Early Signs Of Cardiac Dysfunction Research Articles

Abstract We093: Comparative Analysis of Theoretical Models and Fusion Frameworks for Early Cardiac Dysfunction Detection Using Multimodal Wearable Data

Background: Wearable devices have emerged as promising tools for continuous monitoring of physiological signals, offering opportunities for early detection of cardiac dysfunction. This study aims to compare various theoretical models and fusion frameworks to assess their effectiveness in early detection of cardiac dysfunction. Hypothesis: The study investigates the performance of signal processing-based, machine learning-based, and hybrid models for early cardiac dysfunction detection using multimodal wearable data. Additionally, it explores the efficacy of feature-level fusion, decision-level fusion, and sensor-level fusion frameworks in integrating information from diverse sensors for enhanced detection accuracy.The primary goal of the study is to identify the most effective theoretical models and fusion frameworks for early detection of cardiac dysfunction using multimodal wearable data. By comparing different approaches, the study aims to provide insights into the strengths and limitations of each method and contribute to the development of reliable wearable-based systems for proactive healthcare interventions. Methods/Approach: Three theoretical models—signal processing-based, machine learning-based, and hybrid—were implemented and evaluated for their performance in detecting early signs of cardiac dysfunction. Additionally, three fusion frameworks—feature-level fusion, decision-level fusion, and sensor-level fusion—were investigated to assess their effectiveness in integrating multimodal wearable data. Results/Data: The signal processing-based model achieved a sensitivity of 85%, specificity of 82%, and accuracy of 83% in detecting early signs of cardiac dysfunction. The machine learning-based model outperformed with a sensitivity of 92%, specificity of 88%, and accuracy of 90% . The hybrid model yielded intermediate results with a sensitivity of 89%, specificity of 85%, and accuracy of 87% . Among the fusion frameworks, sensor-level fusion demonstrated superior performance with a sensitivity of 94%, specificity of 90%, and accuracy of 92%. Conclusion: Machine learning-based approaches showed higher efficacy in early cardiac dysfunction detection compared to signal processing-based methods. Sensor-level fusion exhibited the best performance among data fusion frameworks, emphasising the importance of integrating information from diverse wearable sensors for improved accuracy.

Development of cardiac alterations in a rat model of polycystic kidney disease

Polycystic kidney disease is associated with an increased cardiovascular risk in humans. Hypertrophy and impaired relaxation of the heart can be early signs of cardiac dysfunction even with preserved ejection fraction (EF). The aim of the study was to evaluate cardiac alterations in rats with polycystic kidney (PCK). Particularly, the chronological sequence of renal and cardiac damages was assessed. PCK and control rats were studied at 3, 6, and 9 months of age. Renal function was determined with the level of plasma creatinine and urea. Arterial pressure, cardiac hypertrophy (weight), cardiac fibrosis (Sirius red staining), cardiac functional parameters E/A and E/E’ were performed by cardiac echography. Cardiac expression of cardiokines were analyzed by RT-qPCR to investigate the secretory heart function and the signalization implicated in the cardiac alteration. At 9 mo., PCK rats exhibited elevated plasma creatinine and urea, increased arterial pressure, and higher heart weight index. Cardiac fibrosis was higher in PCK rats, increased with time, and was doubled compared to controls at the age of 9 months. Both E/A and E/E’ were reduced in 9 mo. PCK rats while ejection fraction was preserved. Expression of Apelin was reduced and GDF15 was increased at this time. At 6 months of age, kidney function and ejection fraction were maintained. Yet, E/A and E/E’ were already altered despite no significant elevation of cardiac mass and fibrosis. In addition, cardiokines profile was also modified at 6 mo. At the age of 3 months, none of the parameters studied was different in PCK compared to control rats. Diastolic function was modified before the clear reduction of renal function and cardiac ejection fraction. On the other hand, when renal function began to degrade there was an acceleration of alterations of cardiac function and cardiokines profile coupled with development of moderate arterial hypertension.

