Feasibility and reproducibility of semi-automated longitudinal strain analysis: a comparative study with conventional manual strain analysis.

BACKGROUND: Conventional approach to myocardial strain analysis relies on a software designed for the left ventricle (LV) which is complex and time-consuming and is not specific for right ventricular (RV) and left atrial (LA) assessment. This study compared this conventional manual approach to strain evaluation with a novel semi-automatic analysis of myocardial strain, which is also chamber-specific. METHODS: Two experienced observers used the AutoStrain software and manual QLab analysis to measure the LV, RV and LA strains in 152 healthy volunteers. Fifty cases were randomly selected for timing evaluation. RESULTS: No significant differences in LV global longitudinal strain (LVGLS) were observed between the two methods (-21.0% ± 2.5% vs. -20.8% ± 2.4%, p = 0.230). Conversely, RV longitudinal free wall strain (RVFWS) and LA longitudinal strain during the reservoir phase (LASr) measured by the semi-automatic software differed from the manual analysis (RVFWS: -26.4% ± 4.8% vs. -31.3% ± 5.8%, p < 0.001; LAS: 48.0% ± 10.0% vs. 37.6% ± 9.9%, p < 0.001). Bland-Altman analysis showed a mean error of 0.1%, 4.9%, and 10.5% for LVGLS, RVFWS, and LASr, respectively, with limits of agreement of -2.9,2.6%, -8.1,17.9%, and -12.3,33.3%, respectively. The semi-automatic method had a significantly shorter strain analysis time compared with the manual method. CONCLUSIONS: The novel semi-automatic strain analysis has the potential to improve efficiency in measurement of longitudinal myocardial strain. It shows good agreement with manual analysis for LV strain measurement.

Evaluation of left ventricular myocardial work in patients with hyperthyroidism with different heart rates with noninvasive pressure-strain loop based on two-dimensional speck tracking imaging.

Background: We investigated the application value of no-invasive myocardial work in evaluating left ventricular (LV) function in patients with hyperthyroidism. Methods: Sixty-five patients with an initial hyperthyroidism diagnosis were sorted into tachycardia (group TH1, n=31) and without tachycardia (group TH2, n=34) groups. Thirty healthy participants served as the control group (group CON). LV strain parameters and LV myocardial work parameters were evaluated at rest. Each parameter's value in identifying myocardial damage was analyzed using receiver operating characteristic curves. The correlation of myocardial work parameters with global longitudinal strain (GLS), longitudinal peak strain dispersion (normalized by heart rate, PSDN), and systolic blood pressure (SBP) was analyzed. Results: There was no difference in classic echocardiographic parameters between the groups. Compared with that in group CON, GLS decreased in groups TH1 and TH2 (TH1 17.99%±2.21% and TH2: 19.00%±2.85% vs. 20.27%±1.49%; both P<0.05); there was no significant difference between groups TH1 and TH2. PSDN increased in groups TH1 and TH2 (TH1 73.13±19.51 ms and TH2 55.06±17.03 vs. 44.13±8.65 ms; both P<0.05); it was higher in group TH1 than in group TH2 (P<0.05). Myocardial global work efficiency (GWE) decreased in groups TH1 and TH2 {TH1 95% [interquartile range (IQR), 94-95%] and TH2 96% (IQR, 95-97%) vs. 97% (IQR, 96-97%); both P<0.05}; it was lower in group TH1 than in group TH2 (P<0.05). Global constructive work (GCW) decreased in group TH1 (1,865.29±284.13 vs. 2,030.33±252.52 mmHg%; P<0.05), but was not different from that in group TH2; there was no difference between groups TH2 and CON. Global wasted work (GWW) increased in groups TH1 and TH2 [TH1 83.00 (IQR, 74.00-97.00) mmHg% and TH2 69.50 (IQR, 51.25-84.25) vs. 50.50 (IQR, 40.75-65.25) mmHg%; both P<0.05]; it was higher in group TH1 than in group TH2 (P<0.05). The area under the GWE curve was the largest (area under the curve =0.835), and the optimal cutoff point was 96.5%, with a sensitivity of 0.83 and a specificity of 0.70. GWE and GCW were positively correlated with GLS and negatively correlated with PSDN. GWW was negatively correlated with GLS and positively correlated with PSDN. In group CON, GCW and GWW were positively correlated with SBP; GWE was not correlated with SBP. In groups TH1 and TH2, GCW was positively correlated with SBP, but not with GWW or GWE. Conclusions: Hyperthyroidism can significantly decrease the GWE and increase GWW of the left ventricle. This change is more pronounced in patients with tachycardia. Myocardial work could be a novel method for the evaluation of LV myocardial function in patients with hyperthyroidism.

