Tissue Synchronization Imaging Research Articles

QUALITY CONTROL IN ECHOCARDIOGRAPHY REPORTING (PART A)

For cardiac evaluation echocardiography is of immense importance. Easy availability, low cost, and portability lands it in the hands of novices at times. It has a learning curve and expertise must be obtained to keep the standard of reports high and reliable. The referring physician must be fully conversant with the indications of echocardiography. The echocardiographic machine should deliver images of high resolution and fully equipped with all the basic modalities. Availability of 3D (3-dimensional) imaging, tissue synchronization imaging and strain analysis are added advantages. Preliminary data of patient must be collected and the study should be recorded for off-line analysis. Finally, the findings should be narrated on a proforma in the form of a standardized report showing all the relevant features, especially directed to the query of referring physician, thus completing the loop.

Assessment of Left Ventricular Asynchrony after Permanent Cardiac Pacing by Using Speckle Tracking Echocardiography

AbstractBackground: Echocardiography is important in assessing Left Ventricular (LV) Mechanical Dysynchrony (LVMD) and left ventricular function after permanent pacemaker. At present, Real-Time Three Dimensional Echocardiography (RT3DE) and tissue Doppler imaging (TDI) are the most sensitive and commonly used techniques for the quantification of LVMD. Global longitudinal strain (GLS) and LV dyssynchrony as-sessment enables us to detect early signs of LV dysfunction after cardiac pacing.Aim of Study: To evaluate LV mechanical dyssynchrony and LV function in different pacing modes after permanent cardiac pacing by using TDI and speckle tracking echocardi-ography and to correlate these changes with other clinical, electrocardiographic and echocardiographic data.Patients and Methods: Seventy patients were enrolled in this prospective cross sectional observational study, (mean age 60.99±13.77 years, 42 females), in Mansoura Specialized Medical Hospital over a period of 1 year from April 2018 to April 2019. All patients were assessed by thorough history taking, clinical examination, 12 lead surface ECG, echocar-diography, 2D speckle tracking echocardiography STE to assess GLS and tissue Doppler imaging TDI.Results: Regarding diastolic function by pulsed wave Doppler PWD: There was significant decrease in E/e¢ ratio (p<0.001 *), significant increase in myocardial performance index Tei index (p<0.001 *). Regarding internal dimensions and systolic function: There was significant increase in the following: Left Atrial Dimension (LAD) (p=0.001*), Left Ventricular End Systolic Dimension LVESD (p<0.001*) and Left Ventricular End Diastolic Dimension LVEDD (p<0.001 *) while there was significant decrease in ejection fraction EF (p<0.001 *) and fractional shortening FS (p<0.001 *). Regarding parameters of LV dysynchrony: There was significant increase in the following: Aortic preejection delay APED (p<0.001*), interventricular mechanical delay (p<0.001 *) and septal posterior wall motion delay SPWMD by M mode (p<0.001 *). Regarding parameters assessed by tissue synchronization imaging TSI: There was significant increase in the following: SD-Ts (p=0.001 *) and all segments Max delay (p=0.027*). Regarding parameters assessed by STE: There was significant decrease in global longitudinal strain GLS (p=0.034*) while there was significant increase in TP-SD by STE (p<0.001*).Also, there was significant decrease in global longitudinal strain GLS (p<0.001*) and significant increase in TP-SD by STE (p=0.001*) in DDD group. While there was significant decrease in global longitudinal strain GLS (p<0.001 *) and significant increase in TP-SD by STE (p<0.001*) in VVI group.Conclusion: GLS and 2D STE can help in the detection of subclinical left ventricular dysfunction after permanent pacemaker implantation before appearance of symptoms. Also, cardiac pacing leads to LVMD whatever the pacing mode is which may needs later on upgrading to cardiac resynchronization therapy CRT.

Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle branch block

Cardiac resynchronization therapy (CRT) via biventricular pacing has demonstrated clinical benefits in patients with heart failure (HF) and ventricular dyssynchrony. Other approaches of CRT is little known. The purpose of this study was to assess the feasibility, safety, and efficacy of left bundle branch area pacing (LBBAP) in patients with HF and left bundle branch block (LBBB). Eleven consecutive patients with HF, reduced left ventricular ejection fraction and LBBB and indicated for CRT were recruited. LBBAP was achieved via transventricular septal approach and characterized by narrower QRS duration, shortened peak left ventricular activation time, and right bundle branch conduction delay on the electrocardiogram. Electrocardiogram, echocardiogram, and cardiac function were evaluated at baseline and follow-up. Interventricular mechanical delay and 3-dimensional tissue synchronization imaging during LBBAP and intrinsic LBBB status were measured by echocardiography at follow-up. LBBAP significantly shortened QRS duration (from baseline 180.00 ± 15.86 ms to 129.09 ± 15.94 ms; P < .01) and left ventricular activation time (from baseline 108.18 ± 15.54 ms to 80.91 ± 9.95 ms; P < .01). Interventricular mechanical delay and the standard deviation of tissue synchronization imaging of 12 left ventricular (LV) segments were significantly shorter during LBBAP than in intrinsic LBBB status (both with P < .01). At a mean follow-up period of 6.7 months, New York Heart Association functional class, plasma level of B-type natriuretic peptide, LV end-systolic diameter, and left ventricular ejection fraction were significantly improved (all with P < .05 vs baseline). The study demonstrates that LBBAP is clinically feasible in patients with systolic HF and LBBB. LBBAP can be a new CRT technique to correct LBBB, provide ventricular synchrony, and improve clinical symptoms with LV reverse remodeling.

Left ventricular dyssynchrony assessment using tissue synchronization imaging in acute myocardial infarction.

Objectives:To assess left ventricular (LV) dyssynchrony in patients with ST elevation myocardial infarction (STEMI).Background:Mechanical synchronization disorder leads to a decrease in LV ejection fraction (LVEF) and stroke volume, an abnormal distribution of wall tension, and increase in workload during cardiac contraction.Methods:We enrolled 56 participants, 36 with acute STEMI and 20 healthy controls. The automatically color-coded time to peak myocardial velocity was measured using a 6mm sample volume, manually positioned within the two-dimensional-tissue strain image of the 12 basal and middle LV segments.Results:A significant delay was found between the septal-lateral and septal-posterior walls in patients with STEMI compared to patients in the control group (36.36 vs. −6.0ms, P = 0.036; and 42.7 vs. 23.94ms, P = 0.042, respectively). Furthermore, all segment maximum differences and all segment standard deviation (SD; dyssynchrony index) were found to be significantly higher in the STEMI group (131.28 vs. 95.45ms, P = 0.013; and 44.47 vs. 26.45ms, P = 0.001, respectively). A significant delay between the septal-lateral walls and septal-posterior walls, all segment maximum difference, and all segment SD (dyssynchrony index) were found in patients with complicated STEMI (70.89 vs. 15.83ms, P = 0.038; 57.44 vs. 19.06ms, P = 0.040; 138.11 vs. 100.0ms, P = 0.035; and 45.44 vs. 32.50ms, P = 0.021, respectively). There was a significant negative correlation between tissue synchronization imaging parameters and LVEF, and a positive correlation with LV end systolic dimension.Conclusion:Patients with acute STEMI showed significant LV dyssynchrony, which was an independent predictor of inhospital complications.

The Effects of Ivabradine on Left Ventricular Synchronization and Tei Index in Patients with Systolic Heart Failure.

