Cardiovascular autonomic neuropathy (CAN) is a major complication of type 2 diabetes mellitus (T2DM), but the roles of arterial stiffness and right atrial (RA) function in CAN remain unclear. In 120 patients with T2DM, we assessed short-term heart rate variability (CVR-R), cardio-ankle vascular index (CAVI), and two-dimensional speckle-tracking echocardiography (2DSTE). CAN was defined as CVR-R <2%. Multivariable analysis showed that higher CAVI and lower RA function composite scores were independently associated with CAN. Both increased arterial stiffness and impaired RA function characterized CAN, indicating a key cardiovascular interaction. Combined CAVI and RA strain assessment may aid early detection.

It is observed that some atrial fibrillation (AF) patients develop right heart enlargement and severe right heart failure, which affect the prognosis. An abnormal right atrioventricular coupling index (RACI) indicates that AF has led to significant right atrial and right ventricular dysfunction. However, right atrial (RA) remodeling in AF patients is rarely assessed and data on the prognosis of RA is limited. This study aims to determine if the RACI can be used to predict the risk of long-term adverse outcomes in a cohort of patients with non-valvular AF after catheter ablation (CA). A total of 123 non-valvular AF patients who underwent CA in our center were enrolled in this retrospective study. Conventional and speckle tracking echocardiography (STE) were performed for AF patients before CA. Patients were followed up with until April 2025. The adverse outcomes were the composite of atrial tachyarrhythmia recurrence (ATa), stroke or transient ischemic attack (TIA), AF-associated hospitalization, pacemaker insertion and cardiovascular death. Logistic regression analysis was used to determine the optimal cutoff value of correlates for predicting adverse events. The median follow-up time was 5.3(1.6-5.5) years. Among the 123 AF patients, 69 experienced adverse outcomes. Multivariable logistic regression analysis showed that RACI and left atrial ejection fraction (LAEF) were the independent predictors of adverse events (95% CI, 0.643-0.806; P < 0.0001 and 95% CI, 0.628-0.795; P < 0.0001; respectively). The optimal cutoff values of RACI and LAEF were 70.97% and 35%, respectively. Spearman's correlation analysis showed that RACI was negatively correlated with RA reservoir strain and RA boost strain (r=-0.583, P < 0.001; r=-0.572, P < 0.001, respectively), and LAEF was positively correlated with LA reservoir strain and LA boost strain (r = 0.859, P < 0.001; r = 0.765, P < 0.001, respectively). Increased RACI and impaired LAEF are strongly associated with long-term outcomes, with RACI showing better independent predictive value.

Background: Immune checkpoint inhibitors (ICIs) improve cancer outcomes but may cause cardiovascular toxicity, including early subclinical myocardial injury. Conventional echocardiography has limited sensitivity, whereas speckle-tracking echocardiography (STE) allows for early detection of myocardial deformation. Data on short-term ICI-related effects on biventricular mechanics are limited, and atrial function remains poorly characterized. This study evaluated the early impact of ICI therapy on biventricular and biatrial mechanics using STE in patients with advanced cancer. Methods: In this prospective, single-center study, 28 consecutive patients with advanced cancer undergoing ICI therapy were followed for 3 months. Clinical, laboratory, electrocardiographic, and echocardiographic assessments were performed at baseline, 1 month, and 3 months. STE was used to assess left ventricular global longitudinal strain (LV-GLS) and circumferential strain; right ventricular GLS (RV-GLS); and left and right atrial reservoir, conduit, and contractile strain parameters. Subclinical LV dysfunction was defined as a relative LV-GLS reduction &gt;15%. Logistic and Cox regression analyses identified predictors of strain impairment and adverse clinical events. Results: Conventional echocardiographic parameters, including left ventricular ejection fraction, remained stable. In contrast, LV-GLS declined progressively from 20.7 ± 2.1% to 17.6 ± 2.7% at 3 months (p = 0.002), with subclinical LV dysfunction observed in 85.7% of patients. RV-GLS also deteriorated despite preserved TAPSE. Both left and right atrial strain and strain-rate parameters showed an early and marked decline, accompanied by increased left atrial stiffness despite unchanged atrial volumes. Older age and higher neutrophil-to-lymphocyte ratio (NLR) were associated with LV-GLS impairment. Over a mean follow-up of 5.4 ± 3 months, baseline LV-GLS independently predicted adverse clinical events and mortality. Optimal cut-off values were 67 years for age, 4 for NLR, and 19.5% for LV-GLS. Conclusions: Short-term ICI therapy is associated with early, diffuse subclinical myocardial dysfunction involving both ventricles and atria, detectable only by STE. Comprehensive biventricular and biatrial strain assessment may enhance early cardio-oncology surveillance and risk stratification in ICI-treated patients.

