Base Of Left Ventricle Research Articles

Cardiac Resynchronization Therapy

Cardiac Resynchronization Therapy

Left ventricular torsion: feeling the heat

Left ventricular torsion: feeling the heat

Heat Shock Protein, αB Crystallin, Can Prevent the Arrhythmogenic Effect of Ambient Particulate Matter by Attenuating the Repolarization Gradient and Triggered Activity

Introduction: Ambient particulate matter (PM) can increase cardiac arrhythmias via oxidative stress. This study was performed to reveal that the heat shock protein, α B-crystallin, could prevent the arrhythmogenic effect of PM.Methods: Using optical mapping, arrhythmic mechanism were evaluated in Langendorff-perfused Adult Sprague-Dawley rat heart after infusion of diesel exhaust product (DEP) and αB-crystallin.Results: In neonatal rat cardiomyocytes, DEP provoked cell death and ROS generation in dose dependant manner. In Langendorff-perfused rat hearts, DEP infusion of 12.5 mg/L (n=12) prolonged action potential duration (APD90) at only the base of left ventricle (LV) from 101±14 ms to 152±22 ms (p=0.001) increasing apicobasal APD differences from 4±8 ms to 54±25 ms (p=0.003). Pretreatment of αB-crystallin (1 mg/kg, n=9) with a delivery system (TAT-protein transduction domain) prevented the DEP-induced APD prolongation (106±10 ms, p=0.83) and apicobasal APD differences (1.5±15.5 ms, p=0.83). Compared with DEP alone, pretreatment of αB-crystallin decreased triggered activity (67% vs. 11%, p=0.02) and apicobasal reentry (82% vs. 0%, p=0.001). The ventricular tachyarrhythmia (VT) was observed in 9 (75%) and 4 (44%) hearts after DEP alone and pretreatment of αB-crystallin (p=0.04), respectively.Conclusions: Heat shock protein, αB-crystallin, can prevent arrhythmogenic effect of PM by suppressing apicobasal repolarization gradient and triggered activity.

Preferential Right Ventricular Breakout of Ventricular Tachycardia and Critical Slow Conduction in Left Ventricle in a Patient with Postinfarction Ventricular Septal Perforation Repair

A 68 year-old man who had ischemic cardiomyopathy (ejection fraction 40%), with prior coronary artery bypass graft and ventricular septal perforation (VSP) repair, was admitted due to ventricular tachycardia (VT) with left bundle branch block morphology, and QR pattern in inferior leads. Electro anatomical voltage map (CARTO) during sinus rhythm (SR) demonstrated large low voltage zone (low-VZ) (<0.6 mV on amplitude of bipolar voltages) in posteroseptal (basal and mid levels) left ventricle (LV), but no low-VZ in right ventricle (RV). Optimal pace map during SR was obtained in basal posteroseptal RV, not in LV. And during VT (cycle length 459 ms), RV septal activation was earlier than LV. Delayed potential during SR was recorded at low-VZ in a basal posteroseptal LV, where mid diastolic potential during VT preceding QRS onset by 140 ms was seen. Entrainment pacing showed concealed entrainment with stimulus-QRS interval of 140 ms and post pacing interval identical to VT cycle length. Irrigated radiofrequency application terminated VT in three seconds. VT was considered that its central common pathway located in the basal posteroseptal low-VZ in LV between mitral annulus and VSP patch, with preferential breakout to septal RV.

Electrocardiographic and Electrophysiologic Characteristics of Ventricular Extrasystoles Arising from the Aortomitral Continuity

Left ventricular outflow tract arrhythmias originating from the aortomitral continuity, the left coronary cusp, the superior basal septum, and the epicardial left ventricular summit display common electrocardiographic and electrophysiological features, probably due to the close proximity of those locations. Catheter ablation of these arrhythmias can be challenging. The case of a 68-year-old male with frequent premature ventricular extrasystoles arising from the aortomitral continuity of the basal left ventricle is described. The electrocardiographic and electrophysiologic characteristics of this arrhythmia are discussed.

