[Assessment of left atrial size and function -- from M-mode to 3D speckle-tracking echocardiography]

Left atrium is not a passive heart chamber, because it has a dynamic motion respecting heart cycle and, in accordance with its stretching, it releases atrial natriuretic peptides. Since in the course of certain invasive procedures the size of left atrium may change substantially, its exact measurement and functional characterization are essential. The aim of the present review is to summarize echocardiographic methods for the assessment of left atrial size and functional parameters.

[Correlations between mitral annular and left atrial function as assessed by three-dimensional speckle-tracking echocardiography in healthy volunteers. Results from the MAGYAR-Healthy Study]

INTRODUCTION

Left atrium is a heart chamber with dinamic motion communicating with left ventricle through the mitral valve and its annulus.

AIM

The aim of the present study was to analyse whether relationships could exist between three-dimensional speckle-tracking echocardiography-derived morphologic and functional parameters of the left atrium and mitral annulus in healthy subjects.

METHOD

The present study comprised 35 healthy volunteers. Maximum (Vmax) and minimum (Vmin) left atrial volumes and left atrial volume before atrial contraction (VpreA) were measured, and several functional parameters based on these volumes were calculated in all cases. Morphologic and functional characteristics of the mitral annulus were also determined.

RESULTS

While Vmax showed correlations with both systolic and diastolic mitral annulus parameters, Vmin-VpreA correlated with only systolic ones. While total left atrial stroke volume correlated with both systolic and diastolic mitral annular parameters, passive left atrial stroke volume showed correlations only with diastolic ones.

CONCLUSIONS

Correlations exist between left atrial and mitral annular morphological and functional characteristics in healthy subjects.

[Occurrence of acute cardiovascular diseases under different atmospheric parameters]

INTRODUCTION

Research on the effects of meteorological parameters on cardiovascular diseases may allow the development of novel prevention strategies.

AIM

The aim of the authors was to examine the correlation between meteorological parameters and the occurrence of acute cardiovascular diseases.

METHOD

A retrospective analysis was performed in 343 patients diagnosed with acute cardiovascular disease and treated at the Department of Vascular Surgery, Semmelweis University in 2010.

RESULTS

Acute cardiovascular diseases showed a seasonal variation with the highest occurrence in winter months (p = 0.0001). The daily increase of the events (n ≥ 3) were associated with front movements days (in 62.5% of cases). A significant correlation was found between the intraday temperature difference (p<0.0001), the intraday atmospheric pressure difference (p = 0.0034), the lowest maximum daily temperature (p<0.0001) and the occurrence of acute cardiovascular diseases. During the days with front movements 64% of the patients were older than 66 years of age. Among risk factors, hypertension showed front sensitivity.

CONCLUSIONS

Meteorological parameters are minor risk factors in the occurrence of acute cardiovascular diseases.

Three-dimensional speckle tracking echocardiography allows detailed evaluation of left atrial function in hypertrophic cardiomyopathy--insights from the MAGYAR-Path Study

INTRODUCTION

Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. Reduced left atrial (LA) function was demonstrated in HCM by different methods. Three-dimensional (3D) speckle tracking echocardiography (STE) has just been introduced for the evaluation of LA. This study was designed to compare 3DSTE-derived LA volumetric and strain parameters in HCM with healthy controls.

METHODS

The study comprised 23 consecutive HCM patients (mean age: 48.5 ± 15.1 years, 14 men). Their results were compared to 23 age- and gender-matched healthy controls. Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all cases.

RESULTS

Calculated LA maximum (66.4 ± 20.4 mL vs. 36.0 ± 6.1 mL, P < 0.0001) and minimum (39.2 ± 19.1 vs. 16.0 ± 4.6 mL, P < 0.0001) volumes and LA volume before atrial contraction (53.6 ± 19.9 vs. 24.0 ± 6.2 mL, P < 0.0001) were significantly increased in HCM patients. Atrial stroke volumes respecting cardiac cycles proved to be increased, while emptying fractions were decreased in subjects with HCM. Mean global radial (-12.2 ± 6.7% vs. -19.6 ± 11.7, P < 0.05), longitudinal (26.5 ± 16.5% vs. 29.8 ± 12.1%, P < 0.05) and 3D strain (-6.1 ± 4.4% vs. -12.5 ± 10.2%, P < 0.05) proved to be significantly reduced in HCM patients as compared with matched controls.

