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Cyclic variation of integrated backscatter and circumferential strain at the mid left ventricle were larger in patient with reverse left ventricular remodelling (A) than patient with no reverse left ventricular remodelling (B). However, there was no difference of longitudinal strain from apical four chamber between two patients.
Source publication
This study was to evaluate the relationship between ultrasonic tissue characterization by integrated backscatter (IBS) and myocardial deformation assessed by two-dimensional speckled tracking (2DS) imaging for prediction of left ventricular (LV) reverse remodelling in patients with non-ischaemic dilated cardiomyopathy (DCM).
Forty-five consecutive...
Contexts in source publication
Context 1
... IB measurements were displayed in a time-intensity waveform with a range of 0 to 280 dB. The IBS intensity values at end-diastole and end- systole for the septum and posterior wall were obtained using the stan- dard commercial software (EchoPAC; GE Vingmed Ultrasound AS) ( Figure 1). The calibrated IBS (cIBS) was obtained by subtracting the average pericardial IBS intensity from the average end-diastolic myocar- dial IBS intensity of the septum (cIBS-septum) and posterior wall (cIBS-posterior wall) and the regions with less fibrosis have larger values for cIBS. ...
Context 2
... short-axis views at the base (clearly depicting the tips of the mitral valve leaflets), at the level of papillary muscles, and at the apex (as close to the tip of the apex as possible, optimally with the minimal circular LV cavity present at end-systole) were used for circumferential and radial strain and torsion analysis. Echocardiographic recordings were analysed with dedicated software (EchoPAC-PC, version 10.0; GE Medical Systems, Horten, Norway) ( Figure 1) and myocardial motion was automatically tracked in each imaging view. A region of interest was manually adjusted to include the entire myocardial thickness; care was taken to avoid including the pericardium in the region of interest. ...
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Background:
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Citations
... The exclusion criteria were as follows: (I) patients with congenital heart disease (CHD); (II) patients with valvular disease; (III) patients having significant coronary artery disease (defined as showing at least 50% luminal stenosis), previous coronary revascularization, or myocardial infarction (19); (IV) patients with an estimated glomerular filtration rate less than 30 mL/min/1.73 m 2 or implanted devices (20); (V) LVEF ≥35% in CMR (21). A flowchart of the study design and timelines is presented in Figure 1. ...
Background:
Left atrial strain rate (LASR) is rarely used as an indicator of cardiovascular disorder prognosis in dilated cardiomyopathy (DCM). In the present study, we aimed to explore the prognostic value of the LASR in patients with severe idiopathic DCM [left ventricle ejection fraction (LVEF) <35%] using cardiac magnetic resonance feature tracking (CMR-FT).
Methods:
A retrospective cohort study was performed. At the time of enrollment, patients who underwent cardiovascular magnetic resonance (CMR) imaging were selected for the study. Left atrium (LA) strain rate was measured in patients with severe idiopathic DCM from four-chamber and two-chamber views using a 3.0-T CMR scanner. The study endpoint was defined as a combination of all-cause death, implantable cardioverter-defibrillator (ICD), hospitalization due to cardiac failure, and heart transplantation. Cox model analyses were used to assess the statistical significance of the risk factors.
Results:
Fifty-eight patients with a confirmed diagnosis of severe idiopathic DCM were ultimately included in the analysis [mean age of 46 years; 41 (73%) men]. The median follow-up was 43 months (13-72 months). Adverse cardiovascular events occurred in 29 patients: all-cause death occurred in 15 participants (25.8%), ICD was performed in 5 participants (8.6%), heart failure hospitalization occurred in 8 participants (13.8%), and 1 participant (1.7%) underwent heart transplantation. From univariate analysis, the left atrium reservoir strain rate (LASRs) [HR 0.12; 95% CI (0.02, 0.55), P=0.007] and the left atrium booster pump strain rate (LASRa) [HR 3.21; 95% CI (1.08, 9.58), P=0.036] significantly predicted the association with cardiovascular events. In model 1 after adjusting for basic cardiovascular risk factors, including age, hypertension, diabetes mellitus, and N-terminal pro-brain natriuretic peptide (NT-proBNP), the LASRs [HR 0.12, 95% CI (0.02, 0.58), P=0.009] was assessed. The mitral valve regurgitation, LA maximum volume index, and LA diastatic volume index were added in model 2 based on model 1. LASRs [HR 0.13, 95% CI (0.02. 0.82) P=0.030] was the independent prediction factor after adjustment for model 1 and model 2. The LASRs had a good prognostic value with an area under the curve of receiver operating characteristic of 0.697 (0.617, 0.777) at 1 year, 0.716 (0.643, 0.788) at 3 years, 0.716 (0.651, 0.798) at 5 years and 0.703 (0.597, 0.809) at 7 years.
