scholarly journals P735 Septal curvature - a novel, semi-automated parameter to aid in recognition of basal septal hypertrophy in arterial hypertension

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Loncaric ◽  
M Marciniak ◽  
J F Fernandes ◽  
A Gilbert ◽  
L Nunno ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Wall Thickness ◽  
Speckle Tracking ◽  
Endocardial Border ◽  
Hypertensive Patients ◽  
Septal Hypertrophy ◽  
Thickness Measurements ◽  
Contour Curvature ◽  
Septal Curvature ◽  
Myocardial Contour

Abstract Funding Acknowledgements Horizon 2020 European Commission Project MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310). Background and aim Localized basal septal hypertrophy (BSH) is a known marker of increased afterload and localized deformation impairment, and can be seen in one-fifth of patients with arterial hypertension. Although there is variability in the classification, BSH is mainly defined from ratios between several wall thickness measurements. We hypothesize that the curvature of the septum is reflective of localized hypertrophy and will be significantly increased in patients with BSH. Speckle tracking endocardial delineations of the left ventricle (LV) can be used to quantify curvature, with the potential to create a novel, semi-automatized parameter for recognition of patients with an increased impact of afterload on cardiac structure and function. Methods An echocardiogram was performed on a total of 149 patients with a diagnosis of long-standing hypertension, treated with at least one antihypertensive drug and on 19 healthy age and sex-matched controls. The interventricular septum thickness was measured at basal and mid-level in the parasternal long axis (PLAX) and 4-chamber (4C) views. BSH was identified from a two-part criterion: both a positive visual assessment of an abrupt change in septal thickness seen in the 4C or PLAX views and a basal to mid-septal ratio ≥ 1.4. A dedicated software for speckle tracking was used to trace the endocardial border of the LV in 4C and 3C view. In post-analysis, we quantified the maximal curvature of the antero- and inferoseptal segments from the exported myocardial contour. Curvature, measured in m-1, was defined as the reciprocal value of the radius of the circle fitted into the curve defined by three subsequent neighboring points in the myocardial contour. Curvature was considered negative if the curve was convex with respect to the LV long-axis. Results Using septal wall thickness measurements, 19% (n = 28) of hypertensive patients were classified as having BSH, whereas all healthy controls had normal geometry. Basal antero- and inferoseptal wall thickness was significantly increased in the BSH group, which was coupled with regional deformation impairment (basal inferoseptum, controls vs. non-BSH vs. BSH: 16.1 ± 2.33 vs. 15.14 ± 2.8 vs. 13.02 ± 2.98 %, p < 0.001). The curvature of the basal inferoseptum was significantly higher in the BSH group (controls vs. non-BSH vs BSH: -23.4 (-27.2, -10.9) vs. -28.3 (-40.2, -19.3) vs. -50.5 (-66.8, -33.9) m-1, p < 0.001) (Figure 1), with the same trend seen in the basal anteroseptum. The inferoseptal curvature showed a moderately strong correlation with the inferoseptal basal-to-mid wall thickness ratio (R = 0.527, p <0.001). Conclusion Increased septal curvature is an easily quantifiable, single-value, semi-automated parameter reflective of localized thickening that could easily be incorporated into the output of the LV speckle tracking workflow, possibly aiding in the recognition of hypertensive patients in need of a closer clinical follow-up. Abstract P735 Figure 1

scholarly journals P930 Early myocardial deformation index modification in hypertensive patients without hypertensive cardiomyopathy: the role of speckle tracking echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F A Immordino ◽  
C Nugara ◽  
M Legnazzi ◽  
G Novo
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Predictive Value ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Myocardial Dysfunction ◽  
Organ Damage ◽  
Myocardial Deformation ◽  
Hypertensive Patients ◽  
Deformation Index

