ORCID Profile
0000-0002-3333-3317
Current Organisations
University of South Australia
,
Flinders Medical Centre
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Oxford University Press (OUP)
Date: 11-01-2013
DOI: 10.1093/EHJCI/JES323
Abstract: The aims of this study were (1) to evaluate the relationship between novel two-dimensional transthoracic indices of left atrial (LA) mechanical function (speckle-tracking- and tissue Doppler-derived parameters), conventional indices (A-wave peak velocity and velocity-time integral, and A' velocity), and transoesophageal echocardiographic parameters (LA appendage emptying velocity and spontaneous echocardiographic contrast) and (2) to assess to clinical feasibility of these novel transthoracic echocardiographic indices. Transthoracic echocardiography was performed immediately prior to or following clinically indicated transoesophageal echocardiography in 100 in iduals. Longitudinal reservoir LA strain, and reservoir, conduit, and atrial contractile strain rate were measured by both speckle-tracking and tissue Doppler approaches. Inter- and intra-observer variability in 20 randomly selected cases was evaluated by the Bland-Altman technique. The time required per analysis for these novel transthoracic echocardiographic indices was recorded. In relation to LA appendage emptying velocity, the respective absolute r-values for speckle-tracking reservoir strain, and reservoir, conduit, and atrial contractile strain rate were 0.53 (P < 0.001), 0.40 (P < 0.001), 0.21 (P = 0.05), and 0.61 (P < 0.001). The absolute r-values for tissue Doppler reservoir strain, and reservoir, conduit, and atrial contractile strain rate were 0.57 (P < 0.005), 0.53 (P < 0.001), 0.022 (P = 0.8), and 0.46 (P < 0.001), respectively. In contrast, the r-values for A-wave peak velocity and velocity-time integral, and A' velocity were 0.20 (P = 0.01), 0.26 (P = 0.05), and 0.35 (P = 0.007), respectively. Speckle-tracking-derived parameters achieved the greatest area-under-the-receiver-operating characteristic curve in the identification of moderate-severe LA spontaneous echocardigraphic contrast and were more rapidly measured (P < 0.001), while exhibiting similar reproducibility to tissue Doppler-derived measures. Assessment of LA mechanical function using speckle-tracking echocardiography is a valid approach compared with transoesophageal echocardiography, and is clinically feasible.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.ECHO.2019.04.006
Abstract: Extreme levels of both strength and aerobic training result in increased left ventricular (LV) and right ventricular (RV) volumes and LV mass, a key component of athletes' heart. The aim of this study was to document temporal changes in the hearts of elite professional athletes (Australian Football League players) over a 2- to 6-year period. Thirty-six Australian Football League players with 3.5 ± 2.7 years of professional training at enrollment prospectively underwent echocardiography in the preseasons of 2009, 2013, and 2015. At each time point, LV dimension and contractility and RV dimension, area, and contractility were measured using two-dimensional echocardiography. LV volumes, ejection fraction, and mass were measured using three-dimensional echocardiography. The mean age at baseline was 21.8 ± 2.6 years (range, 18-29 years). Most players (n = 20) had increases in fitness between studies (mean maximal oxygen uptake, 62.3 ± 3.6 vs 64.3 ± 2.1 mL/kg/min). In these players, there were increases in both LV and RV size and in LV mass. Players who were >25 years of age at their baseline scans demonstrated a trend toward increases in RV size and a decline in RV global longitudinal strain. Fitness level and playing position also affected the degree of physiological athletic cardiac remodeling. Australian football is a sport that involves both strength and aerobic training. This study, unique in its length and detail, demonstrates that remodeling in the athlete's heart is a continuous spectrum of change. This remodeling occurs over time in response to high levels of exercise, with proportional increase in LV mass and LV dimensions.
Publisher: Wiley
Date: 10-06-2020
DOI: 10.1002/JOA3.12363
Publisher: Elsevier BV
Date: 2008
Publisher: Oxford University Press (OUP)
Date: 10-05-2008
DOI: 10.1093/EJECHOCARD/JEN148
Abstract: To determine whether the degree of untwisting of the apex in early diastole is related to established parameters of diastolic function. Data from 71 hospital inpatients with preserved left ventricular systolic function who underwent standard two-dimensional echocardiography was analysed using an off-line speckle tracking software package. Early diastolic mitral inflow velocity (e), mitral septal annular tissue Doppler velocity (e'), and the rate of early diastolic apical untwist in degrees per second (rotR) from a parasternal short-axis view of the apex were all measured. Of the 71 patients, 14 had normal diastolic function, 25 had an abnormal relaxation pattern, 27 had a pseudonormalized pattern, and 5 had a restrictive pattern as defined by standard echocardiography criteria. Both e' and the ratio of e:e' correlated with the rate (speed) of early diastolic apical untwist (rotR) (P < 0.001 for both). This non-invasive assessment of apical diastolic untwist is related to established echocardiographic measures of diastolic function and may illustrate the importance of a ventricular suction effect in varying left ventricular filling states.
Publisher: Informa UK Limited
Date: 12-11-2017
DOI: 10.1080/07853890.2016.1243801
Abstract: In the Western world, there are now millions of patients who undergo clinical procedures that evaluate coronary artery status each year. Methods span from direct imaging using angiography, computerized tomography, to nuclear magnetic imaging as well as to functional studies, such as positron emission tomography. These techniques have provided significant information to physicians, but there is still need for an improved accessibility. Angiographic methods are expensive and expose the patient to significant amounts of radiation, undesirable in younger patients. Among the novel technologies for coronary diagnostics, transthoracic echocardiography (TTE) of coronary arteries has provided an important alternative, particularly in everyday practice. Diagnostic arterial TTE can allow determination of the coronary wall lumen in at least three major coronary segments (left main [LM], left arterial descending [LAD] and right coronary artery [RCA]). Coronary wall thickness using the LAD has been preliminarily shown to be related to the risk of coronary events. Since it is well ascertained that coronary lesions found in any location indicate that at least 80% of the coronary tree is affected, this is very important clinical information. Evaluation of coronary status by TTE is a novel technology providing important information in ischemic syndromes, in cases of coronary malformations and other coronary diseases. KEY MESSAGES Coronary evaluation can be carried out by a variety of both invasive and non-invasive methods, many requiring radiation exposure or patient immobility. Transthoracic echocardiography (TTE) of the coronaries can, in particular, evaluate the coronary wall thickness, and this may be directly related to the coronary disease risk. TTE is a useful method for the monitoring of coronary flow reserve and can allow the detection of coronary malformations.
