Global Strain Values Research Articles

Anthracycline Chemotherapy-Induced Electro-Mechanical Changes: Strain Echocardiography Combined with Repolarization Parameters on Electrocardiography to Predict Early Cardiotoxicity.

The aim of the study was to describe the acute cardiotoxic effects of anthracycline chemotherapy in echocardiographic strain and electrocardiographic repolarization parameters in patients with breast cancer. A total of 35 consecutive patients (all females, mean age: 48.9 ± 11.8 years) who received chemotherapy due to breast cancer were prospectively included. Pre-treatment (T0) and third month (T2) 2-dimensional strain echocardiography and electrocardiography were performed. Additionally, within 3 hours of the first dose of chemotherapy (T1), additional electrocardiographic images were obtained. All mechanical and electrical parameters from different time intervals (T0, T1, and T2) were compared with each other. In the acute period after treatment, electrocardiographic repolarization parameters were prolonged and this prolongation continued to the third month (QT corrected with Bazett formula [440.10 ± 27.63 (T0), 468.00 ± 38.98 (T1), 467.86 ± 35.09 (T2)], QT dispersion [49.85 ± 19.52 (T0), 69.54 ± 16.06 (T1), 57.63 ± 14.42 (T2)], and T-wave peak-to-end interval [94.00 ± 45.46 (T0), 131.20 ± 17.79 (T1), 120.00 ± 18.32 (T2)]; P < .001). There was no significant change in global longitudinal strain values before and after treatment (global longitudinal strain avg: -21 ± 7.1%; P = .8). However, there were significant reductions in strain parameters including circumferential and radial strain, and torsion (-17.2 ± 3.5 to -13 ± 2.84; P < .001, 45.1 ± 8.3 to 35.6 ± 10; P <.001, and 12.1 ± 3.5 to 7.7 ± 2.1; P < .001, respectively). Both the electrical and mechanical functions of the heart can be impaired acutely extending to 3 months after anthracycline chemotherapy. Therefore, cardiotoxicity should be evaluated early both electrically and mechanically after chemotherapy.

Prognostic value of left ventricular global longitudinal strain in patients with severe aortic stenosis for transcatheter aortic valve implantation-related morbidity and mortality: a meta-analysis

Abstract Aims Current methods, including left ventricular ejection fraction (LVEF), demonstrate limited prognostic value for post-Transcatheter Aortic Valve Implantation (TAVI) outcomes. Studies elaborating on LV global longitudinal strain (GLS) showed promising results, but are often underpowered. Purpose This meta-analysis aims to evaluate the prognostic value of preprocedural global longitudinal strain (GLS) for post-TAVI mortality and morbidity. Methods A systematic search was conducted in PubMed, Embase and Web of Science from 2001 to 2021. All studies that comprised patients with severe aortic stenosis who underwent TAVI and investigated the association between preprocedural speckle-tracking-derived GLS and clinical outcomes, were included. An inversely-weighted random effects meta-analysis was adopted to investigate the association between preprocedural GLS vs primary (i.e. all-cause mortality) and secondary (i.e. major cardiovascular events [MACE]) post-TAVI outcomes. Results Of the 1,057 identified records, 12 were eligible, all of which had a low-to-moderate risk of bias (Newcastle-Ottawa scale). On average, the 2,068 unique patients demonstrated preserved ejection fraction but impaired longitudinal function (mean LVEF 52.2±4.4%, GLS −13.5±1.6%). Patients with a lower GLS had a higher all-cause mortality (pooled hazard ratio (HR) 1.99 [95% confidence interval (CI): 1.59, 2.50]) and MACE (1.26 [95% CI: 1.08, 1.46]) risk compared to patients with higher GLS. In addition, each 1% decrease of GLS was associated with an increased postprocedural mortality (HR 1.06 [95% CI: 1.03, 1.08]) and MACE risk (pooled HR 1.08 [95% CI: 1.01, 1.15]). Conclusion Preprocedural GLS was significantly associated with post-TAVI mortality and morbidity. This suggests a potential clinically important role of pre-TAVI evaluation of GLS for risk stratification of patients with severe aortic stenosis. Funding Acknowledgement Type of funding sources: Public hospital(s).

