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.

Circumferential deformation in diagnosis and risk assessment of patients with left ventricular non-compaction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Anwer ◽  
P.S Heiniger ◽  
S Rogler ◽  
D Cassani ◽  
L Rebellius ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Strong Association ◽  
Global Longitudinal Strain ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Deformation Analysis ◽  
Funding Source ◽  
Apical Rotation ◽  
Increased Risk

Abstract Introduction Echocardiography-based deformation analysis is used for studying left ventricular (LV) mechanics and have an emerging role in the diagnosis of cardiomyopathies. Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterised by a two-layered LV myocardium with prominent trabeculae separated by deep recesses perfused from the LV cavity. Left ventricular hypertrabeculation (LVHT) may be difficult to differentiate from LVNC. In this study, we aim to develop a diagnostic algorithm based on the circumferential deformation (CD) of LVNC, LVHT and controls; and find their associations with LVNC outcomes. Methods We compared 45 LVNC patients, 45 LVHT individuals, and 45 matched healthy controls. LVNC was diagnosed according to current echocardiographic criteria. LVHT was defined as presence of three or more trabeculae in the LV apex visualised in both parasternal short axis and apical views. Controls had a normal echocardiographic examination and no evidence of cardiovascular disease. Strain analysis was performed using TomTec Image-Arena (version 4.6). Results Receiver observer characteristics curve (ROC) analyses revealed that GCS &lt;22.3% differentiated LVNC from control or LVHT. In individuals with global circumferential strain (GCS) below 22.3%, an apical peak circumferential strain (PCS) cut-off value of 18.4% differentiated LVNC [&lt;18.4%] and LVHT [≥18.4%] (fig. 1). An independent echocardiographer (Table 1) performed blind validation of diagnosis on 32 subjects from each group. Combined endpoint of cardiovascular events in LVNC (CVE) is described in figure 2. Multi-variate regression analyses have shown that GCS was associated with 11-fold increased risk of CVE independent of LVEF and NC:C ratio, while global longitudinal strain (GLS) displayed only 2-fold increased risk. Regional basal and apical peak circumferential or longitudinal strain, left ventricular twist, basal-apical rotation ratio have shown significant associations (Fig. 3). Conclusions A diagnostic algorithm with GCS and aPCS (threshold value 18.4%) differentiates LVNC from LVHT and control with very high sensitivity and specificity independent of additional echocardiographic or clinical information. Circumferential strain derived parameters exhibit a very strong association with outcomes independent of LVEF and NC:C ratio. Absence of CVE in LVHT provides further evidence on the distinct nature of LVNC and LVHT. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): 2018 research grant from the Swiss Heart Foundation

Abstract 18181: Left Ventricular Myocardial Mechanics at Rest and During Exercise in Children After Arterial Switch Operation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Barbara Cifra ◽  
Andreea Dragulescu ◽  
Heynric Grotenhuis ◽  
Cedric Manlhiot ◽  
Mark K Friedberg ◽  
...  
Keyword(s):  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Arterial Switch Operation ◽  
Global Longitudinal Strain ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Arterial Switch ◽  
Switch Operation

Introduction: Arterial switch operation (ASO) is the standard surgical procedure for transposition of the great arteries allowing a complete anatomical and physiological repair. In these patients the functional impact of myocardial perfusion on global and regional myocardial function has not been investigated. Stress echocardiography with visual myocardial assessment has been used to detect regional myocardial dysfunction. Studying LV mechanics using speckle-tracking echocardiography during exercise could provide more quantitative information. The aim of the study was to study the myocardial response to exercise in children after ASO using semi-supine cycle ergometry stress echocardiography (SSCE). Materials and Methods: Forty children after ASO and 29 age and gender matched controls were included. Median age was 14 years. A stepwise SSCE protocol was used. LV global longitudinal strain and circumferential strain was measured in all subjects at rest and at incremental heart rate. Results: Resting HR was similar between groups, peak HR was lower in the ASO group compared with controls (142 ±11 vs 157±14 bpm, p=0.0007). LV global longitudinal strain was lower at rest (19±2.3% vs. 21±2.5%, p=0.004) but not at peak exercise (22.7±5.6 % vs. 24±4.5 % p=0.2) in the ASO group compared to controls. No significant difference was found in LV global circumferential strain at rest (23.7±2.3% vs. 24±3.2 %, p=0.6) and peak exercise (28±2.6% vs. 27.9±4.1 %, p=0.9). Also when plotted versus heart rates the increase in longitudinal and circumferential strain values were not significantly different. Conclusions: These data show that circumferential and longitudinal myocardial deformation during exercise is preserved in children after ASO compared to controls. Earlier data obtained using Tissue Doppler in the same study cohort, showed a normal increase in systolic tissue Doppler velocities. These data suggest a preserved LV reserve during exercise in this patient cohort.

