Two-dimensional Speckle-tracking Strain Echocardiography Research Articles

Two-dimensional Speckle Tracking Strain Echocardiography in a Case of Acute Myopericarditis Due to COVID-19 Virus.

Two-dimensional Speckle Tracking Strain Echocardiography in a Case of Acute Myopericarditis Due to COVID-19 Virus.

Diagnostics of Fabry disease in arrhythmology practice: a case report

Heart failure in Fabry disease (FD) is unfavorable prognostic manifestation and cause of death. Given that the disease is rare in clinical practice, the low awareness of physicians about this pathology leads to its late diagnosis and the lack of pathogenetic therapy.Aim. To present a clinical picture of the cardiovascular phenotype in FD in order to increase the awareness of doctors about this disease.Material and methods. In this clinical case, an asymptomatic FD course up to 46 years of age and mani festation in the form of arrhythmia were observed. According to echo car dio graphy, severe left ventricular hypertrophy (myocardial mass index, 214 g/m2) without signs of left ventricular (LV) outflow tract obstruction and left atrial (LA) dilatation were revealed (LA volume index — 47 ml/m2). Right ventricular (RV) and LV systolic function was assessed using two-dimensional speckletracking strain echocardiography. Latent subclinical RV and LV systolic dysfunction was established.Results. Tandem mass spectrometry revealed a sharp decrease in alphagalactosidase activity of 0,03 umol/L/h (norm range, 0,80-15,00 umol/L/h), as well as an in creased Lyso-GB3 concentration of 95,18 ng/ml (normal range, 0,05-3,0 ng/ ml). A molecular genetic study of blood samples was carried out. By direct automatic sequencing of the GLA gene, a variant of the c.1229 C>T nucleotide sequence was identified, leading to the replacement of p.Thr4101le in the hemizygous state.Conclusion. This case shows the possibility and expediency of diagnosing FD in cardiology practice in patients with LV myocardial hypertrophy of unclear etiology, while atypical variants can be diagnosed only by molecular genetic testing.

The value of 2D speckle-tracking strain echocardiography in evaluating the relationship between carotid elasticity and left ventricular systolic function in patients with diabetic nephropathy

ObjectiveTo investigate the relationship between the elasticity of the carotid artery and the LV (left ventricle) systolic function in patients with diabetic nephropathy (DN) by using two-dimensional speckle-tracking strain echocardiography (2D-STE).MethodsDN patients (n = 108) and control subjects (n = 112), all of whom underwent echocardiography and carotid ultrasound. Analysis of LV GLS (global longitudinal strain) from the apical two-chamber (2C), three-chamber (3C), and four-chamber (4C) views. Meanwhile, the circumferential strain (CS) of the carotid artery was obtained from the view of the short-axis right common carotid artery. The differences between the two groups were compared, and a correlation analysis between CS and GLS was performed.ResultsThe 4CGLS, 2CGLS, 3CGLS, and CS of the DN group were significantly lower at significant levels in contrast to the control group (p < 0.05). There was a significantly positive correlation of CS with 4CGLS, 2CGLS, and 3CGLS in all subjects (r = 0.809, p = 0.000; r = 0.830, p = 0.000; r = 0.830, p = 0.000, respectively).Conclusion2D-STE is a relatively new technique for assessing the mechanical characteristics of the carotid artery in patients with DN. Reduced values of CS correlate with reduced LV systolic function as evaluated by strain measurements, which can predict the risk of systolic dysfunction of LV.