Publisher: American Physiological Society
Date: 06-2019
DOI: 10.1152/JAPPLPHYSIOL.01058.2018
Abstract: Recently, buffered salt solutions and 20% albumin (small volume resuscitation) have been advocated as an alternative fluid for intravenous resuscitation. The relative comparative efficacy and potential adverse effects of these solutions have not been evaluated. In a randomized, double blind, cross-over study of six healthy male subjects we compared the pulmonary and hemodynamic effects of intravenous administration of 30 ml/kg of 0.9% saline, Hartmann's solution and 4% albumin, and 6 ml/kg of 20% albumin (albumin dose equivalent). Lung tests (spirometry, ultrasound, impulse oscillometry, diffusion capacity, and plethysmography), two- to three-dimensional Doppler echocardiography, carotid applanation tonometry, blood gases, serum/urine markers of endothelial, and kidney injury were measured before and after each fluid bolus. Data were analyzed with repeated measures ANOVA with effect of fluid type examined as an interaction. Crystalloids caused lung edema [increase in ultrasound B line ( P = 0.006) and airway resistance ( P = 0.009)], but evidence of lung injury [increased angiopoietin-2 ( P = 0.019)] and glycocalyx injury [increased syndecan ( P = 0.026)] was only observed with 0.9% saline. The colloids caused greater left atrial stretch, decrease in lung volumes, and increase in diffusion capacity than the crystalloids, but without pulmonary edema. Stroke work increased proportionally to increase in preload with all four fluids ( R 2 = 0.71). There was a greater increase in cardiac output and stroke volume after colloid administration, associated with a reduction in afterload. Hartmann’s solution did not significantly alter ventricular performance. Markers of kidney injury were not affected by any of the fluids administrated. Bolus administration of 20% albumin is both effective and safe in healthy subjects. NEW & NOTEWORTHY Bolus administration of 20% albumin is both effective and safe in healthy subjects when compared with other commonly available crystalloids and colloidal solution.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 04-2023
DOI: 10.1016/J.ECHO.2022.10.019
Abstract: Significant (moderate or greater) mitral regurgitation (MR) could augment the hemodynamic effects of aortic valvular disease in patients with bicuspid aortic valve (BAV), imposing a greater hemodynamic burden on the left ventricle and atrium, possibly culminating in a faster onset of left ventricular dilation and/or symptoms. The aim of this study was to determine the prevalence and prognostic implications of significant MR in patients with BAV. In this large, multicenter, international registry, a total of 2,932 patients (mean age, 48 ± 18 years 71% men) with BAV were identified. All patients were evaluated for the presence of significant primary or secondary MR by transthoracic echocardiography and were followed up for the end points of all-cause mortality and event-free survival. Overall, 147 patients (5.0%) had significant primary (1.5%) or secondary (3.5%) MR. Significant MR was associated with all-cause mortality (hazard ratio [HR], 2.80 95% CI, 1.91-4.11 P < .001) and reduced event-free survival (HR, 1.97 95% CI, 1.58-2.46 P < .001) on univariable analysis. MR was not associated with all-cause mortality (adjusted HR, 1.33 95% CI, 0.85-2.07 P = .21) or event-free survival (adjusted HR, 1.10 95% CI, 0.85-1.42 P = .49) after multivariable adjustment. However, sensitivity analyses demonstrated that significant MR not due to aortic valve disease retained an independent association with mortality (adjusted HR, 1.81 95% CI, 1.04-3.15 P = .037). Subgroup analyses demonstrated an independent association between significant MR and all-cause mortality for in iduals with significant aortic regurgitation (HR, 2.037 95% CI, 1.025-4.049 P = .042), although this association was not observed for subgroups with significant aortic stenosis or without significant aortic valve dysfunction. Significant MR is uncommon in patients with BAV. Following adjustment for important confounding variables, significant MR was not associated with adverse prognosis in this large study of patients with BAV, except for the patient subgroup with moderate to severe aortic regurgitation. In addition, significant MR not due to aortic valve disease demonstrated an independent association with all-cause mortality.
Publisher: Springer Science and Business Media LLC
Date: 16-03-2022
DOI: 10.1007/S00421-022-04931-5
Abstract: Exercise improves measures of cardiovascular (CV) health and function. But as traditional measures improve gradually, it can be difficult to identify the effectiveness of an exercise intervention in the short-term. Left ventricular global longitudinal strain (LVGLS) is a highly sensitive CV imaging measure that detects signs of myocardial dysfunction prior to more traditional measures, with reductions in LVGLS a strong prognostic indicator of future CV dysfunction and mortality. Due to its sensitivity, LVGLS may offer useful method of tracking the effectiveness of an exercise intervention on CV function in the short-term, providing practitioners useful information to improve patient care in exercise settings. However, the effect of exercise on LVGLS is unclear. This systematic review and meta-analysis aimed to determine the effect exercise has on LVGLS across a range of populations. Included studies assessed LVGLS pre–post an exercise intervention (minimum 2 weeks) in adults 18 years and over, and were published in English from 2000 onwards. Study-level random-effects meta-analyses were performed using Stata (v16.1) to calculate summary standardized mean differences (SMD) and 95% confidence intervals (CI). 39 studies met selection criteria, with 35 included in meta-analyses (1765 participants). In primary analyses, a significant improvement in LVGLS was observed in populations with CV disease (SMD = 0.59 95% CI 0.16–1.02 p = 0.01), however, no significant effect of exercise was observed in CV risk factor and healthy populations. In populations with CV disease, LVGLS could be used as an early biomarker to determine the effectiveness of an exercise regime before changes in other clinical measures are observed.
