2D speckle tracking echocardiography as predictor of major adverse cardiac events (MACE) in patients with non ST elevation myocardial infarction and unstable angina

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND 2D speckle strain echocardiography has been recognized in different studies to provide additional important prognostic information in patients with chronic stable coronary artery disease or acute coronary syndrome (ACS)—more often on (ST elevation myocardial infarction (STEMI) patients. PURPOSE This study aimed to determine the clinical utility of 2D speckle tracking echocardiography in predicting major adverse cardiac events (MACE) in patients with non ST elevation – acute coronary syndrome (NSTE-ACS). METHODOLOGY This is a prospective cohort study which included 91 patients diagnosed to have NSTE-ACS. Baseline characteristics were collected and echocardiographic evaluations of patients were done within 48 hours of admission. In hospital and 6 months MACE were evaluated in relation to their baseline echocardiographic parameters, 2D speckle strain and strain rate analyses. RESULTS Among the conventional echocardiographic parameters, only left ventricular end systolic diameter (LVESD) and wall motion score showed significant difference between those with and without outcomes after 6 months. There were no significant difference among the 2D speckle tracking strain and strain rate parameters between those patients with and without major cardiac events during their in hospital admission. However after 6 months follow-up, there were significantly lower mean left ventricular global longitudinal strain (GLS) (-14.22% ± 4.45 versus -16.44% ± 4.19, p-value 0.0261) and strain rate (-0.69 1/sec ± 0.36 versus -0.94 1/sec ± 0.25, p-value 0.009) were observed among patients with MACE compared to those without. Also, incidence of reduced GLS strain and strain rate, were significantly higher in those with MACE after 6 months. The left ventricular global circumferential strain and strain rate, and right ventricular global longitudinal strain did not have significant difference between those with and without but these had a generally lower value among those who had in-hospital and 6 months MACE. In this study, LV GLS sensitivity and specificity were 64.64% and 61.70% respectively, at cut-off value of <-15.0% for detecting MACE within 6 month follow-up. LV GLS cut-off point <-12.0%, which detects severe LV dysfunction in previous studies, have sensitivity of 40% but high specificity of 82.98% for predicting MACE after 6 months. CONCLUSION Both LV GLS strain and strain rate can be used to predict major adverse cardiovascular events after NSTE-ACS. Abstract Figure. ROC curve LV strain and strain rate

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Left ventricular systolic function impairment in children after balloon valvuloplasty for congenital aortic stenosis assessed by 2D speckle tracking echocardiography

PLoS ONE ◽

10.1371/journal.pone.0248862 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0248862

Author(s):

Krzysztof Godlewski ◽

Paweł Dryżek ◽

Elżbieta Sadurska ◽

Bożena Werner

Keyword(s):

Strain Rate ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Circumferential Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Strain And Strain Rate ◽

Eccentric Hypertrophy

Aims The aim of the study was to evaluate left ventricular (LV) remodeling and systolic function using two-dimensional speckle tracking echocardiographic (2D STE) imaging in children at a long-term (more than 36 months, 107.5±57.8 months) after balloon valvuloplasty for aortic stenosis (BAV). Methods and results 40 patients (mean age 9,68 years, 75% male) after BAV and 62 control subjects matched to the age and heart rate were prospectively evaluated. The 2D STE assessment of LV longitudinal and circumferential strain and strain rate was performed. Left ventricular eccentric hypertrophy (LVEH) was diagnosed in 75% of patients in the study group. Left ventricular ejection fraction (LVEF) was normal in all patients. In study group, global longitudinal strain (GLS), global longitudinal strain rate (GLSr) were significantly lower compared with the controls: GLS (-19.7±2.22% vs. -22.3±1.5%, P< 0.001), GLSr (-0.89±0.15/s vs. -1.04 ±0.12/s, P < 0.001). Regional (basal, middle and apical segments) strain and strain rate were also lower compared with control group. Global circumferential strain (GCS), global circumferential strain rate (GCSr) as well as regional (basal, middle and apical segments) strain and strain rate were normal. Multivariable logistic regression analysis included: instantaneous peak systolic Doppler gradient across aortic valve (PGmax), grade of aortic regurgitation (AR), left ventricular mass index (LVMI), left ventricular relative wall thickness (LVRWT), left ventricular end-diastolic diameter (LVEDd), peak systolic mitral annular velocity of the septal and lateral corner (S’spt, S’lat), LVEF before BAV and time after BAV and showed that the only predictor of reduced GLS was LV eccentric hypertrophy [odds ratio 6.9; (95% CI: 1.37–12.5), P = 0.045]. Conclusion Patients at long-term observation after BAV present the subclinical LV systolic impairment, which is associated with the presence of its remodeling. Longitudinal deformation is the most sensitive marker of LV systolic impairment in this group of patients.

