Longitudinal Peak Systolic Strain Research Articles

Biomarkers of atrial fibrillation-related pathways and left atrial structure and function in an overweight and obese population.

Exploring longitudinal associations of blood biomarkers with left atrial (LA) structure and function can enhance our understanding of atrial fibrillation (AF) etiopathogenesis. We studied 532 participants of the PREDIMED-Plus trial, a multicenter randomized trial in overweight and obese adults with metabolic syndrome. At baseline, 3 and 5 years after randomization, participants underwent transthoracic echocardiography and provided blood for serum biomarker measurements [propeptide of procollagen type I (PICP), high-sensitivity (hs) troponin T (hsTnT), hs C-reactive protein (hsCRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)]. Outcomes of interest included LA peak systolic longitudinal strain (LA PSLS), LA volume index (LAVi), LA function index (LAFi), and LA stiffness index (LASi). We performed cross-sectional and longitudinal analyses to evaluate relationships between log-transformed biomarkers and echocardiographic measurements using multiple linear regression and mixed models. The participants in this analysis had a mean age of 65.0 (SD 4.8) years, and 40% were females. At baseline, increased NT-proBNP and hsTnT were associated with larger LAVi and worse LA function as measured by the LAFi, LASi, and LA PSLS. Longitudinally, higher NT-proBNP, but not higher hsTnT, was associated with increased LAVi and worsening LA function. Over 5 years, 1 unit increase in log(NT-proBNP) was associated with steeper decline in LA PSLS (-0.19%, 95% CI -0.35%, -0.02%) and greater increase in LAVi (0.28 mL/m2, 95% CI 0.10, 0.45) each year. PICP, hsCRP, and 3-NT did not show consistently significant associations with LA outcomes at baseline and through 5 years. In an overweight and obese population, higher NT-proBNP was associated with LA volume enlargement and worsening LA function over 5 years. The implications of these findings for the prevention and prediction of AF warrant further investigation.

Association of Anthropometric Indices With Midlife Cardiovascular Risk in Young Individuals Without Obesity and Traditional Risk Factors.

The aim of this study was to assess how early-adulthood body mass index (BMI) and waist circumference (WC) relate to long-term cardiovascular structure, function, and prognosis in individuals without obesity and with low cardiovascular risk factor (CVRF) burden. A total of 2024 participants aged 18 to 30 from the CARDIA (Coronary Artery Risk Development in Young Adults) study, without obesity and with low CVRFs defined as the absence of cardiovascular disease (CVD), diabetes, hypertension, current smoking, and dyslipidemia were included. A CVRF-optimal subgroup was also defined, with blood pressure<120/80 mm Hg, fasting glucose <100 mg/dL, total cholesterol <200, low-density lipoprotein cholesterol <130, and women with high-density lipoprotein cholesterol ≥50 mg/dL. Coronary artery calcification, carotid intima-media thickness, left ventricular mass, left ventricular ejection fraction, longitudinal peak systolic strain, and diastolic function were assessed in midlife. Cox regression was used to calculate hazard ratios of BMI and WC for all-cause death and CVD events. Logistic regression was used to estimate odds ratios for subclinical CVD. Over 33.9 years (median follow-up), 5.2% (n=105) died, and 2.6% (n=52) had CVD events. Each 1-SD BMI increase was associated with 27% (95% CI, 1.10-1.47), 24% (1.08-1.43), 42% (1.20-1.68), 28% (1.05-1.57), 51% (1.20-1.90), and 49% (1.10-2.02) higher odds of coronary artery calcification presence, increased carotid intima-media thickness, left ventricular hypertrophy, reduced left ventricular ejection fraction, low longitudinal peak systolic strain, and diastolic dysfunction, respectively, in the CVRF-low group. Generally, similar associations were found for WC and in the CVRF-optimal subgroup. No significant associations between BMI and WC with CVD and death were found. Elevations in BMI and WC among young low-risk individuals, even within the nonobesity range, are associated with midlife cardiovascular health.

Left atrial myocardial strain, assessed by the method of speckle-tracking echocardiography, as a marker of fibrosis in patients with ischemic stroke

Introduction. Cardioembolic stroke (CE) is one of the main etiopathogenetic subtypes of ischemic stroke and accounts for approximately 17% of all patients with ischemic stroke. Currently, there is a search for widely accessible radiological diagnostic methods that allow for the accurate diagnosis of left atrial (LA) dysfunction. Among these methods is transthoracic strain echocardiography (EchoCG), which provides additional information about the degree of deformation and change in shape of the LA during the cardiac cycle. To date, the association between strain EchoCG parameters and the severity of fibrotic changes in the LA among patients with CE remains unstudied.Objective. To evaluate the relationship between myocardial deformation parameters of the left atrium and the degree of fibrosis in patients with CE, as well as the impact of LA myocardial deformation changes on the prognosis of patients with CE.Materials and Methods. A prospective cross-sectional study included 132 patients who underwent evaluation and treatment in the Department of Emergency Neurology at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2020 to 2022. Group 1 consisted of 12 patients who died during hospitalization, while Group 2 comprised 120 patients who were discharged from the department after receiving treatment.Results. Deceased patients, compared to survivors, were characterized by the presence of LA myocardial remodeling. Statistically significant differences in LA myocardial deformation parameters were found between the study groups. Correlation analysis revealed statistically significant associations between LA myocardial deformation parameters and the severity of fibrotic changes. In the multifactorial logistic regression model, significant effects on the prognosis of patients were observed for LA strain peak systolic circumferential strain rate (LA-Scs) and LA strain peak systolic longitudinal strain rate (LA-Sls), with each 1% increase in the parameter associated with a 1.128-fold and 1.075-fold increase in the odds of a lethal outcome, respectively (OR: 1.128, 95% CI: 1.021–1.25, p = 0.017, and OR: 1.075, 95% CI: 1.009–1.15, p = 0.025).Conclusions. The conducted study established a strong correlation between LA myocardial deformation and LA fibrosis and the degree of fibrosis in the LA. LA myocardial deformation parameters can be used in risk stratification for the development of a lethal outcome in patients with CE.

