Longitudinal Systolic Strain Rate Research Articles

Impact of Diabetes and Increasing Body Mass Index Category on Left Ventricular Systolic and Diastolic Function

Diabetes and obesity are both worldwide growing epidemics, and both are independently associated with increased risk for heart failure and death. The aim of this study was to examine the additive detrimental effect of both diabetes and increasing body mass index (BMI) category on left ventricular (LV) myocardial systolic and diastolic function. The present retrospective multicenter study included 653 patients (337 with type 2 diabetes and 316 without diabetes) of increasing BMI category. All patients had normal LV ejection fractions. LV myocardial systolic (peak systolic global longitudinal strain and peak systolic global longitudinal strain rate) and diastolic (average mitral annular e' velocity and early diastolic global longitudinal strain rate) function was quantified using echocardiography. Increasing BMI category was associated with progressively more impaired LV myocardial function in patients with diabetes (P<.001). Patients with diabetes had significantly more impaired LV myocardial function for all BMI categories compared with those without diabetes (P<.001). On multivariate analysis, both diabetes and obesity were independently associated with an additive detrimental effect on LV myocardial systolic and diastolic function. However, obesity was associated with greater LV myocardial dysfunction than diabetes. Both diabetes and increasing BMI category had an additive detrimental effect on LV myocardial systolic and diastolic function. Furthermore, increasing BMI category was associated with greater LV myocardial dysfunction than diabetes. As they frequently coexist together, future studies on patients with diabetes should also focus on obesity.

Does Nasal Surgery Affect Right Ventricular Myocardial Functions at the Tissue Level in Patients with Nasal Septum Deviation?

Objective: One of the most common causes of upper airway obstruction in adults is nasal septum deviation (NSD). The chronic hypoxia caused by this obstruction gradually leads to increased pulmonary vascular resistance, pulmonary hypertension (PHT), and right ventricular (RV) failure. The purpose of this study was to determine changes in RV myocardial functions at the tissue level before, and after surgery in patients with NSD. Subjects and Methods: Fifty-eight patients with symptoms of nasal obstruction and snoring were included in this observational study. Preoperative and postoperative third-month peripheral arterial oxygen saturation (SpO2), and RV systolic and diastolic functions measured by pulmonary artery systolic pressure (PASP), tissue Doppler parameters, and speckle tracking echocardiography (STE) were studied in these patients. Results: We observed a very significant decrease in PASP in the postoperative period (32.54 ± 5.24 mmHg vs. 24.22 ± 4.55 mmHg, p = 0.001). Postoperative SpO2 values, measured at room temperature also increased significantly (93.5 ± 0.82% vs. 95.6 ± 0.79%, p = 0.001). There was a significant improvement after surgery in RV systolic functions, represented by global longitudinal strain (GLS) (21.12 ± 2.07 vs. 22.49 ± 1.89, p = 0.013) and systolic global longitudinal strain rate (GLSRs) (1.30 ± 0.12 vs. 1.38 ± 0.13, p = 0.015). No significant differences in terms of RV diastolic function parameters were detected, including the RV early diastolic global longitudinal strain rate (GLSRe) (1.56 ± 0.21 vs. 1.55 ± 0.26, p = 0.86) and RV late diastolic global longitudinal strain rate (GLSRa) (0.88 ± 0.19; 0.89 ± 0.18, p = 0.76). Conclusion: This study was performed with an advanced technique capable of tissue level examination. The findings demonstrated significant improvement in both chronic hypoxia and RV systolic myocardial functions, measured at the tissue level after nasal surgery.

Speckle-tracking parameters as predictors of left ventricular systolic dysfunction in patients with myocarditis

