3D Myocardial Strain Research Articles

Assessment of the Right Ventricle Function in Patients With Significant Tricuspid Regurgitation: A Review.

Tricuspid regurgitation (TR) is an increasingly prevalent condition, especially in older populations, and presents significant challenges due to its association with right heart failure, hospital admissions, and high mortality rates. The management of TR has evolved, with new percutaneous valve repair and replacement techniques emerging alongside traditional surgical approaches. However, accurately assessing right ventricular (RV) function-a key prognostic factor in TR-remains difficult due to the RV's unique anatomy and sensitivity to loading conditions. Current echocardiographic methods, such as Tricuspid Annular Plane Systolic Excursion (TAPSE), S' wave analysis, and RV fractional area change (FAC), offer valuable insights but have limitations, particularly regarding load dependence and incomplete assessment of RV function. Advances in 3D echocardiography and myocardial strain imaging provide more comprehensive evaluations, yet challenges persist in integrating these measures in routine clinical practice. The review highlights the importance of a multimodal approach to RV assessment in TR patients, considering both the right atrium and pulmonary artery interactions, and explores potential future tools such as myocardial work and dynamic testing to improve prognostic accuracy and patient outcomes.

Contribution of Ventricular Motion and Sampling Location to Discrepancies in Two-Dimensional Versus Three-Dimensional Fetal Ventricular Strain Measures

Echocardiographic quantification of fetal cardiac strain is important to evaluate function and the need for intervention, with both two-dimensional (2D) and three-dimensional (3D) strain measurements currently feasible. However, discrepancies between 2D and 3D measurements have been reported, the etiologies of which are unclear. This study sought to determine the etiologies of the differences between 2D and 3D strain measurements. A validated cardiac motion-tracking algorithm was used on 3D cine ultrasound images acquired in 26 healthy fetuses. Both 2D and 3D myocardial strain quantifications were performed on each image set for controlled comparisons. Finite element modeling of 2 left ventricle (LV) models with minor geometrical differences were performed with various helix angle configurations for validating image processing results. Three-dimensional longitudinal strain (LS) was significantly lower than 2D LS for the LV free wall and septum but not for the right ventricular (RV) free wall, while 3D circumferential strain (CS) was significantly higher than 2D CS for the LV, RV, and septum. The LS discrepancy was due to 2D long-axis imaging not capturing the out-of-plane motions associated with LV twist, while the CS discrepancy was due to the systolic motion of the heart toward the apex that caused out-of-plane motions in 2D short-axis imaging. A timing mismatch between the occurrences of peak longitudinal and circumferential dimensions caused a deviation in zero-strain referencing between 2D and 3D strain measurements, contributing to further discrepancies between the2. Mechanisms for discrepancies between 2D and 3D strain measurements in fetal echocardiography were identified, and inaccuracies associated with 2D strains were highlighted. Understanding of this mechanism is useful and important for future standardization of fetal cardiac strain measurements, which we propose to be important in view of large discrepancies in measured values in the literature.

Cardiac functional imaging

During the last 20 years, cardiac imaging has drastically evolved. Positron emission tomography (PET), fast three-dimensional (3D) imaging with the latest generations of echocardiography & multi-detector computed tomography (CT), stress perfusion assessed by magnetic resonance imaging (MRI), blood flow analysis using four-dimensional (4D) flow MRI, all these techniques offer new trends for optimal noninvasive functional cardiac imaging. Dynamic functional imaging is obtained by acquiring images of the heart at different phases of the cardiac cycle, allowing assessment of cardiac motion, function, and perfusion. Between CT and Cardiac MRI (CMR), CMR has the best temporal resolution, which is suitable for functional imaging while cardiac CT provides higher spatial resolution with isotropic data that have an identical resolution in the three dimensions of the space. The latest generations of CT scanners enable whole heart assessment in one beat, offering also an acceptable temporal resolution with the possibility to display the images in a dynamic mode. Another rapidly growing technique using functional and molecular imaging for the assessment of biological and metabolic pathways is the PET using radio-labeled tracers. Meanwhile, the oldest cardiac imaging tool with doppler ultrasound technology has never stopped evolving. Echocardiography today performs 3D imaging, stress perfusion, and myocardial strain assessment, with high temporal resolution. It still is the first line and more accessible exam for the patient. These different modalities are complementary and may be even combined into PET-CT or PET-MRI. The ability to combine the functional/molecular data with anatomical images may implement a new dimension to our diagnostic tools.

