Global Longitudinal Deformation Research Articles

Innovative study of the fetal heart in monochorionic multiple births

Introduction. Fetal echocardiography is currently one of the main methods of prenatal diagnosis. However, in recent years, attention has shifted towards the use of ultrasound to assess fetal myocardial function.The aim of this study is compare global longitudinal deformation of the myocardium of the left (LV) and right ventricles (RV) of the heart in fetuses with uncomplicated singleton pregnancy, in fetuses from monochorionic twins with transfusion syndrome, selective growth retardation and in uncomplicated monochorionic multiple pregnancy.Material and methods. A prospective cohort study was conducted which included 60 pregnant patients: Group I — patients with an uncomplicated singleton pregnancy (n=25); Group II — 35 patients with monochorionic diamniotic twins, whose pregnancy in 10 cases was complicated by feto-fetal transfusion syndrome (stages I-III according to Quintero R.A.), in 10 cases — selective growth retardation of the second fetus and in 15 cases monochorionic twins without complications. The following parameters were determined: global longitudinal deformation (GLD) of the myocardium of the ventricles of fetal hearts using the speckle tracking method of ejection fraction (EF), end-diastolic and end-systolic volumes of the ventricles of the heart.Results. Significant differences were established in GLD of RV and LV between singleton and monochorionic multiple pregnancies (LV: -21.2 ± 2.03 versus -23.41 ± 0 .25, p = 0.003); RV: — 20.3 ± 2.5 versus -23.3 ± 2.5, p = 0.013). Significant differences were revealed in GLD of the LV and RV in recipient fetuses before and after laser coagulation of placental anastomoses (LPCA) [LV in recipients before LCPA (- 20.4 ± 2.98) versus LV recipient after LCPA (-24.2 ± 3.3), p = 0.018], [RV in recipients before LKPA (- 20.4 ± 2.8) vs. RV in recipients after laser coagulation of placental anastomoses (-23.7 ± 3.4, p = 0.012].Conclusion. Assessment of the cardiac function of fetuses from monochorionic twins using the echocardiographic speckle tracking technique makes it possible to identify early changes in fetal myocardial function in twins from monochorionic diamniotic twins, as well as to carry out reliable testing monitoring changes in cardiac function over time.

Comprehensive evaluation of right ventricular function in patients with acute pulmonary embolism

Objective. To study indices of right ventricular (RV) longitudinal deformation at transthoracic echocardiography (TTE) in patients with acute pulmonary embolism (APE), to determine their threshold values; to study indices of right ventricular-arterial coupling (RVAC) in patients with APE, to determine their threshold values.Methods. We examined 34 patients with acute massive and submassive pulmonary embolism. The diagnosis was made on the basis of computed-tomography pulmonary angiogram. The mean age was 61 ±13 years. Of these, 16 were women (47,1%) and 18 were men (52,9%). As a control group, 30 healthy individuals were examined: 14 males and 16 females. The mean age of the healthy individuals was 39±9,8 years. Echocardiography was performed on Vivid E95 (GE HealthCare, USA) with data postprocessing on EchoPak workstation. The indices of right ventricular (RV) systolic and diastolic function, the magnitude of global longitudinal deformation of the right ventricle (GLS RV) and longitudinal deformation of the right ventricular free wall (RVFWLS) were studied using two-dimensional speckle-tracking echocardiography. We studied indices of right ventricular-arterial coupling (RVAC). We determined the relationship of longitudinal deformation of RV and RVAC with other indices of its systolic function. Results. Mean values of traditional parameters of RV contractile function were within normal limits, whereas mean values of longitudinal strain in APE were significantly lower than normal. There was also a significant decrease ( P < 0,0001) of all measured parameters of right ventricular-arterial coupling in patients with APE in comparison with the control group.Conclusions. When longitudinal deformation parameters are included in the criteria of RV dysfunction in APE, its detectability increases from 26,47% to 61,77%. The revealed decrease of right ventricular-arterial coupling parameters in APE indicates a more frequent disturbance of the connection between RV and the small circle of blood circulation

SST2 and morphofunctional parameters of the left ventricle in patients with ischemic heart disease with chronic heart failure and previous COVID-19

