Speckle Tracking Strain Imaging Research Articles

Assessment of ventricular mechanics by means of myocardial work in patients undergoing physiologic versus right ventricular apical stimulation:a prospective study

Abstract Introduction Left bundle branch area (LBBA) pacing has recently gained widespread acceptance in patients that need pacemaker (PM) stimulation. This type of physiologic pacing may improve ventricular mechanical contraction and reduce the risk of PM-induced left ventricular (LV) dysfunction. Myocardial work (MW), a new tool, based on the analysis of pressure-strain loops, combines the information from speckle tracking strain imaging and non-invasive estimate of LV pressure. It provides a better characterization of LV performance and detection of LV myocardial dysfunction. The aim of this study was to compare MW after PM implantation in LBBA pacing patients (group 1) vs right ventricular apical (RVA, group 2) pacing patients. A control group (group 3) was also enrolled for establishing MW normal values. Methods We studied 30 patients (56% females, age 80 y, IQR 75-84) who underwent PM implantation and had a high probability of a high % of stimulation and 21 controls (57% females, age 79 y, IQR 73-85, p=0.46 and p=0.73 respectively) Patients were prospectively included at two large university hospitals from March 23 until February 24. The mode of stimulation was chosen at their physician’s discretion. Exclusion criteria included LVEF <50% or significant structural or valvular disease. We compared MW parameters between group 1 and group 2 before PM implantation, and 24 hours and 3 months post PM implantation by Kruskal Wallis test. Additionally, we compared MW parameters between group 3 and PM patients after 24 hours using U Mann-Whitney test. Results The % of stimulation was 93%±12. There were no differences in baseline characteristics between group 1 (n=21, 71%) and group 2. At baseline, global work index (GWI), global constructive work (GCW), global wasted work (GWW) or global work efficiency (GWE) did not differ significantly between Group 1 and 2. At 24 hours, all the components of MW significantly improved in Group 1 and 2 and were maintained at 3 months, but the improvement was notably greater in Group 1 (see Table 1). Group 3 and PM patients were similar at baseline (HTN, 86% vs 80%, p=0.7197; DM, 29% vs 30%, p=0.91; coronary artery disease, 14% vs 10%, p=0.68; sinus rhythm, 76% vs 83%, p=0.68). Comparing group 3 and PM at 24 h, GWI, GCW, GWE was significantly higher in group 3 (p=0.0023, p=0.009, p=<0.0001) and GWW was significantly lower (p=<0.0001). Regarding the type of stimulation, MW parameters values in Group 1 were still lower than in Group 3 but clearly better than Group 2 values (see Figure 1). Discussion Our results showed that MW parameters improved to a greater extent in LBBA compared to RVA pacing immediately and after 3 months of PM implantation. Compared to our control group, LBBA pacing group achieved better performance than RVA pacing patients, yielding a more coordinated LV contraction. Nevertheless, more studies are needed to clarify if LBBA pacing causes less PM induced LV dysfunction compared to RVA pacing.

Assessment of right ventricular systolic function using speckle tracking strain imaging in patients with severe tricuspid regurgitation: a validation study with cardiac magnetic resonance

BackgroundRight ventricular (RV) systolic dysfunction is an established prognostic factor in patients with severe tricuspid regurgitation (TR). However, accurate assessment of RV systolic function using conventional echocardiography remains challenging. We investigated the accuracy of strain measurement using speckle tracking echocardiography (STE) for evaluating RV systolic function in patients with severe TR.MethodsWe included consecutive patients with severe TR who underwent echocardiography and cardiac magnetic resonance imaging (CMR) within 30 days between 2011 and 2023. Two-dimensional STE was used to measure RV free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS). These values were compared with the RV ejection fraction (RVEF) from CMR. RV systolic dysfunction was defined as a CMR-derived RVEF < 35%.ResultsA total of 87 patients with severe TR were identified during the study period. Among echocardiographic RV strain measurements, RVFWLS was the best correlate of CMR-derived RVEF (r = –0.37, P < 0.001), followed by RVGLS (r = –0.27, P = 0.012). Receiver operating characteristic (ROC) curve analysis revealed that RVFWLS provided better discrimination of RV systolic dysfunction, yielding an area under the ROC curve (AUC) of 0.770 (95% confidence interval [CI], 0.696–0.800) than RV fractional area change (AUC, 0.615; 95% CI, 0.500–0.859).ConclusionsIn patients with severe TR, STE-derived RVFWLS showed the best correlation with RVEF on CMR and displayed superior discrimination of RV systolic dysfunction compared with the RV fractional area change. This study suggests the potential usefulness of STE in assessing RV systolic function in this population.

