1187 Evaluation of left and right ventricular functions with 3D speckle tracking in patients with mitral stenosis

Abstract Background The function of both ventricles have been suggested to be affected in patients with mitral stenosis. In this study, it was aimed to investigate deformation properties of right (RV) and left ventricles (LV) in mild and moderate rheumatic mitral stenosis (MS) patients with three-dimensional speckle tracking echocardiography (3D-STE). Methods A total of 60 patients were included in the study (20 patients with mild MS diagnosis, 20 patients with moderate MS diagnosis and 20 healthy volunteers). Three-dimensional echocardiography datasets were obtained for both ventricles in all patients. An example for RV assessment is shown in Figure 1. LV global longitudinal strain (GLS), LV torsion, RV free wall (FW) LS and interventricular septal (IVS) LS measurements were analyzed. Results The LV ejection fraction (EF), RV fractional area change and tricuspid annular plane systolic excursion values were statistically similar and in the normal range. The LV GLS measurements were significantly different among the groups by being highest in the control group and least in the moderate stenosis group (ANOVA,p < 0.001) (Table 1). Patients with MS showed higher torsional values, correlated with MS severity (ANOVA,p < 0.001) (Table 1). IVS LS, RVFW LS values obtained by RV analysis also differed significantly among groups. The FW-GLS values only showed significant difference between the control group and moderate MS group (Table 1). Conclusion Patients with mitral stenosis showed lower LV-GLS and higher LV torsion values. Although the LV GLS is affected; the LV EF was detected to be normal due to increase in LV torsion. RV deformation indices showed signıficant decrease in correlation with the severity of the mitral stenosis. In conclusion, our data suggest that subclinical LV and RV systolic dysfunction is present in mild-moderate MS patients and this dysfunction can be detected by 3D-STE. Table 1 Parameters Control group Mild MS Moderate MS P LV GLS (%) 23.3 ± 2.08 18.9 ± 1.3 17.5 ± 1.8 <0.001 LV torsion 1.5 ± 0.6 2.1 ± 0.6 2.6 ± 0.5 <0.001 IVS LS (%) 23 ± 3.0% 20 ± 2.6 17.1 ± 2.9 <0.001 RV FW LS (%) 25.4 ± 5 22.7 ± 3.2 21.1 ± 4.8 <0.001 FW; free-wall, GLS; global longitudinal strain, IVS; interventricular septum, LV; left ventricular, RV; right ventricular Abstract 1187 Figure 1

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Evaluation of Cardiac Functions By Speckle Tracking Echocardiography in Type 2 Diabetes Mellitus With Hyperlipidemia

10.21203/rs.3.rs-899277/v1 ◽

2021 ◽

Author(s):

Zhizhi Dong ◽

Jun Zhou ◽

Yue Chen ◽

Zulin Liu ◽

Douzi Shi ◽

...

Keyword(s):

Normal Control ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Normal Control Group ◽

Control Group ◽

Cardiac Functions ◽

Significant Difference

Abstract Background To investigate the value of two-dimensional speckle tracking echocardiography (2D-STE) in evaluating cardiac functions in type 2 diabetes mellitus (T2DM) with hyperlipidemia. Methods Sixty T2DM patients with normal left ventricular ejection fraction (LVEF) and poorly-controlled blood glucose were selected. Among these, thirty had hyperlipidemia. Thirty age- and gender-matched healthy individuals were recruited as the normal control group. Longitudinal strain of left ventricular segments, left ventricular global longitudinal strain (LV GLS), left atrial global longitudinal strain (LA GLS), right ventricular global longitudinal strain (RV GLS) and right atrial global longitudinal strain (RA GLS) were measured by 2D-STE. Results (1) Compared with the normal control group, LV GLS in T2DM group and T2DM with hyperlipidemia group decreased (P < 0.05), but there was no significant difference of LV GLS between T2DM group and T2DM with hyperlipidemia group (P > 0.05). Compared with the normal control group and T2DM group, longitudinal strain of middle segment of LV in T2DM with hyperlipidemia group decreased (P < 0.05). (2) There was a significant difference in LA GLS among the three groups. LA GLS of T2DM with hyperlipidemia group was lower compared with the normal control and T2DM group (P < 0.05). (3) Compared with the normal control group, RV GLS in T2DM group and T2DM with hyperlipidemia group was lower (P < 0.05), but there was no significant difference of RV GLS between T2DM group and T2DM with hyperlipidemia group (P > 0.05). RA GLS in T2DM with hyperlipidemia group decreased (P < 0.05) compared to the normal control group and T2DM group. Conclusion Speckle tracking echocardiography can effectively evaluate cardiac dysfunction in patients with T2DM. LA GLS and RA GLS can be used as potential markers of cardiac dysfunction in T2DM with hyperlipidemia, and provide the basis for early clinical diagnosis and treatment.

