2D Speckle-tracking Echocardiography Research Articles

The role of 3D speckle-tracking echocardiography in predicting long-term outcomes after a first myocardial infarction

Aim. To determine the role of 3D echocardiography parameters in the prognosis of long-term cardiovascular complications in patients with a first acute myocardial infarction (AMI).Materials and methods. А prospective, single-center, observational study included 46 patients with a first AMI and successful PCI without a history of heart failure (HF) and shortness of breath upon admission. The examination of patients was performed in accordance with the Russian standards of medical care provision. Additionally, 3D echocardiography was performed, and N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined. The main outcomes assessed were hospitalization with HF, sudden cardiac death, and combined endpoint. Median follow-up was 554 days (IQR 550–785).Results. During the follow-up period, 9 hospitalizations with HF, 3 sudden cardiac deaths, and 12 combined endpoints were registered. The effect of 3D echocardiography parameters on the development of sudden cardiac death and combined endpoint has not been revealed. The effect of the studied parameters on the development of HF during the follow-up period that required hospitalization was evaluated. A statistically significant increase in the LV sphericity index was revealed in the group of patients with the registered outcome. We found significant direct correlations of left ventricular volume indices with prescription of diuretics in the post-discharge period; hospitalization with HF in the post-infarction period with the level of NT-pro-BNP, left atrial volume with the duration of index hospitalization, duration of eventless survival with ST elevation. We found a negative correlation of radial strain with prescription of diuretics in the post-discharge period. Predictors of hospitalization with HF in the post-infarction period were identified – parameters of radial strain, area strain, and circumferential strain, which were included in the model for calculating the risk of the outcome under study.Conclusion. In patients with the first AMI in the absence of clinical signs of HF, to calculate the risk of hospitalization with HF within 550 days after MI, it is advisable to take into account the level of radial strain and use a prognostic model (1), including parameters of circumferential and area strain (according to 3D echocardiography data).

Comparative assessment of myocardial function between late premature newborns and term neonates using the 2D speckle tracking method.

Assessment of myocardial function through speckle tracking echocardiography (STE) can bring benefits to conventional echocardiography in premature newborns, a particular vulnerable group in terms of adaptation to extra-uterine life. Furthermore, it represents a non-invasive imagistic method which can guide therapeutic approach in the hemodynamically unstable newborn. This study aims to highlight the particularities of myocardial function in late premature newborns, by conducting a comparison with a group of healthy neonates, by using STE. Conducted over a timespan of two years, this prospective study enrolled 64 term neonates and 21 premature newborns, with gestational ages ranging between 28 and 36 weeks, who prior to discharge underwent a cardiac ultrasound, involving two-dimensional image acquisitions of the apical four-chamber view of both ventricles. Afterwards, the images were offline analyzed, by using the autostrain function. After segmental strain analysis, no significant discrepancies between the two groups in terms of interventricular values were found. However, left ventricle and right ventricle strain measurements differed significantly (p < 0.01), for each of the analyzed segments (basal, medial or apical). Moreover, a linear increase in interventricular (IV) basal strain with corrected gestational age progression was noted (p = 0.04). Peak global longitudinal strain (pGLS) and EF were similar between the two study groups. Premature newborns presented significantly more negative mean values of right ventricular free wall longitudinal strain (RVFWSL), (-24.19 ± 4.95 vs. -18.05 ± 5.88, p < 0.01) and of right ventricle global four chamber longitudinal strain (RV4CSL), (-19.71 ± 3.62 vs. -15.46 ± 5.59, p < 0.01), when compared to term neonates. The 2D STE is a reliable method for cardiac assessment of late preterm newborns. The evaluation of two-dimensional global longitudinal LV and RV strains might represent a useful tool in clinical practice. A better response of the right ventricle to the longitudinal deformation within premature neonates was noted. Thus, this study facilitates the identification of accurate reference values for this particular population segment, which will enable the evaluation of ventricular function in premature newborns with concurring disorders. Future longitudinal studies, assessing the fetal heart, could provide more insight into the development of myocardial function.

Fetal Left Ventricle Function Evaluated by Two-Dimensional Speckle-Tracking Echocardiography across Clinical Stages of Severity in Growth-Restricted Fetuses.