Conclusions:
LA reservoir strain rate and active strain rate were powerful prognostic markers. The LASRs by MRI-FT provided independent prognostic value in patients with severe idiopathic DCM.
... LV GLS assessment represents a more sensitive method for systolic function assessment that is relatively independent of ventricular volumes. Several studies have confirmed that GLS is a reliable RR predictor [23]. In a study on 160 patients with DCMP, RR was achieved in 28% of patients, and LV GLS proved to be its only independent predictor [15]. ...
Improvement of left ventricular ejection fraction (LVEF) in patients after the first manifestation of heart failure with reduced ejection (HFrEF) has currently been observed more frequently than it was years ago. This appears to be due to the early initiation of comprehensive HF therapy. According to these observations, a new HF syndrome category, heart failure with improved ejection fraction (HFimpEF), was introduced. In this short review, we present definitions of reverse remodelling, myocardial remission and myocardial recovery. We provide an overview of clinical research aimed at evaluating reverse remodelling in different populations of patients with HFrEF. Clinical and imaging characteristics and biomarkers identified as predictors of reverse remodelling and improvement of the LVEF are discussed. We also briefly address the current views on the management of patients with HFimpEF. In-depth study and knowledge of the molecular mechanisms underlying the reverse remodelling process may lead to the identification of new individualized therapeutic approaches for HFrEF.
... Threedimensional speckle tracking echocardiography after a STsegment elevation myocardial infarction are associated with LV remodelling and a 1-year prognosis [29]. Three-dimensional echocardiography and three-dimensional speckle tracking echocardiography allow a rapid quantification of global LV dyssynchrony and are associated with a positive cardiac resincronization therapy response and reverse remodelling after cardiac resincronization therapy [30,31]. ...
Cardiac remodelling is an adverse phenomenon linked to heart failure progression and an important contributor to heart failure severity. Cardiac remodelling could represent the real therapeutic goal in the treatment of patients with heart failure with reduced ejection fraction, being potentially reversed through different pharmacotherapies. Currently, there are well-established drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and β-blockers with anti-remodelling effects; recently, angiotensin receptor neprilysin inhibitor effects on inhibiting cardiac remodelling (improving N-terminal pro-B-type natriuretic peptide levels, echocardiographic parameters of reverse cardiac remodelling and right ventricular function in patients with heart failure with reduced ejection fraction) were demonstrated. More recently, hemodynamic consequences of gliflozins, reduced cardiac hydrostatic pressure as a possible cause of ventricular remodelling and hypertrophy were proposed to explain potential anti-remodelling effects of gliflozins. Gliflozins exert their cardioprotective effects by attenuating myofibroblast activity and collagen-mediated remodelling. Another postulated mechanism is represented by the reduction in sympathetic activity, through the reduction in renal afferent nervous activity and the suppression of central reflex mechanisms. Benefits of gliflozins on left ventricular hypertrophy, dilation, and systolic and diastolic function were also described. In this review, we aimed to provide a wide overview on cardiac remodelling with a particular focus on possible anti-remodelling effects of angiotensin receptor neprilysin inhibitors and gliflozins.
... Female sex 24,25 Lower HF duration 24,26,27 Non-ischaemic aetiology 25,27,28 Higher systolic BP [29][30][31][32] Hypertension 24,32 Anaemia 24 COPD 24 No diabetes 24,32 Atrial fibrillation/flutter 24 NYHA class I-II 24 Higher peak oxygen consumption, better exercise performance 24,33 Echo/CMR findings Lower LVEF, greater LV diameters 19,27,28 Greater contractility on strain imaging 34 LV dyssynchrony, lower LV volumes, preserved LV contractile reserve, lower degree of MR, lower LA dimensions, preserved right heart geometry and function [35][36][37][38][39][40][41] LGE absence [42][43][44] Lower ECV 45,46 Higher dobutamine LV contractile reserve 47 Biomarkers Lower sST2 27,48 Lower Gal-3, emerging biomarkers (miRNAs, mimecan, etc.) [49][50][51][52] Therapies Start of HF therapy 26 Beta-blocker therapy to HF therapy. [29][30][31][32] Furthermore, hypertension, anaemia, chronic obstructive pulmonary disease, but also absence of diabetes, were associated with a higher likelihood of RR. 24,32 Functional status at baseline could hypothetically display some relationship with the response to HF therapy and the occurrence of RR. ...
