Subclinical Left Ventricular Systolic Dysfunction Research Articles

Association of peripheral neuropathy with subclinical left ventricular dysfunction in patients with type 2 diabetes

ObjectivesThe impacts of diabetic peripheral neuropathy (DPN) on clinical manifestations of left ventricular (LV) function in patients suffering from type 2 diabetes mellitus (T2DM) and the preserved LV ejection fraction (LVEF) lack a full evaluation. This study was carried out to investigate the correlation of peripheral neuropathy with subclinical LV systolic dysfunction, accompanied by the exploration of the relevant clinical features of peripheral neuropathy in these patients. MethodsA retrospective analysis was conducted depending on the data of 101 consecutive inpatients with T2DM and preserved LVEF (all ≥ 50 %), without coronary artery disease and other histories of heart disease. All subjects received both a nerve conduction assessment and a speckle-tracking echocardiography examination. Global longitudinal strain (GLS) was conducted to assess the subclinical LV systolic function. ResultsForty-six (46 %) patients were diagnosed as DPN according to electrophysiological examination and clinical assessment. A significant difference was revealed in GLS between patients with and without DPN (16.5 ± 2.8 vs. 19.3 ± 3.4, p < 0.001). Multiple logistic regression analysis indicated GLS as one of the independent determinative factors for DPN (odds ratio, 0.68; P < 0.001). In addition, motor-sensory nerve conduction exhibited a significant positive correlation with GLS, which may not be revealed between the types of peripheral nerve damage. ConclusionsDespite the preserved LVEF, the subclinical LV myocardial dysfunction may have occurred in T2DM patients with DPN. Peripheral nerve conduction was significantly correlated with GLS. An early assessment of nerve conduction may exert a dual warning significance for the progression of subclinical LV dysfunction in asymptomatic patients with T2DM.

Correlate of Left Ventricular Systolic Function in Children with Human Immunodeficiency Virus Infection on Combined Highly Active Antiretroviral Medications in Aminu Kano Teaching Hospital, Kano State.

Human immunodeficiency virus (HIV) affects many organ systems in the body including the cardiovascular system, often manifesting as a subclinical left ventricular (LV) systolic dysfunction that may progress to heart failure. This study assessed the prevalence of LV systolic dysfunction in children on highly active antiretroviral therapy (HAART) with established clinical stage 1 HIV-disease. The study was a cross-sectional comparative study conducted in Aminu Kano Teaching Hospital from April to August 2019 on 200. It involved study participants comprising 100 WHO clinical stage 1 HIV-infected children and 100 control subjects, aged between 1 and 18 years selected using systematic sampling method. Echocardiography was carried out on the study participants who had already completed a pretested questionnaire. Out of 100 HIV-infected children studied, 49 were males and 51 females (Male: Female ratio; 0.96:1.0). The mean age at diagnosis of HIV infection was 2.6 (±2.6 years) and the median viral load was 35 copies/ml. The mean ejection and shortening fractions in HIV-infected children were 59.0% and 31.0%, respectively, compared to 64.4% and 34.0% in control subjects, respectively, and were statistically significant (P = 0.000). The prevalence of LV systolic dysfunction was 8.0% (8 out of 100) in HIV-infected children while the control groups had zero prevalence (P = 0.002). The age at diagnosis correlated negatively with LV systolic dysfunction (r = 0.23, P = 0.02). This study found a subclinical LV systolic dysfunction in an HAART-established clinical stage 1 HIV-infected children. The age at diagnosis was negatively correlated with the LV systolic function. This study, therefore, support the inclusion of routine echocardiography into the evaluation of HIV-infected children.

Assessment of Left Ventricular Diastolic Reserve in Diabetic Patients by Stress Echocardiography

