Strain Rate Imaging In Patients Research Articles

Assessment of Right Ventricular Function Using Strain and Strain Rate in Patient with Acute Anterior ST Segment Elevation Myocardial Infarction

Introduction: Anterior ST-segment elevation myocardial infarctions (STEMI) are those involving the anterior ECG leads of the heart as a result of transmural ischaemia. They can be subdivided according to their extension into anteroseptal and anterolateral infarctions. Objective: The aim of this study is assessment of right ventricular function using strain and strain rate imaging in patients with anterior ST segment elevated myocardial infarction (STEMI). Methods: This prospective study was conducted on 35 patients with anterior ST segment elevated myocardial infarction (STEMI) who were admitted to ER and CCU department in National Heart Institute from May 2018 to May 2019. Results: Comparison between groups regarding longitudinal strain showed that there is highly statistically significant difference between them in lateral wall (all segments), septum (all segments) and global LS of right ventricle. Comparison between studied groups regarding circumferential strain revealed that there is highly statistically significant difference between them in all segments of right ventricle. Conclusions:Strain and strain rate imaging are feasible and reproducible tools in assessment of right ventricular function in patients with anterior ST segment elevated myocardial infarction (STEMI).

296P - Detection of early cardiac effects of docetaxel plus trastuzumab and pertuzumab through strain rate imaging in patients with HER2-positive metastatic breast cancer

296P - Detection of early cardiac effects of docetaxel plus trastuzumab and pertuzumab through strain rate imaging in patients with HER2-positive metastatic breast cancer

Early detection of regional and global left ventricular myocardial function using strain and strain-rate imaging in patients with metabolic syndrome.

Background:Strain and strain-rate imaging (SRI) have been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. The aim of this study was to evaluate the regional and global left ventricular (LV) myocardial function in metabolic syndrome (MS) with SRI so that we can provide more myocardial small lesions in patients with MS, which is robust and reliable basis for early detection of LV function.Methods:Thirty-nine adults with MS were enrolled in the study. There was a control group of 39 healthy adults. In addition to classic echocardiographic assessment of LV global functional changes, SRI was used to evaluate regional and global LV function. Including: Peak systolic strain (S), peak systolic strain-rate (SR-s), peak diastolic strain-rate (SR-e).Results:There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function. On the other hand, significant differences were observed between MS and the control group in most of the parameters of S, SR-s, SR-e in regional LV function. Multiple stepwise regression analyses revealed that S and SR significantly were negatively correlated with blood pressure, waist circumference, fasting plasma glucose, uric acid, suggesting that risk factories were relevant to regional systolic dysfunction.Conclusion:In MS with normal LV ejection fraction, there was regional myocardial dysfunction, risk factors contributed to the impairment of systolic and diastolic function of the regional myocardium. Assessment of myocardial function using SRI could be more accurate in MS patient evaluation than conventional echocardiography alone.

Evaluation of abdominal aortic elasticity by strain rate imaging in patients with type 2 diabetes mellitus.

To use strain rate imaging (SRI) to compare the abdominal aortic wall elasticity between patients with type 2 diabetes mellitus and controls. We measured the abdominal aorta intima-media thickness (IMT) with B-mode echography, and the anterior and posterior wall displacement (d), strain, and strain rate (SR) with SRI, in 90 patients with type 2 diabetes mellitus and 30 control subjects (group A). The patients were classified into group B (normal IMT), group C (thickened IMT), and group D (one single atheroma plaque). d, strain, and SR were significantly lower in group B, C, and D than in group A (p < .05). Systolic, early-diastolic, and late-diastolic SR were lower in patients with diabetes (especially in group D) than in controls. There were significant differences in systolic SR, early-diastolic SR, and late-diastolic SR between group A and group B (p < .05). SRI is a noninvasive method that can demonstrate a loss in aorta wall elasticity in patients with diabetes with normal IMT.

