Measures Of Left Ventricular Function Research Articles

Evaluating cardiac performance in beagle dogs: Transesophageal echocardiography and myocardial work assessment.

This study aimed to establish standard transesophageal echocardiographic (TEE) measurements of left ventricular (LV) morphology, function, and myocardial work parameters in healthy Beagle dogs using pressure-strain loops (PSL). Additionally, it sought to standardize optimal TEE imaging techniques and explore the potiential application of myocardial work analyis in veterinary medicine. Thirty-seven healthy male Beagle dogs were anesthetized, intubated, and mechanically ventilated for TEE examinations. LV systolic and diastolic function were evaluated, with simultaneous invasive femoral artery pressure measurements. Left ventricular global longitudinal strain (GLS), myocardial work parameters, PSL-derived metrics were analyzed. The mean LV GLS was -16.0±4.0%, and the LV global myocardial work index (GWI) was 888±298.6mmHg∗%. Global Myocardial work efficiency (GWE) was 88±3%, while global myocardial wasted work (GWW) was 152mmHg∗% (38-431mmHg∗%). LV ejection fraction (LVEF) averaged 58.7±4.4%. Left ventricular end-diastolic (LVEDV) and end-systolic volume (LVESV) were 19.3±5.2ml and 8.0±2.3ml, respectively. Regional myocardial work analysis revealed significant differences between the interventricular septum and lateral wall. The lateral wall demonstrated reduced segmental work efficiency (SWE), work index (SWI), and constructive work (SCW) but higher wasted work (SWW) compared to the septum (p<0.05). TEE provides detail morphological and functional assessments of the Beagle hearts, offering reference data for future studies. Myocardial work analysis presents a novel method for evaluate myocardial contractility and mechanical properties, with promising applicatons in veterinary medicine.

Relationship Between Urinary Uranium and Cardiac Geometry and Left Ventricular Function: The Strong Heart Study

BackgroundUranium is a potentially cardiotoxic, nonessential element commonly found in drinking water throughout the United States. ObjectivesThe purpose of this study was to evaluate if urinary uranium concentrations were associated with measures of cardiac geometry and function among American Indian young adults from the Strong Heart Family Study. MethodsUrinary uranium was measured among 1,332 participants free of diabetes, cardiovascular disease, and <50 years of age at baseline (2001-2003). Transthoracic echocardiography and blood pressure were assessed at baseline and at a follow-up visit (2006-2009). We estimated adjusted mean differences in cardiac geometry and function measures at baseline and follow-up using linear mixed-effect models with a random intercept and slope over time. ResultsMedian (interquartile range) uranium was 0.029 (0.045) μg/g creatinine. In fully adjusted cross-sectional models, a log-doubling of urinary uranium was positively associated with left ventricular (LV) mass index (mean difference: 0.49 g/m2, 95% CI: 0.07-0.92 g/m2), left atrial systolic diameter (0.01 cm/m2, 0.01-0.02 cm/m2), and stroke volume (0.66 mL, 0.25-1.08 mL) at baseline. Prospectively, uranium was associated with increases in left atrial diameter (0.01 cm/m2, 0.01-0.02 cm/m2), pulse pressure (0.28 mm Hg, 0.05-0.52 mm Hg), and incident LV hypertrophy (odds ratio: 1.25, 95% confidence interval: 1.06, 1.48). ConclusionsUrinary uranium levels were adversely associated with measures of cardiac geometry and LV function among American Indian adults, including increases in pulse pressure and LV hypertrophy. These findings support the need to determine the potential long-term subclinical and clinical cardiovascular effects of chronic uranium exposure, and the need for future strategies to reduce exposure.

Olympic distance duathlon and cardiac performance in highly-trained triathletes.

The effects of triathlon exercise on cardiac function are well documented. While Olympic triathlon (swim-bike-run) remains the standard format, increasing concerns about water quality in natural waterways present ongoing challenges for open-water swimming events, highlighting the potential need to consider alternative formats such as duathlon (run-bike-run) in some circumstances. An additional run may increase the overall metabolic and cardiovascular demand compared with the swim in triathlon, leading to reduced future performance. Conversely, the majority of EICF research reports reversal of post-exercise perturbations within 24-7 days of recovery but duathlon has not yet been studied in this context. Therefore, this study aimed to investigate the cardiac, autonomic, haemodynamic and biomarker responses during and following two Olympic distance (OD) duathlon separated by 7 days of recovery. Highly-trained (V O2max >60 mL·kg-1·min-1) male participants (n = 10) completed two lab-based OD duathlons, either continuous (BD) or with functional measurements after each leg (UD), separated by 7 days of rest. Conventional echocardiography recorded standard and tissue Doppler measures of left ventricular (LV) structure and function. Speckle tracking echocardiography was used to measure global longitudinal strain (GLS). Time and frequency domain analysis of HRV, as well as plasma high sensitivity cardiac troponin T (hs-cTnT) were measured pre and post exercise. In the broken duathlon trial (BD) cardiac measurements and blood samples were also taken between each leg. In the unbroken duathlon (UD) participants performed each leg sequentially. Duathlon exercise resulted in similar cardiac functional and biomarker alterations as previously reported in triathlon and standalone running and cycling exercise. Cardiac troponins were still elevated following 24 h-1 of recovery. However, functional changes were resolved within 24 h-1 of passive recovery and did not impair subsequent duathlon performance, or pre-exercise measurements 7 days after the first trial. Whether or not elite or recreational athletes experience the same magnitude and reversibility of these changes remains to be elucidated further.

