Difference In Global Longitudinal Strain Research Articles

Application of three-dimensional speckle tracking technique in measuring left ventricular myocardial function in patients with diabetes

BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus (DM). Therefore, early detection of left ventricular systolic function (LVSF) damage in DM is essential. AIM To explore the use of the three-dimensional speckle tracking technique (3D-STI) for measuring LVSF in DM patients via meta-analysis. METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023. The current study involved 9 studies, including 970 subjects. We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI. RESULTS Night articles including 970 subjects were included. No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group (P > 0.05), while differences in global longitudinal strain, global circumferential strain, global radial strain, and global area strain were markedly different between the controls and DM patients (all P < 0.05). CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.

Echocardiographic evaluation of myocardial strain in bipolar disorder across different phases: A comparative study with healthy controls.

This study aims to investigate the relationship between different phases of bipolar disorder (depressive, manic, and euthymic) and myocardial deformation, assessed by echocardiography, compared to healthy controls. It seeks to elucidate whether these phases of bipolar disorder are associated with different myocardial strain patterns, thus contributing to the understanding of cardiovascular implications in bipolar disorder. A cross-sectional design was employed at Dursun Odabaş Medical Centre, Psychiatry Clinic of Van Yüzüncü Yl University. The study enrolled 200 participants, divided into 4 groups: 50 in a depressive phase, 50 in a manic phase, 50 in an euthymic phase of bipolar disorder, and 50 healthy volunteers. Participants underwent detailed electrocardiographic and ECG evaluations, focusing on myocardial strain patterns and cardiac function. Statistical analyses, including ANOVA and chi-square tests, were used to compare the groups. Significant differences in global longitudinal strain (GLS) values were observed between the groups. The manic phase group exhibited the highest GLS (21.51), followed by the euthymic (20.75), depressive (20.25), and healthy control groups (19.0). The E/A ratio of the mitral valve also varied, with the manic group displaying the highest ratio (1.21). Other echocardiographic parameters such as left atria size and Ejection Fraction also differed significantly between the groups. The study concluded that the phases of bipolar disorder are associated with distinct myocardial strain patterns, as evidenced by the variation in GLS values. The findings underscore the importance of cardiac monitoring in bipolar disorder, suggesting potential cardiac risks, particularly during the manic phase. This study advocates integrated care approaches, combining psychiatric and cardiac evaluations for patients with bipolar disorder.

Stress-Mediated Abnormalities in Regional Myocardial Wall Motion in Young Women with a History of Psychological Trauma.

Psychosocial stress has been associated with the development and progression of atherosclerotic cardiovascular disease (CVD). Previously, we reported subtle differences in global longitudinal strain in somatically healthy women with a psychiatric diagnosis of borderline personality disorder (BPD). This study aimed to investigate the impact of BPD on segmental myocardial wall motion using speckle tracking echocardiography (STE) analysis. A total of 100 women aged between 18 and 38 years were included in this study. Fifty patients meeting the diagnostic criteria for BPD were recruited from the Department of Psychiatry (LWL-University Hospital Bochum) and compared with fifty age-matched healthy control subjects without previous cardiac disease. Laboratory tests and STE were performed with segmental wall motion analysis. The BPD group had a higher prevalence of risk factors for CVD, with smoking and obesity being predominant, when compared with the control group. Other cardiovascular parameters such as blood pressure, glucose, and cholesterol levels were also elevated, even though not to pathological values. Moreover, in the STE analysis, the BPD group consistently exhibited decreased deformation in nine myocardial wall regions compared with the control group, along with a shift toward higher values in the distribution of peak pathological segments. Additionally, significantly higher values of free thyroxine concentration and thyroid's secretory capacity were observed in the BPD group, despite falling within the (high-) normal range. BPD is associated with chronic stress, classical risk factors, and myocardial wall motion abnormalities. Further exploration is warranted to investigate the relationship between high-normal thyroid metabolism, these risk factors, and myocardial function in BPD patients. Long-term follow-up studies would be valuable in confirming the potential for predicting adverse events.

