Regional Left Ventricular Systolic Function Research Articles

Relative dilatation of left ventricle and left atrium in patients with Parkinson disease

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was supported by Czech Health Research Council AZV NU21-04-00445 and by the European Regional Development Fund - project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868) Introduction Morbus Parkinson (MP) is the second most common neurodegenerative disease that progressively affects the nervous system. Accompanying heart problems may include mainly cardiovascular autonomic dysfunction. So far, very little is known about structural and functional cardiac changes in patients with MP. Purpose This pilot study aimed to analyse left ventricular (LV) and left atrial (LA) function and volumes using cardiovascular magnetic resonance (CMR). Methods In this study, 37 patients with MP (mean age 59,0 ± 8,0 years) without a history of cardiac disease or symptoms were compared to 37 sex- and age-matched control subjects without any heart disease history (mean age 54,5 ± 11,4 years). All patients underwent CMR examination at 1,5 MR scanner, including cine images for assessment of LV and LA volumetric and functional parameters. LA volumes (LAV) were measured at LV end-systole (maximum LAV - LAVmax), before the atrial contraction (pre-atrial contraction volume - LAVpac), and at late LV diastole (minimum LAV - LAVmin) and indexed (I) to the body surface area. LA strains were analysed for all LA phases: reservoir strain (LSr), conduit strain (LScd), and contractile strain (LSct). Descriptive statistics are reported as the mean (SD) or median (IQR) for normally and non-normally distributed continuous variables. All the p-values were adjusted using a false discovery rate for multiple comparisons. Results MP patients had normal global and regional systolic LV function – LV ejection fraction (EF) 65,9 ± 6,8% vs 68,9 ± 7,0% (p = NS). On the contrary, all indexed LV volumes were significantly higher in comparison to controls: LV end-diastolic volume index was 67,3 ± 12,1 ml/m2 vs 58,3 ± 11,7 ml/m2 (p = 0,013), LV end-systolic volume index was 22,0 (17,8 to 27,5) ml/m2 vs 18,9 (13,2 to 21,9) ml/m2 (p = 0,027), and LV stroke volume index was 43,8 ± 7,2 ml/m2 vs 39,8 ± 6,3 ml/m2 (p = 0,035). Similarly, indexed LAVmax and LAVpac were also relatively increased: LAVImax 42,7 ± 9,0 ml/m2 vs 35,7 ± 10,3 ml/m2 (p = 0,014), LAVIpac 29,8 ± 7,1 vs 23,8 ± 7,6 ml/m2 (p = 0,012). LAVImin was similar in both groups: 17,3 ± 5,5 ml/m2 vs 14,3 ± 6,7 ml/m2 (p = NS). LA strains were slightly lower in the MP cohort during the reservoir and conduit phase, and slightly higher in the contractile one. However, the difference did not reach statistical significance in any phase. Conclusion Patients with Parkinson´s disease have enlarged LV and LA compared to controls.

Strain Imaging in Aortic Stenosis

Although aortic stenosis (AS) is a disease of poor outcomes, timely aortic valve replacement [AVR -surgical AVR (SAVR) or transcatheter AVR (TAVR)] improves the outlook with acceptable procedural risk. Survivors of AVR enjoy life expectancy that is like that of age matched controls. AVR receives a class I indication from the American and European Guidelines, in the presence of symptoms attributable to AS or when left ventricular (LV) systolic dysfunction manifests. However, there are fallacies in timing the intervention based on symptoms or LV ejection fraction. If surgery is delayed till symptoms manifest or LV dysfunction occurs, surgical risks are increased, long term outcomes are poor and in half of the patients, LV function never normalizes. Because of these reasons, pre-emptive intervention based on non-conventional parameters is expected to save more lives and prevent LV dysfunction. Data are emerging towards this approach and researchers have started focussing their attention on biomarkers like brain natriuretic peptide, multimodality imaging like estimation of extracellular volume by cardiac magnetic resonance for choosing the appropriate time for intervention in asymptomatic individuals. A relatively inexpensive way of identifying such high-risk individuals is speckle tracking imaging and in the last decade sufficient data have accumulated in favour of this modality to identify patients who may be benefited by early intervention. Speckle tracking echocardiography is a well validated technique which enables highly reproducible, angle-independent assessment of regional and global LV systolic function in longitudinal, circumferential and radial planes. Longitudinal strain, which is predominantly governed by the subendocardial layer, is most sensitive in the presence of myocardial disease and well-studied. Moreover, when discrepancies occur between gradient and valve area leading to uncertainties about the severity of AS, strain imaging would be of value in predicting outcomes particularly in those with low flow low gradient AS with normal LV ejection fraction.

