Hypoalbuminemia linked to myocardial dysfunction in recent-onset nephrotic syndrome: a cross-sectional case control 3DSTE study

Abstract Background Although myocardial dysfunction in the context of longstanding steroid-resistant nephrotic syndrome (NS) has been the focus of many series, the detection of myocardial involvement in recent-onset NS has not taken sufficient attention. The primary outcome parameter of our study is the detection of myocardial dysfunction in the initial episode of NS (first 4 weeks after the onset), while the secondary outcome parameter is the determination of the best predictor of such dysfunction among systolic blood pressure, diastolic blood pressure, the duration of the initial episode of NS, and biochemical parameters such as serum albumin and cholesterol. Methods Forty NS patients during the initial episode of NS (first 4 weeks from the onset) were examined for anthropometric data as well as for serum albumin and cholesterol. Motion-mode echocardiography was used to determine Fractional shortening, while 3D echocardiography was applied to determine left ventricular (LV) ejection fraction (EF) and GLS (global longitudinal strain). Finally, we employed combined conventional and tissue doppler to determine LV E/e′ ratio (ratio of early transmitral inflow and average early diastolic basal septal and mitral annular velocities). Forty healthy, age- and sex-matched controls were enrolled to control advanced echocardiographic parameters. Results LV GLS was markedly reduced in cases compared to controls, denoting subtle systolic dysfunction, while, LV E/e′ ratio was significantly higher in cases denoting diastolic dysfunction in early NS. Hypoalbuminemia was found to be the best predictor of both LV GLS and LV E/e′ ratio. Conclusion Myocardial dysfunction should be considered in any NS patient even in recent-onset NS, the severity of hypoalbuminemia seems to be the best determinant of this dysfunction either by increasing endothelial dysfunction or through triggering inflammation. Further studies are needed on the mechanism by which hypoalbuminemia induces myocardial dysfunction in NS patients

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Does age at aortic coarctation repair have an impact on left ventricle size and function?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.108 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

S Cardoso Torres ◽

CX Resende ◽

PG Diogo ◽

P Araujo ◽

RA Pinto ◽

...

Keyword(s):

Aortic Coarctation ◽

Surgical Repair ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Negative Relationship ◽

Late Complications ◽

Left Ventricular ◽

Funding Sources ◽

The Mean ◽

Clinical Records

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Adults with repaired aortic coarctation (CoA) require lifelong follow-up due to late complications, including left ventricular (LV) myocardial dysfunction. Age at the time of CoA repair is an important prognostic factor in these patients (pts). Purpose To evaluate LV size, ejection fraction (EF) and global longitudinal strain (GLS) values using 2D speckle tracking echocardiography (STE) in a population of adult pts with repaired CoA and to assess the relationship between these echocardiographic parameters and age at the time of CoA repair. Methods Retrospective analysis of adult pts with repaired CoA, followed in a Grown Up Congenital Heart Disease Centre. Pts with hemodynamically significant concomitant cardiac lesions were ruled out. Epidemiologic and clinical data were obtained from clinical records. Transthoracic echocardiograms were reviewed in order to assess GLS using 2DSTE (Echopac Software, GE). Results The study population consisted of 63 pts (61.9% male), with a mean age of 35.3 years at the time of the echocardiographic evaluation. The mean age at the time of the CoA repair was 117 months (95% CI 89.8-144.1 months). Surgical repair was performed in 46 pts (73%): resection with subclavian artery flap aortoplasty (n = 21); patch aortoplasty (n = 15) and head-to-head anastomosis (n = 10). In 10 pts there was no data regarding the type of surgical repair. Seven pts (11.1%) were submitted to percutaneous intervention (6 with aortic stent implantation and 1 with balloon aortic angioplasty). Mean LVEF was 63.4% (CI 95% 55.6 – 71.2%) and mean LV end-diastolic diameter (LVEDD) was 50mm (CI 95% 43-57mm). Mean GLS was - 17.3 (CI 95% 14.8- 19.8), which is inferior to the mean normal values reported for the software used. Age at the time of CoA repair had a statistically significant positive linear relationship with LVEDD (r= 0.282; p= 0.026) and a linear negative relationship with both GLS (r= -0,29; p= 0.022) and LVEF (r= -0.33; p= 0.05). Conclusion Older age at the time of CoA repair was associated with increased LVEDD and decreased GLS and LVEF. Also, GLS may be an important tool for the identification of subclinical LV dysfunction in adult pts with repaired CoA.

