Peak Twist Research Articles

The Influence of Age and Exercise Training Status on Left Ventricular Systolic Twist Mechanics in Healthy Males-An Exploratory Study.

Age-related differences in twist may be mitigated with exercise training, although this remains inconclusive. Moreover, temporal left ventricular (LV) systolic twist mechanics, including early-systolic (twistearly), and beyond peak twist (twistpeak) alone, have not been considered. Therefore, further insights are required to ascertain the influence of age and training status on twist mechanics across systole. Forty males were included and allocated into 1 of 4 groups based on age and training status: young recreationally active (YRA, n = 9; 28 ± 5 years), old recreationally active (ORA, n = 10; 68 ± 6 years), young trained (YT, n = 10; 27 ± 6 years), and old trained (OT, n = 11, 64 ± 4 years) groups. Two-dimensional speckle-tracking echocardiography was performed to determine LV twist mechanics, including twistearly, twistpeak, and total twist (twisttotal), by considering the nadir on the twist time-curve during early systole. Twisttotal was calculated by subtracting twistearly from their peak values. LV twistpeak was higher in older than younger men (p = 0.036), while twistpeak was lower in the trained than recreationally-active (p = 0.004). Twistpeak is underestimated compared with twisttotal (p < 0.001), and when early-systolic mechanics were considered, to calculate twisttotal, the age effect (p = 0.186) was dampened. LV twist was higher in older than younger age, with lower twist in exercise-trained than recreationally-active males. Twistpeak is underestimated when twistearly is not considered, with novel observations demonstrating that the age effect was dampened when considering twistearly. These findings elucidated a smaller age effect when early phases of systole are considered, while lower LV systolic mechanics were observed in older aged trained than recreationally-active males.

A Characterization of the Cardiac Physiology and Aortic Pulse Wave Properties of Artistic Swimmers Across Competitive Levels.

The distinct physical and environmental stressors of artistic swimming (previously termed synchronized swimming) result in unique hemodynamic stimuli. Given that the hemodynamic stress associated with participation in an exercise modality drives adaptation of the heart and central vasculature, artistic swimming may produce a distinct cardiovascular phenotype. Presumably, athletes competing at the highest levels also have greater training exposure and, thus, exhibit more adaptation. The purpose of this study was to characterize cardiovascular form and function across the competitive spectrum of artistic swimmers. Cardiovascular structure and function were compared in a cross-sectional study of healthy controls, varsity, and elite artistic swimmers, using pulse wave analysis, pulse wave velocity, and echocardiographic images both at rest and during isometric handgrip exercise. Aortic stiffness was similar across all groups, as were characteristics of the decomposed aortic pressure waveform. At rest, both varsity and elite swimmers demonstrated similar systolic function compared to controls. However, peak left ventricular twist was greater in varsity and elites (controls: 8.0 ± 3.9, varsity: 12.8 ± 8.6, elites: 13.4 ± 3.9; both p < 0.02). Furthermore, elites demonstrated greater peak left ventricular radial strain (controls: 29.2 ± 9.9, varsity: 32.5 ± 10.3, elites: 53.9 ± 15.1; both p < 0.001) and longitudinal strain (controls: -16.9 ± 1.6, varsity: -16.5 ± 1.8, elites: -19.5 ± 3.2; both p < 0.04). In contrast to controls, both varsity and elite artistic swimmers demonstrated no change in peak late diastolic transmitral filling velocity (controls: Δ0.2 ± 0.04 m/s, varsity: Δ0.06 ± 0.04 m/s, elites: Δ0.05 ± 0.04 m/s) during isometric handgrip exercise (both p > 0.05), with elites demonstrating lower peak velocity than varsity swimmers, (p = 0.048) indicating preservation of diastolic function. Artistic swimmers demonstrate distinct cardiac physiology at rest and during isometric handgrip, with a greater extent of distinguishing features observed in those competing at the highest level of competition.

Cyclic Degradation Parameters of Flow-Controlled Geomaterial for Pile Group Subjected to Torsional Loads

The pile groups support large foundation structures which often experience cyclic torsional loads. Several theoretical and experimental investigations were carried out on pile groups under axial and lateral cyclic loads; however, the study of the response of cyclic torsional loads on pile foundation groups remains elusive. This paper proposes a numerical scheme to capture the behavior of the symmetrical pile group in the flow-controlled geomaterial under cyclic torsional loading. Based on the numerical scheme, three-dimensional finite element analysis was performed to capture the nonlinear response of the pile group using a computational program. The results from the numerical analysis have been compared with the experimental observations. The peak twist and peak shear stress logarithmically decrease and then become asymptotic after a number of cycles of loading for a pile group (2,2) in a flow-controlled geomaterial. A set of cyclic degradation parameters of flow-controlled geomaterial is identified for the pile group and presented as a function of dilation.

