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Antoniou N, Kalaitzoglou M, Tsigkriki L, Baroutidou A, Tsaousidis A, Koulaouzidis G, Giannakoulas G, Charisopoulou D. Speckle Tracking Echocardiography in Patients with Non-Ischemic Dilated Cardiomyopathy Who Undergo Cardiac Resynchronization Therapy: A Narrative Review. Diagnostics (Basel) 2024; 14:1178. [PMID: 38893704 PMCID: PMC11171556 DOI: 10.3390/diagnostics14111178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Non-ischemic dilated cardiomyopathy (DCM) represents a significant cause of heart failure, defined as the presence of left ventricular (LV) dilatation and systolic dysfunction unexplained solely by abnormal loading conditions or coronary artery disease. Cardiac resynchronization therapy (CRT) has emerged as a cornerstone in the management of heart failure, particularly in patients with DCM. However, identifying patients who will benefit the most from CRT remains challenging. Speckle tracking echocardiography (STE) has garnered attention as a non-invasive imaging modality that allows for the quantitative assessment of myocardial mechanics, offering insights into LV function beyond traditional echocardiographic parameters. This comprehensive review explores the role of STE in guiding patient selection and optimizing outcomes in CRT for DCM. By assessing parameters such as LV strain, strain rate, and dyssynchrony, STE enables a more precise evaluation of myocardial function and mechanical dyssynchrony, aiding in the identification of patients who are most likely to benefit from CRT. Furthermore, STE provides valuable prognostic information and facilitates post-CRT optimization by guiding lead placement and assessing response to therapy. Through an integration of STE with CRT, clinicians can enhance patient selection, improve procedural success rates, and ultimately, optimize clinical outcomes in patients with DCM. This review underscores the pivotal role of STE in advancing personalized management strategies for DCM patients undergoing CRT.
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Affiliation(s)
- Nikolaos Antoniou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (N.A.); (M.K.); (L.T.); (A.T.)
| | - Maria Kalaitzoglou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (N.A.); (M.K.); (L.T.); (A.T.)
| | - Lamprini Tsigkriki
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (N.A.); (M.K.); (L.T.); (A.T.)
| | - Amalia Baroutidou
- Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.B.); (G.G.)
| | - Adam Tsaousidis
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (N.A.); (M.K.); (L.T.); (A.T.)
| | - George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - George Giannakoulas
- Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.B.); (G.G.)
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Melo S, Alzate-Ricaurte S, Pedroza S, Moreno M, Largo J, Rivera R, Cruz G. Optimal Global Longitudinal Strain Thresholds for Pediatric Heart Surgery: Insights from a University Hospital. Pediatr Cardiol 2024; 45:780-786. [PMID: 38421480 DOI: 10.1007/s00246-024-03437-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
Congenital heart diseases impact millions annually, with pediatric care lacking suitable risk assessment tools. This research seeks to illuminate the association between the global longitudinal strain (GLS) and the subsequent impact on postoperative outcomes, contributing to a deeper understanding of its predictive value in the pediatric population affected by congenital heart diseases. An observational, analytic, longitudinal, and prospective study was conducted from May 2022 to May 2023, including all patients under 18 undergoing heart surgery with cardiopulmonary bypass (CBP). Patients not classifiable within the Risk Adjustment for Congenital Heart Surgery were excluded. Using transesophageal echocardiography, GLS was measured pre- and post-CPB. Receiver operating characteristic curve analysis determined GLS cut-off points for 30-day mortality risk, using Youden's method for optimal sensitivity and specificity. Bivariate and multivariate analysis identified the relationships between clinical variables. Eighty-nine patients undergoing congenital heart surgery were included. Fifteen deaths occurred. The area under the curve (AUC) for each GLS classification (pre, post, index) demonstrated effective discriminatory capacity (> 0.70) in predicting 30-day mortality. Pre-CBP GLS showed the strongest predictive power (AUC 0.833, IQR: 0.731 - 0.936) with a cut-off point of 12. Values lower than the cut-off point of pre-CPB GLS correlated with increased vasoactive-inotropic Scores and longer mechanical ventilation. GLS measurement is a reproducible method for assessing ventricular function in pediatric heart surgery, showing potential as a prognostic tool. This study marks the initial effort to establish cut-off points for preoperative GLS, postoperative GLS, and the strain index.
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Affiliation(s)
- Sofía Melo
- Departamento de Anestesiología, Facultad de Medicina, Universidad Icesi, Calle 18 No. 122-135, 760031, Cali, Colombia
| | - Sergio Alzate-Ricaurte
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia
| | - Santiago Pedroza
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia
| | - Mabel Moreno
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia
| | - Jessica Largo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia
| | - Richard Rivera
- Facultad de Medicina, Universidad Icesi, Calle 18 No. 122-135, 760031, Cali, Colombia
| | - Gustavo Cruz
- Departamento de Anestesiología, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia.
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Dell'Angela L, Nicolosi GL. From ejection fraction, to myocardial strain, and myocardial work in echocardiography: Clinical impact and controversies. Echocardiography 2024; 41:e15758. [PMID: 38284670 DOI: 10.1111/echo.15758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Enhancing an echocardiographic tool, aimed to detect even subtle left ventricular (LV) systolic function abnormalities, capable of obtaining both early diagnosis and risk prediction of heart disease, represents an ambitious, attractive, and arduous purpose in the modern era of cardiovascular imaging. Ideally, that tool should be simple, reliable, and reproducible, in order to be concretely applied in routine clinical practice. Importantly, that technique should be physiologically plausible and useful both at the population-level, as well as in the individual subject. For a long time, LV ejection fraction (EF) has been considered the first-line parameter for assessing LV global systolic function, strictly related to the prognosis, at least in some settings. However, LV EF limitations are well-known, even though frequently overemphasized, including its load-dependency. Therefore, myocardial strain techniques have been proposed, deemed able to disclose even subtle early LV function anomalies. Nevertheless, many disadvantages of myocardial strain have been reported as well. More recently, myocardial work (MW) analysis has been introduced as a new echocardiographic tool for the evaluation of LV global systolic function, attempting to overcome EF and strain disadvantages. However, MW has shown many limits as well. Notwithstanding, LV EF still remains a landmark functional classification marker for heart failure and cardiac oncology, allowing reliable fast reassessment of LV function changes during patient management, in order to guide treatment in individual cases as well. Notably, global longitudinal strain and MW parameters seem to show better meaningful results at the population-level, but controversial clinical impact, major limitations, wide cut-offs spread and overlap, when the single value needs to be applied to the single case. Taking into account the recent literature-based evidence, the scope of the present narrative critical review is trying to delineate the different types of information given by the described LV global systolic function parameters, both at the population-level and in the individual case, in order to trace a comparative analysis of advantages and limitations in clinical practice.
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Affiliation(s)
- Luca Dell'Angela
- Cardio-Thoracic and Vascular Department, Cardiology Division, Gorizia & Monfalcone Hospital, ASUGI, Gorizia, Italy
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Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
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Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
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Krljanac G, Apostolovic S, Polovina M, Maksimovic R, Nedeljkovic Arsenovic O, Djordjevic N, Stankovic S, Savic L, Djokovic A, Viduljevic M, Stankovic S, Asanin M. The follow-up of myocardial injury and left ventricular function after spontaneous coronary artery dissection. Front Cardiovasc Med 2023; 10:1276347. [PMID: 38034376 PMCID: PMC10682093 DOI: 10.3389/fcvm.2023.1276347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023] Open
Abstract
Monitoring patients with spontaneous coronary dissection (SCAD) is critical in their care, as there are no accepted recommendations. To this end, finding clinical or imaging predictors of recurrent events in these patients is essential for predicting adverse events and guiding treatment decisions between conservative medical therapy and percutaneous coronary intervention. Myocardial injury and left ventricular function after SCAD can be variable parameters that require monitoring. Echocardiography and cardiac magnetic resonance are two useful imaging techniques to do so. This review aims to analyze previously published results on monitoring myocardial injury and left ventricular function in SCAD patients while highlighting the potential benefits of contemporary imaging techniques that could further improve patient care in the future.
