Correlation between three-dimensional speckle tracking imaging parameter and the cardiotoxicity of chemotherapeutics in patients with lung cancer chemotherapy

Objective: To study the correlation between three-dimensional speckle tracking imaging (3D-STI) parameter global area strain (GAS) and the cardiotoxicity of chemotherapeutics in patients with lung cancer chemotherapy. Methods: Patients with lung cancer who underwent chemotherapy in the Second Affiliated Hospital of Xi'an Medical University between February 2016 and May 2017 were selected as the chemotherapy group, the healthy subjects who received physical examination during the same period were selected as the control group, the 3D-STI examination was performed and GAS was calculated;the serum was collected to determine the contents of cardiotoxicity markers as well as apoptosis and oxidative stress indexes, and the peripheral blood was collected to determine the expression of apoptosis and oxidative stress molecules. Results: GAS level, serum ALDH2 and CAT contents as well as peripheral blood Keap1 and Bcl-2 expression intensity of chemotherapy group were lower than those of control group whereas serum Copeptin, CK-MB, cTnI, cMyBP-c, sTWEAK, sFas, MDA and 8-isoPGF2α contents as well as peripheral blood Nrf-2, gp91phox, p22 phox and Caspase-3 expression intensity were significantly higher than those of control group;the GAS level in chemotherapy group was negatively correlated with serum Copeptin, CK-MB, cTnI, cMyBP-c, sTWEAK, sFas, MDA and 8-isoPGF2α contents as well as peripheral blood Nrf-2, gp91phox, p22 phox and Caspase-3 expression intensity, and positively correlated with serum ALDH2 and CAT contents as well as peripheral blood Keap1 and Bcl-2 expression intensity. Conclusion: The changes of 3D-STI parameter GAS in patients with lung cancer chemotherapy can reflect the degree of cardiotoxicity induced by oxidative stress and apoptosis.

Application of three-dimensional speckle tracking technique in measuring left ventricular myocardial function in patients with diabetes

BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus(DM).Therefore,early detection of left ventricular systolic function(LVSF)damage in DM is essential.AIM To explore the use of the three-dimensional speckle tracking technique(3D-STI)for measuring LVSF in DM patients via meta-analysis.METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023.The current study involved 9 studies,including 970 subjects.We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI.RESULTS Night articles including 970 subjects were included.No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group(P>0.05),while differences in global longitudinal strain,global circumferential strain,global radial strain,and global area strain were markedly different between the controls and DM patients(all P<0.05).CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.

Evaluation of Ventricular-vascular Coupling in Patients with Type 2 Diabetes Mellitus Using 2-Dimensional Speckle Tracking Imaging

The elastic and functional coupling of heart and vessels makes the stroke work （SW） of the heart optimal. Speckle tracking imaging （STI） can evaluate the myocardial strain and function. We studied ventricular-vascular coupling in 80 diabetic patients with different systolic function using STI. The patients were divided into two groups according to ejection fraction （EF）： the diabetes mel- litus with normal EF （DMN） group and the diabetes mellitus with abnormal EF （DMA） group. Forty-two volunteers served as control group. The relative wall thickness （RWT）, left ventricular mass index （LVMI）, stroke volume （SV）, SW, rate-pressure product （RPP）, systemic vascular resis- tance index （SVRI）, left ventricular end-systolic elastance （Ees）, effective arterial elasticity （Ea） and ventricular-vascular coupling index （VVI） were measured and calculated by conventional echocardi- ography. The longitudinal strain （LS） at basement （LSBA）, papillary muscle （LSvM） and cardiac apex （LSAv） was assessed with STI. It was found： （A） compared with control group, in DMN and DMA groups, LSBA, LSvM and LSAp decreased, and they were lower in DMA group. （B） VVI, RPP and SVRI increased, and they were higher in DMN group; Ees decreased, and it was lower in DMA group. （C） LSBA, LSpM, and LSAv had negative correlation with VVI. LSAp, RWT, LVMI and SW were independent predictors for VVI. The area under the receiver operating characteristic （ROC） curves was used for identification of DMA and DMN with LSBA, LSpM, and LSAp, and the area under the ROC of LSAp was the largest. This study supports that myocardial LS could reflect the ventricu- lar-vascular coupling. Different segments had an order to “respond to” the state of the coupling, and the cardiac apex might be the earliest.

