Quantitative assessment of left ventricular function by 3-dimensional speckle-tracking echocardiography in patients with chronic heart failure: a meta-analysis

Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure

Heart failure (HF) is an extremely major health problem with gradually increasing incidence in developed and developing countries. HF may lead to cardiac remodeling; thus, advanced imaging techniques are required to comprehensively evaluate cardiac mechanics. Recently, three-dimensional speckle-tracking echocardiography (3D-STE) has been developed as a novel imaging technology that is based on the three-dimensional speckle-tracking on the full volume three-dimensional datasets. Three-dimensional speckle-tracking echocardiography allows a more accurate evaluation of global and regional myocardial performance, assessment of cardiac mechanics, detection of subclinical cardiac dysfunction, and prediction of adverse clinical events in a variety of cardiovascular diseases. Therefore, this review summarizes the clinical usefulness of 3D-STE in patients with HF.

Usefulness of speckle-tracking echocardiography for early detection in children with Duchenne muscular dystrophy: a meta-analysis and trial sequential analysis

Background

Duchenne muscular dystrophy (DMD) is the most common form of inherited muscle disease in children. The incidence of cardiomyopathy induced by DMD increases with age. Left ventricular ejection fraction usually fails to reflect the subclinical left ventricular dysfunction. Several studies have assessed this dysfunction using myocardial strain measured by speckle-tracking echocardiography (STE). However, the results were inconsistent and incomplete.

Methods

Several databases were searched from their inception to February 5, 2020. The summarized weighted mean difference (WMD) with 95% confidence intervals (CIs) were estimated for myocardial strain between DMD and healthy controls and a meta-analysis was conducted. Trial sequential analysis estimated whether the resulting evidence was sufficient.

Results

Eight studies with a total of 269 DMD children and 299 healthy participants were included. STE revealed that global longitudinal strain (GLS), global circumferential strain, average longitudinal strain (measured by two-dimensional STE at the apical four-chamber view), and average circumferential strain (measured by two-dimensional STE at the papillary muscle short-axis level) decreased (WMD = 4.17, 95% CI: 3.03–5.32; WMD = 3.98, 95% CI: 0.29–7.68; WMD = 4.18, 95% CI: 2.75–5.62; and WMD = 4.90, 95% CI: 2.38–7.43, respectively; all P < 0.05) compared with the controls and global radial strain was unchanged in the DMD group (WMD = − 4.33, 95% CI: − 9.53–0.87, P = 0.103). Trial sequential analysis indicated that available GLS samples were sufficient and confirmed that adequate evidence was accumulated. The credibility of other myocardial strains was questioned due to insufficiently involved studies.

Conclusion

GLS can be useful for early detection of left ventricle myocardial dysfunction in children with DMD.

Pretreatment with glucose-insulin-potassium improves ventricular performances after coronary artery bypass surgery: a randomized controlled trial

Heart failure is the main cause of poor outcome following open heart surgery and experimental studies have demonstrated that glucose–insulin–potassium (GIK) infusion exerts cardioprotective effects by reducing myocardial ischemia–reperfusion injuries. This randomized controlled trial was designed to assess the effects of GIK on left ventricular function in moderate-to-high risk patients undergoing on-pump isolated coronary artery bypass surgery (CABGS), or combined with aortic valve replacement. The primary outcomes were the effects of GIK on two- and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF), and on transmitral flow propagation velocity (Vp), that occurred between the pre- and post-CPB periods. GIK administration was associated with favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp changes over the study periods. In GIK pretreated patients (N = 54), 2-D and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD] + 3.5%, 95% confidence interval [95% CI] − 0.2 to 7.1%, MD + 4.0%, 95% CI 0.6–7.4%, and MD + 22.2%, 95% CI 16.0–28.4%, respectively). In contrast, in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased after CPB (MD − 7.5% [− 11.6 to − 3.4%], MD − 12.0% [− 15.2 to − 8.8%] and MD − 21.3% [− 25.7 to − 16.9%], respectively). In conclusion, the administration of GIK resulted in better preservation of systolic and diastolic ventricular function in the early period following weaning from CPB.

Three-Dimensional Echocardiography-derived strain values acquired by a novel analysis program

OBJECTIVE

This in vitro study calculated longitudinal strain (LS) from different ultrasound systems (GE Vivid E9 and Philips IE 33) before and after myocardial infarct (MI) using a vendor-independent analysis software package (TomTec's 4D LV Analysis) to validate the variation of two ultrasound systems.

METHODS

Ten freshly harvested porcine hearts were passively driven by a pulsatile pump apparatus at stroke volumes (SV) 30-70 mL. Full-volume three-dimensional echocardiography (3DE) data were acquired before and after MI using two different ultrasound systems. LS was derived from TomTec and validated against sonomicrometry data.

