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.

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 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.

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.

Evaluation of left ventricular systolic dyssynchrony by two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography

Background Two-dimensional speckle tracking imaging （2D-STI） and real-time three-dimensional echocardiography （RT-3DE） have more advantages in evaluating left ventricular （LV） systolic dyssynchrony than traditional echocardiographic techniques. The study aimed to evaluate LV dyssynchrony parameters by both 2D-STI and RT-3DE, and the correlation between these two techniques. Methods A total of 43 chronic heart failure （CHF） patients and 27 healthy volunteers were enrolled. There were 23 dyssynchrony parameters selected to evaluate left ventricular systolic synchronization, involving 15 from 2D-STI and 8 from RT-3DE. Results Few of the dyssynchrony parametersshowednegative correlations with LV ejection fraction （LVEF） in the CHF group. The difference between time to peak-systolic radial strain of the anteroseptal and posterior segments at the level of papillary muscles [AS-P（RS）] from 2D-STI showed positive correlations with parts of the parameters from RT-3DE （P 〈 0.05）. Conclusions LV systolic dysfunction does not correlate with dyssynchrony. Moreover, there is a weak association between 2D-STI and RT-3DE in assessment of left ventricular dyssynchrony.

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.

Assessment of diaphragmatic function by ultrasonography:Current approach and perspectives

This article reports the various methods used to assess diaphragmatic function by ultrasonography.The excursions of the two hemidiaphragms can be measured using two-dimensional or M-mode ultrasonography,during respiratory maneuvers such as quiet breathing,voluntary sniffing and deep inspiration.On the zone of apposition to the rib cage for both hemidiaphragms,it is possible to measure the thickness on expiration and during deep breathing to assess the percentage of thickening during inspiration.These two approaches make it possible to assess the quality of the diaphragmatic function and the diagnosis of diaphragmatic paralysis or dysfunction.These methods are particularly useful in circumstances where there is a high risk of phrenic nerve injury or in diseases affecting the contractility or the motion of the diaphragm such as neuro-muscular diseases.Recent methods such as speckle tracking imaging and ultrasound shear wave elastography should provide more detailed information for better assessment of diaphragmatic function.