Background: Patients with type 2 diabetes mellitus (DM) may develop cardiomyopathy independent of traditional risk factors such as hypertension and epicardial coronary artery disease (CAD). The spectrum of myocardial dysfunction may range from subclinical left ventricular (LV) diastolic and systolic dysfunction through to overt systolic dysfunction. Aim and objectives: to determine whether diastolic reserve differs in type 2 DM compared with non-DM, and to identify clinical, anthropological, metabolic and resting echocardiographic correlates of impaired diastolic reserve in patients with DM. Subjects and methods: This study included one hundred consecutive patients (50 patient with DM type II and 50 patient without DM), who underwent rest and exercise echocardiography. Clinical data collected included anthropometric, cardiac risk factors, duration of DM, medications and presence of macrovascular and microvascular complications. Mitral septal é and septal E/é were measured at rest, immediately post, and 10 min into recovery. Results: LDL, cholesterol, triglyceride, creatinine and BMI was significantly higher in in diabetic group than non-diabetic group (P value < 0.05). Regarding rest echocardiography parameters, Septal E/é, Septal é and EF were insignificant between both studied groups. Regarding stress echocardiography parameters, septal E/é was significantly higher and septal é was significantly decreased among diabetic patients among diabetic patients compared to the other group(p

Predictors of Impaired Left Ventricular Global Longitudinal Strain in Patients with Essential Hypertension and Preserved Ejection Fraction

Background: Early identification of hypertensive patients at risk of heart failure (HF) helps guide treatment intensification and predict prognosis. Global longitudinal strain (GLS) derived from two-dimensional speckle-tracking echocardiography (STE) uncovers subclinical left ventricular (LV) systolic dysfunction (SLVSD) in patients with hypertension (HT) and preserved LV ejection fraction (PLVEF). STE is unavailable and/or underutilized in our locality for financial and technical reasons. Objectives: We aim to identify clinical and echocardiographic parameters associated with and/or predictive of impaired GLS in hypertensive patients with PLVEF. Method: In this single-clinic, cross-sectional, observational study, 100 hypertensive patients with PLVEF were examined using conventional and 2D STE. Results: The average GLS was found to be mildly reduced (-18.4 ± 2.2%) in the study group. Lower GLS (than -19%) was more common among patients with poorly controlled HT (Odds Ratio (OR)=9), being on multiple anti-hypertensive agents (OR=5), positive Sokolow-Lyon electrocardiographic criteria (OR=4.3), and obesity (OR=2). Conventional echocardiographic parameters predicting impaired GLS included: mitral annular plane systolic excursion (MAPSE) (p=0.001), inter-ventricular septal thickness (IVSd) (p=0.003), LV mass (p=0.003), and LV remodelling (p=0.02). The aortic acceleration-to-ejection time ratio (AT/ET) had a good correlation with GLS (p=0.034). The novel product (IVSd x AT/ET) ≥2.7 mm was found to be the best predictor of GLS worse than -19% (AU ROC=0.8, 95% CI [0.68-0.93]; p=0.001). Conclusion: In hypertensive patients with PLVEF, GLS was found to correlate well with blood pressure (BP) control, body size, measures of LV mass, and MAPSE. These parameters predict at least 50% of the variance in GLS and could help practitioners with limited access to STE in risk-stratifying hypertensive patients.

Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle-tracking echocardiography in patients with Child-Pugh A and B cirrhosis: A case-control study.

Although studies have proven that liver cirrhosis affects cardiac hemodynamics by means of circulatory overload, they present with definite cardiac functional alteration mostly with end-stage disease. There is limited data on relationship betweenprogression of cirrhosis, cardiac mechanics and sub-clinical dysfunction. This study was done to assess ventricular myocardial mechanics using speckle tracking and deformation imaging among Child-Turcotte-Pugh (CTP) classification A and B cirrhosis. Seventy patients with cirrhosis of Child-Pugh A/B class and sixty-two healthy subjects were prospectively evaluated by standard conventional echocardiography and deformation imaging with rotational echocardiography. Clinical stage of liver cirrhosis was assessed by model for end-stage liver disease (MELD) scores and CTP classification. Mean ages of patients with cirrhosis and controls were 55.64±14 years and 52.24±12 years, respectively. Though left ventricular (LV) dimensions (end diastolic dimension: 47.27±4.6 mm vs. 45.03±3.8 mm, p = 0.003; end systolic dimension: 30.33±4.9 mm vs. 28.40±2.91mm, p = 0.006) and volumes (end diastolic volume: 82.08±22.53 mL vs. 68.18±15.75 mL, p = 0.001; end systolic volume: 28.60±8.42 mL vs. 22.18±7.48 mL, p = 0.001) were significantly higher in patients with cirrhosis, mean ejection fraction (EF) by Simpsons method was higher among controls (65.83±5.79% vs. 68.35±5.79%, p = 0.009). Left atrial volume was higher in cirrhosis group indicating presence of diastolic dysfunction (41.24±14.10 mL vs. 26.08±6.4 mL, p = 0.001). Global longitudinal strain as assessed by speckle tracking echocardiography did not show statistical significant difference between two groups (-22.35±4.08% vs. -21.80±2.54%, p = 0.348). Median value of torsion parameters in patients with cirrhosis did not differ compared to controls (torsion in degrees: 2.46 vs. 2.79, p = 0.268). Patients with Child-Pugh A and B stages of cirrhosis present with preserved longitudinal strain, normal torsion but with subtle diastolic dysfunction. Higher MELD score may correlate with increased longitudinal strain possibly due to hyperdynamic state.

