Segmental and global longitudinal strain measurement by 2-dimensional speckle tracking echocardiography in severe rheumatic mitral stenosis.

BACKGROUND: The present study aimed to detect subtle left ventricular (LV) dysfunction in patients with severe rheumatic mitral stenosis (MS) by measuring global and segmental longitudinal strain with a two-dimensional speckle tracking echocardiography (2D-STE) method. METHODS: In this case-control study, 65 patients with severe rheumatic MS and preserved ejection fraction (EF ≥ 50% measured by conventional echocardiographic methods) were compared with 31 otherwise healthy control subjects. All patients underwent LV strain measurement by the 2D-STE method in addition to conventional echocardiography using a VIVID S60 echocardiography device. RESULTS: Absolute strain values in myocardial segments 1-8, 10, and 12 (all basal, mid anterior, mid anteroseptal, mid inferior, and mid anterolateral segments) were significantly lower in patients with severe MS compared with the control group (P < 0.05 for all). The absolute global longitudinal strain (GLS) value was higher in the control group (-19.56 vs. -18.25; P = 0.006). After adjustment for age, gender, and systolic blood pressure, the difference in GLS between the two groups was as follows: mean difference=-1.16; 95% CI: -2.58-0.25; P = 0.110. CONCLUSION: In patients with severe rheumatic MS and preserved EF, the absolute GLS tended to be lower than healthy controls. Furthermore, the segmental strain values of LV were significantly lower in most of the basal and some mid-myocardial segments. Further studies are warranted to investigate the underlying pathophysiology and clinical implications of this subclinical dysfunction in certain segments of patients with severe rheumatic MS.

Interaction Effect of Diabetes and Acute Myocardial Infarction on the Left Atrial Function as Evaluated by 2-D Speckle-Tracking Echocardiography.

The aim of the study described here was to investigate, using 2-D speckle-tracking echocardiography, whether myocardial infarction (MI) leads to diminished left atrial function in diabetic patients by comparison with non-diabetic patients. A total of 310 consecutive patients were divided into four groups based on the presence or absence of diabetes mellitus (DM) and acute ST-elevation MI. In the adjusted analysis, systolic and early diastolic strain and strain rate were reduced in the diabetic patients. Additionally, all deformation markers were impaired in the patients with MI. The DM-MI interaction was not statistically significant. Although reservoir, conduit and contraction functions of the left atrium were reduced in the patients with MI, left atrial reservoir and conduit functions were decreased in the diabetic patients. The reduction in left atrial function caused by MI was similar for diabetic and non-diabetic patients. Thus, DM and MI additively damaged left atrial function.

Evaluation of the left atrial function by two-dimensional speckle-tracking echocardiography in diabetic patients with obesity.

Obesity and diabetes are risk factors for atrial cardiomyopathy and are, thus, deemed public health concerns. However, the effects of obesity on the left atrial (LA) function in patients with diabetes have not been determined yet. We sought to evaluate the effects of obesity on the LA function in patients with type 2 diabetes. Ninety-six consecutive patients with type 2 diabetes without significant coronary artery stenosis in selective coronary angiography were included in this cross-sectional study. Two-dimensional speckle-tracking echocardiography (2DSTE)-derived longitudinal LA myocardial deformation markers were compared between 42 obese and 54 nonobese patients. The longitudinal strain and the longitudinal strain rate of the LA myocardium during the reservoir phase and the contraction phase were reduced in the obese patients with diabetes compared with the nonobese patients with diabetes in the unadjusted analysis. In the adjusted analysis, longitudinal strain and the longitudinal strain rate during the contraction phase and the longitudinal strain rate during the reservoir phase were decreased in the obese patients with diabetes. The reservoir and contraction functions of the LA as evaluated by 2DSTE were decreased in our obese patients with diabetes compared with our nonobese patients with diabetes.

Glomerular filtration rate is related to severity of obstructive coronary artery disease in patients undergoing coronary angiography.

PURPOSE: Chronic kidney disease is independently associated with an increased risk of cardiovascular events; however, the relationship between the glomerular filtration rate (GFR) and coronary artery disease (CAD) in patients undergoing coronary angiography has yet to be fully elucidated. METHODS: This retrospective study enrolled a total of 7968 patients who underwent diagnostic coronary artery catheterization [mean age = 54.8 ± 10.6 years, 74.4% males] and did not have any previous history of coronary revascularization, diabetes mellitus, hypertension, end-stage renal disease treated by dialysis or renal transplantation, and were not taking diuretics or drugs acting on renin angiotensin system. The severity of CAD was defined as the number of coronary arteries with a luminal stenosis ≥50% on the angiogram, and the GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). RESULTS: There were 2133 (26.8%) patients with GFR ≥ 90 ml/min/1.73 m(2), 4574 (57.4%) patients with 60 ≤ GFR < 90 ml/min/1.73 m(2), 1073 (13.5%) with 45 ≤ GFR < 60 ml/min/1.73 m(2) and 181 (2.3%) with 15 < GFR < 45 ml/min/1.73 m(2). After adjustment for traditional cardiovascular risk factors (age, sex, dyslipidemia, low to high-density lipoprotein ratio, smoking status, and family history), the GFR showed a significant association with the severity of CAD and remained a significant predictor of CAD (Odds Ratio raised from 1.1 in patients with 60 ≤ GFR < 90 ml/min/1.73 m(2) to 1.8 in patients with 15 < GFR < 45 ml/min/1.73 m(2)). CONCLUSIONS: A reduced kidney function, even mildly, is significantly associated with CAD severity, independently of other traditional CAD risk factors.