Myocardial Function Assessed by Multi-Layered Two-Dimensional Speckle Tracking Analysis in Asymptomatic Young Subjects with Diabetes Mellitus Type 1.

BACKGROUND: Diabetes mellitus type 1 (DM1) is associated with a high risk for cardiovascular disease, and early detection of myocardial dysfunction is crucial for the prevention of cardiac complications. OBJECTIVES: The aim of this study was to evaluate left ventricular (LV) and right ventricular (RV) function by using both conventional echocardiography as well as multi-layered speckle tracking echocardiography (STE) in young adults with DM1. METHODS: We included 50 young asymptomatic adults diagnosed with DM1 (mean interval from diagnosis 9 ± 6 years) and 80 healthy controls. STE was acquired using the GE Vivid S60 equipment. The LV longitudinal strain (LS), layer-specific strains of the endocardium, myocardium, and epicardium (global longitudinal strain [GLS]endo, GLSmyo, GLSepi) as well as RV strain were obtained using the EchoPAC BT13 workstation. RESULTS: No significant intergroup differences in LV ejection fraction were noted. GLSendo and GLSmyo were reduced in the DM1 group (-20.6 ± 2.7 vs. -22.0 ± 2.3 and -18.0 ± 2.4 vs. -19.1 ± 1.9, respectively, p < 0.05) compared to controls. Mechanical dispersion was higher in the diabetes group (34 ± 11 vs. 29 ± 7, p < 0.05). RV strain measurements showed no significant difference between the groups. CONCLUSIONS: Young adults with DM1 and without known heart disease have subclinical myocardial dysfunction with lower LV endocardium and myocardium LS and higher mechanical dispersion demonstrated by multi-layered STE.

Variability of right ventricular global and segmental longitudinal strain measurements.

OBJECTIVES: We evaluated intra-observer, test-retest, and inter-observer reproducibility of right ventricular (RV) longitudinal strain (LS) measurements derived from two-dimensional speckle tracking echocardiography. BACKGROUND: The assessment of RV deformation has demonstrated to hold valuable prognostic and diagnostic data in clinical practice. Data about the reproducibility of the measurements, however, are missing. METHODS: In 200 subjects, apical modified four-chamber view focused on the right ventricle (RV) was obtained. In 150 subjects (75%), a second set of images was acquired for test-retest analysis. Global RV LS (RVGLS-4C), free wall strain (RVFW-4C), and segmental maximum peak strain (base, mid, and apex) were calculated (EchoPac vBT13, GE Vingmed Ultrasound, Horten, Norway). Additionally, the reliability and feasibility of RV free wall strain derived from single wall tracking (RVFW-SWT) were tested. The absolute difference between repeated measurements and inter-class correlation coefficients (ICC) for consistency was calculated. RESULTS: RVGLS-4C and RVFW-4C measurement could be obtained in all subjects. RVGLS-4C demonstrated lower intra-observer, test-retest, and inter-observer absolute difference compared to RVFW-4C (1.4 ± 1.2%, 1.8 ± 1.5%, and 1.7 ± 1.9%, respectively, vs 2.4 ± 2.4, 2.2 ± 1.9, and 2.6 ± 3.0, respectively, P < 0.01). ICC ranged between 0.83 and 0.90 for RVGLS-4C measurements and between 0.76 and 0.79 for RVFW-4C measurements. RVFW-SWT was feasible in 82.5% of the subjects and showed noninferior reproducibility compared to RVFW-4C. Basal and apical segments demonstrating the highest variability. CONCLUSIONS: The measurement of RVGLS-4C appears to be reliable in clinical practice and demonstrates better reproducibility compared to RV free wall LS measurements. Segmental LS measurements presented high variability and such parameters should be interpreted with caution.

