Ventricle Global Longitudinal Strain Research Articles

Left Atrial Peak Systolic Strain as an Indicator Pathway of Diastolic Dysfunction of the Left Ventricle.

Left atrial peak systolic strain (LA-PSS) imaging is an emerging index of left atrial function, and it was shown to be decreased in heart failure with preserved ejection fraction (EF). We aimed to determine whether LA-PSS could be used as an additional diagnostic parameter to current existing guidelines for the presence of left ventricle diastolic dysfunction (LVDD). A total of 190 consecutive adult patients with cardiovascular risk factors and normal left ventricle EF with no prior history of heart failure were included in the study. Speckle tracking software was used to study ventricular parietal deformity, left ventricle global longitudinal systolic strain, and LA-PSS. The median left ventricle global longitudinal systolic strain was -19%, with a significant difference ( P < 0.001) between patients with normal diastolic function versus those with LVDD. The median LA-PSS was 33% (30% to 38%) ( P < 0.001). Most patients (61%) had grade 1 atrial dysfunction based on PSS (range 24%-35%). The analysis of the area under the receiver operating characteristic curve of the LA-PSS as a potential indicator pathway of LVDD was 67% [95% confidence interval (CI), 62-72], and 75% (95% CI, 70-80), when the indeterminate pattern was included. The decreased LA-PSS made it possible to reclassify patients with an indeterminate pattern of diastolic function in 96% of cases. These results support the potential role of LA-PSS as an additional parameter for the diagnosis of LVDD in patients with normal EF, and may be integrated into the guidelines for routine evaluation of patients.

CARDIAC ULTRASOUND ALTERATIONS IN INDIVIDUALS WITH PNEUMONIA RELATED TO COVID-19 INFECTION

A wide range of cardiac effects are observed during the acute phase of COVID-19. Interestingly, troponin levels are raised in 8–28% of instances, while systolic myocardial dysfunction symptoms are not always evident. Subclinical myocardial dysfunction is more common and is commonly defined as a decrease in the left ventricle's global longitudinal strain (LV GLS). Up to 80% of individuals exhibit this alteration while they are in the hospital. LV GLS is a crucial component in risk assessment for follow-up care and a strong independent predictor of in-hospital mortality. The first results on the long-term cardiovascular effects of COVID-19 one year after hospitalization are presented in this study. One year after discharge, we found that patients with COVID-19 pneumonia had a negative trend in LV GLS and deformation metrics in the apical and certain middle segments of the LV myocardium, as compared to data collected three months after discharge. The purpose of the study is to look at the prevalence and clinical significance of long-term heart injury following COVID-19. In order to do this, we examined patient data and categorized patients a year following hospital discharge according to their LV GLS values. This method aids in comprehending the clinical ramifications of long-term cardiac injury after COVID-19.

Evaluation of the Effect of Conversion of Nonvalvular Atrial Fibrillation to Sinus Rhythm on Cardiac Remodeling.

Atrial fibrillation (AF)represents the most prevalent cardiac arrhythmia globally, with a significant burden on mortality and morbidity. While rhythm control strategies, particularly electrical cardioversion (EC), have gained traction in recent years, the precise impact of sinus rhythm (SR) restoration on cardiac reverse remodeling remains a subject of debate. In this study, 23 AF patients underwent elective EC. AF diagnosis was made via ECG by a cardiologist, and candidates for cardioversion were selected by an electrophysiologist. Transthoracic echocardiography (TTE) by utilizing two-dimensional, three-dimensional, and tissue Doppler imaging modalities was performed before cardioversion. Patients who maintained SR after six months underwent a second TTE evaluation. SR was restored successfully in all 23 patients and 15 patients (65.2%) maintained SR after six months. SR group had significantly lower baseline cardiac output (CO)and indexed left ventricular end-systolic volume (LVESVi), and better European Heart Rhythm Association (EHRA) scores after six months. Within the SR group, patients exhibited significant changes in mitral regurgitation, tricuspid regurgitation, EHRA score, LVESVi, stroke volume, left ventricle ejection fraction, left ventricle global longitudinal strain, indexed minimum left atrial volume, left atrial emptying fraction, and left and right atrial diameters. Reduced CO was associated with AF recurrence. Receiver operating curve analysis revealed that CO value can predict six-month AF recurrence with a cut-off point of 2.3. Our study underscores the beneficial effects of SR restoration on cardiac parameters in AF patients post EC. Notably, CO value emerged as a predictor of AF recurrence, emphasizing the importance of comprehensive assessments for predicting long-term outcomes.