Epicardial adipose tissue and its association with atrial fibrillation in middle-aged patients without overt heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Obesity and atrial fibrillation (AF) are emerging health problem, associated with significant morbidity and mortality. There is a significant relation between body mass index (BMI) on one hand and the amount of visceral fat and epicardial adipose tissue (EAT) on the other (1,2). EAT volume is positively related to the incidence, duration, and recurrence of AF (2,3). Aim The aim of the study was to assess echocardiographic variables and their association with BMI and EAT in middle-aged patients with AF. Methods Prospective consecutive patients with AF (n= 936), who had been admitted for sinus rhythm restoration in our hospital for the period January 2016- December 2018, were screened for participation in the study. A total of 70 patients met the inclusion criteria- stable sinus rhythm, age between 40–60 years, without over heart disease. They were separated in two groups: with new onset AF (n=33) and recurrent episode of AF(n=37); 30 healthy subjects were enrolled in the control group. All patients underwent 2DE assessment with speckle tracking analyses. EAT thickness was measured perpendicularly on the free wall of the right ventricle at end-systole when both walls collapse and allow the widest measurement. Results There were significant differences in global longitudinal strain (GLS) of left ventricle (LV) and EAT between AF groups and healthy controls, but not in the other LV parameters. There were significant differences in left atrial (LA) structural and functional indices in AF groups in comparison to healthy controls- picture 1. There were significant correlations between BMI and EAT ( p = 0.001;r=0,710), GLS ( p = 0.001;r=0,557), LA volume index ( p = 0.001;r=0,701), LA reservoir strain ( p = 0.001;r=-0,626), LA stiffness index ( p = 0.001;r=0,557)- picture 2 .There were significant correlations between EAT and GLS ( p = 0.001;r=0,478), LA volume index ( p = 0.001;r=0,539), LA reservoir strain (p = 0.001;r=-0,479),LA stiffness index ( p = 0.001;r=0,487). Conclusion Epicardial adipose tissue, assessed by 2DE, was increased in middle-aged patients with obesity and AF. Obesity is significant risk factor for LA remodelling and AF, but further prospective investigation need to define the causality role of EAT in AF initiation and progression.

Assessment of global, segmental longitudinal deformation of the left ventricle and endothelial function in children with family hypercholesterolemia

Background . Familial hypercholesterolemia (FHC) is accompanied by a significant increase in the level of low-density lipoprotein cholesterol in the blood . The relevance of early diagnosis and treatment is due to the risk of premature development of atherosclerosis . Coronary heart disease due to atherosclerosis of the coronary arteries occurs among FHC patients up to 30 years . Currently , cardiac morphology and myocardial function in children with FHC are poorly understood . Objective . To assess global , segmental longitudinal deformation of the left ventricle and endothelial function in children with familial hypercholesterolemia . Design and methods . The study involved 25 healthy children and 34 children with FHC. Endothelin-1 and NO were determined by enzyme immunoassay . Echocardiographic study was carried . Assessment of global and segmental longitudinal deformation of the left ventricle was carried out in 4-chamber apical , 3-chamber and 2-chamber projections . Results . There were no statistically significant differences in global longitudinal strain (GLD) between groups . Individual analysis showed that 2 patients with FHC had a decrease in GLD. There was a statistically significant decrease in parameters in FHC patients at the level of the basal and apical anterior-septal , basal lower segments . Endothelin-1 and NO were increased in FHC compared to the control group . Conclusion . Speckle-tracking echocardiography allowed identifying patients with a decrease in global and segmental longitudinal deformation of the left ventricle among children with FHC.

Speckle-tracking echocardiography for detecting myocardial dysfunction in sepsis and septic shock patients: A single emergency department study.

