GLS) And Circumferential Strain Research Articles

Exploring cardiovascular implications of juvenile dermatomyositis: Insights from aortic stiffness analysis and 3D echocardiography.

Our goal was to use three dimensional (3D) strain analysis to evaluate myocardial function and ascending aorta elasticity changes in juvenile dermatomyositis (JDM). Between 2019 and 2021, 23 JDM patients and 20 healthy volunteers participated. Both groups underwent 2D and 3D strain analysis, assessing aortic stiffness using aortic distensibility, stiffness index, strain, and elastic modulus. JDM patients had a median age of 13.3±5.2 years, while controls had a median age of 13.8±4.76 years. 3D strain analysis revealed significantly lower global longitudinal (GLS) and circumferential strain (GCS) in JDM patients compared to controls. Specifically, 3D GLS was notably reduced in patients (-28.1% vs. -31%, p=.047) compared to controls, and 3D GCS was also lower in patients (-27.5% vs. -30.5%, p=.019) compared to controls. Aortic strain and elastic modulus were significantly lower in JDM patients, while aortic stiffness index and distensibility showed no significant differences. Correlation analyses within the JDM group revealed a negative correlation between 3D GLS and age at diagnosis (r=-.561, p=.04), as well as a positive correlation between 3D GLS and both aortic strain (r=.514, p=.0001) and elastic modulus (r=.320, p=.03) in JDM patients. Our study demonstrated a trend towards lower ejection fraction and strain in patients with JDM, along with increased aortic stiffness using 3D echocardiography. These findings suggest potential cardiovascular involvement in juvenile dermatomyositis, emphasizing the importance of comprehensive cardiac assessments in these patients.

Ventricular Ejection Fraction and Global Strains in Connection with the Volume Regulation Graph.

Ejection fraction (EF) is traditionally considered useful to infer ventricular function. Newer metrics such as global function index (GFI) and various strains add supplemental diagnostic or prognostic value. All these candidates refer to dimensionless ratios, rather than to the characteristics of the underlying components. Therefore, we introduced the volume regulation graph (VRG), relating end-systolic volume (ESV) to end-diastolic volume (EDV). An individual patient is then uniquely defined by the prevailing working point in the volume domain. Alternatively, the combination of EF=(1-ESV/EDV) and any suitable companion (denoted as C) metric (e.g. the Pythagorean mean) specifies this working point.An expression relates EF to global longitudinal (GLS) and circumferential strain (GCS): ESV/EDV = (GLS+1) (GCS+1)2, resembling the empirical regression equation for the VRG. However, the latter has a non-zero intercept (mL). The discrepancy can be solved by the introduction of one or more pertinent companion metrics.We studied 96 patients by cardiac magnetic resonance imaging and calculated EF, EFC, GFI, GLS and GCS. The GFI is inversely related to GLS (R2=0.26). For regression we found: ESV=0.74 EDV-27.0 with R2=0.81 for N=96. Similar results were obtained for echocardiography data (N=25). Graphs relating EF to GLS and GCS indicate that EFC can distinguish patients with nearly identical values for these 3 metrics.Thus, the VRG offers a unifying framework that visualizes the association between ESV and EDV, while documenting iso-EF and iso-EFC trajectories. Newer metrics including GFI, GLS and GCS require consideration of a companion variable such as EFC to permit a comprehensive analysis.Clinical Relevance- The VRG allows insight into ventricular functioning and illustrates the working point concept. Companion metrics (having a physical dimension) should be considered in conjunction with any traditional ratio-based index.

66 MYOCARDIAL EDEMA CONTRIBUTES TO INTERSTITIAL EXPANSION AND ASSOCIATES WITH MECHANICAL AND ELECTROCARDIOGRAPHIC CHANGES IN TAKOTSUBO SYNDROME: A CMR T1 AND T2 MAPPING STUDY

Abstract Background myocardial edema has a central role in takotsubo syndrome (TTS). Relationships between edema, mechanical and electrical abnormalities in TTS are still elusive. Methods n=32 hospitalized TTS patients and n=23 controls were analyzed. We performed cardiac magnetic resonance (CMR) with tissue mapping for the assessment of edema and interstitial expansion, global longitudinal (GLS) and circumferential strain (GCS) were evaluated by CMR feature-tracking. Twelve-lead ECGs were recorded at the time of CMR in TTS patients, aVR voltage, negative T-wave voltage and QTc length were calculated. Results mean age of the TTS cohort was 72±12-year-old, 94% women, undergoing CMR at a median of 4 days (interquartile range 2, 6) after hospital admission. Compared with controls, patients had increased LV mass (55±11 g/m2 vs 46±8 g/m2, p<0.001), worse left ventricular ejection fraction (LVEF), GLS and GCS (all p<0.001), higher septal native T1 (1116±73 msec vs 970±23 msec, p<0.001), T2 (56±5 msec vs 46±2 msec, p<0.001) and extra-cellular volume (ECV) fraction (32±5% vs 24±1%, p<0.001). TTS patients had higher apicobasal gradient of T2 values (12±6 msec vs 2±6 msec, p<0.001), basal LV wall displayed higher native T1, T2 and ECV (all p<0.002) but similar circumferential strain against controls (-23±3% vs -24±4%, p=0.351). In the TTS cohort, septal T2 value showed significant correlations with native T1 (r=0.609, p<0.001), ECV (r=0.689, p<0.001), LVEF (r=-0.459, p=0.008) and aVR voltage (r=-0.437, p<0.05). Negative T waves voltage and QTc length significantly correlated with apicobasal T2 mapping gradient (r=0.499, p=0.007 and r=0.372, p=0.047 respectively) but not with other tissue mapping measurements. Conclusions CMR T1 and T2 mapping demonstrated increased myocardial water content conditioning interstitial expansion in acute TTS. Myocardial edema was detected even outside areas of abnormal wall motion, its burden and distribution associated with mechanical and electrocardiographic changes, making it a potential prognostic marker and therapeutic target in TTS.

