Systolic Displacement Research Articles

Dilated Cardiomyopathy: Normalized Multiparametric Myocardial Strain Predicts Contractile Recovery

Left ventricular contractile injury in dilated cardiomyopathy (DCM) may occur in a consistently heterogeneous distribution, suggesting that early-injury sentinel regions may have prognostic significance. Heightened surveillance of these regions with high-resolution contractile metrics may predict recovery in DCM. Multiple three-dimensional strain parameters were calculated at each of 15,300 left ventricular grid points from systolic displacement data obtained from cardiac magnetic resonance imaging in 124 test subjects. In 24 DCM patients, Z-scores for two strain parameters at each grid point were calculated by comparison of patient-specific strain values to respective point-specific mean and standard deviation values from a normal human strain database (n= 100). Multiparametric strain Z-scores were averaged over six left ventricular regions at basilar, mid, and apical levels (18 subregions). Patients with DCM were stratified into three groups on the basis of a blinded review of clinical contractile recovery (complete, n= 7; incomplete, n= 7; none, n= 10). Basilar-septal subregions were consistently heavily injured. Basilar-septal Z-scores were significantly larger (worse) than those for the rest of the left ventricle (2.73 ± 1.27 versus 2.22 ± 0.83; p= 0.011) and lateral wall (2.73 ± 1.27 versus 1.44 ± 0.72; p < 0.001). All patients with sentinel region average multiparametric strain Z-scores less than two standard deviations (n= 6) experienced complete recovery, whereas 17 of 18 DCM patients with Z-scores greater than two standard deviations experienced incomplete or no contractile recovery. Contractile injury in DCM is heterogeneous, with basilar-septal regions injured more than lateral regions. The targeting of early-injury sentinel regions for heightened surveillance with high-resolution metrics of microregional contractile function may accurately predict recovery on medical therapy. A two standard deviation Z-score threshold may predict contractile recovery.

Ultrasonographic assessment of fetal cardiovascular function in selective intrauterine growth restriction

Objective To evaluate the fetal cardiovascular function in selective intrauterine growth restriction(sIUGR) in monochorionic diamniotic (MCDA) twins by using 2D and color Doppler ultrasonography. Methods Twenty-four sIUGR pregnancies and 20 normal MCDA twins pregnancies were enrolled at the First Affiliated Hospital of Sun Yat-Sen University from December 2013 to September 2014, and cardiac structure of fetus and Doppler patterns of the umbilical artery(UA), umbilical vein(UV), pulsatility index of ductus venosus(DV-PI), atrioventricular valve, semilunar valve, tricuspid annulus systolic displacement(TAPSE), fractional shortening of left ventricle short axis (FS) and myocardial performance index (Tei index) of both ventricles were assessed. Results Cardiothoracic ratio, heart rate, DV-PI, FS, TAPSE, Tei index of the left ventricle(0.34±0.03, 0.34±0.04), Tei index of the right ventricle(0.35±0.03, 0.35±0.03) were not significantly different compared with those of the normal MCDA twins(all P>0.05). Cardiothoracic ratio, ventricular wall thickness, isovolumetric relaxation time(IRT), isovolumetric contraction time(ICT), TAPSE and tricuspid regurgitation(TR)in the larger twins of sIUGR were significantly bigger than those in the smaller twins of sIUGR(all P<0.05), Tei index of both ventricles in the larger twin of sIUGR was significantly higher than that in the smaller twins of sIUGR(Tei index of left ventricle: 0.43±0.06 vs 0.35±0.04, Tei index of right ventricle: 0.43±0.06 vs 0.34±0.04, P<0.05), the peak E in early diastolic /the peak A in atrial contraction (E/A), the percentage of inflow during of cardiac cycle length(inflow/CCL) in larger twin of sIUGR were significantly lower than those in smaller twin of sIUGR(all P<0.05). Conclusions There was no difference of cardiac function in normal MCDA twins, at the beginning of the diagnosis of sIUGR, cardiac dysfunction were found in larger twin, follow-up examination are helpful to clinical decision. Key words: Monochorionic diamniotic twins; Selective intrauterine growth restriction; Cardiac function; Echocardiography

