Left Ventricular Regional Myocardial Function Research Articles

Prognostic Value of Single-Photon Emission Computed Tomography of Left Ventricular Synchronized with ECG for Cardiotoxicity Assessment in Patients with Malignant Lymphoma after High Dose Chemotherapy with Autologous Stem Cell Transplantation

Introduction: High-dose chemotherapy (HDC) with autologous hematopoietic stem cells transplantation (auto-HSCT) is currently widely used for the treatment of relapsed and refractory to standard chemotherapy cases of malignant lymphomas. Examination of patients for evaluation cardiotoxic effect of HDC and auto-HSCT is usually performed with an electrocardiography and echocardiography. The method of single photon emission computed tomography of the left ventricular(LV) myocardium, synchronized with the patient's ECG (Gated - SPECT) is rarely used to assess cardiotoxic effect of HDC and auto-HSCT, and its prognostic value in this field is not determined.Objective: to evaluate perfusion and regional myocardial function of the left ventricle (LV) using Gated-SPECT in malignant lymphomas patients receiving HDC and auto-HSCT. To evaluate whether the age and conditioning regimens influence the worsening of indices of hyperperfusion according to Gated-SPECT.Materials and methods: The study included 127 patients (67 with Hodgkin's lymphoma, 28 with non-Hodgkin's lymphoma, 32 with multiple myeloma). The median age was 37 year (range: 19 to 68 years); 80 females, 47 males. Gated-SPECT was used for assessment of perfusion and regional left ventricular function at rest before the HDC and auto-HSCT (point 1) and at discharge (point 2). The each study was performed on a double-headed rotating gamma camera «Forte» (Philips, USA) after intravenous injection of 740 MBq of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI). Gated-SPECT was used to measure the conventional parameters (total hypoperfusion defect, total LVEF) and also to measure regional myocardial perfusion and thickening used the 20-segment “bull's eye” model (the LV myocardium was divided into 20 segments).Results: The total area of hypoperfusion, expressed as a percentage of the area of the left ventricular myocardial wall did not change significantly during treatment (p> 0,05). However, segmental analysis of regional myocardial perfusion has revealed a statistically significant decrease in the median level uptake of the 99mTc-MIBI in 1,2,3,4,5,6,7,8,9,10,11,13,14,16,17,19,20 segments (p =0,01). The total ejection fraction (TEF) decreased, but change was not significant (median TEF at point 1 was 60,4 %, at point 2 - 59,9 %). But it showed a statistically significant decrease in median of local systolic thickening in 2,3,4,5,6,8,9,11,12,14,15,18,19,20 segments (p <0,05).It was also found that there was no correlation in the age of patients with hypoperfusion changes in the time of admission, but after treatment there was a direct significant weak correlation between these indices (R = 0.22, p = 0.01), So, older patient patient, have the greater size of the general hypoperfusion zone (Table 1).The analysis showed that the conditioning regimen (BEAM, high doses of melphalan or CBV) did not affect the index of the general hypoperfusion zone, which was established when comparing the parameters between pairs: ВЕАМ and high doses of melphalan, ВЕАМ and CBV, CBV and high doses of melphalan. Significant changes of general hypoperfusion zone were not detected when compare this indices at the time patients was admitted to the hospital with indices at the time of discharge from the hospital, that is, after HDC and auto-HSCTConclusions:HDC and auto-HSCT significantly change perfusion and regional LV myocardial function in patients with malignant lymphomas. Changes revealed evidence of diffuse myocardial damage. There was no difference in general hypoperfusion zone between different conditioning regimen before and after the treatment. Gated-SPECT can be considered as a promising method for assessing cardiac HDC and auto-HSCT. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Association between genetic variants in the HIF1A-VEGF pathway and left ventricular regional myocardial deformation in patients with hypertrophic cardiomyopathy.

