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Background: Mitral annular disjunction (MAD) is a structural abnormality characterized by the systolic detachment of the posterior mitral annulus and the ventricular myocardium. It is usually observed coexistent with mitral valve prolapse (MVP) and associated with a mechanical dysfunction despite preserved electrical isolation function of the mitral annulus. This study aimed to evaluate left ventricular (LV) function using speckle tracking echocardiography inMVP patients withMAD. Methods: This study was designed as a prospective, single-center study including 103 patients with MVP and 40 age- and sex-matched control subjects. Transthoracic echocardiography and cardiac magnetic resonance imaging were performed to assess LV function and MAD presence. Results: MAD (+) MVP (n = 34), MAD (-) MVP (n = 69), and control (n = 40) groups were enrolled in the study. Among the MVP patients, 34 (33%) had MAD. T-negativity in the inferior leads on electrocardiography was more frequent in the MAD (+) group than in the MAD (-) patients (4.3% vs. 20.6%, p = .014). Mitral regurgitation degree, Pickelhaube sign (17.6% vs. 1.4%, p = .005), and late gadolinium enhancement frequency (35.3% vs. 10.6%, p = .002) were significantly higher in MAD (+) patients. MAD (+) patients had significantly impaired global longitudinal strain (-23.1 ± 2.1 vs. -23.5 ± 2.3, p < .001), basal longitudinal strain (BLS) (-19.6 ± 1.5 vs. -20.5 ± 1.9, p < .001), Mid-Ventricular Longitudinal Strain (-22.2 ± 1.7 vs. -23.2 ± 2.2, p < .001) and LA strain (-24.5 ± 3.9 vs. -27.2 ± 3.6, p < .001) when compared to MAD (-) MVP patients, despite similar LV ejection fraction. All these values of MVP patients were also significantly lower than the control group. The mean MAD distance was 7.8 ± 3.2 mm in MAD (+) patients. Patients with two or more symptoms were higher in the MAD (+) group than in theMAD (-) group (4.3% vs. 44.1%, p < .001). Conclusion: This study demonstrated a significant decrease in longitudinal strain in MVP patients with MAD, indicating myocardial dysfunction. These findings suggest that MAD may contribute to LV dysfunction and highlight the importance of early detection in younger patients. Further research is needed to explore the functional implications and long-term outcomes of MAD. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac sarcoidosis (CS) is commonly diagnosed based on clinical criteria and abnormalities in noninvasive imaging reported in patients with biopsy‐proven extracardiac sarcoidosis. Electrocardiogram and two‐dimensional echocardiography have a low sensitivity for CS detection. Cardiovascular magnetic resonance imaging (CMR) and positron emission tomography (PET) have limitations in terms of cost and availability. Objectives: This study aimed to assess the usefulness of left ventricular longitudinal strain, measured using two‐dimensional speckle tracking echocardiography (STE), for the prediction of late gadolinium enhancement (LGE) presence in CMR in patients with biopsy‐proven sarcoidosis. Patients and Methods: A total of 119 patients with biopsy‐proven extracardiac sarcoidosis were divided, according to the clinical criteria proposed by the 2014 Heart Rhythm Society expert consensus statement (HRS 2014), into two groups: 43 individuals with "probable cardiac sarcoidosis", CS(+) and 76 individuals without cardiac sarcoidosis, CS (−). Data from echocardiography, CMR, 12‐lead ECG and 24 h Holter monitoring were analyzed. Results: Left ventricular global longitudinal strain (LV‐GLS) was slightly reduced in the entire sarcoidosis group (−18.61± 2.96), no difference between the CS (+) and CS (−) subgroups was found (−18.0% ± 3.2% and −18.9% ± 2.8%, respectively; p =.223). No cut‐off value for LV‐GLS was identified that could predict the presence of LGE. Segmental longitudinal strain impairment partially correlated with the presence of LGE on CMR. Conclusions: In our cohort of sarcoidosis patients, segmental longitudinal strain proved more helpful in the diagnostic process than LV‐GLS. The ultimate role of STE in the diagnosis of CS remains to be established. [ABSTRACT FROM AUTHOR]

Background: Transthoracic echocardiography (TTE) plays a key role in the initial work‐up of myocarditis where the identification of pathologic structural and functional changes may assist in its diagnosis and management. The aim of this systematic review was to appraise the evidence for the utility of echocardiographic parameters of cardiac structure and function in the diagnosis of myocarditis in adult populations. Methods: A systematic literature search of medical databases was performed using PRISMA principles to identify all relevant studies assessing TTE parameters in adult patients with myocarditis (1995–2020; English only; PROSPERO registration CRD42021243598). Data for a range of structural and functional TTE parameters were individually extracted and those with low heterogeneity were then meta‐analyzed using a random‐effects model for effect size, and assessed through standardized mean difference (SMD). Results: Available data from six studies (with a pooled total of 269 myocarditis patients and 240 controls) revealed that myocarditis can be reliably differentiated from healthy controls using echocardiographic measures of left ventricular (LV) size and systolic function, in particular LV end‐diastolic diameter, LV ejection fraction (LVEF) and LV global longitudinal strain (LV‐GLS) (p ≤.01 for all). LV‐GLS demonstrated the highest overall effect size, followed by LVEF and LVEDD (SMD: |0.46–1.98|). Two studies also demonstrated that impairment in LV‐GLS was associated with adverse cardiovascular outcomes in this population, irrespective of LVEF. Conclusions: LV‐GLS demonstrated the greatest overall effect size and therefore ability to differentiate myocarditis populations from healthy controls. GLS was also shown to be a predictor of adverse cardiovascular outcomes, in this population. Hightlights: What is already known on this subject? Myocarditis is a disease process that is often a diagnosis of exclusion, as it frequently mimics other acute cardiac pathologies.Transthoracic echocardiography is traditionally the initial imaging modality used for noninvasive structural assessment in populations with myocarditis. What might this study add? This study demonstrates that left ventricular (LV) global longitudinal strain, LV ejection fraction and LV end‐diastolic diameter can differentiate between myocarditis patients and healthy controls.LV‐GLS demonstrated the greatest overall effect size when comparing these two populations, in comparison to the other measures. How might this impact on clinical practice? This study demonstrates that assessment of myocardial deformation indices allows for sensitive discrimination between myocarditis patients from healthy controls.Routine assessment of LV‐GLS may serve as an important diagnostic tool in the acute care setting. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the predictive value of left ventricular global longitudinal strain (GLS) and left atrial reservoir strain (LARS) on adverse events in chronic coronary artery disease (CAD) patients with reduced systolic function. Methods: A total of 192 consecutive patients clinically diagnosed with chronic CAD and left ventricular ejection fraction (LVEF) ≤ 50% were finally included. Multiple strain parameters were analyzed with speckle tracking echocardiography. The composite endpoint included all‐cause mortality, rehospitalization due to heart failure, myocardial infarction, and stroke. Results: Patients experiencing the endpoint showed lower LVEF, lower absolute GLS and LARS than those without events. Both GLS (AUC = 0.82 [GLS] vs. 0.58 [LVEF], p < 0.001) and LARS (AUC = 0.71 [LARS] vs. 0.58 [LVEF], p = 0.033) were superior to LVEF in predicting adverse events. Multivariate cox regression analysis showed that both GLS (hazard ratio, 0.71; 95% CI, 0.63–0.79; p < 0.001) and LARS (hazard ratio, 0.96; 95% CI, 0.93–0.98; p < 0.001) were independent predictors for the endpoint. The addition of LARS (global chi‐squared, 35.7 vs. 17.4; p < 0.05), GLS (global chi‐squared, 58.6 vs. 17.4; p < 0.05) or both LARS and GLS (global chi‐squared, 79.6 vs. 17.4; p < 0.05) to LVEF in the prediction model significantly improved its performance. The same significant improvement was also shown in the subgroups of mild (30% < LVEF ≤ 50%) and severe (LVEF ≤ 30%) reduced systolic function. Conclusions: Regarding CAD patients with reduced LVEF, both GLS and LARS are superior to LVEF in predicting adverse events, providing significant incremental value to LVEF. [ABSTRACT FROM AUTHOR]

Background: Polycythemia vera (PV), characterized by elevated red blood cell counts, poses challenges to cardiovascular health with potential impacts on cardiac function. Myocardial infarction (MI) and heart failure are major causes of mortality in PV patients. Early detection of left ventricular systolic dysfunction is crucial for optimizing outcomes. Methods: Fifty‐two PV patients and 45 healthy controls were recruited. Four‐dimensional speckle tracking echocardiography (4D‐STE) and fragmented QRS complexes (fQRS) on electrocardiograms were utilized to assess cardiac mechanics. Hematological and echocardiographic parameters were measured, and statistical analyses were performed. Results: PV patients exhibited significantly higher hematocrit and red cell distribution width compared to controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were lower in PV patients. fQRS complexes were associated with longer disease duration and reduced GCS and GAS values. Hematocrit correlated positively with LV‐GCS and LV‐GAS. Multiple linear regression revealed that disease duration and fQRS presence independently predicted LV‐GAS. Conclusion: This study underscores the intricate link between elevated red blood cell counts, disease duration, and cardiac function in PV patients. Combining 4D‐STE and fQRS complexes enhances the identification of early left ventricular systolic dysfunction. These findings offer potential improvements in recognizing and managing cardiovascular complications in PV patients, with implications for future research and clinical practice. Further investigations are needed to elucidate underlying mechanisms and validate these markers in larger cohorts. [ABSTRACT FROM AUTHOR]