NT-proBNP and Echocardiographic Parameters in Liver Cirrhosis - Correlations with Disease Severity.

determined. Liver disease severity in patients with cirrhosis was established by Child-Pugh class, MELD score and presence/absence of ascites. Results: Plasma levels of NT-proBNP were significantly higher in cirrhotic patients than in the healthy subjects. NT-proBNP levels were also significantly elevated in Child-Pugh class C patients compared to those in class B and A. Left atrium size, diastolic function, left ventricular wall thickness and left ventricular ejection fraction were significantly altered in cirrhotic patients compared to controls. Advanced cirrhosis and high levels of NT-proBNP were significantly associated with increased left atrium volume and signs of cardiac diastolic dysfunction. We also observed significant differences between quartile groups of MELD score for the following: NT-proBNP, Troponin I, left atrium volume, left ventricle wall thickness, lateral wall and septum systolic tissue doppler velocities and global longitudinal strain. Conclusion: NT-proBNP is increased in patients with cirrhosis and is correlated with the severity of liver disease as established by Child-Pugh class, MELD score and presence of ascites.

Left and right ventricular morphology and function in athletes with elevated pulmonary systolic arterial pressure.

OBJECTIVES: The objective of the study was to evaluate the prevalence and potential impact of elevated pulmonary arterial systolic pressure (PASP) on left and right cardiac morphology and function in young elite athletes. METHODS: In total, 85 professional athletes (40 endurance, 20 strength, and 25 mixed training, mean age 17.8 ± 4.0) and 50 sedentary controls (mean age 18.6 ± 3.3) underwent transthoracic echocardiographic examination. Two-dimensional measurements of the right (RV) and left ventricle (LV) were obtained. PASP was estimated from the peak tricuspid regurgitant velocity (TRV). Speckle tracking-derived longitudinal LV and RV strain measurements (RV_LS) were calculated for function estimation. RESULTS: Maximum TRV (2.2 ± 0.3 vs 2.0 ± 0.2 m/s, P < .01) and PASP (26 ± 5 vs 22 ± 5 mm Hg, P < .01) were higher in athletes compared to controls. PAPS above 30 mm Hg (35 ± 3 mm Hg, range 31-40 mm Hg) was identified in 11 athletes (12.9%). Athletes with elevated PASP demonstrated higher LV mass (P < .01), LV stroke volume indexed (P < .01), larger RV-end-systolic area (ESAi), RV-end-diastolic area (EDAi), right atrium ES volume and ED volume, and decreased RV fractional area change (FAC) (P < .01) when compared to matched controls and higher RV-EDAi (13.0 ± 1.6 vs 11.1 ± 1.5, P < .01), RV-ESAi (8.2 ± 1.5 vs 6.1 ± 0.9, P < .01), and significantly reduced RV FAC (38.1 ± 5.8 vs 44.6 ± 2.5, P < .01) when compared to matched athletes. LV global longitudinal strain and RV_LS showed no differences between the groups. CONCLUSIONS: Pulmonary arterial systolic pressure elevation in young athletes is associated with pronounced right ventricular enlargement, even when compared to matched athletes. Conventional and speckle tracking echocardiography showed preserved right ventricular function.

Right ventricular remodelling after transcatheter pulmonary valve implantation.

OBJECTIVES: To define the optimal timing for percutaneous pulmonary valve implantation (PPVI) in patients with severe pulmonary regurgitation (PR) after Fallot's Tetralogy (ToF) correction. BACKGROUND: PPVI among the aforementioned patients is mainly driven by symptoms or by severe right ventricular (RV) dilatation/dysfunction. The optimal timing for PPVI is still disputed. METHODS: Twenty patients [age 13.9 ± 9.2 years, (range 4.3-44.9), male 70%] with severe PR (≥3 grade) secondary to previous correction of ToF, underwent Melody valve (Medtronic, Minneapolis, MN) implantation, after a pre-stent placement. Full echocardiographic assessment (traditional and deformation analysis) and cardiovascular magnetic resonance evaluation were performed before and at 3 months after the intervention. 'Favorable remodelling' was considered the upper quartile of RV size decrease (>20% in 3 months). RESULTS: After PPVI, indexed RV effective stroke volume increased from 38.4 ± 9.5 to 51.4 ± 10.7 mL/m2 , (P = 0.005), while RV end-diastolic volume and strain indices decreased (123.1 ± 24.1-101.5 ± 18.3 mL/m2 , P = 0.005 and -23.5 ± 2.5 to -21 ± 2.5%, P = 0.002, respectively). After inserting pre-PPVI clinical, RV volumetric and deformation parameters in a multiple regression model, only time after last surgical correction causing PR remained as significant regressor of RV remodelling [R2 = 0.60, beta = 0.387, 95%CI(0.07-0.7), P = 0.019]. Volume reduction and functional improvement were more pronounced in patients treated with PPVI earlier than 7 years after last RV outflow tract (RVOT) correction, reaching close-to-normal values. CONCLUSIONS: Early PPVI (<7 years after last RVOT operation) is associated with a more favorable RV reverse remodelling toward normal range and should be considered, before symptoms or RV damage become apparent. © 2017 Wiley Periodicals, Inc.

