Circumferential Strain Values Research Articles

Fetal left and right ventricular strain parameters using speckle tracking in congenital heart diseases.

Assessment of fetal ventricular function is mostly subjective, and currently, for the objective assessment left ventricular shortening fraction is obtained. However, this by itself is not very reliable. Hence, more tools that can provide an objective assessment are needed to increase the confidence of functional assessment. Speckle tracking imaging can provide one such tool. In this study we sought to establish the normative value of global longitudinal and circumferential strain for our fetal patients and for two major forms of congenital heart diseases, namely atrioventricular canal defects (AVC) and uncorrected dextro-transposition of the great arteries (dTGA) to act as a benchmark. The study was completed via a single center retrospective analysis on 72 fetal echocardiograms (26 normal, 15 dTGA, and 31 AVC). Tomtec Arena™ echocardiography analysis software was used for analysis. In normal fetuses, mean left ventricular (LV) global longitudinal strain (GLS) was - 22.6% (95% CI -24, -21.1) and mean right ventricular (RV) GLS was - 22.1% (95% CI -23.6, -20.6). In AVC patients LV GLS was-26.6% (95% CI -28,-25.3) and mean RV GLS was - 26.5% (95% CI -27.9,-25.2). In dTGA patients LV GLS was - 22.9% (95% CI of -24.8, -21) and RV GLS was - 21.3% (95% CI was - 23.4, -20.8). There was good intra-rater reliability though poor to fair inter-rater reliability. Notwithstanding its current limitations, strain imaging can provide useful information that can increase confidence of cardiac functional assessment in fetal patients. However, to be reliable across the board, further automation and standardization is required.

The effect of significant weight loss after bariatric surgery on echocardiographic indices: an observational study focusing on left ventricular deformation by 2D speckle echocardiography and right ventricular size

BackgroundObesity is a known risk factor for atherosclerosis and cardiac disease.HypothesisThis study evaluated the effect of significant weight loss following bariatric surgery on myocardial deformation indices and right ventricular size (RV). This was a prospective cohort study. Morbid obese patients scheduled for bariatric surgery from July 2017 to February 2018 at Firoozgar Hospital were included in our study and referred for transthoracic echocardiography at Rajaie Cardiovascular Medical and Research Center.ResultsThirty-four patients entered the study. The absolute value of global longitudinal strain (GLS) at baseline, 3, and 6 months after surgery was 17.42 ± 2.94%, 18.24 ± 3.09%, and 19.52 ± 2.78%, respectively, with a statistically significant difference from baseline to after six months (P value < 0.001). The absolute value of global circumferential strain (GCS) at baseline, 3, and 6 months after surgery was 20.14 ± 4.22%, 23.32 ± 4.66%, and 24.53 ± 4.52%, respectively, with statistically significant changes (P value < 0.001) from baseline to three months and from baseline to six months and no significant difference from three months to six months. A significant decrease was reported in mechanical dispersion of circumferential strain (38.05 ± 23.81–23.37 ± 20.86 ms, P value = 0.006) 6 months after surgery. Right ventricular size three- and six-month post-surgery showed a significant decrease relative to baseline echocardiography.ConclusionsBariatric surgery could enhance cardiac function, as proven by 2D speckle echocardiography. Changes in RV size may be related to weight loss and should be considered when assessing patients who have undergone bariatric surgery.

Assessment of left and right ventricular systolic function in dogs with multicentric lymphoma

ObjectiveMyocardial dysfunction in cardio-oncology is generally thought to be related to the cardiotoxicity of chemotherapy treatment. However, it is known that some tumors have direct effects on myocardial function. These effects have already been studied in man, but there are no publications of these of the effects in dogs. Novel advanced echocardiographic techniques may allow early detection of myocardial dysfunction when compared to conventional echocardiographic techniques. This study aims to assess myocardial systolic function in dogs with multicentric lymphoma prior to initiation of chemotherapy. AnimalsFifteen dogs with multicentric lymphoma and nineteen healthy dogs. MethodsCase-control study. Dogs with multicentric lymphoma and healthy control dogs underwent physical examination, electrocardiography, systolic blood pressure measurement, standard and speckle tracking echocardiography to assess biventricular systolic function. ResultsThere were no differences between groups in terms of ejection fraction, fractional shortening, left ventricular systolic and diastolic diameter, tricuspid annular plane systolic excursion, mitral annular plane systolic excursion and fractional area change of the right ventricle (RV). However, there was a reduction in the values of global circumferential strain (p = 0.0003), RV strain (p = 0.01) and RV tissue motion annular displacement (p < 0.05) in the dogs with lymphoma when compared to the control group. ConclusionsSpeckle tracking techniques appear to demonstrate early systolic dysfunction, primarily affecting the RV, in dogs with lymphoma prior to chemotherapy treatment.

