Subclinical Cardiac Injury Research Articles

Associations of Hypertension and Orthostatic Hypotension With Subclinical Cardiovascular Disease.

Orthostatic hypotension is associated with cardiovascular disease. It remains unclear if low standing blood pressure or high seated blood pressure is responsible for this association. We compared associations of orthostatic hypotension and hypertension with high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide. We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You, a randomized controlled trial funded by the National Institute on Aging, between July 2015 and May 2019. Participants were community-dwelling adults, 70 years or older. Blood tests for high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide were drawn at visits concurrent with blood pressure measurements. Secondary analysis occurred in 2023. We determined associations between blood pressure phenotypes and cardiac biomarkers. Of 674 participants (mean age 76.5 ± 5.4 years, 43% female, 17.2% Black race), 29.1% had prior cardiovascular disease. Participants with seated hypertension had 10.1% greater high-sensitivity cardiac troponin I (95% confidence interval = 3.8-16.9) and 11.0% greater N-terminal pro-B-type natriuretic peptide (4.0-18.6) than those without seated hypertension. Participants with standing hypertension had 8.6% (2.7-14.9) greater high-sensitivity cardiac troponin I and 11.8% greater N-terminal pro-B-type natriuretic peptide (5.1-18.9) than those without standing hypertension. Hypotensive phenotypes were not associated with either biomarker. Both seated and standing hypertension were associated with greater high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide, but hypotensive phenotypes were not. Hypoperfusion may not be the principal mechanism behind subclinical cardiac injury among older adults with orthostatic hypotension.

Abstract 67: Cardiac Biomarkers in Pregnancies with and without Hypertension – a Case Control Study

Background: There is ongoing debate about hypertension (HTN) management during pregnancy with a range of recommended targets. Whether HTN is related to subclinical cardiac injury during pregnancy is unclear. Objective: To determine the relationship between HTN with subclinical cardiac injury during and immediately after pregnancy, measured via high sensitivity troponin I (hs-cTnI). Methods: In a prospective, 1:1 case-control design, we enrolled pregnant women with and without HTN between 24-32 weeks gestation (2019-2022). HTN cases were defined by a clinician diagnosis at <20 weeks gestation or a baseline blood pressure (BP) ≥140/90 mm Hg. The control group (no HTN) had a systolic BP <120 mm Hg. Hs-cTnI was collected at baseline, the delivery admission, and postpartum day 1. We used mixed effects tobit models to compare the groups on log-transformed hs-cTnI, adjusted for age and BMI. Results: The mean age of the HTN group (N=38) was 33.6 (SD 5.4) vs. 30.3 (5.8) years for the no HTN group (N=38). Mean (SD) baseline BP was 131.1 (14.7)/88.2 (13.5) for the HTN group and 110.1 (7.2)/70.9 (8.2) mm Hg for no HTN. At baseline, hs-cTnI was 1.3 (0.2) in the HTN group and 0.6 (0.1) ng/L in the no HTN group ( Figure ). Compared to baseline, hs-cTnI increased 89.1% (95% CI: 27.3-180.8%) and 322% (192-511%) for the HTN group, and 101.6% (41.0-188.3%) and 165.2% (88.6-272.9%) for no HTN at delivery and postpartum, respectively. Across all time points, the HTN group had a higher hs-cTnI of 1.05 (0.07-2.03) ng/L compared to the control group. Discussion: HTN was associated with subclinical cardiac injury during and immediately postpartum. These findings support recommendations to control HTN throughout pregnancy to reduce cardiac injury.

Changes in Mitochondrial Function and Cell Death Patterns in Peripheral Blood Mononuclear Cells during Trastuzumab Treatment Following Doxorubicin Chemotherapy.

