Subclinical Left Ventricular Systolic Dysfunction Research Articles

Subclinical Left Ventricular Systolic Dysfunction in HIV Patients: Prevalence and Associations with Carotid Atherosclerosis and Increased Adiposity.

Background: Human immunodeficiency virus (HIV) is mainly detected in young, otherwise healthy, individuals. Cardiomyopathy and peripheral artery disease affecting these patients appears to be multifactorial. Prompt and potentially more effective implementation of therapeutic measures could be enabled by pre-symptomatic diagnosis of myocardial dysfunction and peripheral artery damage. However, limited data is available to date on this specific topic. Μethods: We investigated the association between global longitudinal strain (GLS), an established index of subclinical left ventricular systolic dysfunction (LVSD) assessed by two-dimensional speckle-tracking echocardiography, and: (a) patient history; (b) demographic and clinical baseline characteristics; (c) carotid intima-media thickness (IMT) and the presence of carotid atherosclerotic plaque(s), measured by ultrasonography; (d) temperature difference (ΔT) along each carotid artery, measured by microwave radiometry; and (e) basic blood panel measurements, including high-sensitivity troponin-T (hsTnT) and NT-proBNP in people living with HIV (PLWH) and no history of cardiovascular disease. Results: We prospectively enrolled 103 consecutive PLWH (95% male, age 47 ± 11 years, anti-retroviral therapy 100%) and 52 age- and sex-matched controls. PLWH had a significantly higher relative wall thickness (0.38 ± 0.08 vs. 0.36 ± 0.04, p = 0.048), and higher rate of LVSD (34% vs. 15.4%, p = 0.015), and carotid artery atherosclerosis (28% vs. 6%, p = 0.001) compared with controls. Among PLWH, LVSD was independently associated with the presence of carotid atherosclerosis (adj. OR:3.09; 95%CI:1.10–8.67, p = 0.032) and BMI (1.15; 1.03–1.29, p = 0.017), while a trend for association between LVSD and left ventricular hypertrophy was also noted (3.12; 0.73–13.33, p = 0.124). No differences were seen in microwave radiometry parameters, NT-proBNP, hs-TnT and c-reactive protein between PLWH with and without LVSD. Conclusions: Subclinical LVSD and carotid atherosclerosis were significantly more frequent in PLWH compared to a group of healthy individuals, implying a possible link between HIV infection and these two pathological processes. Carotid atherosclerosis and increased adiposity were independently associated with impaired GLS in HIV-infected individuals.

Automated Global Longitudinal Strain Assessment in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia.

Simple SummaryHeart failure is a major problem that affects childhood cancer survivors. Thus, early detection of cardiotoxicity before the onset of symptoms is imperative. Global longitudinal strain (GLS) is an echocardiographic tool that can be used to detect subclinical changes in cardiac function. However, its utility in long-term cardiac monitoring is unclear, and its application in routine practice is limited in this setting. We aimed to assess the prevalence of cardiotoxicity in 90 long-term childhood leukemia survivors (CLSs) using conventional echocardiography and automated software that simplifies GLS measurement. Additionally, we compared these measurements and biomarkers with a control group made up of 58 healthy siblings. Our results show that automated GLS outperforms conventional echocardiography in the early detection of cardiotoxicity, emerging as a promising tool in the long-term cardiac surveillance of CLSs.There is limited evidence that supports the use of the global longitudinal strain (GLS) in long-term cardiac monitoring of childhood acute lymphoblastic leukemia survivors (CLSs). Our aim was to assess the utility of automated GLS to detect left ventricular systolic dysfunction (LVSD) in long-term CLSs. Asymptomatic and subclinical LVSD were defined as LVEF < 50% and GLS < 18.5%, respectively. Echocardiographic measurements and biomarkers were compared with a control group. Inverse probability weighting was used to reduce confounding. Regression models were used to identify factors associated with LVEF and GLS in the survivors. Ninety survivors with a median follow-up of 18 (11–26) years were included. The prevalence of LVSD was higher using GLS than with LVEF (26.6% vs. 12.2%). The measurements were both reduced as compared with the controls (p < 0.001). There were no differences in diastolic parameters and NT-ProBNP. Survivors were more likely to have Hs-cTnI levels above the detection limit (40% vs. 17.2%, p = 0.006). The dose of anthracycline was associated with LVEF but not with GLS in the survivors. Biomarkers were not associated with GLS or LVEF. In conclusion, LVSD detection using automated GLS was higher than with LVEF in long-term CLSs. Its incorporation into clinical routine practice may improve the surveillance of these patients.