Information on genetic etiology of pediatric hypertrophic cardiomyopathy (HCM) rarely aids in risk stratification and prediction of disease onset. Little data exist on the association between genetic modifiers and phenotypic expression of myocardial performance, hampering an individual precision medicine approach. Single-nucleotide polymorphism genotyping for six previously established disease risk alleles in the hypoxia-inducible factor-1α-vascular endothelial growth factor pathway was performed in a pediatric cohort with HCM. Findings were correlated with echocardiographic parameters of systolic and diastolic myocardial deformation measured by two-dimensional (2-D) speckle-tracking strain. Twenty-five children (6.1 ± 4.5 years; 69% male) with phenotypic and genotypic (60%) HCM were included. Out of six risk alleles tested, one, VEGF1 963GG, showed an association with reduced regional systolic and diastolic left ventricular (LV) myocardial deformation. Moreover, LV average and segmental systolic and diastolic strain and strain rate were significantly reduced, as assessed by the standardized difference, in patients harboring the risk allele. This is the first study to identify an association between a risk allele in the VEGF pathway and regional LV myocardial function, with the VEGF1 963GG allele associated with reduced LV systolic and diastolic myocardial performance. While studies are needed to link this information to adverse clinical outcomes, this knowledge may help in risk stratification and patient management in HCM. Risk allele in the VEGF gene impacts on LV myocardial deformation phenotype in children with HCM. LV 2-D strain is significantly reduced in patients with risk allele compared to non-risk allele patients within HCM patient groups. Describes that deficiencies in LV myocardial performance in children with HCM are associated with a previously identified risk allele in the angiogenic transcription factor VEGF. First study to identify an association between a risk allele in the VEGF pathway and regional LV myocardial deformation measured by 2-D strain in children with HCM.

Evaluation of the impact of percutaneous coronary intervention of chronic total occlusion on regional myocardial function using strain echocardiography

BackgroundSuccessful revascularization of chronic total occlusions has been associated with potential effects on left ventricular (LV) function. Strain and strain rate are more sensitive measures of LV mechanics than LV ejection fraction (LVEF). This study was conducted to investigate the impact of revascularization of chronic total occlusion (CTO) on LV function using tissue Doppler (TDI) strain echocardiography.ResultsThis study included 60 patients divided into two main groups: the percutaneous coronary intervention (PCI) group including patients who had a successful PCI of CTO on left anterior descending (LAD) artery and was presented for elective PCI with symptomatic angina and/or positive functional ischemic study. They included 18 males with a mean age of 57 ± 5 years. The optimum medical treatment (OMT) group, including 30 patients, had non-revascularized CTO-LAD and was kept on OMT alone; 20 of them were males with a mean age of 58 ± 4 years. In the PCI group, there was a significant improvement in all the TDI strain parameters of the LAD territory segments. Six months after PCI, the peak systolic strain rate improved from − 0.65 ± 0.21 to 1.05 ± 0.31 1/s (p value < 0.01), the peak systolic strain improved from 6.54 ± 2.48 to 11.51 ± 3.33% ( p value < 0.001 ), and the end systolic strain improved from 7.88 ± 2.77 to 10.51 ± 3.14% (p value < 0.01 ). There was no significant improvement in the mean LVEF (60.70 ± 8.33 vs 61.91 ± 8.16% (p value = 0.6)). In the OMT group, there was no improvement in all the strain parameters and there was no change in the mean LVEF. In the PCI group, there was a significant improvement in the angina class (p value = 0.03) while, in the OMT group, there was no significant improvement (p value = 0.835).ConclusionsSuccessful PCI for CTO improved regional LV myocardial function assessed by TDI strain echocardiography. This improvement was associated with improvement in the angina class.

Evaluation of regional left ventricular myocardial function in patients with anterior descending lesion by real-time three-dimensional speckle tracking imaging

Objective To evaluate the systolic and diastolic function of the left ventricular regional myocardium in patients with anterior descending lesion by real-time three-dimensional speckle tracking imaging (RT3D-STI) and investigate the value of RT3D-STI in the diagnosis of anterior descending stenosis. Methods According to coronary angiography, 112 patients were divided into four groups: normal group (20 coronary artery branches without stenosis), mild stenosis group (30 coronary artery branches with stenosis 75%). Transthoracic acquisition of conventional 2D and full-volume real-time three-dimensional image, the routine parameters and the globle longitudinal strain (GLS), globle radial strain (GRS), globle circumferential strain (GCS) and globle area strain (GAS) at the end of the anterior descending blood supply area and corresponding strain of 1/3 of pre-diastolic period were obtained to calcute L-SI-DI, R-SI-DI, C-SI-DI, and A-SI-DI. The diagnostic value of each parameter to the stenosis degree of the anterior descending branch was analyzed. Results Compared among the anterior descending group without stenosis group, mild stenosis group, moderate stenosis group and severe stenosis group, there were no significant differences in conventional ultrasonic parameters such as LVEDV, LVESV, LVEF, E, A, E/A and E/e (all P>0.05). There was no significant difference in GLS, GRS, GCS and GAS between mild stenosis group and no stenosis group (all P>0.05), but the difference in L-SI-DI, R-SI-DI, C-SI-DI and A-SI-DI were statistically significant (all P<0.05). The ROC curve showed that the sensitivity and specificity of the middle anterior segment L-SI-DI were the highest, with 90.0% and 81.5%. Conclusions RT3D-STI can quantitative evaluate myocardial function changes in patients with anterior descending lesion, the anterior septal L-SI-DI can reflect the stenosis degree of the anterior descending branch to a certain extent, it has important guiding significance for clinical diagnosis of the stenosis degree of the anterior descending branch. Key words: Echocardiography, real-time three-dimensional; Coronary stenosis; Ventricular function, left; Speckle tracking imaging; Left descending artery

