Echocardiographic Myocardial Strain Analysis Describes Subclinical Cardiac Dysfunction after Craniospinal Irradiation in Pediatric and Young Adult Patients with Central Nervous System Tumors

Abstract Background: Craniospinal irradiation (CSI) is part of the treatment of central nervous system (CNS) tumors and is associated with cardiovascular disease in adults. Global myocardial strain analysis including longitudinal peak systolic strain (GLS), circumferential peak systolic strain (GCS), and radial peak systolic strain (GRS) can reveal subclinical cardiac dysfunction.Methods: Retrospective, single-center study in patients managed with CSI vs. age-matched controls. Clinical data and echocardiography, including myocardial strain analysis, were collected at early (<12 months) and late ( 12 months) time points after completion of CSI.Results: Echocardiograms were available at 20 early and 34 late time points. Patients at the late time point were older (21.7±10.4 vs. 13.3 9.6 years) and further out from CSI (13.1±8.8 vs. 0.2±0.3 years). Standard echocardiographic parameters were normal for all subjects. For early, CSI vs. control: GLS was -16.8 3.6% vs. -21.3 4.0% (p=0.0002), GCS was -22.5 5.2% vs. -21.3 3.4% (p=0.28), and GRS was 21.8 11.0% vs. 26.9 7.7% (p=0.07). For late, CSI vs. control: GLS was -16.2 5.4% vs. -21.6 3.7% (p<0.0001), GCS was -20.9 6.8% vs. -21.9 3.5% (p=0.42), and GRS was 22.5 10.0% vs. 27.3 8.3% (p=0.03). Radiation type (proton vs. photon), and radiation dose (<30 Gy vs. 30 Gy) did not impact any parameter, although numbers were small.Conclusions: Subclinical cardiac systolic dysfunction by GLS is present both early and late after CSI. These results argue for future studies to determine baseline cardiovascular status and the need for early initiation of longitudinal follow-up post CSI.

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Echocardiographic myocardial strain analysis describes subclinical cardiac dysfunction after craniospinal irradiation in pediatric and young adult patients with central nervous system tumors

Cardio-Oncology ◽

10.1186/s40959-021-00093-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hugo R. Martinez ◽

Ralph Salloum ◽

Erin Wright ◽

Lauren Bueche ◽

Philip R. Khoury ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cardiac Dysfunction ◽

Myocardial Strain ◽

Strain Analysis ◽

Late Time ◽

Systolic Strain ◽

Time Points ◽

Peak Systolic Strain ◽

Myocardial Strain Analysis

Abstract Background Craniospinal irradiation (CSI) is part of the treatment of central nervous system (CNS) tumors and is associated with cardiovascular disease in adults. Global myocardial strain analysis including longitudinal peak systolic strain (GLS), circumferential peak systolic strain (GCS), and radial peak systolic strain (GRS) can reveal subclinical cardiac dysfunction. Methods Retrospective, single-center study in patients managed with CSI vs. age-matched controls. Clinical data and echocardiography, including myocardial strain analysis, were collected at early (< 12 months) and late (≥ 12 months) time points after completion of CSI. Results Echocardiograms were available at 20 early and 34 late time points. Patients at the late time point were older (21.7 ± 10.4 vs. 13.3 ± 9.6 years) and further out from CSI (13.1 ± 8.8 vs. 0.2 ± 0.3 years). Standard echocardiographic parameters were normal for both groups. For early, CSI vs. control: GLS was − 16.8 ± 3.6% vs. -21.3 ± 4.0% (p = 0.0002), GCS was − 22.5 ± 5.2% vs. -21.3 ± 3.4% (p = 0.28), and GRS was 21.8 ± 11.0% vs. 26.9 ± 7.7% (p = 0.07). For late, CSI vs. control: GLS was − 16.2 ± 5.4% vs. -21.6 ± 3.7% (p < 0.0001), GCS was − 20.9 ± 6.8% vs. -21.9 ± 3.5% (p = 0.42), and GRS was 22.5 ± 10.0% vs. 27.3 ± 8.3% (p = 0.03). Radiation type (proton vs. photon), and radiation dose (< 30 Gy vs. ≥ 30 Gy) did not impact any parameter, although numbers were small. Conclusions Subclinical cardiac systolic dysfunction by GLS is present both early and late after CSI. These results argue for future studies to determine baseline cardiovascular status and the need for early initiation of longitudinal follow-up post CSI.