Abstract 131: Evaluation of left ventricular systolic function using global longitudinal strain by 2D speckle tracking echocardiography in patients with acromegaly

Background: Acromegaly is a rare disease resulting from Growth hormone excess. It is associated with an increased risk of cardiovascular mortality and morbidity. Global Longitudinal Strain (GLS) analysis by 2D Speckle tracking echocardiography (STE) offers a more sensitive assessment of myocardial contractility, which may help to identify patients with subclinical LV systolic dysfunction. We report a series of 10 subjects with Acromegaly comparing GLS using 2D STE and ejection fraction by the conventional method.Results: Ten subjects (Male=7, Female=3) with Acromegaly irrespective of their disease activity were included. The mean age was 44.1±7.6. All the subjects had normal ejection fraction, and the mean ejection fraction was 58±2.05%. STE revealed four subjects having abnormal GLS; two had mild, and two had moderately abnormal GLS values. The mean Left Ventricular Mass index was 87.92±23.64 g/m2, and the mean Left Atrial Volume index was 23.2±3.73 ml/m2.Conclusion: In spite of having normal left ventricular ejection fraction, GLS measured by STE were abnormal among four subjects indicating subclinical LV systolic dysfunction revealing decreased myocardial contractility. This study explores the potential application GLS by 2D STE in subjects with Acromegaly.

Early Detection of Subclinical Left Ventricular Dysfunction in Patients with Systemic Lupus Erythematosus: A Case-Control Study

Background: The aim of this study was to evaluate subclinical left ventricular (LV) dysfunction by two-dimensional (2D) speckle tracking echocardiography (STE) and three-dimensional echocardiography in patients with systematic lupus erythematosus (SLE). Methods: This case-control study was performed on 106 patients, divided into the two groups of case (53 patients with SLE) and control (53 healthy individuals). All study participants were evaluated by transthoracic echocardiography, as well as Tissue Doppler echocardiography. Accordingly, ventricular dimensions and LV ejection fraction (LVEF) were assessed. Moreover, E velocity, A velocity, E/A ratio, and E/E’ ratio were evaluated in both groups. The LV global longitudinal strain (GLS) was measured by 2D STE in all individuals. Results: There was no significant difference between the two study groups regarding LVEF based on traditional echocardiography. However, E velocity, A velocity, and the E/e’ ratio were higher in the SLE patients (P &lt; 0.05). In addition, the anti-double-stranded DNA (anti-dsDNA) positivity in SLE patients was associated with the lower levels of LVEF. No significant correlation was found between disease duration, LVEF, and LV GLS (P &gt; 0.05). Conclusions: Detection of subclinical LV systolic dysfunction by GLS is possible in SLE patients despite normal LVEF in traditional echocardiography. Therefore, LV could be used for the early detection and prevention of cardiac involvement in SLE patients.

The prognostic value of reduced global longitudinal strain (GLS) on cardiac outcomes in patients on peritoneal dialysis: a prospective study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction This study aims to evaluate the capacity of left ventricular global longitudinal strain (GLS) in end stage renal failure patients on peritoneal dialysis (PD) to predict cardiovascular mortality and major adverse cardiac events (MACE). GLS has been an established parameter in detecting subclinical left ventricular systolic dysfunction in the setting of preserved ejection fraction (EF &amp;gt; = 50%). We hypothesized that reductions of GLS (i.e. less negative value) are associated with adverse cardiovascular outcome. Methods We prospectively recruited a total of 60 PD patients from a single dialysis center in a tertiary hospital. GLS was determined by two-dimensional speckle-tracking echocardiography, under Philips QLab system. A less negative value reflects underlying subclinical LV dysfunction. The primary outcome was 4-point MACE, which was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalization for heart failure. Surrogate markers of inflammation (C-reactive protein [CRP], tumor necrosis factor [TNF]-alpha), nutrition (serum albumin), arterial stiffness (pulse wave velocity [PWV]), and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were also measured. Results 16 (26.7%) and 34 (56.7%) PD patients had reduced GLS (≥ -18.3%) and left ventricular hypertrophy (LVH) respectively. In 12-month follow up, 4-point MACE occurred in 13.6% and 59.8% of normal and compromised GLS patients respectively (log-rank, P = 0.004), as illustrated by Kaplan-Meier curves (Fig 1). Patients with reduced GLS had higher proportion of uncontrolled blood pressure and higher prevalence of coronary artery disease. Their EF were significantly lower (53.6 ± 7.4% vs. 61.3 ± 4.1%, P= 0.001) compared with patients with normal GLS. In addition, GLS correlated with EF (r = -0.57, P &amp;lt;0.0001) and PWV (r= 0.33, P = 0.01). There was a trend towards an association between GLS and ln(CRP) (r= 0.25, P = 0.057), and ln(NT-proBNP) (r = 0.22, P= 0.09), respectively. Conclusions Subclinical LV systolic dysfunction was present in one-fourth of peritoneal dialysis patients despite having preserved EF. Reduced GLS (less negative than 18.3%, illustrated in Fig 2) is a strong predictor of poor cardiovascular prognosis among PD population. Abstract Figure 1 Abstract Figure 2

