P4546Acute heart failure: speckle tracking echocardiography, a new ally in intensive care unit

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Cameli ◽  
F Falciani ◽  
G E Mandoli ◽  
M L Parisella ◽  
E Incampo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Free Wall

Abstract Background Acute Heart Failure (AHF) is a life-threatening condition with high mortality rate. Purpose The aim of our study was to identify the best predictors of in-hospital mortality and stay, among laboratory blood tests, clinic and echocardiographic (standard and by Speckle Tracking Echocardiography, STE) parameters in patients admitted to our Intensive Care Unit (ICU) for AHF. Methods We enrolled 57 patients (age 70±13 y, 70% man) admitted to our ICU with de novo AHF or acute decompensation of Chronic Heart Failure (CHF). Exclusion criteria were: active malignancies, chronic liver disease, absent acoustic echocardiographic window and patient refusal. At ICU admission, all patients were assessed with vital signs (heart rate, HR; systolic blood pressure, SBP), blood laboratory tests, standard echo and STE of left ventricle (LV), right ventricle (RV) and left atrium (LA). These indexes were then related to the length of stay and mortality. Results The population was finally composed of 52 patients, due to 5 in-hospital deaths. 56% had an ischemic aetiology, 26% idiopathic dilated cardiomyopathy, 11% valvular diseases, 7% other causes of HF. At admission, average HR was 78±16 bpm, SBP 119±24 mmHg and EF 33±13%. Among all the parameters, the ones that showed significant statistical correlation with the length of hospitalization (15,34±7.03 days) were plasmatic creatinine, SBP, Systolic Pulmonary Artery Pressure, high LV filling pressure (E/E' >12) and Peak Atrial Longitudinal Strain (PALS). The maximal dose of intravenous loop diuretics and inotropic drugs also showed a good correlation. Analysing the two sub-populations with mortality data, we observed that patients who died, had a significantly lower EF (19±9.62% vs 35±12.55%; p=0,01), but not a higher left atrial volume indexed (31.04±14.87 vs 26.36±12.03 ml/m2; p= ns) compared to the survivors; instead PALS was significant worse (10.08±4.62 vs 20.64±13,35%; p<001). Free wall RV Longitudinal Strain (fw-RVLS) values for the patients who died (−9.41±4.66%) were significantly lower than in survivors (−13.67±6.02%; p<0.01). LVGLS (Left Ventricular Global Longitudinal Strain) did not show statistical significant differences between the two populations. Based on the results of ROC analysis (Figure 1), we created a score to predict in-hospital mortality, composed of: EF, PALS and RVLS-free wall. The ideal cut point to predict mortality was >1.5. Figure 1 Conclusions AHF represents one of the major challenges in ICU. The use of a combined echocardiographic score, assessed at admission, could help to better predict mortality risk, in addition to commonly used indexes.

Abstract 14937: Evaluation of Biventricular Functions in Patients With Covid-19 Using Speckle Tracking Echocardiography

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Omer F Baycan ◽  
Hasan Ali A Barman ◽  
Adem Atici ◽  
Mustafa A Tatlisu ◽  
furkan bolen ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Arterial Oxygen Saturation ◽  
Left Ventricular ◽  
Arterial Oxygen ◽  
Control Group ◽  
Severe Group ◽  
The Mean

