The comparison of anatomical and functional features between patients with ischemic with non-obstructive coronary artery disease and obstructive coronary artery disease by CT / 中华放射学杂志

Objective:To explore the difference of the vessel and plaque characteristics, myocardial perfusion and cardiac function between patients with ischemia with non-obstructive coronary artery disease (INOCA) and obstructive coronary artery disease (CAD).Methods:From July 2021 to June 2022, 101 patients with angina were referred to dynamic computed tomography myocardial perfusion (CTP) and coronary computed tomography angiography (CCTA) and retrospectively included in our hospital. Based on the results of CTP and CCTA, patients were divided into INOCA (27 cases), moderate obstructive CAD (26 cases) and severe obstructive CAD (48 cases). The anatomical coronary artery stenosis, plaque characteristics and myocardial perfusion features of all patients were analyzed. Furthermore, left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained on full-phase reconstruction CCTA image by using Medis Suite 3.2 postprocessing software. Multigroup analysis used one way ANOVA or Kruskal Wallis H test. Results:Patients with INOCA were younger than patients with moderate and severe obstructive CAD ( P<0.001). INOCA patients (7.4%, 2/27) had lower rate of positive remodeling than both moderate (57.7%, 15/26, P<0.001) and severe obstructive CAD patients (33.3%, 16/48, P=0.017). The percentage of ischemic myocardium volume in patients with INOCA were similar with those in patients with severe CAD (all P>0.05), but significantly higher than those in patients with moderate CAD (all P<0.05). No significant difference in terms of GLS was detected between patients with INOCA [-17.4% (-21.6%, -11.6%)] and severe CAD [-17.6% (-21.9%, -14.8%), P=0.536], however, patients both with INOCA and severe CAD also had higher GLS than patients with moderate obstructive CAD [-22.3% (-29.8%, -19.0%), all P<0.05]. Conclusions:Based on"one-stop-shop"CTP combined with CCTA imaging, early cardiac functional changes including abnormal myocardial perfusion and myocardial strain in INOCA patients were similar to those in patients with severe obstructive CAD and more severe than those in patients with moderate obstructive CAD.

Predictive value of MR myocardial strain in predicting recent adverse cardiovascular events after primary PCI in patients with acute ST-segment elevation myocardial infarction / 中华放射学杂志

Objective:To investigate the clinical application value of left ventricular myocardial strain obtained by cardiac MR (CMR) in recent major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods:From January 2020 to December 2020, a total of 163 patients successfully underwent primary PCI and underwent CMR examination within one week after surgery at Affiliated Hospital of Xuzhou Medical University. The scan sequences included rapid balance-fast field echo and late-gadolinium enhancement. CVI42 post-processing software was used to analyze and measure the left ventricular myocardial strain indices, including left ventricular global longitudinal strain (GLS), left ventricular global circumferential strain (GCS), and left ventricular global radial strain (GRS). According to the results of the 1-year follow-up after surgery, the patients were divided into the MACE group ( n=28) and the non-MACE group ( n=135). For continuous variables with a normal distribution, the t test of two independent samples was used for comparisons between groups. For continuous variables with an abnormal distribution, the variables were compared and analyzed by the rank sum test. For categorical variables, the χ 2 tests were used for between-group comparisons. Cox regression was used to analyze the prognostic value of myocardial strain on the development of MACE in patients with STEMI. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of myocardial strain parameters, and the optimal cut-off value was evaluated by calculating the Youden index. Results:The GLS, GCS, and GRS of the MACE group were (-10.4±3.3)%, [-11.9 (-14.5, -9.3)]%, and (18.3±6.3)%, respectively, and those of the non-MACE group were (-13.7±3.4)%, [-14.6 (-16.4, -11.7)]%, and (22.3±6.1)%, respectively. The difference between the two groups was statistically significant ( t/ Z=-4.71, -3.04, 3.21, P<0.05). Multivariate Cox regression analysis showed that GLS was an independent predictor of MACE (HR=1.546, 95%CI 1.180-2.027, P=0.002). The ROC curve analysis showed that GLS had the largest area under the curve (AUC) (AUC=0.754, 95%CI 0.658-0.851, P<0.001), with a cut-off value of -12.45%. Its diagnostic sensitivity was 71.4%, and the specificity was 67.4%. The value was better than that of the traditional predictor of STEMI prognosis, namely, left ventricular ejection fraction (AUC=0.680, 95%CI 0.567-0.793, P=0.003). Conclusion:GLS of CMR is an independent predictor of MACE in STEMI patients undergoing primary PCI.

Correlation between right atrial volume and function and liver function grading in patients with hepatitis B cirrhosis by four-dimensional ultrasound automatic quantitation analysis / 中华超声影像学杂志

