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ObjectivesThe goal of this study was to assess the relationship among extracellular volume (ECV), native T1, and systolic strain in hypertensive patients with left ventricular hypertrophy (HTN LVH), hypertensive patients without LVH (HTN non-LVH), and normotensive controls.BackgroundDiffuse myocardial fibrosis in HTN LVH patients, as reflected by increased ECV and native T1, may be an underlying mechanism contributing to increased cardiovascular risk compared with HTN non-LVH subjects and controls. Furthermore, increased diffuse fibrosis in HTN LVH subjects may be associated with reduced peak systolic and early diastolic strain rate compared with the other 2 groups.MethodsT1 mapping was performed in 20 HTN LVH (mean age, 55 ± 11 years), 23 HTN non-LVH (mean age, 61 ± 12 years), and 22 control subjects (mean age, 54 ± 7 years) on a Siemens 1.5-T Avanto (Siemens Healthcare, Erlangen, Germany) using a previously validated modified look-locker inversion-recovery pulse sequence. T1 was measured pre-contrast and 10, 15, and 20 min after injection of 0.15 mmol/kg gadopentetate dimeglumine, and the mean ECV and native T1 were determined for each subject. Measurement of circumferential strain parameters were performed using cine displacement encoding with stimulated echoes.ResultsHTN LVH subjects had higher native T1 compared with controls (p < 0.05). HTN LVH subjects had higher ECV compared with HTN non-LVH subjects and controls (p < 0.05). Peak systolic circumferential strain and early diastolic strain rates were reduced in HTN LVH subjects compared with HTN non-LVH subjects and controls (p

Maternal placental syndromes (MPS) occur as a consequence of abnormal placental vessel formation and refer to hypertensive pregnancy disorders and related placental abnormalities. The aim of this study is to investigate early alterations in left ventricular function in patients with history of MPS using tissue Doppler and strain rate imaging.We enrolled 122 females who were 6 months after delivery. Group 1 included 72 patients who experienced MPS. Group 2 included 50 women with normal pregnancy as control.There was no significant difference between both groups with regard to ejection fraction, deceleration time, isovolumetric relaxation time, or E/A ratio. Deterioration of left ventricular systolic and diastolic function was evident in the MPS group, by TDI parameters (significantly lower values of Sm 7.5 ± 1.2 vs. 9.1 ± 1.3, p 0.001; Em 7.0 ± 0.8 vs. 10.0 ± 1.4, p = 0.02; and Em-to-Am ratio 0.84 ± 0.14 vs. 1.2 ± 0.18, p 0.001). Systolic strain, peak systolic strain rate, and early and late diastolic strain rates were also significantly lower in patients who had MPS than in the control group (-18.7 ± 2.6 vs. -20.8 ± 1.5, p 0.001; -0.92 ± 0.14 vs. -1.01 ± 0.23, p 0.001; 1.05 ± 0.11 vs. 1.29 ± 0.24, p 0.001; 1.8 ± 0.3 vs. 1.2 ± 0.4, p 0.001, respectively) and in patients who had severe pre-eclampia than mild pre-eclampsia. Pre-eclamptic women who had preterm delivery showed significantly higher left diastolic dysfunction.Left ventricular systolic and diastolic dysfunction occur in patients with history of MPS. These abnormalities are evident on tissue Doppler and strain imaging even in the absence of changes in ejection fraction or standard diastolic parameters.

Carbon monoxide (CO) poisoning could cause significant cardiac injury. This study aimed to evaluate patients with CO poisoning by using speckle tracking echocardiography (STE), a potentially more sensitive technique, to identify left systolic ventricular dysfunction for the first time in the literature. Seventy-two patients who were exposed to CO poisoning were studied. Blood collection and echocardiography were performed at admission and after patients’ discharge on days 10–15 (mean 12 days). Global longitudinal strain (GLS) and global circumferential strain (GCS) were calculated using STE. In order to find the normal strain levels and to compare it to the patient with CO poisoning, 35 healthy subjects were included in the study. Left ventricular ejection fraction was analyzed according to Simpson’s method. Patients were divided into two groups based on their LVEF values. LVEF

It has been described in humans that chronic obstructive bronchitis leads to pathologic changes, especially in the right ventricular myocardium due to hypoxia, which can be assessed by tissue Doppler imaging (TDI). In our study, different TDI techniques, that is, pulsed-wave TDI and color TDI, were evaluated for applicability in different scan planes (apical long-axis view and short-axis view) for the analysis of right ventricular myocardial function in six healthy horses (control) and six horses affected with recurrent airway obstruction (RAO) (RAO group). Tissue Doppler imaging was applicable to all scan planes described. Myocardial movement directions in general and the absolute values of TDI parameters were assessable. Significantly reduced early diastolic filling velocities (E), elevated late diastolic filling velocities (A), thereby decreased E/A quotient, prolonged electromechanical coupling periods between electrocardiograph Q-wave and maximal velocities, and compensatory elevated systolic strain as well as diminished displacement could be observed in horses with RAO compared with the control group. To conclude, equine right ventricular myocardial function is assessable by TDI. Significant changes of right ventricular myocardial function could be demonstrated by TDI in horses with RAO compared with matched healthy controls. The hypothesis that RAO potentially leads to right ventricular dysfunction detectable by TDI before conventional echocardiography changes are evident is supported by this explorative study.

Aim. To examine the circular and radial deformation of left ventricular in infants, including children born with intrauterine growth retardation (IUGR). Material and methods. The sample of 123 children were examined. 35 children with IUGR were compared with 88 children. The median age was (7,4±3,3) and (7,3±2,4) months, respectively. Using the tissue Doppler examination in Strain Rate Imaging TVI mode speed circular and radial systolic myocardial deformation of the left ventricle were studied at the level of the cross-cut the last echocardiographic short axis. Results and discussion. Were identified two main types of graphs which characterized the deformation rates of myocardial segments. First, a synchronous type, characterized by high-amplitude unidirectional monophasic curves, the second type — asynchronous, combining both positive and negative values of strain rates, which was interpreted as the presence of pronounced systolic

