Tissue Motion Annular Displacement Research Articles

Assessment of left atrial function using tissue motion annular displacement in healthy dogs.

Recently, tissue motion annular displacement by speckle tracking has been shown to be a reliable method for evaluating deformation of the left atrium in healthy dogs. The aim of this study was to investigate whether tissue motion annular displacement is a feasible alternative method for studying left atrial function. One hundred healthy dogs were included. Left atrial function was assessed by tissue motion annular displacement, which was correlated to the left atrial strain and biplane area-length method-derived volumes. Left atrial reservoir function was evaluated by left atrial global tissue motion annular displacement, global left atrial strain and left atrial emptying fraction, while left atrial systolic tissue motion annular displacement and left atrial ejection fraction were used to assess left atrial systolic function. A statistically significant association between body weight and the dependent variables others than age was found. Indexed global and systolic tissue motion annular displacement decreased as body weight increased. Global iTMAD_AIIometric (mm/∛kg) showed a moderate, positive correlation with left atrial emptying fraction and with global left atrial strain. Systolic iTMAD_AIIometric (mm/∛kg) showed a moderate correlation with left atrial ejection fraction. Coefficients of variation for the intraobserver and interobserver analyses were 8.3% and 20.3% for global and 10.5% and 18.9% for systolic tissue motion annular displacement, respectively. Tissue motion annular displacement is a feasible and simple method for the evaluation of left atrial function. Our study documented the effects of body weight on left atrial tissue motion annular displacement, indicating that tissue motion annular displacement must be indexed to body weight. No influence of age or heart rate was observed on tissue motion annular displacement.

Assessment of left and right ventricular systolic function in dogs with multicentric lymphoma

ObjectiveMyocardial dysfunction in cardio-oncology is generally thought to be related to the cardiotoxicity of chemotherapy treatment. However, it is known that some tumors have direct effects on myocardial function. These effects have already been studied in man, but there are no publications of these of the effects in dogs. Novel advanced echocardiographic techniques may allow early detection of myocardial dysfunction when compared to conventional echocardiographic techniques. This study aims to assess myocardial systolic function in dogs with multicentric lymphoma prior to initiation of chemotherapy. AnimalsFifteen dogs with multicentric lymphoma and nineteen healthy dogs. MethodsCase-control study. Dogs with multicentric lymphoma and healthy control dogs underwent physical examination, electrocardiography, systolic blood pressure measurement, standard and speckle tracking echocardiography to assess biventricular systolic function. ResultsThere were no differences between groups in terms of ejection fraction, fractional shortening, left ventricular systolic and diastolic diameter, tricuspid annular plane systolic excursion, mitral annular plane systolic excursion and fractional area change of the right ventricle (RV). However, there was a reduction in the values of global circumferential strain (p = 0.0003), RV strain (p = 0.01) and RV tissue motion annular displacement (p < 0.05) in the dogs with lymphoma when compared to the control group. ConclusionsSpeckle tracking techniques appear to demonstrate early systolic dysfunction, primarily affecting the RV, in dogs with lymphoma prior to chemotherapy treatment.

Prognostic Value of RV Function Analysis During the Interstage Period in Patients with Hypoplastic Left Heart Syndrome.

Cardiac dysfunction is associated with mortality in children with hypoplastic left heart syndrome (HLHS). We evaluated the ability of qualitative and quantitative RV functional parameters to predict outcomes in HLHS patients. In this retrospective, single-center study, echocardiograms from 3 timepoints (pre-stage 1 palliation, 4-8weeks post-stage 1 palliation, and pre-Glenn) were analyzed in infants with HLHS. Patients were stratified into two groups based on outcome of transplant-free survival post-Glenn (survivors) versus mortality or transplantation prior to Fontan (non-survivors). Images were retrospectively reviewed to obtain RV global longitudinal strain (RVGLS), RV-free wall strain (RVFWS), fractional area change (FAC), tricuspid annular systolic plane excursion (TAPSE), tissue motion annular displacement of the tricuspid valve (TMAD-TV) and qualitative systolic function assessment during the predetermined timepoints. An equal variance t-test and chi-square were used to determine significant differences and ROC curve analysis was performed to derive optimal cutoff values to predict mortality/transplant. A total of 47 patients met inclusion criteria, of which, 21 patients met composite endpoint. There were no significant differences in any RV functional parameter during the pre- or post-stage 1 palliation timepoints. The absolute values of RVFWS, RVGLS, and TMAD-TV were significantly greater in survivors than non-survivors during the pre-Glenn timepoint. A pre-Glenn RVGLS > -15.6 (AUC 0.79), RVFWS > -18.6 (AUC 0.75), and TMAD-TV < 12.6% (AUC 0.82) were sensitive and specific for predicting death or need for transplantation prior to Fontan completion. RVGLS, RVFWS, and TMAD-TV may help identify higher-risk HLHS patients during the interstage period.

