Global Longitudinal Strain Research Articles

Cardiovascular Performance in Neonates with Hypoxic-Ischemic Encephalopathy Under Therapeutic Hypothermia: Evaluation by Conventional and Advanced Echocardiographic Techniques.

This study aimed to evaluate the hemodynamic and ventricular performance of neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia using conventional and advanced echocardiographic techniques. This observational, prospective study included 22 neonates with HIE matched with 22 healthy neonates. Echocardiographic studies were performed 24h after achieving target temperature during hypothermia and 24h after rewarming. Evaluated echocardiographic parameters included ejection fraction (EF), shortening fraction (SF), right ventricular fractional area change, biventricular Tei index, right ventricular s' wave velocity, tricuspid annular plane systolic excursion, biventricular stroke volume and cardiac output, left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS), LV circumferential and radial strain, LV twist, and LV torsion. LV EF and SF did not change significantly between the hypothermia and rewarming periods (EF:73 ± 7% vs. 74 ± 5%, p = 0.21; SF:39 ± 6% vs. 41 ± 5%, p = 0.26); however, both were higher after rewarming compared to the control group (EF:70 ± 5%, p = 0.003; SF:36 ± 4%, p = 0.002). There were no significant differences in LV GLS, circumferential and radial strain, twist, and torsion between the HIE and control groups. Pulmonary artery systolic pressure (PASP) and RVGLS were worse in the study group compared to the control group (PASP: hypothermia 45 ± 24mmHg, p = 0.01; rewarming 53 ± 34mmHg, p = 0.01; control group 29 ± 11mmHg; RV GLS: hypothermia 18 ± 5%, p = 0.02; rewarming: 18 ± 4%, p = 0.01; control group 21 ± 2%). Therapeutic hypothermia appears to have no detrimental impact on LV systolic function. RV GLS was the only parameter that demonstrated impaired RV systolic function during therapeutic hypothermia, likely due to elevated PASP.

Imaging predictors of adverse prognosis in Fabry disease cardiomyopathy: A systematic review and meta-analysis.

Cardiac involvement represents the main cause of death in patients with Fabry disease (FD). Echocardiography and cardiovascular magnetic resonance (CMR) have an established diagnostic role, but their prognostic value remains unresolved. This systematic review and meta-analysis sought to assess the prognostic implications of imaging parameters in FD. PubMed, ClinicalTrials.gov, Embase, Cochrane Library and Web of Science databases were searched for studies from inception through 1 May 2024. Studies including FD patients undergoing baseline imaging assessment and clinical follow-up were selected. Pre-defined study outcomes were a cardiovascular endpoint and a composite clinical endpoint. The study protocol was registered in PROSPERO (ID CRD42022342394). Fourteen studies, including 1713 FD patients (44.7% males), were selected. At pooled analysis, late gadolinium enhancement (hazard ratio [HR]: 4.45; 95% CI: 2.82-7.02), left atrium volume indexed (HR: 1.02 per mL/m2; 95% CI: 1.01-1.03), E/e' (HR: 1.14 per unit increase; 95% CI: 1.08-1.21), left ventricular (LV) mass indexed (HR: 1.01 per mg/m2; 95% CI: 1.00-1.02), maximum LV wall thickness (HR: 1.19 per mm, 95% CI: 1.04-1.36) and LV-global longitudinal strain (HR: 1.20 per unit increase; 95% CI: 1.16-1.25) were significantly associated with the cardiovascular endpoint, whereas T1-mapping and LV-ejection fraction were not. T1-mapping was associated with the composite endpoint (HR: 0.99 per msec increase; 95% CI: 0.98-1.00). Meta-regression analysis did not show any significant interaction between each of the potential effect modifiers. Several imaging parameters were significant predictors of adverse clinical outcomes in patients with FD. Late gadolinium enhancement showed the strongest association with adverse prognosis.

Evaluating pulmonary stenosis and regurgitation impact on cardiac strain and strain rate in a porcine model via magnetic resonance feature tracking.