Purpose. To evaluate the prognostic capabilities of speckle-tracking echocardiography for prediction of left ventricular systolic dysfunction persistence after 1-year follow-up of patients with myocarditis. Methods. We included 58 patients with acute diffuse myocarditis and left ventricular (LV) systolic dysfunction – LV ejection fraction (EF) ≤40 % who underwent examination 3 times: within the 1st month after the disease onset, at 6- and 12-month follow-up. Transthoracic 2-dimensional echocardiography (EchoCG) and speckle-tracking echocardiography (STE) were performed with the measurement ofLV end-diastolic volume index (LV EDVi) and LV EF, longitudinal global systolic strain (LGSS) and strain rate (LGSSr), circumferential global systolic strain (CGSS) and strain rate (CGSSr), radial global systolic strain (RGSS) and strain rate (RGSSr). For better clarity, parameters of longitudinal and circumferential strain were presented in absolute values. Results. After 12-month follow-up in comparison with the 1st month we observed improvement of LV EF 43.2 ± 3.1 % vs. 32.2 ± 2.7 % (P < 0.02), respectively, and decrease of LV EDVi 91.1 ± 6.6 ml/m 2 vs. 112.2 ± 7.2 ml/m 2 (P < 0.05), respectively. But statistically significant increase of STE parameters in comparison with their values in the 1st month was indicated after only 6-month follow-up: the absolute value of LGSS increased from 5.40 ± 0.41 % to 8.40 ± 0.63 % (P < 0.01) and the absolute value of CGSS – from 6.60 ± 0.73 to 10.40 ± 0.90 % (P < 0.01). By the 12th month there was a further increase in the absolute values of these indicators which corresponded to the statistically significant increase in LV EF and reduction in LV EDVi. By the use of binary regression analysis we defined cut-off values for STE parameters, measured within the 1st month of myocarditis onset, that with high sensitivity and specificity could predict LV systolic dysfunction persistence after 12 months: LGSS <8.6 %, LGSSr <0.61 s -1 and CGSS <8.3 %. Conclusions. On the basis of dynamic observation we detected STE parameters that within the 1 st month of myocarditis onset could be used for prognostication of LV systolic dysfunction persistence after 1-year follow-up: absolute values of LGSS <8.6 %, LGSSr <0.61 s -1 and CGSS <8.3 %.

The predictive value of left ventricular myocardium mechanics evaluation in asymptomatic patients with aortic regurgitation and preserved left ventricular ejection fraction. A long-term speckle-tracking echocardiographic study.

The management of asymptomatic patients with aortic regurgitation (AR) and preserved left ventricular (LV) ejection fraction (LVEF) remains challenging. The purpose of the study was to assess the early changes of LV mechanics by 2D speckle-tracking echocardiography (2D-STE) in order to predict a decrease in LVEF. Sixty-seven patients (age, 47±15years) with asymptomatic moderate (n=27) and severe AR (n=40) with preserved LVEF were prospectively followed for about 5years. Sixty healthy age-matched controls were included in the study. Standard echocardiography and 2D-STE were performed at the baseline and follow-up. The primary endpoint was a deterioration of the LVEF (≤50%). At baseline, global LV longitudinal peak systolic strain (GLS) and strain rate (GLSRs) were decreased in patients with severe AR compared to controls (-18.9±2.4 vs 20.0±2.1%; -1.05±0.19 vs -1.18±0.15 1/s, P<.05, respectively). In the moderate AR group, GLS was not different from that of the control group, but GLSRs was significantly lower than in controls. The primary endpoint was reached in 12 patients with severe AR, while this was not observed in patients with moderate AR. In multivariate analysis, GLS was an independent predictor of LVEF. According to ROC curve analysis, probability of primary endpoint occurrence was significantly greater in patients with GLS values ≥-18.5% (AUC: 0.89, P<.01). The reduction of LV longitudinal deformation is a sign of early subclinical LV dysfunction. GLS is a prognostic predictor of LV dysfunction and may be potentially useful for optimal timing of surgery for patients with significant AR.

Impaired cardiac and vascular motion in patients with Takayasu's arteritis: A velocity vector imaging-based study.

Takayasu's arteritis (TAK) is a chronic inflammatory vasculitis of the aorta and its major branches. In the present study, we aimed to evaluate the motion of the vascular wall and myocardial contractility by using a novel strain imaging method, velocity vector imaging (VVI), in patients with TAK. We also aimed to compare them with another inflammatory autoimmune disorder, systemic lupus erythematosus (SLE). We studied 33 patients with TAK, 18 patients with SLE, and 20 age- and sex-matched controls. All participants were subjected to carotid artery Doppler ultrasonography and transthoracic echocardiographic evaluation. VVI analysis was also performed to assess subclinical left ventricular (LV) systolic dysfunction and to determine tissue motion of the common carotid arteries (CCAs). Aortic strain and distensibility were significantly impaired in patients with TAK, while the aortic stiffness and carotid artery stiffness indexes were increased. Aortic distensibility was the only parameter that was decreased among SLE patients. The values of CCA peak longitudinal strain, strain rate, and total longitudinal displacement (TLD) were also impaired in patients with TAK. Peak radial velocity was decreased while time-to-peak radial velocity was increased. In the SLE group, peak longitudinal strain, strain rate, TLD, and peak radial velocity were impaired. LV longitudinal peak systolic strain and strain rate were reduced in patients with TAK. Similarly, we revealed impaired subclinical LV systolic function in patients with SLE. VVI is a novel strain imaging technique with additional value to determine early impairment in vascular and myocardial wall motion in patients with TAK.

