Myocardial ischaemia and post-systolic shortening

The assessment of regional wall motion is useful to identify myocardial ischaemia because wall motion abnormalities occur relatively upstream in the ischaemic cascade. Echocardiography is widely used for this, but the subjectivity of visual observation may hamper accurate evaluation. The analysis of myocardial velocity and strain by tissue Doppler and speckle tracking echocardiography has allowed the quantitative assessment of regional wall motion and facilitated the detection of subtle myocardial deformation that is diffi cult to identify by conventional methods, such as post-systolic shortening (PSS). PSS is de fined as myocardial shortening that occurs after end-systole (or aortic valve closure), and it is observed in the myocardium with regional contractile dysfunction. In experimental and clinical studies, it has been reported that the assessment of PSS is superior to that of conventional parameters such as wall thickening or peak systolic strain in detecting acute ischaemia and diagnosing coronary artery disease. Moreover, it has recently been found that PSS remains after recovery from brief ischaemia despite the rapid recovery of peak systolic strain. The assessment of PSS allows after-thefact recognition of myocardial ischaemic insults and is expected to be used for ischaemic memory imaging. In this review, the usefulness of the assessment of PSS for the diagnosis of acute ischaemia and ischaemic memory is demonstrated, and issues that need to be resolved for the widespread use of this assessment in the echocardiographic laboratory are discussed.This article has been accepted for publication in Heart, 2015 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/heartjnl-2013-305403

Almanac 2014: Cardiovascular Imaging

Almanah-izvješća pružaju pregled članaka o određenim temema koji su objavljeni u časopisu „Heart“ tijekom posljednje 2 godine, u kontekstu napredaka unutar tog polja, uključujući publikacije iz nekoliko drugih časopisa. Ovaj je Almanah-članak usredotočen na kadiovaskularnu slikovnu dijagnostiku – kao u općem kardiološkom časopisu, istraživanje slikovne dijagnostike u časopisu „Heart“ je uglavnom klinički orijentirano i često ima utjecaja na naše kliničko djelovanje.The ‘Almanac’ Reviews provide an overview of articles on a specific topic published in Heart over the past 2 years, put in the context of advances in the fi eld, including publications from several other journals. The focus of this Almanac article is Cardiovascular imaging — as a general cardiology journal, the imaging research in Heart tends to be clinically oriented and often will impact our clinical practice

浸潤性発育を示した後腹膜孤立線維性腫瘍の1例

56歳女.悪性後腹膜孤立性線維性腫瘍であり, 主訴は腹部腫瘤触知で, 腹部CT及びMRI検査にて左腎下方に接して, Gerota筋膜に沿うように発育する境界不明瞭な腫瘤を認めた.手術所見では後腹膜腔にゼラチン状の腫瘍を認め, 下行結腸周囲の脂肪組織やGerota筋膜周囲の脂肪組織に浸潤していた.Gerota筋膜内への浸潤は認めなかったので左腎は温存した.病理組織像では間質の膠原線維は著明に増殖し, hemangiopericytoma様のくちばし状を呈する血管も豊富に認められた.腫瘍組織内に腫瘍細胞密度の増加しているところや核異型度が強く分裂像を認める組織が混在しており, また周囲脂肪組織内に浸潤している所見を認めた.以上より, 悪性後腹膜孤立性線維性腫瘍と診断した.治療は外科的切除のみを行い, 2年4ヵ月を経過しても再発無く生存中であるSolitary fibrous retroperitoneal tumor is rare. We present a case with infiltrative growth in a 56-year-old female patient whose initial symptom was palpable tumor in the lower abdomen. Computed tomography and magnetic resonance imaging indicated a mass in the retroperitoneum under the left kidney with a poorly demarcated infiltrative growth. Surgical findings revealed a gelatinous tumor in the retroperitoneum, which had invaded up to the fatty tissue surrounding the Gerota's fascia and to the fatty tissue surrounding the descending colon. However, as there was no invasion into the Gerota's fascia, it was possible to preserve the left kidney. Pathohistological examination revealed increased cellularity in the tumor tissues as well as tissues with atypical nuclei of the tumor cells with some cell division. Due to these findings, it was diagnosed as malignant solitary fibrous tumor. Only surgical treatment was performed and the patient is alive without recurrence 2 years and 4 months after surgery

Deterioration of longitudinal, circumferential, and radial myocardial strains during acute coronary flow reduction: which direction of strain should be analyzed for early detection?

Longitudinal myocardial strain is considered to deteriorate in the early ischemic stage compared to circumferential and radial strains because the subendocardial inner oblique fibers are generally directed along the longitudinal axis. However, it is unclear whether the decrease in longitudinal strain precedes a decrease in circumferential and radial strains during acute coronary flow reduction. The left anterior descending artery was gradually narrowed in 13 open-chest dogs. Whole-wall and subendocardial longitudinal, circumferential, and radial strains were analyzed at baseline and during flow reduction. Peak systolic and end-systolic strains, the postsystolic strain index (PSI), and the early systolic strain index (ESI) were measured in the risk area; the decreasing rate in each parameter and the diagnostic accuracy to detect flow reduction were evaluated. Absolute values of peak systolic and end-systolic strains gradually decreased with flow reduction. The decreasing rate and diagnostic accuracy of longitudinal systolic strain were not significantly different from those in other strains, although the diagnostic accuracy of radial systolic strain tended to be lower. PSI and ESI gradually increased with flow reduction. In these parameters, a lower diagnostic accuracy with respect to radial strain was not demonstrated. During acute coronary flow reduction, the decrease in longitudinal systolic strain did not precede that in circumferential systolic strain; however, the decrease in radial systolic strain may be smaller than that of other systolic strains. In contrast, there appeared to be no differences in the PSI and ESI values among the three strains.This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/S10554-020-01888-

