Speckle tracking for left ventricle performance in young athletes with bicuspid aortic valve and mild aortic regurgitation.

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%IVS(basal), -17.7 +/- 2.7; S%LW(basal), -14.2 +/- 2.2; S%IVS(med-apic), -21 +/- 3.5; S%LW(med-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.

Tissue doppler imaging can be useful to distinguish pathological from physiological left ventricular hypertrophy: a study in master athletes and mild hypertensive subjects.

BACKGROUND: Transthoracic echocardiography left ventricular wall thickness is often increased in master athletes and it results by intense physical training. Left Ventricular Hypertrophy can also be due to a constant pressure overload. Conventional Pulsed Wave (PW) Doppler analysis of diastolic function sometimes fails to distinguish physiological from pathological LVH.The aim of this study is to evaluate the role of Pulsed Wave Tissue Doppler Imaging in differentiating pathological from physiological LVH in the middle-aged population. METHODS: we selected a group of 80 master athletes, a group of 80 sedentary subjects with essential hypertension and an apparent normal diastolic function at standard PW Doppler analysis. The two groups were comparable for increased left ventricular wall thickness and mass index (134.4 +/- 19.7 vs 134.5 +/- 22.1 gr/m2; p > .05). Diastolic function indexes using the PW technique were in the normal range for both. RESULTS: Pulsed Wave TDI study of diastolic function immediately distinguished the two groups. While in master athletes the diastolic TDI-derived parameters remained within normal range (E' 9.4 +/- 3.1 cm/sec; E/E' 7.8 +/- 2.1), in the hypertensive group these parameters were found to be constantly altered, with mean values and variation ranges always outside normal validated limits (E' 7.2 +/- 2.4 cm/sec; E/E' 10.6 +/- 3.2), and with E' and E/E' statistically different in the two groups (p < .001). CONCLUSION: Our study showed that the TDI technique can be an easy and validated method to assess diastolic function in differentiating normal from pseudonormal diastolic patterns and it can distinguish physiological from pathological LVH emphasizing the eligibility certification required by legal medical legislation as in Italy.

Non-invasive tissue Doppler imaging pulmonary capillary wedge pressure measurement improves NT-proBNP prognostic value in heart failure.

OBJECTIVE: The aim of the present study was to investigate whether the improvement of pulmonary capillary wedge pressure (PCWP) non-invasively assessed with tissue Doppler imaging is able to predict prognosis and cardiac-related mortality in patients with heart failure (HF), as previously demonstrated for NT-proBNP. METHODS: We prospectively studied 23 patients (74 +/- 10 y; 17 M, 6 F) with acute HF. NT-proBNP and PCWP were measured at admission and discharge. NT-proBNP concentrations were determined by a chemiluminescent immunoassay kit. PCWP was assessed using the ratio of transmitral E velocity to the early diastolic mitral annulus velocity (E'), with the formula PCWP = 1.9 + 1.24 (E/E'). Patients were divided in two groups according to the clinical end-point based on cardiac death and hospital readmission for HF. RESULTS: After a mean follow-up of 230 days, 10 patients reached the end-point (group A), while 13 patients resulted event-free (group B). In group B, NT-proBNP values significantly decreased (3816 +/- 7424 vs. 6799 +/- 10537 pg/mL, P < 0.01) and PCWP improved (17 +/- 7 vs. 23 +/- 12 mmHg, P < 0.01). The decrease in both NT-proBNP and PCWP values was able to identify the majority of patients (77%) with an event-free survival at follow-up, whereas 70% of patients who reached the end-point had discordant changes in NT-proBNP and PCWP (chi2 = 5.06, P < 0.05). CONCLUSIONS: The combination of a biochemical marker such as NT-proBNP and a new indicator of LV filling pressure (E/E') allows to estimate the prognostic impact of standard medical therapy even in a small group of HF patients.

Supernormal functional reserve of apical segments in elite soccer players: an ultrasound speckle tracking handgrip stress study.

