Apical Longitudinal Strain Research Articles

Changes in left ventricular global and regional longitudinal strain during right ventricular pacing

Background: LV strain and functions may be altered by Right ventricular apical pacing (RVAP). Right ventricular Septal pacing (RVSP) might be a better alternative. The detrimental effect of RV pacing may be mediated by regional LV impairment. Objectives: Our study aimed to demonstrate the short term impacts of right ventricular (RV) apical and septal pacing on Left ventricular (LV) regional and global longitudinal strain (GLS) in patients with preserved ejection fraction (EF). Methods: 62 patients indicated for permanent pacemaker implantation and preserved LV systolic function were included. Dual chamber pacemakers were implanted in all patients. Patients were divided into 2 groups according to RV lead position: group A (RVAP, n = 32) and group B (RVSP, n = 30). Patients were examined at baseline and after 6 months of implantation for LV systolic functions, global and regional strain by echocardiography and 2D speckle tracking echocardiography. Results: Paced-QRS duration was significantly shorter in group B compared to group A patients (P value 0.02). Regarding ventricular strain, there were no statistically significant difference between both groups at baseline measurements in comparisons of GLS, relative apical longitudinal strain (rALS) and regional longitudinal strain (RLS) (P value of >0.05). In contrast there was statistically significant difference between both groups appeared in results of GLS (P value of 0.01) at 6 months. In addition, regional longitudinal strain in septal, apical and rALS were affected after 6 months with P value of 0.02, 0.03 and 0.03 respectively. Conclusion: RVAP appears to worsen global longitudinal strain more than RVSP, and the resultant decrease in apical strain is most correlated region to decrease in GLS.

Changes in left ventricular global and regional longitudinal strain during right ventricular pacing

Background: LV strain and functions may be altered by Right ventricular apical pacing (RVAP). Right ventricular Septal pacing (RVSP) might be a better alternative. The detrimental effect of RV pacing may be mediated by regional LV impairment. Objectives: Our study aimed to demonstrate the short term impacts of right ventricular (RV) apical and septal pacing on Left ventricular (LV) regional and global longitudinal strain (GLS) in patients with preserved ejection fraction (EF). Methods: 62 patients indicated for permanent pacemaker implantation and preserved LV systolic function were included. Dual chamber pacemakers were implanted in all patients. Patients were divided into 2 groups according to RV lead position: group A (RVAP, n = 32) and group B (RVSP, n = 30). Patients were examined at baseline and after 6 months of implantation for LV systolic functions, global and regional strain by echocardiography and 2D speckle tracking echocardiography. Results: Paced-QRS duration was significantly shorter in group B compared to group A patients (P value 0.02). Regarding ventricular strain, there were no statistically significant difference between both groups at baseline measurements in comparisons of GLS, relative apical longitudinal strain (rALS) and regional longitudinal strain (RLS) (P value of >0.05). In contrast there was statistically significant difference between both groups appeared in results of GLS (P value of 0.01) at 6 months. In addition, regional longitudinal strain in septal, apical and rALS were affected after 6 months with P value of 0.02, 0.03 and 0.03 respectively. Conclusion: RVAP appears to worsen global longitudinal strain more than RVSP, and the resultant decrease in apical strain is most correlated region to decrease in GLS.

Changes in Left Ventricular Global and Regional Longitudinal Strain During Right Ventricular Pacing.

BackgroundOur study aimed to demonstrate the short-term impacts of right ventricular apical pacing (RVAP) and right ventricular septal pacing (RVSP) on left ventricular (LV) regional longitudinal strain (RLS) and global longitudinal strain (GLS) in patients with preserved ejection fraction (EF). LV strain and functions may be altered by RVAP. RVSP might be a better alternative. The detrimental effect of right ventricular (RV) pacing may be mediated by regional LV impairment.MethodsSixty-two patients indicated for permanent pacemaker implantation and preserved LV systolic function were included. Dual chamber pacemakers were implanted in all patients. Patients were divided into two groups according to RV lead position: group A (RVAP, n = 32) and group B (RVSP, n = 30). Patients were examined at baseline and after 6 months of implantation for LV systolic functions, global and regional strain by echocardiography and 2D speckle tracking echocardiography.ResultsPaced QRS duration was significantly shorter in group B compared to group A patients (P = 0.02). Regarding ventricular strain, there was no statistically significant difference between both groups at baseline measurements in comparisons of GLS, relative apical longitudinal strain (rALS) and RLS (P > 0.05). In contrast, there was statistically significant difference between both groups in results of GLS (P = 0.01) at 6 months. In addition, RLSs in septal, apical and rALS were affected after 6 months with P values of 0.02, 0.03 and 0.03, respectively.ConclusionRVAP appears to worsen GLS more than RVSP, and the resultant decrease in apical strain is most correlated region to decrease in GLS.

