{
  "abstract": "Introduction Myocardial strain analysis has emerged as a more sensitive tool for detecting subclinical myocardial dysfunction than left ventricular ejection fraction. Among cardiac sarcoidosis (CS) patients, regions of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) may be indicative of fibrosis, inflammation or both. The ability of segmental speckle-tracking echocardiography to accurately detect regions of LGE remains unclear.Methods Patients with confirmed CS were prospectively recruited. All patients underwent speckle-tracking echocardiography, CMR and FDG-PET. The diagnosis of CS was made in line with the 2014 Heart Rhythm Society criteria. Segmental strain measurements were available for circumferential and longitudinal strain. Both the TTE and CMR myocardium were divided into corresponding AHA 16-segment models. LGE segments were scored based on extent of hyperenhancement as a % of healthy myocardium (no LGE, 1-20%, 26-50%, 51-75% and 76-100%).Results A total of 97 CS patients with a mean age of 55 ± 10 years were recruited, of which 65% were male. The median TTE LVEF was 58% (IQR 52-63%). Circumferential and longitudinal strain was feasible in 89 and 72 patients, respectively. Of the 1424 circumferential strain segments, 371 (26%) had co-localised LGE on their respective CMR. Circumferential strain was significantly more impaired in those segments with LGE (-19.6 ± 10.7% vs -22.2 ± 10.6%, p<0.001). The AUC for strain to predict LGE presence was 0.578 (optimal cut-off -17.8%) Agreement between presence of impaired strain segment and LGE was 61% with Cohen’s κ 0.118.One-way ANOVA testing revealed a significant difference in mean circumferential strain across all 5 groups of LGE hyperenhancement (p<0.001). Subgroup comparison showed a significant difference in strain values between segments with no LGE versus 26-50% (p=0.008), no LGE versus 76-100% (p<0.001) and 1-20% LGE versus 76-100% (p=0.010) [figure 1a].Of the 1152 longitudinal strain segments, 286 (20%) had co-localised LGE on CMR. Longitudinal strain was significantly more impaired in those segments with LGE (-15.9 ± 7.6% vs -17.4 ± 7.1%, p=0.002). The AUC for longitudinal strain to predict LGE presence was 0.578 (optimal cut-off -17.2%) Agreement between presence of impaired strain segment and LGE was 53% with Cohen’s κ 0.093. Subgroup comparison showed a significant difference in strain values between segments with no LGE versus 26-50% (p=0.031) [figure 1b].Conclusion The overall predictive value of segmental strain in detecting co-localised regions of LGE is limited. However, segmental circumferential strain shows promise in being able to distinguish between regions of myocardium with none or little LGE versus regions with near transmural enhancement. This information may be of value to the clinician when monitoring CS patients with serial TTE, as a deterioration in segmental circumferential strain could prompt the need for advanced imaging.",
  "authors": [
    {
      "affiliations": [
        "Imperial College London, London, United Kingdom",
        "Imperial College Healthcare NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Joseph Okafor"
    },
    {
      "affiliations": [
        "Imperial College Healthcare NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Lina Lakdim"
    },
    {
      "affiliations": [
        "Imperial College London, London, United Kingdom",
        "Royal Brompton Hospital, London, United Kingdom"
      ],
      "name": "Alessia Azzu"
    },
    {
      "affiliations": [
        "Imperial College London, London, United Kingdom",
        "Royal Brompton Hospital, London, United Kingdom"
      ],
      "name": "Rajdeep Khattar"
    }
  ],
  "title": "424 Longitudinal and circumferential speckle-tracking echocardiography strain to predict presence and degree of late gadolinium enhancement in CMR segments of patients with cardiac sarcoidosis",
  "uid": "0bbce366-b68f-5bed-844c-1f98a80d70f7"
}