Global Circumferential Strain Values Research Articles

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

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

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

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

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

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

Intraoperative Augmented Rotation and Circumferential Strain Compensate for Reduction of Left Ventricular Longitudinal Function After On-Pump CABG Surgery

Left ventricular (LV) longitudinal function is reduced after on-pump coronary artery bypass grafting (CABG), while global LV function often is preserved. There are only limited data on the underlying compensatory mechanism. Therefore, the authors aimed to describe intraoperative changes of LV contractile pattern by myocardial strain analysis. A prospective observational study. At a single university hospital. A total of 30 patients scheduled for isolated on-pump CABG with an uneventful intraoperative course and preoperative preserved LV and RV function, sinus rhythm, without more-than-mild heart valve disease, or elevated pulmonary pressure. Transesophageal echocardiography was performed after induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). Echocardiographic evaluation was performed under stable hemodynamics, in sinus rhythm or atrial pacing, and vasopressor support with norepinephrine ≤0.1 µg/kg/min. EchoPAC v204 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of 2-dimensional (2D) and 3-dimensional (3D) LV ejection fraction (EF), LV global longitudinal strain (GLS), LV global circumferential strain (GCS), LV global radial strain (GRS), LV apical rotation (aRot), LV basal rotation (bRot), and LV twist. Strain analysis was feasible in all included patients after termination of cardiopulmonary bypass (T2). Although there were no significant differences in the values of conventional echocardiographic parameters during the intraoperative interval, GLS deteriorated significantly after CABG compared to pre-bypass assessment (T1 v T2, -13.4% ± 2.9 v -11.8% ± 2.9; p=0.007). GCS improved significantly after surgery (T1 v T2, -19.4% (IQR -17.1% to -21.2%) v -22.8% (IQR -21.1% to -24.7%); p < 0.001) as well as aRot (T1 v T2, -9.7° (IQR -7.1° to -14.1°) v -14.5° (IQR -12.1° to -17.1°); p < 0.001), bRot (T1 v T2, 5.1° (IQR 3.8°-6.7°) v 7.2° (IQR 5.6°-8.2°); p=0.02), and twist (T1 v T2, 15.8° (IQR 11.7°-19.4°) v 21.6° (IQR 19.2°-25.1°); p < 0.001), while GRS remained unchanged. There were no significant changes in the values of GLS, GCS, GRS, aRot, bRot, or twist, as well as in the values of 2D and 3D LV EF before and after sternal closure (T2 v T3). Beyond evaluation of longitudinal LV strain, measurements of circumferential and radial strain, as well as LV rotation and twist mechanics, were feasible in the intraoperative course of this study. Reduction of longitudinal function after on-pump CABG was compensated intraoperatively by improvement of GCS and rotation in the authors' group of patients. Perioperative assessment of GCS, GRS, as well as rotation and twist, might provide deeper insight into perioperative changes of cardiac mechanics.

Four-dimensional speckle tracking echocardiography and fragmented QRS in detection of early left ventricular systolic dysfunction in patients with subclinical hyperthyroidism.

Thyroid disorders are associated with many cardiovascular risk factors. The importance of thyroid hormones in the pathophysiology of heart failure is underlined by the European guidelines of the European Society of Cardiology. However, the role of subclinical hyperthyroidism (SCH) in subclinical left ventricular (LV) systolic dysfunction is not entirely clear. This cross-sectional study included 56 SCH patients and 40 healthy volunteers. The 56 SCH group was divided into two subgroups depending on the presence of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with four-dimensional (4D) echocardiography. GAS, GRS, GLS, and GCS values were significantly different in SCH patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-17.06 ± 1.00 vs. -19.08 ± 1.71, p < .001, and -26.61 ± 2.38 vs. -30.61 ± 2.57, p < .001, respectively). ProBNP was positively correlated with LV-GLS (r = 0.278, p = .006) and LV-GAS (r = 0.357, p < .001). Multiple linear regression analysis showed that fQRS was an independent predictor of LV-GAS. 4D strain echocardiography may be helpful for the prediction of early cardiac dysfunction in patients with SCH. The presence of fQRS may be an indicator of subclinical LV dysfunction in SCH.