BACKGROUND: Ultrasound speckle tracking from grey scale images allows the assessment of regional strain derived from 2D regardless of angle intonation, and it is highly reproducible. The study aimed to evaluate regional left ventricular functional reserve in elite soccer players. METHODS: 50 subjects (25 elite athletes and 25 sedentary controls), aged 26 +/- 3.5, were submitted to an echo exam, at rest and after the Hand Grip (HG) test. Both standard echo parameters and strain were evaluated. RESULTS: Ejection fraction was similar in athletes and controls both at rest (athletes 58 +/- 2 vs controls 57 +/- 4 p ns) and after HG (athletes 60 +/- 2 vs controls 58 +/- 3 p ns). Basal (septal and anterior) segments showed similar strain values in athletes and controls both at rest (athletes S% -19.9 +/- 4.2; controls S% -18.8 +/- 4.9 p = ns) and after HG (athletes S% -20.99 +/- 2.8; controls S% -19.46 +/- 4.4 p = ns). Medium-apical segments showed similar strain values at rest (athletes S% -17.31 +/- 2.3; controls S% -20.00 +/- 5.3 p = ns), but higher values in athletes after HG (athletes S% -24.47 +/- 2.8; controls S% -20.47 +/- 5.4 p < 0.05) CONCLUSION: In athletes with physiological myocardial hypertrophy, a brief isometric effort produces enhancement of the strain in medium-apical left ventricular segments, suggesting the presence of a higher regional function reserve which can be elicited with an inotropic challenge and suitable methods of radial function quantification such as 2D-derived strain.

Two-dimensional tracking and TDI are consistent methods for evaluating myocardial longitudinal peak strain in left and right ventricle basal segments in athletes.

BACKGROUND: Myocardial contractility can be investigated using longitudinal peak strain. It can be calculated using the Doppler-derived TDI method and the non-Doppler method based on tissue tracking on B-mode images. Both are validated and show good reproducibility, but no comparative analysis of their results has yet been conducted. This study analyzes the results obtained from the basal segments of the ventricular chambers in a group of athletes. METHODS: 30 regularly-trained athletes were submitted to an echocardiography at rest and after handgrip. Starting from the four-chamber view, overall myocardial function and regional velocities were evaluated. The images obtained were processed to determine strain in left and right ventricle basal segments. Strain was calculated using the TDI method and a validated "speckle tracking" or, more correctly, "feature tracking" algorithm. The statistical analysis included a Student's t-test (p < 0.05). RESULTS: The range of strain values obtained is in agreement with the data reported in the literature. In the left ventricle (LV) the average strain values of the basal segments calculated with TDI on IVS and LW at rest and after stress were: -21.05 +/- 3.31; -20.41 +/- 2.99 and -20.05 +/- 2.61; -21.20 +/- 2.37, respectively. In the right ventricle (RV) the same method gave IVS and LW strain values at rest of -22.22 +/- 2.58 ; -24.42 +/- 5.84, and after HG of -22.02 +/- 5.20 ;-23.93 +/- 6.34. The values obtained using feature tracking were: LV at rest -20.48 +/- 2.65 for IVS, and -21.25 +/- 2.85 for LW; LV after HG: -19.48 +/- 3 for IVS and -21.69 +/- 3.85 for LW. In RV at rest: -21.46 +/- 3.25 for IVS and -24.13 +/- 5.86 for LW; RV after HG: -24.79 +/- 7.9 for IVS and -24.13 +/- 7.0 for LW. Tissue Doppler and "feature tracking" methods showed the respective consistency of the results in the basal segments of myocardial ventricle walls. CONCLUSION: Provided that echographic imaging is good, strain can be computed in athletes by both Doppler-derived and tracking methods. It is technically feasible to use both -interchangeably, at least in basal segments.

Adaptative or maladaptative hypertrophy, different spatial distribution of myocardial contraction.

SUMMARY BACKGROUND: Left ventricular hypertrophy (LVH) may be an adaptative remodelling process induced by physical training, or result from pathological stimuli. We hypothesized that different LVH aetiology could lead to dissimilar spatial distribution left ventricular (LV) contraction, and compared different components of LV contraction using 2-dimensional (2-D) speckle tracking derived strain in subjects with adaptative hypertrophy (endurance athletes), maladaptative hypertrophy (hypertensive patients) and healthy controls. METHOD: We enrolled 22 patients with essential hypertension, 50 endurance athletes and 24 healthy controls. All subjects underwent traditional echocardiography and 2-D strain evaluation of LV longitudinal, circumferential and radial function. LV basal and apical rotation and their net difference, defined as LV torsion, were evaluated. RESULTS: LV wall thicknesses, LV mass and left atrium diameter were comparable between hypertensive group and athletes. LV longitudinal strain was reduced only in hypertensive patients (P < 0.05). LV apex circumferential strain was higher in hypertensive patients than in other groups (P < 0.001), LV basal circumferential strain, although slightly increased, did not reach significant difference. Hypertensive patients showed significantly increased rotation and torsion (P < 0.001), while no differences were observed between athletes and control. CONCLUSION: In patients with pathological LVH, LV longitudinal strain was reduced, while circumferential deformation and torsion were increased. No differences were observed in LV contractile function between subjects with adaptative LVH and controls. In pathological LVH, increasing torsion could be considered a compensatory mechanism to counterbalance contraction and relaxation abnormalities to maintain a normal LV output.