Standard Echocardiographic Examination Research Articles

Assessment of Left Ventricular Reverse Remodeling by Echocardiography After 90 Days of Sacubitril/Valsartan Therapy in Patients of Heart Failure with Reduced Ejection Fraction

Abstract Background: The present study aimed to assess the response of sacubitril/valsartan therapy on cardiac reverse remodeling (CRR) by standard and advanced echocardiographic parameters in patients of heart failure with reduced ejection fraction (HFrEF). Methods: One hundred and fifty patients ≥18 years of age with symptomatic heart failure with left ventricular ejection fraction (LVEF) <40.0% were included in this prospective observational study. All patients underwent baseline electrocardiography and standard echocardiographic examination. Patients were given sacubitril/valsartan maximal tolerated dose. Echocardiographic measurements were done after 90 days. The primary outcome measure was a change in LVEF, whereas the secondary outcome measures were changes in left ventricular dimensions and volumes, E/e’, pulmonary artery systolic pressure (PASP), and global longitudinal strain (GLS). Comparisons between two discrete variables and medians were performed using the Chi-square test/Fisher’s exact test and the Wilcoxon signed–rank test, respectively. Results: The median LVEF (32.5% vs. 30.0%) was significantly higher, whereas left ventricular end-diastolic volume (180 vs. 177.5 mL), left ventricular end-systolic volume (127.5 vs. 122.5 mL), left ventricular end-diastolic diameter (59 vs. 58 mm), left ventricular end-systolic diameter (51 vs. 50 mm), PASP (38 vs. 35), E/e’ (15 vs. 14), and GLS (−9.0 vs. −10.0) were significantly lower at 3-month follow-up as compared to baseline levels. Sacubitril/valsartan therapy leads to CRR as early as 90 days in patients with HFrEF. Conclusions: In HFrEF patients, sacubitril/valsartan significantly improved CRR.

Should aortic stiffness parameters be used in MIS-C patient follow-up?

We evaluated the short- and long-term effects of multisystem inflammatory syndrome in children (MIS-C) on their cardiovascular system. The study population consisted of 38 MIS-C patients and 55 control patients. Standard echocardiographic measurements and aortic stiffness parameters were compared between the two groups at different time points. During the standard echocardiographic examination at the time of diagnosis, mitral valve insufficiency was detected in 42% of the cases, left ventricular systolic dysfunction in 36%, aortic valve insufficiency in 3%, tricuspid valve insufficiency in 13%, and coronary artery dilatation in 31%. The ejection fraction, pulse pressure of the experimental group were significantly lower than the control group (p < 0.01, p = 0.045, respectively). When aortic stiffness parameters were compared, it was seen that the parameters increased in the experimental group and the difference was significant for aortic distensibility. (p = 0.105, p = 0.029 respectively). When comparing the experimental group's results at diagnosis and at the sixth month, there was a decrease in aortic stiffness parameters at the sixth month compared to the time of diagnosis, but the difference wasn't significant (p = 0.514, p = 0.334). However, no statistically significant difference was detected when comparing the aortic distensibility results of the experimental group with the control group at the sixth month (p = 0.667). Our results showed that many pathological echocardiographic findings detected at diagnosis in MIS-C patients returned to normal within six months. Therefore, we believe that the cardiovascular follow-up period of MIS-C cases should be at least six months.

The use of artificial intelligence for predicting postinfarction myocardial viability in echocardiographic images.

