Left Ventricular Global Circumferential Strain Research Articles

Unveiling myocardial microstructure shifts: exploring the impact of diabetes in stable CAD patients through CMR T1 mapping

BackgroundThis study investigates myocardial structural changes in stable coronary artery disease (CAD) patients with type 2 diabetes (T2D) using cardiac magnetic resonance (CMR) strain and T1 mapping.MethodsA total of 155 stable CAD patients underwent CMR examination, including left ventricular (LV) morphology and function assessment, late gadolinium enhancement (LGE), and feature tracking (CMR-FT) for LV global longitudinal, circumferential, and radial strain. T1 mapping with extracellular volume (ECV) evaluation was also performed.ResultsAmong the enrolled patients, 67 had T2D. Diabetic patients exhibited impaired LV strain and higher ECV compared to non-diabetics. Multivariate analysis identified T2D as an independent predictor of increased ECV and decreased strain.ConclusionsCMR-based strain and T1 mapping highlighted impaired myocardial contractility, elevated ECV, and potential interstitial fibrosis in diabetic patients with stable CAD. This suggests a significant impact of diabetes on myocardial health beyond CAD, emphasizing the importance of a comprehensive assessment in these individuals.Trial registrationhttp://www.controlled-trials.com/ISRCTN09454308

Potential prognostic impact of left-ventricular global longitudinal strain in analysis of whole-heart myocardial mechanics in nonischemic dilated cardiomyopathy.

Cardiac magnetic resonance (CMR) feature-tracking (FT) has an important diagnostic role in non-ischemic dilated cardiomyopathy (NIDCM). To date, the relationship between whole-heart myocardial mechanics by CMR and early primary outcomes in NIDCM has not been elucidated. patients with NIDCM were eligible for this study. CMR-FT was used to analyze whole-heart myocardial mechanics. The primary outcomes were a composite of heart failure (HF) death, heart transplantation (HT), and hospitalization for HF worsening (WHF) after 1-year since diagnosis. 98 patients were included. During a 1-year follow-up, a worse prognosis occurred in 32 patients (30 hospitalizations for WHF, 8 deaths, and 3 HT). The left ventricular (LV) global longitudinal systolic strain (GLS), left ventricular global circumferential strain (LV GCS), strains of right ventricle and both atria were significantly reduced in patients with events vs. those without (GLS -8.0 ± 3.4 vs. -12.1 ± 4.5, p < 0.001; GCS -13.0 ± 6.4 vs. -18.3 ± 7.1, p < 0.001; right ventricular (RV) GLS -12.1 ± 4.9 vs. -17.4 ± 6.4, p < 0.001; left atrial longitudinal strain 7.5 ± 3.8 vs. 15.1 ± 12.3, p < 0.001; right atrial longitudinal strain 11.0 ± 6.7 vs. 17.2 ± 8.0, p < 0.001). Left ventricular ejection fraction (LVEF) was significantly higher in patients with better prognosis (22.7 ± 8.7 vs. 33.56 ± 10.4, p < 0.001). Multivariate regression analysis revealed LV GLS as an independent predictor of a worse prognosis (OR 0.787, CI 95% 0.697-0.890, p < 0.001). reduction of LV GLS showed the strongest predictive value for the composite outcome of WHF, HT, and HF death.

Characteristics and prognostic value of cardiac magnetic resonance strain analysis in patients with different phenotypes of heart failure.

Strain analysis of cardiac magnetic resonance imaging (CMR) is important for the prognosis of heart failure (HF). Herein, we aimed to identify the characteristics and prognostic value of strain analysis revealed by CMR in different HF phenotypes. Participants with HF, including HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction, and controls were enrolled. The baseline information and clinical parameters of participants were collected, and echocardiography and CMR examination were performed. Three-dimensional strain analysis was performed in the left ventricle, right ventricle, left atrium, and right atrium using CMR. A multifactor Cox risk proportional model was established to assess the influencing factors of cardiovascular adverse events in patients with HF. During a median follow-up of 999 days (range: 616-1334), 20.6% of participants (73/354) experienced adverse events (HF readmission and/or cardiovascular death). Univariable Cox regression revealed that a 1% increase in left atrial global longitudinal strain (LAGLS) was associated with a hazard ratio (HR) of 1.21 [95% confidence interval (CI):1.15-1.28; P < 0.001]. Left ventricular global circumferential strain (LVGCS) (HR, 1.18; 95% CI: 1.12-1.24; P < 0.001), and left ventricular global longitudinal strain (LVGLS) (HR, 1.27; 95% CI: 1.20-1.36; P < 0.001) were also associated with HF hospitalizations and cardiovascular deaths. Among clinical variables, hypertension (HR, 2.11; 95% CI: 1.33-13.36; P = 0.002), cardiomyopathy (HR, 2.26; 95% CI: 1.42-3.60; P < 0.001) were associated with outcomes in univariable analysis. Multivariable analyses revealed that LAGLS (95% CI: 1.08-1.29; P < 0.001), LVGLS (95% CI:1.08-1.29; P < 0.001) and LVGCS (95% CI: 1.19-1.51; P < 0.001) were significantly associated with outcomes. Among clinical variables, hypertension (95% CI: 1.09-3.73; P < 0.025) remained a risk factor. CMR plays an obvious role in phenotyping HF. Strain analysis, particularly left atrial and left ventricular strain analysis (LAGLS, LVGLS, and LVGCS) has good value in predicting adverse outcome events.