Abstract 4113405: The Role of Cardiac Power Output and Stroke Work Index in Balloon Pulmonary Angioplasty Therapy for Chronic Thromboembolic Pulmonary Hypertension

Background: Right ventricular (RV) and left ventricular (LV) measures of cardiac power output (CPO) and stroke work index (SWI) are existing markers of cardiac function and clinical outcomes. These metrics have not been used to evaluate the effects of balloon pulmonary angioplasty (BPA) therapy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: CTEPH patients who underwent at least six BPA sessions and were included in the UC San Diego BPA registry were included for analysis. Left and right ventricular CPO and SWI during each session were recorded. Cardiac output was measured using the thermodilution technique. Differences in continuous variable measurements before versus after BPA therapy were evaluated using the Student T-test. P-value &lt;0.05 was significant. Results: A total of 66 subjects underwent six consecutive BPA sessions (55.5% female, BMI 28.3±6.10kg/m 2 ,16.7% prior pulmonary thromboendarterectomy surgery) and were included for analysis. Measurements of RV function, including RVCPO (Pre-BPA 0.38±0.14 vs Post-BPA 0.30±0.13 W, p=0.001)(Figure 1) and RVSWI (Pre-BPA 16.52±5.09 vs Post-BPA 14.14±4.00 g*m/beat/m 2 , p=0.004) significantly decreased after BPA therapy. Measurements of LV function, including LVCPO (Pre-BPA 1.00±0.32 vs Post-BPA 1.04±0.31 W, p=0.523) (Figure 2) and LVSWI (Pre-BPA 37.13±10.14 vs Post-BPA 39.73±9.37 g*m/beat/m 2 , p=0.152) did not change significantly after BPA therapy. The ratio of LVCPO/RVCPO increased in stepwise fashion from baseline to the last BPA session (2.82± 0.95 vs. 3.54±1.31 W, p&lt;0.001)(Figure 3). Conclusions: Hemodynamic work expended by the RV decreased after BPA therapy, while work expended by the LV remained unchanged during BPA therapy. The ratio of LV-to-RV work increased in a stepwise manner during consecutive BPA sessions. These measurements may be useful parameters to monitor clinical response to BPA therapy.

Abstract 4113164: Central Arterial Stiffness in Young Adults with Perinatal HIV Exposure

Intro: Young adults with perinatally acquired HIV (YPHIV) have higher morbidity and mortality than uninfected persons. Antiretroviral therapy (ART) has extended life expectancy making adult CV disease a concern. Perinatal exposure to HIV increases inflammation which is associated with increased arterial stiffness which predicts CV disease. Aims: We compared arterial stiffness between YPHIV and young adults perinatally HIV exposed but uninfected (YPHEU), and evaluated the association of type and duration of ART regimens, HIV disease severity, and cardiac structure and function with arterial stiffness. Methods: In a substudy of the Pediatric HIV/AIDS Cohort Study, 150 participants (95 YPHIV, 55 YPHEU, mean 23.4 yrs, 60% female, 72% Black, 24% Hispanic) had echocardiography and pulse wave velocity (PWV) measured. We compared PWV between YPHIV and YPHEU, adjusting for covariates. Among YPHIV, we fit linear regression models to evaluate the association of current (within 1 year of PWV) and historical measures of HIV disease severity with PWV. We computed correlations between PWV and measures of left ventricular (LV) structure and function, overall and by HIV status. Results: Mean PWV and hemodynamic parameters did not differ between YPHIV and YPHEU (YPHIV 5.63 vs YPHEU 5.39 m/s; p=0.5). HIV control was good (82% with viral load &lt;400 copies/ml), 91% used combination ART: integrase strand inhibitors (INSTIs; median duration 4.6 years), protease inhibitors (PIs 15.1 years), or non-nucleoside reverse transcriptase inhibitors (NNRTIs 5.2 years). Most participants had normal PWV compared to healthy controls but all values above 11.8 m/sec ( Figure , level associated with CV events in adults) were only in YPHIV. Only weak correlations were observed between PWV and echocardiographic measures (&lt;0.20) in both YPHEU and YPHIV. Among YPHIV, HIV severity measures were not associated with PWV using either current or historical measures. Mean PWV was 1.68 (-0.36, 3.72) m/s higher among YPHIV with current PI use than those on INSTIs, and 1.58 (-0.94, 4.11) m/s higher than those on NNRTIs, although these differences were not significant. Conclusions: PWV was within normal ranges in most YPHIV and YPHEU although 5% YPHIV had elevated PWV. PWV may be higher with PI use due to cardiometabolic side effects. Successful HIV treatment and control of traditional CV risk factors may prevent premature vascular aging and subsequent cardiac compromise in YPHIV.