IN ARTERIAL HYPERTENSION THE RIGHT VENTRICLE IS NO LONGER THE “FORGOTTEN CAVITY”

Objective: The right ventricle showed late interest in the assessment and stratification of the severity of arterial hypertension. The complex systemic reaction in the context of arterial hypertension, represented in particular by the activation of the renin angiotensin aldosterone system and the increase in sympathetic activity would suggest an early impairment of diastolic and later systolic function also of the right ventricle. Echocardiography is the most accessible way to evaluate the right ventricle in medical practice. Purpose of the study: to evaluate the precocity and the type of right ventricular function impairment in recently diagnosed hypertensive patients. Design and method: The patients were included after following the recommendations for the diagnosis of arterial hypertension according to the guide published by ESH in 2023. Personal biological data and parameters, cardiovascular risk factors, blood pressure values were recorded. Patients with other comorbidities, with secondary hypertension were excluded.Patients on antihypertensive treatment were also excluded. We investigated echocardiographically by analyzing 2D diastolic parameters, Doppler spectral and mitral and tricuspid tissue parameters as well as the global longitudinal strain of both ventricles. We studied right ventricle global longitudinal strain (RVGLS), septal wall longitudinal strain (RVSWLS), right ventricle lateral wall longitudinal strain (RVLWLS). Results: we studied a group of 61 patients who presented with essential hypertension, recently diagnosed, with an average age of 68.1 +- 6.3 years and who were analyzed according to grade, gender, risk factors. The (RVGLS) was analyzed separately and comparatively for the lateral and septal wall and the values were RVGLS =19%+- 3.2%. RVSWLS=-13.1% +-2.9% and RVFWLS=-22.6%+- 3.4%. The filling ratio of the right ventricle E/e’ was 14. Conclusions: the diastolic function of the right ventricle is affected in recently diagnosed hypertensive patients in relation to the degree of hypertension, myocardial mass and the filling ratio of the left ventricle. Slightly increased values of RVLWGLS could be interpreted as a consequence of sympathetic activation

Del Nido versus cold crystalloid cardioplegia for myocardial protection during ventricular septal defect repair in children under one year of age: a prospective randomized trial

Rationale: The choice of strategy for myocardial protection during procedures with cardiopulmonary bypass and cardioplegic arrest in children is not regulated by clinical guidelines due to insufficient data from clinical studies. The issue of methods to assess myocardial injury remains unresolved.&#x0D; Aim: To assess the frequency and specifics of the development of intraoperative myocardial injury syndrome in children of the first year of life with ventricular septal defect depending on the strategy for cardioplegia.&#x0D; Materials and methods: In a single center, prospective, randomized controlled trial we compared two cardioplegia strategies during surgical closure of ventricular septal defect in infants aged from 1 to 12 months: del Nido blood cardioplegia (n = 102) and cold crystalloid cardioplegia with Custodiol solution (n = 102). The primary endpoint was a persistent over 10-fold increase above the upper limit of the normal in the plasma concentration of high-sensitivity troponin I at 6 hours after surgery persisting after 24 hours. The secondary combined endpoint was myocardial damage verified by persistent increase in troponin I level more than 10-fold above the upper limit of the normal, persisting at 6 and 24 hours, accompanied by new pathological Q waves, acute complete left bundle branch block, abnormalities of the end part of the ventricular complex on the electrocardiography (ST segment elevation 1 mm or ST depression of 1 mm in more than 2 adjacent leads), and a decrease in the global longitudinal strain of the left ventricle by 50% from the initial value at 6 hours after surgery.&#x0D; Results: In 53/204 (26%) patients, the increase in troponin I persisted at 24 hours after the surgery and was associated with electrocardiography abnormalities, changes in the parameters of left ventricle longitudinal mechanics, and in some cases required greater inotropic support. By the end of the 1st postoperative 24 hours, the longitudinal strain of the left ventricle showed more negative changes over time in the Custodiol group compared to that in the del Nido group (-10 [-14.1; -6.27] versus -14.8 [- 16.5; -10]%; p 0.0001). The same was true for the left ventricle global strain rate (-0.71 [-0.9; -0.52] s-1 in the del Nido group and -0.57 [-0.760; - 0.44] s-1 in the Custodiol group; p = 0.0049). The primary endpoint was achieved by 21 (20.6%) and 55 (53.9%) patients in the del Nido and Custodiol groups, respectively (p = 0.032). The combined endpoint in the Custodiol group was achieved by 34 (33.3%) versus 19 (18.6%) patients in the del Nido group (p = 0.049, χ2 = 3.875, DF = 1, φ = 0.191).&#x0D; Conclusion: Del Nido blood cardioplegia compared to cold crystalloid cardioplegia with Custodiol has advantages in terms of preventing intraoperative myocardial damage and minimizing its severity. When assessing myocardial damage, such indicators as left ventricle global longitudinal strain and left ventricle global strain rate are informative, along with an increase in the troponin I level.

