Abstract 14432: Myocardial Work in Stage I and II Hypertensive Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Akshar Jaglan ◽  
Sarah Roemer ◽  
Ana C Perez Moreno ◽  
Bijoy K Khandheria
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Deformation Analysis ◽  
Hypertensive Patients ◽  
Reduced Ejection Fraction ◽  
Work Index ◽  
Significant Difference ◽  
Global Work ◽  
Lv Systolic Function

Introduction: Myocardial work is a novel parameter that can be used in a clinic setting to assess left ventricular (LV) pressures and deformation. This study sought to distinguish patterns of global myocardial work index in hypertensive vs. non-hypertensive patients. Methods: Fifty (25 male, mean age 60±14 years) hypertensive patients and 15 (7 male, mean age 38±12 years) control patients underwent transthoracic echocardiography at rest. Hypertensive patients were divided into stage 1 (26 patients) and stage 2 (24 patients) based on the 2017 American College of Cardiology guidelines. We excluded patients with suboptimal image quality for myocardial deformation analysis, reduced ejection fraction (EF), valvular heart disease, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were estimated from LV pressure strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using a noninvasive brachial artery cuff. Results: Global longitudinal strain (GLS) and EF were preserved between the two groups with no statistically significant difference whereas there was a statistically significant difference in the GWI (p<0.01), GCW (p=0.03), GWW (p<0.01), and GWE (p=0.03) (Figure and Table). Conclusions: Myocardial work gives us a closer look at the relationship between LV pressure and contractility in settings of increased load dependency whereas LVEF and GLS cannot. We show how myocardial work is an advanced assessment of LV systolic function in hypertensive patients.

Myocardial work in Stage 1 and 2 hypertensive patients

2021 ◽  
Author(s):  
Akshar Jaglan ◽  
Sarah Roemer ◽  
Ana Cristina Perez Moreno ◽  
Bijoy K Khandheria
Keyword(s):  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Non Invasive ◽  
Significant Difference ◽  
Lv Ejection Fraction ◽  
Global Work ◽  
Stage 1

Abstract Aims Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. Methods and results Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure–strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P &lt; 0.001), and GWW (P &lt; 0.001). Conclusion Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.

scholarly journals Evaluation of left ventricular myocardial work quantitatively by pressure-strain loop in young strength athletes with different heart rates

2021 ◽  
Author(s):  
Pengge Li ◽  
Yonggao Zhang ◽  
Lijin Li ◽  
Mengjiao Sun ◽  
Zhen Li ◽  
...  
Keyword(s):  
Systolic Function ◽  
Linear Regression Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Control Group ◽  
Peak Strain ◽  
Work Efficiency ◽  
Heart Rates ◽  
Work Index ◽  
Lv Systolic Function

Objective: The present study aimed to investigate the difference in left ventricular (LV) global and regional myocardial (MW) of strength athletes with different heart rates (HR) through non-invasive LV pressure-strain loop (PSL) and further address the effect of athlete’s heart rate variability on the LV systolic function. Methods: Fifty young professional wrestlers were collected randomly and divided into two groups in accordance with their different HR: the low HR (45~60 bpm, n=25) and the high HR (60~80 bpm, n=25). Thirty individuals with gender- and age-matched healthy volunteers served as controls ( n=30). Global and regional MW parameters were evaluated using LV-PSL derived from speckle tracking echocardiography (STE) and brachial artery pressure, and then compared between the above three groups. Results: The indicators of global and regional MW did statistically significantly differ between the athlete and control groups. Peak strain dispersion (PSD) and global myocardial wasted work (GWW) increased while global myocardial work efficiency (GWE) reduced in LHR and HHR groups compared with the control group, and global myocardial work index (GWI), global myocardial constructive work (GCW), global longitudinal strain (GLS) decreased in LHR group ( P＜0.05). In comparison to the LHR group, GWI, GCW, GWW, PSD increased in HHR group and GWE reduced ( P＜0.05). According to the regional MW analysis, the mean regional myocardial work index (RMWI) increasing gradually from basal to apical levels were similar across the three groups and regional myocardial work efficiency (RMWE) did not. Multiple linear regression analysis indicated that the HR, posterior wall thickness (PWT), interventricular septal thickness (IVST), GLS, and PSD were correlated with GWE ( b’= -0.247, -0.390, -0.370, 0.340, and -0.554, respectively, P＜0.05). Conclusions: The LV contractile performance was more impaired in young strength athletes with high heart rates and PSL can be used to assess LV GMW and RMW quantitatively and accurately in reflecting LV systolic function.

