Global Myocardial Strain Research Articles

The possibilities of echocardiography for detecting cardiotoxic effects of antineoplastic medications

Background. In recent decades, advancements in cancer treatment have resulted in enhanced patient survival rates, yet concurrently, escalated morbidity and mortality due to therapy-induced side effects, with cardiovascular complications (CVC) at the forefront. The risk of cardiovascular disease (CVD) during chemotherapy lies in the potentiality of interrupting or discontinuing the treatment of the underlying ailment, thereby diminishing the patient’s prospects of survival. Regrettably, delayed manifestations of cardiotoxic effects subsequent to the completion of anticancer therapy further diminish the patients’ quality of life and escalate mortality rates. Consequently, early diagnosis and timely identification of cardiotoxic effects induced by anticancer drugs have emerged as paramount objectives, shaping a novel domain in medicine termed cardio-oncology. Purpose. Assess the condition and modern ideas of the development of echocardiography in the assessment of cardiac dysfunction in the context of chemotherapy. Materials and Methods. References were analyzed using English-language biomedical databases (MEDLINE (Pubmed), Web of Science (Web of Knowledge) using the following keywords: «cardiotoxicity», «echocardiography», «chemotherapy», «ventricular dysfunction», «anticancer therapy», «risk stratification» for 2019–2024. Results. Cardiotoxicity arising as a consequence of anticancer therapy can manifest in various forms, including left ventricular (LV) myocardial dysfunction, heart failure (HF), pulmonary hypertension, thromboembolic complications, arterial hypertension, coronary heart disease, pericardial disease, valvular heart disease, and others. Detecting the subclinical variant of cardiotoxicity, which precedes the onset of HF, is of paramount importance. Presently, echocardiography remains the preferred method for evaluating the structural and functional status of the LV myocardium. However, studies have demonstrated that measuring LV ejection fraction (EF) via transthoracic echocardiography may not effectively detect LV dysfunction in its early stages. In recent years, novel myocardial imaging techniques have emerged for this purpose, with speckle-tracking echocardiography (STE) in both two-dimensional and three-dimensional modes showing promise. Соnclusion. The early detection of cardiotoxic effects induced by anticancer drugs emerges as a critical concern in cardiology practice. Evaluation of global myocardial strain derived from two-dimensional LV images provides valuable insights into diagnosing early LV dysfunction, especially in patients undergoing chemotherapy.

Assessment of subclinical LV myocardial dysfunction in T2DM patients with diabetic peripheral neuropathy: a cardiovascular magnetic resonance study

BackgroundDiabetic peripheral neuropathy (DPN) is the most prevalent complication of diabetes, and has been demonstrated to be independently associated with cardiovascular events and mortality. This aim of this study was to investigate the subclinical left ventricular (LV) myocardial dysfunction in type 2 diabetes mellitus (T2DM) patients with and without DPN.MethodsOne hundred and thirty T2DM patients without DPN, 61 patients with DPN and 65 age and sex-matched controls who underwent cardiovascular magnetic resonance (CMR) imaging were included, all subjects had no symptoms of heart failure and LV ejection fraction ≥ 50%. LV myocardial non-infarct late gadolinium enhancement (LGE) was determined. LV global strains, including radial, circumferential and longitudinal peak strain (PS) and peak systolic and diastolic strain rates (PSSR and PDSR, respectively), were evaluated using CMR feature tracking and compared among the three groups. Multivariable linear regression analyses were performed to determine the independent factors of reduced LV global myocardial strains in T2DM patients.ResultsThe prevalence of non-infarct LGE was higher in patients with DPN than those without DPN (37.7% vs. 19.2%, p = 0.008). The LV radial and longitudinal PS (radial: 36.60 ± 7.24% vs. 33.57 ± 7.30% vs. 30.72 ± 8.68%; longitudinal: − 15.03 ± 2.52% vs. − 13.39 ± 2.48% vs. − 11.89 ± 3.02%), as well as longitudinal PDSR [0.89 (0.76, 1.05) 1/s vs. 0.80 (0.71, 0.93) 1/s vs. 0.77 (0.63, 0.87) 1/s] were decreased significantly from controls through T2DM patients without DPN to patients with DPN (all p < 0.001). LV radial and circumferential PDSR, as well as circumferential PS were reduced in both patient groups (all p < 0.05), but were not different between the two groups (all p > 0.05). Radial and longitudinal PSSR were decreased in patients with DPN (p = 0.006 and 0.003, respectively) but preserved in those without DPN (all p > 0.05). Multivariable linear regression analyses adjusting for confounders demonstrated that DPN was independently associated with LV radial and longitudinal PS (β = − 3.025 and 1.187, p = 0.014 and 0.003, respectively) and PDSR (β = 0.283 and − 0.086, p = 0.016 and 0.001, respectively), as well as radial PSSR (β = − 0.266, p = 0.007).ConclusionsThere was more severe subclinical LV dysfunction in T2DM patients complicated with DPN than those without DPN, suggesting further prospective study with more active intervention in this cohort of patients.