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P667 Protein supplementation improves left ventricular systolic functions in athletes by 2D speckle tracking echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.347 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

B Yaman ◽

H Kemal Gunsel ◽

L Cerit ◽

E Acikgoz ◽

S Usalp ◽

...

Keyword(s):

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Left Ventricular ◽

Protein Supplementation ◽

Protein Supplements ◽

Strain And Strain Rate ◽

Significant Difference ◽

2D Speckle Tracking ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements none Background Exercise induced left ventricular remodelling is known for many years. Left ventricular enlargement, hypertrophy, left atrial dilatation are adaptive responsive mechanisms of myocardial tissue to increased physiological demand by exercise. In recent years, strain and strain rate have been used for the assessment of myocardial adaptation in athletes’. In literature, left ventricular and right ventricular deformation is decreased in athletes’, compared to normal healthy individuals. Also left atrial reservoir and contractile functions, which can be measured by speckle tracking echocardiography, decrease in endurance athletes with atrial fibrillation. Athletes have been using protein supplementation frequently in recent years however cardiac effects are largely unknown. There is limited data in the literature about cardiac effects of protein supplementation. Purpose In our study, we aim to evaluate the effects of protein supplementation on cardiac functions in athletes with 2D speckle tracking echocardiography. This is the first study in the literature evaluating the effects of protein supplements on echocardiographic parameters. Methods Eighty-three athletes (mean age = 29.7 ± 7.9) without history of cardiac disease or other chronic diseases such as hypertension, diabetes mellitus, kidney failure were prospectively included in our study. 73.5% (n = 61) of them were male. Participants were divided into two groups; participants who use protein supplementation regularly was defined as group 1 (n = 33); did not use protein supplementation was defined as group 2 (n = 50). In addition to Standard 2D echocardiographic measurements, left ventricle global longitidunal strain (LvGLS), right ventricle global longitidunal strain (RvGLS), right ventricle free wall strain (RvFWS), left atrium strain and strain rate were analyzed with Vivid E9, offline using a customized software package (Echo Pac for PC, GE Vingmed) (Figure 1). Results Diameter of interventricular wall was higher in group 1 (10.1 ± 1.0 vs 9.5 ± 1.2, p = 0.022). Systolic peak ejection velocity of the mitral valve medial annulus is higher in group 1 than group 2 (0.09 ± 0.1 vs 0.08 ± 0.1, p < 0.001). Late diastolic velocity of the mitral valve medial annulus is higher in the group 1 (0.09 ± 0.02 vs 0.08 ± 0.02, p = 0.015). LvGLS which was the indicator of left ventricular deformation was significantly higher in the group 1 (-19.49 ± 1.9 vs -18.45 ± 2.2, p = 0.030). Although RvGLS was higher in the group 1, there was no statistically significant difference (-22.93 ± 4.52 vs -21.07 ± 5.02, p = 0.083). Conclusion In recent years protein supplementation usage increases in young adults and athletes. In our study, although there was no statistically significant difference with left ventricular ejection fraction, LvGLS which is the early indicator of LV systolic functions better in the athletes who used protein supplementation. Further studies are needed to evaluate the long term effects of protein supplements on the heart.

