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Objectives: To investigate whether two-dimensional speckle-tracking echocardiography (2DSTE) can be considered a criterion for early left ventricular (LV) systolic impairment in patients with systemic lupus erythematosus (SLE) and to further explore the association with each other. Methods: We included 38 patients with SLE and assessed the degree of disease activity according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000 scoring criteria, together with 38 healthy controls who were matched by sex and age. Routine LV systolic function evaluation parameters were obtained by echocardiography as well as 2DSTE measurement of LV strain parameters to obtain global longitudinal strain (GLS) values, respectively. Results: (I) On routine LV function parameters such as ejection fractions (EF) and left ventricular end-diastolic internal diameter (LVIDd), the SLE group and the control group did not reflect differences. In contrast, on the LV strain parameter obtained from 2DSTE measurements, the GLS values in all cardiac planes were lower in the SLE group than in the control group and showed statistically significant differences. (II) Correlation analysis showed that there was a correlation between SLEDAI and GLS, especially a meaningful correlation with GLS Avg and GLS A4C, with correlation coefficients of 0.35 and 0.47, respectively. Conclusions: The use of 2DSTE can detect early impaired LV systolic function in SLE patients, and GLS is progressively gaining attention as an indicator of subclinical myocardial injury and LV function in SLE patients. The correlation that exists between GLS and SLEDAI might contribute to a better assessment of cardiac involvement in SLE patients. Key Points • Cardiac involvement has become one of the major factors in the poor prognosis of SLE patients, which directly affects the mortality of SLE patients. Traditional echocardiography is difficult to detect early left ventricular function impairment, thus affecting clinicians' judgment and diagnosis. • 2DSTE can recognize subclinical myocardial injury in SLE patients at an early stage, and its derived strain parameters may be used as an indicator to evaluate myocardial involvement and reflect disease activity in SLE patients [ABSTRACT FROM AUTHOR]

Cardiac dysfunction is associated with mortality in children with hypoplastic left heart syndrome (HLHS). We evaluated the ability of qualitative and quantitative RV functional parameters to predict outcomes in HLHS patients. In this retrospective, single-center study, echocardiograms from 3 timepoints (pre-stage 1 palliation, 4–8 weeks post-stage 1 palliation, and pre-Glenn) were analyzed in infants with HLHS. Patients were stratified into two groups based on outcome of transplant-free survival post-Glenn (survivors) versus mortality or transplantation prior to Fontan (non-survivors). Images were retrospectively reviewed to obtain RV global longitudinal strain (RVGLS), RV-free wall strain (RVFWS), fractional area change (FAC), tricuspid annular systolic plane excursion (TAPSE), tissue motion annular displacement of the tricuspid valve (TMAD-TV) and qualitative systolic function assessment during the predetermined timepoints. An equal variance t-test and chi-square were used to determine significant differences and ROC curve analysis was performed to derive optimal cutoff values to predict mortality/transplant. A total of 47 patients met inclusion criteria, of which, 21 patients met composite endpoint. There were no significant differences in any RV functional parameter during the pre- or post-stage 1 palliation timepoints. The absolute values of RVFWS, RVGLS, and TMAD-TV were significantly greater in survivors than non-survivors during the pre-Glenn timepoint. A pre-Glenn RVGLS > −15.6 (AUC 0.79), RVFWS > −18.6 (AUC 0.75), and TMAD-TV < 12.6% (AUC 0.82) were sensitive and specific for predicting death or need for transplantation prior to Fontan completion. RVGLS, RVFWS, and TMAD-TV may help identify higher-risk HLHS patients during the interstage period. [ABSTRACT FROM AUTHOR]

Early detection of cardiac involvement in Juvenile Dermatomyositis (JDM) is difficult due to the absence of clinical signs and symptoms, with systolic dysfunction often emerging in late stages and associated with a poor prognosis. This study aimed to employ two-dimensional speckle-tracking echocardiography (STE) for subclinical assessment of left ventricular (LV) systolic failure in JDM and explore potential associations between impaired LV systolic function (LV-GLS) and disease activity. A prospective study enrolled 20 healthy volunteers and 26 JDM patients (< 18 years old) without cardiac symptoms. Clinical data were collected from medical records, and echocardiograms were conducted by a pediatric cardiologist. Our study cohort demonstrated similar age to controls (13.5 ±.6 vs. 13.8 ± 4.7; p = 0.465). Median illness duration at echocardiography was 5 (1.5–17.5) years, and conventional echocardiography indicated normal LV ejection fraction (> 55%) in all participants. However, STE revealed lowered LV GLS in JDM patients (− 22.2 ± 4.1% vs. − 26.5 ± 5.3% p = 0.022). Pulse steroid users displayed lower GLS average values compared to non-users (β = 4.99, 95% CI 1.34–8.64, p = 0.009). Negative correlations existed between LV-GLS and age at diagnosis (r = − 0.499; p = 0.011), diastolic parameters (E/E′ ratio) and age at diagnosis (r = − 0.469; p = 0.018), as well as RV global strain and age at diagnosis (r = − 0.443; p = 0.024). Employing STE in JDM patients facilitated the identification of preclinical cardiac dysfunction. Given JDM patients' younger age, early myocardial damage detection through STE may impact treatment decisions and long-term cardiovascular prognosis. [ABSTRACT FROM AUTHOR]

Multisystem inflammatory syndrome in children (MIS-C), is a rare but severe, hyperinflammatory complication of COVID-19, in which cardiovascular abnormalities are frequently detected. In this prospective study, we describe the echocardiographic findings in patients with MIS-C, with the use of conventional Echocardiography and Speckle-Tracking Echocardiography (STE) with Left Ventricular (LV) Global Longitudinal Strain (GLS) analysis, in the acute and follow-up phase. In total, 25 MIS-C patients [64% females, mean (± SD) age: 8.3 (± 3.72) years] were included. In the acute phase, median (IQR) Troponin and NT-proBNP and mean heart rate, were 8.07 (14.52) pg/mL, 2875.00 (7713.00) pg/mL, and 102.87 (± 22.96) bpm, respectively. Median (IQR) LV Ejection Fraction (LVEF) was 66 (8)% and LVEF impairment was detected in 2/25 (8%) patients. On follow-up (mean time interval:9.50 ± 4.59 months), heart rate was significantly lower, with a mean value of 90.00 (± 14.56) bpm (p-value = 0.017). Median (IQR) LVEF was 66.00 (6.70)% (p-value = 0.345) and all 25 participants had normal LVEF. In 14/25 patients, additional LV-GLS analysis was performed. During the acute phase, mean LV-GLS was − 18.02 (± 4.40)%. LV-GLS was abnormal in 6/14 patients (42.9%) and among them, only one patient had reduced LVEF. On follow-up (median (IQR) time interval:6.93 (3.66) months), mean LV-GLS was -20.31 (± 1.91)% (p-value = 0.07) and in 1/14 patient (7.1%), the LV-GLS impairment persisted. In conclusion, in the acute and follow-up phase, we detected abnormal LV-GLS values in some patients, in the presence of normal LVEF, indicating that STE-GLS is a valuable tool for identifying subclinical myocardial injury in MIS-C. [ABSTRACT FROM AUTHOR]

Myocardial injury in open-heart surgery is related to several factors including ischemia–reperfusion injury, generation of reactive oxygen species, increased production of inflammatory mediators, and enhancement of apoptosis of cardiomyocytes. The aim of this study was to study the effect of L-carnitine on myocardial injury in children undergoing open-heart surgery. This clinical trial was performed on 60 children with congenital heart disease (CHD) who underwent open-heart surgery. They were randomized into two groups: L-carnitine group who received L-carnitine 50 mg\kg\day once daily for 1 month before cardiac surgery and control group who received placebo for 1 month before cardiac surgery. Left ventricular cardiac function was assessed by conventional echocardiography to measure left ventricular ejection fraction (LVEF) and two-dimensional speckle tracking echocardiography (2D-STE) to determine left ventricular global longitudinal strain (2D-LV GLS). Blood samples were obtained pre-operatively at baseline before the administration of L-carnitine or placebo and 12 h post-operatively to measure the level of malondialdehyde (MDA), superoxide dismutase (SOD), fas, caspase-3, creatinine kinase-MB (CK-MB), and troponin I. L-carnitine group had significantly lower post-operative level of oxidative stress marker (MDA), apoptosis markers (fas and caspase-3), and myocardial injury markers (CK-MB and troponin I), but they had significantly higher SOD post-operative level compared to the control group. In addition, post-operative LVEF and 2D-LVGLS were significantly lower in the control group compared to L-carnitine group. Conclusion: L-carnitine can reduce myocardial injury, improve post-operative left ventricular cardiac function, and may provide myocardium protection in children with CHD who underwent open-heart surgery. Trial registration: The clinical trial was registered at www.pactr.org with registration number PACTR202010570607420 at 29/10/2020 before recruiting the patients. What is Known: • Myocardial injury in open-heart surgery is related to several factors including ischemia–reperfusion injury, generation of reactive oxygen species, increased production of inflammatory mediators, and enhancement of apoptosis of cardiomyocytes. • L-carnitine was reported to have myocardial protective effects in rheumatic valvular surgery and coronary artery bypass graft (CABG) in adults; however, there is no evidence on its effectiveness in children undergoing open-heart surgery. What is New: • L-carnitine significantly lowered the post-operative level of oxidative stress marker (MDA), apoptosis markers (fas and caspase-3), and myocardial injury markers (CK-MB and troponin I) in the treatment group. • L-carnitine can reduce myocardial injury, improve post-operative left ventricular cardiac function, and may provide myocardium protection in children with CHD who underwent open-heart surgery. [ABSTRACT FROM AUTHOR]

