Ventricular Wall Motion Research Articles

Percutaneous coronary intervention in patients with documented coronary vasospasm during long-term follow-up

ObjectiveAlthough recurring coronary artery spasm (CAS) may lead to the development of fixed atherosclerotic coronary stenosis (FS), the relationship between coronary atherosclerosis and CAS is still speculative. We evaluated the...

Temporospatial characterization of ventricular wall motion with real-time cardiac magnetic resonance imaging in health and disease

Cardiac magnetic resonance imaging (MRI) has been largely dependent on retrospective cine for data acquisition. Real-time imaging, although inferior in image quality to retrospective cine, is more informative about motion dynamics. We herein developed a real-time cardiac MRI approach to temporospatial characterization of left ventricle (LV) and right ventricle (RV) wall motion. This approach provided two temporospatial indices, temporal periodicity and spatial coherence, for quantitative assessment of ventricular function. In a cardiac MRI study, we prospectively investigated temporospatial characterization in reference to standard volumetric measurements with retrospective cine. The temporospatial indices were found to be effective for evaluating the difference of ventricular performance between the healthy volunteers and the heart failure (HF) patients (LV temporal periodicity 0.24 ± 0.037 vs. 0.14 ± 0.021; RV temporal periodicity 0.18 ± 0.030 vs. 0.10 ± 0.014; LV spatial coherence 0.52 ± 0.039 vs. 0.38 ± 0.040; RV spatial coherence 0.50 ± 0.036 vs. 0.35 ± 0.035; all in arbitrary unit). The HF patients and healthy volunteers were well differentiated in the scatter plots of spatial coherence and temporal periodicity while they were mixed in those of end-systolic volume (ESV) and ejection fraction (EF) from volumetric measurements. This study demonstrated the potential of real-time cardiac MRI for intricate analysis of ventricular function beyond retrospective cine.

Cardioprotective Role of Estrogen in Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TC) is a rare, reversible cause of left ventricular wall motion abnormality (LVWMA) that mimics the presentation of acute myocardial infarction (AMI). TC is usually preceded by an emotional or physical stressor and appears to be more common in postmenopausal women. Various pathophysiological hypotheses of TC have been proposed, but the exact mechanism of action remains elusive. Elevated levels of catecholamines leading to cardiac dysfunction are the most prevalent hypothesis. The protective role of estrogen in the development of cardiomyopathies has been studied extensively. International Takotsubo Diagnostic Criteria (InterTAK) and Mayo clinic diagnostic criteria both have the stipulation stating prevalence of TC is higher in postmenopausal women which hints towards the protective role of estrogen in the development of TC. To review the protective role of estrogen in the mechanism of this novel pathology, we searched Pubmed and Google scholar for the relevant articles by using keywords such as: “takotsubo cardiomyopathy”, “apical ballooning”, “broken heart syndrome”, “stress cardiomyopathy”, “left ventricle wall motion abnormality”, “estrogen”, “estradiol” and “sex hormones”. Our research revealed that although the prevalence of TC is greater in postmenopausal women as compared to men, the prognosis is worse in men. It also revealed the involvement of multiple cellular pathways under the influence of estrogen that could explain the cardioprotective effect of estrogen. Most of the articles found were based on animal studies, thus, there is an emphasis on future human studies. However, we strongly suggest evaluating estrogen levels as part of the initial workup for any patient presenting with signs and symptoms of cardiac pathology.

Four-dimensional computed tomography of the left ventricle, Part II: Estimation of mechanical activation times.

