Peak Global Strain Research Articles

Evaluation of eSie VVI Technology on Left Ventricular Systolic Function Changes in Uremic Patients Undergoing Dialysis.

To analyze the longitudinal peak systolic strain of left ventricular myocardium in three layers before and after hemodialysis in uremic patients, and to explore the value of eSie VVI (Velocity Vector Imaging) technology in evaluating the changes of left ventricular myocardial systolic function in uremic patients in a short time after hemodialysis, the longitudinal peak systolic laminar strain and global full-thickness strain of 17 segments of the left ventricle are obtained by eSie VVI software analysis, and the results are deduced in Excel form. Statistical analysis is made on the results of longitudinal peak systolic stratified strain of left ventricular inner, middle and outer layers and whole myocardium in uremic patients before and after hemodialysis. The results show that eSie VVI technology can more sensitively and accurately evaluate the changes of left ventricular myocardial systolic function after hemodialysis in uremic patients, and has certain clinical value.

A preliminary study on evaluation of left ventricular systolic function in normal fetuses by automated cardiac motion quantitation

Objective To evaluate the feasibility and value of automated cardiac motion quantitation (aCMQ) for measuring the global and regional longitudinal strain of left ventricle in fetuses. Methods One hundred and eighteen normal fetuses were divided into 4 groups by gestational age, standard four-chamber view clips were collected, the global and segmental longitudinal peak systolic strain of the left ventricle were measured by aCMQ, the variabilities of interobserver and intraobserver were analyzed. Results The success rate of aCMQ analysis was 89%. There was no significant correlation between the gestational age and the global and segmental longitudinal peak strain of the left ventricle (r were 0.00-0.14, all P 0.05). The strain of the apex segment was higher than those of the base and middle segment (P<0.05). Interobserver and intraobserver variability showed a small bias among the observers. Conclusions aCMQ is a feasible and reproducible approach to quantitatively evaluate normal cardiac function of fetus and may have potential in fetuses with congenital heart diseases. Key words: Echocardiography; Fetus; Ventricular function, left; Automated cardiac motion quantitation

Left ventricular subclinical myocardial dysfunction in uncomplicated type 2 diabetes mellitus is associated with impaired myocardial perfusion: a contrast-enhanced cardiovascular magnetic resonance study

BackgroundEarly detection of subclinical myocardial dysfunction in patients with diabetes mellitus (DM) is essential for recommending therapeutic interventions that can prevent or reverse heart failure, thereby improving the prognosis in such patients. This study aims to quantitatively evaluate left ventricular (LV) myocardial deformation and perfusion using cardiovascular magnetic resonance (CMR) imaging in patients with type 2 diabetes mellitus (T2DM), and to investigate the association between LV subclinical myocardial dysfunction and coronary microvascular perfusion.MethodsWe recruited 71 T2DM patients and 30 healthy individuals as controls who underwent CMR examination. The T2DM patients were subdivided into two groups, namely the newly diagnosed DM group (n = 31, patients with diabetes for ≤ 5 years) and longer-term DM group (n = 40, patients with diabetes > 5 years). LV deformation parameters, including global peak strain (PS), peak systolic strain rate, and peak diastolic strain rate (PSDR), and myocardial perfusion parameters such as upslope, time to maximum signal intensity (TTM), and max signal intensity (Max SI, were measured and compared among the three groups. Pearson’s correlation was used to evaluate the correlation between LV deformation and perfusion parameters.ResultsPooled data from T2DM patients showed a decrease in global longitudinal, circumferential, and radial PDSR compared to healthy individuals, apart from lower upslope. In addition, increased TTM and reduced Max SI were found in the longer-term diabetics compared to the normal subjects (p < 0.017 for all). Multivariable linear regression analysis showed that T2DM was independently associated with statistically significant CMR parameters, except for TTM (β = 0.137, p = 0.195). Further, longitudinal PDSR was significantly associated with upslope (r = − 0.346, p = 0.003) and TTM (r = 0.515, p < 0.001).ConclusionsOur results imply that a contrast-enhanced 3.0T CMR can detect subclinical myocardial dysfunction and impaired myocardial microvascular perfusion in the early stages of T2DM, and that the myocardial dysfunction is associated with impaired coronary microvascular perfusion.

