ABSTRACT
ABSTRACT Objective: Evaluation of left ventricular systolic function using speckle tracking echocardiography is more sensitive than conventional echocardiographic measurement in detecting subtle left ventricular dysfunction in septic patients. Our purpose was to investigate the predictive significance of left ventricular global longitudinal strain in normotensive septic intensive care patients. Methods: This observational, prospective cohort study included septic normotensive adults admitted to the intensive care unit between June 1, 2021, and August 31, 2021. Left ventricular systolic function was measured using speckle-tracking echocardiography within 24 hours of admission. Results: One hundred fifty-two patients were enrolled. The intensive care unit mortality rate was 27%. Left ventricular global longitudinal strain was less negative, which indicated worse left ventricular function in non-survivors than survivors (median [interquartile range], -15.2 [-17.2 - -12.5] versus -17.3 [-18.8 - -15.5]; p < 0.001). The optimal cutoff value for left ventricular global longitudinal strain was -17% in predicting intensive care unit mortality (area under the curve, 0.728). Patients with left ventricular global longitudinal strain > -17% (less negative than -17%, which indicated worse left ventricular function) showed a significantly higher mortality rate (39.2% versus 13.7%; p < 0.001). According to multivariate analysis, left ventricular global longitudinal strain was an independent predictor of intensive care unit mortality [OR (95%CI), 1.326 (1.038 - 1.693); p = 0.024], along with invasive mechanical ventilation and Glasgow coma scale, APACHE II, and SOFA risk scores. Conclusion: Impaired left ventricular global longitudinal strain is associated with mortality and provided predictive data in normotensive septic intensive care patients.
RESUMO Objetivo: A avaliação da função sistólica do ventrículo esquerdo utilizando ecocardiografia com speckle tracking é mais sensível do que a medição ecocardiográfica convencional na detecção de disfunções sutis do ventrículo esquerdo em pacientes sépticos. Nosso objetivo foi investigar a significância preditora do strain longitudinal global do ventrículo esquerdo em pacientes sépticos normotensos internados em unidades de terapia intensiva. Métodos: Este estudo de coorte observacional e prospectivo incluiu adultos sépticos normotensos internados em uma unidade de terapia intensiva entre 1° de junho de 2021 e 31 de agosto de 2021. A função sistólica do ventrículo esquerdo foi mensurada utilizando a ecocardiografia com speckle tracking nas primeiras 24 horas após a internação. Resultados: Foram recrutados 152 pacientes. A taxa de mortalidade na unidade de terapia intensiva foi de 27%. O strain longitudinal global do ventrículo esquerdo foi menos negativo, o que indicou pior função do ventrículo esquerdo em não sobreviventes do que em sobreviventes (mediana [intervalo interquartil] -15,2 [-17,2 - -12,5] versus -17,3 [-18,8 - -15,5]; p < 0,001). O valor de corte ótimo para o strain longitudinal global do ventrículo esquerdo foi -17% para prever a mortalidade na unidade de terapia intensiva (área sob a curva de 0,728). Pacientes com strain longitudinal global do ventrículo esquerdo > -17% (menos negativo do que -17%, o que indicou pior função do ventrículo esquerdo) apresentaram taxa de mortalidade significativamente maior (39,2% versus 13,7%; p < 0,001). De acordo com a análise multivariada, o strain longitudinal global do ventrículo esquerdo foi um preditor independente de mortalidade na unidade de terapia intensiva [RC (IC95%), 1,326 (1,038 - 1,693); p = 0,024], com ventilação mecânica invasiva e os escores de risco da escala de coma de Glasgow, APACHE II e SOFA. Conclusão: Alterações do strain longitudinal global do ventrículo esquerdo estão associadas a mortalidade e podem fornecer dados preditivos em pacientes sépticos normotensos internados em unidades de terapia intensiva.
ABSTRACT
Abstract Background Takayasu's arteritis (TA) is a vasculitis that affects the aorta and its branches and causes stenosis, occlusion, and aneurysms. Up to 60% of TA patients are associated with cardiac involvement which confers a poor prognosis. Global longitudinal strain (GLS) analysis is an echocardiographic technique that can detect the presence of subclinical systolic dysfunction. Hence, this study aimed to describe the prevalence of subclinical systolic dysfunction in patients with TA using the GLS method and to correlate this finding with disease activity using the ITAS-2010 (Indian Takayasu Activity Score). Methods Thirty patients over 18 years of age who met the American College of Rheumatology (ACR) 1990 criteria for TA were included. The sample was submitted for medical record review, clinical and echocardiographic evaluation, and application of ITAS-2010. The cutoff for systolic dysfunction was GLS > - 20%. Results Of the 30 patients analyzed, 25 (83.3%) were female, and the mean age was 42.6 years (± 13.2). The median time since diagnosis was 7.5 years [range, 3-16.6 years], and the type V angiographic classification was the most prevalent (56.7%). Regarding echocardiographic findings, the median ejection fraction (EF) was 66% [61-71%] and the GLS was - 19.5% [-21.3 to -15.8%]. Although half of the participants had reduced GLS, only two had reduced EF. Eleven patients (33.%) met the criteria for activity. An association was found between disease activity and reduced GLS in eight patients (P = 0.02) using the chi-square test. Conclusion GLS seems to be an instrument capable of the early detection of systolic dysfunction in TA. The association between GLS and disease activity in this study should be confirmed in a study with a larger sample size.
