Assessment Of Global Longitudinal Strain Research Articles

Cardiac effects of direct anti-viral treatment in type II diabetic patients with hepatitis C infection.

The link between diabetes mellitus and chronic hepatitis C infection remains well established. It is estimated that up to one third of chronic hepatitis C patients have type II diabetes mellitus. Hepatitis C virus infection is one of the main global health burdens. Sofosbuvir and Daclatasvir are used as effective antiviral inhibitors of hepatitis C virus. The cardiovascular effects of those drugs are not well studied. We used electrocardiography and echocardiography with global longitudinal strain assessment by speckle tracking to detect their effect on cardiac function. One hundred diabetic patients with hepatitis C infection were included in the study. Abdominal ultrasound and laboratory work up were carried out for all participants. Left ventricular systolic and diastolic function were assessed by 2D-echocardiography and global longitudinal strain, before and 3months after treatment. Results showed significant decrease in global longitudinal strain 3months after therapy (-21 ± 4 vs. -18 ± 7; P < 0.001) but other echocardiographic findings showed no significant changes. Sofosbuvir and Daclatasvir were associated with early left ventricular systolic dysfunction as assessed by global longitudinal strain in diabetic patients. More deterioration in left ventricular systolic function was detected among those with Child-Pough class B. Further long-term follow-up may be required.

Global longitudinal strain by cardiac magnetic resonance is associated with cardiac iron and complications in beta-thalassemia major patients

BackgroundThe aim of this cross-sectional study was to investigate the association of left ventricular (LV) strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure and arrhythmias) in patients with β-thalassemia major (β-TM). MethodWe considered 266 β-TM patients (134 females, 37.08 ± 11.60 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project and 80 healthy controls (50 females, mean age 39.77 ± 11.29 years). The CMR protocol included cine images for the assessment of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) using feature tracking (FT) and for the quantification of LV function parameters, the T2* technique for the assessment of myocardial iron overload, and late gadolinium enhancement (LGE) technique. ResultsIn comparison to the healthy control group, β-TM patients showed impaired GLS, GCS, and GRS values.Among β-TM patients, sex was identified as the sole independent determinant of all LV strain parameters. All LV strain parameters displayed a significant correlation with LV end-diastolic volume index, end-systolic volume index, mass index, and ejection fraction, and with the number of segments exhibiting LGE. Only GLS exhibited a significant correlation with global heart T2* values and the number of segments with T2* < 20 ms. Patients with cardiac complications exhibited significantly impaired GLS compared to those without cardiac complications. ConclusionIn patients with β-TM, GLS, GCS, and GRS were impaired in comparison with control subjects. Among LV strain parameters, only GLS demonstrated a significant association with cardiac iron levels and complications.

Global longitudinal strain as a predictor of mortality in patients with cardiogenic shock

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Aarhus University Dagmar Marshalls Fond. Background The assessment of left ventricular (LV) function through transthoracic echocardiography (TTE) is essential for guiding diagnosis and treatment in cases of cardiogenic shock (CS). Myocardial global longitudinal strain (GLS) provides an objective and reproducible measure of systolic function, independently predicting outcomes in acute heart failure, regardless of left ventricular ejection fraction (LVEF). However, whether assessment of GLS can predict mortality in patients with CS remains unknown. Purpose In this study, we aimed to evaluate the prognostic significance of GLS in patients with CS. Methods Data from cardiac intensive care unit (CICU) patients admitted between 2007 and 2018 with CS who received vasoactive agents and/or mechanical circulatory support were analysed. GLS (as absolute values) and biplane LVEF were measured via TTE performed within 24 hours of CICU admission. Patients with CS were categorised based on the GLS quartile: mild (GLS &amp;gt;9.7%), moderate (7.0% &amp;lt; GLS &amp;lt;9.6%), severe (5.0% &amp;lt; GLS &amp;lt; 6.9%), and very severe (GLS ≤ 4.9%). CICU and in-hospital mortality were compared across GLS categories, and the relationship between GLS and mortality was assessed using multivariable logistic regression. Results The study included 626 patients with a median age of 68.6 years, a median LVEF of 31% (IQR 24 to 40%), and a median GLS of 7.0% (IQR 5.0 to 9.7%). In-hospital mortality was 29.1%. As GLS deteriorated, there was an increasing need for vasopressors (P&amp;lt;0.001). Patients with progressively lower GLS exhibited significantly higher CICU and in-hospital mortality across the GLS quartiles (Figure A; P&amp;lt;0.001). Patients in the severe (adjusted OR 2.67; p&amp;lt;0.001) and very severe category (adjusted OR 3.54; P&amp;lt;0.001) had significantly increased risk of in-hospital death compared with mild category. In multivariable analysis, every 1% decrease in GLS corresponded to a 14% higher risk of in-hospital mortality (P&amp;lt;0.001). Finally, GLS outperformed LVEF for discrimination of in-hospital mortality (P=0.002), and when both measurements were included in the same multivariable model, only GLS remained significant. When patients were divided according to whether they had GLS and/or LVEF below the median value, patients with low GLS had higher mortality irrespective of the LVEF (Figure B). Conclusion In patients with CS, GLS assessment surpasses LVEF in its prognostic value and improves risk stratification. Routine evaluation of GLS should be considered for patients with CS.Figure AFigure B

