The Predictive Value of 2D Myocardial Strain for Epirubicin-Induced Cardiotoxicity

Introduction. Although epirubicin has significantly improved outcome in breast cancer (BC) patients, it is responsible for myocardial dysfunction that affects patients’ quality of life. The use of 2D global longitudinal strain (GLS) has been reported to detect early myocardial dysfunction. The aim of this study was to evaluate how GLS changes can predict cardiotoxicity. Methods. We conducted a prospective study from March 2018 to March 2020 on 66 patients with no cardiovascular risk factors, who presented with BC and received epirubicin. We measured left ventricular ejection fraction (LVEF) and GLS before chemotherapy, at three months (T3), and at 12 months (T12) from the last epirubicin infusion. Chemotherapy-Related-Cardiac-Dysfunction (CTRCD) was defined as a decrease of 10% in LVEF to a value below 53% according to ASE and EACI 2014 expert consensus. Results. The mean age at diagnosis was 47 ± 9 years old. At baseline, median LVEF was 70% and median GLS was −21%. Shortly after chemotherapy completion, two patients presented with symptomatic heart failure while asymptomatic CTRCD was revealed in three other patients at T12. Three months after the last epirubicin infusion, median LVEF was 65%, median GLS was −19%, and median GLS variation was 5%. However, in patients who presented with subsequent CTRCD, median GLS at T3 was −16% and median GLS variation was 19% ( p = 0.002 and p < 0.001 , respectively, when compared to patients who did not develop cardiotoxicity). Persistent GLS decrease at T3 was an independent predictor of CTRCD at T12. Age and left-sided thoracic irradiation did not increase the risk of cardiotoxicity in our study while the cumulative dose of epirubicin significantly affected cardiologic findings ( p = 0.001 ). Conclusion. This was the first North African study that assesses the value of measuring GLS to early detect cardiotoxicity. Patients whose GLS remained decreased after 3 months from anthracyclines-base chemotherapy had an increased risk for developing subsequent CTRCD. Further studies with larger sample size are warranted to identify the best cardioprotective molecules to be initiated in these patients before LVEF declines.

Download Full-text

P818 Association between baseline left ventricular longitudinal strain and follow-up left ventricular ejection fraction in patients with dilated cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.470 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I H Jung ◽

Y S Byun ◽

J H Park

Keyword(s):

Ejection Fraction ◽

Longitudinal Strain ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Lv Function ◽

Ventricular Ejection Fraction

Abstract Funding Acknowledgements no Background Left ventricular global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction. The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LV reverse remodeling (LVRR) in DCM patients with sinus rhythm and also investigate the relationship between baseline LV GLS and follow-up LVEF. Methods We enrolled patients with DCM who had been initially diagnosed, evaluated, and followed at our institute. Results During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45) within 14.7 ± 10.0 months of medical therapy. The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9% and was not different from the value of 27.1 ± 7.4% (p = 0.49) of those who did not recover. There was a moderate and highly significant correlation between baseline LV GLS and follow-up LVEF (r = 0.717; p <0.001). Conclusion There was a significant correlation between baseline LV GLS and follow-up LVEF in this population. Baseline Follow-up Difference (95% CI) p-value All patients (n = 160) LVEDDI, mm/m2 35.6 ± 6.6 35.6 ± 6.6 -2.7 (-3.4 to -2.0) <0.001 LVESDI, mm/m2 30.3 ± 6.1 26.6 ± 6.6 -3.7 (-4.6 to -2.8) <0.001 LVEDVI, mL/m2 95.0 ± 30.7 74.3 ± 30.2 -20.7 (-25.6 to -15.8) <0.001 LVESVI, mL/m2 70.0 ± 24.8 50.2 ± 26.8 -19.8 (-24.2 to -15.4) <0.001 LVEF, % 26.8 ± 7.5 33.9 ± 12.6 7.2 (5.2 to 9.2) <0.001 LV GLS (-%) 9.2 ± 3.1 11.0 ± 4.8 1.8 (1.3 to 2.2) <0.001 Patients without LVRR (n = 115) LVEDDI, mm/m2 34.9 ± 6.8 34.1 ± 6.8 -0.8 (-1.3 to -0.3) 0.002 LVESDI, mm/m2 29.5 ± 6.1 28.4 ± 6.4 -1.4 (-1.8 to -0.4) 0.002 LVEDVI, mL/m2 92.0 ± 30.5 83.4 ± 29.8 -8.6 (-12.4 to -4.8) <0.001 LVESVI, mL/m2 67.1 ± 24.4 59.5 ± 25.3 -7.6 (-10.9 to -4.3) <0.001 LVEF, % 27.1 ± 7.4 27.8 ± 7.4 0.7 (-0.2 to 1.6) 0.126 LV GLS (-%) 8.2 ± 2.9 8.7 ± 3.2 0.5 (0.7 to 3.6) <0.001 Patients with LVRR (n = 45) LVEDDI, mm/m2 37.4 ± 5.5 29.8 ± 5.2 -7.5 (-9.1 to -6.0) <0.001 LVESDI, mm/m2 32.2 ± 5.7 21.9 ± 4.4 -10.3 (-11.9 to -8.6) <0.001 LVEDVI, mL/m2 102.7 ± 30.2 51.1 ± 15.0 -51.7 (-61.6 to -41.7) <0.001 LVESVI, mL/m2 77.3 ± 24.5 26.4 ± 11.3 -50.9 (-58.8 to -43.1) <0.001 LVEF, % 26.1 ± 7.9 49.4 ± 9.5 23.9 (20.4 to 27.5) <0.001 LV GLS (-%) 11.9 ± 1.6 16.9 ± 2.7 5.1 (4.2 to 5.9) <0.001 Baseline and Follow-up LV Functional Echocardiographic Data Abstract P818 Figure.

