Global Longitudinal Strain Analysis Research Articles

The prognostic value of global longitudinal strain in patients with myocardial infarction and preserved ejection fraction - a prespecified substudy of the REDUCE-AMI trial.

The REDUCE-AMI trial showed that beta-blockers in patients with preserved left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI) had no effect on mortality or cardiovascular outcomes. The aim of this substudy was to evaluate whether global longitudinal strain (GLS) is a better prognostic marker than LVEF, and if beta-blockers have a beneficial effect in patients with decreased GLS. REDUCE-AMI was a registry-based randomized clinical trial. Conventional echocardiographic parameters and GLS were obtained and a likelihood ratio test between models adjusted for age, sex, hypertension, smoking, diabetes, previous AMI, and multi-vessel disease was used to compare LVEF and GLS as prognostic methods. A Cox regression model evaluated the impact of beta-blocker treatment on the composite endpoint of death from any cause or new AMI. 1436 patients (28.6% of total population) were included in this substudy. Due to poor image quality or incompatible equipment, 324 (22.6%) patients were excluded from analysis of GLS. Median GLS was 17.3%. The likelihood ratio test resulted in no difference (P = 0.56) when comparing the combination of GLS to LVEF. The results were robust when adding beta-blocker randomization status as an independent variable. In patients after AMI with preserved LVEF, GLS did not add prognostic value regarding death from any cause or new AMI. In addition, beta-blocker treatment did not alter the prognostic information obtained from GLS. Consequently, this study does not support an additive value of GLS compared to standard echocardiographic measurement in this patient population.

The role of artificial intelligence in standardizing global longitudinal strain measurements in echocardiography.

To evaluate the accuracy and feasibility of artificial intelligence (AI) in left ventricular global longitudinal strain (GLS) analysis as compared to conventional (Manual) and semi-automated (SemiAuto) method in echocardiography (Echo). GLS validation was performed on 550 standard Echo exams by expert cardiologists. The performance of a beginner cardiologist without experience of GLS analysis was assessed on a subset of 90 exams. The AI employs fully automated view selection, classification, endocardial border tracing, and calculation of GLS from an entire Echo exam, while SemiAuto requires manual chamber view selection, and Manual involves full user input. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC) for all three methods. Agreement of measures included Pearson's correlation (R) and Bland-Altman analysis [median bias; limits of agreement (LOA)]. With an 89% feasibility the AI showed good agreement with Manual (R = 0.92, bias = 0.7% and LOA: -3.5 to 4.8%) and with SemiAuto (r = 0.90, bias = 0.10% and LOA: -4.5 to 4%). ICCs for GLS were 1.0 for AI, 0.93 for SemiAuto, and 0.80 for Manual. After the 55th analysis, the beginner showed stable time performance with Manual (171 s), contrasting with the consistent performance of SemiAuto (85-69 s) from the beginning. The highest agreement between beginner and expert readers was achieved with AI (R = 1.00), followed by SemiAuto (R = 0.85) and Manual (R = 0.74). Automated GLS analysis enhances efficiency and accuracy in cardiac diagnostics, particularly for novice users. Integration of automated solutions into routine clinical practice could yield more standardized results.

Two-dimensional fetal speckle tracking; a learning curve study for offline strain analysis

Objectives Two-dimensional speckle tracking (2D-STE) strain analysis holds promise for assessing fetal cardiac function. Understand the learning curve before introducing 2D-STE into obstetrics is crucial. This study examined the learning curve for offline analysis of fetal left (LV) and right ventricular (RV) global longitudinal strain (GLS) using 2D-STE. Methods After 2D-STE training, three trainees (Maternal-Fetal Medicine fellow, OBGYN resident and medical student) analyzed 100 fetal heart clips using 2D-STE to calculate LV- and RV-GLS. Intra-class correlation coefficients (ICC) and Bland-Altman plots were compared GLS values across four sets of 25 clips for each trainee against the expert. Repeated measurements analysis compared GLS score differences between expert and trainees over time and among trainees, adjusting p-values with a Bonferroni correction. Results LV-GLS consistency evolved from poor-to-moderate during the first 50 measurements to moderate-to-good during the second 50 for all trainees. RV-GLS consistency evolved from poor-to-moderate during the first 75 measurements to moderate-to-good during the final 25 measurements for the fellow and resident. The student’s RV-GLS consistency was poor during the first 25 measurements, moderate-to good during the second 25 measurements and again poor-to-moderate during the final 50 measurements. Repeated measurements analysis showed a significant decrease in variability of the LV- and RV-GLS score differences between the expert and trainees over time (padj<0.001), which was not significantly different between trainees. Moreover, the mean of those differences were significantly different for all trainees for LV-GLS (padj<0.001) and RV-GLS (padj = 0.029), and did significantly change over time for RV-GLS (padj<0.001) but not for LV-GLS. Conclusions A clear learning effect was observed by the significant decrease in variability of the difference in the score between the expert and trainees over time. The consistency of fetal GLS analysis with 2D-STE was generally found to be moderate to good after 100 measurements in trainees.

