Speckle Tracking Echocardiography Study Research Articles

Evaluation of the Right Ventricular Function in Prediabetes: A 2-D Speckle Tracking Echocardiographic Study

Pre-diabetes is a common condition associated with cardiovascular changes. The aim of our study was to evaluate the right ventricular (RV) function as assessed by 2-D speckle tracking echocardiography in pre-diabetic patients. This study recruited 94 patients (33 normal patients, 31 pre-diabetic patients and 30 diabetic patients). The absolute amount of the global peak systolic strain, the systolic strain rate and the early diastolic strain rate of the RV free wall (RVFW) was higher in the control group than in the pre-diabetic and diabetic groups. These indices were not different between the pre-diabetic and diabetic groups. The global late diastolic strain rate of RVFW was the same between the three groups. Also, pre-diabetes and diabetes were the independent predictors of the RVFW global peak systolic strain, systolic strain rate and diastolic strain rate. Our study demonstrated that the RV systolic and diastolic functions were impaired in the pre-diabetic and diabetic patients without obstructive coronary artery disease. Also, pre-diabetes and diabetes were independent predictors of systolic and diastolic functions of the RV.

Novel Measures of Cardiac Function in Children Diagnosed With Eating Disorders: A Two-Dimensional Speckle Tracking Echocardiography Study

Novel Measures of Cardiac Function in Children Diagnosed With Eating Disorders: A Two-Dimensional Speckle Tracking Echocardiography Study

The Acute Asthma: It's just a Respiratory Disease? A Speckle Tracking Echocardiography Study

Objective: To determine the presence of acute myocardial dysfunction in status asthmaticus. Methodology: Prospective studies were included acute severe asthma patients admitted to intensive care from January 2008 to September 2013. We included a control group with healthy athletes subjected to stress by bench press n=20- and combat karate for 15 minutes, n=14-, SC2000-2013iƒ’ Siemens Echocardiography was available in the gym. Cardiac stress response of asthmatic patients and athletes was evaluated by echocardiography. An off-line analysis by 3D Image and hybrid speckle tracking was performed. We performed analysis by means of using ANOVA test. Results: 32 asthmatic patients (11 males) were included, with a median age of 31 (17-40 years). The age of the controls was 33.45 ± 0.9 years. The left ventricular ejection fraction was similar although septum and anterolateral segment presented segmental alterations in all acute asthmatics patients evidenced by strain and strain rate. Acute asthmatics patients had lower strain, lower velocities, less displacements, and more asynchrony versus controls. Conclusions: Acute asthmatics patients were complicated with a myocardial dysfunction detected by speckle tracking. This tool could be useful for the proper diagnosis of critically ill patients.

The effect of hemodialysis-induced preload changes on the left ventricular function: a speckle-tracking echocardiographic study

Objective: This study aim to evaluate the effect of hemodialysis (HD)-induced preload changes on the left ventricular (LV) function in patients with chronic renal failure using LV imaging strain. Background: In dialysis patients, both cardiovascular and noncardiovascular mortality are significantly increased as compared with the general population. In particular, cardiovascular mortality contributes to 40% of all-cause mortality in patients on HD. Patients and methods: Twenty-six participants were enrolled in this study on maintenance HD three times per week for 3 h; they included 13 patients with hypertension, six with diabetes mellitus, and eight with ECG criteria of left ventricular hypertrophy. All participants underwent standard two-dimensional echocardiography and myocardial strain imaging. Results: There was a significant reduction of the stroke volume, the LV internal diameter in diastole, the LV internal diameter in systole, the LV posterior wall thickness in systole, the end-diastolic volume, the end-systolic volume, E wave, the E/A ratio, and finally the pulmonary artery systolic pressure after HD set (P 0.05). Also, there was a significant reduction in the global longitudinal peak systolic strain in the long-axis view (GLPS_LAX) (−19.32 ± 4.30 to −16.58 ± 3.87), the global longitudinal peak systolic strain in the apical four-chamber view (GLPS_A4C) (−17.73 ± 4.76 to −15.98 ± 3.70), the global longitudinal peak systolic strain in the apical two-chamber view (GLPS_A2C) (−18.73 ± 4.22 to −16.79 ± 4.25), and the global longitudinal peak systolic strain average (GLPS_AVG) (−18.59 ± 3.96 to −16.45 ± 3.31) after HD set (P < 0.05). Conclusion: The preload reduction resulting from HD is associated with a reduction of the LV systolic function when assessed by the peak systolic longitudinal strain. This indicates preload dependence of the LV systolic function.

