Strain Rate Echocardiography Research Articles

Evaluation of cardiac function in paediatric Wilson's disease patients with advanced echocardiographic modalities (strain and strain rate echocardiography).

In Wilson's disease (WD), copper accumulation in the organs and/or damage caused by oxygen free radicals occurs due to disturbances in copper excretion. In our study, we aimed to evaluate cardiac involvement with advanced echocardiographic modalities (tissue Doppler echocardiography, strain and strain-rate echocardiography). Twenty WD patients and 20 healthy children from the Pediatric Gastroenterology Department of Diyarbakır Children's Hospital were included in the study between 2022 and 2023. The mean age of the WD patients was 12.89 ± 3.79 years. Left ventricular wall thicknesses and diameters (diastolic interventricular septum thickness, diastolic left ventricular posterior wall thickness, left ventricular end-diastolic diameter), left ventricular diastolic function parameters (E, A, E/A, deceleration time) and left ventricular ejection fraction and tricuspid annular plane systolic excursion were similar and not statistically significantly different in the WD and control groups. Mitral lateral e', mitral septal e' and tricuspid lateral e' velocities were lower in the WD patients and statistically significantly different from the controls (p = 0.02, 0.04 and 0.005, respectively), as assessed by tissue Doppler echocardiography. Global longitudinal systolic strain was similar in the WD and control groups and no statistically significant difference was detected. Longitudinal early diastolic strain rate was lower in the WD patients and statistically significantly different (p = 0.002). Subclinical early diastolic dysfunction and segmental systolic dysfunction were detected in WD patients with advanced echocardiographic modalities, in addition to normal cardiac function as assessed by conventional echocardiography. Advanced echocardiographic modalities can be used in the follow up of WD patients.

Assessment of Left Ventricular Functions With Strain and Strain Rate Echocardiography in Children with Duchenne Muscular Dystrophy

Ozet Amac: Calismamizda konvansiyonel ekokardiyografi ile kalp fonksiyonlari normal bulunan Duchenne Muskuler Distrofili (DMD) hastalarin miyokard fonksiyonlarinin pulse wave doku doppler goruntuleme (PWDDG) ve strain/strain rate (S/SR) ekokardiyografi araciligiyla olculmesi ve kontrol grubu ile karsilastirilmasi amaclandi. Materyal ve Metod: Bu calismada; ortalama yasi 85,2 ± 38,4 ay olan 32 DMD’li erkek hasta ve 89 ± 38,9 ay olan 31 saglikli cocuk degerlendirildi. Demografik ozellikler olgular ve kontrol grubunda degerlendirildi. Cinsiyet, yas, vucut kitle indeksi, konvansiyonel ekokardiyografi verileri, pulse wave doku Doppler goruntuleme (PW-TDI) verileri ve iki boyutlu (2D) longitudinal strain (LS) / longitudinal strain rate (LSR) ekokardiyografi degerleri karsilastirildi. Bulgular: Hasta ve kontrol gruplari arasinda kalp hizi bakimindan istatistiksel olarak anlamli fark saptandi (p<0.001) ve DMD’li grupta kalp hizi daha yuksekti. Ventrikuler septumda bazal olcumlerinde E m , S amplitudu, izovolumetrik relaksasyon zamani (IVRZ), miyokard performans indeksi (MPI) bakimindan istatistiksel yonden anlamli fark saptanirken (p<0,05), sol ventriku serbest duvar bazalindeki olcumlerde de E m , S amplitudu ve IVRZ bakimindan istatistiksel yonden anlamli fark bulundu (p<0,05). Sol ventrikulun serbest duvar bazalindeki strain ve strain rate degerlerinde DMD’ligrup ve kontrol grubu arasinda istatistiki yonden anlamli fark saptandi (p<0.001). Yapilan apikal dort bosluk pozisyondaki global strain degerlerinde DMD’li grup ve kontrol grubu arasinda istatistiki yonden anlamli fark saptandi ( p<0,001). Sonuc: Transtorasik ekokardiyografide normal aralik icinde sol ventrikul sistolik fonksiyon saptanan DMD'li asemptomatik hastalarda kontrol grubu ile karsilastirildiginda sol ventrikul anterolateral duvarinda LS ve LSR degerleri anlamli olarak dusuk bulundu. Anahtar kelimeler: Longitudinal strain, longitudinal strain rate, Duchenne muskuler distrofi Abstract Aim: The goal of our study was to detect the left ventricular functions of duchenne muscular dystrophy ( DMD) patients using , pulsed-wave tissue Doppler imaging (PW-TDI, longitudinal strain (LS) and longitudinal strain rate (LSR ) echocardiography who had normal left ventricular functions in standart echocardiography before, and to match them with the results of the control group. Material and Methods: In this study compared 32 boys with DMD whose mean age was 85.2 ± 38.4 months were matched with 31 healthy males whose mean age was 89.0 ± 38.9 months. The following demographic features were assesed in both DMD patients and controls: gender, age, body mass index, standard echocardiography parameters, pulsed-wave tissue Doppler imaging (PW-TDI) findings, and two-dimensional (2D) LS/LSR echocardiography measurements. Results: Asymptomatic boys with DMD were established to have high heart rate (p<0.001). In the calculations performed from the base of the ventricular septum, statistically considerable differences were determined between the Em, S amplitude and isovolumetric relaxation time (IVRT), myocard performance index (MPI) values of the two groups (p<0.05). In the evaluates made from the base of the left ventricular free wall, Em, S amplitude and IVRT, MPI values were demonstrated to be more considerably different (p<0.05). The results of the LS and LSR measurements done from the base of the left ventricular free wall were considerably different between DMD and control group (p<0.001), and in the global strain measurement performed from the four chamber apical position, considerable distinction was noted between the two groups (p<0.001). Conclusion: In patients with DMD in whom standart echocardiography had assesed left ventricular systolic function within the normal range showed significantly lower LS and LSR values at the left ventricular anterolateral wall compared with the control group. Keywords: Longitudinal strain, longitudinal strain rate, duchenne muscular dystrophy,

