Journal articles on the topic 'Subclinical LV dysfunction'
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SHANG, QING, LAI-SHAN TAM, GABRIEL WAI-KWOK YIP, JOHN E. SANDERSON, QING ZHANG, EDMUND KWOK-MING LI, and CHEUK-MAN YU. "High Prevalence of Subclinical Left Ventricular Dysfunction in Patients with Psoriatic Arthritis." Journal of Rheumatology 38, no. 7 (April 1, 2011): 1363–70. http://dx.doi.org/10.3899/jrheum.101136.
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Objective.Endothelial dysfunction and early atherosclerosis have been found in patients with psoriatic arthritis (PsA) without cardiovascular disease (CVD) risk factors. Few studies have investigated whether there is any early impairment of myocardial function. The aims of our study were to determine the prevalence of subclinical left ventricular (LV) dysfunction in PsA patients and the disease-related risk factors.Methods.Ninety-four PsA patients without clinical evidence of CVD and 63 healthy subjects were enrolled. All underwent conventional echocardiography and tissue Doppler imaging.Results.Sixty-one (65%) patients with PsA had evidence of subclinical LV dysfunction as defined by mean myocardial peak systolic velocity (Sm) of basal 6 segments < 4.4 cm/s, lateral E’ < 11.5 cm/s, and/or lateral E/E’ > 10. Thirty-six (38%) patients had only diastolic dysfunction, 4 (4%) had only systolic dysfunction, and 21 (22%) had both systolic and diastolic dysfunction. PsA patients with subclinical LV dysfunction were older, had a higher age at diagnosis of PsA and of psoriasis, a longer disease duration, a higher prevalence of hypertension and hyperlipidemia, higher levels of serum creatinine, and more antihypertensive treatment than those with normal LV function. Multivariate regression showed that age at diagnosis of PsA > 40 years (OR 3.388, 95% CI 1.065–10.777, p = 0.039) and hypertension (OR 4.732, 95% CI 1.345–16.639, p = 0.015) were independent predictors of subclinical LV dysfunction.Conclusion.PsA patients without established CVD disease and in the absence of traditional CV risk factors have a high prevalence of subclinical LV dysfunction.
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Potter, Elizabeth L., Satish Ramkumar, Leah Wright, and Thomas H. Marwick. "Associations of subclinical heart failure and atrial fibrillation with mild cognitive impairment: a cross-sectional study in a subclinical heart failure screening programme." BMJ Open 11, no. 7 (July 2021): e045896. http://dx.doi.org/10.1136/bmjopen-2020-045896.
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ObjectivesEffective identification and management of subclinical left ventricular (LV) dysfunction (LVD) and subclinical atrial fibrillation (AF) by screening elderly populations might be compromised by mild cognitive impairment (MCI). We sought to characterise the prevalence and profile of MCI and evaluate associations with LV and left atrial (LA) dysfunction and AF, in a trial of screening for subclinical LVD and AF.DesignCross-sectional.SettingAustralian, community-based intervention trial.ParticipantsAdults aged ≥65 years with ≥1 LVD risk factors without ischaemic heart disease (n=337).Outcome measuresThe Montreal cognitive assessment (MoCA) was obtained. Subclinical LVD was defined as echocardiographic global longitudinal strain ≤16%, diastolic dysfunction or LV hypertrophy; abnormal LA reservoir strain (LARS) was defined as <24%. Subclinical AF was detected using a single-lead portable electrocardiographic device in those without pre-existing AF who gave consent (n=293).ResultsSubclinical LVD was found in 155 (46%), abnormal LARS in 9 (3.6%) and subclinical AF in 11 (3.8%). MoCA score consistent with MCI (<26) was found in 101 (30%); executive function (69%) and delayed recall (93%), were the most frequently abnormal domains. Compared with normal cognition, MCI was associated with non-adherence to AF screening (25% vs 40%, p=0.01). In multivariable logistic regression modelling, educational achievement, systolic blood pressure, body mass index and waist-to-hip ratio were independently associated with MCI. However, neither subclinical AF nor any measure of cardiac dysfunction, were associated with MCI.ConclusionsThe 30% prevalence of MCI among elderly subjects with risk factors for subclinical LVD and AF has important implications for screening strategies and management. However, MCI is not associated with subclinical myocardial dysfunction nor subclinical AF.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12617000116325).
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Weidemann, F. "Detection of subclinical LV dysfunction by tissue Doppler imaging." European Heart Journal 27, no. 15 (August 1, 2006): 1771–72. http://dx.doi.org/10.1093/eurheartj/ehl144.
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Ayoub, Amal Mohamed, Viola William Keddeas, Yasmin Abdelrazek Ali, and Reham Atef El Okl. "Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction." Clinical Medicine Insights: Cardiology 10 (January 2016): CMC.S38407. http://dx.doi.org/10.4137/cmc.s38407.
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Background Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. Methods We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). Results There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson's method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. Conclusion 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention.
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Brown, Joseph. "PRE-OPERATIVE IDENTIFICATION OF SUBCLINICAL LV DYSFUNCTION USING MYOCARDIAL IMAGING." Heart, Lung and Circulation 18 (January 2009): 15. http://dx.doi.org/10.1016/j.hlc.2009.03.034.
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FANG, Zhi You, Rodel LEANO, and Thomas H. MARWICK. "Relationship between longitudinal and radial contractility in subclinical diabetic heart disease." Clinical Science 106, no. 1 (January 1, 2004): 53–60. http://dx.doi.org/10.1042/cs20030153.
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Subclinical left ventricular (LV) dysfunction may be identified by reduced longitudinal contraction. We sought to define the effects of subclinical LV dysfunction on radial contractility in 53 patients with diabetes mellitus with no LV hypertrophy, normal ejection fraction and no ischaemia as assessed by dobutamine echocardiography, in comparison with age-matched controls. Radial peak myocardial systolic velocity (Sm) and early diastolic velocity (Em), strain and strain rate were measured in the mid-posterior and mid-anteroseptal walls in parasternal views and each variable was averaged for individual patients (radial contractility). These variables were also measured in the mid-posterior and mid-anteroseptal walls in the apical long-axis view and each variable was averaged for individual patients (longitudinal contractility). Mean radial Sm, strain and strain rate were significantly increased in diabetic patients (2.9±0.6 cm/s, 28±5% and 1.8±0.4 s-1 respectively) compared with controls (2.4±0.7 cm/s, 23±4% and 1.6±0.3 s-1 respectively; all P<0.001), but there was no difference in Em (3.3±1.2 compared with 3.1±1.1 cm/s, P=not significant). In contrast, longitudinal Sm, Em, strain and strain rate were significantly lower in diabetic patients (3.6±1.1 cm/s, 4.3±1.6 cm/s, 21±4% and 1.6±0.3 s-1 respectively) than in controls (4.3±1.0 cm/s, 5.7±2.3 cm/s, 26±4% and 1.9±0.3 s-1 respectively; all P ⩽ 0.001). Thus radial contractility appears to compensate for reduced longitudinal contractility in subclinical LV dysfunction occurring in the absence of ischaemia or LV hypertrophy.
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Thakur, Saru, Geeta Ram Tegta, Prakash Chand Negi, Kunal Mahajan, Ghanshyam Verma, Mudita Gupta, Ajeet Negi, Reena Sharma, and and Kuldeep Verma. "Echocardiographic Prevalence and Risk Predictors of Ventricular Dysfunction in Connective Tissue Disorders: Tertiary Care Hospital-Based Prospective Case-Control Study." Indian Journal of Clinical Cardiology 1, no. 3-4 (December 2020): 132–41. http://dx.doi.org/10.1177/2632463620966143.
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Background: There is a paucity of contemporary Indian data about the prevalence of cardiac abnormalities in patients of connective tissue disorders (CTD) and their risk determinants. Methods: We prospectively recorded data from 35 consecutive CTD patients who presented to our out-patient department and had no significant cardiovascular risk factors at baseline. We also recorded data from their age- and sex-matched controls. All cases and controls were subjected to 12 lead electrocardiogram and echocardiography after routine investigations. Results: The CTD group comprised 19 (54.3%) patients of systemic lupus erythematosus, 12 (34.3%) patients of systemic sclerosis, 2 (5.7%) patients of mixed CTD, and 1 (2.9%) patient each of overlap syndrome and dermatomyositis. Cardiovascular involvement on echocardiography was documented in 71.4% of CTD patients despite majority of them having no cardiac symptom. Overt left ventricular (LV) systolic dysfunction was observed in 3 (8.6%) CTD patients, while subclinical LV systolic dysfunction was recorded in 13 (37.1%) patients. LV diastolic dysfunction was observed in 11.4% (n = 4) patients. RV systolic dysfunction was prevalent in 20% (n = 7) patients. Pulmonary hypertension was observed in 40% (n = 14) of CTD patients. Conclusion: The present study evaluated subclinical LV systolic dysfunction and pulmonary hypertension in about one third of CTD patients. It is imperative to screen for these abnormalities in CTD to ensure timely diagnosis and treatment.
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Abdulrahman, Randa M., Victoria Delgado, Arnold C. T. Ng, See Hooi Ewe, Matteo Bertini, Eduard R. Holman, Guido C. Hovens, et al. "Abnormal cardiac contractility in long-term exogenous subclinical hyperthyroid patients as demonstrated by two-dimensional echocardiography speckle tracking imaging." European Journal of Endocrinology 163, no. 3 (September 2010): 435–41. http://dx.doi.org/10.1530/eje-10-0328.
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BackgroundSubclinical hyperthyroidism is associated with cardiovascular morbidity. Recent advances in echocardiography imaging have allowed sophisticated evaluation of myocardial tissue properties.ObjectiveTo investigate the myocardial effects of long-term exogenous subclinical hyperthyroidism using two-dimensional speckle tracking echocardiography imaging (2D-STE).DesignProspective, single-blinded, placebo-controlled randomized trial of 6 months duration with two parallel groups.Patients and methodsTotally 25 patients with a history of differentiated thyroid carcinoma on long-term TSH-suppressive levothyroxine (l-T4) substitution were randomized to persistent TSH-suppressive l-T4 substitution (low-TSH group) or restoration of euthyroidism. Additionally 40 euthyroid controls were studied.Results (proposal)At baseline, the group of patients showed normal left ventricular (LV) systolic function but impaired diastolic function as assessed with conventional echocardiographic parameters. Importantly, 2D-STE analysis demonstrated the presence of subclinical LV systolic and diastolic dysfunction with impaired circumferential and longitudinal strain and strain rate at the isovolumic relaxation time. After restoration of euthyroidism, a significant improvement in LV systolic and diastolic function as assessed with 2D-STE strain was observed.ConclusionProlonged subclinical hyperthyroidism leads to systolic and diastolic dysfunction, which is reversible after restoration of euthyroidism. 2D-STE is a more sensitive technique to evaluate subtle changes in LV performance of these patients.
