scholarly journals Morphofunctional changes in the myocardium of the left ventricle at an early stage of the development of hypertension

2018 ◽  
Vol 20 (4) ◽  
pp. 61-65
Author(s):  
A N Kuchmin ◽  
E P Galova ◽  
A A Kazachenko ◽  
M Yu Yaroslavtcev
Keyword(s):  
Early Diagnosis ◽  
Left Ventricle ◽  
Longitudinal Strain ◽  
Early Stage ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Circulatory System ◽  
World Population ◽  
Longitudinal Deformation ◽  
Initial Stage

Hypertension, as one of the most common diseases of the circulatory system in the world population, has a large number of complications, including leading to chronic heart failure and other serious complications and, as a result, of disability, deserves the attention of clinicians and scientists, working on techniques that allow early diagnosis of morphofunctional changes in the myocardium within this pathology. As soon as standard echocardiography evaluates the systolic function and is based on the indications of the ejection fraction, which reveals a violation of systolic function only at the late stages of the development of hypertension, often irreversible, in our special study we used a technique that allows us to estimate the longitudinal deformation to detect early violations of contractility myocardium of the left ventricle at the initial stage of the disease. The examination of 68 patients revealed uneven changes in the indices of longitudinal deformation of the left ventricle. It was discovered that the early stage of the development of the disease, the segments of the anterior and anterior-septal area, as well as the basal segment of the lower wall of the left ventricle, suffer. An interesting fact is that the vast majority of the above segments are supplied by blood from the anterior interventricular artery. A negative correlation was found between the thickness of the MES in relation to the longitudinal strain indicators in the respective segments, which confirms the development of systolic dysfunction as the hypertrophy of the walls of the left ventricle develops. Thus, it has been proved that the assessment of myocardial longitudinal strain is highly informative in the early diagnosis of disorders of its contractility among hypertensive patients with early stages.

Diastolic Dysfunction with Normal Heart T2* in Thalassemia Major with Heart Failure. a Single Centre Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2457-2457
Author(s):  
Luigi Mancuso ◽  
Angela Vitrano ◽  
Massimiliano Sacco ◽  
Andrea Mancuso ◽  
Antonietta Ledda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Iron Overload ◽  
Diastolic Dysfunction ◽  
Normal Values ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Thalassemia Major ◽  
Doppler Data ◽  
The Right

Abstract Background Heart failure (HF) is the most important cause of death in Thalassemia Major (TM) patients, and results from iron overload which determines progressive systolic dysfunction of the left ventricle. T2* Magnetic Resonance Imaging (CMR) is the only non-invasive tool for detecting and quantifying myocardial iron storage.We had observed that a large number of Thalassemia patients recently observed at our Centre develops a different form of HF, with evidence of diastolic dysfunction and often in absence of systolic dysfunction. Methods We evaluated the clinical, electrocardiographic, echocardiographic and Doppler data of 16 adult Thalassemia patients with HF observed at our Centre between 2008 and 2016, together with the data obtained by means of T2* CMR. All statistical analyses were descriptive. Results are provided as means ± standard deviations, medians with interquartile ranges (IQR), and percentages. Results Table 1 describes demographics, T2* and Echo-Doppler data of 16 TM patients. The 31.2% were females and the mean age was 44.2±5.7 years.One patient presented systolic dysfunction of the left ventricle whereas the others had echocardiographic and Doppler evidence of diastolic dysfunction. Systolic dysfunction of the right ventricle was also found in 81.25% of cases. Furthermore, 30.75% of cases had T2* values consistent with significant risk for heart failure (≤14 ms), whereas the others had normal values. In 68.75% of the cases ECG showed inversion of T wave beyond V2 lead, and low voltages. Conclusions Most of the patients with heart failure recently observed at our Centre had diastolic dysfunction of the left ventricle with normal systolic function, and impairment of systolic function of the right ventricle, and normal values of cardiacT2*. In 68.75% of cases ECG showed inversion of T wave beyond V2 lead and low voltages. Limitations of this study can be summarizes in: a) small number of cases (16 pts); b) Evidence of normal values of T2* values in most patients does not exclude an iron overload in precedent years. However patients with HF due to systolic dysfunction usually show low or very low values; c) a possible bias of this study may be linked to the Centre where this study has been performed. Our Centre is the Reference Centre of Sicilian Region for Thalassemia patients. This implies the possibility of a very strict surveillance of chelation therapy with frequent evaluations of the data of T2* in order to improve at best the treatment with chelation therapy. It is possible that this, at least in part, might prevent the onset of the classical form of systolic dysfunction of the left ventricle due to iron overload, and that in these patients, differently than in patients followed up in other centres, different forms of HF noit linked to cardiac iron overload may occur: that is heart failure preserved ejection fraction (HFpEF), with prevalent left ventricular diastolic dysfunction. Table 1. Demographics, Echo-Doppler and T2* data Table 1. Demographics, Echo-Doppler and T2* data Disclosures No relevant conflicts of interest to declare.