Initiation of dialysis encompasses new cardiovascular challenges on patients with end-stage kidney disease (ESKD). The prognostic value of assessment of left ventricular (LV) myocardial function in peritoneal dialysis (PD) patients is still unclear. This study used global LV myocardial work (MW) indices to investigate the change of LV myocardial function undergoing PD within 1 year. A total of 179 patients with ESKD were enrolled in this prospective study. Among them, 48 patients were diagnosed with diabetic kidney disease (DKD) and 131 patients were non-diabetic kidney disease (NDKD). We evaluated LV myocardial function of patients with ESKD by two-dimensional speckle-tracking echocardiography (2D-STE) with strains and MW indices. Echocardiography and clinical data were evaluated at baseline and 1 year after PD. Compared with NDKD group, patients with DKD had lower global longitudinal strain (GLS) (14.43±3.52 vs. 16.78±4.78 p=0.002), global work index (GWI) (1546.29±496.06 vs. 1750.51±416.97 p=0.006), and global constructive work (GCW) (1955.33±483.86 vs. 2129.65±459.04 p=0.028). After PD therapy, the NDKD group showed significant reduction of GWI (1616.78±360.18 vs. 1750.51±416.97 p＜0.001), GCW (1980.45±385.82 vs. 2129.65±459.04 p=0.006), and global wasted work (GWW) (158.00(102.00, 219.00) vs. 185.00(141.00, 250.00) p＜0.001) and increase of global work efficiency (GWE) (92.00(89.00, 94.00) vs. 91.00 (88.00, 93.00) p=0.008). Compared with NDKD group, the DKD group had less decrease of GWW (-14.00(-69.75, 85.00) vs. -36.00(-97.00, 21.00) p=0.020) and less increase of GWE (-1.00 (-4.00, 2.00) vs. 1.00(-2.00, 4.00) p=0.006) after PD therapy. After multivariable adjustment, Δresidual GFR (β=-0.165; p=0.034) and ΔDBP (β=-0.168; p=0.028) was the significant independent determinants of ΔGWE. ΔDBP was the only significant independent determinants of ΔGWW (β=0.343; p<0.001). After one year of PD treatment, patients with NDKD showed improved LV myocardial function. However, the benefit for DKD patients was relatively limited, reflected in a smaller increase in GWE and a smaller reduction in GWW.

ObjectiveStrain imaging serves as a sensitive marker for detecting early subclinical myocardial systolic dysfunction. The purpose of this study was to evaluate the diagnostic and prognostic value of myocardial work indices in assessing subclinical myocardial systolic dysfunction in active acromegaly patients.Methods27 active acromegaly patients and 27 healthy controls matched for age, sex, height, weight, body mass index and body surface area were included in the study. Active acromegaly was diagnosed based on elevated serum insulin-like growth factor 1 (IGF-1) (>1× upper limit of normal) or insufficient GH suppression (nadir ≥0.4 ng/mL) during an OGTT. All participants underwent two-dimensional speckle-tracking echocardiography (2D-STE) for the assessment of cardiac function. STE extracted the corresponding strain parameters (such as global longitudinal strain (GLS), global circumferential strain and global radial strain) and work parameters (such as global work index, global constructive work, global wasted work (GWW) and global work efficiency (GWE)) by analyzing the motion (strain)–velocity (strain rate) of two or more local myocardial segments, combined with the left ventricular non-invasive pressure estimation technique. At the same time, correlation analysis was used to explore the factors affecting GWW and GWE in the acromegaly group.ResultsIn comparison with the control group, conventional echocardiography revealed that acromegaly patients did not exhibit a significant difference in left ventricular ejection fraction (60.3 ± 3.7 vs 59.1 ± 4.8, P = 0.312), a commonly used index to evaluate ventricular systolic function, STE showed that there was no significant difference in GLS (−18.3 ± 2.4 vs −17.4 ± 2.9, P = 0.514) between the control group and the acromegaly group. However, significant differences can be found in GWW (44.8 ± 31.1 vs 80.6 ± 75.6, P = 0.027) and GWE (97.0 ± 1.8 vs 95.0 ± 3.8, P = 0.020), and a significant correlation was observed between myocardial work parameters and 1.5 × ULN IGF-1.ConclusionGWW and GWE are sensitive markers for identifying subclinical myocardial systolic dysfunction, suggesting their potential as early markers for detecting subclinical myocardial systolic dysfunction in active acromegaly patients.

