Left Ventricular Strain Parameters Research Articles

The Relation Between Thyroid Stimulating Hormone and Left Ventricular Strain Parameters in Patients with Subclinical Hypothyroidism

The Relation Between Thyroid Stimulating Hormone and Left Ventricular Strain Parameters in Patients with Subclinical Hypothyroidism

The Acute Effects of Esmolol in Intact and Infarcted Myocardium–Experimental Study

Aim: Early intravenous use of b-blockers within the first hours of STEMI is less firmly established. The aim of this study was to evaluate the effect of esmolol on left ventricular (LV) haemodynamic, rotational and strain parameters in intact myocardium and early post an experimental acute anterior myocardial infarction (MI). Methods: In 20 healthy pigs LV torsional and strain parameters were calculated from basal and apical short axis epicardial planes with speckle tracking technique using EchoPAC platform. LV measurements at baseline and during esmolol infusion (0.5 mg/kg for 1 min, then 0.05 mg/kg/min for 5 min) were compared in intact myocardium and repeated without b-blocker and during esmolol infusion 2 hours post LAD ligation. Results: LV function was highly dependent on the esmolol infusion, in the intact and even more in the infarcted myocardium. LV ejection fraction, LV dP/dtmax and LV end-systolic pressure decreased significantly, a deterioration produced by the administration of esmolol. Torsion-twist and untwisting rate also presented significant reduction in correlation with ejection fraction and cardiac output, appearing to affect especially the apex torsional and strain parameters. Conclusion: Esmolol infusion significantly reduces LV haemodynamic, torsional and strain parameters in intact myocardium and early post MI. These results suggest that early intravenous use of esmolol in patients with STEMI is risky and it is prudent to wait for the patient to stabilize before starting esmolol.

Fast long-axis strain: a simple, automatic approach for assessing left ventricular longitudinal function with cine cardiovascular magnetic resonance.

In some cardiac pathologies, impairment of left ventricular (LV) longitudinal function may precede reduction in LV ejection fraction. This study investigates the effectiveness of a fast method to quantify long-axis LV function compared to conventional feature tracking and manual approaches. The study consisted of 50 normal controls and 100 heart failure (HF) patients including 40 with reduced ejection fraction (HFrEF), 30 with mid-range ejection fraction (HFmrEF), and 30 with preserved ejection fraction (HFpEF). Parameters including fast long-axis strain (FLAS) at end-systole and peak strain rates during systole (FLASRs), early diastole (FLASRe), and atrial contraction (FLASRa) were derived by a fast semi-automated approach on cine cardiovascular magnetic resonance. FLAS exhibited good agreement with strain values obtained using conventional feature tracking (bias - 2.9%, limits of agreement ± 3.0%) and the manual approach (bias 0.6%, limits of agreement ± 2.1%), where FLAS was more reproducible and required shorter measurement time. The mean FLAS (HFrEF < HFmrEF < HFpEF < controls; 6.1 ± 2.4 < 9.9 ± 2.4 < 11.0 ± 2.5 < 16.9 ± 2.3%, all p < 0.0001) was decreased in all the HF patient groups. A FLAS of 12.3% (mean-2SD of controls) predicted the presence of systolic dysfunction in 67% of patients with HFpEF, and 87% with HFmrEF. Strain parameters using the fast approach were superior to those obtained by conventional feature tracking and manual approaches for discriminating HFpEF from controls. Notable examples are area under the curve, sensitivity, and specificity for FLAS (0.94, 93%, and 86%) and FLASRe (0.96, 90%, and 94%). The fast approach-derived LV strain and strain rate parameters facilitate reproducible, reliable, and effective LV longitudinal function analysis. • Left ventricular long-axis strain can be rapidly derived from cine CMR with shorter measurement time and higher reproducibility compared to conventional feature tracking and the manual approach. • Progressive reductions in left ventricular long-axis strain and strain rate measurements were observed from HFpEF, HFmrEF, to HFrEF group. • Based on long-axis strain, systolic abnormalities were evident in HFmrEF and HFpEF indicating common coexistence of systolic and diastolic dysfunction in the HF phenotypes.

Serelaxin Improves Regional Myocardial Function in Experimental Heart Failure: An In Vivo Cardiac Magnetic Resonance Study.

