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This study aimed to develop, validate and test the clinical feasibility of ultrasound (US) speckle tracking method based on gradient optical flow for quantifying small longitudinal displacements, shear and strain in peripheral nerves. The speckle tracking method was validated using seven thawed, fresh-frozen isolated cadaveric forearms. Longitudinal motion of the median nerve was captured using a high-frequency 22 MHz linear probe. An air bubble marker was inserted as a reference point for manual measurement comparison. The precision and accuracy of the method were assessed by comparing manual and automatic measurements. Clinical feasibility was tested on eight healthy subjects, measuring the longitudinal displacement of the median nerve during elbow extension and shoulder anteflexion. The method demonstrated linearity, high precision and accuracy, particularly with a backtrace of five frames, reducing the displacement underestimation to 4%. In cadaveric models, the highest shear strain was observed at the nerve-tissue interfaces. In healthy subjects, the mean displacement of the median nerve was 3.3 ± 1.0 mm, with good inter-rater reliability (intraclass correlation coefficient = 0.87). The US speckle tracking method based on gradient optical flow effectively quantifies small longitudinal displacements and shear strain in peripheral nerves, with high precision and accuracy. However, the method could not detect longitudinal strain in nerves within the range of tested displacements. Future studies should investigate its applicability to smaller and deeper nerves and its usefulness in different pathological conditions. [ABSTRACT FROM AUTHOR]

Erythrocyte transfusion is a time-consuming process for both health care personnel and patients. This research is aimed at assessing the safety of erythrocyte transfusion over a short period of time in pediatric patients using innovative echocardiographic parameters, such as tissue Doppler imaging and 2D speckle-tracking echocardiography. Twenty pediatric patients with chronic hemolytic anemia were included in the study. Patients with underlying cardiac, renal, or respiratory dysfunction and severe anemia (hemoglobin < 60 g/L) were excluded. The patients were grouped into small cohorts, and erythrocyte transfusion was initiated at 6 ml/kg/h. If tolerated, the rate was progressively increased by 1 ml/kg/h per cohort until reaching 12 ml/kg/h. Symptoms and signs of clinical intolerance and vital signs were evaluated during and following transfusions. Conventional echocardiography, tissue Doppler imaging, and 2D speckle-tracking echocardiography were performed before and after transfusion. No symptoms or signs of clinical intolerance were reported during or after transfusion. Following transfusion, the heart rate decreased significantly (P = 0.018). No significant changes in the systolic or diastolic functions of the right or left ventricles were observed after transfusion. Following transfusion, significant improvements in the ejection times of the left and right ventricles (P = 0.001 and P = 0.007, respectively) were noted. Similarly, the myocardial performance index significantly improved (P = 0.038 and P = 0.046, respectively). Conclusion: This exploratory study addresses the issue of whether erythrocyte transfusion may be administered at up to 12 ml/kg/h in selected stable pediatric patients with chronic anemia without the risk of developing transfusion-associated circulatory overload or affecting cardiac function. In addition to reducing tachycardia, erythrocyte transfusion improves biventricular ejection time and myocardial performance index (Tei-index). What is known? • The erythrocyte transfusion process is lengthy for medical professionals, pediatric patients, and their families. The standard transfusion rate is 5 ml/kg/h. What is new? • A higher rate of erythrocyte transfusion was hemodynamically well tolerated in this study among 20 children aged 1 to 13 years without transfusion-associated circulatory overload (TACO). [ABSTRACT FROM AUTHOR]

The Achilles tendon (AT) is composed of three distinct subtendons, each arising from one of the three heads of the triceps surae muscles: gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and soleus (SOL). These subtendons exhibit a twisted structure, classified as low (Type I), medium (Type II), and high (Type III) twist, based on cadaveric studies. Nevertheless, the in vivo investigation of AT twist is notably scarce, resulting in a limited understanding of its functional significance. The aim of this study was to give insights into the complex 3D AT structure in vivo. A total of 30 healthy participants underwent individual stimulation of each of the triceps surae muscles at rest with the foot attached to the pedal of an isokinetic dynamometer. Ultrasound images were captured to concomitantly examine the displacement of the superficial, middle and deep AT layers. SOL stimulation resulted in the highest AT displacement followed by GM and GL stimulation. Independent of the muscle stimulated, non‐uniformity within the AT was observed with the deep layer exhibiting more displacement compared to the middle and superficial layers, hence important inter‐individual differences in AT displacement were noticeable. By comparing these individual displacement patterns during targeted stimulations with insights from cadaveric twist classifications on each subtendon area, our classification identified 19 subjects with a 'low' twist and 11 subjects with a 'high' twist. These findings enable us to move beyond cadaveric studies and relate the twisted microstructure of the AT in vivo to its dynamic behaviour. [ABSTRACT FROM AUTHOR]

Background An initial assessment method for coronary artery disease (CAD) is echocardiography, which aids medical professionals in the diagnosis and prognostication of cardiac conditions. Visual assessment of wall motion anomalies, however, is not always successful in differentiating between myocardial ischemia that is less obvious or brief. Since it can locate ischemic territories in accordance with coronary lesions and identify subtle myocardial damage, speckle tracking echocardiography (STE) is a widely accessible noninvasive tool that can quickly and easily provide additional information over basic echocardiography. This allows for a clear visualization with a "polar map" that is useful for differential diagnosis and management. As a result, it has been used more often in both acute and chronic coronary syndromes with stress and rest echocardiogram, demonstrating positive outcomes in terms of left ventricular remodeling, clinical outcome prediction, CAD prediction, and the presence and measurement of new or residual ischemia. This review's objective is to present the most recent data on STE's value in CAD assessment and followup. Conclusions: Beyond ECG and biomarkers, echocardiography is a milestone for the evaluation of CAD in acute and chronic settings. STE could provide an additive value over visual wall motion assessment both for diagnostic and prognostic assessment, and the inclusion of LVGLS in clinical diagnostic workup of these patients is supported by plenty of evidence and clear advantages overweighing the intrinsic limitations of STE technique. However, further studies are needed to confirm the potential value of other chambers' strain. [ABSTRACT FROM AUTHOR]

Interest in advanced echocardiographic imaging methods is growing. Left atrial strain (LAS) is among recently developed echocardiographic parameters. LAS represents an index of tissue deformation of the left atrium (LA). This parameter is an expression of LA function. Several arrhythmias are caused by impaired LA function. LAS can be assessed with a resting echocardiogram. The evaluation of LAS during stress echocardiography represents another model for assessing LA function. The development of altered LAS during physical or pharmacological stress is a predictor of early LA disease. Our review aims to evaluate the relationship between alterations in LAS and the development of atrial fibrillation (AF), and the diagnostic and prognostic roles of the stress echocardiogram in clinical practice. [ABSTRACT FROM AUTHOR]

