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INTRODUCTION: The different structural modifications that have been described in the heart of the high-performance athlete depend on factors such as age, gender, type of sport, and the intensity and time dedicated to training. OBJECTIVES: Evaluation of elite athletes through echocardiography for the description of cardiac structure and function, and the comparison between athletes with cardiorespiratory endurance and the rest of the athletes. METHODS: We performed the echocardiographic examination in 224 elite athletes, 96 women and 128 men aged 15 to 38 years (21.7 ± 5.3 years) and they were divided into 2 groups: "Endurance Group" (cardiorespiratory endurance) and "Non-Endurance Group" which included the rest of the sports. Univariate comparison between the two groups was performed by measuring 14 echocardiographic variables. RESULTS: In men, statistically significant higher values were identified in the endurance group for interventricular septum, left ventricular posterior wall, relative wall thickness (RWT), left ventricular mass index and left atrial dimension. In women, the endurance group had significantly lower heart rate values, and significantly higher left ventricular diastolic dimension with normal RWT. CONCLUSIONS: Most of the echocardiographic variables showed higher sample means in the endurance athletes. In the subgroup of men from the Endurance Group, eccentric hypertrophy prevailed with a greater increase in wall thickness, as well as in the diameter of the left atrium, while in women the variables indicated eccentric hypertrophy at the expense of an increase in left ventricle diameter, without increased wall thickness.
Introducción: Las diferentes modificaciones estructurales que han sido descritas en el corazón del deportista de alto rendimiento dependen de factores como la edad, el género, el tipo de deporte, la intensidad y el tiempo dedicados al entrenamiento. OBJETIVOS: Evaluación de atletas de élite por medio de la ecocardiografía para la descripción de la estructura y la función cardíacas, y la comparación entre deportistas de resistencia cardiorrespiratoria y el resto de los deportistas. Métodos: Realizamos el examen ecocardiográfico en 224 deportistas de elite, 96 mujeres y 128 varones con edades de 15 a 38 años (21.7 ± 5.3 años) y se dividieron en 2 grupos: "Grupo de Resistencia" (resistencia cardiorrespiratoria) y "Grupo de no Resistencia" el cual incluyó al resto de los deportes. Se realizó la comparación univariada de 14 variables ecocardiográficas entre los dos grupos. RESULTADOS: En los hombres se identificaron valores estadísticamente significativos más altos en el grupo de resistencia para septum interventricular, pared posterior, grosor parietal relativo, índice de masa del ventrículo izquierdo y aurícula izquierda. En las mujeres, el grupo de resistencia tuvo valores de frecuencia cardíaca más bajos con diámetro diastólico e índice de masa del ventrículo izquierdo significativamente mayores. CONCLUSIONES: La mayoría de las variables ecocardiográficas mostró valores mayores en los atletas de resistencia. En los hombres del Grupo de Resistencia, predominó la hipertrofia excéntrica con mayor incremento en el grosor parietal y del diámetro de la aurícula izquierda, mientras que en las mujeres las variables indicaron hipertrofia excéntrica a expensas de un aumento del diámetro del ventrículo izquierdo, sin incremento del grosor parietal.
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Adaptação Fisiológica , Atletas , Ecocardiografia , Resistência Física , Humanos , Masculino , Feminino , Adulto , Resistência Física/fisiologia , Adulto Jovem , Adolescente , Adaptação Fisiológica/fisiologia , Frequência Cardíaca/fisiologia , Fatores Sexuais , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/anatomia & histologiaRESUMO
Epilepsy is an increasing global neurological health issue. Recently, epidemiological and mechanistic studies have raised concern about cardiac involvement in individuals with epilepsy. This has resulted in the "epileptic heart" concept. Epidemiological data linking epilepsy to cardiovascular disease indicate an increased risk for ventricular and atrial arrhythmias, myocardial infarction, heart failure, and sudden death among individuals with epilepsy. Pathways of this interaction comprise increased prevalence of traditional cardiac risk factors, genetic abnormalities, altered brain circuitry with autonomic imbalance, and antiseizure medications with enzyme-inducing and ionic channel-blocking proprieties. Pathophysiological findings in the atria and ventricles of patients with epilepsy are discussed. Echocardiographic findings and future applications of this tool are reviewed. A risk stratification model and future studies on cardiac risk assessment in individuals with epilepsy are proposed.