Abstract PO1-10-04: Racial and Ethnic Disparities in Anthracycline and HER2-targeted Cardiotoxicity in Patients With Breast Cancer Using Global Longitudinal Strain Imaging Techniques

Abstract Purpose: Studies of global longitudinal strain (GLS) as a predictor of cancer treatment-related cardiac dysfunction (CTRCD) have been limited in racial/ethnic minority populations who are more likely to have risk factors associated with CTRCD. Our aim was to assess the utilization of GLS and development of CTRCD in a racially and ethnically diverse population of patients at an academic center in New York City. Methods: Patients were included if they had a breast cancer diagnosis and began treatment with anthracycline or HER2-directed therapies at Columbia University Irving Medical Center (CUIMC) from February 1, 2020-July 31, 2022. All patients and variables were identified via the electronic health record. Cardiovascular comorbidities including obesity, hypertension, diabetes, hyperlipidemia, coronary artery disease, congestive heart failure, and other cardiac disease, were recorded. Receipt of transthoracic echocardiogram(s) (TTE) with/without GLS were recorded, along with GLS and left ventricular ejection fraction (LVEF) values. CTRCD was defined as LVEF decrease of ≥10% to a LVEF value &amp;lt; 53% or GLS decrease of ≥ 15% from baseline or GLS &amp;lt; -18%. Analyses included descriptive statistics and univariable and multivariable logistic regression models to evaluate predictors of CTRCD by either LVEF or GLS definition. Results: We identified 270 eligible patients. Mean age was 51.8 years (standard deviation 13.0), 85 (31.5%) identified as White, 47 (17.4%) as Black/African, and 16 (5.9%) as Asian; 135 (50.0%) identified as Non-Hispanic/Latino, and 79 (29.2%) as Hispanic/Latino. Approximately half of the patient cohort, n=137 (50.7%) had a TTE with GLS during the study period. Of the TTEs done at CUIMC (n=658), 270 (41%) were ordered with GLS assessment, of which 184 (68%) reported a GLS value and 86 (32%) were not assessable due to image quality. Forty-three (16%) patients developed CTRCD: 20 (7%) by GLS criteria, 13 (5%) by LVEF criteria, and 10 (4%) by both GLS and LVEF criteria. In univariable analyses, race (OR 5.78, 95%CI 1.62-20.4 Asian compared to White), treatment with HER2 therapy without anthracycline versus anthracycline (OR 2.78, 95%CI 1.34-6.23), and prescription for cardiac medication prior to systemic therapy (OR 2.27, 95%CI 1.08-4.63) were predictors of CTRCD by any definition. In multivariable analysis, race (OR 7.86, 95%CI 1.71-38.50 Asian compared to White), and receipt of HER2 therapy without anthracycline compared to anthracycline (OR 5.13, 95%CI 1.42-25.00) were predictors of CTRCD. In multivariable analysis of CTRCD by GLS criteria only, race (OR 78.47, 95%CI 1.47-53.96 Asian compared to White), and treatment (OR 11.23, 95%CI 1.85-219 HER2 therapy compared to anthracycline; OR 58.7, 95%CI 1.05-60.59 HER2 therapy and anthracycline compared to anthracycline). Conclusions: In this retrospective analysis of a racially and ethnically diverse patient population, more than a third of Asian patients developed CTRCD, although the study is limited by small sample sizes. Asian race and receipt of anti-HER2 therapy were independent risk factors for CTRCD. Asian race was especially a predictor of CTRCD by GLS definition. Detection bias may explain the differences in CTRCD by drug class, as patients complete serial TTEs while receiving HER2-directed therapy, while patients who receive an anthracycline without HER2-directed therapy typically only receive a baseline TTE. Future research to better characterize racial differences in CTRCD incidence and develop interventions to reduce this disparity is an area warranting further investigation. Demographic and Tumor Related Factors Associated with CTRCD (n=270) Univariable and multivariable analysis of CTRCD by LVEF or GLS definition. Multivariable analysis was adjusted for all variables listed. Citation Format: Amanda Wang, Jayant Raikhelkar, Rohit Raghunathan, Julia McGuinness, Neil Vasan, Meghna Trivedi, Kevin Kalinsky, Katherine Crew, Melissa Beauchemin, Jason Wright, Dawn Hershman, Melissa Accordino. Racial and Ethnic Disparities in Anthracycline and HER2-targeted Cardiotoxicity in Patients With Breast Cancer Using Global Longitudinal Strain Imaging Techniques [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-04.

