Lower Global Longitudinal Strain Research Articles

DYNAMICS OF ECHOCARDIOGRAPHY CHARACTERISTICS OF THE MYOCARDIUM IN PATIENTS WITH CONFIRMED DIAGNOSIS OF COVID-19

Objective: It has now been shown that the SARS-Cov2 virus can be found in myocardial tissue. It is still unknown whether persistence of the virus in cardiomyocytes always leads to clinically significant heart damage. The aim of the study is to assess the dynamics of echocardiography characteristics in patients with COVID-19 in primary care clinic. Design and method: Material and methods 210 patients were enrolled into the study between Oct and Dec 2020. The mean age was 51.6 ± 14.61 years, 100 (47, 6%) men. All patients had no cardiovascular disease prior to enrollment. 57 patients (26.1%) underwent COVID-19 without significant lung damage on CT, 114 patients (54.1%) had CT1 lung damage, - 31 patients (14.2%) - CT2, 7 patients (3, 2%) - CT 3, 1 patient (0.5%) - CT-4. All patients were examined by Echo before COVID-19 disease and after the discharge from the hospital using Vivid 9 GE with assessment of standard parameters and global longitudinal strain (GLS). Results: In the examined group of patients, 1 case of mild myocarditis and 1 case of pericarditis were recorded. No significant dynamics of the parameters of the LV was revealed by standart Echo. There was a significant increase in the size of the RV from 2.38 ± 0.233 cm to 2.57 ± 0.327 cm (p < 0.001) after the disease. Patients with lung lesions CT2 and higher had lower GLS (17.7 ± 1.06 and 18.7 ± 0.72%, p = 0.032), higher LA size (4.29 ± 0.39 and 3.59 ± 0.49 cm, p = 0,036) and RV size (2.54 ± 0.32 and 2.39 ± 0.23 cm, p = 0.013) compared with patients without lung involvement or with CT1. There was a weak significant correlation between the GLS and the dynamics of the RV diameter (r = 0.288, p < 0.001). Conclusions: After the transferred coronavirus infection, changes are detected mainly in the right ventricle, the severity of which correlates with the severity of lung damage Left ventricular changes can be detected mainly in severe infection and mainly by assessing the global longitudinal deformity of the left ventricle.

THE TRIGLYCERIDE- GLUCOSE INDEX: AN INDEPENDENT FACTOR OF A SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION IN TREATED HYPERTENSIVE PATIENTS

Objective: The triglyceride-glucose (TyG) index is known to be a simple surrogate marker of insulin resistance. The aim of this study was to investigate association between the TyG index and the two- dimensional longitudinal left vetricular global strain in treated hypertensive patients. Design and method: A total of 75 treated hypertensive patients were enrolled in this study. Anthropometric and cardiovascular risk factors were measured. The TyG index was calculated as ln[fasting triglycerides (mg/dl) × fasting glucose(mg/dl)/2]. The two- dimensional longitudinal left vetricular global strain where evaluated and express in absolute value. Others echocardiographic parameters where mesured: E/E’, left atrial volume and biological parameters: Total cholesterol, HDL cholesterol, LDL cholesterol and glomerular filtartion. Multivariable linear regression analysis was performed to identify the associations between this parameters. Results: Multivariable linear regression analysis showed that a higher TyG index was associated with lower global longitudinal LV strain (p = 0,04), higher body mass index (p = 0,000), higher E/E’ (p = 0,009) and lowest glomerular filtration rate (p = 0,001). Conclusions: A high TyG index was significantly associated with a low global longitudinal LV strain. The results suggest that the TyG index, as a simple indicator of insulin resistance, may reflect subclinical cardiac dysfunction.

Association between cardiovascular risk factors and left ventricular strain distribution in patients without previous cardiovascular disease.

BackgroundSome cardiovascular (CV) risk factors, such as hypertension and diabetes mellitus, have been reported to reduce left ventricular (LV) longitudinal strain (LS) even in patients with preserved LV ejection fraction. We hypothesized that multiple CV risk factors might cause changes in myocardial strain. Our study aimed to assess the association between multiple CV risk factors and strain in patients without previous CV disease (CVD).MethodsWe retrospectively evaluated 137 patients without CVD, who underwent echocardiography at our institution between May 2017 and February 2020. They were divided into four groups based on the number of risk factors (group 0: no risk factor, group 1: one risk factor, group 2: two risk factors, and groups 3: three or four risk factors). Risk factors were hypertension, dyslipidemia, diabetes mellitus, and chronic kidney disease. Absolute values of global LS (GLS) and relative apical LS ratio (RALSR) defined using the equation: average apical LS/(average basal LS + average mid LS) and was used as a marker of strain distribution.ResultsOut of 137 patients, group 0 had 35 patients, group 1 had 35 patients, group 2 had 32 patients, and group 3 had 35 patients. GLS was 22.4 ± 2.0%, 21.7 ± 2.1%, 21.3 ± 1.8%, 20.7 ± 2.2%, and RALSR was 0.64 ± 0.06, 0.66 ± 0.06, 0.68 ± 0.08, 0.69 ± 0.07 in groups 0–3, respectively. The one-way ANOVA detected significant differences between groups in GLS (p = 0.005) and RALSR (p = 0.037), respectively. Group 3 had a significantly lower GLS and higher RALSR than group 0 (p < 0.05).ConclusionIn patients without previous CVD, LS decreased especially from the basal segment as the number of cardiovascular risks increased. The segmental LS may be markers of occult LV dysfunction in patients with CV risk factors.