Right Ventricle Strain Assessed by 2-Dimensional Speckle Tracking Echocardiography (2D-STE) to Evaluate Pulmonary Hypertension in Dogs with Dirofilaria immitis.

Echocardiographic assessment of the right ventricle is helpful for analysing the pathophysiology of heartworm disease and detecting pulmonary hypertension (PH) in dogs. In veterinary cardiology, the study of myocardial deformation using two-dimensional speckle tracking (2D-STE) echocardiography has become increasingly acknowledged as useful for quantifying right ventricular function. The aim of this study was to evaluate the usefulness of myocardial deformation strain of the right ventricular free wall (FWS), global deformation strain of the right ventricle, including the interventricular septum (GS), and tissue motion annular displacement of the tricuspid valve (TMAD) in a cohort of dogs with heartworm (Dirofilaria immitis) disease and to determine cut-off values for detecting the presence of PH. Out of the 93 dogs tested, 71% were diagnosed with heartworm infection. PH was identified in 41% of the infected dogs following the American College of Veterinary Internal Medicine (ACVIM) guidelines, based on the peak tricuspid regurgitation velocity to calculate the tricuspid regurgitation pressure gradient (TRPG), while other routine measurements were used, including the right pulmonary artery distensibility index (RPADi). The 2D-STE mode measurements were determined using Right Ventricular Automated Function Imaging (RV AFI®) software. The statistical analysis showed significant differences in the studied parameters among dogs with and without PH. Additionally, sensitivity (sen) and specificity (sp) cut-off values were obtained (GS ≥ -21.25%, sen 96%, sp 86.4%; FWS ≥ -21.95%, sen 92.56%, sp 95.5%; TMAD ≤ 0.85 cm, sen 70.4%, sp 83.3%). These results demonstrated that GS, FWS, and TMAD could be used as supplementary and alternative variables to conventional echocardiographic measurements when detecting PH in dogs with heartworm disease.

Evaluation of left ventricular systolic function by tissue motion annular displacement of the mitral valve derived by speckle-tracking echocardiography in patients with coronary artery disease

ABSTRACT Objectives: Evaluation of the left ventricular systolic function using tissue motion annular displacement of mitral valve derived by speckle - tracking echocardiography and the correlation between mitral valve annular displacement and echocardiographic parameters for left ventricular systolic function in patients with coronary artery disease. Methods: Descriptive cross - sectional study on 106 patients with coronary artery disease and 106 controls, at Hue University of Medicine and Pharmacy Hospital, from 3/2019 - 10/2021. The study population meet all inclusion criteria according to research objectives. Mitral valve annular displacement derived by speckle - tracking echocardiography was acquired and analyzed offline with QLAB 13. Results: Median age was 66.09 ± 13.25 years and 66.7% was woman. Mitral valve annular displacement derived by speckle - tracking echocardiography in patients with coronary artery disease decreased statistically significant when comparing to control group (p &lt; 0.01). This index which was strongly correlated not only with left ventricular ejection fraction on 2D (r = 0.706) but also with peak mitral annular systolic velocity (S’ velocity) by tissue Doppler (r = 0.882). It was a favorable correlation with maximum mitral annular systolic displacement on M - mode (r = 0.419), but was not correlated with the location, degree, and number of coronary stenosis. Conclusions: Tissue motion annular displacement of the mitral valve derived by speckle - tracking echocardiography is a simple, rapid and endothelium - independent parameter that supports the left ventricular ejection fraction parameter in the evaluation of left ventricular systolic function when poor endocardial visualization.

