GE Vivid E9 Research Articles

Diagnostic efficacy of contrast-enhanced ultrasound, dynamic contrast-enhanced MRI combined with tumor markers AFP and DCP for primary hepatocellular carcinoma

ABSTRACT The purpose of this study was to investigate the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with tumor markers alpha-fetoprotein (AFP) and des-γ-carboxyl prothrombin (DCP) for primary hepatic carcinoma (PHC). A total of 70 patients with PHC (PHC group), 42 patients with liver cyst (benign liver disease group (BLDG)) and 30 healthy people (healthy group (HG)) were selected as the research objects. CEUS and DCE-MRI were performed by American GE Vivid E9 color Doppler ultrasound system and Siemens 1.5T magnetic resonance imager, respectively. The levels of AFP and DCP were detected by ABBOTT i2000SR chemiluminescence instrument and enzyme-linked immunoassay (ELISA), respectively. In DCE-MRI examination, the portal phase and prolonged phase were mostly low signal in T1-weighted imaging (T1WI) sequence, and arterial phase was mostly high signal in T2WI sequence. In CEUS, most lesions showed hyper-enhancement in arterial phase, and hypo-enhancement in portal phase and delayed phase. AFP and DCP levels in PHC group were significantly higher than that in BLDG group and HG group. There were statistically significant differences among the three groups. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined diagnosis were statistically significant when compared with CEUS, AFP and DCP alone and either AFP or DCP positive. CEUS, DCE-MRI combined with tumor markers AFP and DCP have high sensitivity, specificity and accuracy in the diagnosis of PHC, which can more accurately diagnose the lesion type, provide basis for further treatment, and is worthy of clinical application.

Role of Myocardial Strain Imaging by Echocardiography for the Early Detection of Anthracyclines-Induced Cardiotoxicity.

SummaryObjectiveTo investigate the role of myocardial strain imaging by echocardiography is for detecting anthracycline-induced cardiotoxicity early.Patients and methodsFifty patients had transthoracic echocardiogram before, during, and after taking anthracyclines. GE Vivid E9 Ultrasound System was used for echocardiographic examination and myocardial strain imaging. All patients were assessed three times: on the first visit, before starting anthracycline medication; on the second visit, three months later; and on the third visit, six months later.ResultsCardiotoxicity occurred in 4 patients at the end of the research. There was a statistically significant association between percentage change in global longitudinal strain (GLS) and ejection fraction (EF) at 3 months p < 0.001 and 6 months p < 0.001. Change in the GLS at 3 months and 6 months had a sensitivity and specificity of 100%, 95.65%, and 100%, 89.13% respectively. Using receiver operating characteristic curve (ROC) for change in GLS showed that Area Under a Curve (AUC) = 1.000, sensitivity, specificity, positive predictive value, and negative predictive value all equals 100%.ConclusionStrain echocardiographic examination using GLS is a good predictor for early detection of left ventricle dysfunction caused by anthracyclines chemotherapy.

Can 2D speckle tracking echocardiography be useful in venesection therapy monitoring in hereditary hemochromatosis patients?

Abstract Funding Acknowledgements Type of funding sources: None. Background. Hereditary hemochromatosis (HH) is a widespread genetic disease. Abnormally increased intestinal iron absorption and accelerated recycling of iron lead to progressive body iron accumulation and the generation of oxidative stress in tissues. Venesection is the primary treatment of such patients. Based on the fact that two-dimensional speckle tracking echocardiography (2D STE) can evaluate left ventricle (LV) dysfunction more accurately and earlier than conventional echocardiography, the purpose of our study was to check whether it could be helpful in venesection therapy monitoring. Methods. We prospectively enrolled 20 patients with genetically confirmed HH. Classic echocardiographic and 2D STE parameters (GE VIVID E9, EchoPAC v202) were analyzed at the moment of diagnosis, and after three years of treatment with venesection; 20 healthy age- and sex-matched persons constituted the control group. Results. The HH patients had all standard echo parameters within the normal range at the first and second examinations. The rotation parameters were initially worse than in healthy people at the first visit and significantly increased after three years of treatment. The radial strain after the treatment was significantly better for the apex but not for basal LV, apart from the epicardial layer (known as the layer of iron overload in the heart). Global longitudinal strain (GLS), significantly lower than in healthy people at the first visit, did not change within the treatment (Table). Conclusions. Venesection leads to significant improvement in the rotation function of LV and increases radial strain mainly in the epicardium, which seems to help monitor the treatment and guide the intensity of venesections. GLS, which is known as a parameter for early detection of heart abnormalities in asymptomatic HH patients, did not increase within the treatment and could reveal irreversible changes in LV. Abstract Figure.

