Reproducibility of Echocardiograph‐Derived Multilevel Left Ventricular Apical Twist Mechanics

Left ventricular (LV) twist mechanics are routinely assessed via echocardiography in clinical and research trials investigating the function of obliquely oriented myocardial fibers. However, echocardiograph‐derived measures of LV twist may be compromised by nonstandardized acquisition of the apical image. This study examined the reproducibility of echocardiograph‐derived parameters of apical twist mechanics at multiple levels of the apical myocardium. Two sets of 2D LV parasternal short‐axis images were obtained in 30 healthy subjects (24 men; 19–57 year) via echocardiography. Images were acquired immediately distal to the papillary muscles (apical image 1), immediately above the point of LV cavity obliteration at end systole (apical image 3), and midway between apical image 1 and apical image 3 (apical image 2). Repeat scans were performed within 1 hour, and twist mechanics (rotation and rotation rate) were calculated via frame‐by‐frame tracking of natural acoustic echocardiographic markers (speckle tracking). The magnitude of apical rotation increased progressively toward the apex (apical image 1: 4.2 ± 2.1°, apical image 2: 7.2 ± 3.9°, apical image 3: 11.8 ± 4.6°). apical images 1, 2, and 3 each had moderate to good correlations between repeat scans (ICC: 0.531–0.856). When apical images 1, 2, and 3 were averaged, rotation was 7.7 ± 2.7° and between‐scan correlation was excellent (ICC: 0.910). Similar results were observed for systolic and diastolic rotation rates. Averaging multiple standardized apical images, tending progressively toward the apex, generated the most reproducible rotation indices and may be optimal for the assessment of LV twist mechanics across therapeutic, interventional, and research studies; however, care should be taken given the influence of acquisition level on the magnitude of apical rotation.     

Velocity vector imaging fails to quantify regional myocardial dysfunction in a mouse model of isoprenaline-induced cardiotoxicity

Background: Regional myocardial deformation patterns are important in a variety of cardiac diseases, including stress‐induced cardiomyopathy. Velocity‐vector‐based imaging is a speckle‐tracking echocardiography (STE)‐based algorithm that has been shown to allow in‐depth cardiac phenotyping in humans. Regional posterior wall myocardial dysfunction occurs during severe isoprenaline stress in mice. We have previously shown that regional posterior wall end‐systolic transmural strain decreases after severe isoprenaline toxicity in mice. We hypothesize that STE can detect and further quantify these perturbations. Methods and results: Twenty‐three mice underwent echocardiographic examination using the VEVO2100 system. Regional transmural radial strain and strain rate were calculated in both parasternal short‐axis and parasternal long‐axis cine loops using the VisualSonics VEVO 2100 velocity vector imaging (VVI) STE algorithm. Eight C57BL/6 mice underwent baseline echocardiographic examination using the VisualSonics VEVO 770 system, which can acquire >1,000 frames/s cine loops. In a parasternal short‐axis cine loop, the heart was divided into six segments, and regional fractional wall thickening (FWT) was assessed manually. The same protocols were also performed 90 minutes post 400 mg/kg intraperitoneally isoprenaline. Regional myocardial FWT is uniform at baseline but increases significantly in anterolateral segments, whereas it decreases significantly in posterior segments (P < 0.05). A similar pattern is seen using the VVI algorithm although the variance is larger, and differences are smaller and fail to reach significance. Conclusions: VVI is less sensitive in detecting regional perturbations in myocardial function than manual tracing, possibly due to the low frame rate in the cine loops used.     