... Speckle-tracking analysis provide an assessment of LV contractility that is relatively independent of LV volumes and shape. A better preserved LV deformation has been associated with greater propensity to RR, 34,72,73 which supports the notion that a functional reserve of the left ventricle is needed to respond favourably to HF therapies. Patients with greater degrees of LV dyssynchrony are more likely to develop RR following CRT. ...
In patients with heart failure (HF), the beneficial effects of drug and device therapies counteract to some extent ongoing cardiac damage. According to the net balance between these two factors, cardiac geometry and function may improve (reverse remodelling, RR) and even completely normalize (remission), or vice versa progressively deteriorate (adverse remodelling, AR). RR or remission predict a better prognosis, while AR has been associated with worsening clinical status and outcomes. The remodelling process ultimately involves all cardiac chambers, but has been traditionally evaluated in terms of left ventricular volumes and ejection fraction. This is the second part of a review paper by the Biomarker Study Group of the Heart Failure Association of the European Society of Cardiology dedicated to ventricular remodelling. This document examines the proposed criteria to diagnose RR and AR, their prevalence and prognostic value, and the variables predicting remodelling in patients managed according to current guidelines. Much attention will be devoted to RR in patients with HFrEF because most studies on cardiac remodelling focused on this setting.
... In addition, compared with two-dimensional CMR-FT, three-dimensional (3D) CMR-FT offers superior repeatability and variability within and between observers (9,10). The myocardial strain parameters measured by 3D CMR-FT are important for accurately evaluating myocardial strain and can predict left ventricular reverse remodeling in patients with severe NIDCM (11). Therefore, this study aims to preliminarily explore the value of cardiac magnetic resonance feature tracking (CMR-FT) for MVA in dilated cardiomyopathy. ...
Background:
Patients with nonischemic dilated cardiomyopathy (NIDCM) and malignant ventricular arrhythmia (MVA) often have a poor prognosis and a high risk of sudden cardiac death. Although the diagnosis of MVA is straightforward by electrocardiogram (ECG), the underlying abnormalities of ventricular mechanics in these patients are unknown. This study aims to preliminarily explore the value of cardiac magnetic resonance feature tracking (CMR-FT) for MVA in dilated cardiomyopathy.
Methods:
In this retrospective study, patients with NIDCM who met inclusion criteria were divided into an MVA group and a non-MVA group (included from January 2018 to September 2021). The interobserver agreement of myocardial strain parameters, including global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), were tested. The GLS, GCS, GRS, left ventricular ejection fraction (LVEF), Tpeak-Tend interval on ECG and brain natriuretic peptide (BNP) were compared between groups. Single-factor and multifactor receiver operating characteristic (ROC) curve analyses were conducted to calculate the area under the ROC curve (AUC), cut-off point, sensitivity, and specificity of these parameters in predicting MVA in NIDCM.
Results:
A total of 161 NIDCM patients were included (54 in the MVA group). GLS, GCS, and GRS had good interobserver agreement (all intraclass correlation coefficients >0.80). The absolute GLS and GCS, GRS and LVEF were lower in the MVA group than the non-MVA group (P<0.001), Tpeak-Tend and BNP were higher (P<0.001). Single-factor ROC curve analysis showed that GLS, GCS and GRS had certain diagnostic value for MVA (AUC =0.795, 0.802, and 0.754, respectively). Among them, GCS had higher sensitivity and specificity (GCS 0.796/0.776, GLS 0.778/0.757, GRS 0.741/0.692). Multifactor ROC curve analysis showed the combination of GLS and GCS (AUC =0.810), the combination of GCS and GRS (AUC =0.802), the combination of GLS and GRS (AUC =0.787), the combination of GLS, GCS, and GRS (AUC =0.810).
