Velocity Vector Imaging Research Articles

Evaluation of the correlation of wall elasticity between different sections of radial artery by velocity vector imaging.

This study aimed to evaluate the correlation between the elasticity of the anterior and posterior walls of the radial artery in different sections using velocity vector imaging. In this retrospective analysis, 30 healthy people who underwent physical examination in our hospital from January 2022 to January 2023 were analyzed offline by velocity vector imaging technology. The following parameters were assessed: peak systolic strain (Ss; %), peak diastolic strain (Sd; %), peak systolic strain rate (SRs; 1/s), and peak diastolic strain rate (SRd; 1/s). Elastic function was evaluated by analyzing the systolic and diastolic motion of the arterial walls. In the long-axis sections, there was a significant positive correlation between Ss, SRs, and SRd of both the anterior and posterior walls (r=0.531, r=0.803, and r=0.898, all p<0.01). Additionally, Sd showed a positive correlation (r=0.402, p<0.05). In the short-axis sections, there was a significant and positive correlation between SRs and SRd of both walls (r=0.762, r=0.667, both p<0.01). Furthermore, a positive correlation was found between SRd in the long-axis and short-axis sections of the anterior wall (r=0.382, p<0.05). Velocity vector imaging is a valuable tool for assessing the elasticity of the radial artery in different sections, and the longitudinal SRd in the long-axis section may serve as a highly sensitive and accurate parameter for assessing changes in wall elastic function during the occurrence of radial artery lesions.

Cascaded Plane Wave Ultrasound for Blood Velocity Vector Imaging in the Carotid Artery.

Cascaded dual-polarity waves (CDWs) imaging increases the signal-to-noise ratio (SNR) by transmitting trains of pulses with different polarity order, which are combined via decoding afterward. This potentially enables velocity vector imaging (VVI) in more challenging SNR conditions. However, the motion of blood in between the trains will influence the decoding process. In this work, the use of CDW for blood VVI is evaluated for the first time. Dual-angle, plane wave (PW) ultrasound, CDW-coded, and noncoded conventional PW (cPW), was acquired using a 7.8 MHz linear array at a pulse repetition frequency (PRF) of 8 kHz. CDW-channel data were decoded prior to beamforming and cross correlation-based compound speckle tracking for VVI. Simulations of single scatterer motion show a high dependence of amplitude gain on the velocity magnitude and direction for CDW-coded transmissions. Both simulations and experiments of parabolic flow show increased SNRs for CDW imaging. As a result, CDW outperforms cPW VVI in low SNR conditions, based on both bias and standard deviation (SD). Quantitative linear regression and qualitative analyses of simulated realistic carotid artery blood flow show a similar performance of CDW and cPW for high SNR (14 dB) conditions. However, reducing the SNR to 6 dB, results in a root-mean-squared error 2.7× larger for cPW versus CDW, and an R2 of 0.4 versus 0.9. Initial in vivo evaluation of a healthy carotid artery shows increased SNR and more reliable velocity estimates for CDW versus cPW. In conclusion, this work demonstrates that CDW imaging facilitates improved VVI of deeper located carotid arteries.

Correlation between melphalan chemotherapy with longitudinal global strain indices of the left ventricle in multiple myeloma patients: A velocity vector imaging (VVI) echocardiography study.

Correlation between melphalan chemotherapy with longitudinal global strain indices of the left ventricle in multiple myeloma patients: A velocity vector imaging (VVI) echocardiography study.

Impact of Neonatal Intervention on Left Ventricular Performance in Ebstein’s Anomaly and Tricuspid Valve Dysplasia

