Isovolumic Myocardial Acceleration Research Articles

Comparison Between Isovolumic Acceleration and Conventional Echocardiograhic Parameters in Detecting Early Right Ventricular Systolic Dysfunction in Patients with Mitral Stenosis

Aim: The aim of the study was to determine if the tissue Doppler imaging (TDI)-derived myocardial acceleration during isovolumic contraction (IVA) of tricuspid lateral annulus could be used in early detection of RV systolic dysfunction in patients with mitral stenosis (MS), before the clinical signs of systemic venous congestion occur and to compare between IVA and conventional echocardiographic parameters in detecting early RV systolic dysfunction in patients with MS .
 Methods: Ninety-six patients with severe rheumatic MS without relevant regurgitation were enrolled in the study. Conventional echocardiographic parameters (mitral valve area, transmitral diastolic gradients, pulmonary artery pressure, RV fractional area change, pulmonary flow acceleration time, tricuspid annular plane systolic excursion) and TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration: IVA, peak myocardial velocity during isovolumic contraction: IVV, peak systolic velocity during ejection period: Sa and RV MPI) were recorded from all patients.
 Results: TDI-derived IVA, IVV, Sa were significantly decreased in patients with MS and RV MPI is increased in patients with MS. IVA was the only parameter which had a significant negative correlation with the traditional echocardiographic parameters and RV Tei index in patients with MS.
 Conclusion: TDI-derived right ventricular IVA may be used as an adjunctive, reliable, noninvasive parameter for the early detection of right ventricular systolic dysfunction in patients with MS but without signs of systemic venous congestion. RV IVA negatively correlate with RV MPI, positively correlate with IVV and Sa. RV IVA shows positive correlation with RVFAC and negative correlation with PAP, LA size. IVA shows no correlation with TAPSE.
 University Heart Journal 2022; 18(2): 80-86

Evaluation of the Effect of Aortic Stenosis and Severity on Left Ventricular Function by Isovolumic Myocardial Acceleration

Aim: Tissue Doppler-derived isovolumic acceleration (IVA) is a parameter that evaluates the systolic function of both ventricles, without being affected by pre-load and post-load. We aimed to detect left ventricular systolic dysfunction at an early stage with IVA in patients with asymptomatic aortic stenosis (AS).
 Material and Methods: A total of 105 patients were included in the study, 75 of which had isolated AS and 30 were free of any valve disease. Patients with AS were divided into three groups (mild, moderate and severe) according to their aortic valve area (AVA) and aortic peak velocities, as determined by means of a transthoracic echocardiography. Conventional echocardiography, systolic and diastolic Tissue Doppler parameters [peak myocardial velocity during isovolumic contraction (IVV), myocardial velocity during ejection phase (Sm), early diastolic myocardial velocity (e'), late diastolic myocardial velocity (a'), and acceleration time (AT)] were calculated in all patients. IVA was obtained by dividing the IVV flow rate by the AT time.
 Results: The systolic parameters IVV (p

Echocardiographic Assessment of the Effect of Mitral Stenosis Severity on Left Ventricular Systolic Function Using Isololumic Myocardial Acceleration

Background: Isovolumic myocardial acceleration (IVA) is a new tissue Doppler parameter in the assessment of systolic function of both right and left ventricles. It remains unaffected with the changes in pre-and after load with in the physiological range. With the advent of newer parameter like IVA, better assessment are naturally expected. Thus it creates a fertile ground where upon many studies are being done as it chosen here. The aim of study was to assess the effect of MS severety on LV systolic function using IVA.
 Methods: In this cross sectional study, considering all ethical issues, data were collected from 96 patient (Isolated mitral stenosis and mitral valve area <2cm2) and 32 healthy control subjects. In addition to standard echocardiographic methods TDI (tissue Doppler imaging) were performed to assess LV function in all participants.
 Results: This study showed a clear female preponderence (76%) of mitral stenosis and most of them belonging to age group 21-39 years. All TDI derived LV systolic (IVV, Sm and IVA) velocities were significanty decreased in patients with mitral stenosis, compared to the healthy control (P<.001, for all). However IVA was not different when the degree of MS was evaluated (P=.056). In addition IVA was not correlated with MVA (r=+0.196. P= 0.056).
 Conclusions: Isovolumic myocardial acceleration was more accurate and consistent than conventional echocardiography in assessing subclinical left ventricular systolic dysfunction, IVA showed that left ventricular function is impaired with mitral stenosis regardless of severety of the disease. So this new echo parameter can be a good supplement to the existing 2D scoring system to detect systolic dysfunction in rheumatic mitral stenosis.
 University Heart Journal Vol. 17, No. 1, Jan 2021; 42-46