INTRODUCTION Assessment of the left atrium (LA) mechanical function provides further information on the level of cardiac compensation. We aimed to evaluate LA function using a strain imaging method: velocity vector imaging (VVI) in chronic primary mitral regurgitation (MR). MATERIAL AND METHODS We recruited 48 patients with chronic, isolated, moderate to severe MR (54.70 ±15.35 years and 56% male) and 30 age- and sex-matched healthy controls (56.52 ±15.95 years and 56% male). The LA volumes during reservoir (RV), conduit (CV) and contractile phases (AV) were measured. Global strain (S), systolic strain rate (SRs), early diastolic (ESRd) and late diastolic strain rate (LSRd) were calculated. RESULTS LA RV (50 ±18.7 to 37.9 ±5.9; p = 0.0001), CV (43.1 ±29 to 21 ±2.56; p = 0.0001), and AV (17.9 ±13.5 to 10.9 ±1.9; p = 0.006) were increased in MR patients. The LA reservoir phase strain was 16.2 ±8.1% in the MR group and 51.1 ±5.7% in the control group (p = 0.0001). The LA SRs (1.01 ±0.52 s(-1) for MR and 2.1 ±0.22 s(-1) for controls; p = 0.0001), LA ESRd (0.83 ±0.34 s(-1) for MR and 2.26 ±0.17 s(-1) for controls; p = 0.0001) and LA LSRd (0.76 ±0.24 s(-1) for MR and 2.2 ±0.26 s(-1) for controls; p = 0.0001) were impaired in MR patients. CONCLUSIONS The LA deformation indices may be used as adjunctive parameters to determine LA dysfunction in chronic primary MR.

Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved., Introduction: The spectrum of hypertensive heart disease is wide, and can include left ventricular dysfunction. The development of echocardiographic parameters to improve patient stratification and to identify early adverse changes could be clinically useful. Aim: To identify subclinical left ventricular dysfunction in hypertensive subjects with preserved ejection fraction (>55%), identified by global parameters of myocardial strain on speckle tracking imaging. Methods: This was a comparative observational study of two groups of individuals: normotensive (n=20, age 59±7 years, 55% male) and hypertensive (n=229, age 62±12 years, 57% male). Left ventricular function was assessed by various conventional clinical and echocardiographic parameters and global longitudinal and circumferential myocardial strain. Cut-off values to detect subclinical left ventricular dysfunction were established and applied in the hypertensive group. The Student's t test, Mann-Whitney test and chi-square test were used for the comparative statistical analysis. Results: Most hypertensive subjects (53.7%) had grade I hypertension; blood pressure was controlled in 64.9%, and 54.8% showed left ventricular structural changes. Comparison between the normotensive and hypertensive groups showed no significant differences in parameters of global longitudinal or circumferential systolic strain. Application of the cut-offs to the hypertensive group identified 35 individuals (15.3%) as having subclinical left ventricular systolic dysfunction as assessed by global longitudinal myocardial strain parameters. Conclusions: In this group of hypertensive patients, global myocardial strain parameters identified a group of individuals with subclinical left ventricular systolic dysfunction despite preserved ejection fraction. The clinical relevance of these findings needs to be assessed in long-term follow-up studies., Introdução: O espectro da cardiopatia hipertensiva é diverso podendo ir até à disfunção ventricular esquerda. O desenvolvimento de metodologias ecocardiográficas que permitam melhorar o estadiamento da cardiopatia hipertensiva e identificar precocemente hipertensos em risco de evolução desfavorável poderá ser clinicamente relevante. Objetivos: Identificar o compromisso subclínico da função ventricular esquerda em indivíduos hipertensos com fração de ejeção preservada (> 55%), utilizando parâmetros globais da deformação miocárdica (Speckle Tracking). Metodologia: Foram estudados dois grupos de indivíduos: normotensos (N = 20; 59 ± 7 anos; 55% homens) e hipertensos (N = 229; 62 ± 12 anos; 57% homens), tendo sido avaliados vários parâmetros clínicos e ecocardiográficos de função ventricular esquerda (convencionais e parâmetros globais da deformação miocárdica longitudinal e circunferencial). Foram determinados os cut-offs da normalidade a partir do grupo de normotensos e aplicados ao grupo de hipertensos, para se detetar disfunção ventricular esquerda subclínica. Foram utilizados os testes t de Student, Mann-Whitney e do Qui-Quadrado. Resultados: O grupo de hipertensos apresentou na sua maioria hipertensão arterial do tipo I (53,7%), pressão arterial controlada (64,9%) e alteração estrutural do ventrículo esquerdo em 54,8% dos indivíduos. Não se detetaram diferenças significativas entre os grupos nos parâmetros globais de deformação longitudinal ou circunferencial. Após aplicação dos cut-offs da normalidade nos hipertensos, foram identificados 35 indivíduos (15,3%) com disfunção ventricular esquerda subclínica. Conclusões: A avaliação da deformação miocárdica permitiu identificar o compromisso sistólico subclínico da função ventricular esquerda num grupo de hipertensos com fração de ejeção preservada. A relevância clínica destes achados deverá ser confirmada por estudos de follow up prolongado.

Fast relaxation of cross-bridge generated force in the myocardium facilitates efficient diastolic function. Recently published research studying mechanisms that modulate the relaxation rate has focused on molecular factors. Mechanical factors have received less attention since the 1980s when seminal work established the theory that reducing afterload accelerates the relaxation rate. Clinical trials using afterload reducing drugs, partially based on this theory, have thus far failed to improve outcomes for patients with diastolic dysfunction. Therefore, we reevaluated the protocols that suggest reducing afterload accelerates the relaxation rate and identified that myocardial relengthening was a potential confounding factor. We hypothesized that the speed of myocardial relengthening at end systole (end systolic strain rate), and not afterload, modulates relaxation rate and tested this hypothesis using electrically-stimulated trabeculae from mice, rats, and humans. We used load-clamp techniques to vary afterload and end systolic strain rate independently. Our data show that the rate of relaxation increases monotonically with end systolic strain rate but is not altered by afterload. Computer simulations mimic this behavior and suggest that fast relengthening quickens relaxation by accelerating the detachment of cross-bridges. The relationship between relaxation rate and strain rate is novel and upends the prevailing theory that afterload modifies relaxation. In conclusion, myocardial relaxation is mechanically modified by the rate of stretch at end systole. The rate of myocardial relengthening at end systole may be a new diagnostic indicator or target for treatment of diastolic dysfunction.