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Saputra, Bagus Made Indrata, Ida Bagus Rangga Wibhuti, Luh Oliva Saraswati Suastika, and Ni Made Ayu Wulan Sari. "The comparison of mitral annular plane systolic excursion (MAPSE) and mitral annular systolic velocity (Sm) in determining subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus." Indonesia Journal of Biomedical Science 16, no. 2 (October 27, 2022): 70–77. http://dx.doi.org/10.15562/ijbs.v16i2.414.
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Background: Type 2 diabetes mellitus (T2DM) is an independent factor in increasing the risk of heart failure in the absence of coronary heart disease and hypertension. Global longitudinal strain (GLS) as the gold standard in determining subclinical left ventricular (LV) systolic dysfunction is not available on all echocardiographic tools and requires good-quality images. Mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic velocity (Sm) are simpler, faster, and widely available method that can determine left ventricular systolic dysfunction regardless of image quality. Methods: This study involved 72 asymptomatic T2DM patients, divided into two groups, patients with subclinical left ventricular systolic dysfunction (GLS >-18%) and normal systolic function (GLS ≤-18%). GLS was obtained from the mean of 18 left ventricular segments on the apical 4-chamber, 3-chamber and 2-chamber images. MAPSE was obtained on the septal and lateral sides of the mitral annulus using M-mode on apical 4-chamber view, while Sm was obtained using tissue doppler imaging (TDI). Results: The study included 72 asymptomatic T2DM patients, 34 samples (47.2%) were found with subclinical LV systolic dysfunction. According to receiver operating characteristic (ROC) curve analysis, lateral TDI Sm had the highest area under the curve (AUC), it was 0.85, followed by average TDI Sm was 0.83 and average MAPSE was 0.81. The cut-off value of average TDI Sm <7.425 cm/s had the best sensitivity and specificity, 82.4% and 81.6%, while cut-off value of average MAPSE <13.4 mm had sensitivity of 76.5% and specificity of 73.7%. Conclusion: TDI Sm had better accuracy than MAPSE in determining subclinical LV systolic dysfunction in T2DM patients. However, both of them can be used as alternative diagnostic methods of GLS.
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Huong, Nguyen Mai, Vu Quynh Nga, and Nguyen Quang Tuan. "Assessment of global longitudinal strain by speckle tracking echocardiography in patients with severe primary mitral regurgitation." Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam 35 (December 31, 2021): 19–25. http://dx.doi.org/10.47972/vjcts.v35i.672.
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Background: In asymptomatic patients with severe primary mitral regurgitation (PMR), early detection of left ventricular (LV) dysfunction indicates the optimal timing of mitral valve surgery and predictes impaired postoperative LV function. Objectives: Evaluation long longitudinal strain by Speckle Tracking in Patients with Severe Primary Mitral Regurgitation Methods and results: 35 preoperative patients with severe PMR and 25 age-matched healthy subjects at Hanoi Heart Hospital from June 2018 to September 2019. Patients with PMR had longitudinal dysfunction by comparison with controls, although EF were similar. Mean global myocardial longitudinal strain (GLS avg) has a linear correlation with FS (r² = 0.127, p <0.05) and EF biplane (r² = 0.216, p <0.005). Conclusion: Longitudinal LV deformation assessed by speckle tracking can detect subclinical LV dysfunction and predict impaired postoperative LV function in asymptomatic patients with severe PMR.
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Saylan, Berna, Ayhan Cevik, Ceyda Tuna Kirsaclioglu, Filiz Ekici, Ozgur Tosun, and Gonca Ustundag. "Subclinical Cardiac Dysfunction in Children with Coeliac Disease: Is the Gluten-Free Diet Effective?" ISRN Gastroenterology 2012 (November 14, 2012): 1–6. http://dx.doi.org/10.5402/2012/706937.
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Objectives. The aim of this study is to investigate the effects of coeliac disease on cardiac function in children using conventional transthoracic echocardiography (TTE) and tissue Doppler echocardiography (TDE). Methods. Coeliac disease patients were evaluated in two different groups based on serum endomysial antibody (EmA) titers (EmA (+) and EmA (−)), and the data obtained by conventional and TDE studies were compared between the patient groups and healthy controls. Results. There was no significant difference between EmA (+) and EmA (−) groups in terms of the conventional TTE parameters, including ejection fraction (EF), fractional shortening (FS), and left ventricle end diastolic diameter (LVEDD), that show the left ventricular systolic function (P=0.727, P=0.317, P=0.118). TDE showed a significant difference in left ventricle (LV) isovolumic relaxation time (LV IVRT) and LV myocardial performance index (LV MPI) parameters between EmA (+) and EmA (−) patient groups (P<0.0001). Conclusion. The measurement of LV MPI and LV IVRT parameters by TDE would be beneficial in early determination of the cardiac involvement and establishing appropriate treatment and followup of patients with coeliac disease as well as in making distinction between EmA (+) and EmA (−) patients.
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Stefani, L., P. Brown, M. Gerges, K. Kairtis, N. Gilroy, M. Altman, S. Trivedi, and L. Thomas. "Subclinical LV and RV Dysfunction in Patients Recovered From COVID-19." Heart, Lung and Circulation 31 (2022): S181—S182. http://dx.doi.org/10.1016/j.hlc.2022.06.290.
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Hilde, J. M., J. Hisdal, M. N. Melsom, V. Hansteen, I. Seljeflot, H. Arnesen, and K. Steine. "Reduced systemic arterial compliance and subclinical LV systolic dysfunction in COPD." European Heart Journal 34, suppl 1 (August 2, 2013): P1525. http://dx.doi.org/10.1093/eurheartj/eht308.p1525.
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Visoiu, Ionela Simona, Roxana Cristina Rimbas, Loredana Gheorghiu, Ruxandra Dragoi Galrinho Antunes Guerra, Alina Ioana Nicula, and Dragos Vinereanu. "Functional assessment in left ventricular non-compaction cardiomyopathy in multimodality imaging era might improve the definition." Romanian Journal of Cardiology 31, no. 1 (March 31, 2021): 122–28. http://dx.doi.org/10.47803/rjc.2021.31.1.122.
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Left ventricular non-compaction (LVNC) is an increasingly recognized phenotype. The current definition of the LVNC does not mention LV dysfunction as an absolute criterion in addition to morphological criteria. LV dilatation and decreased LV ejection fraction (LVEF) are often late manifestations of the disease and correlate with the occurrence of cardiovascular complications. However, to define LVNC as a cardiomyopathy, functional criteria must be fulfilled, in addition to the morphological ones. Multimodality imaging, such as myocardial deformation and myocardial work analysis derived from speckle tracking echocardiography (STE), in combination with cardiac magnetic resonance (CMR) might improve diagnosis and characterization of non-compaction, exposing earlier signs of LV systolic dysfunction. We present two comparative cases of LVNC in order to highlight the idea of subclinical dysfunction even in apparently benign forms with preserved LVEF, and also the importance of multimodality imaging approach.
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Kvasnička, Jan, Tomáš Zelinka, Ondřej Petrák, Ján Rosa, Branislav Štrauch, Zuzana Krátká, Tomáš Indra, Alice Markvartová, Jiří Widimský, and Robert Holaj. "Catecholamines Induce Left Ventricular Subclinical Systolic Dysfunction: A Speckle-Tracking Echocardiography Study." Cancers 11, no. 3 (March 6, 2019): 318. http://dx.doi.org/10.3390/cancers11030318.
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Background: Pheochromocytomas (PHEO) are tumors arising from chromaffin cells from the adrenal medulla, having the ability to produce, metabolize and secrete catecholamines. The overproduction of catecholamines leads by many mechanisms to the impairment in the left ventricle (LV) function, however, endocardial measurement of systolic function did not find any differences between patients with PHEO and essential hypertension (EH). The aim of the study was to investigate whether global longitudinal strain (GLS) derived from speckle-tracking echocardiography can detect catecholamine-induced subclinical impairments in systolic function. Methods: We analyzed 17 patients (10 females and seven males) with PHEO and 18 patients (nine females and nine males) with EH. The groups did not differ in age or in 24-h blood pressure values. Results: The patients with PHEO did not differ in echocardiographic parameters including LV ejection fraction compared to the EH patients (0.69 ± 0.04 vs. 0.71 ± 0.05; NS), nevertheless, in spackle-tracking analysis, the patients with PHEO displayed significantly lower GLS than the EH patients (−14.8 ± 1.5 vs. −17.8 ± 1.7; p < 0.001). Conclusions: Patients with PHEO have a lower magnitude of GLS than the patients with EH, suggesting that catecholamines induce a subclinical decline in LV systolic function.
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Tsvetkov, Vladimir A., Evgeniy S. Krutikov, and Svetlana I. Chistyakova. "Subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus." Problems of Endocrinology 66, no. 1 (August 4, 2020): 56–63. http://dx.doi.org/10.14341/probl12359.
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BACKGROUND: Recent studies have shown a high prevalence of asymptomatic forms of heart failure in patients with type 2 diabetes mellitus. The presence of even subclinical forms of heart failure in type 2 DM is associated with a negative prognosis of the disease, leading to a significant increase in the frequency of hospitalizations and mortality.
AIMS: Identification of left ventricle subclinical dysfunction in terms of its diastolic function, deformation parameters and rotational properties of the myocardium in patients with type 2 diabetes.
METHODS: A prospective case-control single-center study, performed simultaneously in groups of patients with type 2 diabetes and hypertension. To identify left ventricular dysfunction (LV), an echocardiographic study was performed, including tissue dopplerography and Speckle Tracking Echocardiography in 2D and 3D modes.
RESULTS: We examined four groups of patients comparable in age and sex distribution, with no obvious clinical signs of heart failure. Group I comprised 56 patients with type 2 diabetes and moderate hypertension. Group II included 52 patients with type 2 diabetes without an increase of blood pressure. Group III (54 people) consisted of patients with essential II degree hypertension without diabetes. Group IV (control) 30 healthy individuals. The use of tissue dopplerography and Speckle Tracking Echocardiography allows more often (p0.05) to detect signs of LV dysfunction in patients with type 2 diabetes compared with routine echocardiography methods. It was found that in patients with a combination of type 2 diabetes and moderate hypertension, a prognostically unfavorable restrictive variant of diastolic dysfunction is more common (p0.05) in contrast to patients with diabetes without hypertension or those with hypertension without diabetes. The combination of type 2 diabetes and hypertension to a greater extent leads to an increase in the longitudinal global deformation of the left ventricle compared with patients who had only one of these diseases (p0.05). A decrease in the global area strain, an early marker of LV systolic dysfunction, was expressed (p0.05) in patients with type 2 diabetes, regardless of the presence of concomitant hypertension.
