Speckle Tracking Technique Research Articles

Assessment of atrial strain variations in amateur runners: A 10-week unsupervised training program and half-Marathon impact study using 2D and speckle-tracking echocardiography

BackgroundCompetitive running leads to cardiac remodeling and functional changes in cardiovascular haemodynamics in professional runners. Data on atrial changes in amateur runners completing a half-marathon are limited. The study sought to analyze the impact of training and a 21.0975-km run on echocardiographic parameters of left (LA) and right (RA) atrial anatomy and function in recreational runners. MethodsThe study group comprised 52 amateur runners [mean age 32.96 (5.12) years], including 32 men. Echocardiographic evaluations were performed at three stages: prior to the ten-week unsupervised training, and then before and after the run. Morphological and functional parameters were assessed using two-dimensional imaging, Doppler, and speckle-tracking technique. ResultsDuring the training period, both LA dimension [31.87 mm vs. 33.96 mm; p < 0.001] and LA volume [59.00 ml vs. 68.00 ml; p < 0.001] increased and no changes were found for RA morphological parameters. Ten weeks of preparatory training resulted in an increase in LA contractile strain (LASct) [10.50 % vs. 11.00 %; p = 0.030], without affecting the RA function. Change of LASct was particularly pronounced in young women (<32 years; p = 0.029). Half-marathon performance decreased the LA volume. ConclusionsAmateur training for 21.0975-km run remodels LA and enhances LA active contractile function (especially in young women) without influencing RA. The half-marathon decreases LA volume and does not affect RA morphology and function in recreational runners.

THE ROLE OF CARDIAC MAGNETIC RESONANCE IN CLINICAL MONITORING AND ASSESSMENT OF PATHOGENETIC THERAPY EFFICIENCY IN PATIENTS WITH SEVERE COURSE OF MYOCARDITIS

Introduction. Diagnosis of myocarditis often causes significant difficulties due to the heterogeneity of clinical manifestations, the absence of specific symptoms and generally recognized recommendations for diagnosis and treatment. In recent years cardiac magnetic resonance (CMR) has become not only the most common and informative diagnostic tool for myocarditis, but also a method of monitoring the effectiveness of anti-inflammatory therapy.The purpose of the study was to investigate the structural and functional state of the heart and the prevalence of the inflammatory process in patients with severe course of myocarditis associated with COVID-19 infection, who received glucocorticoid therapy.Material and methods. 80 patients with a severe course of myocarditis and reduced ejection fraction (EF) of the left ventricle (LV) were included and divided into 4 groups: 1st group - 25 patients who received glucocorticoid (GC) therapy and had a history of COVID-19 infection; the 2nd group – 25 patients who received GC therapy and did not have a history of COVID-19 infection; the 3rd group – 15 patients who did not receive GC therapy and had a history of COVID-19 infection; the 4th group – 15 patients who did not receive GC therapy and had no history of COVID-19 infection. All patients underwent echocardiography with the speckle-tracking technique and CMR with gadolinium enhancement.Results and discussion. The use of glucocorticoids in addition to optimal drug therapy for heart failure in patients with severe myocarditis who had a recent history of COVID-19 infection showed high efficacy after 6 months: the number of LV segments with inflammatory changes or delayed enhancement on CMR was, respectively by 44,2% and 32,5% less, and the value of the LV EF and the index of longitudinal global systolic deformation of the left ventricle were 15,0% and 24,3% higher in comparison with those in patients who did not receive pathogenetic therapy. In patients of the 1st group, the absence of a linear lesion on CMR at the onset of the disease was associated with recovery of LVEF to ≥50% after 6 months of treatment (r=0,66; p&lt;0.01); a similar regularity was established also in the 2nd group (r=0,59; p&lt;0.05). On the other hand, in patients of the 3rd and 4th groups, who did not receive immunosuppressive therapy with GC, no reliable correlations were established between the absence of a linear lesion on CMR at the onset of myocarditis and recovery of LVEF after 6 months.Conclusions. CMR in patients with myocarditis, including those associated with coronavirus disease, is the main non-invasive method for diagnosis, clinical monitoring, prognosis and determining the tactics of pathogenetic therapy. The presence of a linear lesion on CMR in patients with myocarditis is associated both with a more severe course of the disease, pronounced dilatation and a more significant violation of the LV contractile ability at the onset of the disease, and with a slower recovery of the structural and functional state of the heart despite the influence of drug therapy.