Left ventricle myocardial deformation in olympic athletes assessed by cardiac magnetic resonance: does the sex and discipline matter?

Abstract Funding Acknowledgements Type of funding sources: None. Background Sport induces structural and functional cardiac adaptation with different entity related to several factors including type of training and gender. Cardiovascular Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of athletes’ heart and commonly relies on ventricular volume, wall thickness and ejection fraction (EF) assessment. Data on myocardial deformation (MD) are limited to echocardiography and are scarce. Purpose To assess MD in Olympic athletes and to evaluate the possible influence of sport categories and gender. Methods A group of Olympic athletes evaluated prior the Olympic games with unremarkable cardiovascular pre-participation screening tests underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine-images were post-processed for volume and function evaluation and to assess global longitudinal strain (GLS) and global circumferential strain (GCS) by feature-tracking software. Athletes were divided in subgroups according to ESC sport classification. Male and female athletes were compared. Athletes were also divided based on EF (≤53% or &amp;gt;53%). Results 93 elite athletes (33% power, 33% mixed, 33% endurance) and 18 controls were enrolled. No differences in terms of EF were observed, while endurance athletes showed the greater LV remodeling (Table). GLS and GCS values of the entire population were -22.5±2.7% and -30.7±3.4%, respectively. No significant differences were found comparing athletes of different sport categories and sedentary controls for GLS (p= 0.940) and GCS (p=0.072). Female athletes showed higher GLS compared to male (-23.5±2.8% vs-21.9±2.8%, p=0.002) but not differences in terms of GCS (-31.5±3.1% vs-30.2±3.5%, p=0.076). Athletes with EF≤53% had lower GLS values compared with those with &amp;gt;53% but within normal limits (Figure). Conclusion No differences were observed in MD assessed by CMR between different sport categories and controls. Female athletes showed higher longitudinal but not circumferential strain compared with male. Athletes with lower EF presented lower values of strain but within normal range with the potentiality to be used as a tool for differential diagnosis between normal adaptation and disease.

Ventricular longitudinal function by cardiovascular magnetic resonance predicts cardiovascular morbidity in HFrEF patients.

AimsVentricular longitudinal function measured as basal‐apical atrioventricular plane displacement (AVPD) or global longitudinal strain (GLS) is a potent predictor of mortality and could potentially be a predictor of heart failure‐associated morbidity. We hypothesized that low AVPD and GLS are associated with the combined endpoint of cardiovascular mortality and heart failure‐associated morbidity.Methods and resultsTwo hundred eighty‐seven patients (age 62 ± 12 years, 78% male) with heart failure with reduced (≤40%) ejection fraction (HFrEF) referred to a cardiovascular magnetic resonance exam were included. Ventricular longitudinal function, ventricular volume, and myocardial fibrosis or infarction were analysed from cine and late gadolinium enhancement images. National registries provided data on causes of cardiovascular hospitalizations and cardiovascular mortality for the combined endpoint. Time‐to‐event analysis capable of including reoccurring events was employed with a 5‐year follow‐up. HFrEF patients had EF 26.5 ± 8.0%, AVPD 7.8 ± 2.4 mm, and GLS −7.5 ± 3.0%. In contrast, ventricular longitudinal function was approximately twice as large in an age‐matched control group (AVPD 15.3 ± 1.6 mm; GLS −20.6 ± 2.0%; P < 0.001 for both). There were 578 events in total, and the majority were HF hospitalizations (n = 418). Other major events were revascularizations (n = 64), cardiovascular deaths (n = 40), and myocardial infarctions (n = 21). One hundred fifty‐five (54%) patients experienced at least one event (mean 2.0, range 0–64). Of these patients, 119 (71%) had three events or fewer, and the first three events comprised 51% of all events (295 events). Patients in the bottom AVPD or GLS tertile (<6.8 mm or >−6.1%) overall experienced more than 3 times as many events as the top tertile (>8.8 mm or <−8.4%; P < 0.001). Patients in this tertile also faced more cardiovascular deaths (P < 0.05), HF hospitalizations (P = 0.001), myocardial infarctions (only GLS: P = 0.032), and accumulated longer in‐hospital length‐of‐stay overall (AVPD 20.9 vs. 9.1 days; GLS 22.4 vs. 6.5 days; P = 0.001 for both), and from HF hospitalizations (AVPD 19.3 vs. 8.3 days; GLS 19.3 vs. 5.4 days; P = 0.001 for both). In multivariate analysis adjusted for significant covariates, AVPD and GLS remained independent predictors of events (hazard ratio 1.12 per‐mm‐decrease and 1.13 per‐%‐increase) alongside hyponatremia (<135 mmol/L), aetiology of HF, and LV end‐diastolic volume index.ConclusionsLow ventricular longitudinal function is associated with an increase in number of events as well as longer in‐hospital stay from cardiovascular causes. In addition, AVPD and GLS have independent prognostic value for cardiovascular mortality and morbidity in HFrEF patients.

