scholarly journals Heart transplantation and antibody-mediated rejection: role of myocardial strain as an early marker of cardiac dysfunction in patients with anti-HLA antibody

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Sciaccaluga ◽  
B.M Natali ◽  
G.E Mandoli ◽  
N Sisti ◽  
F.M Righini ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Right Ventricular Strain ◽  
Hla Antibody

Abstract Background Antibody-mediated rejection of the transplanted heart is still currently diagnosed by endomyocardial biopsy whereas clinical elements, anti-Human Leukocite Antigens (HLA) antibody and graft dysfunction represents supplementary components. Purpose The aim of the study was to identify though a non-invasive imaging technique, such as advanced transthoracic echocardiography, early signs of altered cardiac function in patients with anti-HLA antibodies and no histological signs of antibody-mediated rejection. Methods The study population included 117 heart transplanted patients, in whom both acute and chronic rejection was excluded. They were divided into two groups “HLA+`' (45 patients) and “HLA−” (72 patients), based on the presence and the absence of circulating anti-HLA antibodies, respectively. The echocardiographic exam was performed within one week from the biopsy, including Speckle Tracking analysis. Results Deceleration Time of E wave was the strongest traditional echocardiographic parameter which correlated with circulating anti-HLA antibodies (165±39,5 vs 196,5±25; p<0.001). Regarding strain analysis, both left ventricular global longitudinal strain (−16,1±3,4 vs −19,8±2,0; p<0.001) and right ventricular strain (−17,2±0,7 vs −20,6±0,5; p=0.0002) differed significantly between the two subgroups (Figure 1). On the other hand, neither peak atrial longitudinal strain nor peak atrial contraction strain showed a significant correlation with anti-HLA antibodies. Conclusion The presence of circulating anti-HLA antibodies seems to be correlated with a mild cardiac dysfunction, even in the absence of antibody-mediated rejection. This subtle dysfunction is not completely detectable by standard echocardiographic parameters, whereas strain analysis has showed promising results since it revealed more clearly an impaired function of both ventricles in heart transplanted HLA+ patients, with potentially important clinical repercussion. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals P890 Heart transplantation and antibody-mediated rejection: role of the strain as an early marker of cardiac dysfunction in patients with anti-HLA antibody

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
B M Natali ◽  
F M Righini ◽  
M Cameli ◽  
C Sciaccaluga ◽  
S Bernazzali ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Endomyocardial Biopsy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Invasive Technique ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Echocardiographic Parameters ◽  
Hla Antibody

Abstract Background Antibody-mediated rejection of the transplated heart is essentially diagnosed through endomyocardial biopsy whereas clinical elements, anti- Human Leukocite Antigens (HLA) antibody and graft dysfunction are supplementary components. Over the years, several studies have tried to define early diagnostic markers, but to date a univocal consensus has not been achieved. Purpose The aim of the study was to identify though a non-invasive technique, such as transthoracic echocardiography, early signs of impaired cardiac function in heart transplanted patients, in presence of anti-HLA antibodies but without any histological sign of antibody-mediated rejection, assessed through endomyocardial biopsy. Methods In the study 29 heart transplanted patients were enrolled, and they were divided into two groups ‘HLA+’ (15 patients) and ‘HLA-’ (14 patients), based on the presence and the absence of circulating anti-HLA antibodies, respectively. None of the patients had evidence of either coronary allograft vasculopathy or antibody-mediated rejection, attested by endomyocardial biopsy. Each patient underwent through echocardiographic exam, within one month from the biopsy, analysing standard parameters of both systolic and diastolic function, together with strain analysis of right and left ventricle (RV and LV) and left atrium (LA). Results Clinical and demographic characteristics did not different significantly between the two groups, and neither did standard echocardiographic parameters. The only significant parameter that show a statistically significant different was Deceleration Time of E wave (DecT E), which resulted to be lower in the ‘HLA+’ group. Regarding strain analysis, peak atrial longitudinal strain was significantly different between HLA+ and HLA- patients (10,9 ± 5,6 vs 14,9 ± 4,5; p < 0.005), whereas peak atrial contraction strain did not. The study attested a strong difference of both LV global longitudinal strain (- 20,2 ± 5,9 vs - 23,2 ± 3,3; p < 0.005) and RV strain between the two analysed subsets (-16,9 ± 3,4 vs -19,3 ± 3,1 p < 0.005). The figure shows the most significant correlations found in the study, respectively RV strain (on the left), LV strain (in the middle) and DecT E (on the right), the figures on top are representative of HLA- patients, whereas the ones at the bottom are representative of HLA+ patients. Conclusion The presence of circulating anti-HLA antibodies seems to be correlated with a mild cardiac dysfunction, even in the absence of antibody-mediated rejection. This subtle dysfunction is not completely detectable by standard echocardiographic parameters, whereas strain analysis has showed promising results since it revealed more clearly an impaired function of both ventricles in heart transplanted HLA+ patients, with potentially important clinical repercussion. Abstract P890 Figure.