Cardiac damage staging in patients undergoing TAVR. Incremental value of global longitudinal strain and right ventricular-arterial coupling

Abstract Background Transcatheter aortic valve replacement (TAVR) is nowadays a safe and increasingly frequent option to treat severe aortic stenosis (AS). Cardiac damage staging has been proposed and validated in some studies as a prognostic tool; however, many patients continue to undergo aortic valve replacement only after there is evidence of cardiac damage. The aim of this study is to assess the potential incremental value of global longitudinal strain (GLS) and right ventricular-arterial coupling (RV-VAc) in the prognostic performance of the cardiac damage staging. Methods Consecutive patients with AS and undergoing TAVR were included in our hospital registry. Baseline echocardiography was performed before TAVR according to current guidelines. For this study, patients were classified based on the following stage of cardiac damage: Stage 0: no cardiac damage; Stage 1: left ventricular (LV) damage (LV ejection fraction (LVEF) <50%, LV mass index >95 g/m2 for women, >115 g/m2 for men); Stage 2: left atrial (LA) or mitral valve damage (LA volume index >34 ml/m2, mitral regurgitation moderate-severe, or presence of atrial fibrillation); Stage 3: pulmonary vasculature or tricuspid valve damage (systolic pulmonary artery pressure 60 mmHg, or tricuspid regurgitation moderate-severe); Stage 4: RV damage (TAPSE <1.7 cm, S' <9.5 cm/s). Results 496 patients were studied. Mean age of the cohort was 81.9±6.2 years, mean aortic valve area was 0.86±0.6 cm2, mean LVEF was 57.9±12.3%, mean LV-GLS was −15.6±3.5% and RV-Vac was 0.61±0.34. Table 1 shows clinical and echo characteristics of patients. Only one patient (0.2%) met criteria for stage 0; 38 (7.7%) patients were in stage 1; 159 (32.1%) patients in stage 2, 157 (31.7%) patients in stage 3 and 141 (28.4%) patients in stage 4. 1-year mortality for stage 1 was (10.5%), for stage 2 (13.7%), for stage 3 (32.2%) and for stage 4 (19.5%). The area under the ROC curve (AUC) for 1-year mortality for the cardiac damage staging system was 0.622, CI (0.539–0.705); the best cut-off value for LV-GLS to predict 1-year mortality was −14% with an AUC of 0.634 CI (0.487–0.781) and RV-VAc had an AUC of 0.748 CI (0.638–858). Finally, the model that included the staging system, LV-GLS and RV-VAc had an AUC ROC of 0.875, CI (0.780–0.971) (Figure 1). Conclusions Cardiac damage staging is a good prognostic tool and it has been validated in several studies, however, the addition of feasible and widely available echo parameters such as LV-GLS and RV-VAc can significantly increase its prognostic yield. Funding Acknowledgement Type of funding sources: None.

Prognostic value of left and right ventricular strain in heart failure with reduced and preserved ejection fraction: a meta-analysis

Abstract Background The association of speckle tracking echocardiography measures of left ventricular (LV) and right ventricular (RV) strain with clinical outcome in heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF) has been extensively investigated. In fact, while the contribute of LV ejection fraction (LVEF) for prognosis is controversial, myocardial strain has proven to be a strong and independent prognostic predictor in many HF studies. Purpose The aim of this meta-analysis was to assess the prognostic value of LV global longitudinal strain (GLS) and free wall RV longitudinal strain (fwRVLS) by 2-dimensional speckle tracking echocardiography in patients with HFrEF, HF with mildly-reduced ejection fraction (HFmrEF) and HFpEF. Methods A systematic literature search of medical databases including Pubmed, Scopus, Ovid Online, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Scopus was performed using PRISMA principles. All relevant studies in English language reporting the predictive value of LV GLS and/or fwRVLS for mortality and/or cardiovascular events in HFrEF, HFmrEF and HFpEF, with follow up >6 months, were identified. Case reports/series and abstract congresses were excluded (Fig. 1). All-cause mortality and a composite endpoint of cardiovascular death, re-hospitalization for HF, cardiac transplantation, ventricular assist device implantation were analyzed. Hazard ratios (HR) were extracted from univariate and multivariate random-effects models reporting on the association of LV GLS and fwRVLS and outcome and described as pooled estimates with 95% confidence intervals (CI). Results Fifty studies (n=18276 patients) satisfied the inclusion criteria (35 studies in chronic HF, 15 studies in acute HF). Most studies (n=36) included patients with HFrEF, while 14 studies included patients with HFmrEF (n=3) and with HFpEF (n=11); thus HFmrEF and HFpEF were grouped together for the analysis. Overall, 48 studies included LV GLS (median value = −9% [from −17% to −11%], 17 studies included fwRVLS (median value = −18% [from −24% to −14%]). Over a median follow up of 32 [from 7 to 67] months follow up, 5618 (31%) had a cardiovascular event or died. LV GLS and fwRVLS were independently associated with all-cause mortality and the composite outcome, regardless of LVEF (Fig. 2), both in HFrEF (HR 1.26; 95% CI [1.15; 1.37]; p<0.01 for LV GLS and HR 1.06; 95% CI [1.03; 1.09]; p<0.01 for fwRVLS) and in HFpEF (HR 1.07; 95% CI [1.03; 1.12]; p<0.01 for LV GLS and HR 1.08; 95% CI [0.96; 1.21]; p<0.01 for fwRVLS). Conclusions These meta-analysis data demonstrate that LV and RV strain are associated with mortality and cardiovascular events in patients with HF, HFmrEF and HFpEF and may provide important additive prognostic information. These findings emphasize the potential usefulness of LV GLS and fwRVLS in clinical practice to improve the risk stratification and management of patients with HF regardless of LVEF. Funding Acknowledgement Type of funding sources: None.