Decreased left atrial volume and preserved left atrial function in children with congenital Zika syndrome

Abstract Introduction The infection caused by Zika virus during pregnancy leads to congenital Zika syndrome (CZS). In a previous study of our group, we found that the heart is smaller in children with CZS, with few functional alterations. Left atrial strain imaging enables quantitative assessment of left atrial function, and recently its application has also shown promise in the pediatric population. Purpose To evaluate left atrial function in children affected by CZS, using echocardiogram and speckle tracking imaging technique. Methods This observational study was conducted with children with CZS using a two-dimensional speckle tracking technique to measure left atrial reservoir strain (LAS-r), conduit strain (LAS-cd), and contraction strain (LAS-ct). Also, to investigate the relationship between LAS-r and systolic excursion of the septum and lateral mitral annular plane (MAPSE), left atrial volume index and E/e’ ratio. Results A total of 52 patients were included, the median age of the studied population was 5 years (3 to 6), 59.6% male, and the body surface area was 0.66 [0.51, 0.90]. In the echocardiographic evaluation the left atrium volume index (ml/m²) was 13.15 [6.80, 18.00], considered smaller by the reference value. Also, the LAS-r (%) was 40.99 [24-70.5], LAS-cd (%) was 30,94 [32.5-52.5], LAS-cd (%) was 10,91 [5.2-24], values considered normal by the literature. Lateral MAPSE (cm) was 1.25 [0.81, 1.86] and septal MAPSE (cm) was 0.98 [0.78, 1.66] and E/e' ratio was 7.52 [4.57, 10.78]. A positive linear correlation was found between LAS-r and lateral MAPSE (r = 0.51, P = 0.019). Conclusion This original study with children with CZS shows that despite reduced atrial volume, the left atrial function remains normal, and correlates with left ventricular function evaluated by MAPSE. Further studies are needed to prospectively analyze the follow-up of left atrial morphology and function in this population.

Long Term Follow Up of Biatrial Function after Transcatheter Closure of Atrial Septal Defect

Abstract Aim and Objectives The aim of the study is to evaluate long term right and left atrial function using volumetric analysis and strain indices in patients who underwent transcatheter atrial septal defect (ASD) device closure more than 3 years ago. Patients and Methods This study included a group of 40 patients diagnosed with ASD who came for regular follow up at congenital heart disease clinic and another group of 40 healthy controls (age and sex matched). Basic transthoracic echocardiographic examination was done to both groups followed by assessment of atrial function using modified simpson’s method to measure right and left atrial volumes and 2D speckle tracking technique to assess biatrial strain in the three different phases (reservoir, conduit and contractile strain). Results In our study the results showed that there is no significant difference between the patients group and control group regarding volumetric analysis. Regarding left atrial (LA) strain values, there was no difference in reservoir and conduit strain while contractile strain was significantly lower in the patients group (p- value=0.047). On the other hand, all right atrial (RA) strain values were significantly lower in the patients group than control group (p-value&amp;lt;0.05). A subgroup analysis based on age at closure showed that patients underwent closure at age less than 15 years old had significantly higher strain values for all right and left strain indices compared to those who underwent ASD closure at age of 15 years old or older. Conclusion ASD closure at earlier age is associated with better outcomes regarding atrial function. Long term follow-up in patients who underwent ASD closure more than 3 years ago showed similar LA strain values to control except for lower contractile strain while RA strain values were significantly lower in the patients group. Patients who underwent closure at age less than 15 years old had almost normal right and left strain values while those who underwent closure equal to or more than 15 years old had impaired strain values. Earlier closure is associated with better reverse remodeling and atrial function can turn into normal in patients treated earlier.

Innovative study of the fetal heart in monochorionic multiple births

Introduction. Fetal echocardiography is currently one of the main methods of prenatal diagnosis. However, in recent years, attention has shifted towards the use of ultrasound to assess fetal myocardial function.The aim of this study is compare global longitudinal deformation of the myocardium of the left (LV) and right ventricles (RV) of the heart in fetuses with uncomplicated singleton pregnancy, in fetuses from monochorionic twins with transfusion syndrome, selective growth retardation and in uncomplicated monochorionic multiple pregnancy.Material and methods. A prospective cohort study was conducted which included 60 pregnant patients: Group I — patients with an uncomplicated singleton pregnancy (n=25); Group II — 35 patients with monochorionic diamniotic twins, whose pregnancy in 10 cases was complicated by feto-fetal transfusion syndrome (stages I-III according to Quintero R.A.), in 10 cases — selective growth retardation of the second fetus and in 15 cases monochorionic twins without complications. The following parameters were determined: global longitudinal deformation (GLD) of the myocardium of the ventricles of fetal hearts using the speckle tracking method of ejection fraction (EF), end-diastolic and end-systolic volumes of the ventricles of the heart.Results. Significant differences were established in GLD of RV and LV between singleton and monochorionic multiple pregnancies (LV: -21.2 ± 2.03 versus -23.41 ± 0 .25, p = 0.003); RV: — 20.3 ± 2.5 versus -23.3 ± 2.5, p = 0.013). Significant differences were revealed in GLD of the LV and RV in recipient fetuses before and after laser coagulation of placental anastomoses (LPCA) [LV in recipients before LCPA (- 20.4 ± 2.98) versus LV recipient after LCPA (-24.2 ± 3.3), p = 0.018], [RV in recipients before LKPA (- 20.4 ± 2.8) vs. RV in recipients after laser coagulation of placental anastomoses (-23.7 ± 3.4, p = 0.012].Conclusion. Assessment of the cardiac function of fetuses from monochorionic twins using the echocardiographic speckle tracking technique makes it possible to identify early changes in fetal myocardial function in twins from monochorionic diamniotic twins, as well as to carry out reliable testing monitoring changes in cardiac function over time.