Postsystolic shortening as indicator of regional myocardial dysfunction in patients with bipolar disorder.

Background: Right ventricular (RV) dysfunction is common in advanced lung disease due to chronic pressure overload and altered pulmonary vascular mechanics. Lung transplantation (LTx) reduces RV afterload, and pulmonary rehabilitation (PR) may further enhance functional recovery. However, the combined effects of LTx and structured PR on RV myocardial deformation—particularly using speckle-tracking echocardiography (STE)—remain insufficiently characterized. Methods: This single-arm pre–post study included 20 bilateral lung transplant recipients who completed an 8-week, twice-weekly supervised outpatient PR program. Echocardiographic evaluation—including 2D measurements, M-mode, tissue Doppler imaging (TDI), and STE-derived strain parameters—was performed immediately post-discharge (baseline) and after PR. RV global longitudinal strain (RVGLS) and RV free-wall longitudinal strain (RVFWS) served as primary functional outcomes. Results: Improvements were observed in RV myocardial deformation after PR. RVGLS improved from a median of 15.52% to 16.64% (p = 0.004), and RVFWS increased from 15.82% to 17.10% (p = 0.001). RV mid-cavity diameter decreased significantly (p = 0.042), reflecting favorably altered RV geometry. Conventional parameters—including TAPSE, S′ velocity, RVEDA, and FAC—showed no statistically significant changes. These findings indicate that STE parameters are more sensitive than traditional indices for detecting early RV remodeling in the post-transplant period. Conclusions: Lung transplantation combined with a structured PR program was associated with early improvements in RV deformation indices measurable by STE, even when traditional echocardiographic indices remained within normal limits. STE may therefore serve as a sensitive tool for monitoring subclinical RV recovery after LTx and for assessing the additive benefits of PR.

T1 mapping and speckle tracking echocardiography for the assessment of early mechanical dysfunction in transfusion-dependent β-thalassemia with normal T2.

To develop and validate machine learning (ML) models integrating two-dimensional speckle tracking echocardiography (2D-STE) parameters with clinical variables for robust identification of severe coronary artery disease (sCAD). In this retrospective cohort study, five distinct ML models (Random Forest [RF], Support Vector Machine [SVM], K-Nearest Neighbors [KNN], Multi-Layer Perceptron [MLP], and Extremely Randomized Trees [Extra Trees]) were constructed to identify sCAD on a cohort of 204 patients (80% training set, 20% independent test set). Within the independent test set, two junior sonographers' diagnostic performance for sCADwas compared first without and then with ML assistance over a 2-week interval. SHapley Additive exPlanations (SHAP) analysis was applied to visualize and interpret the models, identifying key features driving sCAD prediction accuracy, with results visualized through dependence diagrams and force plot. Furthermore, a clinical nomogram integrating key predictors identified by ML models was developed to enable individualized quantification of sCAD risk. Utilizing five features, the MLP demonstrated the best performance with an area under the curve (AUC) of 0.870 and a sensitivity of 0.944. The SHAP visualization analysis for this modelindicated that "LV AP4 Endo Peak L. Time SD" significantly influenced its predictions. The MLP model (AUC = 0.870) outperformed both junior sonographers (AUC = 0.687) and a nomogram constructed from ML-selected features (AUC = 0.712). Additionally, the results revealed that junior sonographers achieved significantly improved performance when assisted by the ML models. The developed ML models could differentiate patients with angiography-confirmed sCAD from those without. Importantly, these models significantly improved the diagnostic performance of junior sonographers when used as an assistive tool.