Severe Impairment of Left Ventricular Regional Strain in STEMI Patients Is Associated with Post-Infarct Remodeling.

Background: Measures of global left ventricular (LV) systolic function have limitations for the prediction of post-infarct LV remodeling (LVR). Therefore, we tested the association between a new measure of regional LV systolic function—the percentage of severely altered strain (%SAS)- and LVR after acute ST-elevation myocardial infarction (STEMI). As a secondary objective, we also evaluated the association between %SAS and clinical events during follow-up. Methods: Of 177 patients undergoing echocardiography within 24 h from primary percutaneous coronary angioplasty, 172 were studied for 3 months, 167 for 12 months, and 10 died. The %SAS was calculated by dividing the number of LV myocardial segments with ≥−5% peak systolic longitudinal strain by the total number of segments. LVR was defined as the increase in end-diastolic volume >20% at its first occurrence compared to baseline. Results: LVR percentage was 10.2% and 15.8% at 3 and 12 months, respectively. Based on univariable analysis, a number of clinical, laboratory, electrocardiographic and echocardiographic variables were associated with LVR. Based on multivariable analysis, %SAS and TnI peak remained associated with LVR (for %SAS 5% increase, OR 1.226, 95% CI 1.098–1.369, p < 0.0005; for TnI peak, OR 1.025, 95% CI 1.004–1.047, p = 0.022). %SAS and LVR were also associated with occurrence of clinical events at a median follow-up of 43 months (HR 1.02, 95% CI 1.0–1.04, p = 0.0165). Conclusions: In patients treated for acute STEMI, acute %SAS is associated with post-infarct LVR. Therefore, we suggest performing such evaluations on a routine basis to identify, as early as possible, STEMI patients at higher risk.

The Role of Cardiac Magnetic Resonance in Assessment of Myocardial Contractile Function After Exercise Training Based Cardiac Rehabilitation Program in Anterior ST-Elevated Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention

Abstract Back ground Regular exercise training program has been shown to reduce mortality, improve functional capacity and control risk factors in myocardial infarcted patients. Wall motion score index (WMSI) is a strong independent mortality predicator in patient with previous MI AIM The main objective of this study was to investigate the impact of exercise training on regional left ventricular systolic function, in patients post anterior myocardial infarction. using cardiac magnetic resonance imaging Methods We recruited twenty-six adult patients on optimal medical therapy one month after an anterior myocardial infarction underwent successful percutaneous coronary intervention (PCI) were assigned to a three-month exercise training program group or to a control group, (control group: n = 10, training group: n = 16). Symptom limited treadmill exercise (Modified Bruce Protocol) test was done to exercise training group before and repeated after finishing the CR program. Cardiac Magnetic Resonance (CMR) was performed for all patients 4 weeks after PCI and was repeated after completion of the study period that was lasted for 12 weeks. Results A total number of patients, included 26 (100%) males, assigned to control group n:10 without an exercise mean age 50± 8 years, weigh 84 ±17 kg, height 175±7.7 cm and EF was 36.62 ±14.23 and to training group n:16 with 3-months exercise training program, the mean age, weight, height and EF were 50.19±8.68 years, 82.69±16 kg, 172.81±7.74 cm, 36.62±14.32% respectively While there was significant improvement in EF (P &amp;lt; 0.0008), WMSI (P &amp;lt; 0.00003) without significant change in LVESV and LVEDV in exercise training group, there was no significant change in EF, WMSI, LVESV and LVEDV in control group. Conclusion CMR revealed that exercise training in post-myocardial infarction patients could have beneficial effects on LV global and regional function without adversely affecting LV remodeling or causing serious cardiac complications with significant improvement in exercise capacity after 3 months of exercise training program.

Acute Severe Functional Mitral Regurgitation After Non-Mitral Valve Cardiac Surgery—Left Ventricular Dyssynchrony as a Potential Mechanism

Functional mitral regurgitation (MR) describes valve leakage in the absence of disease or damage to the mitral leaflets or subvalvular apparatus. Significant, new functional MR after cardiopulmonary bypass (CPB) may result from a number of intraoperative processes, including left ventricular (LV) ischemia and enlargement, left atrial enlargement secondary to increased filling pressure, and systolic anterior motion of the mitral valve after mitral repair. Assessment of new MR after CPB is important because it may direct hemodynamic maneuvers or prompt reinitiation of CPB if surgical intervention is deemed necessary. Described extensively in the electrophysiology literature but underreported as a cause of MR after CPB, LV dyssynchrony represents another possible mechanism of functional MR, in which resynchronization of conduction via pacing maneuvers may prove beneficial. Herein, a series of 4 patients in whom new MR was found after non-mitral valve cardiac surgery in the setting of normal LV systolic function is presented, and LV dyssynchrony is proposed as a major contributing factor. The findings suggested that the concomitant observation of new or worsened functional MR, together with normal global and regional LV systolic function, should lead the clinician to consider ventricular dyssynchrony as a possible cause. Attempts to improve or alter ventricular conduction should be considered before contemplating a return to CPB for mitral valve intervention.

P1604 T1 mapping in asymptomatic patients with extracardiac sarcoidosis

Abstract Funding Acknowledgements LQ1605 from the National Program of Sustainability II (MEYS CR) Introduction Sarcoidosis is a systemic granulomatous disease affecting in particular the respiratory tract. Estimated 5% of these patients have clinical symptoms of heart involvement. Real number of patients with cardiac sarcoidosis is thought to be higher (around 20-30%), because the granulomatous process is sometimes asymptomatic. Cardiac magnetic resonance (CMR) including T1 relaxation time measurement could potentially detect early asymptomatic stadia of sarcoidosis of the heart. Purpose The aim of this study was to assess T1 mapping in detection of early cardiac involvement in asymptomatic patients with sarcoidosis. Methods One hundred twenty patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis and without any heart disease history were included. One hundred thirteen of them underwent CMR examination at 3,0 MR scanner. Cine images for assessment of left ventricular (LV) volumetric and functional parameters, and pre- and post-contrast Saturation method using adaptive recovery times for cardiac T1 mapping (SMART1map) and Modified Look-Locker Inversion recovery (MOLLI) images were acquired for assessment of native T1 relaxation time and extracellular volume (ECV). The measured parameters were compared between sarcoidosis patients and 22 healthy controls. Results Sarcoidosis patients had not enlarged LV (end-diastolic volume 119 ± 24ml vs 97 ± 20ml, p = NS) and normal global and regional systolic LV function – LV ejection fraction (EF) 65 ± 5% vs 66 ± 7% (p = NS). Mean native T1 relaxation time was not prolonged - 1464 ± 93 msec vs 1482 ± 88msec (p = NS) measured by SMART1map and 1317 ± 60 msec vs 1313 ± 83msec (p = NS) measured using MOLLI sequence. Similarly, mean ECV value was not increased - 16,3 ± 3,4% vs 17,9 ± 3,7% (p = NS) measured by SMART1map and 30,9 ± 2,9msec vs 30,7 ± 5,0% (p = NS) measured using MOLLI sequence. Conclusion Myocardial native T1 relaxation time was not prolonged and ECV was not increased in asymptomatic patients with extracardiac sarcoidosis.

333 Echocardiography Reporting in Ischaemic Heart Disease and Compliance With European Association Cardiovascular Imaging (EACVI) Recommendations

Standardizing transthoracic echocardiography (TTE) reports is an important measure of quality. Compliance with TTE reporting guidelines for coronary artery disease (CAD) may improve management and follow-up of patients. Reporting standards may not align with current recommendations. To assess institutional compliance with EACVI recommendations for TTE reporting in patients investigated for CAD. 140 TTE reports were audited from the Nepean TTE database. The TTE parameters in reports were compared to the EACVI recommendations for reporting TTE in CAD. Comparisons were made to assess compliance with EACVI mandatory echo parameters and recommended parameters. Overall there was good compliance with representing demographic data, however, poor compliance with documenting heart rate (0%), image quality (16.4%), and machine make (0%). Regarding mandatory reporting of left ventricular ejection fraction (LVEF) and LV regional systolic function, the audit highlighted only 37.9% (53/140) and 46.4% (65/14) compliance respectively. There was also poor compliance with assessing right ventricular function with 32.9% (46/140) compliance in reporting TAPSE and S’ prime. Key parameters for diagnosing CAD as specified by the EACVI recommendations were not adequately represented in a significant amount of sampled TTE reports. Some deficits could be accounted for by the limitations of the reporting software. However, these results suggest further education aimed at cardiac physiologists and reporting physicians is needed to improve reporting standards and compliance with EACVI recommendations.

Value of Pulsed Tissue Doppler Imaging in Predicting the Presence of Significant Coronary Artery Insufficiency

Background: Coronary artery disease (CAD) is a paramount cause of death. Global and regional left ventricular (LV) systolic function is an important non-invasive marker of CAD. We can use tissue Doppler imaging (TDI) to measure the low velocities generated by myocardium which are: S'-wave, E'-wave, and A'-wave. We aimed to examine the value of the S'-wave dispersion of TDI across mitral valve annular velocities to predict angiographically significant coronary artery obstruction. Patients and Methods: We included 100 patients with symptoms suggesting CAD. All patients had undergone full history taken and clinical examination; ECG, echocardiographic with assessment of LV function, and Doppler derived mitral valve velocities; TDI with measuring of S'-wave and coronary angiography. Lesions with ≥70% or more stenosis in major epicardial artery or ≥50% stenosis in the left main coronary artery were considered significant. Patients were classified into two groups according to the presence or absence of significant coronary stenosis. Results: Clinical and conventional echocardiographic and Tissue Doppler measures were comparable between the two groups; there was statisticallysignificant difference between Group I and Group II (P value ; patients with significant coronary arteries lesions have higher S' wave dispersion as compared with patients with normal or mild significant coronary lesions. Conclusion: S'-wave dispersion may consider a good predictor of angiographically significant coronary artery disease.

Ischemic postconditioning improves longitudinal contractile function of the reperfused myocardium in patients with anterior wall acute myocardial infarction

To investigate whether ischemic postconditioning (IPTC) can promote the recovery of left ventricular impaired regional or global longitudinal systolic function. Methods: The trial was divided into a percutaneous coronary intervention (PCI) group, an PCI+IPTC group and a control group. Thirty-two patients with anterior acute anterior wall ST-segment elevation myocardial infarction (STEMI) underwent the first emergency PCI in the PCI group, 28 patients with anterior acute STEMI underwent the combination of PCI and IPTC in the PCI+IPTC group, while 30 patients underwent coronary angiography in the control group. Two-dimensional dynamic echocardiography was collected before operation, 0.5 h, 1 day, 3 days, 1 week, 1 month and 6 months after operation, respectively. The longitudinal strain parameters at different time points were analyzed and compared in the 3 groups. Results: The regional longitudinal strain of infracted segments in the PCI+IPTC group after the operation within 1 week was higher than that in the PCI group (P<0.05). The left ventricular global longitudinal strain in the PCI+IPTC group seemed to be higher than that in PCI group after the operation within 1 week, but there was not statistically difference (P>0.05). There was no significant difference in the long-term regional and global longitudinal strains of left ventricle between the PCI+IPTC group and the PCI group (both P>0.05). Conclusion: The IPTC can improve the short-term longitudinal systolic function of the reperfused myocardium in patients with acute anterior wall STEMI after PCI.