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Affiliation(s)
- Gordana Krljanac
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetlana Apostolovic
- Coronary Care Unit, Cardiology Clinic, University Clinical Center of Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marija Polovina
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ruzica Maksimovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Nedeljkovic Arsenovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nemanja Djordjevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Stefan Stankovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lidija Savic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Djokovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Mihajlo Viduljevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milika Asanin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Li J, Jiang H, Cui J, Zhang Y, Li M, Zhou H, Li X. Comparison of ventricular synchrony in children with left bundle branch area pacing and right ventricular septal pacing. Cardiol Young 2023; 33:2078-2086. [PMID: 36601894 DOI: 10.1017/s1047951122003675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to determine the ideal pacing site in children by comparing the postoperative ventricular synchrony in children with left bundle branch area pacing and those with right ventricular septal pacing. METHODS This retrospective study included children with complete atrioventricular block who underwent permanent pacemaker implantation from March 2019 to August 2021. Patients were grouped according to their ventricular pacing site, the left bundle branch area pacing group and the right ventricular septal pacing group. Two-dimensional speckle tracking echocardiography was used to evaluate the ventricular synchrony. RESULTS Forty-eight children (median age, 2.7 years; interquartile range, 1.7-4.6 years) were included. The paced QRS duration in the left bundle branch area pacing group was significantly narrower than that in the right ventricular septal pacing group (100.2 ± 9.3 versus 115.4 ± 15.1 ms, p = 0.001). The median follow-up duration was 1.5 years (interquartile range, 1-2 years). At the last follow-up, the average capture threshold of the ventricular electrode in the left bundle branch area pacing group was lower than that in the right ventricular septal pacing group (0.79 ± 0.18 versus 1.20 ± 0.56 V, p = 0.008). The left ventricular intraventricular synchrony parameters in the left bundle branch area pacing group were better than those in the right ventricular septal pacing group (e.g. standard deviation of the time to peak longitudinal strain, 37.4 ± 4.3 versus 46.6 ± 8.2 ms, p = 0.000). The average interventricular mechanical delay time in the left bundle branch area pacing group was significantly shorter than that in the right ventricular septal pacing group (36.4 ± 14.2 versus 52.5 ± 22.7 ms, p = 0.016). CONCLUSION Compared with right ventricular septal pacing, left bundle branch area pacing in children produces a narrower QRS duration and better pacing and ventricular synchrony parameters postoperatively.
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Affiliation(s)
- Jinghao Li
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - He Jiang
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jian Cui
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
| | - Yi Zhang
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
| | - Meiting Li
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
| | - Huiming Zhou
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiaomei Li
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
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Floria M, Tanase DM. Subclinical systolic dysfunction and myocardial deformation: From GLS to VVI. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1298-1300. [PMID: 37671624 DOI: 10.1002/jcu.23540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Mariana Floria
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
- Internal Medicine Clinic, Sf. Spiridon Emergency Hospital, Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
- Internal Medicine Clinic, Sf. Spiridon Emergency Hospital, Iasi, Romania
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Anan R, Imoto T, Onizuka K, Watanabe H, Mori W, Murakoso M. Concentric hypertrophy geometry is a significant determinant of impaired global longitudinal strain in patients with normal cardiac structure and function. Heliyon 2023; 9:e16252. [PMID: 37265622 PMCID: PMC10230210 DOI: 10.1016/j.heliyon.2023.e16252] [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: 09/06/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
Background In recent years, the assessment of global longitudinal strain (GLS) derived by speckle-tracking analysis has become a clinically feasible alternative to left ventricular (LV) ejection fraction (LVEF) for the assessment of myocardial function. However, the determinant factors of impaired GLS in structurally and functionally normal patients are unclarified. The objective of this study was to elucidate the determinant factors of impaired GLS in structurally and functionally normal patients. Methods We evaluated structurally and functionally normal patients scheduled to undergo noncardiac surgery. The evaluated patient characteristics were age, sex, presence of hypertension, presence of diabetes mellitus, presence of hyperlipidemia, systolic blood pressure, and body mass index. The concentrations of B-type natriuretic peptide and high-sensitivity troponin I were measured. Echocardiography was performed to determine the LVEF, GLS, transmitral early diastolic velocity/transmitral atrial velocity ratio, LV mass index (LVMI), and relative wall thickness (RWT). Patients with preserved LVEF (≥50%) were divided into the normal GLS group (GLS ≤ -20%) and the impaired GLS group (GLS > -20%). On the basis of the RWT and LVMI values, the patients were categorized as having four types of LV geometry. Logistic regression analysis was performed to ascertain the determinant factors of impaired GLS. Results The study cohort comprised 75 structurally and functionally normal patients (age 67.7 ± 12.6 years, 45 men). The GLS was normal in 43 patients and impaired in 32 patients. There was a significant difference in RWT between the impaired and normal GLS groups. The evaluation based on the LV geometry showed that six of seven patients with concentric hypertrophy geometry had impaired GLS, and the GLS was significantly more impaired in patients with concentric hypertrophy geometry than in patients with normal geometry or eccentric hypertrophy geometry. Logistic regression analysis revealed that LV concentric hypertrophy geometry was a significant determinant factor of impaired GLS (odds ratio 22.4, P = 0.042). Conclusions Global longitudinal strain is more impaired in structurally and functionally normal patients with concentric hypertrophy geometry compared with those with eccentric hypertrophy geometry or normal geometry. In addition, concentric hypertrophy geometry is a significant determinant for impaired GLS in patients with normal cardiac structure and function.
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Affiliation(s)
- Ryuichiro Anan
- Department of Cardiology, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Tatsuya Imoto
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Kumi Onizuka
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Hideaki Watanabe
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Wakako Mori
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Mayu Murakoso
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
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Palmiero G, Cesaro A, Galiero R, Loffredo G, Caturano A, Vetrano E, Rinaldi L, Salvatore T, Ruggiero R, Rosaria Di Palo M, Sardu C, Marfella R, Limongelli G, Calabrò P, Carlo Sasso F. Impact of gliflozins on cardiac remodeling in patients with type 2 diabetes mellitus & reduced ejection fraction heart failure: a pilot prospective study. GLISCAR Study. Diabetes Res Clin Pract 2023; 200:110686. [PMID: 37100231 DOI: 10.1016/j.diabres.2023.110686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) and heart failure are closely related entities and together determine an increased risk of mortality compared to patients suffering from only one of these diseases. Sodium-glucose co-transporter type 2 inhibitors (SGLT-2i) have shown favorable effects on cardiovascular system, particularly on heart failure. Aim of this study is to verify whether in individuals with T2DM and heart failure with reduced ejection fraction (HFrEF) treated with SGLT-2i, echocardiographic signs of favorable reverse remodeling follow longitudinal observation. METHODS 31 subjects with T2DM and HFrEF were finally included. All individuals performed clinical visit, medical history, blood sampling and echocardiography at time 0' and at the end of 6 months of follow-up on SGLT-2i treatment. RESULTS After 6 months follow-up, left ventricular ejection fraction (LVEF), global work index (GWI), global work efficiency (GWE), global longitudinal strain (GLS), left atrial expansion index (LAEI) and total left atrial emptying fraction (TLAEF), tricuspid annular plane systolic excursion (TAPSE), septal thickness (St), pulmonary artery systolic pressures (PASP) and TAPSE/PASP ratio significantly improved. CONCLUSIONS Despite the lack of a favorable effect on cardiac remodeling, SGLT-2i treatment significantly improved LV systolic and diastolic function, left atrial (LA) reservoir and total emptying function, RV systolic function and pulmonary artery pressure.
