Doppler Echocardiographic Parameters Research Articles

The Agreement Between Transthoracic and Transesophageal Echocardiography in the Assessment of Right Ventricular Diastolic Dysfunction Grades in Adult Patients Undergoing Cardiac Surgery: A Prospective Observational Study.

Introduction The importance of right ventricular (RV) diastolic function in cardiac surgery cannot be overstated, as it significantly affects prognosis and long-term outcomes. Conventionally, RV diastolic dysfunction (RVDD) is assessed and graded using criteria from either the American Society of Echocardiography (ASE) or the British Society of Echocardiography (BSE), with measurements done by transthoracic echocardiography (TTE). However, during cardiac surgery, perioperative echocardiographic evaluation is done predominantly by transesophageal echocardiography (TEE). This study aimed to assess the agreement between TTE and TEE in grading RVDD using both ASE and BSE criteria. Methods Key two-dimensional (2D) and Doppler parameters were measured in 81 patients undergoing cardiac surgery by both TTE and TEE after anesthesia induction within 10 minutes of each other, under similar hemodynamic, anesthetic, and ventilatory conditions. RVDD gradings were done separately by TTE and TEE with both ASE and BSE criteria using the measured values of the key parameters by TTE and TEE, respectively. RVDD gradings derived from TTE were compared with those derived from TEE. The tricuspid inflow Doppler and tricuspid annular tissue Doppler parameters were measured in TEE in both mid-esophageal RV inflow-outflow (MERVIO) and deep transgastric RV inflow-outflow (DTGRVIO) views. Gradings were done separately for both views of TEE by using the Doppler values measured in the respective views (TEE-MERVIO and TEE-DTGRVIO). The TTE-derived RVDD grades were compared with those derived by both TEE-MERVIO and TEE-DTGRVIO. Weighted κ values were used to assess observed agreement beyond chance. Inter-rater reliability of the RVDD grades derived by both TTE and TEE (both views) was also checked. Individual 2D and Doppler parameters were compared between TTE and TEE in terms of Bland-Altman limits of agreement. Results As per ASE criteria, disagreement of RVDD by ≥1 grade was seen in 43 (53.1%) patients and by 2 grades in eight (9%)patients when comparing TTE and TEE-MERVIO, yielding a weighted κ of 0.14 (p=0.123). Disagreement by ≥1 grade was observed in 32 (39.5%) patients and by 2 grades in 10 (12.3%) patients when comparing TTE and TEE-DTGRVIO, yielding a weighted κ of 0.3 (p=0.002). Using the BSE Criteria, disagreement of RVDD grades occurred in nine (11.1%) patients when comparing TTE and TEE-MERVIO, yielding an unweighted κ of 0.25 (p=0.295). Disagreement occurred in 12 (14.8%) patients when comparing TTE and TEE-DTGRVIO, yielding an unweighted κ of 0.260 (p=0.187). There was almost perfect agreement between independent raters regarding both TTE- and TEE-derived RVDD grades per the ASE criteria, and substantial to almost perfect agreement per BSE criteria. Bland-Altman analysis of paired data between the TTE- and TEE-measured values of individual 2D and Doppler parameters showed wide limits of agreement. Conclusions This study revealed, at best, only fair agreement between TTE and TEE in grading RVDD. The measured 2D and Doppler echocardiographic parameters showed wide limits of agreement between TTE and TEE. We recommend further researchto develop a TEE-based algorithm for grading RVDD, and to evaluate the prognostic effectiveness of perioperative TEE for predicting adverse clinical outcomes associated with RVDD.

Predictive value of Doppler echocardiography parameters for cardiovascular events in patients with systemic lupus erythematosus.

This study aimed to assess the utility of Doppler echocardiography in evaluating left ventricular diastolic function, and prognosis in patients with systemic lupus erythematosus (SLE). A total of 286 SLE patients were selected along with 100 age- and gender-matched healthy individuals who underwent physical examinations. Clinical baseline characteristics were collected. Various Doppler echocardiographic parameters were measured and analyzed, including left ventricular posterior wall thickness (LVPWT), interventricular septal diameter (IVSD), left ventricular mass (LVM), LVM index (LVMI), and others. Compared to the control group, SLE patients exhibited significantly higher levels of C-reactive protein and lower levels of complement (C) 3 and C4 (p < .001). Doppler echocardiographic parameters showed significant differences between SLE patients and healthy controls, including increased LVPWT, IVSD, LVM, LVMI, peak A, PWI + Tei, E/e', TDI-Tei, and decreased e' and E/A (p < .001). Subgroup analyses indicated more severe ventricular diastolic dysfunction in patients with higher SLE activity and those who experienced cardiovascular events. Correlation analysis revealed positive associations of PWI + Tei, TDI-Tei, and GLS with SLE activity and cardiovascular events (p < .01). Multivariate logistic regression analysis identified LVMI, PWI + Tei, TDI-Tei, and GLS as significant predictors of cardiovascular events (p < .05). Doppler echocardiography is a valuable tool for the early diagnosis of left ventricular diastolic dysfunction in SLE patients. Key echocardiographic parameters, including LVMI, PWI + Tei, TDI-Tei, and GLS, are effective in predicting cardiovascular events, underscoring the importance of comprehensive cardiac function assessments in these patients.

