Global longitudinal strain measured by speckle tracking identifies subclinical heart involvement in patients with systemic sclerosis

2018 ◽  
Vol 25 (15) ◽  
pp. 1598-1606 ◽  
Author(s):  
Federico Guerra ◽  
Giulia Stronati ◽  
Colomba Fischietti ◽  
Alessia Ferrarini ◽  
Lucia Zuliani ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Left Ventricle ◽  
Confidence Interval ◽  
Right Ventricle ◽  
Odds Ratio ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Increased Risk ◽  
Left And Right

Background Systemic sclerosis is characterised by progressive cutaneous and organ fibrosis. Among all organs, a subclinical heart involvement is difficult to detect through conventional imaging. Design We evaluated whether speckle tracking-derived global longitudinal strain could help detect early subclinical systolic dysfunction in systemic sclerosis patients without overt clinical involvement. Methods A case–control, single-centre study on 52 systemic sclerosis patients and 52 age and gender-matched controls. Patients with structural heart disease, heart failure, atrial fibrillation and pulmonary hypertension were excluded. For every patient, standard echocardiographic and speckle tracking-derived variables for the systolic and diastolic function of the left ventricle and right ventricle were acquired. Results Traditional parameters of left and right systolic function did not differ between systemic sclerosis patients and controls (all P = ns). Left and right ventricular global longitudinal strain was significantly impaired in patients with systemic sclerosis when compared to controls (–19.2% vs. –21.1%; P = 0.009 and –18.2% vs. –22.3%; P = 0.012, respectively). Systemic sclerosis patients had a 2.5-fold increased risk of subclinical left ventricular systolic impairment (odds ratio 2.5, 95% confidence interval 1.1–5.5; P = 0.027) and a 3.3-fold increased risk of subclinical right ventricular systolic impairment when compared to controls (odds ratio 3.3, 95% confidence interval 1.4–7.7; P = 0.004). Alterations in the myocardial deformation pattern of systemic sclerosis patients were homogeneous in the right ventricle and eccentric in the left ventricle. Conclusions While traditional echocardiographic parameters are ineffective in detecting subclinical systolic impairment, reduced global longitudinal strain is common in patients with systemic sclerosis and significant for both ventricles. Global longitudinal strain could become a low-cost, non-invasive and reliable tool in order to detect early cardiac involvement in systemic sclerosis patients.

3079Subclinical progression of biventricular cardiomyopathy in patients with systemic sclerosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Stronati ◽  
F Guerra ◽  
L Zuliani ◽  
L Manfredi ◽  
A Ferrarini ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Right Ventricle ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Left Ventricular Ejection ◽  
History Of ◽  
Left And Right

Abstract Background Systemic sclerosis (SSc) is a progressive autoimmune disease which has been proven to affect the heart. While it is widely known that the disease can cause pulmonary artery hypertension and therefore secondary right heart impairment, new studies have detected a subclinical heart involvement of both the left and right ventricles. The similar changes in myocardial deformation of both chambers assessed by speckle tracking imaging are consistent with the definition of SSc-related cardiomyopathy as a standalone entity with peculiar characteristics. Purpose The aim of the present study is to describe the progression of myocardial deformation as assessed through speckle tracking in patients with SSc and no pulmonary hypertension. Methods Prospective, longitudinal study on 48 patients affected by SSc. Patients with a history of heart failure, known structural heart disease, atrial fibrillation, and pulmonary hypertension were excluded. For every patient, standard echocardiographical and speckle-tracking derived variables for the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) were acquired at baseline and after 15±6 months. Results While common parameters of systolic function (Simpons's left ventricular ejection fraction, right ventricular fractional area change, TAPSE, tricuspidal S') did not change during follow-up, mean global longitudinal strain (GLS) significantly worsened for both left (from −19.1%±4.2% to −17.2%±5.0%) and right ventricle (from −17.9%±5.2% to −15.9%±4.8%) over 15 months. The increased impairment seen in SSc patients was homogeneous across endocardial layers (LV: from −21.8%±4.8% to −18.8%±5.2%; RV: from −20.6%±4.5% to −19.4%±4.9%), midventricular layers (LV: from −19.2%±4.5% to −17.7%±4.9%; RV: from −17.7%±4.7% to −16.7%±4.6%) and epicardial layers (LV: from −16.3%±4.7% to −16.0%±4.3%; RV: from −15.4%±5.0% to −14.6%±4.1%), as well as across myocardial segments (Figure 1). No difference in progression rate was seen between the diffuse and limited version of SSc, nor between different serotypes. Figure 1 Conclusions While traditional echocardiographical parameters are useless in order to follow the natural history of SSc-related cardiomyopathy during its early stages, GLS impairment progresses during a 15-month follow-up and involves similarly both the left and right ventricle. Whether, how, and how much the altered myocardial deformation contributes to the incidence of pulmonary arterial hypertension in these patients is still to be assessed. Acknowledgement/Funding Marche Polytechnic University

