Strain and strain rate echocardiographic imaging predict occurrence of atrial fibrillation in post-coronary artery bypass grafting patients

Background Atrial fibrillation (AF) occurs very frequently after coronary artery bypass grafting (CABG); it occurs in about 20–edictors can be used for the dedicatio40% of patients. It is associated with several adverse events. This study aimed to extrapolate a predictor for postoperative atrial fibrillation (POAF) occurrence which is reproducible and simple to be a part of routine echocardiography screening before CABG. This study included 89 patients scheduled for isolated coronary artery bypass surgery. History, clinical examination, and complete 2D echocardiography with LA speckle tracking analysis were done preoperatively. Patients were then followed up post-surgery for incidence of AF till discharge from the hospital. The patients were divided into 2 groups according to POAF occurrence. Results Patients who developed postoperative AF had older age (P = 0.0032) and longer hospital stay (P = 0.021) and higher stroke incidence but statistically non-significant (14.3% vs 3.3%). The POAF patients showed less peak atrial longitudinal strain (PALS) value than non-POAF patients. The left atrial strain rate values showed a significant difference with the lower left atrial systolic strain rate and less negative (higher) early diastolic strain rate and late diastolic strain rate. After multivariate logistic regression analysis, the independent predictors for POAF were PALS (OR 0.770, 95% CI 0.627–0.946), late LA diastolic strain rate (LASRa) (OR 3.476, 95% CI 1.207–12.186), and age (OR 1.181, 95% CI 1.011–1.379). Conclusion Preoperative LA global strain assessed by 2D speckle tracking analysis could be helpful as a predictor for AF post-CABG surgery, and identification of these patients may reduce its morbidity and mortality. The study suggested PALS value less than 29.8 to be a predictor for the occurrence of POAF.

Prognostic implications of peak early diastolic strain rate (PEDSR) by feature-tracking cardiac magnetic resonance in patients with st-elevation myocardial infarction

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the National Key Research and Development Program of China OnBehalf Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University Background：The prognostic value of Peak Early Diastolic Strain Rate (PEDSR) measured by Cardiac Magnetic Resonance (CMR) in ST-Elevation Myocardial Infarction (STEMI) is not clear. Methods：420 first-STEMI patients from the EARLY Assessment of MYOcardial Tissue Characteristics by CMR in STEMI (EARLY-MYO-CMR) registry (NCT03768453) and 40 normal people were enrolled and followed up. The patients received timely percutaneous coronary intervention (PCI) within 12h and CMR within 1 week (median,5 days; range, 2-7 days) after infarction. LV circumferential, radial, longitudinal PEDSR and other routine CMR parameters were measured. Clinical end point was a composite major adverse cardiovascular events (MACEs) including cardiovascular death, re-infarction and re-hospitalization for heart failure. Results：During follow-up (median: 52 months, inter-quartile range: 29–78 months), 73 (17.4%) patients experienced a MACE event. Compared with normal people, STEMI patients had lower PEDSR (circumf. PEDSR 0.77 vs. 1.27%/s, P < 0.001). Patients who developed MACEs also had lower PEDSR than patients who didn’t (circumf. PEDSR 0.64 vs. 0.78%/s, P < 0.001). Circumf. PEDSR can significantly predict MACEs with an AUC of 0.659 (95%CI 0.587-0.731, P < 0.001) which is not inferior to LVEF (0.659 vs. 0.651, P = 0.843), LVIS (0.659 vs. 0.661, P = 0.678) and LVMVO (0.659 vs. 0.666, P = 0.600). Circumf. PEDSR ≤ 0.665%/s is the independent predictive factor of MACEs in clinical (HR 2.099 [95%CI 1.273-3.461], P = 0.004) and CMR models (HR 1.795 [95%CI 1.065-3.026], P = 0.028). In Kaplan-Meier curve, patients with impaired PEDSR are more likely to experience MACEs (P < 0.001). When subdivided by LVEF, PEDSR still makes a significant difference to MACEs in patients with LVEF > 50.28% (P = 0.003) but not in reduced LVEF patients (P = 0.204). PEDSR is also incremental to LVEF (Continuous NRI 0.515 [95%CI 0.268-0.763], P < 0.001), LVIS (Continuous NRI 0.576 [95%CI 0.330-0.822], P < 0.001), and LVMVO (Continuous NRI 0.576 [95%CI 0.330-0.822], P < 0.001). Finally, worse TIMI flow post-PCI (HR 3.353 [95%CI 1.603-7.016], P = 0.001) and LVEF (HR 0.920 [95%CI 0.900, 0.940], P < 0.001) are the risk factors for PEDSR impairment. Conclusions：CMR-derived PEDSR can significantly predict MACEs with the discriminative power not inferior to LVEF, LVIS and LVMVO. Circumf. PEDSR ≤ 0.665%/s is an independent predictive factor of MACEs and is incremental in the prognostic risk stratification of STEMI.

