Left Ventricular Longitudinal Systolic Strain Research Articles

Left ventricular longitudinal strain in patients with undifferentiated connective tissue disease and arrhythmia

Aim. To evaluate the left ventricular longitudinal strain in patients with arrhythmia and undifferentiated connective tissue disease (UCTD).Material and methods. This cross-sectional comparative study included young patients with arrhythmia and UCTD (43 men and 84 women; mean age, 30,82±8,17 years (group 1, n=127)). The control group included volunteers with single phenotypic characteristics of UCTD, comparable in age and sex (9 men and 21 women, mean age, 34,13±6,87 years (group 2, n=30)). A standard clinical examination, 72-hour electrocardiographic monitoring, and speckle-tracking echocardiography were performed.Results. Patients of group 1 were characterized by lower global systolic longitudinal myocardial strain compared to the control group: -22,96% [-24,56%; -21,50%] in group 1 vs -24,73% [-25,25%; -23,84%] in group 2 (p=0,016). A local decrease in longitudinal myocardial strain (in two or more segments) was noted in 62,2% of patients in group 1 and 13,3% of patients in group 2 (p=0,025). In group 1, a relationship was revealed between class I premature ventricular contractions (PVCs) and a longitudinal strain decrease in the medial anterior (r1=0,253, p=0,004) and apical anterior (r1=0,253, p=0,004) segments, as well as between class V PVCs and strain decrease in the basal lower (r1=0,215, p=0,021) and middle anterior (r1=0,211, p=0,023) segments. In addition, there was a moderate correlation between mitral valve prolapse (MVP) and a decrease in longitudinal systolic strain in the basal inferolateral (r1=0,405, p=0,041) and basal anterior (r1=0,519, p=0,003) segments.Conclusion. Local decrease in left ventricular longitudinal systolic strain in association with arrhythmia and MVP in patients with UCTD makes it possible to recommend speckle-tracking echocardiography for early non-invasive assessment of myocardial remodeling in this cohort of patients.

Comparative study of the effects of left ventricular and biventricular pacing on indices of cardiac function and clinical status of heart failure patients: preliminary results of READAPT study

Abstract Nonresponse to cardiac resynchronization therapy (CRT) has been related with right ventricular dysfunction. Preferential left ventricular pacing (pLVP) can overcome iatrogenic right ventricular dysfunction by achieving left ventricle resynchronization and by allowing for intrinsic activation of the right side, with ramifications extending beyond cardiac output and atrial fibrillation occurrence. Moreover, the AdaptivCRT® algorithm also automatically adjusts interventricular (V-V) delay every minute, optimizing it by means of comparing relative activation delay between right and left ventricles (electrically – driven optimization). In the present study we evaluated the effects of a pLVP algorithm on 50 heart failure patients (all Caucasians, 49% male; 66 +/- 8 years old; 46% ischemic cardiomyopathy; 41% diabetics; NYHA II-III) following randomization to standard biventricular pacing and pLVP, on echocardiographic and cardiopulmonary exercise test indices of functional status, as well as a self-reported quality of life questionnaire. Device programming was based on echocardiography-evaluated maximization of stroke volume and subsequent interventricular and atrioventricular delay adjustments delegated to the device. The follow-up consisted of 6 and 12-months visits; after the 1rst month of optimizing maximum CRT response. Results Significant comparative effects of LVP over optimized CRT were noted regarding RV systolic velocity in TDI even from 6-months from baseline (6% increase, p=0.01); while end-systolic diameter of left ventricle was increased by 4% in 6-months in CRT group (p=0.01), while no significant difference was observed in LVP group. At 12 months endsystolic volume was significantly decreased (16%, p=0.01) and left ventricular systolic longitudinal strain was improved in 12 months in LVP group compared to CRT group (p- for interaction =0.001). Additionally, in cardiorespiratory exercise test LVP group showed improved inotropic reserve compared to CRT group according to maximum SBP achieved (20% increase, p<0.01 for interaction); while all other cardiorespiratory indices shoed borderline significant changes at 12 -months. Minnesota score was significantly reduced in LV-P group by 70% at 6-months; whereas no significant change was observed in CRT group (p for interaction <0.01). Conclusions In the preliminary findings of READAPT study, it seems that LV pacing optimized by a standardized echocardiographic protocol in patients with preserved AV conduction, LBBB, can achieve a higher percentage of synchronized LV pacing associated with improved patient quality of life; right ventricular function and endsystolic volume at 6 and 12-months of follow-up, over echo-optimized CRT pacing.