Feasibility and discriminatory value of tissue motion annular displacement in sepsis-induced cardiomyopathy: a single-center retrospective observational study

BackgroundThere is no formal diagnostic criterion for sepsis-induced cardiomyopathy (SICM), but left ventricular ejection fraction (LVEF) < 50% was the most commonly used standard. Tissue motion annular displacement (TMAD) is a novel speckle tracking indicator to quickly assess LV longitudinal systolic function. This study aimed to evaluate the feasibility and discriminatory value of TMAD for predicting SICM, as well as prognostic value of TMAD for mortality.MethodsWe conducted a single-center retrospective observational study in patients with sepsis or septic shock who underwent echocardiography examination within the first 24 h after admission. Basic clinical information and conventional echocardiographic data, including mitral annular plane systolic excursion (MAPSE), were collected. Based on speckle tracking echocardiography (STE), global longitudinal strain (GLS) and TMAD were, respectively, performed offline. The parameters acquisition rate, inter- and intra-observer reliability, time consumed for measurement were assessed for the feasibility analysis. Areas under the receiver operating characteristic curves (AUROC) values were calculated to assess the discriminatory value of TMAD/GLS/MAPSE for predicting SICM, defined as LVEF < 50%. Kaplan–Meier survival curve analysis was performed according to the cutoff values in predicting SICM. Cox proportional hazards model was performed to determine the risk factors for 28d and in-hospital mortality.ResultsA total of 143 patients were enrolled in this study. Compared with LVEF, GLS or MAPSE, TMAD exhibited the highest parameter acquisition rate, intra- and inter-observer reliability. The mean time for offline analyses with TMAD was significantly shorter than that with LVEF or GLS (p < 0.05). According to the AUROC analysis, TMADMid presented an excellent discriminatory value for predicting SICM (AUROC > 0.9). Patients with lower TMADMid (< 9.75 mm) had significantly higher 28d and in-hospital mortality (both p < 0.05). The multivariate Cox proportional hazards model revealed that BMI and SOFA were the independent risk factors for 28d and in-hospital mortality in sepsis cases, but TMAD was not.ConclusionSTE-based TMAD is a novel and feasible technology with promising discriminatory value for predicting SICM with LVEF < 50%.

A Novel Speckle-Tracking Echocardiography Derived Parameter That Predicts Clinical Worsening in Children with Pulmonary Arterial Hypertension

Pulmonary arterial hypertension is a severe, progressive disease in children, that causes right ventricular dysfunction over time. Tissue motion annular displacement is a novel speckle-tracking derived echocardiographic parameter used in assessing ventricular function. The aim of our study was to determine the prognostic value of this echocardiographic parameter in children with pulmonary arterial hypertension. We conducted a case-control study by assessing twenty children with pulmonary arterial hypertension (idiopathic or secondary) and twenty age- and sex-matched controls, using clinical (WHO functional class, 6-min walking test), laboratory (brain natriuretic peptide level) and echocardiographic parameters (conventional and speckle-tracking derived tissue motion annular displacement) at enrolment and after one year of follow-up. According to their WHO functional class altering after one year, the pulmonary arterial hypertension patients were divided into two groups: non-worsening (eleven) and worsening (nine). The conventional echocardiographic parameters and all measured tricuspid tissue motion annular displacement indices (lateral, septal, midpoint and midpoint fractional displacement—TMADm%) were significantly lower in both pulmonary arterial hypertension groups (non-worsening and worsening) compared to controls. Comparing the worsening and non-worsening groups, only the TMADm% and brain natriuretic peptide level was significantly lower in worsening in comparison with non-worsening pulmonary arterial hypertension children (p = 0.010 and p = 0.018, respectively). In receiver-operating characteristic curve analysis, we found a cut-off value of 16.15% for TMADm% and a cut-off value of 34.35 pg/mL for the brain natriuretic peptide level that can predict worsening in pulmonary arterial hypertension children. In conclusion, tricuspid annulus midpoint fractional displacement, an angle-dependent speckle-tracking derived parameter, could be a good additional parameter in the assessment of the longitudinal right ventricular systolic function and in prediction of clinical worsening in children with pulmonary arterial hypertension.

Timolol 0.5% ophthalmic solution influences cardiac function in healthy cats.