Abstract 14838: Regional Contributions to Impaired Myocardial Mechanical Function in Heart Failure With Preserved Ejection Fraction

Background: The pathophysiology underlying the transition from hypertensive heart disease (HHD) to heart failure with preserved ejection fraction (HFpEF) remains unclear. Regional differences in impaired myocardial function may contribute to the more pronounced overall mechanical dysfunction seen in HFpEF compared to HHD. Methods: We assessed regional myocardial deformation in 129 HFpEF patients, 158 hypertensive patients with HHD and no heart failure, and 40 healthy controls. Peak systolic strain was assessed in the apical 4 and 2 chamber views and the average was calculated for the 4 apical (ALS), 4 mid ventricular (MLS) and 4 basal (BLS) regions. Results: All 3 groups had preserved left ventricular ejection fraction (LVEF ≥50%). Whereas BLS and MLS were more impaired in HHD than in controls, ALS was significantly more impaired in HFPEF than HHD (Figure). In area under the receiver operating curve (AUC) analyses, ALS was the best diagnostic marker for differentiating HFpEF from HHD (AUC: ALS=0.67; MLS=0.59; BLS=0.60). After adjusting for the main characteristics that differed between HFpEF and HHD (age, e’, systolic blood pressure, NT-pro BNP, LV end-diastolic volume, and LVEF), ALS remained independently associated with HFpEF vs. HHD status (OR 1.18 [1.02-1.37], P=0.030 per 1% decrease). By contrast, global longitudinal strain was not significantly associated with HFpEF vs. HHD status in multivariable analyses (P=0.09). Conclusion: We observed that whereas basal and mid-level longitudinal strain is more impaired in HHD than in controls, apical longitudinal strain is substantially more impaired in HFPEF than HHD. These findings suggest that preservation of apical mechanical function may play an important role in the transition from HHD to HFPEF.

Abstract 18015: “Apical Sparing” Longitudinal Strain Pattern With Cardiac MRI Correlates With LGE Distribution in Cardiac Amyloidosis

Introduction: Regional variations in longitudinal strain (LS) have been demonstrated on echocardiography in patients with cardiac amyloidosis (CA). Hypothesis: We aimed to describe regional patterns in LS using feature-tracking software applied to cardiac MRI images (CMR) in CA, hypertrophic cardiomyopathy (HCM), and Anderson-Fabry’s disease (AFD) and to relate these patterns to late gadolinium enhancement (LGE). Methods: Patients with CA (n=51) were compared to left ventricular mass index balanced patients with HCM (n=20) and AFD (n=20). LS analysis was performed using Velocity Vector Imaging (VVI) on steady state free precession cine images (4, 3, and 2-chamber views). Values were recorded for each of 18 myocardial segments. A regional LS ratio representing “apical sparing” was calculated as the ratio of the sum of the apical segmental LS values divided by the sum of the basal and mid-segmental LS values. LGE was quantified for the basal, mid, and apical myocardial segments using a threshold of 5SD above remote myocardium. A regional LGE ratio was calculated similar to the “apical sparing” ratio. Results: The regional LS ratio was significantly higher in patients with CA (1.05±0.49) than in patients with AFD (0.79±0.24; p=0.025) and HCM (0.84±0.32; p=0.025). In patients with CA there was a regional difference in LGE burden, with lower LGE in the apex (31.9±20%) compared to the basal (52.7±22%) and mid-segments (37.9±19%). The regional LGE ratio was significantly lower in patients with CA (0.34±0.14) than in patients with AFD (0.54±0.64; p<0.001) and HCM (0.73±0.41; p<0.001). Conclusions: Cardiac amyloidosis is characterized by regional variations in LS from base to apex. “Apical sparing” in LS is seen with CMR images and can be an additional tool to differentiate CA from other causes of LVH. The concomitant presence of a base to apex gradient in LGE burden by CMR suggests that the regional strain gradient may be associated with burden of amyloid deposition.