Comparative analysis of left ventricle function and deformation imaging in short and long axis plane in cardiac magnetic resonance imaging.

Advancements in cardiac imaging have revolutionized our understanding of ventricular contraction. While ejection fraction (EF) is still the gold standard parameter to assess left ventricle (LV) function, strain imaging (SI) has provided valuable insights into ventricular mechanics. The lack of an integrative method including SI parameters in a single, validated formula may limit its use. Our aim was to compare different methods for evaluating global circumferential strain (GCS) and their relationship with global longitudinal strain (GLS) and EF in CMR and how the different evaluations fit in the theoretical relationship between EF and global strain. Retrospective monocenter study. Inclusion of every patient who underwent a CMR during a 15 months period with various clinical indication (congenital heart defect, myocarditis, cardiomyopathy). A minimum of three LV long-axis planes and a stack of short-axis slices covering the LV using classical steady-state free precession cine sequences. A single assessment of GLS on long axis (LAX) slices and a double assessment of GCS and EF with both short axis (SAX) and LAX slices were made by a single experienced CMR investigator. GCS-SAX and GCS-LAX were correlated (r = 0.77, P < 0.001) without being interchangeable with a high reproducibility for GCS, GLS and EF. EF calculated from LAX images showed an overestimation compared to EF derived from SAX images of 7%. The correlation between calculated EF and theoretical EF derived from SI was high (r = 0.88 with EF-SAX, 0.95 with EF-LAX). This study highlights the need to integrate strain imaging techniques into clinical by incorporating strain parameters into EF calculations, because it gives a deeper understanding of cardiac mechanics.

Use of 3D Echocardiography Facilitates Analysis of Thrombolytic Efficacy in Patients With Persistent Atrial Fibrillation.

This study seeks to identify the anticoagulant efficacy of rivaroxaban treatment on thrombi detected using echocardiography of the left atrial appendage in 275 patients with persistent atrial fibrillation. During follow-up after 9-24 weeks of rivaroxaban treatment, patients were divided into "effective group" (n = 143) and "ineffective group" (n = 132) according to the thrombolytic effect of the drug. Left atrial diameter (LAD), left atrial ejection fraction (LAEF), left ventricular ejection fraction (LVEF), mean diameter of left atrial appendage (LAAD mean ), angle between left atrial appendage and left atrium (LAA-A), velocity of blood flow in left atrial appendage (LAA-v), and thrombus size were compared before and after drug administration. Following treatment, LAEF, LVEF, and LAA-v values were greater and LAD and LAAD mean values were lower in the effective ( P < 0.05). Logistic regression analysis showed significant correlations of LAD, LAEF, LVEF, LAA-A, and LAA-v with anticoagulant efficacy ( P < 0.05). The efficacy of rivaroxaban in treatment of left atrial auricular thrombosis in patients with persistent AF was correlated with LAD, LAEF, LVEF, LAA-A, and LAA-v. Multivariate logistic regression analysis further revealed LAEF [odds ratio (OR) 1.7, 95% confidence interval (CI), 0.45-16.9, P = 0.008], 3D-EF (OR 6.4, 95% CI, 1.06-16.9, P = 0.039) and left ventricular global longitudinal strain (OR 18.0, 95% CI, 1.38-35.68, P = 0.028) as factors related to left atrial appendage thrombus. Echocardiography with global longitudinal strain assessment could be effectively utilized to evaluate the functional parameters of LAA and thus aid in predicting the safety of rivaroxaban as an anticoagulation agent.

