Regional Diastolic Function Research Articles

The effect of iron deficiency anemia on myocardial function in pediatrics

BackgroundIron deficiency is one of the most common types of anemia in children. Anemia leads to tissue hypoxia, which activates compensatory mechanisms such as increased cardiac output. Tissue Doppler imaging (TDI) is a useful echocardiographic technique for evaluation of regional and global myocardial systolic and diastolic function. ObjectivesThis study aimed to determine whether iron deficiency anemia (IDA) affects myocardial function in pediatric patients using conventional echocardiography and TDI. MethodsThis case-control study was conducted at an outpatient general pediatric clinic in cooperation with the Cardiology Unit of the Pediatric Department of Fayoum University Hospital from May 2021 to February 2022. The study included 30 cases with IDA and 30 apparently healthy children. The two study groups were matched for age and sex. ResultsThere was an increase in left ventricular end-diastolic diameter (LVEDD), while the control group showed increased ejection time (ET). There was a statistically significant lower mean E/A ratio among cases. There was a positive correlation between serum iron levels, ET, and isovolumetric contraction time (IVCT) among the cases. Additionally, there was a negative correlation between hemoglobin levels and LVEDD in the entire study group. No significant difference was found between the two study groups regarding the Tei index. ConclusionMinimal alterations in LV function parameters may occur due to IDA. A decrease in serum iron levels was significantly associated with further decreases in ET and IVCT. Additionally, there was a statistically significant lower mean E/A ratio among cases.

Serial RV wall stress measurements: association with right ventricular function in repaired Tetralogy of Fallot patients

BackgroundOptimal timing of pulmonary valve replacement (PVR) in Tetralogy of Fallot (TOF) patients remains challenging. Ventricular wall stress is considered to be an early marker of right ventricular (RV) dysfunction.ObjectivesTo investigate the association of RV wall stresses and their change over time with functional parameters in TOF patients.MethodsTen TOF patients after surgical repair with moderate/severe pulmonary regurgitation were included. At two timepoints (median follow-up time 7.2 years), patient-specific computational biventricular models for wall stress assessment were created using CMR short-axis cine images and echocardiography-based RV pressures. RV ejection fraction (RVEF), NT-proBNP and cardiopulmonary exercise tests were used as outcome measures reflecting RV function. Associations between regional RV diastolic wall stress and RV function were investigated using linear mixed models.ResultsIncreased wall stress correlated with lower RV mass (rrm = −0.70, p = 0.017) and lower RV mass-to-volume (rrm = −0.80, p = 0.003) using repeated measures. Wall stress decreased significantly over time, especially in patients with a stable RVEF (p < 0.001). Higher wall stress was independently associated with lower RVEF, adjusted for left ventricular ejection fraction, RV end-diastolic volume and time since initial surgery (decrease of 1.27% RVEF per kPa increase in wall stress, p = 0.029) using repeated measurements. No association was found between wall stress, NT-proBNP, and exercise capacity.ConclusionsUsing a computational method to calculate wall stress locally in geometrically complex ventricles, we demonstrated that lower wall stress might be important to maintain ventricular function. RV wall stress assessment can be used in serial follow-up, and is potentially an early marker of impending RV dysfunction.

