Speckle Tracking Technique Research Articles

P1413 Complexity of changes in right ventricular function in patients undergoing cardiac surgery

Abstract Background An impairment of certain echocardiographic parameters of right ventricular (RV) function, such as tricuspid annular peak systolic excursion (TAPSE), is a known phenomenon in patients undergoing cardiac surgery. However, little is known about significance of these alterations with regard to other aspects of RV function. The aim of our study was to clarify this issue using parameters based on 3D echocardiography and speckle tracking technique. Methods The study population comprised 105 patients (76 men, mean age 65 ± 16 years), referred for coronary artery bypass grafting and/or replacement of mitral or aortic valve. Patients undergoing tricuspid annuloplasty and with baseline suboptimal image quality were excluded from the study group. Transthoracic echocardiographic examination was performed on average 2 ± 2 days prior to surgery (TTE1) , and 7 ± 4 days after surgery (TTE2), whereas follow-up TTE (TTE3) was performed on average 12 ± 2months after the surgery. Parameters measured during these examinations included both standard and advanced indices of RV size and function, such as TAPSE, systolic velocity of tricuspid annulus (S"), fractional area change (FAC), RV ejection fraction (EF) and RV global longitudinal systolic strain (GLS). Results Echocardiographic measurements were completed for TTE1, TTE2 and TTE3 in 95% of patients. We noticed a significant postoperative (TTE2) impairment of parameters of RV longitudinal function (TAPSE, S’ and GLS; p < 0,0001). However, neither RV size assessed by both 2D and 3D technique changed, nor the global RV function measured with the use of FAC and EF. After 12 months (TTE3) we observed an improvement in the parameters of the longitudinal RV function. Conclusion Cardiac surgery results in an impairment of the longitudinal systolic RV function, with no influence on the global RV function. After 12 months, an improvement of the longitudinal function can be observed.

P210 The influence of the right ventricle on the right atrium: a speckle tracking echocardiography study

Abstract Purpose To investigate the relationship between right atrial deformation and the right ventricular size and function. Methods 94 patients with various cardiovascular pathologies have been included in the study group. All patients underwent transthoracic echocardiography with subsequent off-line analysis using speckle tracking technique and measurement of numerous right atrial deformation parameters, including peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS), as well as established indices of right ventricular size and function, including right ventricular basal diameter in apical four-chamber view (RVITd), tricuspid annular peak systolic excursion (TAPSE) and global longitudinal strain (GLS). Results There was a statistically significant weak correlation between RA strain (PACS and PALS) and RV parameters. RV-GLS showed significant correlation with PALS (r = -0,38; p = 0,0015) and PACS (r = - 0,30; p = 0,013). Similarly, TAPSE correlated with PALS and PACS (r = 0,34; p = 0,02) and (r = 0,23; p = 0,04) respectively. However, there was no correlation between right atrial function and RVIT. Conclusions Right atrial deformation parameters weakly correlate with right ventricular function indices and show no correlation with the size of the right ventricle.

Evaluation of Sub Clinical Myocardial Systolic Dysfunction Using 2D Global Longitudinal Strain Assessment in Type 2 Diabetes Patients in Sub-Saharan Africa

Background: Heart failure is the commonest cardiovascular complication in type 2 diabetes mellitus. However, subclinical left ventricular dysfunction can’t be detected using 2D echocardiography which is routinely used for cardiac evaluation of diabetic patients. We aimed to determine the prevalence and factors associated to left ventricular global longitudinal strain (LV GLS) impairment in type 2 diabetes Cameroonians patients. Methods: We conducted a cross-sectional study from January 2019 to June 2019, including type 2 diabetes patients with preserved left ventricle ejection fraction. Clinical and echocardiographic data were collected, and LV GLS was assessed using speckle tracking technique, a value ≤ -16% been considered as normal value. Results: We recruited 95 patients, with a mean age of 57.4 ± 11.8 years old and median diabetes duration of 5 [2 - 12] years. Echocardiographic evaluation found 56.3% of left ventricle remodelling, 51.6% of left ventricle diastolic dysfunction and mean left ventricle ejection of 63.3% ± 6.6%. LV GLS impairment was present in 43.2% (95% CI: 32.6 - 53.7) of the participants. After adjustment to all significantly associated factors, Obesity (aOR: 4; 95% CI: 1.5 - 10.6) and diastolic dysfunction (aOR: 3.1; 95% CI: 1.2 - 8.2) were independent factors associated with LV GLS. Conclusions: Subclinical systolic dysfunction assessed by LV GLS impairment is frequent in diabetic patients. Further research should be carried out more extensively to integrate LV GLS in the type 2 diabetes patients’ routine follow up for a better prognostic outcome, especially in low-incomes countries.

