Echocardiographic Global Longitudinal Strain Research Articles

A Study to Assess the Prognosis of Heart Failure with Reduced Ejection Fraction Based on Echocardiographic Global Longitudinal Strain after Initiating ARNI at 6 Months

A Study to Assess the Prognosis of Heart Failure with Reduced Ejection Fraction Based on Echocardiographic Global Longitudinal Strain after Initiating ARNI at 6 Months

Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain.

Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block (LBBB) have to be stratified for the presence of coronary artery disease and the risk of developing heart failure (HF). We investigated the prognostic role of coronary CT-angiography (CTA) and echocardiographic global longitudinal strain (GLS) in those patients in a mid-term follow-up. Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated retrospectively. Development of HF or a cardiovascular death were the events scheduled. Seventy-eight patients (32 female; mean age: 66.0 ± 10.4 years were enrolled. During a follow-up of 33 months (IQR: 17-77), one patient (1.5%) experienced a cardiovascular death, 14 patients (17.9%) required urgent outpatient visits due to acute decompensated HF (12 hospitalizations). Echocardiography showed a slightly reduced left ventricular ejection fraction (LVEF) (50.0% ± 9.8%) and GLS within the normal range (-16.2% ± 4.1%). CTA analysis showed coronary stenosis > 50% in 28 patients (35.9%). A high Agatston score (> 100) was observed in 29.5%. Notably, 25 patients (32.1%) were diagnosed with left main coronary artery disease and 15 patients (16.7%) underwent revascularization during the follow up. Significant associations were observed between events and LVEF (P = 0.001), diastolic dysfunction grade ≥ 2 (P = 0.02), GLS (P < 0.001), multiple coronary stenosis (P = 0.04) and Agatston score (P = 0.05). Multivariate analysis confirmed the relationships with LVEF (R2 = 0.89, P < 0.001), diastolic dysfunction (R2 = 3.30, P = 0.04), GLS (R2 = 1.43, P < 0.001), and Agatston score (R2 = 1.01, P = 0.05). In patients with complete LBBB, CTA and GLS identified those at a high risk of development HF.

Impact of left ventricular hemodynamic forces in adult patients with treated aortic coarctation and preserved left ventricular systolic function.

The LV myocardial strain and hemodynamic forces (HDFs) are innovative markers of LV function. Aortic coarctation is safely repaired in infancy; however, mortality and morbidity remain increased in later life. The study investigated the role of left ventricular myocardial deformation and HDFs in asymptomatic patients who underwent successful aortic coarctation repair. Clinical and echocardiographic data were analyzed from 42 repaired CoA, 32±20 years after surgery, 2D echocardiographic global longitudinal strain (GLS), circumferential strain (GCS) and HDFs were determined. CoA patients were compared with 42 patients affected by blood hypertension and 84 healthy controls; all matched for age and gender. All groups had normal LV ejection fraction (LVEF), dimensions, and volumes. CoA patients showed a significantly higher rate of LV mass indexed (p< .001) and left atrial volumes indexed (p< .001). LV myocardial and endocardial global longitudinal and circumferential strain were decreased in CoA patients (p< .001, p< .001; p= .032 and p< .001, respectively). HDF parameters such as LV longitudinal force, LV systolic longitudinal force and LV impulse (LVim) were uniformly reduced (p= .006, p= .001, and p= .001, respectively). LV myocardial strain and HDF parameter values were independently associated with hospitalization for heart failure on univariable Cox regression analysis. Despite preserved LVEF, patients with CoA had lower LV myocardial strain and HDF parameters values, independently associated with hospitalization for heart failure.

