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Cardioembolic stroke is a serious disease with poor prognosis, whose main embolic source is the left atrial appendage (LAA). Left atrial (LA) strain evaluated by the two-dimensional (2D) speckle tracking technique has been proposed. However, the commonly used peak LA strain reflects only LA reservoir function. The LA strain also includes indicators of the other LA functions, such as booster pump function, which reflects active contraction of the LA. This study aimed to investigate whether a newly developed parameter, the left atrial strain time integral (LASTI), can evaluate LAA dysfunction more accurately in patients with acute stroke. We measured LA strain using a 2D speckle tracking method in 168 patients with acute stroke and 20 age-matched control subjects. LASTI was calculated as the area under the LA strain curve in one cardiac cycle. LAA dysfunction was defined as LAA thrombus and/or severe spontaneous echo contrast by transesophageal echocardiography. LASTI was significantly lower in patients with LAA dysfunction than those without. LASTI was a better correlation with LAA blood flow velocity measured by transesophageal echocardiography than peak LA strain. Multivariate logistic regression analysis showed that LASTI was an independent predictor of LAA dysfunction after adjustment for conventional risk factors. LASTI can be a feasible parameter for predicting LAA dysfunction in patients with acute stroke. [ABSTRACT FROM AUTHOR]

Background: The prognosis for inferior wall myocardial ischemia is better than that of other locations. Objective: The aim of the study was to assess the function of left and right ventricles (LV and RV) in patients with inferior wall perfusion defects. Subjects and methods: The present study included 112 patients with positive inferior wall perfusion defect by single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The echocardiography was done within one month after MPI. Results: There were decreased LV and RV functions as assessed by 2D speckle tracking echocardiography (2D-STE). and 3D echocardiography. The 2D-STE was able to identify subtle LV and RV dysfunction in about 72.5% and 40% respectively while with 3D echocardiography, LV and RV dysfunction was 75% and 46.2% respectively. Conclusion: SPECT as a non-invasive technique; is an important tool to detect extent of myocardial ischemia. 2D speckle tracking and 3D echocardiography are able to identify subclinical LV and RV dysfunction. [ABSTRACT FROM AUTHOR]

Fetal growth restriction (FGR) can result in adverse perinatal outcomes due to cardiac dysfunction. This study used 2D speckle-tracking echocardiography to assess left ventricle (LV) longitudinal strain across FGR severity stages. A prospective longitudinal cohort study measured global (GLS) and segmental LV longitudinal strain in FGR fetuses, with evaluations conducted at various time points. FGR was classified into subtypes based on published criteria using fetal weight centile and Doppler parameters. A linear mixed model was employed to analyze repeated measures and compare Z-score measurements between groups throughout gestational age. The study included 40 FGR fetuses and a total of 107 evaluations were performed: 21 from small for gestational age (SGA), 74 from the FGR stage I, and 12 from the FGR stage ≥ II. The results indicate that SGA and stage I FGR fetuses exhibit higher LV GLS than stages ≥ II. Throughout gestation, SGA and FGR stage I fetuses showed similar behavior with consistently better LV GLS values when compared to FGR stages ≥ II. No significant differences were observed in LV GLS strain behavior between SGA and FGR stage I. In conclusion, all FGRs show signs of early cardiac dysfunction, with severe cases demonstrating significantly a lower LV GLS when compared to mild cases, suggesting deterioration of cardiac dysfunction with progression of fetal compromise. [ABSTRACT FROM AUTHOR]

Arterial stiffness has received increasing interest as a cardiovascular marker in patients with aortic valve stenosis (AS). So far, studies on the impact of aortic valve replacement (AVR) on arterial stiffness have been equivocal. Two-dimensional speckle tracking (2DST) is a novel, non-invasive method to measure the motion of the vessel wall. In this prospective observational study, we aimed to assess the change in arterial stiffness of the common carotid artery (CCA) measured by 2DST in patients undergoing transcatheter aortic valve implantation (TAVI). A total of 47 patients were included in the study (age 80.04 ± 6.065 years). Peak circumferential strain (CS) was significantly improved after TAVI (4.50 ± 2.292 vs. 5.12 ± 2.958, p = 0.012), as was the peak strain rate (CSR) (0.85 ± 0.567 vs. 1.35 ± 0.710, p = 0.002). Body mass index (BMI), mean arterial pressure (MAP) and hemodynamic parameters were associated with this change. 2DST results did not correlate with aortic pulse wave velocity (aPWV) or augmentation index normalized to heart rate (AIx@75), suggesting a distinct difference between arterial stiffness of the CCA and other stiffness parameters. 2DST seems to be a promising new tool to assess arterial stiffness in TAVI patients. [ABSTRACT FROM AUTHOR]

