Global Longitudinal Systolic Strain Research Articles

Left Atrial Peak Systolic Strain as an Indicator Pathway of Diastolic Dysfunction of the Left Ventricle.

Left atrial peak systolic strain (LA-PSS) imaging is an emerging index of left atrial function, and it was shown to be decreased in heart failure with preserved ejection fraction (EF). We aimed to determine whether LA-PSS could be used as an additional diagnostic parameter to current existing guidelines for the presence of left ventricle diastolic dysfunction (LVDD). A total of 190 consecutive adult patients with cardiovascular risk factors and normal left ventricle EF with no prior history of heart failure were included in the study. Speckle tracking software was used to study ventricular parietal deformity, left ventricle global longitudinal systolic strain, and LA-PSS. The median left ventricle global longitudinal systolic strain was -19%, with a significant difference ( P < 0.001) between patients with normal diastolic function versus those with LVDD. The median LA-PSS was 33% (30% to 38%) ( P < 0.001). Most patients (61%) had grade 1 atrial dysfunction based on PSS (range 24%-35%). The analysis of the area under the receiver operating characteristic curve of the LA-PSS as a potential indicator pathway of LVDD was 67% [95% confidence interval (CI), 62-72], and 75% (95% CI, 70-80), when the indeterminate pattern was included. The decreased LA-PSS made it possible to reclassify patients with an indeterminate pattern of diastolic function in 96% of cases. These results support the potential role of LA-PSS as an additional parameter for the diagnosis of LVDD in patients with normal EF, and may be integrated into the guidelines for routine evaluation of patients.

Oxygen venous saturation is associated with subclinical myocardial systolic dysfunction in patients with end-stage renal disease undergoing hemodialysis

IntroductionThe aim of this prospective study was to evaluate the impact of hemodialysis (HD) on myocardial injury, of both right and left ventricle function as well as their association with venous oxygen saturation (ScvO2) alterations.Material and methodsWe included in the study stable consecutive patients with end-stage renal disease (ESRD) undergoing regular HD. Right and left ventricular speckle-tracking echocardiographies were performed in all patients. The examination calculates the global systolic longitudinal strain (GLS). Blood samples were obtained from the central vein in order to measure the O2 saturation (ScvO2) levels prior and post HD. High sensitive troponin (HST) was also measured in all patients before and after HD.ResultsThirty seven patients were evaluated. We found that both mean ScvO2 and left ventricle GLS (LV GLS) were deteriorated after the dialysis session: 76.47 ±1.98 to 71.54 ±5.10, p &lt; 0.05 and –17.73 ±3.44 to –14.21 ±3.44%, p &lt; 0.01, respectively. HST levels were increased at the end of hemodialysis, 22.45 ±13.26 to 106.78 ±146.19 pg/ml, p &lt; 0.01. A significant correlation was also found between the decrease of LV GLS with the ScvO2 reduction, p = 0.001, as well as with the increase of the HST levels, p = 0.001.ConclusionsOur data demonstrate that there is a significant worsening of the GLS of the left ventricle at the end of the dialysis, which is strongly associated with the concomitant deterioration of ScvO2. The may be a reliable index of circulatory stress indicating a subclinical myocardial dysfunction during HD.

Left ventricular function assessment in Kawasaki disease by two-dimensional global longitudinal systolic strain with automated function imaging.

Kawasaki disease is an acute febrile vasculitis of childhood mainly affecting children under 4 years of age. In the acute stage of the disease, heart function decreases and gradually returns to normal after treatment. However, subendocardial involvement may persist, which cannot be assessed by M-mode echocardiography. Strain echocardiography is a recently developed technique to assess subendocardial involvement of myocardial deformation. We aimed to study the stratified strain of left ventricular function in a Kawasaki patient at least 6 months after the acute stage of the disease with special conditions for entering the study using two-dimensional speckle-tracking imaging. Between September 2020 and October 2022, 27 healthy children and 27 children with a history of Kawasaki disease more than 6 months ago were evaluated using two-dimensional global longitudinal peak systolic strain with automated function imaging technology. The mean age of patients was 5.6 years. With M-mode echocardiography, ejection fraction of each group was in the normal range. Mean (± standard deviation) global longitudinal peak strain in four-chamber view of girls with Kawasaki disease was - 23.74 ± 2.77, and that in boys with Kawasaki disease was - 20.93 ± 2.06 (P value = 0.008). GLPS (global longitudinal peak strain) was compared as an overall average and as in a separate segment, which showed significant difference in two comparisons. In our study, a decrease in the function of some cardiac segments is reported. Global longitudinal peak strain in four-chamber view was significantly lower in boys. Comparing different segments, a difference in global left ventricular long-axis strain was found between the two groups. On the other hand, there was a major difference between the two groups in the basal inferolateral, basal anterolateral, and mid-inferolateral, which receives blood from Left Circumflex artery. Using stain echocardiography to detect continued subendocardial involvement in asymptomatic children with a history of Kawasaki disease for a better understanding of the condition, effective management and follow-up is recommended.

Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті

Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті

Evaluation of cardiac function in paediatric Wilson's disease patients with advanced echocardiographic modalities (strain and strain rate echocardiography).

In Wilson's disease (WD), copper accumulation in the organs and/or damage caused by oxygen free radicals occurs due to disturbances in copper excretion. In our study, we aimed to evaluate cardiac involvement with advanced echocardiographic modalities (tissue Doppler echocardiography, strain and strain-rate echocardiography). Twenty WD patients and 20 healthy children from the Pediatric Gastroenterology Department of Diyarbakır Children's Hospital were included in the study between 2022 and 2023. The mean age of the WD patients was 12.89 ± 3.79 years. Left ventricular wall thicknesses and diameters (diastolic interventricular septum thickness, diastolic left ventricular posterior wall thickness, left ventricular end-diastolic diameter), left ventricular diastolic function parameters (E, A, E/A, deceleration time) and left ventricular ejection fraction and tricuspid annular plane systolic excursion were similar and not statistically significantly different in the WD and control groups. Mitral lateral e', mitral septal e' and tricuspid lateral e' velocities were lower in the WD patients and statistically significantly different from the controls (p = 0.02, 0.04 and 0.005, respectively), as assessed by tissue Doppler echocardiography. Global longitudinal systolic strain was similar in the WD and control groups and no statistically significant difference was detected. Longitudinal early diastolic strain rate was lower in the WD patients and statistically significantly different (p = 0.002). Subclinical early diastolic dysfunction and segmental systolic dysfunction were detected in WD patients with advanced echocardiographic modalities, in addition to normal cardiac function as assessed by conventional echocardiography. Advanced echocardiographic modalities can be used in the follow up of WD patients.

Evaluation of Left Ventricular Function in Patients With Severe Aortic Stenosis Utilizing Automated Cardiac Motion Quantitation Techniques

ObjectiveThe objective of this study is to explore the patterns of alteration in left ventricular systolic function among patients with severe aortic stenosis (SAS) through the application of automatic myocardial motion quantification (aCMQ) techniques. Furthermore, we seek to ascertain dependable quantitative markers for the assessment of impaired left ventricular function in patients with SAS and an ejection fraction (EF) ≥ 60%. MethodsSeventy patients who underwent echocardiography and received a diagnosis of severe aortic stenosis (SAS) in the hospital from November 2021 to August 2022 were selected for the SAS group and categorized into three subgroups based on ejection fraction (EF)—SAS group with EF ≥ 60%, SAS group with EF ranging from 50% to 59%, and SAS group with EF < 50%. Concurrently, 30 healthy individuals were recruited at the hospital during the same timeframe to serve as the control group. Participants from both groups underwent standard transthoracic echocardiography to assess conventional echocardiographic parameters. Dynamic images were examined using automatic myocardial motion quantification (aCMQ) software to derive longitudinal peak strain (LPS) parameters, which were then subjected to statistical analysis. ResultsIn comparison to the control group participants, the measurements of ascending aorta diameter (AoD), left atrium diameter (LAD), interventricular septal end diastolic thickness (IVSd), left ventricular posterior wall end diastolic thickness (LVPWd), peak systolic velocity (Vmax), and mean pressure gradient (MPG) were significantly higher in the SAS groups (p < 0.05). When compared to participants in the SAS group with an EF ≥ 60%, the values of IVSd, LVPWd, Vmax, and MPG in the SAS group with EF ranging from 50% to 59% were significantly elevated (p < 0.05). Similarly, left ventricular end-diastolic diameter (LVEDD), the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e'), and the ratio of early to late diastolic mitral inflow velocities (E/A) in the SAS group with EF < 50% were significantly elevated (p < 0.05). The absolute values of longitudinal peak strain (LPS) in the SAS groups were significantly lower in comparison to those in the control group (p < 0.05). Furthermore, all measurements of left ventricular global longitudinal systolic peak strain (GLPS) showed a positive correlation with MPG, a moderate negative correlation with aortic valve area index (AVAI), and a moderate positive correlation with E/A. ConclusionsPatients with SAS and an EF < 50% exhibited the most profound impairment in left ventricular myocardial function. Utilizing the aCMQ technique enables the precise and quantitative evaluation of the severity of impaired left ventricular systolic function in patients within the SAS group with an EF ≥ 60%.

