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Bariatric surgery may have an effect on myocardial mechanics in individuals with obesity and diabetes. In this study, two-dimensional speckle-tracking echocardiography was applied to evaluate the changes of left ventricular myocardial mechanics in individuals with obesity and diabetes before and after bariatric surgery. A total of 58 individuals with obesity were divided into an obesity-only group (30 patients) and an obesity + diabetes group (28 patients). Routine echocardiographic parameters and left ventricular global longitudinal strain (GLS) were compared between the two groups at baseline and 6 and 12 months postoperatively. At all three time points, GLS was lower in the obesity + diabetes group than in the obesity-only group. In both groups, the GLS increased successively at 6 and 12 months postoperatively. The change in GLS (∆GLS) from baseline to 6 months was higher than the △GLS from 6 to 12 months in both groups. The △GLS from baseline to 6 months was lower in the obesity + diabetes group than in the obesity-only group. Therefore, obese individuals can benefit from bariatric surgery, which includes improved heart function, delayed disease progression. [ABSTRACT FROM AUTHOR]

Background: A leadless pacemaker (LP) is a modern alternative to a transvenous pacemaker, allowing certain complications to be avoided; however, some cannot be eliminated. Aim: To highlight the essential role of advanced speckle-tracking echocardiography (STE) in diagnosing pacing-induced cardiomyopathy (PICM) caused by an LP. Clinical case: A 79-year-old male, after LP implantation a year earlier, was admitted due to heart failure (HF). Left ventricular ejection fraction (LVEF) was 40%, global longitudinal strain (GLS) was −10%, and interventricular mechanical delay (IVMD) was 42 ms. All these parameters were significantly better before the operation. Myocardial work indices confirmed dyssynchrony due to the right ventricular (RV) stimulation pattern, and PICM was considered. To verify the impact of RV pacing on the LV, measurements were taken after restoring the native rhythm, showing an improvement in LVEF (45%), GLS (−13%), IVMD (7 ms), and myocardial work indices. After the next HF exacerbation with further deterioration of the LV function, a decision to convert the LP to a standard CRT-P system was made, with immediate relief in clinical symptoms and improved echocardiographic parameters. Conclusions: This case highlights the essential role of STE echocardiography in identifying the detrimental impact of RV pacing, diagnosing PICM, and selecting the appropriate treatment for patients with LPs. [ABSTRACT FROM AUTHOR]

Background: The assessment of left ventricular (LV) filling pressure in heart failure (HF) poses a diagnostic challenge, as HF patients may have normal LV filling pressures at rest but often display elevated LV filling pressures during exercise. Rapid preload increase during passive leg lift (PLL) may unmask HF in such challenging scenarios. We explored the dynamic interplay between simultaneous left atrial (LA) function and volume using LA strain/volume loops during rest and PLL and compared its diagnostic performance with conventional echocardiographic surrogates to detect elevated LV filling pressure. Methods: We retrospectively reviewed 35 patients with clinical HF who underwent simultaneous echocardiography and right heart catheterization before and immediately after PLL. Patients with atrial fibrillation (n = 4) were excluded. Twenty age-matched, healthy controls were added as controls. LA reservoir strain (LASr) was analyzed using speckle-tracking echocardiography. LA strain–volume loops were generated, including the best-fit linear regression line employing simultaneous LASr and LA volume. Results: LA strain–volume slope was lower for HF patients when compared with controls (0.71 vs. 1.22%/mL, p < 0.001). During PLL, the LA strain–volume slope displayed a moderately strong negative correlation with invasive pulmonary arterial wedge pressure (PAWP) (r = −0.71, p < 0.001). At a 0.74%/mL cut-off, the LA strain–volume slope displayed 88% sensitivity and 86% specificity to identify elevated PAWP (AUC 0.89 [0.76–1.00]). In comparison, LASr demonstrated strong but numerically lower diagnostic performance (AUC 0.82 [0.67–0.98]), and mitral E/e' showed poor performance (AUC 0.57 [0.32–0.82]). Conclusions: In this proof-of-concept study, LA strain–volume characteristics provide incremental diagnostic value over conventional echocardiographic measures in the identification of elevated LV filling pressure. [ABSTRACT FROM AUTHOR]

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It has been a challenging work to identify and assess neonatal pulmonary hypertension (PH). Right ventricular longitudinal strain (RVLS) is primarily used in evaluating right ventricular (RV) systolic function. This study aimed to investigate the association of the changes in segmental and global RVLS with neonatal PH, hoping to provide a new marker for indicating neonatal PH other than obtaining information on RV function. This was a cross-sectional study with 62 neonates, generally divided into PH and non-PH groups confirmed by echocardiography. For 30 infants later diagnosed with bronchopulmonary dysplasia (BPD), specific analysis was conducted by subdividing them into BPD with and without PH subgroups. Conventional echocardiography markers and the global and segmental RVLS were measured and compared. Their diagnostic performance in evaluating PH was analyzed. Regardless of grouping, the biventricular function of all infants was similar and in normal range. No significant difference was found in global strain parameters, either. In the case of PH, tricuspid regurgitant velocity (TRV), left ventricle systolic eccentricity index (LVsEI), and the basal-to-apical strain ratio (Ratio bas/api) of RV free wall (RVFW) were significantly higher (P < 0.001, P < 0.05, P < 0.05). By contrast, the magnitude of apical segmental strain reduced significantly (P < 0.05) and was significantly lower than that of basal segmental strain in BPD with PH subgroup (P = 0.024). The area under the curve values for Ratio bas/api was highest (0.846), followed by LVsEI (0.746) and apical segmental strain (0.272). Conclusion: As a relatively standardized parameter, Ratio bas/api of RVFW was significantly higher in the case of neonatal PH with normal cardiac function and could be regarded as a new indicator for PH. What is Known: • It has been challenging work to diagnose neonatal pulmonary hypertension (PH), and conventional echocardiography has been widely applied, though it is not sufficient enough. • RV longitudinal strain (RVLS) is primarily used to assess RV systolic function, and its role in diagnosing PH was rarely considered. What is New: • The basal-to-apical strain ratio (Ratio bas/api) of RV free wall increased significantly in all infants with PH regardless of causes. • As a relatively standardized parameter, Ratio bas/api could be regarded as a new indicator for diagnosing PH, apart from conventional echocardiographic parameters. [ABSTRACT FROM AUTHOR]

Despite increased availability of effective drug therapy for treatment of heart failure (HF), the morbidity and mortality in chronic heart failure (CHF) are unacceptably high. Therefore, there is an urgent need to ascertain new imaging techniques to identify early sub-clinical forms of cardiac dysfunctions, to guide early relevant treatment. It seems that all the behavioral risk factors—such as tobacco, alcoholism, Western-type diet, sedentary behavior and obesity, emotional disorders, and sleep disorder are associated with early cardiac dysfunction, which may be identified by speckle-tracking echocardiography (STE). Cardiac remodeling can also occur chronologically in association with biological risk factors of CHF, such as diabetes mellitus (DM), hypertension, cardiomyopathy, valvular heart disease, and coronary artery disease (CAD). In these conditions, twisting and untwisting of the heart, cardiac fibrosis, and hypertrophy can be identified early and accurately with 2-Dimentional (2D) and 3D echocardiography (2D echo and 3D echo) with tissue Doppler imaging (TDI), strain imaging via STE, and cardiac magnetic resonance imaging (CMR). Both 2D and 3D echo with STE are also useful in the identification of myocardial damage during chemotherapy and in the presence of risk factors. It is possible that global longitudinal systolic strain (GLS) obtained by STE may be an accurate marker for early identification of the severity of CAD in patients with non-ST segment elevation MI. Left ventricular ejection fraction (LVEF) is not the constant indicator of HF and it is normal in early cardiac dysfunction. In conclusion, this review suggests that GLS can be a useful early diagnostic marker of early or pre-cardiac dysfunction which may be treated by suitable drug therapy of HF along with the causes of HF and adhere to prevention strategies for recurrence. In addition, STE may be a superior clinical tool in the identification of cardiac dysfunction in its early stages compared to ejection fraction (EF) based on conventional echocardiography. Therefore, it is suggested that the chances of either stalling or reversing HF are far better for patients who are identified at an early stage of the disease. [ABSTRACT FROM AUTHOR]

