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Quantitative Analysis of an Intraoperative Digitalized Esophageal Heart Sound Signal to Speculate on Perturbed Cardiovascular Function. J Clin Med 2019; 8:jcm8050715. [PMID: 31137509 PMCID: PMC6572513 DOI: 10.3390/jcm8050715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/09/2019] [Accepted: 05/17/2019] [Indexed: 12/21/2022] Open
Abstract
Although visualization of heart sounds, known as phonocardiography, provides valuable information on cardiovascular hemodynamics, its use has not been widely encouraged due to the scarcity of information on its interpretation. In the present study, using the intraoperative phonocardiogram recorded by an esophageal stethoscope, we quantitatively evaluated the time and frequency domains of modulation of the heart sounds components and their association with left ventricular contractility and systemic vascular resistance under the effects of various cardiovascular drugs. We analyzed 29 pairs of intraoperative digitalized phonocardiographic signals and their corresponding hemodynamic data before and after cardiovascular drug administration (ephedrine, esmolol, phenylephrine, and/or nicardipine) in 17 patients who underwent liver transplantation. The S1 and S2 components of the heart sounds (the first and second heart sounds, respectively) were identified and their modulation in time and frequency domains was analyzed. As an index of cardiovascular function, systolic tissue Doppler wave velocity (TDI S'), maximal dP/dt from the arterial waveform, and systemic vascular resistance were simultaneously evaluated. Ephedrine/esmolol and phenylephrine/nicardipine primarily affected the S1 and S2 components of the heart sounds, respectively. This result implies that the intraoperative phonocardiogram may have the potential to be useful in detecting the changes in contractility and afterload that commonly occur in patients receiving anesthesia. In an era of constant need for noninvasive hemodynamic assessment, phonocardiography has the potential for use as a novel and informative tool for monitoring of hemodynamic function.
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Mostafa SA, Sanad Arafa O, Abo-El-Einin HM, Amaar SM, Khaled SM. Value of dobutamine stress tissue Doppler in evaluation of LV functional improvement after elective PCI. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017; 30:101-138. [DOI: 10.1016/j.echo.2016.10.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1191-1229. [DOI: 10.1093/ehjci/jew190] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022] Open
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Ari ME, Cetin II, Kocabas A, Ekici F, Ceylan O, Surucu M. Decreased Deformation in Asymptomatic Children with Isolated Left Ventricular Non-compaction and Normal Ejection Fraction. Pediatr Cardiol 2016; 37:201-7. [PMID: 26396115 DOI: 10.1007/s00246-015-1266-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 09/09/2015] [Indexed: 11/30/2022]
Abstract
Echocardiography is the mainstay of screening and disease surveillance in isolated left ventricular non-compaction (iLVNC). The aim of our study is to determine the early regional and global myocardial functional changes and whether the myocardial changes that cannot be detected by conventional echocardiography could be detected by tissue Doppler imaging (TDI) or two-dimensional speckle-tracking echocardiography (STE) in iLVNC cases without symptoms. Longitudinal and circumferential strain (S) and strain rates (SR) as determined by STE in 20 children aged 12.1 ± 3.3 years was compared with those in 20 controls. All children underwent echocardiographic assessment using two-dimensional, tissue Doppler and speckle-tracking echocardiography. iLVNC patients who had normal systolic function by ejection and shortening fractions were included in this study. According to the TDI in all three segments [the non-compacted (NC), neighboring NC (NNC) and compacted (C) segments], isovolumic contraction time, isovolumic relaxation time and myocardial performance index values were significantly higher, while ejection time were significantly lower in the iLVNC group. According to STE in two segments (NC and NNC-segments) longitudinal S and SR values and also circumferential S and SR values were significantly lower in the iLVNC group compared with the control group; whereas, in the global measurements both longitudinal and circumferential S and SR values in all three segments were significantly lower in the iLVNC group compared with the control group. We believe that TDI and STE that evaluates myocardial deformation can be used for the detection of early myocardial dysfunction in the iLVNC patients who are subclinical and whose left ventricular functions were detected as normal by conventional methods with normal ejection and shortening fractions.
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Affiliation(s)
- Mehmet Emre Ari
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Research and Training Hospital, Ziraat Mah. Irfan Bastug Cad. Kurtdereli Sok. No: 10 Dışkapı/Altındag, Ankara, Turkey.
| | - Ibrahim Ilker Cetin
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Research and Training Hospital, Ziraat Mah. Irfan Bastug Cad. Kurtdereli Sok. No: 10 Dışkapı/Altındag, Ankara, Turkey
| | - Abdullah Kocabas
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Research and Training Hospital, Ziraat Mah. Irfan Bastug Cad. Kurtdereli Sok. No: 10 Dışkapı/Altındag, Ankara, Turkey
| | - Filiz Ekici
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Research and Training Hospital, Ziraat Mah. Irfan Bastug Cad. Kurtdereli Sok. No: 10 Dışkapı/Altındag, Ankara, Turkey
| | - Ozben Ceylan
- Department of Pediatric Cardiology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Murat Surucu
- Department of Pediatric Cardiology, Ankara Children's Hematology and Oncology Research and Training Hospital, Ziraat Mah. Irfan Bastug Cad. Kurtdereli Sok. No: 10 Dışkapı/Altındag, Ankara, Turkey
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Abe K, Yuda S, Sato Y, Yasui K, Nishi R, Hanada K, Hashimoto N, Kawamukai M, Kouzu H, Muranaka A, Hashimoto A, Tsuchihashi K, Watanabe N, Miura T. Intervendor Variabilities of Left and Right Ventricular Myocardial Velocities among Three Tissue Doppler Echocardiography Systems. Echocardiography 2015; 32:1790-801. [PMID: 25925784 DOI: 10.1111/echo.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Whether an intervendor discordance of myocardial velocities determined by tissue Doppler echocardiography (TDE) can be generalized remains unclear. We compared intervendor variabilities of left ventricular (LV) and right ventricular (RV) myocardial velocities among three TDE systems. METHODS Examinations with TDE were performed in 41 healthy subjects and 11 patients with cardiovascular risk factors (CVR) using α-7 (V1, Hitachi Aloka Medical), Artida (V2, Toshiba Medical Systems), and Vivid E9 (V3, GE Healthcare) on the same day. Peak systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities at medial and lateral sites of the mitral annulus and lateral site of the tricuspid annulus were measured using both pulsed-wave TDE and color TDE. Intra-observer and inter-observer variabilities were determined in 10 subjects and test-retest variability in 14 subjects. RESULTS As for test-retest variability, reproducibilities of LV and RV myocardial velocities determined by pulsed-wave TDE and color TDE were relatively low but comparable between V1, V2, and V3. Myocardial velocities in healthy subjects determined by both pulsed-wave TDE and color TDE were significantly different among the three TDE systems. Myocardial velocities by pulsed-wave TDE in V3 were 2-12% lower (P < 0.05) than those by V2 and 5-14% lower (P < 0.05) than those by V1. Similar differences in myocardial velocities determined by both pulsed-wave TDE and color TDE were found in patients with CVR. CONCLUSIONS LV and RV myocardial velocities determined by both pulsed-wave TDE and color TDE are vendor dependent, and reproducibility of the myocardial velocities determined by both TDE systems is relatively low.
