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Growth hormone deficiency (GHD) in adults is associated with increased cardiovascular events, but detailed assessment of cardiac and vascular function is lacking. Thus we assessed cardiac, arterial, and endothelial functions, using conventional and speckle-tracking echocardiography, in adults with GHD compared with controls with similar cardiovascular risk.Fifty-two patients with GHD (47 ± 16 years; 34 men) and no cardiovascular disease or diabetes were enrolled prospectively and compared with 50 age- and sex-matched controls. Comprehensive echocardiography was performed in all participants. Regional left ventricular (LV) function was assessed from global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS), whereas LV torsion (LVtor) was calculated from basal (RotB) and apical (RotA) rotations. Arterial function was assessed from intima-media thickening, local wave speed, and beta index of stiffness, whereas endothelial function was assessed from flow-mediated dilation. Levels of pro-brain natriuretic peptide (proBNP) were measured.GLS and GCS were decreased more in patients with GHD than in controls (-17.2% ± 2.7% vs. -19.3% ± 3.3% and -15.9% ± 5.4% vs. -18.8% ± 3.5%; both P0.01), whereas GRS was similar. RotB and LVtor were also decreased in patients with GHD (-4.8° ± 2.6° vs. -6.2° ± 2.1°/cm and 1.8° ± 0.6° vs. 2.3° ± 1.1°/cm; both P0.05). ProBNP was increased in patients with GHD (61.0 ± 74 pg/dL vs. 24.7 ± 21 pg/dL; P = 0.002). Arterial and endothelial functions were similar between groups.In conclusion, adults with GHD had LV longitudinal dysfunction and increased proBNP levels compared with controls, suggesting intrinsic myocardial disease. Further studies are needed to assess if this cardiac impairment in adults with GHD is reversible after GH replacement.

Resumen Introduccion y objetivos La ecocardiografia con speckle tracking bidimensional es un nuevo instrumento para evaluar la funcion del miocardio. El objetivo de este estudio fue evaluar los parametros de rotacion y strain del ventriculo izquierdo mediante la ecocardiografia con speckle tracking bidimensional en un gran grupo de adultos sanos de una amplia gama de edades, con objeto de establecer los valores de referencia de dichos parametros y determinar la influencia de la edad, el sexo y los factores hemodinamicos. Metodos Se realizaron ecocardiografias transtoracicas a 247 voluntarios sanos (139 mujeres; media de edad, 44 ± 16 [intervalo, 18-80] anos). Efectuamos determinaciones de los valores de strain sistolico maximo longitudinal, circunferencial y radial, asi como de la rotacion y el giro del ventriculo izquierdo. Resultados Los valores medios de strain total longitudinal, radial y circunferencial fueron –21,5% ± 2,0%, 40,1 ± 11,8% y –22,2 ± 3,4%, respectivamente. El strain longitudinal fue significativamente mas negativo en las mujeres, mientras que el strain radial y el circunferencial y los parametros rotacionales fueron similares en ambos sexos. En consecuencia, los limites inferiores de la normalidad para los componentes del strain fueron –16,9% en los varones y –18,5% en las mujeres para el strain longitudinal, –15,4% para el strain circunferencial y 24,6% para el strain radial, con independencia del sexo. Los valores de strain longitudinal fueron mas negativos en la base que en los segmentos apicales. Los valores medios de la rotacion fueron–6,9 ± 3,5 ° en la base, 13,0 ± 6,5° para la rotacion apical y 20,0 ± 7,3° para el giro neto. Conclusiones Presentamos una evaluacion detallada de la deformacion normal del miocardio y la mecanica rotacional en una cohorte amplia de voluntarios sanos. Observamos que las mujeres presentan un strain longitudinal mas negativo, lo cual explica su mayor fraccion de eyeccion del ventriculo izquierdo. La disponibilidad de valores de referencia de esos parametros puede facilitar su aplicacion en la practica clinica habitual.

