Tissue Doppler Imaging Echocardiography Research Articles

P2735Ventricular function in a large cohort of healthy, term newborns assessed by tissue doppler imaging and speckle tracking echocardiography; establishment of normal values and z-scores

Abstract Background There is a paucity of published data presenting reference values for ventricular function in newborns. Purpose This study was conducted to establish echocardiographic normal data and z-scores for ventricular functional parameters in newborns assessed by Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE). Methods We included healthy, term newborns from a prospective, population-based study of newborns, who had a comprehensive, systematic echocardiographic (TTE) examination performed within 14 days of birth. Only newborns without any signs of structural or functional cardiac abnormalities were included. Measurements were obtained according to guidelines. Body surface area (BSA) was calculated using the Haycock formula. Z-score models according to birthweight and BSA at time of TTE were developed for TDI and STE parameters. Results Four hundred newborns (53% male) with gestational age of (median (IQR)) 40.3 (39.4, 41.1) weeks were included. Age, weight, and BSA at TTE were (mean±SD) 11±3 days, 3.7±0.5 kg, and 0.23±0.02m2, resp. Ejection fraction was 67±4%. TDI and STE measurements of ventricular function are presented as mean±SD (Table). Global longitudinal strain was calculated as the average of all left ventricular segmental strain values from apical 4-, 2-, and 3-chamber views. Results for selected parameters according to BSA are illustrated (Figure). TDI and STE of ventricular function Parameter View and modality Value Unit Mitral annulus septal wall e' Apical 4-chamber Tissue Doppler 5.7±0.8 cm/s Mitral annulus septal wall a' Apical 4-chamber Tissue Doppler 5.9±1.0 cm/s Mitral annulus septal wall s' Apical 4-chamber Tissue Doppler 4.6±0.6 cm/s Mitral annulus lateral wall e' Apical 4-chamber Tissue Doppler 6.9±1.0 cm/s Mitral annulus lateral wall a' Apical 4-chamber Tissue Doppler 6.0±1.1 cm/s Mitral annulus lateral wall s' Apical 4-chamber Tissue Doppler 4.8±0.6 cm/s Left ventricular longitudinal strain, 4-chamber Apical 4-chamber 2D 19±2 % Left ventricular longitudinal strain, 2-chamber Apical 2-chamber 2D 20±2 % Left ventricular longitudinal strain, 3-chamber Apical 3-chamber 2D 19±2 % Left ventricular global strain 19±2 % Right ventricular longitudinal strain, free wall Apical 4-chamber 2D 23±4 % Percentile charts Conclusion Normal data for TDI and STE assessment of ventricular function in 400 healthy, term newborns ispresented. An online z-score calculator will be available. Normal data is necessary for the evaluation of pathological changes, and these results contribute substantially to a field where available data is limited. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

P5378The methyltransferase SETD7 promotes myocardial ischemic injury by activating Hippo signalling

Abstract Introduction Despite significant advances in coronary revascularization, acute myocardial infarction remains the leading cause of heart failure and death worldwide. The Hippo pathway is a master regulator of cell survival during myocardial ischemia. Upon cellular stress, activation of Hippo signaling leads to cytosolic retention and degradation of the pro-survival transcription factor YAP. Post-translational modifications, namely methylation, critically affect protein functionality in conditions of cellular stress. The SET domain-containing lysine methyltransferase 7 (SETD7) - which induces a specific mono-methylation of both histone and non-histone proteins - has recently emerged as key player in the pathogenesis of vascular disease. However, the role of SETD7 in the heart is largely unknown. Purpose The present study investigates whether SETD7 regulates the Hippo pathway during myocardial ischemia. Methods Neonatal rat ventricular myocytes (NRVM) were exposed to normal glucose levels or glucose deprivation (GD) for 15 h, in the presence of the selective SETD7 inhibitor [(R)-PFI-2] or its inactive enantiomer [(S)-PFI-2]. Western blot and real time PCR were employed to investigate the effects of energy stress on SETD7 and the Hippo pathway, while apoptosis was assessed by Caspase-3 activity assay. YAP localization was examined by confocal microscopy while its mono-methylation was assessed by immunoblotting. SETD7 knockout (SETD7−/−) mice and wild-type (WT) littermates (male, 8–12 weeks old) underwent 1 h of left anterior descending (LAD) coronary artery ligation followed by 24 h of reperfusion. Infarct size was assessed by TTC staining and shown as infarct size per ventricle surface (I/V). Cardiac function was investigated at 24h by conventional and Tissue Doppler Imaging echocardiography (Vevo 3100, Visualsonics). Results GD for 15h in NRVMs led to both YAP phosphorylation and mono-methylation, and subsequent cytosolic retention, as assessed by confocal microscopy. Reduced nuclear content of YAP was confirmed by downregulation of YAP-dependent pro-survival genes, namely Ctgf and Fgf2. GD-induced YAP inactivation was associated with an increase in SETD7 expression. Interestingly, pharmacological inhibition of SETD7 by (R)-PFI-2 blunted YAP mono-methylation, thus restoring nuclear retention of YAP and transcription of pro-survival genes in GD-treated NRVMs. Moreover, (R)-PFI-2 prevented NRVMs apoptosis. In line with our in vitro findings, SETD7−/− mice showed decreased infarct size as compared to WT littermates (I/V: 16.27%±2 vs. 20.54%±3, p<0.005, respectively). Consistently, cardiac function, as assessed by ejection fraction (EF: 46%±2 vs. 38%±5, p<0.001), fractional shortening (FS: 22%±1 vs. 18%±3, p<0.001) as well as by TDI, was preserved in mice lacking SETD7 as compared to WT animals. Conclusions Pharmacological modulation of SETD7 by (R)-PFI-2 may represent a novel therapeutic approach to prevent myocardial ischemic damage.