Reference intervals of two-dimensional speckle tracking–derived endocardial global longitudinal strain analysis in 132 healthy cats

IntroductionThe assessment of left ventricular myocardial deformation and function by two-dimensional speckle tracking–derived strain analysis is an established method in human cardiology. It also progressively gains recognition in veterinary cardiology in both dogs and cats. ObjectivesThe objectives of this study were to create reference intervals for two-dimensional speckle tracking echocardiography (STE)–derived endocardial global longitudinal strain (GLS) in a population of healthy adult cats of different breeds. Influences of heart rate, body weight, and age were investigated. AnimalsA total of 132 healthy, adult cats were included in this study. Materials and MethodsLeft apical two-, three-, and four-chamber views were obtained prospectively for GLS measurements using two-dimensional speckle tracking performed with cardiac performance analysis. Potential influence of body weight, heart rate, and age was analyzed, and the interobserver and intra-observer variability of the measurements was determined. ResultsEndocardial GLS values were not significantly influenced by body weight (P=0.102), heart rate (P=0.144), or age (P=0.075). A reference interval for GLS of −21.18% to −37.50% (±4.12) was determined. The interobserver and intra-observer variability showed excellent agreement. Discussion and ConclusionsTwo-dimensional STE is a feasible technique for the evaluation of cardiac myocardial deformation and systolic function in cats. Showing an excellent interobserver and intra-observer agreement, two-dimensional STE is a promising method for clinical analysis of cardiac deformation in cats.

Low clinical utility of global longitudinal strain in a real-world breast cancer population

Abstract Background The 2022 European Society of Cardiology (ESC) Cardio-Oncology guidelines recommend the use of global longitudinal strain (GLS) to detect mild asymptomatic cancer therapy related cardiac dysfunction (ma-CTRCD). However, it remains unknown how to best manage these patients in order to prevent clinically significant CTRCD. Purpose To assess the course and outcomes of breast cancer patients meeting criteria for ma-CTRCD. Methods Echocardiograms and medical records were assessed for breast cancer patients receiving trastuzumab or an anthracycline, who underwent serial echocardiographic monitoring, including routine GLS. CTRCD was defined as an absolute decline in LVEF of >10% to <50%. ma-CTRCD was defined as a relative decline in average GLS of >15%, in the absence of significant LVEF decline. Normal was defined as no significant change in LVEF or GLS during cancer therapy. Clinical and echocardiographic course post ma-CTRCD detection was assessed. Baseline risk factors were compared between the three groups. Results 878 echocardiograms from 258 patients were analysed. GLS analysis was available in 76% of echocardiograms. CTRCD occurred in 23 (9%) and ma-CTRCD in 63 (24%). Only eight ma-CTRCD patients had management altered (cancer therapy withheld/ceased in three and heart failure medication commenced in six). Only two ma-CTRCD patients subsequently developed CTRCD, and GLS improved in 74%. Compared to the normal group (172, 67%), at baseline the ma-CTRCD group had higher average GLS (-21.8 vs -19.4, p<0.0001) and less borderline/abnormal average GLS (4% vs 36%, p<0.004). Conclusion Isolated declines in GLS are common and may have low clinical utility in preventing CTRCD. The findings support ESC guideline recommendations that cancer therapy should not be withheld in these patients. Those with higher baseline GLS may be more prone to clinically insignificant declines in GLS during cancer therapy.