Severe neonatal Ebstein's anomaly (EA) and tricuspid valve dysplasia (TVD) are associated with high perinatal morbidity and mortality. The authors recently demonstrated left ventricular (LV) dysfunction and dyssynchrony to be prevalent in affected newborns and to contribute to poor outcomes. The aim of this study was to investigate the impact of patent ductus arteriosus (PDA) closure, spontaneous or surgical ligation, or right ventricular exclusion (Starnes procedure) on LV performance in neonatal EA and TVD. Neonates with EA or TVD encountered from 2004 to 2018 at three institutions were identified. Pre-and postoperative LV function was assessed using two-dimensional, Doppler-derived deformation (six-segment vector velocity imaging) and two measures of mechanical dyssynchrony (the SD of time to peak and global dyssynchrony index), and values were compared using paired t test analysis or the Wilcoxon rank sum test. Before the intervention, LV function was impaired in the PDA (n=18) and Starnes (n=6) groups and was similar between groups. After PDA closure, LV performance did not change. After the Starnes procedure, however, LV function, including synchrony, improved significantly: fractional area change from 45±5% to 58±8% (P=.003), global circumferential strain from -18.2±5.0% to -32.5±5.5% (P=.01), cardiac index from 1.9±0.3 to 3.9±1.5L/min/m2 (P=.05), and circumferential strain dyssynchrony (dyssynchrony index from 0.19±0.09 to 0.04±0.02 [P=.009] and SD of time to peak from 59.8±18.5 to 29.9±8.2 [P=.02]). The Starnes procedure results in early improvements in LV dysfunction and dyssynchrony, not observed after PDA closure in neonatal severe EA and TVD, which may benefit critically unwell neonates.

Biomechanical properties of the ascending aorta in patients with arterial hypertension by velocity vector imaging.

Aortic stiffness is an important risk factor for cardiovascular events and morbidity. Increased aortic stiffness is associated with an increase in cardiac and vascular hypertension-related organ damage.To evaluate the biomechanical properties of the ascending aorta (AA) in patients with arterial hypertension (AH) by velocity vector imaging (VVI).Ninety-five patients with AH and 53 normal healthy control participants were prospectively enrolled. AA biomechanical properties, i.e., ascending aortic global longitudinal strain (ALS), ascending aortic global circumferential strain (ACS), and fractional area change (FAC), were evaluated by VVI. Relative wall thickness (RWT) and left ventricular mass (LVM) were calculated. Pulsed Doppler early transmitral peak flow velocity (E), early diastolic mitral annular velocity (e'), left ventricular global longitudinal strain (GLS), distensibility (D) and stiffness index (SI) of AA were also obtained.The ALS, ACS and FAC were significantly lower in the AH patients, especially in those with ascending aorta dilatation (AAD), than in the normal healthy control subjects. The patients with AAD had a higher E/e' ratio, RWT, LVM and SI and a lower GLS and D than patients without AAD and normal healthy volunteers (p < 0.05). There were significant associations between biomechanical properties and D, SI, E/e' and GLS (ALS and D: r = 0.606, ALS and SI: r = - 0.645, ALS and E/e': r = - 0.489, ALS and GLS: r = 0.466, ACS and D: r = 0.564, ACS and SI: r = - 0.567, ACS and E/e': r = - 0.313, ACS and GLS: r = 0.320, FAC and D: r = 0.649, FAC and SI: r = - 0.601, FAC and E/e': r = - 0.504, FAC and GLS: r = 0.524, respectively, p < 0.05).The biomechanical properties of AA were impaired in patients with AH, especially patients with ascending aorta dilatation. Hypertension is associated with a high prevalence of diastolic and systolic dysfunction and increased arterial stiffness. Further study is needed to evaluate the clinical application of AA biomechanical properties by VVI.

Additional effects of combination therapy of antihypertensive medication on aortic elastic properties beyond blood pressure lowering effect in spontaneously hypertensive rats

Abstract Background Combination therapy in the treatment of hypertension provides better therapeutic efficacy, improved tolerability by lowering the dose and reduced potential for side effects than monotherapy. Especially, combinations of calcium channel blocker (CCB), angiotensin receptor blocker (ARB) or diuretics (thiazide) are generally effective and well tolerated regimen in antihypertensive treatment. However, we have focused more on the antihypertensive power of the combination therapy rather than the effect on the vessel itself. Purpose The purpose of this study is to determine the efficacy of antihypertensive medications as ARB and CCB and its combination with or without thiazide on the aortic structural and functional properties beyond the effect of blood pressure (BP) lowering. Methods Fourteen-week-old male spontaneous hypertensive rats were randomly divided into 5 groups, and treated with 1) vehicle (V), 2) amlodipine besylate (A), 3) olmesartan (O), 4) combined amlodipine and olmesartan (AO) or 5) combined amlodipine, olmesartan and thiazide (AOD), respectively. After 8 weeks of treatment, hemodynamic parameters and structural and functional properties of aorta as intima-media thickness (IMT) and velocity vector imaging (VVI) parameters of aorta including fractional area change (FAC), circumferential strain (CS) and strain rate (CSR) were assessed in each group and collagen contents of aorta were quantified as well. Results During the study period, systolic and diastolic BP were serially decreased in all treatment groups. Especially, AOD group showed lowest systolic and diastolic BP levels and also showed smallest IMT and vessel area and highest elasticity (FAC and CS) among the other groups (p&amp;lt;0.01) at 8 weeks (Table 1). In histologic analysis, collagen contents of aorta in all treatment groups showed significant associations with BP, IMT and VVI parameters (FAC, CS, CSR) (p&amp;lt;0.05), respectively. Particularly, aorta of AO and AOD groups showed significantly lower levels of collagen contents than that of control group. (p&amp;lt; 0.05) (Figure 1) Conclusion(s) Beyond the BP lowering effect, combination of amlodipine and olmesartan with or without thiazide minimize structural changes and shows better protection for the progression of arteriosclerosis than individual monotherapy in treatment of hypertension.Table 1Figure 1

