Subclinical Left Ventricular Research Articles

The roles of global longitudinal strain imaging in contemporary clinical cardiology.

Myocardial deformation imaging is now readily available during routine echocardiography and plays an important role in the advanced care of cardiovascular diseases. Its clinical value in detecting subtle myocardial dysfunction, by helping diagnose disease and allowing prediction of disease progression and earlier pharmacological intervention, has been demonstrated. Strain imaging has been the most studied and clinically used technique in the field of cardio-oncology. A relative percent reduction in left ventricular (LV) global longitudinal strain > 15% from baseline is considered a marker of early subclinical LV dysfunction and may have the potential to guide early initiation of cardioprotective therapy. The role of strain imaging is expanding to other fields, such as cardiac amyloidosis, other cardiomyopathies, valvular heart diseases, pulmonary hypertension, and heart failure with preserved ejection fraction. It is also used for the evaluation of the right ventricle and atria. This review aims to provide a current understanding of the roles of strain imaging in the evaluation and management of patients with cardiovascular diseases in clinical practice.

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

Basal Segmental Strain as a Marker of Cardiac Involvement in Anderson-Fabry Disease

Anderson-Fabry disease (AFD), an X-linked genetic disease, can lead to cardiac involvement, manifesting notably as increased left ventricular (LV) wall thickness and myocardial fibrosis in the 4th-5th decade. We sought to evaluate and validate assessment of global and segmental variations in subclinical LV function by 2D speckle tracking in AFD patients versus healthy controls.

Late consequences of chemotherapy on left ventricular function in women with breast cancer.

Background:Cardiovascular disease is the main cause of death among breast cancer survivors. Several chemotherapy drugs may cause cardiovascular toxicity. Our study aimed to assess the late effects of chemotherapy on left ventricular (LV) systolic and diastolic function in a group of female breast cancer survivors.Methods:Our study was a case-control study consisted of 60 breast cancer survivors who had undergone chemotherapy for more than 5 years and a control group of 49 women without breast cancer. All patients underwent echocardiography and left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), pulse-Doppler early transmitral peak flow velocity (E wave), early diastolic (e'), and left atrial (LA) diameter were calculated.Results:The mean LVEF and GLS were reduced in chemotherapy group (51.63±7.93% vs. 55.37±3.50%, P=0.002 and -17.99±3.27% vs. -19.25±2.27%, P=0.025). Also, the chemotherapy group had a larger left ventricular end-systolic internal diameter than the control group (1.74±0.44cm/m2 vs. 1.58±0.22cm/m2, P= 0.011). Logistic regression analysis showed among the different cardiovascular risk factors, chemotherapy had an association with decreasing LVEF.Conclusion:Breast cancer survivors might have an excess risk of having subclinical LV dysfunction over time. These findings present the potential benefits of echocardiographic assessment in breast cancer survivors.

Associations between Subclinical Myocardial Dysfunction and Premature Fusion of Early and Late Diastolic Filling with Uncertain Cause.

PurposeThe fusion of early (E) and late diastolic filling (A) on mitral inflow Doppler, even in the absence of tachycardia, is often found during assessment of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clinical implications of premature E-A fusion of uncertain cause in the absence of tachycardia.Materials and MethodsWe identified 1014 subjects who showed E-A fusion and normal LV ejection fraction (LVEF) between January 2019 and June 2021 at two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A fusion at heart rates less than 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) were compared with 1:1 age-, sex-, and heart rate-matched controls without E-A fusion.ResultsThe premature E-A fusion group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV diastolic dysfunction according to current guidelines. The group showed prolonged isovolumic relaxation time (107.2±25.3 msec vs. 61.6±15.6 msec, p<0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p<0.001), lower LVEF (63.8±7.0% vs. 67.3±5.6%, p<0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2% vs. 19.7±3.3%, p<0.001) than controls. As the E-A fusion occurred at lower heart rate, the |LV GLS| was also lower (p for trend=0.002).ConclusionPremature E-A fusion at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based indices and LV GLS are helpful for evaluating this easily overlooked population.

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.

Assessment of global longitudinal strain by speckle tracking echocardiography in patients with severe primary mitral regurgitation

Background: In asymptomatic patients with severe primary mitral regurgitation (PMR), early detection of left ventricular (LV) dysfunction indicates the optimal timing of mitral valve surgery and predictes impaired postoperative LV function. Objectives: Evaluation long longitudinal strain by Speckle Tracking in Patients with Severe Primary Mitral Regurgitation Methods and results: 35 preoperative patients with severe PMR and 25 age-matched healthy subjects at Hanoi Heart Hospital from June 2018 to September 2019. Patients with PMR had longitudinal dysfunction by comparison with controls, although EF were similar. Mean global myocardial longitudinal strain (GLS avg) has a linear correlation with FS (r² = 0.127, p &lt;0.05) and EF biplane (r² = 0.216, p &lt;0.005). Conclusion: Longitudinal LV deformation assessed by speckle tracking can detect subclinical LV dysfunction and predict impaired postoperative LV function in asymptomatic patients with severe PMR.

