1
|
Iskander J, Kelada P, Rashad L, Massoud D, Afdal P, Abdelmassih AF. Advanced Echocardiography Techniques: The Future Stethoscope of Systemic Diseases. Curr Probl Cardiol 2022; 47:100847. [PMID: 33992429 PMCID: PMC9046647 DOI: 10.1016/j.cpcardiol.2021.100847] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/11/2023]
Abstract
Cardiovascular disease (CVD) has been showing patterns of extensive rise in prevalence in the contemporary era, affecting the quality of life of millions of people and leading the causes of death worldwide. It has been a provocative challenge for modern medicine to diagnose CVD in its crib, owing to its etiological factors being attributed to a large array of systemic diseases, as well as its non-binary hideous nature that gradually leads to functional disability. Novel echocardiography techniques have enabled the cardiac ultrasound to provide a comprehensive analysis of the heart in an objective, feasible, time- and cost-effective manner. Speckle tracking echocardiography, contrast echocardiography, and 3D echocardiography have shown the highest potential for widespread use. The uses of novel modalities have been elaborately demonstrated in this study as a proof of concept that echocardiography has a place in routine general practice with supportive evidence being as recent as its role in the concurrent COVID-19 pandemic. Despite such evidence, many uses remain off-label and unexploited in practice. Generalization of echocardiography at the point of care can become a much-needed turning point in the clinical approach to case management. To actualize such aspirations, we recommend further prospective and interventional studies to examine the effect of implementing advanced techniques at the point of care on the decision-making process and evaluate their effectiveness in prevention of cardiovascular morbidities and mortalities.
Collapse
Affiliation(s)
- John Iskander
- Faculty of Medicine, Cairo University, Cairo, Egypt,Corresponding author: John Iskander, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Peter Kelada
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lara Rashad
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Massoud
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Peter Afdal
- Residency program, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Antoine Fakhry Abdelmassih
- Pediatric Cardiology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, Egypt,Consultant of Pediatric Cardiology, Children Cancer Hospital of Egypt (57357 Hospital), Cairo, Egypt
| |
Collapse
|
2
|
Reid A, Blanke P, Bax JJ, Leipsic J. Multimodality imaging in valvular heart disease: how to use state-of-the-art technology in daily practice. Eur Heart J 2021; 42:1912-1925. [PMID: 33186469 DOI: 10.1093/eurheartj/ehaa768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/15/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022] Open
Abstract
Our understanding of the complexities of valvular heart disease (VHD) has evolved in recent years, primarily because of the increased use of multimodality imaging (MMI). Whilst echocardiography remains the primary imaging technique, the contemporary evaluation of patients with VHD requires comprehensive analysis of the mechanism of valvular dysfunction, accurate quantification of severity, and active exclusion extravalvular consequences. Furthermore, advances in surgical and percutaneous therapies have driven the need for meticulous multimodality imaging to aid in patient and procedural selection. Fundamental decision-making regarding whom, when, and how to treat patients with VHD has become more complex. There has been rapid technological advancement in MMI; many techniques are now available in routine clinical practice, and their integration into has the potential to truly individualize management strategies. This review provides an overview of the current evidence for the use of MMI in VHD, and how various techniques within each modality can be used practically to answer clinical conundrums.
Collapse
Affiliation(s)
- Anna Reid
- Department of Radiology and Cardiology, Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver V6Z1Y6, BC, Canada
| | - Philipp Blanke
- Department of Radiology and Cardiology, Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver V6Z1Y6, BC, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Jonathon Leipsic
- Department of Radiology and Cardiology, Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver V6Z1Y6, BC, Canada
| |
Collapse
|
3
|
Hiemstra YL, Tomsic A, van Wijngaarden SE, Palmen M, Klautz RJ, Bax JJ, Delgado V, Ajmone Marsan N. Prognostic Value of Global Longitudinal Strain and Etiology After Surgery for Primary Mitral Regurgitation. JACC Cardiovasc Imaging 2020; 13:577-585. [DOI: 10.1016/j.jcmg.2019.03.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
|
4
|
Santoro C, Galderisi M, Esposito R, Buonauro A, Monteagudo JM, Sorrentino R, Lembo M, Fernandez-Golfin C, Trimarco B, Zamorano JL. Global longitudinal strain is a hallmark of cardiac damage in mitral regurgitation: the Italian arm of the European Registry of mitral regurgitation (EuMiClip). Cardiovasc Ultrasound 2019; 17:28. [PMID: 31752893 PMCID: PMC6873488 DOI: 10.1186/s12947-019-0178-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/08/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The search for reliable cardiac functional parameters is crucial in patients with mitral regurgitation (MR). In the Italian arm of the European Registry of MR, we compared the ability of global longitudinal strain (GLS) and left ventricular (LV) ejection fraction (LVEF) to detect cardiac damage in MR. METHODS Five hundred four consecutive patients with MR underwent a complete echo-Doppler exam. A total of 431, 53 and 20 patients had degenerative, secondary and mixed MR, respectively. The main echocardiographic parameters, including LV and left atrial (LA) size measurements, pulmonary artery systolic pressure (PASP) and GLS were compared between patients with mild MR (n = 392) vs. moderate to severe MR (n = 112). RESULTS LVEF and GLS were related one another in the pooled population, and separately in patients with mild and moderate/severe MR (all p < 0.0001). However, a certain number of patients were above the upper or below the lower limits of the 95% confidence interval (CI) of the normal relation in the pooled population and in patients with mild MR. Only 2 patients were below the 95% CI in moderate to severe MR. After adjusting for confounders by separate multivariate models, LVEF and GLS were independently associated with LV and left atrial size in the pooled population and in mild and moderate/severe MR. GLS, but not LVEF, was also independently associated with PASP in patients with mild and moderate to severe MR. CONCLUSIONS Both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure. GLS is a powerful hallmark of cardiac damage in MR.