scholarly journals Global longitudinal strain and left ventricle dyssynchrony changes during stress echocardiography in response to antihypertensive treatment optimization

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Karev ◽  
S Verbilo ◽  
E Malev ◽  
M Prokudina ◽  
A Suvorov
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Antihypertensive Treatment ◽  
Speckle Tracking ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Wall Motion ◽  
Coronary Artery Stenosis ◽  
Global Longitudinal Strain ◽  
Treatment Optimization

Abstract Funding Acknowledgements Type of funding sources: None. Background. The positive effect of blood pressure (BP) lowering medications on global longitudinal strain (GLS) and left ventricle (LV) dyssynchrony even in patients with narrow QRS complexes at rest has been established at rest. The dynamic changes of GLS and dyssynchrony markers on exertion are still remain underinvestigated, especially in patients with hypertensive response to exercise (HRE). Purpose. The aim of the study was to define if any changes in GLS and dyssynchrony markers assessed during exercise stress echocardiography (SE) can occur after the optimization of antihypertensive treatment. Methods. 18 patients without coronary artery stenosis on coronary angiography, underwent exercise SE on treadmill. All patients had arterial hypertension and HRE, defined as elevation of systolic BP ≥190 mmHg in women and ≥210 mmHg in men or ≥180 mmHg from the second stage of standard Bruce protocol. After optimization of BP lowering medications (addition/dose correction of ACEI/ARB, CCB or diuretics) we repeated SE within 138.5 ± 85.1 days. GLS and dyssynchrony markers at rest and on exertion from both tests were subsequently analyzed with the QLab and 3D-Q Advanced software. Results. The target systolic BP at rest was reached in all 18 patients (145.8 ± 21.8 mmHg vs. 126.1 ± 14.5 mmHg, p = 0.03), moreover exercise BP on exercise decreased significantly (209.4 ± 15.4 mmHg vs. 170.8 ± 14.4 mmHg, p = 0.003). We observed improvement in tolerance to exertion (7.2 ± 2.4 METs vs. 8.7 ± 3.0 METs, p = 0.0004), 2D and 3D-ejection fraction increase (4.7 ± 2.2% vs. 8.8 ± 2.1%, p = 0.0002 and 3.9 ± 4.9% vs. 10.8 ± 8.5, p = 0.03) and significant reduction of wall motion score index (1.21 ± 0.24 vs. 1.03 ± 0.11, p = 0.001). The speckle tracking analysis revealed increase in GLS on exertion (-20.4 ± 3.5 vs. -23.78 ± 3.2, p = 0.001) and its increment (-0.28 ± 2.1 vs. 3.17 ± 1.89, p = 0.0006), while the level of rest GLS remained unchanged (-20.61 ± 2.9 vs. -20.61 ± 2.6, p = 0.9) (Fig. 1). The dyssynchrony marker STE-TIME SD-IMPOST (standard deviation of time from QRS onset to peak segmental longitudinal strain on exertion) has also diminished (47.3 ± 18.4 vs. 33.8 ± 12.2, p = 0.005). Conclusions. Stress-induced wall motion abnormalities and poor increase/decrease in GLS observed in patients with HRE even in absence of coronary artery stenosis can resolve or diminish after antihypertensive treatment optimization. Speckle tracking LV-dyssynchrony markers in patients with narrow QRS complexes can also decrease in response to BP-lowering medications. Abstract Figure 1.

