Velocity Vector Imaging Software Research Articles

Validation of an artificial intelligence-based tool for automated evaluation of RV size and function from ultrasound examinations

Funding AcknowledgementsType of funding sources: Private company. Main funding source(s): Study sponsored by DiA Imaging AnalysisBackground The assessment of the right ventricular (RV) function is an essential part of every transthoracic echocardiographic examination. It plays an important role in the diagnosis and management of many diseases and conditions. In covid-19 patients, there is evidence showing that enlarged RV and abnormal Free Wall Strain (FWS) correlate with high mortality. Assessment of the RV in the Point of Care settings can assist the differential diagnosis and provide important clinical information in early stages, close to the onset of symptoms, however, it is done qualitatively by visual estimation and thus subjective and requires high level of expertise. The presented study aims to validate the use of a novel artificial intelligence tool (LVivo RV by DiA imaging analysis) that uses deep learning and image processing algorithms to automatically evaluate RV size and function from apical 4 chamber (4CH) focused or modified ultrasound clips.Methods A retrospective study of 100 patients who underwent routine echocardiographic examination was conducted in three medical centers in US and Israel. The apical 4CH focused or modified clips were interpreted by experts to evaluate RV size and function. The End Diastolic Area (EDA) measured manually by two sonographers and the FWS measured by semi-automated Velocity Vector Imaging software (VVI by Siemens) were compared to the same parameters obtained automatically by the LVivo RV, using linear regression and Bland Altman analysis.Results 100 cases were included, 39% females and 61% males. Mean age was 64.7 [19-92]. Mean BMI was 28.1 [6.8-17.6]. 74% had pulmonary hypertension and 19% had lung disease. 36% were considered abnormal by their fractional area change values and 64% were considered normal. Three cases were non-interpretable by the physicians thus excluded from the analysis. The LVivo RV was able to process 99% of the cases. Excellent correlation was obtained for EDA between the sonographers" average of manual measurements and the automated EDA by LVivo RV with r = 0.92 (p < 0.0001, 95%CI 0.88-0.94). The bias and limits of agreement for EDA were 0.87 ± 5.76cm^2. For FWS, 4 cases were manually excluded due to insufficient image quality. The Bland Altman analysis for FWS showed small bias and limits of agreement of 0.7 ± 12.2%. A very good correlation of r= 0.78, (95% CI 0.69-0.85) was found, indicating good compatibility between the methods. The specificity and sensitivity for FWS were 80% and 77% respectively, using an optimal cutoff value of -16%, and the overall agreement was 79%.Conclusions The performance of LVivo RV demonstrated a very good agreement with manual and semi-automated quantitative methods for RV assessment. LVivo RV provides fast, accurate, objective and reproducible results and has the potential to be used at the Point of Care settings as a powerful tool for RV size and function evaluation. Figure.

Evaluation of eSie VVI Technology on Left Ventricular Systolic Function Changes in Uremic Patients Undergoing Dialysis.

To analyze the longitudinal peak systolic strain of left ventricular myocardium in three layers before and after hemodialysis in uremic patients, and to explore the value of eSie VVI (Velocity Vector Imaging) technology in evaluating the changes of left ventricular myocardial systolic function in uremic patients in a short time after hemodialysis, the longitudinal peak systolic laminar strain and global full-thickness strain of 17 segments of the left ventricle are obtained by eSie VVI software analysis, and the results are deduced in Excel form. Statistical analysis is made on the results of longitudinal peak systolic stratified strain of left ventricular inner, middle and outer layers and whole myocardium in uremic patients before and after hemodialysis. The results show that eSie VVI technology can more sensitively and accurately evaluate the changes of left ventricular myocardial systolic function after hemodialysis in uremic patients, and has certain clinical value.