Neurofibromatosis type 1 (NF1) is an autosomal dominant syndrome caused by mutations in the NF1 gene. Although cardiac abnormalities have been observed in NF1, they are frequently overlooked due to a lack of routine cardiac surveillance. Myocardial strain imaging offers a sensitive and non-invasive method for detecting early subclinical myocardial dysfunction. This study aims to detect cardiac abnormalities in children with NF1 using conventional echocardiography, Doppler tissue imaging (DTI), and myocardial strain analysis. A case–control study was conducted on 38 asymptomatic children with clinically confirmed NF1 and 35 healthy, age- and sex-matched controls. All patients underwent ECG, conventional echocardiography, DTI, and two-dimensional speckle-tracking echocardiography. NF1 patients showed significantly decreased ejection fraction (p = 0.0009) and higher interventricular septal and posterior wall thickness during systole (p < 0.0001). DTI revealed reduced mitral systolic (Sm) and early diastolic (Em) velocities, longer isovolumic contraction and relaxation periods, and increased LV Tei index values (p < 0.0001), indicating combined systolic and diastolic dysfunction. Also, myocardial strain analysis in NF1 children revealed considerably lower peak systolic left ventricular global longitudinal strain (LVGLS) (p 0.0014), as well as lower peak systolic septal and lateral wall strain values (p 0.0046, 0.0027), respectively. Conclusion: Children with NF1 show early subclinical myocardial dysfunction, even when there is no hypertension or overt cardiac symptoms. These findings highlight the significance of frequent echocardiographic screening, including strain imaging, for the early diagnosis and longitudinal monitoring of heart function in NF1 children. What is Known:• Neurofibromatosis type 1 (NF1) is a multisystem syndrome that can involve the cardiovascular system.• Previous studies showed hypertrophic cardiac changes in NF1 patients, but data in children, especially those without hypertension, are limited, as routine echocardiography is not involved in NF1 management.What is New:• Our study revealed early subclinical myocardial dysfunction in NF1 children without the presence of hypertension or overt cardiac symptoms.• This emphasizes the potential of myocardial strain imaging as a sensitive tool for early detection of myocardial dysfunction in NF1 children, thereby supporting the need for routine echocardiographic surveillance in these patients.

A novel index, termed the right ventricle (RV)-pulmonary artery (PA) index, was established by integrating the longitudinal strain of the right ventricular free wall (RVFWLS) and the right ventricular ejection fraction (RVEF), both evaluated using three-dimensional speckle-tracking echocardiography (3D-STE), with the stiffness of the pulmonary artery (PAS). This approach aims to enhance our understanding of the underlying mechanisms associated with heart failure with preserved ejection fraction (HFpEF). The study comprised 80 patients diagnosed with HFpEF, 60 high-risk patients without clinical heart failure (HF), and 50 healthy controls. Clinical data and pulmonary stiffness measurements were collected, and right ventricular function was evaluated using 3D-STE. Furthermore, the corresponding RV-PA coupling parameters were established. Statistical analyses were conducted using SPSS version 26.0 and R software, employing one-way ANOVA, the Kruskal-Wallis H test, Pearson and Spearman correlation coefficients, multivariable linear regression, and receiver operating characteristic (ROC) curve analysis. Patients with HFpEF exhibited elevated levels of PAS, dilated right heart structures, and impaired right ventricular (RV) function when compared to both high-risk and control groups. PAS was identified as an independent risk factor for RV dysfunction. Stratified diagnostic analysis revealed that the novel coupling index, RVEF/PAS, demonstrated exceptional diagnostic performance during the initial screening phase (AUC=0.813) and maintained robust discriminatory power during the differentiation stage of the high-risk population (AUC=0.757). Both newly developed indices, RVEF/PAS and RVFWLS/PAS, exhibited significant positive correlations with tricuspid annular plane systolic excursion (TAPSE)/PASP (r=0.536, p=0.004; r=0.449, p=0.019). The proposed stratified diagnostic model, characterized by a "primary screening-refined discrimination" approach based on parameter characteristics, offers a novel strategy for the early detection of HFpEF. The 3D-STE method reliably assesses right ventricular function in patients with HFpEF, while pulmonary arterial compliance is effectively evaluated through PAS. The novel RV-PA coupling indices, namely RVEF/PAS and RVFWLS/PAS, are developed by integrating these techniques, providing a stratified diagnostic strategy for the early detection of HFpEF. PAS is appropriate for initial screening in primary care settings, whereas RVEF/PAS offers precise diagnostic support in medical centers. Collectively, these methods establish a novel non-invasive tool system for evaluating interactions between the right heart and pulmonary vasculature.