Right ventricular remodelling induced by exercise training in competitive athletes.

Conflicting evidence exists concerning right ventricular (RV) morphological and functional remodelling in trained athletes, with a very few longitudinal data prospectively investigating the RV changes. The aim of this study was to assess the morphological and functional RV changes occurring during the competitive season in young athletes engaged in the most popular team sports. Twenty-nine top-level athletes (age: 20.9 ± 6.7 years), practicing basketball and volleyball, were evaluated at pre-season, mid-season, and end-season time-points, using tissue Doppler imaging and 2D speckle-tracking echocardiography. RV basal and mid-cavity end-diastolic diameters (EDDs; overall P = 0.011 and P < 0.0001, respectively), and RV diastolic area (overall P < 0.0001) increased during the season. Conversely, RV outflow tract did not vary (overall P = 0.96). During the season, no significant differences were observed in RV diastolic functional indexes and in RV fractional area change (overall P = 0.35). Global RV longitudinal strain did not significantly change (overall P = 0.52), although apical longitudinal strain significantly increased (overall P = 0.017). In association, left ventricular (LV) volume and mass increased during the season (overall P = 0.007). On multivariate analysis, LV mass was the only independent predictor of RVEDD at pre-season (β = 0.69, P < 0.0001) and at end-season (β = 0.82, P < 0.0001). Right ventricular chamber size increases during the competitive season in top-level athletes, with no significant changes in the outflow tract. RV morphological adaptation in top-level athletes practicing team sports is not associated with a reduction in RV function or in myocardial deformation and occurs in close association with changes on the left ventricle, suggesting a physiological remodelling of the right ventricle.

Tissue Velocities and Myocardial Deformation in Asymptomatic and Symptomatic Aortic Stenosis.

Assessment of myocardial longitudinal function has proved to be a sensitive marker of deteriorating myocardial function in aortic stenosis, demonstrated by both color Doppler tissue imaging and recently by two-dimensional speckle-tracking echocardiography. The aim of this study was to compare velocity (color Doppler tissue imaging) and deformation (two-dimensional speckle-tracking echocardiography) in relation to global and regional longitudinal function in asymptomatic and severe symptomatic aortic stenosis. In a cross-sectional design, 231 patients with aortic stenosis were divided into four groups: asymptomatic moderate aortic stenosis (aortic valve area, 1.0-1.5 cm(2); n = 38), asymptomatic severe aortic stenosis (aortic valve area < 1.0 cm(2); n = 66), and symptomatic severe aortic stenosis with preserved (n = 68) and reduced (<50%) left ventricular ejection fraction (n = 59). Among all global (peak systolic s', diastolic e' and a', longitudinal displacement, and global longitudinal strain and strain rate) and regional longitudinal (basal, middle, and apical longitudinal strain and strain rate) parameters, only diastolic e', longitudinal displacement, and basal longitudinal strain (BLS) remained significantly associated with symptomatic status, independent of age, gender, heart rate, aortic valve area, stroke volume index, left ventricular mass index, left atrial volume index, and tricuspid annular systolic plane excursion. Furthermore, in a model with the aforementioned parameters, including e', longitudinal displacement, and BLS, only BLS remained significantly associated with symptomatic status in the entire study population (BLS per one-unit decrease: odds ratio, 1.23; 95% CI, 1.04-1.46; P = .017). Furthermore, patients with BLS < 13% were more likely to be symptomatic (odds ratio, 4.97; 95% CI, 2.6-9.4; P < .001), and no patients with asymptomatic severe aortic stenosis with BLS ≥ 13% were admitted with myocardial infarction or heart failure during follow-up of 1,462 days. Among the many echocardiographic measures of longitudinal velocity and deformation, BLS has the strongest association with symptomatic status in aortic stenosis, and BLS < 13% is related to adverse outcomes in severe asymptomatic aortic stenosis.

Impact of endoscopic lung volume reduction on right ventricular myocardial function.

