Assessment of left ventricular systolic function by non-invasive pressure-strain loop area in young male strength athletes

Abstract Background The health of athletes has been recognized as a worldwide public concern with more reported sudden cardiac deaths (SCD). Therefore, early detection of abnormal heart function in athletes can help reduce the risk of exercise. A novel valid non-invasive method to evaluate left ventricular (LV) myocardial work (MW) using LV pressure-strain loop (PSL), was used in this paper to explore LV systolic function in young male strength athletes. Methods 36 professional young male strength athletes (the athlete group) and 32 healthy, age-matched young men (the control group) were involved in the study. The LVMW parameters were calculated as the area of PSL by two-dimensional speckle tracking echocardiography (2D-STE) and peak systolic LV pressure. The differences between two groups of data and the predictive efficacy of MW parameters for LV systolic function were analyzed. Results The athlete group had significantly higher values of global wasted myocardial work (GWW) and peak strain dispersion (PSD) than did the control group (P༜0.05).Global myocardial work index (GWI), global constructive myocardial work (GCW) and global longitudinal strain (GLS) were lower in the athlete group than that in the control group, although statistical significance was not reached (P༞0.05). Due to the proportion of GWW and GCW, statistically significant reduction was found in global myocardial work efficiency (GWE) in the athlete group. The best predictor of LV myocardial contractile performance in the athletes using receiver operating characteristic curve (ROC) was GWE, with the area under ROC (AUC) of 0.733, sensitivity of 83.3% and specificity of 59.4%. Conclusions Subclinical changes have appeared in the hearts of young male strength athletes after long-term intensive exercise and LVMW parameters by PSL play an important role in the evaluation of athlete’s LV contractile performance.

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Assessment of left ventricular systolic function by non-invasive pressure-strain loop area in young male strength athletes

Cardiovascular Ultrasound ◽

10.1186/s12947-020-00227-w ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Pengge Li ◽

Yonggao Zhang ◽

Lijin Li ◽

Yingchun Chen ◽

Zhen Li ◽

...

Keyword(s):

Systolic Function ◽

Global Longitudinal Strain ◽

Young Male ◽

Left Ventricular ◽

Control Group ◽

Peak Strain ◽

Non Invasive ◽

Lv Systolic Function ◽

Contractile Performance ◽

Athlete Group

Abstract Background The health of athletes has been recognized as a worldwide public concern with more reported sudden cardiac deaths (SCD). Therefore, early detection of abnormal heart function in athletes can help reduce the risk of exercise. A novel valid non-invasive method to evaluate left ventricular (LV) myocardial work (MW) using LV pressure-strain loop (PSL), was used in this paper to explore LV systolic function in young male strength athletes. Methods Thirty-six professional young male strength athletes (the athlete group) and 32 healthy, age-matched young men (the control group) were involved in the study. The LVMW parameters were calculated as the area of PSL by two-dimensional speckle tracking echocardiography (2D-STE) and peak systolic LV pressure. The differences between two groups of data and the predictive efficacy of MW parameters for LV systolic function were analyzed. Results The athlete group had significantly higher values of global wasted myocardial work (GWW) and peak strain dispersion (PSD) than did the control group (P<0.05). Global myocardial work index (GWI), global constructive myocardial work (GCW) and global longitudinal strain (GLS) were lower in the athlete group than that in the control group, although statistical significance was not reached (P>0.05). Due to the proportion of GWW and GCW, statistically significant reduction was found in global myocardial work efficiency (GWE) in the athlete group. Conventional echocardiography parameters were well correlated with GWW and GWE (P<0.05). The best predictor of LV myocardial contractile performance in the athletes using receiver operating characteristic curve (ROC) was GWE, with the area under ROC (AUC) of 0.733, sensitivity of 83.3% and specificity of 59.4%. Conclusions Subclinical changes have appeared in the hearts of young male strength athletes after long-term intensive exercise and LVMW parameters by PSL play an important role in the evaluation of athlete’s LV contractile performance.