Evaluation of subclinical LV systolic dysfunction by global longitudinal strain using 2D-speckle tracking echocardiography in patients having angina with normal epicardial coronary arteries

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Self Background Global longitudinal strain (GLS), assessed by 2D speckle tracking echocardiography would be a trustworthy noninvasive tool to detect subclinical LV systolic dysfunction in patients having angina with normal epicardial coronary arteries. Objective The primary objective of the study to detect subclinical LV systolic dysfunction by GLS using 2D-STE in patient having angina with normal coronary arteries and also by conventional echocardiogram at baseline. Materials and Methods This was a comparative case control study that was conducted during the period of March 2018 to August 2018. The study included 60 patients who have been suffering from angina like syndrome despite normal coronary arteries along with 60 normal healthy individuals . All subjects were assessed by transthoracic echocardiography (TTE ) and GLS using 2D speckle-tracking analysis to assess resting LV systolic function . The results of all three planes in GLS (the apical four-chamber , two-chamber , and three-chamber views) were combined in a single bull’s eye summary (agreeing with the standard 17-segment model), which presented the analysis of each segment along with a global peak systolic strain value for the LV. Results This study identified normal reference value of the mean GLS in healthy control group was −19.7 ± 1.84%. GLS assessed by 2D STE was significantly impaired in patients having angina like syndrome with normal epicardial coronary arteries (-18.78 ± 1.87 vs -19.7 ± 1.84%; p &amp;lt; 0.007) than healthy control group despite preserved LVEF. In case group, 8 out of 60 patients (13.3 %) had more negative global longitudinal strain than control subject. Conclusions Patients having angina with normal epicardial coronary arteries are likely to have microvascular disease. GLS assessed by 2D STE has the potential to improve the value of conventional echocardiography in the detection of the coronary microvascular disease. Despite normal LVEF, significant impairment of LV global longitudinal systolic function can differentiate microvascular group of patients from others who have angina with normal coronaries.

Myocardial Injury in Multiple Myeloma Patients With Preserved Left Ventricular Ejection Fraction: Noninvasive Left Ventricular Pressure-Strain Myocardial Work.

IntroductionOver one-half of patients with multiple myeloma (MM) die of heart failure or arrhythmia. Left ventricular ejection fraction (LVEF) is used to describe left ventricular systolic function. However, depressed LVEF means advanced stage of left ventricular dysfunction in patients with MM. Left ventricular pressure-strain-derived myocardial work (LVMW) is a novel and noninvasive method for evaluating LV function related to LV dynamic pressure load. MW is assessed by LV MW index (LVMWI), constructive work, wasted work, and LV MW efficiency (LVMWE). In this study, we aimed to investigate the value of LVMW in cardiac function assessment and clinical prognosis of MM patients with preserved LVEF.MethodsA total of 72 subjects, including 40 untreated MM patients with preserved EF (including the thick wall and normal wall groups) and 32 non-MM patients, were enrolled in this study. Laboratory data and clinical history of all the patients were collected. All the patients underwent comprehensive echocardiographic examinations and then LVMWI and LVMWE were calculated. Moreover, cardiac adverse events (CAEs) were observed in MM patients treated with bortezomib-based therapy after 6 months and the prognostic value of MW was assessed.Results(1) LV myocardial global work index (GWI), myocardial global work efficiency (GWE), and global longitudinal strain (GLS) were lower in the thick wall group of patients with MM compared with the normal wall group and controls. Cardiac segmental analysis of LVMWI in patients with MM showed an apical sparing pattern; (2) The area under the curve (AUC) of GWE for judging the disease severity based on the Revised International Staging System (R-ISS) was 0.835 (95% CI: 0.684–0.933, p < 0.05); (3) GWE, LgdFLC, and arrhythmia were independent risk factors of CAEs. The AUC of GWE for predicting CAEs in MM patients treated with bortezomib-based therapy for 6 months follow-up was 0.896 (95% CI: 0.758–0.970, p < 0.05).ConclusionMM Patients with preserved EF had subclinical LV systolic dysfunction, which was worse in the thick wall group. LVMWI was presented as “apical sparing” in patients with MM. A lower LVGWE may have a predictive value for CAEs in patients with MM after 6 months of follow-up.

