Myocardial Tissue Doppler Research Articles

High-Resolution Tissue Doppler and Strain Imaging for Adult Zebrafish Myocardial Tissue Through Ultrafast High-Frequency Ultrasound Vector Doppler Estimation.

Zebrafish has been considered as an essential small-animal model for investigating the mechanism of heart regeneration. Due to the small size of zebrafish heart, high-frequency ultrasound (HFUS) imaging is often required for in vivo evaluations of its dynamic functions. Although commercial HFUS systems are available for myocardial velocity and strain measurement, only the outer myocardial region can be quantified due to the complex structure of zebrafish heart. In this study, a high-resolution 2-D myocardial tissue Doppler and strain imaging based on ultrafast HFUS imaging was developed for zebrafish heart imaging during heart regeneration. The cardiac flow region was first extracted to recognize the myocardial region, and the myocardial velocity and strain were then determined through vector Doppler estimation. Adult AB-line zebrafish was used for in vivo experiments, and cryoinjury was induced in the apical region of the heart. Both the myocardial velocity and strain of the whole ventricle after cryoinjury were directly visualized over 28 days. Myocardial velocity (during later diastolic motion) and strain, respectively, were significantly decreased (anterior wall: -2.0 mm/s and -3.3%; apical region: -2.0 mm/s and -4.5%; and posterior wall (PW): -1.7 mm/s and -4.3%) at the first three days after cryoinjury, which indicates weak myocardial beating due to heart injury. However, these all returned to the baseline values at 14 days after cryoinjury. All of the experimental results indicate that the proposed method is a useful tool for heart regeneration studies in adult zebrafish. In particular, it allows for the noninvasive evaluation of regional dynamic heart function.

Mitral annular disjunction and mitral valve prolapse extrapolating adult data to an adolescent cohort?

The aim of this study is to provide an update on mitral valve prolapse (MVP) and mitral annular disjunction (MAD) and who may be at risk for ventricular arrhythmias and sudden cardiac death. MVP is generally considered a benign condition. However, a small subset of patients may be at risk for life-threatening ventricular arrhythmias. Among the risk factors identified in adults include patients with bileaflet mitral valves, myxomatous changes, myocardial fibrosis, and the presence of MAD. Advances in multimodal imaging have allowed for improved identification of fibrosis, anatomical valve derangements, and the amount of MAD. Recent guidelines have suggested that patients with MVP with or without MAD may be at risk for life-threatening arrhythmias if they have had prior ventricular arrhythmias, ventricular dysfunction, or unexplained syncope. Yet, extrapolation of adult data to a pediatric cohort with similar MVP and MAD at this juncture is challenging. There is, however, early evidence that some pediatric patients with significant myocardial fibrosis or abnormal tissue Doppler may be at risk for ventricular tachycardia. Mitral valve prolapse and mitral annular disjunction at times coexist and at other times can be seen as isolated entities. While the incidence of arrhythmic MVP is quite rare, there is increasing evidence that certain select adults with MVP may be at risk for ventricular tachycardia and sudden cardiac death. Future multicenter studies are needed to better understand the natural history of arrhythmic mitral valve disease and how early disease manifestation in children may impact findings now being reported in young adults.

Left Atrial Function Predicts Atrial Arrhythmia Recurrence Following Ablation of Long-Standing Persistent Atrial Fibrillation.

