Assessment Of Myocardial Function Research Articles

Assessment of biventricular myocardial systolic function in COVID-19 patients: A Tissue Doppler Imaging echocardiography study

AbstractBackgroundThe 2019 novel coronavirus disease (COVID-19) has been reported as pandemy and the number of patients continues to rise. Based on recent data, cardiac injury is a prominent feature of the disease, leading to increased morbidity and mortality. In the present study we aimed to evaluate myocardial dysfunction using transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI) in hospitalized COVID-19 patients.Methods and ResultsWe recruited 30 patients (56.7% male, 55.80 ± 14.949 years) who were hospitalized with the diagnosis COVID-19 infection. We analyzed left ventricular (LV) and right ventricular (RV) conventional and TDI parameters at the time of hospitalization and during the course of the disease. Patients without any cardiac disease and with preserved LV ejection fraction (EF) were included. TTE examination was performed and all the variables were recorded and analyzed retrospectively.We observed that both LV and RV conventional echocardiographic parameters were similar when the day of admission to the hospital was compared to the 5th day of the disease. Regarding TDI analysis, we demonstrated significant impairment in LV septal and lateral deformation (P < 0.001). In the correlation analysis no marked correlation was observed between impairment in LV deformation and inflammation biomarkers.ConclusionCardiac involvement is an important feature of the COVID-19 infection but the exact mechanism is still undefined. Echocardiography is an essential technique to describe myocardial injury and provide new concepts for the possible definitions of cardiac dysfunction.

Auto left atrial strain by speckle tracking echocardiography and auto left atrial volumes by 3D transthoracic echocardiography after electrical cardioversion for atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction We have evidence that left atrial dysfunction and stunning occur after electric cardioversion for atrial fibrillation (CAF). Additionally, after successful cardioversion to sinus rhythm, a dissociation between electrical and mechanical recovery may be observed. Traditional pulsed Doppler and tissue Doppler imaging parameters demonstrate reduced atrial contractility immediately after cardioversion. Improvement in atrial function occurs within the first 4 weeks after sinus rhythm is restored. Recent advances in the assessment of myocardial function have facilitated the direct measurement of auto left atrial strain using speckle tracking echocardiography, and auto left atrial volumes measurements using dynamic heart model modern 3D transthoracic echo logistics. Purpose Aim of this study was to determine whether auto left atrial strain (auto LAs) by speckle tracking echocardiography, and auto left atrial volumes measurements, auto left atrial volume indices calculations (auto LAVI), could be used to evaluate global left atrial function and when a main improvement occurs after electrical cardioversion for CAF. Methods Auto LAs was measured from transthoracic echocardiography in 25 patients with CAF who had been cardioverted to sinus rhythm and followed up for 4 weeks, and in a cohort of 25 healthy individuals. Left atrial contractile strain (LACTS), conduit strain (LACDS) and reservoir strain (LARSS) were measured. Conventional measures of atrial function derived from transmitral pulsed wave doppler (PW) and tissue doppler imaging (TDI) of lateral mitral annulus were included, such as A wave velocity, A wave velocity time integral, A' wave velocity and A' velocity time integral. Results Immediately after cardioversion all PW, TDI and all three auto LAs parameters were significantly lower than in controls. On the other hand, auto LAVI was significantly higher in patients compared to controls immediately after cardioversion Atrial function was improved over time with maximal change observed 4 weeks after cardioversion and restoration to sinus rhythm. Auto LAs parameters were significantly higher in the group of patients. Auto LA volumes and auto LAVI with dynamic heart model logistics were lower in the same group, but with no statistical significance. Three patients with the lowest auto LAs values immediately after cardioversion, suffered recurrence of atrial fibrillation during the 4 weeks follow up. Conclusions Although left atrial electrical function is immediately restored after cardioversion in CAF patients, a persistent degree of atrial dysfunction remains for up to 4 weeks. This difference could explain the increased propensity for these patients to develop recurrent atrial fibrillation. Additional this dysfunction could indicate the longer-term use of antiarrhythmic and antithrombotic medication in the CAF cohort.