Left Atrial Strain by 2D Speckle Tracking Echocardiography in Patients with Systemic Hypertension in Babylon Province

Abstract Background: Systemic hypertension is an expanding health problem and a major cause of cardiovascular morbidity and mortality. Left atrial (LA) strain by speckle tracking is a new echocardiographic modality that can detect impairment in LA function. Objectives: The aim was to analyze the parameters of LA strain in patients with systemic hypertension and compare them to those of normal persons. Materials and Methods: A case–control study was conducted at the echocardiography department of Marjan Medical City in Hillah from February 2023 to June 2023. The study focused on patients with hypertension and compared their 2D echocardiography, Doppler, tissue Doppler, left ventricle global longitudinal strain, and LA strain to those of a control healthy group. Data collection included a questionnaire, echocardiography using the GE Vivid iq machine, and statistical analysis using Statistical Package for the Social Sciences (SPSS) 27 software. Results: In total, 100 persons were enrolled in the study; 50 of them were patients with systemic hypertension, and the other 50 were persons with negative medical history. The two groups were age, gender, and body surface area matched. Echocardiographic parameters were compared, concentrating on LA strain and diastolic function parameters. A strong correlation was found between hypertension and LA strain parameters. Reservoir, conduit, and contractile strain were lower in the hypertensive group, while the LA volume and LA indexed volume were statistically larger in the hypertensive group than the control group, with a P value of less than 0.001 in both. Conclusion: LA strain by speckle tracking is affected in systemic hypertension more and even before the diastolic function affection. Earlier detection and treatment of dysfunction can delay or even prevent complications.

Arterial Stiffness May Predict Subsequent Cancer Therapy-Related Cardiac Dysfunction in Breast Cancer Patients

Cancer therapy-related cardiac dysfunction (CTRCD) is still a serious problem. Existing risk scores are insufficient for risk classification, especially in low and medium-risk patients. This study aims to evaluate if arterial stiffness (AS) measurement, which is associated with most of the known risk factors, can be a useful parameter for predicting subsequent CTRCD in patients with breast cancer (BC). Patients with BC were included in the study. All patients’ AS parameters such as pulse wave velocity (PWV), augmentation index (AIx), augmentation pressure (AP), and echocardiographic parameters were obtained before treatment. During treatment, echocardiographic follow-up with routine parameters and left ventricle global longitudinal strain (LVGLS) were measured. Patients were evaluated on whether CTRCD occurred or not. A total of 67 patients were analyzed. The mean age of the study population was 54.9 ± 11 years. Baseline characteristics were similar except for age. No CTRCD diagnosis was obtained according to left ventricle ejection fraction (LVEF) reduction, but 18 patients (26.8%) developed CTRCD regarding the decline in LVGLS. Left ventricle hypertrophy and diastolic dysfunction were more frequent in patients with CTRCD (p = 0.016 and p = 0.015, respectively). PWV, AIx, and AP as AS parameters were significantly higher in patients with CTRCD, but Alx@75 were not (p = 0.005, p = 0.034, p = 0.008, p = 0.077, respectively). A positive correlation between PWV and a decreased percent in LVGS (R = 0.607, p < 0.001) was observed. ROC curve analyses revealed an AUC of 0.747 (p = 0.02, 95% CI 0.632–0.832) for PWV. A PWV value of 9.2 m/s predicted CTRCD with 94% sensitivity and 73% specificity. AS measurement may be useful for predicting CTRCD in patients with low to medium-risk BC.Graphical

Longitudinal strain and myocardial work in symptomatic patients having recovered from COVID-19 and possible associations with the severity of the disease.