Ultrasound and Microbubbles Enhance Uptake of Doxorubicin in Murine Kidneys.

The use of ultrasound and microbubble-enhanced drug delivery, commonly referred to as sonoporation, has reached numerous clinical trials and has shown favourable results. Nevertheless, the microbubbles and acoustic path also pass through healthy tissues. To date, the majority of studies have focused on the impact to diseased tissues and rarely evaluated the impact on healthy and collateral tissue. The aim of this study was to test the effect and feasibility of low-intensity sonoporation on healthy kidneys in a mouse model. In our work here, we used a clinical diagnostic ultrasound system (GE Vivid E9) with a C1-5 ultrasound transducer combined with a software modification for 20-µs-long pulses to induce the ultrasound-guided drug delivery of doxorubicin (DOX) in mice kidneys in combination with SonoVue® and Sonazoid™ microbubbles. The acoustic output settings were within the commonly used diagnostic ranges. Sonoporation with SonoVue® resulted in a significant decrease in weight vs. DOX alone (p = 0.0004) in the first nine days, whilst all other comparisons were not significant. Ultrasound alone resulted in a 381% increase in DOX uptake vs. DOX alone (p = 0.0004), whilst SonoVue® (p = 0.0001) and Sonazoid™ (p < 0.0001) further increased the uptake nine days after treatment (419% and 493%, respectively). No long-standing damage was observed in the kidneys via histology. In future sonoporation and drug uptake studies, we therefore suggest including an “ultrasound alone” group to verify the actual contribution of the individual components of the procedure on the drug uptake and to perform collateral damage studies to ensure there is no negative impact of low-intensity sonoporation on healthy tissues.

Peak strain dispersion within the left ventricle detected by two-dimensional speckle tracking in patients with uncomplicated systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) often leads to various cardiovascular diseases. We aimed to investigate the value of peak strain dispersion (PSD) in evaluating left ventricular dysfunction in patients with uncomplicated SLE. Eighty-seven female SLE patients and fifty-nine healthy female controls were recruited. The SLE patients were divided into inactive disease (SLE disease activity index (SLEDAI) ≤ 4; n = 48) and active disease (SLEDAI ≥ 5; n = 39) subgroups. Traditional echocardiography and two-dimensional speckle-tracking echocardiography were performed using a GE VividE9 ultrasound diagnostic system and an advanced quantitative analysis EchoPAC workstation (version 201), respectively. The global longitudinal strain (GLS) in the SLE with SLEDAI ≤ 4 group was comparable to that in the control group (- 19.89% vs - 20.7%; P = 0.061). However, GLS was obviously damaged in the SLE with SLEDAI ≥ 5 group compared with that in the control group (- 19.07% vs - 20.7%; P < 0.001). PSD impairment was observed in the SLE with SLEDAI ≤ 4 group (33.83ms vs 31.44ms; P = 0.012) and SLE with SLEDAI ≥ 5 groups (52.31ms vs 31.44ms; P < 0.001), but the largest difference was observed in the active disease group. Linear regression analysis showed that PSD was moderately correlated with the SLEDAI (r = 0.535; P < 0.001) in SLE patients with SLEDAI ≤ 4 and showed the best correlation with the SLEDAI (r = 0.646; P < 0.001) in the SLE patients with SLEDAI ≥ 5. A correlation between GLS and the SLEDAI (r = 0.359; P = 0.025) was found in the active disease group but not in the inactive disease group (r = 0.253; P = 0.082). PSD is more comprehensive and accurate for evaluating left ventricular subclinical dysfunction in SLE patients. In inactive SLE patients, PSD is a more sensitive index to evaluate early systolic dysfunction of the left ventricle. GLS may be a more vulnerable indicator of early left ventricular cardiac dysfunction in active SLE patients. Controlling disease activity may reduce the events of cardiac dysfunction.