Longitudinal Assessment of Global and Regional Left Ventricular Strain in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C).

Multisystem inflammatory syndrome in children (MIS-C) is one of the most significant sequela of coronavirus disease 2019 (COVID-19) in children. Emerging literature has described myocardial dysfunction in MIS-C patients using traditional and two-dimensional speckle tracking echocardiography in the acute phase. However, data regarding persistence of subclinical myocardial injury after recovery is limited. We aimed to detect these changes with deformation imaging, hypothesizing that left ventricular global longitudinal (GLS) and circumferential strain (GCS) would remain impaired in the chronic phase despite normalization of ventricular function parameters assessed by two-dimensional echocardiography. A retrospective, single-institution review of 22 patients with MIS-C was performed. Fractional shortening, GLS, and GCS, along with regional longitudinal (RLS) and circumferential strain (RCS) were compared across the acute, subacute, and chronic timepoints (presentation, 14–42, and > 42 days, respectively). Mean GLS improved from − 18.4% in the acute phase to − 20.1% in the chronic phase (p = 0.4). Mean GCS improved from − 19.4% in the acute phase to − 23.5% in the chronic phase (p = 0.03). RCS and RLS were impaired in the acute phase and showed a trend towards recovery by the chronic phase, with the exception of the basal anterolateral segment. In our longitudinal study of MIS-C patients, GLS and GCS were lower in the acute phase, corroborating with left ventricular dysfunction by traditional measures. Additionally, as function globally recovers, GLS and GCS also normalize. However, some regional segments continue to have decreased strain values which may be an important subclinical marker for future adverse events.

Systemic ventricular strain is abnormal with elevated BMI in adults with congenital heart disease

BackgroundObesity is associated with left ventricular (LV) hypertrophy and cardiac dysfunction. In obese adults with congenital heart disease (ACHD), a sensitive echocardiographic marker like strain might enable early detection of subclinical cardiac changes. ObjectivesTo assess the association of elevated body mass index (BMI) with global longitudinal (GLS) and circumferential strain (GCS) in ACHD. Methods2D transthoracic echocardiograms (TTE) done on 267 ACHD patients (excluding those with genetic syndromes and single ventricle) in 2016 were analyzed. Echocardiographic images were analyzed offline using TomTec Image Arena to obtain global longitudinal (GLS) and circumferential strain (GCS). Data were analyzed with SAS software using Chi-square and Wilcoxon Rank-Sum tests. ResultsUnivariate analysis shows a significant association of elevated BMI with median GCS (p = 0.01), median GLS (p = 0.01), and hypertension (p = 0.03). Multivariate logistic regression shows a significant association of elevated BMI with GLS (p = 0.01; CI, 1.02–1.25), and GCS (p = 0.02; CI, 1.01–1.23) after adjusting for hypertension, ejection fraction (EF), LV end diastolic volume and type of CHD. There is no association between elevated BMI and gender, LV mass, EF, and type of CHD. Conclusions2D TTE derived longitudinal and circumferential strain is abnormal in ACHD patients with elevated BMI. This may help identify a subset of patients with subclinical myocardial dysfunction as a target for lifestyle modification to prevent progression to cardiac dysfunction.