BackgroundAnimal studies demonstrated that serelaxin lessens fibrosis in heart failure. This study assessed its effect on myocardial deformation using cardiac magnetic resonance and elucidated its relationship to gene regulation and histology in a mouse heart failure model.Methods and ResultsC57BL/6J mice were subjected to SHAM (n=4) or transverse aortic constriction (TAC). At week 10, TAC mice were randomized to receive either serelaxin (0.5 mg/kg per day; n=11) or vehicle (n=13) for 4 weeks. Cardiac magnetic resonance imaging was performed at baseline and repeated at the end of the study (week 14). Cine images were used to calculate left ventricular (LV) global longitudinal, circumferential, and radial strain. Hearts were examined for histology and gene expression. Compared with SHAM, mice 10 weeks after TAC showed increased LV mass with significant decreases in LV deformation parameters, indicating subclinical deterioration of myocardial function. At week 14, TAC mice given serelaxin demonstrated significant improvements in all LV strain parameters and no decrease in LV stroke volume and ejection fraction compared with TAC mice given vehicle. A significant positive correlation between global circumferential strain and the extent of myocardial fibrosis was found, and global circumferential strain correlated significantly with the expression of heart failure genes in serelaxin‐treated mice.ConclusionsSerelaxin improved cardiac magnetic resonance–derived myocardial deformation parameters as well as histomorphometric and gene expression findings in mice with heart failure. Cardiac magnetic resonance–derived myocardial mechanics correlate with histology and gene expression, stressing its utilization in myocardial remodeling.

The effect of varying intensities of lower limb eccentric muscle contractions on left ventricular function

PurposeThe effect of eccentric (ECC) resistance exercise (RE) on myocardial mechanics is currently unknown.MethodThis study investigated ECC RE at varying intensities on left ventricular (LV) function using LV strain (ε), wall stress and haemodynamic parameters. Twenty-four healthy male volunteers completed ECC leg extensions at 20%, 50% and 80% of their ECC maximal voluntary contraction (MVC), whilst receiving echocardiograms. Global longitudinal ɛ, strain rate (SR), longitudinal tissue velocity, heart rate (HR), blood pressure (BP), mean arterial pressure (MAP), LV wall stress and rate pressure product (RPP) were assessed at baseline and during exercise.ResultsLeft ventricular global ɛ, systolic SR and wall stress remained unchanged throughout. Systolic blood pressure (sBP), MAP and RPP increased at 80% and 50% intensities compared to rest (P < 0.01). Eccentric RE increased HR and peak late diastolic SR at all intensities compared to rest (P < 0.02).ConclusionThe findings suggest acute ECC RE may not alter main parameters of LV function, supporting future potential for wider clinical use. However, future studies must investigate the impact of multiple repetitions and training on LV function.

P1383 The effects of doxorubicin on left and right ventricular strain in patients with lymphoma: insights from a retrospective study