Early signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis

The objective of the study – identify early preclinical signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis.Material and methods. We examined 142 people with verified rheumatic diseases. All patients were divided into 2 groups. The first group consisted of patients with rheumatoid arthritis – 95 people. The second group – patients with ankylosing spondylitis – 47 people. The control group included 70 practically healthy individuals. In addition to standard diagnostic tests, all patients underwent tissue dopplerography of the heart using the GE Vivid E9 ultrasound device using the two-dimensional deformation technique (speckle tracking) to assess the deformation and rate of myocardial deformation, as well as determining the level of matrix metalloproteinase-9 in the blood serum.Results. Among patients with rheumatoid arthritis, diastolic dysfunction of both the left ventricle and both ventricles was more common than in the control group. The same pattern was observed in the group with ankylosing spondylitis. The calculation of the relative risk showed that the presence of rheumatoid arthritis in 4,42 times increases the risk of diastolic dysfunction of the left ventricle in comparison with practically healthy people (CI 1,6–12,2). In individuals with rheumatoid arthritis also results in a deterioration of systolic function of both ventricles. The level of matrix metalloproteinase metalloproteinase-9 was highest and most often increased in patients with ankylosing spondylitis. Among patients with rheumatoid arthritis, the average level of metalloproteinase-9 was low, but the incidence was higher than in the control group. The obtained results indicate that in these rheumatic diseases there is a marked degradation of the extracellular matrix components.Conclusion. Patients with rheumatoid arthritis and ankylosing spondylitis are characterized by a deterioration in the diastolic function of the left ventricle or both ventricles simultaneously, which is accompanied by an increase in the level of metalloproteinase-9.

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

Advantage and validation of vendor-independent software for myocardial strain analysis compared to vendor-specific software.

One of the main limitations incorporating strain imaging into widespread clinical practice is inter-vendor incompatibility. This poses a problem when serial strain measurements are required in a multi-vendor echocardiography laboratory. This study sought to compare the variability of two-dimensional speckle-tracking global and regional longitudinal strain using vendor-specific software and vendor-independent software from images acquired by two different commercially available ultrasound systems. Forty subjects underwent two sequential echocardiographic acquisitions using different ultrasound systems (GE Vivid E9 and Philips iE33). Global longitudinal strain and regional peak longitudinal strain were derived using vendor-specific software (EchoPAC BT 13 v201 and QLAB version 10.3) and vendor-independent software (TomTec Image Arena version 4.6). Agreement and reproducibility of global and regional strain between vendor-specific and vendor-independent software were assessed by independent blinded observers. Global longitudinal strain derived from vendor-independent software was comparable to global longitudinal strain derived from vendor-specific software, whilst regional strain was lower in agreement compared to global longitudinal strain. There was good overall agreement and high inter- and intra-observer reproducibility using vendor-independent software for global longitudinal strain and regional strain. Vendor-independent software provides good agreement with vendor-specific software for global longitudinal strain. However, minor variability exists for regional strain measurements between vendor-independent and vendor-specific software. Good agreement of strain measurements derived by vendor-independent software suggests vendor-independent software could potentially be useful for serial follow-up of global longitudinal strain.

282 Advantage and Validation of Vendor-Independent Software for Global and Regional Strain Analysis

One of the main limitations for incorporating strain imaging into widespread clinical practice is inter-vendor incompatibility. This study sought to compare the variability of two-dimensional speckle-tracking derived global and regional longitudinal strain using vendor-specific software (VSS) and vendor-independent software (VIS) from images acquired by two different commercially available high-end ultrasound systems. 40 subjects underwent two sequential echocardiographic acquisitions using two different ultrasound systems (GE Vivid E9 and Philips iE33). Global longitudinal strain (GLS) and regional peak longitudinal strain were derived using VSS (EchoPAC BT 13 and QLAB version 10.3) and VIS (TomTec Image Arena version 4.6). Agreement (Blan-Altman Bias) and reproducibility of strain values between VSS and VIS were assessed using intraclass correlation coefficient (ICC). GLS values analysed by VIS on images acquired on different ultrasound systems showed no significant difference (TomTec strain analysis on GE images; -18.6±4.8 vs TomTec strain analysis on Philips images; -19.2±4.8, p=0.09). VIS GLS was comparable to VSS GLS, whilst regional strain was lower in agreement compared to GLS. There was good overall agreement using VIS for GLS (Bias: Philips images =-0.02, Bias: GE images =-0.91) and high inter- and intra-observer reproducibility (Interobserver ICC =0.92, Intraobserver ICC =0.96). VIS provides good agreement with VSS for GLS. Variability exists for regional strain between VIS and VSS. Good agreement for VIS strain values from images acquired using different ultrasound systems suggest VIS could potentially be useful for serial follow-up of GLS.