Ultrasound Speckle Tracking Imaging Contributes to Early Diagnosis of Impaired Left Ventricular Systolic Function in Patients with Type 2 Diabetes Mellitus

To investigate the value of ultrasound speckle tracking imaging （STI） in the assessment of the short-axis and long-axis systolic function of the left ventricle （LV） in patients with type 2 diabetes mellitus （DM）, 100 subjects with normal ejection fraction were studied, including 41 patients with DM only （DM group）, 22 patients with both DM and left ventricular hypertrophy （DH group）, and 37 healthy subjects （control group）. Left ventricle systolic function in the long axis defined as longitudinal strain, and that in the short axis defined as radial strain, apical and basal LV rotations, and LV twist were assessed respectively. The results showed that average peak strain in the long axis at basal, middle and apical levels, and global peak strain were significantly decreased in the patient groups when compared with the control group （P〈0.001 for each）. The parameters in DH group were significantly lower than those in DM group （P〈0.01 for each）. There were no significant differences in average radial peak strain in the short axis at different levels, and global peak strain among the three groups （P〉0.05）. Apical and basal LV rotations, and LV twist were greater in the patient groups than in the control group （P〈0.01 for each）. Basal LV rotation and LV twist were greater in DH group than those in DM group （P〈0.01）. It was concluded that STI may be used to identify early abnormalities in patients with type 2 DM that have normal left ventricular systolic function.

Assessment of Right Ventricular Free Wall Longitudinal Myocardial Deformation Using Speckle Tracking Imaging in Normal Subjects

To assess fight ventficular free wall longitudinal myocardium deformation and examine the changes with normal age by speckle tracking imaging （STI）, myocardial systolic peak strain （ε）, systolic peak strain rate （SRs）, early diastolic peak strain rate （SRe）, late diastolic peak strain rate （SRa）, the ratio of SRe/SRa were measured in the basal, middle and apical segments of right ventficular free wall in 75 healthy volunteers （age range： 21-71 y） by STI from the apical 4-chamber view. RV longitudinal strain and strain rate were highest in the basal segment of the free wall. Older subjects had lower early diastolic strain rate （SRe） than younger subjects, but they had higher late diastolic strain rate （SRa）. A negative correlation between age and the ratio of SRe/SRa was found in all RV free wall segments （r=-4）.466 - -0.614, P〈0.01）. It is concluded that RV diastolic strain rate changes with age and STI can be used for the study of RV myocardial deformation.

Assessment of Left Ventricular Global Twist in Essential Hypertensive Heart by Speckle Tracking Imaging

The left ventricular twist was evaluated by 2-dimensional ultrasound speckle-tracking imaging （STI） in 50 patients with hypertension with normal geometric left ventricle （LV） and 45 normal subjects as control group. The mean value of LV rotation was obtained at each plane Using STI. LV twist and twist velocity were defined as apical rotation/rotation rate relative to the base respectively. To adjust the intersubject differences in heart rates, the time sequence were normalized. The results showed that peak twist developed near the end of systole. Peak LV twist was significantly higher in patients with hypertension than normal controls （P〈0.001）. The diastolic untwisting mainly occurred in early diastole （=38%）. Compared with normal controls, untwisting rate （Untw R） in patients with hypertension was significantly reduced （P〈0.001）, and untwisting half-time （UHT） was significantly delayed （P〈0.05）. This study demonstrated that STI has a potential ability to evaluate the early change of heart function in patients with hypertension by measuring the twist of LV.

Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging

Background Identifying the transmural extent of myocardial necrosis and the degree of myocardial viability in acute myocardial infarction （AMI） is important clinically. The aim of this study was to assess myocardial viability using two-dimensional speckle tracking imaging （2D-STI） in patients with AMI. Methods 2D-STI was performed at initial presentation, three days, and six months after primary percutaneous coronary intervention （PCI） in 30 patients with AMI, who had a left anterior descending coronary artery （LAD） culprit lesion. In addition, 20 patients who had minimal stenotic lesions （〈 30% stenosis） on coronary angiography were also included in the control group. At six months dobutamine echocardiography was performed for viability assessment in seven segments of the LAD territory. According to the recovery of wall motion abnormality, segments were classified as viable or non-viable. Results A total of 131 segments were viable, and 44 were nonviable. Multivariate analysis revealed significant differences between the viable and nonviable segments in the peak systolic strain, the peak systolic strain rate at initial presentation, and peak systolic strain rate three days after primary PCI. Among these, the initial peak systolic strain rate had the highest predictive value for myocardial viability （hazard ratio： 31.22, P 〈 0.01）. Conclusions 2D-STI is feasible for assessing myocardial viability, and the peak systolic strain rate might be the most reliable predictor of myocardial viability in patients with AMI.