Evaluation of the Left Ventricular Myocardium Using Layer-Specific Strain Analysis in Adolescent Athletes Performing High-Intensity Interval Training.

High-intensity interval training (HIIT) has been demonstrated to be an efficient way of improving physical performance in adolescent athletes compared to conventional training modalities. The objective of this study was to evaluate the impact of HIIT on the myocardial function of adolescent athletes, specifically focusing on left ventricular (LV) function, using conventional echocardiography and layer-specific strain (LSS) analysis. A total of 19 male adolescent athletes (with mean age of 16.83 ± 1.29years) participating in various football clubs were recruited for this study. During the course of 8weeks, these adolescent male athletes engaged in HIIT program centered around running. Upon completion of HIIT program, a treadmill exercise test was conducted. Subsequently, conventional and LSS echocardiography were conducted to acquire the evaluation of LV myocardial function. Interventricular septum thickness and ventricular mass index were significantly increased post high-intensity interval training (p < 0.005). After the HIIT, the treadmill exercise test demonstrated a significant increase in test duration and metabolic equivalent compared to the pre-training values (p < 0.005). Post high-intensity interval training, LSS analysis revealed significantly improved LV circumferential strain values in the basal and mid-segments of the left ventricle when compared to the pre-training measurements (p < 0.005). The implementation of high-intensity interval training led to an enhancement of circumferential LSS in the LV, indicating a favorable physiological adaptation and improved efficiency of the myocardium.

Incremental prognostic value of fully-automatic machine-learning based global circumferential strain during a stress CMR exam

Abstract Background Left ventricular global circumferential strain using cardiovascular magnetic resonance (CMR) is an accurate indicator to predict cardiovascular events. Although several studies have shown the excellent prognostic value of stress CMR, the prognostic value of stress global circumferential strain (sGCS) remains unknown. Purpose To investigate the prognostic value of sGCS for predicting cardiovascular events using a fully automatic 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 major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). A fully automatic machine learning algorithm was trained and validated on unseen CMR studies (MAGNETOM Aera and Skyra, Siemens Healthcare, Erlangen, Germany) to assess the sGCS from short-axis cine images at stress. 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 sGCS. Results Among 2,906 consecutive patients who underwent stress CMR, the automatic sGCS was successfully computed in 2,859 (98.4%) patients (68% male, mean age 64±12 years). A total of 256 (8.8%) MACEs were observed during a median (IQR) follow-up period of 4.5 (3.7-5.3) years. Using Kaplan-Meier analysis, sGCS and the presence of inducible ischemia were significantly associated with the occurrence of MACE (hazard ratio, HR: 1.12 [95% CI, 1.08-1.17]; and HR: 8.48 [95% CI, 6.05-11.91], both p&amp;lt;0.001; respectively). After adjustment for traditional risk factors, inducible ischemia and late gadolinium enhancement (LGE), sGCS was an independent predictor of a higher incidence of MACE (adjusted HR: 1.12 [95% CI, 1.05-1.20]). Finally, sGCS showed an incremental prognostic value to predict MACE compared to a multivariable model including traditional risk factors, the presence of inducible ischemia and LGE (C-statistic improvement: 0.05, p=0.007; NRI= 0.169; IDI= 0.097; both p&amp;lt;0.001). Conclusions Automatic sGCS has an incremental prognostic value to predict MACE above traditional risk factors, and other stress CMR parameters.Survival curvesIncremental prognostic value

Abstract 14291: Novel 4D Procrustes Motion Analysis Applied to CMR Links LMNA Mutation Severity With Myocardial Dynamics