Assessment of Right Ventricular Function by Tissue Doppler, Strain and Strain Rate Imaging in Patients with Left-Sided Valvular Heart Disease and Pulmonary Hypertension

Background: Pulmonary artery hypertension is the presentation of various types of cardiovascular and systematic diseases. There are different kinds of noninvasive methods to determine right ventricular function, pulmonary artery pressure, and effect of pulmonary hypertension on right ventricular function. These methods include the tissue Doppler imaging (TDI) of the tricuspid annulus and the longitudinal deformation indices of the right ventricular free wall. Objectives: In some patients, the echocardiogram cannot help estimate pulmonary artery pressure. In this study, we evaluated the effect of pulmonary hypertension on the TDI of the tricuspid annulus and the longitudinal strain and strain rate of the basal segment of the right ventricular free wall in patients with left-sided valvular heart disease and pulmonary hypertension. Indeed, we sought to investigate whether we can guess the presence of pulmonary hypertension through the measurement of the TDI of the tricuspid annulus and the deformity indices of the basal segment of the right ventricular free wall. Patients and Methods: Eighty consecutive patients with left-sided valvular disease and pulmonary artery hypertension (V/PH Group) and 80 healthy matched controls (H Group) were enrolled in this research. The TDI parameters were obtained in the tissue velocity imaging mode during systole (S, S VTI), early relaxation (E), atrial systole (A), and isovolemic relaxation time (IVRT). The deformation indices included peak systolic longitudinal strain and strain rate measured from the basal segment of the right ventricular free wall and were calculated as the relative magnitude of segmental deformation. Results: S, E, and S VTI were reduced significantly in the V/PH Group, and there was a significant negative correlation between S velocity, S VTI with pulmonary artery systolic pressure (PASP), and right ventricular diameter (RVD). According to the ROC curve, S velocity 40 ms had 78% sensitivity and 67% specificity for the prediction of pulmonary hypertension. In comparison with the H Group, RV longitudinal peak systolic strain (-14/35 ± 4%) and strain rate (-0.65 ± 0.12) at the basal segment of the right ventricular free wall were significantly lower in the V/PH Group (P < 0.001 and P < 0.001). Conclusions: We observed a significant reduction in S, E velocity, and S VTI of the tricuspid annulus. Moreover, the strain/strain rate of the basal segment of the right ventricular free wall had a marked decrease in the V/PH Group in comparison with the healthy subjects.

Evaluation of Left Ventricular Diastolic Function by Global Strain Rate Imaging in Patients with Obstructive Hypertrophic Cardiomyopathy: A Simultaneous Speckle Tracking Echocardiography and Cardiac Catheterization Study

Impaired left ventricular (LV) diastolic function is a common pathophysiological feature of patients with hypertrophic cardiomyopathy (HCM). The noninvasive evaluation of diastolic function in these patients remains a challenge. Speckle tracking echocardiography (STE) provides direct information on intrinsic myocardial function and may improve the diagnostic of diastolic dysfunction in HCM patients. We retrospectively analyzed 51 patients with obstructive HCM (HOCM). Strain rate (SR) curves were obtained for 18 different segments of the LV myocardium. The peak SR during the isovolumic relaxation period (SRIVR ) and the peak early diastolic strain rate (SRE ) were measured for each segment. Cardiac catheterization was performed within 24hours after echocardiographic analysis. LV end-diastolic pressure (LVEDP) was measured and time constant of myocardial relaxation (τ) was calculated. We therefore correlated STE-derived with invasive indices and compared it with flow and tissue Doppler measurements. SRIVR and SRE were significantly reduced in all 51 HOCM patients (0.16±0.09%/sec and 0.71±0.25%/sec).The ratio of peak early mitral inflow velocities to SRIVR and SRE (E/SRIVR and E/SRE ) correlated well with LVEDP (r=0.760, P<0.001; r=0.401, P=0.004). Receiver operating characteristic analysis shown E/SRE ratio had the largest under curve area in predicting HOCM patients with seriously elevated LVEDP. In addition, SRIVR and SRE significantly related with τ (r=-0.611, P<0.001; r=-0.369, P=0.008). Diastolic function was seriously impaired in HOCM patients. The E/SRE ratio can be used to predict LVEDP with acceptable accurate in HOCM patients. In addition, SRIVR is a reliable parameter to assess LV relaxation in patients with HOCM.