Clinical Diagnostic Workflow of Nondilated Left Ventricular Cardiomyopathy: A Case-based Review

Abstract Dilated cardiomyopathy is defined as left ventricular (LV) or biventricular dysfunction and dilatation not explained by abnormal loading conditions or coronary artery disease. However, the existing definition does not cover a range of disorders that manifest as a spectrum of electrical, structural, and functional myocardial abnormalities that change over time. With the rising use of echocardiographic speckle tracking strain imaging and cardiac magnetic resonance imaging, subtle myocardial structural or functional pathology can be detected very early in the natural history of the myocardial disease. The 2023 European Society of Cardiology guidelines for cardiomyopathy have coined a new terminology “nondilated LV cardiomyopathy (NDLVC)” to help in early risk stratification and better patient surveillance and therapeutic management. This article is a case series of NDLVC with an emphasis on systematic clinical workup for early diagnosis and better management of this pathology.

Assessment of Right Ventricular Function by Strain Imaging in Patients Presenting with Acute Myocardial Infarction: An Original Research

ABSTRACT Objective: This study sought to determine the relationship between right ventricular (RV) function and clinical variables and prognosis in individuals with acute myocardial infarction (AMI) utilizing strain imaging. Materials and Methods: A prospective observational research involving 150 patients who had been admitted with AMI was carried out. Utilizing two-dimensional speckle-tracking strain imaging, RV function was assessed. Age, sex, risk factors, and comorbidities were recorded as clinical parameters. A 12-month follow-up was conducted to assess major adverse cardiovascular events (MACE). Results: 65% of the study’s participants were men, with a mean age of 58.2 years. When compared to a healthy control group, individuals with AMI had significantly lower RV longitudinal strain (RVLS) (P 0.001). RVLS and left ventricular ejection fraction had a statistically significant connection (r = 0.642, P 0.001). Patients with compromised RVLS had a greater rate of MACE over the follow-up period compared to those with maintained RV function (P = 0.014). Conclusion: In conclusion, strain imaging offers useful information for evaluating RV function in patients with AMI. Reduced left ventricular performance and a higher likelihood of unfavorable clinical outcomes are linked to impaired RVLS. Utilizing strain imaging to detect RV dysfunction early can help direct treatment plans and enhance patient outcomes.

Dissociation of LA volume and deformation is a hallmark of ATTR-CA

Abstract Background Transthyretin Cardiac amyloidosis (ATTR-CA) is associated with an infiltrative left atrial (LA) cardiomyopathy. Purpose We sought to identify unique characteristics of LA cardiomyopathy in CA compared to non-amyloid states of left ventricular hypertrophy (LVH). Methods In suspected patients, a diagnosis of ATTR-CA was made by a positive Tc-99m PYP in conjunction with negative serum/urine studies for a clonal plasma cell dyscrasia. Endomyocardial biopsy was performed when clinically indicated. All patients underwent complete transthoracic echocardiography (TTE) with speckle tracking strain imaging. Left ventricular (LV) strain, LA reservoir strain (LASr) and LA volume index (LAVI) were measured. LA stiffness index was estimated by the ratio (E/e’)/LASr. ATTR-CA patients were compared to patient with non- CA LVH (interventricular septal thickness &amp;gt; 1.2 cm). Atrial fibrillation (AF) during the TTE was noted. Logistic regression and Cox-regression analyses were performed to find the independent determinant of ATTR-CA and outcome predictors, respectively. Results We studied 98 patients with ATTR-CA (44 with AF) and 62 patients with non-CA LVH (35 with AF). ATTR-CA patients had a higher prevalence of relative apical sparing (RAS) (79% vs 20%, p&amp;lt;0.0001), reduced LASr (9.8±4.8% vs 14.0±7.2%; p&amp;lt;0.001) and high LA stiffness (2.5±0.2 vs 1.4±0.9; p&amp;lt;0.001) irrespective of AF. Surprisingly, LAVI of ATTR-CA patients was significantly lower than non- CA LVH patients (44±15 ml/m2 vs 51±24 ml/m2; p=0.046). Consequently, LAVI correlated strongly with LASr in non-amyloid LVH group (r= -0.52, p&amp;lt;0.001) whereas no correlation was observed in ATTR-CA (p&amp;lt;0.05) (Figure 1). Patients with ATTR-CA had the lowest LASr and highest LA stiffness regardless of AF (Figure 2). Importantly, LASr determined ATTR-CA among all study subjects independently of RAS (p&amp;lt;0.001) and emerged as a predictor of composite endpoint including all-cause mortality, hospitalization from heart failure and stroke in ATTR-CA patients (p=0.037). Conclusion ATTR-CA is characterized by severely reduced LASr and increased LA stiffness, yet LA dilatation is relatively less severe when compared to other causes of LVH. LASr seems promising to make the differential diagnosis of ATTR-CA and is of prognostic importance.Figure 1Figure 2