COVID-19 may have residual consequences in multiple organs, including the cardiovascular system. The purpose of the present investigation is to quantify myocardial function in symptomatic individuals with long COVID and investigate the association between illness severity and myocardial function. A retrospective cross-sectional study was conducted in which symptomatic individuals with previous COVID-19 underwent echocardiographic analysis of left ventricle global longitudinal strain (LVGLS) and myocardial work (MW). Individuals also performed cardiopulmonary testing (CPX) to assess peak oxygen uptake (VO2peak). Differences between illness severity subgroups were analyzed by the Mann-Whitney test. Correlations were calculated using the Spearman correlation test. Multilinear regressions were performed to evaluate the influences of COVID-19 severity, body mass index, age, and sex on MW. Fifty-six individuals were included (critical subgroup: 17; moderate/severe subgroup: 39), 59% females; median age: 56years (IQR: 43-63). CPX revealed a substantial reduction in VO2peak (median of 53% of predicted values). LVGLS were not statistically different between subgroups. Global wasted work (GWW) was higher in the critical subgroup [146 (104-212) versus 121 (74-163) mmHg%, p = 0.01], and global work efficiency (GWE) was lower in this subgroup [93 (91-95) versus 94 (93-96), p = 0.03]. Illness severity was the only independent predictor of GWW and GWE (GWW: r2 = 0.167; p = 0.009; GWE: r2 = 0.172; p = 0.005) in multilinear regressions. In our study with long COVID-19 individuals, despite having a similar LVGLS, patients had subclinical LV dysfunction, demonstrated only by an increase in GWW and a decrease in GWE.

Relationship Between Obesity and Global Longitudinal Strain in the Pediatric Single Ventricle Fontan Population Across Ventricular Morphologies.

Obesity is associated with diminished myocardial function as measured by strain echocardiography in children and young adults with normal cardiac anatomy. Data are lacking about the effect of obesity on myocardial strain in patients with a single ventricle. In this study, the relationship between body mass index (BMI) and single ventricle myocardial strain in the Fontan population was assessed. Thirty-eight abnormal BMI Fontan cases (21 overweight and 17 obese) and 30 normal BMI Fontan controls matched based on single ventricular morphology, age, and sex were included in the study. Ventricular morphology was categorized as single right ventricle, single left ventricle, or biventricular. Single ventricle global longitudinal peak systolic strain (GLS) and other echocardiographic measurements were performed and compared between groups, with a P≤0.05 defined as significant. The abnormal BMI group demonstrated diminished GLS (-15.7±3.6% versus -17.2±3.2%, [P=0.03]) and elevated systolic blood pressure (P=0.04) compared with the normal BMI group. On subgroup analysis of those with single right ventricle morphology, the abnormal BMI group demonstrated diminished GLS compared with controls. There was no significant difference in GLS between the abnormal BMI and control groups in the single left ventricle and biventricular subgroups. Analyzed by ventricular morphology, no other variables were statistically different in the abnormal BMI group including systolic blood pressure. Inter-reader reproducibility for GLS and strain rate were excellent for both measures. Obesity has an adverse relationship with myocardial strain in the young Fontan population, with the most maladaptive response seen in the single right ventricle.