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P4374Biventricular systolic function analysis in patients with Marfan Syndrome using speckle-tracking 2D ecocardiography

European Heart Journal ◽

10.1093/eurheartj/ehz745.0779 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Torres Sanabria ◽

V Monivas Palomero ◽

E Garcia Izquierdo Jaen ◽

A Forteza Gil ◽

J Gonzalez Mirelis ◽

...

Keyword(s):

Right Ventricular ◽

Marfan Syndrome ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Function Analysis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Healthy Controls ◽

Free Wall ◽

Biventricular Function

Abstract Background Left Ventricular systolic disfunction has already been described in Marfan Syndrome (MS) in patients without valvular dysfunction using 2D and 3D speckle tracking echocardiography (STE). This dysfunction has been related to a more severe causal genetic mutation, which suggest the presence of a primary cardiomiopathy in these patients. Right ventricular function has been less studied so far. We sought to evaluate biventricular function in our cohort of MS patients with 2D-STE. Methods 95 unoperated adult patients with MS and 32 healthy controls were prospectively enrolled. Patients with more than mild mitral or aortic regurgitation were excluded. Using STE we obtanied left ventricular global longitudinal strain (LVGLS) from the average of 16 segments from 4,2 and 3-chamber views and RVGLS values were obtained from the average of 6 segments from the apical 4-chamber view. We also measured classic parameters of systolic biventricular function (LVEF and TAPSE). Results Compared to controls, patients with MFS had significantly lower LVGLS and RVGLS (table 1). Values obtanied for LVGLS in MS patients were at the lower limit of normality stablished in the latest cuantification guidelines, while RVGLS and RV free wall LS were slightly above the limit of normality. LVEF and TAPSE were also slightly diminished in MS patients, though the differences found were clinically not relevant. Results of statistical analysis MS (n=93) Controls (n=32) p Age (years) 32.84±12.4 32.41±7.98 0.85 Aortic Root Diameter Valsalva Sinuses (mm) 38.82±5.35 30.91±5.3 <0.001 LVGLS (%) −18.93±2.62 −21.52±2.26 <0.001 RVGLS (%) −21.25±3.54 −24.68±3.08 <0.001 RV free wall LS (%) −22.09±3.92 −25.56±3.63 <0.001 LVEF (%) 59.5±5.34 63.27±4.19 0.001 TAPSE (mm) 23.97±4.57 25.82±3.32 0.03 MS = Marfan Syndrome; LVGLS = Left ventricular global longitudinal strain; RVGLS = right ventricular global longitudinal strain. Conclusions Our study suggests that patients with MFS show lower biventricular strain compared with healthy controls. 2D-STE imaging may be useful to detect subclinical changes in cardiac function in patients with MFS and should be added to routine ecocardiographic evaluation in order to improve the follow-up and treatment of these patients.

