Left Ventricular Systolic Strain Research Articles

ELUCIDATE Trial: A Single-Center Randomized Controlled Study.

Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, is an epochal oral antidiabetic drug that improves cardiorenal outcomes. However, the effect of early dapagliflozin intervention on left ventricular (LV) remodeling in patients with type 2 diabetes free from cardiovascular disease remains unclear. The ELUCIDATE trial was a prospective, open-label, randomized, active-controlled study that enrolled 76 patients with asymptomatic type 2 diabetes with LV ejection fraction ≥50%, randomized to the dapagliflozin 10 mg/day add-on or standard-of-care group. Speckle-tracking echocardiography-based measurements of the cardiac global longitudinal strain were performed at baseline and 24 weeks after treatment initiation. Patients who received dapagliflozin had a greater reduction in LV dimension (1.68 mm [95% CI, 0.53-2.84]; P=0.005), LV end-systolic volume (5.51 mL [95% CI, 0.86-10.17]; P=0.021), and LV mass index (4.25 g/m2.7 [95% CI, 2.42-6.09]; P<0.0001) compared with standard of care in absolute mean differences. Dapagliflozin add-on therapy led to a significant LV global longitudinal strain increment (0.74% [95% CI, 1.00-0.49]; P<0.0001) and improved LV systolic and early diastolic strain rates (0.27/s [95% CI, 0.17-0.60]; and 0.11/s [95% CI, 0.06-0.16], respectively; both P<0.0001) but not in global circumferential strain. No significant changes were found in insulin resistance, NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, or other biomarkers at 6 months after the dapagliflozin administration. Dapagliflozin add-on therapy could lead to more favorable cardiac remodeling accompanied by enhanced cardiac mechanical function among patients with asymptomatic type 2 diabetes. Our findings provide evidence of the efficacy of dapagliflozin use for the primary prevention of diabetic cardiomyopathy. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03871621.

Glycemic control and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: insight from ventricular remodeling using cardiac MRI

BackgroundGlycemic control, as measured by glycosylated hemoglobin (HbA1c), is an important biomarker to evaluate diabetes severity and is believed to be associated with heart failure development. Type 2 diabetes mellitus (T2DM) and heart failure with reduced ejection fraction (HFrEF) commonly coexist, and the combination of these two diseases indicates a considerably poorer outcome than either disease alone. Therefore, glycemic control should be carefully managed. The present study aimed to explore the association between glycemic control and clinical outcomes, and to determine the optimal glycemic target in this specific population.MethodsA total of 262 patients who underwent cardiac MRI were included and were split by HbA1c levels [HbA1c < 6.5% (intensive control), HbA1c 6.5-7.5% (modest control), and HbA1c > 7.5% (poor control)]. The biventricular volume and function, as well as left ventricular (LV) systolic strains in patients in different HbA1c categories, were measured and compared. The primary and secondary outcomes were recorded. The association of different HbA1c levels with adverse outcomes was assessed.ResultsDespite similar biventricular ejection fractions, both patients with intensive and poor glycemic control exhibited prominent deterioration of LV systolic strain in the longitudinal component (P = 0.004). After a median follow-up of 35.0 months, 55 patients (21.0%) experienced at least one confirmed endpoint event. Cox multivariable analysis indicated that both patients in the lowest and highest HbA1c categories exhibited a more than 2-fold increase in the risk for primary outcomes [HbA1c < 6.5%: hazard ratio (HR) = 2.42, 95% confidence interval (CI) = 1.07–5.45; P = 0.033; HbA1c > 7.5%: HR = 2.24, 95% CI = 1.01–4.99; P = 0.038] and secondary outcomes (HbA1c < 6.5%: HR = 2.84, 95% CI = 1.16–6.96; P = 0.022; HbA1c > 7.5%: HR = 2.65, 95% CI = 1.08–6.50; P = 0.038) compared with those in the middle HbA1c category.ConclusionsWe showed a U-shaped association of glycemic control with clinical outcomes in patients with T2DM and HFrEF, with the lowest risk of adverse outcomes among patients with modest glycemic control. HbA1c between 6.5% and 7.5% may be served as the optimal hypoglycemic target in this specific population.