The aim of this study was to ascertain the effect of a drop of timolol 0.5% ophthalmic solution on the systolic function of the left ventricle (LV) and left atrium (LA), and to confirm if timolol helped appraisal of diastolic function by reducing heart rate (HR) and separating the transmitral outflow waves from tissue Doppler imaging (TDI). A total of 41 client-owned healthy cats underwent two echocardiograms 20 mins apart. The timolol group (33 cats) received a drop of timolol solution after the first examination. Standard and speckle-tracking echocardiography evaluated the LV and LA function of both groups at the two time points evaluated. Timolol reduced HR (19%), and fractional shortening from LV (20.3%) and LA (16.6%). Septal S' decreased by 51% (from 7.7 to 5.2 cm/s) and lateral S' dropped by 43.1% (7.3 to 5.1 cm/s). Most longitudinal techniques did not change after timolol, including the mitral annular plane systolic excursion from the interventricular annulus, tricuspid annular plane systolic excursion, LV longitudinal strain and LV tissue motion annular displacement. The isovolumic relaxation time increased by 15.2% (from 54 to 64.6 ms), with most cats presenting this variable above the reference (>60 ms). Timolol did not support diastolic assessment, enabling evaluation in only 2/11 cats when using lateral TDI and 1/9 cats using septal TDI. Regarding side effects, miosis occurred in 18 cats (54.5%). Timolol reduced systolic function, decreasing standard echocardiographic variables. Regarding diastolic evaluation, although timolol decreased HR, it did not separate the mitral diastolic waves, as expected.

Conventional vs. Advanced Echocardiographic Parameters for Predict Fluid Responsiveness in Healthy Dogs

Background: Volume replacement is considered an essential component in the treatment of critically ill patients, but excess fluid administration can be as harmful as the lack of fluid therapy. Therefore, the volume replacement is only beneficial in patients deemed to be fluid responsive, that is, when the individual has an increase in their stroke volume after administration of a volume challenge. This study aim to assess whether conventional and advanced echocardiographic parameters for assessing left ventricular systolic function are able to predict fluid responsiveness in healthy spontaneously breathing dogs. The hypothesis was that some of these parameters would differ between responsive and non-responsive animals and could be used as a complementary measure for assessment of fluid responsiveness.Materials, Methods &amp; Results: A prospective study was carried out in which 22 client-owned healthy dogs over 1 year of age that presented to the Veterinary Medical Teaching Hospital for elective neutering procedure were included. All dogs underwent conventional and advanced echocardiographic examination to obtain the left ventricular internal diameter in diastole normalized (LVIDDn), left ventricular internal diameter in systole normalized (LVIDSn), ejection fraction (EF) and shortening fraction (SF) according to the Teischholz methodology, global longitudinal strain (GLS) and tissue motion annular displacement (TMAD). There parameters were evaluated before and after administration of a volume challenge with 10 mL/kg lactate ringer intravenously for 20 min. Based on the variation in aortic velocity integral time, 31.82% of dogs were considered responsive and 68.18% were non-responsive to the volume challenge. For advanced echocardiography, TMAD indexed by body weight (mm/kg) &gt; 0.89 (P = 0.004) and body surface area (mm/m2) &gt;18.9 (P = 0.004) after volume challenge had the best area under the curve values (both 0.895) and smaller gray zone intervals (0.52 - 0.81 and 14.89 - 17.88) for the identification of responsive dogs. Although, TMAD (mm/kg and mm/m2) before volume challenge was also higher in the responsive dogs (P = 0.041 and P = 0.029). As for conventional echocardiography, the LVIDDn &lt; 1.39 (P = 0.003) before volume challenge had the best area under the curve value (0.866) and the smallest gray zone interval (1.4 - 1.57) for the identification of responsive dogs. The GLS and the TMAD in milimeters (mm), percentage (%) and indexed by cubic root of weight (mm/∛kg) did not differ between the responsive and non-responsive dogs before and after volume challenge.Discussion: TMAD indexed by body weight (mm/kg) and body surface area (mm/m2) before and after volume challenge and the LVIDDn before volume challenge may be useful measures to complement the assessment of fluid responsiveness in spontaneously breathing dogs. This is the first study to use TMAD as a predictive parameter for fluid responsiveness in healthy, spontaneously breathing, dogs. Even it is an advanced echocardiographic technique, TMAD has advantages interms of execution time and the fact that it is less dependence on image quality or operator experience. It is possible that in the future such variables may form a useful part of the evaluation of fluid responsiveness in dogs. However, more studies are needed to better understand the applicability of these techniques, especially in dogs with hemodynamic changes. Keywords: canine, global longitudinal strain, stroke volume, tissue motion annular displacement, TMAD, VTI.

Tissue motion annular displacement to assess the left ventricular systolic function in healthy cats.