Aortic valve sclerosis and subclinical LV dysfunction in the general population with normal LV geometry.

Aortic valve sclerosis (AVS) without hemodynamically significant obstruction is related to cardiovascular morbidity and mortality independent of left ventricular (LV) hypertrophy, although the underlying mechanisms remain unknown. This study investigated the prevalence of AVS and its association with subclinical LV systolic and diastolic dysfunction in individuals with normal LV geometry free of cardiovascular disease. We examined 962 participants with normal LV geometry and free from significant AV stenosis who underwent standard and speckle-tracking echocardiography. AVS was categorized into 4 groups as follows: no AVS, AV thickening, calcification on one leaflet and calcification on ≥2 leaflets. Among the 962 participants, 767 (79.7%) individuals were classified as no AVS, 74 (7.7%) as AV thickening, 87 (9.0%) as calcification on one leaflet, and 34 (3.5%) as calcification on ≥2 leaflets. The prevalence of subclinical LV diastolic dysfunction (E/e' ratio ≥13) and systolic dysfunction (LV global longitudinal strain (GLS) > -17.0% for men and > -18.0% for women) were greater in AVS groups than those in no AVS group. Subclinical LV diastolic impairment was evident from AV thickening and systolic dysfunction was observed at AV calcification. Multivariable logistic regression analysis demonstrated that AV thickening as well as calcification were independently associated with subclinical LV diastolic impairment (all p < 0.05), while only AV calcification on ≥2 leaflets conferred significant increased risk of impaired LVGLS. AVS was observed in approximately 20% individuals without cardiac disease and was associated with subclinical LV diastolic and systolic function even in the absence of LV morphological change.

Coronary microvascular dysfunction affects left ventricular global longitudinal strain response to dipyridamole stress echocardiography: a pilot study.

The aim is to investigate, by means of speckle tracking echocardiography, left ventricular (LV) contractile function at rest and during dipyridamole stress in patients with coronary microvascular dysfunction (CMD). 59 patients (39% women, mean age 65.6 ± 6.1years) with history of chest pain and without obstructive coronary artery disease (CAD) underwent dipyridamole stress echocardiography. Coronary flow was assessed in the left anterior descending coronary artery. Coronary flow reserve (CFR) was determined as the ratio of hyperaemic to baseline diastolic coronary flow velocity. CMD was defined as CFR < 2. Global longitudinal strain (GLS) was measured at rest and at peak dose. Nineteen patients (32%) among the overall population showed CMD. Baseline GLS was significantly lower in patients with CMD (-16.8 ± 2.7 vs. -19.1 ± 3.1, p < 0.01). A different contractile response to dipyridamole infusion was observed between the two groups: GLS significantly increased up to peak dose in patients without CMD (from -19.1 ± 3.1 to -20.2 ± 3.1, p < 0.01), and significantly decreased in patients with CMD (from -16.8 ± 2.7 to -15.8 ± 2.7, p < 0.01). There was a significant inverse correlation between CFR and ∆GLS (r = -0.82, p < 0.01). Rest GLS and GLS response to dipyridamole stress are markedly impaired among patients with chest pain syndrome, non-obstructive CAD and CMD, reflecting subclinical LV systolic dysfunction and lack of LV contractile reserve due to underlying myocardial ischemia.

