424 Left ventricular function after correction of a proportionate mitral regurgitation: impact of the clipping approach

Abstract Aims : Secondary mitral regurgitation (MR) is associated with poor outcome in systolic heart failure (HF-)patients. Percutaneous edge-to-edge mitral valve repair (PMVR) recently failed to prove any beneficial effect over optimal medical treatment (OMT). Nevertheless, little is known about the effect of PMVR on LV performance and mechanics in HF-patients with severe secondary MR. Method and results Thirty-seven patients with severe secondary MR treated by PMVR were included and compared (according to indices of LV myocardial function) to nineteen patients with treated by OMT. Both groups were clinically comparable. At 6-month follow-up, only LV constructive work improve significantly in both groups (977 vs 1101 mmHg.%, p =0,003, 967 vs 1110 mmHg.%, p = 0,002 for PMVR and OMT groups, respectively) whereas left ventricular (LV) end-systolic volume index, LV ejection fraction and global longitudinal strain were not different. Compared to MITRA-FR and COAPT studies, our population had a proportionate MR (blue point in Figure 1, panel A). Figure 1-panel B demonstrate that only five patients of PMVR group had disproportionate MR (red points). Interestingly, these patients hadn’t any major event during 6 months FU. Conclusion Echocardiographic characteristics at 6-month follow-up are not different when compare PMVR and OMT for HF- patients with a severe proportionate secondary MR. Main echocardiographic characteristics PMVR OMT Inclusion 6-month p Inclusion 6-month p NYHA 2.6 ± 0.6* 1.8 ± 0.7* <0.0001 2.3 ± 0.5* 2.2 ± 0.4* 0.43 LVESVi(ml.m-2) 76 ± 36 75 ± 35 0.6 94 ± 32 90 ± 31 0.35 LVEF (%) 33 ± 6 33 ± 13 0.78 30 ± 8 31 ± 8 0.53 GLS (%) -9.8 ± 4 -9.9 ± 3.9 0.84 -10.0 ± 4 -10.3 ± 3.3 0.62 MR grade 3.4 ± 0.5 1.3 ± 1.0* <0.0001 3.5 ± 0.5 2.8 ± 1.1* 0.007 Global work index (mmHg.%) 831 ± 370 933 ± 406 0.07 875 ± 314 939 ± 304 0.14 Constructive work (mmHg.%) 977 ± 366 1101 ± 404 0.003 967 ± 290 1110 ± 349 0.002 *symbols denote p < 0.05 between both groups Abstract 424 Figure.

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Comparison of two methods to predict CRT-response

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.019 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Hubert ◽

A Galard ◽

V Le Rolle ◽

E Galli ◽

A Hernandez ◽

...

Keyword(s):

Global Longitudinal Strain ◽

Left Ventricular Pressure ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Systolic Volume ◽

Pressure Estimation ◽

Crt Response

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital university of Rennes INSERM - LTSI Background Non-invasive estimation of myocardial work by trans-thoracic echocardiography is a novel tool to analyze myocardial contraction efficiency during systole. Two methods are described, on using Left ventricular (LV) strain and a LV pressure estimation, and another with only LV strain integrals. The present study analyzes their utility in prediction of CRT-response. Methods and results: 243 patients implanted by a CRT according to current recommendations were retrospectively included in hospital university of Rennes. All patients had a complete trans-thoracic echocardiography at implantation and at 6-moths follow-up. Responders were defined as having a 15% decrease in indexed LV end-systolic volume at follow-up compared to baseline. Baseline characteristics are described in table 1. 25.1% were non-responders. In this group, there were more men, more ischemic cardiomyopathies with more dilated LV. Strain signals ware analyzed only in the most informative loop, the apical 4 cavities. Myocardial work estimation with LV pressure estimation was previously described. The 3 different integral of strain signal were represented in figure 1. According to ROC curves, myocardial work (particularly wasted work in septal wall with AUC = 0.718 ± 0.04) estimated with LV pressure estimation is better than strain integrals to predict LV positive remodeling (best AUC 0.631 ± 0.040) after CRT-implantation. Conclusion Left ventricular pressure estimation give useful information on top of strain curves for prediction for CRT-response. Table 1 Responders n = 182 Non-responders n = 61 Men (%) 109 (59.9%) 52 (85%) Ischemic cardiomyopathy (%) 42 (23.1%) 34 (55.7%) LVEF (%) 28 ± 6 28 ± 7 GLS (%) -9 ± 3 -7 ± 3 LVEDD (mm) 62 ± 8 67 ± 7 LVEDVi (ml/m2) 85 ± 34 88 ± 30 LVEF Left ventricular ejection fraction; GLS: global longitudinal strain; LVEDD: left ventricular end-diastolic diameter; LVEDVi: left ventricular end diastolic volume index Abstract Figure 1

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Left ventricular myocardial work in patients with secondary mitral regurgitation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1902 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I Yedidya ◽

R.P Lustosa ◽

F Fortuni ◽

P Van Der Bijl ◽

F Namazi ◽

...