A presystolic wave could easily detect subclinical left ventricular dysfunction in prediabetic patients with no history of hypertension.

Prediabetes is associated with left ventricular (LV) systolic and diastolic dysfunction. A presystolic wave (PSW) is detected on late diastole from the Doppler examination of the LV outflow tract and is related to LV dysfunction. LV dysfunction could be detected with different echocardiographic methods, including conventional Doppler and Tissue Doppler imaging (TDI), 2D speckle tracking echocardiography, and myocardial performance index (MPI). In this study, we aimed to investigate the association of the presence of PSW with LV dysfunction assessed by different echocardiographic methods. A total of 137 prediabetic normotensive patients were enrolled in this study. Eighty-one (59.1%) patients had a PSW and 36 (40.9%) patients had not PSW on the Doppler examinations. Echocardiographic features were compared between these groups. LV dysfunction was determined based on MPI, LV global longitudinal strain (LVGLS), and conventional Doppler and TDI measurements. There were no differences between groups regarding clinical and laboratory parameters, except LDL, which was significantly higher in the PSW-positive group. The PSW-positive group had lower E, Em, Ea, E/A, Em/Am, Ea/Aa, LVGLS and higher A, Am, Aa, E/e', isovolumetric relaxation time, and MPI than PSW-negatives. PSW velocity was moderately correlated with MPI (R=.33, p=.003) and LVGLS (R=.35, p=.001). The presence of PSW was independently associated with LV dysfunction assessed by MPI (OR=3.87, p<.001), LVGLS (OR=10.29, p<.001), and conventional Doppler and TDI parameters (OR=8.87, p<.001). PSW was significantly associated with subclinical LV dysfunction in prediabetic normotensive patients assessed with three echocardiographic methods.

Abstract 9916: Relationship Between Blood Pressure Categorization and Subclinical Left Ventricular Dysfunction in Antihypertensive Medication-Naive Individuals

Background: The impact of blood pressure (BP) levels on subclinical left ventricular (LV) dysfunction and possible sex-specific difference remains unclarified. This study aimed to investigate the relationship between BP categories given in the new 2017 ACC/AHA hypertension guideline and subclinical LV dysfunction in subjects free of cardiac disease. Methods: We examined antihypertensive medication-naive 858 individuals who underwent extensive cardiovascular health check-up. LV global longitudinal (GLS) and circumferential strain (GCS) were assessed by 2-dimensional speckle-tracking echocardiography. Participants were categorized into 4 groups according to the BP levels: normal BP, elevated BP, isolated diastolic hypertension (IDH) and systolic hypertension (SH). Results: Among the 858 participants (61±11 years, 459 men), 422 individuals had normal BP, 113 had elevated BP, 160 had IDH, and 163 had SH. Prevalence of abnormal LVGLS (&gt;-18.6%) was greatest in SH group (19.0%), followed by IDH (17.5%), elevated BP (14.2%) and normal BP (7.1%, p&lt;0.001; Figure); no significant differences were observed for LVGCS (p=0.671). In the multivariable analyses, IDH and SH were associated with impaired LVGLS (adjusted odds ratio [OR] 2.69 and 2.66, p&lt;0.001) and borderline significance was observed for elevated BP (adjusted OR 1.90, p=0.060); there was no significant association between any of the BP groups and LVGCS. In sex-stratified analysis, IDH and SH carried the significant risk of abnormal LVGLS in both sexes, while elevated BP was associated with LVGLS only in women. Conclusion: IDH and SH redefined by ACC/AHA guideline carried a significant risk for LVGLS, but not LVGCS. Elevated BP was associated with LVGLS only in women. Our findings provide information on cardiac correlates of the newly established BP categories.

Association of left ventricular systolic dysfunction with coronary artery dilation in Kawasaki disease patients: Assessment with cardiovascular magnetic resonance

