This report describes a 68-year-old female who, immediately after the primary percutaneous coronary intervention of the left anterior descending artery for acute anterior myocardial infarction, developed an apical aneurysm and a “neo-chamber” within the left ventricular cavity separated from the main cavity by a linear thick hyperechoic free-floating fenestrated membrane. This was an excoriated but perforated subendocardial spiral myocardial layer separated from the subepicardial layer due to ischemia and infarction. Multiple orifices on the inner surface were observed, possibly due to patchy necrosis. In addition, there was a large remote intramyocardial hematoma in the inferolateral wall of indeterminate pathogenesis.
{"title":"Communicating Neo-chamber in the Left Ventricle and a Remote Intramyocardial Hematoma Following Acute Myocardial Infarction","authors":"Madhu Shukla, JagdishChander Mohan","doi":"10.4103/jiae.jiae_4_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_4_23","url":null,"abstract":"This report describes a 68-year-old female who, immediately after the primary percutaneous coronary intervention of the left anterior descending artery for acute anterior myocardial infarction, developed an apical aneurysm and a “neo-chamber” within the left ventricular cavity separated from the main cavity by a linear thick hyperechoic free-floating fenestrated membrane. This was an excoriated but perforated subendocardial spiral myocardial layer separated from the subepicardial layer due to ischemia and infarction. Multiple orifices on the inner surface were observed, possibly due to patchy necrosis. In addition, there was a large remote intramyocardial hematoma in the inferolateral wall of indeterminate pathogenesis.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"255 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115205609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shanmugasundaram Somasundaram, U. Ilayaraja, K. Rajeswari
Although aortic stenosis (AS) is a disease of poor outcomes, timely aortic valve replacement [AVR -surgical AVR (SAVR) or transcatheter AVR (TAVR)] improves the outlook with acceptable procedural risk. Survivors of AVR enjoy life expectancy that is like that of age matched controls. AVR receives a class I indication from the American and European Guidelines, in the presence of symptoms attributable to AS or when left ventricular (LV) systolic dysfunction manifests. However, there are fallacies in timing the intervention based on symptoms or LV ejection fraction. If surgery is delayed till symptoms manifest or LV dysfunction occurs, surgical risks are increased, long term outcomes are poor and in half of the patients, LV function never normalizes. Because of these reasons, pre-emptive intervention based on non-conventional parameters is expected to save more lives and prevent LV dysfunction. Data are emerging towards this approach and researchers have started focussing their attention on biomarkers like brain natriuretic peptide, multimodality imaging like estimation of extracellular volume by cardiac magnetic resonance for choosing the appropriate time for intervention in asymptomatic individuals. A relatively inexpensive way of identifying such high-risk individuals is speckle tracking imaging and in the last decade sufficient data have accumulated in favour of this modality to identify patients who may be benefited by early intervention. Speckle tracking echocardiography is a well validated technique which enables highly reproducible, angle-independent assessment of regional and global LV systolic function in longitudinal, circumferential and radial planes. Longitudinal strain, which is predominantly governed by the subendocardial layer, is most sensitive in the presence of myocardial disease and well-studied. Moreover, when discrepancies occur between gradient and valve area leading to uncertainties about the severity of AS, strain imaging would be of value in predicting outcomes particularly in those with low flow low gradient AS with normal LV ejection fraction.