Septic cardiomyopathy (SCM) occurs in the early stage of sepsis and septic shock, which has implications for treatment strategies and prognosis. Additionally, myocardial involvement in the early stages of sepsis is difficult to identify. Here, we assess subclinical myocardial function using laboratory tests and speckle-tracking echocardiography (STE). Emergency department patients diagnosed with sepsis or septic shock were included for analysis. Those with other causes of acute or pre-existing cardiac dysfunction were excluded. Transthoracic echocardiography (TTE), including conventional echocardiography and STE, were performed for all patients three hours after initial resuscitation. Samples for laboratory tests were taken around the time of TTE. Left ventricular functions of 60 patients were analyzed, including 21 septic shock patients and 39 sepsis patients. There was no significant difference in global longitudinal strain (GLS), global circumferential strain (GCS), or global radical strain (GRS) between patients with sepsis and septic shock (all with P>0.05). However, GLS and GCS were significantly less negative in patients with abnormal troponin levels or in patients with abnormal left ventricular ejection fraction (LVEF) values (all with P<0.05). There were also moderate correlations between GLS and levels of cTnI (r=0.40, P=0.002) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) (r=0.44, P=0.001) in sepsis and septic shock patients. Myocardial dysfunction, e.g., lower LVEF or less negative GLS in patients with sepsis or septic shock, is more affected by myocardial injury. GLS could be incorporated into mainstream clinical practice as a supplementary LVEF parameter, especially for those with elevated troponin levels.

CMR-derived myocardial strain analysis differentiates ischemic and dilated cardiomyopathy\u2014a propensity score-matched study

Left ventricular (LV) longitudinal, circumferential, and radial motion can be measured using feature tracking of cardiac magnetic resonance (CMR) images. The aim of our study was to detect differences in LV mechanics between patients with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) who were matched using a propensity score-based model. Between April 2017 and October 2019, 1224 patients were included in our CMR registry, among them 141 with ICM and 77 with DCM. Propensity score matching was used to pair patients based on their indexed end-diastolic volume (EDVi), ejection fraction (EF), and septal T1 relaxation time (psmatch2 module L Feature tracking provided six parameters for global longitudinal, circumferential, and radial strain with corresponding strain rates in each group. Strain parameters were compared between matched pairs of ICM and DCM patients using paired t tests. Propensity score matching yielded 72 patients in each group (DCM mean age 58.6 ± 11.6 years, 15 females; ICM mean age 62.6 ± 13.2 years, 11 females, p = 0.084 and 0.44 respectively; LV-EF 32.2 ± 13.5% vs. 33.8 ± 12.1%, p = 0.356; EDVi 127.2 ± 30.7 ml/m2 vs. 121.1 ± 41.8 ml/m2, p = 0.251; native T1 values 1165 ± 58 ms vs. 1167 ± 70 ms, p = 0.862). There was no difference in global longitudinal strain between DCM and ICM patients (− 10.9 ± 5.5% vs. − 11.2 ± 4.7%, p = 0.72), whereas in DCM patients there was a significant reduction in global circumferential strain (− 10.0 ± 4.5% vs. − 12.2 ± 4.7%, p = 0.002) and radial strain (17.1 ± 8.51 vs. 21.2 ± 9.7%, p = 0.039). Our data suggest that ICM and DCM patients have inherently different myocardial mechanics, even if phenotypes are similar. Our data show that GCS is significantly more impaired in DCM patients. This feature may help in more thoroughly characterizing cardiomyopathy patients.

Impact of a cardio-oncology rehabilitation program in patients with breast cancer undergoing cardiotoxic treatment