Download Full-text

Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.667721 ◽

2021 ◽

Vol 8 ◽

Author(s):

Anum S. Minhas ◽

Nisha A. Gilotra ◽

Erin Goerlich ◽

Thomas Metkus ◽

Brian T. Garibaldi ◽

...

Keyword(s):

Hospital Mortality ◽

Systemic Inflammation ◽

Interleukin 6 ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Work Efficiency ◽

Ventricular Ejection Fraction ◽

Adjusted Logistic Regression

Background: Although troponin elevation is common in COVID-19, the extent of myocardial dysfunction and its contributors to dysfunction are less well-characterized. We aimed to determine the prevalence of subclinical myocardial dysfunction and its association with mortality using speckle tracking echocardiography (STE), specifically global longitudinal strain (GLS) and myocardial work efficiency (MWE). We also tested the hypothesis that reduced myocardial function was associated with increased systemic inflammation in COVID-19.Methods and Results: We conducted a retrospective study of hospitalized COVID-19 patients undergoing echocardiography (n = 136), of whom 83 and 75 had GLS (abnormal >−16%) and MWE (abnormal <95%) assessed, respectively. We performed adjusted logistic regression to examine associations of GLS and MWE with in-hospital mortality. Patients were mean 62 ± 14 years old (58% men). While 81% had normal left ventricular ejection fraction (LVEF), prevalence of myocardial dysfunction was high by STE; [39/83 (47%) had abnormal GLS; 59/75 (79%) had abnormal MWE]. Higher MWE was associated with lower in-hospital mortality in unadjusted [OR 0.92 (95% CI 0.85–0.99); p = 0.048] and adjusted models [aOR 0.87 (95% CI 0.78–0.97); p = 0.009]. In addition, increased systemic inflammation measured by interleukin-6 level was associated with reduced MWE.Conclusions: Subclinical myocardial dysfunction is common in COVID-19 patients with clinical echocardiograms, even in those with normal LVEF. Reduced MWE is associated with higher interleukin-6 levels and increased in-hospital mortality. Non-invasive STE represents a readily available method to rapidly evaluate myocardial dysfunction in COVID-19 patients and can play an important role in risk stratification.

Download Full-text

Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity

PLoS ONE ◽

10.1371/journal.pone.0246764 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246764

Author(s):

Angela Y. Higgins ◽

Amit Arbune ◽

Aaron Soufer ◽

Elio Ragheb ◽

Jennifer M. Kwan ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Immune Checkpoint ◽

Tissue Characterization ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Normal Lvef

Background Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiotoxicity. Methods We identified patients referred for CMR evaluation of ICI cardiotoxicity from September 2015 through September 2019. We assessed structural and functional parameters, feature tracking (FT) left ventricular and atrial strain, T2- weighted ratios and quantitative late gadolinium enhancement (LGE). We also applied the Updated Lake Louise Criteria for diagnosis of myocarditis. Results Of the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (≥53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of −9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at −12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs = −0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs = −0.29, p = 0.22) or GLS (rs = 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment. Conclusion In patients with suspected ICI cardiotoxicity, CMR is an important diagnostic tool, even in the absence of overt left ventricular dysfunction, as abnormalities in left ventricular strain, T2 signal and LGE can identifying disease.

