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Left Ventricular "Longitudinal Rotation" and Conduction Abnormalities-A New Outlook on Dyssynchrony. J Clin Med 2023; 12:jcm12030745. [PMID: 36769391 PMCID: PMC9917432 DOI: 10.3390/jcm12030745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The complete left bundle branch block (CLBBB) results in ventricular dyssynchrony and a reduction in systolic and diastolic efficiency. We noticed a distinct clockwise rotation of the left ventricle (LV) in patients with CLBBB ("longitudinal rotation"). AIM The aim of this study was to quantify the "longitudinal rotation" of the LV in patients with CLBBB in comparison to patients with normal conduction or complete right bundle branch block (CRBBB). METHODS Sixty consecutive patients with normal QRS, CRBBB, or CLBBB were included. Stored raw data DICOM 2D apical-4 chambers view images cine clips were analyzed using EchoPac plugin version 203 (GE Vingmed Ultrasound AS, Horten, Norway). In EchoPac-Q-Analysis, 2D strain application was selected. Instead of apical view algorithms, the SAX-MV (short axis-mitral valve level) algorithm was selected for analysis. A closed loop endocardial contour was drawn to initiate the analysis. The "posterior" segment (representing the mitral valve) was excluded before finalizing the analysis. Longitudinal rotation direction, peak angle, and time-to-peak rotation were recorded. RESULTS All patients with CLBBB (n = 21) had clockwise longitudinal rotation with mean four chamber peak rotation angle of -3.9 ± 2.4°. This rotation is significantly larger than in patients with normal QRS (-1.4 ± 3°, p = 0.005) and CRBBB (0.1 ± 2.2°, p = 0.00001). Clockwise rotation was found to be correlated to QRS duration in patients with the non-RBBB pattern. The angle of rotation was not associated with a lower ejection fraction or the presence of regional wall abnormalities. CONCLUSIONS Significant clockwise longitudinal rotation was found in CLBBB patients compared to normal QRS or CRBBB patients using speckle-tracking echocardiography.
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Peak systolic longitudinal rotation: a new tool for detecting left ventricular systolic function in patients with type 2 diabetes mellitus by two-dimensional speckle tracking echocardiography. BMC Cardiovasc Disord 2019; 19:137. [PMID: 31174469 PMCID: PMC6556012 DOI: 10.1186/s12872-019-1119-y] [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: 09/05/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is one of the most prevalent cardiac and cerebrovascular risk factors. The study aimed to find a new way to investigate left ventricle (LV) systolic dysfunction in T2DM patients using two-dimensional speckle tracking echocardiography (2D-STE). METHODS Fifty-one untreated T2DM patients and 52 normal control subjects were enrolled for the research. Apical four-chamber view was acquired by two-dimensional echocardiography. Segmental and global peak systolic longitudinal rotation (PSLR) degrees were measured by the software of EchoPAC. RESULTS In T2DM patients, global PSLR prominently rotated clockwise, while in normal subjects, global PSLR degrees were so small and almost had no PSLR. HBA1c negatively correlated with apex and global PSLR, that is, T2DM patients with higher HBA1c had a larger clockwise apex and global PSLR. ROC analysis showed that PSLR could detect the accuracy of LV systolic dysfunction. CONCLUSION Cardiac clockwise global PSLR was found in T2DM patients. The cardiac contractile function in T2DM patients was impaired. The new tool of PSLR can conveniently detect cardiac systolic dysfunction in T2DM patients. HBA1c could predict systolic dysfunction in T2DM patients.
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3
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Hui W, Slorach C, Friedberg MK. Apical Transverse Motion Is Associated with Interventricular Mechanical Delay and Decreased Left Ventricular Function in Children with Dilated Cardiomyopathy. J Am Soc Echocardiogr 2018; 31:943-950. [DOI: 10.1016/j.echo.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Indexed: 11/16/2022]
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4
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Collier P, Xu B, Kusunose K, Phelan D, Grant A, Thavendiranathan P, Griffin BP, Grimm RA, Marwick TH, Popović ZB. Impact of abnormal longitudinal rotation on the assessment of right ventricular systolic function in patients with severe pulmonary hypertension. J Thorac Dis 2018; 10:4694-4704. [PMID: 30233841 DOI: 10.21037/jtd.2018.07.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Assessment of right ventricular (RV) function plays an important role in patients with cardiopulmonary disease, and current guidelines recommend parameters including tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic excursion velocity (RVS') to assess RV longitudinal function. We assessed the hypothesis that the previously undescribed motion of RV longitudinal rotation (RVLR) is an independent predictor of both TAPSE and RVS'. Methods We assessed a series of 100 consecutive patients with pulmonary hypertension (PH) undergoing echocardiography. Patients with left ventricular (LV) dilation and dysfunction were excluded. Standard RV parameters were determined using established guidelines, while RVLR and right ventricular global longitudinal strain (RVGLS) measurements were performed using 2-dimensional (2D) speckle tracking technique. Results Mean peak RVLR measured -4.2±3.7 degrees. By convention, negative values implied clockwise motion. In a multiple linear regression model, TAPSE could be predicted from a combination of RVLR and RVGLS (R=0.56, P<0.001). A similar relationship was found for RVS' which could also be predicted from a combination of RVLR and RVGLS (R=0.52, P<0.001). While no association was found between RVLR and RV size, estimated RV systolic pressure (RVSP) or the presence of a pericardial effusion, a mild correlation was noted between RVLR and QRS duration (R=0.25, P=0.01). Conclusions RVLR is an independent predictor of TAPSE and RVS'. Awareness of this motion should be considered in the interpretation of TAPSE and RVS' values as markers of RV systolic function, as abnormal RVLR may account for exaggerated values, particularly in patients with PH and RV dysfunction.