Diagnostic capabilities of instrumental methods for studying early cardiovascular adverse events in patients with lymphoproliferative disorders, quality and safety issues

Aim. To study the possibilities of instrumental research methods in relation to the earliest detection of cardiovascular events in oncohematological patients receiving antitumor immunochemotherapy, as well as to deter­mine the requirements for documenting adverse events.Material and methods. For the study, 63 patients were prospectively selected with a diagnosis of indolent non-Hodgkin lymphoma, who were indicated for antitumor immunochemotherapy. The patients were examined in three stages (before treatment, after 3 and 6 cycles of therapy) and divided into 2 groups by simple randomization. Cardiovascular toxicity in the main group of patients was assessed using 3D transthoracic echocardiography, analysis of left ventricular (LV) global longitudinal systolic strain and electrocardiography. The control group underwent a standard 3D echocardiography with analysis of LV ejection fraction. Clinical manifestations of cardiovascular events were assessed in all patients during treatment.Results. According to the study, significant changes were obtained in LV ejection fraction on the third visit — a decrease from 58,9±1,07 to 48,1±0,73% (p&lt;0,05) and from 57,7±1,13 to 49,4±0,58% (p&lt;0,05) in patients of the main and control groups and global longitudinal LV strain from |21,1±1,18 to |14,0±1,61 |% (p&lt;0,05) in patients of the main group. A mixed clinical phenotype of cardiovascular toxicity was the most common among all patients. An integrated approach to the early diagnosis of cardiovascular events makes it possible to identify a larger percentage of patients with subclinical myocardial dysfunction.Conclusion. The long period of latent cardiovascular toxicity emphasizes the need for early verification of cardiovascular complications of antitumor therapy and expansion of the established paraclinical diagnostic minimum. In addition, taking into account the accumulated experience, recommendations are presented for the preparation of medical documentation in order to ensure the safety and quality of care.

Changes in cardiohemodynamics and cardiac arrhythmias in patients after coronavirus infection

Aim: To study cardiac arrhythmias and morpho-functional changes in patients in 3 months after a coronavirus infection.Material and methods. 96 patients, mean age 36 years, treated for coronavirus infection, after 3 months underwent Echo and Holter ECG monitoring. Patients were divided into groups depending on the degree of lung tissue damage according to computed tomography (CT): 1st 27 patients CT0, 2nd 39 patients CT1-2, 3rd 30 patients CT3-4; 22 patients control group. Statistics: considering the distribution of features different from normal, nonparametric methods of hypothesis testing were used.Results. In patients recovered from coronavirus infection a violation of heart rhythm conduction was established after 3 months. An increase in the activity of the sympathetic part of the autonomic nervous system (LF/HF) was found: in patients of group 2, the median value was – 5.9, in group 3 – 6.0; in addition, the global longitudinal systolic strain of the left ventricle decreased (–17.7 and –17.2, respectively). In patients with CT3–4, systolic pressure in the pulmonary artery increased (37.0 mmHg), the size of the left atrium increased, and segmental systolic LV strain decreased in comparison with the studied groups (p &lt; 0.001). Correlations between left ventricular dysfunction and heart rate variability disorders, as well as prolongation of the QT interval (p &lt; 0.001) were established.Conclusion. Cardiac arrhythmias were detected in patients in 3 months after the coronavirus infection. In patients with moderate and severe disease, the activity of the autonomic nervous system also increases, the global systolic strain of the left ventricle decreases. In addition, patients with CT3-4 increased systolic pressure in the pulmonary artery, increased the size of the left atrium, decreased segmental systolic strain of the left ventricle.

The role of speckle-tracking echocardiography in the heart contraction geometry assessing in combatants with acute myocarditis

The aim – to evaluate the geometry of heart contraction based on speckle-tracking echocardiography data in combatants with acute myocarditis with reduced and mildly reduced left ventricular ejection fraction.Materials and methods. 53 male combatants with acute myocarditis (AM) were examined, who were divided into 2 groups: 1st group – 30 patients with a reduced ejection fraction (EF) of the left ventricle (LV) ≤ 40 %; 2nd group – 23 patients with mildly reduced LVEF 41–49 %. The diagnosis of AM was established on the basis of the recommendations for the diagnosis and treatment of myocarditis of the All-Ukrainian Association of Cardiologists of Ukraine. All patients underwent echocardiography (EchoCG) with speckle tracking (ST) and cardiac magnetic resonance (CMR) imaging with contrast.Results and discussion. Patients of the 1st group, compared to the 2nd, were characterized by more pronounced manifestations of dilatation and more significant violation of the LV contractile function, which was evidenced by a 13.6 % higher value of the LV end-diastolic volume and a 25.4 % smaller value of the LVEF. When evaluating ST echocardiographic indicators, the value of the longitudinal global systolic strain (LGSS) of the LV in the 1st group was 43.1 % lower, its velocity by 19.2 %, and the circular systolic deformation by 20.9 % in comparison with those in the 2nd group. In addition, in the 1st group, in comparison with the 2nd, the value of the indicator of systolic deformation of the left atrium (SDLA) was almost twice smaller. According to the results of CMR, in the 1st group compared to the 2nd, a larger number of segments with the presence of delayed enhancement was determined, which indicated a larger volume of fibrotic/necrotic lesions of the LV. According to the results of the correlation analysis in the 1st group, strong reverse relationships were established between the presence of delayed contrast in ≥ 4 segments of the LV and LGSS (r=–0.76; p&lt;0.01), its speed and (r=–0.71; p&lt;0.02) and SDLA (r=–0.52; p&lt;0.05).Conclusions. Patients with acute myocarditis with a reduced left ventricular ejection fraction compared to patients with a mildly reduced ejection fraction were characterized by a greater violation of the geometry of the contraction of the left ventricle, which was observed on the background of a larger volume of fibrotic/necrotic lesions. With the help of correlation analysis, in combatants with acute myocarditis, a relationship was established between the presence of delayed enhancement in ≥ 4 segments of the left ventricle and a decrease in indicators of longitudinal systolic deformation and its speed, as well as an indicator of systolic deformation of the left atrium.