Evaluation of standard echocardiographic examination with artificial intelligence may help in the diagnosis of myocardial viability and function recovery after acute coronary syndrome. Sixty-one consecutive patients with acute coronary syndrome were enrolled in the present study (43 men, mean age 61 ± 9 years). All patients underwent percutaneous coronary intervention (PCI). 533 segments of the heart echo images were used. After 12 ± 1 months of follow-up, patients had an echocardiographic evaluation. After PCI each patient underwent cardiac magnetic resonance (CMR) with late enhancement and low-dose dobutamine echocardiographic examination. For texture analysis, custom software was used (MaZda 5.20, Institute of Electronics).Linear and non-linear (neural network) discriminative analyses were performed to identify the optimal analytic method correlating with CMR regarding the necrosis extent and viability prediction after follow-up. Texture parameters were analyzed using machine learning techniques: Artificial Neural Networks, Namely Multilayer Perceptron, Nonlinear Discriminant Analysis, Support Vector Machine, and Adaboost algorithm. The mean concordance between the CMR definition of viability and three classification models in Artificial Neural Networks varied from 42% to 76%. Echo-based detection of non-viable tissue was more sensitive in the segments with the highest relative transmural scar thickness: 51-75% and 76-99%. The best results have been obtained for images with contrast for red and grey components (74% of proper classification). In dobutamine echocardiography, the results of appropriate prediction were 67% for monochromatic images. Detection and semi-quantification of scar transmurality are feasible in echocardiographic images analyzed with artificial intelligence. Selected analytic methods yielded similar accuracy, and contrast enhancement contributed to the prediction accuracy of myocardial viability after myocardial infarction in 12 months of follow-up.

Značaj straina leve pretkomore u proceni srčane funkcije

Given the undeniable clinical and prognostic value, the function of the left atrium (LA) plays a leading role in the contemporary evaluation of cardiac diseases and is considered an essential morphological substrate for the development of cardiovascular diseases. It is sensitive to nervous, endocrine, and immunological stimuli. New evidence from the literature highlights the importance of fibrotic, electrical, and autonomic remodeling of the LA, introducing the concept of atrial cardiomyopathy, which is closely associated with atrial fibrillation and stroke. In the past, the diameter of the LA was the most important parameter for assessing its characteristics, but new information about the various roles of the LA has created the need for parameters that more precisely or thoroughly evaluate LA function. The function of the LA is complex, consisting of three phases: the reservoir phase (ventricular systole), the conduit phase (early diastole), and the pump phase (late diastole). The introduction of myocardial deformation analysis, or strain of the LA via speckle tracking, has achieved significant progress in detecting even subtle functional abnormalities before an increase in LA size. This method improves the diagnostic capabilities of standard echocardiographic examinations, and its diagnostic and prognostic value is sometimes comparable to more advanced and less accessible techniques such as cardiac magnetic resonance imaging and computed tomography.

Correlation between mitral valve area and left atrial function in rheumatic mitral valve stenosis patients.

Rheumatic heart disease (RHD) continues to be one of the leading causes of cardiovascular morbidity and mortality. The mitral valve frequently develops mitral stenosis (MS), and it is the most prevalent valve lesion in patients with chronic RHD. Left atrial (LA) functional impairment is associated with rheumatic MS. The aim of this study was to evaluate the association between LA function and mitral valve area (MVA) in rheumatic MS patients, and to assess the echocardiographic parameters in sinus rhythm and atrial fibrillation (AF) patients. This was a cross-sectional, descriptive study that involved patients with rheumatic MS. Patients underwent a standard 12-lead electrocardiogram and echocardiographic examination. MVA was assessed and correlated with LA function. Comparison was made between sinus rhythm and AF patients. Eighty-one patients with rheumatic MS were included in this study, with 71.6% of them having associated MR. MVA showed a statistically highly significant positive correlation with LA and right ventricular (RV) function, and a statistically significant/highly significant negative correlation with their dimensions. A higher percentage of patients with severe MS was in AF (58.1%). There was a positive correlation between LA function and MVA in rheumatic MS patients. AF was related to the severity of MS.

Elevated NT-proBNP predicts worse clinical outcome in patients after acute ischemic stroke

