Left Ventricular Strain Research Articles

Fetal Cardiovascular Magnetic Resonance Feature Tracking Myocardial Strain Analysis in Congenital Heart Disease

BackgroundCardiovascular magnetic resonance (CMR) is an emerging imaging modality for assessing anatomy and function of the fetal heart in congenital heart disease (CHD). This study aimed to evaluate myocardial strain using fetal CMR feature tracking (FT) in different subtypes of CHD. MethodsFetal CMR FT analysis was retrospectively performed on four-chamber cine images acquired with Doppler US gating at 3 Tesla. Left ventricular (LV) global longitudinal strain (GLS), LV global radial strain (GRS), LV global longitudinal systolic strain rate (SR), and right ventricular (RV) GLS were quantified using a dedicated software optimized for fetal strain analysis. Analysis was performed in normal fetuses and different CHD subtypes (d-Transposition of the great arteries (dTGA), hypoplastic left heart syndrome (HLHS), coarctation of the aorta (CoA), tetralogy of Fallot (TOF), RV-dominant atrioventricular septal defect (AVSD), and critical pulmonary stenosis or atresia (PS/PA)). Analyses of variance (ANOVA) with Tukey post-hoc test was used for group comparisons. ResultsA total of 60 fetuses were analyzed (8/60 (13%) without CHD, 52/60 (87%) with CHD). Myocardial strain was successfully assessed in 113/120 ventricles (94%). Compared to controls, LV GLS was significantly reduced in fetuses with HLHS (-18.6±2.7% vs. -6.2±5.6%; p<0.001) and RV-dominant AVSD (-18.6±2.7% vs. -7.7±5.0%; p=0.003) and higher in fetuses with CoA (-18.6±2.7% vs. -25.0±4.3%; p=0.038). LV GRS was significantly reduced in fetuses with HLHS (25.7±7.5% vs. 11.4±9.7%; p=0.024). Compared to controls, RV GRS was significantly reduced in fetuses with PS/PA (-16.1±2.8% vs. -8.3±4.2%; p=0.007). Across all strain parameters, no significant differences were present between controls and fetuses diagnosed with dTGA and TOF. ConclusionsFetal myocardial strain assessment with CMR FT in CHD is feasible. Distinct differences are present between various types of CHD, suggesting potential implications for clinical decision-making and prognostication in fetal CHD.

Evaluation of Left Ventricular Remodeling and Prognosis after PCI in Acute Myocardial Infarction Using Real-Time, Three-Dimensional Echocardiography Combined with Layer-Specific Strain Imaging

Aim: This study aimed to evaluate left atrial and left ventricular volumes, strains, and strain rates in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) using real-time three-dimensional echocardiography and layer-specific strain techniques. The relationships between these parameters and left ventricular remodeling (LVR) and prognosis were also explored. Methods: The study included 217 patients with first-episode STEMI who underwent emergency PCI. Echocardiography and myocardial strain analyses were performed within 24 h post-PCI. Patients were categorized into early and non-early LVR groups based on the increase in left ventricular end-diastolic volume (LVEDV). The occurrence of major cardiovascular adverse events (MACE) was followed up for one-year post-PCI. Differences in clinical data and ultrasound parameters between the groups were compared, and the predictive value of myocardial strain indicators for late LVR was analyzed using a multivariate logistic regression model and receiver operating characteristic (ROC) curves. Results: Early LVR occurred in 54.8% of patients and was characterized by decreased left ventricular systolic function, more segments with abnormal movement, and reduced absolute strain values in the three layers of the left ventricular wall myocardium, with a compensatory increase in left atrial strain rate during the contraction phase. The early LVR group showed a higher incidence of MACE at the one-year follow-up. At 6 months post-PCI, 29.9% of patients developed late LVR, which was not completely related to early LVR. Late LVR was associated with a higher incidence of MACE. The longitudinal strain value of each layer of left ventricular myocardium obtained from layer-specific strain imaging showed predictive value for advanced LVR. Conclusions: More than half of patients with STEMI develop early LVR post-PCI, with a higher incidence of MACE during one-year of follow-up, necessitating attention to early LVR in clinical practice. Late LVR, which develops in some patients after 6 months, is also linked to a higher incidence of MACE. Accurate monitoring of the myocardial deformation function using layer-specific strain imaging is expected to become a reference indicator for clinical diagnosis and treatment. Monitoring the structure and function of the left atrium and mitral valve alongside the LVR is important for prognostic assessment and for formulating diagnostic and treatment plans.

Effect of Coronary Collateral Supply on Left Ventricular Global Longitudinal Strain after Recanalization of Chronic Total Occlusion.

