Two-dimensional speckle tracking echocardiography is useful in early detection of left ventricular impairment in patients with Crohn's disease.

OBJECTIVE: Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect the entire gastrointestinal tract. Cardiac involvement is considered very rare. Pericarditis, myocarditis, endocarditis, cardiomyopathy and complete heart block are some of the cardiac extraintestinal manifestations of CD. The aim of this study was to explore the left ventricular (LV) functions with two-dimensional (2D) speckle tracking echocardiography (STE) in patients with CD with normal cardiac functions. PATIENTS AND METHODS: We enrolled 50 consecutive patients with CD and 50 age and sex matched healthy controls. All patients underwent a transthoracic echocardiogram with evaluation of LV functions with 2D STE. RESULTS: Baseline characteristics were similar between patients with CD (24 male, mean age: 41.0 ± 13.9 years) and controls (24 male, mean age: 40.1 ± 7.3 years). Although conventional echocardiographic parameters were similar between two groups, global longitudinal strain was significantly lower in patients with CD compared to controls (19.6 ± 3.3 versus 21.2 ± 2.9, p = 0.014). Correlation analysis revealed that Crohn's Disease Activity Index is inversely correlated with LV global longitudinal strain (r = -0.703, p < 0.001) in patients with CD. We also evaluated inflammatory parameters such as CRP, erythrocyte sedimentation rate, and complete blood counts in patients with CD. Correlation analysis revealed that only platelet value is weakly correlated with Crohn's Disease Activity Index (r = 0.311, p = 0.083). CONCLUSIONS: Crohn's disease is associated with impairment in LV global longitudinal myocardial function. Crohn's Disease Activity Index is also strongly correlated with LV global longitudinal strain. 2D-STE may be an useful method for early detection of LV impairment in patients with CD.

Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension. Speckle-tracking echocardiographic study.

BACKGROUND: Systemic sclerosis (SSc) is a systemic connective tissue disease and cardiac involvement is one of the most important causes of death. Right ventricular (RV) systolic dysfunction is a poor prognostic finding in SSc patients. Assessment of RV function has some difficulties because of its crescent shape and extensive trabeculations. Two-dimensional (2D) speckle-tracking echocardiography (STE) is an angle-independent quantitative technique to evaluate myocardial function. The aim of this study was to assess the RV and right atrial (RA) functions of SSc patients without pulmonary hypertension by using 2D STE. PATIENTS AND METHODS: A total of 40 patients with SSc (mean age 48.5 ± 11.4 years, 28 female) and 40 healthy volunteers (mean age 45.9 ± 7.6 years, 21 female) were included in the study. All subjects underwent transthoracic echocardiography for evaluation of RV and RA functions with 2D STE. RESULTS: Although left ventricular systolic and diastolic functions, systolic pulmonary artery pressure (PAP), and RA measurements were similar in both groups, tricuspid annular plane systolic excursion (TAPSE) and maximum systolic myocardial velocity (S') were decreased in SSc patients. The RV free wall global longitudinal strain (GLS) of SSc patients was lower than the controls (- 18.5 ± 4.9 % vs. - 21.8 ± 2.4 %, p < 0.001) and the RA reservoir and conduit functions were also decreased in SSc patients compared with controls (34.4 ± 9.9 % vs. 39.7 ± 11.2 %, p = 0.027 and 15.0 ± 5.7 % vs. 18.7 ± 6.4 %, p = 0.009, respectively). Disease duration was inversely correlated with RVGLS and TAPSE (r: - 0.416, p = 0.018 and r: - 0.383, p = 0.031, respectively). CONCLUSION: The use of 2D STE can be helpful in the detection of impairment in RV and RA functions in SSc patients with normal PAP.

Right ventricular longitudinal deformation parameters and exercise capacity : prognosis of patients with chronic thromboembolic pulmonary hypertension.

OBJECTIVE: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease characterized by increased pulmonary vascular resistance resulting in pulmonary hypertension and right heart failure. The six-minute walk test (6MWT) distance is associated with the prognosis of CTEPH patients. Speckle tracking echocardiography (STE) is a reliable method for determining ventricular function. The aim of this study was to assess and compare the right ventricular (RV) function of CTEPH patients according to their 6MWT distances. METHODS: Forty-nine consecutive CTEPH patients (mean age, 50 ± 16 years; 22 male) who were referred to our center for pulmonary thromboendarterectomy (PTE) were included in the study. All patients underwent the 6MWT and right heart catheterization (RHC). Standard echocardiography and STE were performed on all patients before PTE. Patients were divided into two groups based on their 6MWT distance being less or more than 300 m. RESULTS: Patients with a shorter 6MWT distance had a significantly larger RV, while they had a significantly lower RV fractional area change and higher myocardial performance index suggesting impaired RV function. Both RV basal-lateral strain and strain rate measures were significantly lower in patients with shorter 6MWT distances than those with longer 6MWT distances. Similarly, they had lower RV basal-septal, mid-lateral, and global strain measures. 6MWT distances were correlated with RV basal-lateral and mid-lateral strain measures (r = 0.349, p = 0.025 and r = 0.415, p = 0.008, respectively). CONCLUSION: Our data suggest that RV myocardial deformation parameters are associated with 6MWT distances. Determination of RV dysfunction by STE may be helpful in identifying patients with a poor prognosis.

Left ventricular strain and strain rate by two-dimensional speckle tracking echocardiography in patients with subclinical hypothyroidism.

AIM: Subclinical hypothyroidism (SH) is an asymptomatic condition defined by increased serum thyroid-stimulating hormone (TSH) with normal free thyroid hormone levels. Heart is a major target organ for thyroid hormone action. The aim of this study was to evaluate cardiac functions in patients with SH by speckle tracking imaging. PATIENTS AND METHODS: We included 23 consecutive patients with untreated SH (Group A; 7 male, mean age: 40.9±1.6 years) and 21 patients with treated SH (Group B; 6 male, mean age: 40.2±2.1 years). The control group included 25 healthy volunteers (8 male, mean age: 39.9±2.8 years). Left ventricular (LV) functions were assessed with speckle tracking imaging. RESULTS: Age and sex distributions were similar among the groups. Mean serum TSH and free T4 levels were 11.7±2.9 µIU/mL, 1.16±0.06 ng/dL for group A; 2.6±0.3 µIU/mL, 1.35±0.09 ng/dL for group B; 1.4±0.3 µIU/mL, 1.31±0.09 ng/dL for controls, respectively (p = 0.001, p = 0.122). The untreated SH patients had significantly lower LV strain and strain rate values compared to controls. The treated SH patients had higher LV strain and strain rate values compared to untreated SH patients although the difference was not statistically significant. The treated SH patients had lower LV strain and strain rate values compared to controls but the difference was not statistically significant. CONCLUSIONS: Untreated SH is associated with impairment in LV longitudinal myocardial function. Speckle tracking echocardiography appears to be useful both for early detection of LV impairment in patients with SH and documentation of improvement in myocardial deformation parameters with treatment.