Evaluation of Right Ventricular Function by Speckle-Tracking Echocardiography in Patients with Ankylosing Spondylitis: A Case-Control Study.

We aimed to evaluate the right ventricular (RV) systolic function in patients with ankylosing spondylitis (AS) compared to healthy subjects by using standard echocardiography and speckle-tracking echocardiography (STE) methods. This was a case-control study in which 64 patients (mean age, 55.7 ± 9.2 years; male/female, 53/11), who had AS for at least five years (mean disease duration, 7.1 ± 2.6 years) and 70 age-matched healthy subjects (mean age, 54.9 ± 8.5 years; male/female 55/15) were included. Clinical and laboratory signs of cardiac disease were recorded. The RV systolic function was assessed by standard echocardiography and two-dimensional STE method. Case and control groups did not show significant difference in terms of clinical and laboratory signs of cardiac disease. RV function parameters in standard echocardiography were statistically similar between AS patients and control subjects. However, RV parameters in STE revealed significantly impaired RV function in AS patients compared to control group. RV-free wall longitudinal strain, RV-free wall longitudinal systolic strain rate, RV-free wall longitudinal early diastolic strain rate, RV-free wall longitudinal late diastolic strain rate were lower, and RV-early diastolic strain rate/RV-late diastolic strain rate ratio was higher for the patients in the AS group (p < 0.001 for all). AS is associated with impaired RV function as shown by STE even if there is no clinical or laboratory sign of cardiac abnormality. STE is more effective than standard echocardiography to detect RV function. Therefore we suggest regular evaluation of RV function in patients with AS.

Subclinical Right Ventricular Dysfunction in Type 2 Diabetes Mellitus: An Echocardiographic Strain/Strain Rate Study

AbstractBackground: Type II Diabetes Mellitus (DM) was accom-panied by subclinical impairment of Right Ventricular (RV) systolic dysfunction. Two-Dimensional (2D) Speckle Tracking Echocardiography (STE) allows a precise evaluation of myo-cardial function.Aim of the Study: The aim of this study was to assess the RV systolic function in asymptomatic normotensive subjects with type II DM compared with control subjects, using strain/ strain rate qualification by 2D STE.Subjects and Methods: Prospective study enrolled 100 subjects, they were classified into two groups: Group I included seventy subjects known to have type II DM (36 males and 34 females), mean age 41.37±4.72 years, and group II included thirty healthy subjects (15 males and 15 females) with mean age 39.40±3.14 years. All subjects had normal Left Ventricular (LV) Ejection Fraction (EF), calculated by conventional 2D Trans-Thoracic Echocardiography (TTE). Subjects who had diseases affecting LV and RV systolic functionwere excluded as hypertension, coronary artery disease, valvular diseases, arrhythmias, pulmonary diseases and pulmonary hypertension. All studied population were subjected to informed verbal consent, full history taking. General and cardiac examination were done. Resting standard 12-leads Electrocardiogram (ECG) has been recorded for analysis. HaemoglobinA1c (HbA1c %) level was measured for group I. 2D TTE and 2D STE were done for all subjects. LV global longitudinal strain (LVGLS%), RVGLS%, RV segmental peak Longitudinal Systolic Strains (LSS%) and RV segmental longitudinal systolic strain rates (LSSRs 1/sec) were assessed by 2D STE. Data were collected and statistically analysed.Results: Both groups showed no statistically significant difference regarding LV linear internal dimensions, EF, LV Mass Index (LVMI), RV inflow linear dimensions, Fractional Area Change (FAC) and Tricuspid Annular Post-Systolic Excursion (TAPSE). Mean values of LVGLS and RVGLS were significantly lower in group I than in group II, as mean values for GLS of LV & RV were (–19.93±1.48, –21.49±3.80 for group I respectively versus –22.10±1.21, –26.40±2.86 for group II respectively) with (p-value <0.001). The mean values of RV segmental LSS were lower in group I than in group II as mean values for basal septum, mid septum, apical septum, basal RV free wall and apical RV free wall were lower in group I. (–14.81±4.02, –16.77±3.66, –18.20±3.42, –20.53± 2.14, –24.41±5.72 respectively) versus (21.03±1.35, –22.73± 2.00, –24.60±1.94, –30.37±3.11, –30.23±5.45 respectively) for group II, (p-value <0.001), except for mid RV free wall which showed no statistically significant difference between both groups. No statistically significant difference between both groups was detected regarding mean values of RV seg-mental (LSSRs 1/sec), except for apical RV free wall which were significantly lower in group I (1.18±0.54) than in group II (1.48±0.54), (p-value=0.022). There was a reverse correlation between GLS of LV and RV with the duration of diabetes and the level of HbA1 C.Conclusion: Subjects with type II DM were associated with subclinical LV & RV systolic dysfunction compared with control subjects.