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Left ventricular global longitudinal strain in identifying subclinical myocardial dysfunction among patients hospitalized with COVID-19

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2021.100719 ◽

2021 ◽

Vol 32 ◽

pp. 100719

Author(s):

Hezzy Shmueli ◽

Maulin Shah ◽

Joseph E. Ebinger ◽

Long-Co Nguyen ◽

Fernando Chernomordik ◽

...

Keyword(s):

Longitudinal Strain ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular

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Echocardiographic parameters during prolonged targeted temperature Management in out-of-hospital Cardiac Arrest Survivors to predict neurological outcome – a post-hoc analysis of the TTH48 trial

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00849-7 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Thomas Hvid Jensen ◽

Peter Juhl-Olsen ◽

Bent Roni Ranghøj Nielsen ◽

Johan Heiberg ◽

Christophe Henri Valdemar Duez ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Targeted Temperature Management ◽

Temperature Management ◽

Left Ventricular Ejection ◽

Secondary Outcome ◽

Ventricular Ejection Fraction ◽

Hospital Cardiac Arrest

Abstract Background Transthoracic echocardiographic (TTE) indices of myocardial function among survivors of out-of-hospital cardiac arrest (OHCA) have been related to neurological outcome; however, results are inconsistent. We hypothesized that changes in average peak systolic mitral annular velocity (s’) from 24 h (h) to 72 h following start of targeted temperature management (TTM) predict six-month neurological outcome in comatose OHCA survivors. Methods We investigated the association between peak systolic velocity of the mitral plane (s’) and six-month neurological outcome in a population of 99 patients from a randomised controlled trial comparing TTM at 33 ± 1 °C for 24 h (h) (n = 47) vs. 48 h (n = 52) following OHCA (TTH48-trial). TTE was conducted at 24 h, 48 h, and 72 h after reaching target temperature. The primary outcome was 180 days neurological outcome assessed by Cerebral Performance Category score (CPC180) and the primary TTE outcome measure was s’. Secondary outcome measures were left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), e’, E/e’ and tricuspid annular plane systolic excursion (TAPSE). Results Across all three scan time points s’ was not associated with neurological outcome (ORs: 24 h: 1.0 (95%CI: 0.7–1.4, p = 0.98), 48 h: 1.13 (95%CI: 0.9–1.4, p = 0.34), 72 h: 1.04 (95%CI: 0.8–1.4, p = 0.76)). LVEF, GLS, E/e’, and TAPSE recorded on serial TTEs following OHCA were neither associated with nor did they predict CPC180. Estimated median e’ at 48 h following TTM was 5.74 cm/s (95%CI: 5.27–6.22) in patients with good outcome (CPC180 1–2) vs. 4.95 cm/s (95%CI: 4.37–5.54) in patients with poor outcome (CPC180 3–5) (p = 0.04). Conclusions s’ assessed on serial TTEs in comatose survivors of OHCA treated with TTM was not associated with CPC180. Our findings suggest that serial TTEs in the early post-resuscitation phase during TTM do not aid the prognostication of neurological outcome following OHCA. Trial registration NCT02066753. Registered 14 February 2014 – Retrospectively registered,

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Myocardial work analysis in screening of familial dilated cardiomyopathy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0092 ◽

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

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Incremental value of feature-tracking cardiac magnetic resonance imaging in detecting myocardial dysfunction in patients with idiopathic ventricular arrhythmias