The comparison of mitral annular plane systolic excursion (MAPSE) and mitral annular systolic velocity (Sm) in determining subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is an independent factor in increasing the risk of heart failure in the absence of coronary heart disease and hypertension. Global longitudinal strain (GLS) as the gold standard in determining subclinical left ventricular (LV) systolic dysfunction is not available on all echocardiographic tools and requires good-quality images. Mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic velocity (Sm) are simpler, faster, and widely available method that can determine left ventricular systolic dysfunction regardless of image quality. Methods: This study involved 72 asymptomatic T2DM patients, divided into two groups, patients with subclinical left ventricular systolic dysfunction (GLS &gt;-18%) and normal systolic function (GLS ≤-18%). GLS was obtained from the mean of 18 left ventricular segments on the apical 4-chamber, 3-chamber and 2-chamber images. MAPSE was obtained on the septal and lateral sides of the mitral annulus using M-mode on apical 4-chamber view, while Sm was obtained using tissue doppler imaging (TDI). Results: The study included 72 asymptomatic T2DM patients, 34 samples (47.2%) were found with subclinical LV systolic dysfunction. According to receiver operating characteristic (ROC) curve analysis, lateral TDI Sm had the highest area under the curve (AUC), it was 0.85, followed by average TDI Sm was 0.83 and average MAPSE was 0.81. The cut-off value of average TDI Sm &lt;7.425 cm/s had the best sensitivity and specificity, 82.4% and 81.6%, while cut-off value of average MAPSE &lt;13.4 mm had sensitivity of 76.5% and specificity of 73.7%. Conclusion: TDI Sm had better accuracy than MAPSE in determining subclinical LV systolic dysfunction in T2DM patients. However, both of them can be used as alternative diagnostic methods of GLS.

The association of insulin resistance measured through the estimated glucose disposal rate with predictors of micro-and macrovascular complications in patients with type 1 diabetes

Background and aimInsulin resistance (IR) is associated with a higher rate of type 1 diabetes (T1D) complications. We aimed to examine the relationship between estimated glucose disposal rate (eGDR), a readily available marker of IR in clinical practice and early predictor biomarkers of macrovascular and microvascular complications in patients with T1D. DesignA cross-sectional study. MethodsA total of 165 consecutive patients with T1D free of cardiovascular, eye, and renal complications were included in the study from 2016 to 2020. Participants were characterized as insulin resistant if their eGDR value was ≤ 8 mg/kg/min. Pulse wave velocity (PWV) and global longitudinal strain (GLS) were used as surrogates for subclinical atherosclerosis and left ventricular systolic dysfunction (LVSD), respectively. Four previously standardized tests based on the calculation of heart rate variability (HRV) were used to evaluate subclinical cardiac autonomic neuropathy (CAN). Early nephropathy was assessed by assessing urinary albumin to creatinine ratio (ACR). ResultsThe population sample (n = 165) included a majority of female patients (63%) and had a median age of 32 years (24−43), median disease duration of 14 years ( ± 9.5–21.5), a median BMI value of 23.7 kg/m2 (21.4–26.6), an HbA1C of 7.2% (6.7–8.2) and median eGDR (lower values indicate higher insulin resistance) of 9.2 mg/kg/min (8.2–9.9), while 21.8% (n = 36) of the participants were characterized as insulin resistant. After adjustment for age, gender, and the duration of diabetes, the presence of IR was significantly associated with higher prevalence of subclinical atherosclerosis (OR:2.59, 95% CI: 1.06–6.30, p = 0.036), CAN (OR:3.07, 95% CI: 1.02–9.32, p = 0.047) and subclinical LVSD (OR: 4.9, 95% CI: 1.94–12.79, p = 0.001). No association was shown with ACR. ConclusionsIn patients with T1D, insulin resistance, as measured by eGDR, correlates well with early CVD predictors and CAN. These associations appear independent of the effects of gender, aging, and disease duration.