Influence of diffuser grain size on the speckle tracking technique.

The speckle-based X-ray imaging technique (SBT), which includes the three imaging modalities of absorption, phase contrast and dark field, is widely used in many fields. However, the influence of the grain size of the diffuser, the coherence of the X-ray source and the pixel size of the detector on the multi-mode imaging quality of SBT is still woefully unclear. In this paper, the whole SBT process is simulated and the influence of these three factors on image quality is discussed. Based on this discussion, the grain size of the diffuser for SBT applications should be limited by the pixel size of the detector and the coherence length of the X-ray source. According to analysis of the noise signal and correlation map, a suitable grain size is an indispensable condition for high-quality SBT images, because an excessively small or large grain size degrades the resolution of the imaging results and generates false signals. In addition, the power spectral density of the measured raw speckle patterns demonstrates that a smaller grain can better retain high-frequency information from an imaged sample. The simulated and experimental results verify these conclusions. The conclusions of this work will be helpful in designing suitable experimental setups for SBT applications and have the potential to promote the performance of SBT in other applications, such as X-ray optics metrology and coherence measurement.

1028 Early response to a low- dose acubitril/valsartan (ARNI) therapy among stable symptomatic patients with HFrEF

Abstract Funding Acknowledgements no financial support Background Sacubitril/valsartan (S/V) has shown to improve outcomes, that is related to reverse remodeling of the left ventricle (LV) with improved ejection fraction (LVEF) and mitral regurgitation (MR) during long-term therapy. There are limited data on early effects of S/V treatment with respect to the left ventricle function and echocardiographic evaluation of this phenomenon. Aim of the study was to evaluate the early effect of a starting-dose of S/V administered in patients (pts) with stable symptoms of heart failure on clinical symptoms, laboratory tests and echocardiographic parameters using global longitudinal strain (GLS) as a sensitive parameter detecting improvement of LV function. Methods Twenty pts (mean age 60 years, 2 female), with HFrEF (NYHA class II-III) on optimal medical treatment with ICM (75%) or NICM (35%) were included to low-dose S/V treatment (24/26mg) after excluding contraindications. Clinical and echocardiographic evaluation was performed at baseline and after 30 days. The following parameters have been measured: 6-Minutes Walking Test (6MWT) and Minnesota Living with Heart Failure questionnaire, laboratory results and echocardiographic assessment with speckle tracking technique (STE). Results All pts completed 30 days treatment period without complications and no change to medication. During this period the mean values of RR decreased significantly (SBP 129,4mmHg vs 121,25mmHg and DBP 81,6mmHg vs 79,2mmHg respectively). Other clinical parameters did not change. There were no differences NT-pro BNP and TNT levels (respectively 1726 vs 1930 pg/ml and 26 vs 22 ng/ml). After 30days, the mean 6MWT distance increased by 50m (349,5 vs 401,5m p < 0.01), and a positive response was observed in Minnesota Living with Heart Failure Questionnaire (p < 0.001). Echocardiographic parameters revealed positive remodeling of LV and left atrium (LA). There was a significant improvement in LVEDd (67,9mm vs 64,9mm, p < 0.01), LVESd (61,6mm vs 58,8mm, p < 0.01) and stroke volume (40,5 to 45,8ml, p < 0.01). There was no significant increase in LVEF (30% vs 31,5%, p = 0.052). The diastolic parameters of LV function didn’t change during the study. The LA volumes significantly decreased (110 vs 92ml, p < 0.01) during the treatment period as well as the degree of MR (ERO 0.51 vs 0,37 p < 0.01). Out of several LV deformation parameters, only global longitudinal strain has changed significantly (GLS-6,1% vs -7,0%, p = 0,02). The improvement in symptoms and 6MWT correlated only with global systolic radial (RS) and longitudinal (GLS) strain correlated positively after 30 days treatment. Conclusion:Thirty days treatment with low-dose S/V in stable, symptomatic HFrEF patients leads to symptomatic and clinical improvement which correlates with positive remodeling of the left ventricle and reduces the degree of mitral regurgitation. The GLS is a sensitive indicator of LV function improvement after short time S/V treatment and may be used to assess early response.