Fetal growth restriction (FGR) can result in adverse perinatal outcomes due to cardiac dysfunction. This study used 2D speckle-tracking echocardiography to assess left ventricle (LV) longitudinal strain across FGR severity stages. A prospective longitudinal cohort study measured global (GLS) and segmental LV longitudinal strain in FGR fetuses, with evaluations conducted at various time points. FGR was classified into subtypes based on published criteria using fetal weight centile and Doppler parameters. A linear mixed model was employed to analyze repeated measures and compare Z-score measurements between groups throughout gestational age. The study included 40 FGR fetuses and a total of 107 evaluations were performed: 21 from small for gestational age (SGA), 74 from the FGR stage I, and 12 from the FGR stage ≥ II. The results indicate that SGA and stage I FGR fetuses exhibit higher LV GLS than stages ≥ II. Throughout gestation, SGA and FGR stage I fetuses showed similar behavior with consistently better LV GLS values when compared to FGR stages ≥ II. No significant differences were observed in LV GLS strain behavior between SGA and FGR stage I. In conclusion, all FGRs show signs of early cardiac dysfunction, with severe cases demonstrating significantly a lower LV GLS when compared to mild cases, suggesting deterioration of cardiac dysfunction with progression of fetal compromise.

Left atrial strain in adults after the arterial switch operation for transposition of the great arteries.

No study has focused on left atrial (LA) function assessed by echocardiography in adult patients with simple D-TGA after arterial switch operation (ASO). We aimed to describe LA strain parameters in these patients. A prospective cohort study including 42 adult patients with simple D-TGA after ASO and 33 aged-matched controls. Phasic LA and LV global longitudinal strain (GLS) were obtained by transthoracic 2D-speckle tracking echocardiography (STE). Volumetric and functional analysis of LA and LV were also evaluated by 2D and 3D analysis. A multivariable model was performed to investigate the variables that best differentiate patients with D-TGA from healthy controls. LA strain parameters in D-TGA patients were within the normal range described for healthy subjects. However, the three LA strain parameters (Reservoir, Conduit, and Contraction) were lower in patients (LASr: 31.13±7.67vs. 49.71±8.38; LAS cd: -22.91±5.69vs. -34.55±6.54; LASct: -8.14±4.93vs. -15.15±6.07, p<.001 for all three comparisons). LA volumes were similar between patients and controls. LV-GLS remained significantly lower in the D-TGA group than in controls (-17.29±2.68vs. -21.98±1.84, p<.001). D-TGA patients had evidence of worse LV ejection fraction measured by the Teichholz method (63.38±8.23vs. 69.28±5.92, p=.001) and 3D analysis (57.97%±4.16vs. 60.67±3.39, p=.011) and diastolic dysfunction as compared to healthy controls. LV-GLS and conduit LAS were the variables best differentiating patients with D-TGA from healthy controls. LA strain is impaired in young adults with simple D-TGA late after the ASO, probably in agreement with some degree of LV dysfunction previously described.

Diagnostic Utility of 2D and 3D Speckle Tracking Echocardiography to Identify Ischemic Etiology of Left Ventricular Systolic Dysfunction.

Diagnostic Utility of 2D and 3D Speckle Tracking Echocardiography to Identify Ischemic Etiology of Left Ventricular Systolic Dysfunction.

Early Effects of Anthracycline Containing Chemotherapy on Left Ventricular Strain and Strain Rates Using 2D Speckle Tracking Echocardiography

Early Effects of Anthracycline Containing Chemotherapy on Left Ventricular Strain and Strain Rates Using 2D Speckle Tracking Echocardiography

Immediate, short-term, and long-term effects of balloon mitral valvuloplasty on the left atrial global longitudinal strain and its correlation to the outcomes in patients with severe rheumatic mitral stenosis