Effects of iron deficiency on left ventricular functions in young women regardless of anemia: A speckle tracking echocardiography study.

Iron deficiency is one of the most common metabolic disorders worldwide and affects multiple organs and systems including the cardiovascular (CV) system. Iron deficiency can cause structural and functional changes in the myocardium. The aim of the study is to evaluate left ventricular (LV) functions in patients with low ferritin levels without anemia by two-dimensional "speckle tracking" echocardiography (2D STE). We studied 90 participants (all female) that were divided into two groups according to ferritin levels (49 patients with ferritin levels <30 ng/mL, 41 age-matched controls with >30 ng/mL). Patients with anemia (hemoglobin level <12 g/dL), known CV disease, diabetes mellitus, low ejection fraction (<55%), active infection, high ferritin levels (>200 ng/mL) were excluded. All patients were evaluated by transthoracic echocardiography. In addition to conventional echocardiographic parameters and Doppler measurements, LV global longitudinal strain (GLS) and strain rate (GLSR) were obtained by 2D STE. Mean ferritin level was 18.96 ± 7.29 ng/mL in low ferritin group, and was 61.22 ± 26.14 ng/mL in control group. There were no significant differences according to conventional and Doppler echocardiographic parameters between the groups. LV GLS and GLSR values were significantly lower in low ferritin group comparing with control group (17.31% ± 1.56 and 18.96% ± 1.53, p < 0.001; 0.64 ± 0.13 1/s and 0.81 ± 0.13 1/s, p < 0.001, respectively). There was a significant positive correlation between ferritin levels and LV GLS and GLSR values in study group (r = 0.482, p < 0.001; r = 0.387, p < 0.001, respectively). Ferritin level was also detected as an independent risk factor for GLS value < -18% in logistic regression analysis. In ROC curve analysis, the area under the curve for predicting GLS < -18% was 0.801 (p < 0.001, 95% CI 0.70-0.89) and the threshold of ferritin value was 28.5 ng/mL (sensitivity 76.1%, specificity 77.3%). Low ferritin levels can cause subclinical LV systolic dysfunction in patients without anemia. STE provides detailed information about LV functions. With larger studies, these patients should be followed more closely and considered for iron replacement treatment before developing anemia.

Relationship between Fragmented QRS and Microvascular Dysfunction in Masked Hypertension

Aim: The aim of this study was to investigate the presence of fQRS and its association with subclinical systolic and microvascular dysfunction in patients with masked hypertension (MH). Methods: The study population consisted of 95 (mean age 48.9 ± 11.3, 61% males) subjects with MH and 80 age- and gender-matched healthy individuals who served as a control group. Coronary flow reserve (CFR) using transthoracic echocardiography and for left ventricular global longitudinal strain (LVGLS) using speckle-tracking strain imaging were performed. Patients with MH were stratified into two groups according to the presence of fQRS on surface electrocardiogram. Results: Fragmented QRS was more common among MH patients compared with controls (38.9% vs. 6.25%, p < 0.003). CFR was significantly lower in patients with fQRS compared with those without fQRS and controls (p < 0.001). Likewise, LVGLS values were lower in MH patients with fQRS (p < 0.001) compared with subjects without fQRS and controls. Fragmented fQRS was significantly correlated with systolic blood pressure, CFR, and LVGLS. Multivariate analysis showed that the presence of fQRS, number of leads, and CFR were independent predictors of subclinical systolic dysfunction. With ROC cure analysis, number of leads with fQRS ≥4 was the optimal value for predicting the presence of subclinical systolic dysfunction in subjects with MH. Conclusions: Fragmented QRS is more frequent among subjects with MH compared with controls. The presence of fQRS is related with pronounced subclinical left ventricular systolic dysfunction. Furthermore, CFR was significantly reduced in subjects with MH, a finding supposed that microvascular dysfunction to be a mechanistic link.

Preoperative Left Ventricular Global Longitudinal Strain Identifies Aortic Stenosis Patients with Improved Postoperative Recovery of Left Ventricular Geometry: A Prospective Cohort Study.

