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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 -
Journal of the American College of... Aug 2003
Topics: Clinical Trials as Topic; Diuretics; Heart Failure; Humans; Potassium; Renin-Angiotensin System; Spironolactone; Ventricular Dysfunction
PubMed: 12932606
DOI: 10.1016/s0735-1097(03)00766-6 -
The Journal of Thoracic and... Jul 2001Right heart failure after cardiopulmonary bypass can result in severe hemodynamic compromise with high mortality, but the underlying mechanisms remain poorly understood....
BACKGROUND
Right heart failure after cardiopulmonary bypass can result in severe hemodynamic compromise with high mortality, but the underlying mechanisms remain poorly understood. After ischemia-induced right ventricular failure, alterations in the interventricular septal position decrease left ventricular compliance and limit filling but may also distort left ventricular geometry and compromise contractility and relaxation. This study investigated the effect of acute isolated right ventricular ischemia on biventricular performance and interaction and the response of subsequent right ventricular unloading by use of a modified Glenn shunt.
METHODS
In 8 pigs isolated right ventricular ischemic failure was induced by means of selective coronary ligation. A modified Glenn circuit was then established by a superior vena cava-pulmonary artery connection. Ventricular performance was determined by conductance catheter-derived right ventricular pressure-volume loops and left ventricular pressure-segment length loops. Hemodynamic data at baseline, after right ventricular ischemia, and after institution of the Glenn circuit were obtained during inflow occlusion, and the load-independent contractile indices were derived.
RESULTS
Right ventricular free-wall ischemia resulted in acute right ventricular dilation (118 +/- 81 mL vs 169 +/- 70 mL, P =.0008) and impairment of left ventricular contractility indicated by the reduced end-systolic pressure-volume relation slope (50.0 +/- 19 mm Hg/mm vs 18.9 +/- 8 mm Hg/mm, P =.002) and preload recruitable stroke work index slope (69.6 +/- 26 erg x cm(-3) x 10(3) vs 39.7 +/- 13 erg x cm(-3) x 10(3), P =.003). In addition, left ventricular relaxation (tau) was significantly prolonged (33.3 +/- 10 ms vs 53.0 +/- 16 ms, P =.012). Right ventricular unloading with the Glenn shunt reduced right ventricular dilation and significantly improved left ventricular contraction, end-systolic pressure-volume relation slope (18.9 +/- 8 mm Hg/mm vs 35.8 +/- 18 mm Hg/mm, P =.002), preload recruitable stroke work index slope (39.7 +/- 26 erg x cm(-3) x 10(3) vs 63.0 +/- 22 erg x cm(-3) x 10(3), P =.003), and diastolic performance (tau 53.0 +/- 16 ms vs 43.5 +/- 13 ms, P =.001).
CONCLUSIONS
Right ventricular ischemia-induced dilation resulted in acute impairment of left ventricular contractility and relaxation. A modified Glenn shunt attenuated the left ventricular dysfunction by limiting right ventricular dilation and restoring left ventricular cavity geometry.
Topics: Animals; Diastole; Dilatation, Pathologic; Disease Models, Animal; Female; Heart Bypass, Right; Heart Ventricles; Hemodynamics; Male; Myocardial Ischemia; Swine; Systole; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 11436040
DOI: 10.1067/mtc.2001.114632 -
Herz Mar 2023Arrhythmia-induced cardiomyopathy (AIC) is classified as a form of dilated cardiomyopathy in which left ventricular systolic dysfunction (LVSD) is triggered by... (Review)
Review
Arrhythmia-induced cardiomyopathy (AIC) is classified as a form of dilated cardiomyopathy in which left ventricular systolic dysfunction (LVSD) is triggered by tachycardic or arrhythmic heart rates. On the one hand AIC can develop in patients without cardiac disease and on the other hand it can appear in patients with pre-existing LVSD, leading to a further reduction in left ventricular (LV) ejection fraction. A special aspect of AIC is the potential termination or partial reversibility of LVSD; thus, AIC is curatively treatable by the elimination of the underlying arrhythmia. Since arrhythmias are often seen merely as a consequence than as an underlying cause of LVSD, and due to the fact that the diagnosis of AIC can be made only after recovery of LV function, the prevalence of AIC is probably underestimated in clinical practice. Pathophysiologically, animal models have shown that continuous tachycardic pacing induces consecutive changes such as the occurrence of LVSD, increased filling pressures, LV dilatation, and decreased cardiac output. After termination of tachycardia, reversibility of the described pathologies can usually be observed. Studies in human ventricular myocardium have recently demonstrated that various cellular structural and functional mechanisms are activated even by normofrequent atrial fibrillation, which may help to explain the clinical AIC phenotype.
