Two-dimensional Speckle-tracking Strain Research Articles

Two-dimensional fetal speckle tracking; a learning curve study for offline strain analysis

Objectives Two-dimensional speckle tracking (2D-STE) strain analysis holds promise for assessing fetal cardiac function. Understand the learning curve before introducing 2D-STE into obstetrics is crucial. This study examined the learning curve for offline analysis of fetal left (LV) and right ventricular (RV) global longitudinal strain (GLS) using 2D-STE. Methods After 2D-STE training, three trainees (Maternal-Fetal Medicine fellow, OBGYN resident and medical student) analyzed 100 fetal heart clips using 2D-STE to calculate LV- and RV-GLS. Intra-class correlation coefficients (ICC) and Bland-Altman plots were compared GLS values across four sets of 25 clips for each trainee against the expert. Repeated measurements analysis compared GLS score differences between expert and trainees over time and among trainees, adjusting p-values with a Bonferroni correction. Results LV-GLS consistency evolved from poor-to-moderate during the first 50 measurements to moderate-to-good during the second 50 for all trainees. RV-GLS consistency evolved from poor-to-moderate during the first 75 measurements to moderate-to-good during the final 25 measurements for the fellow and resident. The student’s RV-GLS consistency was poor during the first 25 measurements, moderate-to good during the second 25 measurements and again poor-to-moderate during the final 50 measurements. Repeated measurements analysis showed a significant decrease in variability of the LV- and RV-GLS score differences between the expert and trainees over time (padj<0.001), which was not significantly different between trainees. Moreover, the mean of those differences were significantly different for all trainees for LV-GLS (padj<0.001) and RV-GLS (padj = 0.029), and did significantly change over time for RV-GLS (padj<0.001) but not for LV-GLS. Conclusions A clear learning effect was observed by the significant decrease in variability of the difference in the score between the expert and trainees over time. The consistency of fetal GLS analysis with 2D-STE was generally found to be moderate to good after 100 measurements in trainees.

Assessment of Right Ventricular Function by Strain Imaging in Patients Presenting with Acute Myocardial Infarction: An Original Research

ABSTRACT Objective: This study sought to determine the relationship between right ventricular (RV) function and clinical variables and prognosis in individuals with acute myocardial infarction (AMI) utilizing strain imaging. Materials and Methods: A prospective observational research involving 150 patients who had been admitted with AMI was carried out. Utilizing two-dimensional speckle-tracking strain imaging, RV function was assessed. Age, sex, risk factors, and comorbidities were recorded as clinical parameters. A 12-month follow-up was conducted to assess major adverse cardiovascular events (MACE). Results: 65% of the study’s participants were men, with a mean age of 58.2 years. When compared to a healthy control group, individuals with AMI had significantly lower RV longitudinal strain (RVLS) (P 0.001). RVLS and left ventricular ejection fraction had a statistically significant connection (r = 0.642, P 0.001). Patients with compromised RVLS had a greater rate of MACE over the follow-up period compared to those with maintained RV function (P = 0.014). Conclusion: In conclusion, strain imaging offers useful information for evaluating RV function in patients with AMI. Reduced left ventricular performance and a higher likelihood of unfavorable clinical outcomes are linked to impaired RVLS. Utilizing strain imaging to detect RV dysfunction early can help direct treatment plans and enhance patient outcomes.

Clinical outcomes and predictors of delayed echocardiographic response to cardiac resynchronization therapy.

