Mean GLS Research Articles

Accuracy of 2-dimensional speckle tracking echocardiography in diagnosis of coronary artery stenosis in stable angina pectoris

Background It’s difficult to detect the severity of coronary artery disease in the patients who have stable angina pectoris. Echocardiography is a well-validated non-invasive diagnostic tool for detecting myocardial ischaemia, but judging wall motion abnormalities is subjective. Conventional echocardiography can assess radial mechanics only, so it cannot assess the sensitive longitudinal mechanics. 2-Dimensional strain echocardiography is a recent tool that has the ability to solve these drawbacks. Aim of study To detect the accuracy of 2D-STE in prediction of significant coronary artery stenosis in the patients with stable angina pectoris. Methods This study included 70 patients who have stable angina pectoris. Conventional and 2D speckle tracking echocardiography were done to all patients then compared with the coronary angiography results. Patients were classified into three groups according to their coronary arteries affection; patients with normal Coronaries, non-obstructed lesion and patients with significant lesion. Results Our study results show that the mean GLS was (-18.67 ± 0.93) in normal cases, and it was (-15.82 ± 1.11) in non-obstructed lesions but GLS was (-13.19 ± 1.7) in patients with significant CAD. And the best cut-off point of GLS was reported as (-17.35%) with a sensitivity of 97.6% and specificity of 93.3%. Also we found that SLS results in significant lesions of LAD, LCX, RCA territory was (-16.3%, −15.95%, −17.45%) with sensitivity and specificity (87.8%, 93.3%), (70.7%, 93.3%), (82.9%, 93.3%) respectively. Conclusion Global longitudinal strain has a good diagnostic significance over visual evaluation during conventional echocardiogram in predicting significant stenosis of the coronary arteries in patients with stable coronary artery disease. Segmental Longitudinal strain is also a sensitive tool to detect the affected Coronary Territory.

Left atrial function predicts long-term outcome in hypertension and diabetes across genders

Abstract Introduction In the last decade, peak atrial longitudinal strain (PALS) was ascertained to be superior to conventional echocardiographic indices for secondary cardiovascular (CV) prevention. Purpose Standard and advanced echocardiography including PALS was evaluated to find predictors of prognosis in patients with arterial hypertension and/or diabetes for the optimization of primary CV prevention. Methods Hypertensive and/or diabetic patients >40 years old and in sinus rhythm who underwent a complete cardiological evaluation at our centre in 2008-2015 were retrospectively included. Personal history, physical examination, standard and advanced (speckle tracking) echocardiographic data were collected. The exclusion criteria were previous cv events or cardiac surgery, active pacemaker, more than moderate valvular regurgitation and/or stenosis, missing informed consent. All patients were followed up for a mean time of 11.2±1.3 years for the development of first atrial fibrillation (AF) episode, congestive heart failure hospitalization, transient ischemic attack, stroke, myocardial infarction/coronary revascularization, and CV death. Univariate and multivariable stepwise Cox regressions were performed to estimate Hazard Ratio (HR). Kaplan Meier curves (KM) compared the survival between patients with different ranges of Global PALS. Log-rank test was performed to compare the KM curves. Results This retrospective study included 292 adults (mean age 63.0±9.0 years, 50% female), among which 210 hypertensives and 67 diabetics. Mean left ventricular (LV) ejection fraction (EF) was 58.2±4.9%, mean GLS was -17.0±6.6%, mean left atrial volume was 52.9±24.9ml and mean PALS 29.7±11.1%. During follow up, 110 patients developed at least one cv event: 52 all-cause deaths, 28 CV deaths, 30 heart failure admissions, 31 first AF episode, 18 TIA/strokes, 25 myocardial infarction/revascularization. Dividing the population according to events occurrence, patients with events had similar EF (p= 0.06), while being older (65.8±9.6 vs 61.3±9.0 years) and with a worse diastolic function (E/E’ ratio 10.6±5.0 vs 8.7±3.6), LV longitudinal strain (GLS, -17.7±2.9 vs -15.7±3.4%) and PALS (34.6±9.9 vs 21.6±7.7%, all p <0.001). From univariate statistical analysis, age, E/E’, PAPs, GLS and PALS were all predictors of events, but only age (HR 1.03, p=0.03) and PALS (PALS<22.5% HR 18.99 and PALS 22.5-30 HR 7.68, both p<0.001) remained independently associated with outcome at multivariate analysis. Patients with PALS<22.5 have an event-free survival of 82.4% at 1 year, 49.8% at 5 years and 25.3% at 10 years compared to 100% at 1 year, 98.5% at 5 years and 92.5% at 10 years if PALS PALS>30% (Fig.1). The same results were confirmed in female population (Fig.2). Conclusions If confirmed by larger studies, PALS could be a quick, feasible and reliable part of cardiologic evaluation for prognostic stratification in primary CV prevention in hypertensive and/or diabetic patients.Fig. 1Fig. 2

Implementation of Global Longitudinal Strain (GLS) in NON-ST Segment Elevation Myocardial Infarction in AL-Yarmook Teaching Hospital