Supplementary role of left ventricular global longitudinal strain for predicting sudden cardiac death in hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Hyun-Jung Lee ◽  
Hyung-Kwan Kim ◽  
Sang Chol Lee ◽  
Jihoon Kim ◽  
Jun-Bean Park ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Risk Score ◽  
Primary Endpoint ◽  
Cardiac Death ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
C Statistic

Abstract Aims We investigated the prognostic role of left ventricular global longitudinal strain (LV-GLS) and its incremental value to established risk models for predicting sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). Methods and results LV-GLS was measured with vendor-independent software at a core laboratory in a cohort of 835 patients with HCM (aged 56.3 ± 12.2 years) followed-up for a median of 6.4 years. The primary endpoint was SCD events, including appropriate defibrillator therapy, within 5 years after the initial evaluation. The secondary endpoint was a composite of SCD events, heart failure admission, heart transplantation, and all-cause mortality. Twenty (2.4%) and 85 (10.2%) patients experienced the primary and secondary endpoints, respectively. Lower absolute LV-GLS quartiles, especially those worse than the median (−15.0%), were associated with progressively higher SCD event rates (P = 0.004). LV-GLS was associated with an increased risk for the primary endpoint, independent of the LV ejection fraction, apical aneurysm, and 2014 European Society of Cardiology (ESC) risk score [adjusted hazard ratio (aHR) 1.14, 95% confidence interval (CI) 1.02–1.28] or 2011 American College of Cardiology/American Heart Association (ACC/AHA) risk factors (aHR 1.18, 95% CI 1.05–1.32). LV-GLS was also associated with a higher risk for the composite secondary endpoint (aHR 1.06, 95% CI 1.01–1.12). The addition of LV-GLS enhanced the performance of the ESC risk score (C-statistic 0.756 vs. 0.842, P = 0.007) and the 2011 ACC/AHA risk factor strategy (C-statistic 0.743 vs. 0.814, P = 0.007) for predicting SCD. Conclusion LV-GLS is an important prognosticator in patients with HCM and provides additional information to established risk stratification strategies for predicting SCD.

Reference values for two-dimensional myocardial strain echocardiography of the left ventricle in healthy children

2019 ◽  
Vol 29 (3) ◽  
pp. 325-337
Author(s):  
Laurens P. Koopman ◽  
Bas Rebel ◽  
Devi Gnanam ◽  
Mirthe E. Menting ◽  
Willem A. Helbing ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Strain Rate ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Healthy Children ◽  
Deformation Parameters ◽  
Strain And Strain Rate ◽  
Echocardiographic Parameters

AbstractBackgroundMyocardial deformation by speckle tracking echocardiography provides additional information on left ventricular function. Values of myocardial deformation (strain and strain rate) depend on the type of ultrasound machine and software that is used. Normative values for QLAB (Philips) are scarce, especially for children. It is important to evaluate the influence of age and body size on myocardial deformation parameters, since anthropometrics strongly influence many standard echocardiographic parameters. The aim of this study was to provide comprehensive normal values for myocardial deformation of the left ventricle using a Philips platform and to evaluate the association with anthropometric and standard echocardiographic parameters.MethodsHealthy children between 1 and 18 years of age were prospectively examined using a standard echocardiographic protocol. Short-axis and apical four-chamber, two-chamber, and three-chamber views were used to measure peak systolic circumferential and longitudinal strain and systolic and early diastolic strain rate of the left ventricle using dedicated software.ResultsA total of 103 children were included with a mean age of 10.8 and inter-quartile range 7.3–14.3 years. Global circumferential strain values (±SD) were −24.2±3.5% at basal, −25.8±3.5% at papillary muscle, and −31.9±6.2% at apex levels. Global left ventricular longitudinal strain values were −20.6±2.6% in apical four-chamber view, −20.9±2.7% in apical two-chamber, and −21.0 ±2.7% in apical three-chamber. Age was associated with longitudinal strain, longitudinal systolic and early diastolic strain rate, but not with circumferential strain.ConclusionsNormal values for left ventricular deformation parameters in children are obtained using a Philips platform. Age partly explains normal variation of strain and strain rate.

