Comparison of Myocardial Layer-Specific Strain and Global Myocardial Work Efficiency During Treadmill Exercise Stress in Detecting Significant Coronary Artery Disease

BackgroundMyocardial layer-specific strain can identify myocardial ischemia. Global myocardial work efficiency (GWE) based on non-invasive left ventricular (LV) pressure-strain loops is a novel parameter to determine LV function considering afterload. The study aimed to compare the diagnostic value of GWE and myocardial layer-specific strain during treadmill exercise stress testing to detect significant coronary artery disease (CAD) with normal baseline wall motion.MethodsEighty-nine patients who referred for coronary angiography due to suspected of CAD were included. Forty patients with severe coronary artery stenosis were diagnosed with significant CAD, and 49 were defined as non-significant CAD. Stress echocardiography was performed 24 h before angiography. Layer-specific longitudinal strains were assessed from the endocardium, mid-myocardium, and epicardium by 2D speckle-tracking echocardiography. Binary logistic regression analyses were performed to evaluate the association between significant CAD and echocardiographic parameters. A receiver operating characteristic curve was used to assess the capability of layer-specific strain and GWE to diagnose significant CAD.ResultsPatients with significant CAD had the worse function in all three myocardial layers at peak exercise compared with those with non-significant CAD when assessed with global longitudinal strain (GLS). At the peak exercise and recovery periods, GWE was lower in patients with significant CAD than in patients with non-significant CAD. In multivariable binary logistic regression analysis, peak endocardial GLS (OR: 1.35, p = 0.006) and peak GWE (OR: 0.76, p = 0.001) were associated with significant CAD. Receiver operating characteristic curves showed peak GWE to be superior to mid-myocardial, epicardial, and endocardial GLS in identifying significant CAD. Further, adding peak GWE to endocardial GLS could improve diagnostic capabilities.ConclusionsBoth GWE and endocardial GLS contribute to improving the diagnostic performance of exercise stress echocardiography. Furthermore, adding peak GWE to peak endocardial GLS provides incremental diagnostic value during a non-invasive screening of significant CAD before radioactive or invasive examinations.

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

Background This study investigated the value of layer-specific strain analysis by two-dimensional 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 two- chamber, and the LV short-axis views at the basal, middle, and apical segments. The layer-specific speckle tracking (LST) technique was used to analyze the longitudinal strain (LS) and circumferential strain (CS) of LV sub-endocardium, mid-myocardium, sub-epicardium, global longitudinal strain (GLS), global circumferential strain (GCS), the LV 17 segment time to peak LS (TTP), and the peak strain dispersion (PSD). The differences in these parameters were compared between control and MHD groups, and the correlation between PSD and each LS parameter was examined. The receiver operator characteristic (ROC) curve was used to evaluate the efficacy of three myocardial layer LS and CS in the assessment of LV systolic dysfunction in MHD patients. Results MHD patients had comparable left ventricular ejection fraction (LVEF), but significantly smaller LV GLS, GCS, and three-layer LS and CS compared to the control group. The three myocardial layer LS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD patients compared to the normal subjects, while the three myocardial layer CS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD patients compared to the normal subjects, except for the sub-endocardium of the middle and apex segment. MHD patients 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 patients was positively correlated with sub-endocardial and mid-myocardial LS and GLS, but not with sub-epicardial LS. The area under the curves (AUCs) of sub-endocardial, mid-myocardial, and sub-epicardial LS in MHD patients were 0.894, 0.852, and 0.870, respectively; the AUCs of sub-epicardial, mid-myocardial, and sub-endocardial CS were 0.852, 0.837, and 0.669, respectively. Conclusions LST may detect early changes of all three-layer LS and CS and PSD in MHD patients, and is therefore a valuable tool to diagnose LV systolic dysfunction in MHD patients.

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

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.

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

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.