Abstract Background/introduction Elevated levels of NT-proBNP in ischemic stroke patients may indicate increased cardiac stress, which can be associated with poor outcome. However, clinical utility and cut offs are not completely known. Purpose We aimed to describe relation between NT-proBNP elevation with stroke severity and poor clinical outcome in patients after acute ischemic stroke (AIS). Methods Patients after AIS were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24 and 48 hours later to determine the plasma levels of NT-proBNP. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later. Standard echocardiographic examination was performed within the first 7 days of hospitalization if patients were eligible. Demographic characteristics, clinical data, functional outcome, and all-cause mortality were compared between groups according to NT-proBNP levels (NT-proBNP ≤ 125 pg/ml; &amp;gt;125 and ≤450 pg/ml; &amp;gt;450 pg/ml). National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital were used to assess stroke severity and clinical outcome. All analyses were performed with SPSS 29.0 (SPSS Inc). Results Between August 2020 and August 2022, 177 patients after AIS were enrolled. Elevated NT-proBNP &amp;gt;125pg/ml was observed in 82 patients (46,3%), 34 patients (19,2%) presented with NT-proBNP &amp;gt;450pg/ml. Most common comorbidities included arterial hypertension, dyslipidemia, type 2 DM and atrial fibrillation. In analysis, we observed a connection between elevated NT-proBNP with unfavorable outcome evaluated by mRS at 90 days (p&amp;lt;0.001) and with all-cause death at 30 days (P=0.001) and 90 days (P&amp;lt;0.001). Kaplan-Meier survival curve showed that all-cause mortality was significantly higher in patients with elevated NT-proBNP (P&amp;lt;0.001), however with no difference between elevation &amp;gt;125pg/ml and &amp;gt;450pg/ml (p=0.14). In survival analysis, there was close to significant association between patients who presented with elevated NT-proBNP&amp;gt;125pg/ml and &amp;gt;20% change in value comparing to those with elevated NT-proBNP without subsequent change &amp;gt;20%. Moreover, we observed a connection with stroke severity evaluated by NIHSS (p=0.005). In ECG analysis, we showed higher occurrence of T wave inversion (P&amp;lt;0.001), ST segment depression (P&amp;lt; 0.001) and QTc prolongation (P=0.003) in patients with elevated NT-proBNP. In multivariate regression analysis elevated NT-proBNP was associated with atrial fibrillation, high-sensitive troponin I elevation and age≥75 years. Conclusion The results show that elevated NT-proBNP is associated with stroke severity, unfavorable functional outcome, and short-term mortality in patients after acute ischemic stroke. Moreover, we described connection between NT-proBNP elevation and ECG changes.Kaplan Meier survival analysisAssociation worse outcome and severity

Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes

BackgroundCardiovascular involvement is one of the leading causes of mortality in systemic sclerosis (SSc) and is reported to be higher in men as compared with women. However, the cause of...

Insights Into the Standard Echocardiographic Views From Multimodality Imaging: Ventricles, Pericardium, Valves, and Atria

The widespread use of cardiac computed tomography and cardiac magnetic resonance imaging in patients undergoing echocardiography presents an opportunity to correlate the images side by side. Accordingly, the aim of this report is to review aspects of the standard echocardiographic examination alongside similarly oriented images from the two tomographic imaging modalities. It is hoped that this exercise will enhance understanding of the structures depicted by echocardiography as they relate to other structures in the thorax. In addition to reviewing basic cardiac anatomy, the authors take advantage of these correlations with computed tomography and cardiac magnetic resonance imaging to better understand the issue of foreshortening, a common pitfall in transthoracic echocardiography. The authors also highlight an important role that three-dimensional echocardiography can potentially play in the future, especially as advances in image processing permit higher fidelity multiplanar reconstruction images.

Prevalence of myocardial injury in patients after acute ischaemic stroke according to standard criteria.

This study examined the prevalence of acute and chronic myocardial injury according to standard criteria in patients after acute ischaemic stroke (AIS) and its relation to stroke severity and short-term prognosis. Between August 2020 and August 2022, 217 consecutive patients with AIS were enrolled. Plasma levels of high-sensitive cardiac troponin I (hs-cTnI) were measured in blood samples obtained at the time of admission and 24 and 48 h later. The patients were divided into three groups according to the Fourth Universal Definition of Myocardial Infarction: no injury, chronic injury, and acute injury. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later, and on the day of hospital discharge. A standard echocardiographic examination was performed within the first 7 days of hospitalization in patients with suspected abnormalities of left ventricular function and regional wall motion. Demographic characteristics, clinical data, functional outcomes, and all-cause mortality were compared between the three groups. The National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following hospital discharge were used to assess stroke severity and outcome. Elevated hs-cTnI levels were measured in 59 patients (27.2%): 34 patients (15.7%) had acute myocardial injury and 25 patients (11.5%) had chronic myocardial injury within the acute phase after ischaemic stroke. An unfavourable outcome, evaluated based on the mRS at 90 days, was associated with both acute and chronic myocardial injury. Myocardial injury was also strongly associated with all-cause death, with the strongest association in patients with acute myocardial injury, at 30 days and at 90 days. Kaplan-Meier survival curves showed that all-cause mortality was significantly higher in patients with acute and chronic myocardial injury than in patients without myocardial injury (P < 0.001). Stroke severity, evaluated with the NIHSS, was also associated with acute and chronic myocardial injury. A comparison of the ECG findings between patients with and without myocardial injury showed a higher occurrence in the former of T-wave inversion, ST segment depression, and QTc prolongation. In echocardiographic analysis, a new abnormality in regional wall motion of the left ventricle was identified in six patients. Chronic and acute myocardial injury with hs-cTnI elevation after AIS are associated with stroke severity, unfavourable functional outcome, and short-term mortality.