Download Full-text

Abstract 13928: Subclinical Myocardial Dysfunction With Coronavirus Disease 2019

Circulation ◽

10.1161/circ.142.suppl_3.13928 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jordan B Strom ◽

Lila M Martin ◽

Sarah E Fostello ◽

James D Chang ◽

Connie W Tsao ◽

...

Keyword(s):

Left Ventricular Systolic Dysfunction ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Cardiac Injury ◽

Multivariable Analysis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Multicenter Studies ◽

Ventricular Ejection Fraction

Background: Coronavirus disease 2019 (COVID-19) is associated with cardiac injury and overt myocardial dysfunction. However, whether COVID-19 is associated with subclinical myocardial dysfunction is unknown. Methods: We evaluated patients hospitalized for COVID-19 referred for transthoracic echocardiography (TTE), between March 17 and May 22, 2020, with a left ventricular ejection fraction (LVEF) ≥ 50%. Controls in a 1:1 ratio were selected from patients receiving TTE during the same month. Global longitudinal strain (GLS) was used to assess the association of COVID-19 and subclinical myocardial disease. Results: Among 99 patients (49 cases, 50 controls), average GLS was significantly reduced in cases vs. controls (mean ± SD, -14.8 ± 4.0% vs. -21.1 ± 4.0%, p < 0.0001). A total of 82.8% of cases vs. 7.1% of controls had an average GLS below normal (> 18%; p < 0.0001), which persisted despite multivariable adjustment ( Table ). Among COVID-19 patients with a prior TTE, absolute average GLS decreased 3.2% (p = 0.008) despite no change in LVEF (p = 0.41). Average GLS was reduced in non-survivors compared with survivors (p = 0.04), though only septal wall thickness (p = 0.03) was associated with in-hospital mortality on multivariable analysis. Conclusions: Among hospitalized patients receiving TTE, COVID-19 is independently associated with subclinical left ventricular systolic dysfunction in the vast majority of patients, and subclinical LV dysfunction is associated with survival. The clinical implications of these findings should be evaluated in future longitudinal multicenter studies.

Download Full-text

T1 mapping in patients with Fabry disease predicts functional and morphological abnormalities in cardiac MRI

European Heart Journal ◽

10.1093/ehjci/ehaa946.0268 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Gatterer ◽

G Mundigler ◽

S Graf ◽

D Beitzke ◽

G Sunder-Plassmann

Keyword(s):

Fabry Disease ◽

Feature Tracking ◽

T1 Mapping ◽

Tissue Characterization ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Abstract Introduction About 50% of Fabry disease (FD) patients develop cardiac manifestation, also known as Fabry cardiomyopathy. Beside echocardiography, cardiac magnetic resonance imaging (CMR) is included in the regular assessment of these patients, allowing non-invasive tissue characterization via T1 Mapping but also evaluation of morphological and functional characteristics. Purpose Myocardial strain measured by feature-tracking CMR has been previously shown to be a sensitive indicator of mechanical dysfunction in different diseases. We therefore evaluated changes of these parameters over the time, potentially reflecting disease progression in patients with FD. Furthermore, we also assessed the association of T1 mapping with follow-up changes of myocardial strain. Thus, our data may provide novel insights about cardiac changes in the natural course of the disease and cardiac effects of specific therapies. Methods We used post processing software for CMR to analyze baseline and follow-up cardiac involvement in a cohort of FD patients who were enrolled in the KarMA study, which examines cardiac changes over time. We measured left ventricular mass (LVM), left ventricular end-systolic and end-diastolic volume (LVEDV, LVESV), left ventricular ejection fraction (LVEF), mean left ventricular T1 relaxation times (T1), global longitudinal strain (GLS), global regional strain (GRS) and global circumferential strain (GCS). Statistical analyses included T-test and Spearman's correlation. Results CMR Images of 33 Patients were analyzed (22 females; mean age 40.8±16.3 years; at baseline 17 were therapy naïve and 16 on ERT), of whom 31 underwent a second CMR. In 18 patients (10 females; 44.9±16.0 years) myocardial strain measurement by feature-tracking was possible in both examinations. T1, LVM, LVEDV and LVESV, LVEF as well as GLS, GRS and GCS showed no significant change during the mean follow-up period of 43 (±17) months in all patients. However, we found a significant correlation of baseline T1 (967±84.5ms) with follow up values of LVM (84.9±32.7 g/m2; p=0.02, ρ=−0.462), LVEDV (63.0±17.6 g/m2 p=0.049 ρ=−0.398) and GRS (70.2±14.2% p=0.011 ρ=−0.5). Baseline T1 also correlated with changes in LVM (p=0.036 ρ=−0.44) and changes of GCS (p=0.001 ρ=−0.858) from baseline to follow up. Differences in T1 from baseline to follow up correlated with follow-up values of GLS (−19.5±3.57 p=0.044, ρ=−0.414) and GRS (69.1±18.7 p=0.003, ρ=−0.588). Conclusion T1, reflecting glycosphingolipid accumulation might predict changes in LVM, LVEDV and strain. Moreover, changes in T1, reflecting myocardial remodeling, go in parallel with worse left ventricular function shown by more positive values of GLS, GCS and GRS. T1 mapping together with strain parameters are important markers for monitoring patients with FD. Funding Acknowledgement Type of funding source: None