Prognostic value of pre-procedural left ventricular strain for clinical events after transcatheter aortic valve implantation.

BackgroundTranscatheter aortic valve implantation (TAVI) is an alternative therapy for surgically high-risk patients with severe aortic stenosis (AS). Although TAVI improves survival of patients with severe AS, the mechanism of this effect remains to be clarified. We investigated the effects of TAVI on left ventricular (LV) function and identified the predictive parameters for cardiac events after TAVI.Methods and resultsWe studied 128 patients with severe symptomatic AS who underwent TAVI. Echocardiographic assessments were performed before and after TAVI. In addition to the conventional echocardiographic parameters such as LV ejection fraction (LVEF) and LV mass index (LVMI), the LV global longitudinal strain (GLS) and early diastolic peak strain rate (SR_E) using two-dimensional speckle tracking echocardiography were also evaluated. All patients were assessed for clinical events including major adverse cardiac events and stroke according to Valve Academic Research Consortium-2 criteria. GLS, early diastolic peak velocity (eʹ), aortic regurgitation (AR) severity, and SR_E were significantly improved after TAVI. Thirteen patients had an event during the observational period of 591 days (median). Patients with events had higher LVMI, more severe AR, and worse GLS compared to those without events. Furthermore, receiver-operating curve analysis revealed that GLS was the strongest predictor for clinical events (p = 0.009; area under the curve, 0.73).ConclusionPreoperative LV geometric deformation and dysfunction, as a consequence of the cumulative burden of pressure overload, improved after TAVI and could predict cardiac events after TAVI.

The early diagnosis of MYH7 gene mutation carriers of hypertrophic cardiomyopathy using multi-parameter analysis model by conventional two-dimensional echocardiography and three-dimensional speckle tracking imaging

Objective To create multi-parameter analysis model by conventional two-dimensional echorcardiography(2DE) and three-dimensional speckle tracking imaging(3D-STI) in order to improve the early diagnosis in MYH7G+ P- mutation carriers of familiar hypertrophic cardiomyopathy(HCM). Methods Twenty-eight MYH7 mutation carriers without left ventricular hypertrophy (MYH7G+ P-) were enrolled as the research group, while 27 MYBPC3 mutation carriers without left ventricular hypertrophy (MYBPC3G+ P-) were selected as the control group. The clinical data, conventional 2DE and tissue Doppler imaging(TDI) parameters of the two groups were acquired, including the maximum of the thickness of interventricular septum(IVS) and left ventricular posterior ventricular wall thickness(LVPWT) in end of diastole, mitral flow E and A velocities, E peak deceleration time(EDT), atrioventricular filling time, mitral annulus velocity of interventricular septum IVS-e′ and lateral wall L-e′, interventricular septum IVS-a′ and lateral wall L-a′ peak in diastole, calculate mean value e′ and a′, and calculate E/ e′, E/A, left atrial volume index(LAVI), left ventricular mass index(LVMI), left ventricular ejection fraction(LVEF) and isovolumic relaxation time(IVRT), isovolumic contraction time(IVCT). The global longitudinal peak strain(GLS), global radial peak strain(GRS), global circumferential peak strain(GCS) and global area peak strain(GAS) were acquired by 3D-STI. All parameters were compared between research group and control group. Results Compared with the control group, research group significantly increased in LAVI, maximum IVS and LVPWT, LVMI and GAS(P 0.05). For single parameter, the area under ROC curve(AUC) were successively LVPWT>LAVI>IVS>LVMI>GAS(0.772, 0.738, 0.733, 0.719, 0.714, respectively). AUC of multi-parameters was 0.912, the sensitivity and specificity were 85.2% and 96.3%, respectively. Conclusions Multi-parameter analysis model by conventional 2DE and 3D-STI can significantly improve the recognition efficiency of early diagnosis MYH7G+ P- of familiar HCM. With further, maximum LVPWT is an independent predictor of distinction MYH7G+ P- and MYBPC3G+ P-. Key words: Echocardiography; Cardiomyopathy, hypertrophic; MYBPC3; MYH7; Speckle tacking imaging, three-dimensional

Longitudinal strain and peak strain dispersion in evaluating left ventricular systolic function in patients with sleep apnea syndrome

