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Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [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: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
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Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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Alexanderson-Rosas E, Escudero-Salamanca M, Garcia-Diaz JA, Alvarez-Santana R, Cano-Zarate R, Mamani-Tito J, Carvajal-Juarez I, Espinola-Zavaleta N. Light-chain cardiac amyloidosis: A multimodality approach. J Nucl Cardiol 2020; 27:2432-2435. [PMID: 31933154 DOI: 10.1007/s12350-019-02017-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Erick Alexanderson-Rosas
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano N° 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C 14080, Mexico
- Physiology Department, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Mara Escudero-Salamanca
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano N° 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C 14080, Mexico
- Mexican Faculty of Medicine, La Salle University, Mexico City, Mexico
| | - Jesus A Garcia-Diaz
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano N° 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C 14080, Mexico
- Academic Unit of Medicine, Autonomous University of Nayarit, Tepic-Nayarit, Mexico
| | - Ricardo Alvarez-Santana
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano N° 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C 14080, Mexico
- Institute of Medical Sciences, Autonomous University of Ciudad Juarez, Ciudad Juarez, Mexico
| | - Roberto Cano-Zarate
- Magnetic Resonance Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Julio Mamani-Tito
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano N° 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C 14080, Mexico
| | - Isabel Carvajal-Juarez
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano N° 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C 14080, Mexico
| | - Nilda Espinola-Zavaleta
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano N° 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C 14080, Mexico.
- Department of Echocardiography, ABC Medical Center, I.A.P, Mexico City, Mexico.
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Abnormal left ventricular global strain during exercise-test in young healthy smokers. Sci Rep 2020; 10:5700. [PMID: 32231243 PMCID: PMC7105457 DOI: 10.1038/s41598-020-62428-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/11/2020] [Indexed: 11/08/2022] Open
Abstract
Background. It is unknown how much precociously the cigarette smoking (CS) may compromise the integrity of the cardiovascular (CV) system. Myocardial function can be routinely assessed by conventional echocardiography, but abnormalities are only detected when somewhat a remodelling has already occurred. These limitations could be overcome by strain imaging. Methods. We evaluated whether young smokers with normal left ventricular (LV) geometry, wall motion and ejection fraction may present abnormalities in myocardial deformation, both at rest and during physical effort. We selected 50 young smokers with no additional CV risk factors, and 60 non-smokers to undergo a standardized exercise-test. Consistently, we evaluated the CV adaptation to exercise by both conventional echocardiography and speckle-tracking analysis (2D-STE). Results. We found no difference between smokers and controls regarding baseline characteristics; as expected, smokers presented with lower HDL-cholesterol (p < 0.005), and higher fibrinogen, C-reactive protein (CRP), and interleukin-6 (p < 0.001). Conventional echocardiography parameters were not different between groups, while we detected a different behaviour of global longitudinal strain (GLS), global circumferential strain (GCS) and twist by 2D-STE during exercise-test. Indeed, GLS, GCS and twist behaved differently during exercise test in smokers with respect to controls. We found an association between CS, inflammation and LV mechanics changes uncovered by physical effort, and regression analysis confirmed that the intensity of the exposure to cigarette smoking, together with the inflammatory status (CRP, fibrinogen and Il-6) plasma levels, drive this impairment. Conclusions. We confirm strain imaging (2D-STE) as a very useful tool to identify early changes in cardiac mechanics, as adaptation to exercise; our findings may reflect a very precocious functional abnormality in active smokers, likely long before structural damage occurs.
