scholarly journals Left atrial reservoir strain is reduced in patients with myocardial infarction with non-obstructive coronary arteries

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Malaty ◽  
H H L Chen ◽  
G Gan
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Funding Sources ◽  
Group Position ◽  
Lv Dysfunction

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a management conundrum given the poorly understood pathogenic mechanisms. In recent years, novel echocardiographic measures such as deformation/strain analysis have enabled early identification of left atrial (LA) remodelling and dysfunction which take place prior to structural alterations. LA dysfunction is an important biomarker of cardiovascular disease and an independent predictor of atrial arrhythmias which may play a fundamental role in the pathogenesis of MINOCA. Purpose The goal of our study was to evaluate and characterise LA function by speckle tracking strain echocardiography in patients with MINOCA. Methods Patients admitted to our institution with acute myocardial infarction were assessed and those diagnosed with MINOCA who underwent transthoracic echocardiogram (TTE) within 48-hours of their coronary angiogram were included. Diagnosis of MINOCA was based on the 2017 ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Two-dimensional speckle tracking strain analysis of the LA and left ventricle (LV) was performed offline using vendor independent software (TomTec Arena). Clinical and echocardiographic measures were compared to healthy controls identified from our echocardiography database. We excluded patients with history of atrial fibrillation, heart failure and LV dysfunction (LVEF <50%). Results The cohort consisted of 82 patients; 41 patients with MINOCA were compared to 41 age and sex matched controls (61% male, mean age 51±12.8 years). At baseline, patients with MINOCA had a higher prevalence of modifiable vascular risk factors including smoking, hypertension and diabetes (p<0.001 for all). Of the echocardiographic parameters, no differences in left ventricular (LV) parameters including LV global longitudinal strain (p=0.463), indexed LV mass (p=0.084) and the E/e' (p=0.391) was appreciated. Though there was no difference in LA volumes or volumetric parameters of LA function (LAEF; p=0.328), patients with MINOCA had a lower LA reservoir strain (29.7±8.5% vs 33.2±6.5%; p=0.04; 95% CI 0.32–5.33). Conclusion Patients with MINOCA demonstrated lower LASr despite normal LV and LA volumes. This suggests that LA dysfunction may play a role in the pathogenesis of MINOCA. Further studies are required to evaluate the significance of our findings. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Direct comparison of multilayer left ventricular global longitudinal strain using CMR feature tracking and speckle tracking echocardiography

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saikrishna Ananthapadmanabhan ◽  
Giau Vo ◽  
Tuan Nguyen ◽  
Hany Dimitri ◽  
James Otton
Keyword(s):  
Feature Tracking ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Imaging Modality ◽  
Global Longitudinal Strain ◽  
Intraclass Correlation ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Multilayer Strain

Abstract Background Cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) are well-established strain imaging modalities. Multilayer strain measurement permits independent assessment of endocardial and epicardial strain. This novel and layer specific approach to evaluating myocardial deformation parameters may provide greater insight into cardiac contractility when compared to whole-layer strain analysis. The aim of this study is to validate CMR-FT as a tool for multilayer strain analysis by providing a direct comparison between multilayer global longitudinal strain (GLS) values between CMR-FT and STE. Methods We studied 100 patients who had an acute myocardial infarction (AMI), who underwent CMR imaging and echocardiogram at baseline and follow-up (48 ± 13 days). Dedicated tissue tracking software was used to analyse single- and multi-layer GLS values for CMR-FT and STE. Results Correlation coefficients for CMR-FT and STE were 0.685, 0.687, and 0.660 for endocardial, epicardial, and whole-layer GLS respectively (all p < 0.001). Bland Altman analysis showed good inter-modality agreement with minimal bias. The absolute limits of agreement in our study were 6.4, 5.9, and 5.5 for endocardial, whole-layer, and epicardial GLS respectively. Absolute biases were 1.79, 0.80, and 0.98 respectively. Intraclass correlation coefficient (ICC) values showed moderate agreement with values of 0.626, 0.632, and 0.671 respectively (all p < 0.001). Conclusion There is good inter-modality agreement between CMR-FT and STE for whole-layer, endocardial, and epicardial GLS, and although values should not be used interchangeably our study demonstrates that CMR-FT is a viable imaging modality for multilayer strain

