Search Results (19)

Background and Objectives: A more precise understanding of ventriculo–arterial coupling is essential, particularly regarding quantitative and qualitative associations can be demonstrated between the aorta and the left ventricle (LV), which is considered the engine of the central circulation. The aim of the present study was to investigate the associations between three-dimensional speckle-tracking echocardiography (3DSTE) derived unidimensional LV strains and end-systolic and end-diastolic ascending aortic diameters measured by M-mode echocardiography (MME). Additionally, the outcomes were analyzed after stratifying the parameters into below-average, average, and above-average. Materials and Methods: The present retrospective cohort study consisted of 162 healthy adult volunteers enrolled between 2011 and 2017, of which 93 participants (mean age: 30.6 ± 10.0 years; 54 males) were eligible for simultaneous 3DSTE-derived LV strain assessment and MME-based aortic dimension measurement. In all individuals, MME, two-dimensional Doppler echocardiography and 3DSTE were performed. Results: An increase in end-diastolic ascending aortic diameter (AAD) was associated with an increase in end-systolic AAD, and vice versa. At the maximum end-diastolic AAD, the basal, global, and mean segmental LV longitudinal strain (LS) values reached their lowest. When end-systolic AAD reached its maximum, both global and mean segmental LV-LS dropped to their minimum. The highest end-diastolic and end-systolic AADs were detectable in the presence of the lowest global LV-LS. With larger end-diastolic and end-systolic AADs, a trend toward higher LV radial strain was present. Conclusions: Even in the absence of cardiovascular pathology, a finely tuned interaction can be observed between regional LV deformation, especially with LV-LS and the size of the ascending aorta in healthy individuals. Full article

Right ventricular (RV) involvement in left ventricular hypertrabeculation (LVNC) remains under investigation. Due to its complex anatomy, assessing RV function is challenging, but 3D transthoracic echocardiography (3D_TTE) offers valuable insights. We aimed to evaluate volumetric, functional, and strain parameters of both ventricles in LVNC patients with preserved left ventricular ejection fraction (EF) and compare findings to a control group. This study included 37 LVNC patients and 37 age- and sex-matched controls. 3D_TTE recordings were analyzed using TomTec Image Arena (v. 4.7) and reVISION software to assess volumes, EF, and global/segmental strains. RV EF was further divided into longitudinal (LEF), radial (REF), and antero-posterior (AEF) components. LV volumes were significantly higher in the LVNC group, while RV volumes were comparable. EF and strain values were lower in both ventricles in LVNC patients. RV movement analysis showed significantly reduced LEF and REF, whereas AEF remained normal. These findings suggest subclinical RV dysfunction in LVNC, emphasizing the need for follow-up, even with preserved EF. Full article

Introduction. Volumetric changes in the left atrium (LA) and left ventricle (LV) are strongly associated in healthy circumstances, as recent three-dimensional speckle-tracking echocardiographic (3DSTE) studies confirmed. However, the complex relationship of LA and LV deformation in systole has never been assessed in healthy individuals. The present study purposed to perform comparative simultaneous analysis of systolic LA and LV strains in healthy adults by 3DSTE. Methods. The study consisted of 165 healthy adults (mean age: 33.2 ± 12.3 years; 90 males). Complete two-dimensional Doppler echocardiography with 3DSTE was performed in all cases. Results. The increase in global LA radial strain (RS) and longitudinal strain (LS) showed no associations with LV strains. The largest global LA circumferential strain (CS) was associated with the largest basal LV-RS. Lowest basal and global LV-CS could be demonstrated in the presence of mean global LA-CS as compared to the presence of lower than mean global LA-CS. Global LA-RS showed an increase, with global LV-RS being largest when global LV-RS was the largest. Basal and global LA-RS were largest in the case of lowest global LV-CS. Basal LA-LS was largest in the case of mean global LV-CS. With the increase in global LV-LS, basal and global LA-LS showed an increase but only up to a point; in the case of larger than mean global LV-LS, no further increase was detected in basal and global LA-LS. Conclusions. Complex associations between simultaneously assessed LA and LV deformations represented by 3DSTE-derived strains could be demonstrated in healthy adults. Full article