Ventricular tachycardia originating from the aortic sinus cusp in patients with idiopathic dilated cardiomyopathy

Ventricular tachycardia (VT) in patients with idiopathic dilated cardiomyopathy often originates from the basal left ventricular myocardium and also can originate from the conduction system. The basal left ventricular myocardium reaches to the base of the aortic sinus cusps. The purpose of this study was to assess the prevalence of VT originating from the aortic sinus cusps in patients with idiopathic dilated cardiomyopathy. Thirty-three consecutive patients with nonischemic cardiomyopathy (24 men, age: 59 ± 11 years, ejection fraction: 29% ± 14%) were referred for ablation. VTs originating from the aortic sinus cusps were identified in 8 of 33 patients (24%). The presence of low voltage in the basal left ventricle correlated with the inducibility of aortic sinus cusp VTs. All but 1 aortic sinus cusp VTs were effectively ablated. In 1 patient, the site of origin of the VT was <10 mm from the ostium of the left main coronary artery and ablation was not attempted. In patients with idiopathic dilated cardiomyopathy, VT often originates from the aortic sinus cusps. The large majority of these VTs can be successfully ablated.

Two-dimensional Speckle Strain and Dyssynchrony in Single Left Ventricles Vs. Normal Left Ventricles

Patients with single left ventricle (LV) physiology maybe at increased risk for myocardial dysfunction and mechanical dyssynchrony. Newer echocardiographic modalities may be able to better quantitate LV function in this unique population. Our objective was to use 2D-speckle analysis of strain and strain rate to quantify systolic function and dyssynchrony in single LV post-Fontan patients and compare them to control LV patients. Patients with single LV status post-Fontan procedure and patients with normal biventricular anatomy were studied. Two-dimensional speckle echocardiography was used to measure strain, strain rate, time to peak, and longitudinal displacement in a six-segment model of the LV. Independent t-tests were used to compare group means. Twelve patients with single LV physiology and thirteen control patients were studied. There was no significant difference in ages for the single LV patients vs. control patients (7.1 + 2.8 years vs. 5.7 + 1.8 years). Single LV strain values were significantly lower in four of the six segments compared with control LV (mid interventricular septal [IVS]: -19.3 + 6.4% vs. -23.8 + 3.5%, apical IVS: -20.8 + 5.4% vs. -27.4 + 4.7%, basal LV: -20.6 + 6.6% vs. -25.8 + 3.4%, and apical LV: -21.0 + 6.2% vs. -26.1 + 4.3%). Longitudinal displacement was lower for all three segments of the IVS for the single LV vs. control LV. Modified Yu index for strain and strain rate time to peak was longer in the single LV patients vs. controls (51.2 + 18.2 ms vs. 27.9 + 8.0 ms and 90.2 + 24.2 ms vs. 52.5 + 23.7 ms, respectively). Significant differences in strain analysis between single LV patients vs. control patients with normal biventricular physiology exist at a relatively young age. Future studies are needed to determine the significance of these differences.

Assessment of left ventricular volumes; reliable by gated SPECT?

Assessment of left ventricular volumes; reliable by gated SPECT?

Heterogeneity of apex-to-base dispersion in diastolic lengthening is related to impaired global left ventricular relaxation in patients with hypertrophic cardiomyopathy.

The presence of apex-to-base disparity in diastolic left ventricle (LV) endocardial lengthening, based on an electromechanical activation sequence, has been recognized as an important determinant of LV diastolic properties. However, the behavior of LV apical and basal diastolic lengthening and its relationship to LV filling in hypertrophic cardiomyopathy (HCM) are unknown. We obtained basal and apical LV short-axis views in 27 patients with non-obstructive HCM and 25 healthy volunteers. The patients with HCM were subdivided into two groups; those with apical hypertrophy [APH(+)] or those without apical hypertrophy [APH(-)]. Eight equiangular points on the endo-myocardium at end diastole were placed in each view, and the movements of these points were automatically tracked using a two-dimensional echocardiographic tissue tracking system. Time-LV internal diameter curves were obtained and averaged. The time intervals from the aortic valve closure to the point of the first 40% of peak diastolic lengthening (T 40) were measured in each view. The standard deviation of the time to peak systolic circumferential shortening at the base and apex were calculated to assess the heterogeneity of LV contraction. The time difference in the T 40 between the apex and base (dt-T 40) in the HCM-APH(+) and HCM-APH(-) groups was greater than that in the control group. The heterogeneities in LV apical systolic shortening in the HCM groups were greater than those in the control group. There were good linear correlations between the dt-T 40 and the LV early diastolic echo-parameters and the LV mass index. Delayed apical relaxation and filling in patients with HCM is related to LV diastolic dysfunction and systolic dyssynchronous contraction.

