Segmental Longitudinal Strain Research Articles

Advanced Myocardial Characterization in Hypertrophic Cardiomyopathy: Feasibility of CMR-based Feature Tracking Strain Analysis

Abstract Aim of the Work This study aimed to evaluate the role of cardiovascular magnetic resonance feature tracking (CMR-FT) using a commercially available software module for analysis of left ventricular strain in hypertrophic cardiomyopathy patients. Patients and Methods A total of 20 HCM patients and 10 controls were studied. All patients were subjected to detailed clinical history taking and CMRI. Left ventricular global longitudinal, circumferential and radial strains were analyzed as well as segmental longitudinal and circumferential strains. Results LV mass in the HCM group was significantly higher than that in the control group (p < 0.001). No statistical difference was found in ejection fraction (p = 0.074). Global circumferential strain (GCS) global longitudinal strain (GLS), segmental longitudinal strain (SLS) and segmental circumferential strain (SCS) in the HCM group were all significantly lower than the correlated parameters in the control group (p < 0.001, respectively). Global radial strain (GRS) in the HCM group was significantly higher than the control group (p = 0.002). Additionally, SLS & SCS in the HCM group were both significantly lower, before global strain affection (p < 0.001). Conclusion CMR-FT is a promising approach in analyzing impairment of global and segmental myocardium deformation in Egyptian patients with hypertrophic cardiomyopathy, non-invasively and quantitatively.

Assessment of the Ischaemic Effects of Myocardial Bridge by Echocardiographic Exercise Stress Test.

Detection of myocardial bridge (MB) at angiography suggests it has a role in ischaemic-related symptoms in patients with angina without obstructive coronary artery disease. However, evidence that MB may cause myocardial ischaemia is limited. We studied 41 patients with MB of the left anterior descending coronary artery and otherwise normal coronary arteries. Fourteen patients with normal coronary arteries and without MB served as controls. All subjects underwent a maximal treadmill exercise stress test (EST) under ECG monitoring. Standard and speckle-tracking echocardiography were performed at baseline and immediately after peak EST. EST duration and peak heart rate and systolic pressure were similar in the two groups. A positive EST (ST-segment depression .1 mm) was found in 18 patients in the MB group (43.9%) and none in the control group (p=0.001). No abnormalities in both left ventricle systolic and diastolic function were found between the two groups in the standard echocardiographic evaluation. Global and segmental (anterior, inferior) longitudinal strain (LS) did not differ at baseline between the groups. There was a small increase in global LS during EST in MB patients but not in the control group (p=0.01). Similar trends were found for regional LSs, with differences being significant for the medium (p=0.028) and apical (p=0.032) anterior segments. No differences in echocardiographic parameters and both global and segmental LSs were observed between MB patients with ischaemic ECG changes during EST versus those without. Our findings do not support the notion that MB results in significant degrees of myocardial ischaemia during maximal myocardial work.

Lower dose radiotherapy did not alter cardiac function and was not pro-arrhythmic: results of the small prospective HALO trial

Abstract Background Stereotactic arrhythmia radiotherapy (STAR) is a highly promising bail-out treatment for patients with therapy-refractory ventricular tachycardia (VT). Despite precise, noninvasive targeting of the pro-arrhythmic area, surrounding healthy cardiac tissue inadvertently receives low-dose radiation. There is a historical notion that collateral cardiac damage from radiation of extra-cardiac structures can cause heart failure and arrhythmias. In the HALO trial, where non-small cell lung cancer (NSCLC) patients treated with stereotactic ablative radiotherapy (SABR) received relatively low-dose radiotherapy to the heart, detailed cardiac safety after radiotherapy was therefore evaluated. Objective The aim of this study was to prospectively evaluate cardiac function after collateral radiotherapy on the heart in patients with NSCLC treated with SABR. Methods The HALO trial was a prospective observational trial evaluating cardiac adverse effects in patients treated with SABR for early stage NSCLC. Patients with a tumour within 3cm of the pericardium were eligible to participate. The mean radiotherapy dose per segment was calculated by semi-automated angulation and segmentation using an in-house developed tool. The heart was segmented according to the AHA 17-segment model. Patients underwent cardiac magnetic resonance imaging (CMR) pre-treatment, 3 and 12 months after treatment. CMR strain-analysis was conducted by two independent observers using cvi42 software. Longitudinal, radial and circumferential strain were measured both globally and segmentally and evaluated for dose-dependent effects. Results Ten patients were included in this study. Two patients dropped out before first follow-up and were not included in this analysis. Median age was 66 years (range 58-81) and four were male (50%). Median distance between the tumour and pericardium was 0.46cm (range 0.00-2.80). Patients were treated with 8 fractions of 7.0-7.5 Gy (n=6), 5 fractions of 11.0 Gy (n=1) or 3 fractions of 18.0 Gy (n=1). Median global cardiac radiotherapy dose was 6.7 Gy (range 0.1-17.9). Pre-treatment, median left ventricular ejection fraction as measured on CMR was 65% (range 40-75), global longitudinal strain was -15% (-20 - -9), global circumferential strain was -17% (-26 - -9) and global radial strain was 28% (11-60). These did not significantly change comparing 3 months and 12 months after treatment with pre-treatment. As can be appreciated from Table 1, there were no dose-dependent effects on segmental longitudinal, radial and circumferential strain both 3 months or 12 months after SABR. There were no ventricular arrhythmias observed during follow-up. Conclusion In this small study, collateral radiotherapy in patients with NSCLC treated with SABR did not significantly alter cardiac function as measured on CMR, and no relevant pro-arrhythmic effects were observed during short term follow-up. Extending the research into a larger dataset is warranted.