The clinical outcomes and mechanisms of delayed responses to cardiac resynchronization therapy (CRT) remain unclear. We aimed to investigate the differences in outcomes and gain insight into the mechanisms of early and delayed responses to CRT. This retrospective study included 110 patients who underwent CRT implantation. Positive response to CRT was defined as ≥15% reduction of left ventricular (LV) end-systolic volume on echocardiography at 1 year (early phase) and 3 years (delayed phase) after implantation. The latest mechanical activation site (LMAS) of the LV was identified using two-dimensional speckle-tracking radial strain analysis. Seventy-eight (71%) patients exhibited an early response 1 year after CRT implantation. Of 32 non-responders in the early phase, 12 (38%) demonstrated a delayed response, and 20 (62%) were classified as non-responders after 3 years. During the follow-up time of 10.3 ± 0.5 years, the delayed and early responders had a similar prognosis of mortality and heart failure (HF) hospitalization. In contrast, non-responders had a worse prognosis. Multivariate analysis revealed that a longer duration (months) between initial HF hospitalization and CRT (odds ratio [OR]: 1.126; 95% confidence interval [CI]: 1.036-1.222; p = .005), non-exact concordance of LV lead location with LMAS (OR: 32.744; 95% CI: 1.101-973.518; p = .044), and pre-QRS duration (OR: 0.901; 95% CI: 0.827-0.981; p = .016) were independent predictors of delayed response to CRT compared with early response. The prognoses were similar regardless of the response time after CRT. A longer history of HF, suboptimal LV lead position, and shorter pre-QRS duration were related to delayed response than early response.

Left ventricular longitudinal myocardial function in heart failure patients with transition to preserved ejection fraction from reduced ejection fraction and those with preserved ejection fraction

Abstract Background Left ventricular (LV) longitudinal myocardial dysfunction is considered the first marker of a preclinical form of heart failure (HF) with preserved ejection fraction (HFpEF), and is strongly associated with poor outcomes. LV ejection fraction (LVEF) may improve over time during treatment or follow-up in some patients with HF with reduced ejection fraction (HFrEF). Furthermore, it has been reported that patients with HF with improved EF, known as HFimpEF, which was defined as current LVEF > 40% but any previously documented LVEF ≤ 40%, had favorable outcomes compared to those with HFpEF. However, LV longitudinal myocardial function in patients with previously reduced LVEF who had improved LVEF to normal range (≥ 50%), and its association with cardiovascular events remains unclear. Purpose The purpose of this study was the comparison of LV longitudinal myocardial function in patients with HFpEF and those with previously reduced LVEF who had improved LVEF to normal range (reduced LVEF-HFpEF), and to investigate whether LV longitudinal myocardial function was associated with cardiovascular events. Methods We retrospectively studied 70 patients with HFpEF and 45 patients with reduced LVEF-HFpEF. Reduced LVEF-HFpEF was defined as current LVEF ≥ 50% but any previously documented reduced LVEF < 50% (mean: 34 ± 10%). HFpEF was defined as current and all previous LVEF reports ≥ 50%, and met the HFA-PEFF diagnostic algorithm criteria. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS) by means of two-dimensional speckle-tracking strain. The primary endpoint was defined as cardiovascular death over a median follow-up period of 5.0 (0.5-9.0) years. Results As expected, the Kaplan-Meier curve indicated that patients with reduced LVEF-HFpEF experienced fewer cardiovascular death than those with HFpEF (Figure A). GLS in patients with HFpEF was significantly lower than that in patients with reduced LVEF-HFpEF (13.6 ± 3.5% vs. 14.8 ± 2.2%, P = 0.03) regardless of similar LVEF (55.7 ± 3.3% vs 56.8 ± 5.0%, P = 0.15). An important finding of the multivariate Cox proportional hazards analysis showed that GLS was an independently associated with cardiovascular death (Figure B). Conclusion Impaired LV longitudinal myocardial function was observed in patients with HFpEF compared to those with reduced LVEF-HFpEF regardless of similar LVEF. Moreover, LV longitudinal myocardial function was independently associated with cardiovascular death HF patients with current LVEF ≥ 50%. Our findings may provide new insights for the management of HF patients.FigureAFigureB

Association of right atrial strain and long-term outcome in severe secondary tricuspid regurgitation

ObjectiveSevere secondary tricuspid regurgitation (STR) causes significant right atrial (RA) volume overload, resulting in structural and functional RA-remodelling. This study evaluated whether patients with severe STR and reduced RA function,...

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.