Background: It would be advantageous to develop a noninvasive diagnostic tool that could more reliably distinguish between persons who would benefit from early coronary angioplasty and revascularization and those who would not in non-ST-segment elevation acute coronary syndrome. The LVGLS assessment is painless and may be completed quickly without putting patients through intense activities. Aim of study: To evaluate wall motion abnormality by (GLS) method in comparison with 2D echo and ECG changes. Material and method: A cross sectional study that included 60 patients who admitted to Al-Yarmouk teaching hospital due to new onset of acute coronary syndrome. Result: Mean GLS of patients was -13.61 ± 1.67, and the largest proportion of them were aged 56-60 yrs. regarding echo finding, 80% show hypokinetic motion wall abnormality. Patients with abnormal ECG changes, hypokenisia and low EF had significantly lower mean of GLS (p-value 0.0001, 0.0001, 0.004, respectively). The prediction value of GLS over EF was higher when comparing them according to presence of ECG changes and MWA. Conclusion: GLS is a powerful predictor of left ventricular function and appears to be a better metric than ejection fraction in NSTEMI patients.

P37 MULTIMODALITY DIAGNOSTIC APPROACH TO A JUVENILE CASE OF SUSTAINED VENTRICULAR TACHYCARDIA

Abstract Clinical case 31–year–old male subject, former competitive athlete, with family history of coronary artery disease and no further cardiovascular risk factors or previous cardiac events. Previous SARS–CoV2–related paucisymptomatic infection (January 2022) and subsequent episode of fever (August 2022) with negative SARS–CoV2 nasal swab. In September 2022 he reported sudden onset of palpitations after hearty meal. Because of such symptoms, the patient underwent Holter ECG showing 90 episodes of ventricular tachycardia (VT) and one episode of sustained VT. Based on such evidence, the patient went to the emergency room (ER). During the ER stay, blood exams (blood count, high–sensitivity troponin, BNP, CRP, D–dimer) and ECG were normal and SARS–CoV2 test was negative. The patient was then hospitalized in cardiac ICU. The echocardiogram showed left ventricle with normal dimension, thickness and wall motion (EF: 65%, mean GLS: –20%), trivial mitral and aortic regurgitation, no pericardial effusion. Subsequently, a cardiac coronary CT scan was performed showing absence of atherosclerotic lesions and myocardial bridge of the middle segment of LAD artery. The diagnostic pathway went on with cardiac magnetic resonance (CMR) demonstrating focal hypokinesia and wall thickness reduction of the anteroseptal–anterior junctional wall at middle–distal level (minimum thickness: 3 mm) where a millimetric area of late gadolinium enhancement with transmural distribution was described; absence of myocardial oedema. In addition, an EPS was performed with electroanatomical high–density/definition mapping of the left ventricle showing normal volumes, signals and activation and absence of LAVA/LV. Taking into account such findings, a subcutaneous defibrillator was implanted for primary prevention and a control CMR was scheduled in the follow–up period. Conclusions This case underlines the central role of CMR in identifying areas of myocardial fibrosis that can represent the electroanatomical substrate for triggering ventricular arrhythmias. In this case, the arrhythmic events are associated with a focal area of transmural fibrosis and wall thinning, usually indicating ischaemic damage, nonetheless in the presence of normal coronary arteries.

Sleep Inversion and The Left Ventricular Systolic Function

Abstract Background Sleep inversion is sleeping during the day and waking up at night; a depart from the normal sleeping time between 10:00 PM to 5:00 AM. The aim of this study was to detect subtle changes in left ventricular (LV) systolic function caused by sleep inversion using strain imaging in young healthy individuals free of cardiovascular risk factors. Methods 100 healthy persons (18 to 35 years of age) with an inverted sleep pattern, and a normal LV systolic function by conventional 2D echocardiography were compared with 100 healthy individuals from the same age group with normal sleep timings. Conventional and speckle tracking echocardiography were performed. Results Male gender, smoking, less exercise, social media overuse, and junk food were significantly more common in the sleep inversion group. They had lower mean GLS than the controls (-20.90% ± 3.45 vs -22.87% ± 3.67, p < 0.0001). By multivariate analysis, sleep inversion was found to be independently associated with low GLS (Odds ratio: 2.02, 95% confidence interval (CI): 1.07–3.82, p = 0.03). Conclusion Sleep inversion is associated with subclinical left ventricular systolic dysfunction detected by speckle tracking in young healthy individuals. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Basal characteristics of the prospective spanish immunotherapy registry of cardiovascular toxicity: SIR-CVT