Collapse
Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | | | - Regina Sorrentino
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | | | - Bruno Trimarco
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Josè Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
| |
Collapse
|
5
|
Howard-Quijano K, Methangkool E, Scovotti JC, Mazor E, Grogan TR, Kratzert WB, Mahajan A. Regional Left Ventricular Myocardial Dysfunction After Cardiac Surgery Characterized by 3-Dimensional Strain. Anesth Analg 2019; 128:854-864. [PMID: 30896605 PMCID: PMC9815834 DOI: 10.1213/ane.0000000000003785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Three-dimensional (3D) strain is an echocardiographic modality that can characterize left ventricular (LV) function with greater accuracy than ejection fraction. While decreases in global strain have been used to predict outcomes after cardiac surgery, changes in regional 3D longitudinal, circumferential, radial, and area strain have not been well described. The primary aim of this study was to define differential patterns in regional LV dysfunction after cardiac surgery using 3D speckle tracking strain imaging. Our secondary aim was to investigate whether changes in regional strain can predict postoperative outcomes, including length of intensive care unit stay and 1-year event-free survival. METHODS In this prospective clinical study, demographic, operative, echocardiographic, and clinical outcome data were collected on 182 patients undergoing aortic valve replacement, mitral valve repair or replacement, coronary artery bypass graft, and combined cardiac surgery. Three-dimensional transthoracic echocardiograms were performed preoperatively and on the second to fourth postoperative day. Blinded analysis was performed for LV regional longitudinal, circumferential, radial, and area strain in the 17-segment model. RESULTS Regional 3D longitudinal, circumferential, radial, and area strains were associated with differential patterns of myocardial dysfunction, depending on the surgical procedure performed and strain measure. Patients undergoing mitral valve repair or replacement had reduced function in the majority of myocardial segments, followed by coronary artery bypass graft, while patients undergoing aortic valve replacement had reduced function localized only to apical segments. After all types of cardiac surgery, segmental function in apical segments was reduced to a greater extent as compared to basal segments. Greater decrements in regional function were seen in circumferential and area strain, while smaller decrements were observed in longitudinal strain in all surgical patients. Both preoperative regional strain and change in regional strain preoperatively to postoperatively were correlated with reduced 1-year event-free survival, while postoperative strain was not predictive of outcomes. Only preoperative strain values were predictive of intensive care unit length of stay. CONCLUSIONS Changes in regional myocardial function, measured by 3D strain, varied by surgical procedure and strain type. Differences in regional LV function, from presurgery to postsurgery, were associated with worsened 1-year event-free survival. These findings suggest that postoperative changes in myocardial function are heterogeneous in nature, depending on the surgical procedure, and that these changes may have long-term impacts on outcome. Therefore, 3D regional strain may be used to identify patients at risk for worsened postoperative outcomes, allowing early interventions to mitigate risk.
Collapse
Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Emily Methangkool
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Jennifer C. Scovotti
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Einat Mazor
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Tristan R. Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Wolf B. Kratzert
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| |
Collapse
|
6
|
Luis SA, Chan J, Pellikka PA. Echocardiographic Assessment of Left Ventricular Systolic Function: An Overview of Contemporary Techniques, Including Speckle-Tracking Echocardiography. Mayo Clin Proc 2019; 94:125-138. [PMID: 30611439 DOI: 10.1016/j.mayocp.2018.07.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 01/30/2023]
Abstract
Assessment of left ventricular systolic function has a central role in the evaluation of cardiac disease. Accurate assessment is essential to guide management and prognosis. Numerous echocardiographic techniques are used in the assessment, each with its own advantages and disadvantages. This review is based on a literature search of the PubMed, MEDLINE, EMBASE, and Scopus databases from inception through December 30, 2017, using the terms strain echocardiography, tissue Doppler strain, and speckle-tracking echocardiography. We provide the internist with a contemporary overview of current echocardiographic techniques used in the evaluation of left ventricular systolic function. In particular, we focus on the role of speckle-tracking echocardiography, including its utility in the detection of subclinical left ventricular dysfunction and the associated prognostic implications.
Collapse
Affiliation(s)
- Sushil A Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Jonathan Chan
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | | |
Collapse
|
7
|
Is Speckle Tracking Imaging Ready for Prime Time in Current Echo Clinical Practice? Prog Cardiovasc Dis 2018; 61:437-445. [DOI: 10.1016/j.pcad.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 12/24/2022]
|
8
|
Kim HM, Cho GY, Hwang IC, Choi HM, Park JB, Yoon YE, Kim HK. Myocardial Strain in Prediction of Outcomes After Surgery for Severe Mitral Regurgitation. JACC Cardiovasc Imaging 2018; 11:1235-1244. [DOI: 10.1016/j.jcmg.2018.03.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/20/2018] [Accepted: 03/20/2018] [Indexed: 12/29/2022]
|
9
|
Jeffrey RR, Hamburger RF, Gooden-Ebanks J, Petersen JW. Speckle Tracking Echocardiography Identifies Impaired Longitudinal Strain as a Common Deficit in Various Cardiac Diseases. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
10
|
Muraru D, Niero A, Rodriguez-Zanella H, Cherata D, Badano L. Three-dimensional speckle-tracking echocardiography: benefits and limitations of integrating myocardial mechanics with three-dimensional imaging. Cardiovasc Diagn Ther 2018. [PMID: 29541615 DOI: 10.21037/cdt.2017.06.01] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is an advanced imaging technique designed for left ventricular (LV) myocardial deformation analysis based on 3D data sets. 3DSTE has the potential to overcome some of the intrinsic limitations of two-dimensional STE (2DSTE) in the assessment of complex LV myocardial mechanics, offering additional deformation parameters (such as area strain) and a comprehensive quantitation of LV geometry and function from a single 3D acquisition. Albeit being a relatively young technique still undergoing technological developments, several experimental studies and clinical investigations have already demonstrated the reliability and feasibility of 3DSTE, as well as several advantages of 3DSTE over 2DSTE. This technique has provided new insights into LV mechanics in several clinical fields, such as the objective assessment of global and regional LV function in ischemic and non-ischemic heart diseases, the evaluation of LV mechanical dyssynchrony, as well as the detection of subclinical cardiac dysfunction in cardiovascular conditions at risk of progression to overt heart failure. However, 3DSTE generally requires patient's breathhold and regular rhythm for enabling an ECG-gated multi-beat 3D acquisition. In addition, the measurements, normal limits and cut-off values pertaining to 3D strain parameters are currently vendor-specific and highly dependent on the 3D ultrasound equipment used. Technological advances with improvement in spatial and temporal resolution and a standardized methodology for obtaining vendor-independent 3D strain measurements are expected in the future for a widespread application of 3DSTE in both clinical and research arenas. The purpose of this review is to summarize currently available data on 3DSTE methodology (feasibility, accuracy and reproducibility), strengths and weaknesses with respect to 2DSTE, as well as the main clinical applications and future research priorities of this emerging technology.