Evaluation of Subclinical Myocardial Dysfunction Using Tissue Doppler Imaging Echocardiography in Children with Non-Alcoholic Fatty Liver Disease

AbstractBackground: Pediatric Non-Alcoholic Fatty Liver Disease (NAFLD) is a global health problem worldwide and is con-sidered the most common cause of chronic liver disease in pediatrics. Both NAFLD and heart failure are obesity-related conditions with high cardiovascular morbidity and mortality that have reached epidemic proportions.Aim of Study: Evaluate subclinical myocardial dysfunc-tion using Tissue Doppler imaging Echocardiography in a group of overweight/obese children and adolescents with NAFLD.Patients and Methods: This prospective case-control study was carried out upon 80 children (40 cases with NAFLD, 20 cases obese without NAFLD and 20 healthy controls). Diag-nosis of NAFLD was based on the finding of hepatic steatosis detected by abdominal ultrasonography. These children un-derwent full examination, lab investigations and TDI echocar-diography.Results: Using conventional echocardiography mean value of LV mass was significantly higher in patients with NAFLD compared to controls. Using TDI mean values of MPI was significantly higher in patients compared to controls, whereas other parameter showed no significant difference. Left ven-tricular mass by echo showed significant increase as the hepatic steatosis was advancing in severity.Conclusion: Patients with NAFLD have evidence of subclinical myocardial dysfunction using TDI echocardi-ography. Although the TDI provides new insight into alter-ations in LV structure and function related to IR in NAFLD patients, it cannot be used for differentiation of steatosis grading.

The assessment of treatment outcomes in patients with acute viral myocarditis by speckle tracking and tissue Doppler methods.

The aim was to evaluate the role of tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE), to identify myocardial dysfunction, and to evaluate myocardial segmental deformation in acute viral myocarditis. Twenty-one patients and twelve healthy children were studied prospectively. The TDI and STE were performed before and after treatment. The myocardial velocities (Sm , Em , and Am ) and time intervals (isovolumic contraction, isovolumic relaxation, and ejection times [ET]) at interventricular septum (IVS), left, and right ventricular basal segments were examined by TDI. The left ventricular global longitudinal strain (LVGLS) and strain rate (LVGLSR), left ventricular global circumferential strain (LVGCS) and strain rate (LVGCSR), and right ventricular global longitudinal strain (RVGLS) and strain rate (RVGLSR) were examined by STE. Sm and Em at IVS and at LV, ET at IVS, ET at RV, ET at LV were significantly lower in patients before treatment than controls. LVGLS, LVGLSR, LVGCS, LVGCSR, RVGLS, RVGLSR were significantly decreased in patients before treatment than controls. There was significant improvement for LVGLS, LVGLSR, LVGCS, LVGCSR, and RVGLS in patients after treatment. Sm , Em , and Am at LV were significantly lower in patients before treatment than in patients after treatment. In spite of improvements, Sm , Em , and ET at IVS, LVGLS, LVGLSR, LVGCS, LVGCSR were significantly lower in patients after treatment than controls. The TDI and STE were useful methods for detection of early myocardial dysfunction and evaluation of treatment outcomes in acute viral myocarditis.