Three-dimensional myocardial strain for the prediction of clinical events in patients with successfully reperfused ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Two-dimensional (2D) myocardial strain analysis can be used to evaluate the prognosis of patients with acute myocardial infarction and has comparable predictive power as conventional echocardiographic parameters such as left ventricular ejection fraction (LV EF). Three-dimensional (3D) myocardial strain analysis is also expected to have similar clinical usefulness and overcome several inherent limitations of 2D strain analysis. However, no large-scale studies have been reported to date. Purpose We aimed to clarify the prognostic significance of 3D strain analysis in patients with ST-segment elevation myocardial infarction (STEMI) who are most likely to benefit from 3D strain analysis. Methods Patients who underwent successful revascularization for STEMI from June 2011 to April 2017 were retrospectively recruited. In addition to conventional echocardiographic parameters, 3D global area strain (GAS), 3D global longitudinal strain (GLS), as well as 2D GLS were obtained. To evaluate the clinical outcomes, we constructed a composite outcome consisting of all-cause death or re-hospitalisation due to acute decompensation of heart failure. Results From June 2011 to April 2017, 632 patients were retrospectively recruited in our hospital. Of these patients, 545 patients (86.2%) had a reliable 3D strain analysis. The clinical course of each patient was followed up for a maximum of 96 months (median 49.5 months). During follow-up periods, 55 (10.1%) among 545 patients experienced the composite outcome of all-cause death or re-hospitalisation due to acute decompensation of heart failure. Patients with adverse events were older, had more underlying diseases such as obesity, dyslipidemia, previous history of stroke, or chronic kidney disease. (all, p < 0.05) LV EF was significantly lower, while 2D GLS, 3D GLS, and 3D GAS were significantly higher in patients with poor outcomes. (all, p < 0.001) The area under the receiver operating characteristic curve (AUC) values of LV EF, 2D GLS, 3D GLS, and 3D GAS were 0.70, 0.71, 0.67, and 0.65, respectively. (all, p < 0.05) Kaplan-Meier analysis of composite outcomes based on the best cut-off values of each parameter demonstrated similar results. (Figure 1) In the Cox proportional hazard model, the hazard ratios of LV EF, 2D GLS, and 3D GLS were 3.0, 5.5, and 2.0, respectively. (all, p < 0.05) The maximum likelihood-ratio test was performed to evaluate the additional prognostic value of 2D GLS or 3D GLS over the basic prognostic model consisting of baseline clinical characteristics and LV EF, and the likelihood ratio was 15.9 for 2D GLS (p < 0.001) and 1.49 for 3D GLS (p = 0.22). Conclusion(s) 3D strain could be reliably measured in the majority of the patients and had a significant prognostic value. However, the predictive power of the 3D strain was lower than that of the 2D strain. The clinical implications of 3D strain indices should be investigated further. Abstract Figure.

The Predictive Value of 2D Myocardial Strain for Epirubicin-Induced Cardiotoxicity.

Introduction Although epirubicin has significantly improved outcome in breast cancer (BC) patients, it is responsible for myocardial dysfunction that affects patients' quality of life. The use of 2D global longitudinal strain (GLS) has been reported to detect early myocardial dysfunction. The aim of this study was to evaluate how GLS changes can predict cardiotoxicity. Methods We conducted a prospective study from March 2018 to March 2020 on 66 patients with no cardiovascular risk factors, who presented with BC and received epirubicin. We measured left ventricular ejection fraction (LVEF) and GLS before chemotherapy, at three months (T3), and at 12 months (T12) from the last epirubicin infusion. Chemotherapy-Related-Cardiac-Dysfunction (CTRCD) was defined as a decrease of 10% in LVEF to a value below 53% according to ASE and EACI 2014 expert consensus. Results The mean age at diagnosis was 47 ± 9 years old. At baseline, median LVEF was 70% and median GLS was −21%. Shortly after chemotherapy completion, two patients presented with symptomatic heart failure while asymptomatic CTRCD was revealed in three other patients at T12. Three months after the last epirubicin infusion, median LVEF was 65%, median GLS was −19%, and median GLS variation was 5%. However, in patients who presented with subsequent CTRCD, median GLS at T3 was −16% and median GLS variation was 19% (p=0.002 and p < 0.001, respectively, when compared to patients who did not develop cardiotoxicity). Persistent GLS decrease at T3 was an independent predictor of CTRCD at T12. Age and left-sided thoracic irradiation did not increase the risk of cardiotoxicity in our study while the cumulative dose of epirubicin significantly affected cardiologic findings (p=0.001). Conclusion This was the first North African study that assesses the value of measuring GLS to early detect cardiotoxicity. Patients whose GLS remained decreased after 3 months from anthracyclines-base chemotherapy had an increased risk for developing subsequent CTRCD. Further studies with larger sample size are warranted to identify the best cardioprotective molecules to be initiated in these patients before LVEF declines.