The tissue motion annular displacement (TMAD) measures the longitudinal displacement of the mitral annulus during systole, using speckle-tracking echocardiography (STE). The main objective was to determine the TMAD means in healthy cats, exploring the correlations with systolic surrogates. The influence of age, body surface area (BSA), heart rate, and systemic blood pressure on the indices was also analyzed. One hundred ninety-three healthy, client-owned cats participated in this prospective, cross-sectional observational study undergoing conventional and STE. Apical four-chamber (AP4) and two-chamber (AP2) images were recorded for offline calculations. Mean TMAD values were similar to mitral annulus plane systolic excursion (MAPSE), varying between 4 to 4.8mm depending on the annulus and image used. No significant differences between age and BSA categories were detected, except for AP4 MP%, reduced in the heavier group. TMAD variables showed moderate correlation with longitudinal strain (LSt) and MAPSE, but not with fraction shortening (FS) and ejection fraction (EF). The median time required for the offline calculation was 12.2s for AP4 and 11.8s for AP2. The technique showed moderate inter and intraobserver variation, proving a reliable tool for assessing left ventricular longitudinal systolic function in cats.

Assessment of longitudinal systolic function using tissue motion annular displacement in dogs with degenerative mitral valve disease

IntroductionAlthough degenerative mitral valve disease (DMVD) is essentially a disorder of the valve, the progression of the disease leads to structural myocardial changes that may compromise left ventricular systolic function. Tissue motion annular displacement (TMAD) is a surrogate for longitudinal fiber function based on speckle tracking assessment of the movement of the mitral annulus toward the apex during systole. The aim of this study was to evaluate longitudinal systolic function with TMAD in dogs with DMVD. AnimalsNinety-four dogs with DMVD and 32 healthy dogs. MethodsProspective cross-sectional observational study. Dogs with DMVD of various American College of Veterinary Internal Medicine classification stages and healthy control dogs underwent physical examination, electrocardiography, systolic blood pressure measurement, as well as a standard and speckle tracking echocardiography. Global longitudinal strain (GLS) and TMAD were used to assess longitudinal systolic function. ResultsThe global TMADmm and global TMAD% were higher in American College of Veterinary Internal Medicine B2 animals than in the stage CD. Global TMAD (mm/kg,mm/bodyweight3, mm/m2) were correlated with GLS and ejection fraction. Global TMAD (mm/kg,mm/m2,%) and GLS were influenced by sex. In addition, systolic blood pressure influenced GLS (P < 0.01; r = −0.23), global TMADmm/kg (P = 0.017; r = −0.21) and global TMADmm/m2 (P = 0.031; r = −0.19). Tissue motion annular displacement was fast to be performed and produced good repeatability in dogs with DMVD. ConclusionsGlobal TMAD (mm,%), was reduced in DMVD dogs with clinical signs of heart failure compared with stage B2. Tissue motion annular displacement was shown to be a repeatable technique for evaluation of longitudinal systolic function in dogs with DMVD.

A novel echocardiographic parameter to identify individuals susceptible to acute mountain sickness

BackgroundAcute mountain sickness (AMS) may cause life-threatening conditions. This study aimed to screen echocardiographic parameters at sea level (SL) to identify predictors of AMS development. MethodsOverall, 106 healthy men were recruited at SL and ascended to 4100 m within 7 days by bus. Basic characteristics, physiological data, and echocardiographic parameters were collected both at SL and 4100 m above SL. AMS was identified by 2018 Lake Louise Questionnaire Score. ResultsAfter acute high altitude exposure (AHAE), 33 subjects were diagnosed with AMS and exhibited lower lateral mitral valve tissue motion annular displacement (MV TMADlateral) at SL than AMS-free subjects (13.09 vs. 13.89 mm, p = 0.022). MV TMADlateral at SL was significantly correlated with AMS occurrence (OR = 0.717, 95% CI: 0.534–0.964, p = 0.028). The MV TMADlateral<13.30-mm group showed over 4-fold risk for AMS development versus the MV TMADlateral≥13.30-mm group. After AHAE, the MV TMADlateral<13.30-mm group had increased HR (64 vs. 74 bpm, p = 0.001) and right-ventricular myocardial performance index (0.54 vs. 0.69, p = 0.009) and decreased left ventricular global longitudinal strain (−21.50 vs. −20.23%, p = 0.002), tricuspid valve E/A ratio (2.11 vs. 1.89, p = 0.019), and MV E-wave deceleration time (169.60 vs. 156.90 ms, p = 0.035). ConclusionMV TMADlateral at SL was a potential predictor of AMS occurrence and might be associated with differential alterations of ventricular systolic and diastolic functions in subjects with different MV TMADlateral levels at SL after AHAE.

Acute changes of left ventricular function during surgical revascularization by 3D speckle tracking.

