Significant Difference In Global Longitudinal Strain Research Articles

Fetal Right Heart Strain in Systemic Right Ventricles and Impact on Post-surgical Outcomes.

Patients with hypoplastic left heart syndrome (HLHS) and its variants rely on the right ventricle (RV) to provide cardiac output. Diminished RV systolic function has been associated with poor clinical outcomes in this population. Echocardiographic strain has emerged as a useful method to quantify RV deformation. We aimed to describe fetal strain in the systemic RV and further investigate if there was any correlation with clinical outcomes. We conducted a retrospective, single center study evaluating strain in fetuses with systemic RV. We measured fetal RV global longitudinal strain (GLS) and segmental strain using Tomtec 2D speckle tracking software and compared these findings to controls. Fifty patients with systemic RV were included in the study group with controls matched one to one for each echocardiogram. Ten patients died after first-stage palliation. GLS was reproducible, with interobserver ICC 0.82. There was no statistically significant difference in GLS among different HLHS subtypes. Abnormal GLS did not correlate with worse clinical outcomes. GLS in systemic RVs in the 2nd and 3rd trimester did not vary significantly throughout gestation and did not correlate with clinical outcomes. Risk factors associated with poor outcome were mainly postnatal. Multi-centered studies are needed to determine if these findings hold true in a larger sample size.

Noninvasive pressure-strain loop quantitative assessment of left ventricular function in anemic preterm infants with different modes of respiratory support

To investigate noninvasive pressure-strain loop (PSL) combined with two-dimensional speck tracking imaging and left ventricular pressure measurement in the evaluation of cardiac function changes in anemia of prematurity (AOP) with different modes of respiratory support, and to explore its value in detecting subclinical myocardial injury in preterm infants. This retrospective study included 79 preterm infants with anemia, according to different modes of respiratory support, who were divided into invasive respiratory support group (39 cases) and noninvasive respiratory support group (40 cases). A control group of 40 nonanemic preterm infants with matched age, sex, and gestational age were also included. Complete echocardiography was performed for each included infant. There are PSL parameters that used to evaluate cardiac function, including global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) among the three groups were compared. Compared with the control group, the value of GWI, GCW, and GWE were significantly lower and GWW was higher in the AOP groups (P < 0.05), and GWI, GCW and GWE were much significantly lower in the invasive respiratory support group than in the noninvasive respiratory support group (P < 0.05). There was no significant difference in GLS among the three groups (P > 0.05). Noninvasive PSL analysis can quantitatively assess myocardial work in AOP with different respiratory support, which is more sensitive than other conventional echocardiographic indices. This technique may provide a new method for monitoring subclinical myocardial injury with AOP.

Influence of ultrasound transmit frequency on measurement of global longitudinal strain on 2D speckle tracking echocardiography

The reproducibility of longitudinal strain measured by 2D speckle tracking echocardiography (2DSTE) may be affected by ultrasound settings. This study investigated the effect of transmit ultrasound frequency on global longitudinal strain (GLS) by 2DSTE. Apical, 2- and 4-chamber, and long-axis views were obtained in consecutive 162 patients using Philips ultrasound devices. Three different frequency presets were used sequentially: high resolution (HRES, 1.9 to 2.1 MHz), general (HGEN, 1.6 to 1.8 MHz), and penetration mode (HPEN, 1.3 to 1.6 MHz). GLS values were determined for each preset using the Philips Q-station software, resulting in GLS-HRES, GLS-HGEN, and GLS-HPEN. Among the 151 patients with successfully measured GLS, a significant difference in GLS was observed among the three presets (p < 0.0001). GLS-HRES (− 17.9 ± 4.4%) showed a slightly smaller magnitude compared to GLS-HGEN (− 18.8 ± 4.5%, p < 0.0001) and GLS-HPEN (− 18.8 ± 4.5%, p < 0.0001), with absolute differences of 1.1 ± 1.0% and 1.1 ± 1.2%, respectively. This variation in GLS with frequency was evident in patients with both optimal (n = 104) and suboptimal (n = 47) image quality and remained consistent regardless of ultrasound devices, ischemic etiology, or ejection fraction. In conclusion, ultrasound frequency had only a modest effect on GLS measurements. GLS may be reliably assessed in most cases regardless of the ultrasound frequency used.