Introduction: A new infectious outbreak sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spreading all around the world. The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) in patients with coronavirus disease 2019 (COVID-19). Hypothesis: As some studies have shown that COVID-19 could affect the cardiovascular system due to the capability of pathogenity of the virus, biventricular functions could be affected in the tissue level even though the routine evaluations of the heart functions seem normal. Methods: In this prospective, single-center study, data were gathered from patients treated for COVID-19, who had biventricular systolic function and no history of coronary artery disease. Two-dimensional echocardiography (2-DE) and speckle tracking echocardiography (STE) images were obtained for all patients. Patients were divided into three groups: those with severe COVID-19 infection, those with non-severe COVID-19 infection, and those without COVID-19 infection (the control group). Data regarding clinical characteristics and laboratory findings were obtained from electronic medical records. The primary endpoint was in-hospital mortality. Results: A total of 100 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 59.1 ± 12.9, 40% of whom were male. The mean age of the non-severe group (n = 56) was 53.7 ± 15.1, 58% of whom were male. Of these patients, 22 died in the hospital. In patients in the severe group, LV-GLS and RV-LS were decreased compared to patients in the non-severe and control groups (LV-GLS: -14.5 ± 1.8 vs. -16.7 ± 1.3 vs. -19.4 ± 1.6, respectively [p < 0.001]; RV-LS: -17.2 ± 2.3 vs. -20.5 ± 3.2 vs. -27.3 ± 3.1, respectively [p < 0.001]). The presence of cardiac injury, D-dimer, arterial oxygen saturation (SaO2), LV-GLS (OR:1.63, 95% confidence interval [CI] 1.08-2.47; p = 0.010) and RV-LS (OR:1.55, 95% CI 1.07-2.25; p = 0.019) were identified as independent predictors of mortality via multivariate analysis. Conclusions: LV-GLS and RV-LS are independent predictors of in-hospital mortality in patients with COVID-19.

P4378Comparison between left bundle branch pacing and His bundle pacing using two-dimensional speckle tracking echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y F Cheng ◽  
H Y Chen ◽  
M R Zhu ◽  
X Y Chen ◽  
Y G Su ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Free Wall ◽  
Two Dimensional ◽  
His Bundle ◽  
Time To Peak ◽  
Male Patients

Abstract Background Although his bundle pacing (HBP) can achieve physiological electrical activation of the ventricles, its clinical use is limited by lower success rates, high and unstable pacing thresholds and loss of capture. Left bundle branch pacing (LBBP) has been proved to be able to correct Left bundle branch block (LBBB) and generate a narrower QRS duration than conventional RV pacing. However, its effects on ventricular synchronism and contraction function remains unknown. The current study is aimed to compare the echocardiographic characteristics between HBP and LBBP, and to explore whether LBBP leads to a comparable cardiac synchrony and deformation in comparison with HBP. Methods Forty-six pacing-indicated patients were prospectively enrolled. Twenty-nine patients underwent LBBP (17 male patients, mean age 69.6±13.7yrs, the LBBP group) and 17 patients underwent HBP (13 male patients, mean age 70.4±14.7yrs, the HBP group). LBBP was achieved by trans-septal method in the basal ventricular septum. Left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and tricuspid annulus plane systolic excursion (TAPSE) were obtained. Strains and time to peak strains of right ventricular free wall and 16 left ventricle segments were analyzed using two-dimensional speckle tracking echocardiography (2D STE). The standard deviation of time to peak strains of 16 left ventricular segments was calculated as PSD. Results Compared to the baseline, time to peak longitudinal strain (TTPS) of apical septum, apical lateral wall were shortened after 6 months of HBP, while they didn't change significantly after 6 months of LBBP. After pacemaker implantation, the LBBP group had a delayed TTPS of apical septum, apical lateral wall and basal RV free wall than the HBP group (LBBP vs. HBP: apical septum,358.44±61.98ms vs. 296.43±29.47ms; apical lateral wall, 373.11±55.80ms vs. 299.00±83.45ms; basal RV free wall, 404.31±72.93ms vs. 334.50±39.95ms, all p<0.05).However, PSD was comparable between the two groups (p>0.05). Compared to the baseline, global left ventricular longitudinal strain (LVGLS) and longitudinal strain of RV free wall (RVLS) were deteriorated after 6 months of HBP, while they were preserved in the LBBP group. After 6-month pacing, LVGLS and RVLS were significantly stronger in the LBBP group than those in the HBP group. (LVGLS, −16.10±3.75% vs. −13.18±4.11%; RVLS, −17.50±5.46% vs. −13.70±4.35%, both p<0.05). Conclusion Patients received LBBP had a comparable left ventricular synchronism and a better myocardial contraction compared to patients with HBP. LBBP may be a promising alternative pacing strategy. Two-dimensional STE is more sensitive than conventional echocardiography in assessing cardiac synchrony and segmental deformation.