BackgroundThe study of mid- and long-term myocardial function in myocarditis survivors was limited, which cannot fully reflect their clinical prognosis. The present study was carried out to prospectively evaluate the left atrial (LA) and ventricular (LV) function of pediatric myocarditis survivors by speckle tracking echocardiography (STE) combined with stress echocardiography and to uncover its potential risk factors regarding myocardial impairment during follow-up.MethodsFifteen consecutive asymptomatic pediatric myocarditis survivors and fifteen age- and sex-matched healthy controls were prospectively enrolled. LA and LV deformations at rest and after stress tests were evaluated by conventional echocardiography and STE. The cardiac function reserve reflected as the differences in systolic/diastolic indices between at rest and peak-exercise was also explored. After Shapiro-Wilk and homogeneity test, the Chi-squared test, independent-sample t-test, or Mann-Whitney U test was applied to compare the differences between the two groups. Spearman’s correlation analysis was used to explore the relationships between different indices.ResultsBasic clinical data were comparable between two groups. As for the echocardiographic indices at rest, asymptomatic pediatric myocarditis survivors displayed worse resting LA function [reservoir strain (εR) (34.33±5.93 vs. 40.72±6.71, P=0.01), conduit strain (εCD) (25.42±4.88 vs. 30.41±5.52 P=0.014)]. After the exercise stress test, pediatric myocarditis survivors displayed worse LV function in comparison with controls as evidenced by lower peak-systolic myocardial velocity (s) of mitral (10.23±1.75 vs. 12.08±1.84, P=0.012), septal s’ (8.35±0.48 vs. 9.07±0.94, P=0.021), global longitudinal strain (GLS) (19.39±1.08 vs. 21.18±1.44, P=0.001), global circumferential strain (GCS) (18.88±1.34 vs. 20.89±1.59, P=0.001) and impaired systolic function reserve. Additionally, both resting LA εR and εCD displayed moderate correlations with post-exercise LV lateral s, septal s, and GLS as well as changes before and after exercise (Δ) of lateral s, Δseptal s, and ΔGLS.ConclusionsRegular STE-based LA functional assessment is recommended for asymptomatic pediatric myocarditis survivors to detect early myocardial impairment and probably improve risk prediction.

BackgroundChemotherapy-induced cardiotoxicity significantly impacts cancer prognosis, yet conventional assessment methods lack sufficient sensitivity for early detection. This study aimed to evaluate the dynamic changes of left atrial (LA) strain parameters and their utility as diastolic function markers in colorectal cancer patients receiving chemotherapy.MethodsIn this prospective cohort study, 94 patients treated with FOLFOX/XELOX regimens underwent comprehensive echocardiographic assessments at baseline (T0), after the first cycle (T1), mid-therapy (T2), and treatment completion (T3). Left atrial reservoir (LASr), conduit (LAScd), and contractile (LASct) strains, and left ventricular global longitudinal strain (LVGLS) were analyzed using speckle-tracking echocardiography. Linear mixed models characterized strain parameter trajectories, while latent class growth analysis identified heterogeneous response patterns. Correlation matrices evaluated associations between LA strain, LVGLS, and diastolic parameters, with receiver operating characteristic (ROC) curve analysis determining diagnostic performance.ResultsLASr showed strong negative correlations with conventional diastolic parameters (P<0.001), demonstrating superior diagnostic accuracy [area under the curve (AUC): 0.792] versus conventional indices. The model incorporating LA strain parameters significantly outperformed the model based on traditional diastolic parameters (AUC: 0.836 vs. 0.617, P<0.001). Chemotherapy induced progressive LASr decline (40.3% at T0 vs. 35.2% at T3, P<0.001), with distinct trajectories: a gradual decline (75.5% patients) and rapid deterioration (24.5%). LVGLS correlated positively with LASr (r=0.38–0.39). Patients with >15% LVGLS reduction had higher baseline hypertension prevalence (40.7% vs. 16.4%, P=0.007) and greater LASct impairment (2.1% reduction, P=0.012).ConclusionsLA strain parameters, particularly LASr, serve as sensitive biomarkers for chemotherapy-associated diastolic dysfunction, demonstrating diagnostic superiority over conventional measures. The observed strain progression patterns enable individualized risk stratification, providing a rationale for early cardioprotective interventions.