The effect of left ventricular remodeling on the longitudinal myocardial kinetics of both heart ventricles in patients with arterial hypertension and cardiovascular risk factors

The aim – to study the longitudinal kinetics of the left, right ventricles and interventricular septum (IVS), depending on the type of left ventricular (LV) remodeling in patients with arterial hypertension (AH) in combination with additional cardiovascular risk factors with preserved LV contractility, as well as to determine the correlation of changes in the right ventricular systolic and diastolic parameters estimated with the tissue pulsed-wave Doppler imaging (TDI) with the same indices of the LV and IVS.Materials and methods. The study included 71 patients (average age – 54) with essential AH (68 % men) with a normal LV ejection fraction. The patients had the obese stage 1, combined hyperlipidemia, 29.6 % of patients had type II diabetes, 33.8 % were smokers. The patients were distributed into 4 groups depending on the types of remodeling: 1 – normal geometry (12.7 %); 2 – concentric remodeling (47.9 %); 3 – concentric hypertrophy (35.2 %); 4 – eccentric hypertrophy (4.2 %). TDI of the left and right ventricles and IVS was performed, systolic and diastolic TDI indices were determined, and the index of isovolumic myocardial acceleration (IVA) was calculated for the right ventricle (RV).Results and discussion. The type of LV concentric hypertrophy negatively affects the longitudinal myocardial kinetics of LV and IVS in the study group. The early diastolic velocity Em and the systolic velocity Sm were significantly decreased for the LV and IVS, the late diastolic velocity Am was decreased for the IVS and the E/Em for LV ratio was notably increased. Among the diastolic RV TDI indices only the deceleration time DTEm was significantly longer in LV concentric remodeling and concentric hypertrophy, than in its normal geometry. The IVA index was decreased in changing the type of LV geometry from normal to eccentric hypertrophy, indicating worsening of the RV longitudinal myocardial systolic function. There was a close correlation between diastolic and systolic TDI indices of the RV and IVS, which potentially indicated the importance of IVS in the mechanism of interventricular interaction and its effect on the RV function. The reliable dependence of systolic and diastolic RV TDI indices on the LV contractility was established.Conclusions. The type of LV remodeling, especially concentric hypertrophy, negatively affects the longitudinal myocardial kinetics of both ventricles in patients with AH in combination with additional cardiovascular risk factors. IVA can be a sensitive diagnostic criterion in the detection of early myocardial disorders of the RV systolic function with the changes of the LV geometry in this category of patients. Indices of RV longitudinal myocardial kinetics are closely dependent on changes in the function of IVS, which has a leading role in the formation of interventricular interaction.

