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Introduction: Similarly to the ventricles, the atria are under sympathetic/parasympathetic neural regulation. Accordingly, correlations were investigated between Ewing's standard cardiovascular reflex tests (SCRTs) and three‐dimensional speckle‐tracking echocardiography (3DSTE)‐derived right atrial (RA) volumes and strains in healthy subjects. Materials and Methods: The study comprised 45 healthy adults, but 5 subjects were excluded due to inferior image quality for 3DSTE‐derived RA assessments. The remaining 40 individuals being in sinus rhythm had a mean age of 35.1 ± 3.5 years (20 men). Two‐dimensional, Doppler, 3DSTE and SCRTs were performed in all cases. Results: RA maximum volume and total and passive RA stroke volumes correlated with the Valsalva ratio. Active RA stroke volume and emptying fraction showed correlations with 30/15 ratio. Peak global and mean segmental RA circumferential (CS) and longitudinal strains (LS) showed correlation with the Valsalva ratio. At atrial contraction, global RA‐LS and mean segmental RA‐CS showed correlations with the Valsalva ratio. Moreover, mean segmental RA‐CS correlated with 30/15 ratio and mean segmental RA radial strain showed correlations with systolic blood pressure in response to standing. Autonomic neuropathy score correlated with peak global RA‐LS. Conclusions: Autonomic function parameters have significant associations with specific RA functions in healthy adults, making the latter possible indicators of autonomic dysregulation. [ABSTRACT FROM AUTHOR]

Introduction: The functioning of the left atrium (LA) is partly controlled by the neural system. It was purposed to evaluate correlations between the result of Ewing's 5 standard cardiovascular reflex tests (SCRTs) characterizing autonomic function and LA volumetric and functional features as assessed by three‐dimensional speckle‐tracking echocardiography (3DSTE) in healthy individuals. Materials and Methods: The current study comprised 18 healthy volunteers being in sinus rhythm (mean age: 35 ± 12 years, 10 men). Measurement of blood pressure, ECG, 5 SCRTs, two‐dimensional Doppler echocardiography and 3DSTE were performed. These parameters were in normal ranges in all cases. Results: From LA volumetric parameters, only systolic total atrial emptying fraction (r = 0.559, p = 0.037) and early diastolic passive atrial emptying fraction (r = 0.539, p = 0.047) correlated with systolic blood pressure response to standing representing sympathetic autonomic function. From LA strains, peak mean segmental LA radial strain (RS) (r = −0.532, p = 0.050), global and mean segmental LA circumferential strain (CS) (r = 0.662, p = 0.010 and r = 0.635, p = 0.015, respectively) representing systolic LA function correlated with Valsalva ratio representing parasympathetic autonomic function. Global LA‐RS (r = −0.713, p = 0.040) and LA‐CS (r = 0.657, p = 0.011) and mean segmental LA‐CS (r = 0.723, p = 0.003) at atrial contraction representing end‐diastolic atrial contraction showed correlations with Valsalva ratio, as well. Peak global and mean segmental LA‐CS (r = 0.532, p = 0.050 and r = 0.530, p = 0.050) and the same strains at atrial contraction (r = 0.704, p = 0.005 and r = 0.690, p = 0.006) representing systolic function and end‐diastolic atrial contraction correlated with systolic blood pressure response to standing representing both parasympathetic and sympathetic autonomic functions. Conclusions: Significant correlations between features of vegetative autonomic function represented by Ewing's 5 SCRTs and specific LA functions represented by 3DSTE‐derived LA volume‐based functional properties and strains could be demonstrated in healthy adults. [ABSTRACT FROM AUTHOR]

