Myocardial Strain Research Articles

Identification of ischemia with no obstructive coronary arteries using 13N-ammonia positron emission tomography-derived myocardial strain ratio

Abstract Background Ischemia with no obstructive coronary arteries (INOCA) is a chronic health problem with poor prognosis and remains challenging to diagnose. 13N-ammonia positron emission tomography (NH3-PET) is the most reliable method for detecting INOCA. We recently developed a unique myocardial strain analysis for NH3-PET to detect ischemia-related motion abnormalities. Purpose We examined the usefulness of NH3-PET strain analysis to identify patients with INOCA. Methods Overall, 98 patients with non-obstructive coronary arteries who underwent adenosine-stress NH3-PET were enrolled. INOCA was defined based on the ESC guidelines. Using an original feature-tracking algorithm dedicated to NH3-PET, the circumferential strain was calculated. Myocardial strain ratio (MSR) was defined as the ratio of strains at stress and rest. In addition, global myocardial flow reserve (MFR) was obtained. Results Finally, forty-seven patients were diagnosed with INOCA, and 51 without INOCA. Global MFR were significantly lower in patients with INOCA than in those without INOCA (1.82 ± 0.52 vs. 2.65 ± 0.65, p<0.0001). MSR were significantly lower in patients with INOCA than in those without INOCA (0.94 ± 0.11 vs. 1.04 ± 0.12, p<0.001). Receiver-operating characteristic analysis showed that using the optimal cutoff of the MSR, INOCA could be diagnosed with area under the curve of 0.71. At a median follow-up of 957 days, Kaplan–Meier analysis revealed that the survival rate worsened in patients with INOCA and low MSR (log-rank test, p<0.001). Conclusions MSR derived from feature-tracking of NH3-PET is reduced in patients with INOCA. It might suggest a predictive value to identify microvascular dysfunction or related motion abnormalities in patients with INOCA.

Subclinical myocardial disfunction detected by left ventricle myocardial work impairment in patients with long standing human inmmunodeficiency virus infection

Abstract Heart failure is a known complication in patients living with human inmmunodeficiency virus (HVI) infection. Detection of subclinical disfunction is nowadays possible by echocardiographic strain techniques. Myocardial work is a novel technique based on global longitudinal strain (GLS) that measures global work efficiency of left ventricle (GWE) and would allow early detection of subclinical myocardial damage. Methods We performed a cross sectional echocardiographic study of patients with long standing HIV infection, and no previous cardiopathy, assessing GLS of left ventricle (LV), left atrium (LA) and free wall of right ventricle (RV-FW GLS). We identified patients with subclinical disfunction expressed by an impaired GWE , and studied its determinants by lineal regression. Results 110 patients, 78.2% male, median age 53.3 (51.2-55.4) were included. Time from diagnosis was 20.5 (18.6-22.3) years. Myocardial work strain analysis showed an impaired GWE: 91.9% (90.9-92.9);p<0.001) and a GW index of 1840.8 mmHg%(1758.7-1922.9):p<0.001. The rest of deformation parameters laid into normal range: LV GLS was -19.5% (-19.0- -20.0) GLS dispersion 55.1 (50.1-60.1), LA GLS (reservoir) 32.8% (31.2-34.5), and RV free wall GLS -22.3% (-21.4 - -23.2). By univariate analysis, determinants of impaired GWE were age, Score2 risk, time from HIV diagnosis, QRS Interval duration, long QTc Interval, LV ejection fraction (LVEF),diastolic disfunction by doppler tissue imaging, CD4 count nadir, initial and maximun viral load, and exposure to didanosine treatment. After adjustment by cardiovascular risk and diastolic function (Ea velocity by tissue Doppler) , GWE impaired depended on duration of infection (Beta 0.3;95%CI:0.04-0.56;p=0.023), initial viral load (Beta -1.1;95%CI:-2.1- -0.02;p=0.046) and exposure to stavudine (Beta -6.3;95%IC: -11.5- -1.1;p=0.019). Conclusions Subclinical myocardial disfunction is prevalent in long standing HIV infection. Global work efficiency is a very sensitive parameter for detection, even in patients with normal GLS values, and it was related to duration of infection, initial viral load, and exposure to stavudine in our patients.Determinants of Global Work Efficiency

Prognostic implications of right and left atrial strain in diabetes mellitus without coronary artery diseases