Early change in left atrial and left ventricular strain predicts sinus rhythm maintenance after cardioversion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kupczynska ◽  
D Miskowiec ◽  
B Michalski ◽  
L Szyda ◽  
K Wierzbowska-Drabik ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Recurrence Risk ◽  
Left Ventricular ◽  
Mechanical Function ◽  
Af Recurrence

Abstract Background Atrial fibrillation (AF) impairs mechanical function of the heart, especially atria and restoration of sinus rhythm (SR) leads to improvement of mechanics. The predicting role of changes in strain parameters for AF recurrence is not established yet. Purpose To analyse changes in left atrial (LA) and left ventricular (LV) mechanical function after conversion to SR and their prognostic values for AF recurrence during 24 months follow-up. Methods Prospective study involved 59 patients after successful electrical cardioversion (EC) because of nonvalvular AF (mean age 65±4 years, 47% female). Speckle tracking analysis (STE) was applied to calculate longitudinal strain of LV and LA before EC and within 24 hours after restoration of SR and additionally total left heart strain (TS) defined as a sum of absolute peak LV and LA strain. We calculated change in strain between AF and SR analyses expressed as delta (Δ). During follow-up we noticed AF recurrence in 42 (71%) patients, most of them (93%) during 1st year after EC. Median time of AF recurrence was 3 months. Results We noticed significant immediate post-EC improvement in peak LA longitudinal strain (PALS) and LV global longitudinal strain (LVGLS) (table). Unlike CHA2DS2-VASc score, strain parameters were predictors of AF recurrence. Every 1% increment in ΔLVGLS was related with 13% increase in AF recurrence risk (p=0.02) and every 1% increment in ΔPALS and ΔTS were related with 9% decrease in AF recurrence risk (p=0.007 and p=0.0014, respectively). Multivariate analysis revealed ΔTS as a strongest predictor with 9% decrease in AF risk per every 1% increment. The criterion of ΔTS ≤7.5% allows to predict AF recurrence with 81% sensitivity and 63% specificity. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR and these absolute changes in LVGLS as well as PALS can predict AF recurrence, with optimal stratification by novel parameter - TS. Funding Acknowledgement Type of funding source: None

scholarly journals P260Right cardiac chambers remodeling in marathon and ultra-trail athletes detected by speckle-tracking echocardiographyP261Speckle tracking determination of tissue motion annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patientsP262Value of right ventricular 2D-speckle tracking parameters in predicting the TIMI flow grade of the RCA in patients with acute RV infarctionP263The correlation between left atrial deformation indices and the CHA2DS2 - VASc risk score in patients with atrial fibrillationP264Right atrial and ventricular function evaluated with speckle tracking in patients with acute pulmonary embolismP265Enhanced accuracy of a speckle tracking strain based artificial intelligence model to differentiate ischaemic myocardial disease and cardiomyopathyP266Detection of early left ventricular and left atrial dysfunction in type I diabetes mellitus using 2D speckle tracking echocardiographyP267Two-dimensional left ventricular global longitudinal strain dynamics after percutaneous coronary intervention in stable single-vessel coronary artery disease patientsP268Left ventricular twist, torsion and strain in the fetus by 3D echocardiography: feasibility and comparisons with 2DP269Left atrial deformation analysis in acromegaly - a three-dimensional speckle-tracking echocardiographic studyP270Impact of hemodialysis on three-dimensional left ventricular myocardial deformation in end-stage renal disease: relationships with preload reductionP271Right atrial function in noncompaction cardiomyopathy - a three-dimensional speckle-tracking echocardiographic studyP272CABG failure in the era of cardiac computed tomography - after 8 years half the patients have at least one graft affected