Aims Assessment of cardiac structure and function improves risk prediction of new-onset atrial fibrillation (AF) in different populations. We aimed to comprehensively compare standard and newer measures of cardiac structure and function in improving prediction of AF in a cohort of older adults without history of AF and stroke. Methods and results We included 5050 participants without prevalent AF and stroke (mean age 75 ± 5 years, 59% women, and 22% Black) from the Atherosclerosis Risk in Communities (ARIC) study who underwent complete two-dimensional echocardiography, including speckle-tracking analysis of the left ventricle (LV) and left atrium (LA). We assessed the association of cardiac measures with incident AF (including atrial flutter) and quantified the extent to which these measures improved model discrimination and risk classification of AF compared with the CHARGE-AF score. Over a median follow-up time of 7 years, 676 participants developed AF (incidence rate 2.13 per 100 person-years). LV mass index and wall thickness, E/e′, and measures of LA structure and function, but not LV systolic function, were associated with incident AF, after accounting for confounders. Above all, LA reservoir strain, contraction strain, and LA minimal volume index (C -statistics [95% confidence interval]: 0.73 [0.70, 0.75], 0.72 [0.70, 0.75], and 0.72 [0.69, 0.75], respectively) significantly improved the risk discrimination of the CHARGE-AF score (baseline C -statistic: 0.68 [0.65, 0.70]) and achieved the highest category-based net reclassification improvement (29%, 24%, and 20%, respectively). Conclusion In a large cohort of older adults without prevalent AF and stroke, measures of LA function improved the prediction of AF more than other conventional cardiac measures. [ABSTRACT FROM AUTHOR]

Abstract Background Previous studies on the relation of sST2 with atherosclerotic disease mostly focused on the predictive value of sST2 for heart failure. However, there is no definite conclusion about the correlation between sST2 level and a complex coronary lesion morphology detected with coronary angiography (CAG). The purpose of this work was to know sST2 level and 3D speckle-tracking echocardiography as predictor of coronary artery disease (CAD) severity in chronic coronary syndrome (CCS) individuals using Gensini score. This prospective cohort work was performed on 90 participants aging from 18 to 80 years old, both sexes, with stable angina pectoris. Participants had been categorized into three groups: Group I (n = 30): control group scheduled by normal coronary angiography and group II (n = 60): case group which subdivided according to Gensini score into two equal subgroups: IIa: simple lesion (Gensini score

Introduction: This pilot study explores whether left ventricular global longitudinal strain (LV GLS), measured by two-dimensional (2D) speckle-tracking echocardiography (STE), can predict cardiovascular events in patients with left ventricular systolic dysfunction (LVSD), including those with ischemic and nonischemic dilated cardiomyopathy, postvalve surgery, and chemotherapy recipients, compared to traditional parameters such as left ventricular ejection fraction (LVEF) and wall motion score index (WMSI). Materials and Methods: This retrospective study included 45 patients from a tertiary care center, with global longitudinal strain measurements taken between July 2022 and October 2023. Echocardiographic data, including LV-GLS, LVEF, and WMSI, were collected, alongside monitoring for cardiovascular events such as heart failure hospitalizations, cardiac mortality, and all-cause mortality. Results: In a study involving 45 patients (mean age: 57.9 years, 31.1% females), 17.8% experienced events. Patients with events exhibited significantly lower LV GLS values (P = 0.002), reduced LVEF (P = 0.002), and higher WMSI (P = 0.001). Mortality was higher in patients with LVEF

Background: Short-term blood pressure variability (BPV) has been associated with adverse cardiovascular outcomes, but its impact on left atrium (LA) function and structure remains unclear. This study aims to explore the relationship between short-term BPV and LA function in patients with controlled and uncontrolled hypertension, using speckle-tracking echocardiography (STE). Methods: In this cross-sectional study, 150 hypertensive patients were recruited and categorized into controlled and uncontrolled hypertension groups based on ambulatory blood pressure (BP) monitoring. BPV was calculated from 24-h ambulatory BP recordings, and LA function was assessed using STE to measure LA volume, strain, and strain rate parameters. Univariate and multivariate analyses were performed to investigate associations between BPV and LA functions. Results: Higher short-term BPV was significantly associated with impaired LA function, including reduced LA strain and increased LA volume index, in both hypertensive groups. After adjusting for confounding factors such as age, body mass index, and duration of hypertension, BPV remained an independent predictor of LA dysfunction (P < 0.01). The relationship was more pronounced in the uncontrolled hypertension group. Conclusion: Short-term BPV is independently associated with left atrial dysfunction in hypertensive patients, particularly in those with uncontrolled hypertension. These findings suggest that BPV could serve as a potential marker for early left atrial remodeling in hypertensive populations, providing insights for better risk stratification and management.

Abstract Background Speckle tracking echocardiography (STE) provides quantification of left ventricular (LV) deformation and is useful in the assessment of LV function. STE is increasingly being used clinically, and every effort to simplify and standardize STE is important. Manual outlining of regions of interest (ROIs) is labor intensive and may influence assessment of strain values. Purpose We hypothesized that a deep learning (DL) model, trained on clinical echocardiographic exams, can be combined with a readily available echocardiographic analysis software, to automate strain calculation with comparable fidelity to trained cardiologists. Methods Data consisted of still frame echocardiographic images with cardiologist-defined ROIs from 672 clinical echocardiographic exams from a university hospital outpatient clinic. Exams included patients with ischemic heart disease, heart failure, valvular disease, and conduction abnormalities, and some healthy subjects. An EfficientNetB1-based architecture was employed, and different techniques and properties including data set size, data quality, augmentations, and transfer learning were evaluated. DL predicted ROIs were reintroduced into commercially available echocardiographic analysis software to automatically calculate strain values. Results DL-automated strain calculations had an average absolute difference of 0.75 (95% CI 0.58–0.92) for global longitudinal strain (GLS), and 1.16 (95% CI 1.03–1.29) for single-projection longitudinal strain (LS), compared to operators. A Bland–Altman plot revealed no obvious bias, though there were fewer outliers in the lower average LS ranges. Techniques and data properties yielded no significant increase/decrease in performance. Conclusion The study demonstrates that DL-assisted, automated strain measurements are feasible, and provide results within interobserver variation. Employing DL in echocardiographic analyses could further facilitate adoption of STE parameters in clinical practice and research, and improve reproducibility.

Abstract Aims Novel echocardiographic parameters of right ventricular (RV) function, including speckle‐tracking‐derived, three‐dimensional, and RV–pulmonary artery coupling parameters, have emerged for the evaluation of pulmonary arterial hypertension (PAH). The relative role of these parameters in the risk stratification of PAH patients is unclear. We compared the performance of multiple RV parameters and sought to establish an optimal model for identifying the risk profile of patients with PAH. Methods and results Comprehensive risk assessments were performed for 70 patients with PAH. The risk profile of every patient was determined based on the guideline recommendations. Conventional parameters, including fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), novel speckle‐tracking‐derived RV longitudinal strain (RVLS), and three‐dimensional RV ejection fraction (3D‐RVEF), were used to evaluate RV function. Pressure–strain loops were measured for the assessment of RV myocardial work, including RV global wasted work (RVGWW). RV–pulmonary artery coupling was assessed by indexing RV parameters to the estimated pulmonary artery systolic pressure (PASP). The median age was 34 (30–43) years, and 62 (88.6%) patients were female. Forty‐five patients were classified into the low‐risk group, while 25 patients were classified into the intermediate–high‐risk group. Most RV parameters could be used to determine the risk profile and exhibited significantly improved diagnostic performance after indexing to PASP (including FAC/PASP, TAPSE/PASP, and 3D‐RVEF/PASP). RVLS/PASP showed the best performance, with an area under the curve of 0.895. In multivariate analysis (Model 1), only RVGWW (>90.5 mmHg%), RVLS (> −16.7%), and TAPSE ( −0.275 [odds ratio (OR) 20.63, 95% confidence interval (CI) 4.62–92.11, P 90.5 mmHg% (OR 6.17, 95% CI 1.37–27.76, P = 0.018) independently identified a higher risk profile. The addition of RVGWW to two models determined incremental value in identification (continuous net reclassification improvement 1.058, 95% CI 0.639–1.477, P