Abstract Background 2D- speckle-tracking echocardiography (2D-STE) has recently be used to assess subclinical myocardial dysfunction, however its utility in diabetes mellitus (DM) has been specifically focusing on the longitudinal systolic function of the left ventricle (LV). Aim To assess the prognostic relation between left (LA) and right (RA) systolic and diastolic strain parameters with clinical outcome in patients with DM. Methods Of the initial 1721 diabetic patients screened for this study only 502 consecutive patients with DM were eligible and retrospectively enrolled, and 2D-STE strain parameters assessed on the 2D-TTE images. All patients were prospectively followed for development of new outcome/cardiac events which included hospitalization for acute HF, CVS-related death, new onset AF/AFI, stroke, heart transplantation, or need for ventricular assist device implantation. The 2D-STE analysis was used to measure the peak LA (longitudinal, radial and circumferential) and RA (longitudinal) strain. The long-term outcomes were evaluated for all-cause CVS outcomes and recurrent hospitalization. Results For the 502 eligible patients [mean age:58±4; 58 % male sex], 221 reached the combined endpoint. Mean follow-up was 1.1±0.6years. Both LA and RA strain parameters were significantly impaired compared to normal standard references (p<.0001), the RA was more impaired than LA strain parameters. The best performance parameters predictive of CVS (combined outcomes) events were for LA>RA systolic and diastolic strain, global RA systolic and diastolic strain (AUC: 0.74 and 70) and global LA longitudinal systolic and diastolic strain (AUC: 0.86 and 0.77). The strongest association between the degree of atrial myocardial mechanical dysfunction and risk of cardiovascular events was more evident for LA strain (free wall > global strain) and lesser extend to RA strain. More myocardial mechanical strain impairments were demonstrated in those with higher left atrial volume index (LAVI), NYHA ≥II class, significantly impaired diastolic function, lower strain values (LA, LV, RV), and tricuspid annular plane systolic excursion (TAPSE), p<.001). The LA (free wall) strain impairment was the independent predictors of combined outcome (including survival) after multiple adjustments using different models. Conclusion Patients with DM, LA strain parameters are stronger predictors of outcome than RA and other conventional parameters and should be included for regular clinical screening DM patients as these parameters provide a stronger prognostic stratification.

Cardiac chamber three-dimensional volumes and deformation predict clinical outcomes in chronic mitral regurgitation

Abstract Background In patients with mitral regurgitation (MR), cardiac remodeling assessed by two-dimensional (2D) echocardiographic linear indexes is highly variable and not suitable for individualized risk assessment. Purpose To evaluate whether measurements of myocardial strain and left atrial (LA), left ventricular (LV) and right ventricular (RV) three-dimensional (3D) volumes improve risk assessment in MR. Methods In the prospective 3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation study (3D-PRIME), 176 patients with significant (moderate or greater) MR were investigated with 2D/3D echocardiography. Referral criteria for mitral intervention followed current guidelines. LA remodeling was assessed by the maximum and minimum 3D LA volume (3D-LAV), peak reservoir strain (LASr), and stiffness (i.e. the ratio: mitral peak E-wave divided by the annular e’ velocity (E/e´) / LASr). LV and RV were considered dilated in case of increased 3D end-diastolic (LV>=86/74 and RV>=87/74ml/m2 in men/women) and end-systolic volumes indexed for body surface area (LV>=41/33 and RV>=44/36ml/m2 in men/women). Peak global longitudinal strain was measured in the LV (LV-GLS) and the RV free wall (RV-FWS). The primary outcome was a composite of mitral valve surgery, percutaneous mitral edge-to-edge repair and death. Results During a 14 [8-24] months follow-up, the patients (70±13 years, 39% women) experienced 73 events including 14 deaths. In univariate survival analyses, LV and RV dilatation, but not LV-GLS and RV-FWS, were associated with the primary outcome (Figure) and had superior predictive value to 2D volumes and diameters (p<0.05). On contrary, both atrial size and function predicted outcome, with 3D-LAV (HR 1.01, 95% CI 1.00-1.01), LASr (HR 1.03, 95% CI 1.01-1.06) and increased LA stiffness (Figure) all significant predictors of events (p<0.05). In multivariate Cox analysis with adjustment for age, sex, body mass index and MR etiology, dilated LV (HR 2.6, 95% CI 1.5-4.4), dilated RV (HR 2.0, 95% CI 1.1-3.6) and increased LA stiffness ((HR 2.4, 95% CI 1.3-4.6) were independently associated with higher rate of events (p<0.05). Conclusion In patients with moderate or greater MR, increased cardiac chamber 3D volumes and LA stiffness, as well as impaired LA reservoir strain are associated with higher risk of disease progression towards mitral valve intervention and death. Our findings indicate that assessment of both cardiac chamber 3D size and LA deformation can contribute to increased diagnostic and prognostic precision in patients with MR.