Ventricular mechanics after repair of subarterial and perimembranous VSDs

Emerging data suggest impaired biventricular function in adults late after repair of ventricular septal defect (VSD). We assessed and compared right (RV) and left ventricular (LV) mechanics in adolescents and adults after surgical closure of doubly committed subarterial and perimembranous VSDs. A total of 75 subjects were studied: 29 patients after subarterial VSD repair (group I), 17 patients after perimembranous VSD repair (group II) and 29 age-matched controls (group III). RV and LV mechanics were assessed using tissue Doppler and speckle-tracking echocardiography, while RV outflow systolic function was quantified by systolic excursion and fractional shortening (FS). Compared with group III, groups I and II had significantly reduced tricuspid annular systolic and diastolic velocities, isovolumic myocardial acceleration, RV global longitudinal systolic and diastolic deformation parameters and RV outflow systolic excursion (all P < .05). Group I, but not II, had reduced RV outflow FS (P = .008) and the lowest global LV longitudinal systolic strain (P = .008) and systolic strain rate (P = .014). In group I, postoperative aortic regurgitation was associated with lower LV longitudinal systolic strain (P = .009) and early diastolic strain rate (P = .002), while right bundle branch block was associated with lower RV systolic strain rate (P = .048). As a group, RV outflow excursion (P < .001) and FS (P = .001) were correlated with LV global systolic strain. Adolescents and adults late after repair of subarterial and perimembranous VSDs show impairment of RV systolic and diastolic myocardial deformation. The RV outflow function and LV systolic deformation appear to be worse after repair of subarterial defects.

Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure.

Previous studies comparing levosimendan vs. dobutamine have revealed that levosimendan is better in relieving symptoms. Echocardiographic studies have been done using second measurements immediately following a dobutamine infusion or while it was still being administered. The aim of our study was assessment of sustained effects of 24 h levosimendan and dobutamine infusions on left ventricular systolic functions. A total of 61 patients with acutely decompensated heart failure with New York Heart Association (NYHA) class III or IV symptoms were randomized to receive either levosimendan or dobutamine 2:1 in an open label fashion. Before and 5 days after the initiation of infusions, functional class was assessed, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels and left ventricular ejection fraction (LVEF), mitral inflow peak E and A wave velocity, and E/A ratios were measured; using tissue Doppler imaging, isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), early (E') and late (A') diastolic velocities, and E'/A' and E/E' ratios were measured. The NYHA class improved in both groups, but improvements were prominent in the levosimendan group. NT-proBNP levels were significantly reduced in the levosimendan group. Improvements in LVEF and diastolic indices were significant in the levosimendan group. Tissue Doppler-derived systolic indices of IVV and IVA increased significantly in the levosimendan group. Improvements in left ventricular systolic and diastolic functions continue after a levosimendan infusion.

Echocardiographic Assessment of the Right Ventricle, from the Conventional Approach to Speckle Tracking and Three-Dimensional Imaging, and Insights into the "Right Way" to Explore the Forgotten Chamber.

BACKGROUNDThe right ventricle (RV) has an essential function in cardiovascular physiology and pathology. Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions. However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber.OBJECTIVEWe sought to review and discuss the appropriate approach and latest methods of assessment of the RV by echocardiography.METHODSA MEDLINE/Pubmed search was performed, and 55 relevant articles were selected; articles addressing right ventricular assessment by echocardiography, along with the latest recommendations, have been reviewed and discussed.RESULTSA RV diameter >42 mm at the base and >35 mm at the mid-cavitary level indicates right ventricular dilatation; a longitudinal myocardial velocity (S’) <9.5 mm/s, a tricuspid annular plane systolic excursion <17 mm, and a fractional area change <35% are indices of right ventricular systolic dysfunction. A right ventricular ejection fraction of >45% and an absolute value of global longitudinal strain of >21% reflect normal systolic function. The significance of dp/dt, the right myocardial performance index and isovolumic myocardial acceleration, is also discussed along with the parameters of right ventricular diastolic function. The use of novel echocardiographic approaches, such as three-dimensional echo and speckle tracking imaging, allows practitioners to overcome the challenges encountered with conventional echocardiography.CONCLUSIONAccurate assessment of the RV by echocardiography yields early detection of cardiac diseases, enhances risk stratification, and allows timely initiation of appropriate therapy.

