Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

Comprehensive Assessment of the Left Ventricular Systolic Function in the Elderly with Acute Myocardial Infarction Using Echocardiography

Aim

To evaluate the left ventricular (LV) systolic function in elderly with non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) using real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (STI).

Methods

Forty NSTEMI and forty STEMI patients after undergoing percutaneous coronary artery intervention (PCI) were enrolled. The myocardial segments were supplied by the infarct-related artery (Myo-_IRA) which were indicated by the selective coronary arteriography (SCA). The LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV) and ejection fraction (LVEF) were acquired by 4D LV Volume Tom Tec. LV longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS), circumferential peak systolic strain (CPSS) of Myo-_IRA segments, LV rotational peak degree in the base (rot-_base) and in the apex (rot-_apex), and twist were acquired by strain analysis software. Forty older healthy individuals were included as normal controls.

Results

The LVEF of the NSTEMI and STEMI patients at 1 week after PCI were significantly lower (P<0.05), then, this parameter was improved in both groups after 3 months, but was still significantly lower than that of the controls (P<0.05). The LPSS, RPSS, CPSS of the Myo_−IRA segments, rot_−Base, rot_−Apex and twist in both groups were significantly lower than those in the controls. The LPSS and CPSS of the Myo-IRA segments, rot_−Base, rot_−Apex and twist in NSTEMI patients were obviously higher than those in STEMI patients in 1 week and 3 months after PCI (P<0.05). After 3 months, the RPSS of NSTEMI patients was improved notably and was obviously higher than that of STEMI patients (P<0.05). All these values in STEMI and NSTEMI patients were improved after 3 months, apart from LPSS in STEMI patients (P>0.05), but were still significantly lower than those in the controls (P<0.05).

Conclusion

RT-3DE and STI can sensitively assess LV systolic function with different extents of transmural damage.

Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria

Background

Enumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations.

Objectives

The objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography.

Methods

A cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls.

Results

A significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001).

All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p<0.005).

Conclusion

This result shows that children with sickle cell anemia have increased valvar size diameter compared with those with normal hemoglobin type. A significantly higher proportion of respondents in type SS group had abnormal left ventricular systolic and diastolic dysfunction when compared with those in type AA group.

Left Ventricular Twist and Untwist in Patients Undergoing Elective Percutaneous Coronary Intervention

BACKGROUND

Left ventricular (LV) twist and untwist plays important roles in physiological adaptation and development of clinically relevant cardiac diseases.

AIMS

To assess LV twist and untwist in patients undergoing elective percutaneous coronary intervention (PCI) by two-dimensional (2D) speckle tracking echocardiography (STE).

SUBJECTS AND METHODS

Fifty patients who had stable angina pectoris and/or abnormal result from noninvasive stress tests were enrolled after undergoing elective PCI. Conventional and 2D STE were performed before elective PCI and after 3 months.

RESULTS

There was no significant systolic improvement in conventional echocardiography. However, there was a significant diastolic improvement after elective PCI as higher E, E/A, e` and lower E/e` (P < 0.034, <0.042, 0.015, and 0.033, respectively). In addition, there was a statistically significant improvement of STE-derived systolic parameters as regard higher global longitudinal strain, peak twist, and torsion (P value 0.009, 0.009, and < 0.001, respectively). Furthermore, there was significant improvement of STE-derived diastolic parameters as higher peak untwist, recoil, and lower time to peak untwist (P value 0.013, 0.001, and 0.004, respectively).

CONCLUSIONS

LV and untwist parameters were improved before most of conventional echocardiographic parameters in postrevascularization of stable coronary artery disease.

Use of Speckle Tracking Echocardiography to Detect Induced Regional Strain Changes in the Murine Myocardium by Acoustic Radiation Force

BACKGROUND

It is difficult to simulate the abnormal myocardial strain patterns caused by ischemic coronary artery disease (CAD) which are a precursor to heart failure (HF) within an animal model. Simulation of these strain changes could contribute to better understanding of the early formative stages of HF. This is especially important in investigating the poorly understood pathogenesis of heart failure with preserved ejection fraction (HFpEF). Here, we discuss delivery of high intensity focused ultrasound (HIFU) in a murine model to alter left ventricular (LV) regional longitudinal strain (RLS), and use of speckle tracking echocardiography to detect these changes.