Background: An exaggerated hypertensive response (EHR) during exercise is linked to increased cardiovascular risk and mortality. This study aims to assess structural and functional cardiac changes, along with subclinical myocardial damage, using transthoracic echocardiography (ECHO) and 2D longitudinal strain analysis in patients showing a hypertensive response to treadmill exercise. Methods: Patients without known chronic diseases, presenting to the Cardiology Department at Health Sciences University Gülhane Training and Research Hospital, were divided into 2 groups based on their blood pressure response during treadmill exercise: exaggerated hypertensive response (EHR, n = 42) and normal response (control, n = 44). Left ventricular longitudinal strain was assessed using transthoracic echocardiography, and global longitudinal strain (GLS) was calculated as the average from all segments. Data analysis was performed using SPSS 26. Results: No significant differences were found between the groups regarding baseline demographic and laboratory parameters (P > .05 for all). However, the EHR group exhibited significantly higher interventricular septum thickness, mitral A velocity, and mitral annulus velocity (a'), while mitral annulus velocity (e') was significantly lower (P < .05 for all). Additionally, left ventricular (LV) mass index, left atrial volume index, mitral E/e' ratio, deceleration time, and relative wall thickness (RWT) were higher in the EHR group, while the mitral E/A ratio was lower (P < .05 for all). The GLS was also significantly lower in the EHR group (P < .05). Conclusion: Left ventricular geometry parameters, such as LV mass index and RWT, and GLS findings indicating subclinical cardiac damage, were significantly altered in the EHR group, suggesting a higher risk of LV hypertrophy and myocardial dysfunction. [ABSTRACT FROM AUTHOR]

The advancements in cardiovascular imaging over the past two decades have been significant. The miniaturization of ultrasound devices has greatly contributed to their widespread adoption in operating rooms and intensive care units. The integration of AI-enabled tools has further transformed the field by simplifying echocardiographic evaluations and enhancing the reproducibility of hemodynamic measurements, even for less experienced operators. Speckle tracking echocardiography offers a direct, visual, and quantitative assessment of myocardial shortening, serving as a compelling alternative to traditional methods for evaluating right and left ventricular systolic function. In critically ill patients, sublingual microcirculation imaging has revealed a high prevalence of microvascular alterations, which are markers of disease severity. The use of handheld vital microscopes enables the quantification of several key parameters, including vessel density, perfusion, red blood cell velocity, and the perfused vascular density. Such metrics are useful for evaluating microcirculatory health. The development of automated software marks a significant advance toward real-time bedside microvascular assessment. These advancements could eventually allow shock resuscitation to be tailored based on microvascular responses. In parallel with imaging advances, cardiac output monitors have evolved significantly. Once cumbersome devices displaying basic numerical data in tabular form, they now feature sleek, touch-screen interfaces integrated with visual decision-support tools. These tools synthesize hemodynamic data into intuitive graphical formats, allowing clinicians to quickly grasp the determinants of circulatory shock. This visual clarity supports more efficient and accurate decision-making, which may ultimately lead to improved patient care and outcomes. [ABSTRACT FROM AUTHOR]

Background. While the basal region of the left ventricle (LV) rotates in a clockwise (cw) direction, the apical regions of the LV rotate in a counterclockwise (ccw) direction in healthy circumstances. Although LV rotational mechanics help optimize LV ejection, in some cases, LV twist is missing. This clinical situation, when the LV base and the apex rotate in the same cw or ccw direction, is called LV 'rigid body rotation' (LV-RBR). Three-dimensional speckle-tracking echocardiography (3DSTE) seems to be optimal for the simultaneous assessment of the LV and the left atrium (LA). Therefore, the present study aimed to determine the features of LA remodeling in healthy adults having 3DSTE-derived LV-RBR as compared to subjects with normally directed LV rotational mechanics. Methods. This study consisted of 165 healthy subjects (mean age: 33.1 ± 12.3 years, 75 males), from which 156 individuals showed normally directed LV rotational mechanics, while 9 cases had LV-RBR. Results. When LV-RBR subjects were compared to subjects with normally directed LV rotational mechanics, all LA volumes were increased with preserved LA stroke volumes and (non-significantly) reduced LA emptying fractions. When subgroups were compared with each other, it has been clarified that an enlargement of the LA with increased volumes was limited only to ccwLV-RBR cases. While reduced global peak LA longitudinal strain could be detected in LV-RBR subjects as compared to subjects with normally directed LV rotational mechanics, which was limited to cases with the ccw form of LV-RBR (15.1 ± 4.7% vs. 26.6 ± 9.0%, p < 0.05), the global peak LA radial strain was increased in subjects with cwLV-RBR (−23.4 ± 6.3% vs. −14.7 ± 8.0%, p < 0.05). Increased global LA radial strain at atrial contraction could be detected in LV-RBR subjects (−9.9 ± 7.1% vs. −5.2 ± 5.2%, p < 0.05), which was present in both ccw and cw LV-RBR cases. Conclusions. In healthy adults presenting LV-RBR, subclinical LA remodeling could be detected in both forms of LV-RBR, but more pronounced in those who present a counterclockwise-oriented form. [ABSTRACT FROM AUTHOR]

Objective: Hemoglobin (Hb) Bart's disease is a severe manifestation of alpha‐thalassemia, resulting in fetal tissue hypoxia and severe anemia. There is limited research available on assessing speckle‐tracking analysis of the fetal heart as a response to fetal anemia caused by Hb Bart's disease. This study aimed to assess the diagnostic performance of fetal cardiac measurements derived from speckle‐tracking analysis to identify fetuses with Bart's anemia between 17 and 24 weeks of gestation. Methods: This prospective cohort study included 115 women with singleton pregnancies at risk for fetal Hb Bart's disease who underwent either amniocentesis or cordocentesis at Siriraj Hospital, Bangkok, Thailand, in the period between January 2019 and January 2021. Speckle‐tracking analysis of the fetal heart was performed in the four‐chamber view (4CV), assessing ventricular size and shape, ventricular contractility and left ventricular function, prior to invasive prenatal testing. Logistic regression analysis was used to determine significant cardiac predictors and calculate the probability of a fetus having Hb Bart's anemia. Results: Among the cohort, 38 (33.0%) fetuses were diagnosed with Hb Bart's disease, and of these, nine (23.7%) cases exhibited fetal hydrops. In comparison to the control group, affected fetuses displayed enlargement of the 4CV, with a globular shape of the right ventricular chamber. Additionally, there were significant reductions in both global and longitudinal left ventricular contractility in non‐hydropic affected fetuses compared with the controls. At mid‐gestation, no significant differences were observed in transverse contractility or left ventricular function, except for the ejection fraction, between the two groups. Based on logistic regression analysis, combined cardiac measurements derived from speckle‐tracking analysis, as a function of head circumference, could differentiate non‐hydropic fetuses with Hb Bart's anemia from unaffected fetuses, achieving a sensitivity of 100%, specificity of 98.7% and overall accuracy of 99.1%. Conclusions: Speckle‐tracking analysis of the fetal heart has the potential to accurately identify early fetal cardiac changes during the second trimester in individuals with Bart's anemia. These findings not only offer a novel predictive marker for Hb Bart's anemia, but also help address the question of the underlying mechanisms of heart failure associated with fetal anemia. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The fetal heart adapts dynamically to nutrient and oxygen needs from all fetal organs. These continuous changes make it difficult to define normal/abnormal cardiac function based only on the evaluation of a few cycles. Many signs of fetal cardiac dysfunction have been suggested; however, very few can stand as true manifestations of cardiac deterioration, and none has emerged as a single reliable marker of cardiac dysfunction. It is the combination of abnormal findings that provides a more accurate assessment of the status of the fetal heart function [ABSTRACT FROM AUTHOR]

