Tissue Doppler Imaging Echocardiography Research Articles

Echocardiographic assessment of cardiovascular involvements in children with cystic fibrosis

BackgroundOver the past four decades, numerous case reports and clinical studies have highlighted the presence of heart disease in individuals with cystic fibrosis. Given the limited information in this field and the imperative to identify early changes during childhood, our study aims to explore cardiac dysfunction in patients with cystic fibrosis using echocardiography. MethodsIn this case-control study, we examined echocardiographic findings from thirty-three patients with cystic fibrosis and sixty healthy children. Demographic information for both groups was recorded, and the disease severity in patients was assessed using the Schawachman criterion. M-mode, Doppler flow velocity, and Tissue Doppler Imaging echocardiography were performed for all participants, with subsequent data analysis using SPSS 24. ResultsOur study encompassed thirty-three CF patients and sixty healthy children. The estimated pulmonary artery blood pressure (systolic and mean) in patients with cystic fibrosis was significantly higher than in the control group (P < 0.05). Additionally, the mean trans-tricuspid peak early to late diastolic flow velocity (E/A) was significantly lower in the case group than the control group (P < 0.05), along with a significantly lower mean tricuspid valve deceleration time (DT) (P < 0.05). Similarly, the mean TAPSE in the case group was notably lower than in the control group (P < 0.05). No significant difference in Mean left ventricular Ejection Fraction (EF) and Fractional Shortening (FS) existed between the two groups (P > 0.05). Furthermore, Trans-mitral peak early to late diastolic flow velocity (E/A) in the case group was significantly lower than in the control group (P < 0.05), and the mean mitral valve DT in the case group was also significantly lower (P < 0.05). ConclusionOur study findings indicate the presence of some degree of right ventricular dysfunction in children with cystic fibrosis. This finding may have implications for the development or modification of clinical guidelines for managing cystic fibrosis in children. Further investigations are recommended to elucidate the underlying mechanisms and contributing factors, providing valuable insights for clinical management.

Early echocardiographic signs of cardiovascular affection in pediatric familial hypercholesterolemia

Familial hypercholesterolemia (FH) is a rare autosomal dominant genetic disorder caused by defective low-density lipoprotein (LDL) receptors or abnormal apolipoprotein B. FH raises the risk of premature atherosclerotic disease and cardiovascular death in young adults. However, cardiovascular affection in children needs to be more adequately studied. Our study aimed to evaluate the effect of hypercholesterolemia on the cardiovascular system of pediatric patients with homozygous FH using conventional and advanced echocardiographic parameters such as tissue Doppler imaging (TDI) and 2-dimensional speckle-tracking echocardiography (2D-STE). This case-control study matched 25 healthy children with 21 patients with homozygous FH. Both groups had conventional echocardiography, TDI, and 2D-STE. Myocardial velocities of the left and right ventricles, left ventricular strain, and aortic stiffness parameters were measured. The FH group had greater systolic blood pressure, dilated coronary arteries, and hypertrophied left ventricle (LV) compared to the control (P = 0.0001, P = 0.001, P = 0.01, respectively). The mitral E/E′ ratio was higher in the patient group than in the control group (P = 0.007), indicating LV diastolic dysfunction in patients. At the same time, LV systolic function evaluated by 2D-STE was comparable to that in the control group. The abdominal aorta circumferential strain and ascending aorta M-mode-derived strain were significantly lower in patients compared to those in the control (P = 0.024, P = 0.0001, respectively), indicating increased aortic stiffness in the patients’ group; moreover, 85.7% of patients had mild aortic insufficiency. Conclusion: Mild aortic insufficiency, coronary artery dilatation, left ventricular (LV) diastolic dysfunction, and increased aortic stiffness are among early cardiovascular markers in pediatric patients with homozygous FH before impaired LV systolic function.What is Known:• Familial hypercholesterolemia (FH) in adults is associated with accelerated atherosclerosis, aortic valvopathy, dilated coronary arteries, ischemic heart disease, and premature cardiovascular death.• The cardiovascular effects of FH in children require additional research.What is New:• Pediatric patients with familial hypercholesterolemia tend to have an early affection for left ventricular diastolic function before the affection for the systolic function.• The diastolic dysfunction associated with pediatric FH is correlated to the aortic stiffness and low-density lipoprotein levels.

