Velocity Vector Imaging Research Articles

Assessment of brachial artery mechanics using velocity vector imaging does not predict arteriovenous fistula failure; a feasibility study

Strain measurements by US have been suggested as a method of assessing arterial elasticity prior to arterio venous fistula creation. This pilot study sought to develop an imaging protocol to measure strain in the brachial artery via velocity vector imaging (VVI) and determine if differences in strain could be observed between a healthy group and a group with end-stage renal disease (ESRD), and if VVI measurements were associated with arterio-venous fistula malfunction. 40 healthy volunteers and 33 patients with ESRD were included in this study. All participants underwent US assessment of brachial artery strain via VVI. Peak velocity, strain, strain-rate and velocity were assessed. Patients with and without AVF failure at 3-months were assessed for differences in VVI measurement. Mean VVI measurements between the patient and volunteer groups were similar, and no significant differences were observed. Measurements were reproducible. No significant differences were observed in patients with or without AVF dysfunction. The results from this pilot study suggest VVI measurements of brachial artery mechanics are feasible and that VVI measurements may be used to assess age related changes of the brachial artery.

Ultrasonographic evaluation of segmental function of the aorta and carotid arteries in healthy infants

Aim. To study the ultrasonographic parameters of segmental function and mechanics of the aorta and carotid arteries in healthy infants.Methods. We observed 114 healthy infants (age range, 1–12 months; boys 52.6%; mean body surface area (BSA): 0.35 ± 0.8 m2). Echocardiography was performed with an Acuson S 2000 (Siemens Medical Systems, Mountain View, CA, USA) using vector velocity imaging (VVI). The following parameters were estimated at the level of the ascending and abdominal aorta and in the common carotid arteries (CCA): maximum and minimum diameters (mm); circumferential strain (CS, %) and circumferential strain rate (CSR, s-1); fraction area change (FAC, %); arterial stiffness (β2).Results. The maximum and minimum diameters of the examined segments of the aorta and CCA, FAC of the aorta and CCA, CS and CSR of the aorta and CCA showed a correlation with BSA, age, LV stroke index, and LV myocardial mass index. None of the estimated parameters showed a correlation with sex, arterial blood pressure, or left ventricular ejection fraction. The highest CS values were found in CCA 7.85 ± 2.8% [compared with 5.4 ± 0.98% (p = 0.0001) in the ascending aorta and 6.7 ± 1.8 % (p = 0.03) in the abdominal aorta). CSR in the CCA (0.84 ± 0.22 s-1) was significantly higher than that at the abdominal aorta level (0.67 ± 0.24 s-1, p = 0.001), but lower than that in the ascending aorta (1.3 ± 0.3 s-1, p = 0.00001).Conclusion. The parameters of segmental function of the aorta and common carotid artery obtained in our research can serve as normative reference for children in the first year of life. The functional parameters of the aorta and common carotid artery depend on the age and BSA. Received 15 December 2019. Revised 26 February 2020. Accepted 27 February 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Global longitudinal reference ranges for fetal myocardial deformation in the second half of pregnancy.

To construct longitudinal fetal reference ranges for global longitudinal myocardial deformation (strain and strain rate) of the left and right ventricles in the second half of pregnancy. A prospective, observational, longitudinal study of 120 women with uncomplicated singleton pregnancies. The participants underwent ultrasonographic scans every 4 weeks from enrolment (18-28 weeks) until delivery. Strain and strain rate were measured at each examination using velocity vector imaging. Changes in strain and strain rate as functions of gestational age (GA) were modeled using Bayesian mixed effects models. A total of 406 assessments of global longitudinal strain and strain rate were performed for 120 women. Global longitudinal strain and strain rate decreased with increasing GA in the left ventricle. There was, however, no change in strain measurements of the right ventricle over the same gestational time frame. Posterior predictive distributions were used to derive reference centiles for each week of GA. Assessment of myocardial deformation of the fetal heart is easily performed and may be useful for quantitative assessment of heart function, particularly in fetuses at risk of cardiac dysfunction.