Studying of morphology and left ventricular function by conventional and speckle tracking echocardiography in football players

Objective: Recent studies have showed that Tissue Doppler Imaging and Speckle Tracking Echocardiography can discover these changes at functional and structural cardiac in athletes at early stage, especially at the footballers. The purpose of this research was evaluated the structural and functional adaption of left ventricular in footballer by conventional and advanced echocardiography. Materials and methods: We performed a cross-sectional study of 30 footballers who have been trained over 2 years compared to 30 healthy candidate with the same ages. We carried out TM, 2D, STE. Echo machine was Philips Affinity 50CV with QLAB version 10.04 which can analyze online or offline. Result: In comparison with control group, IVSd, LVEDd, PWTd, LVM, LVMI (p = 0.001) was different from athlete group. Left ventricular adaption trended to eccentric hypertrophy and increased left ventricular mass index. A wave was decrease velocity and increased E/A, E/El’, E/E’s ratio. Base circumferential strain, apex circumferential strain, rotation and twist (10.12 ± 1.2) (°) athletes (7.42 ± 2.6) (°) control group with (p = 0.05), were more than control group. Conclusion: Conventional and advanced echocardiography can evaluate structural and functional left ventricular adaption in athletes. Especially, STE provided more data in myocardial deformation, rotation and twist so that it can discover these changes at athlete heart in early stages Key words: Athletes heart, Speckle Tracking Echocardiography, Tissue Doppler Imaging

Tissue Doppler Imaging versus Conventional Echocardiography in Evaluation of Cardiac Functions in Diabetes Mellitus

Background: Conventional echocardiography and tissue Doppler imaging have been highlighted to diagnose diastolic and systolic heart dysfunction. We aimed to compare tissue Doppler imaging with conventional echocardiography to diagnose heart dysfunctions in diabetes mellitus type 1 (DMT1) patients. Materials and Methods: This case-control study was conducted in the Ali Asghar Clinic, Zahedan, Iran. The study lasted from 2017 to 2018 on 140 participants aged from 4-18 years, and consisted of 70 patients with DMT1, and 70 children who referred to hospital for checkup as control group. The participants went under tissue Doppler imaging andconventional echocardiography (M mode and 2D) by an invariable cardiologist. The 5 ml blood samples were taken to test blood leptin and ferritin. The data were analyzed using SPSS software (version 18.0). Results: Conventional findings such as left and right deceleration time, left, and right peak E velocity, left ejection time, left Myocardial performance index and TDI findings such as left, and right ET’, right S’, right E’, left MPI’, right MPI’, and left E/E’ were different in patients and the control group (p<0.05). Left and right deceleration time, and LV Mass index in conventional and left ET’, right ET’ in TDI were different in age groups of patients (p<0.05). In sex groups, left deceleration time, left peak A velocity, right acceleration time, right deceleration time and right E/A in conventional and left ET’, left ICT’, left IRT’, right ICT’, right IRT’, right S’ and right MPI’ in TDI were different (p<0.05). Conclusion: This study concluded that both conventional and TDI were different between DMT1 patients and the control group, but TDI was stronger in discrimination.

Evaluation of Atrial Electromechanical Delay in Children with Obesity.

Background and Objective: Childhood obesity is one of the worldwide health problems with an increasing prevalence and accompanied by severe morbidity and mortality. It is a serious predisposing risk factor especially for the development of cardiovascular diseases and arrhythmias. Electromechanical delay (EMD) is known to be a predictor for the development of atrial fibrillation (AF). Our study aims to investigate whether EMD, which is a predictor of AF, prolongs in obese children or not. Material and Methods: The study included 59 obese patients aged between 8–18 years and 38 healthy patients as the control group with a similar age and gender. All the individuals underwent transthoracic echo and tissue Doppler echocardiography. Systolic and diastolic left ventricular (LV) functions, inter- and intra-atrial electromechanical delay were measured by tissue Doppler imaging (TDI) and conventional echocardiography. Results: Obese patients had significantly lengthened P-wave on surface ECG to the beginning of the late diastolic wave (PA) lateral, PA septum, intra- and inter-atrial electromechanical delays when compared with the control group (p < 0.001, p = 0.001, p < 0.001 and p < 0.001, respectively) Inter-atrial EMD and intra-atrial EMD correlated positively with body mass index (BMI) values (r = 0.484, p < 0.001 and r = 0.376, p = 0.001; respectively) BMI was significantly related with inter-atrial EMD (β = 0.473, p < 0.001) However, there was no relationship between inter-atrial EMD and serum glucose and platelet count. Conclusion: In our study, we declared that electromechanical delay was increased in obese children when compared to the control group and intra- and inter-atrial electromechanical delay was in correlation with body mass index. Furthermore, we discovered that BMI is an independent predictor of the inter-atrial EMD in obese children.