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Affiliation(s)
- Kiyoshi Abe
- Division of Laboratory Diagnosis, Sapporo Medical University Hospital, Sapporo, Japan
| | - Satoshi Yuda
- Department of Infection Control and Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yasumi Sato
- Division of Laboratory Diagnosis, Sapporo Medical University Hospital, Sapporo, Japan
| | - Kenji Yasui
- Division of Laboratory Diagnosis, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ryosuke Nishi
- Department of Clinical Laboratory, Hokkaido Prefectural School of Hygiene, Sapporo, Japan
| | - Kyosuke Hanada
- Department of Clinical Laboratory, Hokkaido Prefectural School of Hygiene, Sapporo, Japan
| | - Naoko Hashimoto
- Department of Clinical Laboratory, Hokkaido Prefectural School of Hygiene, Sapporo, Japan
| | - Mina Kawamukai
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazufumi Tsuchihashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoki Watanabe
- Division of Laboratory Diagnosis, Sapporo Medical University Hospital, Sapporo, Japan.,Department of Infection Control and Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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Weidemann F, Liu D, Niemann M, Herrmann S, Hu H, Gaudron P, Ertl G, Hu K. Abschätzung der linksventrikulären systolischen Funktion bei Patienten mit schlechter Bildqualität. Herz 2015; 40:240-9. [DOI: 10.1007/s00059-013-3924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
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Speckle-tracking and tissue-Doppler stress echocardiography in arterial hypertension: a sensitive tool for detection of subclinical LV impairment. BIOMED RESEARCH INTERNATIONAL 2014; 2014:472562. [PMID: 25389528 PMCID: PMC4214170 DOI: 10.1155/2014/472562] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/06/2014] [Indexed: 01/19/2023]
Abstract
Early diagnosis of cardiac alterations in hypertensive heart disease is still challenging. Since such patients might have depressed global LV systolic strain or strain rate when EF is still normal, speckle-tracking echocardiography (STE) and tissue-Doppler imaging (TDI) combined with stress echocardiography might improve early diagnosis of cardiac alterations. In this prospective study standard 2D Doppler echocardiography, STE, and TDI were performed at rest and during bicycle exercise in 92 consecutive patients—46 hypertensive subjects with normal ejection fraction and 46 healthy controls. STE and TDI were used to measure global peak systolic LV circumferential strain (CS), longitudinal strain (LS), and longitudinal strain rate (SR). Mean arterial blood pressure was significantly higher in hypertensive patients at rest (100.8 mmHg SD 13.5 mmHg; P = 0.002) and during physical exercise testing (124.2 mmHg SD 13.4 mmHg; P = 0.003). Hypertensive patients had significantly reduced values of systolic CS (P = 0.001), LS (P = 0.014), and SR (P < 0.001) at rest as well as during physical exercise—CS (P < 0.001), LS (P < 0.001), and SR (P < 0.001). Using STE and TDI, reduced LV systolic strain and strain rate consistent with early cardiac alterations can be detected in patients with arterial hypertension. These findings were evident at rest and markedly pronounced during exercise echocardiography.
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McNulty CL, Moody WE, Wagenmakers AJ, Fisher JP. Effect of muscle metaboreflex activation on central hemodynamics and cardiac function in humans. Appl Physiol Nutr Metab 2014; 39:861-70. [DOI: 10.1139/apnm-2013-0414] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We sought to determine how the mode of muscle metaboreflex activation influences the central hemodynamic response and cardiac inotropic and lusotropic function in healthy humans. Ten healthy males performed (i) isometric handgrip (IHG) with and without post-exercise ischemia (PEI) to examine the influence of isolated muscle metaboreflex activation and (ii) rhythmic handgrip (RHG) with and without ischemia to examine the influence of enhanced muscle metaboreflex activation. Heart rate (HR) and blood pressure (BP) were continuously monitored. Stroke volume (SV, Doppler echocardiography) was measured, cardiac output (CO = HR × SV) and total peripheral resistance (TPR = mean BP/CO) calculated, and indices of left ventricular systolic and diastolic function were obtained (tissue Doppler imaging). During isolated muscle metaboreflex activation with PEI following IHG, mean BP (+23 ± 3 mm Hg) and TPR were elevated from baseline (p < 0.05), whereas HR, SV, and CO were unchanged. Enhanced muscle metaboreceptor activation during ischemic RHG augmented the increase in mean BP, CO, and HR (p < 0.05 ischemic vs. free-flow RHG), whereas SV and TPR were unchanged from baseline. Neither isolated (PEI) nor enhanced muscle metaboreflex activation altered left ventricular systolic function (systolic myocardial velocity), but left atrial systolic function (late diastolic myocardial velocity) was enhanced. These findings indicate that the mode of muscle metaboreceptor activation (during vs. post handgrip) determines whether the resultant pressor response is flow (CO) or vasoconstriction (TPR) mediated, and that although left ventricular systolic function is unchanged, enhanced left atrial systolic function likely aids the preservation of SV during muscle metaboreflex engagement.
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Affiliation(s)
- Clare L. McNulty
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, England
| | - William E. Moody
- Department of Cardiovascular Sciences, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anton J.M. Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - James P. Fisher
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, England
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Lipshultz SE, Adams MJ, Colan SD, Constine LS, Herman EH, Hsu DT, Hudson MM, Kremer LC, Landy DC, Miller TL, Oeffinger KC, Rosenthal DN, Sable CA, Sallan SE, Singh GK, Steinberger J, Cochran TR, Wilkinson JD. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation 2013; 128:1927-95. [PMID: 24081971 DOI: 10.1161/cir.0b013e3182a88099] [Citation(s) in RCA: 360] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Sehgal A, Wong F, Menahem S. Speckle tracking derived strain in infants with severe perinatal asphyxia: a comparative case control study. Cardiovasc Ultrasound 2013; 11:34. [PMID: 24229323 PMCID: PMC3766009 DOI: 10.1186/1476-7120-11-34] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/27/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Speckle tracking echocardiography is increasingly being used to assess cardiac function in neonates. The objective was to compare speckle tracking strain indices between asphyxiated infants and healthy controls and to ascertain correlations between strain and 2D Doppler derived indices and cardiac troponin (biochemical marker of myocardial injury). METHODS Clinical and echocardiographic data from severely asphyxiated infants undergoing therapeutic hypothermia was evaluated retrospectively. This was compared with prospective data from healthy infants. Correlations between variables were assessed using Pearson's coefficient of correlation. RESULTS Twenty four infants with severe perinatal asphyxia were admitted during the study period of which 3 were not cooled and were excluded. The gestational age and birth weights of cases and controls were comparable. The mean left ventricular global longitudinal strain (GLS) from apical 4 chamber view was noted to be significantly impaired in the asphyxiated infants (- 11.01% ± 2.48 vs - 21.45% ± 2.74, p <0.001). Cardiac output was significantly lower in the asphyxiated infants (97 ± 26 vs 230 ± 60 ml/kg/min). In asphyxiated infants, GLS correlated positively with cardiac output (r2 = 0.86, p< 0.001) and negatively with serum troponin levels (r2 = 0.64, p< 0.001). GLS was less impaired in infants on inotropes compared to those not on inotropic support, -12.55% (1.9) vs -10.2% (1.3), p= 0.018. Infants who died had a lower global strain value compared to survivors, - 9.7% (1.6) vs - 12.8% (2.6), p = 0.02. CONCLUSIONS 2D Speckle derived strain was impaired in asphyxiated infants. Significant correlations between GLS and cardiac output and troponin were noted.
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Affiliation(s)
- Arvind Sehgal
- Monash Newborn, Monash Medical Centre, Melbourne, VIC 3168, Australia.
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Hu K, Liu D, Niemann M, Herrmann S, Gaudron PD, Ertl G, Weidemann F. Methods for Assessment of Left Ventricular Systolic Function in Technically Difficult Patients with Poor Imaging Quality. J Am Soc Echocardiogr 2013; 26:105-13. [DOI: 10.1016/j.echo.2012.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 12/14/2022]
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Yoshikawa H, Suzuki M, Hashimoto G, Kusunose Y, Otsuka T, Nakamura M, Sugi K. Midwall ejection fraction for assessing systolic performance of the hypertrophic left ventricle. Cardiovasc Ultrasound 2012; 10:45. [PMID: 23167789 PMCID: PMC3552820 DOI: 10.1186/1476-7120-10-45] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/04/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In patients with left ventricular hypertrophy (LVH), LV midwall fractional shortening (FS) is used as a measure of LV systolic performance that is more physiologically appropriate than conventional FS. For evaluation of LV volume and ejection fraction (EF), 2-dimensional (2D) echocardiography is more accurate than M-mode echocardiography. The purpose of this study was to assess systolic performance by midwall EF using 2D speckle tracking echocardiography (STE). METHODS Sixty patients were enrolled in the study. Patients were divided into two groups with LVH (n = 30) and without LVH (control group, n = 30). LV systolic function was compared between the two groups and the relationships of left ventricular mass index (LVMI) with LV systolic parameters, including midwall EF, were investigated. RESULTS Midwall EF in the LVH group was significantly lower than that in the control group (42.8±4.4% vs. 48.1±4.1%, p <0.0001). Midwall FS was also significantly lower in the LVH group (13.4±2.8% vs. 16.1±1.5%, p <0.0001), but EF did not differ significantly between the two groups. There were significant correlations between midwall EF and LVMI (r=0.731, p <0.0001) and between midwall FS and LVMI (r=0.693, p <0.0001), with midwall EF having the higher correlation. CONCLUSIONS These results show that midwall EF can be determined using 2D STE. Midwall EF can be used to monitor LV systolic dysfunction, which is not possible with conventional EF. Evaluation of midwall EF may allow assessment of new parameters of LV systolic function in patients with LV geometric variability.
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Affiliation(s)
- Hisao Yoshikawa
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, Japan.
