Ventricular Global Longitudinal Peak Strain Research Articles

Incremental Prognostic Value of Cardiac MRI Feature Tracking and T1 Mapping in Arrhythmogenic Right Ventricular Cardiomyopathy.

Purpose To explore the role of cardiac MRI feature tracking (FT) and T1 mapping in predicting sustained ventricular arrhythmias (VA) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and to investigate their possible incremental value beyond ARVC risk score. Materials and Methods The retrospective study analyzed 91 patients with ARVC (median age, 36 years [IQR, 27-50 years]; 60 male, 31 female) who underwent cardiac MRI examinations between November 2010 and March 2022. The primary end point was the first occurrence of sustained VA after cardiac MRI to first VA, with censoring of patients who were alive without VA at last follow-up. Cox regression analysis was performed to assess the association between variables and time to sustained VA. Time-dependent receiver operating characteristic (ROC) analysis was performed to determine the incremental value of cardiac MRI FT and T1 mapping. Results During a median follow-up of 55.0 months (IQR, 37.0-76.0 months), 36 of 91 (40%) patients experienced sustained VA. A 1% worsening in left ventricular global longitudinal peak strain (GLS), 1% worsening in right ventricular GLS, and a 1% increase in extracellular volume fraction (ECV) were associated with increased risk of sustained VA, with hazard ratios of 1.14 (95% CI: 1.06, 1.23; P = .001), 1.09 (95% CI: 1.02, 1.16; P = .02), and 1.13 (95% CI: 1.08, 1.18; P < .001), respectively, after adjustment for ARVC risk score. Adding both biventricular GLS and ECV to ARVC risk score showed significant incremental value for predicting sustained VA (area under the ROC curve: 0.73 vs 0.65; P < .001). Conclusion Cardiac MRI-derived biventricular GLS and ECV provided independent and incremental value for predicting sustained VA beyond ARVC risk score alone in patients with ARVC. Keywords: Cardiovascular MRI, Feature Tracking, T1 Mapping, Arrhythmogenic Right Ventricular Cardiomyopathy, Sustained Ventricular Arrhythmias Supplemental material is available for this article Published under a CC BY 4.0 license.

Predictive value of left ventricular global longitudinal peak strain for the prognosis of septic patients

To investigate the predictive value of left ventricular global longitudinal peak strain (GLPS) for the prognosis of septic patients. A prospective cohort study was conducted. Patients diagnosed with sepsis and admitted to the intensive care unit (ICU) of the First Affiliated Hospital, Sun Yat-sen University from December 2018 to November 2019 were enrolled. The patient characteristics, cardiac ultrasound parameters [left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), four-dimensional ejection fraction (4DEF), GLPS] and cardiac biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT)] within 24 hours of ICU admission, organ support therapies, severity of illness, and prognostic indicators were documented. The differences in clinical parameters between patients with varying outcomes during ICU hospitalization were assessed. Pearson correlation analysis was employed to explore the correlation between GLPS and other cardiac systolic parameters, as well as the associations between various cardiac systolic parameters and sequential organ failure assessment (SOFA) score. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive capacity of cardiac ultrasound parameters and cardiac biomarkers for death during ICU hospitalization in septic patients. A total of 50 septic patients were enrolled, with 40 surviving and 10 dying during ICU hospitalization, resulting in a mortality of 20.0%. All patients in the death group were male. Compared with the survival group, the patients in the death group were older, had a higher prevalence of diabetes mellitus, and received continuous renal replacement therapy (CRRT) more frequently, additionally, they exhibited more severe illness and had longer length of ICU stay. The levels of GLPS and cTnT in the death group were significantly elevated as compared with the survival group [GLPS: -7.1% (-8.5%, -7.0%) vs. -12.1% (-15.5%, -10.4%), cTnT (μg/L): 0.07 (0.05, 0.08) vs. 0.03 (0.02, 0.13), both P < 0.05]. However, no statistically significant difference was found in other cardiac ultrasound parameters or cardiac biomarkers between the two groups. Pearson correlation analysis revealed a negative correlation between GLPS and LVEF (r = -0.377, P = 0.014) and 4DEF (r = -0.697, P = 0.000), while no correlation was found with RVEF (r = -0.451, P = 0.069). GLPS demonstrated a positive correlation with SOFA score (r = 0.306, P = 0.033), while LVEF (r = 0.112, P = 0.481), RVEF (r = -0.134, P = 0.595), and 4DEF (r = -0.251, P = 0.259) showed no significant correlation with SOFA score. ROC curve analysis indicated that the area under the ROC curve (AUC) of GLPS for predicting death during ICU hospitalization in septic patients was higher than other cardiac systolic parameters, including LVEF, RVEF, and 4DEF, as well as cardiac biomarkers NT-proBNP and cTnT (0.737 vs. 0.628, 0.556, 0.659, 0.580 and 0.724). With an optimal cut-off value of -14.9% for GLPS, the sensitivity and negative predictive value reached to 100%. GLPS < -14.9% within 24 hours of ICU admission in septic patients indicated a reduced risk of death risk during ICU hospitalization, while also correlating with the severity of organ dysfunction in this patient population.

