Left Ventricular Global Systolic Strain Research Articles

Dynamic changes of heart structural and functional condition in patients with acute myocarditis

Diagnosis and prognosis of myocarditis course, which is an inflammatory heart muscle disease, has been and remains one of the most urgent, complex and unresolved problem in modern cardiology. The purpose of the study – to investigate the dynamic changes in the structural and functional heart state in patients with acute myocarditis and reduced left ventricular ejection fraction. Materials and methods. In total, 74 patients with clinically suspected acute myocarditis (AM) with reduced left ventricular (LV) ejection fraction (EF) ≤40 % and NYHA heart failure (HF) functional class II or higher were examined three times: in the first month of myocarditis debut, after 6 and 12 months of observation. All the patients underwent echocardiography and speckle-tracking echocardiography, Holter electrocardiogram monitoring and cardiac magnetic resonance imaging (MRI). Results. It was found that the debut of AM was characterized by the presence of active inflammatory process according to the cardiac MRI - edema and hyperemia of the myocardium were detected in 54.0 % and 70.2 % of cases, respectively, followed by LV dilation and systolic dysfunction as well as by a significant decrease in longitudinal and circumferential LV global systolic strain. After 12 months of observation, there was a significant increase in LV EF, decrease in end-diastolic volume index and an improvement in the parameters of longitudinal and circumferntial LV systolic strain by 30.8 % and 36.8 %, respectively, (P < 0.01), the frequency of active inflammatory changes in the myocardium was significantly reduced, herewith in 41.8 % of cases, delayed enhancement was noted, indicating fibrotic changes in the myocardium. The presence of delayed enhancement in cardiac MRI after 12 months since myocarditis onset was correlated with the presence of unstable ventricular tachycardia episodes (r = 0.62; P < 0.02) and with the frequency of ventricular extrasystoles (r = 0.53; P < 0.05). A significant influence of fibrotic changes in the myocardium on the presence of unstable ventricular tachycardia episodes in 12 months after the disease onset was confirmed by determining Fisher's exact test, its value was: P = 0.016 (P < 0.05). Conclusions. It was established that the debut of myocarditis was characterized by a significant violation of the structural and functional heart state: an active inflammatory process in the myocardium causedLV dilatation and contractile dysfunction. After 12 months, a decrease in detection of active inflammatory myocardial changes followed by regression ofLV dilation and its contractile function improvement was observed. It was proved that the presence of fibrotic changes in the myocardium in patients with myocarditis was associated with the persistence of ventricular rhythm disorders.

Increased myocardial extracellular volume assessed by cardiovascular magnetic resonance T1 mapping and its determinants in type 2 diabetes mellitus patients with normal myocardial systolic strain

BackgroundCardiac magnetic resonance (CMR) T1 mapping and tissue-tracking strain analysis are useful quantitative techniques that can characterize myocardial tissue and mechanical alterations, respectively, in patients with early diabetic cardiomyopathy. The purpose of this study was to assess the left ventricular myocardial T1 value, extracellular volume fraction (ECV), and systolic strain in asymptomatic patients with type 2 diabetes mellitus (T2DM) and their underlying relationships with clinical parameters.MethodsWe recruited 50 T2DM patients (mean age: 55 ± 7 years; 28 males) and 32 sex-, age-and BMI-matched healthy volunteers to undergo contrast-enhanced CMR examinations. The myocardial native T1, post-contrast T1 and ECV values of the left ventricle were measured from T1 and ECV maps acquired using the modified Look-Locker inversion recovery technique. The left ventricular global systolic strain and the strain rates were evaluated using routine cine images and tissue-tracking analysis software. The baseline clinical and biochemical indices were collected before the CMR examination.ResultsThe myocardial ECV and native T1 values were significantly higher in the diabetic patients than in the controls. (ECV: 27.4 ± 2.5% vs. 24.6 ± 2.2%, p < 0.001; native T1: 1026.9 ± 30.0 ms vs. 1011.8 ± 26.0 ms, p = 0.022). However, the left ventricular global systolic strain, strain rate, volume, myocardial mass, ejection fraction, and left atrial volume were similar between the diabetic patients and the healthy controls. In the diabetic patients, the native T1 values were independently correlated with the hemoglobin A1c levels (standardized β = 0.368, p = 0.008). The ECVs were independently associated with the hemoglobin A1c levels (standardized β = 0.389, p = 0.002), angiotensin-converting enzyme inhibitor (ACEI) treatment (standardized β = − 0.271, p = 0.025) and HCT values (standardized β = − 0.397, p = 0.001).ConclusionsType 2 diabetes mellitus patients with normal myocardial systolic strain exhibit increased native T1 values and ECVs indicative of myocardial extracellular interstitial expansion, which might be related to poor glycemic control. The amelioration of myocardial interstitial matrix expansion might be associated with ACEI treatment. A valid assessment of the association of glucose control and ACEI treatment with myocardial fibrosis requires notably larger trials.

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.

Cardiac changes in moderately malnourished children and their correlations with anthropometric and electrolyte changes.

