Use of speckle tracking echocardiography in evaluating cardiac dysfunction in patients with acromegaly: an update

In recent years, cardiovascular disease has garnered increasing attention as the second leading cause of death in individuals with acromegaly, following malignancy. Identifying cardiac dysfunction early in acromegaly patients for timely intervention has become a focal point of clinical research. Speckle tracking echocardiography, a well-established ultrasound technique, surpasses conventional Doppler ultrasound in its sensitivity to assess both local and global cardiac mechanics. It can accurately detect subclinical and clinical myocardial dysfunction, including myocardial ischemia, ventricular hypertrophy, and valvular changes. Over the past five years, the use of speckle tracking echocardiography in acromegaly patients has emerged as a novel approach. Throughout the cardiac cycle, speckle tracking echocardiography offers a sensitive evaluation of the global and regional myocardial condition by quantifying the motion of myocardial fibres in distinct segments. It achieves this independently of variations in ultrasound angle and distance, effectively simulating the deformation of individual ventricles across different spatial planes. This approach provides a more accurate description of changes in cardiac strain parameters. Importantly, even in the subclinical stage when ejection fraction remains normal, the strain parameters assessed by speckle tracking echocardiography hold a good predictive value for the risk of cardiovascular death and hospitalization in acromegaly patients with concomitant cardiovascular disease. This information aids in determining the optimal timing for interventional therapy, offering important insights for cardiac risk stratification and prognosis. In the present study, we comprehensively reviewed the research progress of speckle tracking echocardiography in evaluating of cardiac dysfunction in acromegaly patients, to pave the way for early diagnosis of acromegaly cardiomyopathy.

Intraoperative Augmented Rotation and Circumferential Strain Compensate for Reduction of Left Ventricular Longitudinal Function After On-Pump CABG Surgery

OBJECTIVES

Left ventricular (LV) longitudinal function is reduced after on-pump coronary artery bypass grafting (CABG), while global LV function often is preserved. There are only limited data on the underlying compensatory mechanism. Therefore, the authors aimed to describe intraoperative changes of LV contractile pattern by myocardial strain analysis.

DESIGN

A prospective observational study.

SETTING

At a single university hospital.

PARTICIPANTS

A total of 30 patients scheduled for isolated on-pump CABG with an uneventful intraoperative course and preoperative preserved LV and RV function, sinus rhythm, without more-than-mild heart valve disease, or elevated pulmonary pressure.

INTERVENTIONS

Transesophageal echocardiography was performed after induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). Echocardiographic evaluation was performed under stable hemodynamics, in sinus rhythm or atrial pacing, and vasopressor support with norepinephrine ≤0.1 µg/kg/min.

MEASUREMENTS AND MAIN RESULTS

EchoPAC v204 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of 2-dimensional (2D) and 3-dimensional (3D) LV ejection fraction (EF), LV global longitudinal strain (GLS), LV global circumferential strain (GCS), LV global radial strain (GRS), LV apical rotation (aRot), LV basal rotation (bRot), and LV twist. Strain analysis was feasible in all included patients after termination of cardiopulmonary bypass (T2). Although there were no significant differences in the values of conventional echocardiographic parameters during the intraoperative interval, GLS deteriorated significantly after CABG compared to pre-bypass assessment (T1 v T2, -13.4% ± 2.9 v -11.8% ± 2.9; p = 0.007). GCS improved significantly after surgery (T1 v T2, -19.4% (IQR -17.1% to -21.2%) v -22.8% (IQR -21.1% to -24.7%); p < 0.001) as well as aRot (T1 v T2, -9.7° (IQR -7.1° to -14.1°) v -14.5° (IQR -12.1° to -17.1°); p < 0.001), bRot (T1 v T2, 5.1° (IQR 3.8°-6.7°) v 7.2° (IQR 5.6°-8.2°); p = 0.02), and twist (T1 v T2, 15.8° (IQR 11.7°-19.4°) v 21.6° (IQR 19.2°-25.1°); p < 0.001), while GRS remained unchanged. There were no significant changes in the values of GLS, GCS, GRS, aRot, bRot, or twist, as well as in the values of 2D and 3D LV EF before and after sternal closure (T2 v T3).