Myocardial work by speckle-tracking echocardiography in pacemaker patients according to pacing site: a prospective study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The optimal lead position for right ventricle (RV) pacing is still a matter of debate. Several studies compared 2D-echocardiography left ventricle ejection fraction (LVEF) and LV global longitudinal strain (LVGLS) by speckle-tracking imaging (STI). However, these parameters present limitations, such as load dependency. Recently, myocardial work (MW) has emerged as an alternative tool for myocardial systolic function assessment. Purpose To compare LV MW and LVGLS between patients with RV outflow tract/septum pacing (Group1) and RV apical pacing (Group2). Methods Prospective single-center study of patients with permanent pacemaker (PMK) followed at our cardiac device’s outpatient clinic between july and november of 2022. Patients were divided into two groups according to RV pacing site. Moderate/severe valvular disease, LVEF<50%, segmental wall-motion abnormalities, pulmonary hypertension, cardiomyopathies, or RV dysfunction were exclusion criteria. STI-based LVGLS analysis and MW parameters were obtained (GWI:Global Work Index; GCW:Global Constructive Work; GWW:Global Wasted Work; GWE:Global Work Efficiency). RV pacing was required at the moment of imaging. A 12-lead ECG was also performed. Blood pressure (BP) was simultaneously measured. Results Our cohort comprised 30 patients in group 1 and 25 patients in group 2. The 2 groups were well-matched, except for the median time since PMK implantation, which was significantly higher in Group2 (5.3years vs 0.9years, p<0.001). The QRS was significantly narrower in Group1 (Group1:129ms±9 vs Group2:165ms±15, p<0.001). LVEF was similar in both groups (Group1:58%±7.5 vs Group2:60%±7.5, p = NS). Likewise, both systolic and diastolic BP were comparable (p = NS), but LVGLS was significantly higher in Group1 (15±3.3 vs 13±3.7, p = 0.043). Except for GWI which was also significantly higher in Group1 (1553mmHg%±581 vs 1238mmHg%±516, p = 0.040), no significant differences were found in the other parameters of MW among the groups (all p = NS). Conclusion Our results point to LVGLS being significantly lower in the group of RV apical pacing. Despite most parameters of MW didn’t differ between groups, GWI also showed significant impairment. These findings should be regarded as preliminary and further larger studies are needed to ascertain the value of this new tool in understanding the impact of pacing depolarization site on LV mechanics.

FEATURES OF MYOCARDIA DEFORMATION PROPERTIES IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Determination of myocardium deformation properties depending on degree of arterial hypertension and the presence/absence of left ventricular hypertrophy (LVH) in patients with arterial hypertension. Design and method: 74 patients of both sexes, with I–III degrees of AH (ESC/ESH, 2018) were studied. Average age of patients was 58.72 ± 11.9 years; AH duration was 10.8 ± 7.2 years. Speckle-tracking EchoCG was performed to obtain an objective and quantitative assessment of global and regional myocardial function using the ACUSON x 700 PV 2.0 manufactured by SIEMENS. Among the parameters for assessing the longitudinal deformation of the left ventricle, we have chosen: global longitudinal strain -GLS (%); Strain Rate-SR. To study the segmental LV contractility, analyzed the apical 4-chamber, 3-chamber and 2-chamber section. Results are presented as M±SD. Results: The patients were divided into 3 groups: I- patients with AH I degree, n = 21 (28.4%); II n = 28 patients with II degree of AH (37.8%); III n = 25 (33.8%) patients with III degree of AH. A comparative analysis of groups showed that in patients with grade III AH, the indicators of GLS and the rate of myocardial deformation are significantly lower than in groups of patients with grades I and II of AH. The index of GLS in group III was: 10.3±3.6%, while in group I - 18.1±4.4% and in group II - 11.8% (p = 0.000). The same was noted in terms of SR: 1.0±0.3 s-1 versus 1.5±0.6 s-1 and 1.1±0.5 s-1, respectively (p = 0.001). To study the deformation properties of the myocardium, patients were divided into 2 groups: patients with LVH and without LVH. In 1st group, the GLS index was lower, 14.9±5.8%, than in 2nd group – 17.9±6.1% (p<0.05); the SR index in the group of patients with LVH was also lower- 1.64±0.75 s-1, than in the group of patients without LVH - 1.87±0.81 s-1 (p<0.05). Conclusions: Thus, significant violations of the deformation properties of LV are formed in patients with AH with an increase of degree of AH and the presence of LVH.