Early alterations in lv systolic and diastolic function in patients with type 2 diabetes mellitus using strain and strain rate echocardiography

Early alterations in lv systolic and diastolic function in patients with type 2 diabetes mellitus using strain and strain rate echocardiography

Evaluation of the effect of percutaneous mitral balloon valvuloplasty on left ventricular systolic functions using strain and strain rate echocardiography

Background/aimThis study aimed to evaluate the effect of successful percutaneous mitral balloon valvuloplasty (PMBV) on left ventricular systolic functions using strain and strain rate echocardiography in moderate–severe mitral stenosis (MS) patients with normal left ventricular systolic function confirmed by conventional echocardiography. Materials and methodsPatients with moderate–severe MS who had undergone successful PMBV were included. Conventional echocardiographic parameters were evaluated before and after PMBV. Peak systolic strain and strain rate values of basal, mid, and apical segments of the left ventricular anterior, inferior, septum, and lateral walls were determined. ResultsAfter PMBV, significant decreases were determined in the peak and mean gradients of the mitral valve and pulmonary artery pressure, but a significant increase in the mitral valve area. Significant increases (improvement) were determined in the peak systolic strain and strain rate in the basal, mid, and apical segments of the left ventricular septum, lateral, anterior, and inferior walls and in the left ventricular global peak systolic strain (–17.32 ± 0.58% vs. –12.38 ± 1.06%) and strain rate (–1.65 ± 0.07 vs. –1.22 ± 0.12). ConclusionStrain and strain rate echocardiography can be used for quantitative evaluation of the effect of PMBV on the left ventricular systolic functions in moderate–severe MS patients.

Strain and strain rate echocardiography variables in adult Wilson's disease patients: A speckle tracking echocardiography study.