Right ventricular diastolic dysfunction in patients with obstructive sleep apnea syndrome

This study aimed to assess right ventricular (RV) diastolic dysfunction in patients with obstructive sleep apnea syndrome (OSAS) using velocity vector imaging (VVI) and to evaluate the application of VVI technology. According to the apnea-hypopnea index (AHI), 69 patients with OSAS were divided into three groups: mild, moderate, and severe. A total of 35 cases of healthy subjects were enrolled as the control group. Digital images of apex four-chamber views were acquired to measure the peak early diastolic strain rate (RV-SRe), late diastolic strain rate(RV-SRa), and RV-SRe/RV-SRa using VVI. RV-SRe, RV-Sra, and RV-SRe/RV-SRa were decreasing along with the disease severity. RV-SRe, RV-SRe/RV-SRa in moderate and severe OSAS group showed lower than control and mild OSAS groups. RV-SRa in severe OSAS group showed lower than control group. RV-SRe had the best correlation with AHI than other parameters. Right ventricular diastolic dysfunction starts before the development of heart failure and pulmonary hypertension in patients with OSAS. RV-SRe was the parameter that may reflect subclinical myocardial dysfunction and can better reflect RV diastolic dysfunction.

Effects of modified acidic fibroblast growth factor mediated by nanoliposomes combined with ultrasound-targeted microbubble destruction on left ventricular systolic function in diabetic rats

Objective To investigate the effects of modified acidic fibroblast growth factor (MaFGF) mediated by nanoliposomes combined with ultrasound-targeted microbubble destruction (UTMD) on left ventricular systolic function in early diabetes mellitus(DM) rats. Methods The nanoliposomes containing MaFGF(MaFGF-nlip) were prepared by reverse phase evaporation method. Among 60 male Sprague Dawley (SD) rats, 50 rats were randomly selected and were induced to be DM models by streptozotocin(STZ) through intraperitoneal injecting, the other 10 rats as control group. Then DM rats were randomly divided into 4 groups: DM model group, MaFGF solution group, MaFGF-nlip group and MaFGF-nlip+ UTMD group. After the successful induction of DM model, the intervention was performed twice a week.After 12 weeks of intervention, all rats underwent conventional echocardiography and velocity vector imaging (VVI). Left ventricular ejection fraction (LVEF) and left ventricular fraction shortening(LVFS) were measured by conventional echocardiography. The mean peak systolic radial velocity (Vs), radial strain (Sr) and radial strain rate (SRr) of six walls at the papillary muscle level were measured in left ventricular short-axis view by VVI. At last, myocardial tissue of all rats were stained with Sirius red to evaluate myocardial interstitial fibrosis. The level of myocardial apoptosis was evaluated by TUNEL staining, and the changes of myocardial ultrastructure were observed by transmission electron microscopy. Results The prepared MaFGF-nlip were more rounded, evenly dispersed, and of good stability and high encapsulation efficiency. Twelve weeks later after intervention, LVEF, LVFS, Vs, Sr and SRr in the DM model group were significantly lower than those in the control group (all P<0.05). LVEF, LVFS, Vs, Sr and SRr in the MaFGF-nlip+ UTMD group were significantly higher than those of the DM model group and other intervention groups (all P<0.05). The results of Sirius red staining and Tunel staining showed that CVF and AI in the DM model group were significantly higher than those in the control group (all P<0.05). For MaFGF-nlip+ UTMD group, CVF and AI were significantly decreased compared with the DM model group and other intervention groups(all P<0.05). According to the results of transmission electron microscopy, compared with the DM model group, the improvement of myocardial ultrastructure was the most obvious in the MaFGF-nlip+ UTMD group. Conclusions MaFGF delivered by using nanoliposomes combined with UTMD can improve the left ventricular systolic function in diabetic rats by inhibiting the myocardium cardiac fibrosis and reducing the cardiomyocyte apoptosis. Key words: Ultrasound-targeted microbubble destruction; Diabetic cardiomyopathy; Ventricular function, left; Nanoliposomes; Modified acidic fibroblast growth factor