Spatial relationship between mitral valve and ventricular septum assessed by resting echocardiography to diagnose left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

Echocardiographic diagnosis of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) often requires extensive provocative manoeuvers. We investigated, whether echocardiography-derived parameters obtained at rest can aid to determine the presence of LVOTO in persons with HCM. Consecutive patients with HCM admitted to a referral centre underwent standardized transthoracic echocardiographic examination including provocative manoeuvers. Under resting conditions, the length of mitral leaflets and distances between mitral valve coordinates and ventricular walls were blindly measured in parasternal long axis (PLAX) and apical three-chamber (3ch) views, both at early and late systole. Among 142 patients (mean age 59 ± 13 years, 42% women), 68 (42%) had resting or provocable LVOTO with maximal LVOT gradients ≥30 mmHg. Late-systolic distance between mitral leaflet tip and ventricular septum (TIS) was measurable in 137 participants (96%) in 3ch view and independently associated with LVOTO in multivariable logistic regression analysis. The area under the ROC curve of TIS for the identification of LVOTO was 0.91 [95% confidence interval (CI) 0.87-0.96]. TIS ≤ 14 mm yielded 97% sensitivity and 57% specificity regarding LVOTO. TIS >14 mm ruled out LVOTO with a negative predictive value of 95%. TIS ≤9 mm ruled in LVOTO with a positive predictive value of 92% (sensitivity 73%, specificity 95%). Among 43 patients with TIS between 10 and 14 mm, 35% had LVOTO. In our study, the novel echocardiographic parameter TIS showed high negative and positive predictive values for LVOTO in HCM. These exploratory results await confirmation in larger collectives and prospective investigations.

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

BackgroundReference values for right ventricular function and pulmonary circulation coupling were recently established for the general population. However, normative values for elite athletes are missing, even though exercise-related right ventricular enlargement is frequent in competitive athletes.MethodsWe examined 497 healthy male elite athletes (age 26.1 ± 5.2 years) of mixed sports with a standardized transthoracic echocardiographic examination. Tricuspid annular plane excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Pulmonary circulation coupling was calculated as TAPSE/SPAP ratio. Two age groups were defined (18–29 years and 30–39 years) and associations of clinical parameters with the TAPSE/SPAP ratio were determined and compared for each group.ResultsAthletes aged 18–29 (n = 349, 23.8 ± 3.5 years) displayed a significantly lower TAPSE/SPAP ratio (1.23 ± 0.3 vs. 1.31 ± 0.33 mm/mmHg, p = 0.039), TAPSE/SPAP to body surface area (BSA) ratio (0.56 ± 0.14 vs. 0.6 ± 0.16 mm*m2/mmHg, p = 0.017), diastolic blood pressure (75.6 ± 7.9 vs. 78.8 ± 10.7 mmHg, p < 0.001), septal wall thickness (10.2 ± 1.1 vs. 10.7 ± 1.1 mm, p = 0.013) and left atrial volume index (27.5 ± 4.5 vs. 30.8 ± 4.1 ml/m2, p < 0.001), but a higher SPAP (24.2 ± 4.5 vs. 23.2 ± 4.4 mmHg, p = 0.035) compared to athletes aged 30–39 (n = 148, 33.1 ± 3.4 years). TAPSE was not different between the age groups. The TAPSE/SPAP ratio was positively correlated with left ventricular stroke volume (r = 0.133, p = 0.018) and training amount per week (r = 0.154, p = 0.001) and negatively correlated with E/E′ lat. (r = −0.152, p = 0.005).ConclusionThe reference values for pulmonary circulation coupling determined in this study could be used to interpret and distinguish physiological from pathological cardiac remodeling in male elite athletes.