Impact of transcutaneous aortic valve implantation on myocardial deformation

Aims: To define the impact of transcutaneous aortic valve implantation (TAVI) using the CoreValve prosthesis on myocardial deformation in a serial echocardiographic study with analysis of strain and strain rate. Methods: In 36 patients (83 ± 6 years; EuroScore: 26 ± 13%) with severe aortic stenosis scheduled for CoreValve implantation serial echocardiographic studies pre‐ and postintervention (within 1 month) were performed. Midparasternal short‐axis and three apical views were acquired. Using customized computer software which allows automatic frame‐by‐frame tracking of acoustic markers during the heart cycle circumferential, radial, and longitudinal strain (CS, RS, and LS) and strain rate (CSR, RSR, and LSR) were calculated for each segment in a 16 segment model of the left ventricle. Results: Longitudinal strain, systolic, and early diastolic longitudinal strain rate increased significantly within 1 month after TAVI (LS from –15.8 ± 3.6% to –17.6 ± 3.1%; P < 0.001; LSR(S) from –1.03 ± 0.21 s^?1 to –1.21 ± 0.19 s^?1; P < 0.001 and LSR (E) from –1.15 ± 0.42 s^?1 to 1.51 ± 0.44 s^?1; P < 0.001). Circumferential strain and strain rate values remained unchanged after CoreValve implantation. RS (29.1 ± 17.1 to 34.0 ± 15.8%; ns), RSR (S) (1.56 ± 0.69 to 1.91 ± 0.87 s^?1; ns) and RSR(E) (–1.56 ± 0.78 to –1.81 ± 0.82 s^?1; ns) increased only nonsignificantly after TAVI. Analysis of covariance showed only chronic kidney disease to have a relevant impact on early diastolic LSR (P = 0.01). Conclusions: Mainly longitudinal mechanics respond to unloading of the left ventricle after TAVI for severe aortic stenosis while radial and circumferential deformation is substantially unchanged. Pacemaker implantation or onset of left bundle brunch block after TAVI do not influence early myocardial deformation parameters. (Echocardiography 2011;28:397‐401)     

Left ventricular myocardial performance in patients with dengue hemorrhagic fever and thrombocytopenia as assessed by two-dimensional speckle tracking echocardiography

ObjectivesWe obtained longitudinal, radial and circumferential strains in patients with dengue hemorrhagic fever (DhF) and thrombocytopenia using two-dimensional (2D) speckle tracking echocardiography to analyze left ventricular (LV) myocardial performance.MethodsIn this prospective study, 2D echocardiographic images of the left ventricle in the four-, three- and two-chamber views and parasternal short-axis views at the basal, mid and apical levels were obtained in 40 subjects: 20 patients (23 ± 8 years, 12 male) with DhF and thrombocytopenia and 20 healthy controls (23 ± 5 years, 11 male). Of the 20 patients, imaging was performed again in 19 at discharge after a hospital stay of 8 ± 1 days. Longitudinal, circumferential and radial strains were quantified and compared in an 18-segment model using a novel speckle tracking system.ResultsLeft ventricular global ejection fraction was reduced in patients with DhF at presentation as compared with controls (51.25 ± 0.96% vs. 59.32 ± 1.26%; p = 0.032). Peak longitudinal strain in patients with DhF was significantly attenuated in the subendocardial region compared with normal controls (p < 0.001). A significant increase in circumferential strain for patients with DhF was evident only in the subepicardial region (p = 0.009). Patients with DhF showed significantly higher radial strain than controls (p < 0.001). On multivariate analysis, subendocardial longitudinal strain independently predicted the duration of hospital stay in patients with DhF.ConclusionAssessment of speckle tracking echocardiography-derived LV mechanics helps in understanding myocardial mechanics in patients with DhF and thrombocytopenia. Identification of reduced LV longitudinal strain helps in understanding the mechanism of reduced LV myocardial performance seen in patients with DhF.     

Assessing global and regional left ventricular myocardial function in elderly patients using the bidimensional strain method

Biological and anatomical alterations in the elderly result in modifications of the myocardial deformation detected previously by magnetic resonance imaging (MRI) technology and could have consequences on speckle tracking's parameters in this patient population. Aim: To compare left ventricular (LV) 2D strain between elderly patients and young individuals without heart disease. Population and Methods: Patients without history of cardiac disease were enrolled from the geriatric department. After echocardiographic examination, exclusion criteria were LV myocardial abnormality, valve disease, and atrial fibrillation. The control group consisted of healthy subjects from the medical staff. 2D strain values were obtained from 16 segments in four‐, three‐, and two‐chamber apical views for longitudinal and transversal strains, and from six basal segments in short‐axis view for circumferential strain. Results: Forty‐five elderly patients (35 females) with mean age of 83.4 ± 5.0 years (75–95 years) and 45 young subjects (28 females) with mean age of 33.6 ± 7.5 years (17–45 years) were assessed. There was no difference between the two groups considering LV ejection fraction (66 ± 6% vs. 65 ± 4%, P = ns). Feasibility of segmental 2D strain was 55.6% for circumferential strain, 63% for transversal strain, and 82% for longitudinal strain. Global longitudinal strain was significantly lower in elderly patients (–20.9 ± 1.9% vs. –22.2 ± 2.2%, P < 0.01). There was no significant difference in global transversal and circumferential strain. Conclusion: Aging results in a decrease in global longitudinal strain. This should be taken into account in the assessment of pathological myocardial dysfunction. (Echocardiography 2011;28:978‐982)     