Longitudinal changes in echocardiographic measures of ventricular function after Fontan operation.

While numerous indices have been developed in an attempt to quantify ventricular function in patients with single ventricle heart disease after Fontan, there are little data on how these parameters change over time. A retrospective observational study was performed of individuals who underwent Fontan operation at Children's Hospital of Philadelphia (CHOP) in 2006 and 2007. Measurements of fractional area change (FAC), tricuspid annular planar systolic excursion (TAPSE), myocardial performance index (MPI), systolic to diastolic (s/d) ratio, and myocardial strain and strain rate were made offline. A composite outcome of protein-losing enteropathy (PLE), plastic bronchitis, transplant, or death was created, and change in function was compared between those who did and those who did not meet the outcome. There were 312 echocardiograms from 40 unique patients (75% male, 55% dominant right ventricle). The aggregate mean values for most assessed parameters were worse than what would be expected for a healthy age-matched population. The global longitudinal strain rate increased (worsened) by 0.014 (1/s) per year (P=.02), and the global circumferential strain rate increased (worsened) by 0.011 (1/s) per year (P=.01). There was no difference in the rate of change of ventricular function in the 6 patients who met the composite endpoint vs those who did not. This study demonstrates that global longitudinal strain rate and global circumferential strain rate decrease over 10years following Fontan operation. These measures of ventricular performance may be early signs of cardiac dysfunction that predate more obvious echocardiographic signs of deterioration.

Cardiac Dysfunction Identified by Strain Echocardiography Is Associated With Illness Severity in Pediatric Sepsis.

Sepsis-induced myocardial dysfunction has been associated with illness severity and mortality in pediatrics. Although early sepsis-induced myocardial dysfunction diagnosis could aid in hemodynamic management, current echocardiographic metrics for assessing biventricular function are limited in detecting early impairment. Strain echocardiography is a validated quantitative measure that can detect subtle perturbations in left ventricular and right ventricular function. This investigation evaluates the utility of strain echocardiography in pediatric sepsis and compares with to conventional methods. Retrospective, observational study comparing left ventricular and right ventricular strain. Strain was compared with ejection fraction and fractional shortening and established sepsis severity of illness markers. Tertiary care medical-surgical PICU from July 2013 to January 2018. Seventy-nine septic children and 28 healthy controls. None. Compared with healthy controls, patients with severe sepsis demonstrated abnormal left ventricular strain (left ventricular longitudinal strain: -13.0% ± 0.72; p = 0.04 and left ventricular circumferential strain: -16.5% ± 0.99; p = 0.046) and right ventricular (right ventricular longitudinal strain = -14.3% ± 6.3; p < 0.01) despite normal fractional shortening (36.0% ± 1.6 vs 38.1% ± 1.1; p = 0.5129) and ejection fraction (60.7% ± 2.2 vs 65.3% ± 1.5; p = 0.33). There was significant association between depressed left ventricular longitudinal strain and increased Vasotrope-Inotrope Score (r = 0.52; p = 0.034). Worsening left ventricular circumferential strain was correlated with higher lactate (r = 0.31; p = 0.03) and higher Pediatric Risk of Mortality-III score (r = 0.39; p < 0.01). Depressed right ventricular longitudinal strain was associated with elevated pediatric multiple organ dysfunction score (r = 0.44; p < 0.01) CONCLUSIONS:: Compared with healthy children, pediatric septic patients demonstrated abnormal left ventricular and right ventricular strain concerning for early signs of cardiac dysfunction. This was despite having normal ejection fraction and fractional shortening. Abnormal strain was associated with abnormal severity of illness markers. Strain echocardiography may have utility as an early indicator of sepsis-induced myocardial dysfunction in pediatric sepsis.

