Peak Twist Research Articles

Possibilities of speckle-tracking echocardiography in diagnostic of diastolic dysfunction at the preclinical stage in obese patients

Abstract Funding Acknowledgements Type of funding sources: None. Currently, it is shown that the prevalence of diastolic dysfunction is extremely high. However, with the help of traditional echocardiography (ECG) indicators, it is not possible to detect diastolic dysfunction at the preclinical stage. Therefore, it is important to search for new non-invasive methods for the diagnostic of myocardial fibrosis, as an equivalent of diastolic dysfunction, at an early stage to prevent progression in HF. Objective to study the relationship of left ventricular (LV) mechanics with the level of serum markers of myocardial fibrosis 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 < 7 mm (n = 40) without diastolic dysfunction according to the results of ECG. 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 echocardiography, 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 -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 weak statistically significant effect of tEAT on the peak untwist ratio LV in EO (+) group was revealed (r = 0.24; p = 0.04). In addition, there was a significant relationship between peak untwist ratio LV and markers of myocardial fibrosis MMP-3 (r = 0,21; p = 0.04) and collagen type III (r = 0,26; p = 0.03). Conclusion Given the presence of increasing serum levels of profibrotic factors, we can assume that in patients with EO, there is preclinical diastolic dysfunction LV, identification of which is possible with the help of determining peak untwist ratio LV, time to peak untwist of LV.

Association of endothelial glycocalyx integrity and microvascular perfusion with novel echocardiographic markers and carotid intima-media thickness in patients with psoriasis

Abstract Funding Acknowledgements Type of funding sources: None. 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, markers of myocardial deformation and atherosclerosis (carotid intima-media thickness, IMT). Methods We examined 241 patients with psoriasis and 160 controls, adjusted for age, sex, BMI, smoking, LV mass, heart rate, hyperlipidemia, and office SBP. Perfusion boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels with a diameter ranging from 5-25 µm using a dedicated camera (Side field dark imaging, Micrsoscan, Nedelrands). 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), carotid IMT 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 PBR (PBR5-25: 2.131 ± 0.296 vs. 1.769 ± 0.306; PBR5-9: 1.183 ± 0.150 vs. 1.051 ± 0.132; PBR10-19: 2.318 ± 0.581 vs. 1.993 ± 0.365; PBR20-25: 2.650 ± 0.461 vs. 2.269 ± 0.492, all p < 0.05) and impaired LV twisting-untwisting markers compared to controls (pTw: 14.8 ± 7.8 vs. 13.9 ± 3.5; UtwMVO: 10.3 ± 7.3 vs. 9 ± 4.3; %dpTw – UtwMVO: 31 ± 4.1 vs. 38 ± 7; pTwVel: 105 ± 83 vs. 89 ± 21; pUtwVel: -100 ± 53 vs. -93 ± 31, all p < 0.05). In psoriatic population, levels of PBR5-25 and PBR10-19 were inversely correlated to CFR (r=-0.15 and r=-0.17). The first one was also reversely related to peak LV untwisting at aortic valve closure (r=-0.14). Increased levels of PBR5-9 were associated with reduced untwisting at end of the mitral inflow E wave (UtwEDF, r=-0.13) and reduced percentage difference between peak twisting and untwisting at MVO (%dpTw-UntwMVO) (r=-0.15). Furthermore, decreased RBC filling percentage and perfused microvascular density were related to worse LV longitudinal strain (4-chamber) (r=-0.15), and increased IMT (r=-0.14). Finally, a positive correlation between perfused microvascular density and %dpTw-UntwMVO was observed in patients with psoriasis (r = 0.14). All correlations were statistically significant (p < 0.05). Conclusion Endothelial glycocalyx thickness is reduced in patients with psoriasis and is associated with impaired coronary and myocardial function, and vascular atherosclerosis.

Effects of glucagon like peptide-1 receptor agonists and their combination with sodium-glucose cotransporter-2 inhibitors on myocardial deformation and work index in type 2 diabetes: 1 year follow up