Incremental value of global longitudinal strain in long-term risk prediction after acute coronary syndrome. A SWEDEHEART registry based echo study

Abstract Background Global longitudinal strain (GLS) by 2D speckle tracking echocardiography has emerged as a new method for assessing left ventricular (LV) function, however its added value in long-term risk prediction after Acute Coronary Syndrome (ACS) has not been clearly established. This study aimed to investigate GLS as a predictor of death and heart failure re-hospitalization after ACS in relation to more established echocardiographic measures. Method 1385 consecutive patients with acute coronary syndrome (47% STEMI, 45% NSTEMI, unstable angina 3.6% and unspecified ACS 4.5%), admitted between 2008 and 2014 to the three participating Swedish university hospitals were reported to the SWEDEHEART registry and underwent routine echocardiography during their hospital stay. The echo data was retrospectively collected from each study site and reviewed at a Core Lab. The prognostic value of systolic left ventricular function parameters (LVEF and GLS) regarding all-cause mortality and heart failure (HF) hospitalizations (median follow-up 6.8 years) was studied using the Cox proportional Hazards model. A nested model comparison was performed with C-statistics. Results In the 942 patients remaining after exclusion (median age 65 years, 77% men) median LVEF was 55% (inter quartile range (IQR) 47–60) and median GLS −14.8% (IQR −17.8–11.8). The combined endpoint of HF hospitalization and all-cause death was reached in 17.7% of the patients, 12.1% of the patients died and 8.7% were re-admitted due to HF. After adjustment for baseline characteristics, both LVEF and GLS were individual independent predictors of the combined endpoint, HR 0.964 (95% CI 0.949–0.980, p<0.001) and HR 1.042 (95% CI 1.002–1.084, p=0.042) respectively. The C-statistics increased from 0.752 (95% CI 0.712–0.792) to 0.755 (95% CI 0.706–0.785) when GLS entered the model with clinical data and LVEF. Conclusion In a large cohort of patients with ACS and normal or near-normal ejection fraction, GLS emerged as an independent long-term risk predictor of all-cause mortality and heart failure hospitalizations. The incremental predictive value of GLS on top of clinical background and LVEF was statistically significant, but of limited clinical significance. Funding Acknowledgement Type of funding sources: None.

Right ventricular function and outcome in patients undergoing transcatheter mitral valve repair

Abstract Objectives This study sought to assess the impact of right ventricular dysfunction (RVD) on event-free survival after transcatheter mitral valve repair (TMVR) for severe mitral regurgitation. Background The prognostic value of left and RV global longitudinal strain (LV- and RV-GLS) on cardiovascular magnetic resonance feature tracking (CMR-FT) in patients undergoing TMVR is unknown. Methods Consecutive TMVR patients underwent pre-procedural and follow-up CMR-FT analysis. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization (HFH) and death. Results 62 patients (78.3±7.0y/o, 45% female, EuroSCORE-II: 9.6±7.1%) underwent CMR-FT prior to TMVR, 24% had concomitant tricuspid edge-to-edge repair (TTVR). On presentation, 23 (37%) patients suffered RVD, defined as RV-GLS >−20% on CMR-FT. RVD was associated with reduced LV and RV ejection fraction (LVEF: 39.2 vs. 48.7%, p=0.008, RVEF: 35.1 vs. 46.7%, p<0.001), as well as impaired LV-GLS (−14.0 vs. −19.5%, p=0.012). Eighteen events (12 deaths, 6 HFH) occurred during follow-up (11.4±9.1 months). On multivariable Cox-regression adjusted for baseline, procedural, imaging, and biomarker data, RV but not LV-GLS was significantly associated with outcome (adj.HR 2.50, 95% CI: 1.29–4.86, p=0.007 and 1.46, 95% CI: 0.50–4.28, p=0.491, respectively). Among various definitions of RVD on echocardiography and CMR, only RV-GLS on CMR-FT was significantly associated with outcome (RV-GLS >−20%: adj.HR 7.53, 95% CI: 2.07–27.42, p=0.002), but not RVEF on CMR or echo-indices of RV function (Central Illustration). Follow-up CMR-FT was performed in 21 (34%) patients and RV-GLS significantly improved after TMVR (−20.6 to −25.2%, p=0.016), irrespective of additional TTVR. Conclusions RV-GLS, as determined on CMR-FT, rather than LV-GLS or RVEF, is an independent predictor of outcome in patients undergoing TMVR. Funding Acknowledgement Type of funding sources: None.

