Basal Longitudinal Strain Research Articles

Comparing Echocardiographic Strain Imaging in Cardiac Amyloid and End-Stage Renal Disease Patients.

Diagnosing cardiac amyloidosis (CA) is difficult due to nonspecific clinical symptoms and echocardiographic findings. Prior studies have suggested that apical sparing strain patterns may be diagnostically useful. With increasing strain usage, it remains unclear how specific this pattern is to diagnose CA. We analyzed strain patterns between CA and end-stage renal disease (ESRD) patient populations. Patients with ESRD proven negative for CA (n=19) were compared to CA patients with CKD stage 3 or less (n=25). The ESRD cohort was stratified based on time on dialysis. Echocardiographic longitudinal strain (LS) parameters were collected, including regional and global LS, echocardiographic, and demographic parameters. Relative apical LS was calculated using the following equation: average apical LS/(average mid LS+average basal LS). No significant differences were found regarding regional strain or relative apical strain. Our study showed a sensitivity of 80% and specificity of 42% when using a relative apical strain ratio of >1. All groups demonstrated an apical sparing strain pattern visually on the bulls-eye plot. ESRD demonstrates significant overlapping findings across various imaging modalities compared to CA. We demonstrated that relative apical sparing strain is nonspecific for CA among patients with ESRD. Our study calls into question the clinical value of relative apical-sparing stain patterns in identifying CA in an ESRD population and suggests that diagnostic evaluation should be driven by strong clinical suspicion and other imaging and demographic variables.

Evaluation of left ventricular function in patients with mitral annular disjunction using speckle tracking echocardiography.

Mitral annular disjunction (MAD) is a structural abnormality characterized by the systolic detachment of the posterior mitral annulus and the ventricular myocardium. It is usually observed coexistent with mitral valve prolapse (MVP) and associated with a mechanical dysfunction despite preserved electrical isolation function of the mitral annulus. This study aimed to evaluate left ventricular (LV) function using speckle tracking echocardiography in MVP patients with MAD. This study was designed as a prospective, single-center study including 103 patients with MVP and 40 age- and sex-matched control subjects. Transthoracic echocardiography and cardiac magnetic resonance imaging were performed to assess LV function and MAD presence. MAD (+) MVP (n=34), MAD (-) MVP (n=69), and control (n=40) groups were enrolled in the study. Among the MVP patients, 34 (33%) had MAD. T-negativity in the inferior leads on electrocardiography was more frequent in the MAD (+) group than in the MAD (-) patients (4.3%vs. 20.6%, p=.014). Mitral regurgitation degree, Pickelhaube sign (17.6%vs. 1.4%, p=.005), and late gadolinium enhancement frequency (35.3%vs. 10.6%, p=.002) were significantly higher in MAD (+) patients. MAD (+) patients had significantly impaired global longitudinal strain (-23.1±2.1vs. -23.5±2.3, p<.001), basal longitudinal strain (BLS) (-19.6±1.5vs. -20.5±1.9, p<.001), Mid-Ventricular Longitudinal Strain (-22.2±1.7vs. -23.2±2.2, p<.001) and LA strain (-24.5±3.9vs. -27.2±3.6, p<.001) when compared to MAD (-) MVP patients, despite similar LV ejection fraction. All these values of MVP patients were also significantly lower than the control group. The mean MAD distance was 7.8±3.2mm in MAD (+) patients. Patients with two or more symptoms were higher in the MAD (+) group than in the MAD (-) group (4.3%vs. 44.1%, p<.001). This study demonstrated a significant decrease in longitudinal strain in MVP patients with MAD, indicating myocardial dysfunction. These findings suggest that MAD may contribute to LV dysfunction and highlight the importance of early detection in younger patients. Further research is needed to explore the functional implications and long-term outcomes of MAD.

Echocardiographic two-dimensional strain evaluation of right ventricular function in healthy adults