Objective: to assess the concentration of the sST2 biomarker and its relationship with the morphological and functional parameters of the LV myocardium in patients with coronary artery disease and chronic heart failure (CHF) l-lll functional class (FC), who had and did not have COVID-19. Material and methods. We examined 100 patients (66 males), median (Me) age 65 [63; 67] years, with stable coronary artery disease with CHF l-lll FC (New York Heart Association), divided into 2 groups depending on the COVID-19. Along with the conventional clinical examination, the concentration of serum sST2 was determined by enzyme immunoassay Results. It was found that in patients who underwent COVID-19 (group 1), the sST2 level was 38.4 [35.5; 44.8] ng/ml, in the comparison group (group 2) — 29.63 [27.9; 32.7] ng/ml (p<0.001). In group 1, the final diastolic volume and the final systolic volume of LV significantly exceeded those in group 2 (p=0.004 and p=0.02) and amounted to 118.2 [107.5; 166.5] and 44.1 [35.0; 58.1] ml, respectively, for the 1st and 107.5 [92.4; 129.5] and 37.9 [29.5; 47.4] ml for the 2nd group. The number of patients with grade 2 diastolic dysfunction (DD) in group 1 (18-33.9%) significantly exceeded that in the comparison group (7-14.9%). Changes in global longitudinal deformation of LV in COVID-19 group (-15.6 [-20.8; -13.8]%) were more pronounced than in the comparison group (-19.9 [-21.5; -16.3]%)(p=0.018). Conclusion. CHD patients with CHF l-lll FC and previous COVID-19, have significantly higher serum sST2, more pronounced LV DD and greater global longitudinal deformation.

The effectiveness of hardware CPAP therapy in heart failure with preserved left ventricular ejection fraction and obstructive sleep apnea syndrome

Aim. To evaluate the effectiveness of hardware Continuous Positive Airway Pressure therapy (CPAP therapy) and its likely predictors in patients with heart failure with preserved ejection fraction (HFpEF) associated with obstructive sleep apnea syndrome (OSAS).
 Materials and methods. The study involved 207 men with HFpEF and OSAS (apnea/hypopnea index 15 per hour) who did not initially have ischemic disease and other structural heart pathology. At inclusion in the study, polysomnography and echocardiography were performed with an assessment of diastolic function and global longitudinal deformation of the left ventricular myocardium, as well as a 6-minute walk test (6MWT) and the level of the brain natriuretic peptide precursor (NT-proBNP) in the blood was determined. 80 patients received hardware CPAP the rapy, 127 patients made up the control group. After 12 months, 6MWT was repeated, NT-proBNP was determined, and clinical outcomes were assessed retrospectively.
 Results. The CPAP group had 16% fewer hospitalizations (p=0.011 [95% confidence interval – CI 4.29]) and showed a trend towards an increase in the 6MWT distance (p=0.065). To assess the likely predictors of the effectiveness of CPAP therapy, a subgroup of “responders” was identified, characterized by an increase in the distance according to the 6MWT, a decrease in the level of NT-proBNP, and the absence of adverse clinical events during the observation period. There were significant differences between responders and non-responders in apnea/hypopnea index (p=0.01 [95% CI -10.6; -2.5]), global longitudinal deformation of the left ventricular myocardium (p=0.05 [95% CI -4.7; 0]), diastolic function E/A (p=0.02 [95% CI -0.1; 0]).
 Conclusion. CPAP therapy improves clinical outcomes and functional status in patients with OSAS-associated HFpEF. The predictive model built using the identified efficacy predictors can be used to develop a personalized treatment algorithm for this cohort of patients.

Перспективные подходы неинвазивной диагностики субклинической кардиоваскулярной токсичности химиотерапии

Objective: to present data on available modern methods of diagnosis of subclinical cardiovascular toxicity of chemotherapy. Modern strategies of treatment of cancer allow to stable remission and increase life expectancy of patients, the success of which is balanced by increased mortality of cancer patients due to the development of side effects of chemotherapy, the most prognostically significant of which are cardiovascular complications. Early diagnosis of cardiovascular toxicity in cancer patients is a “new” priority for collaboration of oncologists and cardiologists, as the development or progression of an already existing heart disease has a significant impact on the duration and quality of life of cancer patients. This review, at the current level of development of medical science, presents methods of diagnosis and monitoring of subclinical cardiovascular toxicity against the background of chemotherapy. Use for the diagnosis of subclinical cardiotoxicity such modern methods of visualization as two- and three-dimensional echocardiography, echocardiography with the definition of global longitudinal deformation of the myocardium - spectrum-tracking echocardiography, myocardial work, magnetic resonance tomography, definition of diastolic dysfunction allows to identify manifestations of cardiovascular toxicity in earlier terms, thereby affecting the prognosis and quality of life in cancer patients receiving chemotherapy treatment.