The Impairment of Endocardial Radial Strain Is Related to Aortic Stenosis Severity in Patients with Aortic Stenosis and Preserved LV Ejection Fraction Using Two‐Dimensional Speckle Tracking Echocardiography

Background: Myocardial function is heterogeneous in different myocardial layers. Recently, two‐dimensional speckle tracking echocardiography has been used to define myocardial deformation parameters of the left ventricular (LV) segment. This study aimed to investigate strain in subendocardial and subepicardial layers in patients with aortic stenosis (AS) and preserved LV ejection fraction (LVEF) using speckle tracking echocardiography. Methods: Parasternal short‐axis and apical long‐axis views of the left ventricle were acquired at the mid‐papillary level in 35 control subjects and 32 patients with AS and preserved LVEF. Radial, circumferential, and longitudinal strain in subendocardial and subepicardial layers at the posterior and anteroseptal segments were calculated. Results: There was no significant difference in circumferential strain in subendocardial and subepicardial layers between the control subjects and the patients with AS. Similarly, there was no significant difference in epicardial radial strain at the posterior and anteroseptal segments between the control subjects and the patients with AS. Longitudinal strain at both the posterior and anteroseptal segments was significantly decreased in the AS group compared with that in the control group. AS patients had significantly decreased values of endocardial radial strain compared with those in controls (anteroseptal: 18.2 ± 11.2 vs. 34.5 ± 14.8, P < 0.005; posterior: 25.2 ± 14.8 vs. 32.6 ± 12.6, P < 0.05). In the AS group, endocardial radial strain in the posterior and anteroseptal segments was significantly correlated with the aortic valve area (posterior: r = 0.41, P < 0.05; anteroseptal: r = 0.33, P < 0.05). Conclusion: Patients with AS and preserved LVEF have impaired longitudinal strain and endocardial radial strain, although circumferential strain and epicardial radial strain are preserved. Despite preserved LVEF, endocardial radial strain was associated with AS severity.     

The Right Ventricular Response to High Afterload: Comparison between Healthy Persons and Patients with Transposition of the Great Arteries: A 2D Strain Study

Objective: To evaluate the contraction pattern of the systemic right ventricle (RV) in comparison to healthy controls. Methods: 31 patients (14 female, mean age 21.5 ± 3.3 years) with congenital corrected (ccTGA) and surgical corrected (D‐TGA) TGA and 31 age‐matched healthy controls (17 female, mean age 23.1 ± 2.6 years) were included in the study. We compared the contraction pattern of the systemic RV with findings in the right and left ventricle (LV) of healthy controls. Echocardiograms were performed for all patients (19.3 ± 2.5 years after the operation) and all healthy controls. Using a novel computer software (GE Ultrasound, Horton, Norway) that allows automatic frame‐by‐frame tracking of accoustic markers during the heart cycle longitudinal and circumferential strain and strain rate were defined as parameters of myocardial deformation. Results: In the systemic free RV wall, circumferential strain was greater than longitudinal strain (?25.6 ± 4.2% vs. ?15.2 ± 3.9%, P < 0.001), opposite to the contraction pattern of the subpulmonary free RV wall (?17.7 ± 4.1% vs. ?28.3 ± 3.3%, P < 0.001). Compared with controls, segmental analysis of the free RV wall resulted in lower systolic longitudinal and higher systolic circumferential strain and strain rate values. In the free LV wall, circumferential strain was lower than longitudinal strain (?19.1 ± 2.7% vs. ?26.8 ± 4.5%, P < 0.001) in contrast to the data in the systemic free LV wall (?24.5 ± 3.1% vs. ?16.7 ± 3.5%, P < 0.001). Conclusions: Myocardial deformation parameters were significantly different in systemic and normal RV indicating a dependency of myocardial deformation parameters on right ventricular afterload. The use of myocardial deformation imaging identified a shift from longitudinal to circumferential contraction pattern in the systemic RV in comparison to the LV. This might demonstrate a response to the systemic load creating a myocardial hypertrophy. (Echocardiography 2010;27:1256‐1262)     

