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.     

心肌速率阶差无创评价左室舒缩功能的临床研究

目的　探讨心肌速率阶差MVG评价左室舒缩功能的价值。方法　扩张型心肌病患者 (DCM组 ) 2 0例 ,高血压患者 (HBP组 ) 2 5例 ,正常对照组 2 0例均行常规二维及脉冲多普勒超声心动图 (PW )和多普勒组织成像技术 (DTI)检查。常规超声获得左室射血分数 (EF) ;PW获得二尖瓣口血流速率E/A及E峰下降时间 (DcT) ;运用脉冲DTI于左室乳头肌短轴切面测量左室后壁心内膜下、心外膜下心肌运动速度VS心内膜下 、VS心外膜下 、VE心内膜下、VE心外膜下 ,并计算MVGS、MVGE。结果　与正常组比较 ,DCM组EF显著降低 ,DcT显著缩短 ,E/A显著增高 ;HBP组EF与正常组间无差异 ,E/A显著减低 ,DcT显著延长。与正常组比较 ,DCM组MVGS、MVGE 显著较低 ;HBP组MVGS 与正常组无差异 ,而MVGE 则显著较低。结论　脉冲DTI测量心肌速率阶差MVG可早期、无创、准确地反映心脏收缩、舒张功能。     

Rb-82 PET/CT left ventricular mass-to-volume ratios

Left ventricular (LV) mass:volume ratios indexed to body size (Mi/Vi) provide risk stratification for cardiac events. We sought to determine whether Rb-82 PET mass and volume indices are similar to MRI normal values for low likelihood subjects, and whether abnormal indices are related to abnormal myocardial blood flow (MBF). Data were analyzed retrospectively for 194 patients referred for rest/stress Rb-82 PET. LV EF, volume and mass values were calculated and mass:volume ratios were indexed to patients’ height and weight. MBF was computed from the first pass dynamic component of PET data. 53 patients at low likelihood of CAD had PET Mi/Vi?=?1.35?±?0.27, consistent with the MRI literature range of 1.0–1.5. Compared to patients with normal indexed volume (Vi), patients with abnormally high Vi had lower rest MBF (0.56?±?0.24 vs 0.93?±?0.57 ml/g/min, p?=?0.0001), and lower stress MBF (0.97?±?0.52 vs. 1.83?±?0.96 ml/g/min, p?<?0.0001). Stress EF?<?50% predicted abnormal Vi with 90% accuracy. Patients with Mi/Vi?<?1.0 had abnormally low rest EF (45?±?16% vs. 60?±?15%, p?<?0.0001) and low rest MBF (0.58?±?0.25 vs. 0.96?±?0.59 ml/g/min, p?<?0.0001). In our study population, abnormal LV volume and mass correlated with lower rest and stress MBF and EF, suggesting that the pathophysiologic explanation of these patients’ increased risk is more extensive obstructive CAD.     

The interplay between renin-angiotensin system activation,abnormal myocardial deformation and neurohumoral activation in hypertensive heart disease: a speckle tracking echocardiography study

Angiotensin converting enzyme (ACE) promotes cardiac fibrosis. LV myocardial deformation and torsion are markers of subclinical myocardial dysfunction. We investigated the association of serum ACE levels with LV deformation markers in untreated hypertensives. In 120 untreated patients (age: 53.5?±?11.2 years) with essential hypertension and 60 healthy controls, we measured (a) LV longitudinal, circumferential and radial strain (S), peak torsion and the percentage changes between peak twisting and untwisting at the end of early diastolic filling (%dpTw-Utw_EDF) using speckle tracking echocardiography and (b) serum levels of ACE and NTproBNP. Compared to controls, patients had decreased longitudinal strain (?19.1?±?2.9 vs. ?21.7?±?1.8%), increased peak twisting (19.1?±?4.6 vs.14.0?±?3.7 deg) but decreased %dpTw-Utw_EDF (78?±?8 vs. 86?±?8%) and higher serum ACE levels (27.6?±?8.0 vs 20.9?±?7.1 U/ml) (p?<?0.05 for all comparisons). Increasing serum ACE levels were related to impaired radial strain and longitudinal systolic SR (b?=??0.41 and b?=?0.31 respectively, p?<?0.01), as well as to reduced %dpTw-Utw_EDF (b?=??0.37, p?<?0.05). Furthermore, increasing serum ACE levels were related to increasing NTproBNP levels (b?=?0.41, p?<?0.01). In multivariate analysis, the above relations of serum ACE levels and LV function parameters remained significant after adjustment for other confounding factors (p?<?0.01). The close link between serum ACE levels and impaired LV deformation suggests that activation of renin-angiotensin system is involved in the impairment of LV function resulting in elevated LV filling pressures causing the concomitant elevation of BNP levels in untreated hypertensive patients.     