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Background/Objectives: Bicuspid aortic valve (BAV) is a prevalent congenital heart defect that continues to present a significant challenge in the management of paediatric patients. The assessment of left ventricle systolic function is typically conducted through the measurement of the left ventricular ejection fraction. Currently, left ventricle global longitudinal strain (LV GLS) is regarded as a more sensitive indicator, enabling the quantitative assessment of global and segmental ventricular function through the determination of myocardial deformation. Methods: A prospective study was conducted between 10 January 2023 and 10 January 2024 in a tertiary paediatric cardiology referral centre. The study enrolled children aged 6 to 17 years with BAV who were undergoing periodic evaluation, as well as a control group. The primary objective was to analyse the systolic function (global and segmental LV) using the classical method (LV EF) and speckle tracking echocardiography (STE). Results: The study group comprised 73 patients with a mean age of 13 years and was predominantly male. The control group comprised 55 patients. The phenotype IB with aortic regurgitation (AR) was the most prevalent. The results of the STE evaluation in the control group demonstrated mean GLS values between −22.1% and −22.8%. A comparison of the BAV group and the control group revealed a significant difference in GLS for the apical four-chamber view (p = 0.022). Conclusions: Although the analysis of global LV function demonstrated normal values of EF in patients with BAV, the strain analysis revealed significantly reduced strain in the inferior segment and in the apical four-chamber view, as well as in the anterior segment. Further investigation is required to determine whether reduced LV GLS in paediatric patients with BAV will ultimately result in the development of clinical heart failure. Additionally, it is necessary to ascertain whether this can identify patients with subclinical heart failure and whether early detection can result in a reduction in morbidity. [ABSTRACT FROM AUTHOR]

X-ray speckles have been used in a wide range of experiments, including imaging (and tomography), wavefront sensing, spatial coherence measurements, X-ray photon correlation spectroscopy and ptychography. In this review and experimental comparison, we focus on using X-ray near-field speckle grains as wavefront markers and numerical methods for retrieving the phase information they contain. We present the most common tracking methods, introducing the existing algorithms with their specifications and comparing their performances under various experimental conditions. This comparison includes applications to different types of samples: phantoms for quantitative analysis and complex samples for assessing image quality. Our goal is to unify concepts from several speckle tracking methods using consistent terminology and equation formalism, while keeping the discussion didactic and accessible to a broad audience.

Abstract Background Long-term endurance training is associated with structural, functional, and biochemical markers of cardiac dysfunction in highly trained athletes. Many studies have focused on structural changes in the right ventricle (RV) and few have examined functional adaptation of the right ventricle. This meta-analysis aims to compare the changes in right ventricular systolic function between endurance athletes and controls before and after exercise using speckle tracking echocardiography (STE). Methods A comprehensive search of relevant studies published before March 19, 2024 that examined RV systolic function using speckle tracking technology was conducted. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used as pooled statistics. Meta regression was employed to identify sources of heterogeneity and publication bias was evaluated by Egger’s test and funnel plots. Sensitivity analysis was performed by removing sources of significant change from the results of a single publication to evaluate the stability of the results. Results Twenty studies were included with 1186 participants. A fixed effect meta-analysis revealed RV global longitudinal strain (GLS) WMD = 0.40, 95% CI (-0.08 ~ 0.89), p = 0.102 and free wall longitudinal strain (FWLS) WMD = 0.62, 95% CI (0.28 ~ 0.96), p

Aim: Several imaging techniques are in use for diagnosis and risk assessment in patients with suspected stable coronary artery disease (S-CAD). Measurement of global longitudinal strain (GLS) by two-dimensional speckle tracking (2D-STM) is a more accurate and reliable technique compared to transthoracic echocardiography. It provides a quantitative measure of left ventricular function. The aim of this prospective study was to determine the relationship between resting layer-specific longitudinal strain values and severe coronary lesions in patients with suspected S-CAD. Materials and Methods: A total of 242 patients with suspected S-CAD were included in this study. They were scheduled for elective coronary angiograph. Patients were divided into two main groups: with (n=117) and without severe coronary artery disease (CAD) (n=125). Layer-specific GLS values were compared between groups as mid-myocardial, endocardial and epicardial layers, using 2D-STM. Results: This study showed that GLS values of all layers were significantly lower in patients with severe CAD compared to controls (p

In situ wavefront sensing plays a critical role in the delivery of high-quality beams for X-ray experiments. X-ray speckle-based techniques stand out among other in situ techniques for their easy experimental setup and various data acquisition modes. Although X-ray speckle-based techniques have been under development for more than a decade, there are still no user-friendly software packages for new researchers to begin with. Here, we present an open-source Python package, spexwavepy, for X-ray wavefront sensing using speckle-based techniques. This Python package covers a variety of X-ray speckle-based techniques, provides plenty of examples with real experimental data and offers detailed online documentation for users. We hope it can help new researchers learn and apply the speckle-based techniques for X-ray wavefront sensing to synchrotron radiation and X-ray free-electron laser beamlines.

Background:Coronary artery disease (CAD) is a major cause of cardiovascular mortality. Echocardiography plays a vital role in early detection and treatment. Objectives:We investigated the use of speckle tracking during dobutamine stress echocardiography (DSE) to diagnose CAD in moderate-risk patients. Materials and Methods:A 4-month cross-sectional study enrolled 42 moderate-risk patients without prior CAD history. Data included questionnaires, echocardiographic measurements, and SPSS analysis. Results:Patients were divided into CAD-negative (66.7%) and CAD-positive (33.3%) groups based on coronary angiography. Speckle tracking during stress correlated better with angiography (kappa = 0.78) than at rest (kappa = 0.21) or stress visualization (kappa = 0.66). Sensitivity and specificity were 71.4% and 92.8% (stress test), 57.1% and 85.7% (speckle at rest), and 85.7% and 92.8% (speckle during stress), respectively. Conclusion:Speckle tracking during DSE is a promising approach for diagnosing CAD in moderate-risk patients, enhancing early intervention possibilities.