Effects of lifestyle intervention on left ventricular regional myocardial function in metabolic syndrome patients from the RESOLVE randomized trial

AimsThe purpose of our study was to determine the effect of lifestyle intervention on left ventricular (LV) regional myocardial function in patients with metabolic syndrome (MetS) and investigate the relationships of the changes in myocardial function to changes in epicardial adipose tissue (EAT), inflammatory profile and MetS components. MethodsEighty-seven MetS patients were enrolled in a 6month lifestyle intervention program based on dietary management and increased physical activity, and compared with 44 aged and sex-matched healthy controls. MetS individuals were allocated to different groups randomized (computer-generated randomization) on exercise modalities (high-intensity dominant resistance or aerobic training, and moderate-intensity of both modes). EAT was measured by transthoracic echocardiography and LV longitudinal strains and strain rates were obtained using vector velocity imaging. Blood chemistry allowed assessments of adipocytokines (TNF-α: tumor necrosis factor α, PAI active: active plasminogen activator inhibitor-1 and adiponectin) and glucose tolerance markers. ResultsRegardless of exercise training modalities, lifestyle intervention improved significantly LV strains and strain rates (p<0.001) as well as metabolic and inflammatory profiles. Stepwise multiple regression analyses revealed EAT (β=0.73, p<0.01), log adiponectin (β=−0.13, p<0.05) and log TNF-α (β=0.15, p<0.05) as independent predictors of LV longitudinal strain (R2=0.74, p<0.001) while myocardial function improvement consecutive to lifestyle intervention was explained by EAT changes only (R2=0.54, p<0.001). ConclusionThe mechanisms through which regional myocardial function is impaired in MetS and improved consecutive to intervention involved EAT, possibly via paracrine effects of adipocytokines. EAT should be considered as a future therapeutic target of interest in the treatment of metabolic-related cardiac diseases.

Longitudinal strain bull's eye plot patterns in patients with cardiomyopathy and concentric left ventricular hypertrophy.

Despite substantial advances in the imaging techniques and pathophysiological understanding over the last decades, identification of the underlying causes of left ventricular hypertrophy by means of echocardiographic examination remains a challenge in current clinical practice. The longitudinal strain bull’s eye plot derived from 2D speckle tracking imaging offers an intuitive visual overview of the global and regional left ventricular myocardial function in a single diagram. The bull’s eye mapping is clinically feasible and the plot patterns could provide clues to the etiology of cardiomyopathies. The present review summarizes the longitudinal strain, bull’s eye plot features in patients with various cardiomyopathies and concentric left ventricular hypertrophy and the bull’s eye plot features might serve as one of the cardiac workup steps on evaluating patients with left ventricular hypertrophy.

Right ventricular dilation impairs left ventricular myocardial function through interaction between both ventricles in patients after repaired tetralogy of Fallot