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van den Dorpel MMP, Heinonen I, Snelder SM, Vos HJ, Sorop O, van Domburg RT, Merkus D, Duncker DJ, van Dalen BM. Early detection of left ventricular diastolic dysfunction using conventional and speckle tracking echocardiography in a large animal model of metabolic dysfunction. Int J Cardiovasc Imaging 2017; 34:743-749. [PMID: 29234934 PMCID: PMC5889412 DOI: 10.1007/s10554-017-1287-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
Left ventricular (LV) diastolic dysfunction is one of the important mechanisms responsible for symptoms in patients with heart failure. The aim of the current study was to identify parameters that may be used to detect early signs of LV diastolic dysfunction in diabetic pigs on a high fat diet, using conventional and speckle tracking echocardiography. The study population consisted of 16 healthy Göttingen minipigs and 18 minipigs with experimentally induced metabolic dysfunction. Echocardiography measurements were performed at baseline and 3-month follow-up. The ratio of peak early (E) and late filling velocity (E/A ratio) and the ratio of E and the velocity of the mitral annulus early diastolic wave (E/Em ratio) did not change significantly in both groups. Peak untwisting velocity decreased in the metabolic dysfunction group (- 30.1 ± 18.5 vs. - 23.4 ± 15.5 °/ms) but not in controls (- 38.1 ± 23.6 vs. - 42.2 ± 23.0 °/ms), being significantly different between the groups at the 3-month time point (p < 0.05). In conclusion, whereas E/A ratio and E/Em ratio did not change significantly after 3 months of metabolic dysfunction, peak untwisting velocity was significantly decreased. Hence, peak untwisting velocity may serve as an important marker to detect early changes of LV diastolic dysfunction.
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Affiliation(s)
- Mark M P van den Dorpel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ilkka Heinonen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
| | - Sanne M Snelder
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Hendrik J Vos
- Division of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Daphne Merkus
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands.
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Huang J, Yan ZN, Fan L, Rui YF, Song XT. Left ventricular systolic function changes in hypertrophic cardiomyopathy patients detected by the strain of different myocardium layers and longitudinal rotation. BMC Cardiovasc Disord 2017; 17:214. [PMID: 28768478 PMCID: PMC5541417 DOI: 10.1186/s12872-017-0651-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impairment of left ventricular (LV) longitudinal function has an important role in hypertrophic cardiomyopathy (HCM). This research investigated an association between the longitudinal strain of different myocardial layers, longitudinal rotation and the LV systolic function of HCM patients. METHODS The research was performed on 36 HCM patients and 36 healthy subjects. The peak systolic longitudinal strain of the subendocardial, midmyocardial, and subepicardial layers was measured using 2-dimensional speckle tracking echocardiography (2D-STE). The apical long-axis and 4- and 2- chamber views were acquired via 2D Doppler echocardiography. The curve of the longitudinal rotation was traced at 17 timepoints in the analysis of 2 cardiac cycles. RESULTS Compared with healthy subjects, in HCM patients regional LV peak systolic longitudinal strain was less, not only in hypertrophied LV myocardium, but also in non-hypertrophied myocardium. The rotational degrees of the midmyocardial-septal, apex, and lateral wall of HCM patients were significantly different from that of normal subjects, as follows. In HCM patients, clockwise longitudinal rotation was found. The interventricular septum thickness at end-diastole positively correlated with the peak longitudinal systolic strain of the subendocardial, the midmyocardial, and the subepicardial layers. The area under ROC curve values for subendocardial, midmyocardial and subepicardial layers in HCM patients were 0.923, 0.938, 0.948. CONCLUSION In HCM patients, the longitudinal function was damaged, even with normal LV ejection fraction. The peak longitudinal systolic strain of the subendocardial, midmyocardial, and subepicardial layers, and the longitudinal rotation detected by 2D-STE, are very sensitive predictors of systolic function in patients with HCM.
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Affiliation(s)
- Jun Huang
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China.