Keyword(s):

Mitral Regurgitation ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Blood Pressure Measurement ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Lv Function ◽

Work Efficiency ◽

Constructive Work ◽

Secondary Mitral Regurgitation

Abstract Background Assessment of left ventricular (LV) function in patients with secondary mitral regurgitation (SMR) remains challenging because LV ejection fraction (LVEF) reflects changes in LV volume without taking into account the direction of the blood flow. LV global longitudinal strain better reflects active LV myocardial deformation but does not incorporate afterload. LV myocardial work derived from pressure-strain loops integrates speckle tracking echocardiography with non-invasive blood pressure measurement. Purpose To evaluate LV myocardial work components to better characterize LV function in patients with SMR. Methods 378 patients (72% men, median age 68 [range 60 to 74 years]) with various grades of SMR were retrospectively analysed. LV myocardial constructive work, wasted work and work efficiency were measured with speckle tracking echocardiography. Results 145 patients had mild SMR, 130 moderate SMR and 103 severe SMR. Patients with severe SMR had larger LV volumes, lower LVEF and more impaired LV GLS (Table 1). While LV constructive work was more impaired in patients with severe SMR, wasted work was lower as compared to mild SMR (Table 1). Consequently, patients with severe SMR had better myocardial work efficiency than patients with mild MR. This could reflect, the regurgitant volume which is pumped into a low pressure chamber (the left atrium) resulting in less myocardial wasted work and preservation of myocardial efficiency. Conclusion In patients with severe SMR, LVEF, LV GLS and myocardial constructive work are more impaired when compared to mild SMR. However, myocardial wasted work is lower, resulting in higher better LV myocardial work efficiency. Funding Acknowledgement Type of funding source: None

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481Right ventricular longitudinal strain predicts symptoms in patients with chronic primary mitral regurgitation

European Heart Journal ◽

10.1093/eurheartj/ehz747.0131 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A L Chilingaryan ◽

L G Tunyan ◽

K G Adamyan

Keyword(s):

Mitral Regurgitation ◽

Ejection Fraction ◽

Left Atrial ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Volume Index ◽

Asymptomatic Patients ◽

Lv Ejection Fraction ◽

Primary Mitral Regurgitation

Abstract Mitral regurgitation (MR) leads to subclinical changes that often cannot be detected by low sensitive conventional parameters and early predictors of deterioration could suggest a better timing for intervention. Methods We follow up 175 asymptomatic patients 56±13 years (79 female) with severe primary MR in sinus rhythm and without diabetes mellitus and renal disease for 2 years. Global longitudinal strain (LS) of left ventricle (LVGLS), right ventricular (RV) free wall LS (RVLS), and left atrial (LA) peak reservoir LS as average of two basal segments in 4 chamber view were measured by speckle tracking along with indexes of LV end-systolic and end-diastolic volumes, LV ejection fraction (EF), left atrial end-systolic volume index (LAVi) every 6 months. Normal reference values of LS were obtained from age and sex matched 40 healthy controls. Results Patients with MR had higher LV ejection fraction (EF), LVGLS, LALS and lower values of RVLS compared with controls (EF 67.4±5% vs 59.3±4%, p<0.05; LVGLS –25.2±2.3% vs –21.2±1.9%, p<0.03; LALS 46.2±5.1% vs 42.4±3.7%, p<0.04; RVLS –23.4±5.1% vs –27.3±2.8%, p<0.03). 53 (30%) patients developed symptoms at exercise during follow up. Symptomatic patients at baseline had higher values of RVLS compared with patients who remained asymptomatic during follow up without significant differences in EF, LVGLS, LALS (RVLS –21.4±2.6% vs –25.8±3.2%, p<0.02; EF 66.8±2.4% vs 68.1±3.1%, p>0.05; LVGLS –24.8±2.1% vs –25.3±2.3%, p>0.05; LALS 45.7±4.1% vs 46.5±4.4%, p>0.05). RVLS correlated with LAVi (r=0.53, p<0.01) and LALS (r=0.57, p<0.01). Regression analysis defined RVLS as an independent predictor of symptoms development (OR=3.2; 95% CI=1.37–7.63; p<0.01). Conclusion RV longitudinal strain predicts symptoms in patients with chronic primary mitral regurgitation.

