Assessment Of Left Ventricle Function Research Articles

Mitral Annular Plane Systolic Excursion (MAPSE): A Review of a Simple and Forgotten Parameter for Assessing Left Ventricle Function.

Mitral annular plane systolic excursion (MAPSE) was a widely used and simple M-mode echocardiographic parameter for determining the left ventricle (LV) longitudinal systolic function. The purpose of this review is to analyze the use of MAPSE as a simple LV systolic function marker in different clinical scenarios, especially given the recent paradox of choices in ultrasound markers assessing cardiac performance. Recent data on the use of MAPSE in the assessment of LV function in different settings seem to be relatively scarce, given the wide variety of possible causes of cardiovascular pathology. There remain significant possible clinical applications of MAPSE utilization. This review included all major articles on the topic of mitral annular plane systolic excursion published and indexed in the PubMed, Google Scholar, and Scopus databases. We analyzed the potential implications of using simpler ultrasonographical tools in heart failure diagnosis, prediction, and treatment. MAPSE is a dependable, robust, and easy-to-use parameter compared to ejection fraction (EF) or global longitudinal strain (GLS) for the quick assessment of LV systolic function in various clinical settings. However, there may be a gap of evidence in certain scenarios such as conventional cardiac pacing.

Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care unit: A single center study

BackgroundCritically ill pediatric patients often have multi-system involvement that can overlap different clinical diagnoses, making proper assessment and management challenging. Using echocardiography is increasing as a bedside and noninvasive tool for accurate hemodynamic assessment and guiding treatment. ObjectivesThis study aimed to determine the indication and value of bedside echocardiography in patient management in the pediatric intensive care unit (PICU) at Fayoum University Hospital and the relationship to the Pediatric Risk of Mortality Score III (PRISM). MethodsA total of 200 critically ill pediatric patients admitted to the PICUs of Fayoum University Hospital between January 2020 and January 2021 were prospectively evaluated. Detailed clinical examinations and requested echocardiography were conducted by intensivists and cardiologists. Results200 critically ill pediatric patients had an age range of 0.2–12 years, with 134 patients (67 %) under two years old. The most common admission diagnosis was pulmonary disease in 51 patients (26 %), followed by cardiac disease in 44 (22 %). The most common indication for echocardiography was left ventricle function assessment in 68 patients (34 %). Among the 108 patients (54 %) who underwent echocardiographic assessment, no difference in the management was found, while in the remaining 92 patients (46 %), supplemental information or decision help in management was obtained. There was a positive correlation between the effective value of echocardiography in the management of patients with primary cardiac disease (p-value = 0.001), shock (p-value = 0.001), and hypoxia (p-value = 0.009). Additionally, there was no correlation between the PRISM score and the effectiveness of echocardiographic assessment. ConclusionThe most common clinical indication for bedside echocardiography is assessing cardiac function. Echocardiography is an effective tool in PICU patient management, particularly in cases with primary cardiac disease, hypoxia, and shock, but its effectiveness does not increase according to the severity of the disease.

Abstract 11685: Effects of Pectus Excavatum Surgical Repair on Cardiac Volumes and Systolic Function as Assessed by 3D Transesophageal Echocardiography

Introduction: The consequences of external cardiovascular compression and cardiac displacement from pectus excavatum (PEx) are debated. The complex geometry of the right (RV) and left ventricle (LV) along with distortion from the extrinsic chest deformity pose significant limitations to reliable assessment of LV and RV volumes and function using transthoracic 2D-echocardiography in this population. Hypothesis: A 3D-echocardiography approach can reliably assess the effects of external cardiac compression and the benefits of surgical correction on RV and LV function in PEx patients. Methods: Adult patients undergoing minimally invasive repair of PEx between Oct-2021 and Feb-2023 were included in this prospective study. Intraoperative transesophageal (TEE) 6 beat full volume video loops incorporating LV and RV were captured and compared before and after surgical correction of the PEx. TomTec Software® was used for offline 3D/4D reconstruction ( Figure 1 shows changes in 3D RV and LV shape pre- and post-surgery). Result: The study included 102 patients (mean age of 32.1 ±11.8 years; Haller index 4.9 ±2.5; 60.8% males). Post PEx repair, there was a significant (p<0.001) increase in the 3D RV volumes, RV ejection fraction (EF), RV stroke volume and RV strain ( Figure 1 ). Additionally, there was a significant improvement in 3D LVEF, 3D LV strain (longitudinal and circumferential), LV twist, and torsion ( Figure 1 ). Conclusion: In this PEx cohort, 3D/4D TEE imaging demonstrated significant increases in RV volumes and in RV and LV systolic function after surgical repair. These findings support the negative cardiovascular consequences of PEx compression and benefits of surgical repair.