CONCLUSION

Beyond evaluation of longitudinal LV strain, measurements of circumferential and radial strain, as well as LV rotation and twist mechanics, were feasible in the intraoperative course of this study. Reduction of longitudinal function after on-pump CABG was compensated intraoperatively by improvement of GCS and rotation in the authors' group of patients. Perioperative assessment of GCS, GRS, as well as rotation and twist, might provide deeper insight into perioperative changes of cardiac mechanics.

Dependence of Left Ventricular Rotational Mechanics on Left Atrial Volumes in Non-Smoker Healthy Adults: Analysis Based on the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study

Introduction: As has been established, the left ventricle (LV) and the left atrium (LA) form an organic unit of the left heart; however, little is known about the dependence of LV rotational parameters on LA volumes, even in healthy circumstances. Therefore, the present study aimed to assess the associations between basal and apical LV rotations and LA volumes and volume-based functional properties throughout the cardiac cycle in healthy adults by three-dimensional speckle-tracking echocardiography. Methods: The present study comprised 167 healthy adults (age: 33.4 ± 12.6 years, 77 males) with normally directed LV rotational mechanics. All subjects underwent complete two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE)-derived data acquisition. The 3DSTE-derived LA volumes and LV rotational parameters were determined at a later date. Results: An increasing end-systolic maximum LA volume (Vmax) was associated with increasing pre-atrial-contraction early (VpreA) and minimum end-diastolic (Vmin) LA volumes, and all stroke volumes were increased as well. Systolic basal left ventricular rotation (LVrot) was highest in the case of the highest systolic Vmax and early-diastolic VpreA. Apical LVrot did not show obvious associations with any increasing LA volumes. The highest systolic basal LVrot was associated with significantly increased diastolic VpreA and Vmin. Reduced diastolic LA volumes (VpreA, Vmin) were seen in the case of increased apical LVrot. An increasing basal LVrot was associated with the tendentious lowering of the apical LVrot and the significant elevation of LV twist. Similarly, an increasing apical LVrot was associated with the tendentious lowering of basal LVrot and the significant elevation of LV twist. Conclusions: Strong associations and adaptations between 3DSTE-derived LA volumes throughout the cardiac cycle and LV rotational mechanics were evidenced, even in healthy circumstances.

Correlations between left ventricular rotational mechanics and parasympathetic autonomic function-results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

Left ventricular (LV) twist is calculated from the net difference of counterclockwise apical and clockwise basal rotation during systole. The current study was designed to evaluate correlations between autonomic function and LV rotational mechanics in healthy subjects. The present study comprised 18 healthy subjects (mean age: 36±12 years, 12 men). Three-dimensional speckle tracking echocardiography (3DSTE) could be used for non-invasive evaluation of LV rotation and twist. Autonomic function was assessed by means of 5 standard cardiovascular reflex tests. During 3DSTE, basal LV rotation proved to be -3.24±2.02 degree, while apical LV rotation was 9.08±3.04 degree, therefore LV twist was 11.70±6.80 degree. Valsalva test showed significant correlations with LV basal (r=0.529, P=0.019) and apical rotations (r=-0.534, P=0.022), and LV twist (r=-0.467, P=0.044). Heart rate response to deep breathing significantly correlated with LV twist, as well (r=-0.452, P=0.052). The other tests had no any relationship with rotational characteristics. Correlations exist between parasympathetic autonomic function and 3DSTE-derived LV rotation and twist in healthy subjects.

Dissecting myocardial mechanics in patients with severe aortic stenosis: 2-dimensional vs 3-dimensional-speckle tracking echocardiography

Background

Aortic stenosis (AS) causes left ventricular (LV) pressure overload, leading to adverse LV remodeling and dysfunction. Identifying early subclinical markers of LV dysfunction in patients with significant AS is critical as this could provide support for earlier intervention, which may result in improved long-term outcomes. We therefore examined the impact of severe AS and its consequent increase in LV afterload on myocardial deformation and rotational mechanics by 2-dimensional (2D) and 3-dimensional (3D) speckle-tracking echocardiography.