Aim: This study assessed RV dyssynchrony (irrespective to QRS duration) and RV systolic function in non‐ischemic dilated cardiomyopathy (NIDCM) versus ischemic dilated cardiomyopathy (IDCM) patients by using different echo‐Doppler modalities. Methods: Eighty‐five cases (48 patients with DCM [whether ischemic or non‐ischemic] and 37 age‐matched healthy controls) were studied. Conventional echo‐Doppler study, tissue Doppler (TDI), and speckle tracking (STE) were carried out to measure LV and RV systolic function. Time‐to‐peak negative longitudinal strain at the four RV sites were assessed by TDI derived strain and 2D speckle tracking. Results: Patients with DCM (whether ischemic or non‐ischemic) had significantly lower fractional area change, RV tricuspid annular systolic velocity (p <.001 for both), tricuspid annular plane systolic excursion (p =.01), RV‐GLS whether TDI or 2D derived (p <.001). Twenty‐nine patients (60%) showed right intraventricular delay (RV4SD > 60 ms). The RV‐dyssynchrony index was negatively correlated to %FAC (r = −.362, p =.01), RV Sm (r = −.312, p =.04), and 2D‐RV GLS (r = −.305, p =.05). Insignificant higher RV‐dysynchrony index was detected in NIDCM compared to IDCM group; however, the basal septal segment was significantly delayed in dilated group. More impaired RV systolic function was detected in ischemic group. 2D STE and TDI showed a significant correlation in the assessment of the right‐intraventricular delay (p =.001). Conclusion: Right‐intraventricular dyssynchrony are detectable in patients with dilated cardiomyopathy (whether ischemic or non‐ischemic) with a higher statistically insignificant value in non‐ischemic group by using tissue Doppler imaging and 2D speckle tracking. More impairment of the RV systolic function was noticed in the ischemic group. Impaired RV systolic function was associated with right intraventricular delay. [ABSTRACT FROM AUTHOR]

Background: Overweightness is a considerable step in the process leading to obesity. There are no sufficient studies on the effect of cardiomyopathy defined in obese patients about overweight subjects. We thought that it may be useful to examine the myocardial involvement in overweight individuals electro‐mechanically with more sensitive techniques before the development of obesity cardiomyopathy. Aim: The aim of the present study was to demonstrate whether or not there are subclinical left ventricular (LV) electrical and mechanical dysfunctions in overweight patients using frontal QRS‐T (fQRS‐T) angle (electrically) and 3D‐speckle tracking echocardiography (mechanically). Methods: A total of 80 overweight patients and 80 age‐ and sex‐matched normal weight individuals were enrolled into the study. 3D‐STE examinations of the patients were performed. Electrocardiographic recordings were obtained for fQRS‐T angle assessment. Results: The LV‐GLS and LV‐GCS were significantly depressed in the overweight group than in the normal weight group (−14.5 ± 3.4 vs. −21.7 ± 3.6, p <.001; −15.2 ± 4.6 vs. −24.3 ± 4.8, p <.001, respectively). The fQRS‐T angle was found to be increased in the overweight group (142.5 ± 39.2 vs. 114.7 ± 43.5, p = <.001). Statistically significant positive linear correlations were observed between BMI with LV‐GLS, LV‐GCS, and fQRS‐T angle. LV‐GLS and LV‐GCS were found to be disrupted linearly as BMI increased (r =.718 for BMI and LV‐GLS, r =.653 for BMI and LV‐GCS). As BMI increased, it was found that the fQRS‐T angle increased (r =.692 for BMI and fQRS‐T angle). Conclusion: Our results support that, overweight individuals, despite their being apparently healthy, may have subclinical LV myocardial mechanical and electrical dysfunction. [ABSTRACT FROM AUTHOR]

Background: Premature ventricular complex (PVC) is seen in most individuals. It has been shown that the kinetics‐tracking index or Kawasaki‐Tanaka index (KT index) strongly predicts pulmonary capillary wedge pressure (PCWP) by noninvasively. KT index was defined as log10 (active LAEF/minimum LAV index). We goaled to assess PCWP non‐invasively in patients with frequent PVCs with normal left ventricular systolic functions and to evaluate whether there is an increase in PCWP before systolic and diastolic functions are impaired. Methods: About 55 patients with frequent PVCs as a patient group and 54 healthy volunteers as a control group were involved to the study. After the conventional echocardiographic examination, the vendor‐independent software system (EchoPAC version 202) was used to obtain the time‐left atrial volume (LAV) curve. total left atrial emptying function (LAEF), passive LAEF, and active LAEF were calculated to evaluate phasic left atrial (LA) function. In this study, ePCWP was calculated using the KT index, and KT index results and other echocardiographic parameters were compared between study groups. Results: LA anterior‐posterior dimension, LA maximum volume index, and LA minimum volume index were significantly larger in the patient group (all p values <.001). Total LAEF were significantly reduced in patients with frequent PVC (p <.001). Estimated pulmonary capillary wedge pressure (ePCWP) by KT index was significantly higher in patients with frequent PVCs (p <.001). Conclusions: : Patients with frequent PVC had increased ePCWP as assessed by KT index. [ABSTRACT FROM AUTHOR]

Background: Right ventricular hypertrophy (RVH+) in hypertrophic cardiomyopathy occurs in one third of patients, however, outcomes in apical hypertrophic cardiomyopathy (ApHCM) have not been described. We hypothesized that RVH+ in ApHCM is associated with more ventricular remodeling and dysfunction, and increased adverse events when compared with those without RVH (RVH−). Methods: Ninety‐one ApHCM patients were retrospectively analyzed using 2D and speckle‐tracking echocardiography (64 ± 16 years old, 43% female). RVH+ was defined as wall thickness >5 mm and was present in 23 (25%). Ventricular mechanics were characterized by global longitudinal strain (GLS), RV free wall strain, and myocardial work. Results: New York Heart Association functional class > II, atrial fibrillation, and prior stroke were more prevalent in RVH+. Left ventricular (LV) size and ejection fraction were similar between groups, with greater septal (17 vs. 14 mm, p =.001) and apical (20 vs. 18 mm, p =.04) wall thickness in RVH+. When compared with RVH− patients, RVH+ had worse LV GLS (−8.6 vs. −12.8%), global work index (820 vs. 1172 mmHg%) (both p <.001), and work efficiency (76 vs. 83%, p =.001), as well as RV GLS (−14 vs. −17.5%) and free wall strain (−17.3 vs. −21.3%) (both p =.02). At 3‐year follow‐up RVH+ had greater incidence of heart failure hospitalization compared with RVH− (35 vs. 7%, p =.003). RVH+ was associated with RV GLS (β =.2, p =.03), independent of clinical and echocardiographic variables. Conclusions: RVH+ patients with ApHCM have worse biventricular mechanics and myocardial work, and more heart failure hospitalization, as RVH− at mid‐term follow‐up. [ABSTRACT FROM AUTHOR]

Background and Aim: There is emerging evidence of cardiovascular remodeling and functional impairment in individuals conceived via Assisted Reproductive Technologies (ART). The aim of this study was to serially assess myocardial function and pulmonary hemodynamic measurements in infants conceived via ART over the first year of age and to compare them to a cohort of spontaneously conceived controls. Methods: This was a prospective, observational study. Echocardiography was performed at Day 2, 6 months and 1 year of age. Biventricular function was assessed by deformation analysis. Pulmonary artery acceleration time (PAAT) and left ventricular (LV) eccentricity index (LVEI) provided surrogate measures of pulmonary vascular resistance (PVR). Results: Fifty infants conceived via ART were compared to 50 spontaneously conceived controls. There were no differences in baseline infant demographics between the two groups. At 1 year of age right ventricular (RV) basal and RV mid cavity diameters were higher in the ART group. PAATi was lower and LVEI higher in the ART group at 6 months and 1 year. In the ART group, LV global longitudinal strain, LV systolic strain rate, LV early diastolic strain rate and RV free wall strain were lower on Day 2, 6 months, and 1 year of age in comparison to the control group (all p <.05). Within the ART group, on linear regression, maternal age, the type of ART treatment or egg characteristics did not influence PAAT or deformation measurements. Conclusion: Our findings suggest that greater cardiovascular surveillance of ART conceived infants may be warranted. [ABSTRACT FROM AUTHOR]

Objectives: We sought to explore a novel left atrial appendage (LAA) strain parameter which could represent the cumulative adverse impact of chronic Atrial fibrillation (AF) on the LAA function, and the relationship between the LAA strain parameter and thrombosis risk in patients with non‐valvular AF. Methods: We enrolled 268 patients with non‐valvular AF and 58 sinus rhythm subjects who underwent transesophageal echocardiography in the study. LAA longitudinal strain amplitude (LAA LSA) was defined as the sum of the value of the maximum positive peak strain (LAA PLS) and the absolute value of the minimum negative peak strain (LAA NLS). Dense spontaneous echo contrast (SEC) was defined as grade 3 or 4 SEC. Results: Compared to sinus rhythm group, the global LAA strain parameters were significantly lower in paroxysmal AF (n = 148), and the lowest of them were found in persistent AF (n = 120), which suggested that the global LAA strain parameters could evaluate LAA function in sinus rhythm, paroxysmal AF and persistent AF. Compared with patients in AF without SEC/thrombus (n = 113), the regional and global LAA strain parameters were significantly depressed in AF with SEC/thrombus (n = 155). Multivariate logistic regression analyses showed that LAA global LSA (OR 0.768; 95% CI:0.569, 0.970; p = 0.027) was an independent predicter of the SEC/thrombus. Compared with patients in AF without dense SEC or thrombus (n = 210), the regional and global LAA strain parameters were significantly impaired in the patients with dense SEC/thrombus(n = 58). LAA global LSA (AUC 0.884) had the best predictable accuracy for dense SEC or thrombus, and outperformed LAA PLS, LAA NLS, CHA2DS2‐VASc score and conventional LAA functional parameters that have been used in the evaluation blood flow stasis in LAA. LAA LSA showed excellent interobserver and intra‐observer agreement beyond LAA PLS and LAA NLS. Conclusion: The novel LAA strain parameters, which were feasible and reproducible parameters for evaluation LAA mechanic function, had good predictive accuracy for blood flow stasis in LAA beyond conventional LAA functional parameters. [ABSTRACT FROM AUTHOR]

