Myocardial Global Longitudinal Strain Research Articles

Do diurnal changes in blood pressure affect myocardial work indices?

Do diurnal changes in blood pressure affect myocardial work indices?

Dynamics of myocardial global longitudinal strain in patients with COVID-19 without significant baseline cardiovascular pathology

Abstract Background/Introduction SARS-CoV-2 is notorious for its ability to cause damage to the respiratory system and myocardium, which can result in the development of acute respiratory distress syndrome and myocardial dysfunction. Purpose The aim of our study was to assess the interaction between the severity of COVID-19 and echocardiographic parameters of myocardial dysfunction, as well as lung ultrasound data. Methods 47 COVID-19 patients without signs of cardiovascular pathology were included in our study (33 in the moderate severity subgroup and 14 in the severe subgroup). All patients underwent comprehensive transthoracic echocardiography, including global longitudinal strain (GLS) of both ventricles, and lung ultrasound at days 1 and 9 of the disease. We used GLS cut-off values of 16% and 20% for LV and RV respectively. We performed the lung ultrasonography using an 8-zone protocol for each lung. The EACVI lung ultrasound scoring system for each region and ultrasound pattern was used. Results At day 1, patients in the severe subgroup had a greater tricuspid gradient (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,04) and systolic pulmonary artery pressure (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,02). Moreover, we noted a decrease in the GLS RV index in COVID-19-patients in comparison with the generally accepted reference values (18,45 [15,8; 21,0]). During the course of the disease, an increase in GLS RV was noted in both subgroups, which was especially pronounced among severe patients (18,5 [15,2; 21,1] vs. 20,2 [15,8; 22,0], p=0,038). Assessing the LV function, we noted a difference in the E/e (LV) ratio among severe and moderate subgroups (7,5 [6,8; 9,34] vs. 9,5 [7,7; 10,2], p=0,03). The GLS LV didn't differ between patient subgroups at day 1. We noted an increase in GLS LV at day 9 in both subgroups, but the difference reached significance among moderate patients (17,9 [15,8; 20,1] vs. 19,5 [17,1; 21,8], p=0,038). We observed a greater number of points assessing the B-lines among severe subgroup compared to moderate subgroup (19,5 [17,5; 26,5] vs. 13,0 [7,0; 18,0], p<0,01). Conclusion Among COVID-19 patients without an underlying cardiovascular pathology the transient decrease in LV and RV function assessed via GLS was observed even among patients with moderate disease severity. Funding Acknowledgement Type of funding sources: None.

Cardiovascular magnetic resonance characterisation of anthracycline cardiotoxicity in adults with normal left ventricular ejection fraction

BackgroundAnthracycline therapy may lead to changes in cardiac structure and function not detectable by solely evaluating left ventricular ejection fraction (LVEF). ObjectivesWe hypothesized that cardiovascular magnetic resonance (CMR) would identify structural and functional myocardial abnormalities in anthracycline-treated cancer survivors with normal LVEF, compared to a matched control population. MethodsForty-five cancer survivors (56 ± 16 yrs., 60% female) with normal LVEF (59.5 ± 4.1%) were studied a median of 11 months (range 3–36) following administration of 237 ± 83 mg/m2 anthracycline, and compared with forty-five healthy control subjects of similar age and sex (53 ± 16 yrs., 60% female) with normal LVEF (60.8 ± 2.4%) using 1.5 T CMR. ResultsSignificantly smaller indexed left ventricular mass (45.6 ± 8.7 vs 50.3 ± 10.1 g/m2, p = 0.02) and indexed myocardial cell volume (30.5 ± 5.7 vs 34.8 ± 7.2 ml/m2, p = 0.002) were evident in cancer survivors and the latter was inversely associated with cumulative anthracycline dose (r = −0.31, p = 0.02). Surrogate CMR markers of myocardial fibrosis were significantly increased in cancer survivors (native myocardial T1: 1021 ± 40 vs 996 ± 35 ms, p = 0.002; extracellular volume: 29.5 ± 4.5 vs 27.4 ± 2.3%, p = 0.006). CMR-derived feature-tracking global longitudinal strain (GLS) was significantly impaired in cancer survivors (2D GLS -18.3 ± 2.6 vs −20.0 ± 2.0%, p < 0.001; 3D GLS -14.5 ± 2.3 vs −16.4 ± 2.6%, p < 0.001). Parameters exhibited good to excellent (ICC = 0.86–0.98) inter- and intra-observer reproducibility. ConclusionsAnthracycline-treated cancer survivors with normal LVEF have significant perturbations of LV mass, myocardial cell volume, native myocardial T1, ECV, CMR-derived 2D and 3D GLS, compared to controls, with good to excellent levels of inter- and intra-observer reproducibility.

Assessment of 10-Year Left-Ventricular-Remodeling by CMR in Patients Following Aortic Valve Replacement.