Left ventricular myocardial strain and strain rates in sub-endocardial and sub-epicardial layers before and after a marathon

We assessed myocardial deformation in sub-endocardial and sub-epicardial layers of the left ventricle (LV) wall before and after running a marathon. Echocardiography scans were performed on 14 male, non-elite runners (mean +/- SD; age 32 +/- 10 years) who completed the 42.2-km London marathon. Para-sternal short axis and apical four-chamber views were recorded for off-line analysis. Peak longitudinal, radial and circumferential strains, peak systolic and early diastolic strain rates were recorded. Circumferential rotation in basal and apical LV scans was used to calculate torsion. Pre-race strain and strain rates were generally greater in the sub-endocardial layer of the LV wall. After race completion, a mixed pattern of change was observed with a reduction in sub-epicardial radial strain (32.6 +/- 12.5 to 20.3 +/- 9.6%; P < 0.01) and sub-endocardial circumferential strain (-26.9 +/- 3.6 to -23.7 +/- 4.1%; P < 0.01) at the apex. Rotation was not altered at either the apical or basal levels and thus torsion was not changed in either the sub-endocardium (6.72 +/- 3.46 degrees to 5.67 +/- 4.98 degrees) or the sub-epicardium (3.48 +/- 2.68 degrees to 3.01 +/- 3.23 degrees). Strain rates and rotation rates were only sporadically altered post-race. There are differences in deformation characteristics between the sub-endocardium and sub-epicardium at baseline, and the limited changes observed post-race were not specific to any region or depth of the LV wall.

Misinterpretation of a movable mass attached to the aortic valve imaged by transoesophageal echocardiography

Editor, Intraoperative transoesophageal echocardiography (TEE) is a useful tool not only for monitoring surgical patients but also for evaluating and diagnosing cardiac lesions during surgery and guiding surgical approaches. Several reports have described the incidental identification of cardiac lesions using TEE.1–3 This case alerts echocardiographers regarding the possible misinterpretation of an apparent movable cardiac mass. A 76-year-old man was scheduled for coronary artery bypass graft (CABG) surgery. He was admitted to our hospital and diagnosed with acute myocardial infarction 2 months prior to the scheduled surgery. Coronary angiography revealed total occlusion in segments 1 and 6 and significant stenosis (90%) in segment 13. The total occlusion in segment 1 was alleviated by percutaneous coronary intervention, resulting in nonsignificant stenosis (25%). Preoperative transthoracic echocardiography (TTE) revealed an ejection fraction of 67% with mild hypokinesis of the inferior wall, trivial mitral regurgitation and no abnormalities of the aortic valve. TEE was not performed preoperatively. After induction of anesthesia for the CABG surgery, TEE (ACUSON-CV70, Siemens, Tokyo, Japan), which was equipped with two-dimensional imaging with colour flow Doppler, was performed. A midoesophageal, modified long-axis view of the aortic valve revealed a 6.5 mm × 3.5 mm, high-echoic, mobile, pedunculated mass attached to the noncoronary cusp (Fig. 1 and Video Loop 1, https://links.lww.com/EJA/A1). The movement of the mass appeared to be synchronized with the aortic valve. Colour flow Doppler exhibited only trivial aortic regurgitation. The mass was visible in the wide range of the multiplane angle from the modified long-axis view to the true long-axis view of the aortic valve. A short-axis view of the aortic valve revealed mild hypertrophy of the noncoronary cusp at the level of the aortic valve (Fig. 2 and Video Loop 2, https://links.lww.com/EJA/A2). The view was unable to provide any clear images of the area proximal to the aortic valve due to the appearance of the basal left ventricle, and we were unable to detect the mass there. The movable mass was interpreted as likely representing a tumour, thrombus, vegetation or Lambl's excrescences. After detailed discussion with the cardiac surgeon regarding the movable mass and completion of distal anastomosis of CABG, the aorta was opened and the aortic valve was observed through the transaortic approach. Although no abnormal structures were attached to the aortic valve, part of the noncoronary cusp leaflet had yellowish degenerative bulging hypertrophy. After the aorta was closed and the cardiopulmonary bypass was completed, the aortic valve was again evaluated by TEE. The mass-like structure was still visible in the same view as it was during the pre-bypass period.Fig. 1Fig. 2Accurate diagnosis of the mass-like structure was necessary in this case because a pedunculated, movable mass carries the risk of life-threatening complications such as stroke, embolism and acute valvular dysfunction. TEE is a useful imaging modality for assessment of movable intracardiac masses. With TEE, optimal high resolution and proximity between the transducer and the heart sometimes provide superior evaluation of the characteristics of a movable cardiac mass compared with TTE. It has been reported that a fibroelastoma attached to the aortic valve was incidentally identified with intraoperative TEE although it was not shown by preoperative TTE.2,3 However, in our case, the hypertrophic region of the aortic valve leaflet was misinterpreted as a movable cardiac mass. It was postulated that the bulging hypertrophic region of the noncoronary cusp was imaged only during diastole, this being interpreted as a movable mass during the cardiac cycle. Misinterpretation of cardiac lesions by TEE has been reported.4,5 A mobile mass on a prosthetic mitral valve observed by TEE was reportedly misinterpreted as vegetation when it was actually a pannus.4 In our case, the hypertrophic region of the valve appeared to be a mass-like structure that moved with the cardiac cycle, as viewed by TEE. This is one possible pitfall of TEE. It is extremely important, though sometimes difficult, to differentiate mass-like structures attached to the aortic valve. This case has an important clinical message for the interpretation of a movable mass on the aortic valve with TEE.