Objective To evaluate the value of longitudinal peak strain (GLS) and peak strain dispersion (PSD) in left ventricular myocardial synchrony and systolic function in patients with obstructive sleep apnea syndrome (OSAS). Methods Seventy male patients with OSAS diagnosed by polysomnography and 26 healthy volunteers were enrolled in this study. According to AHI, the OSAS patients were divided into three groups: mild group, moderate group and severe group. Echocardiography was performed on the next day. The Left ventricular ejection fraction (LVEF), diastolic blood pressure, systolic blood pressure, left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left atrial diameter (LAD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPW), global systolic longitudinal strain(GLS) and peak strain dispersion (PSD) were compared among four groups. The correlation between GLS, PSD and AHI were analyzed. Results ①Age, height, weight, body mass index (BMI), LVEF, diastolic blood pressure, systolic blood pressure, LVDd, LVDs, LAD and LVPW were not statistically different among the OSAS mild, moderate, severe group and control group (P>0.05). IVST in severe groups was increased than that in control group (P 0.05). ③Pearson correlation analysis showed that AHI was associated with GLS(r2=0.5026) and PSD(r2=0.6845) (P<0.05). Conclusions GLS and PSD can early evaluate the left ventricular myocardial synchrony and systolic function changes in patients with OSAS. Key words: Three-dimensional speckle tracking imaging; Sleep apnea, obstructive; Global systolic longitudinal strain; Peak strain dispersion

Left atrial, ventricular and atrio-ventricular strain in patients with subclinical heart dysfunction.

Arterial hypertension (AH) and diabetes mellitus (DM) are the most common causes of heart deterioration because of their high prevalence in the population. The aim of this study was to evaluate peak left atrial(LA), longitudinal strain (PALS), left ventricular (LV),longitudinal strain (LS) and global atrial-ventricular strain (GAVS), by speckle-tracking echocardiography (STE), in asymptomatic patients with AH or/and DM and normal LA, LV size and ejection fraction (EF), to analyze their capability to detect early subclinical dysfunction. We enrolled 162 patients affected by AH and/or DM with normal indexed LA volume, LV end-diastolic diameter and a LVEF > 52% (females) or > 54% (males) (60 hypertensives, 52 diabetics and 50 both) and 60 healthy controls. All subjects underwent standard and advanced STE. PALS, LS and GAVS were measured. GAVS was calculated as the algebraic sum of absolute PALS and LS values in four- and two-chambers views. LS, although with lower values in hypertensives, diabetics and both, did not show significant differences between groups. PALS and GAVS were significantly reduced in AH (31.9 ± 10.3% and 49.7 ± 11.2%, respectively) and DM (26.2 ± 7.1% and 42.6 ± 9.8%) compared to controls, and even more if the two coexisted (20.4 ± 6.5% and 37.1 ± 8.4%). PALS had the highest statistical significance and was able to identify subclinical damage independently from LS value. PALS was reduced in patients with AH and/or DM without alteration of standard echo indexes. The value of PALS was independent from LS and was sufficient to identify heart dysfunction in an earlier stage.

Speckle tracking stress echocardiography in children: interobserver and intraobserver reproducibility and the impact of echocardiographic image quality

Speckle tracking echocardiography (STE) is increasingly used during functional assessments. However, reproducibility and dependence on echocardiographic image quality for speckle tracking stress echocardiography in pediatric patients have not been studied to date. 127 consecutive normotensive children without structural heart disease (mean age 13.4 ± 3.0 years, 50.4% female) underwent a stepwise semisupine cycle ergometric protocol. Left ventricular (LV) myocardial peak strain and strain rate were assessed at rest and during exercise. Interobserver and intraobserver assessments were performed and analyzed regarding echocardiographic image quality. LV peak global strain and strain rate were well reproducible with narrow limits of agreement without any significant bias both at rest and during all stages of exercise testing. Moreover, strain rate reproducibility slightly deteriorated in values between −1.5 and −3 s−1. Surprisingly, there was no significant difference in reproducibility between optimal, intermediate and poor quality of echocardiographic images. STE derived strain and strain rate measurements in children are feasible and highly reproducible during semisupine cycle ergometric stress echocardiography. Echocardiographic image quality does not seem to influence strain (rate) reproducibility. Myocardial deformation measurements in images with suboptimal visualization quality must be interpreted with caution.