Introduction: Systemic amyloidosis is an uncommon disorder in which amyloid fibrils deposit extracellularly. Three‐dimensional speckle‐tracking echocardiography (3DSTE) is a novel method able to assess left ventricular (LV) global longitudinal strain (GLS). Our aim was to evaluate the prognostic impact of 3DSTE‐derived LV‐GLS in patients with cardiac amyloidosis (CA). Materials and Methods: A total of 35 patients suffering from light‐chain (AL) CA or transthyretin (TTR) CA were selected, but 7 patients had to be excluded due to insufficient image quality or were lost for follow‐up. With AL‐CA 23 cases, while for TTR‐CA 5 patients were diagnosed. Complete two‐dimensional Doppler and 3DSTE were performed in all subjects. Results: The median follow‐up was 201 days (ranging from 36 to 632 days) during which cardiovascular event was detected in 17 CA patients, including 8 cardiac deaths. Six patients were diagnosed with acute heart failure, two patients needed invasive interventions (percutaneous coronary intervention with stent‐implantation, implantable cardioverter defibrillator implantation) and in one patient new higher grade atrioventricular block was registered. Using ROC analysis, 3DSTE‐derived LV‐GLS ≥11.8% (absolute value) was found to be a significant predictor for cardiovascular event‐free survival (sensitivity 65%, specificity 64%, area under the curve 0.71, p =.05). Lower LV ejection fraction was confirmed in patients with LV‐GLS <11.8% as compared to cases with LV‐GLS ≥11.8%. In case of a cardiovascular event, LV‐GLS was lower as compared to that of subjects with no events. Multivariable regression analysis confirmed that LV‐GLS and LV end‐diastolic diameter were independent predictors of cardiovascular survival. Conclusion: 3DSTE‐derived LV‐GLS is an independent predictor for future cardiovascular events in CA patients. [ABSTRACT FROM AUTHOR]

Aims Lower body half compression of bilateral secondary leg lymphoedema (LE) without relevant cardiac insufficiency gives rise to whether external leg compression may influence left ventricular (LV) function. Patients with LE were subjected to baseline two-dimensional transthoracic echocardiography (2DTTE) for general assessment then three-dimensional speckle-tracking echocardiography (3DSTE) before and 1 h after lower body half external compression for LV torsion analysis. Methods and results Baseline 2DTTE was performed in the cohort of 25 LE patients, and the results were compared with those of age- and gender-matched 52 healthy controls (mean age: 47.8 ± 12.8 vs. 40.7 ± 14.0 years, 24 women/1 man vs. 49 women/3 men, respectively). 3DSTE was conducted for the assessment of LV rotational mechanics where apical (AR), and basal rotations (BR) were measured before and 1 h after the use of compression class 2 (ccl 2) flat-knitted medical compression pantyhoses (pressure range: 23–32 mmHg). 2DTTE showed significantly larger LV end-diastolic volume and ejection fraction among LE patients compared with control subjects (108.3 ± 20.1 vs. 98.5 ± 21.7 mL, 69.8 ± 4.8 vs. 65.5 ± 4.3%, respectively) and notably smaller LV end-systolic diameter and posterior wall thickness (28.9 ± 3.5 vs. 31.2 ± 3.4 mm, 8.1 ± 1.0 vs. 9.0 ± 1.7 mm, respectively). The results of 20 patients with LE were considered in 3DSTE examinations due to the drop-out of five probands with technical failures. The data of four LE patients showing significant LV rotational abnormalities were managed separately, and the rotational parameters of the remaining sixteen patients did not differ significantly from those of matched controls except significant reduction of LV BR following the application of medical compression stockings (MCS) (−2.70 ± 1.26 degrees after 1 h use of pantyhose in patient group vs. −4.28 ± 2.18 degrees of the control group; P < 0.05). Conclusions The application of compression pantyhoses moderately but significantly decreased LV BR without a remarkable impact on twisting mechanism in LE patients in the absence of LV rotational abnormalities. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the relationship between left atrium (LA) volumes and contractility features along the cardiac cycle. The present study aimed to assess, by three-dimensional speckle-tracking echocardiography (3DSTE), correlations between LA volumes, volume-based functional properties, and strains during the cardiac cycle in healthy adults.Methods: We included 217 healthy adult volunteers (mean age 33.4 ± 12.7 years, 112 males) who underwent complete two-dimensional Doppler echocardiography with 3DSTE.Results: LA stroke volumes were greater in subjects with the greater maximum LA volume (Vmax ) in reservoir, conduit, and booster pump phases of LA function. While LA emptying fraction in LA reservoir phase was not different between subjects depending in their Vmax value, a significantly lower LA emptying fraction could be detected in LA conduit phase in subjects whose Vmax was >50 mL. In booster pump function, LA emptying fraction was not significantly different whatever the Vmax . Only global and mean segmental peak LA radial strain (RS) and 3D strain (3DS) and the same strains at atrial contraction appeared greater in subjects with greater Vmax , whereas the other strain parameters were not different.Conclusions: In healthy subjects, LA-RS and LA-3DS, objective features of LA contractility, are greater in subjects with greater LA volumes up to a point beyond which this association disappears. [ABSTRACT FROM AUTHOR]