scholarly journals 292 Mechanical stress, myocardial deformation abnormalities, and ventricular fibrosis: a fatal cascade in arrhythmic mitral valve prolapse patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Annagrazia Cecere ◽  
Manuel De Lazzari ◽  
Alberto Cipriani ◽  
Giulia Brunetti ◽  
Francesca Graziano ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Control Group ◽  
Deformation Pattern ◽  
Basal Region ◽  
Post Contrast

Abstract Aims Arrhythmic mitral valve prolapse (MVP) is characterized by left ventricular (LV) fibrosis in the basal inferolateral wall and papillary muscles. We hypothesized that LV fibrosis are driven by excessive mechanical forces acting on myocardial susceptible cells, representing the last step in the MVP-induced myocardial stretch process. We evaluated the LV myocardial deformation, using strain assessed with cardiac magnetic resonance (CMR), in arrhythmic MVP patients with normal LV ejection fraction (LVEF) and absent/trivial mitral regurgitation (MR) and its correlation with the presence of LV fibrosis, detected by late gadolinium enhancement (LGE) in post-contrast CMR images. Methods and results We enrolled consecutive arrhythmic MVP patients with normal LVEF and no/trivial MR. Sixty-nine (39 female; median age: 40 years) patients without MVP, arrhythmias or cardiovascular history served as control group. All patients underwent CMR for identification of LGE and evaluation of LV myocardial deformation. A total of 66 patients were enrolled (47 female; median age: 44 years). In the overall MVP population, LGE was present in 41 patients (62.1%). MVP patients without LGE (25 patients, 37.9%) presented a higher global radial (median: 42.19 vs. 33; P &lt;0.0001) and higher global longitudinal strain (median: −21.61 vs. −18.10; P &lt;0.0001), compared to the control group. A reduction of regional basal posterolateral radial (BPL median: 50.60 vs. 67.30; P = 0.0015) and longitudinal strain (BPL median: −23.50 vs. −26.70; P = 0.0186) were observed in the MVP patients as compared with controls (Figures A–D). Conversely to the basal region, mid anterolateral and posterolateral region presented a higher radial (MAL median: 52.60 vs. 31.10; P &lt; 0.0001 and MPL median: 52.80 vs. 21.50; P &lt; 0.0001) and longitudinal strain (MAL median: −24.80 vs. −18.30; P &lt; 0.0001 and MPL median: −25.30 vs. −14.80; P &lt; 0.0001), when compared to control group. MVP patients with LGE had a lower global radial (median: 36.48 vs. 42.19; P &lt;0.0047), longitudinal (median: −19.18 vs. −21.61; P = 0.0013), and circumferential strain (median: −17.80 vs. −19.28; P =  0.0134) compared with those without fibrosis. According to MVP patients without LGE, the presence of fibrosis is associated with a lower regional radial (BAL median: 64.40 vs. 82.80; P = 0.0481; MAL median: 42.60 vs. 52.60; P = 0.0287) and circumferential strain (BAL median: −21.90 vs. −24.20; P = 0.0174; BPL median: −16.80 vs. −18.80; P = 0.0411; MPL median: −15.50 vs. −19.40; P = 0.0077) in the LV basal-mid lateral walls (Figures E–H). 292 Figures A–D and E-H  Conclusions Arrhythmic MVP patients with normal LV systolic function and absent/trivial MR presented an abnormal myocardial deformation pattern. The reduced strain in BPL wall of MVP patients without LGE could be considered as an early marker of MVP-induced myocardial stress, that could promote, time by time, LV fibrosis and arrhythmias in MVP patients.

scholarly journals 415 Correlation between tissue abnormalities and myocardial deformation indices in arrhythmogenic cardiomyopathy: a pilot study

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Antonio De Luca ◽  
Chiara Cappelletto ◽  
Maria Perotto ◽  
Davide Stolfo ◽  
Marco Merlo ◽  
...  
Keyword(s):  
Feature Tracking ◽  
Circumferential Strain ◽  
Global Longitudinal Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Arrhythmogenic Cardiomyopathy ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
Tissue Abnormalities