Left atrial (LA) function following catheter or surgical ablation of de-novo long-standing persistent atrial fibrillation (AF) and its impact on AF recurrence was studied in patients participating in the CASA-AF trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation). All patients underwent echocardiography preablation, 3 and 12 months post-ablation. LA structure and function were assessed by 2-dimensional volume and speckle tracking strain measurements of LA reservoir, conduit, and contractile strain. Left ventricular diastolic function was measured using transmitral Doppler filling velocities and myocardial tissue Doppler velocities to derive the e', E/e', and E/A ratios. Continuous rhythm monitoring was achieved using an implantable loop recorder. Eighty-three patients had echocardiographic data suitable for analysis. Their mean age was 63.6±9.7 years, 73.5% were male, had AF for 22.8±11.6 months, and had a mean LA maximum volume of 48.8±13.8 mL/m2. Thirty patients maintained sinus rhythm, and 53 developed AF recurrence. Ablation led to similar reductions in LA volumes at follow-up in both rhythm groups. However, higher LA emptying fraction (36.3±10.6% versus 27.9±9.9%; P<0.001), reservoir strain (22.6±8.5% versus 16.7±5.7%; P=0.001), and contractile strain (9.2±3.4% versus 5.6±2.5%; P<0.001) were noted in the sinus rhythm compared with AF recurrence group following ablation at 3 months. Diastolic function was better in the sinus rhythm compared with the AF recurrence group with an E/A ratio of 1.5±0.5 versus 2.2±1.2 (P<0.001) and left ventricular E/e' ratio of 8.0±2.1 versus 10.3±4.1 (P<0.001), respectively. LA contractile strain at 3 months was the only independent predictor of AF recurrence. Following ablation for long-standing persistent AF, improvement in LA function was greater in those who maintained sinus rhythm. LA contractile strain at 3 months was the most important determinant of AF recurrence following ablation. URL: https://www. gov; Unique identifier: NCT02755688.

Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study.

The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12h (D1) and 48-72h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e' was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e' (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography. Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure. What is Known: •Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension. What is New: •Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.

Systolic function in dogs with pulmonic stenosis of different severities and the effect of balloon valvuloplasty

Introduction/objectivesPulmonic stenosis (PS) is one of the most common congenital heart diseases in dogs leading to right ventricular (RV) pressure overload, myocardial remodeling, and potential RV dysfunction. Our objectives were to investigate the extent of RV systolic dysfunction in canine PS and to examine the immediate influence of balloon valvuloplasty (BV) on systolic function. Animals, materials and methodsThis prospective study evaluated 72 dogs with PS and 86 healthy dogs. Echocardiographic parameters of systolic function included normalized tricuspid annular plane systolic excursion (N-TAPSE), normalized systolic myocardial tissue Doppler velocity of the lateral tricuspid annulus (N-RVFW-S′), fractional area change, and speckle-tracking longitudinal endocardial RV strain. Forty-four dogs underwent BV and were re-examined after surgery. ResultsSystolic function at the basal segment of the RV was significantly lower in the PS group when compared to healthy dogs (mean N-TAPSE 4.29 ± standard deviation 1.18 mm/kg0.285 vs. 5.60 ± 1.29 mm/kg0.285; median N-RVFW-S′ 5.28 [lower-upper 25% quantile 4.35–6.43 cm/s/kg0.186] vs. 7.82 [6.73–8.79 cm/s/kg0.186]; all P<0.001). Global longitudinal RV endocardial strain showed no significant difference between the two groups (−28.50 ± 6.23% vs. 28.61 ± 4.64%; P=0.886), but segmental strain analyses revealed basal hypo- and potential compensatory hyperkinesis of the apical RVFW. Furthermore, BV affected most parameters of systolic function, but not the segmental strain values and N-TAPSE. ConclusionsRight ventricular basal longitudinal systolic function is decreased in dogs with PS in comparison to a healthy cohort. Regional and global function does not necessarily coincide.

Evaluation of Myocardial Tissue Doppler Echocardiography as a Predictor for Recovery of Left Ventricular Function after Percutaneous Coronary Revascularization for Patients with Coronary Artery Disease

Evaluation of Myocardial Tissue Doppler Echocardiography as a Predictor for Recovery of Left Ventricular Function after Percutaneous Coronary Revascularization for Patients with Coronary Artery Disease

KORONER ARTER BYPASS GREFT CERRAHİSİ SONRASI KARDİYOPULMONER REHABİLİTASYON VE NÖROMÜSKÜLER ELEKTRİK STİMÜLASYONUN FONKSİYONEL KAPASİTE, MİYOKARDİAL DOKU DOPPLERİ ÜZERİNDEKİ KISA DÖNEM ETKİLERİ