IntroductionThe left ventricular ejection fraction (LVEF) is commonly used as a marker of aortic stenosis (AS) disease severity and to indicate surgical intervention. However, an LVEF <50% identifies mainly advanced disease. Hence, earlier detection of subclinical LV systolic dysfunction may improve clinical decision-making. The global longitudinal strain (GLS) can identify subclinical systolic dysfunction at earlier stages of AS progression even in the presence of preserved LVEF. To this end, we evaluated the preoperative prognostic significance of the LVGLS to identify patients who will undergo a more extensive postoperative LV reverse remodeling as a surrogate marker for clinical recovery.MethodsWe performed a prospective observational study based on detailed pre- and postoperative 2D transthoracic echocardiographic examinations, including strain analysis with speckle tracking. We screened 60 consecutive patients with severe AS and a preoperative LVEF ≥50% indicated for surgery; 39 patients met the study entry criteria and consented to their participation.ResultsThe median age was 67 (range 30-79) years; 56.4% were female. At baseline, the GLS was 61.64±7.22%. Surgery led to an improvement in the GLS; the mean difference was 3.23% [95% CI=1.96 to 4.49%] during a median follow up time of 5 (interquartile range 4-6) months. The preoperative GLS correlated with the postoperative LV mass index (LVMI) r=0.526, P=0.001 and the intraventricular septal thickness in diastole (IVSd) r=0.462, P=0.003. Furthermore, patients with a normal GLS (≤-18.9%) at baseline experienced a better recovery of their LV morphology and systolic function during the postoperative course compared to those with an abnormal GLS (>-18.9%). The effect size, hedges g, was at least >0.75 for the LVMI, IVSd, intraventricular septal thickness in systole (IVSs), left ventricular posterior wall thickness in diastole (LVPWd) and LVEF, suggesting a clinically significant difference between subgroups at follow-up.ConclusionA normal preoperative left ventricular global longitudinal strain is associated with an improved left ventricular reverse remodeling and systolic function following surgery to resolve aortic stenosis.

Assessment of Subclinical Left Ventricular Systolic and Diastolic Dysfunction in Patients with Type 1 DM with and without Good Metabolic Control

Background: Diabetic patients with normal left ventricular ejection fraction (LVEF)are frequently associated with diastolic dysfunction. However, LVEF is known not to be a sensitive marker for the detection of subclinical LV systolic dysfunction. This study aimed to assess left ventricular systolic and diastolic function in asymptomatic type 1 diabetic patients by conventional, tissue Doppler and two-dimensional speckle tracking echocardiography to assess subclinical left ventricular systolic and diastolic dysfunction.&#x0D; Methods: Case-control study was conducted at 150 patients aged 15-35 y were subdivided into three equal groups: Group A: with type 1 diabetes mellitus (T1DM) with good metabolic control (Hb A1C &lt;7.0), Group B: T1DM with poor metabolic control (Hb A1C&gt;7.0), and Group C: Control group: included 50 normal healthy subjects.&#x0D; Results: Tissue Doppler, diastolic function and strain parameters, AP4C LS, AP2C LS, AP3C LS, and GLS were significantly impaired among the three groups. AP4C LS, AP2C LS, AP3C LS, and GLS were significantly lower in group B than group A and group C and was significantly lower in group A than group C, A velocity was significantly impaired among the three groups. A velocity was significantly higher in group B than group A and group C and was insignificantly impaired in group A than group C.&#x0D; Conclusion: Conventional echocardiography parameters were insignificantly different between the study groups. 2D speckle tracking and tissue Doppler echocardiography showed that subclinical left ventricular systolic function may be affected even before affection of diastolic function. Longer duration and poor glycemic control of diabetes significantly affect GLS.

Do diurnal changes in blood pressure affect myocardial work indices?

Do diurnal changes in blood pressure affect myocardial work indices?

Evaluation of Left Ventricular Dysfunction in Patients with Isolated Mitral Valve Stenosis Using Speckle Tracking Echocardiography

Abstract Aim The aim was to evaluate left ventricular (LV) systolic function in patients with isolated mitral stenosis (MS) using 2D speckle tracking echocardiography. Methods 24 patients (39.50 ± 5.55 years, 17 females) with isolated MS (MVA: 1.35 ± 0.16 cm2) with preserved LV systolic function and sinus rhythm were compared to 12 matched healthy control subjects (36.42 ± 5.99 years, 8 females). Conventional echocardiography was performed to both groups. Longitudinal strain and Circumferential strain echocardiography were obtained. Peak systolic strain was measured from the mean strain profile for a total of 17 segments of the LV for the longitudinal strain and 16 segments for the circumferential strain. Global longitudinal (G.L.) and circumferential strain (G.C.) were calculated separately as the average of the sum of the studied segments. Results The global longitudinal strain of the cases group ranged from -11 – -17% with a mean value of -14.67 ± -1.69% and that of the control group ranged from -15 – -20% with a mean value of -17.83 ± -1.53% with a statistically significant difference between the two groups. In our study, there was a negative but non-significant correlation between LV GLSS and LA diameter (r = -0.054, p = 0.802), Echo score (r = -0.018, p = 0.933) and PASP (r = 0.021, p = 0.922) in patients group. Also, the correlation was negative but non-significant between LV GCSS and LA diameter (r = -0.142, p = 0.507), Echo score (r = -0.200, p = 0.349) and PASP (r = -0.155, p = 0.471) in patients group. Conclusion • 2D speckle tracking echocardiography can detect subclinical LV systolic dysfunction which cannot be recognized by 2D conventional echocardiography. • Isolated rheumatic MS may be associated with subclinical LV systolic dysfunction.

