Left Ventricular Longitudinal Systolic Function Research Articles

Longitudinal Left Ventricular Function in Normotensive Prediabetics: A Tissue Doppler and Strain/Strain Rate Echocardiography Study

Although diabetes mellitus is well known to result in systolic and diastolic left ventricular (LV) dysfunction at the subclinical level, even when it is not accompanied by hypertension and coronary artery disease, this situation has not been sufficiently investigated in prediabetes, which is the precursor of diabetes. The aims of the present study were to investigate LV systolic and diastolic function in normotensive and low-risk prediabetic and diabetic subjects for coronary disease using sensitive tissue Doppler echocardiographic parameters, to investigate early possible negative effects of glucose metabolism impairment on LV longitudinal function. Two hundred subjects (92 with prediabetes, 48 with type 2 diabetes, and 60 age-matched healthy volunteers) were studied by conventional, tissue Doppler, and strain and strain rate echocardiography. All study subjects were normotensive, and coronary artery disease was excluded. Forty-eight patients had isolated fasting glucose impairment, and 44 patients had combined fasting glucose and glucose tolerance impairment. Longitudinal peak systolic strain and the peak systolic and diastolic strain rates of six walls in the apical four-chamber, long-axis, and two-chamber views were evaluated. Clinical and standard echocardiographic characteristics were comparable among all groups. Mean systolic (P= .01) and diastolic (P= .02) tissue velocities, mean strain (P= .004), and mean systolic (P=.002) and diastolic (P= .001) strain rates were significantly lower in the diabetic groups than in control subjects. There were no difference between patients with isolated fasting glucose impairment and controls for tissue Doppler parameters, but mean early diastolic tissue velocity and mean strain and strain rates were statistically lower in patients with combined fasting glucose and glucose tolerance impairment compared with controls (P < .05). LV longitudinal systolic and diastolic function was impaired in both normotensive diabetic and prediabetic patients.

Analysis of Circumferential and Longitudinal Left Ventricular Systolic Function in Patients With Non-Ischemic Chronic Heart Failure and Preserved Ejection Fraction (from the CARRY-IN-HFpEF Study)

Heart failure with preserved left ventricular ejection fraction (HFpEF) is implicitly attributed to diastolic dysfunction, often recognized in elderly patients with hypertension, diabetes, and renal dysfunction. In these patients, left ventricular circumferential and longitudinal shortening is often impaired despite normal ejection fraction. The aim of this prospective study was to analyze circumferential and longitudinal shortening and their relations in patients with nonischemic HFpEF. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S') were measured in 60 patients (mean age 73 ± 13 years) with chronic nonischemic HFpEF in stable New York Heart Association functional class II or III and compared to the values in 120 healthy controls and 120 patients with hypertension without HFpEF. Sc-MS was classified as low if <89% and S' as low if <8.5 cm/s (the 10th-percentile values of healthy controls). Isolated low sc-MS was detected in 46% of patients with HFpEF, 27% of patients with hypertension, and 2% of controls; isolated low S' was detected in 11% of patients with HFpEF, 7% of patients with hypertension, and 5% of controls; and combined low sc-MS and low S' was detected in 26% of patients with HFpEF, 9% of patients with hypertension, and 5% of controls (HFpEF vs others, all p values <0.001). Thus, any alteration of systolic function was found in 83% of patients with HFpEF. The relation between sc-MS and S' was nonlinear (cubic). Changes in S' within normal values corresponded to negligible variations in sc-MS, whereas the progressive decrease below 8.5 cm/s was associated with substantial decrease in sc-MS. In conclusion, circumferential and/or longitudinal systolic dysfunction is present in most patients with HFpEF. Circumferential shortening normalized by wall stress identifies more patients with concealed left ventricular systolic dysfunction than longitudinal shortening.