Evaluation of Left Ventricular Function in Patients With Severe Aortic Stenosis Utilizing Automated Cardiac Motion Quantitation Techniques

ObjectiveThe objective of this study is to explore the patterns of alteration in left ventricular systolic function among patients with severe aortic stenosis (SAS) through the application of automatic myocardial motion quantification (aCMQ) techniques. Furthermore, we seek to ascertain dependable quantitative markers for the assessment of impaired left ventricular function in patients with SAS and an ejection fraction (EF) ≥ 60%. MethodsSeventy patients who underwent echocardiography and received a diagnosis of severe aortic stenosis (SAS) in the hospital from November 2021 to August 2022 were selected for the SAS group and categorized into three subgroups based on ejection fraction (EF)—SAS group with EF ≥ 60%, SAS group with EF ranging from 50% to 59%, and SAS group with EF < 50%. Concurrently, 30 healthy individuals were recruited at the hospital during the same timeframe to serve as the control group. Participants from both groups underwent standard transthoracic echocardiography to assess conventional echocardiographic parameters. Dynamic images were examined using automatic myocardial motion quantification (aCMQ) software to derive longitudinal peak strain (LPS) parameters, which were then subjected to statistical analysis. ResultsIn comparison to the control group participants, the measurements of ascending aorta diameter (AoD), left atrium diameter (LAD), interventricular septal end diastolic thickness (IVSd), left ventricular posterior wall end diastolic thickness (LVPWd), peak systolic velocity (Vmax), and mean pressure gradient (MPG) were significantly higher in the SAS groups (p < 0.05). When compared to participants in the SAS group with an EF ≥ 60%, the values of IVSd, LVPWd, Vmax, and MPG in the SAS group with EF ranging from 50% to 59% were significantly elevated (p < 0.05). Similarly, left ventricular end-diastolic diameter (LVEDD), the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e'), and the ratio of early to late diastolic mitral inflow velocities (E/A) in the SAS group with EF < 50% were significantly elevated (p < 0.05). The absolute values of longitudinal peak strain (LPS) in the SAS groups were significantly lower in comparison to those in the control group (p < 0.05). Furthermore, all measurements of left ventricular global longitudinal systolic peak strain (GLPS) showed a positive correlation with MPG, a moderate negative correlation with aortic valve area index (AVAI), and a moderate positive correlation with E/A. ConclusionsPatients with SAS and an EF < 50% exhibited the most profound impairment in left ventricular myocardial function. Utilizing the aCMQ technique enables the precise and quantitative evaluation of the severity of impaired left ventricular systolic function in patients within the SAS group with an EF ≥ 60%.

Investigation of left ventricular strain by speckle-tracking echocardiography in patients with chronic obstructive pulmonary disease with preserved ejection fraction

Objective: To investigate the left ventricular strain parameters by speckle - tracking echocardiography in patients with chronic obstructive pulmonary disease with preserved ejection fraction. Find out the correlations and relationships between strain parameters with some conventional left ventricular echocardiographic indictors, Pulmonary artery pressure systolic, TAPSE index. Materials and methods: A controlled cross-sectional descriptive study consisted of 51 patients with chronic obstructive pulmonary disease diagnosed according to GOLD 2023. The control group consisted of 52 people with normal lung function. Results: Values ​​of strain parameters on speckle - tracking echocardiography in patients with COPD: GLS (%): -13.52 ± 1.77; GLSR (1/s): -1.64 ± 0.28; GCS (%): -22.07 ± 2.27; GCSR (1/s): -2.70 ± 0.38; longitudinal - circumference index: -17.80 ± 1.71; EF STE (%): 54.21 ± 4.23. These parameters were all reduced compared with the control group with p &lt; 0.05 while there was no statistically significant change of the indices on routine echocardiography. There was no correlation between the parameters of left ventricular systolic strain and the LVMI, FS and LVEF values ​​measured by M-Mode. Meanwhile, there is a positive correlation with PAPs (r = 0.499 - 0.629, p&lt;0.001). There is a negative correlation between GLS and TAPSE index (r = -0.311, p &lt; 0.001). Conclusion: Speckle - tracking echocardiography helps in early detection of cardiac dysfunction, especially left ventricular systolic function in patients with chronic obstructive pulmonary disease even when EF is normal. Key words: chronic obstructive pulmonary disease, Speckle tracking echocardiography.

