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Khaled S, Shalaby G. Myocardial recovery after percutaneous coronary intervention in coronary artery disease patients with impaired systolic function- predictive utility of global longitudinal strain. Indian Heart J 2022; 74:488-493. [PMID: 36372350 PMCID: PMC9773278 DOI: 10.1016/j.ihj.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/19/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Coronary revascularization is associated with better outcomes in coronary artery disease patients. We aim to investigate the prevalence, and factors associated with left ventricular (LV) improvement following successful percutaneous coronary intervention (PCI) of patients with impaired systolic function with specific reference to the value of baseline GLS. METHODS This retrospective study reviewed the records of coronary artery disease patients with impaired systolic function who were admitted and treated with PCI. RESULT Out of 420 consecutive acute coronary syndrome patients with an impaired systolic function who were admitted and treated with PCI during the period from January 2021 to December 2021, 147 patients (35%) showed no improvement in the Left ventricular ejection fraction (LVEF) post PCI and 273 patients (65%) showed improvement of the LVEF post PCI in their follow up echocardiogram. Larger myocardial injury dilated LV dimension at the acute phase showed a strong impact on further improving LV systolic function. Baseline GLS showed a higher statistical difference between the Non-improving LVEF and improving LVEF groups. Moreover, the early GLS and further LV systolic function improvement were strongly correlated (P < 0.001) with higher sensitivity and specificity. A receiver operating characteristic curve (ROC) analysis demonstrated that GLS values greater than 9% are a predictor of significant LVEF improvement in the follow-up stage. CONCLUSION Sizable proportion of patients with impaired systolic function following successful PCI show further LV systolic recovery. We demonstrated that the baseline GLS values of more than 9% are an accurate predictor of significant LVEF improvement.
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Affiliation(s)
- Sheeren Khaled
- Banha University, Egypt,King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia,Corresponding author. King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia.
| | - Ghada Shalaby
- King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia,Zagazig University, Egypt
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2
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Chen W, Ortiz-Leon XA, Posada-Martinez EL, Pereira J, Dewar ML, Darr U, Geirsson A, Sugeng L, Zhu Q. Acute changes of left ventricular function during surgical revascularization by 3D speckle tracking. Echocardiography 2021; 38:623-631. [PMID: 33740279 DOI: 10.1111/echo.15040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Detecting early impact of coronary artery bypass grafting (CABG) on left ventricular (LV) function is important because such measures may contribute to meaningful improvement in clinical outcomes. We aimed to gain knowledge about acute changes of LV performance during surgical revascularization using three-dimensional speckle tracking echocardiography (3D STE). METHODS Thirty-five patients scheduled for CABG surgery who underwent intraoperative transesophageal echocardiography (TEE) were enrolled (mean age 68.9 ± 7.3 years). TEE was performed before and after surgery, as well as before and after grafting. 3D LV ejection fraction (LVEF), tissue motion annular displacement (TMAD) of the mitral valves, 3D global longitudinal strain (GLS), global circumferential strain (GCS), twist, and torsion were quantified. Regional longitudinal strain (LS) was calculated based on coronary perfusion territories in a 16-segment LV model. RESULTS Despite the absence of change in TMAD and 3D LVEF, 3D GLS (-18.6 ± 4.3% at baseline vs -16.0 ± 4.0% after surgery, P = .01) was significantly decreased, followed with no significant effect on GCS, twist, and torsion during surgery. 3D GLS correlated significantly with 3D LVEF (r between -0.34 and -0.51, P < .05 for all) under the whole operation. Territorial LS did not increase immediately after surgery. CONCLUSION 3D speckle tracking imaging allows for detailed and direct evaluation of myocardial deformation, though impaired LV longitudinal function is still apparent immediately after surgery. GLS is more sensitive to an acute reduction in LV function than conventional parameters, which can be potentially useful for serial monitoring of functional recovery.