Publisher: Elsevier BV
Date: 2009
Publisher: International Heart Journal (Japanese Heart Journal)
Date: 31-07-2018
DOI: 10.1536/IHJ.17-230
Abstract: Aortic valve dysfunction and aortic wall changes are well-known complications of bicuspid aortic valve (BAV) disease. The aim of the present study was to investigate whether a remodeling process of the left ventricle (LV) is present in patients with isolated BAV. Twenty-two consecutive patients (39 ± 15 years, 9 males) with clinically normal BAV and 18 age- and gender-matched control subjects (37 ± 10 years, 9 males) were included. Cardiovascular magnetic resonance (CMR) imaging was performed to evaluate LV function, aortic valve morphology, aortic orifice area, and ascending aorta (AA) dimensions. Tissue-tracking analysis was applied to assess LV systolic and diastolic myocardial mechanics in the longitudinal, circumferential, and radial direction and AA circumferential strain (CS). No significant difference was observed between BAV and controls regarding LV ejection fraction and LV mass index. Tissue-tracking analysis demonstrated that BAV patients had significantly impaired LV systolic and diastolic myocardial mechanics. BAV patients had also significantly lower AA CS compared with controls. At multivariate analysis, the presence of BAV was the only variable significantly and independently related to the impaired AA and LV systolic myocardial mechanics. In conclusion, LV myocardial deformation properties are impaired among BAV patients. The impairment of LV systolic mechanics observed in BAV patients appears to be related only to the congenital abnormality of the aortic valve itself.
Publisher: Elsevier BV
Date: 2010
Publisher: AME Publishing Company
Date: 10-2019
Publisher: Wiley
Date: 25-01-2013
DOI: 10.1111/ECHO.12136
Abstract: Recently it has been demonstrated that high resolution transthoracic echocardiography (HRTTE) is able to detect differences in the wall thickness of the left anterior descending coronary artery (LAD) between patients with coronary artery disease (CAD) and normal volunteers. We sought to validate this technique, develop a normal range of values and demonstrate the test-retest variability of each measurement. Two hundred forty-two volunteer participants had a HRTTE study to measure their LAD wall thickness, luminal, and external diameters. Thirty of these subjects had these measurements taken on 3 separate occasions by 2 different echosonographers. All subjects were free of clinical CAD, hypertension, hyperlipidemia, and diabetes mellitus. The average anterior wall thickness was 1.1 ± 0.2 mm posterior wall thickness was 1.1 ± 0.2 mm, luminal diameter 2.2 ± 0.6 mm, and external elastic membrane (EEM) diameter 4.5 ± 0.9 mm. The bias of the measurements within the same operator for LAD wall thickness, luminal diameter, and EEM was 0.042, -0.06, and -0.077 mm, respectively. The bias of the measurements between 2 different operators for LAD wall thickness, luminal diameter, and EEM was 0.082, -0.077, and -0.027 mm, respectively. In conclusion, HRTTE measurement of the LAD vessel is reproducible within and between operators in normal volunteers. This technique therefore warrants further study as a potential screening modality for subclinical coronary atherosclerosis.
Publisher: Elsevier BV
Date: 07-2022
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2019
Publisher: Wiley
Date: 02-05-2017
DOI: 10.1002/JMRI.25720
Abstract: Infiltrative cardiomyopathy represents a heterogeneous group of diseases of the heart tissue with similar phenotypic expression. The condition is rare, but can be easily mistaken for other more common conditions of the heart. The diagnosis of infiltrative cardiomyopathy is therefore challenging and has often required the use of invasive procedures in the past. In the last decade there have been great advances in non-invasive cardiac imaging modalities like echocardiography, cardiovascular magnetic resonance and nuclear imaging. Although no single imaging modality abnormality on its own is pathognomic for infiltrative cardiomyopathy, a combination of these different modalities are synergistic, and can greatly aid in the clinical diagnosis. In this review, we describe these advancements in non-invasive cardiac imaging modalities with a particular focus on cardiovascular magnetic resonance imaging. 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018 :44-59.
Publisher: Oxford University Press (OUP)
Date: 21-01-2019
DOI: 10.1093/EHJCI/JEY220
Abstract: Myocardial oxygenation is impaired in hypertrophic cardiomyopathy (HCM) patients with left ventricular hypertrophy (LVH), and possibly also in HCM gene carriers without LVH. Whether these oxygenation changes are also associated with abnormalities in diastolic function or left ventricular (LV) strain are unknown. We evaluated 60 subjects: 20 MYBPC3 gene positive patients with LVH (G+LVH+), 18 MYBPC3 gene positive without LVH (G+LVH−), 11 gene negative siblings (G−), and 11 normal controls (NC). All subjects underwent 2D transthoracic echocardiography and cardiovascular magnetic resonance imaging for assessment of ventricular volumes, mass, and myocardial oxygenation at rest and adenosine stress using the blood oxygen level dependent (BOLD) technique. Maximal septal thickness was 20 mm in the G+LVH+ group, vs. 9 mm for the G+LVH− group. As expected, the G+LVH+ group had a more blunted myocardial oxygenation response to stress when compared with the G+LVH− group (−5% ± 3% vs. 2% ± 4%, P 0.05), G− siblings (−5% ± 3% vs. 11% ± 4%, P 0.0001) and NC (−5% ± 3% vs. 15% ± 4%, P 0.0001). A blunted BOLD response to stress was also seen in G+LVH− subjects when compared with gene negative siblings (2% ± 4% vs. 11% ± 4%, P 0.05) and NC (15% ± 4%, P 0.050). G+LVH+ patients exhibited abnormal diastolic function including lower Eʹ, higher E to Eʹ ratio and greater left atrial area compared with the G+LVH− subjects who all had normal values for these indices. Myocardial deoxygenation during stress is observed in MYBPC3 HCM patients, even in the presence of normal LV diastolic function, LV global longitudinal strain, and LV wall thickness.
Publisher: Oxford University Press (OUP)
Date: 09-03-2022
Abstract: Breast cancer (BC) patients undergoing chemotherapy are at risk of developing cancer therapy-related cardiac dysfunction (CTRCD). Exercise has been proposed to prevent CTRCD however, its effectiveness remains unclear. The aim of this systematic review was to establish the effect of exercise on global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF) in BC patients undergoing chemotherapy, to determine if exercise can prevent the development of CTRCD. Four databases (Medline, Scopus, eMbase, SPORTDiscus) were searched. Studies were eligible for inclusion if they measured GLS or LVEF prior to and following an exercise intervention of any length in BC patients undergoing chemotherapy and were published in English from 2000 onwards. Risk of bias was evaluated using the QUADAS-2 tool. Of the 398 studies screened, eight were eligible. Changes were similar in exercising (EX) and non-exercising (CON) groups for GLS (EX: pre: −19.6 ± 0.4, post: −20.1 ± 1.0, CON: pre: −20.0 ± 0.4, post: −20.1 ± 1) and LVEF (EX: pre: 58.5 ± 4.1%, post: 58.6 ± 2%, CON: pre: 56.6 ± 4.2%, post: 55.6 ± 4.6%). Exercise maintained or improved peak oxygen uptake (VO2peak) during chemotherapy, while declines were observed in non-exercising groups. The included studies were limited by methodological deficiencies. The ability of exercise to prevent CTRCD is unclear. However, exercise positively impacts cardiorespiratory fitness in BC patients undergoing chemotherapy. Future research must address the methodological limitations of current research to understand the true effect of exercise in the prevention of CTRCD.
