Value of three-dimensional strain parameters for predicting left ventricular remodeling after ST-elevation myocardial infarction

This study was to evaluate the value of multi-directional strain parameters derived from three-dimensional (3D) speckle tracking echocardiography (STE) for predicting left ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) compared with that of two-dimensional (2D) global longitudinal strain (GLS). A total of 110 patients (mean age, 54?±?9 years) after STEMI treated with primary PCI were enrolled in our study. At baseline (within 24 h after PCI), standard 2D echocardiography, 2D STE and 3D STE were performed to acquire the conventional echocardiographic parameters and strain parameters. At 3-month follow-up, standard 2D echocardiography was repeated to all the patients to determine LV remodeling, which was defined as a 20% increase in LV end-diastolic volume. At 3-month follow-up, LV remodeling occurred in 26 patients (24%). Compared with patients without LV remodeling, patients with remodeling had significantly reduced 2D GLS (?12.5?±?3.2% vs ?15.0?±?3.1%, p?<?0.001), 3D GLS (?9.9?±?2.2% vs ?13.1?±?2.7%, p?<?0.001), 3D global area strain (GAS) (?20.3?±?3.9% vs ?23.3?±?4.8%, p?=?0.005) and 3D global radial strain (GRS) (29.0?±?7.4% vs 34.3?±?8.5%, p?=?0.007) at baseline, but there is no significant difference in 3D global circumferential strain (GCS) (?12.7?±?2.9% vs ?13.0?±?3.2%, p?=?0.822). Separated multivariate analysis shows that 2D GLS, 3D GLS, 3D GAS and 3D GRS all can be independent predictors of LV remodeling. However, receiver-operating characteristic curve analysis showed that the area under the curve of 3D GLS (0.82) for predicting LV remodeling was significantly higher than that of 2D GLS (0.72, p?=?0.034), 3D GAS (0.68, p?<?0.001) and 3D GRS (0.68, p?<?0.001). In patients after STEMI, 2D GLS, 3D GLS, 3D GAS and 3D GRS but not 3D GCS measured after primary PCI are independent predictors of LV remodeling and 3D GLS is the most powerful predictor among them.     

Very early stage left ventricular endocardial dysfunction of patients with hypereosinophilic syndrome

Cardiac involvement in hypereosinophilic syndrome (HES) patients entails significant morbidity and mortality. Left ventricular (LV) endocardial damage is important for the development of cardiac involvement in HES patients. However very early stage LV endocardial damage, such as prior to the first stage of an acute necrotic stage, remains uncertain. We studied 32 HES patients, all with normal conventional echocardiographic findings. Global radial and circumferential strain (GRS and GCS) were determined for each peak global strain curve from the mid-LV short-axis view, and global longitudinal strain (GLS) was averaged each peak global strain curve from standard apical views by means of two-dimensional speckle-tracking method. Thirty-one age-, gender-, LV ejection fraction-matched normal subjects were studied for comparison. GRS and GRS were similar for HES patients and normal controls, but GLS for HES patients was significantly lower than that for normal controls (16.2?±?3.3?% vs 19.3?±?2.9?%, p?<?0.001). Furthermore, receiver operating characteristic curve analysis identified GLS ≤17.0?% as the best predictor of LV endocardial dysfunction with a sensitivity of 66?%, specificity of 78?%, and area under the curve of 0.781 (p?=?0.0001). In conclusions, LV endocardial dysfunction pre-existed even in HES patients without apparent cardiac involvement. GLS as assessed with the two-dimensional speckle-tracking method is a promising tool for the better management of very early stage of HES patients.     