Diagnostic capabilities of instrumental methods for studying early cardiovascular adverse events in patients with lymphoproliferative disorders, quality and safety issues

Aim. To study the possibilities of instrumental research methods in relation to the earliest detection of cardiovascular events in oncohematological patients receiving antitumor immunochemotherapy, as well as to deter­mine the requirements for documenting adverse events.Material and methods. For the study, 63 patients were prospectively selected with a diagnosis of indolent non-Hodgkin lymphoma, who were indicated for antitumor immunochemotherapy. The patients were examined in three stages (before treatment, after 3 and 6 cycles of therapy) and divided into 2 groups by simple randomization. Cardiovascular toxicity in the main group of patients was assessed using 3D transthoracic echocardiography, analysis of left ventricular (LV) global longitudinal systolic strain and electrocardiography. The control group underwent a standard 3D echocardiography with analysis of LV ejection fraction. Clinical manifestations of cardiovascular events were assessed in all patients during treatment.Results. According to the study, significant changes were obtained in LV ejection fraction on the third visit — a decrease from 58,9±1,07 to 48,1±0,73% (p&lt;0,05) and from 57,7±1,13 to 49,4±0,58% (p&lt;0,05) in patients of the main and control groups and global longitudinal LV strain from |21,1±1,18 to |14,0±1,61 |% (p&lt;0,05) in patients of the main group. A mixed clinical phenotype of cardiovascular toxicity was the most common among all patients. An integrated approach to the early diagnosis of cardiovascular events makes it possible to identify a larger percentage of patients with subclinical myocardial dysfunction.Conclusion. The long period of latent cardiovascular toxicity emphasizes the need for early verification of cardiovascular complications of antitumor therapy and expansion of the established paraclinical diagnostic minimum. In addition, taking into account the accumulated experience, recommendations are presented for the preparation of medical documentation in order to ensure the safety and quality of care.

Reduced thoracic skeletal muscle size is associated with adverse outcomes in diabetes patients with heart failure and reduced ejection fraction: quantitative analysis of sarcopenia by using cardiac MRI

BackgroundSarcopenia is frequently found in patients with heart failure with reduced ejection fraction (HFrEF) and is associated with reduced exercise capacity, poor quality of life and adverse outcomes. Recent evidence suggests that axial thoracic skeletal muscle size could be used as a surrogate to assess sarcopenia in HFrEF. Since diabetes mellitus (DM) is one of the most common comorbidities with HFrEF, we aimed to explore the potential association of axial thoracic skeletal muscle size with left ventricular (LV) remodeling and determine its prognostic significance in this condition.MethodsA total of 243 diabetes patients with HFrEF were included in this study. Bilateral axial thoracic skeletal muscle size was obtained using cardiac MRI. Patients were stratified by the tertiles of axial thoracic skeletal muscle index (SMI). LV structural and functional indices, as well as amino-terminal pro-B-type natriuretic peptide (NT-proBNP), were measured. The determinants of elevated NT-proBNP were assessed using linear regression analysis. The associations between thoracic SMI and clinical outcomes were assessed using a multivariable Cox proportional hazards model.ResultsPatients in the lowest tertile of thoracic SMI displayed a deterioration in LV systolic strain in three components, together with an increase in LV mass and a heavier burden of myocardial fibrosis (all P < 0.05). Moreover, thoracic SMI (β = -0.25; P < 0.001), rather than body mass index (β = -0.04; P = 0.55), was independently associated with the level of NT-proBNP. The median follow-up duration was 33.6 months (IQR, 20.4–52.8 months). Patients with adverse outcomes showed a lower thoracic SMI (40.1 [34.3, 47.9] cm2/m2 vs. 45.3 [37.3, 55.0] cm2/m2; P < 0.05) but a similar BMI (P = 0.76) compared with those without adverse outcomes. A higher thoracic SMI indicated a lower risk of adverse outcomes (hazard ratio: 0.96; 95% confidence interval: 0.92–0.99; P = 0.01).ConclusionsWith respect to diabetes patients with HFrEF, thoracic SMI is a novel alternative for evaluating muscle wasting in sarcopenia that can be obtained by a readily available routine cardiac MRI protocol. A reduction in thoracic skeletal muscle size predicts poor outcomes in the context of DM with HFrEF.