Defining the Normal Values for Left Ventricular Global Longitudinal Strain in Adult Heart Transplanted Patients

<h3>Purpose</h3> To date, there are no data about normal values of Global Longitudinal Strain (GLS) in adults post heart transplant. The GLS correlation with heart graft rejection was derived based on the GLS values from normal, native heart population data. The aim of the study is to establish the normal GLS values in heart transplant patients, in order to better define risk of rejection or cardiac allograft vasculopathy (CAV). <h3>Methods</h3> This is a single center, retrospective study of consecutive patients from January 1, 2018 to September 1, 2021 who underwent orthotopic heart transplantation. Patients were excluded if post-transplant transthoracic echocardiography with myocardial strain imaging was not performed or if they were treated for rejection. Left ventricular ejection fraction (EF) and strain, were collected for patients at 1-month, 3-months, 6-months, 12-months, and 18-months post-transplant. Results at each time point were described with univariate analysis. Analysis of variance (ANOVA) was then utilized to compare the echocardiographic findings. <h3>Results</h3> Thirty-five patients were included in this study and all of them had echocardiography with GLS performed at the time intervals specified. The mean EF was stable over time from 60.0% ± 6.3% at 1-month post-transplant to 61.9% ± 5.9% at 18-months (Fig 1a). No significant difference in EF between timepoints was detected (p=0.5). The mean GLS increased over time from -14.9 ± 3.4 at 1-month post-transplant to -16.9 ± 3.4 at 18-months (p=0.6). (Fig 1b), but lower than in normal hearts. <h3>Conclusion</h3> This study established normal values of GLS in patients undergoing serial echocardiography after orthotopic heart transplantation that is different from values seen in normal hearts. The lower GLS values at 1 month post-transplant despite normal LVEF, as marker of subclinical LV dysfunction, are probably due to preservation injury and/or reperfusion ischemia. Based on our data, new GLS values should drive consideration of rejection.

Persistent cardiac organ damage in surgically and medically treated primary aldosteronism.

We compared persistent cardiac organ damage in patients treated surgically or medically for primary aldosteronism. Eighty-four patients (age 57 ± 11 years, 27% women) with primary aldosteronism underwent echocardiography at time of diagnosis and after one year of treatment (49% adrenalectomy, 51% medical treatment). Persistent cardiac organ damage was defined as presence of left ventricle (LV) hypertrophy, low LV midwall shortening, global longitudinal strain and/or enlarged left atrium both at baseline and at follow-up. At one year, a significant regression of LV hypertrophy was observed in surgically (44 vs. 22%, P = 0.039), but not in medically treated patients (60 vs. 51%, P = 0.206). The prevalence of enlarged left atrium was reduced in both groups (both P < 0.001), whereas systolic myocardial function remained unchanged. In multivariable logistic regression analysis, medical treatment [odds ratio (OR) 4.88 (95% confidence interval (CI) 1.26-18.88)] was a strong predictor of persistent LV hypertrophy independent of higher BMI [OR 1.20 (95% CI 1.04-1.38)] and presence of diabetes [OR 6.48 (95% CI 1.20-34.83), all P < 0.05]. Persistently low midwall shortening was associated with suppressed plasma renin after one year [OR 6.11 (95% CI 1.39-26.7)] and lower renal function [OR 0.96 (95% CI 0.94-0.99), both P < 0.05]. The strongest predictor of persistently low global longitudinal strain was higher HbA1c [OR 2.37 (95% CI 1.12-5.02), P = 0.024]. Persistent cardiac organ damage was more common in the medical treatment group and associated with incomplete aldosterone blockade, impaired renal function and presence of metabolic comorbidities.

Association between early changes in left atrial strain and global left ventricular function in patients with heart failure with preserved EF ( HFpEF)

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) maximal volume and index (LAVI) had a prognostic value in patients with heart failure and incidence of atrial fibrilation(AF) . Recently, LA mechanical function and LA strain have been introduced as alternative methods to assess LA performance more accuratly. Aim To evaluate the relation between early changes in LA function and strain ( PALS) and correlate the association with global left ventricular (LV) function and longitudinal strain (GLS) in patients with HFpEF. Methods We evaluated 132 subjects in sinus rhythm: 22 normals (31y ± 5), and 70 pts with HFpEF (65y ± 12), 60 pts HFrEF ( 64 y ± 10). Echocardiography was performed in all patients and follow up after 12 monts and analyzed offline in order to extract the global and segmental strain values of the LV and LA and LA volume and LAVI. Results The two groups of patients were comparable for most of clinical variables. LV volumes, ejection fraction, stroke volume, and mitral valve effective regurgitant orifice were similar between the two groups. The LA diameter and maximal volume were higher in HFrEF group. The GLS is significantly reduced in HFrEF group. LV GLS is the main parameter for myocardial dysfunction, which changed significantly in the HFrEF (p &amp;lt; 0,001) at 12mFU. Reduced PALS in HFrEF was associated with impairment of all measures of LV systolic and diastolic function and events of atrial fibrilation / 33 % in HFrEF and 12 % in HFpEF/ and the correlation between global longitudinal strain and PALS was highly significant (p &amp;lt; 0.001; r=-0.71). At 12mFU, PALS was significantly associated with lower global longitudinal strain in group with HFrEF (p &amp;lt; 0.001, r = 0.61 ), LAVI &amp;gt; 28 ml/m2 (p &amp;lt; 0.01,r = 0.57) and slightly decreased in HFpEF /p &amp;lt;0.5, r =0.34/. ROC analysis shows the cut –of value of 29 % for PALS which correlated with AF events. Conclusions: PALS and GLS are significantly reduced in HFpEF patients and decreased in HFpEF. PALS provides additional ,prognostic value beyond LA volume and LAVI. Severe LV myocardial dysfunction and reduced GLS and decreased PALS, even still normal LAVI is a prognostic index for AF.