The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on LV synchronization and Tei index in stable outpatients with systolic HF. We evaluated prospectively 40 (30 males, 10 females) patients with HF. All patients were evaluated before and after treatment by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI) and tissue synchronization imaging (TSI). Standard deviation of Ts of the 12 LV segments (Ts-SD-12) is the most widely used parameter of intra-LV asynchrony. Thirty men and 10 women with mean ± SD age of 64.7 ± 9.9 years were included in this study. Most of the patients benefitted from some degree of clinical improvement, 12/16 (75.0%) from NYHA III to II and 18/24 (75.0%) from II to I, respectively. Resting heart rate was significantly reduced after ivabradine treatment (84.3 ± 11.4 vs. 66.5 ± 11.5 bpm, p < 0.001). E/E' and Tei index were significantly changed after ivabradine treatment (17.3 ± 9.0 vs. 14.8 ± 7.1, p = 0.02 and 0.86 ± 0.74 vs. 0.81 ± 0.69, p = 0.02). Intra-LV synchrony parameters Ts-SD-12 and Ts-12 were significantly reduced after ivabradine (46.8 ± 13.6 vs. 42.7 ± 13.1, p = 0.01 and 142.5 ± 44.0 vs. 128.5 ± 45.2, p = 0.009). The present study demonstrated that adding ivabradine to the standard therapy reduced HR and significantly improved LV ventricular asynchrony and Tei index in systolic HF patients.

Left Ventricular Dyssynchrony in Acute ST Elevated Myocardial Infarction in Patients with Normal QRS duration

Background: The aim of this study was to assess left ventricular dyssynchrony after acute ST elevated myocardial infarction (STEMI) in patients with normal QRS duration. Real time 3D echocardiography (RT3DE) with triplane tissue synchronization imaging (TSI) used to identify segmental left ventricular systolic velocity in ejection phase to evaluate LV dyssynchrony in patients with STEMI and the findings were compared with control.Materials and methods: RT3DE with triplane TSI was performed within 4 days of AMI after thrombolysis or primary PCI in 31 patients and compared with 31 agematched controls. Regional myocardial velocities were assessed in 12 segments in ejection phase, and the corresponding time to peak systolic velocity (Ts) was measured. To assess LV dyssynchrony Ts-4, Ts-6, Ts- SD-6, Ts-12 and Ts-SD-12 were computed by offline dedicated software semi-automatically.Results: The dyssynchrony parameters were significantly prolonged in patients with AMI. Among the dyssynchrony parameters TS-SD-12 was better indicator of LV dyssynchrony. The Ts-SD-12 was significantly prolonged in the STEMI group when compared with controls. In patients with acute STEMI mean Ts-SD-12 was 43.2±19.1 milliseconds whereas in control group it was 23.0 ±6.5 milliseconds (p&lt;0.05). The Ts-SD-12 was prolonged in patients with Anterior than Inferior STEMI as follows respectively 45.9± 17.6 and 40.0± 21 milliseconds.Conclusions: Triplane TSI by RT3DE is useful in evaluating LV dyssynchrony in patients with acute STEMI and even in those with normal QRS duration there is significant left ventricular dyssynchrony early after STEMI.Bangladesh Heart Journal 2015; 30(1) : 13-21

Assessment of hemodialysis effect on left ventricular mechanical dyssynchrony by tissue synchronization imaging

Assessment of hemodialysis effect on left ventricular mechanical dyssynchrony by tissue synchronization imaging

Exercise Stress Echocardiography and Tissue Synchronization Imaging of Myocardial Dyssynchrony