Sleep Inversion and The Left Ventricular Systolic Function

Abstract Background Sleep inversion is sleeping during the day and waking up at night; a depart from the normal sleeping time between 10:00 PM to 5:00 AM. The aim of this study was to detect subtle changes in left ventricular (LV) systolic function caused by sleep inversion using strain imaging in young healthy individuals free of cardiovascular risk factors. Methods 100 healthy persons (18 to 35 years of age) with an inverted sleep pattern, and a normal LV systolic function by conventional 2D echocardiography were compared with 100 healthy individuals from the same age group with normal sleep timings. Conventional and speckle tracking echocardiography were performed. Results Male gender, smoking, less exercise, social media overuse, and junk food were significantly more common in the sleep inversion group. They had lower mean GLS than the controls (-20.90% ± 3.45 vs -22.87% ± 3.67, p &amp;lt; 0.0001). By multivariate analysis, sleep inversion was found to be independently associated with low GLS (Odds ratio: 2.02, 95% confidence interval (CI): 1.07–3.82, p = 0.03). Conclusion Sleep inversion is associated with subclinical left ventricular systolic dysfunction detected by speckle tracking in young healthy individuals. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Global longitudinal strain assessment in long-term survivors of childhood acute lymphoblastic leukemia

Abstract Background The role of global longitudinal strain (GLS) in the long-term cardiac evaluation of childhood acute lymphoblastic leukemia (ALL) survivors is not clearly defined. Purpose To assess the prevalence of subclinical left ventricular systolic dysfunction (SLVD) in long-term survivors of ALL. We also aimed to compare echocardiographic measurements with a control group. Methods Patients &amp;lt;18 years of age diagnosed with ALL between 1985–2015 at our center were enrolled. Healthy siblings willing to participate were conformed the control group. GLS was measured with an automated software (AutoStrain, Tomtec). SLVD was defined as GLS&amp;lt;18.5% (absolute value) based on the lower limit of the 95% confidence interval in the control group. Group differences were accounted with nverse probability of treatment weighting. Results Of the 90 survivors included (37.8% female, time from diagnosis 18 [11–26] years), 24 (26.6%) had SLVD. Left ventricular systolic but not diastolic measurements were reduced compared to the control group (Table 1). Predictors of GLS in the survivors were smoking (p=0.004) and history of hematopoietic stem-cell transplantation (p=0.042) (Table 2). Conclusions Over ¼ of childhood ALL survivors had abnormal GLS values after a median follow-up of 18 years. Left-ventricular systolic parameters were reduced compared to a control group. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Sociedad Española de Cardiología. Sociedad Andaluza de Cardiología.

Early evaluation of subclinical cardiotoxicity in patients with lung cancer receiving immune checkpoint inhibitors by cardiovascular magnetic resonance: a prospective observational study.

BackgroundFew studies have focused on the subclinical cardiotoxicity of immune checkpoint inhibitors (ICIs) in cancer patients. This study aimed to evaluate the manifestations of subclinical cardiotoxicity of ICI therapy using cardiovascular magnetic resonance (CMR) and to explore whether CMR parameters can help predict cardiotoxicity at the early stage of ICI therapy.MethodsA prospective, longitudinal study was conducted among patients with lung cancer. The patients were planned to undergo serial CMRs before (baseline), 3 weeks after (1st follow-up), and 3 months after (2nd follow-up) the initiation of ICI therapy, respectively. Patients with 3 CMRs were included in the analysis. Serial quantitative measurements based on CMR were compared using one-way repeated measures analysis of variance (RM-ANOVA). On the basis of cancer therapy-related cardiac dysfunction (CTRCD) observed at the second follow-up, patients were categorized into a CTRCD group and a non-CTRCD group. Baseline clinical and CMR parameters and the relative reduction of left ventricular global strain at the second follow-up was compared between the CTRCD group and the non-CTRCD group. Receiver operating characteristic (ROC) analysis was used to identify CTRCD that developed 3 months after ICI therapy.ResultsA total of 36 patients with 3 CMRs (60.7±9.2 years old, 77.8% male) were included in the analysis. Left ventricular-global radial strain (LV-GRS) decreased significantly at the second follow-up (37.9%±8.5% vs. 33.1%±1.0%; P=0.014), but left ventricular ejection fraction (LVEF) did not change significantly (51.5%±6.0% vs. 49.2%±6.5%; P>0.05). A total of 7 patients (19.4%) had developed CTRCD by the second follow-up. Baseline clinical and CMR parameters did not differ between the CTRCD group and the non-CTRCD group (P>0.05 for all). In the CTRCD group, the left ventricular-global circumferential strains (LV-GCSs) showed significant reductions at both the first and second follow-up (P=0.008 and 0.035, respectively), but the LVEF only showed a significant reduction at the second follow-up (P<0.001). The relative reduction of LV-GRS at the second follow-up was significantly higher in the CTRCD group than in the non-CTRCD group (29.8%±25.8% vs. 6.8%±20.4%; P=0.036) and was used to predict CTRCD developed at the 3-month timepoint after ICI therapy [area under the curve (AUC) =0.759; P=0.036].ConclusionsIn the early stage of ICI therapy, assessment of myocardial strain can be used to detect subclinical left ventricular systolic dysfunction in patients with lung cancer earlier than LVEF. The relative reduction of LV-GRS can be used to predict CTRCD 3 months after ICI therapy.