Abstract 4115027: Transcutaneous phototherapy improves left ventricular systolic function

Background: The emerging field of cardiac optogenetics uses pulses of light to stimulate optically-sensitive proteins in the heart, influencing cellular physiology with unprecedented spatiotemporal resolution. Potential benefits may include heart rhythm stabilization and relief from congestive heart failure (CHF). Transcutaneous phototherapy devices (LifeWave Inc, San Diego, USA) may provide similar benefit without the need for opsin expression in the heart or exogenous light sources. Objective: To investigate whether upregulation of carnosine activity using a wearable cutaneous phototherapy device may improve echocardiographic measures of left ventricular systolic function. Methods: The Carnosine ® adhesive skin patch (34 mm diameter) contain an organic crystalline material that reflects specific frequencies of infra-red light emitted through the skin, and known to activate carnosine dipeptides throughout the body. These function as a high-energy phosphate system known to enhance muscle function. Study participants (n=12 healthy volunteers, 40-66 years of age) underwent a focused baseline echocardiogram, which included atrial (A) and early (E) mitral valve inflow, peak tissue velocity (E’) at both the lateral and septal mitral annulus, and left ventricular ejection fraction (LVEF). 10-12 patches were then applied along the sternum and across the left thorax (3 rd -5 th interspace), incorporating the anterior axilla. The echocardiogram was repeated after 20-30 minutes. Results: LVEF was improved following application of the phototherapy device, increasing from 59.4±5.8% to 66.65±5.8% (Δ 6.3%, p&lt;0.05), predicting an improvement in overall cardiac function. In those with normal diastolic function at baseline, septal E’ increased 7.3±0.57 cm/s to 8.2±0.58 cm/s (Δ 0.87 cm/s, p&lt;0.05), indicating a direct effect on contractility. E and A wave velocities increased 2.46±0.14 cm/s and by 5.7±0.72 cm/s, indicating augmented hemodynamics trending towards significance. Conclusion: Cutaneous phototherapy devices may enhance left ventricular systolic function without the need for drug delivery, gene manipulation, or exogenous light sources.

Abstract 4131409: Systemic Review and Meta-analysis of Global Longitudinal Strain Changes after Angiotensin Receptor Nephrilysin Inhibitor Initiation in Patients with Heart Failure

Angiotensin Receptor Nephrilysin Inhibitors (ARNi) have been established as a beneficial medication in patients with heart failure (HF). This class of medications has been shown to decrease HF hospitalizations and has been included as one of the pillars in guideline directed medical therapy. Recently, left ventricular (LV) global longitudinal strain (GLS) measurements on echocardiograms have become more common and provide a more precise measurement of LV function than ejection fraction. GLS is now being used as a more intricate way of monitoring improvement in the function of the myocardium, especially in patients with heart failure. This meta-analysis was conducted to determine if treatment with ARNi in HF patients significantly improves myocardial functioning measured by LV GLS. A meta-analysis of 9 studies including observational studies and randomized controlled trials found in a Pubmed search was performed and included patients with heart failure who were initiated on an ARNi for guideline directed medical therapy and had LV GLS measurements taken on an echocardiogram before and after ARNi initiation. The study included patients with heart failure with reduced ejection fraction. Studies were excluded if the patient population did not have a diagnosis of HF and if LV GLS measurements were not available before and after treatment with ARNi. This analysis was performed to determine if initiation of ARNi in patients with HF led to a significant improvement in LV GLS on echocardiography and therefore a significant improvement in myocardial function. There were 9 studies included in the analysis and 879 patients with HF who were treated with ARNi or a control. The change in LV GLS at the conclusion of the study period was measured in both treatment and control groups and the mean difference between the two groups was -1.61 with a 95% confidence interval of (-2.23, -0.98) (p &lt;0.00001). This indicates that the ARNi treatment groups had a significant improvement in GLS compared to the control groups. ARNi initiation was found to significantly improve LV GLS and therefore myocardial function in patients with HF with reduced ejection fraction. LV GLS is a precise measurement of myocardial function. Using this form of measurement in echocardiograms can aid in determining the effect different treatments have directly on myocardial function.