Subtle myocardial effects of rheumatic heart disease in children are revealed earlier with two-dimensional speckle tracking echocardiography.

Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in developing countries and remains a serious public health problem. In the subclinical course of carditis, the absence of typical symptoms and the normal range of classical echocardiographic measurements used to evaluate cardiac functions have required new echocardiographic methods and parameters. Previous studies regarding rheumatic heart disease in children and adults have shown that strain patterns obtained by speckle tracking echocardiography, are in fact affected although left ventricular systolic functions are preserved, yet some studies have suggested otherwise. The aim of our study is to compare the use of speckle tracking echocardiography with conventional methods in the evaluation of cardiac functions and myocardial involvement in children with subclinical RHD. The study group consisted of 24 patients with asymptomatic cardiovascular who had no history of acute rheumatic fever, but had definite or probable rheumatic valve disease. This study group was determined according to the World Heart Federation guidelines by an echocardiographic examination performed for different reasons, as well as the control group of 22 healthy children. In order to evaluate the left ventricular regional myocardial functions of the patients, tissue Doppler echocardiography (TDE) and speckle tracking echocardiographic parameters were compared with the control group. The mean ages of the patient and control groups were 14.1±2.7 years and 13.9±2.3 years, respectively. There was no statistically significant difference between the two groups in terms of conventional methods (p>0.05) but global longitudinal strain and strain rate values were found to be significantly lower in the patient group (p<0.01). These changes appeared to be relevant throughout the duration of the illness. In patients with subclinical rheumatic heart disease, conventional echocardiographic evaluations are likely negative, whereas two-dimensional speckle tracking echocardiography reveal systolic and diastolic dysfunctions of the disease.

Left ventricular deformation in the presence of left ventricular 'rigid body rotation' in healthy adults-three-dimensional speckle-tracking echocardiographic insights from the MAGYAR-Healthy Study.

During the heart cycle, the left ventricle (LV) not only shows a contraction-relaxation pattern, but LV has a rotational mechanics, as well. It is a known fact that certain pathologies may be associated with an absence of LV twist, when LV basal and apical regions rotate in the same clockwise (cw) or counterclockwise (ccw) direction called LV 'rigid body rotation' (LV-RBR), but it can also occur in healthy subjects. The present cohort study aimed to examine LV strains in healthy subjects with LV-RBR versus with normally directed LV rotational mechanics by three-dimensional speckle-tracking echocardiography (3DSTE). The study consisted of 181 healthy individuals, from which 171 cases had normally directed LV rotational mechanics (mean age: 32.5±12.3 years, 79 males) and 10 healthy subject showed LV-RBR (mean age: 35.4±11.3 years, 3 males). Complete two-dimensional (2D) Doppler echocardiography and 3DSTE were performed in all healthy individuals. None of routine 2D Doppler echocardiographic parameters showed differences between the groups examined. There were no subjects with ≥ grade 1 regurgitation on any valves or with significant stenosis on any valves. 3DSTE-derived LV volumes, global and mean segmental strains did not differ between the groups examined. Apical anterior and lateral segments showed reduced segmental LV circumferential strain (CS) (-18.9%±8.5% vs. -26.7%±10.7%, P=0.02; -27.3%±12.6% vs. -34.8%±13.2%, P=0.08, respectively) and LV area strain (AS) (-26.8%±9.8% vs -36.8%±12.0%, P=0.01; -35.7%±13.2% vs. -45.0%±14.6%) in healthy subjects having LV-RBR as compared to cases with normally directed LV rotational mechanics. These abnormalities were present only in subjects having cwLV-RBR. Although global LV deformation is normal in the presence of LV-RBR in healthy adults, reduction of apical anterior and lateral LV-CS (and LV-AS) are present in cases with cwLV-RBR only suggesting segmental deformation abnormalities.

Maternal supplementation with docosahexaenoic acid does not cause constriction of fetal ductus arteriosus: randomized controlled trial.

Docosahexaenoic acid (DHA) is recommended routinely in pregnancy to promote fetal development. DHA has anti-inflammatory activity, but its effects on the fetal heart and circulation are unknown. This study aimed to investigate whether maternal DHA supplementation in the third trimester affects maternal prostaglandin levels and fetal ductus arteriosus flow dynamics. This was a double-blind randomized controlled trial with parallel groups conducted between 2018 and 2021. Pregnant women aged over 18 years with a normal fetus at 27-28 weeks' gestation showing no cardiac/extracardiac anomalies or ductal constriction were eligible for the trial. Women consuming substances with a known inhibitory effect on prostaglandin metabolism, such as non-steroidal anti-inflammatory drugs and polyphenol-rich foods, were excluded. The intervention group received oral supplementation of omega-3 with 450 mg/day of DHA for 8 weeks and the placebo group received capsules of soy lecithin for 8 weeks. Anthropometric measurements, assessment of polyphenol and omega-3 consumption, fetal morphological ultrasound examination, fetal Doppler echocardiographic examination and blood sample collection were performed at the start of the study and the latter two were repeated at follow-up. Prostaglandin E2 (PGE2) level and echocardiographic parameters were compared between the intervention and placebo groups and between baseline and follow-up. A total of 24 participants were included in each group. After 8 weeks, there were no significant differences between the intervention and placebo groups in maternal serum PGE2 level or Doppler echocardiographic parameters of ductal flow. No case of ductus arteriosus constriction was observed. The expected intragroup changes in cardiac morphology, as a result of advancing gestation, were present. Maternal DHA supplementation in the third trimester at a clinically recommended dose did not result in inhibition of PGE2 or constriction of the ductus arteriosus. These findings should be confirmed in postmarket surveillance studies with larger patient numbers in order to test the full safety profile of DHA and provide robust clinical reassurance. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Is plasma citrulline a good marker of hemodynamic status in malnourished patients with anorexia nervosa?