Aims: Aortic valve replacement (AVR) may result in reverse cardiac remodeling. We aimed to assess long-term changes in the myocardium following AVR by Cardiac Magnetic Resonance Imaging (CMR).Methods: We prospectively observed the long-term left ventricular (LV) function and structure of 27 patients with AVR [n = 19 with aortic stenosis (AS); n = 8 with aortic regurgitation (AR)] by CMR. Patients underwent CMR before, as well as 1, 5, and 10 years after AVR. We evaluated clinical parameters, LV volumes, mass, geometry, ejection fraction (EF), global myocardial longitudinal strain (MyoGLS), global myocardial circular strain (MyoGCS), hemodynamic forces (HemForces), and Late Gadolinium Enhancement (LGE).Results: The median of LVMI, EDVI, and ESVI decreased in both groups. Patients with AR had higher initial values of EDVI and ESVI and showed a more prominent initial reduction. In AS, MyoGLS improved already after 1 year and remained constant afterward, whereas, in AR no improvement of MyoGLS was found. MyoGCS remained unchanged in the AS group but deteriorated in the AR group over 10 years. Ejection fraction (EF) was higher in AS patients compared to AR 10 years post-AVR. Late gadolinium enhancement (LGE) could be found more frequently in AS patients.Conclusion: CMR was well suited to investigate myocardial changes over a 10-year follow up period in patients with aortic valve disease. Regarding the long-term functional changes following AVR, patients with AR seemed to benefit less from AVR compared to AS patients. Fibrosis was more common in AS, but this did not reflect functional evolution in these patients. Close monitoring seems indispensable to avoid irreversible structural damage of the heart and to perform AVR at an appropriate stage.

Use of myocardial work for multiparametric detection of subclinical anthracycline cardiotoxicity in breast cancer patients

Abstract Funding Acknowledgements Type of funding sources: None. Background The aim of our study was to assess subclinical cardiac effects of anthracyclines (ANTs) in women treated for breast cancer (BC). Methods We enrolled 46 female patients with BC undergoing adjuvant treatment with anthracycline-containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel). Patients underwent physical examination, electrocardiogram (ECG) and standard transthoracic echocardiography (TTE) including evaluation of diastolic and systolic function, measured as left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS) and myocardial work (MW) expressed as global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE). The parameters were measured at baseline (T0) and at 3 months (T1) and 6 months (T2) follow up. Results All patients completed the chemotherapy cycles. No significant cardiovascular adverse events were observed during treatment. Neither 2D left ventricular ejection fraction (LVEF) nor E/e’ ratio evaluation at TDI were significantly changed after treatment. Conversely, GLS was significantly reduced at T1 and T2 since baseline (GLS - 19,99 % IQR -20,6 -19,3 % at T0 vs -17,88 % IQR -18,8 -16,9 % at T1, p&amp;lt; 0,00 1 and -16,71 % IQR 17,6 -15,7 % at T2, p&amp;lt; 0,001). Consensually, a significant reduction in myocardial work was also measured (GWI 2115 mmHg% IQR 1888 – 2342 mmHg% at T0 vs 1714 mmHg% IQR 1557 – 1870 mmHg% at T1, p&amp;lt; 0,0001 and 1694 mmHg% IQR 1482 – 1907 mmHg% at T2, p&amp;lt; 0,0001). Conclusion Our study demonstrates that evaluation of myocardial work allows very early detection of subclinical cardiac damage induced by chemotherapy, consensually to the reduction of the GLS. A multiparametric assessment of the myocardial function, including myocardial work and GLS, could improve the accuracy of risk stratification of cardiotoxicity in patients undergoing ANTs treatment.

Contribution of sarcomere gene mutations to left atrial function in patients with hypertrophic cardiomyopathy

BackgroundLeft atrial (LA) enlargement and dysfunction are related to clinical course in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate genetic contribution to LA structural and functional remodeling.MethodsTwo hundred twelve patients were consecutively enrolled, and echocardiography and extensive genetic analysis were performed. Cardiac magnetic resonance (CMR) was performed in 135 patients. Echocardiography was also performed in controls (n = 30).ResultsPatients with HCM had lower late-diastolic mitral annular velocity (a’) and higher LA volume index (LAVI) than controls. Patients with pathogenic or likely pathogenic sarcomere gene mutations (PSM, n = 67, 32%) had higher LAVI and lower CMR-derived LA total emptying fraction (37.0 ± 18.5 vs. 44.2 ± 12.4%, p = 0.025). In patients without AF (n = 187), the PSM had lower a’ (6.9 ± 2.0 vs. 7.8 ± 1.9 cm/s, p = 0.004) than others. The PSM had higher prevalence and amount of late gadolinium enhancement (LGE) in the left ventricle (LV). In multivariate analysis, PSM was significantly related to lower a’ independent of E/e’, LV mass index, and LAVI. However, the relation significantly attenuated after adjustment for the extent of LGE in the LV, suggesting common myopathy in the LV and LA. In addition, PSM was significantly related to lower LA total emptying fraction independent of age, E/e’, s’, LV ejection fraction, LV myocardial global longitudinal strain and %LGE mass.ConclusionsPSM was related to LA dysfunction independent of LV filling pressure and LAVI, suggesting its contribution to atrial myopathy in HCM.