Abstract Background Cancer treatment–related cardiotoxicity (CTrCD) is commonly associated with anthracyclines and anti-HER2 agents which are widely used for the treatment of breast cancer. In order to mitgate CTrCD, exercise-based cardio-oncology rehabilitation (COR) involving a structured exercise program has been proposed. Objectives To evaluate the impact of a cardiac-rehabilitation program in breast cancer patients submitted to chemotherapy with known cardiotoxicity. Methods A systematic review was performed. Two databases were searched, PubMed and SCOPUS. All randomized or controlled trials and other prospective studies published between 2000 and March 2020 which evaluate the impact of an aerobic exercise program on cardiorespiratory fitness (CRF), health-related quality of life (QOL), vascular/endothelial function as well as cardiac assessment namely through the evaluation of left ventricular function and cardiac biomarkers in patients undergoing anthracycline and/or anti-HER2 treatments were included. Main results Fourteen studies were included enrolling 578 breast cancer patients with a mean age of 48.80 years. Regarding the impact of exercise in CRF, 5 studies (n=176) reported a significant improvement of VO2 max. and 4 studies of VO2max./kg (n=137). The peak power output was also improved in 4 studies (n=95) in the exercise-group. Considering the assessment of QOL, 3 studies (n=180) revealed significant differences favoring the exercise-group. The results regarding the evaluation of the LVEF were not clear: 2 studies (n=48) reported a significant decrease on LVEF when compared to baseline at the end of the intervention in both groups, despite the exercise program. However, 2 studies (n=97) showed a significant increase on LVEF in the exercise-group. Three studies (n=82) did not found significant differences in global longitudinal strain between groups. Limited evidence was found in vascular and endothelial functon. In 2 studies (n=50), endothelial function measured by brachial artery flow-mediated dilatation significantly improved in the exercise-group. Two studies (n=98) reported no significant impact of exercise on atenuating the increase of cTnI and BNP levels in the course of chemotherapy. On the other hand, when considering NT-proBNP, an increase in its levels was attenuated in the exercise-group. Conclusions This study confirms that exercise-based COR seems to be an effective approach to improve several cardiovascular outcomes and quality of life in breast cancer patients. Funding Acknowledgement Type of funding sources: None.

How to distinguish between hypertrophic cardiomyopathy and left ventricular hypertrophy secondary to Fabry disease?

Abstract Introduction Fabry disease (FD) commonly leads to left ventricular hypertrophy (LVH) that could mimic sarcomeric hypertrophic cardiomyopathy (HCM). Purpose To determine the differences in echocardiographic parameters between FD patients with LVH and HCM patients. Methods We conducted a prospective study encompassing FD patients followed in a Reference Center of Lysosomal Storage Disorders. All patients performed a complete echocardiographic evaluation, including left ventricular strain analysis by two-dimensional speckle tracking imaging. Demographic, clinical characteristics and echocardiographic parameters were analysed. FD patients with LVH were compared with HCM patients, using Chi-square test for categorical variables and Student's T-test for continuous variables. The significance level was 0,05. Results A total of 91 FD patients were included, with a median age of 51 years-old and 62,6% of female predominance. 16,5% of patients were under enzymatic replacement therapy with agalsidase alpha and 7,7% were treated with chaperone therapy (migalastat). 33 FD patients (36%) had LVH and were older than HCM patients (63,6 vs 59,3 years-old; p=0,106). FD patients with LVH had lower interventricular septum (IVS) thickness (16,4 vs 19,6 mm, p&amp;lt;0,001), IVS/posterior wall ratio (1,3 vs 1,8, p&amp;lt;0,001), and left atrial volume index (34,45 vs 42,2 ml/m2; p=0,014). Left ventricle mass index was similar between the two groups (157,7 vs 155,5 g/m2; p=0,819), with lower left ventricular ejection fraction in FD patients (64,5% vs 70,5%; p&amp;lt;0,001). There were no significant differences in global longitudinal strain (−15,6% vs 15,9%; p=0,687), global circumferential strain (−19,9% vs −21,1%; p=0,218) and global radial strain (35,3% vs 33,7%; p=0,623). Interestingly, FD patients had lower base-to-apex circumferential strain gradient (5,7% vs 9,1%; p=0,002) and lower twist (17,5° vs 26,1°; p=0,001) than HCM patients. No significant differences were reported regarding mechanical dispersion (72,4 vs 71,2 ms; p=0,841). Conclusion The pattern of LVH is different between FD and HCM patients. In our study, we revealed that base-to-apex circumferential strain gradient and twist are echocardiographic parameters that could help distinguish both entities. Funding Acknowledgement Type of funding sources: None.

Early cardiac involvement in patients with acute COVID-19 infection identified by multiparametric cardiovascular magnetic resonance imaging.