3078Usefulness of a semi-quantitative and layer-specific assessment of the relative apical sparing pattern of longitudinal strain for the identification of cardiac amyloidosis

Background The relative apical sparing pattern (RASP) of left ventricular longitudinal strain (LS) is determined using a strain polar map, while global longitudinal strain is measured using speckle-tracking echocardiography, and it is frequently associated with cardiac amyloidosis (CA). However, the definition of visual RASP is ambiguous, and this leads to insufficient reproducibility, whereas quantitative RASP takes time and leads to difficulty in the clinical application. Generally, amyloid predominantly accumulates in the endo-myocardial layer. As such, layer-specific analysis of RASP may more accurately identify CA. Therefore, the aims of this study were to explore the reproducible and easy definition of RASP for identifying CA and investigate the effect of layer-specific analysis on the assessment. Methods A total of 40 patients with CA diagnosed by biopsy and technetium pyrophosphate scintigraphy were compared with 120 control patients matched for mean left ventricular wall thickness (40 aortic stenosis, 40 hypertrophic cardiomyopathy, and 40 hypertensive heart disease). We compared the discriminative abilities of three definitions of RASP (visual, quantitative, and semi-quantitative). According to a previous paper, visual RASP was defined as visual reduction of LS in the basal and middle LS segments (light red or blue) relative to the apical LS (red). Quantitative RASP was calculated using the following formula: average apical LS/(average basal LS + average mid-ventricle LS), then binarized by the optimal cut-off value for predicting CA. Semi-quantitative RASP was defined as reduction of LS (≥-10%) in five or more segments out of the basal six segments, relative to apical LS (≤-15%). Sample cases are shown in Figure (left). Visual and semi-quantitative RASP were independently assessed by two blinded sonographers. The RASP at the endo-myocardial and all layers was evaluated using customized software. The concordance was assessed using the kappa statistic, whereas the discriminative ability was assessed using receiver operating characteristic curve analysis. Results The concordance of visual RASP was modest but its semi-quantitative RASP was perfect (Table right). The discriminative ability of semi-quantitative RASP at each layer was significantly better than that of visual RASP and close to that of the binary quantitative RASP. Additionally, the discriminative abilities of visual (p=0.10) and semi-quantitative (p=0.11) RASP at the endo-myocardial layer appeared to be better than those at all layers. Conclusions The assessment method of semi-quantitative RASP is easy and highly reproducible. Furthermore, it accurately discriminates CA. In addition, assessment at the endo-myocardial layer potentially improves the discriminative ability.

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

Background: This study investigated the value of layer-specific strain analysis by two-dimensional 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 two- chamber, and the LV short-axis views at the basal, middle, apical segments. The layer-specific speckle tracking (LST) was used to analyze the longitudinal strain (LS) and circumferential strain (CS) of LV sub-endocardium, mid-myocardium, sub-epicardium, 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 sub-endocardial and mid-myocardial LS and GLS, but not with sub-epicardial 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, mid-myocardial, 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.

Systemic Review: Sexual Dysfunction in Women with type 2 Diabetes Mellitus

Diabetes would not just have a high blood glucose level in the individual body, yet these days diabetes likewise goes with numerous other organic issues like hypertension, feeble the myocardial layer working, sexual broke, and so on. These are some real issue which is these days joined by diabetes to a person’s body. Guys are for the most part being determined to have the sexual broke issue, guys, as well as experience a sexual broke issue. As similarly we may see less clinical examinations, including sexual broke issues looked for the sort two diabetic ladies. The primary goal of this article is to illuminate the situation that females proceed with much trouble with regards to the sexual broke Complication that might be physiological or neurotic if there should arise an occurrence of sorting two diabetes in ladies. It chiefly involves the useful extent of females like sexual drive, excitement, vaginal grease, Orgasm and general fulfilment space. Talking about the treatmentaccess of the ailment in the analyti way for it, Diabetes essentially hinders the sexual execution of Diabetic Women. Determinants of sexual ability incorporate age and extent of diabetes.