CONCLUSIONS: This study shows the importance of using tissue dopplerography and Speckle Tracking Echocardiography in the diagnosis of subclinical heart failure. The results indicate a high prevalence of subclinical systolic-diastolic LV dysfunction in type 2 diabetes, which is aggravated in the presence of concomitant hypertension in patients without obvious clinical signs of heart failure and other cardiovascular diseases.
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Pereira, Alberto M., Victoria Delgado, Johannes A. Romijn, Johannes W. A. Smit, Jeroen J. Bax, and Richard A. Feelders. "Cardiac dysfunction is reversed upon successful treatment of Cushing's syndrome." European Journal of Endocrinology 162, no. 2 (February 2010): 331–40. http://dx.doi.org/10.1530/eje-09-0621.
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ObjectiveIn patients with active Cushing's syndrome (CS), cardiac structural and functional changes have been described in a limited number of patients. It is unknown whether these changes reverse after successful treatment. We therefore evaluated the changes in cardiac structure and dysfunction after successful treatment of CS, using more sensitive echocardiographic parameters (based on two-dimensional strain imaging) to detect subtle changes in cardiac structure and function.MethodsIn a prospective study design, we studied 15 consecutive CS patients and 30 controls (matched for age, sex, body surface area, hypertension, and left ventricular (LV) systolic function). Multidirectional LV strain was evaluated by two-dimensional speckle tracking strain imaging. Systolic (radial thickening, and circumferential and longitudinal shortening) and diastolic (longitudinal strain rate at the isovolumetric relaxation time (SRIVRT)) parameters were measured.ResultsAt baseline, CS patients had similar LV diameters but had significantly more LV hypertrophy and impaired LV diastolic function, compared to controls. In addition, CS patients showed impaired LV shortening in the circumferential (−16.5±3.5 vs −19.7±3.4%, P=0.013) and longitudinal (−15.9±1.9 vs −20.1±2.3%, P<0.001) directions and decreased SRIVRT (0.3±0.15 vs 0.4±0.2/ s, P=0.012) compared to controls. After normalization of corticosteroid excess, LV structural abnormalities reversed, LV circumferential and longitudinal shortening occurred, and SRIVRT normalized.ConclusionCS induces not only LV hypertrophy and diastolic dysfunction but also subclinical LV systolic dysfunction, which reverses upon normalization of corticosteroid excess.
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Mitrovska, Slavica. "Subclinical Diastolic Dysfunction in Diabetic Population." Macedonian Medical Review 70, no. 3 (December 1, 2016): 140–44. http://dx.doi.org/10.1515/mmr-2016-0026.
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Abstract Introduction. Left ventricular dysfunction is very frequent in asymptomatic diabetic population. Tissue Doppler Imaging (TDI) is a new echocardiographic technique, able to record early changes of left ventricular dysfunction and to identify asymptomatic diabetic patients at high risk of developing heart failure. Aim. To assess the role of TDI in early detection of diastolic dysfunction in asymptomatic diabetic patients. Methods. Cross-sectional study that involved a total number of 48 subjects. The target group consisted of 25 asymptomatic diabetic patients and control group was composed of 23 subjects without diabetes. All subjects underwent echocardiography (conventional 2D and Pulsed-Wave Doppler and contemporary-TDI) to analyze left ventricular function. We compared the results from both echo-techniques and analyzed the relation of echo-cardiographic parameters with risk factors. Results. We found statistically significant difference between TDI and PW Doppler (E/E'vs E/A) in target (Z=−3.17, p<0.001) and control group (Z=−2.4, p<0.003). There was no significant difference in E/A between the groups (Z=0.0, p<1.0). TDI identified significantly lower E' (Z= 2.03, p<0.04) and higher E/E' (Z= −2.12, p<0.03) in target vs control group. LVDD strongly correlated with duration of DM (p<0.00001), age (p<0.00001), female gender (p<0.0001) and obesity indices (BMI, BSA) (p<0.00001, p<0.00001) in both groups. Conclusion. TDI unmasks the presence of subclinical LV dysfunction in asymptomatic diabetic patients and has a valuable prognostic importance.
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Holland, David J., Thomas H. Marwick, Brian A. Haluska, Rodel Leano, Matthew D. Hordern, James L. Hare, Zhi You Fang, Johannes B. Prins, and Tony Stanton. "Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus." Heart 101, no. 13 (May 2, 2015): 1061–66. http://dx.doi.org/10.1136/heartjnl-2014-307391.
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Kirillova, I. G., Yu N. Gorbunova, T. V. Popkova, M. E. Diatroptov, and E. L. Nasonov. "Subclinical left ventricular dysfunction and N-terminal pro-brain natriuretic peptide in patients with rheumatoid arthritis." Rheumatology Science and Practice 60, no. 5 (November 11, 2022): 560–65. http://dx.doi.org/10.47360/1995-4484-2022-560-565.
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Aim – to determine the frequency of myocardial dysfunction using echocardiography with speckle tracking (STE) method, the relationship between a low global longitudinal strain (GLS) with the level of NT-proBNP, clinical and laboratory manifestations of rheumatoid arthritis. Material and methods. The study included 43 patients with RA (ACR/EULAR criteria, 2010): 79% women, age – 53.0 [38.0; 63.0] years, disease duration – 60.0 [36; 180] months; DAS28 – 5.9 [5.2; 6.4], positive for ACCP (74%), RF IgM (81%), without prior biological therapy and CVD. Methotrexate was received by 44%, leflunomide – 35%, sulfasalazine – 9.3%, hydroxychloroquine – 7%, glucocorticoids – 67.4%, non-steroidal anti-inflammatory drugs – 74% of patients with RA. All RA patients underwent echocardiography – tissue Doppler and STE. The level of NT-proBNP was determined in the blood serum The normal range for NT-proBNP was less than 125 pg/ml.Results. Low GLS was observed in 26 (61%) patients with RA. RA patients had a decrease GLS, E LV, E’ LV, E/A LV compared with the control group. Left ventricular diastolic dysfunction (LVDD) was higher in RA patients (13 (31%) vs 0%). Patients with RA had significantly higher levels of NT-proBNP (114.8 [45.1; 277.5] and 52 [40.5; 69.1] pg/ml) compared with the control group. There were correlations between a low GLS and DAS28 (r=0.9), the number of painful joints (r=0.6), radiological stage (r=0.6) and the presence of systemic manifestations (r=0.5), age (r=–0.9), E LV velocity (r=–0.5) (p<0.05 in all cases). There were correlations between the level of NT-proBNP and the E/A LV ratio (r=–0.4), A LV velocity (r=0.5) (p><0.05 in all cases).>< 0.05 in all cases). There were correlations between the level of NT-proBNP and the E/A LV ratio (r=–0.4), A LV velocity (r=0.5) (p< 0.05 in all cases).Conclusions. In RA patients with a high frequency the low GLS LV was detected, which is associated with a high activity of the inflammatory process. STE helps to detect myocardial dysfunction in patients with RA at earlier stages than tissue Doppler. The use of STE, the determination of the level of NT-proBNP make it possible to diagnosing preclinical disorders of systolic and diastolic functions of the LV, which can contribute to the early initiation of therapy and improve the prognosis in this category of patients.
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Nur İzgi, Tuba, Dilek Barutcu Ataş, Halil Ataş, Dursun Akaslan, Can Ilgın, Arzu Velioğlu, Hakkı Arıkan, et al. "Prediction of subclinical left ventricular dysfunction by speckle-tracking echocardiography in patients with anti-neutrophil cytoplasmic antibody--associated vasculitis." Archives of Rheumatology 37, no. 1 (December 24, 2021): 129–35. http://dx.doi.org/10.46497/archrheumatol.2022.8916.
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Objectives: This study aims to evaluate left ventricular functions using speckle-tracking echocardiography (STE) in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Patients and methods: Between June 2018 and July 2019, a total of 31 AAV patients (17 males, 14 females; median age: 53 years; range, 47 to 62 years) and 21 healthy controls (11 males, 10 females; median age: 56 years; range, 46 to 60 years) were included in the study. Clinical and biochemical characteristics of all participants were recorded. All participants underwent conventional and two-dimensional STE. The receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value of serum N-terminal prohormone of brain natriuretic peptide (NT-pro-BNP) that predicted subclinical left ventricular dysfunction. The Spearman correlation analysis was used to determine the correlation between left ventricular global longitudinal strain (LV-GLS) and NT-pro-BNP. Results: The LV-GLS was lower in AAV patients (19.3% vs. 21.7%, respectively; p=0.014). NT-pro-BNP was negatively correlated with LV-GLS (p=0.005, r=0.401). Conclusion: Subclinical left ventricular dysfunction can be detected by STE in patients with AAV who have free of clinically overt cardiovascular disease. The LV-GLS is negatively correlated with serum NT-pro-BNP levels.
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Guerra, Federico, Chiara Gelardi, Alessandro Capucci, Armando Gabrielli, and Maria Giovanna Danieli. "Subclinical Cardiac Dysfunction in Polymyositis and Dermatomyositis: A Speckle-tracking Case-control Study." Journal of Rheumatology 44, no. 6 (April 1, 2017): 815–21. http://dx.doi.org/10.3899/jrheum.161311.
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Objective.Subclinical heart disease occurs in up to 50% of patients with idiopathic inflammatory myopathies (IIM) and is difficult to detect through conventional imaging. We investigated the usefulness of global longitudinal strain (GLS) measurement to detect a subclinical systolic ventricular dysfunction in patients with IIM.Methods.We enrolled 28 patients with IIM and 28 matched controls in a 1:1 fashion. Standard variables for the left ventricle (LV) and right ventricle (RV) systolic and diastolic function were measured and compared between cases and controls, along with speckle-tracking GLS of the LV and RV. A possible correlation between GLS and muscle strength, disease activity, cardiovascular risk factors, and other organ systems involvement was searched.Results.Standard variables of systolic and diastolic dysfunction were similar between patients and controls. GLS was significantly lower in patients when compared with controls for both LV (−18.7 ± 4.2% vs −21.2 ± 2.1%, p = 0.006) and RV (−19.3 ± 6.3% vs −22.5 ± 3.8%, p = 0.033). Patients with IIM had a 4.9-fold increased risk for impaired left GLS [relative risk (RR) 4.9, 95% CI 1.5–15.8, p = 0.006], which involved usually basal and mid-segments of the anterior, anterior-septal, and lateral wall. Patients with IIM had a 3.4-fold increased risk for impaired right GLS (RR 3.4, 95% CI 1.1–11.7, p = 0.04) with the basal segment of the free RV wall most frequently involved. Muscle strength, disease activity, damage and duration, other organ system involvement, and previous treatment were not associated with reduced GLS.Conclusion.Subclinical systolic impairment is common in patients with IIM without overt LV dysfunction. In this context, GLS is a potentially useful variable.