Sudden cardiac death in myocarditis

According to statistics, myocarditis is one of the leading causes of sudden cardiac death (SCD) in children and young adults. The etiology of myocarditis includes infectious and non-infectious, including autoimmune diseases, as well as toxicities and hypersensitivity to various drugs or bites of insects, spiders, snakes, etc. The risk of myocarditis among patients with COVID-19 is 15.7-fold higher than that in the general population. The most common cause of death in myocarditis is heart arrhythmia, such as ventricular tachyarrhythmia, ventricular fibrillation, or severe bradycardia. Genetic predisposition, ion and metabolic disorders, mechanisms of autoimmune response, and direct cardiotoxic action in viral diseases play a role in the pathophysiology of inflammatory myocardial damage. While the majority of patients with myocarditis, who died suddenly, was asymptomatic or had few symptoms, a timely and accurate diagnosis of myocarditis seems to be an important challenge for prevention or minimization of SCD risk. Nonetheless, at present there is no convincing evidence of an association between laboratory and instrumental parameters and the SCD risk in such patients. Endomyocardial biopsy remains the "golden standard" in the diagnosis of myocarditis. Biomarkers (troponins or creatine phosphokinase) are not highly specific. The most common electrocardiographic findings in myocarditis are sinus tachycardia and nonspecific changes in the ST-T segment. The presence of Q wave, bundle branch block, Brugada syndrome, shortened or prolonged QT interval, and early ventricular repolarization are associated with an increased risk of SCD in myocarditis. Given the absence of specific echocardiographic signs of myocarditis, special attention is paid to the assessment of the size of the cardiac chambers, wall thicknesses, global and regional systolic and diastolic function of both the left and right ventricles, visualization of pericardial effusion and intracardiac thrombi. A combined cardiac magnetic resonance imaging using T2-weighted imaging and early and late gadolinium enhancement provides high diagnostic accuracy and seems to be a useful tool in the stratification of patients with suspected acute myocarditis. With the established etiology of myocarditis, specific therapy is necessary to eliminate the pathogen. It is necessary to take into account the likely arrhythmogenic effects of the drugs used in treatment. Non-steroidal anti-inflammatory drugs are generally not indicated in patients with myocarditis because they cause renal impairment and sodium retention, which can exacerbate left ventricular dysfunction and increase the risk of SCD. In the case of severe conduction disturbances and ventricular tachyarrhythmias, implantation of a pacemaker or cardioverter-defibrillator is necessary.

#5221 PULMONARY HYPERTENSION: AN IMPORTANT RISK FACTOR IN CARDIOVASCULAR MORTALITY IN DIALYSIS PATIENTS

Abstract Background and Aims It is widely known that chronic dialysis patients experience significantly higher cardiovascular (CV) death rates than the overall population. Among other CV risk factors, recent research has shown pulmonary hypertension (PH) as a consequence of chronic kidney disease and end-stage renal failure. The present study aimed to determine the risk factors that impact survival in chronic haemodialysis and peritoneal dialysis patients and to analyse the correlation of these factors with pulmonary hypertension. Method We studied 125 stable haemodialysis and peritoneal patients (females 40%, mean age 52.42 ±11.88 years) on RRT for more than three months with a two-year follow-up. Demographic information, clinical characteristics, blood tests, and a thorough echocardiographic evaluation were collected at the optimal dry weight. After conventional echocardiographic examination, a tissue Doppler echocardiographic (TDE) examination was performed to evaluate the global and regional myocardial systolic and diastolic functions and pulmonary hypertension. Systolic pulmonary artery pressure (sPAP) of 35 mmHg was used to define PH. Results The cardiovascular mortality rate was 15.5%. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E', and PP, the AUC was 0.76, 0.75, 0.72, respectively, while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. The mean PH was 33.46±5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP), and E/E’ average, the lower left ventricular ejection fraction (EF), the peak systolic velocity at the lateral mitral annulus (MASa), and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found to be predictors of PH. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001. Conclusion Our research demonstrates that cardiovascular morbidity and death in dialysis patients are mainly attributed to pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy. PH is common among dialysis patients. Inflammation, CKD-MBD biomarkers linked to systolic and diastolic left and right ventricular dysfunction, and inflammation all influence it. These conditions are all connected. Cardiovascular imaging is simple to use, offers a favourable viewpoint in the early identification of cardiac abnormalities and quick treatment of this disease, and is thus strongly advised in the dialysis population.

Novel Approaches to Imaging the Pulmonary Vasculature and Right Heart.

