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Ratio of Transmitral Early-Diastolic Velocity to Global Longitudinal Strain Accurately Estimates Filling Pressure Regardless of Left Ventricular Hypertrophy
S162 Journal of Cardiac Failure Vol. 21 No. 10S October 2015
Oral Presentations OP1-1 Ratio of Transmitral Early-Diastolic Velocity to Global Longitudinal Strain Accurately Estimates Filling Pressure Regardless of Left Ventricular Hypertrophy TAICHI HAYASHI1, SATOSHI YAMADA1, HIROYUKI IWANO1, MASAHIRO NAKABACHI2, HIROTSUGU YAMADA3, KAORU DOHI4, YOSHIHIRO SEO5, NOBUYUKI OHTE6, TAISEI MIKAMI7, HIROYUKI TSUTSUI1 1 Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; 2Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan; 3Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan; 4Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan; 5Cardiovascular Division, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; 6Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; 7Faculty of Health Sciences, Hokkaido University, Sapporo, Japan Background: We conducted a multicenter study and have reported the usefulness of E/LS: the ratio of transmitral early-diastolic velocity (E) to peak global longitudinal strain (LS) in estimating left ventricular (LV) filling pressure and the influence of LV hypertrophy (LVH) on the estimation by E/e0 ; the ratio of E to mitral annular earlydiastolic velocity (e0 ). The purpose of this study was to examine whether E/LS better estimates LV filling pressure than E/e0 regardless of LVH. Methods: LV pressure measurement by using a micromanometer-tipped catheter and tissueDoppler and speckle tracking echocardiography were performed in 77 patients with various structural heart diseases from 5 institutions. LV mean diastolic pressure (MDP) was calculated as an index of filling pressure. Patients were divided into LVH (n541) and nonLVH (n536) groups. Results: Transmitral E/A (r50.55), E/e0 (r50.50), and E/LS (r50.70) significantly correlated with MDP. In LVH, E/A (r50.34, p!0.05) and E/e0 (r50.33, p!0.05) weakly, but E/LS (r50.55, p!0.001) modestly correlated with MDP. In non-LVH, E/A (r50.71, p!0.001), E/e0 (r50.74, p!0.001), and E/ LS (r50.83, p!0.001) well correlated with MDP. Areas under the receiver operating characteristic curves of E/LS for predicting elevated MDP in LVH and non-LVH (0.78 and 0.95, respectively) were larger than those of E/A (0.64, 0.73) or E/e0 (0.64, 0.91). Conclusion: E/LS better estimated MDP than E/A or E/e0 in both LVH and non-LVH.
OP1-2 Different Factors Influence the Left Atrial Longitudinal and Circumferential Strain MIKI TSUJIUCHI1, MIO EBATO1, TAKUYA MIZUKAMI1, AYAKA TANABE1, NAOKO IKEDA2, HIDEYUKI MAEZAWA1, HIROSHI SUZUKI1 1 Showa University Fujigaoka Hospital; 2Showa University Koto Toyosu Hospital Background: Left atrial longitudinal strain has been the index of left atrial reservoir function and reported to be influenced by left ventricular longitudinal strain (LVLS). Purpose: The correlation among global two dimensional LVLS (GLVLS), left ventricular diastolic indices, three dimensional left atrial longitudinal and circumferential strain(3DLALS and 3DLACS) were asessed to study the influence of LVLS and left ventricular diastolic indices. Method: Ninety-two heart failure patients randomly selected from the database of three dimensional speckle tracking analysis (3DSTA) were included (age: 63616yo, men: 56%, ischemic heart disease:20, hypertensive heart disease: 30, DCM0 7, HCM 7). Correlation coefficient among 3DLALS, 0 3DLACS, GLVLS, average e , E/e and E/A were calculated. Results: 3DLALS showed stronger correlation to GLVLS than 3DLACS (r250.59 vs 0.32). 3DLACS 0 correlated stronger to E/e and E/A(patients with EF!40%) than 03DLALS(r250.39 vs 0.21, r250.59 vs 0.28). The correlation between average E/e and 3DLALS or 3DLACS was very weak (r250.094 and 0.06) Conclusion: LVLS influenced more on 3DLALS than 3DLACS, whereas 3DLACS was related more with left atrial pressure than 3DLALS. Further study will be needed to clarify the prognostic value of these indices.