Assessment of Left Ventricular Radial Deformation by Speckle Tracking Imaging

The left ventricular radial strain in the inner and outer layers was evaluated by using two-dimensional speckle tracking imaging （2DS）. Twenty-five piglets were studied. The short axis views were acquired. Peak systolic radial strain was measured from 6 circumferential points related to 6 standard segments in the inner and outer layers respectively using 2DS methods. The peak positive first derivative （dp/dt） of left ventricular pressure was compared to the radial strain from 2DS. The inner band showed higher peak radial strain values as compared to the outer band at all of the segments （P〈0.0001）, but the differences had significance just in anteroseptal, posterior, inferior and septal segments （P〈0.05）. Good correlation could be found between radial strain of inner and outer layers and peak dp/dt （P〈0.001）. These preliminary results showed that the degree of local deformation or wall thickening of the ventricular wall in its inner layer was more obvious than its outer layer. It is suggested that the 2DS technique is useful and sensitive for better understanding the regional and global myocar- dial motion and its relationship to the complex architecture of myocardium.

Assessment of Age-related Changes in Left Ventricular Twist by Two-dimensional Ultrasound Speckle Tracking Imaging

To assess the normal value of left ventricular twist （LVtw） and examine the changes with normal aging by 2-dimensional ultrasound speckle-tracking imaging （STI）, 121 healthy volunteers were divided into three age groups： a youth group （19-45 y old）, a middle-age group （46-64 y old ） and an old-age group （≥65 y old）. Basal and apical short-axis images of left ventricular were acquired to analyse LV rotation （LVrot） and LVrot velocity. LVtw and LVtw velocity was defined as apical LVrot and LVrot velocity relative to the base. Peak twist （Ptw）, twist at aortic valve closure （AVCtw）, twist at mitral valve opening （MVOtw）, untwisting rate （UntwR）, half time of untwisting （HTU）, peak twist velocity （PTV）, time to peak twist velocity （TPTV）, peak untwisting velocity （PUV）, time to peak untwisting velocity （TPUV） were separately measured. The results showed that the normal LV performs a wringing motion with a clockwise rotation at the base and a counterclock- wise rotation at the apex （as seen from the apex）. The LVtw velocity showed a systolic counterclockwise twist followed by a diastolic clockwise twist. Peak twist develops near the end of systole （96%±4.2% of systole）. With aging, Ptw, AVCtw, MVOtw, HTU and PUV increased significantly （P〈0.05） and UntwR decreased significantly （P〈0.05）. However, no significant differences in TPUV, PTV and TPTV were noted among the 3 groups （P〉0.05）. It is concluded that LV twist can be measured non-invasively by 2-dimensional ultrasound STI imaging. The age-related changes of LVtw should be fully taken into consideration in the assessment of LV function.

A Modified Monte Carlo Model of Speckle Tracking of Shear Wave Induced by Acoustic Radiation Force for Acousto-Optic Elasticity Imaging

A modified Monte Carlo model of speckle tracking of shear wave propagation in scattering media is proposed. The established Monte Carlo model mainly concerns the variations of optical electric field and speckle. The two- dimensional intensity distribution and the time evolution of speckles in different probe locations are obtained. The fluctuation of speckle intensity tracks the acoustic-radiation-force shear wave propagation, and especially the reduction of speckle intensity implies attenuation of shear wave. Then, the shear wave velocity is estimated quantitatively on the basis of the time-to-peak algorithm and linear regression processing. The results reveal that a smaller sampling interval yields higher estimation precision and the shear wave velocity is estimated more efficiently by using speckle intensity difference than by using speckle contrast difference according to the estimation error. Hence, the shear wave velocity is estimated to be 2.25 m/s with relatively high accuracy for the estimation error reaches the minimum （0.071）.