Abstract Aims The COVID‐19 infection has been described as affecting myocardial injury. However, the relation between left ventricular global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), disease severity and all‐cause mortality in COVID‐19 is unclear. Methods and Results The study consisted of 220 patients with COVID‐19, including 127 (57.5%) with mild, 43 (19.5%) with moderate and 50 (22.7%) with severe/critical conditions. Myocardial dysfunction was analysed by GLS, GCS and GRS using two‐dimensional speckle‐tracking echocardiography. Hazard ratios and Kaplan–Meier curves were produced to assess the association between strains and cardiac biomarker indices with a composite outcome of all‐cause mortality. With an average follow‐up period of 11 days, 19 patients reached the endpoint (death). Significant associations were found for the three strain parameters and the levels of blood urea nitrogen (BUN) (r = 0.206, 0.221 and 0.355, respectively). Cardiac troponin I (cTnI) was closely related to the GLS and GCS (r = 0.240 and 0.324, respectively). In multivariable Cox regression, GCS > −21.6% was associated with all‐cause death {hazard ratio, 4.007 [95% confidence interval (CI), 11.347–11.919]}. Conclusions GLS, GCS and GRS are significantly related to myocardial dysfunction in patients with COVID‐19. Worsening GCS poses an increased risk of death in COVID‐19.

Abstract Establishing normal values of left atrial (LA) phasic strains and strain rates is essential for distinguishing between normal and abnormal functions, determining the degree of abnormality, and understanding the clinical significance of reported values in pediatrics. This meta-analysis aimed to establish normal values of two-dimensional speckle-tracking echocardiography (2DSTE)-derived LA phasic strains and strain rates in the pediatric population and identify the sources of inter-study heterogeneity for these values. A comprehensive search of PubMed, Scopus, and Embase databases was conducted using keywords such as “left atrial/left atrium,” “strain/speckle/deformation,” and “echocardiography” combined with pediatric age categories. Inclusion criteria comprised English-language human studies involving healthy subjects under 18 years of age. Subjects were categorized as neonates (up to 1 month), infants (1–12 months), and children (1–18 years). A random-effects model was applied to determine 2DSTE-derived LA strains and strain rates, and a meta-regression analysis was performed to investigate inter-study heterogeneity. Our analysis included 17 studies involving 1448 healthy subjects. For children, the mean values of LA strains during the reservoir, conduit, and contraction phases were 47.3% (95% CI 42.5–52.1%), 32.8% (95% CI 27.8–37.8%), and 12% (95% CI 10.0–14.1%), respectively. The mean values for LA strain rates were 2.4 s−1 (95% CI 1.1–3.8 s−1), 4.3 s−1 (95% CI 0.6–8.0 s−1), and 2.4 s−1 (95% CI 0.4–4.5 s−1), respectively. Inter-study heterogeneity for 2DSTE-derived LA phasic strains and strain rates was attributed to factors such as the number of study participants, publication year, software utilized, gating methods, the number of analyzed segments, the geographical region of the study, and heart rate. This study established the normal range of 2DSTE-derived LA phasic strains and strain rates. Additionally, inter-study heterogeneity was found to be influenced by various demographic, physiologic, and methodological factors.

Abstract Background It is widely recognized that the right ventricle plays a significant role in the prognosis of numerous diseases. However, the assessment of right ventricular function (RV) has not been given much attention until recently. This study used speckle-tracking echocardiography (STE) to assess RV functions in ischemic cardiomyopathy (ICM) patients. Results This study included 74 patients diagnosed with ischemic cardiomyopathy (ICM) and an ejection fraction (EF) of less than 50%. Although all the selected patients had normal RV systolic function by tricuspid annular plane systolic excursion (TAPSE), a considerable percentage of them had subtle RV systolic dysfunction, which could be identified by right ventricular free wall longitudinal strain (RV FWLS) (36.5%) and right ventricular global longitudinal strain (RV GLS) (55.4%). Moreover, the mean RV FWLS was significantly higher than RV GLS (− 20.4 ± 5.08% vs. − 17.5 ± 6.89%), respectively. Advanced left ventricle (LV) adverse remodeling was associated with subtle RV dysfunction. Using multivariate regression analysis, increased E/e' (p = 0.016, CI 1.135–3.423) and RV myocardial performance index (MPI) (p = 0.007, CI 0.000–0.007) were identified as independent factors of impaired RV FWLS with the greatest effectiveness. Conclusion When standard RV measures are normal in patients with ICM, RV systolic strain analysis offers an incremental utility to detect subtle abnormalities in RV function, especially in resource-constrained settings where cardiac magnetic resonance (CMR) is not practical.

Abstract Left ventricular (LV) hypertrophy (LVH) is frequently observed in patients with hypertension (HTN). LV myocardial work (MW) has recently emerged as a non‐invasive method to assess systolic myocardial deformation relative to afterload conditions. The authors investigated the characteristics of myocardial work with different degrees of LVH in HTN patients. From December 2020 to February 2024, 255 HTN patients and 26 healthy controls undergoing transthoracic echocardiography were included in the current study. Hypertension patients were divided into quintile groups based on left ventricular mass index (LVMI), for the first to fourth LVMI quantiles, global work index (GWI) and global constructive work (GCW) were higher compared to the control group, but the difference was not statistically significant. In the sixth LVMI quantile, GWI and GCW showed a significant decrease. The restricted cubic splines showed that both GWI and GCW exhibited an inverted U‐shaped relationship with LVMI. A LVMI of >151.39 g/m2 could accurately predict reduction both in GWI and GCW (Sensitivity: 0.78, Specificity: 0.89, AUC: 0.90, P

Background: Speckle tracking echocardiography (STE) provides quantification of left ventricular (LV) deformation and is useful in the assessment of LV function. STE is increasingly being used clinically, and every effort to simplify and standardize STE is important. Manual outlining of regions of interest (ROIs) is labor intensive and may influence assessment of strain values. Purpose: We hypothesized that a deep learning (DL) model, trained on clinical echocardiographic exams, can be combined with a readily available echocardiographic analysis software, to automate strain calculation with comparable fidelity to trained cardiologists. Methods: Data consisted of still frame echocardiographic images with cardiologist-defined ROIs from 672 clinical echocardiographic exams from a university hospital outpatient clinic. Exams included patients with ischemic heart disease, heart failure, valvular disease, and conduction abnormalities, and some healthy subjects. An EfficientNetB1-based architecture was employed, and different techniques and properties including data set size, data quality, augmentations, and transfer learning were evaluated. DL predicted ROIs were reintroduced into commercially available echocardiographic analysis software to automatically calculate strain values. Results: DL-automated strain calculations had an average absolute difference of 0.75 (95% CI 0.58–0.92) for global longitudinal strain (GLS), and 1.16 (95% CI 1.03–1.29) for single-projection longitudinal strain (LS), compared to operators. A Bland–Altman plot revealed no obvious bias, though there were fewer outliers in the lower average LS ranges. Techniques and data properties yielded no significant increase/decrease in performance. Conclusion: The study demonstrates that DL-assisted, automated strain measurements are feasible, and provide results within interobserver variation. Employing DL in echocardiographic analyses could further facilitate adoption of STE parameters in clinical practice and research, and improve reproducibility. [ABSTRACT FROM AUTHOR]