Exaggerated myocardial torsion may contribute to dynamic left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

Dynamic left ventricular (LV) outflow tract obstruction (LVOTO) is associated with symptoms and increased risk of developing heart failure in hypertrophic cardiomyopathy (HCM). The association of LVOTO and LV twist mechanics has not been well studied in HCM. The aim of the study was to compare the pattern of LV twist in patients with HCM associated with asymmetrical septal hypertrophy with and without LVOTO. Echocardiography (including speckle tracking) was performed in 212 patients with HCM, divided according to the absence (n = 130) or presence (n = 82) of LVOTO (defined as peak pressure gradient ≥30 mmHg either at rest and/or with Valsalva manoeuvre). Patients with LVOTO were older, had smaller LV dimensions, a higher LV ejection fraction (LVEF), a longer anterior mitral valve leaflet length, and a higher early transmitral pulsed wave to septal tissue Doppler velocity ratio (E/E'). A univariate analysis showed that peak twist was significantly higher in patients with LVOTO compared with patients without LVOTO (19.7 ± 7.3 vs. 15.7 ± 6.0, P = 0.00015). Peak twist was similarly enhanced in patients with LVOTO, manifesting only during Valsalva (19.2 ± 5.6, P = 0.007) and patients with resting LVOTO (19.9 ± 8.0, P = 0.00004) compared with patients without LVOTO (15.7 ± 6.0). A stepwise forward logistic regression analysis showed that LVEF, LV end-systolic dimension indexed to body surface area, anterior mitral valve leaflet length, E/E', and peak twist were all independently associated with LVOTO. This study demonstrates that increased peak LV twist is independently associated with LVOTO in patients with HCM. Peak twist was similarly exaggerated in patients with only latent LVOTO, suggesting that it may play a contributory role to LVOTO in HCM.

Changes in the structure and function of the left ventricle in patients with gout: A study based on three-dimensional speckle tracking echocardiography.

Studies have shown that gout can increase the risk of cardiovascular disease. Three-dimensional speckle-tracking echocardiography (3D-STE), a sensitive imaging technology, enables the detection of subtle myocardial dysfunctions. Our aim is to evaluate the left ventricular (LV) functions in patients with gout using 3D-STE. 80 subjects: 40 with gout and 40 as normal controls were involved. We obtained and analyzed these parameters from the dynamic images of a 3D full-volume dataset: global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), Twist, 16-segmental time-to-peak longitudinal strain (TTP) and systolic dyssynchrony index (SDI)besides other relevant parameters. Compared with the normal group, gout patients were more likely to have left ventricular remodeling. The patients with gout showed decreased Em, increased E/Em and larger volume index of the left atrium (LAVI) indicating reduced diastolic function. The peak GLS (-17.42 ± 2.02 vs. -22.40 ± 2.57, P < 0.001), GCS (-27.04 ± 3.75 vs. -34.85 ± 4.99, P < 0.001), GRS (38.22 ± 4.28 vs. 46.15 ± 5.17, P < 0.001), and Twist (15.18 ± 5.45 vs. 19.02 ± 5.29, P = 0.015) were significantly lower in patients with gout than in healthy participants. The SDI (5.57 ± 1.46 vs. 4.91 ± 1.19, P = 0.016) was significantly increased in patients with gout compared with normal controls. There was no significant between-group difference in TTP (P = 0.43). The systolic GLS, GRS and GCS peak values increased gradually from the base to the apex, with the lowest values in the basal segment in patients with gout. Receiver-operating characteristic curve analysis revealed among these strains GLS has the largest area under the curve (AUC: 0.93, P < 0.001), the cutoff value of -18.97% with a sensitivity and specificity of 80.0% and 92.0%, respectively, for differentiating two groups. A multivariate linear regression analysis shows that the relationship between gout and strain parameters including GLS, GRS, and GCS is statistically significant (P < 0.001). Although patients with gout having a normal ejection fraction, structural remodeling of the left ventricle and subclinical LV deformation may occur. 3D-STE can detect subtle cardiac dysfunctions in patients with gout at an early stage.

Enhanced Torsion Mechanism of Small-Scale Reinforced Concrete Beams with Spiral Transverse Reinforcement

The nonlinear torsional behaviour of small-scale reinforced concrete (RC) beams with continuous staggered spiral as transverse reinforcement stirrups is experimentally investigated. Twelve miniatures RC beams were tested under torsion load considering the closed shape of stirrups and compared with continuous staggered spiral ones. All miniatures beams were scaled down to be one-eighth the prototype beam size. The main parameters considered in this research are stirrup spacing and its configurations. Small scale RC beams were taken into account in the existing study because of their construction simplicity and financial feasibility. Mortar without coarse aggregate was applied instead of concrete to reduce the size effect of applying small scale models. Ongoing research trials have been carried out to obtain an efficacious approach to boost torsion failure mechanisms because brittle torsion failure of RC structural elements should be avoided. This study emphasized boosted torsion capacity, dissipated energy, and helical crack propagation. During testing, the primary cracking torsion moment, ultimate torsion moment, peak twist angle, and failure mechanism of the beams were inspected. The use of spiral stirrups showed great enhancement of the torsional behaviour of samples. It was observed that using spiral stirrups rather than closed stirrups could result in a substantial increase in torsion capacity and dissipated energy of 87.7% and 89.8%, respectively. As a result, the predicted capacities of the RC beams prototype were estimated in detail, taking account the scale down factor implemented by the authors. Values obtained based on international specifications and guidelines were used to compare the experimental results. Doi: 10.28991/CEJ-2022-08-11-019 Full Text: PDF