We demonstrate the viability of a four-dimensional X-ray computed tomography (4DCT) imaging system to accurately and precisely estimate mechanical activation times of left ventricular (LV) wall motion. Accurate and reproducible timing estimates of LV wall motion may be beneficial in the successful planning and management of cardiac resynchronization therapy (CRT). We developed an anthropomorphically accurate in silico LV phantom based on human CT images with programmed septal-lateral wall dyssynchrony. Twenty-six temporal phases of the in silico phantom were used to sample the cardiac cycle of 1 s. For each of the 26 phases, 1cm thick axial slabs emulating axial CT image volumes were extracted, 3D printed, and imaged using a commercially available CT scanner. A continuous dynamic sinogram was synthesized by blending sinograms from these static phases; the synthesized sinogram emulated the sinogram that would be acquired under true continuous phantom motion. Using the synthesized dynamic sinogram, images were reconstructed at 70ms intervals spanning the full cardiac cycle; these images exhibited expected motion artifact characteristics seen in images reconstructed from real dynamic data. The motion corrupted images were then processed with a novel motion correction algorithm (ResyncCT) to yield motion corrected images. Five pairs of motion uncorrected and motion corrected images were generated, each corresponding to a different starting gantry angle (0 to 180 degrees in 45 degree increments). Two line profiles perpendicular to the endocardial surface were used to sample local myocardial motion trajectories at the septum and the lateral wall. The mechanical activation time of wall motion was defined as the time at which the endocardial boundary crossed a fixed position defined on either of the two line profiles while moving toward the center of the LV during systolic contraction. The mechanical activation times of these myocardial trajectories estimated from the motion uncorrected and the motion corrected images were then compared with those derived from the static images of the 3D printed phantoms (ground truth). The precision of the timing estimates was obtained from the five different starting gantry angle simulations. The range of estimated mechanical activation times observed across all starting gantry angles was significantly larger for the motion uncorrected images than for the motion corrected images (lateral wall: 58±15ms vs 12±4ms, p<0.005; septal wall: 61±13ms vs 13±9ms, p<0.005). 4DCT images processed with the ResyncCT motion correction algorithm yield estimates of mechanical activation times of LV wall motion with significantly improved accuracy and precision. The promising results reported in this study highlight the potential utility of 4DCT in estimating the timing of mechanical events of interest for CRT guidance.

Color kinesis-dobutamine stress echocardiography pinpoints coronary artery disease

Background/Aim: Dobutamine stress echocardiography (DSE) can identify significant coronary artery disease (CAD) and where it is localized. However, determining endocardial borders with poor echocardiographic views may create unsatisfactory results. Color kinesis (CK) shows endocardial movement with color, and allows easier and more objective evaluation of ventricular wall motion. In this study, our aim was to evaluate the role of CK in determining CAD localization during DSE. Methods: The study group consists of patients whose CAD diagnosis was confirmed with coronary angiography (CA). Patients with atrial fibrillation (A-Fib), left bundle branch block, poor echocardiography image quality, left ventricular (LV) ejection fraction < 40%, and non-ischemic LV wall motion abnormality were excluded. CK-DSE and dobutamine stress-induced myocardial perfusion scintigraphy (MPS) was done in all patients and compared to CA. Results: A total of twenty patients [16 males (80%) and 4 females (20%)] were included in the study. CK-DSE results were consistent with CA in determining CAD localization (kappa 0.66). Vessel-based kappa values for LAD, RCA, and Cx were 0.81, 0.70 and 0.61, respectively. Consistency between MPS and CK-DSE was evaluated by the area under curves (AUC) within a ROC curve analysis (p > 0.05, 95% CI). Conclusion: Our study showed that CK allows for rapid, objective, and automatic evaluation of segmental wall motion. In addition, CK-DSE is consistent with CA results.

Stress and the baroreflex.

The stress response to emotions elicits the release of glucocorticoids from the adrenal cortex, epinephrine from the adrenal medulla, and norepinephrine from the sympathetic nerves. The baroreflex adapts to buffer these responses to ensure that perfusion to the organs meets the demands while maintaining blood pressure within a within a narrow range. While stressor-evoked autonomic cardiovascular responses may be adaptive for the short-term, the recurrent exaggerated cardiovascular stress reactions can be maladaptive in the long-term. Prolonged stress or loss of the baroreflex's buffering capacity can predispose episodes of heightened sympathetic activity during stress leading to hypertension, tachycardia, and ventricular wall motion abnormalities. This review discusses 1) how the baroreflex responds to acute and chronic stressors, 2) how lesions in the neuronal pathways of the baroreflex alter the ability to respond or counteract the stress response, and 3) the techniques to assess baroreflex sensitivity and stress responses. Evidence suggests that loss of baroreflex sensitivity may predispose heightened autonomic responses to stress and at least in part explain the association between stress, mortality and cardiovascular diseases.

Takotsubo Syndrome: Translational Implications and Pathomechanisms.