Assessment of Right Atrium Function in Patients With Systemic Lupus Erythematosus With Different Pulmonary Artery Systolic Pressures by 2-Dimensional Speckle-Tracking Echocardiography.

To assess right atrium (RA) function of patients with systemic lupus erythematosus (SLE) and pulmonary artery hypertension (PAH) by 2-dimensional speckle-tracking echocardiography. Thirty matched healthy adults were selected as group A. Then, 102 patients with SLE were divided into 3 groups according to the severity of PAH. Group B included 37 patients without PAH (pulmonary artery [PA] systolic pressure ≤ 30 mm Hg); group C included 34 patients with PAH (PA systolic pressure of 30-50 mm Hg); and group D included 31 patients with PAH (PA systolic pressure ≥ 50 mm Hg). Parameters evaluated included RA maximum volume, minimum volume, preatrial contraction volume, passive ejection fraction (EF), and active EF. The global peak longitudinal systolic strain rate and early and late diastolic strain rates of the RA were obtained by 2-dimensional speckle-tracking echocardiography. No significant differences were found in all parameters between groups B and A (P > .05). The RA maximum volume, minimum volume, preatrial contraction volume, active EF, and late diastolic strain rate in groups C and D were significantly increased compared with those in groups A and B, and the parameters in group D were significantly higher than those in group C (P < .05). Although the RA passive EF, early diastolic strain rate, and systolic strain rate in groups C and D were significantly decreased compared with those in groups A and B, those in group D were significantly lower than those in group C (P < .05). Two-dimensional speckle-tracking echocardiography could effectively assess RA function in patients with SLE who have different severities of PAH.

Use of speckle-tracking strain in preload-dependent patients, need for cautious interpretation!

BackgroundIn critical patients, left ventricular ejection fraction and fractional shortening are used to reflect left ventricular systolic function. An emerging technique, two-dimensional-strain echocardiography, allows assessment of the left ventricle systolic longitudinal deformation (global longitudinal strain) and the speed at which this deformation occurs (systolic strain rate). This technique is of increasing use in critical patients in intensive care units and in the peri-operative period where preload constantly varies. Our objective, in this prospective single-center observational study, was to evaluate the effect of fluid resuscitation on two-dimensional-strain echocardiography measurements in preload-dependent critically ill patients. We included 49 patients with preload dependence attested by an increase of at least 10% in the left ventricular outflow track velocity–time integral measured by echocardiography during a passive leg raising maneuver. Echocardiography was performed before fluid resuscitation (echocardiography 1) and after preload independency achievement (echocardiography 2).ResultsTwo-dimensional-strain echocardiography was feasible in 40 (82%) among the 49 patients. With preload dependence correction, the absolute value of global longitudinal strain and systolic strain rate was significantly increased from, respectively, − 13.3 ± 3.5 to − 18.4% ± 4.5 (p < 0.01) and − 1.11 s−1 ± 0.29 to − 1.55 s−1 ± 0.55 (p < 0.001). The fluid resuscitation affects GLS and SSR in preload-dependent patients, with a shift, for GLS, from pathological to normal values.ConclusionIn critically ill patients, the assessment of the systolic function by two-dimensional-strain echocardiography needs prior evaluation of preload dependency, in order to adequately interpret this variable. Future studies should assess the ability of global longitudinal strain to guide fluid management in the critically ill patients.