Subclinical progression of systemic sclerosis-related cardiomyopathy

2020 ◽  
Vol 27 (17) ◽  
pp. 1876-1886
Author(s):  
Giulia Stronati ◽  
Lucia Manfredi ◽  
Alessia Ferrarini ◽  
Lucia Zuliani ◽  
Marco Fogante ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Speckle Tracking ◽  
Cardiac Involvement ◽  
Global Longitudinal Strain ◽  
Prospective Longitudinal Study ◽  
Heart Involvement ◽  
Increased Risk ◽  
Prospective Longitudinal

Aims Cardiac involvement in patients with systemic sclerosis (SSc) is frequent and represents a negative prognostic factor. Recent studies have described subclinical heart involvement of both the right ventricle (RV) and left ventricle (LV) via speckle-tracking-derived global longitudinal strain (GLS). It is currently unknown if SSc-related cardiomyopathy progresses through time. Our aim was to assess the progression of subclinical cardiac involvement in patients with SSc via speckle-tracking-derived GLS. Methods This was a prospective longitudinal study enrolling 72 consecutive patients with a diagnosis of SSc and no structural heart disease nor pulmonary hypertension. A standard echocardiographic exam and GLS calculations were performed at baseline and at follow-up. Results Traditional echocardiographic parameters did not differ from baseline to 20-month follow-up. LV GLS, despite being already impaired at baseline, worsened significantly during follow-up (from –19.8 ± 3.5% to –18.7 ± 3.5%, p = .034). RV GLS impairment progressed through the follow-up period (from –20.9 ± 6.1% to –18.7 ± 5.4%, p = .013). The impairment was more pronounced for the endocardial layers of both LV (from –22.5 ± 3.9% to –21.4 ± 3.9%, p = .041) and RV (–24.2 ± 6.2% to –20.6 ± 5.9%, p = .001). A 1% worsening in RV GLS was associated with an 18% increased risk of all-cause death or major cardiovascular event ( p = .03) and with a 55% increased risk of pulmonary hypertension ( p = .043). Conclusion SSC-related cardiomyopathy progresses over time and can be detected by speckle-tracking GLS. The highest progression towards reduced deformation was registered for the endocardial layers, which supports the hypothesis that microvascular dysfunction is the main determinant of heart involvement in SSc patients and starts well before overt pulmonary hypertension.

scholarly journals Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Arief Wibowo ◽  
Raymond Pranata ◽  
Astri Astuti ◽  
Badai Bhatara Tiksnadi ◽  
Erwan Martanto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Longitudinal Strain ◽  
Meta Analysis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Poor Outcome ◽  
Literature Searches ◽  
Increased Risk ◽  
Left And Right ◽  
Longitudinal Strains

Abstract Background This systematic review and meta-analysis aimed to assess whether ventricular longitudinal strain can be used as a prognostication tool in patients with coronavirus disease 2019 (COVID-19). Methods Systematic literature searches of PubMed, Embase, and EuropePMC databases were performed on 16 November 2020. Left ventricular global longitudinal strain (LV-GLS) refers to LV contraction measurement using the speckle tracking-based method refers to the mean of strain values of the RV free wall (three segments) measured using echocardiography. The main outcome was poor outcome, defined as a composite of mortality and severe COVID-19. Results Seven studies comprising of 612 patients were included in meta-analysis. Six studies have mortality as their outcome, and 1 study has severity as their outcome. Patients with poor outcome have lower LV-GLS (SMD 1.15 (0.57, 1.72), p < 0.001; I2 70.4%). Each 1% decrease in LV-GLS was associated with 1.4x increased risk of poor outcome (OR 1.37 (1.12, 1.67), p = 0.002; I2 48.8%). Patients with poor outcome have lower RV-LS (SMD 1.18 (0.91, 1.45), p < 0.001; I2 0%). Each 1% decrease in RV-LS was associated with 1.3x increased risk of poor outcome (OR 1.25 (1.15, 1.35), p < 0.001; I2 11.8%). Subgroup analysis showed that for every 1% decrease in LV-GLS and RV-LS is increased mortality with OR of 1.30 (1.12, 1.50) and OR of 1.24 (1.14, 1.35), respectively. Conclusion This study shows that lower LV-GLS and RV-LS measurements were associated with poor outcome in patients with COVID-19. Trial registration PROSPERO CRD42020221144

scholarly journals Cardiac Left Ventricle Mitochondrial Dysfunction After Neonatal Exposure to Hyperoxia: Relevance for Cardiomyopathy After Preterm Birth

Hypertension ◽  
2021 ◽  
Author(s):  
Daniela Ravizzoni Dartora ◽  
Adrien Flahault ◽  
Carolina N.R. Pontes ◽  
Ying He ◽  
Alyson Deprez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Young Adults ◽  
Preterm Birth ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricle Ejection Fraction ◽  
Increased Risk ◽  
Neonatal Hyperoxia

Background: Individuals born preterm present left ventricle changes and increased risk of cardiac diseases and heart failure. The pathophysiology of heart disease after preterm birth is incompletely understood. Mitochondria dysfunction is a hallmark of cardiomyopathy resulting in heart failure. We hypothesized that neonatal hyperoxia in rats, a recognized model simulating preterm birth conditions and resulting in oxygen-induced cardiomyopathy, induce left ventricle mitochondrial changes in juvenile rats. We also hypothesized that humanin, a mitochondrial-derived peptide, would be reduced in young adults born preterm. Methods: Sprague-Dawley pups were exposed to room air (controls) or 80% O 2 at postnatal days 3 to 10 (oxygen-induced cardiomyopathy). We studied left ventricle mitochondrial changes in 4 weeks old males. In a cohort of young adults born preterm (n=55) and age-matched term (n=54), we compared circulating levels of humanin. Results: Compared with controls, oxygen-exposed rats showed smaller left ventricle mitochondria with disrupted integrity on electron microscopy, decreased oxidative phosphorylation, increased glycolysis markers, and reduced mitochondrial biogenesis and abundance. In oxygen-exposed rats, we observed lipid deposits, increased superoxide production (isolated cardiomyocytes), and reduced Nrf2 gene expression. In the cohort, left ventricle ejection fraction and peak global longitudinal strain were similar between groups however humanin levels were lower in preterm and associated with left ventricle ejection fraction and peak global longitudinal strain. Conclusions: In conclusion, neonatal hyperoxia impaired left ventricle mitochondrial structure and function in juvenile animals. Serum humanin level was reduced in preterm adults. This study suggests that preterm birth–related conditions entail left ventricle mitochondrial alterations that may underlie cardiac changes perpetuated into adulthood. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03261609.

Abstract 12757: The Combination of Dyssynchrony and Global Longitudinal Strain by 3D Speckle Tracking After ST-Elevation Myocardial Infarction is Useful for Prediction of Final Infarct Size and Left Ventricular Remodeling

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Noriaki Iwahashi ◽  
Masaomi Gohbara ◽  
Shunsuke Kataoka ◽  
Eiichi Akiyama ◽  
Nobuhiko Maejima ◽  
...  
Keyword(s):  
Infarct Size ◽  
Odds Ratio ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Dyssynchrony ◽  
Lv Remodeling ◽  
Final Infarct Size ◽  
St Elevation