Purpose: In patients with repaired tetralogy of Fallot (ToF), right ventricular (RV) dilation and dysfunction caused by residual pulmonary regurgitation are associated with their prognosis. In contrast, left ventricular (LV) function has been focused as a novel determinant of prognosis in patients with repaired ToF. Although RV-LV interaction may cause LV dysfunction in patients with repaired ToF, the mechanism of LV dysfunction has been poorly understood. Then, we aimed to assess LV regional myocardial function through consideration of interaction with RV properties. Methods: Subclinical 32 patients with rToF (17male, 17.5yrs, range 13.5-21yrs) and 20 control subjects (9male, 11.5 yrs, range 9-13yrs) were enrolled. We examined an echocardiographic examination at the time of scheduled outpatients clinic appointment and were in sinus rhythm at the presentation. All cases were Japanese, and QRS durations were measured from the standard 12-lead electrocardiogram. RV and LV volume index (ml/m2) were measured with 3-dimensional echocardiographic system. Pulmonary regurgitation fraction (PRF) was calculated by volumetric method (RV stroke volume – LV stroke volume/RV stroke volume). Left atrium area (LA) and velocity ratio of early mitral flow to mitral ring (MV E/E') were measured for evaluation of LV diastolic function. LV longitudinal strain (LS), radial strain (RS), circumferential strain (CS) and RV-LS were assessed by 2-dimmensinal speckle tracking echocardiography. Results: QRS duration was significantly longer (114±29.7 vs 85.3±12.2, p<0.001), and PRF and RVEDVi were larger in rTOF (0.33±0.16 vs -0.028±0.05; p<0.001, 78.2±19.5 vs 48.6±11.0; p<0.001) as compared to control. Despite no correlation between RVEDVi and LVEF. global LV-LS and LV-CS were negatively correlated with RVEDVi (r= -0.530, p<0.001, r= -0.482, p=0.001). Especially, in apical free wall, the relation was stronger (r=-0.560, p<0.001). LV-LS was not associated with MV E/A, LA area. Conclusions: In subclinical rToF, based on the relation of reduced LV strain with RV remodeling, interaction between ventricles may be an underline mechanism of LV free wall dysfunction.

Quantification of left ventricular regional myocardial function using MRI feature tracking in healthy children - a dual-center study

Background Similar to speckle tracking echocardiography cardiac MR (CMR) feature tracking imaging (FTI) uses a 2-dimensional deforming analysis of the myocardium which allows quantitative evaluation of myocardial motion and contractility. This technique might provide important additional information in children, including those with congenital heart disease (CHD). Until now, there are no reference data from a healthy pediatric population. The availability of this type of data is a requirement for proper interpretation in pediatric heart disease. The aim of this study was to determine normal values of left ventricular (LV) longitudinal, circumferential and radial strain and strain rate in healthy children, using FTI in cardiovascular MR images. Methods Eighty children from 2 centers (mean age: 12±5.5 years, range: 1t o 17 years; 39 female; divided into 3g roups: 0-11y (n=24), 11-15y (n=32), 15-18y (n=24)) were examined at two different 1.5 T scanners (Siemens and GE) using a standard SSFP MRI protocol. LV longitudinal, circumferential and radial strain and strain rate were measured using FTI (2D CPA MR©, TomTec Imaging System, Fulda, Germany). FTI was applied to standard cine-images in the following orientations:3 LV short-axis slices (basal, middle, apical), 4- and 3-chamber views. The effects of age, gender, endo- and epicardial assessment, myocardial segments on strain and strain rate data were also evaluated. Results

Quantification of left ventricular regional myocardial function using two-dimensional speckle tracking echocardiography in healthy volunteers — A multi-center study

BackgroundAlthough two-dimensional speckle tracking (2DST) has been validated in animal and early clinical studies for quantitative evaluation of myocardial motion and contractility, there are only limited measurements in large healthy population to be used as reference data, which severely restricts its clinical application. This study aimed at determining the age-specific normal values of left ventricular (LV) longitudinal, circumferential and radial strain in healthy adults. MethodsWe studied 228 healthy subjects (109 males, mean age 44±15years, range 18–78years). Their LV longitudinal, circumferential and radial strains were measured by 2DST at basal, middle and apical levels of parasternal short-axis and apical 2-, 4- and 3-chamber views. The effects of age, gender and echocardiographic machines (52 patients had measurements obtained by both GE and Philips machines) on these parameters were also evaluated. ResultsThe longitudinal and circumferential strains were −20.4±3.4% and −22.9±3.1%, respectively with higher values being observed at basal than apical segments. On the contrary, the radial strain which ranged 42.6±12.9% decreased towards apical segments. The longitudinal strain declined, the circumferential strain rose and the radial strain remained similar during aging. Adult females had slightly higher circumferential and longitudinal strains than males (23±3% vs −22±3%, −21±3% vs −20±3% respectively; both p<0.01). Strains measured by the 2 different echo machines had good correlations but Phillips-assessed strains (longitudinal and circumferential) were 10% higher than GE measurements. Inter- and intra-observer variabilities were acceptable. ConclusionsStrain measurements by 2DST echocardiography varies with age, gender and echocardiographic vendors in healthy adults. These findings are important to differentiate between health and disease and to assess the severity of disease.

Experimental study of the change of early regional myocardial function with diabetic using omni-directional Mmode echocardiography

Objective To evaluate the role of detecting early change of left ventricular regional myocardial function in the rabbit with type Ⅰ diabetes using omni-directional M-mode echocardiography (OME).Methods Eighty New Zealand rabbits were selected in this study..40 health rabbits were included in the control group,the other 40 with type Ⅰ diabetes were included in the experiment group.The OME was used to measure the peak time of myocardial motion during systole (Ts) and diastole (Td),myocardial velocity gradient during systole (MVGs) and diastole (MVGd) on the left ventricular short axis.These parameters were measured during the first,second,fourth,sixth and eighth week.Results OME was able to detect significant changes of Td during the second week,Ts and MVGd during the fourth week,and MVGs during sixth week after modeling ( P ＜0.05 ).Conclusions OME is an important method to detect early changes of regional myocardial function in the patients with diabetes. Key words: Echocardiography; Diabetes mellitus; Ventricular function,left

Regional Left Ventricular Myocardial Dysfunction as a Predictor of Incident Cardiovascular Events: MESA (Multi-Ethnic Study of Atherosclerosis)

We sought to examine the prognostic value of subclinical left ventricular (LV) regional myocardial dysfunction (RMD) measured by magnetic resonance imaging (MRI) among asymptomatic individuals. LV RMD, defined as segmental impairment in systolic wall thickening, predicts adverse events in patients with established cardiovascular disease. MRI is highly accurate for detecting subtle RMD, of which the prognostic significance in a large multiethnic asymptomatic population is not known. We used MRI to evaluate baseline regional LV myocardial function and prospectively followed a multiethnic (African American, Caucasian, Chinese, and Hispanic) population-based sample of 4,510 men and women without cardiovascular disease for a mean of 4.6 years. Regional myocardial dysfunction was defined as the presence of impaired systolic wall thickening (<10th percentile of segment-specific population distribution) in ≥2 contiguous LV segments within any given coronary artery territory. Baseline prevalence of RMD was 25.6%. Heart failure developed in 34 (1.0%) and 30 (2.6%) participants without and with RMD, respectively (p < 0.001). After adjustment for demographics and traditional risk factors, RMD remained independently associated with incident heart failure (hazard ratio [HR]: 2.62; 95% confidence interval [CI]: 1.56 to 4.39; p < 0.001). The relationship persisted after further adjustment for biomarkers of reported association with cardiovascular disease and indexes of global LV systolic dysfunction and hypertrophy (HR: 1.80; 95% CI: 1.02 to 3.20; p = 0.044). Similarly, RMD independently conferred an increased risk for hard coronary events (myocardial infarction or death from coronary heart disease; HR: 1.75; 95% CI: 1.06 to 2.89; p = 0.029), the composite of hard coronary events and stroke (HR: 1.72; 95% CI: 1.16 to 2.56; p = 0.005), and all atherosclerotic cardiovascular events (HR: 1.50; 95% CI: 1.09 to 2.07; p = 0.012). Among an asymptomatic multiethnic American cohort, RMD is an independent predictor beyond traditional risk factors and global LV assessment for incident heart failure and atherosclerotic cardiovascular events. The clinical utility of early recognition of this subclinical phenotype deserves further investigation. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487).

2D-Speckle Tracking Echocardiography Contributes to Early Identification of Impaired Left Ventricular Myocardial Function in Patients with Chronic Kidney Disease

Background/Aims: Our aim was to investigate left ventricular (LV) physiology and short-axis and long-axis regional LV myocardial function throughout the cardiac cycle with 2D-speckle tracking echocardiography (2D-STE) in patients with chronic kidney disease. Methods: The study population consisted of 40 maintenance hemodialysis patients (hemodialysis group), 20 uremic patients hospitalized for creation of primary arteriovenous fistula (nondialysis group), and a control group of 20 healthy volunteers. LV regional longitudinal, circumferential and radial peak systolic velocity (Vs); early diastolic velocity (Ve); and peak systolic strain (Ε) were measured with 2D-STE. Results: Increased LV wall thickness and a decreased E/A ratio were found in the nondialysis and hemodialysis groups as compared to the control group, but there was no difference between the 2 study groups. Longitudinal Vs and Ve of the LV basal segment and middle segment in hemodialysis group and nondialysis group were all slower than those in the control group, and Vs in the nondialysis group was slower than that of the hemodialysis group. Circumferential and radial Vs and Ve were not different among the 3 groups, except that the radial Vs of LV basal segment was markedly decreased in the nondialysis group. Longitudinal peak systolic strain in the hemodialysis and nondialysis groups were both decreased as compared to the control group. Circumferential and radial peak systolic strain was decreased only in the nondialysis group. Conclusions: 2D-STE may be used to identify early abnormalities in patients with chronic kidney disease who have preserved LV ejection fraction. LV regional function appeared to be better in the hemodialysis group than that in the nondialysis group.