Quantifying fetal heart health in gestational diabetes: a new approach with fetal heart quantification technology.

This study aimed to assess the impact of gestational diabetes mellitus (GDM) on fetal heart structure and function using a technique called fetal heart quantification (Fetal HQ), with a focus on mitochondrial dynamics, which employs advanced imaging technology for comprehensive analysis. A total of 180 fetuses with normal heart structures, aged 24-40weeks of gestation, were examined. A 2-3s cine loop in the standard four-chamber oblique view was captured and analyzed using the speckle-tracking technique with Fetal HQ. Various echocardiographic parameters were evaluated, including four-chamber view (4CV), global spherical index (GSI), global longitudinal strain (GLS), 24-segment spherical index (SI), ventricular fractional area change (FAC), cardiac output (CO), and stroke volume (SV). These parameters were compared between the GDM group and the control group during two gestational periods: 24+0 to 28+0 weeks and 28+1 to 40+1 weeks. Statistical analysis was performed using independent samples t-tests and Mann-Whitney U tests to identify significant differences. Twenty fetuses from mothers with GDM and 40 from the control group were recruited at 24+0 to 28+0 weeks. At 28+1 to 40+1 weeks, 40 fetuses from mothers with GDM and 80 from the control group were recruited. The fetal left ventricular global longitudinal function was similar between the GDM and control groups. However, compared to the controls, right ventricular function in the GDM group was lower only at 28+1 to 40+1 weeks. In the GDM group, the global spherical index (GSI) was lower than in the control group at 28+1 to 40+1 weeks (1.175 vs. 1.22; p = 0.001). There were significant decreases in ventricular FAC (38.74% vs. 42.83%; p < 0.0001) and 4CV GLS for the right ventricle (-22.27% vs. -26.31%; p = 0.005) at 28+1 to 40+1 weeks. Our findings suggest that GDM is associated with decreased right ventricular function in the fetal heart, particularly during the later stages of pregnancy (28+1 to 40+1 weeks), compared to fetuses from healthy pregnancies. The Fetal HQ technique represents a valuable tool for evaluating the structure and function of fetal hearts affected by GDM during the advanced stages of pregnancy.

Value of 2D speckle tracking technique combined with real-time 3-dimensional echocardiography in the evaluation of the right atrial function in patients with 3-branch coronary artery disease without myocardial infarction.

To evaluate the right atrial function in patients with 3-branch coronary artery disease (TBCAD) without myocardial infarction by 2D speckle tracking echocardiography (2D-STE) combined with real-time 3-dimensional echocardiography (RT-3DE). Fifty-six patients admitted to our hospital without myocardial infarction with TBCAD were selected. We divided them into 2 groups according to the coronary angiography results: 28 patients in group B (the rate of stenosis is 50% ~< 75%); 28 patients in group C (the rate of stenosis is ≥75%); in addition, 30 healthy volunteers were screened as group A. All subjects underwent RT-3DE to obtain the right atrial volume (RAVmax, RAVmin, and RAVp), and then we calculated the right atrial passive and active ejection fraction (RAPEF, RAAEF), and maximum volume index (RAVImax). In addition, to measure the strain rates (RASRs, RASRe, RASRa) of the right atrium during systole, early diastole, and late diastole, 2D-STE was applied. Correlations between the 2D-STE parameters and the results of N-terminal pro-brain natriuretic peptide (NT-proBNP) and Gensini scores were analyzed by Pearson linear analysis. Compared with group A, RAPEF and RASRe were reduced, while RAAEF and RASRa were elevated in group B (P < .05). RAPEF, RASRs, RASRe, and RASRa were decreased compared with groups A and B, while RAVmax, RAVmin, RAVp, RAVImax, and RAAEF were increased in group C (P < .05). There was a significant correlation between 2D-STE parameters and the results of NT-proBNP and Gensini scores (P < .05). The storage, conduit, and pump functions of the right atrium are reduced in patients with 3-branch coronary artery disease without myocardial infarction; 2D-STE combined with RT-3DE is valuable in the evaluation of the right atrium in patients with coronary artery disease.

Application of three-dimensional speckle tracking technique in measuring left ventricular myocardial function in patients with diabetes

BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus (DM). Therefore, early detection of left ventricular systolic function (LVSF) damage in DM is essential. AIM To explore the use of the three-dimensional speckle tracking technique (3D-STI) for measuring LVSF in DM patients via meta-analysis. METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023. The current study involved 9 studies, including 970 subjects. We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI. RESULTS Night articles including 970 subjects were included. No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group (P &gt; 0.05), while differences in global longitudinal strain, global circumferential strain, global radial strain, and global area strain were markedly different between the controls and DM patients (all P &lt; 0.05). CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.

