Myocardial Deformation Research Articles

The association between systolic and diastolic dysfunction and autonomic nervous system function in children receiving chronic hemodialysis.

Changes in cardiac function and structureas well as their association with the cardiac autonomic nervous system remain incompletely characterized in children with stage 5 chronic kidney disease (CKD) receiving hemodialysis (HD). A prospective observational cohort study was conducted on 40 Egyptian children with CKD on regular HD compared to 40 age- and sex-matched healthy children. All participants underwent thorough clinical examination, laboratory investigations, 24-h Holter monitoring, and 2D/4D echocardiographic study (conventional and advanced modalities). Participants were followed for mortality and morbidity over 36months. Following HD sessions, CKD children showed significant reductions of left and right ventricular (LV/RV) systolic function by 2D and 4D echocardiography compared to controls. HD children had significant impairment of heart rate variability parameters (evaluated by time and frequency domains). LV/RV global longitudinal shortening (GLS) as well as tricuspid annular plane systolic excursion were closely correlated with different Holter parameters, including frequency domain parameters (including low frequency, high frequency, and LF/HF ratio), time domain parameters including percentage of differences > 50ms between consecutive normal RR intervals (pNN50), and root-mean-square of the difference between successive normal intervals (rMSSD). Over a follow-up of 34.5 ± 16.8months, 10 (25%) patients died. Reduced LV/RV-GLS and decreased rMSSD values were independently associated with higher mortality among HD children. LV and RV myocardial deformation (either 2D or 4D) primarily decreased in HD children. Altered time and frequency domain indices revealed cardiac autonomic dysfunction, evidenced by increased sympathetic activity and decreased vagal activity. Reduced LV/RV-GLS and decreased rMSSD values were independently associated with higher mortality among HD children.

A Novel Staging System of Cardiac Damage in Aortic Stenosis based on Multi-Chamber Myocardial Deformation.

This study evaluates whether multi-chamber myocardial deformation analysis using speckle tracking echocardiography (STE) can enhance validated current staging systems and improve risk stratification for patients with moderate-to-severe aortic stenosis (AS). We reanalyzed 2D, Doppler, and STE data obtained from two cohorts: derivation (654 patients, median age: 82 years; 51% men) and validation (237 patients, median age: 77 years; 55% men) with at least moderate AS (aortic valve area<1.5 cm2). The receiver operator characteristic curve analysis identified optimal cut-off values linked to outcomes: 15% for left ventricular global longitudinal strain (LVGLS), 13% for peak atrial longitudinal strain (PALS), and 19% for right ventricular free-wall strain (RVFWS). Patients have been divided into five stages: Stage 0 - no left-side damage (LVGLS≥15% and PALS≥13%); Stage 1 - partial left-side damage (LVGLS <15% or PALS <13%); Stage 2 - definite left-side damage, (LVGLS<15% and PALS<13%); Stage 3, no right-side damage (RVFWS≥19%); and Stage 4, right-side damage (RVFWS<19%). In a multivariable Cox regression analysis, the new staging scheme remained independently associated with an increased risk of all-cause death (adjusted-hazard ratio [aHR]: 1.28; 95%CI: 1.10-1.48; p=0.001). This new staging classification exhibited higher predictive power (AUC 0.67; 95% CI 0.62-0.73) than those proposed by Généreux (AUC 0.62; 95% CI 0.56-0.67; p=0.002) and Tastet (AUC 0.64; 95% CI 0.58-0.70; p=0.041) for 2-year all-cause death, with similar findings in the validation cohort. Our staging system for detecting cardiac damage, incorporating multi-chamber myocardial deformation, exhibits a stronger association with outcomes than previously validated systems.

Potential of echocardiographic assessment of early systolic lengthening in making diagnosis of various forms of coronary heart disease

The occurrence of paradoxical myocardial deformation, which includes early systolic lengthening and post-systolic shortening, was originally described in the 1970s in experimental animal models and in patients with myocardial ischemia at invasive assessment of the left ventricle (LV). Today, new echocardiographic imaging technology demonstrates that these phenomena are much more common than were initially thought. Quite a lot of studies have been conducred to investigate post-systolic shortening (PSS), but the role of early systolic lengthening (ESL) has become increasingly emphasized in the most recent research articles. In this regard, we have made an attempt to describe most completely and accessibly the clinical potential associated with the mechanisms of occurrence of ESL and the significance of its assessment in various forms of coronary heart disease.