EARLY LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN DETERIORATION AFTER AORTIC ANEURYSM REPAIR IN HYPERTENSIVE PATIENTS: IMPACT OF AORTIC STIFFNESS

Objective: Invasive abdominal aortic aneurysm (AAA) replacement with an endograft interposes between the normal arterial tree which may acutely reduce overall systemic compliance. As a result, the input impedance is significantly increased, as are central systolic and pulse pressures. We evaluated changes in left ventricular global longitudinal peak strain (GLPS) in hypertensive patients undergoing repair of AAA in relation with the changes in arterial stiffness. Design and method: This was a single-center, nonrandomized, prospective, observational cohort study. Consecutive AAA hypertensive patients who underwent open or endovascular repair (EVAR) were enrolled. All patients were asymptomatic from their AAA and were admitted for elective treatment; there were no planned adjunctive procedures at the time of repair. A standard M-mode and 2-dimensional (2D) echocardiographic study was performed in all participants Left ventricular global longitudinal strain (GLS), and carotid-femoral pulse wave velocity (cf-PWV) were estimated 1 week preoperatively, as well as 1 and 6 months postoperatively. Left ventricular global longitudinal strain (GLS), and carotid-femoral pulse wave velocity (cf-PWV) were estimated 1 week preoperatively, as well as 1 and 6 months postoperatively. Results: A total of 70 men, mean age 70 ± 7 years, were evaluated. Of these, 58 underwent EVAR and 12 open repair. A significant time effect was found on cf-PWV, which showed an increase at 1 month and remained thereafter (p = 0.006). Additionally, a deterioration in GLS values was revealed, with a significant increase at 1 month that persisted 5 months later (p &lt; 0.001). No significant group effect was observed between EVAR and open repair (p = 0.98) and there was no significant interaction (p = 0.96). Notably, the difference of global longitudinal strain (DGLS) between baseline and 6 months significantly correlated with the corresponding changes in cf-PWV (r = 0.494, p &lt; 0.0001). Conclusions: AAA repair may have detrimental effects in cardiac systolic function. Our findings highlight the need a more intense cardiac surveillance program after aortic reconstruction. Further studies are needed to investigate how this may translate into long-term manifestations of cardiovascular complications and symptomatology.

Oxygen Uptake Efficiency Slope is Strongly Correlated to VO2peak Long-Term After Arterial Switch Operation

After the arterial switch operation (ASO) for transposition of the great arteries (TGA), many patients have an impaired exercise tolerance. Exercise tolerance is determined with cardiopulmonary exercise testing by peak oxygen uptake (VO2peak). Unlike VO2peak, the oxygen uptake efficiency slope (OUES) does not require a maximal effort for interpretation. The value of OUES has not been assessed in a large group of patients after ASO. The purpose of this study was to determine OUES and VO2peak, evaluate its interrelationship and assess whether exercise tolerance is related to ventricular function after ASO. A cardiopulmonary exercise testing, assessment of physical activity score and transthoracic echocardiography (fractional shortening and left/right ventricular global longitudinal peak strain) were performed to 48 patients after ASO. Median age at follow-up after ASO was 16.0 (IQR 13.0–18.0) years. Shortening fraction was normal (36 ± 6%). Left and right global longitudinal peak strain were reduced: 15.1 ± 2.4% and 19.5 ± 4.5%. This group of patients showed lower values for all cardiopulmonary exercise testing parameters compared to the reference values: mean VO2peak% 75% (95% CI 72–77) and mean OUES% 82(95% CI 77–87); without significant differences between subtypes of TGA. A strong-to-excellent correlation between the VO2peak and OUES was found (absolute values: R = 0.90, p < 0.001; normalized values: R = 0.79, p < 0.001). No correlation was found between cardiopulmonary exercise testing results and left ventricle function parameters. In conclusion, OUES and VO2peak were lower in patients after ASO compared to reference values but are strongly correlated, making OUES a valuable tool to use in this patient group when maximal effort is not achievable.