Left-ventricular global longitudinal systolic strain and strain rate can predict sepsis outcome: comparison between speckle-tracking echocardiography and tissue-Doppler imaging

Background Strain imaging, by either tissue-Doppler imaging (TDI) velocity converted to strain or strain rate or by two-dimensional speckle-tracking echocardiography (STE) analysis, is used to evaluate abnormal left-ventricular (LV) mechanical activation patterns in sepsis. Objective The aim of this study was to predict sepsis outcomes using LV strain and strain-rate measurements as well as to establish a comparison between STE and TDI. Patients and methods This study included 32 patients (43.7±13.7 years, 21 males) [13 patients with sepsis (group 1) and 19 patients with severe sepsis/septic shock (group 2)] and a subset of 10 controls (36.5±8.7 years, eight males). In the first 24 h, color-TDI was performed for LV 16 segments, and Doppler flow profiles were reanalyzed using STE to retrieve LV peak global longitudinal systolic strain (GLSS) and global longitudinal systolic strain rate (GLSSR), which were averaged for the whole segment. Results Compared with the controls, ejection fraction (%EF) of both groups were comparable, but GLSS showed increased values (−17.5±2.9 vs. −20.2±1.6%, P Conclusion LV GLSS and GLSSR obtained using STE were more specific and showed a better correlation with both Acute Physiology and Chronic Health Evaluation II and %EF rather than TDI in predicting mortality.

Early Assessment of Right Ventricular Function in Systemic Lupus Erythematosus Patients using Strain and Strain Rate Imaging.

BackgroundRight ventricular function is a crucial factor of the prognosis of systemic lupus erythematosus (SLE).ObjectivesTo evaluate the right ventricular function in SLE patients with different degrees of pulmonary hypertension (PH) by strain and strain rate imaging.MethodsA total of 102 SLE patients and 30 healthy volunteers were studied between October 2015 and May 2016. Patients were divided into three groups according to pulmonary artery systolic pressure (PASP) estimated by echocardiography: group control (A); PASP ≤ 30 mmHg (group B, n = 37); PASP 30-50 mmHg (mild PH; group C, n = 34); and PASP ≥ 50 mmHg (moderate-to-severe PH; group D, n = 31). Longitudinal peak systolic strain (ε) and strain rate (SR), including systolic strain rate (SRs), early diastolic strain rate (SRe) and late diastolic strain rate (SRa) were measured in the basal, middle and apical segments of the right ventricular free wall in participants by two-dimensional speckle tracking echocardiography (2D-STE) from the apical four-chamber view. A p < 0.05 was set for statistical significance.ResultsThe parameters of ε, SRs, SRe, and SRa were significantly decreased in groups C and D compared with groups A and B. The ε of each segments was significantly lower in group D than in group C, while there were no differences in SRs, SRe and SRa between groups C and D.ConclusionsStrain and strain rate imaging could early detect the right ventricular dysfunction in SLE patients with PH, and provide important value for clinical therapy and prognosis of these patients.

Lipopolysaccharide acutely suppresses right-ventricular strain in rats with pulmonary artery hypertension.

Worsening right ventricular (RV) dysfunction in the presence of pulmonary artery hypertension (PAH) increases morbidity and mortality in this patient population. Transthoracic echocardiography (TTE) is a non-invasive modality to evaluate RV function over time. Using a monocrotaline-induced PAH rat model, we evaluated the effect of acute inflammation on RV function. In this study, both PAH and control rats were injected with Escherichia coli lipopolysaccharide (LPS) to induce an acute inflammatory state. We evaluated survival curves, TTE parameters, and inflammatory markers to better understand the mechanism and impact of acute inflammation on RV function in the presence of PAH. The survival curve of the PAH rats dropped sharply within 9 h after LPS treatment. Several echocardiographic parameters including left ventricular (LV) stroke volume, RV tricuspid annular plane systolic excursion, RV longitudinal peak systolic strain, and strain rate decreased significantly in PAH rats before LPS injection and 2 h after LPS injection. The expression of phospholamban (PLB) and tumor necrosis factor-α (TNF-α) significantly increased and the expression of SERCA2a significantly decreased in PAH rats after LPS administration. LPS suppressed the RV longitudinal peak systolic strain and strain rate and cardiac function deteriorated in PAH rats. These effects may be associated with the signal pathway activity of SERCA2a/PLB.

Left ventricular diastolic and systolic dyssynchrony and dysfunction in heart failure with preserved ejection fraction and a narrow QRS complex.

