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

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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End-systolic wall stress in aortic stenosis: comparing symptomatic and asymptomatic patients

Open Heart ◽

10.1136/openhrt-2019-001021 ◽

2019 ◽

Vol 6 (1) ◽

pp. e001021 ◽

Cited By ~ 2

Author(s):

Rasmus Carter-Storch ◽

Jacob Eifer Moller ◽

Nicolaj Lyhne Christensen ◽

Lars Melholt Rasmussen ◽

Redi Pecini ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Wall Thickness ◽

Global Longitudinal Strain ◽

Wall Stress ◽

Left Ventricular ◽

Volume Index ◽

Aortic Valve Area ◽

The Impact ◽

Systolic Wall Stress

AimsIn aortic stenosis (AS), there is poor association between symptoms and conventional markers of AS severity or left ventricular (LV) systolic function. This may reflect that symptoms arise from LV diastolic dysfunction or that aortic valve area (AVA) and transvalvular gradient do not reflect afterload. We aimed to study the impact of afterload (end-systolic wall stress [ESWS]) on the presence of symptoms in AS and to test whether symptoms are related to increased ESWS or LV remodelling.Methods and resultsIn a prospective study, ESWS was estimated by measuring LV wall thickness from MRI and estimated LV end systolic pressure from echocardiographic mean gradient and systolic blood pressure in 78 patients with severe AS scheduled for aortic valve replacement and 91 patients with asymptomatic severe AS. Symptomatic patients had lower indexed AVA (0.40±0.11 vs 0.45±0.09 cm2/m2, p=0.009). They had undergone more extensive remodelling (MRI LV mass index [LVMi]: 85±24 vs 69±17 g/m2, p<0.0001), had higher tricuspid regurgitant gradient (24±8 mm Hg vs 19 ± 7 mm Hg, p=0.0001) and poorer global longitudinal strain (−15.6±3.8 vs −19.9±3.2%, p<0.0001). ESWS was higher among symptomatic patients (96±51 vs 76±25 kdynes/cm2, p=0.003). Multivariate logistic regression identified echocardiographic relative wall thickness, tricuspid gradient, mitral deceleration time, early diastolic strain rate, MRI LVMi, MRI LV end-diastolic volume index and ESWS as independently associated with being symptomatic.ConclusionESWS can be estimated from multimodality imaging combining MRI and echocardiography. It is correlated with LV remodelling and neurohormonal activation and is independently associated with symptomatic status in AS.

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Short-Term CPAP Improves Biventricular Function in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities

Diagnostics ◽

10.3390/diagnostics11050889 ◽

2021 ◽

Vol 11 (5) ◽

pp. 889

Author(s):

Ioana Mădălina Zota ◽

Radu Andy Sascău ◽

Cristian Stătescu ◽

Grigore Tinică ◽

Maria Magdalena Leon Constantin ◽

...

Keyword(s):

Patient Adherence ◽

Systolic Function ◽

Blood Pressure Monitoring ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Short Term ◽

Biventricular Function ◽

Obesity And Diabetes ◽

Obstructive Sleep ◽

The Impact

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, exhibiting an increasing prevalence and several cardiovascular complications. Continuous positive airway pressure (CPAP) is the gold-standard treatment for moderate-severe OSA, but it is associated with poor patient adherence. We performed a prospective study that included 57 patients with newly diagnosed moderate-severe OSA, prior to CPAP initiation. The objective of our study was to assess the impact of short-term CPAP on ventricular function in patients with moderate-severe OSA and cardiometabolic comorbidities. The patients underwent a clinical exam, ambulatory blood pressure monitoring and comprehensive echocardiographic assessment at baseline and after 8 weeks of CPAP. Hypertension, obesity and diabetes were highly prevalent among patients with moderate-severe OSA. Baseline echocardiographic parameters did not significantly differ between patients with moderate and severe OSA. Short-term CPAP improved left ventricular global longitudinal strain (LV-GLS), isovolumetric relaxation time, transmitral E wave amplitude, transmitral E/A ratio, right ventricular (RV) diameter, RV wall thickness, RV systolic excursion velocity (RV S‘) and tricuspid annular plane systolic excursion (TAPSE). Short-term CPAP improves biventricular function, especially the LV-GLS, which is a more sensitive marker of CPAP-induced changes in LV systolic function, compared to LVEF. All these benefits are dependent on CPAP adherence.