Although the hepatic and neurological consequences of Wilson's disease (WD) have been investigated in detail, its cardiac involvement remains little studied. Our aim was to investigate potential cardiac differences in strain (ST) and strain rate (STR) echocardiography in adult WD patients compared with controls. We included 30 patients with WD and a control group of 26 sex and age matched healthy adults. None of the subjects in either group had cardiac complaint. WD patients were clinically evaluated by a neurologist and undergone cranial magnetic resonance imaging. They were then divided into two groups according to the presence (NW) or absence (non-NW) of neurological involvement. Standard and advanced speckle tracking echocardiographic evaluations were performed in each group according to guidelines. Left ventricular (LV) systolic and diastolic diameters and wall thickness measurements were within normal limits and did not differ significantly between the groups (P > .05). Neither atrial peak longitudinal and circumferential ST variables nor LV global and longitudinal ST and STR variables showed significant differences between the NW, the non-NW, and the control group (P > .05). Our echocardiographic study showed no detectable difference between adult WD patients with or without neurological involvement and healthy subjects.

Asemptomatik Ankilozan Spondilitli Olgularda Sol Ventrikül Fonksiyonlarının Değerlendirilmesinde Doku Doppler, Strain ve Strain Rate Ekokardiyograf

Asemptomatik Ankilozan Spondilitli Olgularda Sol Ventrikül Fonksiyonlarının Değerlendirilmesinde Doku Doppler, Strain ve Strain Rate Ekokardiyograf

Evaluation of Left Ventricular and Left Atrial Functions with Strain and Strain Rate Echocardiography in Patients with Nondipper and Dipper Hypertension

Evaluation of Left Ventricular and Left Atrial Functions with Strain and Strain Rate Echocardiography in Patients with Nondipper and Dipper Hypertension

Assessment of left ventricular functions by strain and strain rate echocardiography in asymptomatic type II diabetic patients

Background and aim The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eye, kidneys, heart and blood vessels, as treatment to reverse this disorder is more likely to be effective at an early (preclinical) stage, defining the mechanism of diabetic cardiomyopathy may be important to its selective treatment. Aim to assess the left ventricle (LV) function using tissue Doppler (TD) strain and strain rate imaging to detect early LV functions affection in type II diabetic patients without overt heart disease. Patients and methods the study included 60 persons presented in Al Azhar University (Asyut branch) Hospital in the period between November 2014 and January 2016. Were divided into two groups: group (1): 30 diabetic patients with normal (ejection fraction) EF and normal coronaries, group (2): 30 individual without diabetes mellitus (DM) with normal EF as a control group. The following was done for the two groups: 1. Complete History taking and complete general and cardiac clinical examination, resting 12 leads electrocardiography (ECG). 2. Laboratory investigation to diagnose diabetes and the control of the disease. 3. Transthoracic echo examination: 4. TD Strain and strain rate of the LV. Results In comparison between group (1) and group (2) the LV strain and strain rate was found to be significantly lower in group (1) as compared to group (2). Among group I, duration of DM was significantly correlated with decreased strain rate in posterior septum only. There was no correlation between methods of control and the degree of control and the impairment of strain and strain rate. From the present study we found that left ventricular strain and strain rate by conventional echo could reveal the presence of subclinical diabetic cardiomyopathy. Conclusions Type 2 DM deteriorates both LV systolic and diastolic performance. Diabetic patients showed some changes in strain and SR of LV walls at rest especially when the duration of diabetes increased. Strain and SR by TD is superior to conventional Doppler in early detection and evaluation of systolic and diastolic dysfunction in type 2 diabetic patients.

Role of Two Dimension Strain and Strain Rate Echocardiography in Assessment of Rheumatic Mitral Valve Stenosis