Prediction of Surgical Approach in Mitral Valve Disease by XGBoost Algorithm Based on Echocardiographic Features.

In this study, we aimed to develop a prediction model to assist surgeons in choosing an appropriate surgical approach for mitral valve disease patients. We retrospectively analyzed a total of 143 patients who underwent surgery for mitral valve disease. The XGBoost algorithm was used to establish a predictive model to decide a surgical approach (mitral valve repair or replacement) based on the echocardiographic features of the mitral valve apparatus, such as leaflets, the annulus, and sub-valvular structures. The results showed that the accuracy of the predictive model was 81.09% in predicting the appropriate surgical approach based on the patient's preoperative echocardiography. The result of the predictive model was superior to the traditional complexity score (81.09% vs. 75%). Additionally, the predictive model showed that the three main factors affecting the choice of surgical approach were leaflet restriction, calcification of the leaflet, and perforation or cleft of the leaflet. We developed a novel predictive model using the XGBoost algorithm based on echocardiographic features to assist surgeons in choosing an appropriate surgical approach for patients with mitral valve disease.

Left atrial reservoir and pump function after catheter ablation with persistent atrial fibrillation: a two-dimensional speckle tracking imaging study.

OBJECTIVE: By using ultrasound strain rate (SR) imaging to evaluate the left atrial (LA) reservoir and pump function after catheter ablation (CA) with persistent atrial fibrillation (PAF). METHODS: A total of 45 patients with PAF underwent echocardiography examination before and after ablation as well as during 6 months of follow-up. Peak SR was measured at each LA segment (septal, lateral, anterior, inferior and posterior) during systole (LAs) and late diastole (LAa). RESULTS: During 6 months after CA, 30 patients were free of atrial fibrillation recurrence (AFR). left atrial area index (LAAI), left atrial maximum volume index (LAVImax), and E/Ea were obviously higher in patients with before CA, left atrial ejection fraction (LAEF), SR-LAs were lower than in normal cases, the SR-LAa was disappeared. Shortly after ablation, SR-LAa was recovered, and SR-LAs was reduced compared to those at baseline. At midterm follow-up, LAEF and SR-LAs were still lower than the control group, and LAAI and LAVImax were higher. SR-LAa was recovered slowly over time, but still lower. CONCLUSION: LA reservoir function was seriously damaged and LA pump function disappeared in patients with PAF. LA reservoir function impairment appeared shortly after ablation, it showed improvement at midterm follow-up, but some degree of damage to the LA reservoir and pump function was still present. Speckle tracking imaging is a feasible technique for the assessment of LA function in patients with PAF, which is a potentially valuable clinical tool to assist in the early detection of atrial remodelling and reverse remodelling.

Early assessment of subclinical myocardial injury in systemic lupus erythematosus by two-dimensional longitudinal layer speckle tracking imaging.