Long term prognostic value of global myocardial work in patients with heart failure with mildly reduced ejection fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) is defined as HF with a left ventricular (LV) ejection fraction (LVEF) of 41–49%. However, the change in LV function and the subsequent prognosis in these patients remain unclear. Echocardiographic global longitudinal strain (GLS) is a useful measure for detection of myocardial function but is influenced by blood pressure changes. In contrast, myocardial work (MW), incorporating blood pressure, may overcome the limitation. Objectives We aimed to investigate whether LV MW could differentiate the changes of LVEF and predict the clinical outcomes in patients with HFmrEF. Methods In this prospective cohort study, 273 outpatients with HFmrEF underwent echocardiograms at diagnosis and one year after HF therapies. GLS, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency were measured. The observed clinical outcome was hospitalizations for HF. Regression analysis was used to study the combined use of GLS and MW for the diagnostic and prognostic assessment of HFmrEF. Results Among patients with HFmrEF, the more impaired the LV GLS at baseline, the higher probability of worsening EF development. An absolute change in GLS and GWI were associated with subsequent worsening EF. Change in GWI and GCW demonstrated incremental value over GLS and clinical factors for the diagnosis of concurrent worsening EF. Regarding the clinical outcome, patients who presented with worsening EF had a higher risk of hospitalization for HF. In Cox regression, patients with more preserved GLS or lesser GLS decline during the follow-up had a lower risk of hospitalization for HF. Notably, the combined use of GLS and MW add incremental value on the prognosis in patients with HFmrEF. Conclusions GLS can be used for differentiating the changes of LVEF and subsequent hospitalization for HF in patients with HFmrEF while MW added predictive values.

Hot septum and strain reversus: additional echocardiographic signs associated to constrictive pericarditis and pericardial involvement detected by CMR

Abstract Funding Acknowledgements Type of funding sources: None. Background A typical echocardiographic global longitudinal strain (GLS) pattern has been described in in patients with constrictive pericarditis (CP): a characteristic reduction in the regional longitudinal strain of the left ventricular free wall and relative sparing of the septal longitudinal strain value which creates the so-called "hot-septum (HSS)" at the bullseye plot, described by some authors as "strain reversus (SR)". Currently, there is no consensus about definition, prevalence and cut-off values of this GLS pattern. Purpose The aim of this study was to evaluate the prevalence of echocardiographic HSS or SR among pericardial diseases, their diagnostic role in constrictive pericarditis and their correlation with pericardial involvement assessed by cardiac magnetic resonance (CMR). Methods This is a retrospective, single centre cohort study. Consecutive patients admitted for pericardial diseases were enrolled if they underwent both to echocardiogram and CMR. Exams were reviewed and all signs of pericardial disease were systematically assessed, including echocardiographic GLS. Diagnosis of CP was confirmed at hemodynamic catheterization. HSS was visually assessed and defined as an area of septal sparing with reduced LS of the lateral wall at bullseye plot. SR was defined as the ratio between septal LS and lateral LS &amp;lt;1 and was assessed as anterolateral wall LS (ALWLS)/inferoseptal wall LS (ISWLS) and inferolateral wall LS (ILWLS)/anteroseptal wall LS(ASWLS) at basal, mid and apical level. Results After screening of 196 patients, a total of 53 were included. The study population was divided in CP (16 patients) and non-constrictive pericarditis (NCP, 37 patients). Left ventricular ejection fraction (LVEF) was similar between CP and NCP (59.5±10.0% vs 62±6.2%, p 0.190) while GLS was significantly reduced in CP (13.8±2.7% vs 17.6±3.8%). The prevalence of HSS was higher in CP than NCP (75% vs 10,8%, p &amp;lt;0.001) and it was strongly associated with the diagnosis of CP (OR: 3.20, CI: 1.67 – 4.74, p &amp;lt;0.001; c-statistic 0.82). SR was significantly lower in CP patients (0.68±0.43 vs 1.18±0.68, p 0.004). Logistic regression model showed an association between CP and a reduced basal ILWLS/ASWLS ratio (OR: 2.23, CI: 0.59 – 4.07; p 0.017; figure 1); the best cut-point for CP prediction was 0.96 (c-statistic: 0.71, sensitivity 0.54, specificity 0.88, figure 2). HSS was mainly associated to pericardial thickening (OR: 2,09, CI: 0.74–3.4; p 0.002) and less to pericardial LGE (OR: 1.78, CI: 0.16 – 3.39; p 0.031) and pericardial oedema (OR: 1.28, CI: 0.36 – 2.53; p 0.044). Conclusion Hot septum and strain reversus are echocardiographic signs associated to constrictive pericarditis and pericardial involvement detected by cardiac magnetic resonance. The use of strain echocardiography can help to distinguish between pericarditis with and without constriction.