Comparison of left ventricular strains and torsion derived from feature tracking and DENSE CMR

BackgroundCardiovascular magnetic resonance (CMR) feature tracking is increasingly used to quantify cardiac mechanics from cine CMR imaging, although validation against reference standard techniques has been limited. Furthermore, studies have suggested that commonly-derived metrics, such as peak global strain (reported in 63% of feature tracking studies), can be quantified using contours from just two frames – end-diastole (ED) and end-systole (ES) – without requiring tracking software. We hypothesized that mechanics derived from feature tracking would not agree with those derived from a reference standard (displacement-encoding with stimulated echoes (DENSE) imaging), and that peak strain from feature tracking would agree with that derived using simple processing of only ED and ES contours.MethodsWe retrospectively identified 88 participants with 186 pairs of DENSE and balanced steady state free precession (bSSFP) image slices acquired at the same locations across two institutions. Left ventricular (LV) strains, torsion, and dyssynchrony were quantified from both feature tracking (TomTec Imaging Systems, Circle Cardiovascular Imaging) and DENSE. Contour-based strains from bSSFP images were derived from ED and ES contours. Agreement was assessed with Bland-Altman analyses and coefficients of variation (CoV). All biases are reported in absolute percentage.ResultsComparison results were similar for both vendor packages (TomTec and Circle), and thus only TomTec Imaging System data are reported in the abstract for simplicity. Compared to DENSE, mid-ventricular circumferential strain (Ecc) from feature tracking had acceptable agreement (bias: − 0.4%, p = 0.36, CoV: 11%). However, feature tracking significantly overestimated the magnitude of Ecc at the base (bias: − 4.0% absolute, p < 0.001, CoV: 18%) and apex (bias: − 2.4% absolute, p = 0.01, CoV: 15%), underestimated torsion (bias: − 1.4 deg/cm, p < 0.001, CoV: 41%), and overestimated dyssynchrony (bias: 26 ms, p < 0.001, CoV: 76%). Longitudinal strain (Ell) had borderline-acceptable agreement (bias: − 0.2%, p = 0.77, CoV: 19%). Contour-based strains had excellent agreement with feature tracking (biases: − 1.3–0.2%, CoVs: 3–7%).ConclusionCompared to DENSE as a reference standard, feature tracking was inaccurate for quantification of apical and basal LV circumferential strains, longitudinal strain, torsion, and dyssynchrony. Feature tracking was only accurate for quantification of mid LV circumferential strain. Moreover, feature tracking is unnecessary for quantification of whole-slice strains (e.g. base, apex), since simplified processing of only ED and ES contours yields very similar results to those derived from feature tracking. Current feature tracking technology therefore has limited utility for quantification of cardiac mechanics.

Comparison of strain parameters in dyssynchronous heart failure between speckle tracking echocardiography vendor systems

BackgroundAlthough mechanical dyssynchrony parameters derived by speckle tracking echocardiography (STE) may predict response to cardiac resynchronization therapy (CRT), comparability of parameters derived with different STE vendors is unknown.MethodsIn the MARC study, echocardiographic images of heart failure patients obtained before CRT implantation were prospectively analysed with vendor specific STE software (GE EchoPac and Philips QLAB) and vendor-independent software (TomTec 2DCPA). Response was defined as change in left ventricular (LV) end-systolic volume between examination before and six-months after CRT implantation. Basic longitudinal strain and mechanical dyssynchrony parameters (septal to lateral wall delay (SL-delay), septal systolic rebound stretch (SRSsept), and systolic stretch index (SSI)) were obtained from either separate septal and lateral walls, or total LV apical four chamber. Septal strain patterns were categorized in three types. The coefficient of variation and intra-class correlation coefficient (ICC) were analysed. Dyssynchrony parameters were associated with CRT response using univariate regression analysis and C-statistics.ResultsTwo-hundred eleven patients were analysed. GE-cohort (n = 123): age 68 years (interquartile range (IQR): 61–73), 67% male, QRS-duration 177 ms (IQR: 160–192), LV ejection fraction: 26 ± 7%. Philips-cohort (n = 88): age 67 years (IQR: 59–74), 60% male, QRS-duration: 179 ms (IQR: 166–193), LV ejection fraction: 27 ± 8. LV derived peak strain was comparable in the GE- (GE: -7.3 ± 3.1%, TomTec: −6.4 ± 2.8%, ICC: 0.723) and Philips-cohort (Philips: −7.7 ± 2.7%, TomTec: −7.7 ± 3.3%, ICC: 0.749). SL-delay showed low ICC values (GE vs. TomTec: 0.078 and Philips vs. TomTec: 0.025). ICC’s of SRSsept and SSI were higher but only weak (GE vs. TomTec: SRSsept: 0.470, SSI: 0.467) (Philips vs. QLAB: SRSsept: 0.419, SSI: 0.421). Comparability of septal strain patterns was low (Cohen’s kappa, GE vs. TomTec: 0.221 and Philips vs. TomTec: 0.279). Septal strain patterns, SRSsept and SSI were associated with changes in LV end-systolic volume for all vendors. SRSsept and SSI had relative varying C-statistic values (range: 0.530–0.705) and different cut-off values between vendors.ConclusionsAlthough global longitudinal strain analysis showed fair comparability, assessment of dyssynchrony parameters was vendor specific and not applicable outside the context of the implemented platform. While the standardization taskforce took an important step for global peak strain, further standardization of STE is still warranted.

