The impairment of endocardial radial strain is related to aortic stenosis severity in patients with aortic stenosis and preserved LV ejection fraction using two-dimensional speckle tracking echocardiography.

BACKGROUND: Myocardial function is heterogeneous in different myocardial layers. Recently, two-dimensional speckle tracking echocardiography has been used to define myocardial deformation parameters of the left ventricular (LV) segment. This study aimed to investigate strain in subendocardial and subepicardial layers in patients with aortic stenosis (AS) and preserved LV ejection fraction (LVEF) using speckle tracking echocardiography. METHODS: Parasternal short-axis and apical long-axis views of the left ventricle were acquired at the mid-papillary level in 35 control subjects and 32 patients with AS and preserved LVEF. Radial, circumferential, and longitudinal strain in subendocardial and subepicardial layers at the posterior and anteroseptal segments were calculated. RESULTS: There was no significant difference in circumferential strain in subendocardial and subepicardial layers between the control subjects and the patients with AS. Similarly, there was no significant difference in epicardial radial strain at the posterior and anteroseptal segments between the control subjects and the patients with AS. Longitudinal strain at both the posterior and anteroseptal segments was significantly decreased in the AS group compared with that in the control group. AS patients had significantly decreased values of endocardial radial strain compared with those in controls (anteroseptal: 18.2 ± 11.2 vs. 34.5 ± 14.8, P < 0.005; posterior: 25.2 ± 14.8 vs. 32.6 ± 12.6, P < 0.05). In the AS group, endocardial radial strain in the posterior and anteroseptal segments was significantly correlated with the aortic valve area (posterior: r = 0.41, P < 0.05; anteroseptal: r = 0.33, P < 0.05). CONCLUSION: Patients with AS and preserved LVEF have impaired longitudinal strain and endocardial radial strain, although circumferential strain and epicardial radial strain are preserved. Despite preserved LVEF, endocardial radial strain was associated with AS severity.

Successful treatment in a case of acute myocardial infarction due to spontaneous coronary artery dissection.

Spontaneous coronary dissection is a rare cause of myocardial ischemia, myocardial infarction, and sudden death. In the present case, we performed stenting only of the severe stenotic lesion of the dissection with a short bare metal stent, and left the remaining long length of dissection vessel untreated. Six months after coronary stenting, follow-up angiography revealed complete healing of the coronary dissection and no significant in-stent restenosis. This case clearly demonstrates the usefulness of intravascular ultrasound (IVUS) imaging in the diagnosis of coronary dissection and IVUS imaging guides to the choice of the best stenting.

Cor triatriatum sinister disclosed after diagnosis of acute myocardial infarction.

We present a case of cor triatriatum sinister diagnosed occasionally after acute anterior myocardial infarction. For management of the acute myocardial infarction (AMI), urgent reperfusion therapy was successfully performed through the left anterior descending coronary artery. Thereafter, no complication associated with AMI occurred. Cor triatriatum sinister was diagnosed and assessed later by means of several modalities. Finally, medical observation was indicated for this patient. This case illustrates the importance of awareness of this congenital disease in an adult when echocardiography shows an abnormal linear echo in the mid portion of the left atrium.