Characterization of Cardiac Function by Echocardiographic Global Longitudinal Strain in a Cohort of Children with Neurofibromatosis Type 1 Treated with Selumetinib.

Plexiform neurofibromas are benign neoplasms that develop in 20-50% children with neurofibromatosis type 1 (NF1). Selumetinib was approved as treatment for symptomatic and inoperable plexiform neurofibromas. Subclinical left ventricular ejection fraction reduction is a less common effect of selumetinib. We aimed to investigate the contractile function of the heart in a cohort of children with NF1 treated with selumetinib. We designed a cross-sectional study including 17 patients with NF1 who received selumetinib. Echocardiographic parameters were compared with a cohort of 17 healthy children matched by sex and age and another group of 17 children with untreated NF1. Compared with healthy controls, patients with NF1 treated with selumetinib had lower mean values of global longitudinal strain (- 22.9 ± 2% vs -25.5 ± 2%; p = 0.001), fractional shortening (36 ± 4% vs 43 ± 8%; p = 0.02) and tricuspid annular plane systolic excursion (19 ± 3 mm vs 23 ± 2 mm; p = 0.001); no difference was found in left ventricular ejection fraction (63 ± 4%vs 65 ± 3%; p = 0.2 respectively). Median treatment time with selumetinib at the time of the echocardiographic evaluation was 22 ± 16 months. Patients with NF1 treated with selumetinib may experience subtle changes in systolic function identified by global longitudinal strain and not revealed by left ventricular ejection fraction. Global longitudinal strain might be useful to monitor cardiac function in this cohort of patients for the duration of therapy.

634: GLOBAL LONGITUDINAL STRAIN IS ASSOCIATED WITH MORTALITY AFTER PEDIATRIC CARDIAC ARREST

Introduction: Depressed left ventricular function is associated with mortality after pediatric cardiac arrest (CA). Echocardiographic global longitudinal strain (GLS) is more sensitive for poor outcomes than ejection fraction (EF) and shortening fraction (SF), with few studies in children. We aimed to identify the frequency of impaired GLS after pediatric CA and its association with hospital mortality. We hypothesized abnormal GLS is associated with mortality. Methods: This is a retrospective single-center cohort study of children < 18 years of age treated in the pediatric intensive care unit after in- and out-of-hospital CA, with echocardiogram performed within 24 hours of admission between 2013-2020. Patients with congenital heart disease, extracorporeal support, or inability to measure GLS were excluded. EF and SF measurements were abstracted and GLS measured post hoc by an investigator blinded to outcome. Abnormal left ventricular GLS was defined as >-18%. Correlation between GLS, EF and SF were calculated with Spearman’s rho. Logistic regression tested association of GLS with mortality. Area under the receiver operator characteristic (AUROC) curve was calculated for discriminative utility of GLS, EF, and SF with mortality. Results: GLS was measured in 124 subjects and abnormal in 49 (40%). Subjects with abnormal GLS were older (median 8 vs 2 years, p< 0.001), had more ventricular tachycardia/fibrillation as initial rhythm (18% vs 4%, p=0.008) and higher maximum troponin in 24 hours (median 2.6 ng/mL vs 0.5, p=0.002). There was no difference between arrest location or CPR duration based on GLS. Subjects with abnormal GLS had lower median EF (43% vs 63%) and SF (24% vs 37%), with strong inverse correlation between GLS and EF (rho -0.76) and SF (rho -0.71), all p< 0.001. Abnormal GLS had higher mortality (57% vs 33%, p=0.009) and GLS was associated with mortality when controlling for age and initial rhythm [aOR 1.17 per 1% increase in GLS (95% CI 1.09-1.26), p< 0.001]. GLS (AUROC 0.69), EF (0.71) and SF (0.71) had similar discrimination for mortality. Conclusions: Post-arrest GLS is a novel complementary metric, strongly correlated with EF and SF and associated with mortality. Future prospective studies should investigate the prognostic utility of GLS alongside SF and EF.

Prognostic value of echocardiographic evaluation of cardiac mechanics in patients with aortic stenosis and preserved left ventricular ejection fraction.