Background: Stress echocardiography represents one of the best possible imaging choice for the diagnosis and stratification of patients with coronary artery disease (CAD). However, this imaging technique presents some limitations such as the quality of the image, high inter-observer variability, and the operator-dependent expertise. New technologies have been recently developed to provide an objective, operator-independent, and quantitative analysis of regional myocardial function. Objectives: The aim of this study was to investigate regional myocardial dyssynchrony using tissue synchronization imaging (TSI) during exercise stress echocardiography (ESE). Patients and Methods: The ESE and TSI analysis of left ventricular (LV) segments was performed for 30 patients with CAD previously treated with revascularization therapy (CADr group) and the results were compared to those in 30 healthy subjects (norm group). The echo protocol comprised echocardiographic examinations at baseline, at the peak of exercise, and at 5 minutes after recovery as well as biplane and triplane acquisitions, pulsed wave of mitral flow, continuous wave of tricuspid regurgitation, tissue Doppler at the mitral annulus, TSI with an automatically detected positive time-to-peak velocity (Tp), and the measurement of the maximum activation time delay between myocardial segments and its standard deviation at baseline and peak stress for each patient. Results: The CADr group showed a lower increase in E (P = 0.005), A (P = 0.006), S' (P < 0.001), and E' (P = 0.006) velocities at both baseline and peak stress and a significantly increased ventricular dyssynchrony at baseline and at peak stress (P < 0.01) compared to the norm group. The baseline-peak variations in the CADr group did not show significant dierences. The relationships between the maximum activation delay and the other echocardiographic parameters showed a significant negative correlation with LV ejection fraction (r = 0.217; P = 0.031) and S' velocity (r = -0.393; P < 0.001) and a positive correlation with the E/E' ratio (r = 0.376; P < 0.001). The comparison between the dierent ischemic territories revascularized in terms of the delay in ventricular activation showed the greatest delay in the revascularized territory in 63% of the patients with ischemia. Conclusions: The TSI analysis in patients with CAD may be considered an interesting parameter in addition to the conventional echocardiographic parameters during ESE.

Exercise Stress Echocardiography and Tissue Synchronization Imaging of Myocardial Dyssynchrony

Exercise Stress Echocardiography and Tissue Synchronization Imaging of Myocardial Dyssynchrony

Hemodynamic device-based optimization in cardiac resynchronization therapy: concordance with systematic echocardiographic assessment of AV and VV intervals

Hemodynamic device-based optimization in cardiac resynchronization therapy: concordance with systematic echocardiographic assessment of AV and VV intervals M&aacute;rio M Oliveira, Luisa M Branco, Ana Galrinho, Nogueira da Silva, Pedro S Cunha, Bruno Valente, Joana Feliciano, Ricardo Pimenta, Ana Sofia Delgado, Rui Cruz Ferreira Santa Marta Hospital, Lisbon, Portugal Background: Inappropriate settings of atrioventricular (AV) and ventriculo-ventricular (VV) intervals can be one of the factors impacting response to cardiac resynchronization therapy (CRT). Optimal concordance of AV and VV intervals between echocardiographic-based assessment and a device-based automatic programming with a hemodynamic sensor was investigated, together with left ventricle (LV) reverse remodeling after 6 months of regular automatic device-based optimization.Methods: We evaluated blindly 30 systematic echocardiographic examinations during 6 months in 17 patients (12 men, 64&plusmn;10 years, in sinus rhythm and New York Heart Association class III; 76% with non-ischemic dilated cardiomyopathy, LV ejection fraction [LVEF] &lt;35%, QRS 130 milliseconds and LV dyssynchrony) implanted with the SonRtip lead and a cardioverter-defibrillator device. Dyssynchrony (AV, VV, or intraventricular) was evaluated by an experienced operator blinded to the device programming, using conventional echocardiography, tissue synchronization imaging, tissue Doppler imaging, radial strain, and 3D echocardiography.Results: Either no AV or VV dyssynchrony (n=11; 36.7%) or a slight septal or lateral delay (n=13; 43.3%) was found in most echocardiography examinations (80%). AV or VV dyssynchrony requiring further optimization was identified in one-fifth of the examinations (20%). At 6 months, 76.5% patients were responders with LV reverse remodeling, of which 69% were super-responders (LVEF &gt;40%). A statistically significant increase in LVEF was observed between baseline and 6 months post implant (P&lt;0.01). One patient died from non-cardiac causes.Conclusion: Concordance between echocardiographic methods and device-based hemodynamic sensor optimization was found in most examinations (80%) post CRT. After 6 months of systematic optimization with SonR, patients showed a statistically significant increase in LVEF, with a high rate of reverse remodeling. Keywords: cardiac resynchronization therapy, hemodynamic sensor, atrioventricular delay, interventricular delay, reverse remodeling

Acute effect of primary percutaneous coronary intervention on left ventricular dyssynchrony in ST-segment elevation myocardial infarction.

