Specific alterations of regional myocardial work in strength-trained athletes using anabolic androgenic steroids compared to athletes with genetic hypertrophic cardiomyopathy

Background:Strength-trained athletes using anabolic androgenic steroids(AAS)have left ventricular(LV)hypertrophy and myocardial fibrosis that can lead to sudden cardiac death.A similar feature was described in athletes with hypertrophic cardiomyopathy(HCM),which complicates the diagnosis for clinicians.In this context,we aimed to compare the LV function of the 2 populations by measuring global and regional strain and myocardial work using speckle-tracking imaging.Methods:Twenty-four strength-trained asymptomatic athletes using AAS(AAS-Athletes),22 athletes diagnosed with HCM(HCM-Athletes),and 20 healthy control athletes(Ctrl-Athletes)underwent a resting echocardiography to assess LV function.We evaluated LV global and regional strains and myocardial work,with an evaluation of the constructive work(CW),wasted work,and work efficiency(WE).Results:Compared to Ctrl-Athletes,both AAS-Athletes and HCM-Athletes had a thicker interventricular septum,with maj ored values in HCM-Athletes.LV strain was reduced in AAS-Athletes and even more in HCM-Athletes.Consequently,global WE was significantly diminished in both AAS and HCM-Athletes(93%±2%in Ctrl-Athletes,90%±4%in AAS-Athletes,and 90%±5%in HCM-Athletes(mean±SD);p<0.05).Constructive work and WE regional analysis showed specific alterations,with the basal septal segments preferentially affected in AAS-Athletes,and both septal and apical segments affected in HCM-Athletes.Conclusion:The regional evaluation of myocardial work reported specific alterations of the major LV hypertrophy induced by the regular use of AAS compared to the LV hypertrophy due to HCM.This finding could help clinicians to differentiate between these 2 forms of pathological hypertrophy.

Advances in the Research Application of Ultrasound Non-Invasive Stress-Strain Loop Technology in Cardiovascular Diseases

The ultrasound pressure-strain loop (PSL) technique is a non-invasive method of examining myocardial work, which takes into account the effect of cardiac afterload on deformation and combines the overall longitudinal strain force of the left ventricle with the changes in the left ventricular pressure, allowing earlier detection of possible subclinical cardiac damage in patients, and a more accurate and non-invasive assessment of the patient’s myocardial work performance. In this article, we will discuss the progress of PSL applications in cardiovascular diseases.

Value of Myocardial Strain in Monitoring Fluorouracil-Based Chemotherapy-Related Cardiac Dysfunction in Gastrointestinal Cancer Patients

Objective To investigate the predictive value of myocardial strain for cardiotoxicity associated with fluorouracil-based chemotherapies in gastrointestinal cancer patients.Methods Patients with diagnosis of gastrointestinal cancers,who were hospitalized for chemotherapy involving antimetabolic drugs,were eligible in this prospective study.Echocardiography was performed before and after each chemotherapy cycle during hospitalization until the completion of chemotherapy.Cancer therapy-related cardiac dysfunction(CTRCD)was identified if there was a decrease in left ventricular ejection fraction(LVEF)by at least 5%to an absolute value of<53%from the baseline,accompanied by symptoms or signs of heart failure;or a decrease in LVEF of at least 10%to an absolute value of<53%from the baseline,without symptoms or signs of heart failure.Subclinical cardiac impairment is defined as a decrease in the left ventricular global longitudinal strain(GLS)of at least 15%from baseline.Clinical data and myocardial strain variables were collected.Changes of echocardiographic indexes after chemotherapy at each cycle were observed and compared to those of pre-chemotherapy.Cox regression analysis was used to determine the associated indexes to CTRCD,and receiver operating characteristic(ROC)curves were plotted for evaluation of their predicting efficacy.Results Fifty-one patients completed 4 cycles of chemotherapy and were enrolled in the study analysis.LVEF,GLS,GLS epicardium(GLS-epi),and GLS endocardium(GLS-endo)were decreased after the 4 cycles of chemotherapy.Throughout the chemotherapy period,6 patients(11.8%)progressed to CTRCD.The Cox regression analysis revealed that the change in left atrial ejection fraction(LAEF)and LAS during the reservoir(LASr)phase after the first cycle of chemotherapy(C1v-LAEF and C1v-LASr,respectively)were significantly associated with the development of CTRCD[C1v-LAEF(HR=1.040;95%CI:1.000-1.082;P=0.047);C1v-LASr(HR=1.024;95%CI:1.000-1.048;P=0.048)].The sensitivity and specificity were 50.0%and 93.3%,respectively,for C1v-LAEF predicting CTRCD when C1v-LAEF>19.68%was used as the cut-off value,and were 66.7%and 75.6%,respectively,for C1v-LASr predicting CTRCD when C1v-LASr>14.73%was used as the cut-off value.The areas under the ROC curve(AUC)for C1v-LAEF and C1v-LASr predicting CTRCD were 0.694 and 0.707,respectively.Conclusion GLS changes among patients with subclinical impairment of cardiac function who were treated with fluorouracil-based chemotherapies,and C1v-LAEF and C1v-LASr of the left atrium are early predictors of cardiac function deterioration.

Takotsubo cardiomyopathy associated with bronchoscopic operation:A case report

BACKGROUND Takotsubo cardiomyopathy(TTC),a syndrome of acute left ventricular(LV)dysfunction,is characterized by transitory hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region.The symptoms of TTC mimic acute myocardial infarction,without significant coronary stenoses on coronary angiography.Echocardiogram plays a key role in the diagnosis and prognosis of TTC.New indicators from echocardiograms may be helpful in disease evaluation.CASE SUMMARY A 67-year-old man with a 10-year history of non-small cell lung cancer was admitted to our hospital for emerging facial edema and dry cough.Bronchoscopic lavage,brushing,and biopsy were performed to evaluate tumor progression.During this procedure,he complained of left chest pain,nausea,and vomiting,with elevated troponin levels.Electrocardiogram showed sinus bradycardia with ST-segment elevation in I,AVL,and V4 to V6 leads.Coronary angiography revealed mild stenosis in the right coronary artery.Echocardiography showed hypokinesis of LV apices with compensatory hyperkinesis of the LV basal region.At the 7-d follow-up,echocardiographic pressure-strain analysis showed a normal LV ejection fraction,but partial recovery of LV myocardial work,which fully recovered 5 mo later.CONCLUSION This is a case of TTC caused by bronchoscopic operation.We strongly recommend noninvasive myocardial work measured by echocardiographic pressure-strain analysis as a necessary supplementary test for the long-term follow-up of TTC.