scholarly journals Normalization of global longitudinal strain after a 30-seconds exercise bout in elite athletes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S M Verwijs ◽  
H A C M De Bruin-Bon ◽  
J C Van Hattum ◽  
J L Spies ◽  
R N Planken ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Elite Athletes ◽  
Imaging Modality ◽  
Global Longitudinal Strain ◽  
Mechanical Strain ◽  
Exercise Bout ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Physiological Adaptation ◽  
Post Exercise

Abstract Background/Introduction Transthoracic echocardiography (TTE) is often the first diagnostic imaging modality of choice in athlete care to differentiate between physiological adaptation to sports and pathology. Mechanical strain as outcome measure, i.e. left ventricular (LV) global longitudinal strain (GLS), has been suggested as a tool to detect early signs of myocardial diseases in athletes. However, low or very low rates of myocardial deformation can also be associated with cardiac adaptation to sports. We hypothesize that observing decreased cardiac deformation in elite athletes may be a sign of an outspoken relaxed cardiac state, rather than pathology. Therefore, we investigated whether a short exercise bout can normalize strain values in elite athletes with abnormal resting GLS. Methods We prospectively enrolled elite athletes who participated in the ELITE (Evaluation of Lifetime Participation in Intensive Top-level Sports and Exercise) cohort. In short, ELITE is a prospective athlete cohort, which collects medical history, ECG, TTE and cardiac magnetic resonance (CMR) data in elite athletes (Olympic/Paralympic level or comparable). For this analysis, we analysed TTEs of asymptomatic athletes without cardiovascular disease and with a structurally normal heart on CMR. TTE (Vivid, GE) was performed in each athlete according to guidelines at rest. After a short exercise bout, consisting of 20 squats, additional measurements were performed when heart-rate (HR) was comparable to HR during pre-exercise measurements. TTE data was assessed using EchoPAC (GE). Paired t-tests were calculated for functional parameters; boxplots for pre- and post-exercise measurements; and GLS delta (pre- to post-exercise) for each athlete was calculated were plotted; using R. GLS ≥−16% was considered decreased and −16% ≥ GLS >−18% borderline. Results Our population comprised 51 athletes (35% women), with a mean age (±SD) of 26.4±5.2 years, and mean BSA of 2±0.3m2. Athletic disciplines consisted of road cycling (n=25), hockey (n=7), swimming (n=5), and 7 miscellaneous sports (n=14). We observed an increase of myocardial deformation after a short bout of exercise: mean GLS delta of 2.6±2% (pre- vs post-exercise GLS: −18.2±2.1% vs −20.8±1.9%; P≤0.001; Figure, A). Furthermore, mean LV stroke volumes were 94±19ml vs 103±23ml (P=0.020), ejection fractions (EF) 57±4% vs 60±4% (P≤0.001), and HR 55±10bpm vs 54±13bpm (P=0.8). Finally, we found a decreased strain in 8 athletes (16%), in 7 of which increased to normal values. Mean delta GLS was 4.5±2.2 (pre- vs post-exercise GLS: −14.9±1.1% vs −19.4±2.7%, P=0.002, Figure, B). The athlete who did not show an increase to normal GLS levels had a decreased LV EF (42%), but showed no other signs of cardiac pathology (MRI, biomarkers, complaints). Conclusion In athletes with abnormal GLS at rest, performing a short exercise bout may provide a pragmatic method to separate decreased GLS due to true pathology from sports adaptation. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Amsterdam Movement Sciences

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

Abstract 15528: Myocardial Deformation Imaging and Obstruction in Hypertrophic Cardiomyopathy, Insights from Cross-sectional and Post-myectomy Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yukari Kobayashi ◽  
Gherardo Finocchiaro ◽  
Genevieve Giraldeau ◽  
David Boulate ◽  
Yuhei Kobayashi ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Cross Sectional ◽  
Alcohol Ablation ◽  
Left Ventricular Deformation ◽  
The Impact

Background: Hypertrophic cardiomyopathy (HCM) has been reported to alter left ventricular deformation. However, little is known about the differences of left ventricular (LV) strain values among healthy and varying levels of HCM patients including non-obstructive and obstructive, nor about the impact of septal reduction therapy on strain values. Methods: Age- and sex matched patients with HCM and varying degree of obstruction as well as 48 healthy controls were studied. Among HCM patients, 28 subjects had non-obstructive HCM, 27 had mildly symptomatic obstructive HCM, and 34 had HCM requiring septal reduction therapy (either myectomy or alcohol ablation). LV global longitudinal strain (LV-GLS) and circumferential strain as well as routine echocardiography were evaluated. Detailed LV longitudinal strain was assessed with septal and lateral longitudinal strain (Sept.-LS and Lat.-LS). In HCM patients treated with septal reduction, echocardiography was performed before, 3-months, and 1-year after the procedure. Results: LV-GLS, Sept.-LS, and Lat.-LS of all HCM patients were significantly lower than controls (p<0.001, p<0.001, p<0.05, respectively), and circumferential endocardial and mid strain were higher (p<0.05). Significant differences among controls and varying levels of HCM subgroups were detected only in Sept.-LS, which enabled to stratify the HCM severity (left panel in Figure). In addition, Sept.-LS has the strongest correlation with the average LV wall thickness (right panel in Figure). Furthermore, Sept.-LS was significantly improved after septal reduction, whereas Lat.-LS and circumferential strain did not change. Conclusions: The strongest relationship between myocardial deformation and obstruction in HCM was found for Sept.-LS. Also, septal reduction procedure preferentially improves Sept.-LS.