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Gorcsan J, Tanaka H. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol 2011; 58:1401-13. [PMID: 21939821 DOI: 10.1016/j.jacc.2011.06.038] [Citation(s) in RCA: 337] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 05/31/2011] [Accepted: 06/10/2011] [Indexed: 01/12/2023]
Abstract
Echocardiographic strain imaging, also known as deformation imaging, has been developed as a means to objectively quantify regional myocardial function. First introduced as post-processing of tissue Doppler imaging velocity converted to strain and strain rate, strain imaging has more recently also been derived from digital speckle tracking analysis. Strain imaging has been used to gain greater understanding into the pathophysiology of cardiac ischemia and infarction, primary diseases of the myocardium, and the effects of valvular disease on myocardial function, and to advance our understanding of diastolic function. Strain imaging has also been used to quantify abnormalities in the timing of mechanical activation for heart failure patients undergoing cardiac resynchronization pacing therapy. Further advances, such as 3-dimensional speckle tracking strain imaging, have emerged to provide even greater insight. Strain imaging has become established as a robust research tool and has great potential to play many roles in routine clinical practice to advance the care of the cardiovascular patient. This perspective reviews the physiology of myocardial strain, the technical features of strain imaging using tissue Doppler imaging and speckle tracking, their strengths and weaknesses, and the state-of-the-art present and potential future clinical applications.
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Thorstensen A, Dalen H, Amundsen BH, Støylen A. Peak systolic velocity indices are more sensitive than end-systolic indices in detecting contraction changes assessed by echocardiography in young healthy humans. ACTA ACUST UNITED AC 2011; 12:924-30. [DOI: 10.1093/ejechocard/jer178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ozyigit T, Ozben B, Oflaz H, Serdaroglu P. Evaluation of biventricular functions with tissue Doppler imaging in patients with myotonic dystrophy. Clin Cardiol 2011; 33:126-31. [PMID: 20235214 DOI: 10.1002/clc.20712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Myotonic dystrophy (MD) is characterized by myotonia with dystrophic involvement of the muscles. Cardiac involvement is usually not evident in the early stages of MD. HYPOTHESIS We investigated biventricular functions by tissue Doppler imaging (TDI) in MD patients with no overt cardiac involvement to explore the value of TDI in the early detection of myocardial dysfunction. METHODS A total of 21 MD patients (15 male, age: 32.2 +/- 12.3 yrs) and 21 healthy controls (13 male, age: 32.2 +/- 7.8 yrs) were included. In addition to conventional echocardiography, pulsed Doppler and TDI were performed including measurement of myocardial performance index (MPI); peak systolic (Sm) and early (Em) and atrial (Am) diastolic myocardial velocities at the basal mitral and tricuspid annulus. RESULTS All patients and controls had normal ejection fraction. Transmitral E peak velocity was significantly lower while both deceleration time of E velocity and isovolumic relaxation time were significantly longer in MD patients (P = 0.007, P = 0.001, and P < 0.001, respectively). Sm, Em and Am peak velocities were significantly lower in MD patients in all segments except for Em of the mitral anterior annulus and Am of the tricuspid lateral annulus. Both left and right ventricular MPI were significantly higher in MD patients (P < 0.001 and P = 0.013, respectively). CONCLUSION There are changes in myocardial systolic and diastolic functions in MD patients although they have no overt heart failure. Myocardial tissue velocities and MPI are useful in identifying subclinical biventricular involvement in these patients.
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Affiliation(s)
- Tolga Ozyigit
- American Hospital, Department of Cardiology, Istanbul, Turkey
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Yoshikawa H, Suzuki M, Hashimoto G, Otsuka T, Sugi K. Impact of Cilostazol on Left Ventricular Geometry and Function: Assessment by Tissue Doppler Imaging and Two-Dimensional Speckle-Tracking Echocardiography. Echocardiography 2011; 28:431-7. [DOI: 10.1111/j.1540-8175.2010.01357.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Sharif D, Sharif-Rasslan A, Shahla C, Rosenschein U. Application of Mitral Annular Systolic Displacements and Velocities for the Evaluation of Left Ventricular Systolic Function and Reserve. Cardiol Res 2011; 2:36-41. [PMID: 28348658 PMCID: PMC5358127 DOI: 10.4021/cr7w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 11/22/2022] Open
Abstract
Background Mitral annular systolic displacement from M-mode echocardiography and velocity from tissue Doppler imaging reflect subendocardial longitudinal systolic LV performance and may precede radial abnormalities. The aim of this study is to evaluate the utility of mitral annular systolic displacement (D) and velocity (V) during dobutamine stress echocardiography (DSE) in detecting left ventricular (LV) functional reserve and wall motion abnormality (WMA). Methods and Results Fifty-nine subjects, 15 with resting WMA, underwent DSE and measurement of mitral systolic (D) and (V) before and immediately after DSE. Annular septal (D) was lower in those with WMA than in those without, at rest 10.5 ± 4 cm versus 13.2 ± 2 cm, p = 0.015, and after DSE, 11.7 ± 3.8 cm versus 14 ± 2.25 cm, p = 0.036, but without significant change after stress. Annular systolic (V) at rest with WMA was 9.7 ± 1.8 cm/sec and similar to those without, 11.25 ± 2.7 cm/sec. In both groups the velocity increased after DSE, 14.5 ± 4.5 cm/sec, p = 0.025 with WMA and 17.8 ± 3.2 cm/sec, p = 1.99 x 10-10 in those without WMA. Velocities after DSE were lower in those with WMA, p = 2.25 x 10-6. Conclusions To evaluate LV systolic performance mitral annular systolic longitudinal displacement is valuable at rest, but for assessment of LV functional reserve after stress velocities are better.
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Affiliation(s)
- Dawod Sharif
- Department of Cardiology, Bnai Zion Medical Center, Israel; Technion - Israel Institute of Technology, Haifa, Israel
| | | | - Camilia Shahla
- Department of Cardiology, Bnai Zion Medical Center, Israel
| | - Uri Rosenschein
- Department of Cardiology, Bnai Zion Medical Center, Israel; Technion - Israel Institute of Technology, Haifa, Israel
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Sharif D, Sharif-Rasslan A, Shahla C. Mitral Annular Systolic Velocities Predict Left Ventricular Wall Motion Abnormality During Dobutamine Stress Echocardiography. Cardiol Res 2011; 2:16-26. [PMID: 28348656 PMCID: PMC5358125 DOI: 10.4021/cr14w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2011] [Indexed: 11/13/2022] Open
Abstract
Background Longitudinal systolic left ventricular contraction is complementary to the radial performance and can be assessed using tissue Doppler imaging (TDI). This study was performed to evaluate the contribution of mitral annular systolic velocities using TDI after dobutamine stress echocardiography (DSE). Methods and Results Fifty subjects with suspected coronary artery disease and chest pain were examined, using DSE as usual, as well as TDI imaging of the mitral annulus at the septal, lateral, inferior, anterior, posterior regions and the proximal anteroseptal region from the apical views, before and immediately after DSE. In 24 subjects the study was normal, while wall motion abnormality was seen in 26, 9 of them only after DSE. Mitral annular systolic velocity at the 6 locations increased significantly after DSE both in normal subjects and in those with wall motion abnormality (WMA). After DSE mitral annular septal systolic velocity in normals, 19.2 ± 3.8 cm/sec, was higher than in those with WMA, 14.6 ± 2.5 cm/sec, P < 0.0003. Post-DSE mitral systolic velocity was senstive and accurate in predicting WMA. Conclusions Systolic mitral TDI velocities increase after DSE, however to a lesser extent in those with wall motion abnormality, and can differentiate them from normal subjects.
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Affiliation(s)
- Dawod Sharif
- Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel; Technion - Israel Institute of Technology, Haifa, Israel
| | | | - Camilia Shahla
- Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel
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Seo JS, Kim DH, Kim WJ, Song JM, Kang DH, Song JK. Peak systolic velocity of mitral annular longitudinal movement measured by pulsed tissue Doppler imaging as an index of global left ventricular contractility. Am J Physiol Heart Circ Physiol 2010; 298:H1608-15. [DOI: 10.1152/ajpheart.01231.2009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We sought to test whether the peak systolic velocity of mitral annular longitudinal movement ( S′) measured by pulsed tissue Doppler imaging technique is useful to assess global left ventricular (LV) contractility under various LV inotropic conditions, including regional wall motion abnormality. In addition, the accuracy of S′ relative to LV ejection fraction (EF), a conventional index of LV contractility, and its association with apical rotation, a new index of LV contractility, were also evaluated. We measured S′ at the medial mitral annulus and apical rotation in 11 open-chest anesthetized dogs at eight inotropic stages before and after ligation of either the left anterior descending or circumflex coronary artery. Maximal positive dP/d t (dP/d tpeak) was monitored using a high-fidelity pressure catheter and used as the standard measure of LV contractility. S′ showed dose-dependent increases and decreases after dobutamine and esmolol infusion, respectively. There was a stronger association between dP/d tpeak and S′ ( R2 = 0.665, P < 0.001) than between dP/d tpeak and EF ( R2 = 0.408, P < 0.001), and this trend was more apparent with coronary ligation, regardless of the ligation site. The strength of association between dP/d tpeak and S′ ( R2 = 0.665) was not different from that between dP/d tpeak and apical rotation ( R2 = 0.726) ( P = 0.350). The association between LV EF and S′ was modest ( R2 = 0.472, P < 0.001), whereas a good association between S′ and apical rotation was observed both with ( R2 = 0.552, P < 0.001) and without ( R2 = 0.674, P < 0.001) coronary ligation. S′ is a more sensitive index of global LV contractility than is LV EF, reflecting both LV longitudinal shortening and torsional deformation.