Mild autonomous cortisol secretion portends similar cardiac compromise as overt endogenous Cushings syndrome

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): German Ministry of Research and Education within the Comprehensive Heart Failure Centre Würzburg OnBehalf CV-CortEx Background Endogenous Cushing’s syndrome (CS) results in increased cardiovascular morbidity and mortality. This risk seems to be lower in patients with incidentally discovered mild autonomous cortisol secretion (MACS) but without the clinical features of CS. We aimed to describe and compare the cardiac morphology and function in patients with overt CS and MACS to a representative sample of a local prospective population-based cohort (STAAB). Methods/Results: We comprehensively characterized 40 patients with overt CS (mean age 47 ± 13 years, 75% women) and 18 patients with MACS (62 ± 11 years, 56% women; both p ≤ 0.001 when compared to CS) including detailed transthoracic echocardiography. Logistic regression adjusted for age and sex showed no significant differences between both groups regarding body mass index (BMI), systolic and diastolic blood pressure (BP), lipids, HbA1c, and echocardiographic parameters of cardiac morphology and function (table). The comparison with STAAB participants (n = 4965, 55 ± 12 years, 52% women; logistic regression adjusted for age and sex) revealed significantly higher BMI, triglycerides, HbA1c, and diastolic but not systolic BP (table). Compared to STAAB participants, patients exhibited a smaller left ventricle (LV) with thicker septal and posterior walls, and a less favorable diastolic function. LV ejection fraction (LVEF) was higher, although longitudinal contraction, measured by tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were lower in both ventricles compared to STAAB participants (table). Conclusion Patients with both MACS or CS exhibited a compromised metabolic profile and diastolic function pattern when compared to a population-based cohort. Higher LVEF despite lower GLS suggests a compensatory increase in LV radial contraction in states of hypercortisolism. Cardiac impairment was similar in patients with CS or MACS suggesting an adverse effect of hypercortisolism even at clinically inconspicuous levels. Abstract Figure.

A left systolic dysfunction study in a group of breast cancer patients and its clinical impact

Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer therapy-related cardiac dysfunction (CTRCD) is one of the major complications being reported in patients with breast cancer (BC) under chemotherapy, in particular with anthracyclines (A) or trastuzumab (T). CTRCD is defined as a reduction of left ventricular ejection fraction (LVEF) &amp;gt;10% to a value &amp;lt;50% or as a relative reduction of global longitudinal strain (GLS) &amp;gt;15%. Purpose We aim to evaluate the frequency of CTRCD and its clinical impact on BC patients. Methods Retrospective study of patients with BC treated with A and/or T between Jan 2017 and Dec 2018 who underwent a transthoracic echocardiography (TTE) before, during, and after chemotherapy. We analysed their baseline characteristics and outcomes based on the type of treatment received, and focusing specially on parameters of ventricular function. Results We included 128 females with median age of 54 ± 11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%). At the end of A therapy, there was a significant decrease in LVEF (64,2 ± 5,4% vs 62.6 ± 5,3%, p &amp;lt; 0.05) and in GLS (-20,7 ± 1.9% vs -18.8 ± 2.2%, p &amp;lt; 0.001) compared to baseline. No change in tricuspid annular systolic velocity (S") (p = 0,842) was observed. At 2 years of follow-up, this group of patients had no significant difference in LVEF (64,58 ± 5,58 vs 62,63 ± 6,48, p = 0,053) but maintained a significant lower GLS (-20,84 ± 2,13 vs -18,51± 2,52, p &amp;lt; 0,001) compared to baseline. A significant decrease in S’ (14,36 ± 2,55 vs 13,25 ± 2,26, p &amp;lt; 0,05) was observed. During T therapy, there was a significant decrease in LVEF (65,04 ± 5,41 vs 59,30 ± 6,21, p &amp;lt; 0,001), in GLS (-21,21 ± 2,75 vs -17,89 ± 2,77, p &amp;lt; 0,001) and in S’ (14,39 ± 3,05 vs 12,19 ± 1,62, p &amp;lt; 0,001) compared to baseline. At the end of T therapy (with or without A), this group of patients maintained a significant decrease in LVEF (65,11 ± 5,65 vs 61,29 ± 6,39, P &amp;lt; 0,001) and in GLS (-21.41%±2,86 vs -19.54%±3,50, p &amp;lt; 0,01). S’ returned to normal values (p = 0,10). At 2 years of follow-up, this group of patients maintained a significant decrease in LVEF (65,00 ± 5,99 vs 61,18 ± 6,30, p &amp;lt; 0,05) but GLS (p = 0,235) returned to normal values. No change in S’ was observed (p =0,379). During a mean follow-up of 38 months, 35 (27%) patients developed CTRCD with a higher prevalence in patients who took A followed by T (18; 14%), 9 (7%) presented with clinical heart failure, 1 (1%) needed hospitalization, 5 (4%) needed to temporarily suspend treatment and 3 (2%) needed to definitely stop treatment. Conclusions Treatment with A was associated with a decrease in LV systolic function at the end of therapy. A decrease in right ventricular (RV) systolic function was observed at 2 years of follow-up. Treatment with T was associated with a decrease in RV and LV systolic function during therapy. CTRCD occurred in 27%, mainly on patients with both A and T therapy, a frequency within literature data. CTRCD had clinical impact leading to HF and suspension of chemotherapy.

