Regional myocardial work by strain Doppler echocardiography and LV pressure: a new method for quantifying myocardial function

2005 ◽  
Vol 288 (5) ◽  
pp. H2375-H2380 ◽  
Author(s):  
Stig Urheim ◽  
Stein Inge Rabben ◽  
Helge Skulstad ◽  
Erik Lyseggen ◽  
Halfdan Ihlen ◽  
...  
Keyword(s):  
Doppler Echocardiography ◽  
Myocardial Function ◽  
Reference Method ◽  
Left Ventricular ◽  
Positive Sign ◽  
Volume Loading ◽  
Short Term ◽  
Loop Area ◽  
Work Index ◽  
Longitudinal Strains

There is a need for better methods to quantify regional myocardial function. In the present study, we investigated the feasibility of quantifying regional function in terms of a segmental myocardial work index as derived from strain Doppler echocardiography (SDE) and invasive pressure. In 10 anesthetized dogs, we measured left ventricular (LV) pressure by micromanometer and myocardial longitudinal strains by SDE and sonomicrometry. The regional myocardial work index (RMWI) was calculated as the area of the pressure-strain loop. As a reference method for strain, we used sonomicrometry. By convention, the loop area was assigned a positive sign when the pressure-strain coordinates rotated counterclockwise. Measurements were done at baseline and during volume loading and left anterior descending coronary artery (LAD) occlusion, respectively. There was a good correlation between RMWI calculated from strain by SDE and strain by sonomicrometry ( y = 0.73 x + 0.21, r = 0.82, P < 0.01). Volume loading caused an increase in RMWI from 1.3 ± 0.2 to 2.2 ± 0.1 kJ/m3 ( P < 0.05) by SDE and from 1.5 ± 0.3 to 2.7 ± 0.3 kJ/m3 ( P = 0.066) by sonomicrometry. Short-term ischemia (1 min) caused a decrease in RMWI from 1.3 ± 0.2 to 0.3 ± 0.04 kJ/m3 ( P < 0.05) and from 1.3 ± 0.3 to 0.5 ± 0.2 kJ/m3 ( P < 0.05) by SDE and sonomicrometry, respectively. In the nonischemic ventricle and during short-term ischemia, the pressure-strain loops rotated counterclockwise, consistent with actively contracting segments. Long-term ischemia (3 h), however, caused the pressure-strain loop to rotate clockwise, consistent with entirely passive segments, and the loop areas became negative, −0.2 ± 0.1 and −0.1 ± 0.03 kJ/m3 ( P < 0.05) by SDE and sonomicrometry, respectively. A RMWI can be estimated by SDE in combination with LV pressure. Furthermore, the orientation of the loop can be used to assess whether the segment is active or passive.

scholarly journals A study of changes in various echocardiographic parameters in patients with chronic stable angina undergoing percutaneous coronary intervention (PCI)

2015 ◽  
Vol 9 (2) ◽  
pp. 99-106
Author(s):  
Muhammad Mobarock Hossain ◽  
AKM Fazlur Rahman ◽  
Md Abu Siddique ◽  
Sajal Krishna Banerjee ◽  
Chowdhury Meskat Ahmed ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Strain Rate ◽  
Doppler Echocardiography ◽  
Stable Angina ◽  
Myocardial Function ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Percutaneous Coronary

