Comparison of Global Longitudinal Strain in Dual-chamber versus Ventricular Pacemaker in Complete Heart Block.

Context: Bradycardia caused by total atrioventricular block (TAVB) is treated by implantation of permanent pacemakers (PPMs) in either dual-chamber (DDD) versus ventricular (VVI) pacing modes. DDD is considered a more physiological pacing mode than VVI as it avoids atrioventricular dyssynchrony. However, previous trials have failed to demonstrate the superiority of DDD in improving quality of life and morbidity. Aims: This study aims to provide postpacemaker function of the left ventricle (LV) measured with global longitudinal strain (GLS), in TAVB patients. Settings and Design: This is a comparative study; samples included in the study are adult TAVB patients undergoing PPM implantation, without significant heart function, and structural abnormality. Echocardiographic parameters are obtained before, after 1 month, and after 3 months post-PPM. Subjects and Methods: A total of 98 TAVB patients undergoes PPM implantation during the study period, 55 patients were excluded, and in the end, only 43 patients fulfill the inclusion criteria. Statistical Analysis Used: Baseline data between DDD and VVI are compared using unpaired t-test. Statistical significance 1 month post-PPM and 3 months post-PPM is analyzed using paired t-test. Results: There were no significant differences between both groups at baseline. However, significant GLS changes are observed 1 month after PPM in the VVI group (P = 0.002), but no significant change was observed in the DDD group even after 3 months (P = 0.055). Conclusions: In our study, we conclude that DDD is superior in maintaining LV function in the short term in TAVB patients after PPM implantation.

Clinical Outcome of Rheumatic Mitral Valve Repair and Replacement Surgery in Indonesia; A Comparison with Non-Rheumatic Aetiology.

Introduction: Mitral valve repair (MVr) has been shown to achieve better outcomes than mitral valve replacement (MVR) in degenerative aetiology. However, that cannot be applied in rheumatic mitral valve disease. Therefore, this study aims to evaluate early and late clinical outcomes and mid-term survival in RHD compared to the non-RHD group and whether mitral valve repair is a better surgical approach in RHD patients. Methods: Patients who underwent mitral valve surgery with or without coronary artery bypass grafting were included in this study. All patients were divided into the RHD and non-RHD group by the type of mitral surgery performed. Early and late outcomes were evaluated, and mid-term cumulative survival was reported. Results: A total of 1382 patients post MV surgeries were included. The 30-day mortality was significantly higher in the RHD group compared to the non-RHD group (8.7% vs. 4.4%, p = 0.003). There was no difference in 30-day mortality between repair and replacement in each respective group. During follow-up (12-54 months), all-cause mortality between RHD and non-RHD groups (16.7% vs. 16.2%) was not different. In the RHD group, the survival of MVr was 85.6% (95% CI 82.0%-88.5%), and MVR was 78.3% (95% CI 75.8%-80.6%), p-value log rank 0.26 However, in the non-RHD group, patients who underwent MVr had better survival than MVR, with cumulative survival of 81.7% (95% CI 72.3%-88.2%) vs. 71.1% (95% CI 56.3%-81.7%) p-value log rank 0.007. Conclusion: Early mortality rate in rheumatic mitral valve surgery was higher than in non-rheumatic valve surgery. Although in rheumatic MV disease MV repair did not show a significant survival advantage over MV replacement, a trend towards more favourable survival in the repair group was observed.

Global Longitudinal Strain and Myocardial Work Index in Post-COVID-19 Syndrome with Mild Symptoms: A Case Series.

The involvement of the cardiovascular system in COVID-19 is prevalent. The effect of SARS-COV-2 infection in both acute and recovery phases is called a post-COVID-19 syndrome. Considering the high prevalence of cardiac abnormalities after COVID-19, clinicians should continue to monitor cardiac function in COVID-19 patients after hospital discharge. Echocardiography is an accurate and accessible tool to assess cardiac function after COVID-19. Left-ventricle (LV) and right ventricle (RV) longitudinal strains are more sensitive to detecting subtle abnormalities than standard parameters, such as left-ventricle ejection fraction and tricuspid annular plane systolic excursion (TAPSE). Myocardial work index is a novel parameter including afterload to evaluate cardiac function. These parameters can give further information on cardiac function in COVID-19 patients. We presented two cases of COVID-19 with serial cardiac assessment using echocardiography.

The Influence of Special Military Training on Left Ventricular Adaptation to Exercise in Elite Air Force Soldiers.

Purpose: The purpose of this study was to observe the influence of level physical training intensity on left ventricular (LV) adaptation in elite air force soldiers compared to regular basic military training. Methods: The LV adaptation of special military physical training for elite air force soldiers was compared with basic military training for regular troops. A group of the nonmilitary subject was also evaluated as a control group. The presence of LV adaptation was evaluated using some echocardiography parameters, including LV mass index (LVMI), LV ejection fraction (LVEF), global longitudinal strain (GLS), and myocardial work index. The parameters of the myocardial work index include global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE). Results: Forty-three elite air force soldiers underwent special military training, 43 regular troops underwent basic military training, and 23 nonmilitary subjects as a control group. Age, heart rate, blood pressure, and Cooper test results significantly differed among the three groups. Multivariate analysis among all groups showed that the level of physical training was associated with the LVMI (coefficient ß = 6.061; 95% confidence interval [CI] = 1.91-10.22; P = 0.005), LVEF (coefficient ß = -1.409; 95% CI = -2.41-[-0.41]; P = 0.006), LVGLS (coefficient ß = 1.726; 95% CI = 1.20-2.25; P < 0.001), GWW (coefficient ß = -13.875; 95% CI = -20.88-[-6.87]; P < 0.001), GWE (coefficient ß = 0.954; 95% CI = 0.62-1.26; P < 0.001), GCW (coefficient ß = 176.128; 95% CI = 121.16-231.10; P < 0.001), and GWI (coefficient ß = 196.494; 95% CI = 144.61-248.38; P < 0.001). Conclusions: Higher intensity of physical training observed in a special military training is associated with higher LV GLS, GWE, GCW, GWI, and lower GWW value suggesting greater physiological adaptation than the lower intensity training.