Percutaneous coronary intervention (PCI) to chronic total occlusion (CTO) is still a subject of debate. The primary goal of revascularization is to provide symptomatic relief and enhance left ventricular (LV) functions. Global longitudinal strain (GLS) is proven to be more sensitive than the ejection fraction (EF), especially for subtle ischemic changes. The purpose of this study was to investigate the improvement in LV GLS after revascularization of symptomatic stable coronary patients with single-vessel CTO, categorized according to their collateral supply grades. Sixty-nine patients with successful CTO-PCI were grouped, according to their collateral supply grades, as well-developed (WD) and poor collateral groups and followed-up for 3 months. Basal characteristics were similar for both groups, except for a lower EF (p = 0.04) and impaired GLS (p < 0.0001) in the poor collateral group. At the end of 3 months follow-up, symptomatic relief was similar in both groups (p = 0.101). GLS improvement reached statistical significance only for the poor collateral, not for the WD group (p < 0.0001 and p = 0.054, respectively). The EF did not change significantly in both groups. Poorly collateralized CTO lesions may not only result in baseline LV dysfunction, but also appear to carry potential for recovery after revascularization. This may not be the case for WD collaterals.

Changes of clinical characteristics, distribution of red flags and prognosis in contemporary patients with wild-type transthyretin amyloidosis cardiomyopathy

Aim Increased diagnostic awareness and specific disease treatments have changed the landscape of transthyretin cardiac amyloidosis (ATTR). Patients with wild-type ATTR (ATTRwt) are increasingly being diagnosed, potentially changing the clinical profile and prognosis compared with existing retrospective data. We aimed to study the clinical characteristics, distribution of red flags and prognosis of contemporary ATTRwt patients. Methods From January 1st 2017, to December 31st 2022, 213 consecutive patients were diagnosed with ATTRwt and prospectively followed up. Data on clinical characteristics, biomarkers, echocardiography findings, hospitalization due to worsening heart failure (WHF) and all-cause mortality were collected. Results A 37% increase in newly diagnosed patients from 2017–2019 (n = 90) vs. 2020–2022 (n = 123) was observed. The majority of patients presented with NAC disease stage I in the latter period (49% in 2017–2019 vs. 58% in 2020–2022, p = .16). Red flags were primarily cardiac-related, including elevated NT-proBNP, impaired left ventricular longitudinal systolic strain with an apical sparing pattern, heart failure with increased left ventricular wall thickness and elevated troponins. NAC disease stage I as well as low NT-proBNP levels (<1000 ng/L) were significantly associated with better survival (both p < .001). When compared with NAC disease stage II + III combined, patients with NAC disease stage I had a significantly lower risk of WHF hospitalization or death (log rank test: p = .0001). Independent predictors of the combined endpoint WHF hospitalization or death were NT-proBNP (HR 1.03 [95% CI 1.00–1.07], p < .049) and prior implantation of permanent pacemaker (HR 2.01 [1.30–3.11], p = .002). Conclusion Increased diagnostic awareness resulted in a 37% increase in newly diagnosed patients in 2020–2022 vs. 2017–2019. As expected all-cause mortality but also the morbidity in terms of risk of hospitalization with WHF were significantly lower in patients with NAC disease stage I, as well as in those with low NT-proBNP levels <1000 ng/L. These findings underline the importance of continuous attention to diagnostic awareness, as early diagnosis is critical for initiating both general and specific ATTR treatment, thus improving prognosis.

The Role of Global Longitudinal Strain in the Follow-Up of Asymptomatic Patients with Chronic Primary Mitral Regurgitation.

Background/Objectives: In patients with chronic primary mitral regurgitation (MR), postoperative persistent left ventricular (LV) dysfunction underlines the lack of a sensitive parameter that can identify subclinical LV dysfunction and optimize the timing of intervention. Left ventricular global longitudinal strain (LV-GLS) is a measure of the longitudinal left ventricular systolic function, with prognostic significance. Its role in the follow-up of asymptomatic patients with MR is, however, poorly defined. The aim of this study was to assess the relative changes in LV-GLS in a cohort of MR patients and to correlate these changes with the need for intervention during a follow-up period. Methods: We conducted a prospective study on a cohort of 218 patients, divided into three subgroups according to MR severity (mild, moderate, severe). LV-GLS was measured at baseline and every six months during a median follow-up period of 30 months. The composite endpoint was the occurrence of heart failure symptoms, hospitalization for heart failure, LVEF < 60%, LVEDD > 45 mm, new onset atrial fibrillation, or cardiovascular death. Results: Patients with moderate and severe MR had a significantly lower GLS at baseline than those with mild MR (19.5% and 19.1% versus 22.3%, p < 0.01) despite a normal LVEF in all subgroups. The relative decrease in LV-GLS occurred earlier (at 12 months vs. 24 months) and was more evident in patients with moderate and severe MR (13.6% and 14.5%, respectively) versus patients with mild MR (6.72%). The baseline LV-GLS being under 18% and a relative decrease of over 10% in GLS were independent predictors of a composite outcome (HR = 1.59, CI 95% 1.17-2.86; HR = 1.74, CI 95% 1.2-2.91, p < 0.01). Conclusions: LV-GLS is a valuable monitoring tool for asymptomatic MR patients, a relative decrease > 10% in GLS may be predictive for the need for valve intervention.

