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Speckle-Tracking Echocardiographic Strain Analysis Reliably Estimates Degree of Acute LV Unloading During Mechanical LV Support by Impella

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Abstract

Non-invasive means of evaluating appropriate cardiac unloading remain to be established. We hypothesized that myocardial deformation assessed by echocardiographic speckle-tracking strain analysis can reliably estimate the degree of left ventricular (LV) unloading under mechanical circulatory support. A total of 24 Yorkshire pigs underwent Impella-mediated acute LV unloading 1–2 weeks after myocardial infarction (MI). Echocardiographic and invasive pressure-volume measurements were used to evaluate the degree of LV unloading. Pressure-volume analysis before and after LV unloading exhibited a significant decrease in stroke work (3399 ± 1440 to 1244 ± 659 mmHg ml, p < 0.001), suggesting reduced external cardiac work. Both longitudinal strain (− 14.6 ± 4.1% to − 10.6 ± 2.3%, p < 0.001) and circumferential strain (− 18.7 ± 6.1% to − 9.3 ± 3.5%, p < 0.001) decreased after LV unloading, and there were linear relationships between stroke work and echocardiographic longitudinal (r = − 0.61, p < 0.001) as well as circumferential strains (r = − 0.75, p < 0.001). Echocardiographic LV strain analysis offers a non-invasive assessment of LV unloading in subacute MI.

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Abbreviations

2DE:

Two-dimensional echocardiography

3DE:

Three-dimensional echocardiography

CS:

Circumferential strain

ICC:

Interclass correlation coefficient

LS:

Longitudinal strain

LV:

Left ventricular

MI:

Myocardial infarction

STE:

Speckle-tracking echocardiography

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Acknowledgements

The authors thank Lauren Leonardson, LVT, for her excellent technical support.

Funding

This study was supported by National Institute of Health (NIH) R01 HL139963 (K.I.), HL117505, HL 119046, HL129814, HL128072, HL131404, HL135093, a P50 HL112324 (R.J.H.), American Heart Association - Scientist Development Grant 17SDG33410873 (K.I.), and two Transatlantic Fondation Leducq grants. O.B. was supported by the Deutsche Herzstiftung. We would like to acknowledge the Gene Therapy Resource Program (GTRP) of the National Heart, Lung, and Blood Institute, NIH.

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Author notes

  1. Nadjib Hammoudi and Shin Watanabe contributed equally to this work.

Authors and Affiliations

  1. Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA

    Nadjib Hammoudi, Shin Watanabe, Olympia Bikou, Kenneth Fish, Kelly P. Yamada, Satoshi Miyashita, Roger J. Hajjar & Kiyotake Ishikawa

  2. Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group, INSERM UMRS 1166, Sorbonne Universités, UPMC Univ Paris 06, Paris, France

    Nadjib Hammoudi & Alexandre Ceccaldi

  3. Institut de Cardiologie (AP-HP), Thoracic and Cardiovascular Surgery Department, Sorbonne Universités, UPMC Univ Paris 06, Paris, France

    Guillaume Lebreton

Authors
  1. Nadjib Hammoudi
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  2. Shin Watanabe
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Corresponding author

Correspondence to Kiyotake Ishikawa.

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Human Subjects/Informed Consent Statement

No human studies were carried out by the authors for this article.

Animal Experiments

All institutional and national guidelines for the care and use of laboratory animals were followed and approved by the appropriate institutional committees.

Conflict of Interest

K.I. received a research grant from Abiomed Inc. (Danvers, MA) and the Impella device was provided from the company. N.H. reports consulting/advisory activities for Philips. G.L. received a research grant from Abiomed Inc. not related to current study.

Additional information

Associate Editor Navin Kumar Kapur oversaw the review of this article

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Hammoudi, N., Watanabe, S., Bikou, O. et al. Speckle-Tracking Echocardiographic Strain Analysis Reliably Estimates Degree of Acute LV Unloading During Mechanical LV Support by Impella. J. of Cardiovasc. Trans. Res. 12, 135–141 (2019). https://doi.org/10.1007/s12265-018-9812-2

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  • DOI: https://doi.org/10.1007/s12265-018-9812-2

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