scholarly journals Left Atrial Strain to Identify Diastolic Dysfunction in Children with Cardiomyopathies

2019 ◽  
Vol 8 (8) ◽  
pp. 1243 ◽  
Author(s):  
Jolanda Sabatino ◽  
Giovanni Di Salvo ◽  
Costantina Prota ◽  
Valentina Bucciarelli ◽  
Manjit Josen ◽  
...  
Keyword(s):  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Operating Characteristics ◽  
Left Atrial Strain ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate ◽  
Significant Difference

Background: Left ventricular (LV) diastolic dysfunction (DD) carries worse prognosis in childhood. 2-dimensional (2-D) left atrial (LA) strain accurately categorizes DD in adults but its role in children is unknown. Thus, the aim of this study is to investigate whether LA strain and strain rate could diagnose and classify DD in children with dilated (CMD), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies (CM). Methods and Results: The study includes 136 children (aged 8.8 ± 6 years): 44 with DCM, 40 with HCM, 7 with RCM and 45 healthy controls (CTRL). They underwent standard echocardiographic examination and 2-D speckle-tracking analyses (LV longitudinal peak systolic strain (LS), LA peak systolic strain and strain rate). No significant differences in mitral E/A and pulmonary S/D ratios were observed among the four groups. Although E/E’ and indexed left atrial volumes were found to be significantly higher in HCM, DCM and RCM compared to CTRL (p < 0.001), they showed no significant difference among the three CM groups. LV LS values were significantly reduced in CM vs CTRL (p < 0.001) and in DCM vs HCM (p < 0.01), with no other differences between the remaining groups. LA peak systolic strain and strain rate values showed a steady and significant decrease with worsening of DD. Receiver Operating Characteristics (ROC) curves showed area under the curve of 0.976 (p < 0.001) for LA strain and 0.946 (p < 0.001) for LA strain rate, to distinguish CTRL from CMs. Conclusions: LA strain and strain rate could be a promising tool to better understand and classify DD in children with cardiomyopathies, opening the way to its clinical use.

scholarly journals P1387 Correlations between left atrial strain parameters and left ventricular function in young patients presenting with acute ST elevation myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A I Scarlatescu ◽  
M M Micheu ◽  
M Stoian ◽  
D Zamfir ◽  
I Petre ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Young Patients ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Left Atrial Strain ◽  
Peak Systolic Strain ◽  
Atrial Strain ◽  
Lv Diastolic Dysfunction

Abstract Funding Acknowledgements This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF Background Previous studies demonstrated the role of left atrial (LA) deformation parameters in characterisation of left ventricular (LV) diastolic dysfunction. It is a marker of the severity of diastolic dysfunction; LA remodelling also proved to be a predictor of clinical outcome, therefore a prognostic marker in acute coronary syndromes. Purpose In this study we aimed to investigate the correlations between left atrial strain and conventional systolic and diastolic dysfunction parameters in a cohort of young patients with acute ST elevation myocardial infarction (STEMI) treated by primary PCI. Material and methods We included 56 consecutive patients in this study: 46 patients under 50 years of age with STEMI and 10 healthy age and sex matched controls. We performed conventional transthoracic echocardiography for all included patients. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient using two-dimensional speckle tracking imaging with measurement LA deformation parameters. Results LV ejection fraction, LV global strain and peak LA systolic strain (PALS) were significantly reduced in STEMI patients compared to controls. PALS had significant correlation with 2D LVEF (p = 0.00), LV global longitudinal strain (p = 0.03), E wave (p &lt; 0.05), E/e’ (p &lt; 0.05), left atrial volume and the type of diastolic dysfunction (p = 0.06). PALS also had inversre correlation with the presence of an occluded coronary artery at angiography. PALS was higher in control group than in STEMI group ( 34.6 vs 20.4, p &lt; 0.05). PALS values progressively decreased with worsening of LV diastolic dysfunction showing significant differences between all diastolic dysfunction grades. Using ROC (Receiver operating Characteristics) analysis we identified a cut off value of 25.9 (Sensibility 88%, Specificity 74%, AUC 0.94, CI 95%, p &lt; 0.05) to discriminate between diastolic dysfunction and normal diastolic function. Moreover, PALS was significantly different in patients with normal vs high LV filling pressures. Using ROC analysis we determined a cut off value of 14.5 for LA peak systolic strain to discriminate between the two subgroups, with excellent discrimination power, AUC 0.935, CI 95%, p = 0.045, Sensibility 100%, Specificity 91%. Therefore LA peak systolic strain could be considered a surrogate estimate of LV filling pressures. Conclusion LA peak systolic strain correlated significantly with LV systolic and diastolic function in young patients with acute myocardial infarction treated with primary PCI. Peak LA strain may be helpful as a complementary method to evaluate diastolic dysfunction in this patient population and may also improve the detection of elevated LV filling pressures.