Evaluation of exercise on left ventricular function in patients with slow coronary flow by excercise-stress echocardiography

Objective To evaluate the role of treadmill exercise-stress echocardiography in the assessment of left ventricular (LV) function in patients with slow coronary flow (SCF), and discuss the possible mechanism of SCF. Methods Forty-six patients with diagnosis of SCF were enrolled as SCF group. Forty age and sex matched adults were included as control group. All subjects had underwent clinical evaluation and exercise stress echocardiography. LV diastolic and systolic functions were assessed by conventional echocardiography, tissue Doppler imaging and two-dimensional speckle tracking echocardiography at rest and during exercise. Results ①LV function in patients with SCF at rest: LV peak systolic longitudinal strain (LS) was lower in patients with SCF than that in controls (P 0.05). Early diastolic mitral annulus velocity (Mitral e′) and the ratio between the early mitral inflow velocity and Mitral e′(Mitral E/e′) were significantly decreased in SCF group(all P 0.05). Compared with control group, ΔLS and ΔMitral e′ were significantly higher in SCF group (all P<0.05). Conclusions LV systolic and diastolic function in patients with SCF are impaired at rest. LV systolic and diastolic function recover in patients with SCF during exercise. Key words: Echocardiography, stress; Slow coronary flow; Ventricular function, left

Focus on echocardiographic right ventricular strain analysis in cystic fibrosis adults without cardiovascular risk factors: a case-control study.

Strain echocardiography is able to detect subclinical ventricular systolic and diastolic dysfunction. Prolonged survival to cystic fibrosis favors heart and vessel involvement. The purpose of the present study was to compare clinically stable adult patients affected by cystic fibrosis without overt pulmonary hypertension with controls to evaluate right ventricular (RV) systolic and diastolic function by means of strain and tissue Doppler imaging (TDI), respectively. 22 adults affected by cystic fibrosis and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors or overt pulmonary hypertension. All people underwent blood pressure measurement and transthoracic echocardiography. Cystic fibrosis patients showed higher sPAP [median 25 (IQR 21-30) vs 22 (22-22) mmHg; p = 0.02] and more frequent RV diastolic dysfunction (p < 0.001). Among cases, some RV systolic parameters were significantly altered than controls, such as TAPSE [20 (18-24) vs. 23 (21-28) mm; p = 0.001], FAC [34 (26-44) vs. 49 (48-50)%; p < 0.001], midwall tissue strain [- 25.0 (- 31.3 to - 22.8) vs. - 30.5 (- 31.8 to - 29.3)%; p = 0.03], apical tissue strain [- 22 (- 29.3 to - 19.0) vs. - 30.5 (- 32.8 to - 28.3)%; p = 0.001] and 2D strain [- 22.0 (- 25.1 to - 19.0) vs. - 29.5 (- 31.8 to - 27.3)%; p < 0.001]. Finally, 2D strain correlated with spirometric FEV1 (ρ = - 0.463, p = 0.03) and nearly with FEF25-75% (ρ = - 0.393, p = 0.07). Our study confirmed a RV subclinical systo-diastolic dysfunction in clinically stable patients affected by cystic fibrosis without overt pulmonary hypertension nor cardiovascular risk factors. This may be due to systemic inflammation and temporary recurrent pulmonary hypertension. We retain that RV 2D strain and TDI echocardiography could become an important tool in the follow-up of these patients.

Feasibility and agreement of a novel combined echocardiographic method to measure global longitudinal strain and strain rate compared to speckle tracking and tissue Doppler imaging