BackgroundLeft atrial global longitudinal strain (LA GLS) has been used as a new assessment tool for left atrial function. This article aims to investigate the effect of balloon mitral valvuloplasty (BMV) in patients with severe rheumatic mitral stenosis on LA GLS and its relation to the mitral valve area achieved after the procedure. The study included 95 patients with severe mitral stenosis who fulfilled the criteria for BMV (case group) and 80 normal healthy subjects (control group). All included participants underwent complete echocardiographic examinations. For the case group, LA GLS was assessed by 2D speckle-tracking Echocardiography before valvuloplasty, immediately after, within 24 h, at 6 months, and at 12 months, and the results were compared.ResultsThe impaired left-atrium strain in patients with severe mitral stenosis was improved immediately after BMV, and the improvement continued at 6 and 12 months post-BMV (23.1% ± 4.2 vs. 36.0% ± 4.9, 36.2% ± 4.5, and 40.1% ± 9.5, respectively p < 0.01). After BMV, there was a significant decrease in left atrial volume (76.3 ± 12.4 ml/m2 vs. 68.6 ± 10.4 ml/m2, p < 0.01) and a significant increase in the area occupied by the mitral valve (1.02 ± 0.18 cm2 vs. 1.60 ± 0.31 cm, p < 0.01). The immediate LA GLS and the mitral valve area were positively correlated (r = 0.64, p < 0.01). Furthermore, the immediate LA GLS was associated with significantly improved function class (p < 0.01).ConclusionsLA GLS can indicate left atrial (mainly reservoir) function. The improvement observed in patients after BMV may indicate that LA GLS can be used to evaluate the progress after BMV.Trial registration: The study was approved by the local ethics committee of the Faculty of Medicine in Minia University (Registration No. MUFMIRB 324-4-2022). Institutional Review Board, Faculty of Medicine, Minia University, Egypt. 324-4-2022, 24 18 April, 2022.

Role of 2d Speckle Tracking Echocardiography in Determining the Most Sensitive Predictor for Impaired Left Ventricular Systolic Function in Overweight and Obese Egyptian Females

Role of 2d Speckle Tracking Echocardiography in Determining the Most Sensitive Predictor for Impaired Left Ventricular Systolic Function in Overweight and Obese Egyptian Females

Speckle tracking echocardiography detects subtle right ventricular systolic dysfunction in post Covid syndrome after mild severity Covid-19

Abstract Introduction Now that the global COVID-19 pandemic has come to an end, many patients seek medical help for its aftermath giving rise to post COVID syndrome. Post COVID syndrome describes individuals with a history of probable or confirmed COVID-19 infection, usually 3 months from the onset of infection with symptoms that last for at least 2 months and no alternative diagnosis can be explained. The affection of the right ventricular (RV) systolic function is a cornerstone in the pathogenesis underlying Post COVID syndrome. Many modalities were used to assess the RV with a widespread debate as to the most accurate one. However, echocardiography remains the modality of choice for the evaluation of RV systolic function, especially when using its novel features as myocardial deformation imaging by speckle tracking echocardiography (STE) to surpass the RV’s peculiar anatomy, retrosternal position and complex architecture. Purpose The aim was to assess RV systolic function by STE 3-6 months after recovery from mild severity COVID-19 disease and correlate these findings with Post COVID syndrome. Methods This study included 96 adults (above 18 years of age) who were classified into three equal groups; the first group recruited 32 subjects 3-6 months after recovery from mild severity COVID-19 disease without post COVID syndrome, the second group included 32 subjects 3-6 months after recovery from mild severity COVID-19 disease with post COVID syndrome and the third group recruited 32 gender-matched healthy subjects of similar ages without previous COVID-19 disease (control group). Each subject underwent a detailed transthoracic echocardiography including RV function assessment using 2D RV STE imaging. Results RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) were significantly lower in patients after recovery from mild severity COVID-19 disease with post COVID syndrome (P-value= 0.010) in comparison to the other groups. There was a statistically significant negative correlation found between RV 2D STE parameters and RV end-diastolic dimension, systolic pulmonary artery pressure and RV myocardial performance index. Also, there was a statistically significant positive correlation found between RV 2D STE parameters and RV fractional area change, tricuspid annular plane systolic excursion and RV S'. The cardiac symptomatology in patients with post COVID syndrome was analyzed showing that the most common three symptoms were fatigue, palpitations and chest pain with a prevalence of 65.6%, 40.6% and 31% respectively. These three symptoms showed a significant negative relation with RV-GLS and RV-FWLS. Conclusion RV function assessed using STE occupied the lower normal ranges in patients recovering from mild severity COVID-19 disease, particularly those with post COVID syndrome. 2D STE may be used for the detection and follow-up of possible subtle long term RV dysfunction after mild severity COVID-19 disease.RV-GLS and RV-FWLS in the studied groupsRV-GLS and RV-FWLS using 2D STE