METHODS

HIFU pulses (pressure amplitude 1.7 MPa) were generated by amplifying a sinusoidal waveform from a function generator into a piezoelectric transducer. These pulses were then directed extracorporeally towards the anterior LV surface of C57BI6 mice during three time periods (early, mid, and late diastole). Speckle tracking echocardiography was then used to quantify changes in RLS within six segments of the LV.

RESULTS

We observed an increase in LV RLS with acoustic augmentation during all three time periods. This augmentation was most prominent near the anterior apical region in early diastole and near the posterior basilar region during late diastole.

CONCLUSIONS

Our findings demonstrate the application of HIFU to non-invasively induce changes in RLS within a murine model. Our results also reflect the capability of speckle tracking echocardiography to analyze and quantify these changes. These findings represent the first demonstration of ultrasound-induced augmentation in LV RLS within a small animal model.

Speckle-tracking echocardiography in comparison with ejection fraction for prediction of cardiovascular mortality in patients with end-stage renal disease

Background

Cardiovascular disease is the major cause of death in end-stage renal disease (ESRD). To develop better means to assess cardiovascular risk in these patients, we compared conventional echocardiography-derived left ventricular ejection fraction (EF) with the novel method of 2D speckle-tracking echocardiography to determine cardiac strain.

Methods

Predictive performances of conventional EF and speckle-tracking echocardiography-derived global longitudinal strain (GLS) were compared using receiver-operator curve (ROC) analyses and calibration by calibration plots. We also took into account other known cardiovascular risk factors through multivariable logistic regression analysis.

Results

The study comprised 171 ESRD patients (mean age 64 years, 64% male) on maintenance dialysis therapy (93% haemodialysis, 7% peritoneal dialysis) for an average period of 39 months. During 2.1 years of follow-up, 42 patients (25%) died from cardiovascular disease. ROC analysis of GLS resulted in an area under the curve of 0.700 [95% confidence interval (CI) 0.603–0.797] compared with an area under the curve of EF of 0.615 (95% CI 0.514–0.716) (P = 0.059 for difference). The total absolute deviation between predicted and observed outcome frequencies obtained by calibration plots were 13.8% for EF compared with only 6.4% for GLS. Best results of ROC analysis (area under the curve = 0.759; P = 0.06), calibration and goodness-of-fit (χ² = 28.34, P ≤ 0.0001, R² = 0.25) were achieved for GLS added to a baseline model consisting of known cardiovascular risk factors in a multivariate regression analysis.

Conclusions

In summary, in chronic dialysis patients, GLS is a more precise predictor of cardiovascular mortality than conventional echocardiography-derived EF.

Soluble urokinase plasminogen activator receptor in one-year prediction of major adverse cardiac events in patients after first myocardial infarction treated with primary percutaneous coronary intervention

INTRODUCTION

Soluble urokinase plasminogen activator receptor (suPAR) level reflects the general condition of the organism and was proved to give independent information in risk stratification of patients. The aim of this study was to assess the usefulness of suPAR in the prediction of adverse cardiac events in patients with first myocardial infarction (MI) undergoing primary percutaneous coronary intervention. Additionally, the diagnostic power of suPAR was assessed.

MATERIAL AND METHODS

One hundred and thirty-nine of 150 consecutive patients were included in the study. Serum suPAR level (ELISA, Virogates) as well as C-reactive protein (on admission and at discharge) and maximum troponin T (assessed from successive 6-hour periods of blood collection) were measured. In the 1-year follow-up study the following major adverse cardiac events were observed: myocardial infarction, revascularization, stroke and death.

RESULTS

Multi-variable analysis revealed prognostic usefulness only for suPAR and glomerular filtration rate: p < 0.0001 and p = 0.018; OR = 2.59 and OR = 0.98 respectively, with area under the curve in receiver operating characteristic analysis for both parameters simultaneously 0.89 (p < 0.0001). There was no correlation between suPAR level and the left ventricular dysfunction parameters or the MI type.

CONCLUSIONS

Soluble urokinase plasminogen activator receptor level appears to be an independent useful biomarker for the prediction of major adverse cardiac events early after first myocardial infarction. The biomarker's level seems to have more prognostic than diagnostic power.