P1355 Short-term cardiac side-effects from radiotherapy in women with breast cancer

Abstract Introduction Breast cancer radiotherapy provides an apparent benefit for long-term survival and local recurrence rate. However, there is still much concern about the early and late radiation-induced cardiac toxicity. Therefore, various radiotherapy techniques have been developed to reduce the cardiopulmonary radiation doses in patients with left-sided breast cancer, who are at particular risk of developing post-radiation cardiac injury. Aim We sought to investigate the early effect of radiotherapy on left (LV) and right ventricular (RV) function in females subjected to this treatment. Methods Fifty left-sided breast cancer patients , who underwent adjuvant radiotherapy between May 2017 and May 2018 were included in the study. Forty-nine enrollees were initially treated with breast conserving surgery, and 1 - with mastectomy and axillary lymph node resection. Adjuvant radiotherapy was carefully planned to minimize the radiation side effects and 37 patient received radiotherapy with deep inspiration breath hold technique and 13 patients with free breathing technique. In most cases (n = 33), 3D conformal tangential field radiation therapy was applied, 13 patients received radiotherapy with dynamic-Rapid-Arc technique with additional 3D fields, and 4 patients underwent radiotherapy only with Rapid-Arc technique. Before surgery and 3 months after radiotherapy, echocardiography with measurement of conventional cardiac function parameters, as well as LV and RV longitudinal deformation analysis by speckle tracking technique was performed, and venous blood for biomarkers - galectin-3 reflecting myocardial fibrosis and NT-proBNP was sampled. Results At a mean follow-up of 97 ± 19 days , there were no significant changes in any of the studied cardiac systolic or diastolic function parameters (Table). There were no relationships between the change in LV longitudinal strain at follow-up and type of radiotherapy, as well as type of radiotherapy gating (both R = 0.02, p = 0.90). Similarly, no analogous associations were demonstrated for RV longitudinal strain (R = 0.02, p = 0.88, and R = 0.04, p = 0.77, respectively). No significant changes were found post radiotherapy in serum galectin-3 (7.2 ± 2.6 ng/ml vs. 6.8 ± 2.5 ng/ml; p = 0.58) and NT-proBNP (83 ± 68 pg/ml vs. 84 ± 54 pg/ml; p = 0.90). Conclusions Breast cancer radiotherapy with the use of contemporary planning techniques shows an excellent early cardiac safety. Abstract P1355 Figure.