Midterm follow-up of healthy young adults with moderate to severe COVID-19: pulmonary and extrapulmonary disease sequelae

BackgroundFollow-up studies on coronavirus disease 2019(COVID-19) were mainly focused on short-term sequelae in patients with comorbid diseases. The aim of this study was to investigate the pulmonary and extrapulmonary sequelae of moderate to severe COVID-19 in the midterm follow-up of healthy young adults.MethodsIn this prospective cohort study, we used the hospital information system (HIS) to identify patients who had recovered from moderate to severe COVID-19 without comorbidity. All eligible patients were invited to participate in the study. Participants were asked to fill out a set of questionnaires to evaluate fatigue, anxiety, and post-traumatic stress disorder (PTSD). They also underwent chest computed tomography (CT) scan, pulmonary function test (PFT), and tissue doppler imaging (TDI) echocardiography. A blood sample and a 12-lead electrocardiogram (ECG) were obtained.ResultsA total of 50 recovered patients and 12 healthy controls were enrolled in the study. Fifteen out of 50 patients received intensive care. Patients had significantly higher fatigue and anxiety scores than controls. PTSD criteria were met in 29 out of 50 patients. Ground glass opacities, nodules, and subpleural lines were the most frequent abnormalities in chest CT scans of patients. Patients had significantly lower left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) than controls (P value 0.019 and < 0.001, respectively).ConclusionsAccording to our findings, COVID-19 survivors might experience anxiety, fatigue, PTSD, pulmonary impairment, leading to reduced cardiac function up to 6 months after discharge.

Assessment of biventricular myocardial systolic function in COVID-19 patients: A Tissue Doppler Imaging echocardiography study

AbstractBackgroundThe 2019 novel coronavirus disease (COVID-19) has been reported as pandemy and the number of patients continues to rise. Based on recent data, cardiac injury is a prominent feature of the disease, leading to increased morbidity and mortality. In the present study we aimed to evaluate myocardial dysfunction using transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI) in hospitalized COVID-19 patients.Methods and ResultsWe recruited 30 patients (56.7% male, 55.80 ± 14.949 years) who were hospitalized with the diagnosis COVID-19 infection. We analyzed left ventricular (LV) and right ventricular (RV) conventional and TDI parameters at the time of hospitalization and during the course of the disease. Patients without any cardiac disease and with preserved LV ejection fraction (EF) were included. TTE examination was performed and all the variables were recorded and analyzed retrospectively.We observed that both LV and RV conventional echocardiographic parameters were similar when the day of admission to the hospital was compared to the 5th day of the disease. Regarding TDI analysis, we demonstrated significant impairment in LV septal and lateral deformation (P &lt; 0.001). In the correlation analysis no marked correlation was observed between impairment in LV deformation and inflammation biomarkers.ConclusionCardiac involvement is an important feature of the COVID-19 infection but the exact mechanism is still undefined. Echocardiography is an essential technique to describe myocardial injury and provide new concepts for the possible definitions of cardiac dysfunction.

The Role of Advanced Imaging in Paediatric Cardiology: Basic Principles and Indications

Tissue Doppler Imaging and Speckle Tracking Echocardiography are newer echo-cardiographic modalities, that assess myocardial and valvular function in congenital and acquired heart diseases in childhood. In addition, cross-sectional imaging including Cardiac Magnetic Resonance (CMR) and Cardiac Computed Tomography has been widely used over the last decade in paediatric cardiology, in order to evaluate intra-cardiac and extra-cardiac anatomy. Cardiac Magnetic Resonance particularly allows detailed analysis of myocardial function, and shunt quantification and has applications even in fetal life. This mini-review summarizes the basic principles of the above-advanced modalities and highlights their main indications and clinical applications in childhood.

Using Mitral Annular Plane Systolic Excursion (MAPSE) and Tissue Doppler Imaging Systolic Velocity (TDIS’) As Surrogates of Left Ventricular Systolic Function