Background: Currently, two echocardiographic techniques are used to measure deformation: tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). Recently, a technique combining STE and TDI (on TDI overlay images) has become available, allowing derivation of STE/TDI results from a single acquisition/reading (combined-STE/combined-TDI). We tested the feasibility and agreement of this novel technique to measure left ventricular deformation in the general population compared to STE and TDI.Methods: We examined a subsample of 106 consecutive subjects of the Asklepios Study, a population-based random sample of male/female volunteers without overt clinical disease (mean age: 55.9 years). Left ventricular deformation measurements were assessed with transthoracic echocardiography using the combined method, STE and TDI.Results: Almost all deformation parameters significantly differed between all methods. Global systolic longitudinal strain (GS) and strain rate (GSRs) values measured by combined-TDI were significantly higher (GS −17.2% ± 3.0, GSRs −0.9 s−1 ± 0.2) compared to TDI (GS −21.1% ± 2.2, GSRs −1.3 s−1 ± 0.2). Measurements by combined-STE were significantly lower (GS −19.1% ± 2.9, GSRs −1.0 s−1 ± 0.2) compared to STE (GS −18.2% ± 3.0, GSRs −0.9 s−1 ± 0.1). Overall, the smallest differences and highest agreement were observed between STE and combined-STE (GS r = 0.84, p < .001; GSRs r = 0.70, p < .001).Conclusions: The comparison of methods showed different values and poor agreement between the echocardiographic modalities. Regrettably, the combined method does not make it possible to obtain in a single image/measurement results that are comparable to STE and TDI data in the general population.

Prolonged total atrial conduction time evaluated with tissue Doppler imaging predicts poor cardiac prognosis in patients with heart failure.

Prolonged total atrial conduction time is caused by atrial remodeling. Left atrial remodeling is associated with poor outcome in patients with heart failure (HF). This study aimed to investigate whether prolonged total atrial conduction time predicts poor prognosis in patients with HF. We performed transthoracic echocardiography in 100 patients (65 men; mean age 68 ± 13years) who were hospitalized for HF. Total atrial conduction time was defined as the duration from P wave onset on electrocardiography to peak A' wave on tissue Doppler imaging (TDI) echocardiography (PA-TDI duration). There were 37 cardiac events (37%) during a median follow-up period of 414days. The PATDI duration was significantly longer in patients with cardiac events than in those without (150 ± 18ms vs 133 ± 19ms; P < 0.05). There were no significant differences in left ventricular end-diastolic dimensions and ejection fractions between patients with and without cardiac events. Patients with HF were divided into 3 groups according to tertiles of the PA-TDI duration. Kaplan-Meier analysis showed that the highest tertile of PA-TDI duration was associated with the greatest risk among patients with HF. Multivariate Cox proportional hazard analysis showed that the PA-TDI duration was an independent predictor of cardiac events, leading to the conclusion that prolonged PA-TDI duration was a feasible predictor of cardiac prognosis in patients with HF.

The cardiac isovolumetric contraction time is an independent predictor of incident atrial fibrillation and adverse outcomes following first atrial fibrillation event in the general population

Colour tissue Doppler imaging (TDI) M-mode through the mitral leaflet is an easy and precise method to obtain cardiac time intervals including the isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), and ejection time (ET). The myocardial performance index (MPI) was defined as [(IVCT + IVRT)/ET]. Our aim was to investigate if cardiac time intervals can be used to predict atrial fibrillation (AF) in the general population. A total of 1915 participants from the general population underwent a health examination including TDI echocardiography. The primary endpoint was AF, and the secondary endpoint was complicated AF as assessed by the occurrence of either stroke or heart failure (HF) after the diagnosis of AF. Participants with known AF were excluded (n = 54). During a median follow-up of 11 years, 166 participants (9%) were diagnosed with AF and of these 44 participants (27%) developed HF or stroke. Assessing the association between IVCT and incident AF, the risk increased with 27% per 10 ms increase in IVCT [per 10 ms increase: hazard ratio (HR) 1.27, 95% confidence interval (CI) (1.17-1.38); P < 0.001]. The association remained significant after multivariable adjustment [per 10 ms increase: HR 1.22, 95% CI (1.09-1.35); P < 0.001]. No associations between the IVRT, ET, MPI, and AF remained significant after multivariable adjustment. The IVCT also predicted complicated AF and the association remained significant even after multivariable adjustment [per 10 ms increase: HR 1.39, 95% CI (1.06-1.81); P = 0.015]. In the general population, the IVCT provides novel and independent prognostic information on the long-term risk of AF. Additionally, the IVCT can identify persons in risk of complicated AF.

Exercise echocardiography in uncomplicated type 2 diabetic patients: Which parameters are useful?