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii45-ii48 ◽  
Author(s):  
K. Ujka ◽  
D Y Y Chiu ◽  
H. Tayel ◽  
SHAIMA Mostafa ◽  
E. Ramberg ◽  
...  
Keyword(s):  
Left Atrial ◽  
Speckle Tracking ◽  
Type I Diabetes ◽  
Global Longitudinal Strain ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Deformation Analysis ◽  
Type I ◽  
Timi Flow Grade ◽  
2D Speckle Tracking

scholarly journals P774 Utility of global longitudinal strain to predict post-operative outcomes in non-cardiac surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C J Park ◽  
L S Tan ◽  
P Huang ◽  
P J Tan ◽  
J H J See
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Risk Stratification ◽  
Longitudinal Strain ◽  
Myocardial Injury ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Operative Outcomes ◽  
Lv Dysfunction

Abstract Background Pre-operative echocardiography is performed in selected groups of patients for cardiac risk stratification prior to surgery. Many parameters, including Left Ventricular Ejection Fraction (LVEF), are assessed during echocardiography. While many studies have cited association between low LVEF and poor operative outcomes such as perioperative myocardial infarction or cardiogenic pulmonary edema, LVEF has limitations such as left ventricular (LV) cavity border tracing, geometric assumptions and inter-observer variability. LVEF may also appear normal in the presence of LV hypertrophy and a small LV cavity size. Studies have described the routine use of global longitudinal strain (GLS) as an alternative measure of ventricular function, with GLS having been reported to be a reliable marker in detecting subclinical LV dysfunction. This adds incremental value in predicting myocardial function and in risk stratification. In fact, some studies have documented GLS being a useful preoperative parameter in predicting postoperative LV dysfunction after cardiac valve surgery. Purpose The aim of this study is to determine the value of GLS in predicting post-operative outcomes in patients undergoing non-cardiac surgeries. Methods This was a retrospective study of all patients who had echocardiography performed for a pre-operative indication from February 2017 to October 2017. These patients were screened for those who had normal LVEF, had undergone subsequent non-cardiac surgery, and had post-operative troponins measured. Medical records were traced for baseline demographics, past medical history and echocardiographic features. GLS evaluation was prospectively performed using TOMTEC-ARENA (TOMTEC Imaging Systems GmbH) by assessors blinded to patient outcomes. Outcomes for major adverse cardiovascular events and mortality up to 1 year post surgery were collected. Post-op myocardial injury was defined as a peak Troponin T value of &gt;30 ng/L or a &gt;20% increment from baseline. Results A total of 42 patients were included. 61.9% (n = 26) were male and mean age was 72.3 years. Only 75.6% of patients were fully independent with activities of daily living and mean creatinine was 153.4μmol/L. Mortality at 1 year was 16.7% (n = 7) and 28.6% (n = 12) were deemed to have post-operative myocardial injury. 1-year mortality was associated with a lower GLS (-23.8% vs -19.2%, p = 0.001). However, GLS was not correlated with post-operative myocardial injury or hospital readmissions. In our study population, only a history of past myocardial infarction predicted post-op myocardial injury (58.3% vs 16.7%, p = 0.019). Conclusion Our study did not demonstrate the utility of GLS in predicting post-operative events, but this is likely because of the small sample size with low event rates. Nevertheless, GLS values did correlate with 1-year mortality and could be a marker of frailty and an increased mortality risk.

Urgent Myocardial Revascularization in Non ST-Segment Elevation Acute Myocardial Infarction Guided by Speckle Tracking Echocardiography: A Challenging Interventional Decision-Making

Cardiology ◽  
2018 ◽  
Vol 140 (4) ◽  
pp. 222-226 ◽  
Author(s):  
Fabio Capasso ◽  
Marco Pepe ◽  
Salvatore Severino ◽  
Giuseppe Valva ◽  
Pietro Landino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Myocardial Revascularization ◽  
Invasive Procedure ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Final Infarct Size

A 68-year-old man with a non-ST elevation myocardial infarction (NSTEMI) presented with a low risk profile indicating invasive revascularization within 72 h. However, left ventricular (LV) global longitudinal strain (GLS) calculated by two-dimensional speckle tracking echocardiography (2D-STE) in the Emergency Room showed substantial myocardial infarction. Therefore, urgent reperfusion therapy was decided and delivered within 30 min from hospital admission. LV GLS fully recovered after the invasive procedure and the final infarct size was 7%. This case shows that very early revascularization in NSTEMI patients can be guided by 2D-STE and might be considered for those patients with substantial LV myocardial infarction.