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.

Feature-based clustering of the left ventricular strain curve for cardiovascular risk stratification in the general population

ObjectiveIdentifying individuals with subclinical cardiovascular (CV) disease could improve monitoring and risk stratification. While peak left ventricular (LV) systolic strain has emerged as a strong prognostic factor, few studies have analyzed the whole temporal profiles of the deformation curves during the complete cardiac cycle. Therefore, in this longitudinal study, we applied an unsupervised machine learning approach based on time-series-derived features from the LV strain curve to identify distinct strain phenogroups that might be related to the risk of adverse cardiovascular events in the general population.MethodWe prospectively studied 1,185 community-dwelling individuals (mean age, 53.2 years; 51.3% women), in whom we acquired clinical and echocardiographic data including LV strain traces at baseline and collected adverse events on average 9.1 years later. A Gaussian Mixture Model (GMM) was applied to features derived from LV strain curves, including the slopes during systole, early and late diastole, peak strain, and the duration and height of diastasis. We evaluated the performance of the model using the clinical characteristics of the participants and the incidence of adverse events in the training dataset. To ascertain the validity of the trained model, we used an additional community-based cohort (n = 545) as external validation cohort.ResultsThe most appropriate number of clusters to separate the LV strain curves was four. In clusters 1 and 2, we observed differences in age and heart rate distributions, but they had similarly low prevalence of CV risk factors. Cluster 4 had the worst combination of CV risk factors, and a higher prevalence of LV hypertrophy and diastolic dysfunction than in other clusters. In cluster 3, the reported values were in between those of strain clusters 2 and 4. Adjusting for traditional covariables, we observed that clusters 3 and 4 had a significantly higher risk for CV (28% and 20%, P ≤ 0.038) and cardiac (57% and 43%, P ≤ 0.024) adverse events. Using SHAP values we observed that the features that incorporate temporal information, such as the slope during systole and early diastole, had a higher impact on the model's decision than peak LV systolic strain.ConclusionEmploying a GMM on features derived from the raw LV strain curves, we extracted clinically significant phenogroups which could provide additive prognostic information over the peak LV strain.

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&amp;lt;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 &amp;lt;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.

Right and left ventricular cardiac magnetic resonance imaging derived peak systolic strain is abnormal in children with myocarditis.

Cardiac Magnetic resonance (CMR) derived left ventricular longitudinal and circumferential strain is known to be abnormal in myocarditis. CMR strain is a useful additional tool that can identify subclinical myocardial involvement and may help with longitudinal follow-up. Right ventricular strain derived by CMR in children has not been studied. We sought to evaluate CMR derived biventricular strain in children with acute myocarditis. Children with acute myocarditis who underwent CMR between2016-2022 at our center were reviewed, this group included subjects with COVID-19 myocarditis. Children with no evidence of myocarditis served as controls Those with congenital heart disease and technically limited images for CMR strain analysis were excluded from final analysis. Biventricular longitudinal, circumferential, and radial peak systolic strains were derived using circle cvi42®. Data between cases and controls were compared using an independent sample t-test. One-way ANOVA with post hoc analysis was used to compare COVID-19, non-COVID myocarditis and controls. 38 myocarditis and 14 controls met inclusion criteria (mean age14.4 ± 3 years). All CMR derived peak strain values except for RV longitudinal strain were abnormal in myocarditis group. One-way ANOVA revealed that there was a statistically significant difference with abnormal RV and LV strain in COVID-19 myocarditis when compared to non-COVID-19 myocarditis and controls. CMR derived right and left ventricular peak systolic strain using traditionally acquired cine images were abnormal in children with acute myocarditis. All strain measurements were significantly abnormal in children with COVID-19 even when compared to non-COVID myocarditis.