Detecting early impact of coronary artery bypass grafting (CABG) on left ventricular (LV) function is important because such measures may contribute to meaningful improvement in clinical outcomes. We aimed to gain knowledge about acute changes of LV performance during surgical revascularization using three-dimensional speckle tracking echocardiography (3D STE). Thirty-five patients scheduled for CABG surgery who underwent intraoperative transesophageal echocardiography (TEE) were enrolled (mean age 68.9±7.3years). TEE was performed before and after surgery, as well as before and after grafting. 3D LV ejection fraction (LVEF), tissue motion annular displacement (TMAD) of the mitral valves, 3D global longitudinal strain (GLS), global circumferential strain (GCS), twist, and torsion were quantified. Regional longitudinal strain (LS) was calculated based on coronary perfusion territories in a 16-segment LV model. Despite the absence of change in TMAD and 3D LVEF, 3D GLS (-18.6±4.3% at baseline vs -16.0±4.0% after surgery, P=.01) was significantly decreased, followed with no significant effect on GCS, twist, and torsion during surgery. 3D GLS correlated significantly with 3D LVEF (r between -0.34 and -0.51, P<.05 for all) under the whole operation. Territorial LS did not increase immediately after surgery. 3D speckle tracking imaging allows for detailed and direct evaluation of myocardial deformation, though impaired LV longitudinal function is still apparent immediately after surgery. GLS is more sensitive to an acute reduction in LV function than conventional parameters, which can be potentially useful for serial monitoring of functional recovery.

Assessment of right ventricular systolic function by tissue motion annular displacement in healthy dogs

Introduction/objectivesThere are few parameters for assessment of right ventricular (RV) systolic function on echocardiographic examination. Morphofunctional studies are limited by the irregular shape of the RV. Recently, tissue motion annular displacement (TMAD), a technique that evaluates valve annulus displacement toward the cardiac apex, has shown a good correlation with left ventricular global longitudinal strain (GLS) in healthy dogs. Therefore, the aim of this study was to evaluate the longitudinal systolic function of the RV of healthy dogs using TMAD. AnimalsA hundred healthy client-owned dogs. Materials and methodsCross-sectional study. Physical examination, electrocardiogram, blood pressure measurement, and echocardiography were recorded. The systolic function of the RV was evaluated by GLS free wall and TMAD. Data were compared with those derived from conventional echocardiography. ResultsTMAD values varied according to body weight. There was a correlation of TMAD in millimeters with all indices of RV systolic function, including GLS free wall (R:-0.239; p:0.017). TMAD had a correlation with age and heart rate; whereas there was no relationship with sex and blood pressure. The coefficient of variation for the intraobserver evaluation was lower for the TMAD in millimeters (9.9%) compared with the GLS free wall (17.9%). In addition, the mean time to perform TMAD (8.1 s) was lower than that of the GLS free wall (37.7 s). ConclusionsTMAD is a fast, reproducible, and promising method for assessing RV systolic function in healthy dogs. However, further studies are needed to understand the applicability of this technique in patients with heart disease.

Comparison of Longitudinal and Apical Foetal Speckle Tracking Echocardiography Using Tissue Motion Annular Displacement and Segmental Longitudinal Strain

The aim of our prospective pilot study with exploratory analysis was to compare longitudinal and apical foetal speckle tracking echocardiography (STE) using tissue motion annular displacement (TMAD) and segmental longitudinal strain (SLS). We compared two different STE quantification tools in a longitudinal and apical four-chamber view in 57 normal foetuses between 20 and 40 wk of gestation. Myocardial mechanical dyssynchrony and strain were assessed using offline quantification software (QLab Version 10.3, Philips Medical Systems, Andover, MA, USA). We compared the dyssynchrony measurements with TMAD and SLS in longitudinal and apical four-chamber views. Furthermore, we examined the segmental strain values of both ventricles with SLS and compared the differences between longitudinal and apical measurements. Dyssynchrony measurements with TMAD and SLS and strain measurements with SLS were feasible in all cases. In the apical view, the dyssynchrony measurements with TMAD were systematically greater than those achieved with SLS (p < 0.001). For the longitudinal view, no differences were observed between tools (p = 0.153). The application of SLS provided similar results for dyssynchrony in both views (intra-class correlation coefficient [ICC] = 0.281, p = 0.623), but the strain measurements in the left and right ventricles differed significantly between views (ICC = –0.082, p = 0.011, and ICC = –0.061, p = 0.024, respectively). For TMAD, we found large differences in the dyssynchrony values between longitudinal and apical assessment (ICC = –0.060, p = 0.03). Furthermore, TMAD exhibited reduced accuracy in the system's automatic tracking algorithm, limiting the data quality. The dyssynchrony assessment is affected less by the foetal position in SLS than in TMAD. The strain readings in SLS varied depending on the view in which they were assessed. The application of TMAD cannot be recommended for foetal STE.