Interpretable artificial intelligence-based transthyretin amyloid cardiomyopathy detection in patients with severe aortic stenosis

Abstract Background The concurrent presence of transthyretin amyloid cardiomyopathy (ATTR-CM) in candidates for transcatheter aortic valve implantation (TAVI) with severe aortic stenosis (AS) is frequently observed. Objective This study aims to develop a multimodal artificial intelligence-based model for ATTR-CM detection in patients with severe AS. Methods A total of 263 prospectively enrolled (57% males, 83±4.6 years) patients with severe AS were enrolled. All underwent DPD-scintigraphy, and coexisting ATTR-CM was confirmed in 27 (10.3%). 4D-cardiac computed tomography (CT), electrocardiogram, echocardiography, angiography, clinical, and laboratory data were assessed. Specifically, in the 4D-CT, LV myocardial radiomics features as well as global- and segmental myocardial strain. All features underwent z-score normalization, and those with high correlation were eliminated. Different feature selection and machine learning (ML) techniques were used for classification in single- and multimodality scenarios. Eighty percent of the dataset was used for pre-processing, feature extraction, and tuning, with the remaining 20% for evaluating the final model. The model's effectiveness was assessed with accuracy, F1 score, and ROC-AUC across 100 random seeds to establish a reliable classifier. The SHAP (SHapley Additive exPlanations) model is used to interpret the output of ML models. Results Among the different algorithms used, Logistic Regression offers the most effective detection of ATTR-CM, surpassing other models with AUC scores of 0.85. CT strain (AUC: 0.85), Radiomics (AUC: 0.76), and clinical features (AUC: 0.70) alone and in combination yielded the highest performance (i.e., AUC: >70), while the remaining modalities had AUC scores ranging from 0.52 to 0.56. Conclusion The study shows that AI is effective for non-invasively detecting ATTR-CM in severe aortic stenosis patients, offering a potential alternative to costly DPD-scintigraphy or invasive biopsy.

Novel cardiovascular magnetic resonance imaging heterogeneity biomarkers to diagnose and predict cardiovascular disease: a UK Biobank CMR strain study

Abstract Background Myocardial strain evaluation on cardiovascular magnetic resonance imaging (CMR) shows significant promise to investigate cardiac function in vivo. There is concern that derived global longitudinal strain (GLS) and global circumferential strain (GCS) are less sensitive to early pathological cardiac remodelling, especially when regional. By quantifying contractile variability across the myocardium, the absolute longitudinal and circumferential strain coefficients of variation, |CoVLS| and |CoVCS| may facilitate earlier diagnosis and improved prognostication. Purpose We compared experimental heterogeneity biomarkers, |CoVLS| and |CoVCS|, to established global strain markers, GLS and GCS, to discriminate prevalent cardiovascular disease (CVD) and predict major adverse cardiovascular events (MACE). Methods Prevalent and incident CVD were defined among 44,955 participants from the UK Biobank (UKBB), who had feature-tracking (FT-CMR) derived strain markers. Prevalent CVD was the sum of established cardiovascular diagnoses at the time of baseline CMR, including hypertension, diabetes, atrial fibrillation, coronary artery disease, stroke and heart failure (HF). Incident CVD was newly identified MACE, including death from any cause, myocardial infarction, HF and stroke. Biomarkers were separately regressed against said endpoints, using ordinal logistic and Cox proportional hazards regression respectively. Statistical adjustment was performed for important baseline co-variables, including age, sex, ethnicity, smoking status, body mass index (BMI), low-density lipoprotein (LDL), left atrial volume, left ventricular mass and ejection fraction. Results Overall, 30,289 (67.4%) participants had no prevalent CVD, 10,362 (23.0%) had 1 CVD and 29 (0.06%) had ≥5 CVD. |CoVLS|, GLS, |CoVCS| and GCS were associated with a higher odds of prevalent CVD diagnoses (Figure 1). GLS had the greatest strength of association (OR 1.25, 95% CI 1.20-1.29), followed by |CoVCS| (OR 1.14, 95% CI 1.10-1.17). Over median 2.7 years (Q1-Q3 1.9-4.1 years), 966 (2.1%) participants experienced MACE, including 379 (0.8%) deaths, 263 (0.6%) MI, 246 (0.5%) HF, 237 (0.5%) stroke. |CoVLS|, |CoVCS| and GLS were comparable risk markers for MACE (Figure 2). The largest and smallest effect sizes were in predicting HF and death from any cause respectively. Conclusion Subclinical cardiac disease is often patchy, diffuse and regional; measures of heterogeneity may be more sensitive to these early pathological signals. We demonstrated that |CoVLS| and |CoVCS| are comparable to GLS and better than GCS in discriminating prevalent cardiac disease and predicting future cardiovascular events. These findings need to be replicated in other population studies and diseased cohorts.