Abstract 9916: Relationship Between Blood Pressure Categorization and Subclinical Left Ventricular Dysfunction in Antihypertensive Medication-Naive Individuals

Background: The impact of blood pressure (BP) levels on subclinical left ventricular (LV) dysfunction and possible sex-specific difference remains unclarified. This study aimed to investigate the relationship between BP categories given in the new 2017 ACC/AHA hypertension guideline and subclinical LV dysfunction in subjects free of cardiac disease. Methods: We examined antihypertensive medication-naive 858 individuals who underwent extensive cardiovascular health check-up. LV global longitudinal (GLS) and circumferential strain (GCS) were assessed by 2-dimensional speckle-tracking echocardiography. Participants were categorized into 4 groups according to the BP levels: normal BP, elevated BP, isolated diastolic hypertension (IDH) and systolic hypertension (SH). Results: Among the 858 participants (61±11 years, 459 men), 422 individuals had normal BP, 113 had elevated BP, 160 had IDH, and 163 had SH. Prevalence of abnormal LVGLS (>-18.6%) was greatest in SH group (19.0%), followed by IDH (17.5%), elevated BP (14.2%) and normal BP (7.1%, p<0.001; Figure); no significant differences were observed for LVGCS (p=0.671). In the multivariable analyses, IDH and SH were associated with impaired LVGLS (adjusted odds ratio [OR] 2.69 and 2.66, p<0.001) and borderline significance was observed for elevated BP (adjusted OR 1.90, p=0.060); there was no significant association between any of the BP groups and LVGCS. In sex-stratified analysis, IDH and SH carried the significant risk of abnormal LVGLS in both sexes, while elevated BP was associated with LVGLS only in women. Conclusion: IDH and SH redefined by ACC/AHA guideline carried a significant risk for LVGLS, but not LVGCS. Elevated BP was associated with LVGLS only in women. Our findings provide information on cardiac correlates of the newly established BP categories.

Association of arterial hemodynamics with left ventricular systolic function in hypertensive patients: A longitudinal study

BACKGROUND Left ventricular (LV) systolic impairment, particularly in the longitudinal direction, is considered an early and sensitive marker of hypertensive heart disease and increased cardiovascular risk. The evidence indicates that aortic stiffness and central hemodynamic factors are important determinants of LV performance, mediating the interaction between the heart and vascular load. Despite the existence of cross-sectional analyses linking central blood pressure (BP) parameters with LV mechanics, no longitudinal data are available which include serial measurements in the course of antihypertensive treatment. OBJECTIVES To investigate the associations between changes in LV longitudinal and circumferential function with alterations in arterial hemodynamics and ventricular-arterial coupling (VAC) in patients with uncomplicated hypertension during a 12-month follow-up. MATERIAL AND METHODS In this retrospective study, 216 patients (age 64.3 ±7.6 years) underwent echocardiography including left ventricular longitudinal (GLS) and circumferential strain (GCS) analysis, brachial BP measurements, VAC (combining echocardiography and brachial BP), and arterial hemodynamics using radial tonometry at baseline and after 12 months of antihypertensive therapy. Patients were grouped into 2 subsets: with improvement in GLS (n = 103) and with deterioration in GLS (n = 113). RESULTS No significant differences were observed in the majority of cardiovascular, demographic or clinical characteristics between the groups. The subset with improvement in GLS demonstrated more favorable changes over follow-up in pulse wave velocity (p = 0.03), central augmentation pressure (p = 0.01) and ventricular-arterial coupling (p = 0.04) compared to patients showing deterioration in GLS. In the multivariable analysis, independent determinants of changes in GLS were: GLS at baseline (-0.48; p < 0.001), changes from baseline to follow-up in central augmentation pressure (-0.29; p = 0.002) and ventricular-arterial coupling (-0.25; p = 0.004). Independent determinants of analogous changes in GCS were: GCS at baseline (-0.46; p < 0.001) and changes in central augmentation pressure (-0.22; p = 0.02). CONCLUSIONS Left ventricular longitudinal and circumferential functional remodeling over time in hypertensive patients is associated with arterial hemodynamics and ventricular-arterial coupling.

Left ventricular mechanics and cardiovascular outcomes in non-compaction phenotype

AimsThis study aims at understanding left ventricular (LV) mechanics of non-compaction (LVNC) phenotype using echocardiographic strain analysis and at assessing the association of functional parameters with cardiovascular (CV) outcomes. Methods and resultsLongitudinal (GLS) and circumferential strain (GCS) as well as rotation of the LV were analyzed in 55 LVNC patients and 55 matched controls. Cardiovascular outcomes were documented for a median follow-up duration of 6 years. GLS and GCS were impaired in LVNC. Similary, regional longitudinal and circumferential strain as well as twist were reduced. CV events occurred in 28 LVNC patients. Apical peak circumferential strain (APCS), peak systolic rotation of apical segments (APSR), and twist were strongly associated with events. This was independent of and incremental to LVEF and non-compacted to compacted myocardial thickness ratio (NC:C ratio). The association of twist with events was also independent of and slightly superior to GLS. ConclusionsGLS, GCS, regional strain, and twist were impaired in LVNC. APCS, APSR, and twist exhibited strong association with CV events independent of and incremental to LVEF and NC:C ratio, and in case of twist even GLS. Thus, STE-derived parameters may complement the echocardiographic assessment of LVNC patients in clinical routine.