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Marwick, Thomas H., Alessia Gimelli, Sven Plein, Jeroen J. Bax, Phillippe Charron, Victoria Delgado, Erwan Donal, et al. "Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging." European Heart Journal - Cardiovascular Imaging 23, no. 2 (November 5, 2021): e62-e84. http://dx.doi.org/10.1093/ehjci/jeab220.
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Abstract Heart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment.
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Shimoni, Or, Roman Korenfeld, Sorel Goland, Valery Meledin, Dan Haberman, Jacob George, and Sara Shimoni. "Subclinical Myocardial Dysfunction in Patients Recovered from COVID-19 Disease: Correlation with Exercise Capacity." Biology 10, no. 11 (November 18, 2021): 1201. http://dx.doi.org/10.3390/biology10111201.
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Aims: Myocardial abnormalities are common during COVID-19 infection and recovery. We examined left (LV) and right (RV) ventricular longitudinal strain in patients who had recovered from COVID-19 and assessed the correlation with exercise capacity. Methods and results: One hundred and eighty-four consecutive patients with history of COVID-19 disease who had been referred to rest or stress echocardiography because of symptoms, mainly dyspnea and chest pain, were included in the study. These patients were compared to 106 patients with similar age, symptoms, and risk factor profile with no history of COVID-19 disease. Clinical and echocardiographic parameters, including strain imaging, were assessed. The patient’s age was 48 ± 12 years. Twenty-two patients had undergone severe disease. There were no differences in the LV ejection fraction and diastolic function between the groups. However, LV and RV global and free wall strain were significantly lower (in absolute numbers) in patients who had recovered form COVID-19 infection (−20.41 ± 2.32 vs −19.39 ± 3.36, p = 0.001, −23.69 ± 3.44 vs −22.09 ± 4.20, p = 0.001 and −27.24 ± 4.7 vs −25.43 ± 4.93, p = 0.021, respectively). Global Longitudinal Strain (GLS) < −20% was present in only 37% of post COVID-19 patients. Sixty-four patients performed exercise echocardiography. Patients with GLS < −20% had higher exercise capacity with higher peak metabolic equivalent and exercise time compared to patients with GLS ≥ −20% (12.6 ± 2 vs 10 ± 2.5 METss and 8:00 ± 2:08 vs 6:24 ± 2:03 min, p < 0.001 and p = 0.003, respectively). Conclusion: In patients, who had recovered from COVID-19 infection, both LV and RV strain are significantly lower compared to control patients. The exercise capacity of these patients correlates with LV strain values. Rest and stress echocardiography in patients with symptoms after COVID-19 infection may identify patients that need further follow up to avoid long term complications of the disease. These preliminary results warrant further research, to test the natural history of these findings and the need and timing of treatment.
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Khalife, Wissam I., Yi-Da Tang, James A. Kuzman, Tracy A. Thomas, Brent E. Anderson, Suleman Said, Patricia Tille, Evelyn H. Schlenker, and A. Martin Gerdes. "Treatment of subclinical hypothyroidism reverses ischemia and prevents myocyte loss and progressive LV dysfunction in hamsters with dilated cardiomyopathy." American Journal of Physiology-Heart and Circulatory Physiology 289, no. 6 (December 2005): H2409—H2415. http://dx.doi.org/10.1152/ajpheart.00483.2005.
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Growing evidence suggests that thyroid dysfunction may contribute to progression of cardiac disease to heart failure. We investigated the effects of a therapeutic dose of thyroid hormones (TH) on cardiomyopathic (CM) hamsters from 4 to 6 mo of age. CM hamsters had subclinical hypothyroidism (normal thyroxine, elevated TSH). Left ventricular (LV) function was determined by echocardiography and hemodynamics. Whole tissue pathology and isolated myocyte size and number were assessed. TH treatment prevented the decline in heart rate and rate of LV pressure increase and improved LV ejection fraction. The percentage of fibrosis/necrosis in untreated 4-mo-old CM (4CM; 15.5 ± 2.2%) and 6-mo-old CM (6CM; 21.5 ± 2.4%) hamsters was pronounced and was reversed in treated CM (TCM; 11.9 ± 0.9%) hamsters. Total ventricular myocyte number was the same between 4- and 6-mo-old controls but was reduced by 30% in 4CM and 43% in 6CM hamsters. TH treatment completely prevented further loss of myocytes in TCM hamsters. Compared with age-matched controls, resting and maximum coronary blood flow was impaired in 4CM and 6CM hamsters. Blood flow was completely normalized by TH treatment. We conclude that TH treatment of CM hamsters with subclinical hypothyroidism normalized impaired coronary blood flow, which prevented the decline in LV function and loss of myocytes.
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Kucuk, Murathan, Can Ramazan Oncel, Aytul Belgi Yıldırım, Fatih Canan, and Mehmet Murat Kuloglu. "Evaluation of Subclinical Left Ventricular Systolic Dysfunction in Chronic Asymptomatic Alcoholics by Speckle Tracking Echocardiography." BioMed Research International 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/6582568.
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By using two-dimensional speckle tracking echocardiography, we aimed to investigate the structural and functional changes on myocardium in chronic asymptomatic alcoholics without any cardiovascular disease. Forty-one consecutive asymptomatic male alcoholics who were admitted to the outpatient alcoholism unit and 30 age matched healthy male volunteers selected as the control group were enrolled in the study. The study group were investigated by using standard two-dimensional echocardiography and speckle tracking echocardiography. The left ventricular (LV) global longitudinal strain and LV global circumferential strain were significantly lower in alcoholics when compared with control subjects. There was no difference in global radial strain between the two groups. To demonstrate the effect of total life time dose of ethanol (TLDE) on echocardiographic abnormalities, we assessed the correlation analysis. There was a nonsignificant weak correlation between global LV circumferential strain and TLDE (r=0.27,p=0.083). Speckle tracking echocardiography derived left ventricular systolic function was impaired in chronic alcoholic patients when compared with healthy controls.
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Tamulėnaitė, Eglė, Rūta Žvirblytė, Rūta Ereminienė, Edita Žiginskienė, and Eglė Ereminienė. "Changes of Left and Right Ventricle Mechanics and Function in Patients with End-Stage Renal Disease Undergoing Haemodialysis." Medicina 54, no. 5 (November 13, 2018): 87. http://dx.doi.org/10.3390/medicina54050087.
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Background and objectives: Chronic kidney disease (CKD) increases the risk of cardiovascular diseases even in its early stages and is associated with structural and functional cardiac abnormalities. The aim of this study was to use speckle-tracking echocardiography (STE) to evaluate left and right ventricle mechanics and function, markers of subclinical dysfunction in patients with end-stage renal disease (ESRD) undergoing haemodialysis. Methods: Patients with ESRD undergoing regular haemodialysis and with preserved left ventricle (LV) ejection fraction (EF) (n = 38) were enrolled in this retrospective study. The control group consisted of 32 age-matched persons with normal kidney function (glomerular filtration rate (GFR) >90 mL/min/1.73 m2 according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)). Conventional 2D echocardiography and STE were performed in all patients. Results: 70 individuals, 31 (44.29%) males and 39 (55.71%) females, were included in the study. There were no significant differences in age, sex and body surface area between the groups. LV end diastolic diameter did not differ between the groups, while LV myocardial mass index was higher in the group of patients on haemodialysis (111.64 ± 27.99 versus 84.21 ± 16.99, p < 0.001) and LV diastolic dysfunction (LVDD) was found in 31 (81.6%) patients of this group. LV global longitudinal strain (GLS) (−22.43 ± 2.71 versus −24.73 ± 2.03, p < 0.001) and LV global circumferential strain (GCS) at the mitral valve and papillary muscles levels (−18.73 ± 3.49 versus −21.67 ± 2.22, p < 0.001; −18.64 ± 2.75 versus −20.42 ± 2.38, p = 0.005, respectively) were significantly lower in haemodialysis group patients. The parameters of the right ventricle (RV) free wall longitudinal function including RV GLS (−22.63 ± 3.04 versus −25.45 ± 2.48, p < 0.001), were reduced in haemodialysis patients compared with the controls. However, RV fractional area change (FAC) did not differ between the groups (p = 0.19). Conclusion: Patients with ESRD and preserved LV ejection fraction undergoing haemodialysis had a higher prevalence of LVDD and impaired LV longitudinal and circumferential deformation indices, as well as reduced RV longitudinal function and deformation parameters compared with the age-matched healthy controls. STE helps to detect subclinical LV and RV dysfunction in chronic haemodialysis patients.
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Tan, Annabel, Sanjiv J. Shah, Jason Sanders, Bruce Psaty, Anne Newman, Chenkai Wu, Julius Gardin, and Michelle Odden. "The Association Between Myocardial Strain and Frailty in the Cardiovascular Health Study." Innovation in Aging 4, Supplement_1 (December 1, 2020): 524–25. http://dx.doi.org/10.1093/geroni/igaa057.1692.
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Abstract Myocardial strain, measured by speckle tracking echocardiography (STE), is a novel measure of subclinical cardiovascular disease and may reflect myocardial aging. We aimed to explore the association between myocardial strain and frailty, a clinical syndrome of impaired resilience and lack of physiologic reserve. Frailty was defined in 4,042 participants of the Cardiovascular Health Study (CHS) as having 3 or more of the following clinical criteria: weakness, slowness, shrinking, exhaustion, and inactivity. We examined the cross-sectional and longitudinal associations of left ventricular (LV) longitudinal strain, LV early diastolic strain rate and left atrial reservoir strain with frailty in participants with no history of cardiovascular disease or heart failure at the time of echocardiography. In cross-sectional analyses, LV longitudinal strain, LV early diastolic strain, left atrial reservoir strain and LV ejection fraction (measured by conventional echocardiography) levels were lower (worse) among frail participants than among those who were not frail and pre-frail (p<0.01). This association of LV longitudinal strain and frailty was robust to adjustment by LV ejection fraction (adjusted OR: 1.34, 95% CI: 1.20, 2.09). Conversely, LV ejection fraction was not associated with frailty after adjustment for LV longitudinal strain. In longitudinal analyses, LV longitudinal strain and LV early diastolic strain were associated with incident frailty (adjusted OR: 1.49, 95% CI: 1.07, 2.08) and 1.65, 95% CI: 1.15, 2.25, respectively). In community-dwelling older adults without prevalent cardiovascular disease, worse LV longitudinal strain, reflective of subclinical myocardial dysfunction, was associated with frailty independent of LV ejection fraction and other risk factors.
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Kujur, Punya Pratap, Malav Darshan Jhala, Charan Pandurang Lanjewar, and Rajesh Amrit Matta. "Follow up study in post Covid survivors with LV dysfunction and subclinical myocarditis." Indian Heart Journal 73 (December 2021): S46—S47. http://dx.doi.org/10.1016/j.ihj.2021.11.090.
