Speckle Tracking Research Articles

Speckle tracking echocardiography of right and left ventricles in children of atrial septal defect and ventricular septal defect

Background Speckle tracking echocardiography (STE) is utilized to evaluate and quantify the heart muscle’s strain and deformation. Aim To assess early myocardial insult in children with atrial septal defect (ASD)/ventricular septal defect (VSD) using STE and to assess left ventricular (LV) and right ventricular (RV) systolic function using STE. Patients and methods This cross-sectional study involved 40 infants and children having isolated VSD or isolated secundum ASD and 20 healthy children as controls. Tissue Doppler and STE were performed to assess the systolic function of RV and LV in these children. Results RV and LV functions in cases with ASD by tissue Doppler measures were insignificantly different between ASD and the control group. Regarding LV function in the ASD group, systolic strain rate (SS) exhibited significantly greater values among ASD cases as opposed to controls (P<0.05). Regarding RV function within the ASD group, SS, systolic function (S), early diastolic strain rate (E’), and late diastolic strain rate (A’) exhibited insignificant variance among ASD cases as well as controls. Regarding LV functions, SS, S, E’, and A’ by STE exhibited insignificantly variance among VSD cases and controls. Regarding RV functions, SS and A’ were significantly different when measured by STE between VSD cases and the control group. Conclusions Speckling tracking use showed potential benefits while assessing LV/RV function among cases of ASD as well as VSD.

Prevalence and predictors of right ventricular dysfunction among adults living with HIV in northwest Nigeria.

People living with the human immunodeficiency virus (PLWH) are at increased risk of cardiovascular diseases. Right ventricular (RV) function has important prognostic value in cardiac pathology, and advances in imaging modalities, such as transthoracic echocardiography have enabled in-depth RV studies. There is, however, a scarcity of multiparameter RV function studies in PLWH in low- and middle-income settings, such as Nigeria. The aim of this study is to determine the prevalence and predictors of RV dysfunction among adult PLWH in northwest Nigeria. This is a retrospective cross-sectional study conducted between February 1, 2023 and August 31, 2023. We consecutively recruited 330 adults [median age 45 years, interquartile range (IQR), 38 to 52 years, 61% female] attending human immunodeficiency virus (HIV) and general outpatient clinics in a tertiary hospital in northwest Nigeria. They included 110 antiretroviral therapy (ART)-experienced PLWH, 110 ART-naïve PLWH, and 110 age- and sex-matched HIV-negative control subjects. All participants had conventional two-dimensional (2D), tissue Doppler (TDI), and speckle tracking (2D-STE) echocardiography to estimate left ventricular (LV) and RV systolic and diastolic function, peak systolic and diastolic myocardial velocities, RV and LV longitudinal strain, and chamber dimensions. All participants also underwent 12-lead electrocardiography. Multiple linear and Firth's logistic regression modeling were performed to assess for independent predictors of RV myocardial performance index (RVMPI) as a continuous and as a dichotomous variable, respectively. The prevalence of RV dysfunction, as determined by the RVMPI among HIV-positive participants was 14.5% [95% confidence interval (CI): 10.5-19.8%] compared to 0% (95% CI: 0.0-3.4%) for those without HIV. Among participants with HIV, RVMPI was associated with participant age (P<0.001) and left ventricular ejection fraction (LVEF) (P<0.001). Results were similar when RVMPI was dichotomized. The association between RV dysfunction and LVEF was modified by ART status: a 10% decrease in LVEF was associated with an average decrease of 0.08 in RVMPI among participants who were ART-experienced (β=-0.08, P<0.001) but a lesser decrease among those who were ART- naïve (β=-0.03, P=0.14). This study highlights the complexity of RV dysfunction in PLWH and underscores the importance of LVEF and age as key factors influencing the risk of RV dysfunction in PLWH.