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Affiliation(s)
- Wanwen Chen
- Department of Cardiology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Xochitl A Ortiz-Leon
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Jason Pereira
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael L Dewar
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Umer Darr
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Qingbing Zhu
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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3
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Nabeshima Y, Seo Y, Takeuchi M. A review of current trends in three-dimensional analysis of left ventricular myocardial strain. Cardiovasc Ultrasound 2020; 18:23. [PMID: 32591001 PMCID: PMC7320541 DOI: 10.1186/s12947-020-00204-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional (3D) left ventricular (LV) myocardial strain measurements using transthoracic 3D echocardiography speckle tracking analysis have several advantages over two-dimensional (2D) LV strain measurements, because 3D strain values are derived from the entire LV myocardium, yielding more accurate estimates of global and regional LV function. In this review article, we summarize the current status of 3D LV myocardial strain. Specifically, we describe how 3D LV strain analysis is performed. Next, we compare characteristics of 2D and 3D strain, and we explain validation of 3D strain measurements, feasibility and measurement differences between 2D and 3D strain, reference values of 3D strain, and its applications in several clinical scenarios. In some parts of this review, we used a meta-analysis to draw reliable conclusions. We also describe the added value of 3D over 2D strain in several specific pathologies and prognoses. Finally, we discuss novel techniques using 3D strain and suggest its future directions.
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Affiliation(s)
- Yosuke Nabeshima
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan.
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, School of Medicine, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
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4
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Detection of abnormal myocardial deformation during acute myocardial ischemia using three-dimensional speckle tracking echocardiography. J Echocardiogr 2019; 18:57-66. [DOI: 10.1007/s12574-019-00449-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/24/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
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5
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Ieroncig F, Breau JB, Bélair G, David LP, Noiseux N, Hatem R, Avram R. Novel Approaches to Define Outcomes in Coronary Revascularization. Can J Cardiol 2019; 35:967-982. [DOI: 10.1016/j.cjca.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023] Open
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6
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Rong LQ, Yum B, Abouzeid C, Palumbo MC, Brouwer LR, Devereux RB, Girardi LN, Weinsaft JW, Gaudino M, Kim J. Echocardiographic predictors of intraoperative right ventricular dysfunction: a 2D and speckle tracking echocardiography study. Cardiovasc Ultrasound 2019; 17:11. [PMID: 31174537 PMCID: PMC6556018 DOI: 10.1186/s12947-019-0161-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background Intraoperative or post procedure right ventricular (RV) dysfunction confers a poor prognosis in the post-operative period. Conventional predictors for RV function are limited due the effect of cardiac surgery on traditional RV indices; novel echocardiographic techniques hold the promise to improve RV functional stratification. Methods Comprehensive echocardiographic data were collected prospectively during elective cardiac surgery. Tricuspid annular plane systolic excursion (TAPSE), peak RV systolic velocity (S′), and RV fractional area change (FAC) were quantified on transesophageal echo (TEE). RV global and regional (septal and free wall) longitudinal strain was quantified using speckle-tracking echo in RV-focused views. Two intraoperative time points were used for comparison: pre-sternotomy (baseline) and after chest closure. Results The population was comprised of 53 patients undergoing cardiac surgery [15.1% coronary artery bypass graft (CABG) only, 28.3% valve only, 50.9% combination (e.g. valve/CABG, valve/aortic graft) surgeries], among whom 38% had impaired RV function at baseline defined as RV FAC < 35%. All conventional RV functional indices including TAPSE, S′ and FAC declined immediately following CPB (1.5 ± 0.3 vs.1.1 ± 0.3 cm, 8.0 ± 2.1 vs. 6.2 ± 2.5 cm/s, 36.8 ± 9.3 vs. 29.3 ± 10.6%; p < 0.001 for all). However, left ventricular (LV) and RV hemodynamic parameters remained unchanged (LV ejection fraction (EF): 56.8 ± 13.0 vs. 55.8 ± 12.9%; p = 0.40, pulmonary artery systolic pressure (PASP): 26.5 ± 7.4 vs 27.3 ± 6.7 mmHg; p = 0.13). Speckle tracking echocardiographic data demonstrated a significant decline in RV global longitudinal strain (GLS) [19.0 ± 6.5 vs. 13.5 ± 6.9%, p < 0.001]. Pre-procedure FAC, GLS and free wall strain predicted RV dysfunction at chest closure (34.7 ± 9.1 vs. 41.6 ± 8.1%, p = 0.01, 17.7 ± 6.5 vs. 21.8 ± 5.4%; p = 0.03, 20.3 ± 6.4 vs. 24.2 ± 5.8%; p = 0.04), whereas traditional linear RV indices such as TAPSE and RV S′ at baseline had no impact on intraoperative RV dysfunction (p = NS for both). Conclusions Global and regional RV function, as measured by 2D indices and strain, acutely decline intraoperatively. Impaired RV strain is associated with intraoperative RV functional decline and provides incremental value to traditional RV indices in predicting those who will develop RV dysfunction.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Brian Yum
- Department of Medicine/Cardiology Division, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Christiane Abouzeid
- Department of Medicine/Cardiology Division, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Maria Chiara Palumbo
- Department of Medicine/Cardiology Division, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Lillian R Brouwer
- Department of Medicine/Cardiology Division, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Richard B Devereux
- Department of Medicine/Cardiology Division, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Medicine/Cardiology Division, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Jiwon Kim
- Department of Medicine/Cardiology Division, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA.