Chitosan/silk fibroin modified nanofibrous patches with mesenchymal stem cells prevent heart remodeling post-myocardial infarction in rats

Poor functional survival of the engrafted stem cells limits the therapeutic efficacy of stem-cell-based therapy for myocardial infarction (MI). Cardiac patch-based system for cardiac repair has emerged as a potential regenerative strategy for MI. This study aimed to design a cardiac patch to improve the retention of the engrafted stem cells and provide mechanical scaffold for preventing the ventricular remodeling post-MI. The patches were fabricated with electrospinning cellulose nanofibers modified with chitosan/silk fibroin (CS/SF) multilayers via layer-by-layer (LBL) coating technology. The patches engineered with adipose tissue-derived mesenchymal stem cells (AD-MSCs) (cell nano-patch) were adhered to the epicardium of the infarcted region in rat hearts. Bioluminescence imaging (BLI) revealed higher cell viability in the cell nano-patch group compared with the intra-myocardial injection group. Echocardiography demonstrated less ventricular remodeling in cell nano-patch group, with a decrease in the left ventricular end-diastolic volume and left ventricular end-systolic volume compared with the control group. Additionally, left ventricular ejection fraction and fractional shortening were elevated after cell nano-patch treatment compared with the control group. Histopathological staining demonstrated that cardiac fibrosis and apoptosis were attenuated, while local neovascularization was promoted in the cell nano-patch group. Western blot analysis illustrated that the expression of biomarkers for myocardial fibrosis (TGF-β1, P-smad3 and Smad3) and ventricular remodeling (BNP, β-MHC: α-MHC ratio) were decreased in cell nano patch-treated hearts. This study suggests that CS/SF-modified nanofibrous patches promote the functional survival of engrafted AD-MSCs and restrain ventricular remodeling post-MI through attenuating myocardial fibrosis. STATEMENT OF SIGNIFICANCE: First, the nanofibrous patches fabricated from the electrospun cellulose nanofibers could mimic the natural extracellular matrix (ECM) of hearts to improve the microenvironment post-MI and provide three dimensional (3D) scaffolds for the engrafted AD-MSCs. Second, CS and SF which have exhibited excellent properties in previous tissue engineering research, such as nontoxicity, biodegradability, anti-inflammatory, strong hydrophilic nature, high cohesive strength, and intrinsic antibacterial properties further optimized the biocompatibility of the nanofibrous patches via LBL modification. Finally, the study revealed that beneficial microenvironment and biomimetic ECM improve the retention and viability of the engrafted AD-MSCs and the mechanical action of the cell nano-patches for the expanding ventricular post-MI leads to suppression of HF progression by inhibition of ventricular remodeling.

Ultrasonic image analysis of longitudinal strain in uremic patients with preserved left ventricular ejection fraction

Background

Patients with uremia have high cardiovascular disease morbidity and mortality despite having normal left ventricular ejection fraction (LVEF). Longitudinal strain (LS) can be associated with subtle changes in LV systolic function. The aim of this study was to use two-dimensional speckle-tracking echocardiography (2DSTE) to assess subclinical LV myocardial dysfunction and to explore strain-changing regularities in uremic patients with LVEF ≥ 55%.

Methods

The study population included 40 uremic patients and 40 healthy volunteers. 2DSTE was performed on all participants to assess peak LS in the basal, mid and apical LV (BLS, MLS and ALS) and the respective time to peak LS (T-BLS, T-MLS, T-ALS).

Results

BLS, MLS, and ALS were significantly decreased in the uremic group relative to healthy controls and LS increased going in a basal to apical direction in both groups. T-BLS, T-MLS and T-ALS was significantly increased in the uremic group compared with the control group. In uremic patients, T-BLS, but not T-MLS or T-ALS, was significantly delayed relative to the control group. Bivariate analysis of creatinine (Cr) or urea nitrogen and strain parameters revealed a correlation only between ALS and Cr.

Conclusion

2DSTE can identify LV myocardial abnormalities in uremic patients with preserved LVEF at early stage, as well as some changing regularities of LS and T-LS in the left ventricle.

Left ventricular structural and functional changes evaluated by echocardiography and two-dimensional strain in patients with sickle cell disease

INTRODUCTION

Patients with sickle cell disease have increased left ventricular size, which is not usually accompanied by changes in systolic function indexes. We assessed echocardiographic abnormalities present in patients with sickle cell anemia (SCA) and compared echocardiographic parameters to other sickle cell diseases (OSCD).

MATERIAL AND METHODS

A blind cross-sectional study with 60 patients with SCA and 16 patients with OSCD who underwent transthoracic echocardiography was performed.