Left atrial and left ventricular strain in feature-tracking cardiac magnetic resonance for predicting patients at high risk of sudden cardiac death in hypertrophic cardiomyopathy.

Sudden cardiac death (SCD) represents the most severe complication of hypertrophic cardiomyopathy (HCM). The risk stratification of SCD in patients with HCM remains a subject of ongoing debate, and the utility of left atrial (LA) and left ventricular (LV) myocardial strain for risk stratification of also SCD remains uncertain. Through use of feature-tracking cardiac magnetic resonance (FT-CMR), this study aimed to investigate the attenuation of LA and LV strain in HCM and to assess their predictive value in SCD. This retrospective and cross-sectional study included patients with HCM who underwent 3.0 T cardiac magnetic resonance (CMR) at a single institution. Feature-tracking strain analysis was conducted to obtain the strain rate (SR) and LV strain and to evaluate LV function. LA strain was measured during different functional phases including left atrial reservoir strain (LARS), LA conduit strain (LACS), and LA booster strain. All patients were categorized into high- and low-risk groups for SCD as defined by the 2020 American Heart Association/American College HCM implantable cardioverter defibrillator class of recommendation algorithm. Comparison between the two groups was conducted using the independent samples t test and the nonparametric rank sum test. Multivariate logistic regression analysis was performed to further identify the factors influencing SCD risk in HCM. Compared with those in the low-risk group, patients in the high-risk group had lower left ventricular ejection fraction (LVEF), LV stroke volume index (LVSVI), and LA stroke volume index (LASVI) but a higher LV end-systolic volume index (LVESVI), LV maximum wall thickness, and late gadolinium enhancement (LGE) (P<0.001). LV strain, SR, and LA strain all showed significant differences between the high- and low-risk groups (LARS: P=0.04; LACS: P=0.02; all other P values <0.001). The LV global circumferential strain (LVGCS) had a strong negative correlation with LVEF in patients with HCM (r=-0.76; P<0.001). Multivariate analysis showed that LV global radial strain (LVGRS) and LARS could be used for categorizing the patients into the high-risk group [LVGRS: odds ratio (OR) =0.69; 95% confidence interval (CI): 0.55-0.87, P<0.001; LARS: OR =1.39; 95% CI: 1.02-1.90, P=0.03]. The combined LVGRS-LARS model exhibited a superior diagnostic value for high risk of SCD [area under the curve (AUC) =0.95; 95% CI: 0.90-1.00; P<0.001] compared to LARS alone (AUC =0.63; 95% CI: 0.51-0.76; P=0.04). LA and LV strain measured by FT-CMR can accurately identify those patients with HCM at a high risk of SCD. This approach may prove considerably value in guiding early therapeutic intervention with implantable cardioverter-defibrillators (ICDs) to prevent adverse clinical outcomes.

Assessment of new-onset heart failure prediction in a diabetic population using left ventricular global strain: a prospective cohort study based on UK Biobank.

Impaired glucose utilization influences myocardial contractile function. However, the prognostic importance of left ventricular global radial strain (LV-GRS), left ventricular global circumferential strain (LV-GCS), and left ventricular global longitudinal strain (LV-GLS) in predicting new-onset heart failure (HF) in a population with diabetes is unclear. The study design is prospective cohort from the UK Biobank. Totally 37,899 participants had a complete data of cardiac magnetic resonance (CMR), of which 940 patients with diabetes were included, and all the participants completed follow-up. LV-GRS, LV-GCS, and LV-GLS were measured by completely automated CMR with tissue tagging. Cox proportional hazards regression analysis and C-index was performed to evaluate the association between the strain parameters and the new-onset HF in patients suffering from diabetes. The average age of the 940 participants was 57.67 ± 6.97 years, with males comprising 66.4% of the overall population. With an average follow-up period of 166.82 ± 15.26 months, 35 (3.72%) patients reached the endpoint (emergence of new-onset HF). Significant associations were found for the three strain parameters and the new-onset HF (LV-GRS-hazard ratio [HR]: 0.946, 95% CI: 0.916-0.976; LV-GCS-HR: 1.162, 95% CI: 1.086-1.244; LV-GCS-HR: 1.181, 95% CI: 1.082-1.289). LV-GRS, LV-GCS, and LV-GLS were closely related to the related indicators to HF, and showed a high relationship to new-onset HF in individuals with diabetes at 5 and 10 years: LV-GRS: 0.75 (95% CI, 0.41-0.94) and 0.76 (95% CI, 0.44-0.98), respectively; LV-GCS: 0.80 (95% CI, 0.50-0.96) and 0.75 (95% CI, 0.41-0.98), respectively; LV-GLS: 0.72 (95% CI, 0.40-0.93) and 0.76 (95% CI, 0.48-0.97), respectively. In addition, age, sex, body mass index (BMI), and presence of hypertension or coronary artery disease (CAD) made no impacts on the association between the global strain parameters and the incidence of HF. LV-GRS, LV-GCS, and LV-GLS is significantly related to new-onset HF in patients with diabetes at 5 and 10 years.