There is an increased appreciation for the importance of the right heart and pulmonary circulation in several disease states across the spectrum of pulmonary hypertension and left heart failure. However, assessment of the structure and function of the right heart and pulmonary circulation can be challenging, due to the complex geometry of the right ventricle, comorbid pulmonary airways and parenchymal disease, and the overlap of hemodynamic abnormalities with left heart failure. Several new and evolving imaging modalities interrogate the right heart and pulmonary circulation with greater diagnostic precision. Echocardiographic approaches such as speckle-tracking and 3-dimensional imaging provide detailed assessments of regional systolic and diastolic function and volumetric assessments. Magnetic resonance approaches can provide high-resolution views of cardiac structure/function, tissue characterization, and perfusion through the pulmonary vasculature. Molecular imaging with positron emission tomography allows an assessment of specific pathobiologically relevant targets in the right heart and pulmonary circulation. Machine learning analysis of high-resolution computed tomographic lung scans permits quantitative morphometry of the lung circulation without intravenous contrast. Inhaled magnetic resonance imaging probes, such as hyperpolarized 129Xe magnetic resonance imaging, report on pulmonary gas exchange and pulmonary capillary hemodynamics. These approaches provide important information on right ventricular structure and function along with perfusion through the pulmonary circulation. At this time, the majority of these developing technologies have yet to be clinically validated, with few studies demonstrating the utility of these imaging biomarkers for diagnosis or monitoring disease. These technologies hold promise for earlier diagnosis and noninvasive monitoring of right heart failure and pulmonary hypertension that will aid in preclinical studies, enhance patient selection and provide surrogate end points in clinical trials, and ultimately improve bedside care.

Trans-endocardial delivery of progenitor cells to compromised myocardium using the "needle technique"and risk of myocardial injury.

Recent analysis from CHART-1 study indicated that the therapeutic effects of trans-endocardial cardiopoetic cell transplantation in chronic ischemic heart failure (iCHF) may be lost with an increasing number of injections perfomed to deliver therapeutic cells. To evaluate global and regional contractility and diastolic function of the left ventricle of patients with iCHF who received trans-endomyocardial cardiopoietic stem cells (CSCs) delivery or sham procedures. The study included patients (mean age: 60.8 ±7.1 years) with iCHF (left ventricular ejection fraction (LVEF) < 35%) and a history of hospitalization for worsening heart failure within 12 months despite optimal medical therapy. The patients underwent transmyocardial CSCs transplantation using perforated needle technique or a sham procedure. The wall motion score index (WMSI), LVEF, transmitral E-velocity, E-wave deceleration time, E/A-ratio, and E/e'-mean value were measured with two-dimensional echocardiography on days 1 and 30. A total of 170 segments were analyzed, including 48 targeted segments where 92 injections of 0.5 ml of CSCs were performed. In the transendocardial injections cohort, a decrease in regional contractility was observed in 30.6% (26/85) and 18.9% (16/85) of the segments on days 1 and 30, respectively. This was accompanied by an increase in WMSI by 0.32 ±0.06 and 0.19 ±0.18 (day 1, p = 0.02, day 30, p = 0.03) and a reduction in LVEF (-3.15 ±1.23%, p = 0.065). Transendocardial injections performed to deliver therapeutic cells were associated with myocardial injury. This adverse effect remained, albeit at a lesser degree, at 30-days. Mechanical injury with trans-endocardial delivery of progenitor cells using the "needle technique" may counterbalance, at least in part, any cell-related benefit(s).

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Abstract 12017: Correlates of Regional Diastolic Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction

Introduction: The underlying mechanisms of regional myocardial dysfunction in patients with heart failure with preserved ejection fraction (HFpEF) remain poorly defined. Hypothesis: We investigated physiological correlates of regional diastolic dysfunction in HFpEF using a novel technique based on point-by-point measurement of local diastolic delay. Methods: We enrolled 30 patients with HFpEF (LVEF &gt;50%, E/e' &gt;15, NT-proBNP &gt;300 pg/ml). In all patients we performed electroanatomical mapping of the left ventricle and assessed regional diastolic function by a novel algorithm based on the measurement of local diastolic delay. Local diastolic delay was considered significant if the time delay between global left ventricular end diastolic time and local diastolic time was &gt;50 msec. At the time of mapping, we performed clinical evaluation, echocardiography and measured plasma levels of 27 biomarkers of angiogenesis and endothelial dysfunction. Results: Our cohort included 23 male and 7 female patients, aged 46-70 years. Using electroanatomical mapping we measured regional diastolic function in 4820 mapping points. The mean local diastolic delay was &gt;50 msec in 12 patients (Group A), and &lt;50 msec in 18 patients (Group B). The groups did not differ in age (64±11 years in Group A vs. 51±8 years in Group B, P=0.22), gender, (male: 83% vs. 73%, P=0.48), creatinine (1.08±0.31 mg/dL vs. 1.10±0.30 mg/dL, P=0.52), LVEF (56±4% vs. 58±7%, P=0.42), or NT-proBNP levels (1570±1310 pg/mL vs. 1230±1240 pg/mL, P=0.22). However, in Group A, we found higher values of E/e’ (18.2±3.4 vs. 17.0±2.8 in Group B, P=0.04), and lower myocardial viability (unipolar voltage: 7.73±1.8 mV vs. 9.03±2.1 mV, P=0.02). When compared to Group B, patients in Group A displayed lower levels of pro-angiogenic biomarkers (vascular endothelial growth factor: 33±22 pg/mL vs. 47±24 pg/mL, P=0.01; platelet-derived growth factor: 47±23 pg/mL vs. 78±34 pg/mL, P=0.02), and higher levels of anti-angiogenic biomarkers (agiopoietin-2: 7.0±3.8 ng/mL vs. 2.7±1.0 ng/mL, P=0.01; endostatin: 87±33 ng/mL vs. 65±21 ng/mL, P=0.02). Conclusion: In patients with HFpEF, regional diastolic dysfunction appears to be associated with increased E/e’, decreased myocardial viability, and impaired angiogenesis.

Influence of selective stimulation of the right ventricle on electric and mechanical myocardial disynchrony

Relevance. Prolonged apical stimulation of the right ventricle can lead to the development of interventricular and intraventricular dyssynchrony. Selective (alternative) stimulation of various parts of the interventricular septum due to a more physiological propagation of the excitation wave makes it possible to prevent the deterioration of the mechanical function of the myocardium associated with constant pacing.Purpose. To study the dynamics of indicators of electrical and mechanical ventricular dyssynchrony in the traditional (apical) and alternative with the installation of a right ventricular electrode in the interventricular septum or the outlet tract of the right ventricle in patients with constant pacing in the early and late postoperative period.Materials and methods. Were included 73 patients (mean age 61.0 ± 2.5 years) with indications for continuous cardiac pacing without signs of heart failure above 2 FC according to NYHA and previous Q-forming myocardial infarction. Patients of group 1 (n = 39) were implanted with a pacing ventricular electrode in the middle section of the interventricular septum (subgroup 1A, n = 25) or in the outflow tract of the right ventricle (subgroup 1B, n = 14). The control group 2 included 34 patients with electrode implantation in the apex of the right ventricle.Results. The time of pre-ejection from the right and left ventricles before and after implantation did not differ in group 1 and significantly differed in group 2 (25 ± 3 ms and 50 ± 6 ms, p &lt; 0.05). There was no significant difference in the parameters of ventricular remodeling between the groups within 2 years, but there was a tendency towards a lower value of the left ventricular ejection fraction (59 ± 6 % and 50 ± 2 %, p = 0.05) and a higher frequency of mitral regurgitation 2 degree and higher in patients in the apical stimulation group. Within the group of alternative stimulation, after 2 years of follow-up, there was a tendency towards a smaller value of the delay time of systolic contraction between the basal segments of the free wall of the right ventricle and the interventricular septum during stimulation of the outflow tract compared with stimulation of the middle part of the interventricular septum (30 ± 8 ms and 38 ± 10 ms , p = 0.05).Conclusions. Alternative stimulation of the right ventricle compared with the apical is characterized by a lower degree of interventricular dyssynchrony both immediately after surgery and in the long-term period. New echocardiographic technologies, including tissue myocardial Doppler ultrasonography, make it possible to quantify the indicators of systolic and diastolic myocardial function and various parameters of dyssynchrony.Conclusion. To assess the physiology, clinical efficacy and safety of the new method of stimulating the interventricular septum, a more thorough study of the severity of intra- and interventricular dyssynchrony, indicators of global and regional systolic and diastolic function of the left and right ventricles is necessary.

Prevalence of the presystolic wave in echocardiography and its association with the extent of coronary artery disease in patients with chronic stable angina.