Tricuspid valve agenesis: a case report of a rare cause of tricuspid regurgitation in an adult.

Background: Tricuspid valve agenesis is an exceptionally rare congenital cardiac disease characterized by the incomplete formation or complete absence of one or more tricuspid leaflets. It is commonly diagnosed during childhood due to the development of heart failure symptoms. Case summary: We report the case of a 62-year-old woman admitted for a worsening of heart failure symptoms (New York Heart Association functional Class IV at admission). A standard transthoracic echocardiogram was performed, which showed severe right heart dilatation and severe tricuspid regurgitation. A three-dimensional echocardiogram revealed the absence of the posterior tricuspid leaflet. The patient underwent an uncomplicated surgical bioprosthetic valve replacement with a favourable outcome and partial recovery of right ventricular function. In our patient, valve repair was not favoured due to the additional mild hypoplasia of the anterior leaflet. The 3-month post-operative evolution of the patient was favourable, with significant symptom relief. Discussion: The diagnosis of tricuspid agenesis during adulthood is uniquely uncommon. A three-dimensional echocardiography can provide accurate pre-procedural insight into the valve anatomy, allowing surgeons to plan for either valve repair when the anatomy is suitable or valve replacement.

Lower Limit of Normality of Segmental Multilayer Longitudinal Strain in Healthy Adult Subjects.

Speckle tracking echocardiography is an advanced imaging technique that allows for a more detailed assessment of cardiac global and regional function. Reference values for segmental longitudinal layered strain (subendocardial, mid-myocardial, and subepicardial) are scarce, limiting the clinical use of these measurements in clinical practice. Two hundred consecutive Caucasian healthy subjects (mean age = 37 ± 11 years) were enrolled in the study. The mean values of global longitudinal strain (GLS) for endocardial (Endo), mid-myocardial (Myo) and epicardial (Epi) layers were -22.9 ± 2.7, -20.0 ± 2.4 and -17.5 ± 2.1, respectively. The GLSEndo/GLSMyo ratio was 1.1 ± 0.05, while the GLSEndo/GLSEpi ratio was 1.3 ± 0.05. The apical strain-sparing ratio was >1 in 10% of the subjects (endocardium) and 7% (mid-myocardium). The lower limits for segmental LS were as follows: for endocardial LS, -10% (basal), -12% (mid), -14% (apical); for mid-myocardial LS, -10% -10% (basal), -10% (mid), -10% (apical); and for epicardial LS, -7% (basal), -8% (mid), -8% (apical). The findings of this study provide data regarding the lower limit of normality of LS for each LV segment and suggest, for practical considerations, that an LS value below 10% should be considered abnormal in any segment. Further larger studies are warranted to confirm these findings.

Three-dimensional echocardiography of the mitral valve: lessons learned.

Three-dimensional echocardiography has markedly improved our understanding of normal and pathologic mitral valve (MV) mechanics. Qualitative and quantitative analysis of three-dimensional (3D) data on the mitral valve could have a clinical impact on diagnosis, patient referral, surgical strategies, annuloplasty ring design and evaluation of the immediate and long-term surgical outcome. This review covers the contribution of 3D echocardiography in the diagnosis of MV disease, its role in selecting and monitoring surgical procedures, and in the assessment of surgical outcomes. Moreover, advantages of this technique versus the standard 2D modality, as well as future applications of advanced analysis techniques, will be reviewed.

Intracardiac mass presenting as acute myocardial infarction.