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Speckle tracking echocardiography in patients with stroke

European Heart Journal ◽

10.1093/ehjci/ehaa946.2441 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Trush ◽

S.V Ivanova ◽

E.N Yushchuk ◽

A.A Savin ◽

I.V Melehina

Keyword(s):

Ischemic Stroke ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Global Longitudinal Strain ◽

Ct Scanning ◽

Left Ventricular ◽

Stroke Severity ◽

Large Artery ◽

Stroke Subtypes ◽

Significant Difference

Abstract Introduction Global longitudinal strain (GLS) via speckle tracking echocardiography (STE) has emerged as a quantitative technique to estimate myocardial function and has been shown to have clinical utility in a variety of settings. The use of this technique in patients with a stroke is limited. Purpose Comparative analysis of myocardial deformation indicators in patients with a stroke, depending on the severity and subtype. Results 230 patients with an acute cerebrovascular accident (132 men and 98 women) were included in our study, with the mean age of 64,9±10,8. Transient ischemic attack (TIA) was diagnosed in 39 (17%), acute ischemic stroke (AIS) in 191 (83%) patients. The type of an ischemic stroke in each patient was classified as one of the following traditional stroke subtypes: large-artery atherosclerosis (LAA) was diagnosed in 85 (44,5%), cardioembolic infarcts were diagnosed in 58 (30,4%), lacunar infarcts were diagnosed in 32 (16,8%) and in 16 (8,4%) the stroke was of another determined or undetermined etiology. There was no significant difference in left ventricular (LV) ejection fraction (EF) between the subgroups of TIA and AIS - 63.0% [60.0; 65.0] and 62.0% [58.0; 65.0], respectively. The LV GLS was within normal limits and amounted to 19.9±2.6 in the TIA group where as in the group of patients with stroke there was a significant (p<0.01) decrease in GLS below standard values - 17.1±3.8. The LV EF showed no significant difference between the groups of stroke subtypes. However, a decrease in GLS was found in the series from cardioembolic infarct > lacunar infarct > LAA - 17.5±3.7 > 16.5±6.5 > 16.2±3.2 (p=0,7). A decrease in GLS was significantly more often observed in male patients. A decrease in the level of GLS in patients with a stroke is associated with duration of type 2 diabetes, stroke severity by the National Institutes of Health Stroke Scale (NIHSS) score, ECG voltage criteria for LVH, increase in heart rate, LV mass/BSA, relative wall thickness (RWT) according to echocardiography. Significant differences in GLS from the size of the stroke focus according to CT scanning/ magnetic resonance imaging were not detected. Conclusion GLS via STE in patients with a stroke correlates with the severity of a stroke, the severity of LV remodeling, risk factors for cardiovascular events and requires a further study to assess the long-term prognosis Funding Acknowledgement Type of funding source: None

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Atrial and Ventricular Structural and Functional Alterations in Obese Children

Medicina ◽

10.3390/medicina57060562 ◽

2021 ◽

Vol 57 (6) ◽

pp. 562

Author(s):