Abstract Funding Acknowledgements South Tees Research and Development Fund (UK) Background Anthracyclines are a cornerstone in the management of lymphoma. However, their use is associated with cardiotoxicity. Speckle tracking echocardiography (STE) has been established as a valid measure of quantifying cardiac function. However, most studies to this date have focused predominantly on left ventricular (LV) global longitudinal strain (GLS) with only a limited number assessing the right ventricle (RV) and other LV strain parameters. Purpose Using 2D STE, we assessed the effects of anthracyclines on LV and RV strain parameters, focusing on LV endocardial (GLS), LV myocardial GLS (myoGLS), LV radial strain (GRS), RV endocardial (RV GLS), myocardial GLS (RV myoGLS), and RV free wall strain (RVFWS). Methods We retrospectively collected data on patients treated for lymphoma between 2015-2018. Two groups (G) were defined: those with a conventional drop in LV ejection fraction (EF), (G1, n = 11) and those without (G2, n = 24). Echocardiograms were performed pre-chemotherapy (T0), mid-treatment (T1), and post-chemotherapy (T2) and were analysed offline using vendor-independent software (TomTec 2D CPA). LV and RV strain analysis was performed in both groups. This study was ethically approved by Health Research Association (REC Reference 18/SS/0139). Results Mean age was 61 ± 16 years (G1) and 65 ± 12 years (G2). 18% (G1) and 17% (G2) of patients had a history of IHD in each group. Mean cumulative dose of doxorubicin was 280 ± 31 mg/m2 (G1) and 280± 48mg/m2 (G2). In both groups, there was no significant change in LV or RV strain parameters from T0 to T1. In G1, between T1 and T2, patients exhibited a significant deterioration in LV GLS (-19.7 ± 2.6% vs.-15.6 ± 2.5% p &amp;lt; 0.0005), and LV myoGLS (-17.3 ± 2.2% vs. -14.1 ± 2.9% p = 0.02). There was also a measurable decline in RV strain parameters between T1 to T2 (RV GLS, -23.1 ± 4.7% vs. -18.8 ± 4.2% p = 0.028) and (RV myoGLS -21.5 ± 5.2% vs -17.3 ± 3.6% p = 0.013). When analysed from T0 to T2, the changes in RV strain were more marked; RV GLS (-25.2 ± 4.9% vs. -18.8 ± 4.2% p = 0.005), RV myoGLS (-22.4 ± 5.2% vs-17.3 ± 3.6% p = 0.005), and RVFWS (-28.8 ± 5.7% vs. -20.9 ± 6.7% p = 0.001). In G2, no change was observed in LV GLS (-20.4 ± 2.3% vs. -19.6 ± 2.8% p = 0.66), LV myoGLS (-18.8 ± 2.5% vs. -17.5 ± 3.1% p = 0.18), RV GLS (-24.2 ± 2.3% vs. -23.1 ± 2.7% p = 0.42), RV myoGLS (-22.4 ± 2.9% vs. -20.6 ± 2.8% p = 0.09), RVFWS (-26.7 ± 4.6% vs. -25.2 ± 3.6% p = 1.0). GRS did not significantly change in either G1 or G2 during treatment. Conclusion In patients with a reduction in LVEF, this analysis demonstrated a significant reduction in LV strain parameters secondary to anthracycline treatment. Novel strain parameters did not change in the normal EF group, or predate EF/GLS decline in those with reduced LVEF. Measurable RV dysfunction was noted in those with LV deterioration, highlighting the global cardiac insult of anthracycline treatment. Preventative and monitoring strategies in cardio-oncology should not overlook RV function.

P1388 LA and LV strains are closely linked in patients with diastolic dysfunction and preserved ejection fraction

Abstract Introduction Left atrial (LA) strain has been proposed as an independent parameter for the assessment left ventricular (LV) diastolic function. However, there is increasing evidence of impaired LV longitudinal function in patients with diastolic dysfunction(DD) and preserved ejection fraction (EF). Purpose To assess the relationship between LA and LV strain parameters with different grades of LV diastolic dysfunction in patients with preserved EF. Methods We included 95 patients with EF &amp;gt; 50% and good image quality. Patients with a mobile interatrial septum, more than mild valvular regurgitation and previous heart surgery were excluded. Standard echocardiographic measurements and the assessment of the diastolic function were performed according to current guidelines. LA and LV strains were assed using speckle tracking in 4 and 2 chambers apical views, using R-R gating. Strain values from LA and LV strain curves were derived in every phase of the cardiac cycle (peak systolic, early and late diastole strain). Results 26 patients had normal diastolic function, 23 had grade 1, 19 grade 2 and 13 grade 3 DD. Fourteen patients with indeterminate DD grade were excluded. Both peak LA and LV strain decreased significant with the degree of DD (Fig.). LA and LV early diastole strain were significantly higher in patients with normal diastolic function than any degree of DD. LA and LV late diastole strain increased in grade 1 DD. LA and LV strain parameters changes correlated significantly in systole, early and late diastole (r = 0.81,p &amp;lt; 0.0001; r = 0.64, p &amp;lt; 0.0001; r = 0.76, p &amp;lt; 0.0001, respectively). Other standard parameters of DD were not capable to differentiate between grades of DD. Conclusion LA and LV strain parameters show similar changes with increasing diastolic dysfunction. Diastolic dysfunction was regularly associated with reduced longitudinal strain in both LA and LV despite preserved EF. This suggest that both LA or LV strain could be used for the assessment of diastolic function. Abstract P1388 Figure. LA and LV strain parameters by DD