Circulation: Cardiovascular Imaging's Editors' Picks

<i>Circulation: Cardiovascular Imaging's</i> Editors' Picks

Quantitative assessment of right atrial function by strain and strain rate imaging in patients with heart failure

Objectives We sought to evaluate the regional longitudinal strain/strain rate profi les in the right atrial wall to quantify right atrial function in systolic heart failure patients.Background According to previous studies on the deformational properties of the left atrium, the systolic strain and strain rates represent the atrial reservoir function and the early and late diastolic strain rates show the conduit and booster functions, respectively.Methods Thirty patients with a diagnosis of heart failure (left ventricular ejection fraction ≤ 35%) scheduled for right heart catheterization were enrolled. Echocardiography was performed to obtain right atrial deformation indices just before the procedure. The control group consisted of 32 healthy adults matched for age and sex.The deformity indices obtained consisted of the right atrial peak systolic strain (RAS), right atrial peak systolic strain rate (RASSR), right atrial early diastolic strain rate (RAEDSR), and right atrial late diastolic strain rate (RALDSR).Results The right atrial deformation indices were signifi cantly compromised in the heart failure patients versus the normal subjects (RAS: 68.5 ± 53.9 vs 189.3 ± 61.2, P= 0.000; RASSR: 2.9 ± 1.9 vs. 5.3 ± 1.5, P= 0.000). There was a signifi cant correlation between the RAS and RASSR and cardiac output (RAS: r = 0.5, P= 0.005; RASSR: r = 0.5, P= 0.003), and cardiac index (RAS: r = 0.6, P= 0.001; RASSR: r = 0.6, P= 0.001).Conclusion In light of our fi ndings, we conclude that a diminished RA function, as assessed by strain imaging, plays a critical role in the pathophysiological process of heart failure patients.

Assessment of left atrial function by strain rate imaging in patients with hypertension

ObjectiveTo compare strain and strain rate in primary hypertensive patients with different configuration of left ventricular (LV) by Strain Rate Imaging (SRI), analysis the dependability of strain rate and traditional...

Detection of early cardiac effects through strain rate imaging in patients undergoing breast cancer treatment with trastuzumab.

e11093 Background:Trastuzumab prolongs survival in patients with human epidermal growth factor receptor type 2-positive breast cancer. Sequential left ventricular (LV) ejection fraction (EF) assessment has been mandated to detect myocardial dysfunction. Changes in cardiac function induced by this therapy, however, are subtle and difficult to quantitate by conventional imaging methods. Doppler myocardial imaging-based velocity, strain, and strain rate measurements have been shown to sensitively quantify abnormalities in cardiac function in other settings. The aim of this study was to determine if sensitive indices of left ventricular (LV) dysfunction, specifically strain rate imaging, would be useful for addressing the early detection of trastuzumab mediated cardiotoxicity. Methods:In a pilot study, we examined 12 women (age 59.8 +/- 3.6 years) with breast cancer receiving 18 cycles of trastuzumab. Conventional and Doppler myocardial imaging echocardiography were obtained at baseline and every 3 months of ...

Left atrial function and remodelling in aortic stenosis

The present study sought to determine the relationship between left atrial (LA) volume (structural changes) and LA function as assessed by strain rate imaging in patients with aortic stenosis (AS). The study consisted of a total of 64 consecutive patients with severe AS (<1 cm&sup2;) and 20 healthy control subjects. The phasic LA volumes and function (tissue Doppler-derived strain) were assessed in all patients. As compared with healthy controls, all strain-derived parameters of LA function were reduced in patients with AS. Conversely, only indexed LA passive volume (increased) (7.6 ± 3.8 vs. 10.5 ± 5.1 ml/m&sup2;, P= 0.02) and LA active fraction (decreased) (43 ± 6.7 vs. 31 ± 13.3%, P< 0.001) (volume-based parameters) were significantly different between AS and controls. In AS, LA volume-derived function parameters were poorly correlated with LA strain parameters. In fact, by multivariable analysis, no LA phasic strain parameters emerged as independently associated with LA phasic volume parameters. In AS, changes in LA function did not parallel changes in LA size. Furthermore, the increase in LA volume does not necessarily reflect the presence of intrinsic LA dysfunction.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Assessment of atrial contractile properties with a color doppler strain rate imaging in patients with paroxysmal atrial fibrillation

Assessment of atrial contractile properties with a color doppler strain rate imaging in patients with paroxysmal atrial fibrillation

Prediction of subclinical left ventricular dysfunction with longitudinal two-dimensional strain and strain rate imaging in patients with mitral stenosis