Left and right ventricular strain using fast strain-encoded cardiovascular magnetic resonance for the diagnostic classification of patients with chronic non-ischemic heart failure due to dilated, hypertrophic cardiomyopathy or cardiac amyloidosis

AimsTo compare the ability of left ventricular (LV) and right ventricular (RV) strain measured by fast-strain encoded cardiovascular magnetic resonance (CMR) (fast-SENC) with LV- and RV-ejection fraction for the diagnostic classification of patients with different stages of chronic heart failure (stages A-D based on American College of Cardiology/American Heart Association guidelines) due to non-ischemic cardiomyopathies.MethodsOur study population consisted of 276 consecutive patients who underwent CMR for clinical reasons, and 19 healthy subjects. Wall motion score index and non-infarct related late gadolinium enhancement (LGE), LV ejection fraction (LVEF) and RV ejection fraction (RVEF) and global LV- and RV-longitudinal (GLS) and circumferential strain (GCS) based on fast-SENC acquisitions, were calculated in all subjects. The percentage of LV and RV myocardial segments with strain ≤ − 17% (%normal LV and RV myocardium) was determined in all subjects.ResultsLVEF and RVEF, LV-GLS, LV-GCS, RV-GLS, RV-GCS and %normal LV- and RV myocardium depressed with increasing heart failure stage (p < 0.001 for all by ANOVA). By multivariable analysis, %normal LV and RV myocardium exhibited closer associations to heart failure stages than LVEF and RVEF (rpartial = 0.79 versus rpartial = 0.21 for %normal LV myocardium versus LVEF and rpartial = 0.64 versus rpartial = 0.20 for %normal RV myocardium versus RVEF, respectively). Furthermore, %normal LV and RV myocardium exhibited incremental value for the identification of patients (i) with subclinical myocardial dysfunction and (ii) with symptomatic heart failure, surpassing that provided by LVEF and RVEF (ΔAUC = 0.22 for LVEF and ΔAUC = 0.19 for RVEF with subclinical dysfunction, and ΔAUC = 0.19 for LVEF and ΔAUC = 0.22 for RVEF with symptomatic heart failure, respectively, p < 0.001 for all). %normal LV myocardium reclassified 11 of 31 (35%) patients judged as having no structural heart disease by clinical and imaging data to stage B, i.e., subclinical LV-dysfunction.ConclusionsIn patients with non-ischemic cardiomyopathy, %normal LV and RV myocardium, by fast-SENC, enables improved identification of asymptomatic patients with subclinical LV-dysfunction. This technique may be useful for the early identification of such presumably healthy subjects at risk for heart failure and for monitoring LV and RV deformation during pharmacologic interventions in future studies.

Assessment of long-term cardiac adaptation in adult patients with type II atrial septal defect : A cardiovascular magnetic resonance (CMR) study.

In type II atrial septal defect (ASD) patients, the left-to-right (LR) shunt causes adaptation of the heart and circulation. The study objective was to evaluate with cardiovascular magnetic resonance imaging (CMR) the impact of LR shunt on left (LV) and right ventricular (RV) volumes, function, and myocardial strain. Thirty-five patients (42 ± 17years, 17 male) were compared to a control group (n = 40). Cine imaging was used to calculate ventricular volumes and ejection fraction (EF), global longitudinal (GLS) and circumferential strain (GCS), and longitudinal free wall (FWS) and interventricular septal (IVS) strain. Phase-contrast imaging was used to calculate pulmonary flow to systemic flow ratio (Qp/Qs). The LR shunt (Qp/Qs 2.2 ± 0.6) resulted in larger RV end-diastolic volume (EDVi) (152 ± 42 vs 82 ± 11ml/m2), lower LV EDVi (72 ± 16 vs 83 ± 9ml/m2), and higher RV/LV EDVi ratio (2.2 ± 0.5 vs 1.0 ± 0.1) than controls (all p < 0.001). Functionally, stroke volumes were larger in RV and lower in LV (both p < 0.001) with a strong trend toward lower RV EF in patients (p = 0.08). The LR shunt negatively impacted RV GLS (p = 0.03) but not RV GCS. Longitudinal IVS but not RV FWS were significantly lower in patients, i.e., p < 0.001, of longitudinal IVS. Shunt severity correlated with RV size and stroke volume, right atrial size, and pulmonary trunk diameter (all p < 0.001), but not with functional nor strain parameters. Long-term cardiac adaptation in ASD patients, with RV overfilling and LV underfilling, has a negative impact on systolic RV performance, a phenomenon which likely can be attributed to longitudinal dysfunction of the interventricular septum. • An LR shunt in type II ASD patients causes cardiac remodeling characterized by RV overfilling and conversely underfilling of the left ventricle. • At the long term, there is evidence of systolic dysfunction of the right ventricle in this group of patients. • Septal dysfunction underlies the observed impairment in RV function.

Neo-aortic Root Dilatation, Aortic Stiffness, and Ventricular interactions in Long-Term Follow-Up After the Ross Procedure in Childhood.