Methods

We prospectively measured various strain parameters in 168 patients (42% female, mean age 72 ± 12 years) with severe AS and LV ejection fraction (EF) ≥50%, and compared them to normal values found in literature. 2D and 3D images were analyzed for global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), basal rotation, apical rotation, and peak systolic twist. We further assessed the degree of concordance between 2D and 3D strain, and examined their association with measures of LV preload and afterload.

Results

Patients with severe AS exhibited significantly lower GLS and GRS but higher GCS, apical rotation, and twist by 2D and 3D echocardiography compared with published normal values (P = 0.003 for 3D twist, P < 0.001 for all others). Agreement between 2D- and 3D-GLS by concordance correlation coefficient was 0.49 (95% confidence interval: 0.39–0.57). GLS was correlated with valvulo-arterial impedance, a measure of LV afterload (r = 0.34, p < 0.001 and r = 0.23, p = 0.003, respectively).

Conclusion

Patients with severe AS demonstrated lower-than-normal GLS and GRS but appear to compensate with higher-than-normal GCS, apical rotation, and twist in order to maintain a preserved LVEF. GLS showed a modest correlation with valvulo-arterial impedance.

Effect of myofibre architecture on ventricular pump function by using a neonatal porcine heart model: from DT-MRI to rule-based methods

Myofibre architecture is one of the essential components when constructing personalized cardiac models. In this study, we develop a neonatal porcine bi-ventricle model with three different myofibre architectures for the left ventricle (LV). The most realistic one is derived from ex vivo diffusion tensor magnetic resonance imaging, and other two simplifications are based on rule-based methods (RBM): one is regionally dependent by dividing the LV into 17 segments, each with different myofibre angles, and the other is more simplified by assigning a set of myofibre angles across the whole ventricle. Results from different myofibre architectures are compared in terms of cardiac pump function. We show that the model with the most realistic myofibre architecture can produce larger cardiac output, higher ejection fraction and larger apical twist compared with those of the rule-based models under the same pre/after-loads. Our results also reveal that when the cross-fibre contraction is included, the active stress seems to play a dual role: its sheet-normal component enhances the ventricular contraction while its sheet component does the opposite. We further show that by including non-symmetric fibre dispersion using a general structural tensor, even the most simplified rule-based myofibre model can achieve similar pump function as the most realistic one, and cross-fibre contraction components can be determined from this non-symmetric dispersion approach. Thus, our study highlights the importance of including myofibre dispersion in cardiac modelling if RBM are used, especially in personalized models.

Normal values of left ventricular rotational parameters in healthy adults-Insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study

INTRODUCTION

Left ventricular (LV) rotation and twist are essential parts of LV function. Three-dimensional speckle tracking echocardiography (3DSTE) is a relatively new method and is useful for the quantification of LV wall deformation and rotational parameters. The aim of the present study was to examine LV rotation and twist differences between different age-groups and genders in a healthy population.

METHODS

The present study is comprised of 297 healthy adults; 120 adults have been excluded due to inferior image quality. The population was further divided into 4 subgroups based on age decades.

RESULTS

Only the LV twist of all patients (13.5 ± 3.7 degree vs 15.6 ± 4.9 degree, P = 0.02) and the LV twist of females (13.0 ± 3.6 degree vs 15.5 ± 5.6 degree, P = 0.03) differed significantly between the age-group of 18-29 years and 50+ years. LV basal and apical rotation were not significantly different between the age-groups; however, they tendentiously increased with aging. No significant differences could be demonstrated regarding LV rotational and twist parameters between genders in any group. A phenomenon called LV rigid body rotation (LV-RBR)-where the base and apex of the LV rotate in the same direction-was present in 10 cases.