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Type-2 diabetes mellitus (T2DM) exacerbates mechanisms of atherosclerosis and heart failure. Purpose We investigated the effect of novel antidiabetic drugs, glucagon like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on myocardial function. Methods A hundred-sixty T2DM patients (age: 58 ± 10years) were randomized to insulin (n = 40), liraglutide (n = 40), empagliflozin (n = 40) or their combination (GLP-1RA + SGLT-2i) (n = 40) as add-on to metformin. We measured at baseline and 1 year post-treatment: a) global LV longitudinal strain (GLS), systolic (GLSR) and diastolic (GLSR E) strain rate, global circumferential (GCS) and radial (GRS) strain, peak twisting (pTw), peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel), b) global myocardial work index (GWI), global constructive (GCW) and global wasted work (GWW) derived by pressure-myocardial strain loops using speckle tracking imaging. Results After 1 year of treatment, all patients improved GLS, GCS, GRS and pUtwVel (p < 0.05). GLP-1RA or GLP-1RA + SGLT-2i provided a greater increase of GLS (11.5% and 13% vs. 6.8% and 2.3%), GWI (12.7% and 17.4% vs. 3.1% and 2%), GCW (12.3% and 15% vs. 2.2% and 7.8%) and a greater reduction of GWW (38.7% and 41.6% vs. 13.5% and 4.9%) compared with insulin or SGLT-2i, despite a similar HbA1c reduction (p < 0.05 for all comparisons) (Table). Patients under combined treatment with GLP-1RA + SGLT-2i achieved a 2-fold reduction of pTw and a 2-fold increase of pUtwVel than those under each one regimen or insulin (p < 0.05). The dual therapy showed the greatest effect on measured myocardial markers in LVEF < 55% (p < 0.05). Conclusions One year treatment with GLP-1RA or combination of GLP-1RA and SGLT-2i resulted in a greater improvement of myocardial deformation and effective cardiac work than insulin or SGLT-2i treatment, independently of glycemic control in T2DM. All patients (n = 160) Insulin (n = 40) GLP-1RA (n = 40) SGLT-2i (n = 40) GLP-1RA + SGLT-2i (n = 40) p-value GLS, % Baseline -16.4 ± 3.7 -16.4 ± 3.5 -16.2 ± 3.5 -17 ± 4 -16 ± 4 0.139 1 year -17.9 ± 3.9 -17.6 ± 4.2 -18.3 ± 3.5 -17.4 ± 3.4 -18.4 ± 4.7 0.003 GWI, mmHg% Baseline 1538 ± 430 1644 ± 416 1510 ± 403 1536 ± 535 1463 ± 362 0.116 1 year 1692 ± 412 1696 ± 377 1730 ± 318 1568 ± 456 1772 ± 499 0.006 pTw, deg Baseline 15.7 ± 6 16 ± 5.1 15.6 ± 5 15.2 ± 6 16.1 ± 8 0.910 1 year 14.6 ± 5.1 15.4 ± 5.4 14.4 ± 5.4 14.7 ± 4.6 14 ± 5 0.034 pUtwVel, deg/s Baseline -104 ± 42 -100 ± 44 -107 ± 41 -101 ± 28 -111 ± 54 0.550 1 year -116 ± 49 -107 ± 55 -114 ± 45 -108 ± 38 -134 ± 61 0.017 Table

Left Ventricular Twist and Untwist in Patients Undergoing Elective Percutaneous Coronary Intervention.

Background:Left ventricular (LV) twist and untwist plays important roles in physiological adaptation and development of clinically relevant cardiac diseases.Aims:To assess LV twist and untwist in patients undergoing elective percutaneous coronary intervention (PCI) by two-dimensional (2D) speckle tracking echocardiography (STE).Subjects and Methods:Fifty patients who had stable angina pectoris and/or abnormal result from noninvasive stress tests were enrolled after undergoing elective PCI. Conventional and 2D STE were performed before elective PCI and after 3 months.Results:There was no significant systolic improvement in conventional echocardiography. However, there was a significant diastolic improvement after elective PCI as higher E, E/A, e` and lower E/e` (P < 0.034, <0.042, 0.015, and 0.033, respectively). In addition, there was a statistically significant improvement of STE-derived systolic parameters as regard higher global longitudinal strain, peak twist, and torsion (P value 0.009, 0.009, and < 0.001, respectively). Furthermore, there was significant improvement of STE-derived diastolic parameters as higher peak untwist, recoil, and lower time to peak untwist (P value 0.013, 0.001, and 0.004, respectively).Conclusions:LV and untwist parameters were improved before most of conventional echocardiographic parameters in postrevascularization of stable coronary artery disease.

Segmental longitudinal strain as the most accurate predictor of the patchy pattern late gadolinium enhancement in hypertrophic cardiomyopathy

BackgroundThe prognostic value of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) has been well-established. Although cardiac magnetic resonance (CMR) is the method of choice in its revealing as the presence of late gadolinium enhancement (LGE), this technique still has limited availability in daily clinical practice. Two-dimensional speckle tracking echocardiography (2D STE) seems to be helpful in verification which HCM patient has the highest probability of LGE presence and hence needs to be qualified to CMR. While the majority of HCM patients have a patchy pattern of myocardial fibrosis, the aim of this study was to evaluate whether segmental rather than global longitudinal strain is more accurate in the identification of the presence of LGE. MethodsForty-six HCM patients had transthoracic echocardiography and CMR imaging performed. Each patient had global longitudinal strain and rotation parameters calculated, as well as segmental analyses for wall thickness, longitudinal strain, and LGE presence based on 736 segments of the left ventricle (LV). The presence of LGE in CMR was confirmed on a per-segment basis, which was similar to LV segments in the echocardiographic examination. All patients were divided into two groups according to the CMR result: LGE (+) and LGE (−). ResultsReceiver-operating characteristic analyses identified peak global longitudinal strain and peak twisting velocity with the cut-off values −14.4% and 116°/s respectively as the accurate predictors of LGE presence in CMR, whereas segmental longitudinal strain of −12.5% cut-off value had the highest area under the curve value (87.4%, confidence interval 84.5–90.3%), with 93.7% sensitivity, 86.5% negative predictive value, and 55% specificity. ConclusionsSegmental longitudinal strain with the cut-off value of −12.5% has the highest discriminatory power for LGE presence and seems to be more adequate than global speckle tracking parameters in identification of HCM patients with strong indications for CMR for more accurate risk stratification.