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Affiliation(s)
- Giuseppe Palmiero
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", I-80131 Naples, Italy.
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", I-80131 Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna & San Sebastiano", I-81100 Caserta, Italy.
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | - Giuseppe Loffredo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | - Teresa Salvatore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | - Roberto Ruggiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | | | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Via L. Bianchi, 80131 Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London WC1E 6DD, UK.
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", I-80131 Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna & San Sebastiano", I-81100 Caserta, Italy.
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I-80138 Naples, Italy.
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Chen PH, Hsiao CY, Chiang SJ, Shen RS, Lin YK, Chung KH, Tsai SY. Cardioprotective potential of lithium and role of fractalkine in euthymic patients with bipolar disorder. Aust N Z J Psychiatry 2023; 57:104-114. [PMID: 34875897 DOI: 10.1177/00048674211062532] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Over a half century, lithium has been used as the first-line medication to treat bipolar disorder. Emerging clinical and laboratory studies suggest that lithium may exhibit cardioprotective effects in addition to neuroprotective actions. Fractalkine (CX3CL1) is a unique chemokine associated with the pathogenesis of mood disorders and cardiovascular diseases. Herein we aimed to ascertain whether lithium treatment is associated with favorable cardiac structure and function in relation to the reduced CX3CL1 among patients with bipolar disorder. METHODS We recruited 100 euthymic patients with bipolar I disorder aged over 20 years to undergo echocardiographic study and measurement of plasma CX3CL1. Associations between lithium treatment, cardiac structure and function and peripheral CX3CL1 were analyzed according to the cardiovascular risk. The high cardiovascular risk was defined as (1) age ⩾ 45 years in men or ⩾ 55 years in women or (2) presence of concurrent cardiometabolic diseases. RESULTS In the high cardiovascular risk group (n = 61), patients who received lithium as the maintenance treatment had significantly lower mean values of left ventricular internal diameters at end-diastole (Cohen's d = 0.65, p = 0.001) and end-systole (Cohen's d = 0.60, p = 0.004), higher mean values of mitral valve E/A ratio (Cohen's d = 0.51, p = 0.019) and superior performance of global longitudinal strain (Cohen's d = 0.51, p = 0.037) than those without lithium treatment. In addition, mean plasma levels of CX3CL1 in the high cardiovascular risk group were significantly lower among patients with lithium therapy compared with those without lithium treatment (p = 0.029). Multiple regression models showed that the association between lithium treatment and mitral value E/A ratio was contributed by CX3CL1. CONCLUSION Data from this largest sample size study of the association between lithium treatment and echocardiographic measures suggest that lithium may protect cardiac structure and function in patients with bipolar disorder. Reduction of CX3CL1 may mediate the cardioprotective effects of lithium.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Cheng-Yi Hsiao
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei.,Cardiovascular Research Center, Taipei Medical University Hospital, Taipei.,Taipei Heart Institute, Taipei Medical University, Taipei.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine, Taipei City Hospital, Taipei
| | - Ruei-Siang Shen
- Department of Clinical Psychology, College of Medicine, Fu-Jen Catholic University, New Taipei City
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei
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11
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Molecular Approaches and Echocardiographic Deformation Imaging in Detecting Myocardial Fibrosis. Int J Mol Sci 2022; 23:ijms231810944. [PMID: 36142856 PMCID: PMC9501415 DOI: 10.3390/ijms231810944] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 12/25/2022] Open
Abstract
The pathological remodeling of myocardial tissue is the main cause of heart diseases. Several processes are involved in the onset of heart failure, and the comprehension of the mechanisms underlying the pathological phenotype deserves special attention to find novel procedures to identify the site of injury and develop novel strategies, as well as molecular druggable pathways, to counteract the high degree of morbidity associated with it. Myocardial fibrosis (MF) is recognized as a critical trigger for disruption of heart functionality due to the excessive accumulation of extracellular matrix proteins, in response to an injury. Its diagnosis remains focalized on invasive techniques, such as endomyocardial biopsy (EMB), or may be noninvasively detected by cardiac magnetic resonance imaging (CMRI). The detection of MF by non-canonical markers remains a challenge in clinical practice. During the last two decades, two-dimensional (2D) speckle tracking echocardiography (STE) has emerged as a new non-invasive imaging modality, able to detect myocardial tissue abnormalities without specifying the causes of the underlying histopathological changes. In this review, we highlighted the clinical utility of 2D-STE deformation imaging for tissue characterization, and its main technical limitations and criticisms. Moreover, we focalized on the importance of coupling 2D-STE examination with the molecular approaches in the clinical decision-making processes, in particular when the 2D-STE does not reflect myocardial dysfunction directly. We also attempted to examine the roles of epigenetic markers of MF and hypothesized microRNA-based mechanisms aiming to understand how they match with the clinical utility of echocardiographic deformation imaging for tissue characterization and MF assessment.
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12
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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: 1] [Impact Index Per Article: 0.5] [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.
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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
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13
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Bewarder Y, Lauder L, Kulenthiran S, Schäfer O, Ukena C, Percy Marshall R, Hepp P, Laufs U, Stöbe S, Hagendorff A, Böhm M, Mahfoud F, Ewen S. Global longitudinal strain differentiates physiological hypertrophy from maladaptive remodeling. IJC HEART & VASCULATURE 2022; 40:101044. [PMID: 35573652 PMCID: PMC9096142 DOI: 10.1016/j.ijcha.2022.101044] [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] [Received: 02/13/2022] [Revised: 03/27/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
Aims Differentiation of left ventricular (LV) hypertrophy in healthy athletes from pathological LV hypertrophy in heart disease is often difficult. We explored whether extended echocardiographic measurements such as E/e’ and global longitudinal strain (GLS) distinguish physiologic from maladaptive hypertrophy in hypertrophic cardiomyopathy, excessively trained athletes’ hearts and normal hearts. Methods Seventy-eight professional athletes (cyclists n = 37, soccer players n = 29, handball players n = 21) were compared with patients (n = 88) with pathological LV hypertrophy (hypertrophic obstructive cardiomyopathy (HOCM, n = 17), hypertensive heart disease (HHD, n = 36), severe aortic valve stenosis (AVS, n = 35) and with sedentary healthy individuals as controls (n = 37). Results LV ejection fraction (LVEF) was ≥50% in all patients, athletes (median age 26 years, all male) and the controls (97% male, median age 32 years). LV mass index (LVMI) and septal wall thickness was in normal range in controls, but elevated in cyclists and patients with pathological hypertrophy (p < 0.001 for both). E/e’ was elevated in all patients with maladaptive hypertrophy but normal in controls and athletes (p < 0.001 vs. pathological hypertrophy). Furthermore GLS was reduced in patients with pathological hypertrophy compared with athletes and controls (for both p < 0.001). In subjects with septal wall thickness >11 mm, GLS (≥−18%) has a specificity of 79% to distinguish between physiological and pathological hypertrophy. Conclusion GLS and E/e’ are reliable parameters unlike left ventricular mass or LV ejection fraction to distinguish pathological and physiological hypertrophy.
