Assessment of Biventricular Myocardial Function with 2-Dimensional Strain and Conventional Echocardiographic Parameters: A Comparative Analysis in Healthy Infants and Patients with Severe and Critical Pulmonary Stenosis

Our aim was to compare the global longitudinal and regional biventricular strain between infants with severe and critical pulmonary stenosis (PS), and controls; to compare pre- and post-procedural strain values in infants with severe and critical PS; and to assess the correlations between echocardiographic strain and conventional parameters. We conducted a retrospective single-center study. The comparisons of echocardiographic variables were performed using separate linear mixed models. The overall mean right ventricle (RV) regional strains measured before intervention in PS patients was significantly different when compared to the control group (p = 0.0324). We found a significant change in the left ventricle, RV, and inter-ventricular septum strain (IVS) values from basal to apical location (p < 0.05). IVS strain values showed a higher decrease in mean strain values from basal to apical in PS patients. There was no significant difference in means of baseline and post-interventional strain values in PS patients (p > 0.05). Following the strain analysis in patients with PS, we obtained statistically significant changes in the RV global-4-chamber longitudinal strain (RV4C). The RV4C, which quantifies the longitudinal strain to the entire RV, can be used in current clinical practice for the evaluation of RV function in infants with severe and critical PS. The longitudinal and segmental strain capture the pathological changes in the IVS, modifications that cannot be highlighted through a classical echocardiographic evaluation.

Maternal Left Ventricular Diastolic and Systolic Function during Normal Pregnancy in Saint Bernard Dogs

This study aimed to evaluate maternal left ventricular (LV) systo-diastolic function using conventional and TDI echocardiography and included 10 healthy Saint-Bernard pregnant bitches. M-mode, peak transmitral flow velocities during early diastole (E) and atrial contraction (A), aortic and pulmonic flow, myocardial performance index (MPI), TDI studies (peak myocardial velocities during early diastole (E’), atrial contraction (A’) and peak systole (S’)), and blood pressure were measured at 21 to 28 (T1), 40 (T2) and 60 (T3) days of gestation and four to eight weeks postpartum (T4). Cardiac output and heart rate were 20% and 9% higher at T3, respectively, compared to T4 (p < 0.01). Lateral S’ was 36% higher at T3 than at T1 (p < 0.05). Changes in diastolic function were demonstrated by 10% lower E wave and 15% A wave at T1, compared to T4 (p < 0.05). E’ and A’ were 23% and 42% higher at T3 compared to T4 (p < 0.01). Both lateral E/E’ and E’/A’ were 6% and 19% lower at T3 compared to T1 (p < 0.01 and p < 0.05, respectively). At T3, MPI was 51% and 34% lower when compared to T1 or T2 (p < 0.05). The echocardiographic evaluation of maternal cardiac function is important, as structural, and functional changes occur throughout pregnancy.

322 Atrial morphological and functional parameters in hypertrophic cardiomyopathy: cardiovascular outcome implication

Aims The impact of atrial function measured by standard and advanced echocardiographic techniques is emerging in various clinical settings but remains poorly explored in patients with hypertrophic cardiomyopathy (HCM). Methods and results Consecutive patients with HCM referred to the heart failure outpatient clinic were prospectively enrolled. Complete clinical and echocardiographic evaluation was performed, including fully automated 2D speckle tracking analysis software (AutoStrain, TomTec). Atrial function was assessed by means of left atrial (LA) volume, LA diameter, a’-TDI, and global peak atrial longitudinal strain (PALS). The primary endpoint was a composite of cardiovascular (CV) events (cardiovascular death or hospitalization, new-onset atrial fibrillation, surgical myectomy, sustained ventricular tachycardia or ventricular fibrillation) during the follow-up. A total of 40 patients with confirmed HCM diagnoses and complete follow-up were included, mean age was 61 ± 14 years, 62% male, ejection fraction 64 ± 8%. LA was frequently enlarged (indexed LA volume 43 ± 14 ml/m2, LA diameter 39 ± 7 mm), and dysfunctional (a’-TDI 7.1 ± 2.2 cm/s, PALS 21 ± 7%). During a mean follow-up of 460 ± 300 days, seven patients had a CV event. Among LA parameters, septal a’-TDI seems to characterize patients with events the most (5.5 ± 2.1 vs. 7.5 ± 2.3, P = 0.03). This was confirmed in an age-adjusted survival model [HR: 0.62 (0.39–0.92), P = 0.03]. The spline curve in the Figure illustrates the relationship between a’-TDI and the age-adjusted probability of CV events; the association began at about 7 cm/s and increased steeply for lower values. Of note, the association between PALS and CV events was highly significant in younger patients (&lt;70 years, P &lt; 0.001). Conclusions According to our pilot study, a’-TDI can be considered a simple, feasible, and routinely available parameter of left atrial function, which can help to identify HCM patients at higher risk of CV events.