Evaluation of the effect of hemodialysis on left ventricular longitudinal strain function of myocardium in patients with uremia by velocity vector imaging

Objective To investigate the velocity vector imaging (VVI) technique to evaluate hemodialysis on left ventricular function and application value of longitudinal strain effect of three myocardial layers. Method Echocardiography was performed in 35 cases of uremia patients with high flux hemodialysis, respectively before and after dialysis within 2H. Use VVI software to analyze the two-dimensional images after conventional measurement and image acquisition and obtain 17 segments of left ventricular peak systolic longitudinal strain (LPS) and layered whole layer strain. Results Left atrial diameter (LAD), left ventricular end diastolic and end systolic diameter (LVIDd, LVIDs), and left ventricular diastolic end and end systolic volume (EDV, ESV), stroke volume (SV)were reduced after dialysis(P 0.05).Layered strain parameter: Compared with before dialysis, the peak systolic longitudinal strain (LPS) of left ventricular global layer and inner layer,the global layer, subendocardial layer, middle layer and epicardial layer of the basal segment,the global layer and subendocardial layer of middle segment were lower than before dialysis. The difference was statistically significant (P 0.05).Single hemodialysis has a negative effect on left ventricular function. Therefore, it is necessary to monitor the heart function in hemodialysis patients to avoid the occurrence of cardiovascular events during dialysis and after dialysis. Conclusion VVI can be more accurate to evaluate the effect of blood dialysis in uremic patients with left ventricular myocardial regional and global function, and has potential applications in clinical practice.

Myocardial strain assessment using velocity vector imaging in normally grown fetuses at term.

To assess prospectively fetal myocardial deformation at term in normally grown fetuses using the velocity vector imaging (VVI) two-dimensional speckle-tracking technique, and to explore myocardial deformation changes over the last 4 weeks of pregnancy. This was a prospective, observational cohort study of 276 women with an uncomplicated singleton pregnancy who underwent fortnightly ultrasound from 36 weeks' gestation until delivery at the Mater Mother's Hospital, Brisbane, Australia. Fetal myocardial deformation (assessed by global and segmental longitudinal systolic myocardial strain and strain rate of both right and left ventricles) was measured using VVI software. Mean global longitudinal left and right ventricular strain and strain rate values decreased between each time point. At 36, 38 and 40 weeks' gestation, left ventricular global strain (%) and strain rate (/s) decreased, respectively, as follows: -14.6 ± 3.8% and -1.2 ± 0.3/s at 36 weeks; -13.6 ± 3.3% and -1.1 ± 0.3/s at 38 weeks; and -12.3 ± 3.1% and -1.0 ± 0.3/s at 40 weeks. At 36, 38 and 40 weeks, mean right ventricular global strain (%) and mean strain rate (/s) decreased, respectively, as follows: -14.2 ± 3.4% and -1.2 ± 0.2/s at 36 weeks; -13.4 ± 3.0% and -1.1 ± 0.2/s at 38 weeks; and -12.8 ± 2.8% and -1.1 ± 0.2/s at 40 weeks. Global ventricular strain values diminish with advancing gestational age. Myocardial deformation imaging is feasible in late gestation and may be useful as an adjunct for the assessment of fetal cardiac function close to birth. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Head to Head Comparison of Speckle Tracking Strain Echocardiography with Invasive Hemodynamic Assessment for the Detection of Acute Cellular Rejection in Cardiac Allograft Recipients

