Prognosis and Risk Stratification of Patients With Advanced Heart Failure (from PROBE)

Cameli, Matteo; Pastore, María; Mandoli, Giulia Elena; Nistor, Dan; Lisi, Edoardo; Tok, Özge Özden; Cavigli, Luna; Romano, Andrea; Mondillo, Sergio

doi:10.1016/j.amjcard.2019.03.041

Cited by 21 publications

(19 citation statements)

References 29 publications

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“…As previously discussed, RV strain by STE allows a reliable and angle‐independent evaluation of RV deformation also in early stages of its dysfunction. In fact, it has demonstrated its superiority over other conventional echocardiographic indices of RV function (TAPSE, S', & RVFAC) for the prediction of cardiovascular outcome in patients with HFrEF, 9 also in patients referred for HTX or LVAD, with a cut‐off value of −15% 10,11 . As stated in the latest European Association of Cardiovascular Imaging standardization document, fwRVLS should be preferred to RV GLS as it specifically analyses RV wall motion, avoiding the influence of interventricular septum 36 .…”

Section: Discussionmentioning

confidence: 99%

“…Speckle tracking echocardiography (STE) emerged as a reliable and available tool to investigate not only LV but also LA and RV function in chronic HF. 5 While the prognostic value of LA strain in patients with HF with reduced 6 and preserved EF, 7 , 8 and of RV strain in patients with advanced HF, 9 , 10 , 11 has already been shown, less is known about their utility to early predict the progressive myocardial damage in HFrEF before overt biventricular dysfunction occurs. The purpose of this echocardiographic study was to assess the prognostic value of isolated LA dysfunction or its association with RV failure in patients with HFrEF, using basic and speckle tracking echocardiographic parameters.…”

Section: Introductionmentioning

confidence: 99%

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New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure

et al. 2021

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Aims The present study investigated the prognostic impact of either isolated left atrial (LA) impairment, or its association with right ventricular (RV) failure, in heart failure (HF) with reduced ejection fraction (HFrEF), using basic and speckle tracking echocardiography (STE). Methods and results One hundred and six outpatients with HFrEF were enrolled in this prospective observational study. Patients with primary lung diseases, non‐sinus rhythm, previous cardiac surgery, and poor acoustic window were excluded. After clinical examination and basic echocardiography, STE was used to measure peak atrial longitudinal strain (PALS) and a new marker of RV performance and pulmonary circulation relation: free‐wall RV longitudinal strain (fwRVLS)/systolic pulmonary artery pressure (sPAP). Patients were followed for all‐cause/cardiovascular death and HF hospitalization. Of 84 eligible patients (60.1 ± 11.5 years; 82% male patients), 48 reached the combined endpoint (cardiovascular death and/or HF hospitalization). Population was divided into three groups: Group 1 (PALS ≥ 15 and fwRVLS/sPAP ≤ −0.5), Group 2 (PALS ≤ 15 and fwRVLS/sPAP ≤ −0.5), and Group 3 (PALS ≤ 15 and fwRVLS/sPAP > −0.5). Mean follow up was 3.5 ± 0.3 years. The higher severity groups were associated with higher LA volume index (P < 0.0001), New York Heart Association class (P = 0.02), mitral regurgitation (P = 0.0004) and tricuspid regurgitation grades (P < 0.0001), lower left ventricular (LV) ejection fraction (P = 0.0003), LV global longitudinal strain (P < 0.0001), PALS (P < 0.0001), tricuspid annular plane systolic excursion (P < 0.007), sPAP (P < 0.0001), and RV strain (P < 0.0001). Reduced PALS and fwRVLS/sPAP were independent predictors of the combined endpoint with adjusted Cox models (hazard ratio = 9.54; 95% confidence interval = 2.95–30.92; P = 0.0002 for Group 3 vs. Group 1). Kaplan–Meier curves showed early and persistent divergence between the three groups for the prediction of the combined endpoint and of all‐cause death (P < 0.0001). Conclusions The combination of LA and right heart damage entails worse prognosis in patients with HFrEF. The evaluation of PALS and fwRVLS/sPAP could aid risk stratification of HFrEF patients to provide them early treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure

et al. 2021

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“…EF may also be preserved in patients with significant mitral regurgitation. In the past, EF was commonly used as the only echocardiographic variable to evaluate HF, which has proven to have a reduced prognostic accuracy, especially in the presence of MR . In patients with LV dilation, 3D‐SI could be a stronger indicator of HF.…”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional echocardiographic comparison of left ventricular geometry and systolic function between dilated cardiomyopathy and mitral regurgitation with similar left ventricular dilation

Zeng

et al. 2019

J of Clinical Ultrasound

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Purpose: This study aimed to analyze left ventricular (LV) remodeling in patients with LV dilation using three-dimensional (3D) echocardiography, and to compare geometry and systolic function between patients with dilated cardiomyopathy (DCM) and with mitral regurgitation (MR) but similar LV dimension.Methods: Cross-sectional study of 60 DCM and 60 MR patients with LV end diastolic diameter (LVEDD) > 35 mm/m 2 , and of 60 healthy control volunteers.Results: Despite a similar LVEDD, DCM patients showed a significantly higher 3D sphericity index (3D-SI) than MR patients, whereas 3D ejection fraction (3D-EF) was significantly lower (P < .01). There was a linear relationship between 3D-EF and 3D-SI in both DCM and MR patients (r = −0. 745 and r = −0. 642, respectively; both P < .001). Receiver operating characteristic (ROC) curves showed that 3D-SI had could better discriminate between DCM and MR (sensitivity 90%; specificity 73%; AUC 0.852, P < .01) than other variables. The area under the ROC curve of 3D-SI was significantly larger than that of 3D-EF for detecting heart failure in both patients with DCM and MR.Conclusions: LV geometry appears to be more spherical and associated with worse systolic function in DCM than in MR patients, in spite of similar LV dimensions. Systolic function correlated significantly with 3D-SI, which provided a better description of LV remodeling and could be a stronger indicator of heart failure in patients with LV dilation. K E Y W O R D S dilated cardiomyopathy, left ventricular remodeling, mitral regurgitation, sphericity index

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“…Advanced echocardiography represents a precious additive tool to help clinicians for the risk stratification of these patients. In fact, many authors assessed RV strain importance for the prediction of RV failure after LVAD implantation [53][54][55][56][57][58] (Table 3), and fwRVLS has been recognized to be superior to RV GLS for this purpose. Particularly, the use of scores for the pre-operative prognostic evaluation of these patients has been proposed by several authors, which showed to have higher prognostic power if including fwRVLS, also confirmed by external validation [56][57][58].…”

Section: Advanced Heart Failure: the Importance Of The Right Ventriclementioning

confidence: 99%

The prognostic role of speckle tracking echocardiography in clinical practice: evidence and reference values from the literature

et al. 2020

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Speckle tracking echocardiography (STE) is a second-level echocardiographic technique which has gradually gained relevance in the last years. It allows semi-automatic quantification of myocardial deformation and function, overcoming most of the limitations characterizing basic echocardiography and providing an early detection of cardiac impairment. Today, its feasibility and usefulness are highly supported by literature. In particular, several studies demonstrated that STE could provide additional prognostic information beyond conventional echocardiographic and traditional clinical parameters. Moreover, a recent standardization of speckle tracking analysis regarding all cardiac chambers paved the way for the integration of STE in diagnostic and prognostic protocols for particular clinical settings. The aim of this review is to describe the prognostic role of STE in different clinical scenarios basing on currently available evidence.

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Prognosis and Risk Stratification of Patients With Advanced Heart Failure (from PROBE)

Cited by 21 publications

References 29 publications

New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure

New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure

Three‐dimensional echocardiographic comparison of left ventricular geometry and systolic function between dilated cardiomyopathy and mitral regurgitation with similar left ventricular dilation

The prognostic role of speckle tracking echocardiography in clinical practice: evidence and reference values from the literature

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