scholarly journals Early diagnosis and misdiagnosis of Glaucoma

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Ghulam Sabir
Keyword(s):  
Intraocular Pressure ◽  
Early Diagnosis ◽  
Early Stage ◽  
Visual Fields ◽  
Fundus Examination ◽  
Group Iii ◽  
Group I ◽  
Initial Stage ◽  
Diagnosis Method ◽  
First Time

Aim: To recognize and draw a line between glaucomatous and non glaucomatous patients at very early stage. Objects: Such silent dangerous ocular problem must be recognized and treated at very initial stage to avoid subsequent complications. Diagnosis: History and all the parameters including intraocular pressure, vision, visual fields and fundus examination were evaluated for diagnosis. Method of study: The study was done at General Hospital and Services Hospital Lahore from 1987 to early 1991. All the patients over the age of 40 year whether coming for first time or already on antiglaucoma treatment were evaluated thoroughly. Patients were examined by senior colleagues also. Results: Total 180 patients were included in study, 120 males 60 females. They were divided into four groups. Group I and II were diagnosed early and included 120 patients with no complications. Group-III and IV were misdiagnosed and included 60 patients. Discussion Until and unless, special care is taken to focus on the diagnosis, it is usually missed with many complications. It is only the casual behaviour of treating physician who considers the patient`s complaint lightly and examines them superficially. Conclusion: Although misdiagnosed cases are relatively less than truly misdiagnosed cases of glaucoma yet they form an important fraction of patients who may go blind within coming years. It is therefore necessary to diagnose such patients at very early stage. The surgeon should take special interest to diagnose such patients. One should not hesitate to consult senior colleagues in doubtful cases. Proper counseling for non cooperative patients is very necessary.

Evaluation of Left Ventricular Dysfunction in Patients with Isolated Mitral Valve Stenosis Using Speckle Tracking Echocardiography

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Mohamed ElGendi ◽  
Mohamed Ayman ◽  
Mohamed Sadaka ◽  
Gehan Magdi
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Mean Value ◽  
Left Ventricular ◽  
2D Speckle Tracking ◽  
Lv Systolic Function