Objective: To explore the feasibility of using two-dimensional speckle tracking echocardiography for measuring right ventricular strain and function in healthy adults, and to analyze the impact of age and gender. Methods: This study is a cross-sectional study. Healthy adults who underwent physical examination in the Physical Examination Center of Beijing Hospital from January 1, 2020 to January 1, 2021 were included. Two researchers independently measured various right ventricular longitudinal strain indices using the Echopac software, including (global longitudinal strain (GLS), apical longitudinal strain (ALS), midventricle longitudinal strain (MLS), basal longitudinal strain (BLS), free wall GLS (FWGLS), free wall ALS (FWALS), free wall MLS (FWMLS) and free wall BLS (FWBLS)) as well as tricuspid annular plane systolic excursion (TAPSE) and right ventricle-fraction of area change (RVFAC). The above indicators were taken as the average of two physicians. The consistency of the measurements by two physicians was evaluated by the within-group correlation coefficient (ICC). Results: A total of 233 subjects were included, including 137 males, aged (58.5±14.2) years. ICC values was all above 0.8 with excellent agreement. The values of FWGLS and GLS in healthy adults were -26.63% and -21.89%, respectively. There was no statistically significant difference in TAPSE ((2.06±0.41)cm vs. (2.10±0.39)cm, P=0.510) and RVFAC ((51.17±9.91)% vs. (50.89±8.65)%, P=0.826) between males and females. The values of various right ventricular long axis strain indicators (GLS, ALS, MLS, BLS, FWGLS, FWMLS, FWMLS, FWBLS) in females aged 18 to 40 and 41 to 65 years were higher than those in males of the same age (all P<0.05), while there was no statistically significant difference in the values of various right ventricular long axis strain indicators between the sexes in subjects aged 65 years and above (all P>0.05). In females, the right ventricular GLS, ALS, MLS, FWGLS, FWALS, FWMLS, and FWBLS values in the groups aged 18 to 40 and 41 to 65 years were significantly higher than those in the group aged 65 years and above (all P<0.05). In contrast, no significant differences were found in these indices among different age groups in males (all P>0.05). Conclusions: Using two-dimensional speckle tracking technology in echocardiography to measure right ventricular strain indicators is feasible and highly reproducible. Gender and age have an impact on right ventricular strain indicators.

Diagnostic accuracy of apical sparing pattern in transthyretin-derived cardiac amyloidosis assessed by two-dimensional strain echocardiography

Abstract Background Cardiac amyloidosis (CA) is a rapidly progressive disease that portends poor prognosis. Recently, transthyretin-derived CA (ATTR-CA) has attracted attention due to the emergence of specific drugs, and its simple and accurate diagnosis is required. Apical sparing pattern of regional longitudinal strain (LS) distribution has been known as specific echocardiographic finding for CA. However, its diagnostic significance is unclear when limited to ATTR-CA. Aims This study aimed to investigate the diagnostic accuracy of apical sparing pattern to distinguish ATTR-CA from other left ventricular hypertrophic diseases. Methods This was a retrospective study evaluating 32 patients underwent endomyocardial biopsy for differentiation of left ventricular hypertrophy from November 2018 to August 2022. Based on clinical data, patients were classified into 9 patients in ATTR-CA, 14 patients in hypertrophic cardiomyopathy (HCM), and 9 patients in hypertensive heart disease (HHD). In addition to routine echocardiographic findings, left ventricular LS analysis was performed. Relative regional strain ratio (RRSR) as an index of apical sparing pattern was measured as the average of apical LS divided by the sum of the average of mid and basal LS values. Results RRSR in ATTR-CA group was significantly higher than in HCM and HHD groups (0.96 vs. 0.68 vs. 0.72, P=0.004) (Table). In the receiver-operating characteristic analysis of RRSR for differentiating ATTR-CA from HCM and HHD, the optimal cut-off value of RRSR for the diagnosis of ATTR-CA was 0.93 (sensitivity 67%, specificity 96%, area under the curve 0.84) (Figure). Conclusions Apical sparing pattern may have acceptable accuracy in diagnosing ATTR-CA versus other left ventricular hypertrophic diseases, but the relatively low sensitivity may be a clinical limitation.Table:Echocardiographic dataFigure

Left ventricular deformation in patients with lymphedema before and after the use of medical compression stockings-detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study.

Lymphedema (LE) is a chronic condition, which refers to tissue swelling due to excess interstitial fluid accumulation or impaired lymphatic conduit. Theoretically, lymphedema-related fluid retention could affect left ventricular (LV) mechanics, which could be detailed by recent three-dimensional speckle-tracking echocardiography. Therefore, it was purposed to examine LV strains in LE patients before and one hour after the use of medical compression stockings and to compare findings to those of matched normal subjects. The study comprised 26 cases with lymphedema, however, 4 cases had to be excluded due to inferior quality of images. Their results were compared to 27 age- and gender-matched healthy controls. Global LV circumferential and area strains and mean segmental LV circumferential strain were increased in lymphedema patients before the use of medical compression stockings as compared to controls. One hour after the use of medical compression stockings, no global and mean segmental LV strain showed significant impairment or improvement, but tendentious reduction was seen in LV circumferential strain. With LV segmental analysis, midventricular LV radial, circumferential and area strains proved to be significantly increased, while basal LV longitudinal strain and midventricular LV three-dimensional strain were decreased as compared to controls. No changes in regional LV strains could be detected after one-hour medical compression stockings use as compared to data collected at rest. Increased global LV circumferential strain is seen in lymphedema. With using medical compression stockings, LV deformation parameters change towards the normal range emphasizing their importance on cardiac function.