Left ventricular morphology in patients with aortic coarctation and bicuspid aortic valve: novel insights from a statistical shape modelling framework

Abstract Background The functional implications of left ventricular (LV) morphological characterization in congenital heart disease (CHD) are not widely explored. Purpose This study qualitatively and quantitatively assessed LV shape associations with a) LV function and b) thoracic aortic morphology in patients with aortic coarctation (CoA) with/without bicuspid aortic valve (BAV). Methods A statistical shape modelling (SSM) framework was employed to analyse three-dimensional (3D) LV shapes from cardiac magnetic resonance (CMR) imaging data in n=110 cases including: isolated CoA (n=25), CoA+BAV (n=30), isolated BAV (n=30), and age-matched healthy controls (n=25). Average 3D templates (Picture 1) and deformations were computed. Correlations between shape data and CMR-derived morphometric parameters (i.e. sphericity, conicity) as well as CMR-derived global and apical strain values were assessed to elucidate possible functional implications. The relationship between LV shape features and arch architecture (i.e. gothicity, tortuosity) was also explored by means of regression analysis. Results The LV template was shorter and more spherical in CoA patient (Picture 1), as also confirmed by statistical analysis of the SSM-derived shape modes. LV sphericity, which was higher in CoA, was associated (p≤0.04) with lower global longitudinal, radial and circumferential strain, irrespective of the presence of aortic stenosis and/or regurgitation. Conversely, neither LV morphology nor LV strain was not associated with arch architecture. Conclusions Differences in LV morphology were observed between CoA and BAV patients. Increasing LV sphericity was associated with reduced strain, independent of aortic arch architecture and functional aortic valve disease. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): British Heart Foundation and NIHR BRC

The impact of left atrial mechanics on adverse events and clinical outcome after cardiac surgery

Abstract Objectives Post-operative atrial fibrillation (POAF) represents a common complication after cardiac surgery that is associated with unfavorable clinical outcome. Identifying patients at risk for POAF is crucial but challenging. Purpose This study aimed to investigate the prognostic potential of speckle tracking echocardiography (STE) on POAF and fatal adverse events from a long-term perspective. Methods A total of 124 patients undergoing elective cardiac surgery were prospectively enrolled and underwent pre-operative STE. Patients were followed prospectively for the occurrence of POAF within the entire hospitalization and reaching the secondary endpoints cardiovascular (CV) and all-cause mortality. Results Within the study population 43.5% (n=53) of enrolled individuals developed POAF. After a median follow-up of 3.9 years, 25 (20.2%) patients died. We observed that patients presenting with POAF had lower global peak atrial longitudinal strain (PALS) values compared to the non-POAF arm (POAF: 14.8% [95% CI: 10.9–17.8] vs. non-POAF: 19.4% [95% CI: 14.8–23.5], p<0.001). Moreover, global PALS was a strong and independent predictor for POAF (adjusted Odds Ratio per 1-SD: 0.37 [95% CI: 0.22–0.65], p<0.001), and independently associated with mortality (adjusted Hazard Ratio per 1-SD: 0.63 [95% CI: 0.40–0.99], p=0.048). CART analysis revealed a cut-off value of <17% global PALS as high-risk for both POAF and mortality. Conclusion Global PALS is associated with the development of POAF following surgery in an unselected patient population undergoing CABG and/or valve surgery. Since patients with global PALS <17% face a poor long-term prognosis, routine assessment of global PALS needs to be considered in terms of proper secondary prevention in the era of personalized medicine. Funding Acknowledgement Type of funding sources: None.

Global and regional left ventricular deformation evaluation with feature tracking in transthyretin cardiac amyloidosis. Comparison with echocardiographic findings

Abstract Background Diagnosis of cardiac amyloidosis (CA) is basically based on imaging techniques. Transthoracic echocardiography (TTE) is crucial to raise suspicion of this disease through detection of the classical features. An specific left ventricular (LV) deformation pattern with apical sparing (“cherry on top”) has been described on speckle tracking (ST) TTE. However, there is no data regarding the role of the LV global and regional analysis with the new tool feature tracking (FT) of cardiac magnetic resonance (CMR) in CA. Purpose Our aim is to analyze the concordance of LV deformation between ST-TTE and FT-CMR. Methods Consecutive patients with definitive diagnosis of transthyretin (TTR) CA, based on DPD scintigraphy, and imaging evaluation with TTE and CMR were retrospectively included. LV volumes and ejection were calculated from both TTE and CMR following the ongoing recommendations. Global and segmental longitudinal strain values were obtained from apical 2-, 3- and 4-chambers projections on TTE, while the same parameters were calculated on the same cine views of CMR using a dedicated software of FT analysis. Student t-test was used to compared mean measurements derived from both imaging techniques. Apical index was calculated as the ratio between apical and basal-mid longitudinal values. Moreover, agreement was established using Passing-Bablok regression analysis. Results 27 patients (80 years-old, 88% men) with definitive diagnosis of TTR CA from our tertiary hospital were included. Regarding echocardiographic findings, 80% showed concentric LV hypertrophy with low normal ejection fraction in the majority (52±10%). When longitudinal LV strain parameters were compared (Table 1), no differences were noted in global and apical values whereas basal and mid measurements were higher from CRM resulting in different apical indexes. Although 42% showed a typical “cherry on top” pattern in ST analysis, in only 18% of the FT apical sparing was detected. Consistently, decremental pattern was observed in 60% of TTE and in 20% of CMR. Concordance analysis with Passing-Bablok showed no constant or proportional differences, meaning both techniques were comparable. Conclusions Among patients with TTR CA there were no differences in global longitudinal LV strain analysis between ST-TTE and FT-CMR. Nevertheless, discordance in regional parameters resulted in a less frequent detection of apical sparing in CMR. Funding Acknowledgement Type of funding sources: None.