Conclusions:
The three-dimensional myocardial strain parameters (especially GLS and GCS) measured by CMR-FT had certain diagnostic value and could reflect the underlying abnormality of ventricular mechanics of NIDCM with MVA.
... However, backscatter has limited ability to reflect fibrosis in those with lower levels of myocardial fibrosis, such as coronary artery disease [45]. Although there are modest relationships between backscatter and STE deformation measures [46], backscatter has major limitations compared to STE: the need for an intrinsic reference frame, the actual position of the sample volume, the limited validated views, the effect of image setting and the presence of artifacts and other reflectors [17]. However, recent advances in computing power and machine learning may improve reproducibility of intensity-based data [47,48]. ...
Myocardial pathology results in significant morbidity and mortality, whether due to primary cardiomyopathic processes or secondary to other conditions such as ischemic heart disease. Cardiac imaging techniques characterise the underlying tissue directly, by assessing a signal from the tissue itself, or indirectly, by inferring tissue characteristics from global or regional function. Cardiac magnetic resonance imaging is currently the most investigated imaging modality for tissue characterisation, but, due to its accessibility, advanced echocardiography represents an attractive alternative. Speckle tracking echocardiography (STE) is a reproducible technique used to assess myocardial deformation at both segmental and global levels. Since distinct myocardial pathologies affect deformation differently, information about the underlying tissue can be inferred by STE. In this review, the current available studies correlating STE deformation parameters with underlying tissue characteristics in humans are examined, with separate emphasis on global and segmental analysis. The current knowledge is placed in the context of integrated backscatter and the future of echocardiographic based tissue characterisation is discussed. The use of these imaging techniques to more precisely phenotype myocardial pathology more precisely will allow the design of translational cardiac research studies and, potentially, tailored management strategies.
... GLS was calculated as the mean of three apical strain peak values. 23 GLS is presented as a negative percentage value because the LV length shortens during contraction in the apical views. And reduced LV shortening reflected by a higher GLS value (less negative) suggests impaired LV systolic function. ...
Background and Objective
Subjects with diabetes and periodontitis are at high risk of cardiovascular events, while the subclinical alterations of cardiac function in this cohort remain unclear. This cross‐sectional study investigated the association of periodontitis with left ventricle (LV) structural and functional abnormalities in subjects with type 2 diabetes mellitus (T2DM).
Material and Methods
A total of 115 subjects with T2DM were divided into Control group (n = 32) with no or mild periodontitis, and the rest with moderate to severe chronic periodontitis (CP) were further categorized into CP‐1 (n = 41) and CP‐2 (n = 42) based on disease severity. Echocardiography was performed to precisely assess (a) LV hypertrophy by LV mass index (LVMi); (b) LV diastolic function by tissue Doppler imaging index E/e’ ratio; and (c) LV systolic function by speckle tracking derived global longitudinal strain (GLS).
Results
Overall, a linear trend in LVMi, E/e’, and GLS existed among the Control, CP‐1, and CP‐2 groups, respectively (P < 0.05). After adjustments of multiple confounders, CP‐2 subjects showed significantly higher E/e’ (log scale, 2.22 ± 0.05 vs 2.07 ± 0.06, P < 0.01) and GLS (−17.42 ± 0.46% vs −18.95 ± 0.54%, P < 0.05) than the Controls. Multivariate analysis revealed that sites% with probing depth ≥4 mm and sites% with clinical attachment loss ≥5 mm were independent indicators for E/e’ (β = 0.005 and β = 0.002, P < 0.01) and GLS (β = 0.03 and β = 0.02, P < 0.05) , respectively. Moreover, the number of missing teeth was significantly associated with LVMi (β = 0.01, P < 0.01).
Conclusion
This study provides the first evidence that severe periodontitis is significantly associated with the exacerbation of LV diastolic and systolic dysfunction in subjects with T2DM.
... Furthermore, a previous study of DCM patients demonstrated that the strain parameters obtained from FT-CMR can provide incremental prognostic information [9]. It was also reported that strain parameters are the predictor of LV reverse remodeling in patients with severe DCM [10]. ...
