Prognostic Impact of Diastolic Wall Strain in Patients at Risk for Heart Failure

Abstract

SummaryDiastolic wall strain (DWS) is based on the linear elastic theory, according to which decreased wall thinning during diastole reflects reduced left ventricular compliance and thus increased diastolic stiffness. Increased diastolic stiffness as assessed by DWS is associated with a worse prognosis in patients who have heart failure (HF) with preserved ejection fraction. However, there are no data about the prognostic value of DWS derived by M-mode echocardiography in patients at risk for HF. We retrospectively enrolled 1829 consecutive patients without prior HF who were hospitalized for cardiovascular (CV) diseases in our hospital between 2005 and 2012. Patients were divided into two groups stratified by DWS (median value 0.34). The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for HF. Over a 4.2-year median follow-up, adverse events were observed in 322 patients (17.6%). In Kaplan-Meier analysis, patients with low DWS (≤ 0.34, n = 915) showed worse prognoses than those with high DWS (> 0.34, n = 914) (MACE incidence 39.4% versus 31.9%, P = 0.011). In multivariate Cox proportional hazards analysis after the adjustment for age, sex, and echocardiographic parameters, low DWS (≤ 0.34) was significantly associated with the incidence of MACE (hazard ratio: 1.26, 95% confidence interval: 1.01-1.59; P = 0 .045). In patients without prior HF, DWS is an independent predictor of MACE. Simple assessment of DWS might improve risk stratification for CV events in those patients. (Int Heart J 2017; 58: 250-256)

Strain Values of Left Ventricular Segments Reduce Non-homogeneously in Dilated Cardiomyopathy with Moderately and Severely Deteriorated Heart Function Assessed by MRI Tissue Tracking Imaging

“…Until recently, ultrasonographic strain analysis has been the mainstay for assessing regional and global myocardial performance. [3][4][5] Matsumoto, et al 6) demonstrated that 3D global circumferential strain (GCS) below 2.71% with dobutamine stress assessed by echocardiography could predict cardiovascular events with 83% sensitivity and 80% specificity. Cardiac magnetic resonance (CMR) imaging based on steady-state free precession (SSFP) cine sequence has been successfully used to evaluate wall motion and strain changes.…”

Interleukin-18

“…Larger scale and long-term follow-up studies are required to verify the relationship between the common risk factor of MACE and IL-18. Second, other factors may also influence MACE, such as IL-12, 12,23) which we did not estimate in this study. Third, we did not compare IL-18 with other inflammatory cytokines in predicting MACE in hemodialysis.…”

Medical Castration is a Rare but Possible Trigger of Torsade de Pointes and Ventricular Fibrillation

“…An impaired relaxation pattern of the LV, which might be normal in elderly people, was also present. 6,14) We did not perform any tissue velocity 15) or strain imaging 15,16) in this patient. However, all of those measurements indicated that the patient might have subclinical diastolic dysfunction before the castration therapy.…”