Impact of papillary muscle infarction on atrial and ventricular myocardial deformation in non-anterior STEMI patients.

The purpose of this study was to explore the impact of papillary muscle (PPM) infarction on left atrial and ventricular strain parameters in patients with non-anterior ST-segment elevation myocardial infarction (NA-STEMI) using cardiovascular magnetic resonance (CMR). This retrospective study performed CMR scans on 88 consecutive patients with NA-STEMI (68 males, 65 ± 10.05 years). Among them, 30 demonstrated PPM infarction (25 males, 67.12 ± 9.49 years), defined as late gadolinium enhancement (LGE) in a papillary muscle head in two contiguous LGE CMR slices, and confirmed on the long-axis LGE CMR slices. Atrial and ventricular strain were analyzed by CMR feature tracking with dedicated post-processing software. Patients with PPM infarction were older (p = 0.001), with lower left ventricular ejection fraction (p = 0.040), higher indexed left ventricular end-diastolic volume (p = 0.020), and end-systolic volume (p = 0.044) compared to patients without LGE in the papillary muscle. Additionally, patients with PPM infarction showed impaired reservoir strain, booster strain, global longitudinal strain (GLS), and higher LGE extent compared to NA-STEMI patients without PPM involvement (p = 0.001, p = 0.004, p = 0.001, and p = 0.003, respectively). In multivariable analysis, GLS, global radial strain, reservoir strain, and booster strain parameters were the only independent determinants of PPM infarction (p = 0.001, p = 0.041, p = 0.002, and p = 0.027, respectively). The presence of PPM infarction assessed by CMR is independently linked to atrial and ventricular strain impairment in patients with NA-STEMI.

The use of ethanol as contrast enhancer in synchrotron X-ray phase-contrast imaging leads to heterogeneous myocardial tissue shrinkage: a case report.

One of the main limitations of conventional absorption-based X-ray micro-computed tomography imaging of biological samples is the low inherent X-ray contrast of soft tissue. To overcome this limitation, the use of ethanol as contrast agent has been proposed to enhance image contrast of soft tissues through dehydration. Some authors have shown that ethanol shrinks and hardens the tissue too much, also causing small tissue ruptures due to fast dehydration. However, the local tissue deformation occurring as a consequence of tissue dehydration and whether tissue shrinkage can modify myocardial architecture has not been quantified yet. The aim of this paper is to quantify the local myocardial tissue deformation due to ethanol dehydration based on 3D non-rigid registration and perform a detailed characterization of its myocardial tissue organization, before and after ethanol dehydration. A rat adult heart was imaged with synchrotron-radiation-based X-ray phase contrast imaging (X-PCI) three times: before, 9 h after and 342 h after ethanol immersion. The total volume shrinkage as well as changes in the left ventricular myocardial thickness were computed. Then, to determine local deformation of the heart caused by ethanol dehydration, the related 3D tomographic datasets were registered by means of a non-rigid registration algorithm. Finally, changes on the orientation and organization of myocytes were assessed. Our results show that the use of ethanol in synchrotron X-PCI can improve image contrast, but the tissue shrinkage is not homogeneous thus changing the local myocardial organization.

Strain echocardiography predictors in patients with concomitant cardiac amyloidosis and aortic stenosis: a cross-sectional study