ABSTRACT
Objective:To investigate the relationship between carotid atherosclerosis(CAS)and subclinical left ventricular(LV)dysfunction in type 2 diabetes mellitus patients with preserved LV ejection fraction(LVEF).Methods:A total of 120 patients with type 2 diabetes mellitus who had LVEF≥50% were selected in the Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from June 2021 to October 2021. The global longitudinal strain(GLS)was obtained by two-dimensional speckle tracking echocardiography(STE)to assess subclinical LV systolic function. The mitral ratio of peak early to late diastolic filling velocity(E/A), and mitral velocity to early diastolic velocity of the mitral annulus(E/E′)ratio were obtained by pulsed tissue Doppler echocardiography to assess LV diastolic function. Acrroding to bilateral carotid ultrasound examination, the subjects were divided into normal carotid arteries group( n=46) and CAS group( n=74). Demographics and biochemical parameters were compared between two groups. Binary logistic regression and Pearson correlation analysis were used to evaluate the relationship between CAS and subclinical LV dysfunction. Results:The CAS group had a higher proportion of men, older age, and a longer duration of diabetes than the normal carotid arteries group(all P<0.05). There was no difference in LVEF and GLS between the two groups [normal carotid arteries group vs CAS group, LVEF: (60.72±4.73)% vs(60.07±4.28)%; GLS: (18.24±3.72)% vs(17.81±3.47)%, respectively; both P>0.05]. However, compared with normal carotid arteries group, E/A ratio was decreased and E/E′ ratio was significantly increased in CAS group(both P<0.01). Pearson correlation analysis showed that GLS was not correlated with carotid plaque thickness and carotid intima-media thickness(CIMT; both P>0.05). By contrast, E/E′ ratio was positively correlated with carotid plaque thickness and CIMT(both P<0.05). Binary logistic regression analysis showed that GLS and E/E′ ratio were not associated with CAS( both P>0.05). However, decreased E/A ratio was significantly associated with the existence of CAS( OR=0.09, 95% CI 0.01-0.67, P=0.018). Conclusions:In type 2 diabetes mellitus patients without overt heart failure and with preserved LVEF, the occurrence of CAS is not associated with subclinical LV systolic impairment assessed by GLS, but is significantly associated with LV diastolic dysfunction, and is independent of traditional cardiovascular risk factors.
ABSTRACT
Objective: Coronary revascularization is associated with better outcomes in coronary artery disease patients. We aim to investigate the prevalence, and factors associated with left ventricular (LV) improvement following successful percutaneous coronary intervention (PCI) of patients with impaired systolic function with specific reference to the value of baseline GLS. Methods: This retrospective study reviewed the records of coronary artery disease patients with impaired systolic function who were admitted and treated with PCI. Result: Out of 420 consecutive acute coronary syndrome patients with an impaired systolic function who were admitted and treated with PCI during the period from January 2021 to December 2021, 147 patients (35%) showed no improvement in the Left ventricular ejection fraction (LVEF) post PCI and 273 patients (65%) showed improvement of the LVEF post PCI in their follow up echocardiogram. Larger myocardial injury dilated LV dimension at the acute phase showed a strong impact on further improving LV systolic function. Baseline GLS showed a higher statistical difference between the Non-improving LVEF and improving LVEF groups. Moreover, the early GLS and further LV systolic function improvement were strongly correlated (P < 0.001) with higher sensitivity and specificity. A receiver operating characteristic curve (ROC) analysis demonstrated that GLS values greater than 9% are a predictor of significant LVEF improvement in the follow-up stage. Conclusion: Sizable proportion of patients with impaired systolic function following successful PCI show further LV systolic recovery. We demonstrated that the baseline GLS values of more than 9% are an accurate predictor of significant LVEF improvement
ABSTRACT