Persistent reduction in global longitudinal strain in the longer term after radiation therapy in patients with breast cancer

BackgroundMore than 80% of breast cancer patients receive radiotherapy (RT). However, RT can lead to cardiotoxicity, which usually develops insidiously over years, making diagnosis difficult. It is also unknown whether early identification of at-risk patients might improve long-term outcome. We have previously described subclinical alterations, detected by two-dimensional speckle tracking strain echocardiography, in left ventricular (LV) function immediately following RT in breast cancer. HypothesisSubclinical myocardial alterations in LV function consequent to RT cardiotoxicity, observed early, persist at 12 months. Methods40 chemotherapy naive women with left-sided breast cancer, treated with surgery and adjuvant breast RT, were prospectively recruited from two tertiary hospitals. Transthoracic echocardiography was performed at baseline (pre-RT), 6 weeks post-RT, and 12 months post-RT. ResultsAn increase in LV end diastolic and end systolic volumes was seen from baseline, consistent with persistent LV remodelling; however, due to the increase in both systolic and diastolic volumes over time, no change in LV ejection fraction (EF) was observed. Global longitudinal strain (GLS) and S′ velocity remained significantly lower at 12 months post-RT. GLS dropped by >10% in 16 patients and by >20% in 4 patients compared to baseline. ConclusionsSubclinical cardiac dysfunction using strain analysis, evident early, persists one year after RT, despite unchanged conventional indices such as LVEF. Persistent GLS reduction may be of particular importance in breast cancer patients receiving concomitant chemotherapy. Longer term prospective studies are required to determine if reductions in strain post-RT are associated with future adverse cardiovascular events.

Change in Strain Echocardiography Predicts Mortality in Takotsubo Cardiomyopathy

IntroductionTakotsubo cardiomyopathy (TC) is an acute heart failure syndrome. Although left ventricular ejection fraction (LVEF) often improves, TC leads to significant morbidity and mortality in select patients. Two-dimensional speckle tracking strain echocardiography measures myocardial deformation, a sensitive marker for myocardial dysfunction. We sought to evaluate the utility of changes in myocardial strain to predict mortality in TC.HypothesisWe hypothesized that temporal changes in strain values will predict mortality in TC better than change in LVEF.MethodsWe retrospectively identified patients with TC based on ICD9/10 codes at a single center between 2006-2017. Two-dimensional echocardiography was used to measure LVEF and speckle tracking strain echocardiography was used to measure global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) with TomTec Arena software version 2.21. Measurements from presentation and follow-up echocardiograms were obtained. Absolute differences in values between echocardiograms was also determined. A multivariable Cox proportional hazards model evaluated association with time to all-cause mortality within 1 year.ResultsWe identified 192 patients with mean age 66.4 +/− 14.8 years, 78% women, and 62% white. Within 1 year, 33 (17%) deaths occurred. A multivariate analysis showed LVEF, GLS, GCS, and GRS at presentation were not significantly associated with time to all-cause mortality (Table 1). A subgroup analysis of 102 patients with a follow-up echocardiogram (median 16.5 days later) assessed change in LVEF and strain. There were 14 deaths (14%) in the subgroup. A multivariate analysis showed absolute change in GLS and GCS values were significantly associated with time to all-cause mortality, whereas LVEF and GRS were not (Table 2).ConclusionIn this single-center, retrospective study, LVEF and strain at presentation were not associated with mortality. However, lack of improvement in GLS and GCS was associated with increased risk of mortality. This finding demonstrates the utility of strain echocardiography in TC, as changes in strain were a better predictor of adverse outcomes than LVEF at presentation, changes in LVEF, and strain measurements at baseline. Takotsubo cardiomyopathy (TC) is an acute heart failure syndrome. Although left ventricular ejection fraction (LVEF) often improves, TC leads to significant morbidity and mortality in select patients. Two-dimensional speckle tracking strain echocardiography measures myocardial deformation, a sensitive marker for myocardial dysfunction. We sought to evaluate the utility of changes in myocardial strain to predict mortality in TC. We hypothesized that temporal changes in strain values will predict mortality in TC better than change in LVEF. We retrospectively identified patients with TC based on ICD9/10 codes at a single center between 2006-2017. Two-dimensional echocardiography was used to measure LVEF and speckle tracking strain echocardiography was used to measure global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) with TomTec Arena software version 2.21. Measurements from presentation and follow-up echocardiograms were obtained. Absolute differences in values between echocardiograms was also determined. A multivariable Cox proportional hazards model evaluated association with time to all-cause mortality within 1 year. We identified 192 patients with mean age 66.4 +/− 14.8 years, 78% women, and 62% white. Within 1 year, 33 (17%) deaths occurred. A multivariate analysis showed LVEF, GLS, GCS, and GRS at presentation were not significantly associated with time to all-cause mortality (Table 1). A subgroup analysis of 102 patients with a follow-up echocardiogram (median 16.5 days later) assessed change in LVEF and strain. There were 14 deaths (14%) in the subgroup. A multivariate analysis showed absolute change in GLS and GCS values were significantly associated with time to all-cause mortality, whereas LVEF and GRS were not (Table 2). In this single-center, retrospective study, LVEF and strain at presentation were not associated with mortality. However, lack of improvement in GLS and GCS was associated with increased risk of mortality. This finding demonstrates the utility of strain echocardiography in TC, as changes in strain were a better predictor of adverse outcomes than LVEF at presentation, changes in LVEF, and strain measurements at baseline.