Trastuzumab, a monoclonal antibody which works against human epidermal growth factor receptor 2 (HER2), possibly causes cardiotoxicity through mitochondrial dysfunction. The usefulness of isolated peripheral blood mononuclear cells (PBMCs) in the assessment of trastuzumab-induced cardiotoxicity remains uncertain. This study aimed to determine the temporal changes in mitochondrial function, oxidative stress, and cell death in the isolated PBMCs of HER2-positive breast cancer patients during breast cancer treatment and to compare the changes with HER2-negative breast cancer patients who did not receive trastuzumab therapy. Eighteen newly diagnosed HER2-positive breast cancer women who received sequential doxorubicin and trastuzumab were consecutively recruited. Age- and gender-matched controls with HER2-negative breast cancer were selected. Echocardiography was carried out, and blood samples for the study of cardiac biomarkers and PBMCs were collected periodically during treatment. Only one patient in our cohort developed asymptomatic left ventricular dysfunction during trastuzumab treatment. However, trastuzumab following doxorubicin aggravated subclinical cardiac injury, determined by cardiac troponin and echocardiography. Cellular and mitochondrial oxidative stress in isolated PBMCs remained unchanged throughout breast cancer treatment. Regarding mitochondrial respiration, the maximal respiration and spare respiration capacity was significantly increased in controls after doxorubicin treatment but not in patients who received trastuzumab therapy. Moreover, the percentage of apoptosis and necroptosis in isolated PBMCs was dramatically decreased in the control, compared to patients with trastuzumab treatment. In conclusion, trastuzumab caused subtle myocardial injury and impaired mitochondrial respiration and cell viability in isolated PBMCs.

Abstract P107: The DASH Diet Reduces Markers of Subclinical Cardiac Injury Over an 8-week Period: Results From an Individual Level Meta-Analysis

Introduction: The Dietary Approaches to Stop Hypertension (DASH) diet has previously been shown to reduce blood pressure and low-density lipoprotein (LDL) cholesterol as compared to the typical American diet. However, direct evidence linking the DASH diet with clinical markers of cardiovascular disease (CVD) is limited. Objectives: To perform a systematic review of trials examining the DASH diet and sensitive markers implicated in CVD: high-sensitivity cardiac troponin (hs-cTnl), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity c-reactive protein (hs-CRP) to determine the effects of the DASH diet on subclinical cardiac injury. Methods: We systematically reviewed 1122 abstracts from PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (date range 1997 to 2022). We retrieved data from two trials (DASH and DASH-Sodium, using 8-week biomarker measurements), and combined data from the trials to determine subgroup effects. We used mixed effects tobit models to determine the effects of the DASH diet (versus an isocaloric typical American diet) on hs-cTnl, NT-proBNP, and hs-CRP. Effects were determined overall and in subgroups of age, sex, race, hypertension status, obesity, and smoking status. Results: Of the 632 participants included, mean age (SD) was 47 (10.5); 54% were female and 55% were Black. Compared to an isocaloric control diet, the DASH diet reduced hs-cTnl (β = -17.7%, 95% CI: -26.3, -8.1), NT-proBNP (β = -8.6%, 95% CI: -16.8, 0.4), and hs-CRP (β = -11.1%, 95% CI: -20.7, 0.2). Effects were consistent across demographic groups, although the DASH diet had a larger effect on hs-CRP among men ( P -interaction = 0.016) ( Figure ). Conclusion: The DASH diet reduced subclinical cardiac damage and inflammation over an 8-week period. These data provide evidence of the direct benefits of the DASH diet on cardiac health.

Cardiac Function in Pediatric Patients with MIS-C Using Speckle Tracking and Conventional Echocardiography: A Longitudinal, Single-Center Study.

Cardiovascular involvement in Multisystem Inflammatory Syndrome in Children (MIS-C), a potential consequence of coronavirus disease-2019 (COVID-19), is common. Conventional transthoracic echocardiography (TTE) provides primary data on the function of the left and right ventricles, while Speckle Tracking Echocardiography (STE) is more sensitive. This study aims to assess longitudinal cardiac function using STE in these patients. This longitudinal study was conducted from late 2021 to early 2022 at Imam Hossein Children's Hospital, Isfahan. Cardiac function was assessed by STE at the time of diagnosis and again two months later. Demographics, clinical characteristics, ECG interpretations, imaging studies, and serum cardiac marker levels were collected. Thirty-five pediatric patients with a mean age of 5.1 years (range: 4 months to 17 years) were included and prospectively followed. Twenty-nine of them, comprising 14 males (48.3%) and 15 females (51.7%), underwent STE and were compared with 29 healthy age- and sex-matched children. Factors related to adverse events included reduced myocardial function, enlarged left atrium or ventricle, and mitral regurgitation (MR). Patients with comorbidities affecting strain measurements were excluded from the strain analyses. A significant difference was observed between the groups in regional strains in the basal and apical septal and middle lateral regions. Global strain rate (GLS) and strain rates were not significantly different but were still lower than the control group. Twenty percent of patients had abnormal GLS but normal left ventricular ejection fraction (LVEF). All patients exhibited reduced segmental myocardial strain in at least one segment. Four out of 26 recovered patients without comorbidities had abnormal GLS at follow-up, despite normal LVEF. STE proves more useful than conventional echocardiography in patients with MIS-C, revealing subclinical cardiac injury in the acute and post-acute phases.