Right ventricular systolic function of patients with pneumoconiosis based on the evaluation of systolic displacement of tricuspid annulus

To determine the tricuspid annular plane systolic excursion (TAPSE) using M-mode echocardiography, and to evaluate the right ventricular systolic function in patients with pneumoconiosis. One hundred and eighty-three patients with pneumoconiosis were enrolled as subjects, and one hundred and ninety-nine healthy volunteers were used as controls. According to the types of ventilation dysfunction, patients were divided into four groups: normal type, obstructive type, restrictive type, and mixed type. In the apex four-chamber sections, the displacement of tricuspid annular plane on the right ventricular free wall side was measured from end-diastole to end-systole using M-mode echocardiography. The average TAPSE in the pneumoconiosis group was significantly lower than that in the control group (18.61 ± 3.08 vs 22.38 ± 3.03 mm, P < 0.01). Along with the progression of pneumoconiosis, the TAPSE values in patients with stage I, II, and III pneumoconiosis were significantly decreased compared with those in the control group (P < 0.01). The TAPSE values in patients diagnosed with normal, obstructive, restrictive, and mixed types of pneumoconiosis in pulmonary function tests were all significantly lower than those in the control group (P < 0.01). Among all patients, patients with mixed type of pneumoconiosis had the most significant reduction in the TAPSE. The TAPSE is substantially decreased in patients with pneumoconiosis and further decreased along with the progression of pneumoconiosis. Measurement of the TAPSE is an easy way to evaluate the right ventricular systolic function in patients with pneumoconiosis.

The use of strain, strain rate, and displacement by 2D speckle tracking for assessment of systolic left ventricular function in goats: applicability and influence of general anesthesia.

BackgroundAssessment of left ventricular (LV) systolic function can be achieved by conventional echocardiographic methods, but quantification of contractility, regional myocardial function, and ventricular synchrony is challenging. The goal of this study was to investigate the applicability of two-dimensional speckle tracking (2DST) to characterize segmental and global wall motion for assessment of LV function and LV synchrony in healthy goats. We aimed to describe the techniques, report normal values of a variety of 2DST indices, and determine the influence of general anesthesia.MethodsProspective study on 22 healthy female Saanen goats (3.7 ± 1.1 y, 60.2 ± 10.5 kg [mean ± SD]). All goats underwent two transthoracic echocardiographic examinations, the first standing and unsedated and the second 7.4 ± 3.5 days later during isoflurane anesthesia and positioned in sternal recumbency. Data analyses were performed offline, blinded, and in random order. Left ventricular longitudinal, radial and circumferential strain and strain rate as well as longitudinal and radial displacement were measured using 2DST methods. Summary statistics were generated and differences of 2DST variables between myocardial segments and treatments (i.e., awake vs. anesthetized) were assessed statistically (alpha level=0.05).ResultsEchocardiographic analyses by 2DST were feasible in all goats and at both time points. Longitudinal systolic strain, strain rate and displacement followed a gradient from apex to base. Absolute systolic strain was generally lower and strain rate was higher in awake goats compared to anesthetized goats. Circumferential and radial indices did not consistently follow a segmental pattern. Generally, peak strain occurred later in anesthetized goats compared to awake goats. General anesthesia did not significantly influence LV synchrony.Conclusions2SDT is a valid method for non-invasive characterization of LV wall motion in awake and anesthetized goats. The results of this study add to the understanding of LV mechanical function, aid in the diagnosis of global and segmental LV systolic dysfunction, and will be useful for future cardiovascular studies in this species. However, effects of anesthesia and species-specific characteristics should be considered when goats are used as animal models for human disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12947-015-0005-8) contains supplementary material, which is available to authorized users.

