Laboratory indicators of inflammation and systolic function of the left and right ventricles in patients with cardiovascular disease who have undergone COVID-19-associated pneumonia

Abstract Introduction It is currently unknown what effect SARS-CoV-2 infection has on the parameters of aseptic inflammation in patients with cardiovascular diseases (CVD) in the long-term follow-up period and whether there is a relationship between the prolonged inflammatory response and the indicators of the global longitudinal strain, as the earliest marker of systolic dysfunction of left and right ventricles. Purpose To study the dynamics of markers of the inflammatory response and to assess the potential relationship of biomarkers of inflammation with parameters of left and right ventricular systolic function in patients with CVD who underwent COVID-19-associated pneumonia at the reference point 3 months after hospitalization. Methods The study included 63 patients (mean age 49.0±16.0 years) within “One-year Cardiac Follow-up of COVID-19 Pneumonia”. Group 1 (n=26) included patients without a history of CVD, group 2 (n=37) - patients with CVD. Three months after discharge from the hospital, patients came for a visit, where blood sampling and echocardiography with speckle tracking analysis were performed. Results At the stage of hospitalization, according to the computed tomography data, there were no differences in the volume of lung lesions in the groups. Patients with CVD had a higher level of highly sensitive C-reactive protein (CRP) upon admission to the hospital (group 1 – 33.12 [4.70–45.00] mg/l; group 2 – 47.16 [7.75–76.40] mg/L, p=0.039). Naturally, in the general group after 3 months, the indicators reflecting the inflammatory response significantly decreased: CRP from 26.10 [5.02–57.5] mg/L to 1.86 [0.76–3.43] mg/L, p<0.001; neutrophil-lymphocyte ratio (NLR), from 2.05 [1.08–2.94] to 1.54 [1.27–1.90], p=0.009; coefficient of large platelets, M±SD from 34.30±6.74 to 23.60±6.59, p<0.001. There were no differences between the groups in the dynamics of inflammation biomarkers. In group 1, there were no laboratory biomarkers associated with the parameters of myocardial systolic function. In group 2 negative relationship was recorded between the global longitudinal strain of the left ventricle and the CRP level c (r=−0.388; p=0.037) and with the platelet-lymphocyte ratio (PLR) (r=−0.383; p=0.040); endocardial global longitudinal strain of the right ventricle with CRP level (r=−0.386; p=0.039). Conclusions In patients who underwent COVID-19-associated pneumonia, after 3 months, the dynamics of laboratory markers of the inflammatory response did not depend on the presence of concomitant cardiac pathology, but only in patients with CVD there was a negative relationship between indicators of systolic function of the left and right ventricles and biomarkers of the inflammatory response. FUNDunding Acknowledgement Type of funding sources: None.

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4938Left ventricular global longitudinal strain recovery predicts scar size reduction and systolic remodelling post ST-elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz746.0008 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Vo ◽

T Nguyen ◽

A Chen ◽

J French ◽

J Otton ◽

...

Keyword(s):