Longitudinal two-dimensional strain deformation is a novel technique which evaluates global and regional left ventricular (LV) function with high reproducibility. The aim of the study was to investigate the global and regional systolic function using this method in patients with pure mitral stenosis (MS). Conventional echocardiography and longitudinal two-dimensional strain analysis were performed in 60 patients (41 +/- 5 years, 48 women) with mild to moderate MS (mitral valve area: 1.9 +/- 0.5 cm(2)), and 52 healthy controls (40 +/- 7 years, 37 women). For strain analysis standard apical views were obtained, and by using a software system peak systolic strain and strain rate were calculated off-line in each segment. In all, 88% of the segments could be optimally tracked by the software system. Despite normal LV systolic function as assessed by ejection fraction (66 +/- 8%), mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) were significantly reduced in patients with isolated MS (GLS -17 +/- 3.3 vs. -19 +/- 2.5%, P = 0.006 and GLSR -1.3 +/- 0.3 vs. -1.5 +/- 0.3 s(-1), P < 0.0001). Regional analysis demonstrated that patients with MS had a significantly reduced longitudinal peak strain and strain rate in all basal, and some mid (inferior, anteroseptal, interventricular septum) segments of the left ventricle. For other segments longitudinal peak strain and strain rate values were similar among the groups. Evaluation of LV systolic function by longitudinal two-dimensional strain deformation identified early abnormalities in MS patients who had apparently normal standard systolic function.

Direct Measurement of Wall Stiffness for Carotid Arteries by Ultrasound Strain Imaging

The elastic properties of the carotid arterial wall have not been directly characterized in the clinical setting. Strain rate (SR) imaging is a newly developed echocardiographic method developed for imaging the tissue motion of the myocardium. The purpose of this study was to directly estimate the elastic properties of the carotid artery by using SR imaging in patients with coronary artery disease (CAD). A total of 135 patients with CAD, 15 age-matched controls, and 35 young healthy subjects had a carotid ultrasound examination for measuring the values of SR and strain of the carotid artery. The intima-media thickness and distensibility coefficient of the carotid artery were estimated. Age and Framingham risk score were significantly related to SR and strain, respectively (r = 0.62-0.67, all P < .001). These strain measurements were significantly correlated with distensibility coefficient and intima-media thickness, respectively (r = 0.30-0.56, all P < .001). Similar values of the areas under the receiver operating characteristic curves were obtained among Framingham risk score (0.70 +/- 0.05), SR (0.67 +/- 0.05), and strain (0.73 +/- 0.05). This study demonstrated that the elastic properties of the carotid artery wall were directly characterized by using SR imaging in patients with CAD.

Assessment of Ascending Aorta Distensibility After Successful Coarctation Repair by Strain Doppler Echocardiography

Increased arterial stiffness may participate in the genesis of hypertension and increase of left ventricular (LV) mass after surgical correction of coarctation of the aorta. The purpose of the current study was to assess the aortic elastic properties using Doppler tissue imaging and strain rate imaging in patients after coarctoplasty. Echocardiography with Doppler tissue/strain rate imaging capabilities was performed in 26 adult normotensive patients who had successful repair of coarctation of the aorta in infancy and in 24 control subjects. Transesophageal aortic transverse sections were imaged at the level of the proximal and distal segments to the repair site. Doppler tissue imaging wall velocities during systole (S(w)), early relaxation (E(w)), and atrial systole (A(w)) and peak systolic strain (ps epsilon) were measured in both groups. Transthoracic ascending aorta (AAo) measurements were also obtained. In the patients with coarctoplasty, S(w) velocities and ps epsilon were significantly decreased in the proximal segments compared with control subjects. Both peak systolic blood pressure after exercise (P < .001) and pulse pressure after exercise (P < .001) were directly related to AAo wall strain. LV annular early diastolic velocity was significantly reduced compared with control subjects in patients with decreased AAo wall strain and exercise-induced hypertension (P < .001) and related to AAo wall velocity (P < .005) and strain (P < .001). In multiple linear regression analysis, only weight, study group, and AAo wall strain were correlated to LV mass index. Patients with coarctation of the aorta have reduced proximal aortic wall velocities and strain and increased stiffness even after successful repair. This amplifies stress-induced hypertension and increases LV burden.