CONCLUSIONS

Three-dimensional speckle tracking echocardiography seems to be a reasonably viable tool for the quantification of LV rotation and twist. Both LV basal and apical rotation and LV twist increase with aging, regardless of gender. LV-RBR is also present in the normal population.

Dataset on the use of 3D speckle tracking echocardiography in light-chain amyloidosis

The dataset presented in this article is related to the research article entitled "Biventricular assessment of light-chain amyloidosis using 3D speckle tracking echocardiography: Differentiation from other forms of myocardial hypertrophy" (Vitarelli et al., 2018) [1], which examined the potential utility of left ventricular (LV) and right ventricular (RV) deformation and rotational parameters derived from three-dimensional speckle-tracking echocardiography (3DSTE) to diagnose cardiac amyloidosis(CA) and differentiate this disease from other forms of myocardial hypertrophy. The combined assessment of LV basal longitudinal strain, LV basal rotation and RV basal longitudinal strain had a high discriminative power for detecting CA. The data of this study provides more understanding on the value of LV 3DSTE deformation parameters as well as RV parameters in this particular cardiomyopathy.

Left ventricular twist is impaired in acromegaly: Insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study

INTRODUCTION

Acromegaly is a rare, chronic, disfiguring, and debilitating disease caused, in 90% of cases, by a benign monoclonal growth hormone-secreting pituitary adenoma. The present study aimed to assess left ventricular (LV) rotational and twist mechanics in acromegalic patients and to compare their results to age- and gender-matched healthy controls.

METHODS

The present study comprised 24 acromegalic patients, from which 4 were excluded due to insufficient image quality (mean age: 57.8 ± 13.7 years, 7 men). The control group consisted of 18 age- and gender-matched healthy individuals (mean age: 54.8 ± 6.9 years, 8 men).

RESULTS

In 4 out of 20 acromegalic patients, LV showed near absence of twist, as the so-called LV "rigid body rotation" (RBR). Between all acromegalic patients without LV-RBR and controls, both LV basal (-3.76 ± 1.73 vs. -6.17 ± 2.66°, P = .004) and apical rotation (6.12 ± 4.03 vs. 10.81 ± 3.65°, P = .001) and LV twist (9.88 ± 4.74 vs. 16.98 ± 3.88°, P < .001) differed significantly. Between active and nonactive acromegaly subgroups, only the time-to-peak LV twist (377 ± 78 vs. 229 ± 97 ms, P = .005) showed significant difference.

CONCLUSIONS

Acromegaly is associated with impaired LV rotation and twist as assessed by 3-dimensional speckle tracking echocardiography. LV-RBR is a frequent phenomenon in acromegaly.

Efficient Two-Pass 3-D Speckle Tracking for Ultrasound Imaging

Speckle tracking based on block matching is the most common method for multi-dimensional motion estimation in ultrasound elasticity imaging. Extension of two-dimensional (2-D) methods to three dimensions (3-D) has been problematic because of the large computational load of 3-D tracking, as well as performance issues related to the low frame (volume) rates of 3-D images. To address both of these problems, we have developed an efficient two-pass tracking method suited to cardiac elasticity imaging. PatchMatch, originally developed for image editing, has been adapted for ultrasound to provide first-pass displacement estimates. Second-pass estimation uses conventional block matching within a much smaller search region. 3-D displacements are then obtained using correlation filtering previously shown to be effective against speckle decorrelation. Both simulated and in vivo canine cardiac results demonstrate that the proposed two-pass method reduces computational cost compared to conventional 3-D exhaustive search by a factor of 10. Moreover, it outperforms one-pass tracking by a factor of about 3 in terms of root-mean-square error relative to available ground-truth displacements.

Three-dimensional speckle tracking echocardiography allows detailed evaluation of left atrial function in hypertrophic cardiomyopathy--insights from the MAGYAR-Path Study

INTRODUCTION

Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. Reduced left atrial (LA) function was demonstrated in HCM by different methods. Three-dimensional (3D) speckle tracking echocardiography (STE) has just been introduced for the evaluation of LA. This study was designed to compare 3DSTE-derived LA volumetric and strain parameters in HCM with healthy controls.