Findings on 3D speckle tracking echocardiography in asymptomatic methamphetamine abusers

To detect potential cardiac abnormalities in asymptomatic methamphetamine abusers using three-dimensional speckle tracking echocardiography (3D STE). Fifty-three male methamphetamine abusers, free of cardiac symptoms/signs, were enrolled in this study. A control group of 53 age-matched male normal subjects was studied for comparison. Standard 3D, flow and tissue Doppler echo with measurements of left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), ejection fraction (LVEF), the ratio of the early to late diastolic transmitral filling velocity (E/A), the ratio of the early diastolic transmitral filling velocity to the early diastolic septal tissue velocity (E/E′) and 3D STE with measurements of global area strain (GAS), global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) were performed, respectively. These echocardiographic parameters were compared between methamphetamine abusers and normal subjects, and receiver operating characteristic curve (ROC) analysis was done to differentiating methamphetamine abusers from normal subjects. LVESV, LVEDV, LVEF, E/A, E/E′ ratios and GRS were not significantly different between methamphetamine abusers and normal subjects (p?>?0.05). However, GAS, GLS and GCS were significantly less in methamphetamine abusers than in normal subjects (p?<?0.05). The areas under ROC (AUC) for GAS were greatest among all the 3D STE derived LV global strains (GAS vs. GLS, GCS and GRS, 0.95 vs. 0.76, 0.69 and 0.61, respectively). The cutoff value with ??30.3% of GAS had sensitivity of 91.8%, specificity of 91.6% and accuracy of 91.3% for differentiating methamphetamine abusers from normal subjects. The potential myocardial function abnormalities can be detected by 3D STE in asymptomatic methamphetamine abusers, and GAS is a good indicator for indentifying methamphetamine abusers from normal population, which can be used to screening and monitor methamphetamine abuse, detect subclinical LV dysfunction, predict potential methamphetamine-related cardiotoxicity, and to initiate early cardioprotective therapy before the onset of overt heart failure in time.     

三维超声斑点追踪成像技术评价高血压患者左心室整体收缩功能的临床研究

目的 探讨三维超声斑点追踪成像技术评价原发性高血压患者左心室整体收缩功能的临床应用价值.方法 左室几何构型正常的原发性高血压患者50例,年龄、性别匹配的对照组29例.采取心尖全容积图像,应用三维超声斑点追踪成像技术测量并比较各组左室整体纵向收缩峰值应变(GLS)、左室整体径向收缩峰值应变(GRS)、左室整体圆周收缩峰值应变(GCS)及左室整体三维径向收缩峰值应变(3DGRS),三维斑点追踪分析软件计算左室射血分数(LVEF).结果 高血压患者左室GLS、GRS、GCS及3DGRS均较对照组减低,差异有统计学意义(P均＜0.05);Pearson相关分析表明高血压组左室GCS、GLS、GRS与LVEF相关(r1=0.930,P1＜0.001;r2=0.705,P2＜0.001; r3=0.474,P3=0.001),对照组左室GCS、GLS与LVEF相关(r1=0.838,P1＜0.001;r2=0.697,P2＜0.001).结论 高血压患者早期左室整体三维形变能力降低,三维超声斑点追踪成像技术可发现高血压患者早期心功能的变化.左室圆周运动在左室三维运动中占重要作用,对左室射血产生重要影响.     

三维斑点追踪技术评价肥厚型心肌病患者左心室心肌力学特点

目的 应用三维斑点追踪技术(3D-STI)评价不同程度室壁肥厚对肥厚型心肌病(HCM)患者左心室整体及局部心肌力学的影响.方法 纳入2016年4月至2017年12月于华中科技大学同济医学院附属协和医院确诊为HCM患者30例,同时纳入此时间段在该院行常规体检的正常对照组30例.根据左心室16节段的室壁厚度将HCM组分为4...     