Assessment of subclinical LV myocardial dysfunction in T2DM patients with diabetic peripheral neuropathy: a cardiovascular magnetic resonance study

BackgroundDiabetic peripheral neuropathy (DPN) is the most prevalent complication of diabetes, and has been demonstrated to be independently associated with cardiovascular events and mortality. This aim of this study was to investigate the subclinical left ventricular (LV) myocardial dysfunction in type 2 diabetes mellitus (T2DM) patients with and without DPN.MethodsOne hundred and thirty T2DM patients without DPN, 61 patients with DPN and 65 age and sex-matched controls who underwent cardiovascular magnetic resonance (CMR) imaging were included, all subjects had no symptoms of heart failure and LV ejection fraction ≥ 50%. LV myocardial non-infarct late gadolinium enhancement (LGE) was determined. LV global strains, including radial, circumferential and longitudinal peak strain (PS) and peak systolic and diastolic strain rates (PSSR and PDSR, respectively), were evaluated using CMR feature tracking and compared among the three groups. Multivariable linear regression analyses were performed to determine the independent factors of reduced LV global myocardial strains in T2DM patients.ResultsThe prevalence of non-infarct LGE was higher in patients with DPN than those without DPN (37.7% vs. 19.2%, p = 0.008). The LV radial and longitudinal PS (radial: 36.60 ± 7.24% vs. 33.57 ± 7.30% vs. 30.72 ± 8.68%; longitudinal: − 15.03 ± 2.52% vs. − 13.39 ± 2.48% vs. − 11.89 ± 3.02%), as well as longitudinal PDSR [0.89 (0.76, 1.05) 1/s vs. 0.80 (0.71, 0.93) 1/s vs. 0.77 (0.63, 0.87) 1/s] were decreased significantly from controls through T2DM patients without DPN to patients with DPN (all p < 0.001). LV radial and circumferential PDSR, as well as circumferential PS were reduced in both patient groups (all p < 0.05), but were not different between the two groups (all p > 0.05). Radial and longitudinal PSSR were decreased in patients with DPN (p = 0.006 and 0.003, respectively) but preserved in those without DPN (all p > 0.05). Multivariable linear regression analyses adjusting for confounders demonstrated that DPN was independently associated with LV radial and longitudinal PS (β = − 3.025 and 1.187, p = 0.014 and 0.003, respectively) and PDSR (β = 0.283 and − 0.086, p = 0.016 and 0.001, respectively), as well as radial PSSR (β = − 0.266, p = 0.007).ConclusionsThere was more severe subclinical LV dysfunction in T2DM patients complicated with DPN than those without DPN, suggesting further prospective study with more active intervention in this cohort of patients.

Left ventricular function assessment in Kawasaki disease by two-dimensional global longitudinal systolic strain with automated function imaging.

Kawasaki disease is an acute febrile vasculitis of childhood mainly affecting children under 4 years of age. In the acute stage of the disease, heart function decreases and gradually returns to normal after treatment. However, subendocardial involvement may persist, which cannot be assessed by M-mode echocardiography. Strain echocardiography is a recently developed technique to assess subendocardial involvement of myocardial deformation. We aimed to study the stratified strain of left ventricular function in a Kawasaki patient at least 6 months after the acute stage of the disease with special conditions for entering the study using two-dimensional speckle-tracking imaging. Between September 2020 and October 2022, 27 healthy children and 27 children with a history of Kawasaki disease more than 6 months ago were evaluated using two-dimensional global longitudinal peak systolic strain with automated function imaging technology. The mean age of patients was 5.6 years. With M-mode echocardiography, ejection fraction of each group was in the normal range. Mean (± standard deviation) global longitudinal peak strain in four-chamber view of girls with Kawasaki disease was - 23.74 ± 2.77, and that in boys with Kawasaki disease was - 20.93 ± 2.06 (P value = 0.008). GLPS (global longitudinal peak strain) was compared as an overall average and as in a separate segment, which showed significant difference in two comparisons. In our study, a decrease in the function of some cardiac segments is reported. Global longitudinal peak strain in four-chamber view was significantly lower in boys. Comparing different segments, a difference in global left ventricular long-axis strain was found between the two groups. On the other hand, there was a major difference between the two groups in the basal inferolateral, basal anterolateral, and mid-inferolateral, which receives blood from Left Circumflex artery. Using stain echocardiography to detect continued subendocardial involvement in asymptomatic children with a history of Kawasaki disease for a better understanding of the condition, effective management and follow-up is recommended.