Download Full-text

Early detection of anthracycline-mediated cardiotoxicity: the value of considering both global longitudinal left ventricular strain and twist

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2012-0398 ◽

2013 ◽

Vol 91 (8) ◽

pp. 601-607 ◽

Cited By ~ 56

Author(s):

Cristian Mornoş ◽

Lucian Petrescu

Keyword(s):

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Radial Strain ◽

Tissue Doppler ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Drug Induced ◽

Ventricular Ejection Fraction ◽

Apical Rotation ◽

Before And After

Anthracyclines are important anticancer drugs, but their use is limited by cardiotoxicity. Left ventricular ejection fraction (LVEF) is often inadequate to detect myocardial disease induced by chemotherapy. Tissue Doppler and bidimensional-strain imaging could detect LV myocardial dysfunction earlier than LVEF. In drug-induced cardiotoxicity, torsional and longitudinal LV deformations [LV twist (LVtw), radial strain (GRS), global longitudinal strain (GLS)] are damaged. We assessed whether a new index, GLS×LVtw, could predict future anthracycline-induced cardiomyopathy. Echocardiography, troponin, and natriuretic peptide determination were prospectively performed in 74 patients before and after 6, 12, 24, and 52 weeks of anthracycline treatment. These patients were treated for breast cancer, Hodgkin’s or non-Hodgkin’s lymphoma, acute lymphoblastic or myeloblastic leukaemia, or osteosarcoma. At 6 weeks after initiation of chemotherapy, isovolumic relaxation time, systolic mitral annular velocity, LVGLS, LVGRS, LV apical rotation, LVtw, and GLS×LVtw deteriorated, and troponin levels became elevated (all p < 0.05 by ANOVA) before LVEF decreased. The receiver operating characteristic curves identified early deterioration of GLS×LVtw as the best predictor of later cardiotoxicity (area under curve = 0.93), followed by GLS (0.84) and LV apical rotation (0.81) deterioration. In conclusion, early change in the GLS×LVtw index seems to be a good predictor of future development of anthracycline-induced cardiotoxicity.

Download Full-text

Abstract 15455: Prevalence of Subclinical Myocardial Dysfunction in Hospitalized Patients With Covid-19 and Association With In-hospital Mortality

Circulation ◽

10.1161/circ.142.suppl_3.15455 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anum Minhas ◽

Nisha A Gilotra ◽

Erin Goerlich ◽

Brian T Garibaldi ◽

Thomas S Metkus ◽

...

Keyword(s):

Hospital Mortality ◽

Myocardial Function ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Cardiac Injury ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lv Function ◽