Background: Chronic right ventricular (RV) apical pacing in patients with congenital complete atrioventricular block (CCAVB) is associated with left ventricle (LV) dyssynchrony and dysfunction. Hence, alternative pacing sites are advocated. The aim of this study was to compare LV function using STE in selected patients with LV epicardial pacing (LVEp) vs. RV transvenous pacing (RVSp). Methods: This was a single-center, retrospective study in patients with CCAVB who underwent permanent pacemaker implant at age ≤ 18 years. Age- and gender-matched patients with a normal heart anatomy and function served as the control group. LV function was comprehensively assessed by conventional 2D Echocardiography and speckle-tracking echocardiography (STE). Results: We included 24 patients in the pacemaker group [27.6% male, mean age of 17.1 at last follow-up, follow-up duration of 8.7 years, RVSp (n = 9; 62.5%)] compared to 48 matched healthy controls. Shortening fraction (SF) and ejection fraction (EF) were normal and similar between cases and controls. However, STE detected abnormal LV function in the pacemaker group compared to controls. The former demonstrated lower/abnormal, Peak Longitudinal Strain myocardial (PLS Myo) [− 12.0 ± 3.3 vs. − 18.1 ± 1.9, p < 0.001] and Peak Longitudinal Strain endocardial (PLS endo) [− 16.1 ± 4.1 vs. 1.7 ± 1.7, p < 0.001]. STE parameters of LV function were significantly more abnormal in LVEp vs. RVSp subgroup as demonstrated by lower values for PLS Myo (− 10.1 ± 3.2 vs. − 13.1 ± 2.9, p = 0.03) and PLS Endo (− 13.8 ± 4.4 vs. − 17.5 ± 3.3, p = 0.03). Conclusion: STE was more sensitive in detecting subtle differences in LV function relative to standard conventional 2D echocardiography (SF and EF) in selected patients with CCAVB and a permanent pacemaker. Furthermore, STE demonstrated that transvenous RV septal pacing was associated with better LV systolic function preservation than LV epicardial pacing for comparable post-implant intervals. [ABSTRACT FROM AUTHOR]

Fetal growth restriction (FGR) is associated with an increased risk of adverse outcomes resulting from adaptive cardiovascular changes in conditions of placental insufficiency, leading to cardiac deformation and dysfunction, which can be evaluated with 2D speckle tracking echocardiography (2D-STE). The aim of the present study was to evaluate whether reduced fetal growth is associated with cardiac left-ventricle (LV) dysfunction, using 2D-STE software widely used in postnatal echocardiography. A prospective longitudinal cohort study was performed, and global (GLO) and segmental LV longitudinal strain was measured offline and compared between FGR and appropriate-for-gestational-age (AGA) fetuses throughout gestation. All cases of FGR fetuses were paired 1:2 to AGA fetuses, and linear mixed model analysis was performed to compare behavior differences between groups throughout pregnancy. Our study shows LV fetal longitudinal strain in FGR and AGA fetuses differed upon diagnosis and behaved differently throughout gestation. FGR fetuses had lower LV strain values, both global and segmental, in comparison to AGA, suggesting subclinical cardiac dysfunction. Our study provides more data regarding fetal cardiac function in cases of placental dysfunction, as well as highlights the potential use of 2D-STE in the follow-up of cardiac function in these fetuses. [ABSTRACT FROM AUTHOR]

Right heart failure (HF) is a poor prognostic factor in patients with HF. The right atrial (RA) function has attracted less attention than the right ventricular (RV) function. The association of RA reservoir strain evaluated by 2D speckle-tracking echocardiography (2DSTE) with clinical outcomes in patients with HF remains unclear. We prospectively enrolled patients with HF admitted to our hospital. We measured the RA, RV, left atrial (LA), and left ventricular (LV) strain using 2DSTE before discharge. The RA reservoir strain (RASr) was measured in the global right atrium. The primary endpoints were cardiac death and worsening of HF requiring rehospitalization or intravenous diuretics. Among 226 patients with HF, 72 primary endpoints were recorded during a median follow-up period of 1081 days. Kaplan–Meier analysis showed a higher cardiac event rate in the low RASr group than in the high RASr group (P = 0.0089). Multivariate Cox hazard analysis showed that RASr was independently associated with cardiac events after adjusting for confounding factors [hazard ratio (HR) 0.71; 95% confidence interval (CI) 0.51–0.96; P = 0.0347]. Decreased RASr could be a feasible marker of cardiac events in patients with HF. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to construct gestational age (GA) based reference values for left ventricle (LV) longitudinal strain in normal fetuses, between 24 and 37 weeks' gestation, assessing its feasibility and reproducibility with automated cardiac motion quantification software (aCMQ-QLab), which is widely used in postnatal echocardiography. Methods: This prospective study included healthy gravid women with singleton pregnancies and no evidence of fetal structural cardiovascular disease. Fetal echocardiographies were performed between 24 and 37 GA. 2D four-chamber view clips were recorded and LV longitudinal strain was analyzed offline. Intra- and interobserver reproducibility between 2 independent observers was evaluated by intraclass correlation coefficients (ICC) and Bland-Altman scatterplots. Regression analysis was used to determine GA adjusted reference ranges and construct nomograms. Results: LV longitudinal strain measurements were feasible in 95.4% of acquisitions. 435 clips were obtained. Intra- and interobserver ICC were 0.998 (95% CI 0.997–0.999) and 0.991 (95% CI 0.984–0.995), respectively. The global longitudinal strain and the middle and apical LV segments showed progressive decline as GA advanced, whereas the basal segments remained stable. Conclusions: Assessment of LV longitudinal strain by aCMQ-QLab is feasible, reproducible, and within normal ranges. Our results offer more information regarding fetal cardiac function assessment with 2D speckle tracking techniques, aiding in the introduction of this software into research practice, encouraging the realization of more studies, and probably helping in its future use in clinical practice, allowing longitudinal surveillance of strain without intervendor variability and aiding in follow-up of fetal cardiac conditions before and after birth, as it is the most commonly used software postnatally. [ABSTRACT FROM AUTHOR]