Left ventricular ejection function (LVEF) is not reliable in identifying subtle systolic dysfunction. Speckle Tracking (ST) plays a promising role and hemodynamic forces (HDFs) are emerging as marker of LV function. The role of LV myocardial deformation and HDFs was investigated in a cohort of patients with aortic stenosis (AS) and normal LVEF. Two hundred fifty three patients (median age 79 years, IQR 73 - 83 years) with mild (n = 87), moderate (n =77) and severe AS (n =89) were retrospectively enrolled. 2D echocardiographic global longitudinal strain (GLS), circumferential strain (GCS) and HDFs were determined. The worsening of AS was associated with raising inappropriate LV mass (p < 0.001) and declined LVEF, despite being in the normal range (p < 0.001). ST and HDFs parameters declined as the AS became severe (p<0.0001, for all). When patients were grouped based on the median of LV endocardial GLS value (> -19,9%) and LV systolic longitudinal force (LVsysLF) value (< 12,49), patients with impaired ST and lower HDFs components had increased incidence of aortic valve replacement (AVR) and worse survival (p <0.024 and p <0.037, respectively). Among ST and HDFs parameters, only LVsysLF was independently associated with AVR and all causes mortality on multivariable Cox regression analysis (HR 0.94; 95% CI 0.89-0.99; p= 0.012). Reduced values of LVsysLF were associated with AVR and reduced survival in AS patients. LVsysLF could provide useful information in the stratification of patients with AS and possibly in the choice of timing for AVR.

Comparison of Echocardiographic global longitudinal strain in patients under risk factors (diabetes and hypertension) with and without Coronary Artery Disease

Background: Global Longitudinal index (GLS) as a noninvasive diagnostic method can be influenced by coronary artery disease (CAD). In addition diabetes mellitus (DM) and hypertension (HTN) as two main risk factor of coronary involvement can affect to GLS. Therefore, the aim of this evaluation was to compare echocardiographic GLS in DM and HTN patients with significant CAD with DM and HTN patients without CAD. Method: In a case-control study conducted (2020-2021) in the hospitals of Ahvaz, 72 patients with and without CAD with risk factors for DM and hypertension, were examined. So that after selecting study samples that have the necessary criteria to participate in the study, the amount of GLS is calculated in each group of patients. After the data were obtained in the expressed groups, in comparison with these values, paired t-test and independent t-test and Anova, Mann-Whitney, and Levene's Test were used. P Value lower than 0.05 was consider as significant value. Results: From 42 patients without CAD and 38 patients with coronary artery disease, the mean and standard deviation of age in patients with CAD was 61.00±8.00 and in the control group was 54.09±10.00 (P = 0.019).

Prediction of anthracycline-induced cardiotoxicity as assessed by global longitudinal strain in women with early breast cancer: insights from the PRADA trial

Abstract Background Early recognition of anthracycline-induced cardiotoxicity is essential to prevent and treat left ventricular dysfunction before permanent damage ensues. Echocardiographic global longitudinal strain (GLS) may be a more sensitive indicator of decline in left ventricular systolic function than measurement left ventricular ejection fraction (LVEF). Many factors have been associated with cardiotoxicity defined by LVEF criteria, but less is known about predictors of early and late cardiotoxicity expressed as GLS. Objective The purpose of this study was to identify factors associated with cardiotoxicity, defined as absolute GLS &amp;lt;18% (a) after completion of anthracycline treatment and (b) at extended follow up after completion of adjuvant therapy for early breast cancer. Methods 120 women with early breast cancer undergoing adjuvant treatment with anthracyclines and/or trastuzumab, were included in the PRADA (PRevention of cArdiac Dysfunction during Adjuvant breast cancer) trial and randomized in a 2x2 factorial fashion to concomitant treatment with candesartan cilexetil, metoprolol succinate or matching placebo. Serial measurements of cardiovascular biomarkers (high sensitivity cardiac troponin I (hs-cTnI), B-type natriuretic peptide (BNP) and Galectin-3), cardiovascular magnetic resonance and echocardiography were performed at baseline, after anthracycline treatment and at extended follow-up median 23 months (interquartile range 21–28 months) after initiation of adjuvant therapy for early breast cancer. To identify potential predictors of cardiotoxicity defined by GLS criteria, associations between demographic, clinical, cancer therapy and biochemical and imaging biomarker data were evaluated by logistic regression analysis. Results 89 patients had GLS measurements performed at baseline, 87 at completed anthracycline therapy and 81 at extended follow-up. An overall decline in absolute GLS of 0.75% was observed at extended follow-up. One patient had absolute GLS &amp;lt;18 prior to anthracycline therapy whereas, 7 out of 87 (8.0%) and 7 out of 81 (8.6%) patients had GLS levels &amp;lt;18 after completion of anthracycline treatment and at extended follow up, respectively. Variables associated with absolute GLS &amp;lt;18% after anthracycline treatment and at extended follow-up are summarized in Tables 1a and 1b. Conclusion In this subanalysis of the PRADA trial, higher age, higher hs-cTnI, lower LVEF, lower E' and higher GLS at baseline predicted subsequent reduced systolic function expressed as reduced absolute GLS after anthracycline treatment. Higher age, hypertension, higher body mass index and higher hs-cTnI concentrations predicted absolute GLS &amp;lt;18 at extended follow up. Assessment of cardiac troponin I, cardiac imaging biomarkers and patient age may assist in the identification of patients at risk for developing cardiotoxicity. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by The South-Eastern Norway Regional Health Authority, The University of Oslo, The Extra Foundation for Health and Rehabilitation, The Norwegian Cancer Society, and Akershus University Hospital. Study medications and matching placebos were provided free of charge by AstraZeneca. Reagents for the analysis of high-sensitivity cardiac troponin I on the Architect platform were provided by Abbott Diagnostics.

