Postsystolic Index Research Articles

Optimizing revascularization timing in late-presenting STEMI patients: insights from post systolic index analysis

Recent issue surrounding the need of urgent PCI for stable, late-presenting patients with ST-elevation myocardial infarction is debatable. Research indicates limited mortality benefits with reduced total ischemic time. Exploring post-systolic index (PSI) through strain echocardiography reveals its potential in assessing left ventricular recovery. We compare PSI values in late presenter STEMI patients undergoing PCI. From June to September 2023, a prospective study focused on stable late presenter STEMI patients undergoing PCI. Total ischemic time was classified as ≤ 24 hours (early intervention) and > 24 hours (late intervention). Echocardiography performed thrice: before PCI, 24 hours after PCI, and 30 days after PCI, followed by comparative analysis of PSI values. A total of 43 patients with mean age of 58 ± 7.9 years, predominantly male (74.4%). There were no significant difference in PSI values 24 hours after PCI between groups [22.5 % vs 22.0 %, p = 0.644]. At the 30-day follow-up, the result showed no difference between the two groups [13.0 % vs 13.3 %, p = 0.356]. PSI values before and after PCI showed a significant decrease (31,0 % and 23,2 % and 33,2 % vs 24,9 %, p < 0,001), as well as at the 30-day follow-up (31,0 % vs 13,2 % and 33,2 % vs 15,9 %, p < 0,001). Our findings suggest that both early and late interventions demonstrated similar beneficial outcomes in terms of myocardial recovery. Intervention in late presenter STEMI has been proven beneficial whether performed early or late.

Potential of speckle tracking echocardiography with the assessment of left ventricle myocardial work in predicting coronary artery disease in non-ST-segment elevation acute coronary syndrome

Aim. The study aimed at evaluating the role of the left ventricular (LV) longitudinal strain (LS) measurement and the left ventricle myocardial work parameters in predicting coronary artery disease (CAD), and determining the indications for early invasive diagnosis and treatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Materials and methods. The study included 51 patients aged from 41 to 93 years who were admitted at the Institute clinic with a diagnosis of NSTE-ACS. Upon admission, the risk of hospital mortality was assessed using GRACE risk score; standard echocardiography (EchoCG) and speckle tracking echocardiography (ST EchoCG) were performed to assess the LV longitudinal strain and the LV myocardial work parameters, and coronary angiography (CAG) was performed within 48 hours. The comparison group consisted of 20 volunteers without CAD.Results. According to the risk assessment with the GRACE score, the patients with low and moderate risk made 41 and 47 %, respectively. Local contractility disorders during standard EchoCG were detected in 15 patients (29 %). When analyzing regional parameters of longitudinal strain and myocardial work, the greatest prognostic value in identifying patients with hemodynamically significant changes in the coronary arteries (CAs) was demonstrated by the functional risk area (FRA) of 4 or more adjacent segments with a myocardial work index ≤1400 mmHg x% (sensitivity and specificity 84,2 and 78,1 %, AUC=0,83). In the dysfunctional segments of the risk zone in almost all patients, a paradoxical mechanism of deformation was detected in the form of post-systolic shortening with a post-systolic index (PSI) reaching a value of ≥20 % at least in one of the adjacent segments. The combination of a significant increase in PSI and the detection of FRA limited to 3 segments indicated the acuity of coronary insufficiency, hemodynamically significant stenosis (sensitivity and specificity 84 % and 79 %). When distributing patients, taking into account the data of standard EchoCG and ST EchoCG with the assessment of myocardial work, in the absence of significant disturbances in systolic function, the patients with intact main CAs or insignificant changes in the main CAs prevailed; among patients without visual impairment of contractility, the detected FRA indicated a hemodynamically significant damage of one of the main CAs; a combination of local contractility disorders and additional FRA was associated with multiple CA damage.Conclusion. The use of ST EchoCG with the assessment of myocardial work and identification of the functional risk area in NSTE-ACS patients makes it possible to predict CAD, detect patients at risk of an unfavorable outcome regardless of the GRACE risk level, determine indications for immediate invasive diagnostics, and choose the optimal method of revascularization.

Role of automated functional imaging and myocardial work in assessment of cardiac function in children with obstructive sleep apnea.