Left Ventricular Systolic Strain of the Cardiac Allograft Evaluated with Three-dimensional Speckle Tracking Echocardiography

Three-dimensional speckle tracking echocardiography was employed to evaluate the changes of left ventricular systolic strain in 23 heart transplant recipients at 1 st, 3rd, 6th and 12th month after heart transplantation, and 23 healthy subjects served as controls. The three-dimensional full-volume echocardiographic images of left ventricle were recorded and then were analyzed using EchoPAC software. The strain curves and peak systolic strain values for each segment and overall left ventricular wall were obtained. Left ventricular global peak longitudinal strain （GPSL）, global peak radial strain （GPSR）, global peak circumferential strain （GPSC） and global peak area strain （GPSA） were measured and then statistically analyzed. There were no significant differences in left ventricular ejection fraction （LVEF） and cardiac output （CO） between heart transplant recipients and controls. The GPSL in heart transplant recipients at 1st month after surgery was significantly lower than that in controls, but close to the normal value at 3rd month after surgery and later. The GPSC, GPSA and GPSR were significantly lower in heart transplant recipients at 1 st, 3rd, 6th and 12th month after surgery than those in controls. It is suggested that three-dimensional speckle tracking echocardiography can be used for monitoring changes of left ventricular systolic strains and evaluating left ventricular systolic function in cardiac allograft.

Evaluation of Left Ventricular Rotation and Twist Using Speckle Tracking Imaging in Patients with Atrial Septal Defect

Speckle tracking imaging （STI） was employed to investigate the effect of right ventricular （RV） volume and pressure overload on left ventricular （LV） rotation and twist in 35 patients with atrial septal defect （ASD）, 18 of which with pulmonary hypertension, and 21 healthy subjects serving as controls. The peak rotations of 6 segments at the basal and apical short-axises and the average peak rotation and interval time of the 6 segments in the opposite direction during early systolic phase were measured respectively. LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated. LV ejection fraction （EF） was measured by Biplane Simpson. Compared to ASD patients without pulmonary hypertension and healthy subjects, the peak rotations of posterior, inferior and postsept walls at the basal level were lower （P〈0.05）, and the average counterclockwise peak rotation of 6 segments at the basal level during early systolic phase was higher （P〈0.05）, and the average interval time was delayed （P〈0.05）. LV peak twist was also lower （P〈0.05）, and had a significant negative correlation with pulmonary arterial systolic pressure （r=-0.57, P=0.001）. No significant differences were found in LVEF among the three groups. It was suggested that although RV volume overload due to ASD has no significant effects on LV rotation and twist, LV peak twist is lower in ASD patients with pulmonary hypertension. Thus LV twist may serve as a new indicator of the presence of pulmonary hypertension in ASD patients.

The Value of Speckle Tracking Strain Imaging at Recovery Period of Dobutamine Stress Echocardiography

Background: Dobutamine stress echocardiography (DSE) is a well-established method for detecting myocardial ischemia. The classic echocardiographic findings of ischemia are new or worsening abnormalities of radial wall thickening. However, interpretation of these findings is subjective and dependent on experience. Speckle tracking strain imaging (STI) has been introduced as a novel method to overcome these limitations. Objective: The aim of the study is to evaluate the value of speckle tracking imaging (STI) by estimating the mean global longitudinal systolic (GLS) and the mean global circumferential systolic (GCS) strain imaging at recovery period of dobutamine stress echocardiography for prediction of significant coronary artery disease (CAD) in patients with chest discomfort. Methods: Fifty three patients presented for evaluation of chest discomfort underwent dobutamine stress echocardiography and coronary angiography at Cardiology Department,Menoufia University Hospital. The mean global left ventricular longitudinal systolic strain (GLS) at apical views—3 chambers, 4 chambers & 2 chambers apical views and global left ventricular circumferential systolic strain (GCS) at short axis view at level of papillary muscle were measured at rest and during recovery period of dobutamine stress echocardiography using automated functional imaging (AFI). Coronary angiography was done for all patients. Significant coronary artery lesion was defined as having a ≥ 70% diameter stenosis on coronary angiography. Patients were divided into two groups based on the presence or absence of significant coronary artery lesion into CAD positive (+ve) group vs. CAD negative (-ve) group. Results: In both groups,there were no statistically significant differences in the clinical characteristics and baseline conventional transthoracic echocardiography. GLS and GSC at recovery were lower in the CAD (+ve) group than in the CAD (-ve) group (-16.69% ± 1.10% vs -19.05% ± 1.41% p ). GLS and GCS during recovery period of DSE were valuable for prediction of CAD when cutoff at recovery is less than -17.95% (sensitivity of 84% & specificity of 84%) for GLS and less than -20.2% (sensitivity of 76% & specificity of 84%) for GCS. Also, we observed that the GLS and GCS percentile decreased from baseline to recovery period of DSE by about -9.95% ± 4.82% and -7.72% ± 3.90% respectively. Conclusion: Speckle tracking Imaging GLS and GCS at recovery period of Dobutamine Stress Echocardiography is feasible and offers an objective technique for prediction of significant coronary artery disease with increasing the accuracy of DSE in patient with chest discomfort.