Evaluation of the Effect of Sigmoid-Shaped Interventricular Septum on Left Ventricular Systolic Function in Patients with Essential Hypertension by Two-Dimensional Speckle Tracking Echocardiography

Objective: To evaluate left ventricular regional and global systolic function by measuring left ventricular longitudinal strain (LS) in hypertensive patients with sigmoid-shaped interventricular septum (SIS) by two-dimensional speckle tracking (2D-STE); in order to explore whether the sigmoid-shaped interventricular septum affects the left ventricular systolic function in patients with hypertension. Methods: Routine echocardiographic parameters were measured in 30 hypertensive patients with SIS (SIS group) and 30 hypertensive patients without SIS (non-SIS group). The left ventricular segments and global LS were measured by 2D-STE, and the two sets of parameters were compared. Results: The value of the thickness of the basal segment of the interventricular septum (IVSBT), the thickness of the middle segment of the interventricular septum (IVSMT) and the ratio of the basal segment of the ventricular septum to the middle segment of the interventricular septum (IVSBT/IVSMT) in SIS group was higher than that in non-SIS group. However, the value of left ventricular outflow tract diameter (LVOTD) in SIS group was lower than that in non-SIS group. There was a significant difference between the two groups (all P < 0 05). The LS values of the basal segment of the left ventricular anterior wall and the posterior wall of the left ventricle in the SIS group were lower than those in the non-SIS group. The difference was statistically significant (all P < 0.05). Conclusion: SIS affects left ventricular regional systolic function of patients with hypertension. 2D-STE can early evaluate left ventricular longitudinal systolic function in hypertensive patients with SIS.

Improvements in left ventricular regional and global systolic function following treatment with S100A4-shRNA after myocardial infarction in mice.

S100A4 plays a vital role in cardiac fibrosis after myocardial infarction (MI), but its effects on myocardial mechanics and remodeling are unknown. We hypothesized that regional and global left ventricular (LV) systolic function as determined by speckle tracking echocardiography (STE) would be improved with inhibition of S100A4 using short hairpin (sh) RNA. This study aimed to investigate whether STE can delineate the efficacy and safety of S100A4-shRNA in MI. A total of 48 mice were randomly assigned to sham+S100A4-shRNA, sham+scrambled (Scr) sequence-shRNA, MI+S100A4-shRNA, and MI+Scr-shRNA groups (n=12 per group) and underwent intramyocardial injection of target agents after MI was produced by left anterior descending ligation. Two-dimensional STE and M-mode echocardiography were performed at baseline and at day 7, 14, and 28 post-MI by GE Vivid 7 ultrasound (il3L linear probe, 10.0-14.0 MHz) and Echopac PC software. Radial strain was analyzed from 6 segments of the mid short axis images with 20-30 frames per cardiac cycle. Post-mortem western blotting, immunohistochemistry, and Masson's trichrome stain were performed to quantify infarct size and detect suppression of S100A4. STE detected a statistically significant improvement in peak radial strain (pRS) and time to peak radial strain (pRSt) by day 14 post-MI in the MI+S100A4-shRNA group (P<0.05), especially in the LV anteroseptal wall (pRS: 23.83%±1.12% vs. 20.25%±1.02%, pRSt: 76.75±3.18 vs. 92.00±3.69 ms, P<0.05). After 1 month of S100A4-shRNA administration, cardiac function improved in the MI+S100A4-shRNA group according to both STE and M-mode tracing in mice. Additionally, both biochemical and histopathological examinations found reduced cardiac fibrosis in the MI+S100A4-shRNA group. S100A4-shRNA can be utilized as a therapeutic target to improve regional deformation and attenuate cardiac fibrosis following MI. Two-dimensional STE is useful in the early and comprehensive assessment of LV systolic function in mice.