Objective:Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension. We evaluate

Background: Chronic kidney disease (CKD) is one of the most important factors affecting cardiovascular morbidity and mortality. Left atrial (LA) volume indexed (LAVI) for body surface area is the most accurate measure of LA size that was obtained by standard echocardiography. The aim of this study was to investigate the value of strain analysis and LA volume in the detection of myocardial involvement in early CKD. Methods: The study included 60 patients divided into two groups: Group I: patients with early CKD (estimated glomerular filtration rate >30 ml/min/1.73 m2) without any previous cardiac illness and Group II: healthy age-matched controls with normal renal function. Echocardiographic examinations including LAVI and LA strain were measured in all participants. Results: LA wall systolic strain values decreased in the CKD group compared to the healthy control group (16.23% ± 6.33% vs. 38.84% ± 9.37%, P

Fabry cardiomyopathy is characterized by progressive left ventricular hypertrophy (LVH) associated with diastolic dysfunction and is the most common cause of death in Fabry disease (FD). However, LVH is not present in all subjects, particularly early in disease progression and in female patients. Direct assessment of myocardial deformation by strain and strain rate (SR) analysis may be sensitive to detect subclinical Fabry cardiomyopathy independent of the presence of LVH.Systolic (longitudinal, circumferential, and radial systolic strain and SR) and diastolic (SR during isovolumic relaxation [SR(IVR)] and early diastole and strain at peak transmitral E wave) function was assessed in 16 patients with FD using two-dimensional speckle-tracking echocardiography. In addition, mean S' and E' mitral annular velocities by Doppler tissue imaging were measured. Diastolic filling indices, including E/SR(IVR) and E/E' ratios, were calculated. The patients were compared with 24 healthy age-matched and gender-matched controls.All 16 patients with FD had normal left ventricular ejection fractions, and nine patients had LVH. Compared with controls, patients with FD had reduced longitudinal systolic strain (P.001) and systolic SR (P = .007), while there were no differences in circumferential systolic strain and S'. Diastolic function assessment showed reduced longitudinal early diastolic SR (P = .001), SR(IVR) (P.001), and E/SR(IVR) (P.001), while radial and circumferential diastolic function was not affected. Of the conventional diastolic function indices, reductions were seen in E (P = .006), E' (P = .021), and E/E' ratio (P.001). After correcting for LVH, only SR(IVR) (P.001) and E/SR(IVR) (P = .025) remained significantly different between patients with FD and controls, with sensitivity of 94% and specificity of 92% for SR(IVR) of 0.235 sec(-1) (area under the receiver operating characteristic curve, 0.953).Strain and SR analysis is useful in identifying patients with FD with reduced myocardial function, with longitudinal systolic strain and diastolic isovolumic SR being superior to the other echocardiographic measurements of myocardial contraction and relaxation and independent of LVH.

AB Introduction: Prolonged and strenuous exercise (PSE) induces transient left ventricular (LV) dysfunction. Although a consensus exists regarding the decrease in diastolic function, the existence of a decrease in systolic function by a PSE remains controversial, probably due to the transient tachycardia and changes in loading conditions observed upon the completion of exercise. Therefore, the objective was to evaluate LV systolic function before and after a PSE using two-dimensional speckle tracking echocardiography not only at rest but also during incremental tests to adjust heart rates (HR). Methods and Results: Sixteen healthy young men (23 +/- 3 yr old) performed a 3-h period of intensity-controlled upright cycling. LV strain (S), systolic strain rate (SR), rotation, and systolic rotational rate were evaluated by two-dimensional speckle tracking echocardiography before and after a 3-h period of PSE at rest and during incremental tests. Posttest evaluation was performed once the HR had returned to the pretest value. Under resting conditions, parameters of systolic function were either unchanged or increased after the PSE. However, during the incremental test, all LV systolic SR and apical rotational rates were decreased after PSE (radial SR at workload 3 (W3): 2.21 +/- 0.12.s-1 vs 1.87 +/- 0.10.s-1, P < 0.01 and apical rotational rate at W3: 128 +/- 28 deg.s-1 vs 105 +/- 26 deg.s-1, P < 0.05). Regression analyses between LV systolic SR and HR showed lower y-intercepts without differences in slopes, suggesting a decrease of both global and regional systolic functions irrespective of HR after the PSE. Conclusion: Our findings based on LV S and SR data during incremental tests demonstrate that the 3-h period of PSE induces LV systolic dysfunction

Objective Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure that develops in the last month of pregnancy or within 5 months of delivery. Longitudinal systolic strain has been shown to be impaired in HF patients with both preserved and depressed EF, but has not previously characterized in patients with PPCM. Methods The purpose of our study was to investigate the prognosis and recovery in patients with PPCM and use 2D strain imaging to characterize regional and global LV strain in patients with PPCM. Between 2009 and 2014, we identified 47 newly diagnosed patients with PPCM and reduced EF (rPPCM), and 14 patients within the first 4 weeks postpartum who presented with signs and symptoms of HF, and elevated BNP/pro-NT-BNP, but preserved LVEF (pPPCM). We compared the echocardiographic characteristics of the patients with rPPCM and pPPCM with 14 healthy controls. Results All-cause mortality was 10.6% (5/47) and rehospitalization for HF rate was 31.9% (15/47) at a median follow-up of 12.5 months (range: 1–60 months) in the rPPCM group. In 25.5% (12/47) of patients with rPPCM, there was no recovery or worsening of LVEF, while complete and partial (more than 10% increase but less than 55%) recovery was seen in 57.4% (27/47) and 17% (8/47) of patients, respectively. Global and longitudinal strain (GLS) values were not independent predictors of all-cause mortality or the composite endpoint of all-cause mortality, rehospitalization, or no LVEF recovery in these patients. GLS and segmental strain were significantly lower in the preserved EF group compared with controls but higher compared with PPCM with reduced EF. Conclusion Global and segmental longitudinal strain parameters were significantly reduced in PPCM patients.