Echocardiographic evaluation of myocardial structural and functional changes in patients with stage 5 chronic kidney disease before and after kidney transplantation

Introduction. Chronic kidney disease, stage 5, leads to structural remodeling of the myocardium, and heart failure. Kidney transplantation promotes normalization of structural and functional parameters of the myocardium through reverse remodeling with an improvement of its systolic function.Aim. To evaluate structural and functional changes of the myocardium in patients before and after kidney transplantation, using echocardiography.Material and methods. A retrospective cross-sectional study included 111 individuals of whom 36 patients underwent evaluation for kidney transplant waiting list placement program (Group I), and 51 patients received kidney transplants from deceased donors (Group II). Group III consisted of 24 individuals without kidney pathology. All patients underwent transthoracic two-dimensional echocardiography using the Phillips Epiq 7 device to determine the structural and functional parameters of the heart, including the use of speckle-tracking technique to assess longitudinal and circumferential myocardial deformation of the left ventricle.Results. There were no statistically significant differences in transthoracic echocardiography results between patients in Group I and Group II. When compared to the parameters of patients in Group III, statistically significant differences were found in the following parameters: volume and volume index of the left atrium, end-diastolic volume index, left ventricular mass index, interventricular septum thickness and posterior wall thickness of the left ventricle, as well as diastolic function parameters (E/A). Patients in Group I and Group II had significantly higher values of left atrium diameter: 32 (26.0;38.0) mmHg and 31.0 (27.3;40.0) mmHg, respectively, (p1-2=0.949), while in Group III this parameter value was 22.5 (20.8;25.3) mmHg (p1-3&lt;0.001, p2-3&lt;0.001). Correlation analysis revealed statistically significant correlations between left ventricular mass index and global circumferential strain (r=0.41, p=0.0027), as well as between E/e' ratio and left ventricular mass index (r=0.323, p=0.00197). It was found that after 3 months post kidney transplantation, there was a decrease in the left atrium diameter, volume, and volume index. The values of left atrium diameter immediately after kidney transplantation and after 3 months were 40 (32.5;45) mmHg and 35 (25.5;41.0) mmHg (p=0.049); those of the left atrium volume were 62.5 (50.0;77.3) and 51.5 (47.5;64.5) ml (p=0.03); and those of the left atrium volume index were 33.4 (29.3;40.2) and 28.3 (25.5;33.6) ml/m2 (p=0.01) respectively.Conclusions. Patients with chronic kidney disease stage 5 have a high incidence of functional and structural abnormalities of the left heart chambers; left ventricular mass index positively correlates with E/e' and global circumferential strain. At 3 months after kidney transplantation, there was a slight positive trend manifested in the form of a decrease in left atrium diameter and a decrease in left ventricle volume. Further dynamic study of this group of patients in the long term after kidney transplantation is planned.

Subclinical Echocardiographic Parameters and Biomarker Approach to Characterize the Pathophysiology of Carcinoid Syndrome

Introduction: Carcinoid heart disease is a rare cause of right-sided valvular dysfunction, an important complication in patients with carcinoid syndrome. Objectives: We aim to present our own experience regarding early myocardial dysfunction in patients with carcinoid syndrome. Methods: 64 patients (35-90 year old, 62,5% female, 37,5% male patients) with carcinoid syndrome were evaluated between October 2017 and June 2021. All patients underwent two-dimensional echocardiography with additional tissue Doppler and speckle-tracking techniques. For all patients there were measured urinary level of 5- hydroxyindolacetic acid, serotonin and NT-proBNP values. Results: The following echocardiographic features: global longitudinal strain of both ventricles, mean systolic velocity of the left ventricle, systolic velocity of the free wall of right ventricle, correlated with high values of specific biomarkers: serotonin, and urinary 5-hydroxyindolacetic acid, and also with the presence of hepatic metastases and poorly differentiated tumors. Discussion: In this study we identified several patients with early myocardial dysfunction due to carcinoid syndrome, representing a predictive model of poor prognosis, requiring further investigations. Conclusion: Echocardiographic assessment based on the measurement of systolic velocities, as well as the global longitudinal strain of both ventricles, together with specific biomarkers may contribute to better recognition of carcinoid heart disease in clinical practice, but this needs validation through further studies enrolling larger number of patients.

Left atrial strain time integral evaluated by two-dimensional speckle tracking predicts left atrial appendage dysfunction in patients with acute ischemic stroke.

Cardioembolic stroke is a serious disease with poor prognosis, whose main embolic source is the left atrial appendage (LAA). Left atrial (LA) strain evaluated by the two-dimensional (2D) speckle tracking technique has been proposed. However, the commonly used peak LA strain reflects only LA reservoir function. The LA strain also includes indicators of the other LA functions, such as booster pump function, which reflects active contraction of the LA. This study aimed to investigate whether a newly developed parameter, the left atrial strain time integral (LASTI), can evaluate LAA dysfunction more accurately in patients with acute stroke. We measured LA strain using a 2D speckle tracking method in 168 patients with acute stroke and 20 age-matched control subjects. LASTI was calculated as the area under the LA strain curve in one cardiac cycle. LAA dysfunction was defined as LAA thrombus and/or severe spontaneous echo contrast by transesophageal echocardiography. LASTI was significantly lower in patients with LAA dysfunction than those without. LASTI was a better correlation with LAA blood flow velocity measured by transesophageal echocardiography than peak LA strain. Multivariate logistic regression analysis showed that LASTI was an independent predictor of LAA dysfunction after adjustment for conventional risk factors. LASTI can be a feasible parameter for predicting LAA dysfunction in patients with acute stroke.