The worsening effect of paroxysmal atrial fibrillation on left ventricular function and deformation in type 2 diabetes mellitus patients: a 3.0 T cardiovascular magnetic resonance feature tracking study

BackgroundAtrial fibrillation (AF) has been linked to an increased risk of cardiovascular death, overall mortality and heart failure in patients with type 2 diabetes mellitus (T2DM). The present study investigated the additive effects of paroxysmal AF on left ventricular (LV) function and deformation in T2DM patients with or without AF using the cardiovascular magnetic resonance feature tracking (CMR-FT) technique.MethodsThe present study encompassed 225 T2DM patients differentiated by the presence or absence of paroxysmal AF [T2DM(AF+) and T2DM(AF−), respectively], along with 75 age and sex matched controls, all of whom underwent CMR examination. LV function and global strains, including radial, circumferential and longitudinal peak strain (PS), as well as peak systolic and diastolic strain rates (PSSR and PDSR, respectively), were measured and compared among the groups. Multivariable linear regression analysis was used to examine the factors associated with LV global strains in patients with T2DM.ResultsThe T2DM(AF+) group was the oldest, had the highest LV end‑systolic volume index, lowest LV ejection fraction and estimated glomerular filtration rate compared to the control and T2DM(AF−) groups, and presented a shorter diabetes duration and lower HbA1c than the T2DM(AF−) group. LV PS-radial, PS-longitudinal and PDSR-radial declined successively from controls through the T2DM(AF−) group to the T2DM(AF+) group (all p < 0.001). Compared to the control group, LV PS-circumferential, PSSR-radial and PDSR-circumferential were decreased in the T2DM(AF+) group (all p < 0.001) but preserved in the T2DM(AF−) group. Among all clinical indices, AF was independently associated with worsening LV PS-longitudinal (β = 2.218, p < 0.001), PS-circumferential (β = 3.948, p < 0.001), PS-radial (β = − 8.40, p < 0.001), PSSR-radial and -circumferential (β = − 0.345 and 0.101, p = 0.002 and 0.014, respectively), PDSR-radial and -circumferential (β = 0.359 and − 0.14, p = 0.022 and 0.003, respectively).ConclusionsIn patients with T2DM, the presence of paroxysmal AF further exacerbates LV function and deformation. Proactive prevention, regular detection and early intervention of AF could potentially benefit T2DM patients.

Echocardiographic assessment of left ventricular myocardial strain, as a non-invasive method for diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease

Background. Pulmonary hypertension is a common complication of chronic kidney disease, with incidence of up to 50%. Currently, the prognostic significance of non-invasive diagnostic methods for pulmonary hypertension in patients with chronic kidney disease remains relevant.Aim. To determine the significance of transthoracic echocardiography in diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease.Material and methods. The study group consisted of 53 patients with chronic kidney disease stage 5D who were evaluated for kidney transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2022. A control group was represented by 24 healthy volunteers. Transthoracic echocardiography was performed on all patients according to a standard protocol, with determination of left ventricular myocardial strain indices.Results. A statistically significant correlation was found between the left ventricular global longitudinal strain and pulmonary artery systolic pressure r=0.488 (p&lt;0.001), as well as between the left ventricular global circumferential strain and pulmonary artery systolic pressure (r=0.545, p&lt;0.001). Regression analysis showed that an increase in pulmonary artery systolic pressure by 1 mmHg increased the odds of lethal outcome by 13% (Odds ratio: 1.13; 95% Confidence interval: [1.05;1.22], p=0.002).Conclusions. Hemodialysis patients are characterized by the development of pre-capillary pulmonary hypertension, which significantly affects their prognosis. Determination of left ventricular myocardial strain indices based on echocardiography provides additional information on the hemodynamics of the pulmonary circulation without using invasive diagnostic methods.