Isolated Left Ventricle Diverticula

A 49-year-old woman with atypical chest pain was referred for a multidetector computed tomography examination of the coronary arteries after a positive electrocardiography stress test. No coronary atherosclerotic disease was observed on the coronary computed tomography scan. The only findings were 2 side-by-side basal left ventricle diverticula, suggested as a possible etiology for her symptoms and electrocardiographic changes. The entity, congenital left ventricle diverticulum, is reviewed.

ECG Criteria to Identify Epicardial Ventricular Tachycardia in Nonischemic Cardiomyopathy

ECG criteria identifying epicardial (EPI) origin for ventricular tachycardia (VT) in nonischemic cardiomyopathy have not been determined. Endocardial (ENDO) and EPI basal left ventricle fibrosis characterizes the VT substrate. We assessed the QRS from 102 basal-superior/lateral EPI and 67 comparable ENDO pace maps in 14 patients with nonischemic cardiomyopathy. Pace mapping focused on low bipolar voltage areas. Published morphology criteria: q wave in lead I (QWLI) and no q waves in inferior leads and interval criteria: pseudo-delta wave > or =34 ms, intrinsicoid deflection time > or =85 ms, shortest RS complex > or =121 ms, and maximum deflection index > or =0.55 were assessed for ability to identify EPI origin. Sixteen EPI and 8 ENDO of the 34 mapped VTs (71%) in the study population and 14 EPI and 7 ENDO VTs from an 11-patient validation cohort were localized to basal-superior/lateral left ventricle and corroborated pacing data. A QWL1 was seen in EPI but not ENDO pace maps (91% versus 4%; P<0.001), identified 14 of 16 EPI VTs (sensitivity, 88%), and was seen in 1 of 8 ENDO VTs (specificity, 88%). None of the remaining criteria achieved similar sensitivity without specificity <50%. We identified 4 criteria (q waves in inferior leads, pseudo-delta wave > or =75 ms, maximum deflection index > or =0.59, and QWL1) having > or =95% specificity and > or =20% sensitivity in identifying EPI/ENDO origin for pace maps. This 4-step algorithm identified the origin in 109 of 115 pace maps (95%), 21 of 24 VTs (88%) in the study population, and 19 of 21 VTs (90%) in validation cohort. Morphological ECG features that describe the initial QRS vector can help identify basal-superior/lateral EPI VTs in nonischemic cardiomyopathy.

Influence of cardiac shape on left ventricular twist

The dynamic interaction between subendocardial and subepicardial fibre helices in the left ventricle (LV) leads to a twisting deformation, which has an important role in LV function. This study sought to assess the influence of cardiac shape on LV twist in the normal and dilated human heart. The study comprised 45 dilated cardiomyopathy (DCM) patients and 60 for age- and gender-matched healthy volunteers. Speckle tracking echocardiography was used to determine basal and apical LV peak systolic rotation (Rot(max)) and instantaneous LV peak systolic twist (Twist(max)). LV sphericity index was calculated by dividing the LV maximal long-axis internal dimension by the maximal short-axis internal dimension at end-diastole. A parabolic relation between the sphericity index and apical Rot(max) or Twist(max) was identified in the total study population (R(2) = 0.56 and R(2) = 0.54, respectively; both P < 0.001) and healthy volunteers (R(2) = 0.39 and R(2) = 0.25, respectively; both P < 0.001), whereas these relations were linear in DCM patients (R(2) = 0.40 and R(2) = 0.43, respectively; both P < 0.001). In a multivariate analysis, LV sphericity index was the strongest independent predictor of apical Rot(max) and Twist(max). In conclusion, LV apical rotation and twist are significantly influenced by LV configuration. Taking the important function of LV twist into account, this finding highlights the vital influence of cardiac shape on LV systolic function.