Purpose: Echocardiography has become a useful method for assessing structural diseases of the heart. MAPSE and TDI S’ have also been shown to be reproducible assessments of longitudinal heart changes as LVEF is ineffective in cases of sub-optimal echocardiographic imagery caused by artefacts or air trapping.&#x0D; Methodology: One hundred patients referred for echocardiography at the cardiac laboratory of DELSUTH, Oghara, Nigeria was recruited for the study. All patients had trans-thoracic echocardiography done with M-Mode, 2D and Spectral Doppler and Tissue Doppler echocardiographic images acquired. Data obtained was analyzed using IBM-SPSS version 22. A p-value of ≤0.05 was considered significant for all comparisons.&#x0D; Findings: Hypertension was the commonest indication for an echocardiogram. The prevalence of abnormal left ventricular function was 13%, 24% and 28% as determined using LVEF, TDI S’ and MAPSE. MAPSE had a higher specificity than TDI S’ with statistically significant correlations found between TDI S’ (p&lt;0.001); MAPSE (p=0.032) and LVEF. Multiple linear and binomial logistic regression analysis showed significant relationships (beta=0.423; p &lt;0.001) and odd ratios [OR(CI) = 10.80(2.56- 49.07)] respectively between TDI S’ and LVEF.&#x0D; Unique Contribution to Theory, Policy and Practice: MAPSE’s specificity allows for diagnosis of longitudinal heart functional changes even in cases where the LVEF may be within normal limits. A combination of both MAPSE and TDI S’ offer a greater prognostic significance. The correlation between MAPSE and TDI S’ were good. Thus, MAPSE and TDI S’ can serve as surrogates for LVEF in assessing left ventricular systolic function and prognosticating cardiac disease

Down syndrome patients with normal hearts: are they really normal?

Even though congenital heart disease is a common finding in down syndrome (DS) patients, some of them have anatomically normal hearts. However, the term "normal" might not be suitable, as these patients usually suffer from functional cardiac dysfunction. Several research highlighted that despite the absence of anatomical heart defects, subtle cardiac function derangements are present in DS patients. We aim to assess cardiac functions by Two-dimensional echocardiography and tissue Doppler imaging (TDI) in pediatric DS patients who have anatomically normal hearts. One hundred seventy-two patients with karyotyping confirmed DS with anatomically normal hearts and 165 healthy normal control children were enrolled in the current study. Their cardiac functions were assessed using both 2-dimensional echocardiography and TDI. Both patients and controls had structurally and anatomically normal hearts. In DS patients, the right side of the heart showed a significant reduction in both systolic and diastolic functions. Systolic dysfunction was evident by significantly decreased levels of Tricuspid annular plane systolic excursion and systolic wave by TDI. Diastolic dysfunction of the right ventricle was evident by prolonged deceleration time by conventional echocardiography and a significant decrease in annular tissue doppler velocity during early diastole/late diastole ratio by TDI. The E/De ratio was significantly increased. Even with anatomically normal hearts, DS patients should undergo cardiac function assessment by echocardiography & TDI. TDI is superior to conventional echocardiography in detecting subtle cardiac dysfunction especially left ventricular diastolic dysfunction in DS patients. TDI showed a significant decrease in the early/atrial ratio of mitral valve annulus and prolongation of left ventricle isometric relaxation time in DS children. Also, the left ventricle E/De ratio was prolonged denoting elevated filling pressures and diastolic dysfunction. This indicates that the TDI has higher sensitivity to detect diastolic dysfunction than conventional Echocardiography. Biventricular TDI-derived myocardial performance index was found to be significantly increased in DS children.

Role of P Wave Duration and Tissue Doppler Imaging as Predictive Indicators for Paroxysmal Atrial Fibrillation in Hypertensive Patients

Background: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the heart. AF accounts for one-third of rhythm disorder hospitalizations. AF increases profoundly the risk of stroke, heart failure, and death. This study used P-wave and transthoracic echocardiography with tissue Doppler imaging (TDI) to determine paroxysmal AF predictors in hypertensive individuals.&#x0D; Methods: This case control study was performed on 100 hypertensive adult patients. They were classified into two equal group: Group I included hypertensive patients diagnosed to have paroxysmal AF. Group II (control group) included hypertensive patients with normal sinus rhythm. All subjects were subjected to electrocardiographic and conventional and tissue Doppler Imaging measurements.&#x0D; Results: Pmax had significantly increased in PAF patients compared to sinus rhythm patients. PAL, PAR, PAI, LR, LI and IR had significantly increased in PAF patients compared to sinus rhythm patients. In Multivariate logistic regression analysis, Pmax, PAL, PAI, PAR, LR, LI and IR were found to be independent predictors for PAF. Therefore, Pmax, PAL PAI, PAR, LR, LI and IR were found to be significant predictors for PAF. Best cut-off values for Pmax, PAL, PAI, PAR, LR, LI and IR were: (118, 81, 61, 49.9, 34, 20 and 16 ms) with sensitivity (76, 96, 96, 88, 82, 86 and 77.5 ), specificity (84, 100, 98, 92, 78, 82 and 76) and the AUC of (0.850, 0.979, 0.987, 0.961, 0.836, 0.891 and 0.798) respectively.&#x0D; Conclusions: Electrocardiographic P-wave analysis and echocardiographic TDI may identify hypertension patients at risk for paroxysmal AF, since the combination of Pmax and TDI may help in predicting the development of AF in hypertensive individuals.

