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Objective: Few cases of Takotsubo cardiomyopathy with apical hypertrophic cardiomyopathy (APH)-like morphological changes during the recovery process have been reported.Patient: A 56-year-old woman diagnosed with Takotsubo cardiomyopathy showed a morphology similar to that of APH during recovery. We examined this patient using 2D speckle-tracking echocardiography based on the method used for hypertrophic cardiomyopathy, which suggested that the circumferential strain (CS) of the middle wall indicated myocardial function of the left ventricle, and the CS of the inner wall was associated with left ventricular chamber function.Results: We measured the CS of the endocardial, middle, and epicardial layers and found that the apical inner layer CS (CSinner), middle layer CS, and outer layer CS were all decreased at the onset. CSinner showed a strong tendency to recover on echocardiography performed when APH-like morphology was observed.Conclusion: The morphology of the apex in our case likely contributed to the maintenance of chamber function.
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RESUMEN Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y la mayoría de los países desarrollados. La ecocardiografía con rastreo de marcas o speckle-tracking bidimensional (ST-2D) es una técnica reciente en la evaluación de la función cardíaca. Objetivo: Determinar la relación entre la deformación miocárdica (strain) circunferencial (GCS) medida por ST-2D y el estado de la circulación coronaria, en pacientes con cardiopatía isquémica. Método: Se realizó un estudio analítico, transversal, con 55 pacientes con indicación de coronariografía a los que se les realizó ecocardiograma para medir la GCS mediante ST-2D, en el Centro de Investigaciones Médico Quirúrgicas (CIMEQ, La Habana, Cuba), durante un año. Se crearon dos grupos: con enfermedad coronaria significativa (ECS=32) y no significativa (ECNS=23). Se utilizó SSPS para análisis de los resultados. Resultados: La edad promedio fue mayor en ECS (55,6 ±9,3 vs. 61,8±8,8; p=0,014). Predominaron los hombres con ECS (47,3%), los hipertensos (ECS=90,6% y ENCS=65,2%; p=0,02) y los fumadores (ECS=59,4% y ENCS=17,4%; p=0,002). El diagnóstico más frecuente fue la angina crónica estable (87%). En ECS predominó la enfermedad de tres vasos (75%). La GCS fue menor en ECS [(-19,5±3.8 vs. -25,2±5,7; p=0,033); área bajo la curva = 0,208]. No hubo diferencias en GCS, según el número de vasos significativamente enfermos. Conclusiones: Los resultados encontrados no justifican el empleo de la GCS por ST-2D para discriminar la presencia o no de ECS.
ABSTRACT Introduction: Cardiovascular diseases are the top cause of death in Cuba as well as in most developed countries. Two-dimensional speckle-tracking (2D-ST) echocardiography is a recent technique in the evaluation of cardiac function. Objective: To determine the relationship between global circumferential strain (GCS) measured through 2D-ST echocardiography and the state of coronary circulation in patients with ischemic heart disease. Method: An analytical, cross-sectional study was carried out on 55 patients with indication of coronary angiography, who underwent echocardiography to measure the GCS through 2D-ST at the Centro de Investigaciones Medico Quirúrgicas (CIMEQ, Havana, Cuba), during one year. Two groups were created: with significant coronary artery disease (SCAD = 32) and non-significant coronary artery disease (NSCAD = 23). The statistical package for the social sciences (SPSS) was used to analyze the results. Results: Mean age was higher in the SCAD group (55.6 ± 9.3 vs. 61.8± 8.8, p=0.014). Men with SCAD (47.3%), patients with high blood pressure (SCAD = 90.6% and NSCAD = 65.2%, p = 0.02) and smokers (SCAD = 59.4% and NSCAD = 17.4%, p = 0.002) predominated. The most frequent diagnosis was chronic stable angina (87%). Three-vessel disease predominated in the SCAD group (75%). The GCS was lower in the SCAD group [(-19.5.0 ± 3.8 vs. -25.2 ± 5.7, p = 0.033); area under the curve = 0.208]. There were no differences in GCS according to the number of significantly diseased vessels. Conclusions: The results found do not justify the use of GCS through 2D-ST echocardiography to discriminate the presence or nor of SCAD.