ObjectiveMalnourished patients with anorexia nervosa (AN) have lower plasma citrulline level compared to healthy controls. Citrulline is a non-essential amino-acid synthetized by the enterocyte and has functions affecting cardiovascular status. The aim of the study is to describe citrulline plasma level and to assess its relationship with hemodynamic status in a cohort of malnourished adult patients with AN. MethodsA retrospective observational study including malnourished patients with AN hospitalized between January 2018 and January 2019 for the treatment of severe malnutrition was carried out. Anthropometric measures, biochemical tests, and cardiac function indicators including doppler echocardiographic parameters were evaluated. ResultsForty-eight patients with a median age of 29 [21–35.5] years old and body mass index (BMI) of 12 [10.5–-13.4] kg/m2 were included. Median systolic blood pressure (SBP) and median diastolic blood pressure (DBP) were respectively 99 [90–110] mmHg and 68 [59–73] mmHg. Median left ventricular ejection fraction (LVEF) was at 65 [58–69] %. Plasma citrulline level was under the normal range in 58% of patients and was positively correlated with fat mass, stroke volume, and left ventricular end diastolic volume, but not BMI. ConclusionCitrulline level may be an innovative associated marker of hemodynamic status in malnourished patients with AN. Further research and prospective studies are needed to elucidate the specific pathways involved.

Evaluation of left ventricular systolic function by speckle tracking echocardiography in type 2 diabetic patients

Background: Cardiovascular complications are the leading cause of death in diabetic patients. Speckle tracking echocardiography can early detect left ventricular systolic dysfunction even when normal ejection fraction. The study aims to evaluate left ventricular systolic function by Speckle tracking echocardiography and its correlation with some cardiovascular risk factors in type 2 diabetic patients; Materials and method: Controlled cross-sectional descriptive study in 60 subjects (30 in type 2 diabetic patients and 30 controls) at Hue University of Medicine and Pharmacy Hospital. Data collection: age, sex, time to detect diabetes, body mass index, waist circumference, blood pressure, fasting blood glucose, HbA1c, lipid blood, traditional Doppler echocardiographic parameters, values of left ventricular longitudinal strain in 2-chamber, 3-chamber, 4-chamber view and value of total left ventricular longitudinal strain; Results: Type 2 diabetic patients had 2-chamber longitudinal strain (-17.01 ± 3.26%), 3-chamber longitudinal strain (-16.41 ± 3.69%), 4-chamber longitudinal strain (-18.46 ± 3.23%, global longitudinal strain (-17.31 ± 2.87%), was lower than control group (p &lt; 0.05). The global longitudinal strain was positively correlated with diabetes duration (r = 0.3), heart rate (r = 0.3), systolic blood pressure (r=0.4), diastolic blood pressure (r = 0.4), fasting plasma glucose (r = 0.4), HbA1c (r = 0.4) (p &lt; 0.05); Conclusion: Type 2 diabetic patients have reduced global longitudinal strain. The reduction of global longitudinal strain was correlated with diabetes duration, heart rate, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, and HbA1c. Key words: diabetes, speckle tracking echocardiography, left ventricular ejection fraction, global longitudinal strain, cardiovascular risk factors.

Three-Dimensional Speckle-Tracking Echocardiography-Derived Tricuspid Annular Dimensions and Right Atrial Strains in Healthy Adults-Is There a Relationship? (Insights from the MAGYAR-Healthy Study).

The tricuspid valve and its annulus (TA) are thought to be integrally related to right atrial (RA) size and function. The present study aimed to assess associations between TA dimensions and RA strains, and quantitative features of its contractility were determined by 3DSTE in healthy adults. The study comprised 145 healthy volunteers with a mean age of 34.4 ± 12.5 years (73 males). Electrocardiographic, two-dimensional Doppler echocardiographic and 3DSTE parameters were in normal reference ranges in all subjects. Enlarged TA areas, regardless of which phase of the cardiac cycle were measured, were not associated with the deterioration of peak RA strains in longitudinal (LS) and circumferential (CS) directions. Increased end-diastolic TA area was associated with reduced RA strain in the radial direction (RS). Dilation of end-diastolic and end-systolic TA areas was related to increased RA volumes. End-diastolic TA area was the smallest in case of increased peak global RA-RS, and other associations between increasing TA areas and peak global strains could not be detected. Peak global RA-CS and RA-LS were not related to TA areas. Increasing peak global RA-RS was not associated with peak global RA-LS and RA-CS, while increasing peak global RA-LS and RA-CS were not associated with peak global RA-RS. Increasing peak global RS did not show associations with RA volumes, Vmin was the smallest in the case of highest peak global RA-CS and RA-LS. Vmax increased with increasing peak global RA-LS. 3DSTE is suitable for simultaneous non-invasive determination of TA dimensions and RA volumes and strains using the same acquired 3D dataset, allowing physiologic studies. RA volumes are associated with end-diastolic and end-systolic TA areas. RA strains in radial direction (RS) show associations with end-diastolic TA area.