13N-ammonia positron emission tomography-derived endocardial strain for the assessment of ischemia using feature-tracking in high-resolution cine imaging

BackgroundAssessing endocardial strain using a single 13N-ammonia positron emission tomography (PET) scan would be clinically useful, given the association between ischemia and myocardial deformation. However, no software has been developed for strain analysis using PET. We evaluated the clinical potential of feature tracking-derived strain values measured using PET, based on associations with the myocardial flow reserve (MFR). Methods and ResultsThis retrospective study included 95 coronary artery disease patients who underwent myocardial 13N-ammonia PET. Semi-automatic measurements were made using a feature-tracking technique during myocardial cine imaging, and values were calculated using a 16-segment model. Adenosine-stressed global circumferential strain (CS) and global longitudinal strain (LS) values were compared with global MFR values. Stressed and resting global strain values were also compared. Global strain values were significantly lower in 39 patients with abnormal MFRs [< 2.0] than in 56 patients with normal MFRs [≥ 2.0]. The global CS values in the stressed state were significantly decreased than the resting state values in patients with abnormal MFRs. ConclusionsThis study applied endocardial feature-tracking to 13N-ammonia PET, and the results suggested that blood flow and myocardial motility could be clinically assessed in ischemic patients using a single PET scan.

Prognostic value of left ventricular global longitudinal strain and mechanical dispersion by speckle tracking echocardiography in patients with ischemic and nonischemic cardiomyopathy: a systematic review and meta-analysis

Aim. To conduct a systematic review and meta-analysis in order to evaluate the prognostic value of left ventricular global longitudinal strain (LV GLS) and LV mechanical dispersion (LVMD) in ischemic and nonischemic cardiomyopathy.Material and methods. We searched PubMed, Google Scholar and Embase for studies on the prognostic value of LV GLS and LVMD in ischemic and nonischemic cardiomyopathy. Hazard ratios (HR) from included studies were pooled for metaanalysis.Results. Twelve studies were selected from 314 publications for this systematic review and meta-analysis. In total, 2624 patients (mean age, 57,3 years; mean follow-up, 40,8 months) were included in the analysis. Meta-analysis showed that decreased LV GLS was associated with an increased risk of ventricular arrhythmias (VAs) (adjusted HR: 1,10 per 1% of GLS; 95% CI: 1,01-1,19; p=0,03) and major adverse cardiovascular events (MACE): adjusted HR: 1,22 per 1% of GLS; 95% CI: 1,11-1,33; p&lt;0,0001). Patients with VAs had greater LVMD than those without it (weighted mean difference, 33,69 ms; 95% CI: -41,32 to -26,05; p&lt;0,0001). Each 10 ms increment of LVMD was significantly and independently associated with VA episodes (adjusted HR: 1,18; 95% CI: 1,08-1,29; p=0,0002).Conclusions. LV GLS and LVMD assessed using speckle tracking provides important predictive value and can be used as an effective tool for stratifying risk in patients with ischemic and nonischemic cardiomyopathy.

Postsystolic shortening and early systolic lengthening for early detection of myocardial involvement in patients with systemic lupus erythematosus.

Cardiac involvement predicts a poor prognosis in patients with systemic lupus erythematosus (SLE). Two-dimensional speckle-tracking echocardiography (2D-STE) are used to identify subclinical myocardial involvement in various diseases. This study objected to evaluate postsystolic shortening (PSS) and early systolic lengthening (ESL) by 2D-STE for early detection of myocardial involvement in patients with SLE. A total of 121 patients with preserved left ventricular ejection fraction (LVEF) in SLE and 30 healthy controls underwent standard 2D-STE in our study. According to SLE disease activity index (SLEDAI), we divided SLE patients into two groups: the group of inactive disease (SLEDAI ≤ 4) and active disease (SLEDAI ≥ 5). The maximum of postsystolic strain index (PSImax ) and early systolic strain index (ESImax ) were acquired from 17 segments of left ventricular (LV). We also compared the PSImax and ESImax of basal, medial, and apical segments between SLE patients and controls. Compared with healthy controls and the group of SLEDAI ≤ 4, the group of SLEDAI ≥ 5 had higher PSImax and ESImax value of global LV and basal segments. The absolute value of global longitudinal strain (GLS) had no difference between the group of active disease and inactive disease. Multivariate analysis demonstrated that PSS was independently associated with SLEDAI and diabetes mellitus. Detection of PSS and ESL enable to identify LV systolic impairment in SLE patients at an early stage.