Lower Limit of Normality of Segmental Multilayer Longitudinal Strain in Healthy Adult Subjects.

Speckle tracking echocardiography is an advanced imaging technique that allows for a more detailed assessment of cardiac global and regional function. Reference values for segmental longitudinal layered strain (subendocardial, mid-myocardial, and subepicardial) are scarce, limiting the clinical use of these measurements in clinical practice. Two hundred consecutive Caucasian healthy subjects (mean age = 37 ± 11 years) were enrolled in the study. The mean values of global longitudinal strain (GLS) for endocardial (Endo), mid-myocardial (Myo) and epicardial (Epi) layers were -22.9 ± 2.7, -20.0 ± 2.4 and -17.5 ± 2.1, respectively. The GLSEndo/GLSMyo ratio was 1.1 ± 0.05, while the GLSEndo/GLSEpi ratio was 1.3 ± 0.05. The apical strain-sparing ratio was >1 in 10% of the subjects (endocardium) and 7% (mid-myocardium). The lower limits for segmental LS were as follows: for endocardial LS, -10% (basal), -12% (mid), -14% (apical); for mid-myocardial LS, -10% -10% (basal), -10% (mid), -10% (apical); and for epicardial LS, -7% (basal), -8% (mid), -8% (apical). The findings of this study provide data regarding the lower limit of normality of LS for each LV segment and suggest, for practical considerations, that an LS value below 10% should be considered abnormal in any segment. Further larger studies are warranted to confirm these findings.

Diverse distribution patterns of segmental longitudinal strain are associated with different clinical features and outcomes in dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) presents with diverse clinical courses, hardly predictable solely by the left ventricular (LV) ejection fraction (EF). Longitudinal strain (LS) offers distinct information from LVEF and exhibits various distribution patterns. This study aimed to evaluate the clinical significance of LS distribution patterns in DCM. We studied 139 patients with DCM (LVEF ≤ 35%) who were admitted for heart failure (HF). LS distribution was assessed using a bull's eye map and the relative apical LS index (RapLSI), calculated by dividing apical LS by the sum of basal and mid-LS values. We evaluated the associations of LS distribution with cardiac events (cardiac death, LV assist device implantation, or HF hospitalization) and LV reverse remodeling (LVRR), as indicated by subsequent LVEF changes. Twenty six (19%) and 29 (21%) patients exhibited a pattern of relatively apical impaired or preserved LS (defined by RapLSI < 0.25 or > 0.75, signifying a 50% decrease or increase in apical LS compared to other segments), and the remaining patients exhibited a scattered/homogeneously impaired LS pattern. The proportion of new-onset heart failure and LVEF differed between the three groups. During the median 595-day follow-up, patients with relatively-impaired apical LS had a higher rate of cardiac events (both log-rank p < 0.05) and a lower incidence of LVRR (both p < 0.01) compared to patients with other patterns. RapLSI was significantly associated with cardiac event rates after adjusting for age, sex, and new-onset HF or global LS. DCM patients with reduced EF and distinct distribution patterns of impaired LS experienced different outcomes.

The usefulness of speckle tracking echocardiography for the prediction of cardiac involvement in patients with biopsy-proven sarcoidosis.