Dapagliflozin reduces systemic inflammation in patients with type 2 diabetes without known heart failure

ObjectiveSodium glucose cotransporter 2 (SGLT2) inhibitors significantly improve cardiovascular outcomes in diabetic patients; however, the mechanism is unclear. We hypothesized that dapagliflozin improves cardiac outcomes via beneficial effects on systemic and cardiac inflammation and cardiac fibrosis.Research and design methodsThis randomized placebo-controlled clinical trial enrolled 62 adult patients (mean age 62, 17% female) with type 2 diabetes (T2D) without known heart failure. Subjects were randomized to 12 months of daily 10 mg dapagliflozin or placebo. For all patients, blood/plasma samples and cardiac magnetic resonance imaging (CMRI) were obtained at time of randomization and at the end of 12 months. Systemic inflammation was assessed by plasma IL-1B, TNFα, IL-6 and ketone levels and PBMC mitochondrial respiration, an emerging marker of sterile inflammation. Global myocardial strain was assessed by feature tracking; cardiac fibrosis was assessed by T1 mapping to calculate extracellular volume fraction (ECV); and cardiac tissue inflammation was assessed by T2 mapping.ResultsBetween the baseline and 12-month time point, plasma IL-1B was reduced (− 1.8 pg/mL, P = 0.003) while ketones were increased (0.26 mM, P = 0.0001) in patients randomized to dapagliflozin. PBMC maximal oxygen consumption rate (OCR) decreased over the 12-month period in the placebo group but did not change in patients receiving dapagliflozin (− 158.9 pmole/min/106 cells, P = 0.0497 vs. − 5.2 pmole/min/106 cells, P = 0.41), a finding consistent with an anti-inflammatory effect of SGLT2i. Global myocardial strain, ECV and T2 relaxation time did not change in both study groups.Clinical Trial.gov Registration NCT03782259.

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.

Effects of diabetes mellitus on left ventricular function and deformation in patients with restrictive cardiomyopathies: a 3.0T CMR feature tracking study

BackgroundDiabetes mellitus (DM) is the most common metabolic disease worldwide and a major risk factor for adverse cardiovascular events, while the additive effects of DM on left ventricular (LV) deformation in the restrictive cardiomyopathy (RCM) cohort remain unclear. Accordingly, we aimed to investigate the additive effects of DM on LV deformation in patients with RCM.Materials and methodsOne hundred thirty-six RCM patients without DM [RCM(DM−)], 46 with DM [RCM (DM+)], and 66 age- and sex-matched control subjects who underwent cardiac magnetic resonance (CMR) scanning were included. LV function, late gadolinium enhancement (LGE) type, and LV global peak strains (including radial, circumferential, and longitudinal directions) were measured. The determinant of reduced LV global myocardial strain for all RCM patients was assessed using multivariable linear regression analyses. The receiver operating characteristic curve (ROC) was performed to illustrate the relationship between DM and decreased LV deformation.ResultsCompared with the control group, RCM (DM−) and RCM(DM+) patients presented increased LV end-diastolic index and end-systolic volume index and decreased LV ejection fraction. LV GPS in all three directions and longitudinal PDSR progressively declined from the control group to the RCM(DM−) group to the RCM(DM+) group (all p < 0.05). DM was an independent determinant of impaired LV GPS in the radial, circumferential, and longitudinal directions and longitudinal PDSR (β = − 0.217, 0.176, 0.253, and − 0.263, all p < 0.05) in RCM patients. The multiparameter combination, including DM, showed an AUC of 0.81(95% CI 0.75–0.87) to predict decreased LV GLPS and an AUC of 0.69 (95% CI 0.62–0.76) to predict decreased LV longitudinal PDSR.ConclusionsDM may have an additive deleterious effect on LV dysfunction in patients with RCM, especially diastolic dysfunction in RCM patients, indicating the importance of early identification and initiation of treatment of DM in patients with RCM.

Additional Impact of Aortic Regurgitation on Left Ventricular Strain and Remodeling in Essential Hypertension Patients Evaluated Using MRI.

Understanding the impact of aortic regurgitation (AR) on hypertensive patients' hearts is important. To assess left ventricular (LV) strain and structure in hypertensive patients and investigate the relationship with AR severity. Retrospective. 263 hypertensive patients (99 with AR) and 62 controls, with cardiac MRI data. Balanced steady-state free precession (bSSFP) sequence at 3.0T. AR was classified as mild, moderate, or severe based on echocardiographic findings. LV geometry was classified as normal, concentric remodeling, eccentric hypertrophy, or concentric hypertrophy based on MRI assessment of LV mass/volume ratio and LV Mass index (LVMI). LV global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS) were obtained by post-processing bSSFP cine datasets using commercial software. ANOVA, Kruskal-Wallis test, Spearman's correlation coefficients (r), chi-square test, and multivariable linear regression analysis. A P value <0.05 was considered statistically significant. Hypertensive patients with AR had significantly lower LV myocardial strain and higher LVMI than the group without AR (GRPS 26.25 ± 12.23 vs. 34.53 ± 9.85, GCPS -17.4 ± 5.84 vs. -20.57 ± 3.57, GLPS -9.86 ± 4.08 vs. -12.95 ± 2.94, LVMI 90.56 ± 38.56 vs.58.84 ± 17.55). Of the 99 patients with AR, 56 had mild AR, 26 had moderate AR and 17 had severe AR. The degree of AR was significantly negatively correlated to the absolute values of LV GRPS, GCPS and GLPS (r = -0.284 - -0.416). LV eccentric hypertrophy increased significantly with AR severity (no AR 21.3%, mild AR 42.9%, moderate AR 73.1%, severe AR 82.4%). In multivariable analysis, the degree of AR was an independent factor affecting LV global strain and LVMI even after considering confounding factors (β values for global myocardial strain were -0.431 to -0.484, for LVMI was 0.646). Increasing AR severity leads to decreased cardiac function and worse ventricular geometric phenotypes in hypertensive patients. 4 TECHNICAL EFFICACY: Stage 3.