149 Myocardial performance in opera singers

Aims Opera singers are subjected to continuous exercise in the cardiopulmonary district, however the impact on cardiac performance has not been studied in depth. In addition to the standard echo parameters, the deformation one offer the possibility to evaluate more clearly the myocardial performance. Objective was to verify the impact of singing in heart’s performance by the evaluation of traditional and particularly deformation parameters as strain, rotation, and twist. Methods and results A population of 17 OS (opera singers, aged 50 ± 5 years) (M/F: 7/9; 5 sopranos; 2 tenors; 2 contraltos; 2 basses) have been submitted to an echocardiographic evaluation (MLX8exp Release F100001) by standard 2D and deformation parameters (Figure 1). The data expressed as mean as SD were compared to an high level athletes (A) group (M 16) regularly trained. T-Student test for paired data was used and P &lt; 0.05 was considered significant. All the 2D standard systo-diastolic parameters were within the normal range and the pulmonary pressure (PP) as well in both. In SO group were: LVDd: 47.31 ± 3.77 mm; LVSd: 30.48 ± 4.42 mm; E/A: 1.07 ± 0.32; RV: 27.63 ± 4.50 mm; in A group: LVDd: 50.81 ± 2.97 mm; LVSd: 31.44 ± 4.26 mm; E/A: 2.68 ± 1.67; RV: 27.63 ± 4.50 mm. As expected Cardiac mass index (CMI) was significantly greater in athletes, while the ejection fraction (EF) resulted to be higher in OS. Despite the deformation parameters were not different among the two groups, with the exclusion of GLS expressing a major value in athletes, on the contrary the rotational parameters resulted, in OS group similar to the athletes and in agreement with an high performance status. Conclusions OS show an high myocardial performance as athletes. The data obtained are suggestive for a positive impact of regular training as an opera singers. Deformation parameters highlight the fitness status in this particular group. Classic music singing seems to have a training effect on the heart. Further studies will be necessary to confirm this hypothesis

Ultrasound-Guided Preload Indices during Different Weaning Protocols of Mechanically Ventilated Patients and its Impact on Weaning Induced Cardiac Dysfunction

BACKGROUND: Elevation of the left ventricular (LV) filling pressure can occur during weaning of mechanical ventilation due to increase in LV preload and/or changes in LV compliance and LV afterload. AIM: The aim of the study was to evaluate respiratory changes in internal jugular vein and inferior vena cava during weaning from mechanical ventilation. METHODS: Prospective observational study conducted on 80 consecutive patients. Patients were divided randomly into two groups who met the readiness criteria to start spontaneous breathing trial (SBT) either on pressure support ventilation (PS/CPAP) for 30 min or T-piece for 120 min. Weaning failure was defined as a failed SBT or reintubation within 48 h. Echocardiographic evaluation was done on assisted controlled ventilation and at the end of SBT for preload assessment. RESULTS: Mitral Septal E/E’ Cutoff value ≥6.1 with sensitivity 81% and specificity 84.2%, and AUC 0.73 for predicting weaning failure. IVC distensibility index on CPAP cutoff value ≥66.5% with sensitivity 100% and specificity 68.4%, and AUC 0.85. In Group II, Mitral Septal E/E’ Cut off value ≥5.8 with sensitivity 83% and specificity 90.9%, AUC 0.83, IVC collapsibility index Cut off value ≥45.5% with sensitivity 72% and specificity 86%, AUC 0.73. CONCLUSION: Mitral Septal E/E’ could predict weaning-induced diastolic dysfunction. IVC plays an important role in predicting weaning failure.

Echocardiography in the Diagnosis and Management of Tricuspid Atresia

This review focuses on the utility of echocardiographic studies in the diagnosis of tricuspid atresia (TA) and in its management. Tricuspid atresia is a cyanotic congenital heart defect (CHD) accounting for nearly 1.5% of all CHDs. It is generally classified according to the morphology of the atretic tricuspid valve and associated heart defects. Following the description of the anatomic features of TA, echocardiographic features characteristic for TA were illustrated. Subsequent to a review of palliative and corrective procedures to treat TA, echocardiographic evaluation at each stage of Fontan was detailed. The role of echocardiography in the assessment of cardiac defects responsible for interstage mortality was also addressed. It was concluded that echo-Doppler studies are useful in the diagnosis and management of TA.

Left ventricular apical mass after myocardial infarction—not always a thrombus: a diagnostic dilemma

Myxomas arising from the left ventricle (LV) are extremely rare and can be easily mistaken for a thrombus. We report a case of a 35-year-old man who presented with an acute cerebrovascular accident, having had a prior history of an anterior wall myocardial infarction 2 years back with an echocardiographic evaluation showing mild LV systolic dysfunction. His present prothrombotic workup revealed hyperhomocystinaemia and elevated levels of factor VIII. Present echocardiography revealed a mass arising from a scarred LV wall. Considering the possibility of a thrombus, he was initially started on parenteral anticoagulation. Unfortunately, consequent echocardiogram evaluation showed no reduction in size of the LV mass hence surgical removal was done. Histopathological evaluation unveiled the mass to be a myxoma.