Myocardial Systolic Velocities and Deformation Assessed by Speckle Tracking for Early Detection of Left Ventricular Dysfunction in Asymptomatic Patients with Severe Primary Mitral Regurgitation

In asymptomatic patients with severe primary mitral regurgitation (PMR), early detection of left ventricular (LV) dysfunction indicates the optimal timing of mitral valve surgery; however, normal ejection fraction (EF) and end-systolic diameter (ESD) can mask significant LV impairment. We studied 28 asymptomatic patients (59 ± 13 years, 18 male) with severe PMR, EF > 60%, and ESD < 45 mm, and 10 age-matched healthy subjects. All underwent echocardiography with tissue velocity imaging to assess LV geometry, EF, and longitudinal systolic function; and two-dimensional speckle tracking to assess longitudinal strain (LS) and longitudinal strain rate (LSR), and radial strain (RS) and radial strain rate (RSR). Patients were reevaluated 14 days after successful mitral valve repair and divided in: IA, with a postoperative EF reduction >10% (13 patients) and IB, with an EF reduction <10% (15 patients). Patients with PMR had longitudinal dysfunction and decreased radial systolic deformation, by comparison with controls, although EF and ESD were similar. Subgroup IA had significantly lower S(TVI) , LS, and RS than IB (7.3 ± 0.9 vs 10.8 ± 1.5 m/s; -16.0 ± 4.2% vs -21.7 ± 2.1%; and 37.4 ± 2.5% vs 41.6 ± 2.4%; all p < 0.001) although preoperative LV mass index, LV diameters, and EF were similar. Multiple stepwise regression analysis showed that S(TVI) and the combination of S(TVI) and LS represent the main independent predictors for a postoperative EF reduction >10% (r(2) = 0.52, p < 0.001; and r(2) = 0.70, p < 0.001, respectively). Myocardial systolic velocities as well as radial and longitudinal LV deformation assessed by speckle tracking can detect subclinical LV dysfunction and predict impaired postoperative LV function in asymptomatic patients with severe PMR.

Quantitative Assessment of Left Ventricular Systolic Function in Patients with Coronary Heart Disease by Velocity Vector Imaging

To assess the left ventricular (LV) longitudinal systolic function and asynchrony in patients with coronary atherosclerotic heart disease (CAD) by syngo velocity vector imaging (VVI). Twenty-eight control subjects and 79 patients with CAD were examined, including 28 patients with myocardial infarction, 26 patients with coronary lumen stenosis <50%, and 25 patients with myocardial ischemia. According to the results of coronary arteriography and electrocardiogram (ECG), the myocardial segments of the LV of CAD patients were divided into four groups: ischemic, infarcted, nonischemic, and normal. Dynamic imaging was performed on all subjects. The systolic peak strain (Smax), systolic strain rate (SRmax), time to peak strain (PTs), and time to peak strain rate (PTsr) in every cardiac cycle were measured. A total of 1,253 out of 1,712 (96.5%) segments were successfully analyzed with VVI. Smax and SRmax of the ischemic and infarcted segments were impaired in CAD patients. Optimal sensitivity and specificity were obtained with strain and strain rate cutoffs of -14.08% and -0.83 s(-1) , respectively, for detecting ischemic segments and -6.65% and -0.38 s(-1) , respectively, for detecting infarcted segments. The PTs and PTsr were significantly longer in the ischemic and infarcted segments compared to those of the control group. Utilizing VVI, the longitudinal strain, strain rate, and peak time in CAD patients are easy to obtain and reproducible. Strain and strain rate cutoff values of abnormal myocardium are valuable for detecting ischemia and infarction. The PTs and PTsr values possibly estimate myocardium asynchrony in CAD patients.

