Role Of Speckle Tracking Echocardiography Research Articles

Role of Speckle Tracking Echocardiography in the Assessment of Subclinical Left Ventricular Dysfunction in Post COVID-19 Patients

Background: The utilization of two-dimensional speckle-tracking echocardiography (2-D STE) serves as a precise measurable technique for conducting an assessment of both global and localized cardiac performance, exhibiting remarkable sensitivity. Its utility is particularly noteworthy in the early identification of cardiac impairments that are not clinically evident. This study’s objective was to investigate the effectiveness of STE in identifying latent left ventricular dysfunction among individuals who have recuperated from COVID-19. Methods: This study was conducted at a single center; this analytical cross-sectional analysis involved 100 individuals over the age of 18. The study comprised two cohorts: one with 50 post COVID-19 patients, confirmed through a positive PCR test within a month of diagnosis, and a control group of 50 healthy subjects be compatible for age, sex, and risk factors. Subsequently, the post COVID-19 patients were stratified based on high-sensitivity troponin levels into two subgroups: Group I included those exhibiting signs of myocardial damage, while Group II consisted of patients showing no evidence of myocardial injury. Results: Elderly individuals, a greater prevalence of hypertension (HTN), raised levels of D-dimer and, serum C-reactive protein (CRP) along with increased Left ventricular end-diastolic volume (LVEDV) and diminished Left ventricular global longitudinal strain (LVGLS) over a one-month observation period, were all significantly linked to myocardial injury, as indicated by a p-value < 0.05. The LVGLS was a reliable indicator of cardiac injuries in COVID-19 survivors, with an AUC of 0.947 and a CI ranging from 0.886 to 1.00 (P < 0.001), particularly at a threshold of ≤ -20%, where it achieved 87.2% sensitivity and 100% specificity. Approximately 35 patients exhibited an LVGLS below this threshold. Furthermore, D-dimer and CRP levels post COVID-19 were notably elevated in those with cardiac injuries in comparison with those not, a difference that was statistically significant (P < 0.05). Furthermore, during the follow-up after one month period, post COVID-19 CRP levels, LVEDV, and LVGLS remained significantly higher in patients with myocardial injury in comparison with those didn’t have myocardial injury (p < 0.05). Conclusions: LV GLS is acknowledged as a noteworthy, autonomous predictor of outcome for myocardial injury in individuals diagnosed with COVID-19. This metric offers preliminary insights into the infection’s severity, potentially aiding in the early intervention and management strategies for affected patients.

The Role of Speckle Tracking Echocardiography in the Evaluation of Advanced-Heart-Failure Patients.

Health care is currently showing a fall in heart failure (HF) incidence and prevalence, particularly in developed countries, but with only a subset receiving appropriate therapy to protect the heart against maladaptive processes such as fibrosis and hypertrophy. Appropriate markers of advanced HF remain unidentified, which would help in choosing the most suitable therapy and avoid major compliance problems. Speckle tracking echocardiography (STE) is a good choice, being a non-invasive imaging technique which is able to assess cardiac deformation in a variety of conditions. Several multicenter studies and meta-analyses have demonstrated the clinical application and accuracy of STE in early and late stages of HF, as well as its association with both left ventricular (LV) filling pressures and myocardial oxygen consumption. Furthermore, STE assists in assessing right ventricular free-wall longitudinal strain (RVFWLS), which is a solid predictor of right ventricle failure (RVF) following LV assist device (LVAD) implantation. However, STE is known for its limitations; despite these, it has been shown to explain symptoms and signs and also to be an accurate prognosticator. The aim of this review is to examine the advantages of STE in the early evaluation of myocardial dysfunction and its correlation with right heart catheterization (RHC) parameters, which should have significant clinical relevance in the management of HF patients.