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

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.238 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Hubert ◽

E Galli ◽

G Leurent ◽

H Corbineau ◽

C Leclercq ◽

...

Keyword(s):

Mitral Regurgitation ◽

Global Longitudinal Strain ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Volume Index ◽

Blue Point ◽

Systolic Volume ◽

Constructive Work ◽

Secondary Mr

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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Athlete’s Heart in Elite Biathlon, Nordic Cross—Country and Ski-Mountaineering Athletes: Cardiac Adaptions Determined Using Echocardiographic Data

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd9010008 ◽

2021 ◽

Vol 9 (1) ◽

pp. 8

Author(s):

Paul Zimmermann ◽

Othmar Moser ◽

Max L. Eckstein ◽

Jan Wüstenfeld ◽

Volker Schöffl ◽

...

Keyword(s):

Cardiac Remodeling ◽

Left Atrial ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Atrial Volume ◽

Left Ventricular ◽

Volume Index ◽

Atrial Remodeling ◽

Winter Sports ◽

Cross Country

Twelve world elite Biathlon (Bia), ten Nordic Cross Country (NCC) and ten ski-mountaineering (Ski-Mo) athletes were evaluated for pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, sports-related cardiac remodeling was analyzed by performing two-dimensional echocardiography including speckle tracking analysis as left ventricular global longitudinal strain (LV-GLS). A multicenter retrospective analysis of echocardiographic data was performed in 32 elite world winter sports athletes, which were obtained between 2020 and 2021 during the annual medical examination. The matched data of the elite world winter sports athletes (14 women, 18 male athletes, age: 18–35 years) were compared for different echocardiographic parameters. Significant differences could be revealed for left ventricular systolic function (LV-EF, p = 0.0001), left ventricular mass index (LV Mass index, p = 0.0078), left atrial remodeling by left atrial volume index (LAVI, p = 0.0052), and LV-GLS (p = 0.0003) between the three professional winter sports disciplines. This report provides new evidence that resting measures of cardiac structure and function in elite winter sport professionals can identify sport specific remodeling of the left heart, against the background of training schedule and training frequency.

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Abnormal myocardial work in children with Kawasaki disease

Scientific Reports ◽

10.1038/s41598-021-86933-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jolanda Sabatino ◽

Nunzia Borrelli ◽

Alain Fraisse ◽

Jethro Herberg ◽

Elena Karagadova ◽

...

Keyword(s):

Kawasaki Disease ◽

Systolic Function ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

High Morbidity ◽

Additional Group ◽

Constructive Work ◽

Lv Systolic Function ◽

Normal Lvef

AbstractKawasaki disease (KD) can be associated with high morbidity and mortality due to coronary artery aneurysms formation and myocardial dysfunction. Aim of this study was to evaluate the diagnostic performance of non-invasive myocardial work in predicting subtle myocardial abnormalities in Kawasaki disease (KD) children with coronary dilatation (CADL). A total of 100 patients (age 8.7 ± 5 years) were included: 45 children with KD and CADL (KD/CADL) (Z-score > 2.5), 45 age-matched controls (CTRL) and, finally, an additional group of 10 children with KD in absence of coronary dilatation (KD group). Left ventricular (LV) systolic function and global longitudinal strain (GLS) were assessed. Global myocardial work index (MWI) was calculated as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Despite normal LV systolic function by routine echocardiography, KD/CADL patients had lower MWI (1433.2 ± 375.8 mmHg% vs 1752.2 ± 265.7 mmHg%, p < 0.001), MCW (1885.5 ± 384.2 mmHg% vs 2175.9 ± 292.4 mmHg%, p = 0.001) and MWE (994.0 ± 4.8% vs 95.9 ± 2.0%, p = 0.030) compared to CTRL. Furthermore, MWI was significantly reduced in children belonging to the KD group in comparison with controls (KD: 1498.3 ± 361.7 mmHg%; KD vs CTRL p = 0.028) and was comparable between KD/CADL and KD groups (KD/CADL vs KD p = 0.896). Moreover, KD/CADL patients with normal GLS (n = 38) preserved significant differences in MWI and MCW in comparison with CTRL. MWI, MCW and MWE were significantly reduced in KD children despite normal LVEF and normal GLS. These abnormalities seems independent from CADL. Thus, in KD with normal LVEF and normal GLS, estimation of MWI may be a more sensitive indicator of myocardial dysfunction.

