Insights into myocardial mechanics in normal and pathologic states using newer echocardiographic techniques

Abstract

Assessment of myocardial mechanics has been an important research endeavor in echocardiography for many years. Advances in understanding cardiac motion, coupled with treatments that address derangements in myocardial mechanics, have suggested that clinical application of this research may benefit patients in the detection of subclinical disease, quantification of myocardial tissue dynamics, and tracking changes in disease progression or in response to therapies. Newer techniques developed over the past two decades may better address the complex mechanics of cardiac motion than standard anatomic and physiologic echocardiographic measurements. This review describes the mechanics underlying the complexities of myocardial motion and describes standard and novel ways to measure these mechanics, including three-dimensional echocardiography, tissue Doppler imaging, and speckle tracking. Current and future applications of these methods are discussed, along with limitations.

Detection of preclinical impairment of myocardial function in rheumatoid arthritis patients with short disease duration by speckle tracking echocardiography

“…For the first time, we assessed that LV radial and longitudinal ε by STE are impaired in RA patients without clinical and echocardiographic evidence of CV involvement. Our data are in agreement with Kirkpatrick et al [25], who underline the importance of the development of more precise non invasive tools to improve sensitivity in detecting cardiac pathology in premorbid stages.…”

“…However, differently from our study, they included RA patients with lower disease activity levels and with longer disease duration [24,25]. Moreover, RA patients had also several CV risk factors other than RA, such as dyslipidaemia, arterial hypertension, and diabetes mellitus [24,25].…”

“…Moreover, RA patients had also several CV risk factors other than RA, such as dyslipidaemia, arterial hypertension, and diabetes mellitus [24,25].…”

Echocardiographic strain imaging and its use in the clinical setting

“…Owing to relaxation occurring in different directions, a transcavitary relaxation gradient is established, the motion of which helps create diastolic suction, aiding in ventricular filling. Throughout the rest of diastole, radial and longitudinal expansion and myocardial thinning occur simultaneously with clockwise rotation [2].…”

The use of echocardiography in predicting heart failure in patients with coronary artery disease

“…Furthermore, although the TTE Heart Failure Index does add prognostic information to age, EF, and NT-proBNP, it is not statistically signifi cant. Perhaps the use of tissue Doppler imaging and speckle tracking, which have been shown to better assess the mechanics of myocardial motion, would add signifi cantly to the prediction of heart failure hospitalizations [7].…”