Pulmonary stenosis (PS) is common in congenital heart disease and an integral finding in Tetralogy of Fallot (TOF). Pulmonary regurgitation (PR) is more commonly found following surgery in repaired TOF. We aimed to evaluate the haemodynamic effects of PS and PR on cardiac physiology in a porcine model using cardiac magnetic resonance-based feature tracking (CMR-FT) deformation imaging. CMR-FT was performed in 14 pigs before and 10-12 weeks after surgery. Surgery included either pulmonary artery banding to simulate PS (n = 7), or an incision to the pulmonary valve to simulate PR (n = 7). CMR-FT assessment included left and right ventricular global longitudinal (LV/RV GLS) and LV circumferential (GCS) strain and strain rates (SR) as well as left and right atrial reservoir/conduit/booster pump (LA/RA Es, Ee, Ea) strain and SR. RV GLS was significantly reduced following PS compared to PR induction (PS -7.51 vs. PR -23.84, p < 0.001). RV GLS improved after induction of PR (before - 20.50 vs. after - 23.84, p = 0.018) as opposed to PS (before - 11.73 vs. after - 7.51, p = 0.128). Similarly, RA Es (PS 14.22 vs. PR 27.34, p = 0.017) and Ee (PS 8.65 vs. PR 20.51, p = 0.004) were decreased in PS compared to PR with detrimental impact of PS (Es before 23.20 vs. after 14.22, p = 0.018, Ee before 15.04 vs. after 8.65, p = 0.028) but not PR (Es before 31.65 vs. after 27.34, p = 0.176, Ee before 20.63 vs. after 20.51, p = 0.499). In a porcine model of RV pressure vs. volume overload, increased after- but not preload shows detrimental impact on RV and RA physiology.

The importance of the Autostrain RV technique in the treatment of right ventricular myocardial alterations in patients with breast cancer receiving chemotherapy

To research the value of Autostrain right ventricular (RV) technology in detecting and preventing right ventricular myocardial injury in patients undergoing breast cancer chemotherapy by providing an imaging basis for early identification. To examine the changes in various cardiac function parameters before and after chemotherapy, two-dimensional echocardiography was employed 48 h before chemotherapy, 48 h after the fourth cycle of chemotherapy, and 48 h after the eighth cycle of chemotherapy, respectively. The patients included those with breast cancer who underwent surgery and were primarily administered anthracycline-based chemotherapeutic drugs. (1) Compared with the pre-chemotherapy period, the absolute values of the right ventricular global longitudinal strain (RV4CSL) and right ventricular free-wall longitudinal strain (RVFWSL) decreased after the fourth chemotherapy cycle, and no significant differences were observed in tricuspidannular plane systolic excursion (TAPSE), right ventricular Tei index, and right ventricular fractional area change (FAC); (2) Compared with the pre-chemotherapy period, the absolute values of RV4CSL and RVFWSL decreased after the eighth chemotherapy cycle. TAPSE and FAC decreased, the right ventricular Tei index increased; (3) Compared with the end of the fourth chemotherapy cycle, the absolute values of RV4CSL and RVFWSL decreased at the end of the eighth chemotherapy cycle. TAPSE, right ventricular Tei index and FAC were not significantly different. (4) Pearson correlation analysis revealed a correlation between the absolute value of RV4CSL, the absolute value of RVFWSL, right ventricular Tei index, TAPSE and FAC. The absolute values of RV4CSL and RVFWSL are sensitive indices that reflect changes in the right ventricular myocardium in the early stages of chemotherapy. They can reflect the effects of anthracycline on the right ventricular myocardium of patients with breast cancer earlier than the TAPSE, FAC and right ventricular Tei indices. A relationship exists between the absolute value of RVFWSL, the absolute value of RV4CSL, right ventricular Tei index, TAPSE, FAC and anthracycline-induced alterations in the right ventricular myocardium. This study is helpful for early detection of right ventricular myocardial function injury caused by anthracyclines in breast cancer patients, and provides imaging basis for early clinical detection and prevention of right ventricular myocardial injury.

Impact of Sex on Cardiac Functional Adaptation to Different Modes of Exercise Training: A Randomized Cross-Over Study.

We hypothesized that male and female volunteers would exhibit distinct changes in cardiac morphology, systolic, and diastolic function following endurance (END) and resistance (RES) training. Thirty-eight females and 26 males participated in a randomized cross-over design trial in which all participants completed 12-weeks END and RES, separated by a 12-week washout. Echocardiograms assessed morphology (left ventricular mass, LVM), systolic function (ejection fraction, EF, and global longitudinal strain, GLS), diastolic function (mitral valve velocities, E, A; tissue Doppler velocities, e', a'), and left atrial volume. Males responded to RES by increasing LVM (Δ 9.1 ± 14.3 g, P = 0.005), while E/e' increased (Δ 0.74 ± 1.08, P = 0.004, indicating a decline in diastolic function). There were no significant changes in females following RES. In response to END, LVM increased in both males (Δ 8.8 ± 15.7 g, P = 0.008) and females (Δ 6.5 ± 12.5 g, P = 0.004), with no difference in E/e' (Δ -0.29 ± 0.90) in males but a significant difference in females (Δ -0.39 ± 1.06, P = 0.012, indicating an improvement in diastolic function). Systolic function was not impacted significantly by END or RES in either sex. Our data suggests that females were less responsive to RES training than males, that RES increased LVM and caused a decline in diastolic function (i.e. an increase in E/e') in males, whereas END improved E/e' (i.e. decreased) in females. These data suggest that sex differences exist in cardiac structural and functional adaptations to different forms of exercise training.