In systemic sclerosis (SSc), pulmonary hypertension remains a significant cause of morbidity and mortality. Although conventionally classified as group 1 pulmonary arterial hypertension, systemic sclerosis-related pulmonary hypertension (SSc-PH) is a heterogeneous disease. The contribution of left-sided cardiac disease in SSc-PH remains poorly understood. How often does left ventricular (LV) dysfunction occur in SSc among patients undergoing right heart catheterization and how does coexistent LV dysfunction with SSc-PH affect all-cause mortality in this patient population? We conducted a retrospective, observational study of 165 patients with SSc who underwent both echocardiography and right heart catheterization. LV dysfunction was identified using LV global longitudinal strain (GLS) on speckle-tracking echocardiography based on a defined threshold of > −18%. SSc-PH was defined by a mean pulmonary artery pressure > 20 mmHg. Among patients with SSc who have undergone right heart catheterization, LV dysfunction occurred in 74.2% with SSc-PH and 51.2% without SSc-PH. The median survival of patients with SSc-PH and LV dysfunction was 67.9 (95% CI, 38.3-102.0) months, with a hazard ratio of 12.64 (95% CI, 1.73-92.60) for all-cause mortality when adjusted for age, sex, SSc disease duration, and FVC compared with patients with SSc without pulmonary hypertension with normal LV function. LV dysfunction is common in SSc-PH. Patients with SSc-PH and LV dysfunction by LV GLS have increased all-cause mortality. This suggests that LV GLS may be helpful in identifying underlying LV dysfunction and in risk assessment of patients with SSc-PH. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The premature-born adult population is set to grow significantly, and prematurity has emerged as an important cardiovascular risk factor. We aimed to comprehensively assess cardiac mechanics and function in a cohort of ex-preterm preschoolers. Methods: Ex-preterm children (<30 weeks of gestation), aged 2 to 5 years, underwent transthoracic 2D, speckle-tracking, and 4D echocardiography. The findings were compared with 19 full-term children. Results: Our cohort of 38 children with prematurity history showed a normal morpho-functional echocardiographic assessment. However, compared to controls, the indexed 3D end-diastolic volumes of ventricular chambers were reduced (left ventricle 58.7 ± 11.2 vs. 67.2 ± 8.5 mL/m2; right ventricle 50.3 ± 10.4 vs. 57.7 ± 11 mL/m2; p = 0.02). Left ventricle global and longitudinal systolic function were worse in terms of fraction shortening (32.9% ± 6.8 vs. 36.5% ± 5.4; p = 0.05), ejection fraction (59.2% ± 4.3 vs. 62.3% ± 3.7; p = 0.003), and global longitudinal strain (−23.6% ± 2.4 vs. −25.5% ± 1.7; p = 0.003). Finally, we found a reduced left atrial strain (47.4% ± 9.7 vs. 54.9% ± 6.8; p = 0.004). Conclusions: Preschool-aged ex-preterm children exhibited smaller ventricles and subclinical impairment of left ventricle systolic and diastolic function compared to term children. Long-term follow-up is warranted to track the evolution of these findings. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is associated with higher incidence of cardiovascular death. Screening for coronary artery disease in asymptomatic or mildly symptomatic patients is challenging. Objective: The aim of this study was to investigate the incremental value of resting deformation analysis in predicting positive results for myocardial ischemia during stress transthoracic echocardiography in patients with end‐stage CKD. Methods: Sixty‐one patients (mean age: 62.3 ± 11.8, 65.7% men) with end‐stage CKD were included in the study. Patients underwent a resting transthoracic echocardiogram and a dobutamine stress contrast echo (DSE) protocol. Positive results of DSE were defined as stress‐induced left ventricular (LV) wall motion abnormalities. Results: The study cohort had normal or mildly impaired systolic function: mean LV ejection fraction (EF) was 49.2% (±10.4) and mean LV global longitudinal strain (GLS) was 14.4% (±4.5). Half of our population had impaired left atrial (LA) strain: mean LA reservoir, conduit, and contractile reserve were 24.1% (±12.6), 10.6% (±5.9), and 13.6% (±9.2), respectively. DSE was positive for ischemia in 55.7%. A significant negative association with DSE results was found for LV EF, LV GLS and the conduit phase of LA strain. Both LV and LA dimensions showed positive correlation with presence of ischemia in DSE. Multivariate logistic regression analysis showed that LV GLS was independently associated with DSE (p = 0.007), after controlling for covariates, with high diagnostic accuracy. Conclusion: Resting LV deformation could predict positive results during DSE, thus may be useful to better identify renal patients who might benefit from coronary artery screening. [ABSTRACT FROM AUTHOR]

Background:Identification of significant coronary artery disease (CAD)in NSTEMI/UA/CSA patients without invasive methodsremains a clinical challenge. Severe CAD is known to cause LV dysfunction. However, the LV ejection fraction is usually normal at a relatively early stage. Therefore, establishing a more sensitive index for the detection of early-stage LV dysfunction is of utmost importance. Methods: This was a cross sectional observational study conducted on 136 patients with NSTEMI/UA/CSAto evaluate the value of global longitudinal strain (GLS) at rest to predict the presence of significant CAD and to determine the severity of CAD. The patients underwent transthoracic echocardiography (TTE) to measure 2DSTE to measure GLS. Results: Overall, Left Anterior Descending artery(43.38%) was the commonest vessel involved. Study revealed that mean GLS value was significantly lower in significant CAD (>70% stenosis)i.e. -15.95+ 2.78 than those with non-significant CAD (<70% stenosis) i.e. -20 + 1.73 with p < 0.001. The sensitivity and specificity for SVD, DVD and TVD were67.53% andTVD were67.53% and 89.83%, 88.90% and 82.60%, 85.30% and 70.40% respectively. Conclusion:Global longitudinal strain (GLS) assessed by 2D speckle tracking echocardiography at rest has good sensitivity and specificity to predict the presence, extent and severity of CAD in patients. [ABSTRACT FROM AUTHOR]

A post hoc analysis of the SURMOUNT-1 trial found that tirzepatide treatment significantly reduced the 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) in individuals with obesity or overweight without diabetes. The study also showed a rapid reduction in waist circumference (WC), indicating that tirzepatide acts on abdominal fat. Another study explored the relationship between global longitudinal strain (GLS), a measure of left ventricular deformability, and WC. The findings revealed a strong linear association between GLS and WC, even after adjusting for relevant variables. These results suggest that abdominal fat reduction may improve cardiovascular risk. Further research is needed to confirm these findings and determine if GLS can be used as a surrogate endpoint for cardiovascular events. [Extracted from the article]

Background: Fetal two-dimensional speckle tracking echocardiography (2D-STE) is an emerging technique for assessing fetal cardiac function by measuring global longitudinal strain. Alterations in global longitudinal strain may serve as early indicator of pregnancy complications, making 2D-STE a potentially valuable tool for early detection. Early detection can facilitate timely interventions to reduce fetal and maternal morbidity and mortality. Therefore, the aim of this study was to investigate the feasibility of performing 2D-STE at 16 weeks gestational age. Methods: This pilot study utilized 50 ultrasound clips of the fetal four-chamber view recorded between 15+5 and 16+2 weeks gestational age from a prospective cohort study. A strict protocol assessed three parameters essential for 2D-STE analysis: fetal four-chamber view ultrasound clip quality, region of interest, and frame rates. Two independent researchers measured global longitudinal strain in all adequate fetal four-chamber view ultrasound clips to determine inter- and intra-operator reliability. Results: Out of the 50 ultrasound clips, 37 (74%) were feasible for 2D-STE analysis. The inter-operator reliability for global longitudinal strain measurements of the left and right ventricles was moderate (ICC of 0.64 and 0.74, respectively), while the intra-operator reliability was good (ICC of 0.76 and 0.79, respectively). Conclusions: Our findings demonstrate that fetal 2D-STE analysis at 16 weeks gestational age is feasible when adhering to a strict protocol. However, further improvements are necessary to enhance the inter- and intra-operator reliability of 2D-STE at this gestational age. [ABSTRACT FROM AUTHOR]

Objective: Sleep is a complex event involving various physiological processes. Recent studies during the last few years have shed light on the effects of sleep duration on health. We investigated the cardiac effects of sleep duration on speckle-tracking echocardiography. We divided the patients into 2 groups who slept more or less than 7 hours and evaluated all of them with transthoracic echocardiography. Methods: This study was a retrospective study was conducted to investigate the cardiac effects of sleep duration. Between June 2021 and February 2022, 129 individuals who were admitted to our hospital for routine check-up with no known chronic disease and with normal and good quality echocardiographic examination were included in the study. The patients who were eligible for the study design were called by the investigator to obtain information on average sleep duration, and two groups were defined by the self-reported sleep duration (=7 hours, >7 hours per day) and were used in the statistical analyses. Results: A total of 129 patients [=7 hours (n=80), >7 hours (n=49) per day] were enrolled in this study. All echocardiographic parameters were compared with sleep duration. Among these parameters, left ventricular (LV) global longitudinal strain (GLS) was found to be greater in the group who slept less. (-21.5±2.6 vs. -20.3±2.2 p=0.005). However, being within normal limits, LV end diastolic diameter and right heart chambers were found to be more enlarged in those who slept 7 hours or less than 7 hours. It was also observed that the right atrial volume was higher in the less sleeper group. Conclusion: As a result, GLS, which is one of the parameters showing LV function, was found to be less in healthy people with a sleep time above a certain period, and we believe that this may be a hypothesis to explain the relationship of long sleep time with cardiovascular events. [ABSTRACT FROM AUTHOR]