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 2819: Identification and Characterization of Super-Responders to Cardiac Resynchronization Therapy: An Echocardiographic Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Amira Zaroui ◽  
Patricia Reant ◽  
Erwan Donal ◽  
Aude Mignot ◽  
Pierre Bordachar ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
End Systolic Volume

In some patients, cardiac resynchronization therapy (CRT) has been recently shown to induce a spectacular effect on left ventricular (LV) function and inverted remodeling with nearby normalization of LV contraction. Objectives: To analyze and characterize super-responders (CRTSR) by echocardiography before CRT. 186 patients have been investigated before and 6 months after implantation of a CRT device with conventional indication according to ESC guidelines. Echocardiographies including measurements of LV dimensions, and contraction by 2-dimensional strain, and pressure assessment, mitral valve analysis were performed at baseline and at 6 months in an independent core-center lab. CRTSR were defined as a reduction of end-systolic volume of at least 15% and an ejection fraction (EF)>50% and were compared to normal responder patients (CRTNo, patients with a reduction of end-systolic volume of at least 15% but an EF <50%). 17/186 patients (9.1%) were identified as CRTSR, only 2 with ischemic cardiomyopathy (p<0.01). No difference was observed regarding NYHA status, EKG duration or EF between CRTSR and CRTNo at baseline. CRTSR presented with significant lower end-diastolic and end-systolic diameters (64±9mm vs 73±9mm (p<0.01) and 53±7.4mm vs 63±8.4mm (p<0.01), respectively), and end-diastolic and end-systolic volumes 161±44ml vs 210±76ml (p<0.02) and 123±43ml vs 163±69ml (p<0.01)) as well as a higher LV dP/dt max (714±251mmHg.s −1 vs 527±188 mmHg.s −1 (p<0.05)). Regarding strain analysis, CRTSR had significantly higher longitudinal values than CRTNo (−12.8±3% vs −9±2.6%, p<0.001) whereas no difference was observed for other components (p ns). Global longitudinal strain obtained by ROC curves was identified as the best parameter for predicting CRTSR with a cut-off value of −11% (Se=80%, Spe=87%, AUC=0.89, p<0.002) and was confirmed as an independent predictor by the logistic regression (RR: 21.3, p<0.0001). In a large multicenter study, CRT super-responders (EF>50%) were observed in 9% of the population and were associated with less-depressed LV function as determined by strain analysis. Global longitudinal strain appears to be the best predictor of CRTSR.

scholarly journals Prognostic Value of Different CMR-Based Techniques to Assess Left Ventricular Myocardial Strain in Takotsubo Syndrome

2020 ◽  
Vol 9 (12) ◽  
pp. 3882
Author(s):  
Thomas Stiermaier ◽  
Kira Busch ◽  
Torben Lange ◽  
Toni Pätz ◽  
Moritz Meusel ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Prognostic Information ◽  
Long Term Mortality

Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS −11.28%, TT-GLS −11.45%, and fast manual LAS −10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS > −11.28% (25.0% versus 9.8%; p = 0.029), TT-GLS > −11.45% (20.0% versus 5.4%; p = 0.016), and LAS > −10.86% (23.3% versus 6.6%; p = 0.014). However, in multivariable analysis, diabetes mellitus (p = 0.001), atrial fibrillation (p = 0.001), malignancy (p = 0.006), and physical triggers (p = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities.