Coronary slow flow and its correlation with reduced left ventricle global longitudinal strain: a case–control study

BackgroundCoronary slow flow (CSF) often links to inflammation and endothelial function disturbance. While conventional ejection fraction measurements fall short in identifying myocardial dysfunction, left ventricular global longitudinal strain (LV GLS) has shown superior efficacy in this regard. Our study aimed to explore subclinical left ventricular systolic dysfunction by assessing LV GLS in patients diagnosed with coronary slow flow (CSF).MethodsThe study included sixty patients with CSF and sixty control individuals without CSF. Coronary angiography employed the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) to identify CSF. LV GLS values were evaluated and compared between the two groups.ResultsSignificantly reduced LV GLS was evident in the CSF group compared to the control group (− 16.18 ± 1.25 vs. − 19.34 ± 1.33, p < 0.001). A notable correlation (r = 0.492, p < 0.001) between LV GLS and TFC was observed in the CSF group. Multivariate logistic regression analysis highlighted reduced LV-GLS (OR 2.2, 95% CI 1.57–3.09, p < 0.001) and smoking (OR 11.55, 95% CI 3.24–41.2, p < 0.001) as significant predictors for CSF presence. The receiver operating characteristic curve established that an LV GLS value of ≥ − 17.8% accurately predicted the presence of CSF (AUC: 0.958, 95% CI: 0.924–0.991, p < 0.001) with 90% specificity and 91.7% sensitivity.ConclusionOur study indicates that reduced LV GLS is associated with CSF presence, offering a valuable means to early detect subclinical left ventricular systolic dysfunction in high-risk patients susceptible to heart failure.Trial registration: ZU-IRB#7038/12-7-2021 Registered 12 July 2021, email: IRB_123@medicine.zu.edu.eg.

Improvement of myocardial contractility with leadless endocardial single-lead atrial sensing ventricular pacing in patients with prolonged PQ interval.

Aim: Micra AV represents a leadless endocardial pacing system able to detect atrial contractions providing atrioventricular synchrony. A reduction of myocardial contractility may be detected in case of first-degree atrioventricular block (AVB). Materials & methods: In six patients with first-degree AVB (PQ interval ≥220msec) was evaluated the left ventricle global longitudinal strain (LV GLS) by speckle tracking (ST) echocardiography during single-lead atrial sensing ventricular pacing (VDD) stimulation as compared with spontaneous rhythm (SR), 24-48h after Micra AV implantation. Results: A statistically significant difference between the two modalities was observed (LV GLS during SR: -14.7% [interquartile range (IQR)5.5], LV GLS during VDD pacing: -16.1% [IQR 5.2]; p value=0.041). Conclusion: Our preliminary results suggest an improvement of myocardial contractility with VDD pacing as compared with SR.

Prognostic value of left atrial strain in patients with tetralogy of fallot.

To demonstrate prognostic utility of left atrial strain (LAS) in adult patients with repaired Tetralogy of Fallot (rTOF). Adults patients with rTOF were prospectively enrolled in this study between years 2011 and 2015. Left atrium (LA) phasic functions were assessed using 2D speckle tracking echocardiography. Association of LA strain (LAS) with primary (any cardiovascular event) and secondary (death, heart failure or arrhythmia) composite endpoints was assessed using Cox regression analysis. Hundred-and-twelve rTOF patients, in whom LAS was feasible and were in sinus rhythm, were included in the final analysis (age 33 ± 10years, 68[61%] male). Median duration of follow-up was 8.6 [4.2-9.7] years in the study group. Primary composite endpoint was reached in 48 patients (mean event-free survival time: 7.2 [6.6-7.9] years), and secondary composite endpoint was reached in 22 patients (mean event-free survival time: 8.7 [8.1-9.2] years). LA reservoir strain (LAS-r) was defined as tertile groups (1st tertile < 33%, 2nd tertile = 33-44%, 3rd tertile > 44%). Decreasing tertiles of LAS-r was associated with primary and secondary composite endpoints in Kaplan-Meier analysis (p = 0.02 and 0.002, respectively). In univariable Cox-regression, both decreasing LAS-r and LAS-r tertiles were associated with primary and secondary composite endpoints. Adjusted by initial repair age and NT-proBNP quartiles, increased LAS-r was associated with significantly decreased occurrence of experiencing any events (HR = 0.97, CI 0.93-0.99, p < 0.001). Decreasing LAS-r was still associated with primary endpoint when adjusted by left atrium volume index (LAVImax) (HR = 0.96, CI 0.92-0.99, p = 0.01), left ventricle global longitudinal strain (HR = 0.96, CI 0.93-0.99, p < 0.001) or right ventricle free wall longitudinal strain (HR = 0.96, CI 0.93-0.99, p = 0.03). Assessment of LA mechanics with the use of STE has incremental utility in determination of mortality and morbidity in rTOF, and may be implemented in clinical practice.