AimsIn order to determine acute cardiac involvement in patients with COVID-19, we quantitatively evaluated tissue characteristics and mechanics by non-invasive cardiac magnetic resonance (CMR) in a cohort of patients within the first 10 days of the onset of COVID symptoms.Methods and resultsTwenty-five patients with reverse transcription polymerase chain reaction confirmed COVID-19 and at least one marker of cardiac involvement [cardiac symptoms, abnormal electrocardiograph (ECG), or abnormal cardiac biomarkers] and 25 healthy age- and gender-matched control subjects were recruited to the study. Patients were divided into those with elevated (n = 8) or normal TnI (n = 17). There were significant differences in global longitudinal strain among patients who were positive and negative for hs-TnI, and controls [−12.3 (−13.3, −11.5)%, −13.1 (−14.2, −9.8)%, and −15.7 (−18.3, −12.7)%, P = 0.004]. Native myocardial T1 relaxation times in patients with positive and negative hs-TnI manifestation (1169.8 ± 12.9 and 1113.2 ± 31.2 ms) were significantly higher than the normal (1065 ± 57 ms) subjects, respectively (P < 0.001). The extracellular volume (ECV) of patients who were positive and negative for hs-TnI was higher than that of the normal controls [32 (31, 33)%, 29 (27, 30)%, and 26 (24, 27.5)%, P < 0.001]. In our study, quantitative T2 mapping in patients who were positive and negative for hs-TnI [51 (47.9, 52.8) and 48 (47, 49.4) ms] was significantly higher than the normal [42 (41, 45.2) ms] subjects (P < 0.001).ConclusionIn patients with early-stage COVID-19, myocardial oedema, and functional abnormalities are a frequent finding, while irreversible regional injury such as necrosis may be infrequent.

P5260Differences in myocardial mechanics between dilated cardiomyopathy and ischemic cardiomyopathy by CMR derived feature tracking strain - A propensity score-matched study

Abstract Background Adult heart failure in industrialized nations is primarily due to dilated (DCM) and ischemic cardiomyopathy (ICM). Both diseases are characterized by different pathological pathways. While ICM is predominantly caused by local, subendocardial myocyte necrosis, DCM is characterized by a general myocyte apoptosis involving all myocardial layers. Using feature tracking, longitudinal, circumferential, and radial motion of the left ventricle (LV) can be measured, which allows the function of subendocardial, mostly longitudinal orientated, and subepicardial, mostly circumferential orientated fibers to be assessed independently. Purpose It was the aim of our study to detect differences of LV motion between DCM and ICM patients in a propensity score-matched cohort. Methods Between April 2017 and December 2018 we included 845 patients with a clinical indication for CMR in our tertiary care center registry. Out of this cohort we identified 273 patients with ICM and 126 with DCM. Propensity score matching was used to pair patients in each group based on their indexed enddiastolic volume (EDVi), ejection fraction (EF), septal T1. Feature tracking technique was used for strain analyses quantified on steady state free precession cine CMR images yielding six strain parameters. Results Propensity score matching yielded 59 patients in each group (ICM mean age 59.4±13.0 years, 11 females; DCM mean age 66.5±10.6 years, 15 females; LV-EF 32.6±11.4% vs. 33.0±14.2%, p=0.8178; EDVi 124.2±36 ml/m2 vs. 132.9±42 ml/m2, p=0.0909; native T1 values 1161±66 ms vs. 1164±59 ms, p=0.7049). There was no difference in global longitudinal strain between ICM and DCM patients (−10.9±4.4% vs. −10.6±5.8%, p=0.686), whereas global circumferential strain and radial strain were reduced in DCM patients (−12.0±4.3% vs. −10.31±4.8%, p=0.0190 and 21.1±8.9% vs. 18.0±15.5%, p=0.0386). Conclusion Our data confirm the inherently different mechanics of ICM and DCM patients. While myocardial fibres are globally affected in DCM, myocardial damage is predominantly confined to subendocardial layers in ICM despite equally reduced EF.