Abstract Aims To evaluate the correlation between cardiac magnetic resonance (CMR) tissue abnormalities and impairment of myocardial deformation indices in patients with definite diagnosis of arrhythmogenic cardiomyopathy (AC). Methods and results 41 AC Patients with available CMR study were enrolled. Myocardial deformation indices (i.e. global longitudinal strain -GLS-; global circumferential strain -GCS-; global radial strain -GRS-) for both ventricles were calculated using feature tracking analysis. Quantification of tissue abnormalities (i.e. late gadolinium enhancement -LGE- extension expressed as percentage of total ventricular mass) was performed. Spearman’s rho correlation was evaluated. Mean age was 44 ± 13 years and 26 (63%) patients were male. Mean left ventricular (LV) ejection fraction (EF) was 54 ± 10% and mean right ventricular (RV) EF was 49 ± 12%. Median LV LGE extension was 8.9% (1.05–21) and median RV LGE extension was 0 (0–6.92). All myocardial deformation indices were moderately associated with LGE extension (for LV 3D GLS Spearman’s Rho 0.423, P 0.016; 2D GCS Spearman’s Rho 0.388, P 0.028; 3D GCS 0.362, P 0.042; 2D GRS Spearman’s Rho −0.417, P 0.018; 3D GRS −0.396, P 0.025; for RV 2D GLS Spearman’s Rho 0.385, P 0.030; RV GCS Spearman’s Rho 0.450, P 0.010; RV GRS Spearman’s Rho −0.459, P 0.008). Conclusions All myocardial deformation indices showed a moderate association with LGE extension in a cohort of patients with definite AC. Further studies are needed to validate this observation and understand its implications.

scholarly journals Left ventricular systolic function impairment in children after balloon valvuloplasty for congenital aortic stenosis assessed by 2D speckle tracking echocardiography

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248862
Author(s):  
Krzysztof Godlewski ◽  
Paweł Dryżek ◽  
Elżbieta Sadurska ◽  
Bożena Werner
Keyword(s):  
Strain Rate ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Strain And Strain Rate ◽  
Eccentric Hypertrophy

Aims The aim of the study was to evaluate left ventricular (LV) remodeling and systolic function using two-dimensional speckle tracking echocardiographic (2D STE) imaging in children at a long-term (more than 36 months, 107.5±57.8 months) after balloon valvuloplasty for aortic stenosis (BAV). Methods and results 40 patients (mean age 9,68 years, 75% male) after BAV and 62 control subjects matched to the age and heart rate were prospectively evaluated. The 2D STE assessment of LV longitudinal and circumferential strain and strain rate was performed. Left ventricular eccentric hypertrophy (LVEH) was diagnosed in 75% of patients in the study group. Left ventricular ejection fraction (LVEF) was normal in all patients. In study group, global longitudinal strain (GLS), global longitudinal strain rate (GLSr) were significantly lower compared with the controls: GLS (-19.7±2.22% vs. -22.3±1.5%, P< 0.001), GLSr (-0.89±0.15/s vs. -1.04 ±0.12/s, P < 0.001). Regional (basal, middle and apical segments) strain and strain rate were also lower compared with control group. Global circumferential strain (GCS), global circumferential strain rate (GCSr) as well as regional (basal, middle and apical segments) strain and strain rate were normal. Multivariable logistic regression analysis included: instantaneous peak systolic Doppler gradient across aortic valve (PGmax), grade of aortic regurgitation (AR), left ventricular mass index (LVMI), left ventricular relative wall thickness (LVRWT), left ventricular end-diastolic diameter (LVEDd), peak systolic mitral annular velocity of the septal and lateral corner (S’spt, S’lat), LVEF before BAV and time after BAV and showed that the only predictor of reduced GLS was LV eccentric hypertrophy [odds ratio 6.9; (95% CI: 1.37–12.5), P = 0.045]. Conclusion Patients at long-term observation after BAV present the subclinical LV systolic impairment, which is associated with the presence of its remodeling. Longitudinal deformation is the most sensitive marker of LV systolic impairment in this group of patients.

scholarly journals The impact of left atrial strain parameters on systolic and diastolic improvement following TAVI

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Vattay ◽  
A I Nagy ◽  
A Apor ◽  
M Kolossvary ◽  
A Manouras ◽  
...  
Keyword(s):  
Left Atrial ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Term Survival ◽  
Lv Mass ◽  
Reverse Remodelling ◽  
The Impact