Glucagon like peptide-1 receptor agonists and their combination with sodium-glucose cotransporter-2 inhibitors improve myocardial deformation and work index in type-2 diabetes after 12-month treatment

Abstract Background/Introduction Type-2 diabetes mellitus (T2DM) exacerbates mechanisms of atherosclerosis and heart failure. Purpose We investigated the effects of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on LV myocardial function of T2DM patients. Methods A hundred-sixty T2DM patients (age: 58±10 years) were randomized to insulin (n=40), liraglutide (n=40), empagliflozin (n=40) or their combination (GLP-1RA+SGLT-2i) (n=40) as add-on to metformin. We measured at baseline, 4 and 12 months post-treatment: a) global LV longitudinal strain (GLS), systolic (LongSr) and diastolic (LongSrE) strain rate, global circumferential (GCS) and radial (GRS) strain, peak twisting (pTw), peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel), b) global myocardial global work index (GWI), global constructive (GCW) and global wasted myocardial work (GWW) derived by pressure-myocardial strain loops using speckle tracking imaging. Results At 4 and 12 months post-treatment, all patients improved GLS, GCS, GRS and pUtwVel (p&amp;lt;0.05). At 12 months, GLP-1RA or GLP-1RA+SGLT-2i provided a greater increase of GLS (11.5% and 13% vs. 6.8% and 2.3%), GCS (11.9% and 14.6% vs. 7.3% and 3.4%), GRS (3.8% and 4.3% vs. 2.2% and 1.6%), GWI (12.7% and 17.4% vs. 3.1% and 2%), GCW (12.3% and 15% vs. 2.2% and 7.8%) and a greater reduction of GWW (38.7% and 41.6% vs. 13.5% and 4.9%) compared with insulin or SGLT-2i, despite a similar HbA1c reduction (p&amp;lt;0.05 for all comparisons) (Table). Patients under combined treatment with GLP-1RA+SGLT-2i achieved a 2-fold reduction of pTw and a 2-fold increase of pUtwVel than those under each one regimen or insulin (p&amp;lt;0.05). The dual therapy showed the greatest effect on measured myocardial markers in patients with LVEF &amp;lt;55% (p&amp;lt;0.05). Conclusions Twelve-month treatment with GLP-1RA or combination of GLP-1RA and SGLT-2i showed a greater improvement of myocardial deformation and effective cardiac work than insulin or SGLT-2i treatment in T2DM. The combined therapy as second line was superior to either insulin, or GLP-1RA and SGLT-2i separately. Funding Acknowledgement Type of funding source: None

Influence of chest conformation on myocardial strain parameters in healthy subjects with mitral valve prolapse.

Chest shape might affect myocardial strain parameters. However, the relationship between myocardial strain parameters and chest conformation has not been previously investigated in subjects with mitral valve prolapse (MVP). Between April 2019 and May 2020, 60 healthy subjects (50.1 ± 8.6year/old, 46.6% females) with MVP and mild-to-moderate mitral regurgitation, and 60 controls matched by age, sex, and cardiovascular risk factors were consecutively studied. Participants underwent modified Haller index (MHI) assessment (ratio of chest transverse diameter over the distance between sternum and spine), and transthoracic echocardiography implemented with 2D-speckle tracking analysis. MHI was significantly greater in MVP group than controls (2.6 ± 0.35 vs 2.1 ± 0.23, p < 0.0001). Left ventricular (LV) ejection fraction was similar in MVP and controls (63.5 ± 3.7% vs 64.3 ± 3.9%, p = 0.25). LV regional and global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) parameters and LV peak twist were all significantly lower in MVP compared to controls (all p < 0.0001). MVP subjects with a tight chest (MHI > 2.5, n = 30), and those with MHI ≤ 2.5 (n = 30) were then separately analyzed. A significant impairment in myocardial strain parameters and LV peak twist was documented in MVP subjects with MHI > 2.5, but not in those with MHI ≤ 2.5. MHI showed a strong inverse correlation with LV-GLS (r = - 0.85), GCS (r = - 0.84), GRS (r = - 0.84) and LV peak twist (r = - 0.94). In MVP subjects, impairment of myocardial strain parameters is not due to intrinsic reduction of cardiac contractility function, but it appears to be related to the degree of chest deformity.