Very low birth weight is associated with reduced right ventricular function detected by strain imaging in early adulthood – findings from a prospective matched cohort study

Abstract Introduction Being born at very low birth weight (VLBW, &amp;lt;1500g) is associated with increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects, including right ventricular (RV) remodelling and occult pulmonary hypertension are emerging. Strain imaging provides prognostically important information regarding RV dysfunction in diverse cardiopulmonary conditions however, these indices have not previously been described within VLBW cohorts. Purpose To assess differences in right heart function using strain in young adults born at VLBW, compared to normal weight term born controls. Methods The New Zealand Very Low Birth Weight Study has followed all infants born in 1986 with birth weight &amp;lt;1500g. Of 323 survivors to adulthood, 228 (71%) had echocardiograms at 26–30 years which were compared to age and sex-matched term-born, normal-weight controls (n=100). RV global longitudinal strain (GLS) was measured by speckle tracking echocardiography by an investigator blinded to group allocation. Established measures of RV function (fractional area change (FAC), tricuspid annular systolic velocity (RV S') and tricuspid regurgitation velocities) were also obtained. Results VLBW subjects were smaller than their peers as young adults (Table 1). Strain measurement showed reduced myocardial deformation among VLBW subjects (RV myocardial GLS: −22.4% vs −23.5%, p=0.008; RV endocardial GLS: −23.6% vs −24.9%, p=0.005; free wall myocardial GLS −25.2% vs −26.1%, p=0.039; free wall endocardial GLS −26.7% vs −27.9%, p=0.009). TR velocity was higher in VLBW: 224 cm/s v 210 cm/s (p=0.002). RV S', and FAC were not different. Conclusion Young adults born at VLBW have impaired myocardial strain despite preserved RV function as assessed by standard techniques. Echocardiographic strain imaging may be an important tool to detect subclinical RV dysfunction. Graph 1 Funding Acknowledgement Type of funding source: None

Speckle-tracking during dipyridamole stress echocardiography in the detection of myocardial ischemia in patients with suspected coronary artery disease

Abstract Background The aim of this study was to investigate the incremental value of global longitudinal strain (GLS), postsystolic strain index (PSI) and prestretch (PSE) by automated function imaging with respect to wall motion (WM) and coronary flow reserve (CFR) for the diagnosis of significant coronary artery disease (CAD) during dipyridamole stress echocardiography. Methods We retrospectibely enrolled 227 patients with known or suspected CAD, approaching our echo lab to perform a DSE; all patient underwent coronary angiography within 1 month for clinical reasons. Obstructive CAD was defined as the evidence of &amp;gt;70% stenosis during coronary angiogram. Obstructive CAD was detected in 143 (63%) patients, while 84 (37%) had no significant CAD. Global longitudinal strain, PSI and PSE were measured at rest and peak of the stress (after 6 minutes of 0,84mg/kg of dipyridamole infusion). Results Patient with CAD showed a significantly lower GLS at rest (−16.9±4.2 vs −18.6±3.4; p&amp;lt;0.01) and peak (14.9±3.8 vs −21.50±3.3; p&amp;lt;0.01) Figure A; the behavior of GLS was opposite, in patient with CAD showed an increase while in patient without CAD a significant decrease after dipyridamole infusion. There was also a significant difference between groups for Delta PSI (PSIpeak − PSIrest) and Delta PSE (PSEpeak − PSErest), respectively 126±145 vs −40±97, (p&amp;lt;0.01) and 108±163 vs −41±106 (p&amp;lt;0.01) Figure C. ROC analyses produced a statistically valid model: Average GLS at peak (p 0.001; AUC=0.906, cut-off value −18%, sensitivity 83% and specificity 82%); on the basis of these results, we compared WM and myocardial deformation analysis and GLS was superior to CFR LAD, Delta EF, Delta ESV and Delta WMI (Figure B). Conclusions GLS, PSE and PSI show an opposite response to dipyridamole, in patients with CAD in patient without CAD and show much higher sensitivity and specificity compared to the conventional parameters like WMI, EF and CFR in detecting CAD Funding Acknowledgement Type of funding source: None

Adenosine stress native T1 mapping demonstrates impaired myocardial perfusion reserve in non-ischemic dilated cardiomyopathy

Abstract Background Impaired myocardial perfusion reserve has been demonstrated in non-ischemic dilated cardiomyopathy (NIDCM) by positron emission tomography (PET) and adenosine-stress first-pass perfusion cardiac magnetic resonance (CMR) imaging. Adenosine stress native T1 mapping is a novel CMR technique able to assess myocardial perfusion without the use of contrast agents. The aim of the present study was to determine the clinical utility of this novel CMR technique in NIDCM. Methods A total of 20 consecutive patients (mean age 61±12 years, 80% males) with diagnosis of NIDCM who consented to be enrolled in the UHSM CMR registry were included in the present study. CMR at 3T including 1. cine imaging for the assessment of LV volumes, mass and global longitudinal strain (GLS) by tissue-tracking imaging; 2. rest and stress (adenosine 140 mcg/kg/min) MOLLI T1 mapping of mid-ventricular slice for the assessment of rest and stress T1 values and T1 reactivity (ΔT1%); 3. first-pass perfusion imaging for the assessment of myocardial perfusion reserve index (MPRI) and 4. late gadolinium enhancement (LGE) imaging for the assessment of myocardial replacement fibrosis, was performed. Twenty control patients without history of known coronary artery disease and evidence of reversible ischemia or previous myocardial infarct on CMR imaging were included for comparison purposes. Results NIDCM patients had significantly higher native T1 value (1263±47 ms vs. 1234±38 ms, p=0.031), significantly lower ΔT1% (3.2±1.5% vs. 5.7±1.7%, p&amp;lt;0.001, Figure A), significantly lower MPRI (1.32±0.18 vs. 1.67±0.13, p&amp;lt;0.001) and significantly impaired GLS (−10±4% vs. −16±2%, p&amp;lt;0.001) as compared to controls. A significant strong relation between ΔT1% and MPRI (β=0.76, p&amp;lt;0.001, Figure B) and significant moderate relation between ΔT1% and GLS (β=−0.54, p&amp;lt;0.001) were observed. Conclusion T1 reactivity, myocardial perfusion reserve and GLS are significantly reduced in NIDCM patients compared to controls. Adenosine stress T1 mapping holds promise for detection of impaired myocardial perfusion reserve in NIDCM without the requirement for contrast agents. Funding Acknowledgement Type of funding source: None