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Affiliation(s)
- Jeong-Sook Seo
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Won-Jang Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Flu WJ, van Kuijk JP, Bax JJ, Gorcsan J, Poldermans D. Three-dimensional speckle tracking echocardiography: a novel approach in the assessment of left ventricular volume and function? Eur Heart J 2009; 30:2304-7. [DOI: 10.1093/eurheartj/ehp343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Abstract
The most common indication for an echocardiogram is for the assessment of left ventricular (LV) function and, in the evaluation of cardiomyopathy (CM), this becomes even more important. However, conventional echocardiographic measures of ventricular function are insensitive at detecting subtle perturbations in contractility. In patients with CM, the ability to detect abnormalities early in the course of the disease to establish a diagnosis can be critical and often may influence specific treatments administered as well as establish important prognostic information. Technologic advances in echocardiographic imaging during the last decade now allow for the measurement of LV strain and strain rate (SR) imaging. Strain and SR imaging allow for a more precise characterization of the mechanics of myocardial contraction and relaxation (deformation imaging) and emerging data are establishing the use of these techniques in a variety of different cardiomyopathic conditions. After establishing a common understanding of strain imaging as well as defining the methods by which these measures can be incorporated into an echocardiographic examination, we will review the accumulating information illustrating the great promise that this imaging modality has in the care of patients with CM. This review will focus on the role of strain and SR imaging in CM.
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Affiliation(s)
- Gillian C Nesbitt
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Brothers RM, Bhella PS, Shibata S, Wingo JE, Levine BD, Crandall CG. Cardiac systolic and diastolic function during whole body heat stress. Am J Physiol Heart Circ Physiol 2009; 296:H1150-6. [PMID: 19218504 PMCID: PMC2670696 DOI: 10.1152/ajpheart.01069.2008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 02/11/2009] [Indexed: 11/22/2022]
Abstract
During a whole body heat stress, stroke volume is either maintained or slightly elevated despite reduced ventricular filling pressures and central blood volume, suggestive of improved cardiac diastolic and/or systolic function. Heat stress improves cardiac systolic and diastolic function in patients with congestive heart failure, although it remains unknown whether similar responses occur in healthy individuals, which is the hypothesis to be tested. Nine male volunteers underwent a whole body heat stress. Echocardiographic indexes of diastolic and systolic function were performed following a supine resting period, and again following an increase in internal temperature of approximately 1.0 degrees C via passive heat stress. Despite previous reports of heat stress-induced decreases in ventricular filling pressures and central blood volume, no changes in indexes of diastolic function were identified during heating [i.e., unchanged early diastolic mitral annular tissue velocity (E'), mitral inflow during the early diastolic phase (E), the E/E' ratio, and isovolumetric relaxation time]. Heat stress increased late diastolic septal (P = 0.03) and lateral (P = 0.01) mitral annular tissue velocities (A'), mitral inflow velocity during atrial contraction (P < 0.001), and the relative contribution of atrial contraction to left ventricular filling during diastole (P = 0.01), all indicative of improved atrial systolic function. Furthermore, indexes of ventricular systolic function were increased by heat stress [i.e., increased septal (P = 0.001) and lateral (P = 0.01) mitral annular systolic velocities and isovolumic acceleration at the septal (P = 0.03) and lateral (P < 0.001) mitral annulus]. These data are suggestive of improved atrial and ventricular systolic function by the heat stress. Together these data support previous findings, which used the less precise measure of ejection fraction, that heat stress improves indexes of systolic function, while diastolic function is maintained.
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Affiliation(s)
- R Matthew Brothers
- Presbyterian Hospital of Dallas, Institute of Exercise and Environmental Medicine, 7232 Greenville Ave., Ste. 435, Dallas, TX 75231, USA
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Nesbitt GC, Mankad S, Oh JK. Strain imaging in echocardiography: methods and clinical applications. Int J Cardiovasc Imaging 2009; 25 Suppl 1:9-22. [DOI: 10.1007/s10554-008-9414-1] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 12/23/2008] [Indexed: 11/29/2022]
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25
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Parilak LD, Taylor DG, Song Y, Burkart T, Shryock JC, Curtis AB, Knot HJ. Contribution of frequency-augmented inward Ca2+ current to myocardial contractility. Can J Physiol Pharmacol 2009; 87:69-75. [DOI: 10.1139/y08-087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The sarcoplasmic reticular Ca2+ pump (SERCA) is thought to be the primary determinant of heart rate-dependent increases in myocardial contractile [Ca2+]i and force (force–frequency relationship (FFR)), an important mechanism to increase cardiac output. This report demonstrates a rate-dependent role for inward Ca2+ current (ICa) in the human and rat FFR. Human action potential plateau height increased linearly with contractility when heart rate increased in vivo, as measured by monophasic action potential catheter and echocardiography. Rat rate-dependent developed force and cytosolic [Ca2+]i transients were quantified in isolated left ventricular papillary muscles, and ICa and action potential duration in cardiomyocytes. ICa and SERCA measurements better reflected [Ca2+]i and force transients than SERCA activity alone. These data support a direct and (or) indirect contribution to myocardial contractility by ICa at heart rates from approximately 1 to 3–4 Hz (60 to 180–240 bpm) in tandem with SERCA to sustain the typical ‘bell shape’ of the FFR across species.
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Affiliation(s)
- Leonard D. Parilak
- Departments of Pharmacology and Therapeutics, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32610, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - David G. Taylor
- Departments of Pharmacology and Therapeutics, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32610, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Yejia Song
- Departments of Pharmacology and Therapeutics, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32610, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas Burkart
- Departments of Pharmacology and Therapeutics, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32610, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - John C. Shryock
- Departments of Pharmacology and Therapeutics, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32610, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Anne B. Curtis
- Departments of Pharmacology and Therapeutics, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32610, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Harm J. Knot
- Departments of Pharmacology and Therapeutics, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL 32610, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
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Skubas N. Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists’ Armamentarium: A Core Review. Anesth Analg 2009; 108:48-66. [DOI: 10.1213/ane.0b013e31818a6c4c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Marcucci C, Lauer R, Mahajan A. New Echocardiographic Techniques for Evaluating Left Ventricular Myocardial Function. Semin Cardiothorac Vasc Anesth 2008; 12:228-47. [DOI: 10.1177/1089253208328581] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ultrasound imaging of the heart continues to play an important role in diagnosis and management of patients with cardiovascular diseases. Recent advances in ultrasound technology and introduction of newer imaging modalities have enabled improved assessment of left ventricular myocardial function. Tissue Doppler imaging and 2-dimensional speckle tracking allow more objective quantification of myocardial function in the form of tissue velocities, displacement, strain, and strain rate. Similarly, contrast-enhanced echocardiography and 3-dimensional echocardiography have provided a unique insight into left ventricular form and function that was not possible by unenhanced 2-dimensional echocardiography. In this review, the authors discuss the clinical application of these new imaging techniques in the assessment of left ventricular myocardial function.