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Myocardial tissue function and characterization in patients with idiopathic cardiac magnetic resonance myopericarditis: evolutionary analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.0239 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Soeiro ◽

A S Bossa ◽

M C Cesar ◽

T C A T Leal ◽

G Garcia ◽

...

Keyword(s):

Right Ventricle ◽

Tissue Characterization ◽

Late Enhancement ◽

Left Ventricular ◽

Volume Index ◽

Systolic Volume ◽

End Systolic Volume ◽

The Right

Abstract Introduction The identification of prognostic markers related to the occurrence of events and recovery of ventricular function may be important in patients with acute myopericarditis (AMP). There is still a lack of data related to tissue characterization by cardiac magnetic resonance (CMR) of AMP, evolution and definition of possible long-term prognostic markers. Purpose To evaluate the myocardial tissue characterization of CMR related to the occurrence of combined events (death from all causes, heart failure and AMP recurrence) and the increase in left ventricular ejection fraction (LVEF) in patients with AMP. Methods Inclusion criteria were chest pain and/or electrocardiographic changes associated with elevated troponin (above the 99th percentile) in the absence of coronary stenosis and diagnosis of AMP by CMR <48 hours of admission confirmed by the presence of edema and/or late enhancement. After a follow-up of up to 24 months, 100 patients remained and in the assessment of the increase in LVEF (increase >5%), 36 cases remained, recalled for a new CMR between 6 and 18 months from the initial event. Results Significant differences in CMR were found between patients who had combined events (n=26) versus no combined events (n=74) in the following characteristics evaluated: initial LVEF (OR=0.938; CI: 0.895–0.984, p=0.008), left ventricular (LV) systolic volume index (OR=1.034; CI: 1.005–1.062, p=0.019), LV diastolic volume index (OR=1.029; CI: 1.002–1.056, p=0.038), presence of hypersignal in T2 (OR=11.325; CI: 2.247–57.075, p=0.003), presence of late anteroseptal enhancement (OR=0.160; CI: 0.037–0.685, p=0.014), basal anteroseptal (OR=0.255; CI: 0.071–0.914, p=0.036) and lateral apical (OR=5.902; CI: 1.236–28.187, p=0.026). In relation to the increase in LVEF, significant differences were found in CMR in the following characteristics evaluated: LVEF (OR=0.870; CI: 0.758–0.988, p=0.047), end systolic volume of the right ventricle (OR=1.047; CI: 1.001–1.096, p=0.047), LV systolic diameter (OR=1.283; CI: 1.034–1.593, p=0.023), LV diastolic diameter (OR=1.225; CI: 1.012–1.482, p=0.038), LV systolic volume index (OR=1.340; CI: 1.066–1.685, p=0.012), LV diastolic volume index (OR=1.111; CI: 1.017–1.213, p=0.019) and right ventricular systolic volume index (OR=1.116; CI: 1.006–1.236, p=0.037). Conclusion We observed a significant association between combined events in the long-term follow-up with initial LVEF, LV systolic and diastolic volume indexes, T2 hypersignal and the presence of mid and basal anteroseptal and lateral apical late enhancement. Already related to the increase in LVEF in evolutionary CMR, we observed a significant association with initial LVEF, end systolic volume of the right ventricle, LV systolic and diastolic diameters, LV systolic and diastolic volume indexes and right ventricle systolic volume index. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): FAPESP

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Feature-Tracking Left Ventricular Global Longitudinal Strain Improves 6 Months After Kidney Transplantation Associated With Reverse Remodeling, Not Myocardial Tissue Characteristics

10.21203/rs.3.rs-211311/v1 ◽

2021 ◽

Author(s):

Maurício Fregonesi Barbosa ◽

Mariana Moraes Contti ◽

Luis Gustavo Modelli de Andrade ◽

Alejandra del Carmen Villanueva Mauricio ◽

Sergio Marrone Ribeiro ◽

...