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7
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Biswas AK, Haque T, Banik D, Choudhury SR, Khan SR, Malik FTN. Identification of significant coronary artery disease in patients with non-ST segment elevation acute coronary syndrome by myocardial strain analyses using three dimensional speckle tracking echocardiography. Echocardiography 2018; 35:1988-1996. [PMID: 30376589 DOI: 10.1111/echo.14181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Speckle-tracking imaging is a novel method for assessing left ventricular function and ischemic changes. This study aimed to predict the presence of significant coronary artery stenosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by 3D strain analysis using speckle tracking echocardiography (3DSTE) at rest. METHODS This cross-sectional study included a total 60 patients with NSTE-ACS who underwent 3DSTE immediately prior to coronary angiography. Subsequently, patients undergone coronary angiogram (CAG) and divided into two groups; group- I: significant stenosis (n = 36), group-II: non-significant stenosis (n = 24). RESULTS Global peak systolic longitudinal strain (GPSLS), circumferential strain (CS), area strain (AS), and radial strain (RS) were obtained successfully in 60 patients. All strain parameters were significantly reduced in patient group of significant stenosis. Receiver operating characteristic (ROC) curve analysis demonstrated that GPSLS could effectively detect patients with significant stenosis (area under ROC curve = 0.840, 95% CI = 0.735-0.945). GPSLS with a cutoff value of -13.50% showed good sensitivity and specificity for predicting significant stenosis (sensitivity 88.9% and specificity 70.8%). CONCLUSION Global peak systolic longitudinal strain using 3D speckle tracking echocardiography at rest was significantly lower in patients with significant stenosis and might be useful for identifying patients with a significant stenosis with good degree of sensitivity and specificity.
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Affiliation(s)
- Asim Kumar Biswas
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Tuhin Haque
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Dhiman Banik
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology & Research, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Sayeedur Rahman Khan
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Fazila-Tun-Nesa Malik
- Department of Cardiology, National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
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8
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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.
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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
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9
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Howard-Quijano K, McCabe M, Cheng A, Zhou W, Yamakawa K, Mazor E, Scovotti JC, Mahajan A. Left ventricular endocardial and epicardial strain changes with apical myocardial ischemia in an open-chest porcine model. Physiol Rep 2017; 4:4/24/e13042. [PMID: 28039400 PMCID: PMC5210372 DOI: 10.14814/phy2.13042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Abstract
Early detection of acute myocardial ischemia is critical to prevent permanent myocardial damage. The impact of apical ischemia on global left ventricular (LV) function can be difficult to characterize using traditional volume‐based echocardiography measures. Myocardial strain imaging is a sensitive, quantitative marker of myocardial deformation that can measure ventricular function. Recent advances allow layer‐specific measurement of endo‐ and epicardial strain, enhancing the ability to evaluate myocardial ischemia. This study investigates the effects of apical ischemia on LV function using epi‐ and endocardial strain. We hypothesize that myocardial strain will identify changes in regional and global myocardial function associated with focal apical ischemia as compared to ejection fraction (EF), and that longitudinal strain will be a better indicator of myocardial dysfunction compared to circumferential or radial strain. In a porcine model (n = 9), acute ischemia was induced by left anterior descending coronary artery occlusion. Echocardiograms were performed at baseline, during 15‐min ischemia, and after reperfusion. Global longitudinal strain decreased with acute focal ischemia of the left ventricular apical region (baseline: −16.4% vs. ischemia: −12.2%; P = 0.010), with no change observed in global circumferential and radial strain or EF. Both endocardial and epicardial longitudinal strain decreased by 68% (P < 0.001) in the ischemic and peri‐ischemic zone, while circumferential and radial strain only decreased in endocardium of the ischemic zone. Longitudinal strain was more sensitive to ischemia, being able to detect changes in global LV function and thus may confer clinical diagnostic advantage in the evaluation of acute LV apical ischemia.