1024 Left ventricle myocardial deformation (strain) pattern in severe aortic valve stenosis. AMY-TAVI study

Abstract OnBehalf AMY-TAVI study PURPOSE. To study left ventricular (LV) myocardial deformation in patients with severe symptomatic aortic stenosis (AS), through the analysis of the Regional and Global Longitudinal Strain (GLS), as well as the phenotypic pattern of peak systolic longitudinal strain represented in the bull´s eye. METHODS. A total of 42 patients with severe symptomatic AS were prospectively and consecutively included. Conventional morphological and functional parameters were analyzed, along with LV strain parameters and the strain pattern phenotype using two-dimensional speckle-tracking echocardiography. Indices derived from strain accepted as suggestive of cardiac amyloidosis were calculated (RELAPS: relative apical sparing: defined using the equation (average apical LS/(average basal LS + mid-LS); ­­Eyection Fraction strain ratio (EFSR= LVEF/GLS). Scintigraphy with technetium pyrophosphate99 and blood protein electrophoresis were performed in all patients for the diagnosis / exclusion of cardiac amyloidosis. RESULTS The mean age was 80 ± 7 years, and 52% were women. The mean aortic valvular area was 0.6 ± 0.1 cm2 and the left ventricular ejection fraction (LVEF) was 56 ± 16%. 19 patients (45.2%) presented a pattern of relative apical sparing of LV longitudinal strain (RELAPS&amp;gt; 1); and 16 patients (38%) showed an EFSR&amp;gt; 4.1. Cardiac amyloidosis was excluded in all patients. In the univariate analysis, RELAPS&amp;gt; 1 was significantly associated with higher degree of LV hypertrophy, lower LV end-diastolic volume, and greater myocardial contraction fraction. CONCLUSIONS. In our series, patients with severe symptomatic AS have with high frequency a "relative apical sparing" longitudinal strain pattern and Eyection Fraction Strain Ratio similar to those described in cardiac amyloidosis. Our results suggest that the classic patterns of cardiac amyloidosis are common in patients with severe AS in the absence of said pathology, findings that we believe may have important clinical implications. Abstract 1024 Figure. Peak systolic LS patterns in severe AS

Left ventricular and atrial strain imaging with cardiac computed tomography: Validation against echocardiography

BackgroundData on left ventricular (LV) deformation imaging using CT angiography (CTA) are scarce and the feasibility of atrial deformation analysis by CT has not been addressed. We aimed to compare 2D echocardiographic and CT derived LV and left atrial (LA) global longitudinal strain (GLS) obtained by using a novel feature tracking algorithm in patients following transcatheter aortic valve implantation. MethodsTwenty-eight patients were included who underwent retrospectively-gated 256-slice CTA and speckle-tracking echocardiography (STE) on the same day. CT datasets in 10% increments were reconstructed throughout the cardiac cycle. LV GLS and LA global peak reservoir strain (LA GS) was measured. ResultsMedian absolute values for LV GLS were 19.9 [14.8–22.4] vs. 19.9 [16.8–24.7], as measured by CT vs STE, respectively (p = 0.017). We found good inter-modality correlation for LV GLS (ρ = 0.78, p < 0.05) with a mean bias of −1.6. Regarding atrial measurements, the median LA GS was 19.0 [13.5–27.3] for CT vs. 28.0 [17.5–32.6] for STE (p < 0.001) with a mean bias of −5.6 between CT and STE and a correlation coefficient of ρ = 0.87, p < 0.001. CT measurements were highly reproducible: intra-observer intra-class correlation coefficient was 0.96 for LV GLS and 0.95 for LA GS. ConclusionWe detected good correlation between CTA and echocardiography-based LV and LA longitudinal strain parameters. CTA provides accurate strain measurements with high reproducibility. Feature tracking-based deformation analysis could provide a clinically important addition to CT examinations by complementing anatomical information with functional data.

Left Ventricular Deformation in Patients with Connective Tissue Disease: Evaluated by 3.0T Cardiac Magnetic Resonance Tissue Tracking

The aim of this study was to assess left ventricular (LV) myocardial strain in patients with connective tissue disease (CTD) and compare LV deformation between subgroups of idiopathic inflammatory myopathy (IIM) and non-IIM. Ninety-eight patients with CTD, comprising 56 with IIM and 42 with non-IIM, and 30 healthy subjects were enrolled and underwent 3.0T cardiac magnetic resonance imaging (MRI) scanning. The LV function and strain parameters were measured and assessed. Our result revealed that CTD patients had preserved LV ejection fraction (60.85%) and had significantly decreased global and regional peak strain (PS) in radial, circumferential, and longitudinal directions (all p < 0.05). IIM patients showed significantly reduced global longitudinal PS (GLPS) and longitudinal PS at apical slice, whereas all strain parameters decreased in non-IIM patients. Except GLPS and longitudinal PS at apical slice, all strain parameters in non-IIM patients were lower than those in IIM patients. By Pearson’s correlation analysis, the LV global radial and circumferential PS were correlated to N-terminal pro-brain natriuretic peptide level and LV ejection fraction in both IIM and non-IIM patients. This study indicated that CTD patients showed abnormal LV deformation despite with preserved LVEF. The impairment of LV deformation differed between IIM and non-IIM patients.