Publisher: BMJ
Date: 08-04-2021
DOI: 10.1136/HEARTJNL-2020-318907
Abstract: To investigate the prognostic value of left atrial volume index (LAVI) in patients with moderate to severe aortic regurgitation (AR) and bicuspid aortic valve (BAV). 554 in iduals (45 (IQR 33–57) years, 80% male) with BAV and moderate or severe AR were selected from an international, multicentre registry. The association between LAVI and the combined endpoint of all-cause mortality or aortic valve surgery was investigated with Cox proportional hazard regression analyses. Dilated LAVI was observed in 181 (32.7%) patients. The mean indexed aortic annulus, sinus of Valsalva, sinotubular junction and ascending aorta diameters were 13.0±2.0 mm/m 2 , 19.4±3.7 mm/m 2 , 16.5±3.8 mm/m 2 and 20.4±4.5 mm/m 2 , respectively. After a median follow-up of 23 (4–82) months, 272 patients underwent aortic valve surgery (89%) or died (11%). When compared with patients with normal LAVI ( mL/m 2 ), those with a dilated LAVI (≥35 mL/m 2 ) had significantly higher rates of aortic valve surgery or mortality (43% and 60% vs 23% and 36%, at 1 and 5 years of follow-up, respectively, p .001). Dilated LAVI was independently associated with reduced event-free survival (HR=1.450, 95% CI 1.085 to 1.938, p=0.012) after adjustment for LV ejection fraction, aortic root diameter, LV end-diastolic diameter and LV end-systolic diameter. In this large, multicentre registry of patients with BAV and moderate to severe AR, left atrial dilation was independently associated with reduced event-free survival. The role of this parameter for the risk stratification of in iduals with significant AR merits further investigation.
Publisher: Elsevier BV
Date: 03-2020
Publisher: Wiley
Date: 08-04-2023
DOI: 10.1002/JMRS.676
Abstract: Linking in idual competencies to entrustable professional tasks provides a holistic view of Sonography graduate work readiness. The Australian Sonographers Accreditation Registry (ASAR) publishes a set of entrustable professional activities (EPAs) as part of its Standards for Accreditation of Sonography Courses. EPAs are distinct ultrasound examinations grouped within six critical practice units. This study reports on industry perspectives of current EPAs and their classification for graduates completing general sonography courses in Australia. The article also examines the value of EPAs and links their function to the assessment of graduate competency. An online survey tool elicited stakeholder feedback on graduate EPAs across six critical practice units and the potential for including a new Paediatric unit. From an original s le size of 655, 309 responded to questions about general sonography courses. A majority (55.3%) recommended no changes to the existing EPA list, and 44.7% recommended amending the list. From respondents that recommended changes (138/309), all current EPAs received % agreement to be retained in addition, nine new examinations received % agreement for inclusion at the graduate level. Whilst 42.7% (132/309) supported the current ASAR model requiring competency in five out of six critical practice units, 45.6% (141/309) recommended increasing it to all six. There was limited support, 11.7% (36/309), to reduce this number. Responding to the potential to add a new Paediatric specific critical practice unit, 61.8% (181/293) recommended its inclusion. The findings demonstrate that the current list of EPAs aligns with industry expectations. In contrast, there are ergent views on the modelling and grouping of critical practice units. The article's critical analysis of the results and implications provides stakeholders with a practical approach to clinical teaching and EPA assessment, and helps to inform any review of accreditation standards.
Publisher: Elsevier BV
Date: 2010
Publisher: Wiley
Date: 11-2012
Publisher: Elsevier BV
Date: 2009
Publisher: Wiley
Date: 09-2020
DOI: 10.1002/SONO.12236
Publisher: Elsevier BV
Date: 2008
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.IJCARD.2017.05.100
Abstract: To investigate the left ventricular (LV) functional, morphological, and structural features revealed by cardiac magnetic resonance (CMR) in children/adolescents with isolated LV non-compaction (iLVNC), and to compare them with those observed in young adults with iLVNC and healthy controls. 56 subjects were included: 12 children/adolescents (mean age 15±3years, 75% male) and 20 young adults (mean age 35±7years, 75% male) with first diagnosis of iLVNC, 12 healthy children/adolescents (mean age 15±3years, 75% male) and 12 healthy young adults (mean age 34±8years, 75% male). CMR with late gadolinium enhancement (LGE) imaging was performed to evaluate LV function, extent of LV trabeculation, and presence/extent of LV LGE, a surrogate of myocardial fibrosis. Tissue-tracking analysis was applied to assess LV global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain. The extent of LVNC and the presence/extent of LV LGE in children/adolescents and young adults with iLVNC were similar. Compared to healthy subjects, young adults with iLVNC had significantly lower LVEF conversely, no significant difference in this parameter was observed between children/adolescents with iLVNC and healthy subjects. However, compared to healthy subjects, LV strain parameters were lower in both children/adolescents and young adults with iLVNC. Complete phenotypic expression, subclinical impairment of myocardial deformation properties, and cardiac injury occur early in iLVNC patients, being already noticeable in the pediatric age group. The application of CMR myocardial deformation imaging permits earlier detection of LV functional impairment in children/adolescents with iLVNC, which would otherwise be missed with standard CMR imaging.