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Affiliation(s)
- Patrick Collier
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Grant
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Paaladinesh Thavendiranathan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Richard A Grimm
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas H Marwick
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.,The Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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5
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What Is the Heart? Anatomy, Function, Pathophysiology, and Misconceptions. J Cardiovasc Dev Dis 2018; 5:jcdd5020033. [PMID: 29867011 PMCID: PMC6023278 DOI: 10.3390/jcdd5020033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 01/08/2023] Open
Abstract
Cardiac dynamics are traditionally linked to a left ventricle, right ventricle, and septum morphology, a topography that differs from the heart's five-century-old anatomic description of containing a helix and circumferential wrap architectural configuration. Torrent Guasp's helical ventricular myocardial band (HVMB) defines this anatomy and its structure, and explains why the heart's six dynamic actions of narrowing, shortening, lengthening, widening, twisting, and uncoiling happen. The described structural findings will raise questions about deductions guiding "accepted cardiac mechanics", and their functional aspects will challenge and overturn them. These suppositions include the LV, RV, and septum description, timing of mitral valve opening, isovolumic relaxation period, reasons for torsion/twisting, untwisting, reasons for longitudinal and circumferential strain, echocardiographic sub segmentation, resynchronization, RV function dynamics, diastolic dysfunction's cause, and unrecognized septum impairment. Torrent Guasp's revolutionary contributions may alter future understanding of the diagnosis and treatment of cardiac disease.
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Huang J, Yan ZN, Fan L, Rui YF, Song XT. Left ventricular longitudinal function assessment in rabbits after acute occlusion of left anterior descending coronary artery by two-dimensional speckle tracking imaging. BMC Cardiovasc Disord 2017; 17:219. [PMID: 28789617 PMCID: PMC5549320 DOI: 10.1186/s12872-017-0655-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/02/2017] [Indexed: 01/24/2023] Open
Abstract
Background To evaluate the left ventricular (LV) longitudinal function changes in rabbits after acute occlusion of the left anterior descending artery (LAD) by two-dimensional speckle tracking imaging (2D–STI). Methods Forty-eight New Zealand white rabbits underwent echocardiography examination. EchoPAC was used to measure LV peak systolic longitudinal strain (LS) of the endocardium, middle myocardium, and epicardium, peak longitudinal strain rate (LSr), segmental and global longitudinal rotation (LR) degrees. Ligated the LAD and repeated all measurements after 10 min. Results Peak LS and LSr were significantly different between the preoperative and postoperative rabbits among most LV walls (P < 0.05). In apical four-chamber view, there was significant difference in the degrees of rotation of the LV lateral wall in preoperative and postoperative rabbits (P < 0.05). In apical three-chamber view, the rotation degrees of the posterior wall and the LR were significantly lower in the postoperative than in the preoperative (P < 0.001). In apical two-chamber view, the rotation degrees of the inferior wall and the LR were significantly lower in the postoperative (P < 0.05). Conclusions Left ventricular function was impaired after acute occlusion of LAD. Segmental rotational degrees and changes in LR could be useful indicators of cardiac function during the early phases of acute myocardial ischemia. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0655-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun Huang
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China.
| | - Zi-Ning Yan
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Li Fan
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Yi-Fei Rui
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Xiang-Ting Song
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
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Huang J, Yan ZN, Fan L, Rui YF, Song XT. Left ventricular systolic function changes in hypertrophic cardiomyopathy patients detected by the strain of different myocardium layers and longitudinal rotation. BMC Cardiovasc Disord 2017; 17:214. [PMID: 28768478 PMCID: PMC5541417 DOI: 10.1186/s12872-017-0651-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impairment of left ventricular (LV) longitudinal function has an important role in hypertrophic cardiomyopathy (HCM). This research investigated an association between the longitudinal strain of different myocardial layers, longitudinal rotation and the LV systolic function of HCM patients. METHODS The research was performed on 36 HCM patients and 36 healthy subjects. The peak systolic longitudinal strain of the subendocardial, midmyocardial, and subepicardial layers was measured using 2-dimensional speckle tracking echocardiography (2D-STE). The apical long-axis and 4- and 2- chamber views were acquired via 2D Doppler echocardiography. The curve of the longitudinal rotation was traced at 17 timepoints in the analysis of 2 cardiac cycles. RESULTS Compared with healthy subjects, in HCM patients regional LV peak systolic longitudinal strain was less, not only in hypertrophied LV myocardium, but also in non-hypertrophied myocardium. The rotational degrees of the midmyocardial-septal, apex, and lateral wall of HCM patients were significantly different from that of normal subjects, as follows. In HCM patients, clockwise longitudinal rotation was found. The interventricular septum thickness at end-diastole positively correlated with the peak longitudinal systolic strain of the subendocardial, the midmyocardial, and the subepicardial layers. The area under ROC curve values for subendocardial, midmyocardial and subepicardial layers in HCM patients were 0.923, 0.938, 0.948. CONCLUSION In HCM patients, the longitudinal function was damaged, even with normal LV ejection fraction. The peak longitudinal systolic strain of the subendocardial, midmyocardial, and subepicardial layers, and the longitudinal rotation detected by 2D-STE, are very sensitive predictors of systolic function in patients with HCM.
