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Objective: This study aimed to assess alterations in right ventricular (RV) function following percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes utilizing three‐dimensional speckle tracking echocardiography (3D‐STE). Methods: A prospective study was conducted involving 136 patients diagnosed with chronic coronary syndromes undergoing PCI, constituting the study group, alongside 110 age‐ and gender‐matched healthy volunteers serving as the control group. Echocardiographic evaluations, including both conventional and three‐dimensional assessments, were performed on all study participants at 1‐week, 6, and 12 months post‐PCI. Parameters such as tricuspid annular plane systolic excursion (TAPSE) were derived from conventional echocardiography, while tricuspid lateral annular systolic velocity (S') was measured via tissue Doppler imaging. 3D‐STE was utilized to quantify metrics including right ventricular fractional area change (RVFAC), right ventricular free wall longitudinal strain (RVFWLS), right ventricular global longitudinal strain (RVGLS), right ventricular stroke volume (RVSV), and right ventricular ejection fraction (RVEF). Results: TAPSE, S', RVFAC, RVFWLS, RVGLS, RVSV, and RVEF exhibited significant increases from 1‐week to 6 months post‐PCI (p < 0.05). However, from 6 to 12 months post‐PCI, RVFAC, RVGLS, RVSV, and RVEF demonstrated no notable changes (p > 0.05). Meanwhile, TAPSE, S', and RVFWLS sustained significant elevations: TAPSE (19.63 ± 3.253% to 22.603 ± 2.885%, p < 0.001); S' (10.57 ± 2.643 to 12.61 ± 2.189 cm/s, p < 0.001); RVFWLS (18.64 ± 2.745% to 19.926 ± 3.291%, p = 0.002). At 12 months post‐PCI, S', RVFAC, RVGLS, RVSV, and RVEF remained lower than those of the healthy control group, but the differences were not statistically significant (p > 0.05). However, RVFWLS was significantly lower compared to the healthy control group (19.926 ± 3.291% vs. 22.10 ± 1.994%, p < 0.001). Conclusion: Following PCI, right ventricular systolic function in patients with chronic coronary syndromes improves significantly over time. However, even at the 12‐month post‐PCI mark, RVFWLS remains lower than that of the control group. Notably, 3D‐STE emerges as a noninvasive method for quantifying right ventricular systolic function post‐PCI in chronic coronary syndrome patients. [ABSTRACT FROM AUTHOR]

Objectives: In a cohort of patients with estimated fetal weights (EFWs) <10th centile, we aimed 1) to compare the prevalence of abnormalities of fetal 4‐chamber view (4CV) cardiac size, shape, and ventricular contractility in fetal growth restricted (FGR) and small‐for‐gestational‐age (SGA) fetuses and 2) to compare umbilical vein flow (UVF) measurements to standard Doppler surveillance in predicting abnormalities of cardiac function. Methods: Prospective observational cohort study of fetuses with EFW <10th percentile. Measurements of size and shape used were 4CV transverse width, 4CV cardiac area, 4CV global sphericity index, and right‐to‐left ventricular mid‐chamber width ratio. Variables of contractility used were fractional shortening change at the mid‐ventricle chamber, global longitudinal strain, fractional area change, and left ventricular cardiac output. The UVF and standard Doppler surveillance including umbilical artery (UA), middle cerebral artery, and cerebroplacental ratio (CPR) were collected. Control data were from previously published studies. Results: A total of 95 fetuses with EFWs <10th centile were included in the study. The rates of abnormalities of cardiac size and shape and ventricular contractility were all significantly elevated compared with normally grown control fetuses but similar between FGR and SGA fetuses. In a subset of 76 patients with UVF data, evaluation UVF identified more patients with any abnormality of contractility compared with UA (37.9 vs 17.2%, P =.02). Conclusions: The addition of UVF doubled the detection rate of ventricular contractility abnormalities. The addition of UVF should be considered in the surveillance of FGR and SGA fetuses to further stratify the severity of hypoxemia and to identify those at greater risk for future cardiovascular dysfunction. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diagnosis of myocarditis remains a challenge in clinical practice; however, magnetic resonance imaging (CMRI) can ease the diagnostic approach by providing various parameters. The prevalence of right ventricular involvement in acute myocarditis is suggested to be more frequent than previously hypothesized. In this study, we sought to investigate subclinical RV involvement in patients with acute myocarditis and preserved RV ejection fraction (EF), using CMRI RV speckle-tracking imaging. Materials and Methods: CMRI of 27 patients with acute myocarditis (nine females, age 35.1 ± 12.2 y) was retrospectively analyzed. A control group consisting of CMRI images of 27 healthy individuals was included. Results: No significant differences were found regarding left ventricle (LV) and atrium dimensions. LV ejection fraction was significantly different between groups (56.6 ± 10.6 vs. 62.1 ± 2.6, p < 0.05). No significant differences were present between parameters used for conventional assessment of RV. However, RV strain absolute values were significantly lower in the acute myocarditis group in comparison with that of the control group (18.4 ± 5.4 vs. 21.8 ± 2.8, p = 0.018). Conclusions: Subclinical RV dysfunction detected by CMR-derived strain may be present in patients with acute myocarditis even with preserved RVEF. [ABSTRACT FROM AUTHOR]

The Achilles tendon (AT) is composed of three distinct subtendons, each arising from one of the three heads of the triceps surae muscles: gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and soleus (SOL). These subtendons exhibit a twisted structure, classified as low (Type I), medium (Type II), and high (Type III) twist, based on cadaveric studies. Nevertheless, the in vivo investigation of AT twist is notably scarce, resulting in a limited understanding of its functional significance. The aim of this study was to give insights into the complex 3D AT structure in vivo. A total of 30 healthy participants underwent individual stimulation of each of the triceps surae muscles at rest with the foot attached to the pedal of an isokinetic dynamometer. Ultrasound images were captured to concomitantly examine the displacement of the superficial, middle and deep AT layers. SOL stimulation resulted in the highest AT displacement followed by GM and GL stimulation. Independent of the muscle stimulated, non‐uniformity within the AT was observed with the deep layer exhibiting more displacement compared to the middle and superficial layers, hence important inter‐individual differences in AT displacement were noticeable. By comparing these individual displacement patterns during targeted stimulations with insights from cadaveric twist classifications on each subtendon area, our classification identified 19 subjects with a ‘low’ twist and 11 subjects with a ‘high’ twist. These findings enable us to move beyond cadaveric studies and relate the twisted microstructure of the AT in vivo to its dynamic behaviour. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the utility of 2D-STI and real-time three-dimensional echocardiography (RT-3DE) in assessing changes in left atrial (LA) structure and function in patients with paroxysmal atrial fibrillation (PAF) post-radiofrequency catheter ablation (RFCA). Methods: A retrospective analysis was conducted on 44 PAF patients who underwent RFCA at BA Hospital from March 2022 to March 2023. An age- and gender-matched control group of 32 healthy individuals was also included. Comprehensive echocardiographic parameters including LA dimensions (LAAPD, LALRD), volumes (LAVmin, LAVmax), ejection fraction (LAEF), and tissue velocities (a’, Ar) were compared between groups. Post-RFCA changes in these parameters were also assessed at 1, 3, and 6 months. Results: Pre-RFCA, PAF patients demonstrated larger LA dimensions and volumes with reduced LAEF and tissue velocities compared to controls. Post-RFCA, there was a significant improvement in LAEF and left ventricular ejection fraction at 1, 3, and 6 months, with the most pronounced changes observed at 6 months. LA dimensions increased initially but then decreased from 1 to 6 months post-RFCA. Notably, strain rate (SRS, SRE, SRA) measurements in various LA segments improved progressively, with the most significant enhancements at 6 months, suggesting improved atrial mechanics. Conclusion: The application of 2D-STI and RT-3DE provides a quantitative means to evaluate the structural and functional changes in the LA of PAF patients following RFCA. The progressive improvements in LA dimensions, volumes, and strain measurements up to 6-month post-RFCA indicate the potential of these techniques in monitoring treatment efficacy and patient recovery. [ABSTRACT FROM AUTHOR]

In situ wavefront sensing plays a critical role in the delivery of high‐quality beams for X‐ray experiments. X‐ray speckle‐based techniques stand out among other in situ techniques for their easy experimental setup and various data acquisition modes. Although X‐ray speckle‐based techniques have been under development for more than a decade, there are still no user‐friendly software packages for new researchers to begin with. Here, we present an open‐source Python package, spexwavepy, for X‐ray wavefront sensing using speckle‐based techniques. This Python package covers a variety of X‐ray speckle‐based techniques, provides plenty of examples with real experimental data and offers detailed online documentation for users. We hope it can help new researchers learn and apply the speckle‐based techniques for X‐ray wavefront sensing to synchrotron radiation and X‐ray free‐electron laser beamlines. [ABSTRACT FROM AUTHOR]