scholarly journals Evaluation of Left Ventricular Global and Regional Myocardial Work Quantitatively by Pressure-strain Loop in Young Strength Athletes With Different Heart Rates

2021 ◽  
Author(s):  
Pengge Li ◽  
Yonggao Zhang ◽  
Lijin Li ◽  
Mengjiao Sun ◽  
Zhen Li ◽  
...  
Keyword(s):  
Systolic Function ◽  
Linear Regression Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Control Group ◽  
Peak Strain ◽  
Work Efficiency ◽  
Heart Rates ◽  
Work Index ◽  
Lv Systolic Function

Abstract Objective: The present study aimed to investigate the difference in left ventricular (LV) global and regional myocardial work (MW) of strength athletes with different heart rates (HR) through non-invasive LV pressure-strain loop (PSL) and further address the effect of athlete’s resting heart rate variability on the LV systolic function.Methods:Fifty young professional wrestlers were collected randomly and divided into two groups in accordance with their different heart rates: the low HR group (45~60 bpm, n1=25) and the high HR group (60~80 bpm, n2=25). Thirty individuals with gender- and age-matched healthy volunteers served as controls (n3=30). Global and regional MW parameters were evaluated using LV-PSL derived from speckle tracking echocardiography (STE) and brachial artery pressure. The differences between three groups of data and the linear relationship among conventional echocardiographic parameters and global myocardial work efficiency (GWE) were analyzed.Results:The indicators of global and regional MW did statistically significantly differ between the athlete and control groups. Compared with the control group, Peak strain dispersion (PSD) and global myocardial wasted work (GWW) increased while GWE reduced all in the low HR and high HR groups, and global myocardial work index (GWI), global myocardial constructive work (GCW), global longitudinal strain (GLS) decreased in the low HR group (all P＜0.05). In comparison to the low HR group, GWI, GCW, GWW, PSD increased in the high HR group and GWE reduced (P＜0.05). According to the regional MW analysis, the mean regional myocardial work index (RMWI) was increased gradually from basal to apical levels, which were similar across the three groups, but regional myocardial work efficiency (RMWE) did not. Multiple linear regression analysis indicated that the HR, posterior wall thickness (PWT), interventricular septal thickness (IVST), GLS, and PSD were well correlated with GWE (b’= -0.247, -0.390, -0.370, 0.340, and -0.554, respectively, P＜0.05).Conclusions:The sub-clinical changes of LV contractile performance were more obvious in young strength athletes with high resting heart rates and PSL could be used to assess LV GMW and RMW quantitatively and accurately in reflecting LV systolic function.

scholarly journals Non-invasive Myocardial Work Index Contributes to Early Identification of Impaired Left Ventricular Myocardial Function in Uremic Patients With Preserved Left Ventricular Ejection Fraction

2021 ◽  
Author(s):  
Huizhen Zhu ◽  
Yanan Li ◽  
Cunying Cui ◽  
Danqing Huang ◽  
Yuanyuan Liu ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Sensitivity And Specificity ◽  
Myocardial Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Non Invasive ◽  
Work Index ◽  
Uremic Patients ◽  
Global Work ◽  
Lv Systolic Function