Role of speckle tracking echocardiography in assessing right ventricle function after percutaneous closure of atrial septal defect

Background; Atrial septal defect (ASD) is one of the most common congenital heart diseases. Right ventricular (RV) dysfunction is closely related to patient outcome in open and closed ASD closure. Aim of work; to quantify RV function in patients with chronic RV volume overload due to an ASD before and after its percutaneous closure. Subjects & methods; In this prospective study which included 40 patients with secundum type ASD and normal sinus rhythm who underwent successful percutaneous ASD closure procedure at Cardiology Department, Faculty of Medicine, Benha University; and Cardiology Department, national-heart-institute. All patients underwent full history taking, clinical examination, ecg & echocardiography including assessment of LA, LV, RA & RV functions & dimensions with special emphasis on TAPSE, RV MPI & 2D speckle tracking. Result: LA diameters (mm) were decreased significantly after ASD closure; Antero-posterior, Medio-lateral, and Apico-basal. RA diameters (mm) were decreased significantly after ASD closure; PASP was decreased significantly after ASD closure. LVEF% was increased significantly after ASD closure. TAPSE was increased significantly after ASD closure. RV end diastolic diameters were decreased significantly after ASD closure. Pulsed Doppler RV MPI was decreased significantly after ASD closure. RV longitudinal strain (%) was increased significantly after ASD closure. there was a positive correlation among delta RVSTE and delta LVEF and TAPSE. Also, there was a negative correlation among delta RVSTE and delta RV MPI, RV end diastolic diameter, RA diameters, and PASP. Conclusion; Our study demonstrated significant improvements in multiple echocardiographic measures of cardiac structure and function including reduced LA/RA diameters, decreased PASP, increased LVEF, higher TAPSE, reduced RVEDD, lower RV MPI, and increased RV longitudinal strain at one month post-procedure. These changes indicate reversal of the chronic volume and pressure overload on the right heart caused by the left-to-right shunt, resulting in measurable reverse remodeling and improved mechanics of the right ventricle.

Role of Speckle Tracking Echocardiography in Differentiating between Ischemic and Non-ischemic Cardiomyopathy

Role of Speckle Tracking Echocardiography in Differentiating between Ischemic and Non-ischemic Cardiomyopathy

Differentiation of Myocardial Properties in Physiological Athletic Cardiac Remodeling and Mild Hypertrophic Cardiomyopathy.

Clinical differentiation between athletes' hearts and those with hypertrophic cardiomyopathy (HCM) can be challenging. We aimed to explore the role of speckle tracking echocardiography (STE) and cardiac magnetic resonance imaging (CMR) in the differentiation between athletes' hearts and those with mild HCM. We compared 30 competitive endurance elite athletes (7% female, age 41 ± 9 years) and 20 mild phenotypic mutation-positive HCM carriers (15% female, age 51 ± 12 years) with left ventricular wall thickness 13 ± 1 mm. Mechanical dispersion (MD) was assessed by means of STE. Native T1-time and extracellular volume (ECV) were assessed by means of CMR. MD was higher in HCM mutation carriers than in athletes (54 ± 16 ms vs. 40 ± 11 ms, p = 0.001). Athletes had a lower native T1-time (1204 (IQR 1191, 1234) ms vs. 1265 (IQR 1255, 1312) ms, p < 0.001) and lower ECV (22.7 ± 3.2% vs. 25.6 ± 4.1%, p = 0.01). MD > 44 ms optimally discriminated between athletes and HCM mutation carriers (AUC 0.78, 95% CI 0.65-0.91). Among the CMR parameters, the native T1-time had the best discriminatory ability, identifying all HCM mutation carriers (100% sensitivity) with a specificity of 75% (AUC 0.83, 95% CI 0.71-0.96) using a native T1-time > 1230 ms as the cutoff. STE and CMR tissue characterization may be tools that can differentiate athletes' hearts from those with mild HCM.

The Contemporary Role of Speckle Tracking Echocardiography in Cirrhotic Cardiomyopathy.