The aim of this study was to prospectively evaluate the effect of percutaneous coronary intervention in the acute period on left ventricular dyssynchrony in ST-segment elevation myocardial infarction patients by using Tissue Synchronization Imaging. Forty-four ST-segment elevation myocardial infarction (MI) patients (29 male, 15 female), who were admitted within the first 12 hours of chest pain symptoms, were enrolled in the study. According to the localization of MI, the patients were divided into groups as anterior MI (n=26) and inferior MI (n=18). All echocardiography measurements were taken just before percutaneous coronary intervention (PCI) and following PCI at a mean of 3-6 days. They were assessed according to the time to reach the peak systolic velocity, which was calculated by the tissue synchronization imaging method from four pairs of non-apical alternate segments. The difference between the duration to reach the peak systolic velocity in alternate segments was regarded as left ventricle dyssynchrony and the results were compared. In the anterior MI group, basal anterior (p<0.01), mid-anterior segment (p<0.01) and basal septal segment (p<0.01); in the inferior MI group, the basal septal segment (p=0.02), mid-septal segment (p=0.02), and basal and mid-inferior segment (p<0.01) values were significantly lower in the post-PCI measurements when compared to the measurements taken prior to PCI. In both groups, the intraventricular dyssynchrony indices of the basal anterior-basal inferior (p<0.01), mid-anterior-mid-inferior (p<0.01) segments were found to be significantly lower in the post-PCI period when compared to the pre-PCI period. It was found that percutaneous coronary intervention in patients with ST-elevation significantly decreases the degree of LV dyssynchrony in the acute period.

Assessment of Left Ventricular Dyssynchrony in Hypertensive Patients with Normal Systolic Function by Tissue Synchronization Imaging

Assessment of Left Ventricular Dyssynchrony in Hypertensive Patients with Normal Systolic Function by Tissue Synchronization Imaging Left ventricular systolic and diastolic dyssynchrony are not uncommon in patients with hypertension. Dyssynchrony is associated with increasing incidence of heart failure, cardiovascular morbidity and mortality. The study aims to assess LV dyssynchrony in hypertensive patients with nor Normal Systolic Function by Tissue Synchronization imaging.

Left ventricular dyssynchrony in hypertensive patients with normal systolic function: tissue synchronization imaging study

ObjectiveThe objective of our study was to assess left ventricular (LV) dyssynchrony in hypertensive patients with normal systolic function using tissue synchronization imaging (TSI).BackgroundLV systolic and diastolic dyssynchrony are not uncommon in patients with hypertension. Dyssynchrony is associated with increasing incidence of heart failure, cardiovascular morbidity, and mortality.Patients and methodsA total of 71 individuals were enrolled in this study. They were divided into two groups.Group A included 51 hypertensive patients with good LV systolic function (ejection fraction≥ 50%) and narrow QRS on the ECG (<120 ms). We excluded individuals with any of the following: acute coronary syndrome, diabetes mellitus, atrial fibrillation, significant valvular heart disease, chronic renal failure, pulmonary hypertension, or myocardial or pericardial disease.Group B included 20 age-matched and sex-matched healthy volunteers and represented the control group.All participants underwent standard two-dimensional echocardiography and TSI.ResultsThe hypertensive group had significantly higher septal wall and posterior wall thickness than the control group. In addition, the LV mass was significantly higher in hypertensive patients than in controls (P < 0.05). The delay between the septal and lateral walls was significantly higher in hypertensive patients than in controls (67.882 ± 53.536 in HTN vs. 44.400 ± 39.495 in controls) (P < 0.05). The severity of dyssynchrony is significantly related to the LV mass, septal wall thickness, posterior wall thickness, and left ventricular end-diastolic dimension.ConclusionPatients with systemic hypertension and normal systolic function may demonstrate LV dyssynchrony by TSI. The severity of dyssynchrony is significantly related to LV mass, septal wall thickness, posterior wall thickness, and left ventricular end-diastolic dimension. Systolic dyssynchrony may identify hypertensive patients at risk for the development of congestive heart failure, and who may benefit from more intensive hypertension control at an earlier stage in their disease process.