Diagnostics of Fabry disease in arrhythmology practice: a case report

Heart failure in Fabry disease (FD) is unfavorable prognostic manifestation and cause of death. Given that the disease is rare in clinical practice, the low awareness of physicians about this pathology leads to its late diagnosis and the lack of pathogenetic therapy.Aim. To present a clinical picture of the cardiovascular phenotype in FD in order to increase the awareness of doctors about this disease.Material and methods. In this clinical case, an asymptomatic FD course up to 46 years of age and mani festation in the form of arrhythmia were observed. According to echo car dio graphy, severe left ventricular hypertrophy (myocardial mass index, 214 g/m2) without signs of left ventricular (LV) outflow tract obstruction and left atrial (LA) dilatation were revealed (LA volume index — 47 ml/m2). Right ventricular (RV) and LV systolic function was assessed using two-dimensional speckletracking strain echocardiography. Latent subclinical RV and LV systolic dysfunction was established.Results. Tandem mass spectrometry revealed a sharp decrease in alphagalactosidase activity of 0,03 umol/L/h (norm range, 0,80-15,00 umol/L/h), as well as an in creased Lyso-GB3 concentration of 95,18 ng/ml (normal range, 0,05-3,0 ng/ ml). A molecular genetic study of blood samples was carried out. By direct automatic sequencing of the GLA gene, a variant of the c.1229 C&gt;T nucleotide sequence was identified, leading to the replacement of p.Thr4101le in the hemizygous state.Conclusion. This case shows the possibility and expediency of diagnosing FD in cardiology practice in patients with LV myocardial hypertrophy of unclear etiology, while atypical variants can be diagnosed only by molecular genetic testing.

Subclinical left ventricular systolic dysfunction and incident stroke in the elderly: long-term findings from Cardiovascular Abnormalities and Brain Lesions.

Heart disease is associated with an increased risk for ischaemic stroke. However, the predictive value of reduced left ventricular ejection fraction (LVEF) for stroke is controversial and only observed in patients with severe reduction. LV global longitudinal strain (LV GLS) can detect subclinical LV systolic impairment when LVEF is normal. We investigated the prognostic role of LV GLS for incident stroke in a predominantly elderly cohort. Two-dimensional echocardiography with speckle tracking was performed in the Cardiac Abnormalities and Brain Lesions (CABL) study. Among 708 stroke-free participants (mean age 71.4 ± 9.4 years, 60.9% women), abnormal LV GLS (>-14.7%: 95% percentile of the subgroup without risk factors) was detected in 133 (18.8%). During a mean follow-up of 10.8 ± 3.9 years, 47 participants (6.6%) experienced an ischaemic stroke (26 cardioembolic or cryptogenic, 21 other subtypes). The cumulative incidence of ischaemic stroke was significantly higher in participants with abnormal LV GLS than with normal LV GLS (P < 0.001). In multivariate stepwise logistic regression analysis, abnormal LV GLS was associated with ischaemic stroke independently of cardiovascular risk factors including LVEF, LV mass, left atrial volume, subclinical cerebrovascular disease at baseline, and incident atrial fibrillation [hazard ratio (HR): 2.69, 95% confidence interval (CI): 1.47-4.92; P = 0.001]. Abnormal LV GLS independently predicted cardioembolic or cryptogenic stroke (adjusted HR: 3.57, 95% CI: 1.51-8.43; P = 0.004) but not other subtypes. LV GLS was a strong independent predictor of ischaemic stroke in a predominantly elderly stroke-free cohort. Our findings provide insights into the brain-heart interaction and may help improve stroke primary prevention strategies.