Left ventricular mechanics following restrictive mitral annuloplasty for functional mitral regurgitation: two-dimensional speckle tracking echocardiographic study

Background: Restrictive mitral annuloplasty (RMA) is widely employed for patients with functional mitral regurgitation (MR). Its improvement of left ventricular (LV) function has been demonstrated by only a gradual increase in LV ejection fraction (EF) in the chronic phase. However, the detailed evaluation of changes in LV function has not been fully elucidated in functional MR patients before and after RMA. Therefore, we performed two‐dimensional speckle tracking echocardiography (2D‐STE), which enables accurate evaluation of myocardial deformation and rotation that are undetectable by conventional echocardiography. Methods: We studied 13 patients (mean age 61 ± 10 years) with functional MR associated with cardiomyopathy undergoing RMA. In addition to conventional echocardiographic measurements, 2D‐STE was performed to measure peak systolic radial (RS), circumferential (CS), and longitudinal (LS) strains and twist before and 4 ± 2 weeks after surgery. LV twist was defined as the difference between the apical and basal rotations. Results: After RMA, EF and LS remained unchanged, but RS and CS were significantly improved at the mid‐LV (RS, 20.6 ± 10.8 vs 24.5 ± 11.6%; CS, ?9.6 ± 5.2 vs ?12.8 ± 5.6%) and at the apex (RS, 15.0 ± 12.2 vs 18.7 ± 8.6%; CS, ?4.4 ± 3.0 vs ?7.8 ± 4.8%). RS and CS were unchanged at the base. The apical and basal rotations changed significantly, from 3.5°± 0.7° to 9.2°± 2.1°, and ?2.1°± 0.7° to ?3.8°± 1.0°, respectively. Consequently, the LV twist increased significantly, from 5.6°± 1.0° to 13.0°± 1.9°. Conclusions: Radial and circumferential strains and LV twist increased significantly in the early postoperative period in functional MR patients after RMA and concomitant procedures. (Echocardiography 2012;29:445‐450)     

Subclinical Left Ventricular Dysfunction in Asymptomatic Severe Aortic Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging Study

Objectives: Our aim was to evaluate subclinical left ventricular (LV) dysfunction, by two novel echocardiographic techniques, velocity vector imaging (VVI)‐derived strain imaging and tissue Doppler imaging (TDI), in patients with asymptomatic, severe aortic regurgitation (AR). Methods: Forty patients with severe AR with normal ejection fraction and 30 controls were included to the study. All patients underwent a standard echocardiography extended with TDI and VVI analyses. To evaluate the LV longitudinal and circumferential deformation, segmental systolic peak strain and strain rate (SRs) data were acquired from parasternal short axis, apical four‐chamber, two‐chamber, and long axis views, and additionally LV myocardial velocities, isovolumic myocardial acceleration (IVA), peak systolic velocity (Sa) and peak myocardial velocity during isovolumic contraction (IVV) assessed by TDI. Results: IVA was the only TDI‐derived parameter which was significantly impaired in AR patients (P = 0.0001). Both longitudinal and circumferential strain and SRs of the LV were significantly decreased in patients with severe AR (P = 0.0001). Longitudinal and circumferential strain/SRs and TDI‐derived LV IVA were inversely correlated with LV end‐diastolic diameter (P = 0.0001) and end‐systolic diameter (P = 0.0001). TDI‐derived IVA was also very well correlated with longitudinal deformation parameters (P = 0.0001). Conclusions: VVI‐ derived strain imaging and TDI‐derived IVA may be used as adjunctive, reliable, noninvasive parameters for evaluating subclinical ventricular dysfunction in patients with chronic, severe AR. This may help to identify patients for closer follow‐up and to determine the need for surgery before developing irreversible, severe heart failure. (Echocardiography 2010;27:260‐268)     

