Value Of Speckle Tracking Imaging Research Articles

The Value of Speckle Tracking Strain Imaging at Recovery Period of Dobutamine Stress Echocardiography

Background: Dobutamine stress echocardiography (DSE) is a well-established method for detecting myocardial ischemia. The classic echocardiographic findings of ischemia are new or worsening abnormalities of radial wall thickening. However, interpretation of these findings is subjective and dependent on experience. Speckle tracking strain imaging (STI) has been introduced as a novel method to overcome these limitations. Objective: The aim of the study is to evaluate the value of speckle tracking imaging (STI) by estimating the mean global longitudinal systolic (GLS) and the mean global circumferential systolic (GCS) strain imaging at recovery period of dobutamine stress echocardiography for prediction of significant coronary artery disease (CAD) in patients with chest discomfort. Methods: Fifty three patients presented for evaluation of chest discomfort underwent dobutamine stress echocardiography and coronary angiography at Cardiology Department,Menoufia University Hospital. The mean global left ventricular longitudinal systolic strain (GLS) at apical views—3 chambers, 4 chambers & 2 chambers apical views and global left ventricular circumferential systolic strain (GCS) at short axis view at level of papillary muscle were measured at rest and during recovery period of dobutamine stress echocardiography using automated functional imaging (AFI). Coronary angiography was done for all patients. Significant coronary artery lesion was defined as having a ≥ 70% diameter stenosis on coronary angiography. Patients were divided into two groups based on the presence or absence of significant coronary artery lesion into CAD positive (+ve) group vs. CAD negative (-ve) group. Results: In both groups,there were no statistically significant differences in the clinical characteristics and baseline conventional transthoracic echocardiography. GLS and GSC at recovery were lower in the CAD (+ve) group than in the CAD (-ve) group (-16.69% ± 1.10% vs -19.05% ± 1.41% p ). GLS and GCS during recovery period of DSE were valuable for prediction of CAD when cutoff at recovery is less than -17.95% (sensitivity of 84% & specificity of 84%) for GLS and less than -20.2% (sensitivity of 76% & specificity of 84%) for GCS. Also, we observed that the GLS and GCS percentile decreased from baseline to recovery period of DSE by about -9.95% ± 4.82% and -7.72% ± 3.90% respectively. Conclusion: Speckle tracking Imaging GLS and GCS at recovery period of Dobutamine Stress Echocardiography is feasible and offers an objective technique for prediction of significant coronary artery disease with increasing the accuracy of DSE in patient with chest discomfort.

Speckle tracking imaging as a predictor of left ventricular remodeling 6 months after first anterior ST elevation myocardial infarction in patients managed by primary percutaneous coronary intervention.

Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. LV remodeling is an important factor in the pathophysiology of advancing heart failure (HF).Aim of the workTo evaluate the value of speckle tracking imaging as a predictor of left ventricular remodeling 6 months after first anterior STEMI in patients managed by primary PCI.MethodologyEighty-five patients with first acute anterior STEMI underwent primary PCI. Patients were followed up for 6 months. Echocardiographywas done within 48 h [1] Standard transthoracic 2D echocardiographic examination: LV internal dimensions and volumes, Left Ventricular EF, and Wall Motion Score Index: [2] LV peak systolic global longitudinal strain and Torsion dynamics were assessed. Echocardiography was repeated at 6 months LV volumes and EF were calculated. LV remodeling was defined as an increase in LV EDV ≥ 20% 6 months after infarction as compared to baseline data. Patients were then classified into Group I: did not develop LV remodeling. Group II: developed LV remodeling. Both groups were studied to determine predictors of LV remodeling.ResultsAt baseline echocardiographic evaluation there was no statistically significant difference between both groups regarding both LVEDD and LVEDV, while there was statistically significant increase in both LV ESD and LV ESV, with statistically significant lower Ejection Fraction, in LV remodeling group. There was also statistically significant higher LV peak systolic GLS values in LV remodeling group, the best cut-off value was >−12.5 (Sensitivity 87%, Specificity 85%) and LV torsion was also statistically significantly lower in the LV remodeling group, with the best cut-off value for LV torsion was <9.5°, [Sensitivity 91%, Specificity 85%].Independent predictors of LV remodeling after AMI: baseline WMSI > 1.8, baseline LV EF < 40, GLS > −12.5%, LV torsion < 9.5°, CK-MB > 500 U/L, baseline Thrombus grade > 4 and total ischemic time.ConclusionAverage peak systolic GLS and LV torsion at echocardiography done early after myocardial infarction are independent predictors of LV remodeling after anterior STEMI and can be used to predict occurrence of LV remodeling after 6 months.