BackgroundConcomitant cardiac amyloidosis (CA) and aortic stenosis (AS) may be mistaken for isolated AS, potentially impacting the treatment strategy and patient’s prognosis. Therefore, it is crucial to distinguish between these conditions, as failure to promptly diagnose CA may lead to considerable complications. The aim of this study is to investigate the diagnostic value of strain predictors in patients with concomitant CA and AS compared to isolated AS.MethodsForty-two patients with severe AS suspected of concomitant CA based on a comprehensive clinical evaluation were selected to undergo 99mTc-DPD scintigraphy. Those showing Perugini grade 2 or 3 tracer uptakes without evidence of monoclonal gammopathy were diagnosed with CA and underwent speckle-tracking echocardiography. Furthermore, strain analysis was performed to evaluate myocardial deformation, with a focus on detecting apical sparing and reduction in bull’s eye mapping, resulting in the characteristic “cherry on top” sign.ResultsEight patients were diagnosed with CA, representing 19.0% of those suspected of concomitant CA and 7.8% of the overall cohort with severe AS. AF arrhythmia was significantly more frequent in these patients compared to those with isolated AS. Echocardiography findings revealed that E/E’ ratio and RALS were significantly higher in patients with concomitant CA, while GLS and mean basal LS were significantly lower in this group. The “cherry on top” sign was detected in 19 patients (45.2%), present in 100% of those with concomitant CA and AS, versus 32.4% in isolated AS cases (P = 0.04). This sign demonstrated a sensitivity of 100% and a specificity of 67.6% for predicting concomitant CA and AS.ConclusionsIn conclusion, the “cherry on top” sign was significantly more prevalent in patients with concomitant CA and AS, compared to those with isolated AS, demonstrating a sensitivity of 100% and a specificity of 67.6% for predicting concomitant CA. Moreover, RALS and E/E’ ratios were significantly higher in patients with concomitant CA, whereas GLS and mean basal LS were significantly lower in this group.

Speckle Strain Analysis of Left Ventricular Dysfunction in Paediatric Patients with Bicuspid Aortic Valve-A Pilot Study.

Bicuspid aortic valve (BAV) is a prevalent congenital heart defect that continues to present a significant challenge in the management of paediatric patients. The assessment of left ventricle systolic function is typically conducted through the measurement of the left ventricular ejection fraction. Currently, left ventricle global longitudinal strain (LV GLS) is regarded as a more sensitive indicator, enabling the quantitative assessment of global and segmental ventricular function through the determination of myocardial deformation. A prospective study was conducted between 10 January 2023 and 10 January 2024 in a tertiary paediatric cardiology referral centre. The study enrolled children aged 6 to 17 years with BAV who were undergoing periodic evaluation, as well as a control group. The primary objective was to analyse the systolic function (global and segmental LV) using the classical method (LV EF) and speckle tracking echocardiography (STE). The study group comprised 73 patients with a mean age of 13 years and was predominantly male. The control group comprised 55 patients. The phenotype IB with aortic regurgitation (AR) was the most prevalent. The results of the STE evaluation in the control group demonstrated mean GLS values between -22.1% and -22.8%. A comparison of the BAV group and the control group revealed a significant difference in GLS for the apical four-chamber view (p = 0.022). Although the analysis of global LV function demonstrated normal values of EF in patients with BAV, the strain analysis revealed significantly reduced strain in the inferior segment and in the apical four-chamber view, as well as in the anterior segment. Further investigation is required to determine whether reduced LV GLS in paediatric patients with BAV will ultimately result in the development of clinical heart failure. Additionally, it is necessary to ascertain whether this can identify patients with subclinical heart failure and whether early detection can result in a reduction in morbidity.

The Prognostic Impact of Myocardial Deformation Measures in Patients with COVID-19

The Prognostic Impact of Myocardial Deformation Measures in Patients with COVID-19

An observational study on global longitudinal strain in acute coronary syndrome and its correlation with coronary angiogram

Background: Coronary angiography (CA) is crucial for diagnosing acute coronary syndrome (ACS) and assessing coronary artery disease (CAD), enabling healthcare providers to determine treatment options and assess the risk of cardiovascular events. Global longitudinal strain (GLS) is a sensitive marker of cardiac function. This study aimed to determine the correlation between GLS in ACS and CA findings. Methods: This prospective observational study was conducted at the cardiology department of the Salem government medical college. The study involved transthoracic echocardiography (TTE) to assess LV volumes, ejection fraction (EF), and LVGLS and strain analysis using 2D echocardiography to measure regional longitudinal peak systolic strain in different LV segments. CA was performed to visualise the coronary vessels and detect significant CAD. Results: The study population consisted predominantly of male patients (n=93, 62%), with notable smoking (n=48, 32%) and alcohol consumption (n=36, 24%). A significant majority of the patients (n=111, 74%) exhibited ECG abnormalities. Obstruction was present in 82% of the patients (n=123), with those showing impaired myocardial function compared to those without obstruction. GLS values below 13.95 were more common in patients with obstruction (n=8 out of 11), indicating reduced myocardial deformation. The GLS demonstrated excellent diagnostic performance for detecting significant coronary artery obstruction, with a high sensitivity of 88.89%, specificity of 90.63%, and overall accuracy of 90.24%. Conclusions: Our study revealed a strong correlation between reduced GLS and CAD, highlighting its importance in CAD assessment and risk stratification in ACS. GLS demonstrated excellent diagnostic performance for detecting significant CAD, showing high sensitivity and specificity.

