Tor Skibsted Clemmensen1, Hans Eiskjær1, Bertil Ladefoged1, Fabian Mikkelsen1, Jens Sørensen2,3, Sven-Olof Granstam4, Sara Rosengren4, Frank A Flachskampf4,5, Steen Hvitfeldt Poulsen1. 1. Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. 2. Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. 3. Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden. 4. Department of Medical Sciences, Clinical Physiology, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden. 5. Department of Cardiology, Akademiska Sjukhuset, Akademiska sjukhuset, 751 85, Uppsala, Sweden.
Abstract
AIMS: Left ventricular (LV) myocardial work index (LVMWI) derived from pressure-strain analysis resembles a novel non-invasive method for LV function evaluation. LV global longitudinal strain (LVGLS) has proven beneficial for risk stratification in cardiac amyloidosis (CA) patients. This study aimed to evaluate the potential additive value of LVMWI for outcome prediction in CA patients. METHODS AND RESULTS: We enrolled 100 CA patients in the period 2014-19 from Aarhus University Hospital, Denmark and Uppsala University Hospital, Sweden. All patients underwent comprehensive echocardiographic evaluation and were prospectively followed until censuring date on 31 March 2019 or death. During follow-up, we registered major adverse cardiac events (MACE) comprising heart failure requiring hospitalization and all-cause mortality. The median follow-up was 490 (228-895) days. During follow-up, a total of 42% of patients experienced MACE and 29% died. Patients with LVMWI <1043 mmHg% had higher MACE risk than patients with LVMWI >1043 mmHg% [hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.2-4.3; P = 0.01]. Furthermore, patients with LVMWI <1039 mmHg% also had higher all-cause mortality risk than patients with LVMWI >1039 mmHg% (HR 2.6, 95% CI 1.2-5.5; P < 0.05). Moreover, the apical-to-basal segmental work ratio was a significant MACE and all-cause mortality predictor. By combining LVMWI and apical-to-basal segmental work ratio, we obtained an independent model for all-cause mortality prediction (high vs. low risk: HR 6.4, 95% CI 2.4-17.1; P < 0.0001). In contrast, LVGLS did not predict all-cause mortality. CONCLUSION: LV myocardial work may be of prognostic value in CA patients by predicting both MACE and all-cause mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Left ventricular (LV) myocardial work index (LVMWI) derived from pressure-strain analysis resembles a novel non-invasive method for LV function evaluation. LV global longitudinal strain (LVGLS) has proven beneficial for risk stratification in cardiac amyloidosis (CA) patients. This study aimed to evaluate the potential additive value of LVMWI for outcome prediction in CA patients. METHODS AND RESULTS: We enrolled 100 CA patients in the period 2014-19 from Aarhus University Hospital, Denmark and Uppsala University Hospital, Sweden. All patients underwent comprehensive echocardiographic evaluation and were prospectively followed until censuring date on 31 March 2019 or death. During follow-up, we registered major adverse cardiac events (MACE) comprising heart failure requiring hospitalization and all-cause mortality. The median follow-up was 490 (228-895) days. During follow-up, a total of 42% of patients experienced MACE and 29% died. Patients with LVMWI <1043 mmHg% had higher MACE risk than patients with LVMWI >1043 mmHg% [hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.2-4.3; P = 0.01]. Furthermore, patients with LVMWI <1039 mmHg% also had higher all-cause mortality risk than patients with LVMWI >1039 mmHg% (HR 2.6, 95% CI 1.2-5.5; P < 0.05). Moreover, the apical-to-basal segmental work ratio was a significant MACE and all-cause mortality predictor. By combining LVMWI and apical-to-basal segmental work ratio, we obtained an independent model for all-cause mortality prediction (high vs. low risk: HR 6.4, 95% CI 2.4-17.1; P < 0.0001). In contrast, LVGLS did not predict all-cause mortality. CONCLUSION: LV myocardial work may be of prognostic value in CA patients by predicting both MACE and all-cause mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Felix Hedwig; Olena Nemchyna; Julia Stein; Christoph Knosalla; Nicolas Merke; Fabian Knebel; Andreas Hagendorff; Felix Schoenrath; Volkmar Falk; Jan Knierim Journal: Front Cardiovasc Med Date: 2021-06-18
Authors: Letizia Spinelli; Giuseppe Giugliano; Antonio Pisani; Massimo Imbriaco; Eleonora Riccio; Camilla Russo; Alberto Cuocolo; Bruno Trimarco; Giovanni Esposito Journal: Int J Cardiovasc Imaging Date: 2020-11-19 Impact factor: 2.357