Association of acute improvement in left ventricular longitudinal function after transcatheter aortic valve implantation with outcomes for severe aortic stenosis and preserved ejection fraction

BackgroundGlobal longitudinal strain (GLS) is reportedly a sensitive marker for early subtle abnormalities in left ventricular (LV) performance of asymptomatic patients with severe aortic stenosis (AS) and preserved LV ejection fraction (LVEF). For symptomatic patients with severe AS and preserved LVEF, however, the association of immediate improvement in GLS after transcatheter aortic valve implantation (TAVI) with long-term outcomes remains uncertain. MethodsThis study concerned 151 symptomatic patients with severe AS and preserved LVEF who had undergone TAVI. Echocardiography was performed before TAVI and 7 (7–9) days after TAVI. GLS was determined by means of a two-dimensional speckle-tracking strain using current guidelines. The primary endpoint was defined as a composite endpoint comprising cardiovascular death or re-hospitalization for HF after TAVI over a median follow-up period of 27.7 (11.9–51.4) months. ResultsMean LVEF and GLS were 65 ± 7 % and 12.8 ± 3.4 %, respectively. The Kaplan-Meier curve indicated that patients with acute improvement in GLS after TAVI experienced fewer cardiovascular events than those without such improvement (log-rank P = 0.02). Multivariate analysis showed that non-acute improvement in GLS after TAVI was independently associated with worse outcomes as well as deterioration of the mean transaortic pressure gradient. ConclusionAssessment of GLS immediately after TAVI is a valuable additional parameter for better management of symptomatic patients with severe AS and preserved LVEF who are scheduled for TAVI.

Subclinical myocardial assessment after BNT162b2 messenger RNA COVID-19 vaccination in adolescents with chronic heart disease: a speckle-tracking echocardiography study.

Case reports of the development of perimyocarditis in adolescents and young adults after BNT162b2 messenger RNA (mRNA) COVID-19 vaccination have raised concerns about the cardiac side effects of the vaccine. The aim of the study was to evaluate clinical follow-up and subclinical myocardial function after mRNA COVID-19 vaccine in adolescents with chronic heart disease. Forty-one adolescents aged 12-18 who were followed up at paediatric cardiology clinic between December 2021 and May 2022, and who had received two doses of the Pfizer-BioNTech COVID-19 mRNA vaccine were included in the study. The patients were evaluated five times in total - before the vaccination, one week after receiving the first dose, one month after receiving the first dose, one week after receiving the second dose, and one month after receiving the second dose. Cardiac assessment for all patients included an electrocardiogram, transthoracic echocardiography, and two-dimensional speckle-tracking strain echocardiography for left ventricular subclinical myocardial function. The mean age of the adolescents was 16.2 ± 1.5 years, and 56% (n = 23) were male. There was no statistically significant difference in patients' echocardiographic measurements including left ventricular global longitudinal strain and electrocardiogram parameters including PR, QRS, and QTc intervals through the follow-up. Seven patients reported cardiac complaints at post-vaccination follow-up visits, but laboratory and echocardiographic evidence of cardiac involvement was not observed. Based on the results of our study, the mRNA COVID-19 vaccine did not cause impairment in subclinical myocardial function assessed by speckle-tracking echocardiography in adolescents with chronic heart disease.

Reduced left atrial contractile strain with speckle tracking analysis predicts abnormal plasma NTproBNP in an asymptomatic community population

BackgroundThe left atrium (LA) is closely related to left ventricular diastolic function. Two-dimensional speckle tracking strain and strain rate (SR) imaging has been applied in the study of LA function. We intended to explore the relationship between global LA deformation parameters and plasma NTproBNP levels in asymptomatic community residents with normal ejection fraction and normal LA volume.MethodsA cross-sectional sample of Beijing residents underwent comprehensive Doppler echocardiography and medical record review in 2009. Global LA longitudinal strain and SR indexes were obtained in the apical four-chamber view. LA stiffness index (LASI) was calculated as the ratio of early diastolic velocity of transmitral flow/early diastolic mitral annular motion velocity (E/E') to LA reservoir strain.ResultsA total of 620 individuals (mean age = 65.8 years, left ventricular ejection fraction = 70.8%, LA volume index = 17.9 ml/m2) were investigated in our study. 117 individuals had increased plasma NTproBNP (≥ 125 pg/ml). LA reservoir and contractile function by LA strain and SR indexes were significantly reduced in the abnormal NTproBNP group compared with the normal NTproBNP group. Multiple regression analysis indicated that LA contractile strain was a negative predictor of plasma NTproBNP in addition to indexed LA volume and E/E'. LASI was higher in the abnormal NTproBNP group and was significantly correlated with NTproBNP (r = 0.342, P < 0.001). The area under ROC analysis for LASI in predicting elevated plasma NTproBNP was 0.690, similar with LA contractile strain, E/E’ and LAVI. The cut-off value of LASI was 0.612.ConclusionsLA reservoir and contractile functions demonstrated by LA strain and SR were significantly impaired in the community-based population with increased plasma NTproBNP levels. LA contractile strain adds incremental information in predicting abnormal NTproBNP levels. As a single index, LASI showed similar diagnostic value with LAVI and E/E’ in predicting abnormal NTproBNP.