Study on the correlation between cardiac function indices measured by velocity vector imaging and disease severity in patients with Parkinson disease.

This study aimed to evaluate cardiac function, particularly left ventricular systolic function, in patients with Parkinson disease (PD) using velocity vector imaging (VVI), and to determine whether a correlation exists between left ventricular global systolic function and PD severity. A case-control study design was used to select 56 PD patients and 30 healthy controls from January 2019 to December 2019. The characteristics of age, sex, BMI and course of disease were collected. The Hoehn-Yahr (H-Y) score was collected to record the grading of PD. The left ventricular systolic function of all patients was evaluated by variable vapor injection (VVI). The left ventricular systolic function was compared between the case group and the control group, and the correlation between cardiac dysfunction and the severity of PD symptoms was assessed using the modified H-Y scale. Compared with control group, left ventricular global systolic function18.22 (17.08, 19.12) vs 18.88 (18.12, 20.01) was lower in PD patients as indicated by left ventricular global longitudinal strain (GLS), and the difference was statistically significant (P = 0.039). Additionally, H-Y scores (r = -0.404) and PD duration(r = -0.323) were significantly correlated with reduced left ventricular ejection fraction (P < 0.01), GLS (P < 0.001), left ventricular global radial strain (GRS; P < 0.001), and left ventricular global circumferential strain (GCS; P < 0.001), along with their associated peak strain rates (GLSr, GRSr, and GCSr; P < 0.001). Subclinical left ventricular global systolic dysfunction in patients with PD can be detected using VVI, and reduced left ventricular systolic function correlates with the modified H-Y score and duration of the disease.

Universal Synthetic Aperture Sequence for Anatomic, Functional, and Super Resolution Imaging.

Synthetic aperture (SA) can be used for both anatomic and functional imaging, where tissue motion and blood velocity are revealed. Often, sequences optimized for anatomic B-mode imaging are different from functional sequences, as the best distribution and number of emissions are different. B-mode sequences demand many emissions for a high contrast, whereas flow sequences demand short sequences for high correlations yielding accurate velocity estimates. This article hypothesizes that a single, universal sequence can be developed for linear array SA imaging. This sequence yields high-quality linear and nonlinear B-mode images as well as accurate motion and flow estimates for high and low blood velocities and super-resolution images. Interleaved sequences with positive and negative pulse emissions for the same spherical virtual source were used to enable flow estimation for high velocities and make continuous long acquisitions for low-velocity estimation. An optimized pulse inversion (PI) sequence with 2 ×12 virtual sources was implemented for four different linear array probes connected to either a Verasonics Vantage 256 scanner or the SARUS experimental scanner. The virtual sources were evenly distributed over the whole aperture and permuted in emission order for making flow estimation possible using 4, 8, or 12 virtual sources. The frame rate was 208 Hz for fully independent images for a pulse repetition frequency of 5 kHz, and recursive imaging yielded 5000 images per second. Data were acquired from a phantom mimicking the carotid artery with pulsating flow and the kidney of a Sprague-Dawley rat. Examples include anatomic high contrast B-mode, non-linear B-mode, tissue motion, power Doppler, color flow mapping (CFM), vector velocity imaging, and super-resolution imaging (SRI) derived from the same dataset and demonstrate that all imaging modes can be shown retrospectively and quantitative data derived from it.

To investigate the correlation between normal fetal biventricular myocardial function and gestational age using velocity vector imaging.