Introduction: A number of studies defined normal reference values of three‐dimensional (3D) speckle‐tracking echocardiography (3DSTE)‐derived left ventricular (LV) strains. The present study aimed to quantify normal reference values of LV strains in healthy adult population in real clinical world settings in different age groups, and to determine age‐ and gender‐dependence of these variables in a high volume single center. Methods: The present prospective study included 296 healthy adult subjects. Among them, 124 were excluded due to inferior image quality during the 6‐year recruitment period (2011‐2017). The remaining population was further divided into four subgroups based on age decades. Results: While global radial (RS) strain showed an increase‐decrease‐increase pattern with age, circumferential, longitudinal, and area strains (CS, LS, AS, respectively) were nonsignificantly lower in older ages. Only global LV‐LS showed gender‐dependency with higher values in females. Although moderately higher RS and 3DS and lower LS, and AS were observed in males, clear gender‐dependency could not be detected in different age decades. Conclusions: This study provides normal reference values of 3DSTE‐derived global, segmental, mean segmental, and regional LV strains in healthy adult subjects based on real‐life clinical experience. Age‐, gender‐, and functional nonuniformity of LV strains were also defined. [ABSTRACT FROM AUTHOR]

Introduction: There is a limited number of echocardiographic studies determining mitral annular (MA) dimensions in healthy subjects. The present study aimed to establish normal reference values of three‐dimensional speckle‐tracking echocardiography‐derived MA dimensions and functional properties in healthy adults in relation with age and gender. Methods: The present study comprised 298 healthy adult subjects. From this population, 94 subjects were excluded due to inadequate image quality. Therefore the remaining group consisted of 204 subjects with the mean age of 33.88 ± 12.97 years (107 males). The population sample was further divided into age categories: 18‐29 years (n = 105; mean age: 24.11 ± 2.98 years, 51 males), 30‐39 years (n = 44; mean age: 33.80 ± 2.39 years, 31 males), 40‐49 years (n = 19; mean age: 43.47 ± 3.18 years, 11 males) and ≥50 years of age (n = 36, mean age: 57.42 ± 6.11 years, 14 males). Results: End‐diastolic MA dimensions did not change significantly during the decades. End‐systolic MA diameter, area, and perimeter were larger over the age of 50 years than in the 18‐29 year‐old group. MA fractional area change was found smaller over the age of 50 years than in 18‐29‐year‐old group. While end‐diastolic MA variables did not show gender‐differences, end‐systolic MA area and perimeter were lower in females in the 18‐29‐year‐old group. Conclusions: End‐systolic MA dimensions change over decades, resulting in a special pattern of MA functional properties with significant reduction over the age of 50 years. [ABSTRACT FROM AUTHOR]

Introduction: The present study was designed to define normal reference values of three‐dimensional speckle‐tracking echocardiography (3DSTE)‐derived left atrial (LA) volumes, stroke volumes (SVs), and emptying fractions (EFs) with regard to the cardiac cycle. Methods: The present study involved 256 healthy adult subjects in sinus rhythm who underwent complete two‐dimensional Doppler echocardiography and 3DSTE at the same time. However, due to inferior image quality, 87 subjects have been excluded. The remaining population sample comprised of 169 patients who gave informed consent to participate in the study. Results: While systolic maximum LA volume and early diastolic preatrial contraction LA volume did not change over age decades, late‐diastolic minimum LA volume decreased and was lowest in subjects aged 40 to 49 years then increased after 50 years. Total atrial EF increased over age decades with a reduction after 50 years. Passive atrial EF showed a significant continuous increase over age decades. Active atrial EF did not change in younger ages and was the highest between ages 40 and 49 years with a significant impairment after 50 years. Conclusions: This study shows the age‐ and gender‐dependency of normal values of 3DSTE‐derived LA volumes, stroke volumes, and emptying fractions with regard to the cardiac cycle in healthy adult subjects. [ABSTRACT FROM AUTHOR]