The role of T1 mapping and Extracellular Volume (ECV) in predicting cardiac reverse remodelling and response to Heart Failure with reduced Ejection Fraction (HFrEF) therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background Adverse cardiac remodelling results from an insult such as myocardial infarction, or as seen in Heart Failure (HF), maladaptive neurohormonal activation. Reverse remodelling describes improvement in cardiac geometry; the left ventricle (LV) recovers more normal structure with improved function and prognosis. Cardiovascular Magnetic Resonance imaging (CMR) allows gold standard assessment of LV volumes and function, diffuse and focal fibrosis and estimation of extracellular volume (ECV) by T1 mapping. Purpose Elevated T1 and ECV values are associated with worse outcome in many cardiac conditions. We conducted the first prospective study to investigate whether T1 mapping and ECV can predict cardiac reverse remodelling in response to treatment, in a cohort of patients hospitalised with a new HF diagnosis. Methods This was a single centre observational study. Inclusion criteria were admission with new HF, LVEF ≤50% or elevated NTproBNP and being treated with intravenous furosemide. Only patients with Heart Failure with reduced Ejection Fraction (HFrEF) and EF <40% on baseline echocardiography were included in this analysis. 36 consecutive eligible participants were included and had both echocardiogram and CMR studies to establish anatomy, function, and myocardial tissue characteristics at baseline. Participants were treated according to international HF guidelines and underwent reviews and repeat echocardiography at 6, 12–18 and 24–30 months. "Responders" to guideline directed HFrEF therapy were defined as those who had an increase in LVEF of ≥10% to a value of ≥40% between their baseline and latest follow-up echocardiogram. Baseline CMR volumes, function, presence of Late Gadolinium Enhancement (LGE), septal and whole heart T1 and ECV values were compared between responder and non-responder groups. Results Median follow-up was 26 months. 27 (75%) participants were responders to therapy. There were no differences in baseline characteristics between groups. There was high uptake of HFrEF medical therapy in both groups. (Table 1) There was no significant difference found between septal or whole heart T1 or ECV values between responder and non-responder groups. There was a trend towards lower whole heart ECV values (29% vs. 35%; p = 0.06) in the responder group but this did not reach statistical significance. (Figure 1) Overall, there was no difference in rates of LGE presence between groups but there was a significantly higher proportion of participants with non-ischaemic LGE pattern in the responder group compared to non-responder group (48% vs 11%; p = 0.05). Conclusions In this cohort of patients hospitalised with a new HFrEF diagnosis, the majority demonstrated reverse remodelling in response to therapy by 26 months. Whole heart ECV (%) as a surrogate marker for fibrosis calculated by whole heart T1 mapping may play a role in understanding which patients are likely to respond to HF therapy but further larger studies are required.

A tale of 2 conversions: Dichotomous decision in the spectrum of Shone syndrome is still a dilemma

A tale of 2 conversions: Dichotomous decision in the spectrum of Shone syndrome is still a dilemma

Assessment of left ventricle function in asymptomatic systemic lupus erythematosus about a comparative study

Assessment of left ventricle function in asymptomatic systemic lupus erythematosus about a comparative study

Left Ventricle Wall Motion Analysis with Real-Time MRI Feature Tracking in Heart Failure Patients: A Pilot Study.

