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Introduction: Using speckle tracking echocardiography (STE), emerging attention is brought to left atrium (LA) that is very complex due to close coupling with left ventricle (LV). LA volume (LAV) and emptying function (LAEF) reflect diastolic function and may serve as a predictor for cardiovascular outcomes. We sought to examine the relation between LV and LA properties in hypertension (HTN) by 3-dimensional STE (3D-STE). Methods: We measured LAV, LAEF and LA strain and estimated LA stiffness in 58 controls (age 67±11), 60 HTN without hypertrophy (LVH-) (69±11), 76 LVH+ (70±11) and 102 hypertensive heart failure (HHF) {40 HF with preserved EF (HFpEF, 77±14) and 62 HF with reduced EF (HFrEF, 68±16)}. We measured LV mass, EF, strain and E/e'. Pulmonary capillary wedge pressure (PCWP) was calculated as 10.8 - 12.4 x log (active LAEF / minimum LAV) as we reported. We estimated Tau and LV end-diastolic stress as isovolumic relaxation time / (ln 0.9 x systolic BP - ln PCWP) and as PCWP x end-diastolic dimension / thickness. LV myocardial and LA chamber stiffness was estimated as LV stress / strain and as PCWP / LAV change. Results: There was no difference in BP among HTN. LVEF in HFrEF decreased associated with increased LV mass and systolic stress (LVEF: control; 67±6, LVH-; 69±6, LVH+; 67±9, HFpEF; 62±9, HFrEF; 38±8*%, *p<0.05 vs control). Tau was prolonged even in LVH- (35±13, 43±15*, 52±17*, 59±16*, 67±19*ms). Stiffness increased in HHF groups (LV stiffness: 0.6±0.3, 0.6±0.4, 0.6±0.3, 0.9±0.8*, 2.3±1.7*, LA stiffness: 0.3±0.1, 0.3±0.2, 0.4±0.2, 0.7±0.5*, 0.9±0.6*mmHg/ml) associated with increased PCWP and LV diastolic stress (PCWP: 7±3, 8±4, 9±4, 15±4*, 17±5*mmHg, diastolic stress: 11±4, 10±8, 11±7, 16±6*, 24±11*Kdynes/cm2). Total LAEF and LA strain gradually decreased from LVH- to HFrEF, whereas active LAEF decreased in HHF groups (36±10, 37±11, 34±10, 20±10*, 17±10*%) associated with increased PCWP and stiffness. On multivariate analysis, LV stiffness is an independent predictor for HHF among STE parameters. Conclusions: LA properties were significantly affected by LV diastolic remodeling by pressure overload. HFrEF has the most negative impact on LA properties. Noninvasive assessment of the relation between LA and LV properties by STE may have a clinical potential. [ABSTRACT FROM AUTHOR]

Introduction: Left ventricular (LV) relaxation in a cardiac cycle is characterized by rapid torsional recoil of LV wall. LV torsion is caused by the contraction of inner and outer oblique muscle and followed by untorsion. Predominant epicardial stretch along myofibers during isovolumic relaxation (IVR) appears to drive global torsional recoil to aid early diastolic filling. However, contribution of transmural arrangement of myofibers to relaxation was not elucidated by echocardiography. The aim of this study was to evaluate whether torsion slope during early diastole (untorsion slope) on time-torsion curve by 3-dimensional speckle tracking echocardiography (3D-STE) could serve as a feasible index of LV relaxation. Methods: Forty five patients with cardiac disease (age 70±10) were prospectively enrolled in this study. The time constant of LV pressure decline (Tau) was obtained by cardiac catheterization as a gold standard for LV relaxation and compared with LV diastolic echo parameters including the untorsion slope. Echocardiography was performed just before the left sided heart catheterization. We examined the LV strain rate of early diastole (SR-E) and isovolemic relaxation time (SR-IVR), and time-torsion curve by 3D-STE in addition to conventional echo parameters such as LV mass index (LVMI), Left atrial volume (LAV), e' and isovolumic relaxation time (IVRT). From the time-LV torsion curve (Figure), we calculated the untorsion slopes from peak to the points of 25%, 33%, and 50% of total untorsion phase (from peak torsion time to minimum torsion time). Results: Table Conclusions: This study demonstrated that the untorsion slope by our noninvasive method using 3D-STE had a good correlation with Tau obtained by cardiac catheterization. The analysis of the untorsion slope on the time-LV torsion curve may be a useful and novel method to estimate LV relaxation and have a clinical value to detect the early stage of diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Left atrium (LA) is very complex due to close coupling with left ventricle (LV). LA structural remodeling and functional impairment might play an important part in the pathogenesis and development of ventricular disorders such as heart failure (HF) with or without preserved LV ejection fraction (EF). Speckle tracking echocardiography (STE) makes it possible to measure phasic LA volume (LAV) and function with relatively high accuracy. We investigated LA features in relation to LV disorders due to hypertension (HTN) by STE. Methods: We performed STE in 58 controls, 60 HTN without LVH, 76 HTN with LVH, 40 HF with preserved EF (HFpEF) and 62 HF with reduced EF (HFrEF). We measured phasic LAV {maximum, pre-atrial contraction (AC) and minimum}, phasic LA emptying function (LAEF) (total, passive and active LAEF} and LA peak strain and phasic strain rate (SR) {SR during LV systole (SR-S), early filling (SR-E) and AC (SR-AC)}. Pulmonary capillary wedge pressure (PCWP) was calculated as we previously reported. LA stiffness was estimated as PCWP / LA strain. LV stiffness was estimated as LV end-diastolic stress / LV strain, where LV stress was calculated as PCWP x LV endo-diastolic dimension / thickness. Results: PCWP and LV and LA stiffness increased from HTN without LVH to HFrEF. There was a correlation between active LAEF and LASR-AC (r=-0.62, p<0.01). Active LAEF and LASR-AC in HTN with LVH were preserved and similar to those of controls despite increased LAV and decreased total LAEF, but decreased in HFpEF and HFrEF associated with increased LAV, PCWP and LV stiffness. Multivariate analysis revealed that LASR-AC and LA stiffness are independent predictors of HF. Conclusions: LA booster pump function assessed by LASR-AC may play a compensatory mechanism to maintain LVEF with increased LA preload assessed by PCWP against increased afterload by LV stiffness, but was broken down in HHF, suggesting that impairment of LA booster function and increased LA stiffness may lead to HHF in HTN. [ABSTRACT FROM AUTHOR]

Introduction: We reported that pulmonary capillary wedge pressure (ePCWP) and time constant of left ventricular (LV) pressure decline (eTau) are noninvasively estimated by speckle tracking echocardiography (STE). LV camber stiffness (e-c stiffness) may be estimated with the use of 2 diastolic pressure-volume coordinates: the end-diastolic pressure (EDP) and volume and the pressure and volume at the time of minimum diastolic pressure (mP). Myocardial stiffness (e-m stiffness) may be assessed using stress and strain by STE. We sought to validate e-c stiffness and e-m stiffness by STE against those by catheterization and to evaluate the clinical utility in patients with normal LVEF. Methods: Validation was performed in 126 patients and LV chamber stiffness was obtained as LV pressure change (EDP minus mP) by catheterization divided by LV volume change that equals to stroke volume by echocardiography. STE was performed in 58 controls, 110 hypertension (HTN), 155 HTN with hemodialysis (HD), 48 HTN heart