Background: Two‐dimensional (2D) strain imaging has become an important tool in assessing subclinical myocardial dysfunction in children. However, there are no published normal values for vendor‐independent strain software. The aim of this study was to estimate 2D strain values in a cohort of healthy children using Tomtec cardiac performance analysis (CPA), a vendor‐independent software. Methods: Transthoracic echocardiograms of healthy pediatric outpatients (0–18 years) were retrospectively analyzed from the Vanderbilt Pediatric Heart Institute using CPA. The cardiac assessment included global longitudinal strain (GLS), global longitudinal strain rate (GLSR), global circumferential strain (GCS), and global circumferential strain rate (GCSR). Mean strain values with standard deviation (SD) are reported. The Wilcoxon rank sum test, linear regression, and one‐way analysis of variance were used to assess differences among the various groups. Results: Among 142 children analyzed, 79 (56%) were male, and the median age was 5.5 (range, 0–18) years. The mean (SD) strain values were GLS –19.3 ± 3.4, GLSR –1.1 ±.22; GCS ‐24.7 ± 4.3, GCSR –1.5 ±.28. Age accounted for <8% of the variation in GLS, GCS, and GCSR. However, for GLSR, there was a statistically significant difference between younger and older age groups with higher GLSR in the younger age group. Age accounted for ∼25% of the variation in GLSR (R2 =.25, p < 0.001). There were no significant differences in strain based on sex. Conclusion: We report normal myocardial strain values in healthy children by age for strain using CPA. These values add to the growing body of literature on myocardial strain in children and provide necessary data for the interpretation of strain imaging. [ABSTRACT FROM AUTHOR]

Background: Premature ventricular contraction (PVC) is a frequent kind of arrhythmia that affects around 1% of the general population. While PVC most frequently impairs ventricular function in structurally normal heart, retrograde ventriculo‐atrial conduction can occur in people with PVC. These retrograde atrial activations may mimic pulmonary vein‐derived atrial ectopies. As a result, PVC may raise the risk of atrial fibrillation (AF) by retrograde ventriculo‐atrial conduction. The Four‐Dimensional Automated Left Atrial Quantification (4D Auto LAQ) tool is a left atrial analytical approach that utilizes three‐dimensional volume data to quantify the volume, as well as LA longitudinal and circumferential strains. The purpose of this study was to determine if clinical diagnosis of PVC is connected with abnormal LA function as determined by LA strain evaluation utilizing a 4D Auto LAQ compared to the healthy population. Methods: The 58 patients with frequent PVCs and 53 healthy volunteers as a control group were enrolled in the study. Imaging was performed using the GE Vivid E95 echocardiography equipment (GE Healthcare; Vingmed Ultrasound, Horten, Norway) equipped with an M5S probe (frequency range: 1.5–4.6 MHz) and a 4V probe (frequency range: 1.5–4.0 MHz). Images were imported into and were selected for analysis using the EchoPAC203 software (GE Healthcare). The analysis mode was selected, followed by the volume and 4D Auto LAQ submodes. Following that, the sample point was positioned in the center of the mitral orifice in each of the three planes. The review function was used to acquire the LA parameters measured by 4D Auto LAQ, including volume and strain parameters. Results: The maximum left atrial volume (LAVmax) and minimal left atrial volume (LAVmin) were significantly higher in the patient group (38.91 ± 9.72 vs. 46.31 ± 10.22, 17.75 ± 4.52 vs. 23.10 ± 7.13, respectively, all p values <.001). On the other hand left atrial reservoir longitudinal strain (LASr), conduit longitudinal strain (LAScd), contraction longitudinal strain (LASct), reservoir circumferential strain (LASr‐c), conduit circumferential strain (LAScd‐c), and contraction circumferential strain (LASct‐c) were significantly lower in patient group (26.64 ± 5.64 vs.19.16 ± 4.58, ‐19.53 ± 3.72 vs. ‐11.28 ± 3.47, ‐10.34 ± 1.56 vs. ‐4.59 ± 1.49, 30.72 ± 4.04 vs. 19.31 ± 2.60, ‐19.91 ± 1.78 vs. ‐13.38 ± 2.85, ‐15.89 ± 6.37 vs. ‐9.24 ± 1.63, respectively, all p values <.001). Conclusions: The present study found that premature ventricular complexes can lead to atrial remodeling as well as ventricular remodeling in patients with PVC and 4D LAQ technology can quantitatively examine left atrial function and determine these alterations early. [ABSTRACT FROM AUTHOR]

Background: Wolff‐Parkinson‐White (WPW) syndrome is one of the most common congenital cardiac abnormalities among ventricular pre‐excitation syndromes. Radiofrequency catheter ablation (RFCA) treatment of accessory pathways (APs) in WPW patients is an established curative therapy restoring normal atrioventricular conduction. We have not encountered any studies evaluating both the LA and LV functions of these patients before and after RFCA with three dimensional‐speckle tracking echocardiography (3D‐speckle tracking echocardiography (STE)). Aim: The purpose of the current study was to assess the LA and LV functions in patients with WPW syndrome before and after RFCA using 3D‐STE. Methods: A total of 21 patients with WPW syndrome who had been scheduled for RFCA were prospectively recruited for this study. 3D‐STE examinations of the patients were performed 12–24 h before ablation and 1 month after ablation. Results: The LV‐global longitudinal strain (LV‐GLS) and LV‐global circumferential strain (LV‐GCS) were significantly depressed in the pre‐RFCA WPW group than in the control group (−14.3 ± 2.1 vs. −21.5 ± 2.2, p <.001; −12.6 ± 1.8 vs. −20.4 ± 1.8, p <.001, respectively). The left atrial strain‐reservoir (LAS‐r) and LAS‐active were significantly decreased in the pre‐RFCA WPW group than in the control group (31.9 ± 2.4 vs. 48.8 ± 2.6, p <.001; 11.7 ± 2 vs. 26.5 ± 2.1, p <.001, respectively). The LV‐GLS, LV‐GCS, LAS‐r, and LAS‐active values improved after RFCA compared to before. Conclusion: The results of our study indicated that there are subclinical impairments in LV and LA myocardial dynamics in the apparently healthy WPW patients, and these deteriorations improve after RFCA of AP. [ABSTRACT FROM AUTHOR]

Objective: Cardiac involvement in recovered COVID‐19 patients assessed by cardiac magnetic resonance imaging (MRI). Methods: Subjects recently recovered from COVID‐19 and with an abnormal left ventricular global longitudinal strain were enrolled. Cardiac MRI in all the enrolled subjects was done at baseline (within 30–90 days following recovery from COVID‐19) with a follow‐up scan at 6 months in individuals with an abnormal baseline scan. Additionally, 20 age‐and sex‐matched individuals were enrolled as healthy controls (HCs). Results: All the 30 enrolled subjects were symptomatic during active COVID‐19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%), and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had late gadolinium enhancement (LGE). No difference was observed in terms of conventional left ventricular (LV) parameters; however, COVID‐19‐recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume, and RV cardiac index compared to HCs. Follow‐up scan was abnormal in 4/16 (25%) with LGE persisting in three patients (who had severe COVID‐19 [3/4;75%]). Subjects with severe COVID‐19 had a greater frequency of LGE (53.8%) and myocardial edema (61.5%) as compared to mild and moderate cases. Myocardial T1 (1284 ± 43.8 ms vs. 1147.6 ± 68.4 ms; p <.0001) and T2 values (50.8 ± 16.7 ms vs. 42.6 ± 3.6 ms; p =.04) were significantly higher in post COVID‐19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID‐19 patients were significantly higher compared to mild and moderate cases. Conclusions: An abnormal CMR was seen in half of the recovered patients with persistent abnormality in one‐fourth at 6 months. Our study suggests a need for closer follow‐up among recovered subjects in order to evaluate for long‐term cardiovascular sequelae. COVID‐19 causes structural changes in the myocardium in a small segment of patients with partial spontaneous resolution. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the role of real‐time three‐dimensional (four‐dimensional) and speckle tracking echocardiography for early detection of left ventricular systolic dysfunction and also for the relationship between myocardial deformation parameters and myocardial iron load which is measured by cardiac magnetic resonance relaxation time T2* values in asymptomatic children with beta‐thalassemia major. Material and Methods: This multicenter cross‐sectional study included 40 patients (mean age 15.4 ± 2.9, 42.1% male) and 40 healthy children whose age, gender, and body mass index‐matched with patients. Each participant underwent conventional echocardiography and tissue Doppler imaging. Left ventricular ejection fraction; global longitudinal, circumferential, radial strains; twist; and torsion were measured by real‐time three‐dimensional and speckle tracking echocardiography. Cardiac magnetic resonance imaging T2* was measured in patients. Results: Left ventricular global longitudinal, circumferential, and radial strains were decreased despite preserved global ventricular function in patients compared to healthy children (p = p =.029, p = p <.001, p =.003, respectively). There were no statistically significant differences between patients with T2* ≥ 20 ms and patients with T2* < 20 ms for all echocardiographic parameters. Also, there were no significant correlations between all echocardiographic parameters and T2* values in all patients, those with T2* ≥ 20 ms, and T2* < 20 ms. Conclusion: We found that even in asymptomatic children with beta‐thalassemia major, left ventricular longitudinal, circumferential and, radial functions were impaired by real‐time three‐dimensional (four‐dimensional) and speckle tracking echocardiography. This novel echocardiographic method might be an important tool for detecting subclinical left ventricular systolic dysfunction irrespective of T2* values. [ABSTRACT FROM AUTHOR]