Incremental value of global longitudinal strain to predict stress echocardiography positivity in asymptomatic diabetic patients

French guideline recently added the presence of an “abnormal left ventricle” on transthoracic echocardiography (TTE) to define very high-risk diabetic patients who may benefit from silent coronary artery disease (CAD) screening. We aimed to investigate the incremental value of resting Global Longitudinal Strain (GLS) in predicting stress TTE positivity in asymptomatic patients with diabetes mellitus (DM). Consecutive asymptomatic patients with DM referred for screening for silent CAD by stress TTE (effort of dobutamine) between January 2017 and December 2018 were included ( n = 273). Stress test positivity was defined as stress-induced new or worsening of preexisting left ventricular wall motion abnormalities. Patients with a positive stress test ( n = 28; 10%) were more likely to be smokers (71% vs. 17%), to have known diabetes for more than 10 years, carotid atheroma, diabetic nephropathy, diabetic retinopathy (57.1% vs. 18.0%), moderate or severe aortic or mitral calcifications and a lower GLS (−16.7 ± 2.9 vs. −18.9 ± 2.2%) than those with a negative test (all P ≤ 0.014). On multivariate logistic regression analysis, a DM duration > 10 years, diabetic retinopathy and lower GLS (OR [95% CI] = 0.76 [0.64–0.93] per % decrease) remained independently associated with a positive stress TTE. The Chi 2 of the model was significantly improved by the addition of GLS on top of the baseline clinical variables, repolarization abnormalities and DM related complications (Chi 2 56.9 to 73.8; P < 0.001) ( Table 1 , Fig. 1 ). Screening CAD in asymptomatic patients with DM is challenging and debated. In this context, it is crucial to identify early markers of CAD in this population. Our study shows that GLS is strongly associated with the presence of silent ischemia and could be one of these new parameters to be routinely assessed in this population.

Left ventricular global longitudinal strain by speckle tracking echocardiography as a noninvasive predictor in evaluation of myocardial infarction

Background: Coronary artery disease (CAD) has assumed epidemic proportions in the world. Accurate risk stratification and early invasive management when indicated can reduce morbidity and mortality substantially. The study aims to correlate left ventricular (LV) function assessed by global longitudinal strain (GLS) with the extent of CAD in patients with myocardial infarction (MI). Methods: The study was conducted in a tertiary care hospital in Southern India. A total of 105 patients admitted with a diagnosis of non ST-elevation MI were included. All patients had a detailed echocardiogram with the evaluation of LV GLS by two-dimensional speckle tracking echocardiography and ejection fraction by Simpson's method. Coronary angiogram was also done in all patients to study the coronary anatomy and the relation between CAD and LV GLS. Results: The mean age of study population was 53.9 years. Echocardiographic study revealed mean LV ejection fraction (LVEF) was 48.16 + 12.27. The mean LVEF in patients with single-vessel disease was 50.11 + 11.62; with two-vessel disease, it was 51.81 + 10.34, and in patients with triple-vessel disease, it was 41.5 + 11.8. The mean GLS in the abovementioned groups was − 15.6 + 3.33, −13.5 + 3.2, and − 11.02 + 4.14, respectively. The follow-up of patients also showed a considerably lower GLS in patients who suffered higher morbidity and mortality. Conclusion: LV GLS is a good noninvasive predictor of the burden of CAD on the angiogram and also a predictor of future cardiovascular events and mortality.