METHODS

The study comprised 23 consecutive HCM patients (mean age: 48.5 ± 15.1 years, 14 men). Their results were compared to 23 age- and gender-matched healthy controls. Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all cases.

RESULTS

Calculated LA maximum (66.4 ± 20.4 mL vs. 36.0 ± 6.1 mL, P < 0.0001) and minimum (39.2 ± 19.1 vs. 16.0 ± 4.6 mL, P < 0.0001) volumes and LA volume before atrial contraction (53.6 ± 19.9 vs. 24.0 ± 6.2 mL, P < 0.0001) were significantly increased in HCM patients. Atrial stroke volumes respecting cardiac cycles proved to be increased, while emptying fractions were decreased in subjects with HCM. Mean global radial (-12.2 ± 6.7% vs. -19.6 ± 11.7, P < 0.05), longitudinal (26.5 ± 16.5% vs. 29.8 ± 12.1%, P < 0.05) and 3D strain (-6.1 ± 4.4% vs. -12.5 ± 10.2%, P < 0.05) proved to be significantly reduced in HCM patients as compared with matched controls.

CONCLUSIONS

Three-dimensional speckle tracking echocardiography allows detailed evaluation of LA (dys) function in HCM by volumetric and strain measurements.

Age-related normal range of left ventricular strain and torsion using three-dimensional speckle-tracking echocardiography

BACKGROUND

Three-dimensional (3D) speckle-tracking echocardiography (STE) is an emerging technology used to quantify left ventricular (LV) function. However, the accuracy and normal values of LV strain and twist using 3D STE have not been established in a large group of normal subjects. The aims of this study were to (1) to evaluate the accuracy of 3D STE analysis of LV strain against a cardiac magnetic resonance (CMR) reference and (2) to establish age-related normal values of LV strain and torsion using real-time 3D echocardiographic (RT3DE) images.

METHODS

In protocol 1, RT3DE data sets and CMR images were acquired on the same day in 19 patients referred for clinically indicated CMR. Global LV longitudinal, circumferential, and radial strain was compared between the two modalities. In protocol 2, global and regional strain and twist and torsion were measured in 313 healthy subjects using 3D STE.

RESULTS

In protocol 1, good correlations for each LV strain component were noted between RT3DE imaging and CMR (r = 0.61-0.86, P < .001). In protocol 2, normal global longitudinal, circumferential, radial, and 3D strain were -20.3 ± 3.2%, -28.9 ± 4.6%, 88.0 ± 21.8%, and -37.6 ± 4.8%, respectively. A significant age dependency was observed for global longitudinal and 3D strain. Aging also affected LV torsion: the lowest values were found in children and adolescents, and values subsequently increased with age, while further aging was associated with a gradual reduction in basal rotation accompanied by an increase in apical rotation.

CONCLUSIONS

This study provides initial validation of 3D strain analysis from RT3DE images and reference values of normal 3D LV strain and torsion. The age-related differences in LV strain and torsion may reflect myocardial maturation and aging.

Comparative evaluation of left ventricular function by two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography in noncompaction cardiomyopathy. Results from the MAGYAR-Path Study

Introduction: Noncompaction cardiomyopathy develops due to the absence of myocardial compaction, and is associated with left ventricular dysfunction. Aim: The aim of the study was to evaluate comparatively left ventricular dysfunction in patients with noncompaction cardiomyopathy using two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography. Method: The present study comprised of 7 patients with noncompaction cardiomyopathy (62.9±8.5 years, 3 males) and 10 age- and gender-matched healthy controls (60.7±7.7 years, 2 males). All patients were examined by two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography for the evaluation of left ventricular function. Results: Increased left ventricular end-diastolic and end-systolic volumes and reduced left ventricular ejection fraction were detected in patients with noncompaction cardiomyopathy as compared to those measured in controls. All three-dimensional speckle-tracking echocardiography-derived strain parameters of patients with noncompaction cardiomyopathy were found to be reduced as compared to the values of controls. Three-dimensional speckle-tracking echocardiography-derived rotational parameters showed movements of the apical and basal segments in the same direction suggesting ’rigid body rotation’ in all noncompaction cardiomyopathy cases. Conclusions: Left ventricular function and contractility are severely reduced in patients with noncompaction cardiomyopathy. Absence of left ventricular twist could be demonstrated in a series of noncompaction cardiomyopathy patients. Orv. Hetil., 2013, 154, 1352–1359.