Introduction: The contraction–relaxation pattern of the left atrial (LA) walls is opposite to that detected in the left ventricle, which includes thinning in radial, lengthening in longitudinal, and widening in circumferential directions in the systolic reservoir phase of LA function as measured by three-dimensional speckle-tracking echocardiography (3DSTE). Global longitudinal strain (GLS) is a quantitative feature of longitudinal wall contraction referring to the whole LA. The present study aims to clarify the expected prognostic impact of peak LA-GLS as assessed by 3DSTE in healthy participants during a long-term follow-up period. Methods: The study consisted of 142 healthy adults (with an average age of 32.1 ± 12.7 years; 72 of the participants were men), in whom complete two-dimensional Doppler echocardiography and 3DSTE were performed on a voluntary basis. Results: Thirteen adults suffered from a cardiovascular event, including two cardiac deaths during a mean follow-up of 8.35 ± 4.20 years. Peak LA-GLS ≥ 20.9%, as assessed by 3DSTE, was found to be a significant predictor for cardiovascular event-free survival by using ROC analysis (specificity 74%, sensitivity 62%, area under the curve 0.69, p = 0.025). Healthy individuals with peak LA-GLS < 20.9% had a lower LV-EF and a significantly higher ratio of cardiovascular events compared to cases with peak LA-GLS ≥ 20.9%. Subjects who experienced cardiovascular events had lower peak LA-GLS and the ratio of subjects with peak LA-GLS < 20.9% proved to be significantly increased compared to that of cases without cardiovascular events. Conclusions: 3DSTE-derived peak LA-GLS representing LA lengthening in the end-systolic reservoir phase of LA function predicts future cardiovascular events in healthy adults. Full article

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. Full article

Assessing myocardial strain remains challenging, particularly in the pediatric population, due to the smaller heart sizes, higher heart rates, and variability in strain parameters compared to adult populations. This study aimed to investigate the utility of myocardial strain measurements using cardiac magnetic resonance-feature tracking (CMR-FT) for early diagnosis of Duchenne muscular dystrophy (DMD) in pediatric patients. Twenty-eight DMD patients and 20 healthy controls were involved in this study. Global circumferential, longitudinal, and radial strain (GCS, GLS, and GRS) were measured for the left ventricle (LV) using CMR-FT. Segmental strain values only of the inferolateral and anterolateral LV segments in DMD patients without late gadolinium enhancement (LGE) and DMD patients with LGE were compared to the healthy controls. Strain measurements using CMR-FT in DMD patients were considerably lower than those of healthy controls, with all p-values lower than 0.001. DMD patients without LGE showed decreased inferolateral and anterolateral segmental values only relative to healthy controls. The same behavior was maintained for the LV geometry. Multivariable linear regression demonstrated that the end-systole (ES) wall thicknesses and thickening were associated with decreased GCS and GLS. CMR-FT is crucial in detecting cardiac abnormalities in patients with DMD. It represents an innovative imaging biomarker that can detect initial myocardial alterations in DMD cardiomyopathy without relying on gadolinium. Full article

Introduction: The right ventricle (RV) lies on the left ventricle (LV), and their shapes and movements are characteristic and significantly different. The aim of the present study was to investigate the relationship between three-dimensional speckle-tracking echocardiography (3DSTE)-derived LV strains, which represent LV contractility as quantitative features, and tricuspid annular plane systolic excursion (TAPSE) as determined by M-mode echocardiography, which represents the longitudinal movement of the RV, in healthy adults. Methods: A total of 79 healthy adults (mean age: 28.1 ± 6.3 years; 33 men) were enrolled in the present study. After two-dimensional Doppler echocardiography, 3DSTE-derived data acquisition was carried out in all cases, and detailed 3DSTE-based analysis was performed offline at a later date. Results: Reduced TAPSE was associated with increased global and basal LV radial strain (RS). Increased TAPSE was also associated not only with increased global and basal LV-RS but also with global LV longitudinal strain (LS). An increase in global LV-RS and global LV circumferential strain (CS) showed associations with other strains except for global LV-LS. An increase in global LV-LS did not show associations with other strains. Increased global LV-RS was associated with reduced TAPSE, while the degree of global LV-LS and global LV-CS did not show associations with TAPSE. Conclusions: Three-dimensional speckle-tracking echocardiography-derived LV-RS and LV-LS are associated with the longitudinal shortening of the RV represented by TAPSE in healthy adults. Full article