Objective:To evaluate right atrial (RA) volume and function in patients with hepatitis B cirrhosis by four-dimensional automatic quantitation analysis technique, and to explore its correlation with liver function grading.Methods:Ninety patients with hepatitis B cirrhosis who were clinically confirmed in Henan Provincial People′s Hospital from December 2020 to July 2021 were randomly enrolled as the research subjects. According to Child-Pugh liver function score criteria, the patients were divided into three groups: Child-Pugh A group ( n=31), Child-Pugh B group ( n=31), Child-Pugh C group ( n=28). Another 30 healthy volunteers with gender and age matched at the same period were selected as the control group. The RA maximum volume (RAVmax), RA minimum volume (RAVmin), RA presystolic volume (RAVpreA), RA maximum volume index (RAVImax), RA emptying volume (RAEV), RA ejection fraction (RAEF), RA reservoir longitudinal and circumferential strains (RASr, RASr-c), RA conduit longitudinal and circumferential strains (RAScd, RAScd-c), RA contraction longitudinal and circumferential strains (RASct, RASct-c) were obtained by four-dimensional automatic quantitation analysis technique. Spearman correlation analysis was used to explore the correlation between the volume and strain parameters of right atrium and liver function grading, and the independent correlation factors of RASr-c were analyzed by univariate and multivariate linear regression analyses. Results:Compared with the control group, Child-Pugh A and Child-Pugh B groups, RAVmax, RAVmin, RAVpreA, RAVImax, and RAEV were all increased in Child-Pugh C group (all P<0.05). Compared with control group, the absolute values of RASr, RASct, RASr-c and RASct-c were increased, and the absolute values of RAScd and RAScd-c were decreased in Child-Pugh A group (all P<0.05). Compared with control group, Child-Pugh A and Child-Pugh B groups, the absolute values of RASr, RAScd, RASct, RASr-c, RAScd-c and RASct-c were decreased in the Child-Pugh C group (all P<0.05). Correlation analysis showed that the volume and strain parameters of the right atrium were correlated with liver function grading. RASr-c was independently correlated with E/e, ALB and BNP(β=-0.543, 0.521, and -0.562 respectively, all P<0.05). Conclusions:During the compensatory stage in patients with hepatitis B cirrhosis, the RA functions of reservoir and contractile were increased, but the function of conduit was decreased. With the aggravation of liver cirrhosis, the RA functions of reservoir, conduit and contractile were all decreased. The four-dimensional volume and strain parameters of the right atrium were correlated with Child-Pugh liver function grading, and RASr-c was independently correlated with E/e, ALB and BNP.

Cardiac magnetic resonance-feature tracking technique can assess cardiac function and prognosis in patients with myocardial amyloidosis / 南方医科大学学报

OBJECTIVE@#To quantitatively assess cardiac functions in patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) using cardiac magnetic resonance-feature tracking (CMR-FT) technique and evaluate the prognostic value of CMR-FT in patients with CA.@*METHODS@#We retrospectively collected the data from 31 CA patients with systemic amyloidosis confirmed by Congo red staining and serum immunohistochemistry after extracardiac tissue biopsy undergoing CMR at our hospital from March, 2013 to June, 2021.Thirty-one age and gender matched patients with asymmetric left ventricular wall hypertrophy and 31 healthy individuals without organic or functional heart disease served as the controls.Radial, circumferential and longitudinal strains and strain rates of the left ventricle at the global level and in each myocardial segment (basal, middle and apical) were obtained with CMR-FT technique and compared among the 3 groups.The predictive value of myocardial strains and strain rates for all-cause mortality in CA patients was analyzed using a stepwise COX regression model.@*RESULTS@#The left ventricular volume, myocardial mass, ejection fraction and cardiac output differed significantly among the groups (P < 0.05).Except for apical longitudinal strain, the global and segmental strains were all significantly lower in CA group than in HCM group (P < 0.05).The global and segmental strains were all significantly lower in CA group than in the healthy individuals (P < 0.05).The basal strain rates in the 3 directions were significantly lower in CA group than in the healthy individuals (P < 0.05), but the difference in apical strain rates was not statistically significant between the two groups.Multivariate stepwise COX analysis showed that troponin T (HR=1.05, 95%CI: 1.01-1.10, P=0.017) and middle peak diastolic circumferential strain rate (HR=6.87, 95%CI: 1.52-31.06, P=0.012) were strong predictors of death in CA patients.@*CONCLUSION@#Strain and strain rate parameters derived from CMR-FT based on cine sequences are new noninvasive imaging markers for assessing cardiac impairment in CA and cardiac function changes in HCM, and provide independent predictive information for all-cause mortality in CA patients.

Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction / 中国医学科学杂志(英文版)

Objective To investigate the impact of microvascular obstruction (MVO) on the global and regional myocardial function by cardiac magnetic resonance feature-tracking (CMR-FT) in ST-segment-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention.Methods Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1 - 7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study. Based on the presence or absence of MVO on late gadolinium enhancement images, patients were divided into groups with MVO and without MVO. The infarct zone, adjacent zone, and remote zone were determined based on a myocardial 16-segment model. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) of the global left ventricle (LV) and the infarct, adjacent, and remote zones were measured by CMR-FT from cine images and compared between patients with and without MVO using independent-samples t-test. Logistic regression analysis was used to assess the association of MVO with the impaired LV function.Results A total of 157 STEMI patients (mean age 56.66 ± 11.38 years) were enrolled. MVO was detected in 37.58% (59/157) of STEMI patients, and the mean size of MVO was 3.00 ±3.76 mL. Compared with patients without MVO (n =98 ), the MVO group had significantly reduced LV global RS (t= -4.30, P < 0.001), global CS (t= 4.99, P < 0.001), and global LS ( t= 3.51, P = 0.001). The RS and CS of the infarct zone in patients with MVO were significantly reduced (t= -3.38, P = 0.001; t= 2.64, P = 0.01; respectively) and the infarct size was significantly larger (t= 8.37, P < 0.001) than that of patients without MVO. The presence of LV MVO [OR= 4.10, 95%CI: 2.05 - 8.19, P<0.001) and its size [OR=1.38, 95%CI: 1.10-1.72, P=0.01], along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis, while only heart rate (OR=1.08, 95%CI: 1.03 - 1.13, P=0.001) and LV infarct size (OR=1.10, 95%CI: 1.03 - 1.16, P=0.003) were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.Conclusion The infarct size was larger in STEMI patients with MVO, and MVO deteriorates the global and regional LV myocardial function.

Valoración del strain auricular izquierdo en competidores de ultramaratón ¿Se extiende la fatiga cardíaca a todas las estructuras miocárdicas? / Evaluation of the left atrium strain in ultramarathon competitors. Does cardiac fatigue extend to all myocardial structures?