Cardiac sarcoidosis (CS) is commonly diagnosed based on clinical criteria and abnormalities in noninvasive imaging reported in patients with biopsy-proven extracardiac sarcoidosis. Electrocardiogram and two-dimensional echocardiography have a low sensitivity for CS detection. Cardiovascular magnetic resonance imaging (CMR) and positron emission tomography (PET) have limitations in terms of cost and availability. This study aimed to assess the usefulness of left ventricular longitudinal strain, measured using two-dimensional speckle tracking echocardiography (STE), for the prediction of late gadolinium enhancement (LGE) presence in CMR in patients with biopsy-proven sarcoidosis. A total of 119 patients with biopsy-proven extracardiac sarcoidosis were divided, according to the clinical criteria proposed by the 2014 Heart Rhythm Society expert consensus statement (HRS 2014), into two groups: 43 individuals with "probable cardiac sarcoidosis", CS(+) and 76 individuals without cardiac sarcoidosis, CS (-). Data from echocardiography, CMR, 12-lead ECG and 24h Holter monitoring were analyzed. Left ventricular global longitudinal strain (LV-GLS) was slightly reduced in the entire sarcoidosis group (-18.61±2.96), no difference between the CS (+) and CS (-) subgroups was found (-18.0%±3.2% and -18.9%±2.8%, respectively; p=.223). No cut-off value for LV-GLS was identified that could predict the presence of LGE. Segmental longitudinal strain impairment partially correlated with the presence of LGE on CMR. In our cohort of sarcoidosis patients, segmental longitudinal strain proved more helpful in the diagnostic process than LV-GLS. The ultimate role of STE in the diagnosis of CS remains to be established.

Layer-specific fast strain-encoded cardiac magnetic resonance imaging aids in the identification and discrimination of acute myocardial injury: a prospective proof-of-concept study

Acute myocardial injury is a common diagnosis in the emergency department and differential diagnoses are numerous. Cardiac magnetic resonance (CMR) strain sequences, such as fast strain ENCoded (fSENC), are early predictors of myocardial function loss. This study assessed the potential diagnostic and prognostic benefits of a layer-specific approach. For this prospective study, patients in the emergency department fulfilling rule-in criteria for non-ST-elevation myocardial infarction (NSTEMI) received an ultra-fast fSENC CMR. Volunteers without cardiac diseases (controls) were recruited for comparison. Measurements were performed in a single heartbeat acquisition to measure global longitudinal strain (GLS) and segmental longitudinal strain and dysfunctional segments. The GLS was measured in two layers and a difference (GLSdifference =GLSepicardial -GLSendocardial) was calculated. The performance of those strain features was compared to standard care (physical examination, cardiac biomarkers, electrocardiogram). According to the final diagnosis after discharge, patients were divided into groups and followed up for 2years. A total of 114 participants, including 50 controls, were included. The 64 patients (51 male) were divided into a NSTEMI (25), myocarditis (16), and other myocardial injury group (23). GLS served as a potent predictor of myocardial injury (area under the curve (AUC) 91.8%). The GLSdifference provided an excellent diagnostic performance to identify a NSTEMI (AUC 83.2%), further improved by including dysfunctional segments (AUC 87.5%, p=0.01). An optimal test was achieved by adding fSENC to standard care (AUC 95.5%, sensitivity 96.0%, specificity 86.5%, p=0.03). No death occurred in 2years for patients with normal GLS and ≤5 dysfunctional segments, while three patients died that showed abnormal GLS or >5 dysfunctional segments. Layer-specific strain is a potential new marker with high diagnostic performance in the identification and differentiation of acute myocardial injuries.

Permanent longitudinal strain damage of cardiotoxic drugs in childhood cancer: What is the safe level?

Anthracycline administration in children is associated with cardiac dysfunction. Speckle-tracking echocardiography (STE) can detect subclinical cardiac damage that may go undetected by conventional two-dimensional (2D) echocardiography. This study aims to investigate medium-term anthracycline cardiotoxicity using STE and determine a safer administrable level of anthracyclines (ACs). This observational case-control study enrolled 37 healthy controls and 78 pediatric cancer survivors who received chemotherapy. The patients were divided into two groups: cardiotoxic received (CR) and cardiotoxic free (CF). Data on segmental longitudinal strain (LS), global LS (GLS), and 2D echocardiographic parameters were collected after a drug-free period of at least one year. A total of 115 children with a mean age of 108 ± 55 months, of whom 66% were males, were included in the study. Both the groups of cancer survivors exhibited significantly reduced GLS compared to healthy controls (CR vs. controls, P = 0.001; CF vs. controls, P = 0.013), but no significant difference in left ventricular ejection fraction (LVEF) was observed (P = 0.75). Overall, cancer survivors treated with ACs demonstrated a significant reduction in strain in 10 left ventricular segments, particularly in the basal segments (P < 0.05). Among CR patients, those with impaired GLS (n = 43, GLS worse than -21.9) had significantly higher mean age and cumulative anthracycline dose compared to CR patients with normal GLS (age, P = 0.024; anthracycline dosage, P = 0.036). Using an anthracycline cutoff of 223 mg/m2 resulted in a higher detection rate (49% vs. 25%) and fewer missed cases (51% vs. 74%) compared to the 360 mg/m2 anthracycline cutoff. Childhood cancer survivors demonstrate significantly reduced GLS while preserving a normal LVEF, which does not differ significantly from reference values of healthy children. The reduction in strain appears to be associated with higher anthracycline doses and older age. Lowering the anthracycline threshold to 223 mg/m2 may improve the predictability of a decline in cardiac function using strain imaging at medium-term follow-up.