Systolic Function ◽

Global Longitudinal Strain ◽

Scar Size ◽

Reverse Remodelling ◽

St Elevation ◽

Group 3 ◽

Group 2 ◽

Lv Systolic Function ◽

Group 1

Abstract Background Left ventricular (LV) strain has prognostic utility following ST-elevation myocardial infarction (STEMI); however, serial changes in LV strain has not been evaluated post-infarct. We sought to determine the relationship between post-STEMI transthoracic echocardiographic (TTE) LV global longitudinal strain (GLS) and cardiac magnetic resonance (CMR) imaging derived scar size and LV systolic remodelling. Methods Following revascularisation, 172 first STEMI patients (85% male, 56.9±10.7 years) had paired TTE for GLS, and CMR to evaluate scar size and LV systolic function at baseline (2–7 days) and follow-up (8–10 weeks). Patients were divided into 3 groups according to absolute baseline GLS: group 1 (GLS ≥16%), group 2 (12%< GLS <16%), group 3 (GLS ≤12%). GLS recovery was defined as ≥10% increase in GLS at follow-up, excluding patients with normal baseline GLS. LV systolic adverse remodelling was defined as ≥15% increase in LVESV. LV systolic reverse remodelling was defined as ≥15% decrease in LVESV. Scar reduction was defined as ≥30% decrease in scar size. Results Group 1 and 2 had smaller follow-up scar size and higher LVEF compared to group 3 (p<0.0001 for both, see table). There was no difference in scar size reduction or systolic reverse remodeling among the baseline GLS groups (p>0.05 for both). Importantly, no patients from group 1 demonstrated systolic adverse remodelling. Relative change in GLS is significantly correlated with changes in LVEF (r=0.354, p<0.0001) and scar size (r=−0.262, p<0.0001), see figure. On multivariate binary logistic analysis, patients who demonstrated GLS recovery had greater reduction in scar size (OR=2.77 (1.09–7.01), p=0.032) and LV systolic reverse remodelling (OR=9.63 (1.21–76.41), p=0.032). Follow-up parameters within GLS groups All patients (n=172) Group 1 (n=47) Group 2 (n=72) Group 3 (n=53) Follow-up GLS, % 16.02±3.44 19.38±1.90 16.36±2.09 12.57±2.69 GLS recovery, n 110 (64%) 19 (40%) 53 (74%) 38 (72%) Follow-up scar size, % 7.67±5.40 5.01±3.38 6.27±3.73 12.02±6.24 Follow-up LVEF, % 51.80±10.20 57.83±6.95 54.14±8.02 43.26±9.83 Data presented as mean ± SD or n (%). Correlation graphs for change in GLS Conclusion Stratification of STEMI patients by baseline GLS was a determinant of CMR scar size as well as LV systolic function. However, the evaluation of GLS recovery could provide additional insights into reduction in scar size and LV systolic remodelling, both important prognostic markers. Thus, echocardiographic serial GLS evaluation may be a relevant non-invasive parameter, that is cheaper and more widely available for monitoring STEMI patients and guiding therapy.

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Left ventricular global longitudinal strain reduction in patients with melanoma and extra-cardiac immune-related adverse events during immune checkpoint inhibitor therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.3261 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R.I Mincu ◽

J Pohl ◽

S Mrotzek ◽

L Michel ◽

L Hinrichs ◽

...

Keyword(s):

Immune System ◽

Adverse Events ◽

Metastatic Disease ◽

Immune Checkpoint ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Group 2 ◽

Group 1

Abstract Background Immune checkpoint inhibitors (ICI) have tremendously improved survival in patients with melanoma. By unbalancing the immune system, ICI also generate immune-related adverse events (IRAEs) that could affect any tissue, including the heart. Early detection of IRAEs is essential to avoid life-threatening adverse events like myocarditis and to maintain patients under this effective therapy. Aim To identify whether patients treated with ICI that develop extra-cardiac IRAEs additionally show a subclinical impairment of the heart function. Methods We have analysed the patients with melanoma without established cardiac disease evaluated in our cardio-oncology unit between July 2018 and December 2019. Data was collected at two timepoints: before initiating the ICI therapy (baseline) and one month after ICI treatment begin (follow-up). Evaluation was performed using clinical data, laboratory parameter including biomarkers, electrocardiography, comprehensive 2D, 3D, tissue Doppler, and speckle tracking echocardiography assessment, and cardiac magnetic imaging. Results A total of 69 patients with melanoma (59±12 years old, 63% males, 93.8% metastatic disease), without known cardiovascular disease were included. Patients were divided in two groups: patients with extra-cardiac IRAEs (Group 1, n=22) and without IRAEs (Group 2, n=46) after one month of ICI therapy. One patient was diagnosed with immune-related myocarditis at follow-up and was excluded from the analysis. Patients in Group 1 developed colitis (n=10), thyroiditis/hypophysitis (n=8), hepatitis (n=2), and pneumonitis (n=2). There were no differences in age, gender distribution, cardiovascular risk factors, or proportion of metastatic disease between the two groups. The proportion of patients treated with combination ICI therapy (nivolumab plus ipilimumab) was significantly higher in Group 1 (72% vs. 33%, p=0.04). The left ventricular systolic and diastolic function were similar at baseline and after one month of therapy between the two groups, except for the global longitudinal strain (GLS), which showed a significant reduction at follow-up for patients in Group 1 vs. Group 2 (−18.8±2.6% vs. −21±1.2%, p=0.03). The radial and circumferential strain were similar. Follow-up GLS had a good correlation with the extra-cardiac IRAEs rate (r=0.43; p=0.03). Patients with combination ICI therapy had a 5 times higher risk to develop extra-cardiac IRAEs (OR 5.33, 95% CI (1.07–26.61), p=0.04). Troponin and NT-proBNP were not significantly different at follow-up between the two groups. Conclusion The abnormal function of the immune system triggered by ICI therapy in patients with extra-cardiac IRAEs seems to induce a subclinical left ventricular dysfunction, signalized by a reduction of the GLS. However, the diagnosis criteria for myocarditis were fulfilled in only one patient. The mechanism of these changes should be further investigated and addressed. Funding Acknowledgement Type of funding source: None

