Longitudinal Strain Measurements Research Articles

Prognostic value of left ventricular apical four-chamber longitudinal strain after heart valve surgery in real-world practice.

BackgroundLeft ventricular longitudinal strain is an emerging marker of ventricular systolic function. However, the prognostic value of apical four-chamber longitudinal strain after heart valve surgery in real-world clinical practice is uncertain. The authors investigated whether left ventricular apical four-chamber longitudinal strain measured in real-world practice is helpful for predicting postoperative outcomes in patients undergoing heart valve surgery.MethodsThis observational cohort study was conducted in patients who underwent heart valve surgery between January 2014 and December 2018 at a tertiary hospital in South Korea. The exposure of interest was preoperative left ventricular apical four-chamber longitudinal strain. The primary outcome was postoperative all-cause mortality. ResultsAmong 1,773 study patients (median age, 63 years; female, 45.9%), 132 (7.4%) died during a median follow-up of 27.2 months. Preoperative left ventricular apical four-chamber longitudinal strain was significantly associated with all-cause mortality (adjusted hazard ratio, 0.94 per 1% increment in absolute value; 95% CI [0.90, 0.99], P = 0.022), whereas left ventricular ejection fraction (LVEF) was not significantly associated with all-cause mortality (adjusted hazard ratio: 1.01, 95% CI [0.99, 1.03], P = 0.222). Moreover, combining left ventricular apical four-chamber longitudinal strain to the LVEF and conventional prognostic factors enhance the prognostic model for all-cause mortality (P = 0.022).ConclusionsIn patients undergoing heart valve surgery without coronary artery disease, left ventricular apical four-chamber longitudinal strain measured in real-world clinical practice was independently associated with postoperative survival. Left ventricular longitudinal strain measurement may be helpful for outcome prediction after valve surgery.

The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis.

Background: Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. Methods: A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. Results: Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible.

Global Longitudinal Strain for the Early Detection of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis

AimsLeft ventricular ejection fraction is used to monitor patients undergoing cardiotoxic chemotherapy. A decrease in left ventricular ejection fraction represents a relatively late stage of systolic involvement. Global longitudinal strain has been studied to detect early changes in left ventricular myocardial contractile function. The aim of the present study was to evaluate the global longitudinal strain measurement in the early detection of cardiotoxicity induced by cardiotoxic chemotherapeutic agents. Materials and methodsA study search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was carried out to report systematic reviews. A search on PubMed, EMBASE, Web of Science and SCOPUS was carried out using the following keywords: ‘echocardiography’ and ‘cardiotoxicity’ and their variations, without language or date restrictions (until March 2021). ResultsIn total, 4873 articles were identified for title and abstract analysis. The systematic review included 10 studies comprising 661 patients with cancer, including mainly breast cancer and haematological malignancies, mainly treated with anthracyclines. The meta-analysis included four studies: patients with cardiotoxicity showed a reduction in strain, compared with baseline, 14.13% greater than patients without cardiotoxicity (95% confidence interval 5.07–23.19; P < 0.01). No heterogeneity was observed between studies (I2 = 0). ConclusionThe meta-analysis showed that strain is a tool with proper predictive capacity for the detection of cardiotoxicity.

Diffuse myocardial fibrosis precedes subclinical functional myocardial impairment and provides prognostic information in systemic sclerosis.