Introduction: Current echocardiographic parameters have a limitation in assessing mitral valve (MV)apparatus in rheumatic mitral stenosis (MS) patient. In the current study, we use 2 dimensional (2D)longitudinal strain (S) and strain rate (Sr) imaging in evaluating the papillary muscle longitudinal strain (LS) as an objective and quantitative echocardiographic parameter with high reproducibility in the assessment of MV apparatus in patients with mild to moderate rheumatic MS with preserved ejection fraction (EF%). Patients and Method: The study included 40 patients with established diagnosis of MS subdivided in to 31 patients with moderate MS (mean age: 32 ± 5) and 9 patients with mild MS (mean age: 31 ± 6). 20 healthy individuals (mean age 31 ± 6) as a control for cases. The mitral valve area (MVA) was estimated using planimetry and pressure half time (PHT) methods. 2D longitudinal systolic S and Sr imaging was carried out for all participants from the apical long axis (LAX), 4 chamber (4C), 2 chamber (2C) views. Global longitudinal systolic S and Sr were estimated by averaging the 3 apical views. Longitudinal myocardial strain of papillary muscle PMs was assessed by the use of the free strain method from apical 4 chamber view for the antrolateral papillary muscle (APM) and apical long axis view for postromedial papillary muscle (PPM). Results: Patients with MS had significantly decreased longitudinal LV systolic S and Sr in comparison with control group (p Conclusion: Patients with MS and preserved EF% had decreased APM-LS & PPM-LS in comparison with control group, and had decreased longitudinal LV systolic S and Sr when compared with control group. 2D strain as well as Sr imaging might be a useful method for assessment of mitral valve apparatus in patients with MS & preserved EF%.

Echocardiographic right ventricular deformation indices before and after atrial septal defect closure: A scomparison between device and surgical closure

Background: Secundum atrial septal defects (ASD2) are one of the most common congenital disorders in children which includes about 10%–20% of congenital heart defects. In recent years, closure of secundum ASD percutaneously has been proposed to reduce mortality, morbidity, and become the standard method in both pediatric and young adults. The aim of this study was to determine the right ventricular (RV) function by strain and strain rate echocardiography parameters in children who underwent surgically versus percutaneous ASD2 device closure. Methods: In this cohort study, all children underwent ASD2 treatment from May 2014 to April 2016 were enrolled in this study. Echocardiography was performed 24 h after transcatheter closure and 3 days after surgical closure. MyLab 60 echo machine (Esoate, Florance, Italy) equipped with a multi-frequency 5 MHz transducer was used, and all echocardiographic data were collected by same pediatric cardiologist. All demographic characteristics and echocardiography indices were compared using SPSS version 18 between two groups. Results: Thirty-six patients (63.2%) were treated by the transcatheter closure and 21 (36.8%) underwent surgery. Longitudinal RV strain (S), longitudinal RV strain rate (S'), and early diastolic longitudinal RV strain rate (E') were improved significantly in device patients in comparison with surgical patients (P 0.05). However, tricuspid valve annular diameter was significantly decreased in patients who underwent ASD percutaneous device closure in comparison with a surgical group (P = 0.004). Conclusion: The results of this study showed that percutaneous ASD2 device closure will results in better RV function in comparison to surgical closure

Predictors of transient left ventricular dysfunction following transcatheter patent ductus arteriosus closure in pediatric age

ObjectivesTo evaluate the left ventricular function before and after transcatheter percutaneous patent ductus arteriosus (PDA) closure, and to identify the predictors of myocardial dysfunction post-PDA closure if present. InterventionsTranscatheter PDA closure; conventional, Doppler, and tissue Doppler imaging; and speckle tracking echocardiography. Outcome measuresTo determine the feasibility and reliability of tissue Doppler and myocardial deformation imaging for evaluating myocardial function in children undergoing transcatheter PDA closure. Patients and methodsForty-two children diagnosed with hemodynamically significant PDA underwent percutaneous PDA closure. Conventional, Doppler, and tissue Doppler imaging, and speckle-derived strain rate echocardiography were performed at preclosure and at 48hours, 1month, and 6months postclosure. Tissue Doppler velocities of the lateral and septal mitral valve annuli were obtained. Global and regional longitudinal peak systolic strain values were determined using two-dimensional speckle tracking echocardiography. ResultsThe median age of the patients was 2years and body weight was 15kg, with the mean PDA diameter of 3.11±0.99mm. M-mode measurements (left ventricular end diastolic diameter, left atrium diameter to aortic annulus ratio, ejection fraction, and shortening fraction) reduced significantly early after PDA closure (p<0.001). After 1month, left ventricular end diastolic diameter and left atrium diameter to aortic annulus ratio continued to decrease, while ejection fraction and fractional shortening improved significantly. All tissue Doppler velocities showed a significant decrease at 48hours with significant prolongation of global myocardial function (p<0.001) and then were normalized within 1month postclosure. Similarly, global longitudinal strain significantly decreased at 48hours postclosure (p<0.001), which also recovered at 1month follow-up. Preclosure global longitudinal strain showed a good correlation with the postclosure prolongation of the myocardial performance index. ConclusionTranscatheter PDA closure causes a significant decrease in left ventricular performance early after PDA closure, which recovers completely within 1month. Preclosure global longitudinal strain can be a predictor of postclosure myocardial dysfunction.