Cardiac remodelling in patients with atrial fibrillation and obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) can cause left atrial (LA) and left ventricular (LV) remodelling, which is linked to atrial fibrillation (AF). Whether continuous positive airway pressure (CPAP) can reverse LA and LV remodelling in patients with OSA and paroxysmal AF (PAF) has yet to be studied. We assessed the impact of CPAP treatment on LA and LV size and function in patients with OSA and PAF before and after catheter ablation. In a randomised controlled trial, we screened patients with PAF for OSA. We enrolled patients with an Apnoea-Hypopnoea Index ≥15/hour. The burden of AF was monitored by an implantable loop recorder in all patients. Patients were then randomised to CPAP treatment or standard care. Transthoracic echocardiography was performed at baseline and after 6 and 12 months to assess LV and LA function and remodelling with advanced echocardiographic imaging techniques. We enrolled 109 patients (63±7 years, body mass index 29.6±4.3, 76% men). 83 patients were scheduled for pulmonary vein isolation (PVI) and 26 for clinical follow-up only. 55 patients were randomised to CPAP and 54 to standard care. The burden of AF decreased significantly in patients who underwent PVI irrespective of treatment with CPAP (p for difference ≤0.001). Patients in the study group had LV ejection fraction (LVEF) and LV global longitudinal strain (GLS) within the normal range, increased LA Volume Index (LAVI), LA volume (by speckle tracking) and decreased LA reservoir strain at baseline. We did not observe any improvement in LVEF, GLS, LAVI, LA volume or LA reservoir strain in either group during the 12 months of follow-up. In patients with PAF and OSA, treatment with CPAP was not associated with reverse LA remodelling within 12 months of follow-up.

Assessment of Left Ventricular Functional Impairment in Patients With Chronic Kidney Disease Using Three-Dimensional Speckle Tracking Imaging.

Chronic kidney disease (CKD) is strongly linked to the incidence and mortality of cardiovascular diseases (CVDs), with left ventricular myocardial damage being the most prevalent. This study aimed to assess left ventricle (LV) dysfunction using three-dimensional speckle tracking imaging (3D-STI) in CKD patients. A total of 110 CKD patients and 55 healthy volunteers underwent echocardiography. CKD patients were divided into CKD1 group and CKD2 group based on the estimated glomerular filtration rate (eGFR). Assessing cardiac function via two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional speckle tracking echocardiography (3D-STE) parameters, with strain presented in absolute terms. Collecting and comparing clinical and echocardiographic parameters from three groups, assessing 3D-STI's value in evaluating LV functional impairment in CKD patients via correlation and receiver operating characteristic (ROC) curve analyses, and identifying risk factors for CKD progression to end-stage renal disease (ESRD) through univariate and multivariate analyses. In CKD2 group, 2D-left ventricular ejection fraction (LVEF), 3D-LVEF, 2D left ventricular global longitudinal strain (2D-LVGLS), 3D-LVGLS, and 3D-left ventricular global circumferential peak strain (LVGCS) significantly worsen compared to the control and CKD1 groups, with statistically significant distinctions between the latter two (all p < 0.05). The absolute value of 3D-LVGLS shows a robust correlation with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and serum creatinine (Scr) (r = -0.598, -0.649, both p < 0.001). ROC curve analysis indicates higher diagnostic efficacy of 3D-LVGLS and 3D-LVGCS for LV systolic function than 2D-LVGLS. Univariate and multivariate analyses reveal an independent association of 3D-LVGLS with the progression to ESRD in CKD. 3D-LVGLS and 3D-LVGCS effectively detect LV dysfunction in CKD patients. Specifically, 3D-LVGLS demonstrates a robust correlation with NT-proBNP and Scr and is independently linked to CKD progressing to ESRD.