Myocardial strain parameters in pulmonary hypertension are determined by changes in volumetric function rather than by hemodynamic alterations

PurposeTo investigate associations of cardiac magnetic resonance feature-tracking-derived left (LV) and right ventricular (RV) global myocardial peak strains and strain rates with volumetric function and hemodynamic parameters to identify the major determinants of myocardial strain alterations in pulmonary hypertension (PH). MethodsSixty-seven patients with PH or at risk of developing PH underwent right heart catheterization (RHC) and cine realtime imaging at 3 T. RHC parameters included mean pulmonary arterial pressure (mPAP), which was used for the diagnosis of PH. LV and RV volumetric function and feature-tracking-derived global radial, circumferential, and longitudinal (GLS) peak strains, together with their strain rates, were evaluated from cine images using routine software. Furthermore, myocardial strain parameters of 24 healthy subjects were evaluated as controls. Means were compared by t-test; relationships between parameters were investigated by correlation and regression analysis. ResultsCompared to controls, RV-GLS, all RV systolic strain rates and the LV systolic longitudinal strain rate showed lower magnitudes in PH (RV-GLS: −21 ± 4% vs. −16 ± 5%, p < 0.0001); the strongest univariate correlate to mPAP was the RV-GLS (r = 0.59). All LV and RV strain parameters yielded stronger correlations with their respective ejection fractions. In bi-linear models using mPAP and ejection fraction as predictors, mPAP remained significant only for diastolic LV radial and circumferential strain rates. ConclusionImpairment of myocardial strains is more strongly associated with alterations in LV and RV volumetric function parameters than elevated mPAP, therefore limiting diagnostic information of myocardial strain parameters in PH.

Right ventricular pressure-strain-volume loop-derived myocardial work for the noninvasive assessment of volume overload-induced dysfunction in patients with secondary tricuspid regurgitation

Abstract Development of secondary tricuspid regurgitation (TR) is associated with poor outcomes in patients with left-sided cardiac diseases. Severe TR imposes substantial volume overload (VO) on the right ventricle (RV), inducing a vicious circle of progressive RV remodelling and dysfunction. Although previous studies have established the value of speckle tracking echocardiography (STE)-derived strain and pressure-strain loop-derived myocardial work indices, these metrics neglect chamber geometry, limiting their utility in conditions accompanied by VO. Accordingly, we aimed to (1) incorporate instantaneous RV volume into myocardial work calculation to define a method capable of detecting VO-induced RV dysfunction using 3D echocardiography (3DE) and (2) to test its prognostic power in patients with secondary TR. We enrolled 195 patients (age: 64±15 years, 69% male) with left-sided cardiac diseases and followed them for a median of 42 months. The primary endpoint was all-cause mortality. TR severity was graded according to current guidelines and we compared patients with significant (moderate+) TR (sTR, n=85) versus non-significant TR (nsTR, n=110). All patients underwent 3DE to measure left (LV), and RV volumes and ejection fractions (EF). A reference RV pressure curve was constructed using previously acquired right heart catheterization data and was individually adjusted by non-invasively estimated RV pressures. To obtain RV pressure-strain loops and global myocardial work index (GMWI), RV pressure and 3DE-derived RV circumferential strain tracings were concatenated. We further adjusted GMWI to instantaneous RV volumes (GMWIV) and constructed pressure-strain-volume loops (Figure 1). Twenty-three patients (11.8%) died during follow-up (16 out of 85 in the sTR group, and 7 out of 110 in the nsTR group). There were no differences in LV and RV volumes and EFs between the sTR and nsTR groups. Interestingly, patients with sTR had significantly higher values of GMWI (sTR vs. nsTR; 667 [438-879] vs. 567 [414-770] mmHg%, p=0.01), whereas GMWIV (292 [169-467] vs. 282 [170-399] mmHg%/mL, p=0.57) did not show difference. We compared patients with versus without adverse outcomes within the sTR group. Patients with sTR who died, presented with significantly lower volume-adjusted GMWIV values (dead vs. alive; 158 [122-332] vs. 312 [207-502] mmHg%/mL, p=0.02), while GMWI did not differ. By Cox regression analysis, GMWIV (hazard ratio [95% CI]: 0.997 [0.994-1.000], p&amp;lt;0.05) was a significant predictor of all-cause mortality in the entire population, whereas GMWI was not. By integrating RV volume into the pressure-strain relationship, our novel metric could detect the detrimental effects of VO on RV function with prognostic implications in patients with secondary TR. Our approach can be able to capture VO-induced subclinical RV dysfunction that conventional echocardiographic metrics could not unveil.Figure 1