PCI has been used increasingly for revascularization in ischemic heart disease patients. In the cardiology practice, the assessment of left ventricular (LV) function is of paramount importance. Two-dimensional echocardiography and Doppler echocardiography remain the most important diagnostic tests/tool for the evaluation of left ventricular function. The present study was conducted to determine the impact of PCI on myocardial function assessed by 2D, M mode and tissue Doppler echocardiography in patients with chronic stable angina. The interventional study was carried out in the Department of Cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka over a period of 1 year between January 2013 to December 2013. Patients with chronic stable angina undergoing percutaneous coronary intervention (PCI) during the study period were the study population. A total of 40 such patients were consecutively included in the study. The myocardial function parameters were assessed by 2D, M mode and Tissue Doppler echocardiography before PCI and 48 hours and 6 weeks after PCI. Left ventricular end diastolic dimension (LVEDD) did not experience any change 2 days after PCI, but a significant reduction was noted 6 weeks after PCI (P < 0.001). Similarly no change was observed 48 hours after PCI in left ventricular end systolic dimension (LVESD) but a significant decrease was evident 6 weeks after PCI (p < 0.001). LVEF also did not exhibit any change in the first 2 days after PCI, but significantly raised 6 weeks after PCI (p < 0.001). Tissue Doppler Imaging (TDI) showed that there was insignificant improvement in Em, Am, and Em/ Am ratio 48 hours after PCI. But there was significant improvement of the same parameters at the lateral mitral annulus 6 weeks after PCI (p = 0.044, p = 0.036 and p = 0.021 respectively). While DTm did not experience any change in first 2 days after PCI, it exhibited significant change at endpoint of study (p = 0.018), RTm and Sm peak velocity however, did not improve following PCI. Q-wave increased from 7.0 cm/sec before PCI to 7.2 cm/ sec 48 hours after PCI and 7.5 cm 6 weeks after PCI (p < 0.001). Percentage of strain decreased from -15.0 before PCI to -15.4 at the endpoint (p < 0.001) and strain rate from -1.3% before PCI to -1.4% 6 at the endpoint. From the findings of the study it can be concluded that Tissue Doppler echocardiographic indices Strain, strain rate and Q analysis can detect the early changes of improvement in the left ventricular myocardium in patient with chronic stable angina after 48 hours of PCI . Other 2D , M mode and tissue Doppler echocardiographic indices showed improvement after 6 weeks of PCI.University Heart Journal Vol. 9, No. 2, July 2013; 99-106

Short-term flexibility of myocardial triglycerides and diastolic function in patients with type 2 diabetes mellitus

2008 ◽  
Vol 295 (3) ◽  
pp. E714-E718 ◽  
Author(s):  
Sebastiaan Hammer ◽  
Rutger W. van der Meer ◽  
Hildo J. Lamb ◽  
Hans H. de Boer ◽  
Jeroen J. Bax ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Function ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Plasma Nefa ◽  
Short Term ◽  
Nonesterified Fatty Acids

Short-term caloric restriction increases plasma levels of nonesterified fatty acids (NEFAs) and is associated with increased myocardial triglyceride (TG) content and decreased myocardial function in healthy subjects. Whether this flexibility of myocardial TG stores and myocardial function is also present in patients with type 2 diabetes mellitus (T2DM) is yet unknown. Myocardial TG content and left ventricular (LV) ratio between the early (E) and atrial (A) diastolic filling phase (E/A) were determined using magnetic resonance (MR) spectroscopy and MR imaging, respectively, before and after a 3-day very low-calorie diet (VLCD) in 11 patients with T2DM. In addition, we studied patients after a 3-day VLCD combined with the antilipolytic drug acipimox. The VLCD induced myocardial TG accumulation [from 0.66 ± 0.09% (mean ± SE, baseline) to 0.98 ± 0.16%, P = 0.028] and a decrease in E/A ratio [from 1.00 ± 0.05 (baseline) to 0.90 ± 0.06, P = 0.002]. This was associated with increased plasma NEFA levels (from 0.57 ± 0.08 mmol/l at baseline to 0.92 ± 0.12, P = 0.019). After the VLCD with acipimox, myocardial TG content, diastolic function, and plasma NEFA levels were similar to baseline values. In conclusion, in patients with T2DM, a VLCD increases myocardial TG content and is associated with a decrease in LV diastolic function. These effects were not observed when a VLCD was combined with acipimox, illustrating the physiological flexibility of myocardial TG stores and myocardial function in patients with T2DM.