Background: Calcific aortic stenosis (AS) is the most common form of valvular heart disease in developed countries. Patients with severe aortic stenosis and a preserved LV ejection fraction have impaired global longitudinal strain (GLS). Objective: This study aimed toassess the prognostic value of global left ventricular strain using 2-dimensional speckle tracking for patients with severe asymptomatic aortic stenosis and its correlation with appearance of symptoms and or major adverse cardiovascular events (MACE). Patients and Methods:A total 160 patients were included in this observational study, 80 patients with isolated senile degenerative severe aortic valve stenosis, all patients were asymptomatic at the beginning of the study and furthermore, we subdivided the patient group into 2 subgroups: patients who developed symptoms and those who remained asymptomatic. 80 normal healthy age and sex matched subjects. All subjects were evaluated by history taking, clinical examination, routine laboratory investigations and a 12-lead ECG. Conventional echo was performed on all patients to assess left ventricular function and aortic valve parameters. Peak systolic strain was measured from the mean strain profile for a total of 17 segments of the left ventricle for the longitudinal strain, then Global longitudinal strain was calculated separately as the average of the sum of the studied segments. All patients were followed up clinically and the development of any symptom of the cardinal symptoms of aortic stenosis was recorded. Results: By comparing the global longitudinal strain in the two groups, the mean GLS in the patient group was -18.70 ± 2.08 % ranging from -23 to -15 % and in the control group the mean GLS was -22.50 ± 1.13 % ranging from -24 to -21 %, showing statistical significance between both groups. The mean GLS in the subgroup of patients who developed symptoms was -17.81 ± 1.10 % ranging from - 19.0 - -15.0 % and the mean GLS in the subgroup of patients who remained asymptomatic was -21.78 ± 1.66 % ranging from -23 to -18 %, there was a statistical significance between both subgroups. Conclusion:Asymptomatic severe aortic stenosis is not always as benign as it seems to be and although severe aortic stenosis may remain silent for a long period, life expectancy is seriously reduced after development of symptoms. Global Longitudinal strain (GLS) can be used in assessment of severe AS due to its robust diagnostic and prognostic values over standard echocardiography. [ABSTRACT FROM AUTHOR]

Left atrial (LA) functional remodeling as well as LA structural remodeling are associated with incident LA appendage (LAA) thrombus formation. This study aimed to elucidate whether combined assessment of LA functional and structural remodeling can predict LAA dysfunction and recurrent cerebrovascular events in patients with acute ischemic stroke. We performed transthoracic and transesophageal echocardiography in 196 patients within 7 days after acute ischemic stroke. Peak systolic LA strain was evaluated using 2D speckle tracking imaging. We defined the ratio of LA peak systolic strain to LA volume index (LAVI) as the LA remodeling index (LARI). All patients were prospectively followed for recurrent cerebrovascular events. We divided patients into four groups according based on the LARI quartile. LAA dysfunction increased with decreasing LARI. In total, 52 recurrent cerebrovascular events were noted during the median follow-up period of 700 days. Patients with recurrent cerebrovascular events had lower LARI than those without recurrent events (0.50 ± 0.45 vs. 1.10 ± 0.95, P < 0.001). Kaplan–Meier analysis showed that patients with lower LARI were more susceptible to recurrent cerebrovascular events than those with higher LARI. Multivariate Cox proportional hazard regression analysis showed that LARI was an independent predictor of recurrent cerebrovascular events after adjustment for confounding factors. Net reclassification index improved with the addition of LARI to basic predictors. LARI is a novel feasible parameter for LAA dysfunction and can predict recurrent cerebrovascular events in patients with acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Summary: The presence of circulating gas bubbles and their influence on pulmonary and right heart hemodynamics was reported after uncomplicated self‐contained underwater breathing apparatus (SCUBA) dive(s). Improvements in cardiac imaging have recently focused great attention on the right ventricle (RV). The aim of our study was to evaluate possible effects of a single air SCUBA dive on RV function using 2D speckle tracking echocardiography in healthy divers after single open sea dive to 18 meters of seawater, followed by bottom stay of 47 minutes with a direct ascent to the surface. Twelve experienced male divers (age 39.5 ± 10.5 years) participated in the study. Echocardiographic assessment of the right ventricular function (free wall 2 D strain, tricuspid annular planes systolic excursion [TAPSE], lateral tricuspid annular peak systolic velocity [RV s`] and fractional area change [FAC]) was performed directly prior to and 30, 60, 90 and 120 minutes after surfacing. Two‐dimensional strain of all three segments of free right ventricular wall showed a significant increase in longitudinal shortening in post‐dive period for maximally 26% (basal), 15.4% (mid) and 16.3% (apical) as well as TAPSE (11.6%), RV FAC (19.2%), RV S` (12.7%) suggesting a rise in systolic function of right heart. Mean pulmonary arterial pressure (mean PAP) increased post‐dive from 13.3 mmHg to maximally 23.5 mmHg (P = .002), indicating increased RV afterload. Our results demonstrated that single dive with significant bubble load lead to increase in systolic function and longitudinal strain of the right heart in parallel with increase in mean PAP. [ABSTRACT FROM AUTHOR]