Objectives: Women with a hypertensive disorder of pregnancy (HDP) are at increased risk of developing hypertension and cardiovascular disease later in life. However, from previous studies, it is difficult to define whether this association reflects pre‐existing maternal cardiovascular risk or a potentially causal relationship between HDP and later cardiovascular risk. In this study, we performed detailed cardiovascular assessment in women in midgestation, prior to development of HDP, and at 2 years postpartum, aiming to identify cardiovascular changes prior to development of HDP and to assess persistent cardiovascular alterations long after the HDP event. Methods: This was a prospective observational study in which we performed detailed cardiovascular assessment in midgestation and at a median of 2.3 (interquartile range, 2.1–2.4) years postpartum. We examined 112 women who developed HDP and 451 women whose pregnancy was not complicated by hypertension. We used conventional and more advanced (i.e. speckle tracking) echocardiographic techniques to determine accurately left ventricular systolic and diastolic function. We used M‐mode measurements to determine left ventricular remodeling and estimate left ventricular mass. Maternal vascular status was assessed using ophthalmic artery Doppler and by calculating peak systolic velocity (PSV) ratio, as a marker of peripheral vascular resistance. Results: In midgestation, women who subsequently developed HDP had increased ophthalmic artery PSV ratio. These women also had mild cardiac functional and morphological alterations, which were accounted for mostly by maternal cardiovascular risk factors. At 2 years postpartum, women who had experienced HDP, compared to those who did not, had cardiovascular abnormalities with reduction in left ventricular systolic and diastolic function, which remained after multivariable analysis. Longitudinal analysis demonstrated that the evolution of cardiovascular changes in the HDP and non‐HDP groups was similar. Conclusions: Mild cardiac functional and morphological alterations precede the development of HDP and such changes persist for at least 2 years postpartum. The cardiac changes are likely to be the consequence of pre‐existing maternal cardiovascular risk factors rather than an adverse consequence of HDP. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Ultrasound speckle tracking is frequently used to quantify myocardial strain, and magnetic resonance imaging (MRI) feature tracking is rapidly gaining interest. Our aim is to validate cardiac MRI feature tracking by comparing it with the gold standard method (i.e., MRI tagging) in healthy subjects and patients. Furthermore, we aim to perform an indirect validation by comparing ultrasound speckle tracking with MRI feature tracking. Forty‐two subjects (17 formerly preeclamptic women, three healthy women, and 22 left bundle branch block patients of both sexes) received 3‐T cardiac MRI and echocardiography. Cine and tagged MRI, and B‐mode ultrasound images, were acquired. Intrapatient global and segmental left ventricular circumferential (MRI tagging vs. MRI feature tracking) and longitudinal (MRI feature tracking vs. ultrasound speckle tracking) peak strain and time to peak strain were compared between the three techniques. Intraclass correlation coefficient (ICC) (< 0.50 = poor, 0.50–0.75 = moderate, > 0.75–0.90 = good, > 0.90 = excellent) and Bland–Altman analysis were used to assess correlation and bias; p less than 0.05 indicates a significant ICC or bias. Global peak strain parameters showed moderate‐to‐good correlations between methods (ICC = 0.71–0.83, p < 0.01) with no significant biases. Global time to peak strain parameters showed moderate‐to‐good correlations (ICC = 0.56–0.82, p < 0.01) with no significant biases. Segmental peak strains showed significant biases in all parameters and moderate‐to‐good correlation (ICC = 0.62–0.77, p < 0.01), except for lateral longitudinal peak strain (ICC = 0.23, p = 0.22). Segmental time to peak strain parameters showed moderate‐to‐good correlation (ICC = 0.58–0.74, p < 0.01) with no significant biases. MRI feature tracking is a valid method to examine myocardial strain, but there is bias in absolute segmental strain values between imaging techniques. MRI feature tracking shows adequate comparability with ultrasound speckle tracking. [ABSTRACT FROM AUTHOR]

Background: Transthoracic echocardiography is usually the first non-invasive imaging modality for the detection of Loeffler endocarditis at thrombotic stage. In the recent decade 3D echocardiography and deformation imaging already proved as a helpful tool for the monitoring of left and right ventricular heart disease. Case presentation: The present case illustrates the diagnostic role of 3D echocardiography and deformation imaging in the acute stage of right sided Loeffler endocarditis in a 70-year-old Western European (German) woman. This case proves that myocardial involvement due to inflammation can be detected at subclinical stages by speckle tracking echocardiography. Acute deterioration of left and right ventricular function and the early response to prednisolone therapy can objectively be monitored. In addition, alterations of effective stroke volume can quantitatively be assessed by 3D right ventricular volumetry with exclusion of thrombus formation in the volume measurements. Conclusion: This case underlines the importance of 3D echocardiography and deformation imaging as a helpful diagnostic tool in disease management in the acute phase of Loeffler endocarditis at thrombotic stage. [ABSTRACT FROM AUTHOR]

Background:Coronary artery disease (CAD) is a major cause of cardiovascular mortality. Echocardiography plays a vital role in early detection and treatment. Objectives:We investigated the use of speckle tracking during dobutamine stress echocardiography (DSE) to diagnose CAD in moderate-risk patients. Materials and Methods:A 4-month cross-sectional study enrolled 42 moderate-risk patients without prior CAD history. Data included questionnaires, echocardiographic measurements, and SPSS analysis. Results:Patients were divided into CAD-negative (66.7%) and CAD-positive (33.3%) groups based on coronary angiography. Speckle tracking during stress correlated better with angiography (kappa = 0.78) than at rest (kappa = 0.21) or stress visualization (kappa = 0.66). Sensitivity and specificity were 71.4% and 92.8% (stress test), 57.1% and 85.7% (speckle at rest), and 85.7% and 92.8% (speckle during stress), respectively. Conclusion:Speckle tracking during DSE is a promising approach for diagnosing CAD in moderate-risk patients, enhancing early intervention possibilities.

In situ wavefront sensing plays a critical role in the delivery of high-quality beams for X-ray experiments. X-ray speckle-based techniques stand out among other in situ techniques for their easy experimental setup and various data acquisition modes. Although X-ray speckle-based techniques have been under development for more than a decade, there are still no user-friendly software packages for new researchers to begin with. Here, we present an open-source Python package, spexwavepy, for X-ray wavefront sensing using speckle-based techniques. This Python package covers a variety of X-ray speckle-based techniques, provides plenty of examples with real experimental data and offers detailed online documentation for users. We hope it can help new researchers learn and apply the speckle-based techniques for X-ray wavefront sensing to synchrotron radiation and X-ray free-electron laser beamlines.

Background:Systemic hypertension is an expanding health problem and a major cause of cardiovascular morbidity and mortality. Left atrial (LA) strain by speckle tracking is a new echocardiographic modality that can detect impairment in LA function. Objectives:The aim was to analyze the parameters of LA strain in patients with systemic hypertension and compare them to those of normal persons. Materials and Methods:A case–control study was conducted at the echocardiography department of Marjan Medical City in Hillah from February 2023 to June 2023. The study focused on patients with hypertension and compared their 2D echocardiography, Doppler, tissue Doppler, left ventricle global longitudinal strain, and LA strain to those of a control healthy group. Data collection included a questionnaire, echocardiography using the GE Vivid iq machine, and statistical analysis using Statistical Package for the Social Sciences (SPSS) 27 software. Results:In total, 100 persons were enrolled in the study; 50 of them were patients with systemic hypertension, and the other 50 were persons with negative medical history. The two groups were age, gender, and body surface area matched. Echocardiographic parameters were compared, concentrating on LA strain and diastolic function parameters. A strong correlation was found between hypertension and LA strain parameters. Reservoir, conduit, and contractile strain were lower in the hypertensive group, while the LA volume and LA indexed volume were statistically larger in the hypertensive group than the control group, with a P value of less than 0.001 in both. Conclusion:LA strain by speckle tracking is affected in systemic hypertension more and even before the diastolic function affection. Earlier detection and treatment of dysfunction can delay or even prevent complications.