Application of speckle tracking imaging in the evaluation of myocardial injury among patients with sepsis

Objective To explore the value of speckle tracking imaging (STI) in the evaluation of left ventricular longitudinal movement function in patients with sepsis. Methods From April 2015 to November 2016, sixty-eight patients (sepsis group) who were admitted into ICU of Sichuan Provincial People’s Hospital and other 68 healthy subjects (control group) were selevted in the study.The total longitudinal strain values of 3 long axes and the longitudinal strain of each segment of the left ventricle were measured by STI technique. Results The overall strain values of the septic group and the control group on the left ventricular long axis were (-17.34±4.34) and (-18.43±2.90), respectively.The difference between the two groups was statistically significant (P=0.04), and the overall strain of the sepsis group was relatively low.The apical segment of posterior ventricular septal, the middle section of anterior septal and lateral wall of the two groups had showed no statistically significant difference (P<0.05), the differences in the other longitudinal strain values of each segment in left ventricular of the two groups were statistically significant(P<0.05). The longitudinal strain values of the posterior ventricular septal were (-14.11±3.21) and (-18.23±2.34), (P=0.018); the longitudinal strain of the middle segment of ventricular septal were (-20.38±2.78) and (-17.30±3.42), (P=0.024); the longitudinal strain of the basal segment of the anterior ventricular septal were (-16.98±3.51) and (-17.32±2.35), (P=0.012); the anterior interventricular septal apical longitudinal strain value were (-13.11±5.21) and (-22.43±1.64) (P=0.044); the longitudinal strain values of the front wall were (-16.22±5.93) and (-19.72±4.81)(P=0.030); the longitudinal strain values of the lower wall were (-18.54±4.97) and (-20.01±3.26), (P=0.002); the longitudinal strain of the posterior wall is (-17.82±2.31) and (-19.57±3.11) (P=0.021). Conclusion The STI technique can find out the myocardial injury in the early stage of sepsis, which offers a reliable way for evaluation of sepsis patients. Key words: Two dimensional speckle tracking imaging; Sepsis; Myocardial injury

Investigation of the predictive value of speckle tracking imaging for the assessment of cardiac function and clinical prognosis in patients with hypercholesterolemia.

The predictive value of speckle tracking imaging (STI) for the assessment of cardiac function and clinical prognosis in patients with hypercholesterolemia was explored. One hundred forty-seven patients with hypercholesterolemia diagnosed in our hospital and 137 healthy adults from our health examination center over the same period were included in this study. Using STI and color Doppler ultrasound, we carried out follow-up of cardiac function in patients with hypercholesterolemia and statistical analysis based on collected data. Global longitudinal strain, global circumferential strain, and the strains of apical long-axis, four-chamber and two-chamber planes, and short-axis mitral valve, short-axis papillary muscle, and short-axis apical levels in the hypercholesterolemia group were significantly lower than those in the control group. Global systolic and early diastolic strain rates were significantly lower than those in the control group. In the coronaries, the percentage of segments with significant differences was 80% (24/30) in the left anterior descending coronary artery (LAD), 66.7% (9/12) in the left circumflex coronary artery (LCX), and 75% (8/12) in the right coronary artery (RCA). The average strains in the long axis, radial, and circumferential directions (StrainSL, SC, SR - Avg) in the three main coronaries were significantly different between the hypercholesterolemia group and control group (P<0.0001). In the three coronaries and their basal and mid segments, there were significant differences between LCX and LAD, and between LCX and RCA (P<0.0001). In conclusion, the application of STI for monitoring cardiac function in patients with hypercholesterolemia provides physicians with useful information related to hypercholesterolemia to achieve early diagnosis and effective treatment.