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.275 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Nikolaidou ◽

C Kotanidis ◽

J Leal-Pelado ◽

K Kouskouras ◽

VP Vassilikos ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Ventricular Arrhythmias ◽

Feature Tracking ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Volume Index ◽

Control Subjects ◽

Cmr Imaging

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac magnetic resonance (CMR) imaging can identify the underlying substrate in patients with ventricular arrhythmias (VAs) and normal echocardiography. Myocardial strain has emerged as a superior index of systolic performance compared to ejection fraction (EF), with an incremental prognostic value in many cardiac diseases. Purpose To assess myocardial deformation using 2-D feature-tracking CMR strain imaging (CMR-FT) in patients with frequent VAs (≥500 ventricular premature contractions (VPC)/24 hours; and/or non-sustained ventricular tachycardia), and structurally normal hearts on echocardiography without evidence of coronary artery disease. Methods Sixty-eight consecutive patients (mean age 46 ± 16 years; 54% female) and 72 healthy controls matched for age and body surface area were included in the study. CMR imaging was performed on a 1.5T Magnetom Avanto (Siemens, Erlangen, Germany) scanner using a standard cardiac protocol. Results CMR showed normal findings in 30 patients (44%), while 16 (24%) had previous myocarditis, 6 (9%) had a diagnosis of non-ischaemic cardiomyopathy (NICM), 15 (22%) were diagnosed with VPC-related cardiomyopathy, and 1 patient had subendocardial infarction [excluded from strain analysis]. Mean left ventricular EF (LVEF) in patients was 62% ± 6% and right ventricular EF 64% ± 6% (vs. 65% ± 3% and 66% ± 4% in controls, respectively). Compared to control subjects, patients with VAs had impaired peak LV global radial strain (GRS) (28.88% [IQR: 25.87% to 33.97%] vs. 36.65% [IQR:33.19% to 40.2%], p < 0.001) and global circumferential strain (GCS) (-17.73% [IQR: -19.8% to -16.33%] vs. -20.66% [IQR: -21.72% to -19.6%], p < 0.001, Panel A). Peak LV GRS could differentiate patients with previous myocarditis from patients with NICM and those with VPC-related cardiomyopathy (Panel B). Peak LV GCS could differentiate patients with previous myocarditis from patients with NICM (Panel C). Peak LV GRS showed excellent diagnostic accuracy in detecting patients from control subjects (Panel D). In a multivariable regression model, subjects with a low GRS (<29.91%-determined by the Youden’s index) had 5-fold higher odds of having VAs (OR:4.99 [95%CI: 1.2-21.95]), after adjusting for LVEF, LV end-diastolic volume index, age, sex, BMI, smoking, hypertension, and dyslipidaemia. Peak LV global longitudinal strain (GLS) and RV strain indices were not statistically different between patients and controls. Conclusion Peak LV GRS and GCS are impaired in patients with frequent idiopathic VAs and can detect myocardial contractile dysfunction in patients with different underlying substrates. Our findings suggest that LV strain indices on CMR-FT constitute independent markers of myocardial dysfunction on top and independently of EF. Abstract Figure.

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Atrial and Ventricular Structural and Functional Alterations in Obese Children

Medicina ◽

10.3390/medicina57060562 ◽

2021 ◽

Vol 57 (6) ◽

pp. 562

Author(s):