Takotsubo syndrome (TTS) is identified as an acute severe ventricular systolic dysfunction, which is usually characterized by reversible and transient akinesia of walls of the ventricle in the absence of a significant obstructive coronary artery disease (CAD). Patients present with chest pain, ST-segment elevation or ischemia signs on ECG and increased troponin, similar to myocardial infarction. Currently, the known mechanisms associated with the development of TTS include elevated levels of circulating plasma catecholamines and their metabolites, coronary microvascular dysfunction, sympathetic hyperexcitability, inflammation, estrogen deficiency, spasm of the epicardial coronary vessels, genetic predisposition and thyroidal dysfunction. However, the real etiologic link remains unclear and seems to be multifactorial. Currently, the elusive pathogenesis of TTS and the lack of optimal treatment leads to the necessity of the application of experimental models or platforms for studying TTS. Excessive catecholamines can cause weakened ventricular wall motion at the apex and increased basal motion due to the apicobasal adrenoceptor gradient. The use of beta-blockers does not seem to impact the outcome of TTS patients, suggesting that signaling other than the beta-adrenoceptor-associated pathway is also involved and that the pathogenesis may be more complex than it was expected. Herein, we review the pathophysiological mechanisms related to TTS; preclinical TTS models and platforms such as animal models, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) models and their usefulness for TTS studies, including exploring and improving the understanding of the pathomechanism of the disease. This might be helpful to provide novel insights on the exact pathophysiological mechanisms and may offer more information for experimental and clinical research on TTS.

A Postoperative Octopus Trap: Reverse Stress Cardiomyopathy

Takotsubo cardiomyopathy (TTC) is a generally reversible syndrome of acute cardiac failure usually triggered by a physical or emotional stressor, with unique left ventricular (LV) wall motion abnormalities and no association with obstructive coronary artery disease.1-3 The presentation mimics acute coronary syndrome with chest pain or dyspnea and abnormal electrocardiogram (ECG) and cardiac injury markers. We present a case of reverse (or inverted) Takotsubo cardiomyopathy (rTTC) following kidney transplantation in a 69-year-old woman.

Fully automated quantification of LV regional wall motion from echocardiograms to detect myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Ultromics Ltd Background Myocardial wall motion analysis from echocardiography allows precise assessment of cardiac contractile function. Strain, which assesses myocardial deformation, has been shown to enable earlier detection of myocardial disease [1]. Current analysis software packages [2] use semi-automated methods to compute strain, which frequently require manual endocardial delineation and iterative contour adjustment based on tracking results, respectively, causing significant variability. Purpose We present a fully automated pipeline for tracking left ventricular (LV) wall motion to quantify global and segmental longitudinal strain from 2D echocardiograms, and go on to validate the pipeline with an openly available myocardial infarction (MI) dataset. Methods We applied our existing deep learning-based automated contouring method [3] to delineate the endocardial border in the A4C, A2C and A3C views and combined this with spline-based elastic image registration to track LV motion through time. We sampled points from a region of interest initiated from the endocardial border at the end-diastolic (ED) frame, and tracked subsequent motion by recomputing updated positions of all sample points based on each frame‘s displacement field, enabling us to both track the myocardium throughout the cardiac cycle and calculate longitudinal strain relative to the ED frame. The automated endocardial contour was used to regularise the process. The pipeline was independently tested on the HMC-QU dataset [4] which was downloaded from Kaggle and consists of a single cardiac cycle from the A4C view from 160 patients who were diagnosed with an acute MI and underwent echocardiography either prior to percutaneous coronary intervention or within 24 hours of undergoing the procedure; the dataset includes the labels of ED and end-systolic (ES) frames, as well as the presence of an MI in 6 segments excluding the apical cap (Fig 1a), as determined by the consensus of cardiologists from HMC Hospital in Qatar. The Wilcoxon signed-rank test was used to compare peak strain between the MI and non-MI segments; ROC curves were computed to compare the performance of the automatically derived peak longitudinal strain against the MI labels. Results Fig 1b shows ROC curves of peak segmental longitudinal strain for detecting MI, with the best performance in the mid-anterolateral segment (AUC 0.84), and a lower performance for basal segments than mid and apical segments, consistent with known variation in clinical practice [5]. Fig 2 shows that peak longitudinal strain computed from our pipeline was statistically significantly more positive in segments with an MI. Conclusions We present a fully automated pipeline for calculating segmental strain across a cardiac cycle to identify infarcted segments without any observer variability. Clinical application of this method has the potential to identify and monitor regional myocardial function and benefit patient management. Abstract Figure. Fig1. ROC of peak longitudinal strains Abstract Figure. Fig2.Boxplot of peak longitudinal strain

Abstract WP222: Outcome Of ESUS With Possible Embolic Sources.