Background: Myocardial strain assessed with speckle tracking echocardiography is a sensitive marker of cardiac dysfunction. Both left‐ventricular global longitudinal strain (LV‐GLS) and right ventricular longitudinal strain (RV‐LS) were affected by severe SARS‐CoV‐2 infection. However, data about cardiac involvement in patients with asymptomatic/mild Coronavirus disease‐19 (COVID‐19) is still lacking. Aim: To evaluate myocardial function using LV‐GLS and RV‐LS in patients with previous asymptomatic/mild COVID‐19. Methods: Forty young adults without previously known comorbidities/cardiovascular risk factors and with a confirmed diagnosis of asymptomatic or paucisymptomatic SARS‐CoV‐2 infection were retrospectively included. A 2D‐transthoracic echocardiogram with speckle tracking analysis was performed at least 3 months after the diagnosis. Forty healthy subjects, matched for age, sex, and body surface area in a 1:1 ratio were used as the control group. Results: Left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and RV‐LS were comparable between the two groups. LV‐GLS was significantly lower in the cases compared to the control group (−22.7 ± 1.6% vs. −25.7 ± 2.3%; p <.001). Moreover, the prevalence of regional peak systolic strain below −16% in at least two segments was three times higher in patients with previous COVID‐19 compared to controls (30% vs. 10%, p =.02). In multivariable logistic regression, previous COVID‐19 infection was independently associated with reduced LV‐GLS values (p <.001). Conclusion: SARS‐CoV‐2 infection may affect left ventricular deformation in 30% of young adult patients despite an asymptomatic or only mildly symptomatic acute illness. Speckle‐tracking echocardiography could help early identification of patients with subclinical cardiac involvement, with potential repercussions on risk stratification and management. [ABSTRACT FROM AUTHOR]

Introduction: Speckle tracking echocardiography (STE) is a new emerging method for evaluation of the cardiac systolic performance. We characterized left ventricular (LV) systolic functions of hypocalcemic infants, and assessed the effects of calcium and vitamin D supplementations on LV systolic functions using two‐dimensional STE. Patients and Methods: A prospective controlled study was conducted in Mansoura University Children's Hospital, Egypt from 2015 to 2018 including 88 hypocalcemic infants (patient group) and 30 healthy controls. We subdivided the patient group into vitamin D deficiency group (n = 32) and normal vitamin D group (n = 56). All infants were investigated for serum phosphorus, alkaline phosphatase and 25‐hydroxy vitamin D levels. Both patients and controls were initially evaluated for LV systolic functions using two‐dimensional STE. After correction of hypocalcemia and vitamin D deficiency, reevaluation of LV systolic functions was done for the patient group. Results: LV systolic strains were lower in the patient group than controls (p <.001). After recovery of hypocalcemia of the patients, we reported significant improvement of strains and significant reductions of the end‐diastolic and end‐systolic volumes of the left ventricle (p <.001). Global longitudinal and circumferential strains were lower in patients with vitamin D deficiency than patients with normal vitamin D levels (p <.001). The LV systolic strain improved after correction of vitamin D deficiency and hypocalcemia (p <.001). Conclusion: Two‐dimensional STE could detect and follow up early LV systolic dysfunction in infants with hypocalcemia and vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Background: Acute right ventricular (RV) failure is common in patients hospitalized with COVID‐19. Compared to the conventional echocardiographic parameters, right ventricular longitudinal strain (RVLS) is more sensitive and accurate for the diagnosis of RV systolic dysfunction. Objective: Our purpose was to investigate the sustained RV dysfunction echo‐quantified by RVLS in patients recovered from severe COVID‐19. Furthermore, we aimed to assess whether disseminated intravascular coagulation (DIC) has a key role to predict the impaired RV strain. Methods: Of 198 consecutive COVID‐19 patients hospitalized from March 1, 2020, to April 15, 2020, 45 selected patients who survived from severe COVID‐19 were enrolled in the study and referred to our echo‐lab for transthoracic echocardiography 6‐months after discharge. RVLS was calculated as the mean of the strain values of RV free wall. DIC was defined with a validated scoring system: DIC score equal to or more than 5 is compatible with overt‐DIC. Categories of acute respiratory distress syndrome (ARDS) were defined based on PaO2/FiO2 ratio. Results: A total 26 of 45 patients showed impaired RVLS at 6‐months' follow‐up. DIC score was significantly higher in patients with worse RVLS than in those with better RVLS (4.8 ±.5 vs. 3.6 ±.6, p =.03). Stages of ARDS did not modulate this relationship. Finally, overt‐DIC results the only independent predictor of sustained RV dysfunction (OR 1.233, 95% CI 1.041–1.934, p =.043). Conclusions: Sustained RV impairment frequently occurs in patients recovered from severe COVID‐19. DIC plays a key role, resulting in an independent predictor of sustained RV dysfunction. [ABSTRACT FROM AUTHOR]

Chronic heart failure (CHF) has different stages and includes pre‐HF (PHF), a state of high risk of developing myocardial dysfunction and advanced CHF. Some major behavioral risk factors of PHF might predispose to biological risk factors such as obesity, diabetes mellitus, dyslipidemia, hypertension, myocardial infarction, and cardiomyopathy. These risk factors damage the myocytes leading to fibrosis, apoptosis, cardiac hypertrophy, along with alterations in cardiomyocyte' size and shape. A condition of physiological subcellular remodeling resulting into a pathological state might be developed, conducting to PHF. Both PHF and heart failure (HF) are associated with the activation of phospholipases and protease, mitochondrial dysfunction, oxidative stress and development of intra‐cellular free Ca2+ [Ca2+]i overloading to an elevation in diastolic [Ca2+]i. Simultaneously, cardiac gene expression is activated leading to further molecular, structural and biochemical changes of the myocardium. The sub‐cellular remodeling may be intimately involved in the transition of cardiac hypertrophy to heart failure. 2D‐ and 3D‐speckle tracking echocardiography (STE) have been used to quantify regional alterations of longitudinal strain and area strain, through their polar projection, which permits a further assessment of both sites and degrees of myocardial damage. The examination of strain can identify sub‐clinical cardiac dysfunction or cardiomyocyte remodeling. During remodeling of the myocardium cardiac strain is attenuated, therefore it is an indicator of disease assessment. [ABSTRACT FROM AUTHOR]

Purpose: Left ventricular mechanical dispersion (LVMD) is a novel speckle tracking parameter for prognostic assessment of arrhythmic risk prediction. There is growing evidence to support its use in a variety of cardiomyopathic processes. There is paucity of data addressing any presence of inter‐vendor discrepancies for LVMD. The aim of this study was to assess inter‐vendor variability of LVMD in vendor specific software (VSS) and vendor independent software (VIS) in subjects with preserved and reduced left ventricular function. Methods: Fifty‐nine subjects (14 normal subjects and 45 subjects with cardiac disease) were recruited and 2D speckle tracking echocardiographic images were acquired on two different ultrasound machines (GE and Philips). LVMD was measured by two different VSS (EchoPac GE and QLAB Philips) and one VIS (TomTec Arena). Results: There was significant bias and wide limits of agreement (LOA) in the overall cohort observed between two different VSS (17.6 ms; LOA: ‐29.6 to 64.8; r:.47). There was acceptable bias and narrower LOA with good agreement for LVMD between images obtained on different vendors when performed on VIS (‐3.1 ms; LOA: ‐27.6 to 21.4; r:.75). QLAB LVMD was consistently higher than GE LVMD and TomTec LVMD in both preserved and reduced left ventricular function. LVMD measurements have high intra‐vendor reproducibility with excellent inter and intra‐observer agreement. Conclusions: There was acceptable bias and narrower LOA for LVMD assessment on a VIS. Inter‐vendor variability exists for LVMD assessment between VSS. Serial measurements of LVMD should be performed using a single vendor for consistent and reliable results. [ABSTRACT FROM AUTHOR]

Background: 2D speckle tracking echocardiography (STE) atrial strain (ε) analysis in children is gaining interest; however, pediatric nomograms remain limited. Comparison among conventional software's (designed for left ventricle and adapted to atria and using R‐gating analysis) and new software's (designed for atria and allowing for both R‐ and P‐gating) are lacking. The present study aims to establish pediatric nomograms for atrial ε using an atrial dedicated software and to compare values obtained by (a) R‐ and P‐gating and, (b) R‐gating with new and conventional software. Methods: Echocardiographic measurements included STE left (LA) and right (RA) atrial longitudinal reservoir, conduit and contractile ε. Age/weigh/height/heart rate, and body surface area (BSA) were used as independent variables in the statistical analysis. Results: In all, 580 healthy subjects (age range, 31 days‐18 years; mean age 7.5 years; median age 7.1 years; inter‐quartile range, 4.3–10.7 months; 45.5% female) were included. Feasibility of atrial ε measurements was high (98.9–96.8%). At lower age, atrial conduit ε was lower (p<0.001) while contractile ε was higher (p<0.001). All atrial ε values calculated with P‐gating method were lower—than R‐gating values (p<0.001). R‐gated LA ε reservoir values generated with the new software were lower, and R‐gated RA contractile ε higher than with the conventional software (p<0.011). Conclusion: We report pediatric atrial ε values from a dedicated atrial software. Maturational changes in STE atrial ε values were demonstrated. Significant differences were observed among ε values obtained with P‐ and R‐gating and with different software's. [ABSTRACT FROM AUTHOR]