Assessment of the Preventive Effect Against Diabetic Cardiomyopathy of FGF1-Loaded Nanoliposomes Combined With Microbubble Cavitation by Ultrasound

Acidic fibroblast growth factor (FGF1) has great potential in preventing diabetic cardiomyopathy. This study aimed to evaluate the preventive effect of FGF1-loaded nanoliposomes (FGF1-nlip) combined with ultrasound-targeted microbubble destruction (UTMD) on diabetic cardiomyopathy (DCM) using ultrasound examination. Nanoliposomes encapsulating FGF1 were prepared by reverse phase evaporation. DM model rats were established by intraperitoneal injection of streptozotocin (STZ), and different forms of FGF1 (FGF1 solution, FGF1-nlip, and FGF1-nlip+UTMD) were used for a 12-week intervention. According to the transthoracic echocardiography and velocity vector imaging (VVI) indexes, the LVEF, LVFS, and VVI indexes (Vs, Sr, SRr) in the FGF1-nlip+UTMD group were significantly higher than those in the DM model group and other FGF1 intervention groups. From the real-time myocardial contrast echocardiography (RT-MCE) indexes, the FGF1-nlip+UTMD group A and A×β showed significant differences from the DM model group and other FGF1 intervention groups. Cardiac catheter hemodynamic testing, CD31 immunohistochemical staining, and electron microscopy also confirmed the same conclusion. These results confirmed that the abnormalities, including myocardial dysfunction and perfusion impairment, could be suppressed to different extents by the twice weekly FGF1 treatments for 12 consecutive weeks (free FGF1, FGF1-nlip, and FGF1-nlip+UTMD), with the strongest improvements observed in the FGF1-nlip+UTMD group. In conclusion, the VVI and RT-MCE techniques can detect left ventricular systolic function and perfusion changes in DM rats, providing a more effective experimental basis for the early detection and treatment evaluation of DCM, which is of great significance for the prevention of DCM.

Evaluation of the Effects of Schisandra chinensis on the Myocardium of Rats with Hyperthyroid Heart Disease by Using Velocity Vector Imaging Combined with the Estimation of p53 Expression and Calmodulin Activity.

Schisandra chinensis (SC) is reported to improve myocardial ischemia. Velocity vector imaging (VVI) is a noninvasive technique for evaluating myocardial function in humans, while few reported on the application in animals. In this study, we aimed to evaluate the improved effects of SC on the myocardium of Sprague Dawley rats having hyperthyroid heart disease (HHD) using VVI technique. HHD models were established by injecting daily with subcutaneous levothyroxine (0.5 mg/kg). Then, the SC group was administered the aqueous extract of SC (2 g/kg) once daily, while the HHD and control (CON) groups were administered the same amount of distilled water daily. All the rats were provided the same amount of food and water daily, and the intervention was stopped after 28 days. The efficacy of SC in HHD rats was evaluated by ultrasound VVI. The serum total triiodothyronine level, total thyroxine level, N-terminal pro-brain natriuretic peptide expression, p53 expression, and calmodulin (CaM) activity were assessed by western blotting, Hematoxylin-Eosin and Masson staining, and electron microscopy. The results indicated that SC significantly improved the systolic velocity, diastolic velocity, strain, systolic strain rate, and diastolic strain rate of the heart by significantly reducing p53 expression and CaM activity (P < 0.05), improving myocardial fibrosis in HHD rats. Also, VVI can be a valuable tool for the evaluation of myocardial function in HHD rats.