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Affiliation(s)
- Jun Huang
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China.
| | - Zi-Ning Yan
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Li Fan
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Yi-Fei Rui
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Xiang-Ting Song
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
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Huang J, Yan ZN, Rui YF, Shen D, Fan L, Chen DL. Longitudinal rotation: a new way to detect the cardiotoxicity of anthracycline-based chemotherapy in breast cancer patients. Oncotarget 2017; 8:70072-70083. [PMID: 29050262 PMCID: PMC5642537 DOI: 10.18632/oncotarget.19585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/28/2017] [Indexed: 12/03/2022] Open
Abstract
Background and aims The study was to compare cardiac parameters before and after anthracycline-based chemotherapy and identify a parameter for detecting cardiotoxicity in breast cancer patients. Methods Cardiac function in 43 female breast cancer patients was evaluated at three time points: baseline, 1-3 days before the initiation of anthracycline-based chemotherapy; 3 weeks and 6 months after the final cycle of chemotherapy. At each visit, the peak longitudinal velocity; strain rate; peak systolic strain; peak systolic longitudinal displacement, and segmental and global longitudinal rotation degrees of the left ventricular were measured. Results The peak early-diastole left ventricular wall velocity at baseline was significantly higher than the values at 3 weeks and 6 months after the final cycle of chemotherapy. The absolute value of the lateral wall peak systolic longitudinal rotation degrees was significantly higher at baseline than at 3 weeks and 6 months after the final cycle of chemotherapy, whereas the absolute value of the global peak systolic longitudinal rotation degrees at baseline was significantly lower than the values at 3 weeks and 6 months after the final cycle of chemotherapy. None of the measured parameters differed significantly between the 3 weeks and 6 months after the final cycle of chemotherapy. Conclusions Cardiac diastolic and systolic dysfunction was found after anthracycline-based chemotherapy in this study, and the peak systolic longitudinal rotation degrees can be used to detect dysfunction after chemotherapy. The cardiotoxicity of epirubicin-based chemotherapy is stronger than that of therarubicin-based chemotherapy.
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Affiliation(s)
- Jun Huang
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to NanJing Medical University, Changzhou 213003, China
| | - Zi-Ning Yan
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to NanJing Medical University, Changzhou 213003, China
| | - Yi-Fei Rui
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to NanJing Medical University, Changzhou 213003, China
| | - Dan Shen
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to NanJing Medical University, Changzhou 213003, China
| | - Li Fan
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to NanJing Medical University, Changzhou 213003, China
| | - Dong-Liang Chen
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to NanJing Medical University, Changzhou 213003, China
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Murtaza G, Virk HUH, Khalid M, Rahman Z, Sitwala P, Schoondyke J, Al-Balbissi K. Role of Speckle Tracking Echocardiography in Dilated Cardiomyopathy: A Review. Cureus 2017; 9:e1372. [PMID: 28744419 PMCID: PMC5519311 DOI: 10.7759/cureus.1372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is an important cause of the heart failure. Timely diagnosis and optimal management decrease morbidity and mortality in heart failure patients. Although transthoracic echocardiography is used as the diagnostic test of choice in these patients, new modalities like speckle tracking echocardiography (STE) have promising results in diagnosing these patients in the earlier course of the disease. Advancements in cardiac imaging are expected as more clinical studies on the role of STE in different cardiac diseases that emerge. In this review article, we will discuss the basics of STE and its role in diagnosing DCM.