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.

Utility of Global Longitudinal Strain in Mitral Regurgitation: A Systematic Review

Background: The assessment of myocardial function is important in both primary and secondary mitral regurgitation (MR), to determine the timing of interventions and to predict outcomes. Ejection fraction is relied on for clinical decisions, even though, it is well understood that it does not reflect myocardial function. Global longitudinal strain (GLS) is a promising parameter that correlates well with outcomes postinterventions. In this review, we aimed to determine the utility of GLS in both primary and secondary MR in predicting clinical outcomes. We also aimed to determine the GLS cutoff at which clinical decisions can be made. Methods: We conducted a systematic review of the literature regarding the use of GLS as a predictor of left ventricular (LV) function. We searched PubMed and Embase for relevant articles and identified 141 articles after removing duplicates. We screened titles and abstracts to identify 28 relevant articles from which data were extracted. Results: In 16 of the 28 studies, patients had primary MR mostly of degenerative etiology and the LV GLS cutoff for events ranged from −17.2% to −21%. In 10 studies, patients with secondary MR were included, and a cutoff ranging from −7%− to −9% was most often reported except for one study that reported-16.3%, as it included patients with atrial functional MR. Conclusion: GLS assesses LV dysfunction and is a good predictor of clinical and echocardiographic outcomes postinterventions. Values lower than the cutoff value of −17.2% to −21% in primary MR and −7% to −9% in secondary MR are associated with poorer outcomes. These findings suggest that the use of GLS as a routine assessment in patients with significant MR may be appropriate for both clinical decision-making and prognostication.

Non-invasive left ventricular myocardial work identifies subclinical myocardial involvement in patients with systemic lupus erythematosus

ObjectiveGlobal myocardial work (MW) is a novel indicator that accounts for deformation and afterload, which may provide additional value for assessment of myocardial function. Non-invasive echocardiographic estimated left ventricular (LV) MW incorporates longitudinal strain curves and blood pressure data. This study sought to assess MW in systemic lupus erythematosus (SLE) patients with normal LV ejection fraction (LVEF) by two-dimensional speckle-tracking imaging (2D-STI) to reflect subclinical myocardial damage. Methods98 SLE patients and 98 gender and age-matched healthy subjects were included. The patients with SLE were divided into mild activity (SLE disease activity index (SLEDAI) ≤ 4; n = 45), moderate activity (5 ≤ SLEDAI ≤ 9; n = 23), and high activity (SLEDAI ≥ 10; n = 30) subgroups. Standard transthoracic echocardiography was applied to evaluate the systolic myocardial function of the global LV. The parameters of non-invasive MW including global wasted work (GWW) and global work efficiency (GWE) were calculated from echocardiographic LV pressure-strain loops (PSL) and blood pressure at rest. ResultsThe SLE group had a significantly higher GWW (75.7 ± 39.1 mmHg% vs 37.9 ± 18.0 mmHg%, P < 0.001) and decreased GWE ratio (95.5 ± 2.0% vs 97.4 ± 1.0%, P < 0.001) compared with the controls. Among the subgroups with elevating level of disease activity, SLE patients with preserved LVEF had a significantly higher GWW (61.6 ± 29.9 mmHg% to 96.2 ± 42.2 mmHg%, P for trend = 0.001) and markedly decreased GWE (96.4 ± 1.5% to 94.4 ± 2.0%, P for trend = 0.001). In two separate multiple linear regression analyses, SLEDAI were independently associated with GWW (β = 0.271, P = 0.005) and GWE (β = −0.354, P<0.001). ConclusionGWW and GWE are promising novel tools for the early detection of subclinical LV dysfunction. GWW and GWE could distinguish distinct patterns in different grades of SLEDAI.

Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study.

The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12h (D1) and 48-72h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e' was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e' (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography. Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure. What is Known: •Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension. What is New: •Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.