PurposeTo quantify global and regional left ventricular (LV) strain parameters in patients with Kawasaki disease (KD) using cardiovascular magnetic resonance (CMR) tissue tracking and assess the association of coronary artery dilation (CA dilation) with LV systolic dysfunction. MethodsThirty-one KD patients with CA dilation, 22 patients without CA dilation and 27 age- and sex-matched normal controls underwent 3.0 T CMR examination. Z score of >2 was defined as CA dilation. Global LV strain parameters and regional LV strain parameters in 16 American Heart Association segmentation, including radial, circumferential and longitudinal peak strain (PS) and LV function were measured and compared among groups. ResultsNo significant difference in LV ejection fraction has been observed among controls, KD patients with CA dilation and without CA dilation (all p > 0.05). However, global longitudinal PS (GLPS) was lower in groups with CA dilation than those without CA dilation (−12.6 ± 4.1% vs −14.9 ± 2.6%, p < 0.05). For regional strain parameters, the segments with CA dilation (n = 301) were lower than those in both normal controls (n = 416) and segments without CA dilation (n = 547) in regional radial, circumferential and longitudinal PS (all p < 0.05). The severity of CA dilation was positively correlated to GLPS and regional longitudinal PS (r = 0.388 and r = 0.222; both p < 0.05) in KD patients. After adjusting for clinical characteristics, the multivariate analysis demonstrated that Z score was independently associated with GLPS in KD patients (β = 0.469, p = 0.000, model R2 = 0.355). ConclusionsCMR tissue tracking could sensitively identify subclinical LV dysfunction in KD patients with CA dilation. LV systolic dysfunction occurs particularly in the myocardium dominated by the dilated coronary artery. CA dilation is an independent predictor of LV systolic dysfunction.

Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging.

Heart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment.

Early onset left ventricular remodeling in juvenile systemic lupus erythematosus; Insight from 3-dimensional speckle tracking echocardiography.

Early diagnosis and treatment of myocardial affection in patients with systemic lupus erythematosus (SLE) are crucial. To evaluate the ventricular systolic function in juvenile-onset systemic lupus erythematosus (j-SLE) patients by 3-D speckle tracking echocardiography (3D-STE) and to determine the predictors of left ventricular (LV) dysfunction if present. Twenty-six SLE patients without heart failure and 21 healthy controls were studied by standard echocardiogram and 3D-STE. Conventional parameters included LV ejection fraction (EF), fractional shortening (FS), and mitral annular plane systolic excursion (MAPSE). Global LV strain (GLS) and global area strain (GAS) were obtained by 3D-STE. Medical records, including diagnosis criteria, duration of disease, and SLE disease activity index (SLEDAI) were evaluated. The mean age was similar in patients and controls 11.42 vs 11.48 years p = 0.93. The mean duration of the disease was 1.87 ± 1.02 years and SLEDAI ranged from 0 to 9. By conventional and tissue Doppler imaging echocardiography, only MAPSE was significantly lower in SLE patients compared to controls (14.56 vs 18.46mm, p < 0.001). By 3D speckle tracking echocardiography, GLS and GAS were significantly reduced in SLE patients compared to controls (-15.07 vs -19.9.4%, -34.6% vs -39.7%, respectively, p < 0.001). Multiple linear regression and ROC analyses indicated that the SLEDAI score was the only predictive factor for the left ventricular remodeling. These results indicate that early subclinical LV dysfunction occur in jSLE patients even with normal EF and SLE disease activity might be a potential driver for LV deformation.

Do diurnal changes in blood pressure affect myocardial work indices?

Do diurnal changes in blood pressure affect myocardial work indices?

Asymptomatic myocardial dysfunction was revealed by feature tracking cardiac magnetic resonance imaging in patients with primary Sjögren's syndrome.

To evaluate subclinical left ventricular (LV) regional dysfunction in patients with primary Sjögren's syndrome (pSS) using feature tracking cardiac magnetic resonance (FT-CMR) imaging and to identify pSS characteristics independently associated with LV regional dysfunction. Fifty patients with pSS and 20 controls without cardiovascular disease underwent non-contrast CMR imaging. Labial gland biopsy was performed in 42 patients (84%). Disease activity was assessed using the European League Against Rheumatism Sjögren's syndrome disease activity index (ESSDAI). LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were measured using FT-CMR. No significant differences in cardiovascular risk factors were found between the pSS group and controls. The pSS group had significantly lower GLS (P=.015) and GCS (P=.008) than the control group. Multiple linear regression analysis indicated that GCS was significantly associated with Raynaud's phenomenon (P=.015), focus score ≥2 (P=.032), and total ESSDAI score ≥8 (P=.029). FT-CMR can reveal subclinical LV regional dysfunction in patients with pSS without cardiovascular disease. Furthermore, patients with pSS and Raynaud's phenomenon, a focus score ≥2, or an ESSDAI score ≥8 were considered to be at high risk for myocardial dysfunction.

Subclinical left ventricle impairment following breast cancer radiotherapy: Is there an association between segmental doses and segmental strain dysfunction?