Relationship between serum soluble suppression of tumorigenicity (ST) 2 and global longitudinal strain in early onset preeclampsia

BackgroundPreeclampsia is one of the leading causes of death in childbearing women worldwide. Hemodynamic changes in preeclampsia can trigger cardiac remodeling as indicated by increase of soluble-ST2 (sST2). Global longitudinal strain were able to detect systolic dysfunction better than the ejection fraction. This study aims to evaluate the correlation between serum levels of sST2 towards GLS in patients with early-onset preeclampsia.MethodsThis is a cross-sectional observational study with correlation analysis. Subjects were patients with severe preeclampsia with gestational age before 34 weeks at Dr. Hasan Sadikin Central General Hospital Bandung and Bandung Kiwari Regional General Hospital from June to August 2022. Examination of sST2 was carried out through blood samples using the ELISA method. sST2 was measured using Presage ST2 Assay reagent. GLS examination was carried out using speckle tracking technique with EchoPAC. Correlation analysis was conducted using the Pearson test if normally distributed, otherwise Spearman’s correlation was conducted. Correlation analysis was followed by linear regression.ResultsA total of 30 patients met the inclusion criteria. The mean age was 30.83 ± 7.09, with 17 (56.7%) multiparous patients. The median sST2 was 145.75 ng/mL, and the median GLS was − 17.4%. Spearman correlation analysis showed that there was a significant positive correlation with moderate strength between sST2 and GLS (r = 0.583; p < 0.002). Linear regression showed that every 1 ng/ml increase in sST2 would give an increase in GLS of 0.014%.ConclusionThere is a significant correlation between sST2 and GLS in patients with early onset severe preeclampsia.

Left ventricular speckle tracking echocardiography in predicting of fibrosis in children after correction of anomalous origin of the left coronary artery from the pulmonary artery in the late postoperative period

The aim of our study is a comprehensive echo assessment of the LV function using the speckle tracking technique in children with abnormal origin of the left coronary artery from the pulmonary artery in the late postoperative period аnd a comparative analysis segmental longitudinal and circumferential LV deformation with cardiac magnetic resonance late enhancement of myocardium. Methods. The search is a prospective observational study. We examined and analyzed 25 children with AOLCA from PA in late postoperative period. Obtained morphofunctional LV and RV echo parameters were compared with LV ejection fraction and dimensions, the grade of mitral insufficiency and age at the time of operation. CMR was performed in 15 patients (60%; n = 15/25) using Avanto 1.5T. The average age of children at the time of the study was 8.8 ± 3.5 years.Results. 1) Reduce of LV segmental longitudinal deformation is unique in each patient’s case. The largest number of segments with reduced longitudinal deformation was detected in the 2d (anteroseptal basal); in 4th (inferior basal); 5th (inferolateral basal), 6th (anterolateral basal), 11th (inferolateral middle) segments of LV myocardium. 2) There is no relationship between LV global longitudinal and circumferential deformation in children in the late postoperative period after correction of AOLCA from PA and initial LV morphological and functional echo data (at the time of defect correction). 3) Segmental LV longitudinal deformation Area Under the Curve is 0.64 (0.56–0.72) with “cut-off” 9.5% with a sensitivity of 92% and a specificity of 85% and circumferential segmental deformity Area Under the Curve is 0.48 (0.40–0.56) in the predicting of fibrosis according to CMR data.

Post-transplant left atrial function depends on the technique used for orthotopic heart transplantation

Abstract Background Even short episodes of post-transplant atrial fibrillation (AF) have been shown to increase the risk of adverse outcomes, including thromboembolic events, graft failure, and increased mortality. Of the two most commonly used heart transplantation techniques - bicaval and total orthotopic heart transplantation (OHTx), the former approach combines the donor and recipient atria, and may predispose to supraventricular arrhythmias, especially atrial fibrillation, as well as lead to a higher incidence of atrioventricular valve incompetence. Existing data relate mainly to the more non-physiological left atrial (LA) size and geometry after bicaval OHTx, while little is known about differences in LA function between patients treated with both techniques. Aim To compare LA functional and morphological characteristics between patients after bicaval and total OHTx. Methods The study group consisted of 28 patients who underwent OHTx between May 2021 and December 2022: 14 consecutive patients after total OHTx and 14 subjects after bicaval OHTx matched by age and time from heart transplant. Echocardiographic examination included standard measurements and left ventricle (LV) and LA longitudinal deformation assessment by speckle tracking technique. Results All enrollees were male. There were no differences between the groups after total and bicaval OHTx in anthropometric and laboratory parameters. Routine endomyocardial biopsies performed during follow-up after OHTx in all patients did not show severe graft rejection. No significant differences were found in LV dimensions, ejection fraction and stroke volume, Doppler velocities of mitral inflow and mitral annulus, as well as LV global longitudinal strain. In contrast to LV measures, significant between-group differences were demonstrated for LA parameters: LA volume index was significantly higher, and peak atrial longitudinal strain (PALS) corresponding to LA early diastole in the reservoir phase and peak atrial contraction strain (PACS) corresponding to LA systole were significantly higher in the total OHTx group than in the bicaval OHTx group (Table). Conclusions Total OHTx technique is associated with a more favorable LA morphology and function, which may explain the lower prevalence of atrial fibrillation reported in the literature in patients treated with this method. The clinical significance of reduced LA contribution to LV filling in patients subjected to bicaval OHTx needs further exploration.