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Introduction: The role of myocardial strain in risk prediction for acute myocarditis (AMC) patients, measured by cardiac magnetic resonance (CMR), deserves further investigation. Our objective was to evaluate the association between myocardial strain measured by CMR and clinical events in AMC patients. Material and methods: This was a prospective single-center study of patients with AMC. We included 100 patients with AMC with CMR confirmation. The primary outcome was the composite of all-cause mortality, heart failure and AMC recurrence in 24 months. A subgroup analysis was performed on a sample of 36 patients who underwent a second CMR between 6 and 18 months. The association between strain measures and clinical events or an increase in left ventricular ejection fraction (LVEF) was explored using Cox regression analysis. Global peak radial, circumferential and longitudinal strain in the left and right ventricles was assessed. ROC curve analysis was performed to identify cutoff points for clinical event prediction. Results: The mean follow-up was 18.7 ± 2.3 months, and the composite primary outcome occurred in 26 patients. The median LVEF at CMR at baseline was 57.5% (14.6%). LV radial strain (HR = 0.918, 95% CI: 0.858-0.982, p = 0.012), LV circumferential strain (HR = 1.177, 95% CI: 1.046-1.325, p = 0.007) and LV longitudinal strain (HR = 1.173, 95% CI: 1.031-1.334, p = 0.015) were independently associated with clinical event occurrence. The areas under the ROC curve for clinical event prediction were 0.80, 0.79 and 0.80 for LV radial, circumferential, and longitudinal strain, respectively. LV longitudinal strain was independently correlated with prognosis (HR = 1.282, CI 95%: 1.022-1.524, p = 0.007), even when analyzed together with ejection fraction and delayed enhancement. LV and right ventricle (RV) strain were not associated with an increase in LVEF. Finally, when the initial CMR findings were compared with the follow-up CMR findings, improvements in the measures of LV and RV myocardial strain were observed. Conclusion: Measurement of myocardial strain by CMR can provide prognostic information on AMC patients. LV radial, circumferential and longitudinal strain were associated with long-term clinical events in these patients.
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Resumen Introducción: La aurícula izquierda cumple varias funciones durante el ciclo cardíaco (reservorio, conducción y contracción), que podrían verse afectadas por la remodelación fisiológica al igual que por el estrés inducido por el ejercicio intenso (carreras de ultra-trail de montaña). Objetivo: Valorar si las adaptaciones fisiológicas de la aurícula izquierda al deporte (aumento del volumen auricular), así como el estrés inducido por las competiciones de ultramaratón, influyen en la función auricular izquierda estimada por strain auricular realizado mediante speckle tracking. Método: Fueron evaluados 28 participantes antes y después del ejercicio (en el transcurso de 1 hora posterior al esfuerzo de carreras de ultra-trail) utilizando ecocardiografía Doppler y nuevas técnicas ecocardiográficas (posprocesamiento). Se excluyeron cinco deportistas: dos por regular ventana ecocardiográfica que no permitía visualizar correctamente el borde endomiocárdico y tres por no finalizar la carrera. Se realizaron estadística descriptiva convencional, análisis comparativo para datos pareados mediante test t de Student y correlación de Pearson para valorar factores que influyeran en las alteraciones detectadas. Resultados La mediana de edad de los competidores fue de 38 ± 9 años, con predominancia del sexo masculino (n = 17, 65%). En el ecocardiograma basal se encontró una media de volumen auricular izquierdo de 33 ± 7 ml/m2 (min. 21 ml/m2, max. 47 ml/m2), con strain auricular izquierdo basal promedio del 31%. En la evaluación tras el esfuerzo se observó una disminución no significativa del volumen auricular izquierdo, que mantuvo el strain auricular e incluso aumentó su deformación, como en el caso de las mujeres evaluadas. Conclusiones: A diferencia de lo observado en otros parámetros de función ventricular tras un esfuerzo, el strain auricular no se ve afectado por la fatiga cardíaca.