Segmental and global longitudinal strain measurement by 2-dimensional speckle tracking echocardiography in severe rheumatic mitral stenosis.

The present study aimed to detect subtle left ventricular (LV) dysfunction in patients with severe rheumatic mitral stenosis (MS) by measuring global and segmental longitudinal strain with a two-dimensional speckle tracking echocardiography (2D-STE) method. In this case-control study, 65 patients with severe rheumatic MS and preserved ejection fraction (EF ≥ 50% measured by conventional echocardiographic methods) were compared with 31 otherwise healthy control subjects. All patients underwent LV strain measurement by the 2D-STE method in addition to conventional echocardiography using a VIVID S60 echocardiography device. Absolute strain values in myocardial segments 1-8, 10, and 12 (all basal, mid anterior, mid anteroseptal, mid inferior, and mid anterolateral segments) were significantly lower in patients with severe MS compared with the control group (P < 0.05 for all). The absolute global longitudinal strain (GLS) value was higher in the control group (-19.56 vs. -18.25; P = 0.006). After adjustment for age, gender, and systolic blood pressure, the difference in GLS between the two groups was as follows: mean difference=-1.16; 95% CI: -2.58-0.25; P = 0.110. In patients with severe rheumatic MS and preserved EF, the absolute GLS tended to be lower than healthy controls. Furthermore, the segmental strain values of LV were significantly lower in most of the basal and some mid-myocardial segments. Further studies are warranted to investigate the underlying pathophysiology and clinical implications of this subclinical dysfunction in certain segments of patients with severe rheumatic MS.

Left ventricular myocardial hypertrophy and strain changes in children with hypertrophic cardiomyopathy

Introduction. An assessment of the relationship between the severity of hypertrophy and changes in the myocardial strain at which systolic disfunction is detected in children with hypertrophic cardiomyopathy (HCM) is clearly essential.Aim. To assess the relationship between hypertrophy and the myocardial strain in children with hypertrophic cardiomyopathy (HCM).Materials and methods. 61 patients aged between 7 and 17 years with a primary form of HCM underwent an ultrasound examination of the heart using standard techniques. An assessment of the left ventricular systolic function performed using of-line the two-dimensional (2D) speckle-tracking mode with analysis parameters that included global and segmental longitudinal, circumferential, and radial myocardial strains. The analysis of hypertrophy of myocardial segments carried out taking into account the absolute values of the thickness of the left ventricular myocardium in systole and diastole, depending on age, in terms of standard deviation units in the population (Z-score factor).Results. A decrease in longitudinal strain below the relevant values, an increase in radial strain, and no changes in circular strain were observed when the thickness of the left ventricular myocardium increased over 2.48Z. A further decrease in radial strain was observed when myocardial thickness was over 4.24Z, and circular strain was over 3.16Z. The relationship between myocardial hypertrophy and longitudinal strain had an inverse linear relationship: the lower the strain values, the greater the thickness of the myocardium. With increasing thickness of the myocardium, the radial strain first tended to increase in a compensatory manner, but it decreased when myocardial thickness increased over 4.24Z. The circular strain, as well as longitudinal one, has an inverse linear relationship, but with longer preservation of normal values when myocardial hypertrophy increases.Conclusion. Children with HCM demonstrate various types of relationships between hypertrophy and myocardial strain, which detection is important for the assessment of the left ventricular systolic function to improve the prognosis and therapeutic approach to the disease. A comprehensive approach to the assessment of myocardial strain in children with HCM should include not only a routine identification of global strain, but also assessment of the segmental strain to detect early signs of myocardial dysfunction. Comparison of measures of various types of strain and the thickness of the left ventricular myocardium has a very important diagnostic value for understanding the degree of changes in its kinetics.

Left ventricle mechanical dispersion is a new universal marker of malignant ventricular tachyarrhythmias in patients with structural heart disease