Progressive Subclinical Left Ventricular Systolic Dysfunction in Severe Aortic Regurgitation Patients with Normal Ejection Fraction: A 24 Months Follow-Up Velocity Vector Imaging Study

We aimed to evaluate long-term changes in left ventricular (LV) longitudinal systolic functions in patients with asymptomatic, severe aortic regurgitation (AR) by using novel 2D strain imaging. Thirty severe AR patients with normal ejection fraction (EF) and 30 healthy controls were evaluated by both conventional echocardiography and velocity vector maging (VVI) based strain imaging at baseline and 24 months follow-up. To evaluate LV longitudinal systolic function, segmental peak systolic strain and strain rate (SRs) data were acquired from apical four-chamber, two-chamber and long-axis views. Longitudinal peak systolic strain and SRs of the LV were decreased in patients with severe AR compared to controls at baseline (P = 0.0001). The impairment was more significant in 24 months follow-up (P = 0.0001 for strain, P = 0.01 for SRs). Longitudinal peak systolic strain was significantly correlated with left ventricular end-diastolic (LVEDD; r =-0.42, P = 0.0001) and left ventricular end-systolic diameter (LVESD) (r =-0.41, P = 0.0001) There was also a strong negative correlation between LV SRs and LVEDD (r =-0.50, P = 0.0001), and LVESD (r =-0.39, P = 0.0001). VVI-derived strain and SRs may be used as adjunctive, noninvasive parameters in the assessment of subclinical LV dysfunction and its progress during clinical follow-up, in patients with severe AR.

Évaluation de la mécanique de torsion du ventricule gauche dans le rétrécissement aortique serré à fraction d’éjection préservée, par échocardiographie bidimensionnelle

Left ventricular (LV) twist is increased in aortic stenosis (AS) and the hypothesis of a compensatory mechanism is suggested but not established. Our aim was to assess LV twist mechanics in severe AS (< 1 cm 2 or 0.6 cm 2/m 2) with preserved LV ejection fraction (LVEF > 50%), and to analyze its relationship with LV systolic longitudinal function, early impaired in this setting, LV diastolic function, and symptomatic status. Methods Forty-five consecutive patients with severe AS and preserved LVEF (mean age 73 ± 11 years, 47% female, LVEF 68 ± 11%, 67% symptomatic) underwent a transthoracic echocardiography including a bidimensional strain analysis by speckle tracking method, and were compared to a control group matched for age and sex ( n = 15). Global longitudinal strain (GLS) was measured using the four, two, and three apical views, and LV twist mechanics from the basal and apical short axis views. LV twist was defined as the net difference between apical and basal rotation, and LV twisting and untwisting rate (in °/s) were derived from twist curves. Results Peak apical rotation, LV twist (25 ± 8° vs 20 ± 6), as well as peak systolic and diastolic apical rotation rate, and peak LV twisting rate were significantly higher in patients with AS when compared to controls (all, P < 0.05), whereas, the other parameters of LV twist mechanics including basal rotation, were not significantly different between groups. By contrast, the GLS was significantly lower in patients with AS when compared to controls (–17.9 ± 4 vs –20.5 ± 2%, P < 0.01). In addition, the GLS was significantly correlated to LV torsion ( r = –0.42, P < 0.01). Moreover, LV twist progressively impaired with the worsening of diastolic dysfunction and with symptoms onset. Conclusion LV twist is increased in severe AS with preserved LVEF, compensating the impairment of systolic longitudinal function. However, above a certain threshold LV twist deteriorates, attesting the failure of the compensatory mechanisms, leading to advanced diastolic dysfunction and symptom onset.

Exercise adaptation of the left ventricular myocardium in men over 50 years of age