The influence of genetic mutations on multilayer global longitudinal strain values in patients with hypertrophic cardiomyopaty

Abstract Background Hypertrophic cardiomyopathy (HCM) is a hereditary heart muscle disorder characterized by diverse genetic mutations. Multilayer global longitudinal strain (GLS) analysis has emerged as a valuable tool for assessing myocardial function. This study aimed to investigate the influence of genetic mutations on myocardial deformation patterns in HCM patients using multilayer GLS analysis. Methods A total of 83 adult patients diagnosed with HCM were included in the study. Genetic testing was performed to identify specific genetic mutations associated with HCM. Echocardiographic assessments were conducted to measure multilayer GLS values for endocardial, mid-myocardial, and epicardial layers. Patients were divided into gene-positive and gene-negative groups for comparative analysis. Results In the gene-negative group (n=41), the mean age was 57.1 ± 11.0 years, whereas in the gene-positive group (n=42), it was 55.5 ± 11.6 years (p=0.516). Significant differences were observed in endocardial (-16.1 ± 2.3 vs. -13.4 ± 3.2, p < 0.001) and mid-myocardial (-14.2 ± 2.1 vs. -12.3 ± 3.1, p = 0.002) GLS involvement between gene-negative and gene-positive HCM patients. However, no significant disparity in epicardial strain was detected. Conclusion The findings demonstrated a greater involvement of the endocardial and mid-myocardial layers in the group of HCM patients with positive genetic mutations. Multilayer GLS analysis has the potential to aid in the identification of subtle alterations in myocardial function associated with specific genetic mutations, contributing to refined risk assessment and personalized management strategies for HCM patients.

High-Intensity interval training improves global longitudinal strain in patients with metabolic syndrome and high risk of heart failure

Abstract Background Metabolic syndrome (MS) has been associated with the development of myocardial dysfunction which can lead to heart failure (HF). It is possible to detect early signs of myocardial dysfunction by assessing the global longitudinal strain (GLS) in a transthoracic echocardiography. A reduced GLS is considered as a predictor of HF development. Preventive strategies are recommended in patients with MS to avoid the progression to HF. Although exercise improves cardiovascular and metabolic health in MS patients, it is unknown whether exercise can affect the evolution of GLS in a group of patients with MS who are under medical treatment. Purpose To assess the prevalence of myocardial dysfunction (i.e., reduced GLS) in a heterogeneous group of patients with MS who are under medical treatment, and to test in these patients if 16 weeks of high-intensity interval training (HIIT) can improve the GLS. Methods Seventy-seven volunteers with MS and without signs or symptoms of HF were randomized in one of two 16-week intervention: i). HIIT in stationary bikes 3 sessions/week, 50 minutes/session + medical treatment (HIIT group), or ii). medical treatment (CONTROL). Maximal oxygen consumption (VO2max), and GLS together with rutinary echocardiographic parameters were assessed before and after intervention. The effect of HIIT compared to CONTROL was analyzed by a split-plot ANOVA to compare the effects of time (pre vs. post) and group (HIIT vs. CONTROL), and the interaction between the two factors. Results Before intervention 48.9% of participants from the HIIT group, and 46.7% from the CON group had a reduced GLS (i.e., >17% for men and >18% for women). However, none of them had a reduced left ventricular ejection fraction (LVEF), signs of diastolic dysfunction or an abnormal VO2max (less than 80% of predicted VO2max). After the 16-week intervention, only individuals from the HIIT group improved their VO2max (time*group P<0.001). LVEF did not improve in any of the experimental groups (time P=0.278) HIIT group improved their GLS by 0.51%, whereas CONTROL group improved it by 0.05% without reaching statistical significance (time*group P=0.186). However, a subgroup analysis of GLS conducted among the participants from the HIIT group discriminated by their pre-intervention values (GLS normal or reduced), showed that individuals with reduced GLS improved significantly by 1,41% (P=0.001) whereas those with a normal GLS improved by 0.14% without reaching statistical significance (P=0.736, time*group P=0.009). Conclusions Myocardial dysfunction assessed by GLS is present in MS even in the absence of symptoms, diastolic dysfunction, or reductions in the LVEF. HIIT can reduce the risk of HF development by improving GLS in patients with MS and early signs of myocardial dysfunction.A. Overall changes in GLSB. Subgroup analysis of GLS pre vs. post

