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Background: Myocarditis have variable clinical presentation, evolution and prognosis. Aim of our study was to evaluate the value of speckle tracking echocardiography and cardiac magnetic resonance (CMR) in the short‐term prediction of supraventricular arrhythmias (SVA) in patients with acute myocarditis. Methods: Seventy patients (mean age 31±14 years old) with acute myocarditis and preserved left ventricular ejection fraction (LVEF) were enrolled. Longitudinal systolic strain (LS) of the left ventricle (LV), mechanical dispersion (MD) and CMR with quantitative measurement of delayed enhancement (DE) were performed in a subset of 43 patients. Logistic regression and ROC analysis were used to identify predictors of SVA Results: Only LS measured at sup‐epicardial, mid‐wall and sub‐endocardial level of the apical 4‐chamber view was significantly lower in patients with SVA, while MD was marginally prolonged in this setting. A value of LS > ‐ 16.1% measured at LV mid‐wall in the apical 4‐chamber view (ROC‐AUC.75, Sensitivity 63%, Specificity 85%) was the most accurate measure to identify patients with SVA. DE mass was also helpful with a ROC‐AUC.76; a DE‐Mass > 18.9 gr. had a Sensitivity 63% and a Specificity 77%, to identify patients at risk of SVA. Conclusions: Both DE mass and LS were associated with higher risk of SVA in patients with acute myocarditis and preserved LVEF. However, LS measured at the mid‐wall level and limited to LV segments included in the apical 4‐chamber view was the most accurate measure and did not show interaction with DE mass. [ABSTRACT FROM AUTHOR]

Objectives: To analyze left ventricular (LV) myocardial deformation and contractile reserve (CR) in asymptomatic patients with severe aortic regurgitation (AR) at rest and during exercise, and their correlation with functional capacity. Background: The natural history of chronic AR is characterized by a prolonged silent phase before onset of symptoms and overt LV dysfunction. Assessment of LV systolic function and contractile reserve has an important role in the decision‐making of AR asymptomatic patients. Methods: Standard echo, lung ultrasound, and LV 2D speckle tracking strain were performed at rest and during exercise in asymptomatic patients with severe AR and in age‐ and sex‐comparable healthy controls. Results: 115 AR patients (male sex 58.2%; 52.3 ± 18.3 years) and 55 controls were enrolled. Baseline LV ejection fraction was comparable between the groups. Resting LV global longitudinal strain (GLS) and myocardial work efficiency (MWE) were significantly reduced in AR (GLS‐15.8 ± 2.8 vs −21.4 ± 4.4; P <.001). Patients with AR and CR− showed reduced resting LV GLS and MWE and increased B‐lines. MWE was closely related to peak effort watts, VO2, LV E/e′, and B‐lines, at a multivariable analysis. Both GLS and MWE were strong independent predictors of CR. A resting LV GLS cutoff of −12% differentiated CR+ and CR− (78% sensitivity and 84% specificity). Conclusions: The lower resting values of LV GLS and MWE in severe AR asymptomatic patients suggest an early subclinical myocardial damage that seems to be closely associated with lower exercise capacity, greater pulmonary congestion, and blunted LV contractile reserve during stress. [ABSTRACT FROM AUTHOR]

Aims Recent advancements in echocardiographic technology allow to analyse myocardial strain in multiple layers. Little is known about the impact of age on layer-specific longitudinal strain in healthy subjects. The aim of this study was to analyse the influence of age on multilayer longitudinal strain and establish normal reference values of layer-specific strain according to age decades in a healthy population referring to our echo laboratory using 2D speckle-tracking echocardiography with layer-specific software. Methods and results Two-hundred sixty-six healthy, consecutive subjects (mean age = 39.2 ± 17.5 years, women/men = 137/129), free of cardiovascular risk factors, were enrolled. Subjects were divided according to six age decades: 10–19, 20–29, 30–39, 40–49, 50–59, >60 years. All subjects underwent a complete echo Doppler examination including quantitation of 2D global longitudinal strain (GLS). Subendocardial longitudinal strain (LSsubendo), subepicardial longitudinal strain (LSsubepi), and strain gradient (LSsubendo − LSsubepi) were also determined. GLS (P < 0.001), LSsubendo, and LSsubepi (both P < 0.0001) were all progressively reduced with increasing age decades, but post hoc intra-group analyses demonstrated that the decline of GLS, LSsubendo, and LSsubepi was significant in the decades 50–60 and ≥60 years. In separate multiple linear regression analyses, the effect of age on GLS, LSsubendo, and LSsubepi remained significant even after adjusting for clinical and echocardiographic confounders. Strain gradient remained unchanged in age decades. Conclusion Ageing shows an independent effect on GLS, LSsubendo, and, particularly on, LSsubepi. Our data also provide normal reference values of layer-specific longitudinal strain for age decades. [ABSTRACT FROM AUTHOR]

The use of conventional echocardiography in the intensive care unit (ICU) is today established to assess left and right ventricular systolic function, for preload determination and procedural guidance. Next step in ICU echocardiography could be the use of novel ultrasound techniques such as strain echocardiography to assist in the management of patients with acute coronary syndrome, heart failure, or pulmonary embolism. This review has gathered the available evidence supporting the incremental value of strain in the diagnostic workup of cardiac diseases treated in ICU. [ABSTRACT FROM AUTHOR]