The Diagnostic Role of Echocardiographic Strain Analysis in Patients Presenting with Chest Pain and Elevated Troponin: A Multicenter Study

Myocarditis presenting as acute chest pain with elevated troponins without significant cardiac compromise is rare in previously healthy children, often referred to as myopericarditis. Diagnosis is challenging, as conventional echocardiographic measures of systolic function can be normal. The aim of this study was to demonstrate the diagnostic utility of strain imaging in this scenario. This was a multicenter, retrospective study including patients presenting with chest pain and elevated troponin from 10 institutions who underwent cardiac magnetic resonance imaging and transthoracic echocardiography within 30days of each other (group 1). Findings were compared with those among 19 control subjects (group 2). Clinical data and conventional echocardiographic and cardiac magnetic resonance imaging data were collected. Echocardiography-derived strain was measured at the core laboratory. Group 1 was divided into subgroups as myocarditis positive (group 1a) or negative (group 1b) on cardiac magnetic resonance imaging on the basis of established criteria. Group 1 included 108 subjects (88 in group 1a, 20 in group 1b). Although all groups had normal mean fractional shortening and mean left ventricular ejection fraction, group 1 had significantly lower ejection fraction (56.8±7.0%) compared with group 2 (62.3±4.9%; P<.005) and fractional shortening (31.2±4.9%) compared with group 2 (34.1±3.5%; P<.05). Additionally, peak global longitudinal strain (GLS) was markedly abnormal in group 1 (-13.9±3.4%) compared with group 2 (-19.8±2.1%; P<.001). In subgroup analysis, GLS was markedly abnormal in group 1a (-13.2±3.0%) compared with group 1b (-17.3±2.6%; P<.001). Fifty-four subjects underwent follow-up echocardiography (46 in group 1a, eight in group 1b), with mean a follow-up time of 10±11months. At follow-up, whereas ejection fraction and fractional shortening returned to normal in all patients, abnormalities in strain persisted in group 1, with 22% still having abnormal GLS. Moreover, mean GLS was more abnormal in group 1a (-16.1±2.6%) compared with group 1b (-17.4±1.2%; P<.05). The present study demonstrates that echocardiographic GLS is significantly worse in subjects with myopericarditis presenting with chest pain and elevated troponins compared with control subjects even when conventional measures of systolic function are largely normal and that these abnormalities persisted over time.

Global Longitudinal Strain is Incremental to Left Ventricular Ejection Fraction for the Prediction of Outcome in Optimally Treated Dilated Cardiomyopathy Patients.