Mitral annular plane systolic excursion by cardiac MRI versus Global longitudinal strain analysis by speckle tracking echocardiography for prognostic assessment in ST-elevation myocardial infarction patients

Mitral annular plane systolic excursion by cardiac MRI versus Global longitudinal strain analysis by speckle tracking echocardiography for prognostic assessment in ST-elevation myocardial infarction patients

Evaluation of changes in cardiac longitudinal strain rate in patients with systemic sclerosis undergoing iloprost treatment: an observational study.

Systemic Sclerosis (SSc) is characterized by widespread microangiopathy and fibrosis of skin and visceral organs. Left ventricle involvement is usually subclinical, characterized by systolic and/or diastolic dysfunction. The global longitudinal strain (GLS), a validated and reliable technique for the measurement of ventricular longitudinal deformation by means of echocardiography, may detect subclinical systolic dysfunction of SSc myocardium. The improvement of myocardial perfusion by means of intravenous Iloprost administration could ameliorate the contractility of SSc heart. Therefore, we aimed to evaluate GLS in a series of SSc patients prior and after Iloprost infusion. Fifteen consecutive SSc patients (age: 54 ± 11 years; 12 females) treated with Iloprost because of the presence/history of digital ulcers underwent echocardiography, including GLS technique. This evaluation was conducted immediately before Iloprost administration and at the end of the 6-h infusion session. Significant improvement in the mean GLS was observed after Iloprost administration (from -13.5 ± 2.5 to -15 ± 3.3; p= 0.011). The echocardiographic data obtained from the four-chamber view showed the best quality for GLS analysis and showed a highly significant improvement of the strain after Iloprost administration (from -13.4 ± 2.2 to -15.6 ± 3; p= 0.001). The degree of GLS improvement did not correlate with any SSc parameters. Iloprost administration improved GLS, suggesting that the increase of myocardial perfusion allowed, at least in part, a correction of left ventricular systolic dysfunction. Further studies are needed to confirm these findings, further exploring the mid/long-term effects of Iloprost on myocardial contraction.

(1224) - Global Longitudinal Strain Analysis on Ventricular Function, Evaluated Six Months to One Year Post Transplant, for Hearts Donated After Cardiac and Brain Death

(1224) - Global Longitudinal Strain Analysis on Ventricular Function, Evaluated Six Months to One Year Post Transplant, for Hearts Donated After Cardiac and Brain Death

Mechanistic basis for rescuing hypertrophic cardiomyopathy with myosin regulatory light chain phosphorylation.

We investigated the impact of the phosphomimetic (Ser15 → Asp15) myosin regulatory light chain (S15D-RLC) on the Super-Relaxed (SRX) state of myosin using previously characterized transgenic (Tg) S15D-D166V rescue mice, comparing them to the Hypertrophic Cardiomyopathy (HCM) Tg-D166V model and wild-type (WT) RLC mice. In the Tg-D166V model, we observed a disruption of the SRX state, resulting in a transition from SRX to DRX (Disordered Relaxed) state, which explains the hypercontractility of D166V-mutated myosin motors. The presence of the S15D moiety in Tg-S15D-D166V mice restored the SRX/DRX balance to levels comparable to Tg-WT, thus mitigating the hypercontractile behavior associated with the HCM-D166V mutation. Additionally, we investigated the impact of delivering the S15D-RLC molecule to the hearts of Tg-D166V mice via adeno-associated virus (AAV9) and compared their condition to AAV9-empty vector-injected or non-injected Tg-D166V animals. Tg-D166V mice injected with AAV9 S15D-RLC exhibited a significantly higher proportion of myosin heads in the SRX state compared to those injected with AAV9 empty vector or left non-injected. No significant effect was observed in Tg-WT hearts treated similarly. These findings suggest that AAV9-delivered phosphomimetic S15D-RLC modality mitigates the abnormal Tg-D166V phenotype without impacting the normal function of Tg-WT hearts. Global longitudinal strain analysis supported these observations, indicating that the S15D moiety can alleviate the HCM-D166V phenotype by restoring SRX stability and the SRX ↔ DRX equilibrium.

