Tissue Doppler-derived Strain Research Articles

IMPACT OF SINGLE-PILL COMBINATION OF VALSARTAN/AMLODIPINE ON LEFT VENTRICULAR HYPERTROPHY AND MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED HYPERTENSIVE PATIENTS

Objective: to investigate effects of single-pill combination (SPC) of valsartan/amlodipine (V/A) on left ventricular (LV) and left atrial (LA) myocardial stiffness (MS) parameters and LV mass index (LVMI) in the middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases. Design and method: Retrospective, cohort, open-label study. According to the medical records data a group of naïve patients 40–65 years old with stage II grade 1–2 EAH (n = 38, mean age 49.7 ± 7.0 years) was retrospectively formed. All the patients were treated with V/A SPC and all of them had achieved target office blood pressure (BP) <140/90 mmHg. In all included patients clinical and echocardiographic data (acquired using Vivid 7 Dimension system, GE) were available at baseline and on 12th week after reaching the target BP. LVMI, diastolic interventricular septum thickness (IVS) and diastolic LV posterior wall thickness (PWT) were used as a measures of LV hypertrophy. LV end-diastolic stiffness, LV end-systolic elastance (ESE), LV diastolic elastance, LA stiffness index, LA expansion index and tissue Doppler-derived LA strain were calculated as MS parameters. 2-D speckle tracking echocardiography data were acquired for determination of LV myocardial global longitudinal peak strain (LV GLPS). Results: at the end of follow-up LV ESE significantly (p < 0.001) decreased from 4.01 ± 1.12 to 3.46 ± 0.88 mmHg/ml. In the subgroup of patients with initially abnormal LV GLPS (less than 19.7%) this parameter significantly (p = 0.005) increased in absolute value from −16.14 ± 2.21 to −17.30 ± 2.13% (+8,45 ± 13.35%). All LV hypertrophy markers significantly decreased (p < 0.001 for all) – LVMI from 113.40 ± 22.24 to 103.52 ± 21.30 g/m2 (−8.58 ± 7.57%), IVS from 1.30 ± 0.20 to 1.23 ± 0.19 cm (−5.38 ± 5.29%) and PWT from 1.03 ± 0.11 to 0.95 ± 0.11 cm (−7.82 ± 9.29%). After the treatment with V/A SPC the number of patients with LV hypertrophy significantly (p = 0.039) reduced from 65.8% to 39.5%. Conclusions: in naïve 40–65 years old patients with stage II grade 1–2 EAH antihypertensive therapy with V/A SPC provides effective BP control, improves LV MS parameters and reduced LV hypertrophy.

BLOOD PRESSURE VARIABILITY AND MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED NAÏVE HYPERTENSIVE PATIENTS

Objective: to assess left ventricular (LV) and left atrial (LA) echocardiographic myocardial stiffness parameters in the middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases in relation to short-term blood pressure variability (BPV). Design and method: Retrospective, controlled study. According to medical records data a group of naïve patients 40–65 years old with stage II grade 1–2 EAH (n = 100, 47.0% men, mean age 51.9 ± 6.5 years) and a group of healthy controls (n = 86, 32.6% men, mean age 48.8 ± 5.8 years) was retrospectively formed. In all included participants clinical, echocardiographic data (acquired using Vivid 7 Dimension system, GE) and ambulatory blood pressure monitoring [ABPM] (BPLab, BP2005–01.04.00.2540, Petr Telegin, Russia) parameters were available. LV end-diastolic stiffness, LV end-systolic elastance, LV diastolic elastance, LA stiffness index (LASI), LA expansion index and tissue Doppler-derived LA strain were calculated as myocardial stiffness parameters. 2-D speckle tracking echocardiography data were used for determination of LV myocardial global longitudinal peak strain (LV GLPS). BPV was estimated as standard deviation based on ABPM reports. Hypertensive patients were divided into 2 subgroups according to median value of day-time systolic BPV (dtSBPV) – 15 mmHg and into 2 subgroups according to median value of night-time systolic BPV (ntSBPV) – 14 mmHg (subgroups of «high» and «normal» dtSBPV and ntSBPV), and study parameters analyzed separately in these subgroups compared to the control group. Results: in hypertensive patients with «high» dtSBPV (n = 59) LV GLPS (−17.5 ± 3.0%) was significantly (p = 0.002) lower in absolute value and LASI (0.17 ± 0.09) was significantly (p = 0.015) higher compared to the controls (respectively, −19.5 ± 2.6% and 0.12 ± 0.06). No significant differences in myocardial stiffness parameters were obtained compared to the controls in hypertensive patients with «normal» dtSBPV and both «normal» and «high» ntSBPV. Conclusions: the present study reveals that higher dtSPBV predispose to increased LV myocardial stiffness in untreated middle-aged patients with stage II grade 1–2 EAH without concomitant cardiovascular diseases in comparison with sex- and age-matched healthy individuals with normal blood pressure.