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Echocardiographic Myocardial Strain Analysis Describes Subclinical Cardiac Dysfunction after Craniospinal Irradiation in Pediatric and Young Adult Patients with Central Nervous System Tumors

10.21203/rs.3.rs-121700/v1 ◽

2020 ◽

Author(s):

Thomas D Ryan ◽

Hugo R. Martinez ◽

Ralph Salloum ◽

Erin Wright ◽

Lauren Bueche ◽

...

Keyword(s):

Central Nervous System ◽

Cardiac Dysfunction ◽

Myocardial Strain ◽

Strain Analysis ◽

Late Time ◽

Systolic Strain ◽

Peak Systolic Strain ◽

Myocardial Strain Analysis ◽

Late Time Point ◽

Time Point

Abstract Background: Craniospinal irradiation (CSI) is part of the treatment of central nervous system (CNS) tumors and is associated with cardiovascular disease in adults. Global myocardial strain analysis including longitudinal peak systolic strain (GLS), circumferential peak systolic strain (GCS) and radial peak systolic strain (GRS) can reveal subclinical cardiac dysfunction.Methods: Retrospective, single-center study in patients managed with CSI vs. age-matched controls. Clinical data and echocardiography, including myocardial strain analysis, were collected at early (<12 months) and late ( 12 months) after completion of CSI.Results: Echocardiograms were available in 20 early and 34 late patients. Patients at the late time point were older (21.7±10.4 vs. 13.3 9.6 years), and further out from CSI (13.1±8.8 vs. 0.2±0.3 years). Standard echocardiographic parameters were normal for all subjects. For the early time, CSI vs. control: GLS was -16.8 3.6% vs. -21.3 4.0% (p=0.0002), GCS was -22.5 5.2% vs. -21.3 3.4% (p=0.28), and GRS was 21.8 11.0% vs. 26.9 7.7% (p=0.07). At the late time point, CSI vs. control: GLS was -16.2 5.4% vs. -21.6 3.7% (p<0.0001), GCS was -20.9 6.8% vs. -21.9 3.5% (p=0.42), and GRS was 22.5 10.0% vs. 27.3 8.3% (p=0.03). Radiation type (proton vs. photon), and radiation dose (<30 Gy vs. 30 Gy) did not impact any parameter.Conclusions: Subclinical cardiac systolic dysfunction by GLS is present both early and late after CSI. These results argue for inclusion of baseline cardiovascular assessment and early initiation of longitudinal follow-up post CSI.

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RONC-31. ADVANCED ECHOCARDIOGRAPHY WITH MYOCARDIAL-STRAIN-ANALYSIS DESCRIBES SUBCLINICAL CARDIAC DYSFUNCTION AFTER CRANIOSPINAL IRRADIATION (CSI) IN PEDIATRIC AND YOUNG ADULT PATIENTS WITH CENTRAL NERVOUS SYSTEM (CNS) TUMORS

Neuro-Oncology ◽

10.1093/neuonc/noaa222.797 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii460-iii461

Author(s):

Hugo Martinez ◽

Ralph Salloum ◽

Erin Wright ◽

Philip Khoury ◽

Justin Tretter ◽

...

Keyword(s):