Subclinical myocardial dysfunction in patients with complete recovery from peripartum cardiomyopathy: a long-term clinical strain-echocardiographic study

ABSTRACT Purpose The aim of this study was to assess long-term left ventricular (LV) systolic function using 3D speckle tracking echocardiography in patients with complete LV recovery following peripartum cardiomyopathy (PPCM). Methods A total of 20 PPCM patients who exhibited LV recovery (ejection fraction ≥50%) in the follow-up period and 20 age-matched, healthy women were included in the study. Standard 2D echocardiographic examinations were performed. Global longitudinal strain and global circumferential strain were analyzed. Results Age, weight, body surface area, smoking, heart rate, and systolic and diastolic blood pressure were similar in both groups. Echocardiographic examination showed no significant difference between both groups. Only the global longitudinal strain (18.1 ± 2.7 vs 20.16 ± 1.7, p = 0.02) and global circumferential strain (22.1 ± 2.9 vs 24.4 ± 1.19, p = 0.01) were significantly lower in PPCM patients. The lowest values for longitudinal strain belonged to the basal and mid regions of anterior, anteroseptal and lateral walls in the PPCM patients. Conclusion Subclinical myocardial damage may persist in PPCM patients with full LV systolic recovery. 3D Speckle Tracking strain analysis is a useful method for detecting subtle myocardial dysfunction.

Is left ventricular function reduced after ultra-endurance exercise?

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Norwegian Health Association Introduction Ultra-endurance exercise can be harmful according to previous studies, indicated by reduction in functional parameters and increase in cardiac biomarkers. Changes in load and heart rate with exercise influence left ventricle systolic function, making assessment of standard echocardiographic examination difficult. Purpose We investigated the effect of ultra-endurance exercise on myocardial function acutely and at restitution. Methods We investigated 10 participants aged 46 ±7 years, before (baseline), within 142 ± 78 minutes after finish (post run) and 5-10 days after (restitution) an ultra-endurance race (3.8 km swimming, 180 km bicycling and 42 km running with a total elevation of 5200 m). Echocardiography was performed at the three time points, including cardiac morphology and -function. Ejection fraction (EF) and stroke volume (SV) were measured by Simpson biplane. Cardiac output was calculated from SV and heart rate (HR). Cardiac power was calculated as the product of CO, mean arterial blood pressure and the conversion factor to Watt (W) 0.00222. Global longitudinal strain (GLS) was calculated using speckle-tracking echocardiography, and myocardial work was calculated by non-invasive pressure-strain analysis. Results Acutely after exercise, myocardial function by GLS (p = 0.002), myocardial work (p &amp;lt; 0.001), mitral annular plane systolic excursion (MAPSE, p = 0.003) and EF (p = 0.004) were substantially reduced compared to baseline, whereas cardiac power and cardiac output (CO) were maintained (see table and figure). Heart rate was moderately increased (p &amp;lt; 0.001). End-diastolic volume (EDV) as an index of preload was numerically, but not significantly reduced. End systolic volume (ESV) was numerically increased (p = NS) even though systolic blood pressure (sBP) was reduced (p = 0.01) post race. After restitution all parameters returned to baseline levels. Conclusions The temporary reduced strain and EF may be a physiologic response due to the higher heart rate. However, despite reduced systolic pressure the heart did not contract to a lower end systolic volume. This suggests loss of contractile function compensated by increase in heart rate. The findings should be explored in further studies. Abstract Figure Abstract Table