Echocardiographic determinants of ventricular arrhythmia in sickle cell disease

Unexplained sudden death remains a leading cause of death in sickle cell disease (SCD) adults. Ventricular arrhythmia is a well-known risk factor for sudden death but its prevalence and determinants in SCD remain understudied. The aim of this study was to identify echocardiographic predictors of ventricular arrhythmia in SCD. From January 2019 to March 2021, SCD adults referred to ambulatory cardiology department for possible cardiac involvement were prospectively included (Drepacoeur cohort). Patients that had 24-hours ECG monitoring (24 h-Holter) and thransthoracic echocardiography (TTE) on the same day were analysed. The primary end point was the occurrence of ventricular arrhythmia (sustained or non-sustained ventricular tachycardia (VT), more than 500 premature ventricular contractions (PVC) on 24 h-Holter, or history of VT ablation). Overall, 90 patients were included and 54 (60%) analysed. Mean age was 47.6 ± 11.6 years (range 21–69), 53% were male. Heart function was mainly preserved with a mean left ventricular ejection fraction (LVEF) of 57.9 ± 4.9% and a mean global longitudinal strain (GLS) of −18 ± 2.8%. Mean tricuspid regurgitation velocity was 2.6 ± 0.4 m/s. Ventricular arrhythmia was observed in 13 (24.1%) patients (4 non-sustained VT, 9 with more than 500 PVC and 1 history of VT ablation). Ventricular arrhythmia was associated with lower GLS (−15.8 ± 1.8% vs. −19 ± 2.7%, P < 0.001), lower tricuspid annular plane systolic excursion (TAPSE 23 ± 5.7 mm vs. 26.9 ± 4.6 mm, P = 0.02) and more dilated right ventricle assessed by tricuspid annulus diameter (38.2 ± 6.1 mm vs. 34.2 ± 4.5 mm, P = 0.02). In multivariate analysis, GLS was independently associated with ventricular arrhythmia (OR = 2.1, 95% CI [1,3; 3,3], P = 0.004) with a moderate exponential correlation with PVC load on 24 h-Holter (R = 0.5, P < 0.001). In SCD adults with preserved LVEF, GLS was the only independent echocardiographic predictor of ventricular arrhythmia.

Subclinical Cardiac Dysfunction and Cognitive Function: A Systematic Review

Background: Cardiovascular disease, and more recently, subclinical cardiac dysfunction have both been implicated as important risk factors for cognitive decline. Several measures have been used to detect subclinical cardiac dysfunction, with global longitudinal strain (GLS) emerging as an important and more sensitive indicator than traditional measures. Yet, the association of GLS with cognitive function remains relatively unexplored. Objective: The aim of this review is to systematically summarize the literature exploring the association between GLS and cognitive function. Methods: We conducted a systematic review of the literature following PRISMA guidelines using the following databases: PubMed, OVID Medline, Embase, Web of Science, and CINAHL. Inclusion criteria were observational studies published in English, measuring GLS and assessing cognitive function through neuropsychiatric tests or brain imaging. Quality assessment was done using the Newcastle Ottawa Scale. Results: The initial search revealed 394 studies, of which three met inclusion criteria and were included for final review. The three studies included were cross-sectional and of high quality. They all reported that lower GLS scores were associated? with worse cognitive function and more brain abnormalities in both bivariate and multivariable analysis. Conclusion: Subclinical cardiac dysfunction, identified by GLS, was associated with worse cognitive function and presence of cerebral abnormality on brain imaging. The underlying mechanism could be attributed to dysfunctional autoregulatory and microvascular processes occurring in the brain vasculature. Further longitudinal studies are needed to better delineate the relationship between GLS and cognitive function.

658 Impairment of strain reserve extends to remote myocardium in the sub-acute phase of ST-elevation myocardial infarction

Abstract Aims In ST-elevation myocardial infarction (STEMI), subtle tissutal changes in remote myocardium predict long-term left ventricular (LV) remodelling and prognosis, independently of infarct size and microvascular obstruction. Whether there is a subclinical dysfunction of remote myocardium, detectable by longitudinal strain (LS) at echocardiography, and whether it varies in different locations of STEMI and with adenosine (ADO) challenge, is still unknown. Methods and results Fifty-three patients (age 65 ± 12.5 years, 44 male, 20 anterior and 33 non-anterior, P = 0.01) underwent rest/stress echocardiography at 7 ± 2 days after successfully treated STEMI, and at 6-months follow-up. Global LS (GLS), ischaemic and remote LS (iLS and rLS) were analysed in anterior and non-anterior STEMI. Both at rest and at follow-up, GLS was stratified by ejection fraction (EF) into three groups: EF &amp;lt; 40%, 40–49%, and ≥50%. Normal subjects, undergoing ADO stress echo, represented controls. Anterior STEMI showed lower GLS than controls (P &amp;lt; 0.001) and non-anterior STEMI (P &amp;lt; 0.001). ADO increased GLS in controls (P = 0.05), but neither in anterior nor in non-anterior STEMI, GLS changed during ADO stress, although significantly improved at follow-up (P &amp;lt; 0.001 and P = 0.002, respectively). In anterior STEMI, rLS was comparable to iLS at rest, during stress and at follow-up (P = ns), while in non-anterior STEMI rLS was higher than iLS throughout the study (P &amp;lt; 0.001). Patients with EF &amp;lt; 40% and 40–49% had similar values of GLS, iLS, and rLS, which were, both at rest and at follow-up, lower than those of patients with EF ≥ 50% (P &amp;lt; 0.001). Conclusions In the subacute phase, anterior STEMI shows the worst impairment of LS in both ischaemic and remote regions. Strain reserve to ADO is absent in remote myocardium, as well as in ischaemic zone, regardless of MI location. Global, ischaemic and remote LS may improve at follow-up.