Echocardiography in the Assessment of Heart Failure Patients.

Doppler echocardiography is the corner-stone of non-invasive investigation of patients with a clinical diagnosis of heart failure. It provides an accurate and quantitative assessment of cardiac structure and function. Furthermore, spectral Doppler measurement is an invaluable technique for estimating intracardiac pressures with their crucial value in the optimum management of heart failure patients, irrespective of ejection fraction. Speckle tracking echocardiography stretches the unique application of echocardiography to analyze the myocardial deformation function which has proved very accurate in detecting ischemia, dyssynchrony, subclinical dysfunction and also in estimating pulmonary capillary wedge pressures. The role of longitudinal myocardial left atrial deformation dynamics has recently emerged as a valuable tool for assessing left ventricular diastolic dysfunction in patients with cardiac diseases regardless of their ejection fraction. Finally, the extent of myocardial deformation has been shown to correlate with the severity of myocardial fibrosis, a common finding in patients with heart failure.

Diagnosis of decreased segmental deformation of the left ventricular myocardium in a teenager at the early stage of hypertrophic cardiomyopathy (clinical observation)

The article presents a clinical observation that revealed a decrease in segmental deformation of the left ventricular myocardium in a 15-year-old teenager at the early stage of asymmetric non-obstructive hypertrophic cardiomyopathy (HCM). To assess myocardial systolic function, the following were used: ejection fraction and shortening of the left ventricle, as well as indicators of global and segmental myocardial deformation, determined by echocardiographic study using the 2D speckle-tracking method. There was no change in ejection fractions and shortening of the left ventricle, global longitudinal deformation of the myocardium, but there was a decrease in longitudinal and circular deformation in individual segments of the left ventricle, which, in general, was the basis for prescribing cardioprotective therapy.

Noninvasive myocardial work in severe aortic regurgitation: implications for postoperative left ventricular dysfunction.

Noninvasive myocardial work offers a promising echocardiographic method to evaluate left ventricular (LV) function as it integrates myocardial deformation and afterload. The study sought to investigate the association of myocardial work indices with post-operative LV dysfunction in patients with chronic severe aortic regurgitation (AR). Pre-operative LV ejection fraction (LVEF), LV global work index (LV GWI), LV global constructive work (LV GCW), LV global wasted work (LV GWW), and LV global work efficiency (LV GWE) were measured. Post-operative LV dysfunction was defined as LVEF < 50% at 12 months after surgery. One hundred and forty-one patients with chronic severe AR and preserved LVEF (52 (42-58) years; 74.5 % men) who underwent aortic valve surgery were studied. Twenty-six patients (18%) developed post-operative LV dysfunction. Patients with post-operative LV dysfunction had lower LV GWI, LV GCW, and LV GWE compared to those without (all P < 0.05). In multivariate analysis, LV GWI (adjusted odds ratio (OR): 0.99; 95% CI: 0.98-1.00; P < 0.001), and LV GCW (adjusted OR: 0.99; 95% CI: 0.99-1.00; P < 0.001) were associated with post-operative LV dysfunction. Moreover, a multivariate logistic regression model with LV GWI (Akaike information criterion = 108.023, Bayesian information criterion = 119.818, C-statistics = 0.836) showed the best capability in predicting post-operative LV dysfunction. The comparative analysis of C-statistics across the three models-LV GWI, LV GCW, and LV GLS-did not reveal statistically significant differences (all P > 0.05). In patients with chronic severe AR and preserved LVEF, impaired myocardial work indices are associated with post-operative LV dysfunction. Myocardial work has potential value for risk stratification and surgical decision-making in such a population.