Relation between global longitudinal strain and acute rejection in pediatric patients within the first-year post heart transplant

BackgroundAcute rejection leading to graft dysfunction remains a major cause of morbidity and mortality. In adults, assessment of global longitudinal strain (GLS) using speckle tracking echocardiography (STE) has been used as an early marker for graft dysfunction. Studies evaluating GLS in a sizable pediatric transplant population are scarce. ObjectivesWe sought to determine association between GLS and acute rejection within first-year post-transplantation in pediatric patients. MethodsPatients 0 to 18 years old who received heart transplants (HT) at Cleveland Clinic Children's Hospital after April 2013 were identified. Clinical data was collected from pre-transplant evaluation and post-transplant surveillance endomyocardial biopsy (EMB) visit from time of transplantation to one-year post-transplantation. Left ventricular (LV) GLS was measured retrospectively using vendor independent software. Significant rejection was defined by escalation in immunosuppression therapy due to pathology or clinical diagnosis. Trends of GLS were compared between patients with (Group 1) and without (Group 2) rejection, controlled for age. At the visit of rejection diagnosis, GLS rejection measurements were compared to the range of “normal”, non-rejection measurements. ResultsTwenty-seven patients met inclusion criteria. Eight patients (29.6 %) had at least one clinically significant rejection episode. There was no significant difference in GLS at the first endomyocardial biopsy visit between groups. At last biopsy visit, subjects with rejection had significantly worse GLS (p ≤ 0.001). In a mixed effect model, average global, 3-chamber, and 4-chamber systolic strain had significant interaction of group and time (p = 0.016, 0.033, 0.003, respectively). Systolic strain in those views significantly worsened over time in rejection group while remaining stable in non-rejection group. GLS of subjects with rejection were worse and out of the range of “normal” by the time of the third EMB visit. ConclusionsThere was a trend toward worse GLS in those who developed acute rejection within first year post-transplant compared to those without rejection.

Value of three-dimensional speckle-tracking imaging in evaluating left ventricular systolic function and its correlation with peripheral arterial elasticity in children with simple obesity: a prospective study

To study the application of three-dimensional speckle-tracking imaging in evaluating left ventricular systolic function and its correlation with peripheral arterial elasticity in children with simple obesity. Random sampling combined with convenience sampling was used to obtain research samples, and then the samples were divided into an obesity group (23 cases), an overweight group (21 cases), and a normal group (24 cases). Three-dimensional speckle-tracking imaging was used to measure the global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) of the left ventricle. An automatic arteriosclerosis tester was used to measure ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV). These parameters were compared among the three groups. The correlation of three-dimensional speckle-tracking parameters with ABI and baPWV was evaluated. There were no significant differences in GLS, GRS, and GCS between the obesity and normal groups (P>0.05). The overweight group had a significantly higher GLS than the normal group [(-24±7) vs (-19±12), P<0.05]. The obesity and overweight groups had a significantly lower ABI than the normal group [(1.00±0.09)/(1.09±0.13) vs (2.25±0.13), P<0.05). The obesity group had a significantly higher baPWV than the normal group [(978±109) vs (905±22), P<0.05]. In the children with obesity, GLS was positively correlated with baPWV (r=0.516, P<0.05) , but not correlated with ABI (P>0.05), and GCS and GRS had no significant correlation with ABI or baPWV (P>0.05). There are varying degrees of changes in left ventricular systolic function and peripheral arterial elasticity in children with simple obesity, and there is a certain correlation between them.

Impaired myocardial work in paediatric patients with wolff-parkinson-white syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardium deformation during systole. Left ventricle (LV) dysfunction due to electrical dyssynchrony may require catheter ablation of the accessory pathway, even in asymptomatic patients. Purpose The study aimed to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in patients with WPW. Methods Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in the study: 12 cases with manifest WPW and 32 age-, sex- and arterial pressure- matched controls (CTR). LV ejection fraction (EF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Results Despite normal LV systolic function by standard echocardiographic parameters, patients with WPW had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs 1624.0 ± 305.8 mmHg% in CTR, p = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs 2069.0 ± 319.9 mmHg% in CTR, p= 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs 90.9 ± 58.9 mmHg% in CTR, p= 0.0008) and GWE (90.5 ± 4.8% in WPW vs 95.2 ± 2.2% in CTR, p= 0.00006). There were no significant differences in GLS and EF between patients with WPW and controls. Conclusion Myocardial work indices were found significantly reduced in patients with WPW, even in presence of normal LV EF and GLS. In patients with WPW, MWI may represent a sensitive measure of myocardial dysfunction and help in the decision-making for catheter ablation. Abstract Figure. Myocardial work in WPW Abstract Figure. Myocardial work in control patient