| | - Zi-Ning Yan
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Li Fan
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Yi-Fei Rui
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Xiang-Ting Song
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
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6
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Doğan C, Bayram Z, Candan Ö, Omaygenç O, Yılmaz F, Acar RD, Akbal ÖY, Kaymaz C, Özdemir N. Prediction of infarct size using two-dimensional speckle tracking echocardiography in acute myocardial infarction. Echocardiography 2017; 34:376-382. [DOI: 10.1111/echo.13457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Cem Doğan
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; İstanbul Turkey
| | - Zübeyde Bayram
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; İstanbul Turkey
| | - Özkan Candan
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; İstanbul Turkey
| | - Onur Omaygenç
- Faculty of Medicine; Cardiology Department; Medipol University; İstanbul Turkey
| | - Fatih Yılmaz
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; İstanbul Turkey
| | - Rezzan Deniz Acar
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; İstanbul Turkey
| | - Özgür Yaşar Akbal
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; İstanbul Turkey
| | - Cihangir Kaymaz
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; İstanbul Turkey
| | - Nihal Özdemir
- Cardiology Department; Kartal Kosuyolu Education and Research Hospital; İstanbul Turkey
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7
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Xu QQ, Ding YY, Lv HT, Zhou WP, Sun L, Huang J, Yan WH. Evaluation of left ventricular systolic strain in children with Kawasaki disease. Pediatr Cardiol 2014; 35:1191-7. [PMID: 24859168 DOI: 10.1007/s00246-014-0915-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 04/25/2014] [Indexed: 11/25/2022]
Abstract
The current study aimed to assess left ventricular (LV) longitudinal systolic strains in children with KD using two-dimensional speckle-tracking imaging and to analyze the relationship of LV myocardial deformation to coronary lesions and laboratory markers. The study enrolled 101 children with acute KD. An additional 50 age- and gender-matched normal children were enrolled as control subjects. During different phases of KD, echocardiograms were recorded for 61 children. Two-dimensional strain analysis software was used to track myocardial movement and obtain the strain from each LV segment. The LV longitudinal systolic strain decreased significantly in children with acute KD but increased immediately after intravenous immunoglobulin therapy. At 6-8 weeks after the onset of KD, all LV strains had recovered to normal. The LV systolic strain was not associated with coronary dilation in either acute or convalescent KD. In acute KD, aspartate transaminase, alanine transaminase, erythrocyte sedimentation rate, C-reactive protein (CRP), and hemoglobin (Hb) were found to be associated with coronary dilation, whereas LV systolic strains were found to be correlated with elevated CRP and decreased Hb. Speckle-tracking imaging of LV systolic strain was simple and accurate in evaluating LV function during different phases of KD. No association between LV dysfunction and coronary dilation was observed, but a relationship with CRP and Hb was found. Further studies are recommended to validate the current study results and explore further how these findings can improve clinical practice.
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Affiliation(s)
- Qiu-Qin Xu
- Department of Pediatric Cardiology, Children's Hospital Affiliated of Soochow University, 303 Jingde Road, Suzhou, 215003, Jiangsu, China
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8
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Buckberg GD, Hoffman JI, Coghlan HC, Nanda NC. Ventricular structure–function relations in health and disease: Part I. The normal heart. Eur J Cardiothorac Surg 2014; 47:587-601. [DOI: 10.1093/ejcts/ezu278] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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9
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Eindhoven JA, Menting ME, van den Bosch AE, Cuypers JAAE, Ruys TPE, Witsenburg M, McGhie JS, Boersma E, Roos-Hesselink JW. Associations between N-terminal pro-B-type natriuretic peptide and cardiac function in adults with corrected tetralogy of Fallot. Int J Cardiol 2014; 174:550-6. [PMID: 24798786 DOI: 10.1016/j.ijcard.2014.04.137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/02/2014] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Amino-terminal B-type natriuretic peptide (NT-proBNP) may detect early cardiac dysfunction in adults with tetralogy of Fallot (ToF) late after corrective surgery. We aimed to determine the value of NT-proBNP in adults with ToF and establish its relationship with echocardiography and exercise capacity. METHODS AND RESULTS NT-proBNP measurement, electrocardiography and detailed 2D-echocardiography were performed on the same day in 177 consecutive adults with ToF (mean age 34.6 ± 11.8 years, 58% male, 89% NYHA I, 29.3 ± 8.5 years after surgical correction). Thirty-eight percent of the patients also underwent a cardiopulmonary-exercise test. Median NT-proBNP was 16 [IQR 6.7-33.6] pmol/L, and was elevated in 55%. NT-proBNP correlated with right ventricular (RV) dilatation (r = 0.271, p < 0.001) and RV systolic dysfunction (r = -0.195, p = 0.022), but more strongly with LV systolic dysfunction (r=-0.367, p<0.001), which was present in 69 patients (39%). Moderate or severe pulmonary regurgitation was not associated with higher NT-proBNP. Tricuspid and pulmonary regurgitation peak velocities correlated with NT-proBNP (r = 0.305, p < 0.001 and r = 0.186, p = 0.045, respectively). LV twist was measured with speckle-tracking echocardiography in 71 patients. An abnormal LV twist (20 patients, 28%) was associated with elevated NT-proBNP (p = 0.030). No relationship between NT-proBNP and exercise capacity was found. CONCLUSIONS NT-proBNP levels are elevated in more than 50% of adults with corrected ToF, while they are in stable clinical condition. Higher NT-proBNP is most strongly associated with elevated pulmonary pressures, and with LV dysfunction rather than RV dysfunction. NT-proBNP has the potential to become routine examination in patients with ToF to monitor ventricular function and may be used for timely detection of clinical deterioration.