Effects of canagliflozin on cardiac remodeling and hemodynamic parameters in patients with type 2 diabetes mellitus

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors have demonstrated to reduce cardiovascular risk in patients with type 2 diabetes mellitus (T2DM) in large trials independent of glycemic control. The mechanisms of this cardioprotective property remain uncertain. Evidence suggests positive hemodynamic changes and favorable cardiac remodeling contributing to the clinical outcomes but results were conflicting. We aim to investigate the potential impact on hemodynamic parameters, cardiac structure and functions. This prospective observational study included T2DM patients receiving canagliflozin 100 mg per day in addition to their antidiabetic treatment. We analyzed hemodynamic parameters assessed by echocardiographic measurements and impedance cardiography (ICG) to evaluate systolic and diastolic functions from baseline to 24 weeks after treatment. A total of 47 patients (25 males and 22 females) averaging 64.6 ± 10.9 years had a significant reduction in HbA1c, body weight, and systolic blood pressure. Hematocrit increased significantly, while NT-proBNP remained unchanged. E/e′, left atrium (LA) volume, and LA stiffness were reduced, while left ventricle (LV) global longitudinal strain (GLS) and LA strain rates increased at 24 weeks by conventional and speckle tracking echocardiography. LV mass and ejection fraction showed no differences. ICG suggested significant improvement in hemodynamic parameters with increased stroke volume index and cardiac output index and decreased systemic vascular resistance index at 12 and 24 weeks. Canagliflozin improved hemodynamic parameters and had a favorable impact on LA and LV reverse remodeling. These changes may explain the beneficial effect on cardiovascular outcomes in large clinical trials.

Right atrial performance of adult patients with repaired tetralogy of fallot

Abstract Background Patients with repaired Tetralogy of Fallot (rToF) present anatomic and hemodynamic sequelae which may impact the right heart mechanics. Right ventricular adaptation to prolonged loading conditions should not be considered in isolation from the right atrium, because the atrial function affects that of the ventricle. Purpose This study aims to describe the right atrial performance using the echocardiographic right atrial longitudinal strain in a population of adult patients with rToF. Methods Echocardiographic images of adult patients (&amp;gt;18 years old) with rToF were retrospectively reviewed, and atrial reservoir (rRAS), conduit (cRAS), and contractile (aRAS) right atrial longitudinal strain were calculated. A group of healthy subjects (CTR) with comparable sex, age, and body surface area was included for comparison. Invasive cardiac catheterization data were also collected for patients with rToF. Results Sixty patients were included in the study: 30 with rToF (age 34 ± 9 years old) and 30 healthy subjects (age 34 ± 11 years old). Patients with rToF presented a lower value of rRAS, cRAS, and aRAS when compared to CTR (rRAS: rToF 20.83 ± 8.44% vs CTR 36.22 ± 9.53%, p&amp;lt;0.0001; cRAS: rToF -11.22 ± 6.41% vs CTR -22.67% ± 8.88%, p&amp;lt;0.0001; aRAS: rToF 9.67 ± 5.94% vs CTR 14.28 ± 6.35%, p=0.03). rRAS presented a good positive correlation with systolic peak velocity at tissue doppler imaging (p=0.006) and a trend toward positive correlation with right ventricle global longitudinal strain (p=0.08) and with the tricuspid annular plane systolic excursion (p=0.07). No correlation was found between invasive right ventricle end-diastolic and -systolic pressure and echocardiographic right atrial longitudinal strain parameters. Conclusion Adult patients with rToF presented a lower value of right atrial longitudinal strain, indicating an impaired atrial performance. Right atrial longitudinal strain provides additional insight for the comprehensive evaluation of right heart mechanics and should be systematically evaluated during the follow-up of adult patients with rToF.