There is minimal information available regarding the early effects of bronchial asthma (BA) and its treatment on cardiac function in children. We used two-dimensional speckle-tracking echocardiography (2D-STE) to evaluate cardiac function before and after the treatment of childhood BA. We enrolled 44 children with moderate and severe BA who had not been treated over the preceding 3 months or who were newly diagnosed. All children received the same treatment (that recommended by the Global Initiative for Asthma [GINA] in 2017). All children also underwent transthoracic 2D-STE before treatment and 6 months later. Clinical data were compared before and after treatment. After treatment, significant increases were evident in right ventricular (RV) systolic and diastolic strain, as well as the systolic strain rate. Before and after treatment, the RV global longitudinal systolic strains were − 22.8 ± 3.6 and − 25.1 ± 4.5, respectively (p = 0.036); the RV global longitudinal diastolic strains were − 18.5 ± 6.0 and − 21.5 ± 5.2, respectively (p = 0.038); and the RV systolic strain rates were − 1.26 ± 0.4 and − 1.12 ± 0.3, respectively (p = 0.025). After treatment, significant increases were observed in the right atrial (RA) peak longitudinal strain and strain rate. Before and after treatment, the RA peak atrial longitudinal strains were 32.5 ± 10.8 and 44.7 ± 11.2, respectively (p = 0.042) and the RA longitudinal strain rates were − 1.6 ± 0.3 and − 2.0 ± 0.5, respectively (p = 0.041). RV and RA subclinical dysfunction may develop in children with early-stage BA. However, asthma treatment appears to improve such dysfunction. In children with BA, clinical and subclinical changes in cardiac functions can be easily detected via 2D-STE. [ABSTRACT FROM AUTHOR]

Background: Heart failure with preserved ejection fraction (HFpEF) represents a significant proportion of heart failure cases. Accurate diagnosis is challenging due to the heterogeneous nature of the disease and limitations in traditional echocardiographic parameters. Main body: This review appraises the application of Global Longitudinal Strain (GLS) and Left Atrial Strain (LAS) as echocardiographic biomarkers in the diagnosis and phenotyping of HFpEF. Strain imaging, particularly Speckle Tracking Echocardiography, offers a superior assessment of myocardial deformation, providing a more detailed insight into left heart function than traditional metrics. Normal ranges for GLS and LAS are considered, acknowledging the impact of demographic and technical factors on these values. Clinical studies have demonstrated the prognostic value of GLS and LAS in HFpEF, especially in predicting cardiovascular outcomes and distinguishing HFpEF from other causes of dyspnea. Nevertheless, the variability of strain measurements and the potential for false-negative results underline the need for careful clinical interpretation. The HFA-PEFF scoring system's integration of these biomarkers, although systematic, reveals gaps in addressing the full spectrum of HFpEF pathology. The combined use of GLS and LAS has been suggested to define HFpEF phenogroups, which could lead to more personalized treatment plans. Conclusion: GLS and LAS have emerged as pivotal tools in the non-invasive diagnosis and stratification of HFpEF, offering a promise for tailored therapeutic strategies. Despite their potential, a structured approach to incorporating these biomarkers into standard diagnostic workflows is essential. Future clinical guidelines should include clear directives for the combined utilization of GLS and LAS, accentuating their role in the multidimensional assessment of HFpEF. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac sarcoidosis (CS) is commonly diagnosed based on clinical criteria and abnormalities in noninvasive imaging reported in patients with biopsy‐proven extracardiac sarcoidosis. Electrocardiogram and two‐dimensional echocardiography have a low sensitivity for CS detection. Cardiovascular magnetic resonance imaging (CMR) and positron emission tomography (PET) have limitations in terms of cost and availability. Objectives: This study aimed to assess the usefulness of left ventricular longitudinal strain, measured using two‐dimensional speckle tracking echocardiography (STE), for the prediction of late gadolinium enhancement (LGE) presence in CMR in patients with biopsy‐proven sarcoidosis. Patients and Methods: A total of 119 patients with biopsy‐proven extracardiac sarcoidosis were divided, according to the clinical criteria proposed by the 2014 Heart Rhythm Society expert consensus statement (HRS 2014), into two groups: 43 individuals with "probable cardiac sarcoidosis", CS(+) and 76 individuals without cardiac sarcoidosis, CS (−). Data from echocardiography, CMR, 12‐lead ECG and 24 h Holter monitoring were analyzed. Results: Left ventricular global longitudinal strain (LV‐GLS) was slightly reduced in the entire sarcoidosis group (−18.61± 2.96), no difference between the CS (+) and CS (−) subgroups was found (−18.0% ± 3.2% and −18.9% ± 2.8%, respectively; p =.223). No cut‐off value for LV‐GLS was identified that could predict the presence of LGE. Segmental longitudinal strain impairment partially correlated with the presence of LGE on CMR. Conclusions: In our cohort of sarcoidosis patients, segmental longitudinal strain proved more helpful in the diagnostic process than LV‐GLS. The ultimate role of STE in the diagnosis of CS remains to be established. [ABSTRACT FROM AUTHOR]

Background: Interstitial lung disease (ILD) comprises a wide variety of pulmonary parenchymal disorders within which progressive fibrosing ILD (PF-ILD) constitutes a phenotypic subset. By use of speckle tracking-based strain analysis we aimed to evaluate the degree of left ventricular (LV) dysfunction in progressive vs. non-progressive fibrosing ILD (non-PF-ILD). Methods: A total of 99 ILD patients (mean age 63.7 ± 13.5 years, 37.4% female), composed of 50 PF-ILD and 49 non-PF-ILD patients, and 33 controls were prospectively enrolled and underwent conventional and speckle tracking echocardiography. Additional laboratory and pulmonary function testing, as well as six-minute walk test were performed. Results: As compared to the non-PF-ILD cohort, PF-ILD patients exhibited a significantly impaired forced vital capacity (2.4 ± 1.0l vs. 3.1 ± 0.9l, p = 0.002), diffusion capacity for carbon monoxide (DLCO, 25.6 ± 16.3% predicted vs. 43.6 ± 16.67% predicted, p <0.001) and exercise capacity response as measured by the six-minute walk test distance (268.1 ± 178.2m vs. 432.6 ± 94.2m, p <0.001). Contrary to conventional echocardiographic LV parameters, both regional and global longitudinal LV strain measurements were significantly altered in ILD patients as compared to controls. No differences in LV strain were found between both patient groups. Significant correlations were observed between global longitudinal strain, on the one hand, and systemic inflammation markers, total lung capacity (TLC) and DLCO, on the other hand (high-sensitivity C-reactive protein: Pearson´s r = -0.30, p< 0.001; interleukin-6: Pearson´s r = -0.26, p = 0.007; TLC % predicted: Pearson´s r = 0.22, p = 0.02; DLCO % predicted: Pearson´s r = 0.21, p = 0.02). Conclusions: ILD is accompanied by LV dysfunction. LV functionality inversely correlates with the severity of the restrictive ventilatory defect and inflammation marker levels. These observations support the assumption of persistent low-grade systemic inflammation that may link systemic cardiovascular function to ILD status. [ABSTRACT FROM AUTHOR]

This study was designed to prospectively investigate the pattern of intraventricular hemodynamic forces (HDFs) associated with left ventricular (LV) function and remodeling in women with uncomplicated twin pregnancy. Transthoracic echocardiography was performed on 35 women (aged 35.9 ± 4.7-yr old) during gestation (T1, <14 wk; T2, 14-27 wk; T3, >28 wk) and 6-7 mo after delivery (T0). LV HDFs were computed from echocardiography long-axis data sets using a novel technique based on endocardial boundary tracking, both in apex-base (A-B) and latero-septal (L-S) directions. HDF distribution was evaluated by L-S over A-B HDF ratio (L-S:A-B HDF ratio). At T1, L-S:A-B HDF ratio was higher than in T0 (P < 0.05) indicating HDF misalignment. At T2, a slight impairment of cardiac function was then recorded with a reduction of global longitudinal strain (GLS) and left ventricular end-systolic elastance (Ees) at pressure-volume relationship analysis versus T1 (both P < 0.05). Finally, at T3, when HDF misalignment and LV contractility reduction (GLS and Ees) were all restored, a rightward shift of the end-diastolic pressure-volume relationship (EDPVR) with an increase of ventricular capacitance was documented. In twin pregnancy, HDF misalignment in the first trimester precedes the slight temporary decrease in left ventricular systolic function in the second trimester; at the third trimester, a rightward shift of the EDPVR was associated with a realignment of HDF and normalization of ventricular contractility indexes. These coordinated changes that occur in the maternal heart during twin pregnancy suggest the role of HDFs in cardiac remodeling. [ABSTRACT FROM AUTHOR]

The prevalence of cardiac complications linked to celiac disease (CD) is on expanding. This study aimed to evaluate the cardiac function in children with CD using two dimensional speckle tracking echocardiography (2D-STE) to detect early myocardial dysfunction, if any. This cross-sectional study included 40 children with CD as the patient group and 40 healthy age- and sex-matched children served as the control group. High sensitive troponin T (Hs-troponin T), anti-tissue transglutaminase immunoglobulin A (tTG-IgA), hemoglobin, ferritin, albumin, and vitamin D levels were measured in all participants. Conventional, tissue Doppler imaging (TDI), and 2D-STE were performed for all included children. Conventional echocardiographic parameters showed no significant difference between the two groups. Left ventricular global longitudinal strain (LV GLS) obtained by 2D-STE was substantially lower in children with CD than the control group; however, myocardial performance index (MPI) obtained by TDI was significantly higher in children with CD. Hs-troponin T levels were comparable in both groups. LV GLS was positively correlated with hemoglobin, ferritin, and albumin level, but it was inversely correlated with the duration of the disease and anti tTG-IgA. Conclusion: 2D-STE can detect subclinical early cardiac dysfunction in children with CD and this cardiac injury correlated to the duration and severity of the disease and some nutritional deficiency in these children. What is Known: • The prevalence of cardiac complications linked to celiac disease (CD) is on expanding. • Only one study evaluated cardiac function in children with CD using two dimensional speckle tracking echocardiography (2D-STE). What is New: • Our study found that 2D-STE can detect early subclinical cardiac dysfunction in children with CD. Cardiac injury in theses children correlated to the duration and severity of the disease, hemglobin, ferritin, and albumin levels. [ABSTRACT FROM AUTHOR]