The effect of different treatment strategies on left ventricular myocardial deformation parameters in patients with chronic renal failure

The aim of this study was to compare left ventricular (LV) functions by speckle tracking echocardiography (STE) in chronic kidney disease (CKD) patients in various stages and under different renal replacement treatments in order to evaluate possible differences between them. This prospective study included 150 patients with CKD. Renal transplantation patients with glomerular filtration rate greater than 60 ml/min/1.73 m², patients receiving hemodialysis three times a week, and patients in the predialysis stage with glomerular filtration rate less than 30 ml/dk/1.73 m² were assigned into Group 1 (n?=?50), Group 2 (n?=?50), and Group 3 (n?=?50), respectively. LV longitudinal, circumferential, and radial myocardial deformation parameters (strain, strain rate [SR], rotation, twist) were evaluated by STE. Peak systolic longitudinal strain was higher in the transplantation group than the hemodialysis group (??19.93?±?3.50 vs???17.47?±?3.28%, p?<?0.017). Peak systolic circumferential strain was lower in the hemodialysis group (??20.97?±?4.90%) than Groups 1 and 3 (??25.87?±?4.20 and ??24.74?±?4.55%, respectively, p?<?0.001). Peak systolic radial SR was higher in the transplantation group than the hemodialysis group (1.84?±?0.52 vs 1.55?±?0.52 s^?1, respectively, p?<?0.017). Other longitudinal and circumferential deformation parameters together with peak early diastolic radial SR and twist were also significantly different between the groups. Strain, SR, and twist values were mostly lower in the hemodialysis patients, but generally higher in the transplantation patients. LV functions evaluated by STE are better in the renal transplantation patients than the hemodialysis patients and than those in the predialysis stage. This may indicate beneficial effects of renal transplantation on cardiac functions.     

Reference ranges for three-dimensional feature tracking cardiac magnetic resonance: comparison with two-dimensional methodology and relevance of age and gender

Myocardial deformation is a sensitive marker of sub-clinical myocardial dysfunction that carries independent prognostic significance across a broad range of cardiovascular diseases. It is now possible to perform 3D feature tracking of SSFP cines on cardiac magnetic resonance imaging (FT-CMR). This study provides reference ranges for 3D FT-CMR and assesses its reproducibility compared to 2D FT-CMR. One hundred healthy individuals with 10 men and women in each of 5 age deciles from 20 to 70 years, underwent 2D and 3D FT-CMR of left ventricular myocardial strain and strain rate using SSFP cines. Good health was defined by the absence of hypertension, diabetes, obesity, dyslipidaemia, or any cardiovascular, renal, hepatic, haematological and systemic inflammatory disease. Normal values for myocardial strain assessed by 3D FT-CMR were consistently lower compared with 2D FT-CMR measures [global circumferential strain (GCS) 3D ??17.6?±?2.6% vs. 2D ??20.9?±?3.7%, P?<?0.005]. Validity of 3D FT-CMR was confirmed against other markers of systolic function. The 3D algorithm improved reproducibility compared to 2D, with GCS having the best inter-observer agreement [intra-class correlation (ICC) 0.88], followed by global radial strain (GRS; ICC 0.79) and global longitudinal strain (GLS, ICC 0.74). On linear regression analyses, increasing age was weakly associated with increased GCS (R²?=?0.15, R?=?0.38), peak systolic strain rate, peak late diastolic strain rate, and lower peak early systolic strain rate. 3D FT-CMR offers superior reproducibility compared to 2D FT-CMR, with circumferential strain and strain rates offering excellent intra- and inter-observer variability. Normal range values for myocardial strain measurements using 3D FT-CMR are provided.     

Cardiovascular magnetic resonance left ventricular strain in end-stage renal disease patients after kidney transplantation

Background

Cardiovascular disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) and kidney transplant (KT) patients. Compared with left ventricular (LV) ejection fraction (LVEF), LV strain has emerged as an important marker of LV function as it is less load dependent. We sought to evaluate changes in LV strain using cardiovascular magnetic resonance imaging (CMR) in ESRD patients who received KT, to determine whether KT may improve LV function.

Methods

We conducted a prospective multi-centre longitudinal study of 79 ESRD patients (40 on dialysis, 39 underwent KT). CMR was performed at baseline and at 12?months after KT.