Introduction and objectives Two-dimensional speckle-tracking echocardiography is a novel tool to assess myocardial function. The purpose of this study was to evaluate left ventricular myocardial strain and rotation parameters by two-dimensional speckle-tracking echocardiography in a large group of healthy adults across a wide age range to establish their reference values and to assess the influence of age, sex, and hemodynamic factors. Methods Transthoracic echocardiograms were acquired in 247 healthy volunteers (139 women, 44 years [standard deviation, 16 years old] (range, 18-80 years). We measured longitudinal, circumferential, and radial peak systolic strain values, and left ventricular rotation and twist. Results Average values of global longitudinal, radial, and circumferential strain were -21.5% (standard deviation, 2.0%), 40.1% (standard deviation, 11.8%) and -22.2% (standard deviation, 3.4%), respectively. Longitudinal strain was significantly more negative in women, whereas radial and circumferential strain and rotational parameters were similar in both sexes. Accordingly, lower limits of normality for the strain components were -16.9% in men and -18.5% in women for longitudinal strain, and -15.4% for circumferential and 24.6% for radial strain, irrespective of sex. Longitudinal strain values were more negative at the base than at apical segments. Mean rotational values were -6.9 ° (standard deviation, 3.5 °) for the base, 13.0 ° (standard deviation, 6.5 °) for apical rotation, and 20.0 ° (standard deviation, 7.3 °) for net twist. Conclusions We report the comprehensive assessment of normal myocardial deformation and rotational mechanics in a large cohort of healthy volunteers. We found that women have more negative longitudinal strain, accounting for their higher left ventricular ejection fraction. Availability of reference values for these parameters may foster their implementation in the clinical routine. Full English text available from: www.revespcardiol.org/en. © 2013 Sociedad Española de Cardiología. Published by Elsevier España, S.L. All rights reserved.

Tricuspid valve (TV) anatomy and function play an important prognostic role in several heart diseases and in the development of functional tricuspid regurgitation. According to current guidelines for management of heart valve disease, the tricuspid annulus (TA) diameter measured by 2-dimensional

Background Intervendor consistency of left ventricular (LV) volume measurements using three-dimensional transthoracic echocardiography (3DTTE) has never been reported. Accordingly, we designed a prospective study to (1) compare head-to-head the accuracy of three three-dimensional echocardiography (3DE) systems in measuring LV volumes and ejection fraction (EF) against cardiac magnetic resonance (CMR); (2) assess the intervendor variability of LV volumes and EF; and (3) compare the accuracy of fully automated versus semiautomated (i.e., manually corrected) methods of LV endocardial delineation against CMR. Methods We studied 92 patients (64% males, 52 years [95% CI, 20-83]) with a wide range of end-diastolic volumes (from 87 to 446 mL) and EFs (from 16% to 77%) using three different 3DE platforms (iE33; Vivid E9; Acuson SC2000) during the same echo study. CMR was performed within 3 ± 5 hours from the 3DE study in 35 patients. Results LV volumes provided by the three 3DE systems correlated with CMR volumes: end-diastolic volume (iE33: R 2 = 0.93; E9: R 2 = 0.94; SC2000: R 2 = 0.94), end-systolic volume (iE33: R 2 = 0.93; E9: R 2 = 0.95; SC2000: R 2 = 0.94), and EF (iE33: R 2 = 0.79; E9: R 2 = 0.80; SC2000: R 2 = 0.77). In the 92 patients studied, LV volumes and EFs measured with the three systems were similar. Use of fully automated endocardial border detection algorithms significantly underestimated LV volumes, and the degree of underestimation was higher with larger LV volumes. Conclusions LV volumes and EFs measured with the three 3DE systems are consistent. Fully automated algorithms underestimated LV volumes. Our findings may help in the clinical interpretation of LV parameters obtained using different 3DE systems and encourage the clinical use of 3DTTE.

Background: Gestational hypertension (GHT) and preeclampsia (PE) are associated with a significant and early cardiovascular risk, however effect of these conditions on cardiac function is insufficiently studied. Methods: We performed a very detailed echo study to evaluate subclinical changes of