scholarly journals Effects of Short-Term High-Fat, High-Energy Diet on Hepatic and Myocardial Triglyceride Content in Healthy Men

2008 ◽  
Vol 93 (7) ◽  
pp. 2702-2708 ◽  
Author(s):  
Rutger W. van der Meer ◽  
Sebastiaan Hammer ◽  
Hildo J. Lamb ◽  
Marijke Frölich ◽  
Michaela Diamant ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Myocardial Function ◽  
Maximum Flow ◽  
High Energy ◽  
Left Ventricular ◽  
Resonance Spectroscopy ◽  
High Fat ◽  
Short Term ◽  
Myocardial Triglyceride ◽  
Healthy Males

Abstract Context: An association has been suggested between elevated plasma nonesterified fatty acid (NEFA) levels, myocardial triglyceride (TG) accumulation, and myocardial function. Objective: Our objective was to investigate the effects of an elevation of plasma NEFA by a high-fat, high-energy (HFHE) diet on hepatic and myocardial TG accumulation, and on myocardial function. Design: There were 15 healthy males (mean ± sd age: 25.0 ± 6.6 yr) subjected to a 3-d HFHE diet consisting of their regular diet, supplemented with 800 ml cream (280 g fat) every day. Methods: 1H-magnetic resonance spectroscopy was performed for assessing hepatic and myocardial TGs. Furthermore, left ventricular function was assessed using magnetic resonance imaging. Results: The HFHE diet increased hepatic TGs compared with baseline (from 2.01 ± 1.79 to 4.26 ± 2.78%; P = 0.001) in parallel to plasma TGs and NEFA. Myocardial TGs did not change (0.38 ± 0.18 vs. 0.40 ± 0.12%; P = 0.7). The HFHE diet did not change myocardial systolic function. Diastolic function, assessed by dividing the maximum flow across the mitral valve of the early diastolic filling phase by the maximum flow of the atrial contraction (E/A ratio), decreased compared with baseline (from 2.11 ± 0.39 to 1.89 ± 0.33; P = 0.031). This difference was no longer significant after adjustment for heart rate (P = 0.12). Conclusions: Short-term HFHE diet in healthy males results in major increases in plasma TG and NEFA concentrations and hepatic TGs, whereas it does not influence myocardial TGs or myocardial function. These observations indicate differential, tissue-specific partitioning of TGs and/or fatty acids among nonadipose organs during HFHE diet.

scholarly journals Non-invasive Myocardial Work Index Contributes to Early Identification of Impaired Left Ventricular Myocardial Function in Uremic Patients With Preserved Left Ventricular Ejection Fraction

2021 ◽  
Author(s):  
Huizhen Zhu ◽  
Yanan Li ◽  
Cunying Cui ◽  
Danqing Huang ◽  
Yuanyuan Liu ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Sensitivity And Specificity ◽  
Myocardial Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Non Invasive ◽  
Work Index ◽  
Uremic Patients ◽  
Global Work ◽  
Lv Systolic Function

Abstract BackgroundCardiac damage is the leading cause of death in uremic patients. This study aimed to evaluate the application of non-invasive myocardial work index (NIMWI) by echocardiography in assessing the left ventricular (LV) systolic function in uremic patients.MethodsTwenty-six uremic patients and twenty-seven age- and sex-matched healthy volunteers were enrolled in the study. Except for the conventional echocardiographic parameters, the LV myocardial work (MW) parameters including GWI (myocardial global work index), GCW (global constructive work), GWW (global wasted work), and GWE (global work efficiency) were calculated in study participants. Differences in MW parameters between the uremic and normal groups were compared by independent-sample t-test. Receiver operating characteristic (ROC) curves were constructed for MW parameters to detect abnormal LV systolic function in uremic patients.ResultsCompared with the normal group, GWW was significantly increased and GWE decreased in the uremic group (P< 0.05). Area under the curve (AUC) for GWE by the ROC analysis was 0.966. The best threshold, sensitivity and specificity values of GWE to detect abnormality of LV systolic function in uremic patients were 92.5%, 0.89 and 0.96 respectively. ConclusionsNIMWI may be applied to assess the global MW of uremic patients. The presence of reduced GWE can help identify impaired left ventricular myocardial function in uremic patients with preserved LV ejection fraction with a high sensitivity and specificity.