Complementary Value of Tissue Doppler Imaging in Dobutamine Stress Echocardiography: A Prospective Cohort Study

Introduction: In patients with Coronary Artery Diseases (CAD), the presence of viable myocardium predicts the recovery of Left Ventricular (LV) systolic function after revascularisation. The identification of myocardial viability during dobutamine stress echocardiography is subjective and with observer bias. Tissue Doppler Imaging (TDI) echocardiography has opened new possibilities for non-invasive quantification of myocardial function by directly interrogating myocardial velocity with high temporal and spatial resolution. Aim: To determine the baseline regional myocardial and mitral annular Maximum Systolic Velocities (MSV) in patients with LV dysfunction and to compare the MSV values in viable and nonviable myocardium. Materials and Methods: In this prospective Cohort study, TDI of regional and annular LV myocardial velocities was performed at the baseline (at rest) in 352 patients with CAD and LV dysfunction who were referred for Dobutamine stress Echocardiography. Viability assessment by 2 Dimensional (2D) methods was done simultaneously using routine Dobutamine stress protocol. Patients were grouped in two groups based on the presence or absence of viability with 2D stress echocardiography. TDI velocities were compared in the two groups of patients with and without myocardial viability. Measurements of regional wall thickness, Ejection Fraction(EF) and Wall Motion Score Index (WMSI) were done to assess the regional and global LV function in these patients. Those patients who underwent revascularisation were subsequently assessed for functional recovery by 2D and TDI echocardiography before discharge from the hospital. Analyses were conducted using Statistical Package for Social Sciences(SPSS) version 16.0. Results: Among 352 patients studied (124 females and 228 males), mean age 58 years (range 36 to 75 years). A total of 243 patients (69%) with viable myocardium as per 2D echocardiography had higher cut-off Baseline Regional Maximum Systolic Velocity (BRMSV) &gt;0.03 m/s and baseline mitral annular systolic velocity &gt;0.06 m/s with high sensitivity and specificity compared to patients with severe contractile dysfunction and non-viable myocardium. Conclusion: Tissue doppler parameters like regional myocardial systolic and mitral annular velocities have shown significantly higher cut-off values in those patients with ischaemic and viable myocardium compared to non-viable myocardium.

Cardiac function in adolescents and young adults with 22q11.2 deletion syndrome without congenital heart disease

BackgroundDiagnosis and treatment of 22q11.2 deletion syndrome (22q11.2DS) have led to improved life expectancy and achievement of adulthood. Limited data on long-term outcomes reported an increased risk of premature death for cardiovascular causes, even without congenital heart disease (CHD). The aim of this study was to assess the cardiac function in adolescents and young adults with 22q11.2DS without CHDs. MethodsA total of 32 patients (20M, 12F; mean age 26.00 ± 8.08 years) and a healthy control group underwent transthoracic echocardiography, including Tissue Doppler Imaging (TDI) and 2-dimensional Speckle Tracking Echocardiography (2D-STE). ResultsCompared to controls, 22q11.2DS patients showed a significant increase of the left ventricle (LV) diastolic and systolic diameters (p = 0.029 and p = 0.035 respectively), interventricular septum thickness (p = 0.005), LV mass index (p < 0.001) and aortic root size (p < 0.001). 2D-STE analysis revealed a significant reduction of LV global longitudinal strain (p < 0.001) in 22q11.2DS than controls. Moreover, several LV diastolic parameters were significantly different between groups. ConclusionsOur results suggest that an echocardiographic follow-up in 22q11.2DS patients without CHDs can help to identify subclinical impairment of the LV and evaluate a potential progression of aortic root dilation over time, improving outcomes, reducing long-term complications and allowing for a better prognosis.

