Correlation of LV Longitudinal Strain by 2D Speckle Tracking with Cardiovascular risk in Elderly. (A pilot study of EGAT-Echo study.
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1 Correlation of LV Longitudinal Strain by 2D Speckle Tracking with Cardiovascular risk in Elderly. (A pilot study of EGAT-Echo study.) Researcher: Dr. Atthakorn Wutthimanop, MD. Research adviser: Dr.PrinVathesathokit, MD. Dr. SukitYamwong, MD. Dr. Oraporn See, MD. Dr.Piyamitr i Sritara,MD. Ramathibbodi hospital
2 INTRODUCTION Echocardiogram is a standard procedure in evaluation of Left ventricular function 2 D speckle tracking is a new tool to measure myocardial deformation and allow quantitative analysis of global and regional myocardial function
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5 Speckle tracking : Strain Tissue imaging evaluation myocardial deformation Good Quantitative assessment Angle independence Validated to CMR and Sonomicrometry Minimal bias ( low intra and interobserver variability)
6 INTRODUCTION Left ventricular function altered with age and previous study had shown reduction of longitudinal strain in elderly (1) Longitudinal strain was shown to be impaired before other directions of strain in those with cardiovascular risk and without overt cardiac disease (2) 1. Jing Ping Sun et al. Int J cardiol; J Am Soc Echocardiogram 2008; 21:
7 o Non invasive for assessment of LV (Global and and regional ) deformation and torsion o Angle independence o Validated to CMR and Sonomicrometry o Minimal bias ( low intra and interobserver variability) o Valid in patient with and without RWMA
8 INTRODUCTION There are no study of correlation to demonstrate relationship between left ventricular longitudinal strain by 2D speckle tracking and cardiovascular risk factors in Thai elderly. This study will be the pilot study of relationship between ventricular longitudinal strain and cardiovascular risk factors.
9 Objective Primary outcome Determination of the relationship between 2D STE of LV longitudinal strain in elderly with and without cardiovascular risk. Secondary outcome Demonstrating correlation 2 D STE longitudinal strain and CAVI.
10 Data collection Cardiovascular disease risk factors (CVD risk factors) data collection HT Diabetes mellitus Tobacco use History of CVA,MI Dyslipidemia Age Gender Kidney function BMI Echocardiography data Allraw datasets were transferred to the core laboratoryof Ramathibodi All raw datasets were transferred to the core laboratory of Ramathibodi hospital. The LV Longitudinal Strain by 2 D speckle tracking analysis was performed using speckle tracking software from Tomtec software.
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12 Study design/statistic Study design Crossectional Correlational research design. Statistic Descriptive statistics, mean, standard deviation, absolute number, percentage will used for subject demographic explanation. Univariate regression and Multivariate regression (stepwise method) analysis willbe used for demonstrating correlation between LV Left ventricular 2 D speckle tracking longitudinal strain with cardiovascular risk in the elderly and CAVI. A p value <0.05 was considered statistically significant. All statistics analysis are calculated by SPSS 16.0 Program.
13 Results
14 Baseline characteristics Baseline characteristics Total 350subjects underwent echocardiogram was reviewed. There were 200 subjects to calculate LV Longitudinal strain because 150 subjects were excluded due to poor echocardiogram images. LV Longitudinal strain (N= 200 subjects ) Mean + SD = %CI = to Kolmogorov Smirnov test (K S test) p value = 0.200>> normal distribution
15 Baseline characteristic and risk factors. Mean + SD n n % Left ventricular mass (g) (n=192) Left ventricular C (g) (n=192) Ejection fraction (%) (n=192) Left ventricular Longitudinal strain (n=200) Age at echocardiogram (years) (n=196) (60 82 yr) Gender (n=199) Female % Ml Male % 32% Hypertension (n=200) Have not hypertension % Have hypertension % Smoking (n=198) Never smoking % 56% Smoker (Both current and former) % Diabetes mellitus (n=200) Have not Diabetes mellitus % Have Diabetes mellitus % Stroke (n=200) Have not experienced stroke % Have experienced stroke % Dyslipidemia (n=200) Have not dyslipidemia % Have dyslipidemia %
16 Baseline characteristic and risk factors. Mean + SD n n % CAD (n=200) Have not current or previous CAD % Have current or previous CAD % BMI (kg/m 2 ) (n=194) Weight (n=194) Normal weight % Over weight % Obesity % Age risk (n=196) Male <= 55 and Female <=65 years % Male > 55 and Female > 65 years % GFR (n=195) Normal GFR % Abnormal GFR (< 60 ml/min) % Peripheral Artery disease Have not PAD as underlying (PAD) % 99% (n=198) Have PAD as underlying disease %