Cardiac magnetic resonance feature tracking myocardial strain analysis in suspected acute myocarditis: diagnostic value and association with severity of myocardial injury

BackgroundAlbeit that cardiac magnetic resonance feature tracking (CMR-FT) has enabled quantitative assessment of global myocardial strain in the diagnosis of suspected acute myocarditis, the cardiac segmental dysfunction remains understudied. The aim of the present study was using CMR-FT to assess the global and segmental dysfunction of the myocardium for diagnosis of suspected acute myocarditis.MethodsForty-seven patients with suspected acute myocarditis (divided into impaired and preserved left ventricular ejection fraction [LVEF] groups) and 39 healthy controls (HCs) were studied. A total of 752 segments were divided into three subgroups, including segments with non-involvement (SNi), segments with edema (SE), and segments with both edema and late gadolinium enhancement (SE+LGE). 272 healthy segments served as the control group (SHCs).ResultsCompared with HCs, patients with preserved LVEF showed impaired global circumferential strain (GCS) and global longitudinal strain (GLS). Segmental strain analysis showed that the peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) values significantly reduced in SE+LGE compared with SHCs, SNi, SE. PCS significantly reduced in SNi (-15.3 ± 5.8% vs. -20.3 ± 6.4%, p < 0.001) and SE (-15.2 ± 5.6% vs. -20.3 ± 6.4%, p < 0.001), compared with SHCs. The area under the curve (AUC) values of GLS (0.723) and GCS (0.710) were higher than that of global peak radial strain (0.657) in the diagnosis of acute myocarditis, but the difference was not statistically significant. Adding the Lake Louise Criteria to the model resulted in a further increase in diagnostic performance.ConclusionsGlobal and segmental myocardial strain were impaired in patients with suspected acute myocarditis, even in the edema or relatively non-involved regions. CMR-FT may serve as an incremental tool for assessment of cardiac dysfunction and provide important additional imaging-evidence for distinguishing the different severity of myocardial injury in myocarditis.

There is more than just longitudinal strain: Prognostic significance of biventricular circumferential mechanics.

Despite the significant contribution of circumferential shortening to the global ventricular function, data are scarce concerning its prognostic value on long-term mortality. Accordingly, our study aimed to assess both left (LV) and right ventricular (RV) global longitudinal (GLS) and global circumferential strain (GCS) using three-dimensional echocardiography (3DE) to determine their prognostic importance. Three hundred fifty-seven patients with a wide variety of left-sided cardiac diseases were retrospectively identified (64 ± 15 years, 70% males) who underwent clinically indicated 3DE. LV and RV GLS, and GCS were quantified. To determine the prognostic power of the different patterns of biventricular mechanics, we divided the patient population into four groups. Group 1 consisted of patients with both LV GLS and RV GCS above the respective median values; Group 2 was defined as patients with LV GLS below the median while RV GCS above the median, whereas in Group 3, patients had LV GLS values above the median, while RV GCS was below median. Group 4 was defined as patients with both LV GLS and RV GCS below the median. Patients were followed up for a median of 41 months. The primary endpoint was all-cause mortality. Fifty-five patients (15%) met the primary endpoint. Impaired values of both LV GCS (HR, 1.056 [95% CI, 1.027-1.085], p < 0.001) and RV GCS (1.115 [1.068-1.164], p < 0.001) were associated with increased risk of death by univariable Cox regression. Patients with both LV GLS and RV GCS below the median (Group 4) had a more than 5-fold increased risk of death compared with those in Group 1 (5.089 [2.399-10.793], p < 0.001) and more than 3.5-fold compared with those in Group 2 (3.565 [1.256-10.122], p = 0.017). Interestingly, there was no significant difference in mortality between Group 3 (with LV GLS above the median) and Group 4, but being categorized into Group 3 versus Group 1 still held a more than 3-fold risk (3.099 [1.284-7.484], p = 0.012). The impaired values of both LV and RV GCS are associated with long-term all-cause mortality, emphasizing the importance of assessing biventricular circumferential mechanics. Reduced RV GCS is associated with significantly increased risk of mortality even if LV GLS is preserved.