Abstract BACKGROUND The structural heart modifications especially for left chambers, in chronic hypertensive status are well known but recently, an increased interest in a global assessment of cardiac dysfunction in arterial hypertension is developing especially concerning the preclinical cardiac damage. The two-dimensional speckle tracking echocardiography (2D STE) is a promising technique to detect the preclinical myocardial dysfunction in different circumstances included hypertension. PURPOSE Our aim was to detect and investigate the early changes in myocardial deformation index in hypertensive patients without evident signs of organ damage, using speckle tracking echocardiography. METHOD We enrolled 92 subjects referred to our outpatient clinic for suspected hypertension without history of previous cardiovascular disease. The blood pressure measurements were always gotten with the patients seated after 5 minutes of rest. Among the selected patients 49 were finally diagnosed with essential hypertension (average office blood pressure (BP) ≥ 140/90 mmHg for at least 3 times or valid 24 hours ambulatory blood pressure measurement (ABPM) with an average BP ≥ 135/85 mmHg) while 43 subjects were not and their data were used as controls. A 2D conventional echocardiography was performed prior to other analysis for an internal protocol to exclude all the subjects with structural pathologic findings and all the patients underwent the echocardiography before the starting of any kind of therapy active on BP. Patients with chronic diseases and pregnant women were considered not eligible. We perform STE analysis of LA, LV, RV free wall, and a multilayer STE analysis for LV and RV (epicardial, mid-wall myocardial, endocardial) using specifics offline software. RESULTS All the patients had always conventional echocardiographic parameters in range of normality without particularly difference between the groups except for IVS thickness and E/E’ratio (P < 0,05). Patients with hypertension were usually overweight. The STE analysis show worsening in myocardial deformation index both for LV GLS (P < 0,001), LA STE (P = 0,03) and RV STE (P = 0,01). In multivariate analysis the LV GLS was the best predictive index of preclinical organ damage (P = 0,0004) however adding to same models the values of multilayer analysis result in best predictive value for the mid-wall RV index (P = 0,015). This index was also well correlated with all the global STE and the E/E’ ratio (P < 0,05) CONCLUSION Our study suggest that 2D STE can be considered a useful method to identify early alterations of myocardial dysfunction in hypertensive patients without a clinical organ damage. All ventricular myocardial layers are involved in arterial hypertension likewise the LA walls. A layer specific pattern of alteration looks to be present in the early phases of arterial hypertension however its predictive value needs more investigation first to become of clinical use.

P3836Myocardial work distribution in hypertensive patients with basal septal hypertrophy - a non-invasive assessment with left ventricular pressure-strain relations

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Loncaric ◽  
M Marciniak ◽  
J F Fernandes ◽  
L Nunno ◽  
M Mimbrero ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Left Ventricular ◽  
Lower Percentage ◽  
Deformation Pattern ◽  
Apical Region ◽  
Basal Region ◽  
Hypertensive Patients ◽  
Non Invasive ◽  
Work Distribution ◽  
Septal Hypertrophy

Abstract Background and aim Localized basal septal hypertrophy (BSH) is a known marker of hypertension. However, the underlying functional significance of this morphologic finding is not clear. Non-invasive LV pressure estimates and speckle-tracking deformation curves can be used to quantify myocardial work (MW), which may offer insights into work distribution in increased afterload leading to better understanding of the early changes in hypertensive heart disease. The aim is to assess segmental strain and MW indices in hypertensive patients with and without BSH, as well as in healthy controls. Methods An echocardiogram was performed on a total of 149 patients with a diagnosis of long-standing hypertension and on 19 healthy age and sex-matched controls. The septum was measured at basal and mid-level in parasternal long-axis and four-chamber views. A two-part criterion - a positive visual assessment of an abrupt change in septal thickness seen in the 4C or PLAX view and a basal to mid-septal ratio ≥1.4 - was used to identify BSH. LV speckle-tracking was performed in 4C, 2C, and 3C views. Myocardial work index was calculated between mitral valve closing and opening. Average regional values of strain and MW indices were calculated by averaging the 4C, 3C, and 2C basal, mid, and apical segments. Results BSH was present in 19.2% (n=28) of the hypertensive cohort. There were no differences in LV ejection fraction or global longitudinal strain between the subgroups. The basal inferoseptum and anteroseptum were thicker in the hypertensive patients, significantly more so in the BSH subgroup, which was coupled with a proportional decrease in local deformation. Averaged regional deformation values showed a gradient increasing from base to apex in all subgroups, more pronounced in the BSH patients due to significantly impaired average basal deformation (controls vs. non-BSH vs. BSH: −18.33±1.92 vs. −17.24±2.14 vs. −15.56±2.08%, p<0.001). This deformation pattern was reflected in myocardial work distribution in hypertension, showing the basal region performing a lower percentage of global work, especially so in the BSH patients, while the apical region performed a significantly higher percentage, with a trend of further increase in the BSH subgroup (Figure 1). Figure 1 Conclusion Localised BSH, a structural finding in one-fifth of the hypertensive population, is related to functional impairment in regional systolic deformation and a pronounced redistribution of myocardial work during the cardiac cycle. An apex-to-base gradient in myocardial work signals an apical compensation of basal impairment in the setting of increased afterload. Clinical follow-up of patients is needed in order to assess the prognostic relevance of these findings. Acknowledgement/Funding Spanish Ministry of Economy and Competitiveness (TIN2014-52923-R), Fundacio La Maratό de TV3 (040310), H2020-MSCA-ITN-2016 (764738)

