Evaluation of Left Ventricular Function after Percutaneous Recanalization of Chronic Coronary Occlusions: The Role of Two-Dimensional Speckle Tracking Echocardiography

Background: The recanalization of a chronic total coronary occlusion is the possible way to improve left ventricular (LV) function through the recovery of hibernating myocardium. Aim: The aim of this study is to evaluate the role of 2D speckle tracking in evaluation of the left ventricular (LV) systolic function in chronic total occlusion (CTO) patients before and at 1 day as well as 3 months after percutaneous coronary intervention (PCI). Patients and Methods: A prospective observational study included 40 patients diagnosed with coronary angiography to have a chronic total occlusion. Percutaneous coronary revascularization was performed according to standard practices with the femoral approach. Conventional 2D echocardiography was used to assess LV functions and wall motion abnormalities scoring index (WMAI). Using speckle-tracking echocardiography was to measure global longitudinal strain (GLS) and. Follow-up of patients was done at day 1 and 3 months later after PCI. Results: Forty patients were included in this study, with a mean age of 58.55 ± 7.98 years. GLS and WMAI difference at baseline and follow-up shows a positive correlation with left ventricular ejection fraction (LVEF) changes at baseline and follow-up (p Conclusion: The results of this study provide evidence to support the clinical use of 2D-STE to monitor the early changes of LV function. In patients undergoing CTO revascularization, change in GLS was more sensitive predictors for LV function improvement at 3-month follow-up.

Value of Platelet to Lymphocytes Ratio in Predicting Angiographic Reflow after Primary Percutaneous Coronary Intervention in STEMI Patient

Background: Acute myocardial infarction is a leading cause of death worldwide nowadays and treatment of choice is primary percutaneous coronary intervention (PCI). No reflow is a complication that increases mortality and morbidity post intervention and one of its predictors is platelet lymphocyte ratio. Aim of Study: To assess relation between admission platelet to lymphocyte ratio (PLR) and angiographic reflow after primary PCI in acute ST elevation myocardial infarction (STEMI). Patients and Methods: This is a prospective study that was conducted from May 2017 to May 2018 at Cardiology Department, Menoufia University Hospital. Sixty patients presented with ST-elevation myocardial infarction who were eligible for primary PCI were enrolled in the study. According to TIMI flow post intervention, patients were arranged into 2 groups: Group 1 (Normal Reflow) included thirty patients with post intervention TIMI flow III and Group 2 (NO Reflow) included thirty patients with post intervention TIMI flow (0, I, II). Comparison between both groups was done regarding platelet lymphocyte ratio (PLR). Result: PLR was significantly higher in patients with coronary no reflow than in patients with normal reflow with a P-value of , timing interval between onset of chest pain to time of intervention and thrombus grading was significantly higher in patients with no reflow than in patients with normal reflow. Conclusion: Pre-intervention PLR is an independent predictor of slow flow/no reflow following PPCI in patient with acute STEMI.

Impact of Left Bundle Branch Block on Left Ventricular Mechanics in Patients with Idiopathic Dilated Cardiomyopathy

Objectives: Left bundle branch block (LBBB) is commonly associated with heart failure. We evaluated the prevalence and impact of LBBB on left ventricular mechanics using 2D strain imaging in patients with idiopathic dilated cardiomyopathy (IDCM). Methods: We included 101 patients with IDCM with mean age 38 ± 18 years: 74% were males and 13.9% of them were in NYHA Class III-IV. LBBB was present in 26 (37%) of included patients. Myocardial mechanics including longitudinal, circumferential strain and rotation and LV synchronization were assessed using two-dimensional strain imaging. Results: LBBB group had higher LV volumes, and PAP compared with non LBBB. Peak LV longitudinal systolic strain (εsys) of the septum and global LV SRsys were significantly lower in LBBB compared to non LBBB group (P 0.01, 0.03). TTP-d was greater in LBBB in comparison to non LBBB group (274.5 ± 116 versus 209.4 ± 139, P 0.02). The electromechanical delay between septal segments was 35 ± 18 ms and between lateral wall segments: 48 ± 24 ms, between anterior wall segments: 21 ± 11 and between inferior wall segments: 41 ± 12. Consequently, LV mechanical dyssynchrony was more evident in IDCM patients with LBBB. QRS width was correlated inversely with LV longitudinal strain and strain rate and electromechanical delay (P 0.0001) in non LBBB group. In LBBB QRS width was not related to cardiac mechanics. Using univariate analysis and after a multiple covariate adjustment, the baseline LBBB was associated with a significantly increased LV dysfunction. Conclusion:After correcting for potential confounders, LBBB was found to be associated with more deterioration of LV mechanics and exaggerated LV dyssynchrony in patients with IDCM.

