Segmental Systolic Strain Research Articles

Changes in cardiohemodynamics and cardiac arrhythmias in patients after coronavirus infection

Aim: To study cardiac arrhythmias and morpho-functional changes in patients in 3 months after a coronavirus infection.Material and methods. 96 patients, mean age 36 years, treated for coronavirus infection, after 3 months underwent Echo and Holter ECG monitoring. Patients were divided into groups depending on the degree of lung tissue damage according to computed tomography (CT): 1st 27 patients CT0, 2nd 39 patients CT1-2, 3rd 30 patients CT3-4; 22 patients control group. Statistics: considering the distribution of features different from normal, nonparametric methods of hypothesis testing were used.Results. In patients recovered from coronavirus infection a violation of heart rhythm conduction was established after 3 months. An increase in the activity of the sympathetic part of the autonomic nervous system (LF/HF) was found: in patients of group 2, the median value was – 5.9, in group 3 – 6.0; in addition, the global longitudinal systolic strain of the left ventricle decreased (–17.7 and –17.2, respectively). In patients with CT3–4, systolic pressure in the pulmonary artery increased (37.0 mmHg), the size of the left atrium increased, and segmental systolic LV strain decreased in comparison with the studied groups (p < 0.001). Correlations between left ventricular dysfunction and heart rate variability disorders, as well as prolongation of the QT interval (p < 0.001) were established.Conclusion. Cardiac arrhythmias were detected in patients in 3 months after the coronavirus infection. In patients with moderate and severe disease, the activity of the autonomic nervous system also increases, the global systolic strain of the left ventricle decreases. In addition, patients with CT3-4 increased systolic pressure in the pulmonary artery, increased the size of the left atrium, decreased segmental systolic strain of the left ventricle.

Ventricular strain analysis in patients with no structural heart disease using a vendor-independent speckle-tracking software

BackgroundVentricular strain measurements vary depending on cardiac chamber (left ventricle [LV] or right ventricle [RV]), type of strain (longitudinal, circumferential, or radial), ventricular level (basal, mid, or apical), myocardial layer (endocardial or epicardial), and software used for analysis, among other demographic factors such as age and gender. Here, we present an analysis of ventricular strain taking all of these variables into account in a cohort of patients with no structural heart disease using a vendor-independent speckle-tracking software.MethodsLV and RV full-thickness strain parameters were retrospectively measured in 102 patients (mean age 39 ± 15 years; 62% female). Within this cohort, we performed further layer-specific strain analysis in 20 subjects. Data were analyzed for global and segmental systolic strain, systolic strain rate, early diastolic strain rate, and their respective time-to-peak values.ResultsMean LV global longitudinal, circumferential, and radial strain values for the entire cohort were − 18.4 ± 2.0%, − 22.1 ± 4.1%, and 43.9 ± 12.1% respectively, while mean RV global and free wall longitudinal strain values were − 24.2 ± 3.9% and − 26.1 ± 5.2% respectively. Women on average demonstrated higher longitudinal and circumferential strain and strain rate than men, and longer corresponding time-to-peak values. Longitudinal strain measurements were highest at the apex compared with the mid ventricle and base, and in the endocardium compared with the epicardium. Longitudinal strain was the most reproducible measure, followed closely by circumferential strain, while radial strain showed suboptimal reproducibility.ConclusionsWe present an analysis of ventricular strain in patients with no structural heart disease using a vendor-independent speckle-tracking software.

1025 Global strain rate do not reduce biological variability compared to S", and do not normalize for body size

Abstract Background As the Left ventricular (LV) apex is stationary, and maximum velocities are in the mitral plane, peak systolic annular velocity (S") normalized for wall length (WL) is a measure of peak systolic strain rate (Fig. 1), as is strain rate measured by tissue Doppler. As the normalization presumably corrects for the size of the heart (and thus body), this should reduce biological variability, but this assumption has previously been shown to be faulty for annular displacement (MAPSE) vs global longitudinal strain. Methods The HUNT study examined 1266 subjects without evidence of heart disease, from a mixed urban / rural population of North Tøndelag county in Norway. Annular systolic velocity was measured by pulsed-wave Tissue Doppler in the septal, lateral, anterior and inferior points, and averaged. Wall lengths was measured in a straight line in the same points, and S" was normalized (S"/WL) and averaged. Segmental systolic strain rate was also measured by combined speckle tracking / Tissue Doppler and averaged to a global value (GLSR). Results are given in table 1. All three measures declined with increasing age (R was -0.23, -0.29 and -0.29, respectively, all p < 0.001) The over-all relative standard deviations were similar for S", normalized S" and global strain rate. Both S"/WL and GLSR correlated negatively with BSA, R was - 0.22 and 0.17, respectively (p < 0.001), while S" showed a modest positive correlation; R = 0.13, (p < 0.001) Conclusion Normalizing peak systolic mitral annular velocity for length do not reduce biological variability, and introduces a systematic error in the body size relation, due to the one-dimensional nature of the normalisation, and the three-dimensional nature of LV deformation. This is in accordance with what has previously been shown for global longitudinal strain vs. annular plane displacement. Table 1 Age (years) S" (cm/s) S"/WL (/s) GLSR (/s) < 40 9.1 (1.2) 0.93 (0.13) 1.08 (0.12) 40 - 60 8.3 (1.3) 0.86 (0.13) 1.03 (0.12) > 60 7.7 (1.3) 0.81 (0.14) 0.98 (0.14) All 8.4 (1.4) 0.87 (0.14) 1.03 (0.13) Relative SD (%) 16.7 16.1 12.6 Mitral annular velocity (S"), normalised velocity (S"/WL) and Global strain by age groups. (Standard deviations in parentheses) Abstract 1025 Figure. Fig. 1