Dynamics of global longitudinal strain of the left ventricular myocardium and blood biomarker levels in patients with rheumatoid arthritis treated with biologic disease-modifying antirheumatic drugs or Janus kinase inhibitors

Objective: to study the dynamics of global longitudinal myocardial strain (GLS) using echocardiography (speckle tracking method) and blood biomarker levels (NT -proBNP, soluble ST2, sST2) in RA patients against a background of 12 months of therapy with biological disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase inhibitors (JAKi). Material and methods. The study included 50 patients with RA (ACR/EULAR criteria, 2010): 84 % were women, median age 51.0 [40.0; 59.0] years, median duration of RA was 4.5 [3.0; 14.0] years, median DAS28 5.7 [5.2; 6.4] points. 78 % of patients were positive for IgM rheumatoid factor, 66 % for antibodies to cyclic citrullinated peptide. At the time of inclusion in the study, 38% of patients were receiving methotrexate, 38 % – leflunomide, 10 % – sulfasalazine, 12 % – hydroxychloroquine, 70 % – glucocorticoids, 82 % – nonsteroidal anti-inflammatory drugs. 60 % of patients with RA had a history of inadequate efficacy of two or more DMARDs. After examination, all patients were prescribed bDMARDs or JAKi. TNF-α inhibitors were given to 38% of patients, anti-B-cell therapy – to 50% of patients, IL-6 inhibitors – to 4%, T-lymphocyte costimulation blockers – to 2 %, JAKi – to 6 % of RA patients. All patients with RA were examined before administration of bDMARDs and in dynamics after 12 months of treatment. Echocardiography was performed – tissue Dopplerography and evaluation by speckle tracking method of left ventricular myocardium GLS (GLD LVM); in blood serum the levels of NT-proBNP, sST2 were determined. The normal range for NT-proBNP was less than 125 pg/ml, and for sST2 less than 17.65 ng/ml. The control group consisted of 20 healthy subjects who were comparable in sex and age. RA patients and subjects in the control group had no cardiovascular disease. Results and discussion. After 12 months of bDMARDs therapy, GLS LVM increased and the frequency of reduced GLS LVM decreased by 47 % (p &lt; 0.05). The indexed end-systolic volume of the left atrium also decreased. RA patients had higher values of NT-proBNP and sST2 compared to the control group (p &lt; 0.05). The variations of NT-proBNP level in blood serum of RA patients after 12 months of therapy were statistically insignificant (p = 0.5). The level of sST2 in the serum of patients with RA decreased significantly after 12 months of therapy compared to baseline (p &lt; 0.01). Direct correlations were found between the delta (Δ) of the level of sST2 and ΔDAS28, the level of ΔsST2 and ΔCRP, and ΔACCP. After 12 months of therapy, RA patients with persistent moderate/high disease activity had higher levels of systolic blood pressure and serum levels of NT-proBNP, lower left ventricular (LV) ejection fraction (LVEF) and GLS LVM than patients who had remission/low RA activity. There were no differences between groups in LVEF, LV size, LV myocardial mass index, and NT-proBNP levels. Negative correlations were observed between ΔGLD LVM and ΔESR and ΔsST2. Conclusion. In patients with RA, a decrease in disease activity on a background of therapy with bDMARDs and JAKi leads to an improvement in GLS LVM. Administration of bDMARDs in patients with active RA and established LV subclinical myocardial dysfunction may slow the progression of myocardial dysfunction. Serum sST2 and NT-proBNP levels were increased in patients with RA compared with the control group. After 12 months of therapy with bDMARDs, the level of sST2 in the serum of RA patients decreased significantly, and the level of NT-proBNP did not change in dynamics.

Quantifying left ventricular myocardial strain in patients with different CAD-RADS levels based on computed tomography feature tracking technology

To evaluate myocardial strain in patients with different coronary artery disease-reporting and data system (CAD-RADS) levels using the computed tomography (CT) feature tracking technology and to investigate the relationship of myocardial strain with coronary artery calcium scores (CACs) and the degree of coronary artery stenosis. We prospectively enrolled 237 consecutive patients to undergo coronary CT angiography. The participants were divided into the following groups: control (n = 87), CAD-RADS 1 (n = 43), CAD-RADS 2 (n = 43), CAD-RADS 3 (n = 38), and CAD-RADS 4 and above (n = 26). Myocardial strains were analyzed by commercial software, and CACs and coronary stenosis were assessed on post-processing stations. Differences between multiple groups were analyzed using one-way analysis of variance or the Kruskal–Wallis test. Logistic regression were used to analyze the effects of dichotomous variables. As the CAD-RADS level increased, the global circumferential strain (GCS), global longitudinal strain (GLS) and global radial strain (GRS) of the left ventricle based on CT gradually decreased. A significant correlation was observed between global myocardial strain and CACs (GRS: r = − 0.219, GCS: r = 0.189, GLS: r = 0.491; P < 0.05). The independent predictors of obstructive CAD were age (β = 0.065, odds ratio [OR] = 1.067, P = 0.005), left ventricular ejection fraction (β = 0.145, OR = 1.156, P = 0.047), and GLS (β = 0.232, OR = 1.261, P = 0.01). CT-derived GLS of the left ventricle is correlated with CAD-RADS levels and CACs. It may be a better indicator than CACs to reflect the severity of CAD.