scholarly journals Speckle-Tracking and Tissue-Doppler Stress Echocardiography in Arterial Hypertension: A Sensitive Tool for Detection of Subclinical LV Impairment

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Kai O. Hensel ◽  
Andreas Jenke ◽  
Roman Leischik
Keyword(s):  
Early Diagnosis ◽  
Arterial Hypertension ◽  
Strain Rate ◽  
Speckle Tracking ◽  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Tissue Doppler ◽  
Systolic Strain ◽  
Hypertensive Patients ◽  
Cardiac Alterations

Early diagnosis of cardiac alterations in hypertensive heart disease is still challenging. Since such patients might have depressed global LV systolic strain or strain rate when EF is still normal, speckle-tracking echocardiography (STE) and tissue-Doppler imaging (TDI) combined with stress echocardiography might improve early diagnosis of cardiac alterations. In this prospective study standard 2D Doppler echocardiography, STE, and TDI were performed at rest and during bicycle exercise in 92 consecutive patients—46 hypertensive subjects with normal ejection fraction and 46 healthy controls. STE and TDI were used to measure global peak systolic LV circumferential strain (CS), longitudinal strain (LS), and longitudinal strain rate (SR). Mean arterial blood pressure was significantly higher in hypertensive patients at rest (100.8 mmHg SD 13.5 mmHg;P=0.002) and during physical exercise testing (124.2 mmHg SD 13.4 mmHg;P=0.003). Hypertensive patients had significantly reduced values of systolic CS (P=0.001), LS (P=0.014), and SR (P<0.001) at rest as well as during physical exercise—CS (P<0.001), LS (P<0.001), and SR (P<0.001). Using STE and TDI, reduced LV systolic strain and strain rate consistent with early cardiac alterations can be detected in patients with arterial hypertension. These findings were evident at rest and markedly pronounced during exercise echocardiography.

scholarly journals Effect of dobutamine stress on basal septal tissue dynamics in hypertensive patients with basal septal hypertrophy

2006 ◽  
Vol 20 (8) ◽  
pp. 628-630 ◽  
Author(s):  
F Yalçin ◽  
F Yiǧit ◽  
T Erol ◽  
M Baltali ◽  
M E Korkmaz ◽  
...  
Keyword(s):  
Dobutamine Stress ◽  
Hypertensive Patients ◽  
Septal Hypertrophy

scholarly journals Validation of semiautomated and locally resolved aortic wall thickness measurements from computed tomography

2015 ◽  
Vol 61 (4) ◽  
pp. 1034-1040 ◽  
Author(s):  
Eric K. Shang ◽  
Eric Lai ◽  
Alison M. Pouch ◽  
Robin Hinmon ◽  
Robert C. Gorman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Wall Thickness ◽  
Aortic Wall ◽  
Aortic Wall Thickness ◽  
Thickness Measurements

Abstract 1882: Use of Speckle Tracking to Quantify Global LV Function: A Comparison with 2D and 3D Echo and Magnetic Resonance Imaging

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Joseph K Brown ◽  
Thomas H Marwick
Keyword(s):  
Ejection Fraction ◽  
Speckle Tracking ◽  
Clinical Decision Making ◽  
Global Longitudinal Strain ◽  
Clinical Decision ◽  
Lv Function ◽  
Endocardial Border ◽  
3D Echo ◽  
2D And 3D ◽  
Better Than