Current clinical use of speckle-tracking strain imaging: insights from a worldwide survey from the European Association of Cardiovascular Imaging (EACVI).

Speckle-tracking echocardiography (STE) strain imaging has been a major advancement in myocardial function quantification. We aimed to explore current worldwide clinical application of STE. Access, feasibility, access, and clinical implementation of STE were investigated with a worldwide open-access online survey of the European Association of Cardiovascular Imaging. Participants (429 respondents and 77 countries) from tertiary centres (46%), private clinics, or public hospitals (54%) using different vendors for data acquisition and analysis were represented. Despite almost universal access (98%) to STE, only 39% of the participants performed and reported STE results frequently (>50%). Incomplete training and time constraints were the main reasons for not using STE more regularly. STE was mainly used to assess the LV (99%) and less frequently the right ventricular (57%) and the left atrial (46%) function. Cardiotoxicity (88%) and cardiac amyloidosis (87%) were the most frequent reasons for the clinical use of LV STE. Left atrial STE was used most frequently for the diagnosis of diastolic dysfunction and right ventricular STE for the assessment of right ventricle (RV) function in pulmonary hypertension (51%). Frequency of STE use, adherence to optimal techniques, and clinical appropriateness of STE differed according to training experience and across vendors. Key suggestions outlined by respondents to increase the clinical use of STE included improved reproducibility (48%) and standardization of strain values across vendors (42%). Although STE is now readily available, it is underutilized in the majority of centres. Structured training, improved reproducibility, and inter-vendor standardization may increase its uptake.

Trends in the clinical use of speckle tracking strain imaging: insights from a worldwide EACVI survey

Abstract Funding Acknowledgements Type of funding sources: None. Background Strain imaging has emerged as a sensitive measure of myocardial function and an early marker of myocardial involvement in different diseases. Purpose and Methods To evaluate the use of speckle tracking strain imaging in clinical practice, an open access online survey was conducted by the EACVI according to published criteria(1). The survey explored the feasibility, appropriate use and clinical implementation of echocardiographic strain imaging. Health care providers in cardiology from all levels of health care centres were encouraged to participate in this global survey. Results In all, 431 respondents from 77 countries participated. Most respondents worked within the cardiology and cardiothoracic departments (95%). Participants from tertiary centres (46%), and private clinics or public hospitals (54%) were also represented. Fifty eight percent of the participants were senior experienced echocardiographers, 40% were trained in strain imaging at an expert centre, 37% via research in strain imaging, 33% via the EACVI e-learning platform or hands-on courses and 29% via national teaching courses. Only 16% reported having no training. Despite almost universal access (98%) to speckle tracking strain quantification, only 39% performed and reported strain results frequently (more than half of their reports) and the majority (61%) reported it either infrequently (25–50% reports) or very rarely (&amp;lt;25% reports). The most common reason (65%) for not using the technology despite having access to it was related to post-processing difficulty. Strain quantification was used mainly to assess the left ventricle (LV)(99%), less frequently the right ventricle (RV)(57%), the left atrium (46%) and rarely the right atrium (8%). Eighty-six percent of users assessed LV global longitudinal strain (GLS) from the 3 apical views, with 88% preferring automated algorithms with manual correction to define the regions of interest. The most common clinical conditions where LV strain assessment was considered useful clinically included chemotoxicity (88%) amyloidosis (87%), hypertrophic cardiomyopathy (73%), heart failure with preserved ejection fraction (68%), ischaemic heart disease (63%) and the early phase of dilated cardiomyopathy (59%, Figure 1). Just over half of the respondents quantified RV strain in pulmonary hypertension. Finally, the key areas of improvements identified by the respondents included higher reproducibility of the results (48%) and the ability to readily compare strain values across vendors (42%) (Figure 2). Conclusion Strain imaging is now widely available and many imagers have been trained in its use. Although strain imaging is used in line with the scientific evidence, it is still underutilised in clinical practice. Improved reproducibility and interchangeability of results across vendors may increase the uptake of this technique.