Trimetazidine improves left ventricular global longitudinal strain value in patients with heart failure with reduced ejection fraction due to ischemic heart disease.

Heart failure with reduced ejection fraction (HFrEF) due to ischemic heart disease (IHD) showed a progressive decline in left ventricular contractile function. However, no previous study has examined the left ventricular global longitudinal strain (LV GLS) parameter that represents LV contractile function. We investigated whether trimetazidine could improve the LV GLS value in patients with HFrEF due to IHD. We performed a double-blind, randomized controlled trial (RCT) including 26 patients with HFrEF due to stable IHD who were given modified-release trimetazidine 35 mg twice per day (n = 13) or placebo (n = 13) for 3 months in addition to standard medication. Left ventricular systolic function including GLS values was assessed at baseline and after 3 months using echocardiography. A total of 25 participants (13 control and 12 trimetazidine groups) were recruited with a baseline average age of 57.1 ± 10 years, and LV ejection fraction (LVEF) value of 34.6% ± 4.4%, and a GLS value of 7.4% ± 2.1%. Baseline clinical characteristics and echocardiogram were similar between the two groups. There was significant GLS improvement in the trimetazidine group (-6.9% ± 2.4% to -8.4% ± 2.6%, p = 0.000), but no significant differences were noted in the control group. The GLS improvement was significantly higher in the trimetazidine group than the control (1.5% + 0.9% vs. -0.7% + 1.7%, p = 0.001). No adverse drug reactions from the administration of trimetazidine in this study. Trimetazidine may improve GLS values in patients with HFrEF due to IHD.

Clinical presentation and cardiac imaging findings in patient cases of perimyocarditis and pericarditis with a temporal association to SARS-CoV-2 vaccination.

AimsWe aimed to investigate and present cases of perimyocarditis and pericarditis verified by cardiovascular resonance (CMR) imaging in patients with a strong temporal association to SARS-CoV-2 vaccination. We sought to describe the clinical presentation including coronary artery angiography, CMR, transthoracic echocardiography, blood samples, electrocardiography, and symptoms.MethodsWe included 10 patients admitted with chest pain shortly after vaccination for SARS-CoV-2, who were diagnosed with pericarditis or perimyocarditis by CMR. We reviewed the CMR, echocardiography, electrocardiography, blood samples, coronary artery angiography, vital signs and medical history. The updated Lake Louise Criteria were used to determine the diagnosis by CMR.ResultsEight patients had perimyocarditis and two patients had pericarditis. The mean age was 22 ± 5 years (range 16 to 31 years), 90% were male. The median time from vaccination to hospital admission was 4 days (range 2 to 28 days). Admissions were seen after vaccination with three different SARS-CoV-2 vaccine manufacturers. Nine Patients had ST-elevation on the initial electrocardiography. Peak troponins varied from 357 to 23,547 ng/l, with a median of 4,304 ng/l. Two patients had an LVEF <50% on echocardiography and four patients had left ventricular global longitudinal strain values <18%. CMR revealed preserved left ventricular ejection fraction (LVEF), although one patient had decreased LVEF on CMR. The T1 and T2 mapping values were increased in all patients. Of the 8 patients with perimyocarditis, all patients had signs of myocardial injury in the lateral segments of the left ventricle.ConclusionsThis case series of 10 patients supports the emerging evidence of an association between vaccination for SARS-CoV-2 and perimyocarditis and pericarditis, especially in young males. The temporal association was seen after vaccines from three different manufacturers. Imaging data from echocardiography and CMR displayed normal to mildly impaired cardiac function, usually with a mild disease course.

Incremental Value of Global Longitudinal Strain to Michigan Risk Score and Pulmonary Artery Pulsatility Index in Predicting Right Ventricular Failure Following Left Ventricular Assist Devices.