Background .- The cardiac consequences of extensive athletic activity in men over the age of 50 years are unknown. Aims .- We intend to describe the remodelling that occur due to intensive athletic activity in men≥50 years of age. Methods .- We conducted a prospective analysis of 21 athletes≥50 years of age. Fifteen sedentary healthy controls and ten patients diagnosed with a left ventricular hypertrophy who were all over the age of 50. All subjects underwent a resting and a sub-maximal exercise echocardiography in order to measure left ventricular systolic and diastolic functions. Results .- Left ventricular (LV) volumes, which were similar at rest in the three groups, were higher in the athletes during exercise (P <0.01). Systolic ejection volumes and longitudinal global left ventricular strains were greater at rest in healthy subjects (athletes and controls) in comparison to those in LVH-patients (P <0.01). During exercise, the increase in longitudinal strain was higher in athletes than in the two other groups (P <0.05). Concerning left ventricular relaxation, septal e'- and lateral e'-waves were higher both at rest and during exercise in the group of healthy subjects in comparison to those in patients (P <0.05). Conclusion .- Distinguishing physiology from pathology is challenging at rest, particularly in the elderly. However, exercise stress echocardiography helps. Only the changes in shape and in the longitudinal LV systolic function during exercise are significantly different between athletes and controls or LVH-subjects.

Arterial wave reflection and subclinical left ventricular systolic dysfunction

Increased arterial wave reflection is a predictor of cardiovascular events and has been hypothesized to be a cofactor in the pathophysiology of heart failure. Whether increased wave reflection is inversely associated with left-ventricular (LV) systolic function in individuals without heart failure is not clear. Arterial wave reflection and LV systolic function were assessed in 301 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study using two-dimensional echocardiography and applanation tonometry of the radial artery to derive central arterial waveform by a validated transfer function. Aortic augmentation index (AIx) and wasted energy index (WEi) were used as indices of wave reflection. LV systolic function was measured by LV ejection fraction (LVEF) and tissue Doppler imaging (TDI). Mitral annulus peak systolic velocity (Sm), peak longitudinal strain and strain rate were measured. Participants with history of coronary artery disease, atrial fibrillation, LVEF less than 50% or wall motion abnormalities were excluded. Mean age of the study population was 68.3 ± 10.2 years (64.1% women, 65% hypertensive). LV systolic function by TDI was lower with increasing wave reflection, whereas LVEF was not. In multivariate analysis, TDI parameters of LV longitudinal systolic function were significantly and inversely correlated to AIx and WEi (P values from 0.05 to 0.002). In a community cohort without heart failure and with normal LVEF, an increased arterial wave reflection was associated with subclinical reduction in LV systolic function assessed by novel TDI techniques. Further studies are needed to investigate the prognostic implications of this relationship.

Mitral annular longitudinal function preservation after mitral valve repair: The MARTE study

BackgroundIn patients with chronic mitral regurgitation (MR), undergoing surgical mitral valve repair, current Guidelines only recommend standard echocardiographic indices i.e. left ventricular (LV) ejection fraction (EF), and LV end-systolic and end-diastolic diameters as preoperative variables. However LV EF is often preserved until advanced stages of the valve disease. Aim of this study was to evaluate changes in LV systolic longitudinal function, 3months after mitral valve repair in patients with chronic degenerative MR and normal preoperative EF. MethodsWe measured M-mode mitral lateral annulus systolic excursion (MAPSE) and Tissue Doppler (TD) peak systolic annular velocity (Sm) in 31 patients with moderate to severe MR and normal EF (59.9±4.7%) candidates for mitral valve repair, preoperatively and 3months after surgery. ResultsAfter mitral valve repair, Sm increased from 7.8±1.4 to 9.6±2.2cm/s (p<0.0001) and MAPSE increased from 1.33±0.26 to 1.55±0.25cm (p=0.0013). EF decreased from 59.9±4.7 to 51.3±5.9% (p<0.0001). As expected, LV diameters and volumes, wall thicknesses, midwall fractional shortening (mFS), and left atrial (LA) size were all reduced after surgery. ConclusionsThis study suggests that assessment of LV long axis systolic velocity and amplitude of excursion by echocardiography is more sensitive than simple determination of EF for revealing the beneficial impact of MR surgery on overall systolic function.