Reduced left atrial contractile strain with speckle tracking analysis predicts abnormal plasma NTproBNP in an asymptomatic community population

BackgroundThe left atrium (LA) is closely related to left ventricular diastolic function. Two-dimensional speckle tracking strain and strain rate (SR) imaging has been applied in the study of LA function. We intended to explore the relationship between global LA deformation parameters and plasma NTproBNP levels in asymptomatic community residents with normal ejection fraction and normal LA volume.MethodsA cross-sectional sample of Beijing residents underwent comprehensive Doppler echocardiography and medical record review in 2009. Global LA longitudinal strain and SR indexes were obtained in the apical four-chamber view. LA stiffness index (LASI) was calculated as the ratio of early diastolic velocity of transmitral flow/early diastolic mitral annular motion velocity (E/E') to LA reservoir strain.ResultsA total of 620 individuals (mean age = 65.8 years, left ventricular ejection fraction = 70.8%, LA volume index = 17.9 ml/m2) were investigated in our study. 117 individuals had increased plasma NTproBNP (≥ 125 pg/ml). LA reservoir and contractile function by LA strain and SR indexes were significantly reduced in the abnormal NTproBNP group compared with the normal NTproBNP group. Multiple regression analysis indicated that LA contractile strain was a negative predictor of plasma NTproBNP in addition to indexed LA volume and E/E'. LASI was higher in the abnormal NTproBNP group and was significantly correlated with NTproBNP (r = 0.342, P < 0.001). The area under ROC analysis for LASI in predicting elevated plasma NTproBNP was 0.690, similar with LA contractile strain, E/E’ and LAVI. The cut-off value of LASI was 0.612.ConclusionsLA reservoir and contractile functions demonstrated by LA strain and SR were significantly impaired in the community-based population with increased plasma NTproBNP levels. LA contractile strain adds incremental information in predicting abnormal NTproBNP levels. As a single index, LASI showed similar diagnostic value with LAVI and E/E’ in predicting abnormal NTproBNP.

Speckle tracking echocardiography in patients with systemic sclerosis: a meta-analysis

Abstract Background Myocardial dysfunction is well established in systemic sclerosis (SSc). The utility of standard echocardiography is limited to detect the onset of myocardial dysfunction. Speckle tracking echocardiography (STE) and strain imaging has emerged as a useful technique to quantify left ventricle hemodynamics and myocardial function in early stages of myocardial dysfunction. We aimed to systematically analyze the existing literature on the application of STE and strain analysis in identifying SSc associated myocardial dysfunction Methods PubMed, Cochrane, and Google Scholar were queried for studies from the inception of the databases to 2022. Case control studies that used 2D STE for assessment of strain in SSc patients and controls, were included for the analysis. PRISMA guidelines were followed for selections of studies. Two independent reviewers extracted data. Analysis was done using Cochrane Review Manager 5.0. Results Total of 19 studies were included in the analysis that compared strain analysis in SSc patient's vs healthy controls. Of the 16 studies that reported left ventricular (LV) global longitudinal strain, we found significantly lower LV global longitudinal strain in SSc patients (mean difference 1.92; 95% CI 0.98–2.87). Six studies reported LV circumferential strain which was noted to be lower in SSc patients compared to healthy controls (mean difference 3.55; 95% CI 1.60–5.51). Five studies reported LV global radial strain with a similar decrease in radial strain among SSc patients compared to controls (mean difference 4.39; 95% CI −6.95 to −1.83). 10 studies reported right ventricular longitudinal strain with a decrease in longitudinal strain in SSc patient's vs controls (mean difference 2.57; 95% CI 2.03–3.12). Conclusions SSc patients have lower strain values compared to controls, which is suggestive of an impaired myocardial function in left and right ventricle. Strain analysis by STE could help with early detection of myocardial dysfunction. Funding Acknowledgement Type of funding sources: None.