scholarly journals Reduction of left atrial strain and strain rate during conduit phase as the earliest marker of left ventricular diastolic disfunction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Savelev ◽  
OV Solovev ◽  
MA Baturova ◽  
YV Shubik
Keyword(s):  
Strain Rate ◽  
Left Atrial ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Left Atrial Strain ◽  
Single Plane ◽  
Strain And Strain Rate ◽  
Significant Difference ◽  
The Difference ◽  
Grade 3

Abstract Funding Acknowledgements Type of funding sources: None. Left atrial (LA) functional abnormalities, including LA strain (LAS) and strain rate (LASR) reduction, are observed in patients with left ventricular diastolic disfunction (LVDD). However, the degree of reduction at different stages of LVDD is not fully clarified. We aimed to assess the interdependence between LAS and LASR parameters and LVDD grades in subjects of advanced age with preserved ejection fraction (EF). Material and methods Consecutive patients, who underwent echocardiography within 12 months, were screened and included into the study in case of age older than 65 years, preserved EF, sinus rhythm at the time of study and preserved dataset of sufficient quality for speckle tracking analysis. LAS and LASR parameters, including LAS and peak LASR during reservoir, conduit, and contractile phases were calulated with single plane apical 4-chamber view assessment. One-way ANOVA analysis with Bonferroni correction was used to assess the difference between groups. Results Among 153 patients (mean age 74 ± 7 years; 105 female, mean EF 64 ± 5%) included in the study there were 38 patients with no evidence of LVDD, 67 with LVDD grade 1, 40 with LVDD grade 2, and 5 with LVDD grade 3. The values of LAS and LASR parameters for these groups are summarized in Table. All parameters were significantly reduced in grade 2 and 3 LVDD patients comparing to the patients with no LVDD. Contractile phase LAS and LASR were slightly higher in grade 1 than in no LVDD patients. Reservoir and conduit phase LAS and LASR were lower in grade 1 LVDD comparing to no LVDD, but only for conduit phase parameters the difference was significant. In ROC analysis for conduit phase LAS and LASR to be associated with the presence of LVDD of any grade the  area under the curve was 0,707 (p &lt; 0.001) and 0,742 (p &lt; 0.001) respectively. Conclusion Impaired LA function is seen in patients with LVDD. Whereas measurements characterizing LA reservoir and contractile functions demonstrate significant decrease at advanced stages of LVDD, conduit function is significantly reduced at grade 1 LVDD, providing the possibility for early detection of LVDD. Group LAS (%) LASR (1/sec) reservoir conduit contractile reservoir conduit contractile No LVDD, n = 38 29,7 ± 9,3 †‡ 15,1 ± 6,6 §†‡ 14,6 ± 5,4 †‡ 1,28 ± 0,37 †‡ 1,18 ± 0,44 §† 1,68 ± 0,60 †‡ Grade 1, n = 69 28,6 ± 8,9 †‡ 11,6 ± 6,2 ƒ 17,0 ± 5,7 †‡ 1,23 ± 0,43 ‡ 0,90 ± 0,38 ƒ 1,99 ± 0,71 †‡ Grade 2, n = 40 19,1 ± 7,1 ƒ§ 9,2 ± 4,5 ƒ 9,9 ± 4,4 ƒ§ 0,87 ± 0,26 ƒ§ 0,72 ± 0,27 ƒ 1,07 ± 0,44 ƒ§ Garde 3, n = 5 13,8 ± 3,6 ƒ§ 7,7 ± 2,5 ƒ 6,1 ± 2,2 ƒ§ 0,8 ± 0,29 ƒ 0,75 ± 0,28 0,67 ± 0,27 ƒ§ Significant difference (p &lt; 0,05): ƒ – with No LVDD, § – with Grade 1 LVDD, † – with Grade 2 LVDD, ‡ – with Grade 3 LVDD