P932 What is new in the assessment of patients with hereditary hemochromatosis - can 2D speckle tracking echocardiography be helpful in the early detection of heart abnormalities?

Abstract Background Hereditary hemochromatosis (HH) is a very common genetic disease. Abnormally increased intestinal iron absorption and accelerated recycling of iron lead to progressive body iron accumulation and the generation of oxidative stress in tissues. In the late stages iron overload of the heart can lead to the left ventricular (LV) dysfunction. It is believed, that two dimensional speckle tracking echocardiography (2D STE) can evaluate LV dysfunction more accurately and earlier than conventional echocardiography. Evaluation of such assessment was the purpose of this paper. Methods We prospectively enrolled 58 patients with genetically confirmed HH; 29 healthy age- and sex-matched volunteers constituted the control group. Classic echocardiographic and 2D STE parameters (GE VIVID E9, EchoPAC v201) were compared between the groups, additionally correlations between echo and iron turnover parameters were performed. Results The HH patients had all standard echo parameters within the normal range. All 2D STE parameters were significantly worse in HH than in control group (Table 1). We did not find any correlation between echo and iron turnover parameters, whilst significant correlation with the time from diagnosis and the numbers of venesections was noticed. Conclusions Novel 2D STE analyzes seem to be helpful in early detection of heart abnormalities in HH patients. The correlations between the echo and iron indices are weak, allowing to suggest the lack of a "direct" relationship between the iron turnover and myocardial function and that myocardial iron overload is not the only mechanism involved in development of HH cardiomyopathy. HH All n = 58 Controls n = 29 p LAVI (ml/BSA) 31 (23-37) 22 (19-27) &amp;lt;0.001 RWT 0.42 (0.38-0.47) 0.38 (0.34-0.43) &amp;lt;0.003 LVMI (g/BSA) 78 (58-96) 66 (53-72) &amp;lt;0.006 E/Em 7.0 (5.6-8.3) 6.7 (5.0-7.5) 0.071 LVEF (%) 60 (54-62) 63 (61-65) &amp;lt;0.006 LV twist (º) 17.2 (13.1-22.2) 24.1 (19.9-32.1) &amp;lt;0.001 LV torsion (º/cm) 2.2 (1.6-2.9) 3.3 (2.7-4.3) &amp;lt;0.001 LV peak rotation velocity (º/s) 118.0 (88.3-146.3) 140.0 (112.7-168.9) &amp;lt;0.015 LV peak untwisting velocity (º/s) -132.0 (-163.5–93.0) -156.0 (-197.0–122.6) &amp;lt;0.039 Peak systolic longitudinal strain (%) -18.3 (-20.0–16.9) -21.0 (-22.0–19.3) &amp;lt;0.001

1180 2D and 3D assessment of the left ventricle volume and ejection fraction in a general population

Abstract Introduction In standard practice, LV volumes and EF are estimated by 2D technique. 3D echocardiographic assessment seems more reliable; however, this method has not yet been validated in the general population. Purpose To validate 3D echocardiography in a large population sample and investigate differences between 2D and 3D LVEF and volumes Methods In The Copenhagen City Heart Study, 4466 echocardiograms were available for analysis. The echocardiograms were obtained during four consecutive heartbeats in both 2D and 3D with GE Vivid E9. Offline analysis was performed on EchoPac v. 201. LVEF was calculated by the modified Simpsons Biplane Auto EF for 2D and by the 4LVQ method for 3D. Results The study included 2090 echocardiograms. The mean 2D LVEF was 57.3 ± 6.1% (IQR 54 - 61%) and 51.7 ± 7.9% (IQR 47 - 57%) by 3D. The mean end-diastolic volume (EDV) and end-systolic volume (ESV) by 2D and 3D techniques were: EDV 2D 106.1 ± 29.6 ml vs EDV 3D 128.2 ± 32.3 ml , ESV 2D 45.7 ± 15.6 ml vs. ESV 3D 45.7 ± 20.7 , p &amp;lt; 0.05 among all variables. The average difference of means between 2D and 3D LVEF was 5.6 ± 11.2%, -22.1 ± 56.8 ml for EDV, and -16.9 ± 32.9 ml for ESV. The correlation coefficient for LVEF was 0.42, EDV 0.76 and for ESV 0.70. Conclusion In our study, we found a significant difference in both LVEF and ventricular volumes when comparing 2D echocardiograms with 3D. 3DE had, in general, lower LVEF, higher EDV and ESV compared to 2D. Table 1: Summary of results Table 1 - Summary of results n = 2090 Variable Min Max Mean IQR (25-75) p-value LVEF, 2D (%) 18 76 57.3 ± 6.1 54-61 &amp;lt; 0.05 LVEF, 3d (%) 13 77 51.7 ± 7.9 47-57 &amp;lt; 0.05 EDV, 2D (ml) 13 275 106.1 ± 29.6 85-123.8 &amp;lt; 0.05 EDV, 3D (ml) 50 270 128.2 ± 32.3 106-148 &amp;lt; 0.05 ESV, 2D (ml) 15 150 45.7 ± 15.6 35-54 &amp;lt; 0.05 ESV, 3D (ml) 13 185 45.7 ± 20.7 48-74 &amp;lt; 0.05 LVEF: left ventricle ejection fraction, EDV: end-diastolic volume, ESV: end systolic volume, IQR: Inter-quartile range Abstract 1180 Figure 1: Correlation and BA-plot