Arbovirus exposure and subclinical myocardial dysfunction in an Indigenous population in Northeast Brazil: a cross-sectional study

BackgroundHuman activities, such as urbanization and climate change, have facilitated the spread of arbovirus-carrying vectors, disproportionately affecting vulnerable traditional Indigenous communities.ObjectiveTo explore the relationships between subclinical myocardial dysfunction, assessed by global longitudinal strain (GLS), and comprehensive arbovirus serology in an Indigenous population, while also describing the serological and epidemiological profile of dengue, chikungunya, and Zika viruses.MethodsThis ancillary study is part of the first phase (2016–2017) of the Project of Atherosclerosis among Indigenous Populations (PAI), a cross-sectional study involving participants from two Indigenous communities with different degrees of urbanization and a highly urbanized city in Northeast Brazil. We assessed the seroprevalence of dengue, chikungunya, and Zika viruses in the Fulni-ô Indigenous community, the less urbanized and most traditional group. Additionally, we explored the relationship between these viruses and subclinical heart disease, assessed by speckle-tracking echocardiography-derived GLS.ResultsOne hundred seventy-four participants were included, with a median age of 45.0 years (interquartile range 38.0–55.0). The majority were female (58.6%; n = 102). The prevalence of anti-ZIKV IgG was 95.3%; anti-DENV IgG was 85.8%, and anti-CHIKV IgG was 70.9%. GLS abnormalities were detected in nearly half (48.3%) of the cohort. However, no significant association was found between arbovirus serology and GLS.ConclusionsThe findings reveal a high prevalence of positive serology for arboviruses and a significant rate of subclinical cardiac dysfunction. There was no significant association between reduced left ventricular longitudinal strain and positive arbovirus serology, likely due to the limited number of participants with indications of acute contact with the viruses studied. However, the unprecedented and relevant results of this study are noteworthy, as they address critical public health issues, particularly in vulnerable populations. Further research is needed to explore these findings in more depth.

Analysis of Factors Related to Early Left Ventricular Dysfunction in Hypertensive Patients with Preserved Ejection Fraction Using Speckle Tracking Echocardiography: A Cross-Sectional Study in Vietnam.

Objective: The purpose of this research was to assess the factors linked to early left ventricular (LV) dysfunction in hypertensive patients who have preserved ejection fraction (EF ≥ 50%) using speckle tracking echocardiography. Methods: A cross-sectional study was carried out involving 579 outpatients recruited from City International Hospital in Ho Chi Minh City using a total sampling approach, where echocardiographic measurements and clinical data were gathered and analyzed. Results: The prevalence of LV diastolic dysfunction among hypertensive individuals was found to be 45.25%, with 9.15% showing abnormal global longitudinal strain (GLS). Factors such as being over the age of 60, having diabetes, concentric LV hypertrophy, concentric LV remodeling, and LV diastolic dysfunction were identified as correlating with abnormal GLS (p < 0.05). In contrast, other cardiovascular risk factors, including smoking and dyslipidemia, did not significantly influence the GLS index (p > 0.05). Conclusions: Key factors including diabetes, diastolic dysfunction, concentric hypertrophy, and concentric remodeling of the LV are significant predictors of abnormal GLS. These results are important for the management of hypertensive patients aimed at enhancing cardiac function.

Relationship Between Myocardial Strain and Extracellular Volume: Exploratory Study in Patients with Severe Aortic Stenosis Undergoing Photon-Counting Detector CT.