There is more than just longitudinal strain: prognostic significance of biventricular circumferential mechanics

Abstract Global longitudinal strain is a well-established predictive parameter of adverse outcomes in several cardiac diseases, therefore, it is widely used in clinical practice. Despite the significant contribution of circumferential shortening to the global ventricular function, data are scarce concerning the biventricular circumferential strain phenotypes and their prognostic value on long-term mortality. Accordingly, the aim of our study was to assess both left (LV) and right ventricular (RV) global circumferential strain (GCS) using 3D echocardiography in order to determine the prognostic importance of the deterioration of biventricular circumferential mechanics. Three hundred and sixty-four patients with various established left-sided heart diseases were retrospectively identified (age: 64.8±15.0 years, 69% males) with a median follow-up of 41 months. All patients underwent clinically indicated transthoracic echocardiography and left (LV) and right ventricular (RV) ejection fractions (EF) were measured by 3D analysis. 3D LV and RV GCS were also quantified by dedicated softwares. In order to determine the prognostic power of the different patterns of biventricular circumferential mechanics, we divided the patient population into four groups using the median values of LV and RV GCS (absolute values of 27.1% and 17.9%, respectively). Group 1 consisted of patients with both LV and RV GCS above median values; Group 2 was defined as patients with LV GCS above the median, while RV GCS below the median, whereas in Group 3 patients had LV GCS values below the median, while RV GCS was above median. Group 4 was defined as patients with both LV and RV GCS below the median. The primary endpoint of our study was all-cause mortality. Fifty-five patients (15.1%) met the primary endpoint. The overall patient population showed balanced values of LV and RV EF (49.0±15.7 and 48.2±9.4%, respectively). Comparing the population separated into the above-mentioned four groups based on LV and RV GCS values enabled a detailed risk stratification as shown on the Kaplan-Meier curve (Figure 1.) When comparing Group 1 vs. Group 4, patients who had lower LV and RV GCS values the risk of all-cause mortality was more than 5 times higher than in patients with both LV and RV GCS above the median (HR, 5.240 [95% CI, 2.750–9.985], p&amp;lt;0.001). By comparing Group 2 with Group 3, the associated risks for all-cause mortality did not show a difference (HR, 0.461 [95% CI, 0.178 to 1.194], p=NS) as shown on the Kapan-Meier curve (Figure 2). Based on the different phenotypes of LV and RV GCS, decreased biventricular circumferential shortening was associated with a significantly increased risk of long-term all-cause mortality. Interestingly, decreased RV GCS with maintained LV GCS showed a similar risk of adverse outcomes than decreased LV GCS with maintained RV GCS. Our results emphasize the importance of the assessment of biventricular circumferential mechanics. Funding Acknowledgement Type of funding sources: None.

Increased circumferential deformation predicts cardiac events when left ventricular ejection fraction is normal

Abstract Background Recent research suggests that early left ventricular (LV) systolic dysfunction is characterized by compromised longitudinal function and a concomitant augmentation of circumferential deformation expressed as increased global circumferential strain (GCS). It is hypothesized that increased GCS could be used to identify people at higher risk of cardiovascular events when left ventricular ejection fraction (LVEF) is preserved. Purpose The present study aimed to investigate whether elevated GCS in individuals with preserved LVEF predicts major adverse cardiovascular events (MACE). Methods A total of 2,874 participants from the general population were included in this prospective cohort study. All participants had echocardiography performed and analyzed. Exclusion criteria were HF at baseline, non-sinus rhythm during echocardiography, and inadequate image quality for GCS assessment. Outcome was MACE including incident heart failure, myocardial infarction, and/or cardiovascular death. Absolute values of strain were used. To determine the optimal transition point of a potential effect modification, Cox regression models with different LVEF thresholds were created. The model with the optimal hazard ratio (HR) and P values of the interaction terms and Akaike information criterion was chosen. Results Mean age was 53±18 years and 60% were female. Mean LVEF and GCS were 57±6% and 21.6±4.0%, respectively. Median follow-up was 3.5 years [IQR: 2.6; 4.4] and a total of 92 (3.2%) developed MACE. A U-shaped relationship was observed between GCS and MACE. The lowest incidence rate was within the GCS range of 20 to 25% (Figure 1a). A significant interaction (P&amp;lt;0.001) between GCS and LVEF was observed regarding MACE. The optimal transition point for this effect modification was determined to be LVEF=50%. In multivariable Cox regressions (including conventional cardiovascular risk factors and global longitudinal strain (GLS)), increasing GCS was significantly associated with future MACE in participants with LVEF ≥50% (HR=1.09 [95% CI: 1.01; 1.17] per 1% increase, n=2420) while decreasing GCS were associated with a higher risk of MACE in individuals with abnormal LVEF (HR=1.16 [95% CI: 1.04; 1.29] per 1% decrease, n=289) (Figure 1b). A total of 50 (2.1%) developed the MACE amongst the participants with LVEF ≥50%. This group had significantly lower GLS (19.0±2.7% vs 19.9±2.0%, P=0.013) and ratio of peak early transmitral filling velocity to peak early diastolic tissue velocity (E/e') (10.7 [IQR: 7.9; 14.3] vs 6.5 [5.3; 8.4], P&amp;lt;0.001) compared to the participants that did not develop MACE with normal LVEF. Figure 2 illustrates a model of the development of GCS, LVEF, GLS, and E/e' as LV function declines. Conclusion In the general population, the prognostic value of GCS is modified by LVEF. In participants with normal LVEF, higher GCS was associated with increased risk of MACE, while the opposite was observed in participants with abnormal LVEF. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Copenhagen City Heart Study is funded by The Danish Heart FoundationThe Metropolitan Region of Denmark (public funding).