The changes of left ventricular longitudinal systolic function depending on hypertension and its control: analysis in a population

Aim To evaluate changes in left ventricular (LV) systolic function by LV myocardial global longitudinal strain (GLS) and global strain rate (GSR) in patients with arterial hypertension (AH) and based on the effectiveness of blood pressure (BP) control in a Russian population sample of individuals older than 55 years.Materials and methods This cross-sectional study was a population-based cohort study (HAPIEE, Novosibirsk). LV myocardial GLS and GSR were studied by echocardiography in a random sample (n=1004, 55-84 years). Statistical analysis was performed with multivariate models of logistic regression.Results AH prevalence in the study sample was 78.4 %. Mean GLS was 19.1 % (SD, 4.07), which was less for men than for women (p=0.001). Mean GSR was 0.86 s-1 (SD, 0.19) and was not different between men and women. In individuals with AH, the GLS absolute value was lower than in normotensive people (18.8 %; SD, 4.04 vs. 20.2 %; SD, 4.03, p˂0.001); these differences remained irrespective of the age, gender, body weight index (BWI) (p=0.027), and LV mass index (p=0.05). When people with AH were divided into groups, the lowest GLS absolute values were observed among "ineffectively treated" or not receiving any therapy individuals (p&lt;0.001 vs. normotensive group). AH 1.6 times increased the risk of LV GLS decrease. In individuals with AH, the GSR absolute value was lower than in normotensive people (- 0.85 s-1 (SD, 0.19) vs.- 0.92 s-1 (SD, 0.18), p&lt;0.001); this difference remained in multivariate models. The lowest GSR absolute values were observed in the "ineffectively treated" group irrespective of the gender, age, and BWI (p=0.036 vs. normotensive group). AH doubled the risk of LV GSR decrease, which could be partially explained by the contribution of BWI and myocardial mass index.Conclusion In this population sample, LV GLS and GSR were independently associated with AH. The lowest GLS and GSR values were observed for ineffectively treated" individuals with AH, which may reflect an early decline of LV systolic function with inadequate control of AH.

Feature Tracking of Global Longitudinal Strain by Using Cardiovascular MRI Improves Risk Stratification in Heart Failure with Preserved Ejection Fraction

Background In heart failure with preserved ejection fraction (HFpEF), echocardiographic studies suggest that global longitudinal strain (GLS) has an impact on survival. Feature-tracking cardiovascular MRI also allows for strain analysis; however, to the knowledge of the authors, little is known about its prognostic value and whether it reflects severity of diffuse fibrosis, as assessed by cardiovascular MRI T1 mapping. Purpose To investigate the association between myocardial strain at cardiovascular MRI with extracellular volume by T1 mapping and outcome in participants with HFpEF. Materials and Methods In this secondary analysis of a prospective study (NCT03405987), consecutive participants with HFpEF underwent cardiovascular MRI between July 2012 and March 2018, including T1 mapping and three-dimensional strain analysis. Extracellular volume and strain results were assessed to determine if there was a correlation between these two factors. Cox regression was performed to determine the prognostic relevance of MRI-derived myocardial strain for a combined end point (events) of heart failure hospitalizations and cardiovascular death. Results In total, 206 consecutive participants with HFpEF (mean age, 71 years ± 8 [standard deviation]; 69% women) were included. Median myocardial global longitudinal strain (GLS) at MRI was -8.5% and showed low correlation with extracellular volume (r = 0.28; P = .003). A total of 109 events (53%) were recorded during a follow-up of 38 months ± 29. Participants with a GLS above the median had higher event rates (log-rank test, P < .001). By multivariable Cox regression analysis, GLS remained independently associated with outcome (hazard ratio, 1.06 per 1% strain increase; 95% confidence interval: 1.01, 1.11; P = .03) when corrected for risk factors including age, diabetes, renal function, N-terminal pro-b-type natriuretic peptide serum concentration, and right ventricular size and function. Conclusion In participants with heart failure with preserved ejection fraction, global longitudinal strain at cardiovascular MRI was correlated with extracellular volume by T1 mapping and was associated with cardiovascular events. © RSNA, 2020 Online supplemental material is available for this article.