Background/Objectives: Diffuse myocardial fibrosis and altered deformation are relevant prognostic factors in aortic stenosis (AS) patients. The aim of this exploratory study was to investigate the relationship between myocardial strain, and myocardial extracellular volume (ECV) in patients with severe AS with a photon-counting detector (PCD)-CT. Methods: We retrospectively included 77 patients with severe AS undergoing PCD-CT imaging for transcatheter aortic valve replacement (TAVR) planning between January 2022 and May 2024 with a protocol including a non-contrast cardiac scan, an ECG-gated helical coronary CT angiography (CCTA), and a cardiac late enhancement scan. Myocardial strain was assessed with feature tracking from CCTA and ECV was calculated from spectral cardiac late enhancement scans. Results: Patients with cardiac amyloidosis (n = 4) exhibited significantly higher median mid-myocardial ECV (48.2% versus 25.5%, p = 0.048) but no significant differences in strain values (p > 0.05). Patients with prior myocardial infarction (n = 6) had reduced median global longitudinal strain values (-9.1% versus -21.7%, p < 0.001) but no significant differences in global mid-myocardial ECV (p > 0.05). Significant correlations were identified between the global longitudinal, circumferential, and radial strains and the CT-derived left ventricular ejection fraction (EF) (all, p < 0.001). Patients with low-flow, low-gradient AS and reduced EF exhibited lower median global longitudinal strain values compared with those with high-gradient AS (-15.2% versus -25.8%, p < 0.001). In these patients, the baso-apical mid-myocardial ECV gradient correlated with GLS values (R = 0.28, p = 0.02). Conclusions: In patients undergoing PCD-CT for TAVR planning, ECV and GLS may enable us to detect patients with cardiac amyloidosis and reduced myocardial contractility.

Impact of papillary muscle infarction on atrial and ventricular myocardial deformation in non-anterior STEMI patients.

The purpose of this study was to explore the impact of papillary muscle (PPM) infarction on left atrial and ventricular strain parameters in patients with non-anterior ST-segment elevation myocardial infarction (NA-STEMI) using cardiovascular magnetic resonance (CMR). This retrospective study performed CMR scans on 88 consecutive patients with NA-STEMI (68 males, 65 ± 10.05 years). Among them, 30 demonstrated PPM infarction (25 males, 67.12 ± 9.49 years), defined as late gadolinium enhancement (LGE) in a papillary muscle head in two contiguous LGE CMR slices, and confirmed on the long-axis LGE CMR slices. Atrial and ventricular strain were analyzed by CMR feature tracking with dedicated post-processing software. Patients with PPM infarction were older (p = 0.001), with lower left ventricular ejection fraction (p = 0.040), higher indexed left ventricular end-diastolic volume (p = 0.020), and end-systolic volume (p = 0.044) compared to patients without LGE in the papillary muscle. Additionally, patients with PPM infarction showed impaired reservoir strain, booster strain, global longitudinal strain (GLS), and higher LGE extent compared to NA-STEMI patients without PPM involvement (p = 0.001, p = 0.004, p = 0.001, and p = 0.003, respectively). In multivariable analysis, GLS, global radial strain, reservoir strain, and booster strain parameters were the only independent determinants of PPM infarction (p = 0.001, p = 0.041, p = 0.002, and p = 0.027, respectively). The presence of PPM infarction assessed by CMR is independently linked to atrial and ventricular strain impairment in patients with NA-STEMI.

The additional impact of metabolic syndrome on left ventricular deformation and myocardial energetic efficiency impairment in ischemia with nonobstructive coronary arteries patients

BackgroundIschemia with nonobstructive coronary arteries (INOCA) has high morbidity, mortality, and poor quality of life. Metabolic syndrome (MetS) is a complex of multiple cardiac metabolic risk factors, significantly increasing the risk of major adverse cardiovascular events in INOCA patients. The study aimed to investigate the aggravating effect of MetS on left ventricular (LV) deformation and function impairment in INOCA patients.Materials and methods This study collected 104 INOCA patients (INOCA [MetS−]: n = 56; INOCA [MetS+]: n = 48) and 41 sex- and age-matched controls. LV function, indexed myocardial energetic efficiency (MEEI), and LV global peak strains (including radial, circumferential, and longitudinal directions) were measured among the three groups. The independent factors of reduced MEEI and impaired LV function and strain parameters for all INOCA patients were assessed using multivariable linear regression analyses.ResultsIn contrast to the INOCA (MetS-) group, the indexed LV stroke volume (LVSVI) (49.57 ± 11.58 mL/m2 vs. 42.58 ± 12.23 mL/m2, p = 0.007), MEEI [0.85(0.70–1.03) ml/s/g vs. 0.75(0.54–0.91) ml/s/g, p = 0.045] and LV global longitudinal peak strain (GLPS) (− 13.26 ± 2.86% vs. -10.95 ± 3.93%, p = 0.001) reduced in the INOCA (MetS+) group. Compared with the controls, LV GLPS decreased in the INOCA (MetS-) group (− 15.14 ± 2.83% vs. −13.26 ± 2.86%, p = 0.017). MetS was negatively associated with LVSVI, MEEI, and LV GLPS (all p < 0.05). After multivariable adjustment, MetS was found to be an independent factor of decreased LVSVI (β = −0.231, p = 0.012), MEEI (β = −0.262, p = 0.009), and LV GLPS (β = −0.266, p = 0.002) in INOCA patients. Using calcium channel blockers medication (β = 0.320, p = 0.001) and hypertension (β = −0.298, p = 0.002) were also independently associated with impaired MEEI.ConclusionsMetS aggravated LV deformation and function impairment in patients with INOCA. MetS was found to be an independent factor of impaired MEEI and LV GLPS, the further decrease of MEEI and LV GLPS in INOCA patients caused by MetS might involve the synergistic injury mechanism. Early diagnosis and treatment of MetS in patients with INOCA are important.