Relationship between epicardial adipose tissue thickness and early impairment of left ventricular systolic function in patients with preserved ejection fraction.

Epicardial adipose tissue (EAT) is metabolically bioactive fat. The present study aimed to clarify the relationship between EAT amount and early impairment of left ventricular (LV) systolic function in patients with preserved ejection fraction (EF), all evaluated echocardiographically. Participants comprised 62 elderly women (mean age±standard deviation, 68±11years) with lifestyle-related diseases and EF≥60%. EAT amount was evaluated as thickness. Parameters suggesting early impairment of systolic function such as decreases in systolic mitral annular velocity (S') and tissue mitral annular displacement percentage (TMAD%) were evaluated along with EF. Correlations between EAT thickness and these LV systolic functions were assessed. Influences of various factors on the resultant significant relationships were also assessed. EAT thickness correlated inversely with S' and TMAD% (r=-0.402, p=0.001 and r=-0.585, p<0.001, respectively), but did not correlate with EF (r=0.054, not significant). These significant relationships were maintained after considering factors such as body mass index, age, presence of lifestyle-related diseases and blood test results. A significant relationship existed between EAT amount and early impairment of LV systolic function in patients with preserved EF. Accumulation of EAT might contribute to the initial development of LV systolic dysfunction.

Inhomogeneous Longitudinal Cardiac Rotation and Impaired Left Ventricular Longitudinal Strain in Children and Young Adults with End-Stage Renal Failure Undergoing Hemodialysis.

Cardiac dysfunction frequently complicates the clinical course of patients with end-stage renal failure (ESRF). Recently, we observed abnormal longitudinal cardiac rotation (LR) among patients with ESRF. In this study, we sought to quantify LR mechanics in patients undergoing hemodialysis (HD). Twenty-four subjects, 12 ESRF patients (58% male; age 17.5±4.4years) receiving HD, and 12 aged-matched controls, were prospectively studied. Patients underwent echocardiographic studies before and after HD. LR mechanics were quantified with two-dimensional speckle tracking echocardiography. Peak systolic left ventricular (LV) longitudinal strain and displacement measurements were obtained in all subjects. LR mechanics were successfully quantified in all subjects using 5 key echocardiographic features of LR. We identified two different inhomogeneous LR motion patterns in 41.7% of ESRF patients, characterized by a delayed timing of LR or increased segmental apical rotation. Inhomogeneous LR patterns were not found in controls. Timing of early-systolic counterclockwise LR increased after HD (P=0.006). In patients, late-systolic clockwise LR occurred earlier (P=0.043), and showed a significant prolongation after HD (P=0.003). Longitudinal strain was significantly impaired in patients (P=0.015), and further decreased after HD (P<0.0001). Strong correlations were observed between strain and displacement parameters and LR mechanics. Quantifying LR using speckle tracking echocardiography was feasible, easy, and reproducible. Inhomogeneous LR motion patterns were demonstrated in a large proportion of patients with ESRF. LV dysfunction seems the most important determinant of inhomogeneous LR. Further studies are required to validate these findings.

Systolic flow displacement correlates with future ascending aortic growth in patients with bicuspid aortic valves undergoing magnetic resonance surveillance.