Assessment of Left Ventricular Mechanical Function in Cardiac Syndrome X: Speckle Tracking Imaging Study

Objective: Early detection of LV mechanical abnormalities in patients with cardiac syndrome X (CSX) by speckle tracking echocardiography (STE). Background: Cardiac syndrome X is a triad of angina pectoris, positive stress test for myocardial ischemia and angiographically free coronary arteries. Two dimensional speckle tracking?echocardiography (2D-STE) provides a more sensitive method for evaluation of global and segmental LV function than conventional two dimensional echocardiographic parameters. Subjects and Methods: Seventy patients proved to have CSX and 20 healthy control volunteers were included with a mean age of 49.43 ± 5.92 vs. 49.40 ±6.27 years respectively with no difference regarding sex for both patients and controls. Patients with hypertension, diabetes mellitus, valvular heart disease, cardiomyopathies, inflammatory diseases, myocarditis and arrhythmias were excluded. All included individuals were subjected to complete conventional echocardiographic assessment and left ventricular global and segmental mechanical function was assessed using 2D based strain and strain rate (longitudinal, radial and circumferential) imaging. Results: There was no statistically significant difference in LV conventional echo parameters between patients and controls. However, global mean longitudinal strain was significantly lower in patients than controls (-15.05 ± 3.28 vs. -20.22 ± 2.49;p 0.001). For radial and circumferential strain stain, there was no significant changes between patients vs. controls (29.75 ± 18.26 vs. 28.09 ± 15.48;p = 0.74) and (-19.88 ± 8.63 vs. -21.93 ± 5.69;p 0.05) respectively. Conclusion: In spite of normal conventional echo parameters among patients and controls, LV longitudinal strain and strain rate by 2D speckle tracking imaging were lower in the patients denoting subclinical left ventricular mechanical dysfunction in patients with CSX.

Left Atrial Appendage Mechanical Changes in Patient with Mitral Stenosis Speckle Tracking Imaging Study

Background: LAA is the major site of thrombus formation in mitral stenosis;active LAA blood flow and contractile function may be disturbed in MS. TEE?is the modality of choice for evaluating LAA and Speckle-tracking?echocardiography (STE) is a recently developed technique for the characterization and quantification of myocardial deformation. It permits measurement of LA and LAA strain and strain rate which can be used to assess the mechanical function of LAA. Objective: To assess the mechanical function of left atrial appendage (LAA) in mitral stenosis (MS) patients with sinus rhythm by 2D?speckle tracking strain and strain rate through transesophageal?echocardiography (TEE). Patients & Method: Thirty-three patients with moderate tosevere MS and sinus rhythm, 38.33 ± 5.66 years as a case group and?twenty-two age and sex matched healthy volunteers as a control group. All?participants underwent compete conventional transthoracic echocardiography;TEE for assessment of LAA morphology and Doppler flow and speckle?tracking strain & strain rate were measured from LAA walls. Results: LAA Doppler flow peak velocities, LAA strain, reservoir strain rate (RSr), conduit strain rate (CSr) and atrial contractile strain rate (ASr) all were significantly lower in patient group. Global Strain of LAA had a negative correlation with LA diameter, pulmonary artery systolic pressure & degree of spontaneous echo contrast and a positive correlation with MS area and LAA Doppler flow.Conclusion: 2D speckle tracking strain and strain rate of LAA is a feasible technique and is significantly reduced in patients with mitral stenosis even with sinus rhythm.