Connective tissue disease as a challenge in heart failure: Three case reports.

Connective tissue disease (CTD) is a heterogeneous group of chronic inflammatory autoimmune disorders derived from a systemically auto-immunological deregulation. CTD may affect cardiac structures through multiple pathophysiological mechanisms, and subclinical cardiac injury is common. Heart failure (HF) is one of the common complications in these patients. Patients with CTD suffer an increased risk of cardiovascular disease and may have chest pain and shortness of breath. HF is characterized by dyspnea or exertional limitation due to impaired ventricular filling and/or blood ejection. HF can be caused by other systemic diseases, not only by cardiovascular disorders but CTD. CTD may cause HF due to diffuse myocardial damage, heart valve damage, coronary ischemia, and so on. The patient with catastrophic antiphospholipid syndrome take prednisone and warfarin. The patient with anti-synthetase syndrome was treated with immunoglobulin, followed by long-term oral medicines of prednisone, methotrexate, and folic acid. The symptoms of chest pain and shortness of breath for patients with CTD improved. HF is one of the common complications in these patients with CTD, which has poor prognosis and severe aggravation. Once such patients experience chest pain, chest tightness, shortness of breath, etc, we should consider the possibility of HF. Early identification and correct treatment can delay the progression of HF, improve the prognosis, and enhance the quality of life for patients. Therefore, we should pay more attention to patients with CTD combined with HF.

Cardiovascular magnetic resonance characterization of myocardial tissue injury in a miniature swine model of cancer therapy-related cardiovascular toxicity

BackgroundLeft ventricular ejection fraction (LVEF) is the most commonly clinically used imaging parameter for assessing cancer therapy-related cardiac dysfunction (CTRCD). However, LVEF declines may occur late, after substantial injury. This study sought to investigate cardiovascular magnetic resonance (CMR) imaging markers of subclinical cardiac injury in a miniature swine model. MethodsFemale Yucatan miniature swine (n=14) received doxorubicin (2mg/kg) every 3 weeks for 4 cycles. CMR, including cine, tissue characterization via T1 and T2 mapping, and late gadolinium enhancement (LGE) was performed on the same day as doxorubicin administration and three weeks after the final chemotherapy cycle. In addition, MR spectroscopy (MRS) was performed during the 3 weeks after the final chemotherapy in 7 pigs. A single CMR and MRS exam was also performed in three Yucatan miniature swine that were age- and weight-matched to the final imaging exam of the doxorubicin-treated swine to serve as controls. CTRCD was defined as histological early morphologic changes, including cytoplasmic vacuolization and myofibrillar loss of myocytes, based on post-mortem analysis of humanely euthanized pigs after the final CMR exam. ResultsOf 13 swine completing five serial CMR scans, 10 (77%) had histological evidence of CTRCD. Three animals had neither histological evidence nor changes in LVEF from baseline. No absolute LVEF <40% or LGE were observed. Native T1, extracellular volume (ECV), and T2 at 12 weeks were significantly higher in swine with CTRCD than those without CTRCD (1178 ms vs. 1134 ms, p=0.002, 27.4% vs. 24.5%, p=0.03, and 38.1 ms vs. 36.4 ms, p=0.02, respectively). There were no significant changes in strain parameters. The temporal trajectories in native T1, ECV, and T2 in swine with CTRCD showed similar and statistically significant increases. At the same time, there were no differences in their temporal changes between those with and without CTRCD. MRS myocardial triglyceride content substantially differed among controls, swine with and without CTRCD (0.89%, 0.30%, 0.54%, respectively, ANOVA, p=0.01), and associated with the severity of histological findings and incidence of vacuolated cardiomyocytes. ConclusionsSerial CMR imaging alone has a limited ability to detect histologic CTRCD beyond LVEF. Integrating MRS myocardial triglyceride content may be useful for detection of early potential CTRCD.

