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Current Opinion in Cardiology Sep 2019To summarize literature on the application of myocardial strain in patients with heart failure published since 2018. (Review)
Review
PURPOSE OF REVIEW
To summarize literature on the application of myocardial strain in patients with heart failure published since 2018.
RECENT FINDINGS
Left ventricular (LV) and right ventricular strain provides important prognostic information in patients with acute and chronic heart failure and new insights in disease mechanisms in amyloidosis. The addition of left atrial strain to current societal diastolic dysfunction criteria may improve detection of clinically relevant diastolic dysfunction. The recently developed method for noninvasive estimation of myocardial work incorporates loading conditions into the evaluation of LV performance that may be important for selection of patients for cardiac resynchronization therapy.
SUMMARY
Evidence linking myocardial strain to adverse outcomes in heart failure is steadily being developed. Although GLS seems to be ready for clinical use, further validation and standardization of RV, LA strain and myocardial work is needed.
Topics: Cardiac Resynchronization Therapy; Diastole; Echocardiography; Heart; Heart Atria; Heart Failure; Heart Ventricles; Humans; Myocardium; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 31219880
DOI: 10.1097/HCO.0000000000000653 -
Magnetic Resonance Imaging Clinics of... Feb 2015Magnetic resonance assessment of regional myocardial function is a novel potentially important tool for early identification of cardiac pathology. Many cardiac magnetic... (Review)
Review
Magnetic resonance assessment of regional myocardial function is a novel potentially important tool for early identification of cardiac pathology. Many cardiac magnetic resonance techniques have been developed for detection and quantification of regional strain abnormalities including steady-state free-precession CINE, tagging, displacement encoding with stimulated echoes, strain encoding imaging, and feature tracking. Potential clinical applications of magnetic resonance strain imaging include early detection of systolic dysfunction in heart failure patients with both ischemic and nonischemic etiologies.
Topics: Algorithms; Elastic Modulus; Elasticity Imaging Techniques; Heart Ventricles; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Reproducibility of Results; Sensitivity and Specificity; Ventricular Dysfunction
PubMed: 25476669
DOI: 10.1016/j.mric.2014.08.005 -
Seminars in Thoracic and Cardiovascular... 2015Congenitally corrected transposition of the great arteries or l-transposition of the great arteries is characterized by discordance of both the atrioventricular and... (Review)
Review
Congenitally corrected transposition of the great arteries or l-transposition of the great arteries is characterized by discordance of both the atrioventricular and ventriculoarterial connections. Physiologic repair of associated conditions, whereby the morphologic right ventricle remains the systemic ventricle, has resulted in unsatisfactory long-term outcomes due to the development of right ventricular failure and tricuspid valve regurgitation. While intuitively attractive, anatomic repair also has inherent challenges and risks, particularly for those patients who present late and require left ventricular retraining. Although early and intermediate-term outcomes for anatomic repair have been encouraging, longer-term follow-up has demonstrated concern for late left ventricular dysfunction in this subgroup of patients. Continued monitoring of this challenging patient population will clarify late outcomes and inform clinical management in the future.
Topics: Arterial Switch Operation; Congenitally Corrected Transposition of the Great Arteries; Humans; Transposition of Great Vessels; Ventricular Dysfunction, Left
PubMed: 25939841
DOI: 10.1053/j.pcsu.2015.01.002 -
Journal of the American College of... Feb 2015The highest-risk patients with heart failure with reduced ejection fraction are those with ischemic cardiomyopathy and severe left ventricular systolic dysfunction... (Review)
Review
The highest-risk patients with heart failure with reduced ejection fraction are those with ischemic cardiomyopathy and severe left ventricular systolic dysfunction (ejection fraction≤35%). The cornerstone of treatment is guideline-driven medical therapy for all patients and implantable device therapy for appropriately selected patients. Surgical revascularization offers the potential for improved survival and quality of life, particularly in patients with more extensive multivessel disease and the greatest degree of left ventricular systolic dysfunction and remodeling. These are also the patients at greatest short-term risk of mortality with coronary artery bypass graft surgery. The short-term risks of surgery need to be balanced against the potential for long-term benefit. This review discusses the evolving data on the role of surgical revascularization, surgical ventricular reconstruction, and mitral valve surgery in this high-risk patient population.
Topics: Echocardiography; Humans; Myocardial Revascularization; Severity of Illness Index; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 25677320
DOI: 10.1016/j.jacc.2014.10.070 -
Current Opinion in Cardiology Jan 2016With a combination of fetal catheter interventions and postnatal catheter and surgical interventions, the left ventricle in patients with hypoplastic left heart can... (Review)
Review
PURPOSE OF REVIEW
With a combination of fetal catheter interventions and postnatal catheter and surgical interventions, the left ventricle in patients with hypoplastic left heart can undergo significant increase in size and remodeling to support cardiac output. However, some will have persistent high left atrial pressures resulting in pulmonary edema and high pulmonary artery pressures, that is, diastolic dysfunction.
RECENT FINDINGS
The manuscript details the medical and surgical strategies to diagnose and treat diastolic dysfunction in this patient population to promote biventricular circulations.
SUMMARY
Often times, this diastolic dysfunction is related to the presence of endocardial fibroelastosis, which affects left ventricular filling and mitral valve function. Ongoing research is investigating what causes and promotes the development of endocardial fibroelastosis, and means to improve the medical and surgical treatment of diastolic dysfunction.