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618 Adaptive myocardial mechanics in aortic stenosis patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.304 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Alfarih ◽

A Alfuhied ◽

P Kumar M ◽

G Lloyd ◽

A D Hughes ◽

...

Keyword(s):

Aortic Stenosis ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Intraclass Correlation ◽

Strain Analysis ◽

Inverse Correlation ◽

Left Ventricular ◽

Lv Function ◽

Myocardial Mechanics ◽

And Gender

Abstract Introduction Left ventricular (LV) hypertrophy in aortic stenosis (AS) becomes maladaptive over time, leading first to a reduction in global longitudinal strain (GLS) and in a later stage a reduction in ejection fraction (EF). The myocardial state of impaired GLS but preserved EF is a key remodeling turning point in AS, yet little is known about the coping mechanics of the LV at or around this sensitive juncture. Aim 1) To study the relationship between LV mass index (LVMi) increase and measures of LV function, including strain in AS; 2) To investigate whether augmentation of global myocardial radial and circumferential strain (GRS, GCS) compensates for the GLS reduction in AS patients with preserved EF. Methods One-hundred and eleven patients with varying degrees of AS, and 20 age- and gender-matched healthy volunteers were prospectively enrolled. transthoracic echocardiography with offline strain analysis was performed using TomTec software. Intra- and inter-observer variability of linear LV internal dimensions/thickness, EF and strain indices was tested on 20 randomly selected patients. Results Clinical and demographic characteristics of cases and controls are shown in Figure 1. GLS was impaired in AS patients compared to controls. In AS with preserved EF (>50%), as LVMi increased, GLS progressively improved up to a point, beyond which any further increase in LVMi appeared counter-productive with impairment of GLS (Figure 1). EF preservation in these AS patients was mediated by a compensatory supernormal augmentation of GRS and a smaller augmentation of GCS (Figure 1). We observed a significant inverse correlation between GRS and GLS (r = 0.3, p = 0.002), and a similar trend between GCS and GLS (r = 0.275, p = 0.004). Intraclass correlation coefficient was high for all measurements (0.7-0.9). Conclusion In patients with AS and preserved EF, progressive myocardial hypertrophy improves GLS up to a point beyond which GLS drops and GRS increase to compensate. This plasticity of myocardial mechanics, in particular the supranormal augmentation of GRS is what enables the pathologically hypertrophied AS ventricle to delay the otherwise inexorable decline in its global systolic function. Abstract 618 Figure 1

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Intramyocardial fast-SENC is less impacted by compensatory mechanisms while monitoring cardiotoxic effects of chemotherapy than echocardiography and conventional CMR: the PREFECT study

European Heart Journal ◽

10.1093/ehjci/ehaa946.1222 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Steen ◽

M Montenbruck ◽

B Gersak ◽

A.K Schwarz ◽

S Esch ◽

...

Keyword(s):

Global Longitudinal Strain ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Funding Source ◽

Peak Strain ◽

Loading Conditions ◽

Compensatory Mechanisms ◽

Private Company ◽

Ventricular Ejection Fraction

Abstract Background Cancer treatments (CT) have been shown to occasionally elicit a toxic reaction on the heart. Echocardiography (ECHO) and cardiac magnetic resonance imaging (CMR) have been used to monitor cardiotoxicity through left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Fast-SENC (fSENC) CMR testing directly measures intramyocardial contraction to quantify subtle changes in function capable of detecting cardiotoxicity missed by conventional imaging modalities. The PREFECT study compares fast-SENC vs ECHO in terms of sensitivity of predicting and detecting subclinical (sCTX) or clinical cardiotoxicity (cCTX) irrespective of loading conditions or changes in cardiac output. Methods A single center, prospective clinical trial of patients receiving anthracycline-based CT had fSENC acquired during CMR exams with a 1.5T scanner. Intramyocardial LV & RV strain was quantified with MyoStrain software. Three short axis scans (basal, midventricular, & apical) were used to calculate peak strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3-, & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. Results 63 patients had 323 scans; 41% experienced sCTX and 15% cCTX. Figure 1 shows a Box and Whisker's plot for the % of fSENC ≤−17 by cardiotoxicity status. Both fSENC and CMR LVEF detected sCTX and cCTX based on ANOVA analysis (p<0.001) although fSENC had better delineation of both sCTX and cCTX. However, ECHO LVEF and GLS did not detect sCTX or cCTX (p=NS). CMR stroke volume index decreased while blood pressure and heart rate increased for both sCTX and cCTX (p<0.001). Meanwhile, mass index and end-systolic volume index increased for cCTX (p<0.001). Conclusion Segmental fSENC detected early CT-induced sCTX regardless of loading conditions. ECHO did not detect sCTX potentially due to compensatory mechanisms or acoustic window limitations in breast cancer and lymphoma patients that had less effect on CMR. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Myocardial solution (MSI)