P1494Usefulness of longitudinal strain adjusted to regional thickness in hypertrophic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Mansencal ◽  
S Utado ◽  
M Hauguelf-Moreau ◽  
S Mallet ◽  
P Charron ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Region Of Interest ◽  
Left Ventricular ◽  
Control Group ◽  
Myocardial Wall ◽  
Regional Strain ◽  
Standard Software

Abstract Background In hypertrophic cardiomyopathy (HCM), longitudinal strain analysis allows to early detect left ventricular (LV) contraction abnormalities despite preserved LV ejection fraction. In current software, the width of the region of interest (ROI) is the same over the entire myocardial wall, and might analyze partially LV hypertrophic segments. Purpose The aim of this study is to evaluate a novel software for strain analysis with an adjustable ROI according to each segment thickness. Methods We included 110 patients: 55 patients with HCM (HCM group) and 55 healthy subjects (age- and sex-matched control group). All patients underwent echocardiography using a Vivid 9 GE system and measurements were performed using EchoPAC software. Global longitudinal strain (GLS) and regional strain for each of the 17 segments was calculated with standard software (for 2 groups) and with software adjusted to the myocardial wall thickness (for HCM group). Results GLS was significantly decreased in the HCM group as compared to the control group (−15.1±4.8% versus −20.5±4.3%, p<0.0001). In HCM group, GLS (standard method versus adjusted to thickness) were not significantly different (p=0.34). Interestingly, regional strain adjusted to thickness was significantly lower than standard strain in hypertrophic segments, especially in basal inferoseptal segment (p=0.0002), median inferoseptal segment (p<0.001) and median anteroseptal segment (p=0.02). Strain adjusted to thickness was still significantly lower in the most hypertrophic segments (≥20 mm) (−3.7±3%, versus −5.9±4.4%, p=0.049 in the basal inferoseptal segment and −5.7±3.5% versus −8.3±4.5%, p=0.0007 in the median inferoseptal segment). Analysis of strain adjusted to thickness had a better feasibility (97.5% versus 99%, p=0.01). Conclusion Analysis of longitudinal strain adjusted to regional thickness is feasible in HCM and allows a better evaluation of myocardial deformation, especially in the most LV hypertrophic segments.

scholarly journals Strain by speckle tracking echocardiography correlates with electroanatomic scar location and burden in ischaemic cardiomyopathy

2021 ◽  
Author(s):  
Siddharth J Trivedi ◽  
Timothy Campbell ◽  
Luke D Stefani ◽  
Liza Thomas ◽  
Saurabh Kumar
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Low Voltage ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Myocardial Contraction ◽  
Left Ventricular ◽  
High Density ◽  
Ischaemic Cardiomyopathy ◽  
Multilayer Strain

Abstract Aims Ventricular tachycardia (VT) in ischaemic cardiomyopathy (ICM) originates from scar, identified as low-voltage areas with invasive high-density electroanatomic mapping (EAM). Abnormal myocardial deformation on speckle tracking strain echocardiography can non-invasively identify scar. We examined if regional and global longitudinal strain (GLS) can localize and quantify low-voltage scar identified with high-density EAM. Methods and results We recruited 60 patients, 40 ICM patients undergoing VT ablation and 20 patients undergoing ablation for other arrhythmias as controls. All patients underwent an echocardiogram prior to high-density left ventricular (LV) EAM. Endocardial bipolar and unipolar scar location and percentage were correlated with regional and multilayer GLS. Controls had normal GLS and normal bipolar and unipolar voltages. There was a strong correlation between endocardial and mid-myocardial longitudinal strain and endocardial bipolar scar percentage for all 17 LV segments (r = 0.76–0.87, P &lt; 0.001) in ICM patients. Additionally, indices of myocardial contraction heterogeneity, myocardial dispersion (MD), and delta contraction duration (DCD) correlated with bipolar scar percentage. Endocardial and mid-myocardial GLS correlated with total LV bipolar scar percentage (r = 0.83; 0.82, P &lt; 0.001 respectively), whereas epicardial GLS correlated with epicardial bipolar scar percentage (r = 0.78, P &lt; 0.001). Endocardial GLS −9.3% or worse had 93% sensitivity and 82% specificity for predicting endocardial bipolar scar &gt;46% of LV surface area. Conclusions Multilayer strain analysis demonstrated good linear correlations with low-voltage scar by invasive EAM. Validation studies are needed to establish the utility of strain as a non-invasive tool for quantifying scar location and burden, thereby facilitating mapping and ablation of VT.

scholarly journals CMR-derived myocardial strain analysis differentiates ischemic and dilated cardiomyopathy - A propensity score-matched study

2021 ◽  
Author(s):  
Julia Vietheer ◽  
Lehmann Lena ◽  
Claudia Unbehaun ◽  
Ullrich Fischer-Rasokat ◽  
Jan Sebastian Wolter ◽  
...  
Keyword(s):  
Propensity Score ◽  
Dilated Cardiomyopathy ◽  
Propensity Score Matching ◽  
Feature Tracking ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Radial Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Myocardial Strain Analysis