Impact of diabetes mellitus on acute and short term left ventricular longitudinal systolic strain recovery after percutaneous coronary intervention in ischemic hypertensive patients

Impact of diabetes mellitus on acute and short term left ventricular longitudinal systolic strain recovery after percutaneous coronary intervention in ischemic hypertensive patients

Subclinical systolic dysfunction detected by 2D speckle tracking echocardiography in adults with diabetes mellitus: systematic review and meta-analysis of 6668 individuals with diabetes mellitus and 7218 controls

PurposeSpeckle tracking echocardiography (STE) can help to identify subclinical features of diabetic cardiomyopathy (DCM). There is, however, significant heterogeneity in the reported strain values in literature. We performed a systematic review and meta-analysis to compare cardiac systolic strain values assessed by 2D-STE in asymptomatic adults with diabetes mellitus (DM) and healthy controls.MethodsFive databases were searched, and a total of 41 valid studies (6668 individuals with DM and 7218 controls) were included for analysis. Pooled mean in each group and mean difference (MD) for left ventricular global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS), LV global radial strain (LVGRS), LV longitudinal systolic strain rate (LVSR), left atrial reservoir strain (LARS) and right ventricular GLS (RVGLS) were assessed.ResultsPatients with DM had overall 2 units lower LVGLS than healthy subjects 17.5% [16.8, 18.3], vs 19.5 [18.7, 20.4], MD = − 1.96 [− 2.27, − 1.64]. Other strain values were also lower in patients with DM: LVGCS (MD = − 0.89 [− 1.26, − 0.51]); LVGRS (MD = − 5.03 [− 7.18, − 2.87]); LVSR (MD = − 0.06 [− 0.10, − 0.03]); LARS (MD = − 8.41 [− 11.5, − 5.33]); and RVGLS (MD = − 2.41 [− 3.60, − 1.22]). Meta-regression identified higher body mass index (BMI) as the single contributor to worse LVGLS, LVGCS and LVSR. Those with higher Hemoglobulin A1c had worse RVGLS.ConclusionMyocardial strains were reduced in whole heart in patients with DM. The largest reduction was observed in LA reservoir strain, followed by RVGLS and LVGLS. Higher BMI in patients with DM is associated with worse LV strain values.

The use of 2-D speckle tracking echocardiography in assessing adolescent athletes with left ventricular hypertrabeculation meeting the criteria for left ventricular non-compaction cardiomyopathy

BackgroundCurrent echocardiographic criteria cannot accurately differentiate exercise induced left ventricular (LV) hypertrabeculation in athletes from LV non-compaction cardiomyopathy (LVNC). This study aims to evaluate the role of speckle tracking echocardiography (STE) in characterising LV myocardial mechanics in healthy adolescent athletes with and without LVNC echocardiographic criteria. MethodsAdolescent athletes evaluated at three sports academies between 2014 and 2019 were considered for this observational study. Those meeting the Jenni criteria for LVNC (end-systolic non-compacted/compacted myocardium ratio > 2 in any short axis segment) were considered LVNC+ and the rest LVNC-. Peak systolic LV longitudinal strain (Sl), circumferential strain (Sc), rotation (Rot), corresponding strain rates (SRl/c) and segmental values were calculated and compared using a non-inferiority approach. ResultsA total of 417 participants were included, mean age 14.5 ± 1.7 years, of which 6.5% were LVNC+ (n = 27). None of the athletes showed any additional LVNC clinical criteria. All average Sl, SRl Sc, SRc and Rot values were no worse in the LVNC+ group compared to LVNC- (p values range 0.0003–0.06), apart from apical SRc (p = 0.2). All 54 segmental measurements (Sl/Sc SRl/SRc and Rot) had numerically comparable means in both LVNC+ and LVNC-, of which 69% were also statistically non-inferior. ConclusionsAmong healthy adolescent athletes, 6.5% met the echocardiographic criteria for LVNC, but showed normal LV STE parameters, in contrast to available data on paediatric LVNC describing abnormal myocardial function. STE could better characterise the myocardial mechanics of athletes with LV hypertrabeculation, thus allowing the transition from structural to functional LVNC diagnosis, especially in suspected physiological remodelling.

Potential role of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in elderly individuals: Baseline echocardiographic findings from the LOOP study.

