Current noninvasive techniques used to evaluate left ventricular systolic function are limited by dependence on the angle of insonation (tissue Doppler imaging/TDI) or limited by availability (MRI tagging). We utilized 2-dimensional speckle strain (epsilon) imaging (1) to establish normal values for all three epsilon vectors; (2) to compare circumferential epsilon values with circumferential shortening (midwall fractional shortening (FS(mw)); (3) to examine the relationship between left ventricular epsilon and wall stress; and (4) to compare 2D echocardiographic characteristics by gender. Echocardiography was performed in 60 normal subjects (mean 39 +/- 15 years). Small, but significant regional heterogeneity was seen in circumferential epsilon, but not in radial or longitudinal epsilon. We found an inverse correlation between circumferential epsilon and stress (r =-0.29, p<0.05) as well as longitudinal epsilon and stress (r =-0.11, P < 0.05), though the relationships were not close. We also observed a linear relationship between mean circumferential epsilon and FS(mw) (r = 0.29, P < 0.05). In conclusion, (1) 2-dimensional epsilon imaging permits measurement of regional systolic epsilon values in the majority of normal individuals; (2) epsilon values furnished by this method obey expected stress-shortening relationships; (3) systolic epsilon displays minor regional heterogeneity in the circumferential direction; (4) for the first time, a close relationship between FS(mw) and mean circumferential epsilon was demonstrated; and (5) there are minor gender-related differences in LV geometry and function.
Background-We hypothesized that abnormalities in regional systolic strain () might be present among hypertensive subjects with normal ejection fraction, and, if present, could be used to identify patients at high risk for heart failure.The aim of the current case-control study was to use speckle tracking imaging to identify subclinical global and regional systolic function abnormalities in hypertensive subjects with normal ejection fraction. Methods and Results-Standard 2D Doppler echocardiography, tissue Doppler imaging, and 2D speckle strain imaging were performed in 52 hypertensive subjects with normal ejection fraction and 52 control subjects of similar age. Peak systolic (SЈ), and diastolic (EЈ) annular velocities were obtained by tissue Doppler imaging, whereas longitudinal myocardial systolic velocity (V l ) and circumferential, longitudinal, and radial strains ( c , l , r ) were obtained by speckle tracking. Midwall shortening and peak basal longitudinal strain ( l ) were used as indices of regional function. Hypertensive subjects had lower velocities-tissue Doppler imaging EЈ and SЈ, and V l -and evidence of reduced regional function. Surprisingly, however, global values did not differentiate hypertensive subjects from control subjects. Among hypertensive patients, significant inverse associations were found between left ventricular mass and global longitudinal and circumferential (both PϽ0.05). Conclusions-Hypertensive heart disease with normal ejection fraction is associated with reduced myocardial velocities and reduced regional function but normal global . Our data suggest that velocity abnormalities occur early in hypertension and may be an appropriate target for preventive strategies because they occur before abnormalities in global . (Circ Cardiovasc Imaging. 2009;2:382-390.)
Background: The syndrome of chest pain associated with characteristic anterior electrocardiographic changes, moderate increases in cardiac enzymes, and a reversible apical wall motion abnormality in the absence of coronary artery disease has been documented in Japan, but has received relatively little attention in other countries. Methods: The clinical and echocardiographic data of 12 patients (11 women, mean age 64 ±14 years) who presented with chest symptoms, electrocardiographic (ECG) changes indicative of an acute anteroapical myocardial infarction, abnormal cardiac enzyme levels and echocardiography showing an apical wall motion abnormality were collected. Coronary angiography was performed in 10 patients. A follow-up echocardiogram was obtained within 2 weeks of the initial diagnosis in most cases. Results: An identifiable, precipitating (‘trigger’) event could be identified in all 12 individuals. Respiratory distress was present in 7, the death of a relative in 3, in 4 a surgical or medical procedure had been performed, and in 1 a panic disorder was diagnosed. The echocardiograms showed a characteristic wall motion pattern of significant apical dysfunction. All of the patients who underwent coronary arteriography had noncritical coronary artery disease. Follow-up echocardiography showed normalization of the LV dysfunction in all instances. Conclusion: We identified a syndrome of chest pain, dyspnea, ECG and enzyme changes mimicking acute myocardial infarction, similar to the ‘Takotsubo’ syndrome described in Japan. It is likely that the widespread use of echocardiography, coupled with increased recognition of this syndrome, will result in this diagnosis being made more commonly.
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