{"title":"Strain Imaging in Aortic Stenosis","authors":"Shanmugasundaram Somasundaram, U. Ilayaraja, K. Rajeswari","doi":"10.4103/jiae.jiae_18_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_18_23","url":null,"abstract":"Although aortic stenosis (AS) is a disease of poor outcomes, timely aortic valve replacement [AVR -surgical AVR (SAVR) or transcatheter AVR (TAVR)] improves the outlook with acceptable procedural risk. Survivors of AVR enjoy life expectancy that is like that of age matched controls. AVR receives a class I indication from the American and European Guidelines, in the presence of symptoms attributable to AS or when left ventricular (LV) systolic dysfunction manifests. However, there are fallacies in timing the intervention based on symptoms or LV ejection fraction. If surgery is delayed till symptoms manifest or LV dysfunction occurs, surgical risks are increased, long term outcomes are poor and in half of the patients, LV function never normalizes. Because of these reasons, pre-emptive intervention based on non-conventional parameters is expected to save more lives and prevent LV dysfunction. Data are emerging towards this approach and researchers have started focussing their attention on biomarkers like brain natriuretic peptide, multimodality imaging like estimation of extracellular volume by cardiac magnetic resonance for choosing the appropriate time for intervention in asymptomatic individuals. A relatively inexpensive way of identifying such high-risk individuals is speckle tracking imaging and in the last decade sufficient data have accumulated in favour of this modality to identify patients who may be benefited by early intervention. Speckle tracking echocardiography is a well validated technique which enables highly reproducible, angle-independent assessment of regional and global LV systolic function in longitudinal, circumferential and radial planes. Longitudinal strain, which is predominantly governed by the subendocardial layer, is most sensitive in the presence of myocardial disease and well-studied. Moreover, when discrepancies occur between gradient and valve area leading to uncertainties about the severity of AS, strain imaging would be of value in predicting outcomes particularly in those with low flow low gradient AS with normal LV ejection fraction.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115459684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarvesh Kumar, K. Rahul, M. Hakim, Vivek Tewarson, Bhupendra Kumar, Shobhit Kumar, Sushil Singh
{"title":"Surgical Revascularization of an Unusual Long Length Rosary Bead-like Coronary Artery Aneurysm: A Surgical Delight","authors":"Sarvesh Kumar, K. Rahul, M. Hakim, Vivek Tewarson, Bhupendra Kumar, Shobhit Kumar, Sushil Singh","doi":"10.4103/jiae.jiae_27_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_27_23","url":null,"abstract":"","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114480964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The assessment of myocardial function is important in both primary and secondary mitral regurgitation (MR), to determine the timing of interventions and to predict outcomes. Ejection fraction is relied on for clinical decisions, even though, it is well understood that it does not reflect myocardial function. Global longitudinal strain (GLS) is a promising parameter that correlates well with outcomes postinterventions. In this review, we aimed to determine the utility of GLS in both primary and secondary MR in predicting clinical outcomes. We also aimed to determine the GLS cutoff at which clinical decisions can be made. Methods: We conducted a systematic review of the literature regarding the use of GLS as a predictor of left ventricular (LV) function. We searched PubMed and Embase for relevant articles and identified 141 articles after removing duplicates. We screened titles and abstracts to identify 28 relevant articles from which data were extracted. Results: In 16 of the 28 studies, patients had primary MR mostly of degenerative etiology and the LV GLS cutoff for events ranged from −17.2% to −21%. In 10 studies, patients with secondary MR were included, and a cutoff ranging from −7%− to −9% was most often reported except for one study that reported-16.3%, as it included patients with atrial functional MR. Conclusion: GLS assesses LV dysfunction and is a good predictor of clinical and echocardiographic outcomes postinterventions. Values lower than the cutoff value of −17.2% to −21% in primary MR and −7% to −9% in secondary MR are associated with poorer outcomes. These findings suggest that the use of GLS as a routine assessment in patients with significant MR may be appropriate for both clinical decision-making and prognostication.
{"title":"Utility of Global Longitudinal Strain in Mitral Regurgitation: A Systematic Review","authors":"Jesu Krupa, Dorothy Lall","doi":"10.4103/jiae.jiae_33_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_33_23","url":null,"abstract":"Background: The assessment of myocardial function is important in both primary and secondary mitral regurgitation (MR), to determine the timing of interventions and to predict outcomes. Ejection fraction is relied on for clinical decisions, even though, it is well understood that it does not reflect myocardial function. Global longitudinal strain (GLS) is a promising parameter that correlates well with outcomes postinterventions. In this review, we aimed to determine the utility of GLS in both primary and secondary MR in predicting clinical outcomes. We also aimed to determine the GLS cutoff at which clinical decisions can be made. Methods: We conducted a systematic review of the literature regarding the use of GLS as a predictor of left ventricular (LV) function. We searched PubMed and Embase for relevant articles and identified 141 articles after removing duplicates. We screened titles and abstracts to identify 28 relevant articles from which data were extracted. Results: In 16 of the 28 studies, patients had primary MR mostly of degenerative etiology and the LV GLS cutoff for events ranged from −17.2% to −21%. In 10 studies, patients with secondary MR were included, and a cutoff ranging from −7%− to −9% was most often reported except for one study that reported-16.3%, as it included patients with atrial functional MR. Conclusion: GLS assesses LV dysfunction and is a good predictor of clinical and echocardiographic outcomes postinterventions. Values lower than the cutoff value of −17.2% to −21% in primary MR and −7% to −9% in secondary MR are associated with poorer outcomes. These findings suggest that the use of GLS as a routine assessment in patients with significant MR may be appropriate for both clinical decision-making and prognostication.