Comparison between Visual Assessment and Longitudinal Strain during Dobutamine Stress Echocardiography.

Background: The relationship between visual assessment and longitudinal strain during dobutamine stress echocardiography (DSE) remains poorly investigated. This study assessed wall motion segments visually graded as normokinetic, hypokinetic, and akinetic at baseline and the peak of DSE and compared with longitudinal strain between segments with and without induced impaired contractility and improved contractility during DSE. Methods: This study included 112 patients examined by DSE, consisting of 58 patients referred for diagnostic study and 54 patients referred for viability study. Regional left ventricular (LV) contractility was assessed visually and longitudinal strain was measured using echocardiography transthoracic. Results: At baseline, the strain of LV segments was -16.33 ± 6.26 in visually normokinetic, 13.05 ± 6.44 in visually hypokinetic, and -8.46 ± 5.69 in visually akinetic segments. During peak dose, the strain of LV segments was -15.37 ± 6.89 in visually normokinetic, -11.37 ± 5.11 in visually hypokinetic, and -7.37 ± 3.92 in visually akinetic segments. In segments with visually observed impaired contractility, the median longitudinal strain was significantly lower than in segments without impaired contractility. For segments with visually observed improved contractility, the median longitudinal strain was significantly higher than for segments without improved contractility. In diagnostic study, sensitivity of visual assessment for absolute decrease of >2% longitudinal strain was 77%, respectively. In the viability study, the sensitivity was 82% for an absolute decrease of ≥2% longitudinal strain. Conclusions: There is good association between strain analysis value and visually assessed wall motion contractility.

Association between Right Ventricle-Pulmonary Artery Coupling with In-Hospital Outcome after Triple Valve Surgery in Rheumatic Heart Disease.

Context: Triple valve surgery (TVS) is a relatively higher in-hospital mortality rate than any isolated valve surgery. In advanced-stage valvular heart disease, maladaptation may occur, creating RV-PA uncoupling. Aims To evaluate whether RV-PA coupling is associated with the in-hospital outcome of patients after TVS. Settings and Design: From the medical records, clinical and echocardiography data were collected and compared between the survived and patients with in-hospital mortality groups. Methods and Material: Patients with the rheumatic multivalvular disease who underwent triple valve surgery were included in the study. Statistical and analysis used Uni and bivariate analysis assessed any association between the RV-PA coupling using TAPSE/PASP and other clinical variables with the in-hospital mortality post TVS. Result: From 269 patients, the in-hospital mortality rate was 10 %. The median value of TAPSE/PASP ratio in all group is 0.41 (0.02-5.79). Impaired RV-PA coupling which value < 0.36 occurs in 38.3 % population. By multivariate analysis, independent predictors of in-hospital mortality were TAPSE/PASP < 0.36 (OR 3.46, 95 % CI 1.21 - 9.89; P 0.02), age (OR 1.04, 95 % CI 1.003-1.094; P 0.035), CPB duration, (OR 1.01, 95 % CI 1.003-1.017; P 0.005). Conclusion: RV-PA uncoupling assessed by TAPSE / PASP ratio < 0.36 is associated with the in-hospital mortality in patients post triple valve surgery. Other factors associated with the outcome were older age and longer CPB machine duration.

Echocardiographic Parameters Correlated with Age in Isolated Severe Rheumatic Mitral Stenosis Patients in Indonesia.

BACKGROUND: Despite the high prevalence of rheumatic mitral stenosis (MS) in Indonesia, the impact of aging on the anatomical and hemodynamic component of rheumatic MS is not well studied. AIM: To analyze the association of age with various echocardiographic parameters in patients with isolated severe rheumatic MS in Indonesia. METHODS: A cross-sectional study was conducted enrolling 263 subjects with isolated severe rheumatic MS who underwent transthoracic echocardiography (TTE) during January 2015 until December 2017 at National Cardiovascular Center of Harapan Kita, Jakarta, Indonesia. Demographic data were collected, and echocardiographic variables were measured based on standard TTE examination using GE Vivid 7 and S6 Doppler Echocardiography System (GE Medical System, Norway). RESULTS: Of 263 subjects, there are 84 men and 179 women aged 18-80 (mean age 42.9) years old. Most patients had atrial fibrillation (80%), with a higher prevalence of AF in the older group. Age was positively correlated with LA diameter and Wilkin's score (r = 0.186, P = 0.002; r = 0.142, P = 0.022; respectively); while mean MVG (r = -0.304, P < 0.001), TR Vmax (r = -0.126, P = 0.04), TR maxPG (r = -0.127, P = 0.039) and TAPSE (r = -0.125, P = 0.044) were correlated negatively with age. Mean MVG has the strongest correlation with age in our subjects. CONCLUSION: This is the first study in Indonesia that analyze the association of age and different echocardiographic parameters in isolated severe rheumatic severe MS patients. Age has a significant correlation with mean MVG, LA diameter, Wilkin's score, TR Vmax, TR maxPG, and TAPSE. We assume that the association of age and these parameters were influenced by the normal aging process and progression of chronic MS.