Early detection of preclinical left ventricular (LV) dysfunction in type 2 diabetic (T2D) patients is crucial because of its associated increased cardiovascular morbidity and mortality. The aim of this study was to: – identify the most sensitive and clinically relevant echocardiographic variables in order to detect early left ventricular (LV) dysfunction in uncomplicated type 2 diabetic patients (T2D) in comparison with sedentary (SC) and trained controls (TC), at rest and during exercise; – to understand the mechanisms of exercise intolerance in these patients. 20 T2D without micro- or macrovascular complications and without any other uncontrolled risk factor, 20 SC, and 20 TC were studied at rest and during a cardiopulmonary exercise test using conventional, tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) including twist-untwist mechanics analysis. LV dysfunction was already detectable in T2D by resting echocardiography. During exercise, T2D had the lowest increase of LV diastolic and systolic function and the most limited vasodilation compared to SC and to TC who showed the highest adaptability. Exercise STE twist-untwist analysis showed lower feasibility and higher variability in T2D compared to SC and TC. T2D patients had lower longitudinal strain and higher untwist/twist ratio compared to SC but not in comparison to TC ( Fig. 1 ). Conventional and TDI data were the most robust echocardiographic parameters, showing early LV dysfunction and evidencing the contribution of diastolic and systolic dysfunction to exercise intolerance with the expected pathophysiological continuum between groups. Exercise STE data, which showed low feasibility and high variability in T2D, did not exhibit the expected distribution between groups, underlining the fact that strain adaptations in different pathophysiological situations need further explorations.

Assessment of Function of the Left Heart Myocardium by Tissue Doppler Imaging and Speckle Tracking Echocardiography in Patients with Chronic Heart Failure with Preserved Left Ventricular Ejection Fraction

to study myocardial function in patients with chronic heart failure (CHF) with preserved left ventricular ejection fraction (PEF) by speckle tracking echocardiography and tissue doppler imaging. We examined 80 patients aged 50-70 years with verified NYHA class I-IIa CHF and PEF due to arterial hypertension and ischemic heart disease, and 35 healthy persons. Examination included echocardiography, and speckle-tracking echocardiography. According to 6-min walk test 26.9 % of patients had functional class (FC) I CHF, 48.3 % - FC II CHF, and 24.8 - FC III CHF. The mean left ventricular ejection fraction (Simpson's method) was 62.3±5.35 %, mean end systolic left atrial volume index - 45±8.1 ml / m2. All patients had left ventricular diastolic dysfunction: 60 patients - abnormal relaxation pattern, 20 patients - pseudonormal pattern. Other findings were reduced global longitudinal strain (GLS, -16.56±2.61 %) and GLS rate (GLSR, -0.75±0.11 s-1) of the left ventricle and reduced segmental strain and strain rate in basal anteroseptal (-13.62±3.44 % and -0.77±0.04 s-1, respectively) and basal anterolateral (-14.17±3.31 % and -0.81±0.11 s-1, respectively) segments. Lowering of global circular left ventricular strain and strain rate (-15.63±4.8% and -1.4±0.23 s-1, respectively) was found to be smaller than that of GLS (p&lt;0.05). There was positive correlation between left ventricular systolic GLS and left atrial volume (r=0.601, р&lt;0.01). In patients with CHF and PEF we revealed alterations of diastolic function (abnormal relaxation and pseudonormal patterns), reductions of global and segmental strain and strain rate of the left ventricle. More pronounced lowering of segmental strain and strain rate was registered in left ventricular basal anteroseptal and basal anterolateral segments. Circular strain was found to be slightly reduced, while radial strain was unchanged.

Reduced myocardial reserve in cirrhotic patients: an evaluation by dobutamine stress speckle tracking and tissue Doppler imaging (TDI) echocardiography

Introduction: Despite the normal systolic function at rest, cirrhotic patients often suffer from volume overload and symptoms of heart failure as they face stressful situations. This study investigated the myocardial reserve in cirrhotic patients at resting condition and peak stress by dobutamine speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). Methods: Twenty cirrhotic patients and 10 normal individuals aged 30-50 were selected randomly. For all of the participants, complete echocardiographic study of 2D, STE and TDI was done at rest and peak stress status with dobutamine. The following parameters were assessed: ejection fraction (EF), global longitudinal LV strain (GLS), strain rate in the septal basal segment and lateral wall and E’ in the septal basal segment by color-coded method. Results: At baseline, EF was higher than 55% in both groups. GLS was higher (-22.6±2.4%) in the case group than the control group (-19.2±1.9%) at resting condition. After stress, it showed a greater increase (-22.5±1.7%) in the controls compared to cirrhotic patients (-22.6±3.3%; mean difference = 2.6 ± 2.03, P = 0.02). In cirrhotic patients, the average strain rate in the basal septal segment decreased after stress (-1.2 ± 0.3/s to-1.1 ± 0.3/s), but it increased in the control group (-1.1 ± 0.2/s to -1.8 ± 0.2/s). Conclusion: Despite the presence of normal resting systolic function in cirrhotic patients, there was insufficient increase or even a decrease in myocardial function with stress; this may indicate the absence of sufficient myocardial reserve in cirrhotic patients. These findings would help to explain the reason for occurrence of heart failure or hemodynamic changes in cirrhotic patients.