Purpose: Recent development in anticancer therapies for breast carcinoma allowed an improvement in patients' survival, notwithstanding a parallel increase of cardiovascular morbidity. Cardiotoxicity of anticancer therapies represents a relevant problem due to its insidious onset and potentially irreversible cardiac damage. The aim of the present study was to test whether 2D speckle tracking analysis can help in predicting overt systolic dysfunction.Methods: A "real world" cohort of 69 patients with breast carcinoma undergoing adjuvant and/or neo-adjuvant chemotherapy was tested 2D-speckle tracking analysis before the beginning of chemotherapy and every 3 months for 1 year. Clinical data, 12-lead ECGs, and lab tests were collected according to the same visit protocol.Results: Over 1-year follow-up, 19 patients (27 %) developed cardiac dysfunction according to the CREC criteria, with an average onset time from enrolment of 6.8 months. A global longitudinal strain (GLS) threshold ≥-16 % at 3 months from chemotherapy was able to predict subsequent systolic dysfunction development with high sensitivity (80 %) and specificity (90 %) and a negative predictive value of 92 %. After the introduction of cardioprotective drugs, left ventricular ejection fraction (LVEF) progressively recovered, while alterations of GLS persisted at 1-year follow-up.Conclusions: Strain imaging with 2D speckle tracking allows the identification of patients at low-risk for chemotherapy-related systolic dysfunction and can help optimizing resources allocations and improving follow-up quality. GLS can also provide a more accurate prognostic index of resolved systolic dysfunction when compared to standard LVEF. [ABSTRACT FROM AUTHOR]

Background The reference values and impact of physiologic variables on echocardiographic quantification of left ventricular (LV) longitudinal and circumferential layer-specific myocardial strains in large series of healthy persons remain unknown. This study prospectively investigated the impact of age, gender, and other physiologic parameters on LV longitudinal and circumferential layer-specific myocardial strains. Methods 119 healthy volunteers (age range, 22-76; 50% women) underwent echocardiography. Short-axis (for circumferential strain) and apical (for longitudinal strain) views were analyzed using modified speckle tracking software enabling the analysis of strains in three myocardial layers. Results In normal subjects, longitudinal and circumferential strain was highest in the endocardium and lowest in the epicardium, longitudinal and circumferential three-layer strain was highest in the apex and lowest in the base. The mean global longitudinal strain in the endocardial layer (GLS-endo), in the mid-myocardial layer (GLS-mid) and in the epicardial layer (GLS-epi) were −24.3 ± 3.1%, −21.3 ± 2.9%, and −18.9 ± 2.8%, respectively. Gender, HR, and SV (stroke volume) were independent predictors of GLS-endo, GLS-mid, and GLS-epi. The mean global circumferential strain in the endocardial layer (GCS-endo), in the mid-myocardial layer (GCS-mid) and in the epicardial layer (GCS-epi) were −34.3 ± 4.4%, −20.5 ± 3.0%, and −11.8 ± 2.7%, respectively. HR independently predicted GCS-endo, GCS-mid, and GCS-epi. Conclusions Three-layer analysis of longitudinal and circumferential strain using two-dimensional speckle tracking imaging (2DSTI) can be performed on a clinical basis and may become an important method for the assessment of real time, quantitative global, and regional LV function. [ABSTRACT FROM AUTHOR]

The Achilles tendon consists of three subtendons, but their functional meaning is still unknown. There are several approaches for the examination in-vivo using sonographic imaging, however, there is no approach for in-vivo examination with respect to the single subtendons of the m. triceps surae. The study's aim was to reveal the single subtendons of the m. triceps surae. The Achilles tendon of 17 subjects was analysed. The muscles (m. gastrocnemius lateralis and medialis) were stimulated separately using neuromuscular electrical stimulation. The intensity of muscle contraction was controlled using electromyographic data. Sonographic videos of the Achilles tendon were recorded during muscle contraction. A speckle tracking algorithm was used to analyse the moving areas within the Achilles tendon during the initial phase of contraction. The muscles were activated at 10–20% of the maximal M-wave. Isolated contraction of m. gastrocnemius lateralis led to local displacement in the lateral part of the Achilles tendon's cross-section whereas isolated contraction of m. gastrocnemius medialis led to displacement in the medial part and to a larger size of the area where initial displacement took place (m. gastrocnemius lateralis to medialis approximately 1:2). The results demonstrate that isolated contractions of m. gastrocnemius lateralis and medialis lead to individual displacements which significantly differ. The differences in position and size of the area of the local displacement indicate an independent individual function. Unlike other studies generally investigating the AT in-vivo using muscle stimulation and ultrasonic imaging, this study investigated the AT's cross-section which had never been investigated before. • Achilles tendon subtendon representation was examined in-vivo. • Novel method combines sonographic imaging and neuromuscular electrical stimulation. • Isolated contractions led to individual displacement within the Achilles tendon. • Differences could be observed in terms of position and size of area of displacement. [ABSTRACT FROM AUTHOR]