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Evaluation of Left Ventricular Function in Polymyositis and Dermatomyositis Patients with Global Longitudinal Strain Using Two Dimensional Speckle Tracking Method

10.32592/ircmj.2021.23.8.771 ◽

2021 ◽

Keyword(s):

Diastolic Dysfunction ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Control Group ◽

Two Dimensional ◽

Ventricular Ejection Fraction ◽

Significant Difference

Background: Heart problems are one of the main causes of death in patients with idiopathic inflammatory myopathies, such as polymyositis (PM) and dermatomyositis (DM). Speckle tracking echocardiography (STE) and global longitudinal strain (GLS) are non-invasive, accurate, repeatable, and angle-independent imaging techniques that facilitate a full global and regional evaluation of the left ventricular (LV) function. Objectives: This study aimed to evaluate myocardial dysfunction in DM and PM patients using STE and GLS methods. Methods: The present control-case study was conducted on 30 polymyositis and dermatomyositis patients and 40 healthy people as the control group. Both groups showed no symptoms of cardiovascular diseases. Both groups underwent two-dimensional STE and GLS evaluation. The GLS value was taken as a marker of LV systolic dysfunction. Results: The 2D GLS value of LV was significantly lower in the DM and PM patients, compared to the control group. A mild diastolic dysfunction was observed in seven (23.3%) patients, and 23 (76.7%) patients had a normal state. The patients’ age and duration of the disease were found to be significantly correlated with the left ventricular diastolic dysfunction. No significant difference was observed between the DM and PM patients with the control group in terms of pulmonary artery pressure level. Conclusion: Although the DM and PM patients had normal left ventricular ejection fraction values, there was a significant difference between the patients in these two groups and the control group in terms of LV dysfunction using GLS. Therefore, GLS is a useful variable that can be used to diagnose sustained and subclinical disorders in LV systolic function of DM and PM patients.

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Abnormal left ventricular global longitudinal strain by speckle tracking echocardiography in COVID-19 patients

Future Cardiology ◽

10.2217/fca-2020-0121 ◽

2020 ◽

Author(s):

Lori B Croft ◽

Parasuram Krishnamoorthy ◽

Richard Ro ◽

Malcolm Anastasius ◽

Wenli Zhao ◽

...

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Healthy Population ◽

Significant Difference ◽

The Mean ◽

Lv Ejection Fraction ◽

Prognostic Implications

COVID-19 infection can affect the cardiovascular system. We sought to determine if left ventricular global longitudinal strain (LVGLS) is affected by COVID-19 and if this has prognostic implications. Materials & methods: Retrospective study, with LVGLS was measured in 58 COVID-19 patients. Patients discharged were compared with those who died. Results: The mean LV ejection fraction (LVEF) and LVGLS for the cohort was 52.1 and -12.9 ± 4.0%, respectively. Among 30 patients with preserved LVEF(>50%), LVGLS was -15.7 ± 2.8%, which is lower than the reference mean LVGLS for a normal, healthy population. There was no significant difference in LVGLS or LVEF when comparing patients who survived to discharge or died. Conclusion: LVGLS was reduced in COVID-19 patients, although not significantly lower in those who died compared with survivors.

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Effect of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors on Left Ventricular Remodelling and Longitudinal Strain: A Prospective Observational Study

10.21203/rs.3.rs-582026/v1 ◽

2021 ◽

Author(s):

Sergio Gamaza-Chulian ◽

Enrique Díaz-Retamino ◽

Fátima González-Testón ◽

José Carlos Gaitero ◽

María José Castillo ◽

...