555 Right ventricular longitudinal strain of patients with pulmonary hypertension

Abstract Introduction Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Recently, speckle-tracking echocardiography has emerged as a new tool in the RV assessment. In this study, we aimed to study the value of global longitudinal strain in the RV evaluation of these patients. Methods We collected clinical, laboratory, echocardiographic and right heart catheterization (RHC) data from consecutive patients referred to an expert tertiary care referral centre from 12/2016 to 11/2018. Global RV systolic peak longitudinal strain (RVS) and RV free wall peak longitudinal strain (RVFWS) (mean of the basal, mid- and apical-segments) were measured by speckle-tracking technique with Echo-Pac software from GE Healthcare®. Results Of the 97 included patients, 76% were female. The mean age was 65 ± 15 years. Most patients were in NYHA class II. Median time between TTE and RHC was 70 days [IQR 34 - 184]. Group 2 PH was the most frequent aetiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7. Both strain parameters significantly correlated with other echocardiographic parameters such as TAPSE, FAC, Tricuspid S wave, RV diastolic diameter, eccentricity index (EI), systolic pulmonary artery pressure (SPAP), pulmonary acceleration time and presence of RV outflow tract notching. Strain parameters were also associated with pulmonary artery pressures and pulmonary vascular resistance (PVR) measured by RHC. Strain parameters did not correlate with PECP (p > 0.05). In multivariate analysis, RV global longitudinal strain predicted invasive mean pulmonary artery pressure and PVR independently of TAPSE and FAC (β=1.38, p < 0.001). RV global strain > -17.1 predicted PVR > 3 wood (OR 3.46, CI 1.50 - 8.02, AUC 0.72) and PMAP > 20 mmHg (OR 4.92, CI 1.67 - 14.51, AUC 0.78). TAPSE < 18 mm predicted PVR > 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72). Conclusion RV global and free wall longitudinal strain significantly correlate with other echocardiographic parameters of RV structure and function and with invasive pulmonary artery pressures and PVR. Abstract 555 Figure.

P1390 Myocardial work indices in the assessment of the systolic function of the left ventricle in amateur half marathon runners

Abstract Background Myocardial work (MW) has been recently introduced as a tool for non-invasive assessment of left ventricular (LV) systolic function. It is based on myocardial strain analysis but incorporates also data regarding loading conditions, which is potential advantage of this technique. Purpose We south to evaluate the impact of a three-month training before the half-marathon on cardiac function using indices of MW. Methods The study included 28 young amateur runners (11 women, mean age 32 years). None of the participants had a prior history of cardiovascular disease. The group was assessed at the beginning of training period, after three month (within 48 hours before half-marathon), and within 72 hours after the run. We collected clinical, laboratory and echocardiographic data. All participants underwent echocardiography to assess myocardial mechanics and MW indices using speckle-tracking technique. Results 23 participants completed the training and all of them finished the race. After the training period we observed significant increase in LV end-diastolic diameter only (49,9 ± 0,94 mm vs 51,6 ± 0,9 mm, p= 0,007) with no significant change after the run. There were no changes in global longitudinal strain (GLS), global work index (GWI) global wasted work (GWW) neither after the training period nor after the run. We observed significant changes suggesting myocardial injury after the race, including slight increase of NT-proBNP and troponin levels, increase in left atrial volume index, and reduction of tissue Doppler lateral e` wave. Global constructive work (GCW) decreased significantly after the training period, with no change after the run (2122,0 ± 299,4 vs 1929,0 ± 227 vs 1986,5 ± 295,7 mmHg%; start of the training vs before the run assessment vs after the run assessment, respectively; p = 0,005). GCW was correlated significantly with systolic blood pressure, which decreased also significantly after the training period. Conclusion Three-months training before the participation in half-marathon run was not associated with significant changes in myocardial work indices except the global constructive work, which could be related to decrease of loading conditions. Despite the signs of myocardial injury there was no deterioration in myocardial mechanics parameters, which may indicate the beneficial effects of training before the half-marathon run.

P4132Decreased myocardial native T1 times and impaired myocardial contractility in young anabolic androgenic steroids users