Rima Šileikienė ◽

Karolina Adamonytė ◽

Aristida Ziutelienė ◽

Eglė Ramanauskienė ◽

Jolanta Justina Vaškelytė

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Radial Strain ◽

Left Ventricular ◽

Z Score ◽

Obese Children ◽

2D Speckle Tracking

Background and objectives: Childhood obesity has reached epidemic levels in the world. Obesity in children is defined as a body mass index (BMI) equal to or above the 95th percentile for age and sex. The aim of this study was to determine early changes in cardiac structure and function in obese children by comparing them with their nonobese peers, using echocardiography methods. Materials and methods: The study enrolled 35 obese and 37 age-matched nonobese children. Standardized 2-dimensional (2D), pulsed wave tissue Doppler, and 2D speckle tracking echocardiography were performed. The z-score BMI and lipid metabolism were assessed in all children. Results: Obese children (aged 13.51 ± 2.15 years; 20 boys; BMI z-score of 0.88 ± 0.63) were characterized by enlarged ventricular and atrial volumes, a thicker left ventricular posterior wall, and increased left ventricular mass. Decreased LV and RV systolic and diastolic function was found in obese children. Atrial peak negative (contraction) strain (−2.05% ± 2.17% vs. −4.87% ± 2.97%, p < 0.001), LV and RV global longitudinal strain (−13.3% ± 2.88% vs. −16.87% ± 3.39%; −12.51% ± 10.09% vs. −21.51% ± 7.42%, p < 0.001), and LV global circumferential strain (−17.0 ± 2.7% vs. −19.5 ± 2.9%, p < 0.001) were reduced in obese children. LV torsion (17.94° ± 2.07° vs. 12.45° ± 3.94°, p < 0.001) and normalized torsion (2.49 ± 0.4°/cm vs. 1.86 ± 0.61°/cm, p = 0.001) were greater in obese than nonobese children. A significant inverse correlation was found between LV and RV global longitudinal strain and BMI (r = −0.526, p < 0.01; r = −0.434, p < 0.01) and total cholesterol (r = −0.417, p < 0.01). Multivariate analysis revealed that the BMI z-score was independently related to LV and RV global longitudinal strain as well as LV circumferential and radial strain. Conclusion: 2D speckle tracking echocardiography is beneficial in the early detection of regional LV systolic and diastolic dysfunctions, with preserved ejection fraction as well as additional RV and atrial involvement, in obese children. Obesity may negatively influence atrial and ventricular function, as measured by 2D speckle tracking echocardiography. Obese children, though they are apparently healthy, may have subclinical myocardial dysfunction.

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Abstract 15706: Association of Blood Pressure Level With Left Atrial Size and Function in Adolescents (SHIP AHOY)

Circulation ◽

10.1161/circ.142.suppl_3.15706 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Edem Binka ◽

Cedric Manlhiot ◽

Elaine M Urbina ◽

Tarek ALSAIED ◽

Tammy M Brady

Keyword(s):

Blood Pressure ◽

Left Atrial ◽

Global Longitudinal Strain ◽

Blood Pressure Level ◽

Left Ventricular ◽

Z Score ◽

Linear Regression Models ◽

Cvd Risk ◽

Strain And Strain Rate ◽

And Function

Introduction: Left atrial (LA) enlargement and dysfunction are risk factors for stroke, atrial fibrillation and death in adults, and are associated with hypertension (HTN). In children, left ventricular hypertrophy is the most common manifestation of cardiac-specific organ damage in those with HTN, but gaps in knowledge remain regarding the association of HTN with LA size and function. Hypothesis: Increasing blood pressure (BP) is associated with increased LA volume and abnormal LA strain in children. Methods: Echocardiographic images of youth, aged 11 to 18 yrs from 5 clinical sites were obtained. LA strain and strain rate were analyzed using 2-D speckle tracking imaging with R-R gating in the apical 4 and 2-chamber views and averages of both views were used. Subjects were grouped by SBP as low-risk (L; <80th %ile), mid-risk (M; 80-<90th %ile), or high-risk, (H;≥90th %ile). Linear regression models were used to determine the association between BP z-score and LA size and function adjusting for age, sex, race and ethnicity. Results: N=347 youth (median age 15.7 yrs) 60% (n=208) male and 40% (n=139) non-white were included. BP groups differed by age (L&H<M) and BMI (L<M&H). BP groups did not differ by LA size and strain but differed by left ventricular mass index (H>L), stroke volume (M&H<L), peak global longitudinal strain (L>H), mitral E/e’ (H>L) and pulse wave velocity (H>L), each indicating worse CVD risk in the H vs. L group (Table). Multivariable analyses revealed DBP z-score to be independently associated with LA conduit strain (beta 0.73, 95% CI 0.01, 1.45, p<0.05). No other LA size or function variables were associated with BP. Conclusions: Greater BP is associated with increased CVD risk among youth as assessed by non-invasive measurements of CV structure and function. DBP is independently associated with LA conduit strain, a finding associated with CV events in adults. Future studies to determine the long-term association of abnormal DBP with LA strain are needed.