197P Epirubicin-induced cardiotoxicity: Use of myocardial strain for early detection of left ventricular dysfunction before LVEF declines

Although epirubicin has improved outcome in breast cancer (BC) patients, it is associated to myocardial dysfunction that affects patients’ quality of life. The use of 2D-myocardial strain echocardiography for Global Longitudinal Strain (GLS) measurment allows to detect early myocardial dysfunction. The aim of this study was to evaluate early changes in GLS and their association with onset of later cardiotoxicity.

Myocardial 2D Strain During Long-Term (>5 Years) Follow-Up of Childhood Survivors of Acute Lymphoblastic Leukemia Treated With Anthracyclines

Anthracycline-induced cardiotoxicity can lead to clinical and subclinical heart failure. Decrease of global longitudinal strain is a predictor for heart failure. Early detection of subclinical cardiotoxicity is crucial for timely intervention and prevention of further progression. Cardiac function of 41 survivors of childhood acute lymphoblastic leukemia (ALL) was assessed. Values of cardiac troponin T, N-terminal-pro-brain natriuretic peptide, conventional and myocardial 2D strain echocardiography were measured before (T = 0), during (T = 1, cumulative dose of 120 mg/m2), shortly after (T = 2) and long after anthracycline treatment (T = 3, ≥5 years after anthracycline exposure). Cardiac function of survivors at the latest follow up was compared with 70 healthy age-matched controls. None of the survivors showed clinical signs of cardiac failure at T = 3. Strain values decreased during anthracycline treatment and an ongoing reduction was seen at the latest follow-up (T = 3) with preserved cardiac function (normal ejection fraction and shortening fraction). At T = 1, a relative reduction in longitudinal strain (≥10% compared with baseline) was observed in 38% of the survivors, which increased to 54% at T=3. ALL survivors showed significantly lower conventional and myocardial 2D strain values, especially strain rate, compared with healthy age-matched controls. At T = 3, we did not find any abnormal cardiac troponin T levels. Six percent of the survivors showed abnormal N-terminal-pro-brain natriuretic peptide levels. This prospective study showed an ongoing reduction of 2D myocardial strain and strain rate, with preserved left ventricular ejection fraction (≤10% decrease compared with baseline) in asymptomatic ALL survivors at late follow-up.

Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity.

Background: Anthracyclines, a widely used chemotherapy agent with a definite survival improvement, can result in cardiac toxicity presenting with HF (heart failure).Objective: We aim to assess the predictive value of cardiac biomarkers assessment in combination with myocardial two-dimensional strain echocardiography for early detection of cardiac toxicity in patients who underwent Anthracycline-based chemotherapy.Methods: Fifty-two consecutive adult patients scheduled to undergo the first course of Anthracycline-based chemotherapy were subjected to the study. All the patients underwent highly sensitive 2D echocardiographic evaluation before the treatment, 4 and 12 weeks after completion of first-course chemotherapy. Longitudinal and segmental strains were measured. Serum levels of High-sensitive cardiac troponin I (hscTn-I) and N-terminal-pro-BNP (NT-proBNP) were also assessed before the initiation and 3 weeks after completion of first-course chemotherapy.Results: Fifteen patients (28.8%) revealed a decrease in LVEF (Left Ventricular Ejection Fraction) throughout the evaluations, while just 5 patients met the criteria of cardiac toxicity (9.6%). AUC for Global Longitudinal Strain (GLS) ROC curve at 4 weeks of follow-up was calculated to be 0.968. Inferoseptal Systolic Longitudinal Strain (SLS) had the highest AUC value (AUC: 0.934) among different wall SLS. LVESD (Left Ventricular End-Systolic Diameter) at first and second evaluation could predict the risk of cardiac toxicity among LVESD, LVEDD (Left Ventricular End Diastolic Diameter) and LVEDV (Left Ventricular End-Diastolic Volume). Among cardiac biomarkers, hs-cTnI had higher sensitivity, while NT-proBNP had higher specificity for cardiac toxicity.Conclusion: This study has shown that hs-cTnI with good sensitivity can predict cardiac toxicity in Anthracycline-based chemotherapy receiver. The use of strain with speckle echocardiography method has a prognostic value; however, both longitudinal and segmental strain should be assessed. Lateral and inferoseptal SLS (Segmental Longitudinal Strain) are specific markers of cardiac toxicity in the course of anthracycline-related cardiac toxicity.