To evaluate electrocardiographic and echocardiographic changes in moderately malnourished children and to correlate them with both anthropometric and electrolyte changes. Sixty moderately malnourished children were taken as patient group, and 60 healthy children of matched age and sex were taken as control group. Weight, height, body mass index (BMI), serum albumin, and electrolytes were measured for all children. Electrocardiographic evaluation for calculated QT (QTc) and QT dispersion (QTd) was performed. Left ventricular (LV) function was also evaluated using conventional echocardiography, tissue Doppler, and strain methods. Left ventricular mass index (LVMI) was also calculated. Weight, BMI, serum levels of albumin, total calcium, and ionized calcium were significantly lower, while QTc and QTd were significantly prolonged in malnourished children (P=.001 for all). There was significant reduction in LV fraction shortening (FS), LV E'/A', LV strain (S), LV myocardial performance index (MPI), LV global systolic strain (GLSS), and LVMI (P=.001 for all) in malnourished children. There was significant correlation between BMI and all cardiac variables. Moreover, there was significant positive correlation between serum albumin level and LV E'/A' (P=.02), LV GLSS (P=.03), and LVMI (P=.03).Total and ionized calcium level were significantly correlated with QTc, QTd, and LVMI (P<.05 for all). BMI was the most powerful predictor of these electrocardiographic and echocardiographic changes. Cardiac changes were present in moderately malnourished children as documented by electrocardiographic and echocardiographic changes, and these changes are in strong association with BMI and for a lesser extent with electrolyte changes especially serum calcium.

Assessment of left ventricular global systolic strain in patients with hypertrophic cardiomyopathy after modified Morrow surgery by two-dimensional speckle tracking imaging

Objective To evaluate left ventriclular systolic function in patients with obstructive hypertrophic cardiomyopathy (HOCM) after modified Morrow surgery using two-dimensional speckle tracking imaging (2D-STI). Methods Twenty three HOCM patients were recruited in this study. Echocardiographic data from HOCM patients during pre-operation, 1-month and 3-month post-operation were analyzed by Qlab software to compare the variation in systolic function indicators 1-month and 3-month post-operation including global and 16 segmental longitudinal strain, circumferential strain and conventional echocardiographic parameters of left ventricle. Results Compared with preoperative data of HOCM patients, postoperative LVOT diameter and pressure gradient, left atrial diameter and volume index were significantly decreased(P<0.05), but there was no significant difference in left ventricular ejection fraction(P<0.05). Compared with the preoperative case, global and segmental longitudinal strain showed significant reduction after 1 week and gradually recovered after 3 months, without significant variation. The longitudinal strain of the anteroseptum reduced significantly and the longitudinal strain of the free wall increased after 3 months, however, the circumferential strain reduced significantly. The circumferential strain of basal and middle segment after 3 months had improved significantly than those of postoperative 1 week. The circumferential strain of surgical site is no obvious change and the strain of free wall was improved after 3 months. Conclusions 2D-STI can effectively evaluate global and regional systolic function of left ventricle for HOCM patients after modified Morrow surgery. Key words: Echocardiography; Cardiomyopathy, hypertrophic; Ventricular function, left; Two-dimensional speckle tracking imaging

Differences in Natural History of Low- and High-Gradient Aortic Stenosis from Nonsevere to Severe Stage of the Disease

The aim of the present study was to assess and compare the disease progression of aortic stenosis (AS) subtypes from nonsevere to severe disease on the basis of measures of gradient and flow. Seventy-seven patients with AS (mean aortic valve area, 1.3±0.3cm(2) at baseline) underwent echocardiographic examination, including two-dimensional speckle-tracking strain measurements. Patients were retrospectively grouped according to mean transvalvular pressure gradient (40mm Hg) into low-gradient (LG/AS) and high-gradient (HG/AS) groups. The LG/AS group was further subdivided into low-flow (LF/LG; i.e., stroke volume index<35mL/m(2)) and normal-flow (NF/LG) groups. For subanalysis, the LF/LG group was split into two groups: "paradoxical" (P-LF/LG; ejection fraction>50%) and "classical" LF/LG (C-LF/LG; ejection fraction<50%). Follow-up echocardiography was performed in patients with severe AS after 3.3±1.7years. Survival status was ascertained after 5.0±2.0years. Coronary artery disease was more frequent in LG/AS than HG/AS patients. Already at baseline, LF/LGpatients showed reduced left ventricular global systolic strain and reduced systemic arterial compliancecompared with HG/AS patients (HG/AS, 1.0±0.4 mL · mm Hg-(1) · m(-2); NF/LG, 0.9±0.2 mL·mm Hg-(1) · m(-2); LF/LG, 0.6±0.2 mL · mm Hg(-1) · m(-2); P<.001). The initially elevated valvuloarterial impedance increased significantly more in LG/AS than in the other groups (HG/AS, 2.2±0.9 mm Hg · mL-(1) · m(-2); NF/LG, 2.2±0.5 mm Hg · mL-(1) · m(-2); LF/LG, 3.2±0.8 mm Hg · mL(-1) · m-(2); P<.001), while aortic valve area decreased by 42% in HG/AS versus 34% in NF/LG and 32% in LF/LG (P<.001). At follow-up, global systolic strain was significantly reduced in C-LF/LG (7.7±2.5 vs 13.5±2.9 in P-LF/LG, P<.001). In P-LF/LG, mitral E/E' ratio increased significantly from 8.9±4.0 to 26.4±9.2 (P<.05). In patients with AS with high-gradient physiology, the valve constitutes the primary problem. By contrast, low-gradient AS is a systemic disease with valvular, vascular, and myocardial components, resulting in a slower progression of transvalvular gradient, but worse clinical outcome. In C-LF/LG, impaired systolic function leads to an LG flow pattern, whereas the pathophysiology in P-LF/LG is predominantly a diastolic dysfunction.