Resumen Introducción: La aurícula izquierda cumple varias funciones durante el ciclo cardíaco (reservorio, conducción y contracción), que podrían verse afectadas por la remodelación fisiológica al igual que por el estrés inducido por el ejercicio intenso (carreras de ultra-trail de montaña). Objetivo: Valorar si las adaptaciones fisiológicas de la aurícula izquierda al deporte (aumento del volumen auricular), así como el estrés inducido por las competiciones de ultramaratón, influyen en la función auricular izquierda estimada por strain auricular realizado mediante speckle tracking. Método: Fueron evaluados 28 participantes antes y después del ejercicio (en el transcurso de 1 hora posterior al esfuerzo de carreras de ultra-trail) utilizando ecocardiografía Doppler y nuevas técnicas ecocardiográficas (posprocesamiento). Se excluyeron cinco deportistas: dos por regular ventana ecocardiográfica que no permitía visualizar correctamente el borde endomiocárdico y tres por no finalizar la carrera. Se realizaron estadística descriptiva convencional, análisis comparativo para datos pareados mediante test t de Student y correlación de Pearson para valorar factores que influyeran en las alteraciones detectadas. Resultados La mediana de edad de los competidores fue de 38 ± 9 años, con predominancia del sexo masculino (n = 17, 65%). En el ecocardiograma basal se encontró una media de volumen auricular izquierdo de 33 ± 7 ml/m2 (min. 21 ml/m2, max. 47 ml/m2), con strain auricular izquierdo basal promedio del 31%. En la evaluación tras el esfuerzo se observó una disminución no significativa del volumen auricular izquierdo, que mantuvo el strain auricular e incluso aumentó su deformación, como en el caso de las mujeres evaluadas. Conclusiones: A diferencia de lo observado en otros parámetros de función ventricular tras un esfuerzo, el strain auricular no se ve afectado por la fatiga cardíaca.

Abstract Introduction: The left atrium fulfills several functions during the cardiac cycle (reservoir, conduction and contraction) that could be affected by physiological remodeling as well as by stress induced by intense exercise (ultra-mountain trail races). Objective: To assess whether the physiological adaptations of the left atrium to sport (increase in atrial volume) as well as the stress induced by ultramarathon competitions influence left atrial function estimated by atrial strain performed by speckle tracking. Method: 28 participants were evaluated pre and post exercise, using Doppler echocardiography and new echocardiographic techniques. Conventional descriptive statistics, comparative analysis were performed for paired data using the t test and Pearson correlation to assess factors that influence the detected alterations. Results: The median age of the competitors was 38 ± 9 years with a predominance of males (n = 17, 65%). In the basal echocardiogram, we found an average left atrial volume of 33 ± 7 ml/m2 (min. 21 ml/m2, max. 47 ml/m2), with an average baseline left atrial strain of 31%. In the post-effort evaluation, a non-significant decrease in left atrial volume was observed, maintaining atrial strain and even increasing its deformation, as in the case of the women evaluated. Conclusions: Unlike what was observed in other parameters of ventricular function after effort, atrial strain is not affected by cardiac fatigue.

Expression analysis of myocardial strain index after repair of abnormal origin of left coronary artery of pulmonary artery in children / 中华胸心血管外科杂志

Objective:To study the expression characteristics of myocardial strain index after the abnormal origin of the left coronary artery of the pulmonary artery in children was repaired.Methods:The data of 30 children (study group) with abnormal origin of pulmonary artery left coronary artery repair from August 2017 to August 2021 were analyzed. In addition, healthy children during the same period were selected as the control group, and the study group was compared before and after treatment and the control group. Circumferential and radial peak myocardial strain index, post-contraction strain index.Results:The longitudinal, circumferential, and radial overall peak strain indexes of the study group before and after treatment were significantly lower than those of the control group, and the longitudinal, circumferential, and radial overall peak strain indexes of the study group after treatment were significantly higher than those before treatment ( P<0.05); The longitudinal, circumferential, and radial peak strain indexes of the study group before treatment were significantly lower than those of the control group. After treatment in the study group, the middle section of the longitudinal inferior wall, the middle section of the anterior wall, the basal section of the anterior wall, the apex, and the circumferential direction were significantly lower The peak strain index of the basal segment of the inferior wall and the middle segment of the inferior wall was significantly lower than that of the control group; and the longitudinal, circumferential, and radial peak strain indexes of the study group after treatment were significantly higher than those before treatment ( P<0.05); the study group children before treatment Longitudinal, circumferential, and radial PSI indexes were significantly lower than those of the control group. After treatment, the study group was treated in the longitudinal inferior wall, septal apical segment, circumferential inferior wall basal segment, inferior wall middle segment, and radial PSI anterior wall basal segment, apex. The part was significantly higher than that of the control group; and the longitudinal, circumferential, and radial PSI of the study group after treatment were significantly lower than before treatment ( P<0.05). Conclusion:After ALCAPA repair, the overall and regional strain and overall synchronization are improved, indicating that the resting myocardium has recovered, but the strain of certain segments supplied by the abnormal left coronary artery fails to normalize after ALCAPA repair. Persistent myocardial injury is consistent, which can provide some guidance for the prognosis assessment of children with ALCAPA.