Evaluation of myocardial strain in patients with subclinical hypertrophic cardiomyopathy and subclinical Hypertensive Heart Disease using Cardiac magnetic resonance feature tracking.

The evaluation of cardiac magnetic resonance feature tracking may have great diagnostic value in hypertrophic cardiomyopathy and hypertensive heart disease. Exploring the diagnostic and clinical research value of cardiac magnetic resonance feature tracks in evaluation of myocardium deformation in patients with subclinical hypertrophic cardiomyopathy(SHCM)and subclinical hypertensive heart disease(SHHD). Cardiovascular Magnetic Resonance (CMR) scans were performed on a 1.5 T MR scanner in 33 patients with SHCM, 31 patients with SHHD, and 27 controls(NS). The CMR image post-processing software was used to analyze the characteristics of routine cardiac function, different global and regional myocardial strain in each group. Analysis of variance (ANOVA) was used to compare age, blood pressure, heart rate, routine cardiac function, body mass index (BMI), as well as the strain between different segments within each of the three groups. Once a significant difference was detected, a least significant difference (LSD) comparison would be performed. The diagnostic efficacy of different parameters in differentiating SHHD from SHCM was evaluated through receiver operating characteristic (ROC) curve analysis, and the best cut-off value was determined. There was no statistical difference among three groups (P>0.05) in routine cardiac function while significant statistical differences were found in the global myocardial strain parameters and the peak strain parameters of some segments (especially basal segments) (P < 0.05). The global radial peak strain (GRPS) was most effective (AUC = 0.885, 95% CI: 0.085-0.971, P<0.001) with a sensitivity and specificity of 84% and 88% at a cut-off value of 40.105, contributing to distinguishing SHCM from SHHD group. Cardiac magnetic resonance feature tracking could detect left ventricular deformation in patients with SHCM and SHHD group. The abnormality of strain has important research value for subclinical diagnosis and clinical evaluation.

Siamese pyramidal deep learning network for strain estimation in 3D cardiac cine-MR.

Strain represents the quantification of regional tissue deformation within a given area. Myocardial strain has demonstrated considerable utility as an indicator for the assessment of cardiac function. Notably, it exhibits greater sensitivity in detecting subtle myocardial abnormalities compared to conventional cardiac function indices, like left ventricle ejection fraction (LVEF). Nonetheless, the estimation of strain poses considerable challenges due to the necessity for precise tracking of myocardial motion throughout the complete cardiac cycle. This study introduces a novel deep learning-based pipeline, designed to automatically and accurately estimate myocardial strain from three-dimensional (3D) cine-MR images. Consequently, our investigation presents a comprehensive pipeline for the precise quantification of local and global myocardial strain. This pipeline incorporates a supervised Convolutional Neural Network (CNN) for accurate segmentation of the cardiac muscle and an unsupervised CNN for robust left ventricle motion tracking, enabling the estimation of strain in both artificial phantoms and real cine-MR images. Our investigation involved a comprehensive comparison of our findings with those obtained from two commonly utilized commercial software in this field. This analysis encompassed the examination of both intra- and inter-user variability. The proposed pipeline exhibited demonstrable reliability and reduced divergence levels when compared to alternative systems. Additionally, our approach is entirely independent of previous user data, effectively eliminating any potential user bias that could influence the strain analyses.

Assessment of early anthracycline-induced cardiotoxicity using segmental strain of cardiac magnetic resonance compared with global strain and functional parameters: an animal study.