Feasibility of Intraoperative 3-Dimensional Speckle-Tracking Echocardiography in Patients Undergoing Surgical Aortic Valve Replacement: A Prospective Observational Pilot Study

To assess the feasibility of intraoperative 3-dimensional speckle-tracking-based myocardial deformation analysis for evaluation of twist, torsion, and strain using speckle tracking, and to investigate the immediate changes in these parameters after aortic valve replacement. Prospective observational study SETTING: Single-center study at a tertiary academic cardiac center PARTICIPANTS: Forty-nine patients undergoing minimally invasive surgical aortic valve replacement INTERVENTIONS: Acquisition of full-volume images of the left ventricle after induction of anesthesia and at the end of surgery using transesophageal echocardiography (TEE), and analysis of the datasets using 3D speckle-tracking-based myocardial deformation analysis (Tomtec Arena). Of the 49 complete volume datasets, 30 (61%) had quality sufficient for speckle tracking. No significant differences were observed between the examinations in terms of ejection fraction (EF) (p = 0.177), global longitudinal strain (GLS) (p = 0.276), circumferential strain (CS) (p = 0.238), twist (p = 0.970), or torsion (p = 0.417). 3D speckle-tracking-based myocardial deformation analysis from intraoperative TEE datasets is feasible in >60% of patients with aortic valve stenosis. There were no statistically significant differences in GLS, CS, twist, or torsion between the intraoperative examinations.

The Relationship Between Right Ventricular Longitudinal Strain and Adverse Outcome in Hypertensive Patients: 10-year Follow-up.

Previous studies showed the importance of right ventricular (RV) remodeling in patients with arterial hypertension and RV longitudinal strain was recognized as very sensitive parameter for detection of subtle cardiac impairment. However, its clinical importance in arterial hypertension has not been established so far. The present study aimed to evaluate the association between RV longitudinal strain (global and free-wall) on adverse outcomes measured by MACE in the large group of hypertensive patients who were followed for mean period of 10 years. This retrospective study finally included 544 hypertensive patients who underwent full echocardiographic examination including 2D speckle tracking imaging. between January 2010 and December 2014. MACE was considered as the primary outcome and it was defined by all-cause mortality, cardiovascular mortality, myocardial infarction, coronary artery by-pass, coronary stent implantation, stroke, development of heart failure, and occurrence of atrial fibrillation during follow-up. Patients who experienced MACE were older than those who did not. There was no difference in demographic and clinical parameters between MACE and non-MACE patients. There was no difference in RV diameter, but MACE patients had higher RV wall thickness. RV systolic function parameters were similar between the two groups. RV global and free-wall longitudinal strain were significantly lower in MACE patients (-22.3 ± 3.6 vs. -24.7 ± 3.9%, p < 0.001 and - 25.8 ± 4.2 vs. -28.1 ± 4.5%, p < 0.001; respectively). Reduced RV GLS [OR 1.10; 95%: 1.02-1.20] and reduced RV free-wall longitudinal strain [OR 1,21; 95%CI: 1.05-1.39] were independently of clinical and echocardiographic parameters related with adverse outcome measured by MACE. RV GLS and RV free-wall longitudinal strain were independently related with adverse outcomes during 10-year follow-up in initially uncomplicated hypertensive patients.

Ultrasound Speckle Tracking Method Based on Gradient Optical Flow to Quantify Small Longitudinal Displacement, Shear and Longitudinal Strain in Peripheral Nerves

ObjectiveThis study aimed to develop, validate and test the clinical feasibility of ultrasound (US) speckle tracking method based on gradient optical flow for quantifying small longitudinal displacements, shear and strain in peripheral nerves. MethodsThe speckle tracking method was validated using seven thawed, fresh-frozen isolated cadaveric forearms. Longitudinal motion of the median nerve was captured using a high-frequency 22 MHz linear probe. An air bubble marker was inserted as a reference point for manual measurement comparison. The precision and accuracy of the method were assessed by comparing manual and automatic measurements. Clinical feasibility was tested on eight healthy subjects, measuring the longitudinal displacement of the median nerve during elbow extension and shoulder anteflexion. ResultsThe method demonstrated linearity, high precision and accuracy, particularly with a backtrace of five frames, reducing the displacement underestimation to 4%. In cadaveric models, the highest shear strain was observed at the nerve-tissue interfaces. In healthy subjects, the mean displacement of the median nerve was 3.3 ± 1.0 mm, with good inter-rater reliability (intraclass correlation coefficient = 0.87). ConclusionThe US speckle tracking method based on gradient optical flow effectively quantifies small longitudinal displacements and shear strain in peripheral nerves, with high precision and accuracy. However, the method could not detect longitudinal strain in nerves within the range of tested displacements. Future studies should investigate its applicability to smaller and deeper nerves and its usefulness in different pathological conditions.