The aim of this study was to evaluate the left and right ventricular segmental and global myocardial function of normal fetuses using velocity vector imaging and explore the correlation between global myocardial function parameters and gestational age. A total of 127 normal fetuses were selected and divided into five groups according to gestational age for the measurement of their left and right ventricular segmental and global velocity, strain, and strain rate. This study also explored the change trend in the global myocardial function parameters at different gestational ages and analyzed its correlation with gestational age. The peak velocities of the biventricular segments of the normal fetuses showed a decreasing trend from the basal to the middle to the apex segment, and the differences were statistically significant (P < 0.05). However, the strain and peak strain rate between adjacent segments showed no significant differences (P > 0.05). The peak global velocity of both ventricles increased with the gestational age, and it was moderately correlated with gestational age; however, the correlation of strain and peak strain rate with gestational age was not statistically significant (P > 0.05). In normal fetuses, the peak myocardial velocity of the biventricular segments showed a decreasing trend from the basal to the apical segment. The global peak myocardial velocity was linearly correlated with gestational age; however, the global strain and peak strain rate did not change as gestational age increased, indicating that the myocardial deformability of the fetus' ventricles was constant in the middle and late trimesters.

Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot.

Aortic wall stiffness has been reported in infants with tetralogy of Fallot (ToF) and may contribute to long-term aortic dilation even after corrective repair surgery. However, little is known about aortic elasticity in fetuses with ToF and the association with neonatal aortic dilation. The objectives of this study were to assess measures of elasticity of the ascending aorta (AAo) in fetuses with ToF and explore the association with neonatal aortic annular dilation in this population. Seventy-six singleton fetuses with ToF and 76 control fetuses of singleton low-risk pregnancies were enroled into this prospective study. Fetal measures of AAo elasticity, including mean longitudinal strain (MLS), global circumferential strain (GCS) and fractional area change (FAC), were assessed by velocity vector imaging. The z-score of the aortic valve (AV) diameter at the level of the annulus, as a measure of aortic annular dilation, was determined in newborns. Logistic regression analysis was used to investigate the association between fetal measures of AAo elasticity and neonatal aortic annular dilation (defined as an AV annular z-score > 2) in cases with ToF identified prenatally. Median MLS, GCS and FAC in fetuses with ToF were lower than those in normal fetuses (7.52%vs 12.15% for MLS, 22.05% vs 29.73% for GCS and 34.2% vs 48.3% for FAC, all P < 0.001). Aortic annular dilation was present in 53/76 (69.7%) newborns with ToF. After adjustment for gestational age at fetal echocardiography and birth weight, fetal MLS, GCS and FAC were independently associated with aortic annular dilation neonatally, with odds ratios of 0.66, 0.78 and 0.82, respectively (P < 0.05). The best cut-off values of these prenatal measures of AAo elasticity for predicting neonatal aortic annular dilation in fetuses with ToF were 9.02% for MLS, 23.56% for GCS and 37.2% for FAC (P < 0.001), with areas under the receiver-operating-characteristics curves of 0.94, 0.91 and 0.93, respectively. Measures of AAo elasticity are decreased in fetuses with ToF. Impaired AAo elasticity in the fetal period is associated with aortic annular dilation postnatally. Additional research is needed to evaluate the relationship between the AAo elasticity injury pattern and degeneration of AAo elasticity under stress as well as the long-term outcome in this population. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Right ventricular systolic function and associated anatomic risk factors in fetuses with transposition of the great arteries: Evaluation by velocity vector imaging.

The aim of this study was to evaluate right ventricular (RV) systolic function in fetuses with transposition of the great arteries (TGA) using velocity vector imaging (VVI) and to investigate the impact of different factors on RV systolic function in TGA fetuses. This was a retrospective cross-sectional study of fetuses referred to our tertiary center between 2015 and 2019. Maternal and fetal baseline characteristics and conventional echocardiographic and myocardial deformation indices were collected in fetuses with TGA at 20-28 weeks' gestation, which were compared with normal fetuses with comparable gestational age (GA). RV deformational parameters including global and regional longitudinal peak systolic strain, strain rate, and velocity were measured using off-line speckle tracking analysis. The univariate and multivariate linear regression analyses were established to evaluate the independent risk factors for RV global longitudinal systolic strain (RVGLSs) and strain rate (RVGLSRs). In total, 78 fetuses with TGA [including 49 fetuses with complete transposition of the great arteries (d-TGA) and 29 fetuses with Taussig-Bing anomaly (TBA)] and 49 normal fetuses were included. Compared with normal controls, global and most regional RV longitudinal systolic peak velocity, strain, and strain rate were lower in d-TGA and TBA fetuses (P < 0.05). Compared with normal controls, global and most regional RV longitudinal systolic strain was lower in d-TGA fetuses without pulmonary stenosis (PS) and ventricular septal defect (VSD), while RVGLSs and RVGLSRs were lower in TBA fetuses without PS. The VSD was an independent determinant of RVGLSRs (P = 0.024) in the d-TGA group. Additionally, PS was an independent determinant of RVGLSs and RVGLSRs (P = 0.012, P = 0.027) in the TBA group. Early impairment of RV systolic function has already occurred in TGA fetuses during the 2nd trimester of pregnancy. PS, VSD, and foramen ovale (FO) were independent risk factors for decreased RV function.