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Comparative Characteristics of The Effects of Drug and Mechanical Reperfusion in The Treatment of Acute Coronary Syndrome with ST Elevation in Patients Working in Environmentally Challenging Conditions

Journal of Medical Biomedical And Applied Sciences ◽

10.15520/jmbas.v8i6.234 ◽

2020 ◽

Vol 8 (6) ◽

pp. 479-486

Author(s):

Javadova Tarana Mamedgasanovna ◽

Mammadgasan Mammadguseynovich Agayev

Keyword(s):

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Coronary Syndrome ◽

Combined Application ◽

St Elevation ◽

Group 2 ◽

Comparison Of The Results ◽

Group 1

Studied clinical and hemodynamic efficacy of complex use heparin,Сyто-Mас, propranolol (obzidan), fosinopril (monopril) with and PCI; PCI conducted separately on hemodynamics on cardiohemodynamics on ekoendotoksikoz (AMP) and the clinical course of patients working in environmentally stressful conditions in the acute phase and follow-up of MI. Comparison of the results of complex mediakamentoz and mechanical revascularization with PCI conducted separately. Investigated 50 patients with STMI in the age of 30 to 70 years (56,7 ± 1,20 years). Of the 50 patients 25 were treated Cyto-Mac, foznopril, propranolol with heparin and PCI (group 1); 25 patients were treated with PCI alone (group 2). In both groups, blood was determined by the degree ekoendotoksikoza (AMP) by EchoCG and Doppler EchoCG studied ESV, EDV, EF, SI, CI , an local contractility violation index of left ventricle (LCVI) , with the aid of restenosis koronorografii. A well established dynamics of systolic and diastolic blood pressure, clinical features of MI during follow-up. Patients treatedheparin,Cуто-мас, propranolol, foznopril and PCIindicators of central hemodynamics stabilizis. The reduced ЕSV,EDV, LCVI and decreased degree ofekoendotoksikoza (АMP), improves left ventricular systolic function of demand , increases PV. However, in this group, one patient on the third day was recorded AHF and one recurrent MI. İn The group spent only 2 PCI in relapse developed MI, 1 - restenosis, 2 -AHF and 1 patients died. The results show that the combined application of drug therapy with PCI provides a positive result in comparsionwiththan separately conducted PCI in ACS with elevation ST.