Myocardial involvement is common in patients with systemic sclerosis (SSc) and causes myocardial fibrosis and subtle ventricular dysfunction. However, the temporal onset of myocardial involvement during the progression of the disease and its prognostic value are yet unknown. We used cardiovascular magnetic resonance (CMR) to investigate subclinical functional impairment and diffuse myocardial fibrosis in patients with very early diagnosis of SSc (VEDOSS) and established SSc and examined whether this was associated with mortality. One hundred and ten SSc patients (86 established SSc, 24 VEDOSS) and 15 healthy controls were prospectively recruited. The patients were followed-up for a median duration of 7.0 years (interquartile range 6.0-7.3 years). Study subjects underwent CMR including assessment of myocardial fibrosis [native T1 and extracellular volume (ECV)] and measurement of global longitudinal (GLS) and circumferential (GCS) myocardial strain. Native T1 values and ECV were elevated in VEDOSS and SSc patients compared with controls (P < 0.001). GLS was similar in VEDOSS and controls but significantly impaired in patients with established SSc (P < 0.001). GCS was similar over all groups (P = 0.88). There were 12 deaths during follow-up. Elevated native T1 [hazard ratio (HR) 5.8, 95% confidence interval (CI): 1.7-20.4; P = 0.006] and reduced GLS (HR 6.1, 95% CI: 1.3-29.9; P = 0.038) identified subjects with increased risk of death. Only native T1 was predictive for cardiovascular mortality (P < 0.001). Subclinical myocardial involvement first manifests as diffuse myocardial fibrosis identified by the expansion of ECV and increased native T1 in VEDOSS patients while subtle functional impairment only occurs in established SSc. Native T1 and GLS have prognostic value for all-cause mortality in SSc patients.

Echocardiographic Abnormalities in Adults With Anorexia Nervosa

Anorexia nervosa (AN) is a psychiatric disorder that may lead to cardiac complications. The objective of this study was to evaluate global and regional longitudinal strain changes in patients affected by AN as an early marker of myocardial damage. We prospectively enrolled 48 consecutive patients with AN and 44 age-matched and gender-matched healthy controls. In all subjects, we performed echocardiography, including global longitudinal strain (GLS) measurement. A subset of 33 patients with AN had further echocardiographic examinations during the follow-up. Compared with healthy controls, patients with AN had a greater prevalence of pericardial effusion (9 of 48 vs 0 of 44, p=0.003), a smaller left ventricular mass (63 ± 15 vs 99 ± 30 g, p < 0.001), a lower absolute value of GLS (-18.9 ± 2.8 vs -20.2 ± 1.8%, p=0.010) and of basal LS (-15.4 ± 6.0 vs -19.4 ± 2.6%, p < 0.001). The bull's eye mapping showed a plot pattern with blue basal areas in 18 of 48 patients with AN versus 1 of 44 controls (p < 0.001). During the follow-up, of 13 patients with blue areas in the first bull's eye mapping, 11 recovered completely, and of 20 patients with a red bull's eye at the first examination, none presented blue areas at the second one. In conclusion, GLS is significantly altered in patients with AN, and a basal blue pattern on bull's eye mapping identifies more severe cases. These changes seem to be reversible.

Impaired left ventricular systolic synchrony in patients with lupus Nephritis: A speckle tracking echocardiography study.

We aimed to explore the value of two-dimensional speckle tracking echocardiography measurements of the global longitudinal strain (GLS) and left ventricular mechanical dispersion (LVMD) in the assessment of early stage left ventricular systolic dysfunction and heterogeneity of myocardial contraction in patients with lupus nephritis (LN). Patients with LN and extra-renal systemic lupus erythematosus (SLE) and healthy participants in the control group underwent echocardiography for the traditional measurement of the left ventricular systolic and diastolic function and speckle tracking measurements of the GLS and LVMD. GLS was defined as the average value of the peak strain during systole of the left ventricular 17 segments, and LVMD was defined as the standard deviation. The demographic characteristics including age, sex, and body mass index (BMI) of all the participants were collected. The clinical and laboratory characteristics of the patients with LN were collected. We included 41 healthy control, 37 patients with extra-renal SLE, and 73 patients with LN. There were statistically significant differences in the GLS and LVMD between the extra-renal SLE and LN groups (GLS -19.36% vs. -17.61%, p < 0.001; LVMD 35.62ms vs 42.96ms, p<0.001). There was a statistically significant difference in the LVMD between the extral-renal SLE and control groups (35.62ms vs 25.51ms, p<0.001), but not in GLS (-19.36% vs -19.52%, p > 0.05). Multiple regression analyses were conducted in a subset of patients, and 24-hour proteinuria was independently associated with LVMD (β [SE], 0.793 [0.302], p < .05). Patients with LN have more severe myocardial involvement than patients with extra-renal SLE. The asynchrony in myocardial contraction represented by the LVMD can be recognized earlier than that of the overall contractile functional impairment represented by GLS. In patients with LN, the 24-hour proteinuria was associated with LVMD. This indicates that the heterogeneity in the contractile function may be associated with the severity of renal damage.