Introduction: Procrustes motion analysis (PMA) is a novel method to extract microstructural tensor data from CMR cines. Aim: To illustrate its usefulness in phenotyping patients with confirmed pathogenic lamin ( LMNA ) mutations ( LMNA+). Methods: This n=187 prospective multi-centre CMR study (NCT03860454) recruited LMNA+ (n=67), participants with dilated cardiomyopathy carrying wild-type LMNA gene (DCMwt; n=73) and healthy volunteers (HV, n=47). Left ventricular (LV) cines were analyzed using 3D feature tracking. Generalized procrustes analysis was used to calculate the radial, circumferential, and longitudinal strains. To explore differences in myocardial dynamics between these groups, PMA was employed to derive the procrustes trajectory size at 16 homologous time points of the cardiac cycle in comparison to a common diastolic reference point. Results: Compared to HV, LMNA+ had worse radial and circumferential strain values ( Fig. 1 ). Compared to DCMwt, LMNA + had better strain profiles after adjusting for late gadolinium enhancement. LMNA+ truncating variant carriers had a smaller procrustes trajectory size during diastole compared to splice and missense variant carriers (i.e., reduced myocardial dynamics according to the PMA) ( Fig. 2A ). Similarly, LMNA+ who had a mutation upstream of nuclear localization signal (worse mutation) had lower myocardial dynamics compared to those who had a downstream mutation ( Fig. 2B ). Conclusion: Detailed information on myocardial deformation patterns between diastole and systole can be inferred using PMA applied to CMR cines. Procrustes trajectory size may be a novel marker of myocardial dynamics linked to mutation severity.

Three-dimensional echocardiography for the evaluation of hypertrophic cardiomyopathy patients: relation to symptoms and exercise capacity

Patients with hypertrophic cardiomyopathy may exhibit impaired functional capacity, associated with increased morbidity and mortality. Systolic function is one of the determinants of functional capacity. Early identification of systolic disfunction may identify patients at risk for adverse outcomes. Myocardial deformation parameters, derived from three-dimensional (3D) speckle-tracking echocardiography (3DSTE) are useful tools to assess left ventricular systolic function, and are often abnormal before a decline in ejection fraction is seen. The aim of this study was to evaluate the correlation between myocardial deformation parameters obtained by 3DSTE and functional capacity in patients with hypertrophic cardiomyopathy. Seventy-four hypertrophic cardiomyopathy adult patients were prospectively evaluated. All patients underwent a dedicated 2D and 3D echocardiographic examination and cardiopulmonary exercise testing (CPET). Values of 3D global radial (GRS), longitudinal (3DGLS) and circumferential strain (GCS) were overall reduced in our population: 99% (n = 73) of the patients had reduced GLS, 82% (n = 61) had reduced GRS and all patients had reduced GCS obtain by 3DSTE. Average peak VO2 was 21.01 (6.08) ml/Kg/min; 58% (n = 39) of the patients showed reduced exercise tolerance (predicted peak VO2 < 80%). The average VE/VCO2 slope was 29.0 (5.3) and 16% (n = 11) of the patients had impaired ventilatory efficiency (VE/VCO2 > 34). In multivariable analysis, 3D GLS (β1 = 0.10, 95%CI: 0.03;0.23, p = 0.014), age (β1 = -0.15, 95%CI: -0.23; -0.05, p = 0.002) and female gender (β1 = -5.10, 95%CI: -7.7; -2.6, p < 0.01) were independently associated with peak VO2. No association was found between left ventricle ejection fraction obtain and peak VO2 (r = 0.161, p = 0.5). Impaired myocardial deformation parameters evaluated by 3DSTE were associated with worse functional capacity assessed by peak VO2.

Biventricular Tissue Tracking with Cardiovascular Magnetic Resonance: Reference Values of Left- and Right-Ventricular Strain.

We derived reference values of left-ventricular (LV) and right-ventricular (RV) strain parameters in a cohort of 100 healthy subjects by feature tracking cardiac magnetic resonance (FT-CMR). Global and regional strain values were calculated for the LV; circumferential and radialSAX strain parameters were derived from the short-axis (SAX) stack, while longitudinal and radialLAX strain parameters were assessed in three long-axis (LAX) views. Only global longitudinal strain (GLS) was calculated for the RV. Peak global LV circumferential strain was -16.7% ± 2.1%, LV radialSAX strain was 26.4% ± 5.1%, LV radialLAX strain was 31.1% ± 5.2%, LV GLS was -17.7% ± 1.9%, and RV GLS was -23.9% ± 4.1%. Women presented higher global LV and RV strain values than men; all strain values presented a weak relationship with body surface area, while there was no association with age or heart rate. A significant association was detected between all LV global strain measures and LV ejection fraction, while RV GLS was correlated to RV end-diastolic volume. The intra- and inter-operator reproducibility was good for all global strain measures. In the regional analysis, circumferential and radial strain values resulted higher at the apical level, while longitudinal strain values were higher at the basal level. The assessment of cardiac deformation by FT-CMR is feasible and reproducible and gender-specific reference values should be used.