P4372Left atrial strain: a potential marker of early diastolic dysfunction in patients with Marfan syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Garcia-Izquierdo Jaen ◽  
S Mingo Santos ◽  
M Torres Sanabria ◽  
V Monivas Palomero ◽  
S Moreno Casado ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ejection Fraction ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Left Atrial Strain ◽  
Strain And Strain Rate ◽  
Atrial Strain

Abstract Background/Introduction Previous studies using conventional echocardiographic measurements have reported subclinical left diastolic dysfunction in patients with Marfan syndrome (MFS). Left atrial strain (LAS) has been shown to be an accurate predictor of left ventricular diastolic dysfunction. However, there is no evidence regarding the use of LAS in MFS. Purpose To assess feasibility of LAS and compare LAS derived measurements along with traditional diastolic parameters in MFS patients vs healthy controls. Methods 46 MFS patients (normal LV ejection fraction, no previous cardiovascular surgery, no significant valvular regurgitation) vs. 20 healthy controls (age and sex-matched). We performed LAS analysis using 2D speckle-tracking (QLAB 10, Philips). LA strain was determined as the average value of the longitudinal deformation (7 segments) in the apical 4-chamber view (RR gating). Results LAS analysis was feasible in 40 MFS patients (87%). All participants had normal diastolic function according to current guidelines (ASE/EACVI 2016). MFS patients showed lower TDI e' velocities and higher average E/e' ratio, but still within normal range. Similarly, LVEF was normal but slightly reduced in MFS patients. LA strain and strain rate parameters during reservoir and conduit phase were significantly impaired in MFS patients compared to controls. MFS vs controls MFS patients (n=40) Controls (n=20) p MFS patients (n=40) Controls (n=20) p Age 33.8±12.4 34.4±8.3 0.846 Septal e' (cm/s) 9.7±2.5 11.7±2.3 0.006 Male (%) 24 (60%) 12 (60%) 1.000 Average E/e' ratio 6.8±1.5 5.5±1.1 0.002 SBP (mmHg) 120.3±12.4 120.1±9.4 0.969 TR velocity (cm/s) 208.6±21.4 201.6±22.9 0.390 DBP (mmHg) 72.0±10.1 67.1±6.2 0.069 LAVi (ml/m2) 23.5±7.1 25.5±4.8 0.260 Aortic root (mm) 40.3±4.6 31.7±3.7 <0.001 LASr (%) 32.6±8.8 43.0±8.3 <0.001 LVEF (%) 60.9±5.6 64.2±4.2 0.022 LAScd (%) −20.1±8.0 −29.4±5.5 <0.001 E-wave (cm/s) 74.6±16.5 76.7±16.5 0.651 LASct (%) −12.8±6.1 −13.6±5.2 0.622 A-wave (cm/s) 55.2±10.9 52.0±12.8 0.327 LASRr 2.02±0.49 2.31±0.43 0.030 E/A ratio 1.4±0.4 1.5±0.4 0.287 LASRcd −2.22±0.61 −3.07±0.68 <0.001 Lateral e' (cm/s) 13.0±3.6 16.3±3.3 0.002 LASRct −2.24±0.90 −2.35±0.75 0.600 SBP: Systolic blood pressure. DBP: Diastolic blood pressure. LVEF: Left ventricular ejection fraction. LAVi: Left atrial volume index. LAS: Left atrial strain. LASR: Left atrial strain rate. (r): Reservoir. (cd): Conduit. (ct): Contraction. Example of LA strain and strain rate Conclusion MFS patients showed a subtle impairment in diastolic function compared to controls. Although further evidence is needed, LAS derived parameters could be early markers of diastolic dysfunction in this group of patients. Acknowledgement/Funding Programa de Actividades de I+D de la Comunidad de Madrid