Abstract 18153: Abnormal Dynamic Myocardial Response to Exercise Despite Normal Resting Ejection Fraction in Childhood Cancer Survivors Treated With Anthracyclines

Introduction: There are limited data on myocardial systolic &amp; diastolic response to exercise in pediatric cancer survivors treated with anthracycline. We used exercise echocardiography to evaluate ventricular systolic and diastolic reserve in these patients. Methods: 50 children (age 14.4±2.4 years) who had received anthracycline treatment with median dose 178mg/m 2 (range 60-450) underwent stepwise exercise echocardiography at 9.3±2.9 years after end of therapy, and compared with 50 normal controls. All subjects had normal resting LVEF. Peak systolic (s’) &amp; early diastolic (e’) myocardial velocities in the LV &amp; RV lateral wall, &amp; basal septum were measured at rest &amp; during exercise using color TDI. Measurements of myocardial isovolumic acceleration (IVA) at incremental heart rates (HR) were used to study force-frequency relationships (FFR). Results: At rest, LV systolic parameters were preserved in patients; septal e’ was significantly lower compared to controls (10.4±1.9cm/s vs 11.4±1.9cm/s; p =0.009). At peak exercise, LV &amp; RV lateral wall, &amp; basal septal e’ velocities were lower in patients (17.4±3.8cm/s vs 19.6±3.1cm/s, p =0.002; 21.5±1.6cm/s vs 22.3±1.9cm/s, p =0.02; &amp; 16.3±2.4cm/s vs 18.7±2.7cm/s, p &lt;0.001; respectively) &amp; the slopes of change with increasing HR were significantly lower in patients for LV lateral e’ [EST (SE): +0.68 (0.08) vs +0.85 (0.05) cm/s per 10 bpm; p &lt;0.001], RV lateral e’ [+1.47 (0.05) vs 1.69 (0.06) cm/s per 10 bpm; p &lt;0.001] &amp; basal septum e’ [+0.50 (0.05) vs 0.58 (0.05) cm/s per 10 bpm; p =0.001]. During exercise, peak contractile force developed by patients was significantly lower (LV IVA 5.12±1.85m/s 2 vs 6.75±3.28m/s 2 ; p =0.004). FFR analysis showed reduced rate-contractility trajectory in patients [+0.202 (0.008) vs +0.217 (0.008) natural log m/s 2 per 10 bpm; p =0.001]. Conclusions: Long-term survivors of anthracycline-treated pediatric cancer have reduced systolic &amp; diastolic myocardial reserve in response to exercise.

Left Ventricular Contractile Reserve in Young Adults Long-Term After Repair of Coarctation of the Aorta

We assessed the left ventricular (LV) contractile reserve in young adults with repaired coarctation of the aorta and interrupted aortic arch by determination of LV force-frequency relation (FFR). Eighteen (7 men) patients aged 24.2 ± 5.4 years and 20 (9 men) healthy controls were studied. Blood pressures in the right arm were measured by oscillometry. Transmitral early (E) and late (A) diastolic velocities, tissue Doppler-derived mitral annular systolic (sm), early diastolic (em) and late diastolic (am) velocities, and myocardial isovolumic acceleration (IVA) were measured. The LV FFR and average slope were derived from the IVA measured at different heart rates during supine bicycle exercise. Blood pressures at rest were similar between patients and controls (all p >0.05). At baseline, patients compared with controls had significantly greater E velocity, E/A and E/em ratios, and lower sm and em velocities (all p <0.05) but similar IVA (p = 0.18). At submaximal exercise, diastolic (p = 0.001) and mean (p = 0.003) blood pressures became significantly higher in patients than controls, sm (p = 0.001) and em (p <0.001) velocities remained reduced, whereas the IVA became lower (p <0.001). The weighted average FFR was flattened (p <0.001), and average FFR slope was lower (p <0.001) in patients compared with controls. The average FFR slope correlated negatively with the magnitude of exercise-induced increase in systolic (r = -0.32, p = 0.050), mean (r = -0.41, p = 0.011), and diastolic (r = -0.40, p = 0.013) blood pressures. In conclusion, young adults after coarctation of the aorta and interrupted aortic arch repair exhibit reduced LV contractile reserve, which is related to the blood pressure response during exercise stress.