Impact of aortic valve stenosis on myocardial deformation in different left ventricular levels: A three-dimensional speckle tracking echocardiography study.

Global systolic left ventricular (LV) myocardial function progressively declines as degenerative aortic valve stenosis (AS) progresses. Whether this results in uniformly distributed deformation changes from base to apex has not been investigated. Eighty-five AS patients underwent three-dimensional (3D) echocardiography in this cross-sectional study. Patients were grouped by peak jet velocity into mild (n=32), moderate (n=31), and severe (n=22) AS. 3D speckle tracking derived strain, rotation, twist, and torsion were obtained to assess global LV function and myocardial function at the apical, mid, and basal levels. Global longitudinal strain (GLS) was lower in patients with severe AS (-16.1±2.4% in mild, -15.5±2.5% in moderate, and -13.5±3.0% in severe AS [all p<.01]). Peak basal and mid longitudinal strain (LS), basal rotation and twist from apical to basal level followed the same pattern, while peak apical LS was higher in moderate AS compared to severe AS (all p<.05). In multivariate analyses, lower GLS was particularly associated with male sex, higher body mass index and peak aortic jet velocity, lower basal LS with higher filling pressure (E/e') and LV mass, lower mid LS with higher RWT and presence of AS symptoms, and lower apical LS with male sex and higher systolic blood pressure, respectively (all p<.05). Using 3D speckle tracking echocardiography reveals regional and global changes in LV mechanics in AS related to the severity of AS, LV remodeling and presence of cardiovascular risk factors.

Spectrum of ascending aortic aneurysms at a peri-urban tertiary hospital: an echocardiography-based study.

Thoracic ascending aortic (TAA) aneurysms are an important cause of disability and death and require early detection for effective management. Currently, there is a paucity of data from Africa pertaining to TAA aneurysms. This study describes the spectrum of TAA aneurysms at a peri-urban tertiary hospital. A descriptive retrospective study based on clinical and echocardiographic imaging data of patients with TAA aneurysms from October 2017-October 2022. Advanced strain imaging was performed to measure left ventricular (LV) basal, apical, and global longitudinal strain as well as circumferential strain (CS) of the ascending aorta as a proxy measurement of aortic compliance. The study comprised 139 cases of TAA aneurysms (52.5% females) with a mean age of 50 ± 14.8 years with 45 age and gender matched controls. Most cases (95%) were of African ethnicity. The main etiologies were hypertension (41.7%), HIV (36.6%), connective tissue disease (10.7%), congenital (2.2%) and mixed pathologies (8.6%). Two-thirds of patients (69.7%) presented in heart failure, 10% presented with aortic dissection. Thirty percent of the patients were classified as New York Heart Association (NYHA) class I, 59.7% NYHA II, 8.6% NYHA III and two patients NYHA class IV. Echocardiography revealed enlarged aortic dimensions compared to controls (P < 0.001). TAA aneurysms were complicated by severe aortic regurgitation (AR) in half (50.3%) of patients, moderate AR in 25.8%, and mild AR in 14.3%. The mean LV ejection fraction (46.9 ± 12.7%) was reduced compared to controls (P < 0.001). Aortic CS was reduced compared to controls [4.4 (3.2-6.2) % vs. 9.0 (7.1-13.4) %, P < 0.001]. Aortic stiffness was higher in the aortic aneurysm group compared to controls (15.39 ± 20.65 vs. 5.04 ± 2.09, P = 0.001). LV longitudinal strain (-13.9 ± 3.9% vs. 18.1 ± 6.7%), basal CS (-13.9 ± 5.6% vs. -17.9 ± 5.8%) and apical CS (-8.7 ± 8.5% vs. -30.6 ± 3.8%) were reduced compared to controls (P < 0.001). Most patients were on diuretic and anti-remodeling therapy. Surgery was performed in 29.4% and overall mortality was 7.9%. Mortality for acute aortic dissection was 40%. TAA aneurysms associated with hypertension and HIV are common in this predominantly African female population and are associated with considerable morbidity and mortality. Two-dimensional echocardiography and advanced strain imaging are potential tools for detecting and risk stratifying TAA aneurysms.

Cardiac Magnetic Resonance Relaxometry Parameters, Late Gadolinium Enhancement, and Feature-Tracking Myocardial Longitudinal Strain in Patients Recovered from COVID-19.