The Effect of Different Circadian Blood Pressure Rhythms on Left Ventricular Systolic Dyssynchrony in Patients with Newly Diagnosed Essential Hypertension

Objectives Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. Methods One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. Results Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1 ± 18.7 vs. 31.8 ± 15.4, P ≤ 0.001); Ts-12 (123.0 ± 50.6 vs. 98.4 ± 42.3, P ≤ 0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. Conclusion Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.

Left ventricular systolic asynchrony: an important sign for cardiac involvement in plaque-type psoriasis

Psoriasis is associated with cardiovascular diseases (CVD). The purpose of this study was to evaluate the relationship between Left Ventricular (LV) asynchrony and psoriasis. Asynchrony was assessed in 31 patients with psoriasis without evidence of CVD and 25 healthy subjects. All the patients and controls were subjected to tissue synchronization imaging (TSI), and conventional and tissue Doppler echocardiography. The time to regional peak systolic tissue velocity (Ts) in LV by the six-basal-six-midsegmental model was measured on ejection phase TSI images, and four TSI parameters of systolic asynchrony were computed. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels in psoriatic patients were measured. All TSI parameters of LV asynchrony increased in psoriatic patients compared to the controls: the standard deviation (SD) of the 12 LV segments Ts (37.3±14.8 vs. 24.6±11.1, P=0.002); the maximal difference in Ts between any two of the 12 LV segments (112.7±39.8 vs. 83.1±38.1, P=0.01), the SD of the six basal LV segments (36.2±17.3 vs. 23.2±14.5, P=0.008); and the maximal difference in Ts between any two of the six basal LV segments (91.3±43.5 vs. 60.5±37.3, P=0.01). LV asynchrony was observed in 67.7% of psoriatic patients. Higher CRP (1.9±1.3 vs. 0.92±1.4, P=0.04) and ESR (34.8±17.3 vs. 20±15.3, P=0.03) levels were determined in patients with LV asynchrony. Regression analysis showed LV systolic asynchrony (P=0.02), Tei index (P=0.03), EF (P=0.04), and E/A ratio (P=0.04) were independently associated with psoriasis. LV asynchrony firstly described in patients with psoriasis may be an important finding of cardiac involvement in psoriasis.

Utility of echocardiographic tissue synchronization imaging to redirect left ventricular epicardial lead placement for cardiac resynchronization therapy

Background Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement for treating congestive heart failure (HF). It has been documented that the placement of the left ventricular lead at the longest contraction delay segment has the optimal CRT benefit. This study described follow-up to surgical techniques for CRT as a viable alternative for patients with heart failure. Methods Between April 2007 and June 2012, a total of 14 consecutive heart failure patients with New York Heart Association (NYHA) Class III-IV underwent left ventricular epicardial lead placements via surgical approach. There were eight males and six females, aged 36 to 79 years ((59.6±9.2) years). The mean left ventricular ejection fraction (LVEF) was (33.6±7.4)%. All patients were treated with left ventricular systolic dyssynchrony and underwent left ventricular epicardial lead placements via a surgical approach. Tissue Doppler imaging (TDI) and intraoperative transesophageal echocardiography were used to assess changes in left heart function and dyssynchronic parameters. Also, echo was used to select the best site for left ventricular epicardial lead placement. Results Left ventricular epicardial leads were successfully implanted in the posterior or lateral epicardial wall without serious complications in all patients. All patients had reduction in NYHA score from III-IV preoperatively to II-III postoperatively. The left ventricular end-diastolic diameter (LVEDD) decreased from (67.9±12.7) mm to (61.2±7.1) mm (P&lt;0.05), and LVEF increased from (33.6±7.4)% to (42.2±8.8)% (P&lt;0.05). Left ventricular intraventricular dyssynchrony index decreased from (148.4±31.6) ms to (57.3±23.8) ms (P&lt;0.05). Conclusions Minimally invasive surgical placement of the left ventricular epicardial lead is feasible, safe, and efficient. TDI can guide the epicardial lead placement to the ideal target location.