Assessment of left ventricular functions and its correlation to the severity of liver cirrhosis caused by hepatitis C virus by different echocardiography modalities (two-dimensional speckle-tracking echocardiography study)

Background Cardiovascular abnormalities are associated with liver cirrhosis observed especially under conditions of stress, so it is important to evaluate the cardiovascular function in every patient with cirrhosis. The Child–Pugh scoring system is the most commonly used clinical method for classifying liver cirrhosis. Tissue Doppler imaging and Two-dimensional speckle-tracking echocardiography (2D-STE) are newer imaging modalities able to accurately quantify left ventricular (LV) systolic function.Aim To assess LV functions in patients with chronic liver cirrhosis caused by hepatitis C virus by different echo modalities and correlate the results with the severity of cirrhosis based on Child–Pugh score.Material and methods A prospective study was done in the Echocardiography Unit, Cardiology Department, Al-Zahraa University Hospital, during a period of one year, including 75 participants, with 45 cirrhotic patients and 30 healthy individuals. For all patients, 2D-STE of the LV was measured. Then the patients with liver cirrhosis were divided into three subgroups according to Child–Pugh score, and LV functions were evaluated with conventional echo, tissue Doppler imaging (TDI), and STE.Results By conventional echo, the LV systolic function increased in the diseased group (P=0.004) but decreased when using TDI and STE. Then the patient group was divided into three subgroups based on the Child–Pugh score. By conventional echo parameters, there were normal LV dimensions in the three groups but increased in class C with lowered systolic function by using 2D-STE. Conventionally, LV diastolic dysfunction was diagnosed in 30% but in 75% when using TDI. There is a correlation between severity of liver cirrhosis and LV systolic dysfunction when measured only by 2D-speckle tracking.Conclusion The 2D-STE is considered a useful tool for early detection of LV systolic dysfunction especially in asymptomatic patients with viral liver cirrhosis. The LV diastolic dysfunction occurs earlier in cirrhotic patients. There is correlation between the extent of severity of liver cirrhosis and LV systolic dysfunction.

Role of echocardiographic tissue Doppler imaging in the assessment of myocardial diastolic dysfunction in children with diffuse lung diseases

Background Pulmonary arterial hypertension (PAH) is a common complication of prolonged diffuse lung diseases in children. It is considered a crucial factor of morbidity, mortality, and severity of the disease in these children. Conventional echocardiography is an indirect tool to assess pulmonary hypertension (PH) with a limited sensitivity compared with right heart catheterization and requires well-trained physicians. So, the aim of the current study was to determine the role of echocardiographic tissue Doppler imaging in the assessment of the effect of pulmonary hypertension on right ventricular functions in children with prolonged, diffuse lung diseases and if it can have a predictive role of the secondary right ventricular (RV) dysfunction in these children. Patients and methods This is a case–control study in which 40 children with diffuse lung diseases were recruited from the chest clinic, Ain Shams University Hospitals. The patients were classified into PH and non-PH groups according to the echocardiographic measurement of mean PAP greater than 25 mmHg. Results Patients with PAH had significantly higher RV stroke volume as well as indexed RV systolic and diastolic areas. Furthermore, these patients had significantly higher RV myocardial performance index and E/E′ ratio suggesting diastolic dysfunction as well as decreased compliance. Conclusion Although conventional echocardiography could detect changes in RV dimensions and stroke volume, tissue Doppler imaging could further highlight changes in RV diastolic functions as well as compliance secondary to PAH.