Abstract Aim The aim was to evaluate left ventricular (LV) systolic function in patients with isolated mitral stenosis (MS) using 2D speckle tracking echocardiography. Methods 24 patients (39.50 ± 5.55 years, 17 females) with isolated MS (MVA: 1.35 ± 0.16 cm2) with preserved LV systolic function and sinus rhythm were compared to 12 matched healthy control subjects (36.42 ± 5.99 years, 8 females). Conventional echocardiography was performed to both groups. Longitudinal strain and Circumferential strain echocardiography were obtained. Peak systolic strain was measured from the mean strain profile for a total of 17 segments of the LV for the longitudinal strain and 16 segments for the circumferential strain. Global longitudinal (G.L.) and circumferential strain (G.C.) were calculated separately as the average of the sum of the studied segments. Results The global longitudinal strain of the cases group ranged from -11 – -17% with a mean value of -14.67 ± -1.69% and that of the control group ranged from -15 – -20% with a mean value of -17.83 ± -1.53% with a statistically significant difference between the two groups. In our study, there was a negative but non-significant correlation between LV GLSS and LA diameter (r = -0.054, p = 0.802), Echo score (r = -0.018, p = 0.933) and PASP (r = 0.021, p = 0.922) in patients group. Also, the correlation was negative but non-significant between LV GCSS and LA diameter (r = -0.142, p = 0.507), Echo score (r = -0.200, p = 0.349) and PASP (r = -0.155, p = 0.471) in patients group. Conclusion • 2D speckle tracking echocardiography can detect subclinical LV systolic dysfunction which cannot be recognized by 2D conventional echocardiography. • Isolated rheumatic MS may be associated with subclinical LV systolic dysfunction.

Feasibility, reproducibility, and clinical implications of the fully automated assessment for global longitudinal strain

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Kawakami ◽  
L Wright ◽  
M Nolan ◽  
E.L Potter ◽  
H Yang ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Cardiovascular Death ◽  
Lv Function ◽  
Automated Assessment ◽  
New Onset ◽  
Excellent Reproducibility

Abstract Background Despite of evidence on its usefulness, measurement of global longitudinal strain (GLS) has not been widely accepted as a clinical routine because it requires proficiency and is time-consuming. Automated assessment of GLS may be a solution to these barriers. This study sought to investigate the feasibility, reproducibility, and predictive value of automated strain analysis compared with semi-automated and manual assessment for global longitudinal strain. Methods In this validation study, different methods for the assessment of GLS were applied to echocardiograms of 561 asymptomatic people (age 71±5 years) with heart failure (HF) risk factors, recruited from the community. All patients were followed up for new-onset of HF and cardiovascular death. Measurement of GLS was repeated using the same apical images on three different measurement packages as follows: (1) fully automated GLS (AutoStrain), (2) semi-automated GLS (automated, corrected by a trained investigator), and (3) manual GLS (standard manual assessment by a trained investigator). We defined abnormal GLS for discrimination of LV systolic dysfunction using the cut-off of GLS =18% (absolute value). Results AutoStrain measurements were feasible in 99.5% of patients. Calculation time for automated (0.5±0.1 min/patient) and semi-automated assessment (2.7±0.6 min/patient) were significantly shorter than that for manual assessment (4.5±1.6 min/patient) (both p<0.001), and the automated assessment showed excellent reproducibility. There was considerable discordance between automated and semi-automated/manual GLS (Figure 1), but normal systolic function was reliable identified. The prediction of cardiovascular events was reliable with automated, semi-automated and manual GLS (Figure 2). Conclusion A novel fully automated assessment for GLS is a feasible, rapid, reproducible and clinically applicable means of assessing LV function, and measurements in the normal range predict a favorable outcome. Figure 1 Funding Acknowledgement Type of funding source: None

P1812Speckle tracking echocardiography for early detection of left ventricular systolic dysfunction in patients with Chagas disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M C P Nunes ◽  
A L P Ribeiro ◽  
O R S Junior ◽  
C D L Olivera ◽  
C S Cardoso ◽  
...  
Keyword(s):  
Early Detection ◽  
Chagas Disease ◽  
Longitudinal Strain ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Lv Dysfunction