The first experience of intraoperative myocardial elastography in cardiac surgery patients

The goal the work was to study the possibility of using elastography on an open heart to determine the stiffness of the left ventricular myocardium. Material and methods. Intraoperative elastography was performed in 6 patients with isolated aortic stenosis and dissecting aneurysm of the ascending aorta with aortic insufficiency. Three patients underwent surgery to replace the aortic valve with mechanical prostheses (SIM-19) and three were operated to replace the ascending aorta with an artificial prosthesis with aortic valve replacement (David’s operation). The average age of the patients was 42±9 years (42–53) years. All patients underwent surgery under conditions of artificial blood circulation. Initially, elastography was evaluated on a working heart, and then on full artificial circulation. The study was performed on a VK 5000 ultrasound device with an intraoperative «stick» type sensor at a frequency of 7.5–15 Mhz, gain of 1.6 Db, resolution of 127 hz. The deformation coefficient was evaluated. The imaging program was exposed as for neurosurgery with a frequency of 15 Mhz. Visualization was performed in B-mode, followed by obtaining shear wave elastography with calculation of the deformation coefficient. Results. Wave elastography was evaluated for various heart pathologies with different myocardial thickness. It was found that the stiffness in the studied areas of the myocardium is different. Thus, in patients with atherosclerotic aortic stenosis and a pressure gradient of more than 100 mmHg, the deformation coefficient was increased, in accordance with the thickness of the myocardium and amounted to 3.81–4.06, and in patients with aortic root dilation and aortic insufficiency, the deformation coefficient was 1.64–2.9. Conclusion. Intraoperative assessment of the left ventricular myocardial deformation coefficient is possible only on a stopped heart and gives an idea of the state of the heart muscle with the possibility of soft and hard areas. Shear wave elastography provides information about the elasticity and hardness of the tissue, which indirectly reflects the viscosity of the myocardium. This study was aimed at verifying the methodology for assessing the characteristics of the elasticity of the left ventricular myocardium for myocardial overload by pressure (aortic stenosis) and volume in case of a dissecting aortic aneurysm with aortic insufficiency.

Clinical significance of myocardial deformation of a left ventricle in children with hypertrophic cardiomyopathy

Purpose: to evaluate the clinical significance of left ventricular myocardial deformation indicators, their relationship with the degree of heart failure and left ventricular hypertrophy in children with hypertrophic cardiomyopathy (HCM). Materials and methods. 61 patients with primary genetically confirmed asymmetric HCM aged 7 to 17 years underwent a comprehensive clinical and echocardiography. Echocardiography determined indicators of left ventricular systolic function: ejection and shortening fractions, global longitudinal, circular and radial myocardial deformations and deformations rates. The assessment of myocardial hypertrophy of left ventricular segments was performed taking into account absolute values in systole and diastole depending on age, recalculated per standard deviation units in the population (Z-score factor). Results. A more pronounced degree of heart failure, a decrease in ejection and shortening fractions, and indicators of left ventricular myocardial deformation were established in all children with non-obstructive and obstructive forms of HCM and an extreme degree of myocardial hypertrophy, in contrast to the non-obstructive form of the disease with a less pronounced degree of hypertrophy. An earlier decrease in myocardial deformation indices was revealed in comparison with ejection and shortening fractions, longitudinal deformation and its speed in comparison with radial and circular, their speeds. Conclusions. 1. In children with HCM and extreme degrees of left ventricular myocardial hypertrophy, compared with mild and moderate hypertrophy, a more pronounced degree of heart failure is observed, which is accompanied by a decrease in left ventricular systolic function. Among them, a decrease in myocardial deformation rates and their velocities is more sensitive compared to left ventricular ejection fractions and shortening. 2. Reduction of left ventricular myocardial deformation in children with HCM depends on the degree of hypertrophy. The earliest, manifesting itself even with a mild degree of hypertrophy, is a decrease in longitudinal deformation and its speed compared to circular and radial deformations and their speeds. 3. Determining the indicators of left ventricular myocardial deformation in children with HCM in comparison with the degree of myocardial hypertrophy is of great clinical importance in assessing the systolic function of the left ventricle to optimize administration tactics and timely treatment of the disease.

Value of two-dimensional speckle-tracking echocardiography in evaluation of cardiac function in small fetuses.