13N-ammonia positron emission tomography-derived endocardial strain for the assessment of ischemia using feature-tracking in high-resolution cine imaging

BackgroundAssessing endocardial strain using a single 13N-ammonia positron emission tomography (PET) scan would be clinically useful, given the association between ischemia and myocardial deformation. However, no software has been developed for strain analysis using PET. We evaluated the clinical potential of feature tracking-derived strain values measured using PET, based on associations with the myocardial flow reserve (MFR). Methods and ResultsThis retrospective study included 95 coronary artery disease patients who underwent myocardial 13N-ammonia PET. Semi-automatic measurements were made using a feature-tracking technique during myocardial cine imaging, and values were calculated using a 16-segment model. Adenosine-stressed global circumferential strain (CS) and global longitudinal strain (LS) values were compared with global MFR values. Stressed and resting global strain values were also compared. Global strain values were significantly lower in 39 patients with abnormal MFRs [< 2.0] than in 56 patients with normal MFRs [≥ 2.0]. The global CS values in the stressed state were significantly decreased than the resting state values in patients with abnormal MFRs. ConclusionsThis study applied endocardial feature-tracking to 13N-ammonia PET, and the results suggested that blood flow and myocardial motility could be clinically assessed in ischemic patients using a single PET scan.

Myocardial strain analysis by cardiac magnetic resonance 3D feature-tracking identifies subclinical abnormalities in patients with neuromuscular disease and no overt cardiac involvement.

Cardiovascular magnetic resonance (CMR) is valuable for the detection of cardiac involvement in neuromuscular diseases (NMDs). We explored the value of 2D- and 3D-left ventricular (LV) myocardial strain analysis using feature-tracking (FT)-CMR to detect subclinical cardiac involvement in NMD. The study included retrospective analysis of 111 patients with NMD; mitochondrial cytopathies (n = 14), Friedreich's ataxia (FA, n = 27), myotonic dystrophy (n = 27), Becker/Duchenne's muscular dystrophy (BMD/DMD, n = 15), Duchenne's carriers (n = 6), or other (n = 22) and 57 age- and sex-matched healthy volunteers. Biventricular volumes, myocardial late gadolinium enhancement (LGE), and LV myocardial deformation were assessed by FT-CMR, including 2D and 3D global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), and torsion. Compared with the healthy volunteers, patients with NMD had impaired 2D-GCS (P < 0.001) and 2D-GRS (in the short-axis, P < 0.001), but no significant differences in 2D-GRS long-axis (P = 0.101), 2D-GLS (P = 0.069), or torsion (P = 0.122). 3D-GRS, 3D-GCS, and 3D-GLS values were all significantly different to the control group (P < 0.0001 for all). Especially, even NMD patients without overt cardiac involvement (i.e. LV dilation/hypertrophy, reduced LVEF, or LGE presence) had significantly impaired 3D-GRS, GCS, and GLS vs. the control group (P < 0.0001). 3D-GRS and GCS values were significantly associated with the LGE presence and pattern, being most impaired in patients with transmural LGE. 3D-FT CMR detects subclinical cardiac muscle disease in patients with NMD even before the development of replacement fibrosis or ventricular remodelling which may be a useful imaging biomarker for early detection of cardiac involvement.

Layer-specific Strain Analysis with Cardiac MRI Feature Tracking in Acute Myocarditis.