Impact of Type 2 Diabetes Mellitus on Left Atrioventricular Coupling and Left Atrial Deformation in Patients with Essential Hypertension: An MRI Feature Tracking Study.

Hypertension (HTN) and type 2 diabetes mellitus (T2DM) are both associated with left ventricular (LV) and left atrial (LA) structural and functional abnormalities; however, the relationship between the left atrium and ventricle in this population is unclear. To identify differences between hypertensive patients with and without T2DM as the basis for further investigation the atrioventricular coupling relationship. Cross-sectional, retrospective study. 89 hypertensive patients without T2DM [HTN (T2DM-)] (age: 58.4 +/- 11.9 years, 48 male), 62 hypertensive patients with T2DM [HTN (T2DM+)] (age: 58.5 +/- 9.1 years, 32 male) and 70 matched controls (age: 55.0 +/- 9.6 years, 37 male). 2D balanced steady-state free precession cine sequence at 3.0 T. LA reservoir, conduit, and booster strain (εs, εe, and εa) and strain rate (SRs, SRe, and SRa), LV radial, circumferential and longitudinal peak strain (PS) and peak systolic strain rate and peak diastolic strain rate (PSSR and PDSR) were derived from LA and LV cine images and compared between groups. Chi-square or Fisher's exact test, one-way analysis of variance, analysis of covariance, Pearson's correlation, multivariable linear regression analysis, and intraclass correlation coefficient. A P value <0.05 was considered significant. Compared with controls, εs, εe, SRe and PS-longitudinal, PDSR-radial, and PDSR-longitudinal were significantly lower in HTN (T2DM-) group, and they were even lower in HTN (T2DM+) group than in both controls and HTN (T2DM-) group. SRs, εa, SRa, as well as PS-radial, PS-circumferential, PSSR-radial, and PSSR-circumferential were significantly lower in HTN (T2DM+) compared with controls. Multivariable regression analyses demonstrated that: T2DM and PS-circumferential and PS-longitudinal (β = -4.026, -0.486, and -0.670, respectively) were significantly associated with εs; T2DM and PDSR-radial and PDSR-circumferential were significantly associated with εe (β = -3.406, -3.352, and -6.290, respectively); T2DM and PDSR-radial were significantly associated with SRe (β = 0.371 and 0.270, respectively); T2DM and PDSR-longitudinal were significantly associated with εa (β = -1.831 and 5.215, respectively); and PDSR-longitudinal was significantly associated with SRa (β = 1.07). In hypertensive patients, there was severer LA dysfunction in those with coexisting T2DM, which may be associated with more severe LV dysfunction and suggests adverse atrioventricular coupling. 3. Stage 3.

Abstract P110: Biomarkers of Atrial Fibrillation-Related Pathways and Left Atrial Structure and Function in an Overweight and Obese Population

Background: Blood biomarkers of atrial fibrillation (AF)-related pathways can characterize the atrial substrate promoting the development of AF. Exploring associations of blood biomarkers with left atrial (LA) structure and function could enhance our understanding of AF etiopathogenesis and inform AF prevention strategies. Methods: We studied 532 participants of the PREDIMED-Plus trial, a multicenter randomized trial in overweight and obese adults (55-75 years) with the metabolic syndrome in Spain. The trial objective was to test a lifestyle intervention for primary prevention of cardiovascular disease. At baseline, 3 and 5 years after randomization, these participants underwent transthoracic echocardiography and provided blood for serum biomarker measurements [propeptide of procollagen type I (PICP), high-sensitivity (hs) troponin T (hsTnT), hs C-reactive protein (CRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)]. Outcomes of interest included LA peak systolic longitudinal strain (LA PSLS), LA volume index (LAVi), LA function index (LAFi), and LA stiffness index (LASi). We performed cross-sectional and longitudinal analyses to evaluate relationships between log-transformed biomarkers and echocardiographic measurements using multiple linear regression and mixed models: 1) baseline biomarkers and LA outcomes; 2) baseline biomarkers and change in LA outcomes from baseline through year 5; 3) concomitant changes in biomarkers and LA outcomes from baseline to year 5. Results: The participants in this analysis had a mean age of 65 (SD 4.8) years, 40% females, and BMI of 32.2 (SD 3.3) kg/m 2 . At baseline, increased NT-proBNP was associated with worse LAVi (0.78 mL/m 2 , 95% CI 0.04, 1.52), LAFi (-3.61, 95% CI -6.75, -0.46), and LASi (0.02, 95% CI 0.00, 0.04). Higher baseline NT-proBNP was associated with a greater decrease in LA PSLS at year 3 (-0.82%, 95% CI -1.57, -0.06) but not year 5 (-0.01%, 95% CI -0.77, 0.75), and an increase in LASi at years 3 (0.04, 95% CI 0.01, 0.06) and 5 (0.02, 95% CI 0.00, 0.04). Over 5 years, larger elevation in NT-proBNP was associated with more decline in LA PSLS (-0.19%, 95% CI -0.35, -0.02) and more elevation in LAVi (0.28 mL/m 2 , 95% CI 0.10, 0.45) each year. PICP, hsTnT, CRP and 3-NT did not show consistently significant associations with LA outcomes at baseline and through 5 years. Conclusion: In an overweight and obese population, higher NT-proBNP was associated with LA volume enlargement and worsening LA function over 5 years. The implications of these findings for prevention and prediction of AF warrant further investigation.