Cardiac tumors, although rare, present intricate diagnostic and therapeutic challenges, necessitating timely intervention for optimal patient outcomes. This case report focuses on a 65-year-old woman admitted with chest pain and loss of consciousness, ultimately diagnosed with a left ventricular cardiac myxoma. The patient's presentation mimicked acute coronary syndrome, highlighting the diagnostic complexity associated with cardiac tumors. Advanced imaging modalities, including transthoracic echocardiography, computed tomography, and invasive coronary angiography, played a pivotal role in characterizing the intracardiac mass. Histopathological (HP) examination, utilizing immunohistochemistry, confirmed the tumor as a cardiac myxoma. The patient management involved a multidisciplinary approach, leading to surgical resection of the mass and mitral valve replacement. The case underscores the importance of the HP confirmation in patients with cardiac masses, especially when multimodality cardiac imaging suggests various tumor types, simultaneously emphasizing the need for a comprehensive diagnostic approach that includes advanced imaging and histopathology to ensure an accurate diagnosis and tailored management of cardiac tumors.

Mechanical Dyssynchrony Combined with Septal Scarring Reliably Identifies Responders to Cardiac Resynchronization Therapy.

Background and aim: The presence of mechanical dyssynchrony on echocardiography is associated with reverse remodelling and decreased mortality after cardiac resynchronization therapy (CRT). Contrarily, myocardial scar reduces the effect of CRT. This study investigated how well a combined assessment of different markers of mechanical dyssynchrony and scarring identifies CRT responders. Methods: In a prospective multicentre study of 170 CRT recipients, septal flash (SF), apical rocking (ApRock), systolic stretch index (SSI), and lateral-to-septal (LW-S) work differences were assessed using echocardiography. Myocardial scarring was quantified using cardiac magnetic resonance imaging (CMR) or excluded based on a coronary angiogram and clinical history. The primary endpoint was a CRT response, defined as a ≥15% reduction in LV end-systolic volume 12 months after implantation. The secondary endpoint was time-to-death. Results: The combined assessment of mechanical dyssynchrony and septal scarring showed AUCs ranging between 0.81 (95%CI: 0.74-0.88) and 0.86 (95%CI: 0.79-0.91) for predicting a CRT response, without significant differences between the markers, but significantly higher than mechanical dyssynchrony alone. QRS morphology, QRS duration, and LV ejection fraction were not superior in their prediction. Predictive power was similar in the subgroups of patients with ischemic cardiomyopathy. The combined assessments significantly predicted all-cause mortality at 44 ± 13 months after CRT with a hazard ratio ranging from 0.28 (95%CI: 0.12-0.67) to 0.20 (95%CI: 0.08-0.49). Conclusions: The combined assessment of mechanical dyssynchrony and septal scarring identified CRT responders with high predictive power. Both visual and quantitative markers were highly feasible and demonstrated similar results. This work demonstrates the value of imaging LV mechanics and scarring in CRT candidates, which can already be achieved in a clinical routine.

Comparison between Nondedicated and Novel Dedicated Tracking Tool for Right Ventricular and Left Atrial Strain.

BACKGROUND: Recently, dedicated speckle-tracking solutions for right ventricular (RV) and left atrial (LA) strain assessment have become commercially available. The purpose of this study was to assess the level of agreement between nondedicated (left ventricular [LV] tracking software) and novel dedicated tracking software for RV and LA strain. METHODS: In 200 patients with various cardiovascular pathologies, we measured global longitudinal strain (GLS), free wall strain (FWS), and segmental values, as well as LA strain during reservoir, conduit, and contraction phases, by using the (1) LV-tracking software and (2) the novel dedicated tracking software for RV or LA strain analysis. Agreement between corresponding measurements obtained with the LV and dedicated RV or LA software was determined by using mean absolute difference (MAD) and Bland-Altman test. The intra- and interobserver reproducibility related to the nondedicated and novel dedicated tracking software was tested in 30 randomly selected subjects. RESULTS: The dedicated RV-tracking software provided slightly lower strain values without reaching statistical significance. The agreement between software was best for RV GLS (MAD, 2.4 ± 1.8) and significantly poorer for segmental values (MAD ranging from 4.5 ± 3.8 to 5.1 ± 4.0; analysis of variance, P < .05). The intra- and interobserver reproducibility for RV measurements was similar with both software (P > .05 for all parameters). Left atrial mean values showed no statistical difference when obtained with the two tracking tools. The use of LA dedicated tracking software increased significantly the intra- and interobserver reproducibility for LA strain during reservoir and atrial contraction (P < .01 for both). CONCLUSIONS: Our results suggest that the choice of tracking software does not significantly impact RV strain measurements. Nonetheless, the use of the same tracking software is recommended when performing serial measurements. The use of the dedicated software for LA strain analysis significantly improved the intra- and interobserver reproducibility.