Abstract 15160: Atrioventricular and Ventricular Functional Interdependence in the Community

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yuriko Yoshida ◽  
Koki Nakanishi ◽  
Masao Daimon ◽  
Jumpei Ishiwata ◽  
Naoko Sawada ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Preventive Strategies ◽  
Lv Dysfunction ◽  
Functional Remodeling ◽  
Integral Role

Introduction: Left atrial (LA) and right ventricular (RV) performance play an integral role in the pathophysiology and prognosis of heart failure (HF). However, the alteration of atrioventricular and ventricular functional interdependence in a preclinical setting is unclear. We aimed to investigate the association between LA/RV functional remodeling and subclinical left ventricular (LV) dysfunction. Methods: LV global longitudinal strain (LVGLS), RV free wall longitudinal strain (RVLS) and LA reservoir strain were assessed by speckle-tracking echocardiography in 1,080 participants (600 men; 62±12 years) without cardiac disease. Results: A hundred and forty-three participants (13.2%) had an abnormal LVGLS (>-18.6%). LA reservoir strain and RVLS were significantly decreased in abnormal LVGLS group compared with normal LVGLS group (both p<0.001). LA and RV dysfunction (LA reservoir strain < 31.4% and RVLS > -19.2%) were present in 18.9% and 19.6% of participants with abnormal LVGLS, respectively (Figure). Decreased LVGLS was significantly associated with worse LA reservoir strain and RVLS (standardized β=-0.20 and 0.11 respectively, both p<0.01) independent of cardiovascular risk factors, pertinent biomarkers and LV geometry and diastolic dysfunction. Conclusions: In the general population without overt cardiac disease, approximately 20% subjects with impaired LVGLS exhibited LA/RV dysfunction, and LVGLS was independently associated with both LA and RV strain. Our findings may provide valuable insights for a better understanding of HF pathophysiology and possibly preventive strategies.

scholarly journals 1030 Usefulness of novel fully automated 2D speckle tracking software for left ventricular, left atrial, and right ventricular longitudinal strain analysis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Y Nabeshima ◽  
K Otani ◽  
T Kitano ◽  
M Takeuchi
Keyword(s):  
Left Atrial ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Strain Analysis ◽  
Automated Analysis ◽  
Left Ventricular ◽  
Medical Systems ◽  
Endocardial Border ◽  
Software Packages ◽  
2D Speckle Tracking