Cirrhotic cardiomyopathy (CCM) is characterized by elevated cardiac output at rest, an inability to further increase contractility under stress, and diastolic dysfunction. The diagnosis of CCM is crucial as it can lead to complications during liver transplantation. However, its recognition poses challenges with conventional echocardiography techniques. Speckle tracking echocardiography (STE), particularly global longitudinal strain (GLS), is a novel index that enhances the diagnostic efficacy of echocardiography for both ischemic and non-ischemic cardiomyopathies. GLS proves more sensitive in identifying early systolic dysfunction and is also influenced by advanced diastolic dysfunction. Consequently, there is an expanding scope for GLS utilization in cirrhotic cases, with newly updated diagnostic criteria for CCM incorporating GLS. Specifically, systolic dysfunction is now defined as either a left ventricular ejection fraction below 50% or an absolute GLS below 18%. However, conflicting data on GLS alterations in liver cirrhosis patients persist, as many individuals with advanced disease and a poor prognosis exhibit a hyperdynamic state with preserved or increased GLS. Consequently, the presence of CCM, according to the updated criteria, does not exhibit a significant association—in the majority of studies—with the severity of liver disease and prognosis. Furthermore, information on other indices measured with STE, such as left atrial and right ventricular strain, is promising but currently limited. This review aims to offer a critical assessment of the existing evidence concerning the application of STE in patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

This article compares the quantitative and functional changes in the left and right ventricles after the Ross procedure, a surgical treatment for aortic valve diseases, to conventional aortic valve surgery. The study enrolled 38 patients who underwent the Ross procedure and matched them with 19 patients who underwent conventional surgery. The results showed that there were no significant differences in left ventricle function and structure between the two procedures. However, the Ross procedure showed improved left ventricle global longitudinal strain three months after surgery. The right ventricle function was comparable between the two procedures, except for a temporary reduction immediately after the Ross procedure. The authors suggest that the improved left ventricle function may be due to the favorable hemodynamics of the autograft used in the Ross procedure. [Extracted from the article]

Background: Adverse left ventricular (LV) remodelling after myocardial infarction is associated with heart failure. We investigated whether aortic stiffness during acute ST‐segment elevation myocardial infarction is associated with LV remodelling at long‐term follow‐up. Methods: In 109 patients within 48 h of myocardial infarction post‐primary percutaneous coronary intervention and after 2 years, we measured: (a) carotid to femoral pulse wave velocity (PWV), (b) LV global longitudinal strain (GLS) and left atrial strain using speckle‐tracking echocardiography, (c) PWV/GLS ratio as a surrogate marker of ventricular‐arterial interaction, and (d) LV end‐diastolic and end‐systolic volumes. A > 15% decrease from the baseline in LV end‐systolic volume at 2‐year follow‐up was considered as a criterion of reverse LV remodelling. Results: Compared with baseline, all patients had reduced PWV, LV end‐diastolic and end‐systolic volumes while PWV/GLS, GLS and reservoir left atrial strain were improved (p <.05) after 2 years. Baseline values of PWV, GLS, PWV/GLS ratio and reservoir left atrial strain were associated with percentage change of LV end‐systolic volume at 2 years (p <.05). Multivariable analysis revealed that lower baseline values of PWV and a less impaired GLS and PWV/GLS were independently associated with reverse LV remodelling at 2 years with a C‐statistic of.748,.711 and.787, respectively. Conclusion: Aortic stiffness early post‐infarction determines LV remodelling after 2 years of the ischemic event despite post successful revascularization. Clinical Trial Registration‐URL: http://www.clinicaltrials.gov. Unique identifier: NCT03984123, 30/04/2020. [ABSTRACT FROM AUTHOR]

• The relationship between GDM and LV-GLS has been poorly investigated. • 10 studies assessing LV-GLS in GDM women were analyzed. • Average LV-GLS magnitude was significantly lower in GDM women than controls. • GDM was independently associated with LV-GLS impairment in pregnancy. • Pathophysiological mechanisms of GDM cardiac remodeling are discussed. The correlation between gestational diabetes mellitus (GDM) and subclinical myocardial dysfunction has been poorly investigated. Accordingly, we performed a meta-analysis to examine the influence of GDM on left ventricular (LV) global longitudinal strain (GLS), assessed by speckle tracking echocardiography (STE), during pregnancy. All echocardiographic studies assessing conventional echoDoppler parameters and LV-GLS in GDM women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. The subtotal and overall standardized mean differences (SMDs) of LV-GLS were calculated using the random-effect model. The full-texts of 10 studies with 1147 women with GDM and 7706 pregnant women without diabetes were analyzed. GDM women enrolled in the included studies were diagnosed with a small reduction in LV-GLS in comparison to controls (average value −19.4 ± 2.5 vs −21.8 ± 2.5 %, P < 0.001) and to the accepted reference values (more negative than −20 %). Substantial heterogeneity was detected for the included studies, with an overall statistic value I2 of 94.4 % (P < 0.001). Large SMDs were obtained for the included studies, with an overall SMD of −0.97 (95 %CI −1.32, −0.63, P < 0.001). Egger's test for a regression intercept gave a P-value of 0.99, indicating no publication bias. On meta-regression analysis, all moderators and/or potential confounders (age at pregnancy, BMI, systolic blood pressure and ethnicity) were not significantly associated with effect modification (all P < 0.05). GDM is independently associated with subclinical myocardial dysfunction in pregnancy. STE analysis allows to identify, among GDM women, those who might benefit of targeted non-pharmacological and/or pharmacological interventions, aimed at reducing the risk of developing type 2 diabetes and cardiovascular complications later in life. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the predictive value of left ventricular global longitudinal strain (GLS) and left atrial reservoir strain (LARS) on adverse events in chronic coronary artery disease (CAD) patients with reduced systolic function. Methods: A total of 192 consecutive patients clinically diagnosed with chronic CAD and left ventricular ejection fraction (LVEF) ≤ 50% were finally included. Multiple strain parameters were analyzed with speckle tracking echocardiography. The composite endpoint included all‐cause mortality, rehospitalization due to heart failure, myocardial infarction, and stroke. Results: Patients experiencing the endpoint showed lower LVEF, lower absolute GLS and LARS than those without events. Both GLS (AUC = 0.82 [GLS] vs. 0.58 [LVEF], p < 0.001) and LARS (AUC = 0.71 [LARS] vs. 0.58 [LVEF], p = 0.033) were superior to LVEF in predicting adverse events. Multivariate cox regression analysis showed that both GLS (hazard ratio, 0.71; 95% CI, 0.63–0.79; p < 0.001) and LARS (hazard ratio, 0.96; 95% CI, 0.93–0.98; p < 0.001) were independent predictors for the endpoint. The addition of LARS (global chi‐squared, 35.7 vs. 17.4; p < 0.05), GLS (global chi‐squared, 58.6 vs. 17.4; p < 0.05) or both LARS and GLS (global chi‐squared, 79.6 vs. 17.4; p < 0.05) to LVEF in the prediction model significantly improved its performance. The same significant improvement was also shown in the subgroups of mild (30% < LVEF ≤ 50%) and severe (LVEF ≤ 30%) reduced systolic function. Conclusions: Regarding CAD patients with reduced LVEF, both GLS and LARS are superior to LVEF in predicting adverse events, providing significant incremental value to LVEF. [ABSTRACT FROM AUTHOR]

The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography, and to assess the effect of sevoflurane on cardiac function. Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia (AS) group and a propofolbased total intravenous anesthesia (AA) group. The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1 (after harvesting all grafts and before coronary anastomosis) and T2 (30 min after completing all coronary anastomoses) (P < 0.05). Moreover, strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group, compared with the AA group at both T1 and T2 (P < 0.01). The flow of the left internal mammary artery-left anterior descending artery graft was superior, and the postoperative concentration of troponin T decreased rapidly in the AS group, compared with the AA group (P < 0.05). Compared with total intravenous anesthesia, sevoflurane resulted in a significantly higher global longitudinal strain, stroke volume, and cardiac output. Sevoflurane also led to an amelioration in the condition of the arterial graft. Furthermore, sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value. The findings need to be replicated in larger studies. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis published in the European Journal of Heart Failure found that relatives of patients with dilated cardiomyopathy (DCM) who test positive for the genetic mutation but do not show symptoms (GEN+ PHEN-) may still have subclinical left ventricular systolic dysfunction. The study analyzed data from seven studies and found that these relatives had worse left ventricular function compared to controls. The findings suggest that these individuals may have an increased risk of developing DCM, but more research is needed to understand the clinical implications and establish specific genotype-phenotype associations. [Extracted from the article]

The top cause of death around the world, cardiovascular disease is also the primary cause of death in India. In 2016, India anticipates a total of 62.5 million premature deaths due to cardiovascular disease. Aim: This research was conducted with the goals of (1) determining whether resting global longitudinal strain (GLS) correlates with angiographic severity in patients with coronary artery disease by using the GENSINI and SYNTAX scores; (2) evaluating the validity of using GLS to diagnose severe coronary artery disease; and (3) determining whether or not GLS can be used to diagnose severe coronary artery disease. It was anticipated that the study's findings would provide solutions to both problems." Materials & methods: To participate in the experiment, participants were required to either have coronary artery disease or a clinically comparable diagnosis. The study was conducted at the SCB Medical College and Hospital in Cuttack, which served as the location. Patients who had unstable angina, chronic stable angina, or myocardial infarction that did not involve ST-elevation were recruited to take part in the trial if they satisfied the inclusion criteria. The observational research method, known as cross-sectional research, was used for this study. One hundred and ten patients were evaluated for coronary artery disease as a potential diagnosis. Patients eligible to take part in the trial, defined as those who satisfied the inclusion criteria and made an appointment with a cardiologist at SCB Medical College and Hospital between August 2020 and December 2021, were allowed to do so. Conclusion: When evaluated during rest using 2D speckle tracking echocardiography, GLS reliably predicts the prevalence, severity, and degree of CAD. This test has a very high sensitivity and specificity. GLS has an early detection rate of 88.89% specificity and 84.62% sensitivity for severe CAD. The well-known SYNTAX and GENSINI scores show a linear but negative relationship between CAD complexity and GLS. 2-D-STE can improve echocardiography for the diagnosis of CAD by identifying high-risk individuals and providing the treating physician with more information. When the pretest chance of coronary artery disease is low, strain imaging can reveal significant illness in the heart's arteries. This is especially true during the entirety of the examination. [ABSTRACT FROM AUTHOR]