Left atrial function in patients with heart failure with mid-range and preserved ejection fraction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Little is known about the left atrial (LA) function in patients with heart failure with mid-range and preserved ejection fraction (EF). We explored LA function in patients with heart failure with mid-range ejection fraction (HFmrEF) and compared to that in patients heart failure with preserved ejection fraction (HFpEF). Methods A total of 66 HF patients (35 HFpEF and 31 HFmrEF) were included in the study. Left venticular EF, global longitudinal strain (GLS) and the mitral E/e" ratio were measured in all patients. LA function was assesed by measuring phasic changes in LA volume - maximal LA volume, pre-atrial contraction volume and minimal LA volume. All volumes were indexed to body surface area before calculating the indices of LA function: LA total emtying fraction (reservoir function), LA passive emptying fraction (conduit function) and LA active emptying fraction (pump function). Peak LA strain during ventricular systole (S-LAs) and peak LA strain during atrial systole (S-LAa) were measured also as LA functional parameters (reservoir and pump function). Conduit function of LA was derived as difference of S-LAs and S-LAa. LA deformation was also assessed by strain rate at different phases of the cardiac cycle. Strain rate analysis was used to measure peak LA strain rate during ventricular systole (SR-LAs), during early LV filling (SR-LAe) and during atrial contraction (SR-LAa). Results There were no significant differences in GLS and the mitral E/e’ between patients with HFmrEF and HFpEF (p &amp;gt; 0.05 for all). Significantly lower values of LA total emptyng fraction (47.6 ± 13.0 vs 38.9 ± 11.8, p = 0.006), LA passive emptyng fraction (26.6 ± 13,2 vs 20.9 ± 9.4, p = 0.049) and LA active emptyng fraction (33.0 ± 10.0 vs. 26.0 ± 9.7, p = 0.005) were observed in HFmrEF tham HFpEF patients, respectively. Significantly lower values of S-LAs (27,3 ± 5,8 vs 22,3 ± 8,0, p = 0,004), S-LAa (12,8 ± 4,0 vs 10,3 ± 3,7, p = 0,01) (Figure 1), SR-LAs (1,40 ± 0,42 vs 1,18 ± 0,43, p = 0,045), SR-Lae (-1,47 ± 0,56 vs -1,13 ± 0,51, p = 0,012) and SR-LAa (-1,90 ± 0,50 vs -1,64 ± 0,55, p = 0,044) were obtained in group of HFmrEF patients. Conclusions All components of left atrial function were worse in patients with HFmrEF than in those with HFpEF, despite similar GLS and mitral E/e" ratio. Clinical and prognostic implications of these observations warrant futher research. Abstract Figure.

Assessment of novel echocardiographic indices of myocardial function in patients with significant primary mitral regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Assessment of left ventricular (LV) function in primary mitral regurgitation remains challenging due to ejection fraction preservation, even in late stages of the disease. Global longitudinal strain (GLS) remains a valuable tool for the assessment of systolic function which is affected, like ejection fraction, by loading conditions. Lately, novel methods, such as myocardial work estimated by echocardiography, have been developed in assessment of LV systolic function, along with left atrial strain in assessment of diastolic function. Early identification of systolic or diastolic dysfunction in primary mitral regurgitation is crucial for further management of these patients. PURPOSE In this study we assessed several indices of LV systolic and diastolic function, such as myocardial work, global longitudinal strain and left atrial strain, in patients with significant primary mitral regurgitation, in order to evaluate early myocardial dysfunction. METHODS We retrospectively assessed echocardiograms of 64 patients, referred to an echocardiography laboratory of a tertiary hospital between 2019 and 2021 with the diagnosis of significant primary MR. Measurements included several echocardiographic indices of LV anatomy and function, such as left atrial volume indexed (LAVi), left atrial strain, global longitudinal strain (GLS), pulmonary hypertension and global myocardial work. Finally we correlated various indices of systolic and diastolic function with severity of mitral regurgitation. RESULTS We analyzed echocardiograms of 64 patients (50 men, mean age 60 ± 13,8) with at least moderate organic MR, 75,8% of which had severe MR, and normal ejection fraction (mean EF 63%±4,9). We identified negative correlation between left atrial strain (reservoir) and pulmonary hypertension measurements (correlation coefficient -358, p &amp;lt; 0,05) in patients with at least moderate MR. However, we were not able to find any statistically significant differences in GLS (21,98 vs 22,26) or myocardial work, even though we noticed a difference in myocardial work between patients with moderate and severe MR (Global Work Index 2302mmHg% vs 2262mmHg% with normal values 2209 ± 307mmHg% in STAAB cohort, Global Constructed Work 2540mmHg% vs 2327mmHg%, Global Waste Work 136,89mmHg% vs 136,43mmHg%, Global Work Efficiency 94,22% vs 93,76%). CONCLUSIONS These data suggest that an early assessment of indices of diastolic function, such as left atrial strain linked to pulmonary hypertension, can guide to a more effective evaluation of patients with severe MR and normal systolic function. Additionally, novel indices of LV function less load-dependent, such as myocardial work, are promising tools in the assessment of left ventricle and early recognition of myocardial dysfunction in patients with severe organic MR, but more prospective studies are needed. Abstract Figure. Abstract Figure.