Value of Transthoracic Echocardiography in Predicting Short Term Major Adverse Cardiac Events after ST Elevation Myocardial Infarction in COVID 19 Era

Abstract Background Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide. In the era of COVID 19, early risk stratification and identification of high-risk patients with ST-segment elevation myocardial infarction are of great significance in prognosis, and in guiding diagnosis and treatment decisions. Measuring left ventricular peak systolic global longitudinal strain may be a useful addition to ejection fraction using echocardiography. Aim of the Study Is to evaluate different parameters of echocardiography in predicting major adverse cardiac events in patients after acute ST-segment elevation myocardial infarction in the era of Covid 19. Methods and patients This study included 97 patients who presented with acute STsegment elevation myocardial infarction within 12 hours of onset of chest pain and managed by primary percutaneous coronary intervention, it was performed in Ain Shams university hospitals from January 2021 to June 2021. Echocardiography was used to measure ejection fraction and left ventricular strain parameters Results The study included 97 patients, 55 % of which presented with anterior STEMI. Out of the whole group 29 patients (21%) developed MACE at 3 months follow up. Within the whole group, the mean ejection fraction was (44.04±6.07% VS .40.07±6.52% p = 0.007) and the mean global longitudinal strain was (-12.56±3.61% VS -10.1±3.25% p=0.002). Based on CT chest finding, 33 patients were Covid 19 patients who were younger in age, included significantly more females and had significantly higher Killip score as compared to the non covid patients. Among COVID-19 patients, the mean ejection fraction was (46.11±5.29% VS 40.6±7.11% p=0.02) and the mean global longitudinal strain was (-13.17±3.35% VS 10.35±3.38% p=0.026). At 3 months follow up, 39% of the Covid patients had MACE as compared to 25% of the non covid patients P = 0.0001. Conclusion In the era of COVID 19, young patients with female gender who suffered from STEMI were more likely to be COVID 19 patients and were liable to develop MACE at 3 months follow up. However, their LV EF and GLS were comparable to non-COVID 19 patients Ethical approval this study protocol was approved by the local ethics committee with a consent was obtained from all participants. Abbreviations MACE: major adverse cardiac events; LV: left ventricle; GLS: global longitudinal strain; STEMI: ST elevation myocardial infarction

Assessment of Myocardial Function in Infants of Mothers with Gestational Diabetes Mellitus Using Deformation Imaging over the First Year of Age

To assess serial myocardial performance and pulmonary vascular resistance (PVR) in infants of mothers with gestational diabetes mellitus (GDM) over the first year of life. This was a prospective, observational study. Echocardiography was performed at birth, 6months, and 1year of age. Pulmonary artery acceleration time and left ventricular (LV) eccentricity index provided surrogate measurements of PVR. Biventricular function was assessed by tissue Doppler imaging and deformation analysis. Fifty infants of mothers with GDM were compared with 50 controls with no difference in gestation (38.9±0.8 weeks vs 39.3±0.9weeks; P=.05) or birthweight (3.55±0.49 kg vs 3.56±0.41kg; P=.95). At 1 year of age, the pulmonary artery acceleration time was lower (70±11 vs 79±10; P=.01) in the GDM group. LV global longitudinal strain (24.7±1.9 vs 28.8±1.8 %; P<.01), LV systolic strain rate (1.8±0.2 vs 2.1±0.3 1/s; P<.01), and RV free wall strain (31.1±4.8 vs 34.6±3.9 %; P<.01) were lower in the GDM cohort at 1year of age (all P values adjusted for gestation, mode of delivery, and maternal body mass index). Our findings demonstrate higher indices of PVR and lower biventricular function in infants ofmothers with GDM compared with controls at each time point assessed in this study over the first year of life.