scholarly journals P1747 Left atrial strain identifies diastolic dysfunction in children with cardiomyopathies and correlates with invasive LV end-diastolic pressure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Sabatino ◽  
N Borrelli ◽  
M Aversani ◽  
E Filippini ◽  
J Paredes ◽  
...  
Keyword(s):  
Strain Rate ◽  
Left Atrial ◽  
Diastolic Pressure ◽  
Area Under The Curve ◽  
Inverse Correlation ◽  
Clinical Indication ◽  
Systolic Strain ◽  
Left Atrial Strain ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate

Abstract Background 2-dimensional (2-D) left atrial (LA) strain accurately categorizes DD in adults but its diagnostic performance in children is unknown. Aim of this study is to investigate whether LA strain and strain rate are able to diagnose and classify DD in children with dilated (CMD), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies (CM). Methods The study includes 136 children (aged 8.8 ± 6 years): 44 with DCM, 40 with HCM, 7 with RCM and 45 healthy controls (CTRL). They underwent standard echocardiography and 2-D speckle-tracking analyses (LV longitudinal peak systolic strain (LS), LA peak systolic strain and strain rate). Cardiac catheterization was performed within 24 hours after the echocardiographic study in 9 children (mean age 9 ± 7 years) with clinical indication and the LV end-diastolic pressure was measured. Results No significant differences in mitral E/A, E/E’, pulmonary S/D ratios and indexed left atrial volumes were observed among the 3 CM groups. LA peak systolic strain and strain rate values showed a steady and significant decrease with worsening of DD. ROC curves showed area under the curve of 0.976 (p &lt; 0.001) for LA strain and 0.946 (p &lt; 0.001) for LA strain rate, to distinguish CTRL from CMs. Moreover, univariate regression analysis demonstrated that peak LA strain had a strong significant inverse correlation with invasive LV end-diastolic pressure (r -0.892, p &lt; 0.001). On the other hand, invasive LV end-diastolic pressure had non-significant correlations with E’ avg (r -0.139, p = 0.721), E/E’ avg (r 0.238, p = 0.537), MV DT (r 0.485, p = 0.186) and LAVi (r 0.514, p = 0.157). Conclusions LA strain is able to recognize and classify DD in children with cardiomyopathies and accurately correlates with invasive LV end-diastolic pressures. Abstract P1747 Figure.

scholarly journals Do left atrial strain and strain rate reflect intrinsic atrial function, or are they determined by left ventricular function?

2015 ◽  
pp. 539-548 ◽  
Author(s):  
Andrei Dumitru Margulescu ◽  
Emma Rees ◽  
Rose-Marie Coulson ◽  
Aled D. Rees ◽  
Dragos Vinereanu ◽  
...  
Keyword(s):  
Left Ventricular Function ◽  
Strain Rate ◽  
Ventricular Function ◽  
Left Atrial ◽  
Left Ventricular ◽  
Atrial Function ◽  
Left Atrial Strain ◽  
Strain And Strain Rate ◽  
Atrial Strain

Echocardiographic Evaluation of Changes in Cardiac Hemodynamics, Loading Conditions, and Atrial Function after Transcatheter Closure of Atrial Septal Defect

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abdelfattah Shoeir ◽  
Ghada Elshahed ◽  
Yasmin Abdelrazek Esmail ◽  
Dina Adel Ezz Eldin
Keyword(s):  
Atrial Septal Defect ◽  
Strain Rate ◽  
Septal Defect ◽  
Atrial Function ◽  
Loading Conditions ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate ◽  
Significant Difference ◽  
Asd Closure