failure with preserved EF (HFpEF) and 34 aortic stenosis (AS). The ePCWP was noninvasively calculated as 10.8 - 12.4 x Log (left atrial active emptying function / minimum volume) (KT index). LVEDP (e-EDP) was estimated as 12.3 - 10.1 x KT index. The eTau is obtained as isovolumic relaxation time / (ln 0.9 x systolic blood pressure - ln ePCWP). The e-c stiffness was noninvasively obtained using e-EDP and 5 mmHg as mP because mP by catheterization was 5.0±2.9mmHg. LVED stress (e-stress) was estimated as e-EDP x LV dimension / thickness. Results: The eTau and e-EDP by STE had a good correlation with Tau and EDP by catheterization (r=0.75 and 0.63, p<0.001). The e-c stiffness and e-stress had a good correlation with stiffness and stress by catheterization (r=0.69 and 0.77, p<0.001). LV stiffness was most increased in HFpEF. Conclusions: LV relaxation and LV stiffness may be noninvasively assessed by STE with reasonable accuracy and may have a utility and value in the routine clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Left ventricular (LV) diastolic dysfunction in normal ejection fraction (EF) is clinically diagnosed by mitral annular tissue velocity (e'), the ratio of early mitral inflow velocity to tissue velocity (E/e'), tricuspid regurgitant velocity and left atrial volume (LAV). We reported that time constant of LV pressure decline (Tau) and pulmonary capillary wedge pressure (PCWP) are noninvasively and accurately estimated by speckle tracking echocardiography (STE). We sought to examine the most reliable predictor of LV diastolic dysfunction among echo parameters. Methods: The e', E/e', Tau, PCWP, LV end-diastolic pressure (EDP), LV myocardial stiffness, LAV, LA emptying function (LAEF) and LA strain were examined by STE in 58 controls (age 67±11), 136 hypertensive patients (HTN) (69±11) and 40 hypertensive heart failure (HF) with preserved LVEF>50% (HFpEF) (77±14) that has a predominant diastolic dysfunction. PCWP was calculated as 10.8 – 12.4 Log (active LAEF / minimum LAV) (KT index). EDP was estimated as 12.3 – 10.1 x KT index as we reported. Tau was calculated as isovolumic relaxation time / (ln 0.9 x systolic blood pressure – ln PCWP). LV stiffness was estimated as ED stress / LV strain by 3D-STE, where ED stress was calculated as 0.334 x PCWP x LV dimension / {LV thickness (1 + LV thickness / LV dimension)}. Tau and EDP by STE were validated by catheterization (n=126). Results: Tau and LVEDP by STE had a good correlation with those by catheterization (r=0.75 and 0.63, p<0.001). The E/e', LVEDP and stiffness increased, LA strain decreased and Tau was prolonged in HFpEF. Multivariate analysis revealed that LVEDP and LA strain were independent predictors of HFpEF among echo parameters. Using LVEDP cutoff of 12.5, the sensitivity and specificity for HFpEF is 83 and 81% with AUC of 0.89. Conclusion: We demonstrated that the diagnosis of diastolic dysfunction may be more accurately and noninvasively performed using LVEDP and LA strain by STE than conventional echo parameters. [ABSTRACT FROM AUTHOR]

Introduction: There has been no established echo parameter to accurately assess left ventricular (LV) diastolic function. We reported that time constant of LV pressure decline (Tau) and pulmonary capillary wedge pressure (PCWP) are noninvasively estimated by speckle tracking echocardiography (STE). Thus, we sought to noninvasively evaluate the impact of hypertension (HTN) on not only systolic but also diastolic properties by STE. Methods: LV ejection fraction (EF), longitudinal strain, strain rate (SR) and torsion as systolic properties and Tau, myocardial stiffness, end-diastolic (ED) pressure (P) and ED stress as diastolic properties