Left ventricular strain-volume loops in bicuspid aortic valve disease: new insights in cardiomechanics.

By combining temporal changes in left ventricular (LV) global longitudinal strain (GLS) with LV volume, LV strain-volume loops can assess cardiac function across the cardiac cycle. This study compared LV strain-volume loops between bicuspid aortic valve (BAV) patients and controls, and investigated the loop's prognostic value for clinical events. From a prospective cohort of congenital heart disease patients, BAV patients were selected and compared with healthy volunteers, who were matched for age and sex at group level. GLS analysis from apical views was used to construct strain-volume loops. Associations with clinical events, i.e. a composite of all-cause mortality, heart failure, arrhythmias, and aortic valve replacement, were assessed by Cox regression. A total of 113 BAV patients were included (median age 32 years, 40% female). BAV patients demonstrated lower Sslope (0.21%/mL, [Q1-Q3: 0.17-0.28] vs. 0.27%/mL [0.24-0.34], P < 0.001) and ESslope (0.19%/mL [0.12-0.25] vs. 0.29%/mL [0.21-0.43], P < 0.001) compared with controls, but also greater uncoupling during early (0.48 ± 1.29 vs. 0.05 ± 1.21, P = 0.04) and late diastole (0.66 ± 1.02 vs. -0.07 ± 1.07, P < 0.001). Median follow-up duration was 9.9 [9.3-10.4] years. Peak aortic jet velocity (HR 1.22, P = 0.03), enlarged left atrium (HR 3.16, P = 0.003), E/e' ratio (HR 1.17, P = 0.002), GLS (HR 1.16, P = 0.008), and ESslope (HR 0.66, P = 0.04) were associated with the occurrence of clinical events. Greater uncoupling and lower systolic and diastolic slopes were observed in BAV patients compared with healthy controls, suggesting presence of altered LV cardiomechanics. Moreover, lower ESslope was associated with clinical events, highlighting the strain-volume loop's potential as prognostic marker.

Cardiomyopathy discovered during pregnancy: Insights from speckle tracking echocardiography in a cohort of pregnant patients.

Heart failure (HF) is considered the leading cause of cardiac-related morbidity and mortality during pregnancy. Peripartum cardiomyopathy (PPCM) presents diagnostic challenges, often mirroring dilated cardiomyopathy (DCM). The aim of the study is to evaluate echocardiographic features, including global and segmental longitudinal strain values, in pregnant women with a history of newly diagnosed left ventricular systolic dysfunction (LVSD) in the third trimester of pregnancy. This cross-sectional study, conducted in two referral cardio-obstetric clinics in Isfahan, Iran, enrolled pregnant women with newly diagnosed LV systolic dysfunction in the third trimester of pregnancy. A multidisciplinary pregnancy heart team assessed the patients. Reevaluation of patients and advanced echocardiographic investigation, including speckle tracking echocardiography (STE), were performed at least six months after delivery. The study included 26 pregnant women. Baseline characteristics revealed varying NYHA functional classes and etiologies, including DCM or non-dilated LV cardiomyopathy and PPCM. Undiagnosed DCM with exacerbation during pregnancy or non-dilated LV cardiomyopathy were the most probable causes for LV systolic dysfunction (65.4%). In five cases, peripartum cardiomyopathy was more relevant. The mean global longitudinal strain (GLS) was -16.94% and -13.95% in PPCM and DCM, respectively. Significantly different regional longitudinal strain numbers among different LV segments in PPCM were observed (P=.042), whereas the segmental strain in DCM patients did not differ. When LVSD is discovered late in pregnancy, it is not easy for the authors to differentiate between peripartum cardiomyopathy and other cardiomyopathies. Advanced echocardiographic techniques, particularly GLS analysis, may be valuable in differentiating between these conditions.