Purpose: Exercise capacity is associated with diastolic function. The aim of our study is to investigate the short term effects of cardiopulmonary rehabilitation and NMES on functional capacity and myocardial tissue doppler (MTD) after coronary artery surgery.&#x0D; Methods: Forty patients with coronary artery bypass graft were randomly divided into two groups: CPR+NMES and CPR. Functional capacity were analyzed through 2 minutes walk test (2MWT) and sit to stand test (SST), left ventricular (LV) diastolic functions were analyzed with MTD and thoracic expansion was analyzed with chest wall measurement on the 2nd and 7th postoperative days.&#x0D; Results: Statistically significant difference was identified between the groups in 2MWT distance (CPR+NMES, Zt*p=0.000*), SST (CPR, Zt*p=0.000*), E’ (CPR+NMES, Zt*p=0.002*), E (CPR+NMES, Zt*p=0.025*), E/E’ (CPR+NMES, Zt*p=0.007*), A (CPR, Zt*p=0.006*) (p

Evaluation of Echocardiographic Parameters for the Prediction of Prognosis in Patients Diagnosed with Pulmonary Arterial Hypertension

Background: We aimed to determine the importance of myocardial tissue Doppler flow rates, pulmonary artery/aorta diameter (PA/Ao), pulmonary venous flow transit time (pPTT), pulmonary artery acceleration time (PAAcTc), and right atrium area index (RAAI) parameters in the prediction of prognosis patients with a diagnosis of pulmonary arterial hypertension (PAH). Materials and Methods: : This retrospective study was done on 30 patients with systemic pulmonary arterial hypertension confirmed via catheterization who had negative vascular reactivity test results (pediatric patients with primary pulmonary hypertension and secondary pulmonary hypertension due to congenital heart disease). PA/Ao diameter, PAAcTc, pPTT, and RAAI were calculated. The patients were grouped as those with PA/Ao , SaO2% , and pro-B-type natriuretic peptide (BNP) , and those receiving combination therapy or monotherapy, and the parameters were compared between the groups. Results: pPTT was shorter in the group with SaO2 > 90%, which was attributed to the high number of patients with idiopathic PAH in this group and more severe PAH stage. PAAcTc was shorter in patients who showed no clinical improvement on monotherapy and required multidrug therapy. RAAI was significantly increased in patients with pro-BNP > 100 pg/ml. A decreased pPTT, accompanied by a lower PAAcTc in the group with PA/Ao >1.5, indicated the severity of PAH in this group. Conclusion: When managing PAH patients, the presence of RAAI > 18 cm2/m2, PA/Ao > 1.5, and PAAcTc < 80 msn indicates a higher disease severity, and suggested that the patients’ treatment regimen should be re-evaluated based on these parameters. Also, the RAAI parameter shows the closest association with pro-BNP levels, which is one of the correct prognosis indicators.