Early identification of abnormal left ventricular function in children with obstructive sleep apnea (OSA) is difficult using conventional echocardiographic indices and commonly used clinical markers of myocardial damage. We sought to investigate the value of automatic function imaging and myocardial work parameters in predicting early cardiac impairment in children having OSA with preserved left heart function and thereby identifying an optimal index for assessment. Fifty-two children who presented with symptoms of nocturnal sleep snoring and open-mouth breathing and 34 healthy controls were enrolled in this study. Clinical characteristics and conventional echocardiographic data were collected, and image analysis was performed using two-dimensional speckle-tracking echocardiography to obtain left ventricular global longitudinal strain (GLS), post-systolic index, peak strain dispersion, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. Children with OSA had significantly lower GLS, GWI, and GCW than those without (P < 0.05). Additionally, GWI (β = -32.87, 95% CI: -53.47 to -12.27), and GCW (β = -35.09, 95% CI: -55.35 to -14.84) were found to correlate with the disease severity in the multiple linear regression mode, with worsening values observed as the severity of the disease increased. ROC curve analysis revealed that GCW was the best predictor of myocardial dysfunction, with an AUC of 0.809 (P < 0.001), and the best cutoff point for diagnosing myocardial damage in children with OSA was 1965.5mmHg%, with a sensitivity of 92.5% and a specificity of 58.7%. GLS, GWI, and GCW were identified as predictors of myocardial dysfunction in children with OSA, with GCW being the best predictor.

Postsystolic shortening by speckle tracking echocardiography predicts cardiovascular events and death in the general population

Abstract Background Postsystolic shortening (PSS) have demonstrated to be a valuable predictor of contractile dysfunction in the myocardium. Our objective was to investigate the prognostic value of PSS, assessed by two-dimensional speckle tracking echocardiography (2DSTE), in relation to cardiovascular morbidity and mortality in a large general population study. Methods This prospective longitudinal study consisted of 4466 participants of the general population. The postsystolic index (PSI) was defined as follows: [(maximum strain in cardiac cycle–peak systolic strain)/(maximum strain in cardiac cycle)]×100. The endpoints were heart failure, major adverse cardiovascular events (MACEs), and all-cause mortality. Results During a median follow-up of 3,5 years, 148 participants (3.8 %) experienced MACE, 85 participants (2.2 %) were diagnosed with heart failure, and 192 (4.9 %) died. In unadjusted models, PSS was significantly associated with both MACE, heart failure and all-cause mortality. Following multivariable adjustments, PSS remained significantly associated with MACE (HR: 1.54; [95% CI, 1.04 – 2.3]; P=0.033) and heart failure (HR: 1.28; [95% CI, 1.11 – 1.49]; P &amp;lt; 0.001). PSI provided incremental prognostic value in relation to MACE (SCORE risk chart with the addition of PSI: 0.86 (0.83-0.89), P &amp;lt; 0.001) and heart failure (SCORE risk chart with the addition of PSI: 0.86 (0.83-0.89), P = 0.014. Conclusions In the general population, PSS as assessed by two-dimensional speckle tracking echocardiography independently predict the occurrence of both MACE and heart failure.Postsystolic index cubic spline curves

The diagnostic accuracy of two-dimensional strain imaging echocardiography to detect the severity of coronary artery disease in non-ST segment elevation acute coronary syndrome

ObjectiveStrain imaging by two-dimensional speckle tracking echocardiography can detect severe coronary artery disease (CAD). This study aims to assess the diagnostic accuracy of various strain parameters in patients with non-ST segment acute coronary syndrome to detect the angiographic severity of CAD and also to compare among them. MethodsThis hospital-based observational study was conducted on 178 patients with NSTEACS and preserved left ventricular ejection fraction who presented in emergency or outdoor from July 2021 to December 2022. We excluded patients with prior coronary revascularization, heart failure, arrhythmia, more than trivial valvular heart disease, or poor acoustic window. Global longitudinal strain (GLS), peak systolic strain (SS), post systolic index (PSI), and systolic strain rate (SR) were calculated by speckle tracking with automated function imaging. Coronary angiography was done in all patients, and the syntax score was calculated. ResultsThe strain parameters showed a significant correlation with the syntax score. There was a statistically significant difference in strain parameters between patients with left main (LM) or triple vessel disease (TVD) and others. Receiver operating characteristic (ROC) curve analysis showed that GLS had a better diagnostic accuracy for detecting LM or TVD than other strain parameters. GLS with a cut-off value of −11.2% had a sensitivity of 85.7% and specificity of 53.5% for detecting LM or TVD. ConclusionStrain imaging can be a helpful bedside adjunct to conventional investigations for detecting severe CAD in patients with NSTEACS.

Diagnostic potential of myocardial early systolic lengthening for patients with suspected non-ST-segment elevation acute coronary syndrome