Assessment of a new index of myocardial strain for the diagnosis of cardiac sarcoidosis

Abstract Background The diagnosis of cardiac involvement in sarcoidosis is challenging and often expensive. Purpose The aim of this study is to assess whether a new strain index proposed by the authors has incremental value in the evaluation of cardiac involvement, compared to the use of left ventricular (LV) global longitudinal strain (GLS). Methods This is a single-center, non-blinded, pilot cross-sectional study. Patients of both genders, >18 years old, with confirmed diagnosis of cardiac sarcoidosis according to the Heart Rhythm Society criteria, and controls consisting of individuals diagnosed with systemic sarcoidosis without cardiac involvement, were included. Patients with obesity grade 2 or higher , moderate or severe primary heart valve disease, myocardial diseases of other etiologies, established coronary artery disease, and inadequate acoustic window were excluded. All patients underwent transthoracic echocardiography, with subsequent measurements performed on a workstation. The following LV indexes were evaluated: GLS and the new proposed index, calculated by the ratio between LVEF and the sum of the two segments with the lowest absolute strain values. ROC curves were calculated for both parameters using an online dedicated software, with determination of the optimal cutoff point for both variables, corresponding to the point of highest sensitivity and specificity. Confidence intervals were established by the DeLong method, and curves were compared using the Bonferroni method. A two-tailed p value of 0.05 was considered significant. Results Twenty patients with cardiac involvement and twenty patients without cardiac involvement were evaluated. The results of the variables are presented in table 1. Conclusions The new index showed a larger area under the curve compared to isolated GLS, as well as higher sensitivity and specificity for the identified cutoff point, although without statistical significance, possibly due to the small sample size. Further studies are needed for subsequent validation of this innovative index.

Long term follow up in pulmonary embolism: can right ventricular strain echocardiographic imaging contribute to refine risk stratification?

Abstract Background In pulmonary embolism (PE), the usual evaluation of early risk of death includes clinical, biological and two-dimensional right ventricular (RV) echocardiographic (TTE) parameters. Purpose We hypothesized that myocardial strain analysis could contribute to risk of death prediction at long term follow up. Methods We retrospectively analyzed 477 patients hospitalized for acute EP. Usual parameters used to define RV dysfunction were evaluated using TTE (RV dilatation, systolic pulmonary arterial pressure, TAPSE, S’, Fractionnal Area Change (FAC), end diastolic RV diameter and right atrial, RA, area). In addition, we evaluated, left ventricle (LV) longitudinal, left atrial (LA), RA and RV free wall strains. Patients without history of cancer (n=419) were analyzed on the primary outcome of death at long term follow up. Results Mean of age was 63.7 ± 17.2 years and 227 (47.6) patients were male. The main clinical and echocardiographic characteristics are displayed in the Table 1. During a mean follow-up was 45.0 ± 16.6 months, the primary outcome occurred in 56 patients. In multivariable analysis, systolic pulmonary arterial pressure, indexed right atrial and left atrial volumes, right ventricle free wall strain, right ventricle global longitudinal strain were the only predictors of death (Table 2). Conclusion Atrial volumes and RV strain appeared as strong predictors of death in PE at long term follow up. Right ventricle myocardial strain analysis should be evaluated in each patient hospitalized for PE.

Association between objectively-measured sleep duration and early cardiac and hepatic imaging changes in adolescents: insights from the EnIGMA study

Abstract Introduction Inadequate sleep duration (SD) has been associated with adverse cardiovascular (CV) events in adults and adiposity in all life stages. Furthermore, previous cross-sectional studies have shown a possible association between self-reported SD and cardiac structural alterations as detected with echocardiography and cardiovascular magnetic resonance (MR), even in young healthy people. However, there is a lack of longitudinal studies demonstrating an association between objectively-measured SD and structural cardiac alterations. Purpose To assess the association between SD and MR-derived cardiac and hepatic parameters in adolescents. Methods This study used longitudinal data collected as part of the SI! Program for Secondary Schools trial in Spain (2017-2021), which enrolled 1326 participants (mean age: 12.5±0.5 years at baseline). Measurements were taken at three different time-points: baseline, 2-year follow-up and 4-year follow-up. SD and physical activity were assessed by accelerometry for seven consecutive days at each follow-up. The participants were offered to undergo a MR scan in the final follow-up as part of the Early imaging markers of unhealthy lifestyles in adolescents (EnIGMA) study. The imaging protocol included a cine SSFP to provide images for chamber size and function, myocardial tagging acquisitions to assess myocardial strain, T1 and T2 mapping sequences to provide precise myocardial relaxation time properties, and a liver mDixonQuant sequence to obtain liver fat content, using a 3-T scanner. The cumulative effect of the independent variable (SD) and the covariates was assessed using the area under the curve (AUC) method, calculating the integral of the curve parameters during the follow-up period for each subject. To facilitate interpretation, AUC values were divided by the years of follow-up. The participants were included in the analysis if they had available data for SD in at least 2 of the 3 time-points. The association between SD and the MR parameters was assessed by linear regression models. Results 109 participants (61 girls [56.0%]; mean age=16.0±0.5 years) were included in this study. Indexed left ventricular (LV) mass, as well as indexed end-diastolic biventricular volumes were higher in boys than in girls (Figure 1). SD AUC (hours/day) was independently and inversely associated with indexed LV mass and liver fat fraction in the unadjusted and adjusted (age, gender, physical activity, body mass index percentile, and systolic and diastolic blood pressure percentiles AUCs) models (Figure 2). There were no significant associations between the SD AUC and other MR-derived parameters. Conclusion Shorter SD is independently associated with initial stages of cardiac remodeling and liver fat accumulation as assessed with state-of-the-art MR as early as in adolescence. Considering these results, health promotion programs should be implemented early in life emphasizing the importance of good sleep habits.Participant characteristicsAssociation between SD and MR