To evaluate the diagnostic performance of layer-specific cardiac MRI feature-tracking (FT) strain analysis in patients with acute myocarditis. Seventy patients (mean age, 43 years ± 19 [SD]; 46 men) with clinically defined acute myocarditis and 42 healthy controls who underwent cardiac MRI from March 2014 to November 2018 were retrospectively analyzed. FT-based left ventricular peak systolic global longitudinal strain (GLS) and global circumferential strain (GCS) were assessed at subendocardial, midmyocardial, and subepicardial layers. The 2018 Lake Louise criteria (LLC) were assessed. Patients with myocarditis were dichotomized into two groups: those with preserved and those with reduced ejection fraction. For statistical analysis, unpaired t test, one-way analysis of variance, Pearson correlation, and receiver operating characteristic analysis were used. GLS and GCS values of all layers (eg, midmyocardial GCS: -21.3% ± 5.5 vs -28.0% ± 4.3; P < .001) were impaired in patients with myocarditis compared with controls. Only subepicardial GLS (-20.0% ± 3.3 vs -17.5% ± 3.3; P < .001) and midmyocardial GCS values (-28.0% ± 4.3 vs -23.1% ± 4.3; P < .001) could differentiate between controls and patients with preserved ejection fraction. Midmyocardial GCS correlated with inflammatory myocardial parameters (eg, late gadolinium enhancement percentage, r = 0.48, P < .001). Midmyocardial GCS (area under the receiver operating characteristic curve [AUC], 0.82) and subepicardial GLS (AUC, 0.77) had the highest diagnostic performance for acute myocarditis diagnosis (P < .05 against all other strain parameters). The diagnostic performance of the 2018 LLC was significantly improved by inclusion of these two strain parameters (AUC, 0.92 vs 0.97; P = .04). Diagnostic performance of cardiac MRI FT strain was different between myocardial layers in acute myocarditis, with midmyocardial GCS and subepicardial GLS providing the highest diagnostic performance.Keywords: MRI, Cardiac, Heart, Left Ventricle, Inflammation, Tissue Characterization, MR-Functional Imaging, Feature-Tracking Strain, Acute Myocarditis Supplemental material is available for this article. © RSNA, 2022.

Left ventricle myocardial deformation in olympic athletes assessed by cardiac magnetic resonance: does the sex and discipline matter?

Abstract Funding Acknowledgements Type of funding sources: None. Background Sport induces structural and functional cardiac adaptation with different entity related to several factors including type of training and gender. Cardiovascular Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of athletes’ heart and commonly relies on ventricular volume, wall thickness and ejection fraction (EF) assessment. Data on myocardial deformation (MD) are limited to echocardiography and are scarce. Purpose To assess MD in Olympic athletes and to evaluate the possible influence of sport categories and gender. Methods A group of Olympic athletes evaluated prior the Olympic games with unremarkable cardiovascular pre-participation screening tests underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine-images were post-processed for volume and function evaluation and to assess global longitudinal strain (GLS) and global circumferential strain (GCS) by feature-tracking software. Athletes were divided in subgroups according to ESC sport classification. Male and female athletes were compared. Athletes were also divided based on EF (≤53% or &amp;gt;53%). Results 93 elite athletes (33% power, 33% mixed, 33% endurance) and 18 controls were enrolled. No differences in terms of EF were observed, while endurance athletes showed the greater LV remodeling (Table). GLS and GCS values of the entire population were -22.5±2.7% and -30.7±3.4%, respectively. No significant differences were found comparing athletes of different sport categories and sedentary controls for GLS (p= 0.940) and GCS (p=0.072). Female athletes showed higher GLS compared to male (-23.5±2.8% vs-21.9±2.8%, p=0.002) but not differences in terms of GCS (-31.5±3.1% vs-30.2±3.5%, p=0.076). Athletes with EF≤53% had lower GLS values compared with those with &amp;gt;53% but within normal limits (Figure). Conclusion No differences were observed in MD assessed by CMR between different sport categories and controls. Female athletes showed higher longitudinal but not circumferential strain compared with male. Athletes with lower EF presented lower values of strain but within normal range with the potentiality to be used as a tool for differential diagnosis between normal adaptation and disease.

Prognostic value of two-dimensional strain in early ischemic heart disease: A 5-year follow-up study.