Incremental prognostic value of fully-automatic machine-learning based global circumferential strain during a stress CMR exam

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular global circumferential strain using cardiovascular magnetic resonance (CMR) is an accurate indicator to predict cardiovascular events. Although several studies have shown the excellent prognostic value of stress CMR, the prognostic value of stress global circumferential strain (sGCS) remains unknown. Aim To investigate the prognostic value of sGCS for predicting cardiovascular events using a fully automatic 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 major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). A fully automatic machine learning algorithm was trained and validated on unseen CMR studies (MAGNETOM Aera and Skyra, Siemens Healthcare, Erlangen, Germany) to assess the sGCS from short-axis cine images at stress. 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 sGCS. Results Among 2,906 consecutive patients who underwent stress CMR, the automatic sGCS was successfully computed in 2,859 (98.4%) patients (68% male, mean age 64±12 years). A total of 256 (8.8%) MACEs were observed during a median (IQR) follow-up period of 4.5 (3.7–5.3) years. Using Kaplan-Meier analysis, sGCS and the presence of inducible ischemia were significantly associated with the occurrence of MACE (hazard ratio, HR: 1.12 [95% CI, 1.08–1.17]; and HR: 8.48 [95% CI, 6.05–11.91], both p&amp;lt;0.001; respectively). After adjustment for traditional risk factors, inducible ischemia and late gadolinium enhancement (LGE), sGCS was an independent predictor of a higher incidence of MACE (adjusted HR: 1.12 [95% CI, 1.05–1.20]). Finally, sGCS showed an incremental prognostic value to predict MACE compared to a multivariable model including traditional risk factors, the presence of inducible ischemia and LGE (C-statistic improvement: 0.05, p = 0.007; NRI= 0.169; IDI= 0.097; both p&amp;lt;0.001). Conclusions Automatic sGCS has an incremental prognostic value to predict MACE above traditional risk factors, and other stress CMR parameters.

Radiotherapy-induced changes in right ventricular function in patients with early-stage breast cancer

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Finnish state research funding for university-level health research Background In breast cancer patient’s adjuvant RT nearly doubles cardiac mortality, and in some subgroups long-term cardiovascular mortality exceeds cancer mortality. The effects of RT on left ventricle are well established, but studies concerning right ventricular (RV) changes are sparse. Methods The study population consisted of 31 patients with early-stage left-sided breast cancer who had undergone adjuvant therapy using modern RT delivery techniques. Echocardiographic examinations including right ventricular (RV) strain analysis were performed prior to the RT, immediately after, as well as three and six years after the RT. In addition, the patients underwent cardiac magnetic resonance (CRM) imaging at six-year control. Results The mean RT dose to the RV free wall was 5.75±2.49 Gy. In echocardiography, basal early diastolic strain rate increased from 1.8±0.8 1/s to 2.3±0.9 1/s (p = 0.045), and the ratio of tricuspid inflow e and a-waves declined from 1.3±0.2 to 1.1±3.0 (p = 0.035), but there were no changes in global or regional strain or strain values in the six-year follow-up. In addition, In CMR imaging, the global circumferential strain values were associated with RV free wall RT dose (p = 0.005) with each mean Gy inducing 0.395% reduction in the circumferential strain [95% CI; −0.658, −0.120] whereas longitudinal strain was not associated with the RT dose. Conclusions Modern conformal breast cancer RT did not influence RV systolic function or result in clinically meaningful cardiac sequelae during six-year follow-up. Minor changes in RV diastolic function and the association between circumferential strain in CRM and the RT dose indicate that these parameters might be more sensitive in detecting RT-induced cardiac changes.

Myocardial injury in patients with acute ischemic stroke detected by cardiovascular magnetic resonance imaging

BackgroundPatients with acute ischemic stroke (AIS) are at high risk of adverse cardiovascular events. Until now, the burden of myocardial injury derived from cardiovascular magnetic resonance imaging (CMR) has not been established in this population. MethodsPatients with AIS underwent CMR at 3 Tesla within 120 h after the index stroke as part of a prospective, single-center study. Patients with persistent atrial fibrillation were excluded. Morphology and function of both cardiac chambers and atria were assessed applying SSFP cine. Myocardial tissue differentiation was based on native and contrast-enhanced imaging including late gadolinium enhancement (LGE) after 0.15 mmol/kg gadobutrol for focal fibrosis and parametric T2- and T1-mapping for diffuse findings. To detect myocardial deformation global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain was measured applying feature tracking. Cardiac troponin was measured using a high-sensitivity assay (99th percentile upper reference limit 14 ng/L). T2 mapping values were compared with 20 healthy volunteers. ResultsCMR with contrast media was successfully performed in 92 of 115 patients (mean age 74 years, 40% female, known myocardial infarction 6%). Focal myocardial fibrosis (LGE) was detected in 31 of 92 patients (34%) of whom 23/31 (74%) showed an ischemic pattern. Patients with LGE were more likely to have diabetes, prior myocardial infarction, prior ischemic stroke, and to have elevated troponin levels compared to those without. Presence of LGE was accompanied by diffuse fibrosis (increased T1 native values) even in remote cardiac areas as well as reduced global radial, circumferential and longitudinal strain values. In 14/31 (45%) of all patients with LGE increased T2-mapping values were detectable. ConclusionsMore than one-third of patients with AIS have evidence of focal myocardial fibrosis on CMR. Nearly half of these changes may have acute or subacute onset. These findings are accompanied by diffuse myocardial changes and reduced myocardial deformation. Further studies, ideally with serial CMR measurements during follow-up, are required to establish the impact of these findings on long-term prognosis after AIS.