Gestational changes in left ventricular myocardial contractile function: new insights from two-dimensional speckle tracking echocardiography

The goal of this study was to evaluate the impact of pregnancy and labor on left ventricular (LV) myocardial mechanics using speckle tracking echocardiography (STE). Pregnancy is characterized by profound hormonal and hemodynamic alterations that directly or indirectly influence cardiac structure and function. However, the impact of these changes on left ventricular (LV) myocardial contractile function has not been fully elucidated. In this prospective, longitudinal study, 35 pregnant women underwent serial clinical and echocardiographic evaluation during each trimester and at labor. Two dimensional STE was performed to measure global LV longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively). Similar data obtained from 20 nulliparous, age-matched women were used as control. All strain values during pregnancy were adjusted for age and hemodynamic parameters. There was a progressive increase in heart rate, systolic and diastolic blood pressure, cardiac output and LV stroke-work during pregnancy. LV end-diastolic and end-systolic volumes also increased progressively but LV ejection fraction remained unaltered, except for slight reduction during the second trimester. Compared to the controls, GLS and GCS were reduced in the first trimester itself (GLS ?22.39?±?5.43?% vs. ?18.66?±?0.64?%, P 0.0002; GCS ?20.84?±?3.20 vs. ?17.88?±?0.09, P?<?0.001) and remained so throughout the pregnancy and labor. In contrast, GRS showed an increase during pregnancy which peaked during the second trimester (24.18?±?0.39?% vs. 18.06?±?8.14?% in controls, P?<?0.001). Alterations in loading conditions during pregnancy are associated with counterbalancing changes in the myocardial mechanics. LV longitudinal and circumferential strain are reduced whereas radial strain is increased. These counterbalancing changes serve to maintain overall LV ejection performance within a normal range and enable the maternal heart to meet the hemodynamic demands of pregnancy and labor.     

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.     

Left atrium passive ejection fraction is the most sensitive index of type 2 diabetes mellitus-related cardiac changes

The aims of this study were to use cardiovascular magnetic resonance (CMR) cine to assess left atrium (LA) and left ventricle (LV) function and structure in normotensive type 2 diabetes mellitus (T2DM) patients and to identify the most sensitive index of those T2DM-related cardiac changes. Fifty T2DM patients with normotension (25 males, age 54.7?±?8.7 years, duration of diabetes: 7.5?±?5.1 years) and 35 controls (16 males, age: 52.2?±?13.2 years) were prospectively enrolled. All patients were scanned using CMR four- and two-chamber long-axis cine to assess LA and LV structure and function. Normotensive T2DM patients were associated with decreased LA total ejection fraction (EF), passive EF and LV end diastolic volume, normal LA active EF and LV myocardial mass and increased LV mass/volume (M/V). LA total EF and passive EF correlated with body mass index, duration of diabetes and M/V. To differentiate between diabetic patients and healthy controls, area under the receiver operating characteristic (ROC) curve (AUC) values were calculated to be 0.763, 0.706, 0.647 and 0.649 for LA passive EF, total EF, LVEDV and M/V, respectively. The addition of LA total EF, LVEDV, M/V and the combination thereof did not significantly improve AUC values in a model containing LA passive EF. Normotensive T2DM patients were associated with LA decreased total ejection fraction, decreased passive EF and LV concentric remodeling. Among these indices, LA passive EF was the most sensitive to T2DM-related LA function changes.     