Could the Size of Ductus Arteriosus be an Independent Predictor for the changes in Left Ventricular Function Post Percutaneous closure! Evaluation by Tissue Doppler and Speckle-derived Strain Rate Echocardiography

Aim: Evaluate the changes of left ventricular (LV) systolic and diastolic function in children after percutaneous closure of patent ductus arteriosus (PDA) and to correlate these changes in relation to the size of the ductus. Methods: 30 children provisional diagnosed with PDA and planned for percutaneous trans-catheter PDA closure. Conventional 2D, Doppler and tissue Doppler imaging (TDI) and speckled-derived strain rate echocardiography were obtained pre-closure, early (I day), and late (1 month) post-PDA closure. Results: Mean age was 26.0 ± 32.17 months (9 male and 21female). The mean PDA diameter was 3.11 ± 1.09 mm. Ejection fraction (EF) and fractional shortening (FS)significant reduced in the day after PDA closure compared with pre closure status (P<0.05), then improved significantly after one month compared with early post- closure measures(p<0.05),but no significant change when compared with pre-closure measure, (P>0.05). There is a negative correlation between the PDA size and changes in left ventricular diastolic dimensions, EF and FS early after PDA closure. Significant reduction in both early and late mitral diastolic flow velocities (EM and AM) after PDA closure (both one day and one month) ,early tissue Doppler velocity of lateral mitral annulus (E`lateral) significant decrease early after PDA closure(P<0.05), but one month after closure E` lateral significantly increased.(P=0.03), EM/E` lateral had a significant reduction in one month after closure compared with pre-closure and early post–closure (P=0.001). There was a significant decrease in global and regional longitudinal strain at early after PDA closure (P=0.001), although there was a significant improvement in all measures in the subsequent one month after closure. Conclusion: Size of PDA considered as an independent predictor for the acute decrease in left ventricular function early after PDA closure which recovers completely within one month.

Strain and strain rate echocardiography in children with Wilson's disease.