Effect of sodium-glucose type 2 cotransporter inhibitors on cardiac structure and function in patients with normal ejection fraction

Abstract Introduction Sodium-glucose cotransporter inhibitors (SGLT2i) have proven a reduction in cardiovascular events in diabetic patients with and without heart failure (HF), as well as in non-diabetic patients with heart failure with reduced and preserved ejection fraction (EF). The mechanisms underlying this benefit are not well known, with contradicting data on the changes that SGLT2i produce on cardiac function and structure. Methods Between October 2020 and October 2021, 31 diabetic patients without prior history of SGLT2i use with normal EF (&amp;gt;50%), glycated hemoglobin &amp;lt;6.5%, renal clearance rate of &amp;gt;60 ml/min/1.73 m2 and sinus rhythm were prospectively included. In all of them, SGLT2i were started. At inclusion and 6-months follow-up, different clinical, ECG, analytical and echocardiographic (standard, 3D and speckle tracking) variables were recorded. Results The average age of our population was 66.4 years (±8.4). 90% were male, 71% were hypertensive, 77.4% were dyslipidemic, 22.6% were obese and 87.1% were current or former smokers. 77.4% of patients had a history of ischemic heart disease, and 10% had vascular disease in other territories. At the time of inclusion, 80.6% of the population was treated with ACEI or ARB, 54.8% with beta-blockers, 29% with diuretics, and 93.5% with statins. After an average follow-up period of 6.6 months (±0.8), medication had to be withdrawn in 5 patients (in 3 of them due to repeated genital or urinary infections, and in 2 of them because of patient choice). An average reduction of 0.89 mm (±0.24, p = 0.001) in myocardial thickness was observed, as well as a reduction in the 3D-estimated left ventricle mass of 9.9 g/m2 (±4.5, p = 0.03), and in the E/é ratio of 1.4 (±4.5, p = 0.02). An increase in absolute left ventricle global longitudinal strain (LVGLS) of 0.74 (±0.35, p = 0.05) was observed, as well as an increase in isovolumetric relaxation time (IVRT) of 9.8 ms (±4.8, p = 0.05). An increase in LA strain and indexed volume was noted, although differences did not achieve statistical significance. No relevant differences in LV dimensions and volumes were observed, as well as in the evaluated RV parameters (picture 1). Conclusions It is necessary to understand the mechanism underlying the clinical benefit of these drugs. This will allow us to better understand its effect in patients with HF. Our data shows that the use of SGLT2i is associated with cardiac improvements, both structural (myocardial mass) and functional (IVRT, LVGLS, E/e'), in a population of patients with normal EF.

Abstract 14919: Speckle Tracking Based Echocardiographic Evaluation of COVID-19 Recovered Patients: A One Year Follow-Up Study

Introduction: The occurrence of myocardial injury during acute COVID-19 is well known however, its persistence and impact over a longer period of time is unclear. Hypothesis: We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricle (RV) longitudinal and free wall strain using speckle tracking echocardiography (STE) in COVID-19 recovered patients. Methods: A total of 189 subjects following recovery from COVID-19 infection and with a normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers and detailed echocardiographic evaluation including STE were done for all. All these patients were followed-up for a period of one year with repeat echocardiography done at six months and one-year. Results: Of the 189 subjects, 176 (93.1%) were symptomatic and categorized as mild [n = 91 (51.8%)], moderate [n = 65 (36.9%)] or severe [n = 20 (11.3%)] illness. Subclinical LV and right ventricle (RV) dysfunction were seen in 58 (30.7%) and 25 (13.2%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -21.4 ± 3.1 %; moderate: -18.8 ± 4.8%; severe: -16.3 ± 2.7%; P &lt; 0.0001). RV longitudinal strain was significantly lower in patients recovered from severe COVID (mild: -22.9 ± 1.7, moderate: -21.8 ± 1.5, severe: -17.9 ± 1.6; P &lt; 0.0001). There was a significant improvement in LVGLS (baseline: -19.1± 5.7, one-year: -19.9±4.6; P &lt; 0.0001) and RVFWS (baseline: -23.5±6.3; one-year: -23.7 ± 5.8; P=0.03) however, RVLS improved though not significant (baseline: -21.4±5.7; one-year: -21.6 ± 5.2; P=.156) over a one-year follow-up period. Of the 58 subjects with baseline reduced LVGLS, over a one-year follow-up, 22 (11.6%) had persistently reduced LVGLS. Conclusions: Subclinical LV dysfunction was seen in one third of recovered COVID-19 patients which improved over a one-year follow-up. A fraction of subjects had persistently reduced LVGLS even at one year which suggests need for closer follow-up among them to elucidate long-term cardiovascular outcomes.