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Affiliation(s)
- Yvonne Bewarder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- Corresponding author at: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Geb. 41, 66421 Homburg/Saar, Germany.
| | - Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Saarraaken Kulenthiran
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ortwin Schäfer
- Cycling Team Israel Start-Up Nation, 4 Hanechoshet St., 6 Floor, Or Towers, 6971069 Tel Aviv, Israel
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | - Pierre Hepp
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Ulrich Laufs
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Stephan Stöbe
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Hagendorff
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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14
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The Diagnostic Role of Echocardiographic Strain Analysis in Patients Presenting with Chest Pain and Elevated Troponin: A Multicenter Study. J Am Soc Echocardiogr 2022; 35:857-867. [PMID: 35301094 DOI: 10.1016/j.echo.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Myocarditis presenting as acute chest pain with elevated troponins without significant cardiac compromise is rare in previously healthy children, often referred to as myopericarditis. Diagnosis is challenging as conventional echocardiographic measures of systolic function can be normal. This study aimed to demonstrate the diagnostic utility of strain imaging in this scenario. METHODS This is a multi-center retrospective study including patients presenting with chest pain and elevated troponin from 10 institutions who underwent cardiac MRI (CMR) and transthoracic echocardiogram (echo) within 30 days of each other (group 1). Findings were compared to 19 controls (group 2). Clinical data, conventional echo and CMR data were collected. Echo-derived strain was measured at the core lab. Group 1 was divided into subgroups as CMR myocarditis positive (group 1a) or negative (group 1b) based on established criteria. RESULTS Group 1 included 108 subjects (88 in group 1a, 20 in group 1b). While all groups had normal mean fractional shortening (FS) and mean left ventricular ejection fraction (LVEF), group 1 had significantly lower EF (56.8+/-7.0) compared to group 2 ( 62.3+/- 4.9, P<0.005) and FS (31.2+/- 4.9) compared to group 2 (34.1+/-3.5, p<0.05). Additionally, peak global longitudinal strain (GLS%) was markedly abnormal in group 1 (-13.9+/-3.4 ) compared to group 2 (-19.8+/-2.1 , P<0.001). In subgroup analysis, GLS% was markedly abnormal in group 1a (-13.2 ± 3.0%) compared to group 1b (-17.3 ± 2.6% and p<0.001). Fifty-four subjects had follow up echocardiograms (46 in group 1a, 8 in group 1b) with mean follow-up time of 10 months (SD=11 months). At follow up, while EF and FS returned to normal in all patients, abnormalities in strain persisted in group 1, with 22% of them still having abnormal GLS. Moreover, mean GLS was more abnormal in group 1a (-16.1 +/- 2.6) compared to group 1b (-17.4+/- 1.2, p<0.05). CONCLUSIONS Our study demonstrates that echo GLS% is significantly worse in subjects with myopericarditis presenting with chest pain and elevated troponins compared to controls even when conventional measures of systolic function are largely normal and that these abnormalities persisted overtime.
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15
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Tissue motion annular displacement to assess the left ventricular systolic function in healthy cats. Vet Res Commun 2022; 46:823-836. [PMID: 35258757 DOI: 10.1007/s11259-022-09907-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
The tissue motion annular displacement (TMAD) measures the longitudinal displacement of the mitral annulus during systole, using speckle-tracking echocardiography (STE). The main objective was to determine the TMAD means in healthy cats, exploring the correlations with systolic surrogates. The influence of age, body surface area (BSA), heart rate, and systemic blood pressure on the indices was also analyzed. One hundred ninety-three healthy, client-owned cats participated in this prospective, cross-sectional observational study undergoing conventional and STE. Apical four-chamber (AP4) and two-chamber (AP2) images were recorded for offline calculations. Mean TMAD values were similar to mitral annulus plane systolic excursion (MAPSE), varying between 4 to 4.8 mm depending on the annulus and image used. No significant differences between age and BSA categories were detected, except for AP4 MP%, reduced in the heavier group. TMAD variables showed moderate correlation with longitudinal strain (LSt) and MAPSE, but not with fraction shortening (FS) and ejection fraction (EF). The median time required for the offline calculation was 12.2 s for AP4 and 11.8 s for AP2. The technique showed moderate inter and intraobserver variation, proving a reliable tool for assessing left ventricular longitudinal systolic function in cats.
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16
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Qingfeng Z, Yi W, Wenhua L, Hongmei Z, Geqi D, Xuebing L, Chunmei L, Yan D, Lixue Y. Evaluation of left ventricular function by treadmill exercise stress echocardiography combined with layer‐specific strain technique in essential hypertension patients. J Clin Hypertens (Greenwich) 2022; 24:312-319. [PMID: 35188326 PMCID: PMC8924995 DOI: 10.1111/jch.14407] [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] [Received: 09/24/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate the diagnostic utility of treadmill exercise stress echocardiography (TESE) combined with left ventricular (LV) layer‐specific strain (LSS) in subclinical myocardial and reserve function of hypertensive patients. A total of 55 hypertensive patients and 51 controls were evaluated during rest and exercise. Two‐dimensional speckle tracking (2DST) and LSS technique was used to measure longitudinal and circumferential strains at rest and peak exercise, strain difference characteristics were then evaluated. Compared to the control subjects, both longitudinal and circumferential LSS showed different degrees of reduction in hypertensive group, which was more pronounced at peak exercise. The global longitudinal endocardium strain (GLSendo) at rest was 24.4% ± 1.5% in the control group versus 20.4% ± 2.3% in the hypertensive group, while the difference was more obvious at peak state (control vs. hypertensive group, 30.8% ± 2.8% and 22.8% ± 2.9%, respectively). In particular, endocardial strain under exercise can be used as a sensitive indicator where the LV contractile reserve (CR) function of the three layers are all impaired. TESE combined with LSS might increase diagnostic accuracy of myocardial performance in hypertension patients.
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Affiliation(s)
- Zhang Qingfeng
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Wang Yi
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Li Wenhua
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Zhang Hongmei
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Ding Geqi
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Liu Xuebing
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Li Chunmei
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Deng Yan
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Yin Lixue
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
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17
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Trivedi SJ, Campbell T, Davey CJ, Stefani L, Thomas L, Kumar S. Longitudinal strain with speckle tracking echocardiography predicts electroanatomic substrate for ventricular tachycardia in non-ischemic cardiomyopathy patients. Heart Rhythm O2 2022; 3:176-185. [PMID: 35496460 PMCID: PMC9043373 DOI: 10.1016/j.hroo.2022.02.002] [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: 11/30/2022] Open
Abstract
Background Longitudinal strain (LS) derived from speckle-tracking echocardiography (STE) corresponds to regions of scar in ischemic cardiomyopathy. Objective We investigated if regional LS abnormalities correlate with scar location and scar burden, identified using high-density electroanatomic mapping (EAM) in nonischemic cardiomyopathy (NICM). Methods Fifty NICM patients with ventricular tachycardia (VT) underwent echocardiography; multilayer (endocardial, midmyocardial, and epicardial) regional LS and global LS (GLS) were evaluated prior to EAM for detection of low-voltage scar. Patients were divided into 3 groups by EAM left ventricular scar location: (1) anteroseptal (group 1, n = 20); (2) inferolateral (group 2, n = 20); and (3) epicardial scar (group 3; n = 10). We correlated (1) location of scar to regional LS and (2) regional strain and GLS to scar percentage. Results Regional LS abnormalities correlated with EAM scar in all groups. Segmental impaired LS and low voltage on EAM demonstrated concordance with scar in ∼75% or its border zone in 25% of segments. In groups 1 and 2, endocardial GLS showed a strong linear correlation with endocardial bipolar scar percentage (r = 0.79, 0.75 for groups 1 and 2, respectively; P < .001), whereas midmyocardial GLS correlated with unipolar scar percentage (r = 0.82, 0.78 for groups 1 and 2, respectively; P < .001). In group 3, epicardial regional LS and GLS correlated with epicardial bipolar scar percentage (r = 0.72, P < .001). Conclusion Regional abnormalities on LS predict scar location on EAM mapping in patients with NICM. Moreover, global and regional LS correlate with scar percentage. STE could be used as a noninvasive tool for localizing and quantifying scar prior to EAM.