Publisher: Springer Science and Business Media LLC
Date: 08-03-2021
DOI: 10.1186/S12968-020-00694-0
Abstract: In pulmonary arterial hypertension (PAH), progressive right ventricular (RV) dysfunction is believed to be largely secondary to RV ischaemia. A recent pilot study has demonstrated the feasibility of Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) to detect in-vivo RV myocardial oxygenation. The aims of the present study therefore, were to assess the prevalence of RV myocardial ischaemia and relationship with RV myocardial interstitial changes in PAH patients with non-obstructive coronaries, and corelate with functional and haemodynamic parameters. We prospectively recruited 42 patients with right heart catheter (RHC) proven PAH and 11 healthy age matched controls. The CMR examination involved standard functional imaging, OS-CMR imaging and native T1 mapping. An ΔOS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments. T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) at the inferior RV segment. The inferior RV ΔOS-CMR SI index was significantly lower in PAH patients compared with healthy controls (9.5 (– 7.4–42.8) vs 12.5 (9–24.6)%, p = 0.02). The inferior RV ΔOS-CMR SI had a significant correlation to RV inferior wall thickness (r = – 0.7, p 0.001) and RHC mean pulmonary artery pressure (mPAP) (r = – 0.4, p = 0.02). Compared to healthy controls, patients with PAH had higher native T1 in the inferior RV wall: 1303 (1107–1612) vs 1232 (1159–1288)ms, p = 0.049. In addition, there was a significant difference in the inferior RV T1 values between the idiopathic PAH and systemic sclerosis associated PAH patients: 1242 (1107–1612) vs 1386 (1219–1552)ms, p = 0.007. Blunted OS-CMR SI suggests the presence of in-vivo microvascular RV dysfunction in PAH patients. The native T1 in the inferior RV segments is significantly increased in the PAH patients, particularly among the systemic sclerosis associated PAH group.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.JCMG.2018.11.039
Abstract: Anderson-Fabry disease (AFD) is a rare X-linked inherited metabolic disorder which results in a deficiency or absence of the enzyme α-galactosidase A, leading to the accumulation of glycosphingolipids in various cells and organs including the heart. Cardiac involvement is common and results in increased myocardial inflammation, left ventricular hypertrophy (LVH), and myocardial fibrosis. Echocardiography and cardiovascular magnetic resonance (CMR) offer distinctive and often complementary use to assist in the diagnosis and monitoring pharmacologic therapy in AFD, including detection of the AFD cardiac phenotype, differentiation from other forms of LVH, and patient selection for therapeutic intervention. Advanced cardiac imaging holds promise in subclinical detection of AFD-related abnormalities as well as disease staging and prognostication.
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.AMJCARD.2007.11.053
Abstract: Recently, it has been demonstrated that high-resolution transthoracic echocardiography (HRTTE) is able to detect differences in the wall thickness of the left anterior descending coronary artery (LAD) between patients with coronary artery disease (CAD) and normal volunteers. The aim of this study was to further validate this technique. One hundred ten volunteers, 58 patients with angiographically proved CAD and 52 control subjects, underwent assessments of their LADs using HRTTE. Anterior and posterior wall thicknesses differed between subjects in the CAD group and controls (1.9 +/- 0.6 vs 1.2 +/- 0.3 mm, p <0.001, and 1.8 +/- 0.5 vs 1.2 +/- 0.3 mm, p <0.001, respectively). External LAD diameter was also greater in subjects in the CAD group compared with controls (5.2 +/- 1.9 vs 4.4 +/- 0.9 mm, respectively, p = 0.01). However, there was no difference in luminal diameter between subjects in the CAD group and the controls (1.9 +/- 0.9 vs 2.1 +/- 0.8 mm, respectively, p = 0.3). In conclusion, HRTTE demonstrated that LAD wall thicknesses and external diameters in patients with CAD were significantly larger than in normal volunteers. Luminal diameter, however, was maintained in the 2 groups, indicating that subjects in the CAD group had undergone positive remodeling at the site measured. This objectively visualized evidence of coronary atherosclerosis with HRTTE would likely be undetected during coronary angiography.
Publisher: Wiley
Date: 17-12-2016
DOI: 10.1111/ECHO.13153
Abstract: Severe aortic stenosis causes chronic increased afterload on the left ventricle (LV) resulting in myocardial hypertrophy and ultimately dysfunction if left untreated. Transcatheter aortic valve implantation (TAVI) immediately decreases the afterload on the LV by reducing the pressure gradient through the aortic valve. In our study, we aim to evaluate immediate changes in LV mechanics using intra-procedural transesophageal echocardiography (TEE) to assess circumferential and radial strain via speckle tracking. Intra-operative TEE was performed during TAVI for 53 patients (mean age 84 ± 8 years). Two-dimensional images in the transgastric view were acquired at the level of the papillary muscle. Circumferential and radial strain was calculated using speckle tracking with Philips Qlab software. Global LV afterload was measured by calculating valvulo-arterial impedance (Zva). Immediately post-TAVI, there was a change in both radial strain rate (Pre: 0.73 ± 0.04 vs. Post: 0.88 ± 0.04 per second, P < 0.001) and circumferential strain rate (-0.53 ± 0.04 (pre) vs. -0.74 ± 0.04 (post) per second, P < 0.001). There was also an immediate improvement in circumferential global strain parameters (-14.5 ± 5% (pre) vs. -16.0 ± 4.7% (post), P < 0.05), whereas there was no significant change seen in global radial strain (15.6 ± 0.8% (pre) vs. 15.2 ± 0.9% (post), P = 0.69). No significant change was seen in LV ejection fraction (51.5 ± 14.2% (pre) vs. 52.1 ± 14.0% (post), P = 0.77). Speckle tracking using TEE images is feasible and identifies significant improvements in LV strain and strain rate immediately following TAVI that is not detected by conventional measure of LV function.
Publisher: Springer Science and Business Media LLC
Date: 02-02-2011
Publisher: Springer Science and Business Media LLC
Date: 2010
Publisher: Wiley
Date: 24-07-2008
DOI: 10.1111/J.1540-8175.2008.00688.X
Abstract: High-dose dobutamine used in dobutamine stress echocardiography (DSE) has hemodynamically based side effects due to a variable combination of beta1 (inotropic) and beta2 (vasodilator) effects. Of concern is the development of an "empty ventricle syndrome" associated with intracavitary or outflow tract obstruction and resultant symptomatic hypotension. This study was undertaken to determine whether the concurrent administration of normal saline (N/S) would decrease symptoms, limit the development of left ventricular outflow tract (LVOT) obstruction and hypotension by maintaining left ventricular volume. One hundred patients, mean age 66 years +/- 12, presenting for a DSE were randomized into two groups. One group (n = 50) received N/S at a rate of 800 ml/hour during the test, the second group received dobutamine alone. Patients were instructed to report and quantify symptoms on a scale of 1 to 10. Echocardiographic measurements of end systolic volume (ESV) and LVOT gradients were taken prior to dobutamine and at peak dose. There was no difference in symptom scores (3.5 +/- 5.1(N/S) vs. 3.0 +/- 4.7, P = 0.6), change in systolic blood pressure (BP) (-0.74 mmHg +/- 33 (N/S) vs. -0.89 +/- 35, P = 0.9) maximum LVOT gradient at peak (16.4 mmHg +/- 16.1 (N/S) vs. 13.9 mmHg +/- 9, P = 0.4), or ESV at peak (17.9 mL +/- 13.4 (N/S) vs. 15.5 ml +/- 10.6, P = 0.37). Furthermore, there was no difference in the number of patients (10/50 (20%) in both groups) who developed a significant LVOT gradient, defined as greater than 20 mmHg at peak dose. Despite the sound theoretical basis of N/S infusion to protect against "empty ventricle syndrome" during DSE this randomized trial does not demonstrate any symptomatic or hemodynamic benefit.
