Peak Early Diastolic Strain Rate Research Articles

Temporal Responses of a Low-Energy Meal Replacement Plan or Exercise Training on Cardiovascular Function and Fibro-Inflammatory Markers in People with Type 2 Diabetes—A Secondary Analysis of the “Diabetes Interventional Assessment of Slimming or Training to Lessen Inconspicuous Cardiovascular Dysfunction” Study

Background: This study assesses the temporal responses of cardiovascular function, fibro-inflammation, and glucometabolic profiles in asymptomatic adults with type 2 diabetes, following a low-energy meal replacement plan (MRP) or exercise training. Methods: Secondary analysis of DIASTOLIC: a randomised, open-label, blinded-endpoint trial of 12 weeks MRP (~810 kcal/day) or exercise training. Cardiac magnetic resonance, plasma fibroinflammatory, and metabolic markers were undertaken at baseline, 4, and 12 weeks. Results: Out of 24 participants in the MRP group and 22 in exercise training, 18 and 11 completed all three visits. MRP resulted in early (0–4 weeks) improvement in insulin resistance (HOMA-IR: 10.82 to 4.32), decrease in FABP-4 (4.87 ± 0.19 to 5.15 ± 0.32 mg/L), and improvement in left ventricular remodelling LV mass: volume (0.86 ± 0.14 to 0.78 ± 0.11), all with large effect sizes. MMP8 levels increased moderately at 4–12 weeks. Peak early diastolic strain rate (cPEDSR) initially decreased, then improved. Exercise training led to minor improvements in insulin resistance and MMP-8 levels, with no significant changes in cPEDSR or LV remodelling. Conclusions: MRP resulted in early improvements in insulin resistance, cardiac remodelling, and inflammation, but with an initial decrease in diastolic function, improving by 12 weeks. Exercise training showed minor early benefits in insulin resistance and inflammation, but no significant cardiac changes.

Ethnic differences in cardiac structure and function assessed by MRI in healthy South Asian and White European people: A UK Biobank Study

BackgroundEchocardiographic studies indicate South Asian people have smaller ventricular volumes, lower mass and more concentric remodelling than White European people, but there are no data using cardiac MRI (CMR). We aimed to compare CMR quantified cardiac structure and function in White European and South Asian people. MethodsHealthy White European and South Asian participants in the UK Biobank Imaging CMR sub-study were identified by excluding those with a history of cardiovascular disease, hypertension, obesity or diabetes. Ethnic groups were matched by age and sex. Cardiac volumes, mass and feature tracking strain were compared. Results121 matched pairs (77 male/44 female, mean age 58 ± 8 years) of South Asian and White European participants were included. South Asian males and females had smaller absolute but not indexed left ventricular (LV) volumes, and smaller absolute and indexed right ventricular volumes, with lower absolute and indexed LV mass and lower LV mass:volume than White European participants. Although there were no differences in ventricular or atrial ejection fractions, LV global longitudinal strain was higher in South Asian females than White European females but not males, and global circumferential strain was higher in both male and South Asian females than White European females. Peak early diastolic strain rates were higher in South Asian versus White European males, but not different between South Asian and White European females. ConclusionsContrary to echocardiographic studies, South Asian participants in the UK Biobank study had less concentric remodelling and higher global circumferential strain than White European subjects. These findings emphasise the importance of sex- and ethnic- specific normal ranges for cardiac volumes and function.

The impact of surgical aortic valve replacement on myocardial deformation in patients with severe aortic stenosis: a comparison between echocardiography and CMR

Abstract Background Aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) leads to reverse remodelling, with reduction in left ventricle (LV) mass and volumes. However, the effect of AVR on left atrial (LA) and LV myocardial deformation using speckle tracking echocardiography (STE) and feature tracking cardiac magnetic resonance (FT-CMR) has not been extensively compared in the same cohort. Methods Patients with severe AS scheduled for AVR were recruited. Same-day TTE and CMR scans were performed pre- and post-AVR using a standard protocol. Myocardial deformation was assessed using STE and FT-CMR by a blinded single observer. LA strain (LAS) corresponding to reservoir, conduit and booster pump function were assessed on 4- and 2-chamber and average values calculated. For the LV, the three long-axis views were utilised for global longitudinal strain (GLS) and peak early diastolic strain rate (PEDSR). Mid circumferential strain (Mid-CS) and PEDSR were calculated from the mid short-axis view. Global circumferential strain (GCS) and PEDSR were derived by averaging values from the basal, mid and apical short axis cine slices by FT-CMR only. Results We recruited 78 patients with severe AS, 66 of whom (mean age 67.0±9.4 years; 75.8% males) had matched pre- and post-AVR CMR scans. Median follow-up period was 6 months. LV assessment by TTE was limited by image quality (>20% unanalysable images). STE demonstrated a significant increase in reservoir and conduit LAS, GLS and longitudinal PEDSR post-AVR (Table 1&2). FT-CMR demonstrated a significant increase in booster-pump LAS, GLS, GCS and longitudinal/ circumferential-PEDSR post-AVR. Conclusion In patients with severe AS, significant increase in LV GLS and longitudinal-PEDSR was seen using both FT-CMR and STE. GCS and circumferential-PEDSR were significantly increased using FT-CMR only, suggesting that CMR may be more sensitive to subtle changes in LV function at 6 months post-AVR. LAS assessment showed significant improvements post-AVR by both imaging modalities.Table 1Table 2

Peak early diastolic strain rate improves prediction of adverse cardiovascular outcomes in patients with ST-elevation myocardial infarction.