The value of serial echocardiography in risk assessment of patients with paroxysmal atrial fibrillation.

Progression from paroxysmal to persistent atrial fibrillation (AF) is associated with increased morbidity and mortality. We examined the association of left atrial (LA) remodeling by serial echocardiography, and AF progression over an extended follow-up period. Two-hundred ninety patients (mean age 61 ± 11years, 73% male) who underwent transthoracic echocardiography performed at first presentation for non-valvular paroxysmal AF (PAF) and repeat echocardiogram 1-year later, were followed for progression to persistent AF. LA and left ventricular (LV) dimensions, volumes, LA reservoir, conduit and booster pump strains, LV global longitudinal systolic strain (GLS) assessedby 2D speckle tracking, and PA-TDI (time delay between electrical and mechanical LA activation- reflecting the extent of LA fibrosis) were compared on serial echocardiography. Sixty-nine (24%) patients developed persistent AF over a mean follow-up period of 6.3years. At baseline, patients with subsequent persistent AF had larger LA dimensions (46mm vs. 42mm, p < 0.001), indexed LA volumes (41ml/m2 vs. 34ml/m2, p < 0.001), lower LA reservoir and conduit strain (17.6% vs. 27.6%, p < 0.001; 10.5% vs. 16.3%, p < 0.001; respectively) and longer PA-TDI (155ms vs. 132ms, p < 0.001) compared to the PAF group. Patients with subsequent persistent AF showed over time significant enlargement in LA volumes (from 37.7ml/m2 to 42.4ml/m2, p < 0.001), lengthening of PA-TDI (from 142.2ms to 162.2ms, p = 0.002), and decline in LA reservoir function (from 21.9% to 18.1%, p = 0.024) after adjusting for age, gender, diabetes and LV GLS. There were no changes in LA diameter, LA conduit or booster pump function. Conversely, the PAF group showed no decline in LA function. Patients who developed persistent AF had larger LAsize and impaired LA function and atrial conduction times at baseline, compared to patients who remained PAF. Over the 1-year time course of serial echocardiographic evaluation, there was progression of LA remodeling in patients who subsequently developed persistent AF, but not in patients who remained inPAF.

Left ventricular longitudinal strain in patients with undifferentiated connective tissue disease and arrhythmia

Aim. To evaluate the left ventricular longitudinal strain in patients with arrhythmia and undifferentiated connective tissue disease (UCTD).Material and methods. This cross-sectional comparative study included young patients with arrhythmia and UCTD (43 men and 84 women; mean age, 30,82±8,17 years (group 1, n=127)). The control group included volunteers with single phenotypic characteristics of UCTD, comparable in age and sex (9 men and 21 women, mean age, 34,13±6,87 years (group 2, n=30)). A standard clinical examination, 72-hour electrocardiographic monitoring, and speckle-tracking echocardiography were performed.Results. Patients of group 1 were characterized by lower global systolic longitudinal myocardial strain compared to the control group: -22,96% [-24,56%; -21,50%] in group 1 vs -24,73% [-25,25%; -23,84%] in group 2 (p=0,016). A local decrease in longitudinal myocardial strain (in two or more segments) was noted in 62,2% of patients in group 1 and 13,3% of patients in group 2 (p=0,025). In group 1, a relationship was revealed between class I premature ventricular contractions (PVCs) and a longitudinal strain decrease in the medial anterior (r1=0,253, p=0,004) and apical anterior (r1=0,253, p=0,004) segments, as well as between class V PVCs and strain decrease in the basal lower (r1=0,215, p=0,021) and middle anterior (r1=0,211, p=0,023) segments. In addition, there was a moderate correlation between mitral valve prolapse (MVP) and a decrease in longitudinal systolic strain in the basal inferolateral (r1=0,405, p=0,041) and basal anterior (r1=0,519, p=0,003) segments.Conclusion. Local decrease in left ventricular longitudinal systolic strain in association with arrhythmia and MVP in patients with UCTD makes it possible to recommend speckle-tracking echocardiography for early non-invasive assessment of myocardial remodeling in this cohort of patients.