Genetic predictors of cardiovascular toxicity in oncohematological patients

Aim. To identify single nucleotide polymorphisms reliably associated with cardiovascular toxicity in oncohematological patients receiving antitumor immunochemotherapy.Material and methods. For the study, 34 patients with an established diagnosis of non-Hodgkin's B-cell follicular lymphoma were prospectively selected at the Clinic of the Samara State Medical University, who were indicated for antitumor immunochemotherapy according to the R-CHOP protocol. During the follow-up, the patients were divided into 2 following groups: the main group consisted of 12 patients with cardiovascular toxicity (mean age, 42,4 (2,8) years, including men — n=3 (25%)), the control group — 22 patients without cardiovascular toxicity (mean age, 39,8 (1,7), including men — n=8 (36%)). Cardiovascular toxicity was verified on the basis of a combination of specific cardiological complaints with a decrease in the left ventricular ejection fraction &gt;10% from the baseline or in absolute terms less than 53% and/or a decrease in the left ventricular longitudinal systolic strain &gt;12% from the baseline and/or an increase in NT-proBNP &gt;125 pg/ml.Results. The study presents the identified genetic features in oncohematological patients in the context of cardiovascular toxicity. ABCC5 rs1879257, PRKAG2 rs13224758, RYR2 rs10925391 and SLC22A7 rs414917 variants had a significant association with an increased risk of cardiovascular toxicity in the target group of patients by 5-6 times. In addition, the ABCB1 rs2032582 variant showed the opposite effect and was associated with a reduced risk of cardiovascular complications, having a protective effect on the cardiovascular system.Conclusion. Although further studies are needed to confirm the diagnostic and prognostic significance of the detected genetic variants, the study results indicate the prospects of genetic screening before antitumor immunochemotherapy as a future tool for stratifying oncohematological patients and minimizing cardiovascular toxicity.

Cardiac Involvement in LAMA2-Related Muscular Dystrophy and SELENON-Related Congenital Myopathy: A Case Series.

LAMA2-related muscular dystrophy (LAMA2-MD) and SELENON-related myopathy (SELENON-RM) are two rare neuromuscular diseases characterized by proximal and axial muscle weakness, scoliosis, spinal rigidity, low bone quality and respiratory impairment. Cardiac involvement has previously been described in retrospective studies and case reports, but large case series and prospective studies in unselected cohorts are lacking. The objective of this study is to conduct prevalence estimations, perform cardiac phenotyping, and provide recommendations for clinical care. In this case series including two time points, we conducted comprehensive assessments with electrocardiography (ECG) and transthoracic echocardiography (TTE). ECGs were systematically assessed for a large subset of variables. TTE included left and right ventricular ejection fraction (LVEF/RVEF) and left ventricular global longitudinal strain (GLS), the latter being a more early and sensitive marker of left ventricular dysfunction. 21 LAMA2-MD (M = 5; 20±14 years) and 10 SELENON-RM patients (M = 7; 18±12 years) were included. In most patients, QRS fragmentation and Q waves, markers of heterogeneous ventricular activation, were present both at baseline and at follow-up. GLS was abnormal (age specific in children, > -18% in adults) in 33% of LAMA2-MD and 43% of SELENON-RM patients at baseline. Reduced LVEF (<52% in males, <54% in females and <55% in pediatric population) was observed in three LAMA2-MD patients at baseline and in none of the SELENON-RM patients. GLS and LVEF did not change between baseline and follow-up. RVEF was normal in all patients. ECG abnormalities and abnormal GLS are prevalent in LAMA2-MD and SELENON-RM, yet abnormal LVEF was only seen in LAMA2-MD patients. One LAMA2-MD patient had a clinically relevant deterioration in LVEF during 1.5-year follow-up. We advise routine screening of all patients with LAMA2-MD or SELENON-RM with ECG and echocardiography at diagnosis, minimally every two years from second decade of life and if new cardiac signs arise.