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Abstract 12952: Global Longitudinal Strain is Simple, Effective & Sensitive Assessment of Cardiac Chamber Function in Patients With Acute-phase Myocarditis

Circulation ◽

10.1161/circ.142.suppl_3.12952 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Shaun Khanna ◽

Aditya Bhat ◽

Henry H Chen ◽

Kennith Gu ◽

Gary Gan ◽

...

Keyword(s):

Acute Phase ◽

Longitudinal Strain ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Disease Process ◽

Left Ventricular ◽

Lv Function ◽

Lv Mass ◽

Echocardiographic Parameters ◽

Cardiac Therapy

Introduction: Myocarditis is an inflammatory disease process with growing clinical relevance in the current COVID-19 pandemic. Acute-phase myocarditis is known to result in subclinical changes in left ventricular (LV) function despite normal LV ejection fraction (LVEF), as assessed by myocardial deformation indices. The presence of right ventricular (RV) and left atrial (LA) subclinical dysfunction however has not been well described in current literature. Hypothesis: Myocarditis patients have subclinical impairment of LV, RV and LA function as assessed by global longitudinal strain (GLS) on speckle tracking echocardiography. Methods: Consecutive patients with clinical diagnosis of myocarditis admitted to our institution during 2013-2018 were assessed (n=76). Patients who did not meet appropriate diagnostic criteria (n=14), had impaired LVEF or prior cardiac disease (n=8) or poor transthoracic echocardiogram images (n=14) were excluded from analysis. Clinical and echocardiographic parameters were compared to age- , gender- and risk factor- matched controls. GLS was performed by two independent observers using vendor independent software (TomTec Arena, Germany v4.6). Results: The final cohort consisted 40 patients with myocarditis (age 44.3±16.7, 60% male) and 40 matched controls (44.5±16.6, 60% male). No significant differences in baseline clinical characteristics were observed between groups. No differences in LVEF, indexed LV mass, RV fractional area change, indexed LA volume or TR pressure gradient (p>0.05 for all) were demonstrated between the two groups. Patients with myocarditis had a lower mean LV strain (GLS%: -16.4±2.9 vs -19.7±2.7, p=0.0001), a lower mean RV Free Wall Strain (FWS) (GLS%: -22.1±4.1 vs -26.2±6.9, p=0.03) and a lower mean LA reservoir strain (GLS%: 27.5±4.6 vs. 33.7±6.3, p<0.0001) when compared to controls. Conclusions: Our results demonstrate the presence of significant subclinical global myocardial dysfunction despite normal traditional echocardiographic indices, in patients with acute-phase myocarditis. Routine assessment of GLS may identify such patients for early targeted cardiac therapy.

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Abstract 14632: Effect of Obesity on Myocardial Strain Determined by Speckle Tracking Imaging

Circulation ◽

10.1161/circ.132.suppl_3.14632 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Meihua Zhu ◽

Cole Streiff ◽

Tao He ◽

Muhammad Ashraf ◽

Jiahui Zhang ◽

...