BackgroundDuring early systole, ischemic myocardium with reduced active force experiences early systolic lengthening (ESL). This study aimed to explore the diagnostic potential of myocardial ESL in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF).MethodsOverall, 195 suspected NSTE-ACS patients with normal wall motion and LVEF, who underwent speckle tracking echocardiography (STE) before coronary angiography, were included in this study. Patients were stratified into the coronary artery disease (CAD) group when there was ≥ 50% stenosis in at least one major coronary artery. The CAD patients were further stratified into the significant (≥ 70% reduction of vessel diameter) stenosis group or the nonsignificant stenosis group. Myocardial strain parameters, including global longitudinal strain (GLS), duration of early systolic lengthening (DESL), early systolic index (ESI), and post-systolic index (PSI), were analyzed using STE and compared between groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic accuracy. Logistic regression analysis was conducted to establish the independent and incremental determinants for the presence of significant coronary stenosis.ResultsThe DESL and ESI values were higher in patients with CAD than those without CAD. In addition, CAD patients with significant coronary stenosis had higher DESL and ESI than those without significant coronary stenosis. The ROC analysis revealed that ESI was superior to PSI for identifying patients with CAD, and further superior to GLS and PSI for predicting significant coronary stenosis. Moreover, ESI could independently and incrementally predict significant coronary stenosis in patients with CAD.ConclusionsThe myocardial ESI is of great value for the diagnosis and risk stratification of clinically suspected NSTE-ACS patients with normal LVEF and wall motion.

Usefulness of post-systolic index in facilitating stratification of risk in patients with intermediate- or low-risk non-ST-segment elevation acute coronary syndrome.

Although there is reportedly a usefulness of left ventricular global longitudinal strain (LV GLS) on 2D speckle-tracking echocardiography in excluding significant coronary artery disease (CAD) in suspected intermediate- or low-risk non-ST-segment elevation-acute coronary syndrome (NSTE-ACS), the efficacy of post-systolic index (PSI) in this context is yet unknown. Therefore, we explored the usefulness of PSI in facilitating stratification of risk in patients with intermediate- or low-risk NSTE-ACS. We assessed 50 consecutive patients suspected of intermediate- or low-risk NSTE-ACS, and finally analyzed 43 patients whose echocardiographic images were suitable for strain analysis. All patients underwent CAG. Among the 43 analyzed patients, 26 had CAD, and 21 underwent percutaneous coronary intervention (PCI). Patients with CAD had higher PSI (25% [20.8-40.3%] vs 15% [8.0-27.5%], P = 0.007). Receiver-operator characteristic curve analysis identified that a PSI of > 20% detected performance of PCI (sensitivity 80.7%, specificity 70.6%, area under curve [AUC] 0.72, 95% confidence interval [CI] 0.57-0.88). Moreover, the AUC obtained using the GRACE risk score was 0.57 (95% CI 0.39-0.75), and increased to 0.75 (95% CI 0.60-0.90) when PSI and LV GLS were added. Thus, the addition of PSI and LV GLS improved the classification of performance of PCI (net reclassification improvement [95%CI] 0.09 [0.0024-0.18], P = 0.04). Post-systolic index is a useful parameter that can facilitate stratification of risk in patients with intermediate- or low-risk NSTE-ACS. We recommend measuring PSI in routine clinical practice.

Predicting Left Ventricular Myocardial Fibrosis in Patients with Hypertrophic Cardiomyopathy by Speckle Tracking Automated Functional Imaging.

The study was performed to explore the predictive value of multiple strain parameters for myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) by using speckle tracking automated functional imaging (AFI). A total of 61 patients diagnosed with HCM were finally enrolled in this study. All patients completed transthoracic echocardiography and cardiac magnetic resonance late gadolinium enhancement (LGE) within 1 month. Twenty age- and sex-matched healthy participants were included as the control group. Multiple parameters, including segmental longitudinal strain (LS), global longitudinal strain (GLS), post-systolic index and peak strain dispersion, were automatically analyzed by AFI. A total of 1458 myocardial segments were analyzed according to the left ventricular 18-segment model. Among the 1098 segments from HCM patients, segments with LGE had a lower absolute value of segmental LS than those without LGE (p < 0.05). The cutoff values of segmental LS for predicting positive LGE in the basal, intermediate and apical regions were -12.5%, -11.5% and -14.5%, respectively. GLS could predict significant myocardial fibrosis (≥2 positive LGE segments) at a cutoff value of -16.5% with a sensitivity of 80.9% and specificity of 76.5%. As an independent predictor of significant myocardial fibrosis, GLS was substantially associated with the severity of myocardial fibrosis and 5 years sudden cardiac death risk score in HCM patients. Speckle tracking AFI could efficiently identify left ventricular myocardial fibrosis in patients with HCM by multiple parameters. GLS predicted significant myocardial fibrosis at a cutoff value of -16.5%, which may indicate the adverse clinical outcomes in HCM patients.

Myocardial deformation in malignant mitral valve prolapse: A shifting paradigm to dynamic mitral valve-ventricular interactions.