Background: Overweight and obesity in adolescents are associated with dyslipidemia and may contribute to early cardiovascular remodelling. Speckle-tracking echocardiography (STE) is a sensitive imaging technique capable of detecting early myocardial functional alterations before the onset of clinical symptoms. This study aimed to evaluate the correlation between cardiac chamber dimensions, left ventricular (LV) geometry and function, and lipid profiles in overweight and obese adolescents. Methods: A cross-sectional study was conducted from June to September 2023, involving 51 overweight and obese adolescents aged 15–18 years in Bandung, Indonesia. Anthropometric measurements, fasting lipid profiles (triglycerides, total cholesterol, LDL, HDL), and transthoracic echocardiography were obtained. LV dimensions, LV mass index (LVMI), ejection fraction (EF), fractional shortening (FS), and global longitudinal strain (GLS) were assessed. Associations were analyzed using Pearson correlation.Results: Participants were predominantly male (64.7%) with a mean age of 16.3±0.6 years. Overweight (47.1%) and obesity (52.9%) were almost equally distributed with a mean BMI of 29.6±4.1 kg/m². LVMI correlated negatively with total cholesterol (r=−0.356; p=0.005), HDL (r=−0.351; p=0.006), and LDL (r=−0.280; p=0.023). The LV posterior wall thickness and LV end-diastolic diameter were also inversely correlated with selected lipid parameters. Interventricular septal thickness in systole correlated positively with triglycerides (r=0.270; p=0.028). No significant correlations were found between lipid profiles and LV function parameters, including EF, FS, and GLS (p&gt;0.05).Conclusions: In overweight and obese adolescents, lipid profiles are associated with early alterations in LV structural dimensions while LV systolic function remains preserved. These findings support the importance of early cardiovascular screening and lifestyle modification to reduce future cardiometabolic risk.

Introduction. Cardiotoxicity is a multifaceted phenomenon involving a range of adverse changes in the cardiovascular system of patients undergoing chemotherapy for cancer. Its incidence is influenced by numerous risk factors. Currently, researchers are actively working to develop standardized protocols for the timely detection of potential cardiotoxic effects. Aim. This study aims to analyze the incidence of cardiotoxicity associated with chemotherapeutic agents. Additionally, it evaluates the relevance and practicality of using cardiac biomarkers – individually and in combination – for predicting the risk and facilitating early detection of cardiac dysfunction caused by various drug classes. Materials and methods. A literature review was conducted using international scientific publications and regulatory documents (including clinical guidelines and management protocols) over the past 10 years. The focus was on cardiovascular complications linked to specific chemotherapeutic agents and the interplay of risk factors contributing to cardiotoxicity. Results. Severe myocardial dysfunction during chemotherapy significantly contributes to poor clinical outcomes and increased mortality in cancer patients. Repeated chemotherapy due to disease progression, especially in the presence of risk factors, heightens the likelihood of developing pronounced cardiotoxic left ventricular dysfunction. Delays in diagnostic evaluations and cardiology consultations may compromise the effectiveness of cancer treatment due to the emergence of substantial cardiac complications. Therefore, efforts to predict cardiotoxicity in specific patient populations and to implement comprehensive cardiovascular assessments remain essential in modern oncology. Conclusions. Speckle-tracking echocardiography shows promise as a tool for the early detection of cardiotoxicity. Incorporating cardiac biomarker panels and assessing global longitudinal strain (GLS) alongside left ventricular ejection fraction may improve the accuracy of early diagnosis and risk prediction for chemotherapy-induced cardiac dysfunction.