Functional and morphometric changes in children after neonatal arterial switch operation for transposition of the great arteries.

The increase in the survival of patients with D-Transposition of the great arteries (TGA) after arterial switch operation (ASO) has now turned our focus to the evaluation of mid and long-term outcomes. Although most patients are followed by conventional echocardiography, the study of cardiac functionality and morphometric parameters in children with TGA after ASO is scarce. The present study aims to describe the functional and morphometric echocardiographic changes in children after ASO. We performed an observational study in patients aged 1-5 years with TGA who underwent neonatal ASO. Morphometric and functional echocardiographic parameters were analyzed in 21 patients and compared with 52 age-matched healthy controls. We found morphological and functional changes, especially in the right ventricle, which is more globular (right ventricle [RV] basal sphericity index 1.5 vs. 1.8, P = 0.016), and with a decreased systolic function compared to healthy controls (fractional area change 51 vs. 58%, P = 0.006; tricuspid annular plane systolic excursion 13 vs. 20 mm, P = 0.001; s' 7 vs. 12 cm/s, P = 0.001). In the speckle-tracking strain imaging, there was a decrease in the longitudinal deformation of the apical septal myocardium (-23% vs. -27%; P = 0.005). Preoperative systemic overload to the right ventricle could be an important factor in the origin of these changes. In patients with TGA after ASO, there are morphometric and functional echocardiographic changes, such as globular form and decreased function, especially in the RV; the effect of these changes on long-term outcomes would require prospective follow-up studies.

COVID-19-induced silent myocarditis and newly developed hypertension in a 3-year-old boy

BackgroundCOVID-19 myocarditis occurs in 7–28% of patients admitted in the hospital with or without multisystem inflammatory syndrome. It may present as fulminant myocarditis. Dilated cardiomyopathy as a sequela of COVID-19 myocarditis has been reported in the pediatric population. However, to date, no case of silent COVID-19 myocarditis progressing to dilated cardiomyopathy has been reported in children. Furthermore, although newly developed hypertension as a sequela of COVID-19 infection has been reported in adults, there is no report of newly developed COVID-induced hypertension in children. We report a 3-year-old boy with silent COVID-19 myocarditis progressing to dilated cardiomyopathy and newly developed systemic hypertension.Case presentationA 3-year-old boy was referred to the emergency department because of respiratory distress. The parents gave a history of SARS-CoV-2 infection in the child 5 months ago that was manifested as fever and cough, for which he was treated as an outpatient. Echocardiographic examination revealed a severe decrease in left ventricular systolic function in favor of dilated cardiomyopathy. Cardiac magnetic resonance imaging established the diagnosis of myocarditis. The patient left ventricular systolic function did not improve after 2 weeks of intravenous inotropic support. Therefore, the child was transferred to another tertiary center with extracorporeal membrane oxygenation and pediatric cardiac transplantation facilities.ConclusionsCOVID-19 can induce silent myocarditis with progression to dilated cardiomyopathy and newly developed systemic hypertension. Thus, a thorough examination of the heart and measurement of blood pressure are mandatory in every child with COVID-19 infection. Cardiac MR is an indispensable tool in the diagnosis, follow-up, and prognostication of COVID-19 myocarditis. Moreover, four-chamber speckle tracking strain imaging showed apical rocking in all the four heart chambers in this child with opposite direction in the failed left ventricle compared with other cardiac chambers. Lastly, the presence of septal flash on M-mode echocardiography, apical rocking and prestretch–rebound stretch patterns on longitudinal strain imaging of the failed left ventricle in this child may be of predictive value for response to cardiac resynchronization therapy.