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Affiliation(s)
- Ghulam Murtaza
- Department of Internal Medicine, East Tennessee State University
| | - Hafeez Ul Hasan Virk
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Muhammad Khalid
- Department of Internal Medicine, East Tennessee State University
| | - Zia Rahman
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University
| | - Puja Sitwala
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University
| | | | - Kais Al-Balbissi
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University
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Marechaux S, Menet A, Guyomar Y, Ennezat PV, Guerbaai RA, Graux P, Tribouilloy C. Role of echocardiography before cardiac resynchronization therapy: new advances and current developments. Echocardiography 2016; 33:1745-1752. [DOI: 10.1111/echo.13334] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sylvestre Marechaux
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
- INSERM U 1088; University of Picardie; Amiens France
| | - Aymeric Menet
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
- INSERM U 1088; University of Picardie; Amiens France
| | - Yves Guyomar
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
| | | | - Raphaëlle Ashley Guerbaai
- Cardiology Department; Grenoble University Hospital; Grenoble France
- Cardiovascular and Thoracic Department; Amiens University Hospital; Amiens France
| | - Pierre Graux
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
| | - Christophe Tribouilloy
- INSERM U 1088; University of Picardie; Amiens France
- Cardiovascular and Thoracic Department; Amiens University Hospital; Amiens France
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11
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Steelant B, Stankovic I, Roijakkers I, Aarones M, Bogaert J, Desmet W, Aakhus S, Voigt JU. The Impact of Infarct Location and Extent on LV Motion Patterns. JACC Cardiovasc Imaging 2016; 9:655-64. [DOI: 10.1016/j.jcmg.2015.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/25/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022]
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12
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Popović ZB, Koneru S. When the Left Ventricle Rocks. JACC Cardiovasc Imaging 2016; 9:665-7. [DOI: 10.1016/j.jcmg.2015.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 07/23/2015] [Indexed: 11/26/2022]
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13
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To ACY, Benatti RD, Sato K, Grimm RA, Thomas JD, Wilkoff BL, Agler D, Popović ZB. Strain-time curve analysis by speckle tracking echocardiography in cardiac resynchronization therapy: Insight into the pathophysiology of responders vs. non-responders. Cardiovasc Ultrasound 2016; 14:14. [PMID: 27090784 PMCID: PMC4835914 DOI: 10.1186/s12947-016-0057-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/08/2016] [Indexed: 11/17/2022] Open
Abstract
Background Patients with non-ischemic heart failure etiology and left bundle branch block (LBBB) show better response to cardiac resynchronization therapy (CRT). While these patients have the most pronounced left ventricular (LV) dyssynchrony, LV dyssynchrony assessment often fails to predict outcome. We hypothesized that patients with favorable outcome from CRT can be identified by a characteristic strain distribution pattern. Methods From 313 patients who underwent CRT between 2003 and 2006, we identified 10 patients who were CRT non-responders (no LV end-systolic volume [LVESV] reduction) with non-ischemic cardiomyopathy and LBBB and compared with randomly selected CRT responders (n = 10; LVESV reduction ≥15 %). Longitudinal strain (εlong) data were obtained by speckle tracking echocardiography before and after (9 ± 5 months) CRT implantation and standardized segmental εlong-time curves were obtained by averaging individual patients. Results In responders, ejection fraction (EF) increased from 25 ± 9 to 40 ± 11 % (p = 0.002), while in non-responders, EF was unchanged (20 ± 8 to 21 ± 5 %, p = 0.57). Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT. Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction. Restoration of contraction synchrony was observed in both groups, though non-responder remained low amplitude of εlong. Conclusions CRT non-responders with LBBB and non-ischemic etiology showed a similar improvement of εlong pattern with responders after CRT implantation, while amplitude of εlong remained unchanged. Lower εlong in the non-responders may account for their poor response to CRT.
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Affiliation(s)
- Andrew C Y To
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.,Department of Cardiology, North Shore Hospital, 124 Shakespeare Rd, Takapuna, Auckland, New Zealand
| | - Rodolfo D Benatti
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Kimi Sato
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - James D Thomas
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Bruce L Wilkoff
- Section of Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Deborah Agler
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Zoran B Popović
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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Motoji Y, Tanaka H, Fukuda Y, Sano H, Ryo K, Sawa T, Miyoshi T, Imanishi J, Mochizuki Y, Tatsumi K, Matsumoto K, Emoto N, Hirata KI. Association of Apical Longitudinal Rotation with Right Ventricular Performance in Patients with Pulmonary Hypertension: Insights into Overestimation of Tricuspid Annular Plane Systolic Excursion. Echocardiography 2015; 33:207-15. [PMID: 26710717 DOI: 10.1111/echo.13036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Current guidelines recommend the routine use of tricuspid annular plane systolic excursion (TAPSE) as a simple method for estimating right ventricular (RV) function. However, when ventricular apical longitudinal rotation (apical-LR) occurs in pulmonary hypertension (PH) patients, it may result in overestimated TAPSE. METHODS We studied 105 patients with PH defined as mean pulmonary artery pressure >25 mmHg at rest measured by right heart cardiac catheterization. TAPSE was defined as the maximum displacement during systole in the RV-focused apical four-chamber view. RV free-wall longitudinal speckle tracking strain (RV-free) was calculated by averaging 3 regional peak systolic strains. The apical-LR was measured at the peak rotation in the apical region including both left and right ventricle. The eccentricity index (EI) was defined as the ratio of the length of 2 perpendicular minor-axis diameters, one of which bisected and was perpendicular to the interventricular septum, and was obtained at end-systole (EI-sys) and end-diastole (EI-dia). Twenty age-, gender-, and left ventricular ejection fraction-matched normal controls were studied for comparison. RESULTS The apical-LR in PH patients was significantly lower than that in normal controls (-3.4 ± 2.7° vs. -1.3 ± 1.9°, P = 0.001). Simple linear regression analysis showed that gender, TAPSE, EI-sys, and EI-dia/EI-sys were associated with apical-LR, but RV-free was not. Multiple regression analysis demonstrated that gender, EI-dia/EI-sys, and TAPSE were independent determinants of apical-LR. CONCLUSIONS TAPSE may be overestimated in PH patients with clockwise rotation resulting from left ventricular compression. TAPSE should thus be evaluated carefully in PH patients with marked apical rotation.