A speckle-tracking strain-based artificial neural network model to differentiate cardiomyopathy type

Objectives. In heart failure, invasive angiography is often employed to differentiate ischaemic from non-ischaemic cardiomyopathy. We aim to examine the predictive value of echocardiographic strain features alone and in combination with other features to differentiate ischaemic from non-ischaemic cardiomyopathy, using artificial neural network (ANN) and logistic regression modelling. Design. We retrospectively identified 204 consecutive patients with an ejection fraction <50% and a diagnostic angiogram. Patients were categorized as either ischaemic (n = 146) or non-ischaemic cardiomyopathy (n = 58). For each patient, left ventricular strain parameters were obtained. Additionally, regional wall motion abnormality, 13 electrocardiographic (ECG) features and six demographic features were retrieved for analysis. The entire cohort was randomly divided into a derivation and a validation cohort. Using the parameters retrieved, logistic regression and ANN models were developed in the derivation cohort to differentiate ischaemic from non-ischaemic cardiomyopathy, the models were then tested in the validation cohort. Results. A final strain-based ANN model, full feature ANN model and full feature logistic regression model were developed and validated, F1 scores were 0.82, 0.79 and 0.63, respectively. Conclusions. Both ANN models were more accurate at predicting cardiomyopathy type than the logistic regression model. The strain-based ANN model should be validated in other cohorts. This model or similar models could be used to aid the diagnosis of underlying heart failure aetiology in the form of the online calculator (https://cimti.usj.edu.lb/strain/index.html) or built into echocardiogram software.

Effect of the Single-Pill Amlodipine/Valsartan Combination on Hypertrophy and Myocardial Deformation Characteristics in Middle-Aged Patients with Essential Arterial Hypertension

Aim. To investigate the impact of amlodipine/valsartan single-pill combination (A/V SPC) on left ventricular hypertrophy (LVH) and left ventricular (LV) myocardial strain and stiffness parameters in naїve middle-aged patients with stage II grade 1-2 essential arterial hypertension (EAH).Material and methods. A group of patients with stage II grade 1-2 EAH who had not previously received regular antihypertensive treatment (AHT) [n=38; mean age 49.7±7.0 years] was retrospectively formed. All the patients were treated with A/V SPC and all of them achieved target office blood pressure (BP) (less than 140/90 mm Hg). And after 12 weeks follow-up (since the time of reaching the target BP) the AHT effectiveness assessment, its impact on LVH and LV myocardial strain and stiffness parameters (general clinical data, ambulatory blood pressure monitoring, conventional and 2D-speckle tracking echocardiography) were performed in all included patients.Results. The number of patients with LVH significantly (p=0.039) decreased from 25 individuals (65.8%) at baseline to 15 patients (39.5%) at the end of follow-up. Among patients with LVH at baseline after the treatment with A/V SPC significantly decreased (p&lt;0.001 for all) interventricular septum thickness (from 1.36±0.19 to 1.28±0.18 cm), LV posterior wall thickness (from 1.08±0.09 to 0.97±0.11 cm) and the LV myocardial mass index (from 123.3±19.3 to 110.8±20.8 g/m2). At the end of follow-up end-systolic elastance significantly (p&lt;0.001) decreased from 4.01±1.12 to 3.46±0.88 mm Hg/ml. In the subgroup of patients with reduced (in absolute value) LV longitudinal 2D-strain (n=27) at baseline, there was a significantly (p=0.005) increasing in this parameter at the end of the study (from -16.14±2.21% to -17.30±2.13%, Δ%=8.45±13.35).Conclusion. In naive patients 40-65 years old with stage II grade 1-2 EAH AHT with A/V SPC provides effective 24 hours BP control, significantly reduced LVH and improves LV strain parameters, which indicates decreasing of LV myocardial stiffness.