Collapse
Affiliation(s)
- Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alice Niero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Hugo Rodriguez-Zanella
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.,Echocardiography Laboratory, National Institute of Cardiology, "Ignacio Chávez", Mexico City, Mexico
| | - Diana Cherata
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.,Department of Cardiology, "Filantropia" Municipal Hospital, Craiova, Romania
| | - Luigi Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| |
Collapse
|
11
|
Piras P, Torromeo C, Evangelista A, Gabriele S, Esposito G, Nardinocchi P, Teresi L, Madeo A, Schiariti M, Varano V, Puddu PE. Homeostatic Left Heart integration and disintegration links atrio-ventricular covariation's dyshomeostasis in Hypertrophic Cardiomyopathy. Sci Rep 2017; 7:6257. [PMID: 28740203 PMCID: PMC5524707 DOI: 10.1038/s41598-017-06189-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/07/2017] [Indexed: 12/29/2022] Open
Abstract
Left ventricle and left atrium are and have been practically always analyzed separately in common clinically and non-clinically oriented cardiovascular investigations. Both classic and speckle tracking echocardiographic data contributed to the knowledge about deformational impairments occurring in systo-diastolic differences. Recently new trajectory based approaches allowed a greater awareness about the entire left ventricle or left atrium revolution and on their deficiencies that take place in presence of hypertrophic cardiomyopathy. However, surprisingly, the concomitant function of the two left heart chambers has not been analyzed for their geometrical/mechanical relationship. For the first time we study here, by acquiring left ventricle and left atrial geometries on the same heartbeat, the trajectory attributes of the entire left heart treated as a whole shape and the shape covariation of its two subunits. We contrasted healthy subjects with patients affected by hypertrophic cardiomyopathy. We found impaired left heart trajectory mainly in terms of orientation and size. More importantly, we found profound differences in the direction of morphological covariation of left ventricle and left atrium. These findings open to new perspectives in pathophysiological evaluation of different diseases by allowing the appreciation of concomitant functioning of both left heart whole geometry and of its two chambers.
Collapse
Affiliation(s)
- Paolo Piras
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy.,Dipartimento di Ingegneria Strutturale e Geotecnica, Sapienza - Università di Roma, Rome, Italy
| | - Concetta Torromeo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | | | - Stefano Gabriele
- Dipartimento di Architettura, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Giuseppe Esposito
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Paola Nardinocchi
- Dipartimento di Ingegneria Strutturale e Geotecnica, Sapienza - Università di Roma, Rome, Italy
| | - Luciano Teresi
- Dipartimento di Matematica e Fisica, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Andrea Madeo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Michele Schiariti
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Valerio Varano
- Dipartimento di Architettura, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Paolo Emilio Puddu
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy.
| |
Collapse
|
12
|
Gunasekaran P, Panaich S, Briasoulis A, Cardozo S, Afonso L. Incremental Value of Two Dimensional Speckle Tracking Echocardiography in the Functional Assessment and Characterization of Subclinical Left Ventricular Dysfunction. Curr Cardiol Rev 2017; 13:32-40. [PMID: 27411342 PMCID: PMC5324318 DOI: 10.2174/1573403x12666160712095938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/26/2016] [Accepted: 06/29/2016] [Indexed: 02/01/2023] Open
Abstract
Subclinical left ventricular (LV) dysfunction refers to subtle abnormalities in LV function which typically precede a reduction in the left ventricular ejection fraction (LVEF). The assessment of myocardial function using LVEF, a radial metric of systolic function, is subject to load dependence, intra-observer and inter-observer variability. Reductions in LVEF typically manifest late in the disease process thus compromising the ability to intervene before irreversible impairment of systolic performance sets in. 2-Dimensional speckle tracking echocardiography (2D-STE), a novel strain imaging modality has shown promise as a sensitive indicator of myocardial contractility. It arms the clinician with a powerful and practical tool to rapidly quantify cardiac mechanics, circumventing several inherent limitations of conventional echocardiography. This article highlights the incremental utility of 2D-STE in the detection of subclinical LV dysfunction.
Collapse
Affiliation(s)
| | | | | | | | - Luis Afonso
- Division of Cardiology, Wayne State University, Detroit Medical Center, 3990 John R, 8-Brush, Harper University Hospital, Detroit, Michigan-48201. United States
| |
Collapse
|
13
|
Candan O, Hatipoglu Akpinar S, Dogan C, Demirkıran A, Dindar B, Bayram Z, Yılmaz F, Kaymaz C, Ozdemir N. Twist deformation for predicting postoperative left ventricular function in patients with mitral regurgitation: A speckle tracking echocardiography study. Echocardiography 2017; 34:422-428. [DOI: 10.1111/echo.13462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ozkan Candan
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | | | - Cem Dogan
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Aykut Demirkıran
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Barış Dindar
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Zubeyde Bayram
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Fatih Yılmaz
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Cihangir Kaymaz
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Nihal Ozdemir
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| |
Collapse
|
14
|
Global and Regional Longitudinal Strains Predict Left Ventricular Dysfunction after Mitral Valve Repair: A Two Dimensional Speckle Tracking Study. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2016. [DOI: 10.5812/rijm.41456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
15
|
Esmaeilzadeh M, Alimi H, Hosseini S, Samiei N, Parsaee M. Global and Regional Longitudinal Strains Predict Left Ventricular Dysfunction after Mitral Valve Repair: A Two Dimensional Speckle Tracking Study. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2016. [DOI: 10.17795/rijm41456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
16
|
Abstract
Non-Doppler, 2-dimensional strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements, which serves as a major advancement in understanding myocardial deformation. It analyzes motion in ultrasound imaging by tracking speckles in 2 dimensions. There are a lot of data emerging with multiple applications of strain imaging in the clinical practice of echocardiography. As incorporation of strain imaging in daily practice has been challenging, we intend to systematically highlight the top 10 applications of speckle-tracking echocardiography, which every cardiologist should be aware of: chemotherapy cardiotoxicity, left ventricular assessment, cardiac amyloidosis, hypertrophic obstructive cardiomyopathy, right ventricular dysfunction, valvular heart diseases (aortic stenosis and mitral regurgitation), cardiac sarcoidosis, athlete heart, left atrial assessment, and cardiac dyssynchrony.