International audience; BACKGROUND:Identification of transmural extent and degree of non-viability after ST-segment elevation myocardial infarction (STEMI) is clinically important. The objective of the present study was to assess the regional mechanics and temporal deformation patterns using speckle tracking echocardiography (STE) in acute and later phases of STEMI to predict myocardial damage in these patients.METHODS AND RESULTS:Ninety-eight patients with first STEMI underwent both echocardiography and cardiac magnetic resonance imaging in acute phase and at 6 months follow-up with 2D STE-derived measurements of peak longitudinal strain (PLS), Pre-STretch index (PST) and post-systolic deformation index (PSI). For each segment, late gadolinium enhancement (LGE) was defined as transmural (LGE >66 %) or non-transmural (

PubMed ID: 27139514 The aim of this study was to investigate subclinical systolic and diastolic dysfunction in juvenile-onset systemic lupus erythematosus (j-SLE) patients with speckle tracking echocardiography (STE) and the effects of disease activity on left ventricular (LV) regional functions. Thirty-five patients with j-SLE and 30 healthy children (control group) were evaluated between January and August 2015. STE was performed on all patients and controls. Medical records, including diagnosis criteria, age at diagnosis, and duration of disease, were evaluated. SLE disease activity was assessed using the SLE Disease Activity Index (SLEDAI). j-SLE patients had lower ejection fraction than did control subjects but still within normal range. LV end-diastolic and end-systolic dimensions were significantly larger in j-SLE patients (32.43 ± 3.2 vs 28.3 ± 3.1 and 21.1 ± 1.9 vs 18.9.0 ± 2.2, respectively; p = 0.001). There was a significant reduction in longitudinal strain of LV segments in the j-SLE patients compared with controls. J-SLE patients were further divided into subgroups. Group 1 comprised patients having SLEDAI scores >8 at the onset of disease but who improved with therapy during follow-up. Group 2 included j-SLE patients with SLEDAI scores >8 at diagnosis and persistently >4 at the end of follow-up. In the LV mid-inferior and mid-inferolateral segments, STE strain measurements of group 2 were significantly lower than those of group 1 (15.9 ± 6.4 vs 20.0 ± 4.4, 17.9 ± 7.2 vs 23.2 ± 3.8; p = 0.075, p = 0.055, respectively). Simple and non-invasive STE would be helpful in predicting cardiovascular prognosis with new therapeutic medications/interventions or in objectively comparing the effects of immunosuppressive drugs in comparison with preceding STE evaluation. © 2016, International League of Associations for Rheumatology (ILAR).

Objective Quantification of fetal right ventricular (RV) function by 2D-echocardiography is challenging. Velocity vector imaging (VVI) is an angle independent speckle tracking technique that assesses regional myocardial mechanics. Alteration in the deformation of the fetal RV in hypoplastic left heart syndrome (HLHS) is unknown. This study aimed to evaluate the regional mechanics of the fetal RV in HLHS. Methods We retrospectively analyzed HLHS fetuses imaged at our center. Velocity, strain and strain rate were obtained using VVI. Global and regional parameters of RV deformation were compared between HLHS fetuses and gestational age matched controls. Results A total of 30 HLHS fetuses and 30 gestational age matched controls were analyzed. The mean gestational age was 30.5 ±3.5 weeks. Global myocardial strain was significantly decreased in HLHS RVs compared to controls (−1.9% vs. -4.1%, p = 0.003). The volume of the hypoplastic left ventricle did not affect RV deformation in HLHS. Conclusions Compared to controls, the RV in HLHS fetuses has decreased systolic strain. Prenatal abnormalities in RV myocardial deformation may be responsible for inefficient cardiac performance and output. RV myocardial performance in HLHS can be measured prenatally and may be predictive of post-natal RV dysfunction. © 2012 John Wiley & Sons, Ltd.

A 45-year-old female breast cancer patient developed heart failure during adjuvant trastuzumab therapy. Her initial left ventricular ejection fraction (LVEF) was 39% and corresponding global longitudinal and circumferential systolic strain measurements were also significantly reduced. Trastuzumab was ceased and supportive cardiac therapy commenced. The ensuing LVEF and systolic strain measurements showed consistent improvement so that trastuzumab was recommenced (while supportive cardiac therapy continued). At this point, reduced circumferential systolic strain with preserved LVEF was observed. Subsequent echocardiograms revealed further reductions in circumferential and longitudinal systolic strain without reductions in LVEF.

Background and aim: The aim of this study was to evaluate the potential clinical application of ultrasonic tissue indices, with a focus on systolic strain (SS) and systolic strain rate (SSR) parameters derived from transthoracic echocardiography, in the assessment of left anterior descending artery (LAD) stenosis. Methods: The data of 30 patients with significant LAD stenosis were analysed. All patients underwent transthoracic echocardiography to obtain systolic myocardial velocity (Sm), longitudinal SS, and SSR from basal, mid, and apical segments of anterior and inferior walls in two-chamber apical view. Severity of LAD obstruction was measured by means of fractional flow reserve (FFR) during coronary catheterisation. Results: Systolic velocities, strain, and strain rate measured in basal, middle, and apical segments of the anterior left ventricular (LV) wall were lower when compared to those obtained from the corresponding, i.e. unaffected, inferior LV wall. There was a significant correlation between FFR and the value of SS, SSR characterising the apical LV segment of the anterior wall (r = –0.583, p = 0.01; r = –0.598, p = 0.01, respectively). Moreover, we found significant correlation between FFR and Sm in the mid-segment of the LV anterior wall (r = 0.611, p = 0.009). Conclusions: We conclude that SS and SSR obtained from the apical segment of the anterior LV wall may be related to the severity of LAD stenosis.

Background: Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction (HFNEF) remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes. Methods: Patients of new CHF and left ventricular ejection fraction > 50% were included. Exclusion criteria were recent myocardial infarction, severe valvular heart disease, severe left ventricular hypertrophy (septum >1.8 cm), or a technically insufficient echocardiogram. Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free. Results: One hundred consecutive patients with a 1st admission for HFNEF from January 1, 2004 through December 31, 2007, inclusive, were analyzed. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls. However, systolic strain did not differ significantly between the two groups (-11.7% for those readmitted compared with -12.9% for those free from readmission, P = 0.198) and systolic strain rates also were similar (-1.05 s -1 versus -1.09 s -1 , P = 0.545). E/e’ was significantly higher in readmitted patients compared with those who remained free from readmission (14.5 versus 11.0, P = 0.013). E/e’ (OR 1.189, 95% CI 1.026-1.378; P = 0.021) was found to be an independent predictor for HFNEF readmission. Conclusions: Among patients with new onset HFNEF, SS and SR rates are reduced compared with patients free of HFNEF, but do not predict hospital readmission. Elevated E/e’ is a predictor of readmission in these patients. Cardiol Res. 2011;2(6):274-281 doi: https://doi.org/10.4021/cr104w

Septal systolic strain measurements showed reduced longitudinal function but its localized nature failed to demonstrate radial disturbances in patients with pathologically thickened septum. No diff ...