Two-dimensional speckle tracking echocardiography in fetuses with critical aortic stenosis before and after fetal aortic valvuloplasty.

Critical aortic stenosis (AS) in fetuses may progress to hypoplastic left heart syndrome (HLHS) with need for postnatal single ventricular (SV) palliation. Fetal aortic valvuloplasty (FAV) is performed to achieve postnatal biventricular (BV) circulation. However, the impact of FAV on fetal myocardial function is difficult to measure. Prediction of postnatal circulatory status and, therefore, counseling is challenging. Retrospective study of fetuses with critical AS who underwent FAV. Global Longitudinal Peak Systolic Strain (GLPSS) of the left ventricle (LV) and right ventricle (RV) were retrospectively analyzed before and after intervention. Fisher's Exact Test and Mann-Whitney-U Test were used for univariant statistical analysis. 23 fetuses with critical AS were included. After intervention fetuses demonstrated more negative LV-GLPSS mean values post- vs. pre-intervention (-5.36% vs. -1.57%; p < 0.05). RV-GLPSS was decreased in all fetuses, there was no peri-interventional change. 20 fetuses were born alive. Postnatally, 10 had BV and 10 SV circulation. Improved post-interventional LV-GLPSS strain values correlated with BV outcome (p < 0.05). Pre-interventional continuous LV-GLPSS values correlated with postnatal SV vs. BV outcome (p < 0.05). In some fetuses, LV myocardial function assessed by speckle tracking echocardiography (STE) improves after FAV. Improved post-interventional LV-GLPSS correlates with biventricular postnatal outcome. Furthermore, pre-interventional LV- and RV-GLPSS correlate with postnatal outcome. Further studies are needed to asses, if pre-interventional STE parameters might predict which fetuses will benefit from FAV with postnatal BV circulation.

Relationship Between Obesity and Global Longitudinal Strain in the Pediatric Single Ventricle Fontan Population Across Ventricular Morphologies.

Obesity is associated with diminished myocardial function as measured by strain echocardiography in children and young adults with normal cardiac anatomy. Data are lacking about the effect of obesity on myocardial strain in patients with a single ventricle. In this study, the relationship between body mass index (BMI) and single ventricle myocardial strain in the Fontan population was assessed. Thirty-eight abnormal BMI Fontan cases (21 overweight and 17 obese) and 30 normal BMI Fontan controls matched based on single ventricular morphology, age, and sex were included in the study. Ventricular morphology was categorized as single right ventricle, single left ventricle, or biventricular. Single ventricle global longitudinal peak systolic strain (GLS) and other echocardiographic measurements were performed and compared between groups, with a P≤0.05 defined as significant. The abnormal BMI group demonstrated diminished GLS (-15.7±3.6% versus -17.2±3.2%, [P=0.03]) and elevated systolic blood pressure (P=0.04) compared with the normal BMI group. On subgroup analysis of those with single right ventricle morphology, the abnormal BMI group demonstrated diminished GLS compared with controls. There was no significant difference in GLS between the abnormal BMI and control groups in the single left ventricle and biventricular subgroups. Analyzed by ventricular morphology, no other variables were statistically different in the abnormal BMI group including systolic blood pressure. Inter-reader reproducibility for GLS and strain rate were excellent for both measures. Obesity has an adverse relationship with myocardial strain in the young Fontan population, with the most maladaptive response seen in the single right ventricle.

Direct comparison of coronary microvascular obstruction evaluation using CMR feature tracking and layer-specific speckle tracking echocardiography in STEMI patients

PurposeLayer-specific speckle tissue echocardiography (LS-STE) is a unique technique used to assess coronary microvascular obstruction (CMVO) that may offer more information on the myocardial anatomy of patients with ST-elevation myocardial infarction (STEMI). Cardiovascular magnetic resonance feature tracking (CMR-FT) has also been gaining popularity as a way to evaluate CMVO. The aim of the present study was to directly compare CMVO assessment in STEMI patients using CMR-FT and LS-STE.Patients and methodsA total of 105 STEMI patients with LS-STE, CMR-FT, and primary percutaneous coronary intervention (PPCI) were included in the study. Longitudinal peak systolic strain (LS), circumferential peak systolic strain (CS), and radial peak systolic strain (RS) were each used to evaluate CMVO using CMR-FT and LS-STE.ResultsCorrelation coefficients were 0.56, 0.53, and 0.55 for CMR-FT CS vs. endocardial CS, midcardial CS, and epicardial CS comparisons, respectively, and 0.87, 0.51, and 0.32 for CMR-FT LS vs. endocardial LS, midcardial LS, and epicardial LS comparisons, respectively. Bland-Altman analysis revealed strong inter-modality agreement and little bias in endocardial LS, while the absolute of limited of agreement (LOA) value was 2.28 ± 4.48. The absolutes LOA values were 1.26 ± 11.16, -0.02 ± 12.21, and − 1.3 ± 10.27 for endocardial, midcardial, and epicardial respectively. Intraclass correlation coefficient value of 0.87 showed good reliability in endocardial LS, and moderate reliability with values of 0.71, 0.70, and 0.64 in endocardial, midcardial, and epicardial CS, respectively (all p < 0.001).ConclusionsCMR-FT is a viable technique for CMVO evaluation in STEMI patients. Endocardial LS showed good reliability for CMR-FT. STEMI patients can undergo LS-STE to assess the CMVO before PPCI.