Assessment of left ventricular global systolic strain in hypertrophic cardiomyopathy by three-dimensional speckle tracking echocardiography

Objective To explore the value of three-dimensional speckle tracking imaging (3D-STI) in evaluating the global systolic strain of left ventricular (LV) in patients with hypertrophic cardiomyopathy (HCM).Methods A total of 90 consecutive patients with HCM were enrolled,in which 58 patients were nonobstructive HCM (HNCM),32 patients were obstructive HCM (HOCM).In addition,72 healthy subjects were recruited as a control group.An ultrasound system iE33 (Philips Medical Systems,Bothell) was used to acquire and analyze two-dimensional images.Full-volume three-dimensional dynamic images were performed using matrix transducer X5-1.LV global longitudinal strain(GLS),global circumferential strain(GCS),global radial longitudinal(GRS),global strain (GS),were analysis using off-line TomTec software,the differences among three groups were compared.Results Compared with the control group,LV end-diastolic,end-systolic volumes and stroke volume significantly decreased,LV mass and LV diastolic wall thickness significanty increased.Howeve,there was no significant difference between LVEF in the HCM and control group (P =0.178).The comparson of the 3D systolic strain in the four groups as followed,compared with the control group,GS was no significant difference,GLS was significantly reduced,however GCS,GRS was significantly increased in HCM groups.When compared with the HNCM,GLS was significant reduced,however GCS,GRS were significant increased in the HOCM group.Bland-Altman analysis showed there were good agreements in both patients with HCM and control subjects.Conclusions 3D-STI can detecte the early impairment of LV global myocardial contractility in HCM,and provides valuable information for clinical in early diagnosis,prevention and treatment. Key words: Echocardiography; Cardiomyopathy, hypertrophic; Ventricular function, left; Three dimensional speckle tracking imaging

Quantitative evaluation of left ventricular global systolic function in patients with myocardial infarction by three-dimensional speckle tracking echocardiography

Objective To evaluate the value and characteristics of left ventricular global systolic strain and its relation to the left ventricular global systolic function in patients with myocardial infarction(MI) by three-dimensional speckle tracking echocardiography (3D-STI).Methods In 24 patient subjects and 20 control subjects,the myocardial motion was tracking by 3D-STI,left ventricular ejection fraction(LVEF),and global longitudinal peak systolic strain(LVGLS),global circular peak systolic strain(LVGCS),global radial peak systolic strain(LVGRS),global area peak systolic strain(LVGAS) were measured.The values were compared between the two groups,the correlations between LVEF and LVGLS,LVGCS,LVGRS,LVGAS were analyzed respectively.Results (1)There was significant difference of each index about LVEF and global strain between normal group and MI group (all P ＜0.05).(2)The correlations among LVEF and LVGLS,LVGCS,LVGRS,LVGAS were found (r =-0.626,-0.770,0.772,-0.748 respectively,P ＜0.01 for all).(3) Bland-Altman analysis showed there were good agreements in both patients with MI and control subjects.Conclusions 3D-STI could be applied non-invisibly and objective to assess alteration of myocardial global systolic function by accurately measuring strain.Therefore,3D-STI appears to be a reliable and useful tool to estimate the left ventricular systolic function of MI. Key words: Echocardiography; Myocardial infarction; Ventricular function, left; Three-dimensional speckle tracking imaging

Assessment of Cardiac Function in Monochorionic Diamniotic Twin Pregnancies with Twin-to-Twin Transfusion Syndrome Before and After Fetoscopic Laser Photocoagulation Using Speckle Tracking

To assess cardiac function with Speckle tracking in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser therapy. A prospective case control study was conducted on 11 monochorionic diamniotic twin pairs with TTTS. Based on normal curves derived from healthy controls, global systolic longitudinal myocardial velocity, strain and strain rate values were transformed to z-scores. Right and left ventricular systolic global strain (-27.45 % and -22.41 %) and strain rate (-4.13/sec and -3.27/sec) were reduced in recipients compared with normal values and all parameters tended to decrease even more after treatment (RV and LV: strain -23.79 % and -20.21 %; strain rate: -3.67/sec and -2.87/sec). The corresponding measurements in donor fetuses revealed no statistical difference compared to reference values. The global systolic myocardial function of donor twins before and after laser therapy was in the normal ranges. In contrast, recipient twins exhibited global cardiac dysfunction with decreased pre- and postoperative strain and strain rate. Speckle tracking can identify compromised ventricular myocardial function in fetuses with TTTS.