Since mortality and morbidity of coronary artery disease are high, there is a need for non-invasive diagnostic methods for early diagnosis and prediction of ischemic heart disease (IHD) outcome. This study aimed to assess the relationship between angiographic findings, the Presystolic wave (PSW) and some of the ischemic related parameters in echocardiography of the patients with chronic stable angina. This cross-sectional study was conducted on the patients with chronic angina pectoris who referred to a tertiary hospital for coronary angiography in Mashhad, Iran. Demographic and medical history of the patients, as well as echocardiography findings, including ejection fraction (EF), regional wall motion abnormalities (RWMA), PSW and diastolic function were recorded. Angiographic findings, including SYNTAX score were also assessed. A total of 220 patients (132 males and 88 females) with the mean age of 62.43±11.40years old participated in this study. The prevalence of PSW was 49.1%. The absence of the PSW was related to more RWMA (P=.002), and higher stages of left ventricular diastolic dysfunction (LVDD) (P=.029) and higher SYNTAX score (P=.001). There was a significant association between the absence of the PSW and EF categories, especially in severe LV systolic dysfunction (LVEF<30%) (P=.001). The findings of this study revealed that PSW is strongly associated with the SYNTAX score. The absence of the PSW may indicate patients at high-risk clinical status (higher SYNTAX score, severe systolic dysfunction, more RWMA, and higher stages of LVDD).

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Recovery of regional systolic and diastolic myocardial function after acute myocardial infarction evaluated by two-dimensional speckle tracking echocardiography.

The assessment of temporal changes in systolic and diastolic regional left ventricle function by two-dimensional speckle tracking echocardiography (STE) after successful reperfusion therapy of acute myocardial infarction (AMI). A total of 97 consecutive patients admitted with AMI and treated with successful percutaneous coronary intervention were included in this study. On days 1, 2, 3, 7, 30 and 180 following admission patients underwent transthoracic echocardiography with subsequent measurement of systolic longitudinal strain (SLS), systolic longitudinal strain rate (SRS) and early diastolic longitudinal strain rate (SRe) in left ventricular segments by speckle tracking technique. The largest increase in regional SLS and SRS was observed between day 1 and 2. On days 3, 7, 30 and 180 further improvement was noticeable, but the changes were less significant. The highest prognostic value among STE parameters for predicting systolic function recovery after 6-month-long follow-up was achieved by measuring SLS on day 3 (area under the curve=0·878). The most of regional systolic function recovery occurs within the first 2days. The recovery of regional diastolic function takes longer - the most significant part of improvement occurs within the first 7days. STE parameters have prognostic value for predicting the improvement of systolic function after 180days.

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Improvement of regional myocardial diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention as assessed by strain rate imaging

Exercise Echocardiography in Children

Exercise echocardiography has been widely used in adult cardiology, and is mainly used for assessing regional myocardial function in patients with known or suspected coronary artery disease. In addition, it is also useful in the evaluation of the haemodynamic significance of valve disease, such as aortic stenosis and mitral regurgitation. In children, exercise echocardiography has found its place in the detection of ischaemia in patients with coronary artery abnormalities such as Kawasaki disease, and abnormal origin of coronary arteries. Other indications include assessment of haemodynamic and myocardial response in patients with different types of congenital heart disease, the early detection of myocardial dysfunction in specific populations such as patients after chemotherapy exposure. The incorporation of tissue Doppler and strain imaging with exercise echocardiography has allowed a more quantitative analysis of regional and global systolic and diastolic function.

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

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

Predictive Value of Dobutamine Stress Perfusion Echocardiography in Contemporary End-Stage Liver Disease.