Effects of moderate-intensity aerobic training on cardiac structure and function in type 2 mellitus diabetic rats: Based on echocardiography and speckle tracking

PurposeThe present study aimed to evaluate the cardiac function changes using Layer-specific Speckle-tracking echocardiography (LS-STE) induced by Moderate-intensity aerobic training (MIAT) in Type 2 diabetes mellitus (T2DM) rats. MethodsTwenty-six rats were divided into four groups: the Control group (Con), the Training control group (CT), the T2DM group (DM), and the T2DM training group (DT). The CT and DT groups underwent an 8 weeks MIAT. Cardiac structure and function were evaluated by echocardiography and LS-STE. ResultsCompared with the Con group, left atrial diameter (LAD), left ventricular end-diastolic diameter(LVEDD), relation wall thickness (RWT), and left ventricular mass (LVM) were significantly higher, and the endo-, mid-, and epi-longitudinal strain (LS), global radial strain (GRS), and endo- and mid-circumferential strain (CS) were significantly lower in DM rats (all p < 0.05). The endo-, mid-, and epi-LS, GRS, endo- and mid-CS were increased in DT rats compared with DM rats (all p < 0.05). Compared with Con rats, CT rats had a significant increase in LVEDD and LVM (all p < 0.05), meanwhile myocardial strains had no significant differences (all p > 0.05). ConclusionLS-STE was a sensitive method to assess subclinical myocardial changes in T2DM rats. MIAT had the benefit of reversing cardiac systolic subclinical dysfunction in T2DM rats.

Mitochondrial Dysfunction and Ion Imbalance in a Rat Model of Hemodialysis-Induced Myocardial Stunning.

Background/Objectives: Hemodialysis-induced myocardial stunning (HIMS) is a frequent complication in patients undergoing maintenance hemodialysis, characterized by transient left ventricular dysfunction due to ischemic episodes. Mitochondrial dysfunction and fluctuations in key ions such as potassium (K+) and calcium (Ca2+) are implicated in the pathogenesis of HIMS. This study aims to investigate the role of mitochondrial dysfunction and the protective potential of mitochondrial ATP-sensitive potassium channels (mitoKATP) in mitigating HIMS. Methods: A 5/6 nephrectomy rat model was established to mimic chronic kidney disease and the subsequent HIMS. The effects of mitoKATP channel modulators were evaluated by administering diazoxide (DZX), a mitoKATP opener, and 5-hydroxydecanoate (5-HD), a mitoKATP blocker, before hemodialysis. Mitochondrial function was assessed by measuring membrane potential, ATP synthase activity, and intramitochondrial Ca2+ levels. Myocardial function was evaluated using speckle tracking echocardiography. Results: Rats undergoing hemodialysis exhibited significant reductions in left ventricular strain and synchrony. DZX administration significantly improved mitochondrial function and reduced myocardial strain compared to controls. Conversely, 5-HD worsened mitochondrial swelling and disrupted myocardial function. Higher K+ and Ca2+ concentrations in the dialysate were associated with improved mitochondrial energy metabolism and myocardial strain. Conclusions: Mitochondrial dysfunction and ion imbalances during hemodialysis are key contributors to HIMS. The activation of mitoKATP channels provides mitochondrial protection and may serve as a potential therapeutic strategy to mitigate HIMS.