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Ventricular Remodelling ◽

Left Ventricular Remodelling ◽

Sodium Glucose Cotransporter ◽

Clinical Benefits

Abstract Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) lower cardiovascular events in type 2 diabetes mellitus (T2DM) patients, although the mechanisms underlying these benefits are not clearly understood. Our aim was to study the effects of SGLT2i on left ventricular remodelling and longitudinal strain.Methods: Between November 2019 and April 2020, we included 52 patients with T2DM ≥18 years old, with HbA1c between 6.5% and 10.0%, and estimated glomerular filtration ≥45 ml/min/1.73 m2. Patients were classified into SGLT2i group and control group, according to prescribed treatment by their referring physician. Conventional and speckle tracking echocardiography were performed by blinded sonographers, at baseline and after 6 months of treatment.Results: Among the 52 included patients (44% females, mean age 66.8±8.6 years, mean HbA1c was 7.40±0.7%), 30 patients were prescribed SGLT2i and 22 patients were classified as control group. Mean change in indexed left ventricular mass (LVM) was -10.85±3.31 g/m2 (p=0.003) in the SGLT2i group, and +2.34±4.13 g/m2 (p=0.58) in the control group. Absolute value of Global Longitudinal Strain (GLS) increased by a mean of 1.29±0.47 (p=0.011) in the SGLT2i group, and 0.40±0.62 (p=0.34) in the control group. We did not find correlations between changes in LVM and GLS, and other variables like change in HbA1c.Conclusions: Among patients with T2DM, SGLT2i were associated with a significant reduction in indexed LVM and a significant increment in longitudinal strain measured by speckle tracking echocardiography, which may explain in part the clinical benefits found in clinical trials.

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Influence of visceral adiposity accumulation on adverse left and right ventricular mechanics in the community

European Journal of Preventive Cardiology ◽

10.1177/2047487319891286 ◽

2019 ◽

Vol 27 (18) ◽

pp. 2006-2015

Author(s):

Naoko Sawada ◽

Koki Nakanishi ◽

Masao Daimon ◽

Yuriko Yoshida ◽

Jumpei Ishiwata ◽

...

Keyword(s):

Right Ventricular ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Global Longitudinal Strain ◽

Multivariable Analysis ◽

Left Ventricular ◽

Abdominal Adiposity ◽

Ventricular Mechanics ◽

Increased Risk

Aims Obesity carries significant risk for unfavorable ventricular remodeling and subsequent heart failure (HF) development, although the association between abdominal fat distribution and subclinical ventricular dysfunction is unclear. This study aimed to compare the subcutaneous and visceral abdominal adiposity with the risk of decreased ventricular strain. Methods We included 340 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination, and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess left ventricular global longitudinal strain (LVGLS) and right ventricular free-wall longitudinal strain (RVLS). Results Mean age was 56 ± 9 years, and 244 of the participants (72%) were male. The mean LVGLS and RVLS were −19.1 ± 3.0% and −25.0 ± 4.1%, respectively. Both VFA and SFA correlated with LVGLS ( r = 0.46 and r = 0.15, both p < 0.01) and RVLS ( r = 0.38 and r = 0.12, both p < 0.05), demonstrating a stronger correlation between VFA and ventricular strain. Multivariable analysis showed that VFA was significantly associated with LVGLS and RVLS, independent of traditional cardiovascular risk factors as well as pertinent laboratory and echocardiographic parameters (both p < 0.05), whereas SFA was not. Serum adiponectin level was correlated with LVGLS ( r = –0.34, p < 0.001) and RVLS ( r = –0.25, p < 0.001), although it lost statistical significance following multivariable adjustment. Conclusion In a sample of the general population, VFA, but not SFA, accumulation was significantly associated with decreased LV and RV strain, an association that may be involved in the increased risk of HF in obese individuals.

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Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s38407 ◽

2016 ◽

Vol 10 ◽

pp. CMC.S38407 ◽

Cited By ~ 12

Author(s):

Amal Mohamed Ayoub ◽

Viola William Keddeas ◽

Yasmin Abdelrazek Ali ◽

Reham Atef El Okl

Keyword(s):

Ejection Fraction ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Hypertensive Patients

Background Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. Methods We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). Results There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson's method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. Conclusion 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention.

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Impact of atrial septal defect device size on biventricular global and regional function: a two-dimensional strain echocardiographic study

Cardiology in the Young ◽

10.1017/s1047951121002948 ◽

2021 ◽

pp. 1-9

Author(s):

Areej Alkhateeb ◽

Alaa Roushdy ◽

Hosam Hasan-Ali ◽

Yehia T. Kishk ◽

Aya El Sayegh ◽

...

