Péter Domsik

Three-dimensional speckle-tracking echocardiography – a further step in the non-invasive three-dimensional cardiac imaging

Three-dimensional speckle-tracking echocardiography is a new cardiac imaging methodology, which allows three-dimensional non-invasive evaluation of the myocardial mechanics. The aim of this review is to present this new tool emphasizing its diagnostic potentials and demonstrating its limitations, as well.

Three‐Dimensional Speckle Tracking Echocardiography–Derived Left Atrial Strain Parameters Are Reduced in Patients with Atrial Fibrillation (Results from the MAGYAR‐Path Study)

Objective: Three‐dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel imaging modality for assessing cardiac function. We aimed to analyze left atrial (LA) function using 3DSTE in patients with atrial fibrillation (AF). Methods: 3DSTE was performed in 20 patients prior to their pulmonary vein isolation for AF. Every patient underwent a complete two‐dimensional echocardiographic study at the same time. 3DSTE‐derived circumferential (CS), longitudinal (LS), radial (RS), 3D (3DS), and area strain (AS) values were measured in the basal (b), mid (m), and superior (s) regions of the LA. 3DSTE‐defined maximal (LAmax) and minimal LA volumes (LAmin) and LA total emptying fraction were calculated automatically. Eleven randomly selected age‐ and gender‐matched healthy volunteers served as controls. Results: Patients with AF had significantly larger LAmax and LAmin and reduced LS, RS and CS.3DS and AS were significantly lower throughout the LA in cases with AF (3DS−b, −m, −s [AF patients vs. controls]: −18 ± 8% vs. −29 ± 8%, P = 0.001; −14 ± 6% vs. −22 ± 7%, P = 0.002; −10 ± 7% vs. −20 ± 9%, P = 0.002; AS−b, −m, −s [AF patients vs. controls]: 35 ± 15% vs. 52 ± 13%, P = 0.004; 50 ± 21% vs. 72 ± 19%, P = 0.009; 31 ± 21% vs. 65 ± 27%, P < 0.0001, respectively). Conclusions: 3DSTE‐derived “uni‐dimensional” LS, RS, CS, as well as novel strain parameters (3DS, AS) are significantly reduced in patients with AF compared to matched controls. 3DS and AS might be new strain parameters providing further insights into the alterations of LA function in patients developing AF.

Three-dimensional speckle tracking echocardiography allows detailed evaluation of left atrial function in hypertrophic cardiomyopathy--insights from the MAGYAR-Path Study.

Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. Reduced left atrial (LA) function was demonstrated in HCM by different methods. Three‐dimensional (3D) speckle tracking echocardiography (STE) has just been introduced for the evaluation of LA. This study was designed to compare 3DSTE‐derived LA volumetric and strain parameters in HCM with healthy controls.

Comparison of three-dimensional speckle tracking echocardiography and two-dimensional echocardiography for evaluation of left atrial size and function in healthy volunteers (results from the MAGYAR-Healthy study).

Noninvasive accurate assessment of left atrial (LA) size and function is an essential requirement in daily clinical practice. Real time three‐dimensional (3D) echocardiography (RT3DE) with direct volumetric method has been found to be a highly accurate and reproducible noninvasive tool for the evaluation of LA dimensions and functional properties. Three‐dimensional speckle tracking echocardiography (3DSTE) has just been introduced for volumetric assessments, which uses different, as called “block‐matching” algorithm by strain analysis. This study was designed to compare two‐dimensional (2D) echocardiography with 3DSTE for calculation of LA volumes and assessment of LA functional properties in healthy subjects.

Identification of left ventricular "rigid body rotation" by three-dimensional speckle-tracking echocardiography in a patient with noncompaction of the left ventricle: a case from the MAGYAR-Path Study.

Noncompaction of the left ventricular myocardium (LVNC) is a new clinical entity firstly described by Engberding and Bender in 1984. LVNC is characterized by the presence of numerous prominent trabeculations and deep intertrabecular recesses within the left ventricle. Recently, it has been demonstrated by two‐dimensional (2D) speckle‐tracking echocardiography (STE), that left ventricular (LV) basal and LV apical rotations are in the same direction resulting in the near absence of LV twist in LVNC patients, which was called as “LV solid/rigid body rotation.” Three‐dimensional (3D)‐STE has just been introduced, and found to be an accurate method for the evaluation of LV rotation mechanics. The aim of this report was to confirm LV “rigid body rotation” in an LVNC patient by 3D‐STE.

Left atrial volumetric and strain analysis by three-dimensional speckle-tracking echocardiography in noncompaction cardiomyopathy: Results from the MAGYAR-path study