Alcohol Impact on the Heart and Cardiovascular System - Hypertrophy, Remodeling and Strain Impairment - Contemporary State-of-the-Art

The recent data show that chronic overuse of alcohol may lead to cardiovascular dysfunction, starting from traditionally judged as low ethanol doses, since the burden of arrhythmias, including atrial fibrillation, increases even in moderate alcohol consumers. The other common mechanisms of the disadvantageous impact of ethanol are related to the development of hypertension and its direct aftermath, hypertrophy, fibrosis, and diastolic dysfunction. Since the chance of the reversibility of cardiac remodeling depends on the early diagnosis of cardiac dysfunction, the wider application of novel and sensitive methods of myocardial function assessment, including longitudinal strain of the left and right ventricles, as well as the adapted protocols for stress echocardiography, should be recommended.

Assessment of Diastolic Myocardial Function in Neonates with Patent Ductus Arteriosus by Tissue Doppler Imaging

Assessment of Diastolic Myocardial Function in Neonates with Patent Ductus Arteriosus by Tissue Doppler Imaging

Association between left ventricular geometry and global myocardial work in patients with heart failure with preserved ejection fraction: assessment using strain-pressure loop.

Concentric LV remodeling and hypertrophy are common structural abnormalities in patients with heart failure with preserved ejection fraction (HFpEF) and tend to be accompanied by impaired LV function. Assessment of global myocardial work (GMW) using strain-pressure loop may provide more comprehensive assessment of LV myocardial function, overcoming the limitations of the conventional parameters. We investigated the value of GMW in patients with HFpEF and assessed the relationship of GMW with concentric remodeling and hypertrophy. Consecutive patients with HFpEF (n = 107) and sex-matched healthy controls (n = 32) were prospectively enrolled. Clinical and conventional echocardiography variables were obtained. Further analyses of offline data were performed to obtain GMW indices including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). Association of concentric remodeling and hypertrophy with GMW was analyzed by univariate and multivariate analysis. HFpEF patients showed lower GWE (94% vs 96%, P < 0.001) and higher GWW (114mmHg% vs 78mmHg%, P = 0.003) than control group, while GWI (2111mmHg% vs 2146mmHg%, P = 0.877) and GCW (2369mmHg% vs 2469mmHg%, P = 0.733) were comparable in the two groups. HFpEF patients with relative wall thickness (RWT) > 0.42 had reduced GWE (94% vs 95%, P = 0.034) compared to HFpEF patients with RWT ≤ 0.42, while GWI, GCW, and GWW were comparable between these two subgroups. Multivariate analysis showed an independent association of RWT with GWI, GCW, and GWE, respectively. Impaired global myocardial work was detected in patients with HFpEF. Impaired LV GMW may be associated with increased RWT.

Beneficial Effects of RNS60 in Cardiac Ischemic Injury.

RNS60 is a physically modified saline solution hypothesized to contain oxygen nanobubbles. It has been reported to reduce ischemia/reperfusion injury in a pig model of acute myocardial infarction. We investigated the effects of RNS60 during cardiac hypoxia in mice and as an additive to cardioplegic solution in rat hearts. ApoE−/−LDLr−/− mice were treated by intravenous injection of RNS60 or saline as a control while monitoring the ECG and post-hypoxic serum release of troponin T and creatine kinase activity. Hearts infused with Custodiol containing 10% RNS60 or saline as the control were subjected to 4 h of 4 °C preservation, followed by an assessment of myocardial metabolites, purine release, and mechanical function. RNS60 attenuated changes in the ECG STU area during hypoxia, while the troponin T concentration and creatine kinase activity were significantly higher in the serum of the controls. During reperfusion after 4 h of cold ischemia, the Custodiol/RNS60-treated hearts had about 30% lower LVEDP and better dp/dtmax and dp/dtmin together with a decreased release of purine catabolites vs. the controls. The myocardial ATP, total adenine nucleotides, and phosphocreatine concentrations were higher in the RNS60-treated hearts. This study indicates that RNS60 enhances cardioprotection in experimental myocardial hypoxia and under conditions of cardioplegic arrest. Improved cardiac energetics are involved in the protective effect, but complete elucidation of the mechanism requires further study.