Assessment of longitudinal systolic function using tissue motion annular displacement in healthy dogs

IntroductionLeft ventricular systolic function is one of the main parameters studied in echocardiography. Longitudinal systolic function, however, is less commonly evaluated in routine examinations but may provide early information on systolic dysfunction. The movement of the mitral annulus toward the apex has already been determined as a method for evaluation of longitudinal systolic function in dogs, but the study of this movement by speckle tracking with the tissue motion annular displacement (TMAD) technique has not yet been evaluated. AnimalsOne hundred fifty-three client-owned healthy dogs. MethodsCross-sectional study. One hundred fifty-three client-owned healthy dogs underwent physical examination, electrocardiography, blood pressure measurement, and a standard and speckle tracking echocardiography. Systolic function was evaluated by global longitudinal strain (GLS) and TMAD. These parameters were compared with the standard echocardiographic data. ResultsA correlation was found between GLS, TMAD, and body weight. Tissue motion annular displacement and GLS were significantly correlated (p < 0.001) with other surrogates of systolic function, including ejection fraction and fractional shortening. There were no differences in TMAD between sexes. The coefficient of variation (CV) of the intraobserver evaluation in the global TMAD (CV 4.44) was slightly higher than that in the GLS (CV 3.74). Also, TMAD was not influenced by heart rhythm and could be acquired more rapidly than GLS. ConclusionsTissue motion annular displacement is a rapid and reproducible method for the assessment of left ventricle longitudinal function in healthy dogs. However, more studies are needed to validate the real clinical applicability of TMAD in animals with heart diseases.

Tissue Motion Annular Displacement of the Mitral Valve Can Be a Useful Index for the Evaluation of Left Ventricular Systolic Function by Echocardiography in Normal Children.

As the important role of longitudinal shortening in ventricular function has been well recognized over the past decade, evaluation of longitudinal systolic function of the left ventricle has become a subject of growing interest. Tissue motion annular displacement of the mitral valve (TMAD) is a new parameter of longitudinal systolic function. Although some studies have reported that this new parameter correlates with left ventricular ejection fraction (LVEF) in adults, little is known about TMAD in normal children. In this work, we investigated 94 children with no history of cardiovascular disease. TMAD was measured in the apical four-chamber view using the two-dimensional speckle tracking technique. Three points for tracking were selected in a diastolic frame: the lateral mitral valve annulus, medial mitral valve annulus, and left ventricular apex. The value was expressed as the percentage of displacement of the midpoint of the mitral valve annulus, using software to correct for left ventricular length at end-diastole. Pearson's coefficient was used to estimate the correlation between TMAD and left ventricular systolic function parameters including the biplane modified Simpson method-derived ejection fraction and global longitudinal strain (GLS). We also analyzed the correlation between TMAD and heart rate (HR), height, age, and body surface area (BSA). TMAD was found to correlate significantly with LVEF (r = 0.71, p < 0.01) and GLS (r = -0.77, p < 0.01). However, no correlation was revealed for HR (r = -0.14, p = 0.19), height (r = -0.17, p = 0.10), age (r = -0.19, p = 0.09), or BSA (r = -0.19, p = 0.08). These results indicate that TMAD is useful for assessing LVEF and longitudinal systolic function in normal children, and is not influenced by changes in HR, height, age, or BSA.

Tissue Motion Annular Displacement Predicts Mortality/Transplant After the Bidirectional Glenn.