GW27-e0206 Prediction of left ventricular remodeling in patients with acute myocardial infarction by speckle tracking imaging with wall motion score index: a clinical follow-up study

Segmental wall motion dysfunction after acute myocardial infarction (AMI) has led to progressing left ventricular remodeling (LVR), which has gradually worsened cardiac function of AMI patients with poor prognosis. Our study sought to explore the prognostic value of speckle tracking imaging (STI)

Prediction of left ventricular remodeling in patients with acute myocardial infarction by speckle tracking imaging with wall motion score index: a clinical follow-up study

Objective To explore the prognostic value of speckle tracking imaging (STI) for left ventricular remodeling(LVR) in acute myocardial infarction (AMI) patients with the analysis of the relation between regional wall motion abnormality after AMI and LVR by STI in association with wall motion score index (WMSI). Methods Eighty-three patients with first onset AMI were enrolled from January 2012 to May 2015 and underwent echocardiography within 24 h of the onset and at 6-month follow-up. LVR was defined as more than 20% of the percentage change of left ventricular end-diastolic volume (ΔLVEDV%) from baseline to 6-month follow-up (divided as LVR and non-LVR group). Standard long-axis and short-axis views were stored and analyzed for longitudinal (LS), radial (RS) and circumferential (CS) strain of STI metrics as well as scores of WMSI. Segments of WMSI≥2 were selected and calculated for the mean values of LS (LS_WMSI), RS (RS_WMSI) and CS (CS_WMSI). Results LVR occurred in twenty-seven AMI patients at 6-month follow-up. No difference has shown for demographics, electrocardiogram, lab tests, coronary angiography as well as the measurements of two-dimensional echocardiography between the two groups from baseline, while all STI metrics had statistical difference when the comparisons (P<0.05, all), especially the WMSI selected STI metrics (P<0.001, all). Linear regression analysis demonstrated that CS_WMSI (r=0.716, P<0.001) was best correlated to ΔLVEDV% among all STI metrics and also the best predictor of LVR by receive operator curve analysis (sensitivity of 92.6%, specificity of 87.5% and area under the curve of 0.9563). Conclusions Baseline STI metrics can precisely predict LVR at 6-month follow-up. Among the STI metrics, CS_WMSI has shown preferable predictive and diagnostic value, which indicates that the impairment of segmental circumferential wall motion is closely correlated to LVR after myocardial infarction. Key words: Echocardiography; Myocardial infarction; Speckle tracking imaging; Ventricular remodeling

Correlation of 99Tcm-MIBI gated myocardial perfusion SPECT imaging and two-dimensional speckle tracking imaging in swine model of myocardial infarction

Objective To evaluate the value of speckle tracking imaging(STI) by investigating the correlation and consistency between two-dimensional STI and 99Tcm-MIBI G-MPI in the assessment of myocardial injury and myocardial infarction (MI) of swine model. Methods Eight healthy and same-age adult female Tibetan swine were used to establish animal models of MI induced by open-chest ligation of the first diagonal branch of the left anterior descending coronary artery. The swine underwent ultrasonic cardiogram and G-MPI before and at 6, 24, 48, 72 and 96 h after the operation. The myocardial perfusion was evaluated. Ultrasonic sectional graphs were collected to analyze ultrasonic short-axis horizontal peak values of systolic radial strain (SR) and systolic circumferential strain (SC) and local myocardial rotation angle (Rot) of different segments of the left ventricle with off-line STI. Left ventricular (LV) EDV, LVESV, LVEF by G-MPI and ultrasonography were compared. Pearson correlation analysis and repeated measures analysis of variance were used. Results Six models were successfully constructed. Six hours after the coronary artery ligation, the G-MPI showed no significant or very few perfusion defects; 24, 48, 72 and 96 h after the ligation, G-MPI showed sparseness and defects at the anterior septum, anterior and lateral wall of apical segment of apical segment. The peak strain values of SR, SC and Rot at the anterior septal apical segment, the anterior and lateral wall of apical segment decreased at different time points after the ligation. Six hours after the coronary artery ligation, the STI was positive. For healthy swine, the LVEF measured with G-MPI and ultrasonic STI showed good correlation ((68±3)% vs (70±4)%, r=0.84, P<0.05). The LVEF values of G-MPI and ultrasonic STI at 6, 24, 48, 72, 96 h after the ligation were (79±1)%, (80±4)%, (58±2)%, (54±4)%, (57±4)%, and(76±2)%, (76±3)%, (57±3)%, (55±3)%, (68±6)% (r: 0.40-0.76, all P<0.05). LVEDV and LVESV measured by the two methods showed variation trends at different time points (F=64.104, 30.069, 35.186, 54.903, all P<0.01) with good consistency after the ligation. Conclusions Ultrasonic STI could estimate the myocardial injury at an earlier stage and measure the severity of damaged myocardium quantitatively, and the resluts are in good agreement with myocardial perfusion and function by G-MPI. Key words: Myocardial infarction; Tomography, emission-computed, single-photon; Ultrasonography; Swine; MIBI

Assessment of the left ventricular myocardium function of hypertension with normal left ventricular geometry using speckle tracking imaging