Changes in cardiac hemodynamic parameters in patients after COVID-19

Aim. To study cardiac hemodynamic disorders in patients 3, 6 and 12 months after coronavirus disease 2019 (COVID-19).Material and methods. Sixty-six patients with bilateral pneumonia (mean age, 36,1 years), treated for COVID-19, underwent echocardiography, Doppler ultrasound of hepatolienal blood flow vessels after 3, 6, 12 months. Patients were divided into groups based on computed tomography (CT) data: group 1 — 21 patients with CT1, group 2 — 25 patients with CT2, group 3 — 20 patients with CT 3-4. In the 3rd group, 60% of patients had excessive weight. IBM SPSS Statistics Version 25.0 was used.Results. Three months after the disease in all groups, there was a impairment of diastolic parameters studied on the tricuspid valve. Patients of the 3rd group had pulmonary hypertension, an increase in splenic vein diameter, and the spleen area. After 6 and 12 months. in all groups, there was an improvement in right ventricular diastolic filling. In group 3, pulmonary artery systolic pressure after 6 months decreased by 6,0 (3,7; 6,5)% (p=0,03), after 1 year by another 8,6 (5,4; 9,1)% (p=0,017). The diameter of the inferior vena cava after 6 months decreased by 4,8 (2,0; 10,2)%, and a year later by another 5,0 (4,4; 6,1)% (p=0,001); the splenic vein diameter decreased after 6 months by 7,3 (3,2; 10,4)% (p=0,005). The left ventricular (LV) global systolic strain reduced after 3, 6 and 12 months.Conclusion. All patients 3 months after COVID-19 had cardiac hemodynamic disorders, which further by 6 and 12 months tend to normalize right ventricular diastolic filling. In patients with CT 3-4, by 12 months after the disease, normalization of pulmonary artery systolic pressure was also noted, a decrease in the diameter of the inferior vena cava and splenic veins, and a decrease in the global LV systolic strain persisted.

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

Four to seven year follow-up of pharmacological postconditioning with mangafodipir as an adjunct to primary PCI in ST-segment elevation myocardial infarction.

Adverse left ventricular remodelling (AR) develops over time in approximately 30 % of patients with a history of coronary artery disease. AR manifests as a structural change in the left ventricle (LV) in terms of increased volumes and reduced left ventricular ejection fraction (LVEF). Manganese dipyridoxyl diphosphate (mangafodipir) has demonstrated interesting cardioprotective features in acute myocardial ischemia. Pharmacological postconditioning (PP) with mangafodipir as an adjunct to primary percutaneous coronary intervention may possibly reduce the development of AR over time in ST-elevation myocardial infarction (STEMI). The aim of this four to seven year follow-up study is to investigate the potential benefits of PP with mangafodipir in STEMI patients. Thirteen out of the initial twenty patients that were included in the primary study of Karlsson et al. were followed up between April and June 2017. The study group underwent review of the hospital records, a clinical examination with ECG and blood sample analysis before cardiac magnetic resonance examination of the patient. LVEF, left ventricular diastolic volume, left ventricular end systolic volume, LV mass and myocardial strain in all directions were computed. The PP group showed a decrease in LV volume, mass and higher LVEF at follow-up (p < 0.05) while the individual response of the placebo group showed features that are seen in AR. Although there was no difference in myocardial strain, measurement for the PP-group was higher in absolute terms. Pharmacological postconditioning with mangafodipir in STEMI demonstrated cardioprotective features compared to the placebo group at follow-up. This article is protected by copyright. All rights reserved.

Machine Learning–Based Phenogrouping in MVP Identifies Profiles Associated With Myocardial Fibrosis and Cardiovascular Events

BackgroundStructural changes and myocardial fibrosis quantification by cardiac imaging have become increasingly important to predict cardiovascular events in patients with mitral valve prolapse (MVP). In this setting, it is likely that an unsupervised approach using machine learning may improve their risk assessment. ObjectivesThis study used machine learning to improve the risk assessment of patients with MVP by identifying echocardiographic phenotypes and their respective association with myocardial fibrosis and prognosis. MethodsClusters were constructed using echocardiographic variables in a bicentric cohort of patients with MVP (n = 429, age 54 ± 15 years) and subsequently investigated for their association with myocardial fibrosis (assessed by cardiac magnetic resonance) and cardiovascular outcomes. ResultsMitral regurgitation (MR) was severe in 195 (45%) patients. Four clusters were identified: cluster 1 comprised no remodeling with mainly mild MR, cluster 2 was a transitional cluster, cluster 3 included significant left ventricular (LV) and left atrial (LA) remodeling with severe MR, and cluster 4 included remodeling with a drop in LV systolic strain. Clusters 3 and 4 featured more myocardial fibrosis than clusters 1 and 2 (P < 0.0001) and were associated with higher rates of cardiovascular events. Cluster analysis significantly improved diagnostic accuracy over conventional analysis. The decision tree identified the severity of MR along with LV systolic strain <21% and indexed LA volume >42 mL/m2 as the 3 most relevant variables to correctly classify participants into 1 of the echocardiographic profiles. ConclusionsClustering enabled the identification of 4 clusters with distinct echocardiographic LV and LA remodeling profiles associated with myocardial fibrosis and clinical outcomes. Our findings suggest that a simple algorithm based on only 3 key variables (severity of MR, LV systolic strain, and indexed LA volume) may help risk stratification and decision making in patients with MVP. (Genetic and Phenotypic Characteristics of Mitral Valve Prolapse, NCT03884426; Myocardial Characterization of Arrhythmogenic Mitral Valve Prolapse [MVP STAMP], NCT02879825)

The 2-year postoperative left heart function in marginal donor heart recipients assessing by speckle tracking echocardiography.