SummaryObjectiveThis study aimed to evaluate strain and strain rate echocardiography in children with Wilson’s disease to detect early cardiac dysfunction.MethodsIn this study, 21 patients with Wilson’s disease and a control group of 20 age- and gender-matched healthy children were included. All the patients and the control group were evaluated with two-dimensional (2D) and colour-coded conventional transthoracic echocardiography by the same paediatric cardiologist using the same echocardiography machine (Vivid E9, GE Healthcare, Norway) in standard precordial positions, according to the American Society of Echocardiography recommendations. 2D strain and strain rate echocardiography were performed after the ECG probes of the echocardiography machine were adjusted for ECG monitoring. Longitudinal, transverse and radial strain, and strain rate were assessed from six basal and six mid-ventricular segments of the left ventricle, as recommended by the American Society of Echocardiography.ResultsLeft ventricular wall thickness, systolic and diastolic diameters, left ventricular diameters normalised to body surface area, end-systolic and end-diastolic volumes, cardiac output and cardiac index values were within normal limits and statistically similar in the patient and control groups (p < 0.05).Global strain and strain rate: the patient group had a statistically significant lower peak A longitudinal velocity of the left basal point and peak E longitudinal velocity of the left basal (VAbasR) point, and higher global peak A longitudinal/circumferential strain rate (GSRa) compared to the corresponding values of the control group (p < 0.05).Radial strain and strain rate: end-systolic rotation [ROT (ES)] was statistically significantly lower in the patient group (p < 0.05). Longitudinal strain and strain rate: end-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain (STSR peak P) were statistically significantly lower in the patient group (p < 0.05).Segmental analysis showed that rotational strain measurement of the anterior and lateral segments of the patient group were statistically significantly lower than the corresponding values of the control group (p < 0.05). Segmental analysis showed statistically significantly lower values of end-systolic longitudinal strain [STSR (ES)] of the basal lateral (p < 0.05) and end-systolic longitudinal strain [SLSC (ES)] of the basal septal segment (p < 0.05) in the patient group.End-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain (STSR peak P) were statistically significantly lower in the patient group (p < 0.05). Segmental analysis showed statistically significantly lower values of endsystolic longitudinal strain [SLSC (ES)] of the mid-anterior and basal anterior segments (p < 0.05), end-systolic longitudinal strain [STSR (ES)] measurements of the posterior and mid-posterior segments, end-systolic longitudinal displacement [DLDC (ES)] of the basal posterior, mid-posterior and mid-antero-septal segments in the patient group.ConclusionCardiac arrhythmias, cardiomyopathy and sudden cardiac death are rare complications but may be seen in children with Wilson’s disease due to copper accumulation in the heart tissue. Strain and strain rate echocardiography is a relatively new and useful echocardiographic technique to evaluate cardiac function and cardiac deformation abnormalities. Our study showed that despite normal systolic function, patients with Wilson’s disease showed diastolic dysfunction and regional deformation abnormalities, especially rotational strain and strain rate abnormalities.

Echocardiographic Test and the Early Detection of Systolic Failure in Systemic Sclerosis Patients: Strain and Strain Rate Echocardiography

Abstract Background: Pulmonary arterial hypertension (PAH) is a leading cause of death in systemic sclerosis (SSc) patients. Early detection of systolic failure in SSc patients will facilitate early treatment and improve the survival rate of these patients. Objectives: In this study, besides studying the RV function in SSC patients, attempts have beenmade to find a new possible nonin- vasive echocardiographic test for early diagnosis of systolic failure as a PAH complication. Methods: 30 patientswith at least a 2-year history of diffuse SSc confirmed by an expert rheumatologistwere enrolled in this study. All the patients underwent transthoracic echocardiography by an echocardiologist. Fractional area change (FAC) of the right ven- tricle (RV), tricuspid annular plane systolic excursion (TAPSE), RV lateralwall strain and strain rate (Base,Mid, Apex), RV-EDD and RV pressure with respect to inferior vena cava (IVC) diameter as well as Left Ventricle’s Ejection Fraction (LVEF) were evaluated. Results: The prevalence rate of PAH was reported 36.6% in this study. There was no significant relationship between LVEF and RV parameters. LVEF was found to be significantly higher in women whereas RV strain turned out to be higher inmen. Besides, there was a significant relation between pulmonary arterial pressure (PAP) and Basal (P = 0.03),mid RV strain (P = 0.002), RV strain rate (P = 0.001) and RV diameter (P = 0.02). Also, an inverse relationwas observed between RV systolic (P = 0.01) and diastolic functions (P = 0.007) with PAP. In addition, no significant relationship was found between LVEF and bodymass index (BMI) and RV parameters (P > 0.05). Moreover, Apical RV strain and LVEF were found to be higher inmales and females respectively. Furthermore, a significant relationshipwas found between RV strain and age (P = 0.027). Finally, the results did not show any relationship between RV systolic and diastolic functions and gender. Conclusions: This paper states the likely advantages of strain and strain rate echocardiography in identifying patients withmore diffused and severe SSc and the need for further longitudinal studies based on thementionedmethod for early diagnosis ofmyocar- dial impairment.

The role of new echocardiographic techniques in athlete's heart.