Patients after the Ross procedure are at risk for right (RV) and left ventricular (LV) dysfunction due to neo-aortic and pulmonary dysfunction. While neo-aortic root dilatation has been related to LV dysfunction, the potential contributions of aortic stiffness and ventricular interactions have not been evaluated. Patients status post Ross procedure up to age 18years with cardiac magnetic resonance (CMR) exam from 2007 to 2018 were retrospectively reviewed. Aortic pulse wave velocity (PWV) was calculated from phase contrast and angiogram images. RV and LV peak global longitudinal (GLS) and circumferential strain (GCS) were measured using tissue tracking software. Multivariable regression was performed for variables associated with parameters of LV function. In 58 patients (median age 20.5years at CMR exam), male gender, longer time since Ross procedure, aortic root dilatation, and lower RV ejection fraction (EF) were associated with decreased LV EF. There was no association with LV late gadolinium enhancement or neo-aortic or conduit regurgitation. LV GCS and GLS also correlated with RV GCS, RV GLS and PWV. In multivariable analysis, the relation of RV and LV systolic function, but not aortic measurements, remained significant. In conclusion, in long-term follow-up after pediatric Ross procedure, RV function rather than aortic root size or aortic stiffness most closely relates to LV function. Ventricular interactions may impact decision-making on timing of conduit intervention, which could differ from established criteria in populations with only aortic or pulmonary valve disease. Further study is warranted to evaluate possible association with clinical outcome.

The effect of successful parathyroid surgery on left ventricle function in patients with primary hyperparathyroidism evaluated with strain echocardiography.

Hyperparathyroidism (PHP) is the most common cause of hypercalcemia in outpatients. It is characterized by many cardiac complications including chronic cardiac arrhythmia, hypertrophy, and diastolic insufficiency. However, there are insufficient data about the cardiac systolic function in PHP. Data regarding the positive effects of surgical treatment on cardiac complications are limited and inadequate. The aim of this study was to evaluate the postoperative changes in the left ventricle functions of patients with PHP using strain echocardiography (STE) instead of traditional echocardiographic evaluation. This prospective study included 29 patients with PHP. Detailed echocardiographic evaluations were made including conventional and STE' ventricle function preoperatively and at 6months after surgery. Then, preoperative and postoperative STE changes, global longitudinal (GLS) and circumferential strain (GCS), were compared. Patients with recurrent surgery, poor echogenicity, and comorbid conditions affecting STE were excluded. No significant change was determined in ejection fraction in the period from preoperative to 6months postoperative (P>.05). The GLS value increased from 18.53±3.06 to 20.25±3.89, to a statistically significant level (P=.004). The other echocardiographic parameters remained unchanged for the same patients. Despite normal 2D echocardiography data, it was determined that the GLS values deteriorated preoperatively and improved by the 6th postoperative month. The detection of early disorders in PHP that cannot be detected on 2D echocardiography, even in asymptomatic patients, may suggest a new treatment indication. For asymptomatic PHP patients, strain echocardiography may be more valuable than 2D echocardiographic evaluation to determine myocardial dysfunction. The recent literature is insufficient, and there is a need for further, more extensive studies with longer follow-up periods.

Effect of intracoronary bone marrow-derived mononuclear cell injection early and late after myocardial infarction on CMR-derived myocardial strain

BackgroundStudies indicate no clear impact of intracoronary injection of bone-marrow unselected mononuclear cells (BM-MNC) after acute myocardial infarction (AMI) on left-ventricular function (LVEF). Strain parameters by cardiovascular magnetic resonance (CMR) have been proposed to be more sensitive to functional changes of the heart. The aim of the present study was to assess changes of global longitudinal (GLS) and circumferential strain (GCS) in a group of patients treated with BM-MNC after AMI. MethodsOne-hundred and forty-nine patients with successfully reperfused AMI and LV dysfunction (LVEF<45%) were retrospectively included into this sub-study of the SWISS-AMI multicentre trial. Patients were divided into control (N = 54), early (5–7 days after AMI, N = 51) and late BM-MNC treatment groups (3–4 weeks, N = 44). The endpoint was the change of GLS and GCS as obtained from cine sequences 4 and 12 months after AMI using feature tracking algorithm. ResultsIn unadjusted analyses, the absolute change of GLS for the early treatment group from baseline to 4 months was 2.5 ± 4.3 (p < 0.01), to 12 months 2.7 ± 5.7% (p = 0.004). For late treatment, it was 1.5 ± 4.0% (p = 0.039, 4 months) and 2.5 ± 5.6% (p = 0.015, 12 months). For controls 0.7 ± 4.7% (p = 0.378), 0.8 ± 3.9% (p = 0.253) respectively. Adjusting for different baseline values, neither an overall treatment effect (both time-points) of BM-MNC nor a treatment time-related (only early or late) effect could be shown for all functional parameters. ConclusionsAmong patients after AMI with successful reperfusion and LV dysfunction, intracoronary infusion of BM-MNC early or late after AMI did not improve global strain parameters at 4- or 12-months follow-up.Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00355186.