MYOCARDIAL STIFFNESS AND LEFT VENTRICULAR HYPERTROPHY IN THE MIDDLE-AGED HYPERTENSIVE PATIENTS

Objective: to investigate left ventricular (LV) and left atrial (LA) stiffness parameters in middle-aged patients with grade 1–2 essentiial arterial hypertension (EAH) without concomitant cardiovascular diseases according to the presence of LV hypertrophy (LVH). Design and method: Case-control study. We examined 127 naive patients with uncomplicated grade 1–2 EAH and divided them into two groups according to the LV mass index (LVMI). The first one is included 96 hypertensive patients (HP) with LVH (mean LVMI 125,8 ± 2,1 g/m2, mean age 52,6 ± 0,7 years; mean office blood pressure (BP) 151,9 ± 1,5/93,8 ± 1,1 mm Hg). The second group consisted of 31 patients without LVH (mean LVMI 89,7 ± 2,1 g/m2, mean age 51,3 ± 1,0 years; mean office BP 138,7 ± 2,1/83,5 ± 1,9 mm Hg). 44 healthy individuals (mean age 51,5 ± 1,0 years; mean office BP 120,1 ± 2,0/80,5 ± 1,0 mm Hg) represented the control group. All the patients underwent 24-hours ambulatory BP monitoring. Comprehensive transthoracic echocardiography using Vivid 7 Dimension system (GE) was also performed. LV end-diastolic stiffness, LV end-systolic elastance, LV diastolic elastance, LA stiffness index, LA expansion index and tissue Doppler-derived (TDD) LA strain were calculated. 2-D speckle tracking echocardiography data were acquired for determination of LV myocardial global longitudinal peak strain (LV GLPS). Results: TDD LA strain was significantly higher in HP without LVH (60,01 ± 4,77%) compared to HP with LVH (49,77 ± 1,49%; p < 0,05). LV GLPS was significantly lower in absolute value in HP with LVH (−16,9 ± 0,3%) and HP without LVH (−17,5 ± 0,6%) compared to controls (−19,9 ± 0,4%; p < 0,001 and p < 0,01, respectively). No significant differences between studied groups were obtained in other myocardial stiffness parameters. LV GLPS showed a weak but significant associations with office diastolic BP (r = 0,354; p < 0,01), 24 h systolic BP (r = 0,291; p < 0,05), 24 h pulse pressure (r = 0,296; p < 0,05), and average night-time systolic and diastolic BP (r = 0,343; p < 0,01 and r = 0,262; p < 0,05, respectively). Conclusions: the present study reveals that disturbances in myocardial stiffness parameters occur early, before the development of echocardiographic signs of LHV. They are earlier markers of target organ damage even in middle-aged untreated patients with grade 1–2 uncomplicated EAH.

MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED HYPERTENSIVE PATIENTS IN THE PRESENCE OF OVERWEIGHT OR OBESITY

Objective: to evaluate left ventricular (LV) and left atrial (LA) stiffness parameters in middle-aged patients with arterial hypertension grade 1–2 without concomitant cardiovascular diseases in terms of the presence of overweight or obesity. Design and method: Case-control study. We examined 127 naive patients with uncomplicated essential arterial hypertension grade 1–2 and divided them into three groups in accordance with body mass index (BMI) values. The first one is included 19 patients with normal weight - mean BMI 23,2 ± 0,2 kg/m2, mean age 50,6 ± 1,0 years; 7 men; mean office blood pressure 142,1 ± 3,6/ 83,2 ± 2,5 mm Hg). The second group consisted of 52 patients with overweight - mean BMI 28,0 ± 0,2 kg/m2, mean age 53,1 ± 1,0 years; 26 men; mean office blood pressure 147,9 ± 2,0/ 90,9 ± 1,5 mm Hg). And the third group is included 56 patients with obesity - mean BMI 34,2 ± 0,4 kg/m2, mean age 52,0 ± 0,8 years; 33 men; mean office blood pressure 151,7 ± 2,0/ 94,4 ± 1,5 mm Hg). Comprehensive transthoracic echocardiography using Vivid 7 Dimension system (GE) were performed. LV end-diastolic stiffness, LV end-systolic elastance (ESE), LV diastolic elastance, LA stiffness index, LA expansion index and tissue Doppler-derived LA strain were calculated. 2-D speckle tracking echocardiography data were acquired for determination of LV myocardial global longitudinal peak strain (LV GLPS). Results: LV GLPS was significantly (p < 0,001) lower in absolute value in patients with obesity (−15,6 ± 0,4%) compared with overweight group (−18,0 ± 0,4%) and the patients with normal weight (−18,5 ± 0,5%). LV ESE was significantly lower in patients with obesity (3,75 ± 0,13 mm Hg/ml) compared with overweight persons (4,34 ± 0,16 mm Hg/ml; p < 0,05) and the patients with normal weight (4,81 ± 0,26 mm Hg/ml; p < 0,001). No significant differences between studied groups were obtained in other myocardial stiffness parameters. Conclusions: The present study reveals that obesity leads to increased LV myocardial stiffness in untreated middle-aged patients with uncomplicated arterial hypertension grade 1–2 in comparison with sex-, age- and hypertension history-matched patients with overweight or normal BMI.

Added clinical value of applying myocardial deformation imaging to assess right ventricular function.

Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking-derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler-derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking-derived right atrial strain, right ventricular longitudinal strain-derived mechanical dyssynchrony, and three-dimensional echocardiography-derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use.

Is left ventricular dysfunction reversed after complete alcohol abstinence in asymptomatic alcoholics? A tissue Doppler-derived strain and 2D strain imaging stress echocardiography study

ABSTRACT BACKGROUND: Long-term alcohol abuse exerts a deleterious effect on the myocardium, although clinical manifestations of alcoholic cardiomyopathy are not always present. In the present study we evaluate left ventricular (LV) dysfunction by means of tissue Doppler (TD) derived strain and 2D strain imaging stress echocardiography techniques in asymptomatic alcoholics and examine the reversibility ofLV dysfunction after complete abstinence from alcohol. METHODS AND RESULTS: In 13 chronic alcoholics (9 men, mean age 45±6 years) with mean alcohol consumption 207.7±98.3 g/day over 16.5±6.9 years, dobutamine stress echocardiography (DSE) was performed.LV deformation in 12 segments was assessed using TD velocity and strain and speckle tracking with 2D strain imaging, at baseline as well as at 5, 10, and 20 μg/kg/min stages of dobutamine infusion. The examinations were repeated one month after alcohol discontinuation. LV dimensions, wall thickness and ejection fraction were within normal limits. Grade I diastolic dysfunction was observed in 9 patients. During DSE peak TD systolic velocity was increased significantly in allLV myocardial segments, whereas TD strain and 2D strain did not change significantly in the majority of the myocardial segments. One month’s complete abstinence from alcohol did not lead to any noticeable improvement, since baseline and peak DSE, TD and 2D strain did not progress significantly. CONCLUSIONS: The lack of myocardial strain improvement during DSE may indicate early effects on the myocardium due to chronic alcohol abuse, before clinical manifestations are even present. No reversibility ofLV dysfunction was observed after complete abstinence from alcohol for one month.