The role of myocardial global longitudinal strain in etiological stratification of heart failure and left ventricular systolic dysfunction

Introduction: In patients with heart failure, global longitudinal strain (GLS) early detects decreased ventricular contractility, with prognostic value, but there is no evidence that GLS properly differentiates etiologies in patients with left ventricular ejection fraction &lt;50%. Methods and aims: 147 patients with heart failure and left ventricular ejection fraction &lt;50% were included retrospectively. The aims were to compare the GLS in patients with heart failure with reduced (&lt;40%) to those with mildly reduced ejection fraction (40-49%) and, to compare GLS between the different etiologies in each of these two subpopulations. Results: 78 patients presented mildly reduced (53%) and 69 reduced ejection fraction (47%). The mean GLS was -13.4% ± 3.3% (mildly reduced -14.9% ± 2.9%, reduced -11.7% ± 3.0%, p &lt;0.001). In mildly reduced ejection fraction, the etiologies were ischemic (47.4%), idiopathic (25.6%), tachycardiomyopathy (12.8%), valvular (11.6%), and toxic (2.6%), with similar mean GLS (p = ns among all etiologies). In reduced ejection fraction, the etiology of 50.7% patients was ischemic, 24.6% idiopathic, 10.1% valvular, 8.7% tachycardiomyopathy, and 5.8% toxic, with similar mean GLS (p = ns among all etiologies). Conclusions: There were no significant differences in GLS between the etiologies of heart failure in any subpopulation. The reduced ejection fraction patients presented worse GLS.

276 Wolff–Parkinson–White syndrome was associated with reduced myocardial work

Abstract Aims Paediatric patients with a diagnosis of Wolff–Parkinson–White (WPW) Syndrome may develop a reduction of local myocardial deformation because of accessory pathway-related electrical dyssynchrony, which may lead to an impairment of left ventricular systolic function. The presence of ventricular dysfunction may be an indication for these patients to undergo radiofrequency catheter ablation (RFCA), even if asymptomatic. However, myocardial abnormalities are sometimes subtle and cannot be detected by standard echocardiographic evaluation. The purpose of this study was to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in paediatric patients with WPW Syndrome. Methods and results Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in this study: 12 cases with manifest WPW Syndrome and 32 age-, sex-, and arterial pressure-matched controls (CTR). Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global constructive work (MCW), wasted work (MWW), and work efficiency (MWE) were estimated. Despite normal LV systolic function by standard echocardiographic parameters, paediatric patients with WPW Syndrome had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs. 1624.0 ± 305.8 mmHg% in CTR, P = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs. 2069.0 ± 319.9 mmHg% in CTR, P = 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs. 90.9 ± 58.9 mmHg% in CTR, P = 0.0008), and GWE (90.5 ± 4.8% in WPW vs. 95.2 ± 2.2% in CTR, P = 0.00006). There were no significant differences in GLS and LVEF between patients with WPW Syndrome and controls. Conclusions WPW Syndrome was found to be associated with a significant reduction of myocardial work indices in the paediatric population. The assessment of MWI may represent a sensitive measure to identify a subtle myocardial dysfunction in an early stage, even when LVEF and GLS are normal. It might be considered a further diagnostic parameter for referring little patients to RFCA.