BackgroundKidney transplantation (KT) improves left ventricular (LV) systolic function, but few studies have examined its impact on left atrial (LA) function. This study aimed to assess LA structural and functional changes in patients with end-stage renal disease (ESRD) after KT through use of two-dimensional speckle-tracking echocardiography (2D-STE).MethodsA prospective cohort of 163 patients with ESRD (85 in the KT group; 78 in the dialysis group) who underwent echocardiography at baseline and 12-month follow-up was included, with LA strain and stiffness being measured via 2D-STE. Inter- and intragroup changes were compared, with multivariate linear regression and adjustment for confounders.ResultsKT significantly improved LA function at 12 months: LA reservoir strain (LASr) increased from 39.0%±11.12% to 42.9%±13.74% (P=0.043), and LA conduit strain (LAScd) increased from 22.4%±7.52% to 25.3%±7.99% (P=0.016). LA volume index (LAVI), LA stiffness (LASt), and LA contractile strain (LASct) showed no significant changes. No improvements were observed in the dialysis group. At follow-up, the KT group had significantly better LA function than did the dialysis group, as indicated by LASr (42.9%±13.74% vs. 36.1%±13.92%; P=0.004), LAScd (25.3%±7.99% vs. 20.1%±10.16%; P<0.001), and LASt (0.25±0.14 vs. 0.40±0.29; P<0.001), with significance persisting after adjustment. Structural parameters (LAVI and LASct) did not differ between the groups.ConclusionsOur study provides insights into the cardiovascular protective mechanisms of KT and indicates that it can improve LA reservoir and conduit function, maintain lower stiffness in patients with ESRD, and thus potentially delay atrial remodeling and stiffness progression.

A systematic review and meta-analysis to determine the prognostic value of left atrial (LA) myocardial strain assessed with speckle tracking echocardiography (stEchoCG) for prediction of new-onset atrial fibrillation (AF) according to population-based studies. The PubMed (Medline) and Google Scholar databases were searched for studies. In all studies, the included patients met the following criteria: general population screening; age over 18 years; absence of AF and history of stroke; availability of 2D echocardiography results obtained in accordance with standard protocols. In all included studies, the endpoint was the development of AF. To determine the difference in the average weighted LA strain values, LA strain values were analyzed in the reservoir phase (peak atrial longitudinal strain, PALS), conduit phase (left atrial conduit strain, LACS), and contraction phase (left atrial contractile strain, LACtS). Adjusted odds ratio (OR) values were obtained from multivariable models.Results The analysis included 7 studies with a total of 12,161 patients, with 5,326 (43.8%) men. According to the meta-analysis, patients with new-onset AF had significantly lower values of LA longitudinal strain in the reservoir phase (PALS) and contraction phase (LACtS) compared with patients without AF: the weighted mean difference was -3.30% (95% confidence interval (CI): -5.58 to -1.01; p=0.005) and -2.51% (95% CI: -4.12 to -0.89; p=0.002), respectively. No statistically significant differences were found in the conduit phase strain (LACS) (-0.63%; 95% CI: -1.37 to 0.11%; p=0.10). The decreases in PALS and LACtS were associated with an increased risk of AF (OR 1.05 for every 1% of PALS; 95% CI: 1.03-1.07; p&lt;0.0001 and OR 1.08 for every 1% of LACtS; 95% CI: 1.04-1.12; p&lt;0.0001), whereas no association was found between LACS and the risk of AF (OR 1.01; 95% CI: 0.99-1.04; p=0.21).Conclusion Decreased left atrial strain values in the reservoir phase (PALS) and contraction phase (LACtS) determined by stEchoCG are associated with an increased risk of a first AF episode, according to population studies.