Early myocardial strain characteristics in type 2 diabetic mellitus mice evaluated by 7.0 T cardiac MR / 中华放射学杂志

Objective:To investigate the characteristics of early myocardial mechanics changes in diabetic cardiomyopathy (DCM).Method:Sixty healthy 4-week-old male C57BL/6J mice were randomly divided into the T2DM group ( n=30) and the control group ( n=30). The T2DM group was fed with high-fat diet for 4 weeks, and accepted injection of a single high-dose of streptozotocin (STZ) intraperitoneally. Finally, the model was established successfully in 23 mice. The control group was fed with a normal diet and treated with citrate buffer liquid at an equal dose as T2DM group. Then, nine mice were randomly selected from each of the two groups every 4 weeks until the end of the 24th week. Six of the nine mice were randomly selected to perform 7.0 T MR scanning after measuring blood glucose and body weight. Cine images were acquired through cardiovascular MR feature tracking (CMR-FT). The obtained parameters included the left ventricle global peak circumferential strain (LV-GPCS), left ventricle global peak radial strain(GPRS) and the ejection fraction (EF), etc. The rest three mice were sacrificed for observation of the changes of interstitial fibers and micro-vessels in myocardial tissue with Sirius red staining. One-way analysis of variance (ANOVA) and t test were used for comparison. Results:There were significant differences in blood glucose levels between the two groups during the observation period ( P<0.05). In the 4 th-24 th week, the value of GPCS in T2DM group showed a downward trend, and the difference was statistically significant ( F = 8.23, P<0.001). Compared with the control group, the value of GPCS in T2DM group was statistically significant at the 20 th and 24 th week (the 20 th week: -11.4%±2.1% in the T2DM group vs. -14.3%±1.9% in the control group, t=2.54, P=0.029;the 24 th week: -12.3%±1.7% in the T2DM group vs. -14.6%±1.8% in the control group, t=2.35 , P=0.040), while the EF value was different at the 24 th week (51%±5% in the T2DM group vs. 62%±6% in the control group, t=3.38, P=0.007). There was no significant difference in the GPRS of the T2DM mice group over time or compared with the controls ( P>0.05). Moreover, the pathological results showed that the myocardial interstitial fibers in the T2DM group had remarkably increased since the 12 th week. Conclusions:The alterations in myocardial interstitial fibers and myocardial contractility appeared early in T2DM mice. Especially, the left ventricle global peak circumferential strain value is superior to the EF value in reflecting the early changes in DCM.

A primary study of evaluating the left ventricular myocardial strain in patients with coronary heart disease by CT feature tracking / 中华放射学杂志

Objective:To explore the technical feasibility of CT feature tracking (CT-FT) technique in evaluating left ventricular myocardial strain and evaluate the change of myocardial strain in patients with coronary heart disease.Methods:Eighty-one patients with coronary heart disease (lesion group) and 33 patients with normal coronary artery (control group) matched with age and sex were collected retrospectively from the Second Affiliated Hospital of Nanchang University from April 2019 to October 2020. The lesion group was first divided into single vessel stenosis group (42 cases) and multi vessel stenosis group (39 cases) according to the number of coronary artery stenosis branches, and the global myocardial strains of the left ventricle between the groups were analyzed. Lesion site included the left anterior descending branch (LAD), right coronary artery (RCA) and left circumflex branch (LCX), respectively. According to the degree of vascular stenosis, the lesion groups were divided into normal group, mild stenosis group, moderate stenosis group and severe stenosis group. The segmental myocardial strains of the branch segment of LAD, RCA or LCX were analyzed between groups. All CCTA examinations were performed with retrospective electrocardiogram gating. CVI 42 cardiac postprocessing software was used to obtain myocardial strain parameters, including global peak longitudinal strain (GPLS), global peak circumferential strain (GPCS), global peak radial strain (GPRS), and the segmental myocardial strains of the branch segment of LAD, RCA or LCX. The segmental myocardial strains included the peak longitudinal strain (PLS), peak circumferential strain (PCS) and peak radial strain (PRS). One way ANOVA or Kruskal Wallis H test were used for multi group analysis. Results:With the increased number of coronary artery stenosis branches, the absolute value of GPLS gradually decreased. The GPLS of the control group, single vessel stenosis group and multi vessel stenosis group were -14.1%±2.7%, -11.5%±2.3% and -8.8%±2.0%, respectively. The difference of GPLS between the 3 groups or any 2 groups was statistically significant (all P<0.001). The absolute values of GPRS and GPRS in multi vessel stenosis group were significantly lower than those in control group and single vessel stenosis group (all P<0.001). There was no significant difference in GPRS or GPRS between single vessel stenosis group and control group ( P=0.083, 0.118). And there were significant differences in the segmental myocardial strains of the branch segment of LAD, RCA or LCX among 3 groups ( P<0.001). In severe stenosis group, the absolute values of PRS, PCS and PLS in LAD, RCA or LCX were significantly lower than those in moderate stenosis group, mild stenosis group and normal group (all P<0.05). In the moderate stenosis group, the absolute value of PLS in each branch segment was lower than that of the mild stenosis and normal group (all P<0.05), and there was no significant difference in any 2 other myocardial strain parameters of each branch (all P>0.05). Conclusions:CT-FT technique was feasible to evaluate left ventricular myocardial function. With the increased number or degree of coronary artery stenosis, the global and segmental myocardial strain parameters of left ventricle gradually decreased, and the longitudinal strain was more sensitive.

The feasibility of assessing left ventricular global and regional myocardial strain in patients with heart failure based on coronary CT angiography / 中华放射学杂志