156 Rivaroxaban in very elderly patients with atrial fibrillation

Abstract Aims The incidence of atrial fibrillation (AF) increases with age. The risk of stroke is increased 4- to 5-fold in old patients with AF. In the Framingham Study, 23.5% of strokes in patients aged 80 and older were attributable to AF. Advanced age is also associated with a progressive increase in the risk of major bleeding in subjects ≥85 years, particularly if treated by oral anticoagulants (OAC). Only 20% of patients &amp;gt;75 years were included in randomized controlled trials (RCTs) involving OACs in AF, due to the high risk of falls and bleeding, especially intracranial haemorrhage (ICH). The management of anticoagulation in the very elderly represents a challenging issue because they are at high thromboembolic risk, and also at high haemorrhagic risk. The aim of our study was to describe the use and tolerability of rivaroxaban in very old patients with heart failure with reduced ejection fraction. The average age of enrolled patients is 76.0 ± 8.4 years with a significant prevalence of the elderly (16.0% with age ≥85 years with a slight male prevalence). Methods We analysed retrospective data from 50 patients from June 2016 to June 2018 and taking rivaroxaban 20 mg. The average age of enrolled patients was 76 ± 8.2 years and 40% were females. The inclusion criteria were patients with at least one episode of documented AF of any duration in the preceding 12 months. The average CHA2DS2-VASc of these subjects is 3.2 ± 1.4, while the haemorrhagic risk expressed by the HAS-BLED appears more contained (2.7 ± 1.1). The risk profile of these patients was complex as documented by an older age, by a CHA2DS2-VASc higher and by the prevalence of comorbidities such as heart failure, valvular disease, peripheral vasculopathy and diabetes mellitus. Follow-up, characterized by clinical examination and blood analysis, was performed at 3, 6, and 12 months. The AF patients were followed for the effectiveness outcome of thromboembolism (ischaemic stroke and/or systemic embolism) and bleeding outcomes (composite of major bleeding, gastrointestinal bleeding, and intracranial Haemorrhage), as well as bleeding requiring hospitalization. A secondary safety endpoint was total minor bleedings. Standard two-dimensional transthoracic echocardiographic examination was performed. Left ventricular end-diastolic volume, end-systolic volume, and ejection fraction (LVEF) were measured using the modified Simpson’s rule from the apical view. Results During follow-up, we observed no major bleedings, strokes, or cardiovascular deaths. Only two minor haemorrhages (one epistaxis and one haematuria, none of which required blood transfusion or hospital admission) observed with no differences observed in LVEF or left atrial dimension at echocardiography, body mass index, and the thrombotic and haemorrhagic risk profile. Conclusions Such data confirm that the new oral anticoagulants, and in particular rivaroxaban, are considered safe even in the most population frail and above all elderly, allowing for enlargement the use of anticoagulant therapy. Results are expected of long-term follow-up to confirm the benefits of that therapeutic choice.

Assessment of intracardiac flow dynamics for the evaluation of patients with different ventricular geometry

Abstract Background Over the last decades growing evidence have demonstrated the promising role of intracardiac flow dynamic analysis in evaluating cardiac performance. Diastolic forces contribute to the formation of vortices, complex structures capable of kinetic energy storage and responsible of a smoother transition of blood from left ventricular (LV) inlet to outlet. Change in shape and location of these structures has been related with cardiovascular disease and prognosis. Purpose To investigate quantitative changes in vortices parameters in patients with different ventricular geometry. Methods We enrolled 72 consecutive patients (age 66±11 years, 49 male, 68%) with LV concentric hypertrophy (CH, n=15), eccentric hypertrophy (EH, n=13), concentric remodeling (CR, n=15) and normal LV geometry (CTRL, n=29). Each patient underwent a complete echocardiographic examination and a non-invasive intracardiac fluid dynamic analysis by Color Vector Flow Mapping. A 3-chamber apical view with a frame rate between 22 and 25 Hz has been acquired and subsequently analyzed offline by a semi-automatic software obtaining the following parameters: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Bland Altman Plot has been used to assess intra and inter-observer variability. Results Mean VD was higher in CR, CH and EH compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). Moreover, CH showed higher VL (p=0.006) and larger VA (p=0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (p=0.21 and p=0.07 for VA and VL respectively). No significative differences in vortices parameters have been observed between CH and EH. Conclusion(s) This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Higher values of VD were found in CR, CH and EG. Quantitative intra dynamic fluid assessment was feasible and reliable in the whole population and could provide additional information to the standard echocardiographic examination. Funding Acknowledgement Type of funding sources: None.

Left atrial strain - a current clinical perspective.

