ABSTRACT
CONTEXT: Four-dimensional speckle-tracking echocardiography (4D-STE) is ideal to accurately assess myocardial deformation. The novel 4D global area strain (GAS) uses global longitudinal and global circumferential strains (GCSs) to detect subtle changes in myocardium. AIMS: The aim of this study was to determine the predictive value of 4D strain echocardiography for major adverse cardiovascular events (MACEs) in ST-elevation acute myocardial infarction (STEMI) patients after successful reperfusion by primary percutaneous coronary intervention (PCI). SETTINGS AND DESIGN: This was a longitudinal study at a single center. PATIENTS AND METHODS: We enrolled 170 patients who underwent successful primary PCI. Each patient was evaluated with 2D echocardiography and 4D echocardiography with 4D strain parameters and followed up over a year for the occurrence of MACE. STATISTICAL ANALYSIS USED: Chi-square test, independent t-tests, and multivariate logistic regression analysis were used. RESULTS: Over 1 year of follow-up, 32 MACE were recorded. Patients with MACE were more likely to have had percutaneous transluminal coronary angioplasty done during the index primary PCI intervention, multivessel coronary artery disease, higher left ventricular end-diastolic and end-systolic dimensions (left ventricle end diastolic dimension (LVEDD) and left ventricle end systolic dimension (LVESD), respectively), lower 2D left ventricular ejection fraction (LVEF), higher wall motion score index, higher baseline heart rate, higher end-diastolic and end-systolic volumes, lower 3D-LVEF, higher 4D global longitudinal strain, 4D-GCS, 4D-GAS, and lower 4D global radial strain (4D-GRS) (P < 0.005 for all parameters). The most powerful predictor for MACE among our study population is 4D-GAS, with the best cutoff value of 4D-GAS >-17 (P = 0.008; odds ratio = 20.668; confidence interval = 2.227-191.827). CONCLUSIONS: The novel 4D-GAS echocardiography predicts adverse clinical events in STEMI patients managed by successful primary PCI.
ABSTRACT
BACKGROUND: Aortic valve assessment by 2D transthoracic echocardiography is a relatively complex task owing to the unique anatomical features of the left ventricular outflow tract and its dynamic nature. We aimed to evaluate the accuracy of 3D transthoracic echocardiography [3D TTE] in assessing the aortic valve in children. RESULTS: The first group included 11 males and six females, with a mean age of 5.76 ± 6.39 years. All of these patients had aortic valve disease with a bicuspid variant. The second group included seven males and seven females, with a mean age of 4.4 ± 4.05 years. All of these patients had normal aortic valve morphology and had another congenital cardiac anomaly. The aortic valve annulus was assessed using the three modalities; 2D, 3D echocardiography in the vertical and horizontal diameters, and angiography. The aortic valve area was measured by 2D and 3D echocardiography using multiplane reformatted mode. The results of the analysis were then compared. They revealed that 3D echocardiographic measurement of the aortic annulus (horizontal diameter) correlated better with angiography than 2D and 3D (vertical diameter) echocardiographic measurements. There was a significant difference between the aortic valve area measured by 2D echocardiography and that measured by 3D echocardiography among the two groups, 2D echocardiography seems to underestimate the true aortic valve area. CONCLUSION: The study concluded that 3D TTE with multiplane reformatted mode allows a more accurate assessment of the aortic valve when compared to 2D echocardiography and this correlates better with the angiographic findings.
ABSTRACT
BACKGROUND: This is a case-control study conducted on 30 children, 15 with VSD who performed VSD transcatheter device closure (group A) and 15 controls of matching age and gender (group B), in the period between September 2015 and February 2018. We aimed to assess the global left ventricular (LV) systolic function by 2D speckle tracking before and after ventricular septal defect (VSD) transcatheter closure, in comparison to normal controls. All patients were subjected to full history taking; general and cardiac examination; ECG; CXR; full transthoracic echocardiographic examination, including VSD number, size, and site; LV dimensions and volumes; estimated pulmonary artery pressure; right ventricular size and function; left ventricular circumferential; and radial strain imaging by 2D speckle tracking. Patients who had ventricular septal defect closed were reassessed by transthoracic echocardiography after 3 months. RESULTS: The study included 15 children with VSD: 3 males and 12 females; their age ranged from 2 to 13 years; all had subaortic VSD except for 1 who had apical muscular VSD: VSD size ranged from 3 to 8 mm; PFM coil was used to close defect in all patients except for 2 patients who had an Amplatzer duct occlude I (ADOI) device, and 1 patient needed an additional vascular plug after significant hemolysis. Pre-procedurally, group A had a significantly higher LVEDD, LVESD, and LVEDV than group B. Mean circumferential strain was significantly higher (more negative) in group A than that in group B either pre- or post-procedure. Post-procedurally, there was a significant decrease in circumferential strain (less negative) and a significant increase in radial strain (more positive). CONCLUSION: Following transcatheter VSD closure, there is a significant decrease in LV circumferential strain and a significant increase in LV radial strain, which conclude a decrease in LV volume overload with the improvement of its contractility.