Influence of mitral transcatheter edge-to-edge repair in patients with severe mitral regurgitation on left ventricle function

Aim. To study the changes of left ventricular (LV) contractile function in patients with severe mitral valve (MV) insufficiency with assessment of global longitudinal strain (GLS) indicators and LV myocardial function after the mitral transcatheter edge-to-edge repair (TEER) within 12-month follow-up.Material and methods. The study consisted of 43 patients with severe mitral regurgitation (MR) as follows: 23 patients with functional MR (FMR), 20 patients with degenerative MR (DMR). A comprehensive echocardiographic study, including speckle tracking echocardiography, was performed at baseline, 4-5 days, 6 and 12 months after TEER. Standard structural and functional indicators of the LV, LV GLS and myocardial performance parameters were assessed.Results. The early postoperative period (4-5 days) was characterized by a decrease in global constructive work (GCW) (FMR group — from 977 [684; 1253] to 857 [736; 1488] mm Hg%, (p=0,038); DMR group — from 1458 [1283; 1848] to 1350 [1010; 1488] mm Hg% (p=0,011)), an increase in global wasted work (GWW) (FMR group — from 177 [130; 280] to 336 [242; 388] mm Hg% (p=0,004); DMR group — from 128 [81; 172] to 216 [164; 279] mm Hg% (p=0,043)), which was accompanied by a decrease in myocardial efficiency (FMR group — from 81,5 [77; 87] to 76 [73; 79]%, (p=0,021); DMR group — from 90 [85; 93] to 82 [79; 85]% (p=0,018)). After 12-month follow-up, there was a significant increase in GCW relative to the initial values in both cohorts of patients as follows: FMR group — to 1128 [890; 1711] mm Hg% (p=0,048); DMR group — to 1818 [1478; 2034] mm Hg% (p&lt;0,001). There was also an increase in GWW in the FMR group to 255 [214; 363] mm Hg% (p=0,024) and in the DMR group to 230 [140; 270] mm Hg% (p=0,043). There were no significant improvement of LV GLS in both groups.Conclusion. The early postoperative period after TEER was characterized by a temporary deterioration in all LV performance parameters, which recovered by 6 and 12 months of follow-up. Myocardial function restoration by one year of follow-up was noted due to an increase in GCW. LV GLS and ejection fraction did not change significantly by 1 year of follow-up compared to baseline values.

Left and right ventricular global longitudinal strain assessment together with biomarker evaluation may have a predictive and prognostic role in patients qualified for hematopoietic stem cell transplantation due to hematopoietic and lymphoid malignancies – a pilot study description

The hematopoietic stem cell transplantation (HSCT) procedure is considered a cardiovascular burden. This is due to the potentially cardiotoxic cytostatic agents used before and the risks associated with peri-transplant procedures. We designed a pilot study to determine the clinical utility of the new ST2 marker; furthermore, we routinely assessed cardiac parameters in HSCT recipients. Based on previous cardio-oncology experience in lung and prostate cancer, we can confirm the prognostic and predictive value of classic cardiac biomarkers and modern echocardiography parameters such as global longitudinal strain of the left and right ventricle. After conducting this pilot study we can create a predictive and prognostic model for patients undergoing HSCT. This will greatly enrich our clinical practice, especially in treating older people.

Kiosk 10R-TB-01 - Fully Automated Assessment of Global Longitudinal Strain by Machine Learning Predicts Death in Patients with a Normal Stress CMR

Kiosk 10R-TB-01 - Fully Automated Assessment of Global Longitudinal Strain by Machine Learning Predicts Death in Patients with a Normal Stress CMR

Artificial intelligence fully automated assessment of global longitudinal strain predicts death in patients undergoing stress CMR

Artificial intelligence fully automated assessment of global longitudinal strain predicts death in patients undergoing stress CMR

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

Fully automated assessment of global longitudinal strain by machine learning predicts death in patients undergoing stress CMR

Abstract Background Several studies described the independent prognostic value of left ventricular global longitudinal strain (GLS) using cardiovascular magnetic resonance (CMR) to predict death and cardiovascular events. While routine GLS evaluation is a time consuming and partially operator-dependent process, the potential interest of GLS using a fully automated method has not yet been established. Purpose To assess the feasibility and prognostic value of GLS to predict all-cause death using a fully automated machine-learning algorithm without human correction in consecutive patients referred for stress CMR. Methods Between 2016 and 2018, all consecutive patients referred for stress CMR were included and followed for the occurrence of all-cause death. A fully automated machine learning algorithm was trained and validated on unseen CMR studies (MAGNETOM Aera and Skyra) to assess the GLS from long-axis cine images acquired at rest. The algorithm combines multiple deep learning networks for detection and segmentation with an active contours approach. Cox regressions were performed to determine the prognostic value of GLS. Results In a retrospective study of 9,883 consecutive patients who underwent stress CMR between 2016 and 2018, automated GLS was successfully computed in 9,638 (97.5%) patients (67% male, mean age 66±12 years). A total of 510 (5.3%) deaths were observed during a median follow-up period of 4.5 years (interquartile range: 3.7-5.2). GLS, the presence of inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of death (hazard ratio, HR: 1.22 [95% CI, 1.17-1.26]; HR: 2.23 [95% CI, 1.61-3.10]; and HR: 2.04 [95% CI, 1.41-2.95], respectively, all p&amp;lt;0.001). After adjustment for traditional risk factors, inducible ischemia and LGE, GLS was an independent predictor of a higher incidence of death (adjusted HR: 1.14 [95% CI, 1.08-1.20]). Automated GLS showed an incremental prognostic value to predict death compared to traditional risk factors, inducible ischemia and LGE (C-statistic improvement: 0.05; NRI=0.146; IDI=0.244; all p&amp;lt;0.001). Conclusions Fully automated GLS measured at rest has an incremental prognostic value to predict all-cause death above traditional risk factors, and other stress CMR parameters. This finding suggests that unsupervised GLS measurements are accurate and allow improved risk stratification.