Methods: The study included 59 patients with normal fetal heart structure, blood flow, and heart rhythm (fetal abnormality‐negative group) and 50 patients with abnormal fetal heart structure, blood flow, and/or heart rhythm (fetal abnormality‐positive group). Automated Cardiac Motion Quantification (aCMQ) was performed in both groups to obtain left and right ventricular endocardial global longitudinal strain (GLSendo), mid‐myocardial global longitudinal strain (GLSmid), and epicardial global longitudinal strain (GLSepi). Parameters between the two groups were compared and correlation analyses performed. A deformation analysis was performed by two trained observers, and reproducibility was assessed. Results: The fetal left ventricular and right ventricular global longitudinal strain (LV‐GLS and RV‐GLS, respectively) decreased in a gradient from the endocardium to the epicardium. LV‐GLS and RV‐GLS of all myocardial layers were lower in the fetal abnormality‐positive than ‐negative group (all P < 0.05). Correlation analysis showed that neither LV‐GLS nor RV‐GLS was significantly correlated with gestational age in the fetal abnormality‐negative group (all P > 0.05), whereas left ventricular GLSendo, GLSmid, and GLSepi were negatively correlated with gestational age in the fetal abnormality‐positive group (r = −.39 to −.44, all P < 0.05). Repeatability testing showed that the inter‐observer and intra‐observer intra‐class correlation coefficients for LV‐GLS and RV‐GLS in each myocardial layer were >.75 (all P < 0.001). Conclusions: As a new speckle tracking echocardiography tool, aCMQ has feasibility and repeatability in evaluating myocardial deformation of the fetal ventricle. This technique might provide helpful information on ventricular myocardial deformation in fetal hearts with abnormal structure or rhythm for clinical guidance in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Pulmonary thromboendarterectomy (PTE) is a curative procedure for chronic thromboembolic pulmonary hypertension (CTEPH). Right ventricular free wall strain (RV FWS) and right atrial strain (RAS) are not well studied in a CTEPH population. We sought to determine temporal trends in RAS and RV FWS in patients post‐PTE. Methods: 28 patients undergoing PTE for CTEPH were prospectively enrolled in a surgical database. Comprehensive echocardiographic assessment of the right heart was performed including RV FWS, right atrial volume, and the three components of RAS: reservoir, conduit, and booster strain. Results: Patients undergoing PTE demonstrated improvement in NYHA functional class (P < 0.001). Hemodynamic assessment showed improvement in mean pulmonary artery pressure from 49.7 ± 8.5 mm Hg to 23.9 ± 6.5 mm Hg (P < 0.001) and pulmonary vascular resistance decreased from 7.8 ± 3.2 wu to 2.4 ± 1.3 wu (P < 0.001). Tricuspid annular plane systolic excursion (TAPSE) and lateral S' declined immediately post‐op. RV FWS improved from −14.4 ± 4% to −19 ± 3.4% post‐op and −21.2 ± 4.7% at long‐term follow‐up (P < 0.001). Improvement in RV FWS post‐op was driven primarily by increases in the apical and mid segments. RA volume declined significantly during the study period. RA reservoir and conduit strain improved after PTE. Conclusion: Patients undergoing PTE for CTEPH had significant improvement in right heart hemodynamics immediately post‐op. Traditional echo metrics of RV performance including TAPSE and lateral S' did not improve. RV FWS improved, which was driven by changes in the apical and mid segments. This highlights that RV FWS is a viable and useful metric to follow in CTEPH patients post‐PTE. [ABSTRACT FROM AUTHOR]

Background: We aim to investigate prognostic effects of carotid strain (CS) and strain rate (CSR) in hypertension. Methods: We prospectively recruited 120 patients being treated for hypertension (65.8 ± 11.8 years, 58% male) in this observational study. Peak circumferential CS and peak CSR after ejection were identified using two‐dimensional speckle tracking ultrasound. Major cardiovascular events were any admission for stroke, acute coronary syndrome, and heart failure. Results: After a mean follow‐up period of 63.6 ± 14.5 months, 14 (12%) patients had cardiovascular events. Age (75.3 ± 9.2 vs 64.6 ± 11.6 years; p = 0.001), systolic blood pressure (131.8 ± 15.5 vs 143.1 ± 16.6 mm Hg; p = 0.021), diastolic blood pressure (74.6 ±11.4 vs 82.1 ± 12.2 mm Hg; p = 0.039), use of diuretics (71 vs 92%; p = 0.014), carotid CS (2.17 ± 1.02 vs 3.28 ± 1.14 %; p = 0.001), and CSR (.28 ±.17 vs.51 ±.18 1/s; p < 0.001) were significantly different between the patients who did and did not reach the end‐points. Multivariate Cox regression analysis controlling for age, systolic blood pressure, diastolic blood pressure, and use of diuretics showed that CS (HR.425, 95%CI.223–.811, p = 0.009) and CSR (HR.001, 95%CI.000–.072, p = 0.001) were independent predictors for cardiovascular events. Conclusion: In conclusions, decreased CS and CSR were associated with cardiovascular events in hypertension. [ABSTRACT FROM AUTHOR]

Background: "Classical" echocardiographic signs of Fabry cardiomyopathy (FC), such as left ventricular hypertrophy (LVH), posterolateral strain impairment (PLSI), and papillary muscle hypertrophy may be of limited diagnostic accuracy in clinical practice. Our aim was to evaluate the diagnostic value of left atrial (LA) strain impairment compared to "classical" echocardiographic findings to discriminate FC. Methods: In standard echocardiographic assessments, we retrospectively analyzed the diagnostic value of the "classical" red flags of FC as well as LA strain in 20 FC patients and in 20 subjects with other causes of LVH. Receiver operating characteristic (ROC) curve analysis was performed to assess the respective diagnostic accuracy. Results: FC was confirmed in 20 patients by genetic testing. In the LVH group, 12 patients were classified by biopsy to have hypertrophic cardiomyopathy, two had hypertensive heart disease, and six LVH combined with borderline myocarditis. Global and regional left ventricular (LV) strain was not significantly different between groups while LA strain was significantly impaired in FC (Left atrial reservoir strain (LASr) 19.1%±8.4 in FC and 25.6%±8.9 in LVH, p = 0.009; left atrial conduction strain (LAScd) ‐8.4%±4.9 in FC and ‐15.9%±8.4 in LVH, p < 0.01). LAScd, with an area under the curve (AUC) of.81 (95% confidence interval [CI].66–.96) showed the highest diagnostic accuracy to discriminate FC. The PLSI pattern showed an AUC of.49, quantification of papillary muscle hypertrophy an AUC of.47. Conclusion: Adding LA strain analysis to a comprehensive echocardiographic work‐up of unclear LVH may be helpful to identify FC as a possible cause. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to characterize echocardiographic changes during pregnancy in women with known LVOT obstruction or AS compared to the healthy pregnancy controls, and to assess the relationship with pregnancy outcomes. Methods: We retrospectively studied 34 pregnant patients with congenital LVOT obstruction or AS with healthy age‐matched pregnant controls. Patients with other significant valvular lesions, structural heart disease (LVEF < 40%), or prior valve surgery were excluded. All LVOTO/AS patients underwent a minimum of two consecutive echocardiograms between 1 year pre‐conception and 1 year postpartum, with at least two studies during the pregnancy. Comprehensive echocardiographic evaluation was performed including speckle‐tracking LV global longitudinal strain. Results: A total of 83 echocardiograms from the study group and 34 echocardiograms from the control group were evaluated. Over the range of LVOTO/AS, a significantly greater increase in the AV gradients and LV and LA volumes were observed as compared with the controls. In the sub‐group of LVOTO/AS pregnant women with ≥ moderate (n = 8) versus < moderate LVOTO/AS (n = 26), averaged 2nd/3rd trimester LVEF was lower (51 ± 12)% versus (58 ± 4)%, (p = 0.02) and GLS was lower (−19.5 ± 2.8) versus (21.2 ± 2.4), (p = 0.06). Pregnancy was well tolerated despite these changes. Conclusion: Among pregnant women with even milder forms of LVOTO/AS, increases in cardiac volumes and AV gradients can be expected over the course of pregnancy. Significant decreases in LV function and mechanics were only observed in women with moderate or greater LVOTO/AS, although still remained in normal range. [ABSTRACT FROM AUTHOR]

Aims: Right ventricular (RV) dysfunction is a predictor of adverse outcomes among patients with HF with reduced ejection fraction (HFrEF); however, differences in RV parameters in HFrEF patients with ischemic (ICM) and non‐ischemic cardiomyopathies (NICM) are not well understood. We investigated echocardiographic characteristics, including RV strain, in patients with acute decompensated heart failure (ADHF) and compared patients with ICM and NICM etiology. Methods: Consecutive patients who presented with ADHF and NYHA class III‐IV were prospectively enrolled if they had LVEF < 40% and history of ICM or NICM. All patients underwent clinical exam, laboratory evaluation and 2‐D echocardiographic assessment of the left ventricular (LV) and RV function, LV and RV global longitudinal strain (LVGLS, RVGLS), and RV free wall strain (RVfwLS). Results: Of 84 patients, 44 had ICM and 40 NICM. The groups had similar blood pressure, NT‐proBNP, and echocardiographic parameters of LV function including LVGLS. Absolute RVGLS values were lower than RVfwLS values in both groups. Patients with NICM had significantly lower RVfwLS, but not RVGLS, compared to patients with ICM (−13% to −17%, p = 0.006). Similar differences in RVfwLS were seen in patients in NYHA class III (NICM vs ICM: −13% and −17%, respectively, 95% CI: −8.5 to −.5) and NYHA class IV (NICM vs ICM: −13.8% and −17%, respectively, 95% CI: −6.4 to −.59). Conclusion: Among patients hospitalized with ADHF, patients with nonischemic etiology compared with the patients with ICM, have more severe RV dysfunction measured by RVfwLS, despite similar extent of LV impairment and the same functional limitation class. [ABSTRACT FROM AUTHOR]

