Left ventricular myocardial deformation assessment in asymptomatic patients with recently diagnosed sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis

Abstract Background Sarcoidosis is a systemic granulomatous disease affecting different organs including the heart. Myocardial strain analysis could potentially detect the early stages of cardiac dysfunction in sarcoidosis patients. The present study aims to assess the use of cardiac magnetic resonance (CMR) strain analysis using feature tracking (FT) in the detection of early cardiac involvement in asymptomatic patients with sarcoidosis. Methods One hundred and thirteen CMR studies of patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis without pre-existing known cardiovascular disease were included in the study and analysed using FT and compared to 22 age and gender-matched controls. Global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) of the left ventricle (LV) were measured. Results The sarcoidosis patients did not significantly differ from the controls in basic demographic data and had normal global and regional systolic LV function—LV ejection fraction (EF) 66 ± 7% vs 65 ± 5% in the controls (p = NS). No statistically significant differences were found in all strain parameters between patients and controls: GLS (− 13.9 ± 3.1 vs. − 14.2 ± 2.5), GCS (− 23.4 ± 4.0 vs. − 22.2 ± 2.9) and GRS (53.4 ± 13.5 vs. 51.2 ± 13.6%) (p = NS). Conclusion Patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis had normal myocardial deformation measured by CMR-FT derived global strain

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Feature tracking cardiovascular magnetic resonance in asymptomatic patients with extracardiac sarcoidosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.069 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

R Panovsky ◽

M Doubkova ◽

ML Mojica-Pisciotti ◽

T Holecek ◽

J Machal ◽

...

Keyword(s):

Magnetic Resonance ◽

Feature Tracking ◽

Demographic Data ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Radial Strain ◽

Strain Analysis ◽

Lv Function ◽

Development Fund ◽

Asymptomatic Patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Regional Development Fund - Project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868) and the Specific University Research (MUNI/A/1685/2020) provided by the Ministry of Education, Youth and Sports of the Czech Republic (MEYS CR) in the year 2020. Introduction Sarcoidosis is a systemic granulomatous disease affecting many organs including heart. Myocardial strain analysis could potentially detect early stadia of cardiac dysfunction in sarcoidosis patients. Purpose The study aims to assess use cardiac magnetic resonance (CMR) strain analysis using feature tracking (FT) in the detection of early cardiac involvement in asymptomatic patients with sarcoidosis. Methods One hundred thirteen CMR studies of patients with extracardiac sarcoidosis without pre-existing known cardiovascular disease were included into the study and analysed using FT and compared to 22 age and gender matched controls. Global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) of left ventricle (LV) were measured. Results The sarcoidosis patients did not significantly differ from controls in basic demographic data and had normal global and regional systolic LV function – LV ejection fraction (EF) 66 ± 7% vs 65 ± 5% in controls (p = NS). No statistically significant differences were found in all strain parameters between patients and controls: GLS (-13.9 ± 3.1 vs. -14.2 ± 2.5), GCS (-23.4 ± 4.0 vs. -22.2 ± 2.9) and GRS (53.4 ± 13.5 vs. 51.2 ± 13.6%) (p = NS). Conclusion Asymptomatic patients with extracardiac sarcoidosis had normal myocardial deformation measured by CMR-FT derived global strain.

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CMR-derived myocardial strain analysis differentiates ischemic and dilated cardiomyopathy - A propensity score-matched study

10.21203/rs.3.rs-695440/v1 ◽

2021 ◽

Author(s):

Julia Vietheer ◽

Lehmann Lena ◽

Claudia Unbehaun ◽

Ullrich Fischer-Rasokat ◽

Jan Sebastian Wolter ◽

...

