Strain echocardiography in predicting LV dysfunction in RV apical pacing

Right ventricular (RV) pacing is associated with a reduction in left ventricular (LV) systolic function, thought to be mediated by pacing-induced ventricular dyssynchrony. The prevalence of heart failure after RV pacing is reported to range from 31±3%. We studied 60 subjects with high-grade atrioventricular block and Complete Heart Block (CHB) scheduled to undergo right ventricular apical pacing. 2D echocardiography was done at baseline, 1 month and 12 months. Pacing-induced cardiomyopathy was defined as a reduction in LVEF to <45%. Strain was evaluated off-line from digitally stored images using all advanced software package (cardiac wall motion quantification (CMQ); Toshiba Medical Systems). Longitudinal strain for individual myocardial segments was measured from the apical four-chamber, two-chamber and long axis views (16 segment AHA/ASE model). None had LV dysfunction at baseline based on 2D and strain echo imaging. Subsequently 18 patients were detected to develop low GLS score (less than -14.5) at 1 month. On subsequent follow up at 1 year, all 18 patients developed LV dysfunction on 2D Echocardiography. Thus Strain imaging with GLS score helped in early detection of LV dysfunction in RV apical pacing subjects. Pacing-induced cardiomyopathy had significant association with high grade AV block with pacemaker dependency. It had no significant associations with other comorbidities like diabetes, hypertension, ischemic heart disease or with the type of medication intake. However there was a statistically significant association with heart failure

Current Awareness and Use of the Strain Echocardiography in Routine Clinical Practices: Result of a Nationwide Survey in Korea

BACKGROUND: Because conventional echocardiographic parameters have several limitations, strain echocardiography has often been introduced in clinical practice. However, there are also obstacles in using it in clinical practice. Therefore, we wanted to find the current status of awareness on using strain echocardiography in Korea. METHODS: We conducted a nationwide survey to evaluate current use and awareness of strain echocardiography from the members of the Korean Society of Echocardiography. RESULTS: We gathered total 321 questionnaires from 25 cardiology centers in Korea. All participants were able to perform or interpret echocardiographic examinations. All participating institutions performed strain echocardiography. Most of our study participants (97%) were aware of speckle tracking echocardiography and 185 (58%) performed it for clinical and research purposes. Two-dimensional strain echocardiography was the most commonly used modality and left ventricle (LV) was the most commonly used cardiac chamber (99%) for clinical purposes. Most of the participants (89%) did not think LV strain can replace LV ejection fraction (LVEF) in their clinical practice. The common reasons for not performing routine use of strain echocardiography was diversity of strain measurements and lack of normal reference value. Many participants had a favorable view of the future of strain echocardiography. CONCLUSION: Most of our study participants were aware of strain echocardiography, and all institutions performed strain echocardiography for clinical and research purposes. However, they did not think the LV strain values could replace LVEF. The diversity of strain measurements and lack of normal reference values were common reasons for not using strain echocardiography in clinical practice.

2-Dimensional Strain Analysis of Regional Change in Right Ventricular Function after Treadmill Exercise

BACKGROUND: Function of right ventricle (RV) influences on symptoms and prognosis in various diseases. However the regional RV function analyzed with 2-dimensional (2D) strain echocardiography before and just after treadmill test has not been evaluated. The aim of this study was to show the change of regional RV function just after treadmill exercise with strain analysis. METHODS: A total of thirty eight patients who visited hospital for hypertension, chest pain or dyspnea between January 2007 and December 2010 were retrospectively analyzed (men, 47.4%; mean age, 54.9 ± 7.2 years). Treadmill exercise test and pre and post echocardiography were performed. 2D strain echocardiography was analyzed off line in RV free wall and septum. RESULTS: Mean exercise duration was 737 ± 132 sec. Tissue velocity in lateral tricuspid annulus is significantly increased in post exercise (initial, 10.5 ± 2.4 cm/sec vs. post exercise, 12.2 ± 1.8 cm/sec, p = 0.006). Systolic strain of RV free wall apex and mid portion were significantly changed in post exercise stage (free wall apex, -18.2 ± 7.6% vs. -22.3 ± 5.8%, p = 0.010; free wall mid, -14.1 ± 6.7% vs. -22.6 ± 6.8%, p = 0.022). CONCLUSION: 2D strain imaging provides a precise tool to quantify regional RV function and reveals a characteristic regional pattern of RV after treadmill exercise.