A deep learning approach for automatic echocardiographic right ventricular strain measurements using a limited dataset

Abstract Background Speckle tracking echocardiography provides quantification of myocardial deformation and is useful in the assessment of myocardial function. Right ventricular (RV) strain has been suggested as a sensitive tool for diagnosing cardiomyopathies and assessing long term patient outcomes for patients with pulmonary hypertension, severe tricuspid regurgitation and COVID-19 infection. Recent advances in deep learning (DL) have made promising advances in automating the labour-intensive delineation of regions of interest (ROIs). However, compared to echocardiograms with left ventricular (LV) strain, RV strain data is scarce, making DL models difficult to train. Purpose To investigate whether annotated LV strain data could be beneficial in training a DL model for automatic RV strain when using a limited RV dataset. Methods The dataset consisted of anonymized still frames from 141 echocardiograms of the RV in the RV-focused 4 chamber view with corresponding cardiologist-defined ROI. Exams included healthy subjects and patients with heart failure, valvular disease, and conduction abnormalities. ROIs and still images were extracted at the mid-systole, and then quality assessed by an experienced cardiologist as high, medium, or low. The dataset was randomly split into 68%/17%/15% sets for training, validation, and testing. A convolutional neural network for image segmentation (U-Net) with a residual neural network (ResNet50) encoder was used, with a combination of binary cross entropy and Dice loss functions. Augmentation, predefined ImageNet weights and pre-training were also employed. For pre-training, 715 still images in the apical 4 chamber view with LV defined ROIs were used, both in their original and horizontally flipped view. Predicted ROIs were reintroduced into commercially available echocardiogram analysis software to automatically calculate longitudinal strain (LS) values. Results The model pre-trained with the flipped LV images achieved the highest performance with a mean absolute difference of 1.26 percentage points (95% confidence interval (CI): 0.62–1.89 percentage points) between manually measured and DL-assisted LS. Median absolute LS difference was 0.85 (95% CI: 0.28–1.57) percentage points. A Bland-Altman plot revealed two outliers and no obvious trends. In comparison, the mean and median absolute LS differences for the model without pre-training were 1.87 (95% CI: 0.73–3.00) and 1.09 (95% CI: 0.56–1.63) percentage points, respectively. Conclusions The current study demonstrates that DL-assisted, automated RV strain measurement is feasible even with a small dataset, and that performance can be increased by using images annotated for LV strain. While the majority of the predicted RV strain results were within the typical range of intra- and interobserver variability, a few outliers were observed. These outliers could possibly be avoided with the use of larger datasets. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research council of Norway

Spontaneous coronary artery dissection: current evidence from cardiac magnetic resonance and angiography screening

Abstract Purpose To assess the distribution and extent of myocardial infarction, as well as possible clinical significance of peripheral arteriopathy screening in a cohort of patients presented with spontaneous coronary dissection (SCAD) using cardiovascular magnetic resonance (CMR) for cardiac and vascular imaging. The adverse CMR features and predictors of infarction in subgroup analysis were also investigated. Methods This is an observational, single centre study of 144 consecutive, angiographically confirmed SCAD survivors &amp;gt;18 years old, based on collected data from Jan 2008-Nov 2020. All scans were performed on a 1.5-Tesla scanner. Cardiac structural and functional indices, myocardial infarct size and distribution were evaluated. In addition, vascular imaging was performed in all patients for thoracic aorta screening as part of the routine protocol, and in 75 patients peripheral arteriopathy screening from Circle of Willis to the iliac arteries was performed using 2D multi-slice and cine imaging, as well as 3D imaging methods. Results In the total population, 64% had infarction. Infarct size (%) was predictive of reduced left ventricular ejection fraction (LVEF) (p&amp;lt;0.001) and increased diastolic volumes (p&amp;lt;0.001 for both). Logistic regression showed SCAD in right coronary artery (Odds Ratio (OR): 5.2, p=0.034) predicted the presence of infarction. In the group who also underwent peripheral vascular screening, the overall prevalence of extra-coronary arteriopathy was 27% with fibromuscular dysplasia accounting for one-fourth of the cases (Figure 1). Of note, most positive vascular screening patients (73.3%) exhibited infarction (OR: 7.0, p=0.041), distributed in more than one territory (OR: 4.0, p=0.015) (Figure 2), while infarct size was negatively correlated with LVEF (p&amp;lt;0.001). Right ventricular ejection fraction was significantly reduced in positive screening patients (58.8±7.4 vs. 63.0±8.0, p=0.045). Further subgroup analysis showed pregnancy associated SCAD patients had significantly larger sized infarcts (25.1±6.1 vs. 6.2±0.7%, p&amp;lt;0.001) with reduced LVEF (51.0 vs 63.6±7.6, p&amp;lt;0.001). In logistic regression, this condition also predicted large infarcts &amp;gt;10% (OR: 9.8, p=0.009) in anterior walls (p&amp;lt;0.001). Conclusions Patients with SCAD require careful assessment of myocardial structure, function and characterization of infarction which may reflect the underlying pathophysiology. Extra coronary vascular screening, although not established in clinical practice, seems a rational strategy to potentially identify a subgroup with more severe infarction and likely to have vascular pathology. Funding Acknowledgement Type of funding sources: None.