P315 Prevalence of left ventricular systolic and diastolic dysfunction in patients with chronic kidney disease and preserved left ventricular ejection fraction

Abstract BACKGROUND Presence of heart failure (HF) is associated with poor outcome in patients with chronic kidney disease (CKD), although Left ventricular (LV) systolic function is often preserved in them. However, CKD patients may have HF symptoms with preserved LVEF. Myocardial Deformation Imaging is more accurate for detecting LV systolic dysfunction. The aim of this study was to evaluate global longitudinal (GLS) and circumferential strain (GCS) in patients with renal function impairment. METHODS Overall, 67 patients (40% men, mean age 45 ± 12 years) with CKD stage 3-4 were studied. All patients had an LV ejection fraction ≥50%. We performed echocardiography including speckle-tracking (STE) measurement of LV GLS and LV GCS and as well as assessment of diastolic function. RESULTS Despite preserved LVEF, impaired LV GLS (&amp;lt;18%) was observed in all patients. The mean value of GLS was 14,1 ± 1,5. This finding indicates that systolic dysfunction in CKD started from compromise LV longitudinal function. However, the GCS parameter was in the normal range – 22,7 ± 1,8. Thereby preserved LVEF was compensated by normal or slightly increase circumferential strain. Impaired diastolic function was observed in 18% of patients including 8% patients with increased left ventricle filling pressure (stage II-III). CONCLUSION The prevalence of impaired LV GLS despite preserved LVEF in patients with CKD stage 3-4 is high, which proved that renal disease is associated with early and subclinical impairment of LV systolic function. Impaired diastolic function was not so common among them. Assessment of it is not always so easy and reliable using current recommendation. Thus, STE can be recommended for early detection impairment of LV function.

P5265Magnetic resonance multilayer assessment of strain in patients with heart failure

Abstract Introduction Muscular architecture of the heart is three dimensionally complex and contractility parameters vary widely. Cardiac magnetic resonance (CMR) feature tracking is a largely available and facile method to assess myocardial strain at different layers of the myocardium. Purpose Assessing and compare the myocardial longitudinal (GLS) and circumferential strain (GCS) at three distinct layers of the myocardium in patients with heart failure (HF). Methods 59 patients with a clinical diagnosis of HF who were post-hoc subdivided according to the measured EF and echo assessment of diastolic impairment into 3 groups, following ESC guidelines, were included: (1) patients with HF with preserved ejection fraction (HFpEF) where EF &gt;50% and diastolic dysfunction (E/e' ratio) is present and plasma levels of natriuretic peptides are elevated, (2) patients with HF with mid-range ejection fraction (HFmrEF), where EF = 40–49% and similar additional criterias are present, (3) patients with HF with reduced ejection fraction (HFrEF) where EF &lt;40%. Exclusion criteria: valvulopathy, arrhythmias, insufficient acquisition and artefacts. Results Strain values are the highest in the Endo− and progressively lower in the Myo− and Epi− layers with a gradient present in all groups but decreasing in HFmEF and further in HFrEF. GLS decrease with the severity of the disease in all 3 layers Normal &gt; HFpEF &gt; HFmrEF &gt; HFrEF (Endo−: −23.0±3.5 vs −20.0±3.3 vs −16.4±2.2 vs −11.0±3.2, p&lt;0.001, Myo−: −20.7±2.4 vs −17.5.0±2.6 vs −14.5±2.1 vs −9.6±2.7, p&lt;0.001, Epi−: −15.7±1.9 vs −12.2±2.1 vs −10.6±2.3 vs −7.7±2.3, p&lt;0.001) (Figure A), GCS is not different between the Normal and HFpEF (Endo−: −34.5±6.2 vs −33.9±5.7, p=0.51; Myo−: −21.9±3.8 vs −21.3±2.2, p=0.39; Epi−: −11.4±2.0 vs −10.9±2.3, p=0.54) but markedly lower in systolic HF groups Normal &gt; HFmrEF &gt; HFrEF (Endo−: −34.5±6.2 vs −20.0±4.2 vs −12.3±4.2, p&lt;0.001; Myo−: −21.9±3.8 vs −13.0±3.4 vs −8.0±2.7, p&lt;0.001; Epi−: −11.4±2.0 vs −7.9±2.3 vs −4.5±1.9) (Figure B). ROC analysis renders Endo− GCS (AUC=0.89) and respectively Endo− GLS (AUC=0.74) as optimal to detect contractile impairment in HF with Youden's thresholds of −20.2 for Endo− GLS and, respectively, −28.1 for Endo− GCS. Endo− GCS is not different between control and HFpEF and GLS impairment is present only inconstantly in HFpEF. Conclusions Feature tracking CMR successfully assess layer-specific myocardial strain and emerges as a powerful tool in functional stratification of patients with HF. Strain amplitude varies consistently throughout the myocardium and its quantification warrants careful standardization. Sub-endocardial strain values of strain are comparatively the highest and show most predictive power to detect contractile impairment. Underlying systolic impairment is present only in a subgroup of patients with HFpEF and only GLS and not the GCS is for this purpose a useful diagnostic tool.