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Abstract
AIM Evidence on the impact of blood pressure (BP)-lowering drugs on left ventricular (LV) mechanics in hypertension is still limited. We performed a meta-analysis of speckle-tracking echocardiographic studies in order to provide a new piece of information on this topic. METHODS The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search for articles published from the inception up to 31 October 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular hypertrophy', 'systemic hypertension', 'BP lowering drugs,' 'antihypertensive therapy'. RESULTS A total of 1140 hypertensive patients (mean age 55.4 years, 50% men, follow-up 6-36 months) were included in eight studies. Pretreatment and posttreatment pooled SBP/DBPs were 148.4 ± 3.5/88.7 ± 2 vs. 127.4 ± 1.9/77.8 ± 0.9 mmHg. Corresponding values for ejection fraction (EF), LV mass (LVM) index, and global longitudinal strain (GLS) were 64 ± 2.3 vs. 65.9 ± 1.7% (SMD: 0.14 ± 0.03, CI 0.08- 0.20, P = 0.001); 108.4 ± 11.2 vs. 100.2 ± 11.0 g/m2 (SMD: -0.27 ± 0.10, CI -0.46 to -0.08, P < 0.01); -17.7 ± 0.6 vs. -19.6 ± 0.4%, (SMD 0.26 ± 0.03, CI 0.20-0.32, P < 0.0001), respectively. A meta-regression analysis showed a significant relation between GLS improvement and the extent of reduction of LVMI (P = 0.0003), but not of SBP (P = 0.27). CONCLUSION Our meta-analysis suggests that antihypertensive treatment has a clear beneficial effect on LV mechanisms, and the improvement in GLS is mainly related to the reduction in LVMI rather than SBP.
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Tudoran C, Tudoran M, Cut TG, Lazureanu VE, Oancea C, Marinescu AR, Pescariu SA, Pop GN, Bende F. Evolution of Echocardiographic Abnormalities Identified in Previously Healthy Individuals Recovering from COVID-19. J Pers Med 2022; 12:jpm12010046. [PMID: 35055360 PMCID: PMC8778114 DOI: 10.3390/jpm12010046] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Although the infection with the SARS-CoV-2 virus affects primarily the lungs, it is well known that associated cardiovascular (CV) complications are important contributors to the increased morbidity and mortality of COVID-19. Thus, in some situations, their diagnosis is overlooked, and during recovery, some patients continue to have symptoms enclosed now in the post-acute COVID-19 syndrome. (2) Methods: In 102 patients, under 55 years old, and without a history of CV diseases, all diagnosed with post-acute COVID-19 syndrome, we assessed by transthoracic echocardiography (TTE) four patterns of abnormalities frequently overlapping each other. Their evolution was followed at 3 and 6 months. (3) Results: In 35 subjects, we assessed impaired left ventricular function (LVF), in 51 increased systolic pulmonary artery pressure, in 66 diastolic dysfunction (DD) with normal LVF, and in 23 pericardial effusion/thickening. All TTE alterations alleviated during the follow-up, the best evolution being observed in patients with pericarditis, and a considerably worse one in those with DD, thus with a reduction in severity (4) Conclusions: In patients with post-acute COVID-19 syndrome, several cardiac abnormalities may be assessed by TTE, most of them alleviating in time. Some of them, especially DD, may persist, raising the presumption of chronic alterations.
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Affiliation(s)
- Cristina Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
| | - Mariana Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Correspondence: (M.T.); (T.G.C.); Tel.: +40-722310302 (M.T.)
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Correspondence: (M.T.); (T.G.C.); Tel.: +40-722310302 (M.T.)
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
| | - Cristian Oancea
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.E.L.); (C.O.); (A.R.M.)
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Silvius Alexandru Pescariu
- Doctoral School, Victor Baes university of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Gheorghe Nicusor Pop
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Felix Bende
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (C.T.); (M.T.); (F.B.)
- County Emergency Hospital, Liviu Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Center of Advanced Research in Gastroenterology and Hepatology, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania
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20
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Chen PH, Chiang SJ, Hsiao CY, Shen RS, Lin YK, Chung KH, Tsai SY. Echocardiographic study of cardiac structure and function in people with bipolar disorder after midlife. J Affect Disord 2022; 296:428-433. [PMID: 34606806 DOI: 10.1016/j.jad.2021.09.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Heart failure is the leading cause of mortality in older people with bipolar disorder (BD). Studies examining cardiac structure and function in middle-aged patients with BD by using echocardiography and cardiac strain imaging are scant. METHODS We recruited 48 patients with bipolar I disorder (BD-I) older than 45 years to undergo conventional and tissue speckle tracking echocardiography. Data of 31 mentally healthy adults older than 45 years were randomly retrieved from the echocardiographic dataset and compared with the data of BD patients. RESULTS Patients with BD-I had significantly higher mean values of interventricular septal thickness (Cohen's d = 0.83, p = 0.001) and left ventricular internal diameter (Cohen's d = 0.90, p = 0.001) at end-diastole relative to controls. Additionally, BD-I patients exhibited significantly lower mean values of mitral valve E/A ratio (Cohen's d = 0.67, p = 0.007) and a more reduced global longitudinal strain (Cohen's d = 0.72, p = 0.029) than controls. Multiple linear regression revealed that body mass index was negatively correlated with the mitral valve E/A ratio (adjustment R2 = 0.363, p = 0.043) in patients with BD-I. LIMITATIONS A relatively small sample size may limit generalization. CONCLUSIONS After midlife, BD patients exhibit cardiac diastolic (low mitral valve E/A ratio) and systolic (reduced global longitudinal strain) dysfunction. High body mass index may play a role in the unfavorable cardiac function in aging patients with BD.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan; School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Yi Hsiao
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ruei-Siang Shen
- Department of Clinical Psychology, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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21
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Echocardiographic Parameters as Predictors for the Efficiency of Resynchronization Therapy in Patients with Dilated Cardiomyopathy and HFrEF. Diagnostics (Basel) 2021; 12:diagnostics12010035. [PMID: 35054202 PMCID: PMC8774311 DOI: 10.3390/diagnostics12010035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) represents an increasingly recommended solution to alleviate symptomatology and improve the quality of life in individuals with dilated cardiomyopathy (DCM) and heart failure (HF) with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy (OMT). However, this therapy does have the desired results all cases, in that sometimes low sensing and high voltage stimulation are needed to obtain some degree of resynchronization, even in the case of perfectly placed cardiac pacing leads. Our study aims to identify whether there is a relationship between several transthoracic echocardiographic (TTE) parameters characterizing left ventricular (LV) performance, especially strain results, and sensing and pacing parameters. Between 2020–2021, CRT was performed to treat persistent symptoms in 48 patients with a mean age of 64 (53.25–70) years, who were diagnosed with DCM and HFrEF, and who were still symptomatic despite OMT. We documented statistically significant correlations between global longitudinal strain, posterolateral strain, and ejection fraction and LV sensing (r = 0.65, 0.469, and 0.534, respectively, p < 0.001) and LV pacing parameters (r = −0.567, −0.555, and −0.363, respectively, p < 0.001). Modern imaging techniques, such as TTE with cardiac strain, are contributing to the evaluation of patients with HFrEF, increasing the chances of CRT success, and allowing physicians to anticipate and plan for case management.
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22
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Kvasnička J, Petrák O, Zelinka T, Klímová J, Kološov B, Novák K, Michalský D, Widimský J, Holaj R. Effect of adrenalectomy on remission of subclinical left ventricular dysfunction in patients with pheochromocytoma: a speckle-tracking echocardiography study. Endocr Connect 2021; 10:1538-1549. [PMID: 34734567 PMCID: PMC8679879 DOI: 10.1530/ec-21-0462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Pheochromocytomas (PHEO) are tumours with the ability to produce, metabolize and secrete catecholamines. Catecholamines overproduction leads to the decrease of longitudinal function of the left ventricle (LV) measured by speckle-tracking echocardiography. Patients with PHEO have a lower magnitude of global longitudinal strain (GLS) than patients with essential hypertension. GLS normalization is expected after resolution of catecholamine overproduction. METHODS Twenty-four patients (14 females and 10 males) with a recent diagnosis of PHEO have been examined before and 1 year after adrenalectomy. An echocardiographic examination including speckle-tracking analysis with the evaluation of GLS and regional longitudinal strain (LS) in defined groups of LV segments (basal, mid-ventricular and apical) was performed. RESULTS One year after adrenalectomy, the magnitude of GLS increased (-14.3 ± 1.8 to -17.7 ± 1.6%; P < 0.001). When evaluating the regional LS, the most significant increase in the differences was evident in the apical segment compared to mid-ventricular and basal segments of LV (-5.4 ± 5.0 vs -1.9 ± 2.7 vs -1.6 ± 3.8; P < 0.01). CONCLUSIONS In patients with PHEO, adrenalectomy leads to an improvement of subclinical LV dysfunction represented by the increasing magnitude of GLS, which is the most noticeable in apical segments of LV.
