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BACKGROUND The aim of present study was to assess left ventricular (LV) myocardial deformation and changes over time in patients with acute myocarditis (AM) with preserved ejection fraction detected by late gadolinium enhancement (LGE) magnetic resonance imaging. METHODS Thirty-five male patients with AM diagnoses and preserved systolic function based on cardiac magnetic resonance imaging (MRI) were prospectively enrolled. On admission, echocardiography with measurements of global and segmental longitudinal (LS) strains was performed both at the endocardial (ENDO) and epicardial (EPI) levels. Findings were compared to 25 control subjects. Twenty-six patients were also monitored over a 22-month follow-up (FU group). RESULTS On admission, global ENDO-LS was poorer in magnitude in AM (-19.2 ± 3.1) than in controls (-24.0 ± 1.05) (P

Objectives In this study, we compared left ventricular (LV) segmental strain measurements obtained with different ultrasound machines and post-processing software packages. Background Global longitudinal strain (GLS) has proven to be a reproducible and valuable tool in clinical practice. Data about the reproducibility and intervendor differences of segmental strain measurements, however, are missing. Methods We included 63 volunteers with cardiac magnetic resonance–proven infarct scar with segmental LV function ranging from normal to severely impaired. Each subject was examined within 2 h by a single expert sonographer with machines from multiple vendors. All 3 apical views were acquired twice to determine the test-retest and the intervendor variability. Segmental longitudinal peak systolic, end-systolic, and post-systolic strain were measured using 7 vendor-specific systems (Hitachi, Tokyo, Japan; Esaote, Florence, Italy; GE Vingmed Ultrasound, Horten, Norway; Philips, Andover, Massachusetts; Samsung, Seoul, South Korea; Siemens, Mountain View, California; and Toshiba, Otawara, Japan) and 2 independent software packages (Epsilon, Ann Arbor, Michigan; and TOMTEC, Unterschleissheim, Germany) and compared among vendors. Results Image quality and tracking feasibility differed among vendors (analysis of variance, p Conclusions In contrast to GLS, LV segmental longitudinal strain measurements have a higher variability on top of the known intervendor bias. The fidelity of different software to follow segmental function varies considerably. We conclude that single segmental strain values should be used with caution in the clinic. Segmental strain pattern analysis might be a more robust alternative.

Objectives The purpose of this study was to compare the accuracy of vendor-specific and independent strain analysis tools to detect regional myocardial function abnormality in a clinical setting. Background Speckle tracking echocardiography has been considered a promising tool for the quantitative assessment of regional myocardial function. However, the potential differences among speckle tracking software with regard to their accuracy in identifying regional abnormality has not been studied extensively. Methods Sixty-three subjects (5 healthy volunteers and 58 patients) were examined with 7 different ultrasound machines during 5 days. All patients had experienced a previous myocardial infarction, which was characterized by cardiac magnetic resonance with late gadolinium enhancement. Segmental peak systolic (PS), end-systolic (ES) and post-systolic strain (PSS) measurements were obtained with 6 vendor-specific software tools and 2 independent strain analysis tools. Strain parameters were compared between fully scarred and scar-free segments. Receiver-operating characteristic curves testing the ability of strain parameters and derived indexes to discriminate between these segments were compared among vendors. Results The average strain values calculated for normal segments ranged from −15.1% to −20.7% for PS, −14.9% to −20.6% for ES, and −16.1% to −21.4% for PSS. Significantly lower values of strain (p Conclusions The accuracy of identifying regional abnormality differs significantly among vendors.

Recognizing the critical need for standardization in strain imaging, in 2010, the European Association of Echocardiography (now the European Association of Cardiovascular Imaging, EACVI) and the American Society of Echocardiography (ASE) invited technical representatives from all interested vendors to participate in a concerted effort to reduce intervendor variability of strain measurement. As an initial product of the work of the EACVI/ASE/Industry initiative to standardize deformation imaging, we prepared this technical document which is intended to provide definitions, names, abbreviations, formulas, and procedures for calculation of physical quantities derived from speckle tracking echocardiography and thus create a common standard.