Keyword(s):

Kidney Transplantation ◽

Feature Tracking ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Volume Index ◽

Reverse Remodeling ◽

Myocardial Tissue ◽

Native T1

Abstract PurposeTo determine whether left ventricular (LV) global longitudinal strain (GLS) measured by feature-tracking (FT) cardiac magnetic resonance (CMR) improves after kidney transplantation (KT) and to analyze associations between LV GLS, reverse remodeling, and myocardial tissue characteristics.MethodsThis is a prospective single-center cohort study of kidney transplant recipients who underwent two CMR examinations in a 3T scanner, including cines, tagging, T1 and T2 mapping. The baseline exam was done until 10 days after transplantation and the follow-up after 6 months. Age and sex-matched healthy controls were also studied for comparison. ResultsA total of 44 patients (mean age 50 ± 11 years-old, 27 (61.4%) male) completed the two CMR exams. LV GLS improved from -13.4% +/- 3.0 at baseline to -15.2% +/- 2.7 at follow-up (p < 0.001), but remained impaired when compared with controls (-17.7% +/- 1.5, p = 0.007). We observed significant correlation between improvement in LV GLS with reductions of left ventricular mass index (r = 0.356, p= 0.018). Improvement in LV GLS paralleled improvements in LV stroke volume index (r = -0.429, p = 0.004), ejection fraction (r = -0.408, p = 0.006), global circumferential strain (r = 0.420, p = 0.004) and global radial strain (r = -0.530, p = 0.002). There were no significant correlations between LV GLS, native T1 or T2 measurements (p > 0.05). ConclusionIn this study, we demonstrated that LV GLS measured by FT-CMR improves 6 months after KT in association with reverse remodeling, but not native T1 or T2 measurements.

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Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

European Heart Journal Open ◽

10.1093/ehjopen/oeab046 ◽

2021 ◽

Author(s):

Maria Concetta Pastore ◽

Giulia Elena Mandoli ◽

Alberto Giannoni ◽

Giovanni Benfari ◽

Frank Lloyd Dini ◽

...

Keyword(s):

Heart Failure ◽

Primary Prevention ◽

Ejection Fraction ◽

Nyha Class ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Volume Index ◽

Early Therapy ◽

Reduced Ejection Fraction

Abstract Background This sub-study deriving from a multicenter Italian register (DISCOVER-ARNI) investigated whether sacubitril/valsartan in adjunction of optimal medical therapy(OMT) could reduce the rate of implantable cardioverter-defibrillator(ICD) indications for primary prevention in heart failure with reduced ejection fraction(HFrEF) according to European guidelines indications, and its potential predictors. Methods In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centers were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical and echocardiographic data were collected at baseline and after 6 months from sacubitril/valsartan initiation. Results Of 351 patients, 225(64%) were ICD carriers and 126(36%) were not ICD carriers (of whom 13 had not indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV)EF≤35% and New York Heart Asscociation(NYHA) class=II-III, 69(60%) did not show ICD indications; 44(40%) still fulfilled ICD criteria. Age, atrial fibrillation, mitral regurgitation>moderate, left atrial volume index(LAVi), and LV global longitudinal strain(GLS) significantly varied between the groups. With ROC curves, age≥75 years, LAVi≥42ml/m2 and LV GLS≥-8.3% were associated with ICD indications persistence (AUC=0.65,=0.68,=0.68 respectively). With univariate and multivariate analysis, only LV GLS emerged as significant predictor of ICD indications at follow-up in different predictive models. Conclusions Sacubitril/valsartan may provide early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline reduced LV GLS was a strong marker of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/hemorrhagic risks and unnecessary costs deriving from ICDs.

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P1390 Myocardial work indices in the assessment of the systolic function of the left ventricle in amateur half marathon runners

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.823 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

R Dankowski ◽

A Szalek ◽

J Tschurl ◽

W Sacharczuk ◽

A Baszko ◽

...