Small fetuses include constitutional small for gestational age (SGA) and fetal growth-restricted (FGR) fetuses. Various adverse intrauterine environments can lead to FGR which has higher risk of abnormal perinatal outcome. The fetal heart is very sensitive to the effects of a negative intrauterine environment. Therefore, we used two-dimensional speckle-tracking echocardiography (2D-STE) to evaluate heart function and find more sensitive indicators of pregnancy outcomes of small fetuses. This prospective cohort study was performed at West China Second Hospital of Sichuan University between July 2023 and December 2023. We prospectively enrolled small fetuses with an estimated weight or abdominal circumference below the 10th percentile for gestational age and controls matched for gestational age. 2D-STE was performed to obtain information on left ventricular function systolic function and strain parameters, including ejection fraction (EF), myocardial global circumferential strain (myoGCS), myocardial global longitudinal strain (myoGLS), endocardial global circumferential strain (endoGCS), endocardial global longitudinal strain (endoGLS), and global radial strain (GRS). The baseline characteristics and various cardiac parameters were compared between the groups. Then, we analyzed the predictive performance of cardiac parameters, and pulsatility index of umbilical artery and middle cerebral artery (UA-PI, MCA-PI) for adverse pregnancy outcomes. A total of 61 small fetuses and 34 gestational age-matched control fetuses were studied ultimately. The value of EF, myoGCS, myoGLS,endoGCS, endoGLS, and GRS were 44.85±10.04, -11.89±4.24, -9.26±4.24, -22.68±6.24, -13.53±6.67, and 24.98±12.44, respectively, in the FGR group, the absolute values of which were significantly lower than in the SGA group (53.28±6.70, -14.42±4.31, -12.63±4.11, -27.29±7.25, -17.71±5.58, and 33.37±9.33, respectively) and the control group (55.46±6.94, -14.93±4.77, -16.15±3.84, -27.69±6.46, -20.55±4.42, and 36.87±12.69, respectively) (P<0.05). The absolute myoGLS and endoGLS values were significantly lower in the SGA group than in the control group (P<0.05). Combination of endoGLS and UA-PI could represent a new predictor to predict the adverse pregnancy outcomes, and the receiver operating characteristic (ROC) curve exhibited a considerably higher area under the curve (AUC) than either one alone (AUC of 0.75 vs. 0.69 and 0.61, respectively). The layer-specific strain technique in 2D-STE is a sensitive tool for evaluation of left ventricular myocardial deformation in the heart of small fetuses, and can be used to identify the changes of cardiac function between FGR and SGA. Moreover, the combination of endoGLS and UA-PI as a new parameter may have better performance in predicting pregnancy outcome of small fetuses.

Echocardiography Analysis with Deep Learning using Priors: Multi-centric Evaluation of Generalisation

Echocardiography is a widely used medical modality to evaluate cardiac function. Automatic solutions for 2D echocardiography analysis could greatly influence cardiac disease diagnosis and prognosis. Within its diverse analysis tasks, segmentation and motion estimation are critical. Segmentation provides insights into cardiac structures, while motion estimation depicts myocardial deformation during cardiac cycles via image registration. These two tasks help extract useful clinical indexes, including ejection fraction and heart wall strain. Deep learning based methods that aim to tackle each of the above tasks have demonstrated efficient performance. However, the predominant focus on a single research dataset raises concerns about the generalisation of these approaches to other datasets and their applicability to downstream clinical tasks (diagnosis, prognosis...). In this paper, we propose a comprehensive echocardiography analysis pipeline, consisting of a segmentation module, a motion tracking module, and a classifier. The segmentation module incorporates a shape prior, leveraging a contour-aware loss function for the endocardium and epicardium. With appropriate data augmentation strategies, this module consistently demonstrates robust segmentation and ejection fraction estimation performance across diverse datasets from distinct medical centres. The motion tracking module integrates a motion prior for the myocardium through a differentiable poly-affine transformation, ensuring smooth and anatomy-aware deformation estimation. This module exhibits improved registration performance and maintains a more acceptable regularity in the deformation field across datasets. Finally, the classifier leverages features extracted from the preceding segmentation and motion tracking modules for downstream classification, providing interpretable inputs. The segmentation model and motion tracking model undergo individual training on two publicly available datasets. Subsequently, the classifier undergoes further training on a third pathology dataset using the estimated features from the previously trained models. To evaluate real-world performance, we directly apply the three trained models to a clinical dataset from a local hospital. Our successful application of these proposed methods in detecting patients with myocardial infarction (0.84 in F1 score and 0.77 in accuracy), a life-threatening cardiac disease, emphasises their potential for clinical utility. Our codes are available at https://github.com/xxx/xxx

Echocardiographic Assessment of Biventricular Mechanics of Fetuses and Infants of Gestational Diabetic Mothers: A Systematic Review and Meta-Analysis.