Abstract 17000: Adipokines and Subclinical Myocardial Injury Following Bariatric Surgery

Background: Bariatric surgery results in marked weight loss and has many cardiometabolic benefits. Adipokines, proteins secreted by adipose tissue with diverse metabolic effects, are affected by bariatric surgery. Whether favorable changes in adipokines after bariatric surgery are associated with improvements in cardiac biomarkers is unknown. Methods: We studied 294 bariatric surgery patients and 294 controls matched on age, sex, BMI, and diabetes in the Geisinger Obesity Registry. We measured serum markers of subclinical cardiac injury (high-sensitivity cardiac troponin I [hs-cTnI]), cardiac fibrosis (galectin-3), and adipokines (adiponectin, leptin, resistin, visfatin) prior to surgery and 6-18 months post-surgery in bariatric surgery patients and at similar intervals in controls. We used linear regression to evaluate the associations of changes in log-transformed adipokines with changes in log-transformed hs-cTnI and galectin-3. Results: Participants (mean age 45; 83% female; 97% White; mean BMI 47 kg/m 2 ) undergoing bariatric surgery lost 38.5 kg and matched controls gained 0.4 kg on average. Leptin, resistin, visfatin, hs-cTnI and galectin-3 decreased while adiponectin increased in bariatric surgery participants. There were no significant changes in any biomarkers in control participants. Increasing adiponectin and decreasing leptin were associated with decreases in hs-cTnI, but these associations were attenuated by adjustment for weight loss ( Table ). Decreasing resistin was linked to decreasing hs-cTnI and galectin-3, and decreasing visfatin with decreasing galectin-3, independent of weight loss. Conclusion: Bariatric surgery induced weight loss results in favorable changes in adipokines, which are associated with reversal of subclinical myocardial injury, and to a lesser degree, with decreasing myocardial fibrosis. Associations for some adipokines were weight loss-dependent, while others were independent of weight loss.

Dose DIBH Really Reduce the Subclinical Cardiac Acute Injury? Analysis of Clinical Real World from Our Institute

The study is aim to investigate whether Deep-inspirational breath-hold (DIBH), compared with free breathing (FB), could provide a short-term cardiac benefit in patients with early left breast cancer after breast-conserving surgery combined whole breast radiotherapy. A total of 78 patients with early stage left breast cancer treated with radiotherapy between 2021-2022 after breast-conserving surgery were enrolled. Among them, 32 cases were treated with DIBH technique and 46 cases were treated with free breathing. Patients with previous cardiac disease such as coronary artery disease were excluded. We performed myocardial enzymes, ECG, and ECHO in all patients within 2 weeks before, during, and 6 months after radiotherapy. The results of the two groups were compared using nonparametric tests and chi-square tests, and P < 0.05 indicated statistical significance. Where subclinical acute cardiac injury was defined as new above-normal myocardial enzymes and/or electrocardiographic ST-T or T-wave changes and/or ECHO abnormalities after the start of radiotherapy. The median follow-up of patients was 6 months and the mean age of patients was 52.3 years for FB and 44.9 years for DIBH. There were no significant differences in staging, molecular subtype, chemotherapy and endocrine therapy history. The proportion of subclinical acute cardiac injury was smaller in the DIBH group compared to the FB group (DIBH = 31/46 and FB = 28/32, p = 0.042). The most sensitive of the subclinical acute cardiac injury events were detected by myocardial enzymes rising, with cTnI (p = 0.034) and NT-proBNP (p = 0.023) appearing significantly lower in the DIBH patients during radiotherapy. The difference of cTnI between 2 groups at 6 months after radiotherapy became non-significant. In contrast, CK-MB was higher in DIBH compared with FB only 6 months after radiotherapy (p = 0.006). The differences in ECG and ECHO were not significant between the two groups. After breast-conserving surgery combined with radiotherapy for left early breast cancer, DIBH compared to FB reduces the proportion of acute subclinical cardiac injury that occurs with the most sensitive changes in myocardial enzymes. Subsequent studies will explore the relationship between the short-term subclinical injury and irradiated dose, as well as long term cardiac injury.