BackgroundThe assessment of cardiac risk in contemporary liver transplantation (LT) has required more sensitive testing for the detection of occult coronary artery disease as well as microvascular and functional cardiac abnormalities. Because dobutamine stress perfusion echocardiography provides an assessment of both regional systolic and diastolic function as well as microvascular perfusion (MVP), we sought to examine its incremental value in this setting.Methods and ResultsWe evaluated the predictive value of dobutamine stress perfusion echocardiography in 296 adult patients with end‐stage liver disease and preserved systolic function who underwent LT between 2008 and 2014. The primary outcome was cardiovascular death, nonfatal myocardial infarction, and/or sustained ventricular arrhythmias following LT. The main causes of liver failure were hepatitis C (25%) and nonalcoholic fatty liver disease (13%). Abnormal MVP during stress was observed in 18 patients (6%), whereas diastolic dysfunction was present in 109 patients (94 grade 1, 15 grade 2). Half of the patients (7 of 14) referred for angiography with abnormal MVP had significant epicardial disease by angiography, and these patients were revascularized prior to LT. Despite these interventions, the primary outcome still occurred in 9 patients (3%). Patients with abnormal MVP during dobutamine stress perfusion echocardiography had a 7‐fold higher risk of a cardiovascular event following LT. Cox proportional hazards modeling examining clinical variables, left ventricular ejection fraction, diastolic function, and stress‐induced wall motion abnormalities or MVP defects demonstrated that abnormal MVP was the only independent predictor of the primary outcome (P=0.004; hazard ratio 7.7).ConclusionsStress MVP assessments are highly predictive of cardiovascular outcome in current LT candidates.

Characterisation of Myocardial Injury via T1 Mapping in Early Reperfused Myocardial Infarction and its Relationship with Global and Regional Diastolic Dysfunction.

Cardiovascular magnetic resonance (CMR) advances in imaging techniques, permits the ability to accurately characterise tissue injury post myocardial infarction. Pre-contrast T1 mapping enables this through measurement of pre-contrast T1 relaxation times. We investigate the relationship between T1 characterisation of myocardial injury with global and regional diastolic function. Revascularised acute myocardial infarction patients with normal left ventricular (LV) systolic function on TTE were assessed by 1.5T CMR. Acute regional diastolic wall motion abnormalities, global diastolic function measurements, acute segmental damage fraction with LGE and mean segmental pre-contrast T1 values were assessed on matching short axis slices. Forty-four patients were analysed. Mean LVEF was 62.1±9.4%. No difference between NSTEMI (22/44) and STEMI in mean pre-contrast T1 values of infarcted (1025.0±109.2 vs 1011.0±81.6ms, p=0.70), adjacent (948.3±45.3 vs 941.1±46.6ms, p=0.70) and remote (888.8±52.8 vs 881.2±54.5ms, p=0.66) segments was detected. There was no correlation between pre-contrast T1 of infarcted segments with global diastolic dysfunction (E/A, r2=0.216, p=0.06; S/D, r2=0.243, p=0.053; E/E', r2=0.240, p=0.072), but there was significantly positive, moderate correlation with circumferential diastolic strain rate, (r2=0.579, p<0.01) with excellent agreement and reproducibility. Cardiac magnetic resonance evaluation of pre-contrast T1 values revealed no difference between NSTEMI and STEMI patients in terms of tissue characterisation post-myocardial infarction. However, pre-contrast T1 of infarcted tissue is significantly correlated with regional diastolic circumferential strain rate.

Stress echocardiography in paediatric cardiology.

Stress echocardiography is a well-established technique in adult cardiology and is mainly used for assessing regional myocardial function in patients with known or suspected coronary artery disease (CAD). Apart from detecting ischaemia, stress echocardiography has found its place in the assessment of the haemodynamic significance of valve disease, particularly in selected patients with aortic stenosis and mitral regurgitation. Also in the paediatric population, stress imaging is most commonly used for the detection of ischaemia in patients with CADs such as post heart transplantation, Kawasaki Disease, and abnormal origin of coronary arteries. Other paediatric indications include the haemodynamic and myocardial response in patients with different types of congenital heart disease, the early detection of myocardial dysfunction in specific populations such as patients after anthracycline exposure, and the evaluation of pulmonary artery pressures and the right ventricular functional response. Techniques have evolved over time and in different paediatric echocardiographic laboratories, exercise stress echocardiography is replacing dobutamine stress echocardiography in older children. Moreover, integrating tissue Doppler and strain technology with stress imaging allows a more quantitative analysis of regional and global systolic and diastolic function. Current clinical applications mainly include patients after transplant, suspected CAD, and hypertrophic cardiomyopathy.