The prognostic role of diastolic dysfunction measured by the circumferential peak early diastolic strain rate (PEDSR) on ST-elevation myocardial infarction (STEMI) is not completely established. We aimed to investigate the prognostic value of diastolic function by measuring PEDSR within 1week after STEMI. The cardiac magnetic resonance (CMR) pictures of 420 subjects from a clinical registry study (NCT03768453) were analyzed and the composite major adverse cardiac events (MACEs) were followed up. The PEDSR of patients was significantly lower compared with that of control subjects (P < 0.001). Within the median follow-up period of 52months, PEDSR of patients who experienced MACEs deceased more significantly than that of patients without MACEs (P < 0.001). After adjusting with clinical or CMR indexes, per 0.1/s reduction of PEDSR increased the risks of MACEs to 1.402 or 1.376 fold and the risk of left ventricular (LV) remodeling to 1.503 or 1.369 fold. When PEDSR divided by best cutoff point, significantly higher risk of MACEs (P < 0.001) and more remarkable LV remodeling (P < 0.001) occurred in patients with PEDSR ≤ 0.485/s. Moreover, when adding the PEDSR to the conventional prognostic factors such as LV ejection fraction and infarction size, better prognostic risk classification models were created. Finally, aging, tobacco use, remarkable LV remodeling, and a low LV ejection fraction were factors related with the reduction of PEDSR. Diastolic dysfunction has an important prognostic effect on patients with STEMI. Measurement of the PEDSR in the acute phase could serve as an effective index to predict the long-term risk of MACEs and cardiac remodeling.

Is increased myocardial triglyceride content associated with early changes in left ventricular function? A 1H-MRS and MRI strain study.

Type 2 diabetes (T2D) and obesity induce left ventricular (LV) dysfunction. The underlying pathophysiological mechanisms remain unclear, but myocardial triglyceride content (MTGC) could be involved. This study aimed to determine which clinical and biological factors are associated with increased MTGC and to establish whether MTGC is associated with early changes in LV function. A retrospective study was conducted using five previous prospective cohorts, leading to 338 subjects studied, including 208 well-phenotyped healthy volunteers and 130 subjects living with T2D and/or obesity. All the subjects underwent proton magnetic resonance spectroscopy and feature tracking cardiac magnetic resonance imaging to measure myocardial strain. MTGC content increased with age, body mass index (BMI), waist circumference, T2D, obesity, hypertension, and dyslipidemia, but the only independent correlate found in multivariate analysis was BMI (p=0.01; R²=0.20). MTGC was correlated to LV diastolic dysfunction, notably with the global peak early diastolic circumferential strain rate (r=-0.17, p=0.003), the global peak late diastolic circumferential strain rate (r=0.40, p<0.0001) and global peak late diastolic longitudinal strain rate (r=0.24, p<0.0001). MTGC was also correlated to systolic dysfunction via end-systolic volume index (r=-0.34, p<0.0001) and stroke volume index (r=-0.31, p<0.0001), but not with longitudinal strain (r=0.009, p=0.88). Interestingly, the associations between MTGC and strain measures did not persist in multivariate analysis. Furthermore, MTGC was independently associated with LV end-systolic volume index (p=0.01, R²=0.29), LV end-diastolic volume index (p=0.04, R²=0.46), and LV mass (p=0.002, R²=0.58). Predicting MTGC remains a challenge in routine clinical practice, as only BMI independently correlates with increased MTGC. MTGC may play a role in LV dysfunction but does not appear to be involved in the development of subclinical strain abnormalities.

Application of two dimensional speckle tracking imaging in the follow up of patients with coronary heart disease treated with metalol

Purpose: To investigate the application of two-dimensional speckle tracking imaging (2D-STI) in the follow-up of patients with coronary heart disease (CHD) who were treated with metalol. Methods: A total of 100 patients with CHD (CHD group) who were treated with metalol and had undergone percutaneous coronary intervention (PCI) at Tangshan Works’ Hospital, Tangshan, China, and another 100 healthy people (control group) were enrolled in this study. Prior to and after 6 months of treatment, echocardiography was performed on patients in control and CHD groups, respectively, and the wall motion score was calculated. The 2D-STI was used to obtain systolic peak longitudinal strain value (SLs), global peak longitudinal strain (GSL) and early diastolic peak longitudinal strain rate (SrLe) in the early diastolic period of 6 wall basal segments, middle segments, and apical segments of the left ventricle. Results: The wall motion score index (WMSI) of CHD group was higher than that of the control group, while the WMSI of CHD group after treatment was significantly lower than the value before treatment, (p &lt; 0.05). In 2D-STI, the SLs, SrLe and GLS of patients after 6 months of treatment were significantly higher than those before treatment (p &lt; 0.05).Conclusion: Thus, 2D-STI can be used to quantify the motion of the chamber wall and the effect of PCI surgery, and it also provides a stable new index and technique for evaluating the effects of treatment of CHD.