COMPARISON BETWEEN DIFFERENT PARAMETERS IN EARLY DETECTION OF LV SYSTOLIC DYSFUNCTION IN PATIENTS WITH CHRONIC STABLE ANGINA

Background: Ischemia plays a pivotal role in the development and progression of both types of HF (HFrEF & HFpEF). Strain echocardiography, performed by using the speckle tracking technique, can identify subclinical left ventricular dysfunction before left ventricular ejection fraction declines. Objective: To assess left ventricular systolic function by different noninvasive imaging modalities in patients with chronic ischemic heart disease. Patients and methods: This study was done at Al Zahra University Hospital from November 2017 till January 2020. It included 80 patients (group I) with chronic ischemic heart disease (IHD), they were 60 males (75%) and 20 females (25%) with mean age 53.5±8.08, and 15 apparently healthy age and sex matched subjects as a control group (group II), they were 11(73.3%) females and 4(26.7%) males with mean age 53.2±7.7. Group I was further sub-classified to impaired and preserved according to their LVEF assessed by 2D echo, speckle tracking echo global longitudinal strain (STE-GLS), tissue Doppler imaging (TDI) strain, TDI Sa and gated SPECT LVEF. Results: The ischemic (group I) showed a statistically significant decrease in the average Sa 5.45±1.69 VS group II 8.7± 0.73 (P value < 0.001), lower LVEF 2D echo in group I 46.3±9.68 compared to group II 58.9±4.68 (P value < 0.001), decrease in gated SPECT LVEF in group I 56.4±13.98 VS group II 67.067±5.66 (P value < 0.001), statistically significant reduction in left ventricular global longitudinal strain (LV-GLS) (-13.89±18.99) in group I vs -21.24±1.23 in group II (P value <0.05). The highest percentage of patients with impaired LV systolic function were those who assessed by STE-GLS (74 patients 92%), 72 patients (90%) impaired LVEF by TDI Sa, 60 patients (75%) impaired LVEF by 2D echo, and by TDI strain, and 22 patients (27.5%) impaired LVEF by gated SPECT. Conclusion: STE is considered the most sensitive method in assessment of subclinical LV systolic dysfunction and is considered superior to other methods.

Assessment of Longitudinal Left Ventricular Function in Patients with Coronary Artery Ectasia by 2D Speckle Tracking Echocardiography

Abstract Background Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders. CAE is one of the known risk factors for acute coronary syndrome, its incidence ranges from 1.5%-5% of patients undergoing coronary angiography, with predominance in males. Coronary artery ectasia (CAE) is defined as dilatation of an arterial segment to a diameter at least 1.5 times that of an adjacent normal artery and involves at least one third of the affected artery (1)(1). The exact pathogenesis of CAE is not well established; however, Coronary atherosclerosis is detected in more than 50% of the patients. Objective To evaluate global left ventricle longitudinal strain by 2D speckle tracking echocardiography in patients with coronary artery ectasia and without significant (&amp;gt;50%) coronary artery stenosis. Patients and Methods This study carried on sixty patients referred to cath lab of Ain Shams university hospital for elective coronary angiography during period between January 2018 and Augest 2019. The patients were divided in to two groups (Group A) included thirty patients with ectasia in one or more of the coronary arteries without any significant coronary artery stenosis and (Group B) included thirty patients with normal coronary angiographic findings serving as control group. Results The present study showed a statistically significant decrease in EF comparing CAE group to control group .As regards other echocardiography parameters, there was a highly significant difference of LVEDD, LVEDD index, LVESD,, LVESD index, LV mass, LV mass index, LA volume and LA volume index between the two groups. Global peak longitudinal strain showed highly significant difference between two groups as its mean value was significantly lower in the CAE group. Conclusion In our study, we have concluded that global peak longitudinal strain was significantly impaired in patients with coronary artery ectasia without significant coronary artery lesion denoting subclinical LV systolic dysfunction .LV diastolic dysfunction was more prevalent in coronary artery ectasia patients compared to control subjects.