Abstract Background The immune checkpoint inhibitors (ICI) have improved the prognosis of many cancers in the last years but concerning cardiovascular toxicity (CVtox) have been reported. Nowadays, specific surveillance protocols are lacking, and early diagnosis of toxicity may be challenging. Purpose To characterize the cardiovascular (CV) effects of immunotherapy and to seek for the mechanisms of CVtox of ICI in a protocolize surveillance program of cardio-oncology. Methods A multicentre national registry was developed by a research consortium of scientific societies of Cardiology and Oncology (SEC and SEOM) and the cardiovascular research centre (CNIC) in Spain (Figure 1). A total of 18 hospitals participate in recruiting since Q4 2021. A follow-up protocol was stablished with clinical, electrocardiographic (EKG), echocardiography, cardiac magnetic resonance (CMR) and laboratory assessment, including cardiac biomarkers, inflammatory panel and the expression of miR-721, a specific myocarditis biomarker. Toxicity management is performed at each institution following international guidelines. Results 53 patients were currently included. Median age was 68 [59, 75] years-old, 79% were male. 83% had at least 1 CV-risk factor (75% smoking history, 20% diabetes mellitus, 50% hyperlipemia, 57% hypertension, 19% chronic kidney injury) and up to34% had previous CV disease. 93% had at least one dose of COVID19 vaccine. Dyspnoea was referred by 23% of patients, 28% have abnormal EKG findings and one-third (33%) abnormal cardiac biomarkers (median Troponin I-hs 5.30 [2.60, 11.00]; NT-proBNP 199 [68, 736]). Mean LVEF (60% [56.15, 66.78]) and GLS (−18 [−19.75, −16]) were within the normal range but 26% showed LGE at baseline. Cancer characteristics are summarized in Table 1. Conclusion Real-world SIR-CVT patients show a high CV risk profile and frequent pre-existing CV diseases before ICI treatment. The prospective follow-up of this cohort will help to develop personalized surveillance protocols according to baseline CVtox risk and to define different grades of cardiotoxicity. Funding Acknowledgement Type of funding sources: None.

HYPERTENSIVE HEART DISEASE, WHAT ARE THE FACTORS PRECIPITATING ITS EARLY ONSET?

Objective: Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular pressure overload, and changes in cardiac geometry and LV hypertrophy. This study is intended to assess the clinical and echocardiographic factors associated with and predictive for early impairment of left ventricular function as assessed using global longitudinal strain evaluation in hypertensive patients. Design and method: Cross-sectional descriptive study, with a total number of 130 hypertensive and with the objective of evaluating the study of longitudinal function by 2D strain in patients with systemic hypertension with preserved LVEF and the determination of predictors the decrease GLS in this population. This work is to make a complete study echo cardiographic, including LVEF biplane Simpson method, calculation of left ventricular mass indexed and relative parietal thickness, analysis diastolic function and the study of longitudinal strain of the LV by the speckle tracking technique (calculation of GLS) Results: The prevalence of left ventricular hypertrophy (LVH) was found in (66%). half of the patients (49%) presented a concentric hypertrophy, It was clearly noted that 73%of the patients had a relative wall thickness (RWT)> 0.42. Alterations in diastolic function were detected in 89% of the group, 18% had severe diastolic dysfunction with elevation in filling pressure. Analysis of the longitudinal systolic function of the left ventricle took the average GLS as a reference value. The mean GLS was found to be -16.9 ± 3.2%, within a range between -25% and-11.6%. Low GLS values (>-17%) were found in 45.5%. In particular, 34.4% of the patients had no left ventricular hypertrophy (LVH) and 50.7% of them presented LVH. The average systolic and diastolic blood pressures, taken at the time of echocardiographic analysis, were found higher in the subgroup of hypertensive patients with low GLS. Statistical analysis revealed significant correlation between the decrease in GLS and diabetes the values of blood pressure and elevated filling pressures. Conclusions: The evaluation of longitudinal systolic function by 2D strain provides new insight of myocardial function in hypertension that could improve the pathophysiological understanding and identify high-risk heart failure patients eligible for preventive strategies.

Cardiovascular involvement in post Covid patients

Objectives: to highlight the cardiovascular sequelae of Covid-19, especially subclinical dysfunction of the left ventricle. Materials and methods: the study included 74 Covid-19 convalescent patients with no history of cardiovascular disease, with a mean age of 42.01 years ± 1.4 years. Patients were assessed by speckle tracking echocardiography. Results: The results of our study determined that 41 (55.4%) Covid-19 convalescent patients have subclinical left ventricular systolic dysfunction, the mean GLS in the group being 15.8 ± 0.39, while in the control group no person has GLS <16% (p <0.001). Other manifestations were: diastolic dysfunction - 23 (31.1%), right ventricular dysfunction - 22 (30.1%), pericardial effusion - 19 (25.7%), symptoms - 67 (90%). Conclusions: Subclinical cardiac dysfunction is a common complication encountered in convalescent Covid-19 patients, and determination of GLS by speckle tracking echocardiography remains a practical and cost-effective tool to detect this injury; The persistence of symptoms, included in longCovid, does not correlate with the results of imaging investigations.