A study on normal reference values of the left ventricular strain parameters in young adults

Background: The left ventricular (LV) function is an important prognostic determinant of cardiopulmonary pathologies in adult. Clinical application of cardiac strain by two-dimensional speckle tracking echocardiography to measure LV function requires knowledge of the range of normal values. Reference values and associated variations of the deformation measures need to be “firmly established before routine clinical adoption” of LV strain measurements can be implemented in Indian population. Aims and Objectives: This study aims to establish normal values of LV strain parameters in normal Indian population. Materials and Methods: An observational, cross-sectional, single-center, hospital-based study. The study period October 2021–October 2022 in Nil Ratan Sircir Medical College, Kolkata. Cardiologically healthy adult subjects (sample size 250) both male and female, aged 18–45 years who were healthcare professionals of this medical college and hospital were included in the study. Routine history taking and investigations were done. Echodoppler was done with special emphasis on LV strain parameters. Results: Distribution of mean LV circumferential strain (LVCS) with age in years was statistically not significant (P=0.8068). The mean value in male and female were −18.9574(±0.9049) and −19.0257(±0.8908) respectively. In the current study, LVCS did not vary in statistically significant a way among different age groups too. The mean values in male and female were −22.5887(±1.8065) and −22.3312(±1.9007) respectively. Conclusion: This current study failed to show significant differences in LV strain parameters between age groups or male and female in Eastern India Population.

Assessing Left Atrial Appendage Functions by Transesophageal Echocardiography and Speckle Tracking Imaging to Predict Recurring Atrial Fibrillation Post-Radiofrequency Catheter Ablation.

To predict recurring atrial fibrillation (AF) following radiofrequency catheter ablation by assessing the attributes of the left atrium and the left atrial (LA) appendage (LAA) using transesophageal echocardiography (TEE) and speckle tracking imaging. The structural and functional indices of the LA and LAA of 80 patients with AF who underwent preoperative transthoracic echocardiography and TEE were measured. Recurrence was recorded postoperatively at 3, 6, and 12 months. The independent determinants of recurring AF were identified by logistic regression, and their optimum cutoff values, sensitivity, and specificity were estimated from the receiver operating characteristic (ROC) curves. The recurrent and nonrecurrent groups comprised 17 and 63 patients, respectively. The LA internal diameter, LA end-diastolic and end-systolic volumes, LAA length, diameter and area of the opening of the LAA, and LAA end-diastolic volume were higher in the recurrent group. The LA strain in the reservoir phase, the ejection fraction and filling velocity of the LAA, the LAA emptying velocity (LAAeV), and the LAA strain (LAAS) reduced considerably. Multifactorial regression analyses demonstrated that the LAAeV and LAAS were independent determinants of recurring AF. ROC curve analysis revealed that the LAAeV and LAAS predicted postoperative recurrence at 34.5cm/s (area under the curve [AUC]: 0.954, sensitivity: 94.1%, and specificity: 92.1%) and 11.61% (AUC: 0.925, sensitivity: 82.4%, and specificity: 95.2%), respectively, while the AUC, sensitivity, and specificity of the combined predictors (LAAeV+LAAS) were 0.978, 94.1%, and 93.7%, respectively. The LAAeV and LAAS independently influenced the postoperative recurrence of AF.