Evaluation of ventricular systolic function by speckle tracking technique in patients with biliary atresia before and after liver transplantation

To evaluate the ventricular function of patients with biliary atresia (BA) before and after liver transplantation using two-dimensional speckle tracking. Observational, analytical study with healthy control group, volunteers. We recruited patients from 0 to 18 years old who were candidates for liver transplantation and patients after six months of liver transplantation performed for BA from January 1997 to August 2015 at Children’s Institute of São Paulo University Medical School. The patients were submitted to a complete conventional echocardiographic study. After that, the images were captured for global longitudinal strain (GLS). A blood sample was collected for brain natriuretic peptide (BNP) level. Ejection fraction obtained by Simpson’s method was significantly higher in the hepatic pre-transplantation group (p < 0.001), as well as left atrial size (p < 0.001) and left ventricle size (p = 0.039). The left ventricular mass index was significantly higher in pre-transplantation group (p < 0.001). The left atrium volume (p = 0.008) and the left ventricular mass index (p t = 0.035) were higher in the post-transplant group. It was observed that the lower the BNP, the lower/more negative the GLS in the post-transplant group (p = 0.038 and r = 0.427). Significant reduction in the overall longitudinal strain of the left ventricle was detected before (p = 0.01) and after liver transplantation (p = 0.019). A subclinical left ventricular systolic dysfunction was evidenced by two-dimensional speckle tracking technique before and after liver transplantation, even when compared to normal values of the last pediatric meta-analysis.

Effect of dipping and nondipping pattern of blood pressure on subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking in hypertensive patients.

The aim of this study was to evaluate the left ventricular (LV) function by conventional two-dimensional speckle tracking echocardiography (2D STE) to detect subclinical LV systolic dysfunction in patients with dipper and nondipper hypertension. One hundred consecutive patients with hypertension were included in our study. Clinical evaluation, baseline laboratory investigations, 24 ambulatory blood pressure monitoring 2D echocardiographic examination and 2D STE were performed for all patients. Patients were classified as dippers and nondippers according to their nighttime MAP (mean arterial blood pressure) reduction rate of ≥10 or <10%, respectively. Of 100 patients, 71% were nondippers while 29% were dippers. Nondippers had a significantly lower global longitudinal strain (LS) value (-22.45 ± 3.26 vs. -18.2 ± 3.3, P < 0.001), global circumferential strain (CS) value (-24.23 ± 3.56 vs. -19.16 ± 8.25, P < 0.001) and global radial strain (RS) value (35.04 ± 11.16 vs. 29.58 ± 8.44, P = 0.009). It was found that nondipper status was associated with worsening of LS by 2.737, (P = 0.001), CS by 3.446, (P = 0.002), RS by -3.256, (P = 0.158) and DM also was found associated with worsening of LS by 1.849, (P = 0.062), CS by 3.284 (P = 0.018), RS by -2.499 (P = 0.381). The nondipping hypertension pattern is associated with subclinical LV systolic dysfunction as shown by the impaired global myocardial strain in all three directions.

Left Ventricular Global Longitudinal Strain Is Associated With Cardiovascular Outcomes in Patients Who Underwent Permanent Pacemaker Implantation.

Background: Patients who underwent permanent pacemaker (PM) implantation have a potential risk of left ventricular (LV) systolic dysfunction. However, assessment of LV ejection fraction (LVEF) shows a limited role in identifying subclinical LV systolic dysfunction and predicting cardiovascular (CV) outcomes.Methods: We reviewed 1,103 patients who underwent permanent PM implantation between January 2007 and December 2017. After excluding patients who did not undergo echocardiograms before or after PM implantation and those with LV ejection fraction (LVEF) <50%, significant valve dysfunction, and history of cardiac surgery before PM implantation, 300 (67 ± 13 years, 119 men) were finally analyzed. LV mechanical function was assessed with LV global longitudinal strain (LV-GLS) using 2-dimensional speckle-tracking echocardiography. CV outcomes were defined as a composite of CV death and hospitalization for heart failure.Results: At 44 ± 28 months after post-PM echocardiogram, 23 patients (7.7%) had experienced CV outcomes. Patients with CV outcomes were older and had more comorbidities and a lower baseline |LV-GLS| than those without CV outcomes. LV mechanical function worsened after PM implantation in patients with CV outcomes. The cut-off value of 11.2% in |LV-GLS| on post-PM echocardiogram had a better predictive value for CV outcomes (AUC; 0.784 vs. 0.647, p = 0.012). CV outcome in patients with |LV-GLS| <11.2% was worse than that in those with |LV-GLS| ≥ 11.2% (log-rank p < 0.001). Multivariate Cox model revealed that reduced |LV-GLS| was independently associated with CV outcomes.Conclusions: Pacing deteriorates LV mechanical function. Impaired LV-GLS is associated with poor CV outcomes in patients who underwent PM implantation.