Objective: This study aimed to assess alterations in right ventricular (RV) function following percutaneous coronary intervention (PCI) in patients with chronic coronary syndromes utilizing three‐dimensional speckle tracking echocardiography (3D‐STE). Methods: A prospective study was conducted involving 136 patients diagnosed with chronic coronary syndromes undergoing PCI, constituting the study group, alongside 110 age‐ and gender‐matched healthy volunteers serving as the control group. Echocardiographic evaluations, including both conventional and three‐dimensional assessments, were performed on all study participants at 1‐week, 6, and 12 months post‐PCI. Parameters such as tricuspid annular plane systolic excursion (TAPSE) were derived from conventional echocardiography, while tricuspid lateral annular systolic velocity (S') was measured via tissue Doppler imaging. 3D‐STE was utilized to quantify metrics including right ventricular fractional area change (RVFAC), right ventricular free wall longitudinal strain (RVFWLS), right ventricular global longitudinal strain (RVGLS), right ventricular stroke volume (RVSV), and right ventricular ejection fraction (RVEF). Results: TAPSE, S', RVFAC, RVFWLS, RVGLS, RVSV, and RVEF exhibited significant increases from 1‐week to 6 months post‐PCI (p < 0.05). However, from 6 to 12 months post‐PCI, RVFAC, RVGLS, RVSV, and RVEF demonstrated no notable changes (p > 0.05). Meanwhile, TAPSE, S', and RVFWLS sustained significant elevations: TAPSE (19.63 ± 3.253% to 22.603 ± 2.885%, p < 0.001); S' (10.57 ± 2.643 to 12.61 ± 2.189 cm/s, p < 0.001); RVFWLS (18.64 ± 2.745% to 19.926 ± 3.291%, p = 0.002). At 12 months post‐PCI, S', RVFAC, RVGLS, RVSV, and RVEF remained lower than those of the healthy control group, but the differences were not statistically significant (p > 0.05). However, RVFWLS was significantly lower compared to the healthy control group (19.926 ± 3.291% vs. 22.10 ± 1.994%, p < 0.001). Conclusion: Following PCI, right ventricular systolic function in patients with chronic coronary syndromes improves significantly over time. However, even at the 12‐month post‐PCI mark, RVFWLS remains lower than that of the control group. Notably, 3D‐STE emerges as a noninvasive method for quantifying right ventricular systolic function post‐PCI in chronic coronary syndrome patients. [ABSTRACT FROM AUTHOR]

Objectives: In a cohort of patients with estimated fetal weights (EFWs) <10th centile, we aimed 1) to compare the prevalence of abnormalities of fetal 4‐chamber view (4CV) cardiac size, shape, and ventricular contractility in fetal growth restricted (FGR) and small‐for‐gestational‐age (SGA) fetuses and 2) to compare umbilical vein flow (UVF) measurements to standard Doppler surveillance in predicting abnormalities of cardiac function. Methods: Prospective observational cohort study of fetuses with EFW <10th percentile. Measurements of size and shape used were 4CV transverse width, 4CV cardiac area, 4CV global sphericity index, and right‐to‐left ventricular mid‐chamber width ratio. Variables of contractility used were fractional shortening change at the mid‐ventricle chamber, global longitudinal strain, fractional area change, and left ventricular cardiac output. The UVF and standard Doppler surveillance including umbilical artery (UA), middle cerebral artery, and cerebroplacental ratio (CPR) were collected. Control data were from previously published studies. Results: A total of 95 fetuses with EFWs <10th centile were included in the study. The rates of abnormalities of cardiac size and shape and ventricular contractility were all significantly elevated compared with normally grown control fetuses but similar between FGR and SGA fetuses. In a subset of 76 patients with UVF data, evaluation UVF identified more patients with any abnormality of contractility compared with UA (37.9 vs 17.2%, P =.02). Conclusions: The addition of UVF doubled the detection rate of ventricular contractility abnormalities. The addition of UVF should be considered in the surveillance of FGR and SGA fetuses to further stratify the severity of hypoxemia and to identify those at greater risk for future cardiovascular dysfunction. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diagnosis of myocarditis remains a challenge in clinical practice; however, magnetic resonance imaging (CMRI) can ease the diagnostic approach by providing various parameters. The prevalence of right ventricular involvement in acute myocarditis is suggested to be more frequent than previously hypothesized. In this study, we sought to investigate subclinical RV involvement in patients with acute myocarditis and preserved RV ejection fraction (EF), using CMRI RV speckle-tracking imaging. Materials and Methods: CMRI of 27 patients with acute myocarditis (nine females, age 35.1 ± 12.2 y) was retrospectively analyzed. A control group consisting of CMRI images of 27 healthy individuals was included. Results: No significant differences were found regarding left ventricle (LV) and atrium dimensions. LV ejection fraction was significantly different between groups (56.6 ± 10.6 vs. 62.1 ± 2.6, p < 0.05). No significant differences were present between parameters used for conventional assessment of RV. However, RV strain absolute values were significantly lower in the acute myocarditis group in comparison with that of the control group (18.4 ± 5.4 vs. 21.8 ± 2.8, p = 0.018). Conclusions: Subclinical RV dysfunction detected by CMR-derived strain may be present in patients with acute myocarditis even with preserved RVEF. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the utility of 2D-STI and real-time three-dimensional echocardiography (RT-3DE) in assessing changes in left atrial (LA) structure and function in patients with paroxysmal atrial fibrillation (PAF) post-radiofrequency catheter ablation (RFCA). Methods: A retrospective analysis was conducted on 44 PAF patients who underwent RFCA at BA Hospital from March 2022 to March 2023. An age- and gender-matched control group of 32 healthy individuals was also included. Comprehensive echocardiographic parameters including LA dimensions (LAAPD, LALRD), volumes (LAVmin, LAVmax), ejection fraction (LAEF), and tissue velocities (a’, Ar) were compared between groups. Post-RFCA changes in these parameters were also assessed at 1, 3, and 6 months. Results: Pre-RFCA, PAF patients demonstrated larger LA dimensions and volumes with reduced LAEF and tissue velocities compared to controls. Post-RFCA, there was a significant improvement in LAEF and left ventricular ejection fraction at 1, 3, and 6 months, with the most pronounced changes observed at 6 months. LA dimensions increased initially but then decreased from 1 to 6 months post-RFCA. Notably, strain rate (SRS, SRE, SRA) measurements in various LA segments improved progressively, with the most significant enhancements at 6 months, suggesting improved atrial mechanics. Conclusion: The application of 2D-STI and RT-3DE provides a quantitative means to evaluate the structural and functional changes in the LA of PAF patients following RFCA. The progressive improvements in LA dimensions, volumes, and strain measurements up to 6-month post-RFCA indicate the potential of these techniques in monitoring treatment efficacy and patient recovery. [ABSTRACT FROM AUTHOR]

