Asymptomatic Cardiovascular Risk Assessment: The Road Less Traveled

Llobet, FredericPrimer pla de l'obra Braser amb Victòries, pertanyent a la Font de la plaça Espanya. És de nit i la trobem il·luminada. L'autor del disseny fou Frederic Llobet. L'element s'instal·là el 1929

Right atrial deformation through speckle tracking echocardiography and feature tracking CMR

The right atrium (RA) plays a vital role in the electromechanical regulation of the heart. Various invasive and non-invasive techniques have been used to elucidate right atrial structure and function. One such novel technique is speckle-tracking echocardiography (STE). Speckle tracking-derived deformation is a relatively new parameter, which is less dependent on loading conditions. STE tracks acoustic scatters (speckles) of myocardium, frame by frame, to calculate the strain or deformation indices of the myocardium. The right atrium is a relatively neglected chamber as it is mostly studied for assessment of atrial mass lesions, congenital and acquired valve lesions and for electro physiological studies. However, its role in the systolic and diastolic function of the right ventricle of the heart has been less explored. I have adapted the STE technique, designed for left ventricular analysis, for use in the right atrial analysis. I undertook a reproducibility study for right atrial deformation parameters and defined normal reference ranges for longitudinal deformation parameters. I have found the analysis approach used generates similar values to those reported in the limited number of previous studies on right atrial STE. I then compared STE derived strain with cardiovascular magnetic resonance feature tracking derived measures of right atrial strain and found moderate agreement between the two techniques. Finally, I investigated whether there are differences in right atrial longitudinal deformation parameters in different patient disease groups. I studied those with Heart Failure with Normal Ejection Fraction (HFNEF) and found a decrease in right atrial function. Whereas, in another cohort of patients with Rheumatoid Arthritis (RhA) there was no statistical difference compared to healthy controls. This thesis therefore demonstrates the feasibility of using STE to measure right atrial strain and provides evidence that right atrial strain does vary in certain disease conditions

Speckle Tracking Echocardiography of the Right Atrium: The Neglected Chamber

The right atrium (RA) plays a pivotal role in electromechanical and endocrine regulation of the heart. Its peculiar anatomical features and phasic mechanical function make it distinct from ventricles. Various invasive and noninvasive techniques have been used to elucidate RA structure and function. Of these modalities, echocardiography has distinct advantages over others. Several conventional measures of RA function through echocardiography have been described in the literature, but they are load dependent. A relatively new technique is speckle tracking-derived strain, which is relatively less dependent on loading conditions. Speckle tracking echocardiography tracks acoustic scatters (speckles) of myocardium frame-by-frame to calculate strain or deformation of the myocardium. Speckle tracking echocardiography has been used extensively for strain assessment of the right and left ventricle to detect subtle disease pathology, to gain mechanistic insight, as a marker of ischemic metabolic memory, as an endpoint in clinical trials, and as a functional assessment tool. The RA is a relatively neglected chamber, as it is mostly studied for assessment of atrial mass lesions, for electrophysiological studies, and in animal models for physiological assessment. However, its role in the systolic and diastolic function of the right heart, pulmonary vascular pathology, congenital heart diseases, and combined electromechanical activation phenomena has been less explored or unexplored. Speckle tracking echocardiography is an ideal tool for the assessment of the RA because of its regional and global functional characterization, angle independence, and high temporal resolution