Echocardiographic Wall Motion Abnormalities in Hypertensive Patients with Electrocardiographic Left Ventricular Hypertrophy

Background: During the cardiac cycle with the effect on cardiac function, Echocardiographic wall motion abnormalities are kinetic alterations in the cardiac wall motion. It can be characterized as per their grades and their distribution pattern like segmental or global. It can be attributed to a coronary territory or follow a non-coronary distribution. Aim of the study: The aim of the study was to evaluate the patterns of echocardiographic wall motion abnormalities among hypertensive patients with electrocardiographic left ventricular hypertrophy.Material & Methods:This was prospective observational study which was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from January 2020 to January 2021. In total 76 hypertensive patients with electrocardiographic left ventricular hypertrophy were included as the study subjects for this study. This study was approved by the ethical committee of the mentioned hospital. A predesigned questioner was used in data collection. All data were collected, processed and analyzed by using MS Office and SPSS version 23 programs as per necessity.Results:In this study, in analyzing the status of wall motion abnormalities (WMA) among the participants we observed that, 22% of the patients were with segmental wall motion abnormalities, 18% were with global dysfunction and 59% were fully free from any type of WMA. Among patients with global dysfunctions, 71% were with mild and 12% were with moderate-to-severe dysfunction whereas this ratio was 47:24 in segmental abnormality patients. On the other hand, in analyzing the severity and location of patients with segmental WMA we observed that 47%, 24%, 53%, 41%, 18%, 24%, 29%, 47%, 35%, 53% and 41% were with mild dysfunction, moderate-to-severe dysfunction, inferior wall dysfunction, antero-septal dysfunction, anterior wall dysfunction, lateral wall dysfunction, posterior wall dysfunction, posterior septal dysfunction, LV base dysfunction, LV mid-cavity dysfunction and LV apical dysfunction respectively.Conclusion:In this study, majority of the participants were found free from any type of wall motion abnormality. ‘Mild dysfunction’, inferior wall dysfunction, anterior wall dysfunction, lateral wall dysfunction, posterior septal dysfunction, LV base dysfunction, LV mid-cavity dysfunction and LV apical dysfunction are found as some more frequent dysfunctions among patients with WMA.

Takotsubo syndrome

Takotsubo syndrome is a reversible acute heart failure frequently precipitated by an emotional or physical stress. The clinical presentation resembles acute coronary syndrome. Pathogenesis is complex and may involve brain-heart axis and neuro-hormonal stunning of the myocardium. Coronary angiography reveals normal epicardial arteries with no obstruction or spasm. NT-ProBNP maybe remarkably elevated. Regional wall motion akinesia (RWMA) of left ventricle extends beyond the territory of one coronary artery. Reduced left ventricle ejection fraction (LVEF) and RWMA recover in 6–12 weeks. Prognosis is generally good. Recent meta-analysis shows in-hospital mortality of 1–4.5% and recurrence rate of 5–10% during five year follow-up.

Evaluation of Regional Wall Motion in Patients with Suspected Coronary Artery Disease by Real-Time Three-Dimensional Echocardiography and Two-Dimensional Speckle Tracking Imaging / 天津医药

Objective To evaluate the clinical value of the regional wall motion in patients with suspected coronary artery disease by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI). Methods A total of 143 hospitaized patients with suspected coronary artery disease and normal wall motion de?tected by two-dimensional echocardiography (2DE) were enrolled and devided into group A (coronary stenosis ≥75%) 73 cases and group B (coronary stenosis<75%) that include 70 cases according to coronary angiography results. Left ventricu?lar segmental ejection fraction (sEF) was measured by RT-3DE and peak systolic longitudial strain (SL) was measured by 2D-STI. ROC curves of the two measurements were generated and compared. Differences in sEF and SL between group A and group B were respectively analyzed. Results (1)Both sEF of RT-3DE and SL of 2D-STI in group A were significantly low?er than those in group B (P<0.05);(2)sEF was positively correlated with SL(r=0.689,P<0.05);(3)Compared with SL, sEF had larger area under ROC curve in some segments of left ventricle where both parameters are abnormal for the diagnosis of the coronary stenosis ≥75% (0.922 vs 0.874). Conclusion Regional wall motion of left ventricular can be measured by both RT-3DE and 2D-STI which can be both used to estimate the extend of stenosis of coronary artery. And RT-3DE is su?perior over 2D-STI.

Accuracy of Two-Dimensional Speckle Tracking Echocardiography for the Detection of Significant Coronary Stenosis

BACKGROUND: Visual assessment of wall motion abnormalities (WMA) by 2-dimensional echocardiography (2DE) is the most semi-quantitative method used to detect coronary artery disease (CAD), but it carries many limitations. Speckle tracking echocardiography (STE) overcomes these limitations and allows an objective quantification of myocardial deformation. The aim of the study to examine the accuracy of global and segmental longitudinal strain (LS) for the detection of CAD compared with visual assessment of WMA using coronary angiography as a golden standard. METHODS: The study enrolled 25 patients (mean age 51.0 +/- 8.7, 64% are male) referred to coronary angiography with clinical suspicion of CAD. 2DE assessment of WMA and evaluation of LS using STE were performed using left ventricular 17-segments models. Significant CAD was defined as > or = 50% stenosis in one or more major coronary arteries by angiography. RESULTS: Patients were classified into 2 groups: group I included 15 patients with significant CAD and group II included 10 patients with insignificant and/or absence of CAD. WM score was strongly correlated with the global LS in group I and II (R = 0.80, p < 0.0001 and R = 0.88, p < 0.0001 respectively). In all patients, 425 segments were analyzed. WMA was detected in 163 segments of 425 (38.3%) while abnormal LS was detected in 214 segments (50.3%). Compared with coronary angiography, the total sensitivity, specificity and accuracy for visual analysis and STE were (56%, 88.2%, and 60% vs. 68.6%, 77%, and 81.8% respectively). CONCLUSION: Segmental LS is more accurate for the detection of ischemic myocardial segment corresponding to functionally relevant coronary anatomy than visual assessment of WM.