0056: Assessment of left ventricular filling pressures: a prospective speckle tracking echocardiography compared to invasive hemodynamic study

Background Assessment of left ventricular filling pressures (LVFP) is a key part of echocardiographic evaluation but actual validated parameters aren’t relevant in some routine cases. Use of diastolic strain rates (DSr) may improve the diagnostic of elevated LVFP in specific cardiomyopathies. Our primary objective was to evaluate the diagnostic performance for elevated LVFP of different DSr indexes in a heterogenous cardiological population. Material and Methods We led a prospective mono-centric two-dimensional speckle tracking echocardiography study compared to invasive hemo-dynamic (left catheterization with measurement of pre-atrial pressure (preA)). Elevation of LVFP was defined as preA>15mmHg. Global DSr indexes tested were: isovolumetric relaxation DSr (IvrDSr), early DSr (EarlyDSr) and late DSr (LateDSr). Additional DSr indexes were calculated by meaning of these parameters: EarlyLateDSr and IvrEarlyLateDSr. DSr values were multiplied by 10 factor and ratios of E wave to the obtained result gave different composite E/10DSr indexes. Results Fifty height patients were included. Patients with preA>15mmHg (n=23) were compared with patients with preA 52% of patients had coronaropathy, 43% had regional dysfunction and 31% had significant valvulopathy. Correlations to LVFP were: E/10IvrEarlyLateDSr (R=0,50), E/10LateDSr (R=0,46), E/10EarlyLateDSr (R=0,42). Optimal cut off values were 11,5 for E/10LateDSr (sensitivity (Se) 64%, specificity (Spe) 91%, positive predictive value (PPV) 82% and negative predictive value (NPV) 80%), 9,5 for E/10EarlyLateDSr (Se 68%, Spe 83%, PPV 71%, NPV 81%) and 15 for E/10IvrEarlyLateDSr (Se 75%, Spe 85%, PPV 79%, NVP 82%). Conclusion E/10DSr composite indexes, especially E/10LateDSr and E/ 10IvrEarlyLateDSr are relevant LVFP indexes, which may be applied to a large spectrum of cardiomyopathies. Download : Download high-res image (135KB) Download : Download full-size image Abstract 0056 - Figure: Used DSr

Right ventricular function in coronary slow flow: A two-dimensional speckle-tracking echocardiographic study.

Coronary slow-flow phenomenon (CSFP) is described as protracted passage of angiographic contrast agent to the distal portion of the epicardial coronary arteries in the absence of stenosis. Few studies have addressed the effects of this condition on right ventricular (RV) dysfunction. The present objective was to assess RV function in CSFP via 2-dimensional speckle-tracking echocardiography (2DSTE). A total of 29 patients with CSFP and 29 participants with normal coronary flow were compared regarding RV systolic and diastolic functions. Participants were matched for age, sex, hypertension, and diabetes mellitus. RV systolic and diastolic functions were evaluated with pulsed-wave tissue Doppler echocardiography and 2DSTE. There were no statistically significant differences between the CSFP group and the control group regarding tissue Doppler echocardiographic and 2DSTE-derived indices. CSFP was not associated with tissue Doppler echocardiographic and 2DSTE-derived indices of RV systolic and diastolic function.

Changes in mitral annular morphology and function in young patients with type 1 diabetes mellitus-results from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study.

Alterations in mitral annular size and function could be demonstrated in cardiomyopathies and ischaemic heart disease. The present study was designed to evaluate mitral annulus (MA) morphology and function in young type 1 diabetes mellitus (T1DM) patients by three-dimensional speckle tracking echocardiography (3DSTE) and to compare their results to matched healthy controls. The study comprised 18 patients with T1DM (mean age: 33.0±8.0 years). Their results were compared to that of 20 age- and gender-matched healthy controls (mean age: 37.8±10.9 years). Complete two-dimensional (2D) Doppler echocardiography and 3DSTE have been performed in all cases. No significant differences could be demonstrated in demographic and standard echocardiographic parameters between the groups. Significantly enlarged diastolic MA diameter (2.87±0.27 mm vs. 2.58±0.32 mm, P=0.01), MA diameter index 1.61±0.20 cm/m(2) vs. 1.30±0.39 cm/m(2), P=0.008, and MA area index (4.81±0.88 cm(2)/m(2) vs. 3.91±1.35 cm(2)/m(2), P=0.03) could be demonstrated in T1DM together with augmented MA fractional shortening (28.64±9.63% vs. 20.35±12.50%, P=0.05). Early alterations in MA size and function could be demonstrated in young patients with T1DM by 3DSTE.