Cirrhotic cardiomyopathy (CCM) is characterized by elevated cardiac output at rest, an inability to further increase contractility under stress, and diastolic dysfunction. The diagnosis of CCM is crucial as it can lead to complications during liver transplantation. However, its recognition poses challenges with conventional echocardiography techniques. Speckle tracking echocardiography (STE), particularly global longitudinal strain (GLS), is a novel index that enhances the diagnostic efficacy of echocardiography for both ischemic and non-ischemic cardiomyopathies. GLS proves more sensitive in identifying early systolic dysfunction and is also influenced by advanced diastolic dysfunction. Consequently, there is an expanding scope for GLS utilization in cirrhotic cases, with newly updated diagnostic criteria for CCM incorporating GLS. Specifically, systolic dysfunction is now defined as either a left ventricular ejection fraction below 50% or an absolute GLS below 18%. However, conflicting data on GLS alterations in liver cirrhosis patients persist, as many individuals with advanced disease and a poor prognosis exhibit a hyperdynamic state with preserved or increased GLS. Consequently, the presence of CCM, according to the updated criteria, does not exhibit a significant association-in the majority of studies-with the severity of liver disease and prognosis. Furthermore, information on other indices measured with STE, such as left atrial and right ventricular strain, is promising but currently limited. This review aims to offer a critical assessment of the existing evidence concerning the application of STE in patients with liver cirrhosis.

The role of speckle-tracking echocardiography in the heart contraction geometry assessing in combatants with acute myocarditis

The aim – to evaluate the geometry of heart contraction based on speckle-tracking echocardiography data in combatants with acute myocarditis with reduced and mildly reduced left ventricular ejection fraction.Materials and methods. 53 male combatants with acute myocarditis (AM) were examined, who were divided into 2 groups: 1st group – 30 patients with a reduced ejection fraction (EF) of the left ventricle (LV) ≤ 40 %; 2nd group – 23 patients with mildly reduced LVEF 41–49 %. The diagnosis of AM was established on the basis of the recommendations for the diagnosis and treatment of myocarditis of the All-Ukrainian Association of Cardiologists of Ukraine. All patients underwent echocardiography (EchoCG) with speckle tracking (ST) and cardiac magnetic resonance (CMR) imaging with contrast.Results and discussion. Patients of the 1st group, compared to the 2nd, were characterized by more pronounced manifestations of dilatation and more significant violation of the LV contractile function, which was evidenced by a 13.6 % higher value of the LV end-diastolic volume and a 25.4 % smaller value of the LVEF. When evaluating ST echocardiographic indicators, the value of the longitudinal global systolic strain (LGSS) of the LV in the 1st group was 43.1 % lower, its velocity by 19.2 %, and the circular systolic deformation by 20.9 % in comparison with those in the 2nd group. In addition, in the 1st group, in comparison with the 2nd, the value of the indicator of systolic deformation of the left atrium (SDLA) was almost twice smaller. According to the results of CMR, in the 1st group compared to the 2nd, a larger number of segments with the presence of delayed enhancement was determined, which indicated a larger volume of fibrotic/necrotic lesions of the LV. According to the results of the correlation analysis in the 1st group, strong reverse relationships were established between the presence of delayed contrast in ≥ 4 segments of the LV and LGSS (r=–0.76; p&lt;0.01), its speed and (r=–0.71; p&lt;0.02) and SDLA (r=–0.52; p&lt;0.05).Conclusions. Patients with acute myocarditis with a reduced left ventricular ejection fraction compared to patients with a mildly reduced ejection fraction were characterized by a greater violation of the geometry of the contraction of the left ventricle, which was observed on the background of a larger volume of fibrotic/necrotic lesions. With the help of correlation analysis, in combatants with acute myocarditis, a relationship was established between the presence of delayed enhancement in ≥ 4 segments of the left ventricle and a decrease in indicators of longitudinal systolic deformation and its speed, as well as an indicator of systolic deformation of the left atrium.

The Role of Speckle-Tracking Echocardiography in Predicting Mortality and Morbidity in Patients With Congenital Heart Disease: A Systematic Review and Meta-analysis

