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Background: The new three-dimensional speckle tracking echocardiography (3DSTE) may enable comprehensive quantification of global left ventricular (LV) myocardial mechanics., Methods: Twenty-four patients aged 29.3 ± 5.2 years and 22 controls were studied. 3DSTE was performed to assess LV 3D global strain, twist and torsion, ejection fraction, and systolic dyssynchrony index (SDI). The LV SDI was calculated as % of SD of times-to-peak strain of 16 segments/RR interval. The global performance index (GPI) was calculated as (global 3D strain·torsion)/SDI. Area under the receiver operating characteristic curve (AUC) was calculated to determine the capability of 3DSTE parameters to discriminate between patients with (cardiac magnetic resonance T2* <20 ms) and those without myocardial iron overload., Results: Compared with controls, patients had significantly lower LV global 3D strain (P < 0.001), twist (P = 0.01), torsion (P = 0.04), and ejection fraction (P < 0.001) and greater SDI (P < 0.001). The GPI was lower in patients than controls (P < 0.001). T2* value correlated positively with global 3D strain (r = 0.74, P < 0.001) and GPI (r = 0.63, P = 0.001), and negatively with SDI (r = -0.44, P = 0.03). The AUCs of GPI, global 3D strain, ejection fraction, torsion, and 1/SDI were 0.94, 0.90, 0.87, 0.82, and 0.70, respectively. The GPI cutoff of 2.7°/cm had a sensitivity of 94.9% and a specificity of 88.9% of differentiating patients with from those without myocardial iron overload., Conclusions: The LV composite index of strain, torsion, and dyssynchrony derived from 3DSTE enables sensitive detection of myocardial iron overload in patients with thalassemia., (© 2016, Wiley Periodicals, Inc.)

Background: This study tested the hypothesis that right atrial (RA) mechanics are altered in patients after repair of pulmonary atresia with intact ventricular septum (PAIVS) and pulmonary stenosis (PS) and to explore their relationships with right ventricular (RV) diastolic function and P-wave indices., Methods: Thirty-six adult patients, 16 with PAIVS and 20 with PS patients, and 20 age-matched healthy subjects were studied. Right atrial mechanics were assessed using speckle tracking echocardiography (STE) with quantification of positive, negative, and total strain, and strain rates at ventricular systole (aSRs ), early diastole (aSRed ), and atrial contraction (aSRac ). Right ventricular diastolic function was assessed by Doppler interrogation and STE. Maximum P-wave duration and P-wave dispersion were measured., Results: Compared with controls, PAIVS and PS patients had significantly lower RA positive and total strain, aSRs and aSRed (all P < 0.05). Parameters of RV diastolic function including transtricuspid early (E) and late (A) diastolic inflow velocities, E/A ratio, early diastolic tricuspid annular velocity (e), early to late diastolic annular velocity ratio, E/e ratio, and RV early diastolic strain rate were found to correlate significantly with RA positive and total strain and aSRed (all P < 0.05). Maximum P-wave duration and P-wave dispersion increased progressively across control, PS, and PAIVS groups (P for trend <0.001). Both P-wave indices correlated negatively with RA positive strain, total strain, and aSRed (all P < 0.05)., Conclusion: Impairment of RA mechanics occurs in patients long term after repair of PAIVS and PS and is associated with RV diastolic dysfunction, longer P-wave duration, and greater P-wave dispersion., (© 2015, Wiley Periodicals, Inc.)

Background: Ventricular diastolic dysfunction in patients with repaired tetralogy of Fallot (TOF) may affect atrial mechanics. This study aimed to explore right atrial (RA) and left atrial (LA) mechanics in repaired TOF patients and their relationship with ventricular diastolic function., Methods: Fifty-four patients (36 males), aged 17.8 ± 8.3 years, who had undergone TOF repair at 3.9 ± 3.3 years and 40 healthy subjects aged 16.9 ± 6.3 years (P = 0.57) were studied. Right and LA peak positive, peak negative, and total strain, strain rate at ventricular systole (SRs ), early diastole (SRed ), and atrial contraction (SRac ), and electromechanical delay were determined using speckle tracking echocardiography (STE). Ventricular diastolic function was assessed by tissue Doppler imaging and STE. Ventricular volumes and pulmonary regurgitant volume were derived from 3D echocardiography., Results: Compared with controls, patients had significantly lower RA and LA peak positive and total strain, SRs , SRed , and SRac (all P < 0.001). The timing of RA (178 ± 33 msec vs. 152 ± 17 msec, P < 0.001) and LA (170 ± 32 msec vs. 152 ± 24 msec, P = 0.006) electromechanical coupling (EMC) was significantly longer in patients than in controls. The RA total strain, SRs , SRed , SRac , and EMC correlated positively with corresponding LA parameters (all P < 0.001). The RA and LA total strain and SRed were associated positively with diastolic annular velocities and strain rates of respective ventricles (all P < 0.05). The LA SRed correlated negatively with pulmonary regurgitant volume (r = -0.33, P = 0.016) and RV end-diastolic volume (r = -0.33, P = 0.015)., Conclusion: Mechanics of both atria are impaired in patients after repair of TOF and are associated with diastolic performance of the respective ventricles., (© 2014, Wiley Periodicals, Inc.)