Diastolic function assessed my CMR feature tracking is a predictor for outcomes in patients with suspected myocarditis and preserved left ventricular ejection fraction

Funding Acknowledgements Type of funding sources: None. Diastolic function assessed my CMR feature tracking is a predictor for outcomes in patients with suspected myocarditis and preserved left ventricular ejection fraction Background Impairment of left ventricular (LV) systolic function was reported to be a valuable predictor for outcomes in patients with myocarditis. However, in patients with myocarditis and preserved LV systolic function, prediction of outcomes remains challenging. So far, minimal data exists about the prognostic role of diastolic function, as assessed by cardiac magnetic resonance imaging (CMR) in the clinical setting of suspected myocarditis. Purpose To determine the predictive value of LV diastolic function in patients with suspected myocarditis and preserved LV ejection fraction (LVEF). Methods In patients referred for CMR with clinically suspected myocarditis and LVEF≥50%, diastolic function was assessed by CMR feature tracking (FT). The primary endpoint was defined as a composite of major adverse cardiovascular events (MACE) including hospitalization for heart failure, recurrent myocarditis, sustained ventricular tachycardia and all-cause death. Results Of 381 patients included with clinically suspected myocarditis (216, 56.7% male, mean age 45.7 ± 16.4 years) late gadolinium enhancement (LGE) was present in 124 (32.4 %) of patients (mean LGE extent 4.9 ± 5.0 g). MACE occurred in 25 (6.6%) individuals at a median follow-up time of 4.5 years. In a univariate cox-regression model, radial, circumferential and longitudinal early diastolic strain rate (EDSR) and circumferential late diastolic strain rate were significantly associated with MACE. After adjustment for age, gender and extent of LGE, radial EDSR remained an independent predictor for MACE (HR = 2.26, 95% CI 1.06 to 4.8; p = 0.034). Conclusion Diastolic strain rate, as assessed by CMR-FT, can be useful in the prediction of outcomes in patients with myocarditis and preserved LVEF.

The Diagnostic Value of 2D- Speckle Tracking Echocardiography for Identifying Subclinical Ventricular Dysfunction in Subjects with Early Repolarization Pattern

Introduction: Early repolarization pattern (ERP) has been known a benign electrocardiographic variant for decades. However, it can exist a silent substrate for arrhytmic events in accordance with the previous studies which have shown that there has been evidence of morphological changes in left ventricle (LV) in subjects with ERP. Despite structural changes in ERP subjects, it has not exactly known that whether a change in functional parameters of LV occur in these population. The aim of our study was to investigate LV functional parameters in subjects with ERP by the use of 2D- speckle tracking echocardiography (2D-STE). Method: In this study, subjects with ERP (n= 50) and subjects without ERP (n= 50) were recruited between 01.04.2018 and 01.09.2018. For each case, 2D- STE evaluation was performed by the same cardiologist. Results: Mean LV global longitudinal strain (GLS) and GLS in all apical chamber views, longitudinal peak systolic strain rate (SRS) at A3C, early diastolic strain rate (SRE) at A3C and late diastolic strain rate (SRA) at A3C in the ERP subjects were significantly lower than those in the subjects without ERP. Furthermore, LV basal segment circumferential SRS and SRE were significantly lower in ERP subjects compared to subjects without ERP. Conclusion: Our study suggests that ERP can be more associated with impaired LV longitudinal function than LV circumferential function. In addition, both LV inferolateral region and LV basal segment can be more affected functionally in ERP subjects.