Background: Left ventricular (LV) global strain estimated immediately after ST elevation AMI (STEMI) was reported as a predictor of LV remodeling. Furthermore, LV dyssynchrony estimated by 2D strain is also a prognosticator. However, strain analysis ideally should be assessed by 3D speckle tracking, in order to avoid through plane motion. We explored the usefulness of these two variable assessed by 3D speckle tracking in patients with a first STEMI. Methods: Consecutive 190 patients (131 men, age 65 years, peak CPK=3169 IU/l) presenting with a first STEMI who underwent primary PCI within 12 hours of onset were enrolled. Within 24 h of PCI, echocardiography was performed by iE33(Philips). 3D speckle tracking was analyzed by 4D LV-Analysis (TOM-TEC, Germany). Global longitudinal strain was calculated (3D-GLS) and the standard deviation (SD) of time to regional peak 3D longitudinal strain (3D-Long-SD) for all 16 segments was assessed as the parameter of dyssynchrony. Final infarct size was defined using Tc99m-sestamibi as the total area of <50%uptake area at 2 weeks. Echocardiography was repeated 12 months later and LV remodeling was defined as an absolute increase in LVEDV of more than 20%. Results: LV remodeling was observed in 52 patients at 12 months. Both 3D-GLS and 3D-Long-SD had significant relationships with infarct size (r2=0.236, 0.169, p<0.0001). Furthermore, both of the worst tertile of them predicted LV remodeling (Odds ratio = 2.634, 95%CI; 1.322-5.308, p<0.001) (Odds ratio = 3.846, 95%CI;1.887-8.011, p<0.001). Table shows logistic regression analysis for LV remodeling and the combination of these indexes was the strongest predictor (Odds ratio = 2.58, 95%CI 1.003-6.723, p=0.04). Conclusions: In patients with a first STEMI, GLS and LV dyssynchrony assessed by 3D speckle tracking echocardiography immediately after PCI can predict final infarct size and LV remodeling. The combination of these parameters was especially useful to predict LV remodeling.

Influence of visceral adiposity accumulation on adverse left and right ventricular mechanics in the community

2019 ◽  
Vol 27 (18) ◽  
pp. 2006-2015
Author(s):  
Naoko Sawada ◽  
Koki Nakanishi ◽  
Masao Daimon ◽  
Yuriko Yoshida ◽  
Jumpei Ishiwata ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Abdominal Adiposity ◽  
Ventricular Mechanics ◽  
Increased Risk

Aims Obesity carries significant risk for unfavorable ventricular remodeling and subsequent heart failure (HF) development, although the association between abdominal fat distribution and subclinical ventricular dysfunction is unclear. This study aimed to compare the subcutaneous and visceral abdominal adiposity with the risk of decreased ventricular strain. Methods We included 340 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination, and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess left ventricular global longitudinal strain (LVGLS) and right ventricular free-wall longitudinal strain (RVLS). Results Mean age was 56 ± 9 years, and 244 of the participants (72%) were male. The mean LVGLS and RVLS were −19.1 ± 3.0% and −25.0 ± 4.1%, respectively. Both VFA and SFA correlated with LVGLS ( r = 0.46 and r = 0.15, both p < 0.01) and RVLS ( r = 0.38 and r = 0.12, both p < 0.05), demonstrating a stronger correlation between VFA and ventricular strain. Multivariable analysis showed that VFA was significantly associated with LVGLS and RVLS, independent of traditional cardiovascular risk factors as well as pertinent laboratory and echocardiographic parameters (both p < 0.05), whereas SFA was not. Serum adiponectin level was correlated with LVGLS ( r = –0.34, p < 0.001) and RVLS ( r = –0.25, p < 0.001), although it lost statistical significance following multivariable adjustment. Conclusion In a sample of the general population, VFA, but not SFA, accumulation was significantly associated with decreased LV and RV strain, an association that may be involved in the increased risk of HF in obese individuals.

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