Objectives: In our study, we aimed to investigate the correlation between reduction in global longitudinal strain value and severity of coronary artery disease in Non-ST-Elevation Myocardial Infarction (NSTEMI) patients. Materials and Methods: Patients admitted with NSTEMI were underwent 2D echocardiography to evaluate LV global longitudinal strain and coronary angiography to evaluate severity of CAD. Data analysis was done to investigate the correlation between global longitudinal strain and severity of CAD. Results: In the present study we were able to demonstrate the correlation between reduction in global longitudinal strain value and severity of coronary artery disease in Non-ST-Elevation Myocardial Infarction (NSTEMI) patients. As the number of coronary arteries involved increases LVGLS reduces. Conclusions: 2D echocardiographic Global longitudinal strain can be used in initial diagnostic workup for early identification and revascularization of NSTEMI patients with severe CAD. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work was assessment of sepsis induced cardiac dysfunction (SIMD) in neonates with sepsis by 2-dimensional speckle tracking echocardiography, tissue Doppler as well as other conventional echocardiographic methods and its correlation with serum procalcitonin (PCT) and, cardiac troponin -T (cTnT). Methods: This study was prospective controlled cohort study that included 60 neonates with diagnosis of neonatal sepsis compared to 60 healthy newborns who were matching in age and sex. both groups was subjected to basic and advanced transthoracic echocardiography and some lab markers in order to assess sepsis induced cardiac dysfunction, and correlates the findings with serum procalcitonin, cardiac troponin -T. Results: Out of the enrolled 60 patients and 60 controls. Mean age of cases was 16.62±4.74 days and 14.85±5.88 days for controls. blood culture was positive in 48.3%; 65.5% was gram positive and 34.4% was gram negative, Median Procalcitonin among cases was 5.20 ng/ml compared to 0.22 among controls, median cTnT among cases was 0.27 compared to 0.03 among controls, LVGLS was -10.79±1.47 among cases vs -14.68±1.13 among controls, P value <0.001. mean EF was 46.03±6.93 among cases versus 62.58±5.69 among controls, P value <0.001, There was significant positive correlation between left ventricular global longitudinal strain (LV GLS) and PCT and cTnT levels. Conclusion. PCT is good markers of neonatal sepsis. cTnT is a good laboratory indicator for cardiac affection in neonatal sepsis. speckle tracking echocardiography is a promising tool in assessment of cardiac function PCT and cTnT were correlated with both LV and RV systolic dysfunction detected by tissue Doppler imaging (TDI) and STE, SIMD is very common comorbidity in neonatal sepsis, [ABSTRACT FROM AUTHOR]

Background: Hereditary transthyretin amyloidosis is a rare disease caused by transthyretin (TTR) gene mutations. The aim of our study was to identify early signs of cardiac involvement in patients with a TTR gene mutation in order to differentiate carriers from patients with neurological or cardiac disease. Methods: A case–control study was carried out on 31 subjects with the TTR mutation. Patients were divided into three groups: 23% with cardiac amyloidosis and polyneuropathy (group A), 42% with only polyneuropathy (group B) and 35% carriers (group C). Speckle-tracking echocardiography (left-ventricular global longitudinal strain—GLS, atrial stiffness) was performed in all patients. The apical/basal longitudinal strain ratio (SAB) and relative apical sparing (RAS) were assessed in all subjects. Results: Analyzing groups C and B, we only found a significant difference in the SAB (p-value 0.001) and RAS (p-value 0.039). These parameters were significantly more impaired in group A compared to group B (SAB p-value 0.008; RAS p-value 0.002). Also, atrial stiffness was significantly impaired in groups A and B compared to group C. Conclusions: Our study suggests the diagnostic role of the SAB and RAS in cardiac amyloidosis. The SAB and RAS showed a gradual increase from carriers to patients with neurological and cardiac diseases. Thus, these parameters, in addition to atrial stiffness, could be used to monitor carriers. More extensive data are needed. [ABSTRACT FROM AUTHOR]

Background: Initiation of dialysis encompasses new cardiovascular challenges on patients with end-stage renal disease (ESRD). This study used two-dimensional speckle-tracking echocardiography (2D-STE) to investigate the change of left ventricular (LV) myocardial function undergoing peritoneal dialysis (PD) within 1-3 months. Methods: A total of 56 patients with ESRD and 27 healthy controls were enrolled in this prospective study. Mean duration of PD was 44.41 ± 16.44 days. We evaluated LV myocardial function of patients with ESRD in baseline and within 1-3 months after PD by 2D-STE with global longitudinal strains (GLS) and myocardial work (MW). Based on the level of serum phosphate before PD, patients were divided into two groups: the group with normal serum phosphate or hyperphosphatemia. Results: Compared with healthy controls, patients with ESRD had impaired GLS (p < .001) and increased global work index (GWI) (p = .034), global constructive work (GCW) (p < .001), global wasted work (GWW) (p < .001), and lower global work efficiency (GWE) (p = .002). After PD therapy, GWI (p = .001), GCW (p < .001), and GWW (p = .023) decreased and closed to healthy subjects (p > .05) and no significant improvement was observed in GLS (p = .387). GLS of basal segments worsened in the hyperphosphatemia group (p = .005) and GWW reduced remarkably in the group with normal serum phosphate after PD treatment (p = .008). The change of left ventricular internal diameter in diastole (LVIDd) was the only parameter influenced GWI in post-dialysis patients (β = 0.324, p = .013). Conclusions: Short-term PD treatment improved LV MW in ESRD patients. They benefited more when receiving treatment before the increase of serum phosphorus. [ABSTRACT FROM AUTHOR]

The reproducibility of longitudinal strain measured by 2D speckle tracking echocardiography (2DSTE) may be affected by ultrasound settings. This study investigated the effect of transmit ultrasound frequency on global longitudinal strain (GLS) by 2DSTE. Apical, 2- and 4-chamber, and long-axis views were obtained in consecutive 162 patients using Philips ultrasound devices. Three different frequency presets were used sequentially: high resolution (HRES, 1.9 to 2.1 MHz), general (HGEN, 1.6 to 1.8 MHz), and penetration mode (HPEN, 1.3 to 1.6 MHz). GLS values were determined for each preset using the Philips Q-station software, resulting in GLS-HRES, GLS-HGEN, and GLS-HPEN. Among the 151 patients with successfully measured GLS, a significant difference in GLS was observed among the three presets (p < 0.0001). GLS-HRES (− 17.9 ± 4.4%) showed a slightly smaller magnitude compared to GLS-HGEN (− 18.8 ± 4.5%, p < 0.0001) and GLS-HPEN (− 18.8 ± 4.5%, p < 0.0001), with absolute differences of 1.1 ± 1.0% and 1.1 ± 1.2%, respectively. This variation in GLS with frequency was evident in patients with both optimal (n = 104) and suboptimal (n = 47) image quality and remained consistent regardless of ultrasound devices, ischemic etiology, or ejection fraction. In conclusion, ultrasound frequency had only a modest effect on GLS measurements. GLS may be reliably assessed in most cases regardless of the ultrasound frequency used. [ABSTRACT FROM AUTHOR]

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors have demonstrated to reduce cardiovascular risk in patients with type 2 diabetes mellitus (T2DM) in large trials independent of glycemic control. The mechanisms of this cardioprotective property remain uncertain. Evidence suggests positive hemodynamic changes and favorable cardiac remodeling contributing to the clinical outcomes but results were conflicting. We aim to investigate the potential impact on hemodynamic parameters, cardiac structure and functions. This prospective observational study included T2DM patients receiving canagliflozin 100 mg per day in addition to their antidiabetic treatment. We analyzed hemodynamic parameters assessed by echocardiographic measurements and impedance cardiography (ICG) to evaluate systolic and diastolic functions from baseline to 24 weeks after treatment. A total of 47 patients (25 males and 22 females) averaging 64.6 ± 10.9 years had a significant reduction in HbA1c, body weight, and systolic blood pressure. Hematocrit increased significantly, while NT-proBNP remained unchanged. E/e′, left atrium (LA) volume, and LA stiffness were reduced, while left ventricle (LV) global longitudinal strain (GLS) and LA strain rates increased at 24 weeks by conventional and speckle tracking echocardiography. LV mass and ejection fraction showed no differences. ICG suggested significant improvement in hemodynamic parameters with increased stroke volume index and cardiac output index and decreased systemic vascular resistance index at 12 and 24 weeks. Canagliflozin improved hemodynamic parameters and had a favorable impact on LA and LV reverse remodeling. These changes may explain the beneficial effect on cardiovascular outcomes in large clinical trials. [ABSTRACT FROM AUTHOR]

Background: Mitral regurgitation (MR) is a common heart valve disease, causing many serious complications in several organ systems, especially the cardiovascular system. The 2D speckle tracking echocardiography (STE) is a new technique for detecting potential cardiac dysfunction when only tissue function abnormalities are present. The study aimed to assess left ventricular (LV) systolic function early by STE in patients with primary MR through global LV deformity along the global longitudinal strain (GLS). Methods: An analytical cross-sectional study was performed on 46 patients with moderate to severe primary MR as recommended by the American Society of Echocardiography (ASE) 2017. Results: The prevalence of patients with GLS reduction with ejection fraction (EF) >60%, New York Heart Association (NYHA) I, and left ventricular internal diameter systolic (LVIDs) <40 mm was 38.1%, 35.7%, and 39.5%, respectively. 100% of patients with EF<60% and LVIDs ≥40 mm had reduced GLS (<16%). The GLS index strongly correlates with the NYHA classification, degree of MR, EF, and echocardiographic parameters. Conclusion: GLS index gives a significant sign in the early detection of cardiac function abnormalities before symptoms or other echocardiographic parameters in patients with MR [ABSTRACT FROM AUTHOR]