Myocardial strain analysis by feature tracking cardiac magnetic resonance to identify subclinical cardiac dysfunction in patients with MINOCA

BackgroundTo investigate whether feature tracking cardiac magnetic resonance (FT-CMR) can identify subclinical myocardial dysfunction in patients with myocardial infarction with non-obstructed coronary arteries (MINOCA).MethodsClinical data and CMR images of MINOCA patients (N = 46) and control individuals (N = 12) were compared. The infarct and edema volume to total myocardium, peak global longitudinal strain (GLS), global longitudinal strain rate (GLSR), peak global circumferential strain (GCS), global circumferential strain rate, peak global radial strain, and global radial strain rate were measured. Diagnostic performances of strain parameters for MINOCA were evaluated by logistic regression and receiver operating characteristics analysis.ResultsExcept smoking history, the two groups showed no significant differences in cardiovascular risk factors and traditional heart function. GLS (-14.67 ± 1.96% vs. -19.19 ± 2.05%), GLSR (-0.94 ± 0.16 S− 1 vs. -1.23 ± 0.14 S− 1) and GCS (-17.59 ± 1.81% vs. -19.22 ± 1.76%) were impaired in MINOCA patients compared with the control group. MINOCA patients with normal routine CMR showed abnormalities in GLS (-16.23 ± 1.16%) and GLSR (-1.04 ± 0.16 S− 1). GLS and GLSR were predictive for MINOCA diagnosis (P = 0.002 vs. P = 0.033). GLS correlated strongly with myocardial infarction and edema. The optimal diagnostic threshold for GLS was <-16.9% for MINOCA diagnosis (sensitivity 87.1%, specificity 92.9%); the area under the receiver operating characteristic curve was 0.968.ConclusionsMyocardial strain by FT-CMR may effectively detect early myocardial impairment with MINOCA, especially in patients with normal routine MRI.

Association between myocardial layer-specific strain and high 10-year risk of atherosclerotic cardiovascular disease in hypertension-findings from the China-PAR project study.

Myocardial layer-specific strain is a sensitive tool for detecting myocardial dysfunction. The objective of this study was to assess changes in the left ventricle (LV) function using myocardial layer-specific strain and its association with 10-year atherosclerotic cardiovascular disease risk (10Y-ASCVDR) in individuals with hypertension (HP). The parameters of LV structure, including layer-specific global longitudinal strain (GLSww, GLSendo, GLSmid, GLSepi) and layer-specific global circumferential strain (GCSww, GCSendo, GCSmid, GCSepi), were analyzed by two-dimensional speckle-tracking echocardiography in 239 hypertensive patients and 124 control subjects. In addition, participants were divided into low-risk (LR) and high-risk (HR) subgroups according to 10Y-ASCVDR scores . The correlation between myocardial layer-specific strain and 10Y-ASCVDR was further analyzed by the restricted cubic spline (RCS) function. The values of GLSww, GLSepi, GLSmid, and GLSendo were significantly lower in HP patients with HR than in HP patients with LR and controls (p < 0.05). However, no significant differences in layer-specific GCS were observed between the groups (p > 0.05). RCS analysis revealed that 10Y-ASCVDR exhibited a significant J-shaped relationship with layer-specific GLS and GCS. After adjusting for confounding factors, GLSww (β = 0.156, p = 0.042), GLSmid (β = 0.161, p = 0.032), GCSendo (β = 0.163, p = 0.024), and GCSmid (β = -0.175, p = 0.030) were identified as independent influencing factors for high 10Y-ASCVDR. In hypertensive patients, myocardial layer-specific strain, especially GLS, sensitively detected LV dysfunction and showed a significant J-shaped relationship with 10Y-ASCVDR. GCSmid may have a compensatory effect on myocardial impairment. LV myocardial layer-specific strain may help to understand the early compensatory mechanisms of the myocardium in hypertension.

The transition from hypertension to hypertensive heart disease and heart failure with preserved ejection fraction: a retrospective cross-sectional study of myocardial magnetic resonance strain and tissue characteristics.