Abstract 17975: Improvement in Exercise Capacity After Surgical Septal Myectomy in Obstructive Hypertrophic Cardiomyopathy Patients is Related to Peak Exercise Strain Rate and Mechanical Reserve

Background: Significant improvements in functional capacity are noted after septal myectomy in symptomatic patients with obstructive hypertrophic cardiomyopathy (oHCM). However, the underlying mechanism behind these improvements is unclear. Methods: Conventional and strain echocardiography, at rest and post-exercise, was performed pre-and post-septal myectomy in 59 OHCM patients (42 men; mean age 50±12years). Exercise capacity was expressed as metabolic equivalents (METs) after treadmill exercise testing. Global longitudinal peak systolic strain (S) and stain rate (SR) were measured at rest and peak-exercise. Results: After myectomy, outflow gradient decreased significantly (resting gradient: 69±43 to 13±8mmHg; provoked gradient: 141±50 to 40±21mmHg; both p&lt;0.001) with no significant change in ejection fraction (66±5% to 65±4%, p=NS). METs improved significantly (9.5±3.2 to 10.6±2.9, p=0.001). There was no significant change in S and SR at rest (S: -15.17±2.89% to -15.27±2.75%; SR:-0.95±0.18S-1 to -0.92±0.15S-1, both p=NS) or post-exercise (S: -17.06±3.63% to -16.68±2.79%; SR: -1.45±0.30S-1 to -1.52±0.28S-1, both p=NS). Mechanical reserve (MRES, change in systolic SR with exercise) increased significantly (55±30% to 67±32%, p=0.02). METs correlated significantly with exercise SR and MRES determined pre-myectomy (exercise SR: r=-0.41, p=0.003; MRES: r=0.33, p=0.017) and post-myectomy (exercise SR: r=-0.53, p&lt;0.001; MRES: r=0.51, p&lt;0.001). Improvement in METs was significantly correlated with changes in MRES (r=0.36, p=0.019). Multivariable linear regression confirmed an independent correlation between exercise SR and MRES with METs. Conclusions: Resting and peak exercise myocardial contractility (longitudinal S and SR) do not change significantly after septal myectomy. Post-myectomy MRES improves significantly and exercise capacity post-myectomy correlates significantly with pre- and post-myectomy functional status.

Right and left ventricular cardiac magnetic resonance imaging derived peak systolic strain is abnormal in children with myocarditis.

Cardiac Magnetic resonance (CMR) derived left ventricular longitudinal and circumferential strain is known to be abnormal in myocarditis. CMR strain is a useful additional tool that can identify subclinical myocardial involvement and may help with longitudinal follow-up. Right ventricular strain derived by CMR in children has not been studied. We sought to evaluate CMR derived biventricular strain in children with acute myocarditis. Children with acute myocarditis who underwent CMR between2016-2022 at our center were reviewed, this group included subjects with COVID-19 myocarditis. Children with no evidence of myocarditis served as controls Those with congenital heart disease and technically limited images for CMR strain analysis were excluded from final analysis. Biventricular longitudinal, circumferential, and radial peak systolic strains were derived using circle cvi42®. Data between cases and controls were compared using an independent sample t-test. One-way ANOVA with post hoc analysis was used to compare COVID-19, non-COVID myocarditis and controls. 38 myocarditis and 14 controls met inclusion criteria (mean age14.4 ± 3 years). All CMR derived peak strain values except for RV longitudinal strain were abnormal in myocarditis group. One-way ANOVA revealed that there was a statistically significant difference with abnormal RV and LV strain in COVID-19 myocarditis when compared to non-COVID-19 myocarditis and controls. CMR derived right and left ventricular peak systolic strain using traditionally acquired cine images were abnormal in children with acute myocarditis. All strain measurements were significantly abnormal in children with COVID-19 even when compared to non-COVID myocarditis.

Influencing factors of anthracycline-induced subclinical cardiotoxicity in acute leukemia patients

BackgroundCurrent treatment of acute leukemia is based on anthracycline chemotherapy. Anthracyclines, despite improving patient survival, have serious cardiotoxicity and therefore cardiac monitoring should be a priority. The purpose of this study is to explore the possible early predictors of anthracycline-induced subclinical cardiotoxicity(AISC)in acute leukemia patients.MethodsWe conducted a prospective observational study involving 51 patients with acute leukemia treated with anthracycline. Demographic data, clinical variables, echocardiography variables and biochemical variables were collected at baseline and after 3 cycles of chemotherapy. Patients were divided into the AISC and No-AISC groups according to changes of global longitudinal peak systolic strain. Regression models and receiver operating characteristic curve analysis were used to explore the relationship between the variables and AISC.Result17 of the patients suffered subclinical cardiotoxicity after 3 cycles of anthracycline treatment. Multiple logistic regression analysis showed a significant association of DBil (OR 0.612, 95% CI 0.409–0.916, p = 0.017), TBil (OR 0.841, 95% CI 0.717–0.986, p = 0.033), PLT (OR 1.012, 95% CI 1.002–1.021, p = 0.016) and Glu (OR 1.873, 95% CI 1.009–3.475, p = 0.047) with the development of AISC. After 3 cycles of chemotherapy, there was a significant difference in PLT between the AISC and NO-AISC groups. Moreover, the dynamic changes in PLT from baseline to after 3 cycles of chemotherapy were each statistically significant in the AISC and NO-AISC groups. The combination of PLT and N-terminal pro–B-type natriuretic peptide (NT-proBNP) had the highest area under curves (AUC) for the diagnosis of AISC than PLT and NT-proBNP alone (AUC = 0.713, 95%CI: 0.56–0.87, P = 0.017).ConclusionTotal bilirubin (TBil), direct bilirubin (DBil), platelets (PLT) and blood glucose (Glu) are independent influencing factors for AISC in acute leukemia patients receiving anthracycline therapy. Bilirubin may be a protective factor and PLT may be a contributing factor for AISC. The combination of baseline PLT and baseline NT-proBNP shows satisfactory predictive ability for AISC in acute leukemia cases treated with 3 cycles of chemotherapy.