Prognostic role of global work efficiency in patients undergoing transcatheter aortic valve implantation

Abstract Background Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative echocardiographic tool for myocardial function assessment. Its role in patients with severe aortic stenosis (AS) after aortic valve implantation (TAVI) has not been adequately investigated. Purpose We aimed to evaluate MW indices as early echocardiographic markers of LV reverse remodeling within a month after TAVI and their prognostic value. Methods and results We conducted a single-centre prospective study, enrolling 88 consecutive patients (mean age 79.9±6.4 years, 35% males) with AS undergoing TAVI between April 2018 and 2021, selected from the EffecTAVI registry. Exclusion criteria were prior valve surgery, atrial fibrillation, left bundle branch block (LBBB) at baseline and and suboptimal quality of imaging. Echocardiographic assessment was performed before TAVI and at 30-day follow-up, including quantification of 2D global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). LV peak systolic pressure was estimated non-invasively from the sum of systolic blood pressure and trans-aortic mean gradient. One month after the procedure, there was a significant improvement of LV GLS (−18.4±4.2 vs −19.5±4.2%, before and after TAVI respectively, p=0.006), a significant reduction of GWI (2406±567 vs 1908±479 mmHg%, p&amp;lt;0.001), GCW (2783±616 vs 2202±463 mmHg%, p&amp;lt;0.001), and GWW (238±203 vs 173±127 mmHg%, p=0.002). Conversely, MWE did not change early after intervention (90.4±6.2 vs 91.4±5.1%, p=0.113). After TAVI, 32 patients (36.4%) developed LV dyssynchrony due to LBBB or pacemaker implantation. When the population was divided according to the presence or absence of LV dyssynchrony at 30-day follow-up, a significant reduction in GWW was found only in the those without dyssynchrony (241±229 vs 142±103 mmHg% before and after TAVI, p&amp;lt;0.001). Consistently, in this subgroup, MWE significantly improved after TAVI (90±7 vs 93±5%, p=0.001), while a trend of MWE reduction was observed in patients who developed dyssynchrony after TAVI (91±5 vs 89±5%, p=0.110). In the overall population, a 30-day value of MWE≤92% was associated with an increased rate of cardiovascular events (composite of all-cause death and rehospitalization for heart failure) at 1-year follow-up (29.5% vs 4.8%, long rank p=0.003). In multivariable Cox-regression analysis, adjusted for confounders, GWE after TAVI (HR: 0.892, CI: 0.817–0.974; p=0.011) was independently associated with events at 1-year follow-up. Conclusions In patients with severe AS undergoing TAVI a significant reduction of GWW and improvement of MWE can be detected only in those who do not develop LV dyssynchrony. In this setting, MWE≤92% early after TAVI is associated with poor outcome. Thus, MWE could represent an alternative tool for myocardial function assessment and prognostic evaluation in patients receiving TAVI. Funding Acknowledgement Type of funding sources: None.