Background: Critical aortic stenosis (AS) in fetuses may progress to hypoplastic left heart syndrome (HLHS) with need for postnatal single ventricular (SV) palliation. Fetal aortic valvuloplasty (FAV) is performed to achieve postnatal biventricular (BV) circulation. However, the impact of FAV on fetal myocardial function is difficult to measure. Prediction of postnatal circulatory status and, therefore, counseling is challenging. Methods: Retrospective study of fetuses with critical AS who underwent FAV. Global Longitudinal Peak Systolic Strain (GLPSS) of the left ventricle (LV) and right ventricle (RV) were retrospectively analyzed before and after intervention. Fisher's Exact Test and Mann–Whitney-U Test were used for univariant statistical analysis. Results: 23 fetuses with critical AS were included. After intervention fetuses demonstrated more negative LV-GLPSS mean values post- vs. pre-intervention (− 5.36% vs. − 1.57%; p < 0.05). RV-GLPSS was decreased in all fetuses, there was no peri-interventional change. 20 fetuses were born alive. Postnatally, 10 had BV and 10 SV circulation. Improved post-interventional LV-GLPSS strain values correlated with BV outcome (p < 0.05). Pre-interventional continuous LV-GLPSS values correlated with postnatal SV vs. BV outcome (p < 0.05). Conclusion: In some fetuses, LV myocardial function assessed by speckle tracking echocardiography (STE) improves after FAV. Improved post-interventional LV-GLPSS correlates with biventricular postnatal outcome. Furthermore, pre-interventional LV- and RV-GLPSS correlate with postnatal outcome. Further studies are needed to asses, if pre-interventional STE parameters might predict which fetuses will benefit from FAV with postnatal BV circulation. [ABSTRACT FROM AUTHOR]

Ultrasound speckle tracking enables in vivo measurement of soft tissue deformation or strain, providing a non-invasive diagnostic tool to quantify tissue health. However, adoption into new fields is challenging since algorithms need to be tuned with gold-standard reference data that are expensive or impractical to acquire. Here, we present a novel optimization approach that only requires repeated measurements, which can be acquired for new applications where reference data might not be readily available or difficult to get hold of. Soft tissue motion was captured using ultrasound for the medial collateral ligament (MCL) of three quasi-statically loaded porcine stifle joints, and medial ligamentous structures of a dynamically loaded human cadaveric knee joint. Using a training subset, custom speckle tracking algorithms were created for the porcine and human ligaments using surrogate optimization, which aimed to maximize repeatability by minimizing the normalized standard deviation of calculated strain maps for repeat measurements. An unseen test subset was then used to validate the tuned algorithms by comparing the ultrasound strains to digital image correlation (DIC) surface strains (porcine specimens) and length change values of the optically tracked ligament attachments (human specimens). After 1500 iterations, the optimization routine based on the porcine and human training data converged to similar values of normalized standard deviations of repeat strain maps (porcine: 0.19, human: 0.26). Ultrasound strains calculated for the independent test sets using the tuned algorithms closely matched the DIC measurements for the porcine quasi-static measurements (R > 0.99, RMSE < 0.59%) and the length change between the tracked ligament attachments for the dynamic human dataset (RMSE < 6.28%). Furthermore, strains in the medial ligamentous structures of the human specimen during flexion showed a strong correlation with anterior/posterior position on the ligaments (R > 0.91). Adjusting ultrasound speckle tracking algorithms using an optimization routine based on repeatability led to robust and reliable results with low RMSE for the medial ligamentous structures of the knee. This tool may be equally beneficial in other soft-tissue displacement or strain measurement applications and can assist in the development of novel ultrasonic diagnostic tools to assess soft tissue biomechanics. [ABSTRACT FROM AUTHOR]

We aimed to identify the major determinants of cardiac troponin changes response to exercise among non-elite runners participating in the Beijing 2022 marathon, with a particular focus on the associations with the cardiac function assessed by tissue Doppler echocardiography and speckle tracking. A prospective study. A total of 33 non-elite participants in the 2022 Beijing Marathon were included in the study. Echocardiographic assessment and blood sample collection were conducted before, immediately after, and two weeks after the marathon. Blood samples were analyzed using the same Abbot high-sensitivity cTnI STAT assay. Echocardiography included tissue Doppler and speckle tracking echocardiography. Following the marathon, significant increases were observed in cardiac biomarkers, with hs-cTnI elevating from 3.1 [2.3–6.7] to 49.6 [32.5–76.9] ng/L (P < 0.0001). Over 72 % of participants had post-race hs-TnI levels surpassing the 99th percentile upper reference limit. There was a notable correlation between pre-marathon hs-cTnI levels (β coefficient, 0.56 [0.05, 1.07]; P = 0.042), weekly average training (β coefficient, − 1.15 [− 1.95, − 0.35]; P = 0.009), and hs-cTnI rise post-marathon. Echocardiography revealed significant post-race cardiac function changes, including decreased E/A ratio (P < 0.0001), GWI (P < 0.0001), and GCW (P < 0.0001), with LVEF (β coefficients, 0.112 [0.01, 0.21]; P = 0.042) and RV GLS (β coefficients, 0.124 [0.01, 0.23]; P = 0.035) changes significantly associated with hs-TnI alterations. All echocardiographic and laboratory indicators reverted to baseline levels within two weeks. Baseline hs-cTnI levels and weekly average training influence exercise-induced hs-cTnI elevation in non-elite runners. Echocardiography revealed post-race changes in cardiac function, with LVEF and RV GLS significantly associated with hs-TnI alterations. These findings contribute to understanding the cardiac response to exercise and could guide training and recovery strategies. [ABSTRACT FROM AUTHOR]

Objective: There is growing interest in speckle tracking echocardiography‐derived strain as a measure of left ventricular function in neonates. However, knowledge gaps remain regarding the effect of image acquisition and processing parameters on circumferential strain measurements. The aim of this study was to evaluate the effect of using different region of interest (ROI) widths on speckle tracking derived circumferential strain in healthy neonates. Methods: Thirty healthy‐term‐born neonates were examined with speckle‐tracking echocardiography in the short‐axis view. Circumferential strain values were acquired and compared using two different ROI widths. Furthermore, strain values in the different vendor‐defined wall layers were also compared. Results: Increasing ROI width led to a decrease in global circumferential strain (GCS) in the midwall and epicardial layers, the respective decreases in strain being ‐23.4 ±.6% to ‐22.0 ± 1.1%, p <.0001 and 18.5 ± 1.7% to ‐15.6 ± 2.0%, p <.0001. Segmental analyses were consistent with these results, apart from two segments in the midwall. There was no statistically significant effect on strain for the endocardial layer. A gradient was seen where strain increased from the epicardial to endocardial layers. Conclusion: Increasing ROI width led to a decrease in GCS in the midwall and epicardium. There is an increase in circumferential strain when moving from the epicardial toward the endocardial layer. Clinicians wishing to implement circumferential strain into their practice should consider ROI width variation as a potential confounder in their measurements. [ABSTRACT FROM AUTHOR]

Objective: Epidemiological studies suggest that, following in‐utero exposure to hypertensive disorder of pregnancy (HDP), children may be at increased long‐term cardiovascular risk, but data in early childhood are lacking. We aimed to investigate the independent influence of HDP on infant cardiac structure and function, after accounting for differences in childhood risk‐factor profile. Methods: This was a longitudinal study of 71 children born of a pregnancy complicated by HDP (gestational hypertension or pre‐eclampsia) and 304 children born of a normotensive pregnancy. Detailed cardiovascular assessment was performed at mid gestation and at a median of 2.3 (interquartile range, 2.1–2.4) years postnatally. Linear mixed‐effects modeling was used to determine the independent influence of HDP on infant cardiac function and structure after accounting for differences in childhood risk‐factor profile. Results: There were no differences in demographic characteristics between children whose mother developed HDP and those born of a normotensive pregnancy, but delivery was earlier and birth weight was lower in the HDP group. In fetal life, there were no significant differences in cardiac function or structure between the HDP and non‐HDP groups. In early childhood, in the HDP group compared with the non‐HDP group, there was greater relative wall thickness (mean ± SD, 0.7 ± 0.3 vs 0.6 ± 0.3; P = 0.047) and increased left ventricular mass (indexed to body surface area) (mean ± SD, 80.9 ± 20.4 g/m2vs 75.7 ± 16.5 g/m2; P = 0.024); however, these differences did not persist on multivariable analysis. Longitudinal analysis revealed that there was no difference in the change in cardiac functional indices from fetal life to early childhood between the HDP and non‐HDP groups. Conclusion: There is no evidence that HDP has an adverse effect on offspring cardiovascular health in fetal life or in early childhood. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to compare left ventricle stroke volume in healthy, eutrophic fetuses in the 2nd and 3rd trimesters evaluated using the velocity time integral and aortic annulus area with left ventricular stroke volume measured using Simpson's single‐plane rule and to determine the discrepancy equation. Methods: The study included 354 fetuses. In each fetus, during the same examination, simultaneous assessment of stroke volume was performed by pulsed‐wave Doppler using the product of the velocity time integral and aortic annulus area and by the fetalHQ® software using Simpson's single‐plane rule. The Mann–Whitney U test was used to compare the "product‐derived" stroke volume and stroke volume using fetalHQ® software values in the 2nd and 3rd trimesters separately. The agreement between the two methods were verified using Bland–Altman analysis. A linear regression model was used to obtain the discrepancy equation. Results: In the 2nd trimester, the mean percentage difference between both the techniques showed that the stroke volume values determined using pulsed‐wave Doppler were, on average, 88% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 146% and the lower limit of agreement was equal to 29.6%. In the 3rd trimester, the results indicated that the stroke volume values determined using pulsed‐wave Doppler were, on average, 76% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 129% and the lower limit of agreement was 23%. Based on the results of the linear regression models, discrepancy formulas of the stroke volume values were obtained. The equations to calculate the predicted mean and standard deviations were used to compute the reference intervals for the mean, 5th and 95th centiles. Conclusion: The calculation of left ventricular stroke volume using pulsed Doppler has higher result in relation to stroke volume determined using Simpson's rule significantly. The aortic annulus area showed a higher correlation regarding stroke volume than the velocity time integral in both the 2nd and 3rd trimesters. Stroke volume increased with the increase in aortic annulus area, whereas the velocity time integral remained relatively constant. The retrospective analysis of the collected material enabled the determination of the discrepancy equation. [ABSTRACT FROM AUTHOR]