COVID-19 infection is associated with myocarditis, and cardiovascular magnetic resonance (CMR) is the reference non-invasive imaging modality for myocardial tissue characterization. Quantitative CMR techniques, such as feature tracking (FT) and left ventricular global longitudinal strain (GLS) analysis, have been introduced as promising diagnostic tools to improve the diagnostic accuracy of suspected myocarditis. The aim of this study was to analyze the left ventricular global longitudinal strain (GLS) and the influence of T1 and T2 relaxation times, ECV, and LGE appearance on GLS parameters in a multiparametric imaging protocol in patients who recovered from COVID-19. The 86 consecutive patients enrolled in the study had all recovered from mild or moderate COVID-19 infections; none required hospitalization. Their persistent symptoms and suspected myocarditis led to cardiac magnetic resonance imaging within 3 months of the diagnosis of the SARS-CoV-2 infection. Results: Patients with GLS less negative than -15% had significantly lower LVEF (53.6% ± 8.9 vs. 61.6% ± 4.8; <0.001) and were significantly more likely to have prolonged T1 (28.6% vs. 7.5%; p = 0.019). Left ventricular GLS correlated significantly with T1 (r = 0.303; p = 0.006) and LVEF (r = -0.732; p < 0.001). Left ventricular GLS less negative than -15% was 7.5 times more likely in patients with prolonged T1 (HR 7.62; 95% CI 1.25-46.64). The reduced basal inferolateral longitudinal strain had a significant impact on the global left ventricular longitudinal strain. ROC results suggested that a GLS of 14.5% predicted prolonged T1 relaxation time with the best sensitivity and specificity. Conclusions: CMR abnormalities, including a myocarditis pattern, are common in patients who have recovered from COVID-19. The CMR feature-tracking left ventricular GLS is related to T1 relaxation time and may serve as a novel parameter to detect global and regional myocardial injury and dysfunction in patients with suspected myocardial involvement after recovery from COVID-19.

Evolution and prognostic value of left ventricular deformation and myocardial work parameters in Transthyretin Amyloid Cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized condition. Prognosis is related to early diagnosis and treatment. It remains clinically challenging to estimate the risk for many patients at the time of the diagnosis. Myocardial work is a novel echocardiographic tool that improves the characterization myocardial impairment. Objective We sought to investigate the evolution in time and prognostic value of myocardial deformation and myocardial work parameters, in ATTR-CM patients. Method We analyzed clinical, electrocardiographic, biological, and echocardiographic characteristics in 113 consecutive patients (median age 82 [77–85], 90,4 % men) diagnosed for a wild-type ATTR-CM based on international consensus. Baseline and 18-months follow-up evaluations were taken into account. All the data came from a single center and all the images were recorded on the same platform (Ve95, GE-healthcare). Results Thirty-four patients died and twelve were hospitalized for heart failure at a median follow-up of 935 days (IQR 691–1159 days). Eighty-six patients were treated with Tafamidis. Left ventricular end-diastolic diameter and thickness, left atrial strain during reservoir phase (LASr), Global, Apical and Basal Longitudinal Strain, Global Work Index (GWI), Global Constructive Work, and TAPSE significantly decreased from baseline to 18 months. Left ventricular Ejection Fraction (LVEF), Right Ventricular Free Wall Strain, Global Wasted Work (GWW) and Global Work Efficiency (GWE) did not alter significantly. Using a multivariate analysis, two parameters could be highlighted for their prognostic value on baseline evaluation: GWW and Global Longitudinal Strain (GLS) were significantly associated with the risk of death and/or hospitalization for heart failure. Patients treated with Tafamidis had a significantly better survival. Conclusion GLS and Myocardial Work parameters, particularly GWW, might be used to improve the risk assessment of major events in ATTR-CM patients. The LV strain and myocardial work-based echocardiographic follow-up might be useful in this condition.

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.

Regional contributions to impaired myocardial mechanical function in heart failure with preserved ejection fraction.

Hypertensive heart disease (HHD) is recognized as a key clinical precursor to heart failure with preserved ejection fraction (HFPEF). However, pathophysiological transition from HHD to HFPEF is not well understood. We sought determine whether regional differences in impaired myocardial function may underlie the greater mechanical dysfunction seen in HFPEF compared to HHD. We used standardized echocardiography to assess regional myocardial deformation in a cohort of n = 327 adults with preserved left ventricular (LV) ejection fraction (≥45%), including: n = 129 with HFPEF, n = 158 with HHD and no heart failure, and n = 40 normotensive controls. From detailed measurements of LV systolic strain performed in multiple views, we derived and then compared regional measures of basal, mid-ventricular, and apical longitudinal strains. In models adjusting for clinical covariates, basal and mid-ventricular LV myocardial deformation was more impaired in HHD than in controls (P ≤ 0.003), whereas apical deformation was more impaired in HFPEF than in HHD (P = 0.005). In multivariable-adjusted analyses, only apical strain remained independently associated with HFPEF vs. HHD status [odds ratio 1.18 (1.02-1.37), P = 0.030 per 1% decrease in apical strain]. Compared to other regional strains, apical longitudinal strain optimally differentiated HFPEF from HHD (area under the receiver operating curve: apical longitudinal strain = 0.67; mid-ventricular longitudinal strain = 0.59; basal longitudinal strain = 0.60). We found that while apical mechanical function is preserved in HHD, it was impaired in HFPEF and may contribute to the transition from an asymptomatic heart disease to a symptomatic heart disease.