BackgroundCardiotoxicity following breast cancer radiotherapy (RT) represents one of the most redoubtable toxicities. The Global longitudinal strain measurement (GLS) based on 2D speckle tracking imaging (STI) allows detection of left ventricular (LV) dysfunction at a subclinical stage. The aim of this prospective study was to detect patients at risk of cardiotoxicity using echocardiographic parameters and to determine the association between segmental RT doses and early cardiac toxicity. Material and methodsThe STI was performed prior to RT and at 3, 6 and 12 months after.The association between subclinical LV dysfunction, defined as a reduction of GLS more than 10% from the initial value, radiation doses to different LV segments and non-radiation factors were performed based on multivariate analyses. ResultsFrom June 2017 to August 2018, a total of 103 female patients were included. Sixty patients had left sided RT. Seven patients (7.8%) developed a GSL impairment. The segmental alterations predominated in the anteroseptal and apical LV segments. The mean Dmean in altered segments was significantly higher than in non-altered segments (6.7 ± 8.8Gy-7.8 ± 8.9Gy vs 4.9 ± 7.9–5.4 ± 8.2Gy; p < 0.05). Age > 55 years and obesity were important confounding factors that should be considered during radiotherapy planning. ConclusionThe results of our study show that radiation dose is correlated with the subclinical LV segments' alteration. Global heart delineation seems to be insufficient during the breast radiotherapy planning. Segmental delineation of the LV may be an interesting alternative to limit segmental doses and to reduce the risk of subclinical alterations. A mean dose of 5Gy could be proposed in exposed heart segment.

Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in ebstein anomaly

Abstract Background Certain factors such as left ventricular (LV) geometry and loading conditions affect the validity and reliability of LV ejection fraction (LVEF) as a true measure of LV contractility. LV global longitudinal strain (LVGLS) is less sensitive to these factors, and it has superior prognostic performance in patients with acquired heart disease. The purpose of this study was to determine the clinical implications of using LVGLS (instead of LVEF) as the measure of LV systolic function in adults with Ebstein anomaly given the inherent abnormalities of LV geometry and preload in this population. Methods Retrospective cohort study of 673 adults with Ebstein anomaly (2003–2018). We hypothesized that LVGLS had a stronger correlation with heart failure indices and transplant-free survival compared to LVEF. Results Compared to LVEF, LVGLS had stronger correlations with cardiac index (r=0.46 vs r=0.21, p=0.007), glomerular filtration rate (r=0.57 vs r=0.19, p&amp;lt;0.001), and NT-proBNP (r=−0.64 vs r=−0.41, p=0.01). Of 673 patients, 514 (76%) had normal LV systolic function (LVGLSNormal-LVEFNormal), 87 (13%) had subclinical LV dysfunction (LVGLSLow-LVEFNormal) and 66 (10%) had overt LV dysfunction (LVGLSLow-LVEFLow). Compared to the overt LV dysfunction group, the subclinical LV dysfunction group had similar 10-year transplant-free survival (64% vs 63%, p=0.6), but were less likely to be on heart failure therapy (12% vs 82%, p&amp;lt;0.001). LVGLS (but not LVEF) was the independent predictor of transplant-free survival Conclusions LVGLS provided more robust risk stratification and prognostication than LVEF in patients with Ebstein anomaly, and patients with low LVGLS had reduced transplant-free survival regardless of LVEF. The use of LVGLS (rather than LVEF) as the measure of LV systolic function has important clinical implications with regards to initiation of medical and surgical therapies. Funding Acknowledgement Type of funding sources: None.

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.

Aggravating effect of obstructive sleep apnoea on left ventricular remodelling and function disorder in patients with type 2 diabetes mellitus: a case-control study by 3D speckle tracking echocardiography

Objectives The purpose of this study was to evaluate the early alterations of left ventricular (LV) structure and function in type 2 diabetes mellitus (T2DM) patients with or without obstructive sleep apnoea (OSA) using 3 D speckle tracking echocardiography (3DSTE). Methods Eighty T2DM patients with preserved LVEF were included, half of whom had OSA as co-morbidity. Forty age- and sex-matched controls were also enrolled. LV structure and function were evaluated by conventional echocardiography and 3DSTE. LV global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were all measured by 3DSTE. Results Four geometric patterns (normal geometry, concentric remodelling, concentric and eccentric hypertrophy) occupied significantly different proportions within the three groups (p = .014). LV remodelling made up higher shares in two T2DM groups than in the controls, whereas LV hypertrophy appeared most frequently in the patients with T2DM and OSA. The patients with T2DM alone had significantly lower GLS and GCS than the controls (both p < .01). The patients with T2DM and OSA had significantly lower GLS, GCS, GAS, and GRS than the controls and the patients with T2DM alone (all p < .01). Fasting plasma glucose (FPG), OSA and BMI had negative impacts on all and part of the strain values in T2DM patients. The T2DM patients with moderate-to-severe OSA showed significantly lower GLS, GCS, GAS, and GRS than those with mild OSA (all p < .05). Conclusions The 3DSTE plus conventional echocardiography could detect the sub-clinical LV alterations in T2DM patients with or without OSA.

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.