Value of myocardial function in children with Kawasaki disease by two-dimensional and three-dimensional ultrasound speckle tracking

Objective:To investigate the value of two-dimensional ultrasound speckle tracking(2D-STI)and three-dimensional ultrasound speckle tracking(3D-STI)in evaluating myocardial function in children with Kawasaki disease.Methods 92 children with Kawasaki disease admitted to our hospital from February 2017 to February 2019 were retrospectively analyzed.50 children who underwent 3D-STI examination were taken as observation group and 42 children who underwent 2D-STI examination were taken as control group.The left ventricular systolic function index,storage time and analysis time of the image,the diameter of coronary artery,the strain difference of left ventricular basal segment,middle segment,apical segment and whole segment were observed.Results The levels of left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular myocardial mass(LVMI)in the observation group were higher than those in the control group(P<0.05),but there was no statistical difference in left ventricular ejection fraction(LVEF)between the two groups(P>0.05).The storage time and analysis time of the image in the observation group were significantly lower than those in the control group(P<0.05).The left coronary artery(LCA)and right coronary artery(RCA)in the observation group were higher than those in the control group(P<0.05).There was no statistical difference between left anterior descending(LAD)in the two groups(P>0.05).The longitudinal peak systolic strain(LS),circumferential peak systolic strain(CS)and radial peak systolic strain(RS)in the observation group were higher than those in the control group(P<0.05).The global longitudinal peak strain(GLS),global circumferential peak strain(GCS)and global radial peak strain(GRS)in the observation group were higher than those in the control group(P<0.05).LS and CS in the middle segment of the observation group were higher than those in the control group(P<0.05).Conclusions Compared with 2D-STI,3D-STI can objectively and accurately reflect the myocardial function of children with Kawasaki disease.

Correlation between three-dimensional speckle tracking parameters and serum index changes during left ventricular remodeling in patients with coronary heart disease

Objective:To study the correlation between three-dimensional speckle tracking parameters and serum index changes during left ventricular remodeling in patients with coronary heart disease. Methods: Patients who were diagnosed with coronary heart disease and angina pectoris in our hospital between March 2015 and May 2017 were selected as the CHD group of the study, and the healthy subjects who received medical examination in our hospital during the same period were taken as the control group;the three-dimensional speckle tracking parameters, peripheral blood signal molecule expression as well as serum cytokine and collagen metabolism index levels of the two groups were measured.Results: GLS and AGS levels in CHD group were significantly lower than those in control group whereas GCS and GRS levels were not significantly different from those in control group, and peripheral blood Notch1, Hes1, NF-κB and PKC expression intensity as well as serum sTWEAK, FGF23, TGF-β1, GDF15, sSema4D, CaN, MMP14, PINP and ICTP contents were significantly higher than those of control group;GLS and AGS levels in CHD group were negatively correlated with peripheral blood Notch1, Hes1, NF-κB and PKC expression intensity as well as serum sTWEAK, FGF23, TGF-β1, GDF15, sSema4D, CaN, MMP14, PINP and ICTP contents.Conclusions:The changes of three-dimensional speckle tracking parameters GLS and AGS in patients with coronary heart disease are closely related to the changes in signal pathway function, cytokine secretion and collagen metabolism during left ventricular remodeling.

Value of two-dimensional speckle tracking imaging in quantitative assessment of left ventricular function in patients with OSAS