Two-dimensional strain echocardiography (2D-SE) is a reliable method for measuring deformation of the left ventricle. Aim of the study was to determine changes in 2D-SE parameters over time collected during dipyridamole stress echo-cardiography (dipy-stress) and prognosis of patients with non-diagnostic dipy-stress results. In the first phase of the study, assessment of a prospective enrolled population with a non-diagnostic dipy-stress test result was conducted, checking through coronary CT angiography (CCTA) the presence of coronary artery disease (CAD). In the follow-up phase, an echocardiographic re-evaluation and outcome analysis during a mean follow-up of 78 months was carried out. In the first phase, Global Circumferential Strain (GCS) values were similar in the CCTA positive and CCTA negative groups at rest and after stress. For Global Longitudinal Strain (GLS), there was a significant reduction (p < .0001) in the CCTA positive group compared to the CCTA negative group. After 78 ± 9 months none of the enrolled patients experimented cardiac events. Values of GCS, both at rest and after stress, did not differ statistically comparing follow-up values with baseline ones. No statistically significant changes were seen in the same analysis for GLS rest and stress values, between baseline and follow-up in the two groups. Performing 2D-SE during dipy-stress can detect mild CAD that conventionalstress-testsmiss. Patients with mild coronary stenosis may have a favorable mid-term prognosis, but efforts should be made to investigate the decrease trend in GLS, at rest and after stress, reported in this patient group.

MO977: Circulating CD14++CD16+MONocytes, NK Cells and LYMPHOcyte Subsets Correlate with Conventional and Novel Deformation Related Indices of Left Ventricular Function in Kidney Transplant Recipients with no Established Cardiovascular Disease

Abstract BACKGROUND AND AIMS Kidney transplant recipients (KTRs) carry a significant burden of cardiovascular disease (CVD), despite improvement of patterns of left ventricular (LV) remodeling following kidney transplantation. Kidney allograft dysfunction and the immunosuppressed milieu play a major adverse role in myocardial structural changes in asymptomatic KTRs. An intricate relationship exists between immune system responses with heart failure syndromes, manifesting among others with aberrant activity and counts of proinflammatory CD16+monocytes, of natural killer (NK) cells and T regulatory cells (Tregs). The associations of immune cell subpopulations with subclinical markers of CVD remain to be determined in KTRs. The aim of our study was to investigate potential correlations between blood levels of specific immune cells subsets with conventional and novel deformation related indices of LV function in KTRs. METHOD 31 stable KTRs (mean age 58 ± 9.28 years, 67% males, 13% diabetics) without established CVD were enrolled. Control population included 17 chronic kidney disease (CKD) stage 3 patients without history of CVD. Additional exclusion criteria were history of malignancy, autoimmune disease and active or chronic infections. The peripheral blood immune cell subsets CD14++CD16-, CD14++CD16+and CD14+CD16++ absolute values and percentages out of total monocytes and NK cells (CD3+CD16+56+), CD3-CD19+B lymphocytes, CD3+CD4+T cells, CD3+CD8+T cells and Tregs (CD4+CD25+FoxP3+) absolute values and percentages out of total lymphocytes were measured by flow cytometry. Simultaneously, conventional (left atrial volume index (LAVI), LV mass index (LVMI), E/E’) and novel 2D speckle tracking (2DST) echocardiographic indices of LV function [global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), TWIST AND UNTWIST] were assessed. RESULTS KTRs had a mean eGFR of 58 ± 18 mL/min/1.73 m2 (CKD-EPI) and mean 24-h proteinuria (PER) 707 ± -1185 mg/24 h. Total lymphocytes, B-cells, T-cells and CD8+T cells counts correlated positively with eGFR (P &amp;lt; 0.05). Increased non-classical CD14+CD16++ monocytes were associated with proteinuria levels (P &amp;lt; 0.01) whereas an inverse correlation was observed between the percentage of classical CD14++CD16- monocytes with PER (P &amp;lt; 0.05). When compared with CKD patients, KTRs displayed higher CD14++CD16- and lower CD14+CD16++ monocytes counts, a lower percentage of NK cells and T cells and lower Tregs (significant differences presented in Table 1). Regarding classical indices of LV function, increased total monocytes were associated with elevated LAVI (P &amp;lt; 0.05), whereas an increased percentage of the intermediate CD14++CD16+monocytes correlated positively with an increased E/E’ value. Increased NK cells were associated with more negative GCS values (P &amp;lt; 0.05). No significant correlations were observed between the rest immune cells with the classical or novel LV dysfunction indices. CONCLUSION Alterations of immune cells subsets correlate with subclinical markers of LV dysfunction in KTRs with no established CVD. Future research is required to evaluate the role of immune subpopulations as tools to identify KTRs who are at the highest risk for complications and guide interventions.