Introduction: The effects of pre-anesthetic single-dose oral pimobendan during inhalational anesthesia, including the comparison with the effects of single intravenous pimobendan under anesthesia, remain unexplored. Therefore, this study aimed to determine changes in hemodynamic and echocardiographic parameters induced by pre-anesthetic administration of oral pimobendan under isoflurane general anesthesia and to compare them with those induced by intravenous pimobendan. Methods: Thirteen clinically normal dogs (4 laboratory and 9 client-owned dogs) with no clinical signs and not on any medical treatment were included. Anesthesia was performed three times: no pimobendan (Control), oral pimobendan (PIMO PO, 0.3  mg/kg), and intravenous pimobendan (PIMO IV, 0.15  mg/kg). Echocardiographic and hemodynamic parameters were monitored at 30-min intervals in all groups. Results: Compared to the Control group, end-systolic volume index (ESVI) and normalized left ventricular internal diameter at end-systole (LVIDSN) were significantly lower, and fractional shortening (FS) and ejection fraction (EF) were significantly higher in the PIMO PO and IV groups (p <  0.001). Global radial strain (GRS) was significantly higher in the PIMO PO and IV groups (p =  0.015). Conclusion: Under general anesthesia, oral pimobendan preserved LV systolic and myocardial function in a manner comparable to intravenous pimobendan. Pre-anesthetic administration of oral pimobendan can be used to compensate for cardiac systolic function in dogs who require therapeutic and diagnostic procedures under general anesthesia with potential risk of circulatory failure. [ABSTRACT FROM AUTHOR]

Purpose: To assess left atrial (LA) function in individuals with known paroxysmal atrial fibrillation (AF) compared with healthy and nonhealthy individuals without atrial fibrillation. Methods: The Akershus Cardiac Examination 1950 Study included 3,706 individuals all born in 1950. LA strain assessment of reservoir (LASr), conduit (LAScd) and contractile (LASct) functions were performed in all participants by investigators blinded to clinical data. Participants with cardiovascular disease, obesity, diabetes, pulmonary or renal disease were defined as nonhealthy, and those without as healthy. Patients with paroxysmal AF were identified through medical history and ECG documentation. Results: LA strain assessment was feasible in 3,229 (87%) of the participants (50% women). The healthy group (n = 758) had significantly higher LASr and LAScd than the nonhealthy (n = 2,376), but LASct was similar between the groups. Participants with paroxysmal AF had significantly lower values of all strain parameters than the other groups. Multivariable logistic regression showed a significantly reduced probability of having AF per standard deviation increase in LASr and LASct. A nonlinear restricted cubic spline model fitted better with the association of LASr with paroxysmal AF than the linear model, and LA strain values below the population mean associated with an increased probability of having AF, but for values above the population mean no such association was present. Conclusion: Compared to participants without AF, those with known paroxysmal AF had significantly lower values of all LA strain parameters during sinus rhythm. Lower values of LA strain were associated with a significantly increased probability of having AF. [ABSTRACT FROM AUTHOR]

Background: During the physiological cardiac cycle, the helix orientation of the muscle fibres induces the rotation of the apex relative to the base of the left ventricular (LV). In heart failure, LV torsion is impaired, and rotation at basal and apical levels occurs in the same direction, a phenomenon called rigid body rotation (RBR). We aimed to evaluate whether the RBR pattern and GLS together could improve the diagnosis of cardiotoxicity in patients treated with anthracyclines and/or anti-HER2. Methods: With an observational, retrospective study involving 175 patients (mean age 55 ± 12 years, 94% females), we evaluated the development of cancer therapeutic–related cardiac dysfunction (CTRCD) defined according to ESC guidelines. We characterised LV dysfunction by echocardiographic standard and speckle-tracking (GLS and RBR pattern) measurements. Patients with a previous diagnosis of structural heart disease or atrial fibrillation were excluded. Results: At the time of enrolment, the chemotherapy regimen included trastuzumab (96%), pertuzumab (21%), and anthracyclines (13%). Twenty-two patients (12.5%) developed cardiotoxicity, and thirteen patients developed an RBR within 6 months of follow-up. In all cases, the RBR pattern was associated with cardiotoxicity (p < 0.001), reporting an optimal specificity but poor sensitivity at three and six months. However, the addition of the RBR pattern to the global longitudinal strain (GLS) ≥ −16% increased the odds ratio (OR) from 25.6 to 32.6 at three months and from 32.5 to 49.6 at six months rather than GLS alone. Conclusions: The RBR pattern improves the diagnostic accuracy of GLS for the detection of cardiotoxicity secondary to anthracyclines and anti-HER2-based treatments. [ABSTRACT FROM AUTHOR]

Background: An increasing proportion of heart failure (HF) patients progress to the advanced stage (AdHF) with high event rates and limited treatment options. Echocardiography, particularly Speckle Tracking-derived myocardial work (MW), is useful for HF diagnosis and prognosis. We aimed to assess MW's feasibility in the prognostic stratification of AdHF. Methods: We retrospectively screened patients with AdHF who accessed our hospital in 2018–2022. We excluded subjects with inadequate acoustic windows; unavailable brachial artery cuff pressure at the time of the echocardiography; atrial fibrillation; and mitral or aortic regurgitation. We measured standard parameters and left ventricular (LV) strain (LS) and MW. The population was followed up to determine the composite outcomes of all-cause mortality, left ventricular assist device implantation and heart transplantation (primary endpoint), as well as unplanned HF hospitalization (secondary endpoint). Results: We enrolled 138 patients, prevalently males (79.7%), with a median age of 58 years (IQR 50–62). AdHF etiology was predominantly non-ischemic (65.9%). Thirty-five patients developed a composite event during a median follow-up of 636 days (IQR 323–868). Diastolic function, pulmonary pressures, and LV GLS and LV MW indices were not associated with major events. Contrarily, for the secondary endpoint, the hazard ratio for each increase in global work index (GWI) by 50 mmHg% was 0.90 (p = 0.025) and for each increase in global constructive work (GCW) by 50 mmHg% was 0.90 (p = 0.022). Kaplan–Meier demonstrated better endpoint-free survival, with an LV GWI ≥ 369 mmHg%. Conclusions: GWI and GCW, with good feasibility, can help in the better characterization of patients with AdHF at higher risk of HF hospitalization and adverse events, identifying the need for closer follow-up or additional HF therapy. [ABSTRACT FROM AUTHOR]

Assessment of fetal ventricular function is mostly subjective, and currently, for the objective assessment left ventricular shortening fraction is obtained. However, this by itself is not very reliable. Hence, more tools that can provide an objective assessment are needed to increase the confidence of functional assessment. Speckle tracking imaging can provide one such tool. In this study we sought to establish the normative value of global longitudinal and circumferential strain for our fetal patients and for two major forms of congenital heart diseases, namely atrioventricular canal defects (AVC) and uncorrected dextro-transposition of the great arteries (dTGA) to act as a benchmark. The study was completed via a single center retrospective analysis on 72 fetal echocardiograms (26 normal, 15 dTGA, and 31 AVC). Tomtec Arena™ echocardiography analysis software was used for analysis. In normal fetuses, mean left ventricular (LV) global longitudinal strain (GLS) was − 22.6% (95% CI -24, -21.1) and mean right ventricular (RV) GLS was − 22.1% (95% CI -23.6, -20.6). In AVC patients LV GLS was-26.6% (95% CI -28,-25.3) and mean RV GLS was − 26.5% (95% CI -27.9,-25.2). In dTGA patients LV GLS was − 22.9% (95% CI of -24.8, -21) and RV GLS was − 21.3% (95% CI was − 23.4, -20.8). There was good intra-rater reliability though poor to fair inter-rater reliability. Notwithstanding its current limitations, strain imaging can provide useful information that can increase confidence of cardiac functional assessment in fetal patients. However, to be reliable across the board, further automation and standardization is required. [ABSTRACT FROM AUTHOR]