BackgroundElderly individuals occupy an increasing part of the general population. Conventional and speckle-tracking transthoracic echocardiography may help guide risk stratification in these individuals. The purpose of this study was to evaluate the potential utility of conventional and speckle-tracking echocardiography in the screening of cardiac abnormalities in the elderly population.MethodsTwo cohorts of elderly individuals (sample size: 1441 and 944) were analyzed, who were part of a randomized controlled clinical trial (LOOP study) and of an observational study (Copenhagen City Heart Study), recruiting participants from the general population >70 years of age with cardiovascular risk factors (arterial hypertension, diabetes mellitus, heart failure, or prior stroke) and sinus rhythm. Participants underwent a comprehensive transthoracic echocardiographic examination, including myocardial speckle tracking. Cardiac abnormalities were defined according to the ASE/EACVI guidelines.ResultsStructural cardiac abnormalities such as left ventricular (LV) remodeling, mitral annular calcification (MAC), and aortic valve sclerosis (with or without stenosis) were highly prevalent in the LOOP study (40%, 39%, and 27%, respectively). Moreover, a high prevalence of functional cardiac alterations such as LV diastolic dysfunction (LVDD), abnormal LV longitudinal systolic strain (GLS), and abnormal left atrial (LA) reservoir strain was present in the LOOP study (27%, 18%, and 9%, respectively). Likewise, the rate of LVDD, abnormal GLS, and abnormal LA reservoir strain was comparable in the validation sample from the Copenhagen City Heart Study. In line with these findings, subjects with LV remodeling, MAC, and aortic valve changes had a higher prevalence of LVDD, abnormal GLS, and abnormal LA reservoir strain than those without structural cardiac alterations.ConclusionThe findings of this study highlight the potential clinical utility of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in the elderly population. Further studies are warranted to determine the prognostic relevance of these findings.

Electrocardiographic, echocardiographic and lipid parameters in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome

Aim. To assess the predictive potential of electrocardiographic (ECG), echocardiographic, and lipid parameters for predicting obstructive coronary artery disease (oCAD) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) prior to invasive coronary angiography (CA).Material and methods. This prospective observational cohort study included 525 patients with NSTE-ACS with a median age of 62 years who underwent invasive coronary angiography. Two groups were distinguished, the first of which consisted of 351 (67%) patients with oCAD (stenosis 50%), and the second — 174 (33%) without oCAD (<50%). Clinical and functional status of patients before CAG was assessed by 40 indicators. Mann-Whitney, Fisher, chi-squared, univariate logistic regression (LR) methods were used for data processing and analysis, while miltivariate LR (MLR), gradient boosting (XGBoost) and artificial neural networks (ANN) were used to develop predictive models. The quality of the models was assessed using 4 following metrics: area under the ROC curve (AUC), sensitivity (Se), specificity (Sp), and accuracy (Ac).Results. A comprehensive analysis of ECG, echocardiography and lipid profile parameters made it possible to identify factors that had linear and non-linear association with oCAD. LR were used to determine their weight coefficients and threshold values with the highest predictive potential. The quality metrics of the best predictive algorithm based on MLR were 0,81 for AUC, 0,74 for Sp and Ac, and 0,75 for Se. The predictors of this model were 4 categorical parameters (left ventricular (LV) ejection fraction of 42-60%, global LV longitudinal systolic strain <19%, low-density lipoprotein cholesterol >3,5 mmol/l, age >55 years in men and >65 years for women).Conclusion. The prognostic model developed on the basis of MLR made it possible to verify oCAD with high accuracy in patients with NSTE-ACS before invasive CA. Models based on XGBoost and ANN had less predictive value.

Reference centiles for left ventricular longitudinal global and regional systolic strain by automated functional imaging in healthy Egyptian children.

Two-dimensional speckle tracking echocardiography-derived left ventricular longitudinal systolic strain is an important myocardial deformation parameter for assessing the systolic function of the left ventricle. Strain values differ according to the vendor machine and software. This study aimed to provide normal reference values for global and regional left ventricular longitudinal systolic strain in Egyptian children using automated functional imaging software integrated into the General Electric healthcare machine and to study the correlation between the global longitudinal left ventricular systolic strain and age, body size, vital data, and some echocardiographic parameters. Healthy children (250) aged from 1 to 16 years were included. Conventional echocardiography was done to measure the left ventricular dimensions and function. Automated functional imaging was performed to measure the global and regional peak longitudinal systolic strain. The global longitudinal strain was -21.224 ± 1.862%. The regional strain was -20.68 ± 2.11%, -21.06 ± 1.84%, and -21.86 ± 2.71% at the basal, mid, and apical segments, respectively. The mean values of the systolic longitudinal strain become significantly more negative from base to apex. Age differences were found as regard to global and regional longitudinal strain parameters but no gender differences. The global peak longitudinal systolic strain correlated positively with age. No correlations were found with either the anthropometric parameters or the vital data. Age-specific normal values for two-dimensional speckle tracking-derived left ventricular longitudinal regional and global systolic strain are established using automated functional imaging.