Collapse
|
17
|
Scandura S, Dipasqua F, Gargiulo G, Capodanno D, Caggegi A, Grasso C, Mangiafico S, Pistritto AM, Immè S, Chiarandà M, Ministeri M, Ronsivalle G, Cannata S, Arcidiacono AA, Capranzano P, Tamburino C. Early results of MitraClip system implantation by real-time three-dimensional speckle-tracking left ventricle analysis. J Cardiovasc Med (Hagerstown) 2016; 17:843-9. [DOI: 10.2459/jcm.0000000000000284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
18
|
Sinha SK, Garg S, Thakur R, Krishna V, Singh K, Sachan M, Goel A, Razi M, Pandey U, Varma CM. Prognostic Importance of Exercise Brain Natriuretic Peptide in Asymptomatic Chronic Organic Severe Mitral Regurgitation: An Observational Study. J Clin Med Res 2016; 8:797-804. [PMID: 27738481 PMCID: PMC5047018 DOI: 10.14740/jocmr2680w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The optimal timing of surgery in patients with chronic organic severe mitral regurgitation (MR) continues to be debated, especially for those who are asymptomatic. The aim of the study was to determine independent and additive prognostic value of exercise brain natriuretic peptide (eBNP) in patients with severe asymptomatic MR and normal left ventricular ejection fraction (LVEF). METHODS Two hundred twenty-three consecutive patients with severe MR defined by effective regurgitant orifice (ERO) area ≥ 40 mm2 and/or residual volume ≥ 60 mL, LVEF > 60%, and normal LV end-systolic diameter < 40 mm underwent symptom limited exercise treadmill test (TMT). Echocardiography was done immediately after exercise. Data were obtained within 3 minutes of peak exercise. BNP levels were assessed before echo (after 30 minutes of supine rest) and at exercise (i.e., within the 3 minutes of the end of effort). Patients were followed up every 3 months up to 15 months for major adverse cardiac events (MACEs) (cardiovascular death, need for mitral valve surgery and hospitalization for acute pulmonary edema or heart failure). RESULTS Mean age was 31.2 ± 9 years (range: 18 - 40) with majority being male (n = 153; 68%). Etiologies were rheumatic (n = 201; 90%), mitral valve prolapse (n = 17; 7.6%) and hypertrophic cardiomyopathy (n = 5; 2.4%). BNP level significantly increased from rest (65.24 ± 43.92 pg/mL; median: 43.5 pg/mL) to exercise (100.24 ± 98.24 pg/mL; median: 66.5 pg/mL; P < 0.001). Patients were divided into three tertiles according to eBNP levels (T1 = 15 - 44; T2 = 45 - 104; T3 = 105 - 400). There was trend for significantly lower exercise time in T3. During TMT, 66 (29.5%) stopped exercise due to dyspnea. They had similar resting BNP level compared with others but had significantly higher eBNP level (136 ± 109.7 pg/mL vs. 84.88 ± 90.2 pg/mL; P < 0.001). During follow-up (15 months), MACE occurred in 83 patients (37.2%): mitral valve replacement (MVR) in 59 patients (symptomatic: 43; LV dilatation or dysfunction: 9; both symptoms and dilatation/dysfunction: 7), 17 hospitalizations for congestive heart failure, five patients developing acute pulmonary edema and atrial fibrillation in remaining two patients. This was 7.6%, 35% and 69% in T1, T2 and T3, respectively and had significantly higher eBNP level than without any event (165 ± 119 pg/mL vs. 57 ± 48 pg/mL; P < 0.001). Using receiver operating characteristic curve analysis, the best cut-off value of eBNP level to predict cardiac events was 90 pg/mL (sensitivity: 75%; specificity: 88.6%; positive predictive value: 79%; negative predictive value: 83.9%). CONCLUSION In asymptomatic patients, eBNP level provides incremental prognostic value beyond echocardiographic data and those with elevated eBNP should be considered at high risk for reduced event-free survival and might be considered for early MVR.
Collapse
Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Shalini Garg
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Karandeep Singh
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Amit Goel
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mahamdula Razi
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Chandra Mohan Varma
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| |
Collapse
|
19
|
Area strain from 3D speckle-tracking echocardiography as an independent predictor of early symptoms or ventricular dysfunction in asymptomatic severe mitral regurgitation with preserved ejection fraction. Int J Cardiovasc Imaging 2016; 32:1189-98. [DOI: 10.1007/s10554-016-0904-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/25/2016] [Indexed: 12/25/2022]
|
20
|
Cho EJ, Park SJ, Yun HR, Jeong DS, Lee SC, Park SW, Park PW. Predicting Left Ventricular Dysfunction after Surgery in Patients with Chronic Mitral Regurgitation: Assessment of Myocardial Deformation by 2-Dimensional Multilayer Speckle Tracking Echocardiography. Korean Circ J 2016; 46:213-21. [PMID: 27014352 PMCID: PMC4805566 DOI: 10.4070/kcj.2016.46.2.213] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/11/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral valve regurgitation (MR) and portends a poor prognosis. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. The aim of the present study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional multilayer speckle-tracking echocardiography (2D MSTE) analysis in patients with chronic severe MR with preserved LV systolic function. Subjects and Methods Forty-three consecutive patients with chronic severe MR with preserved LV systolic function scheduled for mitral valve replacement (MVR) or MV repair were prospectively enrolled. Serial echocardiographic studies were performed before surgery, at 7 days follow-up, and at least 3 months follow-up postoperatively. The conventional echocardiographic parameters were analyzed. Global longitudinal strain (GLS) was obtained quantitatively by 2D MSTE. Results The mean age of patients was 51.7±14.3 years and 25 (58.1%) were male. In receiver-operating characteristic curve analysis, the most useful cutoff value for discriminating postoperative LV remodeling in severe MR with normal LV systolic function was -20.5% of 2D mid-layer GLS. Patients were divided into two groups by the baseline GLS -20.5%. Preoperative GLS values strongly predicted postoperative LV remodeling or LV dysfunction. The postoperative degree of decrease in LV end-diastolic dimension might be an additive predictive factor. Conclusion STE can be used to predict a decrease in LV function after MVR in patients with chronic severe MR. This promising method could be of use in the clinic when trying to decide upon the optimum time to schedule surgery for such patients.
Collapse
Affiliation(s)
- Eun Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Cardiology, Department of Internal Medicine, Cardiology Clinic, National Cancer Center, Goyang, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Rim Yun
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thorax Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thorax Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Abstract
Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population.
Collapse
Affiliation(s)
- Rebecca Hahn
- Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
22
|
Pokharel P, Fujikura K, Bella JN. Clinical applications and prognostic implications of strain and strain rate imaging. Expert Rev Cardiovasc Ther 2015; 13:853-66. [DOI: 10.1586/14779072.2015.1056163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
23
|
Grayburn PA, Smith RL. Left ventricular ejection fraction in mitral regurgitation because of flail leaflet. Circ Cardiovasc Imaging 2014; 7:220-1. [PMID: 24642919 DOI: 10.1161/circimaging.114.001675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul A Grayburn
- Baylor Heart and Vascular Hospital and the Heart Hospital Baylor Plano, Baylor Scott and White Health Care System, Dallas, TX
| | | |
Collapse
|
24
|
Chong A, MacLaren G, Chen R, Connelly KA. Perioperative Applications of Deformation (Myocardial Strain) Imaging With Speckle-Tracking Echocardiography. J Cardiothorac Vasc Anesth 2014; 28:128-140. [DOI: 10.1053/j.jvca.2013.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 12/24/2022]
|
25
|
Kolias TJ, Hagan PG, Chetcuti SJ, Eberhart DL, Kline NM, Lucas SD, Hamilton JD. New universal strain software accurately assesses cardiac systolic and diastolic function using speckle tracking echocardiography. Echocardiography 2014; 31:947-55. [PMID: 24446589 DOI: 10.1111/echo.12512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We have developed new universal strain software (USS) that can be used to perform speckle tracking of any Digital Imaging and Communications in Medicine (DICOM) image, regardless of the ultrasound system used to obtain it. METHODS Fifty patients prospectively underwent echocardiography immediately prior to cardiac catheterization. Biplane peak global longitudinal strain (GLS), peak systolic longitudinal strain rate (SSR), peak early diastolic longitudinal strain rate (DSR), and peak early diastolic circumferential strain rate (DCSR) were determined using conventional strain software (CSS) that uses raw data, and using the new USS applied to DICOM images. RESULTS Universal strain software correlated with CSS for GLS (r = 0.78, P < 0.001), SSR (r = 0.78, P < 0.001), DSR (r = 0.54, P < 0.001), and DCSR (r = 0.43, P = 0.019). GLS and SSR using USS correlated with left ventricular ejection fraction (LVEF) (r = -0.67 and -0.71, respectively) as well as using CSS (r = -0.66 and -0.71). Patients with diastolic dysfunction had significantly lower DSR (0.61 vs. 0.87/sec, P = 0.02) and DCSR (0.89 vs. 1.23/sec, P = 0.03), and less negative GLS (-10.8 vs. -16.1%, P = 0.002) using USS in all patients, as well as among those with LVEF ≥ 50%. Receiver-operating characteristic (ROC) analysis for detection of diastolic dysfunction revealed a sensitivity and specificity of 82% and 83% for DCSR < 1.09/sec (area under the curve [AUC = 0.80]) and 85% and 83% for GLS > -13.7% (AUC = 0.84) using USS. CONCLUSION Universal strain software can be used to accurately assess LV systolic and diastolic function using speckle tracking echocardiography.