scholarly journals P206 Immediate impact of coronary revascularization on global and regional myocardial function evaluated by speckle tracking echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
W W Chen ◽  
Q B Zhu ◽  
E L Posada-Martinez ◽  
X A Ortiz-Leon ◽  
J Pereira ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Myocardial Function ◽  
Speckle Tracking Echocardiography ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Short Term ◽  
Cabg Surgery

Abstract Funding Acknowledgements No. OnBehalf No. Background The immediate effect on myocardial function and deformation after coronary revascularization is incompletely studied. Effective revascularization along with perioperative myocardial injury compromises improved regional and global left ventricular function and leads to the risks of adverse perioperative events following coronary artery bypass grafting (CABG) surgery. Global longitudinal strain (GLS) assessed by speckle-tracking echocardiography (STE) has been reported as a better predictor and a more sensitive marker for postoperative ventricular remodeling. Purpose This study aimed to evaluate changes of left ventricular (LV) systolic function and GLS in the perioperative period during CABG and to investigate the value of GLS using two-dimensional STE in predicting short-term outcome. Methods A total of 22 patients who underwent elective CABG surgery (EuroSCORE II 1.84 ± 1.2) were evaluated. Transesophageal echocardiography was performed, 2D and three-dimensional echocardiography (3DE) data was acquired before sternotomy, before cardiopulmonary bypass (CPB), after bypass and after chest closure. LV GLS and tissue motion annular displacements (TMAD) of the mitral valves were quantified by 2D STE using CMQ software. LV volumes and ejection fraction (EF) were evaluated by 3DE at the same timepoints. Short-term outcomes were defined as death, stroke, myocardial infarction, acute kidney dysfunction, rehospitalization and repeated revascularization in a one-month period after surgery. Results Both 2D and 3DE of all patients were analyzed. The cohort had a mean age of 68.2 ± 7.2 years and 9.1% was women. Before sternotomy, GLS was -15.7 ± 2.9%. Despite little change in 3D LVEF, GLS was immediately impaired after coronary artery bypass graft (before bypass vs after chest closure, -15.9 ± 3.6% vs -13.5 ± 4.0%, P = 0.001). There was strong correlation between GLS and 3D LVEF (r=-0.77, P &lt; 0.001), moderate correlations between GLS and absolute value of TMAD (r=-0.61, P &lt; 0.05), between GLS and percentage of TMAD (r=-0.64, P &lt; 0.05). Patients with poor outcome (n = 6) had a lower longitudinal strain (LS) in the apical 2-chamber (A2C) views (-14.5 ± 4.6% vs -10.8 ± 1.3%, P = 0.007) but no statistical difference between A3C and A4C views. The ROC analysis demonstrated a cut­off value -11.8% for A2C-LS to predict adverse events (AUC 0.81, P = 0.027, 95% CI 0.632-0.993), with an 83.3% sensitivity and 81.2% specificity, followed by 3D LVEF (AUC = 0.29), absolute and percentage of TMAD (AUC = 0. 21, 0.23) as less sensitive predictors of poor postoperative outcome. Conclusion Direct effects of myocardial deformation related to revascularization can be characterized by STE during CABG surgery. GLS could be a more sensitive parameter in the perioperative environment, which correlates well with LV global function assessed by 3D LVEF and TMAD. Early impairment of anterior and inferior wall myocardial strain after CABG may contribute to short-term adverse clinical outcome. Abstract P206 Figure.

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