562 Can 2D speckle tracking echocardiography have an additional impact on prediction of hospitalizations due to heart failure decompensation in patients with ischemic left ventricular systolic dysfunction

Abstract Funding Acknowledgements NA Background Despite advancements in medical therapy and device-based treatment, heart failure (HF) continues to impose enormous burden for both patients and health care system worldwide. Hospitalizations due to HF decompensation is well-known cause of mortality. Objectives were to verify whether 2D speckle tracking echocardiography (2D STE) provides independently of other well-known clinical and echocardiographic parameters, information on the risk of HF decompensation in patients with left ventricular systolic dysfunction of ischemic origin. Materials and Methods In 193 stable ischemic HF patients with left ventricular ejection fraction (LVEF) ≤ 50%, global longitudinal strain (GLS), as well as other echocardiographic (GE VIVID E9, EchoPAC v201) and well-known clinical parameters were analyzed. During 34 (14 – 71) months of follow-up, 58 patients were hospitalized due to HF decompensation (EVENT). Results LVEF, GLS, diastolic function and well-known clinical parameters (age, renal function, hemoglobin, brain natriuretic peptide level, history of diabetes, diuretic treatment and the absence of beta-blockers), as well as cut-off values of these parameters identified in ROC analysis were significantly associated with the risk of EVENT in univariate Cox hazard regression analysis (Table). GLS value of -9.4% was the most accurate predictor of EVENT (AUC 80.7% [CI 57.6 – 100%]), whereas other parameters were characterized by lower discriminatory power. In multivariate Cox analyses GLS of -9.4% was still a significant predictor of the EVENT. Conclusions 2D STE can provide additional information, independently of other well-known clinical and echocardiographic parameters, on the risk of HF decompensation in the patients with left ventricular systolic dysfunction of ischemic origin. GLS value worse than -9.4% can identify the patients with higher risk of this EVENT. Hazard Ratio 95% CI p Age ≥ 71 yo 2.48 1.46 - 4.23 &amp;lt;0.001 GFR ≤ 30 ml/min/1.73 m&amp;sup2; 4.67 1.65 - 13.22 &amp;lt;0.004 Hemoglobin ≤ 14.7 g/dl 3.02 1.19 - 7.70 &amp;lt;0.020 BNP ≥ 214 pg/ml 2.64 1.31 - 5.31 &amp;lt;0.007 LVEF ≤ 32% 2.76 1.55 - 4.90 &amp;lt;0.001 GLS ≥ -9.4% 15.16 1.81 - 56.91 &amp;lt;0.012 E/A ≥ 2.0 8.64 1.91 - 39.05 0.005

P2477Assessment of intraventricular flow dynamics in acute heart failure studied by Vector Flow Mapping

