Alessio De Luca

Comparative numerical study on left ventricular fluid dynamics after dilated cardiomyopathy

INTRODUCTION The role of flow on the progression of left ventricular (LV) remodeling has been presumed, although measurements are still limited and the intraventricular flow pattern in remodeling hearts has not been evaluated in a clinical setting. Comparative evaluation of intraventricular fluid dynamics is performed here between healthy subjects and dilated cardiomyopathy (DCM) patients. METHODS LV fluid dynamics is evaluated in 20 healthy young men and 8 DCM patients by combination of 3D echocardiography with direct numerical simulations of the equation governing blood motion. Results are analyzed in terms of quantitative global indicators of flow energetics and blood transit properties that are representative of the qualitative fluid dynamics behaviors. RESULTS The flow in DCM exhibited qualitative differences due to the weakness of the formed vortices in the large LV chamber. DCM and healthy subjects show significant volumetric differences; these also reflect inflow properties like the vortex formation time, energy dissipation, and sub-volumes describing flow transit. Proper normalization permitted to define purely fluid dynamics indicators that are not influenced by volumetric measures. CONCLUSION Cardiac fluid mechanics can be evaluated by a combination of imaging and numerical simulation. This pilot study on pathological changes in LV blood motion identified intraventricular flow indicators based on pure fluid mechanics that could potentially be integrated with existing indicators of cardiac mechanics in the evaluation of disease progression.

Real-time evaluation of longitudinal peak systolic strain (speckle tracking measurement) in left and right ventricles of athletes

BackgroundStrain, and particularly Longitudinal Peak Systolic Strain (LPSS), plays a role in investigating the segmental and overall contractility of the heart which is a particularly interesting feature in athletes in whom regular training determines several morphological and functional modifications in both the ventricles, that normally work at different loads. Speckle tracking techniques assess the LPSS of LV and RV from B-mode imaging in real time, with uniform accuracy in all segments, and can verify the possible dissimilar segmental contributions of the two chambers to overall myocardial contraction. The aim of the study is to quantify the LPSS in real time in both the ventricles in order to estimate any possible different deformation properties in them during a systolic period.Methods32 subjects (20 athletes and 18 controls) were submitted to a standard echocardiographic examination at rest and after a Hand Grip (HG) stress. From a four-chamber-view image, the LPSS parameter was measured with Speckle Tracking analysis in the basal and medium-apical segments of the two ventricles, at rest and after HG.ResultsIn both athletes and controls, LPSS values were significantly higher in the RV of athletes (RV LPSS medium-apical -23.87 ± 4.94; basalfreewall -25.04 ± 4.12 at rest) and controls (RV LPSSmedium-apical -25.21 ± 4.97; basalfreewall -28.69 ± 4.62 at rest) than in the LV of both (athletes LV LPSS medium-apical -18.14 ± 4.16; basallateralwall -16.05 ± 12.32; controls medium-apical -18.81 ± 2.64; basallateralwall -19.74 ± 3.84) With the HG test a significant enhancement of the LPSS(with P < .05) in the medium-apical segments of LV and RV was evident, but only in athletes; there was no modification of the standard echo-parameters in either group.ConclusionST analysis is an easy method for investigating the contractility of the RV through deformation parameters, showing greater involvement of the RV than LV at rest. In athletes only, after isometric stress the two ventricles show particular myocardial deformation properties of the regions around the apex where the curvature of the wall is more marked. The clinical application of this new approach in athletes and normal subjects requires further investigation.

Speckle tracking for left ventricle performance in young athletes with bicuspid aortic valve and mild aortic regurgitation.

AIMS Longitudinal peak systolic strain (LPSS) quantifies regional and global heart function. Few data are available on left ventricle (LV) performance in young athletes with bicuspid aortic valve (BAV), where a pattern of mild aortic insufficiency is relatively frequent, and the ejection fraction (EF) is often normal for a long time. We report the measurement of LV strain in young BAV athletes. METHODS AND RESULTS Three groups (20 athletes with BAV, 20 healthy athletes, and 20 sedentary healthy subjects, all aged 25 +/- 3 years) underwent standard echo examination to evaluate LPSS at the basal and medium-apical segments of the lateral wall (LW) and interventricular septum (IVS) of the LV. LPSS was within the normal range; however, in BAV athletes, the LPSS of the basal segments tended to be lower (S%IVS(basal), -17.7 +/- 2.7; S%LW(basal), -14.2 +/- 2.2; S%IVS(med-apic), -21 +/- 3.5; S%LW(med-apic), -18.8 +/- 4.2), producing a gradient from basal to apical regions. The EF was normal in all subjects. CONCLUSION Young trained BAV athletes have normal LV performance. Nevertheless, these athletes tend to have lower strain than healthy subjects in the LV basal segments. The clinical implications of this finding are uncertain and require further investigation.