First month global longtudinal strain for predicting early pacemaker-induced left ventricular dysfunction (PIVD) six month after pacemaker implantation

Abstract Background Pacemaker-induced ventricular dysfunction (PIVD) and pacemaker-induced cardiomyopathy (PICM) emerged as a complication following right ventricular permanent pacemaker (PPM) implantation, showing a great occurrence in the first year. Finding an early predictor of PIVD and PICM is crucial in order to alleviate mortality, morbidity, and increase health-care cost efficiency. Purposes to find new predictor by analyzing effect of first month GLS using 2D-speckle tracking echocardiography and reduction of left ventricular ejection fraction (LVEF), known as PIVD, in the first 6 month after PPM implantation. Methods A single center, prospective cohort study was conducted to all patients with normal LVEF, indicated for PPM implantation. Data of GLS was measured before and after one month of PPM implantation. Data of LVEF was measured before and six month after PPM implantation. The change of GLS in one month after PPM implantation was measured as delta GLS, and the change of LVEF in six month was measured as delta EF. Results Fifty-three patients from May 2018 until October 2020 was enrolled for this study based on inclusion and exclusion criteria. Patient’s baseline characteristics show 62±14 years of age, most of them had hypertension (54.7%) and had single chamber pacemaker implantation (81.1%). Study analysis reveals that ejection fraction (EF) reduce significantly after six months pacemaker implantation (66,5±5,6% become 60,7±10.7%; p= &amp;lt;0,00001). There were 6 patients (11.3 % ) suffering PICM. Correlation analysis between the change of GLS in the first month and the change of LVEF in the first six months after PPM implantation was statistically significant with moderate correlation (p&amp;lt;0.00001; r= -0.486). Linear regression analysis shows that every 1 point decrease of first month GLS, affecting 1.83 point decrease of sixth month LVEF (b= -0.1837, p=&amp;lt;0.00001). Conclusion There is significant moderate correlation between the change of GLS in the first month and early reduction of LVEF in the first 6 months after PPM implantation.The Scheme of Research Sampling Method

Atrial cardiomyopathy by strain predicts atrial fibrillation in young Lamin A/C patients

Abstract Introduction Cardiac laminopathy is a malignant and highly arrhythmogenic form of dilated cardiomyopathy caused by variants in the lamin A/C (LMNA) gene. Atrial fibrillation (AF) is common during disease progression and often occurs at a young age, before evident structural cardiac changes and therefore, decision making on anticoagulation for AF is challenging. Whether atrial cardiomyopathy is present at this early stage of LMNA disease has not yet been explored. Purpose We aimed to evaluate for atrial cardiomyopathy in LMNA genotype positive subjects without prior atrial arrhythmias and assess whether atrial cardiomyopathy would be associated with the occurrence of AF during follow-up. Methods We prospectively recruited LMNA genotype-positive patients in a cohort study. Patients without prior documented atrial arrhythmias were evaluated for atrial cardiomyopathy by echocardiography. Atrial cardiomyopathy was evaluated by left atrial (LA) volume index (LAVI) and LA strain (peak reservoir strain and peak conduit strain). LA strain was assessed by 2D speckle-tracking echocardiography, averaged from apical four- and two-chamber views using a LA strain dedicated software with R-wave at end diastole as zero-reference point. Results We evaluated 129 LMNA genotype positive patients (51% women, age 40±15 years), of whom 57 patients (44%) had previous AF. Hence, we included 72 patients (32±14 years old, 49% female, left ventricular ejection fraction 53±11%) for assessment of atrial cardiomyopathy. The mean LA reservoir strain was 35±14%, conduit strain 25±13% and LAVI 38±23 ml/m2. During 7.7±5.0 years of follow-up, 28 (39%) patients developed AF after a median of 2.2 years. Patients with AF during follow-up had larger LAVI (47±30 vs. 32±10ml/m2, p=0.01) and worse LA reservoir strain (29±12% vs. 38±14%, p=0.02) at baseline than those who did not develop AF. LA reservoir strain and LAVI at baseline were both predictors of AF during short-term follow-up (HR 0.95 [CI 0.90-0.99], p=0.025 and HR 1.02 [CI 1.01-1.03], p=0.009, respectively), whereas LA conduit strain was not (HR 0.98 [CI 0.94-1.03], p=0.45). ROC analysis identified LA reservoir strain better than 32.5% as the best discriminating value for survival free of AF (log rank p=0.05) (Figure). Conclusion Atrial cardiomyopathy was common in LMNA genotype positive patients without previous atrial arrhythmias. LA volume and and LA reservoir strain predicted new onset AF during follow-up and may be used as markers for detecting short term risk of AF and potentially guide anticoagulation treatment in LMNA disease.LA reservoir strain and AF in LaminA/C