P1280 Vascular and left ventricular mechanics after surgical correction of aortic coarctation of children

Abstract Background The main cause of the suboptimal long-term outcome after surgical correction of aortic coarctation(CoA) is late correction, residual CoA or reCoA. Cardiovascular remodeling after correction CoA in neonatal period without residual CoA is not well established. Purpose Evaluation of global longitudinal strain of the left ventricle (LV) and circumferential mechanics common carotid artery in children 5 years after surgical correction of the CoA in the neonatal period. Methods We examined 58 children aged 5,2 ± 0,39 years after successful repair CoA in neonate period. We excluded children with residual CoA or reCoA. Echo was performed with using vector velocity imaging. We studied LV longitudinal strain (LS) and strain rate (LSR). In the left common carotid artery we estimated: carotid strain (CC S) and strain rate (CC SR), fraction area change (FAC CC), carotid β2-stiffness index (CC β2), and intima-media thickness (IMT). The obtained data were compared with the results of 25 healthy children. Results LS LV and SR LV are worse of children after CoA correction compare with healthy, even LV ejection fraction is similar to healthy children. We found correlation LV mass index (LV MI) with CC S and CC SR. CC β2 of children after Co A repair was higher than of control group. CC β2 correlated with LS LV, SR LV and with LV MI. IMT and FAC didn’t differ of operated and healthy children. Conclusion Parameters of the LS of the LV and CC β2 of children 5 years after CoA repair significantly differ from healthy children and reflect the ongoing process of cardiovascular remodeling. Assessment of the CC S allows timely confirmation of the presence of increased arterial stiffening.

P1514 Increased myocardial oxygen demand is associated with impaired left ventricular strain in patients with morbid obesity referred for bariatric surgery

Abstract Background Obesity predisposes for left ventricular (LV) hypertrophy and systolic dysfunction. Higher myocardial oxygen demand in LV hypertrophy is associated with higher risk for cardiovascular events, while the association with LV systolic function has been less explored. Purpose To assess the association of myocardial oxygen demand with LV systolic function in morbidly obese subjects without known heart disease. Methods Clinical and echocardiographic data from 110 obese subjects referred for gastric bypass surgery (mean age 42 ± 11 years, 74% women, mean body mass index [BMI] 41.9 ± 4.8 kg/m², 33% with hypertension, 15% with diabetes) in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study was used. LV function was assessed by ejection fraction (EF) by Simpson"s biplane method and endocardial global longitudinal strain (GLS) by 2D vector velocity imaging using a 16-segment model (Image Arena 4.6, Tomtec, Unterschleissheim, Germany). Myocardial oxygen demand was estimated from LV mass - wall stress - heart rate product according to a previously validated formula. Results Myocardial oxygen demand was higher in men (1884 vs. 1579 x 10³ g x kdyne/cm² x bpm, p &amp;lt; 0.05), and associated with higher BMI (r = 0.24) and pulse pressure (r = 0.28), and with lower EF (r = -0.22) and lower GLS (r = 0.26, all p &amp;lt; 0.05). In multiple regression analysis, higher myocardial oxygen demand was associated with lower LV GLS (Beta = 0.21, p &amp;lt; 0.05) independent of age, gender, BMI, pulse pressure, diabetes, and EF (Table). Conclusion In obese patients without known heart disease referred for bariatric surgery, higher myocardial oxygen demand was associated with lower LV systolic function measured by GLS independent of confounders. Covariates of lower GLS in multivariable Variable β correlation coefficient p LV mass - wall stress - heart rate product (g x kdyne/cm&amp;sup2; x bpm x 10&amp;sup3;) 0.21 0.04 Age (years) -0.12 0.22 Gender 0.34 &amp;lt;0.01 BMI (kg/m&amp;sup2;) 0.25 &amp;lt;0.01 Pulse pressure (mmHg) -0.04 0.71 Diabetes -0.17 0.09 LV EF (%) -0.01 0.90

Velocity Vector Imaging technology and standard echocardiography in evaluation of left ventricular function in patients with coronary artery disease before and after coronary bypass surgery