Assessment of leftventricular regional myocardial function after acute occlusion of the left anteriordescending artery in rats model by two-dimensional strain echocardiography

：Objective To explore thevalue of two-dimensional strain echocardiography for quantitative assessing the change ofregional left ventricular myocardial function in rats following acute myocardialinfarction. Methods Sixty Wistar rats were randomly divided into two groups. The studygroup consisted of 50 rats with occlusion of LAD for 30-45 minutes and the sham-operatedgroup consisted of 10 rats without occlusion of LAD. Echocardiography were performedbefore operation, which was defined as baseline, and 1 week, 4 weeks and 8 weeks afteroperation. Left ventricular internal diameter at diastole ( LVIDd) and systole 0. 01). Compared with baseline andsham-operated group,LVIDd,LVIDs and LVM of study group all increased significantly ( P<0. 05) in 4 weeks and 8 weeks after operation,and FS and EF reduced significantly ( P<0. 05). Two-dimensional strain obtained in interobserver and intraobserver both showedhigh agreement. Conclusions Two-dimensional strain echocardiography can assess regionalfunction of myocardium with different perfusion in rats following acute myocardialinfarction, and provides a sensitive and reliable method to follow up the process of leftventricular remodeling after myocardial infarction.

Assessment of regional left ventricular myocardial function in rats after acute occlusion of left anterior descending artery by two-dimensional speckle tracking imaging

This study evaluated the change in regional left ventricular myocardial function in rats following acute occlusion of the left anterior descending coronary artery (LAD) by using two-dimensional speckle tracking imaging (2D-STI). Sixty Wistar rats were randomly divided into two groups, a myocardial infarction (MI) group, in which 50 rats were subjected to LAD occlusion for 30-45 min, and a sham-operated (SHAM) group that contained 10 rats serving as control. Echocardiography was performed at baseline and 1, 4 and 8 week(s) after the operation. High frequency two-dimensional images of left ventricular short axis at papillary muscle level were recorded. Peak systolic radial strain (PRS) and circumferential strain (PCS) were measured in the mid-ventricle in short-axis view by using EchoPAC workstation. Left ventricular internal diameter at diastole (LVIDd) and systole (LVIDs), fractional shortening (FS), ejection fraction (EF) and left ventricular mass (LVM) were measured by anatomical M-model echocardiography. Infarct size was measured using triphenyl tetrazolium chloride (TTC) staining 1 week and 8 weeks after the operation. Fibrosis of left ventricular myocardium was displayed using Van Gieson staining 1 week after the infarction. In terms of the TTC staining results, the left ventricle fell into three categories: infarcted, peri-infarcted and remote myocardial regions. Compared with those at baseline and in the SHAM group, (1) PRS and PCS in the infarcted, peri-infarcted and remote myocardial regions were significantly decreased in the MI group within 1 week after the operation (P<0.05) and the low levels lasted 8 weeks; (2) Compared with those at baseline, LVIDd, LVIDs, FS, EF and LVM in the MI group showed no significant difference 1 week after the operation (P>0.05). However, LVIDd, LVIDs and LVM were increased significantly 4 and 8 weeks after the operation (P<0.05), and FS and EF were decreased substantially (P<0.05). Van Gieson staining showed that fibrosis developed in all the three myocardial regions to varying degrees. It is concluded that 2D-STI is non-invasive and can be used to assess regional function of myocardium with different blood supply in rats following acute occlusion of the LAD, and can be used as a sensitive and reliable means to follow up the process of left ventricular remodeling.