Objectives: Myocardial injury during active coronavirus disease‐2019 (COVID‐19) infection is well described; however, its persistence during recovery is unclear. We assessed left ventricle (LV) global longitudinal strain (GLS) using speckle tracking echocardiography (STE) in COVID‐19 recovered patients and its correlation with various parameters. Methods: A total of 134 subjects within 30–45 days post recovery from COVID‐19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. Results: Of the 134 subjects, 121 (90.3%) were symptomatic during COVID‐19 illness and were categorized as mild: 61 (45.5%), moderate: 50 (37.3%) and severe: 10 (7.5%) COVID‐19 illness. Asymptomatic COVID‐19 infection was reported in 13 (9.7%) patients. Subclinical LV and right ventricle (RV) dysfunction were seen in 40 (29.9%) and 14 (10.5%) patients, respectively. Impaired LVGLS was reported in 1 (7.7%), 8 (13.1%), 22 (44%) and 9 (90%) subjects with asymptomatic, mild, moderate and severe disease, respectively. LVGLS was significantly lower in patients recovered from severe illness(mild: ‐21 ± 3.4%; moderate: ‐18.1 ± 6.9%; severe: ‐15.5 ± 3.1%; p < 0.0001). Subjects with reduced LVGLS had significantly higher interleukin‐6 (p < 0.0001), C‐reactive protein (p = 0.001), lactate dehydrogenase (p = 0.009), serum ferritin (p = 0.03), and troponin (p = 0.01) levels during index admission. Conclusions: Subclinical LV dysfunction was seen in nearly a third of recovered COVID‐19 patients while 10.5% had RV dysfunction. Our study suggests a need for closer follow‐up among COVID‐19 recovered subjects to elucidate long‐term cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Background: Left atrial analysis is employed in diastolic assessment with left atrial volume index (LAVI) incorporated in the 2016 ASE/EACVI diastology guideline algorithm. LAVI has sub‐optimal correlation with invasive left ventricular filling pressure (LVFP) and incorporation of left atrial reservoir strain (LASr) may improve diastolic assessment. Methods: A cross‐sectional prospective study of 139 patients was undertaken with all patients undergoing transthoracic echocardiography immediately prior to cardiac catheterization with invasive evaluation of LVFP. LASr by speckle tracking echocardiography and conventional echocardiographic parameters were assessed in relation to invasive LVFP. Modification of the 2016 guideline algorithm was performed with incorporation of LASr in place of LAVI (LASr ≤23% indicating elevated LVFP). Accuracy of the modified and conventional algorithm were assessed for predicting invasive LVFP. Results: The mean age was 63±12 years with 27% female. LASr demonstrated superior correlation and receiver operator characteristic for predicting LVFP than LAVI (LASr: r ‐.46 (p < 0.01), AUC:.82 vs LAVI: r.19 (p 0.02), AUC:.66). LASr of ≤23% was the optimal cut‐off for discriminating elevated LVFP (sensitivity 80%, specificity 77%). Modification of the 2016 algorithm with incorporation of LASr in place of LAVI reclassified 12% of the patient cohort and improved concordance of echocardiographic and invasive LVFP assessment (modified algorithm κ.47 vs 2016 algorithm κ:.33). No patients were incorrectly reclassified by modified algorithm assessment. Conclusions: LASr better predicts invasive LVFP than LAVI. Modification of the 2016 guideline algorithm with incorporation of LASr in place of LAVI improves accuracy of echocardiographic assessment of LVFP. [ABSTRACT FROM AUTHOR]

Aims: To investigate the left ventricular response to exercise in young adults with hypertension, and identify whether this response can be predicted from changes in left atrial function at rest. Methods: A total of 127 adults aged 18–40 years who completed clinical blood pressure assessment and echocardiography phenotyping at rest and during cardiopulmonary exercise testing, were included. Measurements were compared between participants with suboptimal blood pressure ≥120/80mm Hg (n = 68) and optimal blood pressure <120/80mm Hg (n = 59). Left ventricular systolic function during exercise was obtained from an apical four chamber view, while resting left atrial function was assessed from apical four and two chamber views. Results: Participants with suboptimal blood pressure had higher left ventricular mass (p = 0.031) and reduced mitral E velocity (p = 0.02) at rest but no other cardiac differences. During exercise, their rise in left ventricular ejection fraction was reduced (p = 0.001) and they had higher left ventricular end diastolic and systolic volumes (p = 0.001 and p = 0.001, respectively). Resting cardiac size predicted left ventricular volumes during exercise but only left atrial booster pump function predicted the left ventricular ejection fraction response (β=.29, p = 0.011). This association persisted after adjustment for age, sex, body mass index, and mean arterial pressure. Conclusion: Young adults with suboptimal blood pressure have a reduced left ventricular systolic response to exercise, which can be predicted by their left atrial booster pump function at rest. Echocardiographic measures of left atrial function may provide an early marker of functionally relevant, subclinical, cardiac remodelling in young adults with hypertension. [ABSTRACT FROM AUTHOR]

Aims: We have previously shown that 2‐dimentional strain is not a useful tool for ruling out acute coronary syndrome (ACS) in the emergency department (ED). The aim of the present study was to determine whether in patients with suspected ACS, global longitudinal strain (GLS), measured in the ED using 2‐dimensional strain imaging, can predict long‐term outcome. Methods: Long‐term (median 7.7 years [IQR 6.7–8.2]) major adverse cardiac events (MACE; cardiac death, ACS, revascularization, hospitalization for heart failure, or atrial fibrillation) and all‐cause mortality data were available in 525/605 patients (87%) enrolled in the Two‐Dimensional Strain for Diagnosing Chest Pain in the Emergency Room (2DSPER) study. The study prospectively enrolled patients presenting to the ED with chest pain and suspected ACS but without a diagnostic ECG or elevated troponin. GLS was computed using echocardiograms performed within 24 hours of chest pain. MACE of patients with worse GLS (>median GLS) were compared to patients with better GLS (≤ median GLS). Results: Median GLS was −18.7%. MACE occurred in 47/261 (18%) of patients with worse GLS as compared with 45/264 (17%) with better GLS, adjusted HR 0.87 (95% CI 0.57–1.33, P =.57). There was no significant difference in all‐cause mortality or individual endpoints between groups. GLS did not predict MACE even in patients with optimal 2‐dimensional image quality (n = 164, adjusted HR=1.51, 95% CI 0.76–3.0). Conclusions: Global longitudinal strain did not predict long‐term outcome in patients presenting to the ED with chest pain and suspected ACS, supporting our findings in the 2DSPER study. [ABSTRACT FROM AUTHOR]

Introduction: Early repolarization pattern (ERP) can exist a silent substrate for arrhytmic events in accordance with the previous studies which have shown there has been evidence of morphological changes in left ventricle (LV) in ERP subjects. Despite structural changes in ERP subjects, it has not exactly known whether a change in LV functional parameters occur in ERP. The aim of our study was to investigate LV functional parameters in ERP athletes evaluated by 2D‐ speckle tracking echocardiography (2D‐STE). Method: In this study, athletes with ERP (n = 50) and athletes without ERP (n = 50) were recruited between April 2018 and September 2018. For each case, 2D‐ TTE and 2D‐ STE evaluation were performed by the same cardiologist. Results: Left ventricle mean global longitudinal strain (GLS) (P <.001) and GLS at all apical chamber views (P <.001), longitudinal peak systolic strain rate (SRS) at A3C (P:.011), early diastolic strain rate (SRE) at A3C (P <.001) and late diastolic strain rate (SRA) at A3C (P:.034) in the ERP athletes were significantly lower than those in the athletes without ERP. LV basal segment circumferential SRS (P:.002) and SRE (P:.006) were significantly lower in ERP athletes compared to athletes without ERP. LV mechanical dispersion was significantly higher in ERP athletes compared to athletes without ERP (P <.001). Conclusion: Our study suggests ERP can be more associated with impaired LV longitudinal function than circumferential function. In addition, both LV inferolateral region and basal segment can be more affected functionally in ERP athletes. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was (a) to clarify the detailed mechanisms of structural and functional abnormalities of myocardial tissue in hypertrophic cardiomyopathy (HCM) using layer‐specific strain (LSS) and compare it with healthy subjects (b) to investigate the diagnostic accuracy of LSS for HCM. Methods and Results: Forty‐one patients with HCM and preserved left ventricular ejection fraction (LVEF; 66% male, 52 ± 18 years, LVEF 62.9% ± 3.7%) and 41 controls matched for age and sex (66% male, 52 ± 20 years, LVEF 63.5% ± 8.2%) underwent 2D‐speckle tracking echocardiography. Absolute values of LSS were globally lower and the ratio of endocardial/epicardial layer (End/Epi ratio) was higher in HCM. LSS gradually increased from the epicardial toward the endocardial layer at all chamber views and at all levels of the LV. LSS and End/Epi ratio at the apex were higher than those at the middle or basal level of the LV. End/Epi ratio was correlated with LV maximal wall thickness both controls (r =.35, P =.03) and HCM (r =.81, P <.001). End/Epi ratio was an independent factor associated with LV maximal wall thickness (β = 0.96, P <.001). A higher End/Epi ratio (≥1.31) was associated with diagnostic criteria for HCM (sensitivity 98%, specificity 95%, area under the curve 0.99, P <.001). Conclusion: LSS has the potential for unraveling the mechanism of impaired LV wall motion in HCM and to accurately detect HCM. [ABSTRACT FROM AUTHOR]

Introduction: Takotsubo syndrome (TTS) is an acute heart failure syndrome that leads to significant morbidity and mortality. We sought to evaluate the association of cardiac mechanics on presentation with in‐hospital adverse outcomes in patients with apical TTS. Methods: We retrospectively identified 468 patients with TTS based on ICD‐9/10 codes between 2006 and 2017. The association of echocardiographic parameters with a composite outcome of heart failure and all‐cause mortality during the index hospitalization was analyzed. Results: One hundred and forty one patients with the apical subtype and adequate imaging were included. 113 (80.1%) were female, left ventricular ejection fraction (LVEF) was 41.7% ± 12.4%, and global longitudinal strain was −10.1% ± 3.2%. The composite outcome occurred in 58 patients (41%), with heart failure occurring in 55 patients and death occurring in nine patients. Global longitudinal strain, global circumferential strain, global radial strain, right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular free wall strain were significantly worse in patients who experienced the composite outcome in univariate analyses. However, only LVEF was independently associated with the composite outcome in multivariable‐adjusted analysis. Conclusions: In patients with apical TTS, the strain has limited prognostic utility in the acute setting compared to LVEF, which was the only echocardiographic parameter associated with in‐hospital heart failure and all‐cause mortality. [ABSTRACT FROM AUTHOR]