Serial assessment of left ventricular morphology and function in a rodent model of ischemic cardiomyopathy

Left ventricular remodelling (LVr) occurs post myocardial infarction (MI), predisposing people to heart failure (HF). LV mechanics and morphology are important in this process. We hence sort to characterize LV mechanics and geometry in a post-MI rodent model. Thirty-two male Sprague–Dawley rats (150–200 g) sustained MI (n?=?24) or sham (Sham; n?=?8) surgery. In another six sham rats invasive blood pressure measurements were performed. Ultrasound imaging was done at baseline, and 1, 3, 7, 14, 30 and 60 days following surgery, and LV mechanics and morphology assessed. LV volumes increased with time (p?<?0.01), at a greater rate in the MI group than the Sham group (p?<?0.01). Strain was impaired in MI rats at day 1 (13.50?±?6.64 vs. 25.71?±?4.94%, p?<?0.01) and remained impaired at day 60 (14.07?±?5.37 vs. 22.98?±?5.87%, p?<?0.01). Strain rate was lower at day 1 (4.11?±?1.29 vs. 8.10?±?2.18%/s, p?<?0.01), remained lower throughout follow-up (p?<?0.01), and decreased at a greater rate in MI rats (p?<?0.01). Mean systolic (204?±?43 vs. 322?±?75 1/m, p?<?0.01) and diastolic (167?±?21 vs. 192?±?11 1/m, p?<?0.01) curvature was lower in the MI rats at day 1 post surgery and throughout follow-up (p?<?0.01). Maximum principal curvature decreased throughout time (p?<?0.01), while minimum principal curvature did not (p?=?0.86). Wall stress increased significantly after infarction in MI rats (p?<?0.01). ST-elevation myocardial infarction (STEMI) changed LV shape and contractile function. The assessment of these indices may prove useful in understanding LVr and the development of HF.     

Magnetic resonance assessment of left ventricular diastolic dysfunction for detecting cardiac allograft vasculopathy in recipients of heart transplants

Cardiac allograft vasculopathy (CAV) is a major late complication in heart transplant recipients, graded based on intravascular ultrasound (IVUS), and accelerates left ventricular (LV) diastolic dysfunction. We investigated the clinical feasibility of using magnetic resonance (MR) to assess LV diastolic dysfunction noninvasively in transplant recipients. Thirty-eight asymptomatic recipients (25 men, 37.2 ± 14.9 years) underwent both IVUS and cardiac MR. Based on IVUS, we divided the individuals into 2 groups using Stanford classification to categorize CAV development as either nonsignificant or advanced. We measured LV peak filling rate (PFR) and systolic function parameters, including LV ejection fraction (EF), stroke volume (SV), and cardiac output (CO) using cine MR; compared those values between groups; calculated receiver operating characteristic curve in the relationship between PFR value and CAV; and assessed myocardial late gadolinium enhancement (LGE) on contrast-enhanced MR. We classified CAV as advanced in 20 patients (53%) and nonsignificant in 18 (47%). LV EF, SV, and CO values were not significantly different. PFR was significantly lower in the advanced (3.63 ± 0.90 EDV/s) than nonsignificant group (4.43 ± 0.84 EDV/s, P = 0.01). The area under the curve was 0.76. We observed no myocardial LGE. MR measurement of PFR may permit noninvasive assessment of diastolic dysfunction associated with CAV before LV systolic dysfunction and myocardial infarction or scar formation develop.     

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.     

Early diastolic strain rate predicts response to heart failure therapy in patients with dilated cardiomyopathy

The aim of this prospective study was to assess the value of speckle tracking echocardiographic (2D-STE) parameters to predict response to heart failure therapy in patients with dilated cardiomyopathy (DCM). Eighty-seven patients (mean age 51 ± 13 years) with DCM, defined as ejection fraction (EF) <45 %, left ventricular (LV) end-diastolic diameter >112 % of normal range derived from age and body surface area. Based on 2D-STE following parameters were extracted from three apical views of the LV: global longitudinal strain, systolic and diastolic strain rate (SR_E). Mechanical dispersion was calculated as standard deviation of time-to-peak strain values including all LV segments. After receiving heart failure therapy (mean 39 ± 11 months, range 3–60 months) 50 patients reached combined endpoint defined as following: death, heart transplantation, rehospitalization due to heart failure, and absence of improvement in EF. On stepwise multivariate regression analysis, SR_E was independently of EF and LV volumes predictive for combined endpoint (OR 0.44, 95 %CI 0.27–0.70, p = 0.001) with an area under the ROC-curve (AUC) of 0.91. In patients with cQRS duration ≤120 ms mechanical dispersion was predictive for combined endpoint with the highest AUC (OR 1.53, 95 %CI 1.08–2.16, p = 0.002; AUC = 0.94). In this study, SR_E, a surrogate parameter of myocardial relaxation, was able to predict a response to heart failure therapy in patients with DCM. In patients with narrow QRS complex, mechanical dispersion yielded the highest predictive value. Parameters of 2D-STE may contribute to risk stratification in this patient population.     

