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Abdelmohsen G, El-Farargy N, Abdelaziz O, Lotfy W, Sobhy R, Elmaghawry M, Moustafa A, Ibrahim H. Using 2D speckle-tracking echocardiography to localize the accessory pathway and evaluate cardiac function and dyssynchrony in pediatric patients with Wolf-Parkinson-White syndrome. Eur J Pediatr 2023; 182:3659-3669. [PMID: 37261549 DOI: 10.1007/s00431-023-05040-x] [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: 04/25/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
Wolf-Parkinson-White (WPW) accessory pathway (AP) may be associated with reentry supraventricular tachycardia (SVT) in addition to ventricular dyssynchrony and cardiac dysfunction. Electrophysiological studies (EPS) are the gold standard for the localization of the AP; however, 2D speckle-tracking echocardiography (2D-STE) may help in the localization of the AP noninvasively. Our study aims to evaluate the capability of 2D-STE for AP localization and the identification of AP-related contractile abnormalities and dyssynchrony in pediatric patients with WPW syndrome. This prospective multicenter cohort study involved 18 pediatric patients with ventricular preexcitation from January 2021 to January 2023. Tissue Doppler imaging (TDI), conventional echocardiography, and 2D-STE were done. Myocardial velocities, myocardial performance index (MPI), the global and segmental longitudinal strain of the left ventricle (LV), and time-to-peak longitudinal strain (TPLS) were measured before and after ablation. The longitudinal strain of the LV segments supplied by the AP, or the nearby segments close to the AP, was significantly impaired and improved after ablation (P = 0.0001). The abnormal strain pattern in the affected segments could predict the location of the AP. The TPLS of the affected segments significantly increased after ablation (P = 0.0001), denoting improved dyssynchrony. The ejection time and the LV MPI measured at the basal septum improved significantly after ablation. CONCLUSIONS 2D STE may be used for noninvasive localization of the AP and to evaluate cardiac function and dyssynchrony in patients with WPW. Further research on more patients is necessary to validate this method for AP localization. WHAT IS KNOWN • Accessory pathways (AP) associated with the Wolf-Parkinson-White (WPW) syndrome have been linked to supraventricular tachycardia (SVT). Even without SVT, WPW can cause left ventricular dyssynchrony, contractile dysfunction, and cardiomyopathy. • Electrophysiology study is the gold standard for the localization of the AP in WPW syndrome. WHAT IS NEW • The combination of 2D-speckle-tracking echocardiography (2D-STE) and the modified Arruda algorithm can precisely localize the AP associated with WPW syndrome. • 2D-STE can potentially assess cardiac function and dyssynchrony related to WPW syndrome. Additionally, 2D-STE can be utilized to evaluate the effectiveness of ablation in restoring cardiac function and dyssynchrony.
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Affiliation(s)
- Gaser Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Cairo, 11562, Egypt.
| | - Nourhanne El-Farargy
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Cairo, 11562, Egypt
| | - Osama Abdelaziz
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Cairo, 11562, Egypt
| | - Wael Lotfy
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Cairo, 11562, Egypt
| | - Rodina Sobhy
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Cairo, 11562, Egypt
| | | | - Ahmed Moustafa
- Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Ibrahim
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Cairo, 11562, Egypt
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Ojaghi-Haghighi Z, Mohebbi B, Moladoust H, Haghjoo M, Alizadehasl A, Esmaeilzadeh M, Aghapour S, Bakhshandeh H, Ardeshiri M, Hamidian M. Left ventricular torsional parameters before and after atrial fibrillation ablation: a velocity vector imaging study. Electron Physician 2017; 9:5395-5401. [PMID: 29038727 PMCID: PMC5633243 DOI: 10.19082/5395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND AIM Effects of atrial fibrillation (AF) and its ablative treatment on LV torsion have not yet been fully investigated. This study aimed to examine whether AF patterns of LV contraction and its ablative correction can exert a significant impact on LV torsion by velocity vector imaging (VVI). METHODS This case-control study conducted in Rajaie Cardiovascular, Medical and Research Center between October 2012 and June 2013. Study participants were 30 consecutive patients with symptomatic paroxysmal AF who met the inclusion criteria. The control group included 24 healthy participants with no history of cardiovascular disease. All individuals were in sinus rhythm at the time of echocardiography before and after the ablation procedure. Two-dimensional (2D) and Doppler echocardiography on a commercially