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Assessment of global longitudinal strain and plasma natriuretic peptide in patients with asymptomatic left ventricular dysfunction

Kardiologiia ◽

10.18087/cardio.2021.10.n1692 ◽

2021 ◽

Vol 61 (10) ◽

pp. 53-60

Author(s):

Ganchimeg Ulziisaikhan ◽

Mungun-Ulzii Khurelbaatar ◽

Chingerel Khorloo ◽

Naranchimeg Sodovsuren ◽

Altaisaikhan Khasag ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Roc Curve ◽

Longitudinal Strain ◽

Troponin I ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Lv Systolic Function

Objective The purpose of this study was to investigate the association between global longitudinal strain (GLS) and plasma NT-proBNP for predicting left ventricular (LV) performance in asymptomatic patients after acute myocardial infarction (AMI).Material and methods We prospectively included patients with diagnosis of AMI without clinical signs and symptoms of heart failure (HF) and followed these patients for 6 mos. Baseline echocardiography was performed at admission, and follow-up echocardiography was performed after 6 mos. A normal GLS was defined as having an absolute value of ≥16 %. According to the baseline GLS, participants were divided into two groups and compared. In all participants, blood samples of plasma NT-proBNP were obtained at admission, before discharge, and 6 mo after discharge.Results The study population was consisted of 98 participants, of which 80 (81.6 %) were males, and the mean age was 56.0±9.3 years. Baseline echocardiography showed that most of the participants (60, 61.2 %) had abnormal GLS<16 %, whereas 38 (38.8 %) participants had normal or borderline GLS ≥16 %. Compared with the normal GLS group, participants with abnormal GLS had higher GRACE score, higher troponin I concentration, lower systolic blood pressure, lower mean LV ejection fraction, and decreased LV diastolic function. At 6‑mo follow-up, only LV systolic function remained significantly different between the two groups. Compared to baseline, there was a significant improvement of GLS in the abnormal GLS group at 6‑mo follow-up (p=0.04). Prevalence of complications after AMI was significantly higher in this group. There were significant differences between baseline and discharge NT-proBNP concentrations between the two groups (p<0.05). In the abnormal GLS group, there were significant correlations between baseline and discharge NT-proBNP concentrations with baseline LV systolic function. Discharge NT-proBNP concentration also correlated significantly with 6‑mo follow-up GLS. For determining the effect of baseline GLS abnormality, the areas under the ROC curve for baseline and discharge NT-proBNP concentrations were 0.73 (95 % CI 0.60–0.85, p=0.001) and 0.77 (95 % CI 0.66–0.87, p<0.001), respectively. Regarding early prediction of follow-up GLS abnormality, the area under the ROC curve for discharge NT-proBNP concentration was significantly higher 0.70 (95 % CI 0.55–0.84, p=0.016). The optimum cut-off value of discharge NT-pro-BNP was 688.5 pg / ml, with 72.4 % sensitivity and 65.4 % specificity to predict 6‑mon GLS abnormality following acute myocardial infarction.Conclusion The main finding of this study is that impaired LV GLS is associated with elevated plasma concentrations of NT-proBNP in post-AMI patients. Pre-discharge NT-proBNP concentration combined with impaired initial GLS could predict worsening LV systolic function over time in asymptomatic post-AMI patients.

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Global longitudinal strain as a marker for systolic function in patients with pheochromocytomas

Endocrine Related Cancer ◽

10.1530/erc-20-0137 ◽

2020 ◽

Vol 27 (10) ◽

pp. 561-570

Author(s):

Atanaska Elenkova ◽

Rabhat Shabani ◽

Elena Kinova ◽

Vladimir Vasilev ◽

Assen Goudev ◽

...