Volumetric measurements with cardiac magnetic resonance imaging (MRI) are effective for evaluating heart failure (HF) with systolic dysfunction that typically induces a lower ejection fraction (EF) than normal (<50%) while they are not sensitive to diastolic dysfunction in HF patients with preserved EF (≥50%). This work is to investigate whether HF evaluation with cardiac MRI can be improved with real-time MRI feature tracking. In a cardiac MRI study, we recruited 16 healthy volunteers, 8 HF patients with EF < 50% and 10 HF patients with preserved EF. Using real-time feature tracking, a cardiac MRI index, torsion correlation, was calculated which evaluated the correlation of torsional and radial wall motion in the left ventricle (LV) over a series of sequential cardiac cycles. The HF patients with preserved EF and the healthy volunteers presented significant difference in torsion correlation (one-way ANOVA, p < 0.001). In the scatter plots of EF against torsion correlation, the HF patients with EF < 50%, the HF patients with preserved EF and the healthy volunteers were well differentiated, indicating that real-time MRI feature tracking provided LV function assessment complementary to volumetric measurements. This study demonstrated the potential of cardiac MRI for evaluating both systolic and diastolic dysfunction in HF patients.

Assessment of Physical and Mechanical Parameters of the Left Ventricle by Speckle Tracking Technique for Prediction Coronary Artery Disease Patients

Purpose: The goal of the study was to identify earlier pathology of the Left Ventricle (LV) using Speckle Tracking Echocardiography (STE) without angiography results for detecting Coronary Artery Disease (CAD) patients who have need invasive coronary reperfusion.
 Materials and Methods: A total of seventy-five referral patients to angiography (mean age 57±9 years) with chest pain, underwent Two-Dimensional Echocardiography (2D-ECG). Conventional echocardiographic parameters were calculated for the assessment of LV function. End systole and early diastole longitudinal strain, strain rate, and velocity with 2D-STE were estimated to evaluate myocardial function. Discriminated analysis was performed to detect CAD patients from the healthy group.
 Results: According to the angiography results, patients were divided into CAD group (n=55) and healthy group (n=20). There was a significant decrease in longitudinal strain, strain rate, and velocity in patients with CAD compared to the healthy group (systolic longitudinal strain for CAD group -15.9±2.2% vs. -19.6±2.2% for healthy group and early diastolic longitudinal strain for CAD patients -9.5±1.2% vs. -12.0±1.3% for the healthy group) (P-value<0.05). Discriminate analysis of end-systolic and early diastolic longitudinal strain with 81.8% and 89.1% indicated the highest sensitivity, respectively.
 Conclusions: End systolic and early diastolic longitudinal strain parameters derived with the STE method are superior predictors for detecting CAD patients referred to angiography for revascularization.

Multimodality imaging in the evaluation of left ventricle myocardial deformation determined by edema and scar in acute myocarditis

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION acute myocarditis (aMY) is characterized by the presence of edema and myocardial scar detected by cardiovascular magnetic resonance (CMR). Aim of our study is to investigate the diagnostic value of two-dimensional (2D) speckle tracking echocardiography and Cardiovascular Magnetic Resonance (CMR) feature tracking (FT) in detecting edema and myocardial scar in aMY. METHODS all consecutive patients with clinically suspected aMY were enrolled in our study. Inclusion criteria were: 1) new ECG abnormalities 2) myocardial cytolysis markers and 3) absence of angiographically detectable coronary artery disease. Exclusion criteria included poor cine image quality caused by respiratory motion and arrhythmia. All patients underwent transthoracic echocardiography and cardiac function was evaluated by a comprehensive assessment of LV function, including 2D speckle-tracking echocardiography (2D STE). CMR was performed in all patients in a 3T scanner. Extension of edema and myocardial scar were respectively evaluated on T2 mapping and on Late Gadolinium Enhancement sequences considering numbers of segments involved according to 17-segment model (AHA). FT analysis of the left ventricle (LV) was performed using the Tissue Tracking Module to obtain LV strain data. RESULTS 52 patients were included in the study, mean age was 36± 17 years, three patients were female (6%). Mean LVEF was 56,2 ± 7,2 % and mean end diastolic volume index (EDVi) was 62,52 ± 19,02 ml/m2. 10 patients (19,2%) had impaired EF with mean values of 44,6 ± 6,15%. aMY was confirmed in all patients with the presence of myocardial edema and subepicardial late gadolinium enhancement (LGE). Inferior segments were involved in 28 patients (53,8%), lateral segment in 19 patients (36,5%), septal segments in 7 patients (13,5%) and anterior segments in 15 patients (28,8%). 2D STE LV GLS was -16.41± 5,47% while CMR-FT LV GLS was -19,07 ± 4,65%, showing a good agreement between the two methods (r = 0,5; p < 0,001). The univariate analysis showed a significant correlation between 2D STE LV GLS and CMR-FT LV GLS with the extension of myocardial edema assessed by CMR (r= 0,43; p= 0,002 and r = 0.47; p = 0,002 respectively). The univariate analysis did not show a significant correlation between 2D STE LV and the extension of myocardial scar assessed by CMR (r= 0.2; p= 0.155) while a significant correlation was found between CMR-FT LV GLS and myocardial scar (r = 0.4; p = 0.01). CONCLUSIONS in patients with aMY, good correlation was found between CMR-FT and 2D STE in the evaluation of GLS. 2D STE LV GLS and CMR-FT LV GLS proved to have a good correlation with the extension of myocardial edema, while only CMR-FT LV GLS proved to be associated with myocardial scar extension.