Abstract P325: Additive effect of nighttime blood pressure on left ventricular strain in patients with primary aldosteronism evaluated via cardiac magnetic resonance tissue tracking

Background: Primary aldosteronism (PA) induces left ventricular (LV) remodeling and increases the risk of high nighttime blood pressure (BP), which causes further heart damage. This study aimed to investigate whether nighttime BP aggravates LV deformation dysfunction and to identify independent factors affecting the global peak strain (PS) of LV remodeling in patients with PA compared to patients with essential hypertension (EH). Methods: A total of 280 patients with PA and 280 age- and sex-matched patients with EH who underwent cardiac magnetic resonance examination at the First Affiliated Hospital of Chengdu Medical College were included. According to the results of adrenal computed tomography and/or adrenal venous sampling, there were 154 patients with aldosterone-producing adenoma (APA) and 126 patients with idiopathic hyperaldosteronism (IHA). Twenty-four-hour ambulatory BP monitoring (ABPM), LV function, global strain parameters, and other clinical medical data were compared, and multivariate analysis was performed to identify the independent indicators of the LV PS. Results: No differences in age, sex, body mass index, clinical BP, 24-h mean BP, daytime BP, or duration of hypertension were found between the groups. Nighttime systolic BP (132 ± 17 vs. 126 ± 18 mm Hg, P &lt; 0.05) and diastolic BP (85 ± 11 vs. 80 ±10 mm Hg, P &lt; 0.05) were greater in PA patients than in EH patients. Compared with the EH controls, the PA patients had a lower LV global PS and peak diastolic strain rate (PDSR) in three directions. No significant differences were found in the PS (radial or longitudinal) or PDSR in the three directions between the APA and IHA groups. Furthermore, nighttime BP was an independent predictor of LV global radial, circumferential, and longitudinal PS. Conclusions: High nighttime BP may aggravate LV stiffness in patients with PA, resulting in decreased LV strain and function. Nighttime BP was independently correlated with LV global PS in patients with PA.

Is cardiac function associated with the clinical course of disease in patients with gout? A prospective study.

To analyze the function of the left heart in patients with different courses of gout, the independent influencing factors for left heart functional changes, and interactions between left atrial and left ventricular functions. Patients with gout (n=171) were selected; 87 patients with a disease course <10 years were included in Group I, and 84 patients with a disease course ≥10 years were included in Group II. Ninety-four healthy volunteers comprised the control group. The intergroup differences in cardiac strain parameters were statistically significant (p<.05). Moreover, the differences gradually declined with disease progression. Multivariate logistic regression analysis showed that uric acid was an independent predictor of decreased left ventricular global longitudinal strain (LVGLS). Moreover, LVGLS had a positive effect on the left atrial systolic rate (LASr) and the left atrial systolic contraction time (LASct) but no interaction with the left atrial systolic contraction duration (LAScd). The course of the disease significantly affected the function of the left heart in gout patients, and uric acid was observed to be an independent predictor of decreased LVGLS in gout patients.

Serial Changes in Ventricular Strain in Symptomatic Obstructive Hypertrophic Cardiomyopathy Treated With Mavacamten: Insights From the VALOR-HCM Trial.

In severely symptomatic patients with obstructive hypertrophic cardiomyopathy, VALOR-HCM (A Study to Evaluate Mavacamten in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy Who Are Eligible for Septal Reduction Therapy) demonstrated that mavacamten reduces the need for septal reduction therapy with sustained improvement in left ventricular (LV) outflow tract gradients and symptoms. Global longitudinal strain (GLS), a measure of regional myocardial function, is a more sensitive marker of systolic function. In VALOR-HCM, we assessed serial changes in LV and right ventricular (RV) strain. VALOR-HCM included 112 patients with symptomatic obstructive hypertrophic cardiomyopathy (mean, 60 years; 51% male; LV ejection fraction, 68%). Patients assigned to mavacamten at baseline continued the drug for 56 weeks (n=56) and those assigned to placebo (n=52) transitioned to mavacamten from weeks 16 to 56 (40-week exposure). LV-GLS and RV-GLS assessment was performed using a vendor-neutral software. Non-foreshortened apical (4-, 3-, and 2-chamber) views were used to obtain peak LV-GLS. RV focused 4-chamber view was used to calculate RV 4-chamber and free wall strain. A more negative strain value is favorable. At baseline, the mean LV-GLS, RV 4-chamber, and free wall strain values were -14.7%, -22.2%, and -16.8%, respectively (all worse than reported normal means). In the total study sample, LV-GLS significantly improved from baseline to week 56 (P=0.02). Twelve patients had transient reduction in LV ejection fraction (<50%) requiring temporary drug interruption (including 3 permanent discontinuations). The LV-GLS in this subgroup was worse at baseline versus total study population (-11.4%), with no significant worsening from baseline through week 56 (P=0.64). Both free wall and 4-chamber RV-GLS remained unchanged from baseline to week 56 (P=0.62 and P=0.56, respectively). In VALOR-HCM, treatment with mavacamten improved LV-GLS from baseline through week 56 (with no significant worsening of LV-GLS in patients with a reduction in LV ejection fraction ≤50%), suggesting a favorable long-term impact on regional LV systolic function. Additionally, there was no detrimental impact on RV systolic function. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04349072.