Background and Purpose: Our aim is to investigate the factors of outcome in ESUS with possible embolic source (PES) caused by non-high risk cardiac sources, malignancy, and mild atherosclerosis. Methods: Patients were selected from a comprehensive stroke center between April 2013 and April 2021. Inclusion criteria were: 1) consecutive ischemic stroke patients who fulfilled ESUS criteria based on NAVIGATE-ESUS trial, 2) who underwent TEE 3) who admitted our hospital within 7 days from stroke onset 4) pre stroke modified Rankin scale (mRS) score below 1 and 5) available mRS score at 3 months from stroke onset. PES included atrial cardiopathy (large left atrium diameter, slow out flow in left atrium appendage, and frequent premature atrium contraction), left ventricular dysfunction (history of heart failure, abnormal ventricular wall motion, and reduced ejection fraction), cardiac valve disease, right-to-left shunt, malignancy, and atherosclerosis (ipsilateral carotid plaque and aortic complicated lesion). We compared PES, between mRS score 0-1 (favorable outcome group) and mRS score 2-6 (unfavorable outcome group). Results: We screened 1,824 consecutive ischemic stroke patients, including 191 in ESUS patients. 159 (83%) patients were ESUS with PES. Of all, 33 patients had unfavorable outcomes (25 [76%] male, median age 64 years old, Figure A). Higher National Institute of Health Stroke Scale score on admission (OR 4.50, 95%CI 1.96-10.30, p &lt;0.001) and higher frequency of atherosclerosis (OR 2.67, 95%CI 1.11-6.44, p =0.028) were independently associated with unfavorable outcome (Figure B). Conclusions: Atherothrombotic emboli may contribute to outcome of ESUS with PES.

Refractory electrical storm in coronary artery disease patient, challenges of dying heart

Electrical storm most often occurs in patients with coronary artery disease and left ventricular dysfunction. We report a case of recurrent ventricular Tachycardia (VT) in a 49-year-old male patient previously known to have an inferior myocardial infarction and hypertension, presented with ischemic chest pain accompanied by dizziness, hypotension, and tachycardia. An electrocardiogram showed monomorphic VT. A prompt synchronized electrical cardioversion under sedation has reverted the rhythm to the sinus. An echocardiogram showed left ventricular segmental wall motion abnormalities and ejection fraction of 37%. Then the condition complicated by recurrent VT necessitates multiple electrical cardioversions and defibrillation given for recurrent ventricular Fibrillation (VF) and short cardiopulmonary resuscitations that revived the patient from cardiac arrests. The patient had received a total of 103 electrical shocks over 15 days during which, he developed circulatory and respiratory compromise that required mechanical ventilation on twice occasions. Meticulous care including central monitoring and inotrope for hypotensive episodes was provided. A coronary angiogram showed normal left anterior descending and circumflex coronary arteries and a totally occluded right coronary artery which was failed to be revascularized in an attempt of angioplasty. The patient was successfully weaned off the ventilator and run a quiet course afterward. An implantable cardioverter-defibrillator was placed while maintained on oral amiodarone, mexiletine, metoprolol, and omega-3-acid ethyl esters, then discharged asymptomatic without recorded dysrhythmias. This case report underscores the challenges encountered throughout the management of such particular life-threatening ventricular arrhythmias and their impact on patient safety.

Intracoronary pressures to predict myocardial viability in patients with ischemic left ventricular dysfunction.