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Abstract P137: Nonspecific ST-T Change In Electrocardiogram Was Associated With A Reduced Constructive Myocardial Work In Hypertensive Patients With Preserved Ejection Fraction

Hypertension ◽

10.1161/hyp.78.suppl_1.p137 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Joji Ishikawa ◽

Saori Nakamura ◽

Ayumi Toba ◽

Masashi Miyawaki ◽

Ruri Shimizu ◽

...

Keyword(s):

Ejection Fraction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Work Efficiency ◽

Ventricular Ejection Fraction ◽

Hypertensive Patients ◽

Constructive Work ◽

Global Work

Background: Nonspecific ST-T change in electrocardiogram can be observed in hypertensive heart disease with preserved left ventricular ejection fraction (LVEF); however, the relationship between nonspecific ST-T change and global myocardial work in echocardiography was unclear. Methods: We evaluated global longitudinal strain (GLS), GWI (global work index), GCW (global constructive work), GWW (global wasted work), GWE (global work efficiency), using offline analyzing system (View Pal, GE) in 196 hypertensive patients with preserved LVEF (>50%). Nonspecific ST-T change and major ST-T change (depression of ST in V5 lead >1mV) was also evaluated in electrocardiogram. Results: Mean age was 79.3±8.2 years (men 37.8%). Compared with patients with no ST-T change, those with nonspecific and major ST-change had a smaller absolute value of GLS (-20±3, -18±4, -14±5%, P<0.001) and had smaller constructive work load [GWI (2140±488, 1915±472, 1523±776 mmHg%, P<0.001), GCW (2410±514, 2165±471, 1694±784 mmHg%, P<0.01)]. Additionally, those with nonspecific and major ST-T change had an increased wasted myocardial work [GWW (87±61, 109±58, 138±71 mmHg%, P<0.001)], and this resulted in reduction of myocardial work efficiency [GWE (95±4,93±3,87±12%,P<0.001)]. Even after adjustment for age, sex, diabetes, dyslipidemia, EF, LV mass index, relative wall thickness, parameters of diastolic function (E/A, E/e’, left atrial volume index, tricuspid valve regurgitant flow velocity), and electrocardiogram LVH of Cornell product and Sokolow-Lyon voltage, the patients with nonspecific ST-T change had a significantly smaller LV global constructive work. [GWI (2243±41 vs. 1998±96 mmHg%, P=0.025), GCW (2501±45 vs. 2210±105 mmHg%, P=0.015)]. Conclusion: In hypertensive patients with preserved LVEF, nonspecific ST-T change in electrocardiogram was associated with a reduced constructive work in LV.

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Associations of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet with cardiac remodelling in the community: the Framingham Heart Study

British Journal Of Nutrition ◽

10.1017/s0007114521000660 ◽

2021 ◽

pp. 1-9

Author(s):

Maura E. Walker ◽

Adrienne A. O’Donnell ◽

Jayandra J. Himali ◽

Iniya Rajendran ◽

Debora Melo van Lent ◽

...