Abstract Introduction: The left atrium fulfills several functions during the cardiac cycle (reservoir, conduction and contraction) that could be affected by physiological remodeling as well as by stress induced by intense exercise (ultra-mountain trail races). Objective: To assess whether the physiological adaptations of the left atrium to sport (increase in atrial volume) as well as the stress induced by ultramarathon competitions influence left atrial function estimated by atrial strain performed by speckle tracking. Method: 28 participants were evaluated pre and post exercise, using Doppler echocardiography and new echocardiographic techniques. Conventional descriptive statistics, comparative analysis were performed for paired data using the t test and Pearson correlation to assess factors that influence the detected alterations. Results: The median age of the competitors was 38 ± 9 years with a predominance of males (n = 17, 65%). In the basal echocardiogram, we found an average left atrial volume of 33 ± 7 ml/m2 (min. 21 ml/m2, max. 47 ml/m2), with an average baseline left atrial strain of 31%. In the post-effort evaluation, a non-significant decrease in left atrial volume was observed, maintaining atrial strain and even increasing its deformation, as in the case of the women evaluated. Conclusions: Unlike what was observed in other parameters of ventricular function after effort, atrial strain is not affected by cardiac fatigue.
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Cardiotoxicity (CDT) is the main adverse effect related to trastuzumab (TTZ). The role of the right ventricle (RV) in this context is not clear. We aimed to evaluate the longitudinal changes in RV function during TTZ therapy and to determine RV function changes associated with subclinical CDT. Breast cancer patients underwent echocardiograms at the beginning of TTZ treatment (Exam 1) and every 3 months during the first year (Exams 2, 3, and 4). Subclinical CDT was defined as ≥ 12% relative reduction of left ventricle global longitudinal strain (LV GLS). Twenty-five women (52.1 ± 13.1 y-o) were included. We found a decrease in LV ejection fraction between the first and fourth exams (Ex1: 64.1% ± 4.9 vs Ex4: 60.9% ± 4.9, p = 0.003) and the LV GLS gradually decreased during follow-up (Ex1: - 20.6% ± 2.0; Ex2: - 19.4% ± 2.1; Ex3: - 19.2% ± 1.8; Ex4: - 19.0% ± 2.1, all p < 0.05). RV GLS changed from baseline to 3 month and to 6 month (Ex1: - 23.9% ± 1.6; Ex2: - 22.5% ± 2.1; Ex3: - 22.5% ± 2.3, all p < 0.05), and the RV Fractional Area Change was lower in the third exam (Ex1: 44.3% ± 6.6 vs Ex3: 39.9% ± 6.0, p = 0.004). We found subclinical CDT in 13 patients (52%); worsening in RV parameters did not differ between those with and without subclinical CDT. In this sample, the RV function decreased during TTZ therapy and the decrease was not associated to the observed LV cardiotoxicity.
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RESUMEN Introducción: El estudio ecocardiográfico mediante speckle-tracking ha emergido como un novedoso método para la evaluación cuantitativa de la función miocárdica y se ha correlacionado con la presencia de enfermedad coronaria. Objetivo: Determinar el valor pronóstico de la deformación miocárdica (strain) por speckle-tracking bidimensional en la evolución de pacientes con sospecha de cardiopatía isquémica. Método: Estudio longitudinal prospectivo analítico con 51 pacientes a los que se realizó ecocardiograma con evaluación de la deformación (strain) longitudinal global por speckle-tracking bidimensional y coronariografía en el CIMEQ entre 2016 y 2018. Se siguieron los eventos cardíacos graves (infarto de miocardio, muerte cardíaca y por otras causas, enfermedad cerebrovascular y necesidad de nueva revascularización). Resultados: El 70,6% de los enfermos resultaron ser del sexo masculino, el 81,4% mayores de 50 años y 81,4%, fumadores. El 65,0% tenía enfermedad coronaria significativa y 55,0% de los casos fueron revascularizados. Se registraron 4 muertes (7,8%) y un infarto no fatal (2,0%). Los pacientes con deformación longitudinal global ≤ -15% (en valores absolutos) tuvieron mayor frecuencia de eventos cardíacos graves (p=0,02). Conclusiones: La deformación longitudinal global medida por speckle-tracking bidimensional no pudo predecir la presencia de enfermedad coronaria, pero sí los eventos cardiovasculares graves en los enfermos con enfermedad coronaria significativa.