Quantifying right ventricular function in patients with a systemic right ventricle (RV) is difficult but important for prognosis. Tissue motion annular displacement tracks displacement of the tricuspid annulus toward the apex. We evaluated this measure alongside fractional area change (FAC) on patients with single, RV prior to the bidirectional Glenn procedure. We tested both measures for correlation with outcomes. Retrospective measurement of tissue motion annular displacement and FAC was performed on echocardiographic clips obtained prior to the bidirectional Glenn. A chart review included postoperative outcomes and midterm mortality/transplant. Bivariate correlations and Cox proportional hazards models were used for analyses. Fifty-one patients with dominant RV underwent the bidirectional Glenn procedure and all had image quality that allowed analysis. The age ranged from 3 to 11 months (median 4 months). Neither tissue motion annular displacement nor FAC correlated with short-term postoperative outcomes. Tissue motion annular displacement was independently predictive of mortality/transplant ( P = .03) in the Cox hazard model. The mean for survivors was 12.4% and for nonsurvivors/transplants was 10.0%. Tissue motion annular displacement intra-observer variability was 2.8% (1.2%-3.5%). Interobserver mean variability was 6.1% (3.3%-8.1%). Fractional area change was not predictive of mortality/transplant. Tissue motion annular displacement is an independent predictor of midterm mortality/transplant after the bidirectional Glenn procedure in patients with single, RV, in this study. It may outperform FAC in this regard and has good reproducibility. Tissue motion annular displacement may be a useful measure in identifying high-risk children in this population.

Right Ventricular Longitudinal Shortening Before and After Stage I Surgical Palliation Correlates with Outcomes.

Quantification of right ventricular function is difficult, but important, in patients with single ventricles. Tissue motion annular displacement (TMAD) is an echocardiographic tool that measures displacement of the tricuspid valve relative to the apex. We evaluated TMAD, lateral annular displacement (LAD), and fractional area change (FAC) for correlation with outcomes. We measured TMAD, LAD, FAC, and other variables that may affect prognosis in patients with single right ventricle physiology pre- and post-Stage I palliation and correlated them with outcomes up to the Glenn procedure. Intra- and inter-observer variability for TMAD measurements were 2.7% (1.2-3.5%) and 6.1% (3.3-8.1%), respectively. Sixty-six subjects met the inclusion criteria. Pre-Stage I TMAD was 13.7% (SD 3.9%). TMAD had a linear relationship with FAC (r2 = 0.76). There was a correlation between TMAD and hospital stay (p = 0.044) and ECMO/arrest (p = 0.024). LAD correlated with ECMO/arrest (p = 0.045) and mortality/transplant (p = 0.049). FAC correlated with in-hospital mortality (p = 0.028). Post-Stage I TMAD was 11.8% (SD 3.7%). TMAD, LAD, and FAC all correlated with in-hospital mortality and mortality/transplant. In multivariate models, TMAD was independently predictive of weight for age Z score pre-Glenn. TMAD, FAC, and LAD correlate with clinically significant outcomes after the first-stage palliation. TMAD correlated with more outcomes than FAC and was the only measure that was independently predictive of any outcome. TMAD is a reproducible measure of RV function in this population. TMAD has prognostic value before and after first-stage palliation and may outperform more traditional measures.

Effect of left ventricular hypertrophy and deformation on cardiac function in patients with uremia cardiomyopathy by using quantitative speckle tracking technology

To evaluate the effect of left ventricular hypertrophy and deformation on cardiac function in patients with uremic cardiomyopathy (UCM) by using the technology of two dimensional speckle tracking imaging (2D-STI). Methods: A total of 67 UCM patients were randomly divided into the normal cardiac function group (subgroup A, 32 cases) and the abnormal cardiac function group (subgroup B, 35 cases) according to the New York Heart Association points (NYHA-P). A total of 30 healthy subjetcs served as the control group. Parameters including left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular spherical index (LVSI), left ventricular myocardial mean radial strain (MRS), mean radial strain rate (MRSR), mean longitudinal strain (MLS), local systolic twist angle (STA), and mitral annulus maximum displacement (TMAD) were detected. Results: MLS, MRS, MRSR, LVSI, STA and TMAD in the Group A and Group B were lower than that in the control group (P<0.05), and LVMI in the Group A and Group B was increased than those in the control group (P<0.05); LVEF, MLS, MRS, MRSR, LVSI and STA in the Group B was decreased than that in the Group A (P<0.05). MLS in the Group A and B were positively correlated with LVEF and LVSI, but negatively correlated with LVMI. Using the point of 14.10% for MLS to evaluate UCM patients with NYHA-P>4 points, the sensitivity, the specificity and Yuedden index were 90.5%, 71% and 0.585, respectively. STA in UCM patients were lower than that in the control (P<0.05). Conclusion: 2D-STI possesses a unique advantage in detecting left ventricular strain and strain rate on left ventricular regional function in UCM with left ventricular hypertrophy and ventricular deformation. There is no direct correlation between the left ventricular hypertrophy and ventricular deformation, but the ventricular hypertrophy and deformation are correlated with regional cardiac function and clinical cardiac function. Left ventricular regional dysfunction may occur before cardiac hypertrophy and deformation.