Background: Chagas disease is one of the most common diseases in Latin‐America, and cardiac involvement is a significant cause of death. Assessment of myocardial strain may detect early myocardial damage. Objectives: To determine differences in longitudinal strain using speckle tracking to assess regional and global left ventricular function in patients with the indeterminate form of Chagas disease, in comparison with a control group. Methods: This is a retrospective matched case–control study, conducted in a single center. We evaluated 45 adult patients with Chagas disease, diagnosed with 2 serological methods, without evidence of cardiac involvement, who were compared with 45 healthy control subjects, who were sex‐ and age‐matched. All patients underwent Doppler echocardiography and longitudinal strain with speckle tracking. Results: Median age was 59 years, and 60% were female. Echocardiographic parameters were similar in patients with Chagas and control subjects. In patients with Chagas, global strain differed significantly from that of control subjects (−17 vs −20.3, P <.001). Segmental strain showed 7 abnormal segments in patients with Chagas (P <.05). Conclusions: In patients with the indeterminate form of Chagas disease, global and segmental longitudinal peak systolic strain is reduced compared with healthy subjects, thus suggesting that it could be a sensitive technique to detect early myocardial damage. These findings could provide useful information regarding the pathophysiology of cardiac involvement and understand whether they might have prognostic usefulness or help develop strategies to modify the course and prognosis of patients with Chagas disease. A longitudinal prospective study would be necessary to validate our findings. [ABSTRACT FROM AUTHOR]

Background: More than 50% of patients currently referred for coronary angiography (CAG) with suspected chronic stable angina pectoris (CSAP) shows normal or nonobstructive CAD. Mitral annular displacement (MAD) is a function of global shortening deformation of left ventricle (LV) and mirrors sub‐endocardial ischemia in CAD. The aim of this study was to ascertain if MAD can predict the presence of CAD in patient presenting with suspected CSAP. Methods: This cross‐sectional study was conducted on patients with suspected CSAP (n = 140) and preserved LV function without apparent wall motion abnormalities during the study period. We excluded patients with prior heart disease (valvular, ischemic), presenting with acute coronary syndrome, arrhythmia, heart failure, and poor imaging. All the patients were subjected to speckle tracking echocardiography (STE) and CAG. Average MAD and normalized MAD were calculated by automated function imaging (AFI), and receiver operating characteristic (ROC) curve was plotted for presence of significant CAD considering CAG as gold standard. Results: The results showed that both average MAD (4 segment) and normalized MAD were significantly reduced (P = <.001) in patients with significant CAD (n = 81). In ROC analysis, area under curve (AUC) for predicting significant CAD in patients of CSAP was better for normalized MAD (0.88) compared to average MAD (4 segment, 0.85).The optimal cutoff of normalized MAD and average MAD for detection of significant CAD were ≤15.3% (sensitivity 90.1%, specificity 79.7%) and ≤11.19 (sensitivity 84%, specificity 69.5%), respectively. Normalized MAD showed week inverse correlation with SYNTAX score (−0.24, R2 = 0.058) and Hs CRP (−0.23, R2 = 0.057). Conclusion: MAD is a simple and rapid noninvasive diagnostic tool which accurately predicted the presence of significant CAD in patients with CSAP. [ABSTRACT FROM AUTHOR]

Background: This meta‐analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) are limited by cost and availability. Methods: We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra‐cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random‐effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra‐cardiac sarcoidosis group as compared with controls, SMD −3.98, 95% confidence interval (CI): −5.32, −2.64, P <.001, also was significantly lower in patients who suffered major cardiac events (MCE), −3.89, 95% CI −6.14, −1.64, P <.001. GCS was significantly lower in the extra‐cardiac sarcoidosis group as compared with controls, SMD: −3.33, 95% CI −4.71, −1.95, P <.001. Conclusion: LVGLS and GCS were significantly lower in extra‐cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS. [ABSTRACT FROM AUTHOR]

Aims: Despite three decades of study, it is still challenging to discriminate acute apical variant stress cardiomyopathy (AVSCM) from acute left anterior descending‐myocardial infarction (LAD‐MI) at the time of presentation. A biomarker or practical imaging modality that can differentiate these two entities is highly desirable. Our objective was to characterize left ventricular (LV) mechanical deformation using 2‐dimensional (2D) echocardiographic strain imaging in an attempt to discriminate AVSCM from LAD‐MI at presentation. Methods and Results: We studied 108 women (60 AVSCM, 48 ST segment elevation LAD‐MI). All underwent echocardiography within 48 hours of presentation. 2D longitudinal strain (LS) from an 18‐segment LV model was performed, with global LS (GLS) taken as the average of all 18 segments. GLS was abnormal, but did not differentiate AVSCM from LAD‐MI. Mean LS of the basal and mid‐anterior, basal, and mid‐anteroseptum segments were significantly lower in LAD‐MI vs AVSCM group (−14 ± 9% vs −20 ± 8%; −11 ± 7% vs −14 ± 6%; −9 ± 8% vs −14 ± 8%; −9 ± 7% vs −13 ± 5%, respectively, all P ≤.05). Mean LS of the basal inferior and inferolateral segments was significantly higher in the LAD‐MI vs. AVSCM group (−19 ± 9% vs −13 ± 7%; −23 ± 11% vs −18 ± 7%, respectively, all P ≤.05). Using ROC curve analysis, segmental strain ratio of average basal inferior and inferolateral segments LS to average mid‐ and basal anterior and anteroseptum segments LS of ≥1.58 was 90% specific for LAD‐MI [area under the curve (AUC) 0.87; P <.001]. Conclusion: Longitudinal strain patterns are useful in discriminating AVSCM from LAD‐MI patients at presentation and may be valuable in stratifying patients for invasive evaluation. [ABSTRACT FROM AUTHOR]

Background: Despite speckle tracking echocardiography (STE) has emerged as a sensitive technique for identifying myocardial dysfunction, there are little data available on the appropriate timing to perform STE in the serial assessment after anthracycline administration. Moreover, further uncertainty is increased in the context of STE application in diffuse large B‐cell lymphoma (DLBCL) research, as most recommendations are inferred by studies conducted primarily in breast cancer. Objective: This study aimed to determine whether early measurement of strain parameters derived by STE could predict the development of cardiotoxicity. Methods: Sixty‐five patients were included in the final analysis. The patients were evaluated at baseline, after the third cycle and sixth‐eighth cycle, and during follow‐up. Global longitudinal strain (GLS) was analyzed using STE, and left ventricular ejection fraction (LVEF) was calculated by real time 3D echocardiography (RT3DE). Results: There was a significant decrease in GLS after the third cycle of chemotherapy and remained decreased during subsequent follow‐up, whereas LVEF decreased only at follow‐up. A percentage reduction in GLS of 13.8% between baseline and the third cycle of chemotherapy was the best predictor of further LVEF reduction. Conclusion: Earlier monitoring timing and more accurate assessment methods might be helpful in the prevention of irreversible heart failure. [ABSTRACT FROM AUTHOR]

Background: In orthotopic heart transplant recipients, surveillance with endomyocardial biopsy is crucial to detect acute cellular rejection (ACR) early. ACR is a common and serious complication of transplantation with substantial morbidity and mortality. Speckle tracking echocardiography with global longitudinal strain (GLS) assessment of the left ventricle has emerged as a possible noninvasive screening modality. We have conducted a systematic literature review and meta‐analysis to evaluate the role of GLS in diagnosing ACR. Methods: The following databases were queried: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Embase. We compiled all articles evaluating changes in GLS in comparison to endomyocardial biopsy in ACR dated prior to September 2019. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were pooled by using a random effects model. In order to determine the risk of bias, we used the revised version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool. Results: Twelve studies met inclusion criteria of which ten were chosen. These studies encompassed 511 patients and 1267 endomyocardial biopsies. There was a significant difference in GLS between patients who did and did not have ACR proven by biopsy (WMD = 2.18; 95% CI: 1.57‐2.78, P = <.001; I2 = 76%). The overall sensitivity for GLS in detecting ACR was 78% (CI: 63%‐90%, P =.123; I2 = 52.2%) while the overall specificity was 68% (CI: 50%‐83%, P = <.001; I2 = 88.3%). Conclusion: Global longitudinal strain assessment of the left ventricle by speckle tracking echocardiography is useful in detecting ACR and could potentially reduce the burden of frequent endomyocardial biopsies in heart transplant recipients. [ABSTRACT FROM AUTHOR]

Purpose: In this study, the presence and severity of left ventricular (LV) systolic dysfunction were investigated by speckle tracking echocardiography (STE) technique in patients with mitral triphasic mitral flow pattern (TMFP). The aim of the study was to evaluate the possible role of TMFP in the ethiopathogenesis of congestive heart failure. Methods and results: A total of 45 patients who were diagnosed with TMFP and 30 age‐ and gender‐matched healthy volunteers were included in the study. The mean age in the study and control groups was 64 ± 12 and 62 ± 11 (P =.642), respectively. When echocardiographic parameters were evaluated, LV ejection fraction was found to be 63% ± 14 and 64 ± 12 (P =.745), in the study and control groups, respectively. LV end‐diastolic and systolic diameters and LV mass index were also similar (P <.05). When LV diastolic parameters were compared, diastolic dysfunction was detected in 38 (84.4%) patients in the study population and 13 patients (43.3%) in the control group (P <.001). When STE findings were evaluated, both global longitidunal strain and global circumferential strain were significantly lower in the TMFP group when compared to controls (18.3 ± 1.7 vs 21.5 ± 1.5, P <.001 and 17.9 ± 1.6 vs 21.3 ± 2.1, P <.001, respectively). Conclusion: TMFP results in LV systolic dysfunction. Therefore, these patients may develop congestive heart failure in the long term. It will be rational that the patients with TMFP should be followed up more closely in terms of preventing manifest heart failure symptoms. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate left ventricular functions of obese patients with no known heart disease who underwent laparoscopic sleeve gastrectomy by speckle tracking echocardiography in their early and medium‐term postoperative follow‐up. Patients and Method: Thirty‐seven obese patients (10 M, 27 F) without coronary artery disease or heart failure who had undergone LSG were included in the study. Apical four‐, three‐, and two‐chamber images were analyzed longitudinally by conventional methods and speckle tracking echocardiography (STE) for left ventricle functions preoperatively, at the postoperative Month 1 and at the postoperative Month 6 (QLAB 6.0), using current software. Results: No difference was found between standard echocardiography and Doppler parameters in terms of the 1‐month versus 6‐month follow‐up values compared to baseline. Left ventricular STE longitudinal measurements demonstrated significantly higher longitudinal strain and strain velocity parameters in the follow‐up values at Month 6 compared to the values at Month 1 and at baseline. Global longitudinal strain (GLS) was −17.48 ± 1.09% in 6‐month follow‐up, −16.16 ± 1.26% in 1‐month follow‐up, and −16.06 ± 1.25% at baseline (P < .001). A significant correlation was found between delta GLS, which represents patients' GLS change in 6 months, and delta weight, which represents patients' body weight change in 6 months. Conclusion: Obese patients who had undergone LSG were observed to have improved left ventricular function in the mid‐term. [ABSTRACT FROM AUTHOR]