Longitudinal, radial, circumferential and rotational mechanics in acute myocarditis; a 2D speckle-tracking echocardiography study

Abstract Objectives The aim of our study was to assess the utility of echocardiographic deformation imaging of the left ventricle in patients with CMR-proven acute myocarditis (AM). Background Often conventional echocardiography reveals no obvious abnormalities in AM. While longitudinal strain is known to reflect the subendocardial muscle layer deformation, in AM myocardial damage is predominantly confined to the subepicardium. The latter is involved in circumferential deformation and rotational mechanics. Methods Data were obtained from a prospectively maintained database of patients (n=44) with AM who had an echocardiography and CMR within 2 weeks of hospital presentation. All patients underwent a comprehensive echocardiographic study including measurement of left ventricular (LV) global longitudinal strain (GLS), basal and apical radial strain (RS), basal and apical circumferential strain (CS), basal and apical rotation, peak twist and peak twist rate. Furthermore, LV deformation was analysed in an age-matched control group (CG) of individuals (n=27) with no evidence of cardiovascular disease. Results There was no significant difference in demographics and most echocardiographic parameters (Table 1). LV EF (57±11% vs 63±4%, p=0.005) was lower in AM. Difference in wall thickness (LVPWd 10.6±1.9mm vs 9.5±1.5mm, p=0.002) and diastolic function (E/E' lateral 6.7±3.1 vs 4.9±0.9, p=0.015) were significant but not specific. Deformation imaging revealed significant differences between the 2 groups in parameters reflecting longitudinal and circumferential deformation, and rotational mechanics (Table 2); GLS (−15.4±4.2% vs −18.9±2.1%, p&amp;lt;0.001), apical CS (−26.1±10.2% vs −34.8±9.4%, p&amp;lt;0.001), basal CS (−20.8±7.4% vs −24.4±6.0%, p=0.017), apical rotation (4.5±3.2° vs 7.9±4.0°, p&amp;lt;0.001), peak twist (9.8±5.8° vs 14.5±5.1°, p&amp;lt;0.001) and peak twist rate (69.5±32.7deg/sec vs 89.3±32.7deg/sec, p&amp;lt;0.001). In patients with preserved systolic function (EF ≥50%, n=35) the only statistically significant 2D parameter between groups was LVPWd thickness (10.8±1.7mm vs 9.2±1.5mm, p=0.001), whereas differences in most strain and rotational parameters persisted; GLS (−16.5±3.3% vs −18.9±2.2%, p=0.003), apical CS (−28.0±8.2% vs −34.8±9.4%, p=0.030), apical rotation (4.7±3.2° vs 7.9±4.0°, p&amp;lt;0.001), peak twist (10.3±6.2° vs 14.5±5.5°, p=0.008), peak twist rate (71.1±33.3 deg/sec vs 89.3±32.7 deg/sec, p=0.048). ROC analysis showed fair classification accuracy for apical rotation (0.760, p&amp;lt;0.001), LV PWd (AUC 0.760, p&amp;lt;0.001), peak twist (0.752, p=0.01) and GLS (AUC 0.706, p&amp;lt;0.001). Conclusion Apical rotation and myocardial twist can objectively quantify myocardial mechanics in AM. Circumferential and rotational mechanics are mostly affected, even in patients with preserved ejection fraction, possibly reflecting subclinical LV dysfunction associated with subepicardial muscle layer inflammation. Funding Acknowledgement Type of funding sources: None.

Use of advanced echocardiographic modalities to discriminate preclinical HCM mutation carriers from non-carriers

Abstract Background It is a challenging goal to identify which family members of patients with hypertrophic cardiomyopathy (HCM) will subsequently develop HCM. Previous studies evaluating the utility of two-dimensional conventional Doppler echocardiography in HCM families with a known pathogenic variant identified on genetic testing have been unable to reliably distinguish preclinical genotype-positive, phenotype-negative (G+P−) individuals from their healthy genotype-negative, phenotype-negative (G−P−) relatives. Purpose To determine if advanced echocardiographic modalities can discriminate preclinical HCM mutation carriers (G+P−) from non-carriers (G−P−). Methods A total of 199 participants who had undergone genetic testing from HCM families with a known pathogenic variant were included in the study: 39 G−P−; 58 G+P− and 102 overt HCM patients (G+P+). Speckle tracking echocardiography (STE) and colour M-mode were performed on all participants and longitudinal, circumferential and radial strain, and torsion were compared. Results Patients with overt HCM had the highest septal, posterior wall thickness, septum/posterior wall (Sep/PW) thickness ratio and left ventricular outflow tract (LVOT) gradient and lowest global longitudinal, circumferential and radial strain, and tissue Doppler-derived myocardial systolic and diastolic velocities. Comparing G−P− and G+P− individuals, there were no significant differences in LV cavity size, wall thickness, LVOT gradient, LVEF and tissue Doppler-derived myocardial systolic and diastolic velocities. However, G+P− individuals had significantly higher peak apical rotation, peak twist and colour M-mode flow propagation velocity (Vp). Multivariate linear regression identified two independent predictors (peak apical rotation and Vp), and a regression equation (using multivariate linear regression) {Mutation carrier prediction value = (0.210×peak apical rotation) − (0.002×Vp) + 0.156; r=0.655)} was derived which allowed reliable discrimination of G+P- individuals with a sensitivity of 95.2% and specificity of 94.1% at the optimal cut-off. Conclusion In HCM family members without overt HCM, peak apical rotation and Vp provide good sensitivity and specificity for identifying mutation carriers and may be a clinically useful early marker of HCM before the onset of hypertrophy. Future longitudinal studies involving larger cohorts are required to validate these findings. Funding Acknowledgement Type of funding sources: None.