Assessment of myocardial performance in preterm infants less than 29 weeks gestation during the transitional period

BackgroundThe transitional circulation and its effect on myocardial performance are poorly understood in preterm infants. AimsWe assessed myocardial performance in infants less than 29weeks gestation in the first 48h of life using a comprehensive echocardiographic assessment. DesignInfants <29weeks gestation were prospectively enrolled. Small for gestation, infants on inotropes and/or inhaled nitric oxide and septic infants were excluded. Conventional echocardiography, left ventricular (LV), septal and right ventricular (RV) tissue Doppler imaging (TDI) and tissue Doppler-derived strain and strain rate (SR), tricuspid annular plane systolic excursion (TAPSE) and global RV fractional area change (FAC) were assessed at a median of 10 and 45h post-delivery. ResultsFifty-four infants with a median [IQR] gestation and birth weight of 26.5 weeks [25.8–28.0 weeks] and 915 g [758–1142 g] were included. There was no change in shortening or ejection fraction across the two time points. Systolic and diastolic TDI of the LV, septum and RV increased across the two time points (all p values≤0.01). There was an increase in septal peak systolic and early diastolic SR (p=0.002). Septal systolic strain and late diastolic SR did not change. With the exception of RV strain and early diastolic SR, all RV functional parameters including SR, late diastolic SR, TAPSE, and FAC increased across the two time points (all p values<0.01). ConclusionDescribing the normal hemodynamic adaptations in stable preterm infants during the transitional period provides the necessary information for the assessment of those parameters in various disease states.

Reproducibility and feasibility of right ventricular strain and strain rate (SR) as determined by myocardial speckle tracking during high-intensity upright exercise: a comparison with tissue Doppler-derived strain and SR in healthy human hearts.

This study aimed to establish feasibility for myocardial speckle tracking (MST) and intra-observer reliability of both MST and tissue velocity imaging (TVI)-derived right ventricular (RV) strain (ϵ) and strain rate (SR) at rest and during upright incremental exercise. RV ϵ and SR were derived using both techniques in 19 healthy male participants. MST-derived ϵ and SR were feasible at rest (85% of segments tracked appropriately). Feasibility reduced significantly with progressive exercise intensity (3% of segments tracking appropriately at 90% maximum heart rate (HRmax)). Coefficient of variations (CoVs) of global ϵ values at rest was acceptable for both TVI and MST (7–12%), with low bias and narrow limits of agreement. Global SR data were less reliable for MST compared with TVI as demonstrated with CoV data (systolic SR=15 and 61%, early diastolic SR=16 and 17% and late diastolic SR=26 and 31% respectively). CoVs of global RV ϵ and SR obtained at 50% HRmax were acceptable using both techniques. As exercise intensity increased to 70 and 90% HRmax, reliability of ϵ and SR values reduced with larger variability in MST. We conclude that RV global and regional ϵ and SR data are feasible, comparable and reliable at rest and at 50% HRmax using both MST and TVI. Reliability was reduced during higher exercise intensities with only TVI acceptable for clinical and scientific use.

Evaluation of Human Immunodeficiency Virus Infection‐Related Left Ventricular Systolic Dysfunction by Tissue Doppler Strain Echocardiography