Abstract Background Anabolic androgenic steroids (AAS) have been associated with several injuries on the cardiovascular system. AAS abuse may have a direct toxic effect on the myocardium that could lead to cardiac function and structure alterations. Clinical and forensic cases have been reported myocardial fibrosis in AAS users. Myocardial fibrosis increases the risk of heart failure and sudden death. However, recent studies did not show evidence of focal myocardial fibrosis and diffuse myocardial fibrosis in AAS users using T1-mapping techniques. Thus, it remains unclear the association between AAS and cardiac structure alterations. Purpose The aim of this study was to evaluate cardiac structure by cardiovascular magnetic resonance (CMR) imaging with late-gadolinium enhancement (LGE), cardiac T1-mapping and extracellular volume measurements (ECV). Additionally, we also evaluated the cardiac contractility by CMR and echocardiography in young AAS users. Methods Twenty strength-trained AAS users (AASU) age 29±5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled. Cardiac structure was assessed by LGE, native T1-mapping and ECV. Cardiac contractility was evaluated as cardiac strain measured by CMR (feature tracking imaging technique) and echocardiography (speckle tracking technique). Results Global native T1 times [753 (683–870) vs 916 (815–1239) vs 1205 (825–1242) ms, respectively, p=0.03], and native T1 times at the left ventricle mid-ventricular slice [813 (695–1096) vs 922 (825–1095) vs 1140 (840–1322) ms, respectively, p=0.03] were lower in AASU compared with AASNU and SC. Mid-ventricular ECV was similar between AASU, AASNU and SC (22±6 vs 23±4 vs 24±4%, respectively, p=0.37). Focal myocardial fibrosis was found in 2 individuals (11%) of AASU. The mid anteroseptal and mid inferoseptal were the most affected segments. The total estimated mass of the LV mass was 1.25 g (0.65%). Three participants of SC showed focal myocardial fibrosis. The mid anterolateral, mid inferolateral and mid inferomedial were the most affected segments. The total estimated mass of the LV mass was 3.43 g (2.30%). In contrast, none of the AASNU had myocardial fibrosis. By CMR, AASU showed a lower medial radial strain (30±8 vs. 38±6%, p<0.01), medial circumferential strain (−17±3 vs −20±2%, p<0.01) and global longitudinal strain (−17±3 vs −20±3%, p<0.01) compared with AASNU. Echocardiography also demonstrated a lower 4CH longitudinal strain in AASU compared with AASNU (−15.5±3 vs −18.3±2%, p=0.03). Moreover, the AASU shower a higher left ventricle mass compared with AASNU and SC (185±20 vs 130±17 vs 112±14 g, respectively, p<0.01). Conclusion This study indicates that AAS abuse may be associated with decreased myocardial native T1 times, impaired myocardial contractility and focal myocardial fibrosis. These myocardial structural and functional alterations may be associated to unadapted cardiac hypertrophy in young AAS users. Acknowledgement/Funding Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP], Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes).

3076Individual patient meta-analysis of global longitudinal strain: is one normal range enough?

Abstract Background Despite over a decade of evidence, uptake of GLS into guidelines and practice has been slow. Age, BP, and software have been reported to influence GLS, and have led to uncertainty about defining the normal range (NR). As there have been software changes since the last meta-analysis, we sought to define NR in the current era. Methods Pubmed, Cochrane, and EMBASE were searched using the keywords “Left Ventricle”, “Normal global longitudinal strain”, and “Speckle tracking Echocardiography” and relevant synonyms from 2011. Studies were included if they reported GLS based on speckle tracking techniques, included at least 20 healthy individuals, and had up to date contact details available. Healthy was defined as lack of known disease. Platforms used included General Electric, Philips, Canon and Tomtec. The authors of 8 of the 12 studies (67% response) provided individual patient data. Linear regression was used to determine predictors of GLS. Results There were 2396 pts, mean age 42 years (range 18–92), weight 66±12kg, height 169±9cm, BSA 1.7±0.2m2, and SBP 120±13 mmHg. Normal range for GLS was 21.0±2.6%. In multivariable analysis age (β=-0.02, p<0.01), weight (β=-0.03, p<0.01), SBP (β=-0.01, p<0.01) and platform were associated with GLS. GLS tends to vary with extremes of age and BP (see Figure 1 and Figure 2). GLS vs Age group Conclusion Extremes of age and BP may lead to low GLS, but generally, GLS is <16% is abnormal. Acknowledgement/Funding None

Continent‐Wide, Interferometric SAR Phase, Mapping of Antarctic Ice Velocity

AbstractSurface ice velocity is a fundamental characteristic of glaciers and ice sheets that quantifies the transport of ice. Changes in ice dynamics have a major impact on ice sheet mass balance and its contribution to sea level rise. Prior comprehensive mappings employed speckle and feature tracking techniques, optimized for fast‐flow areas, with precision of 2‐5 m/year, hence limiting our ability to describe ice flow in the slow interior. We present a vector map of ice velocity using the interferometric phase from multiple satellite synthetic aperture radars resulting in 10 times higher precision in speed (20 cm/year) and direction (5°) over 80% of Antarctica. Precision mapping over areas of slow motion (<1 m/year) improves from 20 to 93%, which helps better constrain drainage boundaries, improve mass balance assessment, evaluate regional atmospheric climate models, reconstruct ice thickness, and inform ice sheet numerical models.