Ivabradine for Treatment of Heart Failure with Preserved Ejection Fraction

Aim To evaluate the effect of combination ivabradine-containing therapy for chronic heart failure (CHF) with preserved ejection fraction on quality of life (QoL) and the primary composite endpoint during a one-year follow-up.Material and methods This study included 160 patients aged 45 to 65 years with NYHA functional class (FC) II-III CHF with preserved left ventricular ejection fraction (CHF-PEF) and grade I and II diastolic dysfunction associated with FC III stable angina with sinus rhythm and a heart rate (HR) higher than 70 bpm. Presence of CHF-PEF was confirmed by results of echocardiography and myocardial tissue Doppler imaging. During one year of prospective observation, effects of bisoprolol and ivabradine as a part of the combination therapy on the primary composite endpoint, including death from cardiovascular complications (CVC) and hospitalizations for myocardial infarction (MI) or CHF, were evaluated in patients with CHF-PEF. Patients were randomized to three groups: A, bisoprolol with dose titration from 2.5 to 10 mg; В, combination of bisoprolol 2.5-10 mg and ivabradine 10-15 mg/day; and С, ivabradine 10-15 mg/day. All patients were on a chronic background therapy, including angiotensin-converting enzyme inhibitors (lisinopril) or, if not tolerated, angiotensin II receptor blockers (valsartan), antiaggregants, statins (atorvastatin, rosuvastatin), and short-acting nitrates as required. If edema developed diuretics were added. The follow-up duration was one year.Results After 12 weeks of follow-up, the achievement of goal HR in group A was associated with a tendency to increased distance in the 6-min walk test from 279±19 to 341±21 m (р&gt;0,05); in group B the distance increased from 243±25 to 319±29 m (р&lt;0.05); and in group C the distance increased from 268±21 to 323±22 m (р&lt;0.05). In the combination ivabradine and bisoprolol treatment group, results of the 24-h electrocardiogram monitoring showed a more pronounced anti-ischemic effect associated with a decrease in the number of myocardial ischemic episodes (p&lt;0.05). QoL was evaluated with the Minnesota questionnaire against the background of treatment. At 12 weeks of observation, the total score decreased from 44.5±2.6 to 38.4±2.1 in group A; from 45±2.9 to 38±2.2 in group B; and from 50.9±3.2 to 42.7±2.8 in group C (р&lt;0.05). The risk of acute MI and repeated hospitalization for CHF during the year of observation, as evaluated according to the Kaplan-Meier method, decreased in both bisoprolol and ivabradine combination treatment groups.Conclusion The inclusion of bisoprolol and ivabradine into the background therapy of CHF-PEF patients with stable IHD provided an improvement of QoL and a decrease in the risk of hospitalization for acute MI and CHF during the year of observation.

Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation

BackgroundPatent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm.MethodsProspective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort.DiscussionThe current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in “high-risk” infants most likely to receive benefit.Trial registrationClinicalTrials.gov NCT03782610. Registered 20 December 2018.

Reference ranges for left, right and interventricular septum indices at 20 to 36+6 weeks of gestation derived using spectral myocardial tissue Doppler on Voluson ultrasound machines.

To establish reference range values for peak myocardial tissue Doppler velocity (MTD) and myocardial performance index (MPI) of the left ventricle (LV), the right ventricle (RV), and the interventricular septum (IVS) at 20 to 36+6 weeks of gestation using spectral tissue Doppler. This cross-sectional study was conducted among 360 lowrisk singleton pregnancies. MTD during systole (S'), and early (E') and late diastole (A'), and MPI' were assessed by placing sample volume at the basal segment of the LV free wall, the RV free wall, and the IVS, respectively. Polynomial regression was used to obtain the best-fit curves for MTD and MPI' measurements as a function of gestational age (GA), and adjustments were made using the determination coefficient (R2). Intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC). All MTD velocities (cm/s) progressively increased with advancing GA (p<0.0001). Mean LV MTD values were 4.19 to 6.86 for S', 3.52 to 7.22 for E', and 6.85 to 9.19 for A'; mean RV MTD were 4.85 to 7.97 for S', 4.49 to 8.66 for E', and 8.44 to 11.20 for A'; and mean IVS MTD values were 3.75 to 5.78 for S', 3.34 to 5.79 for E', and 5.88 to 7.98 for A'. LV MPI', RV MPI', and IVS MPI' did not significantly change with advancing GA. The CCC values for MTD were predominantly greater than 0.70, while those for MPI' were <0.70. Reference values for the fetal MTD and MPI' of RV, LV and IVS using tissue Doppler between 20 and 36+6 weeks of gestation were described.

Intervendor Discordance of Fetal and Neonatal Myocardial Tissue Doppler and Speckle-Tracking Measurements