Rationale and design of RESILIENCE: A prospective randomized clinical trial evaluating remote ischaemic conditioning for the prevention of anthracycline cardiotoxicity.

There is a lack of therapies able to prevent anthracycline cardiotoxicity (AC). Remote ischaemic conditioning (RIC) has shown beneficial effects in preclinical models of AC. REmote iSchemic condItioning in Lymphoma PatIents REceiving ANthraCyclinEs (RESILIENCE) is a multinational, prospective, phase II, double-blind, sham-controlled, randomized clinical trial that evaluates the efficacy and safety of RIC in lymphoma patients receiving anthracyclines. Patients scheduled to undergo ≥5 chemotherapy cycles including anthracyclines and with ≥1 AC-associated risk factors will be randomized to weekly RIC or sham throughout the chemotherapy period. Patients will undergo three multiparametric cardiac magnetic resonance (CMR) studies, at baseline, after the third cycle (intermediate CMR), and 2 months after the end of chemotherapy. Thereafter, patients will be followed up for clinical events over an anticipated median of ≥24 months. The primary endpoint is the absolute change from baseline in CMR-based left ventricular ejection fraction (LVEF). The main secondary outcome is the incidence of AC events, defined as (1) a drop in CMR-based LVEF of ≥10 absolute points, or (2) a drop in CMR-based LVEF of ≥5 and <10 absolute points to a value <50%. Intermediate CMR will test the ability of T2 mapping to predict AC versus classical markers (left ventricular strain and cardiac injury biomarkers). A novel CMR sequence allowing ultrafast cine acquisition will be validated in this vulnerable population. The RESILIENCE trial will test RIC (a novel non-invasive intervention to prevent AC) in a cohort of high-risk patients. The trial will also test candidate markers for their capacity to predict AC and will validate a novel CMR sequence reducing acquisition time in a vulnerable population.

Left ventricular global longitudinal strain is associated with filling pressure and cardiac output in an outpatient setting: Insights from CardioMEMS™

Introduction and objectivesLeft ventricular global longitudinal strain (LVGLS) is an indicator of myocardial function in patients with heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Nevertheless, it is not clear whether LVGLS correlates with filling pressures and cardiac output (CO) in an ambulatory setting. We aimed to assess whether LVGLS is associated with invasive pulmonary artery pressures (PAP) and CO in outpatients using the invasive remote monitoring CardioMEMS™ system. MethodsThis single-center, prospective observational study included patients with HFrEF undergoing remote monitoring using the CardioMEMS™ system, between January 2020 and December 2022. Repeated transthoracic echocardiography (TTE) studies were performed in each patient and invasive hemodynamic data were obtained during the TTE studies using the CardioMEMS™ system. Univariate and multivariate models were used to assess the potential association between LVGLS and invasive PAP and CO. ResultsTwelve patients were included and 46 TTE studies were analyzed. LVGLS was correlated with diastolic (d) PAP (r=0.403, p=0.041) and CO (r=−0.426, p=0.039) in the univariate analysis. In multivariate models, LVGLS was an independent predictor of dPAP and CO, but not mean PAP or systolic PAP. The variation of LVGLS between TTE studies was correlated with the variation of dPAP during follow-up (r=0.60, p=0.017). ConclusionsIn a cohort of HFrEF patients under invasive hemodynamic remote monitoring, LVGLS was independently associated with invasive filling pressures and CO, in an outpatient setting. These findings reinforce the value of LVGLS for the management of outpatients with HFrEF.

Ninerafaxstat in the Treatment of Diabetic Cardiomyopathy and Nonobstructive Hypertrophic Cardiomyopathy.