Keyword(s):

Cardiac Function ◽

Longitudinal Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Strong Positive Correlation ◽

Echocardiographic Parameters ◽

Positive Correlations ◽

Fractional Shortening

Cardiomyopathy is a frequent complication of pheochromocytoma, and echocardiography is the most accessible method for its evaluation. The objective of this study was to assess the clinical significance of classical and novel echocardiographic parameters of cardiac function in 24 patients with pheochromocytomas (PPGL) compared to 24 subjects with essential hypertension (EH). Fourteen PPGL patients were reassessed after successful surgery. Left ventricular hypertrophy was four times more prevalent in patients with PPGL vs EH (75% vs 17%; P = 0.00005). Left ventricular mass index (LVMi) significantly correlated with urine metanephrine (MN) (rs = 0.452, P = 0.00127) and normetanephrine (NMN) (rs = 0.484, P = 0.00049). Ejection fraction (EF) and endocardial fractional shortening (EFS) were normal in all participants and did not correlate with urine metanephrines. Global longitudinal strain (GLS) was significantly lower in PPGL compared to EH group (−16.54 ± 1.83 vs −19.43 ± 2.19; P < 0.00001) and revealed a moderate significant positive correlations with age (rs = 0.489; P = 0.015), LVMi (rs = 0.576, P < 0.0001), MN (rs = 0.502, P = 0.00028) and NMN (rs = 0.580, P < 0.0001). Relative wall thickness (RWT) showed a strong positive correlation with urine MN (rs = 0.559, P < 0.0001) and NMN (rs = 0.689, P < 0.00001). Markedly decreased LVMi (118.2 ± 26.9 vs 102.9 ± 22.3; P = 0.007) and significant improvement in GLS (−16.64 ± 1.49 vs −19.57 ± 1.28; P < 0.001) was observed after surgery. ΔGLS depended significantly on the follow-up duration. In conclusion, classical echocardiographic parameters usually used for assessment of systolic cardiac function are not reliable tests in pheochromocytoma patients. Instead, GLS seems to be a better predictor for the severity and the reversibility of catecholamine-induced myocardial function damage in these subjects. RWT should be measured routinely as an early indicator of cardiac remodeling.

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Decreased layer specific longitudinal strain in myocardial segments supplied by stenosed LAD coronary artery: analysis for baseline, peak and recovery phase of stress echocardiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.0004 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Kowalczyk ◽

J.D Kasprzak ◽

P Hamala ◽

B Nowak ◽

R Nowakowski ◽

...

Keyword(s):

Coronary Artery ◽

Stress Echocardiography ◽

Longitudinal Strain ◽

Statistical Significance ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Stress Tests ◽

Myocardial Layers ◽

Group 2 ◽

Group 1

Abstract Background Despite wide utility of global longitudinal strain in the assessment of left ventricular function up to now little is known about layer specific quantification of myocardial function during stress tests and its potential for ischemia detection. Purpose To investigate diagnostic utility of layer specific LS during stress echocardiography using marker segments in patients with established Left Anterior Descending (LAD) coronary artery status. Methods We retrospectively analyzed 63 patients (mean age 62.5±9.9 years, 62% males) with suspected coronary artery disease, who had performed dobutamine stress echocardiography (DSE). Layer specific speckle tracking LS analyses were performed during rest, maximal stress and recovery. As a marker for LAD (segment most probably supplied by this artery) we used mid-anterior left ventricle segments. LAD status were established with coronary angiography or angioCT and consider as significant if ≥70% stenosis was present. Results In our study group 14 patients had significantly stenosed LAD (group 1) and 24 had normal coronaries (group 2). We detected significantly lowered absolute values of strain in endocardial and mid-myocardial layers of segments supplied by stenosed LAD at rest for endocardium −8.6% (group 1) vs −13.4% (group 2); p=0.045; and mid-myocardium −7.3% (group 1) vs −11.2% (group 2); p=0.044. Moreover, we observed similar trend at recovery, however without reaching statistical significance. Conclusions Longitudinal strain analysis focused on segments supplied by assessed coronary artery my provide quantitative data confirming ischemia in the settings of rest and stress echocardiography. Our pilot study suggest that for inotropic agents like dobutamine the potential ischemic dysfunction may be however masked at peak stage of the test. Funding Acknowledgement Type of funding source: None

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P828 Echocardiographic two-dimensional speckle tracking identifies acute myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with MRI

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.478 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Chinali ◽

A Franceschini ◽

P Ciancarella ◽

V Lisignoli ◽

D Curione ◽

...