Wave decomposition applied to LA phasic longitudinal strain evaluated from MRI feature tracking to estimate a true LA booster strain index

Abstract Funding Acknowledgements Type of funding sources: None. Background. Feature tracking (FT) is an emerging approach for the evaluation of both left atrium (LA) and left ventricular (LV) myocardial strain from the same cine MRI dataset. We hypothesized that the LA active contraction longitudinal strain, is a merge of an intrinsic LA booster contraction with the early diastolic LA emptying, especially when this latter is extended because of a poor LV relaxation (Figure 1, bottom). Such index can be estimated through LA phasic strain wave-decomposition as conventionally done for pressure curves to estimate forward and reflected components. Purpose. To compare the newly proposed LA intrinsic or "true" booster index (Sla_fit) against the conventional index (Sla) in terms of associations with LV remodeling (LV mass/ LV volume), LV systolic longitudinal strain (LV_GLS), and transmitral LV filling indices in healthy controls and aortic valve stenosis (AVS) patients with preserved LV ejection fraction. Methods. We studied 55 patients (34 AVS:71 ± 11years, 21 controls:66 ± 9years) who had an MRI exam with cine SSFP and phase contrast (PC) images. FT was applied to cine images to extract LV and LA phasic longitudinal strain and strain rates. Transmitral flow early (E, cm/s) and late (A, cm/s) filling peak velocities were calculated from PC data. To estimate intrinsic LA booster index, the LA longitudinal strain curve corresponding to the reservoir and conduit phases was fitted using two half cosine waves, to account for an eventual LA filling to LA early emptying asymmetry, while fitting the LA contraction with a full cosine wave (Figure 1). The peak of this latter wave was defined as the intrinsic LA booster strain index (Sla_fit), while the second peak of the measured LA strain was defined as the conventional LA booster strain (Sla). Results. While conventional Sla was significantly higher than intrinsic LA booster Sla_fit in AVS patients (13.55 ± 4.26 vs. 8.09 ± 6.07, p = 0.0002), it was nearly equivalent in controls (14.34 ± 4.30 vs.13.43 ± 4.23, p =.49). But the newly proposed LA booster strain index was significantly related to LV_GLS (r=-48,p=.0004); to LV remodeling (r=-.44,p = 0.0012) as well as to transmitral flow A wave ( r=-.49, p=.0005) none of these associations were significant when considering conventional LA booster strain. Interestingly our intrinsic LA booster index Sla_fit was significantly associated with LV longitudinal strain in both controls (r=-.55,p = 0.009) and asymptomatic AVS (N = 10) (r=-.77,p = 0.0081) but not in symptomatic AVS (N = 24) (p>.70). This may reveal a maintained LA-LV coupling in the asymptomatic phase and an uncoupling in the symptomatic phase, caused by elevated LV filling pressures. Conclusions. A promising index for the quantitative evaluation of intrinsic LA booster function was proposed and its consistency was demonstrated through its significant associations with LV remodeling, LV longitudinal strain and transmitral late filling peak. Abstract Figure.

Effects of glucagon like peptide-1 receptor agonists and their combination with sodium-glucose cotransporter-2 inhibitors on myocardial deformation and work index in type 2 diabetes: 1 year follow up

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Type-2 diabetes mellitus (T2DM) exacerbates mechanisms of atherosclerosis and heart failure. Purpose We investigated the effect of novel antidiabetic drugs, glucagon like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on myocardial function. Methods A hundred-sixty T2DM patients (age: 58 ± 10years) were randomized to insulin (n = 40), liraglutide (n = 40), empagliflozin (n = 40) or their combination (GLP-1RA + SGLT-2i) (n = 40) as add-on to metformin. We measured at baseline and 1 year post-treatment: a) global LV longitudinal strain (GLS), systolic (GLSR) and diastolic (GLSR E) strain rate, global circumferential (GCS) and radial (GRS) strain, peak twisting (pTw), peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel), b) global myocardial work index (GWI), global constructive (GCW) and global wasted work (GWW) derived by pressure-myocardial strain loops using speckle tracking imaging. Results After 1 year of treatment, all patients improved GLS, GCS, GRS and pUtwVel (p < 0.05). GLP-1RA or GLP-1RA + SGLT-2i provided a greater increase of GLS (11.5% and 13% vs. 6.8% and 2.3%), GWI (12.7% and 17.4% vs. 3.1% and 2%), GCW (12.3% and 15% vs. 2.2% and 7.8%) and a greater reduction of GWW (38.7% and 41.6% vs. 13.5% and 4.9%) compared with insulin or SGLT-2i, despite a similar HbA1c reduction (p < 0.05 for all comparisons) (Table). Patients under combined treatment with GLP-1RA + SGLT-2i achieved a 2-fold reduction of pTw and a 2-fold increase of pUtwVel than those under each one regimen or insulin (p < 0.05). The dual therapy showed the greatest effect on measured myocardial markers in LVEF < 55% (p < 0.05). Conclusions One year treatment with GLP-1RA or combination of GLP-1RA and SGLT-2i resulted in a greater improvement of myocardial deformation and effective cardiac work than insulin or SGLT-2i treatment, independently of glycemic control in T2DM. All patients (n = 160) Insulin (n = 40) GLP-1RA (n = 40) SGLT-2i (n = 40) GLP-1RA + SGLT-2i (n = 40) p-value GLS, % Baseline -16.4 ± 3.7 -16.4 ± 3.5 -16.2 ± 3.5 -17 ± 4 -16 ± 4 0.139 1 year -17.9 ± 3.9 -17.6 ± 4.2 -18.3 ± 3.5 -17.4 ± 3.4 -18.4 ± 4.7 0.003 GWI, mmHg% Baseline 1538 ± 430 1644 ± 416 1510 ± 403 1536 ± 535 1463 ± 362 0.116 1 year 1692 ± 412 1696 ± 377 1730 ± 318 1568 ± 456 1772 ± 499 0.006 pTw, deg Baseline 15.7 ± 6 16 ± 5.1 15.6 ± 5 15.2 ± 6 16.1 ± 8 0.910 1 year 14.6 ± 5.1 15.4 ± 5.4 14.4 ± 5.4 14.7 ± 4.6 14 ± 5 0.034 pUtwVel, deg/s Baseline -104 ± 42 -100 ± 44 -107 ± 41 -101 ± 28 -111 ± 54 0.550 1 year -116 ± 49 -107 ± 55 -114 ± 45 -108 ± 38 -134 ± 61 0.017 Table