This study sought to assess the value of myocardial deformation using strain echocardiography in patients with mitral valve prolapse (MVP) and severe ventricular arrhythmia and to evaluate its impact on rhythmic risk stratification. MVP is a common valvular affection with an overly benign course. Unpredictably, selected patients will present severe ventricular arrhythmia. Patients with MVP as the only cause of aborted SCD (MVP-aSCD: ventricular fibrillation and monomorphic and polymorphic ventricular tachycardia) with no other obvious reversible cause were identified. Nonconsecutive patients referred for the echocardiographic evaluation of MVP were enrolled as a control cohort and dichotomized according to the presence or absence of premature ventricular contractions (MVP-PVC or MVP-No PVC, respectively). All patients had a comprehensive strain assessment of mechanical dispersion (MD), postsystolic shortening, and postsystolic index (PSI). A total of 260 patients were enrolled (20 MVP-aSCD, 54 MVP-PVC, and 186 MVP-No PVC). Deformation pattern discrepancies were observed with a higher PSI value in MVP-aSCD than that in MVP-PVC (4.6 ± 2.0 vs. 2.9 ± 3.7, p = 0.014) and a higher MD value than that in MVP-No PVC (46.0 ± 13.0 vs. 36.4 ± 10.8, p = 0.002). In addition, PSI and MD increased the prediction of severe ventricular arrhythmia on top of classical risk factors in MVP. Net reclassification improvement was 61% (p = 0.008) for PSI and 71% (p = 0.001) for MD. In MVP, myocardial deformation analysis with strain echocardiography identified specific contraction patterns with postsystolic shortening leading to increased values of PSI and MD, translating the importance of mitral valve-myocardial interactions in the arrhythmogenesis of severe ventricular arrhythmia. Strain echocardiography may provide important implications for rhythmic risk stratification in MVP.

The Association Between Postsystolic Index and SYNTAX Score in Hospitalized Patients With Non-ST-Elevation Acute Coronary Syndrome

Objective: Non-ST-elevation acute coronary syndrome (NSTE-ACS) is a heterogeneous disorder including subgroups with a low or high risk for myocardial ischemia. The presence of postsystolic index (PSI) is associated with myocardial ischemia. The focus of this study was to find probable association between PSI and severity of coronary artery disease (CAD) in a cohort of patients. Materials and Methods: This was a cross-sectional study that consisted of 83 patients with unstable angina, non-ST-segment myocardial infarction (UA/NSTEMI), and a left ventricular ejection fraction ≥50%, without visible regional wall motion abnormalities. All patients underwent echocardiography, and global longitudinal strain (GLS), PSI, and mitral annular peak systolic (s′) and early diastolic (e′) velocities were measured. Coronary angiography was then performed, and a SYNTAX score was calculated. Results: The patient cohort was divided into two groups based on their high and low SYNTAX scores. PSI and GLS were higher in those patients with a higher SYNTAX score than in individuals with a lower score (85.04% ± 67.02% vs 46.67 ± 39.03, P = .001 and −16.09 ± 3.70 vs −17.99 ± 2.87, P = .012, respectively). Among the different variables assessed, only PSI was an independent predictor of a high SYNTAX score ( B = 1.014, 95% confidence interval [CI]: 1.001–1.027, P = .034). Conclusion: This cohort study demonstrated that a cumulative PSI may be predictive of much more complex and extensive CAD, especially in patients with UA/NSTEMI.

Post systolic shortening by speckle tracking echocardiography as a predictor for cardiovascular events in patients with type 2 diabetes

Abstract Background Post systolic shortening (PSS), measured by speckle tracking echocardiography has emerged as a novel method to evaluate left ventricular function and has been linked to adverse outcomes. Purpose Our aim was to assess if the presence of pathological PSS had prognostic value in the prediction of major cardiovascular events in a cohort of patients with type-II diabetes (T2D). Method Three-hundred-and-sixty-four patients with T2D in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care) underwent echocardiography between 2005 and 2009. All patients were evaluated with strain analysis by speckle tracking. PSS was defined as any myocardial contraction occurring after aortic valve closure (Figure 1). Pathological PSS was defined as a post systolic index (PSI) &amp;gt;5% where PSI was calculated as: (peak global longitudinal strain – peak systolic longitudinal strain) / (peak global longitudinal strain) x 100. The composite endpoint of any major cardiovascular event (MACE) was defined as the diagnosis of or death in heart failure, myocardial infarction, or stroke. Cox proportional hazard ratios (HR) with 95% confidence intervals were calculated and were adjusted for sex, age, body mass index, hypertension, smoking, previous cardiovascular events and HbA1c. Results Mean follow-up time was 11.2±2.3 years. Patients with pathological PSS had an increased unadjusted risk of MACE, (HR 3.73, 95% CI 2.06–6.76), which persisted after adjustment (HR 2.20, 95% CI 1.11–4.37) as compared to subjects without pathological PSS. When adding PSS to a risk prediction model including Global Longitudinal Strain (GLS), the adjusted HR (95% CI) for MACE was 2.94 (1.33–6.52) for subjects with reduced GLS (lower limit of normal −16%) and PSI &amp;gt;5%, compared to those with normal GLS and PSI ≤5%. Adverse events were more common in subjects with the combination of pathological PSS and GLS (Figure 2). Conclusions Our results suggest that PSS may provide important additional prognostic information in patients with T2D. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): This work was funded by grant support from FORSS, the Research Council of Southeastern Sweden and from FUTURUM, the Research Council of Jönköping.

