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To investigate and compare the value of right ventricular longitudinal strain detected by two-dimensional and three-dimensional speckle-tracking echocardiography in risk stratification evaluation in pre-capillary pulmonary hypertension. We consecutively screened 66 patients diagnosed with pre-capillary pulmonary hypertension in our center. According to the risk assessment recommended by 2015 European Society of Cardiology Guidelines, all participants were classified into low- and intermediate-high-risk group. Two-dimensional and three-dimensional strains were measured using off-line softwares (GE EchoPAC version 201 and TomTec, 4D RV Function 2.0). Fifty-seven pre-capillary pulmonary hypertension patients (average 35 years old, 18 males and 39 females) were finally enrolled in our study, 32 (56.1%) were classified in low-risk group, while 25 (43.9%) were in the intermediate-high-risk group. Clinical data associated with disease severity, such as N-terminal pro-brain natriuretic peptide (r = 0.574, P < 0.001), peak oxygen consumption (r = –0.484, P < 0.001), and 6-min walking distance (r = –0.356, P = 0.008) were significantly correlated with two-dimensional right ventricular longitudinal strain; while the correlations with three-dimensional right ventricular longitudinal strain were weaker. Receiver operating characteristic curves for the detection of intermediate-high risk stratification showed two-dimensional right ventricular longitudinal strain had the best predictive capacity (area under curve, 0.82, 95% CI: 0.71–0.93, P < 0.001). Univariate and Multivariate Logistic regression analyses identified two-dimensional right ventricular longitudinal strain as an independent predictor (OR: 1.42, 95% CI: 1.18–1.71, P < 0.001) of intermediate-high risk stratification in this cohort of pre-capillary pulmonary hypertension patients, the predictive capacity retained (OR: 1.45, 95% CI: 1.18–1.78, P < 0.001) after adjusted by age, gender, and body mass index, while three-dimensional speckle-tracking echocardiography parameters were not. In conclusion, when used for the detection of intermediate-high risk stratification in pre-capillary pulmonary hypertension, two-dimensional right ventricular longitudinal strain was better than three-dimensional right ventricular longitudinal strain.

Current experimental models of heart failure with preserved ejection fraction (HFpEF) lack standardized approaches for evaluating left atrial (LA) remodelling and atrioventricular (AV) coupling, leaving a critical gap in mechanistic understanding and phenotypic characterization. This study aimed to explore LA function and AV coupling status in a rat model of hypertension‐related HFpEF, thereby providing support for phenotype‐specific therapeutic strategies. We established two experimental rat models: A dual‐hit model (high‐fat diet combined with Nω‐nitro‐l‐arginine methyl ester; HD + NAME) and a high‐salt‐sensitive model (Dahl salt‐sensitive; Dahl/SS). LA function and AV coupling were quantified using speckle‐tracking echocardiography (STE) with a modified LA imaging protocol and dedicated strain analysis software. Key parameters included phasic LA function, circumferential strain rates, LA stiffness index (LASI), and LA reservoir strain (LASr). Correlations with histopathological alterations were also examined. Both HFpEF groups exhibited significant left ventricular remodelling, diastolic dysfunction and reduced LASr compared with control (Control: 25.5 ± 3.4%, Dahl/SS: 17.8 ± 2.6%, and HD + NAME: 15.6 ± 2.9%; all P < 0.001 vs. Control). The HD + NAME model demonstrated higher LASI and E/early diastolic circumferential strain rate, indicating impaired AV coupling. Histological analysis revealed LA cardiomyocyte hypertrophy and interstitial fibrosis (fibrotic area: Control: 1.1 ± 0.5%; HD + NAME: 4.9 ± 1.7%, Dahl/SS: 6.7 ± 1.9%; all P < 0.001 vs. Control). Importantly, LASI correlated strongly with cardiomyocyte hypertrophy (r = 0.0.635) and fibrosis (r = 0.733; all P < 0.001). Standardized STE enables high‐resolution quantification of LA function and AV coupling in preclinical HFpEF models. Comparative evaluation of dual‐hit and salt‐sensitive hypertension models provides phenotypic stratification and yields novel mechanistic insights into atrioventricular decoupling in HFpEF. What is the central question of this study? Can standardized methods be obtained for assessing left atrial (LA) remodelling and atrioventricular (AV) coupling in heart failure with preserved ejection fraction (HFpEF)? What is the main finding and its importance? With a rat‐specific speckle‐tracking echocardiography protocol optimized for LA imaging, LA stiffness index (LASI) and E/early diastolic circumferential strain rate (CSRe) were identified as robust biomarkers of AV uncoupling, establishing a new standard for evaluating LA function in preclinical HFpEF models. Combined use of LASI and CSRe within a unified diagnostic framework improved phenotypic discrimination between distinct HFpEF models and enhanced accuracy in monitoring cardiac functional changes.