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Maurice, Flavia, Bénédicte Gaborit, Clara Vincentelli, Ines Abdesselam, Monique Bernard, Thomas Graillon, Frank Kober, Thierry Brue, Frédéric Castinetti, and Anne Dutour. "Cushing Syndrome Is Associated With Subclinical LV Dysfunction and Increased Epicardial Adipose Tissue." Journal of the American College of Cardiology 72, no. 18 (October 2018): 2276–77. http://dx.doi.org/10.1016/j.jacc.2018.07.096.
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Soufi Taleb Bendiab, Nabila, Souhila Ouabdesselam, Latefa Henaoui, Marilucy Lopez-Sublet, Jean-Jacques Monsuez, and Salim Benkhedda. "Impact of Diabetes on Cardiac Function in Patients with High Blood Pressure." International Journal of Environmental Research and Public Health 18, no. 12 (June 18, 2021): 6553. http://dx.doi.org/10.3390/ijerph18126553.
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Background: Although the combination of high blood pressure (HBP) and type 2 diabetes (T2DM) increases the risk of left ventricular (LV) dysfunction, the impact of T2DM on LV geometry and subclinical dysfunction in hypertensive patients and normal ejection fraction (EF) has been infrequently evaluated. Methods: Hypertensive patients with or without T2DM underwent cardiac echocardiography coupled with LV global longitudinal strain (GLS) assessment. Results: Among 200 patients with HBP (mean age 61.7 ± 9.7 years) and EF > 55%, 93 had associated T2DM. Patients with T2DM had a higher body mass index (29.9 ± 5.1 kg/m2 vs. 29.3 ± 4.7 kg/m2, p = 0.025), higher BP levels (158 ± 23/95 ± 13 vs. 142 ± 33/87 ± 12 mmHg, p = 0.003), a higher LV mass index (115.8 ± 32.4 vs. 112.0 ± 24.7 g/m2, p = 0.004), and higher relative wall thickness (0.51 ± 0.16 vs. 0.46 ± 0.12, p = 0.0001). They had more frequently concentric remodeling (20.4% vs. 16.8%, p < 0.001), concentric hypertrophy (53.7% vs. 48.6%, p < 0.001), elevated filling pressures (25.8 vs. 12.1%, p = 0.0001), indexed left atrial volumes greater than 28 mL/m2 (17.2 vs. 11.2%, p = 0.001), and a reduced GLS less than −18% (74.2 vs. 47.7%, p < 0.0001). After adjustment for BP and BMI, T2DM remains an independent determinant factor for GLS decline (OR = 2.26, 95% CI 1.11–4.61, p = 0.023). Conclusions: Left ventricular geometry and subclinical LV function as assessed with GLS are more impaired in hypertensive patients with than without T2DM. Preventive approaches to control BMI and risk of T2DM in hypertensive patients should be emphasized.
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Agarwal, Subhashish, Vinay Thohan, Michael G. Shlipak, Joao Lima, David A. Bluemke, David Siscovick, Antoinette Gomes, and David M. Herrington. "Association between Cystatin C and MRI Measures of Left Ventricular Structure and Function: Multi-Ethnic Study of Atherosclerosis." International Journal of Nephrology 2011 (2011): 1–7. http://dx.doi.org/10.4061/2011/153868.
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Introduction.Reduced kidney function, approximated by elevated cystatin C, is associated with diastolic dysfunction, heart failure, and cardiovascular mortality; however, the precise mechanism(s) that account for these relationships remains unclear. Understanding the relationship between cystatin C and subclinical left ventricular (LV) remodeling, across ethnically diverse populations, may help explain the mechanisms underlying the association of kidney dysfunction with heart failure and cardiovascular mortality.Methods.Measures of cystatin C and LV parameters were obtained from the multi-ethnic study of atherosclerosis (MESA) cohort at baseline (N=4,970with complete data on cystatin C and LV parameters). LV parameters; LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), LV mass (LVM), concentricity (LV mass/LV end-diastolic volume), and LV ejection fraction (LVEF) were measured using magnetic resonance imaging. Nested linear models were used to examine the relationship between higher quartiles of cystatin C and LV parameters, with and without adjustment for demographics, height, and weight, and traditional cardiovascular risk factors. Similar analyses were performed stratified by ethnicity and gender.Results.A fully adjusted model demonstrated a linear relationship between higher quartiles of cystatin C and lower LVEDV, (Mean ± SE, 128 ± 0.7, 128 ± 0.7, 126 ± 0.7, 124 ± 0.8 mL;P=0.0001). Associations were also observed between higher quartiles of cystatin C and lower LVESV (P=0.04) and concentricity (P=0.0001). In contrast, no association was detected between cystatin C and LVM or LVEF. In analyses stratified by race and gender, the patterns of association between cystatin C quartiles and LV parameters were qualitatively similar to the overall association.Conclusion.Cystatin C levels were inversely associated with LVEDV and LVESV with a disproportionate decrease in LVEDV compared to LVM in a multi-ethnic population. This morphometric pattern of concentric left ventricular remodeling, may in part explain the process by which kidney dysfunction leads to diastolic dysfunction, heart failure and cardiovascular mortality.
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Kirillova, I., T. Popkova, Y. Gorbunova, A. Volkov, and E. Nasonov. "POS0559 SPECKLE TRACKING BETTER DETECTS SUBCLINICAL MYOCARDIAL DYSFUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 514.2–514. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2870.
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Background:The risk of developing cardiovascular complications and death in rheumatoid arthritis (RA) is 50% higher than in the total population. These clinical events depend from risk factors for cardiovascular diseases, chronic inflammation and inflammatory myocardial infiltration. А new method for detecting early myocardial dysfunction is echocardiography using speckle tracking echocardiography.Objectives:to determine the frequency of myocardial dysfunction (lower global longitudinal epicardial strain of left ventrical (LV), diastolic dysfunction of left ventricle (LVDD)) using standard and novel echocardiographic methods in patients (pts) with RA prior to therapy with bDMARDs, examine its relationship with markers of inflammation.Methods:a total of 28 pts with a valid diagnosis of RA (ACR/EULAR, 2010): 23 f (82%) /5 m (18%) were included, median (Me) age - 56 [interquartile range (IR) 34;65] years, Me RA duration-14,5 [IR 7;87] months; all pts with RA demonstrated a high disease activity (Me DAS28 6.06, [IR 5,4;6,6]), seropositive for IgM RF (88%) and/or ACCP (84%) without any experience of administration of bDMARDs. The control group consisted of 10 healthy subjects, which were matched by sex and age. All pts were assessed for traditional risk factors for cardiovascular disease (ESC guidelines, 2011), echocardiography, tissue Doppler imaging, and the speckle tracking assessment of left ventricle longitudinal strain. DD was allocated according to the ESC guidelines for the diagnosis and treatment of heart failure (2018). Arterial hypertension was detected in 5 pts with RA.Results:In pts with RA LVDD was more often detected (8 (31%) vs 0%, p=0.05) than in controls. The values of E LV (0.77 [0.62;0.94] ms vs 1.25 [1.03;1.51] ms, p=0.0001) were lower than in control group. Speckle-tracking method detected lower global longitudinal epicardial strain (–16.5 [-18.9; -13.6]% vs –21.58 [-22.1;-20.4] %, p=0.0001). 17(61%) RA pts showed a decrease global longitudinal epicardial strain. There were no between-group differences in left ventricular ejection fraction, LV sizes, LV myocardial mass index in RA pts with controls. There were correlations between the global longitudinal epicardial strain and DAS28 (r=0,9, p<0,02), tender joint score (r=0,6, p<0,02), radiological stage (r=0,6, p<0,008); the presence of systemic manifestations (r=0,5, p<0,03).Conclusion:In pts with RA frequently (61%) were detected lower global longitudinal epicardial strain, which are associated with a high activity of the inflammatory process. Speckle-tracking echocardiography is better at detecting early myocardial dysfunction than tissue Doppler.Disclosure of Interests:None declared
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Yu, Anthony F., Jayant Raikhelkar, Emily C. Zabor, Emily S. Tonorezos, Chaya S. Moskowitz, Roberto Adsuar, Elton Mara, et al. "Two-Dimensional Speckle Tracking Echocardiography Detects Subclinical Left Ventricular Systolic Dysfunction among Adult Survivors of Childhood, Adolescent, and Young Adult Cancer." BioMed Research International 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/9363951.
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Two-dimensional speckle tracking echocardiography (2DSTE) provides a sensitive measure of left ventricular (LV) systolic function and may aid in the diagnosis of cardiotoxicity. 2DSTE was performed in a cross-sectional study of 134 patients (mean age:31.4±8.8years; 55% male; mean time since diagnosis:15.4±9.4years) previously treated with anthracyclines (mean cumulative dose:320±124 mg/m2), with (n=52) or without (n=82) mediastinal radiotherapy. The prevalence of LV systolic dysfunction, defined as fractional shortening < 27%, LV ejection fraction (LVEF) < 55%, and global longitudinal strain (GLS) ≤ 16%, was 5.2%, 6.0%, and 23.1%, respectively. Abnormal GLS was observed in 24 (18%) patients despite a normal LVEF. Indices of LV systolic function were similar regardless of anthracycline dose. However, GLS was worse (18.0 versus 19.0,p=0.003) and prevalence of abnormal GLS was higher (36.5% versus 14.6%,p=0.004) in patients treated with mediastinal radiotherapy. Mediastinal radiotherapy was associated with reduced GLS (p=0.040) after adjusting for sex, age, and cumulative anthracycline dose. In adult survivors of childhood, adolescent, and young adult cancer, 2DSTE frequently detects LV systolic dysfunction despite a normal LVEF and may be useful for the long-term cardiac surveillance of adult cancer survivors.
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Ran, Hong, Matthias Schneider, Lin-lin Wan, Jun-yi Ren, Xiao-wu Ma, and Ping-yang Zhang. "Four-Dimensional Volume-Strain Expression in Asymptomatic Primary Hypertension Patients Presenting with Subclinical Left Atrium-Ventricle Dysfunction." Cardiology 145, no. 9 (2020): 578–88. http://dx.doi.org/10.1159/000508887.