Multi-parametric speckle tracking analyses to characterize cardiac amyloidosis: a comparative study of systolic left ventricular longitudinal myocardial mechanics

Cardiac amyloidosis (CAM), the most common cardiac storage disease is associated with significant changes in left-ventricular (LV) morphology and function. To gain particular insights into LV systolic longitudinal myocardial mechanics we investigated seven parameters derived by speckle-tracking-echocardiography (STE) in patients with confirmed CAM (n = 59). The results were compared with those of individuals with healthy heart (n = 150) and another primary myocardial disease with also thickened myocardium and severe diastolic and systolic LV-dysfunction (symptomatic LV-non-compaction-cardiomyopathy, LV-NC, n = 30). In addition to standard echocardiographical measures, the STE-derived data were evaluated and documented utilizing polar-diagrams to obtain overviews of longitudinal myocardial mechanics of the entire LV. Compared with healthy individuals, patients with CAM and LV-NC showed significantly reduced LV-ejection-fraction (EF), global longitudinal systolic peak-strain, strain-rate, and displacement. Pre-systolic stretch-index, post-systolic index, and the EF/global peak-longitudinal-strain-ratio (EF/S) were increased. In contrast to healthy-hearts and the LV-NC group only patients with CAM demonstrated significantly reduced time-to-peak systolic longitudinal strain and time-to-peak strain-rate. Although the level of the segmental values in longitudinal mechanics was significantly different between the groups, comparable intraventricular baso-apical parameter-gradients were found for systolic longitudinal peak-strain and strain-rate, pre-systolic-stretch-index, post-systolic-index, and peak systolic displacement. Compared to ATTR-amyloidosis (ATTR-CAM), patients with AL-amyloidosis (AL-CAM) demonstrated significantly lower end-diastolic and end-systolic LV-volumes, LV-mass-indices, relative apical strain, time-to-peak systolic longitudinal strain, and time-to-peak longitudinal strain-rate. CAM and LV-NC demonstrated altered myocardial mechanics with significantly different STE-derived echocardiographical parameters. ATTR-amyloidosis and AL-amyloidosis had at least significantly different time-to-peak strain, time-to-peak strain-rate and relative apical sparing values.

Post-systolic shortening is superior to global longitudinal strain in predicting adverse events in patients with stable coronary artery disease and preserved systolic function

BackgroundPost-systolic shortening (PSS) is an important indicator for early identifying myocardial dysfunction. We aimed to investigate the predictive value of PSS assessed with speckle tracking automated functional imaging (AFI) on adverse events in patients with stable coronary artery disease (CAD) and preserved systolic function.MethodsA total of 204 consecutive patients clinically diagnosed with stable CAD and left ventricular ejection fraction (LVEF) > 50% were included. Multiple parameters were analyzed with AFI technique. The composite endpoint included all-cause mortality, heart failure, myocardial infarction and stroke.ResultsDuring a median follow-up of 24 months (IQR 19–28 months), 30 patients (14.7%) reached the endpoint. Patients experiencing the endpoint had a lower absolute global longitudinal strain (GLS), a higher post-systolic index (PSI), and more left ventricle walls displaying PSS than patients without events. PSI (hazard ratio, 1.15; 95% CI, 1.04–1.27; p = 0.005) and per 1 increase in the number of left ventricle walls with PSS (hazard ratio 1.52, 95% CI 1.21–1.91, p < 0.000) were independent predictors of the endpoint, whereas GLS was not significantly associated with the endpoint after adjustment models. For patients with absolute value of GLS > 15.4%, a significant prognostic superiority was found in PSI compared with GLS (AUC = 0.73 [PSI] vs. 0.58 [GLS], p = 0.024).ConclusionsPSS is an independent predictor for adverse events in stable CAD patients with preserved systolic function, and the prognostic value may be superior to GLS in patients with normal or mildly reduced GLS.

Correlation Between Glycated Hemoglobin (HbA1c) and Post-Systolic Index Measured by Speckle-Tracking Echocardiography in Patients with Non-apparent Coronary Artery Disease.