Abstract Background The changes in loading conditions, atrial function, and the different echocardiographic parameters before and after transcatheter atrial septal defect (ASD) closure are still under study. So we felt the need to evaluate the echocardiographic changes that occur and detect the timing after closure at which the right-sided heart hemodynamics, and measurements are back to normal. Objectives To evaluate the changes in cardiac hemodynamics, loading conditions, and atrial function after percutaneous closure of ASD using echocardiography. Patients and Methods The study included 30 patients referred to percutaneous closure of ASD in Ain Shams University hospital we performed echocardiography before, 1 week, and 3 months after closure. Results The study showed that RV dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p &lt; 0.001). RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p &lt; 0.001). RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure (p &lt; 0.001). LA dimensions and volumes increased significantly 1 week, and 3 months after ASD closure (P &lt; 0.001). LA peak systolic strain showed no significant difference before, 1week, and 3 months after ASD closure (P = 0.063), and strain rate showed no significant difference before, 1week, and 3 months after ASD closure (P = 0.207). Conclusion In our study, we have concluded that RV dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure. RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure. RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure, as a result of improvement of the RA wall velocity, due to relief of the volume overload after closure of the shunt. LA peak systolic strain, and strain rate showed no significant difference before, 1week, and 3 months after ASD closure. Abbreviations list ASD (atrial septal defect), RV (right ventricle), RA (right atrium), LA (left atrium).

scholarly journals Lipopolysaccharide acutely suppresses right-ventricular strain in rats with pulmonary artery hypertension

2017 ◽  
Vol 8 (1) ◽  
pp. 204589321774450 ◽  
Author(s):  
Junjie Zhang ◽  
Yanan Cao ◽  
Xiaowei Gao ◽  
Maoen Zhu ◽  
Zhong Zhang ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Strain Rate ◽  
Acute Inflammation ◽  
Pulmonary Artery Hypertension ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate ◽  
Rv Function

Worsening right ventricular (RV) dysfunction in the presence of pulmonary artery hypertension (PAH) increases morbidity and mortality in this patient population. Transthoracic echocardiography (TTE) is a non-invasive modality to evaluate RV function over time. Using a monocrotaline-induced PAH rat model, we evaluated the effect of acute inflammation on RV function. In this study, both PAH and control rats were injected with Escherichia coli lipopolysaccharide (LPS) to induce an acute inflammatory state. We evaluated survival curves, TTE parameters, and inflammatory markers to better understand the mechanism and impact of acute inflammation on RV function in the presence of PAH. The survival curve of the PAH rats dropped sharply within 9 h after LPS treatment. Several echocardiographic parameters including left ventricular (LV) stroke volume, RV tricuspid annular plane systolic excursion, RV longitudinal peak systolic strain, and strain rate decreased significantly in PAH rats before LPS injection and 2 h after LPS injection. The expression of phospholamban (PLB) and tumor necrosis factor-α (TNF-α) significantly increased and the expression of SERCA2a significantly decreased in PAH rats after LPS administration. LPS suppressed the RV longitudinal peak systolic strain and strain rate and cardiac function deteriorated in PAH rats. These effects may be associated with the signal pathway activity of SERCA2a/PLB.

Abstract 2250: Is Atrial Fibrillation in Hypertrophic Cardiomyopathy Due to Left Atrial Structural Remodeling as Determined by Speckle-Derived Atrial Strain Imaging?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ying Shan ◽  
Grace Lin ◽  
Toshinori Yuasa ◽  
Fletcher A Miller ◽  
Steve R Ommen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Strain Rate ◽  
Left Atrial ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Left Atrial Strain ◽  
Structural Remodeling ◽  
Strain And Strain Rate ◽  
Atrial Strain