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&gt;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.

Normative Reference Values of Left Ventricular Mechanical Dispersion Assessed by Two-Dimensional Longitudinal Speckle-Tracking Strain in Normal Subjects

Normative Reference Values of Left Ventricular Mechanical Dispersion Assessed by Two-Dimensional Longitudinal Speckle-Tracking Strain in Normal Subjects

Association between diabetic nephropathy and left ventricular longitudinal myocardial function in type 1 diabetes mellitus patients with preserved ejection fraction.

Left ventricular (LV) longitudinal myocardial dysfunction can be observed even in type 2 diabetes mellitus (DM) (T2DM) patients with preserved LV ejection fraction (LVEF), and is considered the earliest marker of DM-related cardiac dysfunction. Furthermore, diabetic nephropathy (DN), a common complication in DM, is strongly associated with LV longitudinal myocardial function in T2DM patients, but its association with type 1 DM (T1DM) has not been fully investigated. We studied 125 asymptomatic T1DM patients with preserved LVEF, and 75 age-, gender-, LVEF-matched non-diabetic healthy controls. Two-dimensional speckle-tracking strain LV was used to assess longitudinal myocardial function as global longitudinal strain (GLS). GLS of T1DM patients was significantly lower than that of normal controls (19.7 ± 3.6% vs. 20.6 ± 1.8%, P = 0.049). GLS of T1DM patients with DN was significantly lower that of T1DM patients without DN (17.3 ± 3.7% vs. 20.2 ± 3.5%, P < 0.001), but that of T1DM patients without DN was similar compared to normal controls (20.6 ± 1.8% vs. 20.2 ± 3.5%, P = 0.37). Moreover, multiple regression analysis identified DN the independent determinant parameters for GLS of T1DM patients also correlated significantly with duration of T1DM. Impaired LV longitudinal myocardial function was observed in asymptomatic T1DM patients with preserved LVEF, and DN was associated with LV longitudinal myocardial dysfunction. These findings are clinically useful for better management of T1DM patients to prevent impending development of cardiovascular disease.

Feasibility and reproducibility of auto-strain analysis in a healthy Spanish paediatric population

Abstract Funding Acknowledgements Type of funding sources: None. Background The analysis of systolic-diastolic function by two-dimensional ultrasound speckle-tracking strain (2DSTE) in the paediatric population is becoming progressively more available, its use can be helpful in the diagnosis of subclinical pathology in paediatric disease, both in acquired cardiovascular pathology, congenital heart disease and especially in cardio-oncology(1-4). For this purpose, a reliable, reproducible, and easy-to-use technique is required(5). Purpose To assess the feasibility and reproducibility of the strain using the software of newest software based on artificial intelligence, of one of the widely available companies in our environment. Methods A cross-sectional study was carried out in a population in Andalusia, Spain. Of 265 children who agreed to participate, 156 healthy children aged 6-17 years were selected by excluding congenital or acquired heart disease. Analysis using the new auto-strain software for the left ventricle, right ventricle, and left atrium. Feasibility and gender differences were assessed. As well as inter- and Inter-observer variability. Results The feasibility of the auto-strain measurement ranged from 94.2% for left ventricular global longitudinal strain (LVGLS) to 98.1% for other chamber strain parameters. No differences were found in matters of gender (Table 1). Excellent intra- and interobserver reproducibility was found for the measurement of right and left ventricular strain (intraclass correlation coefficients ranged between 0.88 and 0.98, respectively). (Table 2) Conclusions The strain analysis by auto-strain was both highly feasible and reproducible using this new software. Abstract Figure. Abstract Figure.