P1509The novel application of speckle tracking during dobutamine stress echo for assessment of coronary artery diseases

Abstract Background Major cause of death across the world is coronary artery disease. The choice of treatment strategy should be primarily based on the hemodynamic significance of coronary artery stenosis. Two-dimensional speckle tracking provides valuable information for regional wall motion abnormalities. The purpose of this study was to determine the diagnostic value of left ventricular longitudinal strain and torsion to diagnose coronary artery disease during dobutamine stress echocardiography. Purpose The purpose of this study was to evaluate the diagnostic value of speckle tracking imaging-derived myocardial deformation parameters at rest and during dobutamine stress to determine the hemodynamic significance of coronary artery stenosis in patients with moderate and high probability of CAD. Methods We studied 204 patients (mean age 54.2±9.8 years, 128 male and 76 female) with known or suspected coronary artery disease, excluding those with prior history of transmural infarction. All of them underwent dobutamine stress echo and coronary angiography within one month. Wall-motion score index, left ventricular global longitudinal strain and torsion were measured at rest and peak stress. Optimal cut-offs were derived from receiver operating characteristic curves for strain and torsion values. Additionally, the respective differences between rest and stress were also calculated. Results During dobutamine stress echocardiography we revealed mean left ventricular ejection fraction was 53±6.2%. Coronary angiography revealed significant stenotic lesions in 124 patients (60.7%). Values regarding sensitivity, and specificity for wall motion score index difference were 76% and 84% respectively (area under curve 0.84). Global longitudinal strain difference (median 0.6%) illustrated 83% sensitivity and 74% specificity for disease detection (area under curve 0.82, cut-off value ≤0.5%). The respective values for torsion difference (median 5.1°) were 84% and 79% (area under curve 0.80, cut-off value ≤5.9°). Combination of wall motion score index difference and torsion difference for disease detection showed 89% sensitivity and 77% specificity (area under curve 0.84). Conclusions Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD. The implementation of speckle tracking during dobutamine stress echo could serve as an adjunct method for coronary artery disease assessment, providing quantitative diagnostic information.

Identification of Carditis in Acute Rheumatic Fever with Myocardial T1 Mapping

Background: The pathogenesis of acute rheumatic fever (ARF) is incompletely understood. Valvulitis is used as part of the diagnostic criteria, while pancarditis has only been demonstrated at autopsy. Purpose: To identify carditis in patients with ARF using T1 mapping on cardiac magnetic resonance (CMR) imaging and echocardiographic global longitudinal strain (GLS). We hypothesised that prolonged native T1 time, consistent with myocardial inflammation, would be present in ARF patients compared to controls. Methods: We prospectively recruited 36 patients; 15 fulfilling the Australian modified Jones Criteria for the diagnosis of ARF, 12 controls with an inflammatory condition without major criteria for ARF and 9 healthy controls. All patients underwent CMR with assessment of non-contrast myocardial T1 mapping as well as echocardiography for GLS. The primary outcome was differences in T1 time between the groups. Results: Patients with ARF had evidence of carditis demonstrated by markedly elevated T1 times [976 (± 167 ms)] compared to those with non-cardiac inflammatory conditions [841 (±50 ms)] and healthy controls [811 (±54 ms)], P = 0.002 (Fig. 1). There was no difference in global longitudinal strain between the groups (−19.4% vs −19.5% vs −20.4%, P = 0.66). Conclusions: Patients with ARF have markedly elevated myocardial T1 times on CMR, consistent with active inflammation from carditis. In contrast, GLS was normal in ARF patients. Incorporating CMR T1 mapping into the diagnostic algorithm for ARF may improve diagnostic certainty and lead to more effective delivery of secondary penicillin prophylaxis.