The assessment of left atrial strain (LAS) has emerged as an essential component in the evaluation of cardiac function, especially in pathologies such as heart failure and atrial fibrillation. This narrative review aims to outline the available methods for assessing LAS with a major emphasis on speckle-tracking echocardiography techniques. Other imaging modalities, including cardiac magnetic resonance and cardiac computed tomography, also provide important information on LA dynamics but have disadvantages with respect to cost and availability. The current narrative review underlines basic concepts such as the accurate assessment of LAS and discusses the clinical relevance of LAS by pointing out its significant diagnostic and prognostic role in several cardiovascular conditions. The aim of this article is to discuss the current integration of LAS into clinical practice with a view to further improving patient management and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Left ventricular (LV) apical aneurysms (ApAn+) occur in 10%–15% of apical hypertrophic cardiomyopathy (ApHCM) patients and confer considerable morbidity. We hypothesized that ApAn+ adversely impact ventricular mechanics and mechano‐energetic coupling in ApHCM. Methods: Ninety‐eight ApHCM patients were identified, of which nine (9%) had ApAn+ and were compared with 89 (91%) who did not (ApAn−). 2D speckle‐tracking echocardiography assessed ventricular mechanics using LV global longitudinal strain (GLS) and torsion, and mechano‐energetic coupling as myocardial work indices. Clinical events over follow‐up were adjudicated. Results: Mean age was 64 ± 15 years, 46% were female, and 3% had an HCM family history, with similar clinical risk factors between groups. Of the nine ApAn+ patients, there were six small (<2 cm) and three moderate‐sized (2‐4 cm) aneurysms. There was no difference in LV ejection fraction (65 ± 15 vs. 67 ± 11%, p = 0.51) or GLS (−9.6 ± 3.3 vs. −11.9 ± 3.9%, p = 0.09) between ApAn+ versus ApAn−. ApAn+ patients had greater myocardial global wasted work (347 ± 112 vs. 221 ± 165 mmHg%, p = 0.03) and lower global work efficiency (GWE, 75 ± 5 vs. 82 ± 8%, p = 0.006). LV GLS (β = −0.67, p < 0.001), ApAn+ (β = −0.15, p = 0.04), and twist rate (β = −0.14, p = 0.04) were independently associated with GWE. At 3.9‐year follow‐up, cardiovascular mortality (4%) and heart failure hospitalization (14%) events were similar between groups. Conclusion: ApHCM patients with ApAn+ are characterized by more impaired LV mechano‐energetic coupling when compared with ApAn−. ApAn+ is independently associated with worse GWE. [ABSTRACT FROM AUTHOR]

Background: MYH6 variants are the most well-known genetic risk factor (10%) for hypoplastic left heart syndrome (HLHS) and are associated with decreased cardiac transplant-free survival. MYH6 encodes for α-myosin heavy chain (α-MHC), a contractile protein expressed in the neonatal atria. We therefore assessed atrial function in HLHS patients with MYH6 variants. Methods: We performed a retrospective, blinded assessment of pre-stage I atrial function using 2D speckle-tracking echocardiography (2D-STE). Variant carriers were control-matched based on AV valve anatomy, sex, and birth year. Studies were obtained postnatally from awake patients prior to surgical intervention. Right atrial (RA) and right ventricular (RV) strain and strain rate (SR) were measured from the apical four-chamber view. Results: A total of 19 HLHS patients with MYH6 variants had echocardiograms available; 18 were matched to two controls each, and one had a single control. RA active strain (ASct) was decreased in variant carriers (−1.41%, IQR −2.13, −0.25) vs. controls (−3.53%, IQR −5.53, −1.28; p = 0.008). No significant differences were identified in RV strain between the groups. RA reservoir strain (ASr) and conduit strain (AScd) positively correlated with heart rate (HR) in MYH6 variant carriers only (ASr R = 0.499, p = 0.029; AScd R = 0.469, p = 0.043). RV global longitudinal strain (GLS) as well as RV systolic strain (VSs) and strain rate (VSRs) correlated with HR in controls only (GLS R = 0.325, p = 0.050; VSs R = 0.419, p = 0.010; VSRs R = 0.410, p = 0.012). Conclusions: We identified functional consequences associated with MYH6 variants, a known risk factor for poor outcomes in HLHS. MYH6 variant carriers exhibit impaired RA contractility despite there being no differences in RV function between variant carriers and controls. MYH6 variants are also associated with an ineffective RA reservoir and conduit function at high heart rates, despite preserved RV diastolic function. RA dysfunction and reduced atrial "kick" may therefore be a significant contributor to RV failure and worse clinical outcomes in HLHS patients with MYH6 variants. [ABSTRACT FROM AUTHOR]

Establishing normal values of left atrial (LA) phasic strains and strain rates is essential for distinguishing between normal and abnormal functions, determining the degree of abnormality, and understanding the clinical significance of reported values in pediatrics. This meta-analysis aimed to establish normal values of two-dimensional speckle-tracking echocardiography (2DSTE)-derived LA phasic strains and strain rates in the pediatric population and identify the sources of inter-study heterogeneity for these values. A comprehensive search of PubMed, Scopus, and Embase databases was conducted using keywords such as "left atrial/left atrium," "strain/speckle/deformation," and "echocardiography" combined with pediatric age categories. Inclusion criteria comprised English-language human studies involving healthy subjects under 18 years of age. Subjects were categorized as neonates (up to 1 month), infants (1–12 months), and children (1–18 years). A random-effects model was applied to determine 2DSTE-derived LA strains and strain rates, and a meta-regression analysis was performed to investigate inter-study heterogeneity. Our analysis included 17 studies involving 1448 healthy subjects. For children, the mean values of LA strains during the reservoir, conduit, and contraction phases were 47.3% (95% CI 42.5–52.1%), 32.8% (95% CI 27.8–37.8%), and 12% (95% CI 10.0–14.1%), respectively. The mean values for LA strain rates were 2.4 s−1 (95% CI 1.1–3.8 s−1), 4.3 s−1 (95% CI 0.6–8.0 s−1), and 2.4 s−1 (95% CI 0.4–4.5 s−1), respectively. Inter-study heterogeneity for 2DSTE-derived LA phasic strains and strain rates was attributed to factors such as the number of study participants, publication year, software utilized, gating methods, the number of analyzed segments, the geographical region of the study, and heart rate. This study established the normal range of 2DSTE-derived LA phasic strains and strain rates. Additionally, inter-study heterogeneity was found to be influenced by various demographic, physiologic, and methodological factors. [ABSTRACT FROM AUTHOR]

The article discusses the importance of left atrial volumes and strain in predicting atrial fibrillation (AF) and its recurrence after ablation. AF is a common cardiac arrhythmia, and its pathogenesis involves hemodynamic overload and atrial remodeling. Studies suggest that left atrial enlargement and dysfunction play a significant role in AF development and recurrence. The article highlights the use of echocardiography to assess atrial structural remodeling and predict AF outcomes, emphasizing the potential benefits of monitoring left atrial function postoperatively. The study integrates two-dimensional speckle tracking echocardiography and three-dimensional echocardiography to evaluate changes in left atrial structure and function after ablation in patients with paroxysmal AF, providing insights into the use of advanced echocardiography in managing AF. [Extracted from the article]

Background: The commonest echocardiographic measurement, left ventricular ejection fraction, can not necessarily predict mortality of recipients following heart transplantation potentially due to afterload dependency. Afterload‐independent left ventricular stroke work index (LVSWI) is alternatively recommended by the current guideline; however, pulmonary artery catheters are rarely inserted in organ donors in most jurisdictions. We propose a novel non‐invasive echocardiographic parameter, Pressure‐Strain Product (PSP), as a potential surrogate of catheter‐based LVSWI. This study aimed to investigate if PSP could correlate with catheter‐based LVSWI in an ovine model of brain stem death (BSD) donors. The association between PSP and myocardial mitochondrial function in the post‐transplant hearts was also evaluated. Methods: Thirty‐one female sheep (weight 47 ± 5 kg) were divided into two groups; BSD (n = 15), and sham neurologic injury (n = 16). Echocardiographic parameters including global circumferential strain (GCS) and global radial strain (GRS) and pulmonary artery catheter‐based LVSWI were simultaneously measured at 8‐timepoints during 24‐h observation. PSP was calculated as a product of GCS or GRS, and mean arterial pressure for PSPcirc or PSPrad, respectively. Myocardial mitochondrial function was evaluated following 6‐h observation after heart transplantation. Results: In BSD donor hearts, PSPcirc (n = 96, rho =.547, p <.001) showed the best correlation with LVSWI among other echocardiographic parameters. PSPcirc returned AUC of.825 to distinguish higher values of cardiomyocyte mitochondrial function (cut‐off point; mean value of complex 1,2 O2 Flux) in post‐transplant hearts, which was greater than other echocardiographic parameters. Conclusions: PSPcirc could be used as a surrogate of catheter‐based LVSWI reflecting mitochondrial function. [ABSTRACT FROM AUTHOR]