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Affiliation(s)
- Yoshiki Motoji
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuko Fukuda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Sano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keiko Ryo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuma Sawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Miyoshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junichi Imanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuhide Mochizuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiro Tatsumi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriaki Emoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Clinical Application of Strain Imaging. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Negishi K, Popović ZB, Negishi T, Motoki H, Alraies MC, Chirakarnjanakorn S, Dahiya A, Klein AL. Pericardiectomy is Associated with Improvement in Longitudinal Displacement of Left Ventricular Free Wall Due to Increased Counterclockwise Septal-to-Lateral Rotational Displacement. J Am Soc Echocardiogr 2015; 28:1204-1213, e2. [PMID: 26141982 DOI: 10.1016/j.echo.2015.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pericardiectomy is an effective intervention for constrictive pericarditis. Speckle-tracking echocardiography can provide quantitative information not only about longitudinal strain (LS) but about longitudinal displacement (LD) and septal-to-lateral rotational displacement (SLRD). The aim of this study was to investigate whether pericardiectomy improves myocardial mechanics using speckle-tracking analysis. METHODS Eighty-three patients with constrictive pericarditis who underwent echocardiography were retrospectively assessed (mean age, 58 ± 12 years; 72 men; 50 idiopathic, 20 postoperative, four viral, three radiation, and six others) and compared with 20 healthy volunteers. LD and SLRD were measured from the apical four-chamber view and global LS from three apical views. RESULTS LD was less in the constrictive pericarditis group compared with control subjects (P < .001). Only lateral LS was significantly less than that of control subjects (P < .001), but septal LS was similar (P = .48). In pre- and post-pericardial surgery comparisons (n = 27), values of septal and lateral LD were almost identical (mean, 13.6 ± 4.7 vs 13.3 ± 5.4 mm; P = .70) before pericardiectomy, but septal LD decreased (mean, 9.3 ± 3.5 mm; P < .001) and lateral LD increased (mean, 16.8 ± 4.7 mm; P = .0106) after the surgery, even though the difference in LS between the septal and lateral walls decreased (from 5.6 ± 5.3% to 2.5 ± 4.2%, P = .008). Systolic whole-heart swinging motion significantly increased to a counterclockwise direction after surgery (mean SLRD, -0.8 ± 3.3° vs 2.1 ± 3.0°; P = .001). Although the change in SLRD after pericardiectomy was not different between patients with decreases and increases in New York Heart Association class, SLRD change was significantly greater in patients who received fewer diuretics after surgery (mean, 4.00 ± 0.91 vs 0.27 ± 1.47; P = .027). CONCLUSIONS After surgical removal of the pericardium, LD of the septal and lateral walls became significantly different, and counterclockwise SLRD increased, reflecting loss of pericardial support.
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Affiliation(s)
- Kazuaki Negishi
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Zoran B Popović
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Tomoko Negishi
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Hirohiko Motoki
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - M Chadi Alraies
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Srisakul Chirakarnjanakorn
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Arun Dahiya
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
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17
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Lagies R, Beck BB, Hoppe B, Sheta SS, Weiß V, Sreeram N, Udink ten Cate FEA. Inhomogeneous Longitudinal Cardiac Rotation and Impaired Left Ventricular Longitudinal Strain in Children and Young Adults with End-Stage Renal Failure Undergoing Hemodialysis. Echocardiography 2014; 32:1250-60. [DOI: 10.1111/echo.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ruth Lagies
- Department of Pediatric Cardiology, Heart Center Cologne; University Hospital of Cologne; Cologne Germany
| | - Bodo B. Beck
- Institute of Human Genetics; University of Cologne; Cologne Germany
| | - Bernd Hoppe
- Department of Pediatrics; Division of Pediatric Nephrology; University of Bonn; Bonn Germany
| | - Sahar S. Sheta
- Department of Pediatric Cardiology; Cairo University Children's Hospital (CUCH); Cairo Egypt
| | - Verena Weiß
- Institute for Medical Statistics, Informatics and Epidemiology (IMSIE); University of Cologne; Cologne Germany
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, Heart Center Cologne; University Hospital of Cologne; Cologne Germany
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18