Effect of Temporal and Spatial Smoothing on Speckle\u2013Tracking-Derived Strain in Neonates

Clinical application of strain in neonates requires an understanding of which image acquisition and processing parameters affect strain values. Previous studies have examined frame rate, transmitting frequency, and vendor heterogeneity. However, there is a lack of human studies on how user-regulated spatial and temporal smoothing affect strain values in 36 neonates. This study examined nine different combinations of spatial and temporal smoothing on peak systolic left ventricular longitudinal strain in 36 healthy neonates. Strain values were acquired from four-chamber echocardiographic images in the software-defined epicardial, midwall, and endocardial layers in the six standard segments and average four-chamber stain. Strain values were compared using repeated measure ANOVAs. Overall, spatial smoothing had a larger impact than temporal smoothing, and segmental strain values were more sensitive to smoothing settings than average four-chamber strain. Apicoseptal strain decreased by approximately 4% with increasing spatial smoothing, corresponding to a 13–19% proportional change (depending on wall layer). Therefore, we recommend clinicians be mindful of smoothing settings when assessing segmental strain values.

Inhibition of interleukin-6 by tocilizumab improves endothelial glycocalyx and myocardial work index in patients with rheumatoid arthritis

Abstract Background/Introduction Tocilizumab, an interleukin-6 receptor blocker is used for the treatment of rheumatoid arthritis (RA). Purpose We investigated the effects of tocilizumab on endothelial glycocalyx and myocardial function in patients with RA. Methods Eighty patients with RA (age: 64±9 years) were randomized to tocilizumab (n=40) or prednisolone (n=40)for 3 months. We measured at baseline and 3 months post-treatment: a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced glycocalyx thickness), b) pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI), c) global LV longitudinal strain (GLS), longitudinal systolic (LongSr) and diastolic (LongSrE) strain rate, d) global myocardial work index (GWI), global constructive (GCW) and global wasted work (GWW) using speckle tracking imaging. Results At baseline, all patients had similar disease activity score and markers of vascular and myocardial function. Compared with baseline, patients under tocilizumab had reduced PBR (2.14±0.2 vs. 1.97±0.2μm), PWV (11±3 vs. 10.3±2m/s), cSBP (134±18 vs. 129±16mmHg) and LongSrE (0.91±0.3 vs. 1±0.3 1/s) at 3 months (p<0.05). There were no statistically significant differences in the above measured markers in patients under prednisolone (p>0.05) (Table). Compared with prednisolone, tocilizumab treatment achieved a greater increase of GLS (8.5% vs. 2.4%), GWI (12.2% vs. 2.7%), GCW (10.3% vs. 5.9%) and a greater reduction of GWW (−30% vs. −13%) (p<0.05 for all comparisons), despite a similar reduction in C-reactive protein post-treatment. The percent decrease of PBR was associated with the percent decrease of cSBP (r=0.46), PWV (r=0.37) and reversely related with the percent improvement of GLS (r=−0.43) and GWI (r=−0.39) (p<0.05). Conclusions IL-6 inhibition by tocilizumab improves endothelial and vascular function leading to a greater increase of effective myocardial work compared to prednisolone in patients with RA. Funding Acknowledgement Type of funding source: None

Glucagon like peptide-1 receptor agonists and their combination with sodium-glucose cotransporter-2 inhibitors improve myocardial deformation and work index in type-2 diabetes after 12-month treatment