Impact of Gore Cardioform Atrial Septal Defect Occluder on Atrial and Ventricular Electromechanics in a Pediatric Population

Transcatheter closure is the first-line treatment for ostium secundum atrial septal defect (ASD). The GORE Cardioform ASD Occluder (GCA) is potentially innovative compared with other self-centering devices. This study aimed to compare the mechanic changes in atrial and ventricular properties before and after GCA implantation. All consecutive patients aged <18years who underwent isolated ASD closure with a single GCA device were enrolled from 2 centers. Echocardiography and electrocardiogram were performed the day before, 24hours, and 6months after ASD closure. Between January 2020 and February 2021, 70 pediatric patients with ASD were enrolled. The mean age was 7.9 ± 3.9years, and the mean defect diameter was 17.1 ± 4.5mm. Global longitudinal strain analysis showed no change in left ventricular longitudinal function (T0 -23.2 ± 2.8%, 24 hours -23.0 ± 2.8%, and 6months -23.5 ± 2.7%). An early and transient reduction in longitudinal strain was detected in the basal septal segments (T0 -19.8 ± 3.3%, 24 hours -18.7 ± 3.6%, and 6months -19.2 ± 3.4%), left atrium (T0 41.4 ± 15.3%, 29.2 ± 1.4%, and 39.0 ± 12.9%), and right ventricle (-27.6 ± 5.4%, -23.6 ± 5.0%, and -27.3 ± 4.6) 24hours after closure, secondary to hemodynamic changes because of flow redirection after ASD closure. Six months after the procedure, only the left atrium showed a mild global longitudinal strain reduction because of the presence of the device within the septum. GCA device had no impact on global and regional ventricular function. Atrial mechanics were preserved, except for the segments covered by the device. This is the first device demonstrating no impact on the left and right ventricular mechanics, irrespective of the device size.

Atrial Strain Assessment for the Early Detection of Cancer Therapy-Related Cardiac Dysfunction in Breast Cancer Women (The STRANO STUDY: Atrial Strain in Cardio-Oncology).

Left ventricular global longitudinal strain (GLS) has an important role in the diagnosis of cancer therapy-related cardiac dysfunction (CTRCD). Little is known about the role of atrial function in diagnosing CTRCD. The aim of our study was to assess the impact of anti-cancer drugs on atrial function measured by speckle-tracking echocardiography in breast cancer women. A prospective multicenter study was conducted enrolling 169 breast cancer women treated with anthracyclines. A cardiological evaluation including an electrocardiogram and echocardiogram with an analysis of GLS, left atrial (LA) strain, and LA stiffness (LASi) was performed at baseline (T0), 3 (T1), and 6 months (T2) after starting chemotherapy. The patients were divided into two groups: patients with asymptomatic mild cardiotoxicity at T1 (with a relative reduction in GLS > 15%; Group 1) and those without (Group 2). We did not find a significant change in left ventricular ejection fraction (LVEF) at T1 and T2; we found a significant change in GLS (p-value < 0.0001) in the peak atrial longitudinal strain (PALS) and in LASi (p-value < 0.0001). Impairment of atrial function was greater in Group 1 compared to Group 2. A PALS variation > 20.8% identified patients who were most likely to develop asymptomatic mild cardiotoxicity [AUC 0.62; CI (0.51-0.73) p = 0.06, sensitivity 45%, specificity 69.5%]. Conclusions: PALS and LASi significantly change during chemotherapy in association with GLS. Atrial strain is an additional parameter that could be measured together with GLS to detect cardiotoxicity early.

Effect of diabetes duration on subclinical target organ damage in young diabetic adults with type 1 diabetes mellitus