Aims: Mechanical dyssynchrony has been reported in heart failure with preserved ejection fraction (HFpEF), with a majority of patients having a narrow QRS complex; however, whether any benefit is observed with restoration of dyssynchrony remains unclear. We sought to assess left ventricular (LV) dyssynchrony and function in HFpEF and elucidate the underlying mechanisms that may account for HFpEF.Methods: Seventy-eighty patients with a narrow QRS complex including 47 with HFpEF, 31 with heart failure with reduced ejection fraction (HFrEF) patients, and 29 with asymptomatic left ventricular diastolic dysfunction (LVDD) were recruited. Forty-five normal subjects acted as controls. Systolic LV longitudinal strain (LS), systolic longitudinal strain rate (LSrS), early diastolic longitudinal strain rate (LSrE), and late diastolic longitudinal strain rate (LSrA) were measured using speckle tracking echocardiography. LV diastolic and systolic dyssynchrony (Te-SD and Ts-SD) were calculated.Results: Te-SD and Ts-SD were prolonged in HFpEF and HFrEF patients than in the control group (p<0.05). However, Ts-SD was shorter in HFpEF patients compared to HFrEF patients despite a narrow QRS complex (p<0.05). LV global LS, LSrS, and LSrE were decreased in patients with HFpEF and HFrEF compared to other groups, with HFrEF being even more reduced than HFpEF (p<0.05). Reduced LS, LSrS, and LSrE could effectively differentiate HF from asymptomatic LVDD patients (p<0.05).Conclusion: HFrEF exhibited increased systolic dyssynchrony compared to HFpEF despite a narrow QRS complex in addition to the more reduced diastolic and systolic function. Therefore, targeting to improve diastolic and systolic function instead of managing systolic dyssynchrony might be of great importance in the treatment of HFpEF.

Quantitative assessment of systolic and diastolic right ventricular function by echocardiography and speckle-tracking imaging: a prospective study in 104 dogs.

Our aim was (1) to determine the within-day and between-day variability of several indices of systolic and diastolic right ventricular (RV) function by using conventional echocardiography and speckle-tracking echocardiography (STE) (Study 1), (2) to quantify these variables in a large healthy canine population (n = 104) with Doppler-derived estimated systolic pulmonary arterial pressure (SPAP) and left ventricular (LV) function, and (3) to establish the corresponding reference intervals (Study 2). For both studies, RV variables included tricuspid annular plane systolic excursion (TAPSE), right fractional area change (RFAC), STE longitudinal systolic strain (StS) of the RV free wall (RVFW) and of the entire RV (i.e., global RV StS), STE longitudinal systolic RVFW strain rate (SRS), and the diastolic early:late strain rate ratio. All but one within- and between-day coefficients of variation (13/14) were < 15%, the lowest being observed for TAPSE (3.6–9.8%), global RV StS (3.8–9.9%), and RVFW StS (3.7–7.3%). SPAP was weakly and negatively correlated with the TAPSE:body weight ratio (rs = −0.26, p = 0.01) and RVFW SRS (rs = −0.23, p < 0.05). Reference intervals (lower and upper limits with 90% confidence intervals) were provided for all variables. STE provides a non-invasive evaluation of RV function that may be used for clinical investigations in canine cardiology.

Ventricular mechanics after repair of subarterial and perimembranous VSDs

Emerging data suggest impaired biventricular function in adults late after repair of ventricular septal defect (VSD). We assessed and compared right (RV) and left ventricular (LV) mechanics in adolescents and adults after surgical closure of doubly committed subarterial and perimembranous VSDs. A total of 75 subjects were studied: 29 patients after subarterial VSD repair (group I), 17 patients after perimembranous VSD repair (group II) and 29 age-matched controls (group III). RV and LV mechanics were assessed using tissue Doppler and speckle-tracking echocardiography, while RV outflow systolic function was quantified by systolic excursion and fractional shortening (FS). Compared with group III, groups I and II had significantly reduced tricuspid annular systolic and diastolic velocities, isovolumic myocardial acceleration, RV global longitudinal systolic and diastolic deformation parameters and RV outflow systolic excursion (all P < .05). Group I, but not II, had reduced RV outflow FS (P = .008) and the lowest global LV longitudinal systolic strain (P = .008) and systolic strain rate (P = .014). In group I, postoperative aortic regurgitation was associated with lower LV longitudinal systolic strain (P = .009) and early diastolic strain rate (P = .002), while right bundle branch block was associated with lower RV systolic strain rate (P = .048). As a group, RV outflow excursion (P < .001) and FS (P = .001) were correlated with LV global systolic strain. Adolescents and adults late after repair of subarterial and perimembranous VSDs show impairment of RV systolic and diastolic myocardial deformation. The RV outflow function and LV systolic deformation appear to be worse after repair of subarterial defects.