Publisher: Wiley
Date: 16-12-2012
DOI: 10.1111/J.1540-8175.2011.01594.X
Abstract: Right ventricular (RV) systolic function as measured by right ventricular ejection fraction (RVEF) has long been recognized as an important predictor of outcome in heart failure patients. The echocardiographic measurement of RV volumes and RVEF is challenging, however, owing to the unique geometry of the right ventricle. Several nonvolumetric echocardiographic indices of RV function have demonstrated prognostic value in heart failure. Comparison studies of these techniques with each other using RVEF as a benchmark are limited, however. Furthermore, the contribution of these various elements of RV function to patient functional status is uncertain. We therefore aimed to: (1) Determine which nonvolumetric echocardiographic index correlates best with RVEF as determined by cardiac magnetic resonance (CMR) imaging (the accepted gold standard measure of RV systolic function) and (2) Ascertain which echocardiographic index best predicts functional capacity. Eighty-three subjects (66 with systolic heart failure and 17 healthy controls) underwent CMR, 2D echocardiography, and cardiopulmonary exercise testing for comparison of echocardiographic indices of RV function with CMR RVEF, 6-minute walk distance and VO(2 PEAK). Speckle tracking strain RV strain exhibited the closest association with CMR RV ejection fraction. Indices of RV function demonstrated weak correlation with 6-minute walk distance, but basal RV strain rate by tissue velocity imaging had good correlation with VO(2 PEAK). Strain by speckle tracking echocardiography and strain rate by tissue velocity imaging may offer complementary information in the evaluation of RV contractility and its functional effects.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.HLC.2019.04.017
Abstract: Left ventricular (LV) wall thickening can occur due to both physiological and pathological processes. Some LV wall thickening is caused by infiltrative cardiac deposition diseases - rare disorders from both inherited and acquired conditions, with varying systemic manifestations. They portend a poor prognosis and are generally not reversible except in rare circumstances when early diagnosis and treatment may alter the outcome (e.g., Fabry disease). Cardiac involvement is variable and depends on the degree of infiltration and type of infiltrate. These changes often lead to the development of abnormalities in both the relaxation and contractile function of the heart ultimately resulting in heart failure. Echocardiography is generally the first investigation of choice as it is easily available and gives valuable information about the thickness of the ventricular walls as well as systolic and diastolic function. It is also able to identify unique, characteristic features of the disease as well as detecting any haemodynamic sequelae. This review looks at the role of echocardiography in the diagnosis and prognosis of infiltrative cardiac deposition diseases.
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.ECHO.2007.05.019
Abstract: The study objective was to determine the effects of salbutamol and nitroglycerin (NTG) on the luminal diameter of the left anterior descending (LAD) coronary artery, as measured noninvasively by the novel technique of high-resolution transthoracic echocardiography (HRTTE). Invasive studies of the coronary arteries have demonstrated vasodilatation by salbutamol and NTG. By using a novel technique of HRTTE, combined with assessment of augmentation index (AIx, a marker of peripheral arterial stiffness) by means of applanation tonometry from the radial artery (pulse wave analysis), we studied the vasomotion of the proximal LAD in healthy volunteers. Nineteen male subjects (age 31 +/- 5 years, mean +/- standard deviation) underwent HRTTE measurement of the wall thickness, luminal diameter, and external diameter of the proximal LAD, and AIx at baseline and 5, 10, 15, and 20 minutes after administration of inhaled salbutamol (400 microg) and, after return to baseline, sublingual NTG (300 microg). Salbutamol induced a 44% +/- 28% increase in LAD luminal diameter (2.8 +/- 0.8 mm to 3.7 +/- 0.9 mm, P < .001) and a reduction in AIx (-13.4% +/- 6.6%, P < .001). NTG induced greater changes in both parameters (60% +/- 30% increase in luminal diameter from baseline, 2.7 +/- 0.9 mm to 4.4 +/- 1.1 mm, P < .001 and reduction in AIx -24.1% +/- 8.2%, P < .001). Changes in LAD diameter and AIx were related after both salbutamol (r = -0.53, P = .02) and NTG (r = -0.57, P = .01). No significant change was detected in wall thickness. HRTTE is able to detect the LAD coronary artery vasodilating effects of NTG and salbutamol and correlates with peripheral vascular reactivity to these vasodilators. This approach provides a useful tool for the noninvasive assessment of coronary vasoreactivity.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Elsevier BV
Date: 03-2018
Publisher: Elsevier BV
Date: 12-2020
Publisher: Wiley
Date: 17-03-2021
DOI: 10.1111/JCE.14987
Abstract: Atrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia in clinical practice. However, current therapeutic interventions for atrial fibrillation have limited clinical efficacy as a consequence of major knowledge gaps in the mechanisms sustaining atrial fibrillation. From a mechanistic perspective, there is increasing evidence that atrial fibrosis plays a central role in the maintenance and perpetuation of atrial fibrillation. Electrophysiologically, atrial fibrosis results in alterations in conduction velocity, cellular refractoriness, and produces conduction block promoting meandering, unstable wavelets and micro‐reentrant circuits. Clinically, atrial fibrosis has also linked to poor clinical outcomes including AF‐related thromboembolic complications and arrhythmia recurrences post catheter ablation. In this article, we review the pathophysiology behind the formation of fibrosis as AF progresses, the role of fibrosis in arrhythmogenesis, surrogate markers for detection of fibrosis using cardiac magnetic resonance imaging, echocardiography and electroanatomic mapping, along with their respective limitations. We then proceed to review the current evidence behind therapeutic interventions targeting atrial fibrosis, including drugs and substrate‐based catheter ablation therapies followed by the potential future use of electro phenotyping for AF characterization to overcome the limitations of contemporary substrate‐based methodologies.