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Impact of Inodilator Drugs on Echocardiographic Assessments of Left Ventricular Filling Pressure in Patients With Decompensated End-Stage Heart Failure*. Crit Care Med 2014; 42:2508-17. [DOI: 10.1097/ccm.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Park JH, Negishi K, Kwon DH, Popovic ZB, Grimm RA, Marwick TH. Validation of global longitudinal strain and strain rate as reliable markers of right ventricular dysfunction: comparison with cardiac magnetic resonance and outcome. J Cardiovasc Ultrasound 2014; 22:113-20. [PMID: 25309687 PMCID: PMC4192408 DOI: 10.4250/jcu.2014.22.3.113] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 06/24/2014] [Accepted: 08/20/2014] [Indexed: 11/22/2022] Open
Abstract
Background Right ventricular (RV) dysfunction in ischemic cardiomyopathy (ICM) is associated with poor prognosis, but RV assessment by conventional echocardiography remains difficult. We sought to validate RV global longitudinal strain (RVGLS) and global longitudinal strain rate (RVGLSR) against cardiac magnetic resonance (CMR) and outcome in ICM. Methods In 57 patients (43 men, 64 ± 12 years) with ICM who underwent conventional and strain echocardiography and CMR, RVGLS and RVGLSR were measured off-line. RV dysfunction was determined by CMR [RV ejection fraction (RVEF) < 50%]. Patients were followed over 15 ± 9 months for a composite of death and hospitalization for worsening heart failure. Results RVGLS showed significant correlations with CMR RVEF (r = -0.797, p < 0.01), RV fractional area change (RVFAC, r = -0.530, p < 0.01), and tricuspid annular plane systolic excursion (TAPSE, r = -0.547, p < 0.01). RVGLSR showed significant correlations between CMR RVEF (r = -0.668, p < 0.01), RVFAC (r = -0.394, p < 0.01), and TAPSE (r = -0.435, p < 0.01). RVGLS and RVGLSR showed significant correlations with pulmonary vascular resistance (r = 0.527 and r = 0.500, p < 0.01, respectively). The best cutoff value of RVGLS for detection of RV dysfunction was -15.4% [areas under the curve (AUC) = 0.955, p < 0.01] with a sensitivity of 81% and specificity 95%. The best cutoff value for RVGLSR was -0.94 s-1 (AUC = 0.871, p < 0.01), sensitivity 72%, specificity 86%. During follow-up, there were 12 adverse events. In Cox-proportional hazard regression analysis, impaired RVGLS [hazard ratio (HR) = 5.46, p = 0.030] and impaired RVGLSR (HR = 3.95, p = 0.044) were associated with adverse clinical outcome. Conclusion Compared with conventional echocardiographic parameters, RVGLS and RVGLSR correlate better with CMR RVEF and outcome.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA. ; Cardiology Division of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kazuaki Negishi
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Deborah H Kwon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Zoran B Popovic
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Richard A Grimm
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas H Marwick
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA. ; Menzies Research Institute Tasmania, Hobart, Australia
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20
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Ni XD, Huang J, Hu YP, Xu R, Yang WY, Zhou LM. Assessment of the rotation motion at the papillary muscle short-axis plane with normal subjects by two-dimensional speckle tracking imaging: a basic clinical study. PLoS One 2013; 8:e83071. [PMID: 24376634 PMCID: PMC3869751 DOI: 10.1371/journal.pone.0083071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/07/2013] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study was to observe the rotation patterns at the papillary muscle plane in the Left Ventricle(LV) with normal subjects using two-dimensional speckle tracking imaging(2D-STI). Methods We acquired standard of the basal, the papillary muscle and the apical short-axis images of the LV in 64 subjects to estimate the LV rotation motion by 2D-STI. The rotational degrees at the papillary muscle short-axis plane were measured at 15 different time points in the analysis of two heart cycles. Results There were counterclockwise rotation, clockwise rotation, and counterclockwise to clockwise rotation at the papillary muscle plane in the LV with normal subjects, respectively. The ROC analysis of the rotational degrees was performed at the papillary muscle short-axis plane at the peak LV torsion for predicting whether the turnaround point of twist to untwist motion pattern was located at the papillary muscle level. Sensitivity and specificity were 97% and 67%, respectively, with a cut-off value of 0.34°, and an area under the ROC curve of 0.8. At the peak LV torsion, there was no correlation between the rotational degrees at the papillary muscle short-axis plane and the LVEF in the normal subjects(r = 0.000, p = 0.998). Conclusions In the study, we conclude that there were three rotation patterns at the papillary muscle short-axis levels, and the transition from basal clockwise rotation to apical counterclockwise rotation is located at the papillary muscle level.