RESULTS

Linear regression analyses showed excellent correlations between TomTec-calculated LS values and sonomicrometry data for both normal and simulated MI groups (GE: R²  = 0.72/0.68, Philip: R²  = 0.71/0.66). Bland-Altman analyses demonstrated overestimation of echo-derived strain values for all groups. Both ultrasound system-derived strain values demonstrated decreased LS after MI, and the average change in strain after infarct was roughly 30% in GE images and 25% in Philips images.

CONCLUSIONS

Both GE and Philips echocardiographic systems can be analyzed with TomTec's program, and these images correlated well with sonomicrometry with acceptable variations.

Prognostic implications of left ventricular strain by speckle-tracking echocardiography in population-based studies: a systematic review protocol of the published literature

INTRODUCTION

Left ventricular (LV) strain by speckle-tracking echocardiography (STE) is a comparatively new prognostic marker. Meta-analyses relating LV strain by STE to outcomes have been conducted in selected patient-based populations with established or suspected cardiovascular (CV) diseases. However, the evidence related to population-based studies of community-dwelling individuals is uncertain. The aim of this study is to provide a comprehensive systematic review and analysis of the current available literature regarding LV strain by STE as a predictor of adverse outcomes in population-based studies.

METHODS AND ANALYSES

Thesaurus and text-word searching will be used to search two online databases (MEDLINE and EMBASE) and additional sources will be identified from citation metrics and reference lists' search. Dual search results' screening, data extraction and quality assessment will be performed. Cohort studies of community/population-based samples who have had STE and followed up longitudinally for mortal and morbid events, and published in English and peer-reviewed journals will be included. Primary outcome will be all-cause mortality whereas secondary outcomes will be composite cardiac and CV end points. Risk of bias will be assessed using Newcastle-Ottawa Quality Assessment Scale of cohort studies that will be modified as appropriate. Any arising discrepancies will be discussed and resolved through consensus.

ETHICS AND DISSEMINATION

Ethical approval is not required as this is a protocol for a systematic review. The findings of this study will be presented at scientific conferences and published in a peer-reviewed journal. Any amendments to the protocol will be documented and updated in the PROSPERO registry.

PROSPERO REGISTRATION NUMBER

CRD42018090302.

Comparison of Echocardiography, Cardiac Magnetic Resonance, and Computed Tomographic Imaging for the Evaluation of Left Ventricular Myocardial Function: Part 1 (Global Assessment)

Assessing left ventricular function is an essential part of the cardiovascular evaluation as it plays an important role in managing the patient and predicting prognosis. Recent advances in the imaging modalities currently allow a non-invasive comprehensive assessment of cardiac mechanics and precise estimation of cardiovascular hemodynamics. In this review, we will discuss and compare the currently available techniques and novel approaches utilized by echocardiography, cardiac magnetic resonance, and computed tomography for the assessment of global left ventricular performance.

Role of Echocardiography in the Evaluation of Left Ventricular Assist Devices: the Importance of Emerging Technologies

The role of left ventricular assist devices (LVAD) in patients with end-stage heart failure is well known, both as a temporary treatment before transplantation and as destination therapy, in a scenario of a relative shortage of donors to satisfy the increasing requests for transplantation. The increased population of LVAD patients needs careful imaging assessment before, during, and after LVAD implantation; echocardiography is the best tool for their evaluation and is considered the diagnostic technique of choice for the assessment before, during, and after device implantation. Although the conventional echocardiographic assessment is quite effective in evaluating the main critical issues, the role of new technologies like three-dimensional echocardiography and myocardial deformation measurements is still not properly clarified. In this review, we aim to provide an overview of the main elements that should be considered in the assessment of these patients, underlining the role that could be played by new techniques to improve the diagnostic and prognostic effectiveness of echocardiography in this setting.

The impact of preload on 3-dimensional deformation parameters: principal strain, twist and torsion

Background

Strain analysis is feasible using three-dimensional (3D) echocardiography. This approach provides various parameters based on speckle tracking analysis from one full-volume image of the left ventricle; however, evidence for its volume independence is still lacking.

Methods

Fifty-eight subjects who were examined by transthoracic echocardiography immediately before and after hemodialysis (HD) were enrolled. Real-time full-volume 3D echocardiographic images were acquired and analyzed using dedicated software. Two-dimensional (2D) longitudinal strain (LS) was also measured for comparison with 3D strain values.

Results

Longitudinal (pre-HD: −24.57 ± 2.51, post-HD: −21.42 ± 2.15, P < 0.001); circumferential (pre-HD: −33.35 ± 3.50, post-HD: −30.90 ± 3.22, P < 0.001); and radial strain (pre-HD: 46.47 ± 4.27, post-HD: 42.90 ± 3.61, P < 0.001) values were significantly decreased after HD. The values of 3D principal strain (PS), a unique parameter of 3D images, were affected by acute preload changes (pre-HD: −38.10 ± 3.71, post-HD: −35.33 ± 3.22, P < 0.001). Twist and torsion values were decreased after HD (pre-HD: 17.69 ± 7.80, post-HD: 13.34 ± 6.92, P < 0.001; and pre-HD: 2.04 ± 0.86, post-HD:1.59 ± 0.80, respectively, P < 0.001). The 2D LS values correlated with the 3D LS and PS values.