Cardiovascular involvement causes significant morbidity and mortality among patients with human immunodeficiency virus (HIV) infection. Since the introduction of highly active antiretroviral treatment (HAART), subtle changes in left ventricular (LV) function, which may be clinically silent, have become more pronounced in HIV patients. Echocardiographic strain imaging (SI) may detect subclinical myocardial dysfunction at an earlier stage compared with conventional echocardiography. The aim of this study was to evaluate tissue Doppler-derived LV strain and strain rate (SR) along with conventional measures of LV function in asymptomatic, stable adult HIV patients on HAART. Twenty-one patients with HIV infection (mean age: 37.8 ± 11.9 years, 11 males) who had no cardiovascular complaints and 27 healthy volunteers (mean age: 40.9 ± 5.8 years, 14 males) were enrolled. Traditional parameters including LV ejection fraction (EF) were measured along with tissue velocity imaging (TVI) and tissue Doppler SI parameters using transthoracic echocardiography. The mean duration of HIV infection was 30.8 ± 25.1 (3-120) months. The mean LVEF in HIV group was within normal limits but lower than controls (64.5% ± 10.2% vs. 72.2% ± 6.4%, P = 0.003). There were no differences in other major traditional measures, as well as TVI parameters between groups. LV systolic strain and SR parameters were impaired indicating subtle LV systolic dysfunction in HIV group. No difference in diastolic function was observed between groups. Left ventricular systolic strain parameters may be utilized to demonstrate subtle LV systolic dysfunction in asymptomatic HIV patients.

Tissue Doppler–Derived Strain and Strain Rate during the First 28 Days of Life in Very Low Birth Weight Infants

Preterm infants may have cardiac stress related to patent ductus arteriosus (PDA) or bronchopulmonary dysplasia (BPD). In this study, we examined the development of cardiac function in preterm infants by measuring tissue Doppler-derived peak systolic strain (PSS) and strain rate (PSSR) in the first 28 days of life. Peak systolic strain and strain rate were measured in series in the free wall of the right (RV) and left (LV) ventricles on days 1, 7, 14, and 28 of life in 119 preterm infants <1500 g birth weight along with weight, heart rate, and presence of hemodynamically significant (hs) PDA or BPD. Both were assigned retrospectively. HsPDA was defined as a PDA requiring intervention whereas BPD was determined based on an infant's need for supplemental oxygen at 36 weeks of gestational age. Peak systolic strain and strain rate of the RV rose significantly during the first 28 days of life (P < 0.01). Infants who developed BPD had significantly lower RV free wall PSS on days 14 and 28 (P < 0.01 and <0.05). HsPDA resulted in a significantly lower PSS in the LV free wall as of day 14 (P < 0.01). After PDA intervention (day 28), LV PSS remained significantly lower (P < 0.05), but showed a tendency to increase (P = 0.18). Peak systolic strain determined in preterm infants appears to reflect increased afterload (decreased RV PSS in BPD infants) and increased preload (decreased LV PSS in hsPDA infants). The merits of such measurements as a basis for making clinical decisions still need to be explored.

Right ventricular involvement in anterior myocardial infarction: a tissue Doppler-derived strain and strain rate study

OBJECTIVE:Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction.METHODS:The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained.RESULTS:The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant.CONCLUSION:Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rate

Reproducibility and Optimization of Analysis Parameters of Tissue Doppler-Derived Strain and Strain Rate Measurements for Very Low Birth Weight Infants

To assess the effects of region of interest (ROI) size and strain length (SL) on the quality of analysis and to determine the feasibility and reproducibility of tissue Doppler-derived cardiac strain (S) and strain rate (SR) measurements for preterm infants <1500g birth weight. The beat-to-beat variation (BBV) for different combinations of ROI width (RW), ROI length (RL), and SL was determined from 60 good quality images of left and right free walls and the interventricular septum. We examined the impact of RW, RL, and SL on BBV and estimated inter- and intra-operator variability. BBV was smallest for RW=2mm. Raising SL (even at the cost of RL) led to a decrease in BBV. Several combinations provided a low BBV without significant difference. Coefficients of variation for intra- and inter-operator variability ranged from 15.1% to 65.2%. Both were lower for systolic than for diastolic values. Tissue Doppler imaging-derived S and SR measurements are feasible in very low birth weight infants. Reproducibility is comparable to older infants for systolic S and SR. For optimal analysis quality, SL and RW should be high while RL should be small (though inside segment size). Best results were obtained with RW=2mm, RL=1mm, and SL=6mm.