Left ventricular speckle tracking echocardiography in predicting of fibrosis in children after correction of anomalous origin of the left coronary artery from the pulmonary artery in the late postoperative period

The aim of our study is a comprehensive echo assessment of the LV function using the speckle tracking technique in children with abnormal origin of the left coronary artery from the pulmonary artery in the late postoperative period аnd a comparative analysis segmental longitudinal and circumferential LV deformation with cardiac magnetic resonance late enhancement of myocardium. Methods. The search is a prospective observational study. We examined and analyzed 25 children with AOLCA from PA in late postoperative period. Obtained morphofunctional LV and RV echo parameters were compared with LV ejection fraction and dimensions, the grade of mitral insufficiency and age at the time of operation. CMR was performed in 15 patients (60%; n = 15/25) using Avanto 1.5T. The average age of children at the time of the study was 8.8 ± 3.5 years.Results. 1) Reduce of LV segmental longitudinal deformation is unique in each patient’s case. The largest number of segments with reduced longitudinal deformation was detected in the 2d (anteroseptal basal); in 4th (inferior basal); 5th (inferolateral basal), 6th (anterolateral basal), 11th (inferolateral middle) segments of LV myocardium. 2) There is no relationship between LV global longitudinal and circumferential deformation in children in the late postoperative period after correction of AOLCA from PA and initial LV morphological and functional echo data (at the time of defect correction). 3) Segmental LV longitudinal deformation Area Under the Curve is 0.64 (0.56–0.72) with “cut-off” 9.5% with a sensitivity of 92% and a specificity of 85% and circumferential segmental deformity Area Under the Curve is 0.48 (0.40–0.56) in the predicting of fibrosis according to CMR data.

Influence of moderate prosthesis–patient mismatch on long-term outcomes in patients with severe aortic stenosis with paradoxically reduced gradients against the background of reduced stroke volume after aortic valve replacement with a biological prosthesis: retrospective comparative study

OBJECTIVE: Our aim was to evaluate the impact of moderate prosthesispatient mismatch on long-term results after aortic valve replacement in patients with severe aortic stenosis with paradoxically reduced gradients against the background of a reduced stroke volume of the left ventricle.
 MATERIALS AND METHODS: We analyzed data from 88 patients with symptomatic severe aortic stenosis meeting the criteria: paradoxically reduced gradients against the background of a reduced stroke volume of the left ventricle. Patients were divided into 2 groups: Group 1 (n=42, mean age 674 years) with paradoxically reduced gradients against the background of reduced stroke volume of the left ventricle, with a moderate patientprosthesis mismatch; Group 2 (n=46, mean age 686 years) with paradoxically reduced gradients against the background of reduced stroke volume of the left ventricle, without patientprosthesis discrepancy. All patients underwent transthoracic echocardiographic evaluation.
 RESULTS: The average follow-up period was 84 (quarterly interval 7598) months, during the follow-up period 35 (40%) deaths were registered. There were no significant differences in in-hospital mortality: 2 (4.7%) and 2 (4.3%), respectively (p=0.2). In the long-term follow-up period, there was a significant difference in survival and hospitalization rates for exacerbation of heart failure between patients with and without patientprosthesis mismatch: 46 and 71%, 37 and 72%, respectively (p0.001). In the long-term follow-up period, patients with patientprosthesis mismatch showed a trend towards slower regression of left ventricle mass and left atrial volume, as well as a slower recovery of global longitudinal deformation of the left ventricle and exercise tolerance compared with patients without patientprosthesis mismatch. There were no significant differences in the incidence of stroke (90% and 91%; p=0.7). According to the results of Cox regression, the left ventricular stroke volume index and the aortic valve effective orifice area index were independent predictors of lethal events and the risk of hospitalization for exacerbation of heart failure.
 CONCLUSION: Moderate patientprosthesis mismatch in patients with paradoxically reduced gradients associated with reduced left ventricular stroke volume is independently associated with increased mortality and increased hospitalization for exacerbations of heart failure.

Parameters of left ventricular deformation in elderly and senile patients with aortic stenosis after transcatheter implantation of the aortic valve

Aim: To evaluate the parameters of left ventricle (LV) myocardial deformation (longitudinal, circular and radial) in patients with symptomatic severe aortic stenosis (AS) with preserved LV ejection fraction after transcatheter aortic implantation valve (TAVI) in the early postoperative period.Material and Methods. The study included 31 patients after TAVI out of 69 with symptomatic severe AS. Echocardiography (EchoCG) using two-dimensional speckle tracking technology was performed before TAVI and in the early postoperative period (within 5 ± 1,7 days).Results. There were no significant differences in the analysis of deformation parameters before TAVI and in the early postoperative period. There was a tendency to increase the longitudinal deformation of the LV, including the longitudinal deformation of the basal, middle and apical segments in individual patients. The longitudinal deformation of the left atrium did not change after TAVI.Conclusion. There were no significant changes in deformation parameters in elderly and senile patients with severe AS and preserved LV ejection fraction and with reduced LV deformation (longitudinal, circular and radial) after minimally invasive TAVI in the early postoperative period. There is a tendency to increase the global longitudinal deformation of the LV.