Abstract Introduction Longitudinal strain by speckle tracking echocardiography (STE) imaging is a reliable tool for quantitative measurement of myocardial contractility. Assessment of left ventricular (LV) systolic function has a central role in the evaluation of patients with Chagas disease, particularly for identification of subtle changes that could predict disease progression. Purpose We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in patients with Chagas disease and its relationship to other echocardiographic and laboratory parameters. Methods Eight-hundred and fifty patients with Chagas disease (mean age of 60±12 years, 70% female) who live in remote areas in Brazil were enrolled. Clinical evaluation, ECG, N-terminal pro-brain natriuretic peptide (NT-ProBNP), and echocardiogram were performed. LV GLS was assessed offline on the four-, three- and two-chamber views. Patients were divided into tertiles according to the LV strain. Data were analyzed using One-way ANOVA. Results The ECG was normal in 19%, whereas typical ECG abnormalities related to Chagas cardiomyopathy were found in 58% of the patients. Overall mean LV ejection fraction (LVEF) was 59±11%, and LV GLS was - 14.1±4.4%. Apical aneurysm was detected in 34 patients (4%).The prevalence of LV systolic dysfunction, defined as LVEF <54% and GLS ≤ |16|%, was 19% and 66%, respectively. Abnormal GLS was observed in 408 (48%) patients despite a normal LVEF. Stratified according to tertiles of LV GLS, patients in the first tertile (strain <|10.7|%), had a significantly decreased in LVEF (Fig 1, A), increased E/e' ratio (Fig 2,B), left atrial volume (Fig 1,C), and NT-proBNP levels (Fig 1,D), indicating severity of LV dysfunction (n=215). Similarly, the patients in the third tertile (strain >|17|%), had normal standard echo parameters and NT-proBNP levels (n=210). However, patients in the second tertile (|10.7|% to |17|%; n=425), the strain was abnormal while other parameters were normal, showing LV impairment that was not evidenced by conventional exams. Conclusions LV longitudinal strain assessed by STE in a general population of Chagas disease provided diagnostic information beyond conventionally measured LVEF. Early detection of ventricular impairment may help to identify Chagas disease patients at risk for development of heart failure.

scholarly journals Layer-specific speckle tracking analysis of left ventricular systolic function and synchrony in maintenance hemodialysis patients

2019 ◽  
Author(s):  
Chang Liu ◽  
Zining Yan ◽  
Li Fan ◽  
Jun Huang ◽  
Dan Shen ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Middle Segment ◽  
Basal Segment ◽  
Myocardial Layer

Abstract Background: This study investigated the value of layer-specific strain analysis by twodimensional speckle tracking echocardiography (2D-STE) for evaluating left ventricular (LV) systolic function and synchrony in maintenance hemodialysis (MHD) patients. Methods: A total of 34 MHD patients and 35 healthy controls were enrolled in this study. Dynamic images were collected at the LV apical long-axis, the four- and twochamber, and the LV short-axis views at the basal, middle, apical segments. The layerspecific speckle tracking (LST) was used to analyze the longitudinal strain (LS) and circumferential strain (CS) of LV sub-endocardium, mid-myocardium, subepicardium, global longitudinal strain (GLS), global circumferential strain (GCS), the LV 17 segment time to peak LS (TTP), the peak strain dispersion (PSD). The differences in these parameters were compared between control and MHD, and the correlation between PSD and each LS parameter was examined. The receiver operator characteristic curve was used to evaluate the efficacy of three myocardial layer LS and CS in the assessment of LV systolic dysfunction in MHD. Results: MHD had comparable left ventricular ejection fraction (LVEF), but significantly smaller GLS, GCS, and three-layer LS and CS compared to the control. The three layer LS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD compared to the normal, while the three myocardial layer CS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD compared to the normal, except for the sub-endocardium of middle and apex segment. MHD had significantly higher TTP of LV 17 segments and PSD compared to controls, and had delayed peak time in most segments. In addition, PSD of MHD was positively correlated with subendocardial and mid-myocardial LS and GLS, but not with subepicardial LS. The area under the curves (AUCs) of sub-endocardial, mid-myocardial, and sub-epicardial LS in MHD were 0.894, 0.852, and 0.870, respectively; the AUCs of sub-epicardial, midmyocardial, and sub-endocardial CS were 0.852, 0.837, and 0.669, respectively. Conclusion: LST may detect the early changes of all three-layer LS and CS and PSD in MHD, and is a valuable tool to diagnose LV systolic dysfunction in MHD.