Using a Single Uniaxial Gyroscope to Detect Lateral Ankle Sprain Hazard

Lateral ankle sprain is very common in sports. Recently, there was a wearable assistive technology that stimulates the peroneal muscles to prevent this injury, but it requires a monitoring system to detect injury hazards and actuate the protection. This study presents the feasibility of a uniaxial gyroscope to monitor the peak ankle inversion velocity during common sporting motion and simulated ankle sprain motion. Ten males performed walking, running, 45-deg cutting, vertical jump-landing, stepping-down from a block, 5 kinds of simulated ankle sprain motion on sprain simulators, and a manual ankle-twisting motion in a biomechanics laboratory. The peak ankle inversion velocity was collected by an optical motion analysis system at 120 Hz. Besides, a uniaxial gyroscope was attached to the heel to collect the peak twisting velocity at 500 Hz. Pearson test showed a strong or high positive correlation between the two parameters. Independent t-test showed no difference between the two parameters in all testing motions except the manual ankle-twisting test which the value was 82% of that from the optical motion capture system and both values are above the threshold, 300 deg/s. We concluded the method is applicable to detect the hazard of lateral ankle sprain injury.

Reduced Exercise Capacity in Diabetes Mellitus Is Not Associated with Impaired Deformation or Twist

Exercise capacity is frequently reduced in people with diabetes mellitus (DM) and may be due to subclinical cardiac dysfunction. Speckle-tracking echocardiography is now widely available; however, the clinical utility and significance of left ventricular (LV) strain and twist parameters remain uncertain. We hypothesized that LV strain and twist would be reduced in DM subjects during exercise. Adults with type 1 or type 2 DM and age- and sex-matched controls performed cardiopulmonary exercise testing (VO2 peak) and supine bicycle exercise echocardiography. Detailed echocardiographic assessment of biventricular function was performed at baseline and repeated during incremental exercise to maximal intensity. Of the 60 participants completing the study protocol, 51 (34 DM, 17 controls; mean age, 42±13years; 69% male; DM duration, 16±10years) had sufficient image quality to assess LV deformation and twist mechanics at rest. Of these, 38 (25 DM, 13 controls) were able to be assessed immediately after exercise. Baseline LV systolic and diastolic function using standard echocardiography measurements were similar between groups. Resting LV global longitudinal strain, twist, twist rate and untwist rate, and the corresponding peak exercise and reserve measures did not differ significantly. As compared with the control subjects, exercise capacity was reduced in the DM cohort (VO2 peak 33±10 vs 41±12mL/minute/kg; P=.02); however, no correlation was observed between VO2 peak and LV twist reserve (R=0.28, P=.09), LV twist rate reserve (R=0.14, P=.39), or LV untwist rate reserve (R=0.24, P=.14). Despite reduced VO2 peak, LV twist mechanics at rest and after maximal intensity exercise did not differ significantly in a cohort of asymptomatic DM subjects with normal resting LV systolic and diastolic function compared with age- and sex-matched controls. This would suggest that exercise capacity can be reduced in the absence of subclinical cardiac dysfunction and that noncardiac factors should be considered as alternative explanations.

P319 Evidence for abnormal deformational reserve in hypertrophic cardiomyopathy on exercise: is it a game-changer?

Abstract Funding Acknowledgements None Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by muscle hypertrophy and fibrosis, interfering with force generation and relaxation. Abnormal ventricular (LV) myocardial deformation have been demonstrated in patients with HOCM at rest, but there is lack of data regarding the deformational mechanics in exercise. AIMS: We wanted to assess the adaptability of LV deformational behaviour to physical exercise in HCM patients as compared to healthy control subjects. METHODS 24 obstructive HOCM (age 51.2 ± 14.2yrs; 16 men, LVOT-obstruction 56 ± 19mmHg at rest or on Valsalva maneuver) and 32 control subjects (50.9 ± 6.8 yrs, 19 men from the MAGYAR-PATH Registry) underwent supine bicycle stress echocardiography (ESE) with measurements of 2D- and Doppler, 2D-Speckle Tracking Tracking Imaging and 3D-Full Volume Analysis. Beyond conventional LV/RV functional measurements; peak longitudinal (LS), circumferential (CS) Strain values; peak Twist and Torsion angles; post-systolic shortening index (PSS) and diastolic phase indices (Untwisting time - UTT and rate - UTR) calculated; the UTR/Twist ratio was given as "coupling index". The LV/RV-EF calculated by 3D-Full Volume Analysis off-line by TomTec Arena™ software both at rest and on submaximal ESE. RESULTS The HOCM group had lower resting LS (-14.6 ± 4.5 vs 18.4 ± 2.6%, p &amp;lt; 001) but higher CS (-32.9 ± 5.1 vs 28.8 ± 2.3%, p &amp;lt; 0.001) and Twist angles (9.9 ± 2.6 vs 6.1 ± 2.2º, p &amp;lt; 0.01) than control subjects. Exercise induced an increase in all strains in control subjects, but much less in HOCM (LS: -21.4 ± 3.5 vs 15.1 ± 3.0% and CS: -33.9 ± 3.6 vs 34.1 ± 4.2% in HOCM, p &amp;lt; 0.02 in controls, NS in HOCM); the increase of Twist angle was minimal in HOCM (Δ1.2 ± 1.2 vs Δ3.6 ± 2.3º in controls, p &amp;lt; 0.01). The PSS was more pronounced on ESE in HOCM than in controls (46.6 ± 12 vs 21.2 ± 9.6% in controls, p &amp;lt; 0.001). Peak UTR was slower (118 ± 2.1 vs 133.1 ± 14.1 º/s) during ESE and occured later (141 ± 19 vs 121 ± 9.1% of systolic time, p &amp;lt; 0.02) in HOCM than in controls. There was significant relationship between the Twist and UTR in control subjects (β=-0.0807, p &amp;lt; 0.001), but not in HOCM (β=-0.0046, p = 0.05). The UTR/Twist ratio diminished only in HOCM but not in controls (-8.0 ± 0.6 vs -13.1 ± 2.5 1/s, p &amp;lt; 0.02). CONCLUSIONS The HOCM patients had significantly impaired strain-adaptability; developed post-systolic shortening and no LV Torsional reserve was found on exercise. Also, I detected decreased and delayed UTR indices in the HOCM group. These findings support evidence for reduced systolic-diastolic coupling efficiency, assessed by Twist-Untwist mechanics in HOCM patients, which can contribute to the development of exercise-related symptoms and the dynamic LVOT-obstruction. This unique pattern of deformational behaviour to exercise can help in the differential diagnostic workup in patients with LV hypertrophy of unknown aetiology and also would hold additional value in the risk stratification process for patients with HCM-phenotypes.