Background: Assessment of left ventricular (LV) systolic function can be achieved by conventional echocardiographic methods, but quantification of contractility, regional myocardial function, and ventricular synchrony is challenging. The goal of this study was to investigate the applicability of two-dimensional speckle tracking (2DST) to characterize segmental and global wall motion for assessment of LV function and LV synchrony in healthy goats. We aimed to describe the techniques, report normal values of a variety of 2DST indices, and determine the influence of general anesthesia. Methods: Prospective study on 22 healthy female Saanen goats (3.7 ± 1.1 y, 60.2 ± 10.5 kg [mean ± SD]). All goats underwent two transthoracic echocardiographic examinations, the first standing and unsedated and the second 7.4 ± 3.5 days later during isoflurane anesthesia and positioned in sternal recumbency. Data analyses were performed offline, blinded, and in random order. Left ventricular longitudinal, radial and circumferential strain and strain rate as well as longitudinal and radial displacement were measured using 2DST methods. Summary statistics were generated and differences of 2DST variables between myocardial segments and treatments (i.e., awake vs. anesthetized) were assessed statistically (alpha level=0.05). Results: Echocardiographic analyses by 2DST were feasible in all goats and at both time points. Longitudinal systolic strain, strain rate and displacement followed a gradient from apex to base. Absolute systolic strain was generally lower and strain rate was higher in awake goats compared to anesthetized goats. Circumferential and radial indices did not consistently follow a segmental pattern. Generally, peak strain occurred later in anesthetized goats compared to awake goats. General anesthesia did not significantly influence LV synchrony. Conclusions: 2SDT is a valid method for non-invasive characterization of LV wall motion in awake and anesthetized goats. The results of this study add to the understanding of LV mechanical function, aid in the diagnosis of global and segmental LV systolic dysfunction, and will be useful for future cardiovascular studies in this species. However, effects of anesthesia and species-specific characteristics should be considered when goats are used as animal models for human disease. [ABSTRACT FROM AUTHOR]

Background: The prognostic significance of left atrial (LA) size on cardiovascular outcome is now well recognised in literature. Balloon mitral valvotomy (BMV) can reduce complications and improve outcome in rheumatic patients. On long term follow up in rheumatic mitral stenosis patients after BMV, left atrial volumes were shown to decrease. Methods: This is a prospective study that enrolled 54 patients who undergone successful BMV. Longitudinal Left atrial function was evaluated by speckle tracking derived strain. Left atrial volumes were measured before valvotomy, after the procedure and after 12 months during follow-up. The effect of transmitral pressure gradient drop after balloon mitral valvotomy on left atrial strain was studied. In addition the relation between post-procedural increase of LA strain and left atrial volumes after 12 months was also evaluated. Results: There is significant reduction of mean trans-mitral pressure gradient from 13.104 ± 4.694 to 4.067±1.502 mmHg and significant improvement of mitral valve area from 1.0217 ±0.1178 to 1.766 ± 0.2307cms2 after the procedure (P value < 0.001). The mean peak longitudinal left atrial strain was much improved after BMV from 19.80±9.66 % to 34.39±12.86%. This difference was statistically highly significant. (P value was <0.0001). The percent improvement of left atrial longitudinal strain correlated significantly with mean trans-mitral pressure gradient drop. Also left atrial mean peak left atrial longitudinal strain correlated significantly with left atrial volumes reductions after 12 months. Conclusions: Successful BMV results in reduction of mean left atrial volumes after 12 months which is well correlated with PALS percent change after BMV. [ABSTRACT FROM AUTHOR]