Fetal and neonatal studies report a wide range of cardiac parameters derived by pulsed-wave Doppler tissue imaging (DTI) and two-dimensional speckle-tracking echocardiographic (STE) imaging. The use of different ultrasound systems and their vendor-specific software compromises the ability to compare echocardiographic findings among various studies. The aim of this study was to evaluate intervendor reproducibility as well as intra- and interobserver repeatability of DTI and STE measurements in normal-term fetuses and neonates. A prospective study was conducted of term fetuses (n=196) from uncomplicated pregnancies assessed days before the onset of labor and a few hours after birth. Fetal and neonatal DTI and STE parameters were obtained and analyzed using vendor-specific software on three ultrasound systems: Toshiba Aplio MX versus GE Vivid E9 and GE Vivid E9 versus Philips EPIQ. A reproducibility study in fetuses and neonates (n=118) was performed by systematic scanning with head-to-head comparison. DTI reproducibility showed moderate to good correlation, with good agreement for fetuses and neonates on Toshiba versus GE (intraclass correlation coefficient [ICC]=0.4-0.8). Correlation of DTI measurements on GE versus Philips was poor to moderate for fetuses (ICC=0.1-0.6) and moderate to good for neonates (ICC=0.5-0.8), with wider limits of agreement. Fetal and neonatal STE parameters revealed very poor correlation (ICC=0.1-0.3) and agreement among ultrasound vendors. Intra- and interobserver repeatability demonstrated good to excellent correlation of all fetal and neonatal DTI and STE measurements, with good agreement irrespective of the ultrasound platform used. These findings demonstrate reliable assessment of fetal and neonatal DTI and STE measurements when performed on the same ultrasound platform, whereas ultrasound machines and software from different vendors give significantly divergent estimates of DTI and STE parameters in fetuses and neonates. These intervendor discrepancies have significant clinical and research implications and should be considered when interpreting and comparing study findings, establishing reference standards, or performing systematic reviews.

Limited contribution of left ventricular mass and remodelling to the impact of blood pressure on diastolic function in a community sample.

Although the development of left ventricular (LV) dysfunction in hypertension has traditionally been viewed as a transition process from a phase of structural LV remodelling to dysfunction, the extent to which LV mass (LVM) and remodelling account for blood pressure (BP)-associated alterations in LV diastolic function is uncertain. In product of coefficient mediation analysis, we aimed to determine the extent to which LVM index (LVMI) or relative wall thickness (RWT) account for relations between BP and LV diastolic function. In 709 randomly selected participants from a community sample with a high prevalence of hypertension (49.6%), we determined BP and LVMI, RWT and several indices of diastolic function from transmitral blood flow and myocardial tissue Doppler (E/A, e'/a', e' and E/e') and left atrial volume using standard echocardiographic techniques. With adjustments for confounders, LVMI (P < 0.001-0.0001) and RWT (P < 0.05-0.001) were independently associated with E/A, e'/a', e' and E/e'. However, in product of coefficient mediation analysis, LVM and RWT failed to account for most BP-associated changes in diastolic function. Indeed, whilst a one SD increase in DBP or SBP (13 and 22 mmHg, respectively) translated into a 0.07, 0.13 and 0.53 decrease in E/A, e'/a', e' and a 0.73 increase in E/e', respectively, in mediation analysis LVMI accounted for only 0.0005, 0.0017, 0.05 and 0.08 of the impact of a one SD effect of LVMI on E/A, e'/a', e' and E/e', respectively. Similar contributions of RWT as for LVMI to BP-associated LV diastolic functional changes were noted and the contribution of LVMI or RWT to BP-related alterations in diastolic function was similar in those participants not receiving antihypertensive therapy. Although structural LV remodelling is independently associated with changes in LV diastolic function, LVMI and RWT account for only a minor proportion of the impact of BP on diastolic function. Thus, most BP-associated decreases in LV diastolic function are likely to be a transition process independent of LV hypertrophy or concentric remodelling.

Histopathology of the right ventricular outflow tract and the relation to hemodynamics in patients with repaired tetralogy of Fallot