Background: The new criteria of Cirrhotic Cardiomyopathy Consortium (CCC) propose the use of left ventricular global longitudinal strain (LV‐GLS) for evaluation of systolic function in patients with cirrhosis. The aim of this study was to evaluate LV‐GLS and left atrial (LA) strain in association with the severity of liver disease and to assess the characteristics of cirrhotic cardiomyopathy (CCM). Methods: One hundred and thirty‐five cirrhotic patients were included. Standard echocardiography and speckle tracking echocardiography (2D‐STE) were performed, and dual X‐ray absorptiometry was used to quantify the total and regional fat mass. CCM was defined, based on the criteria of CCC, as having advanced diastolic dysfunction, left ventricular ejection fraction ≤50% and/or a GLS <18%. Results: LV‐GLS lower or higher than the absolute mean value (22.7%) was not associated with mortality (logrank, p = 0.96). LV‐GLS was higher in patients with Model for end stage liver disease (MELD) score ≥15 compared to MELD score <15 (p = 0.004). MELD score was the only factor independently associated with systolic function (LV‐GLS <22.7% vs. ≥22.7%) (Odds Ratio:1.141, p = 0.032). Patients with CCM (n = 11) had higher values of estimated volume of visceral adipose tissue compared with patients without CCM (median: 735 vs. 641 cm3, p = 0.039). On multivariable Cox regression analysis, MELD score [Hazard Ratio (HR):1.26, p < 0.001] and LA reservoir strain (HR:0.96, p = 0.017) were the only factors independently associated with the outcome. Conclusion: In our study, absolute LV‐GLS was higher in more severe liver disease, and LA reservoir strain was significantly associated with the outcome in patients with end‐stage liver disease. [ABSTRACT FROM AUTHOR]

Objective: Pulmonary arterial hypertension (PAH) means high blood pressure in the lungs. We aimed to observe the right ventricular size, wall thickness and characteristic functional changes and their associations with PAH in an established model of beagle dogs, and to explore convenient, reliable and sensitive ultrasound indicators for assessing right ventricular remodeling. Methods: Twenty healthy beagle dogs (8-10 kg) were randomly divided into control group (N-dimethylformamide, n = 10) and dehydromonocrotaline (DHMCT) group (DHMCT, n = 10). N-dimethylformamide or DHMCT was injected through a catheter into the right atrium, and then right heart catheterization, routine echocardiography and two-dimensional speckle tracking imaging (2D-STI) were performed before modeling (0 weeks) and 8, 14 weeks after modeling. Hemodynamic parameters and right ventricular function-related ultrasound data were acquired. At the end of the experiment, the animals were killed and the lung tissues were taken for HE staining. Left and right ventricular walls were separated and weighed respectively, and right ventricular hypertrophy index (RVHI) was measured. The associations of the routine ultrasound data and 2D-STI data at each time point with hemodynamic parameters and RVHI were analyzed. Results: At 0, 8 and 14 weeks, gradual decreases in the right ventricular global longitudinal strain (RVLS) were found in DHMCT group. RVH occurred in DHMCT group, and DHMCT group had a significantly higher RVHI than that of control group (49.83 ± 4.83% vs. 39.80 ± 1.40%, P < .001) and larger pulmonary artery media thickness. RVLS had significant positive correlations with RVSP (r = 0.74, P < .001), mRVP (r = 0.72, P < .001), PASP (r = 0.75, P < .001), mPAP (r = 0.72, P < .001) and PVR (r = 0.68, P < .001). There was a significant positive correlation between RVLS and RVHI (r = 0.74, P < .001). Conclusion: The right ventricular function in PAH can be effectively assessed by echocardiography, and RVLS measured by 2D-STI sensitively reflects right ventricular remodeling following PAH. [ABSTRACT FROM AUTHOR]

The optimal surveillance and management strategies for breast cancer patients receiving anthracycline therapy are limited by our incomplete understanding of the role of biomarkers heralding the onset of cardiotoxicity. The purpose of this study was to determine whether there is a temporal correlation between cardiac biomarkers and subclinical left ventricular dysfunction in breast cancer patients receiving anthracycline chemotherapy. Thirty-one females between 46 and 55 years old with breast cancer treated with anthracycline chemotherapy were prospectively enrolled. Cardiac biomarkers were correlated with echocardiography with speckle tracking at baseline, post-anthracycline therapy, and 6 months post-anthracycline chemotherapy. Subclinical cardiotoxicity was defined as ≥ 10% reduction in global longitudinal strain (GLS). There was a relative reduction in left ventricular ejection fraction (LVEF) ≥ 10% in 5/30 (17%) and 7/27 (26%) patients post-anthracycline therapy and 6 months post-anthracycline therapy, respectively. Subclinical cardiotoxicity was noted in 8/30 (27%) and 10/26 (38%) patients post-anthracycline and 6 months post-anthracycline therapy, respectively. Baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) was the strongest predictor of LVEF (ρ = −0.45; p = 0.019), with post-therapy NT-proBNP values illustrating similar predictive value (ρ = −0.40; p = 0.038). Interim changes in suppression of tumorigenicity 2 (ST2) and galectin-3 correlated with a 6-month change in LVEF (ρ = −0.48; p = 0.012 and ρ = −0.45; p = 0.018, for ST2 and galectin-3, respectively). Changes in galectin-3 from baseline to mid-therapy paralleled changes in GLS. NT-proBNP, ST2, and galectin-3 correlate with reduced LVEF among breast cancer patients receiving anthracycline therapy. Additional trials focusing on a cardiac biomarker approach may provide guidance in the early diagnosis and management of anthracycline-induced cardiotoxicity. [ABSTRACT FROM AUTHOR]

Left ventricular global longitudinal strain (GLS) has an important role in the diagnosis of cancer therapy-related cardiac dysfunction (CTRCD). Little is known about the role of atrial function in diagnosing CTRCD. The aim of our study was to assess the impact of anti-cancer drugs on atrial function measured by speckle-tracking echocardiography in breast cancer women. A prospective multicenter study was conducted enrolling 169 breast cancer women treated with anthracyclines. A cardiological evaluation including an electrocardiogram and echocardiogram with an analysis of GLS, left atrial (LA) strain, and LA stiffness (LASi) was performed at baseline (T0), 3 (T1), and 6 months (T2) after starting chemotherapy. The patients were divided into two groups: patients with asymptomatic mild cardiotoxicity at T1 (with a relative reduction in GLS > 15%; Group 1) and those without (Group 2). We did not find a significant change in left ventricular ejection fraction (LVEF) at T1 and T2; we found a significant change in GLS (p-value < 0.0001) in the peak atrial longitudinal strain (PALS) and in LASi (p-value < 0.0001). Impairment of atrial function was greater in Group 1 compared to Group 2. A PALS variation > 20.8% identified patients who were most likely to develop asymptomatic mild cardiotoxicity [AUC 0.62; CI (0.51–0.73) p = 0.06, sensitivity 45%, specificity 69.5%]. Conclusions: PALS and LASi significantly change during chemotherapy in association with GLS. Atrial strain is an additional parameter that could be measured together with GLS to detect cardiotoxicity early. [ABSTRACT FROM AUTHOR]

Background and Objective: Recently, the antidiabetic drug sodium-glucose cotransporter type 2 inhibitor (SGLT2i) has been approved among the drugs that reduce mortality in patients with Heart failure with reduced ejection fraction (HFrEF). The impact of SGLT2i inhibitors on the left ventricle longitudinal myocardial function in heart failure (HF) patients remained vague. The effect of SGLT2i on left ventricular remodeling and function in patients with HFrEF was studied using speckle tracking (STE) and traditional echocardiography. Objectives: Studying the effects of SGLT2i on left ventricular remodeling and function in HFrEF patients using STE and traditional echocardiography. Methods:. 300 patients with HFrEF were included. Study design: This prospective observational study involves 300 patients with HFrEFadministered SGLT2i (Empagliflozin and Dapagliflozin) and the classical treatment of heart failure. Then the patients were examined 2, 4, and 6 months after treatment with laboratory investigations of baseline glycosylated hemoglobin (HbA1C), glomerular filtration rate (eGFR), 2D echo, and STE studies. Results: The mean age was 50±9.2 for males and females. The mean weight, height, and body mass index (BMI) were 85.6±8.8 kg, 178.6±7.2 cm, and 26.6±2.9, respectively. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 115.3±5.1 and 75.4±4.5, respectively. The mean heart rate was 79.9±10.2. The mean respiratory rate was15±2.2. Regarding functional NYHA class, 0.2 %, 12%, 87.1%, and 0.7% of the patients were in class I, II, III, and IV, respectively. The lab investigations before the treatment: mean HbA1C was 4.2±0.6, and eGFR was 66.4±9.3. Using Empagliflozin, left ventricular ejection fraction (LVEF) showed a significant improvement from 34.73±2.9 at baseline to 34.91±1.2, 35.42±3.5, and 36.54±3.6 at 2, 4, and 6 months (p=0.001), respectively. In addition, Global longitudinal strain GLS showed a remarkable enhancement from -15.67±2.74 to -16.5±3.19, - 17.32±3.21, -18.03±3.05 at 2, 4, and 6 months (p=0.001), respectively as indicated by GLS A2. While GLS A4 indicated that GLS was changed from -15.66±2.65 to -16.50±3.31, - 17.41±3.23, and -17.93±3.32 (p=0.001). By Employing Dapagliflozin, LVEF showed significant improvement from 34.87±2.86 at baseline to 34.87±2.86, 35.05±3.01, and 37.53±4.1 at 2, 4, and 6 months (p=0.001), respectively. GLS showed a remarkable improvement similar to the improvement observed with Empagliflozin. E/e' significantly reduced from 11.2±2.7 to 9.1±2.3 cm/s after administration of Empagliflozin and Dapagliflozin within 6 months (p=0.01). Left atrial volume index (LAVI) improved from 45.6 ± 15.3 to 37.5 ±6.5 (ml/m2) (p=0.001) after 6 months. The results revealed a significant increase of ejection fraction at 4 and 6 months of follow-up and a significant improvement of global longitudinal strain at 2, 4, and 6 months with patients given SGLT2i. Conclusion: SGLT2i was associated with improving left ventricular (LV) longitudinal myocardial function, further enhancing LV diastolic function. SGLT2i is associated with increased ejection fraction (EF) and LV longitudinal myocardial function improvement, subsequently ameliorating LV diastolic function. The Dapa group had a more significant improvement in LVEF at four months and six months compared to the Empa group. The Empa group showed a significant improvement in HbA1C at six months compared to the Dapa group. [ABSTRACT FROM AUTHOR]