Due to the variability of symptoms and signs associated with heart failure, along with the lack of specific tests for definitive diagnosis, the noninvasive diagnosis of heart failure with preserved ejection fraction (HFpEF) continues to pose significant clinical challenges. This investigation was designed to elucidate the clinical manifestations of HFpEF and to analyze cardiac magnetic resonance (CMR)-derived myocardial strain metrics and tissue characteristics in a cohort exhibiting HFpEF with hypertension (HFpEF-HTN). This retrospective analysis consisted of 128 patients diagnosed HFpEF-HTN, 78 individuals with hypertensive heart disease (HHD), 89 individuals with hypertension (HTN), and 60 normotensive healthy controls and was conducted from August 2021 to February 2024. All participants were recruited from The First Hospital of Lanzhou Universityand underwent laboratory examinations and 3.0 T CMR. The study compared clinical features and CMR-derived structural and functional parameters across different groups. Logistic regression was employed to determine the association between CMR parameters and HFpEF-HTN. Spearman correlation coefficient analysis was used to clarify the relationship between myocardial strain parameters and left ventricular (LV) ejection fraction and right ventricular (RV) ejection fraction. Additionally, the area under the curve (AUC) from receiver operating characteristic (ROC) analysis was used to compare the diagnostic performance of different CMR parameters for HFpEF-HTN. Patients diagnosed with (HFpEF-HTN) were characterized by an older demographic profile, a higher prevalence of smoking history, elevated systolic and diastolic blood pressure, increased levels of N-terminal pro-brain natriuretic peptide, and more advanced New York Heart Association functional class as compared to other studied groups. In terms of myocardial deformation, individuals with HFpEF-HTN exhibited pronounced impairments in both LV and RV function, as evidenced by significantly reduced longitudinal strain (LS), circumferential strain (CS), and radial strain (RS), relative to HTN, HHD, the control cohorts (all P values <0.001). Patients with HFpEF-HTN showed significantly elevated levels of late gadolinium enhancement, native T1, and extracellular volume fraction (ECV) indicative of myocardial interstitial fibrosis as compared to patients with HHD. Additionally, as compared to ECV, LV GCS emerged as a superior diagnostic indicator, demonstrating greater diagnostic accuracy in differentiating HFpEF-HTN patients from those with HHD (AUC =0.85; P<0.001). Moreover, LVEF showed a mild correlation with CMR-derived LV GLS (R=-0.43; P<0.001), LV GCS (R=-0.42; P<0.001), and LV GRS, (R=0.56; P<0.001) in all patients. Myocardial strain, T1 mapping, and ECV can be used for the quantitative evaluation of LV and RV ventricular remodeling, dysfunction, and tissue characteristics in patients with HFpEF-HTN and thus hold significant potential for the diagnosis of these patients.

Myocardial mechanical function measured by cardiac magnetic resonance in patients with heart failure

AimStrain analysis offers a valuable tool to assess myocardial mechanics, allowing for the detection of impairments in heart function. This study aims to evaluate the pattern of myocardial strain in patients with heart failure (HF). MethodsIn the present study, myocardial strain was measured by cardiac magnetic resonance imaging feature tracking in 35 control subjects without HF and 195 HF patients. The HF patients were further categorized as HF with preserved ejection fraction (HFpEF, n=80), with mid-range ejection fraction (HFmrEF, n=34), and with reduced ejection fraction (HFrEF, n=81). Additionally, quantitative tissue evaluation parameters, including native T1 relaxation time and extracellular volume (ECV), were examined. ResultsCompared to controls, patients in all HF groups (HFpEF, HFmrEF, and HFrEF) demonstrated impaired left ventricular (LV) strains and systolic and diastolic strain rates in all three directions (radial, circumferential, and longitudinal) (p < 0.05 for all). LV strains also showed significant correlations with left ventricular ejection fraction and brain natriuretic peptide levels (p < 0.001 for all). Notably, septal contraction was significantly affected in HFpEF compared to controls. While LV torsion was slightly increased in HFpEF, it was decreased in HFrEF. Native T1 relaxation times and ECV fractions were significantly higher in HFrEF compared to HFpEF (p < 0.05). Overall, myocardial strain parameters demonstrated good performance in differentiating HF categories. ConclusionsThe myocardial strain impairments exhibit a spectrum of severity in patients with HFpEF, HFmrEF, and HFrEF compared to controls. Assessment of myocardial mechanics using strain analysis may offer a clinically useful tool for monitoring the progression of systolic and diastolic dysfunction in HF patients.

Prognostic value of multimodality imaging in the contemporary management of cardiac sarcoidosis

BackgroundEchocardiography, cardiac magnetic resonance and cardiac 18fluorodeoxyglucose positron emission tomography (FDG-PET) imaging play key roles in the diagnosis and management of cardiac sarcoidosis (CS), but the relative value of each...

CT-derived myocardial strain measurement in patients with chronic constrictive pericarditis

BackgroundWe aimed to compare computed tomography (CT)-derived myocardial strain between patients with constrictive pericarditis (CP) and a matched healthy control group and to identify factors associated with clinical outcomes after pericardiectomy. MethodsThis retrospective study included 65 patients with CP (mean age: 58.9 ​± ​8.0 years) and 65 healthy individuals (mean age: 58.0 ​± ​6.5 years) who underwent multiphase cardiac CT. The type of CP was classified as calcified CP or fibrotic CP. CT-derived strains from four cardiac chambers were compared between the CP and control groups, as well as between different types of CP. Clinical and CT-derived factors associated with adverse outcomes were identified using Cox regression analysis. ResultsCompared with the control group, the CP group showed significantly lower values of left atrium (LA) reservoir strain (15.7 ​% vs. 27.4 ​%), right atrium (RA) reservoir strain (15.1 ​% vs. 27.0 ​%), left ventricle (LV) global longitudinal strain (GLS) (−17.0 ​% vs. −19.5 ​%), and right ventricle free wall longitudinal strain (−21.1 ​% vs. −25.9 ​%) (all p ​< ​0.001). Biatrial reservoir strains and LV GLS were significantly lower in those with calcified CP compared to those with fibrotic CP. LA reservoir strain (hazard ratio, 0.91–95 ​% confidence interval, 0.86–0.96– p ​= ​0.001) was an independent prognostic factor for adverse events in patients with CP. ConclusionCardiac strain differences in CP were predominantly observed in the LA and RA compared to the healthy control group. Biatrial reservoir strains were specifically impaired in those with calcified CP than in those with fibrotic CP. LA reservoir strain was associated with prognosis in patients with CP following pericardiectomy.