Aim. To study strain and strain rate dynamics the left ventricle (LV) myocardium fibers in patients with ischemic heart disease after coronary artery bypass grafting (CABG) in the early and late periods.Material and methods. The dynamics of strain (S) and strain rate (SR) of longitudinal, circular and radial fibers in 148 patients (in 2646 LV segments) before and on the 12th day after CABG was studied using Velocity Vector Imaging technology. In the long-term (6, 12 and 24 months) 40 patients (720 LV segments) were examined.Results. A positive dynamics of SR longitudinal fibers (p = 0.0002) was on the 12th day after CABG. Weak and medium correlation was between S and SR radial (R = –0.56; R = –0.52) and circular fibers with LDG-1 and duration of aortic clamping. In the long term, patients with complaints showed a decrease in global deformation properties in the coronary artery areas. The stable result of improvement S and SR longitudinal and circular fibers and SR radial fibers was obtained in segments with initially low deformation properties.Conclusions. The use of Velocity Vector Imaging technology allows to estimate the dynamics of LV fibers deformation parameters in early and long-term periods. In the early period after CABG was a positive dynamic only from the global SR longitudinal fibers. In the long-term global deformation parameters of longitudinal and circular fibers was decrease in in the area of the coronary arteries. In the long-term was a significant improvement of the deformation parameters of segments with initially low deformation properties.

Velocity vector imaging for evaluation of fetal vertical function throughout gestation

Velocity vector imaging for evaluation of fetal vertical function throughout gestation

4933Comparison of left ventricular global longitudinal strain measurements using contrast-enhanced and non-contrast echocardiographic images

Abstract Background Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are two important index for the quantification of left ventricular systolic function. With the help of ultrasound contrast agents, we can improve the definition of endocardial borders and allow the quantification of LVEF in patients with poor image quality. However, the feasibility of GLS measurements in contrast-enhanced images is still controversial. Purpose Our study aimed to explore the feasibility of GLS measured by velocity vector imaging (VVI) in contrast-enhanced images, compare the difference of measurements in contrast-enhanced and non-contrast images, and analyze the relation between LVEF and GLS in both conditions. Methods A total of 133 patients with cancer, who were registered for transthoracic echocardiography as well as contrast-enhanced echocardiography were studied. LVEF was measured using the biplane modified Simpson's rule and GLS was measured with offline VVI analysis of the three standard apical views in non-contrast and contrast-enhanced images respectively. Linear regression was performed to derive correlation coefficients between LVEF and GLS both in non-contrast and contrast-enhanced images. Results GLS measurements in non-contrast images were discarded in 2/133 patients (1.5%), while in contrast-enhanced images were obtained in all patients. LVEF (64.12±7.47% vs. 66.25±8.61%, respectively; P&lt;0.01) and GLS (−20.99±4.67% vs. −23.40±4.58%, respectively; P&lt;0.01) were both significantly higher in the presence of contrast agents. A linear regression between LVEF and GLS in non-contrast images (r=0.627, P&lt;0.001) was observed, as well as in contrast-enhanced images (r=0.649, P&lt;0.001). Conclusions GLS measured by VVI in contrast-enhanced echocardiography is a feasible and reliable index for the quantification of left ventricular systolic function, even in patients with poor image quality. Compared with the measurements in non-contrast images, both LVEF and GLS measurements are higher in the presence of contrast agents.

P1771Right ventricular mechanical changes after septal myectomy for obstructive hypertrophic cardiomyopathy. Vector velocity imaging study