Abstract P158: Associations Of Orthostatic Hypotension And Resting Hypertension With Biomarkers Of Subclinical Cardiovascular Disease

Background: Orthostatic hypotension (OH) is associated with cardiovascular disease (CVD), but mechanisms for this relationship are unclear. Objective: To determine associations between orthostatic, seated, or standing hypotension with two biomarkers of subclinical injury—high sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)—relative to orthostatic, seated, or standing hypertension (HTN). Methods: We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (STURDY) using standardized seated and standing blood pressure (BP) assessments. We defined OH as a drop in systolic BP (SBP) ≥20 or diastolic BP (DBP) ≥10 mm Hg upon standing; seated or standing hypotension as BP ≤105/≤65 mm Hg; orthostatic HTN as an increase in BP ≥20/≥10 mm Hg upon standing; and seated or standing HTN as BP ≥140/≥90 mm Hg. Associations between BP phenotypes and serum Hs-cTnI and NT-proBNP were determined using mixed-effects Tobit models. Results: Of 673 participants (mean age 76.5 ± 5.4 years; 43% female; 17% Black), 63% had prior CVD. Those with seated HTN had a 10.2% greater hs-cTnI ( P = 0.001) and 11.0% greater NT-proBNP ( P = 0.002) than those without seated HTN ( Table) . Participants with standing HTN had an 8.6% ( P = 0.004) greater hs-cTnI and 11.8% greater NT-proBNP ( P = 0.0005) than those without standing HTN. No hypotensive phenotypes were associated with biomarkers. Conclusions: Both seated and standing HTN are associated with greater hs-cTnI and NT-proBNP, but hypotensive phenotypes were not. Hypoperfusion may not be a major contributor to subclinical cardiac injury among older adults with OH.

Baseline Left Ventricle Longitudinal Strain as a Predictor for Clinical Improvement Following Coronary Sinus Reducer Implantation

Coronary sinus narrowing device (reducer) implantation has emerged as an effective treatment to improve the quality of life and functional capacity in patients suffering from disabling refractory angina. Left ventricle global longitudinal strain (LV-GLS) is a useful tool for early diagnosis of subclinical cardiac injury and an independent predictor for coronary artery disease. We aimed to investigate whether LV-GLS could help predict clinical improvement after coronary sinus reducer implantation. LV-GLS assessments were performed at baseline and 6months after reducer implantation in consecutive patients treated for refractory angina. Patients were divided into 2 groups based on reduced (<17% absolute value) or preserved baseline LV-GLS. Clinical improvement was defined as an increase of ≥25m in the 6-minute walk test (6MWT) at follow-up. Overall, 41 patients were included, 31 in the reduced LV-GLS group and 10 in the preserved LV-GLS group. The mean age was 68±8years, with only 2 female patients (5%). Baseline characteristics did not differ significantly between the 2 groups. Univariable analysis revealed that LV-GLS was the only significant predictor for 6MWT improvement. Baseline preserved LV-GLS reduced the likelihood of 6MWT improvement by 82% (odds ratio 0.18 [0.04 to 0.83], p=0.029). A significant increase in 6MWT (307±97m to 343±92m, p=0.017) was observed in the reduced LV-GLS group, compared with a decrease in the preserved LV-GLS group (378±86m to 361±123m, p=0.651). In conclusion, reduced LV-GLS may serve as a marker for potential clinical improvement in patients with refractory angina treated with reducer. Larger clinical trials are needed to establish its role.

The prevalence of abnormal right ventricle speckle strain in the setting of acute myocarditis and preserved left ventricle function.

Acute myocarditis has a wide spectrum of clinical presentation, from subclinical disease to acute heart failure, and sudden cardiac death. Two-dimensional speckle tracking echocardiography (2D-STE) has been proven effective in early diagnosis of subclinical cardiac injury, however, there is a limited data regarding the right ventricle (RV) involvement among patients with acute myocarditis. We evaluated the prevalence of early subclinical RV injury assessed by 2D-STE, among patients with acute myocarditis and preserved left ventricle (LV) function. We performed a retrospective single-center study at Tel-Aviv Sourasky Medical Center, including all adult patients hospitalized with acute myocarditis, who presented with preserved LV function. 2D-STE analysis of the RV was performed offline, assessing both the RV four-chamber longitudinal strain peak systolic (RV4CLS PK) and the free wall longitudinal strain peak systolic (RVFWLS PK). The myocarditis group was compared to a healthy control group. From 2011 to 2020, a total of 90 patients included in the study and were compared to 70 healthy subjects. RV 2D-STE emerged as significantly lower for both the RV4CLS PK (-21.8 ± 4.2 vs. -24.9 ± 4.8, P < 0.001) and RVFWLS PK (-24.7 ± 4.9 vs. -28.4 ± 5, P < 0.001), and remained significant in a multivariate analysis. We presented for the first time the presence of subclinical RV dysfunction, assessed by 2D-STE, in patients diagnosed with acute myocarditis, in the presence of preserved LV function. Further studies are needed to evaluate its' role in the development of LV dysfunction, heart failure and mortality.