Combined myocardial deformation to predict cardiac resynchronization therapy response in nonischemic cardiomyopathy.

20-30% of patients do not benefit from cardiac resynchronization therapy (CRT) when the established selection criteria were applied. We hypothesized that a combined assessment of mechanical dyssynchrony, myocardial deformation, and diastolic function would identify patients who would benefit most from CRT. In 36 CRT patients, clinical evaluation and echocardiography were performed before and after CRT. Patients were classified into three subgroups according to their amount of response: echocardiographic responders, clinical responders, and nonresponders. Radial dyssynchrony and left ventricular (LV) global longitudinal, radial, and circumferential peak strain was assessed by speckle-tracking image. Diastolic function was quantified by conventional echocardiography. In addition to left bundle branch block, nonspecific intraventricular conduction disturbance with intraventricular dyssynchrony could also improve LV remodeling. Echocardiographic responders had better global longitudinal strain, global circumferential peak strain, and global radial strain at baseline which significantly increased at 12-month follow-up. An improvement in estimates of LV filling pressure and a decrease in mitral regurgitation and left atrial dimensions were observed only in echocardiographic responders to CRT. Patients with clinical but without echocardiographic response showed a significant improvement in atrioventricular (AV) synchrony and a nonsignificant improvement in other parameters. The nonresponder group did not improve the AV and intraventricular dyssynchrony. CRT could not improve restrictive filling pattern with normal filling time. Overall, those patients with AV and intraventricular dyssynchrony and those with best contractile function and short diastolic filling time of restrictive filling pattern at baseline demonstrated the greatest benefit from CRT. Mechanical dyssynchrony, contractile function, and filling pattern are important determinants of the benefits in CRT.

Myocardial Deformation in Cardiac Amyloid Light-chain Amyloidosis: Assessed with 3T Cardiovascular Magnetic Resonance Feature Tracking

Clinically, assessment of myocardial function is essential in patients with amyloid light-chain cardiac amyloidosis (AL-CA) to predict outcome and determine therapeutic approach. The aim of this study was to investigate the feasibility of cardiovascular magnetic resonance (CMR)-derived feature tracking algorithm for assessing left ventricular (LV) myocardial deformation in AL-CA, and to determine if these abnormal myocardial deformation parameters are correlated to impaired LV myocardial microvascular dysfunction. A total of 42 AL-CA patients, including 26 with preserved systolic function and 16 with impaired LVEF, and 35 healthy controls were enrolled and underwent CMR examination. Our result indicated that AL-CA patients had significantly reduced global peak strain (PS) (longitudinal, circumferential, and radial) (all P < 0.05). AL-CA patients with normal LVEF showed preserved longitudinal PS at apical and significantly reduced longitudinal PS at mid and basal segments. By Spearman’s rank correlation analysis, the LV regional radial, circumferential, and longitudinal myocardial deformation values were correlated to myocardial upslope and MaxSI in CA, regardless of LVEF. This study indicated that the abnormal LV myocardial deformation of AL-CA patients can be monitored using feature tracking CMR, even in those with preserved LVEF; and the myocardial deformation was associated with coronary microvascular dysfunction.