Abstract Background Three-dimensional (3D) echocardiography and 2-dimensional (2D) strain measurements of the right ventricle (RV) are important indices in humans with pulmonary hypertension (PH) and need further evaluation in dogs with PH. Objectives To evaluate various RV size and function indices in dogs with PH and to examine differences between pre- and postcapillary PH. Animals A total of 311 client-owned dogs: 100 dogs with PH, 31 with postcapillary and 69 with precapillary PH, and 211 healthy control dogs. Methods Retro- and prospective, multicenter study. Size and function of the RV was determined using several indices, derived using dedicated RV software, including 3D RV end-diastolic volume (EDVn), end-systolic volume (ESVn), ejection fraction, 2D global and free wall RV longitudinal strain (RVLS), end-diastolic area, end-systolic area, fractional area change, tricuspid annular plane systolic excursion, and tissue Doppler imaging-derived systolic myocardial velocity of the lateral tricuspid annulus (S′n). Results The EDVn (1.8 vs 2.5 mL/kg0.942, P < .01) and ESVn (0.8 vs 1.2 mL/kg0.962, P < .001) were significantly larger in the PH group compared to healthy controls. Free wall RVLS was decreased in dogs with severe PH compared to controls (−24% vs −29.6%, P < .001). Dogs with precapillary PH had worse RV systolic function than dogs with postcapillary PH. Conclusion Three-dimensional echocardiography of the RV is a promising tool to detect RV changes in dogs with PH. Also, 2D strain measurements are able to detect decreased RV function and offer several advantages compared to conventional indices.

Objective To assess left atrial (LA) structure and function in marathon runners using two‐dimensional speckle tracking echocardiography (2D‐STE) and real‐time three‐dimensional echocardiography (RT‐3DE). Methods This study enrolled 50 healthy volunteers (control group) and 132 marathon runners, and collected their general information. 2D‐STE and RT‐3DE were performed to obtain LA structural and functional parameters and left ventricular mass index (LVMI). According to the LVMI criteria for diagnosing left ventricular hypertrophy (LVH), all marathon runners were divided into an LVMI normal group and an LVH group. A comparative analysis was performed among the three groups. Multivariate logistic regression was used to analyze the association, and curve fitting was used to show the change trends. Results Compared with the control group, LA total ejection fraction (LATEF) and LA passive ejection fraction (LAPEF) were higher in the LVMI normal group (p < 0.05). Compared with the control group and the LVMI normal group, LA maximal volume index (LAVImax), LA presystolic volume index (LAVIpre), and LA stiffness index (LASI) were higher in the LVH group, whereas LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contraction strain (LASct) were lower (p < 0.05). Multivariate logistic regression analysis showed that LAVImax, LAScd, and LASct were significantly associated with LVH in marathon runners. Curve fitting showed that LAVImax increased with the increase of LVMI, whereas LAScd and LASct decreased. Conclusion 2D‐STE and RT‐3DE can effectively assess LA structure and function in marathon runners. Marathon runners with normal LVMI exhibit normal LA structure and function, and even some functional enhancement, while those with LVH exhibit increased LA volume and decreased LA strain function. Two‐dimensional speckle tracking echocardiography and real‐time three‐dimensional echocardiography can effectively assess left atrial structure and function in marathon runners.