Abstract Objective and aim Cardiovascular disease is a key cause of premature mortality in type 1 diabetes mellitus (DMt1). According to ESC guidelines, 10-year risk of death from cardiovascular disease in 35-year-old patients with diabetes lasting ≤10 years is estimated as moderate, however studies based on the young adult patients with DMt1 are limited. The aim of this study is to identify the relationship between the duration of DMt1 and occurrence of subclinical cardiovascular target organ damage among adult patients before the age of thirty. Material and methods We included patients aged from 18 to 30 years old with childhood- or juvenile-onset diabetes mellitus type 1. In all patients 24-hour blood pressure measurement was performed and a daily pressure profile (dipper or non-dipper) was defined. Non-invasive diagnostics of subclinical cardiovascular damage included: • 2-dimensional echocardiographic examination with the assessment of global longitudinal strain (GLS), • ultrasound of the carotid arteries with the assessment of intima media thickness (IMT), • assessment of the pulse wave velocity (PWV), • assessment of flow-dependent brachial artery vasodilation (FMD), • assessment of the ankle-brachial index (ABI). Results Obtained from non-invasive examination were compared between two groups depending on duration of DMt1: group 1 ( DMt1 lasting ≤10 years) vs group 2 (DMt1 lasting &amp;gt;10 years). Results The study population consist of 56 patients (48% male). Group consist of 25 patients and group 2 consist of 31 patients. Statistical analysis showed that received values of GLS (P=0.04) and PWV (P=0.01) differ significantly between group 1 and group 2. Interestingly the GLS, but not PWV, showed a significant negative linear correlation with the duration of diabetes (r=0.28; P=0.03). A post-hoc analysis showed that among patients with a DMt1 duration of ≤10 years absolute GLS values were significantly lower in patients with non-dipper profile than those with a dipper profile (P=0.04) (Fig. 1). Also a post-hoc analysis demonstrated significant difference in IMT thickness among non-dipping patients according to time of DMt1 duration (P=0.01) (Fig. 1). Conclusions Subclinical target organ damage can be detected even in young adults with DMt1 (aged 18-30 years). Patients with DMt1 lasting &amp;gt;10 years had a significantly lower absolute GLS value and GLS value correlate with the duration of diabetes. Patients with DMt1 lasting &amp;gt;10 years had a significantly higher PWV value.Fig 1. Post-hoc analysis of GLS and IMT

Electrocardiographic Markers of Adverse Left Ventricular Remodeling and Myocardial Fibrosis in Severe Aortic Stenosis.

The optimal timing for aortic valve replacement (AVR) in aortic stenosis (AS) is still controversial and may be guided by markers of adverse left ventricular (LV) remodeling. We aim to assess electrocardiographic (ECG) strain in relation to LV remodeling and myocardial fibrosis. 83 severe AS patients underwent surgical AVR, with preoperative 12-lead ECG, cardiovascular magnetic resonance with T1 mapping and echocardiography with global longitudinal strain analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies sampled during AVR. Patients with ECG strain had more severe AS, more advanced LV remodeling and evidence of heart failure. Patients with ECG strain had more diffuse fibrosis, as evident by higher mean native T1 values (974.8 ± 34 ms vs. 946.5 ± 28 ms, p < 0.001). ECG strain was the only predictor of increased LV mass index on multivariate regression analysis (OR = 7.10, 95% CI 1.46-34.48, p = 0.02). Patients with persistent ECG strain at 1 year following AVR had more advanced LV remodeling and more histological fibrosis (CVF 12.5% vs. 7.3%, p = 0.009) at baseline assessment. Therefore, ECG strain is a marker of adverse LV remodeling and interstitial myocardial fibrosis. Lack of improvement in ECG strain following AVR indicates more advanced baseline LV injury and higher levels of myocardial fibrosis.

Endocardial versus whole-myocardial tracking global longitudinal strain analysis in patients with hypertrophic cardiomyopathy: A preliminary comparative study.

We investigated whether the feasibility of left ventricular (LV) global longitudinal strain (GLS) in hypertrophic cardiomyopathy (HCM) varies according to the methodology (e.g. endocardial vs. whole myocardial tracking techniques). We retrospectively analyzed 111 consecutive patients with HCM (median age, 58 years; male, 68.5%) who underwent both transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (apical 29.7%, septal 33.3%, and diffuse or mixed 37.0%). TTE-whole myocardial and TTE-endocardial GLS were measured and compared in terms of association with late gadolinium enhancement (LGE) extent and discrimination performance for extensive LGE (>15% of the LV myocardium). Although TTE-whole myocardial and TTE-endocardial GLS were significantly correlated, absolute TTE-endocardial GLS values (19.3 [16.2-21.9] %) were higher than TTE-whole myocardial GLS values (13.3[10.9-15.6] %, p<0.001). Both TTE-derived GLS parameters were significantly correlated with the LGE extent and independently associated with extensive LGE (odds ratio [OR] 1.30, p = 0.022; and OR 1.24, p = 0.013, respectively). Discrimination performance for extensive LGE was comparable between TTE-whole myocardial and TTE-endocardial GLS (area under the curve [AUC], 0.747 and 0.754, respectively, pdifference = 0.610). However, among patients with higher LV mass index (>70 g/m2), only TTE-whole myocardial GLS correlated with LGE extent and was independently associated with extensive LGE (OR 1.35, p = 0.042), while TTE-endocardial GLS did not. Additionally, TTE-whole myocardial GLS had better discrimination performance for extensive LGE than TTE-endocardial GLS (AUC, 0.705 and 0.668, respectively, pdifference = 0.006). TTE-derived GLS using either the endocardial or whole myocardial tracking technique is feasible in patients with HCM. However, in those with severe hypertrophy, TTE-whole myocardial GLS is better than TTE-endocardial GLS.