Left ventricle function assessment using gated first-pass 18F-FDG PET: Validation against equilibrium radionuclide angiography

PurposeWe appraised the feasibility of left ventricle (LV) function assessment using gated first-pass 18F-FDG PET, and assessed the concordance of the produced measurements with equilibrium radionuclide angiography (ERNA). Materials and MethodsTwenty-four oncologic patients benefited from 99mTc-labeled red-blood-cell ERNA, in planar mode (all patients) and using SPECT (22 patients). All patients underwent gated first-pass 18F-FDG cardiac PET. Gated dynamic PET images were reconstructed over 1 minute during tracer first-pass inside the LV and post-processed using in-house software (TomPool). After re-orientation into cardiac canonical axes and adjustment of the valves plane using a phase image, pseudo-planar PET images obtained by re-projection were automatically segmented using thresholded region growing and gradient-based delineation to produce an LV ejection fraction (EF) estimate. PET images were also post-processed in fully-tomographic mode to produce LV end diastole volume (EDV), end systole volume (ESV), and EF estimates. Concordance was assessed using Lin’s concordance (ccc) and Bland-Altman analysis. Reproducibility was assessed using the coefficient of variation (CoV) and intra-class correlation (ICC). ResultsPseudo-planar PET EF estimates were concordant with planar ERNA (ccc = 0.81, P < .001) with a bias of 0% (95% CI [− 2%; 3%], limits of agreement [− 11%; 12%]). Reproducibility was excellent and similar for both methods (CoV = 2 ± 1% and 3 ± 2%, P = NS; ICC = 0.97 and 0.92, for PET and ERNA, respectively). Measurements obtained in fully-tomographic mode were concordant with SPECT ERNA: ccc = 0.83 and bias = − 3 mL for LV EDV, ccc = 0.92 and bias = 0 mL for LV ESV, ccc = 0.89 and bias = − 1% for LV EF (all P values < .001 for ccc, all biases not significant). ConclusionsGated first-pass 18F-FDG PET might stand as a relevant alternative to ERNA for LV function assessment, enabling a joint evaluation of both therapeutic response and cardiac toxicity in oncologic patients receiving cardiotoxic chemotherapy.

Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity

Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure. Purpose To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography. Methods Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction &amp;lt; 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline &amp;gt;15%. Results None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p &amp;lt; 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p &amp;lt; 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p &amp;lt; 0.0001). Conclusions Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients. Abstract Figure.

The distribution and relationship between 3D LVEF and 3D strain in a general population