Ninerafaxstat is a novel mitotrope under investigation in 2 large clinical trials: IMPROVE-DiCE (a phase IIa trial investigating ninerafaxstat) and IMPROVE-hypertrophic cardiomyopathy (HCM). IMPROVE-DiCE is a single-center, open-label, phase 2a trial investigating the effectiveness of ninerafaxstat in diabetic cardiomyopathy. Ninerafaxstat significantly improved phosphocreatine/adenosine triphosphate median by 32% (P < 0.01) and reduced myocardial triglyceride content by 34% (P = 0.026). Magnetic resonance imaging (MRI) analysis showed improved left ventricular peak circumferential diastolic strain rate by 15% (P < 0.047) and peak left ventricular filling rate by 11% (P < 0.05). Pyruvate dehydrogenase flux was increased in 7 of 9 patients (P = 0.08), consistent with improved glucose utilization. IMPROVE-HCM (ninerafaxstat safe, effective for nonobstructive hypertrophic cardiomyopathy patients) is a phase 2, multicenter, randomized controlled and double-blinded study. From baseline to 12 weeks, ninerafaxstat was associated with a significantly improved ventilatory efficiency slope compared with placebo (P = 0.006). In a post hoc analysis with 35 patients with baseline Kansas City Cardiomyopathy Questionnaire score ≤80, changes in ventilatory efficiency slope favored ninerafaxstat versus placebo (P = 0.02). Left atrial size, a surrogate marker of diastolic dysfunction, was significantly decreased in patients on ninerafaxstat versus placebo (P = 0.01). These findings support a larger phase 3 study in symptomatic nonobstructive HCM patients to further investigate ninerafaxstat. Several drugs that also improve glucose utilization including fatty acid oxidation inhibitors, carnitine palmitoyltransferase I inhibitors, and glucagon-like peptide-1 receptor agonists are presently under investigation in clinical trials.

Prognostic value of fully-automated left atrial strain in patients with asymptomatic chronic severe aortic regurgitation

BackgroundTo examine whether left atrial (LA) strain was associated with adverse outcomes in asymptomatic chronic aortic regurgitation (AR). MethodsAsymptomatic patients with ≥moderate-severe AR were retrospectively identified from 2008 through 2022 from a university hospital. Apical 4-chamber left ventricular longitudinal strain (A4C-LVLS), LA reservoir (LASr), conduit (LAScd), and contractile strain (LASct) were measured using fully-automated software. Primary endpoint was all-cause death (ACD); secondary endpoints were heart failure (HF) development or aortic valve surgery (AVS). ResultsOf 352 patients (59 ± 17 years; 19 % female), the mean LV ejection fraction (LVEF) was 60 ± 8 %. The median follow-up during medical surveillance was 4.7 (interquartile range: 1.8–9.0) years; during which 68 patients died. Multivariable analysis adjusted for covariates showed that larger maximal LA volume index (iLAVmax), lower LASr and LASct were independently associated with ACD (all P ≤ 0.047); A4C-LVLS and LAScd were not (P ≥ 0.15). Besides, iLAVmax, LASr, and LASct provided incremental prognostic value over A4C-LVLS in terms of ACD (all P ≤ 0.048). HF symptoms occurred in 126 patients at a median of 2 years. Multivariable determinants for HF development included larger minimal LAV index, lower LASr and LASct (all P ≤ 0.03). Adjusted spline curves showed LASr <38–40 % and LASct <20–24 % were associated with increased risks of ACD and HF development, respectively. Using abovementioned LASr and LASct cutoffs, adjusted Kaplan-Meier curves risk-stratified patients for ACD successfully (P ≤ 0.02). Lower LASr was also independently associated with AVS (Hazard ratio per 1 % increase: 0.98)(P = 0.02). ConclusionsIn patients with asymptomatic AR, fully-automated LASr and LASct were robust markers for outcome determination; these markers may identify those who need timely surgical referral.

Additive effect of metabolic dysfunction-associated fatty liver disease on left ventricular function and global strain in type 2 diabetes mellitus patients: a 3.0 T cardiac magnetic resonance feature tracking study

BackgroundType 2 diabetes mellitus (T2DM) and metabolic-associated fatty liver disease (MAFLD) are both metabolic disorders that negatively impact the cardiovascular system. This study comprehensively analyzed the additive effect of MAFLD on left ventricular function and global strain in T2DM patients by cardiac magnetic resonance (CMR).MethodsData of 261 T2DM patients, including 109 with and 152 without MAFLD, as well as 73 matched normal controls from our medical center between June 2015 and March 2022 were retrospectively analyzed. CMR-derived parameters, including LV function and global strain parameters, were compared among different groups. Univariate and multivariate linear regression analyses were conducted to investigate the impact of various factors on LV function and global strain.ResultsOur investigation revealed a progressive deterioration in LV functional parameters across three groups: control subjects, T2DM patients without MAFLD, and T2DM patients with MAFLD. Statistically significant increases in left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular mass index (LVMI) were observed, along with decreases in left ventricular ejection fraction (LVEF) and left ventricular global function index (LVGFI). Among these three groups, significant reductions were also noted in the absolute values of LV global radial, circumferential, and longitudinal peak strains (GRPS, GCPS, and GLPS), as well as in peak systolic (PSSR) and peak diastolic strain rates (PDSR). MAFLD was identified as an independent predictor of LVEF, LVMI, LVGFI, GRPS, GCPS, and GLPS in multivariate linear analysis. Besides, the incidence of late gadolinium enhancement was higher in MAFLD patients than in non-MAFLD patients (50/109 [45.9%] vs. 42/152 [27.6%], p = 0.003). Furthermore, escalating MAFLD severity was associated with a numerical deterioration in both LV function parameters and global strain values.ConclusionsThis study thoroughly compared CMR parameters in T2DM patients with and without MAFLD, uncovering MAFLD’s adverse impact on LV function and deformation in T2DM patients. These findings highlight the critical need for early detection and comprehensive management of cardiac function in T2DM patients with MAFLD.