Objective:To investigate the feasibility of coronary CT angiography(CCTA)-feature tracking(FT) for assessing global and regional myocardial strain in patients with heart failure(HF).Methods:From July 2019 to December 2020, twenty-five patients diagnosed with HF from Peking Union Medical College Hospital were prospectively enrolled into the study. All patients underwent retrospective electrocardiogram-gated CCTA and cardiac MR (CMR) imaging within 7 days. CCTA-FT and CMR-FT were undertaken using cvi 42 dedicated commercial software to measure global and regional strain parameters, including global peak radial strain (GPRS), global peak circumferential strain (GPCS) and global peak longitudinal strain (GPLS), as well as peak radial strain (PRS), peak circumferential strain (PCS) and peak longitudinal strain (PLS) of left ventricular basal segment, middle segment and apical segment. Conventional left ventricular functional parameters were also calculated, including left ventricular ejection fraction (LVEF), left ventricular stroke volume (LVSV) and left ventricular mass index (LVMI). Paired t test or Wilcoxon signed-rank test was used to compare the differences of measurements between CCTA group and CMR group. Pearson or Spearman correlation analysis was used to analyze the correlation between the two groups. Inter-and intra-observer consistence in CCTA group was evaluated by intraclass correlation coefficient (ICC) analysis. Results:The effective radiation dose of CCTA examination was 6.00 (4.86,7.63) mSv. Inter-and intra-observer consistence in CCTA group was excellent, and the ICC value was 0.85-0.98. In the overall strain parameters, GPCS in CCTA group[-8.10%(-10.32%, -5.20%)] was significantly lower than that of CMR group[-8.49%(-13.79%, -5.95%)] ( Z=-2.15, P=0.031). There was no significant difference in GPRS and GPRS between the two measurement methods ( P>0.05). Strong correlations were observed between GPRS, GPCS and GPLS ( r=0.65, 0.63, 0.71,all P<0.001). For local strain parameters, PCS in the middle segment and apical segment of CCTA group were lower than those of CMR group ( Z=-2.17, -2.62, all P<0.05). There were no significant differences in PCS of basal segment, PRS and PLS of all segments between groups (all P>0.05). The PCS and PLS of basal segment, PRS of middle segment and PRS of apical segment were moderately correlated ( r=0.46, 0.52, 0.58, 0.53, P<0.05); The other local strain parameters were strongly correlated, the range of r value was from 0.64 to 0.70 (all P<0.001). For left ventricular functional parameters, LVEF, LVSV and LVMI showed no significant differences between groups ( P>0.05), and the correlation was extremely strong ( r=0.90, 0.89, 0.96, all P<0.001). Conclusions:The repeatability of CCTA-FT technique in measuring myocardial strain was good, and the correlation of parameters measured by CCTA-FT technique and CMR-FT technique was excellent. Therefore, CCTA-FT technique can be used as a new noninvasive and simple method to evaluate myocardial motor function.

Associations of Infarct Size and Regional Myocardial Function Examined by Cardiac Magnetic Resonance Feature Tracking Strain Analysis with the Infarct Location in Patients with Acute ST-Segment Elevation Myocardial Infarction / 中国医学科学杂志(英文版)

Objective To quantitatively evaluate the associations of infarct size, regional myocardial function examined by cardiac magnetic resonance feature tracking (CMR-FT) strain analysis with infarct location in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion. The patients were divided into the anterior wall myocardial infarction (AWMI) and nonanterior wall myocardial infarction (NAWMI) groups. Infarct characteristics were assessed by late gadolinium enhancement. Global and regional strains and associated strain rates in the radial, circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images. The associations of infarct size, regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod. Results There were 44 patients in the AWMI group and 51 in the NAWMI group. The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group (24.47±11.89, 21.06±12.08 %LV; t=3.928, P = 0.008). In infarct zone analysis, strains in the radial, circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group (z=-20.873, -20.918, -10.357, all P < 0.001). The volume (end-systolic volume index), total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group (all P < 0.001). Conclusion In STEMI patients treated by percutaneous coronary intervention, myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.

Valor pronóstico del speckle-tracking bidimensional en pacientes con sospecha de cardiopatía isquémica / Prognostic value of two-dimensional speckle-tracking echocardiography in patients with suspected ischemic heart disease

RESUMEN Introducción: El estudio ecocardiográfico mediante speckle-tracking ha emergido como un novedoso método para la evaluación cuantitativa de la función miocárdica y se ha correlacionado con la presencia de enfermedad coronaria. Objetivo: Determinar el valor pronóstico de la deformación miocárdica (strain) por speckle-tracking bidimensional en la evolución de pacientes con sospecha de cardiopatía isquémica. Método: Estudio longitudinal prospectivo analítico con 51 pacientes a los que se realizó ecocardiograma con evaluación de la deformación (strain) longitudinal global por speckle-tracking bidimensional y coronariografía en el CIMEQ entre 2016 y 2018. Se siguieron los eventos cardíacos graves (infarto de miocardio, muerte cardíaca y por otras causas, enfermedad cerebrovascular y necesidad de nueva revascularización). Resultados: El 70,6% de los enfermos resultaron ser del sexo masculino, el 81,4% mayores de 50 años y 81,4%, fumadores. El 65,0% tenía enfermedad coronaria significativa y 55,0% de los casos fueron revascularizados. Se registraron 4 muertes (7,8%) y un infarto no fatal (2,0%). Los pacientes con deformación longitudinal global ≤ -15% (en valores absolutos) tuvieron mayor frecuencia de eventos cardíacos graves (p=0,02). Conclusiones: La deformación longitudinal global medida por speckle-tracking bidimensional no pudo predecir la presencia de enfermedad coronaria, pero sí los eventos cardiovasculares graves en los enfermos con enfermedad coronaria significativa.

ABSTRACT Introduction: Two-dimensional speckle-tracking echocardiography has emerged as a novel method for the quantitative evaluation of myocardial function and it has been correlated with the presence of coronary artery disease. Objective: To determine the prognostic value of myocardial strain by two-dimensional speckle-tracking echocardiography in the evolution of patients with suspected ischemic heart disease. Method: An analytical prospective longitudinal study was carried out with 51 patients, who underwent global longitudinal strain assessment by two-dimensional speckle-tracking echocardiography, and coronary angiography at CIMEQ between 2016 and 2018. Major cardiac adverse events (myocardial infarction, cardiac and non-cardiac cause of death, cerebrovascular disease, and need for new revascularization) were followed. Results: The 70.6% of patients were male, the 81.4% were older than 50 years old, and the 81.4% were smokers. The 65.0% of patients had significant coronary artery disease and the 55.0% underwent myocardial revascularization. There were four deaths (7.8%) and one non-fatal myocardial infarction (2.0%). Patients with global longitudinal strain ≤ -15% (in absolute or modular values) had a higher frequency of major adverse cardiovascular events (p=0.02). Conclusions: Global longitudinal strain by two-dimensional speckle-tracking echocardiography could not predict the presence of coronary artery disease, but it did predict major adverse cardiovascular events in patients with significant coronary artery disease.