Correlation of myocardial strain by CMR-feature tracking with substrate abnormalities detected by electro-anatomical mapping in patients with nonischemic cardiomyopathy

BackgroundLate gadolinium enhancement (LGE) detected by cardiac MRI (CMR) has low correlation with low voltage zones (LVZs) detected by electroanatomical mapping (EAM). We aim to study correlation of myocardial strain by CMR- Feature Tracking (FT) alongside LGE with LVZs detected by EAM.MethodsNineteen consecutive CMRs of patients with EAM were analyzed offline by CMR-FT. Peak value of circumferential strain (CS), longitudinal strain (LS), and LGE was measured in each segment of the left ventricle (17-segment model). The percentage of myocardial segments with CS and LS > −17% was determined. Percentage area of LGE-scar was calculated. Global and segment–wise bipolar and unipolar voltage was collected. Percentage area of bipolar LVZ (<1.5 mV) and unipolar LVZ (<8.3 mV) was calculated.ResultsMean age was 62±11 years. Mean LVEF was 37±13%. Mean global CS was −11.8±5%. Mean global LS was −11.2±4%. LGE-scar was noted in 74% of the patients. Mean percentage area of LGE-scar was 5%. There was significant correlation between percentage abnormality detected by LS with percentage bipolar LVZ (r = +0.5, p = 0.03) and combined percentage CS+LS abnormality with percentage unipolar LVZ (r = +0.5, p = 0.02). Per-unit increase in CS increased the percentage area of unipolar LVZ by 2.09 (p = 0.07) and per-unit increase in LS increased the percentage area of unipolar LVZ by 2.49 (p = 0.06). The concordance rates between CS and LS to localize segments with bipolar/unipolar LVZ were 79% and 95% compared to 63% with LGE.ConclusionsMyocardial strain detected by CMR-FT has a better correlation with electrical low voltage zones than the conventional LGE.

Experimental research on the evaluation of left ventricular systolic function by layered speckle tracking before and after berberine treatment in a cardiac hypertrophy rat model.

To evaluate the effect of berberine (BBR) intervention on left ventricular hypertrophy and systolic function in rats by ultrasound layered strain imaging and cardiac hypertrophy model. Eighty healthy male Sprague-Dawley (SD) rats were randomly divided into four groups: group A (normal saline control group), group B [isoproterenol (ISO) induced model group], group C (BBR hydrochloride 5 mg/kg + ISO group) and group D (BBR hydrochloride 10 mg/kg + ISO group). Echocardiography was performed on days 1, 7 and 14, respectively. The myocardial tissue was taken for pathological examination. The key proteins of Rho/ROCK signaling pathway were quantified by immunohistochemical staining. On day 7, compared with group A, peripheral strain values of the subendocardium and middle myocardium of rats in groups B, C and D were significantly decreased. The absolute value of circumferential strain (CS) in subendocardium and middle myocardium in group B was significantly lower than that in groups C and D (-24.21 vs. -26.68 vs. -27.69; -14.90 vs. -16.48 vs. -17.69). Pathological results showed that compared with the myocardial cells in control group A, the myocardial cells in group B had significantly increased cross-sectional area, and obvious myocardial interstitial fibrosis. Compared with group B, BBR intervention reduced the deposition of fibrosis in groups C and D, group D was more obvious. Immunohistochemical results showed that compared with group A, the protein expression levels of ROCK, RhoA and Bax in groups B, C and D were significantly increased, while the protein expression levels of Bcl-2 were significantly decreased. Ultrasound layered strain imaging could evaluate the early left ventricular systolic function in isoprenaline-induced hypertrophy rat model. BBR might inhibit oxidative stress through the Rho/ROCK signaling pathway and slow down the progression of myocardial fibrosis after the formation of cardiac hypertrophy. This provides reference and direction for clinical decision-making and further research.