Evaluation of Left Ventricular Function in Healthy Retrievers Using Standard and 2D Speckle-Tracking Echocardiography.

Simple SummaryStandard echocardiography is an essential diagnostic tool for the assessment of cardiac performance in healthy and diseased animals. Two-dimensional speckle-tracking echocardiography is an advanced echocardiographic technique that is useful for the assessment of myocardial function. Factors such as dog breed, age, and body weight (BW) are known to influence the echocardiographic parameters. This study aimed to evaluate the effect of breed, age, and BW on the echocardiographic parameters in healthy Retrievers, including Flat-coated, Golden, and Labrador Retrievers. The results showed that there were no significant associations between breed and echocardiographic parameters. On the other hand, they revealed that left ventricular dimensions increased with BW. Furthermore, parameters including peak aortic blood flow velocity, trans-mitral rapid ventricular filling flow, the ratio of trans-mitral rapid ventricular filling flow to atrial contraction, and global radial strain were influenced by age.Standard echocardiography is vital for the assessment of cardiac performance in healthy and diseased animals. Similarly, two-dimensional speckle-tracking echocardiography (2D-STE) is an advanced echocardiographic technique that is becoming increasingly important for the assessment of myocardial function. Breeds, age, and body weight (BW) are known to be important factors affecting the echocardiographic parameters; therefore, the aim of this study was to evaluate the effect of breed, age, and BW on the echocardiographic parameters in three breeds of clinically healthy Retrievers. A total of 46 Retrievers, including 16 Flat-coated Retrievers (FR), 16 Golden Retrievers (GR), and 14 Labrador Retrievers (LR) were included in the study. The comparison of the breeds revealed significant differences in the LV wall thickness of FR and GR, although further analysis using MLR showed that the differences were most likely associated with BW, similarly to the other LV dimensions. Functional parameters, including ejection fraction, fractional shortening, and left-atrial-to-aortic ratio, were independent of breed, age, and BW. On the other hand, peak aortic blood flow velocity, trans-mitral rapid ventricular filling flow, and the ratio of trans-mitral rapid ventricular filling flow to atrial contraction were influenced by age. The 2D-STE-derived radial and circumferential strain parameters were independent of breed, age, and BW, except for global strain in the radial direction.

MulViMotion: Shape-Aware 3D Myocardial Motion Tracking From Multi-View Cardiac MRI.

Recovering the 3D motion of the heart from cine cardiac magnetic resonance (CMR) imaging enables the assessment of regional myocardial function and is important for understanding and analyzing cardiovascular disease. However, 3D cardiac motion estimation is challenging because the acquired cine CMR images are usually 2D slices which limit the accurate estimation of through-plane motion. To address this problem, we propose a novel multi-view motion estimation network (MulViMotion), which integrates 2D cine CMR images acquired in short-axis and long-axis planes to learn a consistent 3D motion field of the heart. In the proposed method, a hybrid 2D/3D network is built to generate dense 3D motion fields by learning fused representations from multi-view images. To ensure that the motion estimation is consistent in 3D, a shape regularization module is introduced during training, where shape information from multi-view images is exploited to provide weak supervision to 3D motion estimation. We extensively evaluate the proposed method on 2D cine CMR images from 580 subjects of the UK Biobank study for 3D motion tracking of the left ventricular myocardium. Experimental results show that the proposed method quantitatively and qualitatively outperforms competing methods.

Left ventricular strain in neonates using 2-dimensional speckle tracking: Normal range and relation with bi-plan ejection fraction.