Relation between global longitudinal strain and acute rejection in pediatric patients within the first-year post heart transplant

BackgroundAcute rejection leading to graft dysfunction remains a major cause of morbidity and mortality. In adults, assessment of global longitudinal strain (GLS) using speckle tracking echocardiography (STE) has been used as an early marker for graft dysfunction. Studies evaluating GLS in a sizable pediatric transplant population are scarce. ObjectivesWe sought to determine association between GLS and acute rejection within first-year post-transplantation in pediatric patients. MethodsPatients 0 to 18 years old who received heart transplants (HT) at Cleveland Clinic Children's Hospital after April 2013 were identified. Clinical data was collected from pre-transplant evaluation and post-transplant surveillance endomyocardial biopsy (EMB) visit from time of transplantation to one-year post-transplantation. Left ventricular (LV) GLS was measured retrospectively using vendor independent software. Significant rejection was defined by escalation in immunosuppression therapy due to pathology or clinical diagnosis. Trends of GLS were compared between patients with (Group 1) and without (Group 2) rejection, controlled for age. At the visit of rejection diagnosis, GLS rejection measurements were compared to the range of “normal”, non-rejection measurements. ResultsTwenty-seven patients met inclusion criteria. Eight patients (29.6 %) had at least one clinically significant rejection episode. There was no significant difference in GLS at the first endomyocardial biopsy visit between groups. At last biopsy visit, subjects with rejection had significantly worse GLS (p ≤ 0.001). In a mixed effect model, average global, 3-chamber, and 4-chamber systolic strain had significant interaction of group and time (p = 0.016, 0.033, 0.003, respectively). Systolic strain in those views significantly worsened over time in rejection group while remaining stable in non-rejection group. GLS of subjects with rejection were worse and out of the range of “normal” by the time of the third EMB visit. ConclusionsThere was a trend toward worse GLS in those who developed acute rejection within first year post-transplant compared to those without rejection.

Apical sparing pattern during exercise echocardiography in patients with cardiac amyloidosis

Abstract Funding Acknowledgements Type of funding sources: None. Background Apical sparing (AS) is an useful marker of cardiac amyloidosis (CA). However, this pattern can also be found in other conditions that lead to left ventricular hypertrophy (LVI), like hypertension (HT) or hypertropic cardiomyopathy (HCM). We aimed to assess the AS pattern at rest and exercise in patients with CA and LVI-no CA. We hypothesize that patients with CA may have the AS pattern preserved at exercise on the contrary to LVI-no CA, therefore increasing the specificity of this sign. Methods Teen patients with confirmed CA, 31 patients with LVI-no CA (17 HCM, 14 HT plus LVI), and 6 normal subjects were studied by treadmill exercise echocardiography, with assessment of global longitudinal strain (LS) and AS pattern at rest and at peak exercise (Pk-Ex). LVI-no CA and normal subjects should have age &amp;gt;60 y-o, no data of coronary artery disease, absence of ischemia, and LVEF&amp;gt;55%. A relative apical LS of 1.0, by the equation: average apical LS/(average basal LS + mid-LS)) was used for considering AS. Results Patients with CA were older (81±5 yo; LVI-no CA 70±8 yo; normal subjects 74±4 yo; p = 0.001), had lower LVEF (51±14; vs 66±9 the LVI-no CA, and 67±10 the normal subjects group; p = 0.001), and higher E/e´values (21±7, vs 18±10 the LVI-no CA, and 9±1 the normal subjects group; p = 0.03), but achieved similar workload in metabolic equivalents (METs) during exercise (6.3±2.9 METs vs 7.1±2.2 the LVI-no CA, and 7.6±2.7 METs the normal subjects group). AS at rest and Pk-Ex were 0.7±0.2 and 0.6±0.2 in LVI-no CA patients; 0.7±0.5 and 0.7±0.3 in normal subjects; and 1.6±0.8 and 1.2±0.4 in CA (&amp;lt;0.001 between groups either at rest or at Pk-Ex). The highest area under the ROC curve for diagnosing CA corresponded to AS at rest or Pk-Ex (0.86; 95% CI = 0.72–0.99, p = 0.001), followed by AS at Pk-Ex (0.81; 95% CI=0.63–0.99, p = 0.003), AS at rest (0.80; 95% CI=0.62–0.98, p 0.004) and AS at rest plus Pk-Ex (0.75; 95% CI=0.54–0.96, p = 0.02). Among CA patients 5/10 had AS at rest plus at Pk-ex, but none in non-CA subjects, given specificity and positive predictive value of 100%. (figure) In conclusion, AS during exercise adds information for the diagnosis of CA. In our sample, an AS pattern that persists during exercise was pathognomonic of cardiac amyloidosis.