Myocardial synchronized exercise and prognosis in patients with heart failure with preserved ejection fraction assessed by two-dimensional ultrasound speckle tracking stratified strain imaging.

To evaluate myocardial synchronized exercise and clinical prognosis in patients with heart failure preserved ejection fraction (HFpEF), we utilized two-dimensional speckle tracking (2D-STI) stratified strain imaging. We retrospectively summarized 146 patients diagnosed with HFpEF in our hospital from January 2022 to January 2023. 2D-STI combined with stratified strain imaging was used to measure the overall left ventricular global longitudinal strain (LVGLS), the sub-endocardium, mid-myocardium, sub-epicardium LS of the left ventricle, as well as the basal, intermediate, and apical LS, the peak strain dispersion (PSD) and the transmural pressure difference, the postsystolic shortening (PSS), and early systolic lengthening. They were categorized into adverse and better prognosis groups based on major adverse cardiac events (MACE). MACE occurred in a total of 25 of 146 patients (17.12%). Compared with the better group (P < .05), there were significant differences in ages, incidences of myocardial infarction, pre-admission plasma brain natriuretic peptide levels, LVGLS, sub-endocardium and sub-epicardium LS, PSD, and PSS values in the adverse group. Compared to pretreatment in the better group at 1-month follow-up, LVGLS, sub-endocardium, mid-level, sub-epicardium LS, PSD, and PSS values improved significantly (P < .05), but the adverse group did not (P > .05). Multivariate Cox regression demonstrated that pretreatment LVGLS (HR = 1.362, 95% CI = 1.026-1.809, P = .033), sub-epicardium LS (HR = 1.669, 95% CI = 1.068-2.609, P = .025), and PSD values (HR = 1.075, 95% CI = 1.014-1.140, P = .015) were important predictors of the occurrence of MACE in patients with HFpEF. The receiver operating curves manifested that the area under the curve of pretreatment LVGLS, sub-epicardium LS, and PSD values for predicting the occurrence of MACE were 0.812 (95% CI = 0.730-0.894, P < .001), 0.847 (95% CI = 0.775-0.919, P < .001), and 0.924 (95% CI = 0.863-0.984, P < .001). 2D-STI combined with stratified strain imaging can provide a more comprehensive, objective, and accurate assessment of myocardial synchronized exercise and clinical prognosis in patients with HFpEF, and LVGLS, sub-epicardium LS, and PSD values can be used in clinical practice as noninvasive, sensitive indicators for predicting the occurrence of MACE.

Sacubitril-Valsartan in Cancer Therapy-Induced Heart Failure: A Systematic Review and Meta-Analysis of Functional and Hemodynamic Parameters.

Cancer therapy-induced cardiotoxicity (CTRCD), in the form of heart failure with reduced ejection fraction (HFrEF), is being increasingly recognized. However, the potential benefits of sacubitril/valsartan (S/V) in managing HFrEF secondary to CTRCD remain unclear. We performed a systematic review and meta-analysis to assess the effectiveness of S/V in preventing cardiotoxicity. We searched PubMed, Embase, and Cochrane databases for studies evaluating S/V in patients with HFrEF due to CTRCD and reporting the following outcomes: (1) NYHA class; (2) NT-ProBNP and (3) echocardiographic measurements, specifically left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e' ratio. Statistical analyses were performed using RStudio software. Heterogeneity was assessed using I² statistics. We included 257 patients from six studies. All patients received S/V. The mean patient age was 63 ± 8 years, and 85% of patients had breast cancer. The mean LVEF was 34±7% at baseline. S/V significantly improved NYHA class compared to baseline (MD -0.7; 95% CI -1.2 to -0.3; p<0.01), NT-proBNP (MD -985.1 pg/mL; 95% CI -1231.3 to -739.1; p<0.01), GLS (MD -2.5%; 95% CI -3.6 to -1.4; p<0.01;), and E/e' (MD -1.99; 95% CI 3.7 to -0.1; p=0.03). LVEF (MD 7.3%; 95% CI 5.4 to 9.2; p<0.01) with S/V treatment relative to baseline. In patients with HFrEF due to CTRCD, S/V significantly improved the clinical and echocardiographic parameters of left ventricular systolic and diastolic functions.