Objectives: Women with a hypertensive disorder of pregnancy (HDP) are at increased risk of developing hypertension and cardiovascular disease later in life. However, from previous studies, it is difficult to define whether this association reflects pre‐existing maternal cardiovascular risk or a potentially causal relationship between HDP and later cardiovascular risk. In this study, we performed detailed cardiovascular assessment in women in midgestation, prior to development of HDP, and at 2 years postpartum, aiming to identify cardiovascular changes prior to development of HDP and to assess persistent cardiovascular alterations long after the HDP event. Methods: This was a prospective observational study in which we performed detailed cardiovascular assessment in midgestation and at a median of 2.3 (interquartile range, 2.1–2.4) years postpartum. We examined 112 women who developed HDP and 451 women whose pregnancy was not complicated by hypertension. We used conventional and more advanced (i.e. speckle tracking) echocardiographic techniques to determine accurately left ventricular systolic and diastolic function. We used M‐mode measurements to determine left ventricular remodeling and estimate left ventricular mass. Maternal vascular status was assessed using ophthalmic artery Doppler and by calculating peak systolic velocity (PSV) ratio, as a marker of peripheral vascular resistance. Results: In midgestation, women who subsequently developed HDP had increased ophthalmic artery PSV ratio. These women also had mild cardiac functional and morphological alterations, which were accounted for mostly by maternal cardiovascular risk factors. At 2 years postpartum, women who had experienced HDP, compared to those who did not, had cardiovascular abnormalities with reduction in left ventricular systolic and diastolic function, which remained after multivariable analysis. Longitudinal analysis demonstrated that the evolution of cardiovascular changes in the HDP and non‐HDP groups was similar. Conclusions: Mild cardiac functional and morphological alterations precede the development of HDP and such changes persist for at least 2 years postpartum. The cardiac changes are likely to be the consequence of pre‐existing maternal cardiovascular risk factors rather than an adverse consequence of HDP. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

In situ wavefront sensing plays a critical role in the delivery of high‐quality beams for X‐ray experiments. X‐ray speckle‐based techniques stand out among other in situ techniques for their easy experimental setup and various data acquisition modes. Although X‐ray speckle‐based techniques have been under development for more than a decade, there are still no user‐friendly software packages for new researchers to begin with. Here, we present an open‐source Python package, spexwavepy, for X‐ray wavefront sensing using speckle‐based techniques. This Python package covers a variety of X‐ray speckle‐based techniques, provides plenty of examples with real experimental data and offers detailed online documentation for users. We hope it can help new researchers learn and apply the speckle‐based techniques for X‐ray wavefront sensing to synchrotron radiation and X‐ray free‐electron laser beamlines. [ABSTRACT FROM AUTHOR]

Background: Transthoracic echocardiography is usually the first non-invasive imaging modality for the detection of Loeffler endocarditis at thrombotic stage. In the recent decade 3D echocardiography and deformation imaging already proved as a helpful tool for the monitoring of left and right ventricular heart disease. Case presentation: The present case illustrates the diagnostic role of 3D echocardiography and deformation imaging in the acute stage of right sided Loeffler endocarditis in a 70-year-old Western European (German) woman. This case proves that myocardial involvement due to inflammation can be detected at subclinical stages by speckle tracking echocardiography. Acute deterioration of left and right ventricular function and the early response to prednisolone therapy can objectively be monitored. In addition, alterations of effective stroke volume can quantitatively be assessed by 3D right ventricular volumetry with exclusion of thrombus formation in the volume measurements. Conclusion: This case underlines the importance of 3D echocardiography and deformation imaging as a helpful diagnostic tool in disease management in the acute phase of Loeffler endocarditis at thrombotic stage. [ABSTRACT FROM AUTHOR]

Ultrasound speckle tracking is frequently used to quantify myocardial strain, and magnetic resonance imaging (MRI) feature tracking is rapidly gaining interest. Our aim is to validate cardiac MRI feature tracking by comparing it with the gold standard method (i.e., MRI tagging) in healthy subjects and patients. Furthermore, we aim to perform an indirect validation by comparing ultrasound speckle tracking with MRI feature tracking. Forty‐two subjects (17 formerly preeclamptic women, three healthy women, and 22 left bundle branch block patients of both sexes) received 3‐T cardiac MRI and echocardiography. Cine and tagged MRI, and B‐mode ultrasound images, were acquired. Intrapatient global and segmental left ventricular circumferential (MRI tagging vs. MRI feature tracking) and longitudinal (MRI feature tracking vs. ultrasound speckle tracking) peak strain and time to peak strain were compared between the three techniques. Intraclass correlation coefficient (ICC) (< 0.50 = poor, 0.50–0.75 = moderate, > 0.75–0.90 = good, > 0.90 = excellent) and Bland–Altman analysis were used to assess correlation and bias; p less than 0.05 indicates a significant ICC or bias. Global peak strain parameters showed moderate‐to‐good correlations between methods (ICC = 0.71–0.83, p < 0.01) with no significant biases. Global time to peak strain parameters showed moderate‐to‐good correlations (ICC = 0.56–0.82, p < 0.01) with no significant biases. Segmental peak strains showed significant biases in all parameters and moderate‐to‐good correlation (ICC = 0.62–0.77, p < 0.01), except for lateral longitudinal peak strain (ICC = 0.23, p = 0.22). Segmental time to peak strain parameters showed moderate‐to‐good correlation (ICC = 0.58–0.74, p < 0.01) with no significant biases. MRI feature tracking is a valid method to examine myocardial strain, but there is bias in absolute segmental strain values between imaging techniques. MRI feature tracking shows adequate comparability with ultrasound speckle tracking. [ABSTRACT FROM AUTHOR]

Background:Systemic hypertension is an expanding health problem and a major cause of cardiovascular morbidity and mortality. Left atrial (LA) strain by speckle tracking is a new echocardiographic modality that can detect impairment in LA function. Objectives:The aim was to analyze the parameters of LA strain in patients with systemic hypertension and compare them to those of normal persons. Materials and Methods:A case–control study was conducted at the echocardiography department of Marjan Medical City in Hillah from February 2023 to June 2023. The study focused on patients with hypertension and compared their 2D echocardiography, Doppler, tissue Doppler, left ventricle global longitudinal strain, and LA strain to those of a control healthy group. Data collection included a questionnaire, echocardiography using the GE Vivid iq machine, and statistical analysis using Statistical Package for the Social Sciences (SPSS) 27 software. Results:In total, 100 persons were enrolled in the study; 50 of them were patients with systemic hypertension, and the other 50 were persons with negative medical history. The two groups were age, gender, and body surface area matched. Echocardiographic parameters were compared, concentrating on LA strain and diastolic function parameters. A strong correlation was found between hypertension and LA strain parameters. Reservoir, conduit, and contractile strain were lower in the hypertensive group, while the LA volume and LA indexed volume were statistically larger in the hypertensive group than the control group, with a P value of less than 0.001 in both. Conclusion:LA strain by speckle tracking is affected in systemic hypertension more and even before the diastolic function affection. Earlier detection and treatment of dysfunction can delay or even prevent complications.