Global longitudinal strain analysis application for prediction of left ventricular dysfunction in breast cancer under sequential therapy

Transthoracic echocardiography (TEE) plays a major role in the baseline assessment and follow-up of cardio-oncology patients. While left ventricular ejection fraction (LVEF) still has its place in cardiac monitoring, new modalities like myocardial deformation imaging with speckle tracking strain analysis has been validated for early detection of subclinical LV dysfunction. We conducted a longitudinal prospective study including all the breast cancer patients treated with anthracyclines and trastuzumab from January 2017 to March 2022. All patients underwent baseline TEE, and were followed-up every 3 months after that, with GLS assessment whenever it was possible. We evaluated the frequency of GLS drop and its correlation to LVEF reduction. Out of a total of 1583 patients, 677 had available LV GLS assessment. Among them, 83 (12.3%) decreased their GLS during follow-up, 67% of which had no concomitant drop in LVEF. In these patients, impaired LV GLS values were noted at 3 months after chemotherapy and at 6, and 12 months compared with baseline (−22.3 ± 1.8% at baseline, −18.1 ± 2.3% at 3 months, −17.7 ± 2.1% at 6 months, and −16.9 ± 2.1% at 12 months). LV GLS at 3 months was strongly correlated to cardiotoxicity (LVEF < 50%) at 12 months (P < 0.05). A cut-off LV GLS value of −16.9% was then retained to identify LVEF alteration at the end of follow-up. Finally, our study found that GLS at 3 months and 6 months had a prognostic value, since the lower GLS was, the poorest the patient's clinical outcome was, with further development of symptomatic heart failure. Our study demonstrates that myocardial deformation analysis enables detection of early and progressive subclinical cardiac dysfunction, and GLS at 3 months was positively correlated to LVEF drop at 12 months.

Echocardiography Core Laboratory Validation of a Novel Vendor-Independent Web-Based Software for the Assessment of Left Ventricular Global Longitudinal Strain.

Global longitudinal strain (GLS) is an accurate and reproducible parameter of left ventricular (LV) systolic function which has shown meaningful prognostic value. Fast, user-friendly, and accurate tools are required for its widespread implementation. We aim to compare a novel web-based tool with two established algorithms for strain analysis and test its reproducibility. Thirty echocardiographic datasets with focused LV acquisitions were analyzed using three different semi-automated endocardial GLS algorithms by two readers. Analyses were repeated by one reader for the purpose of intra-observer variability. CAAS Qardia (Pie Medical Imaging) was compared with 2DCPA and AutoLV (TomTec). Mean GLS values were -15.0 ± 3.5% from Qardia, -15.3 ± 4.0% from 2DCPA, and -15.2 ± 3.8% from AutoLV. Mean GLS between Qardia and 2DCPA were not statistically different (p = 0.359), with a bias of -0.3%, limits of agreement (LOA) of 3.7%, and an intra-class correlation coefficient (ICC) of 0.88. Mean GLS between Qardia and AutoLV were not statistically different (p = 0.637), with a bias of -0.2%, LOA of 3.4%, and an ICC of 0.89. The coefficient of variation (CV) for intra-observer variability was 4.4% for Qardia, 8.4% 2DCPA, and 7.7% AutoLV. The CV for inter-observer variability was 4.5%, 8.1%, and 8.0%, respectively. In echocardiographic datasets of good image quality analyzed at an independent core laboratory using a standardized annotation method, a novel web-based tool for GLS analysis showed consistent results when compared with two algorithms of an established platform. Moreover, inter- and intra-observer reproducibility results were excellent.