Abstract Background Although left ventricular (LV) flow dynamics should be closely related to LV morphology and function, little is known about how heart failure (HF) changes it. Pathline Analysis (PA), a recently developed software based on Vector Flow Mapping (VFM, Hitachi), enables us to trace the virtual blood particles entering to the LV in diastole and being ejected in systole. We investigated the change of flow dynamics in HF induced in dogs using PA. Methods In 15 open-chest dogs, HF was induced by intracoronary injection of microspheres. Color Doppler images of apical long-axis view were acquired using Prosound F75 (Hitachi) before and after HF and were analyzed by PA. We calculated the ratio of the numbers of entering particles in diastole and ejected particles in systole (ejection rate) and the distance reached by the particles in diastole corrected by the LV long-axis diameter (propagation distance). Apical and basal short axis images were acquired using GE Vivid E9 and were analyzed for peak rotation and peak twist. Results After inducing HF, LV end-diastolic pressure increased from 6±2 to 15±5 mmHg (p&lt;0.001) and ejection fraction (EF), apical peak rotation and peak twist decreased significantly (EF; 58±5 to 36±8%, apical peak rotation; 14±5 to 3±2 degree, peak twist; 19±5 to 6±3 degree, p&lt;0.05, respectively). PA showed most of the entering particles to the LV were ejected in the following systole at the control stage, but in HF, a significant part of the entering particles were not ejected and remained in the LV (Figure). Ejection rate decreased from 50±11 to 26±11% (p&lt;0.001) and the propagation distance decreased from 85±9 to 66±13% (p&lt;0.001) after inducing HF. There were significant relationships between indices obtained by PA and EF and peak twist (Table). Conclusion A significant part of inflow is not ejected directly to the outflow in the next systole and remains in the LV in HF, suggesting inefficient flow dynamics.

Impact of apical foreshortening on deformation measurements: a report from the EACVI-ASE Strain Standardization Task Force.

Foreshortening of apical views is a common problem in echocardiography. It results in an abnormally thick false apex and a shortened left ventricular (LV) long axis. We sought to evaluate the impact of foreshortened (FS) on LV ejection fraction (LVEF) and layer-specific 2D speckle tracking based segmental (S) and global (G) longitudinal strain (LS) measurements. We examined 72 participants using a GE Vivid E9 system. FS apical views were collected from an imaging window one rib-space higher than the optimal images. Ejection fraction as well as layer-specific GLS and SLS measurements were analysed by GE EchoPAC v201 and TomTec Image Arena 4.6 and compared between optimal and FS images. On average, LV long axis was 10% shorter in FS images than in optimal images. FS induced a relative change in LVEF of 3.3% and 6.9% for GE and TomTec, respectively (both, P < 0.001). Endocardial GLS was 9.0% higher with GE and 23.2% with TomTec (P < 0.001). Midwall GLS measurements were less affected (7.8% for GE and 14.1% for TomTec, respectively, both P < 0.001). Segmental strain analysis revealed that the mid-ventricular and apical segments were more affected by foreshortening, and endocardial measurements were more affected than midwall. Optimal image geometry is crucial for accurate LV function assessment. Foreshorhening of apical views has a substantial impact on longitudinal strain measurements, predominantly in the apex and in the endocardial layer. Our data suggest that measuring midwall strain might therefore be the more robust approach for clinical routine use.

Intervendor Discordance of Fetal and Neonatal Myocardial Tissue Doppler and Speckle-Tracking Measurements

Fetal and neonatal studies report a wide range of cardiac parameters derived by pulsed-wave Doppler tissue imaging (DTI) and two-dimensional speckle-tracking echocardiographic (STE) imaging. The use of different ultrasound systems and their vendor-specific software compromises the ability to compare echocardiographic findings among various studies. The aim of this study was to evaluate intervendor reproducibility as well as intra- and interobserver repeatability of DTI and STE measurements in normal-term fetuses and neonates. A prospective study was conducted of term fetuses (n=196) from uncomplicated pregnancies assessed days before the onset of labor and a few hours after birth. Fetal and neonatal DTI and STE parameters were obtained and analyzed using vendor-specific software on three ultrasound systems: Toshiba Aplio MX versus GE Vivid E9 and GE Vivid E9 versus Philips EPIQ. A reproducibility study in fetuses and neonates (n=118) was performed by systematic scanning with head-to-head comparison. DTI reproducibility showed moderate to good correlation, with good agreement for fetuses and neonates on Toshiba versus GE (intraclass correlation coefficient [ICC]=0.4-0.8). Correlation of DTI measurements on GE versus Philips was poor to moderate for fetuses (ICC=0.1-0.6) and moderate to good for neonates (ICC=0.5-0.8), with wider limits of agreement. Fetal and neonatal STE parameters revealed very poor correlation (ICC=0.1-0.3) and agreement among ultrasound vendors. Intra- and interobserver repeatability demonstrated good to excellent correlation of all fetal and neonatal DTI and STE measurements, with good agreement irrespective of the ultrasound platform used. These findings demonstrate reliable assessment of fetal and neonatal DTI and STE measurements when performed on the same ultrasound platform, whereas ultrasound machines and software from different vendors give significantly divergent estimates of DTI and STE parameters in fetuses and neonates. These intervendor discrepancies have significant clinical and research implications and should be considered when interpreting and comparing study findings, establishing reference standards, or performing systematic reviews.