Impact of early stages of CKD with and without proteinuria on cardiac remodelling in UK Biobank cohort

Abstract Background Chronic kidney disease (CKD) is an established predictor of left atrial (LA) and left ventricular (LV) morphological and functional changes, which translate into excessive cardiovascular morbidity and mortality. However, a focussed study exploring the impact of early stages of CKD defined as stage 1 (eGFR &amp;gt; 90 mL/min per 1.73 m2 + albuminuria) and stage 2 (eGFR 60–89 mL/min per 1.73 m2) with and without proteinuria on cardiac magnetic resonance (CMR) parameters is lacking. Purpose In this study, we analysed CMR structural and functional changes in participants with early stages of CKD in the UK Biobank population. Methods 41,095 participants from the UK Biobank imaging study were categorised into CKD stages. We calculated eGFR using the CKD-EPI 2021 equation and proteinuria was ascertained by the urinary protein creatinine ratio (defined as &amp;gt;30mg/mmol). We sought associations between CKD stages (exposure) and CMR parameters: LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV stroke volume (LVSV), LV ejection fraction (LVEF), LV global functional index (LVGFI), LV myocardial contractile function (LVMCF), LV mass (LVM), LV mass-to-volume ratio (LVMVR), LV global longitudinal strain (GLS), LV global radial strain (GRS), LV global circumferential strain (GCS), LA maximum volume and left atrial emptying fraction. In the multivariable regression model, we adjusted for covariates including age, sex, ethnicity, height, body mass index, hypertension, diabetes, smoking status, and hyperlipidaemia Results Among the participants, 26,779 (65.1%) had normal kidney function, 2,787 (6.8%) stage 1 CKD, 10,534 (25.6%) stage 2 CKD without proteinuria, 689 (1.7%) stage 2 CKD with proteinuria, 241 (0.6%) CKD stage 3A (eGFR 59-45mL/min per 1.73 m2) without proteinuria, 28 (0.1%) stage 3A with proteinuria and 37 (0.1%) with more advanced CKD defined as stages 3B and above. Approximately 8 years after characterisation of CKD stages these participants underwent CMR. Using adjusted multivariable regression models setting normal kidney function as the reference group, the presence of proteinuria in stage 3 CKD was associated with smaller LV volume, lower LVM and more impaired LV function (LVSV beta=-11ml, 95% confidence interval (CI): -5 to -16ml and GLS beta=0.9%, 95% CI: 0.2 to 1.7%). Conclusions This study highlights the relationship between proteinuria in the early stages of CKD and cardiac remodelling patterns using CMR. CKD sub-characterisation with presence or absence of proteinuria should be considered for risk stratification.Figure 1

Paradoxical increase in E/e' during severe central hypovolemia in healthy humans

Abstract Introduction The ratio of mitral blood inflow to mitral annular tissue velocity in early diastole (E/e') is widely used as an index of left ventricular (LV) diastolic dysfunction. Theoretically, it is considered that e’ can correct the effect of LV relaxation on E, and thus E/e’ can be applied for the prediction of LV filling pressures in patients with cardiac diseases. However, recent guidelines indicate that E/e’ may not provide a reliable estimate of filling pressures in healthy subjects. Indeed, previous studies have reported that E/e' did not decrease during acute central hypovolemia because both E and e’ are similarly reduced by low preload condtions. However, it is possible that E/e' did not decrease since central hypovolemia are not critical in the previous studies. Purpose The purpose of the present study was to clarify the change of E/e’ during severe central ypovolemia induced by lower body negative pressure. Methods Twelve healthy men (25±5 years old) underwent 2D Doppler and 3D echocardiography during graded lower body negative pressure (LBNP) up to presyncope. We measured LV diastolic function indices by 2D echocardiography including septal and lateral mitral annular early diastolic velocities (e’), and early (E) and late (A) mitral inflow velocities. In addition, we measured LV function indices by 3D echocardiography including end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), global longitudinal strain (GLS), global circumferential strain (GCS), twist and peak untwisting rate. We compared echocardiography indices before LBNP (Baseline) with those at maximal LBNP (LBNPmax) and at half of the maximal LBNP (LBNP1/2max). Results E/e’ (Baseline: 5.8±0.8, LBNP1/2max: 5.4±1.0, LBNPmax: 7.8±2.3, mean±SD, p&amp;lt;0.01, ANOVA) did not change at the LBNP1/2max but increased only at the LBNPmax. E (80±11, 59±10, 62±12 cm/sec, p&amp;lt;0.01) and E/A (2.2±0.8, 1.5±0.5, 1.0±0.3, p&amp;lt;0.01) decreased at the LBNP1/2max as compared to baseline but did not change from LBNP1/2max to LBNPmax. e’ (14.1±2.0, 11.1±1.5, 8.2±2.2 cm/sec, p&amp;lt;0.01) decreased in response to LBNP. LV EF (62±3, 55±5, 43±9 %, p&amp;lt;0.01), LV GLS (-20.5±2.8, -17.6±2.7, -13.6±4.7 %, p&amp;lt;0.01), and LV GCS (-31.2±3.7, -26.8±3.3, -19.4±5.3 %, p&amp;lt;0.01) decreased in response to LBNP. LV twist (15.2±5.1, 14.5±5.4, 20.9±7.7 °, p&amp;lt;0.01) and LV peak untwisting rate (-138±42, -164±50, -245±88 °/cm, p&amp;lt;0.01) increased only at the LBNPmax. Conclusion The present study for the first time showed that E/e’ paradoxically increased during acute severe hypovolemia in healthy humans. This paradox was likely caused by well-preserved E, while e’ decreased in response to acute severe central hypovolemia. The present finding also showed that peak untwisting rate was increased only at severe central hypovolemia, suggesting that the well-preserved E may be caused by high pressure gradient from left atrium to LV induced by enhanced LV untwisting suction function.Key results of this study①Key results of this study②