Myocardial Tissue-Level Characteristics of Adults With Metabolically Healthy Obesity

BackgroundIt remains unclear whether adults with metabolically healthy obesity (MHO) have altered myocardial tissue-level characteristics. ObjectivesThis study aims to assess the subclinical myocardial tissue-level characteristics of adults with MHO. MethodsThe EARLY-MYO-OBESITY (EARLY Assessment of MYOcardial Tissue Characteristics in OBESITY; NCT05277779) registry was a prospective, 3-center, cardiac imaging study of obese nondiabetic individuals without cardiac symptoms who underwent cardiac magnetic resonance. Myocardial tissue-level characteristics, including extracellular volume fraction (ECV) and native T2 values, were measured as indicators of myocardial fibrosis and edema. Global longitudinal peak systolic strain and early diastolic longitudinal strain rate were assessed by tissue tracking analysis to detect subclinical systolic and diastolic dysfunction. ResultsA total of 120 participants were included: MHO (n = 32; mean age, 38 years; 41% men), metabolically healthy controls without obesity (n = 32; mean age: 37 years; 41% men), and metabolically unhealthy obesity (MUHO) (n = 56; mean age: 37 years; 55% men). The MHO group had higher ECV and native T2 values than healthy controls (both P < 0.001); furthermore, the ECV was higher in the MUHO group than in the MHO group (P = 0.002). The prevalence of myocardial fibrosis was 44% (14 of 32) in the MHO group and 71% (40 of 56) in the MUHO group. Although there was no intergroup difference in left ventricular ejection fraction, the MHO group had reduced global longitudinal peak systolic and early diastolic longitudinal strain rates, indicating subclinical systolic and diastolic dysfunction. Multivariate regression analysis identified increased body mass index to be an independent risk factor for myocardial fibrosis (OR: 6.28 [95% CI: 3.17-12.47]; P < 0.001). ConclusionsThis study provides the first evidence of subclinical myocardial tissue-level remodeling in adults with obesity, regardless of metabolic health. Early identification of cardiac impairment may facilitate preventive strategies against heart failure in the MHO population. (EARLY Assessment of MYOcardial Tissue Characteristics in OBESITY [EARLY-MYO-OBESITY]; NCT05277779)

Improved computation of Lagrangian tissue displacement and strain for cine DENSE MRI using a regularized spatiotemporal least squares method.

In displacement encoding with stimulated echoes (DENSE), tissue displacement is encoded in the signal phase such that the phase of each pixel in space and time provides an independent measurement of absolute tissue displacement. Previously for DENSE, estimation of Lagrangian displacement used two steps: first a spatial interpolation and, second, least squares fitting through time to a Fourier or polynomial model. However, there is no strong rationale for such a through-time model. To compute the Lagrangian displacement field from DENSE phase data, a minimization problem is introduced to enforce fidelity with the acquired Eulerian displacement data while simultaneously providing model-independent regularization in space and time, enforcing only spatiotemporal smoothness. A regularized spatiotemporal least squares (RSTLS) method is used to solve the minimization problem, and RSTLS was tested using two-dimensional DENSE data from 71 healthy volunteers. The mean absolute percent error (MAPE) between the Lagrangian displacements and the corresponding Eulerian displacements was significantly lower for the RSTLS method vs. the two-step method for both x- and y-directions (0.73±0.59 vs 0.83 ±0.1, p < 0.05) and (0.75±0.66 vs 0.82 ±0.1, p < 0.05), respectively. Also, peak early diastolic strain rate (PEDSR) was higher (1.81±0.58 (s-1) vs. 1.56±0. 63 (s-1), p<0.05) and the strain rate during diastasis was lower (0.14±0.18 (s-1) vs 0.35±0.2 (s-1), p < 0.05) for the RSTLS vs. the two-step method, with the former suggesting that the two-step method was over-regularized. The proposed RSTLS method provides more realistic measurements of Lagrangian displacement and strain from DENSE images without imposing arbitrary motion models.