Altered systolic blood flow in the ascending aorta has been correlated with increased aortic growth in patients with bicuspid aortic valves (BAVs). We used conventional, 2-dimensional (2D) phase contrast magnetic resonance imaging (PC-MRI) to assess the relationship between altered flow and future growth in patients with BAV. Aortic MRI data were reviewed for 17 adult patients with BAV with right-left leaflet fusion undergoing surveillance imaging who had 2D PC-MRI through their ascending aortas on an initial study, follow-up studies more than 1 year later, and an initial maximum aortic diameter of less than 4.5 cm. Diameters were measured at standard levels by 2 blinded reviewers. Normalized systolic flow displacement was calculated at peak systole from the PC-MRI data, and correlation with the interval aortic growth was performed, with adjustment for clinical/demographic factors. The average follow-up interval was 2.9 ± 1.3 years. Systolic flow displacement at the initial study strongly correlated with ascending aortic growth rate (r = 0.71, P < 0.005) with moderate, non-significant correlation between initial diameter and growth (r = 0.45, P = 0.214). Aortic growth was 4 times faster in patients with initial flow displacement of 0.2 or greater (n = 9) compared with those (n = 8) with initial flow displacement less than 0.2 (0.8 ± 0.4 vs 0.2 ± 0.3 mm/y; P = 0.002). Systolic flow displacement calculated from conventional 2D PC-MRI in the ascending aorta correlates with future aortic growth in patients undergoing routine surveillance imaging for BAV. With a cutoff valve of 0.2, flow displacement may be used to identify a subset of patients likely to have elevated growth rates and may better risk-stratify patients with BAV for aortic disease progression than vessel diameter alone.

Female athlete's heart: Systolic and diastolic function related to circulatory dimensions.

There are relatively few studies on female athletes examining cardiac size and function and how these measures relate to maximal oxygen uptake (VO2max). When determining sports eligibility, it is important to know what physiological adaptations and characteristics may be expected in female athletes, taking body and cardiac size into account. The purposes of this study were (a) to compare right and left heart dimensions and function in female endurance athletes (ATH) and in non-athletic female controls of similar age (CON); and (b) to explore how these measures related to VO2max. Forty-six ATH and 48 CON underwent a maximal bicycle exercise test and an echocardiographic examination at rest, including standard and color tissue Doppler investigation. All heart dimensions indexed for body size were larger in ATH (all P < 0.01). The diastolic mitral E/A ratio was 27% higher in ATH (P < 0.001) while systolic left and right atrio-ventricular longitudinal displacement was 7% (P = 0.002) and 15% (P < 0.001) larger in ATH, respectively. Half (50.3%) of the variability in VO2max could be explained by left ventricular end-diastolic volume. Our results could be useful in evaluating female endurance athletes with suspected cardiac disease and contribute to understanding differences between female athletes and non-athletes.

Bicuspid Aortic Cusp Fusion Morphology Alters Aortic Three-Dimensional Outflow Patterns, Wall Shear Stress, and Expression of Aortopathy

Aortic 3-dimensional blood flow was analyzed to investigate altered ascending aorta (AAo) hemodynamics in bicuspid aortic valve (BAV) patients and its association with differences in cusp fusion patterns (right-left, RL versus right-noncoronary, RN) and expression of aortopathy. Four-dimensional flow MRI measured in vivo 3-dimensional blood flow in the aorta of 75 subjects: BAV patients with aortic dilatation stratified by leaflet fusion pattern (n=15 RL-BAV, mid AAo diameter=39.9±4.4 mm; n=15 RN-BAV, 39.6±7.2 mm); aorta size controls with tricuspid aortic valves (n=30, 41.0±4.4 mm); healthy volunteers (n=15, 24.9±3.0 mm). Aortopathy type (0-3), systolic flow angle, flow displacement, and regional wall shear stress were determined for all subjects. Eccentric outflow jet patterns in BAV patients resulted in elevated regional wall shear stress (P<0.0125) at the right-anterior walls for RL-BAV and right-posterior walls for RN-BAV in comparison with aorta size controls. Dilatation of the aortic root only (type 1) or involving the entire AAo and arch (type 3) was found in the majority of RN-BAV patients (87%) but was mostly absent for RL-BAV patients (87% type 2). Differences in aortopathy type between RL-BAV and RN-BAV patients were associated with altered flow displacement in the proximal and mid AAo for type 1 (42%-81% decrease versus type 2) and distal AAo for type 3 (33%-39% increase versus type 2). The presence and type of BAV fusion was associated with changes in regional wall shear stress distribution, systolic flow eccentricity, and expression of BAV aortopathy. Hemodynamic markers suggest a physiological mechanism by which the valve morphology phenotype can influence phenotypes of BAV aortopathy.