Abstract BackgroundCardiac damage is the leading cause of death in uremic patients. This study aimed to evaluate the application of non-invasive myocardial work index (NIMWI) by echocardiography in assessing the left ventricular (LV) systolic function in uremic patients.MethodsTwenty-six uremic patients and twenty-seven age- and sex-matched healthy volunteers were enrolled in the study. Except for the conventional echocardiographic parameters, the LV myocardial work (MW) parameters including GWI (myocardial global work index), GCW (global constructive work), GWW (global wasted work), and GWE (global work efficiency) were calculated in study participants. Differences in MW parameters between the uremic and normal groups were compared by independent-sample t-test. Receiver operating characteristic (ROC) curves were constructed for MW parameters to detect abnormal LV systolic function in uremic patients.ResultsCompared with the normal group, GWW was significantly increased and GWE decreased in the uremic group (P< 0.05). Area under the curve (AUC) for GWE by the ROC analysis was 0.966. The best threshold, sensitivity and specificity values of GWE to detect abnormality of LV systolic function in uremic patients were 92.5%, 0.89 and 0.96 respectively. ConclusionsNIMWI may be applied to assess the global MW of uremic patients. The presence of reduced GWE can help identify impaired left ventricular myocardial function in uremic patients with preserved LV ejection fraction with a high sensitivity and specificity.

scholarly journals P316 A feasible and accurate method for the assessment of early ventricular dysfunction in children with kawasaki disease: result from the MyoWoRK (myocardial work related to kawasaki disease) study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N S Borrelli ◽  
G Di Salvo ◽  
J Sabatino ◽  
M Avesani ◽  
E Filippini ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Unknown Etiology ◽  
Male Age ◽  
Significant Difference ◽  
Global Work ◽  
Lv Systolic Function

Abstract Funding Acknowledgements EACVI Training Grant Introduction Kawasaki disease (KD) is an acute vasculitis of unknown etiology. It is associated with high morbidity and mortality due to the development of coronary artery aneurysms and myocardial dysfunction. Purpose The aim of this study was to evaluate sensitivity and specificity of left ventricular (LV) pressure–strain loop (PSL) area, which reflects regional myocardial work and metabolic demand, in predicting subtle myocardial abnormalities in KD patients with coronaries aneurisms. Methods A total of 88 patients (59 male, age 8.95 ± 4.95 years) were included in our study. Among the children admitted in our institution with a diagnosis of KD during the study time frame, 42 patients (KDg) (29 male) with coronary artery dilatation (Z-score &gt;2.5) were selected. These cases were compared with 46 (30 male) age-matched controls (CTRg). Classical echocardiographic parameters of LV systolic function were normal in both groups, while global longitudinal strain (GLS) was decreased in 6 KD patients. Global work index (GWI) was calculated as the area of the LV PSL. From GWI, it was estimated also Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE). We also made a subgroup analysis between KD patients with normal GLS (&gt; -19 %) and control patients. Results Despite normal LV systolic function by routine echocardiography, compared to controls, KD patients had lower GWI (1448 ± 382 mmHg% in KDg vs 1751 ± 263] mmHg% in CTRg, p = 0.00003), GCW (1904 ± 390 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p= 0.0004) and GWE (94 ± 5 % in KDg vs 96 ± 2 % in CTRg, p= 0.01). There was not significant difference in GWW between the KDg and CTRg. When KD patients with normal GLS were analysed separately, they preserved a significant difference in GWI, GCW and GWE in comparison with controls (GWI: 1490 ± 347 mmHg% in KDg vs 1751 ± 263 mmHg% in CTRg, p = 0.0002; GCW: 1972 ± 321 mmHg% in KDg vs 2174 ± 292 mmHg% in CTRg, p = 0.004; GWE: 95 ± 3 in KDg vs 96 ± 2 % in CTRg, p= 0.04). No association was found between GWI, GCW, GWW, GWE and number or dimension of the involved aneurysmatic coronaries. Conclusions The estimation of myocardial work by PSL is a novel tool for the evaluation of patients with KD. GWI, GCW and GWE were significantly reduced in KD patients with dilated coronaries. In KD patients with normal GLS, estimation of GWI, GCW and GWE may be a sensitive indicator of myocardial dysfunction and an adjuvant criterion to avoid delayed diagnosis of KD. Abstract P316 Figure. Myocardial work in KD and CTR.

Myocardial work analysis in screening of familial dilated cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Triantafyllou ◽  
R Monteiro ◽  
A Protonotarios ◽  
T Gossios ◽  
P Elliott ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dilated Cardiomyopathy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Systemic Hypertension ◽  
Work Efficiency ◽  
Work Analysis ◽  
Significant Difference ◽  
Global Work

Abstract Introduction Early detection of affected family relatives of patients with dilated cardiomyopathy (DCM) is essential in order to guide follow up, outcomes and initiate early treatment. Myocardial work analysis is a novel method which integrated strain imaging and blood pressure and has the potential to identify patients with subclinical disease. Purpose We analysed myocardial work in family relatives of DCM patients with positive genotype but negative phenotype in order to identify whether myocardial work can identify early changes. Methods Seventy-four family relatives of DCM patients attending for screening were examined. All individuals were asymptomatic with either positive (45/74, G+) or negative (29/74, G-) genotype and no echocardiographic evidence of left ventricular dilatation or systolic impairment. Non-invasive myocardial work analysis using two-dimensional (2D) speckle tracking echocardiography was analysed. Global longitudinal strain (GLS) was measured by the same vendor specific software used for myocardial work analysis. Left ventricular (LV) ejection fraction (EF) was measured with the Simpson's biplane method. The peak systolic arm cuff blood pressure (BP) measurement at the time of echocardiography was used for the myocardial work study. Results In total we included 74 individuals (37±15 years old, 50.7% women) with mean systolic and diastolic BP of 121.3±14 and 73.2±10 mmHg respectively, mean EF was 58±5% and mean GLS at 18.4±2.5%. G+ individuals had pathogenic and very likely pathogenic mutations in 8 different genes (TTN, BAG3, DSP, FLNC, LMNA, DMD, RBM20, TPM1). There was no difference in age, systemic hypertension, diabetes or medical treatment between the 2 groups. No significant difference was found among G+ and G- individuals in mean systolic and diastolic BP (121.2±14.7 vs 121.2±15.2 mmHg), mean EF (57.3±5 vs 59.1±4%), GLS (−18.2±1.5 vs −18.6±2.9%), mean global work index (1818±403 vs 1928±295 mmHg%) and global constructive work (2192±464 vs 2260±318 mmHg%). However, we found significant reduction of the global work efficiency (GWE) with a GWE of 94.4±2.7% in the G+ versus 95.9±1.6% in the G- individuals (p 0.02). Moreover, the global wasted work (GWW) was increased in the G+ with a GWW of 111±58 mmHg% versus 82±41 mmHg% in the G- individuals (p 0.03). Conclusion DCM gene carriers show, early on, decreased myocardial work efficiency and increased wasted work compared to unaffected family members, which appears to be earlier than other parameters such as EF and GLS. Myocardial work analysis could potentially recognize individuals showing early cardiac involvement and guide closer follow up and early initiation of treatment. Funding Acknowledgement Type of funding source: None

scholarly journals Echocardiographic Assessment of Left Ventricular Geometric Patterns in Hypertensive Patients in Nigeria

2013 ◽  
Vol 7 ◽  
pp. CMC.S12727 ◽  
Author(s):  
Rasaaq A. Adebayo ◽  
Olaniyi J. Bamikole ◽  
Michael O. Balogun ◽  
Anthony O. Akintomide ◽  
Victor O. Adeyeye ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Geometric Pattern ◽  
Color Flow ◽  
Hypertensive Patients ◽  
Geometric Patterns ◽  
Concentric Hypertrophy ◽  
Eccentric Hypertrophy ◽  
Lv Systolic Function

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

scholarly journals P334 Heart model method: could it be a new echocardiographic gold-standard for the assessment of the left ventricular systolic function in a population under chemotherapy treatment?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Molinero ◽  
P Cabeza ◽  
N Hernandez ◽  
E Silva ◽  
W Delgado
Keyword(s):  
Gold Standard ◽  
Quantitative Methods ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Chemotherapy Treatment ◽  
Heart Model ◽  
Ventricular Systolic Function ◽  
Significant Difference

Abstract Background Echocardiographic assessment of the left ventricular systolic function is essential in diagnosis and during the follow up of cardiovascular diseases. Although subjective visual approach method is easily applied, quantitative systems give more objective information about systolic function analyses. The purpose of this study is to evaluate the different quantitative methods of estimating systolic function basal in non-invasive techniques Methods We used a group of 40 patients, prospectively collected, under chemotherapy treatment with preserved systolic function. Same echocardiography device (Philips EPIQ-7) has been used in all studies (acquiring apical 4 and 2 chambers and 3 D of apical volume by an experimented operator). We compare three standard methods with impact in the literature (Speckle tracking and 3D Heartmodel system) to the echocardiographic gold-standard (Simpson’s biplane method). The Bland-Altman method has been used for the graphic comparison of the values of the resulting measures while the statistical comparison was made by a T-student method. Results Three quantitative methods were used to compare left ventricular systolic function assessment (Heart Model 3D (60.4% ± 5.2%), Strain (60.50% ± 7.1%), global longitudinal strain (-19.7 ± 3.15%) to Simpson’s biplane (mean 62.10% ± 5.75%). Values of differential means (2.73 with Heart model 3D and 2.08 with Strain) compared to Simpson’s biplane were translated to a Bland-Altman plot and means were compared with a T-student method. A statistically significant difference was found in case of the Heartmodel method compared with Simpson’s biplane (p &lt; 0.05), though it does not imply any clinical difference. Less time consuming and better segmentation of the cardiac cavities in just one beat with the 3D-Heart Model technique was a magnificent point compared to the Strain method that needed a postprocessing modification Conclusions Heartmodel method is probably the most time-saving and with a good accuracy of left ventricular systolic function assesment and it is not inferior compared to the echocardiographic gold-standard Simpson’s biplane method. Abstract P334 Figure 1. Bland-Altman analysis

scholarly journals P286 Inverse relation between systolic blood pressure variability and global longitudinal strain in patients with Parkinson"s disease and autonomic dysfunction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Caminiti ◽  
V D"antoni ◽  
V Morsella ◽  
M Torti ◽  
P Grassini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Autonomic Dysfunction ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Blood Pressure Monitoring ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
S Wave ◽  
Hypertensive Patients

Abstract Background Parkinson"s disease (PD) patients often present cardiac blood pressure (BP) derangement as a result of autonomic dysfunction. However their echocardiography pattern have been poorly investigated yet . Study aim: to evaluate the correlation between indices of left ventricular function ad 24/h blood pressure pattern in patients with PD Methods We evaluated 20 patients with diagnosed PD and autonomic dysfunction and 15 hypertensive age-matched subjects. All patients performed 24/h blood pressure monitoring (ABPM) and echocardiography. Left ventricular systolic function was evaluated through ejection fraction (EF), tissue doppler S wave and global longitudinal strain (GLS). BP variability (BPV) was evaluated through average real variability. Results GLS (17.6 vs 22.8; p = 0.04) was reduced in the PD group compared to hypertensive patients. Conversely EF and S wave was similar between the two groups. Patients with PD had an inverse significant correlation between GLS and 24/h systolic BPV (r= -0.64; p = 0.003) and a trend through significance between S wave and systolic BPV (r= -0.31; p = 0.07). sNocturnal diastolic BP was inversely related to GLS (r= -0.44; p = 0.001) . There were no correlation between GLS and BPV and values in hypertensive patients. Conclusions In PD patients GLS is related to indices of poor BP control. GLS appears to be an early detector of LV dysfunction in patients with PD and autonomic dysfunction.

scholarly journals LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Khanna ◽  
I Wen ◽  
A Gupta ◽  
A Thakur ◽  
A Bhat ◽  
...  
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Autoimmune Encephalitis ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
Age And Gender ◽  
Immunological Disorders ◽  
Significant Difference ◽  
And Gender

Abstract Background Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF). Purpose The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up. Methods Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF &lt;50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE). Results A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p&lt;0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis. Conclusions Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon. FUNDunding Acknowledgement Type of funding sources: None.

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