Assessment of subclinical left ventricular systolic dysfunction and structural changes in patients with chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) can develop left ventricular (LV) systolic dysfunction and geometric changes due to several reasons. To investigate subclinical LV systolic dysfunction and structural features in patients with COPD, and its correlation with the severity of airway obstruction, identified by GOLD classification. We studied 52 patients with COPD and 29 age and sex-matched controls, without any cardiac disease. In addition to conventional echocardiographic evaluation speckle tracking echocardiography (STE)-based strain imaging were performed to analyse sub-clinical LV systolic dysfunction. Also LV volumes were measured by using three-dimensional real time echocardiography (3DRTE). All patients underwent spirometry. Conventional echocardiographic parameters (LV wall thickness and diameters, LV EF) and LV volume measurements were similar between the groups. LV global longitudinal peak systolic strain (-14.76 ± 2.69% to -20.27 ± 1.41%, P < 0.001) and strain rate (0.75 ± 0.25 1/s to 1.31 ± 0.41 1/s, P < 0.001) were significantly impaired in patients, compared to controls demonstrating sub-clinical ventricular systolic dysfunction. Significant positive correlation was obtained between LV strain/strain rate and spirometry parameters (FEV1, FEV%, FEV1/FVC, PEF%) (r = 0.78/0.68, P < 0.001; r = 0.83/0.70, P < 0.001); r = 0.74/0.55, P < 0.001; r = 0.72/0.65, P < 0.001 respectively). In addition, there was significant negative correlation between LV strain/strain rate and GOLD classification (r = -0.80/ -0.69, P < 0.001 respectively). Subclinical LV systolic dysfunction can occur in COPD patients despite normal EF. STE is a technique that provides additional information for detailed evaluation of subtle changes in LV myocardial contractility, significantly associated with the severity of the disease in COPD patients.

Subclinical systolic dysfunction by speckle tracking echocardiography in patients with systemic lupus erythematosus.

We aimed to compare the prevalence of subclinical left ventricular systolic dysfunction in Hispanic systemic lupus erythematosus (SLE) patients versus healthy controls. This cross-sectional study included 46 SLE patients who fulfilled the 2019 European League Against Rheumatism and American College of Rheumatology (EULAR/ACR) classification criteria for SLE and with age ≥ 18years. For comparison, we included a control group with 46 non-SLE subjects matched by age (±5years) and gender. A transthoracic echocardiogram was performed on every participant. The echocardiographic measurements evaluated were left ventricular ejection fraction (LVEF), relative wall thickness (RWT), and tricuspid annular plane systolic excursion (TAPSE). Left ventricular-Global Longitudinal Strain (GLS) was evaluated, and a value higher than -18% was classified as subclinical left ventricular systolic dysfunction. Comparisons between groups were made using the Chi-square test or Fisher's exact test for qualitative variables, and Student's t-test or the Mann-Whitney's U test for quantitative variables. A p-value <.05 was considered significant. We found a significant difference in the presence of subclinical left ventricular systolic dysfunction between SLE-patients and controls (37.0% vs 8.7%, p = .001). We also found that SLE patients had a lower left ventricular GLS (-18.90% vs -20.51%, p = .011), TAPSE (21.63mm vs 23.60mm, p = .009), and LVEF (57.17% vs 62.47%, p = <.001) than controls. Systemic lupus erythematosus diagnosis was independently associated with the presence of subclinical left ventricular systolic dysfunction with an OR of 6.068 (CI 95% 1.675-21.987) (p = .006). Subclinical systolic dysfunction was more common in men (29.4% vs 3.4%, p = .020), patients with obesity (17.6% vs 0%, p = .045), or hypertension (47.1% vs 6.9%, p = .001). Systemic lupus erythematosus Hispanic patients had a higher prevalence of subclinical left ventricular systolic dysfunction, and worse left ventricular GLS, LVEF, and TAPSE values than matched healthy controls. Additionally, we found that male gender, obesity, and hypertension are associated with the presence of subclinical left ventricular systolic dysfunction in SLE patients. The inclusion of speckle tracking echocardiography as part of the cardiovascular evaluation of SLE patients may help identify high cardiovascular risk patients.

The impact of medical therapy on left ventricular strain: Current state and future perspectives.