P936 Early signs of cardiac dysfunction in obesity patients, results of the CARDIOBESE study

Abstract Introduction Obesity is becoming a global epidemic. Current knowledge on early signs of cardiac dysfunction in obesity patients is insufficient. The onset of heart failure in obesity patients cannot be fully explained by the presence of traditional cardiovascular risk factors. Purpose To detect early signs of cardiac dysfunction in obesity patients without known cardiovascular disease. Methods The CARDIOBESE-study is a cross-sectional multicentre study of 100 obesity patients scheduled for bariatric surgery (body mass index (BMI) ≥35 kg/m2) without known cardiovascular disease, and 50 age-matched and gender-matched non-obese controls (BMI ≤30 kg/m2). Speckle tracking echocardiography, biomarkers and Holter monitoring were used to identify parameters that are able to show cardiac dysfunction at a very early stage in obesity patients. Results Obesity patients had impaired left ventricular ejection fraction, global longitudinal strain (GLS) and diastolic function parameters (e.g. septal e" velocity, lateral e" velocity, E/e’ and E/A-ratio) as compared to the non-obese controls (Table). C-reactive protein (CRP) and heart rate were increased, whereas heart rate variability (Standard deviation of NN intervals, SDNN) was decreased. Obesity patients were subdivided in patients with impaired (&amp;lt; -17%, n = 56) or normal GLS (n = 36). Comparison between these patients revealed no differences regarding BMI, prevalence of traditional cardiovascular risk factors or CRP value. Nevertheless, patients with abnormal GLS had a higher waist circumference and lower SDNN. Conclusion There is a high prevalence of subclinical cardiac dysfunction as measured by GLS in obesity patients (56%), which appears to be related to abdominal fat and decreased heart rate variability and not to BMI, traditional cardiovascular risk factors or CRP. Non-obese controls (n = 50) Obesity patients (n = 100) p-value Obesity patients with normal GLS (n = 36) Obesity patients with impaired GLS (n = 56) p-value Age (years) 49.2 ± 9.5 47.9 ± 7.6 0.36 47.6 ± 7.1 48.3 ± 7.6 0.68 BMI (kg/m2) 24.9 ± 3.2 42.9 ± 4.1 &amp;lt;0.001 42.7 ± 4.2 42.7 ± 4.1 0.98 Waist circumference (cm) 81.1 ± 10.4 133.1 ± 12.3 &amp;lt;0.001 128.2 ± 11.5 135.2 ± 10.5 0.006 E/A- ratio 1.19 ± 0.26 1.01 ± 0.3 &amp;lt;0.001 1.08 ± 0.2 0.96 ± 0.27 0.048 Septel e" velocity 10.3 ± 9.8 8.1 ± 1.8 0.03 8.2 ± 1.9 7.8 ± 1.7 0.24 E/e" 8.5 ± 2.1 8.9 ± 2.5 0.32 9.5 ± 2.4 8.7 ± 2.5 0.14 CRP (mg/L) 1.9 ± 2.9 8.8 ± 8.8 &amp;lt;0.001 8.5 ± 7.3 9.3 ± 10.1 0.67 SDNN 160.2 ± 35.4 109.4 ± 46.0 &amp;lt;0.001 130.4 ± 48.3 98.9 ± 41.2 0.001 Table: Selection of parameters. Values are means ± SD. SDNN= Standard deviation of NN intervals (heart rate variability)

P1319 Speckle tracking echocardiography in patients with acute coronary syndrome: the added value

