Brunello Cappelli

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.

Supernormal functional reserve of apical segments in elite soccer players: an ultrasound speckle tracking handgrip stress study

BackgroundUltrasound speckle tracking from grey scale images allows the assessment of regional strain derived from 2D regardless of angle intonation, and it is highly reproducible. The study aimed to evaluate regional left ventricular functional reserve in elite soccer players.Methods50 subjects (25 elite athletes and 25 sedentary controls), aged 26 ± 3.5, were submitted to an echo exam, at rest and after the Hand Grip (HG) test. Both standard echo parameters and strain were evaluated.ResultsEjection fraction was similar in athletes and controls both at rest (athletes 58 ± 2 vs controls 57 ± 4 p ns) and after HG (athletes 60 ± 2 vs controls 58 ± 3 p ns). Basal (septal and anterior) segments showed similar strain values in athletes and controls both at rest (athletes S% -19.9 ± 4.2; controls S% -18.8 ± 4.9 p = ns) and after HG (athletes S% -20.99 ± 2.8; controls S% -19.46 ± 4.4 p = ns). Medium-apical segments showed similar strain values at rest (athletes S% -17.31 ± 2.3; controls S% -20.00 ± 5.3 p = ns), but higher values in athletes after HG (athletes S% -24.47 ± 2.8; controls S% -20.47 ± 5.4 p < 0.05)ConclusionIn athletes with physiological myocardial hypertrophy, a brief isometric effort produces enhancement of the strain in medium-apical left ventricular segments, suggesting the presence of a higher regional function reserve which can be elicited with an inotropic challenge and suitable methods of radial function quantification such as 2D-derived strain.

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.

Non-invasive tissue Doppler imaging pulmonary capillary wedge pressure measurement improves NT-proBNP prognostic value in heart failure

Objective — The aim of the present study was to investigate whether the improvement of pulmonary capillary wedge pressure (PCWP) non-invasively assessed with tissue Doppler imaging is able to predict prognosis and cardiac-related mortality in patients with heart failure (HF), as previously demonstrated for NT-proBNP. Methods — We prospectively studied 23 patients (74 ± 10 y; 17 M, 6 F) with acute HF. NT-proBNP and PCWP were measured at admission and discharge. NT-proBNP concentrations were determined by a chemiluminescent immunoassay kit. PCWP was assessed using the ratio of transmitral E velocity to the early diastolic mitral annulus velocity (E’), with the formula PCWP = 1.9 + 1.24 (E/E’). Patients were divided in two groups according to the clinical end-point based on cardiac death and hospital readmission for HF. Results — After a mean follow-up of 230 days, 10 patients reached the end-point (group A), while 13 patients resulted event-free (group B). In group B, NT-proBNP values significantly decreased (3816 ± 7424 vs. 6799 ± 10537 pg/mL, P < 0.01) and PCWP improved (17 ± 7 vs. 23 ± 12 mmHg, P < 0.01). The decrease in both NT-proBNP and PCWP values was able to identify the majority of patients (77%) with an event-free survival at follow-up, whereas 70% of patients who reached the end-point had discordant changes in NT-proBNP and PCWP (x2 = 5.06, P < 0.05). Conclusions — The combination of a biochemical marker such as NT-proBNP and a new indicator of LV filling pressure (E/E’) allows to estimate the prognostic impact of standard medical therapy even in a small group of HF patients.

651 Improvement of TDI Pulmonary Capillary Wedge Pressure and NT-proBNP: prognostic evaluation in heart failure patients

Eur J Echocardiography Abstracts Supplement, December 2006 Results: A total of 93 echocardiograms were of diagnostic quality. Of these, 6 patients had LVSD. The R-pBNP assay correctly identified all cases of LVSD (sensitivity 100%; specificity 49%; positive predictive value (PPV) 12%; negative predictive value (NPV) 100%). Both BC-BNPB (sensitivity 83%; specificity 79%; PPV 22%; NPV 98.5%) and (sensitivity 83%; specificity 79%; PPV 22%; NPV 98.5%) respectively. Direct inter-BNP assay correlation was good (R squared 0.735-0.887). Conclusion: Use of serum BNP assay on patients referred for suspected heart failure allows for accurate predictive reduction in the echocardiographic workload by 45.3% (R-pBNP) and 73.7% (BC-BNP&BT-BNP) respectively. This equated to a cost reduction per 100 referrals for echocardiography of 1320.50 for R-pBNP and 3313.20 for BC-BNP and BT-BNP.