Comprehensive echocardiographic assessment of biventricular function in the rabbit,animal model in cardiovascular research: feasibility and normal values

Quantification of cardiac structure and function is central in cardiovascular research. Rabbits are valuable research models of cardiovascular human disease; however, there is little normal data available. The aim of this study was to investigate feasibility and provide normal values for comprehensive echocardiographic assessment of biventricular function in rabbits. New Zealand white rabbits underwent trans-thoracic echocardiography using a general electric (GE) Vivid 7/E9 system with a 10 MHz transducer, under light sedation, to evaluate biventricular function and dimensions. Images for two-dimensional, M-mode, tissue Doppler imaging (TDI) and speckle-tracking strain echocardiography were acquired and analysed. 55 male rabbits (sized matched with a newborn human baby) were studied, mean weight was 2.9?±?0.23 kg. Adequate images were obtained in 90% for the left ventricle (LV) and 80% for the right ventricle (RV). Two-dimensional speckle-tracking strain was feasible in 60%. Average heart rate was 248?±?36 beats per minute; LV ejection faction 72?±?8.0; RV fractional area change 45.9?±?9.0%; RV myocardial performance index 0.39?±?0.35; tricuspid annular planar systolic excursion 0.60?±?0.24 cm. LV TDI parameters were S’ 8.6?±?3.1 cm/s; E’ 12.0?±?4.46 cm/s. RV TDI parameters were S’ 10.49?±?3.18; E’ 14.95?±?4.64 cm/s. LV and RV global peak systolic longitudinal strain were ?17?±?5 and ?22?±?8%, respectively. Comprehensive investigation of biventricular dimensions and function by echocardiography is feasible in the rabbit. Apical views and strain imaging have lower feasibility. Normal values of LV and RV functional parameters are with comparable values to human children. Animal cardiovascular research is key to develop new goals in clinical practice.     

Cardiac structure and function in elite Native Hawaiian and Pacific Islander Rugby Football League athletes: an exploratory study

The aim of this exploratory study was to define the Athletes Heart (AH) phenotype in Native Hawaiian & Pacific Islander (NH&PI) Rugby Football League (RFL) athletes. Specifically, (1) to describe conventional echocardiographic indices of left ventricle (LV) and right ventricle (RV) structure and function in NH&PI RFL players and matched RFL Caucasian controls (CC) and (2) to demonstrate LV and RV mechanics in these populations. Ethnicity is a contributory factor to the phenotypical expression of the AH. There are no data describing the cardiac phenotype in NH&PI athletes. Twenty-one male elite NH&PI RFL athletes were evaluated using conventional echocardiography and myocardial speckle tracking, allowing the assessment of global longitudinal strain (ε) and strain rate (SR); and basal, mid and global radial and circumferential ε and SR. Basal and apical rotation and twist were also assessed. Results were compared with age-matched Caucasian counterparts (CC; n?=?21). LV mass [42?±?9 versus 37?±?4 g/(m^2.7)], mean LV wall thickness (MWT: 9.5?±?0.7 and 8.7?±?0.4 mm), relative wall thickness (RWT: 0.35?±?0.04 and 0.31?±?0.03) and RV wall thickness (5?±?1 and 4?±?1 mm, all p?<?0.05) were greater in NH&PI compared with CC. LV and RV cavity dimensions and standard indices of LV and RV systolic and diastolic function were similar between groups. NH&PI demonstrated reduced peak LV mid circumferential ε and early diastolic SR, as well as reduced global radial ε. There was reduced basal rotation at 25–35% systole, reduced apical rotation at 25–40% and 60–100% systole and reduced twist at 85–95% systole in NH&PI athletes. There were no differences between the two groups in RV wall mechanics. When compared to Caucasian controls, NH&PI rugby players have a greater LV mass, MWT and RWT with concomitant reductions in circumferential and twist mechanics. This data acts to prompt further research in NH&PI athletes.     

Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

Purpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dt_max,) during CRT-implantation. The acute change in dP/dt_max, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45?±?18 to 27?±?11 and 23?±?12%, p?<?0.001; SRS from 2.27?±?1.33 to 0.74?±?0.50 and 0.71?±?0.43%, p?<?0.001) and improved LV function (dP/dt_max 668?±?185 vs. 817?±?198 mmHg/s, p?<?0.001; stroke volume 46?±?15 vs. 54?±?20 and 52?±?16 ml; LVEF 19?±?7 vs. 23?±?8 and 27?±?10%, p?<?0.001). Acute recoordination related to reverse remodelling (r?=?0.601 and r?=?0.765 for ISF & SRSlv, respectively, p?<?0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

     

Reproducibility and observer variability of tissue phase mapping for the quantification of regional myocardial velocities

To systematically investigate the reproducibility of global and segmental left ventricular (LV) velocities derived from tissue phase mapping (TPM). Breath held and ECG synchronized TPM data (spatial/temporal resolution?=?2?×?2 mm²/20.8 ms) were acquired in 18 healthy volunteers. To analyze scan–rescan variability, TPM was repeated in all subjects during a second visit separated by 16?±?5 days. Data analysis included LV segmentation, and quantification of global and regional (AHA 16-segment modal) metrics of LV function [velocity–time curves, systolic and diastolic peak and time-to-peak (TTP) velocities] for radial (Vr), long-axis (Vz) and circumferential (VΦ) LV velocities. Mean velocity time curves in basal, mid-ventricular, and apical locations showed highly similar LV motion patterns for all three velocity components (Vr, VΦ, Vz) for scan and rescan. No significant differences for both systolic and diastolic peak and TTP myocardial velocities were observed. Segmental analysis revealed similar regional peak Vr and Vz during both systole and diastole except for three LV segments (p?=?0.045, p?=?0.033, and p?=?0.009). Excellent (p?<?0.001) correlations between scans and rescan for peak Vr (R²?=?0.92), peak Vz (R²?=?0.90), radial TTP (R²?=?0.91) and long-axis TTP (R²?=?0.88) confirmed good agreement. Bland–Altman analysis demonstrated excellent intra-observer and good inter-observer analysis agreement but increased variability for long axis peak velocities. TPM based analysis of global and regional myocardial velocities can be performed with good reproducibility. Robustness of regional quantification of long-axis velocities was limited but spatial velocity distributions across the LV could reliably be replicated.     

Early detection of cardiac alterations by left atrial strain in patients with risk for cardiac abnormalities with preserved left ventricular systolic and diastolic function

This study sought to examine whether early cardiac alterations could be detected by left atrial (LA) strain in patients with risk for cardiac abnormalities. In this cross-sectional and retrospective study, we included patients with (n?=?234) and without (n?=?48) risk for cardiac abnormalities (i.e. those with arterial hypertension, diabetes mellitus and/or a history of coronary artery disease) of similar age and with preserved left ventricular (LV) systolic and diastolic function according to standard criteria. LA strain was significantly altered in patients with risk for cardiac abnormalities in comparison to those without risk (29.2?±?8.6 vs. 38.5?±?12.6%; rate of impaired LA strain: 18.8% vs. 0%; all p?<?0.01) and was the most sensitive parameter to detect early LA alterations in comparison with other LA functional parameters (rate of impaired LA strain rate, LA total emptying fraction, and LA expansion index 3.8%, 7.3%, and 3.8%, respectively). Moreover, in patients with risk for cardiac abnormalities LA strain was altered even in the absence of subtle LV systolic and diastolic alterations (rates 13.9% and 6.8%), albeit to a lesser extent than in patients with an abnormal LV longitudinal systolic strain or abnormal mitral annular e′ velocities (rates 48.5% and 24.4%). Regarding the clinical relevance of these findings, an impaired LA strain (i.e. <?23%) was significantly linked to exertional dyspnea (OR 3.5 [1.7–7.0]) even adjusting the analyses by age, gender and subtle LV abnormalities. In conclusion, the findings from this study suggest that LA strain measurements could be useful to detect early cardiac alterations in patients with risk for cardiac abnormalities with preserved LV systolic and diastolic function and that these early LA strain alterations could be linked to exertional dyspnea.     