The value of isovolumic acceleration for the assessment of right ventricular function in acute pulmonary embolism

AimThe aim of this study was to assess the value of tricuspid annulus myocardial isovolumic acceleration (IVA) in the assessment of right ventricular function in patients with acute pulmonary embolism (PE). MethodsFifteen patients (mean age 60.6±11.3 years) with acute PE were enrolled and a control group was formed of 15 patients with a similar mean age (60.3±11.5). Patients who were diagnosed with acute PE by thoracic computed tomography angiography underwent transthoracic echocardiography at the time of diagnosis and at one month after diagnosis. ResultsIn the control group IVA was 2.8±0.2 m/s2, while in the acute PE group, it was 2.0±0.1 m/s2 at the time of diagnosis and 2.9±0.1 m/s2 at the end of the first month. When IVA values of acute PE patients at the end of the first month were compared with their initial values and those of the control group, they had normalized (control and acute PE p<0.0001; control and PE at one-month follow-up p=0.983). ConclusionIn our study, IVA was shown to be a reliable marker of right ventricular systolic function in patients with acute PE.

The value of isovolumic acceleration for the assessment of right ventricular function in acute pulmonary embolism

AimThe aim of this study was to assess the value of tricuspid annulus myocardial isovolumic acceleration (IVA) in the assessment of right ventricular function in patients with acute pulmonary embolism (PE). MethodsFifteen patients (mean age 60.6±11.3 years) with acute PE were enrolled and a control group was formed of 15 patients with a similar mean age (60.3±11.5). Patients who were diagnosed with acute PE by thoracic computed tomography angiography underwent transthoracic echocardiography at the time of diagnosis and at one month after diagnosis. ResultsIn the control group IVA was 2.8±0.2 m/s2, while in the acute PE group, it was 2.0±0.1 m/s2 at the time of diagnosis and 2.9±0.1 m/s2 at the end of the first month. When IVA values of acute PE patients at the end of the first month were compared with their initial values and those of the control group, they had normalized (control and acute PE p<0.0001; control and PE at one-month follow-up p=0.983). ConclusionIn our study, IVA was shown to be a reliable marker of right ventricular systolic function in patients with acute PE.

Assessment of right ventricular function by isovolumic contraction acceleration before and after percutaneous closure of atrial septal defects: a preliminary study.

The main purpose of present study was to investigate the impact of percutaneous closure of atrial septal defect (ASD) on right ventricular (RV) systolic function assessed by tricuspid annular isovolumic myocardial acceleration (IVA) that is independent of preload and afterload changes. A prospective cohort study was designed involving twenty five patients with secundum type ASD whom were successfully closed percutaneously between 2009 and 2011. Standard transthoracic echocardiography and tissue Doppler imaging were performed in all patients 12 to 24 hours before and one month after closure. Paired t test was performed to determine the statistical significance of variables before and after closure. Significant decreases were observed in RV end-diastolic diameter, RV/left ventricular (LV) end-diastolic diameter ratio, right ventricular systolic myocardial velocity (Sm), right ventricular early myocardial velocity (Em) and right ventricular late myocardial velocity (Am) in the control echocardiography in the first month when compared with pre-procedure values. While significant increase was observed after procedure in right ventricular IVA (3.4 ± 1.3 m/sec2 vs. 4.2 ± 1.8 m/sec2, p=0.001), no significant change was observed in right ventricular global performance index, in right ventricular Em/Am ratio and left ventricular ejection fraction. Percutaneous closure of ASD resulted in recovery of right ventricular function as early as 1 month after closure.

The role of isovolumic acceleration in predicting subclinical right and left ventricular systolic dysfunction in patient with metabolic syndrome.