Tipping the scale: Effects of physical activity and body composition on cardiac parameters in postmenopausal females.

The risk of cardiovascular disease increases significantly after menopause. We sought to assess the impact of different activity levels on cardiac structure and function in postmenopausal women. We grouped age-similar, postmenopausal women by self-reported physical activity levels over two decades. The study involved 34 women (age 61 ± 1 years; 11 ± 2 postmenopausal years; body mass index 23 ± 3 kg/m2) categorized into three activity tiers: sedentary (SED; ≤1 h exercise weekly; n = 9); moderately active (MOD; ≥2 ≤6 h low/moderate intensity exercise weekly; n = 11) and highly active (HIGH; >4 h of moderate/high intensity exercise weekly; n = 14). Maximum oxygen uptake (VO2max) differed significantly (p < 0.05) between the groups (24.9 ± 5.8; 30.5 ± 5.8; 38.4 ± 4.4 mL O2/kg/min; SED, MOD and HIGH respectively). Conversely, there were no differences (p > 0.05) in height, Total fat-free mass, body surface area or in echocardiographic measures of left ventricular (LV) morphology, systolic function, diastolic function and right ventricular function. Contrary to our hypothesis, these findings reveal that marked differences in activity level and VO2max are not reflected in measures of LV morphology or echocardiographic indicators of cardiac diastolic or systolic function in postmenopausal women of similar body size.

Lipoprotein(a) levels and LPA genotypes are not associated with echocardiographic measures of left ventricular structure and function in the general population

Abstract Background Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for myocardial infarction and aortic valve stenosis, and elevated Lp(a) levels are associated with increased risk of heart failure. While part of this heart failure risk is mediated through atherosclerotic and valvular disease, other pathological pathways may also contribute to the association between Lp(a) and heart failure. Purpose To assess if Lp(a) levels and corresponding LPA genotypes are associated with echocardiographic measures of left ventricular structure and function in the general population. Methods We included 3,427 participants from an observational general population study who underwent protocol echocardiography between 2011-15 and had an available measurement of Lp(a) and LPA genotypes. Lp(a) was measured in 1991-94 and 2001-03 using well-validated assays with the most recent measurement used for the present analysis. Participants were divided into groups based on quartiles of Lp(a) with the top quartile further stratified to capture those above the 90th percentile. For genetic analysis, participants were grouped based on kringle IV type 2 [KIV-2] repeat corresponding to plasma Lp(a) percentile groups. Linear regression models were used to estimate β-coefficients for echocardiographic measures associated with Lp(a) levels and genotypes, while logistic regression models were used to estimate odds ratios for cardiac dysfunction or remodeling. All models were adjusted for age and sex. Results Mean age was 63±14 years and 44% were male. Median plasma Lp(a) was 18 mg/dL [IQR 10-40], median number of KIV-2 repeats were 36 [30-40], 102 (3%) were rs3798220 minor allele carriers and 467 (14%) were rs10455872 carriers. Mean left ventricular ejection fraction [LVEF] was 56.0±6.6% and we had 99% power to detect an absolute LVEF difference of 2% between those with Lp(a) levels above the 90th percentile (corresponding to &amp;gt;75 mg/dL) compared with those below the 25th percentile (&amp;lt;10 mg/dL). Mean absolute global longitudinal strain (GLS) was 19.2±2.7% and we had 99% power to detect an absolute difference of 1%. However, we found no statistically significant differences in echocardiographic measures according to Lp(a) levels or LPA genotypes (Table 1). The prevalence of impaired LVEF was 16%, and we had &amp;lt;20% power to detect an odds ratio of 1.2 for those with Lp(a) above the 90th percentile compared with those below the 25th percentile. We found no significant associations between odds for cardiac dysfunction or left ventricular hypertrophy and Lp(a) levels or LPA genotypes (Table 2). Conclusion Elevated Lp(a) levels and corresponding LPA genotypes were not associated with echocardiographic measures of left ventricular structure and function in this general population cohort. While we did not have sufficient power to detect associations between Lp(a) and cardiac dysfunction, our findings do not support a substantial effect of Lp(a).