Abstract Introduction Three-dimensional (3D) echocardiography (3DE) is currently extensively used to estimate left ventricle (LV) morphology and heart valves. However, it is underutilized in the assessment of LV function. Most likely, it is due to limited knowledge of the normal reference intervals. In order to fill this knowledge gap, studies which investigates the 3DE reference ranges in a larger cohort of a general population are needed. The objective of the current study was to study the relationship and distribution of 3D LV ejection fraction (EF) and its corresponding strain values in subjects enrolled in Copenhagen City Heart Study (CCHS). Methods The echocardiograms were acquired from CCHS subjects from 2011–2014 by using GE Vivid E9 (GE Medical, Copenhagen, Denmark), during four consecutive heart beats. Exclusion critera were missing data or measurements in 3D, poor image quality or frame rate (&amp;lt;12 fps) and, based on visual evaluation of the echocardiograms, inappropriate tracking of three or more myocardial segments in the strain analysis. The echocardiograms were analysed in 2019 on EchoPacTM v. 201 (GE Medical, Copenhagen, Denmark). Results are presented in means, interquartile ranges (IQR) and as adjusted correlation values (r2). R2 values equal to or above 0.64 (equals to r=0.8) were considered as strong correlation. LV function parameters included were LVEF, global longitudinal strain (GLS), global circumferential strain (GCS) and area strain (AS). LVEF and strain results are presented as percentages (%). The distribution and relationship between 3D LVEF, GLS, GCS and AS are visualized as scatter plots and box-whiskers plots. The statistical analysis and the visualisation of the data was performed in RStudio v. 3.5.1. P-values &amp;lt;0.005 were considered as markers for statistical significance. Results There were 2955 subject with available 3DEs in CCHS among which 1202 subjects had sufficient image quality for evaluation. The mean 3D LVEF was 54.6% (IQR: 50–60%), 3D GLS −14.5% (IQR: −13 to −16), 3D GCS −13.4% (IQR: −11 to −15) and AS −24.7% (IQR: −22 to −27). The adjusted correlation values between LVEF with strain parameters were: 0.04 (GLS), 0.37 (GCS) and 0.26 (AS), which was poor. Conclusion This study provides valuable data of the distribution of 3D LVEF and its corresponding 3D strain values in a general population. The 3D strain values are lower than the reference interval described in literature for two-dimensional echocardiography. Moreover, correlation was also found to be poor between LVEF and different strain parameters. 3D LVEF vs. 3D Strain (GLS, GCS, AS) Funding Acknowledgement Type of funding source: None

Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity

Abstract Background Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure. Purpose To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography. Methods Fifty Her-2 positive breast cancer women (age = 53.6±11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction &amp;lt;50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline &amp;gt;15%. Results None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p&amp;lt;0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p&amp;lt;0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=−0.40, p=0.006) and after TRZ completion (r=−0.62, p&amp;lt;0.0001). Conclusions Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients. LV and RV strain during cancer therapy Funding Acknowledgement Type of funding source: None

Echocardiographic assessment of CRT candidates. Does it work equally well in intermediate QRS duration?

Abstract Background The presence of mechanical dyssynchrony – such as apical rocking (ApRock) and septal flash (SF) – on echocardiography is associated with favourable outcome after cardiac resynchronization therapy (CRT). Myocardial scar on the other hand, has a considerable negative impact on CRT response. There is growing evidence that a visual echocardiographic assessment of mechanical dyssynchrony by ApRock, SF and scar predicts CRT response. Little is known however if this works equally well in patients with intermediate QRS duration (120–150ms), where guideline recommendation for CRT is weaker. Methods A total of 400 unselected patients referred for CRT, who fulfil the contemporary guidelines, were enrolled in this multicentre study. Echocardiographic images were visually assessed before CRT implantation, focussing on the presence of ApRock, SF and location and extent of scar segments in the left ventricle (LV), resulting in a CRT response prediction (i.e. Reader Interpretation). Readers were blinded to all patient information other than ischaemic aetiology of heart failure. CRT response was defined as ≥15% reduction in LV end-systolic volume on echocardiography, on average 15 months after device implantation. Results Overall, 321 (80%) patients had a left bundle branch block (LBBB), with an average QRS duration of 166±25ms. Ischemic aetiology of heart failure was found in 131 (33%) patients. Before CRT, ApRock and SF were present in 254 (64%) and 244 (61%) patients, respectively. ApRock and SF alone predicted CRT response with an area under the curve (AUC) of 0.79 (95% CI: 0.74–0.84) and 0.78 (95% CI: 0.73–0.83) (Figure A), while the echocardiographic Reader Interpretation had an AUC of 0.85 (95% CI: 0.81–0.89), with a sensitivity of 89% and a specificity of 82% for the prediction of CRT response (Figure B) (p&amp;lt;0.0001 vs. ApRock and SF alone). A total of 92 patients had a QRS duration of 120–150ms, and 48 of them responded to CRT. In these patients, the AUC of Reader Interpretation was comparable to that of the entire study cohort [0.83 (95% CI: 0.75–0.92)], as was sensitivity and specificity (90% and 79%, respectively, p=0.717 vs. the AUC of the entire cohort) (Figure C). Conclusions A visual assessment of LV function, by means of mechanical dyssynchrony and scar, has an excellent predictive value for CRT response, and requires only apical echocardiographic images. Responders were identified equally well in the challenging subgroup of patients with a QRS duration of 120–150 ms. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): KU Leuven

Feasibility and Reliability of Automatic Quantitative Analyses of Mitral Annular Plane Systolic Excursion by Handheld Ultrasound Devices: A Pilot Study.