Abstract 10196: A History of Dengue Infection is Associated with Lower Global Longitudinal Strain by Speckle Tracking Echocardiography in Men from the Amazon Basin

Background: Studies have shown that infection with dengue virus may affect the heart in the acute phase, and that men possibly have a higher risk of severe dengue complications. No studies have investigated if dengue infection also may affect long-term cardiovascular function. Hypothesis: We hypothesized that adults from the general population with a self-reported history of dengue infection had lower myocardial strain compared to controls. Furthermore, that strain could be even lower in men with a history of dengue. Methods: We enrolled individuals from the general population in the Amazon Basin. History of self-reported dengue infection and cardiovascular risk factors were collected by questionnaires. All persons underwent physical examination and bedside echocardiography. We analyzed global longitudinal strain (GLS) and circumferential strain (GCS). Results: We included 529 individuals (mean age 39±15 years, 39% men) of which 49% (n=259) had a history of dengue infection. A history of dengue infection was not associated with lower GLS (Figure A). However, when stratifying the population by sex, dengue infection in men was significantly associated with lower GLS (OR 1.13 per 1% decrease [95%CI 1.02 to 1.24], P=0.014) and GCS (OR 1.06 per 1% decrease [95%CI 1.01 to 1.12], P=0.030), whereas no relationship was found for women (Figure A). In multivariable models adjusted for age, blood pressure, heart rate, creatinine, smoking habits, diabetes and income, the association with GLS (OR 1.13 [95%CI 1.02 to 1.25], P=0.016) and GCS (OR 1.07 [95%CI 1.01 to 1.14], P=0.015) remained significant in men (Figure B and C). We found no significant relationship with left ventricular ejection fraction. Conclusion: Dengue may potentially have long term effects on left ventricular systolic function as measured by strain in men. This calls for further studies to assess long-term cardiac sequelae and subclinical myocardial impairment in individuals with a history of dengue.

Abstract 10291: Electrocardiographic Markers of Subclinical Myocardial Dysfunction in Patients with Severe Obesity and Normal Ejection Fraction. The FatWest Study

Introduction: Patients with severe obesity are predisposed to left ventricular (LV) myocardial dysfunction and increased myocardial oxygen (O 2 ) demand despite preserved ejection fraction (EF). Hypothesis: To test whether electrocardiography (ECG) may be used to identify patients with severe obesity that have myocardial dysfunction despite normal EF by echocardiography. Methods: In the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study, 116 severely obese patients (41±11 years, 75% women, body mass index [BMI] 41.7±4.6 kg/m 2 , 57% with hypertension, EF 61±5%) underwent 12-lead ECG and echocardiography before a Roux-en-Y gastric bypass surgery. Low LV mechanics was defined as global longitudinal strain (GLS) below the median, and high myocardial O 2 demand as LV mass-wall stress-heart rate product above the median value. ECG markers of atrial (P axis and duration) and ventricular (QRS axis and duration, T axis, QRS-T angle, time to intrinsicoid deflection (ID), and corrected QT (QTc)) de- and repolarization were analyzed. Results: Median GLS was -15.5%, and median myocardial O 2 demand 1.47 x106 g kdyne/cm 2 bpm. Patients with low GLS had longer QRS, time to ID and QTc duration, while those with high myocardial O 2 demand had increased P axis and duration (all p&lt;0.05). In multivariate regression analyses, longer QTc was associated with lower GLS (R 2 0.24) and increased P axis with higher myocardial O 2 demand (R 2 0.21) independent of age, gender, BMI and hypertension (all p&lt;0.05). A QTc &gt;435ms and P axis &gt;42° had 70% specificity in detecting low GLS and high myocardial O 2 demand (Figure). Conclusion: In severely obese patients, ECG measures of atrial activation and delayed ventricular repolarization were independently associated with low LV myocardial function and high myocardial O 2 demand. ECG screening before bariatric surgery may identify patients in whom advanced echocardiography is warranted.

Abstract 13764: Prognostic Value of a Novel Echocardiographic Risk Score for Long-Term Clinical Outcomes in Patients With Ischemic Heart Failure

Introduction: Two-dimensional-echocardiography (2DE) derived global longitudinal strain (GLS) could predict outcome in patients with heart failure. Mitral annular plane systolic excursion (MAPSE) derived from M-mode echocardiography is a classical indicator of clinical outcome in heart failure patients. Hypothesis: This study aimed to compare the prognostic performance of GLS and MAPSE as well as a new echocardiographic risk score for the prediction of mortality and cardiovascular (CV) rehospitalization risk in ischemic heart failure (IHF) patients with reduced left ventricular ejection fraction (LVEF). Methods: This retrospective observational study comprised 1277 IHF patients with reduced LVEF (&lt;50%) receiving echocardiography including GLS. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoints included all-cause death, heart transplantation, CV death, or rehospitalization. Measures were used to develop a novel risk score for clinical outcome. Results: After adjusted for age, sex, and other clinical risk factors, lower LVEF (≤30% vs. &gt;30%, HR=1.39 and 1.53, P=0.005 and 0.002), lower MAPSE (≤7 vs. &gt;7mm, HR=1.35 and 1.35, P=0.007 and P=0.021), or lower GLS (≤8.4% vs. &gt;8.4%, HR=1.31 and 1.51, P=0.012 and 0.001) remained as independent predictors for overall and CV mortality, but not for CV rehospitalization. Prediction efficacy of a new echocardiographic risk score including multiple echocardiographic parameters, including systolic dysfunction (LVEF, MAPSE, or GLS), diastolic dysfunction, LV remodeling, and right-side cardiac dysfunction (right ventricular diameter and systolic pulmonary artery pressure) was tested stratifying low, intermediate, and high risk. Patients with high-risk score faced both significantly higher risk of overall mortality (HR=1.99 or 1.42) CV mortality (HR=2.15 or 1.60), and CV rehospitalization risk (HR=2.01 or 1.43) as compared patients with low or intermediate risk score (all P&lt;0.05). Conclusions: The new echocardiographic risk score derived from multiple echocardiographic indicators is associated with satisfactory prognostic performance on both mortality and CV rehospitalization.