Evaluation of subclinical myocardial dysfunction using speckle tracking echocardiography in patients with ankylosing spondylitis

Objective: Ankylosing spondylitis is a part of diseases called “seronegative spondyloarthropathy”. Affects the vertebral column, sacroiliac joint and peripheral joints. This chronic rheumatic disorder involved extra -articular parts like Heart, lungs, central nervous system and eyes. Ankylosing spondylitis lead to multiple cardiac complication such as systolic and diastolic dysfunction of left ventricle, valvular involvement , inflammation of aorta and pericardium with enlargement of the heart. Aim of the study: To evaluate of systolic and diastolic left ventricle dysfunction by echocardiography with speckle tracking in ankylosing spondylitis patients. Method: Fifty adult patients with Ankylosing Spondylitis fulfilling the inclusion criteria coming to outpatients of Merjan Medical City were recruited, diagnosed according to the criteria of the American College of Rheumatology criteria; 2D Echocardiography, Tissue Doppler Imaging and Speckle Tracking Echocardiography was done. Statistical analysis of correlation was done with Chi‑square test and t-test, the statistical significance was taken P &lt; 0.05. Results :There was a significant lowering in the mean of global longitudinal strain in ankylosing spondylitis patients than in control ( p = 0.047*).

ASSESSMENT OF DIASTOLIC FUNCTION IN PATIENTS WITH DIABETIC NEUROPATHY

"Diastolic dysfunction" is thought to be an indication of "diabetic cardiomyopathy" ", and "diabetic cardiovascular autonomic neuropathy" is linked to increased mortality risk. The goal of this study was to see how "diastolic dysfunction" and "cardiovascular autonomic neuropathy" are linked both of which were diagnosed in accordance with the guidelines. Methods: We assessed at seventy three participants Whose elective coronary angiography was referred, Diabetes mellitus was present in twenty-six of them, and twenty four of whom had impaired glucose tolerance, the other twenty-three people had normal "glucose tolerance". To identify "cardiovascular autonomic neuropathy", "autonomic function" tests were done, and "tissue Doppler imaging echocardiography" was employed to confirm "diastolic dysfunction". Results Autonomical cardiovascular neuropathy has been detected with diabetes type 2 diabetes in (28.8%) and with glucose-impaired tolerance in 6 (12.5%) patients. "Diastolic dysfunction" was found in 81 and 33 percent of patients with and without "cardiovascular autonomic neuropathy", respectively (P &lt;0.001). "Early diastolic relaxation velocity" (Em) was considerably less in comparison to the group without cardiovascular autonomic neuropathy. ("5.4 0.9 vs. 7.3 2.1 cm⁄ s;P; P 0.001"), Moreover, the E⁄Em ratio was much higher. ("13.6 4.6 vs. 10.3 3.4 cm⁄ s;P, 0.001"). The significance of these data remained after controlling for "age, gender, coronary artery disease, hypertension, and HbA1c". In individuals with and without "cardiovascular autonomic neuropathy", significant "diastolic dysfunction" was found in 33 and 15% of patients, accordingly (P = 0.001).

Detection of diabetic cardiomyopathy in Egyptian children and adolescents with longstanding Type 1 diabetes and evaluating the effect of α-tocopherol supplementation on cardiac functions after 1 year; a single center prospective study.

IntroductionDiabetic cardiomyopathy (DCM) is a serious complication that frequently occurs in patients with type 1 diabetes (T1D) necessitating early diagnosis. The aim of the current study was to detect subclinical DCM in Egyptian children and adolescents with T1D and evaluate the effect of antioxidants on myocardial dysfunction.Material and methodsThe current prospective observational cohort study included 81 T1D patients (9-20 years old) with diabetes duration &gt; 4 years compared to 50 age and sex matched non-diabetic controls. Serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was assessed in addition to conventional echocardiography, tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). Patients with myocardial dysfunction were supplemented with vitamin E (α-tocopherol) as an antioxidant for 1 year, then follow up echocardiography was done.ResultsNT-proBNP was elevated in 73 (90.1%) patients, 50.6% had left ventricular (LV) diastolic dysfunction, 14.8% had right ventricular (RV) diastolic dysfunction, 84% had LV systolic dysfunction and 91.4% had RV systolic dysfunction with statistically significant difference compared to controls. There was a significant negative correlation between LV global longitudinal strain (GLS) and NT-proBNP (p&lt;0.001, r=-0.796). ROC curve analysis showed that NT-proBNP at a cut-off point ≥ 195 ng/ml detected LV systolic dysfunction function with 89.7% sensitivity and 84.6% specificity. Follow up after one year of α-tocopherol supplementation revealed significant improvement in LV systolic and diastolic functions as well as RV systolic dysfunction.ConclusionsNT-proBNP and non-conventional echocardiography were useful in early detection of subclinical cardiomyopathy in patients with T1D. Antioxidant treatment improved subclinical myocardial dysfunction in T1D patients.