Impact of Aortic Valve Regurgitation on Doppler Echocardiographic Parameters in Patients with Severe Aortic Valve Stenosis.

Diagnosing severe aortic stenosis (AS) depends on flow and pressure conditions. It is suspected that concomitant aortic regurgitation (AR) has an impact on the assessment of AS severity. The aim of this study was to analyze the impact of concomitant AR on Doppler-derived guideline criteria. We hypothesized that both transvalvular flow velocity (maxVAV) and the mean pressure gradient (mPGAV) will be affected by AR, whereas the effective orifice area (EOA) and the ratio between maximum velocity of the left ventricular outflow tract and transvalvular flow velocity (maxVLVOT/maxVAV) will not. Furthermore, we hypothesized that EOA (by continuity equation), and the geometric orifice area (GOA) (by planimetry using 3D transesophageal echocardiography, TEE), will not be affected by AR. In this retrospective study, 335 patients (mean age 75.9 ± 9.8 years, 44% male) with severe AS (defined by EOA < 1.0 cm2) who underwent a transthoracic and transesophageal echocardiography were analyzed. Patients with a reduced left ventricular ejection fraction (LVEF < 53%) were excluded (n = 97). The remaining 238 patients were divided into four subgroups depending on AR severity, and they were assessed using pressure half time (PHT) method: no, trace, mild (PHT 500-750 ms), and moderate AR (PHT 250-500 ms). maxVAV, mPGAV and maxVLVOT/maxVAV were assessed in all subgroups. Among the four subgroups (no (n = 101), trace (n = 49), mild (n = 61) and moderate AR (n = 27)), no differences were obtained for EOA (no AR: 0.75 cm2 ± 0.15; trace AR: 0.74 cm2 ± 0.14; mild AR: 0.75 cm2 ± 0.14; moderate AR: 0.75 cm2 ± 0.15, p = 0.998) and GOA (no AR: 0.78 cm2 ± 0.20; trace AR: 0.79 cm2 ± 0.15; mild AR: 0.82 cm2 ± 0.19; moderate AR: 0.83 cm2 ± 0.14, p = 0.424). In severe AS with moderate AR, compared with patients without AR, maxVAV (p = 0.005) and mPGAV (p = 0.022) were higher, whereas EOA (p = 0.998) and maxVLVOT/maxVAV (p = 0.243) did not differ. The EOA was smaller than the GOA in AS patients with trace (0.74 cm2 ± 0.14 vs. 0.79 cm2 ± 0.15, p = 0.024), mild (0.75 cm2 ± 0.14 vs. 0.82 cm2 ± 0.19, p = 0.021), and moderate AR (0.75 cm2 ± 0.15 vs. 0.83 cm2 ± 0.14, p = 0.024). In 40 (17%) patients with severe AS, according to an EOA < 1.0 cm2, the GOA was ≥ 1.0 cm2. In severe AS with moderate AR, the maxVAV and mPGAV are significantly affected by AR, whereas the EOA and maxVLVOT/maxVAV are not. These results highlight the potential risk of overestimating AS severity in combined aortic valve disease by only assessing transvalvular flow velocity and the mean pressure gradient. Furthermore, in cases of borderline EOA, of approximately 1.0 cm2, AS severity should be verified by determining the GOA.

Two-Dimensional Speckle-Tracking Echocardiography to Monitor Left Ventricular Function After Percutaneous Coronary Intervention

Background: Conventional 2 D Doppler echocardiographic parameters are inadequate for evaluation and monitoring Left ventricle systolic function recovery of patients with ischemic heart disease (IHD) treated by Percutaneous coronary intervention (PCI). Hence, New strain imaging parameters are studied by using 2 D speckle Tracking Echocardiography. The aim is to compare the conventional echocardiographic parameters (Left ventricle ejection fraction, Wall motion score index, regional wall motion score) with speckle tracking echocardiographic parameters (Global longitudinal strain, Regional longitudinal strain) in patients with ischemic heart disease undergo Percutaneous Coronary Intervention (PCI).Method and patient: A prospective Interventional Hospital Based study enrolled 50 patients who had ischemic heart disease (IHD), Percutaneous coronary intervention (PCI) was done for them at IbN Al-Bittar Cardiac Surgery Center from October 2014 to April 2015. Both conventional echocardiographic parameters (Left ventricle ejection fraction, Wall motion score index, regional wall motion score according to coronary artery territory) and Speckle tracking echocardiographic parameters (Global longitudinal strain, Regional longitudinal strain according to coronary artery territory) done for them pre PCI, one day post PCI, and one month post PCI.Result: Regarding conventional echocardiographic parameters: Global LVEF pre PCI 52.34±90% , one month post PCI was (54.00±6.9), there was no significant difference statistically (P value 0.79), also Wall motion score index ,Regional wall motion score according to coronary artery territory were (1.22±0.25,1.44±1.52) respectively, one month post PCI were (1.98±0.26,1.40±0.58) respectively where there's no significant differences statistically (P value 0.25,0.22) respectively.Regarding speckle tracking parameters :Global Longitudinal strain for all patients pre PCI was (-14.30±3.54%) ,one day post PCI was (-14.78±3.81%) ;there was no significant differences (p value 0.77).After one month Global Longitudinal Strain was (-16.38±4.15%) where this consider highly significant differences (p value 0.001).Regional Longitudinal Strain according to the coronary artery territory pre PCI was (-14.49±4.47%),post one day post PCI was (-15.08±4.92%) where there's no significant differences (p value 0.10), while one month post PCI was (-17.70±5.27%),this was highly significant different statistically (0.001).Only in STEMI patients there was significant difference one day post PCI(P value 0.041 for Global LS,0.016 for Regional LS).Conclusions: In all IHD groups (STEMI, NSTEMI ∕UA, chronic stable angina) Speckle Tracking Echocardiographic parameters (Global Longitudinal Strain and Regional longitudinal strain) more reliable and effective than conventional echocardiographic parameters (Global LWEF,WMSI, RWMS) for monitoring improvement in LV systolic function post Percutaneous coronary intervention.

Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study.

The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12h (D1) and 48-72h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e' was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e' (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography. Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure. What is Known: •Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension. What is New: •Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.

Reference Values and Repeatability of Pulsed Wave Doppler Echocardiography Parameters in Normal Donkeys.

Simple SummaryCardiovascular disease is underreported in donkeys, possibly related to their limited athletic posture and frequent poor performance-related examinations. Reports on treatments for cardiovascular disease are anecdotal in donkey. Normal echocardiographic parameters have been reported in healthy donkeys. The aim of the present study was to establish the reference values and repeatability for Pulsed Wave Doppler echocardiographic variables of the mitral valve, aortic valve and myocardial performance. Two-dimensional Color flow mapping and spectral Doppler modes were performed. For the mitral valve, the mean velocity, pressure gradient and duration of E-wave were 57.7 ± 12.5 cm/s, 1.4 ± 0.7 mmHg and 0.4 ± 0.13 s, respectively. The results of the present study provide the reference values of PW echocardiographic parameters measurements in normal adult donkeys. Such reference values are helpful, especially when confronted with clinical cases with cardiovascular disorders.In the present study, thirty clinically healthy donkeys were used to establish the reference values and repeatability for Pulsed Wave Doppler echocardiographic variables of the mitral valve, aortic valve and myocardial performance. 2-dimensional Color flow mapping and spectral Doppler modes were performed. For the mitral valve, the mean velocity, pressure gradient and duration of E-wave were 57.7 ± 12.5 cm/s, 1.4 ± 0.7 mmHg and 0.4 ± 0.13 s, respectively. The velocity, pressure gradient and duration of the A-wave were 32.3 ± 9.1 cm/s, 0.3 ± 0.04 mmHg and 0.3 ± 0.1 s, respectively. The mitral valve area, pressure half time, pulsatility index (PI), resistance index (RI) and velocity time integral (VTI) were 1.8 ± 0.5 cm2, 66 ± 17 ms, 2.8 ± 1.4, 0.9 ± 0.03 and 19.1 ± 5.7 cm, respectively. For the aortic valve, the mean velocity was 64.9 ± 10.4 cm/s, pressure gradient was 1.8 ± 0.4 mmHg, pulsatility index was 1.4 ± 0.3, resistance index was 0.9 ± 0.02, VTI was 25.02 ± 6.2 cm, systolic/diastolic was 19 ± 4.7 and heart rate was 95.7 ± 28.9 per minute. For Myocardial Performance Index (LV)–Tei Index, the mean ejection, isovolumic relaxation, isovolumic contraction time and myocardial performance index were 0.24 ± 0.01, 0.14 ± 0.01, 0.14 ± 0.02 and 1.2 ± 0.1 s, respectively. The results of the present study provide the reference values of PW echocardiographic parameter measurements in normal adult donkeys. Such reference values are helpful, especially when confronted with clinical cases with cardiovascular disorders.

ECHOCARDIOGRAPHIC PARAMETERS OF PAKISTANI ADULTS WITH NORMAL ECHOCARDIOGRAM

Objectives: The objective of this study was to determine the ranges of normal 2D and Doppler echocardiographic parameters in Pakistani population. Methodology: In this cross-sectional study a total of 108 adults with normal echocardiogram were included. Comprehensive transthoracic echocardiogram was done and right and left sided chambers and mitral inflow velocities were measured. Normal ranges were computed as mean ± 2×SD (standard deviation) and normal ranges were compared with the American Society of Echocardiography (ASE) recommended normal ranges. Results: A total of 108 healthy individuals were included in this study, a majority, 64.8% (70) were male and mean age was 32.48 ± 7.7 years with 58.3% (63) ≤ 32 years of age. Local normal reference ranges for most of the parameters are relatively narrower than the ASE reference ranges. Both the minimum and maximum reference values for most of the parameters are smaller in our population as compared to the ASE reference ranges. When comparing mitral inflow velocities, E wave in our population has higher velocities and small deceleration time while A wave has lower velocities than in the western population. Local normal reference range for the LVEF was observed to be mostly similar to the ASE reference ranges for both genders. Conclusion: Comparing our results with internationally recognized ASE recommended values, it becomes evident that our population especially males have small LV dimensions and volumes. LV dimensions are important when decisions are taken about surgeries in valvular heart diseases like aortic regurgitation and mitral regurgitation.