Cardiac magnetic resonance imaging in patients with history of COVID-19

BACKGROUND: Myocarditis is among the most common complications arising from coronavirus infection (COVID-19).
 AIM: This study aims to find the differences in the patterns of myocardial injury between patients who had COVID-19 and those from the pre-pandemic period, as determined by contrast-enhanced cardiac magnetic resonance imaging.
 MATERIALS AND METHODS: The study encompassed a retrospective analysis of 47 patients who underwent contrast-enhanced cardiac magnetic resonance imaging to rule out acute myocarditis. Group 1 comprised 34 patients with a confirmed history of COVID-19 through PCR testing (nasal and/or throat swabs), while Group 2 comprised 13 individuals who underwent contrast-enhanced cardiac magnetic resonance imaging in 2017 prior to the onset of the COVID-19 pandemic. All patients enrolled in the study had clinical manifestation of cardiac injury without signs of coronary artery disease as an underlying cause of condition.
 RESULTS: The mean time from the onset of heart symptoms to the administration of contrast-enhanced cardiac magnetic resonance imaging was 166 days. In group 1, a decrease in exercise tolerance was observed in 77% of patients, and 14 (42%), 30 (88%), and 28 (85%) of patients complained of chest pain, shortness of breath, and heart palpitations, respectively. In group 2, four patients (30%) had dyspnea, nine patients (69%) complained of chest pain, and six patients (46%) had heart palpitations and/or feeling of arrhythmia. Myocardial injury in group 1 was more generalized. The third of them had displayed preserved increased pulmonary vascularity and pleural effusion. Within group 1, men had significantly lower left ventricular ejection fraction, lower values of global longitudinal deformation, and higher values of left atrial function compared with the corresponding parameters in women. Differences in women were found only in the number of the affected segments in the left ventricular myocardium.
 CONCLUSION: SARS-CoV-2 virus caused extended myocardial injury, affecting a significant number of myocardial segments. Men had more frequent postinflammatory complications, characterized by abnormal function of the left ventricle and left atrium. Obtained results require continuous efforts for further assessment of long-term consequences of previous COVID-19 to the cardiovascular system. In this regard, contrast-enhanced cardiac magnetic resonance imaging may represent a sensitive imaging tool for the assessment of cardiac injury severity.

Pacing-induced cardiomyopathy in patients with permanent right ventricular pacing and preserved left ventricle systolic function: characteristics, methods of treatment and prevention

The aim – to determine the frequency of occurrence and describe the characteristics of pacing-induced cardiomyopathy (PICM) in patients with permanent right ventricular pacing (at least 90 %) and preserved left ventricular ejection fraction (LVEF) (≥ 50 %).Materials and methods. The study included 34 patients with indications for permanent ventricular pacing who had pacemaker implantation from 2012 to 2022 (mean follow-up period was 44.97±28.45 months). PICM was defined as a decrease in LVEF < 45 % during follow-up.Results and discussion. The incidence of PICM in this study was 26 %. The average value of LVEF and EDI at the time of the control follow-up was significantly different in the PICM group and non-PICM group: 38.6±5.9 vs. 53.5±5.7 % (p<0.001) and 97.90±20.75 vs. 60.90±19.32 ml/m2 (p<0.001). All patients from the study group during follow-up went through protocol echocardiography, at which intraventricular and interventricular asynchrony were examined, the number of left ventricular segments with reduced deformation were fixed, and the global longitudinal deformation of the left ventricle (GLS) was calculated. The values of these parameters differed significantly in the PICM group and non-PICM group: intraventricular asynchrony was 261.1±61.0 vs. 146.1±62.8 ms (p<0.001), interventricular asynchrony 91.0±36.4 vs. 54.2±22.2 ms (p=0.014), the number of segments with reduced deformation 8.1±2.6 vs. 3.91±2.30 (p<0.001), GLS -9.7±2.6 vs. -14.9±3.4 (p<0.001). At the time of the follow-up examination, sensitivity on ventricular lead in the PICM group was significantly reduced compared to patients with preserved LVEF (6.26±4.02 vs. 11.56±3.86 mV; p=0.045). The paced QRS width in the PICM group was significantly greater (163.0±22.7 vs. 150.8±14.5; p=0.046) and there were more patients with rate-adapted cardiac pacing in the PICM group (4 (40 %) vs. 2 (8 %)), p=0.0305).Conclusions. According to the obtained data, cardiomyopathy due to right ventricular pacing develops rather instantaneously in the first years after PM implantation, rather than slowly progressing over time, although a multivariate regression analysis of risk factors for the development of PICM has yet to be performed on the obtained clinical data. Biventri­­­cular paicng effectively eliminates the consequences of non-physiological right ventricular myocardial paicng, improves LV systolic function. Conduction system pacing may potentially reduce the risk of right ventricular pacing-induced cardiomyopathy in patients with preserved LVEF.