Echocardiographic Evaluation of Diastolic Function Can Be Used to Guide Clinical Care

For normal cardiac performance, the left ventricle (LV) must be able to eject an adequate stroke volume at arterial pressure (systolic function) and fill without requiring an elevated left atrial (LA) pressure (diastolic function). These systolic and diastolic functions must be adequate to meet the needs of the body both at rest and during stress. Response by Tschope and Paulus on p 809 Systolic function is conveniently (although not always accurately) measured as the ejection fraction (EF), calculated as stroke volume divided by end-diastolic volume.1 The LV EF is easily interpreted. The lower limit of normal is ≈50%. The lower the EF is, the greater the reduction in systolic function. Diastolic function has been more difficult to evaluate.2 Traditionally, invasive measures of LV diastolic pressure-volume relations and the rate of LV pressure fall during isovolumetric relaxation have been used. However, these methods are not practical for routine clinical use and do not adequately evaluate all aspects of diastolic filling.3 Comprehensive echocardiographic evaluation of the dynamics of LV filling using blood pool and tissue Doppler has now progressed so that it provides clinically important information that can be used to direct patient care. We present data that support the use of echocardiographic evaluation of diastolic function to recognize cardiac dysfunction in patients with heart failure, especially those with preserved EF; to guide the management of patients by identifying those with and without elevated left filling pressures regardless of underlying EF; and to determine prognosis in a wide variety of patient populations. Although the LV end-diastolic pressure-volume relation describes the passive properties of the LV, LV filling is not a passive or slow process.3 In fact, the peak flow rate across the mitral valve is equal to or greater than the peak flow rate across the aortic valve. …

Presystolic mitral annular septal–lateral shortening is independent from left atrial and left ventricular contraction during acute volume depletion☆☆☆

The mitral annulus (MA) is a dynamic structure that joins the left atrium (LA) and left ventricle (LV), but it is unknown whether MA motion is coupled to the LA or the LV or neither of the two. Since a well orchestrated coordination of LA, MA and LV septal-lateral (S-L) dynamics is essential for efficient valve closure, we assessed their functional coupling in an experimental ovine model. To assess the coupling under a wide range of physiological conditions, data were acquired in normal and acutely volume depleted hearts. In 10 sheep, radiopaque markers were placed in LA, MA and LV base (LVbase). Twelve weeks postoperatively, 4-D marker coordinates were obtained by stereo videofluoroscopy (60 frames/s) before (CTRL) and during acute inferior vena caval occlusion (VCO). Septal-lateral dimensions were calculated as distances between corresponding marker pairs in the LA, MA and LVbase 5 frames before end-diastole (ED-84 ms) and at end-diastole. Dynamics during late diastole are described as changes from ED-84 ms versus end-diastole. To study the functional coupling between LA, MA and LVbase we calculated slopes during late diastole from simple linear regressions on an animal-by-animal basis. During late diastole in CTRL, the LA and MA both shortened along the S-L dimension (32.9 +/- 6.6 mm vs 31.0 +/- 5.5 mm, p = 0.026 and 27.3 +/- 3.7 mm vs 24.6 +/- 4.1 mm, p = 0.005, respectively) whereas the LVbase lengthened (56.2 +/- 9.3 mm vs 57.3 +/- 9.3 mm, p = 0.012). VCO abolished septal-lateral dynamics of LA and LVbase during late diastole (27.8 +/- 4.3 mm vs 27.4 +/- 3.9 mm, p = 0.155 and 49.4 +/- 7.7 mm vs 49.5 +/- 7.5 mm, p = 0.752, respectively) while the MA still shortened (19.0 +/- 2.9 vs 18.0 +/- 2.8, p = 0.042). Under CTRL conditions LA dynamics were linearly dependent from MA dynamics (average coefficient 0.57, p = 0.001), suggesting that LA and MA are functionally coupled. With acute volume depletion, MA dynamics were linearly independent from both, LA and LV (average coefficient 0.28, p = 0.159 and 0.58, p = 0.192, respectively). Whereas MA and LA dynamics are coupled during late diastole in hearts with normal LV volumes, presystolic mitral annular septal-lateral shortening is independent from LA and LV dynamics with acute volume depletion. A better understanding of mitral annular dynamics and their functional coupling may help improve mitral valve repair strategies.