Left ventricular global longitudinal peak strain deterioration in patients undergoing endovascular repair of abdominal aortic aneurysms: the effect of arterial stiffness

Abstract Purpose Invasive abdominal aortic aneurysm (AAA) replacement with an endograft interposes between the normal arterial tree which may acutely reduce overall systemic compliance and increase the input impedance. We evaluated the impact of aortic reconstruction, using currently available grafts and endografts, on pulse wave velocity (pwv) and its effect on early cardiac systolic function indices in these patients. Methods A total of 73 men, mean age 70±8 years, were evaluated. Of these, 61 underwent endovascular repair (EVAR) and 12 open repair (OS). All patients underwent an assessment with a standard conventional transthoracic and a two-dimensional speckle tracking echocardiography at baseline, at 1 and 6 months after the intervention. Carotid - femoral (c-f) artery waveforms were measured and pwv was determined in all participants on each follow up visit. Results No significant changes in blood pressure were observed during the study period. Notably, our findings revealed a significant reduction in global longitudinal peak strain (GLPS) during the 6 months follow-up (from −19.7±−5.9% at baseline to −17.1±−5.9% at 6 months, p=0.03). C-r pwv showed a significant increase 6 months after the procedure (from 10.7±−2.9 m/sec at baseline to 13.9±3.3 m/sec at 6 months, p&amp;lt;0.001). A significant time effect was found on cf-pwv, which showed an increase at 1 month and remained thereafter (p=0.007). Additionally, a deterioration in GLS values was revealed, with a significant increase at 1 month that persisted 5 months later (p&amp;lt;0.001). No significant group effect was observed between EVAR and open repair (p=0.98) and there was no significant interaction (p=0.96). Notably, the difference of global longitudinal strain (ΔGLS) between baseline and 6 months significantly correlated with the corresponding changes in cf-pwv (r=0.494, p&amp;lt;0.0001). Conclusions AAA repair not only leads to an increase in aortic stiffness, as measured by the increase in pwv, but also reduces cardiac systolic function. Our findings highlight the need a more intense cardiac surveillance program after aortic reconstruction. Further studies are needed to investigate how this may translate into long-term manifestations of cardiovascular complications and symptomatology. Funding Acknowledgement Type of funding source: None

MicroRNA-208b gene expression levels as a biomarkers of left ventricular dysfunction in patients with acute myocarditis

Abstract Purpose MicroRNAs (miRs) play a major role in protein regulation by post-transcriptional gene expression and cell to cell interaction. Recently, they have been emerged as important modulators in cardiovascular development and disease. Our aim was to determine whether cardiac related miRs such as miR-208b was differentially expressed in peripheral blood mononuclear cells from patients with acute myocarditis. We also evaluated their expression levels in peripheral blood mononuclear cells in relation with left ventricular global longitudinal peak strain (GLPS) in those patients. Methods We assessed the expression levels of miR-208b in 55 patients with acute myocarditis (48 men, mean age 33±10 years) and 22 healthy individuals (18 men, mean age 33±9 years). Blood samples were taken on admission and miR expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. All patients were also underwent an assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography. Results GLPS was significantly reduced in the group of myocarditis compared to healthy individuals (from −13.9±10.9% versus −22.2±6.7%, p&amp;lt;0.05). Myocarditis patients showed significantly higher miR-208b (28.8±16.6 versus 6.40±1.1, p&amp;lt;0.001) expression levels compared to control group. miR-208b gene expression levels at baseline revealed a significant negative correlation with GLPS on admission (r=−0.51, p&amp;lt;0.05). This correlation was independent of the patients' clinical parameters. Conclusions Our data reveal that miR-208b gene expression levels are upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals. In addition, miR-208b levels have a prognostic value in the deterioration of left ventricular GLPS in those patients. Thus, miR-208b may represent a promising biomarkers in myocarditis or a potential therapeutic target in the future. Funding Acknowledgement Type of funding source: None

P5561MicroRNA-208b gene expression levels as a biomarkers of left ventricular dysfunction in patients with acute myocarditis