Background: Left ventricular stroke work index (LVSWI) and cardiac power index (CPI) account for the haemodynamic load of the left ventricle and are promising prognostic values in cardiogenic shock. However, accurately and non‐invasively measuring these parameters during veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) is challenging and potentially biased by the extracorporeal circulation. This study aimed to investigate, in an ovine model of cardiogenic shock, whether Pressure‐Strain Product (PSP), a novel speckle‐tracking echocardiography parameter, (1) can correlate with pressure‐volume catheter‐based LVSWI and CPI, and (2) can be load‐independent during the flow modification of V‐A ECMO. Methods: Nine Dorset‐cross ewes (51 ± 4 kg) were included. After cardiogenic shock was induced, full support V‐A ECMO (X L/min based on 60 mL/kg/min) commenced. At seven time points during 24‐h observation, echocardiographic parameters as well as pressure‐volume catheter‐based LVSWI and CPI were simultaneously measured with X and following X‐1 L/min of ECMO flow. PSP was calculated by multiplying global circumferential strain or global radial strain, and mean arterial pressure, for PSPcirc or PSPrad, respectively. Results: PSPcirc showed a stronger correlation with LVSWI (correlation coefficient, CC =.360, p <.001) and CPI (CC =.283, p <.001) than other echocardiographic parameters. The predictability of PSPcirc for pressure‐volume catheter‐based LVSWI (AUC.82) and CPI (AUC.80) was also higher than other echocardiographic parameters. No statistically significant differences were identified between the two ECMO flow variations in PSPcirc (p =.558). Conclusions: A novel echocardiographic parameter, PSP, may non‐invasively predict pressure‐volume catheter‐based LVSWI and CPI in a load‐independent manner in a cardiogenic shock supported by V‐A ECMO. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is correlated with serious morbidity and mortality. Efforts have been made to establish and validate mortality predictive scores based mainly on clinical parameters. Patients with PE and traditional indices of echocardiographic right ventricular (RV) dysfunction or pressure overload have a higher probability of a worse outcome. During the last two decades, studies regarding the use of two-dimensional speckle-tracking echocardiography (2DSTE) and its derived indices in the setting of acute PE have been conducted. In this comprehensive review of the literature, we aimed to summarize these studies. Safe conclusions and comparisons among the reviewed studies are prone to statistical errors, mainly because the studies published were heterogenous in design, different 2DSTE-derived parameters were tested, and different clinical outcomes were used as endpoints. Nonetheless, RV strain indices and, more commonly, regional longitudinal strain of the RV free wall have shown a promising correlation with mortality, assisting in the differential diagnosis between PE and other acute or chronic disorders. [ABSTRACT FROM AUTHOR]

Aims: The COVID‐19 infection has been described as affecting myocardial injury. However, the relation between left ventricular global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), disease severity and all‐cause mortality in COVID‐19 is unclear. Methods and Results: The study consisted of 220 patients with COVID‐19, including 127 (57.5%) with mild, 43 (19.5%) with moderate and 50 (22.7%) with severe/critical conditions. Myocardial dysfunction was analysed by GLS, GCS and GRS using two‐dimensional speckle‐tracking echocardiography. Hazard ratios and Kaplan–Meier curves were produced to assess the association between strains and cardiac biomarker indices with a composite outcome of all‐cause mortality. With an average follow‐up period of 11 days, 19 patients reached the endpoint (death). Significant associations were found for the three strain parameters and the levels of blood urea nitrogen (BUN) (r = 0.206, 0.221 and 0.355, respectively). Cardiac troponin I (cTnI) was closely related to the GLS and GCS (r = 0.240 and 0.324, respectively). In multivariable Cox regression, GCS > −21.6% was associated with all‐cause death {hazard ratio, 4.007 [95% confidence interval (CI), 11.347–11.919]}. Conclusions: GLS, GCS and GRS are significantly related to myocardial dysfunction in patients with COVID‐19. Worsening GCS poses an increased risk of death in COVID‐19. [ABSTRACT FROM AUTHOR]

Aims: Novel echocardiographic parameters of right ventricular (RV) function, including speckle‐tracking‐derived, three‐dimensional, and RV–pulmonary artery coupling parameters, have emerged for the evaluation of pulmonary arterial hypertension (PAH). The relative role of these parameters in the risk stratification of PAH patients is unclear. We compared the performance of multiple RV parameters and sought to establish an optimal model for identifying the risk profile of patients with PAH. Methods and results: Comprehensive risk assessments were performed for 70 patients with PAH. The risk profile of every patient was determined based on the guideline recommendations. Conventional parameters, including fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), novel speckle‐tracking‐derived RV longitudinal strain (RVLS), and three‐dimensional RV ejection fraction (3D‐RVEF), were used to evaluate RV function. Pressure–strain loops were measured for the assessment of RV myocardial work, including RV global wasted work (RVGWW). RV–pulmonary artery coupling was assessed by indexing RV parameters to the estimated pulmonary artery systolic pressure (PASP). The median age was 34 (30–43) years, and 62 (88.6%) patients were female. Forty‐five patients were classified into the low‐risk group, while 25 patients were classified into the intermediate–high‐risk group. Most RV parameters could be used to determine the risk profile and exhibited significantly improved diagnostic performance after indexing to PASP (including FAC/PASP, TAPSE/PASP, and 3D‐RVEF/PASP). RVLS/PASP showed the best performance, with an area under the curve of 0.895. In multivariate analysis (Model 1), only RVGWW (>90.5 mmHg%), RVLS (> −16.7%), and TAPSE (<17.5 mm) remained significant (all P < 0.05). Model 1 outperformed every single RV parameter, with a significantly larger area under the curve (all P < 0.05). With PASP indexing in Model 2, RVLS/PASP > −0.275 [odds ratio (OR) 20.63, 95% confidence interval (CI) 4.62–92.11, P < 0.001] and RVGWW > 90.5 mmHg% (OR 6.17, 95% CI 1.37–27.76, P = 0.018) independently identified a higher risk profile. The addition of RVGWW to two models determined incremental value in identification (continuous net reclassification improvement 1.058, 95% CI 0.639–1.477, P < 0.001). Conclusions: The combination models for RV function outperformed any single parameter in identifying the risk profile of patients with PAH. Comprehensive assessment of RV–pulmonary artery coupling using multiparametric methods is clinically meaningful in patients with PAH. [ABSTRACT FROM AUTHOR]

Speckle-tracking echocardiography (STE) parameters are an integral part of the assessment of left ventricular (LV) function. We aimed to evaluate established and novel STE parameters of LV diastolic function and their prognostic role in patients with LV anteroapical aneurysm undergoing surgical ventricular repair (SVR). We retrospectively examined the data of 137 patients with anteroapical LV aneurysm who underwent SVR. In 27 patients, the correlation of STE parameters with invasive hemodynamic parameters was evaluated. Preoperative echocardiographic parameters were assessed for their association with outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation. The late diastolic strain rate (GLSRa) showed a stronger correlation with mean pulmonary artery pressure (r = − 0.75, p < 0.001) than all other parameters. GLSRa was also significantly correlated with mean pulmonary capillary wedge pressure and LV end-diastolic pressure. In the multivariate model, GLSRa and the ratio of early diastolic filling velocity to GLSRa demonstrated incremental prognostic value in addition to clinical and echocardiographic parameters. Patients with GLSRa < 0.59 s−1 had significantly shorter event-free survival than those with GLSRa > 0.59 s−1 (6.7 vs. 10.9 years, p < 0.001). Peak reservoir left atrial strain showed a weaker association with hemodynamic parameters and outcome compared to GLSRa. In patients with LV aneurysm, late diastolic strain rate and left atrial strain can be used for the assessment of LV diastolic function and have a predictive value for the outcome after surgical ventricular restoration. [ABSTRACT FROM AUTHOR]