Speckle-tracking echocardiography (STE) is now routinely included in cardiac evaluations, but its role in predicting mortality and morbidity in congenital heart disease (CHD) is not well described. We conducted a systematic review to evaluate the prognostic value of STE in patients with CHD. The EMBASE, Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to January 2023 for terms related to all CHD, STE, and prognosis. Meta-analysis of association of right ventricle and left ventricle strain (RV Sl and LV Sl, respectively) with major adverse cardiovascular events (MACEs) was performed in atrial switch transposition of the great arteries (asTGA)/congenitally corrected TGA (ccTGA), tetralogy of Fallot (ToF), and congenital aortic stenosis (cAS)/bicuspid aortic valve (BAV). P-value combination analysis was additionally performed for all CHD groups. A total of 33 studies (30 cohorts, n=8,619 patients, children, and adults) were included. Meta-analysis showed the following parameters as being associated with MACE: RV Sl in asTGA/ccTGA (hazard ratio [HR]=1.1/%; CI, [1.03; 1.18]), RV Sl and LV Sl in ToF (HR=1.14/%; CI, [1.03; 1.26] and HR=1.14/%; CI, [1.08; 1.2], respectively), and LV Sl in cAS/BAV (HR=1.19/%; CI, [1.15; 1.23]). The RV Sl and strain rate were associated with outcomes also in single ventricle/hypoplastic left heart syndrome (at all palliation stages except before Norwood stage 1) and LV Sl in Ebstein's anomaly. This systematic review and meta-analysis showed that biventricular strain and strain rate were associated with outcomes in a variety of CHD, highlighting the need for updated recommendations on the use of STE in the current guidelines, specific to disease types.

Abstract 16387: Speckle-Tracking Echocardiographic Features of Cardiac Amyloidosis in Patients With HFrEF

Introduction: The role of speckle-tracking echocardiography (STE) for establishing the diagnosis of cardiac amyloidosis (CA) has been primarily studied in patients with preserved EF (HFpEF). Hypothesis: We sought to determine the prevalence of abnormal STE indices among HF patients with CA who have reduced EF (HFrEF). Methods: We reviewed electronic health records to identify patients consecutively referred for the evaluation of CA by Tc99m PYP imaging between December 2014 to December 2020. Only patients with LVEF &lt; 40% were included. Left ventricular (LV) and atrial (LA) global and segmental strain, relative apical sparing (RELAPS), and end-diastolic wall stress (EDWS) were measured using STE (TomTec). Results: Among 138 patients, 65 (47%) were identified with CA+; they were older compared to amyloid negative group (CA-). LV-GLS was similar in both groups. However, basal segments LV strain, LA strain, and LA fractional area change (LA-FAC) were significantly lower, and RELAPS was higher in CA+ patients (Figure). End-diastolic wall stress was also lower in CA+ (for all p&lt; 0.01, Figure). After adjusting for age and sex, impaired basal segment strain, EDWS, and LA-FAC remained independent predictors of identifying CA+ patients (p&lt; 0.05). Conclusions: The presence of CA among HFrEF patients is associated with regional variability in LV strain, greater impairment of LA function, and lower EDWS.

Role of speckle-tracking echocardiography in diagnosis and further prognosis of coronary heart disease

Echocardiography is one of the first-line methods of detection and evaluation of coronary artery disease, which helps clinicians in the diagnostic and prognostic evaluation of this disease. However, visual assessment of abnormal left ventricular myocardial wall motion is not always appropriate in detecting less severe or transient myocardial ischemia and in making an accurate differential diagnosis. Speckle-tracking echocardiography is a widely available non-invasive tool that can easily and quickly provide clarifying information and significantly extend the standard echocardiographic study, as the method allows you to identify subtle myocardial damage and local areas of ischemia that correspond to the pattern of coronary disease, and obtain an objective report in the form of simple visual scheme, very easy to use for differential diagnosis and treatment. Therefore, this method, which is increasingly used in various manifestations of coronary insufficiency and is convenient to use both at rest and with stress echocardiography, has proved efficient results in terms of predicting coronary heart disease, quantitative interpretation of emerging or persistent ischemia, assessment of the clinical course and outcome, and left ventricular remodeling. In this review, we have attempted to reflect the currently available findings that demonstrate the significance of speckle-tracking echocardiography for the evaluation and follow-up of coronary heart disease, including some congenital anomalies of the coronary arteries, and to touch on the main achievements and discoveries in the use of two-dimensional and three-dimensional deformation parameters and their potential application for a wider introduction into clinical practice.