IntroductionEndoscopic lung volume reduction (ELVR) provides a minimally invasive therapy for patients with severe lung emphysema. As its impact on right ventricular (RtV) function is undefined, we examined the extent of RtV functional changes following ELVR, as assessed by use of speckle tracking-based RtV deformation analysis.MethodsWe enrolled 32 patients with severe emphysematous COPD scheduled for bronchoscopic LVR using endobronchial valves (Zephyr, PulmonX, Inc.), comprising 16 matched clinical responders and 16 non-responders. Echocardiography was conducted one day prior to ELVR and at an eight-week postprocedural interval.ResultsPatients were predominantly of late middle-age (65.8±8.7yrs), male (62.5%) and presented advanced COPD emphysema (means FEV1 and RV: 32.6% and 239.1% of predicted, respectively). After ELVR, RtV apical longitudinal strain improved significantly in the total study cohort (-7.96±7.02% vs. -13.35±11.48%, p=0.04), whereas there were no significant changes in other parameters of RtV function such as RtV global longitudinal strain, TAPSE or pulmonary arterial systolic pressure. In responding patients, 6MWT-improvement correlated with a decrease in NT-proBNP (Pearson´s r: -0.53, p=0.03). However, clinical non-responders did not exhibit any RtV functional improvement.DiscussionELVR beneficially impacts RtV functional parameters. Speckle tracking-based RtV apical longitudinal strain analysis allows early determination of RtV contractile gain and identification of clinical responsiveness.

Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing

BackgroundRecent work has shown no difference in change of LVEF between RV apical (RVA) pacing and non-RVA pacing in patients with normal LV function. We hypothesised that a more sensitive...

Left ventricular strain modifications after maximal exercise in athletes: a speckle tracking study.

The increase in systolic indexes from rest (R) to exercise is achieved by combination of enhanced heart rate (HR) and stroke volume (SV). Aim of this study was to evaluate left ventricular (LV) longitudinal, circumferential, and torsional components immediately after a maximal intensity exercise (ME) by speckle tracking echocardiography (STE). Twenty-seven male water polo players performed an ME that consisted of 6 repeats of 100m freestyle swim sets. An echocardiographic examination was performed before and after ME. STE was performed to obtain the analysis of LV myocardial deformation. There were no differences between R and ME regarding LV longitudinal strains (PVLS). Apical circumferential LV strain (AVCS) and LV longitudinal strain rate (SR) increased at ME with respect to R (R: -23.1±4.9%; ME: -28.4±7.6%, P<0.05; R: -1.1±0.1/sec, ME: -1.5±0.2/sec, P<0.01). LV twisting (LVT) and untwisting (UTW) increased at ME (R: 7.9±2.4°, ME: 14.2±3.2°, P<0.001; R: -107.2±47.4; ME: -158.5±61.5 °/sec; P<0.01). At ME, apical rotation (Arot) had higher values than R values (5.4±3.0°; 10.0±6.0°; P<0.01) and time-to-peak (TTP) of apical segments are earlier than all TTP. SV was related to LVT (r=0.56, P=0.01), AVCS (r=-0.59, P=0.005) and Arot (r=0.46, P=0.04). At multivariate analysis, AVCS was the independent predictor of SV (β=-0.58; P<0.05). Apical fibers and LVT give the main contribution to systolic components at ME. The storage of energy during LVT, released during early diastole, seems to be a fundamental mechanism to support diastolic filling during maximal exercise.

Association of ischemic heart disease to global and regional longitudinal strain in asymptomatic aortic stenosis.

Longitudinal deformation has been shown to deteriorate with progressive aortic stenosis as well as ischemic heart disease. Despite that both conditions share risk factors and are often coexisting, studies have not assessed the influence on longitudinal deformation for both conditions simultaneously. Thus the purpose of this study was to evaluate the association between subclinical ischemic heart disease and global and regional longitudinal strain in asymptomatic patients with significant aortic stenosis. Prevalent patients with a diagnosis of aortic stenosis at six hospitals in the Greater Copenhagen area were screened for inclusion. A total of 104 asymptomatic patients with moderate-severe aortic stenosis (aortic valve area ≤1.5 cm(2)) fulfilled study criteria and underwent advanced echocardiographic analysis and coronary angiography by multi-detector computed tomography. Angiography revealed coronary stenosis >50% in 31% (n = 32). All regional longitudinal strain measures (apical, mid and basal longitudinal strain) were significant predictors of significant coronary stenosis (>70% stenosis), but only apical and mid longitudinal strain were significant predictors in multivariable analyses independent of aortic valve area, stroke volume index, pro-BNP, valvulo-arterial impedance, body mass index and heart rate. In linear regression models with both aortic valve area and significant coronary stenosis, apical (p < 0.001) and mid (p < 0.01) longitudinal strain were associated to significant coronary stenosis but not aortic valve area. Conversely, basal longitudinal strain was significantly associated to aortic valve area (p = 0.001), but not to significant coronary stenosis. Subclinical coronary artery disease is frequent in moderate and severe aortic stenosis, and should be suspected when regional longitudinal dysfunction is predominant in the apical and mid ventricular segments.

