Masataka Sugahara

Additive Prognostic Value of Echocardiographic Global Longitudinal and Global Circumferential Strain to Electrocardiographic Criteria in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy

Background—Response to cardiac resynchronization therapy is most favorable in patients with heart failure with QRS duration ≥150 ms and left bundle branch block and less predictable in those with QRS width 120 to 149 ms or non–left bundle branch block. Methods and Results—We studied 205 patients with heart failure referred for cardiac resynchronization therapy with QRS ≥120 ms and ejection fraction ⩽35%. We tested the hypothesis that contractile function using speckle-tracking echocardiographic global circumferential strain (GCS) from 2 short-axis views and global longitudinal strain (GLS) from 3 apical views add prognostic value to electrocardiographic criteria. There were 112 patients (55%) with GLS >−9% and 136 patients (66%) with GCS >−9%. During 4 years, 81 patients reached the combined primary end point (death, circulatory support, or transplant) and 120 reached the secondary end point (heart failure hospitalization or death). Both GLS >−9% and GCS >−9% were associated with increased risk of unfavorable events as follows: for the primary end point (hazard ratio=2.91; 95% confidence interval, 1.88–4.49; P<0.001) and (hazard ratio=3.73; 95% confidence interval, 2.39–5.82; P<0.001) for the secondary end point (hazard ratio=2.10; 95% confidence interval, 1.45–3.05; P<0.001) and (hazard ratio=3.25; 95% confidence interval, 2.23–4.75; P<0.001). In a prespecified subgroup of 120 patients with QRS 120 to 149 ms or non–left bundle branch block, significant associations of baseline GLS and GCS and outcomes remained: P=0.014 and P=0.002 for the primary end point and P=0.049 and P=0.001 for the secondary end point. Global strain measures had additive prognostic value to routine clinical or electrocardiographic parameters (P<0.001). Conclusions—Baseline GCS and GLS were significantly associated with long-term outcome after cardiac resynchronization therapy and had additive prognostic value to routine clinical and electrocardiographic selection criteria for cardiac resynchronization therapy.

EXTENDED COURSE OF RECOVERY IN PATIENTS WITH PERIPARTUM CARDIOMYOPATHY ASSESSED BY LEFT VENTRICULAR WALL DISTENSIBILITY

Background: Peripartum cardiomyopathy (PPCM) has variable degrees of myocardial recovery over time. The aim was to assess left ventricular (LV) diastolic wall distensibility (DWD) as a measure of diastolic stiffness in PPCM patients. Methods: We studied 100 PPCM patients in the Multicenter

CORRELATION OF A NEW ECHOCARDIOGRAPHIC INDEX OF RIGHT VENTRICULAR REMODELING IN PULMONARY HYPERTENSION WITH INVASIVE HEMODYNAMICS IN RAT MODEL

Right ventricular (RV) remodeling is important to humans with pulmonary hypertension (PH). Small animal models of PH are used to investigate novel therapies, but assessment of RV remodeling is difficult. The aim was to compare a new RV remodeling index (echo RV to LV area ratio) to invasive

AN ECHOCARDIOGRAPHIC RISK SCORE FOR PREDICTION OF MORTALITY IN PATIENTS WITH PULMONARY HYPERTENSION

Pulmonary hypertension (PH) is a progressive disease with variable prognosis and expanding treatment options. Guidelines have supported individual echocardiographic prognostic markers, but their ability to predict mortality remain unclear. The aim was to assess the prognostic significance of

PACEMAKER DEPENDENCY AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IS ASSOCIATED WITH REDUCTION IN GLOBAL LEFT VENTRICULAR FUNCTION

Consequences of conduction abnormalities requiring a permanent pacemaker (PPM) after transcatheter aortic valve replacement (TAVR) are still unclear. Our aim was to determine risk factors for PPM after TAVR and associated effects on LV function over time. Of 389 consecutive TAVR patients, we

NEUROCARDIAC INJURY IN PATIENTS WITH SUBARACHNOID HEMORRHAGE IS ASSOCIATED WITH REGIONAL LEFT VENTRICULAR DISCOORDINATION

Aneurysmal subarachnoid hemorrhage (SAH) may be associated with acute cardiac dysfunction which is variable. The aim was to test the hypothesis that neurocardiac injury in SAH is associated with left ventricular (LV) regional discoordination. We prospectively studied 151 patients with SAH (