This study analyzed the differences and explored the donor/recipient factors between marginal and standard donor heart recipients after heart transplantation (HT) by speckle tracking echocardiography (STE). Seventy-two HT patients were enrolled: 25 standard and 47 marginal donor heart recipients. Thirty HT patients completed 2-year continuous follow-up (1, 6, 12, 24months). Thirty healthy volunteers were controls. STE was used to track the strain characteristics of the left ventricle and atrium for detecting early changes in marginal donor heart recipients, including left ventricular global longitudinal, circumferential and radial strain (LVGLS, LVGCS, LVGRS) and left atrial strain in systole (LAS-S) and late diastole (LAS-A). The perioperative parameters were similar between the standard and marginal groups. No significant differences were found in left heart size, systolic and diastolic function parameters. Left ventricular systolic strain (LVGLS, LVGCS, LVGRS) and systolic and late diastolic left atrial strain (LAS-S, LAS-A) were lower in the HT recipients than the control group (P < 0.05), but there was no difference between the marginal and standard groups (P > 0.05). LVGLS, LVGCS, and LAS-S were low in the marginal group 1month after surgery but recovered gradually at 6months. The patients with donor/recipient body weight ratio < 0.8 group had lower LVGLS and LAS-S. STE showed no significant difference between marginal and standard donor recipients. The LVGLS and LAS-S were lower in those with a smaller donor/recipient body weight ratio. The cardiac function of HT patients was lower in the early postoperative period but gradually recovered over time.

Prognostic value of myocardial flow reserve in patients with heart failure with preserved ejection fraction

Aim. To study the prognostic value of myocardial blood flow (MBF) and myocardial flow reserve (MFR) parameters in patients with heart failure with preserved ejection fraction (HFpEF) and non-obstructive coronary artery disease (CAD) in risk stratification of HFpEF progression during a 12-month follow-up.Materials and methods. The study included 58 patients with non-obstructive CAD and HFpEF (LVEF 62 [58; 66]%). Dynamic CZT-SRECT was used to evaluate MFR and MBF at rest (rest-MBF) and stress (stress-MBF). NT-proBNP levels were determined by the enzyme immunoassay. Diastolic dysfunction parameters were measured using 2D transthoracic echocardiography. Left ventricular systolic global longitudinal strain (GLS) was assessed using 2D speckle tracking.Results. After a 12-month follow-up, the patients were retrospectively divided into 2 groups: group 1 (n = 11) included patients with an unfavorable course of HFpEF, group 2 (n = 47) encompassed patients with a favorable course of the disease. In group 1, the level of NT-proBNP was 3.8 times higher than in group 2 (284.5 [183.42; 716.73] and 1,071.4 [272.4; 2,168.1] pg / ml, respectively). MFR values in group 1 were lower by 45.4%(p &lt; 0.001) than in group 2 (1.19 [0.86; 1.55] vs. 2.18 [1.7; 2.55], respectively). In group 1, rest-MBF levels were higher by 23.6% (p = 0.046) and stress-MBF was lower by 28.2% (p = 0.046) than in group 2. The multivariate regression analysis revealed that NT-proBNP levels (odds ratio (OR) 3.23; p = 0.008), GLS (OR 2.27; p = 0.012), and MFR (OR 8.09; p &lt; 0.001) were independent predictors of adverse outcomes in HFpEF. Based on the ROC analysis, MFR levels ≤ 1.62 (AUC = 0.827; p &lt; 0.001), GLS ≤–18 (AUC = 0.756; p = 0.002), and NT-proBNP≥ 760.5 pg / ml (AUC = 0.708; p = 0.040) may be considered as markers of adverse outcomes. However, the combined determination of NT-proBNP and MFR had a greater significance (AUC 0.935; p &lt; 0.001) in risk stratification compared with the monomarker model, while the addition of GLS did not increase the significance of the analysis.Conclusion. Levels of NT-proBNP, GLS, and MFR may be used as non-invasive markers of an adverse course of HFpEF in patients with non-obstructive CAD, while the combined determination of NT-proBNP and MBF increases the prognostic value of the analysis.