Left Ventricular Systolic‐Diastolic Coupling: Insight from Magnetic Resonance Dobutamine Stress

Left ventricular systolic and diastolic function are intrinsically linked, such that diastolic relaxation is influenced by the preceding systolic contraction – similar to how a springs recoil to its original shape is influenced by the degree of compression. Several clinical investigations have proposed quantifying the ratio between diastolic and systolic function to assess the coupling efficiency between the two, however, these cross‐sectional comparisons may be influenced by additional confounding factors, such as differences in tissue characteristics. Therefore, to extend our understanding, and directly examine the relationship between left ventricular systolic and diastolic coupling, we performed cardiac magnetic resonance imaging in six healthy volunteers (4F/2M, 22 ± 3 years, 24.4 ± 3.0 kg/m2) at rest and during low‐dose intravenous dobutamine infusion (2 µg/kg/min) to increase cardiac inotropy without affecting other, potentially confounding, regulators of diastolic function. Systolic and diastolic function was measured using gold‐standard tissue tagging, from three evenly spaced short axis images spanning the left ventricle from base to apex. As expected, dobutamine infusion increased peak circumferential strain (‐19.8 ± 1.6 % vs ‐21.3 ± 2.0 %, p = 0.002), systolic circumferential strain rate (CSRs: ‐96 ± 2 %/s vs ‐117 ± 7 %/s, p = 0.001), peak twist (8.2 ± 0.9 ° vs 10.7 ± 1.1 °, p = 0.002) and peak rate of systolic twist (TR: 40 ± 7 °/s vs 58 ± 8 °/s, p = 0.004). Independent of any changes in heart rate (59 ± 9 bpm vs 58 ± 9 bpm, p = 0.303) or end‐diastolic volume (171 ± 26 mL vs 170 ± 24 mL, p = 0.882), early diastolic circumferential strain rate (CSRd: 141 ± 15 %/s vs 163 ± 9 %/s, p = 0.019) and peak untwisting rate (UTR: ‐67 ± 24 °/s vs ‐88 ± 16 °/s, p = 0.018) subsequently increased. As a result, the ratio between diastolic and systolic measurements remained unchanged (CSRd/CSRs: 1.47 ± 0.14 vs 1.40 ± 0.15, p = 0.266; UTR/TR: 1.69 ± 0.54 vs 1.57 ± 0.37, p = 0.190). Taken together, these data support a growing body of evidence linking left ventricular systolic function with subsequent early diastolic relaxation and suggest that future investigations examining diastolic function should consider the influence of preceding systolic contractions.

Normal Value Ranges of LV Deformation, Rotation and Twist Parameters in Healthy Adults by 4Dimensional XStrain Speckle Tracking Echocardiography

XStrain 4D Speckle tracking echocardiography is a novel approach to address both the strain deformation and rotational mechanics of LV. The aim was to comprehensively present the normal value ranges of LV strain and rotational parameters of healthy Indian adults after assessment with this innovative technique. The study population comprising of 80 adults (58 males, 22 females; Group A &lt; 30 years, Group B &gt; 31 years) is revealing the values of Global longitudinal strain (GLS), Global longitudinal strain rate (GLSR), Transverse strain (TS), Transverse strain rate (TSR), Shear and Shear rate are greater in men than in women (p&lt;0.01) and moreover in Group A, Global Circumferential strain (GCS), Global Circumferential strain rate (GCSR), Global Radial strain and Global Radial strain rate (GRSR) were similarly higher in men. Peak apical rotation, peak twist, twist rate and untwist rate values were again greater in men (p&lt;0.01) and increased with advancing age. This is the first study to present a candid and comprehensive analysis of extensive parameters of LV strain and rotational mechanics in healthy Indian adults.