1029 Anthracycline and trastuzumab-induced subclinical cardiac damage and its prevention in the SAFE trial. Myocardial strain imaging and 3D echo interim analysis data

Abstract Background Benefit of anthracyclines and trastuzumab therapies on disease-free survival in breast cancer is well known. Cardiotoxicity is a feared potential complication of both drugs. It usually progresses from cardiomyocyte injury to silent left ventricular dysfunction (LVD) which often becomes symptomatic and irreversible. Therefore, its prevention and early detection are of paramount importance in these cancer patients. Purpose SAFE trial (CT registry ID: NCT2236806) is a randomized phase 3, four-arm, single-blind, placebo-controlled study that aims to evaluate the effects of Bisoprolol (B) (5 mg, twice daily), Ramipril (R) (5 mg, twice daily) or the combination of the two (R + B), compared to placebo (P), on subclinical heart heart damage. Interim data of left ventricular function monitored with 3D Echo and Myocardial Strain Imaging are presented. Methods Out of 225 patients asked to participate, 191 were enrolled (mean age 48.9 ± 9.0 years). Follow-up monitoring (at 3, 6, 12 months[m]) comprised 3D ejection fraction (3D-LVEF) and Global Longitudinal Strain (GLS). One patient had sub-acute anthracyclines cardiotoxicity. Data at one year of 123 patients were available (34 P, 28 R, 31 B, 30 R + B). Results At time 0, no significant differences in age, body mass index, hemodynamic parameters were observed among arms. Data of 3D-LVEF and GLS at time 0 and during follow-up are reported in the figure (p level versus time 0 – GLS repeated measures). There was a significant reduction in 3D LVEF and increase in GLS in P arm (3D LVEF: 3m: -3.3%, 6m: - 5.2%, 12m: -3.7%; GLS: 3m: +5,7%, 6m: +7.8%, 12m: + 7,1%). A similar, though less significant, worsening of 3D LVEF (-2.4%,-1.9%,-2.2% at 3, 6, 12m, respectively) and GLS (+2.7%, +3.2% at 3 and 6m, respectively) was found in R arm. In B and B +R arms there was a worsening at 6m (3D LVEF -2.5%, GLS +2.7%), whereas at 12m only GLS increased (+3.2%) in B, not in B + R. Arm differences were significant (repeated measures two ways) both for 3D LVEF (two-way repeated measures ANOVA, p level = 0.038, observed power 0.855) and GLS (p level = 0.002, observed power 0.973). Conclusions This interim analysis of the SAFE trial shows that demonstration of subclinical cardiotoxicity is feasible with 3D echo and myocardial strain imaging. Significant subclinical damage potentially leading to LVD is present at one year. Both B alone on in combination with R may be a successful cardioprotective strategy in patients treated with anthracyclines and trastuzumab. Abstract 1029 Figure. Time course of GLS and 3D LVEF

Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity.

Prognostic Value of Cardiac Biomarkers Assessment in Combination with Myocardial 2D Strain Echocardiography for Early Detection of Anthracycline-Related Cardiac Toxicity.

Hierarchical Template Matching for 3D Myocardial Tracking and Cardiac Strain Estimation

Myocardial tracking and strain estimation can non-invasively assess cardiac functioning using subject-specific MRI. As the left-ventricle does not have a uniform shape and functioning from base to apex, the development of 3D MRI has provided opportunities for simultaneous 3D tracking, and 3D strain estimation. We have extended a Local Weighted Mean (LWM) transformation function for 3D, and incorporated in a Hierarchical Template Matching model to solve 3D myocardial tracking and strain estimation problem. The LWM does not need to solve a large system of equations, provides smooth displacement of myocardial points, and adapt local geometric differences in images. Hence, 3D myocardial tracking can be performed with 1.49 mm median error, and without large error outliers. The maximum error of tracking is up to 24% reduced compared to benchmark methods. Moreover, the estimated strain can be insightful to improve 3D imaging protocols, and the computer code of LWM could also be useful for geo-spatial and manufacturing image analysis researchers.