Recover Glacier Velocity Fields Derived From the SAR Speckle Tracking Technique Using Artificial Neural Network

The speckle tracking technique has demonstrated its great potential in glacier velocity field (GVF) mapping applications. It analyzes the cross correlation between two synthetic aperture radar (SAR) images, which is capable of providing 2-D glacier motion measurements with acceptable accuracy. Since the coherence between a SAR image pair illuminating glacier areas cannot be preserved everywhere in nearly all cases, inevitable no data areas will be presented in SAR speckle tracking products. In this letter, a relatively convenient method is proposed to recover a GVF generated by the speckle tracking technique. This method considers a GVF recovery problem to be a unitary supervised training problem and resolve it via an artificial neural network. A targeted architecture of the network for recovering a GVF is presented. Moreover, the parameters correlative with glacier motion mechanism are proposed to be introduced into the network, which is able to effectively improve the performance of GVF recovery. For the purpose of validation, the proposed method is compared with the well-known Kriging interpolation method based on real speckle tracking products. The experimental results demonstrate that the proposed method can effectively recover a GVF derived from the speckle tracking technique.

Correlation between Diastolic Function and left ventricular global longitudinal stress (GLS) decline in Hypertensive Patients

Heart failure with preserved LVEF is a major cause of morbidity and mortality in hypertensive patients. The close correlation between the impairment of diastolic function and the longitudinal systolic dysfunction has several possible explanations. First the diastole is an energy-dependent process, especially during its first phase, it also includes active systolic components during the isovolumetric relaxation phase; in addition, the achievement of intrinsic myocyte function is part of hypertensive pathology as evidenced by recent studies. Echocardiography was performed in a series of 200 hypertensive patients (25 to 75 years-old). The left ventricular ejection fraction was calculated by biplane method, the indexed left ventricular mass and the relative wall thickness were measured or calculated. In order to differentiate eccentric and concentric LVH, diastolic function analysis and finally study of the LV longitudinal deformation by the speckle tracking technique (GLS calculation) were performed. Patients with secondary hypertension, valve insufficiency or stenosis, arrhythmia, history of coronary insufficiency were excluded from this study. One hundred and seventy-eight patients (89%) of the 200 hypertensive patients had diastolic function impairment, of which 37 patients (18.5%) had high filling pressures. Mean arterial blood pressure was statistically higher in hypertensive patients with high filling pressures than in hypertensives with normal filling diastolic LV pressure. 30 of 37 patients with high filling pressure had low GLS. We reported a significant relationship between the decrease in GLS and the increase in the left ventricular filling pressure. These results suggest that the increase in filling pressures is closely associated with the atrioventricular interaction in hypertensive patients, with a significant correlation with the impairment of longitudinal systolic function and diastolic function. When myocardial fibrosis develops, collagen accumulation increases myocardial rigidity and induces diastolic dysfunction; it also deprives cardiomyocytes of the skeleton necessary for myocardial contraction. Therefore, the degree of myocardial fibrosis can be associated with the defects of systolic and diastolic properties. LVEF is a poorly sensitive indicator of myocardial contractility and subclinical alterations in LV systolic function are already evident in heart failure with preserved LVEF. The decline in the longitudinal function index, despite a preserved LVEF, is well correlated with the increase in filling pressures in hypertensive patients with LVH. The association between HT with LVH and the deterioration of asymptomatic diastolic function is well recognized. A linear relationship is thus established between the increase in left ventricular mass, diastolic dysfunction and LV systolic dysfunction. Finally, the detection of longitudinal systolic dysfunction in an hypertensive patient should impose a therapeutic prevention strategy with the objective of delaying the onset of symptomatic heart failure.

Left Atrial Strain for Predicting Atrial Fibrillation Onset in Hypertensive Patients.