To evaluate and compare the prognostic value of T1 mapping with feature tracking cardiovascular magnetic resonance (FT-CMR) imaging in patients with severe dilated cardiomyopathy (DCM) during short-term follow-up. A total of 46 patients with severe DCM (LVEF < 35%) underwent 3.0-T CMR with T1 mapping and FT-CMR analysis. The study end-point was defined as a combination of cardiac death, heart transplantation, and hospitalization due to cardiovascular events. The significance of the risk factors was mainly evaluated by univariate and multivariate Cox model analyses. During the median follow-up of 13 months (interquartile range 7–17 months), two patients died of heart failure, one received a heart transplantation, and six were hospitalized for heart failure. In the univariate analysis, extracellular volume fraction (ECV) showed significant predictive association with cardiovascular events (hazard ratio [HR] 1.35; 95% confidence interval [CI] 1.13–1.62; P = 0.001). No strain parameters in FT-CMR differed significantly between patients with or without events (all P > 0.05). In the multivariate analyses, ECV was the sole independent predictor of cardiovascular events (HR, 1.48; 95% CI 1.13–1.94; P = 0.005). The area under the curve of the time-dependent receiver operating characteristic in leave-one-out cross-validation (all > 0.70) further confirmed the predictive significance of ECV. In patients with severe DCM, ECV was not only a strong independent predictor of adverse cardiovascular events but also provided prognostic value prior to strain parameters of the FT-CMR in the short term.
... Accordingly, 2D-STE can be used in assessment of LV dysfunction, prognosis, and response to treatment in cases of DCM and HF. 10 Also, cardiac fibrosis index is closely related to myocardial torsion. Reversed apical systolic function can detect extensive fibrosis that may be an indicator for severe LV dyssynchrony and poor LV performance. ...
... It was found to be associated with reversed apical systolic rotation and circumferential deformation. 10 Finally, speckle-tracking techniques are expected to be a portion of the echocardiographic assessment of children with cardiomyopathy (Figs. 8 to 10). ...
Speckle-tracking echocardiography (STE) is a recently developed technique for the characterization and quantification of myocardial deformation, its role emerged because many Patients with subclinical LV dysfunction have an elevated risk of developing symptomatic congestive heart failure and increased mortality, so it is very important to detect these subtle changes in cardiac function (Wang et al, 2003).
Despite the feasibility of left ventricle EF. it is not sensitive enough to reveal subclinical or regional myocardial dysfunction. The detection of myocardial dysfunction can be assessed by myocardial strain from 2-dimensional speckle tracking echocardiography (2D-STE) in patients before an evident reduction in the LVEF (Neilan et al, 2006).
Two dimensional (2D) speckle tracking echocardiography (STE) is a promising new imaging modality. Similar to tissue Doppler imaging (TDI), it permits offline calculation of myocardial velocities and deformation parameters such as strain and strain rate (SR) (Blessberger & Binder, 2010). It allows for an objective and quantitative evaluation of global and regional myocardial function independently from the angle and from cardiac translational movements (Geyer et al, 2010)
... A number of studies have demonstrated that GLS is an accurate parameter to evaluate myocardial function [29,30]. It has been reported to be more sensitive than EF in identifying subclinical left ventricular dysfunction in cardiomyopathies [31] and has shown an independent prognostic value [32,33]. Use of GLS to assess myocardial function has been recommended in a variety of clinical scenarios [15,27,34]. ...
Cardiovascular diseases (CVD) represent the leading cause of maternal mortality and morbidity. Knowledge of CVD in women is constantly evolving and data are emerging that female-specific risk factors as complications of pregnancy are conditions associated with an increased risk for the long-term development of CVD. Echocardiography is a safe and effective imaging technique indicated in symptomatic or asymptomatic pregnant women with congenital heart diseases who require close monitoring of cardiac function. Deformation imaging is an echocardiographic technique used to assess myocardial function by measuring the actual deformation of the myocardium through the cardiac cycle. Speckle-tracking echocardiography (STE) is a two-dimensional (2D) technique which has been found to be more accurate than tissue Doppler to assess both left ventricular (LV) and right ventricular (RV) myocardial function. The use of 2D STE however might present some technical issues due to the tomographic nature of the technique and the motion in the three-dimensional space of the myocardial speckles. This has promoted the use of 3D STE to track the motion of the speckles in the 3D space. This review will focus on the clinical value of the new echocardiographic techniques of deformation imaging used to assess the maternal cardiovascular system in complicated pregnancies.
