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.

Two-dimensional speckle tracking echocardiography for the assessment of atrial function

Echocardiography is the most common diagnostic method for assessing atrial function but the technique has some limitations. Traditionally, assessment of left atrial function has been performed by measuring volumes with 2D echocardiography. Additionally, it can be assessed with transmitral Doppler and pulmonary vein Doppler. Recently, an alternative method has been incorporated, namely, measurement of myocardial deformation with color tissue Doppler-derived strain. However, this method has several limitations, such as suboptimal reproducibility, angle-dependence, signal artifacts and the fact that it only measures regional strain and does not obtain information about the curved portion of the atrial roof. To overcome these limitations in the quantification of atrial function, the use of speckle tracking echocardiography (STE) strain has been proposed. This technique is not derived from Doppler but rather from 2D echocardiography; it is angle-independent and allows one to measure global as well as regional atrial strain. In this editorial, we describe the physical and pathophysiological concepts of STE and underline the clinical usefulness of this new technique.

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.

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.

Assessment of Aortic Root Mechanics in Hypertensive Patients by Speckle Tracking Echocardiography

Objectives: Hypertension is a major risk factor for several cardiovascular diseases, including stroke, atherosclerosis and coronary heart disease. Remodeling of the aortic root may be expected to occur in hypertensive subjects as a result of increased stress on the aortic wall due to the repeated hemodynamic overload. Two-dimensional speckle tracking echocardiography is a promising new imaging modality. The aim of this study is to assess aortic root mechanics in relation to left ventricular mechanics in hypertensive patients by speckle tracking echocardiography. Methods: The study included 50 individuals, 30 patients with hypertension compared with 20 age and sex matched healthy volunteers as control group. For both groups, conventional echo was done and speckle tracking echocardiography of the LV including longitudinal, circumferential, radial strain, LV rotation and the longitudinal strain of the ascending aorta and aortic distensibility were measured. Results: Aortic longitudinal strain of both anterior and posterior walls, andalso LV longitudinal peak systolic strain were lower significantly in patient group, and also in the same group, the apical rotation was higher than control;aortic longitudinal strain was negatively correlated with E/E, and LV global longitudinal strain was correlated positively with septal annular E wave peak velocity and with aortic distensibility. Conclusion: Hypertension significantly lowers ascending aortic longitudinal strain and the changes are correlated significantly with LV longitudinal systolic function and with echo parameters of elevated LV filling pressure.

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.

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.

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.

Association between Pentraxin-3 and Cardiac Troponin-I with Left Ventricular Systolic Function in Patients with Anterior ST-Segment Elevation Myocardial Infarction: Evaluation by Speckle Tracking Echocardiography

Background: Pentraxin 3 is an inflammatory biomarker whose serum level is increased during acute myocardial infarction (AMI). The aim of this study was to measure the serum pentraxin-3 level in anterior ST-segment elevation myocardial infarction (STEMI), to investigate correlation with the left ventricular (LV) systolic function assessed by speckle tracking echocardiography, and compare with the well-established cardiac biomarkers of myocardial injury such as troponin-I. Methods: Serum pentraxin-3 level was measured by ELISA in 50 patients with anterior STEMI. LV strain was measured by speckle tracking echocardiography. The results were compared to twenty sex- and age-matched persons who had history of stable angina and normal LV ejection fraction (LVEF). Results: Serum level of pentraxin-3 was significantly higher in STEMI patients in comparison to the control group (8.3 ± 3.1 versus 3.4 ± 1.2 ng/ml, p 0.001). Average LV global longitudinal strain (GLS) was reduced in STEMI patients in comparison to control subjects (11.2 ± 2.4 versus 20.2 ± 2.1, p 0.001). In addition, there was a significant negative correlation between serum pentraxin-3 level and LVEF (r = -0.557, p 0.001) and the average LVGLS (r =-0.529, p 0.001). Serum pentraxin-3 cutoff value > 8.3 ng/ml had sensitivity of 81.8% and specificity of 86.4% to detect LVEF less than 50% (p 0.001). While, peak cardiac troponin-I level > 34 ng/ml was 86% sensitive to detect LVEF less than 50% with specificity of 90.9%. Conclusions: The elevated serum level of pentraxin-3 and cardiac troponin-I in STEMI patients and their association with both LVEF and GLS support the concept that the magnitude of these biomarkers correlates to the severity of myocardium injury.