Keyword(s):

Propensity Score ◽

Dilated Cardiomyopathy ◽

Propensity Score Matching ◽

Feature Tracking ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Radial Strain ◽

Strain Analysis ◽

Left Ventricular ◽

Myocardial Strain Analysis

Abstract Purpose Left ventricular (LV) longitudinal, circumferential, and radial motion can be measured using feature tracking of cardiac magnetic resonance (CMR) images. The aim of our study was to detect differences in LV mechanics between patients with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) who were matched using a propensity score-based model. Methods Between April 2017 and October 2019, 1224 patients were included in our CMR registry, among them 141 with ICM and 77 with DCM. Propensity score matching was used to pair patients based on their indexed end-diastolic volume (EDVi), ejection fraction (EF), and septal T1 relaxation time. Feature tracking provided six parameters for global longitudinal, circumferential, and radial strain with corresponding strain rates. Results Propensity score matching yielded 72 patients in each group (DCM mean age 58.6 ± 11.6 years, 15 females; ICM mean age 62.6 ± 13.2 years, 11 females, p = 0.084 and 0.44 respectively; LV-EF 32.2 ± 13.5% vs. 33.8 ± 12.1%, p = 0.356; EDVi 127.2 ± 30.7 ml/m² vs. 121.1 ± 41.8 ml/m², p = 0.251; native T1 values 1165 ± 58 ms vs. 1167 ± 70 ms, p = 0.862). There was no difference in global longitudinal strain between DCM and ICM patients (-10.9 ± 5.5% vs. -11.2 ± 4.7%, p = 0.72), whereas in DCM patients there was a significant reduction in global circumferential strain (-10.0 ± 4.5% vs. -12.2 ± 4.7%, p = 0.002) and radial strain (17.1 ± 8.51 vs. 21.2 ± 9.7%, p = 0.039). Conclusion Our data suggest that ICM and DCM patients have inherently different myocardial mechanics, even if phenotypes are similar. The ability to discriminate these two conditions may aid in developing additional prognostic and therapeutic strategies in the future.

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CMR-derived myocardial strain analysis differentiates ischemic and dilated cardiomyopathy—a propensity score-matched study

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02469-9 ◽

2021 ◽

Author(s):

Julia Vietheer ◽

Lena Lehmann ◽

Claudia Unbehaun ◽

Ulrich Fischer-Rasokat ◽

Jan Sebastian Wolter ◽

...

Keyword(s):

Propensity Score ◽

Dilated Cardiomyopathy ◽

Propensity Score Matching ◽

Feature Tracking ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Radial Strain ◽

Strain Analysis ◽

Left Ventricular ◽

Myocardial Strain Analysis

AbstractLeft ventricular (LV) longitudinal, circumferential, and radial motion can be measured using feature tracking of cardiac magnetic resonance (CMR) images. The aim of our study was to detect differences in LV mechanics between patients with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) who were matched using a propensity score-based model. Between April 2017 and October 2019, 1224 patients were included in our CMR registry, among them 141 with ICM and 77 with DCM. Propensity score matching was used to pair patients based on their indexed end-diastolic volume (EDVi), ejection fraction (EF), and septal T1 relaxation time (psmatch2 module L Feature tracking provided six parameters for global longitudinal, circumferential, and radial strain with corresponding strain rates in each group. Strain parameters were compared between matched pairs of ICM and DCM patients using paired t tests. Propensity score matching yielded 72 patients in each group (DCM mean age 58.6 ± 11.6 years, 15 females; ICM mean age 62.6 ± 13.2 years, 11 females, p = 0.084 and 0.44 respectively; LV-EF 32.2 ± 13.5% vs. 33.8 ± 12.1%, p = 0.356; EDVi 127.2 ± 30.7 ml/m2 vs. 121.1 ± 41.8 ml/m2, p = 0.251; native T1 values 1165 ± 58 ms vs. 1167 ± 70 ms, p = 0.862). There was no difference in global longitudinal strain between DCM and ICM patients (− 10.9 ± 5.5% vs. − 11.2 ± 4.7%, p = 0.72), whereas in DCM patients there was a significant reduction in global circumferential strain (− 10.0 ± 4.5% vs. − 12.2 ± 4.7%, p = 0.002) and radial strain (17.1 ± 8.51 vs. 21.2 ± 9.7%, p = 0.039). Our data suggest that ICM and DCM patients have inherently different myocardial mechanics, even if phenotypes are similar. Our data show that GCS is significantly more impaired in DCM patients. This feature may help in more thoroughly characterizing cardiomyopathy patients.