Background: Recent studies on American-style football (ASF) athletes raised questions about the impact of training on the cardiovascular phenotype, particularly among linemen players who engage mostly in static exercise during competition and who exhibit concentric cardiac remodeling, often considered maladaptive. We aimed to examine the cardiovascular adaptation to the inter-season mixed-team training program among ASF players. Methods: A prospective, longitudinal, cohort study was conducted among competitive male ASF players from the University of Montreal before and after an inter-season training, which lasted 7 months. This program includes, for all players, combined dynamic and static exercises. Clinical and echocardiographic examinations were performed at both steps. Left atrial (LA) and ventricular (LV) morphological and functional changes were assessed using a multiparametric echocardiographic approach (2D and 3D-echo, Doppler, and speckle tracking). Two-way ANOVA was performed to analyze the impacts of time and field position (linemen versus non-linemen). Results: Fifty-nine players (20 linemen and 39 non-linemen) were included. At baseline, linemen had higher blood pressure (65% were prehypertensive and 10% were hypertensive), thicker LV walls, lower LV systolic and diastolic functions, lower LA-reservoir and conduit functions than non-linemen. After training, linemen significantly reduced weight (Δ-3.4%, P < 0.001) and systolic blood pressure (Δ-4.5%, P < 0.001), whereas non-linemen maintained their weight and significantly increased their systolic (Δ+4.2%, P = 0.037) and diastolic (Δ+16%, P < 0.001) blood pressure). Mixed training was associated with significant increases in 2D-LA volume (P < 0.001), 3D-LV end-diastolic volume (P < 0.001), 3D-LV mass (P < 0.001), and an improvement in LV systolic function, independently of the field position. Non-linemen remodeled their LV in a more concentric fashion and showed reductions in LV diastolic and LA reservoir functions. Conclusions: Our study underscored the influence of field position on cardiovascular adaptation among university-level ASF players, and emphasized the potential of inter-season training to modulate cardiovascular risk factors, particularly among linemen. [ABSTRACT FROM AUTHOR]

It has been well established that arterial hypertension is considered as a predominant risk factor for the development of cardiovascular diseases. Despite the link between arterial hypertension and cardiovascular diseases, arterial hypertension may directly affect cardiac function, leading to heart failure, mostly with preserved ejection fraction (HFpEF). There are echocardiographic findings indicating hypertensive heart disease (HHD), defined as altered cardiac morphology (left ventricular concentric hypertrophy, left atrium dilatation) and function (systolic or diastolic dysfunction) in patients with persistent arterial hypertension irrespective of the cardiac pathologies to which it contributes, such as coronary artery disease and kidney function impairment. In addition to the classical echocardiographic parameters, novel indices, like speckle tracking of the left ventricle and left atrium, 3D volume evaluation, and myocardial work in echocardiography, may provide more accurate and reproducible diagnostic and prognostic data in patients with arterial hypertension. However, their use is still underappreciated. Early detection of and prompt therapy for HHD will greatly improve the prognosis. Hence, in the present review, we shed light on the role of echocardiography in the contemporary diagnostic and prognostic approaches to HHD. [ABSTRACT FROM AUTHOR]

The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s′), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH. [ABSTRACT FROM AUTHOR]

Intracardiac echocardiography (ICE) enables cardiac imaging with a wide field of view, deep imaging depth, and high frame rate during surgery. However, strong sidelobe and grating lobe artifacts created by the ultra-compact transducer degrade its image quality, making diagnosis and monitoring of treatment difficult. Conventionally, aperture apodization algorithms are often used to suppress sidelobe and grating lobe artifacts at the expense of lateral resolution, which is undesirable in ICE. In this study, we present comparative results of the beamforming methods specifically in ICE application. We demonstrate and compare five nonlinear beamforming algorithms in ICE: nonlinear pth root delay and sum (NL-p-DAS), nonlinear pth root spectral magnitude scaling (NL-p-SMS), delay-and-sum with coherence factors (DAS + SCF), delay and sum with apodization (DAS + apodization) and delay and sum (DAS). Phantom and ex-vivo experiment compare the performance of each algorithm in static and dynamic conditions. DAS + SCF shows the best lateral resolution, and all four algorithms improve the image contrast and sidelobe suppression over conventional DAS. NL-p-SMS stands out for the best axial resolution and suppression of grating lobe artifacts. For motion tracking, NL-p-SMS shows better temporal resolution than other methods. Overall, all the beamforming algorithms other than DAS showed improved image quality. Among them, NL-p-SMS, which has a high temporal resolution, showed the potential for providing more accurate information regards movement tracking. [ABSTRACT FROM AUTHOR]

Multisystem inflammatory syndrome in children (MIS-C) commonly involves cardiac injury with both systolic and diastolic dysfunction. Left atrial strain (LAS) detects subclinical diastolic dysfunction in adults but is infrequently used in children. We evaluated LAS in MIS-C and the associations with systemic inflammation and cardiac injury. In this retrospective cohort study, LAS parameters [reservoir (LAS-r), conduit (LAS-cd), and contractile (LAS-ct)] obtained from admission echocardiograms of MIS-C patients were compared to healthy controls and between MIS-C patients with and without cardiac injury (BNP > 500 pg/ml or troponin-I > 0.04 ng/ml). Correlation and logistic regression analyses were performed to assess LAS associations with admission inflammatory and cardiac biomarkers. Reliability testing was performed. We identified 118 patients with MIS-C and 20 healthy controls. Median LAS parameters were reduced in MIS-C patients compared to controls (LAS-r: 31.8 vs. 43.1%, p < 0.001; LAS-cd: − 28.8 vs. − 34.5%, p = 0.006; LAS-ct: − 5.2 vs. − 9.3%, p < 0.001) and reduced in MIS-C patients with cardiac injury (n = 59) compared to no injury (n = 59) (LAS-r: 29.6 vs. 35.8%, p = 0.001; LAS-cd: − 26.5 vs. − 30.4%, p = 0.036; LAS-ct: − 4.6 vs. − 9.3%, p = 0.008). A discrete LAS-ct peak was absent in 65 (55%) MIS-C patients but present in all controls (p < 0.001). Procalcitonin correlated strongly with averaged E/e' (r = 0.55, p = 0.001). Moderate correlations were found for ESR and LAS-ct (r = − 0.41, p = 0.007) as well as BNP and LAS-r (r = − 0.39, p < 0.001) and LAS-ct (r = 0.31, p = 0.023). Troponin-I had only weak correlations. Intra-rater reliability was good for all LAS parameters, and inter-rater reliability was good to excellent for LAS-r, and fair for LAS-cd and LAS-ct. LAS analysis, particularly the absence of a LAS-ct peak, was reproducible and may be superior to conventional echocardiographic parameters for detecting diastolic dysfunction in MIS-C. No strain parameters on admission were independently associated with cardiac injury. [ABSTRACT FROM AUTHOR]

Aim: Two‑dimensional speckle tracking echocardiography (2D‑STE) and three‑dimensional echocardiography (3DE) may overcome many limitations of the conventional 2D echocardiography (2DE) in assessing right ventricular (RV) function. We sought to determine whether characteristics of the right atrium and right ventricle as measured by 2D‑STE and 3DE are associated with cardiac mortality in patients with ischemic heart failure, over a 6‑year follow‑up. Materials and Methods: The inclusion criteria were ischemic cardiomyopathy with left ventricular ejection fraction of <40% diagnosed using standard 2DE, 2D‑STE, and 3DE examination. Patients were followed for 6 years, and cardiac mortality was recorded. Results: The study sample comprised a total of 54 participants. During the period of follow‑up, 24% (13/54) died. The 2DE models showed that being older, having a higher body mass index (BMI), having higher systolic pulmonary artery pressure (SPAP), and a lower RV global longitudinal strain were associated with cardiac mortality in our cohort after 6‑year follow‑up. Finally, the 3DE models showed that in addition to being older, having higher BMI, having a higher SPAP baseline, lower baseline 3DE RV stroke volume, and larger 3DE RV end‑diastolic volume and 3DE RV end‑systolic volume were associated with cardiac mortality over 6‑year follow‑up. Conclusion: This study provides evidence that RV dysfunction as seen on 2D‑STE and 3DE could be associated with increased risk of cardiac‑related mortality in patients with heart failure over 6 years. [ABSTRACT FROM AUTHOR]