We aimed to find new predictive parameters for atrial fibrillation (AF) onset in hypertensive patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA). One hundred and eight patients with essential hypertension (HTN) were prospectively enrolled, from which 67 patients had no other important comorbidities (HTN group), while 41 patients had a recent AF episode, but were in sinus rhythm at the moment of enrollment (HTN and AF group). LA diameters and maximal volume, LV mass, LV ejection fraction and diastolic function were assessed through 2D conventional echocardiography. Moreover, peak longitudinal and contractile strain of LA walls (PALS and PACS, respectively) were analyzed by speckle tracking technique. Patients were followed up for 1year and recurrent 24-h rhythm monitoring was done, in order to identify atrial fibrillation. Age and time from diagnosis of HTN were higher in HTN and AF group than in HTN group (68.02 ± 19years versus 57.2 ± 1.52years, p = 0.001 and 62.2 ± 9.2months versus 40.4 ± 6.4months, p = 0.04). All LA diameters and LA maximal volume were significantly larger in HTN and AF group (for LA antero-posterior diameter p = 0.02, for all the rest p < 0.0001). LV ejection fraction was preserved in both groups, being significantly lower in HTN and AF patients (58.44 ± 0.79 versus 60.75 ± 0.57, p = 0.02). LV mass was higher in HTN and AF group and these patients had also a more severe diastolic dysfunction, (E/A ratio 1.8 ± 0.51 versus 0.9 ± 0.02, p = 0.04) and lower septal and lateral A' velocities (p < 0.0001 and p = 0.002). The peak LA longitudinal and contractile strain values were also significantly lower in HTN and AF group versus HTN group (for all p < 0.0001). Among the echocardiographic parameters, we identified PALS and PACS as predictors for AF, with a good discriminating capacity (AUC = 0.88 for PALS and AUC = 0.86 for PACS). Compared to patients with isolated hypertension, patients with hypertension and AF display several echocardiographic differences. Among them, LA strain parameters could be useful predictors of AF occurrence in hypertensive patients.

Comparison of clinical and echocardiographic parameters in patients with hypertrophic cardiomyopathy under and over 60 years of age

Background Hypertrophic Cardiomyopathy (HCM) is one of the most common genetic myocardial diseases. Transthoracic echocardiography which includes speckle tracking technique is tool for HCM diagnosis and monitoring the course of the disease. The aim of this study was to compare clinical and echocardiographic parameters in HCM patients older and younger than 60 years old (yo).

Evaluation of myocardial mechanical changes in patients with acute myocardial infarction before and after percutaneous coronary intervention by speckle tracking technique

Objective To evaluate the changes of myocardial mechanics before and after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI) by ultrasonic speckle tracking technique, and investigate the recovery of left ventricular myocardium mechanics and the effects of common complications on the improvement of myocardial mechanics. Methods Sixty-two patients with AMI were examined by echocardiography within 12 hours, 1 week and 3 months after PCI. According to the complications the patients were divided into simple AMI group (21 cases), AMI with diabetes mellitus group (21 cases), and AMI with hypertension group (20 cases). Thirty healthy volunteers were selected as control group. Conventional echocardiographic parameters and left ventricular strain parameters were evaluated in all subjects. Results ①Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV) in each AMI group before PCI were greater than the control group (P 0.05 ). ③The degree of improvement of global longitudinal and circumferential endocardial strain in AMI with diabetes group were less than those in simple AMI group(P<0.05). The degree of improvement of global longitudinal endocardial strain in AMI with hypertension group was less than that in simple AMI group (P<0.05). Conclusions Patients with AMI have poor myocardial mechanics before PCI, especially those with diabetes mellitus; myocardial mechanics improves significantly 3 months after PCI; diabetes mellitus or hypertension affectes the improvement of myocardial mechanics in patients with AMI after PCI. Key words: Echocardiography; Acute myocardial infarction; Speckle tracking; Myocardial mechanics