Abstract Purpose Left ventricular (LV) longitudinal, circumferential, and radial motion can be measured using feature tracking of cardiac magnetic resonance (CMR) images. The aim of our study was to detect differences in LV mechanics between patients with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) who were matched using a propensity score-based model. Methods Between April 2017 and October 2019, 1224 patients were included in our CMR registry, among them 141 with ICM and 77 with DCM. Propensity score matching was used to pair patients based on their indexed end-diastolic volume (EDVi), ejection fraction (EF), and septal T1 relaxation time. Feature tracking provided six parameters for global longitudinal, circumferential, and radial strain with corresponding strain rates. Results Propensity score matching yielded 72 patients in each group (DCM mean age 58.6 ± 11.6 years, 15 females; ICM mean age 62.6 ± 13.2 years, 11 females, p = 0.084 and 0.44 respectively; LV-EF 32.2 ± 13.5% vs. 33.8 ± 12.1%, p = 0.356; EDVi 127.2 ± 30.7 ml/m² vs. 121.1 ± 41.8 ml/m², p = 0.251; native T1 values 1165 ± 58 ms vs. 1167 ± 70 ms, p = 0.862). There was no difference in global longitudinal strain between DCM and ICM patients (-10.9 ± 5.5% vs. -11.2 ± 4.7%, p = 0.72), whereas in DCM patients there was a significant reduction in global circumferential strain (-10.0 ± 4.5% vs. -12.2 ± 4.7%, p = 0.002) and radial strain (17.1 ± 8.51 vs. 21.2 ± 9.7%, p = 0.039). Conclusion Our data suggest that ICM and DCM patients have inherently different myocardial mechanics, even if phenotypes are similar. The ability to discriminate these two conditions may aid in developing additional prognostic and therapeutic strategies in the future.

Abstract 14734: Characterisation and Prognostic Relevance of Left Ventricular Global Longitudinal Strain in Patients With Systemic Lupus Erythematosus

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shaun Khanna ◽  
James M Newman ◽  
Aditya Bhat ◽  
Henry H Chen ◽  
Gary Gan ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiac Function ◽  
Lupus Erythematosus ◽  
Cardiac Dysfunction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Composite Outcome ◽  
Systemic Lupus ◽  
Prognostic Relevance

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease modulated by pro-inflammatory cytokines, which may result in myocardial dysfunction. Mean global longitudinal strain (GLS) is proposed to be a more sensitive measure of cardiac function in comparison to standard two-dimensional measures of left ventricular (LV) systolic function. Quantification of subclinical cardiac function, with impairment of LV-GLS, right ventricular free wall strain (RV-FWS), left atrial strain (LAs), and its prognostic relevance in patients with SLE is undefined. Hypothesis: SLE patients have evidence of subclinical cardiac dysfunction and the presence of impaired LV-GLS in this population portends a poor prognosis. Methods: Consecutive patients admitted to our institution with known history of SLE (> 1-year disease activity) were examined. Patients with pre-existing cardiac disease, LV ejection fraction (EF) <50% and those without comprehensive transthoracic echocardiograms were excluded. Mean GLS was performed offline using vendor-independent software (TomTec v4.6) and compared to age-, gender- and risk factor- matched controls. SLE patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events. Results: A total of 51 patients with SLE were compared to 51 matched controls. No significant differences in baseline demographics, medications and laboratory investigations was observed. Patients with SLE showed evidence of subclinical cardiac dysfunction with significantly lower LV-GLS (%) (-16.7±2.8 vs -21.3±2, p<0.01), lower RV FWS (%) (-21.2±4.8 vs -28.8±4.7, p<0.01) and LAs (%) (31.9±6.7 vs 35.5±6.1, p<0.01) when compared to controls, despite normal LVEF, RV FAC and LAEF. On analysis of outcomes of SLE patients, a total of 11 (21.6%) patients suffered the composite end-point during a mean follow-up of 48 months. Of interest, LV-GLS was a predictor of the composite outcome on log-rank test and cox regression analysis (p<0.01). Conclusions: Our results suggest that SLE patients display evidence of subclinical cardiac dysfunction via a reduction in LV GLS, RV-FWS and LAs. Impairment in LV-GLS is associated with adverse cardiovascular outcomes in this population.

scholarly journals Subclinical cardiac dysfunction in sarcoidosis indicated by impaired left ventricular global longitudinal strain: association with outcome

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P2971-P2971
Author(s):  
E. Joyce ◽  
M. K. Ninaber ◽  
S. Katsanos ◽  
P. Debonnaire ◽  
C. Taube ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular
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