Publisher: Elsevier BV
Date: 2008
Publisher: Elsevier BV
Date: 2010
Publisher: Elsevier BV
Date: 2010
Publisher: Oxford University Press (OUP)
Date: 28-08-2010
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1016/J.ECHO.2006.04.040
Abstract: The primary determinate for the indication of cardiac resynchronization therapy in symptomatic chronic heart failure currently is a prolonged QRS duration. This is based on the premise that a prolonged QRS duration is a marker of left ventricular (LV) dyssynchrony. Tissue synchronization imaging (TSI) is an emerging technology that uses tissue Doppler velocities to determine the time to peak velocity of regions of the ventricular myocardium. Our objectives were to determine the prevalence of dyssynchrony in a cardiomyopathic population referred for echocardiography irrespective of QRS duration, to validate the novel technique of TSI in evaluation of mechanical LV dyssynchrony and to determine the accuracy of QRS duration in predicting significant LV dyssynchrony. A total of 100 patients with significant LV dysfunction (Simpson's ejection fraction < or = 35%) referred for echocardiography underwent TSI. Dyssynchrony was defined as a difference in time to peak contraction of greater than 105 milliseconds between opposing ventricular segments. Overall, 61 patients (61%) demonstrated significant dyssynchrony, whereas 52% had a QRS duration of greater than 120 milliseconds. Among those with a prolonged QRS duration, significant dyssynchrony was evident in 30 (58%). However, dyssynchrony was also common among those with a narrow QRS duration (<120 milliseconds) (31 patients [65%]). Of the 61 patients with dyssynchrony, 31 (51%) would have been missed if QRS criteria were used alone. A substantial proportion of patients have dyssynchrony by TSI, but do not have a prolonged QRS duration. These patients may benefit from cardiac resynchronization therapy but on traditional criteria would be excluded from the therapy. Expanding the criteria for cardiac resynchronization therapy to include echocardiographic parameters may extend the benefit of this technology to a greater population in need.
Publisher: Wiley
Date: 09-03-2012
DOI: 10.1111/J.1540-8175.2012.01667.X
Abstract: Statin therapy has been shown to reduce cardiovascular risk after myocardial infarction (MI). Using a novel technique of high-resolution transthoracic echocardiography (HRTTE), we sought to assess the statin-induced changes in left anterior descending coronary artery (LAD) wall thickness in previously statin naive patients over a 12-month period. Thirty subjects underwent HRTTE assessment of their LAD wall thickness predischarge post-MI (non-LAD territory) and at 3, 6, and 12 months. The LAD anterior and posterior wall thickness and vessel luminal diameter were measured. Blood lipid levels were also assessed at each study visit. All subjects were started on moderate lipid-lowering therapy (40 mg of atorvastatin or simvastatin). There was a sustained decrease in total cholesterol (-23%), triglycerides (-19%), and low-density lipoprotein (-41%) at the 3-month visit from the baseline, with no change in high-density lipoprotein level. Overall, there was no change in the LAD wall thickness and external or vessel lumen diameter over the 12-month period. Of those that demonstrated regression, the only predictor of percentage change in the LAD wall thickness was the baseline LAD wall thickness. Despite a favorable change in blood lipid profile, no overall change in the LAD wall thickness was detected over a 12-month period in subjects on moderate statin therapy using HRTTE. However, using case-based analysis, regression was able to be predicted by the baseline LAD wall thickness. HRTTE may be an instructive noninvasive modality to assess response to statin intervention.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.JCMG.2019.07.026
Abstract: This study sought to determine the long-term prognostic value of myocardial deformation imaging by echocardiography in risk stratification of sudden cardiac death (SCD) and malignant ventricular arrhythmias (VAs) in a large consecutive cohort of patients with left ventricular (LV) systolic impairment, irrespective of its etiology. Left ventricular ejection fraction (LVEF) is limited for prediction of SCD. Echocardiographic strain-derived mechanical dispersion (MD) and global longitudinal strain (GLS) has been linked to VA and SCD. However, due to low event rates, the role of these parameters has not been fully elucidated. Consecutive clinically stable patients who underwent echocardiographic study performed in an outpatient setting from 2008 to 2014 with a Simpson left ventricular ejection fraction (LVEF) ≤45% were included in the study. Strain analysis was performed in which the LV was separated into 16 segments for regional analysis. Mechanical dispersion (MD) was calculated as the SD of the time to peak of each of the 16 regions. Outcome data were obtained from medical records. A total of 939 patients were included in the study, with median LVEF of 37% (interquartile range 30% to 42%). At follow-up (91.4 ± 23.4 months), 96 VA events had occurred. Multivariate analysis demonstrated that only MD ≥75 ms (hazard ratio: 9.45 95% confidence interval: 4.75 to 18.81 p < 0.0001) was predictive of VA events. Low MD predicted a low event rate, irrespective of LVEF. Using LVEF alone is inferior for prediction of VA and SCD, particularly in patients with moderately reduced LVEF. MD is easily obtained from standard echocardiographic images and can be used to improve risk prognosis, particularly in patients who are currently excluded from cardiac defibrillator insertion based on LVEF.
Publisher: Wiley
Date: 19-08-2011
DOI: 10.1111/J.1540-8175.2011.01498.X
Abstract: Mechanical left ventricular (LV) dyssynchrony, as determined by tissue Doppler imaging (TDI), predicts response to cardiac resynchronization therapy (CRT). However, changes in TDI mechanical dyssynchrony after CRT implantation have only limited investigation. Our objective was to detect changes in the extent and location of TDI mechanical dyssynchrony pre- and post-CRT, and to explore their relationship in response to CRT. Thirty-nine consecutive patients undergoing CRT implantation for chronic heart failure underwent TDI analysis pre-CRT and up to 12 months post-CRT. Regional dyssynchrony was determined by the time to systolic peak velocity of opposing LV walls. Dyssynchrony was defined as a difference in time to peak contraction of >105 msec. Two patients were excluded, as suitable coronary venous access was not available. Of the 37 patients, 28 (76%) had significant mechanical dyssynchrony pre-CRT. Of those with dyssynchrony, 18 (64%) had septal delay and 10 (36%) had LV free wall delay. Post-CRT, 29 (78%) patients had significant mechanical dyssynchrony, 17 (59%) with septal delay, and 12 (41%) with LV free wall delay. There was no difference in both the amount of dyssynchrony (P=0.8) or the location of the dyssynchrony (P=0.5), before and after CRT, even though 28 (76%) were considered responders based on symptomatic and echocardiographic parameters. The TDI-derived dyssynchrony does not change with CRT despite significant symptomatic and echocardiographic improvement in cardiac function. The TDI is of limited utility for monitoring response to CRT.
