Longitudinal Strain – ABC CARDIOL

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Editorial

Do We Need New Echocardiographic Parameters for Transplant Recipients without Rejection?

Alberto Rodolpho Hüning et al. Vitor Emer Egypto Rosa

Introduction

Heart transplant represents the principal therapeutic modality for patients with end-stage heart failure unresponsive to maximized medical and surgical management. Brazil boasts one of the most extensive public health systems for organ transplantation globally, with nearly all procedures conducted under the Unified Health System (SUS). However, there is still a lack of studies validating normal echocardiographic parameters in this population, and this was the topic of the study conducted by Dall’Orto et al.

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Original Article

Echocardiographic Evaluation of Late Cardiac Abnormalities Caused by the Chikungunya Fever

José Maria Del Castillo et al. Gabriela Marques Pereira de Alencar Marcus Vinicius Dantas da Nóbrega Carlos Mazzarollo … Jonny Vitor Diniz Eugenio Soares de Albuquerque Antônia Dulcineide Medeiros Sena Carlos Antônio da Mota Silveira Oscar Francisco Sanchez Osella

Abstract

Background

Chicungunya fever causes highly debilitating joint pains. Complications are rare and may affect the cardiovascular system.

Objective

To evaluate, with echocardiography and two-dimensional strain, the cardiovascular changes in the chronic phase of the Chikungunya infection.

Methods

The study included 32 patients, mean age 56 ± 14 years divided into Group A, with < 12 months evolution (12 patients) and Group B, with ≥ 12 months evolution (20 patients). The cardiac dimensions, left ventricular end-diastolic volume indexed to body surface, left ventricular ejection fraction, left ventricular global longitudinal strain and left atrial longitudinal strain were determined. The groups were compared using unpaired analysis. The p significance was < 0.05.

Results

Most Group A patients presented diffuse hypocontratility and decreased left ventricular ejection fraction (45.5 ± 10.4%) with normal left ventricular diastolic indexed volume (58.7 ± 24.9 mL/m²). Most Group B patients presented diffuse hypocontratility (ejection fraction 38.2 ± 6.4%) and increased left ventricular diastolic indexed volume (88.3 ± 26.4 mL/m²). There was segmental changes in 22% of the patients, and hypertrophy or remodelling in seven cases of each Group. There was decreased global longitudinal strain in both Groups (-11.9 ± 4.4% in Group A and -10.3 ± 3.8% in Group B). Lef atrial longitudinal strain were 37.9 ± 17.3% in Group A and 27.5 ± 15.2% in Group B. Patients with pericarditis had normal left ventricular dimensions and function.

Conclusion

The cardiac complications of Chikungunya fever was diffuse hypocontratility with left ventricular normal size observed in the first year of chronic evolution and diffuse hypocontratility with left ventricular dilation observed in later evolution. Patients with pericardial thickening did not present myocardial issues. Echocardiography can be used as an important tool in patients with Chikungunya fever, since it can detects early abnormalities in the cardiovascular system. (Arq Bras Cardiol: Imagem cardiovasc. 2018;31(3):183-190)

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Original Article

Global Longitudinal Strain Predicts Poor Functional Capacity in Patients with Systolic Heart Failure

Rafael José Coelho Maia et al. Simone Cristina Soares Brandão Jéssica Leite Giordano Bruno Parente … Filipe Pinheiro Bruna Thays Santana Araújo Maria Inês Remígio Aguiar Sílvia Marinho Martins Daniella Cunha Brandão Armele Dornelas de Andrade

Abstract

Background:

Left ventricular global longitudinal strain value (GLS) can predict functional capacity in patients with preserved left ventricular ejection fraction (LVEF) heart failure (HF) and to assess prognosis in reduced LVEF HF.

Objetive:

Correlate GLS with parameters of Cardiopulmonary Exercise Test (CPET) and to assess if they could predict systolic HF patients that are more appropriated to be referred to heart transplantation according to CPET criteria.

Methods:

Systolic HF patients with LVEF < 45%, NYHA functional class II and III, underwent prospectively CPET and echocardiography with strain analysis. LVEF and GLS were correlated with the following CPET variables: maxVO₂, VE/VCO₂ slope, heart rate reduction during the first minute of recovery (HRR) and time needed to reduce maxVO₂ in 50% after physical exercise (T_1/2VO₂). ROC curve analysis of GLS to predict VO₂ < 14 mL/kg/min and VE/VCO₂ slope > 35 (heart transplantation’s criteria) was performed.

Results:

Twenty six patients were selected (age, 47 ± 12 years, 58% men, mean LVEF = 28 ± 8%). LVEF correlated only with maxVO₂ and T_1/2VO₂. GLS correlated to all CPET variables (maxVO₂: r = 0.671, p = 0.001; VE/VCO₂ slope: r = -0.513, p = 0.007; HRR: r = 0.466, p = 0.016, and T_1/2VO₂: r = -0.696, p = 0.001). GLS area under the ROC curve to predict heart transplantation’s criteria was 0.88 (sensitivity 75%, specificity 83%) for a cut-off value of -5.7%, p = 0.03.

Conclusion:

GLS was significantly associated with all functional CPET parameters. It could classify HF patients according to the functional capacity and may stratify which patients have a poor prognosis and therefore to deserve more differentiated treatment, such as heart transplantation.

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Do We Need New Echocardiographic Parameters for Transplant Recipients without Rejection?

Introduction

Echocardiographic Evaluation of Late Cardiac Abnormalities Caused by the Chikungunya Fever

Abstract

Background

Objective

Methods

Results

Conclusion

Global Longitudinal Strain Predicts Poor Functional Capacity in Patients with Systolic Heart Failure

Abstract

Background:

Objetive:

Methods:

Results:

Conclusion:

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