To investigate the role of intracoronary pressure parameters in the assessment of viability in the myocardium subtending a significant coronary stenosis. In patients with ischemic left ventricular dysfunction, the presence of myocardial viability is related to the expected benefits derived from coronary revascularization. Intracoronary pressure wire-based measurements were performed in 64 coronary lesions of ≥50% stenosis severity of 59 patients with postischemic left ventricular dysfunction, segmental left ventricular wall motion abnormalities, and substantial viability in the myocardial territory subtending the investigated stenotic coronaries, defined as the percent summed rest score in the target territory (%SRStarget ) ≤60% at the single-photon emission tomography. Invasive pressure-derived indexes like resting and hyperemic Pd/Pa, ΔPd/Pa, and %ΔPd/Pa (defined as the absolute difference and percent decrease between resting and hyperemic Pd/Pa respectively) were compared with %SRStarget . A significant correlation was found between ΔPd/Pa (Spearman's p: -0.760, p < 0.001) and %ΔPd/Pa (p: -0.733; p < 0.001) with %SRStarget. These results were confirmed after correction for potential confounders. According to %SRStarget median value, myocardial areas with high and low viability were compared: ΔPd/Pa and %ΔPd/Pa were significantly higher in areas with high viability (p < 0.001 for both). According to receiver operating characteristic curves, we identified two cut-offs (ΔPd/Pa > 0.11 and %ΔPd/Pa > 15%) able to predict >80% viability with good sensitivity and specificity. Our study suggests that, in patients with postischemic left ventricular dysfunction and significant coronary stenosis, intracoronary pressures indexes like ΔPd/Pa and %ΔPd/Pa are able to predict the magnitude of downstream myocardial viability.

Optical Flow Analysis of Left Ventricle Wall Motion with Real-Time Cardiac Magnetic Resonance Imaging in Healthy Subjects and Heart Failure Patients.

In cardiology, magnetic resonance imaging (MRI) provides a clinical standard for measuring ventricular volumes. Owing to their reliability, volumetric measurements with cardiac MRI have become an essential tool for quantitative assessment of ventricular function. However, as volumetric indices are indirectly related to myocardial motion that drives ventricular filling and ejection, cardiac MRI cannot provide comprehensive evaluation of ventricular performance. To overcome this limitation, the presented work sought to measure ventricular wall motion directly with optical flow analysis of real-time cardiac MRI. By modeling left ventricle (LV) walls in real-time images based on myocardial architecture, we developed an optical flow approach to analyzing LV radial and circumferential wall motion for improved quantitative assessment of ventricular function. For proof-of-concept, a cardiac MRI study was conducted with healthy volunteers and heart failure (HF) patients. It was found that, as real-time images provided sufficient temporal information for correlation analysis between different LV wall motion velocity components, optical flow assessment detected the difference of ventricular performance between the HF patients and the healthy volunteers more effectively than volumetric measurements. We expect that this model-based optical flow assessment with real-time cardiac MRI would offer intricate analysis of ventricular function beyond conventional volumetric measurements.

A prospective observational study of electrocardiographic and echocardiographic changes in traumatic brain injury – effect of surgical decompression

Background Traumatic brain injury (TBI) causes significant changes in myocardial function, which is represented by ECG and echocardiographic changes. We intended to study the effect of surgical decompression on these changes. Materials and methods We recruited adult TBI patients undergoing surgery within 48 h of injury. Preoperatively, the patient’s demographic and clinical details were recorded. ECG and TTE were performed before surgery and 24 h later (first postoperative day [POD1]). ECG was analyzed for heart rate, PR, QRS, and QTc intervals, morphologic end-repolarization abnormalities (MERA), and ST-segment and T wave changes. TTE data included left ventricular ejection fraction (LVEF) and regional wall motion abnormalities (RWMA). Glasgow coma scale (GCS) at discharge was recorded. ECG and TTE changes before and after surgery were compared, and its association with discharge GCS was analyzed. Preoperative predictors of LV dysfunction were analyzed. Results Of the 110 patients recruited, common ECG changes were prolonged QTc interval (42%) and MERA (47%). TTE showed poor LVEF (<50%) in 10% and RWMA in 10.8% of patients. Following surgery, both ECG and TTE changes improved. Preoperative LVEF <50% and/or RWMA were associated with a lower GCS score at discharge. Preoperative poor GCS motor score and prolonged QTc interval were independent predictors of LV dysfunction. Conclusions Poor LV function was associated with poor admission GCS and prolonged QTc interval. Patients with reduced LV function had lower GCS at discharge.