Prognostic value of 6-minute walking test for early prediction of doxorubicin induced cardiotoxicity

Abstract BACKGROUND/OBJECTIVES The 6-minute walking test (6MWT) is an easily performed, widely available and well-tolerated test for assessing the functional capacity of patients with HF in everyday clinical practice. The measurement properties of the 6MWT, such as reliability and validity, have been studied in patients with chronic heart failure, coronary artery disease, and cancer. However, little is currently known about the 6MWT and cardiotoxicity. The study was aimed at assessing the incidence of cancer therapy-related cardiovascular toxicity, identified the role of 6MWT as early predictor of early onset cardiotoxicity. Methods We performed a prospective study of 85 patients with breast cancer, treated with doxorubicin-based chemotherapy in the Department of Oncology and Hematology. 2D echocardiography and speckle tracking echocardiography were performed before anticancer treatment was started and after the treatment. We defined anthracycline-induced subclinical cardiotoxicity if a decline in global longitudinal strain (GLS) by &amp;gt;15% from baseline was observed and based on that patients were divided into two groups– patients with subclinical cardiotoxicity and patients without subclinical cardiotoxicity. The 6MWT was developed by the American Thoracic Society comprehensive guidelines. The 6MWT was performed in a long straight hospital corridor, over a 30-m distance. Statistical analysis was performed with „IBM SPSS statistics 27.0" program. Statistical significance level p&amp;lt;0.05. Results In the study population statistically significant GLS reduction was detected before and after the anticancer treatment (-21±0.53 vs. -18.1± 1.18, p&amp;lt;0.01). Of 85 women (mean age, 54.5 (9.3) years) subclinical left ventricle dysfunction was identified in 51 (60%). We found a significant negative correlation between baseline 6MWT and cardiotoxicity (r = 0.3 and p = 0.02). The baseline 6MWT results were significantly lower among patients with subclinical cardiotoxicity (494.3 ± 40.5 m vs 629.8 ± 60.1 m, p&amp;lt;0.001). The diagnostic validity of 6 MWT as a cardiotoxicity biomarker was evaluated using the non-parametric ROC curve (Pic. 1). We obtained an optimal cut-off point of 6MWT of ≤540m. (AUC = 0.98; p &amp;lt; 0.001). Conclusions Baseline 6MWT may be used as independed prognostic predictor of subclinical anthracycline-induced cardiotoxicity.ROC curve for 6MWT and cardiotoxicity

Global Constructive Work is associated with ventricular arrythmias after cardiac resynchronization therapy

Abstract Aim Non-invasive left ventricular (LV) pressure-strain loops provide a novel method for quantifying myocardial work by incorporating LV pressure in measurements of myocardial deformation. Early studies suggest that myocardial work parameters such as Global Constructive Work (GCW) could be useful and reliable in arrhythmia prediction particularly in patients undergoing cardiac resynchronization therapy. The aim of this study was to evaluate whether the magnitude of GCW was associated with occurrence of ventricular arrhythmias in patients after cardiac resynchronization therapy. Method and results Patients on guideline-recommended treatment with a cardiac resynchronization therapy defibrillator (CRT-D) were evaluated by 2D speckle-tracking echocardiography including measurements of GCW at least six months after implantation. The primary outcome was a composite of appropriate defibrillator therapy and sustained ventricular arrhythmia under the monitor zone. A total of 162 patients (mean age 66 years (±10), 122 males (75%)), were included. 16 (10%) patients experienced the primary outcome during a median follow-up of 18 months (IQR: 12-25) after the index echocardiography. Patients with below-median GCW (&amp;lt;1,473 mmHg%) had a hazard ratio for the outcome of 8.14 [95% CI: 1.83-36.08], P=0.006 compared to patients above the median in a univariate model and remained an independent predictor after multivariate adjustment for eGFR and QRS duration (hazard ratio 4.75 [95% CI: 1.01 – 22.28], P&amp;lt;0.05. Conclusion In patients treated with CRT-D, GCW below median level was associated with a 5-fold increase in risk of ventricular arrhythmias.