Use of strain imaging to detect subtle myocardial involvement in post COVID-19 patients: An Indian perspective

BackgroundThe study assessed Global longitudinal strain imaging (GLS) to detect subtle myocardial dysfunction among patients clinically recovered from COVID-19. MethodsAll patients (n = 101 76 % males, mean age 55.45 ± 11.14 years), and controls (n = 30), underwent clinical assessment and echocardiography, including GLS assessment. ResultsThe prevalence of diabetes mellitus, hypertension and dyslipidemia was comparable amongst patients and controls. The average GLS was significantly lesser in post COVID patients (−16.21 ± 1.96 vs −18.49 ± 1.64 respectively, p = 0.004) and significantly higher proportion of post COVID patients had GLS > -18 % (43 % vs 22.58 % respectively, p = 0.001) as compared to controls. The RV free wall longitudinal strain (RVFLS) was also lower in the patient group (22.35 ± 4.69 vs 24.19 ± 4.11, p = 0.004) and 21.7 % post COVID-19 patients had pathological RV FWLS (> −20 %) vs controls (6.6 %).Average GLS was significantly lesser in severe post COVID patients (viz −14.25 ± 1.92 vs −16.63 ± 1.61 vs −17.63 ± 1.91, p < 0.0001, respectively among severe, moderate and mild COVID-19 patients. On performing regression analysis, severity of COVID-19 (OR 7.762) was a significant predictor of impaired GLS. ConclusionDespite normal global LVEF, post COVID-19 recovered patients had significantly lower LV GLS and RV FWLS with severe COVID-19 infection, regardless of having a clinical recovery. This study reiterates the importance of speckle tracking echocardiography as an important imaging modality for detection of subclinical myocardial dysfunction in the post COVID-19 recovered patients.

Quantitative Analysis of Myocardial Work in Gestational Diabetes Mellitus Using Noninvasive Left Ventricular Pressure-Strain Loop Measurement.

Gestational diabetes mellitus (GDM) poses a risk for cardiovascular damage during pregnancy. This study focused on evaluating changes in left ventricular myocardial performance in GDM patients using the left ventricular pressure-strain loop (LV-PSL) method and examining risk factors associated with reduced myocardial function. A prospective, randomized study involving 112 pregnant women diagnosed with GDM was conducted from June 2021 to June 2024. Additionally, 84 healthy pregnant women from the same period served as the control group. Utilizing both conventional echocardiography and two-dimensional speckle tracking echocardiography, left ventricular myocardial work metrics were assessed using LV-PSL technology. GDM patients demonstrated significantly reduced values for global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), and global constructive work (GCW) (p < 0.05), while conventional ultrasound measures showed no significant difference between GDM and control groups. GWI, GWE, GCW, and GLS had high predictive value for cardiac function changes in GDM patients, with GWE showing the highest predictive value {Area under curve (AUC)=0.866, cutoff value=95.5%, specificity=0.77, sensitivity=0.87}. GWI, GWE, and GCW were negatively correlated with GLS (r=-0.532, -0.411, -0.425, all p < 0.001), whereas global wasted work (GWW) showed a positive correlation with GLS (r=0.325 and p < 0.001). These parameters were also correlated with HbA1c levels (r=-0.316, -0.256, -0.260, all p < 0.001 for negative correlations, and r=0.172, p < 0.05 for positive correlations). Multivariate logistic regression indicated that 1-h OGTT (mmol/L), 2-h OGTT (mmol/L), and HbA1c (%) were significant predictors of left ventricular systolic function (GWE) in GDM patients. LV-PSL is an effective tool for early detection of left ventricular systolic function impairment in GDM patients.