ABSTRACT Introduction: Two-dimensional speckle-tracking echocardiography has emerged as a novel method for the quantitative evaluation of myocardial function and it has been correlated with the presence of coronary artery disease. Objective: To determine the prognostic value of myocardial strain by two-dimensional speckle-tracking echocardiography in the evolution of patients with suspected ischemic heart disease. Method: An analytical prospective longitudinal study was carried out with 51 patients, who underwent global longitudinal strain assessment by two-dimensional speckle-tracking echocardiography, and coronary angiography at CIMEQ between 2016 and 2018. Major cardiac adverse events (myocardial infarction, cardiac and non-cardiac cause of death, cerebrovascular disease, and need for new revascularization) were followed. Results: The 70.6% of patients were male, the 81.4% were older than 50 years old, and the 81.4% were smokers. The 65.0% of patients had significant coronary artery disease and the 55.0% underwent myocardial revascularization. There were four deaths (7.8%) and one non-fatal myocardial infarction (2.0%). Patients with global longitudinal strain ≤ -15% (in absolute or modular values) had a higher frequency of major adverse cardiovascular events (p=0.02). Conclusions: Global longitudinal strain by two-dimensional speckle-tracking echocardiography could not predict the presence of coronary artery disease, but it did predict major adverse cardiovascular events in patients with significant coronary artery disease.
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Isquemia Miocárdica , DisgeusiaRESUMO
BACKGROUND: Controversy exists on the actual occurrence of exercise-induced cardiac fatigue (EICF) with ultraendurance exercise, as well as on whether factors such as age or training status might predispose to this condition. The present study aimed to assess the occurrence of EICF among recreational ultramarathon runners, as well as to determine potential predictive factors. METHODS: Nineteen male recreational runners (42 ± 12yrs) participated in a 55-km trial race at moderate altitude (1,800-2,500 m). Participants were evaluated before and after the race using Doppler echocardiography and myocardial deformation analysis. EICF was determined as a reduction >5% of either left ventricular global longitudinal strain (LVGLS) or right ventricular free wall strain (RVFWS). Demographical (age, body mass index), training (training experience, volume and intensity), competition (finishing time, relative intensity) and biochemical variables (blood lactate, creatine kinase [CK] and CK-MB) were assessed as predictors of EICF. RESULTS: A significant reduction in LVGLS (20.1 ± 2.1% at baseline vs. 18.8 ± 2.4% at post-race, p = 0.026), but not in RVFWS (27.4 ± 7.0 vs. 24.6 ± 5.3%, p = 0.187), was observed after the race. EICF was present in 47 and 71% of the participants attending to the decrease in LVGLS and RVFWS, respectively. No associations were found between any of the analyzed variables and EICF except for age, which was associated with the magnitude of decrement of RVFWS (r = 0.58, p = 0.030). CONCLUSIONS: Ultramarathon running at moderate altitude seems to induce EICF in a considerable proportion of recreational athletes.