Summary: Lipedema is a lymphedema‐masquerading symmetrical, bilateral and disproportional obesity. Its conservative maintenance treatment comprises the use of flat‐knitted compression pantyhoses. Lipedema is known to be associated with left ventricular morphological and functional alterations. The present study aimed to assess the effects of graduated compression stockings on left ventricular (LV) rotational mechanics measured by three‐dimensional speckle‐tracking echocardiography (3DSTE) in lipedema patients. The present study comprised twenty lipedema patients (mean age: 45.8 ± 11.0 years, all females) undergoing 3DSTE who were also compared to 51 age‐ and gender‐matched healthy controls (mean age: 39.8 ± 14.1 years, all females). 3DSTE analysis was performed at rest, and subsequent to 1 hour application of compression class 2 made‐to‐measure flat‐knitted pantyhose. Six lipedema patients showed significant LV rotational abnormalities. Of the remaining fourteen lipedema patients LV basal rotation rotation showed significant reduction, while LV apical rotation showed significant increase with unchanged LV twist after a 60‐minute use of compression garment. Significant changes in LV rotational mechanics could be detected among 14 women with lipedema after the use of compression garment however six probands have special LV rotational abnormalities at baseline and/or after compression. [ABSTRACT FROM AUTHOR]

Purpose: Lipedema is a chronic, common but underdiagnosed disease masquerading obesity, with female predominance, characterized by disproportional abnormal adipose tissue distribution of the lower and also upper extremities. The present study was designed to determine whether lipedema is associated with three-dimensional (3D) speckle-tracking echocardiography (3DSTE)-derived left ventricular (LV) deformation abnormalities, and to assess the effects of 1-hour use of medical compression stockings (MCS).Methods: The present study comprised 19 female patients with lipedema (mean age: 42.2 ± 12.4 years), compared to 28 age-matched healthy female controls (mean age: 42.0 ± 9.8 years).Results: Lipedema patients showed larger left atrial and LV dimensions and greater LV ejection fraction than controls, without significant difference in other echocardiography variables. Lipedema patients had greater 3DSTE-derived global and mean segmental LV circumferential and area strains than controls. Following 1-hour use of wearing MCS, neither global and nor mean segmental LV strains showed significant impairment or improvement.Conclusions: Increased LV strains could be compensatory effects maintaining LV pumping function in lipedema. Short-term wearing of MCS has no global effect on LV strains. [ABSTRACT FROM AUTHOR]

Introduction: The right atrium (RA) roles include being a systolic reservoir, an early diastolic conduit, and a late-diastolic booster pump. The present study aimed to assess normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumetric data and volume-based functional properties in healthy adult subjects.Methods: We included 260 healthy adult subjects in sinus rhythm with complete clinical and demographic dataset, but excluded 110 of them because of inferior image quality. The remaining population sample comprised 150 subjects (31.0 ± 11.6 years, 79 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects.Results: Systolic RA volumetric variables did not show changes over time, but after 50 years, a significant reduction could be demonstrated in RA stroke volume and emptying fraction. While early diastolic RA volume increased over time, RA stroke volume and emptying fraction decreased. While late-diastolic RA volume increased over age decades, similar increase could be detected in RA stroke volume but a reduction occurred in older ages. Late-diastolic RA emptying fraction showed an increasing (after the 40s)-decreasing (after the 50s) pattern.Conclusions: Our study provides normal reference values of 3DSTE-derived RA volumes and volume-based functional properties and their age- and gender dependency in healthy adult subjects. [ABSTRACT FROM AUTHOR]