A002 Very Low Birth Weight is Associated With Reduced Right Ventricular Function Detected by Strain Imaging in Early Adulthood – Findings From a Prospective Cohort Study

Those born at very low birth weight (VLBW, <1500g) have increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects are emerging. Echocardiographic strain imaging provides prognostically important information regarding the right ventricle (RV) in diverse cardiopulmonary conditions but has not been described in VLBW cohorts. We assessed right heart function using strain in young adults born at VLBW, compared to normal-weight term-born controls. The NZ Very Low Birth Weight Study has followed all infants born in 1986 with birth weight <1500g. Of 323 survivors to adulthood, 229 (71%) had echocardiograms at 26-30 years which were compared to age -matched term-born, normal-weight controls (n=100). RV global longitudinal strain (GLS) was measured. Established echo measures of RV function including fractional area change (FAC), tricuspid annular systolic velocity (RV S') and tricuspid regurgitation velocities (TR) were also measured. VLBW subjects were smaller than their peers as young adults (BSA 1.85+/-0.3m2 vs 1.96+/-0.9m2). Strain measurement showed reduced myocardial deformation among VLBW subjects (n=106) compared to controls (n=60): RV myocardial GLS: -22.4%(+/-2.3) vs -23.5%(+/-2.9), p=0.008; RV endocardial GLS: -23.6%(+/-2.7) vs -24.9%(+/-3.2), p=0.005; free wall myocardial GLS: -25.2% (+/-2.9) vs-26.1% (+/-2.7), p=0.039; free wall endocardial GLS: -26.7%(+/-2.9) vs -27.9% (+/-3.1), p=0.009). TR velocity was higher in VLBW: 2.2m/s vs 2.1m/s (p=0.006). RV S' (12.5cm/s vs 12.9cm/s) and FAC: 42.5% vs 43.7% were not different. Young adults born at VLBW have impaired strain despite preserved RV function assessed by standard techniques. Echocardiographic strain imaging may be an important tool to detect subclinical RV dysfunction in this clinically important and growing population.

P1383 The effects of doxorubicin on left and right ventricular strain in patients with lymphoma: insights from a retrospective study

Abstract Funding Acknowledgements South Tees Research and Development Fund (UK) Background Anthracyclines are a cornerstone in the management of lymphoma. However, their use is associated with cardiotoxicity. Speckle tracking echocardiography (STE) has been established as a valid measure of quantifying cardiac function. However, most studies to this date have focused predominantly on left ventricular (LV) global longitudinal strain (GLS) with only a limited number assessing the right ventricle (RV) and other LV strain parameters. Purpose Using 2D STE, we assessed the effects of anthracyclines on LV and RV strain parameters, focusing on LV endocardial (GLS), LV myocardial GLS (myoGLS), LV radial strain (GRS), RV endocardial (RV GLS), myocardial GLS (RV myoGLS), and RV free wall strain (RVFWS). Methods We retrospectively collected data on patients treated for lymphoma between 2015-2018. Two groups (G) were defined: those with a conventional drop in LV ejection fraction (EF), (G1, n = 11) and those without (G2, n = 24). Echocardiograms were performed pre-chemotherapy (T0), mid-treatment (T1), and post-chemotherapy (T2) and were analysed offline using vendor-independent software (TomTec 2D CPA). LV and RV strain analysis was performed in both groups. This study was ethically approved by Health Research Association (REC Reference 18/SS/0139). Results Mean age was 61 ± 16 years (G1) and 65 ± 12 years (G2). 18% (G1) and 17% (G2) of patients had a history of IHD in each group. Mean cumulative dose of doxorubicin was 280 ± 31 mg/m2 (G1) and 280± 48mg/m2 (G2). In both groups, there was no significant change in LV or RV strain parameters from T0 to T1. In G1, between T1 and T2, patients exhibited a significant deterioration in LV GLS (-19.7 ± 2.6% vs.-15.6 ± 2.5% p &amp;lt; 0.0005), and LV myoGLS (-17.3 ± 2.2% vs. -14.1 ± 2.9% p = 0.02). There was also a measurable decline in RV strain parameters between T1 to T2 (RV GLS, -23.1 ± 4.7% vs. -18.8 ± 4.2% p = 0.028) and (RV myoGLS -21.5 ± 5.2% vs -17.3 ± 3.6% p = 0.013). When analysed from T0 to T2, the changes in RV strain were more marked; RV GLS (-25.2 ± 4.9% vs. -18.8 ± 4.2% p = 0.005), RV myoGLS (-22.4 ± 5.2% vs-17.3 ± 3.6% p = 0.005), and RVFWS (-28.8 ± 5.7% vs. -20.9 ± 6.7% p = 0.001). In G2, no change was observed in LV GLS (-20.4 ± 2.3% vs. -19.6 ± 2.8% p = 0.66), LV myoGLS (-18.8 ± 2.5% vs. -17.5 ± 3.1% p = 0.18), RV GLS (-24.2 ± 2.3% vs. -23.1 ± 2.7% p = 0.42), RV myoGLS (-22.4 ± 2.9% vs. -20.6 ± 2.8% p = 0.09), RVFWS (-26.7 ± 4.6% vs. -25.2 ± 3.6% p = 1.0). GRS did not significantly change in either G1 or G2 during treatment. Conclusion In patients with a reduction in LVEF, this analysis demonstrated a significant reduction in LV strain parameters secondary to anthracycline treatment. Novel strain parameters did not change in the normal EF group, or predate EF/GLS decline in those with reduced LVEF. Measurable RV dysfunction was noted in those with LV deterioration, highlighting the global cardiac insult of anthracycline treatment. Preventative and monitoring strategies in cardio-oncology should not overlook RV function.