ObjectiveTo evaluate the relationship between myocardial histopathology and tissue Doppler imaging (TDI) variables of the right ventricle and postoperative peak systolic right-to-left ventricular pressure ratio (Prv/Plv) in patients undergoing intracardiac repair for tetralogy of Fallot (TOF). MethodsOperatively resected crista supraventricularis muscle specimens from 93 patients undergoing intracardiac repair for TOF, aged 18 months to 26 years (mean, 7.02 ± 5.35 years) were subjected to light microscopy. TDI-derived parameters between the normal and abnormal categories of myocardium, the evolution of Prv/Plv, and its relationship to TDI-derived variables were tested using generalized linear random effects model using xtreg command. ResultsThe incidence of myocyte hypertrophy, myocytolysis, and perivascular fibrosis was 89.2%, 83.8%, and 77.4%, respectively. Although tricuspid annular peak systolic excursion, peak myocardial velocity during systole (s′), and early diastolic basal lengthening of right ventricle (e′) continued to improve among patients with myocardial hypertrophy, myocytolysis, and perivascular fibrosis, there was an absence of improvement of the late diastolic relaxation of right ventricular free wall (a′) in patients with perivascular fibrosis. Although there was improvement of postoperative Prv/Plv in patients with myocardial fibrosis as compared with normal histology, the values were not statistically significant (β [standard error] −0.07 [0.08], P = .3). ConclusionsThe great majority of myocardial tissues in cyanotic TOF indicate pre-existing hypertrophic, degenerative, and fibrotic changes. Perivascular fibrosis affects the diastolic compliance of the right ventricle and may account for the absence of improvement of late diastolic relaxation (a′) and greater postoperative Prv/Plv in the absence of a residual surgical lesion.

Can Doppler echocardiography estimate raised pulmonary capillary wedge pressure provoked by passive leg lifting in suspected heart failure?

Non-invasive estimation of left ventricular filling pressure (LVFP) during stress is important for explaining exertional symptoms in patients with heart failure (HF). The aim of this study was to evaluate ability of Doppler echocardiographic measures of elevated LVFP with passive leg lifting (PLL) in patients with suspected HF. Twenty-nine patients with clinical signs of HF who underwent simultaneous Doppler echocardiography and right heart catheterization (RHC) at rest and during PLL were consecutively investigated. Seventeen patients had normal PCWP (≤15mmHg) at rest and during PLL and 12 with normal PCWP at rest but >15mmHg with PLL. Conventional echo and 2D strain were used to assess early diastolic blood flow velocity (E), LV strain rate during early diastole (LVSRe), left atrial SR during atrial contraction (LASRa) and myocardial tissue Doppler velocities to assess lateral e' and further calculate E/e' and E/LVSRe and their relationship with PCWP, at rest and during PLL. Resting LAVI (β=0·45, P=0·009) and LASRa (β=-0·51, P=0·004) were independently related to PCWP during PLL. Also, LASRa (β=-0·77, P<0·001), E/e' (β=0·40, P=0·04) and E/LVSRe (β=0·47, P=0·021) during PLL correlated with PCWP during PLL. Multiple regression analysis identified E/LVSRe (β=0·46, P=0·001) and LASRa (β=-0·58, P=0·002) during PLL as being independently associated with PCWP during PLL. Left atrial volume and myocardial contraction (LASRa) at rest both predict unstable LV filling pressures measured as raised PCWP when provoked by PLL. Furthermore, LASRa at PLL seems to have the strongest association to PCWP during PLL.

Prevalence and predictors of right ventricular diastolic dysfunction in peripartum cardiomyopathy.

This study aimed to assess the prevalence of right ventricular diastolic dysfunction (RVDD) and its potential predictors in peripartum cardiomyopathy (PPCM) patients. This was a cross-sectional study carried out in Nigeria. RVDD was defined and graded using Doppler filling and myocardial tissue Doppler velocities obtained at tricuspid annular level. Forty-three subjects with PPCM and mean age of 26.6±7.0years were recruited over 6months. RVDD was found in 30 (69.8%) subjects, of whom 16 (53.3%) had gradeI, 12 (40.0%) had gradeII and 2 (6.7%) had gradeIII severity. RV systolic dysfunction (RVSD), defined as RV fractional area change <35%, was found in 88.4%, while combined RVSD and RVDD was found in 58.1% of patients. Subjects with RVDD had significantly higher tricuspid E/e' ratio (5.1±2.8 versus 3.5±1.0, p=0.012) and prevalence of pulmonary hypertension (76.7 versus 46.2%; p<0.05), and lower serum selenium concentration (55.6±12.1 versus 72.5±12.0µg/L, p=0.001) than those with preserved RV diastolic function. Regression analyses showed serum selenium [odds ratio (OR)=1.14; 95% confidence interval (CI)=1.0-1.3; p=0.049] and combined RVSD and pulmonary hypertension (OR=79.2; CI=3.9-1593.7; p=0.004) as the only predictors of RVDD, and serum selenium <70µg/L increased the odds of RVDD by 6.67-fold (CI=1.18-37.78; p=0.032). Both RVDD and RVSD were common in PPCM patients. Selenium deficiency and combined RVSD and pulmonary hypertension seemed to be the only determinants of RVDD in this small cohort, a finding that needs verification in a larger sample of patients.