Predictors of Left Ventricular Remodeling Post Acute Myocardial Infarction. Protocol for a Clinical Study

2019 ◽  
Vol 4 (3) ◽  
pp. 120-123
Author(s):  
Ioana Cîrneală ◽  
Diana Opincariu ◽  
István Kovács ◽  
Monica Chițu ◽  
Imre Benedek
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Speckle Tracking ◽  
Ventricular Remodeling ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Serum Biomarkers ◽  
Remodeling Index

Abstract Heart failure is a clinical syndrome that appears as a consequence of a structural disease, and the most common cause of left ventricular systolic dysfunction results from myocardial ischemia. Cardiac remodeling and neuroendocrine activation are the major compensatory mechanisms in heart failure. The main objective of the study is to identify the association between serum biomarkers illustrating the extent of myocardial necrosis (highly sensitive troponin as-says), left ventricular dysfunction (NT-proBNP), and systemic inflammatory response (illustrated via serum levels of hsCRP and interleukins) during the acute phase of a myocardial infarction, and the left ventricular remodeling process at 6 months following the acute event, quantified via speckle tracking echocardiography. The study will include 400 patients diagnosed with acute myocardial infarction without signs and symptoms of heart failure at the time of enrollment that will undergo a complex clinical examination and speckle tracking echocardiography. Serum samples from the peripheral blood will be collected in order to determine the inflammatory serum biomarkers. After 6 months, patients will be divided into 2 groups according to the development of ventricular remodeling, quantified by speckle tracking echocardiography: group 1 will consist of patients with a remodeling index lower than 15%, and group 2 will consist of patients with a remodeling index higher than 15%. All clinical and imaging data obtained at the baseline will be compared between these two groups in order to determine the features associated with a higher risk of deleterious ventricular remodeling and heart failure.

scholarly journals Direct comparison of multilayer left ventricular global longitudinal strain using CMR feature tracking and speckle tracking echocardiography

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saikrishna Ananthapadmanabhan ◽  
Giau Vo ◽  
Tuan Nguyen ◽  
Hany Dimitri ◽  
James Otton
Keyword(s):  
Feature Tracking ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Imaging Modality ◽  
Global Longitudinal Strain ◽  
Intraclass Correlation ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Multilayer Strain

Abstract Background Cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) are well-established strain imaging modalities. Multilayer strain measurement permits independent assessment of endocardial and epicardial strain. This novel and layer specific approach to evaluating myocardial deformation parameters may provide greater insight into cardiac contractility when compared to whole-layer strain analysis. The aim of this study is to validate CMR-FT as a tool for multilayer strain analysis by providing a direct comparison between multilayer global longitudinal strain (GLS) values between CMR-FT and STE. Methods We studied 100 patients who had an acute myocardial infarction (AMI), who underwent CMR imaging and echocardiogram at baseline and follow-up (48 ± 13 days). Dedicated tissue tracking software was used to analyse single- and multi-layer GLS values for CMR-FT and STE. Results Correlation coefficients for CMR-FT and STE were 0.685, 0.687, and 0.660 for endocardial, epicardial, and whole-layer GLS respectively (all p < 0.001). Bland Altman analysis showed good inter-modality agreement with minimal bias. The absolute limits of agreement in our study were 6.4, 5.9, and 5.5 for endocardial, whole-layer, and epicardial GLS respectively. Absolute biases were 1.79, 0.80, and 0.98 respectively. Intraclass correlation coefficient (ICC) values showed moderate agreement with values of 0.626, 0.632, and 0.671 respectively (all p < 0.001). Conclusion There is good inter-modality agreement between CMR-FT and STE for whole-layer, endocardial, and epicardial GLS, and although values should not be used interchangeably our study demonstrates that CMR-FT is a viable imaging modality for multilayer strain

scholarly journals Atrial and Ventricular Structural and Functional Alterations in Obese Children

Medicina ◽  
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.

scholarly journals Assessment of Biventricular Function in Clinically Well Pediatric Heart Transplantation Patients by Three-dimensional Speckle Tracking Echocardiography