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Affiliation(s)
- Xian-Da Ni
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- * E-mail:
| | - Jun Huang
- Department of Echocardiography, Changzhou No. 2 People’s Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yuan-Ping Hu
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rui Xu
- Department of Ultrasound, The First Affiliated Hospital of Henan university of TCM, Zhengzhou, China
| | - Wei-Yu Yang
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li-Ming Zhou
- Department of Ultrasound, The second Affiliated Hospital of ZheJiang Univercity, Hangzhou, China
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21
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Marcucci CE, Samad Z, Rivera J, Adams DB, Philips-Bute BG, Mahajan A, Douglas PS, Aronson S, Mackensen GB, Podgoreanu MV, Mathew JP, Swaminathan M. A Comparative Evaluation of Transesophageal and Transthoracic Echocardiography for Measurement of Left Ventricular Systolic Strain Using Speckle Tracking. J Cardiothorac Vasc Anesth 2012; 26:17-25. [PMID: 21835637 DOI: 10.1053/j.jvca.2011.06.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Indexed: 11/11/2022]
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22
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Tournoux F, Singh JP, Chan RC, Chen-Tournoux A, McCarty D, Manzke R, Ruskin JN, Semigran M, Heist EK, Moore S, Picard MH, Weyman AE. Absence of left ventricular apical rocking and atrial-ventricular dyssynchrony predicts non-response to cardiac resynchronization therapy. ACTA ACUST UNITED AC 2011; 13:86-94. [DOI: 10.1093/ejechocard/jer167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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23
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Szulik M, Tillekaerts M, Vangeel V, Ganame J, Willems R, Lenarczyk R, Rademakers F, Kalarus Z, Kukulski T, Voigt JU. Assessment of apical rocking: a new, integrative approach for selection of candidates for cardiac resynchronization therapy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:863-9. [PMID: 20615904 DOI: 10.1093/ejechocard/jeq081] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Current attempts of improving patient selection in cardiac resynchronization therapy (CRT) are mainly based on echocardiographic timing of myocardial velocity peaks. Regional myocardial function is neglected. Apical transverse motion (ATM) is a new parameter to quantify apical rocking as an integrative surrogate of both temporal and functional inhomogeneities within the left ventricle. In this study, we tested the predictive value of apical rocking for response to CRT. METHODS AND RESULTS Sixty-nine patients eligible for CRT were assessed by echocardiography before and 11 ± 5 months after pacemaker implantation. Response was defined as left ventricular (LV) end-systolic volume decrease >15%. Rocking was quantified (ATM) and visually assessed by four blinded readers. Predictive value for CRT response of both assessments was compared with conventional dyssynchrony parameters. ATM in the four-chamber view plane differentiated best between responders and non-responders (2.2 ± 1.5 vs. 0.06 ± 1.9 mm, P< 0.0001). Quantified ATM predicted reverse remodelling with a sensitivity, specificity, and accuracy of 75, 96, and 83% whereas visual rocking assessment resulted in 89, 75, and 83%, respectively. The accuracy of conventional parameters was significantly lower. CONCLUSION Apical rocking is a new marker to assess LV dyssynchrony and predict CRT response. It is superior to conventional parameters. Even its simple visual assessment may be sufficiently accurate in the clinical setting.
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Affiliation(s)
- Mariola Szulik
- Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
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24
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Popović ZB, Puntawangkoon C, Verhaert D, Greenberg N, Klein A, Thomas JD, Grimm RA. Impact of Longitudinal Cardiac Rotation on Mitral and Tricuspid Atrioventricular Annular Diastolic Motion. Circ Cardiovasc Imaging 2010; 3:368-74. [DOI: 10.1161/circimaging.109.900084] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
It is unknown whether longitudinal rotation (LR), often seen in cardiac resynchronization therapy candidates, may affect mitral annular early diastolic (E′) velocities and tricuspid annular motion. We assessed whether (1) LR affects the amplitude and timing of septal and lateral mitral annular E′ velocities and tricuspid annular systolic and E′ velocities and (2) if systolic strain heterogeneity seen in cardiac resynchronization therapy patients with LR extends into diastole.
Methods and Results—
Ninety-nine cardiac resynchronization therapy candidates with suitable baseline echocardiograms were identified. Early diastolic (E′) and systolic myocardial velocities of the tricuspid annulus and E′ velocities of the septal and lateral part of the mitral annulus were analyzed from tissue Doppler images. Longitudinal rotation and basal systolic and diastolic strain rates were analyzed by speckle-tracking. LR correlated with lateral mitral annular E′ (
r
=0.45,
P
<0.001), tricuspid annular E′ (
r
=−0.3,
P
=0.003), and with a difference between septal and lateral mitral annular E′ velocities (
r
=−0.49,
P
<0.001) but not with septal mitral annular E′ velocity. LR also correlated with tricuspid annular systolic velocity (
r
=0.60,
P
<0.001). After categorizing the patients according to the quartiles of their LR, we showed that with decreasing quartile number, heterogeneity of systolic (
P
=0.003) but not diastolic (
P
>0.1) strain rates increased.
Conclusions—
LR direction and magnitude correlates with the amplitude of, and relative differences between, diastolic velocities of tricuspid, lateral mitral, and septal mitral annulus, which are a cornerstone of diastolic function assessment. LR is associated with systolic but not with diastolic regional heterogeneity.
