[Left ventricular deformation: similarities and dissimilarities in elite sport activity- and acromegaly-related abnormalities. Results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Sport and MAGYAR-Path Studies]

INTRODUCTION

Acromegaly is a chronic endocrine disorder, which produces a significant amount of human growth hormone and consequently insulin-like growth factor in adulthood due to a tumor in the pituitary gland. If left untreated, it can have a significant effect on the cardiovascular system. It is also known that elite sport activity is also associated with physiologic cardiac transformation, the so-called athletes' heart, in which volumetric and functional adaptation of the heart cavities can be observed.

OBJECTIVE

In accordance with the above facts, the question may rightly arise as to what differences can be observed in left ventricular morphology and function in acromegaly, and what similarities and dissimilarities do the obtained results show compared to the values of healthy non-athlete adults compared to the values of the left ventricle of young elite athletes.

METHOD

The present study comprised 21 elite athletes playing high dynamic sports (mean age: 31.2 ± 6.4 years, 13 males) and 18 acromegaly patients (mean age: 47.9 ± 8.9 years, 9 males). Their results were compared to those of 22 negative controls (mean age: 47.7 ± 10.6 years, 13 males).

RESULTS

Left ventricle is dilated, but its function is preserved in both elite athletes and patients with acromegaly. While increased longitudinal and circumferential left ventricular strains could be seen in elite athletes primarily due to the more pronounced contractility of left ventricular apical segments, increased radial left ventricular strain was detected in acromegaly due to increased function of the left ventricular basal region. Left ventricular rotational mechanics show different patterns as well: while basal left ventricular rotation is decreased in elite athletes, apical left ventricular rotation showed a reduction leading to the significant deterioration of left ventricular twist in acromegaly.

CONCLUSION

Both elite athletes playing high dynamic sports and acromegaly patients have dilated left ventricle, more pronounced regional left ventricular contractility and left ventricular rotational abnormalities with differences in nature and extent of these alterations as compared to those of non-sporting healthy subjects. Orv Hetil. 2023; 164(8): 308-316.

[Multimodality imaging of adult patients with surgically corrected tetralogy of Fallot. Results from the CSONGRAD Registry]

INTRODUCTION

There is an increasing ratio of surviving patients with congenital heart disease including tetralogy of Fallot.

OBJECTIVE

The aim of the present study was a comparative assessment of echocardiographic and cardiac magnetic resonance imaging-derived findings in patients with tetralogy of Fallot following early total reconstruction versus early palliation/late correction.

METHODS

The study comprised 17 patients with tetralogy of Fallot (mean age: 28.6 ± 10.4 years; 10 males). Early total reconstruction was performed in 10 cases (mean age: 25.0 ± 8.0 years; 8 males), while early palliation/late construction was done in 7 subjects (mean age: 33.7 ± 11.8 years; 2 males). Complete two-dimensional Doppler echocardiography and cardiac resonance imaging were performed in all patients.

RESULTS

During long-term follow-up, lower left ventricular end-systolic (40.50 ± 10.55 ml/m2 vs. 58.14 ± 19.07 ml/m2, p = 0.013) and end-diastolic volume indices (86.60 ± 12.62 ml/m2 vs. 116.70 ± 23.70 ml/m2, p = 0.002) and stroke volume index (46.00 ± 6.77 ml/m2 vs. 58.43 ± 7.11 ml/m2, p = 0.001) could be detected, which were associated with higher echocardiographic left ventricular ejection fraction (69.75 ± 6.80% vs. 61.67 ± 8.80%, p = 0.038) in patients with tetralogy of Fallot following early total reconstruction as compared to that of subjects late after early palliation/late correction. In regard with the right heart, larger right ventricular muscle mass (72.33 ± 21.03 g/m2 vs. 51.33 ± 22.33 g/m2, p = 0.044) could be seen in patients with tetralogy of Fallot following early total reconstruction.

CONCLUSION

Beneficial left ventricular morphological and functional parameters, but more pronounced right ventricular hypertrophy could be detected in patients with tetralogy of Fallot following early total reconstruction as compared to that of subjects late after early palliation/late correction. Orv Hetil. 2023; 164(5): 186-194.

