Assessment of Left Ventricle Myocardial Function in Hypertensive Patients Using Three-Dimensional Speckle-Tracking Echocardiography (3D-STE)

Background: Increased myocardial fibrosis in hypertension leads to abnormalities in left ventricular diastolic function. 3D-speckle-tracking imaging (3D-STI) is a primary imaging modality used to detect early changes in the left ventricle (LV). The aim of this study was to assess the left ventricular myocardial function in hypertensive patients using 3D-speckle tracking imaging (3D-STI). Methods and Results: A case control, nonintervention, descriptive study was conducted in the Department of Ultrasound Diagnosis of Union Hospital of Tongji Medical College of Huazhong University of Science and Technology (Wuhan, Hubei, China). The study subjects included 64 patients with hypertension (HT) and, as control group, 44 normotensives. HT patients were divided into HT-I group (SBP of 130-139 mmHg or DBP of 80-89 mmHg, and HT-II group (SBP >140 mmHg or DBP >90 mmHg). In this study, LV geometry and function were assessed using conventional 2D- and 3D-echocardiography in a total of 108 consecutive subjects. LV volumes, global and regional strains were measured using 3D-STI. LV ejection fraction (LVEF) was in normal range in three groups, but in general, it slightly decreased in HT-II patients, compared with control and HT-I groups (62.5±2.1%, 68.0±2.2%, and 67.5±1.3%, respectively, P=0.00). Global systolic strain demonstrated a significant decrease in GLS, GCS, and GRS in the HT-II group, compared with control and HT-I groups. All regional strain parameters (longitudinal, circumferential, and radial) significantly decreased in HT-II patients, compared with control and HT-I groups. Conclusion: A significant deterioration of global LV systolic functions is found in hypertensive patients with well-preserved LVEF, especially in patients with hypertension stage II.

A preliminary study on the evaluation of left atrial function of rheumatoid arthritis by two dimensional speckle tracking imaging

To evaluate the changes of left atrial (LA) geometry and function in patients with rheumatoid arthritis (RA) by conventional echocardiography and two-dimensional speckle tracking imaging (2D-STI). We enrolled 46 RA patients with a duration of < 5 years as Group I, 40 RA patients with a duration of ≥ 5 years as Group II, and 40 normal subjects as the control group. Conventional echocardiography was conducted to measure traditional parameters. The LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd), LA strain during contraction phase (LASct), and LA global longitudinal strain (LAGLS) were obtained from 2D-STI. Related ultrasound results were compared. The LASct was significantly higher in Group I than in control group (P < 0.05). The LASr, LAScd, and LAGLS were significantly lower in Group I than in control group (all P < 0.05). The LASr, LAScd, LASct, and LAGLS were significantly lower in Group II than in control group and Group I (all P < 0.05). The function of LA impaired in RA patients, and the impairment aggravated with the clinical course of RA patients. 2D-STI technology can early and accurately evaluate the LA function of RA patients by evaluating LASr, LAScd, LASct, and LAGLS.

Application Effect and Evaluation of Two-Dimensional Speckle Tracking Imaging on Myocardial Damage in Patients with Malignant Lymphoma Treated with Anthracyclines

Objective. The purpose was to study the monitoring effect and application value of two-dimensional speckle tracking imaging (2D-STI) on myocardial function in patients with malignant lymphoma after treatment with anthracyclines. Methods. 50 patients with malignant lymphoma treated in our hospital from June 2017 to December 2019 were randomly selected and were treated with anthracyclines to compare the cardiac global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), left ventricular twist (LVtw), GLS × LVtw, and changes of atrioventricular inner diameters before and after 3 cycles of treatment. According to the pathological examination results, the accuracy of 2D-STI in the detection of changes in myocardial function of patients was also clarified. Results. The absolute values of GLS, GRS and GCS after treatment were significantly lower than those before treatment, with statistical significance (P < 0.05). The LVtw and GLS × LVtw after 3 cycles of treatment were significantly lower than those before treatment, with statistical significance (P < 0.05). There was no significant difference in the atrioventricular inner diameters of patients before and after treatment, with no statistical significance (P > 0.05). There was no significant difference between the monitoring results of 2D-STI and the pathological examination results, with no statistical significance (P > 0.05). Conclusion. Anthracyclines can cause some myocardial damage in patients with malignant lymphoma. The application of 2D-STI to monitor the changes in myocardial function of patients can give more accurate monitoring results, facilitating the early implementation of appropriate treatment.

