Fiorella Caranci

Assessment of right ventricular function by strain rate imaging in chronic obstructive pulmonary disease

The purpose of the current study was to compare right ventricular (RV) myocardial wall velocities (tissue Doppler imaging) and strain rate imaging (SRI) parameters with conventional echocardiographic indices evaluating RV function in chronic obstructive pulmonary disease (COPD) patients. In total, 39 patients with COPD and 22 healthy subjects were included in the current study. Seventeen patients had pulmonary artery pressure <35 mmHg (group I) and 22 patients had pulmonary artery pressure >35 mmHg (group II). Tissue Doppler imaging, strain and strain rate (SR) values were obtained from RV free wall (FW) and interventricular septum. Respiratory function tests were performed (forced expiratory volume in one second/vital capacity (FEV1/VC) and carbon monoxide diffusion lung capacity per unit of alveolar volume (DL,CO/VA)). Strain/SR values were reduced in all segments of group II patients compared with group I patients and controls with lowest values at basal FW site. A significant relationship was shown between peak systolic SR at basal FW site and radionuclide RV ejection fraction. A significant relationship was shown between peak systolic SR at basal FW site and DL,CO/VA and FEV1/VC. In conclusion, in chronic obstructive pulmonary disease patients, strain rate imaging parameters can determine right ventricular dysfunction that is complementary to conventional echocardiographic indices and is correlated with pulmonary hypertension and respiratory function tests.

Comprehensive assessment of biventricular function and aortic stiffness in athletes with different forms of training by three-dimensional echocardiography and strain imaging †

AIMS Previous studies have shown distinct models of cardiac adaptations to the training in master athletes and different effects of endurance and strength-training on cardiovascular function. We attempted to assess left-ventricular (LV) function, aortic (Ao) function, and right-ventricular (RV) function in athletes with different forms of training by using three-dimensional (3D) echocardiography, tissue Doppler imaging (TDI) and speckle-tracking imaging (STI). METHODS AND RESULTS We examined 35 male marathon runners (endurance-trained athletes, ETA), 35 powerlifting athletes (strength-trained athletes, STA), 35 martial arts athletes (mixed-trained athletes, MTA), and 35 sedentary untrained healthy men (controls, CTR). Two-dimensional and three-dimensional echocardiography were performed for the assessment of LV and RV systolic/diastolic function. LV and RV longitudinal strain (LS) and LV torsion (LVtor) were determined using STI (EchoPAC BT11, GE-Ultrasound). Maximum velocity of systolic wall expansion peaks (AoSvel) was determined using TDI. ETA experienced LV eccentric hypertrophy with increased 3D LV end-diastolic volume and mass and significant increase in peak systolic apical rotation and LVtor. In all groups of athletes, RV-LS was reduced at rest and improved after exercise. AoSvel was significantly increased in ETA and MTA and significantly decreased in STA compared with CTR. There were good correlations between LV remodelling and aortic stiffness values. Multivariate analysis showed aortic wall velocities to be independently related to LV mass index. CONCLUSION In strength-trained, endurance-trained, and mixed-trained athletes, ventricular and vascular response assessed by 3DE, TDI, and STI underlies different adaptations of LV, RV, and aortic indexes.

Assessment of ascending aorta distensibility after successful coarctation repair by strain Doppler echocardiography.

BACKGROUND Increased arterial stiffness may participate in the genesis of hypertension and increase of left ventricular (LV) mass after surgical correction of coarctation of the aorta. The purpose of the current study was to assess the aortic elastic properties using Doppler tissue imaging and strain rate imaging in patients after coarctoplasty. METHODS Echocardiography with Doppler tissue/strain rate imaging capabilities was performed in 26 adult normotensive patients who had successful repair of coarctation of the aorta in infancy and in 24 control subjects. Transesophageal aortic transverse sections were imaged at the level of the proximal and distal segments to the repair site. Doppler tissue imaging wall velocities during systole (S(w)), early relaxation (E(w)), and atrial systole (A(w)) and peak systolic strain (ps epsilon) were measured in both groups. Transthoracic ascending aorta (AAo) measurements were also obtained. RESULTS In the patients with coarctoplasty, S(w) velocities and ps epsilon were significantly decreased in the proximal segments compared with control subjects. Both peak systolic blood pressure after exercise (P < .001) and pulse pressure after exercise (P < .001) were directly related to AAo wall strain. LV annular early diastolic velocity was significantly reduced compared with control subjects in patients with decreased AAo wall strain and exercise-induced hypertension (P < .001) and related to AAo wall velocity (P < .005) and strain (P < .001). In multiple linear regression analysis, only weight, study group, and AAo wall strain were correlated to LV mass index. CONCLUSIONS Patients with coarctation of the aorta have reduced proximal aortic wall velocities and strain and increased stiffness even after successful repair. This amplifies stress-induced hypertension and increases LV burden.