Ultrasound speckle tracking enables in vivo measurement of soft tissue deformation or strain, providing a non-invasive diagnostic tool to quantify tissue health. However, adoption into new fields is challenging since algorithms need to be tuned with gold-standard reference data that are expensive or impractical to acquire. Here, we present a novel optimization approach that only requires repeated measurements, which can be acquired for new applications where reference data might not be readily available or difficult to get hold of. Soft tissue motion was captured using ultrasound for the medial collateral ligament (MCL) of three quasi-statically loaded porcine stifle joints, and medial ligamentous structures of a dynamically loaded human cadaveric knee joint. Using a training subset, custom speckle tracking algorithms were created for the porcine and human ligaments using surrogate optimization, which aimed to maximize repeatability by minimizing the normalized standard deviation of calculated strain maps for repeat measurements. An unseen test subset was then used to validate the tuned algorithms by comparing the ultrasound strains to digital image correlation (DIC) surface strains (porcine specimens) and length change values of the optically tracked ligament attachments (human specimens). After 1500 iterations, the optimization routine based on the porcine and human training data converged to similar values of normalized standard deviations of repeat strain maps (porcine: 0.19, human: 0.26). Ultrasound strains calculated for the independent test sets using the tuned algorithms closely matched the DIC measurements for the porcine quasi-static measurements (R > 0.99, RMSE < 0.59%) and the length change between the tracked ligament attachments for the dynamic human dataset (RMSE < 6.28%). Furthermore, strains in the medial ligamentous structures of the human specimen during flexion showed a strong correlation with anterior/posterior position on the ligaments (R > 0.91). Adjusting ultrasound speckle tracking algorithms using an optimization routine based on repeatability led to robust and reliable results with low RMSE for the medial ligamentous structures of the knee. This tool may be equally beneficial in other soft-tissue displacement or strain measurement applications and can assist in the development of novel ultrasonic diagnostic tools to assess soft tissue biomechanics. [ABSTRACT FROM AUTHOR]

Background: Critical aortic stenosis (AS) in fetuses may progress to hypoplastic left heart syndrome (HLHS) with need for postnatal single ventricular (SV) palliation. Fetal aortic valvuloplasty (FAV) is performed to achieve postnatal biventricular (BV) circulation. However, the impact of FAV on fetal myocardial function is difficult to measure. Prediction of postnatal circulatory status and, therefore, counseling is challenging. Methods: Retrospective study of fetuses with critical AS who underwent FAV. Global Longitudinal Peak Systolic Strain (GLPSS) of the left ventricle (LV) and right ventricle (RV) were retrospectively analyzed before and after intervention. Fisher's Exact Test and Mann–Whitney-U Test were used for univariant statistical analysis. Results: 23 fetuses with critical AS were included. After intervention fetuses demonstrated more negative LV-GLPSS mean values post- vs. pre-intervention (− 5.36% vs. − 1.57%; p < 0.05). RV-GLPSS was decreased in all fetuses, there was no peri-interventional change. 20 fetuses were born alive. Postnatally, 10 had BV and 10 SV circulation. Improved post-interventional LV-GLPSS strain values correlated with BV outcome (p < 0.05). Pre-interventional continuous LV-GLPSS values correlated with postnatal SV vs. BV outcome (p < 0.05). Conclusion: In some fetuses, LV myocardial function assessed by speckle tracking echocardiography (STE) improves after FAV. Improved post-interventional LV-GLPSS correlates with biventricular postnatal outcome. Furthermore, pre-interventional LV- and RV-GLPSS correlate with postnatal outcome. Further studies are needed to asses, if pre-interventional STE parameters might predict which fetuses will benefit from FAV with postnatal BV circulation. [ABSTRACT FROM AUTHOR]

We aimed to identify the major determinants of cardiac troponin changes response to exercise among non-elite runners participating in the Beijing 2022 marathon, with a particular focus on the associations with the cardiac function assessed by tissue Doppler echocardiography and speckle tracking. A prospective study. A total of 33 non-elite participants in the 2022 Beijing Marathon were included in the study. Echocardiographic assessment and blood sample collection were conducted before, immediately after, and two weeks after the marathon. Blood samples were analyzed using the same Abbot high-sensitivity cTnI STAT assay. Echocardiography included tissue Doppler and speckle tracking echocardiography. Following the marathon, significant increases were observed in cardiac biomarkers, with hs-cTnI elevating from 3.1 [2.3–6.7] to 49.6 [32.5–76.9] ng/L (P < 0.0001). Over 72 % of participants had post-race hs-TnI levels surpassing the 99th percentile upper reference limit. There was a notable correlation between pre-marathon hs-cTnI levels (β coefficient, 0.56 [0.05, 1.07]; P = 0.042), weekly average training (β coefficient, − 1.15 [− 1.95, − 0.35]; P = 0.009), and hs-cTnI rise post-marathon. Echocardiography revealed significant post-race cardiac function changes, including decreased E/A ratio (P < 0.0001), GWI (P < 0.0001), and GCW (P < 0.0001), with LVEF (β coefficients, 0.112 [0.01, 0.21]; P = 0.042) and RV GLS (β coefficients, 0.124 [0.01, 0.23]; P = 0.035) changes significantly associated with hs-TnI alterations. All echocardiographic and laboratory indicators reverted to baseline levels within two weeks. Baseline hs-cTnI levels and weekly average training influence exercise-induced hs-cTnI elevation in non-elite runners. Echocardiography revealed post-race changes in cardiac function, with LVEF and RV GLS significantly associated with hs-TnI alterations. These findings contribute to understanding the cardiac response to exercise and could guide training and recovery strategies. [ABSTRACT FROM AUTHOR]

Objective: There is growing interest in speckle tracking echocardiography‐derived strain as a measure of left ventricular function in neonates. However, knowledge gaps remain regarding the effect of image acquisition and processing parameters on circumferential strain measurements. The aim of this study was to evaluate the effect of using different region of interest (ROI) widths on speckle tracking derived circumferential strain in healthy neonates. Methods: Thirty healthy‐term‐born neonates were examined with speckle‐tracking echocardiography in the short‐axis view. Circumferential strain values were acquired and compared using two different ROI widths. Furthermore, strain values in the different vendor‐defined wall layers were also compared. Results: Increasing ROI width led to a decrease in global circumferential strain (GCS) in the midwall and epicardial layers, the respective decreases in strain being ‐23.4 ±.6% to ‐22.0 ± 1.1%, p <.0001 and 18.5 ± 1.7% to ‐15.6 ± 2.0%, p <.0001. Segmental analyses were consistent with these results, apart from two segments in the midwall. There was no statistically significant effect on strain for the endocardial layer. A gradient was seen where strain increased from the epicardial to endocardial layers. Conclusion: Increasing ROI width led to a decrease in GCS in the midwall and epicardium. There is an increase in circumferential strain when moving from the epicardial toward the endocardial layer. Clinicians wishing to implement circumferential strain into their practice should consider ROI width variation as a potential confounder in their measurements. [ABSTRACT FROM AUTHOR]