OP1-3 Presence of Temporal Non-Uniformity of Early Diastolic Left Ventricular Wall Expansion in Patients with Heart Failure HIROYUKI IWANO1, DAISUKE KAMIMURA2, SATOSHI YAMADA1, HIROYUKI TSUTSUI1, WILLIAM LITTLE2 1 Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; 2Department of Medicine, University of Mississippi Medical Center, MS, USA Background: Early diastolic left ventricular (LV) longitudinal expansion is delayed with diastolic dysfunction. We hypothesized that, in patients with heart failure (HF) regardless of LV ejection fraction (EF), there is diastolic temporal non-uniformity with a delay of longitudinal relative to circumferential expansion. Methods: Doppler
and speckle-tracking echocardiography was performed in 143 HF patients: 50 with preserved EF (LVEF S 0.50, HFpEF) and 93 with reduced EF (LVEF!0.50, HFrEF) and 31 normal controls. The delay of the onset of early diastolic mitral annular velocity (e0 ) from the onset of the mitral Doppler E (T Ee0 ) was measured as a parameter of the delay of longitudinal wall expansion. The delay of longitudinal relative to circumferential early diastolic peak global strain rate was measured as an amount of temporal non-uniformity (DelayCL). Results: Normal controls had symmetrical LV expansion in early diastole (TEe0 : -6619 ms, DelayCL: 4615 ms). In contrast, TEe0 and DelayCL were significantly prolonged in both HFpEF (TEe0 : 34623 ms, DelayCL: 33625 ms) and HFrEF (TEe0 : 37628 ms, DelayCL: 26627 ms) (all P!0.01 vs controls). Both TEe0 and DelayCL modestly correlated with e0 (TEe0 : R5-0.56; DelayCL: R50.42, both P!0.001). Conclusion: An abnormal temporal non-uniformity of early diastolic expansion is present in HF regardless of EF, with a delay of longitudinal relative to circumferential expansion. This delay was associated with reduced longitudinal LV wall expansion.
OP1-4 The Efficacy of 2D Speckle Tracking Strain Imaging in Diagnosing Cardiac Amyloidosis KOYA ONO1, GO ISHIMARU1, KEN MURATA2, MIHO HAYASHI3, TATSUYA FUJINAMI1, HIROYUKI OKADA1, HIROSHI INAGAKI1, NOBUO TOSHIDA1, TOSHIHIKO TAKAMOTO1, MITSUAKI ISOBE4 1 Department of Cardiology, Soka Municipal Hospital, Soka, Japan; 2Department of Hematology, Soka Municipal Hospital, Soka, JapanHospital, Soka, Japan; 3 Department of Dermatology, Soka Municipal Hospital, Soka, JapanMunicipal Hospital, Soka, Japan; 4Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan A 63 year-old female visited our department due to exertional dyspnea one year ago. Chest X-ray showed cardiomegaly. ECG revealed low QRS voltage and pseudo-anterior infarction. Echocardiography showed concentric LVH with normal ejection fraction. Coronary angiogram was also performed, resulted in no coronary stenosis. She was diagnosed with heart failure with preserved ejection fraction and was treated medically. LVH was present on echocardiography, but high voltage was not found on ECG. This discrepancy was suggestive of infiltrative cardiomyopathy. Four months ago, myocardial biopsy was performed, but amyloid deposits were not proven. Three months ago, she was admitted to our department due to congestive heart failure for the third time. She also suffered from cervical spine fracture concomitantly. After bone marrow examination, she was diagnosed with multiple myeloma. Echocardiography showed granular sparkling in the left ventricular wall. However, biopsy from duodenum and rectum revealed no amyloid deposits. 2D speckle tracking strain imaging showed marked reduction of strain in the basal wall segments with relative apical sparing. This appearance is said to suggest cardiac amyloidosis. After Bortezomib-based chemotherapy was initiated, she was relieved of symptoms. Abdominal wall fat pad biopsy was performed afterwards, and amyloid deposits were proven. In this patient, (not only granular sparkling, but also) relative apical sparing found on 2D speckle tracking strain imaging contributes in diagnosing cardiac amyloidosis.