Prevention strategies are important to optimize and to manage heart care in breast cancer survivors. Regular physical activity at moderate intensity is normally proposed to maintain myocardial performance; however, no data is available about the different impact of different levels of physical exercise. 2D speckle tracking echocardiography (2DSTE) is an accepted method for early detection of myocardial dysfunction. The study aims to monitor the cardiac performances in breast cancer survivors by 2DSTE analysis to manage sports activity vs physical activity. Two groups of previous breast cancer survivors (33 BCS) trained at moderate intensity and 55 athletes practicing dragon boat (DBA) sport were enrolled. They were matched with two healthy subjects groups: 23 competitive female athletes practicing different sports and 20 healthy women trained with exercise as prescription model. All women were studied by a complete echo examination including LV global longitudinal strain (GLS) assessment (XStrain-Esaote). EF and GS are only significantly higher in healthy subjects (-25.4 ± 2.1). Nevertheless, GLS values are within the normal range for all groups. Particularly, GS does not show any significant differences among subjects (-19.93 ± 4) practicing exercise as prescription when compared to the DBA competitive trained group. 2DSTE method is an appropriate method to supervise the intensity of exercise in breast cancer patients. Particularly, GLS can optimize and improve cancer therapy supporting and creating efficiencies within the health system confirming the role of the exercise prescription therapy in maintaining normal heart function.

This study evaluated the impact of prolonged circulatory unloading and subsequent left ventricular (LV) mass decrease on LV myocardial performance. Five-week head-down tilt (-6°) bed rest (HDTBR) was used as a model of prolonged circulatory unloading.Ten young healthy male volunteers (age 23 ± 2 years) were studied a day before and within the first 24 h after the end of HDTBR by two-dimensional Doppler echocardiography and carotid applanation tonometry. LV preload and afterload, cardiac workload, LV mass and wall stress, LV chamber function and diastolic filling were assessed. Longitudinal, radial and circumferential myocardial strain rate were evaluated by tissue tracking algorithm.After HDTBR, stroke volume (P0.01), stroke work (P = 0.01) and LV mass (P0.001) decreased, whereas relative wall thickness, peak and end-systolic wall stress and ejection fraction remained unchanged. HDTBR was also followed by a decrease in longitudinal systolic strain rate (-1.11 ± 0.05 vs. -1.00 ± 0.05 s, P = 0.02) and a prolongation of isovolumic relaxation time (IVRT) (74 ± 2 vs. 82 ± 3 ms, P0.01). Bed rest-induced changes in LV mass index were directly related to changes in stroke work index (r = 0.65, P0.05), and changes in longitudinal systolic strain rate and IVRT correlated with changes in stroke volume index, directly and inversely, respectively (r = 0.69 and -0.64, P0.05 for both).A decrease in LV mass following HDTBR parallels the reduction in cardiac workload and is associated with an attenuation of longitudinal systolic myocardial deformation rate and prolongation of IVRT that seem to reflect a functional adaptation of cardiac muscle to lower LV volume load.

Left ventricular (LV) function is normally improved after renal transplant, however, cardiovascular mortality remains elevated. Moderate physical activity has a positive impact on myocardial function, however, few data are available about the role of 2D echocardiography (2DE) and 2D speckle tracking echocardiography (2DSTE) on renal transplant recipients (RTR). From a large cohort of RTR submitted to a supervised exercise as the prescription program, 10 subjects who were regularly trained were studied for sixth months. They underwent periodically an echo evaluation (ESAOTE MyLab 50), cardiopulmonary test (CPT) and strength test for the lower and upper limbs. The LV function study was completed with the speckle tracking longitudinal strain (Lo Strain) measure calculated by dedicated software (XStrain–Esaote) at the end of the protocol. All of the cardiovascular parameters were normal: the ejection fraction (EF) increased significantly (from 62.7 ± 4 to 67.2 ± 2.3 with p &lt, 0.05), as well as the anaerobic threshold (15.3 ± 6.8 to 20.5 ± 10.1 with p &lt, 0.05). Particularly, the global longitudinal strain (GLS) values were within the normal range (−19.2% ± 5.1), maintaining the physiological gradient from the basal (−13.2 ± 4.1, −16.5 ± 5.21) to the apex level (−21 ± 2.3, −25.7 ± −7.0). 2D speckle tracking echocardiography (2DSTE) can be effectively used to confirm the presence of preserved physiological myocardial function in post-renal transplantation subjects submitted to a physical training.