Utility of Strain Echocardiography at Rest and After Stress Testing in Arrhythmogenic Right Ventricular Dysplasia

The introduction of speckle tracking imaging (STI) allowed the quantification of the regional myocardial function in the right ventricular (RV) free wall using deformation parameters. We sought to evaluate the potential utility of STI at rest and after stress to predict arrhythmogenic RV dysplasia (ARVD). We studied 19 patients with ARVD (diagnosed according to the task force criteria) and 19 healthy age- and gender-matched subjects. Both 2-dimensional and 3-dimensional echocardiography were performed. The RV and left ventricular annular peak systolic velocities were measured using tissue Doppler imaging. The RV-left ventricular peak systolic longitudinal strain (LS) was obtained in the basal, mid, and apical segments in the apical 4-chamber view using STI. An exercise stress-echocardiographic test was undertaken using bicycle ergometry with the patient in the supine position for all patients, and the indexes were assessed at peak effort. The STI measurements were determined using offline analysis programs. The 3-dimensional RV ejection fraction and strain were significantly lower in patients with ARVD than in the controls. The RV strain values at rest did not change significantly during maximum physical effort in the patients with ARVD. The receiver operating characteristic curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the detection of ARVD were 9.35 cm/s for the RV annular peak systolic velocity (area under the curve 0.81), 42% for 3-dimensional RV ejection fraction (area under the curve 0.85), -25% for mean global RV-LS (area under the curve 0.86), -18% for the lowest peak systolic RV-LS (area under the curve 0.88), and -1.2 for peak minus baseline global change of stress RV-LS (area under the curve 0.92). In conclusion, STI at rest and during stress might enable quantitative assessment of RV function and the detection of ARVD and have potential clinical value in the treatment of these patients.

Left ventricular torsion abnormalities in patients with obstructive sleep apnea syndrome: An early sign of subclinical dysfunction

BACKGROUND Previous echocardiographic studies using tissue Doppler imaging (TDI) and speckle tracking imaging (STI) have demonstrated that obstructive sleep apnea syndrome (OSAS) patients may develop subclinical left ventricular (LV) systolic and diastolic dysfunction. Our purpose was to evaluate the impact of OSAS on LV torsion dynamics and aortic stiffness by using TDI and STI echocardiography. METHODS Forty-two patients with OSAS and no comorbidities were studied. They were classified into mild and severe OSAS according to the apnea-hypopnea index (AHI). Thirty-five healthy subjects were selected as controls. Fifteen patients with severe OSAS underwent chronic nocturnal nasal continuous positive airway pressure (CPAP) therapy. Standard echocardiographic parameters were assessed. Global LV longitudinal strain (LS), radial and circumferential strain were determined by STI. Averaged LV rotation and rotational velocities from the base and apex were obtained and used for calculation of LV torsion (LVtor). Mitral annular velocities and aortic wall velocities and strain (AoS) were also obtained by TDI. RESULTS Severe OSAS had decreased LS compared with control subjects. LVtor increased significantly in severe OSAS compared to normals (p<.001) as a result of a predominant increase in apical rotation and was independently related to AHI and AoS in a multiple stepwise linear regression model. The group treated with CPAP had a significant decrease in LVtor and aortic stiffness index and significant increase in LS and AoS. CONCLUSIONS LVtor, LS and AoS were identified as parameters demonstrating an association between LV dysfunction, aortic stiffness and severity of OSAS independently of other possible factors or comorbidities.

Is an abnormal vascular response after renal sympathetic denervation predictive of permanent damage? An unusual case of late renal artery stenosis after energy delivery.

Purpose To describe the effect of renal sympathetic denervation (RDN) on renal arteries immediately after the procedure and at follow-up. Case Report A 52-year-old woman with severe resistant hypertension underwent RDN. A transient spasm occurred in the left renal artery immediately after radiofrequency energy delivery, with subsequent complete resolution without any additional therapy. At 6-month follow-up, the blood pressure increased, and imaging revealed a tight stenosis in the left renal artery, which was successfully treated with a stent. In the next days, there was an immediate significant blood pressure reduction. Conclusion Renal denervation can be complicated by local tissue injury at the ablation sites that could be a possible trigger of late arterial disease.

Vascular response after percutaneous sympathectomy: Not all devices are equal

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