Keyword(s):

Ejection Fraction ◽

Children And Adolescents ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Cardiac Fibrosis ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Specific Reference ◽

Normal Ejection Fraction

Abstract Aim To evaluate the ability of Speckle Tracking Echocardiography (STE), as compared to Cardiac Magnetic Resonance (CMR), in identifying acute and sub-acute abnormalities in systolic function occurring with focal myocarditis in children and adolescents without evident wall motion abnormalities. Methods: We analyzed data from 33 consecutive patients (age 4-17year) with CMR-confirmed focal myocarditis and without regional motion abnormalities and/or reduced ejection fraction. Patients underwent echocardiography with analysis of regional and global longitudinal strain and CMR for the identification of focal edema and myocardial fibrosis. Impaired longitudinal strain was defined according to previously reported age-specific reference values. Results: Despite normal ejection fraction at admission, prevalence of impaired systolic function by STE was present in 58% of patients (n = 19). Reduction in longitudinal strain was regionally related to CMR-identified edema areas, with lowest values found at the level of the infero-lateral segments as compared to the mean of the other segments (p < 0.05). Amount of CMR-edema was strongly correlated with impairment of STE (r=-712; p = 0.01). At follow-up, significant improvement in global longitudinal strain could be observed in all patients (p < 0.001) with STE normalization recorded in 13 of 19 patients. Persistent regional impairement in STE could however still be found 6 patients, consistent with residual focal cardiac fibrosis at follow-up CMR. Conclusion: In children and adolescents with focal myocarditis, STE identifies subclinical abnormalities in systolic function, consistent with regional edema at CMR. In addition, analysis of STE provides insights in the identification of regional recovery or persistent systolic impairment, possibly due to residual focal fibrosis. Abstract P828 Figure.

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Impact of baseline feature tracking multi-detector row computed tomography-derived left ventricular global longitudinal strain on left ventricular functional recovery in TAVI patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.0162 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Gegenava ◽

P Bijl ◽

M Vollema ◽

F Kley ◽

A Weger ◽

...

Keyword(s):

Computed Tomography ◽

Functional Recovery ◽

Feature Tracking ◽

Longitudinal Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lv Systolic Function

Abstract Background Advances in left ventricular (LV) analysis with dynamic multi-detector row computed tomography (MDCT) permit measurement of LV global longitudinal strain (GLS) and have shown their impact on risk stratification of patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Purpose To evaluate the influence of baseline feature tracking (FT) MDCT- derived LV GLS on LV functional recovery in severe AS patients undergoing TAVI. Methods A total of 194 patients with severe AS (50% male, 80±7 years) with dynamic MDCT data allowing LV GLS measurement with a novel FT algorithm and having complete echocardiography evaluation at baseline, at 3–6 months and at 1 year follow-up were evaluated. FT MDCT-derived LV GLS was measured at baseline and the study population was divided according to a cut-off value of MDCT LV GLS −14% (≤−14% [more preserved LV systolic function] vs. >−14% [more impaired LV systolic function]). Results Transthoracic echocardiography (TTE)-derived Left ventricular ejection fraction (LVEF) increased over time in both groups: in patients with preserved and reduced MDCT LV GLS, and reached a higher value in patients with preserved MDCT LV GLS (52±7% at baseline, 55±7% at 3–6 months, 58±7% at 1 year follow-up vs. 43±10% at baseline, 49±10% at 3–6 months, 53±11% at 1 year follow-up; p=0.016) (Figure 1). TTE-derived LV GLS also showed greater improvement for patients with preserved MDCT LV GLS (−17±3% at baseline, −18±3% at 3–6 months, −20±3% at 1 year follow-up vs. −12±3% at baseline, −15±3% at 3–6 months, −16±3% at 1 year follow-up; p=0.027) (Figure 1). Conclusions In severe AS patients treated with TAVI, LV function improves significantly at 3–6 and at 12 months' follow-up and shows superior recovery in patients with more preserved baseline MDCT LV GLS, suggesting that MDCT-derived LV GLS has an important impact on LV functional recovery after TAVI. Funding Acknowledgement Type of funding source: None