OP1-5 Prediction of Response to Cardiac Resynchronization Therapy by Tissue Mitral Annular Displacement (TMAD) YOSHIHIRO OTA, KOICHI INOUE, YUKO TOYOSHIMA, KOJI TANAKA, TAKAFUMI OKA, NOBUAKI TANAKA, MASATO OKADA, ATSUNORI OKAMURA, KATSUOMI IWAKURA, KENSHI FUJII Sakurabashi-Watanabe Hospital, Osaka, Japan Tissue mitral annular displacement (TMAD) is a new echocardiography technique to assess LV longitudinal deformity by measuring valvular annulus displacement toward apex. We investigated whether TMAD could predict clinical outcomes after cardiac resynchronizing therapy (CRT). We measured TMAD in 41 patients with dilated cardiomyopathy (DCM) before and at 6 month of CRT, and determined the interval between onset of QRS complex and peak of displacement on septal- and lateral part of mitral annulus. We calculated the difference in time-to-peak between two regions as D time-to-peak (D TP). D TP were successfully measured in all study patients within 2 minutes. Reverse remodeling (decrease in LV end-systolic volumeO15% at 6 month) was observed in 27 patients (65.9%), and they had significantly longer D TP than those without remodeling (156664 vs. 63661 msec, p!0.0001). Using 104 msec as a cutoff value, TMAD predicted LV reverse remodeling with sensitivity of 79% and specificity of 78% (AUC50.83). We observed 20 cardiac major cardiac and cerebrovascular events (MACCE) during follow-up period (median 1147 days), and D TP was significantly associated with MACCE (p50.048 by Cox hazard model). Kaplan-Meier survival curve analysis demonstrated that patients with D TP S 104ms had better MACCE-free survival than others (p50.02 by log-rank test). TMAD is a promising method for easily predicting LV reverse remodeling and long-term prognosis after CRT in patients with DCM.
Oral Presentations OP1-1 Ratio of Transmitral Early-Diastolic Velocity to Global Longitudinal Strain Accurately Estimates Filling Pressure Regardless of Left Ventricular Hypertrophy TAICHI HAYASHI1, SATOSHI YAMADA1, HIROYUKI IWANO1, MASAHIRO NAKABACHI2, HIROTSUGU YAMADA3, KAORU DOHI4, YOSHIHIRO SEO5, NOBUYUKI OHTE6, TAISEI MIKAMI7, HIROYUKI TSUTSUI1 1 Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; 2Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan; 3Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan; 4Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan; 5Cardiovascular Division, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; 6Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; 7Faculty of Health Sciences, Hokkaido University, Sapporo, Japan Background: We conducted a multicenter study and have reported the usefulness of E/LS: the ratio of transmitral early-diastolic velocity (E) to peak global longitudinal strain (LS) in estimating left ventricular (LV) filling pressure and the influence of LV hypertrophy (LVH) on the estimation by E/e0 ; the ratio of E to mitral annular earlydiastolic velocity (e0 ). The purpose of this study was to examine whether E/LS better estimates LV filling pressure than E/e0 regardless of LVH. Methods: LV pressure measurement by using a micromanometer-tipped catheter and tissueDoppler and speckle tracking echocardiography were performed in 77 patients with various structural heart diseases from 5 institutions. LV mean diastolic pressure (MDP) was calculated as an index of filling pressure. Patients were divided into LVH (n541) and nonLVH (n536) groups. Results: Transmitral E/A (r50.55), E/e0 (r50.50), and E/LS (r50.70) significantly correlated with MDP. In LVH, E/A (r50.34, p!0.05) and E/e0 (r50.33, p!0.05) weakly, but E/LS (r50.55, p!0.001) modestly correlated with MDP. In non-LVH, E/A (r50.71, p!0.001), E/e0 (r50.74, p!0.001), and E/ LS (r50.83, p!0.001) well correlated with MDP. Areas under the receiver operating characteristic curves of E/LS for predicting elevated MDP in LVH and non-LVH (0.78 and 0.95, respectively) were larger than those of E/A (0.64, 0.73) or E/e0 (0.64, 0.91). Conclusion: E/LS better estimated MDP than E/A or E/e0 in both LVH and non-LVH.