Role of Speckle Tracking Echocardiography in Assessment of Right Ventricular Function in Heart Failure with Preserved Ejection Fraction

Background: Patients who exhibit signs and indicators of heart failure (HF) but usual or near to ordinary left ventricular ejection fraction are said to have HFpEF, which is an abbreviation for heart failure with preserved ejection fraction. Our goal was to assess the role that 2D-STE plays in the identification of RV dysfunction in HFpEF patients. Methods: Benha Teaching and Benha University Hospitals were both involved in the research for this study. It was carried out on a total of 100 individuals, each of whom was randomly assigned to one of two groups: group I involving 50 patients diagnosed with HFpEF. The patients who acted as control group were compared to another set of fifty healthy individuals who were the same age and gender. Result: No substantial changes were reported between both groups concerning Tricuspid annular plane systolic excursion (TAPSE), right ventricular diameter (RVD) (mid, basal, longitudinal) (P = 0.473), and right ventricular fractional area change (RVFAC) (P = 0.12). Conclusion: Patients with HFpEF who have features that are detected by 2D-STE have a much higher risk of experiencing a negative outcome. This is in contrast to the results of traditional 2D echocardiography. These results provide credence to the idea that RV 2D-STE might be used to identify individuals with HFpEF who are at a greater risk for unfavorable cardiac events.

Right atrial strain: what does it tell us about cardiac function and prognosis?

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): New Zealand National Heart Foundation Background The role of speckle tracking echocardiography has been expanding thanks to its utility in detecting subtle changes in cardiac function, and has prognostic value(1). Right atrial (RA) strain has shown promise in prognostication amongst patients with pulmonary hypertension and heart failure. It is associated with RA size, RV function and IVC size. However, its clinical utility and application remain under investigation (2–5). We sought to evaluate the associations of right atrial strain with both invasive and non-invasive measure of RV function and the association of RA strain with heart failure hospitalisations and death across a heterogeneous cohort. Methods A single-centre retrospective analysis of data from 225 consecutive patients (age 72 ±11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and date of death were recorded. Statistical analysis was performed using SAS 15.1 to assess the association between right atrial strain and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death. Results Over a median follow up of 28±16 months, there were 59 events. RA strain was associated with the following non-invasive and invasive measures of right heart function and left heart systolic function : TAPSE; RA size, RA pressure, RV strain, PAPi, RVSWI, RV FAC, LAVi, RV PA coupling (TAPSE/systolic PAP), LVEF, cardiac index, diastolic function (E/e’) with a p value of &amp;lt;0.05. Increasing atrial size was associated with lower values of R strain. Despite the association of impaired RV strain with prognosis, HR 2.94 (1.14 – 7.60), RA strain did not appear to be associated independently with prognosis HR 0.98 (0.95–1.0) P value = 0.0676. Conclusions Right atrial strain is independently associated with both invasive and non-invasive measures of RV function and may be a useful tool to help us assess right heart function. It did not appear to be associated with prognosis despite being independently linked with RV strain, which was strongly associated with prognosis in our cohort.

Role Of Speckle Tracking Echocardiography In Prediction Of Responders To Cardiac Resynchronization Therapy.

To assess heart failure patients by speckle tracking echocardiography before cardiac resynchronisation therapy implantation to predict the outcome. The descriptive follow-up study was conducted at Kafrelsheikh and Mansoura University Hospitals, Egypt, from January 2020 to May 2022, and comprised heart failure patients of either gender who had ejection fraction ≤35%, QRS width ≥130msec and symptomatic even on optimal medical therapy. They were subjected to full clinical evaluation, electrocardiogram, basic and speckle tracking echocardiography with calculation of maximal septal to lateral delay at baseline and 3 months after cardiac resynchronisation therapy implantation. The patients were classified according to response into group I having non-responders, group II having patients who improved clinically only, and group III having responders both in clinical and echocardiographic terms. Data was analysed using SPSS 23. Of the 38 patients with mean age 55.24±11.23 years, 16(42%) were females and 22(57.9%) were males. There were 7(18.4%) patients in group I, 7(18.4%) in group II and 24(63.2%) in group III. There was a positive significant correlation between response to cardiac resynchronisation therapy CRT and increase in maximalseptal to lateral delay at baseline (p<0.01). There was an inverse significant correlation between response to cardiac resynchronisation therapy and decrease in maximal septal to lateral delay 3 months after the implantation (p=0.036). Maximal septal to lateral delay was found to be a good tool to predict the response to cardiac resynchronisation therapy before implantation.