17 Baseline characteristic and risk factors. Mean + SD n n % Cardio-Ankle Vascular Index (CAVI) )(n=181) Right CAVI score Left CAVI score CAVI criteria Normal (CAVI score 8.0) % Border line (9 > CAVI >=8 ) % Possible CAVI >=9 Arteroisclerosis %
18 Baseline characteristic and risk factors. Mean + SD n n % Cardio-Ankle Vascular Index (CAVI) (n=181) Right CAVI score Left CAVI score CAVI criteria Normal (CAVI score 8.0) % Border line (9 > CAVI >=8 ) % Possible CAVI >=9 Arteroisclerosis % Ankle Brachial Index Left Ankle Brachial Index (n=182) LfAkl Left Ankle Brachial hilid Index Normal % 00% Abnormal (ABI <0.9) 0.00% Right Ankle Brachial Index (n=182) Right Ankle Brachial Index Normal % 00% Abnormal (ABI <0.9) 0.00% Ankle Brachial Index (n=182) Normal % Abnormal (ABI <0.9) 0.00%
19 Baseline characteristic and risk factors. Mean + SD n n % Lipid id profile test t Total Cholesterol (n=200) Cholesterol level <240 mg/dl % 240 mg/dl % Triglyceride (n=200) Triglyceride level < 200 mg/dl % 200 mg/dl % HDLC (n=200) HDLC level 40 mg/dl % <40 mg/dl % LDLC (n=200) LDLC level < 160 mg/dl % 160 mg/dl % Lipid Profile test Normal Lipid Profile test % Abnormal Lipid Profile test %
20 Baseline characteristic and risk factors. Mean + SD n n % FBS >=126 mg/dl and/or HbA1C > 6.5% No % (n=200) Yes %
21 Univariate analysis Linear regression analysis was used to demonstrate relationship between LV longitudinal strains with each factor. The significant relation factors for LV longitudinal strain were Gender (p value 0.001) Hypertension (p value 0.002) Smoking (p value 0.011) Diabetes mellitus (p value < 0.001) Coronary artery disease (p value 0.002)
22 Univariate analysis n Left ventricular Adjustedd LG strain r Mean + SD 2 B 95% CI p-value* Male Gender No Reference Yes to * 001* Hypertension No Reference Yes to * Current smoker or former No Reference smoker Yes to * Diabetes mellitus No Reference Yes to <0.001* Stroke No Reference Yes to Dyslipidemia No Reference Yes to CAD No Reference Yes to * Weight Normal Reference Overweight and Obesity to
23 Univariate analysis n Left ventricular Adjustedd LG strain r Mean + SD 2 B 95% CI p-value* Male > 55 and Female > 65 No Reference years Yes to Abnormal kidney function No Reference Yes to Peripheral Artery disease No Reference (PAD) Yes to Chronic Kidney Disease No Reference Yes to Abnormal GFR No Reference (< 60 ml/min) Yes to
24 Univariate analysis Cardio-Ankle Vascular Normal Index (CAVI) (CAVI < 8.0) B 95% CI p-value* Left ventricular Adjuste n LG strain d Mean + SD r Reference Border line and Possible to Arteroisclerosis (9 > CAVI >=8 ) And CAVI >=9) FBS >=126 No Reference Yes to HbA1C > 6.5% No Reference Yes to *
25 Multivariate analysis Multivariate analysis Multivariate Regression analysis, stepwise method was analyzed to demonstrate relationship between LV longitudinal strain with significant factors from univariate analysis. Gender Hypertension, Smoking, Diabetes mellitus, Coronary artery disease
26 Multivariate analysis Multivariate analysis The result shown that diabetes mellitus, coronary artery disease, and HT were significant risk factors strongly associated with LV longitudinal strain (p value = < 0.001, Adjusted r 2 = 0.127) Unstandardized standard ized Std. B Beta Error Sig. 95% CI Constant t to Diabetes mellitus to CAD to Hypertension to Adju sted r 2 p-value < Regression model show LV longitudinal strain of the subject without diabetes mellitus, coronary artery, and COPD were (95% CI = to ).
27 Multivariate analysis Multivariate analysis The result shown that diabetes mellitus, coronary artery disease, HT were significant risk factors strongly associated with LV longitudinal strain (p value = < 0.001, Adjusted r 2 = 0.130). Regression model show LV longitudinal strain of the subject without diabetes mellitus, coronary artery, and COPD were (95% CI = to ). 9
28 Conclusion Diabetes mellitus, coronary artery disease, and HT were significant risk factors strongly associated with LV longitudinal strain. ( The subjects without theses factor will have longer LV strain than the subjects who have DM, CAD and HT ) There was no relationship between CAVI and LV strain.
29 Conclusion Diabetes mellitus, coronary artery disease, and COPD were significant risk factors strongly associated with LV longitudinal strain. The subjects without theses factor will have longer LV strain than the subjects who have DM, CAD and COPD. Regression model between DM, CAD and COPD and LV was LV longitudinal strain = ( ) (DM 0, 1) (CAD 0, 1) ( HT 0,1) Normal LV Longitudinal Strain in elderly was , 95% CI = to There was no relationship between CAVI and LV strain.
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