Background: The impact of chronic kidney disease (CKD) and hemodialysis on heart function is not fully understood. We aimed to investigate the influence of different stages of CKD and maintenance hemodialysis on heart function. Methods: One hundred fifty-three patients were categorized into 3 subgroups [56 without CKD as controls; 37 with moderate-advanced CKD, stages 3, 4 or 5, and 60 with end-stage renal disease (ESRD) undergoing maintenance hemodialysis]. Left ventricular (LV) function was assessed by conventional echocardiography and 2-dimensional speckle-tracking echocardiography with strain analysis (2D strain analysis). Results: There was no significant difference of gender, age and LV ejection fraction among groups. Compared with controls, global peak systolic longitudinal strain (GSl), circumferential strain and strain rate were decreased in the CKD group. Along with the decline of renal function, GSl deteriorated. Moreover, compared with moderate-advanced CKD patients, GSl, circumferential strain and strain rate were better in ESRD group receiving maintenance hemodialysis. Conclusions: Worsening renal function was associated with a reduction of systolic function, and could be quantified by 2D strain analysis. The hemodialysis patients have better LV systolic function than the moderate-advanced CKD patients.

Introduction Adverse left ventricular (LV) remodeling following myocardial infarction (MI) involves associated changes in extracellular proteolytic activity and LV biomechanics. This study evaluates how targeted injections of a self-assembling hydrogel (SAgel) loaded with SD-7300, an established matrix metalloproteinase inhibitor (MMPi), impacts regional LV biomechanics post-MI. Hypothesis We hypothesize that delivery of SD-7300 to the MI region will attenuate post-MI changes in biomechanics throughout the LV. Method Mature pigs (25 kg; n=15) were subjected to an ischemia-reperfusion model in which MI is induced by left anterior descending occlusion. At three days post-MI, a subset of pigs were injected with 500μg/mL of SAgel/SD7300 (MI/MMPi; n=7) in a 9 point 100µL array spanning the MI region while the remaining pigs served as controls (MI only; n=8). Peak strain (epeak) and systolic strain rate (γsys), indices of systolic function, were assessed by speckle-tracking echocardiography at baseline and at 28 days post-MI. Regional diastolic myocardial stiffness (Km), an index of diastolic function, was computed from stress-strain relations developed at both time points. Results While global epeak ( Fig 1 A) and global γsys ( Fig 1 B) were reduced at 28 days post-MI in both groups (p Fig 1 C) was significantly lower in the MI/MMPi group relative to MI only in the border zone (3.5 ± 0.4kPa vs. 8.9 ± 1.2kPa, p Conclusions Localized delivery of MMPi mechanically stabilizes the MI region and also impacts border zone and remote myocardial biomechanics over 28 days post-MI. Injectable biomaterials enable the repurposing of an established MMPi for attenuation of post-MI remodeling.

Background There is an increasing interest in echocardiographic strain (e) measurements for the assessment of ventricular myocardial function in children; however, pediatric nomograms remain limited. Our aim was to establish pediatric nomograms for the left ventricular (LV) and the right ventricular (RV) e measured by two-dimensional speckle-tracking echocardiography (2D-STE) in a large cohort of healthy children prospectively enrolled. Methods Echocardiographic measurements included STE LV longitudinal and circumferential and RV longitudinal global end-systolic e. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Echocardiograms were performed by Philips-iE33 systems (Philips, Bothell, WA) and offline measurements on Philips-Q-Lab-9. Results In all, 721 subjects (age 31 days to 17 years; 48% female) were studied. Low coefficients of determination ( R 2 ) were noted among all of the e parameters evaluated and adjusted for age, weight, height, BSA, and HR (i.e., R 2 all ≤ 0.10; range, 0.01-0.088). This hampered the possibility of performing z -scores with a sufficient reliability. Thus, we are limited to presenting data as mean values (±SD) stratified for age groups and divided by gender. LV longitudinal e values decreased with age ( P P Conclusions We report pediatric echocardiographic normative data for 2D-STE for the LV and RV e by using vendor-specific software. Our results confirm previous observations, showing only little variations of strain parameters with age and gender.

Magnetic resonance imaging (MRI) with tissue tagging enables the quantification of multiple strain indices that can be combined through normalization into a single multiparametric index of regional myocardial contractile function. The aim of this study was to test the ability of multiparametric strain analysis to quantify regional differences in contractile function in an ovine model of myocardial injury. Regional variance in myocardial contractile function was induced in eight sheep by the ligation of the blood supply to the anterior and apical left ventricular myocardial walls. Left ventricular systolic strain was obtained from tissue tagged MRI images. A normal strain database (n = 50) defines all parameters of systolic strain and allows normalization of regional function at 15,300 left ventricular points by calculation of a Z-score. Multiparametric systolic strain Z-scores were therefore determined for 15,300 points in each injured sheep left ventricle. Multiparametric Z-scores were found to vary significantly by region (p < 0.001). Z-scores in regions remote to the infarct were found to be significantly smaller than those in the regions most likely to include infarcted myocardium. In this pre-clinical evaluation of MRI-based multiparametric strain analysis, it accurately quantified and visually defined regional differences in myocardial contractile function.

Background Strain imaging, by either tissue-Doppler imaging (TDI) velocity converted to strain or strain rate or by two-dimensional speckle-tracking echocardiography (STE) analysis, is used to evaluate abnormal left-ventricular (LV) mechanical activation patterns in sepsis. Objective The aim of this study was to predict sepsis outcomes using LV strain and strain-rate measurements as well as to establish a comparison between STE and TDI. Patients and methods This study included 32 patients (43.7±13.7 years, 21 males) [13 patients with sepsis (group 1) and 19 patients with severe sepsis/septic shock (group 2)] and a subset of 10 controls (36.5±8.7 years, eight males). In the first 24 h, color-TDI was performed for LV 16 segments, and Doppler flow profiles were reanalyzed using STE to retrieve LV peak global longitudinal systolic strain (GLSS) and global longitudinal systolic strain rate (GLSSR), which were averaged for the whole segment. Results Compared with the controls, ejection fraction (%EF) of both groups were comparable, but GLSS showed increased values (−17.5±2.9 vs. −20.2±1.6%, P Conclusion LV GLSS and GLSSR obtained using STE were more specific and showed a better correlation with both Acute Physiology and Chronic Health Evaluation II and %EF rather than TDI in predicting mortality.