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Assessment of left ventricular systolic function by non-invasive pressure-strain loop area in young male strength athletes

10.21203/rs.3.rs-36881/v2 ◽

2020 ◽

Author(s):

Shaohua Hua ◽

Pengge Li ◽

Yonggao Zhang ◽

Lijin Li ◽

Yingchun Chen ◽

...

Keyword(s):

Systolic Function ◽

Global Longitudinal Strain ◽

Young Male ◽

Left Ventricular ◽

Control Group ◽

Peak Strain ◽

Non Invasive ◽

Lv Systolic Function ◽

Contractile Performance ◽

Athlete Group

Abstract BackgroundThe health of athletes has been recognized as a worldwide public concern with more reported sudden cardiac deaths (SCD). Therefore, early detection of abnormal heart function in athletes can help reduce the risk of exercise. A novel valid non-invasive method to evaluate left ventricular (LV) myocardial work (MW) using LV pressure-strain loop (PSL), was used in this paper to explore LV systolic function in young male strength athletes.Methods 36 professional young male strength athletes (the athlete group) and 32 healthy, age-matched young men (the control group) were involved in the study. The LVMW parameters were calculated as the area of PSL by two-dimensional speckle tracking echocardiography (2D-STE) and peak systolic LV pressure. The differences between two groups of data and the predictive efficacy of MW parameters for LV systolic function were analyzed.Results The athlete group had significantly higher values of global wasted myocardial work (GWW) and peak strain dispersion (PSD) than did the control group (P＜0.05).Global myocardial work index (GWI), global constructive myocardial work (GCW) and global longitudinal strain (GLS) were lower in the athlete group than that in the control group, although statistical significance was not reached (P＞0.05). Due to the proportion of GWW and GCW, statistically significant reduction was found in global myocardial work efficiency (GWE) in the athlete group. Conventional echocardiography parameters were well correlated with GWW and GWE (P＜0.05). The best predictor of LV myocardial contractile performance in the athletes using receiver operating characteristic curve (ROC) was GWE, with the area under ROC (AUC) of 0.733, sensitivity of 83.3% and specificity of 59.4%. ConclusionsSubclinical changes have appeared in the hearts of young male strength athletes after long-term intensive exercise and LVMW parameters by PSL play an important role in the evaluation of athlete’s LV contractile performance.

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

10.22541/au.163550279.92280067/v1 ◽

2021 ◽

Author(s):

Pengge Li ◽

Yonggao Zhang ◽

Lijin Li ◽

Mengjiao Sun ◽

Zhen Li ◽

...

Keyword(s):

Systolic Function ◽

Linear Regression Analysis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Peak Strain ◽

Work Efficiency ◽

Heart Rates ◽

Work Index ◽

Lv Systolic Function

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

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

10.21203/rs.3.rs-623239/v1 ◽

2021 ◽

Author(s):

Pengge Li ◽

Yonggao Zhang ◽

Lijin Li ◽

Mengjiao Sun ◽

Zhen Li ◽

...

Keyword(s):

Systolic Function ◽

Linear Regression Analysis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Peak Strain ◽

Work Efficiency ◽

Heart Rates ◽

Work Index ◽

Lv Systolic Function

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

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

10.21203/rs.3.rs-488914/v1 ◽

2021 ◽

Author(s):

Pengge Li ◽

Lijin Li ◽

Mengjiao Sun ◽

Zhen Li ◽

Mengmeng Liu ◽

...

Keyword(s):

Systolic Function ◽

Linear Regression Analysis ◽

Global Longitudinal Strain ◽

Posterior Wall ◽

Left Ventricular ◽

Control Group ◽

Peak Strain ◽

Work Efficiency ◽

Heart Rates ◽

Work Index

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

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Evaluation of non-invasive myocardial work in tako-tsubo cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.131 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

P Meimoun ◽

A Vernier ◽

V Stracchi ◽

P Gabrion ◽

G Vibou ◽

...