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Affiliation(s)
- Jan Kvasnička
- 3rd Department of Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
| | - Ondřej Petrák
- 3rd Department of Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
| | - Tomáš Zelinka
- 3rd Department of Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
| | - Judita Klímová
- 3rd Department of Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
| | - Barbora Kološov
- 3rd Department of Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
| | - Květoslav Novák
- Department of Urology, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
| | - David Michalský
- 1st Department of Surgery, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
| | - Jiří Widimský
- 3rd Department of Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
| | - Robert Holaj
- 3rd Department of Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
- Correspondence should be addressed to R Holaj:
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23
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Weise Valdés E, Barth P, Piran M, Laser KT, Burchert W, Körperich H. Left-Ventricular Reference Myocardial Strain Assessed by Cardiovascular Magnetic Resonance Feature Tracking and fSENC-Impact of Temporal Resolution and Cardiac Muscle Mass. Front Cardiovasc Med 2021; 8:764496. [PMID: 34796219 PMCID: PMC8593240 DOI: 10.3389/fcvm.2021.764496] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: Cardiac strain parameters are increasingly measured to overcome shortcomings of ejection fraction. For broad clinical use, this study provides reference values for the two strain assessment methods feature tracking (FT) and fast strain-encoded (fSENC) cardiovascular magnetic resonance (CMR) imaging, including the child/adolescent group and systematically evaluates the influence of temporal resolution and muscle mass on strain. Methods and Results: Global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain values in 181 participants (54% women, 11–70 years) without cardiac illness were assessed with FT (CVI42® software). GLS and GCS were also analyzed using fSENC (MyoStrain® software) in a subgroup of 84 participants (60% women). Fourteen patients suffering hypertrophic cardiomyopathy (HCM) were examined with both techniques. CMR examinations were done on a 3.0T MR-system. FT-GLS, FT-GCS, and FT-GRS were −16.9 ± 1.8%, −19.2 ± 2.1% and 34.2 ± 6.1%. fSENC-GLS was higher at −20.3 ± 1.8% (p < 0.001). fSENC-GCS was comparable at−19.7 ± 1.8% (p = 0.06). All values were lower in men (p < 0.001). Cardiac muscle mass correlated (p < 0.001) with FT-GLS (r = 0.433), FT-GCS (r = 0.483) as well as FT-GRS (r = −0.464) and acts as partial mediator for sex differences. FT-GCS, FT-GRS and fSENC-GLS correlated weakly with age. FT strain values were significantly lower at lower cine temporal resolutions, represented by heart rates (r = −0.301, −0.379, 0.385) and 28 or 45 cardiac phases per cardiac cycle (0.3–1.9% differences). All values were lower in HCM patients than in matched controls (p < 0.01). Cut-off values were −15.0% (FT-GLS), −19.3% (FT-GCS), 32.7% (FT-GRS), −17.2% (fSENC-GLS), and −17.7% (fSENC-GCS). Conclusion: The analysis of reference values highlights the influence of gender, temporal resolution, cardiac muscle mass and age on myocardial strain values.
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Affiliation(s)
- Elena Weise Valdés
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Peter Barth
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Misagh Piran
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Kai Thorsten Laser
- Center for Congenital Heart Defects, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Wolfgang Burchert
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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24
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Trivedi SJ, Campbell T, Stefani LD, Thomas L, Kumar S. Strain by speckle tracking echocardiography correlates with electroanatomic scar location and burden in ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 22:855-865. [PMID: 33585879 DOI: 10.1093/ehjci/jeab021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Ventricular tachycardia (VT) in ischaemic cardiomyopathy (ICM) originates from scar, identified as low-voltage areas with invasive high-density electroanatomic mapping (EAM). Abnormal myocardial deformation on speckle tracking strain echocardiography can non-invasively identify scar. We examined if regional and global longitudinal strain (GLS) can localize and quantify low-voltage scar identified with high-density EAM. METHODS AND RESULTS We recruited 60 patients, 40 ICM patients undergoing VT ablation and 20 patients undergoing ablation for other arrhythmias as controls. All patients underwent an echocardiogram prior to high-density left ventricular (LV) EAM. Endocardial bipolar and unipolar scar location and percentage were correlated with regional and multilayer GLS. Controls had normal GLS and normal bipolar and unipolar voltages. There was a strong correlation between endocardial and mid-myocardial longitudinal strain and endocardial bipolar scar percentage for all 17 LV segments (r = 0.76-0.87, P < 0.001) in ICM patients. Additionally, indices of myocardial contraction heterogeneity, myocardial dispersion (MD), and delta contraction duration (DCD) correlated with bipolar scar percentage. Endocardial and mid-myocardial GLS correlated with total LV bipolar scar percentage (r = 0.83; 0.82, P < 0.001 respectively), whereas epicardial GLS correlated with epicardial bipolar scar percentage (r = 0.78, P < 0.001). Endocardial GLS -9.3% or worse had 93% sensitivity and 82% specificity for predicting endocardial bipolar scar >46% of LV surface area. CONCLUSIONS Multilayer strain analysis demonstrated good linear correlations with low-voltage scar by invasive EAM. Validation studies are needed to establish the utility of strain as a non-invasive tool for quantifying scar location and burden, thereby facilitating mapping and ablation of VT.
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Affiliation(s)
- Siddharth J Trivedi
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Luke D Stefani
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.,South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool Hospital, Elizabeth Street, Liverpool, NSW 2170, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Westmead, NSW 2145, Australia
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25
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Tuohinen SS, Skyttä T, Huhtala H, Poutanen T, Virtanen V, Kellokumpu-Lehtinen PL, Raatikainen P. 3-Year Follow-Up of Radiation-Associated Changes in Diastolic Function by Speckle Tracking Echocardiography. JACC: CARDIOONCOLOGY 2021; 3:277-289. [PMID: 34396335 PMCID: PMC8352342 DOI: 10.1016/j.jaccao.2021.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 01/21/2023]
Abstract
Background Radiation therapy (RT) results in myocardial changes consisting of diffuse fibrosis, which may result in changes in diastolic function. Objectives The aim of this study was to explore RT-associated changes in left ventricular (LV) diastolic function. Methods Sixty chemotherapy-naive patients with left-sided, early-stage breast cancer were studied with speckle tracking echocardiography at 3 time points: prior to, immediately after, and 3 years after RT. Global and regional early diastolic strain rate (SRe) were quantified, as were parameters of systolic function. Results Regional changes in SRe, particularly the apical and anteroseptal segments, were observed over time and were more evident than global changes. The apical SRe declined from a median of 1.24 (interquartile range: 1.01 to 1.39) s-1 at baseline to 1.02 (interquartile range: 0.79 to 1.15) s-1 at 3 years of follow-up (p < 0.001). This decline was associated with the left ventricular maximal radiation dose (β = 0.36, p = 0.007). The global SRe was <1.00 s-1 (SRedep) in 11 (18.3%) patients at baseline, 21 (35%) patients (p = 0.013) post-RT, and 17 (28.3%) patients (p = 0.051) at 3 years. SRedep post-RT was independently associated with baseline cardiac abnormalities (odds ratio: 0.26; 95% confidence interval: 0.08 to 0.84; p = 0.025); SRedep at 3 years of follow-up was associated with the baseline Charlson comorbidity index (odds ratio: 2.36; 95% confidence interval: 1.17 to 4.77; p = 0.017). Diastolic function abnormalities were evident even in patients with preserved global longitudinal strain at 3 years. Conclusions RT resulted in changes in the SRe in the apical and anteroseptal segments over 3 years of follow-up. Changes in SRe apical segments were present even in patients with preserved systolic function and were independently associated with RT dose and cardiovascular comorbidities.