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Affiliation(s)
- Carlo Marcucci
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Ryan Lauer
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Aman Mahajan
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California,
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Maturational and Growth-Related Changes in Left Ventricular Longitudinal Strain and Strain Rate Measured by Two-Dimensional Speckle Tracking Echocardiography in Healthy Pediatric Population. J Am Soc Echocardiogr 2008; 21:1207-15. [DOI: 10.1016/j.echo.2008.08.011] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Indexed: 11/21/2022]
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TAKAMURA T, ONISHI K, SUGIMOTO T, KURITA T, FUJIMOTO N, DOHI K, TANIGAWA T, ISAKA N, NOBORI T, ITO M. Patients with a Hypertensive Response to Exercise Have Impaired Left Ventricular Diastolic Function. Hypertens Res 2008; 31:257-63. [DOI: 10.1291/hypres.31.257] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Delfino JG, Fornwalt BK, Eisner RL, Leon AR, Oshinski JN. Determination of transmural, endocardial, and epicardial radial strain and strain rate from phase contrast MR velocity data. J Magn Reson Imaging 2008; 27:522-8. [DOI: 10.1002/jmri.21211] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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31
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Nakamura T, Hirayama M, Ito H, Takamori M, Hamada K, Takeuchi S, Watanabe H, Koike Y, Sobue G. Dobutamine stress test unmasks cardiac sympathetic denervation in Parkinson's disease. J Neurol Sci 2007; 263:133-8. [PMID: 17673233 DOI: 10.1016/j.jns.2007.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 06/22/2007] [Accepted: 07/03/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cardiac uptake of [(123)I]metaiodobenzyl guanidine (MIBG) is reduced in patients with Parkinson's disease (PD). However, the cardiac sympathetic abnormality associated with this reduction is unclear. To unmask this abnormality in PD patients we examined the functional consequences of cardiac beta-receptor activation. METHODS Cardiovascular responses to stepwise administration of the beta1-receptor agonist, dobutamine (DOB), were assessed in 25 PD patients and 12 age-matched controls. Changes in blood pressure were compared to determine the optimal dose at which to detect denervation supersensitivity, and cardiac contractility was measured by DOB echocardiography, based on peak aortic flow velocity. The relations of these cardiovascular responses to the ratio of MIBG uptake into the heart vs. that into the mediastinum (H/M ratio) were analyzed. RESULTS At 4 microg/kg/min DOB, systolic blood pressure increased more in PD patients than in controls (PD, 17.5+/-12.3 mm Hg; control, 7.2+/-6.2 mm Hg, p<0.01), suggesting the presence of denervation supersensitivity. At this DOB dose cardiac contractility also increased more in PD than in controls (PD, 39.0+/-15.7%; control, 23.5+/-5.2%, p<0.005) and this hyperdynamic response was significantly correlated with reduced H/M ratios (early: r=-0.63, p<0.01, delayed: r=-0.66, p<0.01). CONCLUSION Low-dose DOB unmasks cardiac sympathetic denervation in PD patients, and decreased MIBG uptake indicates the presence of denervation supersensitivity within the heart, resulting in hyperdynamic cardiac contractility in response to a beta 1-stress condition.
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Affiliation(s)
- Tomohiko Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Abraham TP, Dimaano VL, Liang HY. Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice. Circulation 2007; 116:2597-609. [PMID: 18040039 DOI: 10.1161/circulationaha.106.647172] [Citation(s) in RCA: 224] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
| | | | - Hsin-Yueh Liang
- From the Division of Cardiology, Johns Hopkins University, Baltimore, Md
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El-Menyar AA, Galzerano D, Asaad N, Al-Mulla A, Arafa SEO, Al Suwaidi J. Detection of myocardial dysfunction in the presence of normal ejection fraction. J Cardiovasc Med (Hagerstown) 2007; 8:923-33. [PMID: 17906478 DOI: 10.2459/jcm.0b013e328014daf2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Detection of subclinical myocardial involvement is of utmost importance in risk stratification and prognosis; the role of ejection fraction in the detection of subclinical disease may be unhelpful. Our aim was to evaluate the methodology and importance of early detection of myocardial involvement in the presence of normal ejection fraction. Most of the pertinent English and non-English articles published from 1980 to 2006 in Medline, Scopus, and EBSCO Host research databases have been reviewed. Serial assessment of systolic function with different techniques should be avoided, since imaging modalities and ejection fraction measurements are not interchangeable. Additional non-invasive tools still are needed for the identification of subclinical left ventricular dysfunction in certain diseases. The recognition of subclinical involvement will prompt initiation of specific therapy to prevent the development of overt left ventricular dysfunction. This also is needed for determining the best timing for intervention in asymptomatic patients with metabolic and valvular disorders.
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Affiliation(s)
- Ayman A El-Menyar
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar.
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Mankad S, Nanda NC. Impact of Newer Echocardiographic Modalities in the Elderly. ACTA ACUST UNITED AC 2007; 16:349-54. [DOI: 10.1111/j.1076-7460.2007.07639.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Minardi G, Manzara C, Pulignano G, Luzi G, Maselli D, Casali G, Musumeci F. Rest and Dobutamine stress echocardiography in the evaluation of mid-term results of mitral valve repair in Barlow's disease. Cardiovasc Ultrasound 2007; 5:17. [PMID: 17386112 PMCID: PMC1845153 DOI: 10.1186/1476-7120-5-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 03/26/2007] [Indexed: 11/10/2022] Open
Abstract
Background Surgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease. Debate, however, persists on the efficacy of this technique, as well as on the durability of the repaired valve, and on its functioning and hemodynamics under stress conditions. Thus, a basal and Dobutamine echocardiographic (DSE) study was carried out to evaluate these parameters at mid-term follow-up. Methods and Results Twenty patients selected for the study (12 men and 8 women, mean age 60 ± 9 years) underwent pre- and post-operative transthoracic echocardiography (TTE) and intra-operative transesophageal echocardiography (TEE). At mid-term follow-up (20 ± 5 months) all patients underwent rest TTE and DSE (3 min. dose increments up to 40 microg/Kg/min protocol). Pre-discharge and one-month TTE showed absence of MR in 11 pts., trivial or mild MR in 9 pts. and normal mitral valve area and gradients. Mid-term TTE showed decrease in left atrial and ventricular dimension, in pulmonary artery pressure (sPAP) and grade of MR. During DSE a significant increase in mitral valve area, maximum and mean gradients, sPAP, heart rate and cardiac output and a decrease in systolic annular diameter and left ventricular volume were found; in 6 pts. a transient left ventricular outflow tract obstruction was observed. Conclusion Basal and Dobutamine stress echocardiography proved to be valuable tools for evaluation of mid-term results of mitral valve repair. In our study population, the surgical technique employed had a favourable impact on several cardiac parameters, evaluated by these methods.
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Affiliation(s)
- Giovanni Minardi
- Division of Cardiology, Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Carla Manzara
- Division of Cardiology, Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Giovanni Pulignano
- Division of Cardiology, Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Giampaolo Luzi
- Division of Cardiovascular Surgery, Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Daniele Maselli
- Division of Cardiovascular Surgery, Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Giovanni Casali
- Division of Cardiovascular Surgery, Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Francesco Musumeci
- Division of Cardiovascular Surgery, Department of Cardiology and Cardiovascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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Sundkvist GMG, Hjemdahl P, Kahan T, Melcher A. Mechanisms of exercise-induced ST-segment depression in patients without typical angina pectoris. J Intern Med 2007; 261:148-58. [PMID: 17241180 DOI: 10.1111/j.1365-2796.2006.01751.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate if exercise-induced ST-segment depression without typical angina pectoris is related to increases in sympatho-adrenal activity or beta-adrenoceptor sensitivity. PATIENTS Thirteen patients (four men) aged 35-62 years with ST-segment depression during exercise but atypical symptoms and normal myocardial scintigraphy, and 13 matched controls. DESIGN AND INTERVENTIONS Patients and controls were compared regarding responses with: (i) exercise testing without treatment, (ii) exercise testing following beta-adrenoceptor blockade by propranolol (0.15 mg kg(-1) i.v.), (iii) incremental adrenaline infusions (0.1, 0.2, 0.4 and 0.8 nmol kg(-1) min(-1)) and (iv) adrenaline infusions during alpha-adrenoceptor blockade by phentolamine (0.5 mg min(-1)). MAIN OUTCOME MEASURES ST-segment depression and tissue Doppler parameters reflecting contractility. RESULTS Exercise lowered the ST-segment by 2.44 mm without and 0.87 mm with beta-adrenoceptor blockade (P < 0.001 for difference) amongst patients, but not amongst controls. Maximal heart rate was slightly higher amongst patients (P < 0.05), despite similar loads and plasma catecholamine responses to exercise in the two groups; this difference disappeared after beta-adrenoceptor blockade with propranolol. ST-segment depression during adrenaline infusion was greater in patients compared with controls (P < 0.01) despite similar increases in heart rate. alpha-Blockade enhanced the ST-segment depression (P < 0.001) and heart rate (P < 0.001) responses to adrenaline infusion more markedly amongst patients. Tissue Doppler imaging showed similar contractility and diastolic relaxation responses of patients and controls to adrenaline, but early diastolic movements did not increase amongst patients after phentolamine (P < 0.01). CONCLUSIONS Exercise-induced ST-segment depression in patients with a low likelihood of ischaemic heart disease is related to increased beta-adrenergic sensitivity regarding chronotropic and electrophysiological, but not inotropic responses.