Background: Psychosocial stress has been associated with the development and progression of atherosclerotic cardiovascular disease (CVD). Previously, we reported subtle differences in global longitudinal strain in somatically healthy women with a psychiatric diagnosis of borderline personality disorder (BPD). This study aimed to investigate the impact of BPD on segmental myocardial wall motion using speckle tracking echocardiography (STE) analysis. Methods: A total of 100 women aged between 18 and 38 years were included in this study. Fifty patients meeting the diagnostic criteria for BPD were recruited from the Department of Psychiatry (LWL-University Hospital Bochum) and compared with fifty age-matched healthy control subjects without previous cardiac disease. Laboratory tests and STE were performed with segmental wall motion analysis. Results: The BPD group had a higher prevalence of risk factors for CVD, with smoking and obesity being predominant, when compared with the control group. Other cardiovascular parameters such as blood pressure, glucose, and cholesterol levels were also elevated, even though not to pathological values. Moreover, in the STE analysis, the BPD group consistently exhibited decreased deformation in nine myocardial wall regions compared with the control group, along with a shift toward higher values in the distribution of peak pathological segments. Additionally, significantly higher values of free thyroxine concentration and thyroid's secretory capacity were observed in the BPD group, despite falling within the (high-) normal range. Conclusions: BPD is associated with chronic stress, classical risk factors, and myocardial wall motion abnormalities. Further exploration is warranted to investigate the relationship between high-normal thyroid metabolism, these risk factors, and myocardial function in BPD patients. Long-term follow-up studies would be valuable in confirming the potential for predicting adverse events. [ABSTRACT FROM AUTHOR]

Aims: Long term survivors of haematopoietic stem cell transplantation (HSCT) for β-thalassemia major are designated "ex-thalassaemics". Whether ex-thalassaemics continue to harbour residual myocardial dysfunction and thereby stand the risk of heart failure-related morbidity and mortality is unknown. The aim of this study was to assess the prevalence and predictors of subclinical left ventricular (LV) dysfunction in an apparently normal ex-thalassaemic population. Methods: We conducted a single centre cross-sectional study among 62 ex-thalassaemic patients, who had undergone HSCT for β-thalassaemia major at our centre. The primary outcome variable was LV systolic dysfunction, as assessed by 1) LV global longitudinal strain (GLS) derived by 2D speckle tracking echocardiography and 2) LV ejection fraction (EF) derived by 2D Simpsons Biplane method. Results: Among the 62 patients included in the study, 7 [11.3%] were found to have LV systolic dysfunction, all of which were subclinical. Of these, 4 [6.5%] had abnormal GLS and LVEF, 2 [3.2%] had abnormal GLS with normal LVEF, and 1 [1.6%] had abnormal LVEF with low normal mean GLS. There were no statistically significant predictors of LV dysfunction in this cohort. Conclusion: There was a high prevalence of subclinical myocardial dysfunction in the ex-thalassaemic population reiterating the need for close follow up of these patients. 2D Speckle tracking echocardiography-derived LV global longitudinal strain is an effective tool in detecting subclinical myocardial dysfunction in this cohort. [ABSTRACT FROM AUTHOR]

Global longitudinal strain (GLS) is a valuable indicator of subclinical myocardial dysfunction. Whether the effect of aging on subclinical left ventricular dysfunction is sex-specific is not well documented. This study aimed to identify age-related changes in GLS according to sex in patients with a normal left ventricular ejection fraction (LVEF). In this cross-sectional, single-center cohort study in Korea, participants who underwent GLS measurement using 2D speckle-tracking echocardiography were retrospectively reviewed, and participants with normal LVEF (≥ 55%) without documented cardiovascular disease were included. Reduced GLS was defined as absolute values below 18%. Of 682 study participants (mean age, 58; female, 51.5%), 209 (30.6%) had reduced GLS. Females with reduced GLS were older than those with normal GLS (68 vs. 58 years, P < 0.001); with no difference of age in males (55 vs. 57 years; P = 0.265). Univariate analysis showed age to correlate significantly with reduced GLS only in female (r = − 0.364; P < 0.001). In multivariable analysis, female > 66 years old had significantly higher risk of reduced GLS (Odds ratio 2.66; 95% CI 1.22–5.76; P = 0.014). In participants with normal LVEF, GLS decreased with age in females but not in males. Particularly, females aged 66 years and older had a significantly higher risk of reduced GLS. These findings suggest that GLS could be a valuable parameter for assessing subclinical cardiac dysfunction, especially in older females. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the role of speckle-tracking echocardiography to identify myocardial deformation in acute rheumatic fever. Methods: Twenty-seven patients and 27 healthy children were prospectively evaluated. The patient group was divided into 2 subgroups based on echocardiographic findings, with or without carditis. The left ventricular global longitudinal strain and strain rate, left ventricular global circumferential strain and strain rate, and right ventricular global longitudinal strain and strain rate were assessed by speckle-tracking echocardiography. Results: In the acute phase of the disease, all values except the right ventricular global longitudinal strain were found to be significantly below the control group in the patient cohort. No significant difference was found between the patients grouped as carditis and non-carditis in the acute period. Comparison of the acute period with the post-treatment period revealed a significant increase in all strain values of the patients with carditis and significant increases observed in all values except left ventricular global longitudinal strain rate, left ventricular global circumferential strain rate, and right ventricular global longitudinal strain rate values in patients without carditis. Apart from the right ventricular global longitudinal strain rate, which was significantly lower in the non-carditis group compared to the control group, there was no significant difference in strain values between the patient and control groups following treatment. Conclusion: In the present study, we found that all patients, including patients in whom no valvular involvement was detected by echocardiography in the acute phase of acute rheumatic fever, had a lower right and left ventricular strain and strain rate measurements and that these findings improved after treatment, suggesting that strain echocardiography may be a helpful diagnostic method, especially in patients without valvular involvement. [ABSTRACT FROM AUTHOR]

Objective: In recent years, coronavirus disease-2019 (COVID-19) has been the primary health problem and because of the virus affinity to endothelial cells, it has become an important reason of vascular problems and cardiac injury. After mild COVID-19 infection, patients frequently attend cardiology clinics with cardiac symptoms and their primary cardiac tests are mostly normal. In this study we aimed to analyze if two-dimensional speckle tracking echocardiography shows any difference between symptomatic and asymptomatic post-COVID- 19 patients when transthoracic echocardiography parameters are normal. Material and Methods: In this retrospective single center study, 2,741 transthoracic echocardiography records were assessed and 108 post-COVID-19 patients were detected and divided into symptomatic and asymptomatic patient groups and left ventricular global longitudinal strain (LV-GLS) values were compared. Results: The number of patients with normal LV-GLS values were equal in the groups and there were 4 patients whose values were borderline in the asymptomatic group, while there was none in the symptomatic group. The number of patients with impaired GLS values in the symptomatic group were higher than the asymptomatic group (15 vs 4 patients) and the difference was statistically different (p=0.008). The average LV-GLS values were -18.88±2.50 in the asymptomatic group and -17.40±3.68 in symptomatic group but the difference was not statistically significant (p=0.098). Conclusion: More symptomatic patients than the asymptomatic ones have impaired LV-GLS values according to the results of this study. Even if it is not statistically significant, the mean LV-GLS values are also reduced in symptomatic patients after mild COVID-19 infection. [ABSTRACT FROM AUTHOR]

Background: Acute stroke is an important cause of morbidity and mortality. Myocardial injury is an important complication of acute cerebrovascular events. Neurogenic stress cardiomyopathy (NSC) is a condition of acute myocardial systolic dysfunction that can be observed after acute cerebrovascular events. Objective: In this study, we aimed to investigate the relationship between myocardial function assessed by two-dimensional speckle-tracking echocardiography and National Institutes of Health Stroke Scale (NIHSS) score in patients with acute ischemic stroke. Materials and Methods: This cross-sectional study screened 97 patients (males, 42; females, 55; 65 ± 16 years) with acute ischemic stroke. Around 17 patients were excluded and 80 patients were studied. Patients were divided into two groups based on the calculated NIHSS score (Group 1, NIHSS score <16; Group 2, NIHSS score =16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac function was evaluated by two-dimensional speckle tracking echocardiography within 48 h of admission to the neurology care unit. Results: There were no significant differences in the demographic parameters of patients. The absolute value of global longitudinal systolic strain (GLS) was significantly higher in Group 1 patients than in Group 2 patients (21.4 ± 2.2 vs 15.9 ± 2.7, P = 0.0281). We found that thirteen patients (22%) had normal LVEF and abnormal LV GLS in Group 1 (P = 0.036). Eight patients (36%) had normal LVEF and abnormal LV GLS in Group 2 (P = 0.042). E/e', QT on ECG, and serum troponin levels were significantly higher in Group 2 patients than in Group 1 patients (P < 0.05). Conclusions: Our results suggest that GLS is associated with stroke severity on admission in patients with acute ischemic stroke. GLS is an indicator of myocardial deformation with a different from LVEF. GLS can detect early myocardial dysfunction despite preserved LVEF. [ABSTRACT FROM AUTHOR]

