Myocardial Global Longitudinal Strain Research Articles

Role of myocardial strain imaging in diagnosing inducible myocardial ischemia with treadmill contrast-enhanced stress echocardiography

IntroductionThe aim of this study is to analyze the diagnostic value of global longitudinal strain (GLS) in detecting inducible myocardial ischemia in patients with chest pain undergoing treadmill contrast-enhanced stress echocardiography (SE).MethodsWe retrospectively enrolled all patients who underwent invasive coronary angiography after treadmill contrast-enhanced SE. Rest and peak-stress myocardial GLS, segmental LS, and LS of 4-chamber (CH), 2-CH, and 3-CH views were reported. Luminal stenosis of more than 70% or fractional flow reserve (FFR) of < 0.8 was considered significant.ResultsIn total 33 patients were included in the final analysis, among whom sixteen patients (48.4%) had significant coronary artery stenosis. Averaged GLS, 3-CH, and 4-CH LS were significantly lower in patients with critical coronary artery stenosis compared to those without significant stenosis (-17.1 ± 7.1 vs. -24.2 ± 7.2, p = 0.041), (-18.2 ± 8.9 vs. -24.6 ± 8.2, p = 0.045) and (-14.8 ± 6.2 vs. -22.8 ± 7.8, p = 0.009), respectively. Receiver operating characteristic (ROC) analysis of ischemic and non-ischemic segments demonstrated that a cut-off value of -20% of stress LS had 71% sensitivity and 60% specificity for ruling out inducible myocardial ischemia (Area under the curve was AUC = 0.72, P < 0.0001).ConclusionMyocardial LS measured with treadmill contrast-enhanced stress echocardiography demonstrates potential value in identifying patients with inducible myocardial ischemia.

Global longitudinal strain as a predictor of mortality in patients with cardiogenic shock

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Aarhus University Dagmar Marshalls Fond. Background The assessment of left ventricular (LV) function through transthoracic echocardiography (TTE) is essential for guiding diagnosis and treatment in cases of cardiogenic shock (CS). Myocardial global longitudinal strain (GLS) provides an objective and reproducible measure of systolic function, independently predicting outcomes in acute heart failure, regardless of left ventricular ejection fraction (LVEF). However, whether assessment of GLS can predict mortality in patients with CS remains unknown. Purpose In this study, we aimed to evaluate the prognostic significance of GLS in patients with CS. Methods Data from cardiac intensive care unit (CICU) patients admitted between 2007 and 2018 with CS who received vasoactive agents and/or mechanical circulatory support were analysed. GLS (as absolute values) and biplane LVEF were measured via TTE performed within 24 hours of CICU admission. Patients with CS were categorised based on the GLS quartile: mild (GLS &amp;gt;9.7%), moderate (7.0% &amp;lt; GLS &amp;lt;9.6%), severe (5.0% &amp;lt; GLS &amp;lt; 6.9%), and very severe (GLS ≤ 4.9%). CICU and in-hospital mortality were compared across GLS categories, and the relationship between GLS and mortality was assessed using multivariable logistic regression. Results The study included 626 patients with a median age of 68.6 years, a median LVEF of 31% (IQR 24 to 40%), and a median GLS of 7.0% (IQR 5.0 to 9.7%). In-hospital mortality was 29.1%. As GLS deteriorated, there was an increasing need for vasopressors (P&amp;lt;0.001). Patients with progressively lower GLS exhibited significantly higher CICU and in-hospital mortality across the GLS quartiles (Figure A; P&amp;lt;0.001). Patients in the severe (adjusted OR 2.67; p&amp;lt;0.001) and very severe category (adjusted OR 3.54; P&amp;lt;0.001) had significantly increased risk of in-hospital death compared with mild category. In multivariable analysis, every 1% decrease in GLS corresponded to a 14% higher risk of in-hospital mortality (P&amp;lt;0.001). Finally, GLS outperformed LVEF for discrimination of in-hospital mortality (P=0.002), and when both measurements were included in the same multivariable model, only GLS remained significant. When patients were divided according to whether they had GLS and/or LVEF below the median value, patients with low GLS had higher mortality irrespective of the LVEF (Figure B). Conclusion In patients with CS, GLS assessment surpasses LVEF in its prognostic value and improves risk stratification. Routine evaluation of GLS should be considered for patients with CS.Figure AFigure B

Incremental value of myocardial global longitudinal strain in predicting major adverse cardiac events among patients with hypertrophic cardiomyopathy.