Echocardiography Assessment of Cardiac Function in Adults Living with HIV: A Speckle Tracking Study in the Era of Antiretroviral Therapy.

Adults living with HIV (human immunodeficiency virus) infection (ALHIV) have high rates of cardiovascular events. New approaches are needed to detect subclinical cardiac dysfunction. We used conventional and speckle tracking echocardiography to investigate whether ALHIV display latent cardiac dysfunction. We analyzed 85 young subjects with HIV infection and free from cardiovascular risk factors (31 ± 4 years) and 80 matched healthy volunteers. We measured left ventricular (LV) layered global longitudinal strain, circumferential strain, peak longitudinal strain in the reservoir and contraction phases of the left atrium (LASr respectively LASct). In the HIV group, LV ejection fraction and s' TDI (tissue doppler imaging) were slightly lower but still in the normal ranges. Layered longitudinal strain showed no significant difference, whereas circumferential global strain was significantly lower in the HIV group (−20.3 ± 3.9 vs. −22.3 ± 3.0, p < 0.001). LASr (34.3% ± 7.3% vs. 38.0% ± 6.9%, p < 0.001) was also lower in ALHIV and multivariate analysis showed that age (ß = −0.737, p = 0.01) and infection duration (ß = −0.221, p = 0.02) were independently associated with LASr. In the absence of cardiovascular risk factors, adults living with HIV display normal LV systolic function. Left atrial reservoir strain, is, however, decreased and suggests early diastolic dysfunction.

Left Atrial Strain Determinants During the Cardiac Phases.

OBJECTIVES: The present study investigated the determinants of left atrial (LA) strain in all phases of the cardiac cycle. BACKGROUND: LA strain by speckle-tracking echocardiography allows the assessment of LA function in each phase of the cardiac cycle. However, its determinants and its relation with left ventricular (LV) function have not yet been fully described. METHODS: The authors performed a retrospective analysis in 127 patients with different cardiovascular pathologies. Using 2-dimensional speckle tracking in 4- and 2-chamber apical views we derived both LA and LV strain curves. Strain-strain loops were reconstructed using LV strain and the corresponding, synchronized LA strain data. Linear regressions were calculated for the entire strain-strain loop as well as for the 3 phases of the cardiac cycle (systole, and early and late diastole). The association between LA strain parameters and LV systolic and diastolic parameters was studied. The prediction of cardiovascular events was evaluated for both measured and predicted LA strain and other parameters. RESULTS: LA and LV strain curves presented excellent correlations with an R2 > 0.90 for the cardiac cycle, and R2 > 0.97 for its phases. Moreover, the ratios of LV/LA maximal volumes and the slopes of the LA-LV strain-strain loops of the individual patients correlated well (R2 = 0.75). In each phase of the cardiac cycle, LA strain parameters correlated well with the corresponding LV strain and the LV-LA volume ratio (R2 > 0.78). No significant difference in predictive ability of cardiovascular events or atrial fibrillation between the measured and predicted LA strain was observed (P > 0.05 for both). CONCLUSIONS: In the absence of abnormal LA/LV volume exchange, LA strain is, to a large extent, determined by LV strain and further modulated by the ratio of LV and LA volumes. Nonetheless, measuring LA strain is of high clinical interest because it integrates several parameters into a single, robust, and reproducible measurement.

Testosterone and quality of life in patients with dilated cardiomyopathy.

BACKGROUND: Testosterone is an important factor that influences the quality of life in men. The purpose of this study is to evaluate how testosterone level impacts the quality of life in patients with dilated cardiomyopathy. METHODS: This cross-sectional single-center included 97 male patients with dilated cardiomyopathy, in whom serum testosterone was measured. Health-related quality of life was measured using the translated validated version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). We used correlation and multivariable regression to assess the association between KCCQ-12 score, serum testosterone level, and clinical and paraclinical variables. RESULTS: The mean age of study participants was 58 (range 29-88). The mean LVEF was 25 ±8.61%. The average total serum testosterone level was 3.13 ±2.72 (range 0.19-13.5 ng/ml). The median global KCCQ-12 score was 44.8 (6.2-90.6) representing a poor to fair impairment in quality of life. There was an inverse correlation between the KCCQ-12 score and NYHA class (Pearson coefficient r = 0.847 p<0.001) and a direct correlation with LVEF (r=0.445, p<0.001). Also, the KCCQ-12 score correlated with hemoglobin level (r=0.214, p=0.037) and plasmatic creatinine level (r=-0.296 p= 0.004). In multivariable regression, the independent predictors of health-related quality of life were testosterone, LVEF, and NYHA class. CONCLUSIONS: The results of this study showed for the first time a significant direct relationship between serum testosterone levels and quality of life in patients with dilated cardiomyopathy.