Right atrial strain: What does it tell us about cardiac function and prognosis?

The role of speckle tracking echocardiography has been expanding thanks to its utility in detecting subtle changes in cardiac function, and has prognostic value. Right atrial (RA) strain has shown promise in prognostication amongst patients with pulmonary hypertension and heart failure. It is associated with RA size, RV function and IVC size. However, its clinical utility and application remain under investigation. We evaluated the associations of right atrial strain with both invasive and non-invasive measure of RV function and the association of RA strain with heart failure hospitalisations and death across a heterogeneous cohort. A single-centre retrospective analysis of 225 consecutive patients (age 72 ± 11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and death were recorded. Statistical analysis was performed using SAS 15.1 to assess the association between right atrial strain and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death. Over a median follow-up of 28 ± 16 months, there were 59 events. RA strain was associated with non-invasive and invasive measures of right and left heart function (see Table 1) with a P-value of < 0.05. Despite the association of impaired RV strain with prognosis, HR: 2.94 (1.14–7.60), RA strain did not appear to be associated independently with prognosis HR: 0.98 (0.95–1.0) P-value = 0.0676. Right atrial strain is independently associated with both invasive and non-invasive measures of RV function and may be a useful tool to help us assess right heart function. It did not appear to be associated with prognosis despite being independently linked with RV strain, which was strongly associated with prognosis in our cohort.

The role of Speckle Tracking Echocardiography and Threedimensional Echocardiography in the Assessment of Left Ventricular Systolic Function in Type II Patients with diabetes with Negative Myocardial Perfusion Imaging in Correlation to Multi-gated Acquisition Scan

The role of Speckle Tracking Echocardiography and Threedimensional Echocardiography in the Assessment of Left Ventricular Systolic Function in Type II Patients with diabetes with Negative Myocardial Perfusion Imaging in Correlation to Multi-gated Acquisition Scan

Role of Speckle Tracking Echocardiography in Assessing Anginal Chest Pain on Exertion

Left bundle branch block (LBBB) poses some restriction on coronary artery disease (CAD) diagnosis with noninvasive diagnostic modalities. Objectives: Evaluating the role of 2-D speckle tracking echocardiography (STE) in the diagnosis of CAD in patients with LBBB.

361 PATISIRAN EFFICACY ON MYOCARDIAL FUNCTION IN H-ATTR PATIENTS EVALUATED WITH THE USE OF CMR AND SPECKLE TRACKING ECOCARDIOGRAPHY

Abstract Introduction Hereditary transthyretin amyloidosis (h-ATTR) is a complex, systemic infiltrative disease characterized by extracellular deposition of transthyretin in different organs. Infiltrative cardiomyopathy and polyneuropathy represent two of the most common and severe manifestations of this pathology. Patisiran is a double-stranded interfering RNA drug, used to stop expression of TTR in h-ATTR. It is recommended in the treatment of cardiac h-ATTR with polyneuropathy or polyneuropathy alone. Recent studies showed the efficacy of Patisiran in slowing the progression of the disease, improving myocardial deformation indices, biomarkers and functional capacity. Aim We aimed to illustrate the efficacy of Patisiran on myocardial function and to evaluate the role of Speckle Tracking Echocardiography (STE) and Cardiac Magnetic Resonance (CMR) as markers of subclinical cardiac efficacy of Patisiran in two h-ATTR patients (males, with mean age 55 ± 1,4 years old) with infiltrative cardiomyopathy and polyneuropathy who were scheduled to receive this drug. Materials and Methods Before receiving Patisiran (T0) the following tests were performed: cardiovascular physical examination, complete echocardiogram including STE. All these exams were repeated after 6 months or 1 year (T1). CMR was performed at the baseline and three years after. Results The CMR evaluation showed, after the use of Patisiran, a significant reduction of myocardial mass (average reduction -13,29%) and myocardial walls thickness (average septal reduction -13,65%). After 1 year follow up myocardial performance indices were also improved: GLS values (average gain 2,3 pt), and myocardial work values (average increase GWI +311,5, GCW +188,5, GWW -114,5, GWE +5,5 pt) at echocardiography. Conclusion The results of our experience showed, according to evidences suggested by the APOLLO trial, the efficacy of Patisiran, in patients with cardiac h-ATTR and polyneuropathy, in reducing myocardial mass and improving myocardial function. STE and CMR could represent useful tools to study cardiac function in A-TTR patients undergoing Patisiran.