Regional myocardial sympathetic denervation precedes the development of left ventricular systolic dysfunction in chronic Chagas’ cardiomyopathy

BackgroundRegional myocardial sympathetic denervation is a conspicuous and early disorder in patients with chronic Chagas’ cardiomyopathy (CCC), potentially associated to the progression of myocardial dysfunction ObjectiveTo evaluate in a longitudinal study the association between the presence and the progression of regional myocardial sympathetic denervation with the deterioration of global and segmental left ventricular dysfunction in CCC. Methods18 patients with CCC were submitted at initial evaluation and after 5.5 years to rest myocardial scintigraphy with 123Iodo-metaiodobenzylguanidine and 99mTc-sestamibi and to two-dimensional echocardiography to assess myocardial sympathetic denervation, extent of fibrosis, and the left ventricular ejection fraction (LVEF) and wall motion abnormalities. ResultsIn the follow-up evaluation, compared to the initial one, we observed a significant decrease in LVEF (56 ± 11 to 49% ± 12; P = .01) and increased summed defects scores in the myocardial innervation scintigraphy (15 ± 10 to 20 ± 9; P < .01). The presence of regional myocardial sympathetic denervation in ventricular regions of viable non-fibrotic myocardium presented an odds ratio of 4.25 for the development of new wall motion abnormalities (P = .001). ConclusionRegional and global myocardial sympathetic denervation is a progressive derangement in CCC. In addition, the regional denervation is topographically associated with areas of future development of regional systolic dysfunction in patients with CCC.

Assessment of Left Ventricular Function and Regional Wall Motion by 256-Slice Dual-Source Coronary CT Angiography: A Comparison With 2D Transthoracic Echocardiography

Assessment of Left Ventricular Function and Regional Wall Motion by 256-Slice Dual-Source Coronary CT Angiography: A Comparison With 2D Transthoracic Echocardiography

Baseline Myocardial Work on Echocardiography Reflects the Severity of Coronary Disease in Patients Presenting with Acute Coronary Syndrome

The aim of the study is to establish a relationship between baseline myocardial work (MW) assessed by echocardiography and the extent of coronary artery disease (CAD) using SYNTAX score in patients presenting with acute coronary syndrome (ACS) who underwent coronary angiography (CA). SYNTAX score from CA has proven to be a clinically useful anatomical scoring system to assess the burden and complexity of coronary artery disease (CAD). MW is a novel non-invasive measure of cardiac function using echocardiography. Other parameters of cardiac function, such as left ventricular ejection fraction (LVEF) and wall motion score index (WMSI), were also assessed. In this retrospective study, consecutive patients with ACS underwent echocardiography at the presentation to a large, tertiary hospital emergency department from March 2019 to April 2020 were included and analysed. There were 94 patients recruited to the study; age ± 12 years, 62% male. Median Syntax score was 12 (IQR 7–19). All echocardiographic parameters correlated with SYNTAX score. While GLS and MW showed a strong relationship with SYNTAX score (GLS r=0.33, p<0.01; GWW r=0.29, p<0.01; GWE r=0.31, p<0.01), WMSI, a standard assessment in assessing the extent of coronary disease, was a less significant predictor for the complexity of CAD (r=0.22, p=0.03). Baseline assessment of myocardial work correlates better with the extent of coronary disease than standard measures. This assessment may have a role in assisting with the type and timing of coronary intervention in patients presenting with acute coronary syndrome.

An Atlas-Based Analysis of Biventricular Mechanics in Tetralogy of Fallot.

The current study proposes an efficient strategy for exploiting the statistical power of cardiac atlases to investigate whether clinically significant variations in ventricular shape are sufficient to explain corresponding differences in ventricular wall motion directly, or if they are indirect markers of altered myocardial mechanical properties. This study was conducted in a cohort of patients with repaired tetralogy of Fallot (rTOF) that face long-term right ventricular (RV) and/or left ventricular (LV) dysfunction as a consequence of adverse remodeling. Features of biventricular end-diastolic (ED) shape associated with RV apical dilation, LV dilation, RV basal bulging, and LV conicity correlated with components of systolic wall motion (SWM) that contribute most to differences in global systolic function. A finite element analysis of systolic biventricular mechanics was employed to assess the effect of perturbations in these ED shape modes on corresponding components of SWM. Perturbations to ED shape modes and myocardial contractility explained observed variation in SWM to varying degrees. In some cases, shape markers were partial determinants of systolic function and, in other cases, they were indirect markers for altered myocardial mechanical properties. Patients with rTOF may benefit from an atlas-based analysis of biventricular mechanics to improve prognosis and gain mechanistic insight into underlying myocardial pathophysiology.