The optimal combination of region-of-interest (ROI) size and strain length (SL) allowing two-segment strain and strain rate analyses in term neonates was investigated. The impact of different ROI sizes and SLs on the strain and strain rate beat-to-beat variation (BBV) was assessed in 80 good-quality tissue velocity images. Both BBVs decreased with increased ROI length and with increased SL (p0.05). There were no significant differences in the BBVs for ROI width 2, 3 and 4 mm (p0.05). Among the combinations eligible for two segment analysis, the lowest BBVs were found using SL 10 mm, ROI length 1 mm and ROI width 3 mm. Using this combination, the mean difference between the single-cycle value and two-cycle compound value for peak systolic strain rate was 6.2%, peak systolic strain was 2.9% and end systolic strain was 3.2% of the two-cycle compound mean values. Hence, strain and strain rate measurement in tissue velocity images in neonates is feasible and reliable.

Background Assessment of left ventricular circumferential (LV circ ) systolic function by standard echocardiography can be performed by estimating midwall fractional shortening (mFS) and stress-corrected mFS (ScmFS). Their determination is based on spherical or cylindrical LV geometric models, which often yield discrepant values. We developed a new model based on a more realistic truncated ellipsoid (TE) LV shape, and explored the concordance between models among hypertensive patients. We also compared the relationships of different mFS and ScmFS estimates with indexes of LV circ systolic strain. Methods In 364 hypertensive subjects, mFS was determined using the spherical (mFS spher ), cylindrical (mFS cyl ), and TE model (mFS TE ). Corresponding values of ScmFS spher , ScmFS cyl , and ScmFS TE were obtained. Global circumferential strain (GCS) and systolic strain rate (GCSR) were also measured by speckle tracking. Results The three models showed poor concordance for the estimation of mFS, with average differences ranging between 11% and 30% and wide limits of agreement. Similar results were found for ScmFS, where reclassification rates for the identification of abnormal LV circ systolic function ranged between 18% and 29%. When tested against strain indexes, mFS TE and ScmFS TE showed the best correlations (R=0.81 and R=0.51, p TE and ScmFS TE showed the strongest independent associations with LV circ strain measures. Conclusions Substantial discrepancies in LV circ midwall systolic indexes exist between different models, supporting the need of model-specific normative data. The use of the TE model might provide indexes that show the best associations with established strain measures of LV circ systolic function.

Background Cirrhosis has been shown to be associated with left ventricular (LV) myocardial dysfunction, but studies of right ventricular (RV) function in cirrhotic patients compared with controls are scarce. Limited studies have prospectively evaluated the progression of myocardial function in patients with cirrhosis and assessed changes in cardiac function following liver transplantation (LTx). So the aim of the study was to evaluate biventricular myocardial function in cirrhotic patients and its alteration with or without liver transplantation. Methods A total of 103 patients with cirrhosis (age 55 ± 7 years, male 75%) were recruited. Conventional and 2-dimensional speckle tracking echocardiography was performed to determine the presence of LV and RV (biventricular) dysfunction. For comparison, 48 matched control subjects were included. Follow-up echocardiography was performed in 41 patients following LTx and in 26 patients who did not undergo LTx. Results Patients with cirrhosis had biventricular dilatation, increased LV mass, impaired LV diastolic function, and biventricular systolic strain compared with controls. Following LTx, cirrhotic patients had reduced biventricular dilatation, a smaller LV mass, and improved biventricular systolic strain after a mean duration of 18.2 ± 6.6 months. Patients who did not undergo LTx had a further increase in LV mass but no significant change in biventricular dimensions or systolic strain (mean duration of 20.4 ± 8.3 months). Conclusions The present study demonstrates that patients with cirrhosis had biventricular dilatation and impaired biventricular systolic strain compared with controls. Following LTx, biventricular dilatation reduced and biventricular systolic strain improved. In contrast, patients who did not undergo LTx experienced a further increase in LV mass.

Assessment of global longitudinal systolic strain (GLS) and basal longitudinal systolic strain (BLS) has shown prognostic value in various cardiac disorders. However, strain has been shown to be inversely proportional to afterload. We assessed the prognostic value of GLS and BLS adjusted for

Background. A novel tissue tracking system (TTS) allows the determination of two-dimensional strain from gray scale digital echocardiographic images. We used TTS to measure myocardial strain of the left ventricle (LV) in healthy children. Methods. The study group consisted of 40 healthy children (2 months to 18 years old). The radial and circumferential strain of the interventricular septum (IVS) and the posterior wall (PW) of the left ventricle were measured using the short axis LV view, and the longitudinal strain of the IVS and lateral wall were calculated from the apical four-chamber view. Results. Large differences were seen in the strain of different cardiac regions. Radial strain was largest in the PW (49.1±12.9%), and longitudinal strain was smallest in the IVS (27.5±8.0%). There were no significant relationships between any of the measured peak systolic strain values and heart rate or age. Bland-Altman analysis showed interand intra-observer standard deviations of 4.7% and 4.9%, respectively. Conclusion: TTS is able to measure three directional strain of the myocardium in a pediatric population. Our data can be used as normal pediatric cardiac myocardial strain values. (J Echocardiogr 2006; 4: 19-24)

We thank Lipiec et al. 1 for their interest in our paper2 and also for bringing up the issue of the appropriateness of linear regression analysis in the evaluation of deformation imaging against left ventricular ejection fraction (LVEF). We agree that LVEF and myocardial systolic strain explore different aspects of the ventricular function within their own limits. LVEF is a well-established parameter of global systolic function, despite its strong dependence on loading …