Collapse
Affiliation(s)
- Theodore J Kolias
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | | | | | | | | | | | | |
Collapse
|
26
|
Measuring Myocardial Deformation: Should We Go Back from Two and Three Dimensions to Linear Measurement? J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
27
|
Zito C, Carerj S, Todaro MC, Cusmà-Piccione M, Caprino A, Di Bella G, Oreto L, Oreto G, Khandheria BK. Myocardial deformation and rotational profiles in mitral valve prolapse. Am J Cardiol 2013; 112:984-90. [PMID: 23800550 DOI: 10.1016/j.amjcard.2013.05.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
We studied whether evaluation of overall left ventricular (LV) and left atrial (LA) mechanics would be useful to detect subclinical dysfunction in patients with mitral valve prolapse (MVP), mitral regurgitation (MR), and normal LV ejection fraction (EF). Fifty consecutive patients (27 men, mean age 61 ± 19 years) with MVP, MR, and normal systolic function (LVEF ≥60%) were prospectively enrolled and compared with 40 age- and gender-matched healthy subjects (22 men, mean age: 59 ± 16 years). At baseline, 2-dimensional and color-flow Doppler transthoracic echocardiography were performed for MR quantification and analysis of left-chambers mechanics. Patients were divided into groups by severity of MR: mild (n = 14), moderate (n = 19), and severe (n = 17). Left ventricular dimensions, volume and mass, and LA area and volume indices were significantly increased in patients with moderate and severe MR compared with control subjects. Circumferential strain, basal/apical rotations, and twist were significantly enhanced in patients with moderate MR compared with controls; with the exception of basal rotation, they decreased in those with severe MR. Furthermore, LA strain and untwisting rate were progressively and significantly reduced from normal subjects to patients with severe MR. Effective regurgitant orifice area and MR vena contracta were significantly related to most systolic and diastolic function parameters and LA volume as well as LA strain and LV untwisting rate in all patients. In conclusion, cardiac mechanics indices, particularly LA deformation and LV rotational parameters, could help unmask incipient myocardial dysfunction in patients with MVP, especially in those with severe MR and yet normal LVEF.
Collapse
|
28
|
Biswas M, Sudhakar S, Nanda NC, Buckberg G, Pradhan M, Roomi AU, Gorissen W, Houle H. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography 2013; 30:88-105. [PMID: 23297852 DOI: 10.1111/echo.12079] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Two-dimensional speckle tracking echocardiography (2D STE) is a novel technique of cardiac imaging for quantifying complex cardiac motion based on frame-to-frame tracking of ultrasonic speckles in gray scale 2D images. Two-dimensional STE is a relatively angle independent technology that can measure global and regional strain, strain rate, displacement, and velocity in longitudinal, radial, and circumferential directions. It can also quantify rotational movements such as rotation, twist, and torsion of the myocardium. Two-dimensional STE has been validated against hemodynamics, tissue Doppler, tagged magnetic resonance imaging, and sonomicrometry studies. Two-dimensional STE has been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. A large number of studies have evaluated the role of 2D STE in predicting response to cardiac resynchronization therapy in patients with severe heart failure. However, the clinical utility of 2D STE in the above mentioned conditions remains controversial because of conflicting reports from different studies. Emerging areas of application include prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and effect of intracoronary injection of bone marrow stem cells on left ventricular function in patients with acute myocardial infarction. The emerging technique of three-dimensional STE may further extend its clinical usefulness.
Collapse
Affiliation(s)
- Monodeep Biswas
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama 35249, USA
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Bartko PE, Heinze G, Graf S, Clavel MA, Khorsand A, Bergler-Klein J, Burwash IG, Dumesnil JG, Sénéchal M, Baumgartner H, Rosenhek R, Pibarot P, Mundigler G. Two-Dimensional Strain for the Assessment of Left Ventricular Function in Low Flow–Low Gradient Aortic Stenosis, Relationship to Hemodynamics, and Outcome. Circ Cardiovasc Imaging 2013; 6:268-76. [DOI: 10.1161/circimaging.112.980201] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Philipp Emanuel Bartko
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Georg Heinze
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Senta Graf
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Marie-Annick Clavel
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Aliasghar Khorsand
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Jutta Bergler-Klein
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Ian Gordon Burwash
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Jean Gaston Dumesnil
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Mario Sénéchal
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Helmut Baumgartner
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Raphael Rosenhek
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Philippe Pibarot
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Gerald Mundigler
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| |
Collapse
|
30
|
Gelsomino S, van Garsse L, Lucà F, Parise O, Cheriex E, Rao CM, Gensini GF, Maessen J. Left ventricular strain in chronic ischemic mitral regurgitation in relation to mitral tethering pattern. J Am Soc Echocardiogr 2013; 26:370-380.e11. [PMID: 23415836 DOI: 10.1016/j.echo.2013.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this retrospective study was to explore whether different tethering patterns in chronic ischemic mitral regurgitation have different distributions of left ventricular (LV) systolic longitudinal, circumferential, and radial strain before and after mitral valve repair. METHODS Sixty-one patients with chronic ischemic mitral regurgitation who underwent mitral repair were divided on the basis of the preoperative anterior/posterior tethering angle ratio (cutoff value, 0.76). There were 29 patients with symmetric (group 1) and 32 with asymmetric (group 2) preoperative tethering patterns. Assessment of longitudinal peak systolic strain was performed offline by applying speckle-tracking imaging to the apical two-chamber, three-chamber, and four-chamber views of the left ventricle. Peak systolic radial and circumferential strain was obtained from short-axis views at the basal, middle, and apical levels. Twenty healthy subjects served as controls. RESULTS In group 1, baseline LV strain was impaired in all LV segments, with the worst values in the anterolateral, anterior, and inferolateral segments at the midventricular and basal levels. In contrast, asymmetric patients showed higher values in the inferior and inferoseptal walls and values closer to normal in the other segments. After surgery, all strain measurements showed significant improvements in all LV segments in group 2, whereas in Group 1, strain worsened in the inferoseptal, inferior, and anteroseptal walls and did not change in the other segments. CONCLUSIONS Patients with baseline symmetric tethering patterns showed more extensive abnormal strain, which was observed in all LV segments and was not reverted by surgery. These findings require confirmation in additional larger studies.