Glycated hemoglobin (HbA1c) is a useful biomarker for the diagnosis of diabetes and also for determination of individuals with an increased risk of a severe disease. Some subtle changes in myocardial contractile function is measurable by post-systolic index (PSI) which is defined as late systolic shortening after aortic valve closure. The aim of our study was to determine the relationship between HbA1c and PSI in patients with non-apparent coronary artery disease (CAD) on angiograms. This study was a historical cohort study on 85 consecutive patients with a left ventricular ejection fraction ≥ 50% and non-apparent CAD on angiogram. Patients were divided into two groups based on their HbA1c levels, regardless of the diagnosis of diabetes in these patients, to patients with an HbA1c level of equal or higher than 5.7% and those with an HbA1c of less than 5.7%. A speckle-tracking echocardiography was performed for all patients and global longitudinal strain, PSI, left ventricular diameters, left atrial volume, pulsed-Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. PSI, E/e' ratio, and A wave were higher and e' velocity was lower in patients with HbA1c ≥ 5.7% than those with a level of < 5.7% (P value = 0.04, 0.001, 0.014, and 0.004, respectively). Other echocardiographic variables were not different between two groups. Multiple linear regression analysis showed the association between HbA1c and PSI was independent of other demographic, biochemical, and echocardiographic variables (B = 35.674, 95% CI 10.741-60.606, P value = 0.006). Our study showed PSI is more pronounced in individuals with an HbA1c > 5.7% than those with a lower value in the absence of CAD. Because PSI is an important indicator of adverse outcome and increased mortality, these data can underline the importance of an abnormal HbA1c level and its association with subtle cardiac dysfunction, irrespective of the diagnosis of diabetes in patients with non-apparent CAD.

Early systolic lengthening in patients with ST-elevation myocardial infarction: a novel tool for risk stratification

Abstract Funding Acknowledgements Type of funding sources: None. Background After an ST-elevation myocardial infarction (STEMI), the risk of subsequent cardiovascular events is high. Risk stratification at index hospitalization remains a core challenge, especially in patients with subtle changes in LV function. Early systolic lengthening (ESL) may occur in ischemic myocardial segments with reduced contractile force and it has been correlated with infarct size and prognosis in STEMI patients with mildly impaired LV function. In this study, we aimed to evaluate the correlation of ESL with common echocardiographic parameters and its prognostic value in STEMI patients with preserved LV function. Methods We retrospectively included all the patients admitted to an intensive care unit with STEMI and a left ventricle ejection fraction ≥55% from January to June of 2016. Patients with inadequate image quality for speckle tracking echocardiographic examination were excluded (n = 14). We evaluated the ESL index, defined as follows: [−100×(peak positive systolic strain/peak negative strain in cardiac cycle)], and ESL duration. Results A total of 37 patients were included in the study. Mean age was 63 ± 12 years with a male preponderance (81%). All patients were submitted to complete revascularization. Median values of the ESL index and ESL duration were 7% (IQR, 4%–10%) and 37 msec (IQR, 21–55 msec), respectively. No significant differences were found between ESL index and ESL duration groups, except for a higher prevalence of heart failure at hospitalization in both highest groups, and women were more prevalent in the ESL index higher group (Tables 1 and 2). ESL index was correlated with post-systolic index (PSI) (r2 = 0.34, p = 0.04) and showed a weak correlation with E/A ratio (r2=-0.37, p = 0.02). ESL duration was correlated with ESL index (r2 = 0.76, p &amp;lt; 0.001) and PSI (r2 = 0.43, p = 0.008). During a median follow-up of 3.2 years (interquartile range, 2.9–3.4 years), 7 (18.9%) patients experienced major adverse cardiovascular events (MACE), a composite of heart failure admission, myocardial infarction, and all-cause mortality Both ESL index (HR 2.5; 95%CI 1.2–5.3; P = 0.02) and ESL duration (HR 1.7; 95%CI 1.1–2.7; P = 0.02) were independent predictors of MACE. Both associations remained significant after adjusting for clinical confounders. Conclusions In our cohort of STEMI patients with preserved LV function, assessment of ESL yielded important and significant prognostic information on MACE. ESL may be a useful tool to enhance routine risk stratification in this population. Abstract TABLE 1 Abstract TABLE 2

Correlation relationships of myocardial work indices with left ventricular ejection fraction and postsystolic strain index in healthy individuals