Introduction Non-invasive alternatives to endomyocardial biopsy (EMB) are highly desirable to monitor acute cellular rejection (ACR). In the present study, we aimed to test the hypothesis that echocardiographic strain quantification, by tracking subtle alterations in myocardial function, is useful and superior to invasive hemodynamic measurements to detect ACR. Materials and Methods All patients underwent serial surveillance EMBs, catheterizations and echocardiography examination according to our institutional protocol. Data from the first rejection episodes were compared with the data obtained after treatment. Patients without rejection during follow-up were also included for comparison. All tests were performed within 48 hours of each other. In addition to standard 2D and Doppler echocardiographic measurements, global longitudinal and circumferential strain (GLS, GCS) were assessed from 16 segments, from digitally stored echocardiograms by using the Velocity Vector Imaging software on Syngo Workplace (Siemens Healthcare GmbH, Erlangen/Germany). Results We observed 16 grade 1R, 14 grade 2R and 1 grade 3R and 18 no rejection. Time to first rejection was 3 months (interquartile range: 3-36). Only GLS and GCS were significantly reduced during grade 1R. During grade ≥2R, GLS, GCS, tricuspid annular peak systolic excursion, cardiac index were significantly reduced, right atrial and systolic pulmonary artery pressures were significantly increased as compared to no rejection. The negative and positive predictive values of the best fit cut-off of GLS (<17%) were 98% and 43% for grade ≥2R, 84% and 70% for any rejection. In the multivariate logistic regression analysis including the most pertinent variables according to univariate analyses, GLS and GCS emerged as independent determinants of any rejection (p=.015 and p=.004, respectively). Despite successful treatment, strain values remained significantly lower than the values of no-rejection group (GLS 17.0% [14.7% - 18.3%] vs 18.9% [16.8% - 22.1%]; p=.006, GCS 25.5% [22% - 27.8%] vs 29.0% [24.0% - 33.4%]; p=.01).Conclusions Echocardiographic strain, but not hemodynamic assessment by cardiac catheterization, is a sensitive tool to detect first rejection episode after HTx. However, incomplete normalization of strain after treatment necessitate intra-individual comparisons on serial follow-up are warranted. Strain is a promising marker of ACR however it needs to be tested in larger series.

Worsening in Longitudinal Strain and Strain Rate Anticipates Development of Pediatric Transplant Coronary Artery Vasculopathy as Soon as OneYear Following Transplant.

Transplant coronary artery vasculopathy (TCAV) following orthotopic heart transplantation (OHT) continues to be the primary reason for late graft failure in children. The current gold standard of diagnosis of TCAV is coronary angiography with or without intravascular ultrasound. This study investigates the longitudinal use of speckle-tracking echocardiographic strain imaging as an early non-invasive marker to screen for development of TCAV. Echocardiograms from patients who underwent OHT between 2006 and 2010 at Children's Hospital Colorado (n=50) were retrospectively assessed. Studies were evaluated at baseline (within a month of transplant), then at each annual clinical follow-up for peak longitudinal (LS) and circumferential (CS) strain, systolic strain rate, and diastolic strain rate using Siemens Velocity Vector Imaging software. Comparisons were made between subjects who did and did not develop TCAV. Mean time to TCAV diagnosis following OHT was 3.2years (range 1-5.1years). One year after transplant, significant differences were seen between groups in LS (non-TCAV mean -19.6%, TCAV mean -17.3%, p=0.03) and longitudinal strain rate (non-TCAV mean -1.7%/s, TCAV mean -1.4%/s, p=0.04). These differences persisted in subsequent years. Differences in LS preceded the catheterization-based diagnosis of TCAV in pediatric heart recipients and were noted as early as one year post transplant. Additionally, within-subject LS changes may have utility as a non-invasive screening tool to predict those patients at increased risk for development of TCAV.

Left Ventricular Torsional Parameters in Patients With Non-Ischemic Dilated Cardiomyopathy

Background: Velocity vector imaging (VVI) is a new echocardiography method to assess myocardial deformation in two dimensions. Objectives: In this study, we used VVI to evaluate left ventricular (LV) main torsional parameters in non-ischemic dilated cardiomyopathy (DCM) patients in compared with normal subjects. Patients and Methods: Twenty-six DCM patients and Twenty-four normal subjects were assessed. Echocardiographic images of the short axis apical and basal views of LV were processed by VVI software to measure peak rotation degrees and also peak rotation rates in systole. LV twist was well-defined as the net difference between apical and basal rotation values and also LV torsion was considered as LV twist divided by left ventricular diastolic longitudinal length. In addition, peak untwisting value and untwisting rate were measured in diastole too. Results: LV twist value (5.54 ± 1.94° in DCM VS. 11.5 ± 2.45° in control group) and also LV torsion (0.71 ± 0.28°/cm in DCM VS. 1.53 ± 0.42°/cm in control group) were significantly decreased in DCM patients compared with normal group (P < 0.001 for both); also, the twisting rate was notably lower in DCM vs. control (38.68 ± 14.43°/s in DCM vs. 75.88 ± 17.25°/s in control; P < 0.001) and also untwisting rate (36.28 ± 13.48°/s in DCM vs. -73.79 ± 24.45°/s in control; P < 0.001), However normalization of these times for systolic duration or LV length creates different values. Conclusions: LV twist, torsion and untwist and also rate of them are significantly impaired in DCM and this impairment is well-related to LV global systolic and diastolic dysfunction. VVI is a new noninvasive technique that can be used to evaluate LV torsional parameters.

Myocardial Strain and Strain Rate from Speckle-Tracking Echocardiography are Unable to Differentiate Asymptomatic Biopsy-Proven Cellular Rejection in the First Year after Cardiac Transplantation

Cellular rejection after cardiac transplantation is treatable with timely diagnosis. Because noninvasive methods for diagnosis are limited, surveillance endomyocardial biopsies are routinely performed in the first year after transplantation. The aim of this study was to test whether myocardial strain and strain rate as assessed by speckle-tracking echocardiography would be a sensitive noninvasive method for the detection of asymptomatic rejection. Surveillance biopsies and echocardiograms obtained in the first year after transplantation were retrospectively reviewed, and patients with asymptomatic biopsy-proven cellular rejection were identified, as well as control transplantation patients without rejection or cardiac complications. Circumferential and longitudinal strain and strain rate were measured using Velocity Vector Imaging software from echocardiograms performed at three time points for patients with rejection-baseline (no rejection), rejection, and resolution (of rejection)-and three time points for control patients-baseline (within the first month after transplantation), 6 months, and 12 months after transplantation. Speckle-tracking strain and strain rate measurements were obtained from 30 patients with asymptomatic biopsy-proven rejection and 14 control transplantation patients. There were no significant differences in circumferential and longitudinal strain or strain rate between the baseline, rejection, and resolution studies. Furthermore, there were no significant differences in strain and strain rate in control transplantation patients during the first year after transplantation or compared with patients with rejection. Speckle-tracking analysis was unable to detect changes on serial studies from patients with asymptomatic rejection and thus cannot replace biopsy. Other noninvasive methods for the diagnosis of cellular-mediated rejection are needed.

Quantitative Assessment of Cardiac Function in Fetuses of Women with Maternal Gestational Thyroid Dysfunction Using VVI Echocardiography.

BackgroundThe study aimed to investigate the clinical value of velocity vector imaging (VVI) in assessing heart function in fetuses of pregnant women with thyroid dysfunction. The inter-observer and intra-observer variability was assessed for all VVI parameters observed.Material/MethodsThe participants were enrolled from singleton pregnant women with gestational ages ranging 24+0 to 40+1 weeks who visited the Department of Obstetrics and Gynecology at the Affiliated Hospital of Qingdao University, China, for prenatal care from July 2011 to February 2014. Digital 2-dimensional (2D) dynamic 4-chamber images of the heart were collected. A total of qualified 226 images from 125 fetuses of pregnant women with normal thyroid (control group), 64 fetuses of pregnant women with hypothyroidism (hypothyroidism group), and 37 fetuses of pregnant women with hyperthyroidism (hyperthyroidism group) were interrogated offline using VVI software. The echocardiographic parameters including the myocardium peak systolic velocity (Vs), peak diastolic velocity (Vd), peak systolic strain (S), peak systolic strain rate (SRs), peak diastolic strain rate (SRd) of RV and LV, were obtained from the velocity curves of 2D myocardial motion. The heart rate was measured using a virtual M-mode algorithm built into the software.ResultsThe study found that the longitudinal Vs and Vd of both ventricles in the control group gradually decreased from basal segments to apical segments and significantly increased over the gestation. S, SRs, and SRd of both ventricles remained stable after middle gestation. Compared with the control group, the hypothyroidism and hyperthyroidism groups exhibited significantly reduced S, SRs, and SRd, even for fetuses at 24-weeks gestation. There were no significant differences in global Vs and global Vd between the control group and the hyperthyroidism or hypothyroidism groups.ConclusionsThe thyroid dysfunction of pregnant women may damage fetal heart function, and VVI could be a sensitive technique to measure the variation of fetal heart function.

Evaluation of left atrial function in hypertensive patients with and without left ventricular hypertrophy using velocity vector imaging.

To study left atrial deformation characteristics using Velocity vector imaging (VVI) in hypertensive patients with and without left ventricular hypertrophy (LVH), and to explore its value for detection of left atrial dysfunction in these patients. Sixty-four patients with essential hypertension were divided into normal left ventricular geometry (LVN, 37 cases) and LVH (27 cases) groups, according to their left ventricular mass index. Twenty-five age-matched healthy participants were included as control group. Two-dimensional dynamic images of the apical four- and two-chamber echocardiographic views were obtained, and strain/strain rate (SR) curves of eight atrial segments were derived by VVI software. Peak systolic strain (ε(sys)), systolic SR (SRs), early and late diastolic SR (SRe, SRa) were measured and calculated. Peak early diastolic mitral inflow and annulus velocities were also measured and their ratio (E/E') calculated. Compared with the control group, SRe decreased and SRa increased significantly in LVH group (P < 0.05), while no significant difference was found between LVN and control groups with respect to SRe, SRa, SRs and ε(sys) (P > 0.05). Also, no significant difference was observed in SRe, SRa, SRs and ε(sys) between LVH and LVN groups (P > 0.05). SRe and SRa correlated significantly with E/E' (r = -0.634, r = 0.609; both P < 0.001). Strain/SR parameters derived from VVI may reflect decreased conduit, increased booster pump function of the left atrium in hypertensive patients with LVH and correlate with left ventricular diastolic function.

Cardiac mechanics in patients with human immunodeficiency virus: a study of systolic myocardial deformation in children and young adults.

Human immunodeficiency virus (HIV) infection causes dysfunction of different organ systems. Myocardial diastolic dysfunction has been reported previously in an adult HIV population. Our aim was to study myocardial strain in children and young adults infected by HIV who have apparently normal ejection fraction. Forty HIV-infected patients (mean age 20.6 ± 1.5 years) with normal ejection fraction and 55 matched normal controls (mean age 17 ± 1.5 years) were studied by two-dimensional echocardiogram. The images were stored then exported to velocity vector imaging software for analysis. Measures considered were left-ventricular peak global systolic strain (LV S) and strain rate (LV SR) as well as right-ventricular peak global systolic strain (RV S) and strain rate (RV SR). Circumferential measures of the left ventricle included the following: LV circumferential peak global systolic strain (LV circ S), strain rate (LV circ SR), radial velocity (LV rad vel), and rotational velocity (LV rot vel) at the level of the mitral valve. Statistical significance was set at p < 0.05. The means of all longitudinal deformation parameters were significantly lower in HIV patients compared with normal controls: LV S (-14.15 vs. -19.31), LV SR (-0.88 vs. -1.30), RV S (-19.58 vs. -25.09), and RV SR (-1.34 vs. -2.13), respectively (p < 0.05). LV rot vel was lower in patients compared with controls (43.23 vs. 51.71, p = 0.025). LV circ S, LV circ SR, and LV rad vel showed no significant difference between the two groups (p ≥ 0.05). HIV infection affects longitudinal systolic cardiac strain and strain rate in children and young adults. Normal ejection fraction might be attributed to preserved circumferential myocardial deformation. Strain and strain rate may help identify HIV patients at high risk for cardiac dysfunction and allow early detection of silent myocardial depression.

Elastic Properties of the Descending Aorta in Patients with a Bicuspid or Tricuspid Aortic Valve and Aortic Valvular Disease

The aim of this study was to explore possible differences in aortic strain, distensibility, and stiffness in the descending thoracic aorta between patients with bicuspid aortic valves (BAVs) and those with tricuspid aortic valves (TAVs) in relation to type of aortic valve disease and known cardiovascular risk factors. Transesophageal echocardiography was used to examine 288 patients (mean age, 64 ± 13 years) in the operating room before surgery. The transesophageal echocardiographic images were analyzed offline using Velocity Vector Imaging software. One hundred forty patients had isolated severe aortic stenosis (AS) (89 of those with BAVs, 51 of those with TAVs), and 52 patients had isolated severe aortic regurgitation (AR) (24 of those with BAVs, 28 of those with TAVs). In patients with AS, stiffness in the descending aorta was 10 (range, 7.3-16) in those with BAVs and 13 (range, 11-18) in those with TAVs (P < .001). Distensibility was 19 kPa(-1) 10(-3) (range, 13-27 kPa(-1) 10(-3)) in patients with BAVs and 15 kPa(-1) 10(-3) (range, 11-19 kPa(-1) 10(-3)) in those with TAVs (P < .01). In patients with AR, stiffness was 6.9 (range, 5.5-7.8) in those with BAVs and 8.0 (range, 6.6-11) in those with TAVs (P < .05). After correction for age, dimension of the ascending aorta, cholesterol, and stroke volume in a multivariate regression model, BAV was associated with lower strain and distensibility of the descending aorta in the AR group and higher distensibility in the AS group, whereas stiffness was no longer related to aortic valve morphology in either of the two groups. The presence of BAVs in patients with severe AR is associated with lower strain and distensibility, suggesting that impairment of the elastic aortic properties may extend to the descending aorta. In patients with AS, BAVs correlate weakly with higher distensibility.

Left ventricular strain and strain rates are decreased in children with normal fractional shortening after exposure to anthracycline chemotherapy

Anthracycline chemotherapeutic agents carry the well-recognised risk of cardiotoxicity. Previous methods to evaluate cardiac function are useful, but have significant limitations. We sought to determine the left ventricular strain and strain rate of paediatric cancer patients with normal fractional shortening treated with anthracyclines using the latest ultrasound feature-tracking technology. Echocardiograms on cancer patients before anthracycline exposure and following completion of treatment were retrospectively analysed using Velocity Vector Imaging software in the circumferential and longitudinal planes. The same analysis was performed on matched controls. Only patients with a fractional shortening ≥28% were included. In all, 71 patients were identified with an age at diagnosis of 10.5 ± 4.7 years. The time from diagnosis to follow-up was 3.9 ± 4.0 years and the cumulative anthracycline dose was 356 ± 106 mg/m². Following anthracycline exposure, paediatric cancer patients had a higher heart rate and a lower longitudinal strain, longitudinal diastolic strain rate, circumferential strain, and circumferential systolic and diastolic strain rate when compared with controls. Diastolic strain rate showed the greatest percent difference following anthracycline exposure versus controls. Despite having a normal fractional shortening, children exposed to anthracyclines have subclinical derangement of their left ventricular deformation as measured by decreases in strain and strain rate in both the circumferential and longitudinal axis. In particular, there was a profound decrease in diastolic strain rate following anthracycline exposure compared with controls. Whether the decline of strain or strain rate can predict future risk of developing cardiomyopathy requires further investigation.

A CMR study of left atrial mechanics in hypertrophic cardiomyopathy: left atrial function predicts paroxysmal atrial fibrillation

Background: Atrial fibrillation is a frequent complication in HCM, often precipitating heart failure or stroke. Identification of patients at risk of developing AF may have implications for management. While left atrial (LA) volumes have been shown to increase the risk of AF, we hypothesized that LA function is an important predictor of risk. Methods: 72 patients (36 without AF-HCM SR); 36 with PAF-HCM PAF) were compared. PAF and SR patients were matched on an individual basis for age, gender, and HCM morphology. Strain analysis with Velocity Vector Imaging software was performed on cine SSFP images obtained from CMR to assess LA volumes and function. All patients were in sinus rhythm at the time of CMR. Results: see Table. View this table: Conclusions: In HCM patients with PAF, LA function is impaired even in the presence of sinus rhythm. This difference is present even in patients with similar degrees of hypertrophy, LVOT obstruction, and mitral regurgitation, suggesting the likelihood of an underlying atrial myopathy. The presence of LA dysfunction in patients with HCM provides an incremental measure of risk of PAF over and above LA volume.

Effects of age on left ventricular twist-displacement loop assessed by velocity vector imaging

To assess effect of age on the characteristic of left ventricular (LV) twist-displacement loop in health volunteers by velocity vector imaging (VVI) and to provide a new method for LV function evaluation in clinic. After obtaining basal and apical LV short-axis images in 98 healthy volunteers (18-75 years old) by 2-dimensional echocardiography, we use VVI software to analysis LV twist motion and radial displacement at each plane off-line. The peak LV twist (Ptw), the peak untwist velocity (PutwV), the proportion of untwist in isovolumetric relaxation period (Iutw%) and LV radial displacement (Dis) were measured and calculated. Then we constructed LV twist-displacement loop and compared the characteristic of them among different groups. Ptw increased gradually with the increase in age. The biggest PutwV was in the group of 30-60 years old. Iutw% increased gradually before 60 years old, then decreased after that. Dis was not obviously different among the three groups. The characteristic of LV twist-displacement loop was like the configuration of 8. There was a linear relation between twist and displacement during systole, and the slope increased gradually with the increase in age. During early diastole, the relatively small radial expanding displacement displayed with untwisting, resulting in a much steeper twist-displacement relationship curve occurred in each group, which was getting smooth gradually when the radial expanding displacement increased during mid to late diastole. VVI can be used to effectively and noninvasively assess LV twist-displacement loop with change in age and provide important information for LV function. The effect of age must take into account when evaluate the LV function by the twist-displacement loop.

THU0076 Strain echocardiography for the evaluation of myocardial function in patients with rheumatoid arthritis

BackgroundPatients with rheumatoid arthritis (RA) are at an increased for cardiovascular disease (CVD), however optimal strategies to evaluate for sub-clinical CVD in RA patients are not well characterized. Myocardial strain...

Left and right ventricular strain and strain rate measurement in normal adults using velocity vector imaging: an assessment of reference values and intersystem agreement

Velocity vector imaging (VVI) software permits quantitative assessment of ventricular function through measurement of myocardial strain (S) and strain rate (SR). The purpose of this study was to define a reference range of ventricular S and SR values in normal adults using VVI software, and to describe the variability among observers and systems. Two-dimensional echocardiography was performed in 186 healthy adults free of cardiovascular disease or risk factors, followed by comprehensive ventricular S and SR analysis using VVI software. Images were acquired using three commercial ultrasound systems. The mean age of patients was 44 ± 16 years, and 114 (61 %) were female. Mean global left ventricular (LV) longitudinal, circumferential, and radial S and SR, and right ventricular (RV) longitudinal S and SR values are presented. Significant segmental variation in regional LV and RV S and SR was detected. Multivariate regression analysis demonstrated global longitudinal LV (p = 0.05) and RV (p = 0.002) S values decline significantly with age. The overall variability of S and SR values accounted for by patient demographic and hemodynamic variables was low (16 and 8 % for LV longitudinal S and SR, respectively). Interobserver agreement was very good, but was lowest for LV radial S and SR. There were no significant differences of LV and RV S and SR between ultrasound systems. Comprehensive reference values for the normal ranges of LV and RV S and SR measured using VVI software are presented. The ultrasound system used for image acquisition did not significantly influence results.