Gestational diabetes mellitus (GDM) is the most common complication in pregnancy, representing a serious risk for the mother and fetus. Identifying new biomarkers to ameliorate the screening and improving GDM diagnosis and treatment is crucial. During the last decade, a few studies have used speckle tracking echocardiography (STE) for assessing the myocardial deformation properties of fetuses (FGDM) and infants (IGDM) of GDM women, providing not univocal results. Accordingly, we performed a meta-analysis to examine the overall influence of GDM on left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) in both FGDM and IGDM. All echocardiographic studies assessing conventional echoDoppler parameters and biventricular strain indices in FGDM and IGDM vs. infants born to healthy pregnant women, selected from PubMed and EMBASE databases, were included. The studies performed on FGDM and IGDM were separately analyzed. The subtotal and overall standardized mean differences (SMDs) in LV-GLS and RV-GLS in FGDM and IGDM studies were calculated using the random-effect model. The full texts of 18 studies with 1046 babies (72.5% fetuses) born to GDM women and 1573 babies of women with uncomplicated pregnancy (84.5% fetuses) were analyzed. Compared to controls, FGDM/IGDM were found with a significant reduction in both LV-GLS [average value -18.8% (range -11.6, -24.2%) vs. -21.5% (range -11.8, -28%), p < 0.05)] and RV-GLS [average value -19.7% (range -13.7, -26.6%) vs. -22.4% (range -15.5, -32.6%), p <0.05)]. Large SMDs were obtained for both LV-GLS and RV-GLS studies, with an overall SMD of -0.91 (95%CI -1.23, -0.60, p < 0.001) and -0.82 (95%CI -1.13, -0.51, p < 0.001), respectively. Substantial heterogeneity was detected for both LV-GLS and RV-GLS studies, with an overall I2 statistic value of 92.0% and 89.3%, respectively (both p < 0.001). Egger's test gave a p-value of 0.10 for LV-GLS studies and 0.78 for RV-GLS studies, indicating no publication bias. In the meta-regression analysis, none of the moderators (gestational age, maternal age, maternal body mass index, maternal glycosylated hemoglobin, white ethnicity, GDM criteria, ultrasound system, frame rate, FGDM/IGDM heart rate, and anti-diabetic treatment) were significantly associated with effect modification in both groups of studies (all p > 0.05). The sensitivity analysis supported the robustness of the results. GDM is independently associated with biventricular strain impairment in fetuses and infants of gestational diabetic mothers. STE analysis may allow for the early detection of subclinical myocardial dysfunction in FGDM/IGDM.

Cardiovascular remodelling and reverse remodelling during pregnancy and postpartum: Looking at the right side

BackgroundConsidering the limited information available on right cardiac remodelling during gestation, we aimed to characterise the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of perinatal CV risk (CVR) factors on these processes. MethodsThis prospective cohort was recruited at two tertiary centres during 2019–2022, including 51 healthy pregnant women and 79 with perinatal CVR factors. Participants were evaluated by transthoracic echocardiography during pregnancy (1st[1T] and 3rd[3T] trimesters) and postpartum (one-month[PP1], six-months[PP2], and one-year postpartum[PP3]). Generalised linear mixed-effects models were used for statistical analysis. ResultsSimilar enlargement of the right atrium (RA) and right ventricle (RV) dimensions was observed throughout pregnancy, normalising at PP2 values similar to PT1. This anatomical postpartum recovery was accompanied by an increase of RV global longitudinal strain, being statistically significant in perinatal CVR group. Interestingly, at 3T, this group revealed lower RV and RA strain compared to healthy participants. Despite both groups maintained preserved RV systolic function from 1T to PP3, a significant reduction of TAPSE and tricuspid S’ velocity was observed at PP1. Concomitantly, all participants showed a significant increase of E/A at the same time-point, suggesting the recovery of diastolic deterioration seen from 1T to 3T that was persistingly higher in the perinatal CVR group througout the postpartum. Constant pulmonary artery systolic pressure (PASP) was documented throughout follow-up time, showing consistently higher values in the perinatal CVR group. All these echocardiographic index changes were within the normality range. ConclusionThis study described subtle right cardiac changes within the normal/physiological range, recovering six-months after delivery. Coexisting perinatal CVR factors seem to affect the magnitude of RV diastolic function changes, PASP and myocardial deformation without any impact on other RV systolic function indexes.

