Echocardiographic Evaluation of Changes in Cardiac Hemodynamics, Loading Conditions, and Atrial Function after Transcatheter Closure of Atrial Septal Defect

Background The changes in loading conditions, atrial function, and the different echocardiographic parameters before and after transcatheter atrial septal defect (ASD) closure are still under study. So we felt the need to evaluate the echocardiographic changes that occur and detect the timing after closure at which the right-sided heart hemodynamics, and measurements are back to normal. Objectives To evaluate the changes in cardiac hemodynamics, loading conditions, and atrial function after percutaneous closure of ASD using echocardiography. Patients and Methods The study included 30 patients referred to percutaneous closure of ASD in Ain Shams University hospital we performed echocardiography before, 1 week, and 3 months after closure. Results The study showed that RV dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p < 0.001). RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p < 0.001). RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure (p < 0.001). LA dimensions and volumes increased significantly 1 week, and 3 months after ASD closure (P < 0.001). LA peak systolic strain showed no significant difference before, 1week, and 3 months after ASD closure (P = 0.063), and strain rate showed no significant difference before, 1week, and 3 months after ASD closure (P = 0.207). Conclusion In our study, we have concluded that RV dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure. RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure. RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure, as a result of improvement of the RA wall velocity, due to relief of the volume overload after closure of the shunt. LA peak systolic strain, and strain rate showed no significant difference before, 1week, and 3 months after ASD closure. Abbreviations list ASD (atrial septal defect), RV (right ventricle), RA (right atrium), LA (left atrium).

Incremental value of early systolic lengthening and postsystolic shortening in detecting left anterior descending artery stenosis using nonstress speckle-tracking echocardiography

The diagnosis of coronary artery disease (CAD) with nonstress echocardiography remains challenging. Although the assessment of either early systolic lengthening (ESL) or postsystolic shortening (PSS) allows the sensitive detection of CAD, it is unclear whether the integrated analysis of ESL and PSS in addition to the peak systolic strain can improve the diagnostic accuracy. We investigated the incremental value of ESL and PSS in detecting left anterior descending artery (LAD) stenosis using nonstress speckle-tracking echocardiography. Fifty-nine patients with significant LAD stenosis but without visual wall motion abnormalities on echocardiography at rest (30 single-vessel stenosis, 29 multivessel stenosis) and 43 patients without significant stenosis of any vessel were enrolled. The peak systolic strain, the time to ESL (TESL), and the time to PSS (TPSS) were analyzed in all LAD segments, and the incremental values of the TESL and TPSS in detecting LAD stenosis and the diagnostic accuracy were evaluated. In the apical anterior segment, the peak systolic strain was significantly lower and TESL and TPSS were significantly longer in the single-vessel group than in the no stenosis group. In the single-vessel group, the addition of TESL and TPSS to the peak systolic strain significantly increased the model power in detecting stenosis, and the integrated analysis improved diagnostic accuracy compared with the peak systolic strain alone. In contrast, this incremental value was not demonstrated in the multivessel group. The integrated analysis of the peak systolic strain, ESL, and PSS may allow better screening of single-vessel LAD stenosis using nonstress speckle-tracking echocardiography.

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

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.

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

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.

Comprehensive Assessment of Changes in Left Ventricular Volume and Myocardial Function After Acute Myocardial Infarction in the Elderly: The Role of Real-Time Three-Dimensional Echocardiography and Two-Dimensional Speckle Tracking Imaging

Background: Conventional echocardiography is not sensitive enough to assess the mild acute myocardial infarction (AMI), especially the non ST elevation AMI (NSTEAMI) that the myocardial motion is often normal or mildly reduced. This research attempt to find some new technology to better assess the left ventricular (LV) volume and myocardial function after percutaneous coronary intervention (PCI) in the elderly patients with NSTEAMI and ST elevation AMI (STEAMI). Methods: Patients with NSTEAMI (n=40) and STEAMI (n=40) underwent imaging investigations 1 week and 3 months after PCI. A group of 40 healthy volunteers was used as a control group. The LV end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were measured using real-time three-dimensional echocardiography (RT-3DE). The longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS), circumferential peak systolic strain (CPSS) and rotational peak degree (Rot) in the myocardium supplied by infarct-related artery (Myo-IRA) segments (LPSS-Api, LPSS-Mid, LPSS-Bas, RPSS-Api, RPSS-Mid, RPSS-Bas, CPSS-Api, CPSS-Mid, CPSS-Bas, Rot-Bas, Rot-Api) were obtained using two-dimensional speckle tracking imaging (2D-STI). The peak torsion angle (Twist) were calculated. Results: Compared with control group, in 1 week after PCI, the ESV and EDV in NSTEAMI and STEAMI patients were significantly increased (P<0.001), the LPSS, RPSS, CPSS in the Myo-IRA segments and the EF, SV, Rot-bas, Rot-Api and Twist in the NSTEAMI and STEAMI patients were significantly lower (P<0.001), and more so in the STEAMI patients. Compared with 1 week after PCI, in 3 months after PCI, the ESV, EDV, SV, EF, RPSS, CPSS, Rot-Bas and Twist in NSTEAMI and STEAMI patients were recovered partially (P<0.01), the LPSS and Rot-Api only in the NSTEAMI patients was improved significantly (P<0.01). Conclusions: The LV volume functions, longitudinal, radial, circumferential, and twist movement in the elderly AMI patients with different degree of transmural damage 1 week and 3 months after PCI can be objectively and sensitively revealed by using RT-3DE and 2D-STI respectively. The LV myocardial multi-dimensional deformation functions are severely damaged in both NSTEAMI and STEAMI patients, but the NSTEAMI patients have a better prognosis after treatment over a long time.

Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major

Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ patients. Demographic, laboratory, echocardiographic, cardiac magnetic resonance (CMR) T2* and 24-hour tape recording data were prospectively collected. The patients were classified according to the median value of premature atrial contractions (PACs) on 24-hour tape. In total, 50 β-TM patients (37.6 ± 9.1 years old, 50% male) were divided in 2 groups; PACs ≤ 24/day and > 24/day. Patients with PACs > 24/day were treated with blood transfusion for a longer period of time (39.0 ± 8.6 vs. 32.0 ± 8.9 years, p < 0.007), compared to their counterparts. Older age (OR: 1.121, 95% CI: 1.032–1.217, p = 0.007), longer duration of blood transfusion (OR:1.101, 95% CI:1.019–1.188, p = 0.014), larger LV end-diastolic diameter (OR: 4.522, 95% CI:1.009–20.280, p = 0.049), higher values of LA peak systolic strain (OR: 0.869, 95% CI: 0.783–0.964, p = 0.008), higher MV E/E′ average (OR: 1.407, 95% CI: 1.028–1.926, p = 0.033) and higher right ventricular systolic pressure (OR: 1.147, 95% CI: 1.039–1.266, p = 0.006) were univariably associated with PACs > 24/day. LA peak systolic strain remained significantly associated with PACs > 24/day after adjusting for the duration of blood transfusions or for CMR T2*. The multivariable model including blood transfusion duration and LA peak systolic strain was the most closely associated with PACs > 24/day. Receiver operating characteristic curve analysis identified a left atrial peak systolic strain of 31.5%, as the best cut-off value (83% sensitivity, 68% specificity) for prediction of PACs > 24/day. In β-TM patients, LA peak systolic strain was associated with the atrial arrhythmia burden independently to the duration of blood transfusions and CMR T2*.

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

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.

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

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&lt;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&lt;0.05, both comparisons). At T2, GLS was -15.8%±5.2% in CSI vs. -21.9±3.5% in controls (p&lt;0.0001); GRS was 22.6%±10.4% in CSI vs. 27.1±8.2% in controls (p&lt;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&gt;0.95); GRS was 5.5±9.5% (p&lt;0.05); GCS was -3.4±4.9% (p&lt;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.

Abstract 15877: Chamber Volumes and Deformation Measures are Abnormal in Chemotherapy-Naïve Cancer Patients: Potential Implications for Surveillance and Definitions of Cardiotoxicity

Background: Cancer Therapeutics-related Cardiac Dysfunction (CTRCD) is defined by an interval drop in contractile performance to below reference lower limits of normal. This definition assumes healthy reference data appropriately represent referral populations with active cancer. However, the influence of active cancer on cardiac chamber volumes and contractile performance has not been established. Using cardiac magnetic resonance (CMR), we studied chamber volume- and deformation-based markers in ~400 cancer patients with comparison to ~100 healthy controls. Methods: 394 active cancer patients referred for first-time anthracycline-based chemotherapy and 102 healthy volunteers (HV) were recruited. Both underwent identical CMR protocols with quantification of chamber volumes and ejection fraction (EF). Left ventricular (LV) mechanics were also assessed by 3D myocardial deformation analysis (3D-MDA), providing global longitudinal, circumferential, radial and principal peak-systolic strain amplitude and rate. Results: The mean age was 53.8±13 years (78% female), with 64% having breast cancer and 36% lymphoma. Table 1 summarizes CMR findings of cancer patients versus HV, stratified by sex. Chamber volumes were significantly smaller while LV mass was significantly greater versus HV. LV EF and global longitudinal (GLS) were similar. However, cancer patients demonstrated significantly higher radial, circumferential and maximal principal strain amplitude. Peak-systolic strain rates were also consistently elevated. Conclusion: Chemotherapy-naïve cancer patients have smaller chamber volumes, greater LV mass, and higher radial, circumferential, and maximal principal strain versus healthy subjects. LV EF and peak GLS remain similar, and therefore are most appropriate to define CTRCD. However, an altered state of cardiac health is apparent by all other CMR-based markers, reflecting a unique cardiac phenotype of patients with active cancer.