Left atrial deformation analysis as a predictor of severity of coronary artery disease.

BACKGROUND: Two-dimensional (2D) speckle-tracking strain imaging is a novel method for assessment of regional myocardial deformation that uses tracking of acoustic speckles or kernels rather than Doppler myocardial velocities. It has been suggested that Left atrial (LA) strain as measured by 2D speckle tracking can be used to evaluate dynamic LA function. OBJECTIVE: To study the relation between left atrial deformation and the severity of coronary artery stenosis in patients with stable coronary artery disease (CAD). STUDY DESIGN: 30 patients with stable coronary artery disease (SCAD) with coronary artery stenosis (>50%) who were admitted for elective coronary angiography at Ain Shams University hospitals and AlAzhar University hospitals were included in the study. Measurements of conventional echocardiographic parameters as well as LA strain and strain rate parameters were obtained, Syntax (SX) score was calculated for all patients. RESULTS: Patients were categorized into 3 groups: low Syntax score of <23 (Group I), moderate syntax score 23-32 (Group II) and high syntax score of ≥33 (Group III). Peak atrial longitudinal strain (PALS) (Group I: 29.80 ±â€¯4.48, Group II: 22.44 ±â€¯1.42, Group III: 19.53 ±â€¯4.46; p < 0.001) and Peak atrial contraction strain (PACS) (Group I: 13.43 ±â€¯4.05, Group II: 10.84 ±â€¯2.47, Group III: 7.19 ±â€¯0.71; p < 0.022) were significantly lower in high syntax group. Significant negative correlation was found between SX score level and LA strain parameters (PALS and PACS) (r = 0.861; p < 0.001). CONCLUSION: Left atrial deformation analysis by 2D Speckle tracking Doppler Echocardiography can predict the severity of coronary affection in patients with stable CAD.

Mitral leaflet separation index. An easy two dimensional echocardiography technique for assessment of mitral valve area before and after percutaneous balloon mitral valvuloplasty.

AIM: To evaluate the reliability of the mitral leaflet separation (MLS) index against the traditional echocardiographic methods in measuring mitral valve area (MVA) pre and post percutaneous balloon mitral valvuloplasty (PBMV). METHODS: Ninety patients suffering symptomatic moderate to severe MS underwent PBMV at Ain Shams University Hospital in cardiology department. Seventy of the patients were females representing 77.8% and 20 were males representing 22.2%. Their age ranged from 22 to 56 years. All patients were subjected to full transthoracic echocardiography (TTE) examination pre and post PBMV. MLS index was introduced as a comparative parameter with traditional echocardiographic methods for assessment of MVA, measuring average of distance between tips of MV leaflets in parasternal long axis and four chamber two dimensional echocardiographic views. RESULTS: MVA increased from 0.95 ±â€¯0.28 to 2.21 ±â€¯0.41 cm2 (P=0.001) using 2D planimetry; and increased from 0.93 ±â€¯0.23 to 2.21 ±â€¯0.46 cm2 (P= 0.0011) by pressure half time method (PHT). MLS index was correlated with MVA by 2D planimetry pre and post PBMV (r=0.453) and (r=0.668) respectively (p=0.0001) and strongly correlated with MVA using PHT post PBMV (r=0.768) (p=0.0001). Post PBMV 14 patients suffered significant mitral regurgitation 3 of them were transferred to surgery. MLS index above 11.75 mm and below 9.15 mm had excellent positive predictive value for detecting mild and severe MS respectively. CONCLUSION: The MLS index it is a simple and effective method for assessment of the MVA, it has an excellent correlation with MVA with an excellent sensitivity and specificity for the prediction of effective MVA. The MLS index cannot evaluate outcome of PBMV because it is an anatomical parameter and not flow dependent thus does not correlate with grades of mitral regurgitation.

Assessment of left ventricular systolic function by tissue Doppler imaging in controlled versus uncontrolled type 2 diabetic patients.

AIM: To detect and quantify early subtle left ventricular (LV) systolic dysfunction using Tissue Doppler Imaging in type 2 diabetic patients with apparently normal LV ejection fraction. METHODS: Ninety age and sex matched subjects were enrolled in the study, sixty of them were suffering from type 2 diabetes mellitus (DM) whom were divided according to HbAlc into 2 groups, 30 uncontrolled diabetic patients with HbAlc > 8% and 30 controlled diabetic patients with HbAlc < 8% and a third group of 30 normal subjects served as controls. We excluded patients with inadequate Doppler signal, all structural heart diseases, systemic disorders with cardiac involvement and patients with false positive HbAlc. Assessment of diastolic function was done by Pulsed Doppler through mitral flow and by propagation flow velocity. Assessment of left ventricular systolic function was done by conventional echocardiography by 2D Simpson method and by Tissue Doppler Imaging (TDI) through detection of mitral annular peak systolic velocities. RESULTS: Left ventricular diastolic function was compared between the studied groups and showed that the mean peak early mitral inflow velocity E wave and the color M-mode flow propagation velocity of early diastolic flow (Vp) were significantly lower, and the mean peak late mitral inflow velocity A wave was significantly higher in uncontrolled diabetics versus controlled diabetic patients and control group with highly significant statistical difference (p < 0.001). Assessment of global systolic function by conventional Simpson's modified biplane method didn't show significant difference between uncontrolled diabetic patients, controlled diabetic patients and normal individuals. However, evaluation of systolic function by Tissue Doppler Imaging showed that the mean peak longitudinal systolic velocity was significantly decreased in uncontrolled diabetic patients when compared to controlled diabetic patients and normal individuals, with highly significant statistical difference (p < 0.001). A cut-off value for systolic dysfunction detected by TDI in uncontrolled diabetic patients was calculated. The peak systolic velocities < 7 cm/s for medial mitral annulus and < 8.2 cm/s for lateral mitral annulus indicated systolic dysfunction in diabetic patients with sensitivity and specificity of 96% and 67% respectively for medial mitral annulus while 98% and 71% respectively for lateral annulus. CONCLUSION: TDI is a simple and effective method for detection of subtle LV systolic dysfunction in type 2 uncontrolled diabetic patients.