Objective: Epidemiological studies suggest that, following in‐utero exposure to hypertensive disorder of pregnancy (HDP), children may be at increased long‐term cardiovascular risk, but data in early childhood are lacking. We aimed to investigate the independent influence of HDP on infant cardiac structure and function, after accounting for differences in childhood risk‐factor profile. Methods: This was a longitudinal study of 71 children born of a pregnancy complicated by HDP (gestational hypertension or pre‐eclampsia) and 304 children born of a normotensive pregnancy. Detailed cardiovascular assessment was performed at mid gestation and at a median of 2.3 (interquartile range, 2.1–2.4) years postnatally. Linear mixed‐effects modeling was used to determine the independent influence of HDP on infant cardiac function and structure after accounting for differences in childhood risk‐factor profile. Results: There were no differences in demographic characteristics between children whose mother developed HDP and those born of a normotensive pregnancy, but delivery was earlier and birth weight was lower in the HDP group. In fetal life, there were no significant differences in cardiac function or structure between the HDP and non‐HDP groups. In early childhood, in the HDP group compared with the non‐HDP group, there was greater relative wall thickness (mean ± SD, 0.7 ± 0.3 vs 0.6 ± 0.3; P = 0.047) and increased left ventricular mass (indexed to body surface area) (mean ± SD, 80.9 ± 20.4 g/m2vs 75.7 ± 16.5 g/m2; P = 0.024); however, these differences did not persist on multivariable analysis. Longitudinal analysis revealed that there was no difference in the change in cardiac functional indices from fetal life to early childhood between the HDP and non‐HDP groups. Conclusion: There is no evidence that HDP has an adverse effect on offspring cardiovascular health in fetal life or in early childhood. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

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Objectives: The aim of the study was to compare left ventricle stroke volume in healthy, eutrophic fetuses in the 2nd and 3rd trimesters evaluated using the velocity time integral and aortic annulus area with left ventricular stroke volume measured using Simpson's single‐plane rule and to determine the discrepancy equation. Methods: The study included 354 fetuses. In each fetus, during the same examination, simultaneous assessment of stroke volume was performed by pulsed‐wave Doppler using the product of the velocity time integral and aortic annulus area and by the fetalHQ® software using Simpson's single‐plane rule. The Mann–Whitney U test was used to compare the "product‐derived" stroke volume and stroke volume using fetalHQ® software values in the 2nd and 3rd trimesters separately. The agreement between the two methods were verified using Bland–Altman analysis. A linear regression model was used to obtain the discrepancy equation. Results: In the 2nd trimester, the mean percentage difference between both the techniques showed that the stroke volume values determined using pulsed‐wave Doppler were, on average, 88% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 146% and the lower limit of agreement was equal to 29.6%. In the 3rd trimester, the results indicated that the stroke volume values determined using pulsed‐wave Doppler were, on average, 76% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 129% and the lower limit of agreement was 23%. Based on the results of the linear regression models, discrepancy formulas of the stroke volume values were obtained. The equations to calculate the predicted mean and standard deviations were used to compute the reference intervals for the mean, 5th and 95th centiles. Conclusion: The calculation of left ventricular stroke volume using pulsed Doppler has higher result in relation to stroke volume determined using Simpson's rule significantly. The aortic annulus area showed a higher correlation regarding stroke volume than the velocity time integral in both the 2nd and 3rd trimesters. Stroke volume increased with the increase in aortic annulus area, whereas the velocity time integral remained relatively constant. The retrospective analysis of the collected material enabled the determination of the discrepancy equation. [ABSTRACT FROM AUTHOR]

Introduction: The effects of pre-anesthetic single-dose oral pimobendan during inhalational anesthesia, including the comparison with the effects of single intravenous pimobendan under anesthesia, remain unexplored. Therefore, this study aimed to determine changes in hemodynamic and echocardiographic parameters induced by pre-anesthetic administration of oral pimobendan under isoflurane general anesthesia and to compare them with those induced by intravenous pimobendan. Methods: Thirteen clinically normal dogs (4 laboratory and 9 client-owned dogs) with no clinical signs and not on any medical treatment were included. Anesthesia was performed three times: no pimobendan (Control), oral pimobendan (PIMO PO, 0.3  mg/kg), and intravenous pimobendan (PIMO IV, 0.15  mg/kg). Echocardiographic and hemodynamic parameters were monitored at 30-min intervals in all groups. Results: Compared to the Control group, end-systolic volume index (ESVI) and normalized left ventricular internal diameter at end-systole (LVIDSN) were significantly lower, and fractional shortening (FS) and ejection fraction (EF) were significantly higher in the PIMO PO and IV groups (p <  0.001). Global radial strain (GRS) was significantly higher in the PIMO PO and IV groups (p =  0.015). Conclusion: Under general anesthesia, oral pimobendan preserved LV systolic and myocardial function in a manner comparable to intravenous pimobendan. Pre-anesthetic administration of oral pimobendan can be used to compensate for cardiac systolic function in dogs who require therapeutic and diagnostic procedures under general anesthesia with potential risk of circulatory failure. [ABSTRACT FROM AUTHOR]

Purpose: To assess left atrial (LA) function in individuals with known paroxysmal atrial fibrillation (AF) compared with healthy and nonhealthy individuals without atrial fibrillation. Methods: The Akershus Cardiac Examination 1950 Study included 3,706 individuals all born in 1950. LA strain assessment of reservoir (LASr), conduit (LAScd) and contractile (LASct) functions were performed in all participants by investigators blinded to clinical data. Participants with cardiovascular disease, obesity, diabetes, pulmonary or renal disease were defined as nonhealthy, and those without as healthy. Patients with paroxysmal AF were identified through medical history and ECG documentation. Results: LA strain assessment was feasible in 3,229 (87%) of the participants (50% women). The healthy group (n = 758) had significantly higher LASr and LAScd than the nonhealthy (n = 2,376), but LASct was similar between the groups. Participants with paroxysmal AF had significantly lower values of all strain parameters than the other groups. Multivariable logistic regression showed a significantly reduced probability of having AF per standard deviation increase in LASr and LASct. A nonlinear restricted cubic spline model fitted better with the association of LASr with paroxysmal AF than the linear model, and LA strain values below the population mean associated with an increased probability of having AF, but for values above the population mean no such association was present. Conclusion: Compared to participants without AF, those with known paroxysmal AF had significantly lower values of all LA strain parameters during sinus rhythm. Lower values of LA strain were associated with a significantly increased probability of having AF. [ABSTRACT FROM AUTHOR]

Background: An increasing proportion of heart failure (HF) patients progress to the advanced stage (AdHF) with high event rates and limited treatment options. Echocardiography, particularly Speckle Tracking-derived myocardial work (MW), is useful for HF diagnosis and prognosis. We aimed to assess MW's feasibility in the prognostic stratification of AdHF. Methods: We retrospectively screened patients with AdHF who accessed our hospital in 2018–2022. We excluded subjects with inadequate acoustic windows; unavailable brachial artery cuff pressure at the time of the echocardiography; atrial fibrillation; and mitral or aortic regurgitation. We measured standard parameters and left ventricular (LV) strain (LS) and MW. The population was followed up to determine the composite outcomes of all-cause mortality, left ventricular assist device implantation and heart transplantation (primary endpoint), as well as unplanned HF hospitalization (secondary endpoint). Results: We enrolled 138 patients, prevalently males (79.7%), with a median age of 58 years (IQR 50–62). AdHF etiology was predominantly non-ischemic (65.9%). Thirty-five patients developed a composite event during a median follow-up of 636 days (IQR 323–868). Diastolic function, pulmonary pressures, and LV GLS and LV MW indices were not associated with major events. Contrarily, for the secondary endpoint, the hazard ratio for each increase in global work index (GWI) by 50 mmHg% was 0.90 (p = 0.025) and for each increase in global constructive work (GCW) by 50 mmHg% was 0.90 (p = 0.022). Kaplan–Meier demonstrated better endpoint-free survival, with an LV GWI ≥ 369 mmHg%. Conclusions: GWI and GCW, with good feasibility, can help in the better characterization of patients with AdHF at higher risk of HF hospitalization and adverse events, identifying the need for closer follow-up or additional HF therapy. [ABSTRACT FROM AUTHOR]