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Layer-specific strain analysis by speckle tracking echocardiography reveals differences in left ventricular function between rats and humans

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00017.2010 ◽

2010 ◽

Vol 299 (3) ◽

pp. H664-H672 ◽

Cited By ~ 26

Author(s):

Noa Bachner-Hinenzon ◽

Offir Ertracht ◽

Marina Leitman ◽

Zvi Vered ◽

Sara Shimoni ◽

...

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Heart Function ◽

Global Longitudinal Strain ◽

Radial Strain ◽

Strain Analysis ◽

Left Ventricular ◽

Lv Function ◽

Disease States

The rat heart is commonly used as an experimental model of the human heart in both health and disease states, assuming that heart function of rats and humans is alike. When studying a rat model, echocardiography is usually performed on sedated rats, whereas standard echocardiography on adult humans does not require any sedation. Since echocardiography results of sedated rats are usually inferred to alert humans, in the present study, we tested the hypothesis that differences in left ventricular (LV) function may be present between rats sedated by a low dose of ketamine-xylazine and alert humans. Echocardiography was applied to 110 healthy sedated rats and 120 healthy alert humans. Strain parameters were calculated from the scans using a layer-specific speckle tracking echocardiography program. The results showed that layer longitudinal strain is equal in rats and humans, whereas segmental strain is heterogeneous ( P < 0.05) in a different way in rats and humans ( P < 0.05). Furthermore, layer circumferential strain is larger in humans ( P < 0.001), and the segmental results showed different segmental heterogeneity in rats and humans ( P < 0.05). Radial strain was found to be homogeneous at the apex and papillary muscle levels in humans and heterogeneous in rats ( P < 0.001). Additionally, whereas LV twist was equal in rats and humans, in rats the rotation was larger at the apex ( P < 0.01) and smaller at the base ( P < 0.001). The torsion-to-shortening ratio parameter, which indicates the transmural distribution of contractile myofibers, was found to be equal in rats and humans. Thus, when evaluating LV function of sedated rats under ketamine-xylazine, it is recommended to measure the global longitudinal strain, LV twist, and torsion-to-shortening ratio, since no scaling is required when converting these parameters and inferring them to humans.

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Abstract 2819: Identification and Characterization of Super-Responders to Cardiac Resynchronization Therapy: An Echocardiographic Study

Circulation ◽

10.1161/circ.118.suppl_18.s_781 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Amira Zaroui ◽

Patricia Reant ◽

Erwan Donal ◽

Aude Mignot ◽

Pierre Bordachar ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Strain Analysis ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Lv Function ◽