Keyword(s):

Right Ventricular ◽

Atrial Septal Defect ◽

Longitudinal Strain ◽

Septal Defect ◽

Transcatheter Closure ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Study Group ◽

Significant Difference ◽

Device Size

ABSTRACT Objective: In this study, we assessed the acute changes in biventricular longitudinal strain after atrial septal defect transcatheter closure and its relation to the device size. Methods: Hundred atrial septal defect patients and 40 age-matched controls were included. Echocardiography and strain study were performed at baseline and 24 hours and 1 month after the intervention. The study group was divided into two subgroups; group 1: smaller devices were used (mean device size = 1.61 ± 0.05 cm, n = 74) and group 2: larger devices were used (mean device size = 2.95 ± 0.07 cm, n = 26). Results: At baseline, there was a significant difference between the study group and controls as regards right ventricular global longitudinal strain with significant hyperkinetic apex (p = 0.033, p = 0.020, respectively). There was a significant immediate reduction in right ventricular global longitudinal strain (from −24.43 ± 0.49% to −21.62 ± 0.47%, p < 0.001), which showed insignificant improvement after 1-month follow-up. While only left ventricular global longitudinal strain increased after 1 month. Within 24 hours of device closure, all the basal- and mid-lateral segments strains and apical right ventricular strains showed a significant reduction. There was a significant negative correlation between the indexed large device size and an immediate change in the right ventricular global longitudinal strain (r = −0.425, p = 0.034). Conclusion: Significant right ventricular global longitudinal strain reduction starts as early as 24 hours after transcatheter closure, irrespective of the device size used. The rapid impact of closure was mainly on the biventricular basal and lateral segments and right ventricular apical ones, especially with the large sized atrial septal defect.

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1033 Prominent longitudinal strain involvement of left ventricular basal segments in native hypertensive patients without clear-cut hypertrophy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.627 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Lembo ◽

R Esposito ◽

C Santoro ◽

R Sorrentino ◽

F Luciano ◽

...

Keyword(s):

Arterial Hypertension ◽

Longitudinal Strain ◽

Linear Regression Analysis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Hypertensive Patients ◽

Clear Cut ◽

Lv Mass ◽

Significant Difference

Abstract Background Left ventricular (LV) global longitudinal strain (GLS) is able to detect an early subclinical dysfunction and it has been demonstrated to be a prognosticator in arterial hypertension. Information of regional longitudinal strain (LS) pattern has not been investigated in this clinical setting. Purpose We analyzed regional LV patterns of LS and base-to-apex behaviour of LS in newly diagnosed and never-treated hypertensive patients (HTN) without clear-cut LV hypertrophy (LVH). Methods 166 HTN (M/F = 107/59; age 43.9 ± 14.3 years, blood pressure [BP] = 146.5± 10.7/90.1 ± 7.5 mmHg) and a control group of 94 healthy subjects (M/F = 58/36; age 41.2 ± 15.0 years) underwent standard echo-Doppler exam, including speckle tracking quantification of regional LS and GLS (considered in absolute values). The average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments and relative regional strain ratio - RRSR = [ALS/(BLS + MLS)] - were also computed. Exclusion criteria were LVH (LV mass index ≥45 g/m^2.7 in females and ≥49 g/m^2.7 in males), diabetes mellitus, coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. Results The two groups were comparable for sex, age, heart rate and LV ejection fraction (EF). Body mass index (BMI), systolic (SBP), diastolic (DBP) and mean BP (MBP) (all p < 0.0001), LV mass index (p = 0.03), relative wall thickness (RWT) (p < 0.02) and E/e’ ratio (p < 0.01) were higher, and GLS lower (21.6 ± 2.0 vs. 22.2 ± 2.1%, p < 0.02) in HTN. By analyzing regional LS, BLS (18.2 ± 2.1% vs. 19.2 ± 2.1%, p < 0.0001) and MLS (20.7 ± 2.0 vs. 21.4 ± 2.1%, p = 0.007) resulted significantly lower in HTN, without significant difference in ALS (26.0 ± 3.6 vs. 25.9 ± 3.8%, p = 0.98). Accordingly, RRSR was higher in HTN (0.67 ± 0.09 vs. 0.64 ± 0.09, p < 0.01). Even after excluding patients with LV concentric remodeling (RWT > 0.42) (n = 34), BLS (p < 0.0001) and MLS (p < 0.002) were again lower and RRSR (p < 0.01) higher in HTN than in controls. In the pooled population, BLS negatively correlated with SBP (r=-0.22), DBP (r=-0.25) and MBP (r=-0.26) (Figure) (all p < 0.0001). By a multiple linear regression analysis, after adjusting for age, sex, BMI and RWT, the association between BLS and MBP remained significant (β coefficient=-0.23, p < 0.0001), with an additional significant impact of male sex (β=-0.33, p < 0.0001) (cumulative R²=0.18, SEE = 1.9%, p < 0.0001). Conclusions Besides normal LV EF, GLS is lower in HTN. LS dysfunction involves basal and, with a lower extent, middle myocardial segments, with a compensation of apical segments. RRSR appears to be significantly higher in HTN. These results are even confirmed in hypertensive patients with normal LV geometry. The association of BLS and BP appears to be independent on several confounders. Regional LS pattern might be useful to detect very early LV systolic abnormalities in arterial hypertension. Abstract 1033 Figure. Relation between MBP and BLS