CONCLUSIONS

Three-dimensional speckle tracking echocardiography allows detailed evaluation of LA (dys) function in HCM by volumetric and strain measurements.

Relationship between early myocardial reperfusion assessed by videodensitometry and late left ventricular function. Results following invasive treatment of acute myocardial infarction

Introduction: It is known that there is a relationship between myocardial perfusion and left ventricular function. Aim: The aim of the current study was to examine the relationship between myocardial reperfusion as assessed by videodensitometry on coronary angiograms following invasive treatment of ST elevation myocardial infarction and magnetic resonance imaging-derived late left ventricular function. Method: The study included 25 patients with ST elevation myocardial infarction. A quantitative parameter of myocardial (re)perfusion was calculated by the ratio of maximal density (Gmax) and the time to reach maximum density (Tmax) following invasive treatment. Magnetic resonance imaging was performed 387±262 days after ST elevation myocardial infarction for the evaluation of left ventricular function in all cases. Results: Significant correlations were demonstrated between left ventricular ejection fraction and Gmax(r = 0.40, p = 0.05) and Gmax/Tmax(r = 0.41, p = 0.04) following vessel masking. Conclusions: The results demonstrate significant relationship between densitometric Gmax/Tmaxand late left ventricular function following ST elevation myocardial infarction. Orv. Hetil., 2014. 155(5), 187–193.

Comparison of three-dimensional speckle tracking echocardiography and two-dimensional echocardiography for evaluation of left atrial size and function in healthy volunteers (results from the MAGYAR-Healthy study)

OBJECTIVE

Noninvasive accurate assessment of left atrial (LA) size and function is an essential requirement in daily clinical practice. Real time three-dimensional (3D) echocardiography (RT3DE) with direct volumetric method has been found to be a highly accurate and reproducible noninvasive tool for the evaluation of LA dimensions and functional properties. Three-dimensional speckle tracking echocardiography (3DSTE) has just been introduced for volumetric assessments, which uses different, as called "block-matching" algorithm by strain analysis. This study was designed to compare two-dimensional (2D) echocardiography with 3DSTE for calculation of LA volumes and assessment of LA functional properties in healthy subjects.

METHODS

This study comprised of randomly selected 35 healthy subjects (40.9 ± 10.9 years, 20 men) in sinus rhythm, they all had undergone standard transthoracic 2D echocardiographic Doppler study extended with 3DSTE.

RESULTS

Two-dimensional echocardiography- and 3DSTE-derived minimum (Vmin ) and maximum (Vmax ) LA volumes and LA volume before atrial contraction (Vpre A ) did not differ significantly. Calculated functional LA properties were also compared. Good correlations were found between both techniques for Vmax (r = 0.93, P < 0.0001), Vmin (r = 0.62, P < 0.0001), and Vpre A (r = 0.74, P < 0.0001).

CONCLUSIONS

It may be stated that 3DSTE seems to be feasible in detection of cyclic changes in LA volumes and calculation of its functional properties is comparable to 2D echocardiography.

[Evaluation of pulmonary artery stiffness using routine clinical imaging methods]

Recently, there has been much debate about pulmonary hypertension due to modern therapeutic options available. Arterial hypertension is frequently associated with stiffening of a given artery. The aim of the present review is to present clinical imaging methods for the evaluation of the function and stiffness of the pulmonary artery.