INTRODUCTION Noncompaction cardiomyopathy (NCCM) is a rare congenital cardiomyopathy characterised by a distinctive 2-layered appearance of the myocardium due to hypertrabecularisation and deep intertrabecular recesses. The present study was designed to assess left atrial (LA) volumes and volumetric and strainbased functional properties by three-dimensional speckle-tracking echocardiography (3DSTE) in NCCM. METHODS The study included 12 consecutive NCCM patients. Their results were compared to 20 age- and sex-matched healthy controls. Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all cases. RESULTS Calculated LA maximum (76.5 ± 26.8 mL vs. 45.3 ± 15.1 mL, p=0.0002) and minimum (56.9 ± 27.3 mL vs. 25.3 ± 15.2 mL, p=0.0002) volumes and LA volume before atrial contraction (67.1 ± 28.2 mL vs. 35.7 ± 16.4 mL, p=0.0004) were significantly greater in NCCM patients. Total, active, and passive LA emptying fractions proved to be smaller in NCCM. Peak global radial (-9.3 ± 7.8% vs. -16.8 ± 10.2%, p=0.05), circumferential (12.8 ± 8.4% vs. 26.2 ± 9.2%, p=0.0003), longitudinal (12.8 ± 8.2% vs. 22.5 ± 8.5%, p=0.004), and area (26.7 ± 18.5% vs. 51.6 ± 20.3%, p=0.001) strains were significantly smaller in NCCM patients as compared to matched controls. CONCLUSIONS Significantly greater LA volumes and compromised LA functional properties could be demonstrated by 3DSTE in patients with NCCM.

Left ventricular strain reduction is not confined to the noncompacted segments in noncompaction cardiomyopathy-insights from the three-dimensional speckle tracking echocardiographic MAGYAR-path study.

Noncompaction cardiomyopathy (NCCM) is a new clinical entity characterized by prominent trabecular meshwork and deep intertrabecular recesses communicating with the left ventricular (LV) cavity due to arrest of the normal embryogenesis of the endomyocardium. The aim of the present study was to evaluate different contributions of noncompacted and compacted LV segments to the global LV dysfunction by three‐dimensional (3D) speckle tracking echocardiography (3DSTE)‐derived strain parameters in NCCM.

Left ventricular rotation and twist of the heart. Let’s reveal some concepts

Egeszseges, normalis sziv eseten a bal kamra bazalis resze szisztoleban az oramutato jarasanak megfelelően rotalodik, mig a szivcsucs azzal ellentetes iranyba mozdul el. Ezt a fajta facsaro-csavaro mozgast a sziv csavarodasanak (twist) nevezik. Ennek az osszefoglalo jellegű kozlemenynek a celja a sziv bal kamrai rotaciojaval es csavarodasaval kapcsolatos fontos tudnivalok es vizsgalati lehetősegeinek bemutatasa. Orv. Hetil., 2012, 153, 1547–1551.

Right atrial deformation analysis in isolated left ventricular noncompaction – insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study

OBJECTIVE Isolated left ventricular noncompaction (ILVNC) is a rare cardiomyopathy characterized by a prominent trabecular meshwork and deep intertrabecular recesses. The present study aimed to examine right atrial (RA) volumes, volume-based functional properties and strains by three-dimensional speckle-tracking echocardiography (3DSTE) in ILVNC patients. METHODS The study group consisted of 13 patients with ILVNC (mean age: 54.6±14.1 years, six male) and 23 healthy age- and gender-matched volunteers (mean age: 50.4±12.4 years, 10 male), who served as normal controls. Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all cases. RESULTS Increased systolic maximum (58.2±15.3 ml vs. 40.5±11.8 ml, p=0.0004) and diastolic pre-atrial contraction (39.6±16.1 ml vs. 28.2±9.2 ml, p=0.01) and minimum (46.2±17.5 ml vs. 34.6±11.6 ml, p=0.02) RA volumes were detected in ILVNC patients. Only total (18.6±8.5 ml vs. 12.2±5.9 ml, p=0.01) and passive (12.0±13.3 vs. 5.9±3.7 ml, p=0.05) RA stroke volumes, representing features of RA reservoir and conduit phases, were increased in ILVNC; active RA stroke volume and all emptying fractions did not differ between ILVNC patients and matched controls. Moreover, global, mean segmental and regional peak strains and strains at atrial contraction showed no differences between ILVNC patients and controls. CONCLUSIONS 3DSTE-derived volumetric analysis confirmed increased cyclic RA volumes in ILVNC. Only mild RA functional alterations were demonstrated in ILVNC.

Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiography (from the MAGYAR-Healthy Study)

INTRODUCTION AND OBJECTIVE Three-dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel method for assessment of left atrial (LA) volumes and function without geometrical assumptions. 3DSTE allows detailed assessment of LA features including volume measurements, strain assessments and calculation of LA ejection force (LAEF). LA strain and volume-based functional parameters originate from the same 3D dataset, but assessment of LAEF requires more data including measurement of mitral annular dimensions and Doppler-derived inflow velocities. The present study was designed to find correlations between LAEF and 3DSTE-derived LA volume-based functional properties and strain parameters in healthy subjects. METHODS The study population comprised 34 randomly selected healthy subjects (age 36.1±11.2 years, 15 men) in sinus rhythm, all of whom had undergone standard two-dimensional transthoracic Doppler echocardiographic study extended with 3DSTE. RESULTS Mitral annulus diameter-based LAEF correlated with global LA peak circumferential (r=0.39, p=0.02), longitudinal (r=0.32, p=0.05) and area (r=0.43, p=0.01) strain, total atrial stroke volume (r=0.30, p=0.05) and total atrial emptying fraction (r=0.31, p=0.05) characterizing (systolic) LA reservoir function and global LA 3D strain at atrial contraction (r=-0.44, p=0.01) and active atrial emptying fraction (r=0.36, p=0.04) characterizing (diastolic) LA contraction function (booster pump phase). CONCLUSIONS Complex LA functional assessment can be provided by 3DSTE, including calculation of LAEF and volume-based and strain functional properties, with significant correlations between these parameters.