Cardiovascular effects of lactate in healthy adults

BackgroundLow-volume hypertonic solutions, such as half-molar lactate (LAC), may be a potential treatment used for fluid resuscitation. This study aimed to evaluate the underlying cardiovascular effects and mechanisms of LAC infusion compared to sodium-matched hypertonic sodium chloride (SAL).MethodsEight healthy male participants were randomized in a controlled, single-blinded, crossover study. Each participant received a four-hour infusion of LAC and SAL in a randomized order. Assessor-blinded echocardiography and blood samples were performed. The primary endpoint was cardiac output (CO) measured by echocardiography.ResultsDuring LAC infusion, circulating lactate levels increased by 1.9 mmol/L (95% CI 1.8–2.0 mmol/L, P < 0.001) compared with SAL. CO increased by 1.0 L/min (95% CI 0.5–1.4 L/min, P < 0.001), driven primarily by a significant increase in stroke volume of 11 mL (95% CI 4–17 mL, P = 0.002), with no significant change in heart rate. Additionally, left ventricular ejection fraction improved by 5 percentage points (P < 0.001) and global longitudinal strain by 1.5 percentage points (P < 0.001). Preload indicators were elevated during SAL infusion compared with LAC infusion. Concomitantly, afterload parameters, including systemic vascular resistance and effective arterial elastance, were significantly decreased with LAC infusion compared with SAL, while mean arterial pressure remained similar. Indicators of contractility improved during LAC infusion.ConclusionsIn healthy participants, LAC infusion enhanced cardiac function, evidenced by increases in CO, stroke volume, and left ventricular ejection fraction compared with SAL. Indicators of contractility improved, afterload decreased, and preload remained stable. Therefore, LAC infusion may be an advantageous resuscitation fluid, particularly in patients with cardiac dysfunction.Clinical trial registrationshttps://clinicaltrials.gov/ct2/show/NCT04710875. Registered 1 December 2020.

Effect of trimetazidine on left ventricular functions and cardiac biomarkers in diabetic patients with left ventricular diastolic dysfunction: a randomized controlled trial

We investigated the impact of trimetazidine treatment on left ventricular (LV) functions and cardiac biomarkers in diabetic patients with diastolic dysfunction as an early stage of diabetic cardiomyopathy. Sixty-three patients were randomly assigned to receive either trimetazidine or a placebo for 3 months. At baseline and after 3-months of treatment, measurements of serum levels of glycemic control parameters, lipid profile, tumor necrosis factor alpha, transforming growth factor beta 1, n-terminal pro brain natriuretic peptide and assessment of modified Medical Research Council (mMRC) dyspnea score, echocardiographic indices of LV functions and LV global longitudinal strain (GLS) were performed. After 3-months, trimetazidine group exhibited a significant reduction in left atrial volume index by 6.99% versus an increase by 0.66% in placebo group, p = 0.034. Moreover, average e’ increased by a significantly higher percentage in trimetazidine versus placebo group (8.46 ± 18.64 vs. -2.49 ± 14.52, respectively. p = 0.015). Trimetazidine treatment resulted in a significant increase in LVGLS by 6.66% versus LVGLS reduction by 2.79% in placebo group (p = 0.004). Trimetazidine group had a significantly lower median mMRC dyspnea score compared to placebo (0 vs. 1, respectively, p = 0.015) and a significantly lower low-density lipoprotein (LDL-C) (103.43 ± 28.31 vs. 125.34 ± 45.27, respectively, p = 0.032). There was no significant difference between both groups in levels of other biomarkers. Three-months treatment with trimetazidine improved diastolic function parameters, LVGLS, dyspnea severity and LDL-C levels in diabetic patients with diastolic dysfunction.

Longitudinal cardiac imaging for assessment of myocardial injury in non-hospitalised community-dwelling individuals after COVID-19 infection: the Rotterdam Study

BackgroundThe aim of this study was to assess the presence of myocardial injury after COVID-19 infection and to evaluate the relation between persistent cardiac symptoms after COVID-19 and myocardial function...