Usefulness of Myocardial Strain and Twist for Early Detection of Myocardial Dysfunction in Patients With Autoimmune Diseases

Cardiac involvement in autoimmune diseases (AD) is common but underdiagnosed due to a lack of sensitive imaging methods. We aim to evaluate the characteristics of left ventricular (LV) systolic dysfunction in patients with AD using deformational parameters from 2-dimensional speckle-tracking echocardiography (STE). We retrospectively enrolled 86 AD patients and 71 healthy controls. All subjects underwent transthoracic echocardiography and STE to analyze LV strain and twist. A twist-radial displacement loop was constructed to investigate the relation between LV contractility and dimension. In AD patients, 68 had preserved LV ejection fraction (EF ≥ 50%), and 18 had reduced LVEF (EF < 50%). The patients with preserved LVEF exhibited significantly lower values of global longitudinal, circumferential, and radial strain than controls (-19.11 ± 4.18 vs -21.49 ± 2.53%, -25.17 ± 5.04% vs -27.37 ± 2.87%, 17.68 ± 5.69% vs 21.17 ± 6.44%, respectively; all p <0.01) and a marked attenuation in peak twist (14.24 ± 5.57 vs 18.10 ± 5.97, p <0.01) attributed to impaired apical rotation (9.03 ± 5.17 vs 12.79 ± 5.99, p <0.01). AD patients were more likely to present with abnormal loop types with flat ascending slope and delayed peak twist time. In conclusion, abnormal strain and twist precede deterioration in LVEF, suggesting early myocardial involvement in AD. STE can be used as a good alternative for early detection of myocardial dysfunction in AD patients.

P2477Assessment of intraventricular flow dynamics in acute heart failure studied by Vector Flow Mapping

Abstract Background Although left ventricular (LV) flow dynamics should be closely related to LV morphology and function, little is known about how heart failure (HF) changes it. Pathline Analysis (PA), a recently developed software based on Vector Flow Mapping (VFM, Hitachi), enables us to trace the virtual blood particles entering to the LV in diastole and being ejected in systole. We investigated the change of flow dynamics in HF induced in dogs using PA. Methods In 15 open-chest dogs, HF was induced by intracoronary injection of microspheres. Color Doppler images of apical long-axis view were acquired using Prosound F75 (Hitachi) before and after HF and were analyzed by PA. We calculated the ratio of the numbers of entering particles in diastole and ejected particles in systole (ejection rate) and the distance reached by the particles in diastole corrected by the LV long-axis diameter (propagation distance). Apical and basal short axis images were acquired using GE Vivid E9 and were analyzed for peak rotation and peak twist. Results After inducing HF, LV end-diastolic pressure increased from 6±2 to 15±5 mmHg (p&lt;0.001) and ejection fraction (EF), apical peak rotation and peak twist decreased significantly (EF; 58±5 to 36±8%, apical peak rotation; 14±5 to 3±2 degree, peak twist; 19±5 to 6±3 degree, p&lt;0.05, respectively). PA showed most of the entering particles to the LV were ejected in the following systole at the control stage, but in HF, a significant part of the entering particles were not ejected and remained in the LV (Figure). Ejection rate decreased from 50±11 to 26±11% (p&lt;0.001) and the propagation distance decreased from 85±9 to 66±13% (p&lt;0.001) after inducing HF. There were significant relationships between indices obtained by PA and EF and peak twist (Table). Conclusion A significant part of inflow is not ejected directly to the outflow in the next systole and remains in the LV in HF, suggesting inefficient flow dynamics.