Impaired Myocardial Function in Hypertrophic Cardiomyopathy

Tissue Doppler imaging (TDI) parameters of peak myocardial velocities (S', E', and A') has been employed to assess the regional left ventricular myocardial function. The global function index (GFI) derived from TDI has been recently employed to distinguish the different etiologies of left ventricular hypertrophy. To analyze whether the GFI or individual TDI parameters of peak myocardial velocities (S', E', and A') allows detecting different degrees of regional myocardial dysfunction in the most frequent forms of hypertrophic cardiomyopathy (HCM). GFI = (E/E')/S' (where E is the peak transmitral flow velocity, E' is the early diastolic myocardial velocity, and S' is the peak systolic myocardial velocity) and TDI peak myocardial velocities was measured in the septal and lateral mitral annulus in 101 patients with HCM (mean age 47.5 +/- 14 years, 58 women) and in age-matched group of 30 healthy controls (mean age 46 +/- 6 years, 16 women). Forty-five patients had nonobstructive asymmetric septal HCM, 20 patients had a subaortic gradient >or= 30 mm Hg, 21 p. had apical HCM, and 15 p. had other forms of HCM (midventricular, symmetric, and biventricular). All patients with HCM exhibited a decrease in early diastolic (E') and systolic (S') myocardial velocities, both in the lateral and septal-mitral annulus border, but more pronounced in septal-mitral annulus. Septal GFI was higher in HCM patients than in healthy subjects (1.8 (1.1-2.5) and (0.57 (0.31-0.92), respectively, P < 0.001), but no differences were seen when different forms of HCM were compared. In a selected population of patients with HCM and a preserved left ventricular(LV) systolic function, GFI and individual TDI parameters of peak velocity (S', E', and A') and E/E' ratio were similar in different forms of HCM, indicating that in all patients with HCM there is regional systolic and diastolic myocardial dysfunction, regardless of the location of hypertrophy.

Assessment of left ventricular regional function after coronary artery bypass grafting by strain rate imaging

Objective To investigate the value of strain rate imaging(SRI) in estimating the changes of left ventricular regional myocardial function in patients with coronary artery disease before and after coronary artery bypass grafting operation. Methods In sixteen patients with coronary artery disease, echoeardiography was performed 3 days before, 12 days after and 3 months after coronary artery bypass grafting operation respectively. SRI was used to quantitatively analyze the regional myocardial function of left ventricular wall. One hundred and ninety-two segments of left ventricular myocardium were analyzed in the study. The left ventricular myocardium was divided into segments with normal(152 segments) and abnormal(40 segments) wall motion according to two-dimensional echocardiography before the operation. Results Peak strain rate during systolic and early diastolic contraction (SRs, SRe) was not statistically significant between segments with normal and abnormal wall motion before operation. In segments with abnormal wall motion,myocardial peak strain rate of atrial contraction (SRa) was increased three months after operation comparing with three days before operation (P<0.05). In segments with normal wall motion,the absolute values of SRs,SRa and SRe were increased three months after operation comparing with three days before operation (P<0.05 and 0.01 ). SRs was increased three months after operation comparing with 12 days after operation (P<0.05 ). Conclusions SRI can be used to evaluate the functional changes of left ventricular regional myocardium quantitatively after coronary artery bypass grafting operation. Key words: Echocardiography; Ventrieular function, left; Coronary disease; Coronary artery bypass grafting; Strain rate imaging

Contribution of the Pericardium to Left Ventricular Torsion and Regional Myocardial Function in Patients with Total Absence of the Left Pericardium

The relationship between left ventricular (LV) torsional deformation and myocardial function has recently been recognized. However, little is known about whether the pericardium affects this relationship. Our aim was to identify the contribution of the pericardium to LV torsion and regional myocardial function in the clinical setting. We examined LV torsion in basal and apical LV short-axis views, and regional LV myocardial function, such as longitudinal strain in apical 4-chamber view, and circumferential and radial strains in parasternal LV short-axis views using 2-dimensional speckle-tracking imaging method in 5 patients with congenital total absence of the left pericardium and systolic paradoxical ventricular septal motion on M-mode echocardiogram and in 10 control subjects. Diagnosis of the pericardial defect was based on chest radiograph, computed tomography, jugular phlebogram, and M-mode and 2-dimensional echocardiogram. LV torsion was defined as the net difference in LV rotation in the basal and apical planes. There was no significant difference in LV ejection fraction determined by 2-dimensional echocardiography between the pericardial defect and control groups. LV torsion was markedly decreased in the pericardial defect group compared with the control group. There were no significant differences in longitudinal, radial, and circumferential systolic strains and systolic and early diastolic strain rates in the LV walls and in longitudinal systolic strains and systolic and early diastolic strain rates in the left atrial walls between the two groups. Pericardial defects cause a lack of LV torsion while maintaining LV regional myocardial function in patients with systolic paradoxical ventricular septal motion. Therefore, pericardium plays an important role in LV torsion.