Longitudinal Echocardiographic Assessment of Donor Hearts in DCD Donors Using Thoracoabdominal Normothermic Regional Perfusion

<h3>Purpose</h3> In the U.S., multiple centers are beginning to develop protocols for DCD organ donation. We describe our intraoperative echo thoracoabdominal normothermic regional perfusion (TA-NRP) DCD protocol for initial donor acceptance and mid-term follow up <h3>Methods</h3> After identification of a suitable DCD donor, withdrawal of life support is performed in the OR until circulatory death occurs. After 5 minutes of observation, circulatory death is declared. The sternum is opened, cerebral vessels are ligated, and cardiopulmonary bypass (CPB) is initiated. Transesophageal echocardiogram (TEE) monitors the following parameters to ensure the heart is acceptable: left ventricular ejection fraction (LVEF) ≥50%, mitral valve annulus lateral S wave (MV S wave) ≥10 cm/sec, left ventricular outflow tract time integral (LVOT VTI) ≥15 cm, and right ventricular systolic function (RVEF) normal by visual estimation. The recipient's LVEF and global longitudinal strain rate (GLS) were followed longitudinally for up to 18 months <h3>Results</h3> From January 2020 to October 2021, 10 TA-NRP DCD transplants were performed: 7 isolated hearts, 2 heart-bilateral lung, and 1heart-kidney. Median donor age was 43.5 years (26-51) and there were 9 males (90%). Fifty percent of donors had a history of opioid drug overdose. The mean preoperative donor LVEF was 68%. Mean TEE parameters while weaning off CPB: LVEF 65%, MV lateral S wave 12 cm/sec, and LVOT VTI 19 cm. RVSF was normal for all donors. None of the donors required inotropic support. The recipient median age was 54 years (44-72) and 70% were male. None of the recipients developed cardiac graft failure. At mean follow-up of 392 days, mean LVEF is 64% and mean GLS is -16.7% and all patients are alive. <h3>Conclusion</h3> A standardized intraoperative TEE protocol to assess TA-NRP DCD donor heart function while weaning CPB is of paramount importance to ensure excellent longitudinal recipient graft function.

Subclinical left ventricular dysfunction during systemic lupus erythematosus activity with follow-up after remission – A speckle tracking echocardiographic study

Aim of the workTo investigate the subclinical left ventricular (LV) dysfunction in patients with active systemic lupus erythematosus (SLE) using speckle tracking echocardiography (STE). The echocardiographic parameters were followed up when the disease activity was controlled. Patients and methodsThis prospective study included 63 patients with active SLE and LV ejection fraction (EF) ≥50%.Safety of Estrogens in Lupus Erythematosus: National Assessment – Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) was assessed and categorized as mild/moderate (≤12) or severe (>12). Fifty SLE patients continued follow-up after 3–6 months of the disease remission. Fifty age- and gender-matched healthy individuals acted as the control group. The measured STE parameters included LV deformation (global longitudinal strain [GLS] and global circumferential strain [GCS]) and rotational parameters (rotation, twist, and torsion). ResultsThe patients were 56 females and 7 males (F:M 8:1) and median age 26 years (IQR: 21–31 years) and a disease duration of 3 years (IQR 2–5 years. Active SLE patients showed worse strain parameters than controls (mean GLS −19.9%±2.1 vs −22.7%±1.3 and mean GCS −21.2 ± 2.5% vs −25.1 ± 1.7% respectively; p < 0.001 for both). Patients had lower LV rotational parameters (p < 0.001 for all). STE parameters were similar in patients with mild-moderate and severe activity and improved after remission in both groups. ConclusionActive SLE patients had modest LV dysfunction by STE despite having normal function by traditional echocardiography. Disease remission resulted in the improvement of STE parameters. STE is a simple tool to use in SLE activity scores to detect early cardiac dysfunction.

Impact of mitral annular calcification on hemodynamic effect in mitral stenosis in multiple valve disease: relevant or not

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Prevalence of mitral annulus calcification (MAC) and degenerative mitral stenosis thus elevated transmitral gradient (TMG) is increased with age and multivalve involvement. The management of degenerative multivalve disease is challenging, as is identification of the presence of multivalve involvement and its hemodynamic impact because of interaction between two or more valve lesions especially in degenerative valve disease. Hemodynamic interaction between significant aortic stenosis and mitral annular calcification is often combined with diastolic disfunction which can result in LA enlargement and abnormal atrioventricular coupling and left atrial and ventricular remodeling. Purpose Study aimed to assess the effect of MAC on mitral valve stenosis in patients with multiple valve disease of degenerative origin. Method We retrospectively analyzed 78 patients with elevated transmitral gradient defined as an elevated TMG &amp;gt;4mmHg, MAC in multivalve involvement, mainly degenerative significant aortic valve stenosis who were treated in our clinic from 2018 to 2021. We excluded patients with prior cardiac surgery, congenital heart disease, hypertrophic obstructive cardiomyopathy and with heart rate &amp;gt;100 bpm at time of study and significant mitral regurgitation. Baseline demographic data were extracted from the electronic medical record and echocardiographic data were analyzed from electronic saved data. Results Study identified a total of 78 patients (average age 71,89 years, 64% females). Of 57 analyzed patients 32% patients had severe MAC and calcification of chordae, and 68% patients had MAC and mild or no significant chordae calcification. Patients with aortic gradients, severe aortic stenosis (AVAi 0,80 cm/m2) were observed more often in patients with severe MAC and significant chordae calcification than in those with nonsevere MAC (p &amp;lt; 0.043).There was no significant difference in mitral annular distension between groups. Baseline mean MV gradients were 6,5+-1.5 mm Hg. Mean MVA (continuity equation) was 1,5+-0.4 cm2, and MVAi 0,8+-0,2 cm/m2, mean LA volume 70 ml/m2, mean E/e 35, mean EF LV 68% and mean GLS -14. Conclusion Result suggest that increasing transmitral gradient if superimposed on severe MAC with only modest mitral stenosis will result in a high mean transmitral gradient. The presence of elevated pressure transmitral gradient in patients with more severe aortic stenosis and more severe MAC combined with chordae calcification may imply hemodynamic effect or stress on mitral valve degeneration in multiple valve involvement. Other imaging modalities and further investigation for better understanding effect of hemodynamic stress in multiple valve disease are needed. These observations need to be evaluated on larger cohorts of patients during a longer period of time.