Association between microvascular dysfunction and impaired myocardial deformation in hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Objective To analyze the relationship between coronary microvascular dysfunction (MCD) and left ventricular (LV) myocardial deformation in hypertrophic cardiomyopathy (HCM). Methods Prospectively inclusion of HCM patients (P). MCD was assessed by CMR, during regadenoson-induced hyperemia. For perfusion assessment, the myocardium was divided into 32 subsegments (16 AHA segments subdivided into an endocardial and epicardial layer). Ischemic burden was calculated as the number of involved subsegments, assigning 3% of myocardium to each subsegment. Epicardial coronary artery disease was excluded by computed tomography or invasive coronary angiography. LV myocardial deformation was evaluated by 2D and 3D speckle-tracking echocardiography (STE), including global longitudinal strain (GLS), peak systolic dispersion (PDS), global circumferential strain (GCS), global radial strain (GRS), area strain, twist and torsion. Results 31 P enrolled (51%male,age57.8 ± 15.5years). Asymmetric septal hypertrophy was seen in 55%, apical in 29%, concentric in 16%,maximal wall thickness (MWT) of 20.5 ± 4.9mm; 26% with LVOT obstruction; LV ejection fraction 67.9 ± 7.9%. In 2DSTE analysis, P with more ischemia (&amp;gt;20%of LV) presented more severe impaired GLS and greater PDS, comparing with patients with ≤20% of ischemia. Similarly, 3DSTE imaging showed worse LV performance in P with greater ischemic burden, expressed by significant difference in GLS, GRS and area strain. GCS also trended to be worse in the presence of &amp;gt;20% of ischemia. The stronger correlation was found between 2D GLS and ischemic burden (Pearson correlation factor 0.545; p = 0.002). Conclusion In HCM, the severity of ischemia secondary to MCD was associated with impairment in LV myocardial deformation evaluated by 2D and 3D STE. Table 1. Echocardiography Ischemic burden (% of LV) 2D parameters ≤ 20% (n = 15) &amp;gt; 20% (n = 16) p-value GLS (%) -15.6 ± 2.7 -12.1 ± 4.7 0.016 PSD (ms) 73.2 ± 25.6 102.1 ± 57.6 0.150 3D parameters GLS (%) -10.3 ± 4.5 -7.3 ± 3.0 0.010 GCS (%) -12.6 ± 3.0 -10.1 ± 4.5 0.079 GRS (%) 30.8 ± 8.5 22.8 ± 11.4 0.035 Area strain(%) -20.8 ± 4.9 -15.8 ± 6.3 0.020 Twist (deg) 6.0 ± 4.8 4.1 ± 4.0 0.175 Torsion (deg/cm) 1.2 ± 0.9 0.8 ± 0.7 0.232

Two-year left ventricular systolic function of percutaneous coronary intervention vs optimal medical therapy for patients with single coronary chronic total occlusion.

In this study, two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (RT-3DE) were applied to compare the changes of left ventricular systolic function associated with percutaneous coronary intervention (PCI) versus optimal medical therapy (OMT) in patients with single chronic total occlusion (CTO). 63 single CTO patients (age 61.88±8.86years) were examined by echocardiography and were divided into the PCI group (n=27) and OMT group (n=36) according to the initial treatment strategy. Two-dimensional left ventricular ejection fraction (2D-LVEF), two-dimensional indexed left ventricular end-systolic volume (2D-LVESVI), and two-dimensional indexed left ventricular end-diastolic volume (2D-LVEDVI) were measured using two-dimensional echocardiography (2DE). Three-dimensional left ventricular ejection fraction (3D-LVEF), three-dimensional indexed left ventricular end-systolic volume (3D-LVESVI), and three-dimensional indexed left ventricular end-diastolic volume (3D-LVEDVI) were measured using RT-3DE. Global circumferential strain (GCS) and global longitudinal strain (GLS) were measured using 2D-STE. After 2years of follow-up, there were no significant differences in the 2D-LVEF, 2D-LVESVI, 3D-LVEF, 3D-LVESVI, 3D-LVEDVI, and GCS, except for GLS (P=.001) between the CTO-PCI and CTO-OMT groups. GLS decreased significantly in OMT group (P=.016) in contrast with PCI group in which GLS increased significantly (P=.007). Left ventricular systolic function assessment using 2D-STE showed a significant difference in GLS between CTO-PCI and CTO-OMT. And the patients who chose PCI revascularization at the 2-year follow-up had better left ventricular systolic function improvement than those who were conservatively treated with OMT.

Impact of biological treatment on left ventricular dysfunction determined by global circumferential, longitudinal and radial strain values using cardiac magnetic resonance imaging in patients with rheumatoid arthritis.