USING NOVEL CARDIOVASCULAR MAGNETIC RESONANCE 4D FLOW HEMODYNAMIC IMAGING TO INVESTIGATING VENTRICULAR AORTIC COUPLING

<h3>Introduction</h3> Ventricular-aortic-coupling (VAC) is a mechanism of growing interest in heart disease and aging. It has been postulated that aortic stiffness could lead to progressive systolic and indirectly diastolic dysfunction. VAC is important to understand the interaction of cardiac contractility and compliance with the arterial system. Studies have reported anesthetic dose and rate of infusion are associated with ventricular-arterial uncoupling. This can be confounded further in patients with severe hemodynamic disorders such as septic shock, however, the relationship between the ventricular and arterial systems is still not fully understood. With 4D-flow cardiovascular magnetic resonance (CMR) imaging, the images of the thoracic cavity can be acquired in a single acquisition. Our goal was to investigate the relationship between intraventricular and aortic hemodynamics in a healthy population, using modern measures of 4D-Flow analysis and myocardial deformation. <h3>Methods</h3> 40 healthy participants were recruited to undergo a 3-Tesla CMR scan. A 4D-flow acquisition of the thoracic cavity was acquired and blood flow in the left ventricle were assessed for direct flow (blood that enters and leaves the ventricle during one heartbeat) and retained inflow (blood that enters the LV during diastole but is not ejected during the same cardiac cycle). From the same acquisition, 4D-pulse wave velocity (PWV) was calculated of the aorta. Systolic and diastolic ventricular function were assessed by peak systolic global longitudinal strain (GLS) and early diastolic strain rate from standard function cines. <h3>Results</h3> Participants (62.5% male) were aged from 21 to 63 years. Mean aortic PWV was 6.1±1.4m/s, LV direct flow fraction was 44.8±12.0% and retained inflow fraction was 25.6±6.3%. GLS was -17.1±2.0% and diastolic strain rate was 0.94±0.24/s. Increasing age was related to three parameters: Increase in aortic PWV (r=0.415, p=0.001), decrease in retained inflow (r=-0.575, p=0.001) and in early diastolic strain rate (r=-0.637, p<0.001). There was no association between systolic measures of GLS and direct flow fraction with age. When comparing flow results to ventricular strain, both a high aortic PWV (β=0.615, p=0.017) and reduced direct flow fraction (β=-0.06, p=0.048) were independently correlated with attenuated GLS, even when accounting for age. Diastolic strain rate was also independently linked to a high aortic PWV indicating aortic stiffness (β=0.024, p=0.001), and there was a correlation with the retained inflow fraction (r=0.408, p=0.031), however this was not significant when accounting for age. <h3>Conclusion</h3> Advanced measures of 4D-flow have shown that aortic pulse wave velocity as a measure of aortic stiffness and intraventricular hemodynamics are associated with reduced diastolic and systolic left ventricular deformation in a healthy control population. These modern quantitative measures should now be implemented in patient cohorts to investigate the role of VAC in cardiovascular disease, and how it may be impacted in an anesthetic setting.

Impaired myocardial calcium handling in people with type 2 diabetes: an in vivo manganese-enhanced magnetic resonance imaging study

Abstract Background There is a high prevalence of subclinical cardiac dysfunction in people with type 2 diabetes (T2D) which is associated with subsequent development of heart failure. Dysregulated myocardial calcium handling has been demonstrated in animal models of T2D and may be a key mechanism driving the development of heart failure. Manganese-enhanced cardiac magnetic resonance imaging (MEMRI) provides a unique method to assess in vivo myocardial calcium handling. Purpose To determine whether myocardial calcium handling is perturbed in people with T2D with no history of cardiovascular disease. We hypothesised that myocardial manganese uptake would be reduced in people with T2D compared with healthy volunteers. Methods Cross-sectional case-control study, adults with (n=20) and without (n=9) T2D underwent both gadolinium-enhanced MRI and MEMRI. Standard gadolinium-enhanced MRI was used to assess cardiac structure, function and tissue characteristics. MEMRI scans were performed within two weeks of the initial scan. Native T1 maps were obtained in the mid-short axis slice position using a Modified Look-Locker Inversion recovery sequence. An intravenous infusion of manganese dipyridoxyl diphosphate (5 μmol/kg (0.1 mL/kg) at 1 mL/min) was administered and T1 maps at the same location were repetitively acquired every 2.5 min for 30 min. Regions of interest were drawn in the inferoseptal segment and blood pool for all T1 maps from 0 to 30 min by a single observer. The primary outcome was the rate of manganese uptake which was assessed by Patlak modelling as a measure of myocardial calcium handling. Manganese uptake constants were compared using analysis of co-variance, with age, sex and body mass index as co-variates. Results Subjects with T2D were older (62±7 vs. 57±5 years, p=0.046) but body mass index (29.0±4.5 vs. 26.2±3.4 kg/m2, p=0.106), systolic (135±16 vs. 134±17 mmHg, p=0.809) and diastolic (81±10 vs. 83±9 mmHg, p=0.736) blood pressures were similar. Compared to control subjects, participants with T2D had normal systolic function but more concentric left ventricular remodelling (mass/volume ratio 0.90±0.14 vs. 0.71±0.06 g/mL, p&amp;lt;0.001) and reduced peak early diastolic strain rate (0.64±0.17 vs. 0.91±0.26 s–1, p=0.002). Myocardial manganese uptake was substantially reduced in people with T2D compared with controls (6.51±1.46 vs. 8.45±2.52 ml/100 g of tissue/min, p=0.003) (Figure 1). Conclusions For the first time, we have demonstrated in vivo that despite no history of cardiovascular disease and normal systolic function, patients with T2D have marked impairment of myocardial calcium handling. This has potential major implications for the pathogenesis, diagnosis and treatment of diabetic cardiomyopathy. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): British Heart Foundation and National Institute for Health Research

Epicardial adipose tissue volume and density is associated with cardiac dysfunction in asymptomatic people with type 2 diabetes