scholarly journals Usefulness of a multiparametric evaluation including global longitudinal strain for an early diagnosis of acute myocarditis

2021 ◽  
Author(s):  
Anna Degiovanni ◽  
Maria Concetta Pastore ◽  
Enrico Guido Spinoni ◽  
Marta Focardi ◽  
Matteo Cameli ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Imaging Modality ◽  
Acute Myocarditis ◽  
Global Longitudinal Strain ◽  
Delayed Diagnosis ◽  
Left Ventricular ◽  
Absolute Value ◽  
Study Population ◽  
Laboratory Examinations ◽  
Wbc Count

AbstractCardiac magnetic resonance imaging (CMRI) represents the main imaging modality for diagnosing acute myocarditis. However, its limited availability could entail missing or delayed diagnosis. A reduction of left ventricular global longitudinal strain (LV GLS) by speckle tracking echocardiography (STE) correlates with amount of oedema in acute myocarditis and here may be early detected. Aim was to evaluate the diagnostic and prognostic role of 3-layers LV GLS in patients with acute myocarditis. Out of 122 patients with suspected acute myocarditis, a total of 86 consecutive patients with CMRI-confirmed acute myocarditis admitted in two Italian institutions were retrospectively screened. Exclusion criteria were met in 29 patients because of poor acoustic window or missing data. A total of 57 patients were then included. Clinical characteristics, laboratory examinations, transthoracic echocardiography data and STE parameters were collected early after hospitalization. In the study population, mean age was 38.8 ± 15.6 years, the prevalence of male gender was 90%. On admission, 22 patients (39%) had fever (body temperature > 37.5 °), mean white blood cell (WBC) count was 10.9 ± 1.7/10^3 and overall LV ejection fraction was 50.1% ± 11.2. An epicardial LV GLS < 18% was present in 74% of patients, and a model including at least one of LV GLS < 18% (absolute value), fever and WBC > 10.0/10^3 was able to identify all patients with CMRI-diagnosed acute myocarditis. An epicardial LV GLS < 15.3% (absolute value) at baseline significantly predicted the lack of myocarditis resolution during follow-up (AUC 0.76, 95% CI 0.58–0.93, p = 0.02). A multiparametric model including epicardial LV GLS, fever and elevated WBC count on admission could be useful for early diagnosing an acute myocarditis, especially when CMRI is not promptly available. Baseline epicardial LV GLS may also identify patients with less-likely myocarditis resolution.

P3552Estimating left ventricular myocardial deformation during cardiopulmonary exercise testing in patients with dilated cardiomyopathy and reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Triantafyllidi ◽  
D Birba ◽  
I Ikonomidis ◽  
G Makavos ◽  
D Benas ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Exercise Testing ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise

Abstract Background Cardiopulmonary exercise testing (CPET) has been recognized as a valuable tool regarding the integrated estimation of exercise ability in patients with several cardiopulmonary diseases, dilated cardiomyopathy (DCM) included. Left ventricular (LV) abnormal myocardial deformation might be studied by newer echocardiography techniques. Aim of this study is to explore differences of LV myocardial deformation in DCM patients during a CPET session. Methods Forty-four DCM patients (mean age 53±13 years, 34 men) with an ejection fraction <50% (mean EF = 33±10%) and no history of previous pulmonary disease were subjected to maximum CPET. Simultaneously, we estimated LV myocardial deformation using speckle tracking imaging and we measured global longitudinal strain (GLS), longitudinal strain rate both at systole (GLSrS) and diastole (GLSrE) at baseline and at peak exercise. The difference between GLS at baseline-GLS at peak exercise was defined as GLS difference. Results All patients finished uneventfully CPET (peakVO2 = 20±7 ml/min/kg) and improved GLS at peak exercise (GLS difference = 1.5±2). We found that at peak exercise, systolic blood pressure (SBP) was increased (119±14 vs. 159±23 mmHg, p<0.001) while GLS (−12.5±4 vs. −14±5, p<0.001), GLSrS (−0.7±0.2 and −1.0±0.4, p<0.001) and GLSrE (0.7±0.4 and 1.0±0.6, p=0.001) were improved. A positive correlation between peakVO2 and GLS difference was found, independent of peak SBP (β=0.38, p=0.01). Relationship between GLS dif and CPET Conclusions Patients with dilated cardiomyopathy and ejection fraction <50% present an increased exercise ability when they manage to improve LV GLS during maximum exercise. Consequently, LV GLS improvement during exercise characterizes beside patient's exercise ability the severity of heart failure as well.

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