The reproducibility of left ventricular strain measured by CT and its agreement with speckle tracking echocardiography / 中华放射学杂志

Objective:To investigate the reproducibility of left ventricular strain assessed by CT feature tracking(CT-FT) and its correlation and agreement with speckle tracking echocardiography (STE).Methods:Thirty outpatients with suspected coronary heart disease who underwent whole cardiac cycle coronary CTA and transthoracic echocardiography within one week were prospectively enrolled in November 2019. Left ventricular volume and strain parameters were measured by CT-FT and STE, including left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), global longitudinal strain(GLS), global radial strain (GRS),and global circumferential strain(GCS). GLS included endocardial global longitudinal strain (EndoGLS) and myocardial global longitudinal strain (MyoGLS), GCS included endocardial global circumferential strain (EndoGCS) and myocardial global circumferential strain (MyoGCS). ICC was used to evaluate intra-and inter-observer differences in strain measured by CT-FT. The differences of measurements between CT-FT and STE were compared by paired-samples t test. Pearson correlation coefficient was used to analyze the correlation between CT-FT and STE measurements. Agreement between measurements of two modalities was assessed by Bland-Altman analysis. Results:There was a good consistency in EDV, ESV, EF, EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT between intra-and inter-observer (ICC was 0.775-0.964, P<0.001). There was no significant difference in EF measured by CT-FT and STE [(60.27±8.70) % and (61.22±5.64) %, P=0.443]. EndoGLS, MyoGLS, GRS and MyoGCS measured by CT-FT were (-20.47±4.01)%, (-18.06±3.75)%, (73.90±20.58) % and (-18.48±3.65)%, respectively, while the strain measured by STE were (-18.97±3.33)%, (-16.49±2.60)%, (18.56±3.06)% and (-20.26±4.45)%, respectively. The differences were statistically significant between CT-FT and STE ( t=-2.367, -2.945, 12.161, 2.459, P<0.05). The EndoGCS measured by CT-FT and STE were (-27.78±6.66)% and (-29.18±7.24)%, respectively, with no statistical significance ( P=0.223).The correlation coefficients of EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT and STE were 0.566, 0.629, 0.509, 0.606 and 0.539, respectively ( P<0.05). The average difference of EndoGLS, MyoGLS, GRS, EndoGCS and MyoGCS measured by CT-FT and STE was -1.5%, -1.6%, 55.3%, 1.4% and 1.8%, respectively, with 95% limits of agreement was -8.3%-5.3%, -7.3%-4.2%, 18.1%-92.5%, -10.7%-13.6% and -6.0%-9.5%, respectively. Conclusions:The left ventricular global strain evaluated by CT-FT was feasible, and the agreement of global strain between CT-FT and STE was good but not interchangeable. CT can be an alternative method for "one-stop" evaluation of cardiac anatomy and function in patients with poor echogenic windows and contraindications for MRI.

Value of left ventricular myocardial strain derived from cardiac magnetic resonance tissue tracking on differentiating constrictive pericarditis from restrictive cardiomyopathy / 中华心血管病杂志

Objective: To compare left ventricular myocardial mechanics detected by cardiac magnetic resonance tissue tracking(CMR-TT) between patients with constrictive pericarditis(CP) and restrictive cardiomyopathy(RCM),and see if those can be used to differentiate CP from RCM patients. Methods: A total of 23 patients with CP, 20 patients with RCM, who hospitalized in Beijing Anzhen Hospital from January 2014 to April 2019 were included in this study and 25 healthy subjects served as control group, all subjects underwent cardiac magnetic resonance examination. Myocardial mechanics were evaluated by 2-dimensional(2D) and 3-dimensional(3D) CMR-TT in terms of global longitudinal strain(GLS), circumferential strain(GCS), radial strain(GRS) and the lateral wall strain to septal wall strain ratio(lateral/septal ratio) of basal, mid-cavity and apical. The diagnostic area under the receiver operating characteristic curve (ROC) was evaluated for differentiating CP from RCM. Results: Age, sex and heart rate were similar between CP and RCM patients(all P>0.05). 2D-GLS, 3D-GLS, GCS and GRS in CP and RCM groups were significantly lower than those in normal control group(all P<0.05).3D-GLS value was significantly lower in RCM patients than in CP patients(P<0.05), the area under the curve (AUC)=0.787(sensitivity 80%, specificity 78%). 3D-GCS was significantly lower in CP group than in RCM group(P<0.05), the AUC=0.737(sensitivity 80%, specificity 65%). However, there was no significant difference between CP and RCM in 3D-GRS(P>0.05). Compared with RCM, the circumferential and radial lateral/septal ratios of the basal were significantly lower in CP group than in RCM group(both P<0.05), AUC=0.737(sensitivity 70%, specificity 83%) and 0.737 (sensitivity 60%, specificity 87%), respectively. The left ventricular myocardial mechanics strain curve of the CP,RCM and normal control were different. The CP patients presented as " rapidly down-a platform" form, the RCM presented as "slowly down" form, and normal control presented as "rapidly down" form. Conclusion: Evaluating the differences in the diastolic process of left ventricular myocardium and left ventricular myocardial mechanics strain curve is helpful to differentiate CP from RCM patients.