Correlations between echocardiographic aortic elastic properties and left ventricular rotation and twist--insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

INTRODUCTION

There is an interaction between the left ventricle (LV) and the vascular system, which plays a crucial role in determining cardiac output. LV twist could be evaluated by three-dimensional speckle-tracking echocardiography (3DSTE) as the net difference of counterclockwise apical and clockwise basal LV rotations during systole. Aortic elasticity parameters could be measured during a routine transthoracic echocardiographic examination. The current study was designed to evaluate correlations between echocardiographic aortic elastic properties and LV rotational mechanics in healthy subjects.

METHODS

The present study comprised 26 healthy volunteers (mean age: 34.5 ± 9.8 years, 13 men). The following aortic elastic properties were measured from aortic data and forearm blood pressure values: aortic strain, distensibility and stiffness index (ASI). 3DSTE was used to measure basal and apical LV rotations and LV twist.

RESULTS

During 3DSTE, basal LV rotation proved to be -2.42 ± 1.43 degree, while apical LV rotation was 8.56 ± 1.43 degree, therefore LV twist was 11.01 ± 5.19 degree. Aortic strain (0.131 ± 0.094), distensibility (3.61 ± 2.54 cm² dynes(-1) 10(-6)) and ASI (4.08 ± 0.79) were also calculated. Apical LV rotation correlated with aortic distensibility (r = -0.36, P<0.05) and ASI (r = 0.41, P<0.05). LV twist showed similar correlation with ASI (r = 0.42, P<0.05).

DISCUSSION

Correlations exist between echocardiographic aortic elastic properties and 3DSTE-derived LV rotation and twist in healthy subjects.

Three-dimensional speckle-tracking echocardiography – a further step in the non-invasive three-dimensional cardiac imaging

Three-dimensional speckle-tracking echocardiography is a new cardiac imaging methodology, which allows three-dimensional non-invasive evaluation of the myocardial mechanics. The aim of this review is to present this new tool emphasizing its diagnostic potentials and demonstrating its limitations, as well. Orv. Hetil., 2012, 153, 1570–1577.

The role of 3D wall motion tracking in heart failure

Heart failure is a major health problem in developed countries and a growing one in developing countries. Cardiac remodeling in heart failure affects myocardial mechanics, which requires comprehensive evaluation in three dimensions. The novel technique of 3D wall motion tracking applies speckle tracking technology to full volume, 3D echocardiographic datasets. Quantification of conventional and novel left ventricular (LV) parameters including volumes, ejection fraction, global and regional 3D strain, endocardial area strain, twist, and dyssynchrony, and identification of the site of latest mechanical activation are feasible on the basis of a single acquisition of a full-volume dataset. Clinical applications of 3D wall motion tracking include the assessment of global and regional LV performance in ischemic and nonischemic heart diseases, evaluation of mechanics in cardiomyopathies and congenital heart disease, potential selection of patients for cardiac resynchronization therapy and prediction of their response, and detection of subclinical cardiac dysfunction in diseases with likelihood of progression to heart failure. Technological advances with improvement in spatial and temporal resolution of this novel imaging modality are expected. Although 3D wall motion tracking is still in its infancy, this method has begun to provide new insights into LV mechanics and has already found clinical applications. Future developments in 3D assessment of right ventricular and myocardial layer-specific mechanics are awaited.