CARFILZOMIB-BASED REGIMEN AND CARDIOTOXICITY IN MULTIPLE MYELOMA: INCIDENCE OF CARDIOVASCU-LAR EVENTS AND ORGAN DAMAGE IN CARFILZOMIB-DEXAMETHASONE VERSUS CARFIL-ZOMIB-LENALIDOMIDE

Objective: Cardiotoxicity is a known adverse effect of Carfilzomib therapy, nevertheless few data are available on cardiovascular complications induced by different Carfilzomib-regimens in a real-life setting. The aim of this perspective study was to investigate the difference in incidence and time of onset of cardiovascular adverse events between Kd and KRd in MM patients in real-life conditions. Furthermore, we investigated differences in subclinical organ damage (both cardiac and vascular ) induced by the two regimens, and offer a discussion on how these data might support different follow up strategies for patients treated with Kd or KRd regimen Design and method: In this prospective study, adults with MM who had haematological indication to Kd or KRd, were consecutively enrolled. They underwent a baseline cardiovascular assessment before treatment initiation and a follow-up evaluation at 6 months, including office blood pressure measurements, ambulatory blood pressure monitoring, 12-leads EKG, trans-thoracic echocardiography with global longitudinal strain assessment (GLS), and estimation of arterial stiffness by the carotid-femoral pulse wave velocity (cfPWV) measurement. Results: A total of 109 patients were enrolled, 47 (43%) received Kd and 62 (57%) KRd. All-types of cardiovascular and hypertensive events occurred more frequently in Kd group compared to KRd (59% vs 40% and 55% vs 35.5% patients, respectively, p&lt;0.05), with higher incidence of hypertensive urgencies. Furthermore, the time of onset of all-type of CVAEs, major and hypertensive event was shorter in Kd regimen compared to KRd (3.6 vs. 10.2 months, 4.0 vs. 10.8 months and 8.6 vs. 14.6 months, respectively (p &lt; 0.05)). At follow-up, Kd patients developed more frequently signs of cardiac as decline of global longitudinal strain (-19.7 vs -21.3, p = 0.009) and vascular organ damage demonstrated by a rise of pulse wave velocity (8.5 vs 1.9, p = 0.009), with respect to KRd. Conclusions: In conclusion, Kd regimen showed greater cardiovascular toxicity with respect to KRd and earlier onset of events. Thus, a closer and careful follow-up should be considered.

P176 GLOBAL LONGITUDINAL STRAIN AS A PREDICTOR OF RESPONSE TO CARDIAC CONTRACTILITY MODULATION IN PATIENTS WITH HEART FAILURE: A CASE SERIES

Abstract Background Cardiac contractility modulation (CCM) in heart failure (HF) patients with reduced ejection fraction (HFrEF) is an innovative therapy which may contribute to increased exercise capacity and quality of life and reduced hospitalizations. With speckle–tracking echocardiography and global longitudinal strain (GLS), changes in myocardial function can be detected with greater sensitivity than conventional approaches for measuring diastolic and systolic function, including left ventricular ejection fraction. We aim to analyze the usefulness of GLS in detecting improvement in systolic function and response to CCM treatment. Methods We studied 5 patients with CCM referred to our outpatient cardiology clinic. All patients underwent complete echocardiography with evaluation of GLS and ejection fraction. Follow–ups were performed at 1, 3, and 6 months. Results All patients were men (mean age 65.3±15.7 yrs). Mean baseline ejection fraction was 37.1±9.3%, mean GLS was 7.7±3.1%, and patients had mild–to–moderate left ventricular enlargement (mean indexed telediastolic volumes 101.4±8.7 ml/m2). Follow–up performed at the first month showed values similar to baseline values. Between the third and sixth months, a non–significant improvement in ejection fraction and GLS was recorded (EF 40.75±9.6% p=0.51; GLS 8.9±4.2 p=0.62). Indexed telediastolic volumes were reduced (101.4±9.3 ml/m2 vs 89.5±7.4 ml/m2 p=0.05). Conclusions CCM therapy seems to be useful in achieving volumetric remodeling in patients with HFrEF. GLS assessment may be useful in detecting improvement in systolic function. Further studies with larger samples and longer follow–up are needed to confirm these results.