OP1-2 Different Factors Influence the Left Atrial Longitudinal and Circumferential Strain MIKI TSUJIUCHI1, MIO EBATO1, TAKUYA MIZUKAMI1, AYAKA TANABE1, NAOKO IKEDA2, HIDEYUKI MAEZAWA1, HIROSHI SUZUKI1 1 Showa University Fujigaoka Hospital; 2Showa University Koto Toyosu Hospital Background: Left atrial longitudinal strain has been the index of left atrial reservoir function and reported to be influenced by left ventricular longitudinal strain (LVLS). Purpose: The correlation among global two dimensional LVLS (GLVLS), left ventricular diastolic indices, three dimensional left atrial longitudinal and circumferential strain(3DLALS and 3DLACS) were asessed to study the influence of LVLS and left ventricular diastolic indices. Method: Ninety-two heart failure patients randomly selected from the database of three dimensional speckle tracking analysis (3DSTA) were included (age: 63616yo, men: 56%, ischemic heart disease:20, hypertensive heart disease: 30, DCM0 7, HCM 7). Correlation coefficient among 3DLALS, 0 3DLACS, GLVLS, average e , E/e and E/A were calculated. Results: 3DLALS showed stronger correlation to GLVLS than 3DLACS (r250.59 vs 0.32). 3DLACS 0 correlated stronger to E/e and E/A(patients with EF!40%) than 03DLALS(r250.39 vs 0.21, r250.59 vs 0.28). The correlation between average E/e and 3DLALS or 3DLACS was very weak (r250.094 and 0.06) Conclusion: LVLS influenced more on 3DLALS than 3DLACS, whereas 3DLACS was related more with left atrial pressure than 3DLALS. Further study will be needed to clarify the prognostic value of these indices.
OP1-3 Presence of Temporal Non-Uniformity of Early Diastolic Left Ventricular Wall Expansion in Patients with Heart Failure HIROYUKI IWANO1, DAISUKE KAMIMURA2, SATOSHI YAMADA1, HIROYUKI TSUTSUI1, WILLIAM LITTLE2 1 Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; 2Department of Medicine, University of Mississippi Medical Center, MS, USA Background: Early diastolic left ventricular (LV) longitudinal expansion is delayed with diastolic dysfunction. We hypothesized that, in patients with heart failure (HF) regardless of LV ejection fraction (EF), there is diastolic temporal non-uniformity with a delay of longitudinal relative to circumferential expansion. Methods: Doppler
and speckle-tracking echocardiography was performed in 143 HF patients: 50 with preserved EF (LVEF S 0.50, HFpEF) and 93 with reduced EF (LVEF!0.50, HFrEF) and 31 normal controls. The delay of the onset of early diastolic mitral annular velocity (e0 ) from the onset of the mitral Doppler E (T Ee0 ) was measured as a parameter of the delay of longitudinal wall expansion. The delay of longitudinal relative to circumferential early diastolic peak global strain rate was measured as an amount of temporal non-uniformity (DelayCL). Results: Normal controls had symmetrical LV expansion in early diastole (TEe0 : -6619 ms, DelayCL: 4615 ms). In contrast, TEe0 and DelayCL were significantly prolonged in both HFpEF (TEe0 : 34623 ms, DelayCL: 33625 ms) and HFrEF (TEe0 : 37628 ms, DelayCL: 26627 ms) (all P!0.01 vs controls). Both TEe0 and DelayCL modestly correlated with e0 (TEe0 : R5-0.56; DelayCL: R50.42, both P!0.001). Conclusion: An abnormal temporal non-uniformity of early diastolic expansion is present in HF regardless of EF, with a delay of longitudinal relative to circumferential expansion. This delay was associated with reduced longitudinal LV wall expansion.
