Reliability of left atrial strain reference values: A 3D echocardiographic study

Background Standard apical four-chamber and two-chamber views often maximize the long-axis of the left ventricle, resulting in artifactitious foreshortening of the left atrium (LA), which may overestimate LA longitudinal reservoir strain (LALS). We compared LALS values between 2D echocardiography (2DE) and 3D echocardiography (3DE) in healthy subjects to determine whether 2DE speckle tracking analysis overestimates the reference value of LALS. Methods and results In this study, 4 types of cohorts were included: 1. 105 normal subjects (retrospectively), 2. 53 patients with cardiovascular diseases (retrospectively), 3. 15 patients who received cardiac magnetic resonance (prospectively), and 4. 20 normal subjects (prospectively). LALS and LA length were measured using both 2DE and 3DE in 105 healthy subjects (median age: 42 years). Biplane LALS was measured in apical four- and two-chamber views using 2DE speckle tracking software, and 3DE LALS was measured using new 3DE LA strain software. To determine sensitivity, we also performed the same analysis in 53 patients with cardiovascular disease. The mean value of biplane LALS was 39.6%. LA length at both end-diastole (r = -0.43) and end-systole (r = -0.54) was negatively correlated with biplane LALS. Multivariate regression analysis revealed that both end-diastolic and end-systolic LA length had significant negative relationships with biplane LALS after adjusting for anthropometric and echocardiographic image quality parameters. 3DE LALS (23.7±7.6%) gave significantly lower values than 2DE LALS (39.5±12.0%, p<0.001) with a weak correlation (r = 0.33). LA length measured by 2DE was significantly shorter than that measured by 3DE. The same trend was observed in diseased patients. Conclusions Our results revealed that in 2DE, the LA cavity consistently appears longitudinally foreshortened in apical views, potentially overestimating LALS. 3DE may overcome this limitation.

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P695 Is reference value of left atrial strain using 2D echocardiography really reliable?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.369 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Takeuchi ◽

K Negishi ◽

Y Nabeshima ◽

K Otani ◽

Y Otsuji

Keyword(s):

Left Ventricle ◽

Left Atrium ◽

Healthy Subjects ◽

Left Atrial ◽

Speckle Tracking ◽

Paired Comparison ◽

Reference Value ◽

Left Ventricular ◽

2D Echocardiography ◽

Longitudinal Length

Abstract Funding Acknowledgements MT received research grant from GE Healthcare. Background Left atrial (LA) longitudinal strain (LALS) assessed by two-dimensional echocardiography (2DE) speckle tracking analysis is increasingly popular for the estimation of left ventricular diastolic dysfunction and the prediction of adverse outcome. Since standard apical 4-chamber and 2-chamber views often maximize the long-axis of the left ventricle, and the long axis of the left ventricle and that of the left atrium do not lie on the same 2D cutting plane, these views have a risk for the foreshortening of the left atrium. It may cause overestimation of LALS due to the reduction of initial perimeter of region of interest that is a denominator for the strain calculation. Purpose The aim of this study was to compare LALS values between 2DE and 3D echocardiography (3DE) in healthy subjects, and investigate whether 2DE speckle tracking analysis overestimates reference value of LALS. Methods LALS and LA longitudinal length were measured by both 2DE and 3DE in 105 healthy subjects (median age, 42 years; 59 men). For 2DE, LA longitudinal length from the mitral annulus to the roof of the left atrium were measured on apical 4-chamber and 2-chamber views at end-diastole and at end-systole, and the values were averaged. Apical 4-chamber and 2-chamber LALS was also measured using 2DE speckle tracking software (EchoPac PC, GE Healthcare) for calculating biplane LALS. 3DE LALS was measured using new 3DE LA strain software (4D Auto LAQ, GE Healthcare). 3DE determined LA longitudinal length at both end-diastole and end-systole was also measured using the same 3DE datasets. Results Mean values of biplane LALS was 39.6 ± 11.8%. 2DE LA longitudinal length at both end-diastole (r=-0.43) and end-systole (r=-0.54) was negatively correlated with biplane LALS. Multivariable regression analysis revealed that both end-diastolic and end-systolic LA longitudinal length had a significant negative association for biplane LALS after adjusting anthropometric and echocardiography image quality parameters. 3DE LALS analysis was not possible in 11 subjects due to the erroneous LA border determination (Feasibility: 90%). 3DE LALS (23.7 ± 7.6%) was significantly lower than biplane LALS (39.5 ± 12.0%, p < 0.001) with a weak correlation (r = 0.33) in 94 subjects who were possible in both analyses. Paired comparison of LA longitudinal length between 2DE and 3DE revealed that 2DE determined LA length at end-diastole (3.51 ± 0.72 cm vs. 4.85 ± 0.56 cm, p < 0.001) and at end-systole (4.63 ± 0.69 cm vs. 5.84 ± 0.54 cm, p < 0.001) was significantly shorter than that obtained from 3DE. Conclusions Our results highlighted that LA cavity visualizing on the standard apical 4-chamber and 2-chamber views are often longitudinally foreshortened, and this is a potential cause for the overestimation of LALS. 3DE may overcome this limitation.