Abstract Funding Acknowledgements Philips Medical Systems Background Continuous efforts of EACVI-ASE strain standardization task force make inter-vendor variability of left ventricular (LV) global longitudinal strain (GLS) lower. However, observer variability is still a major source of measurement inconsistency. The adoption of fully automated 2D strain software has a potential to eliminate this problem. Purpose We aimed to validate the usefulness of novel fully automated LV, left atrial (LA), and right ventricular (RV) 2D speckle tracking software packages. Methods We retrospectively selected 91 healthy subjects who had undergone 2D echocardiography using a specific ultrasound machine (EPIQ, Philips Medical Systems). Standard apical 4-chamber, 2-chamber, and long-axis views which encompassed whole part of both left ventricle and left atrium and RV focused view were acquired in all subjects. Novel fully automated speckle tracking software packages (AutoStrain, QLAB 13.0) were used for measuring GLS on the three apical views, LA longitudinal strain (LALS) on the apical-4-chamber view, and RV free wall longitudinal strain (RVfwLS) on the RV-focused view. Image quality was assessed by 3-point scales (good, fair, and poor). Endocardial border detection was also classified into 3 groups (adequate, poor, and no detection). Endocardial border was manually adjusted, when required. Results of fully automated analysis and results with fully automated analysis + manual editing were compared. Results Mean age was 37 ± 13 years, and 61 subjects were men. The image quality was categorized more than "fair" in 80% of subjects. The software did not recognize LA border in 3 cases and RV border in 4 cases. Thus, the feasibility of fully automated LV, LA, and RV analysis were 100%, 97%, and 96%, respectively. LVGLS, LALS, and RVfwLS using fully automated approach were 19.7 ± 2.3%, 45.5 ± 11.6%, and 25.7 ± 5.6%, respectively. Manual correction was required in all cases. LVGLS, LALS, and RVfwLS after the manual editing were 18.9 ± 2.1%, 44.0 ± 10.4%, and 26.6 ± 6.4%. The intraclass correlation coefficient (ICC) between the two methods were 0.86, 0.72, and 0.74. The fully automated analysis took 22 ± 2 sec, 11 ± 1 sec, and 10 ± 1 sec for the measurements of LVGLS, LALS, and RVfwLS. The corresponding values with manual editing were 98 ± 18 sec, 53 ± 12 sec, and 52 ± 12 sec, respectively. Inter-observer ICCs of LVGLS, LALS, and RVfwLS with fully automated approach were all 1.0, but corresponding values after the manual editing were 0.82, 0.74, and 0.79, respectively. Conclusions Novel fully automated 2D speckle tracking software packages provide LVGLS, LALS, and RVfwLS within one minute, and these values were well correlated with the corresponding values after the manual editing, especially for LVGLS. This is a time-saving approach for longitudinal strain analysis in the three cardiac chambers. Further studies should be required to validate their potential utility in clinical setting.

scholarly journals 158 Myocardial work exposes afterload-dependent changes in strain

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O J Sletten ◽  
J Aalen ◽  
F H Khan ◽  
C K Larsen ◽  
K Inoue ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Stress Test ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Percentage Reduction ◽  
Relative Percentage ◽  
Lv Dysfunction ◽  
Patients At Risk

Abstract Funding Acknowledgements Norwegian Health Association Background Global longitudinal strain (GLS) is used for detection of subclinical left ventricular (LV) dysfunction, for example when screening for chemotherapy-induced cardiotoxicity. A relative percentage reduction in GLS ≥8% is considered abnormal. However, as GLS is load-dependent, modest increases in afterload can potentially prove sufficient to cause clinical implication. In contrast, global myocardial work (GMW) which incorporates afterload, may be more accurate in detecting LV-dysfunction. Purpose We investigated the effect of increased afterload on GLS, and if GMW may be a more accurate parameter of myocardial function during increased afterload. Methods In 20 healthy individuals (age 49 ± 11 years (mean ± SD), 10 men), blood pressure was increased by a 3 minute arithmetic mental stress test. GLS was measured by speckle tracking echocardiography and LV ejection fraction (EF) by biplane Simpson. GMW was calculated from LV pressure-strain analysis using a non-invasive estimate for LV pressure (LVP). Results During the afterload-elevation, systolic blood pressure increased by 25 ± 16 mmHg (p &lt; 0.01), and heart rate by 16 ± 13 bpm (p &lt; 0.01). This was followed by a decrease in EF from 62 ± 5 to 59 ± 5% (p &lt; 0.01) and GLS from 21.9 ± 2.2 to 20.8 ± 2.0% (p &lt; 0.01). In contrast, GMW increased from 2052 ± 278 to 2382 ± 388 mmHg·% (p &lt; 0.01). In 5 of 20 (25%) individuals, the relative percentage reduction of GLS was &gt;8%, despite an increase in GMW. The figure shows an individual example during rest and afterload-elevation, where an increase in systolic blood pressure of 16 mmHg was associated with a 9% relative percentage reduction in GLS, but a small increase in GMW as illustrated by the loop areas. Conclusions This study demonstrated that a modest increase in afterload can result in significant reduction in GLS, that may lead to overdiagnosis of LV-dysfunction. GMW did not decrease, suggesting it has a better specificity in patients at risk for subclinical LV dysfunction. Future studies should investigate if GMW is more accurate than strain in detecting LV-dysfunction. Abstract 158 Figure.

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