Noninvasive Assessment of Left Atrial Function by Strain Rate Imaging in Patients with Hypertension: A Possible Beneficial Effect of Renin-Angiotensin System Inhibition on Left Atrial Function

Renin-angiotensin system (RAS) inhibitors are likely to reduce the development of atrial fibrillation by preventing atrial fibrosis. Strain rate (SR) imaging is a novel echocardiographic technique to quantify left atrial (LA) function. However, it has not been determined whether SR imaging is applicable for detection of LA dysfunction in hypertensive (HT) patients. We used SR imaging to assess alteration in LA function in HT patients and its modification by RAS inhibitors. SR imaging was performed in 80 HT patients and 50 age-matched normotensive (NT) subjects. HT patients were divided into two groups according to left ventricular hypertrophy (LVH) and LA dilatation. Peak SR was measured at each LA segment (septal, lateral, posterior, anterior, and inferior) and mean peak systolic SR (SR-LAs) was calculated by averaging data in each segment. Mean SR-LAs levels in the dilated LA group (1.97+/-0.45 s(-1), n=25) and non-dilated LA group (2.15+/-0.57 s(-1), n=55) were significantly (p<0.05) lower than that in NT subjects (2.53+/-0.71 s(-1)). Irrespective of the presence or absence of LVH, mean SR-LAs in HT patients was lower than that in NT subjects. When RAS inhibitors were used, the mean SR-LAs level in the non-dilated LA group was equivalent to that in NT subjects. In HT patients, mean SR-LAs, an index of LA reservoir function, decreases before development of LA enlargement and LVH. Treatment with RAS inhibitors appears to preserve LA reservoir function in HT patients without dilated LA. SR imaging can detect LA dysfunction in HT patients and is useful for evaluation of the therapeutic benefit on LA reservoir function.

Response to: Noninvasive Assessment of Left Atrial Function by Strain Rate Imaging in Patients with Hypertension: A Possible Beneficial Effect of Renin-Angiotensin System Inhibition on Left Atrial Function

Response to: Noninvasive Assessment of Left Atrial Function by Strain Rate Imaging in Patients with Hypertension: A Possible Beneficial Effect of Renin-Angiotensin System Inhibition on Left Atrial Function

Noninvasive Assessment of Left Atrial Function by Strain Rate Imaging in Patients with Hypertension: A Possible Beneficial Effect of Renin-Angiotensin System Inhibition on Left Atrial Function

Renin-angiotensin system (RAS) inhibitors are likely to reduce the development of atrial fibrillation by preventing atrial fibrosis. Strain rate (SR) imaging is a novel echocardiographic technique to quantify left atrial (LA) function. However, it has not been determined whether SR imaging is applicable for detection of LA dysfunction in hypertensive (HT) patients. We used SR imaging to assess alteration in LA function in HT patients and its modification by RAS inhibitors. SR imaging was performed in 80 HT patients and 50 age-matched normotensive (NT) subjects. HT patients were divided into two groups according to left ventricular hypertrophy (LVH) and LA dilatation. Peak SR was measured at each LA segment (septal, lateral, posterior, anterior, and inferior) and mean peak systolic SR (SR-LAs) was calculated by averaging data in each segment. Mean SR-LAs levels in the dilated LA group (1.97+/-0.45 s(-1), n=25) and non-dilated LA group (2.15+/-0.57 s(-1), n=55) were significantly (p<0.05) lower than that in NT subjects (2.53+/-0.71 s(-1)). Irrespective of the presence or absence of LVH, mean SR-LAs in HT patients was lower than that in NT subjects. When RAS inhibitors were used, the mean SR-LAs level in the non-dilated LA group was equivalent to that in NT subjects. In HT patients, mean SR-LAs, an index of LA reservoir function, decreases before development of LA enlargement and LVH. Treatment with RAS inhibitors appears to preserve LA reservoir function in HT patients without dilated LA. SR imaging can detect LA dysfunction in HT patients and is useful for evaluation of the therapeutic benefit on LA reservoir function.

154 Improved prediction of coronary artery disease by using strain rate imaging in patients with acute chest pain and non-diagnostic ECG

154 Improved prediction of coronary artery disease by using strain rate imaging in patients with acute chest pain and non-diagnostic ECG