Effect of Collateral Circulation on Left Ventricular Systolic Function in Patients with Totally Occluded Artery Undergoing PCI

Background: Over the past three decades, accumulating evidence has documented that pre-existing welldeveloped CCC at the onset of acute myocardial infarction plays an important role in preserving left ventricular function, reducing infarct size, preventing left ventricular aneurysm formation, and survival. Objective: The aim of this study is to evaluate the effect of collateral circulation as measured by Rentrop score on left ventricular regional and global systolic function in patients with totally occluded vessel pre and post PCI and the ensuing impact of successful PCI. Methodology: Sixty patients have single vessel coronary chronic total occlusion with viable myocardium of CTO related territories, successful revascularization at ERMED and ICS, between June 2017 and December 2018, were considered to participate in this prospective study, The study subjects were divided into three groups according to Rentrop score , each group contain 20 patients : Group (I) Rentrop score 0 , Group (II) Rentrop score 1 and Group (III) Rentrop score 2. Results: There was no statistically significant difference between the three groups regarding the incidence of diabetes, smoking and hypertension. There was high statistically significant difference in EF between each group after revascularization, EF was higher in group (III) than group (I) and group (II). There was statistically significant difference in WMSI comparison between each group after revascularization WMSI was lower in group (III) than group (I) and group (II). Conclusion: In general increase Rentrop score before revascularization lead to more improvement in WMSI and EF after successful revascularization with improvement of quality of life.

Association of cardiovascular magnetic resonance-derived circumferential strain parameters with the risk of ventricular arrhythmia and all-cause mortality in patients with prior myocardial infarction and primary prevention implantable cardioverter defibrillator

BackgroundImpaired left ventricular (LV) contraction and relaxation may further promote adverse remodeling and may increase the risk of ventricular arrhythmia (VA) in ischemic cardiomyopathy. We aimed to examine the association of cardiovascular magnetic resonance (CMR)-derived circumferential strain parameters for LV regional systolic function, LV diastolic function and mechanical dispersion with the risk of VA in patients with prior myocardial infarction and primary prevention implantable cardioverter defibrillator (ICD).MethodsPatients with an ischemic cardiomyopathy who underwent CMR prior to primary prevention ICD implantation, were retrospectively identified. LV segmental circumferential strain curves were extracted from short-axis cine CMR. For LV regional strain analysis, the extent of moderately and severely impaired strain (percentage of LV segments with strain between − 10% and − 5% and > − 5%, respectively) were calculated. LV diastolic function was quantified by the early and late diastolic strain rate. Mechanical dispersion was defined as the standard deviation in delay time between each strain curve and the patient-specific reference curve. Cox proportional hazard ratios (HR) (95%CI) were calculated to assess the association between LV strain parameters and appropriate ICD therapy.ResultsA total of 121 patients (63 ± 11 years, 84% men, LV ejection fraction (LVEF) 27 ± 9%) were included. During a median (interquartile range) follow-up of 47 (27;69) months, 30 (25%) patients received appropriate ICD therapy. The late diastolic strain rate (HR 1.1 (1.0;1.2) per − 0.25 1/s, P = 0.043) and the extent of moderately impaired strain (HR 1.5 (1.0;2.2) per + 10%, P = 0.048) but not the extent of severely impaired strain (HR 0.9 (0.6;1.4) per + 10%, P = 0.685) were associated with appropriate ICD therapy, independent of LVEF, late gadolinium enhancement (LGE) scar border size and acute revascularization. Mechanical dispersion was not related to appropriate ICD therapy (HR 1.1 (0.8;1.6) per + 25 ms, P = 0.464).ConclusionsIn an ischemic cardiomyopathy population referred for primary prevention ICD implantation, the extent of moderately impaired strain and late diastolic strain rate were associated with the risk of appropriate ICD therapy, independent of LVEF, scar border size and acute revascularization. These findings suggest that disturbed LV contraction and relaxation may contribute to an increased risk of VA after myocardial infarction.