Topics: Animals; Humans; Atrial Fibrillation; Heart Diseases; Ventricular Function, Left; Ventricular Dysfunction, Left; Cardiomyopathy, Dilated
PubMed: 36695877
DOI: 10.1007/s00059-022-05158-y -
Acta Medica Portuguesa 2007The Peripartum Cardiomyopathy is a rare form of heart disease, of uncertain etiology, more common in black and multiparous women, older than thirty years old. Is defined...
The Peripartum Cardiomyopathy is a rare form of heart disease, of uncertain etiology, more common in black and multiparous women, older than thirty years old. Is defined as development of maternal congestive heart failure, in the last month of pregnancy or within five months after delivery, with documented left ventricular systolic dysfunction, in the absence of a demonstrable cause for heart failure in a previously healthy woman. The diagnosis is commonly established with chest radiography, electrocardiogram and echocardiography. Treatment consist in medical therapy with inotropic support, afterload and preload redution, and anticoagulation. Surgical care with cardiac transplantation is indicated in severe cases with progressive left ventricular dysfunction, despite medical therapy. Prognosis seems dependent on recovery of left ventricular function and maternal mortality rates could reach 50%. Future pregnancy is not recommended in woman with persistent ventricular dysfunction. The authors present a case report in a black nuliparous woman at term, with 33 years old, without previous heart disease that presents a sudden heart failure, with ventricular dysfunction on echocardiography, after the caesarean, with recovery of normal ventricular function at 11th day of puerperium.
Topics: Adult; Female; Heart Failure; Humans; Puerperal Disorders; Ventricular Dysfunction
PubMed: 18282442
DOI: No ID Found -
Journal of Critical Care Aug 2013The purpose of the study is to evaluate the incidence and hemodynamic consequences of right ventricular (RV) and left ventricular (LV) dysfunction in critically ill...
PURPOSE
The purpose of the study is to evaluate the incidence and hemodynamic consequences of right ventricular (RV) and left ventricular (LV) dysfunction in critically ill patients with H1N1 infection.
PATIENTS AND METHODS
This is a retrospective analysis of all patients admitted to the intensive care unit of an academic hospital between October 2009 and March 2011 with severe H1N1 infection. Hemodynamic measurements and respiratory conditions were noted daily during the intensive care unit stay.
RESULTS
Forty-six patients were admitted with severe H1N1 infection. Echocardiography was obtained in 39 patients on admission: 28 (72%) had abnormal ventricular function, of whom 13 (46%) had isolated LV abnormalities, 11 (39%) had isolated RV dysfunction, and 4 (14%) had biventricular dysfunction. Echocardiography was repeated in 19 of the 39 patients during their hospitalization: RV function tended to worsen with time, but LV function tended to normalize. The ventricular abnormalities were not associated with history, severity of the respiratory failure, or hemodynamic status. However, patients with ventricular dysfunction needed more aggressive therapy, including more frequent use of vasopressor and inotropic agents and of rescue ventilatory strategies, such as inhaled nitric oxide, prone positioning, and extracorporeal membrane oxygenation.
CONCLUSIONS
These observations emphasize the high incidence of cardiac dysfunction in patients with H1N1 influenza infections.