The identification of anthracycline-induced cardiotoxicity holds significant importance in guiding subsequent treatment strategies, and recent research has demonstrated the efficacy of cardiac magnetic resonance (CMR) global strain analysis for its diagnosis. On the other hand, it is noteworthy that abnormal global myocardial strain may exhibit a temporal delay due to different cardiac movement in each segment of the left ventricle. To address this concern, this study aims to assess the diagnostic utility of CMR segmental strain analysis as an early detection method for cardiotoxicity. A serials of CMR scans were performed in 18 adult males New Zealand rabbits at baseline time (n=15), followed by scans at week 2 (n=15), week 4 (n=9), week 6 (n=6), and week 8 (n=5) after each week's anthracycline injection. Additionally, following each CMR scan, two to three rabbits were euthanized for pathological comparison. Cardiac functional parameters, global peak strain parameters, segmental peak strain parameters of the left ventricle, and the presence of myocardial cells damage were obtained. A mixed linear model was employed to obtain the earliest CMR diagnostic time. Receiver operating characteristic (ROC) analysis was performed to get the parameter threshold indicative of cardiotoxicity. The left ventricular ejection fraction decreased at week 8 (P=0.002). There were no statistical differences in global strain throughout the experiment period (P>0.05). Regarding segmental strain analysis, the peak segmental radial strain of the apical lateral wall exhibited a decrease starting from week 2 and reached its lowest point at this week (P=0.011). Conversely, peak segmental circumferential strain of the apical anterior wall showed an increase at week 2 and reached its peak at week 6 (P=0.026). The cutoff strain value by ROC analysis for these two walls were 46.285 and -16.920, with the respective areas under the curve (AUC) 0.593 [specificity =0.267, sensitivity =1.000, 95% confidence interval (CI): 0.471-0.777] and 0.764 (specificity =0.733, sensitivity =0.784, 95% CI: 0.511-0.816). Peak segmental longitudinal strain of the apical anterior and apical lateral wall showed relatively delayed changes, occurring in the 4th week (P=0.030 and P=0.048), the cutoff values for these strains were -12.415 and -15.960, with corresponding AUCs of 0.645 (specificity =0.333, sensitivity =0.955, 95% CI: 0.495-0.795) and 0.717 (specificity =0.433, sensitivity =0.955, 95% CI: 0.566-0.902), respectively. Notably, the myocardial injury was also observed at the corresponding periods. Based on experimental evidence, the peak segmental strain of the apical lateral and anterior wall, as determined by CMR, demonstrated an earlier detection of anthracycline-induced cardiotoxicity compared to peak global strain and cardiac function.

Assessment left ventricular function by speckle tracking in patients with mitral valve replacement in Hanoi heart hospital

Background: The evaluation of left ventricular dysfunction in patients with severe mitral valve disease is very important for diagnosis, surgical indication and postoperative follow-up assessments. Speckle Tracking provides additional information to conventional echocardiographic parameters. Objective: Research global longitudinal strain by Speckle Tracking in patiens underwent mitral valve surgery at Hanoi Heart Hospital. Subjects and methods: 35 patients underwent mitral valve surgery at Hanoi Heart Hospital from July 2018 to September 2019. This is a prospective, longitudinal follow-up for at least 3 months research. Results: Postoperative myocardial global longitudinal strain of the left ventricular decreased compared to pre-surgery (-19.85 ± 2.24 vs -16.54 ± 3.01; p &lt; 0.001). The global myocardial longitudinal strain of the left ventricular decreased more in the group whose postoperative EF decreased by ≥10% compared with the group whose EF decreased &lt;10% after surgery (-17.73 ± 2.71 versus -15.28 ± 2.85; p. &lt; 0.05). Mean global myocardial longitudinal strain (GLS avg) after surgery has a linear correlation with left ventricular contraction fraction FS after surgery (r = -0.508; p &lt; 0.005), with left ventricular ejection fraction EF after surgery (r = - 0.402; p &lt; 0.05), with ejection fraction EF biplane after surgery with (r = - 0.768; p &lt; 0.001) and global myocardial longitudinal strain (GLS avg) after surgery há a linear correlation with the degree of change in EF after surgery ≥ 10% (r) = 0.601; p &lt; 0.001). Conclusion: Longitudinal LV deformation assessed by speckle tracking is significant in assessing the decline in left ventricular systolic function in patients with mitral valve surgery.

Assessment of subclinical left ventricular systolic dysfunction in patients with asymptomatic severe aortic stenosis with preserved left ventricular systolic function by three-dimensional speckle tracking echocardiography.

Left ventricular dysfunction and remodeling can occur as a result of aortic valve stenosis (AS). Three-dimensional speckle tracking echocardiography (3D-STE) can detect early left ventricular myocardial dysfunction even before ejection fraction declines. The purpose of this study was to look at the relationship between various myocardial strain parameters measured by 3D-STE in asymptomatic severe AS patients from Bangladesh. This study included 46 patients with asymptomatic severe AS but preserved LV systolic function (mean age 50.11±12.66 years, LVEF 63.78±3.95%, AS group) and 33 healthy subjects with no cardiovascular disease (mean age 48.21±4.53 years, LVEF 65.15±3.13%, control group). 3D-STE was used to measure left ventricular global myocardial strain parameters such as peak systolic longitudinal strain (PSLS), circumferential strain, radial strain, and area strain. The AS group had significantly thicker interventricular septum and posterior ventricular wall than the control group (1.49±.19cm vs. .81±.09cm, p<.001; 1.73±1.71cm vs. .81±.10cm, p=.003, respectively.) In the AS group, the Indexed Aortic Valve Area (AVA) was significantly lower than in the control group. (.29±.10vs. 2.03±.18, p<.001, respectively). In terms of LVEF (p=.102), left ventricular end diastolic volume (p=.075), or left ventricular end systolic volume (p=.092), no significant inter-group difference was found. However, global PSLS (-10.75±2.27vs. -16.42±2.76, p<.001), circumferential strain (-14.26±3.40vs. -16.64±2.56, p=.001), area strain (-22.70±4.19vs. -26.45±9.90, p=.024) and radial strain (32.20±8.77vs. 41.00±7.52, p<.001) in the AS group were significantly lower than in the control group. Our findings showed reductions in left ventricular global myocardial strains, particularly PSLS in patients suffering from asymptomatic severe AS in Bangladesh; this is consistent with other studies. Reduced area strain, detectable with 3D-STE, is also consistent with that pattern.