Background: Speckle tracking echocardiography (STE) is a validated method to measure longitudinal deformation in premature infants, but there is a paucity of data on STE‐derived circumferential and radial strain in this population. We assessed the feasibility and reproducibility of circumferential and radial deformation measurements in premature infants. Methods: In a prospective study of 40 premature infants (<29 weeks of gestation at birth), STE‐derived circumferential and radial strain, systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) were measured on day 2 and day 8. Intra‐ and inter‐observer reproducibility analysis were performed using Bland–Altman analysis, coefficient of variation (COV), and intra‐class correlation coefficient (ICC). The impact of a persistent patent ductus arteriosus (PDA) was analyzed. Results: Deformation analysis was feasible in 98% of the acquisitions. Circumferential parameters demonstrated excellent intra‐ and inter‐observer reproducibility with an ICC between 0.89 and 0.99 (all P < 0.001) and a COV between 4% and 13%. Radial parameters demonstrated acceptable intra‐ and inter‐observer reproducibility with an ICC between 0.73 and 0.96 (all P < 0.001) and a COV between 14% and 27%. Infants with a PDA on day 8 (n = 21, 53%) demonstrated higher radial strain, SRs and SRe. There were no differences in circumferential parameters with a PDA at either time point. Conclusion: This study demonstrates clinical feasibility and reproducibility of circumferential and radial strain by STE in premature infants. A PDA elevates radial deformation measures, suggesting that the increased LV preload from a PDA may augment intrinsic contractility in the radial but not circumferential plane. [ABSTRACT FROM AUTHOR]

Massive and submassive pulmonary thromboembolism carry significant morbidity and mortality. We present an elderly female who was diagnosed with a submassive pulmonary embolism by computed tomographic angiography and treated with ultrasound‐facilitated thrombolysis (UFT). This case demonstrates the usefulness of right ventricular longitudinal strain measurements by two‐dimensional speckle tracking echocardiography in the evaluation of right ventricular function before and after UFT. Evaluation of right ventricle longitudinal strain by speckle tracking echocardiography may supplement other parameters in the assessment of right ventricular function in these patients. [ABSTRACT FROM AUTHOR]

Background: Speckle tracking advancements make now available the analysis of layer‐specific myocardial deformation. This study investigated multilayer longitudinal strain in Anderson–Fabry disease (AFD) patients at diagnosis. Methods: In a case–control study, 33 newly diagnosed, untreated AFD patients and 33 healthy age‐ and sex‐matched healthy controls underwent a complete echocardiogram, including assessment of left ventricular (LV) transmural global longitudinal strain (GLS), subendocardial longitudinal strain (LSsubendo), subepicardial longitudinal strain (LSsubepi), and strain gradient (LSsubendo–LSsubpepi). Results: Anderson–Fabry disease patients had similar blood pressure, heart rate, and ejection fraction but higher body mass index in comparison with controls. LV mass index, maximal, and relative wall thickness were significantly greater in AFD patients. LSsubendo was significantly higher than LSsubepi in both groups, but GLS (P < 0.0001), LSsubendo (P = 0.003), and particularly LSsubepi (21.4 ± 1.7 vs 18.8 ± 1.4%, P < 0.0001) were lower in AFD patients than in controls. Accordingly, LS gradient was higher in AFD patients (P = 0.003). Three patients symptomatic for dyspnoea presented a combination of LV hypertrophy and reduced LSsubepi. After adjusting for confounders by multivariate analyses, LV mass index or maximal wall thickness were independently and inversely associated with transmural GLS and LSsubepi, but not with LSsubendo in the AFD group. At receiver operating curve curves, LSsubepi best discriminated AFD and normals. Conclusions: In newly diagnosed, untreated AFD patients, layer‐specific strain imaging highlights an impairment of LV longitudinal deformation, mainly involving subepicardial strain and causing increase in longitudinal strain myocardial gradient. These findings could be useful for identifying the mechanisms underlying early LV dysfunction in AFD patients. [ABSTRACT FROM AUTHOR]

Purpose: Right ventricular (RV) dysfunction is a common condition that is related to increased adverse outcomes in patients with acute pulmonary embolism (APE). Our aim was to assess timing and magnitude of regional RV function using speckle tracking echocardiography (STE) and to evaluate their relationship to long‐term mortality in patients after APE. Methods: In total, 147 patients were enrolled at the onset of an APE episode and followed for 12 ± 1.1 months. For all patients, the clinical, laboratory, and echocardiography examinations were performed at the diagnosis of APE and at the end of the 1‐year follow‐up. Results: Of the 147 patients, 44 (29.9%) died during the 1‐year follow‐up after APE. The patients who died had lower RV free wall peak longitudinal systolic strains (PLSS) and left ventricular (LV) PLSS and higher RV peak systolic strain dispersion (PSSD) index which means the electromechanical dispersion when compared with the survivors. The difference in time to PLSS between the RV free wall and LV lateral wall (RVF–LVL) which means the electromechanical delay was longer in patients who died than in those who survived during follow‐up, and this difference was an independent predictor of mortality at 1 year of follow‐up after APE, with 86.4% sensitivity and 81.7% specificity. At the end of 1‐year follow‐up, the RV free wall PLSS and the LV global PLSS increased, whereas the RV PSSD index and the difference in time to PLSS between the RVF and LVL decreased. Conclusions: Acute pulmonary embolism was associated with RV dysfunction and RV electromechanical delay and dispersion. These parameters improved at the end of 1‐year follow‐up. The electromechanical delay index might be a useful predictor of mortality in patients after APE. [ABSTRACT FROM AUTHOR]

Objective: To assess left atrial function in type 2 diabetes mellitus (T2DM) patients with nonalcoholic fatty liver disease (NAFLD) by two‐dimensional speckle tracking echocardiography (2D‐STE). Methods: We classified 97 patients with T2DM into three groups according to the results of liver ultrasonography: group A (without NAFLD), group B (mild fatty liver), and group C (moderate to severe fatty liver). Conventional echocardiography parameters included left atrial end‐systolic diameter (LAD), left ventricular end‐systolic and end‐diastolic diameter (LVDs, LVDd), end‐diastolic thickness of ventricular septumi and LV posterior wall (IVSTd, LVPWTd), peak E and A of mitralis (E, A), septal and lateral early (e′) mitral annular diastolic tissue velocities, then calculated E/A and E/mean e′. We measured LV ejection fraction (LVEF) and left atrial (LA) volumes (max, min, and preatrial contraction volume) by Simpson's rule, then calculated LA passive and active ejection fraction (LAPEF, LAAEF), left atrial maximum volume index (LAVImax). The global peak longitudinal systolic strain (LASRs), early diastolic strain (LASRe), and late diastolic strain (LASRa) rates of the LA were obtained by 2D‐STE. Results: No differences were found between groups A and B (all P > 0.05). In group C, LAAEF and LASRa were obviously higher, while LAPEF, LASRe, and LASRs were obviously decreased compared with those values in groups A and B (all P < 0.05). The association between the severity of NAFLD and the differences in LA strain values remained significant after adjustment for confounders. Conclusion: Two‐dimensional speckle tracking echocardiography can evaluate the left atrial function in T2DM patients with NAFLD. [ABSTRACT FROM AUTHOR]

Objectives: The diagnostic difficulty of heart failure with preserved ejection fraction (HFpEF) is differentiating it in patients with similar symptoms and signs. This study aimed to assess the potential predictive value of left ventricular global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), and global area strain (GAS) measured by four‐dimensional speckle tracking echocardiography (4DSTE) combined with red cell distribution width (RDW) in patients with HFpEF. Methods: One hundred and sixty‐nine patients with symptoms or signs indicative of chronic heart failure and a left ventricular ejection fraction (LVEF) ≥ 50% and fifty controls with normal LVEF were recruited in this study. Standard echocardiography and 4DSTE examinations were performed. Laboratory examinations including RDW were performed on the same day as the echocardiographic study. Results: GLS, GCS, GRS, and GAS in the patient cohort were significantly lower, and RDW was significantly higher than those in the control cohort (P < 0.01), and the strain parameters in definite HFpEF patients were also dramatically lower than the rest patients (P < 0.01). The associations of age, gender, NYHA classification, hypertension history, left ventricular end‐diastolic volume index, interventricular septal thickness, and diastolic dysfunction with HFpEF were significantly improved by adding 4DSTE parameters (P < 0.01) and further improved by adding RDW (P < 0.01). Conclusions: In suspected HFpEF patients, who have symptoms or signs of heart failure, even without other conventional evidence of this diagnosis, GLS, GRS, and GCS have potential independent predictive value, while RDW has independent incremental predictive value for HFpEF. [ABSTRACT FROM AUTHOR]

We describe a Fontan patient with severe heart failure who was successfully treated with biventricular cardiac resynchronization therapy (CRT). Our case shows that strain imaging might play a crucial role in guiding placement of pacing leads and in characterizing the electromechanical substrate associated with a favorable CRT response. Furthermore, we demonstrate for the first time that ventriculo‐ventricular interdependency seems an important mechanical concept, which can be utilized to augment cardiac performance in failing Fontan patients with a functional hypoplastic ventricle. [ABSTRACT FROM AUTHOR]