Abstract 203: Inter-rater Reliability Of Myocardial Strain Measurements In Comparison With Ejection Fraction In A Rural, Clinical Setting Using Speckle Tracking Echocardiography

Global longitudinal strain (GLS) analysis via speckle tracking echocardiography is a relatively new and promising imaging technology for the assessment of structural and functional abnormalities in the heart. GLS can be used in conjunction with left ventricular ejection fraction (LVEF) as a valuable predictor of left ventricular function. In fact, current data suggest strain to be a more effective indicator for ventricular dysfunction than LVEF. Despite its promise, the use of speckle tracking echocardiography has been limited to robust academic and research institutions due to concerns of reliability in clinical settings. Therefore, the hypothesis of this study is that high inter-rater reliability can be obtained in the measurement of mean global longitudinal strain in a non-academic, rural setting. GLS and LVEF were evaluated on twenty-one patients undergoing chemotherapeutic treatment during routine standard-of-care visits. The echocardiograms were performed on each patient by two separate technologists on the same day and the measurements were compared via intra-class correlation coefficient (ICC) values. Briefly, higher inter-rater reliability was observed in GLS (ICC 0.895) compared to LVEF (ICC 0.569), suggesting GLS is a reliable and reproducible measure of systolic function.

The Agreement of a Two- and a Three-Dimensional Speckle-Tracking Global Longitudinal Strain.

Background: Two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography (STE) enables assessment of myocardial function. Here, we examined the agreement between 2D and 3D STE measurement of a global longitudinal strain (GLS) in patients with normal left ventricle, reduced ejection fraction, and cardiac pacing. Methods: Our analysis included 90 consecutive patients (59% males; average age: 73.2 ± 11.2 years) examined between May 2019–December 2020, with valid 2D and 3D loops for further speckle-tracking strain analysis. Linear regression, Pearson correlation, and a Bland–Altman plot were used to quantify the association between 2D and 3D GLS and related segments, using the 17-segment American Heart Association (AHA) model. Analyses were performed in the entire study group and subgroups. Intra- and inter-observer variability of 2D and 3D GLS measurement was also performed in all participants. Results: We observed a strong correlation between 2D and 3D GLS measurements (R = 0.76, p < 0.001), which was higher in males (R = 0.78, p < 0.001) than females (R = 0.69, p < 0.001). Associated segment correlation was poor (R = 0.2–0.5, p < 0.01). The correlation between 2D and 3D GLS was weaker in individuals with ventricular pacing of >50% (R = 0.62, p < 0.001) than <50% (R = 0.8, p < 0.001), and in patients with LVEF of <35% (R = 0.69, p = 0.002) than >35% (R = 0.72, p < 0.001). Intra-observer variability for 2D and 3D GLS was 2 and 2.3%, respectively. Inter-observer variability for 2D and 3D GLS was 3.8 and 3.6%, respectively Conclusion: Overall 2D and 3D GLS were closely associated but not when analyzed per segment. It seems that GLS comparison is more representative of global shortening than local displacement. Right ventricular pacing and reduced left ventricular ejection fraction were associated with a reduced correlation between 2D and 3D GLS.

Left Ventricular Global Longitudinal Strain in Patients With COVID-19 Infection.

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, is an ongoing pandemic that has affected millions globally. Many infected patients have been noted to have cardiovascular damage. Prior to the development of clinical symptoms, the use of transthoracic echocardiography, specifically with measurements of left ventricular global longitudinal strain (LVGLS), may provide an additional prognostic marker for patients infected with COVID-19. We sought to determine whether patients with COVID-19 and reduced LVGLS have an increased risk for mortality. The mean LVGLS was determined to be significantly lower in the non-survivors compared to the survivors (−11.6 ± 1.8 vs −15.4 ± 0.74, p<0.05). It should be noted, however, that even those that survived were found to have reduced LVGLS (<−18.5%). A multivariate logistic regression analysis was also performed that demonstrated a relationship between reduced LVGLS and an increased risk for mortality. Overall, our data indicate that COVID-19 patients may have subclinical left ventricular dysfunction, and that critically ill patients may have a greater decline in cardiac dysfunction.

Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation.

BACKGROUNDAlthough transcatheter aortic valve implantation (TAVI) is a safe and effective treatment for aortic stenosis, it still carries some risks, such as valve leaks, stroke, and even death. The left ventricular global longitudinal strain (LVGLS) measurement may be useful for the prediction of adverse events during this operation.AIMTo explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODSIn this study, 61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography. Before surgery, data on left ventricular ejection fraction (LVEF) and LVGLS were collected separately following balloon expansion and stent implantation. Difference in values of LVGLS and LVEF during preoperative balloon expansion (pre-ex), preoperative stent implantation (pre-im) and balloon expansion-stent implantation (ex-im) were also examined. Adverse events were defined as perioperative death, cardiac rupture, heart arrest, moderate or severe perivalvular leakage, significant mitral regurgitation during TAVI, perioperative moderate or severe mitral regurgitation, perioperative left ventricular outflow tract obstruction, reoperation, and acute heart failure. RESULTSThe occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS, but not with difference in pre-ex LVEF. There were significant differences between pre-LVGLS and ex-LVGLS, and between pre-LVGLS and im-LVGLS (P = 0.037 and P = 0.020, respectively). However, differences in LVEF were not significant (P = 0.358, P = 0.254); however differences in pre-ex LVGLS were associated with pre-LVGLS (P = 0.045). Compared to LVEF, LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period. Moreover, the differences in LVGLS were associated with the occurrence of perioperative adverse events, and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery. Furthermore, LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSIONGreater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

Feasibility, Reproducibility, and Prognostic Value of Fully Automated Measurement of Right Ventricular Longitudinal Strain

Right ventricular free wall longitudinal strain (RVFWLS) carries important diagnostic and prognostic significance in a variety of clinical settings, but its measurement is time consuming and operator dependent, limiting its value in routine clinical practice. Automated RVFWLS measurements can overcome these limitations. The purpose of this study was to determine the feasibility, reproducibility, and prognostic implications of automated RVFWLS compared with manual assessment of RVFWLS. A total of 206 patients with a wide range of right ventricular (RV) function were retrospectively selected for this study. Fully automated (Auto-Strain), semiautomated (automated with editing), and manual (standard manual assessment) RVFWLS were measured using two-dimensional speckle-tracking echocardiography in the same RV-focused apical four-chamber view. RV ejection fraction (RVEF) was measured using three-dimensional echocardiography. Abnormal RV systolic function was defined as RVEF < 45%. Agreement for RVFWLS measurements among the three different methods was based on a combination of Pearson correlation, Bland-Altman analyses, and coefficients of variation (CVs). Automated RVFWLS measurements were feasible in 204 subjects (99%). Automated (8±1sec/patient) and semiautomated (50±10sec/patient) assessments had shorter analysis times compared with manual measurement (103±25sec/patient, P<.001 for both). Semiautomated RVFWLS had a stronger correlation with manual RVFWLS than automated RVFWLS (r=0.850 vs r=0.708, P<.001). Semiautomated RVFWLS had smaller biases, narrower limits of agreement (LOA), and lower CVs against manual assessment in comparison with the fully automated method in the whole study population (bias of 0.62 and 1.15, LOA of 6.54 and 10.50, and CVs of 9.3% and 16.9%, respectively), in the subgroup with RVEF < 45% (bias of 0.81 and 1.43, LOA of 6.32 and 10.42, and CVs of 10.2% and 18.6%, respectively), and in those with RVEF ≥ 45% (bias of 0.34 and 0.73, LOA of 6.86 and 10.63, and CVs of 8.0% and 14.5%, respectively). Seventy-six patients experienced adverse cardiovascular events during a median follow-up period of 26months. Fully automated, semiautomated, and manual RVFWLS were associated with poor outcomes. The prognostic implications of fully automated RVFWLS were inferior to those of semiautomated and manual RVFWLS. Three RVFWLS measurements were highly reproducible. Both fully automated and semiautomated RVFWLS provide rapid and reproducible assessments of RV function and carry important prognostic implication. Moreover, the semiautomated approach performs better than the fully automated method. Therefore, semiautomated RVFWLS can provide a better balance between feasibility and clinical significance and displays potential for clinical application.