Reduced myocardial strain of interventricular septum among male amateur marathon runners: a cardiac magnetic resonance study

ObjectivesTo analyze the long-term effect of multiple marathons on cardiac structure and function in amateur marathon runners compared with healthy controls. DesignCross-sectional study using male amateur marathon runners (n = 32) and age-matched cohort of male healthy controls (n = 12). MethodsA total of 32 male amateur marathon runners (age 44 ± 7 years) and 12 male healthy controls (age 42 ± 8 years) underwent cardiac magnetic resonance (CMR). The relevant parameters of cardiac structure and function were studied employing feature-tracking strain analysis. ResultsAmateur marathon runners showed lower heart rates, body mass index and body surface area. The left ventricular (LV) mass index, LV end-diastolic volume index and right ventricular end-systolic volume index were significantly higher in amateur marathon runners compared with healthy controls. Furthermore, walls of interventricular septum (IVS) in amateur marathon runners were thicker than healthy controls. There was no significant difference between two groups in the global myocardial strain (MS) in LV. However, the segmental radial and circumferential strains of the LV were lower in amateur marathon runners compared to healthy controls, specifically in the 8th and 9th segments. Finally, we also found as the total running intensity increased, so did global longitudinal strain. ConclusionsWe reported higher wall thickness and lower regional radial and circumferential strain in the IVS region in amateur marathon runners, suggesting that prolonged and high-intensity exercise may cause cardiac remodeling. Further studies are needed to investigate whether this is an adaptive or maladaptive change in amateur marathon runners.

Number of segments with motion abnormalities is better correlated with infarct size in acute myocardial infarction.

The relationship between the number of segments with motion abnormalities (SMA) on the bull's-eye plots of speckle-tracking echocardiography (STE) and myocardial infarct size (MIS) on late gadolinium-enhanced cardiac MRI (LGE-cMRI) has not been well characterized. This study aimed to determine MIS using the number of SMA in patients with acute myocardial infarction (MI). Left ventricular two-dimensional STE and LGE-cMRI were performed in 380 patients with ST-segment elevation MI within 48 h and 5-6 days after primary percutaneous intervention, respectively. Patients with impaired global and regional myocardial strain, work and greater number of SMA had significantly larger infarcts ( P < 0.05). Multivariate logistic regression analysis that included myocardial strain, work, and number of SMA showed that total number of SMA [odds ratio (OR) = 1.976; 95% confidence interval (CI): 1.539-2.538, P < 0.0001], the number of segments with paradoxalic systolic movements (SPSM, OR = 3.703; 95% CI: 2.112-6.493, P < 0.0001) were independent risk factors of large MIS (>19%). The area under receiver operating characteristic curve (AUC) of 0.904 (0.866~0.942) for total number of SMA was superior to that for global longitudinal strain (GLS, AUC = 0.813, 0.761~0.865), global work efficiency (GWE, AUC = 0.794, 0.730~0.857) and number of SPSM (AUC = 0.851, 0.804-0.899) to predict a large MIS ( P < 0.05). The optimal cutoff value of total number of SMA was 7, with a sensitivity of 85.31%, a specificity of 81.48%, and an accuracy of 83.27%. Total number of SMA is better associated with infarct size, which provided an incremental prognostic value above established prognostic parameters such as GLS and GWE.

Intracavitary blood flow dynamics in the systemic right ventricle: a 4D-Flow MRI study

Abstract Funding Acknowledgements Type of funding sources: None. Background Failure of the systemic right ventricle (SRV) is based on morphological differences between right and left ventricles (RVs and LVs). RV adaptation to systemic afterload includes increased circumferential (GCS) over longitudinal global myocardial strain (GLS) with an unknown impact on intracavitary blood flow distribution. This study aimed to explore the SRV pattern of hemodynamic forces (HFs). Methods 4D-Flow cardiovascular magnetic resonance data were acquired using a prototype sequence on a 1.5-T MAGNETOM Aera. The ratio between transverse (inferior-anterior, HFIA and septal-lateral, HFSL) and longitudinal (basal-apical, HFBA) HFs (RRMS) was calculated as in Figure 1, for systole and diastole. Results We enrolled 12 adults with SRV (6 D-transposition of great arteries after atrial switch operation and 6 L-transpositions) and 12 age-matched healthy subjects (41±12 vs 42±13,p = 0.89). SRVs reported comparable end-diastolic volumes (83±18 ml/m2), ejection fraction (60±8%) and GLS (−20.2±3.8%) to control RVs (75±13 ml/m2,p = 0.18; 64±5%,p = 0.25; −23±5.6%,p = 0.21). Differently, SRV mass (55±24 g/m2) and GCS (−18.9±7.8%) were greater than RVs (20±3 g/m2,p&amp;lt;0.001 and −12.4±4,p = 0.016) and comparable to control LVs (57±11 g/m2,p = 0.7 and −20.2±3.8%,p = 0.3). The 4D-Flow analysis showed that SRV systolic RRMS (0.98±0.31) was similar to LVs (0.94±0.27,p = 0.78) but lower than RVs (1.32±0.45,p = 0.04). This reflected a significantly increased HFBA with respect to RVs (0.338±0.150 vs. 0.162±0.097, p = 0.0025) and similar to LVs (0.462 ± 0.186, p = 0.087). Concomitantly, a moderate correlation was demonstrated between SRV systolic HFBA magnitude and GCS (r2=0.47,p = 0.013). During diastole, SRVs showed lower HFBA (0.173±0.086) than LVs (0.304±0.104,p = 0.0028), revealing a diastolic RRMS (0.74 ± 0.14) comparable to RVs (0.73 ± 0.17,p = 0.95) and significantly different from LVs (0.50 ± 0.19,p = 0.003). Conclusions In SRVs, RRMS is similar to LVs during systole, possibly as a result of increased GCS. Inversely, the SRV filling appears to be closely related to ventricular morphology as suggested by RRMS comparable to RVs during diastole.