P1574 Variation in myocardial work performance after surgical and transcather aortic valve replacement: A pilot echocardiographic study

Abstract Funding Acknowledgements none Objective Perioperative myocardial injury occurs after surgical aortic valve replacement (SAVR) as well as after transcather aortic valve replacement (TAVR). The novel non-invasive method for regional LV pressure– strain corresponds well with invasively measured myocardial work (MW) and is independent of afterload compared to ejection fraction and global longitudinal strain (GLS) . In this pilot study, we aimed to compare changes of LV-MW index (MWI) between SAVR and TAVR in the early postoperative period. Methods 25 TAVR (Corevalve &amp; Symetis) and 25 SAVR (Perimount) patients, scheduled for elective procedures received transthoracic echocardiography studies pre- and 7 days postoperatively. Besides routine measurements the following parameters were analyzed: MWI, global MW efficiency (MWE), global wasted myocardial work (GWMW), GLS and global strain rate (GSR). Results In the TAVR group, 17 patients received transfermoral, 8 patients transapical TAVR. As expected, EuroSCORE II was significantly higher in the TAVR group (p = 0.015). GLS was significantly lower (better) in the SAVR group compared to the TAVR group preoperatively (-13.4 + 4.9 vs.-16.7 ± 4.2, p = 0.027). Postoperative GLS increased (worsened) in the SAVR group, though no significant difference was detected between the groups (-12.7 ± 5.1% vs. -10.4 ± 3.4%, p = 0.215) postoperatively. MWI was significantly lower in the TAVR group preoperatively (p = 0.033). Within the TAVR group MWI did not decrease significantly postoperatively (1242 mmHg% vs. 1108 mmHg%, p = 0.476). However, postoperative MWI decreased significantly in the SAVR group (1632 mmHg% vs. 1267mmHg%, p = 0.043). MWE and GWMW did not differ between the groups or within the groups comparing pre- and postoperative values. Conclusion Despite better GLS values in SAVR patients preoperatively, we could detect a better preservation of GMWI in TAVR Patients postoperatively. To evaluate the clinical impact of MWI, further studies with larger cohort and correlation with biomarkers of myocardial injury and follow-up assessments are required. Abstract P1574 Figure. Myocardial work changes after TAVI

Silent myocardial dysfunction in vitamin D deficiency.

IntroductionVitamin D (VD) deficiency is a common disease that occurs in all stages of life. A growing number of studies call attention to the relationship between VD deficiency and cardiovascular disease. The aim of this study was to investigate the effect of VD on subclinical left ventricular (LV) function in diabetic and non-diabetic patients with no significant coronary artery disease.Material and methodsWe recruited 140 patients (80 diabetics and 60 non-diabetics) with symptoms of stable ischemic heart disease who underwent coronary angiography and who had no significant coronary artery disease in our clinic. The 25(OH)D3 levels were measured and patients who had 25-(OH)D3 levels below 20 ng/dl were defined as the VD deficient group. In addition to conventional echocardiographic parameters, tissue Doppler echocardiography was used for LV diastolic functions and 2D speckle tracking strain echocardiography (2D STE) for evaluating the longitudinal deformation indices of the LV myocardium.ResultsIn all groups, LV global longitudinal strain (GLS) was significantly impaired in patients with VD deficiency (p < 0.001) compared to patients without VD deficiency. LV global longitudinal strain rate (GLSR) was significantly impaired in patients with VD deficiency (p = 0.003). The GLS was negatively associated with 25-(OH)D3 in the VD deficiency group (r = –0.52623, p < 0.001). Conversely, GLS was positively associated with 25-(OH)D3 levels in the normal VD group (r = 0.28, p = 0.048).ConclusionsVD deficiency is associated with impaired myocardial GLS. The present study demonstrated that VD deficiency may be the cause of subclinical myocardial dysfunction in patients with or without diabetes mellitus and no history of significant coronary artery disease.

Global myocardial longitudinal strain in a general population-associations with blood pressure and subclinical heart failure: The Tromsø Study.