A preliminary study of changes in carotid artery elasticity in type 2 diabetes mellitus.

Carotid stiffening is found to be present in patients with type 2 diabetes mellitus (T2DM) together with endothelial dysfunction and it remains unclear about the role of carotid elasticity in the development of diabetic vascular damage. The aim of the study was to investigate changes and significance of carotid artery elasticity in diabetic patients with or without microvascular complications using velocity vector imaging (VVI) analysis. Fifty participants were enrolled and divided into health Control group, the uncomplicated DM (uDM) group and the complicated DM (cDM) group. All of them underwent carotid ultrasound examinations. VVI was used to evaluate the common carotid artery (CCA) elasticity and intima-media thickness (IMT) was also measured. Flow-mediated dilation (FMD) was performed to detect the vascular endothelial function. Then differences and correlations of variables between three groups were compared and analyzed. CCA elasticity measured by VVI decreased significantly between three groups (p < 0.05), while FMD decreased significantly only in cDM group (p < 0.01) and only IMT in cDM group was significantly thicker than that of Control group (p < 0.05). Representative VVI variables were independently, negatively related to the known duration and microalbuminuria (p < 0.05). All VVI variables were significantly correlated with FMD (0.5 ≤ |r | <0.8, p < 0.001), and just a small part of VVI variables were significantly correlated with IMT (0.3 ≤ |r | <0.5, p < 0.05). Compared with FMD, CCA elasticity measured by VVI showed more obvious changes in diabetic patients with different levels of vascular damage and may be considered as an alternative indicator in evaluating arterial status of T2DM.

Left Atrial Velocity Vector Imaging Can Assess Early Diastolic Dysfunction in Left Ventricular Hypertrophy and Hypertrophic Cardiomyopathy

The function of left atrium (LA) is difficult to assess because of its ventricle-dependent, dynamic movement. The aim of this study was to assess LA function using velocity vector imaging (VVI) and compare LA function in patients with hypertrophic cardiomyopathy (HCMP) and left ventricular hypertrophy (LVH) with normal controls. Fourteen patients with HCMP (72% male, mean age of 52.6 ± 9.8), 15 hypertensive patients with LVH (88% male, mean age of 54.0 ± 15.3), and 10 age-matched controls (83% male, mean age of 50.0 ± 4.6) were prospectively studied. Echocardiographic images of the LA were analyzed with VVI, and strain rate (SR) was compared among the 3 groups. The e' velocity (7.7 ± 1.1; 5.1 ± 0.8; 4.5 ± 1.3 cm/sec, p = 0.013), E/e' (6.8 ± 1.6; 12.4 ± 3.3; 14.7 ± 4.2, p = 0.035), and late diastolic SR at mid LA (-1.65 ± 0.51; -0.97 ± 0.55; -0.82 ± 0.32, p = 0.002) were significantly different among the groups (normal; LVH; HCMP, respectively). The e' velocity, E/e', and late diastolic SR at mid LA were significantly different between normal and LVH (p = 0.001; 0.022; 0.018), whereas LA size was similar between normal and LVH (p = 0.592). The mean late diastolic peak SR of mid LA was significantly correlated with indices of diastolic function (E/e', e', and LA size). The SR is a useful tool for detailed evaluation of LA function, especially early dysfunction of LA in groups with normal LA size.

Does types of atrial fibrillation matter in the impairment of global and regional left ventricular mechanics and intra-ventricular dyssynchrony?