Global myocardial work index is an independent predictor of functional capacity on 6-minute walk test in stable non-ischaemic cardiomyopathy

Abstract Background Reduction in 6-minute walk test distance (6MWD) in heart failure (HF) is associated with impaired quality of life and adverse cardiovascular outcomes. Myocardial work (MW) indices are novel non-invasive measures of left ventricular (LV) function which characterise myocardial contractile efficiency and energy utility. Purpose We aim to assess the predictive capacity of MW indices for functional capacity in stable non-ischaemic cardiomyopathy (NICM). Methods We prospectively recruited consecutive patients with stable NICM from our HF service from January 2021 to December 2023. All patients received optimal guideline direct therapy (OGDT) for 3-months before undergoing a comprehensive transthoracic echocardiogram and functional assessment with 6-minute walk test (6MWT). We excluded patients with prior cardiac surgery, severe airways disease, valvular heart disease, and those in atrial fibrillation (AF) or had mechanical limitations to their mobility at time of 6MWT. We collected demographic, clinical, and echocardiographic factors to identify the determinates of reduced 6MWD defined as &amp;lt;300 metres. Results Of 249-patients included (69.9% male; age 57.3±16.5yrs), 65-patients had reduced 6MWD. They were significantly older (62.3±17.2 vs 55.5±16.0yrs, p=0.005), had shorter height (166.3±10.3 vs 171.3±9.8cm, p=0.001), higher prevalence of AF history (39.1 vs 21.4%, p=0.001), lower LV-ejection-fraction (38.1±13.3 vs 43.3±10.2%, p=0.001), lower LV-global-longitudinal-strain (LV-GLS; 10.5±4.4 vs 12.7±3.9%, p&amp;lt;0.001), lower global-work-index (GWI; 943±487 vs 1230±455mmHg%, p&amp;lt;0.001), lower global-constructive-work (GCW; 1286±561 vs 1590±494mmHg%, p&amp;lt;0.001), lower global-work-efficiency (GE; 81.2±9.9 vs 85.4±8.1mmHg%, p=0.04), larger indexed left atrial volume (LAV; 45.0±18.4 vs 40.1±24.5ml/m2, p=0.038), higher E/e’ ratio (14.6±8.9 vs 11.8±6.0, p=0.003), and lower right-ventricular-free-wall-strain (RV-FWS; 19.2±6.7 vs 21.8±6.4, p=0.008; Table 1.). On receiver-operating-characteristics-curve analysis, GWI best predicted 6MWD reduction (Figure 1; AUC 0.68) compared to GCW, GE, LVEF and LVGLS (AUC: 0.62, 0.40, 0.62, and 0.62 respectively). Accounting for covariates, our multiple regression was run to predict 6MWD from age, height, AF history, LAV, E/e’, GWI and RV-FWS. These variables statistically significantly predicted 6MWD, F(4,239)=23.5, p&amp;lt;0.001, R2=0.34). With each 100mmHg% rise in GWI being independently associated with a 6.5m increase in 6MWD. Conclusion GWI was independently associated with 6MWD in our cohort of NICM patients on OGDT. MW indices provide some mechanistic insights into exercise capacity in patients with NICM.Table 1.Baseline CharacteristicsFigure 1.ROC of GWI Discriminating 6MWD

Predictors of B-line count in hospitalized patients with COVID-19

Abstract Background B-lines on lung ultrasound (LUS) are non-specific signs of increased density within lung tissue, which can be secondary to pulmonary congestion, pneumonia, or fibrosis. LUS is recommended for managing acute heart failure (HF); however, its value in non-HF populations is less clear. Purpose To identify clinical, laboratory, and echocardiographic predictors of B-lines in a population with Coronavirus disease 2019 (COVID-19). Methods In the ECHOVID-19 study, hospitalized non-ICU patients ≥18 years with confirmed laboratory diagnosis of COVID-19 in Eastern Denmark underwent 8-zone LUS and echocardiography. We used trend and regression analyses to identify associations with the number of B-lines and adjusted for potential confounders (age, sex, body mass index, C-reactive protein, and pandemic wave). Results Among 270 (89%) patients with adequate LUS images, the mean age was 69±14 years, 58% were male and 11% had prior HF. Median time from hospital admission to LUS was 4 [2-8] days. In total, 263 (97%) had ≥1 B-line (median B-line number 14 [9-22]) and median left ventricular ejection fraction [LVEF] was 59 [54-63]). In adjusted models, more B-lines were associated with higher levels of C-reactive protein with an incidence rate ratio (IRR) of 16% (95%CI: 8%-24%) per log-unit increase (P&amp;lt;0.001) and higher Early Warning Score (IRR 5% [95%CI: 1%-0%] per point, P=0.02). Higher tricuspid regurgitation gradient was associated with more B-lines: IRR 2% (95%CI: 1%-3%) per mmHg, P&amp;lt;0.001) (Figure 1). Echocardiographic measures of left ventricular (LV) function (including LVEF and global longitudinal strain, left atrial volume, and LV filling pressures (E/e’)) and right ventricular function were not significantly associated with the number of B-lines. B-lines were not associated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations, even in patients with established HF. Lastly, B-lines were not associated with 30-day mortality. Conclusions Among hospitalized patients with COVID-19, B-lines on LUS are associated with markers of infectious disease severity and pulmonary hypertension but not with markers of left-sided HF.Figure1.Predictors of B-lines