Myocardial velocity, intra-, and interventricular dyssynchrony evaluated by tissue phase mapping in pediatric heart transplant recipients.

Endomyocardial biopsy (EMB) is the standard method for detecting allograft rejection in pediatric heart transplants (Htx). As EMB is invasive and carries a risk of complications, there is a need for a noninvasive alternative for allograft monitoring. To quantify left and right ventricular (LV & RV) peak velocities, velocity twist, and intra-/interventricular dyssynchrony using tissue phase mapping (TPM) in pediatric Htx compared with controls, and to explore the relationship between global cardiac function parameters and the number of rejection episodes to these velocities and intra-/interventricular dyssynchrony. Prospective. Twenty Htx patients (age: 16.0 ± 3.1 years, 11 males) and 18 age- and sex-matched controls (age: 15.5 ± 4.3 years, nine males). 5T; 2D balanced cine steady-state free-precession (bSSFP), TPM (2D cine phase contrast with three-directional velocity encoding). LV and RV circumferential, radial, and long-axis velocity-time curves, global and segmental peak velocities were measured using TPM. Short-axis bSSFP images were used to measure global LV and RV function parameters. A normality test (Lilliefors test) was performed on all data. For comparisons, a t-test was used for normally distributed data or a Wilcoxon rank-sum test otherwise. Correlations were determined by a Pearson correlation. Htx patients had significantly reduced LV (P < 0.05-0.001) and RV (P < 0.05-0.001) systolic and diastolic global and segmental long-axis velocities, reduced RV diastolic peak twist (P < 0.01), and presented with higher interventricular dyssynchrony for long-axis and circumferential motions (P < 0.05-0.001). LV diastolic long-axis dyssynchrony (r = 0.48, P = 0.03) and RV diastolic peak twist (r = -0.64, P = 0.004) significantly correlated with the total number of rejection episodes. TPM detected differences in biventricular myocardial velocities in pediatric Htx patients compared with controls and indicated a relationship between Htx myocardial velocities and rejection history. 2 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1212-1222.

Cardiac Structure-Function MRI in Patients After Heart Transplantation.

Following heart transplantation (Tx), recipients are closely monitored using endomyocardial biopsy, which is limited by cost and invasiveness, and echocardiography, which is limited regarding detailed structural and functional evaluation. To test the feasibility of comprehensive structure-function cardiac MRI as a noninvasive modality to assess changes in myocardial structure and function. Prospective. MR was performed in 61 heart transplant recipients (age 47.9 ± 16.3 years, 39% female) and 14 age-matched healthy controls (age 47.7 ± 16.7 years, 36% female). 1.5T; 2D CINE steady state free precession (SSF)P imaging, T2 -mapping, pre- and postgadolinium contrast T1 -mapping, and tissue-phase mapping (TPM). Quantification of myocardial T2 (as a measure of edema), pre- and post-Gd T1 (allowing calculation of extracellular volume (ECV) to estimate interstitial expansion), and TPM-based assessment of peak regional left ventricular (LV) velocities, dyssynchrony, and twist. Comparisons between transplant recipients and controls were performed using independent samples t-tests. Relationships between structural (T2 , T1 , ECV) and functional measures (myocardial velocities, dyssynchrony, twist) were assessed using Pearson correlation analysis. T2 and T1 were significantly elevated in transplant recipients compared to controls (global T2 : 50.5 ± 3.4 msec vs. 45.2 ± 2.3 msec, P < 0.01; global T1 : 1037.8 ± 48.0 msec vs. 993.8 ± 34.1 msec, P < 0.01). Systolic longitudinal function was impaired in transplant recipients compared to controls (reduced peak systolic longitudinal velocities, 2.9 ± 1.1 cm/s vs. 5.1 ± 1.2 cm/s, P < 0.01; elevated systolic longitudinal dyssynchrony, 60.2 ± 30.2 msec vs. 32.1 ± 25.1 msec, P < 0.01). Correlation analysis revealed a significant positive relationship between T2 and ECV (r = 0.45,P < 0.01). In addition, peak systolic longitudinal velocities demonstrated a significant inverse relationship with T2 (global r = -0.29, P = 0.02), and systolic radial dyssynchrony was positively associated with peak T2 and peak T1 (r = 0.26,P = 0.04; r = 0.27,P = 0.03). MR techniques are sensitive to structural and functional differences in transplant recipients compared to controls. Structural (T2 , T1 ) and functional (peak myocardial velocities, dyssynchrony) measures were significantly associated, suggesting a structure-function relationship of cardiac abnormalities following heart transplant. 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:678-687.

Abnormalities in Left Ventricular Rotation Are Inherent in Young Children with Repaired Tetralogy of Fallot and Are Independent of Right Ventricular Dilation.