Decreased diaphragm moving distance measured by ultrasound speckle tracking reflects poor prognosis in amyotrophic lateral sclerosis

ObjectiveDecreased cephalocaudal diaphragm movement may indicate respiratory dysfunction in amyotrophic lateral sclerosis (ALS). We aimed to evaluate diaphragm function in ALS using ultrasound speckle tracking, an image-analysis technology that follows similar pixel patterns. MethodsWe developed an offline application that tracks pixel patterns of recorded ultrasound video images using speckle-tracking methods. Ultrasonography of the diaphragm movement during spontaneous quiet respiration was performed on 19 ALS patients and 21 controls to measure the diaphragm moving distance (DMD) in the cephalocaudal direction during a single respiration. We compared respiratory function measures and analyzed the relationship between the clinical profiles and DMD. ResultsDMD was significantly lower in ALS patients than in the control group (0.6 ± 1.4 mm vs 2.2 ± 2.2 mm, p < 0.01) and positively correlated with phrenic nerve compound motor action potential amplitude (R = 0.63, p = 0.01). DMD was negatively correlated with the change in the ALS Functional Rating Scale-Revised scores per month after the exam (R = −0.61, p = 0.02), and those with a larger rate of decline had a significantly lower DMD (p = 0.03). ConclusionsDiaphragm ultrasound speckle tracking enabled the detection of diaphragm dysfunction in ALS. SignificanceDiaphragm ultrasound speckle tracking may be useful for predicting prognosis.

The Utility of Speckle Tracking Echocardiographic Parameters in Predicting Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Non-Valvular Atrial Fibrillation.

Despite the efficacy of catheter ablation (CA) as a treatment for non-valvular atrial fibrillation (NVAF), many patients still experience atrial fibrillation (AF) recurrence after CA. This study aimed to evaluate the predictive value of speckle tracking echocardiographic (STE) parameters for AF recurrence post-ablation. A total of 380 NVAF patients treated with CA at the First Affiliated Hospital of Guangxi Medical University from January 2020 to March 2023 were prospectively recruited. The mean age was 59.4 ± 10.8 years, and 72.1% were male, including 150 patients (39.5%) with persistent AF and 230 patients (60.5%) with paroxysmal AF. STE was used to evaluate baseline left atrial (LA) function before CA within 48h. Over a median follow-up of 9 (interquartile range, 4-17) months, AF recurrence occurred in 132 patients (34.7%). The recurrence group showed lower left ventricular ejection fraction, LA reservoir strain (LASr), and conduit strain (LAScd), but higher LA stiffness than non- recurrence group (all P < 0.05). Multivariable Cox regression identified LA stiffness and LASr as independent risk factors. Time-dependent ROC analysis showed that LA stiffness (AUC 0.768, 95% CI 0.705-0.831) and LASr (AUC 0.755, 95% CI 0.691-0.820) were better at predicting 1-year AF recurrence than other risk factors. For 2-year AF recurrence post-catheter ablation, LA stiffness (AUC 0.866, 95% CI 0.804-0.928) and LASr (AUC 0.860, 95% CI 0.800-0.920) also demonstrated superior predictive performance. Kaplan-Meier curves showed a significant difference in AF recurrence rate for patients with LA stiffness > 0.55 and LASr ≤ 24.3% (Log rank P < 0.01). Evaluation of LA function using STE assists in stratifying the risk of AF recurrence in NVAF patients and guiding follow-up management. LASr and LA stiffness are independent predictors of AF recurrence following CA in NVAF patients, and potentially outperforming other morphological parameters.

Effects of Ventricular Extrasystoles on Right Ventricle Functions (a Speckle Tracking Study). VES and RV Strain Imaging.

The adverse effects of ventricular extrasystoles (VES) on the heart, such as induced dyssynchrony, irregular heart rate, and atrioventricular dissociation, have been demonstrated. The aim of this study was to investigate the effects of VES on the right ventricle (RV) using strain imaging. Fifty patients with 5000 or more VES detected during 24hr Holterrhythm monitoring between April 2022 and September 2022 in the cardiology outpatient clinic were included in this study.A volunteer control group of 50 individuals matching the patients' age and demographic characteristics was selected. Right heart function parameters were compared echocardiographically between the two groups. In the VES group, both RV free wall strain (22.03±3.67, 29.52±3.01; p&lt;0.001) and RV four-chamber strain (19.37±2.95, 22.34±2.11; p&lt;0.001) were lower compared to the control groupIn the univariate regression analysis for decreased RV four-chamber strain, the presence of VES (p&lt;0.001) was identified as a predictor, whereaas in the multivariate regression analysis, it was not considered to be an independent predictor. When evaluating the characteristics of the VES patients, the number of VES detected during Holter monitoring and delta QRS were observed as negative predictors of RV strain. This study demonstrated the adverse effects of VES on the right ventricle, as it is on the left ventricle.Therefore, regular monitoring of RV function with echocardiography is important in the follow-up of patients with VES.

The Predictive Value of Global Longitudinal and Circumferential Strains in Hypertensive Patients: 10-Year Follow-Up

Background: The aim of the current study was to investigate the predictive value of a multidirectional LV strain on adverse outcomes in a large population of uncomplicated hypertensive patients who were followed for a mean period of 10 years. Methods: This retrospective study included 591 recently diagnosed hypertensive patients who underwent clinically indicated echocardiography between January 2010 and December 2014 and were followed for a mean period of 10 years. Global longitudinal, circumferential and radial strains (GLS, GCS and GRS) were measured by 2D speckle tracking imaging. The primary outcome was a MACE occurrence defined by all-cause mortality, cardiovascular mortality, myocardial infarction, coronary artery by-pass, coronary stent implantation, stroke, development of heart failure and the occurrence of atrial fibrillation during follow-up. Results: Our results showed that GLS, GCS and GRS were significantly lower in patients who experienced MACE. Age, male gender, systolic blood pressure, left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) were associated with MACE occurrence. Reduced GLS [OR 1.15; 95%CI: 1.01–1.30] and reduced GCS [OR 1.1; 95%CI: 1.02–1.22] were related with MACE independently of clinical characteristics, LV systolic and diastolic function, as well as LVH. Reduced GRS was not independently associated with adverse outcomes. Conclusions: Reduced GLS and GCS were independently associated with adverse outcomes during 10-year follow-up in patients who were recently diagnosed and uncomplicated hypertensive patients at the baseline.

Evaluation of Cardiac Function Recovery in Patients with Paroxysmal Atrial Fibrillation after Catheter Radiofrequency Ablation Using Two-Dimensional Speckle Tracking Imaging and Real-Time Three-Dimensional Echocardiography

Introduction: The aim of this study was to evaluate the utility of 2D-STI and real-time three-dimensional echocardiography (RT-3DE) in assessing changes in left atrial (LA) structure and function in patients with paroxysmal atrial fibrillation (PAF) post-radiofrequency catheter ablation (RFCA). Methods: A retrospective analysis was conducted on 44 PAF patients who underwent RFCA at BA Hospital from March 2022 to March 2023. An age- and gender-matched control group of 32 healthy individuals was also included. Comprehensive echocardiographic parameters including LA dimensions (LAAPD, LALRD), volumes (LAVmin, LAVmax), ejection fraction (LAEF), and tissue velocities (a’, Ar) were compared between groups. Post-RFCA changes in these parameters were also assessed at 1, 3, and 6 months. Results: Pre-RFCA, PAF patients demonstrated larger LA dimensions and volumes with reduced LAEF and tissue velocities compared to controls. Post-RFCA, there was a significant improvement in LAEF and left ventricular ejection fraction at 1, 3, and 6 months, with the most pronounced changes observed at 6 months. LA dimensions increased initially but then decreased from 1 to 6 months post-RFCA. Notably, strain rate (SRS, SRE, SRA) measurements in various LA segments improved progressively, with the most significant enhancements at 6 months, suggesting improved atrial mechanics. Conclusion: The application of 2D-STI and RT-3DE provides a quantitative means to evaluate the structural and functional changes in the LA of PAF patients following RFCA. The progressive improvements in LA dimensions, volumes, and strain measurements up to 6-month post-RFCA indicate the potential of these techniques in monitoring treatment efficacy and patient recovery.