Abstract Funding Acknowledgements Type of funding sources: None. Purpose to identify correlations between the indicators of the global work of the left ventricular (LV) myocardium with the ejection fraction (EF) and the post-systolic contraction index (iPSI) in healthy individuals. Methods the study included 70 healthy people: 34 men and 36 women aged 21 to 61 years (mean age 39.3 ± 8.9 years). Inclusion criteria: absence of complaints, anamnestic and physical data indicating the presence of cardiovascular diseases and / or damage to other organs and systems; ECG without significant changes; lack of regular intake of any medications. Exclusion criteria: diseases of the cardiovascular system, respiratory system, kidney, liver; type 1 and 2 diabetes mellitus; chest trauma; BMI&amp;gt; 30 kg / m2; poor visualization of the echogram. Echocardiography was performed on a Vivid GE 95 Healthcare scanner (USA). EchoPAC software version 202 (GE Healthcare) has been used. LVEF has been determined by the Simpson biplane method. The index of global myocardial work (GWI, mmHg%), global constructive work (GCW, mmHg%), global wasted work (GWW, mmHg%), global work efficiency have been assessed in automatic mode. (GWE,%). The iPSS and the number of segments, the PSS index of which was more than 1, have been automatically determined. Spearman"s correlation coefficient (r) has been used to study the relationship between quantitative traits. Results indicators of global myocardial work had the following values: GWE - 97.5 (97; 98)%; GWI - 2062.6 ± 345.5 mm Hg%; GCW - 2353.3 ± 344.6 mm Hg%; GWW - 45 (32; 68) mm Hg%. LVEF on average 60.8 ± 4.6%, iPSS - 1.35 (0.73; 2.35). The average number of segments with iPSS&amp;gt; 1 - 4 (3; 6) (26.5%). The correlation coefficient of LVEF with GCW was 0.49 (p = 0.00001), with GWI - 0.45 (p = 0.00007), with GWE - 0.25 (p = 0.032), with GWW - (-0 , 19) (p = 0.1). Correlation coefficient of iPSS with indicators of myocardial work: with GWE - (-0.85) (p = 0.0007), with GWW - 0.85 (p = 0.00004), with GCW - (-0.05) (p = 0.68), with GWI - 0.07 (p = 0.5). When determining the relationship between the number of segments with iPSS&amp;gt; 1 and GWE, the correlation coefficient was 0.46 (p = 0.0002), with GWW - 0.57 (p = 0.0003), with GWI - 0.26 (p = 0 , 03), with GCW - 0.12 (p = 0.3). Conclusions GCW and GWI had moderate positive correlations with LVEF. GWE and GWW had a strong relationship with iPSS and moderate correlations with the number of segments with iPSS&amp;gt; 1.

Diagnostic value of postsystolic shortening of the left ventricular myocardium assessed during speckle tracking stress echocardiography on the treadmill in patients with coronary artery disease.

Aim To evaluate the diagnostic capacity of left ventricular (LV) postsystolic shortening (PSS) values obtained by speckle-tracking stress-echocardiography (stress-EchoCG) using a treadmill test in determining the functional significance of the degree of coronary artery (CA) stenosis.Material and methods The study included 132 patients (80 men aged 65.0±9.3 years) with suspected or previously verified diagnosis of ischemic heart disease. Stress-EchoCG with the treadmill test was performed for all patients. Strain parameters were determined by two-dimensional speckle-tracking on gray-scale images before and after the exercise. Values of LV postsystolic index (PSI) and LV mean postsystolic time (PST) were calculated. Coronary angiography was performed for all patients. Patients were divided into 3 groups based on the severity of CA stenosis according to the G. G. Gensini score.Results LV PSS values at rest did not significantly differ between the patient groups. After completion of the exercise, the mean LV PSI was significantly higher for patients with pronounced CA stenosis than in the group without CA stenosis or with moderate CA stenosis: 8.9 % [3.8; 10.7 %] vs. 3.8 % [2.2; 6.8 %] (p=0.012) and 3.4 % [2.2; 6.2 %] (p=0.012), respectively. The mean LV PSI after completion of the exercise indicated the presence of pronounced CA stenosis with a sensitivity of 75 % and a specificity of 61 % (area under the curve, AUC, 0.74±0.06; р&lt;0.001). After completion of the exercise, the mean LV PST was significantly greater for patients with pronounced CA stenosis than in the group without CA stenosis or with moderate CA stenosis: 27.4 [18.7; 34.7] ms vs. 18.4 [10.8; 26.5] ms (p=0.036) and 20.9 [14.2; 29.5] ms (p=0.036), respectively. The mean LV PST after completion of the exercise exceeding 23.5 ms suggests pronounced CA stenosis with a sensitivity of 71 % and a specificity of 65 % (AUC 0.69±0.06; p=0.004). A complex evaluation of the LV PSI, the LV local contractility disorder (LCD) index, the LV PST, and LV LCD index allows enhancement of the test sensitivity in diagnozing pronounced CA stenosis.Conclusion Determination of LV PSS in speckle-tracking stress-EchoCG may be useful for evaluating the functional significance of the degree of CA stenosis to enhance the sensitivity of stress-EchoCG in patients with pronounced CA stenosis.

Two-dimensional speckle tracking echocardiography derived post systolic shortening in patients with unstable angina and normal left ventricular systolic function.