P17652D and 3D myocardial strain imaging fails to reveal sexual dimorphism of anthracycline-induced cardiotoxicity in long-term survivors of childhood cancers

P17652D and 3D myocardial strain imaging fails to reveal sexual dimorphism of anthracycline-induced cardiotoxicity in long-term survivors of childhood cancers

3109G-CSF effects on left ventricular function assessed with standard echocardiographic evaluation (biplane EF) and 2D myocardial strain in patients with STEMI and LV dysfunction

3109G-CSF effects on left ventricular function assessed with standard echocardiographic evaluation (biplane EF) and 2D myocardial strain in patients with STEMI and LV dysfunction

P4327Myocardial fibrosis but not myocardial hypertrophy affects 3d myocardial CT strain values in hypertrophic cardiomyopathy: a novel 3D myocardial strain study determined by existing 320-slice CT

P4327Myocardial fibrosis but not myocardial hypertrophy affects 3d myocardial CT strain values in hypertrophic cardiomyopathy: a novel 3D myocardial strain study determined by existing 320-slice CT

111 New normal ranges and superior reproducibility of 3d myocardial strain on cardiovascular magnetic resonance-feature tracking

BackgroundMyocardial deformation can be key to clinical decision. 2D feature-tracking of cardiovascular magnetic resonance (CMR-FT) imaging is user-friendly but has poor reproducibility, particularly for radial strain. 3D CMR-FT may improve...

Wall-motion tracking in fetal echocardiography-Influence offrame rate on longitudinal strain analysis assessed by two-dimensional speckle tracking.

Frame rates (FR) used for strain analysis assessed by speckle tracking in fetal echocardiography show a considerable variation. The aim of this study was to investigate the influence of the FR on strain analysis in 2D speckle tracking. Fetal echocardiography was performed prospectively on a Toshiba Aplio 500 system and a Toshiba Artida system, respectively. Based on an apical or basal four-chamber view of the fetal heart, cine loops were stored with a FR of 30fps (Aplio 500) and 60fps (Artida/Aplio 500). For both groups (30fps and 60fps), global and segmental longitudinal peak systolic strain (LPSS) values of both, left (LV) and right ventricle (RV), were assessed by 2D wall-motion tracking. A total of 101 fetuses, distributed to three study groups, were included. The mean gestational age was 25.2±5.0weeks. Mean global LPSS values for RV in the 30fps group and in the 60fps group were -16.07% and -16.47%, respectively. Mean global LPSS values for LV in the 30fps group and in the 60fps group were -17.54% and -17.06%, respectively. Comparing global and segmental LPSS values of both, the RV and LV, did not show any statistically significant differences within the two groups. Performance of myocardial 2D strain analysis by wall-motion tracking was feasible with 30 and 60fps. Obtained global and segmental LPSS values of both ventricles were relatively independent from acquisition rate.

3D Myocardial Elastography In Vivo.

Strain evaluation is of major interest in clinical cardiology as it can quantify the cardiac function. Myocardial elastography, a radio-frequency (RF)-based cross-correlation method, has been developed to evaluate the local strain distribution in the heart in vivo. However, inhomogeneities such as RF ablation lesions or infarction require a three-dimensional approach to be measured accurately. In addition, acquisitions at high volume rate are essential to evaluate the cardiac strain in three dimensions. Conventional focused transmit schemes using 2D matrix arrays, trade off sufficient volume rate for beam density or sector size to image rapid moving structure such as the heart, which lowers accuracy and precision in the strain estimation. In this study, we developed 3D myocardial elastography at high volume rates using diverging wave transmits to evaluate the local axial strain distribution in three dimensions in three open-chest canines before and after radio-frequency ablation. Acquisitions were performed with a 2.5 MHz 2D matrix array fully programmable used to emit 2000 diverging waves at 2000 volumes/s. Incremental displacements and strains enabled the visualization of rapid events during the QRS complex along with the different phases of the cardiac cycle in entire volumes. Cumulative displacement and strain volumes depict high contrast between non-ablated and ablated myocardium at the lesion location, mapping the tissue coagulation. 3D myocardial strain elastography could thus become an important technique to measure the regional strain distribution in three dimensions in humans.