Incremental value of global longitudinal strain to predict stress echocardiography positivity in asymptomatic diabetic patients

French guideline recently added the presence of an “abnormal left ventricle” on transthoracic echocardiography (TTE) to define very high-risk diabetic patients who may benefit from silent coronary artery disease (CAD) screening. We aimed to investigate the incremental value of resting Global Longitudinal Strain (GLS) in predicting stress TTE positivity in asymptomatic patients with diabetes mellitus (DM). Consecutive asymptomatic patients with DM referred for screening for silent CAD by stress TTE (effort of dobutamine) between January 2017 and December 2018 were included ( n = 273). Stress test positivity was defined as stress-induced new or worsening of preexisting left ventricular wall motion abnormalities. Patients with a positive stress test ( n = 28; 10%) were more likely to be smokers (71% vs. 17%), to have known diabetes for more than 10 years, carotid atheroma, diabetic nephropathy, diabetic retinopathy (57.1% vs. 18.0%), moderate or severe aortic or mitral calcifications and a lower GLS (−16.7 ± 2.9 vs. −18.9 ± 2.2%) than those with a negative test (all P ≤ 0.014). On multivariate logistic regression analysis, a DM duration > 10 years, diabetic retinopathy and lower GLS (OR [95% CI] = 0.76 [0.64–0.93] per % decrease) remained independently associated with a positive stress TTE. The Chi 2 of the model was significantly improved by the addition of GLS on top of the baseline clinical variables, repolarization abnormalities and DM related complications (Chi 2 56.9 to 73.8; P < 0.001) ( Table 1 , Fig. 1 ). Screening CAD in asymptomatic patients with DM is challenging and debated. In this context, it is crucial to identify early markers of CAD in this population. Our study shows that GLS is strongly associated with the presence of silent ischemia and could be one of these new parameters to be routinely assessed in this population.

609 Prognostic role of renal function in patients with previous myocardial infarction. A study with cardiac magnetic resonance

Abstract Aims There is not strong evidence in literature about the impact of renal function on the prognosis of patients with ischaemic cardiomyopathy. Thus, the aim of the study was to investigate mild renal impairment [estimated glomerular filtration rate (eGFR): 60–89 ml/min] as an independent prognostic factor in patients with history of myocardial infarction (MI). Methods and results We studied 339 consecutive patients (65 ± 13 years old, female 13%) from 2001 and 2012 with previous MI. Patients with eGFR &amp;lt;60 ml/min were excluded. We performed cardiac magnetic resonance (CMR) in all patients to quantify left ventricular ejection fraction (LVEF), volumes, and wall motion score index (WMSI), and to measure the infarction extent by late gadolinium enhancement (LGE). Renal function was estimated by creatinine value with Cockcroft–Gault formula and patients were divided according to normal (≥90 ml/min) and reduced (60–89 ml/min) eGFR. Patients with normal eGFR were 106 (31%, 56.9 ± 10.5 years old), 233 (69%, 66.1 ± 9.9 years old) had renal impairment. During follow-up (median 3.5 years), cardiac events (cardiac death or appropriate intra-cardiac defibrillator shock) occurred in 28/233 (12%) of patients with eGFR &amp;lt;90 ml/min and in 4/106 (4%) of patients with eGFR ≥90 ml/min (P &amp;lt; 0.05). Furthermore, survival curve showed a significantly worst prognosis in patients with renal impairment (P &amp;lt; 0.03). In the group of patients with ejection fraction (EF) &amp;lt; 35% (121 patients), cardiac events were observed only in patients with eGFR &amp;lt;90 ml/min (23/99, 23%, P &amp;lt; 0.05). At multivariate stepwise analysis, age &amp;gt;65 years old, eGFR &amp;lt;90 ml/min and WMSI &amp;gt;1.7 turned out to be independent predictor of cardiac events (P &amp;lt; 0.05). Conclusions In patients with previous MI, a mild renal impairment (eGFR between 60 and 89 ml/min) was an independent predictor of prognosis, especially if combined with left ventricular disfunction.