Background: It is widely recognized that the right ventricle plays a significant role in the prognosis of numerous diseases. However, the assessment of right ventricular function (RV) has not been given much attention until recently. This study used speckle-tracking echocardiography (STE) to assess RV functions in ischemic cardiomyopathy (ICM) patients. Results: This study included 74 patients diagnosed with ischemic cardiomyopathy (ICM) and an ejection fraction (EF) of less than 50%. Although all the selected patients had normal RV systolic function by tricuspid annular plane systolic excursion (TAPSE), a considerable percentage of them had subtle RV systolic dysfunction, which could be identified by right ventricular free wall longitudinal strain (RV FWLS) (36.5%) and right ventricular global longitudinal strain (RV GLS) (55.4%). Moreover, the mean RV FWLS was significantly higher than RV GLS (− 20.4 ± 5.08% vs. − 17.5 ± 6.89%), respectively. Advanced left ventricle (LV) adverse remodeling was associated with subtle RV dysfunction. Using multivariate regression analysis, increased E/e' (p = 0.016, CI 1.135–3.423) and RV myocardial performance index (MPI) (p = 0.007, CI 0.000–0.007) were identified as independent factors of impaired RV FWLS with the greatest effectiveness. Conclusion: When standard RV measures are normal in patients with ICM, RV systolic strain analysis offers an incremental utility to detect subtle abnormalities in RV function, especially in resource-constrained settings where cardiac magnetic resonance (CMR) is not practical. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess right atrial (RA) function, including RA phase strain, via speckle‐tracking echocardiography (STE) in a cohort of systemic lupus erythematosus (SLE) patients with pulmonary arterial hypertension (PAH) and in particular to explore the relationship between RA phase strain and the occurrence of cardiovascular events. Methods: STE analyses of RA function were evaluated in patients with SLE‐PAH and in 33 healthy control subjects. Clinical associations, serum biomarkers, echocardiographic data, survival times, and adverse cardiovascular events were evaluated. Results: A total of 66 patients with SLE‐PAH were enrolled; they were divided into two groups based on the occurrence of adverse clinical events. RA phase strain was significantly reduced in patients with events than in patients without events. The endpoint was defined as the combined outcome of all‐cause mortality, right heart failure, and rehospitalization due to disease progression. During a mean follow‐up of 17.2 ± 9.9 months, 23 patients (35%) reached the endpoint. Compared with patients with RA reservoir strain (RASr) ≥33.45%, patients with RASr < 33.45% had more adverse long‐term outcomes (log rank p <.0001). RASr was independently associated with adverse clinical outcomes according to multivariate analysis (p =.010). Conclusion: Our data suggest that RA function has prognostic value for SLE‐PAH patients, and strain analysis revealed that the worse the RA function is, the worse the prognosis. [ABSTRACT FROM AUTHOR]

Left ventricular (LV) hypertrophy (LVH) is frequently observed in patients with hypertension (HTN). LV myocardial work (MW) has recently emerged as a non‐invasive method to assess systolic myocardial deformation relative to afterload conditions. The authors investigated the characteristics of myocardial work with different degrees of LVH in HTN patients. From December 2020 to February 2024, 255 HTN patients and 26 healthy controls undergoing transthoracic echocardiography were included in the current study. Hypertension patients were divided into quintile groups based on left ventricular mass index (LVMI), for the first to fourth LVMI quantiles, global work index (GWI) and global constructive work (GCW) were higher compared to the control group, but the difference was not statistically significant. In the sixth LVMI quantile, GWI and GCW showed a significant decrease. The restricted cubic splines showed that both GWI and GCW exhibited an inverted U‐shaped relationship with LVMI. A LVMI of >151.39 g/m2 could accurately predict reduction both in GWI and GCW (Sensitivity: 0.78, Specificity: 0.89, AUC: 0.90, P <.001; Sensitivity: 0.81, Specificity: 0.92, AUC: 0.92, P <.001, respectively). As LVH progressed in HTN patients, both GWI and GCW initially demonstrated an increase, followed by a subsequent decrease. Myocardial work provides additional insights into assessment of cardiac function in HTN patients. [ABSTRACT FROM AUTHOR]

Aims This study aims to explore the presence of left ventricular (LV) and left atrial (LA) morphological and functional abnormalities in patients with Barlow's disease (BD) without significant mitral regurgitation (MR) and to investigate whether these abnormalities may predict MR progression. Methods and results Consecutive patients with BD were retrospectively identified from two tertiary centres; those with MR graded from trivial to mild-to-moderate were selected and matched with healthy controls in a 1:1 ratio. Conventional and speckle-tracking echocardiographic data were collected. The development of moderate-to-severe or greater MR was evaluated on follow-up echocardiograms. Patients with BD (n = 231) showed increased LV dimensions and indexed LV mass (LVMi) in comparison with controls (P < 0.001); LV remodelling worsened with higher MR severity and was accompanied by an increased prevalence of eccentric LV hypertrophy (eLVH). Moreover, BD patients had larger LA volumes and more impaired LA reservoir strain vs. controls (P < 0.001), while LV strain was similar between the two groups. Multivariable linear regression analyses in the overall population identified BD and MR grade as independent predictors of remodelling markers (LV dimensions, LVMi, and LA volume) and BD as independent correlate of LA strain. MR progression was observed in 51 BD subjects (out of 170 patients with available follow-up). On Cox regression analysis, age, eLVH, mild-to-moderate MR, and mitral annular disjunction (MAD) emerged as independent predictors of MR progression. Conclusion BD patients without significant MR show early LV and LA remodelling, together with reduced LA strain. MR progression was associated with eccentric LV remodelling, MAD, and MR severity. [ABSTRACT FROM AUTHOR]

The goal of this study was to determine the potential for right ventricular (RV) and left ventricular (LV) strain to predict cardiopulmonary complications of COVID-19. We identified 276 patients with COVID-19 who underwent transthoracic echocardiography within 30 days of COVID-19 diagnosis at our institution. Patients were excluded if they had a history of any primary outcomes before COVID-19 diagnosis or insufficient imaging. LV global longitudinal strain (GLS) and RV GLS were obtained using 2-dimensional speckle-tracking echocardiography. Primary outcomes were death, pulmonary embolism, congestive heart failure (CHF), cardiomyopathy, pulmonary fibrosis, pulmonary hypertension, acute respiratory distress syndrome (ARDS), and myocardial infarction (MI) occurring after COVID-19 diagnosis. In the final analysis of 163 patients, mean RV GLS and LV GLS were reduced, and 43.6% developed at least one primary outcome. There were significant differences in LV GLS distribution in terms of CHF, cardiomyopathy, and MI in bivariate analysis. However, LV GLS was not significantly associated with CHF after adjusting for LV ejection fraction and RV fractional area change, nor with MI after adjusting for troponin T. RV GLS was significantly associated with ARDS after adjusting for other variables. In the risk stratification of patients with COVID-19, strain imaging can provide incremental prognostic information, as worsened RV GLS is associated with the development of ARDS. [ABSTRACT FROM AUTHOR]

Background: Recent studies have shown that right atrial (RA) function are important predictors of cardiovascular morbidity and mortality. However, the study data about RA phasic function in obstructive sleep apnea syndrome (OSAS) patients are scarce, especially based on the left ventricular geometry. So, we aimed to assess the influence of left ventricular geometry on RA phasic function in OSAS patients via a multimodal echocardiographic approach. Methods: Total of 235 OSAS patients were enrolled in this cross‐section study and underwent complete clinical, polysomnography, and echocardiography examinations. The OSAS patients were divided into four groups based on left ventricular mass index (LVMI) and relative wall thickness (RWT): normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). RA phasic function was evaluated via multimodal echocardiography approach (two‐dimensional echocardiography biplane method [2DE]; two‐dimensional speckle‐tracking echocardiography [2D‐STE]; and three‐dimensional echocardiography [3DE]). The multiple linear regression analysis was used to determine the relationship between left ventricular geometry and RA phasic function. Results: The RA volume and indices increased from NG to CR to EH to CH. RA total emptying fraction and RA strain during systole decreased from NG to CR to EH to CH. RA passive emptying fraction and RA strain during early diastole similarly decreased. RA active emptying fraction and RA strain during late diastole also gradually increased similarly. In analyses that adjusted for gender, age, body mass index, systolic blood pressure, apnea‐hypopnea index, LVMI, systolic pulmonary artery pressure, and right ventricular free wall thickness, CH was associated with RA reservoir and conduit function via 2DE area‐length method, whereas CH and EH were associated with RA reservoir and conduit function via 2D‐STE and 3DE method. Further, CH was associated with RA booster pump function via 2DE area‐length method, 2D‐STE, and 3DE method. Conclusion: The RA volumes and phasic function varied with left ventricular geometry via multimodal echocardiography approach. CH had the apparent negative effect on RA phasic function. [ABSTRACT FROM AUTHOR]

There is increasing evidence that myocarditis starts as a patchy process, accordingly, the detection of segmental affection is important for early recognition of the disease and proper initiation of anti-inflammatory treatment. We present our first experience here with using speckle-tracking echocardiography (STE) to detect subtle segmental involvement of the left ventricle in two cases with suspected myocarditis. STE consolidated the diagnosis and helped with the early initiation of intravenous immunoglobulins and subsequent control of the disease. STE was also able to show the specific topography of distribution of each pathogen linked to inflammation.