Longitudinal Myocardial Deformation Does Not Predict Single Ventricle Ejection Fraction Assessed by Cardiac Magnetic Resonance Imaging in Children with a Total Cavopulmonary Connection

Survival of children with single ventricle heart defects after the total cavopulmonary connection (TCPC) has improved, but impaired cardiac function remains a major cause of morbidity and mortality. Cardiac magnetic resonance imaging (cMRI) is the gold standard in assessing single ventricle volume and function, but high costs and limited availability hamper its routine use. A cheaper and more available alternative is echocardiography. Myocardial function can be studied in more detail using speckle tracking echocardiography (STE). The purpose of the study was to describe the association between myocardial deformation assessed by speckle tracking echocardiography (STE) and single ventricle function assessed by cMRI and to evaluate differences in myocardial deformation in children with single left and single right ventricular morphology. Cross-sectional, multicenter study in 77 children after TCPC was conducted. STE segmental and global longitudinal peak strain and systolic strain rate (SR) of the dominant ventricle were measured. Impaired SV function by cMRI was defined as ejection fraction (EF) < 45%. Mean age was 11.8 (range 9.7–14.3) years. Pearson R for cMRI EF versus global longitudinal strain and SR was − 0.25 (p = 0.06) and − 0.03 (p = 0.82), respectively. Global single ventricle longitudinal strain and SR was similar in patients after TCPC with single left and single right ventricular morphology (− 19.0 ± 3.1% vs 19.2 ± 3.2%, p = 0.94). STE myocardial deformation parameters do not correlate with single ventricle ejection fraction assessed by cMRI.

Age, Sex, and Blood Pressure-Related Influences on Reference Values of Left Atrial Deformation and Mechanics From a Large-Scale Asian Population.

Left atrial (LA) function is tightly linked to several cardiovascular diseases and confers key prognostic information. Speckle tracking-based deformation as a feasible and sensitive LA mechanical assessment has proven its clinical significance beyond volume measures; however, the reference values remain largely unknown. We studied 4042 participants undergoing annual cardiovascular survey. Among them, 2812 healthy participants (65% men; mean age, 47.4±9.9 years) were eligible for speckle tracking analysis. Peak atrial longitudinal systolic strain and strain rate (SR) at systolic (SRs), early diastolic (SRe), and late diastolic atrial contraction phases (SRa) were analyzed by dedicated software (EchoPAC, GE) and compared in terms of age, sex, and blood pressure. Overall, women demonstrated higher peak atrial longitudinal systolic strain (39.34±7.99% versus 37.95±7.96%; P<0.001) and showed age-dependent more pronounced peak atrial longitudinal systolic strain functional decay than those of men (P value for interaction, <0.05), with men showing higher SRs and SRa, although lower SRe (all P<0.001). Both increasing age and higher blood pressure were independently associated with deteriorated peak atrial longitudinal systolic strain, SRs, and SRe, although augmented LA SRa, even after accounting for baseline clinical covariates in multivariable models that incorporated LA volume, NT-proBNP (N-terminal pro-B-type natriuretic peptide), or left ventricular E/e' (all P<0.001). Our findings suggest LA mechanical functional decays in association with increasing age and higher blood pressure, which seem to be compensated for by augmentation of atrial pump function. We have also provided age- and sex-stratified reference values for strain and SR based on a large-scale Asian population.

Genetic Polymorphisms of Alcohol Metabolizing Enzymes and Alcohol Consumption are Associated With Asymptomatic Cardiac Remodeling and Subclinical Systolic Dysfunction in Large Community-Dwelling Asians.