Strain Imaging Detects Dose-Dependent Segmental Cardiac Dysfunction in the Acute Phase After Breast Irradiation

We examined the utility of echocardiographic 2-dimensional speckle tracking strain imaging (SI) for the evaluation of segmental myocardial dysfunction before and after radiation therapy (RT) and the relationship to dose exposure. We prospectively recruited 40 women with left-sided breast cancer, undergoing only adjuvant RT to the left chest. Comparisons of traditional echocardiographic parameters and SI parameters at baseline and 6weeks after RT were analyzed.Regional strain and strain rate (SR) parameters were obtained from all 18 left ventricular segments. The correlation of change in strain parameters with segmental radiation dose was examined. We observed a significant reduction in global and segmental systolic strain parameters at 6weeks after RT compared with baseline, with the largest decrement in the apical segments; this corresponded with the segments receiving the highest radiation dose exposure (apical peak systolic strain of -21.21%±3.49% before RT vs -18.69%±3.34% after RT, percentage change of 11.88%, P=.002; apical peak systolic SR of -1.17±0.24s-1 before RT vs -1.04±0.19s-1 after RT, percentage change of 11.11%, P=.008). There was a modest correlation between the apical segment systolic strain reduction and radiation dose exposure (apical segment Δ change and apical radiation dose, r=0.345, P=.031; apical segment percentage change and apical radiation dose, r=0.346, P=.031). A significant reduction in early diastolic SR was observed in the apical segments after treatment compared with baseline (apical early diastolic SR, 1.54±0.45s-1 before RT vs 1.35±0.33 after RT s-1; percentage change, 12.34%; P=.034). Two-dimensional SI detected dose-related regional myocardial dysfunction in the acute phase after RT in chemotherapy-naive left-sided breast cancer patients. Although the long-term effects remain unknown, this imaging modality may have a potential role in the evaluation of irradiation-related cardiotoxicity.

Ventricular and atrial mechanics and their interaction in patients with congenital scoliosis without clinical heart failure.

This study sought to evaluate left ventricular, right ventricular, and left atrial mechanics and their interactions in patients with congenital scoliosis without clinical heart failure. A total of 23 patients with a median age of 14 years and a median Cobb's angle of 61° were studied. Ventricular and atrial myocardial deformation was measured using speckle tracking echocardiography. The results of the patients were compared with 22 controls. Compared with controls, the patients had a significantly greater annular a velocity (p=0.04) and lower e/a ratio (p=0.03); the left ventricular deformation significantly decreased in radial global (p=0.04) and segmental systolic strain and early diastolic strain rate (p=0.03); the left atrial deformation showed a significantly lower positive strain (p=0.02), greater negative strain (p=0.01), and active contractile strain rate (p=0.01). For the patients, the Cobb's angle was negatively correlated with the left ventricular global radial systolic strain (r=-0.65, p=0.001), left atrial positive strain (r=-0.68, p<0.001), and the left atrial negative strain was positively correlated with the left ventricular circumferential late diastolic strain rate (r=0.46, p=0.01). The left atrial conduit strain rate was positively correlated with the left ventricular circumferential early diastolic strain rate (r=0.42, p=0.03). The left atrial active contractile strain rate was positively correlated with the left ventricular longitudinal late diastolic strain rate (r=-0.4, p=0.03). Impaired left ventricular and altered left atrial mechanics occur relatively early in patients with congenital scoliosis, and are correlated with the severity of their scoliosis. Our findings provide evidence of preclinical heart dysfunction in patients with this disorder.