Preventing Cardiac Damage in Patients Treated for Breast Cancer and Lymphoma: The PROACT Clinical Trial

BackgroundCardiotoxicity is a concern for cancer survivors undergoing anthracycline chemotherapy. Enalapril has been explored for its potential to mitigate cardiotoxicity in cancer patients. The dose-dependent cardiotoxicity effects of anthracyclines can be detected early through the biomarker cardiac troponin. ObjectivesThe PROACT (Preventing Cardiac Damage in Patients Treated for Breast Cancer and Lymphoma) clinical trial assessed the effectiveness of enalapril in preventing cardiotoxicity, manifesting as myocardial injury and cardiac function impairment, in patients undergoing high-dose anthracycline-based chemotherapy for breast cancer or non-Hodgkin lymphoma. MethodsThis prospective, multicenter, open-label, randomized controlled trial employed a superiority design with observer-blinded endpoints. A total of 111 participants, scheduled for 6 cycles of chemotherapy with a planned dose of ≥300 mg/m2 doxorubicin equivalents, were randomized to receive either enalapril (titrated up to 20 mg daily) or standard care without enalapril. ResultsMyocardial injury, indicated by cardiac troponin T (≥14 ng/L), during and 1 month after chemotherapy, was observed in 42 (77.8%) of 54 patients in the enalapril group vs 45 (83.3%) of 54 patients in the standard care group (OR: 0.65; 95% CI: 0.23-1.78). Injury detected by cardiac troponin I (>26.2 ng/L) occurred in 25 (47.2%) of 53 patients on enalapril compared with 24 (45.3%) of 53 in standard care (OR: 1.10; 95% CI: 0.50-2.38). A relative decline of more than 15% from baseline in left ventricular global longitudinal strain was observed in 10 (21.3%) of 47 patients on enalapril and 9 (21.9%) of 41 in standard care (OR: 0.95; 95% CI: 0.33-2.74). An absolute decline of >10% to <50% in left ventricular ejection fraction was seen in 2 (4.1%) of 49 patients on enalapril vs none in patients in standard care. ConclusionsAdding enalapril to standard care during chemotherapy did not prevent cardiotoxicity in patients receiving high-dose anthracycline-based chemotherapy. (PROACT: Can we prevent Chemotherapy-related Heart Damage in Patients With Breast Cancer and Lymphoma?; NCT03265574)

Two-dimensional speckle tracking echocardiography and stress computed tomography myocardial perfusion: potential for early imaging of asymptomatic patients with myocardial bridges

Aim. To evaluate the effectiveness of left ventricular (LV) peak global longitudinal strain and potential of computed tomography myocardial perfusion (CT perfusion) for the early diagnosis of asymptomatic patients with myocardial bridges (MBs).Material and methods. Forty patients were examined (20 with asymptomatic MBs in the area of the left anterior descending (LAD) artery and 20 without MBs) at the S. M. Kirov Military Medical Academy in the period from 2021 to 2023. The patients were divided into 2 equal groups consisting of 20 people (10 with MBs — the main group; 10 without MBs — the comparison group), one of which underwent speckle tracking echocardiography (STE), and the other — stress CT perfusion performed (adenosine triphosphate 160 mg/kg). The results were assessed in accordance with the 17-segment classification of LV proposed by the American Heart Association (2002).Results. When performing STE, 5 (50%) patients with MBs showed a decrease in LV local strain in the segments, the blood supply of which comes from the LAD artery and its branches, while in the comparison group — 1 (10%) (x2=5; p=0,025). When assessing the global longitudinal peak strain (GLPS), a significant difference was revealed among the study groups, amounting to -20,9±1,5% in patients with MBs and -22,1±0,9% in those without MBs (p=0,04). Using ROC analysis, the effectiveness of GLPS in prediction of asymptomatic MBs was calculated as follows: AUC=0,93 (95% confidence interval: 0,819-1,0; p=0,001), the cut-off point — -20,55% (sensitivity 80%, specificity 100%). According to CT perfusion data, impaired myocardial blood supply in the group of asymptomatic patients with MBs was noted in 6 (60%) cases, and in the comparison group — 2 (20%) (x2=9,8; p=0,002).Conclusion. Imaging of initial LV changes according to two-dimensional STE and detection of coronary circulatory disorders according to CT myocardial perfusion in asymptomatic patients with MBs makes it possible to timely suspect intramyocardial course of the coronary artery, as well as to consider further management tactics and carry out early prevention of possible cardiovascular events.