4 Dimensional X-Strain Speckle Tracking Echocardiography: Assessment of Normal Values of Left Ventricular Rotation and Twist, in Healthy Indian Adults during Covid-19 Pandemic

Cardiac MRI and 2Dimensional speckle Tracking Echocardiography (2D STE) are the most sought-after methods to evaluate LV twist mechanics. LV rotational deformation resembles the wringing of a towel, and this deformation is referred as LV twist (LVT), and the subsequent recoil in diastole is known as LV untwist (LVUT). 2D/3D/4D twist mechanics assessment by STE is inherently associated with limitations. Recently introduced 4D XStrain STE has been used for evaluation of strain parameters because of better appraisal of contractile properties of LV, to analyse complex multi-dimensional LV rotational mechanics. This novel technology is a reliable, affordable, and simple tool for quantification of regional myocardial functions, particularly LV strain and rotation parameters. To evaluate and establish the normal values of LV rotation and twist by 4D XStrain STE in healthy Indian adults during the Covid-19 pandemic was the aim of the current study. 46 subjects were enrolled (34 males &amp; 12 females). LA size, LV mass, CO, LVEDV and mitral E/A ratio were significantly greater in males (p&lt;0.01) even though EF was higher in females (p&lt;0.01). GLS, GCS, and GRS were increased in males (p&lt;0.01). Peak basal rotation, peak twist, peak twist rate, and peak untwist rate were also greater in males (p&lt;0.01), nonetheless, peak apical rotation and papillary muscle rotational velocity were greater in females (p&lt;0.01). However, MV rotational velocity was increased in males (p&lt;0.01). This is the first research publication of normal values of LV rotation and twists in healthy Indian adults by 4D XStrain STE.

Cardiac geometry, function and mechanics in left ventricular non-compaction cardiomyopathy with preserved ejection fraction

Left ventricular non-compaction (LVNC) cardiomyopathy in adults has primarily been studied with a phenotypic expression of low ejection fraction (EF) and dilated cardiomyopathy; however, data on LVNC with preserved EF is scarce. The present study aimed to evaluate cardiac geometry and mechanics in LVNC patients with preserved EF. A retrospective cohort study of patients diagnosed with LVNC and a preserved EF between 2008 and 2019 was performed. LVNC was defined according to the presence of established transthoracic 2D echocardiographic (TTE) criteria as follows: (1) prominent LV trabeculations with deep recesses; (2) bi-layered myocardial appearance; and, (3) systolic non-compacted:compacted ratio≥ 2. Subjects were matched 1:1 to controls without LVNC referred for routine TTE. Geometric, functional and mechanics parameters were analyzed in the two cohorts using 2D and speckle-tracking TTE. Seventeen patients with LVNC and preserved EF were identified. Compared with controls, patients with LVNC had similar LV systolic function and chamber dimensions, but a larger mass and relative wall thickness, and more abnormal LV geometry (76% vs. 18%, p = 0.002), LA remodeling, and pulmonary hypertension. Global longitudinal strain was significantly decreased (-15.4 ± 3.2 vs. -18.9 ± 2.8%, p = < 0.01) and the prevalence of rigid body rotation was significantly increased (57% vs. 14%, p = 0.05) in the LVNC population. The peak twist values were comparable in both cohorts. Impaired LV geometry and longitudinal mechanics, as well as increased myocardial stiffness as expressed by rigid body rotation, characterize LVNC with preserved EF when compared with controls.

The Systolic and Diastolic Cardiac Function of Patients With Type 2 Diabetes Mellitus: An Evaluation of Left Ventricular Strain and Torsion Using Conventional and Speckle Tracking Echocardiography.

Objectives: This study aimed to quantify left ventricular (LV) myocardial strain and torsion in patients with type 2 diabetes mellitus (T2DM) and evaluate their systolic and diastolic function using conventional and speckle tracking echocardiography.Methods: Forty-seven patients with T2DM were divided into a group without microvascular complications (the DM A group) and a group with microvascular complications (the DM B group), while another 27 healthy participants acted as the control group. All the participants had had an echocardiography examination. All the original data were imported into EchoPAC workstation for the analysis and quantification of LV strain and torsion.Results: Compared with the control group, the LV end-diastolic volume, end-systolic volume, and ejection fraction of the DM A and DM B groups showed no significant differences, but the global longitudinal strain and the global circular strain were reduced in the DM B group. There were significant differences in the left ventricular relative wall thickness (RWT), left ventricular mass index (LVMI), the early mitral valvular blood flow velocity peak/left ventricular sidewall mitral annulus late peak velocity, left ventricular sidewall mitral annulus early peak velocity/left ventricular sidewall mitral annulus late peak velocity, isovolumic relaxation time, peak twisting, peak untwisting velocity (PUV), untwisting rate (UntwR), time peak twisting velocity (TPTV), and time peak untwisting velocity (TPUV) between the DM A, DM B, and control groups. While the peak twisting velocity (PTV) was slower in the DM B group compared with the control group, the RWT, PTV, PUV, UntwR, TPTV, and TPUV in the DM B group were significantly different from the DM A group.Conclusion: The cardiac function of patients with T2DM in its early stages, when there are no microvascular complications, could be monitored with the analysis of two-dimensional strain and torsion.

Endothelial glycocalyx and microvascular perfusion are associated with carotid intima-media thickness and impaired myocardial deformation in psoriatic disease.