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Early detection with speckle tracking echocardiography of biventricular systolic dysfunction, and its relationship with fatigue, in patients with multiple sclerosis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.384 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

E Michelotto ◽

MC Oliva ◽

MT Amoruso ◽

G Giovannetti ◽

C Battista ◽

...

Keyword(s):

Multiple Sclerosis ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Lv Function ◽

Healthy Population ◽

The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Background Fatigue is a frequent and debilitating symptom of multiple sclerosis (MS), affecting 90% of patients. Symptoms seems multifactorial, but little is known about the contribution of cardiovascular morpho-functional alterations linked to comorbidities, to lifestyle, to MS itself or to drugs (i.e. mitoxantrone). Aim to investigate the presence of cardiac alterations in MS patients, and to evaluate their impact on fatigue. Methods 24 patients with relapsing-remitting MS (RR-MS) underwent an electrocardiogram (ECG), a transthoracic echocardiographic (TTE), a six minutes walking test (6MWT) with Borg scale (BS), and two fatigue self-assessment scales, the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). The patients were divided into 2 groups: group 1, without traditional cardiovascular risk factors (CVRF: smoke, hypertension, diabetes, hypercholesterolemia; n = 12, 11 females), and group 2, with at least one CVRF (n = 12, 5 females). None of the patients had ever been on mitoxantrone therapy. No new control group was studied due to the SARS-CoV-2 pandemic restrictions , so the comparison was performed with general healthy population in internationally validated previous studies. Results No arrhythmias were found. In both MS groups all the TTE left ventricular (LV) systolic function parameters were depressed compared to the healthy population, but only the mean global longitudinal strain (GLS), the mean longitudinal strain rate (LSR) of LV and estimated pulmonary artery systolic pressure (PAPs) were statistically significant depressed compared to the healthy general population (p < 0.005): see table. This reduction was observed in both MS groups, while there were non significant differences among the two groups. TTE LV function depression significantly correlated to variation of parameters of fatigue , especially considering LV GLS in relation to BS values. Conclusions Subclinical biventricular systolic dysfunction is present in MS patients, and it seems to be linked to the disease itself without being influenced by CVRF. This dysfunction, detected by speckle tracking echocardiographic techniques, seems to contribute to the symptom of fatigue in patients with MS. It is important to include TTE in the workup and follow-up of MS patients, in order to promptly treat cardiac dysfunction and relieve fatigue. Echocardiography and LV strain MS total MS no CVRF MS + CVRF Healthy population LV GLS 17.7 ± 2.2* 18.0 ± 2.1* 17.4 ± 2.4* 22.6 ± 1.7 LV LSR 1.0 ± 0.1* 1.0 ± 0.1* 1.0 ± 0.2* 1.2 ± 0.1 PAPs 25.0 ± 2.6* 24.8 ± 2.9* 25.2 ± 2.5* 14.0 ± 6.0 * p < 0.05 vs healthy population

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