Acute sleep deprivation in healthy adults is associated with a reduction in left atrial early diastolic strain rate

Sleep deprivation (SD) is known to be associated with adverse cardiovascular events. Strain and strain rate measure the local deformation of the myocardium and have been used to evaluate atrial phasic function in various disease states. The aim of the study was to investigate whether strain rate imaging enables the identification of left atrial dysfunction in otherwise healthy young adults with acute SD which has not been studied previously. Adequate echocardiographic images of 27 healthy volunteers were obtained both after a night with regular sleep and after a night with SD. Tissue Doppler-derived strain and strain rate were measured from the apical four- and two-chamber views of the left atrium, and global values were calculated as the mean of all segments. Measurements included peak systolic strain, systolic strain rate (S-Sr), early diastolic (E-Sr) and late diastolic (A-Sr) strain rate. Phasic left atrial (LA) volumes and fractions were also calculated. There was no significant difference in the traditional parameters of atrial function and LA volumes. Subjects had similar S-Sr, A-Sr and global atrial strain values after the night of sleep debt when compared after regular sleep, whereas they had significantly reduced E-Sr values (mean (SD) 3.2 (0.7) s(-1) vs 3.7 (0.6) s(-1), p < 0.001). Moreover, global E-Sr showed a significant correlation with sleep time (r = 0.554, p < 0.001). Acute SD in healthy adults is associated with a reduction in LA early diastolic strain rate in the absence of geometric alterations or functional impairment of the left atrium, raising the possibility that chronic SD may more profoundly affect LA function and thereby promote the occurrence of atrial fibrillation.

Longitudinal Left Ventricular Function for Prediction of Survival in Systemic Light-Chain Amyloidosis: Incremental Value Compared With Clinical and Biochemical Markers

The aim of the study was to determine whether longitudinal left ventricular (LV) function provides prognostic information in a large cohort of patients with systemic light-chain (AL) amyloidosis. AL amyloidosis is associated with a high incidence of cardiovascular events. Reduced myocardial longitudinal function is one of the hallmarks of myocardial involvement in this rare disease. Two hundred six consecutive patients with biopsy-proven AL amyloidosis were investigated in this prospective observational study. Echocardiographic imaging parameters, mean tissue Doppler-derived longitudinal strain (LS), and two-dimensional global longitudinal strain (2D-GLS) of the LV, cardiac serological biomarkers, and comprehensive clinical disease characteristics were assessed. The primary endpoint was all-cause mortality or heart transplantation. After a median follow-up of 1207 days, LS and 2D-GLS were significant predictors of survival in AL amyloidosis. The cutoff values discriminating survivors from nonsurvivors were -10.65% for LS and -11.78% for 2D-GLS. In a multivariable echocardiographic Cox model, only diastolic dysfunction and 2D-GLS remained as independent predictors of survival. In comprehensive clinical models, 2D-GLS (p < 0.0001), diastolic dysfunction (p < 0.01), the pathologic free light chains (p < 0.05), cardiac troponin-T (cTnT) (p < 0.01), and the Karnofsky index (p < 0.001) remained as independent predictors. 2D-GLS delineated a superior prognostic value compared with that derived from pathologic free light chains or cTnT in patients evaluated before firstline chemotherapy (n = 113; p < 0.0001), and remained the only independent predictor besides the Karnofsky index in subjects with preserved LV ejection fraction (≥50%; n = 127; p < 0.01). LS and 2D-GLS both offered significant incremental information (p < 0.001) for the assessment of outcome compared with clinical variables (age, Karnofsky index, and New York Heart Association functional class) and serological biomarkers. In the largest serial investigation reported so far, reduced LV longitudinal function served as an independent predictor of survival in AL amyloidosis and offered incremental information beyond standard clinical and serological parameters.