Topics: Belgium; Biomarkers; Cardiac Output; Chi-Square Distribution; Critical Illness; Echocardiography; Extracorporeal Membrane Oxygenation; Female; Hemodynamics; Humans; Incidence; Influenza A Virus, H1N1 Subtype; Influenza, Human; Male; Middle Aged; Statistics, Nonparametric; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 23566732
DOI: 10.1016/j.jcrc.2013.01.010 -
Prevention and Treatment of Right Ventricular Failure During Left Ventricular Assist Device Therapy.Critical Care Clinics Jul 2018Left ventricular assist devices (LVAD) are increasingly used for the treatment of end-stage heart failure. Right ventricular (RV) failure after LVAD implantation is an... (Review)
Review
Left ventricular assist devices (LVAD) are increasingly used for the treatment of end-stage heart failure. Right ventricular (RV) failure after LVAD implantation is an increasingly common clinical problem, occurring in patients early after continuous flow LVAD implant. RV failure is associated with a substantial increase in post-LVAD morbidity and mortality. RV failure can be predicted using preoperative hemodynamic, clinical, and echocardiographic variables and a variety of risk prediction algorithms. However, RV failure may also develop due to unanticipated intraoperative or perioperative factors. Early recognition and treatment are critical in terms of mitigating the impact of RV failure on post-LVAD outcomes.
Topics: Heart Failure; Heart Ventricles; Heart-Assist Devices; Humans; Perioperative Care; Prosthesis Implantation; Risk Assessment; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 29907275
DOI: 10.1016/j.ccc.2018.03.001 -
Journal of Cardiovascular Translational... Feb 2015The diastolic intraventricular ring vortex formation and pinch-off process may provide clinically useful insights into diastolic function in health and disease. The... (Review)
Review
The diastolic intraventricular ring vortex formation and pinch-off process may provide clinically useful insights into diastolic function in health and disease. The vortex ring formation time (FT) concept, based on hydrodynamic experiments dealing with unconfined (large tank) flow, has attracted considerable attention and popularity. Dynamic conditions evolving within the very confined space of a filling, expansible ventricular chamber with relaxing and rebounding, and viscoelastic muscular boundaries diverge from unconfined (large tank) flow and encompass rebounding walls' suction and myocardial relaxation. Indeed, clinical/physiological findings seeking validation in vivo failed to support the notion that FT is an index of normal/abnormal diastolic ventricular function. Therefore, FT as originally proposed cannot and should not be utilized as such an index. Evidently, physiologically accurate models accounting for coupled hydrodynamic and (patho)physiological myocardial wall interactions with the intraventricular flow are still needed to enhance our understanding and yield diastolic function indices useful and reliable in the clinical setting.
Topics: Animals; Diastole; Elasticity; Humans; Hydrodynamics; Models, Cardiovascular; Time Factors; Ventricular Dysfunction; Ventricular Function; Viscosity
PubMed: 25609509
DOI: 10.1007/s12265-015-9607-7 -
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 -
Heart Failure Clinics Apr 2013Takotsubo cardiomyopathy (TTC) is characterized by transient and reversible left ventricular (LV) systolic dysfunction due to extended myocardial stunning. Despite a... (Review)
Review
Takotsubo cardiomyopathy (TTC) is characterized by transient and reversible left ventricular (LV) systolic dysfunction due to extended myocardial stunning. Despite a good long term prognosis, approximately one-third of patients with TTC experience life-threatening complications during the acute phase. Echocardiography is the first imaging modality for an early evaluation of LV systolic and diastolic function in patients with TTC. Moreover, echocardiography allows the detection of specific findings associated with TTC, such as LV outflow tract obstruction, mitral regurgitation, and right ventricular involvement, providing crucial information for clinical management and therapy and for monitoring myocardial function recovery during the follow-up.
Topics: Echocardiography; Heart Ventricles; Humans; Takotsubo Cardiomyopathy; Ventricular Dysfunction, Left
PubMed: 23562116
DOI: 10.1016/j.hfc.2012.12.014