Objective:The aim of this study was to assess subclinical left (LV) and right ventricular (RV) dysfunction novel load-independent isovolumic myocardial acceleration (IVA) derived from tissue Doppler imaging (TDI) in patient with metabolic syndrome (MetS).Methods:This study had an observational case-control design. The study included 133 subjects which were divided into two groups: 75 patients with MetS and 58 controls without MetS. MetS was defined by the presence of ≥3 criteria according to ATP-NCEP III guidelines. All the subjects underwent laboratory blood tests and complete conventional echocardiography and TDI. Student’s t, Mann-Whitney U, Pearson’s, and multiple regression analysis were used for statistical analysis.Results:There were no significant difference between two groups in terms of traditional echocardiographic parameters. The diastolic and global functions of both ventricles were significantly impaired in MetS group. The TDI-derived IVA of the LV and the RV was significantly lower in patients with MetS (3.2±0.9 vs. 4.0±1.4, p<0.001 and 2.6±0.7 vs. 3.1±0.9, p=0.001, respectively). Whereas, TDI derived systolic velocity (Sa), and peak myocardial velocity during isovolumic contraction (IVV) of both ventricles were similar between the two groups. In the multiple regression analysis, waist circumference and diastolic blood pressure were found to be an independent determinant of IVA of LV (β=-.223, 95% CI=-.034 -.002, p=0.004) and RV (β=-.527, 95% CI=-.085 -.020, p=0.002) respectively.Conclusion:MetS affects global, diastolic, and systolic functions of two ventricles. This disruption lead to decreased function of heart was related with raised risk factors of MetS

Assessment of right ventricular systolic function in patients with chronic renal failure before and after hemodialysis by means of various echocardiographic modalities

The goal of the study was to determine the effect of decreased preload on right ventricular systolic function, as measured by new and old echocardiographic parameters in chronic renal failure (CRF) patients. A total of 30 CRF patients (mean age 48±15 years, 11 male and 19 female) undergoing hemodialysis were included in the study. Echocardiography was used to determine left ventricular ejection fraction (LVEF), left atrial volume, right atrial area, right ventricular end-diastolic area, systolic pulmonary artery pressure, right ventricular fractional area change (RV FAC), right ventricular myocardial performance index (Tei index), right ventricular tissue Doppler S' (RV S') velocity, isovolumic myocardial acceleration (IVA), tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow tract systolic excursion (RVOT SE) before and after hemodialysis. The RV S' velocity and RVOT SE parameters, which are indicators of right ventricular systolic function, did not change significantly after hemodialysis (p=0.919, p=0.186). However, the RV FAC, Tei index, IVA and TAPSE values were significantly increased (p<0.001 for all). TAPSE was found to be the only parameter that had a positive correlation with the amount of fluid removed (p=0.041 and r=0.375). Although RV S' velocity and RVOT SE, was found to be independent of preload, RV FAC, Tei index, IVA and TAPSE values were dependent on preload. In addition, TAPSE correlated with the amount of fluid removed.

Isovolumic contraction acceleration before and after percutaneous closure of atrial septal defects.

AimTo compare systemic right ventricular function by isovolumic myocardial acceleration before and 6 months after the percutaneous closure of atrial septal defects (ASD).Material and methodsPatients admitted to our tertiary center for the percutaneous closure of atrial septal defects between January 2010 and August 2012 constituted the study group. Right ventricular function of patients was assessed by tissue Doppler echocardiography before and after surgery. Echocardiographic data in patients were compared to age-matched controls without any cardiac pathology and studied in identical fashion mentioned below.ResultsA total of 44 patients (24 males, 20 females) and 44 age-matched controls (25 males, 19 females) met the eligibility criteria for the study. Right ventricular end-diastolic and end-systolic volume, right ventricular end-diastolic diameter measurements on echocardiogram, and pulmonary artery pressures in both pre- and post-ASD groups were significantly higher than in controls. Tricuspid annular plane systolic excursion and isovolumic myocardial acceleration measurements significantly increased after the percutaneous closure of the defect; however, post-ASD measurements were still significantly lower than the controls.ConclusionsAtrial septal defect device closure resulted in a significant increase of isovolumic myocardial acceleration measurements. Tissue Doppler analysis of regional myocardial function offers new insight into myocardial compensatory mechanisms for acute and chronic volume overload of both ventricles.