Evaluation of alterations on mitral annulus velocities, strain, and strain rates due to abrupt changes in preload elicited by parabolic flight

We tested the hypothesis that in normal subjects, cardiac tissue velocities, strain, and strain rates (SR), measured by Doppler tissue echocardiography (DTE), are preload dependent. To accomplish it, immediately preceding image acquisition, reversible, repeatable, acute nonpharmacological changes in preload were induced by parabolic flight. DTE has been proposed as a new approach to assess left ventricular regional myocardial function by computing tissue velocities, strain, and SR. However, preload dependence of these parameters in normal subjects still remains controversial. DTE images (Philips) were obtained in 10 normal subjects in standing upright position at normogravity (1 Gz), hypergravity (1.8 Gz), and microgravity (0 Gz) with and without -50 mmHg lower body negative pressure (LBNP). Myocardial velocity curves in the basal interventricular septum were reconstituted offline from DTE images, from which peak systolic (S'), early (E') and late (A') diastolic velocities, SR, and peak systolic strain (PSepsilon) were measured and averaged over four beats. At 1.8 Gz (reduced venous return), S', E', and A' decreased by 21%, 21%, and 26%, respectively, compared with 1-Gz values, while at 0 Gz (augmented venous return), E', A', and PSepsilon increased by 57%, 53%, and 49%, respectively. LBNP reduced E' and PSepsilon. In conclusion, our results were in agreement with those obtained in animal models, in which preload was changed in a controlled, acute, and reversible manner, and image acquisition was performed immediately following preload modifications. The hypothesis of preload dependence was confirmed for S', E', A', and PSepsilon, while SR appeared to be preload independent, probably reflecting intrinsic myocardial properties.

Regional myocardial function in healthy adults: assessment through tissue Doppler echocardiography.

To characterize left ventricular regional myocardial function through tissue Doppler echocardiography in healthy adults and to assess the influence of aging in this function. In 45 healthy volunteers divided in two groups (< 45 and > 45 years old) we assessed longitudinal and radial regional function (velocities, times intervals and velocity-time integrals). Data were compared in each group and between groups. Systolic function: a). longitudinal: higher velocities and integrals in lateral and inferior walls and in basal segments, with a trend to reduction of these parameters with aging; b). radial: higher basal velocities, no significant change with aging. Diastolic function: a). longitudinal: higher velocities in lateral and inferior walls and in basal segments. With aging e and e/a velocities and integrals decreased, a increased and older individuals showed lower percentage of segments with e/a >1; b). radial: aging was associated with lower e and higher a velocities. 1). Tissue Doppler echocardiography detects physiological differences between regional myocardial function of different ventricular segments, in velocities, times intervals and integrals, with physiological heterogeneity and asynchrony; 2). Many of these data are age dependent; 3). Our data contribute to define normal values, and may become useful when compared with data from populations with heart diseases.

Novel approach to the quantitation of regional left ventricular systolic and diastolic function using tissue Doppler imaging to create a myocardial velocity profile and gradient.

The myocardial velocity profile (MVP) and gradient (MVG) between the endocardium and epicardium of the left ventricular (LV) wall measured by color-coded tissue Doppler imaging (TDI) are new indices for evaluating regional LV myocardial function. However, accurate recording and measurement of the MVP is difficult using conventional methodology because of the stochastic nature of the ultrasound signal; that is, the effect of speckled noise. The aim of this study was to validate the accuracy and establish the validity of a newly developed method for measuring the MVP and MVG using 10 clinically normal controls and 10 patients with a hypertensive hypertrophied LV posterior wall. A non-isotropic, averaging algorithm was developed that was capable of obtaining a stable MVP (averaged MVP). Averaged MVP was recorded using parasternal, LV short-axis, color-coded TDI, placing regions of interest along the LV posterior wall with the reference point for angle-correction being at the center of LV contraction. The velocity from epicardium to endocardium within the region of interest was automatically angle-corrected to calculate the velocity component radially relative to the LV cavity and was spatially averaged along the circumference within the region of interest. Inter- and intraobserber variabilities of measurements were lower in the averaged MVP and MVG than in the conventional MVP and MVG. The correlation coefficients of the linear regression lines of systolic and early diastolic MVPs in the LV posterior wall were higher in all controls and hypertensive patients with the averaged method than with the conventional TDI procedures. The mean peak systolic and early diastolic MVGs were lower in the hypertensive group than in the controls. In conclusion, the newly developed averaged MVP provides a stable and reproducible index for the quantitative assessment of regional LV myocardial function.