Elisa Gherbesi

Background/Objectives: Although global longitudinal strain (GLS) appears more sensitive than the ejection fraction in uncovering subtle left ventricular (LV) dysfunction, evidence of impaired LV mechanics in children/adolescents with obesity, independent of comorbidities, remains limited. The aim of the present study was to provide new information on clinical and echocardiographic correlates associated with LV mechanics in normotensive children/adolescents with obesity and without comorbidities. Methods: The Pub-Med, Ovid MEDLINE, Ovid EMBASE, and Cochrane databases were searched to identify eligible studies from inception up to 31 March 2025. Studies reporting data on LV mechanics (i.e., GLS, global circumferential strain [GCS]) in children/adolescents with obesity were included. Meta-regression analyses between GLS, GCS, and several clinical, laboratory, and echocardiographic parameters were performed using a random-effect model. Results: Twenty-seven studies including 1398 normotensive children/adolescents with obesity (mean age 12.6 ± 1.8 years) were considered. There was a significant inverse relationship between GLS and body mass index (BMI) (coefficient = −0.33 ± 0.11, p = 0.003) and fat mass (coefficient = −0.19 ± 0.07, p = 0.005); this was not the case for GCS. Notably, both GLS and GCS were unrelated to several clinical/laboratory variables such as blood pressure, metabolic parameters, LV mass, and LV diastolic function indices. Conclusions: Our findings suggest that increasing BMI and fat mass are the only key factors associated with reduced longitudinal myocardial deformation in pediatric obesity. GLS, unlike GCS, can be regarded as an early marker of subclinical organ damage in this setting and should be assessed to optimize cardiovascular prevention strategies in children/adolescents with obesity regardless of hypertension or comorbidities.

Aim: This meta-analysis aims to evaluate the impact of anthracycline chemotherapy on subclinical right ventricular (RV) dysfunction in breast cancer patients, using traditional echocardiographic parameters and strain-based measures, such as the RV global longitudinal strain (RV GLS) and the RV free-wall longitudinal strain (RV FWLS). Methods and Results: A systematic search was conducted according to PRISMA guidelines, including 15 studies with a total of 1148 breast cancer patients undergoing anthracycline chemotherapy. The primary outcome was the evaluation of changes in RV GLS and RV FWLS pre- and post-chemotherapy. Secondary outcomes included changes in traditional echocardiographic parameters: TAPSE, FAC, and TDI S’. Meta-analysis revealed significant declines in RV function post-chemotherapy across all parameters. RV GLS decreased from 23.99% to 20.35% (SMD: −0.259, p < 0.0001), and RV FWLS from 24.92% to 21.56% (SMD: −0.269, p < 0.0001). Traditional parameters like TAPSE, FAC, and TDI S’ also showed reductions, but these were less consistent across studies. A meta-regression analysis showed no significant relationship between post-chemotherapy left ventricular ejection fraction (LVEF) and the changes in RV GLS and RV FWLS, suggesting that RV dysfunction may not be solely a consequence of LV impairment. Conclusions: Anthracycline chemotherapy induces subclinical RV dysfunction in breast cancer patients. RV strain analysis, especially 3D strain, shows greater sensitivity in detecting early dysfunction. However, further research is needed to clarify the clinical significance and prognostic value of these findings, as well as the role of routine RV strain analysis in guiding early interventions.

Coronary artery disease (CAD) is the most common cause of mortality among adults worldwide. In the prognostic risk stratification of these patients, crucial determinants are lumen stenosis, total volume and composition of the plaque. Considering that most of the myocardial infarctions are due to non-obstructive plaques or are associated with high-risk features, plaque composition can serve as an independent predictor of cardiac outcomes. Conversely, although a tight relationship stands between ischemia and CAD severity, the assessment of the degree of ischemia, as a surrogate marker of the coronary plaque burden, remains a controversial issue. Thus, aim of this narrative review is to discuss the usefulness of the imaging methodologies to differentiate the ischemia vs the plaque burden in clinical practice. New diagnostic tools to evaluate the extent of the atheromatous coronary artery could help tailoring a personalized therapeutic approach.

Atrial fibrillation (AF) could impact on left ventricular function leading to a sublinical myocardial dysfunction, as identified by myocardial work parameters in a population-based cohort of AF patients compared with healthy individuals; factors associated with these parameters are also shown. SBP: systolic blood pressure; LAVI: left atrial volume index.