The influence of real-time blood glucose levels on left ventricular myocardial strain and strain rate in pediatric patients with type 1 diabetes mellitus - a speckle tracking echocardiography study.

BackgroundEchocardiographic myocardial performance parameters such as strain and strain rate are increasingly used to assess systolic and diastolic function in patients with diabetes mellitus and several other clinical and scientific scenarios. While long-term metabolic marks such as HbA1C are inherently assessed in diabetic patients, the actual blood glucose level at the very moment of the echocardiographic study has not yet been taken into account for the assessment of cardiac mechanics. The aim of this study was to investigate the influence of real-time blood glucose levels on left ventricular (LV) myocardial strain and strain rate in pediatric patients with type 1 diabetes mellitus (T1DM).MethodsWe performed speckle tracking echocardiography on 39 normotensive pediatric patients with uncomplicated type 1 diabetes mellitus (mean age 11.5 ± 3.5 years, 40 % female) and 44 sex- and age-matched healthy controls (mean age 11.4 ± 2.9 years, 45 % female). T1DM patients were sub-categorized according to their blood sugar levels (with a cutoff of 150 mg/dL) at the moment of the echocardiographic exam. Investigators were blinded to the participants’ study group status.ResultsInterestingly, diabetic patients with higher blood sugar levels demonstrated significantly increased LV circumferential strain (p = 0.003) and strain rate (p = 0.005) as well as global longitudinal strain rate (p = 0.002) in comparison to T1DM patients with lower blood sugar levels or healthy controls.ConclusionsFor the investigation of myocardial performance with sensitive methods such as speckle tracking echocardiography in diabetic study populations real-time blood sugar levels should be taken into account. Further studies are needed to verify these findings in large-scale patient cohorts and serial intra-individual measurements in different metabolic states.

Detection of Myocardial Dysfunction in Septic Shock: A Speckle-Tracking Echocardiography Study.

Patients with septic shock are at increased risk of myocardial dysfunction. However, the left ventricular ejection fraction (EF) typically remains preserved in septic shock. Strain measurement using speckle-tracking echocardiography may quantify abnormalities in myocardial function not detected by conventional echocardiography. To investigate whether septic shock results in greater strain changes than sepsis alone, we evaluated strain in patients with sepsis and septic shock. We prospectively identified 35 patients with septic shock and 15 with sepsis. These patients underwent serial transthoracic echocardiograms at enrollment and 24 hours later. Measurements included longitudinal, radial, and circumferential strain in addition to standard echocardiographic assessments of left ventricular function. Longitudinal strain worsened significantly over 24 hours in patients with septic shock (P < 0.0001) but did not change in patients with sepsis alone (P = 0.43). No significant changes in radial or circumferential strain or EF were observed in either group over the 24-hour measurement period. In patients with septic shock, the significant worsening in longitudinal strain persisted after adjustment for left ventricular end-diastolic volume and vasopressor use (P < 0.0001). In patients with sepsis, adjustment for left ventricular end-diastolic volume and vasopressor use did not alter the finding of no significant differences in longitudinal strain (P = 0.48) or EF (P = 0.96). In patients with septic shock, but not sepsis, myocardial strain imaging using speckle-tracking echocardiography identified myocardial dysfunction in the absence of changes in EF. These data suggest that strain imaging may play a role in cardiovascular assessment during septic shock.

17. Global and regional left ventricular function after arterial switch operation: A speckle tracking echocardiography study