Left ventricular rotation and twist of the heart. Let’s reveal some concepts

In case of a healthy heart basal part of the left ventricle rotates clockwise in systole, while the apex rotates counter-clockwise. This sort of squeezing-turning motion is called “twisting” of the heart. The aim of the current review is to summarize knowledge regarding left ventricular rotation and twist as well as methodological aspects of their evaluation. Orv. Hetil., 2012, 153, 1547–1551.

Three-dimensional speckle-tracking echocardiography: methodological aspects and clinical potential

Speckle-tracking echocardiography (STE) is an advanced echocardiographic technique that allows a novel approach to the assessment of cardiac physiology through the study of myocardial mechanics. In its three-dimensional (3D) modality, it overcomes the drawbacks inherent to other echocardiographic techniques, namely two-dimensional echocardiography and tissue Doppler imaging. Several research studies and software improvements have led 3D-STE to become a promising tool for accurate evaluation of global and regional cardiac function. This article addresses the image acquisition, analytical methods, and parameters of myocardial mechanics that could be derived from 3D-STE. This systematic guidance may help to establish its usefulness in the global and regional evaluation of cardiac function, and to facilitate its clinical application.

Identification of left ventricular "rigid body rotation" by three-dimensional speckle-tracking echocardiography in a patient with noncompaction of the left ventricle: a case from the MAGYAR-Path Study

Noncompaction of the left ventricular myocardium (LVNC) is a new clinical entity firstly described by Engberding and Bender in 1984. LVNC is characterized by the presence of numerous prominent trabeculations and deep intertrabecular recesses within the left ventricle. Recently, it has been demonstrated by two-dimensional (2D) speckle-tracking echocardiography (STE), that left ventricular (LV) basal and LV apical rotations are in the same direction resulting in the near absence of LV twist in LVNC patients, which was called as "LV solid/rigid body rotation." Three-dimensional (3D)-STE has just been introduced, and found to be an accurate method for the evaluation of LV rotation mechanics. The aim of this report was to confirm LV "rigid body rotation" in an LVNC patient by 3D-STE.

Left ventricular dyssynchrony using three-dimensional speckle-tracking imaging as a determinant of torsional mechanics in patients with idiopathic dilated cardiomyopathy

The aim of this study was to use 3-dimensional (3D) speckle-tracking echocardiography to test the hypothesis that left ventricular (LV) dyssynchrony may negatively affect LV torsional mechanics in patients with idiopathic dilated cardiomyopathy (IDC) and that LV torsion may improve after cardiac resynchronization therapy. This study included 65 subjects; 20 with IDC with ejection fractions ≤35% and wide QRS complexes (≥120 ms), 20 with IDC with ejection fractions ≤35% and narrow QRS complexes (<120 ms), and 25 controls. LV dyssynchrony index was determined as the SD of time to peak 3D speckle-tracking radial strain and regional heterogeneity of LV rotation (rotational dispersion index) as the SD of 3D speckle-tracking time to peak rotation. All rotational indexes were significantly impaired in patients with IDC, while LV torsion in patients with IDC with wide QRS complexes was significantly smaller than that in patients with IDC with narrow QRS complexes and controls. Conversely, LV dyssynchrony index (127.3 ± 24.0 ms [p <0.01 vs controls and vs patients with narrow QRS complexes] vs 88.8 ± 22.5 ms [p <0.01 versus controls] vs 30.9 ± 10.0 ms) and rotational dispersion index (115.1 ± 27.5 ms [p <0.01 vs controls and vs patients with narrow QRS complexes] vs 96.0 ± 23.4 ms [p <0.01 versus controls] vs 45.0 ± 13.7 ms) were significantly higher in patients with IDC with wide QRS complexes. Multivariate analysis showed that the LV ejection fraction (β = 0.688, p <0.001) and rotational dispersion index (β = -0.249, p <0.01) were independent determinants of LV torsion. Moreover, LV torsion in patients with IDC with wide QRS complexes improved after cardiac resynchronization therapy (p <0.05), along with reductions in LV dyssynchrony and rotational dispersion indexes. In conclusion, these findings obtained with a novel 3D speckle-tracking system feature a novel aspect of LV torsional mechanics and demonstrate its association with LV dyssynchrony.