Left ventricular non-compaction (LVNC) is a heterogeneous cardiomyopathic phenotype, often associated with impaired systolic function. Advanced imaging modalities such as cardiac magnetic resonance (CMR) and speckle-tracking echocardiography (STE) allow detailed assessment of myocardial structure and deformation, yet the patterns of global and segmental longitudinal strain (LS) in LVNC remain insufficiently defined. This study aimed to evaluate global and regional LS in patients with CMR-confirmed LVNC using two-dimensional STE and CMR feature-tracking, and to assess the consistency between these two modalities. Thirty-five adults with CMR-confirmed LVNC referred to the Cardiovascular Centers of Shiraz University of Medical Sciences (March 2022-December 2023) were retrospectively analyzed. All patients underwent transthoracic echocardiography with LS assessment by 2D-STE, and CMR-derived LS was obtained when image quality permitted. Demographic, clinical, and imaging parameters were recorded. Non-parametric statistical tests were used with correction for multiple comparisons. The mean age was 43.3 ± 14.3 years; 71.4% were men. CMR most frequently identified non-compaction in the lateral (91.4%) and apical (51.4%) segments. Global LS was reduced in all patients. STE demonstrated significantly greater LS impairment in apical segments compared with basal segments (P < 0.001; mid vs. basal P = 0.004; apical vs. mid P = 0.017). Patients with a higher number of non-compacted segments exhibited greater LS reduction. In the subset with analyzable CMR strain data, LS values in the apical and mid-ventricular regions were comparable between CMR and STE (P > 0.05), whereas basal strain values differed significantly between modalities (P = 0.003). Patients with CMR-confirmed LVNC demonstrated reduced global LS and a consistent pattern of more pronounced apical strain impairment. STE and CMR showed reasonable concordance in mid-apical regions, supporting the complementary role of deformation imaging in the evaluation of LVNC. Incorporating LS into routine assessment may improve detection of functional impairment. Further studies are needed to determine the optimal strain-based approach and clarify its relationship with underlying anatomical abnormalities.

Background: Right-ventricular (RV) involvement is starting to gain recognition in pediatric dilated cardiomyopathy (DCM), but its deformation characteristics and its relationship to functional status remain insufficiently defined. Methods: Twenty-nine children with primary DCM were compared with age- and sex-matched healthy controls. Conventional echocardiography and two-dimensional speckle-tracking echocardiography (2D-STE) were performed. Segmental deformation (basal, mid-ventricular and apical levels) was analyzed using a linear mixed-effects model. Associations between strain indices and advanced functional limitation (NYHA/Ross Class III-IV) were evaluated using exploratory logistic regression and ROC analysis. Results: Children with DCM showed significant impairment in both ventricles. Conventional parameters (TAPSE, tricuspid E/A ratio, RV E′ velocity, and LV ejection fraction) were reduced. Right ventricular strain was significantly lower in DCM compared with controls (p &lt; 0.05). Segmental analysis demonstrated a basal-predominant reduction in RV strain. Right-ventricular free-wall longitudinal strain correlated with RV S′ (r = −0.49), RV E′ (r = −0.46), LVGLS (r = 0.79) and LV ejection fraction (r = −0.63, all p &lt; 0.05). In univariable analysis, RVFWSL predicted advanced functional class (OR 1.13 per 1% decrease, p = 0.026), while LVGLS remained the independent predictor in the multivariable model. A combined model incorporating RVFWSL and LVGLS demonstrated excellent discriminative accuracy (AUC 0.95). Conclusions: Pediatric DCM is characterized by RV involvement with a distinct basal-dominant deformation pattern. Biventricular strain assessment improves the identification of children with advanced functional class and may enhance functional stratification beyond conventional indices.

BackgroundFirst-degree relatives (FDRs) of individuals with type 2 diabetes mellitus (T2DM) are at increased cardiometabolic risk due to genetic predisposition, even in the absence of overt disease. To evaluate subclinical myocardial dysfunction using speckle-tracking echocardiography (STE) and to assess serum levels of endothelial dysfunction related biomarkers, Endothelin-1 (ET-1), E-selectin, and Endocan, in normoglycemic FDRs of patients with T2DM, compared with healthy controls.MethodsThis study included 151 normoglycemic participants, comprising 75 individuals in the study group and 76 in the control group. Global longitudinal and circumferential strain values were assessed using STE. Serum levels of ET-1, E-selectin, and Endocan were measured using ELISA.ResultsET-1 levels were significantly higher in the study group (p = 0.047). STE revealed lower strain values in the study group in both SAX Basal/Mid/Apical (p = 0.027) and A4C/A2C/A3C mean views (p = 0.013). E-selectin showed a negative correlation with myocardial strain values, although no significant between-group difference was observed.ConclusionsNormoglycemic FDRs of T2DM patients exhibited subclinical myocardial strain abnormalities and elevated ET-1 levels, suggesting early cardiovascular alterations associated with genetic predisposition. ET-1 and E-selectin may serve as potential biomarkers for preclinical myocardial dysfunction in at-risk individuals.