Objective: To evaluate the value of speckle tracking imaging (STI) in assessing left ventricular myocardium function of hypertension patients with normal left ventricular geometry. Methods : Forty hypertension Patients with normal filling (group A), 40 with abnormal relaxation (group B) and 30 normal controls (group NC) were studied. The global Peak systolic longitudinal strain rate, the mean Peak early diastolic longitudinal strain rate and the mean peak LV systolic longitudinal strain rate during atrial systole of whole-layer myocardium and subendomyocardium were measured. twist at aortic valve closure, twist at mitral valve opening, untwisting rate and twisting half-time of left ventricular were calculated. Results : Compared with those in group NC, the patients in group A had lower values of subendomyocardium GSrL S, but higher values of subendomyocardium GSrL A ( P <0.05), group A and group B had higher values of MV-Prot, AP-Prot,lower values of UntwRand HTU increased ( P <0.05). Compared with group A, AP-Prot increased in group B ( P <0.05), but UntwR decreased ( P <0.05). Conclusion : STI is of great value in quantitative analysis of the left ventricle myocardium function through detecting the subendomyocardium global peak systolic longitudinal strain rate and twisting parameters with essential hypertension. It is also a useful tool to assess the early damage of left ventricle myocardium in patients.

Longitudinal strain is a marker of microvascular obstruction and infarct size in patients with acute ST-segment elevation myocardial infarction.

ObjectivesWe assessed the value of speckle tracking imaging performed early after a first ST-segment elevation myocardial infarction (STEMI) in order to predict infarct size and functional recovery at 3-month follow-up.Methods44 patients with STEMI who underwent revascularization within 12 h of symptom onset were prospectively enrolled. Echocardiography was performed 3.9±1.2 days after myocardial reperfusion, assessing circumferential (CGS), radial (RGS), and longitudinal global (GLS) strains. Late gadolinium-enhanced cardiac magnetic imaging (CMR), for assessing cardiac function, infarct size, and microvascular obstruction (MVO), was conducted 5.6±2.5 days and 99.4±4.6 days after myocardial reperfusion.ResultsGLS was evaluable in 97% of the patients, while CGS and RGS could be assessed in 85%. Infarct size significantly correlated with GLS (R = 0.601, p<0.001), RGS (R = −0.405, p = 0.010), CGS (R = 0.526, p = 0.001), ejection fraction (R = −0.699, p<0.001), wall motion score index (WMSI) (R = 0.539, p = 0.001), and left atrial volume (R = 0.510, p<0.001). Baseline ejection fraction and GLS were independent predictors of 3-month infarct size. MVO mass significantly correlated with GLS (R = 0.376, p = 0.010), WMSI (R = 0.387, p = 0.011), and ejection fraction (R = −0.389, p = 0.011). In multivariate analysis, GLS was the only independent predictor of MVO mass (p = 0.015). Longitudinal strain >−6.0% within the infarcted area exhibited 96% specificity and 61% sensitivity for predicting the persistence of akinesia (≥3 segments) at 3-month follow-up.ConclusionsSpeckle-tracking strain imaging performed early after a STEMI is easy-to-use as a marker for persistent akinetic territories at 3 months. In addition, GLS correlated significantly with MVO and final infarct size, both parameters being relevant post-MI prognostic factors, usually obtained via CMR.

Longitudinal strain provides prognositic value, incremental to that of cardiac magnetic resonance at the acute phase in patients with st-segment elevation myocardial infarction

Objectives: We assessed the value of speckle tracking imaging performed early after a first ST-segment elevation myocardial infarction (STEMI) in order to predict infarct size and functional recovery at 3-month follow-up. Methods: Forty-four patients with STEMI who underwent revascularization within 12 h of symptom onset were prospectively enrolled. Echocardiography was performed 3.9±1.2 days after myocardial reperfusion, assessing circumferential (CGS), radial (RGS), and longitudinal global (GLS) strains. Late gadolinium-enhanced cardiac magnetic imaging (CMR), for assessing cardiac function, infarct size, and microvascular obstruction (MVO), was conducted 5.6±2.5 days and 99.4±4.6 days after myocardial reperfusion. Results: GLS was evaluable in 97% of the patients, while CGS and RGS could be assessed in 85%. Infarct size significantly correlated with GLS (R=0.601, p -6.0% within the infarcted area exhibited 96% specificity and 61% sensitivity for predicting the persistence of akinesia (≥3 segments) at 3-month follow-up. Conclusions: Speckle-tracking strain imaging performed early after a STEMI is an easy-to-use tool for predicting persistent akinetic territories at 3 months. In addition, GLS correlated significantly with MVO and final infarct size, both parameters being relevant post-MI prognostic factors, usually obtained via CMR.