Correlation Between Cardiac Tissue Doppler and Peripheral Vascular Doppler in the Anemic Fetus – An Additional Method to Determine the Transfusion Threshold?

To examine the relationship between cardiac tissue Doppler and peripheral vascular Doppler measurements in fetal anemia. We analyzed high frame rate cardiac Tissue Doppler Imaging (TDI) data files of 26 anemic fetuses. The peak systolic tissue velocity (PSV), peak systolic displacement (PD), and peak systolic strain (PS) were determined in the mid-segment of the ventricular walls (ROI 1 right ventricle (RV), ROI 2 left ventricle (LV)) and in the basal segment of the ventricular walls (ROI 3 tricuspid annulus, ROI 4 mitral annulus). TDI parameters were correlated with established fetal vascular Doppler parameters (peak systolic blood flow velocity (Vmax) in the middle cerebral artery (MCA), pulsatility index (PI) in the MCA, in the umbilical artery (UA), and in the venous duct (DV)). The PSV in the LV correlated significantly negatively with the PI in the MCA. Both the PSV and PD in the LV correlated significantly negatively with the PI in the UA. The PS in the RV correlated significantly negatively with the PI in the UA. The left ventricular PSV and PD correlated significantly positively with the PI in the DV. The Vmax in the MCA did not correlate with any systolic myocardial TDI parameter. In fetal anemia, peak systolic myocardial TDI parameters correlate with vascular Doppler parameters, confirming that TDI is a promising method to evaluate myocardial function in the anemic fetus. This suggests combining both techniques to quantify fetal myocardial function in anemia even more accurately, possibly allowing for the determination of the indication for intrauterine transfusion.

Early Effect of Essential Hypertension on the Left Ventricular Twist‐Displacement Loop by Two‐Dimensional Ultrasound Speckle Tracking Imaging

To investigate two-dimensional (2D) ultrasound speckle tracking imaging (STI) in the evaluation of the early changes in the left ventricular (LV) twist-displacement loop in patients with hypertension (EH). Sixty-five EH patients with left ventricular normal geometry (LVN) - including 33 cases with non-left atrial enlargement (NLAE) and 32 cases with left atrial enlargement (LAE) - along with 45 healthy individuals were enrolled in this study. Basal and apical 2D LV short-axis images were acquired and analyzed to obtain the LV rotation (LVrot) and LV radial displacement. Once the LV twist and LV radial displacement were calculated, an LV twist-displacement loop was constructed. Group comparisons between peak twist (Ptw), twist at mitral valve opening (MVOtw), untwisting rate (Utw R), systolic radial displacement (SD), systolic slope (SS), isovolumic relaxation radial displacement (IVRD) and isovolumic relaxation slope (IVRS) were performed. (1) The Ptw and MVOTw were greater in the NLAE and LAE groups when compared to the normal group while the UTw R was lower in likewise comparison. (2) The LV twist was correlated to the radial displacement in systole and in the isovolumic relaxation period. The SS and IVRS were greater in the NLAE and LAE groups when compared to the normal group. The LV twist-displacement loop can be reconstructed noninvasively by 2D ultrasound STI. EH affects the systolic and early diastolic component of the twist-displacement loop by increasing the LV twist and decreasing the LV untwisting respectively impairing LV relaxation. The assessment of the LV twist-displacement loop may be useful in the evaluation of early features of LV dysfunction in EH patients.