Reduction in global tissue deformation of the left ventricle as a cause of heart failure and worse quality of life in patients with takotsubo syndrome in the long period of the disease: prospective cohort study

Objective. This study evaluates the severity of chronic heart failure (CHF), ejection fraction (EF), and global contractility of the left ventricle (LV) using Speckletracking (STE) in patients with takotsubo syndrome (TS) in the early and late disease stages of the disease and compares these data with an assessment of the quality of life (QoL) of patients.
 Material and methods. The study included 60 patients with TS, with a mean age of 65.513.4 years. The severity of CHF symptoms was assessed using the SHOKS scale (assessment of the clinical condition in CHF). The Minnesota Questionnaire and the HeartQol questionnaire were used to study QoL. Echocardiography data (ECHOCG) were recorded during the acute period and at discharge from the hospital. In the late disease period, ECHOCG was performed using the STE method. After 1 year, endothelial function was studied using the EndoPAT 2000 device to determine the reactive hyperemia index.
 Results. According to the SHOKS scale, the severity of CHF symptoms corresponded to 12 functional class (FC) in all patients with TS in the long-term disease; however, before the development of TS, only 15 people had signs of CHF at the level of 12 FC. According to ECHOCG, LVEF in patients with TS was 44.59.7% at admission, 60.27.6% at discharge, 61.69.2% after a year, and 60.09.0% after 2 years. The average values of global longitudinal and global circular deformation of the left ventricle in patients with TS were 14.03.1 and 15.04.1%, respectively, after 1 year from disease onset and 12.31.9 and 13.11.9%, respectively, after 2 years. When comparing the data of the Minnesota Questionnaire and HeartQol questionnaires, QoL in the long-term of ST was significantly lower than the initial one before disease development. Mean reactive hyperemia index values after 1 year were 1.740.19.
 Conclusion. Despite the complete restoration of LVEF in patients with TS, clinical manifestations of CHF persist. Using the STE technique during the long term, 90% of patients had abnormalities in the global tissue deformity of the left ventricle. These changes may explain the CHF clinical manifestations and QoL decrease in patients with TS during long-term disease.

Изменение показателей деформации левого желудочка при гипертонической болезни в сочетании с его диастолической дисфункцией

Aim: To study the parameters of longitudinal, radial and circular deformation of the left ventricle in patients with hypertension, depending on the presence of its diastolic dysfunction. Design: Single-stage cross-sectional cohort study. Materials and methods. 60 patients (28 female and 32 male, the average age — 42 ± 9.4 years.) with hypertonic disease 1–2 stage, leading to the Cardiology Department of the first Clinical Hospital of the state of Chita II. Deformation of the left gastric myocardium was studied on the device Artida pro Toshiba (Japan) by the method of dual sero-modal modeling with the help of automatic post-processing given in the 2D Wall Motion Tracking program. Define the mean of the global segment. Results. Differences were revealed in the groups of patients with hypertension in terms of global and longitudinal deformation: global longitudinal deformation decreased in the group of patients with GB in combination with diastole disorder by 23.3% compared with patients without diastolic dysfunction (p = 0.0047). The index of radial deformation also decreased in patients of group 2 by 28.1% (p = 0.003). The anterior middle segment of the LV makes a significant contribution to the reduction of the global level of longitudinal strain in patients with hypertension in combination with a violation of diastole. Conclusion. In patients with hypertension, latent myocardial dysfunction is observed, more pronounced in patients with the presence of diastolic relaxation of the left ventricle. Keywords: left ventricular deformity, hypertension, diastolic dysfunction

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

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

His-pacing and biventricular pacing show similar efficiency in resynchronization and improvements in longitudinal contractile function