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Key Words
- CI, confidence interval
- DLVmax, maximal left ventricular radiation dose
- GLS, global longitudinal strain
- IQR, interquartile range
- LAVI, left atrial volume indexed to body surface area
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- RT, radiotherapy
- SR, strain rate
- SRe, early diastolic strain rate
- SReapex, apical early diastolic strain rate
- SRedep, global early diastolic strain rate <1 s-1
- SRs, systolic strain rate
- breast cancer
- diastolic strain rate
- radiotherapy
- speckle tracking echocardiography
- ΔGLS15, relative decline of more than 15% in global longitudinal strain
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Affiliation(s)
- Suvi Sirkku Tuohinen
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland.,Heart Hospital, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Tanja Skyttä
- Department of Oncology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tuija Poutanen
- Center for Child Health Research, Tampere, Finland.,Department of Pediatrics, Faculty of Medicine and Heath Technology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Vesa Virtanen
- Heart Hospital, Tampere University Hospital, University of Tampere, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Department of Oncology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Raatikainen
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland
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26
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Seol SH. High-Intensity Focused Ultrasound Induced Changes in Left Ventricular Two-Dimensional Speckle-Tracking Strain in a Mouse Model. J Cardiovasc Imaging 2021; 29:158-159. [PMID: 33938169 PMCID: PMC8099568 DOI: 10.4250/jcvi.2021.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sang Hoon Seol
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea.
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27
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Trivedi SJ, Tang S, Byth K, Stefani L, Lo Q, Otton J, Jameson M, Tran D, Batumalai V, Holloway L, Delaney GP, Koh ES, Thomas L. Segmental Cardiac Radiation Dose Determines Magnitude of Regional Cardiac Dysfunction. J Am Heart Assoc 2021; 10:e019476. [PMID: 33749308 PMCID: PMC8174310 DOI: 10.1161/jaha.120.019476] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Subclinical left ventricular dysfunction detected by 2‐dimensional global longitudinal strain post breast radiotherapy has been described in patients with breast cancer. We hypothesized that left ventricular dysfunction postradiotherapy may be site specific, based on differential segmental radiotherapy dose received. Methods and Results Transthoracic echocardiograms were performed at baseline, 6 weeks, and 12 months postradiotherapy on 61 chemotherapy‐naïve women with left‐sided breast cancer undergoing tangential breast radiotherapy. Radiation received within basal, mid, and apical regions for the 6 left ventricular walls was quantified from the radiotherapy treatment planning system. Anterior, anteroseptal, and anterolateral walls received the highest radiation doses, while inferolateral and inferior walls received the lowest. There was a progressive increase in the radiation dose received from basal to apical regions. At 6 weeks, the most significant percentage deterioration in strain was seen in the apical region, with greatest reductions in the anterior wall followed by the anteroseptal and anterolateral walls, with a similar pattern persisting at 12 months. There was a within‐patient dose–response association between the segment‐specific percentage deterioration in strain at 6 weeks and 12 months and the radiation dose received. Conclusions Radiotherapy for left‐sided breast cancer causes differential segmental dysfunction, with myocardial segments that receive the highest radiation dose demonstrating greatest strain impairment. Percentage deterioration in strain observed 6 weeks postradiotherapy persisted at 12 months and demonstrated a dose–response relationship with radiotherapy dose received. Radiotherapy‐induced subclinical cardiac dysfunction is of importance because it could be additive to chemotherapy‐related cardiotoxicity in patients with breast cancer. Long‐term outcomes in patients with asymptomatic strain reduction require further investigation.
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Affiliation(s)
- Siddharth J Trivedi
- Department of Cardiology Westmead Hospital Sydney NSW Australia.,Westmead Clinical School University of Sydney NSW Australia
| | - Simon Tang
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia.,Ingham Institute of Applied Medical Research Sydney NSW Australia.,Central Coast Cancer Therapy Centre Gosford NSW Australia
| | - Karen Byth
- Research and Education Network Western Sydney Local Health DistrictWestmead Hospital Sydney NSW Australia.,NHMRC Clinical Trials CentreUniversity of Sydney NSW Australia
| | - Luke Stefani
- Department of Cardiology Westmead Hospital Sydney NSW Australia
| | - Queenie Lo
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia.,Department of Cardiology St George Hospital Sydney NSW Australia
| | - James Otton
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia.,Department of Cardiology Liverpool Hospital Sydney NSW Australia
| | - Michael Jameson
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia.,Ingham Institute of Applied Medical Research Sydney NSW Australia.,Cancer Therapy Centre Liverpool Hospital Sydney NSW Australia
| | - David Tran
- Department of Cardiology Liverpool Hospital Sydney NSW Australia
| | - Vikneswary Batumalai
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia.,Ingham Institute of Applied Medical Research Sydney NSW Australia.,Cancer Therapy Centre Liverpool Hospital Sydney NSW Australia
| | - Lois Holloway
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia.,Ingham Institute of Applied Medical Research Sydney NSW Australia.,Cancer Therapy Centre Liverpool Hospital Sydney NSW Australia
| | - Geoff P Delaney
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia.,Ingham Institute of Applied Medical Research Sydney NSW Australia.,Cancer Therapy Centre Liverpool Hospital Sydney NSW Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia.,Ingham Institute of Applied Medical Research Sydney NSW Australia.,Cancer Therapy Centre Liverpool Hospital Sydney NSW Australia
| | - Liza Thomas
- Department of Cardiology Westmead Hospital Sydney NSW Australia.,Westmead Clinical School University of Sydney NSW Australia.,South Western Sydney Clinical School University of New South Wales Sydney NSW Australia
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28
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The strain and strain rate imaging paradox in echocardiography: overabundant literature in the last two decades but still uncertain clinical utility in an individual case. Arch Med Sci Atheroscler Dis 2021; 5:e297-e305. [PMID: 33644489 PMCID: PMC7885811 DOI: 10.5114/amsad.2020.103032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Almost two decades ago strain and strain rate imaging were proposed as a new, potentially more sensitive modality for quantifying both regional and global myocardial function. Until now, however, strain and strain rate imaging have been slow to be incorporated into everyday clinical practice. More recently, two dimensional strain has been claimed as of greater clinical utility, given that it is angle independent, with improved feasibility and reproducibility as compared to tissue Doppler strain. Nevertheless, speckle tracking strain is reliant on 2D image quality and frame rates. Three dimensional speckle tracking could eliminate the problem of through-plane motion inherent in 2D imaging, but 3D strain is currently limited by low frame rates. Another limitation of strain imaging is that the results are dependent on the ultrasound machine on which analyses are performed, with variability in measurements between different vendors. Despite the diagnostic and prognostic advantages of 2D strain, there is a lack of specific therapeutic interventions based on strain and a paucity of long-term large-scale randomized trial evidence on cardiovascular outcomes. After overabundant literature the same definition of normal cut-off values is controversial and not univocal. Further studies are needed, involving both manufacturers and medical professionals, on the additive contribution, possibly different case by case, of interfering and artifactual factors, aside from myocardial function per se. These artifactual determinants and motion artifacts components could be dominant in individual cases and should always be taken into account in the clinical decision making process in a single case.