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Objective: The purpose of this study was to evaluate the different components of left atrial (LA) dysfunction predictors in asymptomatic primary systemic hypertension patients with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (4D) longitudinal and circumferential strain values. Methods and Results: Patients with no left ventricular hypertrophy (NLVH) and left ventricular hypertrophy (LVH) are all asymptomatic regarding primary blood hypertension. Thirty NLVH patients and 30 LVH patients according to LV mass index and 40 controls analyzed by 4D echocardiography were prospectively enrolled. LA volumes and longitudinal and circumferential strains were measured using 4D volume-strain echocardiography with a Vivid E95 Version 203 instrument. Correlation analysis indicated a significant relation between LV 4D mass index and LA 4D longitudinal/circumferential strain (r = –0.446 to 0.381, p = 0.000–0.042). LVH patients had a reduced LA emptying fraction compared with NLVH patients and control subjects (p < 0.01). NLVH patients had an impaired LA conduit function and increased contractile function compared with the control group (p < 0.01). LVH patients had increased LA volumes and significantly decreased reservoir, conduit and contractile functions compared with the controls (p < 0.01). LVH patients had increased LA volumes and decreased reservoir and contractile functions compared with NLVH patients (p < 0.01). The clinical utility of LA 4D volume-strain measurement was verified by receiver-operating characteristic curve analysis showing larger net benefits as evaluated with NLVH, LVH and control group comparisons. Interclass correlation coefficients of interobserver and intraobserver assessments in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively. Conclusions: LVH patients showed increased LA volumes and decreased LA emptying fractions. LA reservoir, conduit and contractile functions were significantly impaired in LVH patients. Decreased LA conduit function and increased contractile function were revealed in NLVH patients. LA volumetric and functional analyses with 4D volume-strain echocardiography may facilitate the recognition of subtle LA and LV dysfunctions in asymptomatic systemic hypertension patients.
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Wang, Tingjun, Hongbin Zhong, Guili Lian, Xiaoqi Cai, Jin Gong, Chaoyi Ye, and Liangdi Xie. "Low-Grade Albuminuria Is Associated with Left Ventricular Hypertrophy and Diastolic Dysfunction in Patients with Hypertension." Kidney and Blood Pressure Research 44, no. 4 (2019): 590–603. http://dx.doi.org/10.1159/000500782.
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Introduction: Microalbuminuria is a risk factor for cardiovascular morbidity and mortality in hypertensive patients. However, the relationship between low-grade albuminuria, a higher level of albuminuria below microalbuminuria threshold, and hypertension-related organ damage is unclear. Left ventricular (LV) hypertrophy (LVH) is well recognized to be a subclinical organ damage of hypertension, and LV diastolic dysfunction is also reported to be an early functional cardiac change of hypertension that predicts heart failure. The present study aimed to investigate the association of low-grade albuminuria with LVH and LV diastolic dysfunction in hypertensive patients. Methods: This cross-sectional observational clinical study was retrospectively performed in 870 hypertensive patients admitted to our hospital. Urinary albumin to creatinine ratio (UACR) was calculated to assess the levels of albuminuria: macroalbuminuria (≥300 mg/g), microalbuminuria (≥30 mg/g, but <300 mg/g), and normal albuminuria (<30 mg/g). Low-grade albuminuria was defined as sex-specific highest tertile within normal albuminuria (8.1–29.6 mg/g in males and 11.8–28.9 mg/g in females). LVH and LV diastolic dysfunction were identified as recommended by American Society of Echocardiography. Results: Of the 870 patients, 765 (87.9%) had normal albuminuria, 77 (8.9%) had microalbuminuria, and 28 (3.2%) had macroalbuminuria. Percentage of LVH and LV diastolic dysfunction was increased with ascending UACR. UACR was independently associated with LVH and LV diastolic dysfunction, even in patients with normal albuminuria. Multivariable logistic regression showed that the patients with the highest tertile within normal albuminuria had nearly 80% increase in LVH and nearly 60% increase in LV diastolic dysfunction (adjusted OR for LVH 1.788, 95% CI 1.181–2.708, p = 0.006; adjusted OR for LV diastolic dysfunction 1.567, 95% CI 1.036–2.397, p = 0.034). After further stratification analyses in patients with normal albuminuria, it was shown that this independent association persisted in female patients, those who were younger than 70 years old, and those with duration of hypertension <15 years. Conclusion: Low-grade albuminuria was associated with LVH and LV diastolic dysfunction in hypertensive patients, especially in patients younger than 70 years old, and those with duration of hypertension <15 years.
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Ravera, Maura, Gian Marco Rosa, Paolo Fontanive, Elisabetta Bussalino, Ulrico Dorighi, Daniela Picciotto, Luca Di Lullo, Frank Lloyd Dini, and Ernesto Paoletti. "Impaired Left Ventricular Global Longitudinal Strain among Patients with Chronic Kidney Disease and End-Stage Renal Disease and Renal Transplant Recipients." Cardiorenal Medicine 9, no. 1 (November 28, 2018): 61–68. http://dx.doi.org/10.1159/000494065.
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Background: Although heart failure is the most prevalent cardiovascular disease associated with adverse outcome in chronic kidney disease (CKD) and after kidney transplantation, left ventricular (LV) systolic function is often preserved in renal patients. The aim of this study was to evaluate global longitudinal strain (GLS), which is reportedly a more accurate tool for detecting subclinical LV systolic dysfunction, in patients with various degrees of renal function impairment, including kidney transplant recipients (KTRs). Methods: This prospective study evaluated demographic, clinical, and ultrasound data, including the assessment of LV GLS and mitral E peak velocity and averaged ratio of mitral to myocardial early velocities (E/e’), of 70 consecutive renal patients (20 with stage 2–4 CKD, 25 with end-stage renal disease on hemodialysis [HD], and 25 KTRs). All patients had an LV ejection fraction ≥50% and no history of heart failure or coronary artery disease. We used multivariable logistic analysis to assess the risk of compromised GLS. One hundred and twenty control subjects with or without hypertension served as controls. Results: A compromised GLS <–18% was shown in 55% of patients with stage 2–4 CKD, 60% of HD patients, and 28% of KTRs, while it was 32% in hypertensive controls and 12% in non-hypertensive controls (p < 0.0001). Patients with HD had higher systolic pressure and a significantly greater prevalence of increased LV mass and diastolic dysfunction. In renal patients, E/e’ (p = 0.025), and LV mass index (p = 0.063) were independent predictors of compromised GLS at logistic regression analysis. E/e’, systolic artery pressure, and LV mass also exhibited the greatest areas under the curve on receiver operating characteristic analysis to identify a compromised GLS. Conclusions: Renal disease proved to be associated with early and subclinical impairment of LV systolic function, which persists after starting dialysis and even in spite of successful kidney transplantation. An increased E/e’ resulted to be the most powerful independent predictor of abnormal GLS.
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Laufer-Perl, Michal, Moran Perelman-Gvili, Svetlana Sirota Dorfman, Guy Baruch, Ehud Rothschild, Gil Beer, Yaron Arbel, et al. "Prevalence of Right Ventricle Strain Changes following Anthracycline Therapy." Life 12, no. 2 (February 15, 2022): 291. http://dx.doi.org/10.3390/life12020291.
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Background: Anthracycline (ANT) is the most recognized therapy known to cause cardiotoxicity, mainly left ventricle (LV) dysfunction. Global Longitudinal Strain (GLS) is the optimal tool for assessment of subclinical LV dysfunction. Right ventricle (RV) function has been recognized as an independent factor for cardiac outcomes; however, data evaluating RV GLS is limited. We aimed to evaluate the change in RV GLS following ANT therapy. Methods: The study cohort is part of the Israel Cardio-Oncology Registry (ICOR). All patients performed echocardiography before (T1) and at the end (T3) of ANT therapy. A significant reduction was defined as a relative reduction of ≥10% in RV GLS values. Results: The study included 40 female patients with breast cancer treated with ANT. During follow-up, both RV GLS and free wall longitudinal strain systolic peak (RV FWLS PK) decreased significantly (p < 0.001 and p = 0.002). Altogether, 30 (75%) and 23 (58%) patients showed RV GLS and RV FWLS PK ≥ 10% relative reduction. At T3, LV ejection fraction and LV GLS were within normal range. Conclusions: RV GLS and RV FWLS PK reduction following ANT exposure is extremely frequent, comparing to LV GLS reduction.
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Zhou, Wunan, Jenifer M. Brown, Navkaranbir S. Bajaj, Alvin Chandra, Sanjay Divakaran, Brittany Weber, Courtney F. Bibbo, et al. "Hypertensive coronary microvascular dysfunction: a subclinical marker of end organ damage and heart failure." European Heart Journal 41, no. 25 (March 28, 2020): 2366–75. http://dx.doi.org/10.1093/eurheartj/ehaa191.
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Abstract Aims Hypertension is a well-established heart failure (HF) risk factor, especially in the context of adverse left ventricular (LV) remodelling. We aimed to use myocardial flow reserve (MFR) and global longitudinal strain (GLS), markers of subclinical microvascular and myocardial dysfunction, to refine hypertensive HF risk assessment. Methods and results Consecutive patients undergoing symptom-prompted stress cardiac positron emission tomography (PET)-computed tomography and transthoracic echocardiogram within 90 days without reduced left ventricular ejection fraction (<40%) or flow-limiting coronary artery disease (summed stress score ≥ 3) were included. Global MFR was quantified by PET, and echocardiograms were retrospectively analysed for cardiac structure and function. Patients were followed over a median 8.75 (Q1–3 4.56–10.04) years for HF hospitalization and a composite of death, HF hospitalization, MI, or stroke. Of 194 patients, 155 had adaptive LV remodelling while 39 had maladaptive remodelling, which was associated with lower MFR and impaired GLS. Across the remodelling spectrum, diastolic parameters, GLS, and N-terminal pro-B-type natriuretic peptide were independently associated with MFR. Maladaptive LV remodelling was associated with increased adjusted incidence of HF hospitalization and death. Importantly, the combination of abnormal MFR and GLS was associated with a higher rate of HF hospitalization compared to normal MFR and GLS [adjusted hazard ratio (HR) 3.21, 95% confidence interval (CI) 1.09–9.45, P = 0.034), including in the adaptive remodelling subset (adjusted HR 3.93, 95% CI 1.14–13.56, P = 0.030). Conclusion We have demonstrated important associations between coronary microvascular dysfunction and myocardial mechanics that refine disease characterization and HF risk assessment of patients with hypertension based on subclinical target organ injury.
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Locquet, Médéa, Daan Spoor, Anne Crijns, Pim van der Harst, Arantxa Eraso, Ferran Guedea, Manuela Fiuza, et al. "Subclinical Left Ventricular Dysfunction Detected by Speckle-Tracking Echocardiography in Breast Cancer Patients Treated With Radiation Therapy: A Six-Month Follow-Up Analysis (MEDIRAD EARLY‐HEART study)." Frontiers in Oncology 12 (June 28, 2022). http://dx.doi.org/10.3389/fonc.2022.883679.