The effect of different circadian blood pressure rhythms on left ventricular systolic dyssynchrony in patients with newly diagnosed essential hypertension

Objectives Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. Methods One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. Results Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1 ± 18.7 vs. 31.8 ± 15.4, P ≤ 0.001); Ts-12 (123.0 ± 50.6 vs. 98.4 ± 42.3, P ≤ 0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. Conclusion Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.

The Effect of Different Circadian Blood Pressure Rhythms on Left Ventricular Systolic Dyssynchrony in Patients with Newly Diagnosed Essential Hypertension

Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1±18.7 vs. 31.8±15.4, P≤0.001); Ts-12 (123.0±50.6 vs. 98.4±42.3, P≤0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.

Left ventricular mechanical dyssynchrony in patients with different stages of chronic kidney disease and the effects of hemodialysis

Left ventricular (LV) dyssynchrony is a known cause of mortality in patients with heart failure and may possibly play a similar role in patients with chronic kidney disease (CKD) in whom sudden death is one of the most common and as yet not fully explained cause of death. LV synchronicity and its relationship with increased volume load and various biomarkers was analyzed in 145 patients including 53 patients with CKD stages 3 and 4 and in 92 CKD stage 5 patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) using color tissue Doppler imaging and tissue synchronization imaging. The HD patients were evaluated both before and after a single HD session. LV dyssynchrony was defined as a regional difference in time to peak systolic myocardial velocity, between 12 LV segments > 105 milliseconds. LV dyssynchrony was present in 54% of the patients with no difference between CKD 3 and 4 (58%), HD (48%), and PD (51%). LV dyssynchrony was independently associated with LV mass index and increased estimation of LV end-diastolic pressure. A single HD session resulted in significant changes in LV synchronicity variables-with improvement in 50% of the patients-especially in patients with higher myocardial systolic velocities and lower LV mass index. Abnormalities in LV synchronicity are highly prevalent in CKD patients already prior to dialysis treatment and are associated with LV hypertrophy, LV dysfunction and load conditions, underlining the importance of volume status for LV synchronicity in CKD patients.

Assesment of Myocardial Ischemia by Combination of Tissue Synchronisation Imaging and Dobutamine Stress Echocardiography

Background and ObjectivesDobutamine stress echocardiography (DSE) is an important non-invasive imaging method for evaluating ischemia. However, wall motion interpretation can be impaired by the experience level of the interpreter and the subjectivity of the visual assessment. In our study we aimed to combine DSE and tissue syncronisation imaging to increase sensitivity for detecting ischemia.Subjects and Methods50 patients with indications for DSE were included in the study. In 25 patients we found DSE positive for ischemia and in the other 25 patients we found it to be negative. The negative group was accepted as the control group. There was no significant difference in terms of risk factors and echocardiographic parameters between the two groups, except for wall motion scores. In both groups, left ventricular dyssychrony was accepted as the difference between time to peak systolic velocity (Ts) in the reciprocal four couple of non-apical segments at rest and during peak stress. Timings were corrected for heart rate. We compared the differences of the dyssynchronisation value at rest and during peak stress to determine the distinctions within the groups and between the groups of DSE positive and negative patients.ResultsWe found that stress and ischemia did not create any significant difference over the left intraventricular dyssynchrony with DSE, although at the segmenter level it prolonged the time to peak systolic velocity (p<0.05). These alterations did not show any significant difference between positive and negative DSE groups.ConclusionAs a result, this segmenter dyssynchrony and the time to peak systolic velocity, which is corrected for heart rate, did not enhance any new value over DSE for detecting ischemia.