Background: To investigate the feasibility of quantitatively assessing left ventricular function and synchronization and diagnose subclinical myocardial injury in patients with systemic lupus erythematosus (SLE) using two-dimensional (2D) longitudinal layer speckle tracking imaging (STI). Methods: This was a single-center prospective study. A total of 69 patients with SLE were included in the case group and further divided into 2 subgroups, a nonactive and an active group, according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000 scoring standard. We selected 30 healthy volunteers as the control group. The global longitudinal strain (GLSglobal), global endocardial longitudinal strain (GLSendo), global epicardial longitudinal strain (GLSepi), and peak strain dispersion (PSD) were obtained. The transmural gradient of longitudinal strain (TGLS) was calculated for the difference in strains between the inner and outer membranes. Results: (I) Compared with the control group, decreased speckle strain parameters and elevated PSD were observed in patients with SLE (GLSglobal: -18.80%±2.41% vs. -21.19%±2.16%, GLSendo: -21.15%±2.47% vs. -24.09±2.49%; GLSepi: -16.58%±2.39% vs. -18.50±1.77%; TGLS: -4.56%±1.24% vs. -5.59%±1.39%; and PSD: 36.61±10.85 vs. 30.00±8.54 ms). More severely impaired layer strains were observed in active-stage patients. Compared with the nonactive group, GLSendo, GLSglobal, GLSepi, TGLS, complement C3, and complement C4 were decreased in the active group, while SLEDAI, erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein (Hs-CRP) were elevated. (II) Receiver operating characteristic (ROC) analysis demonstrated that subendocardial myocardial longitudinal strain was the most powerful tool for detecting myocardial insufficiency early in patients with SLE [area under the curve (AUC) =0.809], especially in patients in the active stage (AUC =0.734), and the optimal cut-off point was -21.35%, with a sensitivity of 71.9% and a specificity of 62.2%. (III) Correlation analysis revealed that GLSendo was moderately correlated with PSD, SLEDAI, ERS, Hs-CRP, and complement C3 (correlation coefficients: 0.535, 0.428, 0.659, 0.559, and -0.440, respectively). Conclusions: Subclinical myocardial injury in patients with SLE can be assessed early using 2D longitudinal STI, and the injury is more obvious in active-stage patients. Endocardial longitudinal strain is a more sensitive index than epicardial longitudinal strain for the early detection of subclinical myocardial injury in patients with SLE, which is a potentially valuable clinical tool to assist in the early detection of myocardial damage.

Noninvasive Evaluation of Myocardial Work in Patients with Chronic Kidney Disease Using Left Ventricular Pressure-Strain Loop Analysis.

(1) Objective: To evaluate myocardial injury by observing the different parameters of global myocardial work (MW) by left ventricular pressure-strain loop (PSL) analysis in patients with chronic kidney disease (CKD). (2) Methods: According to the left ventricular mass index, the study patients with CKD were further divided into two groups: the left ventricular normal group (CKDN-LVH, 59) and left ventricular hypertrophy group (CKDLVH, 46). Thirty-three healthy controls (CON) matched in age and sex with the CKD group were recruited. The routine ultrasonic parameters were obtained by routine TTE, and the strain index and different parameters of the left ventricular MW were obtained by dynamic image offline analysis. (3) Results: This study found that (1) compared with the CON group, the CKDN-LVH group had a significantly increased global waste work (GWW) and significantly decreased global work efficiency (GWE), the GWW further increased, and GWE further decreased in the CKDLVH group. There was no significant change in the global work index (GWI) and global constructive work index (GCW) in the CKDN-LVH group, but the GWI and GCW in the CKDLVH group were significantly increased. (2) According to the grouping analysis of systolic blood pressure (SBP), we found that the GWW increased and GWE decreased in CKD patients with an elevated SBP. (3) Correlation analysis showed that the increase of the peak strain dispersion, SBP, and left ventricular mass index and the decrease of the estimated glomerular filtration rate were significantly correlated with the decrease of the GWE and the increase of the GWW. (4) Receiver operating characteristic curve analysis showed that the area under the curve (AUC) of myocardial damage induced by the GWE and GWW in the CKD group and CON group was higher than that of left ventricular global longitudinal strain (AUCs: 0.87 and 0.878 versus 0.72, respectively). (4) Conclusions: Noninvasive left ventricular PSL analysis can be used to evaluate the global MW in patients with CKD. The study justified the role of GWW in the noninvasive assessment of myocardial function in patients with CKD.