Collapse
Affiliation(s)
- Sandro Gelsomino
- Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Dolor-Torres MC, Ling LH. Surgical timing of degenerative mitral regurgitation: what to consider. J Cardiovasc Ultrasound 2012; 20:165-71. [PMID: 23346284 PMCID: PMC3542508 DOI: 10.4250/jcu.2012.20.4.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/09/2012] [Accepted: 11/21/2012] [Indexed: 01/19/2023] Open
Abstract
Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.
Collapse
|
32
|
Perry R, Joseph M. Advanced echocardiographic techniques. Australas J Ultrasound Med 2012; 15:126-142. [PMID: 28191159 PMCID: PMC5024913 DOI: 10.1002/j.2205-0140.2012.tb00196.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Echocardiography has advanced significantly since its first clinical use. The move towards more accurate imaging and quantification has driven this advancement. In this review, we will briefly focus on three distinct but important recent advances, three‐dimensional (3D) echocardiography, contrast echocardiography and myocardial tissue imaging. The basic principles of these techniques will be discussed as well as current and future clinical applications.
Collapse
Affiliation(s)
- Rebecca Perry
- Flinders Clinical Research; South Australian Health and Medical Research Institute; Adelaide South Australia Australia
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park South Australia Australia
- Discipline of Medicine Flinders University; Bedford Park South Australia Australia
| | - Majo Joseph
- Flinders Clinical Research; South Australian Health and Medical Research Institute; Adelaide South Australia Australia
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park South Australia Australia
- Discipline of Medicine Flinders University; Bedford Park South Australia Australia
| |
Collapse
|
33
|
van Garsse L, Gelsomino S, Cheriex E, Lucà F, Rao CM, Parise O, Gensini GF, Maessen J. Tethering Symmetry Reflects Advanced Left Ventricular Mechanical Dyssynchrony in Patients With Ischemic Mitral Regurgitation Undergoing Restrictive Mitral Valve Repair. Ann Thorac Surg 2012; 94:1418-28. [DOI: 10.1016/j.athoracsur.2012.05.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/22/2012] [Accepted: 05/25/2012] [Indexed: 11/30/2022]
|
34
|
Shudo Y, Nakatani S, Sakaguchi T, Miyagawa S, Yoshikawa Y, Takeda K, Saito S, Takeda Y, Sakata Y, Yamamoto K, Sawa Y. Left ventricular mechanics following restrictive mitral annuloplasty for functional mitral regurgitation: two-dimensional speckle tracking echocardiographic study. Echocardiography 2012; 29:445-50. [PMID: 22486374 DOI: 10.1111/j.1540-8175.2011.01607.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Restrictive mitral annuloplasty (RMA) is widely employed for patients with functional mitral regurgitation (MR). Its improvement of left ventricular (LV) function has been demonstrated by only a gradual increase in LV ejection fraction (EF) in the chronic phase. However, the detailed evaluation of changes in LV function has not been fully elucidated in functional MR patients before and after RMA. Therefore, we performed two-dimensional speckle tracking echocardiography (2D-STE), which enables accurate evaluation of myocardial deformation and rotation that are undetectable by conventional echocardiography. METHODS We studied 13 patients (mean age 61 ± 10 years) with functional MR associated with cardiomyopathy undergoing RMA. In addition to conventional echocardiographic measurements, 2D-STE was performed to measure peak systolic radial (RS), circumferential (CS), and longitudinal (LS) strains and twist before and 4 ± 2 weeks after surgery. LV twist was defined as the difference between the apical and basal rotations. RESULTS After RMA, EF and LS remained unchanged, but RS and CS were significantly improved at the mid-LV (RS, 20.6 ± 10.8 vs 24.5 ± 11.6%; CS, -9.6 ± 5.2 vs -12.8 ± 5.6%) and at the apex (RS, 15.0 ± 12.2 vs 18.7 ± 8.6%; CS, -4.4 ± 3.0 vs -7.8 ± 4.8%). RS and CS were unchanged at the base. The apical and basal rotations changed significantly, from 3.5°± 0.7° to 9.2°± 2.1°, and -2.1°± 0.7° to -3.8°± 1.0°, respectively. Consequently, the LV twist increased significantly, from 5.6°± 1.0° to 13.0°± 1.9°. CONCLUSIONS Radial and circumferential strains and LV twist increased significantly in the early postoperative period in functional MR patients after RMA and concomitant procedures.
Collapse
Affiliation(s)
- Yasuhiro Shudo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Van de Heyning CM, Magne J, Lancellotti P, Piérard LA. The importance of exercise echocardiography for clinical decision making in primary mitral regurgitation. J Cardiovasc Med (Hagerstown) 2012; 13:260-5. [PMID: 22367571 DOI: 10.2459/jcm.0b013e3283515c70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary mitral regurgitation is generally an insidious disease with late onset of symptoms. Current European and American guidelines recommend surgery in severe primary mitral regurgitation when symptoms, overt left ventricular dysfunction, pulmonary hypertension or atrial fibrillation, occur. However, recent large studies reported an improved outcome in asymptomatic patients with severe mitral regurgitation referred for early mitral valve repair despite the risk of operative mortality or mitral valve replacement. Moreover, primary mitral regurgitation appears to have an important dynamic character in up to one-third of patients. This article provides an overview of the incremental evidence of the ability of exercise echocardiography to assess the functional repercussions of mitral regurgitation and the identification of high-risk patients who might benefit from early referral for surgery.