'Athlete's heart' is a common term for the various adaptive changes induced by intensive exercise. Exercise causes alterations of the heart in hemodynamic response to the increased systemic and pulmonary demand during exercise. The understanding of these adaptations is of high importance, since they may overlap with those caused by pathological conditions. Cardiac imaging assessment of the athlete's heart should begin with a complete echocardiographic examination. In recent years classical echocardiographic surveys have been joined by new developments: tissue Doppler imaging, strain rate echocardiography, and real-time 3-dimensional echocardiography. This review paper focuses on the importance of these new echocardiographic techniques in delineating the morphological characteristics and functional properties of the athlete's heart.

Strain rate echocardiography uncovers subclinical left ventricular dysfunction in cystic fibrosis

BackgroundCFTR is expressed in cardiac myocytes. In mice, lack of CFTR alters cardiomyocyte contraction and Ca2+ signaling, and decreases cardiac reserve. We undertook a pilot study evaluating left ventricular (LV) function in CF patients using strain and strain rate echocardiography. MethodsEchocardiography with tissue Doppler and strain and strain rate imaging were performed in 8 CF adults following pulmonary function tests. Results were compared to literature values obtained in healthy subjects. ResultsAll CF individuals had normal LV ejection fractions. In contrast, 50% of men and 100% of women with CF had decreased LV systolic strain. Strain rates were significantly decreased in 100% of CF individuals. RV function was normal and LV function did not correlate with lung function. ConclusionsStrain and strain rate echocardiography identified LV systolic abnormalities in CF individuals not detected by conventional echocardiography. We propose that this echocardiography modality may identify subclinical cardiac dysfunction in CF.

Regional myocardial contractile reserve assessed by strain echocardiography and the response to cardiac resynchronization therapy

Overall response rate to cardiac resynchronization therapy (CRT) is still not optimal. The aim of the study was to evaluate the influence of the regional myocardial contractile reserve during dobutamine infusion in the area of left ventricular (LV) electrode on the response rate and reverse remodeling LV in patients receiving CRT. Biventricular pacemaker was implanted in 41 consecutive patients (33 men, mean age 62 ± 10 years) with LV ejection fraction (LVEF) ≤ 35%, New York Heart Association class III and QRS duration ≥ 120 ms. Myocardial contractile reserve was assessed by LV strain during dobutamine infusion (20 μg/kg/min) using speckle tracking echocardiography. Patients were classified as responders if an increase in LVEF ≥ 5% or decrease in end-systolic volume ≥ 15% was observed after 6 months of CRT. Twenty-four patients were responders and 17 were non-responders. During dobutamine infusion at a rate of 20 μg/kg/min, responders showed significant increase in regional deformation (Δ strain) when compared to non-responders (2.14 ± 2.9 vs. - 0.94 ± 1.74, p = 0.042). Patients with increased deformation in the LV lead area during dobutamine stimulation were more likely to be responders to CRT compared to patients without increased deformation in this area (81% vs. 20%, p = 0.0002). They exhibited significant increase in LVEF (8.8% ± 10.3% vs. 0.3% ± 6.4%, p = 0.01). LV electrode localization in viable myocardium was a good predictor of response to CRT (AUC 0.852, p < 0.0001). Regional contractile reserve assessed by strain rate echocardiography during dobutamine infusion predicts the response to CRT.

Assessment of left ventricular functions with tissue Doppler, strain, and strain rate echocardiography in patients with familial Mediterranean fever.