Echocardiography for Management of Cardiovascular Disease in Pregnancy.

Cardiovascular disease (CVD) continues to be a leading contributor to maternal mortality and morbidity. Echocardiography is an essential tool for patients with suspected and known CVD to establish symptom etiology, treatment strategy, and prognosis. We summarize the current status of conventional and novel techniques for assessment of CVD during pregnancy. Conventional techniques are still useful for evaluation of known or suspected CVD. Advanced technology using speckle tracking continues to evolve and is increasingly applied for diagnosis of subclinical disease including hypertensive disorders of pregnancy and left ventricular (LV) dysfunction. Precise recommendations on how frequently echocardiography should be performed and for whom remain in flux. However, a recently published consensus statement and new screening tool for pregnancy assessment of patients with valvular heart disease provide additional advice on using this modality. Echocardiography remains the diagnostic modality of choice for evaluation and risk stratification in pregnancy.

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.

Dual antiplatelet including clopidogrel and aspirin, cardiac MRI, and speckle tracking echocardiography parameters in ST-elevation myocardial infarction patients

Coronary artery disease is the medical term for atherosclerotic coronary disease, which causes the coronary arteries to constrict and inadequately provide blood to the heart. ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, &amp; unstable angina are the three conditions that comprise acute coronary syndromes. Studied cases with STEMI have been advised to take several drugs in addition to early reperfusion treatment, such as antiplatelet &amp; anticoagulant medications. The goal of antiplatelet medications is to stop platelets from aggregating together. Oral dual antiplatelet medication, which combines lifetime aspirin with an oral P2Y12 receptor inhibitor, is the main antiplatelet therapy in STEMI. Aspirin ought to be administered to all studied cases immediately following diagnosis, and a low dose of treatment should be continued indefinitely. Heart mortality and severe adverse cardiac events are strongly and independently correlated with the presence &amp; size of scarred tissue seen by cardiac MRI. Scar transmurality measured by cardiac MRI in studied cases with healed infarcts &amp; ventricular dysfunction predicts patient survival and functional recovery following revascularization. Patients with heart illnesses that have a history of ST-segment elevation myocardial infarction may be at risk for unfavorable results based on echocardiographic evaluation of cardiac structure &amp; function. Because speckle tracking echocardiography (STE) is quick and simple to do, it can be used in acute settings as well. It can be used for further risk stratification following revascularization, before invasive coronary angiography, or in cases when a diagnosis is unclear, if available.

Cardiac Magnetic Resonance Speckle Tracking Analysis of Right Ventricle Function in Myocarditis with Preserved Right Ventricular Ejection Fraction.

Background and Objectives: Diagnosis of myocarditis remains a challenge in clinical practice; however, magnetic resonance imaging (CMRI) can ease the diagnostic approach by providing various parameters. The prevalence of right ventricular involvement in acute myocarditis is suggested to be more frequent than previously hypothesized. In this study, we sought to investigate subclinical RV involvement in patients with acute myocarditis and preserved RV ejection fraction (EF), using CMRI RV speckle-tracking imaging. Materials and Methods: CMRI of 27 patients with acute myocarditis (nine females, age 35.1 ± 12.2 y) was retrospectively analyzed. A control group consisting of CMRI images of 27 healthy individuals was included. Results: No significant differences were found regarding left ventricle (LV) and atrium dimensions. LV ejection fraction was significantly different between groups (56.6 ± 10.6 vs. 62.1 ± 2.6, p < 0.05). No significant differences were present between parameters used for conventional assessment of RV. However, RV strain absolute values were significantly lower in the acute myocarditis group in comparison with that of the control group (18.4 ± 5.4 vs. 21.8 ± 2.8, p = 0.018). Conclusions: Subclinical RV dysfunction detected by CMR-derived strain may be present in patients with acute myocarditis even with preserved RVEF.