The speckle-tracking technique has become an easily accessible, quick-to-use, and straightforward tool for assessing advanced myocardial function. Achievements in the analysis of the left atrium have demonstrated that it plays an important role in the physiology and pathophysiology of the circulatory system. Deformation analysis allows the detection of even subtle functional abnormalities when atrial enlargement is not yet detected. Thus, left atrial strain has a documented diagnostic and prognostic value in many clinical scenarios. Furthermore, this technique is increasingly entering routine clinical practice. The analysis becomes possible thanks to new tools that simplify the speckle-tracking assessment. Left atrial strain improves diagnostic possibilities of standard echocardiographic examination, and its diagnostic and prognostic value is sometimes comparable with more advanced and less available techniques. In this review, we discuss the principles of performing strain analysis and the results of current research, and thus the potential possibilities of sophisticated atrial assessment application in various clinical scenarios.

Triglyceride-Glucose Index Independently Predicts New-Onset Atrial Fibrillation After Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy Beyond the Traditional Risk Factors.

The triglyceride–glucose index is a valuable marker of insulin resistance. However, the predictive value of this index for postoperative atrial fibrillation in patients undergoing septal myectomy remains unclear. A total of 409 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were recruited in this study. The triglyceride–glucose index was calculated for all patients preoperatively. All patients underwent clinical data collection, blood sampling, and standard echocardiographic examinations during hospitalization. The prevalence of postoperative atrial fibrillation was approximately 15% in the present study. Multivariate logistic regression revealed that age (odds ratio [OR]: 1.053, 95% CI: 1.016–1.090, P = 0.004), hypertension (OR: 2.399, 95% CI: 1.228–4.686, P = 0.010), left atrial diameter (OR: 1.101, 95% CI: 1.050–1.155, P < 0.001), and triglyceride–glucose index (OR: 4.218, 95% CI: 2.381–7.473, P < 0.001) were independent risk factors for postoperative atrial fibrillation in patients undergoing septal myectomy. In receiver operating characteristic curve analysis, the triglyceride–glucose index could provide a moderate predictive value for postoperative atrial fibrillation after septal myectomy 0.723 (95% CI: 0.650–0.796, P < 0.001). Moreover, adding the triglyceride–glucose index to conventional risk factor model could numerically but not significantly increase our ability to predict postoperative atrial fibrillation (area under the receiver: 0.742 (0.671–0.814) vs. 0.793 (0.726–0.860), p = 0.065) after septal myectomy. In our retrospective cohort study, the triglyceride–glucose index was identified as an independent predictor of postoperative atrial fibrillation in patients undergoing septal myectomy.

Age-changes in right ventricular function-pulmonary circulation coupling: from pediatric to adult stage in 1899 healthy subjects. The RIGHT Heart International NETwork (RIGHT-NET).

The present study analyzes age-specific changes in RV function and RV-PA coupling in a large cohort of apparently healthy subjects with a wide age-range, to identify reference values and to study the influence of clinical and echocardiographic cofactors. 1899 Consecutive healthy subjects underwent a standardized transthoracic echocardiographic examination. Tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Ventriculo-arterial coupling was then inferred from the TAPSE/SPAP ratio. A quantile regression analysis was used to estimate quantiles 0.05, 0.10, 0.50 (median), 0.90, and 0.95 of TAPSE, SPAP and TAPSE/SPAP. The association between age and each of these values was determined. The mean age of the group was 45.2 ± 18.5years (range 1 to 102years), 971 were males. SPAP increased with age, whereas TAPSE and TAPSE/SPAP ratio decreased. Upon multivariate modeling, the most significant positive associations for TAPSE were body surface area (BSA) driven by the pediatric group, stroke volume (SV), E/A and negatively heart rate and E/e' ratio. SPAP was positively associated with increasing age, SV, E/A, E/e' and negatively with BSA. TAPSE/SPAP ratio was negatively associated with age, female sex, and E/e' and positively with BSA. A preserved relationship between TAPSE and SPAP was found across the different age groups. TAPSE, SPAP and TAPSE/SPAP demonstrate important trends and associations with advancing age, impaired diastolic function, affected by female sex and BSA However the relationship between TAPSE and SPAP is relatively well preserved across the age spectrum.

Effect of aerobic exercise on physiological and left ventricular echocardiographic characteristics of non-athletic adult males in northern Ethiopia.