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.

Evaluation of the Effect of Sigmoid-Shaped Interventricular Septum on Left Ventricular Systolic Function in Patients with Essential Hypertension by Two-Dimensional Speckle Tracking Echocardiography

Objective: To evaluate left ventricular regional and global systolic function by measuring left ventricular longitudinal strain (LS) in hypertensive patients with sigmoid-shaped interventricular septum (SIS) by two-dimensional speckle tracking (2D-STE);in order to explore whether the sigmoid-shaped interventricular septum affects the left ventricular systolic function in patients with hypertension. Methods: Routine echocardiographic parameters were measured in 30 hypertensive patients with SIS (SIS group) and 30 hypertensive patients without SIS (non-SIS group). The left ventricular segments and global LS were measured by 2D-STE, and the two sets of parameters were compared. Results: The value of the thickness of the basal segment of the interventricular septum (IVSBT), the thickness of the middle segment of the interventricular septum (IVSMT) and the ratio of the basal segment of the ventricular septum to the middle segment of the interventricular septum (IVSBT/IVSMT) in SIS group was higher than that in non-SIS group. However, the value of left ventricular outflow tract diameter (LVOTD) in SIS group was lower than that in non-SIS group. There was a significant difference between the two groups (all P Conclusion: SIS affects left ventricular regional systolic function of patients with hypertension. 2D-STE can early evaluate left ventricular longitudinal systolic function in hypertensive patients with SIS.

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 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.

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.

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.

Evaluation of Right Ventricular Global Longitudinal Function in Patients with Tetralogy of Fallot by Two-dimensional Ultrasound Speckle Tracking Imaging

Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot(TOF)by 2-dimensional ultrasound speckle tracking imaging(STI).Thirty-eight patients with TOF were enrolled in this study and divided into child group(n=25)and adult group(n=13)according to age.Thirty-eight age-and sex-matched normal subjects were selected as c...

Tissue Doppler,speckling tracking and four-dimensional echocardiographic assessment of right ventricular function in children with dilated cardiomyopathy

BACKGROUND Right ventricular(RV)function is frequently overlooked during dilated cardiomyopathy(DCM)evaluation.AIM To evaluate RV function in children with idiopathic DCM using relatively recent echocardiographic modalities.METHODS We prospectively studied the cardiac function in 50 children with idiopathic DCM and 50 healthy children as a control group,using four-dimensional echocardiography(4-DE),Tissue Doppler Imaging(TDI),and two-dimensional-speckles tracking echocardiography(2-D-STE).RV EF was measured by 4-DE.RESULTS The auto left(LV)ejection fractions(EF)measured by 2-D-STE were significantly lower in the patients'group than in the control.The sphericity index was also significantly lower in children with DCM than in the control.RV EF measured by 4-DE was significantly lower in the patient's group than the control.RV S wave,e´/a'ratio,myocardial performance index(MPI),and tricuspid annular plane systolic excursion(TAPSE)were significantly impaired in children with DCM than in control.Both LV and RV global longitudinal strains(GLS)were significantly reduced in children with DCM than in control.RVGLS was significantly associated with the duration since diagnosis,tricuspid annulus S wave,RV MPI,and TAPSE,but not with the age of the patients,RV EF,or e´/a'ratio.CONCLUSION There was impairment of the RV LGS and other systolic and diastolic parameters in children with DCM.STE and TDI can help to detect the early decline of RV function.

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.

Speckle Tracking for Assessment of Left Ventricular Dyssynchrony

Cardiac resynchronization therapy (CRT) is an established therapy for selected heart failure (HF) patients to improve symptoms, ventricular function, and survival. Although increasingly used, left ventricular (LV) dyssynchrony assessment by echocardiography has failed to show enough predictive value to assess patient response to CRT and the current guidelines do not recommend its routine use. Furthermore, a variety of echocardiographic techniques used for the purpose, including tissue Doppler imaging (TDI), real time three-dimensional echocardiography, M-mode, and various Doppler parameters, showed limited value and poor agreement between the studies and methods, greatly influenced by interobserver variability. Speckle tracking echocardiography (STE) is a more recent approach that uses strain imaging to assess LV dyssynchrony. This article discusses the speckle tracking for LV dyssynchrony and its current clinical applications.