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Affiliation(s)
- Jannet A Eindhoven
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Myrthe E Menting
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Judith A A E Cuypers
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Titia P E Ruys
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jackie S McGhie
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Bussadori C, Salvo GD, Pluchinotta FR, Piazza L, Gaio G, Russo MG, Carminati M. Evaluation of Right Ventricular Function in Adults with Congenital Heart Defects. Echocardiography 2014; 32 Suppl 1:S38-52. [DOI: 10.1111/echo.12566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Claudio Bussadori
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Giovanni Di Salvo
- Heart Institute; Pediatric Cardiology; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
| | - Francesca R. Pluchinotta
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Luciane Piazza
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
| | - Giampiero Gaio
- Department of Cardiology; Division of Pediatric Cardiology; Second University of Naples-Monaldi Hospital; Naples Italy
| | - Maria Giovanna Russo
- Department of Cardiology; Division of Pediatric Cardiology; Second University of Naples-Monaldi Hospital; Naples Italy
| | - Mario Carminati
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS San Donato Hospital; Milan Italy
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11
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Ni XD, Huang J, Hu YP, Xu R, Yang WY, Zhou LM. Assessment of the rotation motion at the papillary muscle short-axis plane with normal subjects by two-dimensional speckle tracking imaging: a basic clinical study. PLoS One 2013; 8:e83071. [PMID: 24376634 PMCID: PMC3869751 DOI: 10.1371/journal.pone.0083071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/07/2013] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study was to observe the rotation patterns at the papillary muscle plane in the Left Ventricle(LV) with normal subjects using two-dimensional speckle tracking imaging(2D-STI). Methods We acquired standard of the basal, the papillary muscle and the apical short-axis images of the LV in 64 subjects to estimate the LV rotation motion by 2D-STI. The rotational degrees at the papillary muscle short-axis plane were measured at 15 different time points in the analysis of two heart cycles. Results There were counterclockwise rotation, clockwise rotation, and counterclockwise to clockwise rotation at the papillary muscle plane in the LV with normal subjects, respectively. The ROC analysis of the rotational degrees was performed at the papillary muscle short-axis plane at the peak LV torsion for predicting whether the turnaround point of twist to untwist motion pattern was located at the papillary muscle level. Sensitivity and specificity were 97% and 67%, respectively, with a cut-off value of 0.34°, and an area under the ROC curve of 0.8. At the peak LV torsion, there was no correlation between the rotational degrees at the papillary muscle short-axis plane and the LVEF in the normal subjects(r = 0.000, p = 0.998). Conclusions In the study, we conclude that there were three rotation patterns at the papillary muscle short-axis levels, and the transition from basal clockwise rotation to apical counterclockwise rotation is located at the papillary muscle level.
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Affiliation(s)
- Xian-Da Ni
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- * E-mail:
| | - Jun Huang
- Department of Echocardiography, Changzhou No. 2 People’s Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yuan-Ping Hu
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rui Xu
- Department of Ultrasound, The First Affiliated Hospital of Henan university of TCM, Zhengzhou, China
| | - Wei-Yu Yang
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li-Ming Zhou
- Department of Ultrasound, The second Affiliated Hospital of ZheJiang Univercity, Hangzhou, China
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12
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Akasheva DU, Plokhova EV, Strazhesko ID, Dudinskaya EN, Tkacheva ON. HEART AND AGE (PART II): CLINICAL MANIFESTATIONS OF AGEING. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-4-86-90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Ageing is an inevitable process which affects quality of life and reduces life expectancy. Age-related cardiac changes reduce compensatory reserves of the heart and accelerate the disease development. Such changes in cardiac structure and function, observed in the absence of cardiovascular disease (CVD), are considered age-related. However, taking into account the high prevalence of CVD in the elderly, it is problematic to define the genuine cardiac ageing. This review discusses a range of subclinical cardiac conditions which are common in older people.