Results

Among 79 participants (mean age 55 years; 30% women), KT patients had significant improvement in global circumferential strain (GCS) (p?=?0.007) and global radial strain (GRS) (p?=?0.003), but a decline in global longitudinal strain (GLS) over 12?months (p?=?0.026), while no significant change in any LV strain was observed in the ongoing dialysis group. For KT patients, the improvement in LV strain paralleled improvement in LVEF (57.4?±?6.4% at baseline, 60.6%?±?6.9% at 12?months; p?=?0.001). For entire cohort, over 12?months, change in LVEF was significantly correlated with change in GCS (Spearman’s r?=???0.42, p?<?0.001), GRS (Spearman’s r?=?0.64, p?<?0.001), and GLS (Spearman’s r?=???0.34, p?=?0.002). Improvements in GCS and GRS over 12?months were significantly correlated with reductions in LV end-diastolic volume index and LV end-systolic volume index (all p?<?0.05), but not with change in blood pressure (all p?>?0.10).

Conclusions

Compared with continuation of dialysis, KT was associated with significant improvements in LV strain metrics of GCS and GRS after 12?months, which did not correlate with blood pressure change. This supports the notion that KT has favorable effects on LV function beyond volume and blood pessure control. Larger studies with longer follow-up are needed to confirm these findings.

     

Reduced global longitudinal and radial strain with normal left ventricular ejection fraction late after effective repair of aortic coarctation: a CMR feature tracking study

We sought to determine whether global and regional left ventricular (LV) strain parameters were altered in repaired coarctation of the aorta (COA) with normal LV ejection fraction (EF) when compared with healthy adult controls, and whether such alterations were related to LV hypertrophy (LVH). We identified 81 patients after COA repair (31 female, age 25 ± 8.5 years) with inclusion criteria at follow-up CMR of: age ≥13 years, time post-repair ≥10 years, no aortic valve disease, LV-EF >50 %). LV deformation indices derived using CMR-feature tracking and volumetric EF were compared between COA patients and normal controls (n = 20, 10 female, age 37 ± 7 years), and between COA with versus without LVH. In repaired COA versus controls, LV-EF (%) was 62 ± 7.2 versus 58 ± 3.0 (p = 0.01), and LV mass (g/m²) 66 ± 16.8 versus 57.7 ± 6.0 (p = 0.0001). LV global longitudinal strain (GLS) was decreased to ?17.0 ± 4.7 % in COA (?20 ± 5 % in controls, p = 0.02), and global radial strain (GRS) reduced to 40 ± 15 % (50 ± 12.4 % in controls, p = 0.003). The global circumferential strain (GCS) was preserved in COA at ?23 ± 4.7 % (?24.6 ± 2.4 % in controls, p = 0.14). Regionally, LS decrease was marked in the basal segments (septal, p = 0.005, lateral, p = 0.013). In COA with LVH (n = 45, mass 76.3 ± 12.8 g/m²) versus without LVH (n = 36, mass 52.2 ± 10 g/m²), GLS was more markedly decreased (?15.7 ± 4.8 vs. ?18.5 ± 4.2 %, p = 0.016, but GRS and GCS were similar (p = 0.49 and 0.27). In post-repair COA with normal LV-EF, GLS and GRS are reduced whilst GCS is preserved. GLS reduction is more pronounced in the presence of LVH. GLS may qualify as indicator of early LV dysfunction.     

Myocardial strain pattern in patients with cardiac amyloidosis secondary to multiple myeloma: a cardiac MRI feature tracking study