Context:Global longitudinal strain (GLS) measured by speckle?tracking echocardiography demonstrates excellent prognostic ability in predicting major adverse cardiac events after cardiac surgery. However, the optimal timing of intraoperative GLS measurement that provides the best prognostic value is unclear. Aim: Our goal was to evaluate whether GLS measured prior to cardiopulmonary bypass (pre?CPB GLS), following CPB (post?CPB GLS), or change in GLS provides the strongest association with postoperative complications. Setting and Design: Post hoc analysis of prospectively collected data from a clinical trial (NCT01187329). 72 patients with aortic stenosis undergoing elective AVR ± coronary artery bypass grafting between January 2011 and August 2013. Material and Methods: Myocardial deformation analysis from standardized transesophageal echocardiographic examinations were performed after anesthetic induction and chest closure. We evaluated the association between pre?CPB GLS, post?CPB GLS, and change in GLS (percent change from pre?CPB baseline) with postoperative atrial fibrillation and hospitalization >7 days. The association of post?CPB GLS with duration of mechanical ventilation, N?terminal pro?BNP (NT?proBNP) and troponin T were also assessed. Statistical Analysis: Multivariable logistic regression. Results: Risk?adjusted odds (OR[97.5%CI] of prolonged hospitalization increased an estimated 27% (1.27[1.01 to 1.59];Padj =0.035) per 1% decrease in absolute post?CPB GLS. Mean[98.3%CI] NT?proBNP increased 98.4[20 to 177]pg/mL; Padj =0.008), per 1% decrease in post?CPB GLS. Pre?CPB GLS or change in GLS were not associated with any outcomes. Conclusions: Post?CPB GLS provides the best prognostic value in predicting postoperative outcomes. Measuring post?CPB GLS may improve risk stratification and assist in future study design and patient outcome research.
ABSTRACT
Background: Left ventricular outflow tract obstruction (LVOTO) is commonly observed in patients with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH). Some patients develop LVOTO provoked by physical exertion, and hence termed dynamic LVOTO (DLVOTO). However, its precise prevalence and mechanism are still unclear. Aim: Two-dimensional speckle tracking echocardiography (2D STE) seems to be helpful for the detection of early LV structural abnormalities. This study aimed to examine the possible role of segmental as well as global longitudinal strain in identifying DLVOTO non-HCM patients as detected by dobutamine stress echocardiography (DSE). Methods and results: Two hundred and fifty patients without structural heart disease had undergone conventional transthoracic echocardiography, 2D STE, and DSE. All patients with non-ischemic evidence were divided into two groups according to the DSE results; DLVOTO (þ) and DLVOTO (). Among 250 patients, 50 patients (36%) had shown DLVOTO after DSE (15 males, 35 females; mean age 55±7years). They were compared with 90 non -LVOTO obstruction patients (43 males, 47 females; mean age 57±6years). Based on multivariate logistic regression analysis, the independent predictors of provoked DLVOTO during DSE were resting basal septal longitudinal strain BS-LS average (p < 0.001), resting LA reservoir strain (p < 0.001), and systolic LVOT diameter (p ¼ 0.03). Resting BS-LS average with cut-off - 17.5% was recognized as a critical indicator of DLVOTO, with sensitivity 78%, and specificity 95% (better than systolic LVOT diameter of sensitivity 76%, and specificity 15% and resting LA reservoir strain which showed poor AUC at ROC curve 0.007). Conclusion: We demonstrate that provoked LVOTO during DSE in non HCM symptomatic patients is directly correlated to resting regional LS, where the increased BS-LS of 17.5% was a key determinant of LVOT gradient provocation. Assessment of baseline BS-LS average might be a bedside simple tool for detection of patients with DLVOTO not able to do DSE.
ABSTRACT
Background: The objectives of this study were to find out of normal reference value for age?dependent longitudinal strain values in children and find its correlation with conventional echocardiographic parameters. Methods: In total, 100 healthy normal children aged between 2 and 15 years were enrolled and divided into three age groups, namely, 2–5 years, 5–10 years, and 10–15 years. Using the GE Vivid 7 ultrasound platform with 4 or 7 MHz probes, both LV and RV global longitudinal strains and conventional echocardiographic parameters were acquired. Results: In normal healthy children, left ventricular GLS values were –20.10 to –19.68 (mean: –19.89), –21.93 to –21.02 (mean: –21.48), and –20.87 to –20.41 (mean: –20.64)) in children aged 2–5 years, 5–10 years, and 10–15 years and right ventricular GLS values were –16.80 to –16.44 (mean: –16.62), –27.85 to –27.27 (mean: –27.56), –28.44 to –27.93 (mean: –28.19) in the above three groups, respectively. No significant increase was noted in the left ventricular strain value from basal to the apical segment from age group 2 years to 15 years and no gender differences were seen. None of the conventional echocardiographic parameters commonly used to assess the left or right ventricular systolic function had a significant correlation with LVGLS and RVGLS. Conclusions: The mean LVGLS values were –19.89, –21.48, and –20.64 and RVGLS were –16.62, –27.56, and –28.19 in healthy normal children aged 2–5 years, 5–10 years, and 10–15 years, respectively, and conventional echocardiographic parameters did not have any significant correlation with these values.