Abstract Purpose MicroRNAs (miRs) play a major role in protein regulation by post-transcriptional gene expression and cell to cell interaction. Recently, they have been emerged as important modulators in cardiovascular development and disease. Our aim was to determine whether cardiac related miRs such as miR-208b was differentially expressed in peripheral blood mononuclear cells from patients with acute myocarditis. We also evaluated their expression levels in peripheral blood mononuclear cells in relation with left ventricular global longitudinal peak strain (GLPS) in those patients. Methods We assessed the expression levels of miR-208b in 45 patients with acute myocarditis (38 men, mean age 31±10 years) and 22 healthy individuals (18 men, mean age 33±9 years). Blood samples were taken on admission and miR expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. All patients were also underwent an assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography. Results GLPS was significantly reduced in the group of myocarditis compared to healthy individuals (from −13.7 ± −7.9% versus −22.2±6.7%, p&lt;0.05). Myocarditis patients showed significantly higher miR-208b (28.5±6.6 versus 6.40±1.1, p&lt;0.001) expression levels compared to control group. miR-208b gene expression levels at baseline revealed a significant negative correlation with GLPS on admission (r=−0.51, p&lt;0.05). This correlation was independent of the patients' clinical parameters. Conclusions Our data reveal that miR-208b gene expression levels are upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals. In addition, miR-208b levels have a prognostic value in the deterioration of left ventricular GLPS in those patients. Thus, miR-208b may represent a promising biomarkers in myocarditis or a potential therapeutic target in the future.

ASSESSMENT OF MICRORNA-21 GENE EXPRESSION LEVELS IN RELATION WITH THE DETERIORATION OF LEFT VENTRICULAR STRAIN IN HYPERTENSIVE PATIENTS

Objective: MicroRNAs (miRs) modulate cardiovascular development and disease by post-transcriptional gene expression regulation and thus they are emerging as potential biomarkers and promising therapeutic targets in cardiovascular disease. miR-21 is found to play important roles in vascular smooth muscle cell proliferation and apoptosis, cardiac cell growth and death, and cardiac fibroblast functions.. We evaluated miR-21 gene expression levels in peripheral blood mononuclear cells in patients with essential hypertension in relation to left ventricular global longitudinal peak strain (GLPS). Design and method: We included 50 patients with newly diagnosed essential hypertension stage 1 and 2 (31 men, mean age 69.5 ± 11.8 years, mean systolic blood pressure (SBP) 167 ± 19 mmHg and mean diastolic blood pressure (DBP) 107 ± 11 mmHg). All patients underwent a serial assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography at baseline and at 24 months follow-up. miR-21 gene expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Results: Systolic and diastolic blood pressure was significantly reduced in the 12 months follow up under antihypertensive medication (SBP: from 167 ± 19 mmHg to 147 ± 15 mmHg and DBP: from 107 ± 11 mmHg to 95 ± 15 mmHg, p < 0.05 for both). GLPS showed a significant reduction during the 24 months follow-up (from −18.3 ± −4.9 % at baseline to −16.5 ± −6.9%, p = 0.04). miR-21 gene expression levels at baseline revealed a significant positive correlation with the reduction of GLPS (r = 0.52, p < 0.001). This correlation was independent of the patients’ clinical parameters Conclusions: Our data reveal that miR-21 might have a prognostic value in the deterioration of left ventricular GLPS in essential hypertension. In addition, it may be involved in the pathophysiology of in hypertensive heart disease and may be a promising therapeutic target.

Abstract WMP64: Global Longitudinal Peak Strain to Predict Atrial Fibrillation in Ischemic Stroke

Cerebral infarction due to atrial fibrillation is more severe and has a higher risk of death than other stroke subtypes. Anticoagulation reduces the risk of recurrence in patients with atrial fibrillation, and so it is crucial to find atrial fibrillation in stroke patients. In the present study, we investigated whether left atrial volume index (LAVI) and global longitudinal peak strain (GLPS) on speckle echocardiography could discriminate a high-risk group of atrial fibrillation in stroke patients. We prospectively enrolled 678 ischemic patients. Stroke subtypes were determined by the consensus of experienced neurologists, using a validated MRI-based algorithm. Left ventricular GLPS was measured averaging by speckle tracking imaging echocardiography from 4-chamber, 2-chamber, and the apical longitudinal long-axis view with breathing hold and an echocardiogram recording. To evaluate the predictability of LAVI and GLPS for the presence of atrial fibrillation, we used the optimism-corrected c-statistics and the net reclassification improvement with prespecified atrial fibrillation risk categories of low (10%), intermediate (10% to 30%), and high (≥30%). Patients with atrial fibrillation were likely to be older and to have more vascular risk factors. LAVI (74 ml/m 2 vs. 42 ml/m 2 ) and GLPS (-14% vs. -17%) were higher in patients with atrial fibrillation. Age (adjusted odds ratio 1.04, 95% confidence interval 1.02-1.07), LAVI (1.07, 1.06-1.09), and GLPS (1.08, 1.03-1.12) were independently associated with atrial fibrillation. As a base model, age and LAVI had a C-statistics of 0.89 (95% confidence interval 0.86 - 0.93). When GLPS levels were added to a base-model, net reclassification improvement was 6.1% (p = 0.03), albeit area under curve marginally improved (C-statistics = 0.90, 95% confidence interval 0.87 - 0.93, p = 0.058) compared to a base model. In patients with ischemic stroke, GLPS levels combined with LAVI were associated with the presence of atrial fibrillation. Our data imply that rigorous screening tests to detect atrial fibrillation may be warranted for the patients with high LAVI and GLPS levels.