Background: Atrial fibrillation (AF) is common in HCM yet the mechanisms are poorly understood but are likely secondary to either the consequences of left atrial structural remodeling (LASR) or myopathy, or triggers arising from pulmonary and other thoracic veins. The presence and severity of LASR as characterized by left atrial strain (LA ϵ), and its relationship to AF in HCM, has not been determined. Therefore, we measured LA ϵ and strain rate (SR) in Pts with HCM both with (AF+) and without (AF−) prior AF and compared these measures to those in age and gender matched controls without HCM or AF. Methods: Two-dimensional speckle-derived LA longitudinal peak ϵ, SR during systole (SR S ), early (SR E ) and late diastole (SR A ) were measured at the basal and mid portions of the lateral, septal, and posterior LA walls using Vector Velocity Imaging during sinus rhythm and were averaged. Results: Mean age of Pts in each of the matched groups was 56 ± 2 years (16 males; 59%). Significant left ventricular outflow tract obstruction was present in all Pts with HCM. Diastolic dysfunction was similar in both HCM groups and worse when compared to controls. Peak LA 3 , SR S , SR E , and SR A for each group is shown (table 1 ). HCM was associated with significantly lower LA ϵ and SR compared to controls. Although LA size was increased in Pts with HCM when compared to controls there was no correlation between LA size and ϵ or SR (p>0.05 for all). No differences in LA ϵ and SR were found between AF+ versus AF− Pts. Conclusion: HCM is associated with LASR as determined by decreased LA ϵ and SR. However, LA ϵ and SR were similar in AF+ versus AF− Pts suggesting that the occurrence of AF in HCM is not due to LASR alone. Table 1. Left Atrial Strain and Strain Rate in Hypertrophic Cardiomyopathy

Abstract 11769: Impact of Exercise to the Heterogeneity of Regional Left Ventricular Mechanics

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rayji S Tsutsui ◽  
Kenya Kusunose ◽  
James D Thomas ◽  
Zoran B Popovic
Keyword(s):  
Strain Rate ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Exercise Heart Rate ◽  
Strain Rates ◽  
Systolic Strain ◽  
Ventricular Mechanics ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate ◽  
Segmental Heterogeneity

Background: The segmental heterogeneity of strain and strain rate in speckle tracking echocardiography are pitfalls in the assessment of left ventricular (LV) mechanics in subjects without LV wall motion abnormality. We aimed to assess the segmental heterogeneity of strain and strain rate at rest and during exercise in healthy subjects. Methods: Twenty-three healthy young volunteers (38 ± 10 years, 13 female) underwent supine bicycle stress testing. Segmental circumferential (Scirc), radial (Srad) and longitudinal (Slong) end-systolic strains and corresponding peak systolic strain rates (SRcirc, SRrad, SRlong) were obtained by STE (EchoPac, GE Medical) for each of 16 LV segments at rest and during exercise. Global values of strain and strain rate components were obtained by averaging segmental values. Results: At rest, all three end-systolic strains showed significant segmental heterogeneity (p < 0.01 for all comparisons). In contrast, peak systolic SRcirc and SRrad had uniform values throughout segments, while SRlong had modest segmental heterogeneity (p = 0.02). During exercise, heart rate (67 ± 10 to 136 ± 19 bpm), systolic blood pressure (124 ± 13 to 170 ± 21mmHg), and biplane ejection fraction (58 ± 4 to 72 ± 5 %), increased significantly (p < 0.001 for all comparisons). At peak exercise, there was a small, but significant increase in global Slong (-19.9 to -23.9%, p < 0.001) and Scirc (-19.6 to -24.2%, p < 0.001) without the change in Srad (46.8 to 41.1%, p > 0.05). On the other hand, all global systolic strain rates almost doubled during exercise; SRcirc from -1.26 to -2.49 s -1 , p < 0.0001; SRrad from 1.82 to 3.26 s -1 , p < 0.0001; SRlong from -1.56 to -2.93 s -1 , p < 0.0001. Importantly, segmental heterogeneity following exercise was not present for all strain and strain rate components (p > 0.05 for all comparisons). Conclusions: Segmental heterogeneity was less pronounced in peak systolic strain rates than in end-systolic strains at rest. Exercise abolished segmental heterogeneity for all strain and strain rate components. Overall, peak systolic strain rate is least affected by segmental heterogeneity and may be more useful in the assessment of LV mechanics than end-systolic strain.

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