Handheld ultrasound devices (HUDs) have previously been limited to grayscale imaging without options for left ventricle (LV) quantification. We aimed to study the feasibility and reliability of automatic measurements of mitral annular plane systolic excursion (MAPSE) by HUDs. An algorithm that automatically measured MAPSE from live grayscale recordings was implemented in a HUD. Twenty patients at a university hospital were examined by either a cardiologist or a sonographer. Standard echocardiography using a high-end scanner was performed. The apical 4-chamber view was recorded 4 times by both echocardiography and the HUD. MAPSE was measured by M-mode and color tissue Doppler (cTD) during echocardiography and automatically by the HUD. The automatic method underestimated mean MAPSE ± SD versus M-mode (9.6 ± 2.2 versus 10.9 ± 2.6 mm; difference, 1.2 ± 1.4 mm, P < .005). The difference between the automatic and cTD measurements was not significant (0.8 ± 1.8 mm; P = .073). The intraclass correlation coefficients (ICCs) between automatic and M-mode measurements was 0.85, and 0.81 for cTD measurements. There was good agreement between the methods, and the intra- and inter-rater ICCs were excellent for all methods (≥0.86). In this novel study evaluating automatic quantification of LV longitudinal function by HUD, we showed the high feasibility and reliability of the method. Compared to M-mode imaging, the automatic method underestimated MAPSE by 8% to 10%, but the difference with cTD imaging was nonsignificant. We conclude that this study's method for automatic quantitative assessment of LV function can be integrated in HUDs.

ResDUnet: Residual Dilated UNet for Left Ventricle Segmentation from Echocardiographic Images.

Echocardiography is the modality of choice for the assessment of left ventricle function. Left ventricle is responsible for pumping blood rich in oxygen to all body parts. Segmentation of this chamber from echocardiographic images is a challenging task, due to the ambiguous boundary and inhomogeneous intensity distribution. In this paper we propose a novel deep learning model named ResDUnet. The model is based on U-net incorporated with dilated convolution, where residual blocks are employed instead of the basic U-net units to ease the training process. Each block is enriched with squeeze and excitation unit for channel-wise attention and adaptive feature re-calibration. To tackle the problem of left ventricle shape and size variability, we chose to enrich the process of feature concatenation in U-net by integrating feature maps generated by cascaded dilation. Cascaded dilation broadens the receptive field size in comparison with traditional convolution, which allows the generation of multi-scale information which in turn results in a more robust segmentation. Performance measures were evaluated on a publicly available dataset of 500 patients with large variability in terms of quality and patients pathology. The proposed model shows a dice similarity increase of 8.4% when compared to deeplabv3 and 1.2% when compared to the basic U-net architecture. Experimental results demonstrate the potential use in clinical domain.

160 Echocardiographic assessment of CRT candidates. Does additional scar evaluation by MRI improve prediction of response?