Abstract 11702: Sex Differences in Diabetic Cardiomyopathy: Greater Reduction in Myocardial Perfusion Reserve in Women Than Men Driven by Increased Resting Perfusion

Introduction: Type 2 diabetes (T2D) confers a higher relative risk of heart failure in women than men. Women also have a greater prevalence of heart failure with preserved ejection fraction (HFpEF), linked to microvascular dysfunction. We hypothesize that sex-specific differences are present in the pathophysiological alterations of myocardial structure, function, and perfusion associated with T2D. Methods: Cross-sectional case-control study. Participants underwent comprehensive cardiac phenotyping with echocardiography and cardiac magnetic resonance with adenosine stress/rest perfusion. Global myocardial perfusion was derived as a mean of three short axis slices. Image analysis was performed by two observers blinded to all participant information. Statistical analysis was performed with independent-sample T-tests or Mann-Whitney test. Results: Individuals with T2D (n=287, 41% female) were compared with age-matched controls (n=87, 41% female). Women with T2D were more obese than men (body mass index 35.7±7.2 vs 32.4±5.3 kg/m 2 , p&lt;0.05). Both women and men with T2D had increased left ventricular (LV) concentric remodelling (greater LV mass/volume ratio), impaired diastolic (higher E/e’) and systolic (lower global longitudinal strain) function compared to controls. LV mass index was significantly increased in women only. Comparing T2D and controls, stress perfusion was not significantly different in both sexes whereas resting perfusion was increased in women (1.4±0.6 vs 1.0±0.4 ml/min/g, p&lt;0.05) but not in men. Consequently, women with T2D have a lower myocardial perfusion reserve than men (2.6±0.9 vs 3.1±0.9, p&lt;0.001). Conclusions: In asymptomatic people with T2D, women have increased LV mass index and lower myocardial perfusion reserve than men, driven primarily by increased resting perfusion. These findings support the growing evidence that microvascular dysfunction partly explains the greater risk of HFpEF in women with T2D.

Abstract 9950: Right Ventricular Hemodynamic Forces: Linking Pulmonary Insufficiency to Wall Motion in Repaired Tetralogy of Fallot Patients

Introduction: Patients with repaired Tetralogy of Fallot (rTOF) will develop right ventricle (RV) dysfunction from chronic pulmonary insufficiency (PI). Cardiac magnetic resonance (CMR) biomarkers informs timing of pulmonary valve replacement (PVR), but do not clarify the direct impact of PI on myocardial biomechanics. 4D flow studies have shown that RV hemodynamic forces (HDF) are altered in rTOF. In this study, we derived HDF in rTOF, exclusively using RV wall motion from conventional cine. Methods: This was a retrospective study using CMR of rTOF patients who had no PVR at time of imaging. Feature-tracking (QStrain, Medis) was used to capture RV wall motion from cine imaging. A novel diffeomorphic mapping technique was used to calculate 3D RV kinematic models (Figure 1A) and global HDF vector generated throughout the cardiac cycle. The RVOT-to-Diaphragm HDF vector was isolated for analysis. Global longitudinal strain, QRS duration and RV size/function were collected. Repeat analysis was performed on subgroup of rTOF who had subsequent PVR and follow-up CMR. Results: 44 rTOF studies (21±11 years) were included with regurgitant fraction (PR%) 33±15%, RV ejection fraction 50±5%, and RV end-diastolic volume 144±37 mL/m 2 . PR% correlated with RVOT-to-Diaphragm HDF vector in diastole (Figure 1B). Higher diastolic:systolic HDF ratio correlated with lower RV ejection fraction (R = -0.31, p = 0.04), lower global longitudinal strain (R = -0.38, p = 0.009), and longer QRS duration (R = 0.44, p = 0.004). 9 rTOF patients had follow-up CMR after PVR and demonstrated decrease in RVOT-to-Diaphragm HDF (Figure 1C). Conclusions: PI in rTOF patients is correlated to diastolic HDF exerted along the direction of the RVOT. Diastolic HDF correlates with RV dysfunction in rTOF patients, and as a global parameter can be captured by RV wall motion without the need to analyze 4D flow details. HDF is a potential biomarker that may provide early detection of RV dysfunction and inform PVR timing.