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BackgroundIn the case of breast cancer (BC), radiotherapy (RT) helps reduce locoregional recurrence and BC-related deaths but can lead to cardiotoxicity, resulting in an increased risk of long-term major cardiovascular events. It is therefore of primary importance to early detect subclinical left ventricular (LV) dysfunction in BC patients after RT and to determine the dose–response relationships between cardiac doses and these events.MethodsWithin the frame of the MEDIRAD European project (2017–2022), the prospective multicenter EARLY‐HEART study (ClinicalTrials.gov Identifier: NCT03297346) included chemotherapy naïve BC women aged 40–75 years and treated with lumpectomy and adjuvant RT. Myocardial strain analysis was provided using speckle‐tracking echocardiography performed at baseline and 6 months following RT. A global longitudinal strain (GLS) reduction >15% between baseline and follow-up was defined as a GLS-based subclinical LV dysfunction. Individual patient dose distributions were obtained using multi-atlas-based auto-segmentation of the heart. Dose-volume parameters were studied for the whole heart (WH) and left ventricle (LV).ResultsThe sample included 186 BC women (57.5 ± 7.9 years, 64% left-sided BC). GLS-based subclinical LV dysfunction was observed in 22 patients (14.4%). These patients had significantly higher cardiac exposure regarding WH and LV doses compared to patients without LV dysfunction (for mean WH dose: 2.66 ± 1.75 Gy versus 1.64 ± 0.96 Gy, p = 0.01). A significantly increased risk of subclinical LV dysfunction was observed with the increase in the dose received to the WH [ORs from 1.13 (V5) to 1.74 (Dmean); p <0.01] and to the LV [ORs from 1.10 (V5) to 1.46 (Dmean); p <0.01]. Based on ROC analysis, the LV-V5 parameter may be the best predictor of the short-term onset of subclinical LV dysfunction.ConclusionThese results highlighted that all cardiac doses were strongly associated with the occurrence of subclinical LV dysfunction arising 6 months after BC RT. Whether measurements of GLS at baseline and 6 months after RT combined with cardiac doses can early predict efficiently subclinical events occurring 24 months after RT remains to be investigated.
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Yoshida, Yuriko, Koki Nakanishi, Masao Daimon, Kazutoshi Hirose, Jumpei Ishiwata, Hidehiro Kaneko, Tomoko Nakao, et al. "Aortic valve sclerosis and subclinical LV dysfunction in the general population with normal LV geometry." European Journal of Preventive Cardiology, November 22, 2022. http://dx.doi.org/10.1093/eurjpc/zwac279.
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Abstract Aims Aortic valve sclerosis (AVS) without hemodynamically significant obstruction is related to cardiovascular morbidity and mortality independent of left ventricular (LV) hypertrophy, although the underlying mechanisms remain unknown. This study investigated the prevalence of AVS and its association with subclinical LV systolic and diastolic dysfunction in individuals with normal LV geometry free of cardiovascular disease. Methods We examined 962 participants with normal LV geometry and free from significant AV stenosis who underwent standard and speckle-tracking echocardiography. AVS was categorized into 4 groups as follows: no AVS, AV thickening, calcification on one leaflet and calcification on ≥2 leaflets. Results Among the 962 participants, 767 (79.7%) individuals were classified as no AVS, 74 (7.7%) as AV thickening, 87 (9.0%) as calcification on one leaflet, and 34 (3.5%) as calcification on ≥2 leaflets. The prevalence of subclinical LV diastolic dysfunction (E/e’ ratio ≥13) and systolic dysfunction (LV global longitudinal strain (GLS) > -17.0% for men and > -18.0% for women) were greater in AVS groups than those in no AVS group. Subclinical LV diastolic impairment was evident from AV thickening and systolic dysfunction was observed at AV calcification. Multivariable logistic regression analysis demonstrated that AV thickening as well as calcification were independently associated with subclinical LV diastolic impairment (all p < 0.05), while only AV calcification on ≥2 leaflets conferred significant increased risk of impaired LVGLS. Conclusions AVS was observed in approximately 20% individuals without cardiac disease and was associated with subclinical LV diastolic and systolic function even in the absence of LV morphological change.
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Walker, Valentin, Olivier Lairez, Olivier Fondard, Atul Pathak, Baptiste Pinel, Christian Chevelle, Denis Franck, et al. "Early detection of subclinical left ventricular dysfunction after breast cancer radiation therapy using speckle-tracking echocardiography: association between cardiac exposure and longitudinal strain reduction (BACCARAT study)." Radiation Oncology 14, no. 1 (November 14, 2019). http://dx.doi.org/10.1186/s13014-019-1408-8.
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Abstract Background Breast cancer (BC) radiotherapy (RT) can induce cardiotoxicity, with adverse events often observed many years after BC RT. Subclinical left ventricular (LV) dysfunction can be detected early after BC RT with global longitudinal strain (GLS) measurement based on 2D speckle-tracking echocardiography. This 6-month follow-up analysis from the BACCARAT prospective study aimed to investigate the association between cardiac radiation doses and subclinical LV dysfunction based on GLS reduction. Methods The patient study group consisted of 79 BC patients (64 left-sided BC, 15 right-sided BC) treated with RT without chemotherapy. Echocardiographic parameters, including GLS, were measured before RT and 6 months post-RT. The association between subclinical LV dysfunction, defined as GLS reduction > 10%, and radiation doses to whole heart and the LV were performed based on logistic regressions. Non-radiation factors associated with subclinical LV dysfunction including age, BMI, hypertension, hypercholesterolemia and endocrine therapy were considered for multivariate analyses. Results A mean decrease of 6% in GLS was observed (− 15.1% ± 3.2% at 6 months vs. − 16.1% ± 2.7% before RT, p = 0.01). For left-sided patients, mean heart and LV doses were 3.1 ± 1.3 Gy and 6.7 ± 3.4 Gy respectively. For right-sided patients, mean heart dose was 0.7 ± 0.5 Gy and median LV dose was 0.1 Gy. Associations between GLS reduction > 10% (37 patients) and mean doses to the heart and the LV as well as the V20 were observed in univariate analysis (Odds Ratio = 1.37[1.01–1.86], p = 0.04 for Dmean Heart; OR = 1.14 [1.01–1.28], p = 0.03 for Dmean LV; OR = 1.08 [1.01–1.14], p = 0.02 for LV V20). In multivariate analysis, these associations did not remain significant after adjustment for non-radiation factors. Further exploratory analysis allowed identifying a subgroup of patients (LV V20 > 15%) for whom a significant association with subclinical LV dysfunction was found (adjusted OR = 3.97 [1.01–15.70], p = 0.048). Conclusions This analysis indicated that subclinical LV dysfunction defined as a GLS decrease > 10% is associated with cardiac doses, but adjustment for non-radiation factors such as endocrine therapy lead to no longer statistically significant relationships. However, LV dosimetry may be promising to identify high-risk subpopulations. Larger and longer follow-up studies are required to further investigate these associations. Trial registration ClinicalTrials.gov: NCT02605512, Registered 6 November 2015 - Retrospectively registered
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Steen, Henning, Sorin Giusca, Moritz Montenbruck, Amit R. Patel, Burkert Pieske, Andre Florian, Jennifer Erley, Sebastian Kelle, and Grigorios Korosoglou. "Left and right ventricular strain using fast strain-encoded cardiovascular magnetic resonance for the diagnostic classification of patients with chronic non-ischemic heart failure due to dilated, hypertrophic cardiomyopathy or cardiac amyloidosis." Journal of Cardiovascular Magnetic Resonance 23, no. 1 (April 5, 2021). http://dx.doi.org/10.1186/s12968-021-00711-w.
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Abstract Aims To compare the ability of left ventricular (LV) and right ventricular (RV) strain measured by fast-strain encoded cardiovascular magnetic resonance (CMR) (fast-SENC) with LV- and RV-ejection fraction for the diagnostic classification of patients with different stages of chronic heart failure (stages A-D based on American College of Cardiology/American Heart Association guidelines) due to non-ischemic cardiomyopathies. Methods Our study population consisted of 276 consecutive patients who underwent CMR for clinical reasons, and 19 healthy subjects. Wall motion score index and non-infarct related late gadolinium enhancement (LGE), LV ejection fraction (LVEF) and RV ejection fraction (RVEF) and global LV- and RV-longitudinal (GLS) and circumferential strain (GCS) based on fast-SENC acquisitions, were calculated in all subjects. The percentage of LV and RV myocardial segments with strain ≤ − 17% (%normal LV and RV myocardium) was determined in all subjects. Results LVEF and RVEF, LV-GLS, LV-GCS, RV-GLS, RV-GCS and %normal LV- and RV myocardium depressed with increasing heart failure stage (p < 0.001 for all by ANOVA). By multivariable analysis, %normal LV and RV myocardium exhibited closer associations to heart failure stages than LVEF and RVEF (rpartial = 0.79 versus rpartial = 0.21 for %normal LV myocardium versus LVEF and rpartial = 0.64 versus rpartial = 0.20 for %normal RV myocardium versus RVEF, respectively). Furthermore, %normal LV and RV myocardium exhibited incremental value for the identification of patients (i) with subclinical myocardial dysfunction and (ii) with symptomatic heart failure, surpassing that provided by LVEF and RVEF (ΔAUC = 0.22 for LVEF and ΔAUC = 0.19 for RVEF with subclinical dysfunction, and ΔAUC = 0.19 for LVEF and ΔAUC = 0.22 for RVEF with symptomatic heart failure, respectively, p < 0.001 for all). %normal LV myocardium reclassified 11 of 31 (35%) patients judged as having no structural heart disease by clinical and imaging data to stage B, i.e., subclinical LV-dysfunction. Conclusions In patients with non-ischemic cardiomyopathy, %normal LV and RV myocardium, by fast-SENC, enables improved identification of asymptomatic patients with subclinical LV-dysfunction. This technique may be useful for the early identification of such presumably healthy subjects at risk for heart failure and for monitoring LV and RV deformation during pharmacologic interventions in future studies.
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Khedr, Dina, Mona Hafez, Soha Emam, Antoine Abdelmassih, Fatma El-Mougy, Rasha Elkaffas, Oscar Lorenzo, and Noha Musa. "Detection of diabetic cardiomyopathy in Egyptian children and adolescents with longstanding Type 1 diabetes and evaluating the effect of α-tocopherol supplementation on cardiac functions after 1 year; a single center prospective study." Archives of Medical Science, April 4, 2022. http://dx.doi.org/10.5114/aoms/147176.
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IntroductionDiabetic cardiomyopathy (DCM) is a serious complication that frequently occurs in patients with type 1 diabetes (T1D) necessitating early diagnosis. The aim of the current study was to detect subclinical DCM in Egyptian children and adolescents with T1D and evaluate the effect of antioxidants on myocardial dysfunction.Material and methodsThe current prospective observational cohort study included 81 T1D patients (9-20 years old) with diabetes duration > 4 years compared to 50 age and sex matched non-diabetic controls. Serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was assessed in addition to conventional echocardiography, tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). Patients with myocardial dysfunction were supplemented with vitamin E (α-tocopherol) as an antioxidant for 1 year, then follow up echocardiography was done.ResultsNT-proBNP was elevated in 73 (90.1%) patients, 50.6% had left ventricular (LV) diastolic dysfunction, 14.8% had right ventricular (RV) diastolic dysfunction, 84% had LV systolic dysfunction and 91.4% had RV systolic dysfunction with statistically significant difference compared to controls. There was a significant negative correlation between LV global longitudinal strain (GLS) and NT-proBNP (p<0.001, r=-0.796). ROC curve analysis showed that NT-proBNP at a cut-off point ≥ 195 ng/ml detected LV systolic dysfunction function with 89.7% sensitivity and 84.6% specificity. Follow up after one year of α-tocopherol supplementation revealed significant improvement in LV systolic and diastolic functions as well as RV systolic dysfunction.ConclusionsNT-proBNP and non-conventional echocardiography were useful in early detection of subclinical cardiomyopathy in patients with T1D. Antioxidant treatment improved subclinical myocardial dysfunction in T1D patients.