A novel speckle-tracking echocardiography parameter assessing left ventricular afterload.

Left ventricular stroke work index (LVSWI) and afterload-related cardiac performance (ACP) consider left ventricular (LV) afterload and could be better prognosticators in septic cardiomyopathy. However, their invasive nature prevents their routine clinical applications. This study aimed to investigate (1) whether a proposed speckle-tracking echocardiography parameter, Pressure-Strain Product (PSP), can non-invasively predict catheter-based LVSWI, ACP and serum lactate in an ovine model of septic cardiomyopathy; and (2) whether PSP can distinguish the sub-phenotypes of acute respiratory distress syndrome (ARDS) with or without sepsis-like conditions. Sixteen sheep with ARDS were randomly assigned to either (1) sepsis-like (n = 8) or (2) non-sepsis-like (n = 8) group. Each ARDS and sepsis-like condition was induced by intravenous infusion of oleic acid and lipopolysaccharide, respectively. Pulmonary artery catheter-based LVSWI (the product of stroke work index, mean arterial pressure and .0136), ACP (the percentage of cardiac output measured to cardiac output predicted as normal) and serum lactate were measured simultaneously with transthoracic echocardiography. Two PSP indices were calculated by multiplying the mean arterial blood pressure and either global circumferential strain (PSPcirc) or radial strain (PSPrad). PSPcirc showed a significant correlation with LVSWI (r2 = .66, p < .001) and ACP (r2 = .82, p < .001) in the sepsis-like group. Although PSP could not distinguish subphenotypes, PSPcirc predicted LVSWI (AUC .86) and ACP (AUC .88), and PSPrad predicted serum lactate (AUC .75) better than LV ejection fraction, global circumferential and radial strain. A novel PSP has the potential to non-invasively predict catheter-based LVSWI and ACP, and was associated with serum lactate in septic cardiomyopathy.

Left ventricular deformation in patients with lymphedema before and after the use of medical compression stockings-detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study.

Lymphedema (LE) is a chronic condition, which refers to tissue swelling due to excess interstitial fluid accumulation or impaired lymphatic conduit. Theoretically, lymphedema-related fluid retention could affect left ventricular (LV) mechanics, which could be detailed by recent three-dimensional speckle-tracking echocardiography. Therefore, it was purposed to examine LV strains in LE patients before and one hour after the use of medical compression stockings and to compare findings to those of matched normal subjects. The study comprised 26 cases with lymphedema, however, 4 cases had to be excluded due to inferior quality of images. Their results were compared to 27 age- and gender-matched healthy controls. Global LV circumferential and area strains and mean segmental LV circumferential strain were increased in lymphedema patients before the use of medical compression stockings as compared to controls. One hour after the use of medical compression stockings, no global and mean segmental LV strain showed significant impairment or improvement, but tendentious reduction was seen in LV circumferential strain. With LV segmental analysis, midventricular LV radial, circumferential and area strains proved to be significantly increased, while basal LV longitudinal strain and midventricular LV three-dimensional strain were decreased as compared to controls. No changes in regional LV strains could be detected after one-hour medical compression stockings use as compared to data collected at rest. Increased global LV circumferential strain is seen in lymphedema. With using medical compression stockings, LV deformation parameters change towards the normal range emphasizing their importance on cardiac function.

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

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

Study on the correlation between cardiac function indices measured by velocity vector imaging and disease severity in patients with Parkinson disease.