Prevalence and significance of relative apical sparing in aortic stenosis: insights from an echo and cardiovascular magnetic resonance study of patients referred for surgical aortic valve replacement.

This study aims to assess the prevalence of relative apical sparing pattern (RASP) in patients with severe symptomatic aortic stenosis (AS), referred for surgical aortic valve replacement (AVR), to evaluate its significance, possible relation to amyloid deposition, and persistence after surgery. Prospective study of 150 consecutive patients [age 73 (interquartile range: 68-77), 51% women], with severe symptomatic AS referred to surgical AVR. All patients underwent cardiac magnetic resonance (CMR) before surgery. RASP was defined by [average apical longitudinal strain (LS)/(average basal LS + average mid LS)] > 1 by echocardiography. AVR was performed in 119 (79.3%) patients. Both Congo red and sodium sulphate-Alcian blue (SAB) stain were used to exclude amyloid on septal myocardial biopsy. LV remodelling and tissue characterization parameters were compared in patients with and without RASP. Deformation pattern was re-assessed at 3-6 months after AVR.RASP was present in 23 patients (15.3%). There was no suspicion of amyloid at pre-operative CMR [native T1 value 1053 ms (1025-1076 ms); extracellular volume (ECV) 28% (25-30%)]. None of the patients had amyloid deposition at histopathology. Patients with RASP had significantly higher pre-operative LV mass and increased septal wall thickness. They also had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels [1564 (766-3318) vs. 548 (221-1440) pg/mL, P = 0.010], lower LV ejection fraction (53.7 ± 10.5 vs. 60.5 ± 10.2%, P = 0.005), and higher absolute late gadolinium enhancement (LGE) mass [9.7 (5.4-14.1) vs. 4.8 (1.9-8.6) g, P = 0.016] at CMR. Follow-up evaluation after AVR revealed RASP disappearance in all except two of the patients. RASP is not specific of cardiac amyloidosis. It may also be found in severe symptomatic AS without amyloidosis, reflecting advanced LV disease, being mostly reversible after surgery.

Longitudinal strain bull’s eye plot patterns in young women with type 1 diabetes – association of regional cardiac systolic function with thyroid autoimmunity and iron status

IntroductionAlthough heart failure (HF) in diabetes develops insidiously and affects even young people especially those with type 1 diabetes (T1DM), there is still lack of non-invasive methods to facilitate its early diagnosis. The main aims of this pilot study were to evaluate early left ventricular (LV) segmental changes in young women with T1DM and to determine if they correlate with Hashimoto’s thyroiditis (HT) and iron or ferritin serum levels.Material and methodsThirty women with T1DM (20 of whom had HT) and 30 age-matched controls included in the study underwent medical interview, laboratory tests (serum iron and ferritin levels, glycated hemoglobin, lipid and thyroid profile) and echocardiography using two-dimensional speckle tracking imaging.ResultsWomen with T1DM had significantly reduced longitudinal strain (LS) in the basal and medial anterior and anterolateral segments (p=0.022, p=0.010, respectively) and basal inferior and inferolateral segments than controls (p= 0.035). The significant correlation were found between global and medial anterior and anterolateral LS and HT duration (r=-0.366, p=0.046, r=-0.411, p=0.024, respectively), basal inferolateral LS and iron levels (r=0.404, p=0.027) and medial anteroseptal and inferoseptal LS and ferritin levels (r=-0.498, p=0.005).ConclusionsThe LS bull's eye plot pattern appears to be a non-invasive method for identifying early changes in contractile function, which in women with T1DM are characterized by lesions in basal and medial parts of anterior and anterolateral segments and basal inferior and inferolateral segments. Moreover, part of these changes may be correlated with longer duration of HT and lower serum iron levels.

Feasibility of a New Regional Myocardial Strain Parameter for the Detection of Wall Motion Abnormalities in Arrhythmogenic Right Ventricular Cardiomyopathy.