Background: Myocardial fibrosis and perfusion abnormalities can occur in patients with Kawasaki disease (KD). We explored using the new three-dimensional speckle tracking echocardiography (3DSTE) the left ventricular (LV) mechanics in adolescents and young adults with a history of KD., Methods: Twenty-five KD patients (18 males) aged 17.0 ± 5.2 years, 14 with (group I) and 11 without (group II) coronary aneurysms, were studied. The 3D volume datasets were acquired for quantification of LV global 3D strain, global and regional area strain, systolic dyssynchrony index (SDI), twist, twist gradient (twist/LV length), and ejection fraction., Results: The results were compared with those of 14 age-matched controls. Of the 14 group I patients, 6 had left, 2 had right, and 6 had both left and right coronary aneurysms. Compared with controls, group I patients had significantly lower LV systolic global 3D strain (43.7 ± 7.3% vs. 50.4 ± 6.6%, P = 0.02), twist (8.7 ± 1.3° vs. 11.4 ± 2.0°, P < 0.001), and twist gradient (1.5 ± 0.3°/cm vs. 1.9 ± 0.4°/cm, P = 0.01), greater SDI (6.8 ± 1.9% vs. 4.7 ± 1.9%, P < 0.001), and similar ejection fractions. Six patients in group I had perfusion defects, who had global 3DSTE parameters similar to those of the 8 patients without perfusion abnormalities (all P > 0.05). For group II patients, only the global area strain was significantly lower than that of controls (37.6 ± 3.5% vs. 40.7 ± 3.6%, P = 0.038)., Conclusion: In adolescents and young adults with a history of KD, impairment of LV mechanics occurs and is worse in patients with than those without coronary complications., (© 2013, Wiley Periodicals, Inc.)

Background: Anthracycline has been shown to degrade titin that plays a role in myocardial twisting and untwisting. This study aimed to test the hypothesis that left ventricular (LV) twisting and untwisting motion may be altered in children after anthracycline therapy., Methods: Thirty-six childhood leukemia survivors aged 15.6 ± 5.5 years and 20 healthy controls aged 16.8 ± 7.7 years (P = 0.54) were studied. LV twisting and untwisting motion was determined using speckle tracking imaging, whereas LV ejection fraction and systolic and diastolic mitral annular velocities were determined respectively by three-dimensional and tissue-Doppler echocardiography., Results: Compared with controls, patients had significantly lower LV ejection fraction (P = 0.01) but similar systolic and diastolic mitral annular velocities (all P > 0.05). Their peak LV torsion (P = 0.003), systolic twisting velocity (P < 0.001), and diastolic untwisting velocity (P = 0.04) were significantly lower than controls, which could be attributable to their reduced apical rotation (P = 0.03) and apical untwisting rate (P = 0.002). For the whole cohort, LV systolic torsion and twisting velocity correlated significantly with apical untwisting rate (P < 0.001) and LV diastolic untwisting velocity (P < 0.001). In patients, none of the twisting or untwisting parameters were found to correlate with cumulative anthracycline dose (all P > 0.05). Twenty-eight (78%) patients had LV ejection fractions ≥50%. Although their systolic and diastolic mitral annular velocities were similar to those of controls, their peak LV torsion (P = 0.005), apical untwisting rate (P = 0.01), and LV systolic twisting velocity (P = 0.001) remained significantly lower., Conclusion: Impairment of LV twisting and untwisting motion is evident in children after anthracycline therapy, even in those with "normal" LV ejection fractions., (© 2011, Wiley Periodicals, Inc.)

Background: Increasing data suggest that parameters of myocardial deformation are strong indices of ventricular systolic and diastolic function. We sought to determine myocardial deformation of the left ventricle and assess relationship of deformation rates with myocardial iron load in patients with beta-thalassemia major., Methods: The left ventricular longitudinal, circumferential, and radial myocardial deformation was determined using speckle tracking echocardiography in 42 thalassemia patients aged 24.4 +/- 6.4 years. The results were compared with those of 38 age-matched controls. The rates of longitudinal and circumferential deformation were correlated with cardiac T2* magnetic resonance findings., Results: Compared with controls, patients had significantly greater global systolic radial strain (P = 0.001), but similar global systolic longitudinal (P = 0.12) and circumferential strain (P = 0.84). On the other hand, patients had significantly lower longitudinal systolic strain rate (SR) (P = 0.019), longitudinal early diastolic SR (P = 0.036), and circumferential early diastolic SR (P = 0.04) than controls. The cardiac T2* findings correlated positively with longitudinal (r = 0.44, P = 0.004) and circumferential early diastolic SR (r = 0.37, P = 0.019), but not with the respective systolic SRs and left ventricular ejection fraction (all P > 0.05). Patients with iron overload (T2*< 20 msec), compared to those without, had significantly lower longitudinal (1.45 +/- 0.33/sec vs. 1.76 +/- 0.27/sec, P = 0.002) and circumferential (1.01 +/- 0.31/sec vs. 1.22 +/- 0.31/sec, P = 0.03) early diastolic SR., Conclusions: Patients with beta-thalassemia major have reduced longitudinal systolic SR, longitudinal early diastolic SR, and circumferential early diastolic SR. The rates of diastolic deformation in the longitudinal and circumferential dimensions are inversely related to myocardial iron overload.