Application of Layered Strain Technique in NSTE-ACS.

Background To explore the application value of layered strain technique in non-ST elevation acute coronary syndrome (NSTE-ACS). Methods 120 patients with suspected NSTE-ACS undergoing coronary angiography in our hospital from December 2018 to December 2019 were prospectively selected. According to the results of coronary angiography, the patients were divided into the significant CAD group and the nonsignificant CAD group. Echocardiography was performed 1-2 hours before invasive coronary angiography. The long axis and circumferential strain of the endocardium, myocardial layer, and epicardium were evaluated by the layered strain technique. The territorial longitudinal strain (TLS), the global longitudinal strain (GLS) of the three myocardial layers, and the global circumferential strain (GCS) were calculated based on the perfusion region of the three coronary arteries and the 17-segment model of the left ventricle. The primary endopoints were TLS and GCS of the three-layer myocardium. Results Compared with the nonsignificant CAD patients, the TLS and GCS of three-layer myocardium in significant CAD patients were decreased, especially in the endocardium. The absolute values of TLS and GCS of the endocardium and epicardium in significant CAD patients were lower than those in nonsignificant CAD patients. This indicates a significant decrease in endocardial function. Receiver operating characteristic (ROC) curve analysis showed that endocardial TLS was superior to LVEF, Troponin I (TnI), and other strain parameters in evaluating the extent of coronary lesions. Conclusions The layered strain technique of 2D-STE can evaluate the severity of coronary lesions in patients with NSTE-ACS, and for significant CAD patients, endocardial function is significantly more impaired than epicardial function.

Speckle Tracking Echocardiographic Assessment of Left Ventricular Function by Myocardial Strain Before and After Aortic Valve Replacement.

Background & objectivesIn patients of aortic stenosis and regurgitation, pressure and volume effects on left ventricular function are occult and missed by routine echocardiography markers like ejection fraction (EF). Speckle tracking analysis by measuring global longitudinal strain and global circumferential strain seems to ascertain this occult LV function parameters at an early phase in a more comprehensive manner. Limited studies have examined these parameters pre/post aortic valve replacement (AVR).Methods94 consecutive patients with symptomatic severe aortic stenosis (AS) or aortic regurgitation (AR), planned for AVR were included (as per set inclusion criteria) along with 15 normal controls-15 months prospective study. Routine echocardiography and speckle tracking imaging was done at baseline (pre AVR) and post AVR at 1st week, 1st month and 3rd month of follow up.Results90 patients completed study (70 in AS and 20 in AR group). In AS group mean values (± 2 standard deviations) of global longitudinal strain (GLS) improved from a baseline −10.9% (± 3.9) to −19.4% (±3.8) at 3rd month (p value < 0.0001). Mean values of global circumferential strain (GCS) too improved from −17.3% (±4.5) to −21.4% (±3.6) respectively (p value < 0.0001). In AR group too mean values of global longitudinal strain progressed from a baseline −12.6% (±3.9) to −19.4% (±3.4) at three months of follow (p value < 0.0001) and mean values of global circumferential strain also progressed from −15.3% (±3.4) at baseline to −21.7% (±3.1) respectively (p value < 0.0001).ConclusionMagnitude of recovery of GLS and GCS after AVR was more as compared to recovery in EF. Poor GLS/GCS values at baseline were associated with lesser recovery pressing need for an earlier intervention.

Abstract 9923: Global Circumferential Strain and Cardiovascular Events in Patients with Myocarditis Related to Immune Checkpoint Inhibitors