Impact of levosimendan on right ventricular functions by using novel tissue Doppler derived indices in patients with ischaemic left ventricular failure

Right ventricular (RV) dysfunction complicates advanced left ventricular (LV) heart failure (HF) and contributes to a poor prognosis. Levosimendan is a positive inotropic agent improving cardiac contractility without increasing myocardial oxygen consumption in HF. To evaluate the effect of levosimendan therapy on RV systolic function, by using derived tissue Doppler imaging (TDI) in patients with ischaemic HF. The study consisted of 30 patients with HF who were admitted to our hospital due to new onset of decompensated HF, having LV ejection fraction < 40%, with functional status class III-IV, according to the New York Heart Association (NYHA). TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration [IVA], peak myocardial velocity during isovolumic contraction [IVV], peak systolic velocity during ejection period [Sa]) and diastolic indices (early [Ea] and late diastolic [Aa] velocities, Ea/Aa, E/Ea ratios and myocardial performance index [Tei index]) were measured. 72 hours after treatment, all measurements were re-evaluated. Considering TDI-derived systolic indices of the RV, IVA and IVV increased significantly, whereas Tei index decreased, after the therapy. Also, there was a significant decrease in serum levels of B-type natriuretic peptide. No significant change was observed in TDI derived diastolic indices of the RV. Levosimendan improves RV systolic function as expressed by TDI-derived parameters in patients with acutedecompensated HF.

The Role of Myocardial Acceleration During Isovolumic Contraction in Predicting Subclinical Right and Left Ventricular Systolic Dysfunction in Metabolic Syndrome

Aim: The aim of this study was to assess subclinical the left and right ventricular dysfunction by using novel load-independent tissue Doppler imaging (TDI) derived isovolumic myocardial acceleration (IVA) in metabolic syndrome (MetS) patients and the association of this impairment with the number of MetS components. Methods: The study included 133 subjects divided into two groups: 75 patients with MetS and a control group (n 1⁄4 58) without MetS. MetS was defined by the presence of 3 ATP-NCEP III criteria. All the subjects underwent laboratory blood tests and complete conventional echocardiography and TDI. Results: There were no significant changes in traditional echocardiographic parameters. The diastolic and global functions of both ventricles (early (E') and late (A') diastolic velocities, E'/A' ratio, myocardial performance index) were significantly impaired (p 0.05 for all). The IVA of the LV was inversely correlated with the patient's waist circumference (r1⁄4 -0.28, p1⁄40.001), triglyceride levels (r1⁄4 -0.22, p1⁄40.014), and the number of risk factors (r1⁄4 0.28, p1⁄40.001). The RV IVA was inversely correlated with diastolic blood pressure (r1⁄4 -0.37, p1⁄4<0.001) and systolic blood pressure (r1⁄4 -26, p1⁄40.003), triglyceride levels (r1⁄4 -0.29, p1⁄40.001), and the number of risk factors (r1⁄4 -0.28, p1⁄4 0.001) and correlated with HDL cholesterol (r1⁄4 0.24, p1⁄40.001). Conclusions: MetS is associated with subclinical systolic dysfunction of both the RV and the LV. More severe MetS was associated with increasingly compromised left ventricular and right ventricular function.

Left ventricular contractile reserve after arterial switch operation for complete transposition of the great arteries: an exercise echocardiographic study