Echocardiographic assessment of Left ventricular systolic function is traditionally being performed by estimation of fractional shortening (FS) and ejection fraction (EF). Speckle tracking echocardiography (STE) is a promising tool for assessment of myocardial function. The aim of this study is to evaluate the global longitudinal strain (GLS) using 2D-STE in healthy neonates to establish normal reference ranges. It is a retrospective study through an analysis of transthoracic echocardiogram of normal healthy neonates. We enrolled all neonates in our institution from January 1st, 2021 to February 28th, 2021. 2-D STE was used to assess left ventricular GLS from the apical views. 185 neonates were enrolled. Mean value for left ventricle GLS (%) was -19.9±1.2, GLS-derived EF (%) was 60.0±2.7; while the left ventricle EF by biplane Simpson's method (%) was 61.0±3. There is a good positive correlation between the Left Ventricle EF by biplane Simpson's method and EF by 2-D STE, which was statistically significant (r=.294,n=102,p=.003). Apical 4-chamber longitudinal strain and strain-derived EF is significantly correlated with GLS and bi-plan EF respectively. 2-STE is feasible technique for analyzing newborn myocardial systolic function. The normal range of GLS in neonates is not much different than reported for the pediatric. There is a good positive correlation between the Left Ventricle EF by 2-D STE and EF by biplane method.

Assessment of diastolic myocardial function in neonates with patent ductus arteriosus using tissue Doppler imaging

Background: The present study was an analytic case control study was done and included full and preterm neonates with PDA and respiratory distress. Neonates with no PDA were also included as a control. Aim of the study: This study aimed to assess diastolic myocardial functions in neonates with different degrees of ductal patency in 1st week of life using tissue Doppler imaging. Methods: The study was conducted at neonatal intensive care unit (NICU) in Bab-Sheria hospital, pediatric department, faculty of medicine, Al Azhar University in the period from June 2018 to June 2021. The present work was conducted on fifty Neonates categorized into 3 groups as follow: Haemodynamically significant dusctus arteriosus cases: ductal diameter more than 2.5 mm and left atrium to aorta (LA: AO) ratio more than 1.5. Non haemodynamically significant ductus arteiosus cases: ductal diameter less than 2.5 mm or (LA: AO) ratio less than 1.5 and Non patent dusctus arteriosus ( Control group). Results: Amount of left-to-right shunt will increase according to the size of the systemic-to-pulmonary communication, and it results in an increased pulmonary blood flow which agrees with our study.

Comprehensive assessment of biventricular myocardial function by two-dimensional speckle tracking echocardiography in infants of gestational diabetic mothers.

No previous research provided a complete biventricular and multidirectional left ventricular (LV) functional assessment by two-dimensional (2D) speckle tracking echocardiography (STE) in infants of gestational diabetic mothers (IGDM) METHODS: A total of 30 consecutive IGDM and 30 infants of healthy mothers were examined between March 2021 and July 2021. Both groups of infants underwent evaluation by neonatologist and 2D transthoracic echocardiography (TTE) implemented with 2D-STE quantification of LV-global longitudinal strain (GLS), LV-global circumferential strain (GCS), LV-global radial strain (GRS) and right ventricular (RV)-GLS, within 3 days of life and at 40 days after birth. Predictors of persistent subclinical myocardial dysfunction, defined as a LVGLS less negative than -20% at 40-day follow-up, in IGDM population, were determined. At 2.2 ± 1.3 days after birth, LV-GLS (- 17.2 ± 1.9 vs. - 23.9 ± 3.8%), LV-GCS (- 17.9 ± 2.7 vs. - 27.3 ± 3.4%), LV-GRS (25.6 ± 3.4 vs. 35.8 ± 3.6%) and RV-GLS (- 17.6 ± 3.6 vs. - 22.6 ± 3.8%) were significantly impaired in IGDM than controls (all p < 0.001). At 36.8 ± 5.2 days of life, LV-GLS was still impaired (less negative than -20%) in 26.6% of IGDM. Maternal third trimester body mass index (BMI) (OR 1.89, 95%CI 1.05-3.39) and third trimester glycosylated hemoglobin (HbA1C) (OR 1.59, 95%CI 1.08-2.19) were independently associated with persistent LV-GLS impairment in IGDM. Maternal BMI ≥ 30 Kg/m2 and HbA1C ≥ 38 mmol/mol showed the maximum of sensitivity and specificity for predicting persistent subclinical myocardial dysfunction in IGDM at 40 days of life. IGDM have diffuse pattern of myocardial dysfunction during perinatal period. This dysfunction may be persistent up to 40 days of life in infants of GDM women with obesity and uncontrolled diabetes.