Introduction: In systole, when the left ventricle (LV) twists, the left atrium (LA) behaves like a reservoir, having a special wall contractility pattern opposite to that of the LV wall. Accordingly, the objective of the present study was to investigate the associations between LV rotational mechanics and LA peak (reservoir) strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) under healthy conditions. Methods: In the present study, 157 healthy adults (mean age: 33.2 ± 12.7 years, 73 men) were involved. Complete two-dimensional Doppler echocardiography with 3DSTE-derived data acquisition were performed in all cases. The 3DSTE-derived LV rotational and LA strain parameters were determined at a later date. Results: Global LA peak reservoir circumferential (22.7 ± 6.4% vs. 27.6 ± 6.8%, p < 0.05) and area (57.8 ± 20.0% vs. 66.0 ± 22.7%, p < 0.05) strains proved to be reduced in the case of the highest vs. lowest basal LV rotation; other LA peak reservoir strains were not associated with increasing basal LV rotation. Global LA peak radial strain was highest in the case of the lowest vs. highest apical LV rotation (−19.2 ± 9.4% vs. −13.0 ± 8.2%, p < 0.05). Global LA peak reservoir 3D strain was lowest in the case of the highest vs. lowest apical LV rotation (−9.9 ± 6.8% vs. −5.0 ± 4.2%, p < 0.05). Only apical LV rotation proved to be significantly reduced in the case of the highest vs. lowest global LA peak reservoir 3D strain (8.12 ± 3.23° vs. 10.50 ± 3.44°, p < 0.05). Other global LA peak reservoir strains were not associated with basal and apical LV rotations. Conclusions: In LV systole, LV rotational mechanics is associated with LA deformation represented by LA peak (reservoir) strains even in healthy circumstances. While basal LV rotation is associated with LA widening, apical LV rotation is associated with LA thinning, suggesting the close cooperation of the LV and LA in systole even in healthy adults. Full article

Background: Aortic valve stenosis (AS) is the most common degenerative valvular heart disease, significantly impacting the outcome. Current guidelines recommend valve replacement only for symptomatic patients, but advanced cardiovascular imaging, particularly cardiac magnetic resonance (CMR), may refine these recommendations. Feature-tracking CMR (FT-CMR) effectively assesses left ventricular (LV) strain and shows promise in predicting major adverse cardiovascular events (MACEs), though data on AS are limited. This study explored the role of CMR-derived LV strain in predicting MACEs occurrence in patients with severe AS. Method: We prospectively assessed 84 patients with severe AS and 84 matched controls. Global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were evaluated using FT-CMR. A composite endpoint—cardiac death, ventricular tachyarrhythmias, and heart failure hospitalization—was analyzed over a median follow-up of 31 months. Results: GLS was considerably reduced in AS patients (−15.8% vs. −19.7%, p < 0.001) and significantly predicted MACEs (HR = 1.24, p = 0.002) after adjusting for LVEF, 6 min walk distance, native T1, and late gadolinium enhancement. This underscores GLS’s unique and robust predictive capability for MACEs in severe AS patients. Kaplan–Meier curves and ROC analysis both showed that GLS had the highest predictive performance for MACEs, with an AUC of 0.857. Conclusions: GLS provided independent incremental predictive value for outcome. Full article

Background: Although takotsubo syndrome (TTS) is characterized by transient systolic dysfunction of the left ventricle (LV), the time course and mechanism of LV function recovery remain elusive. The aim of this study is to evaluate cardiac functional recovery in TTS via serial cardiac magnetic resonance feature tracking (CMR-FT). Methods: In this Japanese multicenter registry, patients with newly diagnosed TTS were prospectively enrolled. In patients who underwent serial cardiovascular magnetic resonance (CMR) imaging at 1 month and 1 year after the onset, CMR-FT was performed to determine the global circumferential strain (GCS), global radial strain (GRS) and global longitudinal strain (GLS). We compared LV ejection fraction, GCS, GRS and GLS at 1 month and 1 year after the onset of TTS. Results: Eighteen patients underwent CMR imaging in one month and one year after the onset in the present study. LV ejection fraction had already normalized at 1 month after the onset, with no significant difference between 1 month and 1 year (55.8 ± 9.2% vs. 58.9 ± 7.3%, p = 0.09). CMR-FT demonstrated significant improvement in GCS from 1 month to 1 year (−16.7 ± 3.4% vs. −18.5 ± 3.2%, p < 0.01), while there was no significant difference in GRS and GLS between 1 month and year (GRS: 59.6 ± 24.2% vs. 59.4 ± 17.3%, p = 0.95, GLS: −12.8 ± 5.9% vs. −13.8 ± 4.9%, p = 0.42). Conclusions: Serial CMR-FT analysis revealed delayed improvement of GCS compared to GRS and GLS despite of rapid recovery of LV ejection fraction. CMR-FT can detect subtle impairment of LV systolic function during the recovery process in patients with TTS. Full article