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Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Melissa McCabe
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Alexander Cheng
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Wei Zhou
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Kentaro Yamakawa
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Einat Mazor
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Jennifer C Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
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10
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Xu L, Cai Z, Xiong M, Li Y, Li G, Deng Y, Hau WK, Li S, Huang W, Qiu J. Efficacy of an early home-based cardiac rehabilitation program for patients after acute myocardial infarction: A three-dimensional speckle tracking echocardiography randomized trial. Medicine (Baltimore) 2016; 95:e5638. [PMID: 28033254 PMCID: PMC5207550 DOI: 10.1097/md.0000000000005638] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/14/2016] [Accepted: 11/21/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The effect of an early short-term home-based cardiac rehabilitation (CR) program on ventricular function in acute myocardial infarction (AMI) patients is not yet clear. The purpose of this study was to evaluate the efficacy of our CR program on the improvement of myocardial function using three-dimensional speckle tracking echocardiography (3D-STE) in AMI patients. METHODS Fifty-two AMI patients were randomly assigned to 2 groups after discharge: the rehabilitation group, which participated in an early, home-based CR program, and the control group, which received only usual care. All subjects in both groups underwent 3D-STE examinations of the left ventricle within 48 hours of percutaneous coronary intervention and again 4 weeks after discharge. Global longitudinal strain (GLS), global radial strain (GRS), global area strain (GAS), global circumferential strain (GCS), left ventricular ejection fraction (LVEF), and segmental strains were computed. The CR program was initially conducted with supervised inpatient training, followed by an unsupervised home-based training program during a 4-week follow-up. RESULTS We obtained segmental strains from 832 segments, of which 319 were defined as interventional segments, 179 as ischemic segments, and the remaining segments as normal segments. At the 4-week follow-up, when controlling for baseline values, the rehabilitation group showed significant improvements in GLS, GRS, GCS, GAS, LVEF, and in all of the segmental strains of the 3 subgroups compared with the control group (P <0.05). CONCLUSION Our study suggests that an early, home-based CR program can greatly improve the ventricular function of AMI patients in a short period of time.
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Affiliation(s)
- Lin Xu
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, PLA
| | - Zekun Cai
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, PLA
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Meihua Xiong
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, PLA
| | - Yekuo Li
- Department of Ultrasound, Guangzhou General Hospital of Guangzhou Military Region, PLA, Guangzhou
| | - Guoying Li
- Department of Ultrasound, Guangzhou General Hospital of Guangzhou Military Region, PLA, Guangzhou
| | - Yu Deng
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, PLA
| | - William Kongto Hau
- LiKaShing Faculty of Medicine, Institute of Cardiovascular Medicine and Research, University of Hong Kong, Hong Kong, China
| | - Shuo Li
- Department of Medical Imaging, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Wenhua Huang
- School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jian Qiu
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, PLA
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11
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Schouver ED, Moceri P, Doyen D, Tieulie N, Queyrel V, Baudouy D, Cerboni P, Gibelin P, Leroy S, Fuzibet JG, Ferrari E. Early detection of cardiac involvement in sarcoidosis with 2-dimensional speckle-tracking echocardiography. Int J Cardiol 2016; 227:711-716. [PMID: 27836307 DOI: 10.1016/j.ijcard.2016.10.073] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/27/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND/OBJECTIVES Cardiac sarcoidosis (CS) is associated with high morbidity and sudden death. The absence of specific symptoms and lack of diagnostic gold standard technique is challenging. New imaging methods could improve the diagnosis of CS. The aim of our study was to assess the role of left ventricular (LV) longitudinal and circumferential strain as estimated by 2D speckle-tracking imaging in patients with diagnosed sarcoidosis without cardiac involvement according to the current guidelines. We investigated the prevalence of LV strain impairment in this population and assessed its relationship with clinical outcomes, composite of mortality, heart failure, arrhythmia and/or secondarily development of CS and cardiac device implantation. METHODS AND RESULTS We performed a prospective case-control longitudinal study including 35 patients with diagnosed sarcoidosis and normal cardiac function as assessed by standard transthoracic echocardiography and 35 healthy age- and gender-matched controls. All patients underwent a comprehensive echocardiographic study. Mean age of patients was 47.9±14.8years old (22 women). Compared with controls, global LV longitudinal strain (LV GLS) was reduced in sarcoidosis patients: (-17.2±3.1 vs -21.3±1.5%, p<0.0001). Circumferential LV strain was preserved in patients compared to controls (-19.9±-4.3% vs -21.3±1.5%, p=0.12). Impaired LV GLS was significantly associated with clinical outcomes (HR 1.56; [1.16-2.11], p<0.01) on univariate analysis. CONCLUSION Speckle-tracking echocardiography revealed decreased longitudinal LV strain in sarcoidosis patients that was associated with outcomes. LV GLS may represent an early marker of myocardial involvement in sarcoidosis patients that needs to be studied further.