Distribution of strain patterns in children with dilated cardiomyopathy.

This study aimed to evaluate the predicting value of quantitative and qualitative dyssynchrony parameters as assessed by two-dimensional speckle tracking echocardiography (STE) on outcome in children with dilated cardiomyopathy (DCM). Furthermore, the reproducibility of these parameters was investigated. In previous studies in adults with heart failure, several dyssynchrony parameters have been shown to be a valuable predictor of clinical outcome. This multicenter, prospective study included 75 children with DCM and 75 healthy age-matched controls. Using STE, quantitative (time to global peak strain and parameters describing intraventricular time differences) and qualitative dyssynchrony parameters (pattern analysis) of the apical four-chamber, three-chamber, two-chamber views, and the short axis of the left ventricle were assessed. Cox regression was used to identify risk factors for the primary endpoints of death or heart transplantation. Inter-observer and intra-observer variability were described. During a median of 21months follow-up, 10 patients (13%) reached an endpoint. Although quantitative dyssynchrony measures were higher in patients as compared to controls, the inter-observer and intra-observer variability were high. Pattern analysis showed mainly reduced strain, instead of dyssynchronous patterns. In this study, quantitative dyssynchrony parameters were not reproducible, precluding their use in children. Qualitative pattern analysis showed predominantly reduced strain, suggesting that in children with DCM dyssynchrony may be a minor problem.

Assessment of left ventricular deformation in patients with Ebstein’s anomaly by cardiac magnetic resonance tissue tracking

PurposeThe aim of this study was to clarify the feasibility of myocardial strain using cardiovascular magnetic resonance (CMR) for the evaluation of left ventricular (LV) deformation in patients with Ebstein’s anomaly (EA). Materials and methodsWe recruited 32 patients with EA and 30 controls for CMR examination and measured LV function, dimension and tissue tracking parameters (the global and regional radial, circumferential and longitudinal peak strain), together with the right ventricle (RV) dimension. LV strain parameters were compared among the controls, patients with preserved LV ejection fraction (LVEF; ≥55%), and patients with reduced LVEF (<55%). Pearson’s correlation was used to evaluate relationships between tissue tracking parameters with the RVEDD/LVEDD index and LVEF. An ROC analysis was also performed to determine whether the cut-off values for PS could be used to differentiate LV dysfunction between patients with EA and controls. The intraclass correlation coefficient (ICC) was used to assess the inter- and intra-observer variability. ResultsThe global strain parameters all decreased significantly in the EA group compared with the control group (all P<0.05). Furthermore, the global radial and circumferential peak strain (PS) were obviously even lower in the reduced LVEF group than the strain measured in preserved LVEF groups (28.64% vs. 37.39%, p<0.05; and −8.20% vs. −17.89%; p<0.05; respectively). The regional strain abnormalities in EA patients were mainly involved in basal and middle segments. The results also demonstrated a significant correlation between the ratio of the RV end-diastolic dimension to the LV end-diastolic dimension (RVEDD/LVEDD index) with the global circumferential PS (r=0.508) and the longitudinal PS (r=0.474), as well as a good correlation between radial PS and LVEF (r=0.465). The ICCs for intra- and inter-observer variability were 0.797–0.904 and 0.701–0.896. ConclusionsLV strain serves an earlier and more comprehensive measurement of LV dysfunction than LVEF in EA, which could potentially be included as a supplementary diagnostic procedure in the evaluation of EA.

Left ventricular dyssynchrony and 2D and 3D global longitudinal strain for differentiating physiological and pathological left ventricular hypertrophy