Decreased Mechanical Function of Left Atrium Assessed by Speckle Tracking and Tissue Doppler Echocardiography in Patients with Congestive Heart Failure

Mechanical dysfunction of left atrium (LA) could be documented by tissue Doppler and speckle tracking echocardiography in patients with congestive heart failure (CHF). This study included 28 CHF, 46 untreated hypertension (HT), and 52 normal (NM) individuals with normal sinus rhythm. LA volumes and emptying fraction (LAEF) were measured by biplane area-length method. Peak LA strain (LAS) and strain rate (LASR) measured from speckle tracking echocardiography were identified as the peak negative deflection after P-wave. Tissue velocity (LATV) and tissue Doppler-derived strain (LATS) of LA were also used as indices of LA mechanical function. LAEF, LAS, LASR, LATV, and LATS were significantly lower in CHF than in HT and NM. After multivariate analysis controlling for age and sex, LAS, LASR, and LATV were still significantly lower in CHF. LASR was significantly correlated with LAEF. In conclusion, LA mechanical function was decreased in patients with CHF.

Atrial strain rate is a sensitive measure of alterations in atrial phasic function in healthy ageing

ObjectiveStrain and strain rate measure local deformation of the myocardium and have been used to evaluate phasic atrial function in various disease states. The aim of this study was to...

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.

Two-dimensional speckle tracking echocardiography for the assessment of atrial function

Echocardiography is the most common diagnostic method for assessing atrial function but the technique has some limitations. Traditionally, assessment of left atrial function has been performed by measuring volumes with 2D echocardiography. Additionally, it can be assessed with transmitral Doppler and pulmonary vein Doppler. Recently, an alternative method has been incorporated, namely, measurement of myocardial deformation with color tissue Doppler-derived strain. However, this method has several limitations, such as suboptimal reproducibility, angle-dependence, signal artifacts and the fact that it only measures regional strain and does not obtain information about the curved portion of the atrial roof. To overcome these limitations in the quantification of atrial function, the use of speckle tracking echocardiography (STE) strain has been proposed. This technique is not derived from Doppler but rather from 2D echocardiography; it is angle-independent and allows one to measure global as well as regional atrial strain. In this editorial, we describe the physical and pathophysiological concepts of STE and underline the clinical usefulness of this new technique.

Echocardiography and a quest of the promised land of the accurate assessment of cardiac mechanics

This editorial refers to ‘Feasibility and reproducibility of left ventricular rotation parameters measured by speckle tracking echocardiography’ by Bas M. van Dalen et al ., pp. 669–76, ‘Interpretation of two-dimensional and tissue Doppler-derived strain (1) and strain rate data: is there a need to normalize for individual variability in left ventricular morphology?’ by David Oxborough et al ., pp. 677–82, and ‘Echocardiographic assessment of left ventricular untwist rate: comparison of tissue Doppler and speckle tracking methodologies’ by V. Ferferieva et al ., pp. 683–90, in this issue. Echocardiography is in the midst of revolution. Its cause is the emergence of the new techniques to quantify segmental systolic and diastolic function. However, as in all revolutions, ‘old’ ways may be held in low esteem, whereas ‘new’ ways are held in awe, although frequently with insufficient information to support these views. Early in this last decade, we witnessed the emergence of segmental strain measurements based on tissue Doppler imaging (TDI). While initial studies showed good correlation with magnetic resonance imaging, later studies demonstrated that, compared with assessment of velocities, variability in the measurement of strain was much higher. Additionally, this new method required defining normal ranges of segmental strain as functions of age, gender, and wall location within the heart, work that has not yet been fully completed.1 Fast on the heels of TDI-based strain, speckle tracking echocardiography (STE) has been introduced, …

Effects of exercise intervention on myocardial function in type 2 diabetes

Objective:To identify the effects of a 1-year exercise intervention on myocardial dysfunction in patients with type 2 diabetes mellitus (T2DM).Design:Randomised controlled trial, the Diabetes Lifestyle Intervention Study.Setting:University hospital.Patients:223 T2DM patients...