Is There a Relationship Between Aortic Valve Annular Plane Systolic Excursion and Left Ventricular Rotational Mechanics in Healthy Adults? Insights from the MAGYAR-Healthy Study

Left Ventricular Longitudinal Strain Is Associated with Ascending Aortic Diameters in Healthy Adults—A Detailed Single-Center Retrospective Analysis from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study

Even in the absence of cardiovascular pathology, a finely tuned interaction can be observed between regional LV deformation, especially with LV-LS and the size of the ascending aorta in healthy individuals.

EXPLORATORY ASSESSMENT OF LEFT VENTRICULAR 1 STRAIN-VOLUME LOOPS IN SEVERE AORTIC VALVE 2 DISEASES

Left ventricular rotational characteristics in healthy mid-term pregnancy—insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Preg Study

Background Haemodynamic, neurohormonal, plasma volume, haematological, and structural cardiac changes occur during healthy pregnancy to varying degrees depending on the trimester. The aim of the present observational cross-sectional study was to compare left ventricle (LV) rotational mechanics in healthy pregnant subjects with those of age-matched non-pregnant women using three-dimensional speckle-tracking echocardiography (3DSTE). Methods The initial study population consisted of 27 healthy subjects in mid-term pregnancy; however, 6 cases were excluded due to suboptimal image quality. Consequently, the final analytical cohort comprised 21 subjects (mean age: 30.7±2.7 years). This group was compared to a control group of 27 age-matched healthy non-pregnant volunteers (mean age: 28.4±6.0 years). Results In three pregnant subjects, the near absence of LV rotational mechanics, referred to as rigid body rotation (RBR), was observed (3 of 21, 14%) with counterclockwise orientation. The remaining 18 subjects showed normally directed LV rotational mechanics (18 of 21, 86%). A significant reduction in apical LV rotation (4.0±3.9° vs. 9.2±3.2°, P<0.05) and LV twist (6.8±3.6° vs. 13.1±3.4°, P<0.05) could be detected in healthy pregnant women compared with non-pregnant subjects. Basal LV rotation did not differ significantly between the two groups (−3.2±2.3° vs. −3.8±1.8°, P=ns). Time to peak apical LV twist tended to be shorter in pregnant women; however, this difference did not reach statistical significance. Conclusions Reduced apical LV rotation and consequent LV twist with preserved basal LV rotation could be detected in healthy mid-term pregnancy. In some cases, counterclockwise LV-RBR was observed.

Quantitative MRI assessment of left ventricular filling: associations with left atrial and pulmonary artery dimensions in a population-based study

Introduction Left ventricular diastolic dysfunction is associated with left atrial remodeling and alterations of the pulmonary circulation. However, whether these interconnected changes across the cardiopulmonary axis can be simultaneously characterized using a non-dedicated whole-body MRI examination in individuals free of overt cardiovascular disease remains unclear. Methods 339 subjects (mean age 56.4 years; 43.4% female) without overt cardiovascular disease were included. Linear regression models, adjusted for age, sex, and cardiovascular risk factors, explored the association of Left ventricle (LV) filling rates with left atrium (LA) size and function, and mean pulmonary artery (MPA). Results Average maximal LA was 19.6 cm2, minimal LA 11.8 cm2, area-based LA function 39.8%, non-electrocardiogram-synchronized LA size 16.8 cm2, LV early filling rate 227.1 mL/s, late filling rate 238.4 mL/s, and MPA diameter 2.67 cm. Higher early and late LV filling rates were associated with larger maximal LA size across all models (β = 2.30; β = 1.00), minimal LA size (β = 1.41; β = 0.77), and non-electrocardiogram-synchronized LA size (β = 1.86; β = 0.90, all p < 0.001, fully adjusted model). Higher early LV filling rates, but not higher late LV filling rates, were associated with larger MPA diameter across all models (β = 0.06, p = 0.03, fully adjusted model). Conclusion In individuals free of overt cardiovascular disease, MRI-derived LV filling dynamics were associated with structural alterations of the left atrium and pulmonary vasculature, suggesting that changes across the cardiopulmonary axis may already be detectable by whole-body MRI before clinical disease becomes apparent.