(1) Objective: Myocarditis can be associated with ventricular arrhythmia (VA), individual non-invasive risk stratification through cardiovascular magnetic resonance (CMR) is of great clinical significance. Our study aimed to explore whether left atrial (LA) and left ventricle (LV) myocardial strain serve as independent predictors of VA in patients with myocarditis. (2) Methods: This retrospective study evaluated CMR scans in 141 consecutive patients diagnosed with myocarditis based on the updated Lake Louise criteria (29 females, mean age 41 ± 20). The primary endpoint was VA; this encompassed ventricular fibrillation, sustained ventricular tachycardia, nonsustained ventricular tachycardia, and frequent premature ventricular complexes. LA and LV strain function were performed on conventional cine SSFP sequences. (3) Results: After a median follow-up time of 23 months (interquartile range (18–30)), 17 patients with acute myocarditis reached the primary endpoint. In the multivariable Cox regression analysis, LA reservoir (hazard ratio [HR] and 95% confidence interval [CI]: 0.93 [0.87–0.99], p = 0.02), LA booster (0.87 95% CI [0.76–0.99], p = 0.04), LV global longitudinal (1.26 95% CI [1.02–1.55], p = 0.03), circumferential (1.37 95% CI [1.08–1.73], p = 0.008), and radial strain (0.89 95% CI [0.80–0.98], p = 0.01) were all independent determinants of VA. Patients with LV global circumferential strain > −13.3% exhibited worse event-free survival compared to those with values ≤ −13.3% (p < 0.0001). (4) Conclusions: LA and LV strain mechanism on CMR are independently associated with VA events in patients with myocarditis, independent to LV ejection fraction, and late gadolinium enhancement location. Incorporating myocardial strain parameters into the management of myocarditis may improve risk stratification. Full article

Background: there are many prognostic factors of heart failure (HF) based on their evaluation from imaging, to laboratory tests. In clinical practice, it is crucial to use widely available, cheap, and easy-to-use prognostic factors, such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, 6 min walk test (6MWT), B-type natriuretic peptide (BNP), etc. We sought to evaluate the relationships between whole-heart myocardial mechanics and cardiac morphometrics with the main commonly used prognostic factors of HF in patients with non-ischemic dilated cardiomyopathy (NIDCM). Methods and results: two-dimensional (2D) echocardiography for myocardial mechanics (global longitudinal, radial, and circumferential strains of the left ventricle; right ventricular longitudinal strain; strain values of reservoir, conduit, and contraction function of both atria) and cardiac morphometric (diameters and volumes of both atria and ventricles) parameters were performed, and the HF main traditional prognostic factors were identified. We assessed 109 patients (68.8% male; 49.7 ± 10.5 years) with newly diagnosed NIDCM. Myocardial mechanics and morphometrics were weakly correlated with the patient’s age, gender, and smoking (R = 0.2, p < 0.05). Stronger relationships were observed with NYHA class, 6MWT, and BNP (the strongest correlations were with LVEF: R = −0.499, R 0.462, R = −0.461, p < 0.001, respectively). There were moderately strong correlations with LVEF and other whole-heart myocardial mechanics or morphometrics. Moreover, LVEF with global regurgitation volume (GRV) and right ventricle free wall longitudinal strain (RVFWLS) were the most usually detected parameters in multivariate analysis to be associated with changes in HF prognostic factors. Conclusions: in NIDCM patients, the main prognostic factors of HF are correlated with whole-heart myocardial mechanics and morphometrics. However, LVEF, GRV, and RVFWLS are the most usually found 2D echocardiographic factors associated with changes in HF prognostic factors. Full article