CAPABILITIES AND LIMITATIONS OF SPECKLE TRACKING STRESS ECHOCARDIOGRAPHY

Stress echocardiography is a technique that allows to evaluate myocardial contractility and intracardiac hemodynamics under conditions of physical exercise or reaction to a pharmacological drug. Evaluation of systolic function of the left ventricle plays an important role in establishing the prognosis and choosing a treatment strategy for various cardiovascular diseases. Speckle tracking technique is one of the most promising methods for determining values of left ventricular deformation, due to which not only visual, but also quantitative assessment of left ventricular myocardial contractility is possible at rest and during stress tests. In this review, we analyzed the possibility of using speckle tracking stress echocardiography with physical exercise or with the pharmacological drug, in order to diagnose various diseases, such as ischemic heart disease, valvular heart disease, diabetes mellitus, and microvascular damage. Along with this, differences between the values of the longitudinal systolic deformation depending on age were considered. We also compared diagnostic values of the data of speckle-tracking stress echocardiography and coronary angiography and values of the data of speckle-tracking stress echocardiography and computed tomography of the coronary arteries.

CAPABILITIES AND LIMITATIONS OF SPECKLE TRACKING STRESS ECHOCARDIOGRAPHY

Stress echocardiography is a technique that allows to evaluate myocardial contractility and intracardiac hemodynamics under conditions of physical exercise or reaction to a pharmacological drug. Evaluation of systolic function of the left ventricle plays an important role in establishing the prognosis and choosing a treatment strategy for various cardiovascular diseases. Speckle tracking technique is one of the most promising methods for determining values of left ventricular deformation, due to which not only visual, but also quantitative assessment of left ventricular myocardial contractility is possible at rest and during stress tests. In this review, we analyzed the possibility of using speckle tracking stress echocardiography with physical exercise or with the pharmacological drug, in order to diagnose various diseases, such as ischemic heart disease, valvular heart disease, diabetes mellitus, and microvascular damage. Along with this, differences between the values of the longitudinal systolic deformation depending on age were considered. We also compared diagnostic values of the data of speckle-tracking stress echocardiography and coronary angiography and values of the data of speckle-tracking stress echocardiography and computed tomography of the coronary arteries.

Study on the Value of Three-dimensional Speckle Tracking Technique

Study on the Value of Three-dimensional Speckle Tracking Technique

The role of two-dimensional speckle tracking echocardiography in evaluating left ventricular function of patients with multi-vessel coronary artery disease

Objective To explore the role of two-dimensional speckle tracking echocardiography in evaluating left ventricular function of patients with multi-vessel coronary artery disease (MVD). Methods 40 patients with MVD without obviously abnormal ventricular wall activity admitted to our hospital from June 2017 to January 2018 were selected as the study objects, and were classified as MVD group, and 42 normal persons were selected as the control group. The left atrial end systolic diameter (LAd) and left ventricular end diastolic diameter (LVEDD) were measured by echocardiography, and then the dynamic gray scale images of all patients were collected. The left ventricular global systolic longitudinal strain (GLS), left ventricular global radial strain (GRS), global circumferential strain (GCS), left ventricular basal global longitudinal strain (Bas-GLS), basal global circumferential strain (Bas-GCS), basal global radial strain (Bas-GRS), middle global longitudinal strain (Mid-GLS), middle global circumferential strain (Mid-GCS), middle global radial strain (Mid-GRS), global longitudinal strain of apical segment (Ap-GLS), global circumferential strain value of apical segment (Ap-GCS), and global radial strain value of apical segment (Ap-GRS) were measured by two-dimensional speckle tracking technique. Results In MVD group, 84.21% of patients with coronary artery occlusion or subtotal occlusion showed collateral formation on coronary angiography; there was no significant difference in the indexes detected by conventional echocardiography (P>0.05). The GLS, Bas-GLS, Mid-GLS, Bas-GCS, Mid-GCS, GRS, and Bas-GRS in MVD gro-up were significantly lower than those in control group, with statistically significant differences (P<0.05). Conclusions Compared with echocardiography, two-dimensional speckle tracking technique can detect myocardial lesions more sensitively in patients with coronary multi-vessel disease without abnormal wall activity, and find out the dysfunction of myocardial contraction, especially the damage of longitudinal myocardial contraction and the damage of basal myocardium. Key words: Echocardiography; Coronary artery disease; Atrial function, left