Outcome of patients with myocarditis according to clinical risk classification and cardiac magnetic resonance parameters

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocarditis is an inflammatory disease defined by precise histological, immunological and immunohistochemical criteria and characterized by a great heterogeneity of presentation. The early evaluation of the possible outcomes and long-term prognosis of patients with myocarditis remains a challenge for the cardiologists, with repercussions on the most appropriate therapeutic choices for the patient. Purpose The purpose of this study was to analyze the outcomes of patients with acute myocarditis using the multiparametric integration of clinical, echocardiographic and cardiac magnetic resonance imaging data. Methods We retrospectively collected data from 127 patients admitted for acute myocarditis from 2011 to 2021 in 3 Sicilian hospitals. The main anamnestic information, risk factors and clinical manifestations at onset, electrocardiogram, echocardiogram including the global longitudinal strain (GLS) measurement and morphofunctional parameters at cardiac magnetic resonance (CMR), presence of edema and delayed enhancement (DE) and myocardial segments involved were collected. Patients were stratified according to the classification proposed by the group of Trieste group in 2017 in high-risk, intermediate-risk patients and low-risk patients. The occurrence of adverse events during follow up in the 3 groups was evaluated. Results High-risk patients had a higher frequency of total adverse events (66.7%) compared to intermediate (14%) and low (16%) risk (p &amp;lt; 0,0001), while no significant differences were observed regarding relapses. Intermediate-risk patients had a tendency to develop events comparable to low-risk patients. At baseline, FE was 34.02 ± 12.98% for high risk patients vs 59.24 ± 3.82% low risk vs 58.41 ± 5.21% intermediate risk (p &amp;lt; 0,0001). The mean GLS was -16 ± 4.43 for high risk patients vs -19 ± 2.37 low risk vs -18 ± 2.06 intermediate risk (p &amp;lt; 0,0271). 78% high-risk patients, 72% low-risk patients, and 75% intermediate-risk patients had edema at baseline MRI (p &amp;lt; 0,0249). 90% patients with high risk, 85% patients with low risk and 97% patients with intermediate risk had DE at baseline MRI (p &amp;lt; 0,0001). In intermediate-risk patients, an association was observed between the number of segments affected by DE at baseline MRI and the occurrence of events (p &amp;lt;0.013). The number of segments involved by DE that, with the best sensitivity and specificity, identifies the subjects most likely to develop events was 2.5 [AUC 0.5; p-value of 0.24]. The sum of the segments involved by DE at MRI statistically correlated with the detection of a reduced mean GLS (p &amp;lt; 0.009). Conclusions Our study confirms the usefulness of the clinical prognostic classification of the Trieste group. Intermediate-risk patients, who still represent a gray area from a prognostic point of view, have shown to have an overall good prognosis, not significantly different since low-risk patients. The extent of edema and the extent of DE at baseline are the major predictors of events.

Strain measurement for 2D echo with ultrasound enhancing agents can be performed with software available for non-enhanced recordings