Ventricular Myocardial Function and Central Hemodynamics in Patients with Secondary Atrial Septal Defect and Persistent or Paroxysmal Atrial Fibrillation

Background. Atrial fibrillation (AF) is the world’s most frequent arrhythmia associated with significant morbidity and mortality. Non-invasive multimodal imaging provides all necessary information for tactical decisions about radiofrequency catheter ablation and other methods of pharmacological and invasive AF treatment. Survival of patients with congenital heart diseases (CHDs) has grown over the past years. Still, there is a significant gap in evidence-based data regarding management of such patients with AF. Previously in Ukraine there were no studies of echocardiography parameters in patients with CHDs with paroxysmal or persistent AF, namely, those to find predictors for successful AF treatment before atrial septal defect (ASD) surgical or percutaneous closure.&#x0D; The aim. To evaluate ventricular myocardial function and central hemodynamics in patients with secondary ASD and paroxysmal or persistent AF compared to patients with paroxysmal or persistent AF without CHD.&#x0D; Methods. Weexamined54patients(36[66.7%]menand18[33.3%]women)aged61.4±9.8yearswithsecondaryASDand paroxysmal or persistent AF. Control group included 56 patients (38 [67.9%] men and 18 [32.1%] women) without CHD with non-valvular paroxysmal or persistent AF. All the patients underwent transthoracic and transesophageal echocardiography with tissue Doppler imaging and speckle-tracking echocardiography for longitudinal myocardial strain evaluation.&#x0D; Results. The patients in the study and control groups were comparable in terms of age and gender as well as comorbidities and cardiovascular risk factors. There were significant differences in the left heart remodeling indices and central hemodynamics alteration grades, for instance, the patients of the study group had significantly higher grade of left ventricular (LV) hypertrophy. Patients with ASD also had significantly more dilated LV and left atrium (LA) cavities and higher combined indices of LV filling pressure – E/E’ (14.9±4.2 vs. 9.6±5.3, p&lt;0.0001) and E/Vp (2.84±0.44 vs. 2.25±0.61, p&lt;0.0001), explaining more frequent AF in patients with ASD. The study group patients also had significantly higher systolic (sPAP) (52.4±2.8 vs. 44.6±3.2, p&lt;0.0001) and mean (mPAP) (38.6±4.3 vs. 31.7±1.9, p&lt;0.0001) pulmonary artery pressure compared to control group, as well as significantly worse all known indices of right ventricle (RV) myocardial function and right chambers overload. Global RV longitudinal strain strongly correlated with RV fractional area change (r = 0.75; p&lt;0.0001), and especially highly with tricuspid annular plane systolic excursion (r = 0.97; p&lt;0.0001) and tricuspid annular peak systolic velocity S’ (r = 0.98; p&lt;0.0001) during tissue Doppler imaging, making it trustworthy and valuable predictor of RV myocardial dysfunction and its potential restoration after defect correction. Patients with ASD much more often had significant moderate-to-severe functional tricuspid regurgitation (92.6% vs. 53.4%, p&lt;0.0001) with significantly higher central venous pressure indices (16.4±2.4 vs. 10.2±2.5, p&lt;0.0001) as per significantly wider inferior vena cava (IVC) (1.89±0.31 vs. 1.43±0.42, p&lt;0.0001) and it’s higher inspiratory collapse. IVC diameter strongly correlated with integral RV filling pressure (that is, right atrial pressure) index E/E’ (r = 0.98; p&lt;0.0001). Also, study group demonstrated significantly more frequent LA appendage thrombosis (40.7% vs. 21.4%, p=0.029) along with much more marked spontaneous contrast phenomenon and lower LA appendage expulsion rate (26.7±5.1 vs. 34.3±7.2, p&lt;0.0001).&#x0D; Conclusions. Stratification of patients with ASD complicated by paroxysmal or persistent AF for radiofrequency catheter ablation requires thorough echocardiographic examination with targeted certain indices evaluation aiming at earlier intervention in order to earlier diagnosis and invasive or surgical treatment in this specific patient group, namely LV hypertrophy grade, left chambers dilation with LV global systolic function evaluation, pulmonary hypertension grade as per sPAP and mPAP evaluation, as well as combined right chambers overload grade indices, including RV myocardial function by all methods including speckle-tracking echocardiography.