Relationship between Fragmented QRS and Microvascular Dysfunction in Masked Hypertension

Aim: The aim of this study was to investigate the presence of fQRS and its association with subclinical systolic and microvascular dysfunction in patients with masked hypertension (MH). Methods: The study population consisted of 95 (mean age 48.9 ± 11.3, 61% males) subjects with MH and 80 age- and gender-matched healthy individuals who served as a control group. Coronary flow reserve (CFR) using transthoracic echocardiography and for left ventricular global longitudinal strain (LVGLS) using speckle-tracking strain imaging were performed. Patients with MH were stratified into two groups according to the presence of fQRS on surface electrocardiogram. Results: Fragmented QRS was more common among MH patients compared with controls (38.9% vs. 6.25%, p < 0.003). CFR was significantly lower in patients with fQRS compared with those without fQRS and controls (p < 0.001). Likewise, LVGLS values were lower in MH patients with fQRS (p < 0.001) compared with subjects without fQRS and controls. Fragmented fQRS was significantly correlated with systolic blood pressure, CFR, and LVGLS. Multivariate analysis showed that the presence of fQRS, number of leads, and CFR were independent predictors of subclinical systolic dysfunction. With ROC cure analysis, number of leads with fQRS ≥4 was the optimal value for predicting the presence of subclinical systolic dysfunction in subjects with MH. Conclusions: Fragmented QRS is more frequent among subjects with MH compared with controls. The presence of fQRS is related with pronounced subclinical left ventricular systolic dysfunction. Furthermore, CFR was significantly reduced in subjects with MH, a finding supposed that microvascular dysfunction to be a mechanistic link.

Strain-based staging classification of left bundle branch block-induced cardiac remodeling predicts reverse remodeling after cardiac resynchronization therapy

Abstract Background Left bundle branch block (LBBB)-induced adverse remodeling is a gradual but largely unknown process, causing a variable degree of left ventricular (LV) dysfunction and response to cardiac resynchronization therapy (CRT). In LBBB patients with septal flash (SF), an electro-mechanical continuum of different speckle-tracking strain patterns was observed, with each pattern tightly correlating with the degree of LV remodeling and dysfunction (1) (Figure 1). Purpose In this study, we investigated the relationship between the staged LBBB strain patterns in CRT-eligible patients and their prediction with respect to reverse remodeling and clinical outcome. Methods This study enrolled CRT patients from the PREDICT-CRT study population (2). Inclusion criteria were LV ejection fraction (LVEF) ≤35%, QRS duration ≥120 ms, NYHA class II–IV, absence of right ventricular pacing and availability of speckle tracking strain imaging. All patients underwent an echocardiographic examination before and 12 months after CRT implant. LV volumes, strain and dyssynchrony were assessed. Mid-septal longitudinal strain curves were classified into 5 patterns (LBBB-0 through LBBB-4; Figure 1). Primary endpoint was all-cause mortality. Results The study involved 250 patients (mean age 64±10 years; 79% men) with a mean LVEF of 26±7%. LBBB was present in 220 (89%) patients and 206 (82%) patients had SF. Prior to CRT implant, a LBBB-0 pattern was observed in 33 (13%), LBBB-1 in 33 (13%), LBBB-2 in 39 (16%), LBBB-3 in 44 (18%) and LBBB-4 in 101 (40%) patients. Patients with LBBB-3 and -4 patterns more frequently had LBBB, lower LVEF, increased mechanical dyssynchrony and more prominent SF (p&amp;lt;0.001 for all) compared with patients with LBBB-0, -1 and -2 patterns. Across the stages, CRT resulted in a gradual volumetric response, ranging from no response in stage LBBB-0 patients (ΔLV end-systolic volume +7±33%; ΔLVEF −2±9%) to super-response in stage LBBB-4 patients (ΔLV end-systolic volume −40±29%; ΔLVEF +15±13%) (p&amp;lt;0.001 for all). Interestingly, following reverse remodeling, the LV function of stage LBBB-2, -3 and -4 patients improved to a similar LVEF of 38% (p=1.000) in this cohort. Patients in stage LBBB-0 had a significantly less favorable five-year outcome compared to those in stage LBBB≥1 (log-rank p=0.003). There was no difference in long-term outcome between stage LBBB-1 to −4 patients (log-rank p=0.510). Conclusion Strain-based LBBB staging predicts the extent of LV reverse remodeling in CRT patients. CRT did not translate into improved absolute survival in the more advanced stages, but the observed gradual volumetric response suggests that CRT corrects the LBBB-induced mortality. Funding Acknowledgement Type of funding sources: None. Figure 1

Strain analysis by two-dimensional speckle tracking echocardiography for evaluating left ventricular systolic function in women with pre-eclampsia