Keyword(s):

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Myocardial Performance ◽

Total Recovery ◽

Transthoracic Doppler Echocardiography ◽

Non Invasive ◽

2D Strain ◽

Tako Tsubo Cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Tako-tsubo cardiomyopathy (TTC) is characterized by the presence of transient left ventricular (LV) wall motion abnormalities (WMA). However, whether systolic performance fully recover is unclear. Non-invasive myocardial work (MW) is a new index of global and regional myocardial performance which has never been described in this setting. Objective: to assess global and regional MW in typical TTC (apical variant). Methods: fifty patients with typical TTC (mean age, 77 ± 10 years, 47 women) were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 24 hours of admission and a median of 32 days at follow-up (FU). MW is derived from the non-invasive strain-pressure loop obtained from the 2D strain data, integrating in its calculation the non-invasive brachial arterial pressure. Constructive MW (CMW), MW index (MWI), MW efficiency (MWE), and wasted work (WW) were measured. Hospital complications (HC) were defined as a composite of heart failure, right ventricular extension, and LV apical thrombus. A control group of 24 patients matched for age and sex without overt cardiovascular disease served as a comparative group. Results: In the TTC group, global and regional MW improved significantly between the two examinations (global, regional apical and medial CMW, MWI, MWE, WW, and regional basal CMW, and MWI, all p < 0.01). The acute apical –basal gradient of MW inverted at FU. In TTC, global CMW and MWI were significantly correlated to acute LV systolic function parameters and their change, and were significantly impaired in patients with HC (n = 13) (all, p < 0.01). At FU, despite total recovery of WMA, global and regional MW was significantly reduced in TTC by comparison to the control group (p < 0.01 for all components), although hemodynamics, LV ejection fraction, and 2D global longitudinal strain were similar (all, p = NS). Conclusion: Global and regional myocardial performance is transiently impaired in typical TTC and significantly associated to HC. And despite total recovery of WMA, subtle dysfunction of myocardial performance persist at FU.

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Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice

Journal of Clinical Medicine ◽

10.3390/jcm10194521 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4521

Author(s):

Federica Ilardi ◽

Antonello D’Andrea ◽

Flavio D’Ascenzi ◽

Francesco Bandera ◽

Giovanni Benfari ◽

...

Keyword(s):

Clinical Practice ◽

Current Knowledge ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

New Method ◽

Added Value ◽

Non Invasive ◽

Potential Applications ◽

Lv Systolic Function

Left ventricular (LV) global longitudinal strain (GLS) has established itself in the last decade as a reliable, more objective method for the evaluation of LV systolic function, able to detect subtle abnormalities in LV contraction even in the presence of preserved ejection fraction (EF). However, recent studies have demonstrated that GLS, similar to LV EF, has important load dependency. Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative tool for myocardial function assessment. This new method, incorporating measurement of strain and LV pressure, has shown to overcome GLS and LV EF limitations and provide a loading-independent evaluation of myocardial performance. The presence of a commercially available echocardiographic software for the non-invasive MW calculation has allowed the application of this new method in different settings. This review sought to provide an overview on the current knowledge of non-invasive MW estimation, showing its potential applications and possible added value in clinical practice.

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Estimation of myocardial work – a new concept of non-invasive left ventricular systolic function assessment

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2021.1.5665 ◽

2021 ◽

Vol 28 (1) ◽

pp. 56-65

Author(s):

M.Yu. Kolesnyk

Keyword(s):

Heart Failure ◽

Cardiovascular Diseases ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Non Invasive ◽

