Torsion, Mechanical – ABC CARDIOL

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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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Left Ventricular Rigid Body Rotation in Ebstein's Anomaly from the MAGYAR-Path Study

Attila Nemes et al. Kálmán Havasi Péter Domsik Anita Kalapos Tamás Forster

A 70-year-old female patient with Ebstein’s anomaly (EA) that had never undergone palliation was assessed (the case originates from the MAGYAR-Path Study). Complete two-dimensional (2D) Doppler and three-dimensional (3D) speckle-tracking echocardiography were carried out with commercially available Toshiba Artida^™ echocardiography equipment. During 2D echocardiography, the septal leaflet-tricuspid annulus distance showed to be 25 mm, confirming EA. While the right ventricle (RV) was enlarged with tricuspid annular plane systolic excursion > 23 mm and mitral regurgitation grade III, left ventricular (LV) size and function showed to be normal with an ejection fraction of 56% without wall motion abnormalities. However, all LV regions moved in almost the same counterclockwise direction, confirming absence of LV twist, called “rigid body rotation” (RBR) (). The mean global LV radial, circumferential, longitudinal, 3D and area strain parameters showed to be 11.5 ± 10.0%, -25.5 ± 15.4%, -18.6 ± 10.2%, 15.2 ± 10.8% and -34.7 ± 20.8%, respectively. EA is a congenital heart defect in which septal and posterior leaflets of the tricuspid valve are displaced towards the RV apex, leading to RV partial atrialization, although the anatomic annulus of the valve is in the normal position. Malformation and displacement of the anterior leaflet can also be present. To the best of our knowledge, this is the first report to demonstrate LV-RBR, a known feature in LV myocardial mechanics, in a single patient with unrepaired EA. LV-RBR could be partially explained by the impaired ventricle-to-ventricle interactions due to displaced tricuspid valve leaflet attachments, alterations in the anatomic myocardial fiber orientation, but other reasons could also not be excluded.

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