The arterial switch operation (ASO) is now days the standard procedure for transposition of the great arteries (d-TGA) repair. Nonetheless, reduced exercise capacity, coronary artery abnormalities, decreased coronary artery vaso-reactivity, reduced coronary flow reserve, proximal intimal proliferation, and reversible myocardial perfusion defects have been demonstrated in ASO patients. Despite of this, indices of systolic function, as assessed by standard echocardiography are within the normal range in ASO patients. Speckle-tracking echocardiography (STE), can detect early subclinical myocardial abnormalities in several diseases even in presence of normal left ventricular (LV) ejection fraction (EF). to assess LV myocardial deformation and torsion in asymptomatic ASO patients with normal LV EF (⩾55%) by using two-dimensionally derived STE. We studied: (a) Sixty-two asymptomatic patients (26 female) who have undergone 1-stage ASO for simple d-TGA, aged 8.5 ± 5.7 years, with a normal LV EF (⩾55%); (b) Thirty-two age and sex comparable controls (14 female), aged 7.9 ± 4.9 years. In ASO patients, global LV longitudinal strain was significantly lower than in controls (−19.2 ± 2.9% vs −22.7 ± 2.4%, respectively, p < 0.0001). Longitudinal deformation was significantly impaired in the anterior and both anterior and posterior septal walls. In ASO patients global circumferential strain (−23.9 ± 4.8% vs −25.9 ± 4.1%, respectively, p = 0.06) and LV torsion (12.1 ± 4.8° vs 13.1 ± 5.4°, respectively, p = 0.351) were similar to those measured in controls. To the best of our knowledge this is the largest study on ASO patients by using STE. We demonstrated that in asymptomatic ASO patients despite a normal LV EF (⩾55%) there is a significant reduction in longitudinal myocardial deformation while circumferential deformation and LV torsion are preserved, in order to maintain a normal LV EF.

Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study

The aim of this article is to assess the left atrial (LA) reservoir function in patients with severe aortic stenosis (AS) and to evaluate its impact on the recurrence of major adverse cardiac events (MACEs). About 128 patients (mean age 79 ± 9 years) with severe AS were included in the study. Global peak LA strain (PLAS) measured by two-dimensional speckle-tracking echocardiography (STE) during left ventricular (LV) systole represented the LA reservoir function. Overall death, hospitalization for cardiac cause, and worsening heart failure were defined as MACEs. With respect to the values observed in a control group of 20 healthy patients, PLAS resulted significantly reduced in AS. According to the multivariate linear regression analysis, LV global longitudinal strain, mitral E/e' ratio, and systolic pulmonary arterial pressure (sPAP) were the best correlates to PLAS. During follow-up, the predefined MACEs occurred in 39 patients. According to the multivariate Cox regression analysis, a PLAS <21% was a significant predictor of MACEs [hazard ratio (HR) 2.88, P = 0.04], as was coronary artery disease (HR 2.68, P = 0.004) and the New York Heart Association functional class (HR 2.08, P = 0.03). In patients with severe AS, a global PLAS <21% is an independent predictor of prognosis. Given the combined influence of LV diastolic and systolic function and of LA performance on sPAP, the decline of PLAS might be considered a marker of global myocardial impairment in AS. Further studies are needed to confirm the critical role of LA relaxation in prognosis and to validate its relevance in routine clinical practice.

Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study

Objectives: The main purpose of the study was to investigate left ventricular (LV) subclinical systolic and diastolic dysfunction in childhood-onset systemic lupus erythematosus (c-SLE) patients using two-dimensional speckle-tracking (2DST) echocardiography. We also interrogated possible correlations between impairment of myocardial deformation and the SLE Disease Activity Index 2000 (SLEDAI-2K), as well as the presence of traditional and disease-related cardiovascular risk factors (CRFs).Method: A total of 50 asymptomatic patients and 50 controls (age 14.74 vs. 14.82 years, p = 0.83) were evaluated by standard and 2DST echocardiography.Results: Despite a normal ejection fraction (EF), there was reduction in all parameters of LV longitudinal and radial deformation in patients compared to controls: peak longitudinal systolic strain (PLSS) [−20.3 (−11 to −26) vs. −22 (−17.8 to −30.4)%, p < 0.0001], PLSS rate [−1.19 ± 0.21 vs. −1.3 ± 0.25 s−1, p = 0.0005], longitudinal strain rate in early diastole [1.7 (0.99–2.95) vs. 2 (1.08–3.00) s−1, p = 0.0034], peak radial systolic strain [33.09 ± 8.6 vs. 44.36 ± 8.72%, p < 0.0001], peak radial systolic strain rate [1.98 ± 0.53 vs. 2.49 ± 0.68 s−1, p < 0.0001], and radial strain rate in early diastole [−2.31 ± 0.88 vs. −2.75 ± 0.97 s−1, p = 0.02]. Peak circumferential systolic strain [−23.67 ± 3.46 vs. −24.6 ± 2.86%, p = 0.43] and circumferential strain in early diastole [0.37 ± 0.17 vs. 0.41 ± 0.15, p = 0.27] were similar between patients and controls, although peak circumferential systolic strain rate [−1.5 ± 0.3 vs. −1.6 ± 0.3 s−1, p = 0.036] was reduced in c-SLE. Further analysis of patients revealed a negative correlation between LV PLSS and SLEDAI-2K (r = –0.52, p < 0.0001), and also between LV PLSS and the number of CRFs per patient (r = –0.32, p = 0.024).Conclusions: 2DST echocardiography has identified subclinical LV deformation impairment in c-SLE patients. Disease activity and cumulative exposure to CRFs contribute to myocardial compromise.