Excessive consumption of alcoholic beverages is associated with cardiac remodeling and cardiomyopathy. We examined the possible association of alcohol use, common Asian genetic variants in genes involved in alcohol metabolism, and cardiac structures/functions alterations. A prospective, community-dwelling survey among individuals with available complete echocardiography examined the associations of alcohol use, cardiac structure/functions, and three common alcohol metabolizing genetic variants, including aldehyde dehydrogenase 2 (ALDH2), alcohol dehydrogenase 1B (ADH1B) and cytochrome P450 (CYP) isoform 2E1 (CYP2E1). Among 1577 participants (mean age: 53 ± 9, 59.7% female), we observed that in subjects with more frequent weekly ethanol intake showed greater left ventricle (LV) mass, more impaired diastolic functions, and reduced global longitudinal strain (GLS), systolic (SRs) and early diastolic strain rates (SRe) (P<0.05). After propensity matching for clinical confounders (n = 330:30 for frequent users and non-users), frequent alcohol use and subjects carrying ALDH2 (A/G or A/A), ADH1B (A/A) or CYP2E1(T/C or T/T) polymorphisms were all associated with worse GLSRs and GLSRe, with combined alcohol use and any given genetic variant aggravated these associations (all P < 0.05). Finally, we observed Gene-Gene synergistic effects on LV functional decline in frequent alcohol users by using linear mixed effect model (all interaction P < 0.05). Among East Asians, even moderate alcohol consumption can confer subclinical adverse effects on cardiac systolic functions, which was most pronounced in subjects carrying common variants in alcohol metabolizing genes. These findings challenge the notion of beneficial influences of less heavy ethanol consumption on the heart, especially among East Asians. This study evaluated the association of level of alcohol consumption and genetic variants in genes involved in alcohol metabolism with changes in cardiac function in East Asians. Even moderate alcohol use conferred subclinical adverse effects on cardiac systolic functions, which were most pronounced in subjects carrying common alcohol metabolizing genes.

Standard and Strain Measurements by Echocardiography Detect Early Overloaded Right Ventricular Dysfunction: Validation against Hemodynamic and Myocyte Contractility Changes in a Large Animal Model

Early detection of right ventricular (RV) failure is required to improve the management of patients with congenital heart diseases. The aim of this study was to validate echocardiography for the early detection of overloaded RV dysfunction, compared with hemodynamic and myocyte contractility assessment. Using a porcine model reproducing repaired tetralogy of Fallot, RV function was evaluated over 4months using standard echocardiography and speckle-tracking compared with hemodynamic parameters (conductance catheter). Sarcomere shortening and calcium transients were recorded in RV isolated myocytes. Contractile reserve (ΔEmax) was assessed by β-adrenergic stimulation invivo (dobutamine 5μg/kg) and exvivo (isoproterenol 100nM). Six operated animals were compared with four age- and sex-matched controls. In the operated group, hemodynamic RV efficient ejection fraction was significantly decreased (29.7% [26.2%-34%] vs 42.9% [40.7%-48.6%], P<.01), and inotropic responses to dobutamine were attenuated (ΔEmax was 51% vs 193%, P<.05). Echocardiographic measurements of fraction of area change, tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity (S') and RV free wall longitudinal systolic strain and strain rate were significantly decreased. Strain rate, S', and tricuspid annular plane systolic excursion were correlated with ΔEmax (r=0.75, r=0.78, and r=0.65, respectively, P<.05). These alterations were associated in RV isolated myocytes with the decrease of sarcomere shortening in response to isoproterenol and perturbations of calcium homeostasis assessed by the increase of spontaneous calcium waves. In this porcine model, both standard and strain echocardiographic parameters detected early impairments of RV function and cardiac reserve, which were associated with cardiomyocyte excitation-contraction coupling alterations.

Load-dependence of myocardial deformation variables - a clinical strain-echocardiographic study.

The effects of left ventricular (LV) loading on myocardial deformation variables are not well-studied in the clinical setting. In the present study, we evaluated the effects of isolated changes in preload, afterload and heart rate on LV longitudinal strain, systolic (SR-S) and early diastolic strain rate (SR-E) in post-cardiac surgery patients. Twenty-one patients were studied early after cardiac surgery. Longitudinal myocardial strain and SR were analysed off-line using 2-D speckle echocardiography. The experimental protocol consisted of three consecutive interventions: (1) preload was increased by passive leg elevation, (2) afterload was increased by an infusion of phenylephrine to increase arterial blood pressure by 10-15% and (3) heart rate was increased 10% and 20% by atrial pacing. During both the preload and afterload challenges heart rate was kept constant by atrial pacing. Central venous pressure was kept constant during pacing by infusion of hetastarch/albumin. The increase in preload increased LV strain, SR-S and SR-E by 20%, 11% and 17%, respectively. The phenylephrine-induced increase in afterload, did not affect LV strain, SR-S or SR-E. LV strain was not affected while SR-S and SR-E increased by pacing-induced heart rate increase. After cardiac surgery, systolic and early diastolic strain rate are dependent on both preload and heart rate, while neither of these variables was afterload-dependent. LV strain was preload-dependent but not affected by atrial pacing. When evaluating the direct effects of various pharmacological or other interventions on myocardial contractility and relaxation, preload and heart rate must be controlled.