The incremental utility of right ventricular (RV) strain on predicting right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation, beyond clinical and haemodynamic indices, is not clear. Two hundred and forty-six (246) patients undergoing LVAD implantation, who had transthoracic echocardiograms pre and post LVAD, pulmonary artery pulsatility index (PAPI) measurements and Michigan risk score, were included. We analysed RV global longitudinal strain (GLS) using speckle tracking echocardiography. RVF following LVAD implantation was defined as the need for medical support for >14 days, or unplanned RV assist device insertion after LVAD implantation. Mean preoperative RV-GLS was -7.8±2.8%. Among all, 27% developed postoperative RVF. A classification and regression tree analysis identified preoperative Michigan risk score, PAPI and RV-GLS as important parameters in predicting postoperative RVF. Eighty per cent (80%) of patients with PAPI <2.1 developed postoperative RVF, while only 4% of patients with PAPI >6.8 developed RVF. For patients with a PAPI of 2.1-3.2, having baseline Michigan risk score >2 points conferred an 81% probability of subsequent RVF. For patients with a PAPI of 3.3-6.8, having baseline RV-GLS of -4.9% or better conferred an 86% probability of no subsequent RVF. The sensitivity and specificity of this algorithm for predicting postoperative RVF were 67% and 93%, respectively, with an area under the curve of 0.87. RV-GLS has an incremental role in predicting the development of RVF post-LVAD implantation, even after controlling for clinical and haemodynamic parameters.

Comparison of DeepStrain and Feature Tracking for Cardiac MRI Strain Analysis.

Myocardial feature tracking (FT) provides a comprehensive analysis of myocardial deformation from cine balanced steady-state free-precession images (bSSFP). However, FT remains time-consuming, precluding its clinical adoption. To compare left-ventricular global radial strain (GRS) and global circumferential strain (GCS) values measured using automated DeepStrain analysis of short-axis cine images to those calculated using manual commercially available FT analysis. Retrospective, single-center. A total of 30 healthy subjects and 120 patients with cardiac disease for DeepStrain development. For evaluation, 47 healthy subjects (36 male, 53 ± 5 years) and 533 patients who had undergone a clinical cardiac MRI (373 male, 59 ± 14 years). FIELD STRENGTH/SEQUENCE: bSSFP sequence at 1.5T (Phillips) and 3T (Siemens). Automated DeepStrain measurements of GRS and GCS were compared to commercially available FT (Circle, cvi42) measures obtained by readers with 1 year and 3 years of experience. Comparisons were performed overall and stratified by scanner manufacturer. Paired t-test, linear regression slope, Pearson correlation coefficient (r). Overall, FT and DeepStrain measurements of GCS were not significantly different (P=0.207), but measures of GRS were significantly different. Measurements of GRS from Philips (slope=1.06 [1.03 1.08], r=0.85) and Siemens (slope=1.04 [0.99 1.09], r= 0.83) data showed a very strong correlation and agreement between techniques. Measurements of GCS from Philips (slope=0.98 [0.98 1.01], r=0.91) and Siemens (slope=1.0 [0.96 1.03], r=0.88) data similarly showed a very strong correlation. The average analysis time per subject was 4.1 ± 1.2minutes for FT and 34.7 ± 3.3 seconds for DeepStrain, representing a 7-fold reduction in analysis time. This study demonstrated high correlation of myocardial GCS and GRS measurements between freely available fully automated DeepStrain and commercially available manual FT software, with substantial time-saving in the analysis. 3 TECHNICAL EFFICACY: Stage 3.

A convolutional neural network based crystal plasticity finite element framework to predict localised deformation in metals

Convolutional neural networks (CNNs) find vast applications in the field of image processing. This study utilises the CNNs in conjunction with the crystal plasticity finite element method (CPFEM). This research presents a framework that enables CNNs to make rapid and high-fidelity predictions for materials under uniaxial tension loading. The inputs to the CNN model are material hardening parameters (initial hardness and initial hardening modulus), a global tensile strain value, and microstructure with a varying number of grains, grain size, grain morphology and texture. This input selection allows performing simulations for a wide range of materials, as defined by microstructure and flow curves. The outputs of the CNN are the local stress and strain values. The proposed framework involves the following stages: feature engineering, generation of synthetic microstructures, CPFEM simulations, data extraction and preprocessing, CNN design and selection, CNN training, and validation of the trained network. The trained CNN was successfully demonstrated to predict local stress and strain evolution for the completely new dataset (test set) containing synthesised microstructures. The test set predictions were evaluated, and the median, worst, and best predictions were presented and discussed. Overall, the CNN demonstrated excellent agreement with CPFEM simulations, thus validating its accuracy. Then, the CNN was applied to predict the stress and strain evolution for AA5754 and AA6061 microstructures obtained using electron backscatter diffraction. These two microstructures were entirely new for the CNN and displayed size and grain morphology different from the synthesised microstructures. For both microstructures, the obtained stress and strain evolution predictions demonstrated excellent agreement with CPFEM simulations, thus confirming the flexibility of the trained CNN model. Then, the framework was extended to predict strain localisation and was evaluated on an AA6061 microstructure. The results presented in this research demonstrate a clear computational advantage of CNN without loss of accuracy. Finally, the research offers prospects for future advances.