Keyword(s):

Risk Factors ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Root Diameter ◽

Left Ventricular ◽

Cardiac Remodelling ◽

Lv Function ◽

The Mediterranean ◽

Diet Score ◽

Mind Diet

Abstract Normal cardiac function is directly associated with the maintenance of cerebrovascular health. Whether the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet, designed for the maintenance of neurocognitive health, is associated with cardiac remodelling is unknown. We evaluated 2512 Framingham Offspring Cohort participants who attended the eighth examination cycle and had available dietary and echocardiographic data (mean age 66 years; 55 % women). Using multivariable regression, we related the cumulative MIND diet score (independent variable) to left ventricular (LV) ejection fraction, left atrial emptying fraction, LV mass (LVM), E/e’ ratio (dependent variables; primary), global longitudinal strain, global circumferential strain (GCS), mitral annular plane systolic excursion, longitudinal segmental synchrony, LV hypertrophy and aortic root diameter (secondary). Adjusting for age, sex and energy intake, higher cumulative MIND diet scores were associated with lower values of indices of LV diastolic (E/e’ ratio: logβ = −0·03) and systolic function (GCS: β = −0·04) and with higher values of LVM (logβ = 0·02), all P ≤ 0·01. We observed effect modification by age in the association between the cumulative MIND diet score and GCS. When we further adjusted for clinical risk factors, the associations of the cumulative MIND diet score with GCS in participants ≥66 years (β = −0·06, P = 0·005) and LVM remained significant. In our community-based sample, relations between the cumulative MIND diet score and cardiac remodelling differ among indices of LV structure and function. Our results suggest that favourable associations between a higher cumulative MIND diet score and indices of LV function may be influenced by cardiometabolic and lifestyle risk factors.

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Visualizing myocardial injury from elective cardioversion with CMR

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.310 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Fischer ◽

C Riecker ◽

S Overney ◽

M Stucki ◽

H Tanner ◽

...

Keyword(s):

Myocardial Injury ◽

Systolic Function ◽

T2 Mapping ◽

Extracellular Volume ◽

Left Ventricular ◽

Diffuse Fibrosis ◽

Lv Function ◽

Chronic Injury ◽

The Third ◽

Myocardial Area

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Association of Cardiothoracic Anaesthesiologists Research Grant Background Despite everyday use of electrical interventions in cardiovascular care, the extent and type of concomitant myocardial injury is not fully understood. Current literature disagrees about the question whether and how cardioversion or defibrillation damage the myocardium, especially when serologic markers are used. Such markers are not always cardiac-specific, nor diagnostic for type and region of myocardial injury. These limitations may be overcome by parametric T1 and T2 mapping. We aimed to investigate whether the acute and long-term impact of electrical cardioversion on myocardial structure and function is detectable using CMR imaging. Methods Patients scheduled for elective cardioversion were enrolled to undergo three CMR exams (3 Tesla): on the morning prior to cardioversion to assess pre-existing injury; two to five hours after cardioversion to assess the acute response; and six to ten weeks later to investigate chronic injury. The CMR exam studied left ventricular (LV) function, T2 mapping to measure edema, and extracellular volume (ECV) from T1 maps to measure diffuse fibrosis. Both the degree of injury and proportion (%) of myocardial area affected were analysed. Results Eight patients completed the study, requiring 1-2 shocks (totalling 120-300 J biphasic energy) to achieve sinus rhythm. LV ejection fraction increased after cardioversion from 47 ± 13% to 55 ± 15% (p = 0.020), and was 52 ± 16% at the third exam (p = 0.199). Even prior to intervention, some patients showed edema (baseline T2 > 40ms) afflicting 49 ± 23% of their LV myocardium. Area affected by edema expanded to 72 ± 18% after cardioversion (p = 0.002) and returned to 54 ± 24% by the third exam. T2 rose from baseline (40.4 ± 1.8ms) after cardioversion acutely to 44.1 ± 5.2ms (p = 0.028) and normalized until the late exam (40.8 ± 3.1ms). Myocardial area affected by diffuse fibrosis (ECV > 30%) was 28.3 ± 9.4% at baseline and 38.8 ± 18.9% late after cardioversion (p = 0.018). Pathologic T2 increases (indicative of edema) were not observed in all patients, but individuals with higher baseline ECV also experienced greater T2 increase after cardioversion (r = 0.840, p = 0.036). Conclusion Elective cardioversion improves LV systolic function, but also aggravates myocardial edema and possibly adds to diffuse fibrosis during several weeks thereafter. Such sequelae of cardioversion were observed mainly in patients with a greater burden of pre-existing myocardial injury. More data is needed to corroborate these preliminary findings and to study whether this type of myocardial injury predicts worse outcome. Moreover, changes in CMR markers caused by electrical interventions including defibrillation, may have the potential to confound diagnostic assessments of the underlying cardiac injury. Abstract Figure

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