The prognostic value of global longitudinal strain in patients with myocardial infarction and preserved ejection fraction - a prespecified substudy of the REDUCE-AMI trial.

The REDUCE-AMI trial showed that beta-blockers in patients with preserved left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI) had no effect on mortality or cardiovascular outcomes. The aim of this substudy was to evaluate whether global longitudinal strain (GLS) is a better prognostic marker than LVEF, and if beta-blockers have a beneficial effect in patients with decreased GLS. REDUCE-AMI was a registry-based randomized clinical trial. Conventional echocardiographic parameters and GLS were obtained and a likelihood ratio test between models adjusted for age, sex, hypertension, smoking, diabetes, previous AMI, and multi-vessel disease was used to compare LVEF and GLS as prognostic methods. A Cox regression model evaluated the impact of beta-blocker treatment on the composite endpoint of death from any cause or new AMI. 1436 patients (28.6% of total population) were included in this substudy. Due to poor image quality or incompatible equipment, 324 (22.6%) patients were excluded from analysis of GLS. Median GLS was 17.3%. The likelihood ratio test resulted in no difference (P = 0.56) when comparing the combination of GLS to LVEF. The results were robust when adding beta-blocker randomization status as an independent variable. In patients after AMI with preserved LVEF, GLS did not add prognostic value regarding death from any cause or new AMI. In addition, beta-blocker treatment did not alter the prognostic information obtained from GLS. Consequently, this study does not support an additive value of GLS compared to standard echocardiographic measurement in this patient population.

Usefulness of Echocardiographic Parameters of Myocardial Work in Patients with Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation.

Background: Myocardial work (MW) is a new echocardiographic parameter used in the assessment of cardiac energy expenditure. The aim of the current study was to evaluate changes in left ventricular MW parameters in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Methods: One hundred and thirty five consecutive patients who underwent TAVI at one center were evaluated before and after the procedure using transthoracic echocardiography (TTE) to assess the following MW indices: global constructive work (GCW), global wasted work (GWW), global work index (GWI) and global work efficiency (GWE). Results: The comparison of MW parameters before and an average of 5.9 days after TAVI showed an increase in GCW, GWW and GWI, and no significant change in GWE. A detailed analysis showed an increase in GCW and GWI only in patients with the worst initial global longitudinal strain (GLS) > -8.0%: 845.2 vs. 852.2; p < 0.001 and 469.7 vs. 499.0 mmHg%; p < 0.001, respectively, whereas in the group of patients with GLS < -16.0%, a reduction in these indices was observed: 2135.8 vs. 2043.0; p < 0.001 and 1732.4 vs. 1633.1 mmHg%; p < 0.001. The significant increase in GWE was observed in patients with left ventricular ejection fraction (LVEF) < 30%: 77.7 vs. 72.0; p = 0.043 and GLS > -8.0%: 74.4 vs. 71.0 mmHg%; p < 0.001. The increase in GCW and GWI parameters after TAVI was strongly correlated with LVEF and pressure aortic gradient (PGA) before the procedure. Conclusions: Echocardiographic assessment of myocardial work parameters is a valuable method of documenting hemodynamic changes in patients with severe aortic stenosis before and after TAVI. Long-term left ventricular overload in patients with aortic stenosis results in a global reduction of myocardial work parameters; therefore, in patients with the lowest LVEF and GLS, the increased GCW, GWI and GWE reflect energy reserves enabling a rapid increase in the effective work of the heart.

Right ventricular subclinical dysfunction in high-burden idiopathic outflow tract premature ventricular contraction population.

The relationship between premature ventricular contractions (PVC) and right ventricular (RV) function is not widely known. Left ventricular (LV) dysfunction due to PVC is known as PVC-induced cardiomyopathy (PIC) and suppressing the PVC substrate would improve LV function. The effect of PVC ablation on changes in RV function in patients with subtle RV subclinical dysfunction remains unknown. Understanding the alterations in RV function parameters after PVC ablation. Basic and speckle-tracking echocardiography has been performed on 42 individuals with symptomatic idiopathic outflow tract PVC before and 1 month after a successful ablation. At the baseline of the study, there were 26 patients with RV subclinical dysfunction and 16 patients without RV dysfunction. Patients with RV subclinical dysfunction exhibited significantly higher PVC burden and QRS complex duration than those with normal RV function (p < 0.05). A PVC burden ≥ 21% (OR 9.11, 1.54-53.87, p = 0.015) and a QRS complex duration ≥ 138 ms (OR 5.74, 1.07-30.90, p = 0.042) were independently associated with RV subclinical dysfunction. In both groups, measurements of RV subclinical function before and after ablation, specifically by free wall longitudinal strain (FWLS) and global longitudinal strain (GLS), demonstrated significant changes. These improvements were more pronounced in the group with RV dysfunction (FWLS 9.7 ± 4.0, p < 0.001; GLS 7.5 ± 4.2, p < 0.001). Lower initial FWLS and GLS before ablation emerged as significant parameters in the multivariate analysis for the improvement of RV function post-ablation. Patients with RV subclinical dysfunction had higher PVC burden and wider QRS duration. Patients with idiopathic outflow tract PVC with RV subclinical dysfunction may experience improvements in RV function after successful PVC ablation.