Comparative study of echocardiographic parameters in young males with early repolarization pattern

Összefoglaló. Bevezetés: Az EKG-n megjelenő korai repolarizációs mintázat diagnosztikai kritériumai és klinikai jelentősége elsősorban az elmúlt évtizedben került tisztázásra, ugyanakkor viszonylag kevés vizsgálat foglalkozott mind ez idáig a korai repolarizációs mintázathoz köthető esetleges strukturális szívelváltozások felderítésével. Módszer: Egy prospektív vizsgálat során azonosított 30, korai repolarizációs mintázatot mutató fiatal férfi (átlagéletkor: 22,5 ± 1,5 év) echokardiográfiás paramétereit hasonlítottuk össze egy 32 főből álló (átlagéletkor: 22,3 ± 1,9 év) megfeleltetett kontrollcsoport azonos jellemzőivel. A hagyományos paraméterek mérésén túlmenően, szöveti Doppler- és 'strain' (deformáció - speckle tracking módszerrel) vizsgálatot is végeztünk, összesen 35 jellemzőt követve. A paraméterek összehasonlítása kétmintás t-próba, illetve khi-négyzet-próba segítségével történt (szignifikancia: p<0,05). Eredmények: Nem találtunk patológiás elváltozásokat egyik személy esetében sem, és a két csoport között csupán két paraméter tekintetében fedeztünk fel szignifikáns eltérést. A korai repolarizációs mintázatot mutató csoportban kisebbnek bizonyult a bal kamra végsystolés térfogata (37,6 ± 15,2 ml vs. 45,5 ± 13,4 ml; p = 0,037), illetve gyakoribbnak találtuk az enyhe mitralis regurgitatio előfordulását (41,4% vs. 6,5%; p<0,001). Következtetés: A korai repolarizációs mintázatot mutató fiatal férfiak esetén kimutathatók bizonyos echokardiográfiás jellegzetességek. Ezek időbeli alakulásának, illetve prognosztikai, aritmológiai jelentőségének megítélése további, longitudinális követést igényel. Orv Hetil. 2021; 162(19): 741-745.

SUMMARY

INTRODUCTION

The diagnostic criteria and clinical significance of early repolarization pattern on ECG were clarified mainly in the last decade. However, there are only a few studies published on the exploration of cardiac structural changes underlying early repolarization pattern.

METHOD

We compared the echocardiographic parameters of 30 young males with early repolarization pattern (mean age: 22.5 ± 1.5 years), who were identified during a prospective survey, with the same parameters of a matched control group consisting of 32 young males (mean age: 22.3 ± 1.9 years). Beyond measuring the conventional parameters, tissue Doppler and strain measures (speckle tracking) were obtained. Comparison of parameters was performed using t-test and chi-square test (significancy: p<0.05).

RESULTS

There were no pathological changes in any person, and we found significant difference between the two groups only in the case of two parameters. In the early repolarization pattern group, the left ventricular end-systolic volume was smaller (37.6 ± 15.2 ml vs. 45.5 ± 13.4 ml; p = 0.037) and the presence of mild mitral regurgitation was more frequent (41.4% vs. 6.5%; p<0.001).

CONCLUSION

In young males with early repolarization pattern, we managed to demonstrate the existence of certain echocardiographic features. The assessment of their time course, prognostic and arrhythmological significance requires a longer follow-up. Orv Hetil. 2021; 162(19): 741-745.

[Left ventricular deformation in cardiac light-chain amyloidosis and hypereosinophilic syndrome. Results from the MAGYAR-Path Study]

Introduction: Hypereosinophilic syndrome (HES) and immunoglobulin light-chain amyloidosis (ALA) are two, rare haematological disorders associated with cardiac alterations. Aim: The goal of the present study was a comparative assessment of left ventricular (LV) deformational parameters in HES and ALA patients using three-dimensional speckle-tracking echocardiography (3DSTE). Method: In the present study, results of 10 HES patients (mean age: 60.9 ± 14.7 years) and 19 ALA patients (mean age: 63.4 ± 7.8 years, 13 males) were analysed. The control group contained 13 age- and gender-matched healthy adults (mean age: 59.2 ± 4.3 years, 5 males). All patients underwent a complete two-dimensional Doppler echocardiography followed by 3DSTE. Results: All basal segmental LV strains were significantly reduced in ALA patients as compared to the control group. Global and mean segmental LV longitudinal strain (LS) values of ALA patients proved to be significantly decreased as compared to those of the healthy control group. During comparison of HES patients and healthy controls, significant difference could be detected in global LV-LS, while segmental basal LV-LS was also significantly reduced in HES patients. Basal LV radial and 3D strains showed significant differences when parameters of HES and ALA patient groups were compared. Conclusion: 3DSTE is a feasible tool for the detailed assessment of LV deformation in HES and ALA patients. Significant LV deformational abnormalities could be detected in both groups. In the case of ALA, these abnormalities are more prominent. Orv Hetil. 2020; 161(5): 169-176.