Adaptative or maladaptative hypertrophy, different spatial distribution of myocardial contraction.

Background:  Left ventricular hypertrophy (LVH) may be an adaptative remodelling process induced by physical training, or result from pathological stimuli. We hypothesized that different LVH aetiology could lead to dissimilar spatial distribution left ventricular (LV) contraction, and compared different components of LV contraction using 2‐dimensional (2‐D) speckle tracking derived strain in subjects with adaptative hypertrophy (endurance athletes), maladaptative hypertrophy (hypertensive patients) and healthy controls.

3D Strain helps relating LV function to LV and structure in athletes

IntroductionThe evaluation of cardiac contraction could benefit from a connection with the underlying helical structure of cardiac fibers in athletes either completely healthy or with minor common cardiopathies like Bicuspid Aortic Valve (BAV). This study aims to exploit the potential role of 3D strain to improve the physiological understanding of LV function and modification due to physical activity as a comparative model.MethodsThree age-matched groups of young (age 20.3 ± 5.4) individuals are prospectively enrolled: 15 normal healthy subjects, 15 healthy athletes, and 20 athletes with bicuspid aortic valve (BAV). All subjects underwent echocardiographic examination and both 2D and 3D strain analysis.ResultsAll echo parameters were within the normal range in the three groups. Global values of end-systolic longitudinal and circumferential strain, assesses by either 2D or 3D analysis, were not significantly different. The 3D strain analysis was extended in terms of principal and secondary strain (PS, SS). Global PS was very similar, global SS was significantly higher in athletes and displays a modified time course. The comparative analysis of strain-lines pattern suggests that the enhancement of LV function is achieved by a more synchronous recruitment of both left- and right-handed helical fibers.Conclusions3D strain analysis allows a deeper physiological understanding of LV contraction in different types of athletes. Secondary strain, only available in 3D, identifies increase of performances due to physical activity; this appears to follow from the synergic activation of endocardial and epicardial fibers.

Three-Dimensional Reconstruction of the Functional Strain-Line Pattern in the Left Ventricle From 3-Dimensional Echocardiography

Advances in 3-dimensional (3D) echocardiography offer a rapid, effective imaging technique with adequate temporal and spatial resolution for left ventricular motion assessment. 3D multidirectional tracking of the endocardial left ventricular layer has shown that the functional pattern of directional strain arrangement during cardiac contraction closely relates with the structural architecture of the myocardial helical muscle fiber orientation.1 In a similar manner, we carried out segmentation tracking of the endocardial-epicardial layers in 10 healthy young athletes (nonprofessional athletes, enrolled at the Sport Medicine Center of the University of Florence, Italy, training 2–3 days a week for 2 hours daily; all exhibiting an excellent echographic window) to evaluate the 3D strain pattern over the whole myocardium thickness and to compare with the hypothesized underlying fiber architecture. An echocardiographic 3D full-volume image of the left ventricular was recorded by a Philips IE33 machine (frame rate, 15–30 Hz). Imaging data were processed by 3D feature tracking (4DLVA 3.0; TomTec Gmbh, Unterschleissheim, Germany), and the endocardial and epicardial tracked surfaces were exported for the following principal strain analysis.1 Principal strain analysis allows to define the direction along which the main contractile strain (S1) develops, accompanied by a secondary strain (S2) that is typically of much …

A case of carcinoid heart metastases

Carcinoid tumor is an uncommon tumor that has often already developed metastases at the time of diagnosis. The primary site of tumors are the gastrointestinal tract, breast, and bronchus. The first manifestation of “carcinoid syndrome” occurs as a result of hormone production and cardiac involvement can be recognized in approximately half of the patients. The tricuspid or pulmonary valves are often affected, while, more rarely, the myocardial wall is of interest. A 51-year-old female patient affected by a primary pancreatic carcinoid showed interventricular septum carcinoid disease diagnosed by 2D echocardiography.

Left Ventricle Twisting in Athletes: A Comparison between Subjects with Bicuspid Aortic Valve and Tricuspid Ones

Aim: In athletes with Bicuspid Aortic Valve (BAV) a slight but progressive left ventricle (LV) enlargement with a reduction of longitudinal strain values at basal segments of the same chamber, have been previously demonstrated. The aim of the study is to verify by deformation parameters any possible asymptomatic myocardial dysfunction in BAV athletes.