Myocardial work and aortic valve stenosis cardiac damage stages are predictors of all-cause mortality in patients undergoing transcatheter aortic valve replacement

Abstract In aortic stenosis (AS) patients, assessment of left ventricular (LV) systolic function is complicated due to the significant impact of increased afterload on conventional parameters. Myocardial work (MW) analysis, a novel echocardiographic method adjusts myocardial deformation to instantaneous LV pressure which may better reflect the LV contractile state. Importantly, long-term LV pressure overload has marked backward effects beyond the LV: classification of this extravalvular cardiac damage effectively represents the involvement of the cardiopulmonary system in AS. Both MW and cardiac damage staging could hold remarkable prognostic power in the clinically complex population of transcatheter aortic valve replacement (TAVR) candidates. Accordingly, our aim was to assess the prognostic value of MW analysis and cardiac damage staging in patients undergoing TAVR. We enrolled 289 patients (79±6 years, 41% female) prior to TAVR. Echocardiographic measurements were performed one day before the procedure. We calculated LV ejection fraction (EF) and by speckle-tracking echocardiography global longitudinal strain (GLS), as well. Global constructive work (GCW) was quantified with dedicated software and LV pressure was estimated using transaortic mean gradient and systolic blood pressure. Based on the echocardiographic data, we also determined the extent of cardiac damage associated with AS: patients were classified as Stage 0 (no cardiac damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (pulmonary artery vasculature or tricuspid valve damage), or Stage 4 (right ventricular damage). Our primary outcome was all-cause mortality, reached by 68 patients (median follow-up: 26 months). In our cohort, preprocedural EF was 47±13 %, GLS was -12.3±4 %, while GCW was 2043±791 mmHg%. 14 (5%) patients were classified as Stage 0, 61 (21%) as Stage 1, 128 (44%) as Stage 2, 15 (5%) as Stage 3, and 71 (25%) as Stage 4. GCW showed a continuous decline through the AS Stages (from Stage 0-4: 2963±652 vs. 2154±652 vs. 2168±718 vs. 1988±969 vs. 1552±772 mmHg%; p&amp;lt;0.001). Using univariate Cox analysis GCW (HR 0.968 [95% CI 0.938-0.998] per 100 unit change; p=0.034) and AS Staging (HR 1.236 [95% CI 1.015-1.505]; p=0.035) were both associated with all-cause mortality, while EF (HR 0.984 [95% CI 0.966-1.002]; p=0.085) and GLS (HR 1.042 [95% CI 0.984-1.103]; p=0.160) were not. In multivariate Cox regression models, both GCW (HR 0.957 [95% CI 0.922-0.992] per 100 unit change; p=0.018) and AS cardiac damage staging (HR 1.263 [95% CI 1.029-1.549]; p=0.025) were proven to be significant independent predictors of all-cause mortality. In TAVR patients, preoperative GCW values exhibited a persistent decrease across AS Stages. As opposed to EF and GLS, GCW and AS Staging both showed strong association with all-cause mortality in our cohort. Moreover, GCW had higher prognostic value than any other conventional or advanced measure of LV function.

Ventricular Dysfunction in Patients With Congenital Diaphragmatic Hernia Who Die After Repair

BackgroundQuantitative echocardiographic (echo) measures of ventricular function predict mortality in pediatric pulmonary hypertension (PH), but studies in congenital diaphragmatic hernia (CDH)-related PH are limited. Few studies report quantitative echo data beyond the first week of life in CDH non-survivors. MethodsA single-center retrospective, cross-sectional, cohort study included CDH patients born between January 2013 and April 2022 who survived to surgical repair but died during the neonatal hospitalization. Quantitative measures of right (RV) and left ventricular (LV) size and function including tricuspid annular plane systolic excursion Z-score (TAPSEZ), RV fractional area change (FAC), RV/LV ratio, LV eccentricity index, LV M-mode dimensions, and RV/LV systolic strain were performed offline on the last echocardiogram before death. Data were compared between patients who died ≤30 days after repair (“early”) vs. >30 days after repair (“late”) using the Wilcoxon rank sum test. ResultsTwenty-five (11 early, 14 late) deceased patients had echo images available for analysis. LV size by end-diastolic dimension Z-score was smaller in patients who died early vs. late after repair [-3.03 (−3.93, −2.51) vs. −0.24 (−2.11, 0.53), p = 0.021]. There were trends toward worse RV function (TAPSEZ, RVFAC, RV global and free wall strain) and LV function (apical 4 chamber strain) in patients who died early vs. late after repair. ConclusionThese preliminary findings support future study of the impact of ventricular hypoplasia and dysfunction on mortality and opportunities for risk stratification based on quantitative echo findings in CDH. Level of EvidenceCohort study, 4.