BackgroundSpeckle tracking echocardiographic global longitudinal strain (GLS) predicts outcome in patients with new onset heart failure. Still, its incremental value on top of left ventricular ejection fraction (LVEF) in patients with nonischemic, nonvalvular dilated cardiomyopathy (DCM) after optimal heart failure treatment remains unknown.Methods and ResultsPatients with DCM were included at the outpatient clinics of 2 centers in the Netherlands and Italy. The prognostic value of 2‐dimensional speckle tracking echocardiographic global longitudinal strain was evaluated when being on optimal heart failure medication for at least 6 months. Outcome was defined as the combination of sudden or cardiac death, life‐threatening arrhythmias, and heart failure hospitalization. A total of 323 patients with DCM (66% men, age 55±14 years) were included. The mean LVEF was 42%±11% and mean GLS after optimal heart failure treatment was −15%±4%. Twenty percent (64/323) of all patients reached the primary outcome after optimal heart failure treatment (median follow‐up of 6[4–9] years). New York Heart Association class ≥3, LVEF, and GLS remained associated with the outcome in the multivariable‐adjusted model (New York Heart Association class: hazard ratio [HR], 3.43; 95% CI, 1.49–7.90, P=0.004; LVEF: HR, 2.13; 95% CI, 1.11–4.10, P=0.024; GLS: HR, 2.24; 95% CI, 1.18–4.29, P=0.015), whereas left ventricular end‐diastolic diameter index, left atrial volume index, and delta GLS were not. The addition of GLS to New York Heart Association class and LVEF improved the goodness of fit (log likelihood ratio test P<0.001) and discrimination (Harrell’s C 0.703).ConclusionsWithin this bicenter study, GLS emerged as an independent and incremental predictor of adverse outcome, which exceeded LVEF in patients with optimally treated DCM. This presses the need to routinely include GLS in the echocardiographic follow‐up of DCM.

Cardiovascular outcome 6 months after severe coronavirus disease 2019 infection.

In coronavirus disease 2019 (COVID-19), cardiovascular risk factors and myocardial injury relate to increased mortality. We evaluated the extent of cardiac sequelae 6 months after hospital discharge in patients surviving ICU hospitalization for COVID-19. All survivors of Maastricht-ICU were invited for comprehensive cardiovascular evaluation 6 months after discharge from ICU. Cardiac screening included an electrocardiogram, cardiac biomarkers, echocardiography, cardiac magnetic resonance (CMR) and, wherever indicated, cardiac computed tomography or coronary angiogram. Out of 52 survivors, 81% ( n = 42) participated to the cardiovascular follow-up [median follow-up of 6 months, interquartile range (IQR) 6.1-6.7]. Eight patients (19%) had newly diagnosed coronary artery disease (CAD), of which two required a percutaneous intervention. Echocardiographic global longitudinal strain (GLS) was abnormal in 24% and CMR-derived GLS was abnormal in 12%, despite normal left ventricular ejection fraction in all. None of the patients showed elevated T 1 relaxation times and five patients (14%) had an elevated T 2 relaxation time. Late gadolinium enhancement (LGE) reflecting regional myocardial fibrosis was increased in eight patients (21%), of which three had myocarditis and three had pericarditis. Cardiovascular follow-up at 6 months after ICU-admission for severe COVID-19 revealed that one out of five invasively mechanically ventilated survivors had CAD, a quarter had subclinical left ventricular dysfunction defined as reduced echocardiographic GLS, and 42% of the patients had CMR abnormalities (reduced LVEF, reduced GLS, LGE presence, and elevated T 2 ). On the basis of these findings, long-term cardiovascular follow-up is strongly recommended in all post-IC COVID-19 patients. Trial Register number [NL8613]) https://www.trialregister.nl/trial/8613Video abstract:http://links.lww.com/HJH/B899 .

Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis.

Aims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on cardiovascular magnetic resonance (CMR) and validate the prognostic value of LV-GLS thresholds associated with fibrosis.Methods and results: LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57 ± 10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71 ± 12 years; 58% males; NYHA functional class I–II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, and myocardial infarction. In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74 [0.66–0.83]; P < 0.001) and calibration (Hosmer-Lemeshow χ2 = 6.37; P = 0.605) for replacement fibrosis. In the outcome cohort, 47 events occurred over 16 [3.3, 42.2] months. Patients with LV-GLS > −15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS < −21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P < 0.001). LV-GLS offered independent prognostic value over clinical variables, AS severity and echocardiographic LV mass and E/e′.Conclusion: LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF.

