Search

Background: The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) has recently emerged as a measure of left ventricular filling pressure. Reference values are needed for this new parameter for it to be used clinically., Methods: Healthy participants from a prospective general population study, the Fifth Copenhagen City Heart Study, were assessed to establish reference values for E/e'sr derived from two-dimensional speckle-tracking echocardiography. The prevalence of abnormal E/e'sr was assessed in participants with cardiovascular risk factors or specific diseases., Results: The population comprised 1,623 healthy participants (median age, 45; interquartile range, 32-56; 61% female). The upper reference limit for E/e'sr in the population was 79.6 cm. Following multivariable adjustment, male participants exhibited significantly higher E/e'sr than female participants (upper reference limit for male participants, 83.7 cm; for female participants, 76.5 cm). For both sexes, E/e'sr increased in a curvilinear fashion with age such that the largest increases in E/e'sr were observed in participants >45 years. In the entire CCHS5 population with E/e'sr available (n = 3,902), increasing age, body mass index, systolic blood pressure, male sex, estimated glomerular filtration rate, and diabetes were associated with E/e'sr (all P < .05). Total cholesterol was associated with a less steep increase in E/e'sr. Abnormal E/e'sr was seldomly observed in participants with normal diastolic function but became more frequent in participants with increasing grades of diastolic dysfunction (normal, mild, moderate, severe [abnormal E/e'sr for each grade: 4.4% vs 20.0% vs 16.2% vs 55.6%, respectively])., Conclusion: The E/e'sr differs between sexes and is age dependent such that E/e'sr increases with advancing age. Therefore, we established sex- and age-stratified reference values for E/e'sr., (Copyright © 2023 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background: Height-based indexations for the evaluation of left atrial (LA) volumes have been proposed as an alternative method to account for body stature when body composition is abnormal. The aim of this study was to derive reference values for these indexation methods and to examine their association with atrial fibrillation (AF)., Methods: A healthy population was randomly split into derivation and validation cohorts (n = 493 each). The derivation cohort was used to derive reference values for iso- and allometric height-indexed LA volumes. Echocardiography included measurement of maximal LA volume (LAV max ) and minimal LA volume (LAV min ). Associations between these measures and AF were investigated in the validation cohort. Cox proportional-hazards regression was performed, adjusting for CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation) risk score., Results: From 986 healthy subjects, allometric height-indexed exponents were determined to 1.72 and 1.56 for LAV max and LAV min , respectively. Upper reference values were determined to be LAV max > 22.1 mL/m 1.72 and LAV min > 12.7 mL/m 1.56 . In the validation cohort, 41 patients (8%) developed AF during follow-up (median, 14.7 years). In unadjusted analyses, both isometric and allometric indexed LAV max were associated with AF (hazard ratio, 1.07 [95% CI, 1.03-1.11; P < .001] and 1.11 [95% CI, 1.05-1.18; P < .001] per 1 mL/m and 1 mL/m 1.72 increase, respectively) with equal C statistics of 0.63. Height-indexed LAV min was also associated with AF, with higher C statistics than for LAV max . All findings were consistent after multivariable adjustment. LAV max > 22.1 mL/m 1.72 posed an increased risk for AF (hazard ratio, 4.65; 95% CI, 1.83-11.86), but LAV min > 12.7 mL/m 1.56 carried a higher risk (hazard ratio, 6.33; 95% CI, 2.66-15.07)., Conclusions: Both isometric and allometric height-indexed LA volumes are associated with AF in the general population. LAV min is more strongly associated with AF than LAV max regardless of indexation., (Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background: Postsystolic shortening (PSS) may occur during myocardial ischemia. We aimed to assess the diagnostic and prognostic potential of PSS in patients with suspected stable angina pectoris (SAP)., Methods: This is a prospective study of patients with suspected SAP (N = 293), no prior cardiac history, and normal ejection fraction, who were examined by speckle-tracking echocardiography, coronary angiography, and exercise electrocardiogram. We excluded patients with known heart disease (ischemia, heart failure, valve disease), bundle branch block, pathological Q-waves, and arrhythmias. PSS was assessed using the postsystolic index (PSI), and categorical presence of PSS was defined as PSI ≥ 20% in one myocardial wall. The primary end point was major adverse cardiovascular events (MACEs), a composite of incident heart failure, myocardial infarction, and stroke. The secondary end point was MACE and revascularization (percutaneous coronary intervention/coronary artery bypass graft)., Results: A stenosis ≥70% in one or more coronary arteries defined significant coronary artery disease (CAD; n = 107). Patients with significant CAD had a higher prevalence of PSS (55% vs 39%; P < .002), and presence of PSS was an independent predictor of significant CAD in multivariable models adjusted for clinical data, exercise test, and echocardiographic measures (odds ratio, 2.45; 95% CI, 1.08-5.60; P = .033). The PSI confirmed this association (odds ratio, 1.71; 95% CI, 1.04-2.82; P = .034 per 1% increase). During median follow-up of 3.5 years (interquartile range, 2.7, 4.1) a total of 25 patients (8.5%) experienced MACE and 46 (15.7%) had the secondary end point. Presence of PSS was a predictor of MACE (hazard ratio, 2.57; 95% CI, 1.12-5.95; P = .028), and the association remained significant in adjusted models. Both presence of PSS and PSI were independent predictors of the secondary end point., Conclusions: In patients with suspected SAP, presence of PSS provides independent diagnostic information on significant CAD and offers novel prognostic information regarding risk of future cardiovascular events., (Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)