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132729835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome of effort intolerance based on structural and functional abnormalities of the cardiovascular system (CVS). Its prevalence is increasing progressively in comparison to that of heart failure with reduced ejection fraction due to aging, obesity, metabolic stress, and hypertension. Multiple domains of the CVS and peripheral organs have reduced reserve capacity and increased stiffness in patients with HFpEF. This high-gain CVS exhibits increased filling pressures and reduced filling volumes under stress despite the left ventricular ejection fraction, commonly estimated parameter of contractile performance, being normal, i.e., >50%. The cost of increasing cardiac output in terms of left ventricular filling pressures is increased and their relationship shows an upward and more left-directed slope due to reduced ventricular and arterial compliance. At the tissue level, there is myocytic hypertrophy and increased extracellular matrix with capillary rarefaction. There are many phenogroups of HFpEF based on the heart's ability to secrete natriuretic peptides, degree of dysmetabolism, age, renal function, body fat, rhythm, underlying etiology, and subclinical systolic dysfunction. The left ventricle may be pressure-loaded, volume-loaded, or have equipoise with regard to remodeling. Myocardial performance estimated by parameters other than those based on distance or volume displacement may be abnormal in more than half of the patients underlying the presence of subtle systolic dysfunction. This review looks at myocardial performance and characteristics in HFpEF by deformation imaging using acoustic speckle tracking and its diagnostic and prognostic significance. Research points toward the utility of global longitudinal strain in early detection, biological characterization, and risk stratification of HFpEF. Echocardiographic speckle-tracking-based longitudinal strain analysis represents a method of relatively high value and for sensitive phenotyping of HFpEF which is yet to be utilized optimally. Other dimensions of strain, although extensively studied in HFpEF, do not add much value. The focus is on systolic deformation since there is limited utility of diastolic strain and its rate.
{"title":"Left Ventricular Strain in Heart Failure with Preserved Ejection Fraction","authors":"Madhu Shukla, JagdishChander Mohan","doi":"10.4103/jiae.jiae_22_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_22_23","url":null,"abstract":"Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome of effort intolerance based on structural and functional abnormalities of the cardiovascular system (CVS). Its prevalence is increasing progressively in comparison to that of heart failure with reduced ejection fraction due to aging, obesity, metabolic stress, and hypertension. Multiple domains of the CVS and peripheral organs have reduced reserve capacity and increased stiffness in patients with HFpEF. This high-gain CVS exhibits increased filling pressures and reduced filling volumes under stress despite the left ventricular ejection fraction, commonly estimated parameter of contractile performance, being normal, i.e., >50%. The cost of increasing cardiac output in terms of left ventricular filling pressures is increased and their relationship shows an upward and more left-directed slope due to reduced ventricular and arterial compliance. At the tissue level, there is myocytic hypertrophy and increased extracellular matrix with capillary rarefaction. There are many phenogroups of HFpEF based on the heart's ability to secrete natriuretic peptides, degree of dysmetabolism, age, renal function, body fat, rhythm, underlying etiology, and subclinical systolic dysfunction. The left ventricle may be pressure-loaded, volume-loaded, or have equipoise with regard to remodeling. Myocardial performance estimated by parameters other than those based on distance or volume displacement may be abnormal in more than half of the patients underlying the presence of subtle systolic dysfunction. This review looks at myocardial performance and characteristics in HFpEF by deformation imaging using acoustic speckle tracking and its diagnostic and prognostic significance. Research points toward the utility of global longitudinal strain in early detection, biological characterization, and risk stratification of HFpEF. Echocardiographic speckle-tracking-based longitudinal strain analysis represents a method of relatively high value and for sensitive phenotyping of HFpEF which is yet to be utilized optimally. Other dimensions of strain, although extensively studied in HFpEF, do not add much value. The focus is on systolic deformation since there is limited utility of diastolic strain and its rate.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"188 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134045393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Left ventricular (LV) diastolic pressure estimation is essential for characterization of heart failure. Despite extensive research and the availability of numerous metrics, the assessment of LV diastolic pressures both at rest and after exertion has been challenging. Left atrial strain assessment by echocardiography has recently shown promise in correlating with LV end-diastolic pressure. This review provides information about this novel technology.