[What should we know about cardiac amyloidosis? From clinical signs to treatment]

Systemic amyloidosis is a rare disease, in which the heart involvement is rather frequent and determines survival remarkably. Regarding the disease and organ involvement, new diagnostic procedures help to establish the diagnosis and to start the adequate treatment as soon as possible. Cardiac involvement is more likely to be characterised by monoclonal immunglobulin free light chain (AL amyloidosis) type and transthyretin type. In case of AL amyloidosis, heart involvement can lead to serious consequences. Biomarker assessments for cardiac function are important to determine disease severity at the beginning and to measure response to the treatment. In case of amyloidosis, the incidence of the heart involvement grows with age. The prevalence is not known exactly, but probably there are more cases than recognised. The authors present the clinical signs and diagnostic methods, emphasizing the importance of the cardiac examination methods. Orv Hetil. 2017; 158(46): 1811-1818.

[Echocardiographic evaluation of the right atrium - from M-mode to 3D speckle-tracking imaging]

Echocardiographic assessment of the right atrium is a great challenge in present practice and only limited opportunities are available. Technical improvements in the last decades enable volumetric and functional analysis of the complex right atrial cardiac cyclic movements. The aim of the present review is to demonstrate the most recent three-dimensional and/or speckle tracking echocardiographic techniques over routine methodologies in the evaluation of the right atrium. Orv. Hetil., 2016, 157(43), 1698-1707.

[Recent echocardiographic examination of the left ventricle – from M-mode to 3D speckle-tracking imaging]

The left ventricle has a vital role in maintaining circulation of the body, therefore, its non-invasive assessment is essential. The aim of the present review is to demonstrate clinical relevance of different echocardiographic methods in the evaluation of left ventricle emphasizing the importance of the most recent three-dimensional (and) speckle-tracking methodologies.

[Assessment of left atrial size and function -- from M-mode to 3D speckle-tracking echocardiography]

Left atrium is not a passive heart chamber, because it has a dynamic motion respecting heart cycle and, in accordance with its stretching, it releases atrial natriuretic peptides. Since in the course of certain invasive procedures the size of left atrium may change substantially, its exact measurement and functional characterization are essential. The aim of the present review is to summarize echocardiographic methods for the assessment of left atrial size and functional parameters.

[Correlations between mitral annular and left atrial function as assessed by three-dimensional speckle-tracking echocardiography in healthy volunteers. Results from the MAGYAR-Healthy Study]

INTRODUCTION

Left atrium is a heart chamber with dinamic motion communicating with left ventricle through the mitral valve and its annulus.

AIM

The aim of the present study was to analyse whether relationships could exist between three-dimensional speckle-tracking echocardiography-derived morphologic and functional parameters of the left atrium and mitral annulus in healthy subjects.

METHOD

The present study comprised 35 healthy volunteers. Maximum (Vmax) and minimum (Vmin) left atrial volumes and left atrial volume before atrial contraction (VpreA) were measured, and several functional parameters based on these volumes were calculated in all cases. Morphologic and functional characteristics of the mitral annulus were also determined.

RESULTS

While Vmax showed correlations with both systolic and diastolic mitral annulus parameters, Vmin-VpreA correlated with only systolic ones. While total left atrial stroke volume correlated with both systolic and diastolic mitral annular parameters, passive left atrial stroke volume showed correlations only with diastolic ones.

CONCLUSIONS

Correlations exist between left atrial and mitral annular morphological and functional characteristics in healthy subjects.

[Evaluation of pulmonary artery stiffness using routine clinical imaging methods]

Recently, there has been much debate about pulmonary hypertension due to modern therapeutic options available. Arterial hypertension is frequently associated with stiffening of a given artery. The aim of the present review is to present clinical imaging methods for the evaluation of the function and stiffness of the pulmonary artery.