Left atrial functional assessment a prime clue in solving the puzzle of stable angina symptoms in suspected coronary artery disease patients

Abstract Background Assessing clinically for significant coronary artery disease (CAD) in stable angina patients presents a formidable task. Routinely performed echocardiography is limited in diagnosing CAD with provision for the regional wall motion abnormality (RWMA) for left ventricle (LV) systolic dysfunction and altered mitral inflow velocities for LV diastolic dysfunction. However, the advent of two-dimensional (2D) speckle-tracking technique has established the era of strain imaging, opening new possibilities in echocardiography. It is now possible to have a detailed functional assessment of left atrium (LA). We utilised speckle tracking imaging to obtain strain parameters for LA function. Combining these strain parameters with the doppler myocardial velocities and mitral inflow velocities, may prove useful mode of imaging to diagnose significant CAD in stable angina patients. Purpose To study the parameters of left atrial functions utilising echocardiographic strain imaging and evaluate their correlation with the syntax score-II in patients with symptoms of stable angina. Methods 103 patients with symptoms of stable angina undergoing coronary angiography for suspected coronary artery disease(CAD), were considered for LA function assessment and compared with their syntax-II score. Results The LA reservoir function parameters, peak atrial longitudinal strain (PALS) and peak global systolic strain rate (LAsSR), decreased with increasing syntax-II score (p values 0.011 and 0.001 respectively) and the parameter of LA conduit function, peak global early diastolic strain rate (LAeSR) increased (p value &amp;lt;0.001). The LA filling pressures reflected by E/e`, also increased with more severe syntax-II score (p value &amp;lt;0.001). We, further, configured cut off values of &amp;lt; 23.56 for PALS, &amp;lt; 1.15 for LAsSR, &amp;gt; -1.09 for LAeSR, and E/e` ratio &amp;gt; 10.39 as predictors of significant CAD, with good sensitivity and specificity. Therefore, stable angina patients who had significant CAD on coronary angiogram represented by severe syntax score-II, had higher LA filling pressures and deranged LA function with transition from more of reservoir chamber to merely a conduit. Conclusion Our study shows a significant association between LA strain parameters (PALS, LAsSR, and LAeSR) and LA filling pressures (E/e`), with the presence of significant CAD in these patients. The stable angina patients with more severe CAD as quantified by their severe syntax score-II, have an impaired LA reservoir and LA functions more as a conduit, with elevated filling pressures. This study establishes a significant association between LA deformation strain variables and severity of CAD and hence LA strain imaging can be a useful tool to diagnose significant CAD in stable angina patients.

Tele-ultrasound in community with limited resources: The association of hypertension on reduced carotid artery circumferential strain

Introduction: Stroke is one of the leading causes of death worldwide, in majority triggered by modifiable risk factors such as hypertension. AIM: to assess relations between hypertension and carotid arteries radial and circumferential deformation, assessing a population of participants after a first ischemic stroke and healthy controls. Methods: Retrospective study, from 2016 to 2017, with a sample of the PAI project control group, an urban population of the São Francisco Valley in the Northeast of Brazil, 105 people between 40-80 years-old, including patients after a first episode of ischemic stroke in the absence of known cardiovascular disease; and a control group of healthy volunteers, matched by age, sex, and presence of hypertension. Asynchronous analysis was performed by tele-ultrasonography of carotid artery ultrasound with images acquisition of EKG-synchronized videos in cross-section of the common carotid artery bilaterally and then strain values were acquired by Speckle Tracking technique, computing the mean circumferential and radial peaks of both carotids. Univariate and multivariable analyses assessed the association between carotid strain and hypertension. Results: 84 participants had analyzable images (29 patients after a first episode of stroke). The mean age was 60.5 + 11.6 years, 46.5% were women, 70.2% had hypertension. Radial deformation was lower but non-significant in participants with hypertension compared to those without hypertension (-3.13% vs. -3.35%, respectively, p = 0.54). There was significantly less circumferential deformation among participants who had hypertension compared to those without hypertension (4.16% vs. 5.3%, respectively, p = 0.003). Hypertension maintained association with lower circumferential strain in multivariate analysis (coef = -1.13; p = 0.019). Conclusion: hypertension was independently associated with the decrease in the carotid artery circumferential deformation. Tele-ultrasound associated with carotid strain analysis shows promising results for the evaluation of subclinical changes in carotid arteries in populations with limited resources in remote regions such as the Northeast of Brazil.