Regional contributions to impaired myocardial mechanical function in heart failure with preserved ejection fraction.

Hypertensive heart disease (HHD) is recognized as a key clinical precursor to heart failure with preserved ejection fraction (HFPEF). However, pathophysiological transition from HHD to HFPEF is not well understood. We sought determine whether regional differences in impaired myocardial function may underlie the greater mechanical dysfunction seen in HFPEF compared to HHD. We used standardized echocardiography to assess regional myocardial deformation in a cohort of n = 327 adults with preserved left ventricular (LV) ejection fraction (≥45%), including: n = 129 with HFPEF, n = 158 with HHD and no heart failure, and n = 40 normotensive controls. From detailed measurements of LV systolic strain performed in multiple views, we derived and then compared regional measures of basal, mid-ventricular, and apical longitudinal strains. In models adjusting for clinical covariates, basal and mid-ventricular LV myocardial deformation was more impaired in HHD than in controls (P ≤ 0.003), whereas apical deformation was more impaired in HFPEF than in HHD (P = 0.005). In multivariable-adjusted analyses, only apical strain remained independently associated with HFPEF vs. HHD status [odds ratio 1.18 (1.02-1.37), P = 0.030 per 1% decrease in apical strain]. Compared to other regional strains, apical longitudinal strain optimally differentiated HFPEF from HHD (area under the receiver operating curve: apical longitudinal strain = 0.67; mid-ventricular longitudinal strain = 0.59; basal longitudinal strain = 0.60). We found that while apical mechanical function is preserved in HHD, it was impaired in HFPEF and may contribute to the transition from an asymptomatic heart disease to a symptomatic heart disease.

Cardiovascular indicators associated with ventricular remodeling in chronic high-altitude disease: a cardiovascular MRI study.

This study aimed to assess biventricular function and mechanics in patients with the chronic high-altitude disease (CHAD) using cardiovascular MRI and explore the possible risk factors associated with ventricular remodeling. In this prospective study, consecutive CHAD patients and healthy controls at high-altitude (HA) and at sea level (SL) underwent cardiovascular MRI. Right ventricular (RV) and left ventricular (LV) function and global strain parameters were compared. To identify risk factors associated with ventricular remodeling, multiple linear regression analyses were used. A total of 33 patients with CHAD (42.97years ± 11.80; 23 men), 33 HA (41.18years ± 8.58; 21 men), and 33 SL healthy controls (43.48years ± 13.40; 21 men) were included. A Significantly decreased biventricular ejection fraction was observed in patients (all p < 0.05). Additionally, the HA group displayed lower magnitudes of biventricular longitudinal peak strain (PS) (RV, - 13.67% ± 4.05 vs. - 16.22% ± 3.03; LV, - 14.68% ± 2.20 vs. - 16.19% ± 2.51; both p < 0.05), but a higher LV circumferential PS (- 20.74% ± 2.02 vs. - 19.17% ± 2.34, p < 0.05) than the SL group. Moreover, multiple linear regression analyses revealed that HGB (β = 0.548) was related to the LV remodeling index, whereas BUN (β = 0.570) was associated with the RV remodeling index. With the deterioration of RV function in patients with CHAD, LV function was also impaired concomitantly. Hypoxia-induced erythrocytosis may contribute to LV impairment, while BUN was considered an independent risk factor for RV remodeling. • A significantly lower biventricular ejection fraction was observed in patients, with a decreased magnitude of left ventricular (LV) peak systolic strain rate (radial and circumferential) and peak diastolic strain rate (all p < 0.05). • High-altitude healthy natives showed a lower biventricular longitudinal peak strain (all p < 0.05). • Hemoglobin was related to LV remodeling (β = 0.548), while BUN (β = 0.570) was independently associated with RV remodeling in CHAD patients.