Left ventricular strain reduction is not confined to the noncompacted segments in noncompaction cardiomyopathy-insights from the three-dimensional speckle tracking echocardiographic MAGYAR-path study

INTRODUCTION

Noncompaction cardiomyopathy (NCCM) is a new clinical entity characterized by prominent trabecular meshwork and deep intertrabecular recesses communicating with the left ventricular (LV) cavity due to arrest of the normal embryogenesis of the endomyocardium. The aim of the present study was to evaluate different contributions of noncompacted and compacted LV segments to the global LV dysfunction by three-dimensional (3D) speckle tracking echocardiography (3DSTE)-derived strain parameters in NCCM.

PATIENTS AND METHODS

The present study comprised 9 patients with typical features of NCCM. Due to the limited image quality, one patient was excluded from the evaluations. Finally, 128 segments of 8 NCCM patients were assessed. Their results were compared to 176 segments of 11 healthy volunteers. Complete two-dimensional Doppler echocardiography extended with 3DSTE has been performed in all cases.

RESULTS

Fifty-five of 128 LV segments (43%) proved to be noncompacted in NCCM patients. All strain parameters of segments of NCCM patients were significantly lower as compared to segments of controls. Only radial strain (6.99 ± 7.36% vs. 12.58 ± 12.78% vs. 25.24 ± 11.76%, P < 0.001 and P < 0.05, respectively) and 3D strain (7.79 ± 7.59% vs. 14.67 ± 14.04% vs. 27.78 ± 12.57%, P < 0.001 and P < 0.05, respectively) showed further reduction in noncompacted segments as compared to compacted segments.

CONCLUSIONS

Left ventricular strain reduction is not confined to the nocompacted segments in NCCM. Radial and 3D strain parameters show further reduction in noncompacted segments compared to compacted segments.

[Vascular functional alterations in hypertrophic cardiomyopathy]

Hypertrophic cardiomyopathy is a hereditary, not uncommon cardiac disease, which is associated with asymmetric thickening and hypertrophy of the interventricular septum unrelated to hemodynamic reasons. Despite hypertrophic cardiomyopathy is considered to be a disorder of the heart muscle, several associated vascular alterations have been described. The aim of the present review is to summarize vascular functional alterations in hypertrophic cardiomyopathy.

Comparative evaluation of left ventricular function by two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography in noncompaction cardiomyopathy. Results from the MAGYAR-Path Study

Introduction: Noncompaction cardiomyopathy develops due to the absence of myocardial compaction, and is associated with left ventricular dysfunction. Aim: The aim of the study was to evaluate comparatively left ventricular dysfunction in patients with noncompaction cardiomyopathy using two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography. Method: The present study comprised of 7 patients with noncompaction cardiomyopathy (62.9±8.5 years, 3 males) and 10 age- and gender-matched healthy controls (60.7±7.7 years, 2 males). All patients were examined by two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography for the evaluation of left ventricular function. Results: Increased left ventricular end-diastolic and end-systolic volumes and reduced left ventricular ejection fraction were detected in patients with noncompaction cardiomyopathy as compared to those measured in controls. All three-dimensional speckle-tracking echocardiography-derived strain parameters of patients with noncompaction cardiomyopathy were found to be reduced as compared to the values of controls. Three-dimensional speckle-tracking echocardiography-derived rotational parameters showed movements of the apical and basal segments in the same direction suggesting ’rigid body rotation’ in all noncompaction cardiomyopathy cases. Conclusions: Left ventricular function and contractility are severely reduced in patients with noncompaction cardiomyopathy. Absence of left ventricular twist could be demonstrated in a series of noncompaction cardiomyopathy patients. Orv. Hetil., 2013, 154, 1352–1359.

Quantification of changes in septal strain after alcohol septal ablation in hypertrophic obstructive cardiomyopathy-cases from the three-dimensional speckle tracking echocardiographic MAGYAR-path study

Patients with hypertrophic obstructive cardiomyopathy undergoing alcohol septal ablation are presented. Three-dimensional speckle tracking echocardiography (3DSTE) is a new, noninvasive tool for quantification of myocardial deformation. In both cases, 3DSTE was performed 1 day before and 3 days after alcohol septal ablation to quantify changes in septal strain of ablated area. Results could suggest the possible role of 3DSTE in the quantitative evaluation of the success of alcohol septal ablation.