Background: During the physiological cardiac cycle, the helix orientation of the muscle fibres induces the rotation of the apex relative to the base of the left ventricular (LV). In heart failure, LV torsion is impaired, and rotation at basal and apical levels occurs in the same direction, a phenomenon called rigid body rotation (RBR). We aimed to evaluate whether the RBR pattern and GLS together could improve the diagnosis of cardiotoxicity in patients treated with anthracyclines and/or anti-HER2. Methods: With an observational, retrospective study involving 175 patients (mean age 55 ± 12 years, 94% females), we evaluated the development of cancer therapeutic–related cardiac dysfunction (CTRCD) defined according to ESC guidelines. We characterised LV dysfunction by echocardiographic standard and speckle-tracking (GLS and RBR pattern) measurements. Patients with a previous diagnosis of structural heart disease or atrial fibrillation were excluded. Results: At the time of enrolment, the chemotherapy regimen included trastuzumab (96%), pertuzumab (21%), and anthracyclines (13%). Twenty-two patients (12.5%) developed cardiotoxicity, and thirteen patients developed an RBR within 6 months of follow-up. In all cases, the RBR pattern was associated with cardiotoxicity (p < 0.001), reporting an optimal specificity but poor sensitivity at three and six months. However, the addition of the RBR pattern to the global longitudinal strain (GLS) ≥ −16% increased the odds ratio (OR) from 25.6 to 32.6 at three months and from 32.5 to 49.6 at six months rather than GLS alone. Conclusions: The RBR pattern improves the diagnostic accuracy of GLS for the detection of cardiotoxicity secondary to anthracyclines and anti-HER2-based treatments. [ABSTRACT FROM AUTHOR]

Assessment of fetal ventricular function is mostly subjective, and currently, for the objective assessment left ventricular shortening fraction is obtained. However, this by itself is not very reliable. Hence, more tools that can provide an objective assessment are needed to increase the confidence of functional assessment. Speckle tracking imaging can provide one such tool. In this study we sought to establish the normative value of global longitudinal and circumferential strain for our fetal patients and for two major forms of congenital heart diseases, namely atrioventricular canal defects (AVC) and uncorrected dextro-transposition of the great arteries (dTGA) to act as a benchmark. The study was completed via a single center retrospective analysis on 72 fetal echocardiograms (26 normal, 15 dTGA, and 31 AVC). Tomtec Arena™ echocardiography analysis software was used for analysis. In normal fetuses, mean left ventricular (LV) global longitudinal strain (GLS) was − 22.6% (95% CI -24, -21.1) and mean right ventricular (RV) GLS was − 22.1% (95% CI -23.6, -20.6). In AVC patients LV GLS was-26.6% (95% CI -28,-25.3) and mean RV GLS was − 26.5% (95% CI -27.9,-25.2). In dTGA patients LV GLS was − 22.9% (95% CI of -24.8, -21) and RV GLS was − 21.3% (95% CI was − 23.4, -20.8). There was good intra-rater reliability though poor to fair inter-rater reliability. Notwithstanding its current limitations, strain imaging can provide useful information that can increase confidence of cardiac functional assessment in fetal patients. However, to be reliable across the board, further automation and standardization is required. [ABSTRACT FROM AUTHOR]

Background/Objectives: Bicuspid aortic valve (BAV) is a prevalent congenital heart defect that continues to present a significant challenge in the management of paediatric patients. The assessment of left ventricle systolic function is typically conducted through the measurement of the left ventricular ejection fraction. Currently, left ventricle global longitudinal strain (LV GLS) is regarded as a more sensitive indicator, enabling the quantitative assessment of global and segmental ventricular function through the determination of myocardial deformation. Methods: A prospective study was conducted between 10 January 2023 and 10 January 2024 in a tertiary paediatric cardiology referral centre. The study enrolled children aged 6 to 17 years with BAV who were undergoing periodic evaluation, as well as a control group. The primary objective was to analyse the systolic function (global and segmental LV) using the classical method (LV EF) and speckle tracking echocardiography (STE). Results: The study group comprised 73 patients with a mean age of 13 years and was predominantly male. The control group comprised 55 patients. The phenotype IB with aortic regurgitation (AR) was the most prevalent. The results of the STE evaluation in the control group demonstrated mean GLS values between −22.1% and −22.8%. A comparison of the BAV group and the control group revealed a significant difference in GLS for the apical four-chamber view (p = 0.022). Conclusions: Although the analysis of global LV function demonstrated normal values of EF in patients with BAV, the strain analysis revealed significantly reduced strain in the inferior segment and in the apical four-chamber view, as well as in the anterior segment. Further investigation is required to determine whether reduced LV GLS in paediatric patients with BAV will ultimately result in the development of clinical heart failure. Additionally, it is necessary to ascertain whether this can identify patients with subclinical heart failure and whether early detection can result in a reduction in morbidity.

Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic disorder associated with an elevated risk of life-threatening arrhythmias and progressive ventricular impairment. Risk stratification is essential to prevent major adverse cardiac events (MACE). Our study aimed to investigate the incremental value of strain measured by two-dimensional speckle-tracking echocardiography in predicting MACE in ARVC patients compared to conventional echocardiographic parameters. Methods and Results This was a retrospective, single-centre cohort study of 83 patients with ARVC (51% males, median age 37 years (IQR: 23, 53)) under the care of the Inherited Cardiac Conditions clinic at University Hospital Birmingham. MACE was defined as one of the following: sustained ventricular tachycardia (Sus VT), ventricular fibrillation (VF), appropriate implantable cardio-defibrillator (ICD) therapy [shock/anti-tachycardia pacing (ATP)], heart failure (defined as decompensated heart failure, cardiac index by heart catheter, HF medication, and symptoms), cardiac transplantation, or cardiac death. Echocardiography images were analysed by a single observer for right ventricle (RV) and left ventricular (LV) global longitudinal strain (GLS). Multivariable Cox regression was performed in combination with RV fractional area change and tricuspid annular plane systolic excursion. During three years of follow-up, 12% of patients suffered a MACE. ARVC patients with MACE had significantly reduced RV GLS (−13 ± 6% vs. −23 ± 6%, p < 0.001) and RV free wall longitudinal strain (−15 ± 5% vs. −25 ± 7%, p < 0.001) compared to those without MACE. Conclusions Right ventricular free wall longitudinal strain (RVFWLS) may be a more sensitive predictor of MACE than conventional echocardiographic parameters of RV function. Moreover, RV-free wall longitudinal strain may have superior predictive value compared to RV GLS.