Cardiac MRI and Echocardiography for Early Diagnosis of Cardiomyopathy Among Boys With Duchenne Muscular Dystrophy: A Cross-Sectional Study

BackgroundCardiomyopathy is an important cause of morbidity and mortality in boys with Duchenne muscular dystrophy (DMD). Early diagnosis is a prerequisite for timely institution of cardioprotective therapies.ObjectiveWe compared cardiac MRI (CMRI) with transthoracic echocardiography (TTE) including tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) for diagnosis of cardiomyopathy in early ambulatory boys with DMD.MethodologyThis cross-sectional study was conducted between June 2018 and December 2020. Consecutive boys between 7 and 15 years of age with DMD were enrolled. Percentage ejection fraction (EF), fractional shortening, wall motion abnormalities, early diastolic mitral annulus velocity (Ea), medial mitral annulus ratio (E/Ea), and global strain were measured with STE. CMRI-derived EF, segmental hypokinesia, and late gadolinium enhancement (LGE) were studied and compared.ResultsA total of 38 ambulatory boys with DMD were enrolled. The mean age was 8.8 ± 1.6 years, and none had clinical features suggestive of cardiac dysfunction. In the TTE, EF was ≤55% in 5 (15%), FS was ≤28% in 3 (9%), and one each had left ventricular wall thinning and wall hypokinesia. In TDI, none had diastolic dysfunction, and STE showed reduced global strain of < 18% in 3 (9%) boys. CMRI-derived EF was ≤55% in 20 (53%) boys and CMRI showed the presence of left ventricular wall hypokinesia in 9 (24%) and LGE in 4 (11%) boys.ConclusionCardiomyopathy remains clinically asymptomatic among early ambulatory boys with DMD. A significantly higher percentage of boys revealed early features of DMD-related cardiomyopathy in CMRI in comparison with echocardiography.

Left ventricular function assessment after aortic and renal intervention in Takayasu arteritis by speckle tracking echocardiography: A pilot study

BackgroundOvert left ventricular (LV) dysfunction and congestive heart failure are known entities in Takayasu arteritis (TA). Subclinical LV dysfunction may develop in these patients despite normal LV ejection fraction (LVEF). Moreover, effect of treatment of aortic or renal artery narrowing in such patients is unknown. MethodsThis study included 15 angiographically confirmed TA patients undergoing aortic and/or renal intervention. A comprehensive clinical, biochemical and echocardiographic (2-dimensional, speckle tracking and tissue doppler imaging) evaluation were done at baseline, 72 h, and six months post intervention. ResultsSix patients (40%) had reduced LVEF (<50%) at baseline while rest 9 (60%) patients had reduced global longitudinal strain (GLS) but normal EF. Diastolic filling pattern was abnormal in all the patients. In patients with baseline reduced EF, mean EF improved from 24.62 ± 12.14% to 45.6 ± 9.45% (p = 0.001), E/e’ ratio decreased from 15.15 ± 3.19 to 10.8 ± 2.56 (p = 0.005) and median NT pro BNP decreased from 1673 pg/ml (970–2401 pg/ml) to 80 pg/ml (40–354 pg/ml) (p = 0.001) at 6 months after interventional procedure. In patients with baseline normal EF, median NT pro BNP decreased from 512 pg/ml (80–898.5 pg/ml) to 34 pg/ml (29–70.8 pg/ml) (p < 0.01), mean GLS improved from −8.80 ± 0.77% to −16.3 ± 0.78% (p < 0.001) and mean E/e’ decreased from 12.93 ± 2.63 to 7.8 ± 2.73 (p = 0.005) at 6 months follow up. ConclusionLV dysfunction is common in patients with TA and obstructive lesions in aorta or renal arteries. GLS can be used to assess subclinical systolic dysfunction in these patients. Timely intervention can improve LV dysfunction and can even reverse the subclinical changes.

Do type 1 diabetic children have echocardiographic signs of subclinical cardiac dysfunction?