Comparative effects of losartan and nifedipine therapy on exercise capacity, Doppler echocardiographic parameters and endothelin levels in patients with secondary pulmonary hypertension

Comparative effects of losartan and nifedipine therapy on exercise capacity, Doppler echocardiographic parameters and endothelin levels in patients with secondary pulmonary hypertension

Effects of iron deficiency on left ventricular functions in young women regardless of anemia: A speckle tracking echocardiography study.

Iron deficiency is one of the most common metabolic disorders worldwide and affects multiple organs and systems including the cardiovascular (CV) system. Iron deficiency can cause structural and functional changes in the myocardium. The aim of the study is to evaluate left ventricular (LV) functions in patients with low ferritin levels without anemia by two-dimensional "speckle tracking" echocardiography (2D STE). We studied 90 participants (all female) that were divided into two groups according to ferritin levels (49 patients with ferritin levels <30 ng/mL, 41 age-matched controls with >30 ng/mL). Patients with anemia (hemoglobin level <12 g/dL), known CV disease, diabetes mellitus, low ejection fraction (<55%), active infection, high ferritin levels (>200 ng/mL) were excluded. All patients were evaluated by transthoracic echocardiography. In addition to conventional echocardiographic parameters and Doppler measurements, LV global longitudinal strain (GLS) and strain rate (GLSR) were obtained by 2D STE. Mean ferritin level was 18.96 ± 7.29 ng/mL in low ferritin group, and was 61.22 ± 26.14 ng/mL in control group. There were no significant differences according to conventional and Doppler echocardiographic parameters between the groups. LV GLS and GLSR values were significantly lower in low ferritin group comparing with control group (17.31% ± 1.56 and 18.96% ± 1.53, p < 0.001; 0.64 ± 0.13 1/s and 0.81 ± 0.13 1/s, p < 0.001, respectively). There was a significant positive correlation between ferritin levels and LV GLS and GLSR values in study group (r = 0.482, p < 0.001; r = 0.387, p < 0.001, respectively). Ferritin level was also detected as an independent risk factor for GLS value < -18% in logistic regression analysis. In ROC curve analysis, the area under the curve for predicting GLS < -18% was 0.801 (p < 0.001, 95% CI 0.70-0.89) and the threshold of ferritin value was 28.5 ng/mL (sensitivity 76.1%, specificity 77.3%). Low ferritin levels can cause subclinical LV systolic dysfunction in patients without anemia. STE provides detailed information about LV functions. With larger studies, these patients should be followed more closely and considered for iron replacement treatment before developing anemia.

Сучасний підхід до діагностики серцево-судинних розладів у новонароджених із груп перинатального ризику в неонатальний період

З метою удосконалення та систематизування підходу до діагностики серцево-судинних розладів у новонароджених шляхом комплексної оцінки допплерехокардіографічних параметрів, біохімічних маркерів (рівень лактатдегідрогенази, γ-глутамілтрансферази) та поліморфними варіантами С786Т у гені ендотеліальної синтази оксиду азоту (еNOS), T58C у гені мітохондріальної супероксиддисмутази (MnSOD2) та Ser49Gly в гені β1-адренорецептора (ADRB1) обстежені 133 новонароджені, із них 73 з групи перинатального ризику (І група) та 60 здорових доношених новонароджених (ІІ група). За результатами обстеження, бівентрикулярна дисфункція встановлена в 19,1 % дітей І групи, серед яких у 4 (5,5 %) обстежених встановлена систоло-діастолічна, у 10 (13,6 %) новонароджених — діастолічна дисфункція шлуночків серця. У 12 (20,0 %) передчасно народжених дітей та в 4 (30,7 %) новонароджених із затримкою внутрішньоутробного розвитку встановлено гіпокінетичний тип центральної гемодинаміки, що супроводжувалося підвищеними рівнями лактатдегідрогенази і γ-глутамілтрансферази в сироватці крові та змінами діастолічного наповнення шлуночків серця. Встановлена наявність асоціації між генотипом СС поліморфізму гена еNOS та скоротливою здатністю міокарда лівого шлуночка, інтегральною функцією лівого шлуночка за індексом Теї у передчасно народжених дітей із групи перинатального ризику, носіїв алелі С за поліморфізмом гена MnSOD2 та з легеневою гіпертензією, в неонатальний період. Наявність генотипу GG поліморфізму гена ADRB1 можна вважати предиктором розвитку гіпокінетичного режиму центральної гемодинаміки.

Interleukin-6 level is an independent predictor of right ventricular systolic dysfunction in patients hospitalized with COVID-19.