­CardiOvascular examination in awake Orangutans (Pongo pygmaeus pygmaeus): Low-stress Echocardiography including Speckle Tracking imaging (the COOLEST method)

Introduction: Cardiovascular diseases have been identified as a major cause of mortality and morbidity in Borneo orangutans (Pongo pygmaeus pygmaeus). Transthoracic echocardiography is usually performed under anesthesia in great apes, which may be stressful and risky in cardiac animals. The aim of the present pilot study was hence to develop a quick and non-stressful echocardiographic method (i.e., the COOLEST method) in awake Borneo orangutans (CardiOvascular examination in awake Orangutans: Low-stress Echocardiography including Speckle Tracking imaging) and assess the variability of corresponding variables.Materials and Methods: Four adult Borneo orangutans trained to present their chest to the trainers were involved. A total of 96 TTE examinations were performed on 4 different days by a trained observer examining each orangutans 6 times per day. Each examination included four two-dimensional views, with offline assessment of 28 variables (i.e., two-dimensional (n=12), M-mode and anatomic M-mode (n=6), Doppler (n=7), and speckle tracking imaging (n=3)), representing a total of 2,688 measurements. A general linear model was used to determine the within-day and between-day coefficients of variation.Results: Mean±SD (minimum-maximum) images acquisition duration was 3.8±1.6 minutes (1.3-6.3). All within-day and between-day coefficients of variation but one (n=55/56, 98%) were <15%, and most (51/56, 91%) were <10% including those of speckle tracking systolic strain variables (2.7% to 5.4%).Discussion: Heart morphology as well as global and regional myocardial function can be assessed in awake orangutans with good to excellent repeatability and reproducibility.Conclusions: This non-stressful method may be used for longitudinal cardiac follow-up in awake orangutans.

Myocardial Work Index during Normal Dobutamine Stress Echocardiography

PurposeDobutamine stress echocardiography is an alternative method to exercise stress echocardiography for the evaluation of ischemia. Recently, the novel speckle tracking imaging derived parameter, myocardial work index, was suggested for the evaluation of cardiac performance and was evaluated during exercise stress echocardiography. In this study we analyzed the effect of dobutamine on myocardial work index variables during normal dobutamine stress echocardiography.MethodsEchocardiography examinations of patients with normal dobutamine stress echocardiography were collected and underwent off-line speckle tracking imaging analysis. Myocardial work index parameters were calculated at each dose of dobutamine and compared.Results286 patients underwent dobutamine stress echocardiography during the study period. 102 patients were excluded due to pre-existed coronary artery disease or ischemia at dobutamine stress echocardiography. 65 patients were excluded due to suboptimal image quality unsuitable for speckle tracking imaging analysis. The remaining 119 patients with normal results were included. The global work index decreased from 2393.3 to 1864.7 mmHg', p < 0.0004. Global constructive work decreased from 2681.7 to 2152.6 mmHg', p = 0.001. Global wasted work increased from 78.8 to 128.3%, p < 0.003. Global work efficacy decreased from 96.1 to 91.9%, p < 0.00001. Global strain increased from – 19.6 to -23.7%, P < 0.00001. Conclusion. Dobutamine stress echocardiography results in a decrease of all specific myocardial work index parameters even in normal subjects. Only global myocardial strain improved.

Speckle tracking imaging combined with myocardial comprehensive index to evaluate left ventricular function changes in patients with systemic lupus erythematosus

Objective: To evaluate early changes in left ventricular systolic function in patients with systemic lupus erythematosus (SLE) using three-dimensional speckle tracking imaging (3D-STI). Methods: Thirty SLE patients and 30 healthy people (control group) were selected, the patients were further divided into subgroups according to their Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index (SELENA-SLEDAI) score: SELENA-SLEDAI ≤ 12 (mild-to-moderate group), SELENA-SLEDAI > 12 (severe group). Blood samples were obtained from patients and laboratory investigations were performed. All participants were examined using 3D-STI, the 3D conventional and strain parameters were obtained. The above parameters were compared in the three studied groups. Receiver operating curves (ROC) were prepared for above parameters and analyzed to identify correlations among LVEF, GLS, GCS, LVtw, Tor, MCI and hs-TropT. Results: Compared with the control group, the absolute values of LVEDV, LVEF, GLS, GCS, LVtw, Tor and MCI decreased, LV EDmass, LV ESmass and PSD increased in the mild-to-moderate and the severe groups (P2 < 0.05, P3 < 0.05). There was statistically significant difference in terms of strain parameters between the mild-to-moderate group and the severe group (P1 < 0.05). The highest area under the ROC for MCI was 0.909, the highest sensitivity for MCI was 90.00%, and the highest specificity for Tor was 86.67%. Correlation analysis showed that there was a good correlation between the MCI and hs-TropT (r = − 0.677). Conclusion: 3D-STI technology may help detect early changes in left ventricular systolic function in patients with SLE