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Affiliation(s)
- G M G Sundkvist
- Division of Clinical Physiology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Van Pelt NC, Stewart RAH, Legget ME, Whalley GA, Wong SP, Zeng I, Oldfield M, Kerr AJ. Longitudinal left ventricular contractile dysfunction after exercise in aortic stenosis. Heart 2006; 93:732-8. [PMID: 17090563 PMCID: PMC1955170 DOI: 10.1136/hrt.2006.100164] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether longitudinal left ventricular systolic function measured by Doppler tissue imaging (DTI) after exercise can identify early left ventricular dysfunction in asymptomatic patients with moderate-severe aortic stenosis. DESIGN Case-control study. SETTING Outpatient cardiology departments. PATIENTS 20 patients with aortic stenosis, with or without equivocal symptoms, a peak aortic valve velocity > or =3 m/s, and left ventricular ejection fraction >50% and 15 aged-matched normal controls. INTERVENTIONS Echocardiogram performed at rest and immediately after treadmill exercise. MAIN OUTCOME MEASURES The peak systolic velocity of the lateral mitral annulus (S') by DTI at rest and immediately after exercise, exercise capacity, exercise systolic blood pressure and the plasma level of B-type natriuretic peptide (BNP). RESULTS For patients with aortic stenosis, mean (SD) aortic valve area was 0.95 (0.3) cm(2). At rest, S' was similar for patients with aortic stenosis and controls, respectively (8.5 (1.5) vs 9.1 (1.8) cm/s, p = 0.15). However, after exercise, S' (12.2 (3.2) vs 17 (2.8) cm/s, p<0.001) and the increase in S' between rest and exercise (4 (3) vs 7.9 (1.5) cm/s, p<0.001) were lower in patients with aortic stenosis. In patients with aortic stenosis, a smaller increase in S' after exercise was associated with lower exercise capacity (r = 0.5, p = 0.02), a smaller increase in exercise systolic blood pressure (r = 0.6, p = 0.005) and higher plasma level of BNP (r = 0.66, p = 0.002). CONCLUSION In asymptomatic patients with moderate-severe aortic stenosis a lower than normal increase in peak systolic mitral annular velocity after treadmill exercise is a marker of early left ventricular systolic dysfunction.
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Affiliation(s)
- Niels C Van Pelt
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
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Ha JW, Ahn JA, Kim JM, Choi EY, Kang SM, Rim SJ, Jang Y, Shim WH, Cho SY, Oh JK, Chung N. Abnormal Longitudinal Myocardial Functional Reserve Assessed by Exercise Tissue Doppler Echocardiography in Patients with Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2006; 19:1314-9. [DOI: 10.1016/j.echo.2006.05.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Indexed: 10/23/2022]
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Maclaren G, Kluger R, Prior D, Royse A, Royse C. Tissue Doppler, Strain, and Strain Rate Echocardiography: Principles and Potential Perioperative Applications. J Cardiothorac Vasc Anesth 2006; 20:583-93. [PMID: 16884996 DOI: 10.1053/j.jvca.2006.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Graeme Maclaren
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia.
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40
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Vitarelli A, Montesano T, Gaudio C, Conde Y, Cimino E, D'angeli I, D'orazio S, Stellato S, Battaglia D, Padella V, Caranci F, Ciancamerla M, Di Nicola AD, Ronga G. Strain Rate Dobutamine Echocardiography for Prediction of Recovery After Revascularization in Patients With Ischemic Left Ventricular Dysfunction. J Card Fail 2006; 12:268-75. [PMID: 16679259 DOI: 10.1016/j.cardfail.2006.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Revised: 12/11/2005] [Accepted: 02/02/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND The purpose of the present study was to assess the accuracy of quantitative segmental analysis by strain rate imaging (SRI) technique during dobutamine test for detecting myocardial recovery after revascularization in patients with chronic ischemic regional left ventricular (LV) dysfunction and compare results with those of 2-dimensional echocardiography (2D) and tissue Doppler imaging (TDI) as well as rest-4 hours-24 hours redistribution thallium SPECT (Tl SPECT). METHODS AND RESULTS Forty-one patients with chronic ischemic regional LV dysfunction (EF 29 +/- 8%) underwent dobutamine 2D/TDI/SRI and Tl SPECT before and after myocardial revascularization. The sensitivity, specificity, and accuracy for the recovery of regional LV function were 73%, 81%, and 77% for dobutamine 2D; 77%, 82%, and 80% for dobutamine TDI; 86%, 88%, and 85% for dobutamine SRI; and 94%, 76%, and 84% for Tl tomography. The area under the ROC curve (AUC), which reflects the overall performance for the prediction of recovery, was 0.79 for systolic-SR, 0.81 for Tl SPECT, 0.83 for postsystolic strain, and 0.87 for isovolumic-SR. If both systolic and postsystolic SRI indexes were combined with Tl SPECT, the AUC was improved to 0.94. CONCLUSIONS Dobutamine SRI is more accurate than TDI in identifying hibernating myocardium. Systo-diastolic values obtained using dobutamine SRI echocardiography and values derived from nuclear perfusion techniques may be complementary in assessing myocardial viability.
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MESH Headings
- Adult
- Angioplasty, Balloon, Coronary
- Area Under Curve
- Coronary Angiography
- Coronary Artery Bypass
- Echocardiography, Stress/methods
- Female
- Humans
- Image Processing, Computer-Assisted
- Male
- Middle Aged
- Myocardial Contraction
- Prospective Studies
- Recovery of Function
- Sensitivity and Specificity
- Tomography, Emission-Computed, Single-Photon
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/surgery
- Ventricular Dysfunction, Left/therapy
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41
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García EH, Perna ER, Farías EF, Obregón RO, Macin SM, Parras JI, Agüero MA, Moratorio DA, Pitzus AE, Tassano EA, Rodriguez L. Reduced systolic performance by tissue Doppler in patients with preserved and abnormal ejection fraction: New insights in chronic heart failure. Int J Cardiol 2006; 108:181-8. [PMID: 15922464 DOI: 10.1016/j.ijcard.2005.04.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 03/11/2005] [Accepted: 04/20/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) is useful in the evaluation of systolic and diastolic function. It allows assessment of ventricular dynamics in its longitudinal axis. We sought to investigate the difference in systolic and diastolic longitudinal function in patients with chronic heart failure (CHF) with normal and reduced ejection fraction. METHODS AND RESULTS One hundred ten outpatients with CHF and 68 controls were included. Ejection fraction (EF) was obtained and longitudinal systolic (S) and diastolic (E' and A') wall velocities were recorded from basal septum. Group A (controls) were normal and CHF patients were classified by EF in Group B1: > 45% and B2: < or = 45%. In A, B1 and B2 the mean S peak was 7.74; 5.45 and 4.89 cm/s (p<0.001); the mean E' peak was 8.56; 5.72 and 6.1 cm/s (p<0.001); and the mean A' peak was 10.2; 7.3 and 5.3 cm/s (p<0.001). Also, isovolumic contraction and relaxation time were different among control and CHF groups, (both p<0.001). The most useful parameters for identifying diastolic CHF were IVRT and S peak, with area under ROC curves of 0.93 and 0.89. The cut-off of 115 ms for IVRT and 5.8 cm/s for S peak showed a sensitivity of 94 and 97%, with a specificity of 82 and 73%, respectively. CONCLUSION These findings suggest that impairment of left ventricular systolic function is present even in those with diastolic heart failure, and that abnormalities may have an important role to identifying the condition.
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Affiliation(s)
- Edgar H García
- Echocardiography Laboratory, Instituto de Cardiología Juana F. Cabral, Bolívar 1334, Corrientes 3400, Argentina.
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Sade LE, Sezgin A, Uluçam M, Taymaz S, Simşek V, Tayfun E, Tokel K, Aşlamaci S, Müderrisoğlu H. Evaluation of the Potential Role of Echocardiography in the Detection of Allograft Rejection in Heart Transplant Recipients. Transplant Proc 2006; 38:636-8. [PMID: 16549194 DOI: 10.1016/j.transproceed.2005.12.098] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Our objective was to determine the most relevant systolic and diastolic echocardiographic parameters to detect left ventricular (LV) dysfunction associated with allograft rejection among heart transplant recipients. PATIENTS AND METHODS Seven consecutive recipients underwent serial echocardiographic studies with two-dimensional spectral Doppler and tissue Doppler (TD) according to our institutional protocol. Results were compared with clinical status and endomyocardial biopsies (EMB) whenever available. RESULTS The time since transplantation was 22 to 850 days. Patient no. 2 had a biopsy-proven acute rejection at the 11th week which was associated with decreased TD velocities, ejection fraction (EF), and stroke volume (SV), as well as increased pericardial effusion and posterior wall thickness. Interestingly, changes in TD parameters preceded those in EF and SV. However, similar but less remarkable changes in TD velocities, EF, SV, pericardial effusion, and posterior wall thickness also occurred during other events, such as systemic infection and immediate postoperative hemodynamic compromise despite no rejection. A biopsy performed 7 months later in a patient with a previous rejection episode due to a relatively low EF and SV as well as increasing pericardial effusion with normal TD velocities revealed no rejection. CONCLUSIONS These data suggest that echocardiographic findings, although not specific for acute rejection, may play a potential role as a screening test to exclude rejection in heart transplant recipients.