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13
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van Dalen BM, Tzikas A, Soliman OII, Heuvelman HJ, Vletter WB, Ten Cate FJ, Geleijnse ML. Assessment of subendocardial contractile function in aortic stenosis: a study using speckle tracking echocardiography. Echocardiography 2013; 30:293-300. [PMID: 23347129 DOI: 10.1111/echo.12051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Angina and an electrocardiographic strain pattern are potential manifestations of subendocardial ischemia in aortic stenosis (AS). Left ventricular (LV) twist is known to increase proportionally to the severity of AS, which may be a result of loss of the inhibiting effect of the subendocardial fibers due to subendocardial dysfunction. It has also been shown that the ratio of LV twist to circumferential shortening of the endocardium (twist-to-shortening ratio [TSR]) is a reliable parameter of subendocardial dysfunction. The aim of this study was to investigate whether these markers are increased in AS patients with angina and/or electrocardiographic strain. METHODS The study comprised 60 AS patients with an aortic valve area <2.0 cm(2) and LV ejection fraction >50%, and 30 healthy-for age and gender matched-control subjects. LV rotation parameters were determined by speckle tracking echocardiography. RESULTS Comparison of patients without angina and strain (n = 22), with either angina or strain (n = 28), and with both angina and strain (n = 8), showed highest peak systolic LV apical rotation, peak systolic LV twist, and TSR, in patients with more signs of subendocardial ischemia. In a multivariate linear regression model, only severity of AS and the presence of angina and/or strain could be identified as independent predictors of peak systolic LV twist and TSR. CONCLUSIONS Peak systolic LV twist and TSR are increased in AS patients and related to the severity of AS and symptoms (angina) or electrocardiographic signs (strain) compatible with subendocardial ischemia.
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Affiliation(s)
- Bas M van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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14
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Kauer F, van Dalen BM, Soliman OII, van der Zwaan HB, Vletter WB, Schinkel AFL, ten Cate FJ, Geleijnse ML. Regional left ventricular rotation and back-rotation in patients with reverse septal curvature hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2012; 14:435-42. [DOI: 10.1093/ehjci/jes163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Imbalzano E, Zito C, Carerj S, Oreto G, Mandraffino G, Cusmà-Piccione M, Di Bella G, Saitta C, Saitta A. Left Ventricular Function in Hypertension: New Insight by Speckle Tracking Echocardiography. Echocardiography 2011; 28:649-57. [DOI: 10.1111/j.1540-8175.2011.01410.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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16
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Porciani MC, Cappelli F, Perfetto F, Ciaccheri M, Castelli G, Ricceri I, Chiostri M, Franco B, Padeletti L. Rotational mechanics of the left ventricle in AL amyloidosis. Echocardiography 2011; 27:1061-8. [PMID: 21039810 DOI: 10.1111/j.1540-8175.2010.01199.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim of this study was to investigate whether alterations in left ventricular (LV) twisting and untwisting motion could be induced by cardiac involvement in patients with immunoglobulin light-chain (AL) systemic amyloidosis. METHODS AND RESULTS Forty-five patients with AL amyloidosis and 26 control subjects were evaluated. After standard echocardiographic measurement and two-dimensional (2D) speckle tracking echocardiography, LV rotation at both basal and apical planes, twisting, twisting rate, and longitudinal strain were measured. Tissue Doppler imaging (TDI) derived early diastolic peak velocity at septal mitral annulus (E') was also evaluated. Twenty-six of 45 patients with systemic amyloidosis were classified as having cardiac amyloidosis (CA) if the mean value of the LV wall thickness was ≥ 12 mm or not (NCA) if this value was not reached. In NCA patients, both LV twist and untwisting rate were increased while they were decreased in CA patients making them similar to the control group. Longitudinal strain was reduced only in CA patients. Impaired relaxation as indicated by E' values was progressively reduced in the course of the disease. CONCLUSIONS Both twisting and untwisting motions are increased in patients with AL systemic amyloidosis with no evidence of cardiac involvement while they are reduced in patients with evident amyloidosis cardiac involvement. This finding suggests that impaired LV relaxation induces a compensatory mechanism in the early phase of the disease, which fails in more advanced stage when both twisting and untwisting rates are reduced. The increase in LV rotational mechanics could be a marker of subclinical cardiac involvement.
