Normal values for tissue velocity and strain rate imaging parameters of left and right atrial myocardium in normal subjects.

OBJECTIVE: To determine normal values for tissue velocity imaging (TVI) and strain rate imaging (SRI) in the left atrium (LA) and right atrium (RA) in normal subjects. METHODS: A total of 63 healthy volunteers (50.8% male, age: 20-50 years) prospectively underwent TVI and SRI. The peak systolic velocity (TVs), strain (STs) and strain rate (SRs), peak early and late diastolic velocities (TVe and TVa), strain (STe and STa), and strain rate (SRe and SRa) were measured in the base and mid of the LA and RA walls and roofs. RESULTS: By TVI, TVs and TVe of LA walls decreased significantly from basal to mid-level and from mid to the roof. Mean Tva of LA walls reduced significantly from basal to mid-level and to the roof. By SRI, mean STs and STe of LA walls increased remarkably from basal to mid-level and to the roof and also mean SRs, SRe and SRa increased significantly from basal to mid-level and to the roof. For SRe, the changes were also significant from mid-LA wall to the roof. Mean Tvs, Tve, and Tva of the RA walls reduced significantly from base to mid and then to the RA roof. RA systolic, early, and late diastolic ST and SR increased from base to mid and to the roof. CONCLUSION: Peak systolic and diastolic velocities of the LA and RA decreased from the base to the mid and to the roof, while systolic and diastolic ST and SR increased from the base to the mid to the roof.

Strain imaging for evaluating response to thrombolytic therapy in pulmonary thromboembolism.

OBJECTIVE: Patients with acute pulmonary thromboembolism (PTE) and right ventricular (RV) dysfunction may benefit from thrombolytic therapy. We sought to determine the usefulness of RV strain imaging in the demonstration of improvement in RV function in response to thrombolytic therapy. METHODS: This study prospectively enrolled 32 consecutive patients who received thrombolytic therapy due to diagnosis of PTE.The diagnosis was verified by 256-slice multi-detector computed tomography. Right ventricular function parameters were assessed via conventional and tissue Doppler imaging echocardiography before and 2-3 days after thrombolytic therapy. RESULTS: Echocardiographic study showed that mean tricuspid annular plane systolic excursion and RV fractional shortening area change increased significantly from 13.32 +/- 3.46 mm to 18.18 +/- 4.77 mm and from 22.95 +/- 9.73% to 36.20 +/- 10.17%, respectively, before compared to after treatment. A significant decrease was observed in systolic pulmonary artery pressure from 61.57 +/- 10.49 mm Hg to 38.78 +/- 14.27 mm Hg. Mid-ventricular peak systolic strain and strain rate of the RV also significantly improved (-6.08 +/- 11.19% to -19.13 +/- 9.51% and -0.72 +/- 0.96 S(-1) to -1.54 +/- 0.66 S(-1), respectively). CONCLUSIONS: Tissue Doppler-derived peak systolic strain of RV mid-ventricular wall may be potentially useful in the serial quantification of improvement in RV function in response to thrombolytic therapy in acute PTE.

Mitral annular calcification predicts immediate results of percutaneous transvenous mitral commissurotomy.

BACKGROUND: Many previous studies have evaluated the impact of mitral valve (MV) deformity scores on the percutaneous transvenous mitral commissurotomy (PTMC) outcome in patients with mitral stenosis; however, the relationship between mitral annulus calcification (MAC) and the PTMC result has not yet been established. The current study aimed to investigate whether MAC could independently influence the immediate result of PTMC. METHODS: Of all patients undergoing PTMC in our institution between April 2005 and November 2009, we included 87 patients (28.7%male, mean ± SD age = 42.8 ± 12.6 years) with rheumatic mitral stenosis who had additional data on the echocardiographic evaluation of MAC along with MV leaflets morphology. Echocardiographic assessments were repeated up to six weeks after PTMC to evaluate the immediate PTMC outcome. The frequency of the optimal PTMC result (secondary MV area > = 1.5 cm(2) with > = 25% increase and without final mitral regurgitation grade > 2) was compared between two groups of patients with MAC (n = 17) and those without MAC (n = 70). RESULTS: The optimal result was obtained in 55 (63.2%) patients, whereas the result was suboptimal in 32 (36.8%) patients due to insufficient MV area increase in 31(96.9%) subjects and post-procedure mitral regurgitation grade > 2 in 1(3.1%). The rate of optimal PTMC results was less in patients with MAC in comparison to those without MAC (29.4% vs.71.4%). After adjustments for possible confounders such as age and leaflets morphological subcomponents (thickening, mobility, calcification, and subvalvular thickening), MAC remained a significant negative predictor of a suboptimal PTMC result (odds ratio = 0.154; 95%CI = 0.038-0.626, p value = 0.009) together with leaflet thickening (odds ratio = 0.214; 95%CI = 0.060-0.770, p value = 0.018). CONCLUSIONS: MAC appeared to independently influence the immediate result of PTMC; therefore, mitral annulus evaluation may be considered in the echocardiographic assessment of the mitral apparatus prior to PTMC.

Percutaneous transvenous mitral commissurotomy: significance of echocardiographic assessment in prediction of immediate result.

BACKGROUND: The current study aims to identify demographic, clinical characteristics, echocardiographic and/or mitral valve morphological parameters that may predict the successful result of percutaneous transvenous mitral commissurotomy (PTMC).  METHODS: The medical records of 196 patients (48 males, mean age: 42.7 ± 11.5 years) who underwent PTMC were reviewed. Prior to PTMC, a combination of transthoracic and transesophageal echocardiography were used to investigate substantial mitral valve morphological subcomponents (thickening, mobility, calcification, and subvalvular thickness) and suitability for PTMC. The second transthoracic echocardiographic assessment was performed within six weeks after PTMC. Patients were divided into two categories of successful or unsuccessful according to PTMC results. Successful PTMC was defined as: final mitral valve area (MVA) ≥1.5 cm2 without a post-procedure mitral regurgitation (MR) grade >2. The significant predictor of the result was identified by comparing demographic data, initial echocardiographic assessments and mitral valve morphological scores within both groups.  RESULTS: The mean MVA increased from 1.0 ± 0.2 cm2 to 1.7 ± 0.4 cm2, and mitral valve mean gradient (MVMG) decreased from 11.5 ± 5.2 to 5.2 ± 3.3 mmHg (P < 0.001 for both). Successful results were obtained in 139 (70.9%) patients compared to unsuccessful results in 57 (29.1%). Unsuccessful results were due to suboptimal secondary MVA < 1.5 cm2 in 50 (25.5%) patients and post-procedure MR grade >2 in 7 (3.6%). Multiple logistic regression analysis indicated that young age, lower size of the left atrium (LA), and smaller degree of mitral valve thickness were the predictors of successful result.  CONCLUSION: Pre-procedure echocardiographic assessment appears to be helpful in predicting PTMC results. Successful PTMC is influenced by the patients' age, LA size, and mitral valve thickness.