Diagnosis of hypertrophic cardiomyopathy (HCM) in athletes can be challenging. To ascertain parameters that differentiate patients with HCM from athletes with moderate left ventricular (LV) hypertrophy (LVH 13-15mm). We retrospectively included 100 men: 50 elite rugby players (25 with moderate LVH and 25 with no LVH), 25 patients with HCM and moderate LVH and 25 controls. LV dyssynchrony was defined as the standard deviation of time to peak 2D longitudinal strain (16-segment model) and global strain components were computed from two- (2D) and three-dimensional (3D) speckle tracking. 2D global longitudinal strain (GLS) (18±2% vs. 19±2%) and various 3D strain components were similar in athletes with moderate LVH and controls, while LV volumes and dyssynchrony (39±8 vs. 31±9ms; P<0.001) were greater in athletes with moderate LVH. The accuracy for differentiating patients with HCM from athletes ranged between 0.57 and 0.92 for various markers, with the best obtained for LV dyssynchrony (AUC=0.92;>48ms had sensitivity=83%, specificity=89%). Binary logistic regression showed that accuracy was improved when LV dyssynchrony was combined with 2D GLS. HCM was excluded when 2D GLS was preserved (>18%) and there was no LV dyssynchrony (>48ms) and only patients with HCM had reduced longitudinal strain and LV dyssynchrony. LV dyssynchrony combined with GLS can be used to differentiate athletes with moderate LVH from patients with HCM.

Pulmonary artery and right ventricle function in patients with bicuspid aortic valve.

Bicuspid aortic valve (BAV) is a complex developmental anomaly caused by abnormal aortic leaflet formation during valvulogenesis. The present study is an assessment of the effects of BAV disease on the ascending aorta and pulmonary artery (PA), and an evaluation of the consequences for systolic and diastolic functioning of the left and right ventricles. Total of 66 patients were eligible for inclusion. Pulmonary artery maximum diameter (PAD) was obtained 1 cm distal to the pulmonary annulus. Using pulsed-wave tissue Doppler imaging, left ventricular (LV) early diastolic velocity (E') measurement was obtained at the annulus with placement of sample volume. Right ventricle (RV) peak global strain rate during systole (RV-SRS), early diastole (RV-SRE), and late diastole (RV-SRA) were calculated. In this study, 40.9% (n=27) of patients were female and average age was 35±11years. RV-SRS values (ß=-.781, t=-2.723; p=0.010) and log-LV tissue Doppler imaging E' (ß=-2.996, t=-5.405; p=<0.001) were negatively correlated, and log-PAD (ß=4.861, t=3.052; p=0.005) was positively and independently correlated with ascending aortic diameter. Ascending aorta diameter is positively correlated with PA diameter in BAV patients, and RV strain rate and LV diastolic parameters are affected before development of the valve disease.

Speckle Tracking Imaging in Normal Stress Echocardiography.

Exercise stress echocardiography is a widely used modality for the diagnosis and follow-up of patients with coronary artery disease. During the last decade, speckle tracking imaging has been used increasingly for accurate evaluation of cardiac function. This work aimed to assess speckle-tracking imaging parameters during nonischemic exercise stress echocardiography. During 2011 to 2014 we studied 46 patients without history of coronary artery disease, who completed exercise stress echocardiography protocol, had normal left ventricular function, a nonischemic response, and satisfactory image quality. These exams were analyzed with speckle-tracking imaging software at rest and at peak exercise. Peak strain and time-to-peak strain were measured at rest and after exercise. Clinical follow-up included a telephone contact 1 to 3 years after stress echo exam, confirming freedom from coronary events during this time. Global and regional peak strain increased following exercise. Time-to-peak global and regional strain and time-to-peak strain adjusted to the heart rate were significantly shorter in all segments after exercise. Rest-to-stress ratio of time-to-peak strain adjusted to the heart rate was 2.0 to 2.8. Global and regional peak strain rise during normal exercise echocardiography. Peak global and regional strain occur before or shortly after aortic valve closure at rest and after exercise, and the delay is more apparent at the basal segments. Time-to-peak strain normally shortens significantly during exercise; after adjustment to heart rate it shortens by a ratio of 2.0 to 2.8. These data may be useful for interpretation of future exercise stress speckle-tracking echocardiography studies.