Endocardial global longitudinal strain (endo-GLS) measured with echocardiography (echo) has been demonstrated to be associated with myocardial fibrosis (MF) and is a prognostic predictor in patients with hypertrophic cardiomyopathy (HCM). Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging showed that MF is primarily located in the myocardial layer of the extremely hypertrophic septal or ventricular wall. We hypothesized that GLS of the myocardial layer (myo-GLS) is more strongly correlated with the extent of LGE (%LGE) and is a more powerful prognostic factor than endo-GLS. A total of 177 inpatients (54.0 [IQR: 43.0, 64.0] years, female 37.3%) with HCM were retrospectively included from May 2019 to April 2021. Among them, 162 patients underwent echocardiographic examination and contrast-enhanced CMR within 7 days. Myo-GLS and %LGE were blindly assessed in a core laboratory. All the patients were followed after they were discharged. During a mean follow-up of 33.77 [IQR 30.05, 35.40] months, 14 participants (7.91%) experienced major adverse cardiac events (MACE). The MACE (+) group showed lower absolute endo-GLS and myo-GLS than the MACE (-) group. Myo-GLS was more associated with %LGE (r=-.68, P<.001) than endo-GLS (r=-.64, P<.001). Cox multivariable analysis indicated that absolute myo-GLS was independently associated with MACE (adjusted hazard ratio=.75, P<.05). Myo-GLS was better than endo-GLS at detecting MACE (+) patients (-8.64%, AUC.939vs. - 16.375%, AUC.898, P<.05). Myo-GLS is a stronger predictor of MACE than endo-GLS in patients with HCM and is highly correlated with %LGE.

Pathophysiological role of epicardial adipose tissue and its phenotypes in patients with diabetes and cardiovascular comorbidities

Abstract Introduction Epicardial adipose tissue (EAT) is an active endocrine organ that regulates multiple aspects of cardiac biology including myocardial redox state, intracellular Ca2+ cycling, the electrophysiological and contractile properties of cardiomyocytes, cardiac fibrosis, and coronary atherosclerosis progression. Purpose We evaluated associations of CMR-measured EAT area (EATa) with myocardial structure, function and 31P-MRS assessed energetics (phosphocreatine to ATP ratio) in patients with type 2 diabetes (T2D) with and without comorbidities of coronary artery disease (CAD) requiring coronary artery bypass grafting (CABG) and aortic stenosis requiring aortic valve replacement (AVR). We also examined the EAT phenotypes in patients with T2D with and without CAD, CAD patients without T2D and compared them to controls with severe AS without T2D. Methods 145 participants were recruited including CAD patients undergoing CABG with (30) and without T2D (25); severe AS patients with (20) and without T2D (20) undergoing AVR; T2D patients without cardiovascular disease (30) and healthy controls (20). A month prior to surgery cardiac PCr/ATP; EATa; LV volumes, mass, ejection fraction, mitral inflow E/A ratio, global longitudinal strain (GLS) and myocardial tissue characteristics were assessed. EAT samples were obtained from patients undergoing cardiac surgery for histological assessments. Results Participants were matched in age, sex distribution, and body mass index. Across all groups, patients with T2D showed higher EATa compared to those without T2D (138±50 vs 101±51cm2; p&amp;lt;0.0001). EATa was significantly higher in AS patients with T2D versus AS patients without T2D, while there was no significant difference in EATa between the CAD patients with and without T2D. Among the structural parameters, there were significant correlations between the EATa and myocardial pre-contrast T1 (p=0.02; r=0.20). Among the functional parameters there were inverse correlations of EATa with mitral inflow E/A (r=-0.34, p=0.002) and with GLS (r=-0.23, p=0.009). Among the metabolic biomarkers, there were no correlations between the EATa and PCr/ATP ratio. Histologically, compared to the control group of AS patients without T2D, patients with CAD with and without T2D showed larger adipocyte size and higher tissue fibrosis. There were no significant differences in EAT phenotype in adipocyte size, tissue fibrosis or inflammation between CAD patients with and without T2D. Conclusions This comprehensive EAT phenotyping study combined invasive and non-invasive methodologies and showed similar magnitudes of changes in EATa, adipocyte size and EAT fibrosis in CAD patients with and without T2D. While we have detected significant relationship of the EATa with the myocardial fibrosis, diastolic function and GLS, there were no correlations of myocardial PCr/ATP with the EATa suggesting other key mechanisms involved in the energetic deficit in patients with T2D.