Abstract Background Speckle tracking echocardiography with assessment of left ventricular global longitudinal strain (GLS) allows to identify early signs of cardiac dysfunction. The superiority of GLS in the prediction of all-cause mortality in the general population compared with LVEF is well known; in addiction GLS improves risk stratification and recognize early left ventricular dysfunction in several clinical setting. Purpose the aim of this study was to assess the diagnostic and prognostic role of global and segmental strain in the early identification of cardiac dysfunction in patients with myocardial infarction without persistent ST segment elevation (NSTEMI) and without obvious wall motion abnormalities and to assess the ability to predict the presence/extension of coronary artery disease in this population. Methods an observational study was carried out enrolling 56 patients (median age 66 ± 11,7 years) admitted for NSTEMI. Electrocardiogram, echocardiogram with global and segmental strain measurement (GE’s Automated Function Imaging) and coronary angiography were performed in all patients. In addition we measured territorial longitudinal strain (TLS) defined as the mean of peak systolic strain of the segments pertinent to the perfusion territories of each epicardial coronary arteries in a 17-segment LV model. Results mean LVEF was 53%. We found a significant relationship between GLS values and coronary artery disease extension: GLS -19,1 % ±5,7% in patients without significant coronary artery stenosis, -18,74% ±4,85% in patients with one coronary artery disease, -15,6% ±4,3% in patients with two coronary artery disease, -14,2% ±5,4% in patients with 3 coronary artery disease (p = 0,03). We also found a correlation between territorial strain value and corresponding coronary artery stenosis. TLS was significantly reduced in patients with significant coronary disease of the perfused territory for each artery (LAD TLS 15,1% ± 6,74 % vs -20,73± 4,47 p = 0,002; CX TLS -11,42 % ± 6,59 %,vs -17,06 ± 7,1, p = 0,0 05 , RCA -14,02 % ± 6,00 % vs-17,6 ± 5,21 p = 0,02). At ROC analysis we identified a TLS value of -16,9 % to identify patients with significant stenosis of LAD (sensibility 58,3% and specificity 89,4%, AUC = 0,74, P &amp;lt; 0,001), TLS -18,2% for circumflex artery (sensibility 86,2% and specificity 78,9%, AUC = 0,78, P &amp;lt; 0,001) TLS -18% for right coronary (sensibility 73,9% and specificity 56,2%, AUC = 0,67, P = 0,027) Conclusions global and segmental strain measurement in patients with NSTEMI help to identify the presence and extension of significant coronary artery disease.

Cross-sectional and prospective follow-up study to detect early signs of cardiac dysfunction in obesity: protocol of the CARDIOBESE study

IntroductionIn view of the increasing occurrence of both obesity and heart failure, a growing overlap of these two clinical entities in the near future is expected. Significant advances in our...

Novel approaches to the prediction, diagnosis and treatment of cardiac late effects in survivors of childhood cancer: a multi-centre observational study

BackgroundAnthracycline-induced cardiac toxicity is a cause of significant morbidity and early mortality in survivors of childhood cancer. Current strategies for predicting which children are at greatest risk for toxicity are imperfect and diagnosis of cardiac injury is usually made relatively late in the natural history of the disease. This study aims to identify genomic, biomarker and imaging parameters that can be used as predictors of risk or aid in the early diagnosis of cardiotoxicity.MethodsThis is a prospective longitudinal cohort study that recruited two cohorts of pediatric cancer patients at six participating centres: (1) an Acute Cohort of children newly diagnosed with cancer prior to starting anthracycline therapy (n = 307); and (2) a Survivor Cohort of long-term survivors of childhood cancer with past exposure to anthracycline (n = 818). The study team consists of three collaborative cores. The Genomics Core is identifying genomic variations in anthracycline metabolism and in myocardial response to injury that predispose children to treatment-related cardiac toxicity. The Biomarker Core is identifying existing and novel biomarkers that allow for early diagnosis and prognosis of anthracycline-induced cardiac toxicity. The Imaging Core is identifying echocardiographic and cardiac magnetic resonance (CMR) imaging parameters that correspond to early signs of cardiac dysfunction and remodeling and precede global dysfunction and clinical symptoms. The data generated by the cores will be combined to create an integrated risk-prediction model aimed at more accurate identification of children who are most susceptible to anthracycline toxicity.DiscussionWe aim to identify genomic risk factors that predict risk for anthracycline cardiotoxicity pre-exposure and imaging and biomarkers that facilitate early diagnosis of cardiac injury. This will facilitate a personalized approach to identifying at-risk children with cancer who may benefit from cardio- protective strategies during therapy, and closer surveillance and earlier initiation of medications to preserve heart function after cancer therapy.Trial registrationNCT01805778. Registered 28 February 2013; retrospectively registered.