To evaluate a cardiac MRI feature tracking (FT)-derived parameter that combines right ventricular (RV) longitudinal and radial motions in detecting arrhythmogenic right ventricular cardiomyopathy (ARVC). Patients with ARVC (n = 47; median age, 46 [IQR, 30-52] years; 31 men) were compared with controls (n = 39; median age, 46 [IQR, 33-53] years; 23 men) and separated into two groups based on fulfillment of major structural 2020 International criteria. Cine data from 1.5-T cardiac MRI examinations were analyzed using FT, resulting in conventional strain parameters and a novel composite index named the longitudinal-to-radial strain loop (LRSL). Receiver operating characteristic (ROC) analysis was used to assess diagnostic performance of RV parameters. Volumetric parameters differed significantly between patients in the major structural criteria group and controls but not between patients in the no major structural criteria group and controls. Patients in the major structural criteria group had significantly lower magnitudes of all FT parameters than controls, including RV basal longitudinal strain, radial motion fraction, circumferential strain, and LRSL (-15.6% ± 6.4 vs -26.7% ± 13.9; -9.6% ± 4.89 vs -13.8% ± 4.7; -6.9% ± 4.6 vs -10.1% ± 3.8; and 217.0 ± 128.9 versus 618.6 ± 356.3, respectively). Only LRSL differed between patients in the no major structural criteria group and controls (359.5 ± 195.8 vs 618.6 ± 356.3; P < .0001). Parameters with the highest area under the ROC curve values for discriminating patients in the no major structural criteria group from controls were LRSL, RV ejection fraction, and RV basal longitudinal strain (0.75, 0.70, and 0.61, respectively). A new parameter combining RV longitudinal and radial motions showed good diagnostic performance in ARVC, even in patients without major structural abnormalities.Keywords: Arrhythmogenic Right Ventricular Dysplasia, Strain, Wall Motion Abnormalities, Right Ventricle, MRI, Inherited Cardiomyopathy Supplemental material is available for this article. © RSNA, 2023.

Evolution and prognostic value of deformations parameters and myocardial work in transthyretin amyloid cardiomyopathy

Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized condition. Prognosis is related to the early diagnosis and treatment. It remains clinically challenging to estimate the risk for many patients at the time of the diagnosis. Myocardial work is a novel echocardiographic tool, that improve characterization and prognostic value of the myocardial damages. We sought to analyze echocardiographic deformation parameters, their evolution, and to evaluate their incremental prognostic value, in ATTR-CM patients. We retrospectively analyzed clinical, electrocardiographic, biological, and echocardiographic characteristics in 113 consecutive patients (median age 82 [77–85], 90,4% men) diagnosed for a wild-type ATTR-CM based on international consensus. Baseline and 18 months follow-up evaluation were taken into account. All the data came from a single center and all the images were recorded on the same platform (Ve95, GE-healthcare). Eighty-six patients were treated with Tafamidis. Thirty-four patients died and twelve were hospitalized for heart failure at a median follow-up of 935 days (IQR 691–1159) days. Right ventricle strain (RVS), left atrial strain during contraction phase (LASct), global and basal longitudinal strain, Global Work Index (GWI) and TAPSE significantly decreased from baseline to 18 months follow-up. Left ventricular ejection fraction (LVEF), global wasted work (GWW) and global work efficiency (GWE) did not differ significantly. Using a multivariate analysis, two parameters could be highlighted for their prognostic value on baseline evaluation: GWI < 1347 mmHg and a RV end-diastole area of > 19 cm2 were significantly associated with the risk of death and/or hospitalization for heart failure. Treated patients with Tafamidis had a significantly better survival. Myocardial work, and particularly GWI might be consider at baseline as well as RV size to best assess the risk of major events in ATTR-CM patients.

Impact of residual coronary artery disease on left ventricular function after percutaneous coronary intervention: atwo-dimensional strain echocardiography study.

The aim of this study was to investigate the relationship between the residual SYNTAX score (rSS) and recovery of left ventricular function after percutaneous coronary intervention (PCI) in stable symptomatic patients. Overall, 81patients (mean age: 62.3 ± 9.1years, 72.8% male) were included in the study. Echocardiographic parameters were measured before PCI (baseline) and 3months after PCI (follow-up). The patients were divided into two groups based on rSS: complete revascularized group (CR) with rSS = 0(n =32; 39.5%) and incomplete revascularized group (iCR) with rSS > 0 (n = 49; 60.5%). The median (25th-75th percentile) SYNTAX score (SS) and rSS values were8 (5-11) and2 (0-3), respectively. The difference between basal and follow-up global longitudinal strain (GLS) values (∆GLS) was significantly higher in the CR group (1.25% ± 1.52 vs. 0.11% ± 1.66% p = 0.003). At the follow-up, there was asignificant increase in left ventricular ejection fraction (58.41 ± 6.91% vs. 61.74 ± 5.76%, p < 0.001), asignificant decrease in Tei index (0.46 ± 0.18 vs. 0.35 ± 0.16%, p < 0.001), and asignificant increase in GLS (14.92 ± 2.76% vs. -15.49 ± 2.66%, p = 0.004). In the linear regression analysis, the only variable related to ∆GLS was rSS (β = -0.113, 95% CI: -0.217--0.010; p = 0.033). Increased residual coronary artery disease burden has anegative impact on recovery of left ventricular function after PCI.