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, which is associated with cardiac dysfunction. This study aimed to compare the impairment severity of left ventricular strain and intra-ventricular dyssynchrony using echocardiography-derived velocity vector imaging in patients with different types of AF without heart failure. 168 non-valvular AF patients with normal left ventricular ejection fraction (98 paroxysmal AF patients and 70 persistent AF patients) and 86 healthy control subjects were included in this study. Regional and global left ventricular longitudinal and circumferential strain were measured. Time to regional peak longitudinal strain was measured and the standard deviation of all 12 segments (SDT-S) was used as a measure of intra-ventricular dyssynchrony. Significantly lower GLS (-18.71 ± 3.00% in controls vs. -17.10 ± 3.01% in paroxysmal AF vs. -12.23 ± 3.25% in persistent AF, P < 0.05) and GCS (-28.75 ± 6.34% in controls vs. -24.43 ± 6.86% in paroxysmal AF vs. -18.46 ± 6.42% in persistent AF, P < 0.01) were observed in either persistent AF subjects or paroxysmal AF subjects compared with healthy control subjects (P < 0.05). The impairment was much worse in persistent AF subjects compared with paroxysmal AF subjects (P < 0.001). Intraventricular dyssynchrony was found in both persistent AF patients and paroxysmal AF patients, and it's worse in persistent AF patients (52 ± 18 ms in controls, 61 ± 17 ms in paroxysmal AF, and 70 ± 28 ms in persistent AF, P < 0.05). Multivariate regression analysis revealed AF types were independent risk factors of GLS, GCS, and intraventricular dyssynchrony. AF types were not only associated with impaired longitudinal and circumferential left ventricle mechanics but also intra-ventricular mechanical dyssynchrony. Worse systolic mechanics and intra-ventricular dyssynchrony were found in patients with persistent AF compared with these in patients with paroxysmal AF.

Post-systolic shortening index by echocardiography evaluation of dyssynchrony in the non-dilated and hypertrophied left ventricle

Abstract Background Post-systolic shortening index (PSI) is defined as myocardial shortening that occurs after aortic valve closure, and is an emerging measure of regional LV contractile dysfunction. PSI measurement variability amongst software vendor and its relationship with mechanical dyssynchrony and mechanical dispersion index (MDI) remains unknown. We evaluated PSI by speckle-tracking echocardiography from several vendors in patients with increased left ventricular wall thickness, and associations with MDI. Methods This is a prospective cross-sectional study of 70 patients (36 hypertrophic cardiomyopathy [HCM], 18 cardiac amyloidosis and 16 healthy controls) undergoing clinically indicated echocardiography. PSI was measured using QLAB/aCMQ (Philips), QLAB/LV auto-trace (Philips), EchoPAC (GE), Velocity Vector Imaging (Siemens), and EchoInsight (EPSILON) software packages, and calculated as 100% × (post systolic strain − end-systole strain)/post systolic strain. Results There was a significant difference in mean PSI among controls 2.1±0.6%, HCM 6.1±2.6% and cardiac amyloidosis 6.8±2.7% (p&amp;lt;0.001). Variations between software vendors were significant in patients with pathologic increases in LV wall thickness (for HCM p=0.03, for amyloidosis p=0.008), but not in controls (p=0.11), as seen in Figure 1. Furthermore, there were moderate correlations between PSI and both MDI (r=0.77) and left ventricular global longitudinal strain (r=0.69), as seen in Figure 2. Conclusion PSI was greater in HCM and cardiac amyloidosis patients than controls, and a valuable tool for dyssynchrony evaluation, with moderate correlations to MDI and strain. However, there were significant variations in PSI measurements by software vendor especially in patients with pathological increase in LV wall thickness, suggesting that separate vendor-specific thresholds for abnormal PSI are required. Funding Acknowledgement Type of funding sources: None.

Impact of weight loss on cardiac function: improvement in left ventricular global longitudinal strain following metabolic surgery