Abstract P365: Left Ventricular Hypertrophy In Hypertension-correlation Of Electrocardiography Criteria, Echocardiography And Myocardial Strain Imaging

Background: LVH on ECG has been defined by 37 different criteria with modest degree of differences in accuracy amongst them leading to a lack of consensus. Objectives: Study aims to correlate sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of selected 17 standard ECG criteria in the diagnosis of LVH, correlation with echocardiography and myocardial global longitudinal strain (GLS). Demographics: Average age of the 104 hypertensive individuals included in the study was 61.86 years with 43.3% women. 73% of subjects had LVH on echocardiography with mean LVMI 115.97g/m2 and mean RWT 0.5. Results: Groningen criteria (24.70%) and Cornell voltage criteria (20.98%) had the best sensitivity for LVH detection. Groningen criteria was defined as QV2+R1+RV5+RV6+SV2+SV4+SV5+SV6 &gt;= 49.5 mm in women and R1+RV5+SII+ SV2+SV6 x QRS duration &gt;= 4500mm msec in men. Sensitivity for other criteria were lesser; Peguero Lo presti(PL) 13.58%, Sokolow Lyon index(SL) 11.11% and Cornell voltage product (CVP) 6.17%. Specificity and Positive predictive value (PPV) with Groningen criteria were 90% and 95.6% and with Cornell voltage criteria 100% and 100% respectively. Best sensitivity results were on combining all 17 ECG LVH criteria (39.5%). Addition of Groningen criteria improved the sensitivity of SL+CV+PL from 28.39% to 38.3%. Combination of the commonly used CV+SL+PL criteria yielded better sensitivity (28.39%) as compared to CV (20.98%) alone. Subjects with mild LVH on echo had an average GLS of -15.46+/-2.4% in 75%, subjects with moderate LVH had an average GLS of -14.23+/-2.8% in 71.4% and subjects with severe LVH had an average GLS of -12.6+/-4.9% in 80%. Conclusion: Irrespective of the voltage criteria used, singular or in combination, sensitivity to diagnose LVH proven on echocardiography is low. Novel Groningen criteria was more sensitive than the previously established standard ECG LVH criteria and had the highest association amongst all in patients with reduction in average GLS. Combination of four criteria SL+CV+PL+Groningen had the best sensitivity (38.3%) which improved only by 1.2% if all 17 criteria were combined.

Assessment left ventricular function by speckle tracking in patients with mitral valve replacement in Hanoi heart hospital

Background: The evaluation of left ventricular dysfunction in patients with severe mitral valve disease is very important for diagnosis, surgical indication and postoperative follow-up assessments. Speckle Tracking provides additional information to conventional echocardiographic parameters. Objective: Research global longitudinal strain by Speckle Tracking in patiens underwent mitral valve surgery at Hanoi Heart Hospital. Subjects and methods: 35 patients underwent mitral valve surgery at Hanoi Heart Hospital from July 2018 to September 2019. This is a prospective, longitudinal follow-up for at least 3 months research. Results: Postoperative myocardial global longitudinal strain of the left ventricular decreased compared to pre-surgery (-19.85 ± 2.24 vs -16.54 ± 3.01; p &lt; 0.001). The global myocardial longitudinal strain of the left ventricular decreased more in the group whose postoperative EF decreased by ≥10% compared with the group whose EF decreased &lt;10% after surgery (-17.73 ± 2.71 versus -15.28 ± 2.85; p. &lt; 0.05). Mean global myocardial longitudinal strain (GLS avg) after surgery has a linear correlation with left ventricular contraction fraction FS after surgery (r = -0.508; p &lt; 0.005), with left ventricular ejection fraction EF after surgery (r = - 0.402; p &lt; 0.05), with ejection fraction EF biplane after surgery with (r = - 0.768; p &lt; 0.001) and global myocardial longitudinal strain (GLS avg) after surgery há a linear correlation with the degree of change in EF after surgery ≥ 10% (r) = 0.601; p &lt; 0.001). Conclusion: Longitudinal LV deformation assessed by speckle tracking is significant in assessing the decline in left ventricular systolic function in patients with mitral valve surgery.

Endocardial versus whole-myocardial tracking global longitudinal strain analysis in patients with hypertrophic cardiomyopathy: A preliminary comparative study.

We investigated whether the feasibility of left ventricular (LV) global longitudinal strain (GLS) in hypertrophic cardiomyopathy (HCM) varies according to the methodology (e.g. endocardial vs. whole myocardial tracking techniques). We retrospectively analyzed 111 consecutive patients with HCM (median age, 58 years; male, 68.5%) who underwent both transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (apical 29.7%, septal 33.3%, and diffuse or mixed 37.0%). TTE-whole myocardial and TTE-endocardial GLS were measured and compared in terms of association with late gadolinium enhancement (LGE) extent and discrimination performance for extensive LGE (>15% of the LV myocardium). Although TTE-whole myocardial and TTE-endocardial GLS were significantly correlated, absolute TTE-endocardial GLS values (19.3 [16.2-21.9] %) were higher than TTE-whole myocardial GLS values (13.3[10.9-15.6] %, p<0.001). Both TTE-derived GLS parameters were significantly correlated with the LGE extent and independently associated with extensive LGE (odds ratio [OR] 1.30, p = 0.022; and OR 1.24, p = 0.013, respectively). Discrimination performance for extensive LGE was comparable between TTE-whole myocardial and TTE-endocardial GLS (area under the curve [AUC], 0.747 and 0.754, respectively, pdifference = 0.610). However, among patients with higher LV mass index (>70 g/m2), only TTE-whole myocardial GLS correlated with LGE extent and was independently associated with extensive LGE (OR 1.35, p = 0.042), while TTE-endocardial GLS did not. Additionally, TTE-whole myocardial GLS had better discrimination performance for extensive LGE than TTE-endocardial GLS (AUC, 0.705 and 0.668, respectively, pdifference = 0.006). TTE-derived GLS using either the endocardial or whole myocardial tracking technique is feasible in patients with HCM. However, in those with severe hypertrophy, TTE-whole myocardial GLS is better than TTE-endocardial GLS.