Remodeling of the aortic wall layers with ageing.

AIM: The authors aimed to evaluate the correlations between the variation of two of the main morphological parameters of the aortic wall (intima and media thicknesses) and ageing. MATERIALS AND METHODS: Aortic cross sections (base region, cross region, thoracic region, and abdominal region) were collected from 90 cases of all ages died and autopsied in the hospital. Tissue samples were processed using the classical histopathological technique (formalin fixation and paraffin embedding) and stained with Orcein and Goldner's trichrome. The obtained histological slides were transformed into virtual slides. Intima and media thicknesses were determined on virtual slides using a custom-made software, developed in MATLAB (MathWorks, USA). RESULTS AND DISCUSSIONS: The intima layer underwent an obvious and continuous process of thickening both from the aortic base region to its terminal (abdominal) region and from young ages to old age. The processes were similar in men and women but almost always more pronounced in men than in women. The media layer underwent a thickness reduction process from the aortic base to the terminal (abdominal) region whereas with age, the thickness of the layer increased. This divergent profile of evolution was similar in both men and women but with some variations depending on either topography or ageing. CONCLUSIONS: Each of the main layers of the aortic wall revealed dynamic individual evolutionary profiles related to age, gender and topography along the aortic path. Studies must be continued in a more detailed, standardized and integrated way.

Testosterone, cardiomyopathies, and heart failure: a narrative review.

Testosterone exerts an important regulation of cardiovascular function through genomic and nongenomic pathways. It produces several changes in cardiomyocytes, the main actor of cardiomyopathies, which are characterized by pathological remodeling, eventually leading to heart failure. Testosterone is involved in contractility, in the energy metabolism of myocardial cells, apoptosis, and the remodeling process. In myocarditis, testosterone directly promotes the type of inflammation that leads to fibrosis, and influences viremia with virus localization. At the same time, testosterone exerts cardioprotective effects that have been observed in different studies. There is increasing evidence that low endogenous levels of testosterone have a negative impact in some cardiomyopathies and a protective impact in others. This review focuses on the interrelationships between testosterone and cardiomyopathies and heart failure.

Assessment of Left Ventricular Diastolic Function in Young Adults with Nonalcoholic Fatty Liver Disease.

There is strong evidence that, in addition to increasing the risk of cirrhosis as well as hepatocellular carcinoma, nonalcoholic liver disease represents an independent risk factor for different diseases including cardiovascular and chronic kidney disease and also type 2 diabetes. OBJECTIVE: to assess whether nonalcoholic fatty liver disease is associated with diastolic dysfunction of the left ventricle, independent of other classic risk factors. METHODS: we included 79 patients aged 15-45, diagnosed with non-alcoholic liver disease, and a group of 80 healthy people in the same age group. We assessed left ventricular diastolic function using Doppler pulsed wave transmitral flow and Tissue Doppler Imaging methods. RESULTS: there were lower velocities of E and e' wave, a decrease in E/A ratio and an increase in E/e' ratio in the group of patients with hepatic steatosis and in those with associated diabetes compared to the control group, but not the same was observed when comparing patients with steatosis alone vs. hepatic steatosis and associated diabetes mellitus. CONCLUSION: nonalcoholic steatosis is linked to echocardiographic features of early diastolic dysfunction that are present in patients suffering from diabetes.