Introduction: Hypereosinophilic syndrome (HES) is a very heterogeneous group of disorders with varied etiologies characterized by peripheral eosinophilia and eosinophilic tissue/end‐organ damage. Three‐dimensional speckle‐tracking echocardiography (3DSTE) was used for assessment of left ventricular (LV) rotational mechanics in HES patients. Methods: The study comprised 13 HES patients, from which one patient was excluded due to insufficient image quality. The remaining patient population consisted of 12 HES cases (mean age: 59.7 ± 13.7 years, eight males). The control group consisted of 36 healthy volunteers (mean age: 52.9 ± 8.3 years, 23 males). 3DSTE was used for the evaluation of LV rotational abnormalities. Results: Both LV apical rotation (4.86 ± 1.92 degree vs 10.07 ± 3.92 degree, P < .0001) and LV twist (8.52 ± 2.79 degree vs 14.41 ± 4.26 degree, P < .0001) showed significant deteriorations in most of HES patients. Time‐to‐peak LV apical rotation (380 ± 115 ms vs 344 ± 69 ms, P = .56), LV basal rotation (335 ± 148 ms vs 337 ± 111 ms, P = .89), and LV twist (348 ± 91 ms vs 320 ± 60 ms, P = .64) were not significantly different between HES patients and controls. No correlations could be detected between absolute eosinophil count and eosinophil ratio and apical LV rotation (r = 0.12, P = .51 and r = 0.23, P = .45, respectively) and LV twist (r = 0.24, P = .39 and r = 0.31, P = .34, respectively). In two subjects, the absence of LV twist called LV "rigid body rotation" (RBR) was detected. Conclusions: Reduced LV apical rotation and twist could be demonstrated in HES. LV‐RBR could be detected in some HES patients. [ABSTRACT FROM AUTHOR]

Introduction: Lipedema is a barely recognized and poorly diagnosed, but common disease affecting almost exclusively female patients. The pathomechanism of lipedema is not known, and clinically, it is a bilateral, symmetrical, disproportional fatty enlargement of the lower half of the body, the disease does not affect the feet, and the upper extremities are often involved. Since lipedema is associated with increased aortic stiffness and altered left ventricular (LV) rotational mechanics, the present study was designed to compare the size and function of the mitral annulus (MA) between lipedema patients and controls by three‐dimensional speckle‐tracking echocardiography (3DSTE). Methods: Twenty‐four patients with stage 2 lipedema and 48 age‐, gender‐, and body mass index‐matched healthy control patients were included in the study. Each person from the lipedema and the control groups underwent two‐dimensional Doppler echocardiography and 3DSTE. Results: Significantly enlarged left atrial diameter, LV end‐diastolic diameter and volume, and LV end‐systolic volume could be detected in lipedema patients as compared to controls. None of the lipedema patients and controls showed ≥grade 1 mitral or tricuspid regurgitation. Dilated end‐systolic and end‐diastolic MA diameter, area, and perimeter could be demonstrated in lipedema patients as compared to controls, and these changes were accompanied by impaired MA fractional area change at rest. Following 1‐hour use of compression stockings, no significant improvement was seen in these parameters. Conclusions: Lipedema is associated with MA enlargement and functional impairment. The use of compression stockings does not improve these alterations. [ABSTRACT FROM AUTHOR]

Introduction: Left ventricular (LV) rotation and twist are essential parts of LV function. Three‐dimensional speckle tracking echocardiography (3DSTE) is a relatively new method and is useful for the quantification of LV wall deformation and rotational parameters. The aim of the present study was to examine LV rotation and twist differences between different age‐groups and genders in a healthy population. Methods: The present study is comprised of 297 healthy adults; 120 adults have been excluded due to inferior image quality. The population was further divided into 4 subgroups based on age decades. Results: Only the LV twist of all patients (13.5 ± 3.7 degree vs 15.6 ± 4.9 degree, P = 0.02) and the LV twist of females (13.0 ± 3.6 degree vs 15.5 ± 5.6 degree, P = 0.03) differed significantly between the age‐group of 18–29 years and 50+ years. LV basal and apical rotation were not significantly different between the age‐groups; however, they tendentiously increased with aging. No significant differences could be demonstrated regarding LV rotational and twist parameters between genders in any group. A phenomenon called LV rigid body rotation (LV‐RBR)—where the base and apex of the LV rotate in the same direction—was present in 10 cases. Conclusions: Three‐dimensional speckle tracking echocardiography seems to be a reasonably viable tool for the quantification of LV rotation and twist. Both LV basal and apical rotation and LV twist increase with aging, regardless of gender. LV‐RBR is also present in the normal population. [ABSTRACT FROM AUTHOR]