Left ventricular (LV) dysfunction is a risk factor for adverse outcomes in older children and adults with repaired Tetralogy of Fallot (rToF). Pulmonary regurgitation (PR), right ventricular (RV) dilation, and dysfunction have been shown to result in abnormal LV myocardial mechanics and dysfunction. The aim of our study was to evaluate LV rotational mechanics, especially apical rotation in young children with rToF with and without RV dilation. This is a retrospective, single center study in 28 asymptomatic young children with rToF (16 with RV dilation; 12 without RV dilation); 29 age-matched normal controls. RV and LV systolic and diastolic function was studied using conventional two-dimensional echocardiography (2DE) and speckle tracking echocardiography (STE). Rotational mechanics studied included basal and apical rotation (BR, AR), peak twist (calculated by difference between the apical and basal rotation), twist rate (TR), and untwist rate (UnTR). The mean age of the cohort was 4.7years (± 2.3). Abnormal AR, BR, TR, and UnTR were noted in patients with rToF. The abnormalities were significant in magnitude as well as the direction of rotation; more pronounced in the absence of RV dilation. LV systolic and diastolic dysfunction as evidenced by abnormal AR and degree of untwist is inherent in rToF and not associated with RV dilation in rToF children. Abnormal BR may reflect a lack of maturation to adult type of rotational mechanics. Further longitudinal studies are required to study the progression of these abnormalities and their correlation with clinical outcomes.

Effects of 6-month treatment with the glucagon like peptide-1 analogue liraglutide on arterial stiffness, left ventricular myocardial deformation and oxidative stress in subjects with newly diagnosed type 2 diabetes

BackgroundIncretin-based therapies are used in the treatment of type 2 diabetes mellitus (T2DM) and obesity. We investigated the changes in arterial stiffness and left ventricular (LV) myocardial deformation after 6-month treatment with the GLP-1 analogue liraglutide in subjects with newly diagnosed T2DM.MethodsWe randomized 60 patients with newly diagnosed and treatment-naive T2DM to receive either liraglutide (n = 30) or metformin (n = 30) for 6 months. We measured at baseline and after 6-month treatment: (a) carotid-femoral pulse wave velocity (PWV) (b) LV longitudinal strain (GLS), and strain rate (GLSR), peak twisting (pTw), peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography. LV untwisting was calculated as the percentage difference between peak twisting and untwisting at MVO (%dpTw–UtwMVO), at peak (%dpTw–UtwPEF) and end of early LV diastolic filling (%dpTw–UtwEDF) (c) Flow mediated dilatation (FMD) of the brachial artery and percentage difference of FMD (FMD%) (d) malondialdehyde (MDA), protein carbonyls (PCs) and NT-proBNP.ResultsAfter 6-months treatment, subjects that received liraglutide presented with a reduced PWV (11.8 ± 2.5 vs. 10.3 ± 3.3 m/s), MDA (0.92 [0.45–2.45] vs. 0.68 [0.43–2.08] nM/L) and NT-proBNP (p < 0.05) in parallel with an increase in GLS (− 15.4 ± 3 vs. − 16.6 ± 2.7), GLSR (0.77 ± 0.2 vs. 0.89 ± 0.2), pUtwVel (− 97 ± 49 vs. − 112 ± 52°, p < 0.05), %dpTw–UtwMVO (31 ± 10 vs. 40 ± 14), %dpTw–UtwPEF (43 ± 19 vs. 53 ± 22) and FMD% (8.9 ± 3 vs. 13.2 ± 6, p < 0.01). There were no statistically significant differences of the measured markers in subjects that received metformin except for an improvement in FMD. In all subjects, PCs levels at baseline were negatively related to the difference of GLS (r = − 0.53) post-treatment and the difference of MDA was associated with the difference of PWV (r = 0.52) (p < 0.05 for all associations) after 6-month treatment.ConclusionsSix-month treatment with liraglutide improves arterial stiffness, LV myocardial strain, LV twisting and untwisting and NT-proBNP by reducing oxidative stress in subjects with newly diagnosed T2DM.ClinicalTrials.gov Identifier NCT03010683

Improvement of continuous subcutaneous insulin infusion on patients with type 2 diabetes mellitus by 3-dimensional speckle tracking echocardiography.

Three-dimensional speckle tracking echocardiography (3D-STE) was used to evaluate the improvement of continuous subcutaneous insulin infusion on the left ventricular (LV) systolic function of patients with type 2 diabetes mellitu (T2DM). We recruited T2DM patients (38 cases, diabetic group) and healthy volunteers (35 cases, control group) to collect LV full volume imaging. TomTec software was used for calculating LV global longitudinal strain (LVGLS), global circumferential strain (LVGCS), peak twist (LVTW), peak apical rotation (LVPAR), ejection fraction (LVEF), and torsion (LVT). All indices were re-tested 2weeks later after intensive treatment of insulin pump. LVGLS, LVGCS, LVTW and LVPAR in diabetic group were significantly decreased than control group. LVGLS and LVGCS in pre-treatment diabetic group were significantly increased than post-treatment. LVGLS, LVGCS, LVTW and LVPAR had correlations among control, pre-treatment and post-treatment diabetic groups. There were no significant differences in LVEDV, LVESV, LVEF, LVT and R-R. LV systolic function of patients with T2DM complicated with microangiopathy was improved after treatment of continuous subcutaneous insulin infusion. In addition, therapeutic effect could be accurately evaluated by 3D-STE which had vital clinical application.