Rima Šileikienė ◽

Karolina Adamonytė ◽

Aristida Ziutelienė ◽

Eglė Ramanauskienė ◽

Jolanta Justina Vaškelytė

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Radial Strain ◽

Left Ventricular ◽

Z Score ◽

Obese Children ◽

2D Speckle Tracking

Background and objectives: Childhood obesity has reached epidemic levels in the world. Obesity in children is defined as a body mass index (BMI) equal to or above the 95th percentile for age and sex. The aim of this study was to determine early changes in cardiac structure and function in obese children by comparing them with their nonobese peers, using echocardiography methods. Materials and methods: The study enrolled 35 obese and 37 age-matched nonobese children. Standardized 2-dimensional (2D), pulsed wave tissue Doppler, and 2D speckle tracking echocardiography were performed. The z-score BMI and lipid metabolism were assessed in all children. Results: Obese children (aged 13.51 ± 2.15 years; 20 boys; BMI z-score of 0.88 ± 0.63) were characterized by enlarged ventricular and atrial volumes, a thicker left ventricular posterior wall, and increased left ventricular mass. Decreased LV and RV systolic and diastolic function was found in obese children. Atrial peak negative (contraction) strain (−2.05% ± 2.17% vs. −4.87% ± 2.97%, p < 0.001), LV and RV global longitudinal strain (−13.3% ± 2.88% vs. −16.87% ± 3.39%; −12.51% ± 10.09% vs. −21.51% ± 7.42%, p < 0.001), and LV global circumferential strain (−17.0 ± 2.7% vs. −19.5 ± 2.9%, p < 0.001) were reduced in obese children. LV torsion (17.94° ± 2.07° vs. 12.45° ± 3.94°, p < 0.001) and normalized torsion (2.49 ± 0.4°/cm vs. 1.86 ± 0.61°/cm, p = 0.001) were greater in obese than nonobese children. A significant inverse correlation was found between LV and RV global longitudinal strain and BMI (r = −0.526, p < 0.01; r = −0.434, p < 0.01) and total cholesterol (r = −0.417, p < 0.01). Multivariate analysis revealed that the BMI z-score was independently related to LV and RV global longitudinal strain as well as LV circumferential and radial strain. Conclusion: 2D speckle tracking echocardiography is beneficial in the early detection of regional LV systolic and diastolic dysfunctions, with preserved ejection fraction as well as additional RV and atrial involvement, in obese children. Obesity may negatively influence atrial and ventricular function, as measured by 2D speckle tracking echocardiography. Obese children, though they are apparently healthy, may have subclinical myocardial dysfunction.

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P260Right cardiac chambers remodeling in marathon and ultra-trail athletes detected by speckle-tracking echocardiographyP261Speckle tracking determination of tissue motion annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patientsP262Value of right ventricular 2D-speckle tracking parameters in predicting the TIMI flow grade of the RCA in patients with acute RV infarctionP263The correlation between left atrial deformation indices and the CHA2DS2 - VASc risk score in patients with atrial fibrillationP264Right atrial and ventricular function evaluated with speckle tracking in patients with acute pulmonary embolismP265Enhanced accuracy of a speckle tracking strain based artificial intelligence model to differentiate ischaemic myocardial disease and cardiomyopathyP266Detection of early left ventricular and left atrial dysfunction in type I diabetes mellitus using 2D speckle tracking echocardiographyP267Two-dimensional left ventricular global longitudinal strain dynamics after percutaneous coronary intervention in stable single-vessel coronary artery disease patientsP268Left ventricular twist, torsion and strain in the fetus by 3D echocardiography: feasibility and comparisons with 2DP269Left atrial deformation analysis in acromegaly - a three-dimensional speckle-tracking echocardiographic studyP270Impact of hemodialysis on three-dimensional left ventricular myocardial deformation in end-stage renal disease: relationships with preload reductionP271Right atrial function in noncompaction cardiomyopathy - a three-dimensional speckle-tracking echocardiographic studyP272CABG failure in the era of cardiac computed tomography - after 8 years half the patients have at least one graft affected

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jew236.003 ◽

2016 ◽

Vol 17 (suppl 2) ◽

pp. ii45-ii48 ◽

Cited By ~ 1

Author(s):

K. Ujka ◽

D Y Y Chiu ◽

H. Tayel ◽

SHAIMA Mostafa ◽

E. Ramberg ◽

...

Keyword(s):

Left Atrial ◽

Speckle Tracking ◽

Type I Diabetes ◽

Global Longitudinal Strain ◽

Three Dimensional ◽

Left Ventricular ◽

Deformation Analysis ◽

Type I ◽

Timi Flow Grade ◽

2D Speckle Tracking

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Abstract 14632: Effect of Obesity on Myocardial Strain Determined by Speckle Tracking Imaging

Circulation ◽

10.1161/circ.132.suppl_3.14632 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Meihua Zhu ◽

Cole Streiff ◽

Tao He ◽

Muhammad Ashraf ◽

Jiahui Zhang ◽

...