Territorial Post-Revascularization Remodeling of Chronic Coronary Syndromes: Cardiac Magnetic Resonance Feature Tracking Study.

MRI feature-tracking (MRI-FT) can accurately assess ventricular myocardial deformation and regional function and may be a better predictor of mortality than ejection fraction and infarct extension. However, role of MRI-FT in assessing coronary revascularization is unclear. To assess coronary revascularization effect on territorial left ventricle (LV) function of chronic coronary syndrome (CCS) patients by MRI-FT. Prospective. 50 CCS patients (age: 62.22 ± 8.70 years) scheduled for elective percutaneous coronary intervention (PCI), and 30 healthy controls (age: 35.33 ± 11.57 years). 1.5T with balanced steady-state free precession cine sequence. Global and segmental peak systolic longitudinal, circumferential, and radial myocardial strains were quantified in both patient and healthy control groups by an experienced operator using dedicated software. Patients were studied both pre-PCI and 6-month post-PCI and LV territorial myocardial strain values were calculated by averaging the segmental values of each revascularized territory. Student's t-test, paired t-test, Mann Whitney test, and Wilcoxon signed ranks test. Significance was judged at the 5% level. Territorial longitudinal strain showed significant 6-month post-PCI improvement in the left anterior descending (LAD) and right coronary artery (RCA) territories, but there was not in the left circumflex (LCX) territory (LAD: mean - 11.41% ± 3.45% pre, -13.01% ± 3.53% post; RCA: mean - 11.11% ± 2.65% pre, -13.25% ± 2.81% post; and LCX: mean - 15.43% ± 3.97% pre, -16.17% ± 4.38% post, P = 0.215). Territorial circumferential strain showed significant post-PCI improvement in all revascularized territories (LAD: mean - 13.73% ± 6.56% pre, -16.98% ± 6.01% post; LCX: mean - 13.23% ± 4.23% pre, -16.34% ± 3.45% post; and RCA: mean - 11.24% ± 3.36% pre, -13.80% ± 3.51% post). Territorial radial strain showed no significant post-PCI improvement (LAD: mean 22.73% ± 12.38% pre, 21.79% ± 11.55% post, P = 0.541; LCX: mean 27.73% ± 7.95% pre, 29.0% ± 7.25% post, P = 0.264; and RCA: mean 36.68% ± 11.10% pre, 31.75% ± 10.95% post, P = 0.208). Territorial LV systolic function was significantly improved by coronary revascularization in CCS patients. 1 TECHNICAL EFFICACY: Stage 4.

Correlation between Global Longitudinal and Circumferential Peak Systolic Strain and Coronary Artery Disease Severity as Assessed by the Angiographically Derived SYNTAX Score

Abstract Aim and objectives the main objective of the current study is to assess the correlation between the SYNTAX score in patients undergoing elective coronary angiography and the longitudinal and circumferential peak systolic strain performed at rest by speckle tracking echocardiography to predict the presence, extent and severity of coronary artery disease. Patients and Methods The study included 60 patients suspected to have coronary artery disease either by symptoms or done a positive non-invasive test for myocardial ischemia with no history of previous ischemia and no previously detected segmental wall motion abnormalities in previous resting echocardiogram. All patients were recruited from the catheter laboratory at the cardiology department of Ain Shams university hospitals and they underwent echocardiographic assessment before elective coronary angiography. Results The study included 60 symptomatic patients suspected to have chronic coronary syndrome aging 31 to 77 years (excluding those with significant structural heart disease). All patients underwent clinical evaluation, surface electrocardiogram, transthoracic echocardiographic, twodimensional speckle tracking, and conventional coronary angiography with SYNTAX score calculation. Patients were divided into 3 groups based on the results of the coronary angiogram: normal CAD on angiogram (n = 12), low SS (n = 28, SS &amp;lt; 22), and high SS (n = 20, SS ≥ 22). Age, sex and most of the risk factors had no statistically significant correlation with the SYNTAX score while There was a significant inverse correlation between GLPSS and GCPSS and SS values (r = 0.458, P = 0.0002), (r = 0.411, P = 0.0011) respectively. Conclusion The results of our study suggest that GLPSS and GCPSS might be promising for the detection of patients with high SYNTAX score on coronary angiogram. There is an inverse correlation between resting GLPSS and GCPSS and SYNTAX score as assessed by coronary angiography.