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BACKGROUND AND AIM: Ventricular function evaluation in coarctation of the aorta (CoA) has become more sophisticated and precise with speckle tracking, revealing subclinical changes. However, CoA stenting treatment effects in on myocardial strain are still controversial. This study aimed to estimate the extent to which changes in left ventricular global longitudinal strain (LV GLS) occur in patients with CoA who undergo stenting. METHODS: The study included 21 patients with CoA (median age: 15 years [8-39]) and 21 healthy individuals matched by age and gender. Clinical and echocardiographic evaluations were performed 1 day before, 6 months, and 1 year after stenting. Correlations between LV GLS and arm-leg gradient, isthmus gradient on echocardiogram, age at intervention, left ventricular mass, and ejection fraction were tested. RESULTS: Before treatment, patients with CoA had lower LV GLS than the control group (-18.4% ± 1.96 vs -21.5% ± 1.37; P < .01), showing significant increase to -19.4% ± 2.1 at 6 months and -20.7% ± 2.19 at 1 year, P < .001. Only 28.5% (6 patients) had preserved GLS before treatment, improving to 80.9% (17 patients) in 1 year. The only variable correlated with low LV GLS values before treatment was age at intervention (Spearman's index = -0.571; P = .007). CONCLUSION: Percutaneous therapy showed significant LV GLS improvement 12 months after aortic stenting. Older patients have lower GLS, suggesting that early intervention may have positive effects on preservation of LV systolic function.
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Coartação Aórtica , Disfunção Ventricular Esquerda , Adolescente , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Volume Sistólico , Sístole , Função Ventricular EsquerdaRESUMO
BACKGROUND: Chagas disease is one of the most common diseases in Latin-America, and cardiac involvement is a significant cause of death. Assessment of myocardial strain may detect early myocardial damage. OBJECTIVES: To determine differences in longitudinal strain using speckle tracking to assess regional and global left ventricular function in patients with the indeterminate form of Chagas disease, in comparison with a control group. METHODS: This is a retrospective matched case-control study, conducted in a single center. We evaluated 45 adult patients with Chagas disease, diagnosed with 2 serological methods, without evidence of cardiac involvement, who were compared with 45 healthy control subjects, who were sex- and age-matched. All patients underwent Doppler echocardiography and longitudinal strain with speckle tracking. RESULTS: Median age was 59 years, and 60% were female. Echocardiographic parameters were similar in patients with Chagas and control subjects. In patients with Chagas, global strain differed significantly from that of control subjects (-17 vs -20.3, P < .001). Segmental strain showed 7 abnormal segments in patients with Chagas (P < .05). CONCLUSIONS: In patients with the indeterminate form of Chagas disease, global and segmental longitudinal peak systolic strain is reduced compared with healthy subjects, thus suggesting that it could be a sensitive technique to detect early myocardial damage. These findings could provide useful information regarding the pathophysiology of cardiac involvement and understand whether they might have prognostic usefulness or help develop strategies to modify the course and prognosis of patients with Chagas disease. A longitudinal prospective study would be necessary to validate our findings.
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Cardiomiopatia Chagásica , Doença de Chagas , Disfunção Ventricular Esquerda , Adulto , Estudos de Casos e Controles , Cardiomiopatia Chagásica/diagnóstico por imagem , Doença de Chagas/complicações , Doença de Chagas/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos RetrospectivosRESUMO
BACKGROUND: Fabry disease (FD) is a rare X-linked storage disorder caused by deficiency of the lysosomal enzyme α-galactosidase A, and it typically causes multiorgan dysfunction. The main cause of death is heart disease resulting from left ventricular (LV) diastolic dysfunction, LV systolic dysfunction, severe LV hypertrophy (LVH), and sudden death. In several cardiac disorders, LV systolic dysfunction and ventricular arrhythmias are associated with mechanical dispersion (MD). MD has until now not been studied in patients with FD. OBJECTIVE: To investigate the prevalence of MD in patients with FD. METHODS: Complete echocardiographic data and speckle tracking echocardiographic data were collected. MD is an index of inter-segmental discoordination of contraction and is defined as the standard deviation (SD) of the time-to-peak longitudinal negative strain in 17 LV segments with a value >49 milliseconds. Patients with FD were divided into the following 2 groups: group I (patients with FD but no LVH, n = 64) and group II (patients with FD and LVH, n = 25). These groups were compared with a group of healthy subjects (group III, n = 50). Parametric variables were expressed as mean ± SD, and nonparametric variables were expressed as median and inter-quartile range. A P value <.05 was considered significant. RESULTS: A total of 113 patients with FD were included in this study. Of these, 24 (21%) were excluded because of poor imaging quality or presence of comorbidities, and the final study population consisted of 89 patients (mean age of 33.5 ± 14.5 years, 64% female). Group II patients were older than group I patients (46 ± 13 years vs 27 ± 11 years, P < .0001). There was no difference in LV ejection fraction between the 3 groups. There was also no difference in MD between groups I and III (32.4 ms [26-39] vs 32 ms [26-39]). In group II, the MD in 19 patients (76%) was 56 ms (39-80). CONCLUSIONS: To the best of our knowledge, this is the first study to assess the prevalence of MD in patients with FD. MD was observed in 76% of patients with FD and LVH. The use of MD in strain echocardiography may be beneficial in the assessment of patients with FD who develop heart failure.