Correlation of Invasively Estimated Left Ventricular End Diastolic Pressure with Acceleration of E’ Wave by Tissue Doppler Imaging of Mitral Annulus

Background: There is no single noninvasive index that provides a direct measure of LV filling pressure. However, invasive measuring of LV end diastolic pressure (LVEDP) provides reliable assessment of LV diastolic dysfunction, but its invasive nature limits its use in daily practice. Accurate noninvasive assessment of LV diastolic dysfunction is highly desirable, and the relationship between the degree of LVEDP and acceleration of E’ wave obtained by tissue Doppler imaging (TDI) of mitral annulus is not clearly assessed;here in our study we aimed to assess the relation between the degree of LVEDP and the acceleration rate of E’ wave of mitral annular Doppler tissue. Patients and Methods: The study included 60 patients divided equally into 3 groups according to the degree of LVEDP, group I (Normal): ’ ratio and E’ wave acceleration rate. Coronary angiography and left sided heart catheterization and measuring LVEDP were performed for correlating E’ wave acceleration rate with invasively estimated LVEDP.?Results: There was significant progressive decrease in E’ acceleration rate (E’ Acc rate) with progressive increase in LVEDP from I to III (P 0.001), while there was significant progressive increase in E/E’ ratio with progressive increase in LVEDP from I to III (P 0.003). Peak E’ acceleration rate had a significant negative correlation with LVEDP in all three groups, with p value of 0.003, 0.044 and 0.021 respectively in group I, II & III. Regarding E/E’ ratio there was a significant positive correlation in predicting normal and elevated LVEDP with p value (0.001 and 0.006) respectively while there was a non-significant correlation between E/E’ and LVEDP within grey zone group. Conclusion: E’ acceleration rate could be used as a reliable index to assess LVEDP.

Correlation between Left Ventricular End Diastolic Pressure and Torsion Dynamics in Patients with Diastolic Dysfunction, Speckle Tracking Imaging Study

Background: Invasive measuring of LV end diastolic pressure (LVEDP) provides reliable assessment of LV diastolic dysfunction, but its invasive nature limits its use in daily practice. Accurate noninvasive assessment of LV diastolic dysfunction is highly desirable, and the relationship between the degree of LVEDP and LV torsion dynamics assessed by 2D speckle tracking is not clearly assessed;here in our study we aimed to assess the relation between the degree of LVEDP and torsion dynamics of left ventricle. Methods: The study included sixty patients divided equally into 3 groups according to the degree of LVEDP, group I: mmHg, group II: 12 - 18 mmHg, and group III: >18 mmHg;complete conventional echo-Doppler study includes also annular septal E wave peak velocity, E/E’ ratio and 2D-speckle tracking including parameters of LV global longitudinal strain (GLS), peak and time to peak of twist ratio (TR & TT respectively), peak and time to peak of untwist ratio (UTR & UTT respectively). Results: There was significant progressive decrease in GLS with progressive increase in LVEDP from I to III. Untwist ratio increased in group II and decreased in significant degree in group III;Twist ratio did not differ with different grades of LVEDP. LA diameter and E/E’ increase from group I to III. The LVEDP is negatively correlated with the UTR and GLS is positively correlated with UTT, E/E & LA diameter. The E/E’ ratio is correlated negatively with the UTR, GLS and positively with LVEDP & UTT and LA diameter. Conclusions: Noninvasive assessment of LV torsion and untwisting was feasible in patients with various grades of LVEDP and diastolic dysfunction;the peak untwist ratio increased in mild degree of increased LVEDP then decreased again with more increase in LVEDP;LVEDP wasnegatively correlated with the peak untwist ratio and GLS was positively correlated with UTT and E/E’.