Accuracy of Clinical Symptoms, Electrocardiographic and Echocardiographic Parameters for Diagnosis of Significant Proximal Right Coronary Artery Lesion in Acute Inferior Wall Myocardial Infarction

&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim&lt;/strong&gt;: Tissue Doppler (TDI) systolic annular velocity (S') and myocardial performance index may be useful predictors of proximal right coronary artery (RCA) stenosis as a culprit lesion in Inferior wall myocardial infaection in association with clinical symptoms and ECG changes. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In a prospective study, patients with first episode of acute IWMI underwent early conventional and tissue Doppler echocardiographic assessment (within 24 h) of symptom onset and RV indices ; Tricuspid annular systolic plane excursion(TAPSE), myocardial performance index (MPI) and tissue Doppler velocities from RV free wall were measured. Patients underwent coronary angiogram within one month, our Patients divided into two groups(A,B) according to angiographic findings based on the presence or absence of a significant proximal RCA stenosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; Results&lt;/strong&gt;: There were 35 patients with first episode of IWMI, group A includes (n 14 patient) and group B includes (n 21patient), There was significant difference between groups in TAPSE (1.28cm vs 1.98 p &amp;lt; 0.001) ,MPI-TDI (0.69±0.12 vs 0.38±0.05 p &amp;lt; 0.001), and in S'velocity from RV free wall ( 0.09m/s±0.02 vs 0.12m/s ±0.02 p &amp;lt; 0.001). It was found that S'&amp;lt;10cm/s is apredictor of proximal RCA lesion with sensitivity of 92.86% and specificity of 85.71%ppv 81.25, npv 94.74 , MPI-TDI&amp;gt;0.55 with a sensitivity of 92.86 % and specificity of 100% ,100% PPV and 95.45% NPv, and TAPSE&amp;lt;16mm (sensitivity93%, specificity100%).&lt;/p&gt;&lt;p&gt; &lt;strong&gt;Conclusion&lt;/strong&gt;; RV indices (S' velocity, MPI-TDI and TAPSE ) are useful in predicting proximal RCA as infarct related artery in IWMI.&lt;/p&gt;

Tissue Doppler tricuspid annular motion in acute inferior wall myocardial infarction and infarction related artery

BackgroundPatients with inferior wall myocardial infarction (IWMI) associated with right ventricular (RV) infarction have much higher rates of adverse events. AimTissue Doppler (TDI) systolic annular velocity (S′) and myocardial performance index may be useful predictors of proximal right coronary artery (RCA) stenosis as a culprit lesion in inferior wall myocardial infarction. MethodsIn a prospective study, patients with first episode of acute IWMI underwent early conventional and tissue Doppler echocardiographic assessment (within 24h) of symptom onset and RV indices; Tricuspid annular systolic plane excursion(TAPSE), myocardial performance index (MPI) and tissue Doppler velocities from RV free wall were measured. Patients underwent coronary angiogram within one month and were divided into two groups (A, B) according to angiographic findings based on the presence or absence of significant proximal RCA stenosis. ResultsThere were 35 patients with first episode of IWMI, group A includes (n 14 patients) and group B includes (n 21patients), There was significant difference between groups in TAPSE (1.28cm vs 1.98 p<0.001), MPI–TDI (0.69±0.12 vs 0.38±0.05 p<0.001), and in S′ velocity from RV free wall (0.09m/s±0.02 vs 0.12m/s±0.02 p<0.001). It was found that S′<10cm/s is a predictor of proximal RCA lesion with a sensitivity of 92.86% and a specificity of 85.71%ppv 81.25, npv 94.74, MPI–TDI>0.55 with a sensitivity of 92.86% and a specificity of 100%, 100%ppv and 95.45%npv, and TAPSE<16mm (sensitivity 93%, specificity 100%). ConclusionRV indices (S′ velocity, MPI–TDI and TAPSE) are useful in predicting proximal RCA as infarct related artery in IWMI.