Normal values of strain in a Spanish paediatric population

Abstract Funding Acknowledgements Type of funding sources: None. Background The analysis of systolic-diastolic function by two-dimensional ultrasound speckle-tracking strain (2DSTE) in the paediatric population is becoming progressively more available. Its use can be helpful in the diagnosis of subclinical pathology in paediatric disease, both in acquired cardiovascular pathology, congenital heart disease and especially in cardio-oncology1-4. However, there is a lack of normal reference strain values in our paediatric population. Purpose To provide the normal values of strain in our paediatric population and its relationship with gender, age, and body surface area. Methods A cross-sectional study was carried out in a population in Andalusia, Spain. Of 265 children who agreed to participate, 156 healthy children aged 6-17 years were selected by excluding congenital or acquired heart disease. Analysis using the new auto-strain software of the left ventricle, right ventricle, and left atrium. Normal values are given for our population, stratified by age, gender and body surface area (BSA). Results Tables 1,2,3 shows the strain values of the different cardiac chambers, categorized by gender, age groups and BSA. Figure 1 presents the bivariate correlations of the strain and the different cardiac chambers with age and BSA. Average strain values were significantly higher in females, except for LALScd. We also found a significant tendency to lower mean strain values with higher age, except for LALScd. Finally, higher BSA was also inversely related to mean strain values for most variables in bivariate correlations although these associations were only significant for right ventricle strain and LALSr when BSA was categorized in tercile groups. Conclusions We provide for the first time in our region normal strain values for left ventricle, right ventricle, and left atrium in the paediatric population through the usage of new auto-strain software. A discrete positive correlation of strain values with respect to female gender and a negative correlation with respect to BSA and age was found. Abstract Figure. STRAIN VALUES CATEGORIZED Abstract Figure. BIVARIATE CORRELATIONS

Left atrial reservoir strain is reduced in patients with myocardial infarction with non-obstructive coronary arteries

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a management conundrum given the poorly understood pathogenic mechanisms. In recent years, novel echocardiographic measures such as deformation/strain analysis have enabled early identification of left atrial (LA) remodelling and dysfunction which take place prior to structural alterations. LA dysfunction is an important biomarker of cardiovascular disease and an independent predictor of atrial arrhythmias which may play a fundamental role in the pathogenesis of MINOCA. Purpose The goal of our study was to evaluate and characterise LA function by speckle tracking strain echocardiography in patients with MINOCA. Methods Patients admitted to our institution with acute myocardial infarction were assessed and those diagnosed with MINOCA who underwent transthoracic echocardiogram (TTE) within 48-hours of their coronary angiogram were included. Diagnosis of MINOCA was based on the 2017 ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Two-dimensional speckle tracking strain analysis of the LA and left ventricle (LV) was performed offline using vendor independent software (TomTec Arena). Clinical and echocardiographic measures were compared to healthy controls identified from our echocardiography database. We excluded patients with history of atrial fibrillation, heart failure and LV dysfunction (LVEF &amp;lt;50%). Results The cohort consisted of 82 patients; 41 patients with MINOCA were compared to 41 age and sex matched controls (61% male, mean age 51±12.8 years). At baseline, patients with MINOCA had a higher prevalence of modifiable vascular risk factors including smoking, hypertension and diabetes (p&amp;lt;0.001 for all). Of the echocardiographic parameters, no differences in left ventricular (LV) parameters including LV global longitudinal strain (p=0.463), indexed LV mass (p=0.084) and the E/e' (p=0.391) was appreciated. Though there was no difference in LA volumes or volumetric parameters of LA function (LAEF; p=0.328), patients with MINOCA had a lower LA reservoir strain (29.7±8.5% vs 33.2±6.5%; p=0.04; 95% CI 0.32–5.33). Conclusion Patients with MINOCA demonstrated lower LASr despite normal LV and LA volumes. This suggests that LA dysfunction may play a role in the pathogenesis of MINOCA. Further studies are required to evaluate the significance of our findings. Funding Acknowledgement Type of funding sources: None.