Background: The left ventricular ejection fraction (LVEF) measurement is a common tool for evaluating the LV systolic function. The application of the global longitudinal systolic strain (GLS) parameter in the assessment of the myocardial function has also received special attention recently. Objectives: This study was aimed at comparing the LVEF and LV volumes obtained by the two methods of catheterization and twodimensional (2D) echocardiography (available in our institution) and assessing the correlation between the LVEF and the GLS. Patients and Methods: In this cross-sectional study, 45 patients were recruited from coronary angiography candidates. The patients underwent echocardiography immediately before catheterization. The LVEF and LV volumes were measured via echocardiography using the apical four- and two chamber-views. The GLS was calculated through the automated functional imaging algorithm. Left ventriculography was performed by calculating the LVEF in the right and left oblique views. Results: The LVEF values obtained by the two methods of ventriculography and echocardiography were not significantly different. The highest correlation regarding the echocardiographic LVEF was obtained in the angiographic right anterior oblique view (P < 0.001, r = 0.95). There was a good agreement as regards the biplane LVEF between 2D echocardiography and ventriculography (-0.5 ± 13.27; CI of 95%). The GLS showed a significant correlation with the estimated EF in both methods, the highest being with the Biplane Simpson method (r = -0.84; P < 0.001). Linear regression was used to obtain the formula for estimating the 2D LVEF from the GLS [LVEF = 2.53 (GLS) + 10.48]. The GLS values ≥ -21.7% and≤ -11.7% were consistent with normal and severe global LV systolic dysfunction, respectively. The inter- and intraobserver agreement was more evident in the GLS measurement rather than in the LVEF. Conclusions: Despite the widespread use of 2D LVEF and its good agreement with ventriculography, strain analysis seems to be more reliable as a quantitative tool for ventricular assessment.

To assess the feasibility of feature tracking (FT)-measured systolic strain post acute ST-segment elevation myocardial infarction (STEMI) and compare strain values to those obtained with tagging.Cardiovascular MRI at 1.5T was performed in 24 patients, 2.2 days post STEMI. Global and segmental circumferential (Ecc) and longitudinal (Ell) strain were assessed using FT and tagging, and correlated with total and segmental infarct size, area at risk and myocardial salvage.All segments tracked satisfactorily with FT (p0.001 vs. tagging). Total analysis time per patient was shorter with FT (38.2±3.8 min vs. 63.7±10.3 min, p0.001 vs. tagging). Global Ecc and Ell were higher with FT than with tagging, apart from FT Ecc using the average of endocardial and epicardial contours (-13.45±4.1 [FT] vs. -13.85±3.9 [tagging], p=0.66). Intraobserver and interobserver agreement for global strain were excellent for FT (ICC 0.906-0.990) but interobserver agreement for tagging was lower (ICC0.765). Interobserver and intraobserver agreement for segmental strain was good for both techniques (ICC0.7) apart from tagging Ell, which was poor (ICC=0.15). FT-derived Ecc significantly correlated with total infarct size (r=0.44, p=0.03) and segmental infarct extent (r=0.44, p0.01), and best distinguished transmurally infarcted segments (AUC 0.77) and infarcted from adjacent and remote segments. FT-derived Ecc correlated strongest with segmental myocardial salvage (rs=-0.406).FT global Ecc and Ell measurement in acute STEMI is feasible and robust. FT-derived strain is quicker to analyse, tracks myocardium better, has better interobserver variability and correlated more strongly with infarct, area at risk (oedema), myocardial salvage and infarct transmurality.

The transitional circulation and its effect on myocardial performance are poorly understood in preterm infants.We assessed myocardial performance in infants less than 29 weeks gestation in the first 48 h of life using a comprehensive echocardiographic assessment.Infants29 weeks gestation were prospectively enrolled. Small for gestation, infants on inotropes and/or inhaled nitric oxide and septic infants were excluded. Conventional echocardiography, left ventricular (LV), septal and right ventricular (RV) tissue Doppler imaging (TDI) and tissue Doppler-derived strain and strain rate (SR), tricuspid annular plane systolic excursion (TAPSE) and global RV fractional area change (FAC) were assessed at a median of 10 and 45 h post-delivery.Fifty-four infants with a median [IQR] gestation and birth weight of 26.5 weeks [25.8-28.0 weeks] and 915 g [758-1142 g] were included. There was no change in shortening or ejection fraction across the two time points. Systolic and diastolic TDI of the LV, septum and RV increased across the two time points (all p values ≤ 0.01). There was an increase in septal peak systolic and early diastolic SR (p=0.002). Septal systolic strain and late diastolic SR did not change. With the exception of RV strain and early diastolic SR, all RV functional parameters including SR, late diastolic SR, TAPSE, and FAC increased across the two time points (all p values0.01).Describing the normal hemodynamic adaptations in stable preterm infants during the transitional period provides the necessary information for the assessment of those parameters in various disease states.

An 80-year-old man was referred to us for further evaluation of suspected left ventricular non-compaction (LVNC). His cardiovascular history was notable for atrial fibrillation and previous CABG. The transthoracic echocardiogram revealed marked apical hypertrophy (26 mm) and no LVNC. A small apical pouch was also noted. An LVEF was 68%, with a reduced global longitudinal systolic strain of −7%. Grade …

In apical hypertrophic cardiomyopathy (HCM), apical left ventricular (LV) hypertrophy contributes to systolic obliteration of the apical LV. Patients often have refractory chest pain and apical perfusion defects; we sought to determine whether these features were associated with duration of cavity

Background Left atrial (LA) mechanics has been poorly investigated in women with subclinical hypothyroidism (SHT), and the effect of levothyroxine therapy on LA deformation and function is unknown. Aim To investigate LA phasic function and mechanics assessed by two-dimensional echocardiography (2DE) and speckle tracking in women with SHT, and to estimate the influence of levothyroxine therapy on LA remodeling. Methods We included 48 untreated women with SHT and 38 healthy control women of the same age. All the SHT patients received levothyroxine therapy and were followed for 1 year after euthyroid status was achieved. All the participants underwent laboratory analyses and complete 2DE examination. Results Left atrial total emptying fraction was significantly lower in the SHT patients at the baseline in comparison with the controls. LA passive emptying fraction gradually decreased from the controls, throughout the treated SHT patients, to the untreated SHT patients. LA active emptying fraction was lower in the controls than in the untreated and the treated SHT participants. 2DE LA longitudinal strain and systolic strain rate gradually decreased from the controls to the untreated SHT patients, whereas LA early diastolic strain rate significantly increased in the same direction. Late diastolic LA strain was lower in the controls than in the untreated and the treated SHT patients. Conclusion Subclinical hypothyroidism significantly affects LA mechanics. Reservoir, conduit, and booster pump LA functions are all impacted by SHT. A 1-year levothyroxine therapy significantly improves, but does not completely restore LA phasic function and mechanics in the SHT patients.