Abstract Background The clinical role for HIS-pacing in cardiac resynchronization therapy (HIS-CRT) is promising but is yet to be established. The randomised His-alternative study showed better remodelling with HIS-CRT compared to patients receiving conventional biventricular pacing (BIV-CRT) in the per-protocol-analysis. Purpose In this substudy we investigated whether HIS-pacing was more efficient compared to BIV-CRT in improving mechanical synchrony and longitudinal contractile function. Methods In the His-Alternative study 50 patients with symptomatic heart failure, left ventricular ejection fraction (LVEF) ≤35% and Left bundle branch block were randomized 1:1 to His-CRT or BiV-CRT and followed for 6 months. At implantation, 7 patients crossed over from His-pacing to LV-pacing in the His-CRT group and 1 patient crossed over from LV-pacing to His-pacing in the BiV-CRT group. All patients had echocardiography performed including 2D-strain echocardiography to asses global systolic longitudinal deformation (GLS) at baseline and 6 months. Mechanical dyssynchrony was measured as SD of time-to-peak in all 12 segments of the left ventricle (TPS-SD). Results There were no significant differences in baseline characteristics between patients receiving HIS-CRT and BIV-CRT with regard to dyssynchrony and longitudinal systolic strain. LVEF was significantly higher at 6 months (48±8% vs. 42±8%; p<0.05) in the HIS-CRT group. However, GLS did not significantly improve more with HIS-CRT compared to BIV-CRT, (−8.7ms ± 2.0 to −11.1 ms ± 2.0 vs −9.1 ms ± 2.7 to −10.8±2.5 ms ± 2.8, P = ns for difference) and regarding resynchronization measured as TPS-SD there was no significant difference either (110 ms ± 51 to 47 ms ± 10 vs. 115 ms ± 42 to 60 ms ± 21, P = ns for difference). Conclusion In this substudy, HIS-pacing did not prove more efficient than BIV-CRT in resynchronizing the left ventricle, nor did the observed improvement in longitudinal function differ significantly between methods. However, the number of included patients was rather small and larger studies are needed to fully assess the possible benefits of HIS-CRT. Funding Acknowledgement Type of funding sources: None.

Features of global longitudinal deformation of the left ventricle in relation to coronary and carotid atherosclerosis in patients with coronary artery disease

Background and Aims : Identify the relationship of the LV deformation properties with the presence of coronary and carotid atherosclerosis in patients with CAD.Methods: 94 patients with CAD of class II-IV aged 40 to 70 years were studied by the general clinical and laboratory blood tests, Holter -ECG monitoring, TTE, 2D-Echo with speckle tracking (STE), ultrasound of carotid artery lesions and coronary angiography (CAG). The SYNTAX score was calculated retrospectively in accordance with the SYNTAX evaluation algorithm. All patients were divided into 2 groups: group 1 included patients with a low syntax index (0-22); group 2 included patients with an average syntax index (23-32). A more objective quantitative assessment of the contractile function of the LV myocardium was obtained by assessing the global longitudinal deformation (GLS) and the strain rate (SR).Results: A comparative analysis showed that in group 2, GLS and SR indicators were significantly lower than in group 1 (P=0.0001 and P=0.0133, respectively). GLS was significantly correlated with LVL (r=-0.309; P<0.005), with the degree of atherosclerotic damage to the coronary arteries (r=0.925; P<0.005) and the number of atherosclerotic plaques in the carotid arteries (r=0.245; P<0.05). SR was also correlated with LVL (r=-0.281; P<0.005), coronary artery disease (r=0.767; P<0.0005) and the number of atherosclerotic plaques of the carotid arteries (r=0.233; P<0.05).Conclusions: The results obtained indicate the diagnostic value of STE with the determination of GLS and SR in a comprehensive assessment of severity of coronary and carotid atherosclerosis within group of patients with CAD. Background and Aims : Identify the relationship of the LV deformation properties with the presence of coronary and carotid atherosclerosis in patients with CAD. Methods: 94 patients with CAD of class II-IV aged 40 to 70 years were studied by the general clinical and laboratory blood tests, Holter -ECG monitoring, TTE, 2D-Echo with speckle tracking (STE), ultrasound of carotid artery lesions and coronary angiography (CAG). The SYNTAX score was calculated retrospectively in accordance with the SYNTAX evaluation algorithm. All patients were divided into 2 groups: group 1 included patients with a low syntax index (0-22); group 2 included patients with an average syntax index (23-32). A more objective quantitative assessment of the contractile function of the LV myocardium was obtained by assessing the global longitudinal deformation (GLS) and the strain rate (SR). Results: A comparative analysis showed that in group 2, GLS and SR indicators were significantly lower than in group 1 (P=0.0001 and P=0.0133, respectively). GLS was significantly correlated with LVL (r=-0.309; P<0.005), with the degree of atherosclerotic damage to the coronary arteries (r=0.925; P<0.005) and the number of atherosclerotic plaques in the carotid arteries (r=0.245; P<0.05). SR was also correlated with LVL (r=-0.281; P<0.005), coronary artery disease (r=0.767; P<0.0005) and the number of atherosclerotic plaques of the carotid arteries (r=0.233; P<0.05). Conclusions: The results obtained indicate the diagnostic value of STE with the determination of GLS and SR in a comprehensive assessment of severity of coronary and carotid atherosclerosis within group of patients with CAD.