Noninvasive estimation of pulmonary capillary wedge pressure in patients with mitral regurgitation: A speckle tracking echocardiography study

BackgroundEchocardiographic parameters to predict pulmonary capillary wedge pressure (PCWP) in mitral regurgitation (MR) are not yet elucidated. We reported that PCWP could be accurately estimated by novel KT index which is defined as log10[left atrial (LA) emptying function (EF)/LA volume]. We examined the usefulness of the KT index as a predictor of PCWP in primary and secondary MR with sinus rhythm and also MR with atrial fibrillation. MethodsLA dimension, strain, volume, EF, and E/e′ were measured in moderate to severe MR with sinus rhythm (n=58, age: 67±8 years) and MR with atrial fibrillation (n=24, age: 69±11 years) just before catheterization and in normal subjects (n=26, age: 67±11 years) using speckle tracking echocardiography. MR with sinus rhythm was divided into primary MR (n=27) and secondary MR (n=31). The estimated PCWP (ePCWP) was calculated as 10.8–12.4×KT index. ResultsThere was a correlation between PCWP and LA dimension, E/e′, minimum LA volume index, active LAEF, total LAEF, or LA strain (r=0.32, r=0.31, r=0.55, r=−0.61, r=−0.51, and r=−0.50, respectively, p<0.05). The better correlation was found between PCWP and ePCWP in MR including both primary and secondary MR and also MR with atrial fibrillation (r=0.70, r=0.67, and r=0.58, respectively, p<0.01). Multiple regression analysis revealed that ePCWP was an independent predictor of PCWP in MR. The ePCWP demonstrated good diagnostic accuracy (area under the curve of 0.86) and sensitivity (81%) and specificity (71%) to predict elevated PCWP >15mmHg using a cut-off of 16mmHg. ConclusionThe ePCWP was the reliable echocardiographic parameter to predict PCWP in primary and secondary MR and might also be useful in MR with atrial fibrillation. The ePCWP may have an incremental value in a clinical setting.

Maternal cardiac remodeling and dysfunction in preeclampsia: a three-dimensional speckle-tracking echocardiography study.

Aims preeclampsia (PE) is a pregnancy complication that remains a main cause of maternal morbidity and mortality. The aims of this study were to investigate left ventricle (LV) performance in PE and to compare maternal cardiac function between early-onset preeclampsia (EP) and late-onset preeclampsia (LP) by novel threedimensional (3D) speckle-tracking echocardiography (STE) parameters while considering LV loading and shape. Methods and Results Two-dimensional echocardiography and 3D STE were performed in 43 women with EP, 41 women with LP, and 81 normal pregnancies. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were measured using 3D speckle-tracking software. There was eccentric hypertrophy and reduced LV ejection fraction (EF) in PE; meanwhile, GLS in EP and LP, GCS in LP, as well as GAS and GRS in EP significantly decreased in PE versus controls. All 3D strain indices were correlated with gestation age. Increased left atrial (LA) volume index was detected in PE. Higher LV mass index and lower 3D-derived strain value were present in women with EP compared to that in women with LP. Conclusion PE cases exhibited significant eccentric hypertrophy, ventricular dysfunction, and LA remodeling. Furthermore, myocardial deformation abnormalities preceded chamber dysfunction in this hypertensive disorder complicated pregnancy. Compared with LP, women with EP demonstrated more remarkable cardiac damage.

Noninvasive Evaluation of Myocardial Systolic Dysfunction in the Early Stage of Kawasaki Disease: A Speckle-Tracking Echocardiography Study.