We evaluated the interaction of left atrial and ventricular diastolic performance in asymptomatic children and young adults after ToF-repair (n=25). Those young people, as well as 25 age matched healthy children and young adults were examined using non-invasive conventional echocardiography. Regional systolic and diastolic myocardial strain and strain rate in left atrium and ventricle were analysed using 2D-speckle-tracking (Vivid VII, EchoPacGE). We collected planimetric data about the left atrial and ventricular performance during systole (volumetric LVEF, LV-Tei-Index, MV-E/E'-Ratio) and diastole (LAEF, LVEDV, left atrial volume). Registration of right pulmonary-venous inflow-patterns during ventricular systole, diastole and active atrial contraction was used to support assessment of left atrial function. To verify the timing of left atrial contraction and possible electromechanical delay we measured several ECG-related time-intervals. Statistical analysis included Mann-Whitney-U-Test, Bonferroni-Holm-Test and two-tailed Spearman-Correlation. Systolic pulmonary-venous inflow in ToF-patients was not different compared to the controls. Early diastolic pulmonary-venous inflow was significantly higher in ToF-patients as well as the LV-Tei-Index. The MV-E/E'-ratio, which is closely related to LVEDP, was significantly higher in ToF-patients and correlated with the early diastolic pulmonary venous inflow parameters such as the maximum diastolic bloodflow speed. Diastolic left atrial and ventricular strain and strain rate in ToF-patients did not differ from those in the controls. During late diastole there was a significantly premature timing of maximum myocardial strain rate of the interatrial septum and time-ratio of P-wave origin to maximum reverse pulmonary-venous blood flow and the duration of one heart action. Furthermore the maximum late diastolic reverse pulmonary-venous blood flow was significantly higher in ToF-patients. Those observations indicate a premature active left atrial contraction in late diastole in ToF-patients compared to the controls. In asymptomatic young patients after ToF-repair earlier and increased left atrial contraction was found, which may indicate adaptive compensatory mechanisms to overcome latent and asymptomatic altered systolic and diastolic left ventricular performance. Extensive assessment of left atrial parameters including the pulmonary veins should be considered in terms of an entire evaluation of left heart function in patients after ToF-repair. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of cardiac function in the fetal heart is challenging because of its small size and high heart rate, restricted physical access to the fetus, and impossibility of fetal ECG recording. We aimed to standardize the acquisition and postprocessing of fetal echocardiography for deformation analysis and to assess its feasibility, reproducibility, and correlation for longitudinal strain and strain rate measurements by tissue Doppler imaging (TDI) and 2D speckle tracking (2D-strain) during pregnancy. Methods: Echocardiography was performed in 56 fetuses. 2D and color TDI in apical or basal four-chamber views were recorded for subsequent analysis. Caution was taken to achieve a frame rate >70 Hz for speckle tracking and >150 Hz for TDI analysis. For each acquisition, 7.5 s of noncompressed data were stored in cine loop format and analyzed offline. Since fetal ECG information is by definition not available, aortic valve closure was marked from aortic flow and the onset of each cardiac cycle was manually indicated in the 2D images. Sample volume length was standardized at the minimum size. Two observers measured the left and right ventricular peak systolic longitudinal strain and strain-rate. Results: Strain and strain rate measurements were feasible in 93% of the TDI and 2D-strain acquisitions. The mean time spent on analyzing TDI images was 18 min, with an intraclass agreement coefficient of 0.86 (95% CI 0.77-0.92), 0.83 (95% CI 0.72-0.90), 0.96 (95% CI 0.93-0.98), and 0.86 (95% CI 0.76-0.92) for basal left and right free wall peak systolic strain and strain rate, respectively. Agreement between observers using tissue Doppler also showed high reliability. The mean time spent for 2D-strain analysis was 15 min, with an intraclass agreement coefficient of 0.97 (95% CI 0.95-0.98), 0.94 (95% CI 0.89-0.96), 0.96 (95% CI 0.93-0.98), and 0.84 (95% CI 0.73-0.90) for basal left and right free wall peak systolic strain and strain rate, respectively. Agreement between observers also showed a high reliability that was similar for TDI and 2D-strain. There was a weak correlation between TDI and 2D-strain measurements. Conclusions: A standard protocol with fixed acquisition and processing settings, including manual indication of the timing events of the cardiac cycle to correct for the lack of ECG, was feasible and reproducible for the evaluation of longitudinal ventricular strain and strain rate of the fetal heart by TDI as well as 2D-strain analysis. However, both techniques are not interchangeable as the correlation between them is relatively poor. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Two-dimensional (2D) speckle tracking (2DST) is a new technique independent of ventricular geometry but not independent of preload and afterload. Using 2DST, this study aimed to investigate differences in right ventricular (RV) function and intraventricular dyssynchrony in patients with hypoplastic left heart syndrome (HLHS) before and after preload-reducing stage 2 palliation. For 31 HLHS patients, this study compared global longitudinal strain (S) and strain rate (SR) as well as regional peak systolic longitudinal S, SR, and velocity (V) in six RV segments on echocardiograms before and after stage 2 surgery. Intraventricular dyssynchrony was assessed by calculating the standard deviation of the intervals from the beginning of systole to peak S, SR, and V. Global S (−16.7 ± 5.0 vs −15.6 ± 5.5%) and global SR (−1.2 ± 0.3 vs −1.2 ± 0.3 s) did not change after surgery. After surgery, V decreased in the mid lateral segment (2.3 ± 1.3 vs 1.7 ± 0.9 cm/s; p = 0.01) and the basal lateral segment (3.6 ± 1.1 vs 2.8 ± 1.0 cm/s; p = 0.001), whereas S was lower in both of these segments (−19.9% ± 6.0% vs −17.4% ± 6.3%; p = 0.01 and 20.0 ± 5.1 vs 15.8 ± 7.1%; p = 0.002, respectively). Segmental SR and dyssynchrony did not change. Decreased V and S in the RV free wall could be explained by reduced preload of the systemic RV after stage 2 palliation. [ABSTRACT FROM AUTHOR]

We assessed myocardial deformation in sub-endocardial and sub-epicardial layers of the left ventricle (LV) wall before and after running a marathon. Echocardiography scans were performed on 14 male, non-elite runners (mean +/- SD; age 32 +/- 10 years) who completed the 42.2-km London marathon. Para-sternal short axis and apical four-chamber views were recorded for off-line analysis. Peak longitudinal, radial and circumferential strains, peak systolic and early diastolic strain rates were recorded. Circumferential rotation in basal and apical LV scans was used to calculate torsion. Pre-race strain and strain rates were generally greater in the sub-endocardial layer of the LV wall. After race completion, a mixed pattern of change was observed with a reduction in sub-epicardial radial strain (32.6 +/- 12.5 to 20.3 +/- 9.6%; P < 0.01) and sub-endocardial circumferential strain (-26.9 +/- 3.6 to -23.7 +/- 4.1%; P < 0.01) at the apex. Rotation was not altered at either the apical or basal levels and thus torsion was not changed in either the sub-endocardium (6.72 +/- 3.46 degrees to 5.67 +/- 4.98 degrees) or the sub-epicardium (3.48 +/- 2.68 degrees to 3.01 +/- 3.23 degrees). Strain rates and rotation rates were only sporadically altered post-race. There are differences in deformation characteristics between the sub-endocardium and sub-epicardium at baseline, and the limited changes observed post-race were not specific to any region or depth of the LV wall. [ABSTRACT FROM AUTHOR]