Contribution of Modern Echocardiographic Techniques in the Detection of Subclinical Heart Dysfunction in Young Adults with Non-Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease affects about 30% of the population and it has a growing tendecy with the increasing incidence of obesity. Currently, a large amount of clinical evidence has shown that cardiovascular disease represents the main cause of mortality in patients suffering from non-alcoholic fatty liver disease. OBJECTIVE: In this study we investigated the structural and functional changes of the left ventricle in young adults with hepatic steatosis using modern echocardiographic techniques. METHODS: By using tissue Doppler imaging and also Speckle tracking echocardiography the left ventricle systolic function was assessed. RESULTS: All patients included in the study had a normal left ventricular ejection fraction but, when the longitudinal function of the left ventricle was assessed using the tissue Doppler technique (maximum systolic velocity S) statistically significant differences were found in both the group of patients with non-alcoholic fatty liver as well as in the group of patients associated with diabetes. Using speckle tracking echocardiography, we found a statistically significant decrease of the global longitudinal strain in the endocardium, in the group of patients with non-alcoholic liver disease but also in the group of those with diabetes. The overall longitudinal strain at the myocardium was significantly reduced only in the group of patients with non-alcoholic fatty liver disease and diabetes, while the overall longitudinal strain at the epicardium showed no changes in any of the groups studied. Also, no changes were observed at the circumferential strain. CONCLUSION: Non-alcoholic fatty liver disease, diagnosed in asymptomatic young adults may be a risk factor for remodeling the left ventricle over time, being associated with subclinical myocardial dysfunction, regardless of the presence of other cardiovascular risk factors.

Quality Assurance of Segmental Strain Values Provided by Commercial 2-D Speckle Tracking Echocardiography Using in Silico Models: A Report from the EACVI-ASE Strain Standardization Task Force.

The aim of this study was to determine the accuracy and reproducibility of vendor-specific regional strain values by echocardiography using in silico data. Synthetic 2-D ultrasound gray-scale images of the left ventricle (LV) were generated with knowledge of the longitudinal segmental strain values from the underlying electromechanical LV model. Four of five models mimicked transmural infarctions with systolic segmental stretching in different vascular areas. Cine loops in the three apical views were synthetically generated at four noise levels. All in silico images were repeatedly analyzed by a single investigator and some by another investigator. The absolute errors varied significantly between vendors from 3.3 ± 3.1% to 11.2 ± 5.9%. The area under the curve for the identification of segmental stretching ranged from 0.80 (confidence interval: 0.77-0.83) to 0.96 (0.95-0.98). The levels of agreement for intra-investigator variability varied between -3.0% to 2.9% and -5.2% to 4.8%, and for inter-investigator variability, between -3.6% to 3.5% and -14.5% to 8.5%. Segmental strain analysis allows the identification of areas with segmental stretching with good accuracy. However, single segmental peak-strain values are not accurate and should be interpreted with caution. Nevertheless, our results indicate the usefulness of semiquantitative strain assessment for the detection of regional dysfunction.

Inter-vendor variability in strain measurements depends on software rather than image characteristics.

Despite standardization efforts, vendors still use specific proprietary software algorithms for echocardiographic strain measurements, which result in high inter-vendor variability. Using vendor-independent software could be one solution. Little is known, however, how vendor specific image characteristics can influence tracking results of such software. We therefore investigated the reproducibility, accuracy, and scar detection ability of strain measurements on images from different vendors by using a vendor-independent software. A vendor-independent software (TomTec Image Arena) was used to analyse datasets of 63 patients which were obtained on machines from four different ultrasound machine vendors (GE, Philips, Siemens, Toshiba). We measured the tracking feasibility, inter-vendor bias, the relative test-re-test variability and scar discrimination ability of strain measurements. Cardiac magnetic resonance delayed enhancement images were used as the reference standard of scar definition. Tracking feasibility on vendor datasets were significantly different (p < 0.001). Variability of global longitudinal strain (GLS) measurements was similar among the vendors whereas variability of segmental longitudinal strain (SLS) showed modest difference. Relative test-re-test variability of GLS and SLS showed no relevant differences. No significant difference in scar detection capability was observed. Average GLS and SLS values were similar among vendors. Reproducibility of GLS measurements showed no difference among vendors and was in acceptable range. SLS reproducibility was high but similar for all vendors. No relevant difference was found for identifying regional dysfunction. Tracking feasibility showed a substantial difference among images from different vendors. Our findings demonstrate that tracking results depend mainly on the software used and show little influence from vendor specific image characteristics.