Abstract Background Type 2 diabetes (T2D) is associated with several perturbations of cardiac structure and function, which are precursors to the development of heart failure. Excess accumulation of epicardial adipose tissue (EAT) may contribute to cardiac dysfunction in individuals with T2D. Lipid-laden adipocytes have a lower computed tomography (CT) attenuation and can be readily identified using cardiac CT. Using a multimodality cardiac imaging approach, we aimed to assess the association of total and low attenuation EAT volume with early markers of cardiac dysfunction in people with T2D. Methods Prospective case-control study, in which participants with and without T2D and no known cardiovascular disease, underwent comprehensive cardiovascular phenotyping including multiparametric cardiac magnetic resonance imaging (MRI), echocardiography and non-contrast cardiac CT. EAT volume was measured from CT scans using a deep learning method and volumes indexed to body surface area. Total EAT was defined according to CT adipose tissue attenuation range of −30 to −190 Hounsfield Units (HU) and low attenuation EAT as −90 to −190 HU. Left ventricular (LV) volumes, function and strain measurements were derived from cardiac MRI images and diastolic function also assessed using echocardiography. Markers of early cardiac dysfunction in those with T2D were assessed for associations with EAT in T2D participants using multivariable linear regression analyses. Results Two hundred and fifty-four participants were included: demographic, anthropometric and imaging variables are displayed in Table 1. Subjects with T2D had increased LV concentric remodelling (higher LV mass/volume ratio), diastolic dysfunction (lower circumferential peak early diastolic strain rate (PEDSR) and average E/e') and reduced systolic function (global longitudinal strain, GLS) compared with controls. Total and low attenuation indexed EAT volumes were 1.6-fold and 2-fold higher, respectively, in participants with T2D compared to controls (Figure 1). After adjustment for age, gender, ethnicity, insulin resistance, systolic blood pressure and waist/hip ratio, total and low attenuation indexed EAT volume were independently associated with LV mass/volume ratio (total indexed EAT volume: β=0.002, p=0.02, low attenuation indexed EAT volume: β=0.004, p=0.01) and LV GLS (total indexed EAT volume: β=−0.02, p&amp;lt;0.01, low attenuation indexed EAT volume: β=−0.04, p=0.02) in subjects with T2D, but not indices of diastolic dysfunction. Conclusion Total and low attenuation EAT volumes are higher in individuals with T2D, and excess EAT accumulation is independently associated with early markers of cardiac dysfunction. Further studies into the underlying mechanisms of this interaction may facilitate the development of interventions targeted at EAT, which could mitigate against the development of heart failure in people with T2D. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): United Kingdom National Institute for Health Research

Cardiovascular structure and function assessed by MRI in healthy South Asians compared to White Europeans: a UK Biobank study

Abstract Background There is limited data on ethnic specific comparisons for measures of cardiovascular structure and function in healthy cohorts. Echocardiographic data indicate South Asian's (SAs) have smaller mass and evidence of more concentric remodelling compared to White Europeans (WEs). Furthermore, there is no data published for strain or strain rates. Purpose To compare Cardiac Magnetic Resonance (CMR) derived measures of structure and function between age and sex matched healthy SAs and WEs from the UK biobank cohort. Methods South Asian and WE participants from the UK Biobank who underwent CMR imaging were included. Individuals with a history of cardiovascular disease, hypertension, obesity (BMI ≥30 kg/m2 in WEs and ≥27 kg/m2 in SAs) and diabetes were excluded. Ethnic groups were matched according to age and sex at recruitment. Cine images (bSSFP) were analysed blinded to participant details using commercially available software. Left ventricular (LV) mass, LV volumes, global longitudinal and circumferential systolic strain (GLS and GCS), together with peak early diastolic strain rates (PEDSR), were obtained. Data distributions were assessed and T-Test or Man Whitney U conducted as appropriate. Results Datasets from the UK biobank were screened (n=45000). After applying exclusion criteria, 111 pairs of matched SAs and WEs were available for analysis (n=69 male and n=42 female matched pairs). Mean age of the entire cohort was 58±8 years. Data has been corrected according to body surface area (BSA),(males: WE 2.0±0.1 vs SA 1.8±0.1 m2, p≤0.001; females: WE 1.7±0.2 vs SA 1.6±0.1 m2, p≤0.001). There was no difference in heart rate (males: WE 64.5±9.3 vs SA 65.8±9.6 bpm, p=0.113; females: WE 66.2±7.8 vs SA 69.5±10.3 bpm, p=0.125). Results by sex and ethnicity are displayed in table 1. In males there was no difference in ejection fraction (EF) or indexed LV end diastolic volume (LVEDV). However indexed mass and mass/volume ratio were significantly lower in SAs, and GLS but not GCS was significantly higher than in SAs. Longitudinal PEDSR were significantly higher in SAs than in WE. By contrast, SA females had significantly lower EF with no difference in indexed LVEDV compared to WE females. However, as seen with the males SA females had significantly lower indexed LV mass and mass/volume ratio compared to WE females. Finally, both GLS and GCS were significantly higher in SAs compared to WE females, whereas there was no difference in longitudinal PEDSR. Conclusion Substantial differences in cardiovascular structure and function exist between SA and WE ethnic groups, in both men and women. Contrary to previous echocardiographic studies, LV volumes were similar between ethnicities and SA have less, not increased, concentric remodelling than WE. These findings highlight the need for ethnicity and sex-specific healthy reference ranges derived from CMR. Funding Acknowledgement Type of funding sources: None.