ABSTRACT
AIM: To Determine the Prognostic Value Of 2D- Right ventricle Free Wall Longitudinal Strain In Patients With Acute Decompensated Heart Failure. BACKGROUND Ÿ The prognostic impact of 2-dimensional strain is unclear in patients with acute decompensated heart failure (HF). Ÿ we investigate whether left ventricular and right ventricular (RV) strain parameters assessed by speckle tracking echocardiography provide incremental prognostic information in hospitalized patients because of acute decompensated HF. METHODS AND RESULTS Ÿ FOURTY SIX patients (age, 54±9 years; 6.5% women; ejection fraction, 36±5%) hospitalized for acute decompensated HF underwent clinical and echocardiographic evaluation just before discharge. We performed strain analyses of left ventricular global longitudinal strain and RV longitudinal strain only from the free wall (RV-fwLS) and from all segments of the RV global longitudinal strain wall by echocardiogram. The primary composite end point was cardiovascular death and readmission for HF. There were 30.4% cardiac events during a median follow-up of 180 days. Among echocardiographic parameters, only impaired RV-fwLS (Less Than 11.4±4.9) was independently associated with cardiac events. Adding RV-fwLS to clinical risk evaluation (age, New York Heart Association class III/IV, blood urea nitrogen, and brain natriuretic peptide) markedly improved prognostic utility. CONCLUSIONS: Ÿ RV-fwLS is an independent predictor of cardiac events in acute decompensated HF. Although there are various standard echocardiographic parameters, RV-fwLS has improved prognostic utility.
ABSTRACT
Background: Overt left ventricular (LV) dysfunction and congestive heart failure are known entities in Takayasu arteritis (TA). Subclinical LV dysfunction may develop in these patients despite normal LV ejection fraction (LVEF). Moreover, effect of treatment of aortic or renal artery narrowing in such patients is unknown. Methods: This study included 15 angiographically confirmed TA patients undergoing aortic and/or renal intervention. A comprehensive clinical, biochemical and echocardiographic (2-dimensional, speckle tracking and tissue doppler imaging) evaluation were done at baseline, 72 h, and six months post intervention. Results: Six patients (40%) had reduced LVEF (<50%) at baseline while rest 9 (60%) patients had reduced global longitudinal strain (GLS) but normal EF. Diastolic filling pattern was abnormal in all the patients. In patients with baseline reduced EF, mean EF improved from 24.62 ± 12.14% to 45.6 ± 9.45% (p ¼ 0.001), E/ e’ ratio decreased from 15.15 ± 3.19 to 10.8 ± 2.56 (p ¼ 0.005) and median NT pro BNP decreased from 1673 pg/ml (970e2401 pg/ml) to 80 pg/ml (40e354 pg/ml) (p ¼ 0.001) at 6 months after interventional procedure. In patients with baseline normal EF, median NT pro BNP decreased from 512 pg/ml (80 e898.5 pg/ml) to 34 pg/ml (29e70.8 pg/ml) (p < 0.01), mean GLS improved from 8.80 ± 0.77% to 16.3 ± 0.78% (p < 0.001) and mean E/e’ decreased from 12.93 ± 2.63 to 7.8 ± 2.73 (p ¼ 0.005) at 6 months follow up. Conclusion: LV dysfunction is common in patients with TA and obstructive lesions in aorta or renal arteries. GLS can be used to assess subclinical systolic dysfunction in these patients. Timely intervention can improve LV dysfunction and can even reverse the subclinical changes
ABSTRACT
RESUMEN Introducción: Los avances en la detección precoz y el tratamiento del cáncer han reducido de manera significativa la mortalidad. El resultado neto es el surgimiento de una cohorte de pacientes cuya supervivencia es suficiente para evidenciar los efectos secundarios de las terapias utilizadas. La cardiotoxicidad es el conjunto de enfermedades cardiovasculares derivadas de los tratamientos onco-hematológicos. Objetivos: Evaluar el papel de la deformación miocárdica (strain) longitudinal global en la detección precoz de cardiotoxicidad en pacientes con tratamiento quimioterápico. Método: Se realizó un estudio cuantitativo, analítico, longitudinal, prospectivo en 44 pacientes con diagnóstico de cáncer de mama o linfoma, que iniciaron tratamiento con quimioterapia en el Instituto de Oncología y Radiobiología de Cuba, en el período comprendido entre febrero de 2017 y abril de 2018. Se utilizaron métodos primarios y secundarios para la recolección del dato primario y se emplearon varias pruebas estadísticas para su análisis. Resultados: Las medias de edad y tiempo de tratamiento fueron de 47,7 años y 5,05 meses, respectivamente. Predominó la hipertensión arterial (18,1%) como factor de riesgo y la mayor cardiotoxicidad (27,8%) en pacientes con disfunción diastólica previa. Entre los que desarrollaron cardiotoxicidad, la variable que demostró mayor afectación fue el strain longitudinal global (p<0,0001), con una reducción de 19,6% respecto al basal. Conclusiones: El strain longitudinal global es un índice ecocardiográfico de deformación miocárdica, que presentó un valor discriminante significativo con respecto a la cardiotoxicidad en pacientes que recibieron tratamiento quimioterápico.