Aim. To evaluate the possibility to use parameters of global, segmental longitudinal left ventricle (LV) strain and LV mechanical dispersion (MD) as new possible markers of malignant ventricular tachyarrhythmias (MVT) in patients with structural heart disease and reduced and intermediate LV ejection fraction (EF).Methods. The study included 113 patients (105 male, age 66 [59;73] year) with ischemic (n=89) or non-ischemic (n=24) dilated cardiomyopathy and LVEF&lt;50%, implanted cardioverter-defibrillators, cardiac resynchronization therapy devices-defibrillators, pacemakers or documented MVT. All patients underwent transthoracic echocardiography with an assessment of speckle-tracking echocardiography parameters (global and segmental longitudinal LV strain, LV MD). Comparative univariate and ROC-analyses were performed between patients with and without MVT separately for patients with LVEF &lt;35% (n=60) and LVEF 36-50% (n=53) LVEF.Results. The group of patients with LVEF ≤35% with MVT (n=30) was characterized by lower values of longitudinal strain of the basal segment of the LV septum wall (-5[-6,5;-0,5] vs -6,8[-11;-4.4], р=0,01, respectively) and the middle segment of the LV inferior wall (-3[-6;2] vs -6[-9;-1,5], р=0,04, respectively). The group of patients with LVEF 36-50% with MVT (n=33) was distinguished by a large value of LV end-diastolic volume (166,5[146,3;193] vs 156[133,8;165,5], р=0,04, respectively). The greater values of LV MD were noted in both groups of patients with MVT. The optimal cut-off value of LV MD was 120 ms (area under the ROC curve 0.817, sensitivity-73,3%, specificity-80%) for patients with LVEF≤35%, and 90 ms (area under the ROC curve 0.761, sensitivity-72.7%, specificity-75%) for patients with LVEF 36-50%.Conclusion. Speckle-tracking echocardiography parameters may serve as additional markers of increased risk of MVT in patients with structural heart disease and impaired LVEF. Only LV MD is useful for risk stratification of MVT in patients with either reduced or intermediate LVEF.

Assessment of early anthracycline-induced cardiotoxicity using segmental strain of cardiac magnetic resonance compared with global strain and functional parameters: an animal study.

The identification of anthracycline-induced cardiotoxicity holds significant importance in guiding subsequent treatment strategies, and recent research has demonstrated the efficacy of cardiac magnetic resonance (CMR) global strain analysis for its diagnosis. On the other hand, it is noteworthy that abnormal global myocardial strain may exhibit a temporal delay due to different cardiac movement in each segment of the left ventricle. To address this concern, this study aims to assess the diagnostic utility of CMR segmental strain analysis as an early detection method for cardiotoxicity. A serials of CMR scans were performed in 18 adult males New Zealand rabbits at baseline time (n=15), followed by scans at week 2 (n=15), week 4 (n=9), week 6 (n=6), and week 8 (n=5) after each week's anthracycline injection. Additionally, following each CMR scan, two to three rabbits were euthanized for pathological comparison. Cardiac functional parameters, global peak strain parameters, segmental peak strain parameters of the left ventricle, and the presence of myocardial cells damage were obtained. A mixed linear model was employed to obtain the earliest CMR diagnostic time. Receiver operating characteristic (ROC) analysis was performed to get the parameter threshold indicative of cardiotoxicity. The left ventricular ejection fraction decreased at week 8 (P=0.002). There were no statistical differences in global strain throughout the experiment period (P>0.05). Regarding segmental strain analysis, the peak segmental radial strain of the apical lateral wall exhibited a decrease starting from week 2 and reached its lowest point at this week (P=0.011). Conversely, peak segmental circumferential strain of the apical anterior wall showed an increase at week 2 and reached its peak at week 6 (P=0.026). The cutoff strain value by ROC analysis for these two walls were 46.285 and -16.920, with the respective areas under the curve (AUC) 0.593 [specificity =0.267, sensitivity =1.000, 95% confidence interval (CI): 0.471-0.777] and 0.764 (specificity =0.733, sensitivity =0.784, 95% CI: 0.511-0.816). Peak segmental longitudinal strain of the apical anterior and apical lateral wall showed relatively delayed changes, occurring in the 4th week (P=0.030 and P=0.048), the cutoff values for these strains were -12.415 and -15.960, with corresponding AUCs of 0.645 (specificity =0.333, sensitivity =0.955, 95% CI: 0.495-0.795) and 0.717 (specificity =0.433, sensitivity =0.955, 95% CI: 0.566-0.902), respectively. Notably, the myocardial injury was also observed at the corresponding periods. Based on experimental evidence, the peak segmental strain of the apical lateral and anterior wall, as determined by CMR, demonstrated an earlier detection of anthracycline-induced cardiotoxicity compared to peak global strain and cardiac function.

Left ventricular strain echocardiography in advanced uremic cardiomyopathy compared to dilated cardiomyopathy

BackgroundCardiac involvement is common in end-stage renal disease patients. The presenting study aimed to evaluate the global and segmental longitudinal strain in patients with advanced uremic cardiomyopathy (AUCM) and compare it to dilated cardiomyopathy (DCM).ResultsThe mean global longitudinal strain (GLS) was significantly lower in AUCM (P value = 0.045). Comparing segmental strain showed a lower strain in mid inferoseptal (P value = 0.048), base and mid anterolateral (P value = 0.026, 0.001 respectively), base and mid anteroseptal (P value = 0.005, 0.009 respectively), base and mid inferior (P value = 0.015, 0.034 respectively) and mid anterior (P value = 0.015) in patients with AUCM compared with DCM. In both groups, the segmental strain increased from base to apex.ConclusionsSegmental and GLSs in advanced uremic cardiomyopathy were significantly lower than those of dilated cardiomyopathy. In both groups, the segmental strain increased from base to apex.