Identifying Carditis in Acute Rheumatic Fever With Myocardial T1 Mapping

Background: The pathogenesis of acute rheumatic fever (ARF) is incompletely understood. Valvulitis is used as part of the diagnostic criteria, while pancarditis has only been demonstrated at autopsy. Purpose: To identify carditis in patients with ARF using T1 mapping on cardiac magnetic resonance (CMR) imaging and echocardiographic global longitudinal strain (GLS). We hypothesised that prolonged native T1 time, consistent with myocardial inflammation, would be present in ARF patients compared to controls. Methods: We prospectively recruited 36 patients; 15 fulfilling the Australian modified Jones Criteria for the diagnosis of ARF, 12 controls with an inflammatory condition without major criteria for ARF and 9 healthy controls. All patients underwent CMR with assessment of non-contrast myocardial T1 mapping as well as echocardiography for GLS. The primary outcome was differences in T1 time between the groups. Results: Patients with ARF had evidence of carditis demonstrated by markedly elevated T1 times [976(±167 ms)] compared to those with non-cardiac inflammatory conditions [841(±50 ms)] and healthy controls [811(±54 ms)], P = 0.002 (Figure 1). There was no difference in global longitudinal strain between the groups (−19.4% vs −19.5% vs −20.4%, P = 0.66). Conclusions: Patients with ARF have markedly elevated myocardial T1 times on CMR, consistent with active inflammation from carditis. In contrast, GLS was normal in ARF patients. Incorporating CMR T1 mapping into the diagnostic algorithm for ARF may improve diagnostic certainty and lead to more effective delivery of secondary penicillin prophylaxis.

The impact of arterial hypertension on left ventricular strain in patients with aortic stenosis and preserved ejection fraction.

The influence of arterial hypertension on aortic stenosis severity is still controversial. The aim of this study was to evaluate the influence of hypertension on LV strain in patients with moderate and severe aortic stenosis. This cross-sectional study included 115 patients with moderate and severe aortic stenosis and preserved LV ejection fraction (>50%) and 89 age-matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. Aortic stenosis patients were divided into normotensive and hypertensive groups. There was no significant difference in LV ejection fraction between hypertensive and normotensive aortic stenosis patients. LV mass index gradually increased with the grade of aortic stenosis. LV global longitudinal strain, as well as endocardial and epicardial longitudinal strains, was significantly lower in hypertensive patients with severe aortic stenosis than in their normotensive counterparts. There was no significant difference in LV global circumferential strain between normotensive and hypertensive patients with severe aortic stenosis. Among patients with moderate aortic stenosis, there was no difference in global longitudinal strain between normotensives and hypertensive patients, whereas circumferential was significantly lower in hypertensive patients. LV radial strain was reduced in patients with severe aortic stenosis than in control subjects. SBP and mean aortic valve gradient were associated with LV global longitudinal and circumferential strains in aortic stenosis patients independently of LV mass index, LVEF, age and BMI. Hypertension had additional significant negative influence on LV mechanics in patients with significant aortic stenosis. Blood pressure was associated with LV global longitudinal and circumferential strains in aortic stenosis patients independently of main clinical and demographic characteristics.

The correlation between cardiac magnetic resonance T2* and left ventricular global longitudinal strain in people with β-thalassemia.

Heart failure is the biggest cause of mortality and morbidity in people with thalassemia, and iron deposition in cardiac tissue impairs cardiovascular function. Therefore, early detection of cardiac involvement is important to improve the prognosis in these individuals. Two- and three-dimensional echocardiography was performed to evaluate left ventricular ejection fraction (LVEF), left ventricular volumes and diameters, and global longitudinal strain (GLS) in 130 individuals with β-thalassemia using the speckle tracking method. Magnetic resonance imaging (MRI) was carried out on both the heart and liver. The participants were divided into 2 groups based on cardiac T2* values (normal and abnormal cardiac iron load), and the correlation between cardiac T2* MRI and GLS was evaluated. The statistical analysis showed a significant correlation between cardiac T2* MRI and left ventricular global longitudinal strain. There was a significant difference in global longitudinal strain (P<.0001), liver MRI T2*( P<.0001), and left ventricular ejection fraction (P<.001) between the 2 groups. The optimal cutoff value for GLS was -18.5% with sensitivity and specificity 73.0% and 63.0%, respectively (postitive predictive value=50%, negative predictive value=82.3%, AUC=0.742, std. error=0.046) which predicts T2* value of <20ms, according to cardiac MRI. The participants with cardiac iron overload had a lower GLS than those without one. This suggests that GLS may be a useful method to predict myocardial iron overload particularly in β-thalassemia patients with subclinical cardiac involvement.