Conclusion

Various parameters representing left ventricular mechanics were easily acquired from 3D echocardiographic images; however, like conventional parameters, they were affected by acute preload changes. Therefore, strain values from 3D echocardiography should be interpreted with caution while considering the preload conditions of the patients.

Assessment of left ventricular function in chronic alcoholics by real-time three-dimensional echocardiography

Chronic alcohol consumption may lead to progressive cardiac dysfunction. The aim of this study was to evaluate the feasibility of using real-time 3-dimensional echocardiography (3DE) on assessing left ventricular (LV) function in chronic alcoholics.We classified 92 male alcoholics into mild, moderate, and severe groups; 30 age-matched controls were also recruited. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), LV mass (LVM), LV mass index (LVMI), and systolic dyssynchrony index (SDI) were measured by 3DE and 2-dimensional echocardiography (2DE).Compared to the control group, LV volume and mass were higher in the moderate and severe alcoholic groups (P < 0.05). The severe alcoholic (symptomatic) group demonstrated decreased LVEF and increased SDI (detected by 3DE) (P < 0.05).Real-time 3DE can detect the increases of LV volumes and mass in asymptomatic alcoholics, and the changes of LVEF and systolic synchrony index in symptomatic alcoholics.

Differences in Left Ventricular Global Function and Mechanics in Paralympic Athletes with Cervical and Thoracic Spinal Cord Injuries

Following a spinal cord injury, there are changes in resting stroke volume (SV) and its response to exercise. The purpose of the following study was to characterize resting left ventricular structure, function, and mechanics in Paralympic athletes with tetraplegia (TETRA) and paraplegia (PARA) in an attempt to understand whether the alterations in SV are attributable to inherent dysfunction in the left ventricle. This retrospective study compared Paralympic athletes with a traumatic, chronic (>1 year post-injury), motor-complete spinal cord injury (American Spinal Injury Association Impairment Scale A-B). Eight male TETRA wheelchair rugby players (34 ± 5 years, C5-C7) and eight male PARA alpine skiers (35 ± 5 years, T4-L3) were included in the study. Echocardiography was performed in the left lateral decubitus position and indices of left ventricular structure, global diastolic and systolic function, and mechanics were derived from the average across three cardiac cycles. Blood pressure was measured in the supine and seated positions. All results are presented as TETRA vs. PARA. There was no difference in left ventricular dimensions between TETRA and PARA. Additionally, indices of global diastolic function were similar between groups including isovolumetric relaxation time, early (E) and late (A) transmitral filling velocities and their ratio (E/A). While ejection fraction was similar between TETRA and PARA (59 ± 4 % vs. 61 ± 7 %, p = 0.394), there was evidence of reduced global systolic function in TETRA including lower SV (62 ± 9 ml vs. 71 ± 6 ml, p = 0.016) and cardiac output (3.5 ± 0.6 L/min vs. 5.0 ± 0.9 L/min, p = 0.002). Despite this observation, several indices of systolic and diastolic mechanics were maintained in TETRA but attenuted in PARA including circumferential strain at the level of the papillary muscle (−23 ± 4% vs. −15 ± 6%, p = 0.010) and apex (−36 ± 10% vs. −23 ± 5%, p = 0.010) and their corresponding diastolic strain rates (papillary: 1.90 ± 0.63 s⁻¹ vs. 1.20 ± 0.51 s⁻¹, p = 0.028; apex: 3.03 ± 0.71 s⁻¹ vs. 1.99 ± 0.69 s⁻¹, p = 0.009). All blood pressures were lower in TETRA. The absence of an association between reduced global systolic function and mechanical dysfunction in either TETRA or PARA suggests any reductions in SV are likely attributed to impaired loading rather than inherent left ventricular dysfunction.

The Relationship Between High-Sensitivity C-Reactive Protein Levels and Left Ventricular Hypertrophy in Patients With Newly Diagnosed Hypertension

The authors aimed to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) and presence of left ventricular hypertrophy and diastolic dysfunction in patients with hypertension. A total of 95 newly diagnosed hypertensive patients (mean age, 54±10 years) and 20 controls were included in this study. Patients were divided into four groups according to relative wall thickness as normal, concentric remodeling, concentric, and eccentric hypertrophy. hs-CRP was measured in all patients and serum hs-CRP level was shown to be increased in patients with hypertension compared with controls (0.57 mg/dL vs 0.25 mg/dL, respectively; P<.001). The hs-CRP level was highest in patients with concentric hypertrophy. When compared with controls, serum hs-CRP level was significantly higher in patients with concentric remodeling (0.61±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.030) and concentric hypertrophy (0.69±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.032). The present study shows that serum hs-CRP is significantly associated with left ventricular diastolic function and concentric hypertrophy in patients with hypertension.