Evaluation of Left Ventricular Systolic Function Using Layer-Specific Strain in Rats Performing Endurance Exercise: A Pilot Study.

The functional characteristics of exercise-induced myocardial hypertrophy were studied in a rat model in conjunction with ultrasound layered strain technique to investigate the hidden changes in the heart brought about by exercise. Forty specific pathogen free (SPF) adult Sprague-Dawley rats were selected and randomly divided into two groups of 20 exercise and 20 control rats. The longitudinal and circumferential strain parameters were measured using the ultrasonic stratified strain technique. The differences between the two groups and the predictive effect of stratified strain parameters on left ventricular systolic function were analyzed. The exercise group had significantly higher global endocardial myocardial longitudinal strain (GLSendo), global mid-myocardial global longitudinal strain (GLSmid) and global endocardial myocardial global longitudinal strain (GCSendo) values than the control group (p < 0.05). Even though global mid-myocardial circumferential strain (GCSmid) and global epicardial myocardial circumferential strain (GCSepi) were higher in the exercise group than in the control group, statistical significance was not reached (p > 0.05). Conventional echocardiography parameters were well correlated with GLSendo, GLSmid, and GCSendo (p < 0.05). GLSendo was the best predictor of left ventricular myocardial contractile performance in athletes determined using the receiver operating characteristic curve, with an area under the curve of 0.97, sensitivity of 95% and specificity of 90%. Rats performing endurance exercise exhibited subclinical changes in the heart after prolonged high-intensity exercise. A stratified strain parameter, GLSendo, played an important role in the evaluation of LV systolic performance in exercising rats.

Predictive value of cardiac magnetic resonance mechanical parameters for myocardial fibrosis in hypertrophic cardiomyopathy with preserved left ventricular ejection fraction.

Myocardial fibrosis leads to systolic dysfunction in hypertrophic cardiomyopathy (HCM) patients. This study aims to investigate the relationship between cardiac magnetic resonance mechanical parameters for evaluating the left ventricular function in HCM with preserved left ventricular ejection fraction (LVEF ≥50%) and the association between myocardial fibrosis defined by late gadolinium enhancement (LGE). This study was a retrospective analysis of CMR images of 93 patients with HCM with preserved ejection fraction (HCMpEF) and 96 controls diagnosed by cardiac magnetic resonance (CMR) at our hospital from July 2019 to January 2022. The myocardial contraction fraction (MCF) was calculated, and myocardial mechanical parameters, including global myocardial longitudinal strain (GLS), circumferential strain (GLS), and myocardial strain (GLS), were obtained by tissue tracking and LGE quantitative modules of dedicated software, respectively. The correlation between myocardial strain and LGE was analyzed, and a multivariate logistic regression model was developed to discuss the risk predictors of LGE. Compared to the control group, the left ventricular mechanical parameters GLS (-13.90 ± 3.80% versus -18.20 ± 2.10%, p < 0.001), GCS (-16.62 ± 3.50% versus -18.4 ± 2.69%, p < 0.001), GRS (28.99 ± 10.38% versus 33.02 ± 6.25%, p < 0.01), and MCF (64 ± 16% versus 99 ± 18%, p < 0.001) were found significantly lower in HCM group. Moreover, even in LGE-negative HCM patients, GLS (-16.3 ± 3.9%) and MCF (78 ± 19%) were significantly lower compared to the control group. Left ventricular GLS [OR = 1.61, (1.29, 2.02), p = 0.001] and MCF [OR = 0.90, (0.86, 0.94), p = 0.001] independently predicted myocardial late gadolinium enhancement (LGE). In participants of HCM with preserved ejection fraction, the early onset of reduced left ventricular GLS and MCF in patients with HCMpEF may provide new evidence for evaluating impaired myocardial systolic function. The reduction of myocardial mechanical indexes may reflect the presence and extent of myocardial fibrosis, and the more significant the reduction, the more severe the myocardial fibrosis; GLS and MCF may be ideal predictors for LGE.