OC11_01 Predictive Value of Frequent Premature Ventricular Complexes During Exercise Testing, on Long-Term Combined Arrhythmia Outcome

Introduction: Peripartum cardiomyopathy (PPCM) is an important cause of morbidity and mortality in Northern Nigeria and many other parts of the world. Although right ventricular (RV) systolic dysfunction was found to be common in PPCM, RV diastolic dysfunction (RVDD) and its determinants have not been previously described. Objectives: To assess RVDD and its predictors in PPCM patients. Methods: This cross-sectional study was carried out in 3 referral hospitals in Kano, Nigeria. Consecutive newly diagnosed PPCM patients who had satisfied the inclusion criteria were recruited. RVDD was defined and graded using its Doppler filling and myocardial tissue Doppler velocities obtained at the tricuspid annular level. Results: Forty three subjects with PPCM of mean age 26.6 7.0 years were recruited over 6 months. RVDD was found in 30 (69.8%) subjects, of whom 16 (53.3%) had grade I, 12 (40.0%) had grade II and 2 (6.7%) had grade III severity. In comparison, subjects with RVDD had significantly higher tricuspid E/e’ ratio(5.1 2.8 vs 3.5 1.0, p1⁄40.012) and lower serum selenium concentration (55.6 12.1 vs 72.5 12.0 mg/L, p1⁄40.001) than those with preserved RV diastolic function. Logistic regression analysis showed serum selenium as the only predictor of RVDD. A decrease in serum selenium by 0.131 mg/L increased the odds of RVDD by 14% (odds ratio1⁄41.14; 95% confidence interval (CI) 1⁄41.03-1.26; p1⁄40.009). Also, serum selenium <70 mg/L increased the odds of RVDD by 6.67 fold (CI1⁄41.18-37.78; p1⁄40.032). Furthermore, serum selenium only correlated with RV ‘A’ filling wave (Spearman’s correlation coefficient 1⁄4 -0.392; p1⁄40.027), suggesting that selenium deficiency is related to impaired RV relaxation in late diastole. Conclusion: RVDD is common in PPCM patients, and seems to be related to serum selenium levels, deficiency of which appears to be related to impaired late diastolic RV relaxation. Disclosure of Interest: None Declared

Myocardial Tissue Doppler Velocity in Child Growth.

BackgroundIn adults, tissue Doppler imaging (TDI) is a recommended component of routine echocardiography. However, TDI velocities are less accepted in pediatrics, due to their strong variability and age dependence in children. This study examines the distribution of myocardial tissue Doppler velocities in healthy children to assess the effect of age with cardiac growth on the various echocardiographic measurements.MethodsTotal 144 healthy children were enrolled in this study. They were recruited from the pediatric outpatient clinic for routine well-child visits. The statistical relationships between age and TDI values were analyzed. Also, the statistical relationships between body surface area (BSA) and TDI values, left ventricle end-diastolic dimension (LVEDD) and TDI values were analyzed. Also, we conducted multivariate analysis of cardiac growth parameters such as, age, BSA, LVEDD and TDI velocity data.ResultsAll of the age, BSA, and LVEDD had positive correlations with deceleration time (DT), pressure half-time (PHT), peak early diastolic myocardial velocity, peak systolic myocardial velocity, and had negative correlations with peak late diastolic velocity (A) and the ratio of trans-mitral inflow velocity to early diastolic velocity of mitral annulus (E/E'). In the multivariate analysis, all of the age, BSA, and LVEDD had positive correlations with DT, PHT, and negative correlations with A and E/E'.ConclusionThe cardiac growth parameters related alterations of E/E' may suggest that diastolic myocardial velocities are cardiac growth dependent, and diastolic function has positive correlation with cardiac growth in pediatric group. This cardiac growth related myocardial functional variation would be important for assessment of cardiac involvement either in healthy and sick child.