Abstract Introduction Obesity leads to an increased risk of cardiovascular disease (CVD) morbidity and mortality and is associated with the metabolic risk factors such as hypertension, diabetes mellitus, hyperlipidemia [1]. Metabolic surgery has been proven to be the most effective long term weight management tool and has known benefits in CVD prevention [2]. Global longitudinal strain (GLS) is an effective quantitative measurement of left ventricular (LV) function that is also a powerful predictor of future CVD events and mortality [3]. The impact of metabolic surgery on LV structure and function is unknown. Purpose This study investigated the changes in cardiac structure and function after metabolic surgery, including GLS. To our knowledge there has not been a study investigating this relationship previously reported. Methods Consecutive patients undergoing metabolic surgery at our center between March 2005 and February 2019 were recruited. Patients with transthoracic echocardiographic imaging (TTE) pre and post metabolic surgery (May 2005 to January 2019) were included. Electronic medical records were searched to obtain demographic, surgical and clinical data. GLS was calculated with Velocity Vector Imaging (VVI, Siemens, v2.0, Pennsylvania, USA). Averaged GLS values were derived from 4 chamber, 2 chamber and 3 chamber calculations. Results 398 patients with pre- and post-operative cardiac imaging were included. Please see Table 1 for the baseline demographics of our study population. The mean age was 60.0 years with 70% being female. There were significant rates of CVD risk factors such as: hypertension (76.4%), diabetes mellitus (58.8%) and hyperlipidemia (76.4%). The clinical and echocardiographic changes noted post metabolic surgery are detailed in Table 2. Along with decreases in weight post operatively, there were significant improvements in the markers of CVD risk factors such as mean blood pressure (134/75 to 129/72 mmHg, p value &amp;lt;0.001), mean gylcated hemoglobin levels (7.0 to 6.1%, p value &amp;lt;0.001) and mean low density lipoprotein (LDL) levels (97.7 to 88.2 mg/dl, p value &amp;lt;0.001). There were a number of statistically significant positive changes in the left ventricular structure and function. The mean LV ejection fraction increased from 56.3% to 57.4% (p=0.008); left ventricular mass decreased from 238.2 g to 179.3 g (p value &amp;lt;0.001), and both septal and posterior wall thicknesses decreased significantly (p value &amp;lt;0.001). The LV mass indexed to body surface area (BSA) also decreased from 93.5 g/m2 to 83.1 g/m2. The average global LV GLS was −15.7% pre-operatively, improving significantly to −17.9% post-operatively (p&amp;lt;0.001). Conclusion Our study has shown for the first time the impact of metabolic surgery on ventricular structure and function, with reduction in LV mass and improvement in LV GLS. These novel findings lends further support to the cardiovascular benefits of metabolic surgery. Funding Acknowledgement Type of funding sources: None.

Post-systolic shortening index by echocardiography evaluation of dyssynchrony in the non-dilated and hypertrophied left ventricle.

Post-systolic shortening index (PSI) is defined as myocardial shortening that occurs after aortic valve closure, and is an emerging measure of regional LV contractile dysfunction. PSI measurement variability amongst software vendor and its relationship with mechanical dyssynchrony and mechanical dispersion index (MDI) remains unknown. We evaluated PSI by speckle-tracking echocardiography from several vendors in patients with increased left ventricular wall thickness, and associations with MDI. This is a prospective cross-sectional study of 70 patients (36 hypertrophic cardiomyopathy [HCM], 18 cardiac amyloidosis and 16 healthy controls) undergoing clinically indicated echocardiography. PSI was measured using QLAB/aCMQ (Philips), QLAB/LV auto-trace (Philips), EchoPAC (GE), Velocity Vector Imaging (Siemens), and EchoInsight (EPSILON) software packages, and calculated as 100%×(post systolic strain-end-systole strain)/post systolic strain. There was a significant difference in mean PSI among controls 2.1±0.6%, HCM 6.1±2.6% and cardiac amyloidosis 6.8±2.7% (p <0.001). Variations between software vendors were significant in patients with pathologic increases in LV wall thickness (for HCM p = 0.03, for amyloidosis p = 0.008), but not in controls (p = 0.11). Furthermore, there were moderate correlations between PSI and both MDI (r = 0.77) and left ventricular global longitudinal strain (r = 0.69). PSI was greater in HCM and cardiac amyloidosis patients than controls, and a valuable tool for dyssynchrony evaluation, with moderate correlations to MDI and strain. However, there were significant variations in PSI measurements by software vendor especially in patients with pathological increase in LV wall thickness, suggesting that separate vendor-specific thresholds for abnormal PSI are required.

Evaluation of Left Ventricular Longitudinal, Radial, and Circumferential Strains in Subjects with Normal Variations of Coronary Dominance: A Preliminary Comparative Study.