Myocardial Deformation in Patients with Beta‐Thalassemia Major: A Speckle Tracking Echocardiographic Study

Background: Increasing data suggest that parameters of myocardial deformation are strong indices of ventricular systolic and diastolic function. We sought to determine myocardial deformation of the left ventricle and assess relationship of deformation rates with myocardial iron load in patients with beta‐thalassemia major. Methods: The left ventricular longitudinal, circumferential, and radial myocardial deformation was determined using speckle tracking echocardiography in 42 thalassemia patients aged 24.4 ± 6.4 years. The results were compared with those of 38 age‐matched controls. The rates of longitudinal and circumferential deformation were correlated with cardiac T2* magnetic resonance findings. Results: Compared with controls, patients had significantly greater global systolic radial strain (P = 0.001), but similar global systolic longitudinal (P = 0.12) and circumferential strain (P = 0.84). On the other hand, patients had significantly lower longitudinal systolic strain rate (SR) (P = 0.019), longitudinal early diastolic SR (P = 0.036), and circumferential early diastolic SR (P = 0.04) than controls. The cardiac T2* findings correlated positively with longitudinal (r = 0.44, P = 0.004) and circumferential early diastolic SR (r = 0.37, P = 0.019), but not with the respective systolic SRs and left ventricular ejection fraction (all P > 0.05). Patients with iron overload (T2*< 20 msec), compared to those without, had significantly lower longitudinal (1.45 ± 0.33/sec vs. 1.76 ± 0.27/sec, P = 0.002) and circumferential (1.01 ± 0.31/sec vs. 1.22 ± 0.31/sec, P = 0.03) early diastolic SR. Conclusions: Patients with beta‐thalassemia major have reduced longitudinal systolic SR, longitudinal early diastolic SR, and circumferential early diastolic SR. The rates of diastolic deformation in the longitudinal and circumferential dimensions are inversely related to myocardial iron overload. (Echocardiography 2010;27:253‐259)     

Speckle tracking imaging in acute inflammatory pericardial diseases

Background: Left ventricular (LV) function in acute perimyocarditis is variable. We evaluated LV function in patients with acute perimyocarditis with speckle tracking. Methods: Thirty‐eight patients with acute perimyocarditis and 20 normal subjects underwent echocardiographic examination. Three‐layers strain and twist angle were assessed with a speckle tracking. Follow‐up echo was available in 21 patients. Results: Strain was higher in normal subjects than in patients with perimyocarditis. Twist angle was reduced in perimyocarditis—10.9°± 5.4 versus 17.6°± 5.8, P < 0.001. Longitudinal strain and twist angle were higher in normal subjects than in patients with perimyocarditis and apparently normal LV function. Follow‐up echo in 21 patients revealed improvement in longitudinal strain. Conclusions: Patients with acute perimyocarditis have lower twist angle, longitudinal and circumferential strain. Patients with perimyocarditis and normal function have lower longitudinal strain and twist angle. Short‐term follow‐up demonstrated improvement in clinical parameters and longitudinal strain despite of residual regional LV dysfunction. (Echocardiography 2011;28:548‐555)     

Effect of preload on left ventricular longitudinal strain by 2D speckle tracking

Background: Peak systolic longitudinal strain (PSLS) obtained using the 2D speckle tracking method is a novel indicator of the long‐axis function of the left ventricle (LV). We used the 2D strain profile to examine the effect of preload reduction by hemodialysis (HD) on LV PSLS in patients with end‐stage renal disease (ESRD). Method and results: Twenty‐nine pairs of echocardiographic evaluations were obtained before and after dialysis. Global LV PSLS was ?18.4 ± 2.9%, at baseline and decreased to ?16.9 ± 3.2% after HD (P < 0.001). Segmental analysis showed that the decrease in PSLS after dialysis was most prominent in mid‐LV segments (?17.1 ± 3.5% vs. ?15.4 ± 3.4%, P < 0.001). Conclusion: PSLS obtained from the 2D strain profile is a reliable parameter that may be useful for evaluating LV systolic long‐axis function. However, PSLS should be applied cautiously in ESRD patients because it could be affected by dialysis.     