Evaluation of Left Ventricular Function in Patients with Coronary Slow Flow by the Dobutamine Stress Echocardiography.

The study aims to assess the changes to left ventricular (LV) function of patients with the coronary slow flow (CSF) in response to stress induced by low dose dobutamine. Based on coronary angiography (CAG) results, a total of 186 patients undergoing CAG for chest pain and suspected coronary heart disease were assigned to the CSF group (n = 142) and control group (n = 44). Patients in the CSF group underwent two-dimensional speckle-tracking echocardiography (STE) during the dobutamine stress test to evaluate LV systolic and diastolic functions. At rest, there were no statistically significant differences in LV peak systolic longitudinal strain (LS), LV peak systolic longitudinal strain rate (LSRs), LV peak early diastolic longitudinal strain rate (LSRed), LV circumferential strain (CS), or LV circumferential strain rate (CSRed) between the CSF and control groups. In the CSF group, LS and LSRs first increased as the infusion rate was increased to 10 μg/kg/min (all, p < 0.05), before decreasing at infusion rates of 15 and 20 μg/kg/min (all, p < 0.05). CS and CSRed increased in the CSF group at infusion rates of 5, 10, and 15 μg/kg/min, (all, p < 0.05), but decreased significantly at 20 μg/kg/min (all, p < 0.05). At rest, LV systolic and diastolic functions were comparable between the CSF and control groups. However, when blood flow to the heart muscles was insufficient, LSRed decreased first, followed by LS. In terms of sensitivity to myocardial ischemia, LS is a better strain parameter than CS.

Remission of type 2 diabetes and improved diastolic function by combining structured exercise with meal replacement and food reintroduction among young adults: the RESET for REMISSION randomised controlled trial protocol

IntroductionType 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime risk of cardiovascular disease. Diastolic dysfunction is its earliest cardiac manifestation. Low energy diets incorporating...

Real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging in the evaluation of left atrial function in patients with triple-vessel coronary artery disease without myocardial infarction.

To evaluate left atrial function in patients with triple-vessel disease (TVD) without myocardial infarction by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STE). Sixty patients with coronary artery disease (CAD) without myocardial infarction were classified into two groups in accordance with the coronary angiography results: group B (all triple-vessel stenosis ≥ 50% and < 75%) and group C (all triple-vessel stenosis ≥ 75%). Thirty healthy individuals were selected as group A. LA volume related parameters including left atrial maximum volume index (LAVImax), LA passive and active ejection fraction (LAPEF, LAAEF) and LA total ejection fraction (LATEF) were measured by RT-3DE. The global peak atrial longitudinal systolic strain (LASRs), early and late diastolic LA strain (LASRe and LASRa) rates were measured by 2D-STE. We found statistically significant differences between 2D-STE and RT-3DE related parameters of these three groups. Furthermore, in groups B and C, N-terminal fragment brain natriuretic peptides (NT-pro-BNP) and left ventricular end-diastolic pressure (LVEDP) were found to be significantly correlated with LASRs and LASRa. And NT-pro-BNP had a moderate correlation with LVEDP. 2D-STE and RT-3DE can assess the LA function in patients with TVD without myocardial infarction. And LA strain values may provide additional information for predicting increased LVEDP and NT-pro-BNP.

Size of transcatheter patent foramen ovale closure device affects atrial function