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

Global longitudinal strain and its association with quantitative and qualitative analyses of myocardial perfusion correlate in patients with abnormal SPECT results

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Global longitudinal strain (GLS) is being used more commonly in the evaluation of patients with ischemic heart disease (IHD). Even though GLS is known to be associated with infarct size, its relationship with parameters derived from myocardial perfusion studies (MPS) has not been explored enough. AIMS We assessed the correlation of GLS measured with echocardiography with quantitative and qualitive analyses parameters of SPECT-MPS, particularly stress and rest total perfusion deficits (TPDS and TPDR) and summed stress and summed rest scores (SSS and SRS) respectively. METHODS A cross-sectional cohort of patients classified with an abnormal nuclear medicine result using SPECT were tested with doppler echocardiography in a center of reference in Mexico City. Pearson correlation tests and polynomial regression models were used to extract the correlation coefficient and the explained variability for each variable. RESULTS 122 subjects with abnormal nuclear medicine results were assessed. 87 (71.3%) were male with a mean left ventricular GLS of -16 (±5), SRS of 12.9 (±14.5), SSS of 18 (±15.8), TPDR of 12 (±14.3) and TPDS of 17.7 (±15.6). We observed a negative cubic adjusted correlation between GLS and TPDR (r = 0.501, 95% CI: 0.336-0.637, p= &amp;lt;0.001), TPDS (r = 0.470, 95% CI: 0.300-0.612, p= &amp;lt;0.001), SRS (r = 0.472, 95% CI: 0.302-0.613, p= &amp;lt;0.001) and SSS (r = 0.460, 95% CI: 0.288-0.603, p= &amp;lt;0.001). CONCLUSION GLS has a moderate cubic correlation with a negative leading coefficient with TPDR, TPDS, SRS and SSS. This data suggests that GLS may be an adequate parameter for assessing patients with IHD. Abstract Figure. Scatter plot with regression model

Evaluation of subclinical LV systolic dysfunction by global longitudinal strain using 2D-speckle tracking echocardiography in patients having angina with normal epicardial coronary arteries

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Self Background Global longitudinal strain (GLS), assessed by 2D speckle tracking echocardiography would be a trustworthy noninvasive tool to detect subclinical LV systolic dysfunction in patients having angina with normal epicardial coronary arteries. Objective The primary objective of the study to detect subclinical LV systolic dysfunction by GLS using 2D-STE in patient having angina with normal coronary arteries and also by conventional echocardiogram at baseline. Materials and Methods This was a comparative case control study that was conducted during the period of March 2018 to August 2018. The study included 60 patients who have been suffering from angina like syndrome despite normal coronary arteries along with 60 normal healthy individuals . All subjects were assessed by transthoracic echocardiography (TTE ) and GLS using 2D speckle-tracking analysis to assess resting LV systolic function . The results of all three planes in GLS (the apical four-chamber , two-chamber , and three-chamber views) were combined in a single bull’s eye summary (agreeing with the standard 17-segment model), which presented the analysis of each segment along with a global peak systolic strain value for the LV. Results This study identified normal reference value of the mean GLS in healthy control group was −19.7 ± 1.84%. GLS assessed by 2D STE was significantly impaired in patients having angina like syndrome with normal epicardial coronary arteries (-18.78 ± 1.87 vs -19.7 ± 1.84%; p &amp;lt; 0.007) than healthy control group despite preserved LVEF. In case group, 8 out of 60 patients (13.3 %) had more negative global longitudinal strain than control subject. Conclusions Patients having angina with normal epicardial coronary arteries are likely to have microvascular disease. GLS assessed by 2D STE has the potential to improve the value of conventional echocardiography in the detection of the coronary microvascular disease. Despite normal LVEF, significant impairment of LV global longitudinal systolic function can differentiate microvascular group of patients from others who have angina with normal coronaries.

Longitudinal Assessment of Global and Regional Left Ventricular Strain in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C).