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Ji L, Hu W, Yao J, Yu J, Chen C, Yong Y, Zhou L, Xu D. Acute Mechanical Effect of Right Ventricular Pacing at Different Sites Using Velocity Vector Imaging. Echocardiography 2010; 27:1219-27. [DOI: 10.1111/j.1540-8175.2010.01221.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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18
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Left ventricular rotation: a neglected aspect of the cardiac cycle. Intensive Care Med 2010; 37:156-63. [DOI: 10.1007/s00134-010-2053-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
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Grabskaya E, Spira C, Hoffmann R, Altiok E, Ocklenburg C, Hoffmann R, Becker M. Myocardial Rotation but Not Circumferential Strain Is Transducer Angle Dependent: A Speckle Tracking Echocardiography Study. Echocardiography 2010; 27:809-14. [DOI: 10.1111/j.1540-8175.2010.01158.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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van Dalen BM, Soliman OII, Vletter WB, ten Cate FJ, Geleijnse ML. Left Ventricular Untwisting in Restrictive and Pseudorestrictive Left Ventricular Filling: Novel Insights into Diastology. Echocardiography 2010; 27:269-74. [DOI: 10.1111/j.1540-8175.2009.00996.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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21
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Govind SC, Gadiyaram VK, Quintana M, Ramesh SS, Saha S. Study of Left Ventricular Rotation and Torsion in the Acute Phase of ST-Elevation Myocardial Infarction by Speckle Tracking Echocardiography. Echocardiography 2010; 27:45-9. [DOI: 10.1111/j.1540-8175.2009.00971.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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van Dalen BM, Kauer F, Vletter WB, Soliman OII, van der Zwaan HB, ten Cate FJ, Geleijnse ML. Influence of cardiac shape on left ventricular twist. J Appl Physiol (1985) 2010; 108:146-51. [DOI: 10.1152/japplphysiol.00419.2009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The dynamic interaction between subendocardial and subepicardial fibre helices in the left ventricle (LV) leads to a twisting deformation, which has an important role in LV function. This study sought to assess the influence of cardiac shape on LV twist in the normal and dilated human heart. The study comprised 45 dilated cardiomyopathy (DCM) patients and 60 for age- and gender-matched healthy volunteers. Speckle tracking echocardiography was used to determine basal and apical LV peak systolic rotation (Rotmax) and instantaneous LV peak systolic twist (Twistmax). LV sphericity index was calculated by dividing the LV maximal long-axis internal dimension by the maximal short-axis internal dimension at end-diastole. A parabolic relation between the sphericity index and apical Rotmaxor Twistmaxwas identified in the total study population ( R2= 0.56 and R2= 0.54, respectively; both P < 0.001) and healthy volunteers ( R2= 0.39 and R2= 0.25, respectively; both P < 0.001), whereas these relations were linear in DCM patients ( R2= 0.40 and R2= 0.43, respectively; both P < 0.001). In a multivariate analysis, LV sphericity index was the strongest independent predictor of apical Rotmaxand Twistmax. In conclusion, LV apical rotation and twist are significantly influenced by LV configuration. Taking the important function of LV twist into account, this finding highlights the vital influence of cardiac shape on LV systolic function.
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Affiliation(s)
- Bas M. van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Floris Kauer
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wim B. Vletter
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Osama I. I. Soliman
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Heleen B. van der Zwaan
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Folkert J. ten Cate
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel L. Geleijnse
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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van Dalen BM, Tzikas A, Soliman OII, Kauer F, Heuvelman HJ, Vletter WB, ten Cate FJ, Geleijnse ML. Left ventricular twist and untwist in aortic stenosis. Int J Cardiol 2009; 148:319-24. [PMID: 20036018 DOI: 10.1016/j.ijcard.2009.11.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 11/16/2009] [Accepted: 11/25/2009] [Indexed: 12/23/2022]
Abstract
BACKGROUND To optimally exploit the potential added diagnostic and prognostic value of new left ventricular (LV) deformation parameters, better understanding of LV mechanics in aortic stenosis (AS) is warranted. We sought to determine a broad spectrum of LV rotation parameters in AS patients and age-matched healthy controls, in order to gain insight into the mechanical properties of the LV in AS. METHODS The study comprised 48 AS patients with an aortic valve area<2.0 cm2 and LV ejection fraction>50%, and 24 healthy--for age and gender matched--control subjects. LV peak systolic rotation (Rotmax), LV peak systolic twist (Twistmax), untwisting rate (mean diastolic untwisting velocity from Twistmax to mitral valve opening), peak diastolic untwisting velocity, and time-to-peak diastolic untwisting velocity were determined by speckle tracking echocardiography. RESULTS AS patients had normal basal Rotmax and increased apical Rotmax, resulting in increased Twistmax (13.4±4.0° vs. 11.4±2.7°, P<0.05). Apical Rotmax and Twistmax correlated significantly to echo-Doppler indicators of AS severity. Time-to-peak diastolic untwisting velocity was increased (20±10% vs. 15±9%, P<0.05) and untwisting rate was decreased (-38±21°/s vs. -50±28°/s, P<0.01) in AS patients. CONCLUSIONS Twistmax increases proportionally to the severity of AS, which might serve as a compensatory mechanism to maintain systolic LV function. LV diastolic untwisting is delayed and the untwisting rate is reduced in AS.