Preliminary clinical study of left ventricular myocardial strain in patients with non-ischemic dilated cardiomyopathy by three-dimensional speckle tracking imaging

Background

Non-ischemic dilated cardiomyopathy (DCM) is the most common cardiomyopathy worldwide, with significant mortality. Correct evaluation of the patient's myocardial function has important clinical significance in the diagnosis, therapeutic effect assessment and prognosis in non-ischemic DCM patients. This study evaluated the feasibility of three-dimensional speckle tracking imaging (3D-STE) for assessment of the left ventricular myocardial strain in patients with non-ischemic dilated cardiomyopathy (DCM).

Methods

Apical full-volume images were acquired from 65 patients with non-ischemic DCM (DCM group) and 59 age-matched normal controls (NC group), respectively. The following parameters were measured by 3D-STE: the peak systolic radial strain (RS), circumferential strain (CS), longitudinal strain (LS) of each segment. Then all the parameters were compared between the two groups.

Results

The peak systolic strain in different planes had certain regularities in normal groups, radial strain (RS) was the largest in the mid region, the smallest in the apical region, while circumferential strain (CS) and longitudinal strain (LS) increased from the basal to the apical region. In contrast, the regularity could not be applied to the DCM group. RS, CS, LS were significantly decreased in DCM group as compared with NC group (P < 0.001 for all). The interobserver, intraobserver and test-retest reliability were acceptable.

Conclusions

3D-STE is a reliable tool for evaluation of left ventricular myocardial strain in patients with non-ischemic DCM, with huge advantage in clinical application.

Review of novel clinical applications of advanced, real-time, 3-dimensional echocardiography

Advances in computer processing speed and memory along with the advent of the microbeam former that can sample an entire crystal of the ultrasound transducer made possible the performance of 3-dimensional echocardiography in real time (RT3DE). The miniaturization of a 3-dimensional transducer permitting its extension to transesophageal mode rapidly expanded its use in a variety of conditions. Recent development of user-friendly automated/semiautomated cropping and display software may make it rather simple, even for the novice to gather useful information from RT3DE. We discuss the background, technique, and cutting-edge research and novel clinical applications of advanced RT3DE, including left ventricular dyssynchrony assessment, 3-D speckle tracking, myocardial contrast echocardiography, complete 4-dimensional (4-D) shape and motion analysis of the left ventricle, 4-D volumetric analysis of the right ventricle, 3-D volume rendering of the mitral valve, and other percutaneous and surgical procedural applications.

Echocardiographic assessment of myocardial strain

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.

Three-dimensional echocardiography for left ventricular quantification: fundamental validation and clinical applications

One of the earliest applications of clinical echocardiography is evaluation of left ventricular (LV) function and size. Accurate, reproducible and quantitative evaluation of LV function and size is vital for diagnosis, treatment and prediction of prognosis of heart disease. Early three-dimensional (3D) echocardiographic techniques showed better reproducibility than two-dimensional (2D) echocardiography and narrower limits of agreement for assessment of LV function and size in comparison to reference methods, mostly cardiac magnetic resonance (CMR) imaging, but acquisition methods were cumbersome and a lack of user-friendly analysis software initially precluded widespread use. Through the advent of matrix transducers enabling real-time three-dimensional echocardiography (3DE) and improvements in analysis software featuring semi-automated volumetric analysis, 3D echocardiography evolved into a simple and fast imaging modality for everyday clinical use. 3DE provides the possibility to evaluate the entire LV in three spatial dimensions during the complete cardiac cycle, offering a more accurate and complete quantitative evaluation the LV. Improved efficiency in acquisition and analysis may provide clinicians with important diagnostic information within minutes. The current article reviews the methodology and application of 3DE for quantitative evaluation of the LV, provides the scientific evidence for its current clinical use, and discusses its current limitations and potential future directions.