Impaired Myocardial Radial Function in Asymptomatic Patients with Type 2 Diabetes Mellitus: A Speckle-Tracking Imaging Study

Diabetic cardiomyopathy has been characterized by an early impairment of left ventricular (LV) longitudinal function as opposed to preserved LV radial function. Conventional echocardiography and longitudinal (ε(L)) and radial (ε(R)) systolic strain assessed by speckle-tracking imaging were obtained in 114 type 2 diabetic patients and 88 age-matched controls. LV ejection fraction was similar in diabetic patients and controls. The presence of subclinical LV systolic dysfunction in diabetic patients was demonstrated by lower values of midwall fractional shortening (18% ± 3% vs 20% ± 3%, P = .006), ε(L) (-19% ± 3% vs -22% ± 2%, P < .001), and ε(R) (50% ± 16% vs 56% ± 12%, P = .003) compared with controls. On multivariate analysis, factors predicting strain values were diabetes (P = .001) and gender (P = .001) for ε(L) and diabetes (P = .003) for ε(R). Diabetic patients without overt heart disease display subclinical alteration of both radial and longitudinal LV systolic function even after adjustment for blood pressure, age, and body mass index.

Impact of diabetes and hypertension on left ventricular longitudinal systolic function

Background The assessment of the longitudinal component of left ventricular (LV) function is of major clinical importance for the early detection of LV contractile impairment. The aim of this study was to compare the impact of isolated type-2 diabetes, isolated hypertension, and co-existence of both on LV longitudinal systolic performance, with particular focus on their potential interaction effect. Methods The study population included 163 consecutive patients: 84 patients with hypertension, 36 with diabetes, and 43 who have both hypertension and diabetes; 70 healthy controls were also recruited. Systolic mitral annulus velocity ( S m) by Tissue Doppler and left atrioventricular plane displacement (AVPD) by M-mode were measured in all subjects. Results AVPD was similarly reduced in hypertensives (13.2 ± 2.2 mm) and diabetics (13.5 ± 2.3 mm) when compared with the controls (15.1 ± 2.4 mm), and further depressed in diabetic hypertensives (11.5 ± 3.0 mm). Similar results were found for S m. General linear model analysis revealed no significant interaction terms between diabetes and hypertension. Conclusions Normotensive diabetics and nondiabetic hypertensives show comparable depression in LV longitudinal systolic indices when compared with age- and gender-matched healthy controls; the co-existence of diabetes and hypertension leads to further impairment in LV longitudinal systolic function in an additive manner.

Left ventricular longitudinal systolic function after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a long-term follow-up study focused on speckle tracking echocardiography

To examine left ventricular (LV) longitudinal systolic myocardial function in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and after transcoronary ablation of septal hypertrophy (TASH). Twenty-three of 39 consecutive patients with HOCM had serial two-dimensional (2D) echocardiograms available for speckle tracking analyses before and up to 36 months after TASH. Before TASH, overall LV myocardial longitudinal systolic 2D strain was decreased despite normal LV ejection fraction (EF). A significant reduction of LV mass and left ventricular outflow tract (LVOT) gradients occurred during long-term follow-up after TASH, but this was not accompanied by improvement of average LV longitudinal systolic strain. However, in the basal LV segments remote to the site of alcohol injection longitudinal systolic strain increased [baseline: -13.1 ± 5.4%; 1 month: -16.0 ± 5.5% (NS); 12 months: -16.5 ± 4.9% (P < 0.05 vs. baseline); 36 months: -17.4 ± 4.2% (P < 0.01 vs. baseline)]. In contrast, the alcohol-treated basal segments of the septum and adjacent myocardium showed unchanged strain over time. Average LV longitudinal myocardial systolic function is depressed in HOCM despite normal LV EF. TASH-induced reduction of the LVOT obstruction does not improve average LV longitudinal systolic 2D strain. This is in contrast to global improvement of longitudinal systolic function after valve replacement in aortic valve stenosis. The discrepancy may be caused by the fact that HOCM is a primary myocardial disease.