A study on normal reference values of the left ventricular strain parameters in young adults

Background: The left ventricular (LV) function is an important prognostic determinant of cardiopulmonary pathologies in adult. Clinical application of cardiac strain by two-dimensional speckle tracking echocardiography to measure LV function requires knowledge of the range of normal values. Reference values and associated variations of the deformation measures need to be “firmly established before routine clinical adoption” of LV strain measurements can be implemented in Indian population. Aims and Objectives: This study aims to establish normal values of LV strain parameters in normal Indian population. Materials and Methods: An observational, cross-sectional, single-center, hospital-based study. The study period October 2021–October 2022 in Nil Ratan Sircir Medical College, Kolkata. Cardiologically healthy adult subjects (sample size 250) both male and female, aged 18–45 years who were healthcare professionals of this medical college and hospital were included in the study. Routine history taking and investigations were done. Echodoppler was done with special emphasis on LV strain parameters. Results: Distribution of mean LV circumferential strain (LVCS) with age in years was statistically not significant (P=0.8068). The mean value in male and female were −18.9574(±0.9049) and −19.0257(±0.8908) respectively. In the current study, LVCS did not vary in statistically significant a way among different age groups too. The mean values in male and female were −22.5887(±1.8065) and −22.3312(±1.9007) respectively. Conclusion: This current study failed to show significant differences in LV strain parameters between age groups or male and female in Eastern India Population.

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.

Racial Differences in Age-Related Changes in Left Ventricular Structural and Functional Echocardiographic Measurements Among Healthy Japanese and American Participants - A Subanalysis of the World Alliance Society of Echocardiography Normal Values Study.

Age-related changes in left ventricular (LV) structure and function lower the threshold for the onset of heart failure with preserved ejection fraction (HFpEF). LV parameters change also with race; however, the racial differences in age-related changes in LV parameters with and without adjustment for body mass index (BMI), heart rate (HR), and blood pressure (BP) remain unclear. We performed a subanalysis of the World Alliance Society of Echocardiography Normal Values Study, an international cross-sectional study that examined normal echocardiographic values in 15 countries. The age-related changes in 2-dimensional echocardiographic derived parameters including LV size, systolic function, and mass, were compared between healthy Japanese (n=227) and healthy White (n=98) and Black (n=69) American participants. In men, age-related changes in all parameters did not differ significantly among races. However, compared with Japanese women, White American women had a smaller body surface area (BSA)-indexed LV volume, BSA-indexed LV internal dimension at end-systole, BSA-indexed LV stroke volume, and LV mass index to BSA, and a larger LV ejection fraction with age, even after adjusting for BMI, HR, and BP. Age-related changes in LV structure and function, which are important for the pathophysiology of HFpEF, may differ by race. Therefore, future studies examining echocardiographic reference values for each age group in each race are needed.

Non-invasive myocardial work as an independent predictor of postprocedural NT-proBNP in elderly patients undergoing transcatheter aortic valve replacement.

Aortic stenosis has become the most prevalent valvular disease with increasing life expectancy and the ageing of the population, representing a significant clinical burden for health care providers. Its treatment has been revolutionized by transcatheter aortic valve replacement (TAVR) as a safe and minimally invasive option for elderly patients. Left ventricular (LV) functional measurement is of particular importance before TAVR, however, increased afterload significantly influences the conventional echocardiographic parameters. Non-invasive myocardial work examines myocardial deformation in the context of instantaneous LV pressure, thus, it might be a more reliable measure of LV function. Accordingly, we aimed to study non-invasive myocardial work and its relationship with functional outcome following TAVR.We enrolled 90 TAVR candidates (80 [75-84] years; 44% female). Using echocardiography, we quantified ejection fraction (EF), global longitudinal strain (GLS), global myocardial work index (GWI) and global constructive work (GCW) before and 12 months after the procedure. Serum NT-proBNP levels were also measured. EF did not change (52.6 ± 13.1 vs. 54.2 ± 10.5%; p = 0.199), while GLS increased (-13.5 ± 4.6 vs. -15.2 ± 3.8%; p < 0.001). GWI decreased (1913 ± 799 vs. 1654 ± 613 mmHg%; p < 0.001) and so did GCW (2365 ± 851 vs. 2177 ± 652 mmHg%; p = 0.018). History of atrial fibrillation (AF) (β = 0.349) and preprocedural GCW (β = -0.238) were independent predictors of postprocedural NT-proBNP (p< 0.001).GLS, GWI and GCW changed after TAVR while there was no alteration in EF. The preprocedural GCW and history of AF were independent predictors of postprocedural NT-proBNP. Accordingly, myocardial work indices may help patient selection and the prediction of the functional outcome in this population.