Value of Transthoracic Echocardiography in Predicting Short Term Major Adverse Cardiac Events after ST Elevation Myocardial Infarction in COVID 19 Era

Abstract Background Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide. In the era of COVID 19, early risk stratification and identification of high-risk patients with ST-segment elevation myocardial infarction are of great significance in prognosis, and in guiding diagnosis and treatment decisions. Measuring left ventricular peak systolic global longitudinal strain may be a useful addition to ejection fraction using echocardiography. Aim of the Study Is to evaluate different parameters of echocardiography in predicting major adverse cardiac events in patients after acute ST-segment elevation myocardial infarction in the era of Covid 19. Methods and patients This study included 97 patients who presented with acute STsegment elevation myocardial infarction within 12 hours of onset of chest pain and managed by primary percutaneous coronary intervention, it was performed in Ain Shams university hospitals from January 2021 to June 2021. Echocardiography was used to measure ejection fraction and left ventricular strain parameters Results The study included 97 patients, 55 % of which presented with anterior STEMI. Out of the whole group 29 patients (21%) developed MACE at 3 months follow up. Within the whole group, the mean ejection fraction was (44.04±6.07% VS .40.07±6.52% p = 0.007) and the mean global longitudinal strain was (-12.56±3.61% VS -10.1±3.25% p=0.002). Based on CT chest finding, 33 patients were Covid 19 patients who were younger in age, included significantly more females and had significantly higher Killip score as compared to the non covid patients. Among COVID-19 patients, the mean ejection fraction was (46.11±5.29% VS 40.6±7.11% p=0.02) and the mean global longitudinal strain was (-13.17±3.35% VS 10.35±3.38% p=0.026). At 3 months follow up, 39% of the Covid patients had MACE as compared to 25% of the non covid patients P = 0.0001. Conclusion In the era of COVID 19, young patients with female gender who suffered from STEMI were more likely to be COVID 19 patients and were liable to develop MACE at 3 months follow up. However, their LV EF and GLS were comparable to non-COVID 19 patients Ethical approval this study protocol was approved by the local ethics committee with a consent was obtained from all participants. Abbreviations MACE: major adverse cardiac events; LV: left ventricle; GLS: global longitudinal strain; STEMI: ST elevation myocardial infarction

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI

BackgroundInsulin is commonly used in type 2 diabetes mellitus (T2DM) to achieve glycemic control. However, recent evidence showed that insulin use is associated with poor outcomes in the context of heart failure (HF). Since heart failure with reduced ejection fraction (HFrEF) accounts for approximately 50% of cases in the general HF population, we aimed to evaluate the effect of insulin treatment on left ventricular (LV) remodeling and contractility abnormalities in a HFrEF cohort and assess whether insulin was a predictor of adverse outcomes in this entity.MethodsA total of 377 HFrEF patients who underwent cardiac MRI were included and divided according to diabetes status and the need for insulin treatment. LV structural and functional indices, as well as systolic strains, were measured. The determinants of impaired myocardial strains were assessed using linear regression analysis. The associated endpoints were determined using a multivariable Cox proportional hazards model.ResultsT2DM patients on insulin displayed a higher indexed LV end-diastolic volume and LV mass than those with T2DM not on insulin or those without T2DM, despite similar LV ejection fractions, accompanied by a higher three-dimensional spherical index (P < 0.01). Worse longitudinal and circumferential peak systolic strain was shown to occur in T2DM patients on insulin (P < 0.01). Insulin treatment was independently associated with impaired magnitudes of systolic strain. The median follow-up duration was 32.4 months (IQR, 15.6–43.2 months). Insulin treatment remained consistently associated with poor outcomes after adjustment for established confounders, with an adjusted hazard ratio of 3.11; (95% CI, 1.45–6.87; P = 0.009) in the overall cohort and 2.16 (95% CI, 1.08–4.59; P = 0.030) in the diabetes cohort.ConclusionsInsulin may further lead to adverse LV remodeling and contractile dysfunction in the context of HFrEF with T2DM. Considerable care should be taken when treating HFrEF patients with insulin.

Assessment of subclinical left ventricular systolic dysfunction in patients with asymptomatic severe aortic stenosis with preserved left ventricular systolic function by three-dimensional speckle tracking echocardiography.

Left ventricular dysfunction and remodeling can occur as a result of aortic valve stenosis (AS). Three-dimensional speckle tracking echocardiography (3D-STE) can detect early left ventricular myocardial dysfunction even before ejection fraction declines. The purpose of this study was to look at the relationship between various myocardial strain parameters measured by 3D-STE in asymptomatic severe AS patients from Bangladesh. This study included 46 patients with asymptomatic severe AS but preserved LV systolic function (mean age 50.11±12.66 years, LVEF 63.78±3.95%, AS group) and 33 healthy subjects with no cardiovascular disease (mean age 48.21±4.53 years, LVEF 65.15±3.13%, control group). 3D-STE was used to measure left ventricular global myocardial strain parameters such as peak systolic longitudinal strain (PSLS), circumferential strain, radial strain, and area strain. The AS group had significantly thicker interventricular septum and posterior ventricular wall than the control group (1.49±.19cm vs. .81±.09cm, p<.001; 1.73±1.71cm vs. .81±.10cm, p=.003, respectively.) In the AS group, the Indexed Aortic Valve Area (AVA) was significantly lower than in the control group. (.29±.10vs. 2.03±.18, p<.001, respectively). In terms of LVEF (p=.102), left ventricular end diastolic volume (p=.075), or left ventricular end systolic volume (p=.092), no significant inter-group difference was found. However, global PSLS (-10.75±2.27vs. -16.42±2.76, p<.001), circumferential strain (-14.26±3.40vs. -16.64±2.56, p=.001), area strain (-22.70±4.19vs. -26.45±9.90, p=.024) and radial strain (32.20±8.77vs. 41.00±7.52, p<.001) in the AS group were significantly lower than in the control group. Our findings showed reductions in left ventricular global myocardial strains, particularly PSLS in patients suffering from asymptomatic severe AS in Bangladesh; this is consistent with other studies. Reduced area strain, detectable with 3D-STE, is also consistent with that pattern.