Abstract Background Previous echocardiographic studies have shown that most women affected by pre-eclampsia present with mild-to moderate diastolic dysfunction and left ventricle remodelling with a preserved systolic function. These alterations appear more severe when pre-eclampsia develops before 34 weeks of gestation. Purpose The aim of this study is to compare left ventricular systolic (LV) function by using 2-D speckle tracking echocardiography in women with early-onset and late-onset pre-eclampsia. Methods In this single-centre prospective longitudinal study, 119 women with a diagnosis of pre-eclampsia underwent standard trans-thoracic echocardiography (TTE) in the immediate peripartum period from February 2019 to December 2020. LV function was assessed using two-dimensional speckle-tracking strain imaging on 4-chamber views with a frame rate of 60–90 frames/second. Strain analysis quantification was performed using a commercial software. Results Pre-eclampsia was diagnosed before and after 34 weeks in 37.3% (44/119) and 62.7% (74/119) of the patients, respectively. Maternal characteristics, such as maternal age, body mass index, pre-existing hypertension and nulliparity, did not show any significant difference between the two groups. Although LV remodelling/hypertrophy and diastolic dysfunction occurred more often in early-onset pre-eclampsia compared to late-onset (65.9% vs 60.8% and 59.1% vs 51.4%, respectively), this difference was not statistically significant (p=0.580 and p=0.414, respectively). Similarly, LV mass index was 80.1±16.3 in pre-eclampsia &amp;lt;34 and 79.1±15 &amp;gt;34 (p=0.715) and E/e' was 7.8±1.9 and 7.6±1.7 (p=0.424). However, global longitudinal strain (GLS) was significantly lower (−16.4±2.4 vs −17.6±2.4, p=0.030) and apical rotation was higher (11.1±5.9 vs 8.7±4.7, p=0.019) in early-onset pre-eclampsia. A positive weak correlation has been found between GLS and difference in days from pre-eclampsia diagnosis to delivery (r=0.2, p=0.002). Conclusions Lower GLS in women affected by early-onset pre-eclampsia compared to late-onset pre-eclampsia might be useful to detect sub-clinical LV systolic impairment. Although further studies are needed, this sensitive marker may have a role in identifying women at risk of preterm delivery and/or severe maternal morbidity in the peripartum period. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Veronica Giorgione and Carolina Di Fabrizio have received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 765274 (iPLACENTA project).

Physiological compensatory mechanisms of improved left heart function in response to simulated acute weightlessness: A human echocardiographic study by speckle tracking strain imaging

<p indent="0mm">The gravity-induced hydrostatic pressure gradient in the cardiovascular system is altered under the aerospace condition of weightlessness, leading to the increase of returned blood volume, and thus changes in cardiac structure and function. However, the characteristics and compensatory mechanisms are still unclear. The present study was to investigate the characteristics and compensatory mechanisms of cardiac preload and function in simulated acute aviation negative gravity and space microgravity using two-dimensional echocardiographic speckle-tracking strain imaging, and to provide theoretical evidence for aerospace heart protection. A total of 27 healthy young male volunteers were recruited. The tilting table was used to simulate acute microgravity (0.87~0 G) and negative gravity (0~−0.87 G). The left heart volumes, strain and functional parameters were collected and analyzed by both conventional and speckle tracking echocardiography. The systemic vascular resistance, compliance and ventricular-arterial coupling were calculated. The results showed that, the left heart volume and strain, left atrial emptying fraction and left ventricular ejecting fraction were all increased as gravity decreased. The arterial compliance was increased and the ventricular-arterial coupling index was decreased within the normal range. Of note, the reservoir, conduit and contraction function of left atrial strain were elevated proportionally; the flow velocity of left ventricular filling during early and late diastolic phases were both increased at the constant ratio. That is, the compensatory pattern was characterized by proportional improvement of cardiac motion in different phases and directions, which is different from that in aging and diseases. The present study demonstrated that the heart of healthy young men can effectively compensate the increase of preload caused by simulated acute microgravity and negative gravity. The major compensatory mechanism is the proportional improvement of myocardial motion of left atrium and ventricle during different phases (early and late diastole, systole) and along different directions (longitudinal and circumferential). The findings suggest that the aviators or astronauts generally have enough cardiac systolic/diastolic reserve to counter the acute change of cardiac preload induced by weightlessness (−0.87~1 G).

Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part II: Chronic aortic regurgitation of the native valve.

Inadequate diastolic closure of the aortic valve causes aortic regurgitation (AR). Diastolic regurgitation towards the left ventricle (LV) causes LV volume overload, resulting in eccentric LV remodelling. Transthoracic echocardiography (TTE) is the first line examination in the work-up of AR. TTE allows quantification of left ventricular end-diastolic diameter and volume and left ventricular ejection fraction, which are key elements in the clinical decision making regarding the timing of valve surgery. The qualitative echocardiographic features contributing to the AR severity grading are discussed: fluttering of the anterior mitral valve leaflet, density and shape of the continuous wave Doppler signal of the AR jet, colour flow imaging of the AR jet width, and holodiastolic flow reversal in the descending thoracic aorta and abdominal aorta. Volumetric assessment of the AR is performed by measuring the velocity time integral of the left ventricular outflow tract (LVOT) and transmitral valve (MV) plane, and diameters of LVOT and MV. We explain how the regurgitant fraction and effective regurgitant orifice area (EROA) can be calculated. Alternatively, the proximal isovelocity surface area can be used to determine the EROA. We overview the utility of pressure half time and vena contracta width to assess AR severity. Further, we discuss the role of transoesophageal echocardiography, echocardiography speckle tracking strain imaging, cardiac magnetic resonance imaging and computed tomography of the thoracic aorta in the work-up of AR. Finally, we overview the criteria for valve surgery in AR.

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate.

Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage renal disease. Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility. Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after HD (52.4 ± 40.2 ng/L vs. 66.8 ± 48.5 ng/L, p < 0.001 and 20.1 ± 3.6% vs. 16.8 ± 3.8% p < 0.001, respectively). Moreover, ultrafiltration rate and GLS were found as the strongest independent variables in relation to the relative increase in hs-cTnT. Hemodialysis can cause a significant increase in hsTnT. This can jeopardize the accuracy of clinical diagnoses based on hs-TnT measurements. GLS may be used as a determinant of this hs-TnT increase. The influence of HD on the cardiovascular system should be kept in mind to prevent unnecessary interventions.

ASSESSMENT OF LEFT ATRIAL STRAIN BEFORE AND AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT

Speckle tracking strain imaging of the left atrium (LA) is an emerging modality to assess LA contractile function, and subsequently diastolic function. Abnormal diastology is seen with left-sided valvular disease and has been shown to improve after valve replacement. We measured LA strain before and

HIV and pericardial fat are associated with abnormal cardiac structure and function among Ugandans

ObjectivesTo examine the relationship between pericardial fat (PCF) and cardiac structure and function among HIV-infected patients in the sub-Saharan African country of Uganda. People living with HIV (PLHIV) have altered...

Application of strain and other echocardiographic parameters in the evaluation of early and long-term clinical outcomes after cardiac surgery revascularization

BackgroundCoronary artery bypass graft (CABG) surgery is an effective therapeutic strategy for coronary heart disease (CHD). Myocardial longitudinal strain echocardiography with 2D speckle tracking could obtain ventricular function with better accuracy and reliability than the left ventricular ejection fraction.The aim of the study was to assess changes in left ventricular function in patients before and after surgical revascularization for a 24-month period of observation, using echocardiography with speckle tracking strain imaging. We searched for echocardiographic predictors of poor early and long-term outcome after CABG.MethodsWe enrolled 69 patients scheduled for elective coronary bypass grafting. Patients were divided into groups based on pre-operative systolic and diastolic parameters, depending on the GLS value and the E’ Lat and E/E’ value. The correlation between these parameters and early and long-term outcomes was analyzed.ResultsPreoperative EF was preserved in 86, 95% (60) patients. Pre-operative reduced GLS was observed in 73.91% (51) of patients and severely reduced in 31.88% (22).In the first post-operative 6-month period, we observed a significant decrease in the GLS. The GLS was a predictor of early postoperative outcome for intubation time, the inotropes use and length of ICU stay. Diastolic dysfunction was a predictor of the greater inotrope requirements.ConclusionsGlobal longitudinal strain and diastolic dysfunction parameters are a good predictors of worse early outcome after CABG.