Multisystem inflammatory syndrome in children (MIS-C) is one of the most significant sequela of coronavirus disease 2019 (COVID-19) in children. Emerging literature has described myocardial dysfunction in MIS-C patients using traditional and two-dimensional speckle tracking echocardiography in the acute phase. However, data regarding persistence of subclinical myocardial injury after recovery is limited. We aimed to detect these changes with deformation imaging, hypothesizing that left ventricular global longitudinal (GLS) and circumferential strain (GCS) would remain impaired in the chronic phase despite normalization of ventricular function parameters assessed by two-dimensional echocardiography. A retrospective, single-institution review of 22 patients with MIS-C was performed. Fractional shortening, GLS, and GCS, along with regional longitudinal (RLS) and circumferential strain (RCS) were compared across the acute, subacute, and chronic timepoints (presentation, 14–42, and > 42 days, respectively). Mean GLS improved from − 18.4% in the acute phase to − 20.1% in the chronic phase (p = 0.4). Mean GCS improved from − 19.4% in the acute phase to − 23.5% in the chronic phase (p = 0.03). RCS and RLS were impaired in the acute phase and showed a trend towards recovery by the chronic phase, with the exception of the basal anterolateral segment. In our longitudinal study of MIS-C patients, GLS and GCS were lower in the acute phase, corroborating with left ventricular dysfunction by traditional measures. Additionally, as function globally recovers, GLS and GCS also normalize. However, some regional segments continue to have decreased strain values which may be an important subclinical marker for future adverse events.

Global longitudinal strain as a predictor of cardiovascular events and mortality in patients with ischemic heart disease and heart failure with preserved/mid-range ejection fraction

Abstract Introduction Global longitudinal strain (GLS) is considered a more sensitive marker of systolic dysfunction than other measures commonly used in clinical practice, such as left ventricle ejection fraction (EF). Our objective was to evaluate the impact of reduced GLS in death and cardiovascular events in patients hospitalized due to heart failure with mid-range or preserved ejection fraction, with previous history of acute myocardial infarction. Methods A retrospective analysis of 170 patients admitted to a Cardiology ward due to acute heart failure (AHF) was performed. Patients with reduced EF (Simpson biplane method - EF&amp;lt;40%) were excluded based on echocardiographic evaluation after AHF stabilization. GLS measured by “speckle tracking” technique was calculated for each patient. Measurements were made by the same operator to minimize interoperator variability. Mann-Whitney U test was used for univariate analysis. Kaplan-Meier survival plots and Cox-regression analysis were performed to assess differences in 12-month mortality (12MM) and in the composite endpoint of cardiovascular event or death (12CVM) at 12 months. Results A total of 127 patients were included. Mean patient age was 64 (±14) years; 72% were men. 48% of patients had history of ST elevation AMI. Mean EF was 54% (±8) and mean GLS was −14.3 (±3.8). Rates of 12MM and 12CV M were 14.2% and 19.3%, respectively. A statistically significant association between 12MM and 12MCV was found in univariate analysis for GLS (p&amp;lt;0.001). Kaplan-Meyer survival plots revealed that a compromised GLS (&amp;lt;−16) was associated with significantly increased 12MM (23% vs 2.5%, X2: 7.999, p=0.005) and 12CVM (26.6% vs 10%, X2: 4.139, p=0.042). When stratified by mid-range vs preserved EF, GLS &amp;lt;−16 was associated with worse outcomes, although the results did not reach statistical significance (p&amp;gt;0.05). However, when considering a severely compromised GLS (&amp;lt;−13), GLS was significantly associated with increased 12MM (52% vs 8.3%, X2: 5.533, p=0.019) and 12CVM (50% vs 8.3%, X2: 4.970, p=0.026), in the subgroup of patients with heart failure with mid-range EF. Cox-regression analysis demonstrated that GLS was independently associated with 12MM (HR: 0.668p, &amp;lt;0.001) and the 12CVM composite endpoint (HR: 0.819, p=0.008), even after adjustment for other important prognostic markers such as chronic kidney disease, pulmonary disease and diabetes, with significant hazard ratio reduction for each positive point increase in GLS. Conclusion GLS is an independent predictor of 12MM and 12CVM in patients hospitalized due to AHF, with an EF ≥40% and previous history of acute myocardial infarction. In the subgroup of patients with heart failure with mid-range EF, a severely compromised GLS (&amp;lt;−13) is a strong predictor of 12MM and 12CVM. Funding Acknowledgement Type of funding sources: None.

CAN EXERCISE PREVENT CHEMOTHERAPY-INDUCED CARDIAC DYSFUNCTION? AN ECHOCARDIOGRAPHIC ASSESSMENT OF CARDIAC MECHANICS IN WOMEN WITH BREAST CANCER