were measured by 3D-STE in 58 controls (age 67±11) and 238 HTN {60 hypertrophy(-) (LVH-) (69±11), 76 LVH+ (70±11), 40 heart failure with preserved EF>50% (HFpEF, 77±14) and 62 HF with reduced EF (HFrEF, 68±16)}. Tau and EDP was calculated as isovolumic relaxation time / (ln 0.9 x systolic BP – ln PCWP) and as 12.3 – 10.1 x Log (left atrial active emptying function / minimum volume) and validated by catheterization (n=126). ED stress and stiffness was estimated as EDP x dimension / thickness and as ED stress / LV strain. Results: There was no difference in BP among HTN. Tau, EDP and stress by STE had a good correlation with those by catheterization (r=0.75, 0.63 and 0.77, p<0.001). LV mass and dimension increased prominently in HFrEF (mass: control; 89±19, LVH-; 91±18, LVH+; 132±31*, HFpEF; 132±42*, HFrEF; 168±59* g/m2, dimension: 45±4, 45±6, 47±6, 45±5, 56±7* mm, *p<0.05 vs control). Tau was prolonged even in LVH- (35±13, 43±15*, 52±17*, 59±16*, 67±18*ms). Stiffness increased in HFpEF and further increased in HFrEF (0.6±0.3, 0.6±0.4, 0.7±0.6, 1.3±0.7*, 2.9±2.7*) associated with increased stress (11±4, 10±8, 11±7, 16±6*, 24±11* Kdynes/cm2). LV strain and SR reduced in LVH+ and further reduced in HFrEF (strain; -19±3, -17±4, -16±4*, -14±5*, -11±4*), whereas torsion increased in LVH+ associated with preserved EF but reduced in HFrEF (1.4±0.2, 1.4±0.3, 1.5±0.3*, 1.3±0.3, 1.1±0.2* °/cm). There was a correlation between LV strain and tau (r=0.34, p<0.01). Conclusion: Tau, EDP and ED stress were noninvasively assessed by STE with a reasonable accuracy. LV systolic and diastolic properties in HTN may be noninvasively evaluated using 3D-STE. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of new-onset atrial fibrillation (AF) increases with age. However, useful predictors of new-onset AF is complicated. Hypothesis: We reported that pulmonary capillary wedge pressure (ePCWP) estimated by the combination of left atrial (LA) volume (V) and emptying function (EF) had a strong relationship with PCWP that measured by catheterization (r=0.9). We sought to examine the association of echocardiographic parameters and the risk of AF in elderly and elucidate the most useful predictor of new-onset AF including ePCWP. Methods: We measured left ventricular (LV) ejection fraction and E/e' in consecutive 663 elderly patients without a history of AF. We examined LAV, EF, ePCWP by speckle tracking echocardiography (STE). ePCWP was determined as 10.8 - 12.4 x log (active LAEF / minimum LAV) as we previously reported. The data of 566 elderly patients (age 72±6) were followed-up and analyzed. Results: During mean follow-up period of 50 months, 63 elderly (age 73±6, 39 men) developed electrocardiographically conformed AF. Subjects with new-onset AF had lower active LAEF (18±7 vs. 28±8%) and larger phasic LAV (maximum: 57±16 vs. 47±16ml/m2; pre-atrial contraction: 46±14 vs. 38±14ml/m2; minimum: 38±13 vs. 27±11ml/m2) compared with subjects with non-AF. E/e' and ePCWP in new-onset AF were significantly elevated compared with non-AF (9.6±1.8 vs. 8.5±1.7, 14.8±3.7 vs. 10.3±3.1 mmHg, respectively). In multivariate regression analysis, ePCWP and active LAEF were strong independent predictors of AF. Using 13mmHg of ePCWP and 22% of active LAEF as a cutoff value, hazard ratio for five years was 3.53 (95% CI: 1.68-7.44, p<0.001) and 4.06 (95% CI: 1.90-8.65, p<0.001). By combining >13mmHg and ≤22%, hazard ratio became excellent 11.84 (95% CI: 6.85-20.5, p<0.001). Conclusions: The ePCWP and active LAEF estimated by STE were the strong predictors of new-onset AF. Estimation of ePCWP by STE would provide an incremental value for the risk stratification of new-onset AF. [ABSTRACT FROM AUTHOR]