Abstract Background/Introduction Type-2 diabetes mellitus (T2DM) exacerbates mechanisms of atherosclerosis and heart failure. Purpose We investigated the effects of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on LV myocardial function of T2DM patients. Methods A hundred-sixty T2DM patients (age: 58±10 years) were randomized to insulin (n=40), liraglutide (n=40), empagliflozin (n=40) or their combination (GLP-1RA+SGLT-2i) (n=40) as add-on to metformin. We measured at baseline, 4 and 12 months post-treatment: a) global LV longitudinal strain (GLS), systolic (LongSr) and diastolic (LongSrE) strain rate, global circumferential (GCS) and radial (GRS) strain, peak twisting (pTw), peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel), b) global myocardial global work index (GWI), global constructive (GCW) and global wasted myocardial work (GWW) derived by pressure-myocardial strain loops using speckle tracking imaging. Results At 4 and 12 months post-treatment, all patients improved GLS, GCS, GRS and pUtwVel (p<0.05). At 12 months, GLP-1RA or GLP-1RA+SGLT-2i provided a greater increase of GLS (11.5% and 13% vs. 6.8% and 2.3%), GCS (11.9% and 14.6% vs. 7.3% and 3.4%), GRS (3.8% and 4.3% vs. 2.2% and 1.6%), GWI (12.7% and 17.4% vs. 3.1% and 2%), GCW (12.3% and 15% vs. 2.2% and 7.8%) and a greater reduction of GWW (38.7% and 41.6% vs. 13.5% and 4.9%) compared with insulin or SGLT-2i, despite a similar HbA1c reduction (p<0.05 for all comparisons) (Table). Patients under combined treatment with GLP-1RA+SGLT-2i achieved a 2-fold reduction of pTw and a 2-fold increase of pUtwVel than those under each one regimen or insulin (p<0.05). The dual therapy showed the greatest effect on measured myocardial markers in patients with LVEF <55% (p<0.05). Conclusions Twelve-month treatment with GLP-1RA or combination of GLP-1RA and SGLT-2i showed a greater improvement of myocardial deformation and effective cardiac work than insulin or SGLT-2i treatment in T2DM. The combined therapy as second line was superior to either insulin, or GLP-1RA and SGLT-2i separately. Funding Acknowledgement Type of funding source: None

Apport du 2D strain et des outils échocardiographiques classiques pour la recherche d’anomalies myocardiques induites par l’exposition chronique à un phéochromocytome

IntroductionPheochromocytoma is a rare disease, which may manifest as severe cardiac complications. Apart from these situations, the “chronic” cardiac impact is not clearly defined. A cardiac MRI study suggests that these patients are carrying areas of fibrosis and foci of left ventricular myocarditis. Since these abnormalities are usually associated with altered left ventricular longitudinal systolic strain, we hypothesize that this strain is altered in patients with a “chronic” pheochromocytoma. MethodThis retrospective case-control study was performed using patients from the Bordeaux University Hospital database, included between 2008 and 2016. We compared the left ventricular global longitudinal strain (GLS), radial and circumferential systolic strain and classic echocardiographic parameters between patients with pheochromocytoma and controls matched for age, sex, body mass index and systolic blood pressure. ResultsThe analysis included 47 patients and 47 correctly matched controls. There were no statistically significant differences between the 2 groups in terms of GLS (−20.7±2.4% vs. −20.2±2.7%, P=0.40), radial strain, left ventricular mass or diastolic function. Left ventricular ejection fraction and circumferential strain were significantly higher in patients than in controls, with a significantly lower telediastolic diameter. ConclusionNo significant changes in GLS were observed in our pheochromocytoma patients, compared with controls. Several hypotheses may explain these results. The presence of fibrosis foci and areas of left ventricular myocarditis being associated with a poor cardiological prognosis, a systematic cardiac MRI could be discussed in these patients, until further studies are performed.

Left Ventricular Stiffness in Adolescents and Young Adults After Arterial Switch Operation for Complete Transposition of the Great Arteries.

We tested the hypothesis that left ventricular (LV) myocardial stiffness is altered in patients with transposition of great arteries (TGA) after arterial switch operation (ASO) and explored its associations with myocardial calibrated integrated backscatter (cIB) and LV myocardial deformation. Thirty-one patients and twenty-two age-matched controls were studied. LV myocardial stiffness was assessed by diastolic wall strain (DWS) and stiffness indices including (E/e)/LV end-diastolic dimension, (E/LV global longitudinal early diastolic strain rate)/LV end-diastolic volume, and (E/LV global circumferential early diastolic strain rate)/LV end-diastolic volume, where E and e are early diastolic transmitral and mitral annular velocities, respectively. LV myocardial cIB and longitudinal and circumferential myocardial deformation were determined by conventional and speckle tracking echocardiography. Patients had significantly lower DWS, higher stiffness indices, and greater myocardial cIB than controls (all p < 0.05). The LV longitudinal and circumferential systolic strain and systolic and diastolic strain rates were significantly lower in patients than controls (all p < 0.05). Greater average myocardial cIB was associated with lower DWS (r = - 0.44, p = 0.002). Worse DWS and LV stiffness indices were found to correlate with lower mitral annular systolic velocity, mitral annular late diastolic velocity, and LV longitudinal late diastolic strain rate (all p < 0.05). LV longitudinal and circumferential systolic strain and strain rate were also found to correlate with DWS (all p < 0.05). In conclusion, LV myocardial stiffening occurs in adolescents and young adults with TGA after ASO and is associated with impairment of ventricular systolic and diastolic myocardial deformation and myocardial fibrosis.