To evaluate left ventricular (LV) dysfunction in patients with rheumatoid arthritis (RA) and to determine the impact of biological treatment on LV function in these patients using global circumferential strain (GCS), global longitudinal strain (GLS) and global radial strain (GRS) values assessed by feature tracking cardiac magnetic resonance (FT-CMR) imaging. Eighty patients with RA and 20 controls without cardiovascular disease underwent non-contrast CMR imaging. Patients with RA received conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic DMARDs (bDMARDs). Global strains were calculated in 16 LV segments. No significant differences in cardiovascular risk factors were found between the RA group and controls. GCS was 21% lower in the RA group compared with controls (P< 0.001) and was 14% lower in the csDMARDs group compared with the bDMARDs group (P=0.002), whereas, there was no significant difference in GLS and GRS between the RA group and the controls. In regard to strain rates, diastolic GCS and GRS rates were significantly lower in the RA group (P<0.001, 0.011, respectively). In univariate analyses, GCS was significantly associated with the Simplified Disease Activity Index, bDMARDs, swollen joint count, anti-cyclic citrullinated peptides antibodies and matrix metalloproteinase-3, but in multivariable analysis, only bDMARDs was significantly associated with GCS (P=0.021). Global circumferential strain, GLS and GRS assessed by FT-CMR can reveal subclinical LV dysfunction in patients with RA. Furthermore, they can be used to determine the normalization of LV regional dysfunction induced by bDMARDs possibly related to disease activity reduction.

Establishment of Myocardial Strain Measurement Data in Pediatric Patients Without Structural Heart Disease: A Single Center Study.

Accurate assessment of LV systolic function remains a challenge, especially in the pediatric population. Myocardial strain measurement by 2D speckle tracking echocardiography (2DSTE) is a relatively new modality for assessment of regional and global myocardial wall motion. This study aims to establish the normative value among various pediatric age groups at a large pediatric tertiary care institution and to describe the challenges encountered in establishing such strain data. Transthoracic echocardiograms were acquired in 121 healthy children (age 0-21years) and were retrospectively analyzed. The global longitudinal strain (GLS) was obtained by 2D speckle tracking using Philips Epiq7® and QLAB post processing software. The normative value for left ventricular GLS (%) obtained in our study was - 20.8 ± 2.3 (< 1year); - 21.4 ± 2.2 (1-4years); - 19.6 ± 2.4 (5-9years); - 19.4 ± 2.6 (10-14years); - 18.9 ± 3.0 (15-21years). There was a statistically significant difference in GLS between the different age groups. The BMI (kg/m2) of assessed subjects were 14.6 ± 2.3 (< 1year); 16.3 ± 1.5 (1-4years); 16.7 ± 2.3 (5-9years); 21.3 ± 4.6 (10-14years); 23.9 ± 5.9 (15-21years). There was no significant difference in GLS by gender or by BMI found in our study. We present our experience with establishment of normative values of 2DSTE in our pediatric echocardiography lab. This study shows that age is the major determinant of variation in peak GLS in healthy subjects, emphasizing the importance of establishment of normative data among various age groups in pediatrics.

Global longitudinal strain assessment of the left ventricle by speckle tracking echocardiography detects acute cellular rejection in orthotopic heart transplant recipients: A systematic review and meta-analysis.

In orthotopic heart transplant recipients, surveillance with endomyocardial biopsy is crucial to detect acute cellular rejection (ACR) early. ACR is a common and serious complication of transplantation with substantial morbidity and mortality. Speckle tracking echocardiography with global longitudinal strain (GLS) assessment of the left ventricle has emerged as a possible noninvasive screening modality. We have conducted a systematic literature review and meta-analysis to evaluate the role of GLS in diagnosing ACR. The following databases were queried: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Embase. We compiled all articles evaluating changes in GLS in comparison to endomyocardial biopsy in ACR dated prior to September 2019. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were pooled by using a random effects model. In order to determine the risk of bias, we used the revised version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Twelve studies met inclusion criteria of which ten were chosen. These studies encompassed 511 patients and 1267 endomyocardial biopsies. There was a significant difference in GLS between patients who did and did not have ACR proven by biopsy (WMD=2.18; 95% CI: 1.57-2.78, P=<.001; I2 =76%). The overall sensitivity for GLS in detecting ACR was 78% (CI: 63%-90%, P=.123; I2 =52.2%) while the overall specificity was 68% (CI: 50%-83%, P=<.001; I2 =88.3%). Global longitudinal strain assessment of the left ventricle by speckle tracking echocardiography is useful in detecting ACR and could potentially reduce the burden of frequent endomyocardial biopsies in heart transplant recipients.