舒张早期心肌速率阶差评价左室舒张功能障碍的超声研究

目的 :探讨舒张早期心肌速率阶差 (MVGE)评价左室舒张功能的可行性。方法 :扩张型心肌病患者 (DCM)组 2 2例 ,高血压患者 (HBP)组 2 7例 ,正常对照组 2 5例均行常规二维超声心动图 (2 - DE)及脉冲多普勒超声心动图 (PW)和脉冲多普勒组织成像技术 (PW- DTI)检查。 2 - DE获得左室射血分数 (EF) ;PW获取二尖瓣口血流速率 E、 A、 E峰下降时间 (Dc T)及 E/ A;PW- DTI于左室乳头肌短轴切面获取左室后壁心内膜下、心外膜下心肌舒张早期峰值运动速率 VE endo、VE epi,并计算 MVGE。结果 :与正常组比较 ,DCM组 EF显著降低 (P<0 .0 1 ) ,Dc T显著缩短 (P<0 .0 5) ,E/ A显著增高 (P<0 .0 5) ;HBP组 EF与正常组间无差异 ,E/ A显著减低 (P<0 .0 1 ) ,Dc T显著延长 (P<0 .0 5)。与正常组比较 ,DCM组 VE endo、MVGE 显著减低 (分别为 P<0 .0 5和 P<0 .0 1 ) ;HBP组 VE endo、 MVGE亦显著减低 (分别为 P<0 .0 5和 P<0 .0 1 )。结论 :脉冲 DTI测定 MVGE 可早期、无创、准确反映心脏舒张功能障碍而不受收缩功能的影响     

Left ventricular dysfunction in repaired tetralogy of Fallot: incidence and impact on atrial arrhythmias at long term-follow up

Left ventricle (LV) systolic dysfunction in repaired tetralogy of Fallot (TOF) has been identified as a risk factor for functional status and adverse outcome. The aims of this cross-sectional followed by a prospective study were: (1) to evaluate the prevalence of LV systolic dysfunction in a large cohort of adults with repaired tetralogy of Fallot, (2) to test the relationship between LV systolic dysfunction and other known risk factors and (3) to evaluate the impact of LV systolic dysfunction on adverse cardiac events. In a multicenter study, 237 adults repaired TOF (58?% males, age 30?±?10 years) were evaluated by cardiac magnetic resonance (CMR). Demographics, surgical history, ECG, Echo-Color Doppler and follow-up data were recorded. LV was dilated (Z value >2) in 16 patients (6?%), however 56 patients (23.6?%) had a reduced LV systolic function left ventricle ejection fraction (LVEF) (Z value <?2). Patients with LV systolic dysfunction were mainly males (82?%), had reduced right ventricle ejection fraction (RVEF), and higher right and left Late Gadolinium Enhanced scores. In a multivariate regression analysis male gender and RVEF resulted to be independent factors associated to LV systolic dysfunction. Atrial arrhythmias were the main adverse cardiac event at the follow-up and were associated to higher biventricular volumes and lower biventricular ejection fraction (EF); however multivariable analysis identified age, right ventricle end-diastolic volume (RVEDVi) and tricuspid regurgitation as independents factors associated to atrial arrhythmias. At long term follow-up at least ¼ of repaired TOF has LV dysfunction. Lower LVEF is associated to male gender and lower RVEF.     