Objective: To research the clinical application of two-dimensional speckle tracking imaging (2D-STI) in quantitative assessment of left ventricular function in patients with obstructive sleep apnea-hypopnea syndrome (OSAS). Method: From July 2016 to December 2018, 86 patients with OSAS were selected as OSAS group. According to sleep apnea hypopnea index (AHI), they were divided into mild OSAS group (24 cases), moderate OSAS group (29 cases) and severe OSAS group (33 cases). Another 50 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. The left ventricular function of all patients was quantitatively assessed by 2D-STI. The left ventricular function of all patients was quantitatively assessed by 2D-STI. The results of routine echocardiography and left ventricular global strain parameters of the OSAS group, the control group and the OSAS patients with different severity were compared and analyzed. Result: There were no significant differences in the levels of left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESd) between the two groups and OSAS patients with different severity (P>0.05). The levels of IVST, LVPW and LVMI in the OSAS group were significantly higher than those in the control group, the levels of end-diastolic interventricular septal thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular mass index (LVMI) in the severe OSAS group were significantly higher than those in the mild and moderate OSAS group, and the levels of IVST, LVPW and LVMI in the moderate OSAS group were significantly higher than those in the mild OSAS group, there were significant differences between groups (P<0.05). The levels of GLS, GRS and GCS in the OSAS group were significantly lower than those in the control group (P<0.05). GLS, GRS and GCS levels in the severe OSAS group were significantly lower than those in the mild OSAS group and the moderate OSAS group, while the levels of global longitudinal strain (GLS), global radial strain (GRS) and global circumferential strain (GCS) in the moderate OSAS group were significantly lower than those in the mild OSAS group (P<0.05). Conclusion: The left ventricular systolic function of OSAS patients is obviously impaired. Left ventricular function in OSAS patients can be assessed timely and accurately by two-dimensional speckle tracking imaging.

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.

Speckle tracking echocardiography:A new approach to myocardial function

Echocardiography is the most common diagnostic method for assessing cardiac function but some limitations affect this technique.Until now,visual assessment of wall motion and thickening has allowed only a subjective evaluation of myocardial function and requires long-term training.Recently,new echocardiographic techniques have been introduced to evaluate myocardial mechanics.Tissue Doppler imaging(TDI)technique is limited by angle-dependency such that only deformation along the ultrasound beam can be derived from velocities,while myocardium deforms simultaneously in three dimensions.Speckle tracking echocardiography (STE)is a more recent technique that provides a global approach to left ventricular myocardial mechanics,giving information about the three spatial dimensions of cardiac deformation.In this editorial,we describe the physical and pathophysiological concepts of STE,discussing the differences compared to TDI and underlining the pitfalls of this new technique.

Speckle Tracking Echocardiography Identifies Impaired Longitudinal Strain as a Common Deficit in Various Cardiac Diseases

The use of speckle-tracking echocardiography(STE)is becoming an increasingly useful tool in the evaluation of myocardial disease.STE software can track the motion of the specular pattern created by the interference of ultrasound with the myofibers of the heart and provide a quantitative means to evaluate subtle changes in ventricular function that often occur before changes in ventricular ejection fraction are observed.STE is most often used to measure the change in shape(strain)of myocardial segments in the circumferential,radial,and longitudinal directions.In various diseases,including coronary artery disease,aortic stenosis,and mitral regurgitation,deficits in longitudinal strain appear to occur earlier than deficits in other measures of strain or in ejection fraction.Consideration of STE measures of left ventricular contraction has the potential to significantly affect clinical management and outcomes of ischemic and valvular heart disease given the ability to separate those with asymptomatic disease who may benefit from earlier interventions than current guidelines may suggest.

Comprehensive Left Ventricular Mechanics Analysis by Speckle Tracking Echocardiography in COVID-19

Background: Cardiac involvement and the consequences of inflammation induced by SARS-CoV2 infection could have catastrophic long-term consequences. Left ventricular mechanics could identify a specific pattern of myocardial fiber damage in patients infected with COVID-19. To our knowledge there are no publications referring to the global description of ventricular mechanics in patients with COVID-19. Objective: To describe left ventricular mechanics in hospitalized patients with COVID-19. Methods: In this cross-sectional study, we included 40 hospitalized patients with confirmed diagnostic of COVID-19, from April 11, 2020, to September 6, 2020. Demographic and laboratory data, clinical and echocardiographic characteristics were collected, as well as events during hospitalization. Left ventricular deformation was analyzed and reported. Results: Subclinical dysfunction was observed in 82.5% (left ventricular longitudinal strain [LVGLS] -17.05% and global circumferential strain [GCS] -18.6%) of the patients, likewise, the mean twist and apical rotation were preserved, and even increased as part of the compensating mechanism to maintain the ejection fraction. Conclusion: In patients hospitalized with COVID-19, despite having a normal left ventricular ejection fraction, subclinical myocardial damage was found, manifested by a decrease in Global Longitudinal Strain (GLS) and Global Circumferential Strain (GCS). This behavior is similar to that of cardiomyopathies in the early stage of the disease, and given the pathophysiological mechanisms involved in the disease, its long-term consequences should be monitored and evaluated.