P127 ASSESSMENT OF LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN IN A POPULATION AFFECTED BY CANCER AND IN THERAPY WITH POTENTIALLY CARDIOTOXIC CHEMOTHERAPY

Abstract Echocardiographic left ventricular global longitudinal strain (GLS) detects early subclinical ventricular dysfunction and can be used in patients receiving potentially cardiotoxic chemotherapy. The aim of this observational study is to analyse some echocardiographic (echo) features of patients affected by cancer evaluated in our laboratory. Methods We studied patients who came to our laboratory for echo assessment of potential chemotherapeutic cardiotoxicity in October and November 2022. We performed complete echocardiograms (Philips Epiq 7) with a focus on systolic (left ventricular ejection fraction, LVEF and GLS) and diastolic function. Results Over the study period, 112 cancer patients underwent echo. Twenty–six patients waiting to start radio/chemotherapy were excluded from analysis. Twenty patients were excluded due to poor quality of echo images. The majority of patients were female (92%, mean age 61.9 years). The predominant type of cancer was breast cancer (78%), followed by prostate cancer (4%), ovarian cancer (2%), and lymphoma (2%). No patients had signs or symptoms of heart failure. Twenty–three patients had a history of hypertension, 3 had diabetes mellitus, and 1 had coronary artery disease (Table 1). We separately evaluated patients according to cancer treatment. Twenty–four patients (28%) had been treated with anthracycline (AT), 3 patients (3%) had been treated with AT in combination with trastuzumab, 9 patients (10%) had been treated with trastuzumab monotherapy, 25 patients (29%) had been treated with left chest radiotherapy (RT) and were currently undergoing hormone therapy (HT), and 25 patients (29%) had been treated with other chemotherapy (CT), specifically tyrosine kinase inhibitors, anti VEGF–drugs, taxanes, and antimetabolites. No moderate or severe dysfunction was found in the study population, however 52 patients (60%) had mild diastolic dysfunction. The mean EF value was 63% and the mean GLS value was 17.4% (Table 2). Ten patients had reduced GLS values (&amp;lt; 16%) with normal EF. Of these patients, 2 had been treated with AT, 3 with trastuzumab, 2 with HT, and 3 with other CT (Table 3). Conclusions According to the literature, GLS assessment during/after cardiotoxic CT could help identify subclinical left ventricular dysfunction. Our data, derived from a short observation period, show mild reduction in GLS in asymptomatic patients treated with different CT, thus suggesting a potential benefit of closer follow–up of these pts.

Concentric hypertrophy geometry is a significant determinant of impaired global longitudinal strain in patients with normal cardiac structure and function

BackgroundIn recent years, the assessment of global longitudinal strain (GLS) derived by speckle-tracking analysis has become a clinically feasible alternative to left ventricular (LV) ejection fraction (LVEF) for the assessment of myocardial function. However, the determinant factors of impaired GLS in structurally and functionally normal patients are unclarified. The objective of this study was to elucidate the determinant factors of impaired GLS in structurally and functionally normal patients. MethodsWe evaluated structurally and functionally normal patients scheduled to undergo noncardiac surgery. The evaluated patient characteristics were age, sex, presence of hypertension, presence of diabetes mellitus, presence of hyperlipidemia, systolic blood pressure, and body mass index. The concentrations of B-type natriuretic peptide and high-sensitivity troponin I were measured. Echocardiography was performed to determine the LVEF, GLS, transmitral early diastolic velocity/transmitral atrial velocity ratio, LV mass index (LVMI), and relative wall thickness (RWT). Patients with preserved LVEF (≥50%) were divided into the normal GLS group (GLS ≤ -20%) and the impaired GLS group (GLS > -20%). On the basis of the RWT and LVMI values, the patients were categorized as having four types of LV geometry. Logistic regression analysis was performed to ascertain the determinant factors of impaired GLS. ResultsThe study cohort comprised 75 structurally and functionally normal patients (age 67.7 ± 12.6 years, 45 men). The GLS was normal in 43 patients and impaired in 32 patients. There was a significant difference in RWT between the impaired and normal GLS groups. The evaluation based on the LV geometry showed that six of seven patients with concentric hypertrophy geometry had impaired GLS, and the GLS was significantly more impaired in patients with concentric hypertrophy geometry than in patients with normal geometry or eccentric hypertrophy geometry. Logistic regression analysis revealed that LV concentric hypertrophy geometry was a significant determinant factor of impaired GLS (odds ratio 22.4, P = 0.042). ConclusionsGlobal longitudinal strain is more impaired in structurally and functionally normal patients with concentric hypertrophy geometry compared with those with eccentric hypertrophy geometry or normal geometry. In addition, concentric hypertrophy geometry is a significant determinant for impaired GLS in patients with normal cardiac structure and function.

