The Oxygen Cascade According to HFpEF Likelihood: A Focus on Sex Differences.

Background: Women are at greater risk for heart failure with preserved ejection fraction (HFpEF).

Objectives: The aim of the study was to compare sex differences in the pathophysiology of exertional breathlessness in patients with high vs low HFpEF likelihood.

Methods: This cohort study evaluated consecutive patients (n = 1,936) with unexplained dyspnea using cardiopulmonary exercise testing and simultaneous echocardiography and quantified peak oxygen uptake (peak VO) and its determinants.

Exercise pulmonary hypertension by the mPAP/CO slope in primary mitral regurgitation.

Aims: Exercise-induced pulmonary hypertension (PH), defined by a mean pulmonary arterial pressure over cardiac output (mPAP/CO) slope >3 mmHg/L/min, has important diagnostic and prognostic implications. The aim of this study is to investigate the value of the mPAP/CO slope in patients with more than moderate primary mitral regurgitation (MR) with preserved ejection fraction and no or discordant symptoms.

Methods And Results: A total of 128 consecutive patients were evaluated with exercise echocardiography and cardiopulmonary testing.

Determinants of myocardial work indices in women.

Objective: By incorporating myocardial deformation and afterload, novel echocardiographic myocardial work indices appear to be advantageous compared to load-dependent left ventricular (LV) deformation analyses. As such, these indices may provide a more accurate and, above all, load-independent estimation of LV function in patients with chronically increased afterload. To date however, data on the relation of these indices to clinical and conventional echocardiographic parameters are scarce.

Automated quantification of mitral valve tenting volume in functional mitral regurgitation by three-dimensional echocardiography.

Background: Tenting of the mitral leaflets is a major pathophysiological factor contributing to functional mitral regurgitation (FMR). A novel software tool allows automated quantification of the tenting volume (TnV) by 3D transesophageal echocardiography (TEE). The aims of this study are to investigate the correlations of biometric patient characteristics with the TnV and whether a threshold value for the diagnosis of a moderate or severe FMR can be calculated for the TnV.

Machine learning of the spatio-temporal characteristics of echocardiographic deformation curves for infarct classification.

The aim of this study was to analyze the whole temporal profiles of the segmental deformation curves of the left ventricle (LV) and describe their interrelations to obtain more detailed information concerning global LV function in order to be able to identify abnormal changes in LV mechanics. The temporal characteristics of the segmental LV deformation curves were compactly described using an efficient decomposition into major patterns of variation through a statistical method, called Principal Component Analysis (PCA). In order to describe the spatial relations between the segmental traces, the PCA-derived temporal features of all LV segments were concatenated.

Multi-transmit beam forming for fast cardiac imaging--experimental validation and in vivo application.

High frame rate (HFR) echocardiography may be of benefit for functional analysis of the heart. In current clinical equipment, HFR is obtained using multi-line acquisition (MLA) which typically requires broadening of transmit beams. As this may result in a significant degradation of spatial resolution and signal-to-noise ratio (SNR), the capacity of MLA to obtain high quality HFR images remains limited.

Incremental value of the en face view of the tricuspid valve by two-dimensional and three-dimensional echocardiography for accurate identification of tricuspid valve leaflets.

Background: In this study, advanced postprocessing of three-dimensional echocardiographic (3DE) data sets was used to identify tricuspid valve (TV) leaflets in two-dimensional echocardiographic (2DE) views, and the feasibility of the subcostal view to obtain 2DE en face views of the TV, as an alternative imaging option to image reconstruction from 3DE imaging, was also tested.

Methods: In 155 consecutive patients, attempts were made to obtain the en face view of the TV by 2DE imaging (from the subcostal window) and by reconstruction from 3DE imaging. Using both in-house-developed and commercially available software for postprocessing of 3DE data, image planes from the standard 2DE views were reconstructed and TV leaflets identified in each view.

Consistent regional heterogeneity of passive diastolic stretch and systolic deformation in the healthy heart: age-related changes in left ventricle contractility.

The consistency of the normal spatial distribution of segmental passive stretch (PreS) and systolic strain (SS) within the left ventricle was investigated and a recently proposed echocardiographic estimate of left ventricular (LV) contractility was used to detect contractility changes with age. Hereto, in 54 healthy subjects, segmental PreS and SS were measured on tissue Doppler images of six left ventricle walls. For each subject, a linear regression line was estimated through the segmental PreS and SS values.

Elastic image registration to quantify 3-D regional myocardial deformation from volumetric ultrasound: experimental validation in an animal model.

Although real-time 3-D echocardiography has the potential to allow more accurate assessment of global and regional ventricular dynamics compared with more traditional 2-D ultrasound examinations, it still requires rigorous testing and validation should it break through as a standard examination in routine clinical practice. However, only a limited number of studies have validated 3-D strain algorithms in an in vivo experimental setting. The aim of the present study, therefore, was to validate a registration-based strain estimation methodology in an animal model.

The slope of the segmental stretch-strain relationship as a noninvasive index of LV inotropy.

Objectives: The aim of this study was to test the hypothesis that the noninvasively constructed slope of the relationship between left ventricular (LV) regional systolic strain and stretch during atrial contraction represents LV inotropic state.

Background: LV systolic response to a changing preload depends on its inotropic state. Changing the preload has allowed constructing the slope of the end-systolic pressure-volume relationship that is used as an invasive measurement of LV inotropy.

Elastic image registration versus speckle tracking for 2-D myocardial motion estimation: a direct comparison in vivo.

Despite the availability of multiple solutions for assessing myocardial strain by ultrasound, little is currently known about the relative performance of the different methods. In this study, we sought to contrast two strain estimation techniques directly (speckle tracking and elastic registration) in an in vivo setting by comparing both to a gold standard reference measurement. In five open-chest sheep instrumented with ultrasonic microcrystals, 2-D images were acquired with a GE Vivid7 ultrasound system.

Current state of three-dimensional myocardial strain estimation using echocardiography.

With the developments in ultrasound transducer technology and both hardware and software computing, real-time volumetric imaging has become widely available, accompanied by various methods of assessing three-dimensional (3D) myocardial strain, often referred to as 3D speckle-tracking echocardiographic methods. Indeed, these methods should provide cardiologists with a better view of regional myocardial mechanics, which might be important for diagnosis, prognosis, and therapy. However, currently available 3D speckle-tracking echocardiographic methods are based on different algorithms, which introduce substantial differences between them and make them not interchangeable with each other.

The heart in Friedreich ataxia: definition of cardiomyopathy, disease severity, and correlation with neurological symptoms.

Background: This cross-sectional study provides a practical approach for the clinical assessment of Friedreich ataxia (FA) cardiomyopathy (FA-CM).

Methods And Results: A comprehensive cardiac assessment, including standard echocardiography, color Doppler myocardial imaging, cardiac magnetic resonance imaging, ECG, and exercise stress testing, was performed in 205 FA patients. To assess myocardial hypertrophy in FA-CM, the end-diastolic interventricular septal wall thickness (IVSTd) was found to be the best echocardiographic parameter compared with cardiac magnetic resonance imaging-determined left ventricular mass.

Comparison of a new methodology for the assessment of 3D myocardial strain from volumetric ultrasound with 2D speckle tracking.

An alternative approach to extract 3D myocardial strain based on elastic registration of the ultrasound images (3DSE) was developed by our lab. The aim of the present study was to test its clinical performance by comparing strain values obtained by 3DSE with the ones obtained with 2D speckle tracking (2DST). Standard 2D B-mode and volumetric datasets were acquired in 12 patients with coronary heart disease (CHD) and in 12 control subjects.