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Affiliation(s)
| | - Pamela Moceri
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France.
| | - Denis Doyen
- Medical Intensive Care Unit, Hôpital L'Archet, CHU de Nice, Nice, France
| | - Nathalie Tieulie
- Internal medicine Department, Hôpital L'Archet, CHU de Nice, Nice, France
| | - Viviane Queyrel
- Internal medicine Department, Hôpital L'Archet, CHU de Nice, Nice, France
| | - Delphine Baudouy
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France
| | - Pierre Cerboni
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France
| | - Pierre Gibelin
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France
| | - Sylvie Leroy
- Respiratory medicine Department, Hôpital Pasteur, CHU de Nice, Nice, France
| | | | - Emile Ferrari
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France
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12
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Feasibility of One-Beat Real-Time Full-Volume Three-Dimensional Echocardiography for Assessing Left Ventricular Volumes and Deformation Parameters. J Am Soc Echocardiogr 2016; 29:853-860.e2. [DOI: 10.1016/j.echo.2016.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Indexed: 11/20/2022]
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13
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Nie Y, Zhang Z, Zou J, Liang Y, Cao X, Liu Z, Shen B, Chen X, Ding X. Hemodialysis-induced regional left ventricular systolic dysfunction. Hemodial Int 2016; 20:564-572. [PMID: 27312507 DOI: 10.1111/hdi.12434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Hemodialysis (HD) patients are under observably elevated cardiovascular mortality. Cardiac dysfunction is closely related to death caused by cardiovascular diseases (CVD). In the general population, repetitive myocardial ischemia induced left ventricular (LV) dysfunction may progress to irreversible loss of contraction step by step, and finally lead to cardiac death. In HD patients, to remove water and solute accumulated from 48 or 72 hours of interdialysis period in a 4-hour HD session will induce myocardial ischemia. In this study, we evaluated the prevalence and potential risk factors associated with HD-induced LV systolic dysfunction and provide some evidences for clinical strategies. Methods We recruited 31 standard HD patients for this study from Fudan University Zhongshan hospital. Echocardiography was performed predialysis, at peak stress during HD (15 minutes prior to the end of dialysis), and 30 minutes after HD. Auto functional imaging (AFI) was used to assess the incidence and persistence of HD-induced regional wall motion abnormalities (RWMAs). Blood samples were drawn to measure biochemical variables. Findings Among totally 527 segments of 31 patients, 93.54% (29/31) patients and 51.40% (276/527) segments were diagnosed as RWMAs. Higher cTnT (0.060 ± 0.030 vs. 0.048 ± 0.015 ng/mL, P = 0.023), phosphate (2.07 ± 0.50 vs. 1.49 ± 0.96 mmol/L, P = 0.001), UFR (11.00 ± 3.89 vs. 8.30 ± 2.66 mL/Kg/h, P = 0.039) and lower albumin (37.83 ± 4.48 vs. 38.38 ± 2.53 g/L, P = 0.050) were found in patients with severe RWMAs (RWMAs in more than 50% segments). After univariate and multivariate analysis, interdialytic weight gain (IDWG) was found as independent risk factor of severe RWMAs (OR = 1.047, 95%CI 1.155-4.732, P = 0.038). Discussion LV systolic dysfunction induced by HD is prevalent in conventional HD patients and should be paid attention to. Patients would benefit from better weight control during interdialytic period to reduce ultrafiltration rate.
