Kappa measurements of intra- and inter-observer agreement with regard to diastolic dysfunction.

<p>Legend: 95% CI: 95% confidence interval</p><p>Kappa measurements of intra- and inter-observer agreement with regard to diastolic dysfunction.</p

Bland-Altman plots of intra-observer agreement for left ventricular ejection fraction, LV mass, LA Volume, E-wave, E-wave deceleration time, A-wave velocities, A-wave and pulmonary vein reversal A duration, as well as <i>s</i>eptal and lateral Ep Velocity.

<p>Bland-Altman plots of intra-observer agreement for left ventricular ejection fraction, LV mass, LA Volume, E-wave, E-wave deceleration time, A-wave velocities, A-wave and pulmonary vein reversal A duration, as well as <i>s</i>eptal and lateral Ep Velocity.</p

Speckle Tracking Echocardiography (Illustrative Figure).

<p>Patient with first inferior STEMI in acute phase STE with peak systolic strain measurements by GE Vivid EchoPAC software: (A) apical 4 chamber view with longitudinal strain calculation, (B) parasternal short axis view with circumferential (CS), radial strain (RS), and (C) LV twist calculation based on rotation values. The left panels show the direction (arrows) in which the various strain parameters are being measured. The middle panels demonstrate the region of interest and segmental strain values (except for circumferential strain) while the right panels illustrate the regional strain curves.</p

Forest Plot.

<p>Pooled Odds Ratios (OR) for the association of global left ventricular peak systolic longitudinal (GLS) strain evaluated in acute phase of STEMI and left ventricular remodeling at follow-up. (A) Univariable OR with 2D GLS as explanatory variable and adverse remodeling as outcome were available in 4 studies (pooled OR = 1.27, 1.17 to 1.38, p<0.001) (B). In addition, multivariable OR were available in 4 studies (pooled OR = 1.38, 1.13–1.70, p = 0.002). (C) Univariable OR with 2D GLS as explanatory variable and reverse remodeling as outcome were available in 3 studies (pooled OR = 0.75, 0.54–1.06, p = 0.09).</p

Table1_Myocardial deformation in malignant mitral valve prolapse: A shifting paradigm to dynamic mitral valve–ventricular interactions.docx

ObjectivesThis study sought to assess the value of myocardial deformation using strain echocardiography in patients with mitral valve prolapse (MVP) and severe ventricular arrhythmia and to evaluate its impact on rhythmic risk stratification.BackgroundMVP is a common valvular affection with an overly benign course. Unpredictably, selected patients will present severe ventricular arrhythmia.MethodsPatients with MVP as the only cause of aborted SCD (MVP-aSCD: ventricular fibrillation and monomorphic and polymorphic ventricular tachycardia) with no other obvious reversible cause were identified. Nonconsecutive patients referred for the echocardiographic evaluation of MVP were enrolled as a control cohort and dichotomized according to the presence or absence of premature ventricular contractions (MVP-PVC or MVP-No PVC, respectively). All patients had a comprehensive strain assessment of mechanical dispersion (MD), postsystolic shortening, and postsystolic index (PSI).ResultsA total of 260 patients were enrolled (20 MVP-aSCD, 54 MVP-PVC, and 186 MVP-No PVC). Deformation pattern discrepancies were observed with a higher PSI value in MVP-aSCD than that in MVP-PVC (4.6 ± 2.0 vs. 2.9 ± 3.7, p = 0.014) and a higher MD value than that in MVP-No PVC (46.0 ± 13.0 vs. 36.4 ± 10.8, p = 0.002). In addition, PSI and MD increased the prediction of severe ventricular arrhythmia on top of classical risk factors in MVP. Net reclassification improvement was 61% (p = 0.008) for PSI and 71% (p = 0.001) for MD.ConclusionsIn MVP, myocardial deformation analysis with strain echocardiography identified specific contraction patterns with postsystolic shortening leading to increased values of PSI and MD, translating the importance of mitral valve–myocardial interactions in the arrhythmogenesis of severe ventricular arrhythmia. Strain echocardiography may provide important implications for rhythmic risk stratification in MVP.</p

Image1_Myocardial deformation in malignant mitral valve prolapse: A shifting paradigm to dynamic mitral valve–ventricular interactions.tiff

ObjectivesThis study sought to assess the value of myocardial deformation using strain echocardiography in patients with mitral valve prolapse (MVP) and severe ventricular arrhythmia and to evaluate its impact on rhythmic risk stratification.BackgroundMVP is a common valvular affection with an overly benign course. Unpredictably, selected patients will present severe ventricular arrhythmia.MethodsPatients with MVP as the only cause of aborted SCD (MVP-aSCD: ventricular fibrillation and monomorphic and polymorphic ventricular tachycardia) with no other obvious reversible cause were identified. Nonconsecutive patients referred for the echocardiographic evaluation of MVP were enrolled as a control cohort and dichotomized according to the presence or absence of premature ventricular contractions (MVP-PVC or MVP-No PVC, respectively). All patients had a comprehensive strain assessment of mechanical dispersion (MD), postsystolic shortening, and postsystolic index (PSI).ResultsA total of 260 patients were enrolled (20 MVP-aSCD, 54 MVP-PVC, and 186 MVP-No PVC). Deformation pattern discrepancies were observed with a higher PSI value in MVP-aSCD than that in MVP-PVC (4.6 ± 2.0 vs. 2.9 ± 3.7, p = 0.014) and a higher MD value than that in MVP-No PVC (46.0 ± 13.0 vs. 36.4 ± 10.8, p = 0.002). In addition, PSI and MD increased the prediction of severe ventricular arrhythmia on top of classical risk factors in MVP. Net reclassification improvement was 61% (p = 0.008) for PSI and 71% (p = 0.001) for MD.ConclusionsIn MVP, myocardial deformation analysis with strain echocardiography identified specific contraction patterns with postsystolic shortening leading to increased values of PSI and MD, translating the importance of mitral valve–myocardial interactions in the arrhythmogenesis of severe ventricular arrhythmia. Strain echocardiography may provide important implications for rhythmic risk stratification in MVP.</p