Changes in the left ventricle in workers with long work experience of the coal and aluminum industry

Introduction. The leading role in the industrial structure of Kuzbass belongs to the coal and metallurgical industry associated with exposure to harmful production factors and high risks to the health of workers. The main pathogenetic factors triggering occupational and production-related diseases are hypoxic conditions potent of promoting changes in the heart structure and function. Materials and methods. The study included one hundred sixteen miners and 84 workers in the main occupations of aluminum production. The average age of miners was 47.63±0.33 years, of workers in the aluminum production - 48.41±0.53 years, p=0.191. Work experience in harmful working conditions in the study groups exceeded 20 years and did not differ significantly (p=0.281). All subjects underwent echocardiography according to the standard technique with automatic calculation of the global longitudinal deformity of the left ventricle. Results. The left ventricular ejection fraction and its longitudinal deformation were lower in aluminum industry workers with arterial hypertension not only in comparison with metallurgists with normal blood pressure (p&lt;0.0001), but also with miners with arterial hypertension (p=0.015). Longitudinal deformation of the left ventricle in aluminum workers without arterial hypertension was significantly lower than in miners with normal blood pressure (p=0.0062). The parameters of the diastolic function of the left ventricle changed in the study groups under the influence of arterial hypertension. Limitations. This investigation is limited to a selection of workers in the main professions of the aluminum and coal industries undergoing periodic medical examinations at the Research Institute for Complex Problems of Hygiene and Occupational Diseases. Conclusion. A decrease in global longitudinal left ventricular myocardial deformation in miners and aluminum industry workers was associated with the presence of arterial hypertension and with the specifics of the main adverse production factors. The indices of left ventricular contractile function in aluminum industry workers were significantly lower compared to those in miners, regardless of the presence of arterial hypertension.

Left atrial longitudinal strain analysis in diagnostic of cardiotoxicity

A wide range of extremely effective chemotherapy drugs has a negative effect on the cardiovascular system, leveling oncological treatment success. Early diagnosis of cardiotoxicity is very important, allowing timely application of preventive and therapeutic measures. Left ventricular ejection fraction evaluation using echocardiography is the basic non-invasive instrumental method to assess cardiac function and the main guideline in cardiac dysfunction diagnosis during chemotherapy. However, if dysfunction is subclinical, the ejection fraction can remain normal for a long time, and also has a pronounced inter-operator variability and dependence on volumetric load. Specialists are constantly in search of optimal echocardiographic parameters that allow early-stage cardiac dysfunction diagnosis. Analysis of the global longitudinal deformation of the left atrium seems to be a promising method for these purposes. A large amount of accumulated data suggests that the left atrium is not just a conduit chamber, but a reflection of the filling pressure of the left ventricle, being a sensitive marker of its systolic and diastolic dysfunction. This review presents an analysis of currently available studies on applying the methodology for assessing global longitudinal deformation of the left atrium in cardiac dysfunction diagnosis in the use of cardiotoxic drugs.

P121 ECHOCARDIOGRAPHIC EXAMINATION ON AGONIST ATHLETES WITH RECENT PAUCISYMPTOMATIC SARS COV 2 INFECTION, FOR THE RENEWAL OF AGONIST SPORT ACTIVITY ELIGIBILITY: PLAUSIBLE ROLE AND UTILITY OF GLS ANALYSIS THROUGH SPECKLE TRACKING

BackgroundThe aim of this work is to highlight whether or not the methodical echocardiography done through the analysis of global and segmental longitudinal deformation (GLS–SLS) can be useful to identify subclinical myocardial lesions in paucisymptomatic young agonist athletes with recent SarsCov2 infection before they return to agonist practice.Material and MethodsFrom 12/2020 to 12/2021 84 agonist athletes with previous SarsCov2 infection have been examined at “Cardiomed Center” Maglie (Lecce, IT), as part of screening for their return to sport practice; all of them under standard echocardiographic analysis associated to GLS analysis, Holter–ECG analysis with 24h on 12 derivations.ResultsThe base echocardiographic examination didn’t show any myocardial cynesis anomalies in any patient. In 5 patients there was a presence of a light pericardial effusion, how it was supposed to be as an outcome of a previous inflammatory ingjury The GLS analysis, that resulted in reliability considering the optimal acoustic window, showed a slightly lower medium value compared to the values cited in the literature (19.4 ± 2.9) and particularly 4 patients show considerable deficit reductions of segmentary strain. In these patients Holter analysis showed the presence of a moderate non–complex extrasystolic arrhythmia. These elements–that are a reduced GLS with marked regional anomaly, coupled with the presence of ventricular arrhythmia even in absence of segmentary dissinergyes– led to cardiac RMN evaluation. In 2 out of 4 patients there have been flaws that were compatible to modest myocardial lesions, in one case it was observed a marked flaw in medium–apical–lateral region that was correlated to the described areas at the specle tracking. ConclusionOur experience at the Cardiology and Sports integrated clinic, although it relied on a meager population of patients, it still demonstrated how echocardiographic analysis through GLS evaluation and the highlighting of sectorial alterations even in absence of cynesis anomalies can be used as a parameter to suppose the presence of miocarditic lesions that might be sent to the next RMN examination for confirmation, in young athletes with recent paucisymptomatic Covid–19 infection.