{"title":"Left Atrial Strain: Crucial Cardiac Navigator in Practice","authors":"Shantanu Sengupta, A. Agarwal","doi":"10.4103/jiae.jiae_16_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_16_23","url":null,"abstract":"Left ventricular (LV) diastolic pressure estimation is essential for characterization of heart failure. Despite extensive research and the availability of numerous metrics, the assessment of LV diastolic pressures both at rest and after exertion has been challenging. Left atrial strain assessment by echocardiography has recently shown promise in correlating with LV end-diastolic pressure. This review provides information about this novel technology.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127396206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lack of therapeutic response in nearly 30% of patients undergoing cardiac resynchronization therapy (CRT) remains a major therapeutic challenge. Given the role of echocardiography in detecting mechanical dyssynchrony, extensive research has been undertaken to identify the echocardiographic predictors of CRT response. After the initial setback, the interest in this field has renewed with the introduction of speckle-tracking echocardiography (STE) for quantifying myocardial deformation. Several newer and potentially useful indices of mechanical dyssynchrony have been developed. In addition, the non-invasive assessment of myocardial work has also become feasible and many of the myocardial work indices have shown considerable promise in the initial studies. The strain imaging may also help in identifying the optimum site for left ventricular lead placement. This review summarizes the current understanding regarding the role of left ventricular strain imaging in patients undergoing CRT.
{"title":"Role of Left Ventricular Strain Imaging in Patients Undergoing Cardiac Resynchronization Therapy","authors":"M. Bansal","doi":"10.4103/jiae.jiae_50_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_50_23","url":null,"abstract":"Lack of therapeutic response in nearly 30% of patients undergoing cardiac resynchronization therapy (CRT) remains a major therapeutic challenge. Given the role of echocardiography in detecting mechanical dyssynchrony, extensive research has been undertaken to identify the echocardiographic predictors of CRT response. After the initial setback, the interest in this field has renewed with the introduction of speckle-tracking echocardiography (STE) for quantifying myocardial deformation. Several newer and potentially useful indices of mechanical dyssynchrony have been developed. In addition, the non-invasive assessment of myocardial work has also become feasible and many of the myocardial work indices have shown considerable promise in the initial studies. The strain imaging may also help in identifying the optimum site for left ventricular lead placement. This review summarizes the current understanding regarding the role of left ventricular strain imaging in patients undergoing CRT.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124536063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Systemic diseases consist of various pathological conditions with a wide range of symptoms, often with progressive clinical worsening. Cardiac involvement is not uncommon in many of these conditions. Subclinical myocardial dysfunction is the common manifestation during the early stages of the disease and recognition of early myocardial dysfunction is very important for diagnosis and future prognosis. Left ventricular ejection fraction (LVEF) is considered less sensitive to detect early LV myocardial dysfunction. Strain imaging, performed using speckle-tracking echocardiography (STE), has emerged as a robust tool for detecting early subclinical myocardial dysfunction. The longitudinal muscle fibres are predominantly found in the sub-endocardium and are more susceptible to damage since the sub-endocardium is comparatively less perfused. Hence, longitudinal strain is impaired early in the course of the disease and helps in detecting subtle cardiac involvement in various systemic diseases. Global longitudinal strain, which is the average longitudinal strain of all the LV myocardial segments, is currently the most useful strain parameter for this purpose.
{"title":"Left Ventricular Strain in Systemic Diseases","authors":"Aniruddha De","doi":"10.4103/jiae.jiae_12_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_12_23","url":null,"abstract":"Systemic diseases consist of various pathological conditions with a wide range of symptoms, often with progressive clinical worsening. Cardiac involvement is not uncommon in many of these conditions. Subclinical myocardial dysfunction is the common manifestation during the early stages of the disease and recognition of early myocardial dysfunction is very important for diagnosis and future prognosis. Left ventricular ejection fraction (LVEF) is considered less sensitive to detect early LV myocardial dysfunction. Strain imaging, performed using speckle-tracking echocardiography (STE), has emerged as a robust tool for detecting early subclinical myocardial dysfunction. The longitudinal muscle fibres are predominantly found in the sub-endocardium and are more susceptible to damage since the sub-endocardium is comparatively less perfused. Hence, longitudinal strain is impaired early in the course of the disease and helps in detecting subtle cardiac involvement in various systemic diseases. Global longitudinal strain, which is the average longitudinal strain of all the LV myocardial segments, is currently the most useful strain parameter for this purpose.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"72 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130385746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 27-year-old male was admitted with dyspnea of sudden onset and was initially diagnosed to have acute pulmonary embolism, bilateral pleural effusion, and mild pericardial effusion. Detailed echocardiographic examination revealed echocardiographic features of constrictive pericarditis (CP), marked spontaneous contrast in inferior vena cava, and a right atrial thrombus. The patient had bilateral lung consolidation and pleural effusion presumably of tubercular origin. Intracardiac thrombi are rare in patients with CP and may impact prognosis and management strategy.