Impaired global and segmental myocardial deformation assessed by two-dimensional speckle tracking echocardiography in patients with vitamin B12 deficiency

Contrary effects of vitamin B12 deficiency have been shown on the cardiovascular system. Aim of our study was to analyze left ventricular (LV) myocardial deformation, by using the two dimensional (2D) speckle tracking echocardiography (STE) in patients with vitamin B12 deficiency and normal LV ejection fraction. Twenty-five patients with vitamin B12 deficiency (B12 levels < 200 pg/mL; mean age: 29.6 ± 8.2 years, 15 female), and 27 healthy controls (B12 levels > 200 pg/mL; mean age: 30.1 ± 6.9 years, 13 female) were included in the study. 2D echocardiography images were transferred to a workstation for further offline analysis. Longitudinal peak systolic (LPSS) and global strain (LGS) was obtained from 4 chamber and apical long axis (APLAX) views. Standard echocardiographic parameters and tissue Doppler imaging (TDI) velocities were compared between the groups. All LPSS values in the patient group except for apical 4C septal wall longitudinal strain were significantly decreased than those in the control group. There was a positive correlation between B12 levels and strain values except apical 4C septal wall strain values. We found that in patients with vitamin B12 deficiency, global and segmental myocardial deformation was impaired and this impairment was correlated with the levels of vitamin B12.

The Effects of Serum Potassium and Magnesium Levels in a Patient with Gitelman's Syndrome on the Timing of Ventricular Wall Motion and the Pattern of Ventricular Strain and Torsion

Gitelman's syndrome is a primary renal tubular hypokalemic metabolic alkalosis. Hypokalemia and hypomagnesemia can cause cardiac tissue excitability and conduction. Global ventricular mechanical function is directly related to the contractile properties of cardiac myocytes, which are largely dependent on the flow of ions such as potassium and magnesium. Here, we show that increased levels of potassium, in addition to magnesium, in a patient with Gitelman's syndrome significantly impacts the timing of ventricular wall motion and the pattern of ventricular strain and torsion. Two-dimensional speckle tracking echocardiography was used for evaluation of the hypokalemic-hypomagnesemic period (first day) and third day after potassium chloride and magnesium replacement therapy. The transthoracic echocardiography showed that the percent ejection fraction was similar in hypokalemic-hypomagnesemic (63%) and normokalemic-normomagnesemic (after potassium and magnesium therapy, 67%) hearts. However, decreased left ventricular apical 4-chamber peak systolic longitudinal strain, left ventricle global peak systolic strain, and global torsion values increased after potassium chloride and magnesium replacement therapy.

Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis

BackgroundThe diagnosis of cardiac amyloidosis (CA) is challenging owing to vague symptomatology and non-specific echocardiographic findings.ObjectiveTo describe regional patterns in longitudinal strain (LS) using two-dimensional speckle-tracking echocardiography in CA and...

Diagnostic value of echocardiography in the diagnosis of pulmonary hypertension.