BACKGROUND Cardiotoxicity from breast cancer (BC) therapy, specifically with anthracyclines, is a significant cause of morbidity and mortality in women with BC. Although aerobic exercise (AE) during anthracycline therapy has been shown to reduce side effects including fatigue, nausea, and pain, the cardioprotective benefits of exercise remain unclear. Thus, we investigated the effect of a 24-week home-based AE program on cardiac function in women with BC receiving anthracyclines using echocardiography. METHODS AND RESULTS Women with BC were randomized to either a control group (standard of care) or to standard of care with a 24-week home-based AE program. Based on our previous exercise feasibility study in this patient population, the graduated exercise program consisted of 2 self-directed sessions per week (performed at 35-85% incremental heart rate reserve intensity) to achieve a minimum of 90 minutes of exercise weekly. Serial transthoracic echocardiography (TTE) was conducted at baseline and at 24-weeks to assess cardiovascular systolic and diastolic function, and strain parameters. A total of 11 women with BC (49 ± 10 years old) were recruited and randomized to either control (n = 5) or AE (n = 6). Ten patients received adriamycin and cyclophosphamide for 8 weeks and 1 patient received fluorouracil, epirubicin, and cyclophosphamide for 9 weeks. Additionally, 5 patients received adjuvant radiation therapy. A total of 5 women had baseline cardiovascular risk factors including hypertension (n=1), hyperlipidemia (n=1), smoking history (n=2), and family history of premature coronary artery disease (n=2). The characteristics of patients in the two groups were similar. Participants randomized to AE demonstrated an average of 94% adherence to the program. There were no significant differences between the two groups in the measured cardiovascular morphologic or functional parameters (Table 1). At baseline, mean LVEF was 63±1% in the control group and 63±2% in the AE group (Figure 1). At 24-weeks, mean LVEF was 60±2% and 59±8% in the control and exercise groups, respectively (p = NS). Additionally, at baseline, mean GLS was -18.8±0.4% in the control group and -18.7±1.1% in the AE group. At 24-weeks, mean GLS was -17.6±1.0% in the control group and -17.7±2.1% in the AE group (p = NS). CONCLUSION These preliminary echocardiographic findings indicate that although a 24-week home-based AE program was feasible, we were unable to demonstrate cardioprotection in women with BC receiving chemotherapy in comparison to standard of care. Cardiotoxicity from breast cancer (BC) therapy, specifically with anthracyclines, is a significant cause of morbidity and mortality in women with BC. Although aerobic exercise (AE) during anthracycline therapy has been shown to reduce side effects including fatigue, nausea, and pain, the cardioprotective benefits of exercise remain unclear. Thus, we investigated the effect of a 24-week home-based AE program on cardiac function in women with BC receiving anthracyclines using echocardiography. Women with BC were randomized to either a control group (standard of care) or to standard of care with a 24-week home-based AE program. Based on our previous exercise feasibility study in this patient population, the graduated exercise program consisted of 2 self-directed sessions per week (performed at 35-85% incremental heart rate reserve intensity) to achieve a minimum of 90 minutes of exercise weekly. Serial transthoracic echocardiography (TTE) was conducted at baseline and at 24-weeks to assess cardiovascular systolic and diastolic function, and strain parameters. A total of 11 women with BC (49 ± 10 years old) were recruited and randomized to either control (n = 5) or AE (n = 6). Ten patients received adriamycin and cyclophosphamide for 8 weeks and 1 patient received fluorouracil, epirubicin, and cyclophosphamide for 9 weeks. Additionally, 5 patients received adjuvant radiation therapy. A total of 5 women had baseline cardiovascular risk factors including hypertension (n=1), hyperlipidemia (n=1), smoking history (n=2), and family history of premature coronary artery disease (n=2). The characteristics of patients in the two groups were similar. Participants randomized to AE demonstrated an average of 94% adherence to the program. There were no significant differences between the two groups in the measured cardiovascular morphologic or functional parameters (Table 1). At baseline, mean LVEF was 63±1% in the control group and 63±2% in the AE group (Figure 1). At 24-weeks, mean LVEF was 60±2% and 59±8% in the control and exercise groups, respectively (p = NS). Additionally, at baseline, mean GLS was -18.8±0.4% in the control group and -18.7±1.1% in the AE group. At 24-weeks, mean GLS was -17.6±1.0% in the control group and -17.7±2.1% in the AE group (p = NS). These preliminary echocardiographic findings indicate that although a 24-week home-based AE program was feasible, we were unable to demonstrate cardioprotection in women with BC receiving chemotherapy in comparison to standard of care.

Risk stratification and prognostic value of CMR in DCM; parametric mapping and GLS- value beyond EF and LGE?