Soccer Training Improves Cardiac Function in Men with Type 2 Diabetes

Patients with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular disease, which is worsened by physical inactivity. Subclinical myocardial dysfunction is associated with increased risk of heart failure and impaired prognosis in T2DM; however, it is not clear if exercise training can counteract the early signs of diabetic heart disease. This study aimed to evaluate the effects of soccer training on cardiac function, exercise capacity, and blood pressure in middle-age men with T2DM. Twenty-one men age 49.8 ± 1.7 yr with T2DM and no history of cardiovascular disease participated in a soccer training group (n = 12) that trained 1 h twice a week or a control group (n = 9) with no change in lifestyle. Examinations included comprehensive transthoracic echocardiography, measurements of blood pressure, maximal oxygen consumption (V(˙)O(2max)), and intermittent endurance capacity before and after 12 and 24 wk. Two-way repeated-measures ANOVA was applied. After 24 wk of soccer training, left ventricular (LV) end-diastolic diameter and volume were increased (P < 0.001) compared to baseline. LV longitudinal systolic displacement was augmented by 23% (P < 0.001) and global longitudinal two-dimensional strain increased by 10% (P < 0.05). LV diastolic function, determined by mitral inflow (E/A ratio) and peak diastolic velocity E', was increased by 18% (P < 0.01) and 29% (P < 0.001), respectively, whereas LV filling pressure E/E' was reduced by 15% (P = 0.05). Systolic, diastolic, and mean arterial pressures were all reduced by 8 mm Hg (P < 0.01, P < 0.001, and P < 0.001, respectively). V(˙)O(2max) and intermittent endurance capacity was 12% and 42% (P < 0.001) higher, respectively. No changes in any of the measured parameters were observed in control group. Regular soccer training improves cardiac function, increases exercise capacity, and lowers blood pressure in men with T2DM.

The Impact of the Width of the Tracking Area on Speckle Tracking Parameters—Methodological Aspects of Deformation Imaging

The aim of this study was to analyze the impact of the tracking area width on myocardial wall motion and deformation parameters in 2D speckle tracking. Standardized apical views were acquired in 30 healthy subjects and 15 patients with left ventricular systolic dysfunction using 2D echocardiography. Longitudinal peak systolic strain (PSS), longitudinal peak systolic strain rate (PSSR), postsystolic index (PSI), peak longitudinal (PLD), and peak transverse displacement (PTD) were determined by 2D speckle tracking to analyze the impact of the tracking area width on global and regional myocardial wall motion and deformation parameters. The dimension of the tracking area has a significant impact on all parameters. With increasing width of the tracking area higher values of PSS, PSSR, PSI, and lower values of PLD and PTD were determined. With increasing width of the tracking area a significant number of segments were not tracked. In summary, especially global PSS is significantly influenced by the width of the tracking area. The strain values determined by 2D speckle tracking are significantly influenced by the tracking area width. The tracking of the subendocardial layers only results in lower global strain values than tracking the complete ventricular wall using the medium or wide tracking area widths. The tracking quality in the far field is worse if the tracking area is too wide. The present data show that standard and reference values of deformation imaging should include detailed information about the position and the width of the tracking area.

Mild Expression of Mitral Valve Prolapse in the Framingham Offspring: Expanding the Phenotypic Spectrum

Mitral valve (MV) prolapse (MVP) is a common disorder associated with mitral regurgitation, endocarditis, heart failure, and sudden death. Nondiagnostic morphologies have been described in the familial context and may represent early expression of MVP in those genetically predisposed. The aim of this study was to explore the spectrum of MVP abnormalities in the community and compare their clinical and echocardiographic features. We measured annular diameter MV leaflet displacement, thickness, anterior and posterior leaflet projections onto the annulus, MV leaflet coaptation height (posterior MV leaflet projection/annular diameter), and MR jet height in 296 individuals of the Framingham Offspring Study with MVP (n= 77), the "abnormal anterior coaptation" (AAC) phenotype (n= 11) or "minimal systolic displacement" (MSD) (n= 57), and 151 age-matched and sex-matched referents with no MVP or its nondiagnostic forms. AAC did not meet diagnostic displacement criteria but resembled MVP with regard to annular diameter and leaflet thickness (P > .05 for both). AAC was similar to posterior MVP with regard to posterior leaflet asymmetry and an anteriorly shifted coaptation (P= .91). Compared to patients with MSD and referents, patients with AAC had greater leaflet coaptation height, thickness, and annular diameter (P < .05 for all). MSD shared the posterior leaflet asymmetry with MVP, but the coaptation point was more posterior (coaptation height= 31% vs. 42%, P < .0001), as seen in referents. A higher proportion of patients with MVP had jet height ≥ 2 mm (mild or greater MR) compared with the other participants (44% vs. 16%, P < .0001). Nondiagnostic morphologies are observed in the community and share the common feature of posterior leaflet asymmetry with MVP. AAC and MSD may thus represent early expressions of MVP. Longitudinal studies are warranted to elucidate the natural history of these phenotypes.