Resynchronization Therapy ◽

Systolic Volume ◽

End Systolic Volume

In some patients, cardiac resynchronization therapy (CRT) has been recently shown to induce a spectacular effect on left ventricular (LV) function and inverted remodeling with nearby normalization of LV contraction. Objectives: To analyze and characterize super-responders (CRTSR) by echocardiography before CRT. 186 patients have been investigated before and 6 months after implantation of a CRT device with conventional indication according to ESC guidelines. Echocardiographies including measurements of LV dimensions, and contraction by 2-dimensional strain, and pressure assessment, mitral valve analysis were performed at baseline and at 6 months in an independent core-center lab. CRTSR were defined as a reduction of end-systolic volume of at least 15% and an ejection fraction (EF)>50% and were compared to normal responder patients (CRTNo, patients with a reduction of end-systolic volume of at least 15% but an EF <50%). 17/186 patients (9.1%) were identified as CRTSR, only 2 with ischemic cardiomyopathy (p<0.01). No difference was observed regarding NYHA status, EKG duration or EF between CRTSR and CRTNo at baseline. CRTSR presented with significant lower end-diastolic and end-systolic diameters (64±9mm vs 73±9mm (p<0.01) and 53±7.4mm vs 63±8.4mm (p<0.01), respectively), and end-diastolic and end-systolic volumes 161±44ml vs 210±76ml (p<0.02) and 123±43ml vs 163±69ml (p<0.01)) as well as a higher LV dP/dt max (714±251mmHg.s −1 vs 527±188 mmHg.s −1 (p<0.05)). Regarding strain analysis, CRTSR had significantly higher longitudinal values than CRTNo (−12.8±3% vs −9±2.6%, p<0.001) whereas no difference was observed for other components (p ns). Global longitudinal strain obtained by ROC curves was identified as the best parameter for predicting CRTSR with a cut-off value of −11% (Se=80%, Spe=87%, AUC=0.89, p<0.002) and was confirmed as an independent predictor by the logistic regression (RR: 21.3, p<0.0001). In a large multicenter study, CRT super-responders (EF>50%) were observed in 9% of the population and were associated with less-depressed LV function as determined by strain analysis. Global longitudinal strain appears to be the best predictor of CRTSR.

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

European Heart Journal Supplements ◽

10.1093/eurheartj/suab142.032 ◽

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.

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Quantitative assessment of left ventricular longitudinal function and myocardial deformation in Duchenne muscular dystrophy patients

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01704-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Roman Panovský ◽

Martin Pešl ◽

Jan Máchal ◽

Tomáš Holeček ◽

Věra Feitová ◽

...

Keyword(s):

Duchenne Muscular Dystrophy ◽

Muscular Dystrophy ◽

Cardiac Involvement ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Radial Strain ◽

Strain Analysis ◽

Left Ventricular ◽

Muscle Impairment ◽

Lv Systolic Function

Abstract Background Duchenne muscular dystrophy (DMD) manifests in males mainly by skeletal muscle impairment, but also by cardiac dysfunction. The assessment of the early phases of cardiac involvement using echocardiography is often very difficult to perform in these patients. The aim of the study was to use cardiac magnetic resonance (CMR) strain analysis and mitral annular plane systolic excursion (MAPSE) in the detection of early left ventricular (LV) dysfunction in DMD patients. Methods and results In total, 51 male DMD patients and 18 matched controls were examined by CMR. MAPSE measurement and functional analysis using feature tracking (FT) were performed. Three groups of patients were evaluated: A/ patients with LGE and LV EF < 50% (n = 8), B/ patients with LGE and LVEF ≥ 50% (n = 13), and C/ patients without LGE and LVEF ≥ 50% (n = 30). MAPSE and global LV strains of the 3 DMD groups were compared to controls (n = 18). Groups A and B had significantly reduced values of MAPSE, global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) in comparison to controls (p < 0.05). The values of MAPSE (11.6 ± 1.9 v 13.7 ± 2.7 mm) and GCS (− 26.2 ± 4.2 v − 30.0 ± 5.1%) were significantly reduced in group C compared to the controls (p < 0.05). Conclusion DMD patients had decreased LV systolic function measured by MAPSE and global LV strain even in the case of normal LV EF and the absence of LGE. FT and MAPSE measurement provide sensitive assessment of early cardiac involvement in DMD patients.

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Heart transplantation and antibody-mediated rejection: role of myocardial strain as an early marker of cardiac dysfunction in patients with anti-HLA antibody

European Heart Journal ◽

10.1093/eurheartj/ehab724.0961 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C Sciaccaluga ◽

B.M Natali ◽

G.E Mandoli ◽

N Sisti ◽

F.M Righini ◽

...