Abstract 9957: Utility of Cardiac MRI Assessment of Right Ventricle Function Before LVAD Implantation

Introduction: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is a feared complication. Right ventricle (RV) dysfunction by echocardiogram prior to LVAD implant is a significant risk factor for post-LVAD RVF. However, RV’s unique crescent shape makes it difficult for accurate assessment through echocardiogram. Cardiac MRI can image RV in its entirety and is the gold standard for evaluating RV size and function. Hypothesis: Our study aimed to assess RV comprehensively through cardiac MRI before LVAD implantation to predict severe RVF post-LVAD. Methods: This retrospective cohort study included 231 consecutive patients who underwent LVAD from January 2015 to July 2021. We utilized the commercially available QStrain Application (Medis Suite, the Netherlands) for feature-tracking myocardial strain using gated cine SSFP images. We also assessed for quantitative measurements of RV (systolic/ diastolic volume, stroke volume, and systolic function). Results: There were 12 patients with cardiac MRI before LVAD, of which 4 patients developed severe RVF after LVAD. There were 9 cardiac MRIs available for strain analysis (image quality and old studies before 2012). The RV end-systolic volume (ESV) was higher in severe RVF post-LVAD, but not RV ejection fraction. Endocardial and myocardial global longitudinal strain and global radial strain of RV were not different in severe RVF. Conclusions: In this small series investigating RV function before LVAD implant, we have shown that ESV was higher with severe RVF. Although feature tracking strain of RV was not different in patients with severe RVF, a larger cohort study is warranted to investigate this.

Early Left Ventricular Dysfunction and Non-Dipping: When Ejection Fraction is Not Enough. A Meta-Analysis of Speckle tracking Echocardiography Studies.

There is evidence that a reduced nocturnal fall in blood pressure (BP) entails an increased risk of hypertensive-mediated organ damage (HMOD) and cardiovascular events. Most studies focusing on left ventricular (LV) systolic function, assessed by conventional LV ejection fraction (LVEF) in non-dippers compared to dippers failed to detect significant differences. To provide a new piece of information on LV systolic dysfunction in the non-dipping setting, we performed a meta-analysis of speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of LV systolic function. A computerized search was performed using PubMed, OVID, EMBASE, and Cochrane library databases from inception until 31 July, 2022. Full articles reporting data on LV GLS and LVEF in non-dippers and dippers were considered suitable. A total of 648 non-dipper and 530 dipper individuals were included in 9 studies. LV GLS was worse in non-dipper than in their dipper counterparts (-18.4 ± 0.30 vs. -20.1 ± 0.23%, standard means difference [SMD]: 0.73 ± 0.14, confidence interval [CI]: 0.46/1.00, P < 0.0001) whereas this was not the case for LVEF (61.4 ± 0.8 and 62.0 ± 0.8%, respectively), SMD: --0.15 ± 0.09, CI: -0.32/0.03, P = 1.01). A meta-regression analysis between nighttime systolic BP and myocardial GLS showed a significant, relationship between these variables (coefficient 0.085, P < 0.0001). Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the non-dipping setting can be unmasked by STE; implementation of STE in current practice may improve the detection of HMOD of adverse prognostic significance in individuals with altered circadian BP rhythm.

P133 UTILITÀ DEL MYOCARDIAL WORK NELLA VALUTAZIONE ECOCARDIOGRAFICA MULTIPARAMETRICA DI PAZIENTI CON CARCINOMA MAMMARIO

Abstract Background The aim of our study was to assess subclinical cardiac effects of anthracyclines (ANTs) in women treated for breast cancer (BC). Methods We enrolled 46 female patients with BC undergoing adjuvant treatment with anthracycline–containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel). Patients underwent physical examination, electrocardiogram (ECG) and standard transthoracic echocardiography (TTE) including evaluation of diastolic and systolic function, measured as left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS) and myocardial work (MW) expressed as global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE). The parameters were measured at baseline (T0) and at 3 months (T1) and 6 months (T2) follow up. Results All patients completed the chemotherapy cycles. No significant cardiovascular adverse events were observed during treatment. Neither 2D left ventricular ejection fraction (LVEF) nor E/e’ ratio evaluation at TDI were significantly changed after treatment. Conversely, GLS was significantly reduced at T1 and T2 since baseline (GLS – 19,99 % IQR –20,6 –19,3 % at T0 vs –17,88 % IQR –18,8 –16,9 % at T1, p &amp;lt; 0,00 1 and –16,71 % IQR 17,6 –15,7 % at T2, p &amp;lt; 0,001). Consensually, a significant reduction in myocardial work was also measured (GWI 2115 mmHg% IQR 1888 – 2342 mmHg% at T0 vs 1714 mmHg% IQR 1557 – 1870 mmHg% at T1, p &amp;lt; 0,0001 and 1694 mmHg% IQR 1482 – 1907 mmHg% at T2, p &amp;lt; 0,0001). Conclusion Our study demonstrates that evaluation of myocardial work allows very early detection of subclinical cardiac damage induced by chemotherapy, consensually to the reduction of the GLS. A multiparametric assessment of the myocardial function, including myocardial work and GLS, could improve the accuracy of risk stratification of cardiotoxicity in patients undergoing ANTs treatment.