Cytokine storm with elevated levels of multiple proinflammatory cytokines and inflammatory system activation underlie the pathogenesis of coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate whether increased interleukin (IL)-6 levels can predict right ventricular (RV) systolic impairment in patients hospitalized with COVID-19. This prospective, observational study included 100 consecutive patients hospitalized with mild and moderate COVID-19. All the patients underwent chest computerized tomography, detailed laboratory tests including IL-6, and two dimensional (2D) transthoracic echocardiography (TTE) with assessment of 2D conventional and Doppler echocardiography parameters and RV systolic functions. After the elimination of six patients with exclusion criteria, the remaining patients were classified into two groups, namely normal RV systolic functions (n=60) and impaired RV systolic functions (n=34). IL-6 levels were significantly higher in patients with impaired RV systolic functions than in those with normal RV systolic functions (20.3, 4.6, p<0.001, respectively). Tricuspid annular plane systolic excursion and RV derived tissue Doppler imaging (TDI) S' measurements were similar between the two groups. RV fractional area change was significantly lower, and RV TDI derived index of myocardial performance was significantly higher in patients with impaired RV systolic functions. In multivariate analysis, IL-6 levels independently predicted deterioration in RV systolic function at a significant level (odds ratio: 1.12, 95% confidence interval: 1.04-1.20, p=0.003). IL-6 is an independent predictor of RV systolic impairment in patients hospitalized with mild and moderate COVID-19 suggesting a possible pathogenetic mechanism. IL-6 levels can be used to predict RV systolic impairment in patients suffering from this infection.

Correlation between Body Mass Index and Left Ventricular Remodeling and Function in Children with Sickle Cell Disease

Background:Cardiovascular complications play an important role in morbidity and mortality of patients with sickle cell disease (SCD). Historically, patients with SCD were underweight, but due to changes in the diet and advances in therapies there is a trend of increasing BMI, with some patients developing metabolic syndrome (MS). We hypothesized that obesity, MS, and SCD are associated with left ventricular (LV) remodeling and dysfunction and the presence of these conditions may increase the risk of cardiac disease.Objective:We aimed to evaluate the association between BMI and LV remodeling and dysfunction in pediatric patients with SCD, as well as the association with laboratory markers and clinical outcomes.Methods:We performed a retrospective study that included patients 10 to 22 years old with SCD followed at St. Christopher's Hospital for Children. Data collected included BMI, markers of MS, hemolysis, and inflammation, clinical outcomes and 2D and Doppler echocardiographic parameters. Echocardiogram parameters included those of cardiac structure, geometry, systolic function, and diastolic function. Analysis of variance (ANOVA) tests were performed to examine the differences between biomarkers and various weight categories. Pearson correlations were calculated to evaluate associations of BMI percentile with biomarkers and LV remodeling variables. A chi square test was used to assess differences in geometry by weight categories. Differences in BMI percentile associated with MS status was explored with a T-Test. ANOVA was used to assess differences in mean LV remodeling and functional variables associated with the various weight categories.Results:Demographic and laboratory data was collected on all 139 patients who met inclusion criteria, 35 had both pediatric cardiology evaluation and complete echocardiography. Of the 139 patients, 17 (12%) were obese, with 5 of them meeting the criteria for MS as defined by the International Diabetes Federation. Blood pressure was found to be significantly higher in obese patients when compared to non-obese patients (p = 0.026). Hemoglobin was statistically different among weight groups (underweight, normal weight, overweight, obese), with higher mean values being seen in the overweight and obese groups (p = 0.006). No significant correlations were found between cardiac biomarkers, BMI percentile and MS. In 35 patients with echocardiographic data, BMI percentile was positively correlated with relative wall thickness and negatively correlated with peak early LV filling and peak early LV filling/septal annuli early peak (E/Ea) velocities. Relative wall thickness was also positively associated with age. Partial correlations of BMI percentile with these variables were therefore calculated and remained significant in the same directions: Relative wall thickness (r = 0.345, p = 0.046), peak early LV filling velocity (r = -0.473, p = 0.011) and E/Ea (r = -0.415, p = 0.015). E/Ea was also significantly associated with weight category, with higher values in the normal and underweight groups (p = 0.020). Weight category and geometry were not significantly related.Conclusions:Obese patients were found to have significantly higher blood pressures and higher BMI percentiles were associated with LV remodeling, contributing to the risk of cardiac disease. Conversely, higher BMI percentile was associated with lower diastolic function measures (improved LV diastolic function) and the trend of higher mean hemoglobin values. This study suggests a complex relationship between BMI, hemoglobin and cardiovascular risks in children with SCD. Further prospective studies with larger sample size are necessary to validate our findings and to develop preventive strategies for cardiovascular risks in SCD. DisclosuresNo relevant conflicts of interest to declare.

Urgent neonatal balloon atrial septostomy in simple transposition of the great arteries: predictive value of fetal cardiac parameters

