations.

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Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure

Cited by 390 publications

References 23 publications

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Heart Failure with Preserved Ejection Fraction

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

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