Evaluation of left ventricular systolic function in children with sickle cell anemia: contribution of 2D strain.

Children with sickle cell anemia (SCA) are at an increased risk of cardiovascular complications. The aim of this study was to assess the role of speckle tracking echocardiography in detecting subclinical myocardial damage in children with SCA. A cross-sectional case-control study was conducted at the echocardiography laboratory of the military hospital of Tunis between July and December 2018. Thirty patients with SCA were included. A control(C) group including 30 normally developing children was selected and matched to the SCA group by sex and age. We compared between the two groups: conventional echocardiographic parameters including cardiac output, left ventricular ejection fraction (LVEF), thickness and the global longitudinal strain (GLS). The echocardiographic measurements were indexed according to body surface area. The left ventricular (LV) GLS association with clinical characteristics and echocardiographic parameters were also evaluated. Patients and controls were matched for age and sex: the mean age was (11± 2years) in SCA group versus (12± 1 years) in C group with a sex ratio of (1.31 versus 1.27, respectively). Body surface area was comparable. LV hypertrophy and dilation were revealed in the SCA group, whereas measurements were normal in the C group. No significant differences were observed for cardiac output (p=0.4). LVEF were preserved in both groups. However, two-dimensional (2D) LVGLS was impaired in 46% of SCA group (n=14) with mean value of (-21%±3.07 vs -25%±2.98; p<0.01).In SCA group, impaired LVGLS was significantly associated with LVmass (r = - 0.399, p<0.01), LV tele diastolic diameter(r= -0.419, p<0.01) and left atrial volume (r= - 0.399, p< 0.04). In multivariate analysis, LV mass was the only independent factor. In the present study, LVGLS measurement revealed subclinical LV systolic impairment in patients with SCA. Therefore, 2D strain could be beneficial to detect the natural history of LV dysfunction in SCA.

Role of speckle tracking echocardiography in predicting Cardiac Resynchronization Therapy response

Role of speckle tracking echocardiography in predicting Cardiac Resynchronization Therapy response

Role of Speckle Tracking Echocardiography to Predict Left Ventricular Dysfunction Post Mitral Valve Replacement Surgery for Severe Mitral Regurgitation.

Despite improvement in the surgical procedure and strictly following the guidelines for mitral valve replacement (MVR), left ventricular dysfunction still occurs. Novel echocardiographic indices can predict development of LV (left ventricle) dysfunction post MVR. LV-GLS (global longitudinal strain) derived from speckle tracking echocardiography, has been proposed as a novel measure to better depict latent LV dysfunction. A total of 100 patients with severe MR (mitral regurgitation) planned for MVR were included. Speckle tracking echocardiography was performed at baseline and at follow up post MVR. ROC (Receiver operating characteristics) curve was plotted to derive the cutoff value of LV-GLS for prediction of LV dysfunction post MVR. Univariate and multi variate regression was analyzed to predict the independent predictors of LV dysfunction after MVR. LV-GLS was decreased from baseline data (-19.9 vs. -17.7) in patients with LVEF <50% after MVR compared to patients with LVEF≥ 50%. Baseline value of LVESD (35.36 mm vs. 28.23 mm) and LVEDD (49.33 mm vs. 45.10 mm) were significantly higher in patients with LVEF<50% compared to LVEF ≥50% at 3 months follow up. A cutoff value of GLS -19% with sensitivity of 80.3% and specificity of 75.7% was associated in patients with LV dysfunction after MVR. In multivariate regression model GLS < -19% (OR = 21.8, CI:6.61-82.4, P=<0.001) was an independent predictor of LV dysfunction post MVR. A GLS value of less than -19% was demonstrated as an independent predictor of short term LV dysfunction after mitral valve surgery, LVESD ≥40 mm was also verified additional parameter to predict the LV dysfunction post MVR.