Left Ventricular Diastolic Dysfunction and Exercise Intolerance in Obese Heart Failure with Preserved Ejection Fraction

This study tested the hypothesis that early left ventricular (LV) relaxation is impaired in older obese heart failure with preserved ejection fraction (HFpEF) patients, and related to decreased peak exercise oxygen uptake (peak VO2). LV strain and strain rate were measured by feature tracking of magentic resonance cine images in 79 older obese HFpEF patients (mean age: 66 years; mean BMI: 38 kg/m2) and 54 healthy control participants. LV diastolic strain rates were indexed to cardiac preload as estimated by echocardiography derived diastolic filling pressures (E/e'), and correlated to peak VO2. LV circumferential early diastolic strain rate was impaired in HFpEF compared to controls (0.93±0.05 s-1 vs 1.20±0.07 s-1, p=0.014); however, we observed no group differences in early LV radial or longitudinal diastolic strain rates. Isolating myocardial relaxation by indexing all three early LV diastolic strain rates (i.e. circumferential, radial, and longitudinal) to E/e' amplified the group difference in early LV diastolic circumferential strain rate (0.08±0.03 vs 0.13±0.05, p<0.0001), and unmasked differences in early radial and longitudinal diastolic strain rate. Moreover, when indexing to E/e', early LV diastolic strain rates from all three principal strains, were modestly related with peak VO2 (R=0.36, -0.27, 0.35, respectively, all p<0.01); this response, however, was almost entirely driven by E/e' itself, (R=-0.52, P<0.001). Taken together, we found that while LV relaxation is impaired in older obese HFpEF patients, and modestly correlates with their severely reduced peak exercise VO2, LV filling pressures appear to play a much more important role in determining exercise intolerance.

Left atrial dysfunction in patients with prosthesis-patient mismatch after transcatheter aortic valve replacement

Funding Acknowledgements Type of funding sources: None. Background. Transcatheter aortic valve replacement (TAVR) prostheses have better hemodynamics compared to surgical prostheses, with lower incidence of prosthesis-patient mismatch (PPM). Nonetheless, this complication is neither rare nor benign in the expanding population of TAVR patients (pts). Data regarding the effect of TAVR PPM on cardiac function is scarce. Our aim was to determine the short-term impact of PPM on left atrium (LA) function in patients undergoing transfemoral TAVR. Methods. One hundred forty-three consecutive pts (76.3 ± 7.5 yrs, 74 men) considered to be at high risk for SAVR were enrolled and examined before and 30 days after TAVR. All pts underwent a comprehensive echocardiogram, including speckle tracking echocardiography (STE) for LA and left ventricular (LV) strain analysis. Longitudinal LA strain parameters were assessed from the apical 4-chamber view. Peak values of global longitudinal LA strain (LAε) and LA systolic strain rate (SSr, reservoir function) and early diastolic strain rate (ESr, conduit function) were measured in all. Contractile LA function (late diastolic strain rate, ASr) was assessed in patients in sinus rhythm (106 pts). Results. Fifty-five pts (38%) had PPM (defined as an indexed effective orifice area, EOA ≤0.85 cm2/m2). Most of these pts (71%) had moderate PPM (indexed EOA between 0.65 and 0.85 cm2/m2). No significant differences in age (76.4 ± 8.1 vs 76.3 ± 7.2 yrs, p = 0.9), gender (p = 0.2), body surface area (p = 0.8), body mass index (p = 0.2) and the presence of cardiovascular risk factors (p &gt; 0.2 for all) were observed between pts with and without PPM. The severity of post-TAVR aortic regurgitation was mild in 92 pts (64%) and moderate in 12 pts (8%) without any significant difference between pts with and without PPM. The post-TAVR prevalence of ³moderate mitral regurgitation was not different between the two groups (p = 0.40). After TAVR, there were no significant differences in terms of indexed LV mass, volumes, ejection fraction (p &gt; 0.5 for all). LV global longitudinal strain was also similar between groups (-13.7 ± 4.3 vs -14 ± 3.6%, p = 0.7). Although LA volumes were similar between patients with and without PPM (47.8 ± 12.4 vs 49.3 ± 20.3 ml/m2, p = 0.6), in the mismatch-group we found a significantly reduced systolic global LA strain (12.7 ± 6.2 vs 15.9 ± 7.9%, p = 0.009) and impaired LA contractile function (ASr: -1.0 ± 0.4 vs -1.2 ± 0.5, p = 0.03). Parameters of LV diastolic function were also worse in the mismatch-group, with an E/e’sep ratio of 22 ± 10 vs 17 ± 7, p = 0.01. Conclusions. In our study group TAVR was associated with an incidence of PPM of 38%. The short-term follow-up of these patients revealed a significantly impaired LA function and increased LV filling pressure in patients with PPM compared to those without PPM. To our knowledge, this is the first report about the effect of PPM on the LA global and contractile function.