{"title":"Right Atrial Thrombus and Pulmonary Embolism in a Patient with Constrictive Pericarditis","authors":"Madhu Shukla, JagdishChander Mohan","doi":"10.4103/jiae.jiae_5_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_5_23","url":null,"abstract":"A 27-year-old male was admitted with dyspnea of sudden onset and was initially diagnosed to have acute pulmonary embolism, bilateral pleural effusion, and mild pericardial effusion. Detailed echocardiographic examination revealed echocardiographic features of constrictive pericarditis (CP), marked spontaneous contrast in inferior vena cava, and a right atrial thrombus. The patient had bilateral lung consolidation and pleural effusion presumably of tubercular origin. Intracardiac thrombi are rare in patients with CP and may impact prognosis and management strategy.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114592590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Two-dimensional strain imaging has an established role in the detection of subtle or subclinical left ventricular (LV) dysfunction in cardiomyopathies. The application of strain imaging, particularly longitudinal strain (LS), is emerging as a simple yet powerful tool in the detection of the early decline of LV function in valvular heart diseases also, including aortic regurgitation (AR). The advantages of strain imaging include its simplicity of the concept and imaging technique, its rapidity, and less interpersonal variability. The detection of lower strain values may help the clinician to optimally time the surgical intervention among asymptomatic individuals with preserved ejection fraction (EF). Such a preemptive approach is expected to improve the surgical results and offer better outcomes in terms of longevity and reverse remodeling of LV. Numerous studies have confirmed that a global LS value of 19.5% is the ideal cutoff for the detection of early LV dysfunction in AR. It has been shown in studies that a decreased strain correlates with mortality in medically treated as well as in operated patients. Apart from being potentially helpful in the timing of surgery in asymptomatic individuals, the estimation of strain is also useful in the detection of the contractile reserve, which is translated into better postoperative outcomes. If this finding is supported by future studies, strain imaging may eventually replace stress echocardiography in evaluating asymptomatic patients with valve diseases. Even in patients with advanced disease and low EF, strain values are helpful in identifying the subset of individuals who show better response to surgery. A cutoff of 12% appears to be useful in the detection of responders in this high-risk group. The usefulness of radial and circumferential strain, apical and basal rotation, and layered strain remains to be established. The extension of strain measurements in assessing myocardial work appears to be an attractive option for assessing LV function without load dependency.
{"title":"Strain Imaging in Aortic Regurgitation","authors":"Manivasagam Gopal, M. Bharathkumaran","doi":"10.4103/jiae.jiae_21_23","DOIUrl":"https://doi.org/10.4103/jiae.jiae_21_23","url":null,"abstract":"Two-dimensional strain imaging has an established role in the detection of subtle or subclinical left ventricular (LV) dysfunction in cardiomyopathies. The application of strain imaging, particularly longitudinal strain (LS), is emerging as a simple yet powerful tool in the detection of the early decline of LV function in valvular heart diseases also, including aortic regurgitation (AR). The advantages of strain imaging include its simplicity of the concept and imaging technique, its rapidity, and less interpersonal variability. The detection of lower strain values may help the clinician to optimally time the surgical intervention among asymptomatic individuals with preserved ejection fraction (EF). Such a preemptive approach is expected to improve the surgical results and offer better outcomes in terms of longevity and reverse remodeling of LV. Numerous studies have confirmed that a global LS value of 19.5% is the ideal cutoff for the detection of early LV dysfunction in AR. It has been shown in studies that a decreased strain correlates with mortality in medically treated as well as in operated patients. Apart from being potentially helpful in the timing of surgery in asymptomatic individuals, the estimation of strain is also useful in the detection of the contractile reserve, which is translated into better postoperative outcomes. If this finding is supported by future studies, strain imaging may eventually replace stress echocardiography in evaluating asymptomatic patients with valve diseases. Even in patients with advanced disease and low EF, strain values are helpful in identifying the subset of individuals who show better response to surgery. A cutoff of 12% appears to be useful in the detection of responders in this high-risk group. The usefulness of radial and circumferential strain, apical and basal rotation, and layered strain remains to be established. The extension of strain measurements in assessing myocardial work appears to be an attractive option for assessing LV function without load dependency.","PeriodicalId":325663,"journal":{"name":"Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122308581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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