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Doença de Fabry , Disfunção Ventricular Esquerda , Adulto , Ecocardiografia , Doença de Fabry/complicações , Doença de Fabry/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to examine echocardiographic parameters of left ventricle (LV) mechanics in obese patients before and after sleeve gastrectomy (SG). DESIGN AND METHODS: Twenty-five obese individuals submitted to laparoscopic SG were enrolled in this study. Echocardiography was performed before and after the procedure, and left ventricle mechanics were evaluated by speckle tracking imaging. RESULTS: Before surgery, altered global longitudinal strain (GLS) values were present in 56% of the patients. In a mean follow-up of 3.6 ± 0.5 months after surgery, there was an increase in GLS values (from 17.4 ± 3.2 to 19.3 ± 2.7%, P = 0.01). There was an inverse correlation between the absolute values of GLS in the preoperative period and the variation in the GLS at follow-up (r = 0.577, P = 0.002). Measurements of global circumferential strain (GCS), global radial strain (GRS), and LV twist were normal preoperatively and did not change after surgery. CONCLUSIONS: Altered global longitudinal strain values were common in young obese patients. Sleeve gastrectomy increased global longitudinal strain even in the early postoperative phase without promoting changes in global radial strain, global circumferential strain, and left ventricle twist measurements.
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Gastrectomia/efeitos adversos , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/cirurgia , Função Ventricular Esquerda/fisiologia , Adulto , Estudos Controlados Antes e Depois , Ecocardiografia/métodos , Feminino , Gastrectomia/métodos , Gastrectomia/reabilitação , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Contração Miocárdica/fisiologia , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
RESUMEN Introducción: El ejercicio físico intenso y prolongado puede producir adaptaciones fisiológicas y cambios agudos en el sistema cardiovascular, que han sido motivo de estudio en múltiples oportunidades. En este contexto, algunos autores sostienen que estas alteraciones agudas y transitorias serían adjudicables a la fatiga cardíaca. Objetivos: Examinar los cambios ecocardiográficos observados en los deportistas de ultratrail o ultramaratón (carreras de montaña con recorridos superiores a 42 km) en pre- y posesfuerzo mediante técnicas de deformación miocárdica por speckle tracking, teniendo en cuenta algunas características de la población (sexo, edad, carga de entrenamiento semanal). Material y métodos: Se reclutaron 28 participantes para ser evaluados antes y después del ejercicio (dentro de la primera hora posterior a aquel) utilizando ecocardiografía Doppler y nuevas técnicas ecocardiográficas (posprocesamiento). Se excluyeron 5 deportistas, 2 por presentar Regular ventana ecocardiográfica ecocardiográfica que no permitía visualizar correctamente el borde endomiocárdico y 3 por no haber finalizado la carrera. Se realizó una estadística descriptiva convencional y el análisis comparativo para datos apareados (pre- y posesfuerzo) mediante el test t de Student. Resultados: La mediana de edad de los deportistas fue de 38 ± 9 años, con predominancia de sexo masculino (n=17; 65%). En el ecocardiograma basal, encontramos función sistólica biventricular conservada, media de strain longitudinal global (SLG) de -19 ± 2% y media de strain de la pared libre del ventrículo derecho (SPLVd) de -25 ± 3%. En la evaluación posesfuerzo, se observaron alteraciones significativas al compararlas con los datos del ecocardiograma basal, como caída de la fracción de eyección, disminución del strain longitudinal global (SLG) y del SPLVd, y aumento del volumen del Vd. La torsión ventricular no se vio afectada. Conclusión: Después del ejercicio intenso se observa una disminución de los parámetros de deformación miocárdica medidos por speckle tracking, esto se interpreta como fatiga cardíaca inducida por el ejercicio.