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Affiliation(s)
- L E Sade
- Department of Cardiology, Başkent University, Faculty of Medicine, Ankara, Turkey.
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Galetta F, Cupisti A, Franzoni F, Carpi A, Barsotti G, Santoro G. Acute effects of hemodialysis on left ventricular function evaluated by tissue Doppler imaging. Biomed Pharmacother 2006; 60:66-70. [PMID: 16459054 DOI: 10.1016/j.biopha.2005.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 10/03/2005] [Indexed: 11/26/2022] Open
Abstract
Evidence exists that left ventricular function is impaired in chronic uremic patients. During hemodialysis (HD) treatment, myocardium undergoes electrolyte, hemodynamic and neuro-humoral stress; however, data about the acute changes on ventricular function are controversial. Aim of the present study was to evaluate the effect of a single hemodialysis session on left ventricular (LV) systolic and diastolic function using pulsed tissue Doppler imaging (TDI) sampled by echocardiography. The study group included 20 uremic patients (17 males, aged 51+/-13 yrs) on maintenance HD, free from clinically overt cardiac dysfunction who underwent echocardiography with pulsed TDI 30 min prior and 30 min after a HD session. TDI was performed by placing the sample volume in the center of the basal lateral segment and the basal interventricular septum in the apical four-chamber view. Myocardial systolic wave (S(m)) and early (E(m)) and atrial (A(m)) diastolic waves were measured. On standard sonography examination, no significant changes in LV systolic function parameters were observed after HD, but the indices for LV diastolic function deteriorated significantly (peak E, 75.4+/-11.2 vs. 58.8+/-12.5 cm/s, P<0.01; E/A ratio, 1.0+/-0.3 vs. 0.8+/-0.2, P<0.01). However, regarding TDI measures following HD, the patients exhibited a lower S(m) peak (septum: 7.6+/-1.1 vs. 5.9+/-0.8 cm/s; lateral wall: 7.7+/-1.7 vs. 6.8+/-1.2 cm/s, P<0.001), a lower E(m) peak (septum: 8.3+/-1.6 vs. 6.3+/-1.7 cm/s; lateral wall: 10.2+/-2.4 vs. 7.1+/-1.9 cm/s, P<0.001), and a reduced E(m)/A(m) ratio (septum: 1.0+/-0.4 vs. 0.7+/-0.2; lateral wall: 1.2+/-0.5 vs. 0.7+/-0.2, P<0.001, respectively), as compared to pre-HD parameters. Of interest, peak E(m), and E(m)/A(m) ratio of the lateral wall were negatively related to ultrafiltration rate (r = -0.60, P<0.05 and -0.69, P<0.01, respectively). Our data indicate that a single hemodialysis session is associated with acute deterioration of diastolic and systolic parameters of myocardial function, as assessed by TDI. These reversible changes could be considered as a cardiac stunning that seems to be related to the ultrafiltration rate and then to the interdialysis weight gain. These findings suggest that low ultrafiltration volume and/or limited interdialytic weight gain are cardioprotective measures in hemodialysis patients.
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Affiliation(s)
- Fabio Galetta
- Department of internal medicine, University of Pisa School of Medicine, Via Roma, 67, 56126 Pisa, Italy.
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Koffas H, Dukes-McEwan J, Corcoran B, Moran C, French A, Sboros V, Simpson K, McDicken W. Pulsed Tissue Doppler Imaging in Normal Cats and Cats with Hypertrophic Cardiomyopathy. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02825.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Miyasaka Y, Haiden M, Kamihata H, Nishiue T, Iwasaka T. Usefulness of strain rate imaging in detecting ischemic myocardium during dobutamine stress. Int J Cardiol 2005; 102:225-31. [PMID: 15982489 DOI: 10.1016/j.ijcard.2004.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2003] [Revised: 04/30/2004] [Accepted: 05/05/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Tissue Doppler imaging-derived systolic myocardial velocity can detect subtle alterations in contractility during dobutamine stress. However, increased cardiac translation and tethering during dobutamine stress may affect measurements. METHODS To examine the hypothesis that regional ischemic myocardium can be sensitively detected during dobutamine stress using myocardial strain rate, a new indicator of regional myocardial contraction that is independent of cardiac translation and tethering, we studied seven closed-chest pig confirmed chronic ischemic models produced by placing an ameroid constrictor on the left circumflex artery. Left ventricular short-axis tissue Doppler imaging was obtained at baseline and during dobutamine stress (10 and 30 microg/kg/min). Peak systolic myocardial velocity and peak systolic myocardial strain rate in anterior and posterior segments were derived offline at each stage. RESULTS In peak systolic myocardial velocity and peak systolic myocardial strain rate, repeated-measures analysis of variance showed significant interaction between nonischemic and ischemic segments during dobutamine stress. Statistical significance between nonischemic and ischemic segments was reached at baseline, 10 microg/kg/min dobutamine, and 30 microg/kg/min dobutamine in peak systolic myocardial strain rate, and at 30 microg/kg/min dobutamine in peak systolic myocardial velocity. By receiver operating characteristic (ROC) analysis for predicting ischemic segments at 30 microg/kg/min dobutamine, a cutoff value of peak systolic myocardial strain rate was 4.84, with a sensitivity of 100% and a specificity of 100%. Peak systolic myocardial velocity was the less discriminating parameter (cutoff, 6.46; sensitivity, 86%; specificity, 86%). CONCLUSIONS Myocardial strain rate imaging might represent an accurate parameter for clinical recognition of regional ischemic myocardium during dobutamine stress echocardiography.
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Affiliation(s)
- Yoko Miyasaka
- Cardiovascular Division, Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan
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Dagdelen S, Yuce M, Emiroglu Y, Ergelen M, Pala S, Tanalp AC, Izgi A, Kirma C. Correlation between the tissue Doppler, strain rate, strain imaging during the dobutamine infusion and coronary fractional flow reserve during catheterization: a comparative study. Int J Cardiol 2005; 102:127-36. [PMID: 15939109 DOI: 10.1016/j.ijcard.2004.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Revised: 05/11/2004] [Accepted: 05/18/2004] [Indexed: 11/24/2022]
Abstract
UNLABELLED Coronary fractional flow reserve (FFR) as an invasive, and dobutamine stress echocardiography (DSE) as a noninvasive technique were used to detect critical coronary stenosis. This study was undertaken to assess correlation between these two techniques by using tissue Doppler, strain rate (SR), and strain imaging (S). METHODS In 17 patients (aged 54.9+/-12.6, 4 F), a total of 22 vessels were studied. On dobutamine stress echocardiography, baseline and peak systolic (Sm), early (Em) and late (Am) diastolic myocardial velocities, SR and S were recorded from parasternal view (mid-posterior segment) for radial and apical view (mid-septum) for longitudinal deformation. Then coronary FFR was performed by using intracoronary adenosine infusion, and the value of < or = 0.75 was accepted as critical coronary stenosis. RESULTS FFR was found to be significant in 10 vessels (FFR critical). Baseline Sm, Em/Am, SR, S values, and peak Em/Am, SR, S values were similar between critical or noncritical FFR groups. Baseline Sm and Em, and change between baseline and peak Sm and S were significantly higher in noncritical FFR group (p < 0.01, < 0.05, < 0.001, < 0.001, respectively). In all vessels, FFR after adenosine infusion showed a poor correlation with WMSI, Em, Am, Em/Am values, and the change in SR values (r = -0.22, 0.16, -0.14, 0.21, 18, respectively) showed a good correlation with the change in S (r = 0.51; p = 0.014), and a very good correlation with the change in Sm values (r = 0.77; p < 0.001) during DSE. When FFR values at left coronary system were analyzed for longitudinal SR and S values, it had a mild correlation with SR (r = 0.47, p = 0.044) and a good correlation with S (r = 0.66, p = 0.002). CONCLUSION The quantification of regional myocardial deformation by using DSE rather than the motion would be more appropriate in detecting the ischemic dysfunctional segment supplied by the critical coronary stenosis. Strain measurement during the dobutamine infusion may provide an information on the FFR results of the culprit vessel.