Publisher: Elsevier BV
Date: 2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-08-2015
Abstract: Coronary artery disease and left ventricular hypertrophy are prevalent in the chronic kidney disease ( CKD ) and renal transplant ( RT ) population. Advances in cardiovascular magnetic resonance ( CMR ) with blood oxygen level–dependent ( BOLD ) technique provides capability to assess myocardial oxygenation as a measure of ischemia. We hypothesized that the myocardial oxygenation response to stress would be impaired in CKD and RT patients. Fifty‐three subjects (23 subjects with CKD , 10 RT recipients, 10 hypertensive ( HT ) controls, and 10 normal controls without known coronary artery disease) underwent CMR scanning. All groups had cine and BOLD CMR at 3 T. The RT and HT groups also had late gadolinium CMR to assess infarction/replacement fibrosis. The CKD group underwent 2‐dimensional echocardiography strain to assess fibrosis. Myocardial oxygenation was measured at rest and under stress with adenosine (140 μg/kg per minute) using BOLD signal intensity. A total of 2898 myocardial segments (1200 segments in CKD patients, 552 segments in RT , 480 segments in HT , and 666 segments in normal controls) were compared using linear mixed modeling. Diabetes mellitus ( P =0.47) and hypertension ( P =0.57) were similar between CKD , RT , and HT groups. The mean BOLD signal intensity change was significantly lower in the CKD and RT groups compared to HT controls and normal controls (−0.89±10.63% in CKD versus 5.66±7.87% in RT versus 15.54±9.58% in HT controls versus 16.19±11.11% in normal controls, P .0001). BOLD signal intensity change was associated with estimated glomerular filtration rate (β=0.16, 95% CI =0.10 to 0.22, P .0001). Left ventricular mass index and left ventricular septal wall diameter were similar between the CKD predialysis, RT , and HT groups. None of the CKD patients had impaired global longitudinal strain and none of the RT group had late gadolinium hyperenhancement. Myocardial oxygenation response to stress is impaired in CKD patients and RT recipients without known coronary artery disease, and unlikely to be solely accounted for by the presence of diabetes mellitus, left ventricular hypertrophy, or myocardial scarring. The impaired myocardial oxygenation in CKD patients may be associated with declining renal function. Noncontrast BOLD CMR is a promising tool for detecting myocardial ischemia in the CKD population.
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.IJCARD.2018.03.025
Abstract: Anthracycline (A) and trastuzumab (T) chemotherapy have well-recognized cardiac toxicity, potentially leading to significant morbidity and mortality. Our previous work in 46 prospectively enrolled breast cancer patients showed early left ventricular (LV) and right ventricular (RV) function decline at 1 and 3 months, but only persistent RV dysfunction at 12 months which correlated with myocardial oedema observed early (1 and 3 months) after administration of chemotherapy regimes. To investigate late cardiac effects, the same cohort were re-imaged with advanced Cardiovascular Magnetic Resonance (CMR) imaging including T1 mapping 5 ± 1 year post chemotherapy. Twenty-six out of 46 (50%) patients underwent follow-up imaging. A statistical but non-clinically significant decrease was observed in LV ejection fraction (EF) from baseline to 5 years (72.2 ± 6.6 to 65.4 ± 9.3, p 10% at 3 months (n = 5) or at 12 months (n = 3) did not demonstrate any difference in LV or RVEF at 5 years. No correlation was observed between myocardial oedema and LV or RVEF at 5 years. At 5 years, T1 values were within normal limits overall (935 ± 48 ms). One patients had significantly elevated (>1000 ms) T1 values with no correlation to LV or RVEF. No subjects demonstrated replacement myocardial fibrosis at 5 years. Using advanced CMR, contemporary chemotherapy regimes demonstrate minimal long-term cardiac toxicity. There is minimal diffuse and no replacement fibrosis as demonstrated by LGE, following chemotherapy. This study suggests limiting serial imaging in these patients at 12 months post chemotherapy.
Publisher: Oxford University Press (OUP)
Date: 21-10-2019
DOI: 10.1093/EHJCI/JEZ252
Abstract: In patients with bicuspid aortic valve (BAV) and preserved left ventricular (LV) ejection fraction (EF), the frequency of impaired LV global longitudinal strain (GLS) and its prognostic implications are unknown. The present study evaluated the proportion and prognostic value of impaired LV GLS in patients with BAV and preserved LVEF. Five hundred and thirteen patients (68% men mean age 44 ± 18 years) with BAV and preserved LVEF (& %) were ided into five groups according to the type of BAV dysfunction: (i) normal function BAV, (ii) mild aortic stenosis (AS) or aortic regurgitation (AR), (iii) ≥moderate isolated AS, (iv) ≥moderate isolated AR, and (v) ≥moderate mixed AS and AR. LV systolic dysfunction based on 2D speckle-tracking echocardiography was defined as a cut-off value of LVGLS (−13.6%). The primary outcome was aortic valve intervention or all-cause mortality. The proportion of patients with LVGLS ≤−13.6% was the highest in the normal BAV group (97%) and the lowest in the group with moderate and severe mixed AS and AR (79%). During a median follow-up of 10 years, 210 (41%) patients underwent aortic valve replacement and 17 (3%) died. Patients with preserved LV systolic function (LVGLS ≤ −13.6%) had significantly better event-free survival compared to those with impaired LV systolic function (LVGLS & −13.6%). LVGLS was independently associated with increased risk of events (mainly aortic valve replacement): hazard ratio 1.09 P & 0.001. Impaired LVGLS in BAV with preserved LVEF is not infrequent and was independently associated with increased risk of events (mainly aortic valve replacement events).
Location: Australia
Start Date: 2019
End Date: 2021
Funder: Sanofi Australia
View Funded ActivityStart Date: 2016
End Date: 2018
Funder: National Heart Foundation of Australia
View Funded Activity