available ultrasound system was performed for all the patients. Scanning was done by a wide-band ultrasound transducer with the frequency range between 2.5-3.5 MHz. The two short-axis views at basal and apical levels were subsequently processed off-line by VVI XStrain software. In order for data analysis, SPSS 16 utilized using paired and independent t-test. p-value ≤0.05 was considered significant. RESULTS LV torsion (°/cm) mean ± SD was significantly lower in paroxysmal AF patients before ablation (0.8±0.3) than the control group (1.5±0.4) (p<0.001) and increased significantly after ablation (1.1±0.5) compared with before ablation (p=0.004), but still significantly lower than the control group (p=0.003). LV Twist, twist rate and untwist rate mean ± SD were significantly lower in paroxysmal AF patients before ablation than the control group and increased significantly after ablation compared with before ablation, but still significantly lower than the control group. CONCLUSION Subclinical LV dysfunction may be detected in paroxysmal AF rhythm by measuring torsional parameters through VVI which improves after AF ablation.
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Affiliation(s)
- Zahra Ojaghi-Haghighi
- Professor, Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- M.D., Assistant Professor, Interventional Cardiologist, Department of Cardiology, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Moladoust
- Ph.D., Associate Professor, Healthy Heart Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Majid Haghjoo
- M.D., FESC, FACC, Associate Professor, Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- M.D., Associate Professor, Echocardiologist, Department of Cardiology, Department of Cardiology, Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeilzadeh
- M.D., FACC, FCAPSC, Associate Professor, Echocardiologist, Department of Cardiology, Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sevil Aghapour
- M.D., Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- M.D., Ph.D., Associate Professor, Epidemiologist, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ardeshiri
- M.D., Assistant Professor of Endocrinology and Metabolism, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Hamidian
- B.Sc. of Nursing, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Zhou J, Pu DR, Tian LQ, Tong H, Liu HY, Tang Y, Zhou QC. Noninvasive assessment of myocardial mechanics of the left ventricle in rabbits using velocity vector imaging. Med Sci Monit Basic Res 2015; 21:109-15. [PMID: 26031608 PMCID: PMC4459573 DOI: 10.12659/msmbr.894053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Our study aimed to investigate the feasibility of velocity vector imaging (VVI) to analyze left ventricular (LV) myocardial mechanics in rabbits at basal state. MATERIAL AND METHODS The animals used in this study were 30 New Zealand white rabbits. All rabbits underwent routine echocardiography under VVI-mode at basal state. The 2-dimensional (2-D) echocardiography images acquired included parasternal left long-axis views and short-axis views at the level of LV mitral valve, papillary muscles, and apex. Images were analyzed by VVI software. RESULTS At basal state, longitudinal LV velocity decreased from the basal to the apical segment (P<0.05). In the short axis direction, the highest peak myocardial velocity was found between the anterior septum and anterior wall for each segment at the same level; the peak strains and strain rates (SR) were the highest in the anterior and lateral wall compared to other segments (all P<0.05). During systole, LV base rotated in a clockwise direction and LV apex rotated in a counter-clockwise direction, while during diastole, both LV base and apex rotated in the direction opposite to systole. The rotation angle, rotation velocity and unwinding velocity in the apical segment were greater than the basal segment (P<0.05). CONCLUSIONS VVI is a reliable tool for evaluating LV myocardial mechanics in rabbits at basal state, and the LV long-axis short-axis and torsional motions reflect the normal regular patterns. Our study lays the foundation for future experimental approaches in rabbit models and for other applications related to the study of human myocardial mechanics.
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Affiliation(s)
- Jia Zhou
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Da-Rong Pu
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Lei-Qi Tian
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Hai Tong
- Department of Ultrasound, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China (mainland)
| | - Hong-Yu Liu
- Department of Ultrasound, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China (mainland)
| | - Yan Tang
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Qi-Chang Zhou
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
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