Tissue Doppler imaging in very preterm infants during the first 24 h of life: an observational study

BackgroundVery preterm newborn infants often need cardiovascular support. More knowledge about myocardial function and factors that influence the immature myocardium may be helpful for optimising cardiovascular support in these infants.ObjectiveSerial...

Usefulness of segmental tissue doppler imaging in predicting outcome in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Purpose: To investigate the prognostic value of segmental Tissue Doppler Imaging (TDI) after an ST-elevation myocardial infarction (STEMI). Method: In total 391 patients were admitted with a STEMI. Echocardiography was performed median 2 days after the STEMI. The longitudinal systolic (s'), early diastolic (e') and late diastolic (a') myocardial velocities together with the maximal longitudinal systolic displacement (LD) were measured by color TDI at 6 mitral annular sites. Median-follow-up: 25 months. Primary endpoint: Death, heart failure or a new myocardial infarction. Results: Using the mean value of s', e', a' and LD at each of the 6 myocardial segments as cutoff, each segment was classified as high or low segmental s', e', a' or LD, respectively. Patients were stratified into three groups defined by having 4 segments with low s', e', a' or LD, respectively. Patients with >4 segments with low s', e' or LD had more than two times the risk of the combined endpoint, than patients with <2 myocardial segments of low s', e' or LD, respectively (s': HR 2.52, p=0.007; e': HR 2.66, p= 0.001; LD: HR 2.78, p<0.001). The septal and inferior myocardial segments seemed to provide most prognostic information, since only the TDI parameters obtained from these two segments generally remained as independent predictors of the combined endpoint after multivariate adjustment (Table). View this table: Segmental TDI parameters as predictors Conclusion: The risk of an adverse outcome increases incrementally with increasing number of impaired myocardial segments determined by TDI for patients with STEMI. Impaired septal and inferior myocardial performances are paramount markers of an adverse prognosis.

Assessment of Age‐Related Changes in Left Ventricular Twist by 3‐Dimensional Speckle‐Tracking Echocardiography

The purpose of this study was to determine the normal value of left ventricular (LV) twist in 3-dimensional (3D) geometry and to study the effects of aging on 3D LV twist by sophisticated newly developed 3D speckle-tracking echocardiographic techniques. Recent developments in miniaturized ultrasound arrays have provided us with high-quality 3D echocardiographic data. Speckle tracking based on 3D images is robust to out-of-plane motion error, whereas 2-dimensional speckle tracking is inherently unable to analyze 3D cardiac motion and may lead to measurement inaccuracies. Three-dimensional LV volumetric images were acquired from 124 healthy volunteers (aged 21-82 years) and were analyzed by a recent speckle-tracking method. Left ventricular twist was analyzed as apical rotation relative to the base in the 3D coordinates. The measured parameters in this study were peak apical rotation, peak basal rotation, peak LV twist, normalized peak LV twist, and peak untwist velocity. As seen from the apex, the normal LV maintains a wringing systolic displacement with an initial counterclockwise rotation followed by a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal twist increases during the aging process, leading to an increased LV twist value. The mean peak twist ± SD in young participants (21-35 years) was 11.73° ± 2.67°, whereas the value for older participants (>65 years) was 18.57° ± 3.08° (P < .001). Three-dimensional speckle-tracking echocardiography can be an effective noninvasive method for assessing 3D LV twist. Age-related differences in the 3D LV twist may be the result of the age-related changes in the endocardial myofibers.