Assessment of Early Left Ventricular Diastolic Dysfunction in Patients with Metabolic Syndrome by 2D Speckle Tracking Echocardiography

Background: Metabolic syndrome predisposes to left ventricular dysfunction and heart failure, early detection of associated subclinical cardiac changes has important diagnostic and prognostic values. 2D strain and strain rate allow detection of subtle abnormalities of global and regional left ventricular systolic and diastolic functions. Objectives: To detect early diastolic dysfunction in the left ventricle in patients with metabolic syndrome by 2D speckle tracking echocardiography based on global longitudinal isovolumic relaxation strain rate. Subjects and Methods: This prospective study included a total of 100 subjects divided in to 75 metabolic syndrome (MS) patients referred to Al-Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and/or diabetes mellitus and 25 age and sex matched healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of diastolic dysfunction by speckle tracking. Results: There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function. On the other hand, significant differences were observed between MS and the control group in most of the parameters of GLS and SR IVR. Conclusion: Impairment of diastolic function detected by speckle tracking based on global longitudinal isovolumic relaxation strain rate in metabolic syndrome patients.

Clinical study on assessment of left ventricular systolic function in patients with hypertrophic cardiomyopathy by vector velocity imaging

Objective To analyze the strains of patients with hypertrophic cardiomyopathy (HCM) by vector velocity imaging(VVI), and to identify abnormal early systolic function. Methods Forty patients with HCM (HCM group) and 25 healthy subjects (control group) were enrolled. Standard two-dimensional echocardiography was performed. Left ventricular ejection fraction (LVEF), diameters and wall thickness were measured. Peak systolic strains in all directions and their time to peak were analyzed off-line. Results ①All but the endocardial circumferential strain were apparently smaller in HCM group than those in the control group(P<0.000 1). The difference was greater in long axis than that in short axis. ②The HCM group maintained the characteristics of strain gradient as the control group, including the endocardium-epicardium gradient with endocardial strains was significantly greater than epicardial ones and the base-apex gradient, among which epicardial longitudinal strain decreased from the base to the apex and endocardial circumferential strain increased toward the apex. ③The HCM group suffered significant dyssynchrony in terms of strain and rotation, with greater changes in longitudinal than in short axis, in epicardium than in endocardium. Conclusions VVI offers an overall assessment of regional and global left ventricular systolic function, including longitudinal and circumferential strain. Moreover, it can be used to evaluate subclinical systolic dysfunction and dyssynchrony in patients with HCM. Key words: Echocardiography; Ventricular function, left; Cardiomyopathy, hypertrophic; Strain; Vector velocity imaging

Evaluation of two-dimensional strain rate imaging on left ventricular longaxis systolic function in patients with slow coronary flow

Objective: To evaluate the value of two-dimensional strain rate imaging (STE) in detecting the alteration of regionally left ventricular long-axis systolic function in patients with slow coronary flow (SCF). Methods: 24 patients who were with SCF but without significant coronary artery stenosis in LAD were included in left anterior descending artery (LAD) group, and 15 patients with slow flow in right coronary artery (RCA) were included in RCA group, and 20 patients who were without significant coronary stenosis or abnormal corrected thrombolysis in myocardial infarction frame count (CTFC) were included in control group. CTFC was carried on 3 groups. Peak systolic strain rate (PSRs) were measured at basal, middle and apical segments in left ventricular walls, including the septal, lateral, inferior and anterior. Results: CTFC of left anterior descending coronary artery blood flow (39.88 ± 7.48) was significantly higher in LAD group than control group (19.84 ± 5.91, P<0.01). CTFC of right coronary artery blood flow (23.78 ± 8.15) was significantly higher in RCA group than control group (21.55 ± 8.12, P<0.01). PSRs of anterior wall in LAD group and interior wall in RCA group were significantly lower than that in control group (P<0.01). Linear regression showed that the CTFC of left anterior descending artery was negatively correlated with the PSRs of anterior wall (r=-0.55, P<0.01), as well as the CTFC of right coronary artery and the PSRs of interior wall in RCA group (-0.86, P<0.01). Conclusions: STE can evaluate the regional left ventricular long-axis systolic function in the patients with SCF.