Early Improvement of the Regional and Global Ventricle Function Estimated by Two‐Dimensional Speckle Tracking Echocardiography after Percutaneous Aortic Valve Implantation Speckle Tracking after CoreValve Implantation

Background: To assess changes in myocardial deformation and ejection fraction (EF) by two‐dimensional speckle tracking echocardiography (2DSTE) after transcatheter aortic valve implantation (TAVI). Methods: A total of 24 patients (50% males, age 78 ± 4 years) were selected for TAVI because of severe aortic stenosis. A comprehensive echocardiographic study was performed before TAVI, at discharge, and after 1‐month follow‐up. EF was assessed by 2D conventional echocardiography with Simpson method and by 2DSTE. Radial and circumferential strains were evaluated in six segments in the short‐axis view at the level of the papillary muscles, and longitudinal strain in six segments in the four‐chamber apical view, by means of 2DSTE. All studies were performed with an iE‐33 echocardiography device (Philips). Results: At discharge, the mean EF estimated by 2DSTE improved significantly when compared with the basal one (56 ± 7% vs. 51 ± 8%, P < 0.01), while EF by Simpson method did not change (67 ± 9% vs. 64 ± 16%, P = 0.2). At that time, global radial (21.4 ± 9% vs. 11.5 ± 7.6%, P = 0.000), circumferential (?20.7 ± 8% vs. ?15.2 ± 7%, P = 0.02), and longitudinal strains (?14.8 ± 6.2% vs. ?12 ± 6%, P = 0.02) improved significantly when compared with the basal one. At 1‐month follow‐up, global radial (20.1 ± 5.6% vs. 21.4 ± 9%, P = 0.88) and circumferential (?20 ± 8% vs. ?20.7 ± 8%, P = 0.35) strains did not vary and a new significant improvement was observed in longitudinal global strain (?19.2 ± 6.5% vs. ?14.8 ± 6.2%, P = 0.002). Conclusions: A new echocardiographic technique, such as 2DSTE, shows a significant early improvement in global and segmental left ventricular systolic function after TAVI, which could not be detected by conventional methods.     

Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction.

AIMS: Pixel tracking-derived myocardial deformation imaging is a new echocardiographic modality which allows quantitative analysis of segmental myocardial function on the basis of tracking of natural acoustic markers in 2D echocardiography. This study evaluated whether myocardial deformation parameters calculated from 2D echocardiography allow assessment of transmurality of myocardial infarction as defined by contrast-enhanced cardiac magnetic resonance imaging (ceMRI). Methods In 47 patients with ischaemic left ventricular dysfunction, transmurality of myocardial infarction was assessed using pixel-tracking-derived myocardial deformation imaging and ceMRI. For each left ventricular segment in a 16-segment model, peak systolic radial strain, circumferential strain, radial strain rate, and circumferential strain rate were calculated from parasternal 2D echocardiographic views using an automatic frame-by-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound). Myocardial deformation parameters were related to the segmental extent of hyperenhancement by ceMRI. The relative amount of contrast-enhanced myocardial tissue per segment was used to define no infarction (0% hyperenhancement), non-transmural infarction (1-50% hyperenhancement), or transmural infarction (51-100% hyperenhancement). Results Analysis of myocardial deformation parameters was possible in 659 segments (88%). Systolic strain and strain rate parameters decreased with increasing relative hyperenhancement defined by ceMRI. Radial strain was 27.7+/-8.0, 20.5+/-9.7, and 11.6+/-8.5% for segments with no infarction (n=422), non-transmural infarction (n=106), and transmural infarction (n=131), respectively (P<0.0001). Radial strain allowed distinction of non-transmural infarction from transmural infarction with a sensitivity of 70.0% and a specificity of 71.2% (cut-off value for radial strain 16.5%). CONCLUSION: Frame-to-frame tracking of acoustic markers in 2D echocardiographic images for the analysis of myocardial deformation allows discrimination between different transmurality states of myocardial infarction.     