Prognostic value of left atrial longitudinal strain by cardiac MRI feature tracking in atrial fibrillation patients with mitral valve disease

To evaluate the prognostic value of left atrial global longitudinal strain (LAGLS) in atrial fibrillation (AF) patients with mitral valve disease (MVD). In this single-centre retrospective study, 48 consecutive AF patients with MVD who underwent cardiac magnetic resonance imaging (CMRI) before surgery were enrolled. The LAGLS was assessed by cine-CMRI images and feature tracking (CMRI-FT) technique. Logistic regression and receiver operating characteristic (ROC) analysis were performed to identify the value of LAGLS in predicting atrial tachyarrhythmia recurrence after surgery. The LAGLS level of the total patients was 4.4% (interquartile range: 2.7-9.2%). LAGLS was significantly associated with many evaluated parameters of severity of disease including biventricular volumetric function, left atrial (LA) ejection fraction, and the European System for Cardiac Operative Risk Evaluation II score (all p<0.05). Multivariate Cox analysis showed that LAGLS (hazard ratio=0.52, 95% confidence interval [CI]: 0.31, 0.87; p=0.013) was an independent predictor of atrial tachyarrhythmia recurrence after adjustment for LA diameter, LA and biventricular ejection fraction, aetiology of MVD (rheumatic or degenerative), and surgical procedure (valve surgery alone or valve surgery combined with Maze IV). The optimal cut-off value of LAGLS was 4.1% for predicting recurrent atrial tachyarrhythmia (sensitivity 81.8%, specificity 78.4%) and the area under the ROC curve was 0.854 (95% CI: 0.711, 0.996, p<0.001). CMRI-FT-derived LAGLS may act as a novel non-invasive imaging biomarker with which to evaluate the severity of disease and offer independent prognostic information for atrial tachyarrhythmia recurrence after surgery in AF patients with MVD.

High-Spatiotemporal-Resolution Visualization of Myocardial Strains Through Vector Doppler Estimation: A Small-Animal Study.

High-frequency ultrasound (HFUS) imaging is extensively used for cardiac diseases in small animals due to its high spatial resolution. However, there is a lack of a system that can provide a 2-D high-spatiotemporal dynamic visualization of mouse myocardial strains. In this article, a dynamic HFUS (40 MHz) high-resolution strain imaging was developed through the vector Doppler imaging. Following in vitro tests using a rubber balloon phantom, in vivo experiments were performed on wild-type (WT) and myocardial infarction (MI) mice. High-resolution dynamic images of myocardial strains were obtained in the longitudinal, radial, and circumferential directions at a frame rate of 1 kHz. Global peak strain values for WT mice were -19.3% ± 1.3% (longitudinal), 31.4% ± 1.7% (radial in the long axis), -19.9% ±.8% (circumferential), and 34.4% ± 1.9% (radial in the short axis); those for the MI mice were -16.1% ±.9% (longitudinal), 26.8% ± 2.9% (radial in the long axis), -15.2% ± 2.7% (circumferential), and 21.6% ± 4.8% (radial in the short axis). These results indicate that the strains for MI mice are significantly lower than those for WT mice. Regional longitudinal strain curves in the epicardial, midcardial, and endocardial layers were measured and the peak strain values for WT mice were -22.% and -16.8% in the endocardial and epicardial layers, respectively. However, no significant difference in the layer-based values was noted for the MI mice. Regional analysis results revealed obvious myocardial strain variation in the apical anterior region in the MI mice. The experimental results demonstrate that the proposed dynamic cardiac strain imaging can be useful in high-performance imaging of small-animal cardiac diseases.

Routine assessment of cardiotoxicity in patients undergoing long-term immune checkpoint inhibitor therapy.

The indications for immune checkpoint inhibitors (ICIs) are expanding in cancer drug therapy, and while cardiac events associated with ICIs are often fatal, there are few reports regarding cardiac complications associated with long-term ICI therapy. We aimed to study cardiac complications in patients undergoing long-term ICI therapy. From the database of our local cardio-oncology unit, we enrolled patients with cancer undergoing ICI therapy for more than 6months and for whom cardiologists continuously performed routine follow-ups. We defined the primary endpoint as discontinuation of ICI due to cardiac events. We also analyzed changes in cardiac biomarkers and echocardiographic parameters. We retrospectively analyzed 55 consecutive patients (43 males, mean age: 65 ± 11years) treated with ICI therapy in our hospital between January 2017 and June 2021. None of the patients discontinued ICI therapy due to cardiac events more than 6months after treatment was initiated. Among the participants, we observed four patients with elevated serum troponin I levels, seven patients with decreased global longitudinal strain values, and two patients with elevated plasma brain natriuretic peptide levels. No patient required drug intervention for these cardiac events; furthermore, there were no cases of clinically diagnosed myocarditis. In the present study, there were no cardiac events causing ICI discontinuation in patients undergo ICI therapy for more than 6months.