Cardiac dysfunction in children and young adults with heart transplantation: A comprehensive echocardiography study

Transplanted heart dysfunction is a serious life-threatening condition in pediatric transplant recipients. Several studies have focused on echocardiographic detection of early signs of cardiac dysfunction in this population. We evaluated advanced echocardiographic indices of cardiac function in a large sample of children and young adults with heart transplants with apparently normal cardiac function. The study included 60 patients with normal ejection fraction with transplantation performed at pediatric age between 1986 and 2014 and 60 healthy control subjects. All patients and control subjects underwent a complete transthoracic echocardiographic examination including tissue Doppler analysis, 2-dimensional speckle tracking, and 3-dimensional echocardiography. Two-dimensional speckle tracking analysis was used to obtain measures of left ventricular (LV) radial, circumferential, and longitudinal strain and to derive LV twist and torsion from basal and apical rotation. Three-dimensional echocardiography was used to measure LV volumes and ejection fraction and to evaluate LV systolic synchrony. No differences were observed between groups in LV volumes, left atrial diameters, LV ejection fraction, or right ventricular fractional area change. However, patients showed lower values of longitudinal systolic excursion of valvular planes at both the mitral and the tricuspid valve level as well as higher mitral E/E' ratio. Cardiac radial strain was similar between groups; a significant net reduction in both global left and right ventricular longitudinal strain and LV global circumferential strain could be observed between the 2 groups (all p < 0.05). In addition, reduced LV twist and torsion was found in patients compared with healthy control subjects (p < 0.01) mainly owing to a significant reduction in basal rotation (-2.4° vs -3.8°; p < 0.05). none of the control subjects demonstrated LV dyssynchrony, whereas systolic dyssynchrony was observed in 20% of heart transplant recipients. Even in the absence of signs of graft failure and in the presence of a normal ejection fraction, transplanted hearts show a significant reduction in biventricular function. Additional prognostic studies are needed to establish whether these abnormalities predict development of overt heart failure.

The Use of Speckle Tracking Echocardiography for Early Detection of Myocardial Dysfunction in Patients with Duchenne Muscular Dystrophy.

Cardiac complications are the leading cause of death in patients with Duchenne muscular dystrophy (DMD). Two-dimensional echocardiography is the current standard for monitoring of LV systolic function in these patients, but it might not detect early systolic dysfunction. The current study examined the use of speckle tracking echocardiography (STE) to detect early signs of cardiac dysfunction in DMD patients. A retrospective review of charts and offline strain analysis of transthoracic echocardiographic studies of DMD patients at our institution from April 2014 to January 2015 were performed and compared to age-matched healthy male subjects. Nineteen DMD patients (age range 12.6±3.1years) with normal ejection fraction and shortening fraction were compared with sixteen controls. The global circumferential strain was lower in DMD patients compared with controls (-14.7±4.7 vs. -23.1±2.9%, respectively, p value: 0.001). Circumferential strain measured at basal, mid-ventricular and apical parasternal short-axis views was lower in DMD patients compared with controls. Segmental circumferential strain was lower in DMD patients in most segments compared with controls. The global longitudinal strain was lower in DMD patients compared with controls (-13.6±5 vs. -18.8±3%, respectively, p value: 0.001). Segmental longitudinal strain measured in various segments was lower in DMD patients compared with controls. DMD patients can have occult cardiovascular dysfunction as shown by reduction in circumferential and longitudinal strain measurements with STE despite normal standard echocardiographic parameters. The clinical significance of early detection of cardiac dysfunction in these patients warrants further studies.