2020 ◽  
Author(s):  
Qing Lv ◽  
Meng Li ◽  
He Li ◽  
Chun Wu ◽  
Nianguo Dong ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Three Dimensional ◽  
Free Wall ◽  
Ischemic Time ◽  
Biventricular Function ◽  
Pediatric Heart Transplantation

Abstract Background Studies on pediatric heart transplantation (HTx) are uniquely challenging because pediatric HTx center volumes are generally low. And, the biventricular function plays an important role in the prognosis of pediatric HTx. The primary aim of our study was to evaluate biventricular function of pediatric HTx by three-dimensional speckle tracking echocardiography(3D-STE). Methods We enrolled 30 clinically well pediatric HTx patients and 30 sex- and age- matched healthy controls. All subjects underwent comprehensive echocardiographic examinations. Left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS), LV and right ventricular (RV) ejection fraction (EF) and RV longitudinal strain (RVLS) of free wall and septum were acquired by 3D-STE. And the correlations between strains and clinical data were explored. Results Compared with controls, LV GLS was decreased in pediatric HTx patients (P<0.05), while LV GCS and LVEF showed no difference. RVEF, RVLS (free wall) and RVLS (septum) in HTx group were diminished (P<0.05), but RVEF was still in normal range. Cold ischemic time was correlated inversely with LV GLS (β=-0.401, P<0.05). The mean pulmonary artery pressure (β=0.447, P<0.05) and postoperative tricuspid regurgitation pressure (β=0.607, P<0.05) were associated with RVLS (free wall). Conclusion Biventricular longitudinal systolic function rather than global systolic function was impaired after HTx. 3D STE may be able to evaluate the ventricular function better. Prolonged ischemic time leads to impaired LV longitudinal systolic function in pediatric HTx patients. It’s interesting that in HTx patients, it shows compensatory enhancement due to increased pulmonary vascular resistance.

Abstract 14760: Right Ventricular Function in Preterm Neonates: Reference Values for Longitudinal Strain by Two-dimensional Speckle Tracking Echocardiography From Birth to One Year of Life

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Philip T Levy ◽  
Meghna D Patel ◽  
Mark R Holland ◽  
Timothy J Sekarski ◽  
Amit Mathur ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Reference Values ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Free Wall ◽  
Two Dimensional ◽  
One Year

Introduction: Right ventricle (RV) systolic function is an important determinant of cardiopulmonary outcomes in premature infants. Two-dimensional speckle tracking echocardiography (2DSTE) derived myocardial strain is a reliable measure of RV systolic function in premature infants, but lacks reference values for clinical application in premature infants. We aimed to determine the maturational (age- and weight- related) changes in RV strain to establish reference values in preterm infants from birth to one year corrected age (CA). Methods: RV peak global longitudinal strain (pGLS) and RV free wall longitudinal strain (FWLS) were measured in a prospective longitudinal study in 115 preterm infants (< 29 weeks at birth) at 24 and 72 hours of age (HOA), 32 and 36 weeks postmenstrual age (PMA), and one year (CA) by 2DTSE (GE EchoPac) from a RV-focus apical 4-chamber view using a validated protocol. Premature infants that developed chronic lung disease or had a hemodynamically significant PDA were excluded (n=65) from analysis for the reference values. Results: RV pGLS ranged from -16% at birth to -26% by one year CA and RV FWLS ranged from -18% at birth to -27% to one year CA in healthy preterm infants. RV pGLS and FWLS strain correlated with increasing weight (r=0.87, p < 0.001), PMA in weeks (r=0.85, p < 0.001; r=0.83, p < 0.001), but were independent of gestational age at birth (r=0.4, p=0.38; r=0.3, p=0.5). RV strain was significantly lower in preterm infants with bronchopulmonary dysplasia (p=0.004) at 32 and 36 weeks PMA, and one year CA (Figure). RV strain was independent of gender or need for mechanical ventilation. Conclusions: This study establishes reference values of RV global and free wall longitudinal strain and tracks their postnatal maturational changes in preterm infants. These measures increase from birth to one year CA and are linearly associated with increasing weight reflecting the postnatal cardiac growth as a contributor to the maturation of RV function.

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