Scientific Blogs

The latest developments of Medis Suite Ultrasound

April 2023 edition

In this first newsletter dedicated to Medis Suite Ultrasound and QStrain Echo Research Edition, we would like to update you regarding the latest publications involving the advanced echocardiographic measurement technology that we currently offer in our solution.

We are therefore delighted to share with you these five recent clinical research articles on echocardiography-based hemodynamic forces:

Introduction to hemodynamic forces by echocardiography.

Laenens et al. – International Journal of Cardiology – 2023

In this manuscript Laenens, from the Leiden University Medical Centre group led by Prof. JJ Bax (Department of Cardiology), and co-authors, introduce to the IJC audience the concept of Echocardiography-based hemodynamic forces, i.e., non-invasive estimates of intra-ventricular pressure gradients obtained by means of endocardial speckle tracking applied to routine transthoracic echocardiographic scans.

The potential of such technique to add incremental clinical value is demonstrated by showcasing various cases: ST segment elevation in myocardial infarction, and non-ischemic cardiomyopathy with typical left bundle branch block (LBBB).

For further read: click here

Acute modification of hemodynamic forces in patients with severe aortic stenosis after transcatheter aortic valve implantation 

Vairo et al. – Journal of Clinical Medicine (2023)

Vairo et al., from the Division of Cardiology – Cardiovascular and Thoracic Department in Turin (Città della Salute e della Scienza Hospital), report in this paper how Echocardiography-based hemodynamic forces can be used as an effective post-operative monitoring tool for patients who underwent transcatheter aortic valve implantation (TAVI). On average, hemodynamic force amplitude parameters improved significantly after the procedure: LV longitudinal forces Forces (LF) apex-base [mean difference (MD) 1.79%; 95% CI 1.07–2.5; p-value < 0.001]; LV systolic LF apex-base (MD 2.6%; 95% CI 1.57–3.7; p-value < 0.001); LV impulse (LVim) apex-base (MD 2.9%; 95% CI 1.48–4.3; p-value < 0.001).

Similarly, hemodynamic force orientation parameters improved: LV LF angle (MD 1.5_; 95% CI 0.07–2.9; p-value = 0.041); LVim angle (MD 2.16_; 95% CI 0.76–3.56; p-value = 0.004). Conversely, no significant differences were found when measuring global longitudinal strain GLS and LV ejection fraction (LVEF) before and after the procedure. This prospective study shows that the non-invasive estimation of hemodynamic forces based on cardiac Ultrasound could help differentiate patients with LV function recovery after TAVI from patients with persistent hemodynamic dysfunction.

For further read: click here

Added value of hemodynamic forces for left ventricle function evaluation

Monosilio et al. – eBioMedicine – Part of The Lancet discovery science (2023)

The authors, from the Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences of “Sapienza” University / Policlinico Umberto I in Rome, hereby substantiate the increasing evidence in literature pointing in the direction of it being time to move beyond the simplified evaluation of LV function relying only on LVEF and strain, which do not fully consider the complexity of left ventricular mechanics.

To this end, Echocardiography-based and MR-based non-invasive hemodynamic force analysis can be a step forward for clinicians, since parameters based on hemodynamic forces have been shown by studies to be a) more sensible than GLS in LV functional alterations when ejection fraction is normal, and b) superior to other variables in predicting cardiovascular events. Therefore, hemodynamic forces estimation based on non-invasive imaging appears now at a stage where its further introduction and standardization in the clinics can be very beneficial for cardiology practitioners.

For further read: click here

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Hemodynamic forces as predictors of cardiac remodelling and outcome in heart failure with reduced ejection fraction treated with sacubitril/valsartan

Fabiani et al. – Proceedings of the 2022 European Society of Cardiology Congress (2022)

Fabiani (Gabriele Monasterio Foundation, Pisa, Italy) and co-authors hereby indicate that hemodynamic forces estimated by means of cardiac Ultrasound may help predict response to angiotensin receptor-neprylisin inhibitor (ARNI) treatment in heart failure patients.

After multivariate logistic regression analysis, in comparison with other indicators from conventional echocardiography and functional assessment, whole cardiac cycle LV strength (wLVS) derived from echo-based hemodynamic force analysis was the only independent predictor of ARNI response at 6 months. Moreover, the increase of wLVS from baseline to 6 months (DwLVS) also showed a high discrimination ability, and remained an independent predictor of the composite endpoint even after adjusting for other parameters. This substantiates further the predictive value of Echocardiography-based hemodynamic force estimation.

For further read: click here

Cardiac and vascular remodeling after 6 months of therapy with sacubitril/valsartan: mechanistic insights from advanced echocardiographic analysis

Monosilio et al. – Frontiers in Cardiovascular Medicine (2022)

Monosilio (Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University / Policlinico Umberto I, Rome) and colleagues report hereby about the Ultrasound-based assessment of hemodynamic force distribution improvements after Sacubitril/Valsartan treatment for heart failure patients.

Hemodynamic forces were non-invasively evaluated over the entire cardiac cycle, in systole and diastole, both in apex-base and in latero-septal directions for the LV. At 6 months during the treatment, a re-alignment of hemodynamic forces occurred. This was observed in conjunction with measurements of GLS and PV-loops, showing how hemodynamic forces, non-invasively assessed by means of Echocardiography, can help shed more light on the complex phenomenon of post-treatment reverse remodeling involving also increased myocardial contractility and afterload reduction.

For further read: click here

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