Contributions of different components of myocardial motion to left ventricular contraction by two-dimensional speckle tracking echocardiography

Objective To decompose left ventricular contractile motions and analyze the corresponding contributions of different components to left ventricular systolic function. Methods Sixty-nine healthy adults with normal left ventricular eject fraction (LVEF) were recruited. Two-dimensional speckle tracking echocardiography was performed by GE Vivid E9 system, and strain parameters were analyzed by EchoPac software. Correlation and multiple stepwise regression analysis were performed to analyze the contributions of different components of myocardial motion to left ventricular contraction. Results Global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and twist were all significantly correlated with LVEF (r=-0.668, P<0.001; r=-0.552, P<0.001; r=0.335, P=0.006; r=0.428, P<0.001). Significant correlations were found between all the strain parameters, except for GRS and twist. Multiple stepwise regression adjusted for sex, and age showed that the uni-contributions of GLS, GCS, GRS and twist to LVEF were 21.3%, 13.0%, 7.5%, 8.8%, respectively. However, with all strain parameters in the general regression model, only GLS and twist were still significantly related with LVEF (R2=0.566, P<0.001). Conclusions The contributions of various components of myocardial motion to left ventricular contraction in healthy adults are different. Although every component is significantly related with LVEF, the longitudinal and twist motion are most important in the integrated view. Key words: Two-dimensional speckle tracking imaging; Ventricular function, left; Myocardial strain

Layer-specific strain assessment of left ventricular systolic function in patients with bicuspid aortic valve

Objective To quantitatively evaluate left ventricular (LV) systolic function in bicuspid aortic valve (BAV) using layer-specific strain (LSS). Methods Thirty BAV patients were divided into normal function (NF) group (10 cases) and non-normal function (N-NF) group (20 cases) based on aortic valvular lesion types, and 20 healthy volunteers were taken as control group. Longitudinal strain(LS) and circumferential strain (CS) of three-layer myocardium and full thickness myocardium were assessed using layer-specific speckletracking imaging, available by GE Vivid E9 and EchoPac workstation. Results There was no significant difference in left ventricular ejection fraction(LVEF) among the N-NF group, NF group and control group (P>0.05), all of them within the normal range[(63.3±7.1)%, (64.6±6.2)%, (65.3±3.9)%]. It showed a gradient decrease from the endocardium to the epicardium in both control and BAV group. LS of endocardium (LSendo) and LS of epicardium (LSepi) in N-NF group and NF group were significantly reduced compared with those in control group (P 0.05). Compared with NF group[CS: (-19.57±2.9)% vs (-13.43±2.19)% vs (-20.03±3.04)%; LS: (-21.38±2.05)% vs (-18.85±2.12)% vs (-21.09±2.03)%] and control group[CS: (-21.63±3.01)% vs (-14.34±2.55)% vs (-21.48±2.16)%; LS: (-22.18±2.30)% vs (-20.72±2.28)% vs (-22.89±2.30)%], CS[(-16.78±3.65)% vs (-11.40±3.78)% vs (-15.83±2.61)%]and LS[(-18.34±2.85)% vs (-16.08±2.68)% vs (-18.51±2.86)%] of middle myocardium, epicardial myocardium and full-thickness myocardium in N-NF group were decreased significantly (P<0.05). Conclusions It is essential to maintain normal valvular function to prevent the progress of myocardial deterioration. LSendo and LSepi can be used to sensitively identify early left ventricular systolic dysfunction in BAV patients with normal LVEF. Key words: Echocardiography; Ventricular function, left; Layer-specific strain; Bicuspid aortic valve

Speckle-Tracking Echocardiographic Layer-Specific Strain Analysis on Subclinical Left Ventricular Dysfunction in Patients With Primary Aldosteronism.