Psoriatic disease is associated with vascular and myocardial dysfunction. We aimed to evaluate endothelial glycocalyx barrier properties and microvascular perfusion in psoriatic patients, as well as their correlation with carotid intima-media thickness (cIMT) and markers of left ventricular (LV) myocardial deformation. We examined 297 psoriatic patients and 150 controls, adjusted for age, sex, and atherosclerotic risk factors. The severity of psoriatic disease was estimated using the psoriasis area and severity index (PASI). Perfused boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels with a diameter 5-25 μm using Sidestream Dark Field camera (Microscan, GlycoCheck). Increased PBR indicates reduced glycocalyx thickness. Indexes of microvascular perfusion, including red blood cells filling (RBCF) and functional microvascular density, were also calculated. We measured cIMT, coronary flow reserve (CFR) and markers of myocardial deformation by speckle-tracking imaging, namely global longitudinal strain (GLS) and percentage changes between peak twisting and untwisting at mitral valve opening (%dpTw-UtwMVO). Compared to controls, psoriatic patients had higher PBR5-25μm (2.13 ± 0.29μm versus 1.78 ± 0.25μm, p < 0.001) and lower RBCF and functional microvascular density (p < 0.001). Increased PASI was associated with elevated PBR and more impaired cIMT and GLS (p < 0.05). There was an inverse association of PBR with RBCF and functional microvascular density (p < 0.001). In psoriatic population, increased PBR was related to increased cIMT, reduced CFR, impaired GLS and decreased %dpTw-UtwMVO (p < 0.001). Glycocalyx thickness is reduced in psoriatic patients, which in turn impairs microvascular perfusion, and is associated with carotid IMT and impaired coronary and myocardial function.Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02144857.

Loss of apical suction assessed by noninvasive pressure differences and twist in acute heart failure: a novel method using vector flow mapping

Abstract Background Early diastolic intraventricular pressure difference (IVPD) reflects left ventricular (LV) apical suction, and IVPD is closely related to cardiac function, especially LV twist. Vector Flow Mapping (VFM) allows visualization of regional pressure distribution and noninvasive quantification of IVPD. The purpose of the present study was to investigate if and how IVPDs are related to LV twist in a model of acute heart failure (HF). Methods In 15 open-chest dogs, HF was induced by intracoronary injection of microspheres. The HF model was classified into two groups based on the LV end-diastolic pressure (LVEDP) (group1: LVEDP&amp;lt;18 mmHg (n=10), group2: LVEDP≥18 mmHg (n=8)). Color Doppler images from apical long-axis views were acquired at baseline and during HF. From these images, pressure differences (ΔP) were calculated along the LV inflow tract throughout the cardiac cycle. For the purpose of this study, the differences between apex and base during isovolumic relaxation time (ΔPIRT) and rapid early inflow period (ΔPE) were used for analyses. Furthermore, apical and basal short axis high frame rate 2D images were acquired, and peak rotation and peak twist were analyzed. Results LVEDP was 7±9, 14±2, 21±3 mmHg for baseline, group1 HF, and group2 HF, respectively. Pressure differences (both ΔPIRT and ΔPE) were visibly changed by the increase of LVEDP (Figure), and the magnitude of ΔPIRT, ΔPE and peak twist decreased significantly with the severity of heart failure. There were significant relationships between pressure differences (ΔPIRT and ΔPE) and dP/dtmin, tau, EF and peak twist (Table). In multivariate analyses, tau and peak twist were independent predictors for ΔPIRT and peak twist was independent predictor for ΔPE. Conclusion VFM analysis is feasible to noninvasively assess the IVPDs in acute heart failure. The IVPDs are closely related to the twisting motion of the LV, and reflect loss of apical suction during severe HF. Funding Acknowledgement Type of funding sources: None. VFM images of pressure differencesCorrelations of pressure differences

Endothelial glycocalyx integrity and microvascular perfusion are associated with novel echocardiographic markers and carotid intima-media thickness in patients with psoriasis

Abstract Background/Introduction Psoriasis has been associated with vascular and myocardial dysfunction through mechanisms of inflammation and oxidative stress. Purpose We aimed to evaluate sublingual microvascular perfusion and glycocalyx barrier properties in psoriasis patients, as well as their correlation with coronary microcirculatory function and markers of myocardial deformation and atherosclerosis (carotid intima-media thickness, cIMT). Methods We examined 297 patients with psoriasis and 150 controls, adjusted for age, sex, and atherosclerotic risk factors. Perfusion boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels with a diameter ranging from 5–25μm using a dedicated camera (Sidestream Dark Field imaging, Microscan, GlycoCheck). Increased PBR indicates reduced glycocalyx thickness. Indexes of microvascular perfusion, including red blood cell (RBC) filling percentage and functional microvascular density, were also calculated. We measured coronary flow reserve (CFR), cIMT and markers of myocardial deformation by speckle tracking imaging utilizing echocardiography [peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw-UtwMVO), at peak (%dpTw-UtwPEF), and the end of early LV diastolic filling (%dpTw-UtwEDF)]. Results Psoriasis patients had higher PBR5–25 compared to controls (2.13±0.29 versus 1.78±0.25μm, p&amp;lt;0.05). There was an inverse association of PBR5–25 with perfused microvascular density (r=−0.42, p&amp;lt;0.001) and RBC fraction (r=−0.80, p&amp;lt;0.001). In psoriatic population, PBR5–25 was inversely correlated to CFR (r=−0.30, p=0.045). Increased values of PBR5–9 were associated with reduced untwisting at the end of the mitral inflow E wave (r=−0.24, p=0.006) and reduced %dpTw-UtwMVO (r=−0.35, p&amp;lt;0.001). Furthermore, decreased RBC filling percentage and perfused microvascular density were related to worse LV longitudinal strain and increased cIMT (p&amp;lt;0.05). Finally, a positive correlation between perfused microvascular density and %dpTw-UtwMVO was observed in patients with psoriasis (p&amp;lt;0.05). Conclusion Endothelial glycocalyx thickness is reduced in patients with psoriasis and is associated with impaired coronary and myocardial function, and vascular atherosclerosis. Funding Acknowledgement Type of funding sources: None.