AimsTo determine the value of echocardiography including tissue Doppler imaging (TDI) and right ventricular (RV) speckle tracking analysis for the diagnosis of pulmonary hypertension (PH) and discrimination between pre- and postcapillary PH.Methods and Results155 consecutive patients (mean age 70.5±13.0 years, 81 [52%] male gender, BMI 27.2±6.1 kg/m2) with PH undergoing right heart catheterization (RHC) and transthoracic echocardiography (TTE) with TDI between January 2008 and December 2009 were retrospectively evaluated including offline speckle tracking analysis of RV contractility. After RHC 23.2% of patients (36) were diagnosed with precapillary PH. Invasive results from RHC were significantly correlated to TTE measurements (E/é, postcapillary wedge pressure [PCWP], r = 0.61, P<0.001; mean, systolic pulmonary arterial pressure [mPAP, sPAP], r = 0.43, P<0.001). Single echocardiographic parameters were of good predictive value for final PH-diagnosis (sPAP, area under the curve [AUC] 0.63, P = 0.025; lateral apical RV longitudinal strain [RVaSl)], AUC 0.76, P = 0.001; E/é, AUC 0.84, P<0.001) which could be increased by combining most predictive parameters after receiver operating curves (ROC) cut off analysis (sPAP>69 mmHg, E/é<12, RVaSl ≥−8.4%). TTE had a sensitivity of 33.33% and a specificity of 100% to identify patients with precapillary PH, and a negative predictive value of 84.72% to rule out precapilary PH.ConclusionEchocardiography allows feasible and reliable estimation of PH and seems helpful to distinguish between pre-and postcapillary PH. Further prospective studies on patients with different manifestations of PH must validate the predictive value of echocardiography in this clinical setting.

Mitral annular plane systolic excursion on exercise: a simple diagnostic tool for heart failure with preserved ejection fraction

Current guidelines for the diagnosis of heart failure with normal or preserved ejection fraction (HFpEF) are based on measurements at rest. However, in HFpEF ventricular dysfunction is more apparent on exercise. We hypothesized that Mitral annular plane systolic excursion (MAPSE) which is easy to acquire on exercise could be used to detect occult left ventricular (LV) impairment. Cardiopulmonary exercise testing and 2D-Doppler echocardiography were performed at rest and on exercise. MAPSE was assessed by using M-mode (apical four-chamber view). Sixty-two patients with HFpEF [LV ejection fraction (LVEF)=60 ± 7%] with reduced VO(2) max (18.6 ± 5.2 mL/min/kg) and 36 control subjects (LVEF=62 ± 7%, VO(2) max 29.4 ± 4.8 mL/min/kg) were studied. MAPSE at rest was significantly lower in patients (10.9 ± 2.1 vs. 12.1 ± 2.2 mm in controls, P= 0.008) which was even more pronounced on exercise (12.0 ± 2.2 mm and 16.2 ± 2.7 mm, respectively, P< 0.001). At rest MAPSE correlated with longitudinal strain (r = 0.432, P= 0.001), peak systolic myocardial velocity (r = 0.545, P< 0.001), and early diastolic myocardial velocity (r = 0.322, P= 0.02) and on exercise with LV apical rotation (r = 0.582, P< 0.001), longitudinal strain (r = 0.589, P< 0.001), and myocardial tissue velocities (P< 0.001). The area under the receiver operating characteristic curve for MAPSE was 0.655 (confidence interval 0.540-0.770) at rest and 0.901 (confidence interval 0.835-0.967) on exercise, to differentiate between patients and controls. Mitral annular plane systolic excursion at rest and on exercise correlates well with more sophisticated measurements of ventricular function in HFpEF patients. It is potentially a useful and easily acquired measurement, especially on exercise, for the diagnosis of HFpEF.

Rotational Mechanics of the Left Ventricle in AL Amyloidosis

The aim of this study was to investigate whether alterations in left ventricular (LV) twisting and untwisting motion could be induced by cardiac involvement in patients with immunoglobulin light-chain (AL) systemic amyloidosis. Forty-five patients with AL amyloidosis and 26 control subjects were evaluated. After standard echocardiographic measurement and two-dimensional (2D) speckle tracking echocardiography, LV rotation at both basal and apical planes, twisting, twisting rate, and longitudinal strain were measured. Tissue Doppler imaging (TDI) derived early diastolic peak velocity at septal mitral annulus (E') was also evaluated. Twenty-six of 45 patients with systemic amyloidosis were classified as having cardiac amyloidosis (CA) if the mean value of the LV wall thickness was ≥ 12 mm or not (NCA) if this value was not reached. In NCA patients, both LV twist and untwisting rate were increased while they were decreased in CA patients making them similar to the control group. Longitudinal strain was reduced only in CA patients. Impaired relaxation as indicated by E' values was progressively reduced in the course of the disease. Both twisting and untwisting motions are increased in patients with AL systemic amyloidosis with no evidence of cardiac involvement while they are reduced in patients with evident amyloidosis cardiac involvement. This finding suggests that impaired LV relaxation induces a compensatory mechanism in the early phase of the disease, which fails in more advanced stage when both twisting and untwisting rates are reduced. The increase in LV rotational mechanics could be a marker of subclinical cardiac involvement.