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Affiliation(s)
- Zoran B. Popović
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chirapa Puntawangkoon
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Verhaert
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neil Greenberg
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan Klein
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - James D. Thomas
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard A. Grimm
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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25
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Verhaert D, Mullens W, Borowski A, Popović ZB, Curtin RJ, Thomas JD, Tang WHW. Right ventricular response to intensive medical therapy in advanced decompensated heart failure. Circ Heart Fail 2010; 3:340-6. [PMID: 20176715 DOI: 10.1161/circheartfailure.109.900134] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right ventricular (RV) systolic dysfunction is a strong predictor of adverse outcomes in heart failure, yet quantitatively assessing the impact of therapy on this condition is difficult. Our objective was to compare the clinical significance of changes in RV echocardiographic indices in response to intensive medical treatment in patients admitted to the hospital with acute decompensated heart failure (ADHF). METHODS AND RESULTS Serial comprehensive echocardiography was performed in 62 consecutive patients with ADHF, and adverse events (death, cardiac transplantation, assist device, heart failure rehospitalization) were prospectively documented. RV peak systolic strain was assessed using speckle-tracking longitudinal strain analysis as the average of the basal, mid-, and apical segment of the RV free wall. Other conventional parameters of RV function (RV fractional area change, RV myocardial performance index, tricuspid annular peak systolic excursion, and tissue Doppler peak tricuspid annular systolic velocity) were measured for comparison. In our study cohort [left ventricular ejection fraction, 26+/-10%; cardiac index, 2.0+/-0.6 L/(min . m(2))], overall mean RV peak systolic strain was -14+/-4% at baseline and -15+/-4% at 48 to 72 hours (P=0.27). Among all the RV functional indices measured, only RV peak systolic strain at 48 to 72 hours was associated with adverse events (P=0.02). In particular, improvement in RV peak systolic strain after intensive medical treatment was associated with lower adverse events in this patient population (26% versus 78%; hazard ratio, 0.13; 95% CI, 0.02 to 0.84; P=0.02). CONCLUSION Dynamic improvement in RV mechanics in response to intensive medical therapy was associated with lower long-term adverse events in patients with ADHF than in patients not showing improvement.
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Affiliation(s)
- David Verhaert
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
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26
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Nihtyanova SI, Tang EC, Coghlan JG, Wells AU, Black CM, Denton CP. Improved survival in systemic sclerosis is associated with better ascertainment of internal organ disease: a retrospective cohort study. QJM 2010; 103:109-15. [PMID: 19966313 DOI: 10.1093/qjmed/hcp174] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) has high mortality and morbidity. Current management focuses on early detection and treatment of organ-based manifestations. AIM To determine whether the ascertainment of major organ complications of SSc has changed over time and if this is associated with better survival. DESIGN Retrospective cohort analysis. METHODS A total of 520 SSc patients, 234 with disease onset between 1990 and 1993 (historical cohort) and 286 with disease onset between 2000 and 2003 (contemporary cohort), were included. Survival and frequency of internal organ complications were compared between the two cohorts. RESULTS Five-year survival among diffuse cutaneous SSc (dcSSc) patients has improved from 69% in the 1990-93 cohort to 84% in the 2000-03 cohort (P = 0.018), whereas 5-year survival among the limited cutaneous SSc (lcSSc) patients has remained unchanged-93 and 91%, respectively. Sixteen per cent of the lcSSc subjects and 38% of the dcSSc subjects from the contemporary cohort were diagnosed for the clinically significant pulmonary fibrosis compared with 3 and 7%, respectively, of the historical cohort (P < 0.001). Similarly, the diagnosis of pulmonary arterial hypertension was more frequent in the patients from the contemporary cohort (8 and 7% for lcSSc and dcSSc, respectively) compared with [ < 1% (P = 0.002) and 1% (P = 0.148), respectively] the historical cohort. There was no significant difference between the two cohorts in terms of scleroderma renal crisis and cardiac involvement. CONCLUSION Survival has substantially improved for the diffuse cutaneous subset of SSc with better and more complete ascertainment of lung complications as a result of systematic annual screening.
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Affiliation(s)
- S I Nihtyanova
- Centre for Rheumatology, Royal Free Hospital, London NW3 2QG, UK
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27
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Popovic ZB, Thomas JD. In search of a holy grail: predicting cardiac resynchronization therapy outcomes by echocardiography. Circ Cardiovasc Imaging 2009; 1:3-5. [PMID: 19808508 DOI: 10.1161/circimaging.108.797175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Phillips KP, Popović ZB, Lim P, Meulet JE, Barrett CD, Biase LD, Agler D, Thomas JD, Grimm RA. Opposing Wall Mechanics Are Significantly Influenced by Longitudinal Cardiac Rotation in the Assessment of Ventricular Dyssynchrony. JACC Cardiovasc Imaging 2009; 2:379-86. [DOI: 10.1016/j.jcmg.2008.12.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 11/25/2008] [Accepted: 12/05/2008] [Indexed: 11/26/2022]
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29
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Rock 'n Roll Ventricle of the Dyssynchronous Heart. JACC Cardiovasc Imaging 2009; 2:387-9. [DOI: 10.1016/j.jcmg.2009.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 02/19/2009] [Indexed: 11/22/2022]
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30
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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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