Topics: Cardiac Surgical Procedures; Diastole; Humans; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 26627316
DOI: 10.1097/HCO.0000000000000250 -
Heart, Lung & Circulation Aug 2021COVID-19 has rapidly spread around the world and threatened global health. Although this disease mainly affects the respiratory system, there is increasing evidence that... (Review)
Review
COVID-19 has rapidly spread around the world and threatened global health. Although this disease mainly affects the respiratory system, there is increasing evidence that SARS-CoV-2 also has effects on the cardiovascular system. Echocardiography is a valuable tool in the assessment of cardiovascular disease. It is cost-effective, widely available and provides information that can influence management. Given the risk of personnel infection and equipment contamination during echocardiography, leading world societies have recommended performing echocardiography only when a clinical benefit is likely, favouring focussed evaluations and using smaller portable equipment. In the past months, multiple reports have described a wide pattern of echocardiographic abnormalities in patients with COVID-19. This review summarises these findings and discusses the possible mechanisms involved.
Topics: Biomarkers; COVID-19; Echocardiography; Humans; Prognosis; SARS-CoV-2; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 33715970
DOI: 10.1016/j.hlc.2021.02.004 -
Anaesthesia and Intensive Care Jan 2018Sepsis continues to be a leading cause of mortality and morbidity in the intensive care unit. Cardiovascular dysfunction in sepsis is associated with worse short- and... (Review)
Review
Sepsis continues to be a leading cause of mortality and morbidity in the intensive care unit. Cardiovascular dysfunction in sepsis is associated with worse short- and long-term outcomes. Sepsis-related myocardial dysfunction is noted in 20%-65% of these patients and manifests as isolated or combined left or right ventricular systolic or diastolic dysfunction. Echocardiography is the most commonly used modality for the diagnosis of sepsis-related myocardial dysfunction. With the increasing use of ultrasonography in the intensive care unit, there is a renewed interest in sepsis-related myocardial dysfunction. This review summarises the current scope of literature focused on sepsis-related myocardial dysfunction and highlights the use of basic and advanced echocardiographic techniques for the diagnosis of sepsis-related myocardial dysfunction and the management of sepsis and septic shock.
Topics: Echocardiography; Humans; Sepsis; Shock, Septic; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 29361252
DOI: 10.1177/0310057X1804600104 -
Infection Jun 2021SARS-COV-2 infection can develop into a multi-organ disease. Although pathophysiological mechanisms of COVID-19-associated myocardial injury have been studied throughout...
PURPOSE
SARS-COV-2 infection can develop into a multi-organ disease. Although pathophysiological mechanisms of COVID-19-associated myocardial injury have been studied throughout the pandemic course in 2019, its morphological characterisation is still unclear. With this study, we aimed to characterise echocardiographic patterns of ventricular function in patients with COVID-19-associated myocardial injury.
METHODS
We prospectively assessed 32 patients hospitalised with COVID-19 and presence or absence of elevated high sensitive troponin T (hsTNT+ vs. hsTNT-) by comprehensive three-dimensional (3D) and strain echocardiography.
RESULTS
A minority (34.3%) of patients had normal ventricular function, whereas 65.7% had left and/or right ventricular dysfunction defined by impaired left and/or right ventricular ejection fraction and strain measurements. Concomitant biventricular dysfunction was common in hsTNT+ patients. We observed impaired left ventricular (LV) global longitudinal strain (GLS) in patients with myocardial injury (-13.9% vs. -17.7% for hsTNT+ vs. hsTNT-, p = 0.005) but preserved LV ejection fraction (52% vs. 59%, p = 0.074). Further, in these patients, right ventricular (RV) systolic function was impaired with lower RV ejection fraction (40% vs. 49%, p = 0.001) and reduced RV free wall strain (-18.5% vs. -28.3%, p = 0.003). Myocardial dysfunction partially recovered in hsTNT + patients after 52 days of follow-up. In particular, LV-GLS and RV-FWS significantly improved from baseline to follow-up (LV-GLS: -13.9% to -16.5%, p = 0.013; RV-FWS: -18.5% to -22.3%, p = 0.037).
CONCLUSION
In patients with COVID-19-associated myocardial injury, comprehensive 3D and strain echocardiography revealed LV dysfunction by GLS and RV dysfunction, which partially resolved at 2-month follow-up.
TRIAL REGISTRATION
COVID-19 Registry of the LMU University Hospital Munich (CORKUM), WHO trial ID DRKS00021225.
Topics: Aged; COVID-19; Echocardiography, Three-Dimensional; Female; Follow-Up Studies; Heart Ventricles; Hospitalization; Humans; Male; Middle Aged; Prospective Studies; SARS-CoV-2; Stroke Volume; Troponin T; Ventricular Dysfunction
PubMed: 33515390
DOI: 10.1007/s15010-020-01572-8 -
Circulation. Cardiovascular Imaging Jul 2021
Topics: Heart Ventricles; Humans; Ventricular Dysfunction, Left
PubMed: 34281364
DOI: 10.1161/CIRCIMAGING.121.013060 -
Chest Mar 2015In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the... (Review)
Review
In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.
Topics: Acute Disease; Critical Illness; Echocardiography; Fluid Therapy; Heart Ventricles; Humans; Prevalence; Respiration, Artificial; Ventricular Dysfunction, Right
PubMed: 25732449
DOI: 10.1378/chest.14-1335