Impaired Global Right Ventricular Longitudinal Strain Predicts Long-Term Adverse Outcomes in Patients with Pulmonary Arterial Hypertension

BACKGROUND: New 2-dimensional strain echocardiography enables quantification of right ventricular (RV) mechanics by assessing global longitudinal strain of RV (GLSRV) in patients with pulmonary arterial hypertension (PAH). However, the prognostic significance of impaired GLSRV is unclear in these patients. METHODS: Comprehensive echocardiography was performed in 51 consecutive PAH patients without atrial fibrillation (40 females, 48 +/- 14 years old) with long-term follow-up. GLSRV was measured with off-line with velocity vector imaging (VVI, Siemens Medical System, Mountain View, CA, USA). RESULTS: GLSRV showed significant correlation with RV fractional area change (r = -0.606, p or = -15.5%) was associated with lower event-free survival (HR = 4.906, p = 0.001) and increased mortality (HR = 8.842, p = 0.005). CONCLUSION: GLSRV by VVI showed significant correlations with conventional echocardiographic parameters indicating RV systolic function. Lower GLSRV (> or = -15.5%) was significantly associated with presence of adverse clinical events and deaths in PAH patients.

S1-3 Effect of Waon therapy on vasospastic angina / 日本温泉気候物理医学会雑誌

Background: Transient severe myocardial ischemia in patients with coronary vasospasm impairs regional left ventricular (LV) relaxation which persists for several weeks. Methods: We studied 40 consecutive patients (17 women, 52±8) with vasospastic angina (VA) who had recurrent angina despite treatment with the conventional calcium channel blockers (CCBs) during the follow-up period. These 40 patients were registered and randomly assigned to either Waon therapy group or the high dose of CCBs therapy. In Waon therapy, the patients were treated with a far infrared-ray dry sauna at 60 degrees centigrade for 15 minutes and then kept on bed rest with a blanket for 30 minutes for 2 weeks. Strain imaging (SI) was acquired in the LV mid-papillary short-axis view and radial strain was measured using 2D speckle tracking echocardiography. The peak values of stain at the closure of aortic valve (A) and at the one third diastole duration (B) were measured. The SI-diastolic index (SI-DI) was determined as (A-B)/A 100%. The repeated SI study was conducted 1 weeks and 2 weeks in Waon therapy. Chest pain was scored by a numeric pain intensity rating scale. Results: The mean SI-DIs was 20±17% in the 45 territories perfused by the coronary arteries with spasm at baseline. The SI-DI significantly improved at 1 weeks (50±14%, p<0.001), and further improved after 2 weeks (77±10%, p<0.001). In contrast, the index did not improve in the high-dose CCBs therapy group. The pain score significantly decreased after 2 weeks of Waon therapy. Conclusion: The repeated Waon therapy improved the LV postischemic diastolic dysfunction and chest pain in patients with VA.

S1-3Effect of Waon therapy on vasospastic angina / 日本温泉気候物理医学会雑誌

<b>Background: </b>Transient severe myocardial ischemia in patients with coronary vasospasm impairs regional left ventricular (LV) relaxation which persists for several weeks. <BR><b>Methods: </b>We studied 40 consecutive patients (17 women, 52±8) with vasospastic angina (VA) who had recurrent angina despite treatment with the conventional calcium channel blockers (CCBs) during the follow-up period. These 40 patients were registered and randomly assigned to either Waon therapy group or the high dose of CCBs therapy. In Waon therapy, the patients were treated with a far infrared-ray dry sauna at 60 degrees centigrade for 15 minutes and then kept on bed rest with a blanket for 30 minutes for 2 weeks. Strain imaging (SI) was acquired in the LV mid-papillary short-axis view and radial strain was measured using 2D speckle tracking echocardiography. The peak values of stain at the closure of aortic valve (A) and at the one third diastole duration (B) were measured. The SI-diastolic index (SI-DI) was determined as (A-B)/A 100%. The repeated SI study was conducted 1 weeks and 2 weeks in Waon therapy. Chest pain was scored by a numeric pain intensity rating scale. <BR><b>Results: </b>The mean SI-DIs was 20±17% in the 45 territories perfused by the coronary arteries with spasm at baseline. The SI-DI significantly improved at 1 weeks (50±14%, p<0.001), and further improved after 2 weeks (77±10%, p<0.001). In contrast, the index did not improve in the high-dose CCBs therapy group. The pain score significantly decreased after 2 weeks of Waon therapy.<BR><b>Conclusion: </b>The repeated Waon therapy improved the LV postischemic diastolic dysfunction and chest pain in patients with VA.