Quantitative evaluation of acute myocardial infarction by feature-tracking cardiac magnetic resonance imaging.

To assess the value of feature-tracking cardiac magnetic resonance (FT-CMR) imaging in the quantitative evaluation of acute myocardial infarction (AMI). We retrospectively analyzed medical records of patients with acute myocardial infarction (AMI) diagnosed in the Department of Cardiology of Hubei No.3 People's Hospital of Jianghan University from April 2020 to April 2022, who underwent feature-tracking cardiac magnetic resonance (FT-CMR) examination. Based on the electrocardiogram (ECG) findings, patients were divided into ST-elevation myocardial infarction (STEMI) (n=52) and non-STEMI (NSTEMI) (n=48) groups. We compared myocardial strain parameters between the two groups and applied the Pearson's test to reveal any correlations between the left ventricular myocardial strain parameters and the number of late gadolinium enhancement (LGE) positive segments; we assessed the clinical value of FT-CMR for predicting STEMI using a receiver operating characteristic (ROC) curve. The number of LGE-positive segments in the STEMI group was significantly higher than that in the NSTEMI group. The myocardial radial, circumferential and longitudinal strains in the STEMI group were significantly lower than those in the NSTEMI group (p<0.05). The number of LGE-positive segments in patients with AMI negatively correlated with the radial, circumferential and longitudinal strains. The results of the ROC curve analysis showed that radial, circumferential and longitudinal strain values have a diagnostic value for STEMI (p<0.05). FT-CMR, a non-invasive and rapid method for analyzing myocardial strains, has a high diagnostic value for AMI and should be helpful for the prevention and intervention of ventricular remodeling after myocardial infarctions.

Impaired left-ventricular global longitudinal strain by feature-tracking cardiac MRI predicts mortality in systemic sclerosis.

Impaired left-ventricular (LV) and right-ventricular (RV) cardiac magnetic resonance (CMR) strain has been documented in systemic sclerosis (SSc). However, it is unknown whether the CMR strain is predictive of adverse outcomes in SSc. Therefore, we set out to investigate the prognostic value of CMR strain in SSc. Patients with SSc who underwent CMR for clinical indications between 11/2010 and 07/2020 were retrospectively studied. LV and RV strain was evaluated by feature tracking. The association between strain, late gadolinium enhancement (LGE), and survival was evaluated with time to event and Cox-regression analyses. During the study period, 42 patients with SSc (age: 57 ± 14years, 83% female, 57% limited cutaneous SSc, SSc duration: 7 ± 8years) underwent CMR. During the median follow-up of 3.6years, 11 patients died (26%). Compared to surviving patients, patients who died had significantly worse LV GLS (-8.2 ± 6.2% versus -12.1 ± 2.9%, p = 0.03), but no difference in LV global radial, circumferential, or RV strain values. Patients within the quartile of most impaired LV GLS (≥ -12.8%, n = 10) had worse survival when compared to patients with preserved LV GLS (< -12.8%, n = 32, log-rank p = 0.02), which persisted after controlling for LV cardiac output, LV cardiac index, reduced LV ejection fraction, or presence of LGE. In addition, patients who had both impaired LV GLS and LGE (n = 5) had worse survival than patients with LGE or impaired GLS alone (n = 14) and compared to those without any of these features (n = 17, p = 0.003). In our retrospective cohort of patients with SSc undergoing CMR for clinical indications, LV GLS and LGE were found to be predictive of overall survival.

Local and global distensibility assessment of abdominal aortic aneurysms in vivo from probe tracked 2D ultrasound images.