Alterations in cardiac function correlate with a disruption in fatty acid metabolism in a mouse model of SMA.

Spinal Muscular Atrophy is an autosomal dominant disease caused by mutations and deletions within the SMN1 gene, with predominantly childhood onset. Although primarily a motor neuron disease, defects in non-neuronal tissues are described in both patients and mouse models. Here, we have undertaken a detailed study of the heart in the Smn2B/- mouse models of SMA, and reveal a thinning of the ventriclar walls as previously described in more severe mouse models of SMA. However most structural changes are resolved by accounting for the smaller body size of the SMA mouse, as was also confirmed in the SMN∆7 model. Echocardiography revealed increased systolic function, which was particularly pronounced in subsets of mice and an increase in global longitudinal strain, collectively indicative of increased cardiac stress in the Smn2B/- mouse model. We have used TMT proteomics to perform a longitudinal study of the proteome of the hearts of Smn2B/- mice and reveal a progressive dysregulation of LXR/RXR signalling which is a regulator of lipid metabolism. We further show consistent perturbations in lipid metabolism in the Smn2B/-, Smn-/-;SMN2;SmnΔ7and SmnΔ7/Δ7;SMN2 mouse models of SMA on the day of birth. This work indicates that although structural changes in the heart can be overstated by failing to account for body size, there are functional defects which could predispose the heart to subsequent failure. We identify a common molecular signature across mouse models pointing to a dysregulation in lipid metabolism, and suggest that manipulation of LXR/RXR signalling offers an opportunity to impact upon these pathways.

Prognostic Value of LV Global Longitudinal Strain by 2D and 3D Speckle-Tracking Echocardiography in Patients With HFpEF.

In patients with heart failure with preserved ejection fraction (HFpEF), the impact of type 2 diabetes (T2D) on left ventricular global longitudinal strain (LV GLS) and its prognostic implications remains unclear. We aimed to evaluate LV function using two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography in patients with HFpEF with and without T2D, and to investigate its prognostic significance. A total of 335 patients with HFpEF were prospectively enrolled for echocardiographic evaluation. LV GLS was obtained using 2D- and 3D-speckle-tracking echocardiography. Cox proportional hazards regression was used to determine predictors of adverse outcomes. The C-index, Akaike information criterion, integrated discrimination improvement, and net reclassification improvement were used to assess model performance and discriminative ability. LV 2D-GLS and 3D-GLS were impaired in patients with HFpEF and T2D compared with those without T2D. After a median follow-up of 17.6 months, 150 patients experienced adverse outcomes. Both 2D-GLS (hazard ratio, 1.323 [95% CI, 1.225-1.429]; P<0.001) and 3D-GLS (hazard ratio, 1.412 [95% CI, 1.316-1.515]; P<0.001) were independent predictors of adverse outcomes in patients with HFpEF after adjustment for confounders. The predictive accuracy of a model incorporating 3D-GLS (Akaike information criterion=-583.9, C-index=0.775 [95% CI, 0.742-0.808]) was superior to models using 2D-GLS (Akaike information criterion=-533.3, C-index=0.719 [95% CI, 0.678-0.760], ΔC-index=0.056; P=0.034) and LV ejection fraction (Akaike information criterion=-498.9, C-index=0.659 [95% CI, 0.610-0.708], ΔC-index=0.116; P<0.001). The addition of 2D-GLS and 3D-GLS to the base model significantly enhanced its discriminatory and predictive abilities (integrated discrimination improvement=0.225 and 0.280; net reclassification improvement=0.612 and 0.734, respectively, P<0.001 for all). LV 2D-GLS and 3D-GLS are impaired in patients with HFpEF and T2D, and are independent predictors of adverse outcomes. Moreover, 3D-GLS provides incremental prognostic value over 2D-GLS. URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR2100047487.