P3445Subclinical myocardial dysfunction in pediatric kidney transplant recipients: a two-dimensional speckle-tracking echocardiography study

Abstract Chronic kidney disease is associated with increased risk of cardiovascular mortality and morbidity in pediatric patients as well. Renal transplantation results in improved survival, however, several factors contribute to markedly elevated cardiovascular complication rate compared to the healthy population. While major cardiac events occur rarely in pediatric population, detection of subclinical changes in cardiac morphology and function may be of high interest to effectively identify high-risk patients. Accordingly, our aim was to investigate left (LV)- and right ventricular (RV) morphology and function using conventional and two-dimensional (2D) speckle-tracking echocardiography (STE) in pediatric renal transplant recipients. Our study group consisted of 41 kidney transplanted children (RTX; mean age: 14±3 years, m/f: 25/16) and 39 age- and gender matched healthy controls. Using 2D echocardiography, LV and RV focused apical loops were obtained and LV end-diastolic volume index (EDVi), ejection fraction (EF), mass index (Mi), RV end-diastolic area index (EDAi) and fractional area change (FAC) were measured. Using STE, we have determined LV global longitudinal (GLS) and circumferential strain (GCS), RV GLS, and LV and RV early diastolic longitudinal strain rate (LSrE). LV EDVi did not differ between RTX and controls (51±13 vs. 52±10 mL/m2, p=NS), while LVMi was markedly higher in RTX patients (36±8 vs. 28±6 g/m2, p&lt;0.0001). LVEF was comparable between the two groups (62±5 vs. 62±3%; p=NS), while LV GLS was significantly lower in RTX (−20.6±2.1 vs. −21.8±2.1%, p=0.01) along with a tendential increase in LV GCS (−31.6±4.3 vs. −29.7±4.6%, p=0.06). LV LSrE was significantly lower in RTX patients (1.29±0.29 vs. 1.45±0.27 1/s, p&lt;0.05). RV EDAi did not differ between the two groups (11.2±2.3 vs. 11.6±2.0 cm2/m2, p=NS). Interestingly however, RTX patients had significantly higher RV FAC and RV GLS (FAC: 46±7 vs. 42±4%, GLS: −24.6±3.7 vs. −22.4±2.6%, both p&lt;0.01) along with lower RV LSrE (1.32±0.57 vs. 1.60±0.43, p&lt;0.05). Cardiac morphology and function shows distinct changes after RTX. Along with comparable ventricular dimensions, LV hypertrophy and subclinical systolic and diastolic dysfunction is present. RV systolic function is relatively increased accompanied by subclinical diastolic dysfunction of the chamber, which may refer to previous RV overload. STE may be a useful tool to reveal early myocardial dysfunction in pediatric kidney transplant recipients.

Left ventricular myocardial dysfunction in young and middle-aged ischemic stroke patients: the Norwegian stroke in the young study.

Hypertension is highly prevalent in ischemic stroke patients, but less is known about its impact on subclinical left ventricular (LV) dysfunction in such patients. Conventional and speckle tracking echocardiography was performed in 276 young (15-44 years) and middle-aged (45-60 years) ischemic stroke patients (mean age 50 ± 9 years, 66% men). Hypertension was defined as a history of hypertension, use of antihypertensive medications, persistently elevated blood pressure (BP) during hospitalization or elevated clinic BP (≥140/90 mmHg) and ambulatory BP (≥130/80 mmHg) at follow-up visits. LV myocardial dysfunction was assessed by peak systolic global longitudinal (GLS) and circumferential strain (GCS). Hypertension was present in 68% of patients and associated with higher age, BMI and LV mass, male sex and the presence of diabetes (all P < 0.01). Compared with normotensive patients, hypertensive patients had significantly lower peak systolic GLS (-16 ± 3 vs. -19 ± 2%, P < 0.001) and GCS (-16 ± 3 vs. -18 ± 4%, P < 0.001) while ejection fraction did not differ between groups (P = 0.134). In univariable regression analyses, reduced peak systolic GLS and GCS were both associated with hypertension (β = 0.43 and 0.29, respectively, both P < 0.001). The association with hypertension remained significant for GLS (β = 0.25) after adjustment for LV mass, ejection fraction, male sex, obesity and diabetes (multiple R = 0.35, P < 0.001), whereas the association of hypertension with reduced peak systolic GCS was attenuated. In ischemic stroke survivors, hypertension was associated with reduced peak systolic GLS but not GCS independent of confounders.