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Interatrial communications such as patent foramen ovale (PFO) are common abnormalities. For most people they are accidental findings; however, in some cases lead to paradoxical embolization. Transcatheter closure of PFO in patients with cryptogenic stroke is associated with reduced rates of recurrent stroke. The size of closure device is established according to anatomical features of atria. However, the impact of atrial septal closure on atrial remodelling is less known. Methods We prospectively enrolled 108 patients with cryptogenic ischemic stroke and PFO eligible for transcatheter PFO closure. Thirty-three patients had 6 month clinical follow-up examinations (mean age 46 ± 13 years, 34% females). National Institute of Health Stroke Score (NIHSS) was calculated as marker of clinical severity of the index stroke. Presence of any shunt, atrial volumes and functional parameters were evaluated including left atrial (LA) reservoir, conduit and contraction function before PFO closure and 6 months after procedure. Beyond conventional transthoracic echocardiography (Philips Epiq CVx Ultrasound), two dimensional speckle tracking method was used to assess body surface area-indexed LA maximal volume (LAVmaxi), LA minimal volume (LAVmini), LA volume before left atrial contraction (LApreAi), LA ejection fraction (LAEF), LA reservoir strain (LASres), LA conduit strain (LAScond), LA contraction strain (LAScontr), LA peak systolic strain rates (LASRs), LA peak early diastolic strain rate (LASRe) and LA peak late diastolic strain rate (LASRa) using dedicated software on separate workstation (Cardiac Performance; TomTec Imaging, Unterschleissheim, Germany). Zero reference point was set at the onset of QRS wave. Results The index stroke was modest and non-disabling, with an NIHSS 3.2 ± 2.6. Baseline LA volumes and functions were in normal range (LAVi 27.4 ± 10.3 ml/m2; LASres 46.85 ± 19.6 %; LAScond 25.6 ± 15.4%; LAScontr 21.35 ± 12.15 %; LASRa -1.9 ± 0.77 s-1). The 6 month clinical follow-up examinations revealed no significant differences (all p values &amp;gt;0.05) in atrial volumes and strain parameters. However, LASRa was significantly lower (-1.4 ± 0.82 s-1, p = 0.01). Closure device size (25mm vs 30mm) and smoking proved to be independent predictors of 25% decrease of LASRa (p = 0.06, p = 0.03, respectively). No new cerebral ischaemic events, aortic erosions, atrial fibrillation, significant residual shunts or device thrombosis and displacement were recorded during the follow-up. Conclusion PFO-associated strokes in young and middle-aged individuals are mainly non-disabling. Transcatheter interatrial closure was safe and effective in our study without promoting unfavourable anatomical atrial remodelling during short-term follow-up, however, it may affect active atrial contraction. Smoking and larger devices may decrease the rate of atrial deformation at short-term follow-up. Shorter PFO occluders are preferable in case of anatomical applicability.

Segmental speckle tracking strain and strain rate in stable coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Northern Norway Regional Health Authority Background It is known that patients with coronary artery disease (CAD) display reduced global and regional strain and strain rate (SR). However, knowledge about segmental strain and SR in stable CAD patients is still limited. Purpose The purpose of this study was to explore whether segmental strain and SR analyses are different between patients with normal and stenotic coronary arteries among individuals with chest-pain. Methods A total of 510 patients with chest pain, referred to coronary computed tomography angiography (CCTA) and additional 102 patients with myocardial infarction (MI) were prospectively included. All patients underwent transthoracic echocardiography (TTE) with strain-rate analysis. All patients with CCTA-suspected CAD subsequently underwent invasive CAG, as well as in all MI patients. Global longitudinal strain (GLS) and average for segmental peak longitudinal strain during systole (PLS), peak systolic strain rate (PLSR S), peak early diastolic strain rate (PLSR E), post systolic shortening (PSS) measurements were analysed. Further, different cut-off values for reduced strain and SR were used to define the percentage of functionally reduced segments between patients with normal CAD (no CAD), MI, and stable CAD patients who were further treated by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Results As shown in the table 1, all average segmental strain and SR parameters differed significantly between no CAD and MI groups. However, only PLSR E showed significant differences between no CAD and PCI groups . PLSR E, PLS and GLS showed significant differences between no CAD and CABG groups. The percentage of reduced segmental strain and SR showed similar results. Regarding the percentage of pathological segments at different cut-off values, PLSR E showed the most significant difference between these four groups at a cut-off value 1.5 (p &amp;lt; 0.001) (Figure 1). Conclusion Patients with MI or CABG display clearly reduced segmental strain and SR values. However, in patients with chest-pain, segmental PLSR E seemed to be the only indicator revealing subtle differences between patients with no CAD or those assigned to PCI. The diagnostic value of PLSR E needs to be investigated in further studies. Abstract Table 1 Abstract Figure 1

Reproducibility and its confounders of CMR feature tracking myocardial strain analysis in patients with suspected myocarditis

ObjectivesCardiovascular magnetic resonance feature tracking (CMR-FT) is an emerging technique for assessing myocardial strain with valuable diagnostic and prognostic potential. However, the reproducibility of biventricular CMR-FT analysis in a large cardiovascular population has not been assessed. Also, evidence of confounders impacting reader reproducibility for CMR-FT in patients is unknown and currently limits the clinical implementation of this technique.MethodsFrom a dual-center database of patients referred to CMR for suspected myocarditis, 125 patients were randomly selected to undergo biventricular CMR-FT analysis for 2-dimensional systolic and diastolic measures, with additional 3-dimensional analysis for the left ventricle. All image analysis was replicated by a single reader and by a second reader for intra- and inter-reader analysis (Circle Cardiovascular Imaging). Reliability was tested with intraclass correlation (ICC) tests, and the impact of imaging confounders on agreement was assessed through multivariable analysis.ResultsLeft and right ventricular ejection fractions were reduced in 34% and 37% of the patients, respectively. Good to excellent reliability was shown for 2D (all ICC > 0.85) and 3D (all ICC > 0.70) peak strain and early diastolic strain rate for both ventricles in longitudinal orientation as well as circumferential orientations for the left ventricle. An increased slice number improved agreement while the presence of pericardial effusion compromised diastolic strain rate agreement, and arrhythmia compromised right ventricular agreement.ConclusionIn a large clinical cohort, we could show CMR-FT yields excellent inter-reader and intra-reader reproducibility. Multi-parametric CMR-FT of the right and left ventricles appears to be a robust tool in cardiovascular patients referred to CMR.Clinical trial registration.ClinicalTrials.gov Identifier: NCT03470571, NCT04774549.Key Points• Cardiovascular magnetic resonance feature tracking (CMR-FT) is an emerging technique to measure myocardial strain in cardiovascular patients referred for CMR; however, the evaluation of its reproducibility in a large cohort has not yet been performed.• In a large clinical cohort, CMR-FT yields excellent inter-reader and intra-reader reproducibility for both left and right ventricular systolic and diastolic parameters.• Arrhythmia and pericardial effusion compromise agreement of select FT parameters, but poor ejection fraction does not.