OP1-4 The Efficacy of 2D Speckle Tracking Strain Imaging in Diagnosing Cardiac Amyloidosis KOYA ONO1, GO ISHIMARU1, KEN MURATA2, MIHO HAYASHI3, TATSUYA FUJINAMI1, HIROYUKI OKADA1, HIROSHI INAGAKI1, NOBUO TOSHIDA1, TOSHIHIKO TAKAMOTO1, MITSUAKI ISOBE4 1 Department of Cardiology, Soka Municipal Hospital, Soka, Japan; 2Department of Hematology, Soka Municipal Hospital, Soka, JapanHospital, Soka, Japan; 3 Department of Dermatology, Soka Municipal Hospital, Soka, JapanMunicipal Hospital, Soka, Japan; 4Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan A 63 year-old female visited our department due to exertional dyspnea one year ago. Chest X-ray showed cardiomegaly. ECG revealed low QRS voltage and pseudo-anterior infarction. Echocardiography showed concentric LVH with normal ejection fraction. Coronary angiogram was also performed, resulted in no coronary stenosis. She was diagnosed with heart failure with preserved ejection fraction and was treated medically. LVH was present on echocardiography, but high voltage was not found on ECG. This discrepancy was suggestive of infiltrative cardiomyopathy. Four months ago, myocardial biopsy was performed, but amyloid deposits were not proven. Three months ago, she was admitted to our department due to congestive heart failure for the third time. She also suffered from cervical spine fracture concomitantly. After bone marrow examination, she was diagnosed with multiple myeloma. Echocardiography showed granular sparkling in the left ventricular wall. However, biopsy from duodenum and rectum revealed no amyloid deposits. 2D speckle tracking strain imaging showed marked reduction of strain in the basal wall segments with relative apical sparing. This appearance is said to suggest cardiac amyloidosis. After Bortezomib-based chemotherapy was initiated, she was relieved of symptoms. Abdominal wall fat pad biopsy was performed afterwards, and amyloid deposits were proven. In this patient, (not only granular sparkling, but also) relative apical sparing found on 2D speckle tracking strain imaging contributes in diagnosing cardiac amyloidosis.
OP1-5 Prediction of Response to Cardiac Resynchronization Therapy by Tissue Mitral Annular Displacement (TMAD) YOSHIHIRO OTA, KOICHI INOUE, YUKO TOYOSHIMA, KOJI TANAKA, TAKAFUMI OKA, NOBUAKI TANAKA, MASATO OKADA, ATSUNORI OKAMURA, KATSUOMI IWAKURA, KENSHI FUJII Sakurabashi-Watanabe Hospital, Osaka, Japan Tissue mitral annular displacement (TMAD) is a new echocardiography technique to assess LV longitudinal deformity by measuring valvular annulus displacement toward apex. We investigated whether TMAD could predict clinical outcomes after cardiac resynchronizing therapy (CRT). We measured TMAD in 41 patients with dilated cardiomyopathy (DCM) before and at 6 month of CRT, and determined the interval between onset of QRS complex and peak of displacement on septal- and lateral part of mitral annulus. We calculated the difference in time-to-peak between two regions as D time-to-peak (D TP). D TP were successfully measured in all study patients within 2 minutes. Reverse remodeling (decrease in LV end-systolic volumeO15% at 6 month) was observed in 27 patients (65.9%), and they had significantly longer D TP than those without remodeling (156664 vs. 63661 msec, p!0.0001). Using 104 msec as a cutoff value, TMAD predicted LV reverse remodeling with sensitivity of 79% and specificity of 78% (AUC50.83). We observed 20 cardiac major cardiac and cerebrovascular events (MACCE) during follow-up period (median 1147 days), and D TP was significantly associated with MACCE (p50.048 by Cox hazard model). Kaplan-Meier survival curve analysis demonstrated that patients with D TP S 104ms had better MACCE-free survival than others (p50.02 by log-rank test). TMAD is a promising method for easily predicting LV reverse remodeling and long-term prognosis after CRT in patients with DCM.