Left ventricular deformation and myocardial fibrosis in pediatric patients with Duchenne muscular dystrophy

BackgroundLeft ventricular (LV) strain and rotation are emerging functional markers for early detection of LV dysfunction and have been associated with the burden of myocardial fibrosis in several disease states. This study examined the association between LV deformation (i.e., LV strain and rotation) and extent and location of LV myocardial fibrosis in pediatric patients with Duchenne muscular dystrophy (DMD). Methods and results34 pediatric patients with DMD underwent cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) to assess LV myocardial fibrosis. Offline CMR feature-tracking analysis was used to assess global and segmental longitudinal and circumferential LV strain, and LV rotation. Patients with fibrosis (n = 18, 52.9%) were older than those without fibrosis (14 ± 3 years (yrs) vs 11 ± 2 yrs., p = 0.01). There was no significant difference in LV ejection fraction (LVEF) between subjects with and without fibrosis (54 ± 6% vs 56 ± 4%, p = 0.18). However, lower endocardial global circumferential strain (GCS), but not LV rotation, was associated with presence of fibrosis (adjusted Odds Ratio 1.25 [95% CI 1.01–1.56], p = 0.04). Both GCS and global longitudinal strain correlated with the extent of fibrosis (r = .52, p = 0.03 and r = .75, p < 0.01, respectively). Importantly, segmental strain did not seem to correspond to location of fibrosis. ConclusionA lower global, but not segmental, strain is associated with presence and extent of LV myocardial fibrosis in pediatric DMD patients. Therefore, strain parameters might detect structural myocardial alterations, however currently more research is needed to evaluate its value (e.g., prognostic) in clinical practice.

Cardiac "hypertrophy" phenotyping: differentiating aetiologies with increased left ventricular wall thickness on echocardiography.

Differentiating phenotypes of cardiac "hypertrophy" characterised by increased wall thickness on echocardiography is essential for management and prognostication. Transthoracic echocardiography is the most commonly used screening test for this purpose. We sought to identify echocardiographic markers that distinguish infiltrative and storage disorders that present with increased left ventricular (LV) wall thickness, namely, cardiac amyloidosis (CA) and Anderson-Fabry disease (AFD), from hypertensive heart disease (HHT). Patients were retrospectively recruited from Westmead Hospital, Sydney, and Princess Alexandra Hospital, Brisbane. LV structural, systolic, and diastolic function parameters, as well as global (LVGLS) and segmental longitudinal strains, were assessed. Previously reported echocardiographic parameters including relative apical sparing ratio (RAS), LV ejection fraction-to-strain ratio (EFSR), mass-to-strain ratio (MSR) and amyloidosis index (AMYLI) score (relative wall thickness × E/e') were evaluated. A total of 209 patients {120 CA [58 transthyretin amyloidosis (ATTR) and 62 light-chain (AL) amyloidosis], 31 AFD and 58 HHT patients; mean age 64.1 ± 13.7 years, 75% male} comprised the study cohort. Echocardiographic measurements differed across the three groups, The LV mass index was higher in both CA {median 126.6 [interquartile range (IQR) 106.4-157.9 g/m2]} and AFD [median 134 (IQR 108.8-152.2 g/m2)] vs. HHT [median 92.7 (IQR 79.6-102.3 g/m2), p < 0.05]. LVGLS was lowest in CA [median 12.29 (IQR 10.33-15.56%)] followed by AFD [median 16.92 (IQR 14.14-18.78%)] then HHT [median 18.56 (IQR 17.51-19.97%), p < 0.05]. Diastolic function measurements including average e' and E/e' were most impaired in CA and least impaired in AFD. Indexed left atrial volume was highest in CA. EFSR and MSR differentiated secondary (CA + AFD) from HHT [receiver operating curve-area under the curve (ROC-AUC) of 0.80 and 0.91, respectively]. RAS and AMYLI score differentiated CA from AFD (ROC-AUC of 0.79 and 0.80, respectively). A linear discriminant analysis with stepwise variable selection using linear combinations of LV mass index, average e', LVGLS and basal strain correctly classified 79% of all cases. Simple echocardiographic parameters differentiate between different "hypertrophic" cardiac phenotypes. These have potential utility as a screening tool to guide further confirmatory testing.