PREDICTION OF SUBCLINICAL LEFT VENTRICULAR SYSTOLIC DYSFUNCTION BY MITRAL ANNULAR PLANE SYSTOLIC EXCURSION IN M-MODE ECHOCARDIOGRAPHY IN CORRELATION TO SPECKLE TRACKING BY 2-DIMENSIONAL ECHOCARDIOGRAPHY AND TISSUE DOPPLER IMAGING IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Background: Diabetes mellitus (DM) is considered as a major risk factor for heart failure with preserved Ejection fraction (EF). Using M-Mode echocardiographic method may be useful in prediction of early LV systolic dysfunction in patient with type II diabetes mellitus by measurement of mitral annular plane systolic excursion (MAPSE) in correlation to global longitudinal strain (GLS) and to tissue Doppler imaging (TDI). Objective: To emphasize on the usefulness of M-mode echocardiographic methods like the mitral annular plane systolic excursion (MAPSE) correlated to speckle tracking by 2 dimensional (STE) and tissue Doppler imaging in prediction of subclinical LV systolic dysfunction in patients with type 2 diabetes. Patients and methods: The study included 100 asymptomatic patients with type II DM and 50 healthy subjects as a control group. Echocardiography was performed to all of them All cases were recruited from the outpatient clinic in Maadi military Hospital in Cairo. Results: The study included 100 asymptomatic patients with type II DM, 65 of them were females, and 50 healthy subjects as a control group, 27 of them were females. MAPSE were significantly lower in DM group [1.2 (1.1 – 1.25) cm] compared to control group [1.4 (1.3 – 1.5) cm] (p < 0.001). MAPSE linearly had a significant positive correlation with EF, GLS and Sa wave [r= 0.565, 0.723, 0.595 respectively], (p < 0.01). MAPSE linearly had a significant negative correlation with DM duration and HbA1C Level [r= -0.495, -0.776 respectively], (p < 0.01). Average MAPSE at a cut-off point (≤1.2cm) with good (82%) accuracy, sensitivity= 68% and specificity= 82% (p < 0.01). Conclusions: MAPSE is a useful M-mode method in prediction of subclinical LV systolic dysfunction in asymptomatic type II diabetic patients, and it has a positive correlation to GLS and Sa wave of TDI. It has a negative correlation with duration of DM and HbA1C level.

Hidden danger of COVID-19 outbreak: evaluation of subclinical myocardial dysfunction in patients with mild symptoms.

The COVID-19 infection, which is caused by the novel coronavirus SARS-CoV-2, has rapidly emerged as a global public health issue. Cardiac complications secondary to this infection are common and associated with mortality. This study aimed to evaluate whether subclinical myocardial dysfunction exists in non-hospitalized mildly symptomatic COVID-19 patients using left ventricular global longitudinal strain (LVGLS). In this cross-sectional, single-center study, data were collected from non-hospitalized mildly symptomatic COVID-19 patients between January 01 and February 01, 2021. Fifty (26 male, 24 female) COVID-19 patients and 50 age- and sex-matched healthy volunteers were included in the study. Apical four-, three-, and two-chamber images were analyzed longitudinally by conventional methods and speckle tracking echocardiography (STE) for left ventricle functions. The mean age of the COVID-19 patients was 39.5 ± 8.96, and 52% of them were male. The most prevalent presenting symptoms were fever [in 34 (68%)], asthenia [in 30 (60%)], loss of appetite [in 21 (42%)], myalgia [in 20 (40%)], and cough [in 13 (26%)]. Plasma levels of C-reactive protein (CRP) were significantly higher in the COVID-19 patients than in the controls (10.84 ± 12.44 vs. 4.50 ± 2.81, p < 0.001). There was no significant difference between the groups in terms of standard echocardiography and Doppler parameters (p > 0.05). Left ventricular longitudinal strain and strain velocity parameters were significantly decreased in COVID-19 patients compared to healthy individuals. LV-GLS values (− 21.72 ± 3.85% vs. − 23.11 ± 4.16%; p = 0.003) were significantly lower in COVID-19 patients compared with the healthy controls. Mildly symptomatic COVID-19 patients also have subclinical myocardial dysfunction similar to hospitalized patients. STE has the potential for detecting subclinical LV systolic dysfunction, and can provide useful information regarding cardiac status in mildly symptomatic COVID-19 population.