Instantaneous Decrease in Left Ventricular Afterload during Transcatheter Aortic Valve Implantation Results in Immediate Changes in Left Ventricular Strain

Severe aortic stenosis causes chronic increased afterload on the left ventricle (LV) resulting in myocardial hypertrophy and ultimately dysfunction if left untreated. Transcatheter aortic valve implantation (TAVI) immediately decreases the afterload on the LV by reducing the pressure gradient through the aortic valve. In our study, we aim to evaluate immediate changes in LV mechanics using intra‐procedural transesophageal echocardiography (TEE) to assess circumferential and radial strain via speckle tracking. Intra‐operative TEE was performed during TAVI for 53 patients (mean age 84 ± 8 years). Two‐dimensional images in the transgastric view were acquired at the level of the papillary muscle. Circumferential and radial strain was calculated using speckle tracking with Philips Qlab software. Global LV afterload was measured by calculating valvulo‐arterial impedance (Zva). Immediately post‐TAVI, there was a change in both radial strain rate (Pre: 0.73 ± 0.04 vs. Post: 0.88 ± 0.04 per second, P < 0.001) and circumferential strain rate (?0.53 ± 0.04 (pre) vs. ?0.74 ± 0.04 (post) per second, P < 0.001). There was also an immediate improvement in circumferential global strain parameters (?14.5 ± 5% (pre) vs. ?16.0 ± 4.7% (post), P < 0.05), whereas there was no significant change seen in global radial strain (15.6 ± 0.8% (pre) vs. 15.2 ± 0.9% (post), P = 0.69). No significant change was seen in LV ejection fraction (51.5 ± 14.2% (pre) vs. 52.1 ± 14.0% (post), P = 0.77). Speckle tracking using TEE images is feasible and identifies significant improvements in LV strain and strain rate immediately following TAVI that is not detected by conventional measure of LV function.     

Left Ventricular Systolic Function Changes in Primary Hypertension Patients Detected by the Strain of Different Myocardium Layers

This study investigated left ventricular (LV) systolic dysfunction associated with differential strain among myocardial layers in primary hypertension (PH) patients with or without LV hypertrophy (LVH), and normal patients.In 63 PH and 42 healthy patients, two-dimensional speckle tracking echocardiography was used to measure the peak systolic longitudinal and circumferential strain of the myocardial subendocardial, middle and subepicardial layers, and the peak systolic radial strain. To assess LV systolic function, the apical long axis, 4- and 2-chamber views, and parasternal short axis at the basal, middle, and apical levels were acquired by cardiovascular ultrasound (Vivid E9, GE Healthcare, USA).Overall, the pattern in peak systolic longitudinal strain among myocardial layers was subendocardial > middle > subepicardial. In the peak systolic circumferential strain, this was middle > subepicardial > subendocardial. The peak systolic longitudinal strain was normal > NLVH > LVH. Among the groups, the peak systolic circumferential strain at the basal parasternal short-axis level was statistically similar, but at the middle and the apical parasternal short-axis levels were NLVH > normal > LVH. In normal and NLVH patients, the peak radial strain was middle > apical > basal, and in LVH patients was apical > middle > basal. The peak averages of the longitudinal and subendocardial circumferential strains differed significantly when LVH compared with NLVH and normal patients.The systolic function of PH patients was damaged in comparison with normal individuals, which could be detected conveniently and accurately using two-dimensional speckle tracking echocardiography.     

Hypertrophic cardiomyopathy is associated with abnormal echocardiographic aortic elastic properties and arteriograph-derived pulse-wave velocity

Objective: Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease and defined by the presence of unexplained left ventricular hypertrophy (LVH). Vascular alterations are frequently associated with HCM including microvascular and/or peripherial endothelial dysfunction. This study was designed to evaluate echocardiographic ascending aortic elastic properties and arteriograph‐derived pulse‐wave velocity (PWV) and augmentation index (Aix) in HCM. Methods: This study comprised 38 patients with typical features of HCM. Their results were compared to 20 hypertensive patients with LVH and 23 controls. Systolic and diastolic ascending aortic diameters were recorded in M‐mode at a level of 3 cm above the aortic valve from a parasternal long‐axis view. The following echocardiographic aortic elastic properties were measured from aortic data and forearm blood pressure values: aortic strain, distensibility, and stiffness index. Arteriograph‐derived PWV and AIx were also measured. Results: Aortic stiffness index (18.4 ± 17.6 vs. 6.88 ± 3.63, P < 0.05), PWV (9.44 ± 4.08 vs. 7.97 ± 1.20 m/sec, P < 0.05) and Aix (‐24.9 ± 32.6 vs. –41.4 ± 24.3, P < 0.05) were increased, while aortic strain (0.061 ± 0.053 vs. 0.100 ± 0.059, P < 0.05) and aortic distensibility (1.94 ± 1.68 cm²/dynes 10^?6 vs. 3.08 ± 1.77 cm²/dynes 10^?6, P < 0.05) were decreased in HCM patients compared to controls. Aortic elastic properties of hypertensive patients with LVH showed similar alterations to HCM patients. Conclusions: Abnormal echocardiographic aortic elastic properties and arteriograph‐derived PWV and Aix could be demonstrated in HCM patients compared to matched controls. (Echocardiography 2011;28:848‐852)     