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Patients with acute myocarditis and preserved systolic left ventricular function: comparison of global and regional longitudinal strain imaging by echocardiography with quantification of late gadolinium enhancement by CMR

Clinical Research in Cardiology ◽

10.1007/s00392-021-01885-0 ◽

2021 ◽

Author(s):

Christine Meindl ◽

Michael Paulus ◽

Florian Poschenrieder ◽

Florian Zeman ◽

Lars S. Maier ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Longitudinal Strain ◽

Acute Myocarditis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Gadolinium Enhancement ◽

Ventricular Ejection Fraction ◽

Group 2 ◽

Group 1

Abstract Background Conventional transthoracic echocardiography (TTE) does often not accurately reveal pathologies in patients with acute myocarditis and preserved left ventricular ejection fraction (LVEEF). Therefore, we investigated the diagnostic value of two-dimensional (2D) speckle tracking echocardiography compared to late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging in patients with acute myocarditis and normal global LVEF. Methods and results 31 patients (group 1) with the diagnosis of acute myocarditis confirmed by CMR according to the Lake Louise criteria and 20 healthy controls (group 2) were analyzed including global longitudinal strain (GLS) and regional longitudinal strain (RLS) derived by the bull’s eye plot. Although preserved LVEF was present in both groups, GLS was significantly lower in patients with acute myocarditis (group 1: GLS − 19.1 ± 1.8% vs. group 2: GLS − 22.1 ± 1.7%, p < 0.001). Compared to controls, lower RLS values were detected predominantly in the lateral, inferolateral, and inferior segments in patients with acute myocarditis. Additionally RLS values were significantly lower in segments without LGE. Conclusion In patients with acute myocarditis and preserved LVEF, a significant reduction of GLS compared to healthy subjects was detected. Further RLS adds important information to the localization and extent of myocardial injury. Graphic abstract

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Right ventricular systolic function in severe tricuspid regurgitation: prognostic relevance of longitudinal strain

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab030 ◽

2021 ◽

Author(s):

Francesco Ancona ◽

Francesco Melillo ◽

Francesco Calvo ◽

Nadia Attalla El Halabieh ◽

Stefano Stella ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Tricuspid Regurgitation ◽

Longitudinal Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Clinical Signs ◽

Strain Analysis ◽

Severe Tricuspid Regurgitation

Abstract Aims The aim of this study is to analyse the prognostic implications of right ventricular (RV) dysfunction as detected by strain analysis in patients with severe tricuspid regurgitation (TR). The evaluation of RV systolic function in presence of severe TR is of paramount importance for operative risk stratification; however, it remains challenging, as conventional echocardiographic indexes usually lead to overestimation. Methods and results We enrolled 250 consecutive patients with severe TR referred to our centre. Baseline clinical and echocardiographic data and follow-up outcomes were collected. Patients were predominantly female, with multiple cardiovascular risk factors and comorbidities, history of heart failure, and atrial fibrillation. Most of them had presented with clinical signs of RV heart failure (RVHF) and advanced New York Heart Association class. The RV strain analysis [both RV free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (RVGLS)] reclassified ∼42–56% of patients with normal RV systolic function according to conventional parameters in patients with impaired RV systolic function. RVFWLS ≤17% (absolute values, AUC: 0.66, P = 0.002) predicted the presence of RVHF [odds ratio (OR) 0.93, P = 0.01]. At follow-up, patients with RVFWLS >14% (absolute values, AUC: 0.70, P = 0.001, sensitivity 72%, specificity 54%) showed a better survival (P = 0.01). Conclusion Different ranges of RVFWLS have different implications in patients with severe TR, allowing to identify a preclinical and a clinical window, with correlations to RVHF and survival.

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