Introduction: Acromegaly is a chronic and disfiguring hormonal disease caused by a benign growth hormone‐secreting pituitary adenoma in most of the cases. The objective of this study was to investigate three‐dimensional (3D) speckle tracking echocardiography (3DSTE)‐derived left atrial (LA) volumetric and functional properties in patients with acromegaly. It was also examined whether the activity of acromegaly is associated with further alterations in these LA parameters. Methods: A total of 23 patients with acromegaly were involved in this study. Due to inadequate image quality, 4 patients were excluded from the 3DSTE analysis. The mean age of the remaining acromegalic subjects was 58.5 ± 13.1 years (7 males). The control group consisted of 21 age‐ and gender‐matched healthy subjects (mean age 51.8 ± 10.3 years, 10 males). Results: Maximum (44.8 ± 12.7 mL vs 78.7 ± 25.4 mL, P < .05), minimum (24.1 ± 9.0 mL vs 44.5 ± 15.5 mL, P < .05), and preatrial contraction (35.5 ± 11.2 mL vs 66.0 ± 22.8 mL, P < .05) LA volumes were significantly different between all acromegaly patients compared with controls. Increased peak global and mean segmental radial and 3D strains and decreased LA circumferential strain (CS) could be detected in all acromegaly patients as compared to healthy subjects. Significant correlation could be detected between insulin‐like growth factor 1 (IGF‐1) index and peak superior LA‐CS (r = .49, P = .05) in acromegaly. Conclusion: Acromegaly is associated with increased LA volumes and changes in LA functional properties. [ABSTRACT FROM AUTHOR]

Objective: Cardiac amyloidosis (CA) is as an infiltrative disorder primarily caused by extracellular tissue deposition of amyloid fibrils in the myocardial interstitium. The current study was designed to test whether alterations in ascending aortic elastic properties could be detected by echocardiography in CA patients, and to compare their results to controls.Patients and Methods: We included 19 CA patients from which CA proved to be AL amyloidosis in 17 cases and transthyretin (TTR) amyloidosis in 2 cases. Their results were compared to 20 age-, gender-, and risk factor-matched controls.Results: There was significantly greater interventricular septum and left ventricular (LV) posterior wall thickness, lower LV ejection fraction and greater E/A in CA patients than in controls, suggesting systolic, and diastolic dysfunction. CA patients also showed significantly reduced aortic strain and pulsatile change in aortic diameter, and increased aortic stiffness index.Conclusion: These results suggest increased aortic stiffness in CA patients. [ABSTRACT FROM AUTHOR]

Introduction: Acromegaly is a rare, chronic, disfiguring, and debilitating disease caused, in 90% of cases, by a benign monoclonal growth hormone-secreting pituitary adenoma. The present study aimed to assess left ventricular (LV) rotational and twist mechanics in acromegalic patients and to compare their results to age- and gender-matched healthy controls.Methods: The present study comprised 24 acromegalic patients, from which 4 were excluded due to insufficient image quality (mean age: 57.8 ± 13.7 years, 7 men). The control group consisted of 18 age- and gender-matched healthy individuals (mean age: 54.8 ± 6.9 years, 8 men).Results: In 4 out of 20 acromegalic patients, LV showed near absence of twist, as the so-called LV "rigid body rotation" (RBR). Between all acromegalic patients without LV-RBR and controls, both LV basal (-3.76 ± 1.73 vs. -6.17 ± 2.66°, P = .004) and apical rotation (6.12 ± 4.03 vs. 10.81 ± 3.65°, P = .001) and LV twist (9.88 ± 4.74 vs. 16.98 ± 3.88°, P < .001) differed significantly. Between active and nonactive acromegaly subgroups, only the time-to-peak LV twist (377 ± 78 vs. 229 ± 97 ms, P = .005) showed significant difference.Conclusions: Acromegaly is associated with impaired LV rotation and twist as assessed by 3-dimensional speckle tracking echocardiography. LV-RBR is a frequent phenomenon in acromegaly. [ABSTRACT FROM AUTHOR]

A patient with previous coronary stenting presented with stable angina and positive exercise treadmill test. Echocardiography with three-dimensional speckle-tracking demonstrated left ventricular rigid body rotation (near absence of left ventricular twist), whose characteristics changed dramatically during dipyridamole-induced vasodilatation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:152-156, 2018. [ABSTRACT FROM AUTHOR]