Introduction: Myocarditis is a rare but highly morbid complication of immune-checkpoint inhibitors (ICI) use. Improved methods for detection and risk stratification are needed. Cytotoxic chemotherapy associates with reduced global circumferential strain (GCS) but no data is available on the utility of GCS in ICI myocarditis. Hypothesis: We hypothesized that GCS by echocardiography would be reduced in ICI myocarditis and the magnitude of reduction would have prognostic implications. Methods: In this retrospective cohort, GCS from 75 patients with ICI myocarditis (cases) and 49 ICI treated patients without myocarditis (controls) was compared. Pre-ICI GCS values were available for 10 cases and 39 controls. Measurements were performed by a reader blinded to group and time (TomTec, Germany). Major adverse cardiac event was defined as a composite of cardiogenic shock, cardiac arrest, complete heart block, and cardiac death. Results: Cases and controls had similar age (66±15 vs. 63±12 years; p=0.19), sex (male: 55% vs. 66%; p=0.22) and cancer type (p=0.08). Pre-ICI GCS values were lower in cases (n=10) than in controls (n=39) (-21.7±2.0 vs. -23.5±2.9, p=0.04), but within normal range. Overall, 56% (n=42) of cases had left ventricular ejection fraction (LVEF) &gt;50% at presentation. The GCS was lower in cases than in controls (-17.5±4.2 vs. -23.5±3.0, p&lt;0.001) in the entire cohort and in both preserved (-19.7±3.8 vs. -23.6±3.0, p&lt;0.001) and reduced EF (-14.6±2.7 vs. -20.9±2.3, p&lt;0.001) strata. Over a median follow-up of 30 days, 28 events occurred. An absolute GCS value &lt; the median (17.1%) was associated with an increased rate of events (HR: 4.9, 95% CI: 1.6-15.0, p=0.005, Figure), adjusted for age and LVEF. The association was also noted when GCS is treated as continuous (HR: 1.18, 95% CI: 1.03-1.35, p=0.02). Conclusions: Global circumferential strain is lower in patients with ICI-myocarditis and the magnitude of the reduction in GCS has prognostic significance.

Application Effect and Evaluation of Two-Dimensional Speckle Tracking Imaging on Myocardial Damage in Patients with Malignant Lymphoma Treated with Anthracyclines.

Objective The purpose was to study the monitoring effect and application value of two-dimensional speckle tracking imaging (2D-STI) on myocardial function in patients with malignant lymphoma after treatment with anthracyclines. Methods 50 patients with malignant lymphoma treated in our hospital from June 2017 to December 2019 were randomly selected and were treated with anthracyclines to compare the cardiac global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), left ventricular twist (LVtw), GLS × LVtw, and changes of atrioventricular inner diameters before and after 3 cycles of treatment. According to the pathological examination results, the accuracy of 2D-STI in the detection of changes in myocardial function of patients was also clarified. Results The absolute values of GLS, GRS and GCS after treatment were significantly lower than those before treatment, with statistical significance (P < 0.05). The LVtw and GLS × LVtw after 3 cycles of treatment were significantly lower than those before treatment, with statistical significance (P < 0.05). There was no significant difference in the atrioventricular inner diameters of patients before and after treatment, with no statistical significance (P > 0.05). There was no significant difference between the monitoring results of 2D-STI and the pathological examination results, with no statistical significance (P > 0.05). Conclusion Anthracyclines can cause some myocardial damage in patients with malignant lymphoma. The application of 2D-STI to monitor the changes in myocardial function of patients can give more accurate monitoring results, facilitating the early implementation of appropriate treatment.

Speckle tracking echocardiography in severe patient-prosthesis mismatch.

Although aortic valve replacement (AVR) when successfully performed boasts low mortality rates in selected patients, prosthesis-patient mismatch (PPM) can be found in the majority of these individuals. Limited research is available supporting the benefit of two-dimensional speckle tracking echocardiography (2D-STE) in patients with severe PPM. This study sought to assess myocardial strain using 2D-STE to determine the relationship between subclinical left ventricular (LV) dysfunction and aortic PPM in patients undergoing AVR with preserved LV ejection fraction. We retrospectively examined all consecutive patients with isolated AVR who presented to our center from 2005 to 2018. The data of 1086patients were analyzed. Severe PPM was defined as an indexed effective orifice area of 0.65 cm2/m2 or less. As aresult of the detailed assessment, 54patients meeting the eligibility criteria were included in the study. Baseline data were collected and compared between the two groups of patients with severe PPM (n = 27) and those with normofunctional aortic prosthesis valve as acontrol group (n = 27). All patients underwent baseline echocardiography. Global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 2D-STE. When compared with controls, patients with severe PPM had significantly decreased GLS (18.6 ± 2.9 vs. 21.4 ± 2.1; p < 0.01) and GCS (17.2 ± 3.6 vs. 21.7 ± 2.1; p < 0.01) values. In addition to standard clinical and echocardiographic parameters, GLS and GCS suggest subclinical dysfunction and have incremental value in patients with severe PPM.