Abstract 9063: Global Longitudinal Strain and Longitudinal Early Diastolic Strain Rate May Identify Those Williams Syndrome Patients at Risk of Cardiomyopathy Development

Introduction: Williams syndrome (WS) is a rare disease caused by a chromosomal microdeletion at 7q11.23 resulting in elastin insufficiency and vascular disease, most commonly supravalvar aortic stenosis. Previous studies show WS patients are at risk for cardiomyopathy, but, to date, no markers predict such disease. This study was designed to test the hypothesis that WS left ventricular (LV) longitudinal strain and longitudinal early diastolic strain rate differ significantly from controls and may identify those at risk of cardiomyopathy development. Methods: Echocardiograms were performed in 43 WS subjects and equal numbers of sex, age and BSA-matched controls enrolled in a prospective cross-sectional NIH study of end organ WS disease (ClinicalTrials.gov Identifier: NCT0284044). Myocardial strain analysis was performed using TomTec software by two independent observers to determine global longitudinal peak systolic strain (GLS) and early diastolic peak strain rate (DSR) in the apical 4 chamber view (A4C). Mann Whitney test was used for all comparisons. Results: WS subject mean cohort ages (years) were: group A: 7±2, n=12; group B: 13±2, n=11; group C: 26±2, n=10; group D: 48±9, n=10, and matched control mean age and sample size were not different. All subjects had ejection fraction&gt;55%. Groups C and D WS subjects showed significantly diminished median GLS (%) compared to controls (Fig 1A): C: -20.6 vs. -24.6, P&lt;0.04; D: -22.4 vs. -25.5, P&lt;0.04. DSR (1/s) was significantly decreased in all WS age groups (P&lt;0.02) and decreased with age compared to controls (Fig 1B): 1.25 vs. 2.2 to 0.9 vs. 1.0. Conclusion: WS subjects demonstrate decreased DSR indicating diminished diastolic function from childhood. GLS differences appeared in adulthood, possibly indicating early systolic impairment. This data suggests GLS and DSR may be useful in targeting therapies towards those WS patients at greatest risk of cardiomyopathy development.

Lifestyle intervention improves Left atrial strain in type 2 diabetes: results from the DIASTOLIC randomised trial

Abstract Introduction Left atrial (LA) strain has been shown to be an independent predictor of cardiovascular events in many conditions and superior to conventional measures of LA function (LA volumes and emptying fraction). The effects of low-energy diet or exercise on cardiovascular function in younger adults with type 2 diabetes (DIASTOLIC) study has previously demonstrated an improvement in left ventricle peak early diastolic strain rate in response to aerobic exercise in patients with type-2 diabetes (T2D). However, the effect of lifestyle intervention on LA function, assessed by cardiac magnetic resonance (CMR) imaging, is unknown. Methods The DIASTOLIC study was a prospective, randomised, open-label, blind endpoint trial, that randomised 90 obese participants with T2D (aged 18–65 years) to a 12-week intervention of: (i) routine care, (ii) aerobic exercise training, or (iii) low energy (≈810kcal/day) meal replacement plan (MRP). CMR was performed at baseline and week-12. Images were analysed using Medis v3.1. LA strain (LAS) was assessed using Feature Tracking (QStrain v2.0), corresponding to LA reservoir (LAS-r), conduit (LAS-cd), and booster pump (LAS-bp) using 4- and 2-chamber standard steady-state free precession cine images, and average values calculated. LA emptying fraction (LAEF) was calculated using biplane area-length method (QMass v8.1) for total, passive and active EF. Results 73 participants with T2D completed the trial and had analysable LA images (28 routine care, 22 exercise and 23 MRP). There was no significant change in CMR measured standard LA volumetric function (LAV/LAEF) and echocardiogram measured LV filling pressures (E/e') in any groups. The routine care arm showed no significant change in body mass index (BMI) or LAS (see Table). In the MRP group, there were significant reductions in BMI (4.8 kg/m2), mean systolic blood pressure (SBP) (13mmHg), and a significant increase in LAS-r and LAS-bp (29.9±7.0 to 32.3±7.0,p=0.036 and 14.6±5.3 to 17.2±3.7,p=0.034). The exercise arm showed a small reduction in BMI (0.8kg/m2), with no significant change in BP or LAS. Conclusion There was significant improvement in LAS post-lifestyle intervention in young adults with T2D, despite no change in volumetric measurements. MRP led to weight loss and improved SBP, with associated improved LA filling and contraction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health Research (NIHR) a career development fellowship.