Two-dimensional speckle tracking for the assessment of coronary artery disease during dobutamine stress echo: clinical tool or merely research method.

BackgroundTwo-dimensional speckle tracking provides valuable information for regional wall motion abnormalities. The purpose of this study was to determine the diagnostic value of left ventricular longitudinal strain and torsion to diagnose coronary artery disease during dobutamine stress echocardiography.MethodsWe studied 100 patients (mean age 60.8 ± 10.7 years, 72 male) with known or suspected coronary artery disease, excluding those with prior history of transmural infraction. All of them underwent dobutamine stress echo and coronary angiography within one month. Wall-motion score index, left ventricular global longitudinal strain and torsion were measured at rest and peak stress. Additionally, the respective differences between rest and stress were also calculated. Optimal cut-offs were derived from receiver operating characteristic curves for strain and torsion values.ResultsMean left ventricular ejection fraction was 55 ± 5.4 %. Coronary angiography revealed significant lesions in 67 patients. Values regarding sensitivity, and specificity for wall motion score index difference were 78 % and 88 % respectively (area under curve 0.84). Global longitudinal strain difference (median 0.5 %) illustrated 81 % sensitivity and 72 % specificity for disease detection (area under curve 0.80, cut-off value ≤0 %). The respective values for torsion difference (median 4.7°) were 81 % and 82 % (area under curve 0.76, cut-off value ≤6.5°). Combination of wall motion score index difference and torsion difference for disease detection showed 91 % sensitivity and 79 % specificity (area under curve 0.85).ConclusionsThe implementation of speckle tracking during dobutamine stress echo could serve as an adjunct method for coronary artery disease assessment, providing quantitative diagnostic information.

109 Left ventricular systolic function and Response to Cardiac Resynchronization Therapy is influenced by Right ventricular function as assessed by Echocardiography

Right ventricular (RV) function has been proven to be a major determinant of clinical outcome in Chronic Heart Failure (CHF). The right and left (L) ventricles inter dependence has been weakly evaluated but might impact on response to treatments and prognosis. We sought to assess the impact of RV-function on LV-function by studying longitudinal and radial strains in CHF-patients selected for cardiac resynchronization therapy (CRT). Thirty-eight consecutive CHF-patients (New York Heart Association class III/IV, left ventricular ejection fraction [LVEF] less than 35%, QRS greater than 120 ms) were studied before and after 6-month of CRT. RV function was assessed by tricuspid annulus plane systolic velocity (Vs) with a cut-off of 11.5 cm/s. Global LV longitudinal strain (GLS) was measured (from the apical 4-chamber, apical 3-chamber and apical 2-chamber views) before and after CRT. Mean radial strain was measured from the parasternal mid-ventricular view. Reverse remodeling was defined by echocardiography at 6-month by a decrease in LV end-systolic volume ≥ 15%. Eighteen patients had RV-dysfunction (mean Vs=7.6 ±1.2cm/s) and 20 had normal RV-function (13.6±2.7cm/s). LVEF and volumes were non different between groups. Patients with RV-dysfunction had significantly worst global longitudinal strain before CRT (A-4Ch=-5.3±1.5% vs. -7.4±2.2%, p=0.01; A-2Ch=-5.7±1.2% vs. -9±2%, p<0.01; A-3Ch=-5±0.9% vs. -8.4±2.2%, p<0.01). After CRT, differences in global longitudinal strain were still significant. Considering mean radial strain, there were no differences between groups. The likelihood of response to CRT was significantly worse in patients having a RV dysfunction (75% vs. 44%, p<0.05). RV dysfunction diagnosed in patients planed for CRT is associated with a significantly worse LV global longitudinal function and a significantly weak likelihood of response to CRT at 6-month.