A graph theoretic approach for computing 3D+time biventricular cardiac strain from tagged MRI data

Tagged magnetic resonance imaging (tMRI) is a well-established method for evaluating regional mechanical function of the heart. Many techniques have been developed to compute 2D or 3D cardiac deformation and strain from tMRI images. In this paper, we present a new method for measuring 3D plus time biventricular myocardial strain from tMRI data. The method is composed of two parts. First, we use a Gabor filter bank to extract tag points along tag lines. Second, each tag point is classified to one of a set of indexed reference tag lines using a point classification with graph cuts (PCGC) algorithm and a motion compensation technique. 3D biventricular deformation and strain is computed at each image time frame from the classified tag points using a previously published finite difference method. The strain computation is fully automatic after myocardial contours are defined near end-diastole and end-systole. An in-vivo dataset composed of 30 human imaging studies with a range of pathologies was used for validation. Strains computed with the PCGC method with no manual corrections were compared to strains computed from both manually placed tag points and a manually-corrected unwrapped phase method. A typical cardiac imaging study with 10 short-axis slices and 6 long-axis slices required 30 min for contouring followed by 44 min of automated processing. The results demonstrate that the proposed method can reconstruct accurate 3D plus time cardiac strain maps with minimal user intervention.

Mesenchymal stem cells preserve neonatal right ventricular function in a porcine model of pressure overload.

Limited therapies exist for patients with congenital heart disease (CHD) who develop right ventricular (RV) dysfunction. Bone marrow-derived mesenchymal stem cells (MSCs) have not been evaluated in a preclinical model of pressure overload, which simulates the pathophysiology relevant to many forms of CHD. A neonatal swine model of RV pressure overload was utilized to test the hypothesis that MSCs preserve RV function and attenuate ventricular remodeling. Immunosuppressed Yorkshire swine underwent pulmonary artery banding to induce RV dysfunction. After 30 min, human MSCs (1 million cells, n = 5) or placebo (n = 5) were injected intramyocardially into the RV free wall. Serial transthoracic echocardiography monitored RV functional indices including 2D myocardial strain analysis. Four weeks postinjection, the MSC-treated myocardium had a smaller increase in RV end-diastolic area, end-systolic area, and tricuspid vena contracta width (P < 0.01), increased RV fractional area of change, and improved myocardial strain mechanics relative to placebo (P < 0.01). The MSC-treated myocardium demonstrated enhanced neovessel formation (P < 0.0001), superior recruitment of endogenous c-kit+ cardiac stem cells to the RV (P < 0.0001) and increased proliferation of cardiomyocytes (P = 0.0009) and endothelial cells (P < 0.0001). Hypertrophic changes in the RV were more pronounced in the placebo group, as evidenced by greater wall thickness by echocardiography (P = 0.008), increased cardiomyocyte cross-sectional area (P = 0.001), and increased expression of hypertrophy-related genes, including brain natriuretic peptide, β-myosin heavy chain and myosin light chain. Additionally, MSC-treated myocardium demonstrated increased expression of the antihypertrophy secreted factor, growth differentiation factor 15 (GDF15), and its downstream effector, SMAD 2/3, in cultured neonatal rat cardiomyocytes and in the porcine RV myocardium. This is the first report of the use of MSCs as a therapeutic strategy to preserve RV function and attenuate remodeling in the setting of pressure overload. Mechanistically, transplanted MSCs possibly stimulated GDF15 and its downstream SMAD proteins to antagonize the hypertrophy response of pressure overload. These encouraging results have implications in congenital cardiac pressure overload lesions.

A NOVEL THREE-DIMENSIONAL MYOCARDIAL STRAIN PARAMETERS ON RESTING SPECKLE TRACKING TTE COULD DETECT STABLE LV MYOCARDIAL ISCHEMIC SEGMENTS CONFIRMED BY INVASIVE FRACTIONAL FLOW RESERVE

Parameters derived from 3D myocardial strain on resting speckle tracking TTE, including area (AS), longitudinal (LS), circumferential (CS) and radial strain (RS) may be useful to detect ischemic left ventricular (LV) myocardium confirmed by invasive fractional flow reserve (FFR). This is a