Abstract Objectives The impairment of right ventricular (RV) myocardial mechanics is evident in hypertrophic cardiomyopathy (HCM). It is independently influenced by LV mechanics and correlated to the severity of LV phenotype. We investigated the changes in RV global and regional deformation following surgical septal myectomy using vector velocity imaging (VVI). Methods 25 HCM patients, 68% males with mean age (34.5±12 years) were examined before and within two months after surgical myectomy using VVI. In addition to conventional echocardiographic parameters, peak systolic strain (εsys), strain rate (SR) and time to peak εsys (TTP) of regional RV free wall (RVFW) &amp; septal walls were analyzed in longitudinal (long) directions from apical four chamber view and their (Δ)changes were calculated. Similar parameters were quantified in LV from apical 2 &amp; 4 CH views. Intra-V-delay was defined as SD of TTP and inter-V dyssynchrony was estimated from TTP difference between the most delayed LV segment &amp; RVFW. Results All study patients showed improvement of their functional class from NYHA class III to class I and reduction of LVOT gradient to below 20 mmHg except one patient who had 30 mmHg gradients at rest. There was significant reduction of septal thickness, left atrial diameter&amp; volume, LVOT gradient, LVMI, severity of mitral regurgitation, tricuspid annular velocities (P&lt;0.0001), RV diameter (P&lt;0.02) and increase in LV internal dimensions (P&lt;0.001) post myectomy. However, there was significant reduction of RV and LV systolic mechanics; RV global εsys % (from −16.1±4.4 to −12.9±2.9, P&lt;0.0001) and LV global εsys %: from −11.6±2.8 to −9.4±2.2%, P&lt;0.0001) respectively. The magnitude of reduction of RV strain (Δ RV εsys%, Δ SRsys) was directly correlated LV maximal wall thickness (r=0.46, P&lt;0.01) and ΔRV dyssynchrony (TTP-SD), (r=0.4, P&lt;0.05) and negatively correlated to age (r=−0.46, P&lt;0.02), pre-op RV SRsys (r=−0.52, P&lt;0.01) and pre-op LV EF% (r=−0.43, P&lt;0.03). Meanwhile the reduction in RV diastolic mechanics: Δ RV SRe &amp; SRa were directly correlated to PAP and LVOT gradient before surgery (r=0.62, P&lt;0.002). Conclusion Despite improvement of patient functional status and reduction LVOT gradient, RV mechanics shows further deterioration after surgical myectomy. The magnitude of reduction is modestly related to cardiac phenotype and pre-op mechanical function.

P1951Serial left ventricular global longitudinal strain and mortality in patients with Takotsubo cardiomyopathy

Abstract Background Recent studies on Takotsubo cardiomyopathy (TC) have challenged the common conception that it is a relatively benign condition with functional recovery observed in the majority of cases. However, it is important to recognize that overt functional recovery might not reflect the true regional recovery, which might have an adverse impact on survival. Objective We sought to assess baseline and follow-up left ventricular function characteristics and their impact on longer-term mortality in patients presenting with documented Takotsubo cardiomyopathy (TC) at a tertiary centre. Methods 339 patients (66±14 years, 88% women) presented to our centre between 2006 and 2018 with acute anginal symptoms and were subsequently diagnosed with TC following clinical and angiographic evaluation. All patients returned for a follow-up evaluation including transthoracic echocardiography (TTE). Baseline and follow-up (3–6 months after TC diagnosis) LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS using velocity vector imaging) were recorded on TTE. The primary endpoint was longer-term mortality. Results Hypertension, dyslipidaemia, and diabetes were present in 71%, 56%, and 26% of patients. Baseline mean troponin I peak, LVEF and LV-GLS were 0.9±7 ng/ml, 36±9%, and 11±3%; respectively. 94% had baseline LVEF&lt;50%, 272 (80%) had apical ballooning, and 94% had LV-GLS worse than −18%. No patient had angiographically obstructive coronary artery disease. At 3–6 months follow-up, mean LVEF, and LV-GLS improved to 57±9% and 16±3%, respectively. 87% of patients had LVEF &gt;50%, but in 70% LV-GLS remained worse than −18%. After 3.3±3 years, 72 patients (21%) died. On multivariable Cox survival analysis (adjusted for age, gender, baseline troponin peak and follow up LVEF), follow up LV-GLS was independently associated with longer-term mortality (hazard ratio 1.12 [95% confidence interval 1.05, 1.20], p&lt;0.001). Significantly more patients with follow up LV-GLS worse than −18% died vs. those with LV-GLS better than −18% (57/237 [24%] vs. 15/102 [15%], log-rank statistic p-value 0.01, Kaplan-Meier figure 1). Kaplan-Meier curve of freedom from death Conclusions In this large single-centre study of patients with documented TC (majority women), 87% recovered LVEF at 3–6 months, but in 70% LV-GLS remained worse than −18%, which was independently associated with higher longer-term mortality.