Re: Correspondence on 'Fetal myocardial deformation measured with two-dimensional speckle-tracking echocardiography: longitudinal prospective cohort study of 124 healthy fetuses' I read with interest the Reply by de Vet I et al i . to my previous correspondence regarding the Original Paper by van Oostrum I et al i .[[1], [3]]. Our LV-GLS values were comparable to the values of Li I et al i . between 20 and 27 weeks, and our RV-GLS values were comparable to the values of Erickson I et al i .'[[5]]. [Extracted from the article]

Pediatric hemato-oncology patients undergoing anthracycline therapy are at risk of cardiotoxicity, with disease type and treatment intensity potentially affecting cardiac function. Novel echocardiographic measures like speckle tracking echocardiography (STE), global longitudinal strain (GLS), and the myocardial performance index (MPI) may predict early changes in cardiac function not detected by traditional methods. This study aimed to assess the impact of cancer type and treatment protocol on these parameters and their potential in predicting long-term cardiac complications. We conducted a single-center, retrospective cohort study of 99 pediatric oncology patients and 46 controls that were assessed at 3, 6, and 12 months. The median age was 10.7 ± 4.4 years for cases and 10.2 ± 3.6 years for controls. STE, GLS, and MPI were measured, and statistical analyses were performed to determine any significant correlations with cardiotoxicity. Significant variations were observed in traditional cardiac function measurements between the patient and control groups, with a lower average ejection fraction (EF) of 62.8 ± 5.7% in patients vs. 66.4 ± 6.1% in controls (p < 0.001), poorer GLS of −16.3 ± 5.1 in patients compared to −19.0 ± 5.4 in controls (p = 0.004), and higher MPI values of 0.37 ± 0.06 in patients compared to 0.55 ± 0.10 in controls, indicating worse overall cardiac function (p < 0.001). However, differences in cardiac function measurements by cancer histology or treatment protocol were not statistically significant. Regression analyses showed that the combination of GLS, SMOD, and MPI increased the odds of cardiac toxicity with an odds ratio of 7.30 (95% CI: 2.65–12.81, p < 0.001). The study underscores the predictive value of the combined GLS, SMOD, and MPI measurements in pediatric oncology patients undergoing anthracycline treatment for cardiotoxicity. Although variations across cancer types and treatment protocols were not significant, the study emphasizes the potential utility of these novel echocardiographic measures in early detection and long-term prediction of anthracycline-induced cardiotoxicity. Further studies in larger, multi-center cohorts are required for validation. [ABSTRACT FROM AUTHOR]

Wolf-Parkinson-White (WPW) accessory pathway (AP) may be associated with reentry supraventricular tachycardia (SVT) in addition to ventricular dyssynchrony and cardiac dysfunction. Electrophysiological studies (EPS) are the gold standard for the localization of the AP; however, 2D speckle-tracking echocardiography (2D-STE) may help in the localization of the AP noninvasively. Our study aims to evaluate the capability of 2D-STE for AP localization and the identification of AP-related contractile abnormalities and dyssynchrony in pediatric patients with WPW syndrome. This prospective multicenter cohort study involved 18 pediatric patients with ventricular preexcitation from January 2021 to January 2023. Tissue Doppler imaging (TDI), conventional echocardiography, and 2D-STE were done. Myocardial velocities, myocardial performance index (MPI), the global and segmental longitudinal strain of the left ventricle (LV), and time-to-peak longitudinal strain (TPLS) were measured before and after ablation. The longitudinal strain of the LV segments supplied by the AP, or the nearby segments close to the AP, was significantly impaired and improved after ablation (P = 0.0001). The abnormal strain pattern in the affected segments could predict the location of the AP. The TPLS of the affected segments significantly increased after ablation (P = 0.0001), denoting improved dyssynchrony. The ejection time and the LV MPI measured at the basal septum improved significantly after ablation. Conclusions: 2D STE may be used for noninvasive localization of the AP and to evaluate cardiac function and dyssynchrony in patients with WPW. Further research on more patients is necessary to validate this method for AP localization. What is Known: • Accessory pathways (AP) associated with the Wolf-Parkinson-White (WPW) syndrome have been linked to supraventricular tachycardia (SVT). Even without SVT, WPW can cause left ventricular dyssynchrony, contractile dysfunction, and cardiomyopathy. • Electrophysiology study is the gold standard for the localization of the AP in WPW syndrome. What is New: • The combination of 2D-speckle-tracking echocardiography (2D-STE) and the modified Arruda algorithm can precisely localize the AP associated with WPW syndrome. • 2D-STE can potentially assess cardiac function and dyssynchrony related to WPW syndrome. Additionally, 2D-STE can be utilized to evaluate the effectiveness of ablation in restoring cardiac function and dyssynchrony. [ABSTRACT FROM AUTHOR]

Aims/Introduction: The triglyceride‐glucose (TyG) index is a simple and reliable indicator of insulin resistance, and is associated with the development and poor outcomes of cardiovascular disease. Subclinical left ventricular dysfunction (SLVD) is frequently detected in approximately one‐third of diabetes patients, but it has not been established whether the TyG index correlates with SLVD. We carried out this research to evaluate the relationship between the TyG index and SLVD in type 2 diabetes mellitus patients. Materials and Methods: This was a cross‐sectional and observational study of 183 type 2 diabetes mellitus inpatients at Nanjing Drum Tower Hospital, Nanjing, China. The TyG index and homeostasis model assessment 2 estimates for insulin resistance (HOMA2‐IR) were calculated from biochemical measurements, and speckle‐tracking echocardiography was carried out. According to global longitudinal strain (GLS) by echocardiography, participants were categorized into the SLVD (GLS <18%) group or the non‐SLVD (GLS ≥18%) group. Results: In comparison with non‐SLVD participants, SLVD participants had higher insulin resistance, as reflected by elevated TyG and HOMA2‐IR indices, as well as a higher body mass index, waist circumference and triglyceride level (P < 0.05 for each). When grouped by TyG index tertiles, an elevated TyG index was correlated with other cardiometabolic risk factors, as well as a decrease in GLS. In the multivariate logistic regression analyses, the TyG index was an independent risk factor for SLVD in type 2 diabetes mellitus patients (odds ratio 2.047, 95% confidence interval 1.07–3.914, P = 0.03), whereas HOMA2‐IR was not. Conclusions: The TyG index is independently associated with SLVD in type 2 diabetes mellitus patients and is a more reliable indicator of SLVD than HOMA2‐IR. [ABSTRACT FROM AUTHOR]

Background: Conventional approach to myocardial strain analysis relies on a software designed for the left ventricle (LV) which is complex and time-consuming and is not specific for right ventricular (RV) and left atrial (LA) assessment. This study compared this conventional manual approach to strain evaluation with a novel semi-automatic analysis of myocardial strain, which is also chamber-specific. Methods: Two experienced observers used the AutoStrain software and manual QLab analysis to measure the LV, RV and LA strains in 152 healthy volunteers. Fifty cases were randomly selected for timing evaluation. Results: No significant differences in LV global longitudinal strain (LVGLS) were observed between the two methods (-21.0% ± 2.5% vs. -20.8% ± 2.4%, p = 0.230). Conversely, RV longitudinal free wall strain (RVFWS) and LA longitudinal strain during the reservoir phase (LASr) measured by the semi-automatic software differed from the manual analysis (RVFWS: -26.4% ± 4.8% vs. -31.3% ± 5.8%, p < 0.001; LAS: 48.0% ± 10.0% vs. 37.6% ± 9.9%, p < 0.001). Bland–Altman analysis showed a mean error of 0.1%, 4.9%, and 10.5% for LVGLS, RVFWS, and LASr, respectively, with limits of agreement of -2.9,2.6%, -8.1,17.9%, and -12.3,33.3%, respectively. The semi-automatic method had a significantly shorter strain analysis time compared with the manual method. Conclusions: The novel semi-automatic strain analysis has the potential to improve efficiency in measurement of longitudinal myocardial strain. It shows good agreement with manual analysis for LV strain measurement. [ABSTRACT FROM AUTHOR]

A subset of patients with atrial fibrillation (AF) presents without established AF risk factors and normal left ventricular (LV) systolic function, called idiopathic AF (IAF). Traditionally, echocardiography derived LV dimensions and ejection fraction (EF) are used to exclude LV dysfunction in IAF, but their sensitivity is limited. Our objective is to evaluate the presence of subtle alterations in LV function despite normal LVEF in patients with IAF compared to healthy controls, using speckle-tracking echocardiography (STE) based global longitudinal strain (GLS). Standard transthoracic echocardiography was performed in 80 patients with IAF and 129 healthy controls. Patients with overt cardiac disease as well as known established AF risk factors were excluded. STE analysis was performed to assess GLS of the LV, and left atrial strain (LAS). LVEF was normal and comparable between patients with IAF and healthy controls (63 ± 4% for both groups; p = 0.801). Mean GLS was within normal limits for both groups but statistically significantly more negative in patients with IAF (−20.6 ± 2.5% vs. -19.7 ± 2.5%; p = 0.016), however not when indexed for ventricular cycle length (p = 0.784). No differences in LA volume or non-indexed LAS were seen in patients with IAF compared to healthy controls. In this selected group of IAF patients, STE did not detect any overt LV or LA dysfunction compared to healthy controls. Thus, IAF occurred in these patients not only in the absence of established AF risk factors but also without evidence of ventricular or atrial dysfunction. • Idiopathic atrial fibrillation occurred in the absence of established AF risk factors. • Global longitudinal strain was normal in patients with idiopathic atrial fibrillation. • Speckle-tracking imaging did not detect any overt LV dysfunction compared to healthy controls. [ABSTRACT FROM AUTHOR]