Background: The aim of this study was to evaluate the contractile function of the left ventricular muscles in subjects with normal coronary artery and normal variations of coronary dominance.Methods: This study was performed on 90 adult subjects with normal results of coronary arteries angiography, echocardiography, and electrocardiography. The participants were categorized into 3 groups of 30 with right-dominant, left-dominant, and codominant variations. Two-dimensional transthoracic echocardiography was performed with apical 2-, 3-, and 4-chamber views and parasternal basal, mid, and apical short-axis views. Then, images were analyzed offline using the velocity vector imaging method. In all studied groups, the mean and standard deviation of left ventricle coronary territorial longitudinal, circumferential, radial strains, and left ventricle global strains were determined. They were compared in 3 layers of sub-endocardial, myocardium, and sub-epicardial.Results: In terms of longitudinal and circumferential strains, there were significant differences in the most coronary territories and global strain among the right-dominant, left-dominant and codominant groups (P < .05). No significant differences in terms of territorial and global radial strains were observed among the study groups (P > .05).Conclusion: Strain level decreased from endocardium to epicardium in all studied groups. Territorial and global contractile functions (longitudinal and circumferential strains) of the left ventricle vary depending on the variations of coronary arteries.

Vascular Alterations Preceding Arterial Wall Thickening in Overweight and Obese Children.

Background: Childhood obesity is linked to adverse cardiovascular outcomes in adulthood. This study aimed to assess the impact of childhood obesity on the vasculature and to investigate whether vascular alteration precedes arterial wall thickening in childhood. Methods: A total of 295 overweight (body mass index [BMI] 85th to 95th percentile, n = 30) and obese (BMI ≥ 95th percentile, n = 234) children aged 7–17 years and 31 normal-weight controls with similar age and gender were prospectively recruited. We assessed anthropometric data and laboratory findings, and measured the carotid intima–media thickness (IMT), carotid artery (CA) diameter, M-mode-derived arterial stiffness indices, and velocity vector imaging parameters, including the CA area, fractional area change, circumferential strain, and circumferential strain rate (SR). Results: The mean ± standard deviation age of the participants was 10.8 ± 2.1 years; 172 (58%) children were male. Regarding structural properties, there was no difference in the IMT between the three groups. The CA diameter was significantly increased in obese children, whereas the CA area showed a significant increase beginning in the overweight stage. Regarding functional properties, contrary to β stiffness and Young’s elastic modulus, which were not different between the three groups, the circumferential SR showed a significant decrease beginning in the overweight stage and was independently associated with BMI z-scores after adjusting for covariates. Conclusion: We have demonstrated that arterial stiffening and arterial enlargement precede arterial wall thickening, and that these vascular alterations begin at the overweight stage in middle childhood or early adolescence.

Differentiation of the Left and Right Side Interventricular Septum Function in Healthy Subjects by Vector Velocity Imaging.

Background: The present study aimed to assess and compare regional strain of the right and left sides of interventricular septum in healthy subjects using velocity vector imaging analysis due to the importance of interventricular septum and limited basic information about the exact function of the interventricular septum.MethodsThe present study was conducted on 40 healthy subjects. Echocardiography was performed in the apical 4-chamber view in the left lateral decubitus position. Image analysis was done offline with velocity vector imaging; the longitudinal strain and strain rate were calculated during 3 cardiac cycles. Strain-time and strain rate-time curves in basal, middle, and apical segments of the left and right sides of interventricular septum were recorded; peak values and time to peak strain were determined. ResultsThere was no significant difference between the longitudinal strain in the right and left basal (−17.7 ± 5.10% vs. −18.2 ± 5.14%, P = .550), middle (−17.1 ± 4.53% vs. −17.9 ± 4.29%, P = .197) segments, strain rate of basal (−1.1 ± 0.36 1/s vs. −1.0 ± 0.36 1/s, P = .350), and middle (−1.0 ± 0.30 1/s vs. −1.1 ± 0.32 1/s, P =0.551) segments. However, there was a significant difference between the longitudinal strain (−22.2 ± 5.55% vs. −16.6 ± 4.45%, P < .001) and strain rate (−1.5 ± 0.46 1/s vs. −1.1 ± 0.33 1/s, P < .001) of the apical segment. Time to peak strain was significantly different only in the middle segment of interventricular septum (right side: 351.0 ±11.5 ms vs.left side: 344.4 ± 13.1 ms, P = .004). ConclusionsThe findings of this study suggest that the right and left function of the septum was comparable in the basal and middle segments of healthy subjects; this function was significantly different in the apical segments.