Haydar K. Saleh

Normal left ventricular mechanical function and synchrony values by speckle-tracking echocardiography in the transplanted heart with normal ejection fraction.

BACKGROUND The purpose of this study was to describe the normal values for strain (S), systolic strain rate (SRs) and synchrony by speckle-tracking echocardiography (STE) in heart transplant (HTx) recipients who had normal left ventricular ejection fraction (LVEF) and no clinically significant complications. METHODS We evaluated S and SRs in 40 HTx patients at 1 year after transplant and 82 healthy controls with STE using velocity vector imaging. RESULTS Mean (SD) global longitudinal S and SRs, respectively, were lower in the transplant group compared with controls [-13.43% (2.39%) vs -17.28% (2.30%), p < 0.001; -0.83 (0.15) s(-1) vs -0.96 (0.13) s(-1), p < 0.001]. These variables were good for differentiating between groups: area under the curve was 0.88 for S and 0.73 for SRs. The differences remained significant after adjustment for other clinical variables. Global circumferential S and SRs were similar between groups. The standard deviation of the global longitudinal S time to peak of the 16 segments for HTx and control groups, respectively, was 41.67 (13.53) milliseconds vs 32.57 (12.81) milliseconds (p < 0.001). With 58.2 milliseconds as a cutoff value to define left ventricular synchrony, only 3 (8%) of the HTx patients and 4 (5%) of the control subjects were above that value (p = 0.6). CONCLUSION To our knowledge, this is the first study describing normal values for S and SRs and synchrony by STE in a HTx population with normal LVEF: longitudinal S and SRs were reduced; circumferential deformation indexes were normal; and left ventricular synchrony was preserved.

Changes in Left and Right Ventricular Mechanics During the Mueller Maneuver in Healthy Adults A Possible Mechanism for Abnormal Cardiac Function in Patients With Obstructive Sleep Apnea

Background—Obstructive sleep apnea is highly prevalent in patients with cardiovascular disease and has detrimental effects on systolic and diastolic function of the ventricles. In this research, the changes in strain (S) and strain rate (SR) during the performance of the Mueller maneuver (MM) in an effort to better understand how negative intrathoracic pressures affect ventricular mechanics. Methods and Results—The MM was performed to maintain a target intrathoracic pressure of −40 mm Hg. Echocardiography was used to measure various parameters of cardiac structure and function. Myocardial deformation measurements were performed using tissue speckle tracking. Twenty-four healthy subjects (9 women; mean age, 30±6 years) were studied. Global left ventricular longitudinal S in systole and SR in early filling were significantly decreased during the MM (S: baseline, −17.0±1.6%; MM, −14.5±2.2%; P<0.0001, SR: baseline, 1.09±0.20 s−1; MM, 0.92±0.21 s−1; P=0.01). Global right ventricular longitudinal S was also significantly decreased during the MM (baseline, −22.0±3.1%; MM, −17.2±2.5%; P<0.0001), as was global right ventricular longitudinal systolic SR (baseline, −1.34±0.35 s−1; MM, −1.02±0.21 s−1; P=0.0006). Conclusions—Left ventricular and right ventricular longitudinal deformation are significantly reduced during the MM. These results suggest that negative intrathoracic pressure during apnea may contribute to changes in myocardial mechanics. These results could help explain the observed changes in left ventricular and right ventricular mechanics in patients with obstructive sleep apnea.

Changes in myocardial mechanics in patients with obesity following major weight loss after bariatric surgery

The purpose of this study was to evaluate myocardial mechanics in obese subjects using 2D‐speckle tracking echocardiography (2D‐STE).

Pendulum Heart in Congenital Absence of the Pericardium

A 20-year-old man with pectus excavatum status after GORE-TEX mesh placement presented because of symptomatic dyspnea on exertion and stabbing chest pain. On physical examination, mild residual pectus excavatum and laterally displaced apical impulse were observed, with otherwise normal physical examination results. An ECG showed right axis deviation with incomplete right bundle branch block and poor R wave progression in the precordial leads (Figure 1A). Chest x-ray showed leftward position of the heart and flattening and elongation of the left heart border. A lucent area between the aorta and pulmonary artery secondary to lung interposition was noticed (Figure 1B). Figure 1. A, ECG showing right axis deviation with incomplete right bundle branch block and poor R wave progression in the precordial leads. B, Chest radiograph showing leftward position of the heart, flattening and elongation of left heart border (“Snoopy sign”), and a lucent area between the aorta and pulmonary artery secondary to lung interposition (white arrow). The patient was referred for stress echocardiography for …