Ventricular Ejection Fraction ◽

Artery Disease

Introduction: Acute cardiac injury has been reported in COVID-19. However, the extent of subclinical myocardial dysfunction on imaging has not been characterized. We determined the prevalence of myocardial dysfunction using speckle tracking echocardiography (STE) in hospitalized COVID-19 patients and its association with cardiovascular risk factors and mortality. Methods: We retrospectively studied hospitalized COVID-19 patients undergoing echocardiography with STE (n=83). We investigated the association of global longitudinal strain (GLS) and myocardial work efficiency (MWE), a load independent measure of myocardial function, with clinical parameters. Logistic regression was used to examine associations of GLS and MWE with in-hospital mortality. Abnormal left ventricular ejection fraction (LVEF) was defined as <50%. Abnormal GLS and MWE were defined as >-18% and <95%, respectively. Results: Mean age was 66±14 years and 59% were men. There were 16/83 (19%) with reduced LVEF (<50%), while 64% (53/83) had abnormal GLS (>-18%) and 79% (59/75) had abnormal MWE (<95%) ( Figure ). Patients with abnormal GLS had higher body mass index (BMI) (32±8 vs 28±5 kg/m 2 , p=0.016) and more frequent diabetes (47 vs 23%, p=0.03) and patients with abnormal MWE had more frequent diabetes (49 vs 6%, p=0.002), compared to normal. Higher MWE was associated with lower mortality unadjusted (OR 0.92 [95% CI 0.85-0.99]; p=0.048) and after adjusting for age, sex, diabetes, hypertension, and coronary artery disease (OR 0.87 [95% CI 0.78-0.97]; p=0.014). This remained true on sensitivity analysis of only those with normal LVEF, adjusting for age and sex (n=61). GLS and LVEF were not associated with mortality. Conclusions: Abnormal myocardial function is prevalent in hospitalized COVID-19 patients undergoing STE. Higher MWE was associated with lower in-hospital mortality. Larger studies are warranted to determine the prognostic role of sensitive markers of LV function in COVID-19.

Download Full-text

Serum biomarkers for detection of cardiomyopathy in survivors of childhood cancer: A report from the St. Jude Lifetime Cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e21526 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e21526-e21526

Author(s):

Stephanie Dixon ◽

Carrie R. Howell ◽

Lu Lu ◽

Kirsten K. Ness ◽

Juan Plana ◽

...

Keyword(s):

Childhood Cancer ◽

Troponin T ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

New Onset

e21526 Background: Childhood cancer survivors are at increased risk for cardiovascular morbidity and mortality. Little is known about the utility of cardiac biomarkers (NT-proBNP, cardiac troponin-T [TnT]) for long-term surveillance. Methods: Cross-sectional analyses of 1213 survivors ≥18 years of age and ≥10 years from cancer diagnosis (786 exposed to cardiotoxic therapy [174 radiation therapy (RT) alone, 366 anthracycline alone, 246 both] and 427 unexposed). TnT > 0.01 ng/ml and NT-proBNP levels > 97.5th percentile age- and sex-specific cutoffs were considered abnormal. Three-dimensional left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diastolic function and cardiomyopathy (CM) according to the CTCAE v4.03 were evaluated. Generalized linear models estimated risk ratios (RR) and 95% confidence intervals (CI). Results: Among survivors (median 8.7 [range 0.0-23.6] years at diagnosis; 35.5 [range 19.1-62.2] years at evaluation), NT-proBNP and TnT were abnormal in 22.5% and 0.4%, respectively. A dose-dependent increased risk for abnormal NT-proBNP was seen with exposure to chest RT (referent no RT, 1- < 20 Gy RR 1.62 [CI 1.07-2.46], 20- < 30 Gy RR 1.68 [1.23-2.30], ≥30 Gy RR 3.66 [2.89-4.64]; p for trend < 0.0001) and anthracycline (referent no anthracycline, 1-200mg/m2 RR 1.39 [1.01-1.91], 201-350mg/m2 RR 2.28 [1.74-2.99], > 350mg/m2 RR 2.99 [2.27-3.95]; p for trend < 0.0001). Survivors with CM at the time of evaluation had abnormal NT-proBNP (grade 2 CM RR 1.46, CI 1.08-1.99; grade 3-4 CM 2.66, 2.02-2.39). However, among exposed survivors previously undiagnosed with clinical CM, NT-proBNP had poor sensitivity and moderate specificity in identifying those with new onset of abnormal LVEF ( < 53%), GLS or diastolic dysfunction: sensitivity (29%, 30%, 33%), specificity (75%, 77%, 76%). Also, 132 (20.2%) had abnormal NT-proBNP with normal LVEF (≥53%). Conclusions: Abnormal NT-proBNP levels were prevalent and associated with prior cardiotoxic therapy and established CM but were not sensitive for detection of new onset CM. Longitudinal follow-up is needed to determine whether abnormal NT-proBNP in the large number of survivors without CM is predictive of future CM.

