Raluca Tomoaia1, Ruxandra Stefana Beyer2, Dumitru Zdrenghea3, Alexandra Dadarlat-Pop4, Gabriel Cismaru5, Gabriel Gusetu6, Radu Rosu7, Adela Serban8, Dana Pop9. 1. Cardiology Department "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania Heart Institute "N. Stancioiu", Cluj-Napoca, Romania. raluca.tomoaia@gmail.com. 2. Heart Institute "N. Stancioiu", Cluj-Napoca, Romania. anda_bogdan@yahoo.com. 3. "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania. dzdrenghea@yahoo.com. 4. Heart Institute "N. Stancioiu", Cluj-Napoca, Romania "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.. dadarlat.alexandra@yahoo.ro. 5. "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania. cismaru.gabriel@umfcluj.ro. 6. "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania. gusetu.gabriel@umfcluj.ro. 7. "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania. rosu.radu@umfcluj.ro. 8. Heart Institute "N. Stancioiu", Cluj-Napoca, Romania "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.. serban.adela@umfcluj.ro. 9. "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania. pop67dana@gmail.com.
Abstract
AIM: To determine the relationship between myocardial work (MW) indices derived from non-invasive pressure-strain loops (PSL) and established parameters of left ventricular (LV) performance in patients with acute myocardial infarction (AMI) and heart failure (HF) with preserved or mid-range ejection fraction (HFpEF/HFmrEF). MATERIAL AND METHODS: Speckle-tracking echocardiography (STE) was used to determine MW indices and global longitudinal strain (GLS) in the first 24-48 hours after admission in patients with AMI, HF symptoms, NT-proBNP >300 pg/mL and left ventricular ejection fraction (LVEF) >40%. MW was calculated by using PSL, which combine strain and non-invasive blood pressure measurement. Global MW index (GWI) was defined as the work inside the area of the PSL. RESULTS: Forty-nine patients (mean age 68±13 years) fulfilled the inclusion criteria. Both GWI (1057±338 mmHg%) and GLS (-10.4±3.3%) were reduced in the majority of the patients. However, a proportion of patients with abnormal GLS showed normal GWI. There was a strong inverse relationship between GWI and GLS (r=-0.81). GWI demonstrated a strong relationship with LVEF (r=0.69) and a moderate correlation to NT-proBNP (n=-0.29). NT-proBNP showed a tendency to higher values in patients with more reduced GWI (820 [590-2550] vs 707 [460-1335], p=0.17). Out of the diastolic dysfunction parameters, GWI showed moderate correlations to LA volume index (r-0.29), E/A (r=-0.23) and E/e' (r=-0.39), which were also significantly more impaired in patients with more reduced GWI. CONCLUSION: Non-invasive PSL might bring further information to LVEF and GLS in patients AMI at the early stages of HFpEF/HFmrEF, since LV performance depends on both contractile properties and variations in load in the ischemic segments.
AIM: To determine the relationship between myocardial work (MW) indices derived from non-invasive pressure-strain loops (PSL) and established parameters of left ventricular (LV) performance in patients with acute myocardial infarction (AMI) and heart failure (HF) with preserved or mid-range ejection fraction (HFpEF/HFmrEF). MATERIAL AND METHODS: Speckle-tracking echocardiography (STE) was used to determine MW indices and global longitudinal strain (GLS) in the first 24-48 hours after admission in patients with AMI, HF symptoms, NT-proBNP >300 pg/mL and left ventricular ejection fraction (LVEF) >40%. MW was calculated by using PSL, which combine strain and non-invasive blood pressure measurement. Global MW index (GWI) was defined as the work inside the area of the PSL. RESULTS: Forty-nine patients (mean age 68±13 years) fulfilled the inclusion criteria. Both GWI (1057±338 mmHg%) and GLS (-10.4±3.3%) were reduced in the majority of the patients. However, a proportion of patients with abnormal GLS showed normal GWI. There was a strong inverse relationship between GWI and GLS (r=-0.81). GWI demonstrated a strong relationship with LVEF (r=0.69) and a moderate correlation to NT-proBNP (n=-0.29). NT-proBNP showed a tendency to higher values in patients with more reduced GWI (820 [590-2550] vs 707 [460-1335], p=0.17). Out of the diastolic dysfunction parameters, GWI showed moderate correlations to LA volume index (r-0.29), E/A (r=-0.23) and E/e' (r=-0.39), which were also significantly more impaired in patients with more reduced GWI. CONCLUSION: Non-invasive PSL might bring further information to LVEF and GLS in patients AMI at the early stages of HFpEF/HFmrEF, since LV performance depends on both contractile properties and variations in load in the ischemic segments.