Aims: Coronary microvascular function has important diagnostic and prognostic implications but routine assessment is difficult. The index of microcirculatory resistance (IMR) is a reliable but invasive measure. We evaluated whether left ventricular contractile reserve (CR), measured with strain imaging on dobutamine echocardiography (DSE), is a reliable non-invasive measure of coronary microvascular function. Methods and results: Forty-five patients underwent low-dose DSE and invasive coronary angiography with IMR measurement in the left anterior descending artery. Global mean peak systolic longitudinal strain was measured in three apical views at rest, and with low-dose DSE. CR was the difference between the resting and low-dose values. Mean IMR was 19.8 (range 6-104): mean peak global systolic strain at rest was –17.90% and at low-dose was –21.46%, giving a mean CR of +3.6% (20% relative increase). IMR and CR were significantly correlated, IMR –1 =(0.0014×CR+0.05), r=0.64, p

Objectives This study sought to determine the frequency and magnitude of impaired systolic deformation in heart failure with preserved ejection fraction (HFpEF).Background Although diastolic dysfunction is widely considered a key pathophysiologic mediator of HFpEF, the prevalence of concomitant systolic dysfunction has not been clearly defined.Methods We assessed myocardial systolic and diastolic function in 219 HFpEF patients from a contemporary HFpEF clinical trial. Myocardial deformation was assessed using a vendor- independent 2- dimensional speckle- tracking software. The frequency and severity of impaired deformation was assessed in HFpEF, and compared to 50 normal controls free of cardiovascular disease and to 44 age- and sex- matched hypertensive patients with diastolic dysfunction (hypertensive heart disease) but no HF. Among HFpEF patients, clinical, echocardiographic, and biomarker correlates of left ventricular strain were determined.Results The HFpEF patients had preserved left ventricular ejection fraction and evidence of diastolic dysfunction. Compared to both normal controls and hypertensive heart disease patients, the HFpEF patients demonstrated significantly lower longitudinal strain (LS) (- 20.0 +/- 2.1 and - 17.07 +/- 2.04 vs. - 14.6 +/- 3.3, respectively, p Conclusions Strain imaging detects impaired systolic function despite preserved global LVEF in HFpEF that may contribute to the pathophysiology of the HFpEF syndrome. (LCZ696 Compared to Valsartan in Patients With Chronic Heart Failure and Preserved Left- ventricular Ejection Fraction; NCT00887588) (C) 2014 by the American College of Cardiology Foundation

Ejection fraction (EF) and global longitudinal strain (GLS) provide measures of left ventricle (LV) contraction that are closely related and also reflect different aspects of systolic function. Their comparative analysis can be informative about additional physiological properties on how LV contraction is achieved. The mathematical underlying relationship between EF and the GLS has been exploited and verified through data collected from recent literature. It was demonstrated that GLS and EF are bi-univocally related in the case of a self-similar systolic contraction. The deviation from this relationship, which can be quantified in terms of a shape function, characterizes the change of LV shape during the contraction. This analysis provides a firm ground to highlight the incremental information carried by GLS in the clinical evaluation of cardiac function.

The current study aimed to assess left ventricular (LV) longitudinal systolic strains in children with KD using two-dimensional speckle-tracking imaging and to analyze the relationship of LV myocardial deformation to coronary lesions and laboratory markers. The study enrolled 101 children with acute KD. An additional 50 age- and gender-matched normal children were enrolled as control subjects. During different phases of KD, echocardiograms were recorded for 61 children. Two-dimensional strain analysis software was used to track myocardial movement and obtain the strain from each LV segment. The LV longitudinal systolic strain decreased significantly in children with acute KD but increased immediately after intravenous immunoglobulin therapy. At 6–8 weeks after the onset of KD, all LV strains had recovered to normal. The LV systolic strain was not associated with coronary dilation in either acute or convalescent KD. In acute KD, aspartate transaminase, alanine transaminase, erythrocyte sedimentation rate, C-reactive protein (CRP), and hemoglobin (Hb) were found to be associated with coronary dilation, whereas LV systolic strains were found to be correlated with elevated CRP and decreased Hb. Speckle-tracking imaging of LV systolic strain was simple and accurate in evaluating LV function during different phases of KD. No association between LV dysfunction and coronary dilation was observed, but a relationship with CRP and Hb was found. Further studies are recommended to validate the current study results and explore further how these findings can improve clinical practice.

Background— Left ventricular assist devices (LVADs) provide better outcome than biventricular devices, but it is a challenge to predict the impact of LV mechanical unloading on postoperative right ventricular (RV) function preoperatively. We assessed the load dependency in RV performance before and after LVAD implantation aiming to improve preoperative decision making. Methods and Results— Laboratory, echocardiography, and right heart catheterization data collected from 205 patients before LVAD implantation were tested for relationship with postoperative RV function. Comparing patients with different time-course of RV function after LVAD implantation, we found significant differences ( P P RV−RA ), tricuspid regurgitation velocity-time integral, and pulmonary arterial pressure between patients with and without postoperative RV failure. High predictive values for postoperative RV failure were found for end-diastolic short-/long-axis ratio ≥0.6, tricuspid annulus peak systolic velocity P RV−RA 2 and pulmonary arterial pressure P RV−RA ≥35 mm Hg showed high predictive values for postoperative freedom from RV failure. The RV load adaptation index seemed particularly predictive for RV function after LVAD implantation. Conclusions— RV geometry and velocity of contraction before LVAD implantation become more predictive for postoperative RV function and can improve decision making before VAD implantation if preoperative RV pressure load and tricuspid regurgitation are also considered.

The consistency of the normal spatial distribution of segmental passive stretch (PreS) and systolic strain (SS) within the left ventricle was investigated and a recently proposed echocardiographic estimate of left ventricular (LV) contractility was used to detect contractility changes with age. Hereto, in 54 healthy subjects, segmental PreS and SS were measured on tissue Doppler images of six left ventricle walls. For each subject, a linear regression line was estimated through the segmental PreS and SS values. The slopes and intercepts of this PreS-SS relationship did not differ between age groups, suggesting no changes in LV contractility with age. Moreover, a consistent regional distribution of PreS was observed, with the highest values measured in the septum, resulting in a similar distribution of SS as a direct consequence of the Frank-Starling mechanism.