Evaluation of myocardial mechanical changes in patients with acute myocardial infarction before and after percutaneous coronary intervention by speckle tracking technique

Objective To evaluate the changes of myocardial mechanics before and after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI) by ultrasonic speckle tracking technique, and investigate the recovery of left ventricular myocardium mechanics and the effects of common complications on the improvement of myocardial mechanics. Methods Sixty-two patients with AMI were examined by echocardiography within 12 hours, 1 week and 3 months after PCI. According to the complications the patients were divided into simple AMI group (21 cases), AMI with diabetes mellitus group (21 cases), and AMI with hypertension group (20 cases). Thirty healthy volunteers were selected as control group. Conventional echocardiographic parameters and left ventricular strain parameters were evaluated in all subjects. Results ①Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV) in each AMI group before PCI were greater than the control group (P 0.05 ). ③The degree of improvement of global longitudinal and circumferential endocardial strain in AMI with diabetes group were less than those in simple AMI group(P<0.05). The degree of improvement of global longitudinal endocardial strain in AMI with hypertension group was less than that in simple AMI group (P<0.05). Conclusions Patients with AMI have poor myocardial mechanics before PCI, especially those with diabetes mellitus; myocardial mechanics improves significantly 3 months after PCI; diabetes mellitus or hypertension affectes the improvement of myocardial mechanics in patients with AMI after PCI. Key words: Echocardiography; Acute myocardial infarction; Speckle tracking; Myocardial mechanics

Association of cardiovascular magnetic resonance-derived circumferential strain parameters with the risk of ventricular arrhythmia and all-cause mortality in patients with prior myocardial infarction and primary prevention implantable cardioverter defibrillator

BackgroundImpaired left ventricular (LV) contraction and relaxation may further promote adverse remodeling and may increase the risk of ventricular arrhythmia (VA) in ischemic cardiomyopathy. We aimed to examine the association of cardiovascular magnetic resonance (CMR)-derived circumferential strain parameters for LV regional systolic function, LV diastolic function and mechanical dispersion with the risk of VA in patients with prior myocardial infarction and primary prevention implantable cardioverter defibrillator (ICD).MethodsPatients with an ischemic cardiomyopathy who underwent CMR prior to primary prevention ICD implantation, were retrospectively identified. LV segmental circumferential strain curves were extracted from short-axis cine CMR. For LV regional strain analysis, the extent of moderately and severely impaired strain (percentage of LV segments with strain between − 10% and − 5% and > − 5%, respectively) were calculated. LV diastolic function was quantified by the early and late diastolic strain rate. Mechanical dispersion was defined as the standard deviation in delay time between each strain curve and the patient-specific reference curve. Cox proportional hazard ratios (HR) (95%CI) were calculated to assess the association between LV strain parameters and appropriate ICD therapy.ResultsA total of 121 patients (63 ± 11 years, 84% men, LV ejection fraction (LVEF) 27 ± 9%) were included. During a median (interquartile range) follow-up of 47 (27;69) months, 30 (25%) patients received appropriate ICD therapy. The late diastolic strain rate (HR 1.1 (1.0;1.2) per − 0.25 1/s, P = 0.043) and the extent of moderately impaired strain (HR 1.5 (1.0;2.2) per + 10%, P = 0.048) but not the extent of severely impaired strain (HR 0.9 (0.6;1.4) per + 10%, P = 0.685) were associated with appropriate ICD therapy, independent of LVEF, late gadolinium enhancement (LGE) scar border size and acute revascularization. Mechanical dispersion was not related to appropriate ICD therapy (HR 1.1 (0.8;1.6) per + 25 ms, P = 0.464).ConclusionsIn an ischemic cardiomyopathy population referred for primary prevention ICD implantation, the extent of moderately impaired strain and late diastolic strain rate were associated with the risk of appropriate ICD therapy, independent of LVEF, scar border size and acute revascularization. These findings suggest that disturbed LV contraction and relaxation may contribute to an increased risk of VA after myocardial infarction.

Evaluation of the effects of right ventricular pressure load on left ventricular myocardial mechanics in patients with chronic obstructive pulmonary disease by ultrasound speckle tracking imaging.