Myocardial deformation in children post cardiac surgery, a cross-sectional prospective study

BackgroundMyocardial deformation by speckle tracking echocardiography provides valuable information on the left ventricular function. The study aims to assess myocardial deformation in terms of left ventricular strain as an indicator of myocardial function in children after cardiac surgery at outpatient follow-up visits.MethodsThe study design was a prospective observational cross-sectional study that included pediatric patients after biventricular cardiac surgery during the postoperative follow-up visits in the outpatient department. In addition to conventional echocardiographic examination, two-dimensional speckle tracking echocardiography was done to evaluate myocardial deformation in terms of left ventricular strain. Echocardiographic measurements were done offline and were compared to published reference normal values for age. Study subjects were divided according to age at follow-up into four groups (1 month–1 year, 1–2 years, 2–5 years, and 5–11 years).ResultsOver ten months, 100 patients (64 males and 36 females) were included in the study. The median age was 30.8 months (IQR 12.8–65.3 months), the median weight was 11.7 kg (IQR 8–17 kg) and the median duration after surgery was 7.3 months (IQR 3.2–30.8 months). Longitudinal strain values were significantly (p < 0.001) lower than reference values for different age groups. Global circumferential strain showed no significant difference from the reference values. The duration after surgery had a statistically significant effect on longitudinal strain values, with improvement of the strain values with increasing intervals after surgery.ConclusionUsing myocardial deformation method to evaluate cardiac function may detect underlying cardiac function abnormalities even with normal traditional functional parameters, which could have implications for patient management and follow-up.

Assessing coronary artery stenosis exacerbated impact on left ventricular function and deformation in metabolic syndrome patients by 3.0 T cardiac magnetic resonance imaging

BackgroundMetabolic syndrome (MetS) and coronary artery stenosis (CAS) independently increase the risk of cardiovascular events, while the impact of CAS on left ventricular (LV) function and deformation in MetS patients remains unclear. This study investigates how varying degrees of CAS exacerbate LV function and myocardial deformation in MetS patients.MethodsOne hundred thirty-one MetS patients who underwent CMR examinations were divided into two groups: the MetS(CAS−) group (n = 47) and the MetS(CAS+) group (n = 84). The MetS(CAS+) group was divided into MetS with non-obstructive CAS(NOCAS+) (n = 30) and MetS with obstructive CAS(OCAS+) group (n = 54). Additionally, 48 age- and sex-matched subjects were included as a control group. LV functional and deformation parameters were measured and compared among subgroups. The determinants of decreased LV global peak strains in all MetS patients were identified using linear regression. The receiver operating characteristic (ROC) curve and logistic regression model (LRM) evaluated the diagnostic accuracy of the degree of CAS for identifying impaired LV strain.ResultsCompared to MetS(CAS−), MetS(NOCAS+) showed a significantly increased LV mass index (p < 0.05). Global longitudinal peak strain was decreased gradually from MetS(CAS−) through MetS(NOCAS+) to MetS(OCAS+) (− 13.02 ± 2.32% vs. − 10.34 ± 4.05% vs. − 7.55 ± 4.48%, p < 0.05). MetS(OCAS+) groups showed significantly decreased LV global peak strain (GPS), PSSR and PDSR in radial and circumferential directions compared with MetS(NOCAS+) (all p < 0.05). The degree of CAS was independently associated with impaired global radial peak strain (GRPS) (β = − 0.289, p < 0.001) and global longitudinal peak strain (GLPS) (β = 0.254, p = 0.004) in MetS patients. The ROC analysis showed that the degree of CAS can predict impaired GRPS (AUC = 0.730) and impaired GLPS (AUC = 0.685).ConclusionBesides traditional biochemical indicators, incorporating CAS assessment and CMR assessment of the LV into routine evaluations ensures a more holistic approach to managing MetS patients. Timely intervention of CAS is crucial for improving cardiovascular outcomes in this high-risk population.