Cardiovascular magnetic resonance feature tracking technique in diagnosis of early hypertensive heart disease / 中国介入影像与治疗学

Objective: To explore the value of cardiovascular magnetic resonance feature tracking (CMR-FT) in diagnosis of early hypertensive heart disease (HHD). Methods: Totally 54 patients with HHD were selected, including 26 patients with left ventricular ejection fraction (LVEF) ≤50% (LVEF≤50% group) and 28 LVEF>50% (LVEF>50% group). Forty healthy volunteers were selected in control group. Cardiac magnetic resonance (CMR) was performed to obtain the cardiac function parameters and global longitudinal strain (GLS). Results: There were significant differences of left ventricular function parameters, including left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), stroke volume (SV), LVEF, cardiac output (CO), cardiac index (CI), heart rate (HR), left ventricular systolic mass (MyoMass [Diast]), diastolic mass (MyoMass [Syst]) and GLS among all 3 groups and between each 2 groups (all P<0.05). GLS were positive correlated with LVEDV, LVESV, HR, MyoMass (Diast) and MyoMass(Syst) (r=0.340, 0.460, 0.284, 0.640, 0.570, all P<0.01) but negative correlated with SV, LVEF, CO and CI (r=-0.223, -0.516, -0.052, -0.260, all P<0.01). Conclusion: CMR-FT can be used to evaluate the left ventricular function, which is helpful for early diagnosis of HHD.

Fatiga cardíaca en corredores de ultra trail, observada por parámetros de nuevas técnicas ecocardiográficas / Cardiac Fatigue in Ultra-Marathon Runners Measured with Novel Techniques in Echocardiography

RESUMEN Introducción: El ejercicio físico intenso y prolongado puede producir adaptaciones fisiológicas y cambios agudos en el sistema cardiovascular, que han sido motivo de estudio en múltiples oportunidades. En este contexto, algunos autores sostienen que estas alteraciones agudas y transitorias serían adjudicables a la fatiga cardíaca. Objetivos: Examinar los cambios ecocardiográficos observados en los deportistas de ultratrail o ultramaratón (carreras de montaña con recorridos superiores a 42 km) en pre- y posesfuerzo mediante técnicas de deformación miocárdica por speckle tracking, teniendo en cuenta algunas características de la población (sexo, edad, carga de entrenamiento semanal). Material y métodos: Se reclutaron 28 participantes para ser evaluados antes y después del ejercicio (dentro de la primera hora posterior a aquel) utilizando ecocardiografía Doppler y nuevas técnicas ecocardiográficas (posprocesamiento). Se excluyeron 5 deportistas, 2 por presentar Regular ventana ecocardiográfica ecocardiográfica que no permitía visualizar correctamente el borde endomiocárdico y 3 por no haber finalizado la carrera. Se realizó una estadística descriptiva convencional y el análisis comparativo para datos apareados (pre- y posesfuerzo) mediante el test t de Student. Resultados: La mediana de edad de los deportistas fue de 38 ± 9 años, con predominancia de sexo masculino (n=17; 65%). En el ecocardiograma basal, encontramos función sistólica biventricular conservada, media de strain longitudinal global (SLG) de -19 ± 2% y media de strain de la pared libre del ventrículo derecho (SPLVd) de -25 ± 3%. En la evaluación posesfuerzo, se observaron alteraciones significativas al compararlas con los datos del ecocardiograma basal, como caída de la fracción de eyección, disminución del strain longitudinal global (SLG) y del SPLVd, y aumento del volumen del Vd. La torsión ventricular no se vio afectada. Conclusión: Después del ejercicio intenso se observa una disminución de los parámetros de deformación miocárdica medidos por speckle tracking, esto se interpreta como fatiga cardíaca inducida por el ejercicio.

ABSTRACT Introduction: Intense and prolonged physical exercise can produce physiological adaptations and acute changes in the cardiovascular system that have been the subject of study multiple times. In this context some authors speak that these acute and transient alterations would be attributable to cardiac fatigue. Objective: The objective of this work is to examine the echocardiographic changes observed in ultra trail athletes (mountain races over 42 kilometers) pre and post effort, according to population characteristics (sex, age, weekly training load), using techniques of myocardial deformation by speckle traking. Material and methods: Twenty-eight participants were evaluated pre and post exercise (within one hour after exertion) using Doppler echocardiography and new echocardiographic techniques (post processing). Conventional descriptive statistics and comparative analysis were performed for paired data using a T test. Results: The median age of the patients was 38 ± 9 years with male predominance (N17 / 65%). In the baseline echocardiogram, we found preserved bi-ventricular systolic function, mean global longitudinal strain (GLS) of -19% ± 2, mean right ventricular free wall strain (FWSVd) -25% ± 3. In the Post-stress evaluation significant alterations were observed when compared with the baseline echocardiogram data, such as drop in ejection fraction, decrease in GLS, FWSVd and increase in volume of you. Ventricular torsion was not affected. Conclusion: Post intense exercise is observed a decrease in myocardial deformation parameters measured by Speckle tracking, this is interpreted as cardiac fatigue induced by the exercise.

Effects of dobutamine with those of milrinone on myocardial strain in patients undergoing valve replacement surgery / 临床麻醉学杂志

Objective To compare the effects of dobutamine with those milrinone on myocardial strain in patients undergoing valve replacement surgery.Methods Fifty-five patients udergoing valve replacement surgery, 27 males and 28 females, aged 40-75 years, falling into ASA physical statusⅡ orⅢ, New York Heart Association (NYHA) ⅡorⅢ, were included in this study.They were divided into 3 groups by using a random number table:intravenous infusion dobutamine group (group D, n=18), intravenous infusion milrinone group (group M, n=20) and intravenous infusion saline group (group C, n=17).All patients were used general anesthesia.In groups D, the patients received intravenous infusion dobutamine (4μg·kg-1·min-1) for an hour starting from 15 min after termination of CPB.In group M, the patients did intravenous infusion milrinone (0.4μg·kg-1·min-1) in the same way.In group C, the patients got intravenous infusion saline also.After induction of anesthesia, these patients were recorded for hemodynamic measurement at three points after induction of anesthesia and before splitting of sternum (T0), starting from 15 min after termination of CPB (T1), intravenous infusion medicine for 30 min (T2), intravenous infusion medicine for one hour (T3):HR, CVP, cardiac output (CO), left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), cardiac index (CI) and systemic vascular resistance index (SVRI) and strained indicator:global longitudinal strain of left ventricle (S-LVL), global circumferential strain of the left ventricle (S-LVM), global longitudinal strain of right ventricle (S-RV).Results Compared with group M, HR in group D at T2 and T3 was higher (P<0.05).Compared with group C, HR in group D at T3 was higher (P<0.05).And CI in group D at T2 was higher than that in groups C and M (P<0.05).Compared with groups C, S-LVMin groups D and M at T2 and T3 were stronger, S-LVL, S-RV in group D and S-RV in group M at T3 were stronger (P<0.05).Conclusion Intravenous infusion dobutamine can improve S-LVM, S-LVLand S-RV;Intravenous infusion milrinone can improve S-LVMand S-RV.