Abstract 13839: Value of 2D Speckle Tracking Echocardiography in Predicting Short-Term Cardiovascular Outcomes in Multisystem Inflammatory Syndrome in Children: Analysis of the MUSIC Data

Introduction: Cardiovascular (CV) involvement in multisystem inflammatory syndrome in children (MISC) is frequent (80-85%). Data on 2D speckle tracking echocardiography and its value in predicting CV outcomes are limited. Hypothesis: We hypothesized that an association exists between 2D speckle tracking strain/strain rate parameters at admission and adverse CV outcomes during hospitalization (inotropic support, major arrhythmias, cardiac arrest, ECMO, death, or transplant). Methods: We performed a multicenter (33 centers) cohort study on MISC patients hospitalized from 03/2020 to 11/2021 with at least one echocardiogram read by the Core Lab. The association between each 2D speckle tracking strain parameter and adverse CV outcomes was assessed by logistic regression. Results: Of 349 patients (median age 8.7 years [IQR 5.3,12.9]), 122 (35%) had decreased left ventricle (LV) ejection fraction (EF) and 156 (45%) had depressed LV 4-chamber longitudinal strain (LS) or basal circumferential strain (CS) during hospitalization. Worst EF and strain occurred around 5 days of illness. Of those with abnormal LS or CS strain, 50% normalized in ≤1 week, 95% within 50 days. Adverse CV outcomes occurred in 121 (35%) patients. Patients with adverse outcomes were older (p=0.003), more likely to have an underlying metabolic/genetic disorder (p=0.015), abnormal troponin (p&lt;0.001), and higher C-reactive protein (CPR) at admission (p&lt;0.001). They also had higher indexed LV end-diastolic volume (p&lt;0.001) and mass (p=0.015), worse EF (p&lt;0.001), worse LS (p=0.002), and worse CS (p=0.001). When adjusting for days of illness, age, gender, race, obesity, comorbidities, SARS-CoV-2 positivity, CRP, and abnormal troponin at admission, LS Z-score (adjusted OR 1.24 [95% CI 1.03,1.49], AUC 0.754 and longitudinal early diastolic strain rate (LEDSR; adjusted OR 1.98 [IQR 1.18, 3.33], AUC 0.760) at admission were independently associated with adverse CV outcomes. Conclusion: Almost half of the MISC patients had abnormal LS or CS at admission, but the majority recovered quickly. LS and LEDSR at admission were independently associated with adverse CV outcomes. These data may help in early characterization, risk stratification, and prognostication in patients with MISC.

Abstract 12980: Left Ventricular Alterations in Neonatal Encephalopathy - A Case-Control Study Using 3D Echocardiography

Introduction: Despite therapeutic hypothermia (TH), neonates with neonatal encephalopathy (NE) often present with multi-organ dysfunction, including cardiac alterations in the first days of life. Objectives: Describe the cardiac performance of neonates with moderate to severe NE treated with TH using three-dimensional echocardiography (3D-ECHO) relative to a control population without NE. Methods: Single-centre prospective case-control study of neonates with moderate to severe NE treated with TH between 2019 and 2021, compared to healthy neonates. The control group were newborns recruited in the nursery without need for resuscitation. 3D-ECHO was performed on day of life (DOL) 2. Left ventricular (LV) metrics were measured using 3D-Speckle Tracking Echocardiography. Descriptive statistics were used to compare the two groups. Results: We included 16 neonates with NE and 50 controls. Birthweight and gestational age at birth were similar (Table 1). Neonates with NE had lower systolic blood pressure (BP) but similar diastolic BP at ECHO, while 11/16 were exposed to cardiovascular medications at ECHO. These neonates had lower LV end-diastolic volume (4.2 [1.2] vs 5.0 [1.4] mL; p=0.04), lower stroke volume (2.2 [0.7] vs 2.9 [0.8] mL; p=0.002) and lower ejection fraction (52 [6] vs 56 [8] %; p=0.0008). These infants also had lower peak global circumferential strain (-25 [5] vs -28 [5] %; p=0.03). The association between NE and LV-ejection fraction remained significant after adjusting for weight (b=-5.7%, 95% Confidence Interval [-9.2; -2.2], p=0.002). Conclusions: Neonates with moderate to severe NE had reduced LV functional markers on DOL 2 as comparted to healthy controls. They had decreased systolic BP and LV end diastolic volume. These findings may be secondary to the asphyxia, catecholamines and medications exposure, or to TH. Future studies should consider 3D-ECHO as a modality to investigate these patients and the impact of therapeutic interventions.