Young Adult ◽

Myocardial Strain ◽

Strain Analysis ◽

Cns Tumors ◽

Systolic Strain ◽

Tumor Patients ◽

Cns Tumor ◽

Peak Systolic Strain ◽

Myocardial Strain Analysis ◽

Subclinical Dysfunction

Abstract CSI is part of the treatment of CNS tumors and is associated with cardiovascular disease; data in pediatric/young-adult patients are limited. Myocardial-strain-analysis can reveal subclinical dysfunction. Retrospective, single-center study in CNS tumor patients managed with CSI from 1986–2018. Clinical details, and echocardiography including myocardial-strain-analysis were collected at T1=first echocardiogram after CSI, and T2=most recent echocardiogram. Data are mean±standard deviation. Echocardiograms were available in 44 patients (36%female, 14±8.0years) at T1 and 39 patients (38%female, 21.0±11.3years) at T2. Standard echocardiography was normal for all subjects. At T1, global longitudinal peak systolic strain (GLS) was -16.3%±3.7% in CSI vs. -21.6%±3.5% in controls (p<0.0001); global radial peak systolic strain (GRS) was 21.5%±10.1% in CSI vs. 26.5%±7.4% in controls, and global circumferential peak systolic strain (GCS) was -19.5%±6.0% in CSI vs. -21.4%±3.4% in controls (p<0.05, both comparisons). At T2, GLS was -15.8%±5.2% in CSI vs. -21.9±3.5% in controls (p<0.0001); GRS was 22.6%±10.4% in CSI vs. 27.1±8.2% in controls (p<0.05); GCS was -20.5%±6.9% in CSI vs. -21.8±3.5% in controls (p=0.10). For 17 patients with myocardial-strain-analysis available for both time points: difference in GLS was 0.06±7.2% (p>0.95); GRS was 5.5±9.5% (p<0.05); GCS was -3.4±4.9% (p<0.05). Subclinical dysfunction is present at first echocardiogram after CSI. Myocardial impairment may recover with time, however further analysis is needed to identify risk factors and trends. These results argue for inclusion of baseline cardiovascular assessment and longitudinal follow-up in CNS tumor patients post CSI.

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Do Neurotrophins Connect Neurological Disorders and Heart Diseases?

Biomolecules ◽

10.3390/biom11111730 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1730

Author(s):

Masashi Fujitani ◽

Yoshinori Otani ◽

Hisao Miyajima

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cardiovascular Diseases ◽

Cardiac Dysfunction ◽

Neurological Disorders ◽

Direct Evidence ◽

Heart Diseases ◽

Cns Disorders ◽

New Treatment ◽

Pituitary Adrenal Axis

Neurotrophins (NTs) are one of the most characterized neurotrophic factor family members and consist of four members in mammals. Growing evidence suggests that there is a complex inter- and bi-directional relationship between central nervous system (CNS) disorders and cardiac dysfunction, so-called “brain–heart axis”. Recent studies suggest that CNS disorders, including neurodegenerative diseases, stroke, and depression, affect cardiovascular function via various mechanisms, such as hypothalamic–pituitary–adrenal axis augmentation. Although this brain–heart axis has been well studied in humans and mice, the involvement of NT signaling in the axis has not been fully investigated. In the first half of this review, we emphasize the importance of NTs not only in the nervous system, but also in the cardiovascular system from the embryonic stage to the adult state. In the second half, we discuss the involvement of NTs in the pathogenesis of cardiovascular diseases, and then examine whether an alteration in NTs could serve as the mediator between neurological disorders and heart dysfunction. The further investigation we propose herein could contribute to finding direct evidence for the involvement of NTs in the axis and new treatment for cardiovascular diseases.

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Myocardial strain analysis of echocardiographic sequences using non-rigid registration

Computers in Cardiology, 2004 ◽

10.1109/cic.2004.1442935 ◽

2005 ◽

Cited By ~ 2

Author(s):

M.J. Ledesma-Carbayo ◽

A. Santos ◽

J. Kybic ◽

P. Mahia-Casado ◽

M.A. Garcia-Feernandez ◽

...

Keyword(s):

Myocardial Strain ◽

Strain Analysis ◽

Rigid Registration ◽

Myocardial Strain Analysis

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P1470Myocardial dysfunction index: a novel myocardial strain parameter for diagnosing myocardial ischemia

European Heart Journal ◽

10.1093/eurheartj/ehz748.0235 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Tanekda ◽

T Asanuma ◽

K Masuda ◽

A Kozuma ◽

S Minami ◽

...