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Florescu, Maria, Diana C. Benea, Gheorghe Cerin, Marco Diena, Mircea Cinteza, and Dragos Vinereanu. "Abstract 4696: Myocardial Velocities and Longitudinal Strain Assessed by Speckle Tracking can Predict Optimal Timing of Surgery in Asymptomatic Patients with Severe Primary Mitral Regurgitation." Circulation 118, suppl_18 (October 28, 2008). http://dx.doi.org/10.1161/circ.118.suppl_18.s_932-a.
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Optimal timing of mitral valve repair in asymptomatic patients with primary mitral regurgitation (PMR) is still controversial. LV ejection fraction (EF) and end-systolic diameter (ESD) represent the most widely used indices to demonstrate LV dysfunction, however, in many cases, a normal EF can mask significant LV impairment. Therefore, new methods might be better to detect subclinical LV dysfunction, and thereby, to improve timing of mitral valve surgery. To assess accuracy and predictive value of indices of tissue Doppler and speckle tracking to detect subclinical LV dysfunction with further impaired postoperative LV function, in asymptomatic patients with severe PMR. 23 asymptomatic patients (59±13 years, 14 male) with severe PMR (regurgitant volume > 65 ml), and LVEF > 60% and ESD < 45 mm, were evaluated preoperatively and at 14 days after successful MVR. 11 patients had a postoperative EF reduction >10% (group A), and 12 patients an EF reduction <10% (group B). Conventional and tissue Doppler echo were used to assess LV diameters and volumes, LV mass index, EF, and long-axis systolic function (from mean 6 basal segments velocities - STDE, and mean time-to-peak systolic contraction - TTP-S); and 2D speckle tracking was used to assess mean negative longitudinal strain of 6 segments in the apical 4-chamber view (LS). Although both groups had similar preoperative LV mass index, LV diameters and volumes, and EF, group A had significantly lower STDE and LS (7.58±0.9 vs. 10.7±1.3 m/s; and −16.29±4.6% vs. −20.57±2.1%, both p<0.01), and a significant higher TTP-S (207.3±73.6 vs. 147.3 ±24 ms, p=0.01) than group B. Multiple regression analysis showed that STDE, and the combination of STDE and LS, represent the main independent predictors for postoperative EF reduction >10% (R 2 = 0.66, p<0.001; and R 2 = 0.80, p<0.05, respectively). A cutoff limit of STDE of 9.2 cm/s had a 100% sensitivity and 100% specificity to predict a postoperative EF reduction >10%. Tissue Doppler systolic indices and longitudinal strain assessed by speckle tracking can detect subclinical LV dysfunction and predict impaired postoperative LV dysfunction, in asymptomatic patients with severe PMR.
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Santoro, C., R. Soloperto, O. Casciano, R. Esposito, F. Luciano, M. Canonico, M. Lembo, G. Arpino, S. De Placido, and M. Galderisi. "Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.0143.
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Abstract Background Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure. Purpose To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography. Methods Fifty Her-2 positive breast cancer women (age = 53.6±11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction <50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%. Results None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p<0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p<0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=−0.40, p=0.006) and after TRZ completion (r=−0.62, p<0.0001). Conclusions Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients. LV and RV strain during cancer therapy Funding Acknowledgement Type of funding source: None
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Santoro, C., R. Soloperto, O. Casciano, R. Esposito, M. Lembo, M. Canonico, G. Arpino, M. Giuliano, S. De Placido, and G. Esposito. "Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity." European Heart Journal - Cardiovascular Imaging 22, Supplement_1 (January 1, 2021). http://dx.doi.org/10.1093/ehjci/jeaa356.187.
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Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure. Purpose To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography. Methods Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction < 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%. Results None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p < 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p < 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p < 0.0001). Conclusions Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients. Abstract Figure.
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Khanna, Shaun, James M. Newman, Aditya Bhat, Henry H. Chen, Gary Gan, and Timothy C. Tan. "Abstract 14734: Characterisation and Prognostic Relevance of Left Ventricular Global Longitudinal Strain in Patients With Systemic Lupus Erythematosus." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.14734.
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Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease modulated by pro-inflammatory cytokines, which may result in myocardial dysfunction. Mean global longitudinal strain (GLS) is proposed to be a more sensitive measure of cardiac function in comparison to standard two-dimensional measures of left ventricular (LV) systolic function. Quantification of subclinical cardiac function, with impairment of LV-GLS, right ventricular free wall strain (RV-FWS), left atrial strain (LAs), and its prognostic relevance in patients with SLE is undefined. Hypothesis: SLE patients have evidence of subclinical cardiac dysfunction and the presence of impaired LV-GLS in this population portends a poor prognosis. Methods: Consecutive patients admitted to our institution with known history of SLE (> 1-year disease activity) were examined. Patients with pre-existing cardiac disease, LV ejection fraction (EF) <50% and those without comprehensive transthoracic echocardiograms were excluded. Mean GLS was performed offline using vendor-independent software (TomTec v4.6) and compared to age-, gender- and risk factor- matched controls. SLE patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events. Results: A total of 51 patients with SLE were compared to 51 matched controls. No significant differences in baseline demographics, medications and laboratory investigations was observed. Patients with SLE showed evidence of subclinical cardiac dysfunction with significantly lower LV-GLS (%) (-16.7±2.8 vs -21.3±2, p<0.01), lower RV FWS (%) (-21.2±4.8 vs -28.8±4.7, p<0.01) and LAs (%) (31.9±6.7 vs 35.5±6.1, p<0.01) when compared to controls, despite normal LVEF, RV FAC and LAEF. On analysis of outcomes of SLE patients, a total of 11 (21.6%) patients suffered the composite end-point during a mean follow-up of 48 months. Of interest, LV-GLS was a predictor of the composite outcome on log-rank test and cox regression analysis (p<0.01). Conclusions: Our results suggest that SLE patients display evidence of subclinical cardiac dysfunction via a reduction in LV GLS, RV-FWS and LAs. Impairment in LV-GLS is associated with adverse cardiovascular outcomes in this population.
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Isa Tafreshi, Roya, Mohammad Radgoodarzi, Kadijeh Arjmandi Rafsanjani, and Fahimeh Soheilipour. "Subclinical Left Ventricular Dysfunction in Children and Adolescence With Thalassemia Intermedia." Frontiers in Pediatrics 10 (June 17, 2022). http://dx.doi.org/10.3389/fped.2022.774528.
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BackgroundCardiac complications are important causes of morbidity in patients with thalassemia intermedia (TI). We aimed to assess left ventricular (LV) function, using new tissue Doppler imaging (TDI) indices, in order to diagnose early ventricular impairment in asymptomatic children and adolescence with the TI.Materials and MethodsWe investigated possible differences in echocardiographic systolic and diastolic parameters between a population of 28 asymptomatic patients (mean age, 13.6 ± 5.7 years) and 35 age-matched healthy control members. All of them underwent 2-D, pulsed Doppler, and tissue Doppler echocardiographic studies for the assessment of the LV mass, Trans-mitral velocities, mitral annular systolic and diastolic velocities, myocardial performance index (MPI), and myocardial acceleration during isovolumic contraction (IVA). The cardiac iron load was estimated by magnetic resonance imaging T2*.ResultsLeft ventricular hypertrophy (LVH) was found in 13 (46.4%) patients. We found significantly reduced TDI-derived peak systolic myocardial velocity (s′) in patients, whereas no significant difference was identified between the patients and control group members when the IVA was compared. The ratio of peak mitral inflow velocity to annular early diastolic velocity (E/e′) of the mitral valve as an index of the diastolic function was significantly higher in patients (9 ± 1 vs. 6 ± 1, p < 0.05). Choosing a TDI-derived MPI > 0.33 as a cutoff point, the global LV dysfunction was detected with a sensitivity of 78% and a specificity of 80%. The patients with LVH significantly exhibited higher values of TDI-MPI and lower values of s′ velocity and IVA when compared against the subjects with normal LV mass.ConclusionSubtle LV systolic and diastolic dysfunction develops early in young patients with the TI who have normal cardiac iron concentration. Moreover, LV remodeling as a main cardiac adaptive response plays a principal role in developing myocardial impairment.
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Devara, J., M. Iftikhar, A. Goda, L. Shaik, R. Katta, A. Egbe, and H. Connolly. "Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in ebstein anomaly." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.1872.
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Abstract Background Certain factors such as left ventricular (LV) geometry and loading conditions affect the validity and reliability of LV ejection fraction (LVEF) as a true measure of LV contractility. LV global longitudinal strain (LVGLS) is less sensitive to these factors, and it has superior prognostic performance in patients with acquired heart disease. The purpose of this study was to determine the clinical implications of using LVGLS (instead of LVEF) as the measure of LV systolic function in adults with Ebstein anomaly given the inherent abnormalities of LV geometry and preload in this population. Methods Retrospective cohort study of 673 adults with Ebstein anomaly (2003–2018). We hypothesized that LVGLS had a stronger correlation with heart failure indices and transplant-free survival compared to LVEF. Results Compared to LVEF, LVGLS had stronger correlations with cardiac index (r=0.46 vs r=0.21, p=0.007), glomerular filtration rate (r=0.57 vs r=0.19, p<0.001), and NT-proBNP (r=−0.64 vs r=−0.41, p=0.01). Of 673 patients, 514 (76%) had normal LV systolic function (LVGLSNormal-LVEFNormal), 87 (13%) had subclinical LV dysfunction (LVGLSLow-LVEFNormal) and 66 (10%) had overt LV dysfunction (LVGLSLow-LVEFLow). Compared to the overt LV dysfunction group, the subclinical LV dysfunction group had similar 10-year transplant-free survival (64% vs 63%, p=0.6), but were less likely to be on heart failure therapy (12% vs 82%, p<0.001). LVGLS (but not LVEF) was the independent predictor of transplant-free survival Conclusions LVGLS provided more robust risk stratification and prognostication than LVEF in patients with Ebstein anomaly, and patients with low LVGLS had reduced transplant-free survival regardless of LVEF. The use of LVGLS (rather than LVEF) as the measure of LV systolic function has important clinical implications with regards to initiation of medical and surgical therapies. Funding Acknowledgement Type of funding sources: None.