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Affiliation(s)
- Yuxin Nie
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Zhen Zhang
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Jianzhou Zou
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.,Key Laboratory of Kidney and Blood Purification of Shanghai, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Yixiu Liang
- Division of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Xuesen Cao
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Zhonghua Liu
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Bo Shen
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Xiaohong Chen
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China. .,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China. .,Key Laboratory of Kidney and Blood Purification of Shanghai, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
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Malik V, Subramaniam A, Kapoor PM. Strain and strain rate: An emerging technology in the perioperative period. Ann Card Anaesth 2016; 19:112-21. [PMID: 26750682 PMCID: PMC4900405 DOI: 10.4103/0971-9784.173026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Newer noninvasive parameters are being used for perioperative detection of myocardial ischaemia. TDI and global strain rate are some of these parameters. TDI signal is a modification of the routine Doppler flow signal. It is obtained by using thresholding and filtering algorithms that reject echoes originating from the blood pool (by-passing the high pass filter). Set-Up of the machine by activating the TDI function allows decreasing the system gain using a low pass filter and eliminates the signal produced by blood flow. Doppler shift obtained from myocardial tissue motion are of higher amplitudes (reflectivity 40 dB higher) and move about 10 times slower than blood (velocity range: 0.06 to 0.24 m/s). Speckle tracking echocardiography (tissue tracking, 2D strain) utilizes routine gray-scale 2D echo images to calculate myocardial strain. Interactions of ultrasound with myocardium result in reflection and scattering. These interactions generate a finely gray-shaded, speckled pattern (acoustic marker). This speckled pattern is unique for each myocardial region and relatively stable throughout the cardiac cycle. Spatial and temporal image processing of acoustic speckles in both 2D and 3D allows for the calculation of myocardial velocity, strain, and Strain rate.
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15
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Wang D, Sun JP, Lee APW, Ma GS, Yang XS, Yu CM, Ding JD, Liu NF. Evaluation of left ventricular function by three-dimensional speckle-tracking echocardiography in patients with myocardial bridging of the left anterior descending coronary artery. J Am Soc Echocardiogr 2015; 28:674-82. [PMID: 25795472 DOI: 10.1016/j.echo.2015.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND To understand the influence of myocardial bridging (MB) on left ventricular (LV) function, myocardial function was studied in patients with MB of the left anterior descending coronary artery (LAD) using three-dimensional speckle-tracking echocardiography (STE). METHODS Left anterior descending coronary artery MB was diagnosed by coronary angiography in 82 subjects. Patients were divided into three groups according to the percentage of systolic narrowing of the compressed segment: 30% to 49% was defined as group I (24 patients), 50% to 74% as group II (28 patients), and ≥75% as group III (30 patients). Thirty gender- and age-matched normal subjects were included as controls. Left ventricular myocardial deformation was estimated by three-dimensional STE. RESULTS Left ventricular ejection fractions were normal in all patients, but diastolic function was impaired in groups II and III (E/E' ratio, 9 ± 3 and 10 ± 3, respectively). The amplitudes of longitudinal strain (LS) and area strain (AS) of the LAD territory was significantly reduced in groups II and III compared with controls and group I (LS, -15 ± 2% and -12 ± 1% vs -19 ± 2% and -18 ± 2%; AS, -22 ± 2% and -13 ± 2% vs -33 ± 4% and -33 ± 3%; P < .0001), but the amplitudes of circumferential and radial strain showed no intergroup differences. Longitudinal strain and AS were significantly lower in patients with fractional flow reserve < 0.75 than in those with fractional flow reserve ≥ 0.75 (P < .0001), with relative preservation of circumferential and radial strain. The severity of LAD compression was significantly associated with AS and LS of the LAD territory (r = -0.92 and r = -0.84, respectively, P < .0001), but the correlations with circumferential and radial strain were modest (r = -0.36 and r = -0.32, respectively, P < .05). CONCLUSIONS With the increasing severity of systolic compression of the mural coronary artery, LV diastolic function and regional systolic deformation (AS and LS) of the MB perfusion territory were reduced. Three-dimensional STE can detect subtle myocardial dysfunction in patients with MB.
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Affiliation(s)
- Dian Wang
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Jing Ping Sun
- Division of Cardiology, Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Alex Pui-wai Lee
- Division of Cardiology, Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Gen Shan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Xing Sheng Yang
- Division of Cardiology, Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk-man Yu
- Division of Cardiology, Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jian Dong Ding
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Nai Feng Liu
- Department of Cardiology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China.
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Muraru D, Cucchini U, Mihăilă S, Miglioranza MH, Aruta P, Cavalli G, Cecchetto A, Padayattil-Josè S, Peluso D, Iliceto S, Badano LP. Left Ventricular Myocardial Strain by Three-Dimensional Speckle-Tracking Echocardiography in Healthy Subjects: Reference Values and Analysis of Their Physiologic and Technical Determinants. J Am Soc Echocardiogr 2014; 27:858-871.e1. [DOI: 10.1016/j.echo.2014.05.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Indexed: 01/05/2023]
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