Changes in cardiac function and structure in newly diagnosed Graves’ disease. A conventional and 2D-speckle tracking echocardiography study

Overproduction of thyroid hormones leads to structural as well as functional cardiac changes. Conventional echocardiography but also recently developed sophisticated two-dimensional echocardiography speckle (2D-STE) tracking allow elaborate evaluation of these changes. Our purpose was to investigate the effects of thyroid hormones overproduction on the heart in patients with Graves’ disease and changes that occur after 6 months thyrostatic therapy. We conducted a prospective, case-control study of 6 months duration. Full echocardiographic assessment at diagnosis and after 6 months of thyrostatic therapy were performed in 44 patients with Graves’ disease, aged 37.6?±?9.1 years. Additionally, 43 euthyroid controls were studied for the same time period. Left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were higher in the patient group while triscupid annular plane systolic excursion (TAPSE) was lower in the patient group. Moreover, left ventricular (LV) mass index and left atrium (LA) volume index were higher in the Graves’ disease group. Diastolic impairment as assessed with conventional echocardiography including tissue Doppler was present in the patient group (E/A ratio 0.87?±?0.10,). 2D-STE analysis, revealed an increase in the strain rate at the isovolumic relaxation time (SRIVRT, 0.310?±?0.07 patients versus 0.298?±?0.09 s^?1 controls). Improvement in diastolic and right systolic function as well as in left ventricular structural parameters was observed after restoration of euthyroidism (E/A ratio from 0.87?±?0.10 versus 0.9?±?0.08, p?<?0.05). Patients with newly diagnosed Graves’ showed an improvement in diastolic function, right systolic function and structural parameters after 6 months of thyrostatic treatment.     

Assessment of left ventricular diastolic function using color kinesis: differentiation between normal and pseudonormalized patterns

Purpose  Doppler examination of transmitral flow has been widely used to noninvasively assess left ventricular (LV) diastolic function. However, it has been demonstrated that transmitral flow velocity is dependent on LV relaxation and left atrial pressure. Increases in left atrial pressure compensate for the effects of impaired LV relaxation, frequently resulting in a “pseudonormalization” of the transmitral flow pattern. The purpose of this study was to assess whether analysis of diastolic color kinesis (CK) can be applied to differentiation between normal and pseudonormalized (PN) patterns of LV inflow. Methods  We studied 60 subjects with a ratio of early to late transmitral peak velocities (E/A) greater than 1.0 according to conventional Doppler echocardiography. All subjects simultaneously underwent measurement of the early diastolic mitral annular velocity (e′), which was measured by tissue Doppler imaging, and LV ejection fraction (EF), which was calculated by the modified Simpson method. Study subjects were classified into the following three groups according to the value of e′ and EF: (1) the normal group (e′ > 10 cm/s, EF > 60%), including 20 subjects (mean age 35 ± 10 years); (2) the PN1 group (e′ < 7 cm/s, EF > 50%), consisting of 20 patients [mean age 63 ± 11 years, 15 patients with hypertensive heart disease (HHD), 5 patients with aortic valve stenosis]; and (3) the PN2 group (e′ < 7 cm/s, EF < 50%), consisting of 20 patients (mean age 61 ± 17 years, 18 patients with dilated cardiomyopathy, 2 patients with HHD). Diastolic CK images were obtained for each subject from the LV midpapillary short-axis view. Analysis of CK diastolic images was performed using ICK software. The CK-diastolic index (CK-DI) was defined as the calculated LV segmental filling fraction during the first 30% of diastole, expressed as a percentage. The mean CK-DI was determined from the average CK-DI of six LV segments. Results  The mean CK-DI was 70.9% ± 6.5% in the normal group, 46.3% ± 10.4% in the PN1 group, and 36.3% ± 5.1% in the PN2 group. The mean CK-DI was significantly reduced in the PN1 and PN2 groups compared with the normal group (P < 0.0001). Although there was no difference in e′ (PN1 group: 4.6 ± 1.8 cm/s, PN2 group: 4.4 ± 1.7 cm/s) between the two pseudonormalized patient groups, the mean CK-DI was significantly reduced in the PN2 group compared with the PN1 group (P < 0.005). The reduction in mean CK-DI was seen not only in pseudonormalized patients with LV systolic dysfunction but also in those with preserved LV systolic function. Conclusion  The analysis of diastolic CK with ICK software is a useful method for detecting delayed early diastolic relaxation. We concluded that diastolic CK images may be applied to differentiating between normal and pseudonormalized patterns of LV inflow.