Left atrium can be involved by amyloid deposition in familial amyloid polyneuropathy (FAP). The aim of our study is to assess left atrium function in atrial amyloidosis.Twenty-eight FAP patients (53 ± 12 years) and a control group of 22 asymptomatic individuals (49 ± 11 years) underwent strain echocardiography and cardiac magnetic resonance (CMR). CMR by late gadolinium enhancement (LGE) was used to assess the left atrium amyloid deposition, whereas strain echocardiography was used to quantify the left atrium deformation. The following atrial longitudinal strain (ALS) parameters were assessed: peak at the end of ventricular systole (peak-ALS), peak at early diastole (early-ALS), negative peak in late diastole, precontraction (prec)-ALS (difference between peak-ALS and early-ALS), and late ALS (sum of negative peak and prec-ALS).CMR showed atrial LGE in 14 FAP patients (LGE-atrial group), whereas 14 FAP patients showed no LGE (no-LGE-atrial group). Peak-ALS was significantly lower in the LGE-atrial group (22.8 ± 13%) compared with the no-LGE-atrial group (59.6 ± 33.1%; P = 0.001) and controls (47.4 ± 16.4%; P = 0.001). Early-ALS was lower in the LGE-atrial group (10.2 ± 6.2%) compared with the controls (26.3 ± 11.9%; P = 0.02) and the no-LGE-atrial group (30.2 ± 22.4%; P = 0.01). Prec-ALS was lower (P = 0.001) in the LGE-atrial group (12.6 ± 7.8%) compared with the no-LGE-atrial group (26.2 ± 15%). Conversely, late-ALS was higher (P = 0.04) in the no-LGE-atrial group (22.8 ± 12.3%) compared with the controls (13.9 ± 9%); no significant differences were found in the negative peak among groups.Patients with atrial amyloidosis have an adverse left atrium remodeling associated with left atrium dysfunction. Left atrium assessment may provide useful information in the clinical and prognostic stratification of amyloidotic patients.

Aims Speckle tracking echocardiography has already demonstrated its clinical potential. However, its use in routine practice is jeopardized by recent reports on high inter-vendor variability of the measurements. As such, the European Association of CardioVascular Imaging (EACVI) and the American Society of Echocardiography (ASE) set up a standardization task force, which was joined by all manufacturers of echocardiographic equipment as well as by companies offering software solutions only, with the ambition to tackle this problem by standardization and quality assurance (QA). Methods and results In this study, a first step towards QA of all commercially available tracking solutions based on computer-generated ultrasound images is presented. The accuracy of the products was acceptable with relative errors below 10% and intra-vendor reproducibility within 5%. Conclusion Whether these results can be extrapolated to the clinical setting is the topic of an ongoing study of the EACVI/ASE/Industry Task Force to standardize deformation imaging. This study was an important first step in the development of generally accepted tools for QA of speckle tracking echocardiography.

Aim: In athletes with Bicuspid Aortic Valve (BAV) a slight but progressive left ventricle (LV) enlargement with a reduction of longitudinal strain values at basal segments of the same chamber, have been previously demonstrated. The aim of the study is to verify by deformation parameters any possible asymptomatic myocardial dysfunction in BAV athletes. Study Design: Cross-sectional study. Place and Duration of Study: Department of Sports Medicine (Emergency Unit) between June 2009 and July 2010. Methodology: The study protocol included all athletes investigated for a prime evaluation to enter the criteria for this particular study. 30 BAV athletes (aged 25± 3) and 30 Tricuspid Aortic Valve (TAV) athletes, regularly trained were submitted to an echocardiographic exam. From the short axis LV view images, the circumferential strain, rotation, twist, distinguished in the endocardial and epicardial component at the basal and apical level, were calculated by the speckle tracking (ST) multi-layer approach. This is a special assisted mode (AHSTM, Aided Heart Segmentation) to track the LV Endo/Epi myocardial points. Results: In BAV only the epicardial (5.74±1.4) and endocardial (8.64±4.0) apical rotation are significantly higher than in TAV (p