ABSTRACT Introduction: Advances in early detection and treatment of cancer have significantly reduced mortality. The net result is the emergence of a cohort of patients whose survival is sufficient to evidence the side effects of the used therapies. Cardiotoxicity is the set of cardiovascular diseases resulting from onco-hematological treatments. Objectives: To evaluate the role of global longitudinal strain in the early detection of cardiotoxicity in patients undergoing chemotherapy. Method: A quantitative, analytical, prospective, longitudinal study was carried out in 44 patients diagnosed with breast cancer or lymphoma, who started chemotherapy treatment at the Instituto de Oncología y Radiobiología of Cuba, from February 2017 to April 2018. Primary and secondary methods were used for raw data collection and several statistical tests were used for its analysis. Results: The mean age and treatment period were 47.7 years old and 5.05 months, respectively. The most prevalent risk factor was high blood pressure and cardiotoxicity was higher (27.8%) in patients with previous diastolic dysfunction. Among those who developed cardiotoxicity, the variable that showed the greatest affectation was global longitudinal strain (p<0.0001), with a reduction of 19.6% with respect to the basal one. Conclusions: Global longitudinal strain is an echocardiographic index of myocardial performance, which presented a significant discriminating value with respect to cardiotoxicity in patients who received chemotherapeutic treatment.
Subject(s)
Sprains and Strains , Echocardiography , Drug Therapy , CardiotoxicityABSTRACT
RESUMEN Introducción: La evaluación de la función miocárdica es fundamental para la toma de decisiones durante el seguimiento de pacientes con enfermedades oncológicas que reciben quimioterapia. Con las técnicas de speckle-tracking bidimensional se puede determinar el grado de deformación de la fibra miocárdica y obtener una medida más directa de la función sistólica que la que aporta la fracción de eyección del ventrículo izquierdo (FEVI). Objetivo: Evaluar la función miocárdica, mediante ecocardiografía, en pacientes con enfermedades oncológicas y tratamiento quimioterápico. Método: Se realizó un estudio descriptivo longitudinal prospectivo en 21 pacientes con diagnóstico de enfermedad oncoproliferativa e indicación de quimioterapia con trastuzumab, en el Hospital de Fuerteventura (España), entre enero de 2017 y mayo de 2020. A todos se les realizó ecocardiograma transtorácico con técnica de speckle-tracking (strain longitudinal global) antes del tratamiento y durante el seguimiento. Resultados: Predominaron las mujeres (95,2%) con diagnóstico de cáncer de mama (90,5%) y la edad promedio fue de 53,8 años (rango 38-75). La FEVI y el strain longitudinal global fueron normales (100%) antes del inicio de la quimioterapia. Fue necesario suspender el tratamiento en 3 pacientes (14,3%); pero solo en 2 de ellos (9,5%) por cardiotoxicidad detectada por ecocardiografía. Cinco pacientes (23,8%) presentaron síntomas de insuficiencia cardíaca, 1 (4,8%) tenía cardiotoxicidad y en los otros 4 (19,0%) se demostró ausencia de disfunción miocárdica, por lo que se pudo continuar el tratamiento con seguridad. Conclusiones: El ecocardiograma con técnica de speckle-tracking bidimensional fue de vital importancia para evaluar la función miocárdica y guiar el tratamiento quimioterápico en pacientes con enfermedades oncológicas.
