ECHO provides layer‐specific insight of both myocardial deformation and microcirculation dysfunction in dilated cardiomyopathy patients: Clinical value of combined application of left ventricular layer‐specific strain and myocardial contrast echocardiography

Abstract

Aim: To investigate the pattern of left ventricular (LV) function and myocardial perfusion and their relationship in dilated cardiomyopathy (DCM) patients using layer-specific speckle tracking imaging (STI) and layer-specific myocardial contrast echocardiography (MCE).Material and Methods: Thirty DCM patients and 30 controls were recruited and underwent STI and MCE examination. The peak values of longitudinal strain (LS), circumferential strain (CS) of each layer of LV were recorded and compared between groups. Additionally, cross-sectional area of a microvessel (A) and average myocardial microvascular lesion (β) of each layer were measured, myocardial blood flow (MBF) was estimated using A Â β, above parameters were compared between two groups. Results:The LS of endo-(LS endo ), mid-(LS mid ) and epicardium (LS epi ), as well as CS of endo-(RS endo ), mid-(RS mid ), (LS epi ) epicardium and LS endo/epi, CS endo/epi were significantly decreased in DCM patients. More importantly, DCM patients demonstrated decreased A, β and A Â β in all three myocardium layers and A endo/epi, β endo/epi, A Â β endo/epi compared to the controls. The time to peak and the cardiac cycle required to reach the peak were prolonged in DCM patients (p < 0.05). Longitudinal strain parameters of each layer had a negative relationship with perfusion parameter A and this relationship was strongest between LSendo and Aendo (r = 0.690, p < 0.01). Conclusions:The cardiac strain and, more importantly, coronary microcirculation perfusion was impaired in each layer in DCM patients. The longitudinal function of the LV myocardium was closely related to changes in myocardial microcirculation perfusion.

Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease

“…Cardiac magnetic resonance imaging and echocardiography are the most commonly used methods for detecting subclinical left ventricle (LV) systolic and diastolic dysfunction in T2DM patients[ 8 - 10 ]. Layer-specific global longitudinal strain (GLS) and peak strain dispersion (PSD), derived from two-dimensional speckle tracking echocardiography (STE), accurately detect LV systolic dysfunction in patients with most cardiovascular diseases, such as cardiomyopathy[ 11 , 12 ], coronary artery disease (CAD)[ 13 ], and hypertension[ 14 ].…”

Malperfusion in dilated cardiomyopathy: One more link in the pathologic chain?

“…7 In this issue of the Journal of Clinical Ultrasound Sha Tang et al, for the first time the MCE was combined with speckle tracking strain analysis in a layer-specific manner in patients with DCM and compared with the same parameters in healthy volunteers. 8 While the poor global and regional LV systolic function assessed by speckle tracking strain in DCM patients in comparison to healthy subjects is awaited, the authors performed the comprehensive analysis of the interaction between segmental parameters by dividing the myocardium into standard segments plus three layers in each segment.…”