The speckle tracking strain is becoming a frequently used marker of subclinical left ventricular systolic dysfunction. Despite the wide range of data concerning left ventricular strain variability in the general population and its changes in various pathologic conditions, the information about the impact of medical therapy on left ventricle strain is limited. This article provides an analysis of published studies of left ventricle strain changes in response to different agents and combinations of medical therapies used for hypertension and congestive heart failure.

Comparison of left ventricular subclinical systolic dysfunction between hemodialysis patients and renal transplant recipients using real time three-dimensional echocardiography.

The relationship between chronic kidney disease and development of heart failure is a well-known clinical entity. Systolic dyssynchrony index (SDI_16) is a new diagnostic tool for detection of subclinical left ventricular (LV) systolic dysfunction by using three-dimensional echocardiography (3DE). We aimed to investigate this parameter in patients with end-stage renal disease who were receiving hemodialysis and patients with renal transplant compared to healthy control subjects. Forty-five hemodialysis patients, 45 patients with renal transplant and 45 age-sex matched healthy control subjects included in the study. All participants were evaluated with 3DE in the interdialytic phase for measurement of LV volumes, ejection fraction and SDI_16 parameter. Both LV diastolic and systolic volumes were significantly higher in hemodialysis group compared to renal transplant group and healthy controls, but this finding did not translate to a statistically significant difference for LVEF measurements between groups (58.71 ± 3.53 vs. 57.17 ± 2.97 vs. 59.23 ± 3.26, p = .16 for renal transplant and hemodialysis and healthy control groups, respectively). Mean value of SDI_16 parameters was significantly higher in hemodialysis group compared to renal transplant group (7.93 ± 2.50 vs. 3.72 ± 1.71, p < .001) and healthy controls (7.93 ± 2.50 vs. 3.00 ± .99, p < .001); whereas, it was similar between renal transplant group and control subjects (3.72 ± 1.71 vs. 3.00 ± .99, p = .10). SDI_16 was significantly higher in hemodialysis patients compared to patients with renal transplant and healthy controls.

Real-time three-dimensional echocardiography for detection of cardiac sarcoidosis in the early stage: a cross-sectional single-centre study

Background Sarcoidosis with cardiac involvement has a relatively high morbidity and mortality, and early diagnose of cardiac sarcoidosis is a critical issue. Systolic dyssynchrony index (SDI) measured by three-dimensional echocardiography was used in our study for detection of subclinical left ventricular (LV) systolic dysfunction in patients with sarcoidosis and normal LV function on two-dimensional echocardiography. Methods Forty-four patients diagnosed with sarcoidosis (without clinically apparent cardiac involvement) and 44 healthy control subjects were included in this study. Two-dimensional echocardiographic parameters, also LV volumes and SDI measured by 3D echocardiography were analyzed in all participants. Results While two-dimensional echocardiographic results of both study groups were similar; SDI_16 (SDI for 16 segments of LV) results were significantly higher in sarcoidosis group compared to healthy controls (6.99 ±5.02 vs 2.89 ± 1.32, p < 0.0001). Conclusion SDI_16 was higher in patients with sarcoidosis compared to healthy controls probably due to patchy infiltration characteristic of the disease. This parameter could be used as a marker to identify patients with cardiac involvement of sarcoidosis in the early phase.

Cardiovascular involvement in post Covid patients

Objectives: to highlight the cardiovascular sequelae of Covid-19, especially subclinical dysfunction of the left ventricle. Materials and methods: the study included 74 Covid-19 convalescent patients with no history of cardiovascular disease, with a mean age of 42.01 years ± 1.4 years. Patients were assessed by speckle tracking echocardiography. Results: The results of our study determined that 41 (55.4%) Covid-19 convalescent patients have subclinical left ventricular systolic dysfunction, the mean GLS in the group being 15.8 ± 0.39, while in the control group no person has GLS &lt;16% (p &lt;0.001). Other manifestations were: diastolic dysfunction - 23 (31.1%), right ventricular dysfunction - 22 (30.1%), pericardial effusion - 19 (25.7%), symptoms - 67 (90%). Conclusions: Subclinical cardiac dysfunction is a common complication encountered in convalescent Covid-19 patients, and determination of GLS by speckle tracking echocardiography remains a practical and cost-effective tool to detect this injury; The persistence of symptoms, included in longCovid, does not correlate with the results of imaging investigations.