Post systolic shortening (PSS) had been shown to be sensitive in detecting ischemia on stress echocardiography. This work aims to study the diagnostic potential of resting PSS and post systolic index (PSI) in patients with suspected unstable angina (UA). Total of 159 participants with suspected UA without any wall motion abnormalities were recruited. They all underwent speckle tracking echocardiography (STE) and coronary angiogram (CAG). Global longitudinal strain (GLS), presence or absence of pathological PSS, PSI17 and PSI12, PSI in left anterior descending, left circumflex and right coronary artery territories were assessed. Based on CAG those who had more than 70% stenosis were labelled to have obstructive CAD. Obstructive disease was noted in 54.7% patients. The prevalence of PSS (62.1% Vs 13.9%), mean PSI17 (5.4 Vs 3.3) and PSI12 (6.2 Vs 3.7) were significantly higher in those with CAD compared to patients without obstructive disease. Both PSS (Odds ratio-10.145; 95% CI, 4.577-22.489; p=0.001) and PSI17 (odds ratio-1.217;95 CI, 1.064-1.393; p=0.004) were predictors of CAD by multivariate regression analysis. PSS had a sensitivity of 62.1% and specificity of 86.1% with a positive predictive value of 84.4%. PSI17 (area under curve- 0.637; p=0.003) and PSI12 (AUC- 0.661; p=0.001) have moderate accuracy in identifying obstructive CAD. In patients presenting with suspected UA, STE derived PSS has reasonable sensitivity and good specificity in diagnosis of obstructive CAD. Patients identified to have PSS can be subjected to CAG without further stress testing because of its high positive predictive value.

New Indicators of Myocardial Work in Healthy Individuals

Aim. To study in healthy individuals the gender and age characteristics of left ventricular (LV) myocardial work indicators, their correlations with global LV deformity indicators and echocardiographic parameters characterizing LV systolic and diastolic functions.Materials and methods. 70 Healthy individuals (n=70; 34 men and 36 women; aged 39.3±8.9 years) were included in the study. The echocardiographic examination determined the standard parameters and indicators of myocardial work: global work efficiency (GWE), global constructive work (GCW), global wasted work (GWW), global myocardial work index (GWI); as well as the myocardium deformation characteristics: global longitudinal deformation (GLS), global radial deformation (GRS) and global circular deformation (GCS). Spearman's correlation coefficient was used to investigate the relationship between parameters. A correlation was considered weak at r≤0.3, moderate at 0.3&lt;r&lt;0.7, and strong at r≥0.7.Results. The average value of global work efficiency (GWE) in men was 97% (96; 98), in women – 98% (97; 98). Global constructive work (GCW) in men was 2343.8±350.4 mm Hg%, in women – 2362.2±343.8 mm Hg%. The average value of global wasted work (GWW) in men was 46 mm Hg% (27; 75), in women – 44 mm Hg% (33; 55.5). The global myocardial work index (GWI) in men was 2069.9±356.4 mm Hg%, in women – 2055.7±339.9 mm Hg%. No significant differences were found in the comparative analysis of performance indicators. The analysis of correlations found that the myocardial work indicators didn't have significant correlations with age. Ejection fraction was moderately correlated with GWI (r=0.45) and GCW (r=0.49). Global longitudinal strain was strongly correlated with GWI (r=0.77) and GCW (r=0.77). Global radial strain correlated moderately directly with GWI (r=0.4) and GCW (r=0.4). Global circular strain was moderately correlated with GCW (r=0.35). A strong negative correlation was found between the GWE indicator and the post systolic contraction index (PSI) (r=-0.85). At the same time, PSI and GWW had a strong positive correlation (r=0.85).Conclusion. Indicators of LV myocardial work in healthy individuals do not have gender differences. The efficiency of the work of the myocardium depends primarily on the deformation of the LV, while the constructive work is determined by the volume characteristics. The wasted work indicator depends on the number of segments that peak in the post-systolic period.

The effect of external counterpulsation on intrinsic myocardial function evaluated by speckle tracking echocardiography in refractory angina patients: a randomized controlled trial.

External Counterpulsation (ECP) is one of the therapeutic options in patients with refractory angina inadequately controlled by medical, interventional, or surgical therapy. The 2D Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement. We would like to evaluate any improvement ofmyocardial intrinsic function using 2D-STE in patients underwent standard ECP protocol (35 sessions). We conducted a double-blind randomized controlled trial. Patients with refractory angina who could not be revascularized conventionally were randomized into two groups: (1) the ECP group (300mmHg) and (2) the Sham/control group (75mmHg). ECP standard therapy was given for 35 sessions (1h/day/session). The 2D-STE data, including longitudinal strain and post systolic index (PSI) were obtained before and after therapy. 43 subjects were analyzed, with 22 subjects in ECP group and 21 control subjects (Sham group). A homogenous baseline strain was found either globally (12.42 ± 4.55 vs 12.00 ± 4.92 [-%]; P = 0.774) or segmentally/regionally (12.63 (0.01-25.16) vs 12.43 (0.01-27.20) [-%]; P = 0.570). There was no statistically significant improvement between groups in the left ventricle longitudinal strain globally (P = 0.535) and segmentally/regionally (P = 0.434). PSI parameters showed improvement in the ECP group (P = 0.049), and segments with PSI ≥ 20% seemed to improve longitudinal strains in the ECP group after therapy (P = 0.042). In conclusion, 35 ECP therapy sessions did not improve either global or segmental/regional left ventricular mechanical function in patients with refractory angina.However, the mechanical function of myocardial segments with PSS tends to improve after ECP therapy.