Persistent Reductions in Global Longitudinal Strain Late After Radiotherapy in Chemotherapy Naive Left-Sided Breast Cancer Patients

Background: More than 80% of breast cancer (BC) patients receive radiotherapy (RT). However, RT can lead to cardiotoxicity, which develops over time, making diagnosis difficult. We have previously described subclinical alterations, detected by two-dimensional speckle tracking strain echocardiography, in left ventricular (LV) function immediately following RT in BC.

THE INCREASING BURDEN OF AMYLOIDOSIS FROM APEX TO BASE: NEW INSIGHTS FROM TECHNETIUM-99M PYROPHOSPHATE IMAGING

Background: Two-dimensional speckle-tracking strain echocardiography (2D STE) in cardiac amyloidosis (CA) patients has shown relatively preserved left ventricle apical systolic function as measured by longitudinal strain (LS). Technetium-99m pyrophosphate (99mTc-PYP) myocardial imaging has gained

Optimal Analysis of Left Atrial Strain by Speckle Tracking Echocardiography: P‐wave versus R‐wave Trigger

Left atrial (LA) strain analysis using speckle tracking echocardiography is useful for assessing LA function. However, there is no established procedure for this method. Most investigators have determined the electrocardiographic R-wave peak as the starting point for LA strain analysis. To test our hypothesis that P-wave onset should be used as the starting point, we measured LA strain using 2 different starting points and compared the strain values with the corresponding LA volume indices obtained by three-dimensional (3D) echocardiography. We enrolled 78 subjects (61±17years, 25 males) with and without various cardiac diseases in this study and assessed global longitudinal LA strain by two-dimensional speckle tracking strain echocardiography using EchoPac software. We used either R-wave peak or P-wave onset as the starting point for determining LA strains during the reservoir (Rres, Pres), conduit (Rcon, Pcon), and booster pump (Rpump, Ppump) phases. We determined the maximum, minimum, and preatrial contraction LA volumes, and calculated the LA total, passive, and active emptying fractions using 3D echocardiography. The correlation between Pres and LA total emptying fraction was better than the correlation between Rres and LA total emptying fraction (r=0.458 vs. 0.308, P=0.026). Pcon and Ppump exhibited better correlation with the corresponding 3D echocardiographic parameters than Rcon (r=0.560 vs. 0.479, P=0.133) and Rpump (r=0.577 vs. 0.345, P=0.003), respectively. LA strain in any phase should be analyzed using P-wave onset as the starting point rather than R-wave peak.

Biventricular Tako‐Tsubo cardiomyopathy: Usefulness of 2D speckle tracking strain echocardiography

Tako-Tsubo cardiomyopathy is a transient left ventricular apical ballooning syndrome also known as stress-induced cardiomyopathy. This reversible cardiomyopathy without epicardial coronary artery disease mimics acute myocardial infarction. Right ventricular involvement, which has been infrequently reported, is present in about a quarter of cases of Tako-Tsubo cardiomyopathy and is associated with a more severe clinical outcome. We report the case of a 55-year-old postmenopausal woman with transient biventricular apical ballooning. She recently had acute exacerbation of multiple sclerosis. Regional and global function of both ventricles was estimated using two-dimensional speckle tracking strain echocardiography.