Collapse
|
36
|
Witkowski TG, Thomas JD, Debonnaire PJMR, Delgado V, Hoke U, Ewe SH, Versteegh MIM, Holman ER, Schalij MJ, Bax JJ, Klautz RJM, Marsan NA. Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair. Eur Heart J Cardiovasc Imaging 2012; 14:69-76. [DOI: 10.1093/ehjci/jes155] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
37
|
Smith DN, Bonagura JD, Culwell NM, Schober KE. Left ventricular function quantified by myocardial strain imaging in small-breed dogs with chronic mitral regurgitation. J Vet Cardiol 2012; 14:231-42. [PMID: 22361170 DOI: 10.1016/j.jvc.2011.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/15/2011] [Accepted: 11/21/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND The presence of left ventricular (LV) systolic dysfunction may influence prognosis or therapy in dogs with chronic mitral regurgitation (MR). Assessment of LV function in MR by conventional echocardiography is confounded by altered ventricular loading. Myocardial deformation (strain) imaging might offer more sensitive estimates of LV function in this disease. OBJECTIVE Prospectively measure myocardial strain in dogs with asymptomatic MR compared to a control group. ANIMALS, MATERIALS AND METHODS Forty healthy dogs (3.5-11.5 kg): 20 Controls; 20 dogs with MR and LV remodeling (Stage B2), were evaluated in this study. LV size and function were assessed in a short-axis plane. Segmental radial strain and strain rate and global circumferential strain were measured using a 2D echocardiographic speckle-tracking algorithm (GE EchoPAC). Groups were compared using Bonferroni t-tests. Influences of heart rate and body weight were explored with linear regression. RESULTS The MR group had significantly greater mean values for heart rate, LV size, and LV systolic function. Specifically, LV diastolic diameter, diastole area, shortening fraction, averaged peak systolic and early diastolic radial strain, global circumferential strain, and averaged radial strain rate were significantly greater in the MR group (p < 0.015 to p < 0.001). Strain was unrelated to weight, but weakly correlated with heart rate. CONCLUSIONS Similar to conventional indices, Stage B2 dogs with MR demonstrate hyperdynamic deformation in the short-axis plane. Short-axis strain variables measured by 2D speckle tracking are greater than for controls of similar age and weight. These results imply either preserved LV systolic function or that LV dysfunction is masked by altered ventricular loading.
Collapse
Affiliation(s)
- Danielle N Smith
- Department of Veterinary Clinical Sciences and Veterinary Medical Center, The Ohio State University College of Veterinary Medicine, 601 Vernon L Tharp St., Columbus, OH 43210, USA
| | | | | | | |
Collapse
|
38
|
Gorcsan J, Tanaka H. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol 2011; 58:1401-13. [PMID: 21939821 DOI: 10.1016/j.jacc.2011.06.038] [Citation(s) in RCA: 337] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 05/31/2011] [Accepted: 06/10/2011] [Indexed: 01/12/2023]
Abstract
Echocardiographic strain imaging, also known as deformation imaging, has been developed as a means to objectively quantify regional myocardial function. First introduced as post-processing of tissue Doppler imaging velocity converted to strain and strain rate, strain imaging has more recently also been derived from digital speckle tracking analysis. Strain imaging has been used to gain greater understanding into the pathophysiology of cardiac ischemia and infarction, primary diseases of the myocardium, and the effects of valvular disease on myocardial function, and to advance our understanding of diastolic function. Strain imaging has also been used to quantify abnormalities in the timing of mechanical activation for heart failure patients undergoing cardiac resynchronization pacing therapy. Further advances, such as 3-dimensional speckle tracking strain imaging, have emerged to provide even greater insight. Strain imaging has become established as a robust research tool and has great potential to play many roles in routine clinical practice to advance the care of the cardiovascular patient. This perspective reviews the physiology of myocardial strain, the technical features of strain imaging using tissue Doppler imaging and speckle tracking, their strengths and weaknesses, and the state-of-the-art present and potential future clinical applications.
Collapse
|
39
|
Florescu M, Benea DCCM, Rimbas RC, Cerin G, Diena M, Lanzzillo G, Enescu OA, Cinteza M, Vinereanu D. Myocardial Systolic Velocities and Deformation Assessed by Speckle Tracking for Early Detection of Left Ventricular Dysfunction in Asymptomatic Patients with Severe Primary Mitral Regurgitation. Echocardiography 2011; 29:326-33. [DOI: 10.1111/j.1540-8175.2011.01563.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
40
|
Yurdakul S, Tayyareci Y, Yildirimturk O, Memic K, Aytekin V, Aytekin S. Subclinical Left Ventricular Dysfunction in Asymptomatic Chronic Mitral Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging-Based Study. Echocardiography 2011; 28:877-85. [DOI: 10.1111/j.1540-8175.2011.01428.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
41
|
Smedsrud MK, Pettersen E, Gjesdal O, Svennevig JL, Andersen K, Ihlen H, Edvardsen T. Detection of left ventricular dysfunction by global longitudinal systolic strain in patients with chronic aortic regurgitation. J Am Soc Echocardiogr 2011; 24:1253-9. [PMID: 21908174 DOI: 10.1016/j.echo.2011.08.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether global longitudinal strain measured by two-dimensional speckle tracking echocardiography could detect incipient myocardial dysfunction in patients with chronic aortic regurgitation (AR). Disclosing left ventricular (LV) dysfunction is of decisive importance for optimal timing of surgery but challenging because of the altered loading conditions. METHODS Forty-seven patients referred for aortic valve replacement because of chronic AR were studied, along with 31 healthy controls. Myocardial deformation as determined by longitudinal, circumferential, and radial strain was calculated using two-dimensional speckle-tracking echocardiography technique, in addition to LV volumes, dimensions, and ejection fraction. Strain values were normalized to end-diastolic volume to correct for the volume dependency of deformation. RESULTS Global systolic longitudinal strain was significantly lower in patients with AR before surgery compared with the healthy controls (-17.5 ± 3.1% vs -22.1 ± 1.8%, P < .01), while global circumferential strain and LV ejection fraction did not differ (-21.7 ± 3.4% vs -22.6 ± 2.5%, P = .22 and 59 ± 5% vs 59 ± 6%, P = .59, respectively). However, differences between patients and controls were evident for both longitudinal and circumferential strain when normalized to end-diastolic volume (-0.09 ± 0.04 vs -0.23 ± 0.08, P < .01, and -0.11 ± 0.05 vs -0.24 ± 0.08, P < .01, respectively). In contrast to their absolute values, both normalized variables demonstrated improvement in myocardial shortening after valve replacement (P < .01). CONCLUSIONS The study demonstrated reduced global longitudinal strain in patients with chronic AR with preserved LV ejection fractions. Global longitudinal strain might therefore disclose incipient myocardial dysfunction with a consequent potential for improved timing of aortic valve surgery.
Collapse
|
42
|
Song JM, Kang SH, Lee EJ, Shin MJ, Lee JW, Chung CH, Kim DH, Kang DH, Song JK. Echocardiographic Predictors of Left Ventricular Function and Clinical Outcomes After Successful Mitral Valve Repair: Conventional Two-Dimensional Versus Speckle-Tracking Parameters. Ann Thorac Surg 2011; 91:1816-23. [DOI: 10.1016/j.athoracsur.2011.02.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/15/2011] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
|
43
|
Moustafa SE, Kansal M, Alharthi M, Deng Y, Chandrasekaran K, Mookadam F. Prediction of incipient left ventricular dysfunction in patients with chronic primary mitral regurgitation: a velocity vector imaging study. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:291-8. [DOI: 10.1093/ejechocard/jer003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
44
|
Shizukuda Y, Bhatti S, Munjal J, Hu YL, Harrelson A. Personalized echocardiography: clinical applications of advanced echocardiography and future directions. Future Cardiol 2010; 6:833-44. [PMID: 21142639 DOI: 10.2217/fca.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Future cardiology practice will be increasingly individualized, and thus to maintain its central role, echocardiography must keep pushing to expand the boundaries of real-time data acquisition from tissue and fluid motion, and yet still provide efficient and timely data analysis that leads to succinct, clear clinical recommendations tailored to each person in our care. In this article, recent efforts to expand echocardiography techniques into an era of increasingly personalized cardiology, including advances in color-coded tissue Doppler, 3D echocardiography and complex exercise stress echocardiography are described. The common metric for success in each of these efforts is the development of robust and institutionally supportable echocardiography protocols for specific cardiology disease populations that currently may be underdiagnosed and/or undertreated. The common result in each case should be the creation of new guidelines that can supplement the current standard protocols advocated by professional echocardiography organizations.