Global longitudinal strain assessment in contrast-enhanced echocardiography in breast cancer patients: a feasibility study

BackgroundLeft ventricular global longitudinal strain (GLS) obtained from two-dimensional speckle-tracking echocardiography (2D-STE) can reflect cancer therapy-related cardiac dysfunction in breast cancer (BC) patients, however, the accuracy and reproducibility of 2D-STE are restricted due to poor image quality.MethodsBetween January 2019 and October 2021, 160 consecutive BC patients aged ≥ 18 years were recruited. The 160 BC patients (mean age: 48.41 ± 9.93 years, 100% women) underwent both 2D-STE and Contrast-enhanced echocardiography (CEcho), 125 of whom were included in the measurement of GLS. The intraclass correlation coefficient (ICC) was used to determine the intra- and inter-observer reproducibility of 2D-STE and CEcho-STE. Correlation (r) was calculated using Pearson correlation. Statistical significance was set at P < 0.05.ResultsAmong 160 BC patients, more segments were recognized by CEcho-STE than by 2D-STE (2,771, 99.53% vs. 2,440, 84.72%). The left ventricular ejection fraction (LVEF) obtained by 2D was lower than CEcho (61.75 ± 6.59% vs. 64.14 ± 5.97%, P < 0.0001). The GLS obtained by 2D-STE was lower than CEcho-STE (-21.74 ± 2.77% vs. -26.79 ± 4.30%, P = 0.001). The ICC of the intraobserver and interobserver agreements in the CEcho-STE group was lower than that in the 2D-STE group. GLS measurements were in good agreement between the 2D-STE and CEcho-STE groups (r = 0.773).ConclusionsCEcho can overcome some imaging limitations and recognize more segments than 2D, which may provide an LVEF and GLS closer to the true value. Based on AutoStrain, CEcho-STE may serve as a complementary method for those with poor image quality.Graphical

Prevalence of Diastolic Dysfunction in Adult Survivors of Childhood Cancer: A Report From SJLIFE Cohort

BackgroundThe prevalence of diastolic dysfunction has not been systematically evaluated in a large population of survivors of childhood cancer using established guidelines and standards. ObjectivesThis study sought to assess the prevalence and progression of diastolic dysfunction in adult survivors of childhood cancer exposed to cardiotoxic therapy. MethodsComprehensive, longitudinal echocardiographic examinations of adult survivors of childhood cancer ≥18 years of age and ≥10 years from diagnosis in SJLIFE (St. Jude Lifetime Cohort Study) were performed. Diastolic dysfunction was defined based on 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. ResultsAmong 3,342 survivors, the median (25th-75th percentiles [quartile (Q)1-Q3]) age at diagnosis was 8.1 years (Q1-Q3: 3.6-13.7 years), 30.1 years (Q1-Q3: 24.4-37.0 years) at the baseline echocardiography evaluation (Echo 1), and 36.6 years (Q1-Q3: 30.8-43.6 years) at the last follow-up echocardiography evaluation (1,435 survivors) (Echo 2). The proportion of diastolic dysfunction was 15.2% (95% CI: 14.0%-16.4%) at Echo 1 and 15.7% (95% CI: 13.9%-17.7%) at Echo 2, largely attributable to concurrent systolic dysfunction. Less than 5% of survivors with preserved ejection fraction had diastolic dysfunction (2.2% at Echo 1, 3.7% at Echo 2). Using global longitudinal strain assessment in adult survivors with preserved ejection fraction (defined with a cutpoint worse than −15.9%), the proportion of diastolic dysfunction increased to 9.2% at baseline and 9.0% at follow-up. ConclusionsThe prevalence of isolated diastolic dysfunction is low among adults who received cardiotoxic therapies for childhood cancer. The inclusion of left ventricular global longitudinal strain significantly increased the identification of diastolic dysfunction.