Effect of Candesartan Treatment on Left Ventricular Remodeling After Aortic Valve Replacement for Aortic Stenosis

In hypertension, angiotensin receptor blockers can augment regression of left ventricular (LV) hypertrophy. It is not known whether this also is the case after aortic valve replacement (AVR) for severe aortic stenosis (AS). To test the hypothesis that treatment with candesartan in addition to conventional treatment is able to augment LV and left atrial (LA) reverse remodeling in patients with AS undergoing AVR, we studied 114 patients scheduled for AVR. Patients were randomized to treatment with candesartan 32 mg 1 time/day or conventional therapy immediately after AVR. Patients were followed with echocardiographic evaluations 3, 6, and 12 months after surgery. Primary end point was change in LV mass index. At baseline and during follow-up no differences in systolic, diastolic, and pulse pressures were seen between groups. Baseline LV mass index was 134 +/- 41 g/m(2) with no difference between groups. Mean decrease in LV mass index in the control group was 12 +/- 28 g/m(2) compared to 30 +/- 40 g/m(2) in the candesartan group (p = 0.015) during follow-up. After 12 months LV mass index was significantly lower in the candesartan group (103 +/- 29 vs 119 +/- 31 g/m(2), p = 0.01). In addition, the candesartan group had greater improvement in longitudinal LV systolic function assessed by tissue Doppler S' wave (0.6 +/- 0.1-cm/s increase in control group vs 1.4 +/- 0.1 cm/s in candesartan group, p = 0.01, p for trend = 0.02) and a decrease in LA volume (p for trend = 0.01). Treatment had no effect on diastolic E/e' ratio or B-type natriuretic peptide. In conclusion, angiotensin receptor blockade with candesartan after AVR in patients with AS is associated with augmented reverse LV and LA remodeling compared to conventional management.

Assessment of longitudinal left ventricular systolic function by different echocardiographic modalities in patients with newly diagnosed mild-to-moderate hypertension

Standard echocardiographic methods reflect chamber dynamics and do not provide a direct measure of myocardial fiber shortening. Therefore we evaluated longitudinal left ventricular myocardial function by tissue Doppler echocardiography; strain (S), strain rate (SR), tissue Doppler velocity (TDV) in newly diagnosed mild to moderate hypertensive patients. Our cross-sectional and observational study population consisted of 57 patients and 48 normotensive control subjects. Patients with obesity, diabetes mellitus, regional wall motion abnormality, secondary hypertension and a history or clinical evidence of cardiovascular disease, arrhythmias or conduction abnormalities were excluded from the study. Ejection fraction, endocardial fractional shortening (eFS), meridional end-systolic stress (mESS), stress-adjusted eFS (observed /predicted eFS) were measured by M-mode echocardiography. Relationship between the left ventricular mass index and mESS was assessed by Pearson's linear regression model. Hypertensive patients had significantly decreased longitudinal myocardial function compared to control subjects determined by septal (-1.25+/-0.30 vs. -1.02+/-0.33, p<0.001) and lateral (-1.20+/-0.28 vs. 1.02+/-0.41, p<0.01) SR (1/s) measurements. However, there was no significant correlation between the mESS and strain-strain rate measurements in both normal and hypertensive subjects. Early impairment in longitudinal left ventricular systolic function can be expected despite normal endocardial left ventricular function indicated by M-mode echocardiography in patients with newly diagnosed and never treated mild to moderate hypertension.

Relation of circulating markers of fibrosis and progression of left and right ventricular dysfunction in hypertensive patients with heart failure