Rupture risk estimation of abdominal aortic aneurysm (AAA) patients is currently based on the maximum diameter of the AAA. Mechanical properties that characterize the mechanical state of the vessel may serve as a better rupture risk predictor. Non-electrocardiogram-gated (non-ECG-gated) freehand 2D ultrasound imaging is a fast approach from which a reconstructed volumetric image of the aorta can be obtained. From this 3D image, the geometry, volume, and maximum diameter can be obtained. The distortion caused by the pulsatility of the vessel during the acquisition is usually neglected, while it could provide additional quantitative parameters of the vessel wall. In this study, a framework was established to semi-automatically segment probe tracked images of healthy aortas (N = 10) and AAAs (N = 16), after which patient-specific geometries of the vessel at end diastole (ED), end systole (ES), and at the mean arterial pressure (MAP) state were automatically assessed using heart frequency detection and envelope detection. After registration AAA geometries were compared to the gold standard computed tomography (CT). Local mechanical properties, i.e., compliance, distensibility and circumferential strain, were computed from the assessed ED and ES geometries for healthy aortas and AAAs, and by using measured brachial pulse pressure values. Globally, volume, compliance, and distensibility were computed. Geometries were in good agreement with CT geometries, with a median similarity index and interquartile range of 0.91 [0.90-0.92] and mean Hausdorff distance and interquartile range of 4.7 [3.9-5.6] mm. As expected, distensibility (Healthy aortas: 80 ± 15·10-3 kPa-1; AAAs: 29 ± 9.6·10-3 kPa-1) and circumferential strain (Healthy aortas: 0.25 ± 0.03; AAAs: 0.15 ± 0.03) were larger in healthy vessels compared to AAAs. Circumferential strain values were in accordance with literature. Global healthy aorta distensibility was significantly different from AAAs, as was demonstrated with a Wilcoxon test (p-value = 2·10-5). Improved image contrast and lateral resolution could help to further improve segmentation to improve mechanical characterization. The presented work has demonstrated how besides accurate geometrical assessment freehand 2D ultrasound imaging is a promising tool for additional mechanical property characterization of AAAs.

The Effects of Vitamin D on Myocardial Function Demonstrated by Speckle-Tracking Echocardiography in Children with Beta Thalassemia.

Beta thalassemia major is an inherited hemoglobin disorder resulting in chronic hemolytic anemia. Cardiac involvement is the main cause of death in patients. Speckle-tracking echocardiography is a feasible method for the evaluation of cardiac function via an assessment of the longitudinal deformation of the myocardium through the cardiac cycle. The aim of our study is to evaluate the association between vitamin D deficiency and deformation of the left ventricular myocardium measured by speckle-tracking echocardiography in children with thalassemia major. In this prospective study, 33 thalassemic patients with vitamin D deficiency were enrolled. Cardiac magnetic resonance T2* value, conventional echocardiography, and speckle tracking, and also left ventricular longitudinal and circumferential strain values were measured. Myocardial functions of the patients with vitamin D deficiency or insufficiency were evaluated by speckle-tracking echocardiography before and after vitamin D replacement. The mean age of the patients was 15.4 ± 3.09 years. Vitamin D level was deficient in 30 (90%) and insufficient in 3 (10%) of them. Speckle-tracking analysis showed a significantly decreased absolute value of the left ventricular global longitudinal strain before vitamin D replacement. A significant improvement in the global longitudinal strain was detected after vitamin D replacement (P < 0.05). A statistically significant increase was observed in parameters showing left ventricular systolic and diastolic functions after vitamin D replacement. Vitamin D deficiency is frequently observed and causes decreased contractility in thalassemic patients. In our study, we observed that our patients' cardiac functions had improved after vitamin D replacement therapy.

Age-, Sex-, and Race-Based Normal Values for Left Ventricular Circumferential Strain from the World Alliance Societies of Echocardiography Study

Left ventricular (LV) circumferential strain has received less attention than longitudinal deformation, which has recently become part of routine clinical practice. Among other reasons, this is because of the lack of established normal values. Accordingly, we aimed to establish normative values for LV circumferential strain and determine sex-, age- and race-related differences in a large cohort of healthy adults. Complete 2D transthoracic echocardiograms were obtained in 1572 healthy subjects (51% male), enrolled in the World Alliance of Societies of Echocardiography (WASE) Study. Subjects were divided into 3 age groups (<35, 35-55, >55 years) and stratified by sex and by race. Vendor-independent semi-automated speckle tracking software was used to determine LV regional and global circumferential strain (GCS) values. Limits of normal for each measurement were defined as 95% of the corresponding sex and age group falling between the 2.5th and 97.5th percentiles. Intergroup differences were analyzed using unpaired t-tests. Circumferential strain showed a gradient, with lower magnitude at the mitral valve level, increasing progressively towards the apex. Compared to men, women had statistically higher magnitude of regional and global strain. Older age was associated with a stepwise increase in GCS despite an unaffected EF, a decrease in LV volume and a relatively stable GLS in men with a small gradual decrease in women. Asian subjects demonstrated significantly higher GCS magnitudes than whites of both sexes and blacks in women only. In contrast, no significant differences in GCS were found between white and black subjects of either sex. Importantly, despite statistical significance of the above differences across sex-, age- and races, circumferential strain values were similar in all groups, with variations of the order of magnitude of 1-2%. Notably, no differences in GCS were found between brands of imaging equipment. This study established normal values of LV regional and global circumferential strain, and identified sex-, age- and race-related differences, where present.