Cardiac MRI is frequently used in the diagnosis of cardiac amyloidosis. Feature tracking is a novel method of analyzing myocardial strain at the myocardial borders. We investigated myocardial deformation mechanics of both the right and left ventricles in patients with multiple myeloma with suspected cardiac amyloidosis. Comprehensive strain analysis was performed in 43 patients with multiple myeloma and suspected cardiac amyloidosis. MRI strain by feature tracking was measured using 2D cardiac performance analysis MR software (Tomtec, Germany). Global longitudinal (GLS) and global circumferential (GLC) strain were calculated in endo and epicardium. In addition, right ventricular longitudinal strain was measured in the endocardium only. All patients later underwent endomyocardial biopsy. Average wall thickness in biopsy proven cardiac amyloidosis group (22 patients) was 1.4?±?0.4 cm with wall thickness ≤ 1.2 cm in 36?%. LGE was present in all patients with biopsy confirmed disease. There was significantly decreased global longitudinal strain and strain rate in the epicardial and endocardial layers. Global circumferential strain was significantly reduced in the epicardial layer but not the endocardium. GLS was significantly decreased at the base in both layers compared to the mid and apical regions of the myocardium. However, the base to apex GLS gradient was suggestive of apical sparing in the endocardial layer among patients with amyloidosis (?8.2?±?2 vs. ?2.7?±?1; p?=?0.001) but not the epicardial layer. Apical sparing was evident even in those with normal thickness CA. This feature tracking MRI analysis sheds light on strain mechanics in a cohort of multiple myeloma associated cardiac amyloidosis with a significant number of cases with normal LV wall thickness and explains mechanism of apical sparing effect.     

Fibrosis assessment by integrated backscatter and its relationship with longitudinal deformation and diastolic function in heart failure with preserved ejection fraction

Myocardial reflectivity, as assessed by calibrated integrated backscatter (cIB) analysis, is a non-invasive surrogate for the amount of left ventricular (LV) fibrosis. The aim of this study was to assess the myocardial reflectivity pattern in patients with heart failure and preserved ejection fraction (HFpEF), and to evaluate its relationship with longitudinal systolic deformation of LV by 2D-speckle tracking echocardiography, and degree of diastolic dysfunction. Transthoracic echocardiography, myocardial Doppler-derived systolic (Sm) and early diastolic velocity (E′), global longitudinal strain (GLS), and tissue characterization by cIB, were obtained in 86 subjects, 46 with HFpEF, and 40 controls. GLS was significantly impaired in HFpEF patients (?15.4?±?3.5?% vs ?21.5?±?2.9?% in controls; P?<?0.0001). Increased myocardial reflectivity, as evidenced by less negative values of cIB, was also found in HFpEF compared to controls (?21.2?±?4.4 dB vs ?25.3?±?3.9 dB, P?<?0.0001). In HFpEF patients, myocardial reflectivity was positively related to GLS (r?=?0.68, P?<?0.0001), E/E′ ratio (r?=?0.38, P?=?0.009), and Tau (r?=?0.43, P?=?0.002), and inversely related to E′ velocity (r?=??0.46, P?=?0.0012). These associations remained significant after adjustment for age, preload and afterload indices. Patients with HFpEF show changes of LV structure consistent with enhanced fibrosis—as evidenced by increased myocardial reflectivity- which parallel the degree of diastolic dysfunction, and of longitudinal systolic dysfunction.     

Evaluation of left ventricular myocardial mechanics by three-dimensional speckle tracking echocardiography in the patients with different graded coronary artery stenosis

To investigate the relationship between left ventricular (LV) myocardial mechanics evaluated by three-dimensional speckle tracking echocardiography (3D-STE) and degree of coronary artery stenosis in patients with coronary artery disease (CAD). Ninety-seven suspected CAD patients without LV regional wall motion abnormality (RWMA) observed visually form traditional echocardiography were divided into four groups according to coronary artery angiography (CAG): 23 patients in slight stenosis group [stenosis rate (SR)?≤25%], 26 patients in mild stenosis group (25<?SR?≤50%), 28 patients in moderate stenosis group (50<?SR?≤75%), and 20 patients in severe stenosis group (SR?>75%). Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), area strain (AS) and three dimensional strain (3D-Strain) were obtained. The parameters from 3D-STE were compared between different groups and then the diagnostic value of global strains indicating different graded coronary artery stenosis was analyzed by the receiver operating characteristic curve. (1) There were significant difference in GLS, GCS, GRS, GAS and 3D-Strain between the severe stenosis group and any other group while all 3D-STE parameters except GCS in the moderate stenosis group were remarkably different from those respectively in mild group. (2) Receiver operator characteristic curve (ROC) analysis showed that the area under the curve of GLS, GRS, GCS, GAS, 3D-Strain were 0.899, 0.873, 0.723, 0.856 and 0.863 respectively for the identification of stenosis rate?>50%, and 0.896, 0.866, 0.797, 0.909 and 0.899 respectively for the identification of severe stenosis. GAS less than ?29.13% allowed a sensitivity of 95% and a specificity of 71.4%, while 3D strain less than 41.35% allowed a sensitivity of 90% and a specificity of 80.5% for evaluating serve coronary artery stenosis. The myocardial mechanics from 3D-STE in the CAD patients were characteristic. It could be expected to identify serve coronary stenosis with a good sensitivity and an acceptable specificity by using GAS or 3D-strain especially in the suspected CAD patients without RWMA on conventional echocardiography.     