SUBCLINICAL PREDICTORS OF HEART FAILURE IN UNTREATED SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT KNOWN HEART DISEASE

SUBCLINICAL PREDICTORS OF HEART FAILURE IN UNTREATED SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT KNOWN HEART DISEASE

Effects of glucose and blood pressure reduction on subclinical cardiac damage: Results from ADVANCE

ObjectiveObservational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial. MethodsThe Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization. ResultsAmong the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (−10.3%; 95%CI: −20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (−2.9%; 95%CI: −8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95). ConclusionsIn adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes.This trial is registered at clinicaltrials.gov, number: NCT00145925.

Subclinical Cardiac Injury And Clinical Congestion

<h3>Introduction</h3> Clinical congestion is associated with worse outcomes in patients with heart failure (HF). The pathophysiological mediators of this association remain uncertain. <h3>Hypothesis</h3> Detailed phenotyping of patients with HF, including clinical examination and measurement of invasive hemodynamics and cardiac biomarkers, will provide insights into the pathophysiology of clinical congestion. <h3>Methods</h3> In a prospective cohort of patients with HF and reduced LVEF, a clinical examination followed the same day by right heart catheterization and blood sampling for biomarker measurement was performed. A clinical congestion score was created based on JVP (cm H20 <10 = 0, 10-14 =1, >14 =2 points), bendopnea (0-1), S3 (0-1) and peripheral edema (0-2). Congestion tier was defined as Absent, Mild (1 point) or Moderate-Severe (≥ 2 points). Biomarker elevation was defined as high-sensitivity troponin T ≥52 ng/L or NT-proBNP ≥1000 pg/mL. Elevated right atrial pressure (RAP) was ≥10 mmHg and pulmonary capillary wedge pressure (PCWP) ≥22 mmHg. Univariate and multivariable analyses tested the association of biomarkers, RAP, and PCWP with clinical congestion. <h3>Results</h3> Of 154 subjects, 65 (42%) had no congestion, 35 mild (23%) and 54 (35%) moderate-severe. Increasing congestion tier was associated with NT-proBNP, troponin, RAP and PCWP (P<0.001 for each). Increasing congestion tier was associated with the combined presence of elevated troponin, NT-proBNP and PCWP (Figure). Only 22% of those with absent congestion had more than one of these findings, whereas 76% of those with moderate-severe congestion had at least 2 of them (p<0.001). In multivariable regression, elevated troponin was associated with the presence of clinical congestion (OR 2.8, 1.1-7.3, p=0.03) independently of RAP, PCWP, and NT-proBNP levels. <h3>Conclusions</h3> Increased ventricular filling pressures, elevated natriuretic peptide levels, and subclinical myocardial injury frequently coexist in patients with clinical congestion. Elevated troponin was associated with clinical congestion independently of ventricular filling pressures and natriuretic peptide levels, suggesting that subclinical cardiac injury contributes to the pathophysiology of clinical congestion.

Abstract 047: Effects Of The Dash Diet On Change In High-Sensitivity Cardiac Troponin I Over Time: Results From The Dash-Sodium Trial