This study tested the hypothesis that left ventricular (LV) contractile reserve is altered in patients after arterial switch operation (ASO) for complete transposition of the great arteries (TGA) by non-invasive determination of LV force-frequency relationship (FFR). Thirty-two patients aged 16.2 ± 2.1 years and 22 healthy controls were studied. M-mode parameters, transmitral early (E) and late (A) diastolic velocities, and tissue Doppler-derived systolic (sm), early (em), and late (am) diastolic mitral annular velocities were determined at baseline and during submaximal exercise testing. The LV myocardial isovolumic acceleration (IVA) was measured at different heart rates during exercise for derivation of LV FFR and the average slope of IVA increment with heart rate. At baseline, patients had significantly greater E velocity, E/A and E/em ratios, shorter E deceleration time, and reduced mitral annular sm, em, and am velocities (all P < 0.05), but similar IVA (P = 0.29) compared with controls. During exercise, sm and em remained significantly reduced (P < 0.001), and LV IVA became lower (P < 0.001) in patients. The average FFR slope was significantly lower in patients (0.039 ± 0.019 vs. 0.070 ± 0.024 m/s(2) bpm, P < 0.001). The weighted average FFR curve of patients was flattened compared with the reported positive FFR reference curve based on a healthy paediatric cohort (P < 0.0001). Patients with variant compared with those with usual coronary arterial anatomy had significant flattening of FFR (P < 0.001) and a reduced FFR slope (P = 0.007). In adolescents and young adults after ASO, exercise stress revealed reduced LV contractile reserve, which is worse in those having variant coronary arterial anatomy.

Subclinical left and right ventricular systolic dysfunction in behcet's disease: A combined tissue doppler and velocity vector imaging study

Behcet's disease (BD) is a chronic inflammatory disease characterized by recurrent oral and genital ulcerations and ocular lesions. Subclinical cardiac involvement may develop in BD patients. We aimed to evaluate subclinical left ventricular (LV) and right ventricular (RV) systolic dysfunction in BD patients without any apparent cardiovascular disease. We studied 50 BD patients (43.8 ± 9.7 years, 59% men) and 30 healthy controls (45.4 ± 8.2 years, 60% men). Conventional echocardiography, tissue Doppler imaging, and velocity vector imaging-based strain measurements were performed to analyze LV and RV systolic functions. LV isovolumic myocardial acceleration, peak systolic velocity during isovolumic contraction (isovolumic contraction velocity), were significantly lower, while myocardial performance index was increased in BD patients. RV peak systolic velocity, isovolumic myocardial acceleration, and isovolumic contraction velocity were also markedly lower in BD patients. LV and RV longitudinal peak systolic strain and strain rate were significantly lower in patients than in controls, demonstrating subclinical ventricular systolic dysfunction. Ventricular long-axis functions are important markers of myocardial contractility. Novel echocardiographic techniques may provide additional data for detecting early deterioration in ventricular systolic function in patients with BD.

Left Ventricular Function and Exercise Capacity in Patients with Slow Coronary Flow

Endothelial and microvascular dysfunction have been implicated in slow coronary flow (SCF). How and to what extent do these etiological factors affect left ventricular (LV) function and exercise capacity? The aim of the study was to evaluate LV systolic and diastolic function by pulsed tissue Doppler imaging (TDI) in SCF patients and their effects on exercise capacity. Sixty SCF patients and 20 control subjects were included in the study. Echocardiographic examination, treadmill exercise test, and TDI were performed. Isovolumic myocardial acceleration (IVA) and myocardial performance index (MPI) were measured. TDI mean parameters for systolic and diastolic LV function were significantly impaired in SCF group with decreased Sa, IVA, Ea/Aa, and increased MPI (0.31 ± 0.06 vs. 0.26 ± 0.04, P < 0.01) compared to control. There was significant correlation between thrombolysis in myocardial infarction (TIMI) frame count and TDI mean parameters for LV systolic function (Sa & IVA, r =-0.53, P < 0.01 & r =-0.36, P < 0.05, respectively). Mean TIMI frame count was correlated with MPI and E/Ea. SCF patients had poorer peak exercise capacity than the controls (9.9 ± 1.9 METs vs. 12.7 ± 2.3, P < 0.01) with significant negative correlation with mean TIMI frame count (r =-0.46, P < 0.01). There is impairment of LV systolic and diastolic function in SCF patients with clinical impact on exercise capacity which emphasizes the importance of close follow-up of these patients for risk stratification.