The early detection of subclinical myocardial dysfunction can contribute to the treatment and prevention of heart failure (HF). The aim of the study was to (i) describe myocardial global longitudinal strain (GLS) patterns in a large general population sample from Norway and their relation to established cardiovascular disease (CVD) risk factors; (ii) to determine its normal thresholds in healthy individuals and (iii) ascertain the relation of myocardial GLS to stage A subclinical heart failure (SAHF). Participants (n = 1855) of the 7th survey of the population-based Tromsø Study of Norway (2015-2016) with GLS measurements were studied. Linear and logistic regression models were used for assessment of the associations between CVD risk factors and GLS. Mean GLS (SD) in healthy participants was - 15.9 (2.7) % in men and - 17.8 (3.1)% in women. Among healthy subjects, defined as those without known cardiovascular diseases and comorbidities, GLS declined with age. An increase of systolic blood pressure (SBP) of 10mm Hg was associated with a 0.2% GLS reduction. Myocardial GLS in individuals with SAHF was 1.2% lower than in participants without SAHF (p < 0.001). Mean myocardial GLS declines with age in both sexes, both in a general population and in the healthy subsample. SBP increase associated with GLS decline in women. Our findings indicate high sensitivity of GLS for early subclinical stages of HF.

Value of cardiac MR in evaluating myocardial infarction with chronic mitral insufficiency

Objective To evaluate the value of cardiac MR imaging in chronic ischemie mitral regurgitation (IMR) in patients with myocardial infarction. Methods All patients clinically diagnosed with coronary heart disease and myocardial infarction in our hospital from January 2016 to September 2018 were retrospectively selected, myocardial infarction time more than 3 months and confirmed to have necrotic myocardium by cardiac magnetic resonance examination. All patients underwent echocardiography at the same time. Based on the results of echocardiography, patients were divided into the myocardial infarction group without IMR (40 cases), the mild IMR group (39 cases) and the moderate to severe IMR group (51 cases). Cardiac MR and delayed enhancement (LGE) scan images were analyzed. Cardiac function indexes were measured and left ventricular LGE positive segments were recorded. The indexes of myocardial global longitudinal strain (GLS), global peripheral strain (GCS) and global radial strain (GRS) of left ventricle of IMR patients were measured by feature tracking(FT). Cardiovascular history, coronary artery stenosis and location of myocardial infarction were compared by chi-square test between the without IMR, mild IMR and moderate to severe IMR groups.Univariate analysis of variance was used to compare the measurement data of left ventricular myocardial infarction volume, left heart function and left ventricular myocardial globle strain, and LSD test was used for pair-wise comparison. Results There was no difference in age, sex and cardiovascular history among the three groups. Comparison of myocardial infarction patients in the three groups: (1) There was no statistically significant difference in the myocardial infarction volume between the three groups (P=0.052), while the myocardial infarction volume tended to increase as the grade of mitral regurgitation increased. The number of patients with myocardial infarction in the inferior wall and the inferolateral wall in the moderate to severe IMR group were significantly higher than those of the other two groups (P<0.05), and there was no significant difference in the volume of myocardial infarction between the without IMR group and mild IMR group, and no difference in the number of patients with inferior wall and inferolateral wall. (2) Cardiac function measured by CMR: ejection fraction (EF) was significantly reduced in the moderate to severe IMR group compared with the without IMR group and the mild IMR group (P<0.05), the end diastolic volume (EDV) increased significantly and the end systolic volume (ESV) increased significantly (P<0.05). Mass of myocardium increased significantly (P<0.05); Stroke volume (SV) and cardiac output (CO) there was no significant difference among the three groups. (3) Comparison of the moderate to severe IMR group to the without IMR group and the mild IMR group respectively: left ventricular GLS and GRS decreased (P<0.05), the difference of the GCS was no statistically significant. There was no statistical difference in the three strain values between the without IMR group and the mild IMR group. Conclusion The globe myocardial strain of the left ventricle in myocardial infarction patients with chronic moderate to severe IMR was significantly impaired, the myocardial infarction in the inferior wall and the inferolateral wall in the level of the papillary muscle may be correlated with chronic moderate to severe IMR, and the myocardial infarction volume of the left ventricle may also be related. Key words: Myocardial infarction; Mitral regurgitation; Magnetic resonance imaging

Myocardial global longitudinal strain: An early indicator of cardiac interstitial fibrosis modified by spironolactone, in a unique hypertensive rat model.

Is global longitudinal strain (GLS) a more accurate non-invasive measure of histological myocardial fibrosis than left ventricular ejection fraction (LVEF) in a hypertensive rodent model. Hypertension results in left ventricular hypertrophy and cardiac dysfunction. Speckle-tracking echocardiography has emerged as a robust technique to evaluate cardiac function in humans compared with standard echocardiography. However, its use in animal studies is less clearly defined. Cyp1a1Ren2 transgenic rats were randomly assigned to three groups; normotensive, untreated hypertensive or hypertensive with daily administration of spironolactone (human equivalent dose of 50 mg/day). Cardiac function and interstitial fibrosis development were monitored for three months. The lower limit of normal LVEF was calculated to be 75%. After three months hypertensive animals (196±21 mmHg systolic blood pressure (SBP)) showed increased cardiac fibrosis (8.8±3.2% compared with 2.4±0.7% % in normals), reduced LVEF (from 81±2% to 67±7%) and impaired myocardial GLS (from -17±2% to -11±2) (all p<0.001). Myocardial GLS demonstrated a stronger correlation with cardiac interstitial fibrosis (r2 = 0.58, p<0.0001) than LVEF (r2 = 0.37, p<0.006). Spironolactone significantly blunted SBP elevation (184±15, p<0.01), slowed the progression of cardiac fibrosis (4.9±1.4%, p<0.001), reduced the decline in LVEF (72±4%, p<0.05) and the degree of impaired myocardial GLS (-13±1%, p<0.01) compared to hypertensive animals. This study has demonstrated that, myocardial GLS is a more accurate non-invasive measure of histological myocardial fibrosis compared to standard echocardiography, in an animal model of both treated and untreated hypertension. Spironolactone blunted the progression of cardiac fibrosis and deterioration of myocardial GLS.