This paper aims to evaluate the effects of right ventricular pressure load on left ventricular myocardial mechanics in patients with chronic obstructive pulmonary disease (COPD) by ultrasound speckle tracking imaging. 119 patients with COPD and pulmonary hypertension (PH) were selected from December 2016 to March 2018 in Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University. 42 healthy subjects were selected as control group. According to the pulmonary arterial systolic pressure (PASP), 41 patients were classified into mild group, 47 in moderate group, and 31 cases in severe group. Echocardiography and STI were used to measure the indexes. Compared with those in control group, EI and E/e of moderate group and severe group increased significantly (p<0.001). Compared with those in control group, parameters in moderate and severe groups significantly decreased (p<0.001), including early diastolic mitral annular velocity/late peak blood flow velocity (E/A), left ventricular end diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), PASP and left ventricular end-diastolic diameter (LVEDD), stroke volume (SV), left ventricular end-systolic diameter (LVESD), cardiac output (CO), peak rotation angle and peak time of in the basal and apical segments. Compared with those in control group, parameters in moderate group significantly decreased (p<0.001), including left ventricular strain parameters segmental systolic peak longitudinal strain (LS), circumferential strain (CS), and radial strain (RS). Compared with those in control group, parameters in mild group significantly decreased (p<0.001), including peak rotation angle of basal segment and apical segment of the left ventricle. Compared with those in moderate group, peak rotation angle and peak time of the whole basal segment and apical segment of severe group gradually decreased (p<0.001). Left ventricular whole peak rotation angle can be used to sensitively evaluate the change of left ventricular myocardial mechanics function in PH patients, and can reflect changes of left ventricular myocardial mechanics function in patients with COPD when mild PH occurs.

OP-375 - Relation between Thyroid Stimulating Hormone and Left Ventricular Strain Parameters in Patients with Subclinical Hypothyroidism

OP-375 - Relation between Thyroid Stimulating Hormone and Left Ventricular Strain Parameters in Patients with Subclinical Hypothyroidism

Cardiac magnetic resonance evaluation of left ventricular functional, morphological, and structural features in children and adolescents vs. young adults with isolated left ventricular non-compaction

AimTo investigate the left ventricular (LV) functional, morphological, and structural features revealed by cardiac magnetic resonance (CMR) in children/adolescents with isolated LV non-compaction (iLVNC), and to compare them with those observed in young adults with iLVNC and healthy controls. Methods56 subjects were included: 12 children/adolescents (mean age 15±3years, 75% male) and 20 young adults (mean age 35±7years, 75% male) with first diagnosis of iLVNC, 12 healthy children/adolescents (mean age 15±3years, 75% male) and 12 healthy young adults (mean age 34±8years, 75% male). CMR with late gadolinium enhancement (LGE) imaging was performed to evaluate LV function, extent of LV trabeculation, and presence/extent of LV LGE, a surrogate of myocardial fibrosis. Tissue-tracking analysis was applied to assess LV global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain. ResultsThe extent of LVNC and the presence/extent of LV LGE in children/adolescents and young adults with iLVNC were similar. Compared to healthy subjects, young adults with iLVNC had significantly lower LVEF; conversely, no significant difference in this parameter was observed between children/adolescents with iLVNC and healthy subjects. However, compared to healthy subjects, LV strain parameters were lower in both children/adolescents and young adults with iLVNC. ConclusionsComplete phenotypic expression, subclinical impairment of myocardial deformation properties, and cardiac injury occur early in iLVNC patients, being already noticeable in the pediatric age group. The application of CMR myocardial deformation imaging permits earlier detection of LV functional impairment in children/adolescents with iLVNC, which would otherwise be missed with standard CMR imaging.

Longitudinal strain assessed by cardiac magnetic resonance correlates to hemodynamic findings in patients with severe aortic stenosis and predicts positive remodeling after transcatheter aortic valve replacement