Progress in Cardiac Magnetic Resonance Feature Tracking for Evaluating Myocardial Strain in Type-2 Diabetes Mellitus.

The global prevalence of type-2 diabetes mellitus (T2DM) has caused harm to human health and economies. Cardiovascular disease is one main cause of T2DM mortality. Increased prevalence of diabetes and associated heart failure (HF) is common in older populations, so accurately evaluating heart-related injury and T2DM risk factors and conducting early intervention are important. Quantitative cardiovascular system imaging assessments, including functional imaging during cardiovascular disease treatment, are also important. The left-ventricular ejection fraction (LVEF) has been traditionally used to monitor cardiac function; it is often preserved or increased in early T2DM, but subclinical heart deformation and dysfunction can occur. Myocardial strains are sensitive to global and regional heart dysfunction in subclinical T2DM. Cardiac magnetic resonance feature-tracking technology (CMR-FT) can visualize and quantify strain and identify subclinical myocardial injury for early management, especially with preserved LVEF. Meanwhile, CMR-FT can be used to evaluate the multiple cardiac chambers involvement mediated by T2DM and the coexistence of complications. This review discusses CMR-FT principles, clinical applications, and research progress in the evaluation of myocardial strain in T2DM.

Prevalence and predictors of right ventricular dysfunction among adults living with HIV in northwest Nigeria.

People living with the human immunodeficiency virus (PLWH) are at increased risk of cardiovascular diseases. Right ventricular (RV) function has important prognostic value in cardiac pathology, and advances in imaging modalities, such as transthoracic echocardiography have enabled in-depth RV studies. There is, however, a scarcity of multiparameter RV function studies in PLWH in low- and middle-income settings, such as Nigeria. The aim of this study is to determine the prevalence and predictors of RV dysfunction among adult PLWH in northwest Nigeria. This is a retrospective cross-sectional study conducted between February 1, 2023 and August 31, 2023. We consecutively recruited 330 adults [median age 45 years, interquartile range (IQR), 38 to 52 years, 61% female] attending human immunodeficiency virus (HIV) and general outpatient clinics in a tertiary hospital in northwest Nigeria. They included 110 antiretroviral therapy (ART)-experienced PLWH, 110 ART-naïve PLWH, and 110 age- and sex-matched HIV-negative control subjects. All participants had conventional two-dimensional (2D), tissue Doppler (TDI), and speckle tracking (2D-STE) echocardiography to estimate left ventricular (LV) and RV systolic and diastolic function, peak systolic and diastolic myocardial velocities, RV and LV longitudinal strain, and chamber dimensions. All participants also underwent 12-lead electrocardiography. Multiple linear and Firth's logistic regression modeling were performed to assess for independent predictors of RV myocardial performance index (RVMPI) as a continuous and as a dichotomous variable, respectively. The prevalence of RV dysfunction, as determined by the RVMPI among HIV-positive participants was 14.5% [95% confidence interval (CI): 10.5-19.8%] compared to 0% (95% CI: 0.0-3.4%) for those without HIV. Among participants with HIV, RVMPI was associated with participant age (P<0.001) and left ventricular ejection fraction (LVEF) (P<0.001). Results were similar when RVMPI was dichotomized. The association between RV dysfunction and LVEF was modified by ART status: a 10% decrease in LVEF was associated with an average decrease of 0.08 in RVMPI among participants who were ART-experienced (β=-0.08, P<0.001) but a lesser decrease among those who were ART- naïve (β=-0.03, P=0.14). This study highlights the complexity of RV dysfunction in PLWH and underscores the importance of LVEF and age as key factors influencing the risk of RV dysfunction in PLWH.

156 - Quantitative Evaluation of Left Ventricular Myocardial Strain in Hypertrophic Cardiomyopathy by Cardiac Magnetic Resonance Tissue Tracking Technology

156 - Quantitative Evaluation of Left Ventricular Myocardial Strain in Hypertrophic Cardiomyopathy by Cardiac Magnetic Resonance Tissue Tracking Technology