Three-dimensional speckle tracking echocardiography-derived left atrial strain parameters are reduced in patients with atrial fibrillation (results from the MAGYAR-path study)

OBJECTIVE

Three-dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel imaging modality for assessing cardiac function. We aimed to analyze left atrial (LA) function using 3DSTE in patients with atrial fibrillation (AF).

METHODS

3DSTE was performed in 20 patients prior to their pulmonary vein isolation for AF. Every patient underwent a complete two-dimensional echocardiographic study at the same time. 3DSTE-derived circumferential (CS), longitudinal (LS), radial (RS), 3D (3DS), and area strain (AS) values were measured in the basal (b), mid (m), and superior (s) regions of the LA. 3DSTE-defined maximal (LAmax ) and minimal LA volumes (LAmin ) and LA total emptying fraction were calculated automatically. Eleven randomly selected age- and gender-matched healthy volunteers served as controls.

RESULTS

Patients with AF had significantly larger LAmax and LAmin and reduced LS, RS and CS.3DS and AS were significantly lower throughout the LA in cases with AF (3DS-b, -m, -s [AF patients vs. controls]: -18 ± 8% vs. -29 ± 8%, P = 0.001; -14 ± 6% vs. -22 ± 7%, P = 0.002; -10 ± 7% vs. -20 ± 9%, P = 0.002; AS-b, -m, -s [AF patients vs. controls]: 35 ± 15% vs. 52 ± 13%, P = 0.004; 50 ± 21% vs. 72 ± 19%, P = 0.009; 31 ± 21% vs. 65 ± 27%, P < 0.0001, respectively).

CONCLUSIONS

3DSTE-derived "uni-dimensional" LS, RS, CS, as well as novel strain parameters (3DS, AS) are significantly reduced in patients with AF compared to matched controls. 3DS and AS might be new strain parameters providing further insights into the alterations of LA function in patients developing AF.

Correlations between echocardiographic aortic elastic properties and left ventricular rotation and twist--insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

INTRODUCTION

There is an interaction between the left ventricle (LV) and the vascular system, which plays a crucial role in determining cardiac output. LV twist could be evaluated by three-dimensional speckle-tracking echocardiography (3DSTE) as the net difference of counterclockwise apical and clockwise basal LV rotations during systole. Aortic elasticity parameters could be measured during a routine transthoracic echocardiographic examination. The current study was designed to evaluate correlations between echocardiographic aortic elastic properties and LV rotational mechanics in healthy subjects.

METHODS

The present study comprised 26 healthy volunteers (mean age: 34.5 ± 9.8 years, 13 men). The following aortic elastic properties were measured from aortic data and forearm blood pressure values: aortic strain, distensibility and stiffness index (ASI). 3DSTE was used to measure basal and apical LV rotations and LV twist.

RESULTS

During 3DSTE, basal LV rotation proved to be -2.42 ± 1.43 degree, while apical LV rotation was 8.56 ± 1.43 degree, therefore LV twist was 11.01 ± 5.19 degree. Aortic strain (0.131 ± 0.094), distensibility (3.61 ± 2.54 cm² dynes(-1) 10(-6)) and ASI (4.08 ± 0.79) were also calculated. Apical LV rotation correlated with aortic distensibility (r = -0.36, P<0.05) and ASI (r = 0.41, P<0.05). LV twist showed similar correlation with ASI (r = 0.42, P<0.05).

DISCUSSION

Correlations exist between echocardiographic aortic elastic properties and 3DSTE-derived LV rotation and twist in healthy subjects.

[Evaluation of vascular function by modern non-invasive methods]

Vascular functional alterations frequently precede morphological changes and, therefore, their recognition may theoretically improve early detection of vascular injury. The aim of this review is to demonstrate recently available non-invasive clinical methods including vascular stiffness examinations, flow-mediated vasodilatation, coronary flow reserve and myocardial flow reserve measurements.