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): ABACUS Cardiovascular Research Centre, Mazankowski Alberta Heart Institute Background Global longitudinal strain (GLS) measurement are less reliable when 2D image quality is reduced. While ultrasound enhancing agents (UEA; also known as "echo contrast") have been shown to enhance the reliability of EF measurements, there has been sparse evidence on performing GLS measurements after UEA injection. The aim of this study was to assess the feasibility of GLS analysis using the same software validated for non-enhanced 2D recordings. Methods GLS measurements were performed before and after injection of an approved UEA in 131 patients with acceptable image quality for GLS measurements. These patients were referred prior to chemotherapy initiation or were being monitored for potential cardiotoxic effects. As all these patients undergo echocardiography with UEA in order to achieve the best reproducibility of EF measurements, comparison of GLS measurements with and without UEA was possible. A commercially available ultrasound system was used and the same analysis software was applied. On end-diastolic and end-systolic frames, the inner border of the region of interest was manually adjusted to align with interface between the compact and trabeculated myocardium on non-enhanced images and the LV blood pool on the recordings with UEA. Results GLS measurements on recordings with UEA were performed in 131 patients. A strong positive correlation (r 0.67, p &amp;lt; 0.001) was found between measurements on non-enhanced recordings with mean bias 0.58% (see figure). Mean GLS was 19.5 +/- 2.1% from non-enhanced recordings and 20.1 +/- 2.2% from UEA recordings. Differences in GLS &amp;gt; 2% between methods were related to foreshortening or suboptimal delineation of segments on non-contrast recordings. Conclusion On a commercially available echocardiography scanner, software developed for GLS measurements on non-enhanced 2D recordings can be also applied to recordings that use UEA. Comparable results are obtained, provided the LV cavity is well delineated and not foreshortened. Abstract Figure 1

Myocardial work in hypertrophic cardiomyopathy - a new non-invasive parameter for segmental myocardial function?

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): DFG Introduction Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Alcohol septal ablation (PTSMA) is an established treatment option for patients with intracavitary obstruction. In non-obstructive patients, measurement of myocardial work (MW) using pressure strain loops was introduced as a new non-invasive tool to estimate myocardial performance. Purpose In this preliminary study, we compared global constructive work (GCW) and global wasted work (GWW) as well as the respective values for the septal- and lateral-basal segments in HOCM after successful PTSMA and non-obstructive HCM. Methods We included 12 patients (4 women, mean age 59.1 ± 17.6 years) with non-obstructive (maximal left ventricular gradient &amp;lt;30 mmHg; mean 10.6 ± 6.2 mmHg) HCM. 7 (58%) patients (subgroup A) had successful gradient reduction by PTSMA ≥3 months before analysis, whereas 5 patients had non-obstructive HCM (subgroup B). Using echocardiographic measurements of longitudinal strain and non-invasive measurements of peripheral- and calculated (PWA) central blood pressure (BP) as left ventricular systolic pressure (LVSP), we estimated and compared GCW and GWW as well as constructive work (CW) and wasted work (WW) of septal-basal and lateral-basal segments. Results In subgroup B, NTproBNP was significant higher than in subgroup A (2050 ± 1957 vs. 552 ± 845 pg/ml; p &amp;lt; 0.05). There were no differences between both subgroups in maximal septal thickness (20.7 ± 2.9 mm (A) vs. 22.2 ± 3.6 mm) and left atrial volume (91.6 ± 33.0 (A) vs. 114.0 ± 49.8 ml (B)). Using the measured peripheral BP as LVSP, GCW (1653 ± 347 (A) mmHg% vs 1641 ± 698mmHg%) and GWW (171 ± 89mmHg% (A) vs. 200 ± 126 mmHg%) showed no differences between both subgroups. Compared to published data of a healthy population, values of GCW were lower and values of GWW higher in HCM. Comparison in segmental analysis in subgroup A showed lower CW in septal-basal than in lateral-basal segments (1032 ± 385mmHg% vs. 1929 ± 699 mmHg%). In the subgroup B the finding was the same pattern (1024 ± 504mmHg% vs. 2301 ± 1069 mmHg%). In contrast, WW showed no difference between basal-septal and lateral-basal segments in both subgroups. Conclusions Our preliminary data show decreased GCW and increased GWW in HCM patients without obstruction at rest. As expected, we found lower CW in septal-basal segments than lateral-basal in patients after PTSMA with basal-septal-induced therapeutic infarction. Surprisingly, we found the same pattern in non-obstructive HCM patients. This finding might be one pathophysiological reason for not developing LVOT obstruction, which should be investigated in further detail.

Longitudinal Speckle Tracking Strain Abnormalities in Chagas Disease: A Systematic Review and Meta-Analysis.