Reproducibility study on myocardial strain assessment using fast-SENC cardiac magnetic resonance imaging

Myocardial strain is a well validated parameter for estimating left ventricular (LV) performance. The aim of our study was to evaluate the inter-study as well as intra- and interobserver reproducibility of fast-SENC derived myocardial strain. Eighteen subjects (11 healthy individuals and 7 patients with heart failure) underwent a cardiac MRI examination including fast-SENC acquisition for evaluating left ventricular global longitudinal (GLS) and circumferential strain (GCS) as well as left ventricular ejection fraction (LVEF). The examination was repeated after 63 [range 49‒87] days and analyzed by two experienced observers. Ten datasets were repeatedly assessed after 1 month by the same observer to test intraobserver variability. The reproducibility was measured using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Patients with heart failure demonstrated reduced GLS and GCS compared to healthy controls (−15.7 ± 3.7 vs. −20.1 ± 1.4; p = 0.002 for GLS and −15.3 ± 3.7 vs. −21.4 ± 1.1; p = 0.001 for GCS). The test-retest analysis showed excellent ICC for LVEF (0.92), GLS (0.94) and GCS (0.95). GLS exhibited excellent ICC (0.99) in both intra- and interobserver variability analysis with very narrow limits of agreement (−0.6 to 0.5 for intraobserver and −1.3 to 0.96 for interobserver agreement). Similarly, GCS showed excellent ICC (0.99) in both variability analyses with narrow limits of agreement (−1.1 to 1.2 for intraobserver and −1.7 to 1.3 for interobserver agreement), whereas LVEF showed larger limits of agreement (−14.4 to 10.1). The analysis of fast-SENC derived myocardial strain using cardiac MRI provides a highly reproducible method for assessing LV functional performance.

Inter- and intraobserver consistency in LV myocardial strain measurement using a novel multi-layer technique in patients with severe aortic stenosis and preserved LV ejection fraction

BackgroundA new transthoracic echocardiography (TTE) technique allows multi-layer measurement of left ventricular (LV), endocardial, epicardial, and whole layer myocardial strain. We evaluated interobserver and intraobserver TTE reproducibility for 2D LV global longitudinal (GLS) and circumferential strain (GCS) estimates using data from severe aortic stenosis (AS) subjects with preserved LV ejection fraction (EF). MethodsTwenty severe AS subjects (11 male; mean age, 75±7years; LV EF >50%) underwent TTE (Vivid E9, GE Healthcare). Quantitative strain measurements of whole, endocardial, and epicardial layers were performed. GLS was defined as all 17 averaged LV segments, according to the American Heart Association classification. GCS was measured at the levels of the mitral valve, papillary muscle, and apex. ResultsInterobserver correlation coefficients in whole, endocardial, and epicardial layers for GLS estimates were 0.81, 0.83, and 0.80, respectively, whereas those for GCS estimates were 0.38, 0.56, and 0.19, respectively, for the mitral valve, 0.44, 0.54, and 0.36, respectively, for the papillary muscle, and 0.55, 0.29, and 0.59, respectively, for the apex. Intraobserver correlation coefficients in whole, endocardial, and epicardial layers for GLS estimates were 0.97, 0.97, and 0.94, respectively, whereas those for GCS estimates were 0.86, 0.81, and 0.50 , respectively, for the mitral valve, 0.56, 0.72, and 0.28, respectively, for the papillary muscle, and 0.70, 0.69, and 0.62, respectively, for the apex. ConclusionIn severe AS subjects with preserved LVEF, inter- and intra-observer TTE reproducibility in whole, endocardial, and epicardial layers were more consistent for 2D LV GLS than for 2D LVGCS.

Left ventricular markers of mortality and ventricular arrhythmias in heart failure patients with cardiac resynchronization therapy.

AimsCardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure. However, prediction of the outcome remains difficult. We aimed to investigate for echocardiographic predictors of ventricular arrhythmias and fatal outcome and to explore how myocardial function is changed by biventricular pacing in heart failure.Methods and resultsWe prospectively included 170 heart failure patients (66 ± 10 years, New York Heart Association class 2.8 ± 0.5, 48% ischaemic cardiomyopathy) and recorded ventricular arrhythmias and fatal end point defined as death, heart transplantation, or left ventricular assist device implantation during 2 years. Two-dimensional echocardiography was performed before and 6 months after CRT implantation. CRT response was defined as ≥15% reduction in end-systolic volume at 6 months. Speckle-tracking technique was performed to assess longitudinal and circumferential left ventricular function, defined as global longitudinal (GLS) and circumferential strain (GCS), and to assess mechanical dyssynchrony, defined as mechanical dispersion. GLS before CRT was a predictor of fatal end point independently of CRT response [hazard ratio, HR 1.14 (1.02–1.27), P = 0.02]. Patients with GLS better than −8.3% showed event-free survival benefit (log rank, P < 0.001). Mechanical dispersion at 6 months was an independent predictor of ventricular arrhythmias [HR 1.20 (1.06–1.35), P = 0.005]. CRT responders (59%) had improvement of both GLS and GCS.ConclusionIn heart failure patients with CRT, worse longitudinal function before CRT was an important predictor of fatal outcome during 2 years, independently of CRT response. Mechanical dispersion at 6 months was a strong predictor of ventricular arrhythmias. CRT response by reverse remodelling was dependent on improvement of both longitudinal and circumferential function.