Concordance of left ventricular volumes and function measurements between two human readers, a fully automated AI algorithm, and the 3D heart model.

Echocardiography is essential in cardiovascular medicine for screening, diagnosis, and monitoring. Artificial intelligence (AI) has the potential to improve echocardiography by reducing variability and analysis time. While 3D echocardiography is becoming more accurate, 2D imaging still dominates clinical care. We aimed to evaluate agreement in measures of left ventricular (LV) volumes and function between human readers, a fully automated AI 2D algorithm, and the 3D Heart Model. A retrospective analysis was conducted on 109 patients who underwent 2D and 3D transthoracic echocardiography. LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and ejection fraction (LVEF) were measured by two operators, a commercially available AI algorithm (US2ai), and the 3D Heart Model. Global longitudinal strain (GLS) was measured by the integrated semi-automated software and the AI algorithm. Outcomes included measures of agreement [bias, limit of agreement and Pearson's correlation (R)]. For LV volume measurements, the AI algorithm was strongly correlated with the average of the human operators (r = 0.89 for LVEDV and r = 0.92 for LVESV), which was higher than between the operators (r = 0.74 and r = 0.84, respectively, p < 0.01). The same trend was seen for measures of reliability with respect to LVEDV, but not LVESV. AI demonstrated comparable performance to human operators in measuring LVEF, while the 3D Heart Model had a weaker correlation and reliability compared with human operators and AI measurements. The correlation between human operators and AI for GLS was only moderate. This study demonstrates AI-based echocardiography as a promising tool for accurately assessing LV volumes and LVEF in clinical practice. AI-based measures demonstrated a significantly lower inter-operator variability, thereby improving the consistency and reliability of these assessments. Moreover, AI may prove particularly effective for conducting retrospective bulk analyses, offering a valuable tool for comprehensive evaluations of past data.

Left atrial strain assessment unveils left ventricular diastolic dysfunction in neonates with transient tachypnea of the newborn: A prospective observational study.

An inadequate clearance of lung fluid plays a key role in the pathogenesis of transient tachypnea of the newborn (TTN). To evaluate if left ventricular diastolic dysfunction contributes to reduced clearance of lung fluid in TTN. This was a prospective, observational study. Echocardiography and lung ultrasound were performed at 2, 24 and 48 h of life (HoL) to assess biventricular function and calculate lung ultrasound score (LUS). Left atrial strain reservoir (LASr) provided surrogate measurement of left ventricular diastolic function. Twenty-seven neonates with TTN were compared with 27 controls with no difference in gestation (36.1 ± 2 vs. 36.9 ± 2 weeks) or birthweight (2508 ± 667 vs. 2718 ± 590 g). Biventricular systolic function was normal in both groups. LASr was significantly lower in cases at 2 (21.0 ± 2.7 vs. 38.1 ± 4.4; p < 0.01), 24 (25.2 ± 4.5 vs. 40.6 ± 4.0; p < 0.01) and 48 HoL (36.5 ± 5.8 and 41.6 ± 5.2; p < 0.01), resulting in a significant group by time interaction (p < 0.001), after adjusting for LUS and gestational diabetes. A logistic regression model including LUS, birth weight and gestational diabetes as covariates, showed that LASr at 2 HoL was a predictor of respiratory support at 24 HoL, with an adjusted odds ratio of 0.60 (CI 0.36-0.99). LASr was reduced in neonates with TTN, suggesting diastolic dysfunction, that may contribute to the delay in lung fluid clearance.

Increasing region of interest width reduces neonatal circumferential strain.

There is growing interest in speckle tracking echocardiography-derived strain as a measure of left ventricular function in neonates. However, knowledge gaps remain regarding the effect of image acquisition and processing parameters on circumferential strain measurements. The aim of this study was to evaluate the effect of using different region of interest (ROI) widths on speckle tracking derived circumferential strain in healthy neonates. Thirty healthy-term-born neonates were examined with speckle-tracking echocardiography in the short-axis view. Circumferential strain values were acquired and compared using two different ROI widths. Furthermore, strain values in the different vendor-defined wall layers were also compared. Increasing ROI width led to a decrease in global circumferential strain (GCS) in the midwall and epicardial layers, the respective decreases in strain being -23.4±.6% to -22.0±1.1%, p<.0001 and 18.5±1.7% to -15.6±2.0%, p<.0001. Segmental analyses were consistent with these results, apart from two segments in the midwall. There was no statistically significant effect on strain for the endocardial layer. A gradient was seen where strain increased from the epicardial to endocardial layers. Increasing ROI width led to a decrease in GCS in the midwall and epicardium. There is an increase in circumferential strain when moving from the epicardial toward the endocardial layer. Clinicians wishing to implement circumferential strain into their practice should consider ROI width variation as a potential confounder in their measurements.