PO-703-07 IMPROVED LEFT VENTRICULAR EJECTION FRACTION AND STROKE VOLUME WITH HIS BUNDLE PACING ARE ASSOCIATED WITH HIGHER MAGNITUDES OF GLOBAL LONGITUDINAL AND CIRCUMFERENTIAL STRAINS

In recently reported clinical studies, His bundle pacing (HBP) improved cardiac function in patients with pre-existing heart failure. The effect of HBP vs RBP on global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) in the absence of pre-existing heart failure has not yet been explored. To investigate whether the improved systolic function observed with HBP compared to RVP results in higher magnitudes of myocardial GLS, GCS, and GRS. Seven healthy adult mixed breed hounds (25 to 35 kg) were anesthetized, and pacing leads were implanted in the right atrium (RA), RV apex, and the HB region. Echocardiographic data were recorded for each pacing configuration to assess the left ventricular function. Finally, 2-D tissue tracking analysis was performed to estimate GLS from the 4-chamber apical views and GCS and GRS from short-axis views. Consistent with prior reports,HBP significantly improved both LVEF (Fig. A) and stroke volume (Fig. B). Similarly, HBP showed higher magnitudes for GLS and GCS than RVP, as shown in Fig. C and Fig. D, respectively. Interestingly, the GRS outcome for both HBP and RVP revealed a minimal difference (Fig. E). Compared to the RAP, HBP showed similar hemodynamic and strain measurements (GLS, GCS, and GRS). The paired comparisons in this canine study under the same experimental conditions demonstrate an increase in longitudinal and circumferential strain (but not radial strain) with HBP relative to RVP. These results indicate that systolic improvements mediated by HBP are driven by longitudinal and circumferential rather than radial strain.

Anthracycline chemotherapy and its effects on left ventricular mechanics: insights into the PROACT PLUS study

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): South Tees Research and Development Fund Background Anthracyclines continue to form the backbone of chemotherapy treatment for breast cancer and lymphoma. However, their use has been directly associated with dose-dependent cardiotoxicity. Most studies to date have focused on the effects of high dose anthracyclines on left ventricular (LV) systolic function with a particular interest in peak global longitudinal strain (GLS). Not much attention has been directed to the effects of lower dose anthracyclines and other strain parameters of LV systolic and diastolic function. Purpose In this prospective study, we performed a comprehensive 2-dimensional echocardiographic assessment on the effects of anthracyclines on both the LV systolic and diastolic strain measures. We focused on the changes in the LV end-systolic (ES) GLS, myocardial GLS (myoGLS), global radial strain (GRS), global circumferential strain (GCS), myocardial GCS (myoGCS), twist and torsion. Additionally, peak systolic (PS), ES, early-diastolic (ED), and late-diastolic (LD) strain-rates were measured. Methods Patients with a new diagnosis of breast cancer or lymphoma undergoing anthracycline chemotherapy (any dose) were recruited between October 2018 to March 2020. Echocardiograms were performed pre-chemotherapy (V1) and 1 month post treatment (V2). These were analysed offline using vendor-independent software (TomTec 2D CPA). The study was ethically approved by the Health Research Association (REC reference 18/EM/0177). Results A total number of 62 were recruited into the study of which 7 patients passed away during treatment and 5 failed to attend their follow-up appointment at V2. Of the remaining patients, 6 dropped their LV ejection fraction (EF) to &amp;lt; 53% at V2 (G1). In these patients, a significant reduction in the LV ES-GLS (-19.3% vs. -15.3%, p = 0.0041), myoGLS (-16.8% vs. -12.8%, p = 0.0014), LV longitudinal PS strain-rate (-1 1/s vs. 0.78 1/s, p = 0.0063), and LV longitudinal ED strain-rate (1.1 1/s vs. 0.67 1/s, p = 0.026) was seen from V1 to V2. There was no statistically significant change in the other systolic and diastolic strain parameters in this group of patients. In patients with a normal EF at V2 (G2), a reduction in the LV ES-GLS (-20.8% vs. -19.9%, p = 0.013) and myoGLS (-17.9% vs. -16.9%, p = 0.012) was also seen from V1 to V2. Additionally, a deterioration in the LV radial ED strain-rate (-1.37 1/s vs. -1.2 1/s, p = 0.009), LV longitudinal ED strain-rate (0.98 1/s vs. 0.85 1/s, p = 0.01), and LV circumferential ED strain rate (1.62 1/s vs. 1.33 1/s, p = 0.045) was observed. Conclusion In G1, a more extensive deterioration (&amp;gt;15%) in the LV ES-GLS, myoGLS, and longitudinal ED strain-rate was evident when compared to G2. The additional reduction in LV early diastolic strain-rate in both patient groups highlights the global insult that anthracyclines can pose on both LV systolic and diastolic function. However, whether these findings translate into future development of cardiotoxicity is not yet known.