Download Full-text

Hypertensive coronary microvascular dysfunction: a subclinical marker of end organ damage and heart failure

European Heart Journal ◽

10.1093/eurheartj/ehaa191 ◽

2020 ◽

Vol 41 (25) ◽

pp. 2366-2375 ◽

Cited By ~ 7

Author(s):

Wunan Zhou ◽

Jenifer M Brown ◽

Navkaranbir S Bajaj ◽

Alvin Chandra ◽

Sanjay Divakaran ◽

...

Keyword(s):

Heart Failure ◽

Risk Assessment ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Microvascular Dysfunction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Coronary Microvascular Dysfunction ◽

Ventricular Ejection Fraction ◽

Flow Reserve

Abstract Aims Hypertension is a well-established heart failure (HF) risk factor, especially in the context of adverse left ventricular (LV) remodelling. We aimed to use myocardial flow reserve (MFR) and global longitudinal strain (GLS), markers of subclinical microvascular and myocardial dysfunction, to refine hypertensive HF risk assessment. Methods and results Consecutive patients undergoing symptom-prompted stress cardiac positron emission tomography (PET)-computed tomography and transthoracic echocardiogram within 90 days without reduced left ventricular ejection fraction (<40%) or flow-limiting coronary artery disease (summed stress score ≥ 3) were included. Global MFR was quantified by PET, and echocardiograms were retrospectively analysed for cardiac structure and function. Patients were followed over a median 8.75 (Q1–3 4.56–10.04) years for HF hospitalization and a composite of death, HF hospitalization, MI, or stroke. Of 194 patients, 155 had adaptive LV remodelling while 39 had maladaptive remodelling, which was associated with lower MFR and impaired GLS. Across the remodelling spectrum, diastolic parameters, GLS, and N-terminal pro-B-type natriuretic peptide were independently associated with MFR. Maladaptive LV remodelling was associated with increased adjusted incidence of HF hospitalization and death. Importantly, the combination of abnormal MFR and GLS was associated with a higher rate of HF hospitalization compared to normal MFR and GLS [adjusted hazard ratio (HR) 3.21, 95% confidence interval (CI) 1.09–9.45, P = 0.034), including in the adaptive remodelling subset (adjusted HR 3.93, 95% CI 1.14–13.56, P = 0.030). Conclusion We have demonstrated important associations between coronary microvascular dysfunction and myocardial mechanics that refine disease characterization and HF risk assessment of patients with hypertension based on subclinical target organ injury.

Download Full-text

276 Wolff–Parkinson–White syndrome was associated with reduced myocardial work

European Heart Journal Supplements ◽

10.1093/eurheartj/suab132.010 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Giovanni Domenico Ciriello ◽

Nunzia Borrelli ◽

Giovanni Di Salvo ◽

Jolanda Sabatino ◽

Valentina Bucciarelli ◽

...

Keyword(s):

Early Stage ◽

Systolic Function ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Accessory Pathway ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Wpw Syndrome ◽

Paediatric Patients

Abstract Aims Paediatric patients with a diagnosis of Wolff–Parkinson–White (WPW) Syndrome may develop a reduction of local myocardial deformation because of accessory pathway-related electrical dyssynchrony, which may lead to an impairment of left ventricular systolic function. The presence of ventricular dysfunction may be an indication for these patients to undergo radiofrequency catheter ablation (RFCA), even if asymptomatic. However, myocardial abnormalities are sometimes subtle and cannot be detected by standard echocardiographic evaluation. The purpose of this study was to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in paediatric patients with WPW Syndrome. Methods and results Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in this study: 12 cases with manifest WPW Syndrome and 32 age-, sex-, and arterial pressure-matched controls (CTR). Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured 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 standard echocardiographic parameters, paediatric patients with WPW Syndrome had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs. 1624.0 ± 305.8 mmHg% in CTR, P = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs. 2069.0 ± 319.9 mmHg% in CTR, P = 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs. 90.9 ± 58.9 mmHg% in CTR, P = 0.0008), and GWE (90.5 ± 4.8% in WPW vs. 95.2 ± 2.2% in CTR, P = 0.00006). There were no significant differences in GLS and LVEF between patients with WPW Syndrome and controls. Conclusions WPW Syndrome was found to be associated with a significant reduction of myocardial work indices in the paediatric population. The assessment of MWI may represent a sensitive measure to identify a subtle myocardial dysfunction in an early stage, even when LVEF and GLS are normal. It might be considered a further diagnostic parameter for referring little patients to RFCA.

Download Full-text