Hipertrofia cardíaca associada à hipertensão arterial com disfunção sistólica subclínica: relato de caso / Cardiac hypertrophy associated with arterial hypertension with subclinical systolic sysfunction: a case report

Relata-se um caso de uma paciente de 66 anos, com diagnóstico de hipertensão arterial sistêmica há seis anos, obesa e tabagista, que compareceu à consulta para avaliação cardiológica pré-operatória de cirurgia ginecológica. Ao exame clínico, apresentava-se com pressão arterial de 132 x 80mmHg, pulsos radiais e femorais simétricos, auscultas cardíaca e respiratória normais. O eletrocardiograma mostrou ritmo sinusal, sem alterações, enquanto o ecocardiograma transtorácico revelou hipertrofia concêntrica do ventrículo esquerdo, câmaras cardíacas com dimensões normais e fração de ejeção do ventrículo esquerdo preservada. A avaliação do strain longitudinal global demonstrou diminuição da deformação miocárdica sistólica. Neste relato, ilustramos um caso clínico de hipertrofia ventricular esquerda associada à hipertensão arterial, com fração de ejeção do ventrículo esquerdo preservada e disfunção sistólica subclínica diagnosticada pelo strain miocárdico.

We report a case of a 66-year-old obese and smoker woman, with a 6-year diagnosis of systemic hypertension, who searched medical assistance for pre-operative cardiology evaluation. The clinical examination revealed blood pressure of 132x80mmHg, symmetrical radial and femoral pulses, and normal cardiac and lung auscultation. The electrocardiogram showed sinus rhythm with no alterations, while an echocardiogram showed concentric left ventricular hypertrophy, normal cardiac chambers dimensions and normal left ventricular ejection fraction. Left ventricular global longitudinal strain evaluation revealed reductions in systolic myocardial deformation. In this case, we discuss the presence of left ventricular hypertrophy secondary to hypertension, with preserved left ventricular ejection fraction and subclinical systolic dysfunction detected with myocardial strain.

Myocardial Layer-Specific Strain Analysis in Children with Mitochondrial Disease

PURPOSE: Children with mitochondrial disease (MD) have clinical phenotypes that are more severe than those found in adults. In this study, we assessed cardiac function in children with MD using conventional and advanced echocardiographic measurements, explored any unique patterns present, and investigated the development of early cardiomyopathy (CMP). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 33 children with MD. All patients underwent transthoracic echocardiography with conventional and advanced myocardial analysis. We compared all data between patients and an age-matched healthy control group. RESULTS: Conventional echocardiographic diastolic measurements of mitral E, E/A, and tissue Doppler E′ were significantly lower and E/E′ was significantly higher in children with MD, compared with the measurements from the control group. There was no significant difference in longitudinal and radial strain between the groups. Circumferential strain in the endocardium (p=0.161), middle myocardium (p=0.008), and epicardium (p=0.042) were lower in patients, compared to the values in controls. Circumferential strain was correlated with E′ (p 0.60). CONCLUSION: In children with MD, myocardial circumferential strain may develop early in all three layers, even with normally preserved longitudinal and radial strain. This may be an early diagnostic indicator with which to predict CMP in this patient population.

Echocardiographic and electrocardiographic presentations of patients with endomyocardial biopsy-proven cardiac amyloidosis

@#Objective: Cardiac amyloidosis is under diagnosed and its prevalence is unknown. This is a retrospective, nonrandomised, single centre study of patients with endomyocardial biopsy-proven cardiac amyloidosis focusing on their echocardiographic and electrocardiogram (ECG) presentations. This is the first case series in Malaysia on this subject. Methods: We identified all of our endomyocardial biopsyproven cardiac amyloidosis patients from January 2010 to January 2018 and reviewed their medical records. All patients echocardiographic and ECG findings reviewed and analysed comparing to basic mean population value. Results: In total there are 13 biopsy-proven cardiac amyloidosis patients. All of the biopsies shows light chain (AL) amyloid. Majority of the patients (8, 61.5%) is male, and most of our patients (8, 61.5%) is Chinese. All seven patients on whom we performed deformation imaging have apical sparing pattern on longitudinal strain echocardiogram. Mean ejection fraction is 49.3%, (SD=7.9). All patients have concentric left ventricular hypertrophy and right ventricular hypertrophy. Diastolic dysfunction was present in all of our patients with nine out of 13 patients (69.2%) having restrictive filling patterns (E/A ≥2.0 E/e' ≥15). On electrocardiogram, 12 (92%) patients have prolonged PR interval (median 200ms, IQR 76.50ms) and 9 (69.2%) patients have pseudoinfarct pattern. Conclusion: Echocardiography plays an important role in diagnosing cardiac amyloidosis. The findings of concentric left ventricular hypertrophy with preserved ejection fraction without increased in loading condition should alert the clinician towards its possibility. This is further supported by right ventricular hypertrophy and particularly longitudinal strain imaging showing apical sparing pattern.