Assessment of subclinical left ventricle myocardial dysfunction using global myocardial work in type 2 diabetes mellitus patients with preserved left ventricle ejection fraction

BackgroundThe purpose of this study was to assess subclinical left ventricle (LV) myocardial dysfunction using global myocardial work (MW) in type 2 diabetes mellitus (T2DM) patients with preserved left ventricle ejection fraction (LVEF).MethodsSixty T2DM patients and 60 normal controls were enrolled in the study. Apical 4-, 3- and 2-chamber views were acquired by two-dimensional echocardiography. Peak systolic myocardial global longitudinal strain (GLS), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and myocardial work efficiency (GWE) were determined by speckle-tracking echocardiography (STE).ResultsThe GLS values in the T2DM patients were significantly lower than those in normal controls (p < 0.001). The GWW in T2DM patients was significantly greater than that in normal controls, while GWI, GCW and GWE was significantly lower (p < 0.001). Receiver operating characteristic (ROC) analysis showed there were no significant different difference between GWW, GWE and GLS in the area under the curves (AUCs). In T2DM patients, fasting plasma glucose was positively correlated with GWW but negatively correlated with GWE, and GLS was negatively correlated with GWI and GCW.ConclusionFrom the research, we found that global MW as new technique could detect the subclinical LV myocardial dysfunction and confirm that the impaired LV function in T2DM patients with preserved LV systolic function.

Evaluation of the effectiveness of the chronic heart failure therapy using the device cardiac contractility modulation according to the new non-invasive method of the myocardium work analysis

Aim To analyze echocardiographic parameters that reflect left ventricular (LV) myocardial contractility, using a novel method for evaluation of myocardial performance in patients with chronic heart failure (CHF) and atrial fibrillation (AF) during heart contractility modulation (HCM).Material and methods Standard echocardiographic parameters and indexes of myocardial strain and work were analyzed for 66 patients (52 men and 14 women; median age, 60 [54; 66] years). 36 patients had paroxysmal AF and 30 patients had permanent AF. All patients had CHF with a duration of 17 [4; 60] months; duration of AF was 12 [6; 36] months. At baseline, the left ventricular ejection fraction (LV EF) was 33 [27; 37] %.Results After one year of HCM, LV EF significantly increased from 33 [27; 37] to 38 [33; 44] % (р=0.001). Also, there were improvements in the myocardial global longitudinal strain (from -6.00 [ - 8; - 4] to -8 [ - 10; - 6] %; р=0.001) and parameters of myocardial work, including the global work efficiency (from 74 [65; 79] to 80 [73; 87] mm Hg%; р=0.001), global constructive work (from 699 [516; 940] to 882 [714; 1242] mm Hg%; р=0.001), and global myocardial work index (from 460 [339; 723] to 668 [497; 943] mm Hg%; р=0.001). A segmentary analysis of LV work parameters showed positive changes in the myocardial constructive work in the area of the interventricular septal apical segment (at baseline, 844 [614; 1224]; after HCM, 1027 [800; 1520] mm Hg%; р=0.05) and the medium segment of the LV anteroseptal wall (at baseline, 593 [312; 1000]; after HCM, 877 [494; 1145] mm Hg%; р=0.05).Conclusion This method for analysis of the myocardial work provides a more detailed examination of LV structural and functional remodeling and mechanisms for its effects on the LV contractile function in patients with CHF. This method is promising and merits further study in various clinical situations.

Some indicators of left ventricular dysfunction in hypertensive patients, depending on the level of matrix metalloproteinases and tissue inhibitors of metalloproteinase-1