Background: Chronic Chagas cardiomyopathy (CCM) is ranked among heart failure etiologies with the highest mortality rates. CCM is characterized by alterations in left ventricular function with a typical and unique pattern of myocardial involvement. Left ventricle longitudinal speckle tracking strain is emerging as an important additive method for evaluating left ventricular function and risk of future cardiovascular events. This systematic review aimed to characterize the left ventricle (LV) longitudinal strain by speckle tracking patterns in the different stages of Chagas disease, compared to healthy controls. Methods: Searches in Medline, EMBASE, and LILACS databases (from inception to 20 May 2021) were performed. Articles written in any language that assessed patients with Chagas disease and reported any measures derived from the left ventricular strain by speckle tracking were included. Two reviewers independently selected the studies, extracted the data, and assessed the quality of evidence. Standardized mean differences (SMD) were pooled using random-effects meta-analyses. Results: Of 1044 references, ten studies, including a total of 1222 participants (CCM: 477; indeterminate form: 444; healthy controls: 301), fulfilled the selection criteria and were included in the final analysis. Patients with CCM had a significantly higher mean global longitudinal strain (GLS) value than indeterminate form (IF) patients (SMD 1.253; 95% CI 0.53, 1.98. I2 = 94%), while no significant difference was observed between IF patients and healthy controls (SMD 0.197; 95% CI −0.19, 0.59. I2 = 80%). Segmental strain analyses revealed that patients with the IF form of CD had significantly worse strain values in the basal-inferoseptal (SMD 0.49; 95% CI 0.24, 0.74. I2: 24%), and mid-inferoseptal (SMD 0.28; 95% CI 0.05, 0.50. I2: 10%) segments compared to healthy controls. Conclusions: Our results suggest different levels of functional derangements in myocardial function across different stages of Chagas disease. Further research is needed to assess the prognostic role of LV longitudinal strain and other measures derived from speckle tracking in CD patients regarding progression to cardiomyopathy and clinical outcomes prediction.

Correlation between short-term heart rate variability and QT-Interval with left ventricular systolic function in patients with stable Coronary Artery Disease (CAD): a cross-sectional study

Background: The ischemic process in stable Coronary Artery Disease (CAD) causes cardiac remodeling and dysfunction, signaling the progress towards irreversible heart failure. Early identification for the presence of Left ventricular (LV) remodeling and dysfunction is important. Several methods can be used to assess LV dysfunction using echocardiography, including peak Global Longitudinal Strain (GLS) and ejection fraction measurements. Short-term Heart Rate Variability (HRV) and QT interval are considered practical parameters in electrocardiography identifying LV dysfunction. This study aimed to determine the relationship between short-term HRV and QT interval with LV systolic function in stable angina pectoris patients.Methods: This cross-sectional study was conducted in Prof. Dr. R. D. Kandou Hospital, Manado, from March to September 2021. All study subjects who met the inclusion criteria underwent a clinical history and further examinations, including electrocardiography, laboratory, and echocardiography examinations. The relationship of HRV variables and QT interval with LV systolic function were analyzed using Pearson correlation and linear regression models by SPSS version 21 for Windows.Results: A total of 33 subjects were included with a mean age of 62.3±8.9 years. Non-parametric correlation analysis between HRV variables and left ventricular systolic function showed no significant correlation. There was a significant correlation between QTc interval by Fridericia and LV peak GLS, but not with ejection fraction (r=0.426; p=0.013). The univariate regression analysis showed a relationship between QTc interval by Bazett and Fridericia with peak GLS (Bazett B=0.036; ?=0.35; R2=0.122; p=0.046; Fridericia B=0.052; ?=0.426; R2=0.181; p=0.013).Conclusion: There was a weak and moderate positive correlation between the QTc interval by Bazett and Fridericia formula with left ventricular systolic function. There was no statistically significant correlation between the short-term HRV variable and left ventricular systolic function.

Right ventricular functional assessment by 2D multi-plane echocardiography prior to left ventricular assist device implantation.