EP13.05: A preliminary study of the evaluation of heart function in fetus with tetralogy of Fallot by velocity vector imaging

EP13.05: A preliminary study of the evaluation of heart function in fetus with tetralogy of Fallot by velocity vector imaging

Quantitative Assessment of Left Ventricular Dysfunction in Fetal Ebstein's Anomaly and Tricuspid Valve Dysplasia

Fetal Ebstein's anomaly and tricuspid valve dysplasia (EA/TVD) are associated with high perinatal mortality relative to pulmonary atresia with intact ventricular septum (PAIVS), despite both requiring redistribution of the cardiac output (CO) to the left ventricle (LV). LV dysfunction is suspected to contribute to adverse outcomes in EA/TVD. We sought to examine global and segmental LV function in fetal EA/TVD with comparison to normal controls and PAIVS. We hypothesized that LV dysfunction in EA/TVD is associated with abnormal LV remodeling and interventricular mechanics. We retrospectively identified 63 cases of fetal EA/TVD (40 with retrograde ductal flow) and 22 cases of PAIVS encountered from 2004 to 2015 and compared findings to 77 controls of comparable gestational age. We measured the combined CO and global LV function using two-dimensional, Doppler-derived, deformational (six-segmental vector velocity imaging) and dyssynchrony indices (DIs; SD of time to peak), and a novel global DI. EA/TVD fetuses demonstrated abnormal LV global systolic function with reduced ejection fraction, fractional area change, and CO, while in PAIVS we observed a normal ejection fraction, fractional area change, and CO. PAIVS, but not EA/TVD, demonstrated increased LV sphericity, suggestive of remodeling, and associated enhanced radial function in the third trimester. In contrast, while EA/TVD fetuses had normal LV segmental longitudinal strain, there was abnormal radial segmental deformation and LV dyssynchrony with increased SD of time to peak and DI. Fetal EA/TVD is associated with a lack of spherical remodeling and presence of mechanical dyssynchrony, which likely contribute to reduced CO and ejection fraction. Clinical monitoring of LV function is warranted in fetal EA/TVD. Further studies incorporating quantification of LV function into prediction models for adverse outcomes are required.

The results of standard echocardiography and use of Velocity Vector Imaging technology after surgical revascularization in patients with coronary artery disease

The aim of the study was to assess the impact of surgical revascularization on left ventricular function using standard echocardiographic study and Velocity Vector Imaging technology. Materials and methods. 40 patients with ischemic heart disease were examined before and 12 days, 6, 12 and 24 months after coronary artery bypass grafting (CABG). A standard echocardiographic (EchoCG) study was performed on ultrasound scanner Acuson Х 300 (Siemens, USA) with a 5–1 MHz sector multifrequency sensor. For objective assessment of myocardial function, the analysis of left ventricular (LV) deformation and rotational properties was performed using Syngo VVI (Siemens Medical Solutions USA Inc., США) in 720 LV segments. Results. Standard EchoCG showed a stable systolic, diastolic and contractile LV function during 2 years of follow-up. The study of global values of strain (S) and strain rate (SR) showed a decrease in longitudinal S 6 months after CABG in the right coronary artery (RCA) area in the group of patients with complaints compared to those who had no complaints (p = 0.004), in addition, in this zone there was a tendency to a difference in longitudinal SR between these two groups (p = 0.07). In anterior descending artery area was a tendency to decreased strain of longitudinal fibers (p = 0.06) during the same period of observation. 1 year after CABG, strain decreased in patients with complaints (p = 0.04) in the circumference artery area only in circular fibers. Positive dynamics were noted in the diastolic function of left ventricular fibers and rotation indices. Conclusion. The use of Velocity Vector Imaging after coronary bypass surgery shows a change in the function of myocardial fibers in the areas of coronary arteries, which is important in patients complaining of angina pain.