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29
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Ferkh A, Stefani L, Trivedi SJ, Brown P, Byth K, Pathan F, Thomas L. Inter-vendor comparison of left atrial strain using layer specific strain analysis. Int J Cardiovasc Imaging 2021; 37:1279-1288. [PMID: 33389361 DOI: 10.1007/s10554-020-02114-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/20/2020] [Indexed: 12/09/2022]
Abstract
Left atrial strain (LAS) on transthoracic echocardiogram (TTE) is increasingly recognised to have clinical utility in cardiovascular disease. Differences in LAS measurements between vendors remains a barrier for clinical use. We sought to compare LAS between two commonly used software platforms; the layer-specific endocardial and mid-myocardial measurements of LAS on General Electric (GE) Echopac were compared to TomTec strain. LAS was measured in 88 individuals with no previous cardiac history and 40 paroxysmal AF (PAF) patients, in sinus rhythm at TTE. Conventionally, LAS measured using GE Echopac is mid-myocardial strain (GE-mid); additionally, endocardial (GE-endo) LAS was evaluated. Both LAS measurements by GE were compared to TomTec-Arena (v2.30.02) measurements. Reservoir (ƐR), contractile (ƐCT) and conduit (ƐCD) phasic strain were evaluated. Both GE-mid and GE-endo LAS correlated well with TomTec LAS. On Bland-Altman analysis, GE-mid LAS measurements were systematically lower than TomTec LAS (ƐR: mean difference (MD) - 6.08%, limits of agreement (LOA) - 12%, 0%, ƐCT: MD - 0.8%, LOA - 7%, 5%, ƐCD: MD - 5.2% LOA - 12%, 1%). GE-endo LAS demonstrated no systematic difference from TomTec LAS, but had wider limits of agreement (ƐR: MD 0.41%, LOA - 7%, 8%, ƐCT: MD 0.50%, LOA - 6%, 7%, ƐCD: MD - 0.08%, LOA - 7%, 7%). ƐR had the best reproducibility. Mid-myocardial LAS, routinely evaluated by GE Echopac software, systematically underestimates LAS compared to TomTec. Using GE endocardial LAS eliminated this bias, but introduced greater variation between measurements. Serial measurements of LAS should therefore be performed on the same vendor system.
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Affiliation(s)
- Aaisha Ferkh
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Westmead Hospital, Westmead, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Luke Stefani
- Cardiology Department, Westmead Hospital, Westmead, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Siddharth J Trivedi
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Westmead Hospital, Westmead, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Paula Brown
- Cardiology Department, Westmead Hospital, Westmead, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Karen Byth
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Faraz Pathan
- Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia.,Charles Perkins Centre, University of Sydney ,University of Sydney, Nepean Clinical School, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, Australia
| | - Liza Thomas
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia. .,Cardiology Department, Westmead Hospital, Westmead, Australia. .,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia. .,South Western Clinical School, University of New South Wales, Sydney, Sydney, Australia. .,Cardiology Department, Westmead Hospital, Corner Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia.
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Comparison of mitral annular displacement and global longitudinal strain imaging for predicting significant coronary atherosclerotic disease in patients of chronic stable angina pectoris. Int J Cardiovasc Imaging 2020; 37:861-870. [PMID: 33078275 DOI: 10.1007/s10554-020-02058-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Myocardial strain by two-dimensional speckle-tracking echocardiography (2D-STE) is a validated clinical index of myocardial deformation, for predicting CAD in patients with chronic stable angina pectoris (CSAP) with preserved ejection fraction (EF). However, it is complex, imaging dependant with intra and intervendor variability. The mitral annulus displacement (MAD) has been correlated to left ventricular (LV) longitudinal deformation and may be interchanged with strain imaging. This cross-sectional study was conducted on patients with suspected CSAP (n = 146) and preserved LVEF without wall motion abnormalities. We excluded patients with prior heart disease, ACS, arrhythmia, heart failure or poor imaging. GLS, Average MAD and normalized MAD were calculated using 2D-STE by automated function imaging. CAG was gold standard. MAD had significantly lesser dropout due to suboptimal imaging. Receiver operating characteristic (ROC) analysis showed that GLS had significantly better area under curve (AUC) compared to Normalised MAD and Average MAD (P = 0.035) in predicting significant CAD in patients of CSAP. The optimal cut-off of GLS, normalized MAD and Average MAD were ≥ - 20.67% (sensitivity 94.2%, specificity 86.7%), ≤ 15.22% (sensitivity 90.7%, specificity 80%) and ≤ 11.18 mm (sensitivity 83.7%, specificity 71.1%) respectively. GLS showed strong correlation with Normalised MAD (R = 0.669, P < 0.001) and good correlation to Average MAD (R 0.572, P < 0.001). Absolute GLS and Normalised MAD showed significant inverse correlation to SYNTAX score. GLS is a more accurate measure for predicting presence and severity of CAD then MAD however latter is a reliable simpler, robust, and expeditious tool with lesser dropouts. It can be at least of complementary value to other imaging markers for myocardial function when LV curvatures are poorly visualized or in busy outdoors with time constraint.
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Jin Wang N, Perry R. A sonographer's guide to the clinical utility of left ventricular speckle tracking strain. SONOGRAPHY 2020. [DOI: 10.1002/sono.12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nikolas Jin Wang
- Department of Cardiology Eastern Health Box Hill Victoria Australia
| | - Rebecca Perry
- Medical Sonography, UniSA Allied Heath and Human Performance University of South Australia Adelaide South Australia Australia
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Trivedi SJ, Campbell T, Stefani L, Kumar S, Thomas L. Speckle-Tracking Strain Echocardiography in the Assessment of Myocardial Mechanics in Patients With Idiopathic Ventricular Arrhythmias. Circ Arrhythm Electrophysiol 2020; 13:e008748. [DOI: 10.1161/circep.120.008748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Siddharth J. Trivedi
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia (S.J.T., T.C., L.S., S.K., L.T.)
- Westmead Clinical School, The University of Sydney, NSW, Australia (S.J.T., S.K., L.T.)
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia (S.J.T., T.C., L.S., S.K., L.T.)
- Westmead Applied Research Centre, The University of Sydney, NSW, Australia (T.C., S.K.)
| | - Luke Stefani
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia (S.J.T., T.C., L.S., S.K., L.T.)
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia (S.J.T., T.C., L.S., S.K., L.T.)
- Westmead Clinical School, The University of Sydney, NSW, Australia (S.J.T., S.K., L.T.)
- Westmead Applied Research Centre, The University of Sydney, NSW, Australia (T.C., S.K.)
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia (S.J.T., T.C., L.S., S.K., L.T.)
- Westmead Clinical School, The University of Sydney, NSW, Australia (S.J.T., S.K., L.T.)
- South Western Sydney Clinical School, University of New South Wales, NSW, Australia (L.T.)
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Trivedi SJ, Terluk AD, Kritharides L, Chow V, Chia EM, Byth K, Mussap CJ, Ng ACC, Thomas L. Right ventricular speckle tracking strain echocardiography in patients with acute pulmonary embolism. Int J Cardiovasc Imaging 2020; 36:865-872. [DOI: 10.1007/s10554-020-01779-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/24/2020] [Indexed: 12/31/2022]
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Gregory AT, Stanton T, Thomas L, Selvanayagam JB, Robert Denniss A. Echocardiography: Navigating Complexities to Provide Many Useful Applications in Contemporary Clinical Cardiology. Heart Lung Circ 2019; 28:1303-1306. [PMID: 31352993 DOI: 10.1016/j.hlc.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Tony Stanton
- Department of Cardiology, Sunshine Coast University Hospital, Brisbane, Qld, Australia; University of the Sunshine Coast, Brisbane, Qld, Australia; School of Medicine, Griffith University, Sunshine Coast University Hospital, Brisbane, Qld, Australia
| | - Liza Thomas
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Joseph B Selvanayagam
- College of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; Cardiac Imaging Research, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - A Robert Denniss
- Heart Lung and Circulation, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Department of Cardiology, Blacktown Hospital, Western Sydney University, Australia
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