Lv Systolic Function

Assessment of left ventricular (LV) systolic function is a mandatory component of cardiovascular diseases diagnostics. In clinical practice, the main parameters are the ejection fraction and LV global longitudinal strain. Both parameters have a number of limitations, including dependence on afterload. This review describes a new technique for non-invasive assessment of global and segmental myocardial contractility based on the calculation of myocardial work by analyzing pressure-strain curves. The main advantage of the technique is the ability to take into account the afterload conditions by the traditional measurement of blood pressure on the brachial artery. The characteristics of the key parameters of the methodology (global work index, global constructive work, global effective and wasted work) as well as their normative values are presented. The stages of the analysis and the limitations of the method are described separately. The results of the main pilot studies of myocardial work parameters in various cardiovascular diseases are presented. Possibilities of the technique for characterizing LV segmental function in left bundle branch block, selection of patients for cardiac resynchronization therapy with subsequent response assessment are presented. The diagnostic and prognostic value of the parameters of myocardial work in arterial hypertension, acute and chronic forms of ischemic heart disease, hypertrophic and dilated cardiomyopathy, chronic heart failure are analyzed. The possibilities of the technique in assessing the effectiveness of therapy in patients with heart failure are described. Potential advantages of the parameters of myocardial work over other markers of LV systolic function, such as ejection fraction and global longitudinal strain, have been determined. The review is illustrated with clinical examples of the use of the technique for various cardiovascular diseases from our own practice.

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Comparison of Left Ventricular Global Longitudinal Strain Measured with Real Time Triplane and 2-Dimensional Echocardiography in Patients with Atrial Fibrillation

International Cardiovascular Forum Journal ◽

10.17987/icfj.v4i0.156 ◽

2015 ◽

Vol 4 ◽

pp. 24 ◽

Cited By ~ 1

Author(s):

Ling Yun Kong ◽

Chao Yu ◽

Jihong Guo ◽

Tiangang Zhu

Keyword(s):

Atrial Fibrillation ◽

Real Time ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Simultaneous Presentation ◽

Left Ventricular ◽

Control Group ◽

Reproducibility Study ◽

Dimensional Echocardiography ◽

Lv Systolic Function

Background: Left ventricular (LV) global longitudinal peak systolic strain (GLPS, also known as GLS) based on speckle tracking echocardiography (STE) is validated to evaluate global LV systolic function, particularly the global average GLPS (GLPSAvg, which is averaged from three apical longitudinal views). But its application is limited in patients with atrial fibrillation (AF) due to its variability of cycle lengths. A novel imaging technique, real time triplane echocardiography (3PE), allows simultaneous presentation of apical 4-, 2-, and 3- chamber views within one ultrasonic view. We compared GLPS measures using 3PE and conventional 2-dimensional echocardiography (2DE) in patients with AF.Methods: Patients with AF and a control group with sinus rhythm were enrolled prospectively. Three apical sectional GLPSs and GLPSAvg were measured with conventional 2D (2D-STE) and 3PE (3P-STE) modes. Comparison, correlation and agreement of measurements with both modes were made. Ten patients were selected randomly for reproducibility study.Results: (1) A total of 39 patients with AF and 38 control subjects were analyzed. Adequate apical 3PE views were acquired in most subjects (95%). Measurement of GLPSs with 3P-STE was more readily available than with 2D-STE in AF group (97.5% vs. 60.0%, P=000). (2) The GLPSs measured with 3P-STE was constantly lower than that of 2D-STE, but linearly correlated, with GLPSAvg revealing the best correlation (r=0.86, P=0.00 in both groups). (3) The reproducibility of GLPS measured by 3P-STE was valid.Conclusions: Triplane echocardiography may extend the use of LV GLPSAvg to patients with AF for assessment of LV systolic function.

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Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02174-7 ◽

2021 ◽

Author(s):

Philippe C. Wouters ◽

Geert E. Leenders ◽

Maarten J. Cramer ◽

Mathias Meine ◽

Frits W. Prinzen ◽

...

Keyword(s):

Systolic Function ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Lv Function ◽

Peak Strain ◽

Cardiac Resynchronisation ◽

Reverse Remodelling ◽

Resynchronisation Therapy ◽

Lv Systolic Function

AbstractPurpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

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