Sex difference in the age-related decline of global longitudinal strain of left ventricle

Global longitudinal strain (GLS) is a valuable indicator of subclinical myocardial dysfunction. Whether the effect of aging on subclinical left ventricular dysfunction is sex-specific is not well documented. This study aimed to identify age-related changes in GLS according to sex in patients with a normal left ventricular ejection fraction (LVEF). In this cross-sectional, single-center cohort study in Korea, participants who underwent GLS measurement using 2D speckle-tracking echocardiography were retrospectively reviewed, and participants with normal LVEF (≥ 55%) without documented cardiovascular disease were included. Reduced GLS was defined as absolute values below 18%. Of 682 study participants (mean age, 58; female, 51.5%), 209 (30.6%) had reduced GLS. Females with reduced GLS were older than those with normal GLS (68 vs. 58 years, P < 0.001); with no difference of age in males (55 vs. 57 years; P = 0.265). Univariate analysis showed age to correlate significantly with reduced GLS only in female (r =  − 0.364; P < 0.001). In multivariable analysis, female > 66 years old had significantly higher risk of reduced GLS (Odds ratio 2.66; 95% CI 1.22–5.76; P = 0.014). In participants with normal LVEF, GLS decreased with age in females but not in males. Particularly, females aged 66 years and older had a significantly higher risk of reduced GLS. These findings suggest that GLS could be a valuable parameter for assessing subclinical cardiac dysfunction, especially in older females.

Three-dimensional echocardiography for the evaluation of hypertrophic cardiomyopathy patients: relation to symptoms and exercise capacity

Patients with hypertrophic cardiomyopathy may exhibit impaired functional capacity, associated with increased morbidity and mortality. Systolic function is one of the determinants of functional capacity. Early identification of systolic disfunction may identify patients at risk for adverse outcomes. Myocardial deformation parameters, derived from three-dimensional (3D) speckle-tracking echocardiography (3DSTE) are useful tools to assess left ventricular systolic function, and are often abnormal before a decline in ejection fraction is seen. The aim of this study was to evaluate the correlation between myocardial deformation parameters obtained by 3DSTE and functional capacity in patients with hypertrophic cardiomyopathy. Seventy-four hypertrophic cardiomyopathy adult patients were prospectively evaluated. All patients underwent a dedicated 2D and 3D echocardiographic examination and cardiopulmonary exercise testing (CPET). Values of 3D global radial (GRS), longitudinal (3DGLS) and circumferential strain (GCS) were overall reduced in our population: 99% (n = 73) of the patients had reduced GLS, 82% (n = 61) had reduced GRS and all patients had reduced GCS obtain by 3DSTE. Average peak VO2 was 21.01 (6.08) ml/Kg/min; 58% (n = 39) of the patients showed reduced exercise tolerance (predicted peak VO2 < 80%). The average VE/VCO2 slope was 29.0 (5.3) and 16% (n = 11) of the patients had impaired ventilatory efficiency (VE/VCO2 > 34). In multivariable analysis, 3D GLS (β1 = 0.10, 95%CI: 0.03;0.23, p = 0.014), age (β1 = -0.15, 95%CI: -0.23; -0.05, p = 0.002) and female gender (β1 = -5.10, 95%CI: -7.7; -2.6, p < 0.01) were independently associated with peak VO2. No association was found between left ventricle ejection fraction obtain and peak VO2 (r = 0.161, p = 0.5). Impaired myocardial deformation parameters evaluated by 3DSTE were associated with worse functional capacity assessed by peak VO2.

Evaluation of left atrial and left ventricular functions with 3D speckle-tracking echocardiography in patients with coronary artery tortuosity.