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Echocardiography , Myocardial Ischemia , Heart Function TestsABSTRACT
Objectives: To evaluate the degree of coronary artery stenosis with duration of myocardial early systolic lengthening derived from 2D speckle tracking imaging (2D-STD in patients with coronary artery disease (CAD). Methods: 185 patients with suspected CAD underwent 2D-STI before coronary CT angiography (CCTA) were included in this study. Duration of myocardial early systolic lengthening, LS, RS, and CS were measured by 2D-STI. According to the results of CCTA, the myocardial segment were divided into normal group (without coronary artery stenosis), mild stenosis group(coronary artery stenosis<50%), moderate stenosis group (50%>coronary artery stenosis < 70%) and severe stenosis group (70%>coronary artery stenosis <100%). Results: Duration of myocardial early systolic lengthening, LS, RS and CS were similar between mild stenosis group and normal group (P>0.05). Duration of myocardial early systolic lengthening was increased, and LS was decreased in moderate stenosis group than in normal group (P<0.05). Duration of myocardial early systolic lengthening was increased, LS, RS and CS were significantly decreased in severe stenosis group than in normal group (P<0.01). The cutoff value of early systolic lengthening for diagnose severe stenosis was 60.0 ms (area under ROC curve [AUCl=0.91, P<0.01), with the sensitivity 85.5% and specificity 74.1%, respectively. Conclusions: Duration of myocardial early systolic lengthening is prolonged in patients with significant CAD (moderate and severe stenosis), and might be used a useful parameter to identify patients with significant CAD (moderate and severe stenosis).
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Objective To study the effects of abnormal blood flow on the secretion of ET-1/NO and the expression of the mRNA and the protein of ET-1, eNOS, VCAM-1, ICAM-1 and MCP-1 in human umbilical vein endothelial cells (HUVECs), so as to explore the mechanism of atherosclerosis （AS） caused by abnormal hemodynamics. MethodsThe HUVECs were divided into stress group, wall pressure group and normal group according to the different stress. The HUVECs were cultured under the corresponding stress for 24 hours and then collected. The secretion levels of NO and ET-1 were detected by enzyme method and radioimmunoassay method. The mRNA expression levels of eNOS and ET-1 were detected by qPCR. The expression levels of the mRNA and the protein of VCAM-1, ICAM-1, MCP-1 were detected by qPCR and Western blot. Results Compared with normal group, the secretion level and the mRNA expression level of ET-1 in wall pressure group increased significantly (P＜0.01), and the secretion level of NO and the mRNA expression level of eNOS in stress group also increased significantly (P＜0.01), The expressions level of the mRNA and the protein of VCAM-1, ICAM-1 and MCP-1 obviously increased in stress group and wall pressure group (P＜0.01). Conclusions Stress or wall pressure acting on HUVECs alone could lead to its dysfunction of the secretion and the expression of gene and protein. The mechanism of AS caused by abnormal blood flow was related to these dysfunction of HUVEC.
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Objective To study the effects of abnormal blood flow on the secretion of ET-1/NO and the expression of the mRNA and the protein of ET-1, eNOS, VCAM-1, ICAM-1 and MCP-1 in human umbilical vein endothelial cells (HUVECs), so as to explore the mechanism of atherosclerosis （AS） caused by abnormal hemodynamics. MethodsThe HUVECs were divided into stress group, wall pressure group and normal group according to the different stress. The HUVECs were cultured under the corresponding stress for 24 hours and then collected. The secretion levels of NO and ET-1 were detected by enzyme method and radioimmunoassay method. The mRNA expression levels of eNOS and ET-1 were detected by qPCR. The expression levels of the mRNA and the protein of VCAM-1, ICAM-1, MCP-1 were detected by qPCR and Western blot. Results Compared with normal group, the secretion level and the mRNA expression level of ET-1 in wall pressure group increased significantly (P＜0.01), and the secretion level of NO and the mRNA expression level of eNOS in stress group also increased significantly (P＜0.01), The expressions level of the mRNA and the protein of VCAM-1, ICAM-1 and MCP-1 obviously increased in stress group and wall pressure group (P＜0.01). Conclusions Stress or wall pressure acting on HUVECs alone could lead to its dysfunction of the secretion and the expression of gene and protein. The mechanism of AS caused by abnormal blood flow was related to these dysfunction of HUVEC.