Background: The DASH (Dietary Approaches to Stop Hypertension) diet has been shown to reduce high-sensitivity cardiac troponin I (hs-cTnI), a biomarker of subclinical cardiac injury. However, the time course of the DASH diet’s effects on this biomarker has not been determined. Hypothesis: The DASH diet lowers hs-cTnI within 4 weeks and the effects gradually increase over time. Methods: We analyzed data from the DASH-Sodium trial, a randomized controlled feeding study of healthy adults with systolic blood pressure 120 to 159 mm Hg and diastolic blood pressure 80 to 95 mm Hg. Participants were randomly assigned to the DASH diet or a typical American diet (control). Within each arm of the study, participants were assigned three sodium levels, in random order, changed every 4 weeks. Hs-cTnI was measured from serum collected at baseline and at 4, 8, and 12 weeks of feeding. Energy intake was adjusted to maintain body weight throughout the trial. Results: Of the 411 participants included in the final analysis, their mean age was 48 years, 56% were women, and 56% were Black. The mean baseline systolic/diastolic blood pressure was 135/86 mm Hg. Compared with baseline, the control diet did not have a significant effect on hs-cTnI at any of the measured time points. In contrast, the DASH diet reduced hs-cTnI by 0.18 ng/l (95% CI: -0.32, -0.04) at 4 weeks, 0.14 ng/l (95% CI: -0.29, 0.00) at 8 weeks, and 0.33 ng/l (95% CI: -0.48, -0.18) at 12 weeks ( Figure ; P -trend = 0.025). The %-difference in mean change from baseline of hs-cTnI for DASH vs. control was -13.30% (95% CI: -25.34, 0.69), -10.47% (95% CI: -23.08, 4.21), and -17.78% (95% CI: -29.51, -4.09) at 4, 8, and 12 weeks, respectively. Conclusions: The DASH diet reduced hs-cTnI within 4 weeks of feeding with greater diet effects occurring at 12 weeks of feeding. These results suggest that the DASH diet has both early and cumulative effects on subclinical cardiac injury.

Deformation analysis in post-hospitalised patients with moderate SARS-CoV-2 infection

Abstract Funding Acknowledgements Type of funding sources: None. Background SARS-CoV-2 infection is associated with multiple cardiac manifestations (1,2). Global longitudinal strain (GLS) by speckle tracking echocardiography (STE) is a novel transthoracic echocardiography (TTE) measure of myocardial deformation, which could early recognize subclinical cardiac injury in COVID-19 patients (3,4). Purpose We aimed to explore GLS profiles in post-hospitalized COVID-19 patients to identify features of eventual subclinical cardiac injury and to investigate the possible correlation with the severity of infection. Methods We enrolled 33 patients (mean age 59.2 ± 13, 64% men) with positive SARS-CoV-2 RT-PCR, hospitalized for moderate COVID-19 disease, with no admission to intensive care unit. Patients were submitted to TTE 1-2 months after discharge. Images were anonymised and analysed offline by two accredited cardiologists. Clinical parameters and laboratory findings from hospitalization were also collected. Acute myocardial infarction and pulmonary embolism were exclusion criteria. Results Mean duration of hospitalization was 12.9 ± 8.0 days. Study population had normal systolic function with a mean LV ejection fraction 58.6% (±3.6) while the majority of patients had relative low values of LV global longitudinal strain, mean 15.2% (±2.3). Arterial hypertension was present in 51.5% of patients and a history of previous myocardial infarction was referred in 6.1% of the population. Only 24.2% of patients had elevated troponin levels during the previous in-hospital period (mean maximal value of hs-troponin was 18.1 ±16.6 pg/mL) whereas 81.8% had abnormal D-Dimers values (mean 2424 μg /L, range ±2825) and 93.1% had high hs-CRP values (138.2 ±92.0 mg/L) . Duration of hospitalization had strong significant correlation with D-Dimers (rho: 0.708, p: &amp;lt;0.001) and hs CRP (rho:0383, p:0.028) and marginal association with troponin ( rho: 0.335, p:0.056). Moreover, global longitudinal strain showed significant association with duration of hospitalization (rho:-0.545, p: 0.007). Traditional systolic indices as LVEF and the various diastolic parameters showed no significant association with severity of disease reflected by the duration of hospitalization and the other clinical and laboratory biomarkers. Conclusion Cardiac manifestations of SARS-CoV-2 infections could be present in mild to moderate disease and seems to associate with the severity of infection. The novel echocardiographic parameters such as GLS could add valuable information and identify possible subclinical cardiac injury often unrecognized by traditional TTE examination.