Evaluation of Left Ventricular Systolic Function Using Layer-Specific Strain in Rats Performing Endurance Exercise: A Pilot Study.

The functional characteristics of exercise-induced myocardial hypertrophy were studied in a rat model in conjunction with ultrasound layered strain technique to investigate the hidden changes in the heart brought about by exercise. Forty specific pathogen free (SPF) adult Sprague-Dawley rats were selected and randomly divided into two groups of 20 exercise and 20 control rats. The longitudinal and circumferential strain parameters were measured using the ultrasonic stratified strain technique. The differences between the two groups and the predictive effect of stratified strain parameters on left ventricular systolic function were analyzed. The exercise group had significantly higher global endocardial myocardial longitudinal strain (GLSendo), global mid-myocardial global longitudinal strain (GLSmid) and global endocardial myocardial global longitudinal strain (GCSendo) values than the control group (p < 0.05). Even though global mid-myocardial circumferential strain (GCSmid) and global epicardial myocardial circumferential strain (GCSepi) were higher in the exercise group than in the control group, statistical significance was not reached (p > 0.05). Conventional echocardiography parameters were well correlated with GLSendo, GLSmid, and GCSendo (p < 0.05). GLSendo was the best predictor of left ventricular myocardial contractile performance in athletes determined using the receiver operating characteristic curve, with an area under the curve of 0.97, sensitivity of 95% and specificity of 90%. Rats performing endurance exercise exhibited subclinical changes in the heart after prolonged high-intensity exercise. A stratified strain parameter, GLSendo, played an important role in the evaluation of LV systolic performance in exercising rats.

Association of abdominal adiposity, hepatic shear stiffness with subclinical left-ventricular remodeling evaluated by magnetic resonance in adults free of overt cardiovascular diseases: a prospective study

BackgroundAbdominal ectopic fat deposition and excess visceral fat depots in obesity may be related to cardiovascular disease (CVD) as both are involved in the metabolic syndrome (MetS). The awareness of the link between abdominal adiposity and subclinical cardiac remodeling would help improve treatment and outcome. Besides, liver fibrosis has also shown a potential relationship with cardiac dysfunction. Thus, we aimed to investigate the associations of magnetic resonance (MR)-based abdominal adiposity and hepatic shear stiffness with subclinical left ventricular (LV) remodeling while taking account of MetS-related confounders in adults free of overt CVD.MethodsThis was an exploratory, prospective study of 88 adults (46 subjects with obesity, 42 healthy controls) who underwent 3 T cardiac and body MR exams. Measures of abdominal MR included hepatic and pancreatic proton density fat fraction (H-PDFF and P-PDFF), hepatic shear stiffness by MR elastography, and subcutaneous and visceral adipose tissue (SAT and VAT). Cardiac measures included epicardial adipose tissue (EAT) and parameters of LV geometry and function. Associations were assessed using Pearson correlation and multivariable linear regression analyses, in which age, sex, and MetS-related confounders were adjusted for.ResultsThe LV ejection fractions of all participants were within the normal range. Higher H-PDFF, P-PDFF, SAT and VAT were independently associated with lower LV global myocardial strain parameters (radial, circumferential and longitudinal peak strain [PS], longitudinal peak systolic strain rate and diastolic strain rate) (β = − 0.001 to − 0.41, p < 0.05), and P-PDFF, SAT and VAT were independently and positively associated with LV end-diastolic volume and stroke volume (β = 0.09 to 3.08, p ≤ 0.02) in the over-all cohort. In the obesity subgroup, higher P-PDFF and VAT were independently associated with lower circumferential and longitudinal PS, respectively (β = − 0.29 to − 0.05, p ≤ 0.01). No independent correlation between hepatic shear stiffness and EAT or LV remodeling was found (all p ≥ 0.05).ConclusionsEctopic fat depositions in the liver and pancreas, and excess abdominal adipose tissue pose a risk of subclinical LV remodeling beyond MetS-related CVD risk factors in adults without overt CVD. VAT may play a more considerable role as a risk factor for subclinical LV dysfunction than does SAT in individuals with obesity. The underlying mechanisms of these associations and their longitudinal clinical implications need further investigation.