Longitudinal Strain and Troponin I Elevation in Patients Undergoing Immune Checkpoint Inhibitor Therapy

BackgroundImmune checkpoint inhibitors (ICIs) are a central part of cancer therapy; however, cardiac complications, such as myocarditis, have the potential for significant morbidity and mortality. Within this population, the clinical significance of longitudinal strain (LS) remains unknown. ObjectivesThis study sought to define the changes in LS in ICI-treated patients, and their associations with high-sensitivity troponin I (hsTnI) and myocarditis. MethodsWe conducted a retrospective cohort study of patients who received ICIs at our hospital from April 2017 to September 2021. All patients underwent echocardiography and blood sampling at standardized time intervals. We measured the changes in global and regional LS before and after ICI administration. Age- and sex-adjusted Cox regression analysis was used to evaluate the association between LS and elevations in hsTnI and myocarditis. ResultsIn a cohort of 129 patients with a median follow-up period of 170 (IQR: 62-365) days; 6 and 18 patients had myocarditis and hsTnI elevation, respectively. In an age- and sex-adjusted Cox proportional hazards model, an early relative worsening of ≥10% in the basal and mid LS and ≥15% in global LS was associated with hsTnI elevation. Relative reductions in LS were not significantly associated with myocarditis; however, 4 of the 6 patients with myocarditis had relative reduction of ≥10% in the basal LS. ConclusionsAn early worsening in the global and regional LS was associated with increased hsTnI in patients receiving ICIs. Assessment of LS early after ICI administration should be further studied as a strategy for risk stratification of ICI-treated patients.

Impact of T2DM on right ventricular systolic dysfunction and interventricular interactions in patients with essential hypertension: evaluation using CMR tissue tracking

BackgroundPrevious studies reported that there was right ventricular (RV) systolic dysfunction in patients with hypertension. The aim of this study was to evaluate the impact of type 2 diabetes mellitus (T2DM) on RV systolic dysfunction and interventricular interactions using cardiac magnetic resonance feature tracking (CMR-FT) in patients with essential hypertension.Methods and methodsEighty-five hypertensive patients without T2DM [HTN(T2DM −)], 58 patients with T2DM [HTN(T2DM +)] and 49 normal controls were included in this study. The biventricular global radial, circumferential and longitudinal peak strains (GRS, GCS, GLS, respectively) and RV regional strains at the basal-, mid- and apical-cavity, were calculated with CMR-FT and compared among controls and different patient groups. Backward stepwise multivariable linear regression analyses were used to determine the effects of T2DM and left ventricular (LV) strains on RV strains.ResultsThe biventricular GLS and RV apical longitudinal strain deteriorated significantly from controls, through HTN(T2DM-), to HTN(T2DM +) groups. RV middle longitudinal strain in patient groups were significantly reduced, and LV GRS and GCS and RV basal longitudinal strain were decreased in HTN(T2DM +) but preserved in HTN(T2DM-) group. Multivariable regression analyses adjusted for covariates demonstrated that T2DM was independently associated with LV strains (LV GRS: β = − 4.278, p = 0.004, model R2 = 0.285; GCS: β = 1.498, p = 0.006, model R2 = 0.363; GLS: β = 1.133, p = 0.007, model R2 = 0.372) and RV GLS (β = 1.454, p = 0.003, model R2 = 0.142) in hypertension. When T2DM and LV GLS were included in the multiple regression analysis, both T2DM and LV GLS (β = 0.977 and 0.362, p = 0.039 and < 0.001, model R2 = 0.224) were independently associated with RV GLS.ConclusionsT2DM exacerbates RV systolic dysfunction in patients with hypertension, which may be associated with superimposed LV dysfunction by coexisting T2DM and suggests adverse interventricular interactions.

Optimal Echocardiographic Parameters to Improve the Diagnostic Yield of Tc-99m-Bone Avid Tracer Cardiac Scintigraphy for Transthyretin Cardiac Amyloidosis.