The Correlation Between Strain and Strain Rate Left Ventricle with Functional Capacity in Post Myocardial Infarction Patients with Heart Failure

Myocardial infarction (MI) may alter left ventricular (LV) systolic function, which, in turn, may reflect on functional capacity. Objective systolic function assessment using 2D speckle-tracking echocardiography is promising to assess the correlation between LV longitudinal strain and strain rate with functional capacity in post-MI patients with heart failure. A cross-sectional study was done on 33 consecutive post-MI patients with class I-II NYHA heart failure visiting the cardiology outpatient clinic of Dr. Soetomo General Hospital, Surabaya. The resting echocardiogram was taken, followed by a treadmill stress test using Naughton protocol. Appropriate statistical analyses were used to determine the correlation of systolic longitudinal strain and strain rate with exercise capacity. Study subjects were 69.7% males with age 58.45±6.2 years old. EF by Biplane was 40.55±8.26%; with global peak longitudinal strain –12.23±5.19%, and strain rate – 0.67±0.25s−1; and peak exercise capacity 3.69±1.8 METs. Using Pearson’s test, there was a strong negative correlation of systolic longitudinal strain and strain rate with functional capacity (r = –0.577, r = –0.607respectively; p<0.05). LV systolic longitudinal strain and strain rate were strongly correlated with functional capacity in post-MI patients with heart failure.

Left ventricular systolic function assessment with two-dimensional strain imaging among patients with rheumatic mitral stenosis

Introduction: Two-dimensional (2D) strain is a novel technique which evaluates left ventricular (LV) systolic functions more objectively and quantitatively and does not have the limitations seen in ejection fraction (EF), tissue Doppler imaging, and Doppler strain. In this study, we aimed to evaluate the role of 2D strain in the assessment of LV systolic function and the relationship between the presence of atrial fibrillation (AF) and LV dysfunction in patients with mitral stenosis (MS). Materials and Methods: This study is a cross-sectional study. The 2D strain was obtained from LV apical LAX, 4C, and 2C view. Peak LV longitudinal systolic strain was calculated for apical LCX, 4C, and 2C view, and global LV systolic strain was calculated by averaging the three apical views. Results: A total of thirty patients were enrolled in the study. They included 24 (80%) females and 6 (20%) males. There were 11 patients (36.7%) had AF and 21 patients (63.3%) had sinus rhythm. There were mean mitral valve area 1.17 cm2 (by planimetry) and 1.19 cm2 (by pressure half-time), mean mitral valve gradient 12.0 mmHg, mean peak gradient 22 mmHg, and mean right ventricular systolic pressure (50.6 vs. 37.4 mmHg) compared to sinus group. In this study, the mean ALAX LSS (−15.12), mean A4C LSS (−14.65), mean A2C LSS (−13.89), and mean GLOBAL LSS (−14.52) were statistically significant (P Conclusion: Despite normal LV dimensions and EF, there was a highly significant lower (P

Reduced Biventricular Volumes and Myocardial Dysfunction Long-term After Pediatric Heart Transplantation Assessed by CMR.

Long-term cardiac remodeling after heart transplantation (HT) in children has been insufficiently characterized. The aim of our study was to evaluate ventricular size in HT patients using cardiovascular magnetic resonance (CMR) imaging, to find underlying factors related to potentially abnormal cardiac dimensions and to study its impact on functional class and ventricular function. Seventy-five pediatric HT recipients (age 14.0 ± 4.2 y) were assessed by using CMR 11.2 ± 5.4 years after HT. Right ventricular (RV) and left ventricular (LV) volumes and mass were derived from short-axis cine images and myocardial strain/strain rate was assessed using myocardial feature tracking technique. Results were compared with a healthy reference population (n = 79, age 13.7 ± 3.7 y). LV end-diastolic ventricular volumes were smaller (64 ± 12 versus 84 ± 12 mL/m; P < 0.001) while mass-to-volume ratio (0.86 ± 0.18 versus 0.65 ± 0.11; P < 0.001) and heart rate (92 ± 14 versus 78 ± 13 beats/min; P < 0.001) were higher in HT patients. LV-ejection fraction (EF) was preserved (66% ± 8% versus 64% ± 6%; P = 0.18) but RV-EF (58 ± 7 versus 62% ± 4%, P = 0.004), LV systolic longitudinal strain (-12 ± 6 versus -15% ± 5%; P = 0.05), diastolic strain rate (1.2 ± 0.6 versus 1.5 ± 0.6 1/s; P = 0.03), and intra and interventricular synchrony were lower in the HT group. Smaller LV dimensions were primarily related to longer follow-up time since HT (β = -0.38; P < 0.001) and were associated with worse functional class and impaired ventricular systolic and diastolic performance. Cardiac remodeling after pediatric HT is characterized by reduced biventricular size and increased mass-to-volume ratio. These adverse changes evolve gradually and are associated with impaired functional class and ventricular dysfunction suggesting chronic maladaptive processes affecting allograft health.