An echocardiographic study of left ventricular torsion in patients with latent obstructive hypertrophic cardiomyopathy

Objective To explore the changes of left ventricular torsion function in patients with latent obstructive hypertrophic cardiomyopathy(HCM), and provide quantitative informations for clinical evaluation of cardiac function. Methods A total of 49 consecutive patients with HCM without left ventricular outflow tract obstruction at rest were enrolled.All subjects underwent exercise stress echocardiography. After exercise left ventricular outflow tract pressure gradient(LVOT-PG)≥30 mmHg was positive for exercise stress test (latent obstruction), while LVOT-PG<30 mmHg was negative for exercise stress test (non-obstruction). An ultrasound system obtained two-dimensional ultrasound images of resting and moving peaks. The global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) of the left ventricle 16 segments and left ventricular rotation, twist were analysis using off-line EchoPAC software. The differences of the above parameters were compared between the two groups. Results There were no significant differences in GLS, GRS, GCS and Rotation-B between the two groups in resting and peak period of exercise (all P>0.05), GRS in both groups were significantly increased compared with that before exercise (all P 0.05). Conclusions Left ventricular torsion function is significantly changed in rest and after exercise in latent obstructive HCM patients, providing valuable quantitative information for clinical comprehensive evaluation of cardiac function. Key words: Echocardiography, stress; Latent left ventricular outflow tract obstruction; Cardiomyopathy, hypertrophic; Two-dimensional strain; Left ventricular twist

Abstract 11749: Prognostic Value of Left Ventricular Global Longitudinal Strain and Ejection Fraction in Patients With Non-ischemic and Ischemic Heart Disease

Background: Both Left ventricular (LV) global longitudinal strain (GLS) and LV ejection fraction (LVEF) are useful parameters for assessment of LV function. The aim of this study is to confirm the prognostic value of them in patients with non-ischemic and ischemic heart disease. Methods: We studied 179 patients (DCM group: Age 61±15 years, 70 females, LVEF 33±9%) with non-ischemic dilated cardiomyopathy and heart failure symptom, and 97 patients (MI group: Age 66±13 years, 18 females, LVEF 45±7%) who were successfully treated with percutaneous coronary intervention for acute anteroseptal myocardial infarction. Echocardiography was used for LV GLS derived from 2D speckle-tracking method and LVEF with modified Simpson’s method. Outcome was assessed according to death and re-hospitalization with heart failure in the follow-up period. Results: 40 patients in DCM group and 10 patients in MI group experienced at least one event. In these 2 groups, significant differences in GLS and LVEF were found between patients with and without cardiac events (p&lt;0.05). Kaplan-Meier analysis showed patients with worse GLS had an unfavorable outcome in both DCM and MI groups (p&lt;0.05), but LVEF did not associated with outcome. Conclusion: LV GLS has the potential to predict the outcome with higher sensitivity than LVEF in patients with heart disease regardless of ischemic etiology.

Changes in Longitudinal Myocardial Deformation during Acute Cardiac Rejection: The Clinical Role of Two-Dimensional Speckle-Tracking Echocardiography

Diagnosing and monitoring acute cellular rejection (ACR) is a major objective in the surveillance of heart-transplanted patients. The aim of this study was to evaluate the value of global longitudinal strain (GLS), measured by two-dimensional speckle-tracking echocardiography, as a noninvasive tool for graft function monitoring in relation to ACR. The study population consisted of all heart-transplanted patients who underwent biopsy and corresponding echocardiography at one institution from 2011 to 2013 (n=64). ACR was classified according to the International Society of Heart and Lung Transplantation (0R-3R). Changes in graft function were serially evaluated before, during, and in the resolving period after ACR. No sign of rejection was seen in 268 biopsies (52.7%), minimal rejection (1R) in 202 biopsies (39.7%), and moderate rejection (2R) in 39 biopsies (7.7%); no patients had severe (3R) rejection. A significant difference in GLS was observed comparing the groups with 0R (-15.5%; 95% confidence interval, -16.2% to -14.2%), 1R (-15.3%; 95% confidence interval, -16.0% to -14.6%), and 2R (-13.8%; 95% confidence interval, -14.6% to -12.9%) rejection (P<.0001). GLS remained significantly reduced in the 2R group despite the exclusion of patients with impaired systolic function (ejection fraction < 50%), allograft vasculopathy, and late rejection (>2 years) after transplantation. In the serial assessment, GLS was decreasing significantly at the time of moderate 2R rejection and improved significantly in the resolving period. The traditional diastolic Doppler parameters, E-wave deceleration time and isovolumetric relaxation time, were unaffected by rejections, whereas the E/A and E/e' ratios were significantly higher in the 2R group (P=.004 and P=.01) compared with the 0R and 1R groups. GLS is significantly reduced during moderate (2R) ACR and improves significantly in the resolving period. The present results provide encouraging evidence to consider the routine use of GLS as a marker of graft function involvement during ACR.