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Affiliation(s)
- Sinan Dagdelen
- Acibadem Hastanesi, Tekin sk. No. 18, Acibadem, Kadikoy, Istanbul, Turkey.
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Vitarelli A, Conde Y, Cimino E, D'Angeli I, D'Orazio S, Ventriglia F, Bosco G, Colloridi V. Quantitative assessment of systolic and diastolic ventricular function with tissue Doppler imaging after Fontan type of operation. Int J Cardiol 2005; 102:61-9. [PMID: 15939100 DOI: 10.1016/j.ijcard.2004.04.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Revised: 03/30/2004] [Accepted: 04/02/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is evidence that "inappropriate hypertrophy" of the single left ventricle, which occurs as a result of acute preload reduction, leads to adverse consequences on ventricular function. However, a systematic study of the capability of tissue Doppler imaging (TDI) to assess systolic and diastolic ventricular functions after the Fontan procedure is still missing. METHODS Twenty-four postoperative patients aged 12-33 years were prospectively evaluated with two-dimensional echocardiography equipped with TDI capabilities. Nineteen age-matched normal subjects were selected as controls. Good-quality echoes for the measurement of ejection fractions were available in 21 patients. Ten patients (group 1) had systolic dysfunction (ejection fraction < 50%), and 11 patients (group 2) had normal systolic function. Peak systolic and diastolic wall velocities were acquired from the two-chamber view in the myocardia and mitral annulus. RESULTS Compared with controls, the Fontan patients had a significantly reduced peak systolic velocity at wall and annulus sites. A linear correlation existed between ejection fraction and systolic myocardial velocity from the annular sites. Group 1 patients had lower wall velocities and lower annulus velocities both in systole and diastole. Group 2 patients had preserved systolic velocities but decreased regional and annular early diastolic velocities, suggesting impaired filling. Multiple correlation analysis showed a relation between peak early diastolic mitral velocity and ventricular ejection fraction, mean mitral annular motion at systole, mass/volume ratio, and the number of years post Fontan revision. CONCLUSIONS Myocardial velocities recorded after the Fontan operation give insight into systolic and diastolic ventricular functions. The peak systolic mitral annular velocity correlated well with the ventricular ejection fraction. The peak early diastolic velocity and the ratio between the early and late diastolic mitral annular velocity are reduced and reflect diastolic dysfunction even in the presence of normal systolic ejection fraction.
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Affiliation(s)
- Antonio Vitarelli
- Adult and Pediatric Cardiology, La Sapienza University, Rome, Italy.
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Kozakova M, Fraser AG, Buralli S, Magagna A, Salvetti A, Ferrannini E, Palombo C. Reduced left ventricular functional reserve in hypertensive patients with preserved function at rest. Hypertension 2005; 45:619-24. [PMID: 15723960 DOI: 10.1161/01.hyp.0000158838.34131.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many hypertensive patients, left ventricular pump function is normal at rest but abnormal during exercise. Myocardial dysfunction or altered left ventricular loading may be responsible for this finding. To verify the hypothesis of impaired myocardial functional reserve in the hypertensive heart, we assessed the response of stress-adjusted midwall shortening to graded, low-dose dobutamine infusion in hypertensive subjects with normal midwall shortening at rest. Sixty-five subjects (45 never treated hypertensive subjects and 20 normotensive volunteers comparable for age) received dobutamine at 1, 2, 3, 4, and 5 microg x kg(-1) x min(-1) for 5-minute steps; within this range of infusion rates, heart rate and systemic blood pressure were stable. Two-dimensional, M-mode, and Doppler echocardiography were performed at baseline and at the end of each step. In normotensive controls, midwall shortening increased from baseline during 2 microg x kg(-1) x min(-1) dobutamine by an average of 16+/-4.5% (P<0.01); a value of 2 standard deviations below this mean response was taken as the lower limit of normal. In the hypertensive subjects, 24 had a normal midwall shortening response to dobutamine at this dose (group I) and 21 had a subnormal response (group II). Whereas blood pressure and left ventricular mass were similar in group II and group I, the former had greater relative wall thickness (P<0.01) than the latter. beta-adrenergic stimulation by very-low-dose dobutamine unmasks subtle impairment of myocardial functional reserve in hypertensive subjects with normal myocardial performance at rest. This alteration seems to be related mainly to increase in left ventricular relative wall thickness.
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Affiliation(s)
- Michaela Kozakova
- Department of Internal Medicine, University of Pisa School of Medicine, Italy
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Bountioukos M, Schinkel AFL, Bax JJ, Biagini E, Rizzello V, Krenning BJ, Vourvouri EC, Roelandt JRTC, Poldermans D. Pulsed-wave tissue Doppler quantification of systolic and diastolic function of viable and nonviable myocardium in patients with ischemic cardiomyopathy. Am Heart J 2004; 148:1079-84. [PMID: 15632896 DOI: 10.1016/j.ahj.2004.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Detection of myocardial viability is crucial for clinical treatment of patients with ischemic cardiomyopathy. Currently, quantitative information for the evaluation of systolic and diastolic function of viable tissue is limited. Our aim was to compare quantitatively systolic and diastolic function in viable and nonviable dysfunctional myocardium in patients with ischemic cardiomyopathy. METHODS A total of 93 patients (mean age, 62 +/- 10 years) underwent dobutamine stress echocardiography to assess myocardial viability. Pulsed-wave tissue Doppler imaging (TDI) was used to assess systolic ejection velocity (V(S)) and early (V(E)) and late (V(A)) diastolic velocities at rest and at low-dose dobutamine infusion (10 microg/kg per minute) in viable and nonviable dysfunctional regions. Analysis was repeated after dividing study population in patients >or=65 years old (n = 40) and <65 years old (n = 53). RESULTS Pulsed-wave TDI demonstrated that V(S) was comparable in dysfunctional viable and nonviable regions at rest (V(S), 6.3 +/- 1.9 cm/s vs 6.3 +/- 2.0 cm/s, respectively, P = .93). However, at low-dose dobutamine challenge, V(S) was significantly higher in viable regions (8.5 +/- 2.7 cm/s vs 7.8 +/- 2.4 cm/s, P = .002). Viable regions had higher V(E) at rest compared with nonviable regions (8.4 +/- 2.5 cm/s vs 7.5 +/- 2.8 cm/s, P = .003). Myocardial velocities were significantly higher in patients >or=65 years old, both in viable and nonviable regions. CONCLUSIONS Quantification of myocardial motion by pulsed-wave TDI demonstrates that at low-dose dobutamine stress, systolic velocity is markedly improved in viable myocardium, indicating the presence of contractile reserve in viable regions. A superior early diastolic filling at rest can also differentiate viable from nonviable myocardium.
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Affiliation(s)
- Manolis Bountioukos
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Veyrat C, Larrazet F, Cohen L, Laborde F, Pellerin D. A new Doppler tissue ratio to revisit systole: The pre-ejectional isovolumic to ejectional velocity ratio–application to aging. J Am Soc Echocardiogr 2004; 17:1251-8. [PMID: 15562263 DOI: 10.1016/j.echo.2004.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most diagnostic applications of Doppler tissue echocardiography rely on peak (Pk) velocity (V) values of single variables or myocardial V gradient. Whereas age-related changes in diastolic V are well-known, previous Doppler tissue echocardiography studies of systolic function showed no age effect for pre-ejectional (Ej) isovolumic (PEI) and Ej inward wall motion Pk V. In addition to myocardial V gradient, ratios were calculated between PEI and Ej Pk V, and mean V averaged over systole (PEI/Ej V ratios) at each layer of the posterior wall using M-mode color on two control groups: A (27 +/- 5 years) and B (54 +/- 10 years). The only changes were for PEI/Ej V ratios (mean V endocardial 21 +/- 7% vs 34 +/- 20%, P = .01; mean V epicardial 27 +/- 8% vs 40 +/- 18%, P = .006; Pk epicardial V 21 +/- 10% vs 30 +/- 16%, P = .04 for groups A and B, respectively). Correlation versus age were r = 0.52 and P = .005 (mean V endocardial), r = 0.50 and P = .007 (mean V epicardial), and r = 0.32 and P = .03 (Pk epicardial V). PEI/Ej V ratios and mean V studied in separate layers showed that the new systolic approach had advantages over single variable or Pk V to study age-related changes.
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Affiliation(s)
- Colette Veyrat
- Department of Cardiology, L'Institut Mutualiste de Montsouris, Paris, France.
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