Echocardiographic global longitudinal strain as a marker of myocardial fibrosis predicts outcomes in aortic stenosis

Abstract Background Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) reflects intrinsic myocardial function, influenced by interstitial abnormalities. Cardiovascular magnetic resonance (CMR) detects myocardial fibrosis non-invasively, but it is limited for widespread use. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on CMR and validate the prognostic value of LV-GLS thresholds associated with fibrosis. Methods LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57±10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR for replacement myocardial fibrosis. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71±12 years; 58% males; NYHA functional class I-II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, myocardial infarction and cerebrovascular events. Results In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74; 95% confidence interval: 0.66–0.83; P&amp;lt;0.001) and calibration (Hosmer-Lemeshow X2=6.37; P=0.605) for replacement fibrosis. In the outcome cohort, 52 events occurred over 16 [3.1, 42.0] months of follow-up. Patients with LV-GLS &amp;gt;−15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS &amp;lt;−21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P&amp;lt;0.001; Figure 1). Furthermore, LV-GLS offered independent prognostic value over clinical variables, AS severity, echocardiographic LVEF and E/e' (hazard ratio 1.18; 95% confidence interval: 1.07 to 1.30; P=0.001). Conclusions LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF (Figure 2). Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council Figure 1Figure 2

CT Derived Perimeter Strain In Severe Aortic Regurgitation - Comparison With Speckle Tracking Echocardiography

Introduction: We assessed CT-derived left ventricular (LV) perimeter strain in a cohort of patients with severe regurgitation of the aortic valve or biological aortic valve prothesis and validated it against echocardiographic global longitudinal strain (GLS) derived by 2 dimensional speckle tracking echocardiography as the gold standard.

Associations of subclinical heart failure and atrial fibrillation with mild cognitive impairment: a cross-sectional study in a subclinical heart failure screening programme

ObjectivesEffective identification and management of subclinical left ventricular (LV) dysfunction (LVD) and subclinical atrial fibrillation (AF) by screening elderly populations might be compromised by mild cognitive impairment (MCI). We sought...

Prevalence and prognostic value of small fiber neuropathy assessed by Sudoscan ® in transthyretin wild-type cardiac amyloidosis

The prevalence of small-fiber neuropathy (SFN) is high in patients with hereditary transthyretin amyloidosis (ATTRv) but remains unknown in transthyretin wild-type cardiac amyloidosis (ATTRwt-CA). To determine the prevalence of SFN in patients with ATTRwt-CA using Sudoscan®, a non-invasive method used to provide evidence of SFN in clinical practice and based on measurement of electrochemical skin conductance at the hands (hESC) and feet (fESC). A series of 62 non-diabetic patients with ATTRwt-CA was prospectively included over 2 years and compared to healthy elderly subjects, matched on age, gender and body mass index. The presence of SFN was defined as hESC < 60 μS and/or fESC < 70 μS and conductances were analyzed according to clinical, biological, and echocardiographic data. Mean hESC and fESC were significantly lower in patients with ATTRwt-CA than in elderly controls: 61.5 vs. 70.0 μS ( P = 0.006) and 68.3 vs. 76.9 μS respectively ( P < 0.0001). Prevalence of hESC < 60 μS and fESC < 70 μS was higher in patients with ATTRwt-CA than in controls: 33.9% versus 16.7% and 48.4% versus 19.9%, P < 0.05. Univariate analysis showed that fESC, NT-proBNP, creatinine plasma levels, and echocardiographic global longitudinal strain were associated with decompensated cardiac failure and death. Multivariate analysis revealed that fESC was an independent prognostic factor and Kaplan-Meier estimator evidenced a larger occurrence of cardiac decompensation and death in patients with fESC < 70 μS, P = 0.046. A reduced fESC was observed in almost 50% of patients with ATTRwt-CA and was associated with a worse prognosis. Sudoscan® could be used easily to screen ATTRwt-CA patients for the presence of SFN and identify patients at higher risk of outcome.