ABSTRACT Introduction: Assessment of myocardial function is critical for decision making during the follow-up of patients with oncologic diseases undergoing chemotherapy. Two-dimensional speckle-tracking techniques help to determine the degree of myocardial fiber deformation and provide a more direct measure of systolic function than left ventricular ejection fraction (LVEF). Objective: To evaluate myocardial function by means of echocardiography in patients with oncological diseases undergoing chemotherapy. Methods: A prospective longitudinal descriptive study was performed in 21 patients diagnosed with cancer and with indication for chemotherapy with trastuzumab, in the Hospital of Fuerteventura (Spain), between January 2017 and May 2020. All underwent transthoracic echocardiography with speckle-tracking technique (global longitudinal strain) before treatment and during follow-up. Results: Women (95.2%) with a diagnosis of breast cancer (90.5%) predominated and the mean age was 53.8 years (range 38-75). Left ventricular ejection fraction and global longitudinal strain were normal (100%) before starting chemotherapy. It was necessary to suspend treatment in 3 patients (14.3%); but only in 2 of them (9.5%) due to cardiotoxicity detected by echocardiography. Five patients (23.8%) presented symptoms of heart failure, 1 (4.8%) had cardiotoxicity and in the other 4 (19.0%) the absence of myocardial dysfunction was demonstrated, so that treatment could be continued safely. Conclusions: Two-dimensional speckle-tracking echocardiography was of vital importance for assessing myocardial performance and guiding chemotherapy in patients with oncologic diseases.
Subject(s)
Echocardiography , Drug Therapy , Cardiotoxicity , Heart FailureABSTRACT
The features of myocardial strains from speckle-tracking echocardiography (STE) have not been well defined in fulminant myocarditis (FM) patients. In this study, changes in the left ventricular ejection fraction (LVEF) and global and layer-specific myocardial strains over time were monitored. We aimed to determine the echocardiographic patterns of FM and ascertain their significance in FM treatment. Twenty patients who were clinically diagnosed with FM and received mechanical life support were prospectively enrolled. Conventional echocardiographic measurements were obtained, and serial strain echocardiography was performed from admission to hospital discharge until LVEF recovery (> 50%). Global/regional peak systolic longitudinal strains (GLS/RLS) and layer-specific longitudinal strains were quantified, and their changes with time were monitored in 14 FM patients. All patients had severely impaired cardiac function. Steep improvement in LVEF and GLS were observed within 6 days. Layer-specific strain analysis showed that reduction at admission or recovery at discharge in the endocardium and epicardium strains were equal. In conclusion, FM patients who received mechanical circulatory supports exhibited steep improvement in ventricular function within 6 days. The patchy and diffused distribution pattern of reduced RLS and equally and severely impaired strain in the endocardium and epicardium are valuable features in the diagnosis of FM.
ABSTRACT
Abstract Introduction: Speckle-tracking echocardiography has shown its usefulness in the evaluation of the right ventricle (RV) in healthy subjects and in pulmonary hypertension. It is unknown whether this technique could be sensitive to assess healthy RV with increases in preload. Methods: Consecutive subjects were studied without evidence of cardiopulmonary disease. They underwent speckle-tracking echocardiography in General Electric Vivid 7® equipment. The "segmental longitudinal strain" (SLS) and "global longitudinal strain" (GLS) of the RV was determined at rest and with an increase in the preload through elevation the legs to 45°. Results: We analyzed 31 subjects, 16 men and 15 women, aged 16-53 years, in which were measured SLS and GLS. Basal of the RV free wall: —29.1 ± 3.3 versus −32.7 ± 5.5%, p = 0.0002. Mid of the RV free wall: —28.6 ± 6.4 versus —31.5 ± 4.9 %, p = 0.001. Apical of the free wall of the RV: —21.9 ± 6.5 versus —23.3 ± 6.1 %, p = 0.118. Basal inferoseptum: —19.40 ± 3.2 versus —18.9 ± 3.0 %, p = 0.204. Mid inferoseptum: —19.3 ± 3.2 versus —19 ± 3.1 %, p = 0.249. Apical septum: —17.1 ± 5.1 versus —17 ± 5.4 %, p = 0.457. GLS of the RV: —23.06 ± 3.4 versus —24.5 ± 2.9 %, p = 0.002. ICC: 0.773, 95 % CI: 0.534-0.890, p < 0.001. Conclusions: This method was sensitive to detect differences in the GLS and SLS basal and mid of the RV free wall.