P3256Pregnant women with gestational hypertension or preeclampsia had lower global and regional left ventricular systolic function by comparison with normotensive pregnant women

P3256Pregnant women with gestational hypertension or preeclampsia had lower global and regional left ventricular systolic function by comparison with normotensive pregnant women

Four-dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis.

The aim of this prospective study was to assess the diagnosis value of four-dimensional echocardiography area strain (AS) combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild singlevessel coronary artery stenosis. Based on treadmill exercise load status, two-dimensional conventional echocardiography and four-dimensional echocardiography area strain were performed on patients suspected coronary artery disease before coronary angiogram. Thirty patients (case group) with mild left anterior descending coronary artery stenosis (stenosis <50%) and thirty gender- and age-matched patients (control group) without coronary artery stenosis according to the coronary angiogram results were prospectively enrolled. All the patients had no left ventricular regional wall motion abnormality in two-dimensional echocardiography at rest and exercise stress. There was no significant difference in the 16 segmental systolic peak AS at rest between two groups. After exercise stress, the peak systolic ASrest-stress at mid anterior wall (-7.00%±10.90% vs 2.80%±23.69%) and mid anterolateral wall (-4.40%±18.81% vs 8.80%±19.16%) weredecreased, while increased at basal inferolateral wall (14.00%±19.27% vs -5.60%±15.94%) in case group compared with control group (P<.05). In patients with mild singlevessel coronary artery stenosis, the area strain was decreased at involved segments, while compensatory increased at noninvolved segments after exercise stress. Four-dimensional echocardiography area strain combined with exercise stress echocardiography could sensitively find left ventricular regional systolic function abnormality in patients with mild singlevessel coronary artery stenosis, and locate stenosis coronary artery accordingly.

Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery

ObjectivesTo define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (n=501) or...

The quantitative assessment of left ventricular local myocardial systolic function in patients with coronary heart disease by velocity vector imaging

Objective To explore the preliminarily clinical value of strain rate parameters using velocity vector imaging (VVI) evaluating left ventricular regional endocardial systolic function in patients with coronary artery heart disease (CAD). Methods A total of eight six inner subjects who were suspected as CAD was enrolled in the study. Patients with the vascular stenosis rate ≥50% were defined as the CAD group, patients with the vascular stenosis rate <50% were defined as the coronary atherosclerosis group, and patients with the completely normal angiographic results were included in the control group, according to the results of angiography. The left ventricular endocardial systolic strain rate parameters of VVI were obtained in standard long axis views (apical two, three, and four-chamber view) and short axis views (at the level of the mitral valve, papillary muscles, and apex). The strain rate parameters were global longitudinal endocardial systolic strain rate in the apical two, three, and four-chamber views (A2-GLSRs, A3-GLSRs, and A4-GLSRs), global radial endocardial systolic strain rate in short axis view of the mitral valve level, papillary muscles, and apex (MV-GRSRs, PM-GRSRs, and AP-GRSRs), and global circumferential endocardial systolic strain rate in short axis view of the mitral valve level, papillary muscles, and apex (MV-GCSRs, PM-GCSRs, and AP-GCSRs). The parametric differences were compared among three groups. Results All the subjects included in the present study had normal left ventricular ejection fraction (LVEF) and there was no significant difference in LVEF across three groups. Compared to other groups, the control group had significantly higher E/A ratio. The LV endocardial systolic strain rate parameters were all significantly reduced in the CAD group compared to the control group and the coronary atherosclerosis group (all P<0.05). Compared to the control group[(-1.37 ± 0.25)/s], the coronary atherosclerosis group[(-1.12 ± 0.42)/s] had significantly lower MV-GCSRs (P<0.01). Conclusions VVI is useful for quantitative assessment of the left ventricular systolic function in CAD. MV-GCSRs might have the potential to predict early left ventricle (LV) systolic dysfunction in subjects with coronary artery stenosis<50% . Key words: Echocardiography; Coronary disease/US