Novel Estimation of Left Ventricular Filling Pressure Using 3-D Speckle-Tracking Echocardiography: Assessment in a Decompensated Systolic Heart Failure Model

E/e′ allows for the non-invasive estimation of left ventricular (LV) filling pressure; however, Doppler malalignment can make the estimation unreliable, especially in dilated systolic failing hearts. The ratio of peak early diastolic filling rate to peak early diastolic global strain rate (FRe/SRe), which is a parameter derived from 3-D speckle-tracking echocardiography to estimate filling pressure, may be better applied in dilated systolic failing hearts because it can be obtained without the Doppler method. We investigated whether FRe/SRe could provide a better estimation of filling pressure than E/e′ in 23 dogs with decompensated systolic heart failure induced by microembolization. FRe/SRe had better correlation coefficients with LV end-diastolic pressure (0.75–0.90) than did E/e′ (0.40). The diagnostic accuracy of FRe/SRe in distinguishing elevated filling pressure was significantly higher than that of E/e′. This study indicates that FRe/SRe may provide a better estimation of LV filling pressure than E/e′ in dilated systolic failing hearts.Takeda S., Asanuma T., Masuda K., et al. Novel Estimation of Left Ventricular Filling Pressure Using 3-D Speckle-Tracking Echocardiography: Assessment in a Decompensated Systolic Heart Failure Model. Ultrasound in Medicine and Biology 47, 1536 (2021); https://doi.org/10.1016/j.ultrasmedbio.2021.02.008

Myocardial layer-specific analysis of ischemic memory using speckle tracking echocardiography

The assessment of post-systolic shortening (PSS) by speckle tracking echocardiography allows myocardial ischemic memory imaging. Because the endocardial layer is more vulnerable to ischemia, the assessment of this layer might be useful for detecting ischemic memory. Serial echocardiographic data were acquired from nine dogs with 2 min of coronary occlusion followed by reperfusion. Regional deformation parameters were measured in the risk and normal areas. Using speckle tracking echocardiography, circumferential strain was analyzed in the endocardial, mid-wall, and epicardial layers; and radial strain was analyzed in the inner half, outer half and entire (transmural) layers. In the risk area, peak systolic and end-systolic strain in the circumferential and radial directions significantly decreased during occlusion, but recovered to the baseline levels immediately after reperfusion in all layers. However, circumferential post-systolic strain index (PSI), a parameter of PSS, significantly increased during occlusion, and the significant increases persisted until 20 min after reperfusion in the endocardial and mid-wall layers. Radial PSI tended to increase after reperfusion in the inner half and entire layers but these increases were not significant compared with baseline. In the normal area, systolic strains and PSI in the radial and circumferential directions hardly changed before and after occlusion/reperfusion in all layers. In layer-specific analysis with speckle tracking echocardiography, circumferential PSS in the endocardial and mid-wall layers may be useful for detecting ischemic memory. © 2014 Springer Science+Business Media.This is a post-peer-review, pre-copyedit version of an article published in International Journal of Cardiovascular Imaging. The final authenticated version is available online at: https://doi.org/10.1007/s10554-014-0388-x

Detection of abnormal myocardial deformation during acute myocardial ischemia using three-dimensional speckle tracking echocardiography

Background: Three-dimensional (3D) speckle tracking echocardiography can simultaneously evaluate circumferential, longitudinal, and radial strain without being affected by through-plane motion. Moreover, the assessment of area change ratio may allow measuring regional myocardial deformation more accurately. We investigated the changes in each deformation parameter during acute coronary flow reduction, and evaluated whether the spatial extent of the abnormal values in each deformation parameter corresponded to that of the perfusion abnormality. Methods: In 10 dogs, myocardial strains of three directions and area change ratio were analyzed at baseline and during three different ischemic conditions. The peak systolic value and the post-systolic index (PSI) were measured in both the ischemic and normal segments. The function abnormality, derived from the deformation parameter, and the perfusion abnormality, derived from Evans blue staining, were evaluated in each segment during complete occlusion and the concordance rate between both abnormalities was calculated. Results: In all deformation parameters, the peak systolic value tended to gradually decrease and the PSI tended to gradually increase with the severity of flow reduction in the ischemic segment. Especially in area change ratio, significant changes were observed in both the peak systolic value and the PSI during occlusion compared to baseline. The concordance rate was the highest in the PSI assessed by area change ratio. Conclusions: Among 3D myocardial deformation parameters, area change ratio demonstrated better detectability of acute coronary flow reduction than conventional strain components. Area change ratio may be a useful parameter for detecting acute ischemia by 3D speckle tracking echocardiography.This is a post-peer-review, pre-copyedit version of an article published in Journal of Echocardiography. The final authenticated version is available online at: http://dx.doi.org/10.1007/s12574-019-00449-6.https://doi.org/10.1007/s12574-019-00449-