Keyword(s):

Speckle Tracking ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Left Ventricular ◽

Control Group ◽

Speckle Tracking Imaging ◽

Initial Weight ◽

Newborn Mice ◽

2D Speckle Tracking

Introduction: Obesity may affect cardiac function, which is hard to detect by traditional echocardiography in the early stages. Speckle tracking imaging (STI) is sensitive to subtle myocardial dysfunction. The aim of this study was to determine the influence of obesity on left ventricular (LV) myocardial function in diet-induced obesity (DIO) mice using two-dimensional (2D) speckle tracking echocardiography (STE). Hypothesis: 2D STE is useful to detect obesity-caused myocardial dysfunction. Methods: Twenty newborn mice were divided into two groups: a DIO group (high-fat diet) and a control group (regular-fat diet). 2D image loops were acquired at the end of each month for 6 months. Global longitudinal strain (GLS) and global circumferential strain (GCS) were analyzed at feeding periods over 3 months and 6 months, and compared between the two groups. Results: The control group gained 64% of its initial weight, while the DIO group gained 82% of its initial weight at the 3 month feeding period; and the two groups gained 88% (control) and 125% (DIO) respectively at 6 months. STE analysis revealed an insignificant decrease in strain values in the DIO mice after 3 months; however, after 6 months, the DIO group demonstrated a significant decrease in strain values (P<0.05) despite normal ejection fractions in both groups. Conclusions: 2D STE is highly feasible to detect the myocardial dysfunction caused by obesity in earlier stage. These strain values appear to be related to the severity of obesity.

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Comparison between strain and strain rate in hypertensive patients with and without left ventricular hypertrophy: a speckle-tracking study

Menoufia Medical Journal ◽

10.4103/1110-2098.141691 ◽

2014 ◽

Vol 27 (2) ◽

pp. 322 ◽

Cited By ~ 2

Author(s):

AhmadGabr Braik ◽

SaidShalaby Monaster ◽

MahmoudKamel Ahmad

Keyword(s):

Left Ventricular Hypertrophy ◽

Strain Rate ◽

Speckle Tracking ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Hypertensive Patients ◽

Strain And Strain Rate

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1187 Evaluation of left and right ventricular functions with 3D speckle tracking in patients with mitral stenosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.686 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

O Seckin ◽

S Unlu ◽

G Tacoy

Keyword(s):

Right Ventricular ◽

Mitral Stenosis ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Three Dimensional ◽

Left Ventricular ◽

Control Group ◽

Free Wall ◽

Significant Difference

Abstract Background The function of both ventricles have been suggested to be affected in patients with mitral stenosis. In this study, it was aimed to investigate deformation properties of right (RV) and left ventricles (LV) in mild and moderate rheumatic mitral stenosis (MS) patients with three-dimensional speckle tracking echocardiography (3D-STE). Methods A total of 60 patients were included in the study (20 patients with mild MS diagnosis, 20 patients with moderate MS diagnosis and 20 healthy volunteers). Three-dimensional echocardiography datasets were obtained for both ventricles in all patients. An example for RV assessment is shown in Figure 1. LV global longitudinal strain (GLS), LV torsion, RV free wall (FW) LS and interventricular septal (IVS) LS measurements were analyzed. Results The LV ejection fraction (EF), RV fractional area change and tricuspid annular plane systolic excursion values were statistically similar and in the normal range. The LV GLS measurements were significantly different among the groups by being highest in the control group and least in the moderate stenosis group (ANOVA,p < 0.001) (Table 1). Patients with MS showed higher torsional values, correlated with MS severity (ANOVA,p < 0.001) (Table 1). IVS LS, RVFW LS values obtained by RV analysis also differed significantly among groups. The FW-GLS values only showed significant difference between the control group and moderate MS group (Table 1). Conclusion Patients with mitral stenosis showed lower LV-GLS and higher LV torsion values. Although the LV GLS is affected; the LV EF was detected to be normal due to increase in LV torsion. RV deformation indices showed signıficant decrease in correlation with the severity of the mitral stenosis. In conclusion, our data suggest that subclinical LV and RV systolic dysfunction is present in mild-moderate MS patients and this dysfunction can be detected by 3D-STE. Table 1 Parameters Control group Mild MS Moderate MS P LV GLS (%) 23.3 ± 2.08 18.9 ± 1.3 17.5 ± 1.8 <0.001 LV torsion 1.5 ± 0.6 2.1 ± 0.6 2.6 ± 0.5 <0.001 IVS LS (%) 23 ± 3.0% 20 ± 2.6 17.1 ± 2.9 <0.001 RV FW LS (%) 25.4 ± 5 22.7 ± 3.2 21.1 ± 4.8 <0.001 FW; free-wall, GLS; global longitudinal strain, IVS; interventricular septum, LV; left ventricular, RV; right ventricular Abstract 1187 Figure 1