Background:Evaluation of myocardial function by speckle-tracking echocardiography is a new method for the early diagnosis of systolic dysfunction.Objectives:We aimed to determine myocardial speckle-tracking echocardiography indices in Kawasaki Disease (KD) patients and compare them with the same indices in control subjects.Patients and Methods:Thirty-two patients (65.5% males) with KD and 19 control subjects with normal echocardiography participated in this study. After their demographic characteristics and clinical findings were recorded, all the participants underwent transthoracic echocardiography. Strain (S), Strain Rate (SR), Time to Peak Strain (TPS), and Strain Rate (TPSR), longitudinal velocity and view point velocity images in the two, three, and four-chamber views were semi-automatically obtained via speckle-tracking echocardiography.Results:Among the patients, Twenty-four cases (75%) were younger than 4 years. Mean global S and SR was significantly reduced in the KD patients compared to controls (17.03 ± 1.28 vs. 20.22 ± 2.14% and 1.66 ± 0.16 vs. 1.97 ± 0.25 1/second, respectively), while there were no significant differences regarding mean TPS, TPSR, longitudinal velocity and view point velocity. Using repeated measure of analysis of variances, we observed that S and SR decreased from base to apical level in both groups. The change in the pattern of age adjusted mean S and SR across levels was significantly different between the groups (P < 0.001 for both parameters).Conclusions:We showed changes in S and SR assessed in KD patients versus control subjects in the acute phase of KD. However, we suggest that further studies be undertaken to compare S and SR in the acute phase and thereafter in KD patients.

The relationship between tricuspid regurgitation severity and right atrial mechanics: a speckle tracking echocardiography study.

The aim at this study was to assess the influence of the tricuspid regurgitation volume (TRvol) in right atrium (RA) reservoir phase myocardial mechanics. We included 55 heart failure (HF) patients referred for transthoracic echocardiography during a 2-month period. 18 Had HF with a reduced ejection fraction (HFREF) and 37 HF with a preserved ejection fraction (HFPEF). TR was chronic and functional. TRvol was calculated according to the PISA method. This study of RA used 2D-speckle tracking echocardiography to measure strain (rεR) and strain rate (rSR(R)). The reference frame coincided with the onset of the QRS. RA stiffness was assessed as the ratio: (rE/e')/rε(R). The median age of the sample was 78 (64-84) years, with female gender predominance (63.6%). The median value of rε(R) was 16% (range, 12.7-24.0) and of rSR(R) was 1.57 s(-1) (range, 1.09-2.05). We observed a significant negative correlation between rε(R) (r = -0.68, p < 0.01) and rSR(R) (r = -0.58, p < 0.01) and TRvol. RA mechanics decreased significantly with an increase in the TR grade. We created two multivariate linear regression models for rε(R) and rSR(R), separately for the patients with sinus rhythm or atrial fibrillation. The TRvol was independently associated with rε(R) after adjusting to the RA area, right ventricular longitudinal systolic function and the estimated pulmonary vascular resistance. We demonstrated an increase in RA stiffness with an increase in TR severity, and an association for functional status (NYHA class) and RA compliance. The HFREF group had a significantly lower rε(R) and rSR(R) that the HFPEF patients. According to our study, in HF patients, a chronic volume overload state significantly reduced the RA reservoir phase mechanics.

Myocardial function in aortic stenosis--insights from radial multilayer Doppler strain.

BackgroundLeft ventricular (LV) radial tissue Doppler imaging (TDI) strain increases gradually from the subepicardial to the subendocardial layer in healthy individuals. A speckle tracking echocardiography study suggested this gradient to be reduced in parallel with increasing aortic stenosis (AS) severity.MethodsWe used TDI strain in 84 patients with AS (mean age 73 ± 10 years, 56% hypertensive) for superior assessment of layer strain. 38 patients had non-severe and 46 severe AS by aortic valve area corrected for pressure recovery. Peak systolic radial TDI strain was measured in the subendocardial, mid-myocardial and subepicardial layers of the basal inferior LV wall, each within a region of interest of 2 × 6 mm (strain length 2 mm).ResultsRadial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial). In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05). In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = −0.23) and AS severity (β = −0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = −0.35, p < 0.01).ConclusionsIn AS, both the AS severity and concomitant hypertension attenuate radial TDI strain in the inferior LV wall. The subendocardial radial strain is mainly influenced by AS severity, while midmyocardial radial strain is attenuated by both hypertension and AS severity.

Structural and functional changes in maternal left ventricle during pregnancy: a three-dimensional speckle-tracking echocardiography study.