P5490Changes of left ventricular global longitudinal peak strain in patients undergoing endovascular repair of abdominal aortic aneurysms: the effect of arterial stiffness

P5490Changes of left ventricular global longitudinal peak strain in patients undergoing endovascular repair of abdominal aortic aneurysms: the effect of arterial stiffness

P6051Associations of microRNAs gene expression and left ventricular global longitudinal peak strain in patients with essential hypertension

P6051Associations of microRNAs gene expression and left ventricular global longitudinal peak strain in patients with essential hypertension

Change in left ventricular global longitudinal peak strain for early diagnosis of high-risk coronary atherosclerotic heart disease in older adult patients: study protocol for a single-center diagnostic trial

Background and objective: Previous studies have demonstrated that tissue Doppler echocardiography and two-dimensional speckle tracking echocardiography are minimally invasive imaging methods used to screen for coronary atherosclerotic heart disease. However, they are not highly sensitive and specific for patients with suspected heart disease presenting with normal ventricular wall motion or for patients with early coronary heart disease. The newly emerging three-dimensional longitudinal strain imaging technology can overcome these shortcomings and has become a relatively mature technique for quantitative assessment of myocardial function. The left ventricular global longitudinal peak strain (LVGLPS) measured by three-dimensional longitudinal strain imaging technology contributes to early diagnosis of high-risk coronary atherosclerotic heart disease. Design: Single-center, open-label, diagnostic trial. Methods: Three hundred older adult patients with suspected coronary atherosclerotic heart disease receiving treatment from January 2013 to December 2017 at the Department of Ultrasound Medicine, Taihe Hospital of China, are being included in this study. These patients will be divided into three groups: low-risk group (n = 100; ≥ 70* diameter stenosis in one or two branches of the right main coronary artery and the left circumflex artery), high-risk group (n = 100; ≥ 50* diameter stenosis in the left main coronary artery or ≥ 70* diameter stenosis in the left anterior descending branch), and control group (n = 100; Outcome measures: The primary outcome measure is the sensitivity of the LVGLPS for prediction of coronary atherosclerotic heart disease. The secondary outcome measures are: (1) the specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy rate of the LVGLPS for prediction of coronary atherosclerotic heart disease; (2) change in the LVGLPS; (3) change in conventional echocardiography parameters; and (4) change in the receiver operating characteristic curve for prediction of high-risk coronary atherosclerotic heart disease using the LVGLPS. Discussion: The findings from this study will help to confirm that three-dimensional longitudinal strain imaging technology is highly sensitive and specific for patients with abnormal coronary arteries with suspected coronary heart disease but who present with normal ventricular wall motion. The change in the LVGLPS contributes to early diagnosis of high-risk coronary atherosclerotic heart disease in older adult patients. This helps clinicians to diagnose early coronary heart disease and take timely strategies to avoid serious cardiovascular events as much as possible. Ethics and dissemination: This study will be performed in accordance with the Declaration of Helsinki. All patients are informed of the study protocol and procedure and provide written informed consent. This trial was approved by Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) (approval number: ethics No. 2013(03)) in January 2013. Participant recruitment and data collection began in January 2013 and will continue through December 2017. Outcome measure analysis will be performed and the trial will be completed in January 2018. Results will be disseminated through presentations at scientific meetings and publications in peer-reviewed journals. Trial registration: This trial was registered with the Chinese the Clinical Trial Registry (registration number: ChiCTR-DDD-17012839).