Collapse
Affiliation(s)
- Yukitaka Shizukuda
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | | | | | | | | |
Collapse
|
45
|
Nguyen JS, Lakkis NM, Bobek J, Goswami R, Dokainish H. Systolic and Diastolic Myocardial Mechanics in Patients with Cardiac Disease and Preserved Ejection Fraction: Impact of Left Ventricular Filling Pressure. J Am Soc Echocardiogr 2010; 23:1273-80. [DOI: 10.1016/j.echo.2010.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Indexed: 11/30/2022]
|
46
|
de Agustín JA, Pérez de Isla L, Núñez-Gil IJ, Vivas D, Manzano MDC, Marcos-Alberca P, Fernández-Golfín C, Corros C, Almería C, Rodrigo JL, Aubele A, Herrera D, Rodríguez E, Macaya C, Zamorano J. Assessment of myocardial deformation: Predicting medium-term left ventricular dysfunction after surgery in patients with chronic mitral regurgitation. Rev Esp Cardiol 2010; 63:544-53. [PMID: 20450848 DOI: 10.1016/s1885-5857(10)70116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The development of left ventricular dysfunction after mitral valve replacement is a common problem in patients with chronic severe mitral regurgitation. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. Our aim was to compare the value of the preoperative strain and strain rate derived by either speckle-tracking echocardiography or tissue Doppler imaging (TDI) for predicting the medium-term decrease in left ventricular ejection fraction (LVEF) following surgery. METHODS This prospective study involved 38 consecutive patients with chronic severe mitral regurgitation who were scheduled for mitral valve replacement. The longitudinal strain and strain rate in the interventricular septum were measured preoperatively using speckle-tracking echocardiography and TDI. The LVEF was determined preoperatively and postoperatively using 3-dimensional echocardiography. Echocardiographic assessments were performed in the 48 hours prior to surgery and 6 months postoperatively. RESULTS The patients' mean age was 59.9+/-11.3 years and 10 (29.4%) were male. Both speckle-tracking echocardiography and TDI were found to be predictors of a >10% decrease in LVEF at 6 months. However, the predictive value of speckle-tracking echocardiography was greater than that of TDI. The longitudinal strain at baseline in the interventricular septum as measured by speckle-tracking echocardiography was the most powerful predictor; the area under the curve was 0.85 and the optimal cut-off value was -0.11. CONCLUSIONS Speckle-tracking echocardiography can be used to predict a decrease in LVEF over the medium term after mitral valve replacement. Moreover, the predictive accuracy of speckle-tracking echocardiography was greater than that of TDI.
Collapse
|
47
|
Teixeira R, Lourenço C, António N, Jorge E, Baptista R, Saraiva F, Mendes P, Monteiro S, Gonçalves F, Monteiro P, Freitas M, Providência LA. Can we improve outcomes in patients with previous coronary artery bypass surgery admitted for acute coronary syndrome? Rev Esp Cardiol 2010; 63:554-63. [PMID: 20450849 DOI: 10.1016/s1885-5857(10)70117-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Prognosis and in-hospital management of patients with acute coronary syndrome (ACS) and a history of coronary artery bypass graft (CABG) surgery are still debated. The objective of this study was to characterize ACS patients with a CABG and to compare their in-hospital and postdischarge outcomes with those of patients without a CABG. METHODS This ongoing prospective observational study included 1,495 consecutive patients admitted for ACS to a coronary care unit and followed up for a mean of 19 months. There were two groups: group A (n=73), with CABGs; and group B (n=1,223), without CABGs. RESULTS Group A patients were more often male (86.3% versus 69.1%; P=.002), and more frequently had a history of diabetes, myocardial infarction and heart failure. Group B patients more frequently had ST-elevation myocardial infarction, and had a higher median ejection fraction (53% [interquartile range, 47%-60%] vs. 50% [42%-55%]; P< .01) and peak troponin-I concentration. There was no difference in the use of invasive techniques. Regarding medication, Group B patients were more likely to receive dual antiplatelet therapy at discharge. No significant difference was observed in in-hospital mortality (9.5% versus 5.9%; P=.2) or mortality at 1 month, 6 months or 1 year (9.8% versus 9.1%; log-rank test, P=.87) and the cumulative major adverse cardiac event rate was equally low in both groups. The presence of a CABG was associated with more readmissions for unstable angina (11.3% vs. 3.1%; P< .01). CONCLUSIONS In our ACS patients, the presence of a CABG had no significant influence on short- or medium-term outcomes, such as all-cause mortality and adverse cardiac events.
Collapse
Affiliation(s)
- Rogério Teixeira
- Unidad de Cuidados Coronarios, Hospital Universitario, Coimbra, Portugal.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
de Agustín JA, de Isla LP, Núñez-Gil IJ, Vivas D, Manzano MDC, Marcos-Alberca P, Fernández-Golfín C, Corros C, Almería C, Rodrigo JL, Aubele A, Herrera D, Rodríguez E, Macaya C, Zamorano J. Estudio de la deformación miocárdica: predictor de disfunción ventricular a medio plazo tras cirugía en pacientes con insuficiencia mitral crónica. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70116-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
49
|
Cottrell C, Kirkpatrick JN. Echocardiographic strain imaging and its use in the clinical setting. Expert Rev Cardiovasc Ther 2010; 8:93-102. [PMID: 20030024 DOI: 10.1586/erc.09.165] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of echocardiography has grown tremendously over the past several years. It is used routinely for diagnosis, prognosis and monitoring changes of cardiac function in coronary artery disease, heart failure, pulmonary hypertension, arrhythmias, pericardial disease and valvular disease, as well as congenital conditions. In recent years, the advancing technology used to evaluate the heart by ultrasound has allowed physicians to understand the mechanics of the heart muscle and the contribution of abnormalities in myocardial movement to heart disease. This review will discuss novel echocardiographic strain imaging techniques, placing them in the context of myocardial mechanics and describing current and future applications.
Collapse
Affiliation(s)
- Caroline Cottrell
- University of Pennsylvania, Echocardiography Laboratory, 9021 Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | | |
Collapse
|