A Comparison of Different Techniques of Two-Dimensional Speckle-Tracking Strain Measurements of Right Ventricular Systolic Function in Patients with Acute Pulmonary Embolism

BACKGROUND: Speckle-tracking echocardiography has been applied to measure right ventricular (RV) systolic function in various diseases. However, variations in strain measurement by different vendors have limited the application of these techniques for assessment of RV function. We sought to compare two methods for the assessment of RV systolic function in patients with acute pulmonary embolism (PE). METHODS: From August 2007 to May 2011, all consecutive PE patients were prospectively included in this cohort study. Global longitudinal strains of RV measured with EchoPAC PC software (GLSRV-EchoPAC; GE Medical Systems) and velocity vector imaging (GLSRV-VVI; Siemens Medical Systems) were recorded on the same set of echocardiographic images. RESULTS: We analyzed a total of 50 patients (12 males, 68 +/- 14 years) with acute PE in this study. GLSRV-EchoPAC and GLSRV-VVI were correlated (r = 0.793, p < 0.001) and they showed significant correlations with conventional echocardiographic parameters of RV systolic function and Log B-type natriuretic peptide (BNP) level. However, GLSRV-VVI only showed significant correlations with cardiac biomarkers as serum creatinine kinase-MB (r = 0.367, p = 0.010) and tropoinin-I concentrations (r = 0.294, p = 0.040). CONCLUSION: GLSRV-VVI and GLSRV-EchoPAC showed significant correlations with conventional echocardiographic parameters of RV systolic function and LogBNP value in patients with PE.

Similar Morphology, but Different Function: Acute Improvement of Myocardial Longitudinal Strain after Percutaneous Transcatheter Aortic Valve Implantation Therapy in a Severe Aortic Stenosis Patient

No abstract available.

Validation of Global Longitudinal Strain and Strain Rate as Reliable Markers of Right Ventricular Dysfunction: Comparison with Cardiac Magnetic Resonance and Outcome

BACKGROUND: Right ventricular (RV) dysfunction in ischemic cardiomyopathy (ICM) is associated with poor prognosis, but RV assessment by conventional echocardiography remains difficult. We sought to validate RV global longitudinal strain (RVGLS) and global longitudinal strain rate (RVGLSR) against cardiac magnetic resonance (CMR) and outcome in ICM. METHODS: In 57 patients (43 men, 64 +/- 12 years) with ICM who underwent conventional and strain echocardiography and CMR, RVGLS and RVGLSR were measured off-line. RV dysfunction was determined by CMR [RV ejection fraction (RVEF) < 50%]. Patients were followed over 15 +/- 9 months for a composite of death and hospitalization for worsening heart failure. RESULTS: RVGLS showed significant correlations with CMR RVEF (r = -0.797, p < 0.01), RV fractional area change (RVFAC, r = -0.530, p < 0.01), and tricuspid annular plane systolic excursion (TAPSE, r = -0.547, p < 0.01). RVGLSR showed significant correlations between CMR RVEF (r = -0.668, p < 0.01), RVFAC (r = -0.394, p < 0.01), and TAPSE (r = -0.435, p < 0.01). RVGLS and RVGLSR showed significant correlations with pulmonary vascular resistance (r = 0.527 and r = 0.500, p < 0.01, respectively). The best cutoff value of RVGLS for detection of RV dysfunction was -15.4% [areas under the curve (AUC) = 0.955, p < 0.01] with a sensitivity of 81% and specificity 95%. The best cutoff value for RVGLSR was -0.94 s-1 (AUC = 0.871, p < 0.01), sensitivity 72%, specificity 86%. During follow-up, there were 12 adverse events. In Cox-proportional hazard regression analysis, impaired RVGLS [hazard ratio (HR) = 5.46, p = 0.030] and impaired RVGLSR (HR = 3.95, p = 0.044) were associated with adverse clinical outcome. CONCLUSION: Compared with conventional echocardiographic parameters, RVGLS and RVGLSR correlate better with CMR RVEF and outcome.