Regional Variability in Longitudinal Strain Across Vendors in Patients With Cardiomyopathy Due to Increased Left Ventricular Wall Thickness.

Cardiomyopathies with increased left ventricular wall thickness such as cardiac amyloidosis, septal hypertrophic cardiomyopathy (HCM), and apical HCM exhibit characteristic regional longitudinal strain (LS) patterns. However, between-vendor agreement of segmental and regional LS has not been tested in these diseases. We sought to assess LS values among vendors in specific cardiomyopathies that exhibit regional strain variation: cardiac amyloidosis, septal HCM, and apical HCM. This was a prospective, cross-sectional study of 69 patients (18 amyloidosis, 30 septal HCM, 6 apical HCM, and 15 controls) who underwent clinically indicated outpatient echocardiography at the Cleveland Clinic. Peak systolic segmental, regional (basal, mid, and apical), and global LS were evaluated using GE (EchoPAC), Siemens (Velocity Vector Imaging), and Phillips (QLab) systems in the same imaging session. Between-vendor, differences were analyzed using correlation coefficients, Bland Altman plots, and a mixed model. Global LS was highly correlated among the 3 software packages and most abnormal in patients with amyloidosis (P<0.001). Regional LS analysis demonstrated that QLab software tended to produce more negative LS values, driven by differences in apical strains. EchoPAC had the greatest ability to discriminate patients with amyloidosis using regional strain values (area under the curve, 0.932) as compared with Velocity Vector Imaging and QLab (P<0.001). Global and regional variations in LS exist between-vendors in patients with cardiomyopathies with increased left ventricular wall thickness (amyloidosis, septal HCM, and apical HCM). It is important to be aware of these differences for diagnosis, prognosis, and serial examinations in these conditions.

Prognostic Value of Longitudinal Strain Measured by Velocity Vector Imaging, in Asymptomatic Severe Aortic Stenosis with Preserved Ejection

Background: Longitudinal systolic strain (LSS) abnormalitiess have been described in patients with preserved ejection fraction(EF). The prognostic value of LSS in asymptomatic severe aortic stenosis (AoS) is under discussion.Objetive: The aim of this study was to assess whether LSS assessment using velocity vector imaging (VVI) predicts theprogression and indication of aortic valve replacement (AVR) in asymptomatic patients with severe AoS and preserved EF.Methods: The study included patients with severe AoS and preserved EF who were considered asymptomatic and withoutinitial indication for AVR. They underwent two, three and four-chamber echocardiography that evaluated LSS of each segmentand global longitudinal strain (GLS) by VVI, as well as NT-proBNP assessment. The primary endpoint was need for AVR.Results: A total of 57 patients with mean age 69±8 years, 49% women, were included in the study. After two years of follow-up,13 patients (22.8%) required AVR. This group had lower GLS (-15.5±3.4 vs.-18.9±3.1, p=0.03) and two-chamber LSS (-12.8±5.5vs.-16.3±5.6, p=0.04). In univariate analysis, GLS, NT-proBNP and the E/e’ ratio were predictors of the endpoint, while inthe multivariate analysis, only GLS was an independent predictor of need for AVR (HR: 1.28 (95% CI 1.04-1.58), p=0.01).Conclusions: Global longitudinal strain measured by VVI was an independent predictor of need for AVR

Prognostic Value of Longitudinal Strain Measured by Velocity Vector Imaging, in Asymptomatic Severe Aortic Stenosis with Preserved Ejection

Prognostic Value of Longitudinal Strain Measured by Velocity Vector Imaging, in Asymptomatic Severe Aortic Stenosis with Preserved Ejection