正常儿童三维左室心肌应变特征及Z-score建立的研究

目的分析正常儿童左室心肌应变的变化特征并建立其Z-score。方法获取173例正常儿童的三维左室整体纵向、径向、圆周应变(GLS、GRS、GCS)参数。比较不同体表面积(BSA)组正常儿童三维应变参数的差异。有明显变化趋势者做进一步回归分析,并建立Z-score。结果随着儿童BSA增加,GLS、GRS递减,差异有统计学意义;不同BSA组GCS较为均一,差异无统计学意义。年龄、身高、体质量、BSA与GLS、GRS均存在非线性相关,选取BSA作为生长发育指标建立正常儿童GLS、GRS的Z-score优于年龄、身高、体质量。结论不同BSA组正常儿童左室心肌功能存在不均一性,建立正常儿童GLS、GRS的Z-score,为临床定量评估儿童心肌功能提供科学、准确的方法。     

超声心动图评价2型糖尿病患者的左心室重构和功能损害

目的联合运用常规超声心动图和三维斑点追踪成像技术评价不同左室构型的2型糖尿病患者心脏功能的损害情况。方法 78例2型糖尿病患者(LVEF≥55%)分为左室正常构型组(34例)和左室重构组(44例)。40例年龄、性别匹配且无左室重构的健康体检者作为对照组。采集左心室全容积图像分析,计算射血分数(EF)、整体纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)和径向应变(GRS)。结果糖尿病左室正常构型组仅有GLS显著低于对照组(P<0.05);而糖尿病左室重构组GLS、GCS、GAS和GRS均显著低于对照组和糖尿病左室正常构型组(all P<0.01)。糖尿病左室肥厚组(向心性和离心性)的GLS、GAS和GRS显著低于糖尿病左室向心性重构组(all P<0.05)。结论常规超声心动图和三维斑点追踪成像联合运用可以检测出2型糖尿病患者的左心室代谢性重构和伴随的功能损害。     

三维斑点追踪成像检测冠心病心肌缺血的临床价值

目的探讨三维斑点追踪成像（3D—STI）评估冠心病患者心肌缺血的临床应用价值。方法经冠状动脉造影证实的冠心病患者50例和对照组32例,经胸采集全容积动态三维图像,脱机分析,得到左室17个节段的整体应变参数：左室整体长轴应变（GLS）、整体圆周应变（GCS）、整体径向应变（GRS）及整体面积应变（GAS）,绘制各个参数的受试者工作特征曲线,确定曲线下面积和最佳截断点,比较其检测冠心病心肌缺血的敏感性和特异性。结果冠心病组GLS、GCS、GRS、GAS较对照组明显减低,差异均有统计学意义（均P〈0．001）。受试者工作特征曲线表明GLS、GCS、GRS、GAS诊断心肌缺血的敏感性分别为75．6％、64．1％、66．7％、78．9％,特异性分别为64．3％、65．4％、62．1％、74．1％。结论3D—STI能较敏感地检测冠心病心肌缺血,其中GAS诊断冠心病心肌缺血的敏感性和特异性最高。     

The role of left ventricular deformation in the assessment of microvascular obstruction and intramyocardial haemorrhage