Correlation between left atrial strain and left ventricular diastolic function in hypertensive patients.

Early detection of asymptomatic diastolic dysfunction is essential to prevent the development of heart failure in hypertensive patients. Current studies suggest that left atrial strain contributes to the evaluation of left ventricular diastolic function, but there are fewer studies on the correlation between left atrial strain and diastolic function in hypertensive patients. In this study, we applied a two-dimensional speckle tracking technique to evaluate the changes in left atrial strain in hypertensive patients, and to investigate the relationship between left atrial strain and left ventricular diastolic function. A total of 82 hypertensive patients who were visited the Department of Cardiology at the Third Xiangya Hospital of Central South University from July 2021 to January 2022, were enrolled for this study, and 59 healthy subjects served as a control group. According to the number of left ventricular diastolic function indexes recommended by the 2016 American Society of Echocardiography Diastolic Function Guidelines (mitral annular e´ velocity: Septal e´<7 cm/s, lateral e´<10 cm/s, E/e´ ratio>14, left atrial volume index>34 mL/m2, peak tricuspid regurgitation velocity>2.8 m/s), the hypertensive patients were divided into 3 groups: Group Ⅰ (0 index, n=36 ), Group Ⅱ (1 index, n=39), and Group Ⅲ (2 indexes, n=7). Two-dimensional speckle tracking technique was used to measure left atrial reservoir strain (LASr), conduit strain, and contraction strain, and to analyze the correlation between left atrial strain and left ventricular diastolic function in hypertensive patients. The LASr, left atrial conduit strain (LAScd), and LASr/(E/septal e´) of the hypertension group were lower than those of the control group, and E/LASr was higher than that of the control group. There was no significant difference in left atrium volume index between the 2 groups (P>0.05). Compared with Group Ⅰ, LASr, LAScd, and LASr/(E/septal e´) were decreased in Group Ⅱ and Group Ⅲ, LASr/(E/septal e´) was also decreased in Group Ⅲ compared with Group Ⅱ (all P<0.05). Compared with Group Ⅰ, E/LASr was increased in Group Ⅲ. LASr was positively correlated with septal e´, lateral e´, E, and E/A, and negatively correlated with E/septal e´. The changes of left atrial function in patients with early hypertension are earlier than those of left atrial structure. Left atrial strain and its combination with conventional ultrasonographic indices [LASr/(E/septal e´)] of diastolic function are potentially useful in assessing left ventricular diastolic function in hypertensive patients.

Echocardiography identifies geometric and functional cardiac alterations in patients with Familial Partial Lipodystrophy

Abstract Funding Acknowledgements Type of funding sources: None. Lipodystrophy (LPD) is a rare condition characterized by levels of loss of adipose tissue in a generalized or partial form. Cardiovascular disease is a significant cause of morbidity in this population,n but cardiomyopathy associated with LPD is still not well described. We sought to characterize cardiac morphology and left ventricle function in patients with partial LPD with no cardiac symptoms. Methods This is a cross-sectional case-control study. Adult patients with clinical diagnosis of familial partial LPD and Controls were invited to collect echocardiographic images prospectively. Transthoracic echocardiography was performed with conventional bidimensional and Doppler techniques and LV Speckle-tracking technique. Left atrium (LA) dimension and volumes, LV dimension, thickness, mass, and diastolic and systolic function were measured. Data between groups compared with appropriate tests according to variable distribution. Relation between echocardiographic variables and LPD diagnosis were tested with simple and multiple regression models, considering the effect of systolic arterial blood pressure (SBP) as an independent variable. The significance level was set as p &amp;lt;0.05. Results twenty-nine patients with LPD were compared to 17 control. LPD patients and control group did not differ in age (44.58±11.77 vs. 43.84±13.32, p = 0.94), gender, BMI (26.73±4.30 vs. 24.52±5.04 Kg/ml, p = 0.05) or BSA (1.70±0.23 vs. 1.67±0.16, p = 0.9). Patients with LPD had statistically higher SBP (122.7±14.85 vs. 110.9±11.08, p = 0.02). LPD had LA higher dimension (37.27±4.44 vs. 32.12±4.25 mm, p = 0.001) and volume (LAVi)(30.17±7.24 vs. 24.94±9.04 ml/m2, p = 0.02), LV mass_i (79.29±17.38 vs. 67.10±19.36, p = 0.02), and also reduced diastolic LV parameters as mitral tissue Doppler E' lateral (11.07±3.48 vs. 14.94±2.35 cm/s, p = 0.001) and E' septal ( 8.0±2.73 vs. 11.38±2.02 cm/s, p = 0.001, and also E/E' ratio (7.89±2.22 vs. 6.35±1.29, p = 0.02). Parameters of LV systolic function as LVEF (64.70±4.56 vs. 62.15±4.35 %, p = 0.08) or GLS were not statistically different between groups (−17.06±2.70vs. −18.02±1.98%, p = 0.25). There was a positive relation of LA dimension ( β 5.6, p&amp;lt;0.001), wall thickness (β 1.3, p 0.011), tissue Doppler E' lateral (β −3.5, p = 0.002) and E' septal (β −3.2, p&amp;lt;0.001) to LPD diagnosis, even after adjusted for SBP. Conclusion patients with familial partial LPD present early cardiomyopathy with LV hypertrophy, LA enlargement, and LV diastolic dysfunction before LV systolic dysfunction. Echocardiographic parameters are related to LPD diagnosis independent of SBP.