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NORMAL RANGES OF LEFT ATRIAL STRAIN BY SPECKLE TRACKING ECHOCARDIOGRAPHY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 1,789 HEALTHY SUBJECTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)31583-2 ◽

2016 ◽

Vol 67 (13) ◽

pp. 1582 ◽

Cited By ~ 1

Author(s):

Faraz Pathan ◽

Nicholas D’Elia ◽

Mark Nolan ◽

Thomas Marwick ◽

Kazuaki Negishi

Keyword(s):

Systematic Review ◽

Healthy Subjects ◽

Left Atrial ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Meta Analysis ◽

Left Atrial Strain ◽

Normal Ranges ◽

Atrial Strain

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Responses of Platelets to Strains of Streptococcus sanguis: Findings in Healthy Subjects, Bernard-Soulier, Glanzmann’s, and Collagen-Unresponsive Patients

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651098 ◽

1987 ◽

Vol 57 (02) ◽

pp. 222-225 ◽

Cited By ~ 19

Author(s):

A H Soberay ◽

M C Herzberg ◽

J D Rudney ◽

H K Nieuwenhuis ◽

J J Sixma ◽

...

Keyword(s):

Platelet Aggregation ◽

Healthy Subjects ◽

Normal Subjects ◽

Membrane Glycoprotein ◽

Response Mechanism ◽

Platelet Response ◽

Induce Platelet Aggregation ◽

Streptococcus Sanguis ◽

Lag Times ◽

Bernard Soulier Syndrome

SummaryThe ability of endocarditis and dental strains of Streptococcus sanguis to induce platelet aggregation in plasma (PRP) from normal subjects were examined and compared to responses of PRP with known platelet membrane glycoprotein (GP) and response defects. S. sanguis strains differed in their ability to induce normal PRPs to aggregate. Strains that induced PRP aggregation in more than 60% of donors were significantly faster agonists (mean lag times to onset of aggregation less than 6 min) than those strains inducing response in PRPs of fewer than 60% of donors.Platelets from patients with Bernard-Soulier syndrome aggregated in response to strains of S. sanguis. In contrast, platelets from patients with Glanzmann’s thrombasthenia and from a patient with a specific defect in response to collagen were unresponsive to S. sanguis. These observations show that GPIb and V are not essential, but GPIIb-IIIa and GPIa are important in the platelet response mechanism to S. sanguis. Indeed, the data suggests that the platelet interaction mechanisms of S. sanguis and collagen may be similar.