Features of changes in left ventricular mechanics in patients with epicardial obesity

Abstract Currently, there is no single non-invasive marker that can directly assess left ventricular (LV) diastolic function. Untwist of LV contributes to diastolic suction and early filling. Speckle-tracking imaging can be used to diagnose diastolic dysfunction at the preclinical stage. Objective To study the features of changes in the parameters of LV mechanics and their relationship with the levels of serum markers of myocardial fibrosis in patients with epicardial obesity (EO). Materials and methods The study included 125 men with general obesity. All patients underwent transthoracic echocardiography (ECG) to assess the thickness of epicardial adipose tissue (tEAT) as equivalent to visceral obesity, as well as to diagnose diastolic dysfunction (DD) of left ventricle (LV). According to the results of ECG, the patients were divided into 2 groups: EO(+) with epicardial fat thickness (tEAT) ≥7 mm (n=78); EO(−) with (tEAT) &amp;lt;7 mm (n=40). DD LV was detected in 7 patients, who were subsequently excluded from the analysis. Profibrotic markers in blood serum (MMP-3, collagen I, collagen III, TGF-β, VEGFA, PICP) were determined in all patients using enzyme immunoassay. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus. Results In the group of patients with EO(+) statistically significant increase the level of all studied profibrotic markers was revealed. According to the results of speckle-tracking ECG in the EO(+) group an increase peak untwist ratio LV to −125.56 (−141.0; −117.0)deg/s (p=0.003) and an increase time to peak untwist of LV of 469.44 (509.0; 401.0) msec was determined in comparison with the EO(−) group (p=0.03). A weak statistically significant effect of tEAT on the peak untwist ratio LV in EO(+) group was revealed (r=0.28; p=0.03). In addition, there was a significant relationship between peak untwist ratio LV and markers of myocardial fibrosis MMP-3 (r=0.23; p=0.03) and collagen type III (r=0.25; p=0.04). Conclusion Thus, LV unwinding may be a new non-invasive marker of LV DD at the preclinical stage, since this parameter reflects the mechanical aspect of global diastolic function, especially the early phase of diastole. Funding Acknowledgement Type of funding sources: None.

Apremilast improves endothelial glycocalyx and microvascular perfusion: a possible protective mechanism against COVID-19

Abstract Background/Introduction The phosphodiesterase 4 inhibitor apremilast is an approved treatment option for psoriasis. Purpose We aimed to investigate the effects of apremilast on endothelial glycocalyx, vascular and left ventricular (LV) myocardial function in psoriasis. Methods Ninety patients with psoriasis were randomized to receive apremilast (n=30), anti-tumor necrosis factor-a (etanercept, n=30), or cyclosporine treatment (n=30). At baseline and 4 months post-treatment, we measured: (1)Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using a dedicated camera (Sidestream Dark Field imaging, Microscan, Glycocheck). Increased PBR indicates reduced glycocalyx thickness. Perfused microvascular density (PMD), an index of microvascular perfusion, was also measured. (2)Pulse wave velocity (PWV - Complior; ALAM Medical) and central systolic blood pressure (cSBP), and (3)LV global longitudinal strain (GLS) and percent difference between peak twisting and untwisting at mitral valve opening (%dpTw-UtwMVO) using speckle-tracking echocardiography. Results Compared with baseline, PBR20–25 decreased only after apremilast treatment (−13% at 4 months, P&amp;lt;0.05) whereas no statistically significant changes in PBR20–25 were observed after etanercept or cyclosporine. Compared with etanercept and cyclosporine, apremilast resulted in a greater increase of PMD (+12% versus +3% versus +3%) and in a higher reduction of PWV (−10% versus −3% versus +8%) and cSBP (−8% versus −2% versus +7%) at 4 months. Apremilast showed a greater increase of GLS (+12% versus +5% versus +2%) and %dpTw-UtwMVO (+15% versus +3% versus +3%) than etanercept and cyclosporine (P&amp;lt;0.05 for all comparisons). Changes of PBR and PMD post-apremilast treatment correlated with a concomitant reduction of PWV and cSBP (P&amp;lt;0.05). Conclusions In psoriasis, apremilast confers a greater improvement of endothelial glycocalyx, microvascular perfusion and LV myocardial function compared with etanercept or cyclosporine treatment. Apremilast restores glycocalyx integrity and thus reduces vascular permeability to pro-inflammatory molecules. This may explain the beneficial effects of apremilast on COVID-19. Funding Acknowledgement Type of funding sources: None.