Detection of symptom-related coronary arteries in patients with coronary artery disease using real-time three-dimensional stress echocardiography with adenosine triphosphate

Aim 1) To develop normative values of global and regional left ventricular longitudinal deformation (LVLD) during real time three-dimensional stress echocardiography with adenosine triphosphate (ATP) and utilization of automated function imaging technology (4D Stress-Echo + LVLD with ATP); 2) to compare the effectiveness of detection of symptom-related coronary arteries during 4D Stress-Echo with ATP using: a) traditional visual assessment of regional myocardial contractility and b) step-by-step analysis of segmental LVLD.Material and Methods 15 healthy subjects and 32 patients with coronary artery disease (CAD) were examined after coronary angiography. All individuals underwent 4D Stress-Echo + LVLD with ATP (Vivid E95, General Electric).Results The normative values of global LVLD at three stages of the pharmacological stress-test (before, during and after ATP infusion) were –19.5 (95% CI: -20.4 – -19.0), –21.6 (95% CI: -22.8 – -20.4) and –19.5 (95% CI: -20.3 – -18.6), respectively; the values of LVLD in each of the 17 segments of left ventricular myocardium in healthy subjects were also determined. In patients with CAD visual control of contractility during stress test revealed dynamic decrease in local thickening of the myocardium, appearance of new zones of contractility disorders and expansion of previously noted in 31.2% of cases, while analysis of deformation detected the appearance of new zones of deformation disturbances and expansion of previously found – in 68.7% (р = 0.0055). Stress-induced worsening of myocardial deformation during ATP infusion in the zones of blood supply of left anterior descending coronary artery, circumflex artery and right coronary artery (with presence of hemodynamically significant stenoses and occlusions detected during coronary angiography) were found in 28.0, 77.7 and 65.2% respectively (р1-3 = 0.0194; р1-2 = 0.0019; р2-3 = 0.2864).Conclusion The normal values of global and segmental LVLD for each stage of 4D Stress-Echo + LVLD with ATP were determined. 4D Stress-Echo + LVLD with ATP can significantly increase the effectiveness of symptom-related coronary arteries identification in patients with CAD in comparison with traditional Stress-Echo with visual assessment of local myocardial contractility.

New Indicators of Myocardial Work in Healthy Individuals

Aim. To study in healthy individuals the gender and age characteristics of left ventricular (LV) myocardial work indicators, their correlations with global LV deformity indicators and echocardiographic parameters characterizing LV systolic and diastolic functions.Materials and methods. 70 Healthy individuals (n=70; 34 men and 36 women; aged 39.3±8.9 years) were included in the study. The echocardiographic examination determined the standard parameters and indicators of myocardial work: global work efficiency (GWE), global constructive work (GCW), global wasted work (GWW), global myocardial work index (GWI); as well as the myocardium deformation characteristics: global longitudinal deformation (GLS), global radial deformation (GRS) and global circular deformation (GCS). Spearman's correlation coefficient was used to investigate the relationship between parameters. A correlation was considered weak at r≤0.3, moderate at 0.3&lt;r&lt;0.7, and strong at r≥0.7.Results. The average value of global work efficiency (GWE) in men was 97% (96; 98), in women – 98% (97; 98). Global constructive work (GCW) in men was 2343.8±350.4 mm Hg%, in women – 2362.2±343.8 mm Hg%. The average value of global wasted work (GWW) in men was 46 mm Hg% (27; 75), in women – 44 mm Hg% (33; 55.5). The global myocardial work index (GWI) in men was 2069.9±356.4 mm Hg%, in women – 2055.7±339.9 mm Hg%. No significant differences were found in the comparative analysis of performance indicators. The analysis of correlations found that the myocardial work indicators didn't have significant correlations with age. Ejection fraction was moderately correlated with GWI (r=0.45) and GCW (r=0.49). Global longitudinal strain was strongly correlated with GWI (r=0.77) and GCW (r=0.77). Global radial strain correlated moderately directly with GWI (r=0.4) and GCW (r=0.4). Global circular strain was moderately correlated with GCW (r=0.35). A strong negative correlation was found between the GWE indicator and the post systolic contraction index (PSI) (r=-0.85). At the same time, PSI and GWW had a strong positive correlation (r=0.85).Conclusion. Indicators of LV myocardial work in healthy individuals do not have gender differences. The efficiency of the work of the myocardium depends primarily on the deformation of the LV, while the constructive work is determined by the volume characteristics. The wasted work indicator depends on the number of segments that peak in the post-systolic period.