In the setting of acute ST-elevation myocardial infarction (STEMI), it remains unclear which strain parameter most strongly correlates with microvascular obstruction (MVO) or intramyocardial haemorrhage (IMH). We aimed to investigate the association of MVO, IMH and convalescent left ventricular (LV) remodelling with strain parameters measured with cardiovascular magnetic resonance (CMR). Forty-three patients with reperfused STEMI and 10 age and gender matched healthy controls underwent CMR within 3-days and at 3-months following reperfused STEMI. Cine, T2-weighted, T2*-imaging and late gadolinium enhancement (LGE) imaging were performed. Infarct size, MVO and IMH were quantified. Peak global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS) and their strain rates were derived by feature tracking analysis of LV short-axis, 4-chamber and 2-chamber cines. All 43 patients and ten controls completed the baseline scan and 34 patients completed 3-month scans. In multivariate regression, GLS demonstrated the strongest association with MVO or IMH (beta?=?0.53, p?<?0.001). The optimal cut-off value for GLS was ?13.7% for the detection of MVO or IMH (sensitivity 76% and specificity 77.8%). At follow up, 17% (n?=?6) of patients had adverse LV remodeling (defined as an absolute increase of LV end-diastolic/end-systolic volumes >20%). Baseline GLS also demonstrated the strongest diagnostic performance in predicting adverse LV remodelling (AUC?=?0.79; 95% CI 0.60–0.98; p?=?0.03). Post-reperfused STEMI, baseline GLS was most closely associated with the presence of MVO or IMH. Baseline GLS was more strongly associated with adverse LV remodelling than other CMR parameters.     

实时三维斑点追踪成像技术评价无节段性室壁运动异常的不同程度冠状动脉病变患者的心肌应变

目的 探讨实时三维斑点追踪成像（RT3D-STI）技术评价不同程度冠状动脉病变患者左心室心肌应变的价值。方法 收集超声结果提示无节段性室壁运动异常（RWMA）的冠心病患者109例,并根据冠状动脉造影（CAG）结果分为：对照组（n=30）、单支病变组（n=34）、多支病变组（n=45）。应用RT3D-STI技术获得左心室整体纵向应变（GLS）、整体周向应变（GCS）、整体面积应变（GAS）、整体径向应变（GRS）及左心室射血分数（LVEF）等,比较各参数的组间差异,并分析不同应变参数间及其与LVEF的相关性。结果 随着冠状动脉病变程度的加重,GLS、GCS、GAS、GRS逐渐减低,单支病变组低于对照组（P均<0.05）,多支病变组低于单支病变组（P均<0.05）,GAS组间差异较显著。GLS、GCS、GAS与GRS相关系数分别为-0.874、-0.848、-0.906,GAS与GRS相关关系更为密切;GLS、GCS、GAS、GRS与LVEF的相关系数分别为-0.684、-0.657、-0.717、0.672,GAS与LVEF相关性最好。结论 RT3D-STI技术参数能够定量评价无节段性室壁运动异常的不同程度冠状动脉病变患者心肌应变,测量准确性及可重复性高,新参数GAS更具优势。     

Three-dimensional speckle tracking longitudinal strain is related to myocardial fibrosis determined by late-gadolinium enhancement

Three-dimensional (3D) speckle tracking echocardiography (STE) is a reliable clinical tool for accurate measurements of left ventricular (LV) volumes and ejection fraction (EF). In this prospective study, we sought to identify an association between 3DSTE longitudinal strain abnormalities and areas of late gadolinium enhancement (LGE). In 50 patients (52?±?18.5 years old) referred to our hospital for clinically indicated CMR, 3D full-volume trans-thoracic acquisitions on apical views were performed within 1 h of CMR, in order to obtain LV volumes and ejection fraction as well as global and segmental peak systolic longitudinal strain. Relative amount of fibrosis was defined based on LGE CMR with grey-scale threshold of 5 standard deviations above the mean signal intensity of the normal remote myocardium. We found a moderate positive correlation between global longitudinal strain (GLS) by 3DSTE and LGE proportion (r?=?0.465, p?=?0.001). The area under the receiver operating characteristic curve was 0.79. In addition, abnormal GLS could detect LGE-determined myocardial fibrosis with a sensitivity of 84.6%, a specificity of 84.8%, a positive predictive value of 69% and negative predictive value of 93%, considering an optimal GLS cut-off value of ??15.25%. Regarding 3DSTE capacity of localizing segmental LGE involvement, about 70% of LGE-positive segments presented a concomitant longitudinal strain reduction. This prospective study shows that 3DSTE longitudinal deformation is moderately associated with the extent of myocardial fibrosis, with a promising potential role in ruling out prognostically relevant fibrosis as detected by LGE.     