scholarly journals Layer-specific speckle tracking analysis of left ventricular systolic function and synchrony in maintenance hemodialysis patients

2019 ◽  
Author(s):  
Chang Liu ◽  
Zining Yan ◽  
Li Fan ◽  
Jun Huang ◽  
Dan Shen ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Middle Segment ◽  
Basal Segment ◽  
Myocardial Layer

Abstract Background: This study investigated the value of layer-specific strain analysis by twodimensional speckle tracking echocardiography (2D-STE) for evaluating left ventricular (LV) systolic function and synchrony in maintenance hemodialysis (MHD) patients. Methods: A total of 34 MHD patients and 35 healthy controls were enrolled in this study. Dynamic images were collected at the LV apical long-axis, the four- and twochamber, and the LV short-axis views at the basal, middle, apical segments. The layerspecific speckle tracking (LST) was used to analyze the longitudinal strain (LS) and circumferential strain (CS) of LV sub-endocardium, mid-myocardium, subepicardium, global longitudinal strain (GLS), global circumferential strain (GCS), the LV 17 segment time to peak LS (TTP), the peak strain dispersion (PSD). The differences in these parameters were compared between control and MHD, and the correlation between PSD and each LS parameter was examined. The receiver operator characteristic curve was used to evaluate the efficacy of three myocardial layer LS and CS in the assessment of LV systolic dysfunction in MHD. Results: MHD had comparable left ventricular ejection fraction (LVEF), but significantly smaller GLS, GCS, and three-layer LS and CS compared to the control. The three layer LS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD compared to the normal, while the three myocardial layer CS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD compared to the normal, except for the sub-endocardium of middle and apex segment. MHD had significantly higher TTP of LV 17 segments and PSD compared to controls, and had delayed peak time in most segments. In addition, PSD of MHD was positively correlated with subendocardial and mid-myocardial LS and GLS, but not with subepicardial LS. The area under the curves (AUCs) of sub-endocardial, midmyocardial, and sub-epicardial LS in MHD were 0.894, 0.852, and 0.870, respectively; the AUCs of sub-epicardial, midmyocardial, and sub-endocardial CS were 0.852, 0.837, and 0.669, respectively. Conclusion: LST may detect the early changes of all three-layer LS and CS and PSD in MHD, and is a valuable tool to diagnose LV systolic dysfunction in MHD.

scholarly journals Subclinical LV Dysfunction Detection Using Speckle Tracking Echocardiography in Hypertensive Patients with Preserved LV Ejection Fraction

2016 ◽  
Vol 10 ◽  
pp. CMC.S38407 ◽  
Author(s):  
Amal Mohamed Ayoub ◽  
Viola William Keddeas ◽  
Yasmin Abdelrazek Ali ◽  
Reham Atef El Okl
Keyword(s):  
Ejection Fraction ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Control Group ◽  
Hypertensive Patients

Background Early detection of subclinical left ventricular (LV) systolic dysfunction in hypertensive patients is important for the prevention of progression of hypertensive heart disease. Methods We studied 60 hypertensive patients (age ranged from 21 to 49 years, the duration of hypertension ranged from 1 to 18 years) and 30 healthy controls, all had preserved left ventricular ejection fraction (LVEF), detected by two-dimensional speckle tracking echocardiography (2D-STE). Results There was no significant difference between the two groups regarding ejection fraction (EF) by Simpson's method. Systolic velocity was significantly higher in the control group, and global longitudinal strain was significantly higher in the control group compared with the hypertensive group. In the hypertensive group, 23 of 60 patients had less negative global longitudinal strain than −19.1, defined as reduced systolic function, which is detected by 2D-STE (subclinical systolic dysfunction), when compared with 3 of 30 control subjects. Conclusion 2D-STE detected substantial impairment of LV systolic function in hypertensive patients with preserved LVEF, which identifies higher risk subgroups for earlier medical intervention.

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