{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:32:12Z","timestamp":1760059932200,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health","award":["P20RR020173-01"],"award-info":[{"award-number":["P20RR020173-01"]}]},{"name":"Noguchi\/Asano Fund","award":["P20RR020173-01"],"award-info":[{"award-number":["P20RR020173-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: The onset of cardiomyopathy in Duchenne muscular dystrophy (DMD) is insidious and poorly defined. We proposed integrated wall stress (iWS) as a marker of total left ventricular (LV) workload and tested whether the increased iWS represents early DMD cardiomyopathy. Methods: Peak systolic wall stress (PS-WS) was calculated in M-mode echocardiography with simultaneous blood pressure measurement. iWS was defined as a product of PS-WS and heart rate (HR) divided by 60 (=PS-WS\/RR interval). We measured iWS in normal controls (CTRL), DMD with normal LV shortening fraction (%LVSF \u2265 30%) (DMD-A), and DMD with decreased %LVSF (&lt;30%) (DMD-B). Results: 40 CTRL and 79 DMD patients were studied. Despite comparable %LVSF, both HR and iWS were significantly higher in DMD-A (n = 50) than in CTRL (p &lt; 0.0001). iWS was significantly higher in DMD-B (n = 29) than in DMD-A (p &lt; 0.0001) despite comparable HR. PS-WS was significantly higher in DMD-A than in CTRL and higher in DMD-B than in DMD-A, suggesting high HR is not a sole determinant of increased iWS in DMD-A compared with CTRL. In a longitudinal study in 35 DMD patients over 4.0 \u00b1 2.0 years, iWS showed significant increase (p = 0.0062) alongside a significant decline in %LVSF (p &lt; 0.0001). Conclusions: iWS significantly increased in DMD before %LVSF declined. The progressive increase of iWS in DMD is initially associated with increased HR and then with increased PS-WS. iWS may serve as a useful echocardiographic marker in identifying preclinical DMD cardiomyopathy.<\/jats:p>","DOI":"10.3390\/jcdd12080280","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T10:49:17Z","timestamp":1753267757000},"page":"280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sinus Tachycardia and Unrelieved Wall Stress Precede Left Ventricular Systolic Dysfunction During Preclinical Cardiomyopathic Changes in Duchenne Muscular Dystrophy"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8110-1388","authenticated-orcid":false,"given":"Takeshi","family":"Tsuda","sequence":"first","affiliation":[{"name":"Nemours Cardiac Center, Nemours Children\u2019s Health Delaware, 1600 Rockland Rd., Wilmington, DE 19803, USA"},{"name":"Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Walczak","sequence":"additional","affiliation":[{"name":"Nemours Cardiac Center, Nemours Children\u2019s Health Delaware, 1600 Rockland Rd., Wilmington, DE 19803, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"O\u2019Neil","sequence":"additional","affiliation":[{"name":"Nemours Cardiac Center, Nemours Children\u2019s Health Delaware, 1600 Rockland Rd., Wilmington, DE 19803, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1161\/CIRCULATIONAHA.114.015151","article-title":"Contemporary cardiac issues in Duchenne muscular dystrophy. 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