Objective:This study assessed the early changes in regional and global systolic and diastolic myocardial functions in patients with familial Mediterranean fever without any cardiovascular symptoms using tissue Doppler and strain and strain rate echocardiography and compared them to the results of a control group.Methods:This study has a cross-sectional and observational design. FMF patients with normal left ventricular function were included in the study. We excluded patients who had arrhythmia, acquired/congenital heart disease, pericarditis, or acute attack. We compared 45 children with familial Mediterranean fever on colchicine therapy and 45 age- and sex-matched healthy children.Results:The 45 patients with familial Mediterranean fever included 24 (55.3%) girls and 21 (46.7%) boys with a mean age of 11.3±3.7 (range 2-18) years. The mean disease duration was 4.6±2.4 (range 0.5-10) years. In the patient group, the homozygous M694V mutation was the most common (64.4%) mutation. The patients with familial Mediterranean fever had statistically lower longitudinal global strain, radial global strain, and strain rates (-14.44±4.77%, 14.80±6.29%, and 0.59±0.24 s, respectively) than the controls (-17.40±1.79%, 17.53±4.63%, and 0.83±0.51 s) (p<0.05). The circumferential global strain did not differ significantly between the groups.Conclusion:Patients with familial Mediterranean fever who are subclinical from a cardiac aspect might have normal left ventricular function as measured by conventional echocardiography. However, the disease affects their myocardial tissue, and these patients should be followed with conventional, strain, and strain rate echocardiography techniques regularly.

Atrial apoptosis and fibrosis adversely affect atrial conduit, reservoir and contractile functions.

Chronic atrial volume overload and atrial fibrillation (AF) induce structural changes within atrial myocardium. The aim of this study was to evaluate the effect of adverse cellular remodelling on echocardiographic strain rate (SR) deformation indices of atrial contractile, conduit and reservoir functions. Forty-four consecutive patients with organic mitral regurgitation were analysed. Twenty-eight patients had long-standing persistent AF (AF group), while 16 were in normal sinus rhythm (NSR group). Left atrial (LA) samples were harvested from all the patients for histological analysis. Postoperative echocardiographic data acquisition was performed exclusively during organized atrial electrical activity in order to assess the contractile reserve of patients from both groups. Fibrotic atria had inferior conduit (SR-E: r = -0.36, P = 0.017), reservoir (SR-S: r = -0.31, P = 0.041) and contractile functions (SR-A: r = -0.33, P = 0.027). Analogously, atria with greater apoptotic burdens showed a negative correlation with multiple indices of left atrial functions (SR-E: r = -0.38, P = 0.010; SR-S: r = -0.33, P = 0.028; SR-A: r = -0.28, P = 0.067). The efficiency of atrial contractility was significantly reduced among AF-group patients after conversion to sinus rhythm, when compared with patients in the NSR group (LA active emptying fraction: 20 ± 12 vs 30 ± 10%, P = 0.004; SR-A: 1.1 ± 1.0 vs 2.8 ± 1.9 s(-1), P < 0.001). Superior strain-rate indices of atrial conduit and reservoir functions were noted in the NSR group (SR-E: 3.5 ± 2.3 vs 1.3 ± 1.0 s(-1), P < 0.001; LA expansion index: 86 ± 31 vs 60 ± 42%, P = 0.004). Fibrosis was evident in 7.2 [3.3;9.4]% of the LA tissue sample in the AF group, while it accounted for 3.4 [1.2;8.1]% of atrial tissue in the NSR group (P = 0.054). Apoptosis was documented in 13 (46%) patients in the AF group, whereas none of the patients in the NSR group exhibited signs of programmed cell death (P = 0.001). Myocyte degeneration was more prevalent in the AF group (odds ratio: 7.0, 95% confidence interval: 1.3-36.7, P = 0.021). Age showed a positive correlation with worsening degrees of atrial fibrosis and apoptosis (r = 0.41, P = 0.006; r = 0.49, P = 0.001, respectively). Multiple regression analysis identified SR-S (β = -1.263, P = 0.036) and age (β = 0.144, P = 0.057) as independent predictors of fibrosis. Independent determinants of apoptosis were preoperative AF (β = 4.539, P = 0.007), age (β = 0.188, P = 0.009) and SR-S (β = -1.780, P = 0.002). Atria exhibiting greater fibrotic and apoptotic burdens had impaired conduit, reservoir and contractile function, as evaluated by deformation imaging. Among patients with chronic LA volume overload, exposure to long-standing persistent AF induced more pronounced degrees of adverse atrial cellular remodelling. Strain-rate descriptors of atrial reservoir function harboured potential to predict atrial fibrosis and apoptosis.

Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism

Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was -20.88 ± 2.30 and -24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (-1.38 ± 0.19 vs -1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement.