Ventricular Long-axis Function Research Articles

Determinants of left ventricular structure, filling and long axis function in systemic sclerosis.

Abnormalities of left ventricular (LV) structure, filling and long-axis function have all been reported in subjects with systemic sclerosis (SSc) and a normal LV ejection fraction (EF), but previous study findings have not been consistent. The aim of this study was to identify factors which could have confounded the analyses in previous studies of SSc, and in particular to consider the variables of body surface area (BSA), sex, age, heart rate, blood pressure (BP), disease duration (DD), disease type (limited versus diffuse) and interstitial lung disease (ILD). Echocardiography was performed on 100 subjects with SSc (79 women; age 56±15 years) with a LVEF ≥50% and free of pulmonary arterial hypertension, coronary artery disease, more than mild valvular heart disease and atrial fibrillation. Measurements were performed of the LV end-diastolic dimension (LVEDD) and septal wall thickness (SWT), the transmitral Doppler E, A and deceleration time (DT), and the peak systolic (s') and early diastolic (e') LV long-axis velocities. Multivariate analyses were performed to investigate correlations of the above LV variables with BSA, sex, age, heart rate, BP, DD, disease type, and the presence of ILD. DD varied between 0.1 and 41.2 years, 25% had diffuse and 75% had limited disease, and 37% had ILD. SWT and LVEDD were positively correlated with BSA, SWT was also positively correlated with age and larger in males, and LVEDD was larger in diffuse disease. Age was positively correlated with A and DT, and inversely correlated with E and E/A, and heart rate was inversely correlated with E and E/A. None of E, A, E/A, or DT were independently associated with DD or disease type. Septal and lateral LV wall s' and e' were all inversely correlated with age, and there was a small independent contribution to the prediction of lateral s' from DD, but no association of either s' or e' with disease type. The presence of ILD was not a predictor of any of the LV variables. In SSc there are associations of sex, body size, age and disease type with LV structural variables, of age and heart rate with E/A, and of age with both systolic and early diastolic LV long-axis velocities. Appropriate adjustment for these variables could help to resolve current uncertainties regarding SSc effects on the left ventricle.

Left ventricular long-axis function in hypertrophic cardiomyopathy - Relationships between e`, early diastolic excursion and duration, and systolic excursion.

The peak velocity of early diastolic mitral annular motion (e`) is believed to provide sensitive detection of left ventricular (LV) diastolic dysfunction in hypertrophic cardiomyopathy (HCM), but other aspects of LV long-axis function in HCM have received less attention. Systolic mitral annular excursion (SExc) is also reduced in HCM and must be an intrinsic limitation to the extent of the subsequent motion during diastole. However, the effects of HCM on excursion during early diastole (EDExc) and atrial contraction (AExc), the duration of early diastolic motion (EDDur), and the relationships of EDExc with SExc, and of e`with EDExc and EDDur, are all unknown. The study group was 22 subjects with HCM and there were 22 age and sex matched control subjects. SExc, EDExc, e`, AExc and EDDur were measured from pulsed wave tissue Doppler signals acquired from the septal and lateral walls. In the combined group of HCM and control subjects, multivariate analyses were performed to identify independent predictors of EDExc and e`for both LV walls. SExc, EDExc and e`were all lower, and EDDur was longer in the HCM group compared to the control group for both LV walls (p<0.05 for all). In contrast, AExc was lower for the septal wall in the HCM group (p<0.05), but not different between the groups for the lateral wall. In regression analyses of the combined group, EDExc was positively correlated with SExc, and SExc explained 57-86% of the variances in septal and lateral EDExc, e`was positively correlated with EDExc, and EDExc explained 58-68% of the variances of e`, whereas the combination of EDExc with EDDur explained 87-92% of the variances in e`. A diagnosis of HCM was not an independent predictor of EDExc when in combination with SExc, but was a minor contributor to the prediction of e`in combination with EDExc and EDDur. In HCM, the decrease in LV longitudinal contraction is the major mechanism accounting for a lower EDExc, the lower e`is accounted for by contributions from the lower EDExc and prolongation of early diastolic motion, and there is no atrial compensation for the reduction of long-axis contraction.

Longitudinal evaluation of myocardial function in preterm infants with respiratory distress syndrome

Preterm births and respiratory distress syndrome (RDS) are associated with pulmonary vascular disease and altered myocardial function. We serially assessed up to 1year of age the effects of RDS on global and regional myocardial function of preterm infants, compared to preterm and term controls using conventional echocardiography parameters, tissue Doppler velocities and deformation analysis. A total of 120 infants (30 preterm [PT] with RDS, 30 PT controls without RDS, and 60 term controls) underwent conventional and tissue Doppler echocardiography within 72hours of birth, at corrected term age for the preterm infants, at 1month corrected, and at 1year corrected age. At birth, compared to preterm and term controls, the PT-RDS group had decreased right ventricular (RV) long-axis function, systolic velocity, peak systolic strain, shorter pulmonary arterial acceleration time (PAAT), and lower ratio of PAAT to RV ejection time (PAAT:RVET). Preterm infants had left ventricular (LV) diastolic dysfunction at birth (lower early diastolic myocardial velocity, mitral E velocity, and mitral E:A ratio), and reduced long-axis systolic velocities and shortening. Differences between groups disappeared by 1month corrected age, except PAAT:RVET which remained lower in the PT-RDS group. At 1year, RV function was normal in PT-RDS apart from systolic strain rate, and LV function was normal apart from lower stroke volume and shortening, relative to body weight. PT-RDS had lower left and right ventricular systolic and diastolic function at birth which improved over time, suggesting postnatal maturation of cardiac function and resolution of lung disease.

Machine Learning Analysis of Left Ventricular Function to Characterize Heart Failure With Preserved Ejection Fraction.

Current diagnosis of heart failure with preserved ejection fraction (HFpEF) is suboptimal. We tested the hypothesis that comprehensive machine learning (ML) of left ventricular function at rest and exercise objectively captures differences between HFpEF and healthy subjects. One hundred fifty-six subjects aged >60 years (72 HFpEF+33 healthy for the initial analyses; 24 hypertensive+27 breathless for independent evaluation) underwent stress echocardiography, in the MEDIA study (Metabolic Road to Diastolic Heart Failure). Left ventricular long-axis myocardial velocity patterns were analyzed using an unsupervised ML algorithm that orders subjects according to their similarity, allowing exploration of the main trends in velocity patterns. ML identified a continuum from health to disease, including a transition zone associated to an uncertain diagnosis. Clinical validation was performed (1) to characterize the main trends in the patterns for each zone, which corresponded to known characteristics and new features of HFpEF; the ML-diagnostic zones differed for age, body mass index, 6-minute walk distance, B-type natriuretic peptide, and left ventricular mass index (P<0.05) and (2) to evaluate the consistency of the proposed groupings against diagnosis by current clinical criteria; correlation with diagnosis was good (κ, 72.6%; 95% confidence interval, 58.1-87.0); ML identified 6% of healthy controls as HFpEF. Blinded reinterpretation of imaging from subjects with discordant clinical and ML diagnoses revealed abnormalities not included in diagnostic criteria. The algorithm was applied independently to another 51 subjects, classifying 33% of hypertensive and 67% of breathless controls as mild-HFpEF. The analysis of left ventricular long-axis function on exercise by interpretable ML may improve the diagnosis and understanding of HFpEF.

Evaluation of two-dimensional strain rate imaging on left ventricular longaxis systolic function in patients with slow coronary flow

Objective: To evaluate the value of two-dimensional strain rate imaging (STE) in detecting the alteration of regionally left ventricular long-axis systolic function in patients with slow coronary flow (SCF). Methods: 24 patients who were with SCF but without significant coronary artery stenosis in LAD were included in left anterior descending artery (LAD) group, and 15 patients with slow flow in right coronary artery (RCA) were included in RCA group, and 20 patients who were without significant coronary stenosis or abnormal corrected thrombolysis in myocardial infarction frame count (CTFC) were included in control group. CTFC was carried on 3 groups. Peak systolic strain rate (PSRs) were measured at basal, middle and apical segments in left ventricular walls, including the septal, lateral, inferior and anterior. Results: CTFC of left anterior descending coronary artery blood flow (39.88 ± 7.48) was significantly higher in LAD group than control group (19.84 ± 5.91, P<0.01). CTFC of right coronary artery blood flow (23.78 ± 8.15) was significantly higher in RCA group than control group (21.55 ± 8.12, P<0.01). PSRs of anterior wall in LAD group and interior wall in RCA group were significantly lower than that in control group (P<0.01). Linear regression showed that the CTFC of left anterior descending artery was negatively correlated with the PSRs of anterior wall (r=-0.55, P<0.01), as well as the CTFC of right coronary artery and the PSRs of interior wall in RCA group (-0.86, P<0.01). Conclusions: STE can evaluate the regional left ventricular long-axis systolic function in the patients with SCF.

Left ventricular long axis tissue Doppler systolic velocity is independently related to heart rate and body size.

BackgroundThe physiological factors which affect left ventricular (LV) long-axis function are not fully defined. We investigated the relationships of resting heart rate and body size with the peak velocities and amplitudes of LV systolic and early diastolic long axis motion, and also with long-axis contraction duration.MethodsTwo groups of adults free of cardiac disease underwent pulsed-wave tissue Doppler imaging at the septal and lateral mitral annular borders. Group 1 (n = 77) were healthy subjects <50 years of age and Group 2 (n = 65) were subjects between 40–80 years of age referred for stress echocardiography. Systolic excursion (SExc), duration (SDur) and peak velocity (s') and early diastolic excursion (EDExc) and peak velocity (e') were measured.ResultsSExc was not correlated with heart rate, height or body surface area (BSA) for either LV wall in either group, but SDur was inversely correlated with heart rate for both walls and both groups, and after adjustment for heart rate, males in both groups had a shorter septal SDur. Septal and lateral s` were independently and positively correlated with SExc, heart rate and height in both groups, independent of sex and age. There were no correlations of heart rate, height or BSA with either e` or EDExc for either wall in either group.ConclusionHeart rate and height independently modify the relationship between s` and SExc, but neither are related to EDExc or e`. These findings suggest that s` and SExc cannot be used interchangeably for the assessment of LV long-axis contraction.

Left Ventricular Long-Axis Function and Structure in Scleroderma

Left Ventricular Long-Axis Function and Structure in Scleroderma

Importance of chronotropic response and left ventricular long-axis function for exercise performance in patients with heart failure and preserved ejection fraction

BackgroundWe evaluated the relationship between the degree of chronotropic incompetence and left ventricular (LV) impairment during exercise with severity of exercise intolerance in patients with heart failure and preserved ejection fraction (HFPEF). MethodsAll patients underwent exercise echocardiography during bicycle Ergometer exercise with the acquisition of long-axis tissue Doppler imaging (TDI). Peak heart rates during exercise were also recorded and the percentages of maximal age-predicted heart rate (%MPHR) and heart rate reserve (%HRR) were calculated thereby. Besides, cardiopulmonary exercise testing was performed with peak oxygen consumption (VO2) measuring averaged at the highest 30-second during exercise. ResultsForty HFPEF patients (aged 65±9years; 75% male) were divided into two groups according to the median of peak VO2: patients with peak VO2 <16.5 and ≥16.5ml/kg/min, respectively. Patients with lower peak VO2 had decreased peak heart rates, %MPHR, %HRR, stroke volume and cardiac indices (LVSI and LVCI) than those with higher peak VO2 (all p<0.05). The LV long-axis functions (TDI Sm, Em, s′ and e′) were reduced in patients with lower peak VO2 (all p<0.05). Moreover, peak VO2 correlated with the following parameters: peak heart rates, %MPHR, %HRR, LVSI, LVCI, TDI Sm, Em, s′ and e′(all p<0.05). ConclusionsThe degree of blunted chronotropic response and impaired LV long-axis function were more profound in HFPEF patients with poor exercise performance.

Independent association between brachial-ankle pulse wave velocity and global longitudinal strain of left ventricle.

Data regarding the influence of arterial stiffness on left ventricular (LV) long-axis function has been scarce. This study was performed to investigate the association between brachial-ankle pulse wave velocity (baPWV) and LV global longitudinal strain (GLS). A total of 248 subjects (mean age 59.2 ± 12.3 years; 50% were men) without structural heart problems were retrospectively evaluated. LV GLS was measured by 2-dimensional speckle-tracking echocardiography. baPWV measurements were made on the same day of echocardiography. The incidences of hypertension, diabetes mellitus, and dyslipidemia were 51.2, 19.4, and 22.2%, respectively. The mean value of baPWV was 1557 ± 285 cm/s. In simple linear regression analysis, baPWV had a significant positive association with LV GLS (β = 0.215, P = 0.001). In multiple linear regression analysis, baPWV was independently associated with LV GLS even after controlling for potential confounders, including age, gender, body mass index, systolic blood pressure, heart rate, HbA1c, total cholesterol, estimated glomerular filtration rate, left ventricular mass index, E/A, septal e' velocity and pulmonary artery systolic pressure (β = 0.211, P = 0.028). The results of this study suggest that baPWV may be independently associated with LV GLS, supporting the evidence of a close interaction between arterial stiffness and LV function. Increased arterial stiffness may result in impaired LV longitudinal function.

Left ventricular long-axis performance during exercise is an important prognosticator in patients with heart failure and preserved ejection fraction

BackgroundAlthough many prognostic variables have been reported, the risk stratification of patients with heart failure and preserved ejection fraction (HFPEF) has long been controversial due to considerable discordance. Ergometry stress echocardiography may provide a more clinical relevant evaluation in HFPEF. We aimed at evaluating the prognostic value of echocardiographic parameters during exercise in HFPEF patients. MethodsComprehensive echocardiographic examination with symptom-limited exercise testing on a semi-recumbent and tilting bicycle Ergometer (Lode BV, Groningen, the Netherlands) was performed on 80 consecutive HFPEF patients (aged 66±8years; 64% male). The exercise images for two-dimensional (2D) speckle tracking analysis were acquired with heart rate of 90–100bpm, while exercise images for tissue Doppler imaging (TDI) and M-mode echocardiography were stored with attainment of >85% of maximal age-predicted heart rate. All patients were followed up for 3years after stress echocardiography for all-cause mortality and/or heart failure (HF) hospitalization. ResultsDuring the follow-up, 43 (54%) patients reached the combined end point: 5 (6%) patients died, and another 38 (48%) patients experienced HF hospitalizations. Univariate predictors were: decreased resting left atrial ejection fraction (LAEF), lower peak heart rate, elevated E/e′ ratio, reduced TDI myocardial velocities, and impaired 2D global longitudinal strain (GLS) during exercise. Only impaired GLS (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.67 to 0.91) remained independent after multivariate analysis (p=0.008). ConclusionsMore than half of the HFPEF patients died or were hospitalized for HF at 3-year follow-up and this was significantly related to impaired left ventricular long-axis function during exercise.

A novel method to risk stratify patients undergoing exercise stress echocardiography using a set of combined criteria.

Background and Purposes A novel method using quantitative long-axis function and tissue Doppler in addition to wall motion analysis in exercise stress echocardiography was evaluated. We hypothesized that the novel criteria added additional accuracy in stress echocardiography. Methods Patients with chest pain and at low-to-intermediate risk for obstructive coronary artery disease (CAD) were retrospectively studied. They underwent stress echocardiography with attention to wall motion abnormalities, left ventricular long-axis function, and tissue Doppler measurement. Results The results showed that the combined novel criteria (i.e., classifying a case as positive if three out of the following four criteria were fulfilled: (1) abnormal segmental wall motion shortly after peak stress; (2) Ee wave after peak stress less than 10 cm/s and Ee/Aa ratio after peak stress less than 1; (3) Sm wave after peak stress less than 10.5 cm/s; (4) abnormal long-axis left ventricular function) offered a better accuracy for predicting obstructive CAD and future revascularization with a high sensitivity (100%) and high negative predictive value (100%) . Conclusion From a practical standpoint, the combined novel criteria may be useful in improving the diagnostic accuracy of stress echocardiography.

Transoesophageal echocardiography for prediction of postoperative atrial fibrillation after isolated aortic valve replacement: two-dimensional speckle tracking for intraoperative assessment of left ventricular longitudinal strain.

Recent studies suggested association between impaired left ventricular long-axis function and arrhythmic events early after open heart surgery. This prospective study investigated the predictive value of a depressed intraoperative global longitudinal strain (GLS) for postoperative atrial fibrillation after isolated aortic valve replacement in patients with preserved ejection fraction. A total of 107 patients with ejection fraction ≥50% and moderate-to-severe aortic stenosis undergoing isolated aortic valve replacement were enrolled. All patients underwent intraoperative transoesophageal echocardiography before surgical incision (T1) and after closure of the sternotomy (T2) with semiautomated measurement of GLS, and were followed for the occurrence of postoperative atrial fibrillation during the hospitalization. The incidence of postoperative atrial fibrillation was 37/107 (34.6%). Patients with postoperative atrial fibrillation were associated with increased length of hospitalization and a higher risk of low cardiac output syndrome and pulmonary complications. On univariate analysis, significant risk factors associated with postoperative atrial fibrillation were E/e' ratio, left atrial volume index (LAVi), GLST2 and ΔGLS%. On multivariable analysis, GLST2 (odds ratio: 1.21; 95% confidence interval (CI): 1.06-1.56, P = 0.031) and ΔGLS% (odds ratio: 3.66; 95% CI: 1.85-6.79, P = 0.001) were independent predictors of postoperative atrial fibrillation. The best cut-off values for the prediction were GLST2 >-12.75% and ΔGLS% >19.50%, the latter of which had incremental predictive value for postoperative atrial fibrillation. A significant reduction of intraoperative GLS provides independent information for predicting postoperative atrial fibrillation in patients undergoing aortic valve replacement, and may help to identify patients who are most likely to benefit from targeted prophylaxis.

Left ventricular long-axis function: Reference values of the mitral annular plane systolic excursion in 558 healthy children and calculation of z-score values

Longitudinal myocardial function has gained more interest in the last years. The mitral annular plane systolic excursion (MAPSE) is an echocardiographic measurement to assess left ventricular (LV) long-axis function in adults. The aim of this study was to evaluate MAPSE values in a healthy pediatric population and to propose reference values. A prospective study was conducted in a group of 558 healthy children and adolescents (age day 1 to 18 years) (body surface area [BSA] 0.18-2.21 m(2)). We determined the effects of age and BSA on MAPSE values and a possible correlation of MAPSE values with LV ejection fraction values. The MAPSE ranged from a mean of 0.57 cm (z-score ±2: 0.38-0.76 cm) in neonates to 1.63 cm (z-score ±2: 1.31-1.95 cm) in 18-year-old adolescents. The MAPSE values showed a positive correlation with age (r = 0.87, P < .001) and BSA (r = 0.89, P < .001) with a nonlinear course. There was no significant difference in MAPSE values between females or males. A positive correlation was found between MAPSE values and LV ejection fraction values (r = 0.28, P < .001). Z-scores of MAPSE values were calculated, and percentile charts were established to serve as reference data in patients with congenital heart disease or heart failure in the future.

Progression of Subclinical Myocardial Dysfunction in Type 2 Diabetes after 5 years Despite Improved Glycemic Control

Patients with uncomplicated diabetes have reduced left ventricular long-axis function, related to poor glycemic control and increased conduit arterial stiffness, with increased radial function. It is unknown if improved control of risk factors can reverse these subclinical changes. We studied 27 patients with type 2 diabetes (18 men) 57 ± 1 months (mean ± SD) after an initial visit when they were compared with healthy age- and sex-matched controls. On both visits patients had detailed echocardiographic studies including tissue Doppler, noninvasive tests of conduit arterial function, and metabolic and lipid profiling. Mean age at this second review was 63.4 ± 8.1 years; 48% of patients received insulin. Mean HbA1c had decreased by 13% to 8 ± 1.6% and cholesterol by 17% to 4.3 ± 1.3 mmol/L (both, P < 0.01), but long-axis systolic and early diastolic myocardial velocities had also declined, by 13% and 20%, respectively (both, P < 0.001). Body mass index had increased by 4%, arterial pulse pressure by 17% (both P < 0.01), and carotid arterial stiffness by 49% (P < 0.01). Fractional shortening (by 21%, P < 0.001), radial systolic velocity (by 13%, P < 0.05), and ejection fraction (by 9% to 68 ± 7%, P < 0.01) had all declined. Reductions in longitudinal function were best predicted by its baseline measurements, duration of diabetes, fasting triglycerides, and arterial stiffness (epsilon index). Despite improved diabetic control, subclinical left ventricular dysfunction progressed over 5 years. Radial compensation was reversed. Prevention of subclinical myocardial dysfunction in diabetes might require more intensive control of net cardiovascular risk.

Early Changes in Left Ventricular Long-Axis Function in Friedreich Ataxia: Relation with the FXN Gene Mutation and Cardiac Structural Change

Friedreich ataxia (FRDA) is an autosomal recessive condition due to a GAA triplet expansion in the FXN gene that causes increased left ventricular (LV) wall thickness and can progress to LV systolic dysfunction. However, the changes in myocardial function that occur before a reduction in LV ejection fraction are incompletely understood. LV long-axis function was assessed by measurement of tissue Doppler imaging (TDI) peak systolic (S`), early diastolic (E`), and atrial velocities (A`) at the septal and lateral borders of the mitral annulus in 60 subjects homozygous for a GAA expansion in the FXN gene who had preserved LV ejection fraction. Comparison was made with 60 sex- and age-matched controls. TDI velocities at 5 years were compared with baseline values in 17 FRDA subjects with follow-up studies who still had preserved ejection fraction. S` and E` were reduced in FRDA subjects at both the septal and the lateral mitral annular borders. Lateral E` was independently and inversely related to age, blood pressure, septal wall thickness, and the number of GAA repeats in the smaller allele of the FXN gene, whereas septal E` was not correlated with GAA repeat number. At 5 years, there was a reduction in lateral S` and E` but no change in septal TDI velocities. Subjects with FRDA have impairment of septal and lateral long-axis LV function, but there also seem to be regional differences in the effects of this condition that are at least partly related to the degree of genetic abnormality.

Assessment of left ventricular long-axis systolic function by mitral annulus systolic displacement:a review TA

Assessment of left ventricular long-axis systolic function by mitral annulus systolic displacement:a review TA

Left Ventricular and Ascending Aortic Function After Stenting of Native Coarctation of Aorta

Patients with surgically corrected aortic coarctation have increased proximal aortic stiffness that might contribute to the known worse cardiovascular outcomes. We examined the effect of stenting on the mid-term ascending aortic elastic properties and its relation to cardiac structure and function in adults with native coarctation of the aorta. A total of 20 consecutive patients (13 men, age at stenting 30 + or - 8 years) were prospectively studied before and 14 + or - 2 months after coarctation stenting. The aortic stiffness index was calculated using the ascending aortic diameters and right arm blood pressure values. The ventricular long-axis function was assessed using pulsed-wave tissue Doppler imaging at the septal site. The results were compared to those from 31 normal controls. Statistically significant improvement was found in aortic narrowing (catheter-derived gradient 32 + or - 11 vs 10 + or - 6 mm Hg), left ventricular mass index (132.8 + or - 50.1 vs 114.7 + or - 47.7 g/m(2)), long-axis function, and left atrial volume index (26.5 + or - 5.3 vs 23.7 + or - 5.6 mm(3)/m(2)). The patients continued to have a thicker left ventricle, reduced long-axis function, and larger left atrium after intervention than did the controls. They also had impaired proximal aortic function with respect to the controls that remained unchanged after stenting (aortic stiffness index 10.7 + or - 4.5 to 10.1 + or - 3.0). The poststenting aortic stiffness index correlated modestly with the left ventricular mass index and reduced long-axis velocity. In conclusion, aortic stenting resulted in partial mid-term improvement in cardiac structure and function in adults with coarctation of aorta but the ascending aortic elastic properties remained abnormal. Such a degree of impairment was related to residual left ventricular hypertrophy and dysfunction. Early identification of such patients and optimum management might avoid these irreversible ventriculoaortic disturbances and their known consequences.

The right ventricular annular velocity reduction caused by coronary artery bypass graft surgery occurs at the moment of pericardial incision

BackgroundRight ventricular (RV) long-axis function is known to be depressed after cardiac surgery, but the mechanism is not known. We hypothesized that intraoperative transesophageal echocardiography could pinpoint the time at which this happens to help narrow the range of plausible mechanisms.MethodTransthoracic echocardiography was conducted in 33 patients before and after elective coronary artery bypass graft. In an intensively monitored cohort of 9 patients, we also monitored RV function intraoperatively using serial pulsed wave tissue Doppler (PW TD) transesophageal echocardiography.ResultsThere was no significant difference in myocardial velocities from the onset of the operation up to the beginning of pericardial incision, change in RV PW TD S′ velocities 3% ± 2% (P = not significant).Within the first 3 minutes of opening the pericardium, RV PW TD S′ velocities had reduced by 43% ± 17% (P < .001). At 5 minutes postpericardial incision, 2 minutes later, the velocities had more than halved, by 54% ± 11% (P < .0001). Velocities thereafter remained depressed throughout the operation, with final intraoperative S′ reduction being 61% ± 11% (P < .0001).One month after surgery, in the full 33-patient cohort, transthoracic echocardiogram data showed a 55% ± 12% (P < .0001) reduction in RV S′ velocities compared with preoperative values.ConclusionsMinute-by-minute monitoring during cardiac surgery reveals that, virtually, all the losses in RV systolic velocity occurs within the first 3 minutes after pericardial incision. Right ventricular long-axis reduction during coronary bypass surgery results not from cardiopulmonary bypass but rather from pericardial incision.

Left Ventricular Long-Axis Function During Dobutamine Stress Echocardiography for the Prediction of Post- Revascularization Recovery: Comparison with SPECT Thallium Scintigraphy

Aim: Το compare echocardiographic left ventricular (LV) long axis function and single photon emission computed tomography (SPECT) thallium-201 scintigraphy for the prediction of recovery of LV dyssynergies after revascularization. Methods: Thirty patients with a history of previous myocardial infarction and LV dysfunction underwent a transthoracic echocardiographic study before and after successful revascularization (101±14 days), in order to evaluate post-revascularization recovery of asynergic myocardial walls. In these patients and in 25 ageand sex-matched healthy subjects, an additional study during dobutamine infusion was also performed. All subjects also underwent SPECT thallium-201 scintigraphy. Prior and during dobutamine infusion the LV systolic atrioventricular (AV) plane displacement was recorded from the apical four and two chamber views, by M-Mode, at four LV sites, corresponding to the septal, lateral, anterior and inferior walls. Results: Healthy subjects showed a significant increase in AV displacement at all LV sites during dobutamine infusion (p 0.05). Selecting a maximum LV systolic AV displacement increase of >2 mm, the method proved to have a sensitivity of 91%, specificity of 83%, positive predictive value of 88% and negative predictive value of 87%. When SPECT thallium scans were used, the above indices were 86%, 65%, 74% and 79% respectively. Conclusion: The assessment of LV long axis function with the measurement of left systolic AV plane displacement during dobutamine infusion constitutes a simple and accurate method, better than SPECT thalium images, for the prediction of recovery of LV asynergy after revascularization. Euroclinic Hospital, Athens, Greece Nikaia General Hospital, Piraeus, Greece 1 Department of Cardiology, Evagelismos Hospital, Athens, Greece 2 Department of Cardiology, University of Athens, Attikon Hospital, Athens, Greece Agia Varvara Hospital, Athens, Greece

Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

In aortic stenosis (AS), the increased afterload results in progressive structural and functional changes that precede the development of symptoms. We hypothesized that the detection of abnormalities in left ventricular long-axis function could identify patients with asymptomatic AS at increased risk of events. We prospectively examined the outcome of 126 patients with asymptomatic AS who underwent a comprehensive echocardiographic examination, including tissue Doppler imaging. B-type natriuretic peptide (BNP) was measured in all patients. During a median follow-up period of 20.3 + or - 17.8 months, 6 patients died, 8 developed symptoms but did not undergo surgery, and 48 underwent aortic valve replacement. On multivariate Cox regression analysis, the parameters associated with the predefined outcome were gender (p = 0.048), left atrial area index (p = 0.011), systolic annular velocity (p = 0.016), E/Ea ratio (p = 0.024), late diastolic annular velocity (p = 0.023), and BNP (p = 0.012). Using receiver operating characteristics curve analysis, a left atrial area index of > or = 12.4 cm(2)/m(2), systolic annular velocity of < or = 4.5 cm/s, E/Ea ratio >13.8, late diastolic annular velocity of < or = 9 cm/s, and BNP of > or = 61 pg/ml were identified as the best cutoff values to predict events. In conclusion, in asymptomatic AS, tissue Doppler imaging and BNP measurements provide prognostic information beyond that from clinical and conventional echocardiographic parameters.