Left ventricular (LV) hypertrophy (LVH) is frequently observed in patients with hypertension (HTN). LV myocardial work (MW) has recently emerged as a non‐invasive method to assess systolic myocardial deformation relative to afterload conditions. The authors investigated the characteristics of myocardial work with different degrees of LVH in HTN patients. From December 2020 to February 2024, 255 HTN patients and 26 healthy controls undergoing transthoracic echocardiography were included in the current study. Hypertension patients were divided into quintile groups based on left ventricular mass index (LVMI), for the first to fourth LVMI quantiles, global work index (GWI) and global constructive work (GCW) were higher compared to the control group, but the difference was not statistically significant. In the sixth LVMI quantile, GWI and GCW showed a significant decrease. The restricted cubic splines showed that both GWI and GCW exhibited an inverted U‐shaped relationship with LVMI. A LVMI of >151.39 g/m2 could accurately predict reduction both in GWI and GCW (Sensitivity: 0.78, Specificity: 0.89, AUC: 0.90, P < .001; Sensitivity: 0.81, Specificity: 0.92, AUC: 0.92, P < .001, respectively). As LVH progressed in HTN patients, both GWI and GCW initially demonstrated an increase, followed by a subsequent decrease. Myocardial work provides additional insights into assessment of cardiac function in HTN patients.

Hypertension increases arterial stiffness, leading to dysfunction and structural changes in the left atrium (LA) and left ventricle (LV). However, the effects of hypertension on the right atrium (RA) and the right ventricle are still not fully understood. The purpose of this study was to clarify whether there is an interaction not only in the left ventricular system but also in the right ventricular system in hypertensive patients with preserved LV ejection fraction. The current retrospective observational study included patients (n = 858) with some risk of metabolic abnormalities (hypertension, diabetes, and dyslipidemia) who had visited our hospital and undergone echocardiography between 2015 and 2018. Among them, we retrospectively studied 165 consecutive hypertensive patients with preserved LV ejection fraction who had echocardiography performed on the same day as a cardio-ankle vascular index (CAVI) in our hospital. The phasic function of both atria was evaluated by two-dimensional speckle-tracking echocardiography. CAVI was measured using Vasela 1500 (Fukuda Denshi®). In the univariate analysis, CAVI was significantly correlated with LA and RA conduit function (LA conduit function, r = −0.448, p = 0.0001; RA conduit function, r = −0.231, p = 0.003). A multivariate regression analysis revealed that LA and RA conduit function was independently associated with CAVI (LA, t = −5.418, p = 0.0001; RA, t = −2.113, p = 0.036). CAVI showed a possibility that the association between heart and vessels are contained from not only LA phasic function but also RA phasic function in hypertensive patients.

Background Recent reports have indicated the beneficial role of strain measurement in COVID‐19 patients. Hypothesis To determine the association between right and left global longitudinal strain (RVGLS, LVGLS) and COVID‐19 patients' outcomes. Methods Hospitalized COVID‐19 patients between June and August 2020 were included. Two‐dimensional echocardiography and biventricular global longitudinal strain measurement were performed. The outcome measure was defined as mortality, ICU admission, and need for intubation. Appropriate statistical tests were used to compare different groups. Results In this study 207 patients (88 females) were enrolled. During 64 ± 4 days of follow‐up, 22 (10.6%) patients died. Mortality, ICU admission, and intubation were significantly associated with LVGLS and RVGLS tertiles. LVGLS tertiles could predict poor outcome with significant odds ratios in the total population (OR = 0.203, 95% CI: 0.088–0.465; OR = 0.350, 95% CI: 0.210–0.585; OR = 0.354, 95% CI: 0.170–0.736 for mortality, ICU admission, and intubation). Although odds ratios of LVGLS for the prediction of outcome were statistically significant among hypertensive patients, these odds ratios did not reach significance among non‐hypertensive patients. RVGLS tertiles revealed significant odds ratios for the prediction of mortality (OR = 0.322, 95% CI: 0.162–0.640), ICU admission (OR = 0.287, 95% CI: 0.166–0.495), and need for intubation (OR = 0.360, 95% CI: 0.174–0.744). Odds ratios of RVGLS remained significant even after adjusting for hypertension when considering mortality and ICU admission. Conclusion RVGLS and LVGLS can be acceptable prognostic factors to predict mortality, ICU admission, and intubation in hospitalized COVID‐19 patients. However, RVGLS seems more reliable, as it is not confounded by hypertension.