Inadequate R wave amplitude (RWA) after implantable cardiac defibrillator (ICD) implantation in patients with arrhythmogenic cardiomyopathy (ACM) was suspected to relate to right ventricle impairment. However, little data-based evidence was provided to quantify the association. We retrospectively enrolled ACM patients receiving CMR examinations before transvenous ICD implantation from Fuwai Hospital. The RWA was obtained within 24 h and at 2–6-month follow-up after the operation. Structural, functional, as well as tissue characterization of the left ventricle (LV) and right ventricle (RV), were analyzed in relation to RWA. Among the 87 ACM patients (median RWA: 8.0 mV), 19 (21.8%) patients were found with low initial RWA (<5 mV) despite attempts in multiple positions. RV end diastolic diameter (RVEDD), (r = −0.44), RV ejection fraction (RVEF, r = 0.43), RV end diastolic volume index (RVEDVi, r = −0.49), RV end systolic volume index (RVESVi, r = −0.53), RV global circumferential (RVGCS, r = −0.64), and radial strain (RVGRS, r = 0.61, all p < 0.001) rather than LV metrics correlated strongly with initial RWA. RVGCS, RVESVi, and RVGRS were decent predictors of low RWA (areas under the curve AUC: 0.814, 0.769, 0.757, respectively) early after implantation and during 2–6-month follow-up. To summarize, low RWA of ICD lead in ACM patients was associated with RV abnormalities. The RVGCS, RVGRS, and RVESVi can be valuable predictors for identifying low RWA prior to ICD implantation. Full article

To evaluate both left and right ventricular (LV and RV) function in patients with pulmonary arterial hypertension (PAH) using cardiac magnetic resonance tissue-tracking (CMR-TT) technology and explore its clinical value. Methods: A total of 79 participants (including 47 patients with PAH and 32 healthy controls) underwent cardiac magnetic resonance imaging (CMRI) with a short-axis balanced steady-state free precession (SSFP) sequence. The biventricular cardiac function parameters and strain parameters were obtained by postprocessing with CVI42 software. A comparative analysis was performed between the LV and RV strain parameters in all PAH patients and in PAH patients with reduced or preserved cardiac function. Results: The results showed preferable repeatability of CMR-TT in analyzing the global radial strain (GRS), circumferential strain (GCS), and longitudinal strain (GLS) of the left and right ventricles in the PAH group. The GRS, GCS, and GLS of the left and right ventricles except for LV GRS (LVGRS) of PAH patients were significantly lower than those of healthy controls (p < 0.05 for all). The GRS and GCS of the left and right ventricles showed a moderate correlation in the PAH group (r = 0.323, p = 0.02; r = 0.301, p = 0.04, respectively). PAH patients with preserved RV function (n = 9) showed significantly decreased global and segmental RS, CS, and LS of the right ventricles than healthy controls (p < 0.05 for all), except for basal RVGCS (RVGCS-b, p = 0.996). Only the LVGLS was significantly different between the PAH patients with preserved LV function (n = 32) and the healthy controls (−14.23 ± 3.01% vs. −16.79 ± 2.86%, p < 0.01). Conclusions: As a nonradioactive and noninvasive technique, CMR-TT has preferable feasibility and repeatability in quantitatively evaluating LV and RV strain parameters in PAH patients and can be used to effectively detect early biventricular myocardial damage in patients with PAH. Full article

Background: Left ventricular non-compaction (LVNC) is a rare cardiomyopathy typically involving the left ventricle (LV); however, the right ventricle (RV) can also be affected. This case-control study aimed to assess the morphology and function of LV and RV in children with LVNC. Methods: Sixteen children (13 ± 3 years, six girls) with LVNC were compared with 16 sex- and age-matched controls. LV and RV morphology and function were evaluated in cardiovascular magnetic resonance (CMR) studies. Additionally, LV and RV global radial (GRS), circumferential (GCS), and longitudinal strain (GLS) were assessed using tissue-tracking analysis. Results: Patients with LVNC did not differ from the healthy controls in terms of age, height, weight, and body surface area (BSA). In total, 4/16 subjects with LVNC had mid-wall late gadolinium enhancement (LGE). Compared to the control group, patients with LVNC had higher end-diastolic volume (EDV) indexed for body surface area (BSA), lower ejection fraction (EF), and lower LV strain parameters (all p < 0.05). Children with LVNC also presented with thicker RV apical trabeculation, whereas there were no differences in RV EF and EDV/BSA between the groups. Nevertheless, children with LVNC had impaired RV GRS and GCS (both p < 0.05). Conclusions: LVNC in pediatric patients is associated with LV enlargement and impaired LV systolic function. Additionally, children with LVNC have increased RV trabeculations and subclinical impairment of RV myocardial deformation. Full article