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Objective To evaluate the left ventricular systolic circumferential strain by layer specific speckle tracking imaging in healthy volunteers and patients with left bundle branch block (LBBB).Methods Forty patients with LBBB were divided into two groups,LBBB1 group [left ventricular ejection fraction (LVEF≥50％] and LBBB2 group (LVEF＜50％),and 25 healthy subjects were selected as the control group.High frame rate two dimensional images were recorded from the left ventricular short-axis views at the levels of the mitral annulus,papillary muscle and apex respectively.The peak systolic circumferential strain of the endocardium,myocardium and epicardium were measured using layer-specific strain software.Results The circumferential strain of the epicardium and myocardium at the level of the apex showed a statistically significant difference between the LBBB1 group and the control group (P =0.004),while there was no statistically significant difference demonstrated at the levels of the mitral annulus and papillary muscle(P ＞0.01).The circumferential strain of the endocardium at the levels of the papillary muscle and apex showed a statistically significant difference between the LBBB1 group and the control group (P =0.000),while there was no statistically significant difference demonstrated at the level of the mitral annulus (P ＞0.01).The circumferential strain of the endocardium,myocardium and epicardium at the three short axis view levels showed statistically significant differences between the LBBB2 group and the control or LBBB1 groups respectively(P =0.000).Conclusions The circumferential strain of the endocardium at the level of the apex can provide more information about disease prognosis,especially in LBBB patients with a LVEF of ≥50％.
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Objective To study the influence of different microembolism on left ventricular systolic synchronism in pigs by detecting the real-time dypyridamole stress contrast echocardiography (RT-MCE).Methods Eighteen miniature pigs were randomly divided into three groups and underwent microembolization injection procedure through the middle of anterior descending coronary artery with different numbers of microsphere injection,as:group A(dosage 50 thousands,3 pigs),group B (dosage 120 thousands,8 pigs) and group C (dosage 150 thousands,7 pigs).The peak values and the time-to-peak circumferential strain(Circ.Strain),radial velocity (Radial Vel.) and radial strain (Radial Strain) were obtained both at mitral valve level and papillary muscle level at left ventricle short axis views using two-dimensional speckle tracking imaging(STI)analyzed by Philips Q-Lab 8.1 workshop,respectively.Results No significant difference in the presence of contraction synchrony was observed using RT-MCE.The time-to-peak Circ.Strain of microembolism related segments were prolonged at 1 week after microembolism detecting with dypyridamole stress RT-MCE (P＜0.05,both intro-group and inter-group).While time-to-peak radial strain were extended since 6 hours after the intervention to 1 week after the procedure.Conclusions Dypyridamole stress RT-MCE can be used to measure the myocardial perfusion accurately.The elongation of time-to-peak circ.strain and radial strain were developed with time in microembolism related segments.
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Objective To investigate the clinical value of circumferential strain and strain rate in estimating the carotid elasticity. Methods Thirty-five consecutive patients of hypertension were enrolled in this study as the patient group and 36 healthy volunteers whose ages were matched with the patient group were included as controls. The intima-media thickness(IMT) of common carotid arteries of both the patients and controls were measured using RF-Data technique of ultrasound vascular measurement and the following traditional parameters reflecting common carotid elasticity were obtained: pulse wave velocity (PWV),arterial compliance (AC). While the new parameters reflecting vascular strain including endovascular longitudinal strain(EN-LS), endovascular circumferential strain(EN-CS), endovascular longitudinal strain rate(EN-LSR) ,endovascular circumferential strain rate(EN-CSR), adventitial longitudinal strain(EP-LS),adventitial circumferential strain ( EP-CS ), adventitial longitudinal strain rate ( EP-LSR ), adventitial circumferential strain rate(EP-CSR) were collected using the technique of X-strain. All the corresponding parameters were compared between hypertensive group and controls. The correlations between elasticity and hemodynamic parameters were analyzed. Results In the hypertension patients,PWV was higher while AC,EN-CS,EN-CSR,EP-CS and EP-CSR were lower than that of the control group( P ＜0.05). No significant differences were detected in the longitudinal strain and strain rate. In the hypertension group,AC correlated positively with PWV, while EN-CS, EN-CSR, EP-CS and EP-CSR correlated negatively with PWV and positively with AC. Conclusions Circumferential strain and strain rate conform well to the mechanical principle and the characteristic anatomic and histological structure of the vessels and may be used to reflect the early changes of the vascular elasticity.