Regular aerobic exercise can induce alterations in structural and hemodynamic physiology of the heart in both athletic and nonathletic populations. This is because due to cardiac adaptation to exercise improves cardiac workout capacity by increasing left ventricular function. The aim of the present study was to examine the effect of aerobic exercise on blood pressure and left ventricular structural and myocardial function in Ethiopian non-athletic males. Twenty male adults (aged 19-23 years) were recruited and they were engaged in aerobic exercise training for 3 months (3 days/week, 50-75%MHR). Selected participants underwent standard transthoracic doppler echocardiographic examinations before and after intervention of the exercise training. Collected data were analyzed through Paired Sample T test using IBM SPSS version 21 statistical software with significance level set at P<0.05. Finding of the study indicated that significant reduction in systolic and diastolic blood pressure was observed after exercise training (P<0.05). Improvement was recorded in PWT (7.4±0.94 mm vs. 7.95±0.61 mm, P=0.017) and IVST (7.95±0.83mm vs 8.25±0.72 mm, P=0.030) while significant reduction was recorded in LVIDS (33.85±0.99 mm vs. 32.45±2.04 mm, P=0.002). Aerobic exercises also induced significant improvement on left ventricular myocardial function parameters (P<0.05) in end diastolic volume (95.8±8.4 mL vs. 100.45±11.42 mL), stroke volume (52.55±7.12 mL vs. 58.15±11.18 mL) and ejection fraction (54.73±4.11 vs. 57.53±6.2). However, exercise didn't stimulate significant change in the internal diameter at end diastole (0.086), end systolic volume (P=0.173) and cardiac output (P=0.13). Aerobic exercise induces structural and myocardial physiological changes within the left ventricle in Ethiopian non-athletic young adult males.

Associations of excess myocardial mass, echoreflectiveness and aldosterone synthase gene polymorphism in men with hypertension

Hypertensive remodeling of the left ventricle (LV) is largely due to the influence of a number of control genes. In particular, the regulatory gene CYP11B2, which is responsible for the activity of aldosterone in blood plasma, affects the processes of cardiomyocyte hypertrophy, myocardial fibrosis and microcirculation. This study is devoted to the search for the effect of polymorphic aldosterone synthase carriers on the severity of the components of left ventricular hypertrophy in men with essential hypertension (EH) and representatives of the control group, residents of Podyllia region. The aim of the study was to determine associations between excess (inappropriate) myocardial mass, parameters of standard echocardiography and parameters of echoreflectivity in men with essential hypertension, carriers of different polymorphic variants of aldosteronesynthase gene. The study involved 150 men, aged 45-60 years, residents of the Podyllia region, who had no irreversible damage of target organs. Among them, 50 were in the control group, 58 – had EH of 1st stage and 42 men had EH of 2nd stage. All participants were measured for office blood pressure, performed a standard echocardiographic examination with the addition of standard EchoCG protocol by determination of the parameters of echoreflectivity and evaluation of appropriateness of left ventricular l mass (LVM) to hemodynamic load, according to the formula de Simone et al. and calculating the excessiveness ratio (ER) and determined the C-344T polymorphism of the CYP11B2 gene in venous blood samples by PCR. Statistical processing of the obtained results is performed using a specialized statistical application “Statistica 12.0”. It was found that the prevalence of CC polymorphism of the CYP11B2 gene in men with inappropriate LVM was almost twice higher than in men with appropriate to hemodynamic load LVM (p=0.015 by criterion χ2). At the same time, men with inappropriate LVM were characterized by higher values of echoreflectivity parameters BB and mCSV. In contrast to patients of the control group and patients with EH of 1st stage, patients with EH of 2nd stage, actual LVM (287.4 (53.9) g) significantly (p&lt;0.001) exceeded the predicted values (189 (37.8) g). According to the results of Spearman's rank correlation analysis, it was found that the carrier of the CC genotype of aldosterone synthase gene is associated with higher values of the LVM ER. Thus, patients carrying the polymorphic CC variant of CYP11B2 gene are characterized by more pronounced cardiomyocyte hypertrophy, greater excess of LV mass relative to individual hemodynamic needs, more aggressive processes of myocardial fibrosis.