Early Detection of Left Ventricular Systolic Dysfunction Using Two‐Dimensional Speckle Tracking Strain Evaluation in Healthy Subjects after Acute Alcohol Intoxication

Objectives: We evaluated the ability of two-dimensional speckle tracking strain echocardiography to detect left ventricular (LV) systolic dysfunction as compared with LV ejection fraction (EF) in healthy subjects following acute alcohol intoxication. Methods and Results: In total, 25 healthy subjects were investigated using echocardiography 4–6 hours after the onset of alcohol intoxication at a regional festive gathering, and then compared to 23 healthy control subjects without alcohol consumption. Heart rate, blood pressure, blood alcohol level, LV volumes, EF, shortening fraction, E/A ratio, as well as global longitudinal strain (LS) were recorded. Mean blood alcohol level was 1.3 ± 0.3 g.L−1. Mean systolic blood pressure and heart rate were slightly increased in the alcohol group compared to controls (147.5 ± 21.8 mmHg vs 127.0 ± 9.9 mmHg, P = 0.003, and 79.7 ± 10.7 bpm vs 70.6 ± 7.6 bpm, P < 0.001, respectively). While there was no significant difference in terms of LVEF (62.9 ± 4.4% vs 64.8 ± 5.9%, P = 0.18) or shortening fraction (34.7 ± 5.9% vs 36.0 ± 4.3%, P = 0.54), global LS was significantly impaired (–17.8 ± 2.0% vs −21.2 ± 1.8%, P < 0.001). In addition, subjects who consumed alcohol had increased LV end-diastolic (108.3 ± 20.1 mL vs 95.5 ± 14.6 mL, P = 0.037) and end-systolic volumes (41.6 ± 11.4 mL vs 33.7 ± 6.9 mL, P = 0.024), along with depressed aortic time-velocity integral (19.9 ± 3.2 mL vs 21.9 ± 2.5 mL, P = 0.034). According to multivariate linear regression analyses, blood alcohol level was the only factor significantly associated with global LS (β=−3.6 ± 1.0, P = 0.005). Conclusion: Alcohol intoxication around festive days induces acute LV contraction abnormalities, which may be detected using global LS by speckle tracking at an earlier stage and more accurately than LVEF decreases.

Two-dimensional speckle-tracking strain echocardiography in long-term heart transplant patients: a study comparing deformation parameters and ejection fraction derived from echocardiography and multislice computed tomography

Longitudinal strain determined by speckle tracking is a sensitive parameter to detect systolic left ventricular dysfunction. In this study, we assessed regional and global longitudinal strain values in long-term heart transplants and compared deformation indices with ejection fraction as determined by transthoracic echocardiography (TTE) and multislice computed tomographic coronary angiography (MSCTA). TTE and MSCTA were prospectively performed in 31 transplant patients (10.6 years post-transplantation) and in 42 control subjects. Grey-scale apical views were recorded for speckle tracking (EchoPAC 7.0, GE) of the 16 segments of the left ventricle. The presence of coronary artery disease (CAD) was assessed by MSCTA. Strain analysis was performed in 1168 segments [496 in transplant patients (42.5%), 672 in control subjects (57.7%)]. Global longitudinal peak systolic strain was significantly lower in the transplant recipients than in the healthy population (-13.9 ± 4.2 vs. -17.4 ± 5.8%, P< 0.01). This was still the case after exclusion of the nine transplant patients with CAD (-14.1 ± 4.4 vs. -17.4 ± 5.8%, P=0.03). Transplant patients exhibited significantly lower regional strain values in 9 of the 16 segments. Left ventricular ejection fraction (%) (MSCTA/Simpsons method) was 60.7 ± 10.1%/60.2 ± 6.7% in transplant recipients vs. 64.7 ± 6.4%/63.0 ± 6.2% in the healthy population, P=ns. Even though 'healthy' heart transplants without CAD exhibit normal ejection fraction, deformation indices are reduced in this population when compared with control subjects. Our findings suggests that strain analysis is more sensitive than assessment of ejection fraction for the detection of abnormalities of systolic function.