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Abnormal left ventricular global longitudinal strain by speckle tracking echocardiography in COVID-19 patients

Future Cardiology ◽

10.2217/fca-2020-0121 ◽

2020 ◽

Author(s):

Lori B Croft ◽

Parasuram Krishnamoorthy ◽

Richard Ro ◽

Malcolm Anastasius ◽

Wenli Zhao ◽

...

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Speckle Tracking Echocardiography ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Healthy Population ◽

Significant Difference ◽

The Mean ◽

Lv Ejection Fraction ◽

Prognostic Implications

COVID-19 infection can affect the cardiovascular system. We sought to determine if left ventricular global longitudinal strain (LVGLS) is affected by COVID-19 and if this has prognostic implications. Materials & methods: Retrospective study, with LVGLS was measured in 58 COVID-19 patients. Patients discharged were compared with those who died. Results: The mean LV ejection fraction (LVEF) and LVGLS for the cohort was 52.1 and -12.9 ± 4.0%, respectively. Among 30 patients with preserved LVEF(>50%), LVGLS was -15.7 ± 2.8%, which is lower than the reference mean LVGLS for a normal, healthy population. There was no significant difference in LVGLS or LVEF when comparing patients who survived to discharge or died. Conclusion: LVGLS was reduced in COVID-19 patients, although not significantly lower in those who died compared with survivors.

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Behavior of fetal longitudinal myocardial fibers assessed by speckle tracking to obtain strain and strain rate values for low-risk pregnancies

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0342 ◽

2020 ◽

Vol 48 (2) ◽

pp. 144-152

Author(s):

Mariana Biancardi ◽

Renato Augusto Moreira de Sa

Keyword(s):

Strain Rate ◽

Gestational Age ◽

Speckle Tracking ◽

Age Groups ◽

Cross Sectional Study ◽

Observer Agreement ◽

Cross Sectional ◽

Strain And Strain Rate ◽

Significant Difference ◽

Myocardial Fibers

AbstractObjectiveTo analyze the behavior of fetal longitudinal myocardial fibers assessed by speckle tracking (STE) after fetal viability.MethodsA cross-sectional study was performed in 156 women with normal singleton pregnancies from 22 to 31 weeks of gestation. Strain (S) and strain rate (SR) values were measured in both ventricles during the fetal cardiac cycle. The population was divided into five gestational age groups based on 2-week intervals. The correlations of maternal variables with the S and SR variables and intra-observer analysis were performed.ResultsThere was a significant difference in the S and SR values of the left ventricle (LV) among the gestational age groups (P = 0.007). Significantly higher S and SR values were observed in early age groups demonstrating reductions in LV S and SR values at 26 weeks, followed by stabilization. For the right ventricle (RV), there was no significant difference between gestational age groups. Significant intra-observer agreement was observed for S values of the RV (P = 0.008) and LV (P = 0.0004) and SR values of the RV (P = 0.0001) and LV (P = 0.015).ConclusionDecreases in the S and SR values of the LV occurred after 26 weeks, followed by stabilization. No significant difference was observed in the S or SR value of the RV among the gestational age groups, and no significant association of any maternal variable evaluated with S and SR values was observed. Significant intra-observer agreement was obtained among the results.

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