Assessment of risk factors and left ventricular function in patients with slow coronary flow

Slow coronary flow (SCF) is characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. Life-threatening arrhythmias and sudden cardiac death can occur; however, the pathological mechanism and influence on left ventricular function remain undetermined. We aimed to assess the risk factors and left ventricular (LV) function in SCF and evaluate the relationships between thrombolysis in myocardial infarction frame count (TFC) and the number of involved coronary arteries with LV function in patients with SCF. We included 124 patients who underwent coronary angiography because of symptoms of angina; 71 patients with angiographically proven SCF and 53 cases with normal coronary flow pattern. SCF was diagnosed as TFC >27 in at least one coronary artery. Complete blood count and biochemical parameters were compared between the two groups. Conventional echocardiography and tissue Doppler imaging were used to assess LV systolic and diastolic function. Platelet aggregation rate induced by ADP was an independent predictor of SCF and positively correlated with coronary artery mean TFC (mTFC) (r = 0.514, P < 0.001) and the number of coronary arteries with SCF (r = 0.628, P < 0.001). Early diastolic mitral inflow velocity (E) (0.66 ± 0.15 vs. 0.74 ± 0.17, P = 0.008), ratio of early to late diastolic mitral inflow velocity (E/A) (0.95 ± 0.29 vs. 1.15 ± 0.35, P = 0.002), global myocardial peak early diastolic velocity (gVe) (4.41 ± 1.25 vs. 4.96 ± 1.45, P = 0.037), and ratio of global myocardial peak early to late diastolic velocity (gVe/gVa: 1.09 ± 0.45 vs. 1.36 ± 0.58, P = 0.006) were decreased in patients with SCF compared with controls. gVe (3 vs. 0 branches, 4.08 ± 1.14 vs. 4.97 ± 1.45, respectively, P = 0.008) deteriorated significantly in patients with SCF involving three coronary arteries. mTFC negatively correlated with E and E/A (r = -0.22, P = 0.02; r = -0.20, P = 0.04, respectively). The number of coronary arteries with SCF negatively correlated with E, E/A, gVe and gVe/gVa (r = -0.23, P = 0.02; r = -0.25, P = 0.009; r = -0.25, P = 0.008; r = -0.21, P = 0.03, respectively). Platelet aggregation rate induced by ADP was an independent predictor of SCF and positively correlated with coronary artery TFC and the number of affected coronary arteries. Left ventricular global and regional diastolic function was impaired in SCF patients. Furthermore, the number of coronary arteries involved rather than coronary artery TFC determined the severity of left ventricular dysfunction in patients with SCF.

Comparison of magnetic resonance feature tracking with harmonic phase imaging analysis (CSPAMM) for assessment of global and regional diastolic function

AimsComplex post-processing is required for strain-derived assessment of diastolic dysfunction (DD) using CMR-tagging (TAG). Feature-tracking (FT), allows for rapid systolic strain assessment using conventional steady-state free precession (SSFP)-Cine sequences. Aim of this study was to investigate whether FT may be employed for the clinically applicable quantification of DD. Methods and Results40 individuals (20 patients with DD I-III°, 20 controls) were investigated. CSPAMM and SSFP-Cine sequences were acquired in identical short-axis locations. Global and regional early diastolic strain rate (EDSR), peak diastolic strain rate (PDSR), twist, untwist and torsion were calculated from tagged and SSFP-Cine datasets. DD indices were compared, intra- as well inter-observer variability assessed. Resultsfor global EDSR correlated strongly (r=0.94), revealed good agreement and no significant differences between both methods. Correlation for regional EDSR was lower, results differed significantly in the anterior wall (p<0.05). Correlation for PDSR was moderate (r=0.63), results in the healthy control group differed significantly (p<0.05). FT derived rotational indices correlated poorly with TAG (twist: r=0.28; untwist: r=0.02; torsion: r=0.26), subgroup analysis revealed significant differences (p<0.05). Intra- and inter-observer variability for FT derived global EDSR and PDSR were comparable to TAG, but significantly higher for regional EDSR and rotational indices. ConclusionFT derived global EDSR allows for rapid clinical determination of diastolic dysfunction, revealing good agreement with TAG and low intra- as well as interobserver variability. However, TAG analysis not only yields higher accuracy and reproducibility of global- and regional diastolic strain, but also delivers reliable information about diastolic rotational and untwisting dynamics.