Echocardiographic deformation-based ratios and novel multi-parametric scores have been suggested to discriminate transthyretin cardiac amyloidosis (ATTR-CM) from other causes of increased left ventricular wall thickness among patients referred for ATTR-CM evaluation. Their relative predictive accuracy has not been well studied. We sought to (1) identify echocardiographic parameters predictive of ATTR-CM and (2) compare the diagnostic accuracy of these parameters in patients with suspected ATTR-CM referred for technetium-99m-pyrophosphate scintigraphy. Echocardiograms from 598 patients referred to 3 major amyloidosis centers for technetium-99m-pyrophosphate to detect ATTR-CM were analyzed, including longitudinal strain (LS) analysis. Deformation ratios (septal apex to base ratio, relative apical sparing, ejection fraction to global LS), a multi-center European increased wall thickness score, and Mayo Clinic derived ATTR score (transthyretin cardiac amyloidosis score) were calculated. A logistic regression model was used to identify the parameters that best associated with a diagnosis of ATTR-CM. Comparison of the diagnostic capacity of the parameters was performed by receiver operating characteristic curves and the area under the curve (AUC). Over half of the subjects (54.2%) were diagnosed with ATTR-CM (78% were men, median age of 76 years). Age, inferolateral wall thickness, and basal LS were the strongest predictors of ATTR-CM, AUC of 0.87 (95% CI: 0.83, 0.90), superior to the increased wall thickness score AUC of 0.78 (95% CI: 0.73, 0.83; P=0.004). An inferolateral wall thickness of ≥14 mm (AUC: 0.73) was as accurate as the published cut-offs for transthyretin cardiac amyloidosis score and septal apex to base (AUC: 0.72 and 0.69, P=0.8 and P=0.1, respectively), and was superior to ejection fraction to global LS and relative apical sparing (AUC: 0.64 and 0.53, P<0.001, respectively). A cut-off of ≥-8% for average basal LS (AUC: 0.76, CI: 0.72-0.79) had a similar area under the curve to transthyretin cardiac amyloidosis score (TCAS) (P=0.2); outperforming the other indices (P<0.01). Inferolateral wall thickness and average basal LS performed as well as or better than more complex echo ratios and multiparametric scores to predict ATTR-CM.

Relative apical sparing in severe aortic stenosis: does it mean concomitant amyloid cardiomyopathy?

Abstract Background Relative apical sparing (RAS) of left ventricular (LV) longitudinal strain (LS) is a red flag marker for the suspicion of amyloid cardiomyopathy. However, it has also been described in patients with severe aortic stenosis (AS). Aim To assess the prevalence of RAS in patients with severe symptomatic AS referred for surgical aortic valve replacement (AVR), to evaluate its clinical significance and assess its presence after surgery. Methods We prospectively studied 135 consecutive patients (age: 73 y [IQR 68–77 y], 49% men) with severe symptomatic AS – mean transaortic pressure gradient (AVmean): 60.9±17.7 mmHg; mean aortic valve area: 0.7±0.2 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. Beyond 12 lead-ECG and transthoracic echocardiography (TTE), all patients underwent cardiac magnetic resonance (CMR) before surgery. RAS was defined by the ratio &amp;gt;1 of average LS at apical segments/sum of the average basal and mid LS at speckle tracking analysis. AVR with septal myocardial biopsy, for investigational purposes, was performed in 80 patients. AS severity indexes, LV remodeling and tissue characterization parameters were compared in both groups of patients, with and without RAS. LS deformation pattern was reassessed at 3–6 months after AVR. Results RAS was present in 24 patients (18%). In the whole cohort there were neither pseudoinfarct pattern or low voltage ECG criteria, nor infiltration suspicion from CMR (native T1 value 1053 ms [IQR 1025–1071 ms] for institutional reference values: 972–1070 ms; ECV 24% [IQR 21–27%]). None of the patients had amyloid deposition at histopathology. Overall, mean CMR LV ejection fraction (LVEF) was 59.6±10.5% and 98 patients (74%) had non-ischemic delayed enhancement, with a median fibrosis fraction of 4.1% [IQR 1.6–7.8%]. RAS cohort had a significantly higher AVmean gradient, relative wall thickness, maximum septal thickness, peak systolic dispersion, with lower global LS at TTE, as well as higher LV mass and lower LVEF at CMR. RAS group has also higher NT-proBNP ambulatory values (Table 1). Follow-up evaluation after AVR revealed RAS disappearance in 19 patients (79.2%). Conclusions RAS occurs in almost one-fifth of the patients in this cohort despite the absence of signs of myocardial infiltration. This deformation pattern elapses with worse indexes of LV remodeling consistent with a more advanced stage of the disease, being reversible after AVR, which stands for the absence of concomitant myocardial infiltration. Funding Acknowledgement Type of funding sources: None.