To study the association of circulating markers of fibrosis: procollagen type III amino-terminal propeptide (PIIINP), procollagen type I carboxy-terminal propeptide (PIP) and collagen type I carboxy-terminal telopeptide (CITP): with left (LV) and right ventricular (RV) longitudinal and LV radial systolic function in patients with heart failure in the course of essential hypertension. The study population consisted of 81 patients with hypertension divided into four groups according to NYHA classification and 20 healthy controls. Cardiac function was estimated by myocardial deformation indices assessed by tissue Doppler imaging. Serum PIIINP, PIP and CITP levels were quantified by radioimmunoassay. Progressive LV longitudinal function impairment was demonstrated in all hypertension groups as indicated by reduced peak systolic strain and strain rate and increased postsystolic strain index. The respective indicators of LV radial function were deteriorated only in NYHA classes III-IV. Concurrently, RV longitudinal function was found abnormal in NYHA classes II-IV. PIIINP concentration was higher in NYHA class III and IV, whereas CITP level was increased and PIP/CITP ratio was decreased in the NYHA IV individuals. PIIINP was an independent correlate of LV and RV longitudinal strain (R = 0.52, beta = -0.34, P < 0.001; R = 0.25, beta = -0.27, P < 0.01, respectively). PIP/CITP ratio independently determined LV radial strain in patients with LV ejection fraction less than 50% (R = 0.44, beta = 0.52, P < 0.008). In hypertensive patients, the progressive decline in cardiac longitudinal function is related to increased collagen III synthesis, whereas the changes in collagen I turnover favoring its increased degradation might contribute to LV radial and global systolic dysfunction seen in the advanced hypertensive heart disease.

Findings from Left Ventricular Strain and Strain Rate Imaging in Asymptomatic Patients With Type 2 Diabetes Mellitus

Regional left ventricular (LV) myocardial functional changes in early diabetic cardiomyopathy have not been well documented. LV multidirectional strain and strain rate analyses by 2-dimensional speckle tracking were used to detect subtle myocardial dysfunction in 47 asymptomatic, male patients (age 57 +/- 6 years) with type 2 diabetes mellitus. The results were compared to those from 53 male controls matched by age, body mass index, and body surface area. No differences were found in the LV end-diastolic volume index (40.7 +/- 8.9 vs 44.1 +/- 7.8 ml/m(2), p = NS), end-systolic volume index (16.0 +/- 4.8 vs 17.8 +/- 4.3 ml/m(2), p = NS), ejection fraction (61.0 +/- 5.5% vs 59.8 +/- 5.3%, p = NS). The transmitral E/A (0.95 +/- 0.21 vs 1.12 +/- 0.32, p = 0.007) and pulmonary S/D (1.45 +/- 0.28 vs 1.25 +/- 0.27, p = 0.001) ratios were more impaired in the patients with diabetes mellitus. Importantly, the diabetic patients had impaired longitudinal, but preserved circumferential and radial systolic and diastolic, function. Diabetes mellitus was an independent predictor for longitudinal strain, systolic strain rate and early diastolic strain rate on multiple linear regression analysis (all p <0.001). In conclusion, the LV longitudinal systolic and diastolic function were impaired, but the circumferential and radial functions were preserved in patients with uncomplicated type 2 diabetes mellitus.

Echocardiography in the assessment of left ventricular longitudinal systolic function: current methodology and clinical applications

Quantification of left ventricular (LV) systolic function represents a major aspect of echocardiographic assessment in the spectrum of cardiac diseases. However, because of the high complexity of LV contraction mechanics, the classical approach with assessment of a single measure of systolic function, such as ejection fraction or fractional shortening, has been largely superseded. During the last years, through the considerable technical advances in the field of ultrasonography, a number of different echocardiographic methodologies have become available to perform a detailed assessment of different aspects of LV contraction. In particular, evaluation of LV longitudinal systolic dynamics has progressively gained importance as a key aspect in the assessment of LV systolic function. For most of the techniques currently used to explore LV longitudinal function, the clinical usefulness in both research and daily practice has been validated by consistent evidence and their use is rapidly increasing. Technical considerations and potential clinical applications of the assessment of LV longitudinal systolic function are reviewed.

