title: Left Ventricular Deformation and Myocardial Fibrosis in Patients With Advanced Heart Failure Requiring Transplantation.
abstract: OBJECTIVE
  To evaluate potential relationships between different components of left ventricular (LV) function and histopathological evidence for myocardial fibrosis in patients undergoing heart transplantation.
  
  
  METHODS
  The study population included patients with advanced heart failure, referred for an echocardiographic examination before heart transplantation. Traditional LV function measurements and global longitudinal strain (GLS) by speckle tracking echocardiography, averaging all LV segments in 4-, 2-, and 3-chamber views were obtained in all subjects. LV tissue samples were obtained from all patients who underwent heart transplantation. Myocardial fibrosis was assessed using Masson's staining.
  
  
  RESULTS
  Of 106 patients referred for cardiac transplantation, 47 underwent cardiac transplantation and were enrolled in the study. LV myocardial fibrosis and its grade strongly correlated with GLS (r = 0.75, P = .0001), modestly with global circumferential strain and LV torsion (r = 0.61, P = .001 and r = 0.52, P = .01, respectively) and weakly with mitral S' wave (r = -0.41; P = .01) and mitral annular plane systolic excursion (r = -0.35; P = .05) but did not correlate with LV ejection fraction (r = -0.12; P = NS). GLS had the strongest accuracy for detecting LV fibrosis (area under the curve, 0.92). None of the echo parameters correlated with patient's exercise capacity.
  
  
  CONCLUSIONS
  Global longitudinal strain is the most accurate LV global function measure that correlates with the extent of myocardial fibrosis in patients with advanced systolic HF requiring heart transplantation.
authors.affiliation: Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden; Department of Cardiovascular Diseases, University of Siena, Siena, Italy. Electronic address: cameli@cheapnet.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Francesca Maria
authors.initials: FM
authors.lastname: Righini
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Lisi
authors.affiliation: Department of Cardiac Surgery, University of Siena, Siena, Italy.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Dokollari
authors.affiliation: Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Lindqvist
authors.affiliation: Department of Cardiac Surgery, University of Siena, Siena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Maccherini
authors.affiliation: Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Henein
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D004452:Echocardiography / Q000379:methods; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007150:Immunohistochemistry; D007558:Italy; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery
keywords: Advanced cardiac failure; LV fibrosis; LV strain; echocardiography; heart transplantation; speckle tracking