Conventional and 2-Dimensional Speckle Tracking Echocardiography in Fabry Disease

Abstract OBJECTIVE To analyze the myocardial involvement and explore the strain characteristics of the left atrium and the left ventricle in patients with Fabry disease (FD) using conventional echocardiography and 2-dimensional speckle tracking echocardiography (2D-STE). METHODS A retrospective study was conducted. Sixty-nine patients with FD who were treated in the Department of Cardiology, Neurology and Nephrology of Peking University First Hospital from August 2014 to February 2023 and underwent echocardiography examination in the Cardiology Department were collected (FD group). During the same time, 69 age- and sex-matched individuals who had no cardiovascular, cerebrovascular, renal, metabolic, and autoimmune diseases, and had no obvious abnormalities on echocardiography were included in the control group. The clinical data and laboratory tests were collected, and routine echocardiography and 2D-STE were performed to analyze left atrial strain and left ventricular longitudinal strain. The differences in relevant parameters between groups were compared. RESULTS Compared with the control group, the patients in the FD group had smaller body mass index and body surface area, slower heart rate, poorer estimated glomerular filtration rate, and significantly increased brain natriuretic peptide and cardiac troponin I (all P &amp;lt; 0.05). E’med in the FD group was reduced (8.4 ± 3.4 vs. 9.9 ± 2.8, P = 0.006) and E peak, E peak deceleration time, pulmonary artery systolic pressure increased, interventricular septum and left ventricular posterior wall thickened, left ventricular mass index, and early diastolic transmitral inflow velocity/septal mitral annular velocity (E/Eʹ) increased (all P &amp;lt; 0.05). Compared with the control group, left atrial strains [including left atrial strain during reservoir phase (LASr), left atrial strain during contraction phase (LASct), left atrial strain during conduit phase (LAScd)] and left ventricular average global longitudinal strain (GLSavg) were reduced in the FD group. In the segmental longitudinal strain of the left ventricular, the strain was significantly reduced except for the strain of the basal and middle segment of the inferior wall (P &amp;lt; 0.05). CONCLUSIONS Patients with FD usually have multisystem involvement such as kidney and heart. Echocardiography usually shows varying degrees of myocardial hypertrophy and diastolic dysfunction, while left ventricular ejection fraction is normal. Left atrial strain, left ventricular global, and segmental longitudinal strain are all decreased to varying degrees.

Myocardial Strain Imaging: Theory, Current Practice, and the Future.

Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.

Identification of Novel Independent Correlations between Cellular Components of the Immune System and Strain-Related Indices of Myocardial Dysfunction in CKD Patients and Kidney Transplant Recipients without Established Cardiovascular Disease.

The role of immune system components in the development of myocardial remodeling in chronic kidney disease (CKD) and kidney transplantation remains an open question. Our aim was to investigate the associations between immune cell subpopulations in the circulation of CKD patients and kidney transplant recipients (KTRs) with subclinical indices of myocardial performance. We enrolled 44 CKD patients and 38 KTRs without established cardiovascular disease. A selected panel of immune cells was measured by flow cytometry. Classical and novel strain-related indices of ventricular function were measured by speckle-tracking echocardiography at baseline and following dipyridamole infusion. In CKD patients, the left ventricular (LV) relative wall thickness correlated with the CD14++CD16- monocytes (β = 0.447, p = 0.004), while the CD14++CD16+ monocytes were independent correlates of the global radial strain (β = 0.351, p = 0.04). In KTRs, dipyridamole induced changes in global longitudinal strain correlated with CD14++CD16+ monocytes (β = 0.423, p = 0.009) and CD4+ T-cells (β = 0.403, p = 0.01). LV twist and untwist were independently correlated with the CD8+ T-cells (β = 0.405, p = 0.02 and β = -0.367, p = 0.03, respectively) in CKD patients, whereas the CD14++CD16+ monocytes were independent correlates of LV twist and untwist in KTRs (β = 0.405, p = 0.02 and β = -0.367, p = 0.03, respectively). Immune cell subsets independently correlate with left ventricular strain and torsion-related indices in CKD patients and KTRs without established CVD.