Abnormal left ventricular systolic reserve function detected by treadmill exercise stress echocardiography in asymptomatic type 2 diabetes

AimsSubclinical left ventricular (LV) dysfunction may occur in T2DM patients at the early asymptomatic stage, and LV reserve function is a sensitive index to detect subtle LV dysfunction. The purpose of our study is (1) to assess the LV reserve function using treadmill exercise stress echocardiography (ESE) in asymptomatic type 2 diabetes mellitus (T2DM) patients; (2) to explore the link of serum biological parameters and LV reserve function.MethodsThis study included 84 patients with asymptomatic T2DM from September 2021 to July 2022 and 41 sex- and age-matched healthy controls during the corresponding period. All subjects completed treadmill ESE, LV systolic function-related parameters such as global longitudinal strain (GLS) and systolic strain rate (SRs), as well as diastolic function-related parameters such as E wave (E), early diastolic velocity (e′), E/e′ ratio, early diastolic SR (SRe), and late diastolic SR (SRa) were compared at rest and immediately after exercise. The difference between LV functional parameters after treadmill exercise and its corresponding resting value was used to compute LV reserve function. In addition, the associations of LV reserve function and serum biological parameters were analyzed.ResultsPatients with T2DM did not significantly vary from the controls in terms of alterations in LV diastolic reserve measures, the changes of LVGLS and SRs (ΔGLS: 2.19 ± 2.72% vs. 4.13 ± 2.79%, P &amp;lt; 0.001 and ΔSRs:0.78 ± 0.33 s−1 vs. 1.02 ± 0.28 s−1, P &amp;lt; 0.001) in the T2DM group were both lower than those in the control group. Glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NTproBNP), waist circumference, and high-sensitive C-reactive protein (hsCRP) were identified as independent predictors of LV systolic reserve by stepwise multiple linear regression analysis.ConclusionLV systolic reserve function, as measured by pre- and post-exercise differences in GLS and SRs were significantly impaired in patients with asymptomatic T2DM, whereas diastolic reserve remained normal during exercise and was comparable to that of the control group. This was different from previous findings. High levels of HbA1c, NTproBNP, hsCRP, and increasing waist circumference were independent predictors of LV systolic reserve.

Detection of Early Myocardial Dysfunction by Imaging Biomarkers in Cancer Patients Undergoing Photon Beam vs. Proton Beam Radiotherapy: A Prospective Study.

1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March 2016 and March 2017, 70 patients with breast or thoracic cancer were prospectively enrolled and underwent transthoracic echocardiography with comprehensive strain analysis at pretreatment, mid-treatment, end of treatment, and 3 months after RT. 3. Results: PBT was used to treat 44 patients; PhT 26 patients. Mean ± SD age was 55 ± 12 years; most patients (93%) were women. The median (interquartile range) of the mean heart dose was lower in the PBT than the PhT group (47 [27-79] vs. 217 [120-596] cGy, respectively; p < 0.001). Ejection fraction did not change in either group. Only the PhT group had reduced systolic tissue Doppler velocities at 3 months. 2D-STE showed changes in endocardial and epicardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing PhT (global longitudinal SRe, pretreatment vs. end of treatment (p = 0.04); global circumferential SRe, pretreatment vs. at 3-month follow-up (p = 0.003); global radial SRe, pretreatment vs. at 3-month follow-up (p = 0.02) for endocardial values). Epicardial strain values decreased significantly only in patients treated with PhT. Patients in the PhT group had a significant decrease in epicardial global longitudinal systolic strain rate (GLSRs) (epicardial GLSRs, at baseline vs. at end of treatment [p = 0.009]) and in GCSRe and GRSRe (epicardial GCSRe, at baseline vs. at 3-month follow-up (p = 0.02); epicardial GRSRe, at baseline vs. at 3-month follow-up (p = 0.03)) during treatment and follow-up. No changes on 2D-STE were detected in the PBT group. 4. Conclusions: Patients who underwent PhT but not PBT had reduced tissue Doppler velocities and SRe values during follow-up, suggesting early myocardial relaxation abnormalities. PBT shows promise as a cardiac-sparing RT technology.

Potential Prognostic Relevance of Left-Ventricular Global Longitudinal Strain and of the Summation of the Mitral and Tricuspid Regurgitation Volume in Patients with Non-Ischemic Dilated Cardiomyopathy.