Dapagliflozin Improved Cardiac Function and Structure in Diabetic Patients with Preserved Ejection Fraction: Results of a Single Centre, Observational Prospective Study.

Sodium-glucose cotransporter inhibitors (SGLT2i) have demonstrated a reduction in cardiovascular events in diabetes and heart failure (HF). The mechanisms underlying this benefit are not well known and data are contradictory. The purpose of this study is to analyse the effect of dapagliflozin on cardiac structure and function in patients with normal ejection fraction. Between October 2020 and October 2021, we consecutively included 31 diabetic patients without prior history of SGLT2i use. In all of them, dapagliflozin treatment was started. At inclusion and during six months of follow-up, different clinical, ECG, analytical, and echocardiographic (standard, 3D, and speckle tracking) variables were recorded. After a follow-up period of 6.6 months, an average reduction of 18 g (p = 0.028) in 3D-estimated left ventricle mass was observed. An increase in absolute left ventricle global longitudinal strain (LV-GLS) of 0.3 (p = 0.036) was observed, as well as an increase in isovolumetric relaxation time (IVRT) of 10.5 ms (p = 0.05). Moreover, dapagliflozin decreased the levels of plasma creatin-kinase (CK-MB) and atrial natriuretic peptide (ANP). In conclusion, our data show that the use of SGLT2i is associated with both structural (myocardial mass) and functional (IVRT, LV-GLS) cardiac improvements in a population of diabetic patients with normal ejection fraction.

Correlation analysis of the abdominal visceral fat area with the structure and function of the heart and liver in obesity: a prospective magnetic resonance imaging study

BackgroundThe differences in fat deposition sites exhibit varying degrees of systemic inflammatory responses and organ damage, especially in obese individuals with excessive visceral fat. Visceral fat, which is closely related to an increase in mortality rates related to heart and liver diseases. However, few studies have analysed the differences in heart and liver indicators and their correlation among groups based on the abdominal visceral fat area (AVFA).ObjectiveClarifying the differences in and correlations of heart and liver indicators among groups with different severities of AVFA by magnetic resonance imaging (MRI).MethodsSixty-nine subjects with obesity were enrolled. The study group consisted of forty-one individuals (AVFA ≥ 150 cm2), and the control group consisted of twenty-eight individuals (100 cm2 ≤ AVFA < 150 cm2). The differences in and correlations between clinical, laboratory, and MRI indicators of the heart and liver between the two groups were analysed.ResultsIn the study group, the incidences of type 2 diabetes mellitus (T2DM) and insulin resistance were higher, and liver function indicators were worse. The left ventricular eccentricity ratio (LVER), left ventricular mass (LVM) and global peak wall thickness (GPWT) were higher in the study group than in the control group (P = 0.002, P = 0.001, P = 0.03), and the left ventricle global longitudinal strain (LVGLS) was lower in the study group than in the control group (P = 0.016). The pericardiac adipose tissue volume (PATV) and myocardial proton density fat fraction (M-PDFF) were higher in the study group than in the control group (P = 0.001, P = 0.001). The hepatic proton density fat fraction (H-PDFF) and abdominal subcutaneous fat area (ASFA) were higher in the study group than in the control group (P < 0.001, P = 0.012). There was a moderate positive correlation (ρ = 0.39–0.59, P < 0.001) between the AVFA and LVER, LVM, GPWT, LVGLS, and H-PDFF. There was no difference in right ventricular and most left ventricular systolic and diastolic function between the two groups.ConclusionThe high AVFA group had a larger LVM, GPWT and PATV, more obvious changes in LVER, impaired left ventricular diastolic function, an increased risk of heart disease, and more severe hepatic fat deposition and liver injury. Therefore, there is a correlation between the amount of visceral adipose tissue and subclinical cardiac changes and liver injury.

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

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

Left Ventricle Global Longitudinal Strain as a Predictor of Outcomes After Transcatheter Edge-to-Edge Mitral Repair in Severely Depressed Ejection Fraction

Left Ventricle Global Longitudinal Strain as a Predictor of Outcomes After Transcatheter Edge-to-Edge Mitral Repair in Severely Depressed Ejection Fraction