Many canine cardiac diseases are associated with left atrial (LA) remodeling and decreased function. For accurate assessment of LA indices, large-scale and prospectively determined reference intervals are necessary. To generate reference intervals of LA size and function using two-dimensional and three-dimensional echocardiography. Two hundred and one healthy adult dogs. Left atrial volume was assessed in right parasternal long-axis, left apical four-chamber and two-chamber views using monoplane Simpson's method, two-dimensional and three-dimensional speckle tracking. Additionally, LA diameter was measured in right parasternal short-axis and long-axis views. Furthermore, LA function was determined by measuring strain and calculating LA fractional shortening and ejection fraction. All variables were tested for correlation to heart rate, age, and body weight. For LA diameter and volume, scaling exponents and prediction intervals were generated using allometric scaling. Reference intervals for LA function parameters were calculated using nonparametric methods. Left atrial diameter and volume showed a strong correlation with body weight. The scaling exponent for LA diameter was approximately 1/3 (0.34–0.40) and approximately one for volume measurements (0.97–1.26). Parameters of LA function showed no clinically relevant correlation with body weight, except for two variables, which showed a mild negative correlation. No clinically relevant correlations with age or heart rate were found. Reference intervals for linear, two-dimensional and three-dimensional measurements of LA size and function were established. The wide range of measurement methods offers the opportunity to select the appropriate reference values for LA evaluation depending on the available technical possibilities. [ABSTRACT FROM AUTHOR]

To evaluate the changes of cardiac morphology and function in fetuses conceived through assisted reproductive technologies (ART) by speckle tracking echocardiography. A retrospective study was conducted in 101 spontaneously conceived (SC) fetuses and 99 ART-conceived ones. Fetal echocardiography was performed, fetal cardiac morphology and function were analyzed using two-dimensional speckle tracking software, including global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC) of the left and right ventricles, as well as segmental sphericity index (SI), end-diastolic diameter (ED), and fractional shortening (FS) in 24 segments. Compared to the SC fetuses, the ART-conceived fetuses exhibited decreased GSI (median [interquartile range], 1.22 [1.16–1.27] vs. 1.18 [1.11–1.24], p=0.007), decreased right ventricular GLS (24.9 [21.5–27.6] vs. 23.2 [20.4–26.8], p=0.026), and decreased right ventricular FAC (mean ± standard deviation, 39.7 ± 6.4 vs. 37.2 ± 7.1, p=0.003). Analysis of the 24 segments showed that ART-conceived fetuses had reduced SI in the apical segments of right ventricle and increased ED in several segments of the right ventricle. Fetuses conceived through ART had a more spherical shape of the global heart and predominantly right-sided cardiac remodeling and systolic function impairment. [ABSTRACT FROM AUTHOR]

Speckle tracking strain echocardiography allows one to visualize the timing of maximum regional strain and quantifies left ventricular–mechanical dispersion (LV-MD). Whether LV-MD and LV-global longitudinal strain (LV-GLS) provide similar or complementary information in mortality risk stratification in patients with severe aortic stenosis (SAS) remains unknown. The authors hypothesized that LV mechanical dyssynchrony assessed by LV-MD is associated with an increased risk of mortality and provides additional prognostic information on top of LV-GLS in patients with SAS. A total of 364 patients with SAS (aortic valve area indexed ≤0.6 cm2/m2 and/or aortic valve area ≤1 cm2), LV ejection fraction ≥50% and no or mild symptoms were enrolled. The endpoint was overall mortality. During a median follow-up period of 41 months, 149 patients died. After adjustment, LV-MD ≥68 ms was significantly associated with an increased risk of mortality (adjusted HR: 1.41; 95% CI: 1.01-1.96; P = 0.044). Adding LV-MD ≥68 ms to a multivariable Cox regression model including LV-GLS ≥−15% improved predictive performance in terms of overall mortality, with improved global model fit, reclassification, and better discrimination. Patients with both criteria had an important increase in mortality compared to patients with none or one criterion (adjusted HR: 2.02; 95% CI: 1.34-3.03; P = 0.001). Interobserver reproducibility of LV-MD was good with an intraclass correlation coefficient of 0.90 (95% CI: 0.72-0.97). LV-MD is a reproducible parameter independently associated with an increased risk of mortality in SAS. Increased LV-MD associated with depressed LV-GLS identifies a subgroup of patients with an increased mortality risk. Whether early aortic valve replacement improves the outcome of these patients deserves further studies. [Display omitted] [ABSTRACT FROM AUTHOR]

Aim. To evaluate the effectiveness of left ventricular (LV) peak global longitudinal strain and potential of computed tomography myocardial perfusion (CT perfusion) for the early diagnosis of asymptomatic patients with myocardial bridges (MBs).Material and methods. Forty patients were examined (20 with asymptomatic MBs in the area of the left anterior descending (LAD) artery and 20 without MBs) at the S. M. Kirov Military Medical Academy in the period from 2021 to 2023. The patients were divided into 2 equal groups consisting of 20 people (10 with MBs — the main group; 10 without MBs — the comparison group), one of which underwent speckle tracking echocardiography (STE), and the other — stress CT perfusion performed (adenosine triphosphate 160 mg/kg). The results were assessed in accordance with the 17-segment classification of LV proposed by the American Heart Association (2002).Results. When performing STE, 5 (50%) patients with MBs showed a decrease in LV local strain in the segments, the blood supply of which comes from the LAD artery and its branches, while in the comparison group — 1 (10%) (x2=5; p=0,025). When assessing the global longitudinal peak strain (GLPS), a significant difference was revealed among the study groups, amounting to -20,9±1,5% in patients with MBs and -22,1±0,9% in those without MBs (p=0,04). Using ROC analysis, the effectiveness of GLPS in prediction of asymptomatic MBs was calculated as follows: AUC=0,93 (95% confidence interval: 0,819-1,0; p=0,001), the cut-off point — -20,55% (sensitivity 80%, specificity 100%). According to CT perfusion data, impaired myocardial blood supply in the group of asymptomatic patients with MBs was noted in 6 (60%) cases, and in the comparison group — 2 (20%) (x2=9,8; p=0,002).Conclusion. Imaging of initial LV changes according to two-dimensional STE and detection of coronary circulatory disorders according to CT myocardial perfusion in asymptomatic patients with MBs makes it possible to timely suspect intramyocardial course of the coronary artery, as well as to consider further management tactics and carry out early prevention of possible cardiovascular events.

الملخص: أهداف البحث: هدفت الدراسة إلى استخدام ''تخطيط صدى القلب بتتبع البقع'' كتقنية جديدة لتشخيص فشل البطين الأيمن لدى الأطفال مع التصحيح الكامل لجراحة رباعية فالوت. طريقة البحث: أجريت دراسة شبه تجريبية في مستشفى قلب الأطفال والمستشفى عالي الجودة في السليمانية لمدة تسعة أشهر. تم تسجيل 150 طفلا تتراوح أعمارهم بين 3 و13 عاما في حالة رباعية فالوت التي تم إصلاحها بالكامل للتحقيق في حمى الوادي المتصدع. تم تقدير حجم العينة اعتمادا على معدل انتشار رباعية فالوت بنسبة 7% إلى 10% من مجمل أمراض القلب التاجية. قياسات تخطيط صدى القلب التقليدية، بما في ذلك الكسر القذفي للبطين الأيمن، والانحراف الانقباضي للمستوى الحلقي ثلاثي الشرفات، ومؤشر أداء عضلة القلب، وحجم البطين الأيمن الانقباضي والانبساطي. بالإضافة إلى ذلك، تتبع البقع للإجهاد الإقليمي والطولي ومعدل الإجهاد في المنظر القمي المكون من 4 غرف. يتضمن تشخيص حمى الوادي المتصدع تخطيط كهربية القلب لقياس ثلاث عوامل: تشتت الموجة ''بي''، وتشتت الموجة ''تي''، ومدة ''كيو آر اس''. النتائج: أظهر الأطفال الذين تم إصلاح رباعية فالوت والذين تم تشخيص إصابتهم بحمى الوادي المتصدع من خلال تخطيط صدى القلب التقليدي انحرافا انقباضيا غير طبيعي في المستوى الحلقي ثلاثي الشرفات قدره 1.3 ± 0.11 سم، وجزء القذف البطيني الأيمن 35.5 ± 6.72، ونهاية انقباضية للبطين الأيمن 69.8 ± 15.13 مل، ونهاية انقباضية والحجم الانبساطي 110.1 ± 14.13 مل، مؤشر أداء عضلة القلب 0.60 ± 0.12 ، و أقصى ضغط لجهاز التنفس الصناعي 52.4 ± 14.08. مقارنة بالأطفال ذوي وظيفة البطين الأيمن الطبيعية. كشف تطبيق تتبع البقع في تشخيص حمى الوادي المتصدع عن انخفاض معدل الإجهاد والإجهاد الطولي (-12.1 ± 2.3 و-0.9 ± 0.3) في الأطفال المصابين بحمى الوادي المتصدع. علاوة على ذلك، كانت هناك ارتباطات إيجابية ملحوظة بين سلالة البطين الأيمن الطولية والانحراف الانقباضي للمستوى الحلقي ثلاثي الشرفات (ص = 0.656) وكذلك الكسر القذفي (ص = 0.675) بينما تظهر الارتباطات السلبية مع حجم البطين الأيمن الانبساطي (ص = -0.684)، حجم نهاية الانقباضي للبطين الأيمن ( ص = -0.718)، مؤشر أداء عضلة القلب ( ص = -0.735)، و أقصى ضغط لجهاز التنفس الصناعي ( ص = -0.767). الاستنتاجات: يعد تطبيق تتبع البقع مع ''معدل الإجهاد والانفعال'' البطيني الأيمن الطولي لتقدير وظيفة البطين الأيمن في رباعية فالوت التي تم إصلاحها طريقة جديدة ومتقدمة تعمل على تحسين تشخيص تشوهات عضلة القلب الإقليمية وسرعة حركة عضلة القلب بشكل كبير مقارنة بالصدى التقليدي. Abstract: Objectives: The study was aimed at using speckle tracking echocardiography as a novel technique to diagnose right ventricular failure (RVF) in children with total correction of tetralogy of Fallot (TOF) through surgery. Methods: A quasi-experimental study was performed at the Children's Heart Hospital of Sulaimani for 9 months. A total of 150 children with completely repaired TOF were enrolled to investigate RVF. Conventional echocardiographic data were recorded, including right ventricular (RV) ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), and RV end-systolic and diastolic volume (RVESV and RVEDV). Additionally, speckle tracking was performed for the regional and longitudinal strain and strain rate in four-chamber apical view. RVF diagnosis was determined on the basis of electrocardiography measurement of P-wave dispersion, T-wave dispersion, and QRS duration. Results: Children with repaired TOF who were diagnosed with RVF through conventional echocardiography exhibited abnormalities with respect to children with normal RV function, including a TAPSE of 1.3 ± 0.11 cm, RVEF of 35.5 ± 6.72, RVESV of 69.8 ± 15.13 ml, RVEDV of 110.1 ± 14.13 ml, MPI of 0.60 ± 0.12, and Pmax of 52.4 ± 14.08. The use of speckle tracking in RVF diagnosis revealed a relatively lower longitudinal strain and strain rate (−12.1 ± 2.3 and −0.9 ± 0.3, respectively) in the children with RVF. Moreover, longitudinal right ventricular strain was positively correlated with TAPSE (r = 0.656) and EF (r = 0.675), and negatively correlated with RVEDV (r = −0.684), RVESV (r = −0.718), MPI (r = −0.735), and Pmax (r = −0.767). Conclusions: The application of speckle tracking with the longitudinal RV strain and strain rate to estimate RV function in children with repaired TOF is a new advanced method that, compared with conventional echo, significantly improves the diagnosis of regional myocardial deformations and cardiac muscle motion velocity.