Assessment and Treatment of Post Patent Ductus Arteriosus Ligation Syndrome

To compare differences in tissue Doppler imaging, global longitudinal strain (GLS), and cardiac troponin T (cTnT) between infants with low (<200 mL/kg/min) and high (>200 mL/kg/min) left ventricular (LV) output 1 hour after duct ligation and assess the impact of milrinone treatment on cardiac output and myocardial performance. LV function was assessed preoperatively and 1 and 18 hours postoperatively. Infants were categorized into a low-output or a normal-output group based on the echocardiographic assessment of LV output at 1 hour. Thirty infants with a mean gestation of 25.3 weeks were enrolled. LV basal lateral S', basal septal S', and basal right ventricular S' were lower in the low-output group (n = 19) at 1 hour postoperatively, with no significant difference in GLS (low-output -10.3% vs high-output -14.4%, P >.05) or cTnT between the groups. Patients in the low-output group were treated with milrinone, and by 18 hours LV performance recovered to levels comparable with the high output group. cTnT values increased at 18 hours in the whole cohort with no significant difference between the groups. Tissue Doppler imaging and GLS provide novel insights and further characterization of myocardial performance immediately after patent ductus arteriosus ligation. A reduction in tissue Doppler-derived LV systolic velocity may further help in monitoring cardiac performance after patent ductus arteriosus ligation and for monitoring the effects of treatment.

Can longitudinal strain by 2 dimensional speckle tracking echocardiography provide diagnostic and prognostic value in immunoglobulin light chain and hereditary transthyretin cardiac amyloidosis?

Purpose: The aim of our study was to determine if longitudinal strain and strain rate (LS/LSR) provide diagnostic and prognostic value to distinguish hereditary transthyretin cardiac amyloid (HCA) from immunoglobulin light chain cardiac amyloid (ICA) in patients with preserved LVEF. Methods: Forty age and gender matched ICA and HCA patients with normal LVEF were included. LVEF, left ventricular mass index (LVMI) and NT-pro BNP were detected. Left ventricular global longitudinal strain (GLS) and strain rate (GLSR), as well as average basal, mid and apical systolic strain and SR were obtained with 2 dimensional speckle tracking echocardiography. Survival was also calculated. Results: NT-pro BNP in ICA (3537±4005 pg/ml) vs. HCA (844±1806 pg/ml) was significantly different (P<0.01); LVEF (65±7% vs. 64±7%) and LVMI (124±30 g/m2 vs. 129±41 g/m2) were not significant. There were significant differences in GLS (-12.0±4.2% vs. -13.9±2.8%, P<0.05) and GLSR (-0.73±0.22 s-1 vs.-0.84±0.18 s-1, P<0.05) between ICA and HCA group. The most significant difference was seen in apical LS (-13.1±4.3% vs. -17.3±3.3%, P<0.001) and LSR (-0.82±0.24s-1 vs.-1.02±0.23 s-1, P<0.001), in mid LS (-12.0±4.6% vs.-13.7±3.1%, P<0.05) and LSR (-0.66±0.23s-1 vs. -0.77±0.18s-1, P<0.05) as well, but not in basal LS/LSR. Patients with HCA had a better 3 year survival than those with ICA (P<0.01), the most significantly independent predictor was apical LS [cut-off -14.7%, OR 4.1 (1.37, 12.4), P<0.01], but LVMI and NT-pro BNP showed no superiority to longitudinal strain in survival. ![Figure][1] Survival curve of HCA vs. ICA Conclusions: There are regional variations in LS/LSR that can distinguish HCA from ICA. Longitudinal strain might be a good predictor for survival in patients with light chain and hereditary cardiac amyloidosis. [1]: pending:yes