THE ASSOCIATION OF HYPERTENSION AND OBESITY: WHAT IMPACT ON THE LONGITUDINAL SYSTOLIC FUNCTION OF THE LEFT VENTRICLE

Objective: Hypertension and obesity are well known each result in heart failure with preserved ejection fraction. Indeed, there is ample evidence that the accumulation of adipose tissue in obese subjects negatively affects the left atrial and ventricular structure, as well as diastolic and systolic function. Predisposing factors for heart failure with preserved LVEF are advanced age, hypertension, diabetes, dyslipidemia and obesity. The development of the 2D strain has made it possible to make an early diagnosis of ventricular dysfunction in patients with cardiovascular risk factors. Design and method: This work consists of performing in a series of 128 hypertensive patients divided into two subgroups: 58 obese patients and 70 patients with normal BMI. A complete cardiographic echo study was performed in both subgroups, including LVEF by Simpson biplane method, calculation of indexed left ventricular mass and parietal relative thickness, analysis of diastolic function and finally study of longitudinal LV deformation by speckle tracking technique. Results: We note in this work that dyslipidemia and diabetes were significantly more prevalent in the HTA+obesity arm. The average blood pressure figures were slightly higher in the HTA+obesity arm. LVH was clearly predominant in the HTA+obesity arm with a more consequent decrease in the longitudinal contraction index. In obese hypertensive patients, LVH was most often concentric (53.4%). An increase in filling pressures was found in 11 obese hypertensive patients compared to only 4 non-obese hypertensive patients (p = 0.0001), with a good correlation with the decrease in GLS. These results suggest that increased BMI is closely associated with atrioventricular interaction in patients with hypertension, with a perfect correlation with impairment of longitudinal systolic function and diastolic function compared to the control group. Conclusions: Although the pathophysiological mechanism behind obesity is disputed, several possible explanations have been proposed: obesity has been considered a state of chronic volume overload, increased blood volume, neurohormonal activation, thus increasing oxidative stress. Therefore, obesity is associated with mild ventricular dilation (eccentric remodeling). However, this finding is in contrast to other studies that associate obesity with a concentric rather than eccentric remodeling of the LV.

Correlation between heart failure symptoms and parameters of myocardial deformation in patients with cardiac amyloidosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and objectives Cardiac amyloidosis (CA) causes a restrictive cardiomyopathy, generally associated with symptoms and poor prognosis. Echocardiography plays a fundamental role in its diagnosis, and can also provide important prognostic information. Although left ventricular global longitudinal strain (GLS) has been studied using speckle-tracking echocardiography, and is known to be predictive of outcome, RV and LA involvement evaluated by deformation pattern is not yet well defined. The aim of this study is to characterize LV, RV and LA involvement in patients with CA, and to evaluate whether parameters of myocardial deformation of these cavities are correlated with functional class and/or number of hospitalizations in this group of patients. Material and methods We included 19 patients diagnosed with CA between 2021 and 2022. Demographic, clinical data and echocardiographic parameters were collected, including diastolic function parameters and study of myocardial deformation, using the speckle tracking technique of left ventricle, right ventricle, and left atrium. Statistical analysis was performed to evaluate the association between symptoms and imaging parameters. Results The mean age was 66 y.o. 77% male. The percentage of Cardiovascular risk factors was HTN 77%, DM 23%, dyslipidemia 23%. CAD 15%. Hospital admission in last year 23%. NYHA functional class II 23%. All echocardiographyc parameters and and significant correlations are showed in table 1. Regarding basic echocardiographic parameters, mean LV and RV systolic function was in normal range: LVEF 64%; RV TAPSE 21mm; mean Tricuspid annular peak systolic velocity 11,6cm/seg; RV fractional area change 40%. Concerning deformation parameters RV and LA parameters were decreased, RV free wall longitudinal strain -26,8%; RV four-chamber longitudinal strain -21,7%; LA reservoir strain 26,6%; LA conduit strain -15,1%; LA contractile strain -11%, although not significantly associated with a worse NYHA functional class or a higher number of hospital admissions, possibly due to a low sample size. In addition, a larger LA area and volume, shorter deceleration time and worse GLS correlated statistically significantly with a worse NYHA functional class, while a larger LA diameter and mean E/e' correlated with a higher number of admissions. Conclusions Echocardiography is a non-invasive, fast and simple diagnostic tool. Strain data from different cardiac chambers would allow early detection, or at least suspicion, of this entity. In addition, strain data of left atrium and right ventricle would allow to predict evolution and to be an important prognostic factor. Atrial and ventricular strain have promise for clinical utility.