Cardiac ultrasound imaging is widely used in the clinical setting. Deep learning algorithms have shown increased potential in automating routine clinical tasks for improved diagnosis and prognosis. However, the lack of large and diverse training databases hinders their employment on a full scale in clinics. Difficulties associated with creating large training databases include scarcity of clinical data, privacy related data access concerns and labor-intensive ground-truth annotations. To overcome these issues, realistic cardiac ultrasound simulation is considered advantageous. Nevertheless, our state-of-the-art cardiac ultrasound simulation pipeline is limited to small-scale databases particularly because of the underlying computationally complex finite-element heart model. In this paper, we developed a realistic simulation pipeline to facilitate large-scale synthetic cardiac ultrasound datasets. This pipeline utilizes a well-validated and computationally efficient lump-parameter heart model for generating cardiovascular mechanics, and the convolution based ultrasound simulator COLE for short simulation times. We implemented the proposed pipeline to create a large open-access database of 2-D realistic cardiac ultrasound recordings with diversity in the geometries, ultrasound speckle texture and motions of the left ventricle. Quantitative assessment of the simulated data demonstrated that the synthetic cardiac ultrasound frames contained realistic speckle patterns. Moreover, the left ventricular motion in the simulated frames was tracked using the medical imaging tracking toolbox and was shown to closely match the kinematically imposed ground-truth left ventricular motion. The presented pipeline is valuable for creating large and diverse ground-truth training databases. The resulting database is a potential augmentation tool for machine learning-based ultrasound data processing algorithms and made publicly available.

Background: Systolic inter-arm pressure difference (SIAD) is considered as cardiovascular risk. We aimed to ascertain whether the presence of (SIAD) is associated with impaired left ventricular (LV) functions or not. Methods: Blood pressure (BP) was measured on both arms of 81 participants, echocardiographic parameters of LV functions; ejection fraction, mitral E, A, e', a'and tricuspid regurgitant velocities, left atrial volume index, E/A and E/e' ratio, LV stiffness index and myocardial performance index (MPI) were measured, and global longitudinal strain (GLS) was assessed. Results: Higher SIAD level had good positive correlations with age, body mass index (BMI), duration of hypertension (HTN), MPI, and LV end-systolic volume. SIAD had good negative correlations with mitral E wave velocity, E/A ratio, e' and s' wave velocities, and with the average GLS. Impaired LV average GLS is independently associated with: Years from HTN discovery followed by BMI, gender, and age. Conclusion: BP reading in both arms on the first visit is not sufficient; hypertensive patients need evaluation of the SIAD on follow up. We need to consider the SIAD on risk stratification and BP control. This will be simple to follow in primary care and areas with low resources.

Abstract Background To evaluate the changes of right ventricular (RV) myocardial perfusion and function in patients with hypertrophic cardiomyopathy (HCM) by myocardial contrast echocardiography (MCE) and speckle tracking (2D-STE), and to explore the relationship between RV myocardial perfusion and strain. Methods Conventional ultrasound, MCE and 2D-STE were performed on 29 HCM patients and 21 healthy subjects to analyze RV myocardial perfusion, RV global strain, RV free wall strain, and strain of each segment. The correlation between RV myocardial perfusion and strain was further analyzed in HCM patients. Results MCE results showed that the regional myocardial perfusion of the RV in HCM patients was decreased. Compared with the normal control group, the mean slope (β) in the middle and apical segments of the RV free wall, and the peak intensity (A), β, myocardial blood flow (MBF) of the ventricular septum decreased in HCM patients (P

Speckle-tracking X-ray imaging is an attractive candidate for dynamic X-ray imaging owing to its flexible setup and simultaneous yields of phase, transmission and scattering images. However, traditional speckle-tracking imaging methods suffer from phase distortion at locations with abrupt changes in density, which is always the case for real samples, limiting the applications of the speckle-tracking X-ray imaging method. In this paper, we report a deep-learning based method which can achieve dynamic X-ray speckle-tracking imaging with high-accuracy phase retrieval. The calibration results of a phantom show that the profile of the retrieved phase is highly consistent with the theoretical one. Experiments of polyurethane foaming demonstrated that the proposed method revealed the evolution of the complicated microstructure of the bubbles accurately. The proposed method is a promising solution for dynamic X-ray imaging with high-accuracy phase retrieval, and has extensive applications in metrology and quantitative analysis of dynamics in material science, physics, chemistry and biomedicine.

Abstract Background Image and performance enhancing drugs (IPEDs) are commonly used in resistance trained (RT) individuals and negatively impact left ventricular (LV) structure and function. Few studies have investigated the impact of IPEDs on atrial structure and function with no previous studies investigating bi-atrial strain. Additionally, the impact of current use vs. past use of IPEDs is unclear. Methods Utilising a cross-sectional design, male (n = 81) and female (n = 15) RT individuals were grouped based on IPED user status: current (n = 57), past (n = 19) and non-users (n = 20). Participants completed IPED questionnaires, anthropometrical measurements, electrocardiography, and transthoracic echocardiography with strain imaging. Structural cardiac data was allometrically scaled to body surface area (BSA) according to laws of geometric similarity. Results Body mass and BSA were greater in current users than past and non-users of IPEDs (p 0.05). Left atrial reservoir (p = 0.008, p

ABSTRACTArterial thromboembolism (ATE) in cats usually relates to cardiogenic causes that can be diagnosed by conventional echocardiography. Two-dimensional speckle-tracking echocardiography (2D-STE) is a new ultrasound modality with higher sensitivity. Our objective was to investigate left atrial myocardial deformation in cats with both cardiogenic and non-cardiogenic ATE and normal cats using 2D-STE. Twenty-three normal cats and 21 cats with ATE cats were recruited and performed conventional echocardiography and 2D-STE. From the results, left atrial (LA) strain and strain rate from 2D-STE were significantly decreased in cats with cardiogenic ATE (P

Background and Objectives: Diagnosis of myocarditis remains a challenge in clinical practice; however, magnetic resonance imaging (CMRI) can ease the diagnostic approach by providing various parameters. The prevalence of right ventricular involvement in acute myocarditis is suggested to be more frequent than previously hypothesized. In this study, we sought to investigate subclinical RV involvement in patients with acute myocarditis and preserved RV ejection fraction (EF), using CMRI RV speckle-tracking imaging. Materials and Methods: CMRI of 27 patients with acute myocarditis (nine females, age 35.1 ± 12.2 y) was retrospectively analyzed. A control group consisting of CMRI images of 27 healthy individuals was included. Results: No significant differences were found regarding left ventricle (LV) and atrium dimensions. LV ejection fraction was significantly different between groups (56.6 ± 10.6 vs. 62.1 ± 2.6, p < 0.05). No significant differences were present between parameters used for conventional assessment of RV. However, RV strain absolute values were significantly lower in the acute myocarditis group in comparison with that of the control group (18.4 ± 5.4 vs. 21.8 ± 2.8, p = 0.018). Conclusions: Subclinical RV dysfunction detected by CMR-derived strain may be present in patients with acute myocarditis even with preserved RVEF.