Abstract 9020: Utilizing Speckle Tracking Echocardiography to Analyze Strain Patterns in Pediatric Patients with Suspected Myocarditis

Background: Myocarditis is a rare disease involving inflammation of the myocardium which causes significant morbidity and mortality in children. Currently, endomyocardial biopsy is the only definitive way to diagnose myocarditis but techniques such as echocardiography and cardiac MRI can be utilized to aid in diagnosis. New advances such as speckle tracking echocardiography (STE) can analyze myocardial strain patterns which are a more sensitive measure of ventricular function. The primary aim of this study is to determine if 2D strain imaging via STE in children with suspected myocarditis correlates with other methodologies currently used in making the diagnosis. Methods: A retrospective review was conducted to identify all patients with suspected myocarditis from 2004-2010.Standard 2D echocardiograms were analyzed off-line using the Syngo Velocity Vector imaging software to determine global strain and strain rate in the longitudinal and circumferential views. Results: A total of 66 patients with suspected myocarditis were compared to 29 age matched controls. Of the 66 study patients, 48% (32/66) underwent endomyocardial biopsy and/or MRI. Global longitudinal and circumferential strain and strain rates were lower in the suspected myocarditis group compared to controls ( P &lt;0.005). Patients who underwent further workup with either biopsy and/or MRI had significantly decreased circumferential strain rate ( P &lt;0.03) and especially decreased longitudinal strain rate ( P &lt;0.003) when compared to those who did not have further diagnostic testing with biopsy or MRI. Furthermore, all patients with biopsy or MRI proven myocarditis had decreased longitudinal and circumferential global strain and strain rates as compared to controls ( P &lt;0.0008). Conclusions: : STE can be a useful diagnostic tool in identifying patients with suspected myocarditis. In our study, all global strain and strain rate values were significantly decreased in patients with proven myocarditis as compared to controls. Specifically, longitudinal strain rate may be a more sensitive diagnostic tool to select patients who merit further testing. Further work is needed to determine if STE correlates with segmental abnormalities on MRI in children with suspected myocarditis.

Circumferential and Longitudinal Ventricular Strain in the Normal Human Fetus

Echocardiography with speckle tracking is a novel, angle-independent technique for assessing global and regional cardiac function. Normal data on longitudinal strain have been reported for human fetuses. The aim of this study was to define circumferential left ventricular (LV) strain in a normal fetal population. Singleton fetuses between 17 and 42 weeks in gestational age with no adverse maternal health issues or fetal abnormalities were studied. Regional and averaged cardiac strain were measured using syngo Velocity Vector Imaging software. Data from 81 fetuses were analyzed (mean gestational age, 29.2 ± 5.7 weeks). Overall, average midventricular circumferential strain was 18.7 ± 3.3%, LV longitudinal strain was 15.2 ± 2.7%, and right ventricular longitudinal strain was 16.0 ± 3.3%, with no correlation with gestational age. This is the first study to report normal fetal LV circumferential strain. These data may be useful as a reference for assessing fetal cardiac function. The retrospective study design and relatively low frame rates used in this study were important limitations.

Hypertrophy Pattern and Regional Myocardial Mechanics Are Related in Septal and Apical Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is associated with considerable phenotypic heterogeneity. Previous studies have shown a relationship between the degree and location of hypertrophy and the prognosis of patients. The aim of this study was to compare left ventricular (LV) circumferential and longitudinal regional mechanics in patients with septal HCM and apical HCM to study the relationship between hypertrophy and function as assessed by myocardial mechanics. Seventy-two patients with HCM (27 with apical HCM, 45 with septal HCM) were compared with 25 clinically normal and age-matched subjects. Myocardial mechanics were assessed using Velocity Vector Imaging, which extracts myocardial motion estimates from B-mode clips by tracking user-defined points and feature tracking. The Velocity Vector Imaging software generated data on global and regional systolic and diastolic longitudinal and circumferential strain, strain rate, and rotational angle velocities. One-way analysis of variance with post hoc multiple comparisons was used among the three groups. Normal subjects had relatively uniform strain and strain rates for all LV segments. Compared with the normal group, patients with septal HCM had decreased LV regional longitudinal strain rates and strain at both the basal and mid septal and lateral segments (all P < .01). Compared with patients with apical HCM, thosewith septal HCM had higher LV circumferential strain rates and strain at the basal and mid segments (P < .05 to P < .01). There were significant differences in rotational velocities at the mid segments among the three groups (P < .05 to P < .001). Patients with HCM have abnormalities in myocardial mechanics that are related to the site of abnormal myocardial hypertrophy.