The potential impact of hereditary hemochromatosis on the heart considering the disease stage and patient age-the role of echocardiography.

Hereditary hemochromatosis (HH) is a genetic disease that leads to increased iron accumulation in several organs. Cardiomyocytes are highly susceptible to this damage owing to their high iron uptake, and cardiovascular complications account for 1/3 of the deaths in the natural course of HH. Additionally, excess iron intake and associated oxidative stress may accelerate the aging of the cardiovascular system, regardless of the age of patients with HH. We aimed to investigate the role of standard and speckle-tracking echocardiography (STE) in revealing heart differences in patients with HH considering the disease stage and the patient age. Consecutive patients with HH (n = 58) without heart pathologies (except hypertension) and 29 age- and sex-matched healthy individuals underwent echocardiography. Patients were compared according to the time since HH diagnosis (the recently diagnosed HH group [31 patients] with diagnosed HH for less than 6 months and had no more than one venesection; the medium group [11 patients] with diagnosed HH between 6 and 24 months; and the long-lasting group [16 patients] with diagnosed HH for more than 2 years) and the quartile contribution of their age. Standard echocardiography revealed differences in diastolic parameters between patients with HH and controls, which were the most prominent between healthy and long-lasting HH patients. Regarding systolic function, left ventricular ejection fraction was lower in HH patients, with the most evident differences between the healthy and recently diagnosed HH patients. STE revealed additional differences in systolic parameters, with LV rotation the worst in recently diagnosed patients and its increase in patients with medium and long-lasting HH. Significantly worse peak systolic longitudinal strain values were observed in all patients with HH. Analyses of the results according to the age quartiles of patients with HH revealed that some changes ocurred earlier than expected according to age. Echocardiography can reveal possible heart damage in HH patients at different stages of the disease and highlight potential features of accelerated myocardial aging in these patients.

Relationships between biventricular myocardial function and oxygen uptake during exercise in healthy adolescent male athletes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK Research and Innovation Medical Research Council Doctoral Training Programme Grant Work supported as part of a research partnership between the University of Bristol and Canon Medical Systems UK that determines the independence of the research from either parties. Background Biventricular cardiac function improves with increasing work-rate during exercise in healthy elite athletes, but how it relates to concomitantly measured oxygen uptake (VO2) is not well known. Assessing cardiac determinants of cardiorespiratory fitness through multimodal evaluations may lead to improvements in clinical stress testing protocols and better understanding of exercise physiology. Purpose The aim of this study was to investigate whether left and right ventricular (LV and RV) systolic function measured by speckle tracking echocardiography (STE) at submaximal exercise (moderate and high intensity domains) is associated with concomitantly measured VO2 in healthy adolescent male athletes. Methods Elite male football players &amp;lt;16 years-old underwent cardiopulmonary exercise testing with concomitant STE at 50 W steps. Exercise intensity domains were defined based on the gas exchange threshold (GET). LV and RV free wall (FW) peak systolic longitudinal strain (Sl), strain rate (SRl) and LV average (12 mid and basal segments) circumferential strain (Sc) and strain rate (SRc) were measured. Cardiac function relation to peak VO2 was evaluated using linear regression, and its relationships to VO2 within each exercise intensity domain using repeated measures mixed linear models, before and after adjusting for heart rate (HR). Results A total of n=94 athletes were included (mean age 14.7 ± 1 years). Mean peak VO2 and work-rate were 43 ± 7 mL·min-1·kg-1 and 215 ± 40 W, respectively. Relationships between cardiac function and VO2, by exercise intensity domain are shown in Figure 1 with all regression coefficients shown in Table 1. Only LV Sl at high intensity was correlated to peak VO2 (p = 0.04). Within exercise intensity domains higher LV Sl (Figure 1A) and SRl (Figure 1B) were associated with higher concomitantly measured VO2 at both moderate and high intensity. Higher SRc (Figure 1C) and RV FW SRl (Figure 1F) were associated with higher VO2 only at moderate intensity. LV Sc (Figure 1C) and RV FW Sl (Figure 1E) were not associated with concomitant VO2 during exercise at moderate or high intensity. Only LV Sl and SRl at moderate and high intensity remained significantly associated to concomitantly measured VO2 after further adjusting by HR (Table 1). Conclusions In healthy adolescent athletes, only LV longitudinal strain and strain rate measured at moderate and high intensity were associated with VO2 independent of HR response. There were differences in myocardial response to exercise both between the two ventricles, and between the longitudinal and circumferential components of LV function. These require further research, both in healthy and disease groups, especially in RV pathology, where components of myocardial function could play different roles in limiting exercise capacity.