Tortuosity in the coronary arteries is a very common entity encountered during angiography. The effect of coronary artery tortuosity (CAT) on the myocardium has not been completely investigated. The aim of the current study was to assess the effects of CAT on left atrial (LA) and left ventricular (LV) myocardial functions by 3D speckle-tracking echocardiography (3D-STE). Seventy-five patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms (CAG) were enrolled into the study. Following CAG, the 2D images were obtained first, and then 3D images were obtained for strain analysis. The LAS-r, LAS-active, and LV-GLS were significantly depressed in the CAT (+) group (p<.001, p<.001, p=.012, respectively). The multivariate regression models demonstrated that LAS-r (p<.001), LAS-active (p=.009), and LV-GLS (p=.024) were found to be independent factors predicting CAT. The current study is the first to focus on the assessing both LA and LV myocardial dynamics in CAT (+) patients by strain echocardiography. The results of our study support the patients with CAT may have subclinical LA and LV myocardial involvements.

Subtle Changes in Myocardial Work Indices Assessed by 2D-Speckle Tracking Echocardiography Are Linked with Pathological LV Remodeling and MACEs Following an Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention.

The goal of this study was to assess whether subtle changes in myocardial work indices may predict left ventricular (LV) remodeling and major cardiac events (MACEs) in patients with a first ST-elevation acute myocardial infarction (STEMI) and preserved LVEF after successful myocardial revascularization with PCI. Methods. Consecutive STEMI patients in sinus rhythm and with an LV ejection fraction ≥ 50% following a successful PCI were recruited. Conventional and two-dimensional speckle tracking echocardiography (2D-STE) was conducted within 36 h of the PCI and 3 months later. Patients having an increase of more than 20% in LV diastolic volume were included in the LV remodeling group. MACEs were noted throughout a four-year period of follow-up. Results: The study comprised 246 STEMI patients with a mean age of 66; 72% of whom were men. In 24% (58) of the patients, LV remodeling developed. These patients were older, more frequently hypertensive, and had a smoking history. They also exhibited significantly lower baseline and 3-month values for the myocardial global index (GWI), global constructive work (GCW), and global myocardial efficiency (GWE). The cut-off values of 1670 mmHg% for GWI and 83% for GWE were predictive of LV remodeling (p < 0.0001). During the four-year follow-up period, 19% of STEMI patients experienced a MACE, involving 15% from non-LV remodelers and 34% from LV remodelers (p = 0.01). The cut-off values for baseline GWI of 1680 mmHg% and baseline GWE of 84% had the best accuracy in predicting MACEs. In conclusion, non-invasive myocardial work indices offered a reproducible and accurate method to predict post-MI LV remodeling and MACEs.

Role of Cardiovascular Magnetic Resonance Imaging in Early Detection of Myocarditis in Patients Recovered from COVID-19

Objective: To assess cardiac involvement in patients recovered from COVID-19 with no clinical evidence of myocarditis, using various non-invasive parameters including Transthoracic Two-dimensional Speckle Tracking Echocardiography (STE) and cardiac magnetic resonance imaging (CMR). Methods: This prospective study was conducted in the Cardiology Departments of Maadi Military Hospital and Benha University Hospitals. A total of 74 patients were initially enrolled during their hospital stay, but only 50 of them met the inclusion and exclusion criteria. The CMR examination was performed in conjunction with echocardiography, ECG, and laboratory investigations on the same day, which occurred 2-12 weeks after recovering from confirmed COVID-19 infection. Patient scheduling for CMR and other examinations depended on the availability of the CMR machine. Results: According to CMR diagnosis, 23 (46%) patients were diagnosed to have myocarditis by CMR, the patients were categorized into two groups based on these results: normal group (27 patients) &amp; myocarditis group (23 patients). According to GLS, 21 (42%) patients were diagnosed to have myocarditis by STE (diagnosis of Myocarditis with Global longitudinal strain was considered with cut-off point of &gt;-21.33 with Sensitivity of 91.30% and Specificity of 92.59% (P &lt;0.0001). 2D STE showed 87.50% sensitivity, 92.31% specificity and 90.00% accuracy to diagnose myocarditis, while CMR showed a 95.83% sensitivity, 96.15% specificity of and 96.00% accuracy. Conclusion: Myocarditis was found in 46% of asymptomatic COVID-19-recovered patients. CMR is a valuable tool for early myocarditis detection when combined with 2D STE, offering high accuracy. Significant differences were observed between suspected myocarditis patients and those with normal results on both 2D STE and CMR.