AimsTo assess left-ventricular strain parameters before and after transcatheter aortic valve replacement (TAVR) by feature tracking cardiac magnetic resonance imaging (FT CMR) and to correlate the findings to hemodynamic state and left-ventricular remodeling.Methods and resultsPatients with symptomatic AS underwent FT CMR before and after TAVR. Patients were carefully evaluated by a comprehensive work-up including CMR, echocardiography and left and right heart catheterization. Thirty patients formed the study population. High-flow/high-gradient (HF/HG) aortic stenosis was diagnosed in 11 patients (36.7%), 6 patients (20.0%) exhibited low-flow/low-gradient AS (LF/LG) and 13 patients (43.3%) were classified to have so-called paradoxical low-flow/low-gradient (PLF/LG) AS. The HF/HG patients had a significantly reduced longitudinal strain which recovered after TAVR (−12.67 ± 4.60 to −15.46 ± 5.61%, p = 0.048). In the LF/LG group, an even more pronounced reduction of longitudinal strain and also an impairment of longitudinal velocity could be observed. Both parameters improved after therapy (strain: −5.06 ± 4.25 to −8.02 ± 3.28%, p = 0.045; velocity: 25.33 ± 9.63 to 37.13 ± 11.64 mm/s, p = 0.042). Patients with PLF/LG showed preserved longitudinal strain but a reduction of longitudinal velocity similar to the LF/LG group. These patients did not show a significant improvement of strain parameters after TAVR. Longitudinal velocity exhibited the highest predictive power for the identification of a low-flow state (sensitivity 75%, specificity 80%).ConclusionImprovement of longitudinal strain parameters after TAVR is dependent on the initial hemodynamically defined AS subgroup.

Short-Term Prognostic Value of Strain Echocardiography in Patients with STEMI

Objectives: Left ventricular (LV) systolic function is major predictor of outcome after acute myocardial infarction (AMI). In recent years, speckle-tracking echocardiography (STE) derived strain measurement has been demonstrated to directly reflect myocardial deformation patterns and to be superior to conventional echocardiographic measurements. Our study aimed to reveal the prognostic value of strain parameters for 30-day mortality in patients with ST elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Methods: We prospectively included patients with STEMI after primary PCI treatment. The primary endpoint was 30-day mortality. 2D STE was used to determine LV strain parameters. Results: 414 patients were selected. 30-day mortality occurred in 15 patients (3.6%). LV global longitudinal strain (GLS) was significantly impaired in the 30-day mortality group compared with survivors (-8.0±2.6% vs. -15.4±3.8%, p&lt;0.001). Multivariate regression revealed that LV GLS was independently associated with 30-day mortality (OR 1.71, 95% CI 1.23-2.38, p&lt;0.001). Adding GLS into the clinical and echocardiographic model improved model performance. Conclusion:The LV GLS parameter is an independent predictor of 30-day mortality in patients with STEMI after primary PCI treatment. Adding LV GLS into the prediction model improved its predictive performance.

Assessment of left ventricular deformation in patients with Ebstein’s anomaly by cardiac magnetic resonance tissue tracking

PurposeThe aim of this study was to clarify the feasibility of myocardial strain using cardiovascular magnetic resonance (CMR) for the evaluation of left ventricular (LV) deformation in patients with Ebstein’s anomaly (EA). Materials and methodsWe recruited 32 patients with EA and 30 controls for CMR examination and measured LV function, dimension and tissue tracking parameters (the global and regional radial, circumferential and longitudinal peak strain), together with the right ventricle (RV) dimension. LV strain parameters were compared among the controls, patients with preserved LV ejection fraction (LVEF; ≥55%), and patients with reduced LVEF (<55%). Pearson’s correlation was used to evaluate relationships between tissue tracking parameters with the RVEDD/LVEDD index and LVEF. An ROC analysis was also performed to determine whether the cut-off values for PS could be used to differentiate LV dysfunction between patients with EA and controls. The intraclass correlation coefficient (ICC) was used to assess the inter- and intra-observer variability. ResultsThe global strain parameters all decreased significantly in the EA group compared with the control group (all P<0.05). Furthermore, the global radial and circumferential peak strain (PS) were obviously even lower in the reduced LVEF group than the strain measured in preserved LVEF groups (28.64% vs. 37.39%, p<0.05; and −8.20% vs. −17.89%; p<0.05; respectively). The regional strain abnormalities in EA patients were mainly involved in basal and middle segments. The results also demonstrated a significant correlation between the ratio of the RV end-diastolic dimension to the LV end-diastolic dimension (RVEDD/LVEDD index) with the global circumferential PS (r=0.508) and the longitudinal PS (r=0.474), as well as a good correlation between radial PS and LVEF (r=0.465). The ICCs for intra- and inter-observer variability were 0.797–0.904 and 0.701–0.896. ConclusionsLV strain serves an earlier and more comprehensive measurement of LV dysfunction than LVEF in EA, which could potentially be included as a supplementary diagnostic procedure in the evaluation of EA.