Abstract P4-01-21: Head to head comparison of standard echo doppler versus 3D speckle tracking echocardiography for early subclinical cardiotoxicity detection in breast cancer patients treated with anthracycline adjuvant chemotherapy

Abstract Background. Anthracycline (ANT)-containing regimens represent the prevalent choice for adjuvant therapy in early breast cancer (EBC) patients. However, cardio toxicity is a major limitation, strongly affecting the quality of life and the overall survival of cancer patients, regardless of the oncologic prognosis. Aims: To assess the diagnostic power of real-time 3D Speckle Tracking Echocardiography (STE) in comparison with standard echo Doppler (SED) in detection of early subclinical ANT related cardio toxicity in breast cancer patients. Methods: Fifty-five consecutive patients (F/M = 54/1, mean age = 48 years) with EBC were prospectively enrolled in the study. All patients received three cycles of epirubicin (EPI) based chemo regimen followed by taxanes. Overall, average EPI cumulative dose per patient was 505 ± 68 mg/m2 (range = 360-720 mg/m2). Complete SED exam including determination of 2D ejection fraction (EF) and pulsed Tissue Doppler of the mitral annulus were measured at baseline and at the end of the three cycles of EPI. Three-D determination of left ventricular volumes and EF as well as 3D STE-derived global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS) were assessed, whenever feasible, at the same time points. Results: All the patients completed the three cycles of EPI as per protocol. No overt clinical manifestation of heart failure was observed. Standard echo doppler was performed in all the patients. Two-D EF did not significantly change with EPI treatment. However, the E/e’ ratio measured by SED, was significantly increased after EPI administration (6.7±1.7 vs. 7.25±1.8 before and after treatment, respectively; p&amp;lt;0.05). Overall, 3D ventricular volumetric assessment was feasible in the 63.6% (35/55) of patients and 3D STE in the 60% (33/55) of patients due to anatomical or technical problems. Among parameters measured by 3D STE, a reduction of EF (58.8±8% vs. 61.7±7.1%, before and after treatment, respectively; p&amp;lt;0.02) and a significant increase of the left ventricular end-systolic volume (p&amp;lt;0.01) was observed. Importantly, a significant decrease of the following 3D STE parameters: GLS (p&amp;lt;0.01), GRS (p&amp;lt;0.001), GCS (p&amp;lt;0.0001) and GAS (p&amp;lt;0.0001) were observed after EPI therapy. Conclusions: Results from the present study confirm the increased sensitivity of real time 3D STE technique in detecting early subclinical signs of cardio toxicity in patients with EBC treated with EPI adjuvant chemotherapy. However, due to technical problems, STE was not feasible in the entire patient population included in the study. Among parameters measured by SED, the E/e’ ratio identifies early signs of cardiac dysfunction more accurately compared to the standard 2D EF determination. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-21.

Effects of sex differences on constitutive nitric oxide synthase expression and activity in response to pressure overload in rats

Clinical studies have documented sex differences in left ventricular (LV) hypertrophy patterns, but the mechanisms are so far poorly defined. This study aimed to determine whether 1) severe pressure overload altered expression and/or activity of cardiac constitutive nitric oxide synthase (NOS1 and NOS3) and 2) these changes were modulated according to sex. Analyses were performed 0.4-20 wk after thoracic aortic constriction (TAC) in male and female Wistar rats. Male rats with TAC exhibited early signs of cardiac dysfunction, as shown by echocardiographic and LV end-diastolic pressure measurements, whereas females with TAC exhibited higher LV hypertrophy (+96% vs. males at 20 wk; P < 0.05). After TAC, cardiac NOS1 expression was rapidly induced (0.4 wk) and stable afterward in males (P < 0.05 vs. sham groups), whereas it was delayed in females. Accordingly, specific NOS1 activity was increased by 2 wk in male rats with TAC (+122%; P < 0.001 vs. sham groups) and only by 20 wk in females (+220%; P < 0.001 vs. sham groups). NOS1 activity was correlated with NOS1 level. Regarding cardiac NOS3, expression was unaffected by TAC, and the decrease in activity observed at early and late times in male and female rats with TAC, respectively, is shown to be related to NOS3 allosteric regulator caveolin-1 level. The data demonstrated a unique sex-dependent regulation of the constitutive NOSs in response to TAC in rats; such a difference might play a role in the sex-dependent adaptability of the heart in response to pressure overload.