Keyword(s):

Myocardial Injury ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Volume Index ◽

Training Period ◽

Loading Conditions ◽

Myocardial Mechanics ◽

Constructive Work ◽

The Impact

Abstract Background Myocardial work (MW) has been recently introduced as a tool for non-invasive assessment of left ventricular (LV) systolic function. It is based on myocardial strain analysis but incorporates also data regarding loading conditions, which is potential advantage of this technique. Purpose We south to evaluate the impact of a three-month training before the half-marathon on cardiac function using indices of MW. Methods The study included 28 young amateur runners (11 women, mean age 32 years). None of the participants had a prior history of cardiovascular disease. The group was assessed at the beginning of training period, after three month (within 48 hours before half-marathon), and within 72 hours after the run. We collected clinical, laboratory and echocardiographic data. All participants underwent echocardiography to assess myocardial mechanics and MW indices using speckle-tracking technique. Results 23 participants completed the training and all of them finished the race. After the training period we observed significant increase in LV end-diastolic diameter only (49,9 ± 0,94 mm vs 51,6 ± 0,9 mm, p= 0,007) with no significant change after the run. There were no changes in global longitudinal strain (GLS), global work index (GWI) global wasted work (GWW) neither after the training period nor after the run. We observed significant changes suggesting myocardial injury after the race, including slight increase of NT-proBNP and troponin levels, increase in left atrial volume index, and reduction of tissue Doppler lateral e` wave. Global constructive work (GCW) decreased significantly after the training period, with no change after the run (2122,0 ± 299,4 vs 1929,0 ± 227 vs 1986,5 ± 295,7 mmHg%; start of the training vs before the run assessment vs after the run assessment, respectively; p = 0,005). GCW was correlated significantly with systolic blood pressure, which decreased also significantly after the training period. Conclusion Three-months training before the participation in half-marathon run was not associated with significant changes in myocardial work indices except the global constructive work, which could be related to decrease of loading conditions. Despite the signs of myocardial injury there was no deterioration in myocardial mechanics parameters, which may indicate the beneficial effects of training before the half-marathon run.

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Physiological and prognostic differences between types of exercise stress echocardiography for functional mitral regurgitation

Open Heart ◽

10.1136/openhrt-2021-001583 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001583

Author(s):

Nobuyuki Kagiyama ◽

Misako Toki ◽

Takuya Yuri ◽

Shingo Aritaka ◽

Akihiro Hayashida ◽

...

Keyword(s):

Mitral Regurgitation ◽

Adverse Events ◽

Stress Echocardiography ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Exercise Stress ◽

Functional Mitral Regurgitation ◽

Exercise Stress Echocardiography ◽

Ergometer Exercise ◽

Secondary Mr

ObjectiveSecondary mitral regurgitation (MR) demonstrates dynamic change during exercise. This prospective observational study aimed to compare exercise stress echocardiography (ESE) where handgrip exercise (handgrip-ESE) or semisupine ergometer exercise was performed (ergometer-ESE) for patients with secondary MR.MethodsHandgrip-ESE and symptom-limited ergometer-ESE were performed for 53 patients (median age (IQR): 68 (58–78) years; 70% male) on the same day. Baseline global longitudinal strain (GLS) was 9.2% (6.0%–14.0%) and MR volume was 20 (14–26) mL. All-cause death and cardiac hospitalisation were tracked for median 439 (101–507) days.ResultsHandgrip-ESE induced slightly but significantly greater degrees of MR increase (median one grade increase; p<0.001) than ergometer-ESE, although the changes in other parameters, including GLS (+1.1% vs −0.6%, p<0.001), were significantly smaller. Correlations between the two examinations with respect to the changes in the echocardiographic parameters were weak. Kaplan-Meier analyses revealed poor improvement in GLS during ergometer-ESE, but not the change in MR, was associated with adverse events (p=0.0065). No echocardiographic change observed during handgrip-ESE was prognostic. After adjusting for a clinical risk score, GLS changes during ergometer-ESE remained significant in predicting the adverse events (HR 0.39, p=0.03) A subgroup analysis in patients with moderate or greater MR at baseline (n=27) showed the same results as in the entire cohort.ConclusionsThe physiological and prognostic implications of handgrip-ESE and ergometer-ESE findings significantly differ in patients with left ventricular dysfunction and secondary MR. The type of exercise to be performed in ESE should be carefully selected.

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Global Constructive Work predicts left ventricular reverse remodeling one year after MitraClip implantation in patients with functional mitral regurgitation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0148 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Papadopoulos ◽

I Ikonomidis ◽

M Chrissoheris ◽

A Chalapas ◽

P Kourkoveli ◽

...