Avaliação das alterações cardiotóxicas decorrentes do uso da doxorrubicina: estudo experimental em ratos / Clinical evaluation of the doxorubicin-induced cardiotoxicity: experimental study in rats

A doxorrubicina é um dos quimioterápicos mais utilizados no tratamento de tumores sólidos e hematopoiéticos, embora possa causar reações adversas, especialmente cardiomiopatia secundßria. Apesar do potencial cardiotóxico, a doxorrubicina ainda é amplamente utilizada devido a sua alta eficßcia e baixo custo. esse trabalho objetiva-se estudar a sintomatologia associada ao uso da doxorrubicina em ratos, para elucidar seus efeitos cardiotóxicos. Dez ratos Wistar machos foram distribuidos em dois grupos: tratado, o qual recebeu 5mg/kg de doxorrubicina em 1,0mL de salina, via intraperitoneal a cada sete dias, durante quatro se- manas; e controle, o qual recebeu apenas 1,0 mL de salina nas mesmas condições descritas. Realizou-se eletrocardiograma antes dos tratamentos e após quatro semanas, juntamente com ecocardiograma. Os animais do grupo tratado apresentaram apatia, emagrecimento, desidratação e fezes diarreicas com muco, indicando disfunção metabólica decorrente da toxicidade do quimioterßpico. Em dois animais, o quadro clínico evoluiu para óbito, 19 dias após início do tratamento. No eletrocardiograma detectou-se aumento na amplitude das ondas P e R, sugerindo sobrecarga atrial e ventricular esquerda, respectivamente. A onda T apresentou amplitude superior à onda R, provavelmente devido a alterações eletrolíticas secundßrias ao quadro de desidratação e diarreia. Arritmias atriais e ventriculares, contudo, não foram detectadas. Foi diagnosticada disfunção ventricular nos animais que receberam doxorrubicina, quando avaliados por ecocardiografia de deformação miocßrdica (velocidade e deslocamento radiais do ventrículo esquerdo). Conclui-se que a doxorrubicina provoca cardiotoxicidade dose-dependente com redução progressiva da função ventricular esquerda, a qual pode ser diagnosticada precocemente com a ecocardiografia strain...

Doxorubicin is one of lhe most common drugs used in lhe treatment of solid and emopoietic tumors; however it causes a dose-dependet adverse effects, mainly cardiomyopathy. Despite the obvious cardiac toxicity potential, doxorubicin is still widely used due t0 its high efficiency and low cost. Therefore, this research aims to study the sytmptoms associated with the use of doxorubicin in rats, in order to elucidate its cardiac toxicity. Ten male Wistar rats were distributed into two groups: treated, which received 5mg/kg of doxorubicin in 1.0 mL saline intraperitoneal weekly, for four weeks, and control, which received only 1.0 mL of saline under lhe same conditions described. Electrocardiography was performed before treatment and atter four weeks when echocardiography was done as well. The treated group showed apathy, weight loss, dehydration and diarrheal stools with mucus, indicating metabolic dystunction due to the toxicity of chemotherapy. Two animals died, 19 days after lhe beginning of the experiment The electrocardiogram detected an increase in the amplitude of P. R and S waves, suggesting atrial and ventricular overload, respectively. The greater amplitude of the T-wave when compared to the R wave occurred probably due to electrolyte alterations caused by dehydration and diarrhea. Nevertheless, atrial and ventricular ar- rhythmias were not detected. Ventricular dysfunction was diagnosed in animais that received doxorubicin when evaluated by strain echocardiography (left ventricular radial velocity and displacement). It was concluded that doxorubicin causes a dose-dependent cardiotoxicity, with a progressive left ventricular dysfunction which may be early detected using the strain echocardiography...