The aim of this pilot study was to determine the potential prognostic relevance of novel multidirectional myocardial and volumetric echocardiographic parameters in patients with non-ischemic dilated cardiomyopathy (NIDCM). Multidirectional myocardial parameters (longitudinal, radial, and circumferential left-ventricular (LV) strain using speckle tracking echocardiography) and a new volumetric parameter (the sum of the mitral and tricuspid regurgitation volume (mitral-tricuspid regurgitation volume) were assessed. The cardiovascular (CV) outcome was a composite of cardiac death and hospitalization for heart failure (HF) at 1 year. Approximately 102 patients were included in this pilot study. The mean LV ejection fraction (LVEF) was 28.4 ± 8.9%. During a follow-up of 1 year, the CV outcome occurred in 39 patients (10 HF deaths, and 36 hospitalizations for HF). The LV global longitudinal systolic strain (GLS) and mitral-tricuspid regurgitation volume were the main parameters that were seen to be significantly altered in the comparison of patients with events vs. those without events (GLS (absolute values) 7.4 ± 2.7% vs. 10.3 ± 2.6%; mitral-tricuspid regurgitation volume 61.1 ± 20.4 mL vs. 40.9 ± 22.9 mL, respectively; p-value < 0.01). In line with these findings, in a multivariate continuous logistic regression analysis, the GLS and mitral-tricuspid regurgitation volume were the main parameters associated with worse CV outcomes (GLS: OR 0.77 (95%CI 0.65-0.92); mitral-tricuspid regurgitation volume OR 1.09 (95%CI 1.01-1.25)), whereas the radial and circumferential LV global strain and mitral regurgitation volume and tricuspid regurgitation volume were not linked to the CV outcome. Furthermore, in a receiver operating characteristic curve analysis, a GLS cutoff of <7.5% and mitral-tricuspid regurgitation volume > 60 mL were the identified values for the parameters associated with worse CV outcomes. The findings of this pilot study suggest that the GLS and a novel volumetric parameter (the sum of the mitral and tricuspid regurgitation volume) are linked to worse CV outcomes in patients with non-ischemic dilated cardiomyopathy. Hence, these promising results warrant further validation in larger studies.

Value of Transthoracic Echocardiography in Predicting Short Term Major Adverse Cardiac Events after ST Elevation Myocardial Infarction in COVID 19 Era

Abstract Background Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide. In the era of COVID 19, early risk stratification and identification of high-risk patients with ST-segment elevation myocardial infarction are of great significance in prognosis, and in guiding diagnosis and treatment decisions. Measuring left ventricular peak systolic global longitudinal strain may be a useful addition to ejection fraction using echocardiography. Aim of the Study Is to evaluate different parameters of echocardiography in predicting major adverse cardiac events in patients after acute ST-segment elevation myocardial infarction in the era of Covid 19. Methods and patients This study included 97 patients who presented with acute STsegment elevation myocardial infarction within 12 hours of onset of chest pain and managed by primary percutaneous coronary intervention, it was performed in Ain Shams university hospitals from January 2021 to June 2021. Echocardiography was used to measure ejection fraction and left ventricular strain parameters Results The study included 97 patients, 55 % of which presented with anterior STEMI. Out of the whole group 29 patients (21%) developed MACE at 3 months follow up. Within the whole group, the mean ejection fraction was (44.04±6.07% VS .40.07±6.52% p = 0.007) and the mean global longitudinal strain was (-12.56±3.61% VS -10.1±3.25% p=0.002). Based on CT chest finding, 33 patients were Covid 19 patients who were younger in age, included significantly more females and had significantly higher Killip score as compared to the non covid patients. Among COVID-19 patients, the mean ejection fraction was (46.11±5.29% VS 40.6±7.11% p=0.02) and the mean global longitudinal strain was (-13.17±3.35% VS 10.35±3.38% p=0.026). At 3 months follow up, 39% of the Covid patients had MACE as compared to 25% of the non covid patients P = 0.0001. Conclusion In the era of COVID 19, young patients with female gender who suffered from STEMI were more likely to be COVID 19 patients and were liable to develop MACE at 3 months follow up. However, their LV EF and GLS were comparable to non-COVID 19 patients Ethical approval this study protocol was approved by the local ethics committee with a consent was obtained from all participants. Abbreviations MACE: major adverse cardiac events; LV: left ventricle; GLS: global longitudinal strain; STEMI: ST elevation myocardial infarction

Early impairment of right ventricular systolic function in patients with prediabetes and type 2 diabetes mellitus: An analysis of two-dimensional speckle tracking echocardiography.