Background Diabetes mellitus is a major illness in which cardiac problems play a significant role in patient mortality.Objectives We aimed to evaluate whether children with diabetes mellitus type 1 have early echocardiographic signs of subclinical cardiac dysfunction and whether their sex, metabolic control, and duration of diabetes have an effect.Patients and methods A case–control study was performed from January 2022 to November 2022 that included 29 children and adolescents with type 1 diabetes aged from 4 to 15 years. A control group of 15 healthy children was also included. They were recruited from the pediatric endocrinology clinic, Al-Fayoum University Children’s Hospital, Al-Fayoum University, Egypt. Conventional echocardiographic study and tissue Doppler imaging measurements were done.Results With glycated hemoglobin levels less than 7%, the study group of diabetic children had inadequate glycemic control. There was a statistically significant low mean of fractional shortening and high mean of left ventricular septal wall thickness in diastole among diabetic children in comparison with controls, with P values of 0.04 and 0.038, respectively, but still within normal range.Conclusion Children with diabetes have poor glycemic control and scanty echocardiographic evidence of subclinical cardiac dysfunctions. According to the study, cardiac dysfunction in children with diabetes is uncommon. For the early identification of any potential cardiac dysfunctions, distant periodic cardiac examination using both conventional and tissue Doppler echocardiography is advised.

Preliminary assessment of left ventricular function by tissue Doppler imaging and two-dimensional speckle tracking echocardiography in horses with equine metabolic syndrome

Preliminary assessment of left ventricular function by tissue Doppler imaging and two-dimensional speckle tracking echocardiography in horses with equine metabolic syndrome

Early myocardial functional abnormalities in primary dyslipidemia: clinical and echocardiographic observations in young children from a highly consanguineous population.

Background Dyslipidemia is a major health problem among children and adolescents worldwide due to its significant association with cardiovascular disease. Primary dyslipidemias are commonly familial syndromes that can be completely asymptomatic.Purpose Apart from the risk of coronary artery disease (CAD), limited data are currently available on the direct effects of dyslipidemia on myocardial function in children.Methods We recruited 25 children with primary dyslipidemia (14 with isolated hypercholesterolemia, 4 with isolated hypertriglyceridemia, and 7 with combined dyslipidemia). Relevant clinical manifestations and laboratory and radiological investigations were evaluated. Pulsed-wave Doppler and tissue Doppler imaging echocardiography were performed for all recruited patients and the results were compared with those of 15 age- and sex-matched healthy children.Results The median age of the dyslipidemic children was 8 years (range, 1.5–16 years). A family history was documented in 13 cases (52%), while 18 (72%) had consanguineous parents. None of the dyslipidemic children had a personal history or clinical manifestations of CAD. In contrast, echocardiographic findings differed in several diastolic function parameters of both right and left ventricles in dyslipidemic children compared to controls. Based on normalized z scores, aortic valve narrowing was detected in 7 patients (28%), while narrowing of the aortic sinus (sinus of Valsalva) was detected in 15 patients (60%).Conclusion Different types of primary dyslipidemia produce functional myocardial abnormalities early in childhood. Biochemical and echocardiographic screening of high-risk children is advised to minimize the incidence of serious cardiovascular complications.

Tissue Doppler echocardiography in children with OSA before and after tonsillectomy and adenoidectomy: A systematic review and meta-analysis

BackgroundWhen to order an echocardiogram in children with obstructive sleep apnea (OSA) is debated. Studies evaluating the utility of pre-operative standard echocardiography are inconsistent. Tissue Doppler imaging (TDI) is an additional technique that quantifies the velocity of myocardial motion to assess cardiac function. The utility of TDI in pediatric OSA remains unclear. MethodsA systematic review and meta-analysis were performed in accordance with PRISMA guidelines using PubMed, Scopus, CINAHL, and Cochrane Library databases. Studies of echocardiographic findings using TDI in children with polysomnogram confirmed OSA before and after tonsillectomy and adenoidectomy (T&A) were included. 1,423 studies were screened, and 4 studies met inclusion criteria. Meta-analysis of echocardiographic findings was performed. ResultsData from 560 children were analyzed. Study groups included pre- and post-T&A children with OSA and non OSA controls. Pre-T&A S′ wave at the tricuspid annulus (S′ RV) was decreased with a mean difference of −1.04 [95% CI -1.57, −0.52, p < 0.001] and E’/A′ ratio at the mitral annulus (E’/A’ LV) was decreased with a mean difference of −0.74 [95% CI -0.85, −0.64, p < 0.001] when compared to controls. These variables were not statistically different when comparing post-T&A to controls. ConclusionsTDI appears to successfully detect subclinical changes in cardiac function in children with OSA. However, echocardiography parameters of post-T&A and non OSA control children were similar. Further prospective studies stratified by OSA severity are needed with both TDI and standard echocardiography to define the utility of pre-operative cardiac imaging.