Background: Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality, attributed in part to myocardial dysfunction. Global longitudinal strain (GLS) measured by speckle-tracking echocardiography is a sensitive marker of myocardial function. This study aimed to investigate the association between RA serology markers, including rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, and GLS in RA patients. Materials and Methods: This one-year cross-sectional study was conducted at Imam Hossein Hospital in Tehran, Iran, focusing on patients diagnosed with RA. Rheumatoid arthritis serology markers, including RF and anti-CCP antibodies, were assessed. GLS was measured using speckle-tracking echocardiography. The association between RA serology markers and GLS categories was analyzed using chi-square tests with IBM SPSS Statistics version 26. Results: A total of 71 patients were included in the study, with a mean age of 52.31 years. Among the RA patients, 28 individuals (71.8%) with negative RA serology exhibited abnormal GLS values, while 11 (28.2%) had normal GLS values. Conversely, all 21 (100%) RA patients with positive serology showed abnormal GLS values. Statistical analysis revealed no significant association between RA serology markers and GLS category (χ2 = 0.313, P>0.05). Conclusion: In this study, RA serology markers, including RF and anti-CCP antibodies, were not significantly associated with GLS abnormalities in RA patients. Further research is needed to elucidate other factors contributing to myocardial dysfunction in RA.

Abstract Mitral stenosis (MS) is a complex valvular pathology with significant clinical burden even today. Its effect on the right heart is often overlooked, despite it playing a considerable part in the symptomatic status. We enrolled 39 mitral valve stenosis patients and 39 age- and gender-matched healthy controls. They underwent conventional, speckle-tracking and 3D echocardiographic examinations. The 3D data was analyzed using the ReVISION software to calculate RV functional parameters. In the MS group, 3D RV ejection fraction (EF) (49 ± 7% vs. 61 ± 4%; p

Aims Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive myocardial dysfunction and associated with an increased risk of major cardiovascular (CV) events. To determine right heart strain (ventricular and atrial global longitudinal strain (RVGLS and RAGLS) in patients with definite ARVC and its association with adverse events during follow-up. Methods and results RVGLS and RAGLS were analysed in focused right heart apical views from 70 patients using TomTec ImageArena and association with a composite endpoint was determined (sustained ventricular arrhythmia and cardiovascular death). Over a median follow-up duration of 4.9 years, 26 (37%) patients met the endpoint. RVGLS was significantly impaired in the event group (−11.5 [−13.3 to −10.2] %) vs. the no-event group (−15.8 [−17.1 to −14.5] %, P < 0.001), and so was RAGLS (22.8 [21.4–27.4] % vs. 31.5 [25.1–39.6] %, respectively, P < 0.001). In Cox regression, RVGLS (HR 1.36, P < 0.001) and RAGLS (HR 0.92, P = 0.002) were associated with a higher risk of adverse events. In multivariable Cox regression models, RVGLS and RAGLS remained independent of and were incremental to age, gender, and conventional RV parameters, and model fitness was improved when RVGLS and RAGLS were applied together rather than alone. Conclusion RVGLS and RAGLS are more impaired in patients with adverse events and associated with adverse events independent of age, gender, and conventional RV parameters. When RVGLS and RAGLS are applied together, prediction models are improved suggesting that right heart strain may form part of the echocardiographic routine protocol in patients with ARVC. [ABSTRACT FROM AUTHOR]

Mitral stenosis (MS) is a complex valvular pathology with significant clinical burden even today. Its effect on the right heart is often overlooked, despite it playing a considerable part in the symptomatic status. We enrolled 39 mitral valve stenosis patients and 39 age- and gender-matched healthy controls. They underwent conventional, speckle-tracking and 3D echocardiographic examinations. The 3D data was analyzed using the ReVISION software to calculate RV functional parameters. In the MS group, 3D RV ejection fraction (EF) (49 ± 7% vs. 61 ± 4%; p < 0.001), global circumferential (GCS) (− 21.08 ± 5.64% vs. − 25.07 ± 4.72%; p = 0.001) and longitudinal strain (GLS) (− 16.60% ± 4.07% vs. − 23.32 ± 2.82%; p < 0.001) were reduced. When comparing RV contraction patterns between controls, MS patients in sinus rhythm and those with atrial fibrillation, radial (REF) (32.06 ± 5.33% vs. 23.62 ± 7.95% vs. 20.89 ± 6.92%; p < 0.001) and longitudinal ejection fraction (LEF) (24.85 ± 4.06%; 17.82 ± 6.16% vs. 15.91 ± 4.09%; p < 0.001) were decreased in both MS groups compared to controls; however, they were comparable between the two MS subgroups. Anteroposterior ejection fraction (AEF) (29.16 ± 4.60% vs. 30.87 ± 7.71% vs. 21.48 ± 6.15%; p < 0.001) showed no difference between controls and MS patients in sinus rhythm, while it was lower in the MS group with atrial fibrillation. Therefore, utilizing 3D echocardiography, we found distinct morphological and functional alterations of the RV in MS patients. [ABSTRACT FROM AUTHOR]

Background: The presence of a relative apical sparing (RAS) echocardiographic strain pattern raises a suspicion of underlying cardiac amyloidosis (CA). However, it is also increasingly observed in patients with aortic stenosis (AS). We aimed to evaluate the prevalence, dynamics, and clinical characteristics of the RAS strain pattern in severe AS patients who had been referred for surgical aortic valve replacement (SAVR). Methods: A total of 77 patients with severe AS and without CA were included with a mean age of 70 (62–73) years, 58% female, a mean aortic valve area index of 0.45 ± 0.1 cm2/m2, and a mean gradient of 54.9 (45–70) mmHg. Results: An RAS strain pattern was detected in 14 (18%) patients. RAS-positive patients had a significantly higher LV mass index (125 ± 28 g/m2 vs. 91 ± 32, p = 0.001), a lower LV ejection fraction (62 ± 12 vs. 68 ± 13, p = 0.040), and lower global longitudinal strain (–14.9 ± 3 vs. –18.7 ± 5%, p = 0.002). RAS strain pattern-positive patients also had higher B-type natriuretic peptide (409 (161–961) vs. 119 (66–245) pg/L, p = 0.032) and high-sensitivity troponin I (15 (13–29) vs. 9 (5–18) pg/L, p = 0.026) levels. Detection of an RAS strain pattern was strongly associated with increased LV mass index (OR 1.03, 95% CI 1.01–1.06, p < 0.001). The RAS strain pattern had resolved in all patients by 3 months after SAVR. Conclusions: Our findings suggest that the RAS strain pattern can be present in patients with severe AS without evidence of CA. The presence of an RAS strain pattern is associated with adverse LV remodeling, and it resolves after SAVR. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to compare global longitudinal strain of the left ventricle (LV-GLS) and reservoir strain of the left atrium (R-LAS) values between patients with acute decompensation of chronic heart failure (HF) and a control group. Methods: Sixteen patients admitted to our ward for acute decompensation of HF were enrolled in this study. Transthoracic echocardiography (TTE) with two-dimensional speckle-tracking analysis (2D ST) was performed in each patient. The patients were divided into two subgroups according to the value of left ventricular ejection fraction (EF) using a cut-off value of ≤40% to distinguish heart failure with reduced ejection fraction (HFrEF) from heart failure with preserved ejection fraction (HFpEF). The control group consisted of 16 individuals without a history of cardiovascular disease, each of whom underwent 2D ST analysis as well. Results: We found that LV-GLS and R-LAS were significantly lower in both the HFrEF and HFpEF subgroups in comparison with the control group (LV-GLS: −13.4 ± 4.7% vs. −19.7 ± 2.5%, p ˂ 0.05; R-LAS: +12.2 ± 6.9% vs. +40.3 ± 7.4%, p ˂ 0.05). Furthermore, there was a significant difference in LV-GLS (−9.6 ± 3.2% vs. −15.2 ± 4.3%, p ˂ 0.05) but not in R-LAS (+13.7 ± 8.6% vs. +11.4 ± 6.2%) between the HFrEF and HFpEF subgroups. Conclusions: Our study demonstrated a significant difference in LV-GLS and R-LAS in all enrolled HF patients compared to the control group. There was also a significant difference in LV-GLS between the HFrEF and HFpEF subgroups. [ABSTRACT FROM AUTHOR]