ABSTRACT Introduction: Intense and prolonged physical exercise can produce physiological adaptations and acute changes in the cardiovascular system that have been the subject of study multiple times. In this context some authors speak that these acute and transient alterations would be attributable to cardiac fatigue. Objective: The objective of this work is to examine the echocardiographic changes observed in ultra trail athletes (mountain races over 42 kilometers) pre and post effort, according to population characteristics (sex, age, weekly training load), using techniques of myocardial deformation by speckle traking. Material and methods: Twenty-eight participants were evaluated pre and post exercise (within one hour after exertion) using Doppler echocardiography and new echocardiographic techniques (post processing). Conventional descriptive statistics and comparative analysis were performed for paired data using a T test. Results: The median age of the patients was 38 ± 9 years with male predominance (N17 / 65%). In the baseline echocardiogram, we found preserved bi-ventricular systolic function, mean global longitudinal strain (GLS) of -19% ± 2, mean right ventricular free wall strain (FWSVd) -25% ± 3. In the Post-stress evaluation significant alterations were observed when compared with the baseline echocardiogram data, such as drop in ejection fraction, decrease in GLS, FWSVd and increase in volume of you. Ventricular torsion was not affected. Conclusion: Post intense exercise is observed a decrease in myocardial deformation parameters measured by Speckle tracking, this is interpreted as cardiac fatigue induced by the exercise.
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BACKGROUND: A weak correlation has been reported between left ventricular filling pressures and the traditional echocardiographic tools for the evaluation of diastolic function in patients with coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF). On the other hand, studies that compared invasive measurements with speckle tracking echocardiography have shown promising results, but they were not exclusively targeted on this specific population. METHODS AND RESULTS: Immediately before the left heart catheterization, a comprehensive two-dimensional Doppler echocardiography and speckle tracking analysis was prospectively performed in outpatients referred for coronary angiography. Left ventricular end-diastolic pressure (LVEDP) was measured before any contrast exposure. Eighty-one patients with coronary artery disease were studied, and the group with high LVEDP (n = 40) showed increased left atrial volume index (22 ± 6 mL/m2 vs 26 ± 8.26 mL/m2 , P = 0.04), E-wave velocity (65 ± 15 cm/s vs 78 ± 20 cm/s, P = 0.02), E/e` (average) ratio (8.14 ± 2.0 vs 11.54 ± 2.7, P = 0.03), and E/global circumferential strain rate E peak ratio (E/GCSRE ) (39 cm vs 46 cm, P < 0.01). There was a positive correlation between LVEDP and E/e` (ρ = 0.56; P = 0.03), and between LVEDP and E/GCSRE ratio (ρ = 0.43; P < 0.01). The area under the receiver operating characteristics (ROC) curve was 0.83 and 0.73, respectively (P < 0.05). E/e` and E/GCSRE were both independent predictors of elevated LVEDP (P < 0.05), with a higher C-statistic for the model including E/e` (0.89 vs 0.85). CONCLUSION: The E/e` ratio was able to identify elevated LVEDP in CAD patients with preserved LVEF with more accuracy than the E/GCSRE ratio.
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Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia Doppler/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Cateterismo Cardíaco , Angiografia Coronária , Diástole , Feminino , Hemodinâmica , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Volume SistólicoRESUMO
Relata-se um caso de uma paciente de 66 anos, com diagnóstico de hipertensão arterial sistêmica há seis anos, obesa e tabagista, que compareceu à consulta para avaliação cardiológica pré-operatória de cirurgia ginecológica. Ao exame clínico, apresentava-se com pressão arterial de 132 x 80mmHg, pulsos radiais e femorais simétricos, auscultas cardíaca e respiratória normais. O eletrocardiograma mostrou ritmo sinusal, sem alterações, enquanto o ecocardiograma transtorácico revelou hipertrofia concêntrica do ventrículo esquerdo, câmaras cardíacas com dimensões normais e fração de ejeção do ventrículo esquerdo preservada. A avaliação do strain longitudinal global demonstrou diminuição da deformação miocárdica sistólica. Neste relato, ilustramos um caso clínico de hipertrofia ventricular esquerda associada à hipertensão arterial, com fração de ejeção do ventrículo esquerdo preservada e disfunção sistólica subclínica diagnosticada pelo strain miocárdico.