Resumen Introducción: La ecocardiografía speckle-tracking (EST) ha mostrado su utilidad en la evaluación del ventrículo derecho (VD) en sujetos sanos y en hipertensión pulmonar. Se desconoce si esta técnica es sensible para evaluar el VD en sujetos sanos con aumento en la precarga. Método: Se evaluaron sujetos consecutivos sin evidencia de enfermedad cardiopulmonar. Se realizó EST con equipo General Electric Vivid 7®. La deformación longitudinal segmentaria (DLS) y la deformación longitudinal global (DLG) del VD se determinaron en reposo y con incremento en la precarga mediante la elevación de las piernas a 45°. Resultados: Analizamos 31 sujetos, 16 hombres y 15 mujeres. Edad: 16-53 años. Basal de la pared libre del VD: —29.1 ± 3.3 vs. —32.7 ± 5.5%, p = 0.0002. Medio de la pared libre del VD: —28.6 ± 6.4 vs. —31.5 ± 4.9%, p = 0.001. Apical de la pared libre del VD: —21.9 ± 6.5 vs. —23.3 ± 6.1, p = 0.118. Basal septum inferior: —19.40 ± 3.2 vs. —18.9 ± 3.0%, p = 0.204. Medio septum inferior: —19.3 ± 3.2 vs. —19 ± 3.1%, p = 0.249. Apical septal −17.1% ± 5.1 vs. −17 ± 5.4, p = 0.457. DLG del VD: —23.06 ± 3.4 vs. —24.5 ± 2.9%, p = 0.002. CCI: 0.773, IC 95%: 0.534-0.890, p < 0.001. Conclusiones: El método fue sensible para detectar diferencias en la DLG y DLS basal y media de la pared libre del VD.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Echocardiography/methods , Ventricular Function, Right , Heart Ventricles/diagnostic imaging , Patient Positioning , Healthy Volunteers , LegABSTRACT
Background: Atrial septal defect (ASD) is a common congenital heart disease associated with volume overload of Right ventricle (RV) with variable effect on Left ventricle (LV). Two-dimensional (2D) Strain analysis is a new tool for objective analysis of myocardial function. This prospective study evaluated the systolic function of right and left ventricle by conventional 2D echo and strain echo and measured changes in cardiac hemodynamics that occurred in patients of ASD before and after correction. Patients and Methods: 2D echo and strain analysis of each patient before and at 48 hrs, 3 months and 6 months after correction was performed. Routine 2D echo parameters and global longitudinal strain of both ventricles were measured. Result: Improvement in LV ejection fraction (P = 0.0001) and myocardial performance index (MPI) (P < 0.0001) occurred at the end of 6 months, whereas decrease in RV MPI (P < 0.0001) and tricuspid annular plane systolic excursion (P < 0.0001) became statistically significant after 3 months of ASD correction. In comparison to conventional 2D echo, global longitudinal strain of RV decreased significantly only after 48 hours of ASD correction while there was no improvement in left ventricular global longitudinal strain after 6 month of correction. Conclusion: There was improvement in RV function with subtle change in LV function by strain imaging and most of these changes were completed within 6 months of ASD correction and nearly correlated with conventional 2DEchocardiography.
ABSTRACT
Abstract Objectives: The cross-sectional study aimed to assess left ventricular systolic function using global longitudinal strain (GLS) by speckle-tracking echocardiography (STE) and arterial stiffness using cardio-ankle vascular index (CAVI) in Thai adults with rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD). Methods: Confirmed RA patients were selected from a list of outpatient attendees if they were 18 years (y) without clinical, ECG and echocardiographic evidence of CVD, diabetes mellitus, chronic kidney disease, and excess alcoholic intake. Controls were matched with age and sex to a list of healthy individuals with normal echocardiograms. All underwent STE and CAVI. Results: 60 RA patients (females = 55) were analysed. Mean standard deviation of patient and control ages were 50 ± 10.2 and 51 ±9.9 y, respectively, and mean duration of RA was 9.0 ± 6.8 y. Mean DAS28-CRP and DAS28-ESR were 2.9 ± 0.9 and 3.4 ± 0.9, respectively. There was no between-group differences in left ventricular ejection fraction (LVEF), LV sizes, LVMI, LV diastolic function and CAVI were within normal limits but all GLSs values was significantly lower in patients vs. controls: 17.6 ± 3.4 vs 20.4 ± 2.2 (p = 0.03). Multivariate regression analysis demonstrated significant correlations between GLSs and RA duration (p = 0.02), and GLSs and DAS28-CRP (p = 0.041). Conclusions: Patients with RA and no clinical CV disease have reduced LV systolic function as shown by lower GLSs. It is common and associated with disease activity and RA disease duration. 2D speckle-tracking GLSs is robust in detecting this subclinical LV systolic dysfunction.