This study aimed to evaluate cardiac function, particularly left ventricular systolic function, in patients with Parkinson disease (PD) using velocity vector imaging (VVI), and to determine whether a correlation exists between left ventricular global systolic function and PD severity. A case-control study design was used to select 56 PD patients and 30 healthy controls from January 2019 to December 2019. The characteristics of age, sex, BMI and course of disease were collected. The Hoehn-Yahr (H-Y) score was collected to record the grading of PD. The left ventricular systolic function of all patients was evaluated by variable vapor injection (VVI). The left ventricular systolic function was compared between the case group and the control group, and the correlation between cardiac dysfunction and the severity of PD symptoms was assessed using the modified H-Y scale. Compared with control group, left ventricular global systolic function18.22 (17.08, 19.12) vs 18.88 (18.12, 20.01) was lower in PD patients as indicated by left ventricular global longitudinal strain (GLS), and the difference was statistically significant (P = 0.039). Additionally, H-Y scores (r = -0.404) and PD duration(r = -0.323) were significantly correlated with reduced left ventricular ejection fraction (P < 0.01), GLS (P < 0.001), left ventricular global radial strain (GRS; P < 0.001), and left ventricular global circumferential strain (GCS; P < 0.001), along with their associated peak strain rates (GLSr, GRSr, and GCSr; P < 0.001). Subclinical left ventricular global systolic dysfunction in patients with PD can be detected using VVI, and reduced left ventricular systolic function correlates with the modified H-Y score and duration of the disease.

Imaging Predictors of Left Ventricular Functional Recovery after Reperfusion Therapy of ST-Elevation Myocardial Infarction Assessed by Cardiac Magnetic Resonance.

Left ventricular global longitudinal strain (LV GLS) is a superior predictor of adverse cardiac events in patients with myocardial infarction and heart failure. We investigated the ability of morphological features of infarcted myocardium to detect acute left ventricular (LV) dysfunction and predict LV functional recovery after three months in patients with acute ST-segment elevation myocardial infarction (STEMI). Sixty-six STEMI patients were included in the C-reactive protein (CRP) apheresis in Acute Myocardial Infarction Study (CAMI-1). LV ejection fraction (LVEF), LV GLS, LV global circumferential strain (LV GCS), infarct size (IS), area-at-risk (AAR), and myocardial salvage index (MSI) were assessed by CMR 5 ± 3 days (baseline) and 12 ± 2 weeks after (follow-up) the diagnosis of first acute STEMI. Significant changes in myocardial injury parameters were identified after 12 weeks of STEMI diagnosis. IS decreased from 23.59 ± 11.69% at baseline to 18.29 ± 8.32% at follow-up (p < 0.001). AAR and MVO also significantly reduced after 12 weeks. At baseline, there were reasonably moderate correlations between IS and LVEF (r = -0.479, p < 0.001), LV GLS (r = 0.441, p < 0.001) and LV GCS (r = 0.396, p = 0.001) as well as between AAR and LVEF (r = -0.430, p = 0.003), LV GLS (r = 0.501, p < 0.001) and weak with LV GCS (r = 0.342, p = 0.020). At follow-up, only MSI and change in LV GCS over time showed a weak but significant correlation (r = -0.347, p = 0.021). Patients with larger AAR at baseline improved more in LVEF (p = 0.019) and LV GLS (p = 0.020) but not in LV GCS. The CMR tissue characteristics of myocardial injury correlate with the magnitude of LV dysfunction during the acute stage of STEMI. AAR predicts improvement in LVEF and LV GLS, while MSI is a sensitive marker of LV GCS recovery at three months follow-up after STEMI.

Prognostic value of myocardial strain on cardiac magnetic resonance imaging in patients with non-ischemic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial strain measurements using feature tracking imaging (FTI) on cardiac magnetic resonance (CMR) has emerged as a reliable method for evaluating myocardial function. However, the prognostic value of left ventricular strain measurements on CMR remains unclear in patients with nonischemic cardiomyopathy (NICM). Purpose The purpose of this meta-analysis is to evaluate the association of myocardial strain measurements with adverse outcomes in patients with NICM. Methods A literature search was conducted for studies reporting on the association of left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), and left ventricular global radial strain (LVGRS) using FTI on CMR with cardiovascular outcomes on long term follow-up in patients with NICM. The primary endpoint was major adverse cardiac events (MACE). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 6 studies with 1004 participants (251 with MACE and 753 without MACE) met inclusion criteria. Mean follow-up duration was 39 months. Mean ejection fraction was 27%. Baseline LVGLS, LVGCS, and LVGRS were significantly lower in NICM patients who subsequently experienced MACE on follow-up compared to patients without MACE (SMD −0.58, 95% CI −1.01, −0.15; p&amp;lt;0.01; SMD −0.58, 95% CI −0.96, −0.21; p&amp;lt;0.01; SMD −0.43, 95% CI −0.81, −0.05; p = 0.03). Conclusions Myocardial strain measurement using FTI on CMR may represent a useful clinical tool for risk stratification of NICM patients at risk for adverse cardiac events.