Diagnostic value of myocardial deformation pattern in children with noncompaction cardiomyopathy

The current echocardiographic diagnostic criteria for noncompaction cardiomyopathy (NCC) have variable sensitivity and low specificity. Moreover, there are limited data on the use of myocardial deformation imaging for early detection of myocardial dysfunction in children with NCC. We describe left ventricular (LV) deformation patterns in children with NCC, with the goal of identifying a potential diagnostic pattern. We prospectively enrolled 30 children with NCC (47% male; mean age 7.2 years) and 30 age- and gender-matched controls. Extent and severity of non compaction in each segment were evaluated in LV 16-segment model. Regional (base, mid and apex) and segmental (16 segments) longitudinal strain (LS), circumferential strain (CS) and radial strain (RS) were measured using speckle tracking echocardiography. In all patients with NCC, regional and segmental CS and RS at the apex were significantly decreased compared to controls (CS apex: ??19.2?±?5.4% vs. ??30.2?±?6.9%, p?<?0.001/RS apex: 23.5?±?8.6% vs. 44.1?±?14.5%, p?<?0.001). Thirty percent (9/30) of patients had an EF?<?50%. In these patients, there was additional decrease in CS in basal segments and in LS in basal, mid-cavity and apical segments (CS base: ??16.4?±?4.7% vs. ??24.6?±?3.9%, p?<?0.001/LS (average all LV segments): ??13.9?±?3.1% vs. ??20.7?±?4.7%, p?<?0.001). A cut-off value of CS at the apex of ??24.5% was a strong differentiating feature between patients with NCC and EF?>?50% and controls (sensitivity: 87%, specificity 79%, AUC 0.88, p?<?0.001). Children with NCC exhibit a deformation pattern characterized by decreased apical circumferential strain, which may serve as a potential diagnostic tool for NCC. The role of decreased global LV longitudinal and basal circumferential strain should be further evaluated as a potential prognostic tool.     

Capability of three-dimensional speckle tracking radial strain for identification of patients with cardiac sarcoidosis

Since cardiac sarcoidosis (CS) leads to substantial morbidity and sudden death, early diagnosis and appropriate management are crucial for patients with CS. Echocardiography used to be considered a useful diagnostic tool for patients with CS, but CS may clinically present as dilated cardiomyopathy (DCM). Our objective was to investigate whether a novel three-dimensional (3-D) speckle-tracking strain can identify patients with CS more accurately. We studied 23 CS patients with an ejection fraction (EF) of 46 ± 10 %, and 16 EF-matched patients with DCM (EF 45 ± 11 %). Global radial (GRS), circumferential (GCS) and longitudinal (GLS) strain was assessed using 3-D speckle-tracking system. GRS of patients with CS was significantly lower than that of patients with DCM (18.5 ± 8.4 vs. 28.5 ± 8.3 %, p < 0.01), but GCS and GLS in patients with CS and DCM were similar. GRS ≦ 21.1 could differentiate CS from DCM with a sensitivity of 70 %, specificity of 88 % and area under the curve of 0.79. An additional noteworthy findings was that, patients with CS showed more negative radial strain curves than did those with DCM (1.7 ± 2.3 vs. 0.1 ± 0.5, p < 0.01). In conclusion, 3-D speckle-tracking radial strain shows good potential to distinguish CS from DCM. Our observations can thus be expected to have clinical implications for management of CS patients.