The influence of accessory pathway localization on left ventricular mechanics in adult patients with Wolff-Parkinson-White syndrome: a speckle-tracking echocardiographic investigation

Background Ventricular pre-excitation can cause left ventricular (LV) mechanical dyssynchrony and dysfunction. However, the specific impact of accessory pathway (AP) location on LV mechanics remains incompletely characterized. This study utilized two-dimensional speckle-tracking echocardiography (2D-STE) to quantify and compare LV deformation and synchrony across these anatomical subgroups. Methods We retrospectively analyzed 91 patients with Wolff-Parkinson-White (WPW) syndrome (age 38.2±1.4 years) and 56 matched controls using 2D-STE. Global and regional LV deformation and synchrony were compared across AP-location groups: septal (n=34), right (n=38), and left (n=19). LV deformation parameters included circumferential strain (CS), longitudinal strain (LS), and radial strain (RS). LV synchrony was assessed by peak strain dispersion (PSD) of LV segments for each strain direction. Results All patient groups (septal: −19.0%±0.7%, right: −19.3%±0.6%, and left AP: −19.2%±0.8%) had lower global CS (GCS) compared with controls (−23.1%±0.4%, all P<0.001). The septal AP group showed lower global LS (GLS) (−17.2%±0.5%), global RS (GRS) (30.1%±2.0%), and prolonged GLS-PSD (51.3±3.1 ms) than the left AP group and controls (P<0.05). The right AP group exhibited lower GLS (−17.5%±0.5%) than the left AP group (−19.6%±0.5%, P<0.05) and prolonged GLS-PSD (46.7±2.5 ms) compared with controls (31.6±1.1 ms, P<0.001). The left AP group showed GLS (−19.6%±0.5%), GRS (40.0%±2.6%), and GLS-PSD (40.1±2.3 ms) that were not significantly different from controls (all P>0.05). LV ejection fraction (LVEF) was lower in septal (59.2%±1.2%) and right AP groups (59.8%±1.0%) vs. controls (65.0%±0.3%; P<0.001). LVEF correlated negatively with GLS (r=−0.53, P<0.001) and with GLS-PSD (r=−0.41, P<0.001). Conclusions LV mechanical dysfunction in WPW syndrome varies by AP location. Septal and right APs lead to widespread strain impairment, dyssynchrony, and lower LVEF, whereas left APs mainly reduce CS. Reduced LVEF is closely associated with impaired LV mechanics and dyssynchrony.

Three-dimensional right ventricular free-wall strain for identifying a higher Doppler-estimated PASP subgroup in high-altitude heart disease

Background High-altitude heart disease (HAHD) is characterized by pulmonary hypertension and progressive right ventricular dysfunction. Tricuspid annular plane systolic excursion (TAPSE) may have limited ability to characterize right ventricular impairment at higher pulmonary pressures. We aimed to determine whether three-dimensional speckle-tracking-derived right ventricular free-wall longitudinal strain, reported as an absolute magnitude (absolute RVFWLS), better identifies an operationally defined higher Doppler-estimated pulmonary artery systolic pressure (PASP) subgroup within HAHD than TAPSE, and to explore the relationships of PASP with right ventricular volumetric remodeling and strain. Methods This retrospective study included 100 participants who underwent standardized two-dimensional and three-dimensional echocardiography: 40 high-altitude controls and 60 patients with HAHD. Patients with HAHD were categorized using an operational analytical threshold into higher-PASP (PASP ≥60 mmHg) and lower-PASP (PASP <60 mmHg) subgroups. Single-index receiver operating characteristic (ROC) curves were compared using paired DeLong tests. A logistic model evaluated absolute RVFWLS beyond TAPSE, age, and sex. Exploratory regression-based mediation-model frameworks with 5,000 bootstrap iterations examined whether right ventricular end-systolic volume (RV-ESV) statistically accounted for the associations of PASP with three-dimensional right ventricular ejection fraction (3D-EF) and absolute RVFWLS. Results Of the 60 patients with HAHD, 26 met the operational higher-PASP threshold. Absolute RVFWLS showed better discrimination than TAPSE, with areas under the ROC curve of 0.886 and 0.647, respectively (difference, 0.238; P = 0.002). Adding absolute RVFWLS to TAPSE, age, and sex improved model fit (likelihood-ratio P < 0.001); the odds ratio per 1-percentage-point decrement in absolute RVFWLS was 1.81 (95% confidence interval, 1.29–2.54). RV-ESV statistically accounted for 45.0% (95% confidence interval, 34.8%–67.2%) of the PASP–3D-EF association, whereas it did not materially account for the PASP–absolute RVFWLS association (−1.6%; 95% confidence interval, −8.4% to 5.7%). Septal longitudinal strain was also reduced in HAHD. Conclusion Three-dimensional absolute RVFWLS showed better discrimination than TAPSE for identifying an operationally defined higher-PASP subgroup within HAHD. The association between PASP and absolute RVFWLS was less closely related to RV-ESV than the PASP–3D-EF association. These exploratory cross-sectional findings require prospective validation against invasive hemodynamic measurements and clinical outcomes.