Changes in components of left ventricular mechanics under selective beta-1 blockade: insight from traditional and new technologies in echocardiography

Myocardial inotropism is considered to be reduced under beta-1 adrenoreceptor blockage (beta1-block). However, relationships between components of left ventricular (LV) systolic mechanics under beta1-block accounting for physiological correlates are only partially explored. Hypertensive outpatient without previous cardiovascular events and with normal LV ejection fraction (EF) at rest underwent echocardiographic evaluations of LV size and systolic function by standard, tissue-Doppler, and speckle-tracking methods before and after 2 weeks of treatment with bisoprolol to obtain change in LV systolic mechanics at a stable heart rate reduction (-20 +/- 10% from baseline) without significant change in LV mass. In the study sample (n = 26, 62% women, mean age 52 +/- 10 years), under bisoprolol, afterload [i.e. circumferential (CESS) and meridional (MESS) end-systolic stress], LV mass, left atrial volume, and EF did not change significantly; LV chamber contractility [i.e. CESS/LV end-systolic volume index (CESS/ESVi) as well as MESS/ESVi] and relative wall thickness (RWT) decreased; stroke volume increased (all P < 0.05). Circumferential LV contractility (i.e. stress-corrected midwall shortening) increased, whereas regional longitudinal strain and strain rate, and global longitudinal strain decreased (all P < 0.05). Peak velocities of the systolic displacement of the lateral and medial mitral anulus did not change under bisoprolol. Parameters of longitudinal LV systolic function did not correlate with preload, afterload, RWT, or with stoke volume. In hypertensive subjects with preserved LV EF, parameters of longitudinal LV systolic mechanics may not reflect the LV myocardial contractility status in steady-state conditions under short-term treatment with beta1-block.

Assessment of Regional Myocardial Function in Patients with Dilated Cardiomyopathy by Velocity Vector Imaging

To assess the left ventricular (LV) longitudinal systolic and diastolic function in patients with dilated cardiomyopathy (DCM) by syngo Velocity Vector Imaging (VVI). Digital dynamic images of 30 DCM patients and 30 healthy subjects were collected; then the longitudinal velocity, strain, and strain rate were measured in systolic early and late diastolic periods, and the time to peak systolic velocity, strain, and strain rate were measured and recorded. The parameters of the two groups were compared. All of the parameters of the DCM were significantly lower than those of the normal group (P < 0.05-0.01), except that the parameter of late diastolic strain was not different between the two groups (P > 0.05). VVI is a novel noninvasive tool to assess quantitatively and objectively LV regional systolic and diastolic function in patients with DCM; it provides another useful modality for evaluating cardiac function.

Progression of Left Ventricular Functional Abnormalities in Hypertensive Patients with Heart Failure: An Ultrasonic Two-Dimensional Speckle Tracking Study

Two-dimensional (2-D) strain imaging is a novel echocardiographic technique for myocardial function evaluation. We sought to investigate left ventricular (LV) systolic function in patients with heart failure caused by hypertension using a 2-D strain approach and to validate this method against Doppler strain measurements. The study population comprised 81 patients (66.4 +/- 7.4 years) with hypertension in New York Heart Association (NYHA) class I to IV and 20 healthy controls. Decreased longitudinal strain was demonstrated in the basal septal segment in NYHA I, in the basal and mid septal and basal lateral segments in NYHA II, and in all segments in NYHA III and IV. Radial and circumferential strain were reduced in patients with NYHA III and IV. Independent predictors of strain were duration of HT, LV mass index, LV end-diastolic volume index, and systolic blood pressure. The agreement between 2-D and Doppler strain remained within acceptable ranges (mean difference +/- 1 standard deviation: 0.61%-1.92% +/- 2.38%-2.92% for longitudinal strain in particular segments and 4.98% +/- 5.26% for radial strain). In hypertensive patients, (1) LV longitudinal systolic function progressively deteriorates from NYHA I to IV and abnormalities commence in the basal septum, (2) LV radial and circumferential systolic impairment appears in NYHA III and IV, and (3) 2-D strain measurement provides a feasible tool for the quantitation of LV systolic performance.