Type 2 diabetes mellitus is a metabolic disease that affects multiple target organs. Current data on right ventricular damage in type 2 diabetes, especially in prediabetes, are limited. Due to the anatomical characteristics of the right ventricle, the assessment of the right ventricle by conventional echocardiography is difficult, whereas the ultrasound two-dimensional speckle tracking echocardiography can provide information on myocardial systolic function by tracking the motion information of myocardial speckles, which can sensitively reflect myocardial mechanical changes. To assess the effect of prediabetes and diabetes with preserved left ventricular ejection fraction on right ventricular myocardial systolic function and to identify independent risk factors affecting right ventricular systolic function. A total of 49 normoglycaemic (NG) healthy individuals, 43 prediabetics (PDM), and 52 type 2 diabetics (T2DM) were recruited. All study subjects underwent conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE). The right ventricular global longitudinal strain (RVGLS) (20.80±1.96%vs. 18.99±3.20%vs. 16.85±4.01%), left ventricular global longitudinal strain (LVGLS), and interventricular septal longitudinal strain (IVS-LS) (17.28±2. 35%vs. 16.14±3.22%vs. 15.53±3.33%) gradually decreased from the controls, through patients with prediabetes, to those with diabetes (p<.001). Right ventricular free wall strain (RVFW-LS) was higher in the control group (25.63±4.58%vs. 22.83±4.83%vs. 20.79±4.92%) than in the other two groups with a statistically significant difference (p<.001), while RVFW-LS was not statistically different between the prediabetic and diabetic groups. Multivariate regression analysis showed that HbA1c (β=-.626, p<.001), IVS-LS (β=.417, p<.001), and left ventricular end-diastolic diameter (LVEDd) (β=.191, p=.011) were independently correlated with RVGLS. Two-dimensional speckle tracking echocardiography can sensitively detect subtle changes in the early impairment of right ventricular systolic function in patients with abnormal glucose metabolism. Type 2 diabetes is the common mechanism causing impaired myocardial mechanics in the right and left ventricles. The reduced global systolic longitudinal strain of the right ventricle was associated with reduced global septal longitudinal strain and left ventricular remodeling. HbA1c is an independent predictor of the global longitudinal strain of the right ventricle, and controlling blood glucose levels may be expected to improve the extent of myocardial damage.

Changes in the structure and function of the left ventricle in patients with gout: A study based on three-dimensional speckle tracking echocardiography.

Studies have shown that gout can increase the risk of cardiovascular disease. Three-dimensional speckle-tracking echocardiography (3D-STE), a sensitive imaging technology, enables the detection of subtle myocardial dysfunctions. Our aim is to evaluate the left ventricular (LV) functions in patients with gout using 3D-STE. 80 subjects: 40 with gout and 40 as normal controls were involved. We obtained and analyzed these parameters from the dynamic images of a 3D full-volume dataset: global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), Twist, 16-segmental time-to-peak longitudinal strain (TTP) and systolic dyssynchrony index (SDI)besides other relevant parameters. Compared with the normal group, gout patients were more likely to have left ventricular remodeling. The patients with gout showed decreased Em, increased E/Em and larger volume index of the left atrium (LAVI) indicating reduced diastolic function. The peak GLS (-17.42 ± 2.02 vs. -22.40 ± 2.57, P < 0.001), GCS (-27.04 ± 3.75 vs. -34.85 ± 4.99, P < 0.001), GRS (38.22 ± 4.28 vs. 46.15 ± 5.17, P < 0.001), and Twist (15.18 ± 5.45 vs. 19.02 ± 5.29, P = 0.015) were significantly lower in patients with gout than in healthy participants. The SDI (5.57 ± 1.46 vs. 4.91 ± 1.19, P = 0.016) was significantly increased in patients with gout compared with normal controls. There was no significant between-group difference in TTP (P = 0.43). The systolic GLS, GRS and GCS peak values increased gradually from the base to the apex, with the lowest values in the basal segment in patients with gout. Receiver-operating characteristic curve analysis revealed among these strains GLS has the largest area under the curve (AUC: 0.93, P < 0.001), the cutoff value of -18.97% with a sensitivity and specificity of 80.0% and 92.0%, respectively, for differentiating two groups. A multivariate linear regression analysis shows that the relationship between gout and strain parameters including GLS, GRS, and GCS is statistically significant (P < 0.001). Although patients with gout having a normal ejection fraction, structural remodeling of the left ventricle and subclinical LV deformation may occur. 3D-STE can detect subtle cardiac dysfunctions in patients with gout at an early stage.

Exploring the prospect of intrinsic wave propagation in evaluating myocardial stiffness among patients with type 2 diabetes.

Diabetes predisposes affected individuals to impaired myocardial perfusion and ischemia, leading to cardiac dysfunction. Increased myocardial stiffness is an independent and significant risk factor in diastolic dysfunction. This study sought to estimate myocardial stiffness in Type 2 diabetes (T2DM) patients using the intrinsic wave velocity propagation (IVP) along the longitudinal wall motion during late diastole and evaluate the value of IVP in assessing cardiac function and structure. 87 and 53 participants with and without T2DM (control group) were enrolled. Of the 87 T2DM patients (DM group), 43 were complicated with hypertension (DM + H group), and 44 were not (DM-H group). Ultrasound parameters were measured and analyzed, including color M-mode flow propagation velocity, global longitudinal systolic strain (GLS), and IVP. IVP was higher in the DM group than in the control group (1.62 ± 0.25 m/s and 1.40 ± 0.19 m/s, P < 0.001). After stratification for hypertension, IVP in both DM + H (1.71 ± 0.25 m/s) and DM-H (1.53 ± 0.20 m/s) groups were found to be significantly higher than that in the control group (1.40 ± 0.19 m/s); also, the difference of IVP between DM + H and DM-H group reached statistical significance. Moreover, IVP was significantly correlated with flow propagation velocity during early diastole (Pve) (r = -0.580, P < 0.001), flow propagation velocity during late diastole (Pva) (r = 0.271, P < 0.001), GLS (r = 0.330, P < 0.001), interventricular septal thickness at end-diastole (IVSd) (r = 0.321, P < 0.001), blood glucose (r = 0.246, P < 0.003), systolic blood pressure (r = 0.370, P < 0.001) and diastolic blood pressure (r = 0.389, P < 0.001). The results indicated the application potential of IVP in assessing the early detection of cardiac function changes noninvasively and sensitively. The correlation with myocardial stiffness warrants further studies to substantiate its potential clinical utility.