To investigate the impact of abnormal perinatal loading conditions on cardiac geometry and function in term fetuses and neonates with transposition of the great arteries with intact interventricular septum (simple TGA), and to explore the predictive value of fetal cardiac parameters for an urgent balloon atrial septostomy (BAS) after birth. This was a prospective longitudinal follow-up study of women delivering at term, including both uncomplicated pregnancies with normal outcome and pregnancies affected by fetal simple TGA. Conventional, spectral-tissue Doppler and speckle-tracking echocardiographic parameters were obtained within 1 week before delivery and within the first few hours after delivery. Neonates with simple TGA that required urgent BAS were assessed after the procedure and before corrective arterial switch surgery. Cardiac parameters were normalized by cardiac cycle length, ventricular end-diastolic length or end-diastolic dimension, as appropriate. Fetal and neonatal cardiac parameters were compared between simple-TGA cases and controls, and perinatal changes in the simple-TGA group were assessed. Receiver-operating-characteristics (ROC)-curve analysis was used to assess the predictive value of fetal cardiac parameters for urgent BAS after birth in the simple-TGA group. A total of 67 pregnant women delivering at term were included in the study (54 normal pregnancies and 13 with a diagnosis of fetal simple TGA). Compared with normal term fetuses, term fetuses with simple TGA exhibited more globular hypertrophied ventricles, increased biventricular systolic function and diastolic dysfunction (right ventricular (RV) sphericity index (SI), 0.58 vs 0.54; left ventricular (LV)-SI, 0.55 vs 0.49; combined cardiac output (CCO), 483 vs 406 mL/min/kg; LV torsion, 4.3 vs 3.0 deg/cm; RV isovolumetric relaxation time (IVRT'), 127 vs 102 ms; P < 0.01 for all). Compared with normal neonates, neonates with simple TGA demonstrated biventricular hypertrophy, a more spherical right ventricle and altered systolic and diastolic functional parameters (RV-SI, 0.61 vs 0.43; RV myocardial performance index, 0.47 vs 0.34; CCO, 697 vs 486 mL/min/kg; LV-IVRT', 100 vs 79 ms; RV-IVRT', 106 vs 71 ms; P < 0.001 for all). Paired comparison of neonatal and fetal cardiac indices in the simple-TGA group showed persistence of the fetal phenotype, increased biventricular systolic myocardial contractility and CCO, and diastolic dysfunction (RV systolic myocardial velocity (S'), 0.31 vs 0.24 cm/s; LV-S', 0.23 vs 0.18 cm/s; CCO, 697 vs 483 mL/min/kg; LV torsion, 1.1 vs 4.3 deg/cm; P < 0.001 for all). Several fetal cardiac parameters in term fetuses with simple TGA demonstrated high predictive value for an urgent BAS procedure after birth. Our proposed novel fetal cardiac index, LV rotation-to-shortening ratio, as a potential marker of subendocardial dysfunction, for a cut-off value of ≥ 0.23, had an area under the ROC curve (AUC) of 0.94, sensitivity of 100% and specificity of 83%. For RV/LV end-diastolic area ratio ≥ 1.33, pulmonary-valve-to-aortic-valve-dimension ratio ≤ 0.89, RV/LV cardiac output ratio ≥ 1.38 and foramen-ovale-dimension-to-total-interatrial-septal-length ratio ≤ 0.27, AUC was 0.93-0.98, sensitivity was 86% and specificity was 83-100% for all. Simple-TGA fetuses exhibited cardiac remodeling at term with more profound alterations in these cardiac parameters after birth, suggestive of adaptation to abnormal loading conditions and possible adaptive responses to hypoxemia. Perinatal adaptation in simple TGA might reflect persistence of the abnormal parallel arrangement of cardiovascular circulation and the presence of widely patent fetal shunts imposing volume load on the neonatal heart. The fetal cardiac parameters that showed high predictive value for urgent BAS after birth might reflect the impact of late-gestation pathophysiology and progressive hypoxemia on fetal cardiac geometry and function in simple TGA. If these findings are validated in larger prospective studies, detailed cardiac assessment of fetuses with simple TGA near term could facilitate improvements in perinatal management and refinement of the timing of postnatal intervention strategies to prevent adverse pregnancy outcomes. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Identifying Unique Patterns of Myocardial Deformation through Segmental Speckle Tracking Stress Strain Following High‐Fat Diet

Early detection of functional and structural changes to the heart are pivotal in treating cardiovascular disease and mitigating morbidity and mortality. This study utilized segmental stress strain analysis to evaluate whether different insults (diet induced obesity (DIO) and chronic stress) cause preferential dysfunction to specific regions of the heart. Male C57Bl/6 mice were randomized into lean or obese groups (N = 24/group) at 6 weeks of age. Mice in the obese group underwent 12 weeks of DIO with a high-fat diet (HFD). At 18 weeks, mice in lean and obese groups were further randomized into unpredictable chronic mild stress (UCMS) and non-UCMS groups to elicit a chronically stressed phenotype (UCMS; 7 hrs/day, 5 days/week, for 8 weeks). M-Mode, Pulse-Wave Doppler, and speckle tracking stress-strain echocardiographic parameters were measured at baseline (6 weeks), post-HFD (17 weeks), and post-UCMS (26 weeks). Supervised machine learning identified the predictive capacity of each diagnostic echocardiographic technique in DIO and chronic stress using 10-fold cross validation. Comparing the DIO group to control mice, the machine learning model provided robust prediction (AUC: 0.921), with the two most important features being radial strain of the lateral wall and anterior free wall. Changes in radial strain of the lateral wall (-64%, P≤0.001) and anterior free wall (-53%, P<0.001) were more pronounced compared to ejection fraction (-9%, P<0.001) and global longitudinal strain (-16%, P=0.08). The ability to predict mice that underwent chronic stress, irrespective of diet, was assessed (AUC: 0.714) revealing longitudinal strain rate of the anterior mid wall and radial strain of the posterior septal wall as the top two features. The wall segments indicate a predilection for changes in deformation patterns to the free wall (DIO) and septal wall (chronic stress). This study suggests that segmental analysis can provide early indications of disease-specific changes to the myocardium.