RESULTS

Echocardiographic findings were: left atrial volume index 47.7 ±11.5 ml/m² in SCA group and 31.7 ±8.42 ml/m² in OSCD group (p < 0.001); left ventricular diastolic diameter index 3.47 ±0.37 cm/m² in SCA group and 2.97 ±0.41 cm/m² in OSCD group (p < 0.001); left ventricular systolic diameter index 2.12 ±0.31 cm/m² in SCA group and 1.86 ±0.28 cm/m² in OSCD group (p < 0.001). There were no differences in the left ventricular ejection fraction: 68.2 ±6.69% in SCA group and 67.1 ±6.21% in OSCD group (p = 0.527). The ratio between mitral E wave and mean mitral annulus e' wave velocities was higher in the SCA group (7.72 ±1.54 vs. 6.70 ±1.65; p = 0.047). Mitral A wave correlated significantly with hemoglobin levels (r = -0.340; p = 0.032).

CONCLUSIONS

There was an increase of left ventricular and left atrial sizes in patients with SCA, compared to patients with OSCD, without changes in systolic or diastolic function in both groups. This could be due to the hyperkinetic state due to the more severe anemia in the SCA subjects.

Lipoprotein(a) is associated with left ventricular systolic dysfunction in a Chinese population of patients with hypertension and without coronary artery disease

INTRODUCTION

Data on relationship between lipoprotein(a) (Lp(a)) and non-ischemic heart dysfunction are limited. This study is aimed to assess the association between Lp(a) and left ventricular systolic dysfunction in a Chinese population of patients with hypertension and without coronary artery disease (CAD).

MATERIAL AND METHODS

This cross-sectional study included 1611 patients with hypertension and without CAD in China. The factors associated with left ventricular ejection fraction (LVEF) were evaluated using univariate and multivariate analysis.

RESULTS

A higher percentage of hypertensive patients with LVEF < 50% were men, and had lower plasma high-density lipoprotein cholesterol, but higher plasma Lp(a), serum creatinine, and hemoglobin levels than those with LVEF ≥ 50% using univariate analysis. When participants were classified as four groups according to Lp(a) quartiles, LVEF was decreased with increased Lp(a) levels. The prevalence of LVEF < 50% was increased with Lp(a) quartiles. Multiple linear regression analysis indicated that plasma Lp(a) levels, man, and serum creatinine levels were independently correlated with LVEF in hypertensive patients. Multiple logistic regression analysis indicated that plasma Lp(a) levels (OR = 5.566, 95% CI: 1.745-17.758, p = 0.004) or Lp(a) quartiles (quartile 4: OR = 3.234, 95% CI: 1.290-8.105, quartile 1 as reference, p = 0.012) was independently correlated with LVEF < 50% with adjustment for other potential confounders. Ordinal logistic regression analysis demonstrated that Lp(a) (OR = 5.760, 95% CI: 1.831-18.120, p = 0.003) was independently correlated with different LVEF categories (≥ 50%, 35-49%, and < 35%) in hypertensive patients.

CONCLUSIONS

Left ventricular ejection fraction is decreased with increased plasma Lp(a) levels. Lipoprotein(a) is independently correlated with left ventricular systolic dysfunction in patients with hypertension and without CAD.

Magnetic Resonance Imaging of Myocardial Strain After Acute ST-Segment-Elevation Myocardial Infarction: A Systematic Review

The purpose of this systematic review is to provide a clinically relevant, disease-based perspective on myocardial strain imaging in patients with acute myocardial infarction or stable ischemic heart disease. Cardiac magnetic resonance imaging uniquely integrates myocardial function with pathology. Therefore, this review focuses on strain imaging with cardiac magnetic resonance. We have specifically considered the relationships between left ventricular (LV) strain, infarct pathologies, and their associations with prognosis. A comprehensive literature review was conducted in accordance with the PRISMA guidelines. Publications were identified that (1) described the relationship between strain and infarct pathologies, (2) assessed the relationship between strain and subsequent LV outcomes, and (3) assessed the relationship between strain and health outcomes. In patients with acute myocardial infarction, circumferential strain predicts the recovery of LV systolic function in the longer term. The prognostic value of longitudinal strain is less certain. Strain differentiates between infarcted versus noninfarcted myocardium, even in patients with stable ischemic heart disease with preserved LV ejection fraction. Strain recovery is impaired in infarcted segments with intramyocardial hemorrhage or microvascular obstruction. There are practical limitations to measuring strain with cardiac magnetic resonance in the acute setting, and knowledge gaps, including the lack of data showing incremental value in clinical practice. Critically, studies of cardiac magnetic resonance strain imaging in patients with ischemic heart disease have been limited by sample size and design. Strain imaging has potential as a tool to assess for early or subclinical changes in LV function, and strain is now being included as a surrogate measure of outcome in therapeutic trials.