Strain analysis by two-dimensional speckle tracking echocardiography for evaluating left ventricular systolic function in women with pre-eclampsia

Abstract Background Previous echocardiographic studies have shown that most women affected by pre-eclampsia present with mild-to moderate diastolic dysfunction and left ventricle remodelling with a preserved systolic function. These alterations appear more severe when pre-eclampsia develops before 34 weeks of gestation. Purpose The aim of this study is to compare left ventricular systolic (LV) function by using 2-D speckle tracking echocardiography in women with early-onset and late-onset pre-eclampsia. Methods In this single-centre prospective longitudinal study, 119 women with a diagnosis of pre-eclampsia underwent standard trans-thoracic echocardiography (TTE) in the immediate peripartum period from February 2019 to December 2020. LV function was assessed using two-dimensional speckle-tracking strain imaging on 4-chamber views with a frame rate of 60–90 frames/second. Strain analysis quantification was performed using a commercial software. Results Pre-eclampsia was diagnosed before and after 34 weeks in 37.3% (44/119) and 62.7% (74/119) of the patients, respectively. Maternal characteristics, such as maternal age, body mass index, pre-existing hypertension and nulliparity, did not show any significant difference between the two groups. Although LV remodelling/hypertrophy and diastolic dysfunction occurred more often in early-onset pre-eclampsia compared to late-onset (65.9% vs 60.8% and 59.1% vs 51.4%, respectively), this difference was not statistically significant (p=0.580 and p=0.414, respectively). Similarly, LV mass index was 80.1±16.3 in pre-eclampsia &amp;lt;34 and 79.1±15 &amp;gt;34 (p=0.715) and E/e' was 7.8±1.9 and 7.6±1.7 (p=0.424). However, global longitudinal strain (GLS) was significantly lower (−16.4±2.4 vs −17.6±2.4, p=0.030) and apical rotation was higher (11.1±5.9 vs 8.7±4.7, p=0.019) in early-onset pre-eclampsia. A positive weak correlation has been found between GLS and difference in days from pre-eclampsia diagnosis to delivery (r=0.2, p=0.002). Conclusions Lower GLS in women affected by early-onset pre-eclampsia compared to late-onset pre-eclampsia might be useful to detect sub-clinical LV systolic impairment. Although further studies are needed, this sensitive marker may have a role in identifying women at risk of preterm delivery and/or severe maternal morbidity in the peripartum period. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Veronica Giorgione and Carolina Di Fabrizio have received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 765274 (iPLACENTA project).

The utility of strain imaging in the cardiac surveillance of bone marrow transplant patients

ObjectiveTo evaluate the utility of two-dimensional multiplanar speckle tracking strain to assess for cardiotoxicity post allogenic bone marrow transplantation (BMT) for haematological conditions.MethodsCross-sectional study of 120 consecutive patients post-BMT (80...

Physiological compensatory mechanisms of improved left heart function in response to simulated acute weightlessness: A human echocardiographic study by speckle tracking strain imaging

<p indent="0mm">The gravity-induced hydrostatic pressure gradient in the cardiovascular system is altered under the aerospace condition of weightlessness, leading to the increase of returned blood volume, and thus changes in cardiac structure and function. However, the characteristics and compensatory mechanisms are still unclear. The present study was to investigate the characteristics and compensatory mechanisms of cardiac preload and function in simulated acute aviation negative gravity and space microgravity using two-dimensional echocardiographic speckle-tracking strain imaging, and to provide theoretical evidence for aerospace heart protection. A total of 27 healthy young male volunteers were recruited. The tilting table was used to simulate acute microgravity (0.87~0 G) and negative gravity (0~−0.87 G). The left heart volumes, strain and functional parameters were collected and analyzed by both conventional and speckle tracking echocardiography. The systemic vascular resistance, compliance and ventricular-arterial coupling were calculated. The results showed that, the left heart volume and strain, left atrial emptying fraction and left ventricular ejecting fraction were all increased as gravity decreased. The arterial compliance was increased and the ventricular-arterial coupling index was decreased within the normal range. Of note, the reservoir, conduit and contraction function of left atrial strain were elevated proportionally; the flow velocity of left ventricular filling during early and late diastolic phases were both increased at the constant ratio. That is, the compensatory pattern was characterized by proportional improvement of cardiac motion in different phases and directions, which is different from that in aging and diseases. The present study demonstrated that the heart of healthy young men can effectively compensate the increase of preload caused by simulated acute microgravity and negative gravity. The major compensatory mechanism is the proportional improvement of myocardial motion of left atrium and ventricle during different phases (early and late diastole, systole) and along different directions (longitudinal and circumferential). The findings suggest that the aviators or astronauts generally have enough cardiac systolic/diastolic reserve to counter the acute change of cardiac preload induced by weightlessness (−0.87~1 G).