Keyword(s):

Mitral Regurgitation ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

Reverse Remodeling ◽

Left Ventricular Reverse Remodeling ◽

Work Index ◽

Constructive Work ◽

Global Work ◽

One Year

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVr) has recently been identified as an effective method for treating patients with functional mitral regurgitation. However, it is still unknown which patients will benefit by showing clinical improvement and left ventricular reverse remodeling. Purpose The purpose of this study is to analyze novel echocardiographic markers and identify markers of LV reverse remodeling after MitraClip implantation. Methods We retrospectively analyzed 58 high surgical risk (logistic EuroSCORE 23±15%) consecutive patients (aged 72±10yrs) with functional moderate-to-severe and severe mitral regurgitation (EROA 29±14mm2) and reduced LV contractility (EF 32±8%, GLS −8.6±3.7%). At baseline and 1-year after PMVr we assessed echocardiographic parameters such as MR severity, EF, Global Longitudinal Strain (GLS), Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE). Results In patients with MitraClip implantation there was a significant reduction of MR (3.7±0.4 vs 1.7±0.8, p<0.001) one year after the intervention. The EF and GLS did not improve after the implantation (32±8 vs 33±10%, p=0.178 & −8.6±3.7 vs −8.6±3.7%, p=0.922 respectively) but Global Work Index (GWI) and Global Constructive Work (GCW) demonstrated significant improvement (607±282 vs 650±260mmHg%, p=0.04 & 854±288 vs 949±325mmHg%, p<0.001 respectively). The baseline EF, GLS, GWI, GCW and EROA were the factors that were significantly associated with more than 20% reduction of LVEDV one year after intervention (p<0.02 for all). To be more specific, left ventricles with better performance and contractility combined with worse mitral regurgitation were the ones that responded better. Further, baseline GCW was the only factor that was significantly associated with reduction of the LVESV. A ROC curve analysis identified a cut-off value of 846mmHg% (AUC 0.759, 95% CI: 0.588–0.930; p=0.007) to be associated with 10% reduction of LVESV, with a sensitivity and specificity of 79% and 74% respectively. Conclusions Transcatheter edge-to-edge repair is an effective method for treating patients with FMR and improves LV performance one year after intervention. A preserved baseline GCW seems to be a good predictor of LV reverse remodeling after MitraClip implantation. Funding Acknowledgement Type of funding source: None

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Detection of the Early Cardiotoxic Effects of Doxorubicin-Containing Chemotherapy Regimens in Patients with Breast Cancer through Novel Cardiac Magnetic Resonance Imaging: A Short-term Follow-up

Journal of Clinical Imaging Science ◽

10.25259/jcis_58_2021 ◽

2021 ◽

Vol 11 ◽

pp. 33

Author(s):

Afsaneh Maddah Safaei ◽

Tara Molanaie Kamangar ◽

Sanaz Asadian ◽

Nahid Rezaeian ◽

Ebrahim Esmati ◽

...

Keyword(s):

Breast Cancer ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Tissue Characterization ◽

Myocardial Edema ◽

Left Ventricular ◽

Volume Index ◽

Systolic Volume ◽

Global Strain

Objectives: Many patients with breast cancer (BC) require cardiotoxic anthracycline-based chemotherapy. We intended to assess the early cardiotoxic effects of doxorubicin utilizing cardiac magnetic resonance (CMR) imaging. Material and Methods: Forty-nine patients including 21 otherwise healthy females with BC at a mean age (±SD) of 47.62 ± 9.07 years and 28 normal controls at a mean age (±SD) of 45.18 ± 4.29 years were recruited. They underwent CMR and transthoracic echocardiography at baseline and 7 days after four biweekly cycles of doxorubicin and cyclophosphamide. Biventricular functional, volumetric, global strain, and tissue characterization findings were analyzed and compared with those of 28 controls. Results: In post-chemotherapy CMR, 4 patients (19.04%), three symptomatic and one asymptomatic, exhibited evidence of doxorubicin cardiotoxicity. Significant differences in biventricular ejection fraction, left ventricular end-systolic volume index, and all 3D global strain values were noted after chemotherapy in comparison with the baseline (all P < 0.05). More than half of the study population showed a significant change in all right ventricular global strain values. One patient (4.76%) exhibited evidence of diffuse myocardial edema in post-chemotherapy CMR, and 3 patients (14.28%) showed myocardial fibrosis. The study participants were clinically followed up for 4–10 months (mean = 7 months). Overall, 8 patients (38.09%) complained of dyspnea on exertion and fatigue on follow-up. None of the CMR markers was associated with the development of symptoms. Conclusion: Our investigation revealed striking changes in CMR parameters in the follow-up of BC patients treated with cardiotoxic chemotherapy. These exclusive CMR features assist in the early initiation of preventive cardiac strategies.

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