ObjectivesRight ventricular (RV) failure post left ventricular assist device (LVAD) implantation is associated with increased morbidity and mortality. A novel RV multi‐plane imaging method using two‐dimensional echocardiography and electronic plane rotation (MPE) was used to quantify RV function prior to LVAD implantation and to identify potential added value in this patient population.MethodsIn twenty‐five end‐stage heart failure patients (age 58.9 ± 6.8 years, 76% male), systolic function of four different RV walls (lateral, anterior, inferior and inferior coronal) were evaluated from one focussed apical view using MPE.ResultsFeasibility of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (RV‐S') measurements were high (84–100%), with lower TAPSE values measured in the inferior (14.2 ± 4.6 mm) and inferior coronal (12.3 ± 5.0 mm) walls compared to the lateral (16.3 ± 4.5 mm) and anterior walls (16.0 ± 4.5 mm). RV wall longitudinal strain (RV‐LS) measurement was most feasible in the lateral wall (80%; mean: –12.1 ± 4.2%). TAPSE and RV‐LS values were significantly reduced in patients compared to matched healthy individuals (p = <0.001). Seven (28%) patients who developed moderate to severe RV failure (RVF) early post‐implant (≤30 days) had lower pre‐implant values across all multi‐plane parameters compared to those without significant post‐implant RVF, notably four‐wall averaged TAPSE (11.1 ± 3.4 mm vs 15.9 ± 4.0 mm; p = 0.02).Conclusion2D MPE was highly feasible for RV wall quantification pre‐LVAD surgery, detecting differences in regional wall function. This novel method comprehensively quantifies RV wall function and could complement current pre‐LVAD screening protocols.

Subclinical Systolic Dysfunction during Chemotherapy for Breast Cancer

Background Cardiotoxicity is the main complication related to cancer therapy. Studies indicate that global longitudinal strain is an early detector of subclinical dysfunction of the left ventricle, preceding the decline in ejection fraction (EF). However, the reproducibility of such methodology has not been tested outside specialized centers. Objectives To assess the frequency of subclinical cardiotoxicity and to compare global longitudinal strain and EF measurements during the clinical course of patients undergoing chemotherapy for breast cancer. Methods This was an [...]

Changes in circumferential strain can differentiate pediatric heart transplant recipients with and without graft rejection.

Routine surveillance protocols rely heavily on endomyocardial biopsy (EMB) for detection of rejection in pediatric heart transplant recipients. More sensitive echocardiographic tools to assess rejection may help limit the number of EMBs. This study compared changes in left ventricular (LV) strain in patients who had rejection versus those who did not. A single center retrospective review was conducted between 2013 and 2020. Patients were categorized based on rejection history. Echocardiograms were evaluated at the time of 2 consecutive EMBs; in the rejection group, the second echocardiogram was collected at the time of a rejection episode. Conventional measures of LV function and speckle-tracking echocardiography-derived longitudinal (LS) and circumferential strain (CS) were measured. 17 patients were in the non-rejection group and 17 were in the rejection group (30 total rejection episodes). The rejection group was older at the time of transplant (12.5 vs. 1.3years, p=.01). A decline in CS was seen in the rejection group at the second echocardiogram [-18.5 (IQR -21.5, -14.6) to -15.7 (IQR -19.8, -13.2)] while CS improved in the non-rejection group [-20.8 (IQR -23.9, -17.8) to -23.9 (IQR -24.9, -20.1)]. This difference in change reached significance (p=.02). A similar pattern was seen in LS that neared significance (p=.06). There was no significant difference in ejection fraction change (p=.24). Patients in the non-rejection group displayed improvement in CS between echocardiograms while patients in the rejection group showed subsequent decline. Worsening of LV CS may help identify acute rejection in the early post-transplant period.

How to standardize measurement of global longitudinal strain.

Global longitudinal strain (GLS) is a robust and sensitive marker of left-ventricular systolic function, reflecting longitudinal shortening of the ventricle. A growing body of evidence indicates its superiority in identifying subclinical, early alterations in cardiac function compared to traditional markers, such as ejection fraction. Therefore, there is a growing demand to assess GLS in clinical settings, but limited availability on how to obtain GLS accurately and appropriately in the current literature. This review summarizes key aspects of GLS measurement, including image acquisition, post-processing, and training/experience needed to facilitate the clinical implication with standardization.