Objective: To evaluate left ventricular (LV) dyssynchrony in patients with left ventricular hypertrophy (LVH), and to compare abnormalities associated with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) using 2D speckle tracking imaging. Methods: Basal, middle, and apical 2D LV short-axis images were acquired in 43 patients with LVH including 20 with HCM and 23 with HHD, and in 15 age-matched controls. Radial strain, circumferential strain, time interval from the R-wave to peak radial strain (Trs), and time to peak circumferential strain (Tcs) were measured in six equidistant segments at each level of the 3 LV short-axis views using 2D speckle tracking analysis. To assess LV dyssynchrony, Trs(cs)-18SD, the standard deviation (SD) of Trs(cs) in all 18 segments, was calculated. Results: Regional radial strain in the middle and apical short-axis segments was significantly less in patients with HCM than in those with HHD. Regional circumferential strain in the apical short-axis segments was also less in HCM. Trs-18SD and Tcs-18SD were significantly longer in patients with HCM than in age-matched controls and patients with HHD (Trs-18SD: HCM: 88 ± 32 ms, HHD: 51 ± 20 ms, control: 45 ± 12 ms P < 0.001, Tcs-18SD: HCM: 71 ± 27 ms, HHD: 46 ± 14 ms, control: 45 ± 14 ms P < 0.001). Conclusions: The presence of LVH is thus not always associated with LV dyssynchrony. However, the greater reduction of regional strain and severe LV dyssynchrony in HCM may contribute to the adverse cardiovascular outcomes associated with this disease. [ABSTRACT FROM AUTHOR]

Introduction: The function descriptors and size of the left atrium are commonly found in inversely proportional terms. Enlarged left atrium is the most common predictor of adverse cardiovascular event.1 Professional athletes are exposed to great physical exertion that leads to cardiac remodeling as a consequence of hemodynamic adaptation. Large meta-analyses confirmed that the linear dimensions and volume of the LA are significantly higher in athletes while the assessment of function is significantly more complex2. Patients and Methods: The aim of the study was to compare the difference between let atrium size and function in professional athletes and healthy people. The sample included 20 healthy individuals (17 female and 3 male), divided into two groups: athletes (N=12) and control. The size of the left atrium was measured linearly using M mode and 2D, and by using biplane method from an apical position. All patients also underwent pulse and tissue Doppler and 2D speckle tracking analysis of left atrium. The following parameters were included: body surface area, left atrium diameter in M mode, left atrium endsystolic volume index, left ventricular mass index, mitral valve E wave velocity/mitral A wave velocity ratio, deceleration time, mitral valve E wave velocity/e’ wave velocity lateral ratio, pulmonary vein systolic wave velocity/diastolic wave velocity ratio, pulmonary vein reversal A wave duration/ mitral valve A wave duration ratio, left atrium strain average reservoir, left atrium strain average conduit, left atrium strain average conduit contraction, and left ventricular global longitudinal strain. All exams were done on Philips Epiq 7G, and quantified off-line by Philips QLAB Autostrain. Results: Statistically significant difference between two groups was identified for variables: mitral valve E wave velocity/mitral A wave velocity ratio, left atrium strain average reservoir, left atrium strain average conduit. For all three variables the values were higher in the athletes group. Conclusion: Our study did not show difference in size of the left atrium between two groups. Significantly higher values of global deformation of the left atrium, represented by the average value of the reservoir function, the average conduit strain and the mitral valve E wave velocity/mitral A wave velocity ratio, were noticed in the athletes group. We infer the cause lies in the better compliance of LA, associated with increased left atrium passive emptying volumes3. Introduction: The function descriptors and size of the left atrium are commonly found in inversely proportional terms. Enlarged left atrium is the most common predictor of adverse cardiovascular event.1 Professional athletes are exposed to great physical exertion that leads to cardiac remodeling as a consequence of hemodynamic adaptation. Large meta-analyses confirmed that the linear dimensions and volume of the LA are significantly higher in athletes while the assessment of function is significantly more complex2. Patients and Methods: The aim of the study was to compare the difference between let atrium size and function in professional athletes and healthy people. The sample included 20 healthy individuals (17 female and 3 male), divided into two groups: athletes (N=12) and control. The size of the left atrium was measured linearly using M mode and 2D, and by using biplane method from an apical position. All patients also underwent pulse and tissue Doppler and 2D speckle tracking analysis of left atrium. The following parameters were included: body surface area, left atrium diameter in M mode, left atrium endsystolic volume index, left ventricular mass index, mitral valve E wave velocity/mitral A wave velocity ratio, deceleration time, mitral valve E wave velocity/e’ wave velocity lateral ratio, pulmonary vein systolic wave velocity/diastolic wave velocity ratio, pulmonary vein reversal A wave duration/ mitral valve A wave duration ratio, left atrium strain average reservoir, left atrium strain average conduit, left atrium strain average conduit contraction, and left ventricular global longitudinal strain. All exams were done on Philips Epiq 7G, and quantified off-line by Philips QLAB Autostrain. Results: Statistically significant difference between two groups was identified for variables: mitral valve E wave velocity/mitral A wave velocity ratio, left atrium strain average reservoir, left atrium strain average conduit. For all three variables the values were higher in the athletes group. Conclusion: Our study did not show difference in size of the left atrium between two groups. Significantly higher values of global deformation of the left atrium, represented by the average value of the reservoir function, the average conduit strain and the mitral valve E wave velocity/mitral A wave velocity ratio, were noticed in the athletes group. We infer the cause lies in the better compliance of LA, associated with increased left atrium passive emptying volumes3. [ABSTRACT FROM AUTHOR]