Features of the relationship between the parameters of left ventricular mechanics and the level of biomarkers of heart failure in patients with epicardial obesity

Abstract Funding Acknowledgements Type of funding sources: None. Currently, there is no serum biomarker that is a marker of the presence of heart failure (HF) at an early stage. It is also shown that the traditional indicators used for the diagnosis diastolic dysfunction (DD) of left ventricular (LV) using echocardiography (ECG) are not informative enough. Thus, it is currently relevant to study new serum biomarkers of DD, such as sST2, as well as to study the mechanics of LV. Objective to study the relationship between mechanics of LV and the level of sST2 (bioamarker of HF) in patients with epicardial obesity (EO). Materials and methods The study included 110 men with general obesity. According to the results of echocardiography (ECG), patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT &amp;lt;7 mm (n = 40) without diastolic dysfunction according to the results of ECG. All patients were assessed for sST2 and NT-pro-BNP levels using enzyme immunoassay. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus. Results In the group patients with EO ( + ) a statistically significant increase in the level of sST2 was revealed in comparison with the group of EO (-) [21,55 ng/ml (26,52; 15,40) and 9.89 ng/ml (11.12; 7.95); p = 0.001, respectively], while the levels of NT-pro-BNP in both groups were not statistically different [211.36 pg / ml (254.0; 156.0) and 204.81 pg / ml (268.0; 157.0), respectively, p = 0.85]. When determining the parameters of DD LV by ECG, there were no statistical differences between the EO (+) and EO (-) groups [e ", cm / sec 0.09 (0.11; 0.09) and 0.09 (0.11; 0.09), respectively, p = 0.63; E/e " , units, 7.80 (8.90; 6.55) in the EO (+) and 8.53 (9.70; 7.20) in the EO group ( - ), p = 0.08; left atrial volume index, ml / sq2, in the EO group (+) 28.39 (31.25; 24.17) and in the EO group(-) 27,82 (30,21; 25,66), p = 0.55; in the EO group ( + ), the maximum speed of tricuspid regurgitation, m / sec, is 2.78 (2.9; 2.58) in the EO group(-) 2,67 (2,87; 2,41), p = 0.13]. According to the results of speckle-tracking ECG in the EO (+) group, an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined in comparison with the EO ( - ) group (p = 0.03). A significant relationship between peak untwist ratio LV and sST2 was revealed (r = 0.37; p = 0.02). Conclusion Thus, it can be assumed that patients with EO have DD LV at the preclinical stage, which is not diagnosed using traditional ECG indicators. The serum biomarker sST2 is an early marker of the presence of HF.

Diastolic dysfunction of left ventricle as a consequence of lipotoxic myocardial damage in epicardial obesity

Abstract Funding Acknowledgements Type of funding sources: None. Visceral obesity results in lipotoxic myocardial damage and myocardial fibrosis with impaired diastolic function (DD) of left ventricle (LV), followed by progression to heart failure. However, there are no markers for early diagnosis DD of LV. Objective to study the relationship between levels of serum markers of lipotoxic myocardial damage and echocardiographic (ECG) parameters DD of LV in patients with epicardial obesity (EO). Materials and methods The study included 110 men with general obesity. According to the results of ECG, patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT &amp;lt;7 mm (n = 40) without DD according to the results of ECG. All patients were assessed for the level of free fatty acids (FFA), as early markers of lipotoxic myocardial damage, markers of myocardial fibrosis in the blood serum (MMP-3, collagen I, collagen III, TGF – β, VEGFA, PICP) using enzyme immunoassay. ECG was used to determine such parameters DD of LV as the velocity of the lateral part of the mitral valve fibrous ring (e"); the ratio of the velocity E of the transmitral diastolic flow to the average velocity of the mitral ring E/e"; the left atrial volume index; the maximum speed of tricuspid regurgitation. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). Results The level of serum markers of myocardial fibrosis a statistically significant increase all studied markers was revealed in the EO (+) group compared to the EO (-) group, and a statistically significant increase in the level of FFA in the EO (+) group compared to the EO (-) group (0.82 ± 0.02 mmol/l and 0.35 ± 0.01 mmol/l, respectively). According to the results of speckle-tracking ECG in the EO (+) group, an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined (p = 0.03). There were no statistically significant differences in the study DD of LV parameters in the study groups. Weak statistically significant relationship between the level of FFA and peak untwist ratio LV was revealed (r = 0.26; p = 0.04) in the EO (+) group. Relationships between the level of FFA and the parameters of ECG (e"; E/e"; left atrial volume index; maximum tricuspid regurgitation rate) was not found in both groups. Conclusion In EO, as a result of neurohumoral disorders, lipotoxic myocardial damage develops and progresses, leading DD to LV, the detection of which is probably possible with the help of the rate of LV untwist.