Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation

BACKGROUND Although transcatheter aortic valve implantation(TAVI)is a safe and effective treatment for aortic stenosis,it still carries some risks,such as valve leaks,stroke,and even death.The left ventricular global longitudinal strain(LVGLS)measurement may be useful for the prediction of adverse events during this operation.AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODS In this study,61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography.Before surgery,data on left ventricular ejection fraction(LVEF)and LVGLS were collected separately following balloon expansion and stent implantation.Difference in values of LVGLS and LVEF during preoperative balloon expansion(pre-ex),preoperative stent implantation(pre-im)and balloon expansion-stent implantation(ex-im)were also examined.Adverse events were defined as perioperative death,cardiac rupture,heart arrest,moderate or severe perivalvular leakage,significant mitral regurgitation during TAVI,perioperative moderate or severe mitral regurgitation,perioperative left ventricular outflow tract obstruction,reoperation,and acute heart failure.RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS,but not with difference in pre-ex LVEF.There were significant differences between pre-LVGLS and ex-LVGLS,and between pre-LVGLS and im-LVGLS(P=0.037 and P=0.020,respectively).However,differences in LVEF were not significant(P=0.358,P=0.254);however differences in pre-ex LVGLS were associated with pre-LVGLS(P=0.045).Compared to LVEF,LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period.Moreover,the differences in LVGLS were associated with the occurrence of perioperative adverse events,and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery.Furthermore,LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

Early Detection of Regional and Global Left Ventricular Myocardial Function Using Strain and Strain-rate Imaging in Patients with Metabolic Syndrome

Background：Strain and strain-rate imaging （SRI） have been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies,and identifying early subclinical changes in various pathologies.The aim of this study was to evaluate the regional and global left ventricular （LV） myocardial function in metabolic syndrome （MS） with SRI so that we can provide more myocardial small lesions in patients with MS,which is robust and reliable basis for early detection of LV function.Methods：Thirty-nine adults with MS were enrolled in the study.There was a control group of 39 healthy adults.In addition to classic echocardiographic assessment of LV global functional changes,SRI was used to evaluate regional and global LV function.Including：Peak systolic strain （S）,peak systolic strain-rate （SR-s）,peak diastolic strain-rate （SR-e）.Results：There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function.On the other hand,significant differences were observed between MS and the control group in most of the parameters of S,SR-s,SR-e in regional LV function.Multiple stepwise regression analyses revealed that S and SR significantly were negatively correlated with blood pressure,waist circumference,fasting plasma glucose,uric acid,suggesting that risk factories were relevant to regional systolic dysfunction.Conclusion：In MS with normal LV ejection fraction,there was regional myocardial dysfunction,risk factors contributed to the impairment of systolic and diastolic function of the regional myocardium.Assessment of myocardial function using SRI could be more accurate in MS patient evaluation than conventional echocardiography alone.

Assessment of right ventricular strain in children with repaired tetralogy of Fallot using speckle tracking imaging

To the Editor: Tetralogy of Fallot (TOF) was first surgically repaired in 1955. Initial TOF repairs were performed using a trans-annular right ventricular outflow tract patch to relieve the obstruction. However, this procedure resulted in long-standing pulmonary valve regurgitation and increased right ventricular (RV) volume, causing arrhythmias and sudden death.[1] Thus, pulmonary annulus preservation became the most prevalent surgical strategy for TOF repair, possibly causing a mix of pulmonary stenosis and pulmonary valve regurgitation. Currently, clinicians concerned with RV function decrease during the long-term follow-up use of cardiac magnetic resonance imaging (CMR) to predict the appropriate timing of interventions for valve sparing. Although CMR techniques have evolved as the reference standard for assessing RV volumes and function during the last two decades, routinely monitoring the progression of repaired tetralogy of Fallot (rTOF) RV dysfunction remains difficult.