Left Ventricular Segmental Strain Based On Speckle Tracking Echocardiography Versus Indications Of Immune Inflammation In Patients After COVID-19 Pneumonia

Background — The significance of cytokine activation and immune inflammation in subclinical damage to cardiomyocytes and resulting development of the congestive heart failure (CHF) is frequently discussed in published studies, as well as whether there are cardiac lesions in COVID-19 survivors identified by the speckle tracking echocardiography (STE). Objective — To examine the association of echocardiographic parameters with indications of immune inflammation in patients recovered from COVID-19 pneumonia depending on segmental longitudinal strain (LS) of the left ventricle (LV) identified by STE. Methods — Our study encompassed 216 patients (51.1% men, mean age of 50.1±11.1 years) distributed among two groups: Group I (n=108) included study subjects with segmental LS (≥3 LV segments) revealed by the STE; Group II (n=108) comprised patients without visually detectable LV lesions. All patients were examined three months after COVID-19 pneumonia. Results — Groups did not differ statistically significantly in terms of LV ejection fraction (68.7±4.3% in Group I vs. 68.6±4.3% in Group II; p=0.916). Global LS was significantly lower in the Group I than in the Group II at the time of the control follow-up visit three months later (-18.2 [-16.7; -19.4] % vs. -20.6 [-19.5; -22.1] %, respectively; p&lt;0.001). When analyzing laboratory indications of immune inflammation in groups, we revealed statistically significantly higher values in Group I vs. Group II in the concentrations of interleukin 6 (3.1 [2.4;3.9] pg/mL vs. 2.5 [3.8;4.7] pg/mL; p=0.009), C-reactive protein (4.7 [2.9;8.3] mg/L vs. 3.0 [1.5; 5.3] mg/L; p&lt;0.001), and tumor necrosis factor α (6.0 [4.8;4.1] pg/ml vs. 5.0 [4.0;6.4] pg/ml; p=0.001). In Group I, we detected diffuse lesion of LS (≥4 segments of the same LV level; 38.0% of patients) and regional lesion of LS (≥3 segments corresponding to the blood supply pools of the anterior, circumflex, or right coronary arteries; 62.0% of patients). According to logistic regression, the LS of the basal LV level (OR 3.028; 95% CI 1.909-4.802; р&lt;0.001) in combination with LS of the apical LV level (OR 1.287; 95% CI 1.099-1.507; р=0.002) and LV lateral wall annular velocity assessed by tissue Doppler imaging, peak e’ (OR 0.774; 95% CI 0.657-0.911; р=0.002) had an independent relationship with each of diffuse and regional LS lesions. Conclusion — Based on STE data, we have identified a relationship of diffuse and regional LV lesions with features of systolic and diastolic LV dysfunction and markers of immune inflammation in patients three months after COVID-19 pneumonia.

Segmental longitudinal strain and regional myocardial work index could help identify mitral valve prolapse patients with increased risk of ventricular arrhythmia

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Mitral valve prolapse (MVP) could associate with malignant ventricular arrhythmias. Mitral annular disjunction (MAD), which leads to excessive mobility, mechanical stretch, and myocardial damage, has been studied as a putative mechanism for an arrhythmic substrate. However, it is unclear whether that is the only sufficient arrhythmic risk factor in that patients. The aim of our study was to check whether two–dimensional speckle tracking echocardiography (STE) with segmental longitudinal strain and STE-derived myocardial work (MW) analysis may allow for a more accurate assessment of the arrhythmic risk in MVP patients. Methods and results Seventy-two MVP patients and twenty healthy volunteers enrolled in the study had performed echocardiography with STE assessment. Non-sustained ventricular tachycardia (NSVT) was the arrhythmic outcome for further calculations. Pre-specified cut-off values for peak segmental longitudinal strain (PSS) and segmental myocardial work index (MWI) for basal lateral (−25% and 2200 mmHg%), mid-lateral (−25% and 2500 mmHg%), mid posterior (−25% and 2400 mmHg%), and mid inferior (−23% and 2400 mmHg%) segments were accurate predictors of NSVT. A combination of PSS and MWI increased the probability of NSVT occurrence, reaching the highest predictive value for the basal lateral segment (Figure): odds ratio 32.15 (3.78–273.8), p &amp;lt; 0.001 for PSS ≥ (−25%) and MWI ≥ 2200 mmHg%. Conclusions 2D STE may be a valuable tool for assessing arrhythmic risk in MVP patients. Excessively increased segmental longitudinal strain with augmented regional myocardial work index identifies patients with the highest risk of NSVT.

Genetics, patterns of hypertrophy and fibrosis on myocardial mechanics in hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Asymmetrical hypertrophy, myocyte disarray and fibrosis due to genetic cause are underlying pathology of hypertrophic cardiomyopathy (HCM). However, their contribution to myocardial functional mechanics are not extensively evaluated yet. Purpose In this study, we sought to investigate effects of genetic mutation, patterns of ventricular hypertrophy and fibrosis on myocardial mechanics in HCM. Methods In 133 patients with HCM, chamber geometry, segmental late gadolinium enhancement (LGE), extracellular volume fraction (ECV) by cardiac magnetic resonance imaging (CMR), echo-derived diastolic function analyses and genetic test were performed. Left ventricular (LV) segmental and global longitudinal strain (LS), circumferential strain (CS), and rotation were measured by feature tracking analysis of CMR. Results Patients with sarcomere gene mutation (SM) had lower LV-CS (global and all three slices) along with higher prevalence of midwall type LGE, LGE amount and ECV. Despite global LS was not lower in SM, anteroseptal-LS was significantly impaired accompanying with higher septal wall thickness. To compensate impaired anteroseptal LS, basal endocardial rotation was paradoxically increased in SM. Augmented basal segmental was significantly related to obstructive HCM. In apical HCM, although apical segmental LS was significantly lower, higher apical rotation and preserved apical CS along with lower prevalence of SM. The E/e’ was significantly related to LV mass index, LGE extent but not with SM. Conclusion Circumferential myocardial function was significantly reduced in SM independent of fibrosis extent, suggesting primary phenotype. However, longitudinal fiber function was more related to hypertrophy regardless of SM. LV diastolic function was more related to LV mass, extent and degree of fibrosis including non-thickened myocardium regardless of SM.