Abstract Introduction Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and has been shown to improve long term survival. Data on the prognostic value of left atrial (LA) strain following TAVI are scarce. LA strain – a surrogate of LV filling pressure - can aid the early detection of diastolic dysfunction and correlates with the extent of fibrosis in atrial remodelling. Purpose In this multimodality study, we aimed to evaluate the prognostic value of LA function measured before hospital discharge following TAVI and to further elucidate its association with LV and LA reverse remodelling. Methods In this prospective single center study, we investigated 90 patients (mean age 78.5 years, 46.7% female) with severe, symptomatic aortic stenosis (AS) who underwent transthoracic echocardiography immediately after TAVI and 6 months later. LA and LV global longitudinal strain parameters were obtained by speckle tracking echocardiography. CT angiography (CTA) was performed for pre-TAVI planning and repeated at 6 months follow-up. LV mass values were derived from the serial CTA images. We defined LV reverse remodelling as reduction of myocardial mass quantified on CTA and as an improvement of LV global longitudinal strain (GLS). LA reverse remodelling was assessed based on the peak reservoir strain values (LAGS). The association of LA and LV global strain parameters, LA stiffness, systolic and diastolic functional parameters and LV mass based reverse remodelling were analysed using Pearson correlation coefficient and linear regression models. Results The mean LAGS and LVGLS values were 17.7% and 15.3% at discharge and 20.2% and 16.6% at follow-up, respectively (p=0.024, p&lt;0.001). LA and LV strain values improved in 60.6% and 74.5% of all patients. Reduced LAGS (&lt;20%) was found in 66.7% of all patients at baseline. LA strain at discharge correlated significantly with diastolic parameters (E wave, E/e', LAVI, all p&lt;0.05). Atrial reverse remodelling based on LAGS change correlated with LVGLS change (p&lt;0.01, standardized β=0.53) and LAGS at discharge (p=0.012, standardized β=−0.30). LAGS correlated with the extent of morphological LV remodelling based on LV mass reduction (p=0.002, coeff: 0.36). Elevated LA stiffness at discharge (upper tercile) leads to substantially lower LAGS at 6 months versus patients with lower LA stiffness value (1. and 2. tercile): 16.4±10.0 vs 21.9±9.8, p=0.042. Conclusion Patients with reduced LAGS immediately after TAVI showed a larger extent of LV reverse remodelling during follow up. On the other hand, increased LA stiffness at discharge was consistent with irreversible LA damage as demonstrated by a lack of improvement in LA function. FUNDunding Acknowledgement Type of funding sources: None.

Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography

2019 ◽  
Vol 29 (12) ◽  
pp. 1494-1500
Author(s):  
Jyothsna Akam-Venkata ◽  
Gilda Kadiu ◽  
James Galas ◽  
Steven E. Lipshultz ◽  
Sanjeev Aggarwal
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Global Longitudinal Strain ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
Normal Left Ventricular ◽  
Fractional Shortening ◽  
Anthracycline Chemotherapy

AbstractAim:Anthracycline-associated cardiotoxicity in childhood cancer survivors may relate to global or segmental left ventricular abnormalities from associated thromboembolic events and myocardial microinfarcts. We characterized left ventricular segmental changes by two-dimensional speckle-tracking echocardiography in anthracycline-treated asymptomatic childhood cancer survivors.Methods and Results:Childhood cancer survivors’ echocardiograms with normal left ventricular fractional shortening >1 year after anthracycline chemotherapy were studied. Cancer-free control children had normal echocardiograms. Apical two-, three-, and four-chamber peak systolic left ventricular longitudinal and global longitudinal strain, and peak systolic left ventricular radial and circumferential strain at papillary muscle levels were analyzed. The mean (standard deviation) age was 12.7 (3.8) years in 41 childhood cancer survivors. The median (interquartile range) follow-up after anthracycline chemotherapy was 4.73 (2.15–8) years. The median (range) cumulative anthracycline dose was 160.2 (60–396.9) mg/m2. In childhood cancer survivors, the mean (standard deviation) left ventricular longitudinal strain was lower in two- (−18.6 [3.2] versus −21.3 [2.5], p < 0.001), three- (−16.3 [6.0] versus −21.7 [3.0], p < 0.001), and four- (−17.6 [2.7] versus −20.8 [2.0], p < 0.001) chamber views compared to controls. The left ventricular global longitudinal strain (−17.6 [2.7] versus −21.3 [2.0]) and circumferential strain (−20.8 [4.3] versus −23.5 [2.6], p < 0.001) were lower in childhood cancer survivors. Among childhood cancer survivors, 12 out of 16 left ventricular segments had significantly lower longitudinal strain than controls.Conclusions:Asymptomatic anthracycline-treated childhood cancer survivors with normal left ventricular fractional shortening had lower global longitudinal and circumferential strain. The left ventricular longitudinal strain was lower in majority of the segments, suggesting that anthracycline cardiotoxicity is more global than regional.

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