Strain Imaging: From Physiology to Practical Applications in Daily Practice

Non-Doppler, 2-dimensional strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements, which serves as a major advancement in understanding myocardial deformation. It analyzes motion in ultrasound imaging by tracking speckles in 2 dimensions. There are a lot of data emerging with multiple applications of strain imaging in the clinical practice of echocardiography. As incorporation of strain imaging in daily practice has been challenging, we intend to systematically highlight the top 10 applications of speckle-tracking echocardiography, which every cardiologist should be aware of: chemotherapy cardiotoxicity, left ventricular assessment, cardiac amyloidosis, hypertrophic obstructive cardiomyopathy, right ventricular dysfunction, valvular heart diseases (aortic stenosis and mitral regurgitation), cardiac sarcoidosis, athlete heart, left atrial assessment, and cardiac dyssynchrony.

Assessment of the Utility of the Septal E/(E' × S') Ratio and Tissue Doppler Index in Predicting Left Ventricular Remodeling after Acute Myocardial Infarction

Background. The aim of this study is to show whether the septal E/(E′ × S′) ratio assessed by tissue Doppler echocardiography can predict left ventricular remodeling after first ST segment elevation myocardial infarction treated successfully with primary percutaneous intervention. Methods. Consecutive patients (n = 111) presenting with acute anterior myocardial infarction for the first time in their life were enrolled. All patients underwent successful primary percutaneous coronary intervention. Standard and tissue Doppler echocardiography were performed in the first 24-36 hours of admission. Echocardiographic examination was repeated after 6 months to reassess left ventricular volumes. Septal E/(E′ × S′) ratio was assessed by pulsed Doppler echocardiography. Results. Group 1 consisted of 33 patients with left ventricular (LV) remodeling, and Group 2 had 78 patients without LV remodeling. E/(E′ × S′) was significantly higher in Group 1 (4.1 ± 1.9 versus 1.65 ± 1.32, p = 0.001). The optimal cutoff value for E/(E′ × S′) ratio was 2.34 with 87.0% sensitivity and 82.1% specificity. Conclusion. Septal E/(E′ × S′) values measured after the acute anterior myocardial infarction can strongly predict LV remodeling in the 6-month follow-up. In the risk assessment, the septal E/(E′ × S′) can be evaluated together with the conventional echocardiographic techniques.

Association Between Myocardial Mechanics and Ischemic LV Remodeling

The outcomes associated with heart failure after myocardial infarction are still poor. Both global and regional left ventricular (LV) remodeling are associated with the progression of the post-infarct patient to heart failure, but although global remodeling can be accurately measured, regional LV remodeling has been more difficult to investigate. Preliminary evidence suggests that post-MI assessment of LV mechanics using stress and strain may predict global (and possibly regional) LV remodeling. A method of predicting both global and regional LV remodeling might facilitate earlier, targeted, and more extensive clinical intervention in those most likely to benefit from novel interventions such as cell therapy.

Role of ultrasonography in the evaluation of correlation between strain and elasticity of common carotid artery in patients with diabetic nephropathy

OBJECTIVE

This study aimed to investigate the correlation between strain and elasticity of the common carotid artery (CCA) by ultrasonography and evaluate its clinical significance in patients with diabetic nephropathy (DN).

METHODS

A total of 68 DN patients and 54 healthy subjects were randomly recruited from the Ultrasound Department from April 2014 to March 2015. The maximum of circumferential strain (CSmax), maximum of circumferential strain rate (CSRmax), compliance coefficient (CC) and stiffness index (β) of the CCA were determined by ultrasonography in all the patients, and correlation analysis was performed.

RESULTS

The CC, CSmax and CSRmax in DN group were significantly lower than in healthy controls (P<0.05), but β was markedly higher than in control group (P<0.05). There was a significantly positive correlation of CSmax and CSRmax with CC and a negative correlation with β in both control group and DN group.

CONCLUSION

There is significant correlation between strain and elastic of the CCA. CSmax and CSRmax may be used to reflect the mechanical characteristics of CCA.