Prognostic value of strain echocardiography measurements in patients with non-ischemic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Speckle tracking echocardiography has been increasingly used in the evaluation of myocardial function. However, the association of reduced strain measurements with cardiovascular outcomes remains unclear in patients with nonischemic cardiomyopathy (NICM). Purpose The purpose of this meta-analysis is to evaluate the prognostic value of speckle tracking echocardiography in patients with NICM. Methods A literature search was conducted for studies reporting on the association of left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), left ventricular global radial strain (LVGRS), and right ventricular global longitudinal strain (RVGLS) on baseline echocardiography with cardiovascular outcomes on long term follow-up in patients with NICM. The primary endpoint was major adverse cardiac events (MACE). Secondary endpoints included left ventricular reverse remodeling (LVRR) and ventricular arrhythmias (VA). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 17 studies with 2375 participants (640 with adverse outcomes and 1735 without adverse outcomes) met inclusion criteria. Mean follow-up duration was 33 months. Mean ejection fraction was 30%. Baseline LVGLS, LVGCS, LVGRS, and RVGLS were significantly lower in NICM patients who subsequently experienced MACE on follow-up compared to patients without MACE (SMD −0.57, 95% CI −0.82, −0.32; p&amp;lt;0.01; SMD −0.54, 95% CI −0.75, −0.33; p&amp;lt;0.01; SMD −0.51, 95% CI −0.7, −0.32; p&amp;lt;0.01; SMD −0.46, 95% CI −0.75, −0.18; p&amp;lt;0.01). Baseline LVGLS was significantly higher in patients who experienced LVRR on follow-up compared to patients without LVRR (SMD 0.36, 95% CI 0.05–0.68; p = 0.02). Baseline LVGLS was significantly lower in NICM patients who experienced VA on follow-up (SMD −1.19, 95% CI −2.12, −0.26, p = 0.01). Conclusions Speckle tracking echocardiography may represent a useful clinical tool for risk stratification of NICM patients at risk for adverse cardiac events and poor treatment response.

Cardiac troponin T predicts future lower left ventricular systolic function and synchrony assessed by cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Akershus University Hospital Trust and Vestre Viken Hospital Trust. Roche Diagnostics provided reagents for high sensitivity cardiac troponin T analyses free of charge. Background In the general population, higher concentrations of cardiac troponin T (cTnT) are associated with risk of cardiovascular (CV) disease even within the normal range. Cardiac magnetic resonance (CMR) offers state-of-the-art assessment of the left ventricle with recently developed techniques allowing assessment of myocardial strain and synchrony. There is little prospective observational data describing the association between cTnT and future left ventricular (LV) function assessed by CMR. Purpose To investigate whether cTnT is predictive of future lower LV systolic function and synchrony in the general population. Methods The cohort included 186 participants from the general population who underwent cTnT measurements at baseline followed by CMR feature-tracking 4–7 years later. All participants were born in year 1950, had no overt coronary artery disease and normal kidney function at inclusion. Outcomes were LV global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as mechanical dispersion (MD). MD was calculated as the standard deviation of time to peak longitudinal strain of 16 left ventricular segments adjusted for heart rate. Associations between cTnT concentrations and outcomes were evaluated using linear regression with cTnT modeled as (1) a continuous variable and (2) dichotomized at the level of detection (≥ 3.0 ng/L). Models adjusted for a priori selected confounders influencing CV risk and cTnT concentrations were obtained (model 1: sex, age and estimated glomerular filtration rate; model 2: additionally, hypertension, body mass index, diabetes mellitus and daily smoking). An extended adjustment model included metrics affecting LV loading conditions (model 3: systolic blood pressure, heart rate and end diastolic volume indexed by body surface area at the time of CMR), as well as QRS duration for MD. Results Participants with detectable cTnT had significantly lower absolute GLS, GCS and GRS and higher MD than those with undetectable cTnT (Table 1). The detectable cTnT group had a greater proportion of males, a higher prevalence of hypertension, lower kidney function and was slightly younger at inclusion. Higher cTnT concentrations were independently associated with lower absolute GLS, GCS and GRS and higher MD in both risk factor adjusted models (table 2). For detectable cTnT, similar associations were found in model 1 but the association between detectable cTnT and MD was attenuated in model 2. In the fully adjusted model 3 both detectable and continuous cTnT concentrations remained associated with lower absolute GLS, whereas only detectable cTnT was associated with lower absolute GCS and GRS. Conclusion Higher cTnT, largely within the normal range, is predictive of future lower LV systolic function and synchrony assessed by CMR in a general middle-aged population.