Prevalence and prognostic value of autonomic neuropathy assessed by Sudoscan® in transthyretin wild‐type cardiac amyloidosis

AimsThe prevalence of autonomic neuropathy (AN) is high in patients with hereditary transthyretin amyloidosis but remains unknown in transthyretin wild‐type cardiac amyloidosis (ATTRwt‐CA). This study aimed to determine the prevalence of AN in patients with ATTRwt‐CA using Sudoscan®, a non‐invasive method used to provide evidence of AN in clinical practice and based on measurement of electrochemical skin conductance at the hands and feet (fESC).Methods and resultsA series of 62 non‐diabetic patients with ATTRwt‐CA was prospectively included over 2 years and compared with healthy elderly subjects, matched by age, gender, and body mass index. The presence of AN was defined as electrochemical skin conductance at the hands <60 μS and/or fESC <70 μS, and conductances were analysed according to clinical, biological, and echocardiographic data. Mean fESC was significantly lower in patients with ATTRwt‐CA compared with elderly controls: 68.3 (64.1–72.5) vs. 76.9 (75.6–78.1) μS (P < 0.0001), respectively. Prevalence of fESC <70 μS was higher in ATTRwt‐CA patients than in controls: 48.4% vs. 19.9%, P < 0.05. Univariate analysis showed that fESC, N‐terminal pro‐B‐type natriuretic peptide, creatinine plasma levels, and echocardiographic global longitudinal strain were associated with decompensated cardiac failure and death. Multivariate analysis revealed that fESC was an independent prognostic factor, and Kaplan–Meier estimator evidenced a greater occurrence of cardiac decompensation and death in patients with fESC <70 μS, P = 0.046.ConclusionsReduced fESC was observed in almost 50% of patients with ATTRwt‐CA and was associated with a worse prognosis. Sudoscan® could easily be used to screen ATTRwt‐CA patients for the presence of AN and identify patients at higher risk for a poor outcome.

Abstract 15153: Functional Cardiac Adaptation to 60 Days Strict Head-Down-Tilt Bedrest

Background: Reduced physical activity increases the risk for heart failure. Myocardial strain measurements capture subtle abnormalities in myocardial function. We tested the hypothesis that bedrest deconditioning produces cardiac dysfunction in healthy persons. Methods: In the AGBRESA study, which assessed artificial gravity through centrifugation as potential countermeasure for space travel, 24 healthy persons (8 women) were submitted to 60 days strict -6°-head-down-tilt bedrest. 8 subjects each were included in a control group or groups subjected to continuous artificial gravity training on a short-arm centrifuge [30 minutes/day] or intermittent centrifugation [6x5 min/day]. We assessed cardiac morphology, function, strain and hemodynamics by cardiac-MRI (baseline, end of bedrest, recovery) and echocardiography (baseline, end of bedrest). Before and after bedrest, we assessed orthostatic heart rate responses as measure of cardiovascular deconditioning. Results: We conducted a pooled analysis because cardiovascular responses to bedrest did not differ between groups. Supine heart rate (baseline: 64±9.6bpm; bedrest: 72.3±10.5bpm; recovery: 69.6±10.5bpm, p &lt;0.0001) and diastolic blood-pressure (69.6±7.3mmHg; bedrest: 78.5±6.9mmHg; recovery: 70.3±6.3mmHg, p &lt;0.0001) increased with bedrest. With head-up tilt, heart rate increased 22.8±10.5bpm before and 45.9±213bpm at the end of bedrest ( p &lt;0.0001) consistent with cardiovascular deconditioning. Cardiac-output decreased from 6.6±0.9l/min to 6±1l/min at end of bedrest (recovery: 6.8±1.2l/min, p =0.0096). Left ventricular ejection fraction and mass-index did not change. Echocardiographic global longitudinal strain (baseline: -19.90±2.1%; bedrest: -18.1±2.1%, p &lt;0.0001) decreased, whereas global circumferential strain in MRI tended to increase (baseline: -18.6±1.7%; bedrest: -19.1±1.6%, p =0.0843). After four days of recovery MRI measurements had returned to baseline. Conclusion: In healthy persons, cardiovascular deconditioning through 60 days head-down-tilt bedrest does not lead to cardiac atrophy or sustained reductions in cardiac performance. The transient nature of cardiac strain changes suggests functional rather than structural changes in the heart.