Subclinical LV and RV Dysfunction in Patients Recovered From COVID-19

Cardiac injury is reported acutely in hospitalised COVID-19 patients, however sustained impairment in recovered patients is unclear. We evaluated cardiac involvement in patients who had recovered from acute COVID-19 infection but had ongoing symptoms, using echocardiography (TTE). Forty-two patients with recovered COVID-19 were followed up at a median time from infection of 112 [109] days and were compared to age and gender-matched healthy controls. Traditional TTE parameters left ventricular (LV), 2D global longitudinal strain (GLS), and right ventricular (RV) free wall strain were measured. Among COVID patients, 10 (23.8%) were hypertensive, 6 (14.3%) diabetic, 2 (4.8%) had atrial fibrillation and 1 (2.4%) a history of IHD. LV wall thickness was significantly higher in the COVID-19 group (Table). LV volumes and LVEF were similar to controls; however, LV GLS was significantly worse in the COVID-19 cohort (p=0.002, Table). Similarly, RV volumes and traditional function parameters (FAC, TAPSE, S’ velocity) were similar, but RV free wall strain (RVFWS, p=0.009) and RV global strain (p=0.015) were reduced. On univariant analysis, COVID-19 infection, sex, admission to ICU, LV volume and mass and RV area were associated with LV GLS. On multivariant analysis, COVID-19 infection was the only independent determinant of LV GLS (β=0.269, p=0.008). Prior COVID-19 infection was the only independent determinant of reduced LV GLS, suggesting persisting subclinical cardiac injury even in recovered patients with ongoing symptoms.Tabled 1ParametersControlsCOVID-19p valuePW ED (mm)8.12±1.648.76±1.560.029IVS ED (mm)8.17±1.829.17±1.890.002LVEDVI (ml/m2)47.10±10.8946.70±17.280.867LVESVI (ml/m2)19.25±5.1418.91±9.210.782LVEF (%)59.40±5.2760.19±5.430.427LV GLS (%)-19.86±1.90-18.33±2.430.002TAPSE (mm)22.41±3.7721.48±4.650.300RVS' (cm/s)11.51±1.6011.93±2.090.359RV FAC (%)40.81±6.7039.79±7.980.352RVFWS (%)-27.32±4.56-24.05±5.890.009 Open table in a new tab

Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19

BackgroundCoronavirus disease 2019 (COVID-19) can cause cardiac injury resulting in abnormal right or left ventricular function (RV/LV) with worse outcomes. We hypothesized that two-dimensional (2D) speckle-tracking assessment of LV global longitudinal strain (GLS) and RV free wall strain (FWS) by transthoracic echocardiography can assist as markers for subclinical cardiac injury predicting increased mortality. MethodsWe performed 2D strain analysis via proprietary software in 48 patients hospitalized with COVID-19. Clinical information, demographics, comorbidities, and lab values were collected via retrospective chart review. The primary outcome was in-hospital mortality based on an optimized abnormal LV GLS value via ROC analysis and RV FWS. ResultsThe optimal LV GLS cutoff to predict death was −13.8%, with a sensitivity of 85% (95% CI 55–98%) and specificity of 54% (95% CI 36–71%). Abnormal LV GLS >-13.8% was associated with a higher risk of death [unadjusted hazard ratio 5.15 (95% CI 1.13–23.45), p = 0.034], which persisted after adjustment for clinical variables. Among patients with LV ejection fraction (LVEF) >50%, those with LV GLS > −13.8% had higher mortality compared to those with LV GLS <-13.8% (41% vs. 10%, p = 0.030). RV FWS value was higher in patients with LV GLS >-13.8% (−13.7 ± 5.9 vs. −19.6 ± 6.7, p = 0.003), but not associated with decreased survival. ConclusionAbnormal LV strain with a cutoff of >−13.8% in patients with COVID-19 is associated with significantly higher risk of death. Despite normal LVEF, abnormal LV GLS predicted worse outcomes in patients hospitalized with COVID-19. There was no mortality difference based on RV strain.

The Role of Speckle Strain Echocardiography in the Diagnosis of Early Subclinical Cardiac Injury in Cancer Patients-Is There More Than Just Left Ventricle Global Longitudinal Strain?

With the improvement in survival rate, cardiotoxicity has emerged as a significant adverse effect of cancer therapy. Early diagnosis of subclinical cardiac injury may allow the initiation of cardioprotective therapy and preventing the interruption of optimal cancer therapy and the development of irreversible cardiac dysfunction. In this article, we review the role of two-dimensional speckle tracking echocardiography (2D-STE), beyond the common left ventricle global longitudinal strain in the diagnosis of early subclinical cardiac injury in patients treated with cancer therapies.