The potential role of 2D-speckle tracking echocardiography for detecting left ventricular systolic dysfunction in patients with Parkinson’s disease: a case control study

Background The prevalence of heart failure among patients with Parkinson’s disease (PD) was found to be twice that of the general population. The aim of this work is to evaluate the global left ventricular systolic function in patients with PD in comparison with healthy controls using speckle tracking echocardiography and to correlate the global left ventricular systolic function with both motor and cognitive functions in PD patients. Methods A case-control study was conducted on 40 patients diagnosed with PD and 40 healthy controls. Evaluation and staging of PD were performed using the Modified Hoehn and Yahr staging scale (H&Y staging) and Unified Parkinson’s Disease Rating Scale (UPDRS). Cognitive assessment for PD patients was done using Parkinson’s Disease - Cognitive Rating Scale (PD-CRS). Conventional and two-dimensional (2D) speckle-tracking strain echocardiography was done for both groups to assess the global left ventricular systolic function. Results There was a statistically significant difference between PD patients and controls regarding global longitudinal strain (p = 0.025), left ventricular end-diastolic dimension (p = 0.032), left ventricular end-systolic dimension (p = 0.003) and ejection fraction (p = 0.015). There were statistically significant negative correlations between both H&Y staging and UPDRS and both GLS (p ˂ 0.001, p ˂ 0.001) and EF (p = 0.017, p = 0.05). There were statistically significant positive correlations between PD-CRS and both GLS (p = 0.025) and EF (p = 0.012) Conclusion PD patients were found to have significant subclinical left ventricular systolic dysfunction in comparison with healthy controls. Such dysfunction was correlated with the severity of the motor disability and cognitive impairment.

Evaluation of temporal changes in longitudinal strain distribution during the systolic period to determine left ventricular activation sequence: a study using 2D speckle-tracking echocardiography

Abstract Background Evaluation of two-dimensional (2D) speckle-tracking longitudinal strain (LS) is useful for assessing global and regional left ventricular (LV) dysfunction. Purpose The purpose of this study was to test the hypothesis that temporal changes in regional 2D-LS distribution, (i.e., changes in area and intensity of the negative strain), during the systolic period may reflect the LV activation sequence. Methods We studied 52 patients with an ejection fraction &amp;lt;35% who were classified into four groups: complete left bundle branch block (LBBB, QRS 162±17 ms, n=17); right ventricular pacing from inferior septum (RVP, QRS 180±29 ms, n=16); left VP from lateral branch of the coronary sinus (LVP, QRS 182±21 ms, n=9); and no conduction block (Narrow QRS, QRS 100±9 ms, n=19). Longitudinal strain was evaluated in three standard apical views, and then bulls-eye distribution maps were constructed every 50 ms from the QRS onset to aortic valve closing (AVC) and at the time of the end of QRS. Segments indicating negative strain at the end of QRS were regarded as an early contraction site. Segments with intensifying negativity of strain as it got closer to the AVC were regarded as a late contraction site. Results In patients with LBBB, negative strain appeared initially in the septum region. Then, the contracted area enlarged including the apical region, and the basal lateral region contracted late. On the other hand, Narrow QRS showed a few regional differences in strain at the end of QRS (standard deviation in 17-segments: Narrow QRS 1.3±0.4%*, LBBB 3.3±1.1%, RVP 3.2±1.0%, LVP 3.3±1.1%, *p&amp;lt;0.001), and contracted homogeneously during the systolic period. RVP and LVP showed negative strain at the end of QRS in septum and lateral regions respectively, with the contracted area becoming enlarged towards the opposite regions of the early contracted regions. Conclusion The 2D-LS distribution during the systolic period reflects the LV contraction process in patients with an altered ventricular activation sequence, and may have potential for identifying the regions of early activation site and subsequent activation propagation. Funding Acknowledgement Type of funding source: None