Early detect left ventricular subclinical myocardial dysfunction in patients with systemic lupus erythematosus by a left ventricular pressure-strain loop.

OBJECTIVE: Noninvasive myocardial work (MW) is a new technology which is based on strain after considering the load influence on myocardial deformation. We aimed to investigate the feasibility of quantitatively assessing left ventricular myocardial work (LVMW) in patients with systemic lupus erythematosus (SLE) using a left ventricular pressure-strain loop (LVPSL). METHODS: 76 patients with SLE were included in the study (A), further divided into two subgroups according to the presence of lupus nephritis (LN). Global longitudinal strain (GLS), peak strain dispersion (PSD), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained. RESULTS: 1: Patients with SLE demonstrated a significantly reduced GWE and GLS compared with control group, GWW and PSD were increased, above changes were more pronounced in patients with LN. There was no significant difference in GWI and GCW. 2: Receiver operating characteristic (ROC) analysis demonstrated that GWE was the most powerful tool for detecting myocardial insufficiency early in SLE patients, and the area under the curve (AUC) was 0.804, and was superior to GLS (AUC = 0.707). GWE remains the best indicator of subclinical myocardial injury in patients with LN. The AUC was 0.910, and the best cutoff point was 96.5% (sensitivity 83.3%, specificity 73.3%). CONCLUSIONS: LVPSL can be used to noninvasively assess changes in MW in patients with SLE. Noninvasive GWE is a more sensitive index than GLS to detect subclinical myocardial injury early in SLE patients. This is a potential valuable clinical tool to assist in the early-find myocardial damage.

[Correlation of ¹8F-FDG PET-CT maximum standard uptake value and T/N ratio with the prognosis of postoperative colorectal cancer].

OBJECTIVE: To assess the correlation of primary colorectal cancer (CRC) lesions' maximum standardized uptake value (SUVmax) and tumor to normal tissue SUVmax ratio (T/N ratio) detected by ¹8F-deoxyglucose positron emission computed tomography (¹8F-FDG PET-CT) imaging with the postoperative prognosis. METHODS: Clinicopathological data of 92 CRC patients who underwent curative resection after the PET-CT examination and received ¹8F-FDG PET-CT examination from January 2009 to December 2013 in the First Affiliated Hospital of Sun Yat-sen University were reviewed retrospectively. The correlation of SUVmax and T/N ratio in primary lesions with clinicopathological factors was analyzed. The optimal cutoff point of disease-free survival time of SUVmax, T/N ratio and the maximum tumor diameter were investigated by using ROC curve analysis. Association of clinicopathological factors and prognosis was examined and the Cox proportional hazard regression model was used in the multivariate analysis. RESULTS: Primary SUVmax was associated with tumor TNM staging, location, differentiation degree and the maximum tumor diameter, while T/N ratio was only associated with pathological type (all P<0.05). The optimal cutoff point of disease-free survival time of SUVmax, T/N ratio and the maximum tumor diameter were 12.2 (sensitivity 67.6%, specificity 63.6% ), 6.9 (sensitivity 51.4%, specificity 74.5%) and 4.3 cm (sensitivity 56.8%, specificity 80.0%) respectively. Univariate analysis showed that age, TNM staging, tumor location, differentiation degree, the maximum tumor diameter, T/N ratio and CA125 level were significant predictors of survival. Multivariate analysis demonstrated that TNM staging (P=0.000, OR=3.98, 95% CI:2.12-7.45), tumor location (P=0.009, OR=0.43, 95% CI:0.23-0.81), tumor differentiation degree (P=0.001, OR=7.52, 95% CI:2.12-25.9) and T/N ratio (P=0.008, OR=2.92, 95% CI:1.33-6.411) were independent predictors of survival. However, SUVmax was not independent predictor of disease-free survival. CONCLUSION: For postoperative prognosis of colorectal cancer patients, T/N ratio is more valuable than the of primary tumor SUVmax.