Primary aldosteronism (PA) may cause myocardial injury. We investigated myocardial dysfunction using speckle-tracking echocardiographic (STE) layer-specific strain in patients with PA. Our study included 62 patients with PA (33 aldosterone-producing adenoma [APA] and 29 idiopathic hyperaldosteronism [IHA]) and 30 patients with primary hypertension. STE was acquired using the GE Vivid E9 equipment. The longitudinal (LS) and circumferential (CS) layer-specific strains of the endocardium, midmyocardium, and epicardium (LSendo, LSmid, LSepi, CSendo, CSmid, and CSepi) were obtained using the EchoPAC BT13 workstation. Patients with APA, compared with those with primary hypertension and IHA, had a significantly (P < 0.001) lower serum potassium concentration and plasma renin activity, and higher 24-h urinary aldosterone, plasma aldosterone concentration, and aldosterone-to-renin ratio. Left ventricular ejection fraction was normal in all patients (58-60%). Layer-specific strain showed decreasing gradient from the endocardium to epicardium in all 3 groups (P < 0.01). However, LSendo and CSendo were lowest in APA (-20.2 ± 2.3% and -33.3 ± 3.2%), intermediate in IHA (-22.1 ± 1.9% and -35.7 ± 2.8%) and highest in primary hypertension (-24.1 ± 2.1% and -38.9 ± 3.1%, P < 0.001). Similar trends were observed for LSmid, LSepi, CSmid, and CSepi, but statistical significance was only reached for the comparison between APA and primary hypertension (P < 0.001), but not others (P > 0.05). Layer-specific strain was significantly correlated with plasma aldosterone concentration for all echocardiographic parameters (r = -0.69 to -0.53, P < 0.001) in all 3 groups. Patients with PA, especially APA, had impaired regional systolic function with myocardial deformation changes at similar levels of blood pressure, probably because of elevated plasma aldosterone concentration.

A7140 Layer-specific Strain Analysis of Myocardial Dysfunction by Speckle Tracking Echocardiography in Patients with Primary Aldosteronism

Objectives: Primary aldosteronism may cause subclinical myocardial injury due to plasma aldosterone elevation. We aimed to investigate myocardial dysfunction using layer-specific strain in patients with primary aldosteronism. Methods: Our study included 62 patients with primary aldosteronism (33 with aldosterone-producing adenoma and 29 idiopathic hyperaldosteronism) and 30 patients with primary hypertension. Speckle tracking echocardiography was acquired using GE Vivid E9 equipment. Longitudinal and circumferential layer strains of the endocardium, midmyocardium and epicardium (LSendo, LSmid, LSepi, CSendo, CSmid, CSepi) were then obtained using EchoPAC BT13 workstation. Results: Patients with aldosterone-producing adenoma (369.2 pg/ml and 144), but not those with idiopathic hyperaldosteronism (220.4 pg/ml and 45), had significantly (P ≤ 0.01) higher plasma aldosterone concentration and plasma aldosterone-to-plasma renin activity ratio (ARR) than patients with primary hypertension (183.1 pg/ml and 13). Layer-specific strain showed decreasing gradient from the endocardium to epicardium in all three groups of patients (P ≤ 0.01). LSendo and CSendo were lowest in aldosterone-producing adenoma, intermediate in idiopathic hyperaldosteronism and highest in primary hypertension (P ≤ 0.01 vs both groups of patients with primary aldosteronism). However, LSmid, LSepi, CSmid and CSepi were significantly (P ≤ 0.01) lower only in the presence of aldosterone-producing adenoma than primary hypertension, but not idiopathic hyperaldosteronism ( P ≥ 0.05). Conclusion: Patients with primary aldosteronism show prominent myocardial deformation changes, to a large extent in parallel with the plasma aldosterone elevation, especially those with aldosterone-producing adenoma and at the endocardial layer.

Three-Dimensional Echocardiography-derived strain values acquired by a novel analysis program.

This in vitro study calculated longitudinal strain (LS) from different ultrasound systems (GE Vivid E9 and Philips IE 33) before and after myocardial infarct (MI) using a vendor-independent analysis software package (TomTec's 4D LV Analysis) to validate the variation of two ultrasound systems. Ten freshly harvested porcine hearts were passively driven by a pulsatile pump apparatus at stroke volumes (SV) 30-70mL. Full-volume three-dimensional echocardiography (3DE) data were acquired before and after MI using two different ultrasound systems. LS was derived from TomTec and validated against sonomicrometry data. Linear regression analyses showed excellent correlations between TomTec-calculated LS values and sonomicrometry data for both normal and simulated MI groups (GE: R2 =0.72/0.68, Philip: R2 =0.71/0.66). Bland-Altman analyses demonstrated overestimation of echo-derived strain values for all groups. Both ultrasound system-derived strain values demonstrated decreased LS after MI, and the average change in strain after infarct was roughly 30% in GE images and 25% in Philips images. Both GE and Philips echocardiographic systems can be analyzed with TomTec's program, and these images correlated well with sonomicrometry with acceptable variations.