Left ventricular (LV) global longitudinal strain (GLS) has recently garnered attention as a reliable and objective method for evaluating LV systolic function. One of the key advantages of GLS is its ability to detect subtle abnormalities even when the ejection fraction (EF) appears to be preserved. However, it is important to note that GLS, much like LVEF, is significantly influenced by load conditions. In recent years, researchers and clinicians have been exploring noninvasive myocardial work (MW) quantification as an innovative tool for assessing myocardial function. This method integrates measurements of strain and LV pressure, providing a comprehensive evaluation of the heart's performance. Notably, MW offers an advantage over GLS and LVEF because it provides a load-independent assessment of myocardial performance. The implementation of commercial echocardiographic software that facilitates the noninvasive calculation of MW has significantly broadened the scope of its application. This advanced technology is now being utilized in multiple clinical settings, including ischemic heart disease, valvular diseases, cardiomyopathies, cardio-oncology, and hypertension. One of the fundamental aspects of MW is its correlation with myocardial oxygen consumption, which allows for the assessment of work efficiency. Understanding this relationship is crucial for diagnosing and managing various cardiac conditions. The aim of this review is to provide an overview of the noninvasive assessment of myocardial by echocardiography, from basic principles and methodology to current clinical applications. [ABSTRACT FROM AUTHOR]

Objectives: The severity of pulmonary artery hypertension affects the outcomes of patients undergoing mitral valve replacement (MVR). Speckle-tracking derived strain is a new modality for the assessment of the right ventricular (RV) function as well as the longitudinal contractile pattern. Our main objective of this study was to evaluate the right ventricular (RV) function in patients undergoing MVR with pulmonary artery systolic pressure (PASP) of more than 50 mmHg at 1 and 4 weeks postoperatively. Material and Methods: This prospective cohort study included 40 patients with rheumatic heart disease (RHD) (mitral stenosis [MS] and mitral regurgitation [MR]) scheduled to undergo MVR between January 2022 and December 2023 in AIIMS, New Delhi. Serial 2D echocardiography, tissue Doppler imaging, as well as RV speckle-tracking echocardiography were performed, and serum brain natriuretic peptide (BNP) levels were measured during the pre-operative period, 1st week and 4th weeks postoperatively to evaluate RV function. Results: Tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fractions (LVEFs) were significantly lower at 1 week after surgery, compared to pre-operative levels, and reached the pre-operative values at 4 weeks after surgery. The RV fractional area change (RVFAC) at 4 weeks postoperatively significantly increased compared to 1st week and baseline values. The tricuspid valve (TV) tissue velocity in systole (S′), TV velocity in diastole (E′), RV global strain (RVGLS), and RV free wall strain (RVFWLS) at post-operative 4 weeks were lower than pre-operative values, and this difference was statistically significant. Conclusion: Four weeks after MVR, in adult patients with RHD (MS and MR) having PASP >50 mmHg, it was observed that deformational indices or speckle-tracking echocardiography such as RVGLS and RVFWLS predict better RV dysfunction than linear indices like TAPSE. The BNP, PASP (delta TR), right atrial volume, left atrial volume, LV internal diameter in systole, and LV internal diameter in diastole decreased significantly in these patients. RVFAC increased significantly to compensate for the loss of longitudinal function. [ABSTRACT FROM AUTHOR]

Aims We sought to investigate the association of left atrial strain with the outcome in a large cohort of patients with at least moderate aortic stenosis (AS). Methods and results We analysed 467 patients (mean age 80.6 ± 8.2 years; 51% men) with at least moderate AS and sinus rhythm. The primary study endpoint was the composite of all-cause mortality and hospitalizations for heart failure. After a median follow-up of 19.2 (inter-quartile range 12.5–24.4) months, 96 events occurred. Using the receiver operator characteristic curve analysis, the cut-off value of peak atrial longitudinal strain (PALS) more strongly associated with outcome was <16% {area under the curve (AUC) 0.70 [95% confidence interval (CI): 0.63–0.78], P < 0.001}. The Kaplan–Meier curves demonstrated a higher rate of events for patients with PALS < 16% (log-rank P < 0.001). On multivariable analysis, PALS [adjusted HR (aHR) 0.95 (95% CI 0.91–0.99), P = 0.017] and age were the only variables independently associated with the combined endpoint. PALS provided incremental prognostic value over left ventricular (LV) global longitudinal strain, LV ejection fraction, and right ventricular function. Subgroup analysis revealed that impaired PALS was also independently associated with outcome in the subgroups of paucisymptomatic patients [aHR 0.98 (95% CI 0.97–0.98), P = 0.048], moderate AS [aHR 0.92, (95% CI 0.86–0.98), P = 0.016], and low-flow AS [aHR 0.90 (95% CI 0.83–0.98), P = 0.020]. Conclusion In our patients with at least moderate AS, PALS was independently associated with outcome. In asymptomatic patients, PALS could be a potential marker of sub-clinical damage, leading to better risk stratification and, potentially, earlier treatment. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality, attributed in part to myocardial dysfunction. Global longitudinal strain (GLS) measured by speckle-tracking echocardiography is a sensitive marker of myocardial function. This study aimed to investigate the association between RA serology markers, including rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, and GLS in RA patients. Materials and Methods: This one-year cross-sectional study was conducted at Imam Hossein Hospital in Tehran, Iran, focusing on patients diagnosed with RA. Rheumatoid arthritis serology markers, including RF and anti-CCP antibodies, were assessed. GLS was measured using speckle-tracking echocardiography. The association between RA serology markers and GLS categories was analyzed using chi-square tests with IBM SPSS Statistics version 26. Results: A total of 71 patients were included in the study, with a mean age of 52.31 years. Among the RA patients, 28 individuals (71.8%) with negative RA serology exhibited abnormal GLS values, while 11 (28.2%) had normal GLS values. Conversely, all 21 (100%) RA patients with positive serology showed abnormal GLS values. Statistical analysis revealed no significant association between RA serology markers and GLS category (χ2 = 0.313, P>0.05). Conclusion: In this study, RA serology markers, including RF and anti-CCP antibodies, were not significantly associated with GLS abnormalities in RA patients. Further research is needed to elucidate other factors contributing to myocardial dysfunction in RA. [ABSTRACT FROM AUTHOR]

There is increasing evidence that myocarditis starts as a patchy process, accordingly, the detection of segmental affection is important for early recognition of the disease and proper initiation of anti-inflammatory treatment. We present our first experience here with using speckle-tracking echocardiography (STE) to detect subtle segmental involvement of the left ventricle in two cases with suspected myocarditis. STE consolidated the diagnosis and helped with the early initiation of intravenous immunoglobulins and subsequent control of the disease. STE was also able to show the specific topography of distribution of each pathogen linked to inflammation. [ABSTRACT FROM AUTHOR]