Visualization and quantification of myocardial mechanical changes of left ventricle in systemic lupus erythematosus patients using ultrasonic layer-specific strain imaging

Objective To evaluate the damage of longitudinal mechanical parameters of left ventricular myocardium by ultrasonic layer-specific strain imaging in patients with systemic lupus erythematosus (SLE) without conventional evidence of cardiovascular system involvement. Methods Seventy-eight patients suffered from SLE without conventional evidence of cardiovascular system involvement (SLE group) and 48 healthy volunteers with age and sex matched (control group) were selected for this study. The left ventricular conventional structure and functional parameters were measured by conventional echocardiography. Then layer-specific strain imaging was performed in both groups to obtain left ventricular endocardial myocardial global longitudinal strain (GLSendo), mid-myocardial GLS (GLSmid), epicardial GLS (GLSepi) and basal segment, middle segment and apex longitudinal strain (LS) of all three layers of the myocardium. Then the transmural difference of the GLS (ΔLS=GLSendo-GLSepi) were calculated. The related parameters between these two groups were compared for difference and correlation analysis of related mechanical parameters were also made. Results ①There was no significant difference in the left ventricular ejection fraction (LVEF) and left ventricular stroke volume (LVSV ) between the two groups (all P>0.05); Compared with the control group, the mean E/e in the SLE group was increased and the E/A, E, e were decreased (all P 0.05). ②The myocardial global longitudinal strain(GLS) of the two groups were decreased from endocardial to epicardial gradient; the values of GLS and segmental LS of all three layers in the SLE group were decreased (all P<0.05); the ΔLS of the SLE group was decreased compared with the control group (P<0.05); the value of peak strain dispersion (PSD) were increased in SLE patients (P<0.05). ③The correlation analysis showed the GLS of each layer of myocardium in SLE patients were negatively correlated with disease duration (rs=-0.34~-0.36, all P<0.05) and SLE disease activity index(SLEDAI) (rs=-0.25~-0.30, all P<0.05). Conclusions The ultrasonic layer-specific strain imaging can quantitatively detect the damage of mechanical parameters of left ventricle in SLE patients, which is more sensitive than the conventional echocardiography in evaluating left ventricular systolic function. It may provide visual evidence for early diagnosis of cardica dysfunction in SLE patients. Key words: Ultrasonography; Systemic lupus erythematosus; Myocardium; Layer-specific strain

SAT-332 THE EFFECT OF SPIRONOLACTONE IN A RAT MODEL OF ESTABLISHED HYPERTENSION.

Hypertension is one of the leading contributors to cardiovascular and renal disease. Spironolactone (SP) improves cardiac outcomes following injury, but its impact on hypertension-induced kidney fibrosis is uncertain. We aimed to investigate the impact of sustained hypertension with and without daily administration of spironolactone (SP) on the function and injury progression in both heart and kidney, in a transgenic rat model of hypertension. Male, eight week old, Cyp1a1Ren2 rats were randomised to either normal chow or chow with the addition of 0.167% w/w Indol-3-carbinol to induce hypertension (systolic >150mmHg). Hypertensive rats were further divided into those receiving spironolactone daily (human equivalent dose of 50mg), or not, following the establishment of hypertension. Measurement of systolic blood pressure (SBP) and echocardiograms were performed regularly and tissue collected for analyses following termination (after three months). The extent of fibrosis was determined histologically using quantitative pixel count analysis while glomerulosclerosis was scored semi-quantitatively. Induction of chronic hypertension resulted in elevated SBP (196±21 vs 91±13 mmHg (controls)), proteinuria (60±19 vs 14±3 ml.kg-1.hr-1), cortical fibrosis (7±0.4% vs 0.2±0.1%) and glomerulosclerosis index scores (GSI: 2.6±0.3 vs 0.2±0.06) [all variables were significant at p<0.001]. Hypertension also reduced cardiac left ventricular ejection fraction (LVEF, 67±7 vs 80±3%, p<0.001) and myocardial global longitudinal strain (myoGLS, -11±2 vs -17±2%, p<0.001) compared to normotensive animals. Treatment of hypertensive animals with SP resulted in reduced SBP (184±15, p<0.01) and blunted the deterioration of LVEF (72±4, p<0.05) and myoGLS (-13±1, p<0.01) when compared to untreated animals. While SP had no impact on proteinuria, it did result in significant reductions in cortical fibrosis (3±1.3%, p<0.05) and GSI (2±0.1, p<0.05) when compared to untreated hypertensive animals. Prolonged elevation of untreated SBP caused significant and progressive cardiac and renal damage over three months. The addition of spironolactone to established hypertensive animals improved physiological measurements and significantly decreased fibrotic and sclerotic damage in the kidney. Further work aims to explore the relationship between hypertension and renal deterioration.