Significant dependency of left atrial strain on left ventricular longitudinal motion.

The effects of left ventricular longitudinal function on the left atrial strain, including the left atrial reservoir function, have not been adequately quantified. A total of 124 patients who underwent echocardiography were enrolled in this study. Left atrial strain analysis was performed using two-dimensional speckle tracking echocardiography, and the left atrial volume was derived using the modified Simpson's method. The peak left atrial strain (LAS) and left atrial expansion index (LAEI), as indices of left atrial reservoir function, were measured. The global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE), which are indices of contractile motion toward the left ventricular apex, were also measured. The correlation between LAS and candidate determinants, including left ventricular systolic longitudinal function, was evaluated, and multivariate regression analysis was performed. A significant correlation was found between LAS and left ventricular systolic longitudinal functions, GLS (r = 0.63, p < 0.001), and MAPSE (r = 0.65, p < 0.001). Two models, which were selected by multiple regression analyses for LAS, included GLS or MAPSE as independent determinants. GLS and MAPSE were also the strongest predictors, among other factors. LAS, when determined by evaluating the left atrial reservoir function, was significantly associated with left ventricular function, especially the systolic longitudinal function. Left ventricular function should be considered when assessing left atrial function by LAS.

P202 A study on myocardial dysfunction in Indian patients with Takayasu's arteritis

Abstract Background/Aims Takayasu’s arteritis (TA) is a form of predominantly large vessel vasculitis affecting young individuals. Signs of vascular insufficiency or systemic inflammation may be seen in the vast majority of patients, with cardiac involvement noted in more than one-third of the cases. Previous histopathologic studies from India have revealed the presence of myocarditis in up to 50% of patients. We conducted this study to assess myocardial dysfunction using Speckle Tracking Echocardiography (STE), a novel method to assess global longitudinal systolic strain (GLSS), in TA patients and healthy controls. Methods This was a cross-sectional, case-control study. Between August 2018 and May 2021, all consenting adult patients classified as per the ACR 1990 Criteria as Takayasu’s arteritis were included in the study after taking their informed consent. Age and gender-matched healthy controls without known comorbidities like hypertension, diabetes, or coronary artery disease were included for comparison. Demographic, clinical, and laboratory parameters were assessed. All enrolled participants underwent 2D echocardiography with speckle tracking and GLSS evaluation as well as B-mode ultrasonography to measure carotid intimal medial thickness (CIMT) of bilateral carotid arteries, by a single, blinded cardiologist with over 20 years of experience in his field. The study was approved by the Institutional Ethics Committee. Results Fifty patients with TA who consented to the study were included, with fifty healthy controls. 66% of the cohort were female. TA patients had significantly lower mean LVEF (56% vs 60%, p &amp;lt; 0.0001), worse mean GLSS (-19.3% vs -20.9%, p = 0.003), more patients with GLSS &amp;gt;-19.7 (48% vs 24%, p = 0.01), and higher mean CIMT values (0.58mm vs 0.44mm, p = 0.001) than the healthy controls. Cases with GLSS less negative than -19.7% (24 out of 50) were significantly older (mean age 42.8 vs 35.4 years, p = 0.049), had more cardiac (62.5% vs 19.2%, p = 0.02) and coronary artery involvement (37.5% vs 7.7%, p = 0.011). Mean CIMT values were significantly more in patients with active disease as per the ITAS 2010 score. GLSS could not differentiate between active and inactive disease, nor did they correlate with raised inflammatory markers. There was no significant correlation between higher CIMT values and worse GLSS. Conclusion This is a pilot study comparing TA cases with healthy controls using STE and CIMT values. While mean CIMT values and GLSS were increased in patients with TA, GLSS did not correlate with disease activity status. Older age and a greater proportion of patients with cardiac involvement were the only significant differences noted in patients with worse GLSS. Longitudinal studies based on STE may help us document changes in subclinical myocarditis in TA. Disclosure R. Bajaj: None. S. Ghosh: None. D. Tanna: None. D. Yadavalli: None. W. Kazi: None. V. Singal: None. R. Gupta: None.