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Faculty Opinions recommendation of Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2881958.2550057 ◽

2010 ◽

Author(s):

Vincent Sorrell ◽

Nishant Kalra

Keyword(s):

Left Atrial ◽

Speckle Tracking ◽

Atrial Function ◽

Left Atrial Function ◽

Two Dimensional ◽

Left Atrial Strain ◽

Atrial Strain

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Assessment of right ventricular free wall longitudinal myocardial deformation using speckle tracking imaging in normal subjects

Journal of Huazhong University of Science and Technology [Medical Sciences] ◽

10.1007/s11596-008-0220-8 ◽

2008 ◽

Vol 28 (2) ◽

pp. 194-196 ◽

Cited By ~ 10

Author(s):

Chun Tong ◽

Chunlei Li ◽

Jialin Song ◽

Hongyun Liu ◽

Youbin Deng

Keyword(s):

Right Ventricular ◽

Speckle Tracking ◽

Normal Subjects ◽

Myocardial Deformation ◽

Ventricular Free Wall ◽

Free Wall ◽

Speckle Tracking Imaging ◽

Right Ventricular Free Wall

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Impact of Matrix Metalloproteinase-9 during Periodontitis and Cardiovascular Diseases

Molecules ◽

10.3390/molecules26061777 ◽

2021 ◽

Vol 26 (6) ◽

pp. 1777

Author(s):

Gaetano Isola ◽

Alessandro Polizzi ◽

Vincenzo Ronsivalle ◽

Angela Alibrandi ◽

Giuseppe Palazzo ◽

...

Keyword(s):

Matrix Metalloproteinase ◽

Healthy Subjects ◽

Multivariate Regression Analysis ◽

Matrix Metalloproteinase 9 ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp ◽

The Impact ◽

Negative Predictor ◽

Metalloproteinase 9

Matrix metalloproteinase-9 (MMP-9) has been shown to play a key role in endothelial function and perhaps pivotal in the correlation between periodontal disease and cardiovascular disease (CVD). For the study, the impact of MMP-9 of periodontitis and CVD on serum and saliva concentrations was analyzed. For the study patients with periodontitis (n = 31), CVD (n = 31), periodontitis + CVD (n = 31), and healthy patients (n = 31) were enrolled. Clinical and demographic characteristics as well as serum and salivary MMP-9 were evaluated. MMP-9 concentrations in serum and saliva were statistically elevated in patients with CVD (p < 0.01) and in patients with periodontitis plus CVD (p < 0.001) compared to patients with periodontitis and healthy subjects. Multivariate regression analysis showed that c-reactive protein (hs-CRP) was the only significant predictor for MMP-9 serum (p < 0.001), whereas hs-CRP (p < 0.001) and total cholesterol (p = 0.029) were the statistically significant salivary MMP-9 predictors. This study evidenced that patients with CVD and periodontitis + CVD presented elevated MMP-9 concentrations in serum and saliva compared to patients with periodontitis and healthy subjects. Furthermore, hs-CRP was a negative predictor of serum and salivary MMP-9.

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Urinary Neopterin Levels in Hematologic Malignancies

Tumori Journal ◽

10.1177/030089168607200204 ◽

1986 ◽

Vol 72 (2) ◽

pp. 139-143 ◽

Cited By ~ 6

Author(s):

Giovanni Santelli ◽

Antonio Marfella ◽

Giuseppe Abate ◽

Pasquale Comella ◽

Ferdinando Nitsch ◽

...

Keyword(s):

Cancer Patients ◽

Healthy Subjects ◽

Normal Limit ◽

Bone Marrow Involvement ◽

Hematologic Malignancies ◽

Mean Value ◽

Urinary Neopterin ◽

Hodgkin's Lymphomas ◽

Normal Controls ◽

Active Disease

We studied urinary excretion levels of neopterin in 30 cancer patients affected by non-Hodgkin's lymphomas, Hodgkin's disease and multiple myeloma compared to 30 healthy subjects. Mean value of neopterin excretion in cancer patients (576.01 ± 620.37) appeared significantly increased (p < 0.001) compared to normal controls (134.40 ± 41.65). A neopterin excretion above the upper normal limit was observed in 23/28 (82%) patients with active disease. A trend to an increased urinary level of neopterin with more advanced stage was observed, namely in patients with bone marrow involvement and constitutional symptoms. We suggest that the evaluation of urinary neopterin levels may be of value in the diagnosis and follow-pu of hematologic malignancies.

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