Abstract Background Myocardial scar presence and extent, has a considerable influence on response to cardiac resynchronization therapy (CRT). Apical rocking (ApRock) and septal flash (SF) are associated with favourable outcome after CRT. Little is known however to which extent visual assessment of mechanical dyssynchrony by ApRock, SF and scar predicts CRT response. We therefore investigated, if additional scar assessment by cardiac magnetic resonance imaging (MRI) adds to the predictive value of the visual evaluation of echocardiographic images in CRT candidates. Methods A total of 201 unselected patients referred for CRT, who fulfil the contemporary guidelines for CRT implantation, were enrolled in this prospective multicentre study. Two experienced observers visually assessed echocardiographic images before CRT implantation, focussing on the presence of ApRock, SF and location and extent of scar segments of the left ventricle (LV), resulting in a CRT response prediction (i.e. Integrative Prediction). A third observer provided a consensus reading in case of disagreement. All observers were blinded to all patient information other than the ischaemic aetiology of heart failure. Independent from that, segmental myocardial scar burden was objectified by late gadolinium enhancement (LGE) cardiac MRI (LGE &amp;gt; 50%). CRT response was defined as ≥15% reduction in LV end-systolic volume on echocardiography, one year after device implantation. Results Overall, 69 (34%) patients had an ischaemic aetiology of heart failure. Before CRT, ApRock and SF were present in 129 (64%) and 136 (68%) patients, respectively. ApRock and SF alone predicted CRT response with an area under the curve (AUC) of 0.85 (95% CI: 0.79-0.91) and 0.84 (95% CI: 0.77-0.91) (Figure A), while the echocardiographic Integrative Prediction had an AUC of 0.90 (95% CI: 0.84-0.95), with a sensitivity of 93% and a specificity of 87% for the prediction of CRT response (Figure B) (p &amp;lt; 0.05 vs. ApRock and SF alone). When combining information on ApRock, SF and the number of scarred segments on MRI in a statistical model, the AUC was comparable to the echocardiographic Integrative Prediction [0.90 (95% CI: 0.84-0.96)] as was sensitivity and specificity (91% and 83%, respectively, p = N.S. vs. Integrative Prediction) (Figure C). Conclusions An integrative visual assessment of LV function has an excellent predictive value for CRT response. Our data show, that the echocardiographic estimation of scar burden is sufficiently accurate and cannot be further improved by an additional MRI scar assessment. Abstract 160 Figure.

Assessment of Left Ventricle Function with 2-D Strain Speckle Tracking Echocardiography in Patients Following Balloon Aortic Valvuloplasty For Aortic Valve Stenosis

Background: Balloon aortic valvuloplasty (BAV) is the first line of treatment for aortic valve stenosis. The long-term effects of the procedure on left ventricular function remain uncertain. Our hypothesis was that left ventricular dysfunction persists following BAV when assessed by the more sensitive 2-D speckle tracking echocardiography, compared to normal controls. Methods: This was a retrospective cross-sectional study of patients who had undergone BAV for aortic valve stenosis >1 year before enrollment. …

Assessment of Left Ventricle Function with 2-D Strain Speckle Tracking Echocardiography in Patients Following Balloon Aortic Valvuloplasty For Aortic Valve Stenosis

Assessment of Left Ventricle Function with 2-D Strain Speckle Tracking Echocardiography in Patients Following Balloon Aortic Valvuloplasty For Aortic Valve Stenosis

Assessment of LV Function in Children with Wilson’s Disease: Speckle Tracking Imaging Study

Background and Objective: Wilson’s disease is a genetic disorder of copper metabolism that affects liver and other organs including heart. In early stages of myocardial affection, the left ventricle (LV) appears apparently normal when evaluated by traditional two-dimensional (2D) echocardiography. The aim of this study was to detect subclinical LV dysfunction in children with Wilson’s disease using 2D speckle tracking echocardiography. Patients and Methods: Twenty children with Wilson’s disease were compared with age- and sex-matched 20 healthy children. All subjects were evaluated by traditional 2D echocardiography and speckle tracking echocardiography. Results: There were no significant differences between patients and controls regarding conventional echo parameters except for lower E mitral flow and E' annular septal peak velocity in patient group. The regional peak longitudinal strain of apical 4 chamber view was -17.8% ± 4.2% in patients and -20.1% ± 2.3 % in control subjects (P = 0.043), and for apical 2 chambers view, it was -20.1%± 3.6% in patients and -22.6% ± 3.4% in control subjects (P = 0.034) and it was -18% ± 3.5% in patients and -20.5% ± 3.2% in control subjects (P = 0.025) in apical long axis view. The global peak longitudinal strain was also lower in patients than control group (18.3% ± 3.2%, and 20.85% ± 2.4%) respectively (P = 0.014). There were no significant differences between both groups regarding circumferential and radial strains (P > 0.05). Conclusions: Despite apparently normal LV systolic function, the children with Wilson’s disease demonstrated significantly lower peak longitudinal strain as an indicator for early affection of LV systolic function.