Abstract 13241: Additive Predictive Value of Strain Rate Dispersion Index for Responses to Cardiac Resynchronization Therapy: Substudy From the START Study

Background: Response to cardiac resynchronization therapy (CRT) depends not only on the degree of mechanical dyssynchrony but on that of discoordination, which could associate with insufficient predictive value of the parameters of mechanical dyssynchrony for the response especially in patients with moderately prolonged QRS duration and/or ischemic heart disease. We thus investigated an additive predictive value of strain rate dispersion index (SRDI), an index of the amount of discoordination, in patients undergoing CRT in a multicenter study. Methods: We studied 180 patients included in the Speckle Tracking Imaging for the Assessment of Cardiac Resynchronization Therapy (START) study, a prospective multicenter cohort study in Japan. Time from QRS to first peak of strain (T first ) was measured and its standard deviation (SD) was calculated as a dyssynchrony parameter for longitudinal (L-T first -SD) and circumferential (C-T first -SD) strains. SRDI was calculated as the average of segmental peak systolic strain rates minus peak global strain rate for longitudinal (L-SRDI) and circumferential (C-SRDI) strain rates. Responses to CRT was defined as a reduction of left ventricular end-systolic volume &gt;15% at 6 months after CRT. Results: One-hundred and nine (61%) patients were identified as responders. By Cox proportional hazards model, the addition of SRDIs resulted in a significant incremental improvement in the predictive value for the CRT response on LV end-diastolic volume (EDV) at baseline, QRS duration, ischemic etiology, and T first -SDs (Chi square: 41.0 vs 59.0, P&lt;0.001) in overall patients. Moreover, the same results were observed regardless of QRS duration or ischemic etiology ( Figure ). Conclusion: SRDI had an additive predictive value of responses to CRT even in patients with moderately prolonged QRS duration and those with ischemic heart disease.

Relationships of left ventricular strain and strain rate to wall stress and their afterload dependency.

Whether and how left ventricular (LV) strain and strain rate correlate with wall stress is not known. Furthermore, it is not determined whether strain or strain rate is less dependent on the afterload. In 41 healthy young adults, LV global peak strain and systolic peak strain rate in the longitudinal direction (LS and LSR, respectively) and circumferential direction (CS and CSR, respectively) were measured layer-specifically using speckle tracking echocardiography (STE) before and during a handgrip exercise. Among all the points before and during the exercise, all the STE parameters significantly correlated linearly with wall stress (LS: r=-0.53, p<0.01, LSR: r=-0.28, p<0.05, CS in the inner layer: r=-0.72, p<0.01, CSR in the inner layer: r=-0.47, p<0.01). Strain more strongly correlated with wall stress than strain rate (r=-0.53 for LS vs. r=-0.28 for LSR, p<0.05; r=-0.72 for CS vs. r=-0.47 for CSR in the inner layer, p<0.05), whereas the interobserver variability was similar between strain and strain rate (longitudinal 6.2 vs. 5.2%, inner circumferential 4.8 vs. 4.7%, mid-circumferential 7.9 vs. 6.9%, outer circumferential 10.4 vs. 9.7%), indicating that the differences in correlation coefficients reflect those in afterload dependency. It was thus concluded that LV strain and strain rate linearly and inversely correlated with wall stress in the longitudinal and circumferential directions, and strain more strongly depended on afterload than did strain rate. Myocardial shortening should be evaluated based on the relationships between these parameters and wall stress.

Very early stage left ventricular endocardial dysfunction of patients with hypereosinophilic syndrome.

Cardiac involvement in hypereosinophilic syndrome (HES) patients entails significant morbidity and mortality. Left ventricular (LV) endocardial damage is important for the development of cardiac involvement in HES patients. However very early stage LV endocardial damage, such as prior to the first stage of an acute necrotic stage, remains uncertain. We studied 32 HES patients, all with normal conventional echocardiographic findings. Global radial and circumferential strain (GRS and GCS) were determined for each peak global strain curve from the mid-LV short-axis view, and global longitudinal strain (GLS) was averaged each peak global strain curve from standard apical views by means of two-dimensional speckle-tracking method. Thirty-one age-, gender-, LV ejection fraction-matched normal subjects were studied for comparison. GRS and GRS were similar for HES patients and normal controls, but GLS for HES patients was significantly lower than that for normal controls (16.2 ± 3.3 % vs 19.3 ± 2.9 %, p < 0.001). Furthermore, receiver operating characteristic curve analysis identified GLS ≤17.0 % as the best predictor of LV endocardial dysfunction with a sensitivity of 66 %, specificity of 78 %, and area under the curve of 0.781 (p = 0.0001). In conclusions, LV endocardial dysfunction pre-existed even in HES patients without apparent cardiac involvement. GLS as assessed with the two-dimensional speckle-tracking method is a promising tool for the better management of very early stage of HES patients.