Keyword(s):

Speckle Tracking ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Left Ventricular ◽

Control Group ◽

Speckle Tracking Imaging ◽

Initial Weight ◽

Newborn Mice ◽

2D Speckle Tracking

Introduction: Obesity may affect cardiac function, which is hard to detect by traditional echocardiography in the early stages. Speckle tracking imaging (STI) is sensitive to subtle myocardial dysfunction. The aim of this study was to determine the influence of obesity on left ventricular (LV) myocardial function in diet-induced obesity (DIO) mice using two-dimensional (2D) speckle tracking echocardiography (STE). Hypothesis: 2D STE is useful to detect obesity-caused myocardial dysfunction. Methods: Twenty newborn mice were divided into two groups: a DIO group (high-fat diet) and a control group (regular-fat diet). 2D image loops were acquired at the end of each month for 6 months. Global longitudinal strain (GLS) and global circumferential strain (GCS) were analyzed at feeding periods over 3 months and 6 months, and compared between the two groups. Results: The control group gained 64% of its initial weight, while the DIO group gained 82% of its initial weight at the 3 month feeding period; and the two groups gained 88% (control) and 125% (DIO) respectively at 6 months. STE analysis revealed an insignificant decrease in strain values in the DIO mice after 3 months; however, after 6 months, the DIO group demonstrated a significant decrease in strain values (P<0.05) despite normal ejection fractions in both groups. Conclusions: 2D STE is highly feasible to detect the myocardial dysfunction caused by obesity in earlier stage. These strain values appear to be related to the severity of obesity.

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P321 Cardiotoxicity related to cancer therapy. is the study of mechanical dispersion an additional value?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.174 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

F Privitera ◽

V Losi ◽

I P Monte

Keyword(s):

Ventricular Dysfunction ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Treated Group ◽

Left Ventricular ◽

Lv Function ◽

Breast Cancer Chemotherapy ◽

Mechanical Dispersion ◽

Group 2 ◽

Group 1

Abstract Myocardial dysfunction are the most concerning cardiovascular complications of cancer therapies with a poor prognosis, so it’s critical to detect subclinical cardiac abnormalities in order to start cardioprotective therapy early or increased surveillance frequency. Global longitudinal strain (GLS) by echocardiography is an excellent tool for assessing regional and global left ventricular (LV) function. Mechanical dispersion (MD) reflects heterogeneous myocardial contraction, evaluated in many cardiopathies. We evaluated subclinical myocardial dysfunction by GLS and MD using 2D Speckle-tracking Echo, in order to established if MD could be a predictor of ventricular dysfunction in the field of Cardiotoxicity (CTX). Were enrolled 42 women with breast cancer chemotherapy-treated and underwent to Echo evaluation during 3- and 6-months follow-up, compared to evaluation performed before starting chemotherapy (T0). Depending on chemotherapy type were identified 2 groups: Anthracyclines ± Taxol treated (group 1) and Anti-HER2 treated (group 2). CTX diagnosis was made according ESC criteria: LVEF < 50%, LVEF decrease >10% or GLS decrease >15% compared to previous check. At three months, 28% patients (p < 0,009) developed CTX and, in this group, MD was significantly increased compared to T0 (64,4ms ± 18,6 vs 43,48ms ± 7.88 p < 0,001). This finding was consistent regardless treatment group: 65,2 ms ± 5,30 (p < 0.0001) in group 1 and 63,14 ms ± 36,40 (p 0.02) in group 2. Also, GLS was significantly changed: in CTX patients decreased of 9% compared to T0 (p 0.02), but this finding was consistent in group 1 in which GLS decreased of 18% (p 0,01), while in group 2 decrease only of 5% and wasn’t statistically significant compared to T0 (p = 0,3). These patients were treated by beta-blockers or ACE-inhibitors. At six months there was a normalization of MD value (47.7 ± 15.97 ms in CTX group) that was not statistically significant compared to T0 (p = 0,2) and we have interpreted as consequence of positive effect induced by cardioprotective therapy. We believe that MD is a predictor of ventricular dysfunction earlier than GLS during Anti-HER2 treatment, so in this field MD could integrates information obtained from GLS about subclinical dysfunction.

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