Background Regular training, in particular endurance exercise, induces structural myocardial adaptation, so-called "athlete's heart". In addition to the 2D standard echo parameters, assessment of myocardial function is currently possible by deformation parameters (strain, rotation and twist). Aim of study is to assess the role of rotation and twist parameters for better characterize the heart performance in trained elite young athletes from different kind of sports. Eventually, verify early on any possible impact due to the regular sport activity not revealed by the standard parameters. Methods 50 young athletes (16 cyclists, 17 soccer players, 17 basket players) regularly trained at least three times a week for at least 9 months a year and 10 young controls (mean age 18.5 ± 0.5 years) were evaluated either by to 2D echocardiography or by a Speckle Tracking (ST) multi-layer approach to calculate Left Ventricle (LV) endocardial and epicardial rotation, twist, circumferential strain (CS) and longitudinal strain (LS). Data were compared by ANOVA test. Results All the found values were within the normal range. Left Ventricle Diastolic Diameter (LVDD 51.7 ± 2.6 mm), Cardiac Mass index (CMi 114.5 ± 18.5 g/m2), epi-CS, epi-LS, epicardial apex rotation and the Endo/Epi twist were significantly higher only in cyclists. In all the groups, a physiological difference of the Endo/Epi basal circumferential strain and twist values have been found. A weak but not significant relationship between the Endo and twist values and LVDD (r2 = 0.44, p = .005) and CMi was also reported in cyclists. Conclusions Progressive increase of apical LV twist may represent an important component of myocardial remodelling. This aspect is particularly evident in the young cyclists group where the CMi and the LVDD are higher. ST multilayer approach completes the LV performance evaluation in young trained athletes showing values similar to adults.

Aim of the study: To compare three different methods for obtaining interventricular-(VV) interval optimization. Methods: A total of 30 patients undergoing cardiac resynchronization therapy (CRT) were enrolled. All the patients underwent VV-interval optimization performed with three different echocardiographic methods at seven different settings: simultaneous right (RV) and left (LV) ventricular pacing, LV stimulation only, LV preexcitation (LV+20,+40,+60 ms, respectively), RV preexcitation (RV+20 and+40 ms, respectively). Optimal VV delay was selected by: (1) measuring the aortic velocity time integral (VTI method); (2) measuring the time to maximum delay between septal and lateral longitudinal motion in the four-chamber view (velocity method); and (3) measuring the segment with maximal temporal difference of peak circumferential strain in short-axis view at papillary muscles level, (strain method). Velocity and strain methods measurements were obtained relying on two-dimensional ultrasound border tracking algorithm thus providing angle-independent measurements. Results: Immediately after CRT, VTI, maximum peak circumferential strain delay and maximum septal-to-lateral delay were significantly improved (P < 0.001). Particularly, VV-interval optimization determined a further improvement of these indices as compared to the other VV settings (P < 0.001). Furthermore, a substantial concordance was found between the optimal VV interval obtained according to the VTI method and velocity method (k = 0.68), between the optimal VV interval obtained according to the VTI method and strain method (k = 0.63); and between the optimal VV interval obtained according to the velocity method and strain method (k = 0.71). Conclusions: VV-interval optimization was shown to determine a further benefit beyond CRT. A significant concordance was present between VV programming based on different echocardiographic methods. (Echocardiography 2010;27:38-43)

Aims Longitudinal peak systolic strain (LPSS) quantifies regional and global heart function. Few data are available on left ventricle (LV) performance in young athletes with bicuspid aortic valve (BAV), where a pattern of mild aortic insufficiency is relatively frequent, and the ejection fraction (EF) is often normal for a long time. We report the measurement of LV strain in young BAV athletes. Methods and results Three groups (20 athletes with BAV, 20 healthy athletes, and 20 sedentary healthy subjects, all aged 25 ± 3 years) underwent standard echo examination to evaluate LPSS at the basal and medium-apical segments of the lateral wall (LW) and interventricular septum (IVS) of the LV. LPSS was within the normal range; however, in BAV athletes, the LPSS of the basal segments tended to be lower ( S %IVSbasal, −17.7 ± 2.7; S %LWbasal, −14.2 ± 2.2; S %IVSmed-apic, −21 ± 3.5; S %LWmed-apic, −18.8 ± 4.2), producing a gradient from basal to apical regions. The EF was normal in all subjects. Conclusion Young trained BAV athletes have normal LV performance. Nevertheless, these athletes tend to have lower strain than healthy subjects in the LV basal segments. The clinical implications of this finding are uncertain and require further investigation.

Left ventricular (LV) dyssynchrony is a predictor of response to biventricular (BiV) pacing in patients with heart failure (HF) and LV dysfunction. In this study we compared a novel two-dimensional speckle tracking technique to standard Tissue Doppler Imaging (TDI) with regard to LV dyssynchrony assessment in 10 HF patients candidated to BiV pacing. Substantial correlation was found between the two techniques in measuring LV dyssynchrony (r=0.69; p