Correlation of QRS duration with intraventricular mechanical dyssynchrony on tissue Doppler imaging in heart failure

Introductions: Wide QRS complex with left bundle branch block morphology is one of the three criteria for cardiac resynchronization therapy (CRT) in heart failure (HF) patients who do not improve on medical management. Approximately 30% of patients do not respond to CRT. This study investigates to find out to what extent the wide QRS duration correlates with the intraventricular mechanical dyssynchrony (IVMD) as measured by Tissue Doppler Imaging (TDI) echocardiography.&#x0D; Methods: The HF patients of dilated or ischemic cardiomyopathy with ejection fraction £35% admitted in the medical ward of Patan Hospital, Nepal from March to August 2017 were enrolled in the study. They were divided into two groups, narrow QRS duration of &lt;120ms (Gr1) and wide QRS duration of ³120ms (Gr2). TDI was performed to measure time to peak systolic velocity of the left ventricular walls. The IVMD, defined as 60 ms (millisecond) or greater difference in time to peak velocity between any two points of the left ventricular walls, was compared in both groups.&#x0D; Results: There were 26 patients, 18 in group-1, and eight in Gr2.In Gr1, IVMD was observed 13/18 (72%) patients and in group-2 in 7/8 (87%) patients, (χ2 = 0.70, p = 0.403). There was no significant difference of IVMD between Gr1 and Gr2 (73±36ms vs 97±38ms, t = 1.54, p = 0.136). &#x0D; Conclusions: Assessment of intraventricular mechanical dyssynchrony (IVMD) by Tissue Doppler Imaging (TDI) is probably superior to QRS duration in heart failure patients.

Left ventricular myocardial deformation abnormalities in seizure-free children with epilepsy

PurposeAlthough there is a higher risk of structural cardiac disease in people with epilepsy, there is no detailed advanced analysis of cardiac functions in patients with epilepsy. This study aimed to determine early echocardiographic findings of Left Ventricular (LV) dysfunction using cardiac strain technique in seizure-free children with epilepsy. MethodThe study investigated 60 children with epilepsy who had no seizures in the preceding 6 months, without any known cardiovascular disease and treated with one antiepileptic drug and 60 healthy subjects who underwent clinical evaluation including electrocardiography (ECG), standard echocardiography, tissue Doppler imaging (TDI) and two-dimensional Speckle Tracking Echocardiography (2DSTE). ResultsDespite the normal M-mode values, global longitudinal strain of the epilepsy of the control group was as follows: −16.86 ± 3.71, -18.95 ± 3.75, respectively (p = 0.001); global strain rates were determined as follows: -0.99 ± 0.23, -1.14 ± 0.31, respectively (p = 0003). The patients also had increased A-wave velocity, and decreased E/A ratio (p < 0.01). TDI results showed diastolic dysfunction as mirrored by significantly increased isovolemic relaxation time (IVRT), Early mitral inflow (E)/ Early diastolic velocity (E’), and Tei index (p < 0.01). There was no significant difference in LV torsion, Peak LV twist, and ECG parameters between the patients and the controls. ConclusionsIn seizure-free patients, cardiac systolic and diastolic functions were impaired when compared to healthy children. There was no difference in the patient group to explain the decline in cardiac functions and there may be unknown different factors besides the known risk factors.

Evaluation of heart dysfunction in patients with rheumatoid arthritis

Cardiovascular diseases are the most common causes of death in patients diagnosed with rheumatoid arthritis (RA). The high prevalence of cardiovascular disease is independent of known risk factors in RA patients. The present study aimed to estimate the left ventricular diastolic function in patients suffering from RA using conventional Doppler and tissue Doppler echocardiographic imaging (TDI). This descriptive, cross-sectional study was conducted on 40 patients who had an established diagnosis of RA for over five years (2, 7, 9) and referred to the Rheumatology Department and Clinic of Ghaem Hospital, affiliated with Mashhad University of Medical Sciences. Patients with normal electrocardiography, chest examination, and chest radiography were subjected to M-mode, two-dimensional Doppler echocardiography. Data analysis was performed with the SPSS statistical software package (version 11.5). A p-value less than 0.05 was considered statistically significant. According to the results, mitral and tricuspid insufficiencies were the most common valvular diseases (72.5% and 52%, respectively). In 70% of the patients, diastolic function was normal. A significant relationship was observed between systolic function and diastolic abnormality (P=0.001). Pulmonary hypertension was detected in 40% of patients. Nevertheless, no significant relationship was observed between E and Em or between A and Am (P=0.432, P=0.844, respectively). The Mann-Whitney U test revealed a statistical difference between the two groups in terms of EF, which was significantly lower in the diastolic dysfunction group (P=0.047). A wide and frequent variety of cardiac diseases, especially mitral, aortic, and tricuspid regurgitation, may be found in RA patients. It can be concluded that active RA patients have a significantly high incidence of diastolic dysfunction in the absence of clinical evidence of heart disease.