Two‐Dimensional Ultrasound Speckle Tracking Imaging in Evaluation of Early Changes in Left Ventricular Diastolic Function in Patients with Essential Hypertension

To investigate two-dimensional ultrasound speckle tracking imaging (STI) in evaluating values of early changes in left ventricular diastolic function in patients with essential hypertension (EH). Seventy-five EH patients with left ventricular normal geometry (LVN), including 38 cases with nonleft atrial enlargement (NLAE) and 37 cases with left atrial enlargement (LAE), and 50 healthy persons were enrolled as study participants. Two-dimensional images of LV apical four-chamber view, two chamber view, and LV long-axis view and short-axis view of mitral annular, papillary muscle, and apical levels were obtained to measure early diastolic E' peak value, late diastolic A' peak value, and E'/A' ratio at LV apical longitudinal strain rate (SrL) and short-axis radial strain rate (SrR), circumferential strain rate (SrC), and rotation rate (RotR) in all cardiac segments. Average values of E', A', and E'/A' at SrL in three segments on long-axis and SrR, SrC, and RotR on three short-axis levels were calculated. Untwisting rate (Untw R) and untwisting half-time (UHT) were also calculated. (1) Data on 110 of 125 patients were usable for STI analysis. (2) There were no intersegment significant differences between A' at SrL in three segments or interlevel significant differences between A' at SrR in three levels in the NLAE group and the LAE group. (3) Compared with the normal group, E' at SrL and E'/A' at SrL, SrR and SrC, and Untw R reduced in the NLAE group and the LAE group, while A' at SrL, SrR, and SrC and E' at RotR increased and UHT extended. STI may be helpful for the detection of early changes in left ventricular diastolic function in patients with EH.

‘Let's twist again’: surgically induced renewal of left ventricular torsion in ischemic cardiomyopathy

To test the potential of the heart to be surgically restored at a near-normal global condition, granted that its physiological characteristics are respected (working volumes, chamber geometry, fiber orientation, opposite rotation of apex and base, global torsion and strain). From May 2007 to December 2008, 12 consecutive patients with ischemic cardiomyopathy were included in this study. All patients underwent modified surgical anterior ventricular restoration combined with complete coronary revascularization and, when indicated, mitral anuloplasty. The modified restoration aims to re-approach residual myocardium, redirecting fiber orientation displaced by infarct scar toward a more physiological gross disposition. Patients were studied preoperatively and postoperatively with a complete echocardiographical assessment, including speckle-tracking analysis. Standard parameters significantly improved after the operation (end diastolic volume, P < 0.001; end systolic volume, P < 0.001; ejection fraction, P = 0.004), and so did peak systolic apical rotation, peak systolic left ventricular torsion and two-chamber and four-chamber longitudinal strain (P = 0.004, 0.003, 0.05 and 0.01, respectively). Pearson's correlation between apical rotation and longitudinal strain (two-chamber and four-chamber) was -0.877 (P < 0.001) and -0.720 (P = 0.008), respectively, and between torsion and longitudinal strain was -0.845 (P = 0.001) and -0.785 (P = 0.002), respectively. This study reveals an unexpected potential of the myocardium to be restored at a near-normal global condition, with regard to all of its physiological characteristics. The concept of fiber-based surgical treatment, supported by an imaging-guided preoperative study, could widen the potential of repairing a failing heart.

Right Ventricular Free Wall Apical Longitudinal Strain Correlates with Right Ventricular Pressure in Patients with Pulmonary Arterial Hypertension

Conclusions: Reopening of CTO in symptomatic patients with baseline resting perfusion defects is associated with improved microvascular flow, and improved regional and global myocardial function. MCE may be a useful tool for selecting CTO patients who will benefit from intervention. doi:10.1016/j.hlc.2010.06.471