Cardiac magnetic resonance imaging parameters show association between myocardial abnormalities and severity of chronic kidney disease.

Chronic kidney disease patients have increased risk of cardiovascular abnormalities. This study investigated the relationship between cardiovascular abnormalities and the severity of chronic kidney disease using cardiac magnetic resonance imaging. We enrolled 84 participants with various stages of chronic kidney disease (group I: stages 1-3, n = 23; group II: stages 4-5, n = 20; group III: hemodialysis patients, n = 41) and 32 healthy subjects. The demographics and biochemical parameters of the study subjects were evaluated. All subjects underwent non-contrast cardiac magnetic resonance scans. Myocardial strain, native T1, and T2 values were calculated from the scanning results. Analysis of covariance was used to compare the imaging parameters between group I-III and the controls. The left ventricular ejection fraction (49 vs. 56%, p = 0.021), global radial strain (29 vs. 37, p = 0.019) and global circumferential strain (-17.4 vs. -20.6, p < 0.001) were significantly worse in group III patients compared with the controls. Furthermore, the global longitudinal strain had a significant decline in group II and III patients compared with the controls (-13.7 and -12.9 vs. -16.2, p < 0.05). Compared with the controls, the native T1 values were significantly higher in group II and III patients (1,041 ± 7 and 1,053 ± 6 vs. 1,009 ± 6, p < 0.05), and T2 values were obviously higher in group I-III patients (49.9 ± 0.6 and 53.2 ± 0.7 and 50.1 ± 0.5 vs. 46.6 ± 0.5, p < 0.001). The advanced chronic kidney disease stage showed significant positive correlation with global radial strain (r = 0.436, p < 0.001), global circumferential strain (r = 0.386, p < 0.001), native T1 (r = 0.5, p < 0.001) and T2 (r = 0.467, p < 0.001) values. In comparison with the group II patients, hemodialysis patients showed significantly lower T2 values (53.2 ± 0.7 vs. 50.1 ± 0.5, p = 0.002), but no significant difference in T1 values (1,041 ± 7 vs. 1,053 ± 6). Our study showed that myocardial strain, native T1, and T2 values progressively got worse with advancing chronic kidney disease stage. The increased T1 values and decreased T2 values of hemodialysis patients might be due to increasing myocardial fibrosis but with reduction in oedema following effective fluid management. ChiCTR2100053561 (http://www.chictr.org.cn/edit.aspx?pid=139737&htm=4).

Assessment of Cardiotoxicity after a Single Dose of Combretastatin A4-Phosphate in Dogs Using Two-Dimensional Speckle-Tracking Echocardiography.

Combretastatin A4-phosphate (CA4P) is a vascular disrupting agent that was recently described for the treatment of solid canine tumors. Conventional echocardiography and pulsed wave tissue Doppler imaging did not reveal cardiotoxicity in dogs, however, the gold standard for assessing myocardial damage in humans receiving cardiotoxic chemotherapeutics is two-dimensional speckle-tracking echocardiography. The current study evaluated the cardiotoxic effect of a single dose of CA4P in dogs using peak systolic strain measurements and the variability of these measurements. Echocardiographic examinations of seven healthy beagles and five canine cancer patients that received CA4P were retrospectively reviewed. Peak systolic regional longitudinal strain (LSt), peak systolic regional circumferential strain (CSt), and peak systolic regional radial strain (RSt) were measured before and 24 h after administration of CA4P. Peak systolic strain measurements were compared to serum cardiac troponin I (cTnI). To quantify intra- and inter-observer measurement variability, seven echocardiographic examinations were selected and each strain parameter was measured by three observers on three consecutive days. After CA4P administration, the median LSt and CSt values decreased by 21.8% (p = 0.0005) and 12.3% (p = 0.002), respectively, whereas the median RSt values were not significantly different (p = 0.70). The decrease in LSt was correlated with increased serum cTnI values (Spearman rho = -0.64, p = 0.02). The intra-observer coefficients of variation (CV) were 9%, 4%, and 13% for LSt, CSt, and RSt, respectively, while the corresponding interobserver CVs were 11%, 12%, and 20%. Our results suggest that regional peak systolic strain measurements may be useful for the early detection of cardiotoxicity that is caused by vascular disrupting agents and that LSt may be promising for the follow-up of canine cancer patients.