Left Ventricular Rotational and Twist Mechanics in the Human Fetal Heart

The authors investigated left ventricular (LV) rotational indices, twist, and torsion in a large cohort of fetuses using two-dimensional speckle-tracking echocardiography. Pregnant women (N=102) were prospectively recruited for fetal two-dimensional speckle-tracking echocardiography. Because of variable fetal position, ventricular orientation was established using the location of the liver and LV position in relation to the right ventricle. Twist measurements required correction to account for fetal position, reconciling directionality across all fetal orientations. Peak apical and basal rotations, global longitudinal strain, global circumferential strain (GCS), longitudinal strain rate, circumferential strain rate (CSR), twist, and torsion were reported and tested for associations with gestational age (GA) and estimated fetal weight (EFW). Measurement of rotational indices was feasible in 175 examinations (73%). The mean maternal age was 31±6years, the mean GA 24±6weeks, and the EFW 1.0±1.0kg. Mean peak apical rotation, basal rotation, twist, and torsion were 9.5±2.0°, -4.4±1.1°, 13.1±2.3°, and 7.9±3.4°/cm, respectively. Mean global longitudinal strain, GCS, longitudinal strain rate, and CSR were -22.3±4.3%, -25.0±6.1%, -1.4±0.5sec-1, and -1.6±0.5sec-1, respectively. Absolute GCS, CSR, apical rotation, and twist declined moderately with GA and EFW (P<.05). There were strong negative nonlinear correlations of torsion with GA and EFW: torsion=1,104×GA-1.591 (r2=0.760, P<.001); torsion=115.88×EFW-0.427 (r2=0.772, P<.001). Determination of fetal LV rotational mechanics is feasible and reproducible using two-dimensional speckle-tracking echocardiography. Basal rotation, longitudinal strain, and strain rate vary little with EFW and GA. Interpretation of LV apical rotation, twist, torsion, GCS, and CSR, however, must take GA or EFW into account. These data form the basis for comparison with findings in fetuses with abnormal cardiacanatomy and function.

105 Differences in myocardial mechanics between ischaemic and non-ischaemic cardiomyopathy assessed by cmr: a sub-group analysis of the vindicate trial

BackgroundPrognosis and treatment of patients with chronic heart failure (CHF) differs according to whether it is ischaemic (ICM) or non-ischaemic cardiomyopathy (NICM). Multi-parametric cardiovascular magnetic resonance (CMR) can distinguish these...

Early detection of left ventricular dysfunction in first-degree relatives of diabetic patients by myocardial deformation imaging: The role of endothelial glycocalyx damage

BackgroundFirst-degree relatives of type-2 diabetes patients (FDR) present insulin resistance. We investigated whether FDR and dysglycaemic subjects demonstrate abnormal endothelial glycocalyx and LV deformation during postprandial hyperglycemia. MethodsWe studied 40 FDR with normal oral glucose test (OGTT), 40 subjects with abnormal OGTT (dysglycaemic) and 20 subjects with normal OGTT without parental history of diabetes (normoglycaemic). At 0 and 120min of OGTT we measured: a) LV longitudinal strain (LS) of subendocardial, mid-myocardial and subepicardial layers, global LS (GLS), peak twisting (pTw), untwisting velocity (pUtwVel), by speckle tracking echocardiography b) perfused boundary region (PBR) of the sublingual arterial microvessels; high PBR values represent reduced glycocalyx thickness. Insulin resistance was evaluated using insulin sensitivity index (ISI). ResultsISI was related with baseline PBR, GLS and pTw in all subjects (p<0.05). Compared to normoglycaemics, FDR and dysglycaemics had higher PBR, lower ISI, GLS (−18.4±2.6 and −16.8±2.0 vs. −19.2±2.4%), subendocardial LS (−19.0±4.2 and −17.9±3.0 vs. −20.1±3.4%), pTw (14.4±4.4 and 15.6±6.4 vs. 16.9±6.5deg) and pUtwVel (p<0.05 for all comparisons). A GLS<−18% identified FDR with LV dysfunction (p=0.016).Post-OGTT, GLS and the subendocardial LS decreased while pTw and pUtwVel increased in FDR and dysglycaemics (p<0.05) indicating prevalence of the motion of the subepicardial over a dysfunctioning subendocardial myocardial helix. Increased PBR was related with impaired deformation markers at baseline and 120min of OGTT (p<0.05). ConclusionFirst-degree relatives and dysglycaemics have reduced glycocalyx thickness related with impaired LV longitudinal, twisting-untwisting function. Postprandial hyperglycemia when combined with insulin resistance causes LV longitudinal dysfunction leading to increased LV twisting.