Background: Ejection fraction (EF) plays a prominent role in clinical decision making but this calculation is time-consuming and dependent on load and geometry. A simple and quick technique for assessing global LV function would be useful. We sought to evaluate the robustness of global longitudinal strain (GLS) for assessment of LV function in comparison to Simpsons biplane ejection-fraction (2D-EF), 3D ejection fraction (3D-EF) and MRI ejection fraction (MRI-EF). We further investigated the automated measures of EF (auto-EF) from wall tracking. Methods: 2D and 3D echo and MRI measurement of EF were performed in 53 pts with previous infarction. GLS was measured by offline speckle-tracking in the apical 4C and 2C views. Abnormal curves were excluded on the basis of visual assessment. Auto-EF was calculated using the method of discs, using the traced endocardial border to establish end-diastolic and end-systolic volumes. Results: Average global TQ (tracking quality) was 1.14±0.22, permitting reliable derivation of strain from all segments. GLS showed a significant linear correlation with MRI-EF, similar to that between 3D-EF and MRI and better than that between 2D-EF and MRI and automated EF and MRI (Table ). Of 26 pts with a normal MRI-EF (≥50%), 85% had GLS within normal limits and 81% had normal 3D-EF, but significantly fewer were recognized as normal by 2D-EF (Table ). In pts with ≤5 abnormal segments, 3D-EF was the most accurate modality for assessing global LV function, while GLS was better than 2D-EF and auto-EF. In pts with >5 abnormal segments, GLS was the most accurate modality of quantifying global LV function against MRI-EF (r = −0.83, p <0.0001), comparatively better than 3D-EF against MRI-EF (r = 0.75, p <0.0001). Conclusion: GLS is an effective method of quantifying global LV function. In pts with >5 abnormal segments, GLS offered the best correlation with MRI-EF, reflecting the benefit of a geometry independent and site-specific parameter.

scholarly journals Early Left Ventricular Dysfunction Detected by Speckle Tracking in Long-Term Hemodialysis Patients with Valvular Calcification

2018 ◽  
Vol 9 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Jiahui Li ◽  
Aili Li ◽  
Jiali Wang ◽  
Yu Zhang ◽  
Ying Zhou
Keyword(s):  
Wall Thickness ◽  
Speckle Tracking ◽  
Heart Function ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Subtle Change ◽  
Lv Mass ◽  
And Function

Purpose: Cardiac valve calcification (VC) is very common in patients on hemodialysis. However, the definite effect of VC on left ventricular (LV) geometry and function in this population is unknown, especially when LV ejection fraction (LVEF) is normal. The aim of this study was to determine the effect of VC on LV geometry and function in long-term hemodialysis patients by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE). Methods: A total of 47 hemodialysis patients (2–3 times weekly for 5 years or more) were enrolled in this study. Cardiac VC was defined as bright echoes of more than 1 mm on one or more cusps of the aortic valve or mitral valve or mitral annulus using echocardiography as the screening method. LV longitudinal global strain (GLS) was assessed on the apical four-chamber view and calculated as the mean strain of 6 segments. LV global circumferential strain was acquired on the LV short axis view at the level of papillary muscles. Results: Twenty-five patients with VC had higher mean values of interventricular septum thickness, LV posterior wall thickness, LV mass index, relative wall thickness, and LV mass/end-diastolic volume than 22 patients without VC (p < 0.05, respectively), indicating more obvious LV hypertrophy (LVH). VC patients had higher mitral annular E/E′ values, especially at the septal side representing increased LV filling pressure compatible with diastolic dysfunction, while only the E/E′ ratio of the septal side was significantly different between the 2 groups (16.7 ± 4.1 vs. 12.3 ± 4.4, p < 0.01). When assessed by GLS, LV longitudinal systolic function was also lower in in patients with VC compared with those without VC (–0.18 ± 0.03 vs. –0.25 ± 0.04; p < 0.01). Conclusions: Cardiac VC diagnosed by echocardiography when it occurs in long-term hemodialysis patients may indicate more severe LVH, myocardial damage, and worse heart function in comparison to those without VC. Tissue Doppler imaging and 2D-STE can detect the subtle change of heart function in this population in the early stage of LV dysfunction when LVEF is normal.

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