Introduction: Right-ventricular-to-pulmonary artery (RV-PA) coupling, measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), has emerged as a predictor factor in patients undergoing transcatheter aortic valvular replacement (TAVR). Right ventricular longitudinal shortening fraction (RV-LSF) outperformed TAPSE as a prognostic parameter in several diseases. We aimed to compare the prognostic ability of two RV-PA coupling parameters (TAPSE/PASP and the RV-LSF/PASP ratio) in identifying MACE occurrences. Method: A prospective and single-center study involving 197 patients who underwent TAVR was conducted. MACE (heart failure, myocardial infarction, stroke, and death within six months) constituted the primary outcome. ROC curve analysis determined cutoff values for RV-PA ratios. Multivariable Cox regression analysis explored the association between RV-PA ratios and MACE. Results: Forty-six patients (23%) experienced the primary outcome. No significant difference in ROC curve analysis was found (RV-LSF/PASP with AUC = 0.67, 95%CI = [0.58–0.77] vs. TAPSE/PASP with AUC = 0.62, 95%CI = [0.49–0.69]; p = 0.16). RV-LSF/PASP < 0.30%.mmHg−1 was independently associated with the primary outcome. The 6-month cumulative risk of MACE was 59% (95%CI = [38–74]) for patients with RV-LSF/PASP < 0.30%.mmHg−1 and 17% (95%CI = [12–23]) for those with RV-LSF/PASP ≥ 0.30%.mmHg−1; (p < 0.0001). Conclusions: In a contemporary cohort of patients undergoing TAVR, RV-PA uncoupling defined by an RV-LSF/PASP < 0.30%.mmHg−1 was associated with MACE at 6 months. [ABSTRACT FROM AUTHOR]

(1) Background: Reverse septal movement (RSM) often occurs after cardiac surgery, consisting of a paradoxical systolic movement of the interventricular septum. In this retrospective study, we aimed to investigate possible determinants of RSM after coronary artery bypass surgery (CABG). (2) Methods: Patients who underwent CABG with on- or off-pump techniques at our center from March 2019 to October 2021 were retrospectively included. Exclusion criteria were: exposure to combined procedures (e.g., valve implantation), prior cardiac surgery, intraventricular conduction delays, and previous pacemaker implantation. Laboratory tests and echocardiographic and cardiopulmonary bypass (CPB) duration data were collected. (3) Results: We enrolled 138 patients, of whom 32 (23.2%) underwent off-pump CABG. Approximately 89.1% of the population was male; the mean age was 70 ± 11 years. There was no difference in RSM incidence in patients undergoing the off-pump and on-pump techniques (71.9% vs. 62.3%; p = 0.319). In patients undergoing on-pump surgery, the incidence of RSM was slightly higher in longer CPB procedures (OR 1.02 (1.00–1.03) p = 0.012), and clamping aortic time was also greater (OR 1.02 (1.00–1.03) p = 0.042). (4) Conclusions: CPB length seems to be correlated with a higher RSM appearance. This better knowledge of RSM reinforces the safety of CABG and its neutral effect on global biventricular function. [ABSTRACT FROM AUTHOR]

Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy, characterized by abnormal cell adhesions, disrupted intercellular signaling, and fibrofatty replacement of the myocardium. These changes serve as a substrate for ventricular arrhythmias, placing patients at risk of sudden cardiac death, even in the early stages of the disease. Current echocardiographic criteria for diagnosing arrhythmogenic right ventricular cardiomyopathy lack sensitivity, but novel markers of cardiac deformation are not subject to the same technical limitations as current guideline-recommended measures. Measuring cardiac deformation using speckle tracking allows for meticulous quantification of global systolic function, regional function, and dyssynchronous contraction. Consequently, speckle tracking to quantify myocardial strain could potentially be useful in the diagnostic process for the determination of disease progression and to assist risk stratification for ventricular arrhythmias and sudden cardiac death. This narrative review provides an overview of the potential use of different myocardial right ventricular strain measures for characterizing right ventricular dysfunction in arrhythmogenic right ventricular cardiomyopathy and its utility in assessing the risk of ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to evaluate the association between fetal cardiac deformation analysis (CDA) and cardiac function with severe adverse perinatal outcomes in fetuses with isolated left congenital diaphragmatic hernia (CDH). Methods: CDA in each ventricle (contractility, size, and shape), evaluated by speckle tracking and novel FetalHQ software, and markers of cardiac function (E/A ratios, pulmonary and aortic peak systolic velocities, and sigmoid annular valve diameters), were evaluated in fetuses with isolated left CDH. Two evaluations were performed: at referral (CDA and function) and within 3 weeks of delivery (CDA). Severe adverse neonatal outcomes were considered neonatal death (ND) or survival with CDH-associated pulmonary hypertension (CDH-PH). Differences and associations between CDA, cardiac function, and severe adverse outcomes were estimated. Results: Fifty fetuses were included, and seventeen (34%) had severe adverse neonatal outcomes (11 ND and 6 survivors with CDH-PH). At first evaluation, the prevalence of a small left ventricle was 34% (17/50) with a higher prevalence among neonates presenting severe adverse outcomes (58.8 [10/17] vs. 21.2% [7/33]; p = 0.01; OR, 5.03 [1.4–19.1; p = 0.01]) and among those presenting with neonatal mortality (8/11 [72.7] vs. 9/39 [23.0%]; p = 0.03; OR, 8.9 [1.9–40.7; p = 0.005]). No differences in cardiac function or strain were noted between fetuses with or without severe adverse outcomes. Within 3 weeks of delivery, the prevalence of small left ventricle was higher (19/34; 55.8%) with a more globular shape (reduced transverse/longitudinal ratio). A globular right ventricle was significantly associated with ND or survival with CDH-PH (OR, 14.2 [1.5–138.3]; p = 0.02). Conclusion: Fetuses with isolated CDH at risk of perinatal death or survival with CDH-PH had a higher prevalence of a small left ventricle and abnormal shape of the right ventricle. [ABSTRACT FROM AUTHOR]

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Objectives: To investigate the biomechanical properties of porcine oral tissues with in vivo ultrasonography and to compare the difference between oral alveolar mucosa and gingival tissue concerning compressional and tensile mechanical strain. Materials and Methods: Sinclair minipigs (6 females and 4 males, 6 to 18 months of age) were anesthetized for ultrasonography. In vivo high‐frequency tissue harmonic ultrasound (12/24 MHz) cine‐loops were obtained while inducing mechanical tissue stress (0 to 1 N). Post‐processing strain analysis was performed in a cardiac speckle tracking software (EchoInsight®). Region of interest (ROI) was placed for gingival and alveolar mucosa tissues for longitudinal (compressional) and tensile strain analyses. A calibrated gel pad was employed to determine the absolute force (pressure) for the measured tissue strain response function. The resulting elasticity data was statistically analyzed using custom Matlab scripts. Results: In total, 38 sonography cine‐loops around the third premolars were included in the investigation. The longitudinal strain of alveolar mucosa εAML was found to be significantly (P <.05) larger than that of gingiva εGL. Across the measured force range, εAML ~ 1.7 × εGL. Significant differences between alveolar mucosa and gingiva tissues were found for all forces. The tensile strain of the alveolar mucosa εAMT was found to be ~2 × εGT (on the epithelial surface of the gingiva). Both were statistically significantly different for forces exceeding ~0.08 N. At depth, that is, 500 and 1000 μm below the epithelial surface, the gingiva was found to have less ability to stretch contrary to the alveolar mucosa. Gingival tissue at 500 μm depth has significantly less tensile strain than at its surface and more than at 1000 μm depth. In contrast, the tensile strain of alveolar mucosa is largely independent of depth. Conclusion: Ultrasonography can reveal significant differences in oral alveolar mucosal and gingival elastic properties, such as compressional and tensile strain. Under minute forces equivalent to 10 to 40 g, these differences can be observed. As dental ultrasound is a chairside, and noninvasive modality, obtaining real‐time images might soon find clinical utility as a new diagnostic tool for the objective and quantitative assessment of periodontal and peri‐implant soft tissues in clinical and research realms. As ultrasound is a safe modality with no known bioeffects, longitudinal monitoring of areas of concern would be particularly attractive. [ABSTRACT FROM AUTHOR]