Index of contractile asymmetry improves patient selection for CRT: a proof-of-concept study

BackgroundNearly one-third of heart failure (HF) patients do not respond to cardiac resynchronization therapy (CRT) despite having left bundle branch block (LBBB). The aim of the study was to investigate a novel method of quantifying left ventricular (LV) contractile asymmetry in HF.MethodsPatients with HF and LBBB undergoing CRT (n = 89, 37.1% females, 68 ± 9 years, ischemic etiology in 61%, LV ejection fraction 27.1 ± 7.1%) were analyzed. LV longitudinal systolic strain rate values were extracted from curved anatomical M-mode plots of standard long-axis 2D-echocardiography images and cubic spline interpolation was used to generate a 3D-phantom. Index of contractile asymmetry (ICA) was calculated based on standard deviation of differences in strain rate of opposing walls. Average ICA was individually assessed pairwise in 12 opposing 30-degree LV sectors. Reduction in LV end-systolic volume (ESV) ≥15% after 6 months was considered as positive response to CRT.ResultsCRT response was found in 66 (74.2%) patients. Responders with both ischemic and non-ischemic cardiomyopathy had a higher and more extensive contractile asymmetry at baseline and achieved a greater ICA reduction after CRT than non-responders. Higher baseline ICA predicted higher degree and wider extent of ICA improvement. Also, both ICA at baseline and reduction of ICA correlated with the degree of ESV reduction after CRT.ConclusionsQuantification of asymmetrical LV activation in 3D by ICA provides valuable insights into LV contraction in case of LBBB and is a promising tool for improved patient selection for CRT.

P4435Effects of interleukin 6 inhibitor tocilizumab on endothelial glycocalyx, vascular and myocardial function compared to prednisolone

Abstract Background/Introduction Tocilizumab, a humanised monoclonal antibody against the human interleukin-6 receptor, is used for the treatment of rheumatoid arthritis (RA). Purpose We investigated the effects of tocilizumab on arterial function, LV myocardial deformation and endothelial glycocalyx in RA patients. Methods 80 patients with rheumatoid arthritis were randomized to tocilizumab (n=40) or prednisolone (n=40) for 3 months. At baseline and after 3-month treatment we assessed: a) carotid-femoral pulse wave velocity (PWV-Complior SP ALAM), b) LV longitudinal strain (GLS), systolic (LongSr) and diastolic (LongSrE) strain rate using speckle tracking echocardiography, c) perfused boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–25μm) using Sideview Darkfield imaging (Microscan, Glycocheck). Increased PBR is considered an accurate index of reduced endothelial glucocalyx thickness, d) flow mediated dilatation (FMD) of the brachial artery after and percentage difference of FMD (FMD%) after hyperemia, e) coronary flow reserve (CFR) of the LAD using Doppler echocardiography, and f) malondialdehyde (MDA), protein carbonyls (PCs) and C-reactive protein (CRP) plasma levels. Results At baseline, all patients had similar disease activity score and markers of vascular and myocardial function. Compared to baseline, all patients had reduced CRP post treatment, while MDA and PCs levels were reduced only after tocilizumab treatment (p&lt;0.05). The percent decrease of MDA was correlated with percent increase of GLS (p&lt;0.001). Compared to baseline, tocilizumab-treated patients reduced PWV (11±3% vs. 10.3±2m/sec) and PBR (2.11±0.2 vs. 1.95±0.18μm) (Figure 1) and increased GLS (−16.1±2.9 vs. −17.6±2.5%), CFR (2.73±0.8 vs. 3.06±1), and FMD% (5.9±2.9 vs. 11.6±3.6) (p&lt;0.05 for all comparisons). No significant changes were observed among prednisolone-treated patients. Figure 1 Conclusions IL-6 inhibition improves endothelial function and oxidative stress resulting to improved vascular function and LV myocardial deformation.