BackgroundPregnancy represents a physiological adaptation to the transient load changes of maternal heart. This study aimed to investigate maternal left ventricle (LV) performance during normal pregnancy by three-dimensional speckle-tracking echocardiography (3D STE) parameters considering LV loading and shape.MethodsSequential two-dimensional echocardiography (2DE) and 3D STE were performed on 68 women during each pregnancy trimester and 6 to 9 weeks after delivery, while thirty age-matched, healthy, nonpregnant women served as controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS) were measured.ResultsIncreased cardiac index and progressive eccentric hypertrophy was detected, which subsequently recovered postpartum. In late pregnancy, GLS, GCS, GAS and GRS significantly decreased (P < 0.05) accompanied by a slight reduction of LV ejection fraction (EF) (P < 0.05), and these values returned postpartum to baseline level. All 3D strain indices correlated well with gestation age (P < 0.01), while compared to other components, GAS exhibited the strongest association with 3D EF (r = 0.549) and sphericity index (r = 0.328), and was the only parameter that correlated well with LV mass index (r = 0.22).ConclusionsThis study gives normal ranges of 3D STE indices in pregnancy. 3D STE demonstrated modified myocardial deformation and changes in maternal LV structure and function during the gestation period.

Predictive role of left atrial and ventricular mechanical function in postoperative atrial fibrillation: a two-dimensional speckle-tracking echocardiography study.

The aim of this study was to determine the role of left-sided mechanical parameters in postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). Ninety patients with coronary artery disease and normal left ventricular (LV) function in sinus rhythm were enrolled in the study. Preoperative LV and left atrial (LA) mechanics were evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE), including strain and rotation parameters, and volume indices. Patients were monitored in order to detect POAF during the postoperative period. Twenty-three of 90 patients (25.6%) developed POAF. Age (p<0.001) and preoperative beta blocker usage (p=0.001) were the clinical parameters associated with POAF. Left atrial maximum volume index (LAV[max]i) increased, and peak left atrial longitudinal strain (PALS) was impaired in POAF patients (p=0.001, p<0.001, respectively). Left ventricular twist (LVtw) and left ventricular peak untwisting velocity (UntwV) were augmented in POAF patients (p=0.013, p=0.009, respectively). Receiver operating characteristic analysis showed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels above 70 pg/ml and predicted POAF with a sensitivity of 74% and specificity of 78% (area under curve: 0.758, 95% confidence interval [CI] 0.631-0.894, p<0.001). Logistic regression analysis demonstrated that age (odds ratio [OR] 1.1, CI 1.01-1.20, p=0.034), preoperative beta blocker usage (OR 8.84, CI 1.36-57.28, p=0.022), NT-proBNP (values >70 pg/ml, OR 22.377, CI 3.286-152.381, p<0.001), PALS (OR 0.86, CI 0.75-0.98, p=0.023), and UntwV (OR 1.02, CI 1.00-1.04, p=0.029) were the independent predictors of POAF. The combination of 2D STE, clinical, and biochemical parameters may help predict POAF.

A novel ultrasound predictor of pulmonary capillary wedge pressure assessed by the combination of left atrial volume and function: A speckle tracking echocardiography study

BackgroundWe hypothesized that a development of a novel index based on the combination of left atrial volume (LAV) and left atrial (LA) function evaluated by the time–LA volume curve using speckle tracking echocardiography (STE) would be accurate and useful to estimate pulmonary capillary wedge pressure (PCWP). Our goal was to develop a novel index of PCWP based on a combination of LAV and LA function using STE. MethodsA cross-validation study was performed with the patients divided into a training study to define the novel index (n=50) and a testing study to validate the index (n=196). PCWP was measured by right heart catheterization, and phasic LAV and emptying function (EF) were measured by STE. ResultsSimple linear regression analysis in the training study revealed that the novel index that best estimated PCWP was the kinetics-tracking index [KT index=log10 (active LAEF/minimum LAV index)]. Multiple regression analysis revealed that the KT index was the most reliable predictor of PCWP. It had the strongest correlation with PCWP (r=−0.86, p<0.001) among all echocardiographic parameters. In the testing study, PCWP estimated by the KT index was also strongly correlated with measured PCWP (r=0.92, p<0.001). These correlations were also strong in the patients with reduced left ventricular ejection fraction (<50%), chronic heart failure, and chronic atrial fibrillation (r=0.92, r=0.91, r=0.79, p<0.001, respectively). ConclusionsA novel index (KT index) using a combination of LAV and LA function was a powerful and useful predictor of PCWP and may be valuable in routine clinical practice.