Aim. To study the level of matrix metalloproteinases-1 and -2, and tissue inhibitor of metalloproteinases-1, the indicator of left ventricular myocardial deformation in patients with stage 12 hypertension. Methods. 114 patients (40 women and 74 men) with hypertension of 12 stages observed in the cardiology Department of the Road clinical hospital Chita II were examined. The median age was 428.3 years. Left ventriclular diastolic function was studied by using tissue Doppler imaging in apical four-chamber views. Serum matrix metalloproteinase-1, matrix metalloproteinase-2, and tissue inhibitor of metalloproteinases-1 levels were measured in all patients on automated immunoassay analyzers using ready-to-use ELISA kits. Results. An increase in serum levels of matrix metalloproteinases-1 and -2 in the group of patients with hypertension and diastolic dysfunction by 46 and 47%, respectively, was found against increased levels of serum tissue inhibitor of metalloproteinase-1 (р=0.049). In patients with diastole dysfunction, myocardial global longitudinal strain was decreased in was observed by 22.8% compared with patients without diastole dysfunction (p 0.05). The analysis revealed a moderate negative relationship between left ventricular global longitudinal strain and the serum levels of metalloproteinases-2 (r=0.64, p 0.05). Conclusion. In patients with hypertension and left ventricular diastolic dysfunction, a decrease in left ventricular global longitudinal strain is associated with the serum level of matrix metalloproteinase-2; a tissue inhibitor of metalloproteinases-1 is unrelated to left ventricular global myocardial strain.

Impact of blood pressure changes on myocardial work indices in hypertensive patients in a day.

Evaluating left ventricular function through instantaneous left ventricular deformation parameters might not always be accurate for patients with high fluctuations in blood pressure value due to afterload dependence. Myocardial work (MW) is a more advanced tool that combines global myocardial longitudinal strain (GLS) with LV (left ventricular) systolic pressure. The purpose of this study was to investigate the effect of blood pressure changes on MW indices in the population with normal blood pressure and hypertension in a day. A total of 117 participants (34 control subjects and 83 hypertensive patients) underwent echocardiographic measurements at rest, twice a day. Simultaneously, the brachial blood pressure was also measured. LV pressure‐strain loop (PSL) was used to calculate global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). The differences in the GLS and MW indices between the groups were compared, and the correlation of blood pressure changes with the changes in GLS and MW indices were evaluated. Compared to the control group, the hypertensive group showed higher GWI, GCW, and GWW but lower GLS and GWE. Absolute changes in blood pressure, GLS, and MW indices in hypertensive patients were significantly higher than that of the control subjects. Blood pressure changes had significant univariate correlation with changes in GLS and MW indices. In conclusion, significant fluctuations in blood pressure could induce changes in MW indices to preserve left ventricular systolic function. Repeated assessment of MW indices is necessary for hypertensive patients with large blood pressure fluctuations.

Do diurnal changes in blood pressure affect myocardial work indices?

Do diurnal changes in blood pressure affect myocardial work indices?

Dynamics of myocardial global longitudinal strain in patients with COVID-19 without significant baseline cardiovascular pathology

Abstract Background/Introduction SARS-CoV-2 is notorious for its ability to cause damage to the respiratory system and myocardium, which can result in the development of acute respiratory distress syndrome and myocardial dysfunction. Purpose The aim of our study was to assess the interaction between the severity of COVID-19 and echocardiographic parameters of myocardial dysfunction, as well as lung ultrasound data. Methods 47 COVID-19 patients without signs of cardiovascular pathology were included in our study (33 in the moderate severity subgroup and 14 in the severe subgroup). All patients underwent comprehensive transthoracic echocardiography, including global longitudinal strain (GLS) of both ventricles, and lung ultrasound at days 1 and 9 of the disease. We used GLS cut-off values of 16% and 20% for LV and RV respectively. We performed the lung ultrasonography using an 8-zone protocol for each lung. The EACVI lung ultrasound scoring system for each region and ultrasound pattern was used. Results At day 1, patients in the severe subgroup had a greater tricuspid gradient (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,04) and systolic pulmonary artery pressure (22,0 [21,0; 26,0] vs. 30,0 [24,0; 34,5], p=0,02). Moreover, we noted a decrease in the GLS RV index in COVID-19-patients in comparison with the generally accepted reference values (18,45 [15,8; 21,0]). During the course of the disease, an increase in GLS RV was noted in both subgroups, which was especially pronounced among severe patients (18,5 [15,2; 21,1] vs. 20,2 [15,8; 22,0], p=0,038). Assessing the LV function, we noted a difference in the E/e (LV) ratio among severe and moderate subgroups (7,5 [6,8; 9,34] vs. 9,5 [7,7; 10,2], p=0,03). The GLS LV didn't differ between patient subgroups at day 1. We noted an increase in GLS LV at day 9 in both subgroups, but the difference reached significance among moderate patients (17,9 [15,8; 20,1] vs. 19,5 [17,1; 21,8], p=0,038). We observed a greater number of points assessing the B-lines among severe subgroup compared to moderate subgroup (19,5 [17,5; 26,5] vs. 13,0 [7,0; 18,0], p&amp;lt;0,01). Conclusion Among COVID-19 patients without an underlying cardiovascular pathology the transient decrease in LV and RV function assessed via GLS was observed even among patients with moderate disease severity. Funding Acknowledgement Type of funding sources: None.