Subject(s)
Female , Humans , Male , Middle Aged , Arthritis, Rheumatoid/physiopathology , Ventricular Dysfunction, Left/physiopathology , Arthritis, Rheumatoid/blood , Blood Sedimentation , C-Reactive Protein/analysis , Echocardiography/methods , Cardiovascular Diseases , Cross-Sectional Studies , Regression Analysis , Reproducibility of Results , Diagnosis, Computer-Assisted/methods , Ventricular Dysfunction, Left/diagnostic imaging , Vascular StiffnessABSTRACT
Introduction Normative comprehensive echocardiographic measurements data for healthy Indians are not available while data for American and European population is available from American Society of echocardiography and European Society of Cardiology/European Association of Cardio-Vascular Imaging and their publications. Available studies of Indian subjects are small and report only limited measurements with focus on left ventricular (LV) volumes. Objective We aim to provide comprehensive normative echocardiographic data for healthy Indians from a large sample size. Methods A retrospective cross-sectional single-center study of 707 healthy Indian adults age and sex segregated which presented detailed and comprehensive echocardiographic measurements including two-dimensional, M-mode, tissue Doppler imaging, speckle tracking echocardiography, chamber volumes, LV ejection fraction (LVEF), global longitudinal strain (GLS), segmental longitudinal strain and effort tolerance. Results Our findings show healthy Indians, as compared to US and European population, to have higher relative wall thickness. LV volumes, LV mass, LVEF and effort tolerance that were within American Society of Echocardiography described ranges for chamber quantification. Higher GLS values were observed in Indian population compared to European and American population. Women had higher LVEF and GLS values as compared to men and both showed a gradual decline with aging. Conclusion We present normal reference values for echocardiographic measurements in healthy Indian population, which could be used for future reference and comparison work.
ABSTRACT
Objective To observe the value of speckle-tracking imaging (STI) in evaluation on degree of coronary artery stenosis in patients with coronary artery disease (CAD).Methods Totally 74 CAD patients,including 59 with coronary artery stenosis (coronary artery stenosis group) and 15 without coronary artery stenosis (no coronary artery stenosis group) underwent STI and echocardiography.Based on Gensini scores,the patients in coronary artery stenosis group were further divided into mild,moderate and severe subgroups.The average global longitudinal strain (GLS-Avg),basement global longitudinal strain (GLS-Bas),middle global longitudinal strain (GLS-Mid) and apical global longitudinal strain (GLS-AP) value were measured and compared.Results GLS-Avg,GLS-Bas,GLS-Mid and GLS-AP value in coronary artery stenosis group were lower than those in no coronary artery stenosis group (all P ＜ 0.001).In coronary artery stenosis group,with the increase of stenosis severity,GLS-Avg,GLS-Bas,GLS-Mid and GLS-AP value decreased,and statistical differences were found between each two subgroups (all P＜0.05).In coronary artery stenosis group,there were positive correlations between GLS-Avg,GLS-Bas,GLS-Mid,GLS-AP value and Gensini scores (r=0.861,0.847,0.819 and 0.778,all P＜ 0.05).Conclusion GLS value of STI can reflect the severity of coronary artery stenosis in CAD patients.
ABSTRACT
Objective To systematically evaluate the effects of left ventricular global longitudinal strain (GLS) determined by two dimensional speckle tracking imaging technology (2D-STI) and left ventricular ejection fraction (LVEF) on the prognosis of patients with sepsis/septic shock.Methods Databases such as the National Library of Medicine PubMed database, Dutch medical abstracts Embase, Cochrane Library, Netherlands Elsevier, Springer and China biomedical literature database (CBMdisc), China National Knowledge Internet (CNKI), Wanfang database, China science and technology journal full-text database, Vip Chinese biomedical journal database were searched from the establishment of literature database to April 2018 to study GLS, LVEF and their relationships with mortality of septic/septic shock patients. The literatures screening and data collecting were independently conducted by two researchers, and the quality of the included literature was evaluated. The sensitivity and heterogeneity analysis were performed with RevMan 5.3 software, and the combined effects were calculated. Funnel plot was used to evaluate publication bias.Results A total of 6 articles including 5 English articles and 1 Chinese article were enrolled. There were 503 patients, 333 in the survival group and 170 in the death group. The quality of the literature was high, and the Newcastle-Ottawa scale (NOS) score was 8-9. Meta-analysis showed that short-term mortality was associated with higher GLS in patients with sepsis/septic shock [standardized mean difference (SMD) = -0.47, 95％ confidence interval (95％CI) = -0.76 to -0.18, Z = 3.16,P = 0.002], and there was no significant difference in LVEF between the survival group and the death group (SMD = 0.18, 95％CI = -0.03-0.39,Z = 1.64, P = 0.10). Sensitivity analysis was carried out for each effect index by removing each document one by one, and the results showed that there was no significant change in the combined effect before and after each document, indicating that the results were stable. The funnel plot showed that the effect points of each literature were roughly in the form of "inverted funnels" with a large symmetric distribution centered on the combined effect, but the number of studies included in this study was too small, so the publication bias could not be completely excluded.Conclusion Compared with LVEF, GLS might be a more sensitive indicator for detecting myocardial dysfunction in patients with sepsis/septic shock and might have important predictive value for short-term mortality.
ABSTRACT
PURPOSE: Impaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients. MATERIALS AND METHODS: A total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction < 50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples. RESULTS: In simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p < 0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (β=0.35, p=0.028) and log UACR (β=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria. CONCLUSION: There are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.