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Dr Pamela Brown was suppoerted by funding from Alliance Medical. Background; Arrhythmia risk stratification and device implantation in dilated cardiomyopathy (DCM) poses significant challenges and as demonstrated by the DANISH trial appears to have reached the asymptote of clinical efficacy. A body of evidence now demonstrates that risk stratification of and device selection for DCM patients may be enhanced by inclusion of patients" LGE-status. Furthermore, it has been suggested that CMR based parametric mapping and strain analysis may further advance risk stratification. Methods; 703 patients with DCM undergoing clinically indicated CMR scans and prospectively enrolled into the UHSM-CMR study (NCT02326324) between 03/2015-12/2018 were analysed. Multivariable Cox proportional hazard models and Youden index driven C-statistics were used to assess additive prognostic value of GLS, T1 and ECV mapping on the combined endpoint of cardiovascular death, cardiac transplantation, LVAD insertion or hospitalisation for heart failure in models incorporating NHYA class, EF and LGE status. Additionally. the value of GLS, T1, and ECV on predicting significant arrhythmic events (SAV) (ventricular arrhythmia (VA), resuscitated cardiac arrest (rCA) or sudden cardiac death (SCD)) was assessed. Results; Patients (mean age 59, 66% male, 60% ≥NYHA II, mean EF 42%, mean GLS -12%, mean ECV 27%) were on good medical therapy (beta blocker 74%%, ACE 79%, MRA 38%, Entresto 5%, CRT 23%). Mean follow-up was 21 months; the combined endpoint occurred in 34 patients (5%). On univariate analysis NYHA class (HR 2.44 (1.67-3.57), p &amp;lt; 0.001), ECV (HR 1.14 (1.05-1.22), p &amp;lt; 0.001), GLS% (HR 1.14 (1.07-1.21) p &amp;lt; 0.001,) T1 (HR 1.06 (1.005-1.1), p = 0.03), RVEF (HR 0.95 (0.93-0.98), p &amp;lt; 0.001), LVEF (HR 0.92 (0.9-0.95), p &amp;lt; 0.001) were all significantly associated with outcome. On multivariate analysis only EF and NYHA class was associated with outcome. SAV occurred as the first manifestation of disease or during follow up in 27 patients (4%). At univariate analysis LGE, ECV, GLS, EF and NYHA class were all associated with SAV. However, on multivariable analysis only EF, LGE and ECV (HR 1.11 (1.01-1.22), p = 0.03) but not GLS remained independently predictive in a model already incorporating EF, NYHA and LGE. Conclusion Optimally treated DCM populations have very low event rates. CMR based assessment of fibrosis status/burden with both LGE and ECV assessment has the potential to enhance patient selection for ICD therapy. Whilst GLS is increasingly recognised as a sensitive imaging biomarker of early disease detection it provides no additive value, likely because of it’s high co-linearity with EF, in models already containing EF, NYHA class and LGE status.

Predictors of pacing induced left ventricular dysfunction and cardiomyopathy assessed by three-dimensional echocardiography and speckle tracking strain

BackgroundLong-term RV pacing leads to ventricular dyssynchrony, in the form of LBBB-like morphology, with subsequent detrimental effects on LV structure and function. Three-dimensional echocardiography allowed early detection of volumetric changes associated with PICMP and provided more accurate assessment of mechanical dyssynchrony. Speckle tracking strain is able to identify LV dysfunction even before any reduction in LVEF. Our aim was to study pacing effects on LV function and hemodynamics using 3D echo and speckle tracking strain.ResultsThis was a prospective study of 175 consecutive patients without structural heart disease (LVEF > 50%) presented for permanent pacing. Full-volume 3D echocardiography done before implantation, 1 week, and 6 months together with GLS. Patients were followed for 6 months to detect incidence of PIVD (defined as reduction in LVEF > 10% but still above 50%) and PICMP (defined as decrease in LVEF by 10% from baseline in absence of other known causes of cardiomyopathy resulting in EF< 50%). PIVD and PICMP predictors and risk factors were analyzed. Only 50 patients met study criteria. Twenty-five (50%) patients developed LV systolic dysfunction; of these, 19 (38%) developed PIVD and 6 (12%) developed PICMP. Pre-implantation GLS was significantly lower in the 6 patients who subsequently developed PICMP, compared to those who developed PIVD and the preserved EF group (mean GLS − 15.50 vs. − 21.0, − 20.0 respectively; p = 0.005, 0.033, respectively). At 1 week, GLS was significantly lower in the 25 patients who subsequently developed PIVD, compared to those who did not (GLS − 13.0 vs. − 18.0, respectively; p = 0.002). A reduction of baseline GLS by 15% or more at 1 week was associated with the development of PIVD and PICMP (p = < 0.001). A wider native QRS complex was associated with PIVD and PICMP (p = 0.008, 0.018, respectively). The other predictors were found non-significant.ConclusionPICMP may be more common than previously reported and it may occur shortly after implantation. Pre-implantation GLS is a sensitive parameter for PICMP. One-week GLS, pre-implantation QRS complex width are early predictors for PICMP and PIVD before any reduction in EF.

THE PREFERENCE OF USING GLOBAL LONGITUDINAL STRAIN SPECKLE TRACKING ECHO STUDY OVER MEASUREMENT OF LEFT VENTRICLE EJECTION FRACTION (LVEF) IN THE EARLY DETECTION OF SUBCLINICAL SYSTOLIC DYSFUNCTION IN DIABETIC PATIENTS

The aim: Prove that the use of GLS by speckle tracking ECHO study is more sensitive to detect early systolic dysfunction. Materials and methods: In this case control study 40 diabetic patients 22 males (55%) &amp; 18 females (45%) who have no symptom or clinical finding of a cardiac problem with normal LVEF and a 30 healthy control subjects. The ECHO study includes measuring their LVEF &amp;comparing it with the result global longitudinal strain by speckle tracking for assessment of systolic function. Results: A 62.5% of diabetic patients who are have no CVS complaint neither they have systolic dysfunction with normal LVEF they have early systolic dysfunction revealed by speckle tacking technique in compares to a healthy control group where only 10% have systolic dysfunction with mean GLS of the patients was -17.43±3.016, while that for the control group -20.58 ± 1.729 A P value of 0. 012. Also there is a significant correlation between the duration of DM &amp; the systolic dysfunction as detected by GLS. Conclusions: Diabetic patients got early systolic dysfunction before they show any symptoms, even their LVEF is normal, which can be detected by speckle tracking ECHO study.