Background: Intraoperative or post procedure right ventricular (RV) dysfunction confers a poor prognosis in the post-operative period. Conventional predictors for RV function are limited due the effect of cardiac surgery on traditional RV indices; novel echocardiographic techniques hold the promise to improve RV functional stratification.Methods: Comprehensive echocardiographic data were collected prospectively during elective cardiac surgery. Tricuspid annular plane systolic excursion (TAPSE), peak RV systolic velocity (S'), and RV fractional area change (FAC) were quantified on transesophageal echo (TEE). RV global and regional (septal and free wall) longitudinal strain was quantified using speckle-tracking echo in RV-focused views. Two intraoperative time points were used for comparison: pre-sternotomy (baseline) and after chest closure.Results: The population was comprised of 53 patients undergoing cardiac surgery [15.1% coronary artery bypass graft (CABG) only, 28.3% valve only, 50.9% combination (e.g. valve/CABG, valve/aortic graft) surgeries], among whom 38% had impaired RV function at baseline defined as RV FAC < 35%. All conventional RV functional indices including TAPSE, S' and FAC declined immediately following CPB (1.5 ± 0.3 vs.1.1 ± 0.3 cm, 8.0 ± 2.1 vs. 6.2 ± 2.5 cm/s, 36.8 ± 9.3 vs. 29.3 ± 10.6%; p < 0.001 for all). However, left ventricular (LV) and RV hemodynamic parameters remained unchanged (LV ejection fraction (EF): 56.8 ± 13.0 vs. 55.8 ± 12.9%; p = 0.40, pulmonary artery systolic pressure (PASP): 26.5 ± 7.4 vs 27.3 ± 6.7 mmHg; p = 0.13). Speckle tracking echocardiographic data demonstrated a significant decline in RV global longitudinal strain (GLS) [19.0 ± 6.5 vs. 13.5 ± 6.9%, p < 0.001]. Pre-procedure FAC, GLS and free wall strain predicted RV dysfunction at chest closure (34.7 ± 9.1 vs. 41.6 ± 8.1%, p = 0.01, 17.7 ± 6.5 vs. 21.8 ± 5.4%; p = 0.03, 20.3 ± 6.4 vs. 24.2 ± 5.8%; p = 0.04), whereas traditional linear RV indices such as TAPSE and RV S' at baseline had no impact on intraoperative RV dysfunction (p = NS for both).Conclusions: Global and regional RV function, as measured by 2D indices and strain, acutely decline intraoperatively. Impaired RV strain is associated with intraoperative RV functional decline and provides incremental value to traditional RV indices in predicting those who will develop RV dysfunction. [ABSTRACT FROM AUTHOR]

Background: Non-invasive imaging tests are widely used in the evaluation of stable angina pectoris (SAP). Despite these tests, non-significant coronary lesions are not a rare finding in patients undergoing elective coronary angiography (CAG). Two-dimensional (2D) speckle tracking global longitudinal strain (GLS) imaging is a more sensitive and accurate technique for measuring LV function than conventional 2D methods. Layer-specific strain analysis is a relatively new method that provides endocardial and epicardial myocardial layer assessment. The aim of the present study was to evaluate longitudinal layer-specific strain (LSS) imaging in patients with suspected SAP.Methods: Patients who underwent CAG for SAP were retrospectively screened. A total of 79 patients with no history of heart disease and wall motion abnormalities were included in the study. Forty-three patients with coronary lesions > 70% constituted the coronary artery disease (CAD) group and 36 patients without significant CAD constituted the control group. Layer-specific GLS transmural, endocardium, and epicardium values (GLS-trans, GLS-endo, and GLS-epi, respectively) were compared between the groups.Results: Patients in the CAD group had significantly lower GLS values in all layers (GLS-trans: -18.2 + 2.4% vs -22.2 + 2.2% p < .001; GLS-endo: -20.8 + 2.8% vs -25.3 + 2.6%, p < .001; GLS-epi: 15.9 + 2.4% vs -19.5 + 1.9%, p < .001). Multivariate adjustment demonstrated GLS-trans as the only independent predictor of CAD [OR:0.472, CI (0.326-0.684), p < .001]. Additionally, the GLS values were all lower in myocardial perfusion scintigraphy (MPS) true-positive patients compared with MPS false-positive patients (GLS-trans: -17.7 ± 2.4 vs. -21.9 ± 2.4%, p < .001; GLS-endo: -20.2 ± 2.9% vs -24.9 ± 2.9%, P < .001; GLS-epi: 15.4 ± 2.6% vs. -19.2 ± 1.8%, P < .001).Conclusion: Resting layer-specific strain as assessed by 2D speckle tracking analysis demonstrated that GLS values were reduced in all layers of myocardium with SAP and with no wall motion abnormalities. LSS analysis can improve the identification of patients with significant CAD but further prospective larger scale studies are needed to put forth the incremental value of LSS analysis over transmural GLS. [ABSTRACT FROM AUTHOR]