Is there a significant transmural gradient in repolarization time in the intact heart?

Is there a significant transmural gradient in repolarization time in the intact heart?

Effect of ectopic excitation on pump function of the hen and dog right heart ventricle

The pump function of the right heart ventricle has been studied in anesthetized dogs and hens at sinus rhythm, supraventricular rhythm, and subepicardial ectopic excitation of base and apex of the right and left ventricles. Dynamics of the ventricle intracavital pressure was recorded by transmural catheterization. The pump function of the right ventricle in hen (as compared with sinus rhythm) retained to the greater degree at stimulation of the left ventricle apex and deteriorated significantly at stimulation of the right ventricle, whereas in dog (as compared with supraventricular rhythm) it retained to the greater degree at stimulation of the left ventricle base and deteriorated at stimulation of the right ventricle apex. Changes of the pump function of the right heart ventricle at ectopic ventricle stimulation are similar in birds and mammals. Differences in changes of dog and hen pump functions under effect of location of the ectopic excitation seem to be due to morphofunctional peculiarities of heart ventricles.

The Left Ventricular Ostium

Received June 17, 2008; accepted September 4, 2008. Idiopathic ventricular arrhythmias (VAs) arising from the left ventricle (LV) are often accessible for catheter ablation from the aortic sinuses of Valsalva or adjacent to the mitral annulus (MA).1 The aortic and mitral valves are direct apposition and attach to an elliptical opening at the base of the LV known as the LV ostium.2 The VAs arising from this region are being increasingly recognized as targets for catheter ablation.3–7 This review describes the anatomic features of the LV ostium and the electrocardiographic, electrophysiological, and angiographic characteristics that are relevant to the mapping and ablation of these arrhythmias. The dominant central structure of the heart is the junction of the aorta with the LV. Fundamental for understanding idiopathic VAs arising near the aortic and mitral valves are 2 concepts: first, these arrhythmias arise from the LV ostium (Figure 1); and second, the LV ostium is covered by the aorto-ventricular membrane, a tough fibrous structure which is perforated by the aorta anteriorly and the mitral valve (MV) posteriorly (Figure 2). The anatomic concept of the LV ostium and its covering, the aorto-ventricular membrane, are based on the pioneering work of McAlpine.2 Figure 1. The left ventricular ostium (postero-cranial view). The left panel includes the aortic root with the right coronary sinus (R), left coronary sinus (L), and noncoronary sinus (N). In the right panel, the root of the aorta has been removed to demonstrate the elliptical ostium of the left ventricle (LV) with the junction of the right coronary cusp (RCC), left coronary cusp (LCC), and LV summit demonstrated. APM indicates anterior papillary muscle; LA, left atrium; LAFT, left anterior fibrous trigone; LFT, left fibrous trigone; L-RCC, the junction between the LCC and RCC; PPM, posterior papillary muscle; PSP, postero-superior …

Ultrasound speckle tracking imaging contributes to early diagnosis of impaired left ventricular systolic function in patients with type 2 diabetes mellitus

To investigate the value of ultrasound speckle tracking imaging (STI) in the assessment of the short-axis and long-axis systolic function of the left ventricle (LV) in patients with type 2 diabetes mellitus (DM), 100 subjects with normal ejection fraction were studied, including 41 patients with DM only (DM group), 22 patients with both DM and left ventricular hypertrophy (DH group), and 37 healthy subjects (control group). Left ventricle systolic function in the long axis defined as longitudinal strain, and that in the short axis defined as radial strain, apical and basal LV rotations, and LV twist were assessed respectively. The results showed that average peak strain in the long axis at basal, middle and apical levels, and global peak strain were significantly decreased in the patient groups when compared with the control group (P<0.001 for each). The parameters in DH group were significantly lower than those in DM group (P<0.01 for each). There were no significant differences in average radial peak strain in the short axis at different levels, and global peak strain among the three groups (P>0.05). Apical and basal LV rotations, and LV twist were greater in the patient groups than in the control group (P<0.01 for each). Basal LV rotation and LV twist were greater in DH group than those in DM group (P<0.01). It was concluded that STI may be used to identify early abnormalities in patients with type 2 DM that have normal left ventricular systolic function.