Keyword(s):

Myocardial Ischemia ◽

Myocardial Dysfunction ◽

Myocardial Strain ◽

Integrated Analysis ◽

Acute Ischemia ◽

Systolic Strain ◽

Operating Characteristics ◽

Strain Index ◽

Peak Systolic Strain ◽

Normal Ranges

Abstract Background and purpose Peak systolic strain (ε-sys) derived from speckle tracking echocardiography (STE) is a useful parameter for assessing regional contractile dysfunction during acute ischemia. However, low ε-sys does not always indicate myocardial ischemia because of its relatively large variation in segmental normal ranges and intervendor differences. Therefore, comparison of strain before and after an ischemic event and demonstration of a decrease in ε-sys should be necessary to confirm myocardial ischemia, which is not always possible in clinical situations. It is well known that early systolic lengthening (ESL) and post-systolic shortening (PSS) occur during acute ischemia. We hypothesized that ESL and PSS would correlate with the decrease in ε-sys and integrated analysis of ESL and PSS could be useful to diagnose the presence of myocardial ischemia. Methods 2D short-axis or 3D full-volume images were acquired by Artida at baseline, during flow-limiting stenosis (mean 50±20% flow reduction), and during complete occlusion of the left circumflex coronary artery in 22 dogs (2D-STE = 12, 3D-STE = 10).Circumferential strain was analyzed in the center of risk area, and the absolute value of peak systolic strain (ε-sys), post-systolic strain index (PSI) as a parameter of PSS, and early systolic strain index (ESI) as a parameter of ESL were measured. A new parameter, myocardial dysfunction index (MDI), which was calculated as follows: (ESL amplitude + PSS amplitude)/maximal strain amplitude during the cardiac cycle, was also calculated. The difference in ε-sys between at baseline and during ischemia (Δε-sys) was measured and the diagnostic accuracy for estimating Δε-sys < −3% was assessed by the receiver operating characteristics (ROC) curve analysis. Results During ischemia, ε-sys decreased from 19±3 to 12±6% and MDI increased from 2±4 to 27±30%. MDI was significantly correlated with Δε-sys (2D-STE: r=−0.80, 3D-STE: r=−0.83, p<0.01, respectively) (Figure). The area under the curve (AUC) of MDI for estimating Δε-sys < −3% tended to be larger than those of ESI and PSI (MDI: 0.9, ESI: 0.73, PSI: 0.85). Figure 1 Conclusions The novel parameter, MDI was correlated with the decrease in ε-sys during acute ischemia. Integrated analysis of ESL and PSS may be useful for diagnosing the presence of myocardial ischemia.

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Osteopontin ImpactsWest Nile virusPathogenesis and Resistance by Regulating Inflammasome Components and Cell Death in the Central Nervous System at Early Time Points

Mediators of Inflammation ◽

10.1155/2017/7582437 ◽

2017 ◽

Vol 2017 ◽

pp. 1-12 ◽

Cited By ~ 4

Author(s):

Nikki Bortell ◽

Claudia Flynn ◽

Bruno Conti ◽

Howard S. Fox ◽

Maria Cecilia G. Marcondes

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Viral Infections ◽

Early Time ◽

Cns Infection ◽

Critical Threshold ◽

Type I ◽

Time Points ◽

Viral Spread ◽

The Impact

Osteopontin (OPN) is a molecule that is common in central nervous system (CNS) pathologies, which participates in the activation, migration, and survival of inflammatory cells. However, the mechanisms by which OPN modulates inflammatory pathways are not clear. To understand the role of OPN in CNS viral infections, we used a lethal mouse model ofWest Nile virus(WNV), characterized by the injection of high doses of the Eg101 strain of WNV, causing the increase of OPN levels in the brain since early time points. To measure the impact of OPN in neuropathogenesis and resistance, we compared C57BI/6 WT with mice lacking the OPN gene (OPN KO). OPN KO presented a significantly higher mortality compared to WT mice, detectable since day 5 pi. Our data suggests that OPN expression at early time points may provide protection against viral spread in the CNS by negatively controlling the type I IFN-sensitive, caspase 1-dependent inflammasome, while promoting an alternative caspase 8-associated pathway, to control the apoptosis of infected cells during WNV infection in the CNS. Overall, we conclude that the expression of OPN maintains a critical threshold in the innate immune response that controls apoptosis and lethal viral spread in early CNS infection.

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