Disfunção sistólica ventricular esquerda detetada por speckle tracking em hipertensos com fração de ejeção preservada

Introduction The spectrum of hypertensive heart disease is wide, and can include left ventricular dysfunction. The development of echocardiographic parameters to improve patient stratification and to identify early adverse changes could be clinically useful.Aim To identify subclinical left ventricular dysfunction in hypertensive subjects with preserved ejection fraction (>55%), identified by global parameters of myocardial strain on speckle tracking imaging.Methods This was a comparative observational study of two groups of individuals: normotensive (n=20, age 59±7 years, 55% male) and hypertensive (n=229, age 62±12 years, 57% male). Left ventricular function was assessed by various conventional clinical and echocardiographic parameters and global longitudinal and circumferential myocardial strain. Cut-off values to detect subclinical left ventricular dysfunction were established and applied in the hypertensive group. The Student's t test, Mann-Whitney test and chi-square test were used for the comparative statistical analysis.Results Most hypertensive subjects (53.7%) had grade I hypertension; blood pressure was controlled in 64.9%, and 54.8% showed left ventricular structural changes. Comparison between the normotensive and hypertensive groups showed no significant differences in parameters of global longitudinal or circumferential systolic strain. Application of the cut-offs to the hypertensive group identified 35 individuals (15.3%) as having subclinical left ventricular systolic dysfunction as assessed by global longitudinal myocardial strain parameters.Conclusions In this group of hypertensive patients, global myocardial strain parameters identified a group of individuals with subclinical left ventricular systolic dysfunction despite preserved ejection fraction. The clinical relevance of these findings needs to be assessed in long-term follow-up studies.     

Advanced speckle tracking echocardiography allowing a three-myocardial layer-specific analysis of deformation parameters

AIMS: Different layers of myocardium may contribute differently to myocardial deformation. Speckle tracking based on high resolution two-dimensional (2D) echocardiography has been used to define myocardial deformation parameters of whole left ventricular (LV) segments. This study evaluated with a Novell analysis modality allowing layer-specific analysis of deformation if there are differences in myocardial deformation between different layers of myocardium. METHODS AND RESULTS: In 30 normal subjects and 20 patients with impaired myocardial function 2D parasternal short-axis echocardiographic views of the LV were acquired at the basal, mid-papillary, and apical levels. Using a Novell automatic frame-to-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound, Haifa, Israel), circumferential strain (CS) and strain rate of the endocardial, mid-myocardial and epicardial layer was calculated for each LV segment in an 18-segment model. Wall motion for each segment was defined as normokinetic, hypokinetic, and akinetic based on 2D echocardiographic images. Peak systolic CS could be analysed in 837 segments (93%). In the normal subjects peak systolic CS was greatest in the endocardial layer, lower in the mid-myocardial layer, and lowest in the epicardial layer (38.1+/-9.0%, 28.9+/-9.3%, and 24.0+/-9.4%, respectively, P<0.001). In the patients with impaired LV function 151 segments were hypokinetic and 92 segments akinetic by visual analysis. In all myocardial layers peak systolic CS and strain rate decreased with decreasing segmental function. CONCLUSION: Decreasing myocardial deformation from endocardial to epicardial layers can be demonstrated with the use of an advanced analysis system allowing definition of deformation parameters for three myocardial layers. Myocardial deformation is reduced in all layers of segments with impaired wall motion.