Prognostic role of left atrial morpho-functional parameters in left ventricular remodeling following acute st-elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite prompt reperfusion and optimal medical therapy of acute ST-elevation myocardial infarction (STEMI), patients may undergo left ventricular (LV) remodeling (REM), which may lead to systolic and/or diastolic heart failure. Little is known regarding factors and mechanisms leading to LV REM, and this knowledge gap hinders potential strategies to prevent this complication. Left atrium (LA) functional and dimensional parameters are emerging as independent prognostic markers in ischemic heart disease. Purpose The present study aims at exploring the potential role of LA morpho-functional parameters by CMR-FT in predicting LV REM following STEMI. Methods This study derives from a sub-analysis of the prospective and multicenter "VavirimS" trial. All patients were assessed through 2 consecutive CMR scans, at 1 and 6 months after STEMI. CMR-FT was applied to both LA and LV. The endpoint was to evaluate the association between LA volumes and phasic functions with LV REM at 6-month follow up, defined as: i) LV REMEDV: ≥10% increase in LV end diastolic volume (EDV); ii) LV REMEDV-ESV: ≥12% increase in LV EDV and ≥6% LV end systolic volume (ESV). Results Out of 193 patients included in the VavirimS trial, 149 were enrolled and 44 have been excluded either for inadequate image quality for CMR-FT analysis or for the presence of factors impacting on LA morphology and function (i.e. mitral regurgitation and atrial fibrillation). LV REMEDV occurred in 34 patients (23%), who showed worse LA strain parameters (reservoir, conduit and booster function), LV global radial strain (GRS) and LV global circumferential epicardial strain [Fig. 1]. At multivariate analysis, LA reservoir and LV global radial strain (GRS) were confirmed as independent predictors of LV-REMEDV [Fig. 1]. The best cut-off for LA reservoir and LV GRS were 20% (sensitivity 97%; specificity 45%) and 56% (sensitivity 67%; specificity 69%), respectively. LV REMEDV-ESV occurred in 17 patients (11%), who showed reduced LA strain and LV GRS [Fig. 1]. The only independent predictor of LV remodeling in this group was LA reservoir [Fig. 1]. A subgroup analysis has been performed on two groups, according to EF: i) p-EF: preserved ejection fraction, ii) r-EF: reduced ejection fraction. In the p-EF group both LA reservoir and LV GRS were confirmed to be associated with LV REM [Fig. 1], while in the r-EF group the only independent predictor of LV REM was LV GRS [Fig. 1]. Conclusions CMR-derived LA reservoir and LV GRS are independent predictors of LV remodeling following STEMI. In patients with preserved EF LA reservoir is confirmed as independent predictor of LV remodeling, hinting at early and subclinical impairment of left chambers compliance. LA functional parameters following STEMI may help physicians in identifying patients at higher risk of LV remodeling.

Three-dimensional echocardiographic left ventricular strain analysis in Fabry disease: correlation with heart failure severity, myocardial scar, and impact on long-term prognosis.

Fabry disease (FD) is a multisystemic lysosomal storage disorder caused by a defect in the alpha-galactosidase A gene that manifests as a phenocopy of hypertrophic cardiomyopathy. We assessed the echocardiographic 3D left ventricular (LV) strain of patients with FD in relation to heart failure severity using natriuretic peptides, the presence of a cardiovascular magnetic resonance (CMR) late gadolinium enhancement scar, and long-term prognosis. 3D echocardiography was feasible in 75/99 patients with FD [aged 47 ± 14 years, 44% males, LV ejection fraction (EF) 65 ± 6% and 51% with hypertrophy or concentric remodelling of the LV]. Long-term prognosis (death, heart failure decompensation, or cardiovascular hospitalization) was assessed over a median follow-up of 3.1 years. A stronger correlation was observed for N-terminal pro-brain natriuretic peptide levels with 3D LV global longitudinal strain (GLS, r = -0.49, P < 0.0001) than with 3D LV global circumferential strain (GCS, r = -0.38, P < 0.001) or 3D LVEF (r = -0.25, P = 0.036). Individuals with posterolateral scar on CMR had lower posterolateral 3D circumferential strain (CS; P = 0.009). 3D LV-GLS was associated with long-term prognosis [adjusted hazard ratio 0.85 (confidence interval 0.75-0.95), P = 0.004], while 3D LV-GCS and 3D LVEF were not (P = 0.284 and P = 0.324). 3D LV-GLS is associated with both heart failure severity measured by natriuretic peptide levels and long-term prognosis. Decreased posterolateral 3D CS reflects typical posterolateral scarring in FD. Where feasible, 3D-strain echocardiography can be used for a comprehensive mechanical assessment of the LV in patients with FD.

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.