Indexing of Speckle Tracking Longitudinal Strain of Right Ventricle to Body Surface Area Does Not Improve Its Efficiency in Diagnosis and Mortality Risk Stratification in Patients with Acute Pulmonary Embolism.

Acute pulmonary embolism (PE) is associated with a serious mortality rate. Thus, the rapid diagnosis and identification of patients at high risk of death is pivotal. The search for echocardiographic parameters for this purpose continues. Recent publications reveal correlations between myocardial longitudinal strain (LS) and body surface area (BSA). The aim of the study was to evaluate the usefulness of indexing the right ventricular (RV) speckle tracking LS to BSA in detecting PE and stratifying the risk of 30-day all-cause mortality. the prospective cross-sectional observational study group consisted of 167 consecutive patients (76 men, 45.5%) aged 69.5 ± 15.3 years, and they were referred for computed tomography pulmonary angiography. Patients underwent a transthoracic echocardiographic examination within 24 h of admission to the hospital ward. RVLS and their derivatives indexed to BSA were included in the analysis. PE was confirmed in 88 patients, while 79 patients had no radiological features of PE. The only echocardiographic parameters that differed between subgroups were pulmonary flow acceleration (Act), McConnell's sign, LS of the middle segment of the RV free wall, and its derivative indexed to BSA. During the 30-day follow-up of a subgroup of subjects with PE, 12 patients died. The mortality predictors with increasing prediction value included a RV free wall mid-segment LS (cut-off value: -21%, Area Under the Curve-AUC 0.6, p = 0.02) and its derivative indexed to BSA (-14 %/m2, AUC 0.62, p = 0.003), body mass index (24.7 kg/m2, AUC 0.63, p = 0.002), D-dimer serum concentration (3559 pg/mL, AUC 0.66, p < 0.001), Act (67 ms, AUC 0.67, p < 0.001), septal basal LS (-15%, AUC 0.68, p = 0.02), RV free wall basal segment LS (-14%, AUC 0.7, p = 0.015), age (66 years, AUC 0.74, p = 0.004), NT-proBNP (1120 pg/mL, AUC 0.75, p = 0.01), troponin T (66 ng/mL, AUC 0.78, p = 0.005), and the complex score of the Pulmonary Embolism Severity Index (AUC 0.88, p < 0.001). indexing of RVLS to BSA does not improve its prognostic value in patients with acute PE.

Changes in Computed-Tomography-Derived Segmental Left Ventricular Longitudinal Strain After Transcatheter Aortic Valve Implantation

Patients with severe aortic stenosis (AS) may show left ventricular (LV) apical longitudinal strain sparing. Transcatheter aortic valve implantation (TAVI) improves LV systolic function in patients with severe AS. However, the changes in regional longitudinal strain after TAVI have not been extensively evaluated. This study aimed to characterize the effect of the pressure overload relief after TAVI on LV apical longitudinal strain sparing. A total of 156 patients (mean age 80 ± 7years, 53% men) with severe AS who underwent computed tomography before and within 1year after TAVI (mean time to follow-up 50 ± 30days) were included. LV global and segmental longitudinal strain were assessed using feature tracking computed tomography. LV apical longitudinal strain sparing was evaluated as the ratio between the apical and midbasal longitudinal strain and was defined as an LV apical to midbasal longitudinal strain ratio >1. LV apical longitudinal strain remained stable after TAVI (from 19.5 ± 7.2% to 18.7 ± 7.7%, p=0.20), whereas LV midbasal longitudinal strain showed a significant increase (from 12.9 ± 4.2% to 14.2 ± 4.0%, p ≤0.001). Before TAVI, 88% of the patients presented with LV apical strain ratio >1% and 19% presented with an LV apical strain ratio >2. After TAVI, these percentages significantly decreased to 77% and 5% (p=0.009, p ≤0.001), respectively. In conclusion, LV apical sparing of strain is a relatively common finding in patients with severe AS who underwent TAVI and its prevalence decreases after the afterload relief after TAVI.