We report a case of a 66-year-old obese and smoker woman, with a 6-year diagnosis of systemic hypertension, who searched medical assistance for pre-operative cardiology evaluation. The clinical examination revealed blood pressure of 132x80mmHg, symmetrical radial and femoral pulses, and normal cardiac and lung auscultation. The electrocardiogram showed sinus rhythm with no alterations, while an echocardiogram showed concentric left ventricular hypertrophy, normal cardiac chambers dimensions and normal left ventricular ejection fraction. Left ventricular global longitudinal strain evaluation revealed reductions in systolic myocardial deformation. In this case, we discuss the presence of left ventricular hypertrophy secondary to hypertension, with preserved left ventricular ejection fraction and subclinical systolic dysfunction detected with myocardial strain.
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INTRODUCTION: Early detection of left ventricular systolic dysfunction (LVSD) is important for therapeutic strategies for Duchenne muscular dystrophy (DMD) patients. We analyzed myocardial strain using echocardiography for early detection of LVSD and determined the predictors of early LVSD. METHODS: This investigation was a cross-sectional study of 40 DMD patients with normal left ventricular ejection fraction. Global longitudinal strain (GLS) was used to analyze subtle disturbances in longitudinal contraction of the myocardium. Patients were determined to have early LVSD (GLS > -18) or normal left ventricular systolic function (GLS ≤ -18). RESULTS: Patients who had early LVSD were older and had a higher frequency of corticosteroid therapy and of mutations in exons 45, 46, 47, 48, 49, 50, and 52. DISCUSSION: Myocardial strain measurements are useful for the early diagnosis of LVSD in DMD patients. Older age, use of corticosteroids, and mutations within the "hot-spot" region of the DMD gene are associated with early LVSD. Muscle Nerve, 2018.
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BACKGROUND: Strain and strain rate are sensitive markers of left ventricular (LV) myocardial function. The aim of this study was to assess reference ranges and regional patterns of LV strain and strain rate using two-dimensional speckle-tracking echocardiography in a large population of black and white subjects. METHODS: This study involved a retrospective review of prospectively collected images in 557 participants in the Coronary Artery Risk Development in Young Adults study who remained healthy at the year 25 examination. LV deformation parameters were measured in apical four-chamber, apical two-chamber, and parasternal short-axis views in 509, 391, and 521 subjects, respectively. RESULTS: Patients' mean age was 49.6 ± 3.6 years, 61.6% were women, and 69.5% were white. White women showed the highest LV systolic and diastolic deformation values, reflected by a more negative reference range for apical four-chamber longitudinal strain (-16.4%; 95% prediction interval [PI], -20.8% to -12.0%) and a higher positive reference range for early diastolic strain rate (0.93 1/sec; 95% PI, 0.41 to 1.46 1/sec), respectively. The lowest LV systolic and diastolic deformation values were found in black men, with apical four-chamber longitudinal strain (14.7%; 95% PI, -19.1% to -10.3%) and early diastolic strain rate (0.79 1/sec; 95% PI, 0.42 to 1.16 1/sec). Absolute strain increased from the epicardium toward the endocardium. A base-to-apex gradient of longitudinal strain toward the apex was exhibited in inferior and inferoseptal regions and, in contrast, in the opposite direction in anterior and anterolateral walls. Sex had the strongest influence on LV deformation variability. CONCLUSIONS: Strain and strain rate reference values were sex and race related. White women showed the highest reference ranges for LV deformation, while the lowest values were found in black men. Significant layer- and level-specific patterns in regional LV deformation were identified.