Effects of Age and Gender on Right Ventricular Systolic and Diastolic Function Using Two-Dimensional Speckle-Tracking Strain

Accurate assessment of the right ventricle is increasingly important. Measures of right ventricular (RV) systolic function, including fractional area change, tissue Doppler (s' velocity), and tricuspid annular plane systolic excursion, show significant variation, and the impacts of age and gender are unclear. The aim of this study was to determine the effects of gender and age on global and segmental RV systolic and diastolic function using both traditional echocardiographic and two-dimensional strain parameters. Detailed transthoracic echocardiographic studies were performed on 142 healthy adult volunteers, with particular emphasis on the right ventricle to determine RV dimensions and function, including fractional area change, tricuspid annular plane systolic excursion, s' velocity, global and segmental systolic strain, and systolic, early diastolic, and late diastolic strain rates. Tricuspid annular plane systolic excursion (r= -0.4, P < .001) and RV s' velocity (r= -0.5, P < .001) aswell as diastolic functional parameters, including transtricuspid peak E velocity and RV free wall e' velocity (r= -0.4, P < .001), decreased with age. Global systolic strain was also reduced, with differential reductions in basal and mid segmental strain with age. Early diastolic strain rate decreased, with a corresponding increase in late diastolic strain rate. RV function parameters, including fractional area change, e' velocity, strain, and strain rate, were significantly lower in men. RV functional analysis by two-dimensional strain demonstrates a small yet significant change in global and segmental RV function with age and gender, and therefore adjustment for these measures is required in the evaluation of RV function.

Comparison of Left Atrial Phasic Function in Hypertrophic Cardiomyopathy Versus Systemic Hypertension Using Strain Rate Imaging

The aim of this study was to determine if left atrial (LA) phasic function evaluated by Doppler tissue imaging-derived strain and strain rate would be differentially decreased in patients with hypertrophic cardiomyopathy (HC) compared to patients with hypertension and to normal controls. Thirty-seven patients with HC were compared to 44 patients with systemic hypertension (SH) and 65 normal controls using transthoracic echocardiography. Maximal and minimal LA volume and LA volume just before active atrial contraction (pre-P LA volume) were measured, and phasic LA volumes were calculated. Global and segmental systolic strain rate, early diastolic strain rate, and late diastolic strain rate (A-Sr) and strain were measured from Doppler tissue imaging. Left ventricular mass was increased in the HC and SH groups compared to normal controls, but diastolic dysfunction was greater in the HC group. LA volumes were increased in patients with HC compared to those with SH and to normal controls, with corresponding reductions in A-Sr and atrial strain in the HC group. In contrast, only early diastolic strain rate was decreased in the SH group compared to controls. A-Sr remained reduced in patients with HC compared to the SH group, even after adjusting for left ventricular mass. When left ventricular mass, parameters of diastolic function (peak E and E' velocity), and the effect of patient group (SH vs HC) were examined in a stepwise regression model, patient group (SH vs HC) was the only independent determinant of A-Sr. In conclusion, HC results in LA enlargement with reduced LA phasic function that is reflected in reductions in A-Sr and atrial strain. Atrial enlargement is a likely consequence of the greater diastolic dysfunction in the HC group.

What indices quantify regional myocardial function during supine bicycle in healthy subject: natural strain and strain rate?

Background Evaluation and quantification of regional myocardial function remain a challenge for imaging techniques in stress test. Strain and strain rate can be calculated from velocity gradients in time and space. This new technique has been developed to allow quantifiable stress echocardiography. The aim of this study was to define normal regional strain rate and strain values for both radial and deformation longitudinal myocardial deformation during supine bicycle. Methods Real-time color Doppler myocardial velocities were acquired as data superimposed on an underlying two-dimensional (2D) grey-scale image at a frame rate >150/s, a depth of 16 cm, and a sector angle of 60° in 18 healthy volunteers, mean age 34±7 years (25–43 years). During acquisition, a complete cardiac cycle of each view was acquired at rest and during supine bicycle (from 25 W to maximal charge). Maximal systolic velocity, strain rate, and strain were processed offline for both radial (basal posterior wall segment) and longitudinal (septum, lateral, inferior, anterior walls) function. For analysis, each wall was divided into three segments (basal, mid, apical). All the velocity and SR/ S values were averaged over three consecutive cycles. Results During exercise, heart rate and systolic blood pressure increased significantly from rest to peak stress (69±14 vs. 152±7 beats/min, p<0.0001 and 118±9 vs. 178±28 mm Hg, p<0.001). For the Lax view, both the mean velocity and mean strain rate increased significantly between rest and peak exercise, respectively, for the velocity and for the strain rate. Similarly is said for the Sax view. In contrast, the systolic strain response was biphasic during exercise, basal, mid, and apical segments of walls showed a significant increase of velocity in each workload step. The resting base–apex velocity gradient observed at rest remained in all walls throughout supine bicycle. The mean peak systolic SR data were homogeneous throughout in all segments analysed at rest. This homogeneity remained at peak exercise. The SR increased significantly between rest and peak exercise, respectively, p<0.0117. The segmental systolic strain response was biphasic. Conclusion This study demonstrated that strain rate imaging may represent a new and interesting method for quantifying regional myocardial function during supine bicycle, which appears to be less influenced by tethering than Doppler tissue imaging. Further studies are needed to determine whether this approach will be clinically useful.