Ventricular Septal Dysfunction After Surgical Closure of Multiple Ventricular Septal Defects

We assessed the global and regional ventricular septal functions using conventional echocardiography and two-dimensional speckle tracking imaging in children with postoperative multiple ventricular septal defects. Thirty-six children were studied: 16 with postoperative multiple ventricular septal defects and 20 normal control subjects. In children with multiple ventricular septal defects, 60 ventricular septal defects were closed using one of three different techniques (patch closure, the sandwich technique, direct closure). Speckle tracking imaging was applied to three short-axis echocardiographic images. The total patch area used in the multiple ventricular septal defects group was correlated with the postoperative ejection fraction (r=0.703) and Tei index (r=0.778). The global septal peak systolic radial displacement and global septal peak systolic radial strain in the multiple ventricular septal defects group were significantly lower than those observed in the control subjects. The peak systolic radial strain in the segments closed with patches and the peak systolic radial displacement in the segments closed with the felt sandwich technique were significantly lower than those observed in the intact septal segments. No significant regional functional depressions were identified in the segments that were closed directly. The postoperative ventricular global and septal functions were significantly reduced in children with multiple ventricular septal defects, especially in the cases with complex congenital heart disease and that were closed with large prosthetic materials. These results suggest that an effort to minimize the use of patch materials may lead to preserved postoperative ventricular function.

Ventricular Function and Dyssynchrony Quantified by Speckle-Tracking Echocardiography in Patients with Acute and Chronic Right Ventricular Pressure Overload

The aim of this study was to noninvasively investigate right ventricular and left ventricular (LV) adaptation to right ventricular pressure overload in patients with acute pulmonary thromboembolism (APTE) and chronic pulmonary artery hypertension (CPAH). Thirty-seven patients with APTE, 36 patients with CPAH, and 33 controls were retrospectively enrolled. Myocardial deformation and wall motion were analyzed using speckle-tracking strain and displacement imaging echocardiography in the right and left ventricles. The standard deviation of the heart rate-corrected intervals from QRS onset to peak systolic strain and peak systolic displacement (PSD) for the six segments was used to quantify right ventricular and LV mechanical dyssynchrony (peak systolic strain dyssynchrony and PSD dyssynchrony). The myocardial performance index in both ventricles was also evaluated. The APTE and CPAH groups had reduced ventricular performance (LV myocardial performance index, 0.40 ± 0.10, 0.66 ± 0.18 [P < .05 vs controls], and 0.58 ± 0.19 [P < .05 vs controls] in the control, APTE, and CPAH groups, respectively) and large mechanical dyssynchrony (LV longitudinal PSD dyssynchrony, 58 ± 41 msec, 119 ± 49 msec [P < .05 vs controls], and 83 ± 37 msec [P < .05 vs controls and the APTE group] in the control, APTE, and CPAH groups, respectively) in both ventricles. Multiple regression analysis indicated that LV longitudinal PSD dyssynchrony in the APTE group and the LV eccentricity index in the CPAH group were independent determinants of LV myocardial performance index. Pathophysiologic mechanisms that regulate ventricular performance vary depending on whether the ventricles are exposed to acute or chronic right ventricular pressure overload.

PRELIMINARY CLINICAL STUDY OF LEFT VENTRICULAR GLOBAL SYSTOLIC FUNCTION IN PATIENTS WITH CORONARY ARTERY HEART DISEASE BY AUTOMATED MOTION TRACKING OF MITRAL ANNULAR DISPLACEMENT

ObjectivesTo assess the left ventricular global systolic function in patients with coronary artery heart disease by automated motion tracking of mitral annular displacement (TMAD).Methods30 patients (20 males and 10 females,...