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Affiliation(s)
- Bas M van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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van Dalen BM, Soliman OII, Kauer F, Vletter WB, Zwaan HBVD, Cate FJT, Geleijnse ML. Alterations in left ventricular untwisting with ageing. Circ J 2009; 74:101-8. [PMID: 19966501 DOI: 10.1253/circj.cj-09-0436] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In order to gain further insight into age-associated changes of left ventricular (LV) diastolic function, the purpose of the current study was to investigate alterations in LV untwisting with ageing. METHODS AND RESULTS The study comprised 75 healthy volunteers, classified into 3 groups: age 16-35 (n=25), 36-55 (n=25) and 56-75 (n=25) years. LV untwisting (as a percentage of peak systolic twist) at 5%, 10%, 15% and 50% of diastole, peak diastolic untwisting velocity, time-to-peak diastolic untwisting velocity and untwisting rate (mean untwisting velocity during the time interval from peak systolic twist to mitral valve opening) were assessed using speckle-tracking echocardiography. Untwisting at 5%, 10%, 15% and 50% of diastole decreased with ageing. Although the peak diastolic untwisting velocity and untwisting rate were not significantly different between the age groups, when normalized for LV peak systolic twist, these parameters decreased with advancing age (both P<0.01). Time-to-peak diastolic untwisting velocity increased with ageing (P<0.01). CONCLUSIONS Impairment of the relative peak diastolic untwisting velocity and untwisting rate, resulting in delayed LV untwisting, may help to explain diastolic dysfunction in the elderly. (Circ J 2010; 74: 101 - 108).
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Affiliation(s)
- Bas M van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, The Netherlands
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van Dalen BM, Soliman OII, Vletter WB, Kauer F, van der Zwaan HB, ten Cate FJ, Geleijnse ML. Feasibility and reproducibility of left ventricular rotation parameters measured by speckle tracking echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:669-76. [PMID: 19383641 DOI: 10.1093/ejechocard/jep036] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS This study sought to find the most robust method for left ventricular (LV) rotation measurement by speckle tracking echocardiography (STE) with the new QLAB Advanced Quantification Software (version 6.0, Philips, Best, The Netherlands). METHODS AND RESULTS The study population consisted of 40 non-selected patients (mean age 48 +/- 18 year, 20 men) and 50 non-selected healthy volunteers (mean age 34 +/- 12 year, 21 men). Feasibility and intra-observer reproducibility of the measurement of LV rotation parameters by STE were assessed for two different methods (Method A: six tracking points placed mid-myocardial and Method B: six tracking points placed endocardial and epicardial forming six myocardial segments). Subsequently, inter-observer and temporal reproducibility of the most robust method were assessed. Complete LV rotation assessment was more feasible with Method A (60 out of 90 subjects, 67% vs. 50 out of 90 subjects, 56%). In the 49 subjects in whom both Methods A and B were feasible, intra-observer reproducibility of LV rotation parameters was better with Method A (variabilities 2 +/- 3 to 10 +/- 9% vs. 2 +/- 4 to 21 +/- 18%). With this method, inter-observer variability varied from 4 +/- 4 to 13 +/- 9% and temporal variability from 4 +/- 6 to 19 +/- 15%. CONCLUSION The most robust method to assess LV rotation with QLAB software is from the mid-myocardium. This method is feasible in approximately two-thirds of subjects and has good intra-observer, inter-observer, and temporal reproducibility, allowing to study changes over time in LV rotation in an individual patient.
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Affiliation(s)
- Bas M van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230 Room BA 302, 3015 CE Rotterdam, The Netherlands
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