Keyword(s):

Cardiac Dysfunction ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Strain Analysis ◽

Left Ventricular ◽

Hla Antibodies ◽

Antibody Mediated Rejection ◽

Right Ventricular Strain ◽

Hla Antibody

Abstract Background Antibody-mediated rejection of the transplanted heart is still currently diagnosed by endomyocardial biopsy whereas clinical elements, anti-Human Leukocite Antigens (HLA) antibody and graft dysfunction represents supplementary components. Purpose The aim of the study was to identify though a non-invasive imaging technique, such as advanced transthoracic echocardiography, early signs of altered cardiac function in patients with anti-HLA antibodies and no histological signs of antibody-mediated rejection. Methods The study population included 117 heart transplanted patients, in whom both acute and chronic rejection was excluded. They were divided into two groups “HLA+`' (45 patients) and “HLA−” (72 patients), based on the presence and the absence of circulating anti-HLA antibodies, respectively. The echocardiographic exam was performed within one week from the biopsy, including Speckle Tracking analysis. Results Deceleration Time of E wave was the strongest traditional echocardiographic parameter which correlated with circulating anti-HLA antibodies (165±39,5 vs 196,5±25; p<0.001). Regarding strain analysis, both left ventricular global longitudinal strain (−16,1±3,4 vs −19,8±2,0; p<0.001) and right ventricular strain (−17,2±0,7 vs −20,6±0,5; p=0.0002) differed significantly between the two subgroups (Figure 1). On the other hand, neither peak atrial longitudinal strain nor peak atrial contraction strain showed a significant correlation with anti-HLA antibodies. Conclusion The presence of circulating anti-HLA antibodies seems to be correlated with a mild cardiac dysfunction, even in the absence of antibody-mediated rejection. This subtle dysfunction is not completely detectable by standard echocardiographic parameters, whereas strain analysis has showed promising results since it revealed more clearly an impaired function of both ventricles in heart transplanted HLA+ patients, with potentially important clinical repercussion. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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P5253Does regional myocardial strain by cardiac magnetic resonance feature tracking reflect scar in ischemic heart disease?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0224 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Stathogiannis ◽

V Mor-Avi ◽

R Lang ◽

A R Patel

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Feature Tracking ◽

Circumferential Strain ◽

Myocardial Strain ◽

Strain Analysis ◽

Left Ventricular ◽

Lv Function ◽

Regional Strain ◽

The Relationship

Abstract Background Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) is the gold standard for detection of myocardial scar. We hypothesized that CMR Feature Tracking (FT)-derived regional myocardial strain may reflect the presence of scar and could thus potentially be used instead of LGE imaging. Purpose The aim of this study was to determine the relationship between FT-derived regional myocardial strain and LGE in patients with coronary artery disease (CAD). Methods Seventy-five patients with CAD and typical ischemic LGE patterns on CMR (1.5T) were included (mean age 60±12 years, 70% males). Myocardial strain analysis and LGE identification were performed using dedicated commercial software. Scar was defined by presence of LGE in the same area of the myocardium in both short- and long-axis views. Peak systolic regional longitudinal and circumferential strain (RLS, RCS) values were calculated in the region of interest corresponding to the LGE area and also in a non-LGE myocardial region as a reference in each patient. These comparisons were repeated for a subgroup of 36 patients with left ventricular (LV) ejection fraction (EF) <40% to determine whether the relationship between strain and LGE holds in the presence of reduced LV function, when strain measurements may be altered as a reflection of reduced LVEF itself. Results Both global longitudinal and circumferential strain values were abnormal (−12.8±5.1% and −11.4±4.1%, respectively), reflecting LV dysfunction in this CAD cohort (EF = 40±16%). The magnitude of both RLS and RCS was significantly reduced in areas of LGE, compared to those without LGE: RLS −10.0±5.8% versus −20.4±7.5% (p<0.001); RCS −10.1±5.3±% versus −18.9±7.5%, respectively (p<0.001). Same pattern was noted in the reduced EF subgroup: RLS −8.0±4.7% versus −16.9±6.6% (p<0.001), RCS −7.7±4.3±% versus −16.0±7.9%, respectively (p<0.001). The figure depicts 2 representative cases in long and short axis views, LGE detection and concomitant regional strain analysis. LGE and regional strain analysis. Conclusion Reduced magnitude of regional longitudinal and circumferential strain by CMR-FT correlates with presence of LGE. Pending further validation, this finding may constitute the basis for detection of scar without contrast enhanced imaging, and would result in reduced cost, scan time and risk associated with gadolinium. Acknowledgement/Funding ARP: Research support (software) from Neosoft and Philips

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P903 Myocardial work in moderate to severe aortic versus primary mitral regurgitation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1191 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Bouziane ◽

R E Dulgheru ◽

S Marchetta ◽

S Khaddi ◽

F Cozza ◽

...

Keyword(s):

Mitral Regurgitation ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Lv Function ◽

Severe Aortic Regurgitation ◽

Asymptomatic Patients ◽

Work Index ◽

Valvular Stenosis ◽

Primary Mitral Regurgitation ◽

Global Work

Abstract Funding Acknowledgements None OnBehalf None BACKGROUND Myocardial work is an emerging non-invasive technic based on echocardiographic pressure-strain loops that assess left ventricular (LV) function. The method was studied in a large variety of pathologies, but its role in the assessment of valvular regurgitations is still unknown. PURPOSE To compare myocardial work indices in moderate and severe aortic and primary mitral regurgitation. METHODS Seventy-eight patients with moderate and severe aortic regurgitation (AR) or primary mitral regurgitation (MR) and preserved LV ejection fraction (LVEF > 50%) were retrospectively analyzed.. Patients with significant valvular stenosis were excluded. Demographic, clinical and echocardiographic data, including LV global longitudinal strain (GLS) and myocardial work indices, were assessed. RESULTS The mean age was 58 ± 14 years, and 46 patients (59%) were men. Thirty seven patients had moderate or severe AR and 41 patients had moderate or severe MR. The two groups were homogeneous in terms of demographic and clinical data, except for age. As expected, diastolic blood pressure was lower in patients with AR compared to MR group (67 ± 8 mmHg vs. 73 ± 10 mmHg, p = 0,003), patients with MR had a higher LVEF compared to AR group (63 ± 6% vs 59 ± 6%, p = 0,03), and a higher left atrial indexed volume (53 ± 16ml/m² vs 34 ± 12ml/m², p < 0.0001). Overall, GLS, myocardial work index (GWI) and myocardial constructive work (GCW) were significantly lower in patients with moderate or severe AR compared to MR ( -18,1 ±3% vs -21,3 ±3,3%, p < 0,0001; 1849 ± 393 vs 2285 ± 499, p < 0,0001; and 2194 ± 395 vs 2576 ± 594, p = 0,003, respectively). Global wasted work (GWW) and global work efficiency (GWE) were similar. When comparing only asymptomatic patients, results were similar, with higher GLS, GWI and GCW in moderate to severe MR vs. AR (-22,9 ± 3,4 vs.-18,4 ± 3,4%, p <0,001; 2446 ± 570 vs. 1927 ± 338, p = 0.001 and 2767 ± 688 vs. 2236 ± 377, p = 0.005). Interestingly, when comparing asymptomatic patients with a LVEF > 50% for AR, and LVEF > 60% for MR, GWI and GCW were significantly lower in MR group, despite higher GLS values (1852 ± 398 vs. 2322 ± 527, p < 0.001; 2194 ± 400 vs. 2615 ± 638, p = 0.005; -22,1 ± 3,3% vs. -18,2 ± 2,9, p < 0.001). CONCLUSION Patients with moderate to severe MR have higher values of GLS, global work index and global constructive myocardial work. This could translate into the fact that in moderate or severe MR, the myocardium develops a higher amount of work than in AR, maybe to account for the loss of stroke volume into the left atrium. In asymptomatic moderate to severe MR with LVEF > 60%, LV myocardium develops less work than in moderate to severe AR with a LVEF > 50%, suggesting maybe a compensated state.

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