Assessing pre-clinical ventricular dysfunction in obese children and adolescents: the value of speckle tracking imaging

Obesity has become a major health problem worldwide. Cardiovascular abnormalities have been described not only in obese adults but also in obese children and adolescents. The aim of the present study was to investigate left and right, systolic and diastolic ventricular dysfunction in obese paediatric patients without comorbidities using 2D speckle tracking longitudinal strain. Doppler echocardiogram was performed on 50 obese children and adolescents with body mass index (BMI) above the 95th percentile (OG) and 46 non-obese sex- and age-matched controls (CG). Systolic and diastolic functions of both ventricles were investigated through conventional Doppler echocardiography. Tissue Doppler imaging (TDI), colour Doppler myocardial imaging (CDMI), and two-dimensional (2D) speckle tracking were also used to analyse ventricular performance in both groups. Left-ventricular (LV) ejection fraction was similar between groups (68.2 ± 6.2 vs. 68.3 ± 5.3, P = 0.931). Left-ventricular diastolic parameters did not differ between groups, except for a lower mitral A wave (61.6 ± 13.0 vs. 51.9 ± 10.0 cm/s, P > 0.001) and higher E/A ratio (1.8 ± 0.5 vs. 2.1 ± 0.4, P = 0.007) in the controls. Left-ventricular global strain was lower in the OG by both methods (CDMI: 22.0 ± 2.8 vs. 24.6 ± 2.7%, P = 0.020; 2D speckle tracking: 18.4 ± 1.6 vs. 20.4 ± 1.7%, P < 0.001). In multivariate analysis, 2D longitudinal global strain correlated negatively with BMI, r = -0.433, p = 0.002. Although EF was not different between the two groups, LV 2D speckle tracking longitudinal strain was lower in the obese group, even in the absence of other comorbidities, indicating that obesity effects on LV function is an early finding in obesity.

Evaluation of regional left ventricular function in patients with myocardial infarction by speckle tracking imaging

Objective To evaluate the clinical value of speckle tracking imaging in the measurement of two-dimensional strain in patients with myocardial infarction. Methods High frame rate two-dimensional echocardiography were performed in 30 healthy subjects,21patients with anterior myocardial infarction and 15 patients with inferior myocardial infarction. Longitudinal strain (LS), radial velocity (Vs), regional shortening fraction (RFS),radial strain (RS) were measured in the apical two-chamber view and short-axis view(the level of papillary muscle) using two-dimensional strain software. Results Compared with healthy subjects, LS, Vs, RFS, RS decreased in the segments with infarction(P<0.05). LS, Vs, RFS, RS of the two myocardial infarction groups had partly differences(P<0.05). Conclusions Regional wall motion of left ventricle in patients with myocardial infarction can be evaluated accurately with speckle tracking imaging. Key words: Echocardiography; Myocardial infarction; Ventricular function; Two-dimensional strain imaging

Early changes in left ventricular diastolic and systolic function assessed by speckle tracking imaging in patients with essential hypertension

Objective To observe the value of speckle tracking imaging(STI) in assessing early changes of left ventricular diastolic and systolic function in patients with essential hypertension (EH). Methods Sixty-five EH patients with left ventricular normal geometry (LVN) ,including 33 cases with non-left atrial enlargement(NLAE) and 32 cases with left atrial enlargement (LAE),and 45 normal persons out of them were recruited as study subjects. Peak systole (S), peak early diastole (E'), peak late diastole (A')and E'/A' ratio at longitudinal strain rate(SrL) of three segments in long-axis views and radial strain rate (SrR),circumference strain rate(SrC) and rotation rate(RotR) of three levels in short-axis views were measured. Results There were no segment differences between A' at SrL in three segments or level differences between S and A' at SrR and S at SrC in three levels in NLAE group and LAE group. Compared with controls,NLAE group and LAE group had significantly decreased S and E' at SrL and E'/A' at SrL, SrR and SrC,increased A' at SrL,SrR and SrC and E' at RotR. Conclusions It was indicated by STI that early LV dysfunction in EH was appeared on diastolic as well as systolic dysfunction. Key words: Echocardiography; Ventricular function,left; Hypertension; Speckle tracking imaging