Pulmonary vascular disease and resultant pulmonary hypertension (PH) have been increasingly recognized in the preterm population, particularly among patients with bronchopulmonary dysplasia (BPD). Limited data exist on the impact of PH severity and right ventricular (RV) dysfunction at PH diagnosis on outcome. The purpose of this study was to evaluate if echocardiography measures of cardiac dysfunction and PH severity in BPD-PH were associated with mortality. The study is a retrospective analysis of the echocardiography at three months or less from time of PH diagnosis. Survival analysis using a univariate Cox proportional hazard model is presented and expressed using hazard ratios (HR). We included 52 patients with BPD and PH of which 16 (31%) died at follow-up. Average gestational age at birth was 26.3 ± 2.3 weeks. Echocardiography was performed at a median of 43.3 weeks (IQR: 39.0–54.7). The median time between PH diagnosis and death was 117 days (range: 49–262 days). Multiple measures of PH severity and RV performance were associated with mortality (sPAP/sBP: HR 1.02, eccentricity index: HR 2.02, tricuspid annular plane systolic excursion Z-score: HR 0.65, fractional area change: HR 0.88, peak longitudinal strain: HR 1.22). Hence, PH severity and underlying RV dysfunction at PH diagnosis were associated with mortality in BPD-PH patients. While absolute estimation of pulmonary pressures is not feasible in every screening echocardiography, thorough evaluation of RV function and other markers of PH may allow to discriminate the most at-risk population and should be considered as standard add-ons to the current screening at 36 weeks.

Patients with heart failure (HF) have high morbidity and mortality. Accurate assessment of right ventricular (RV) function has important prognostic significance in patients with HF. However, conventional echocardiographic parameters of RV function have limitations in RV assessments due to the complex geometry of right ventricle. In recent years, speckle tracking echocardiography (STE) has been developed as promising imaging technique to accurately evaluate RV function. RV longitudinal strain (RVLS) using STE, as a sensitive index for RV function evaluation, displays the powerfully prognostic value in patients with HF. Therefore, the aim of the present review was to summarize the utility of RVLS in patients with HF.

This study was to evaluate the value of multi-directional strain parameters derived from three-dimensional (3D) speckle tracking echocardiography (STE) for predicting left ventricular (LV) remodeling after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) compared with that of two-dimensional (2D) global longitudinal strain (GLS). A total of 110 patients (mean age, 54 ± 9 years) after STEMI treated with primary PCI were enrolled in our study. At baseline (within 24 h after PCI), standard 2D echocardiography, 2D STE and 3D STE were performed to acquire the conventional echocardiographic parameters and strain parameters. At 3-month follow-up, standard 2D echocardiography was repeated to all the patients to determine LV remodeling, which was defined as a 20% increase in LV end-diastolic volume. At 3-month follow-up, LV remodeling occurred in 26 patients (24%). Compared with patients without LV remodeling, patients with remodeling had significantly reduced 2D GLS (−12.5 ± 3.2% vs −15.0 ± 3.1%, p < 0.001), 3D GLS (−9.9 ± 2.2% vs −13.1 ± 2.7%, p < 0.001), 3D global area strain (GAS) (−20.3 ± 3.9% vs −23.3 ± 4.8%, p = 0.005) and 3D global radial strain (GRS) (29.0 ± 7.4% vs 34.3 ± 8.5%, p = 0.007) at baseline, but there is no significant difference in 3D global circumferential strain (GCS) (−12.7 ± 2.9% vs −13.0 ± 3.2%, p = 0.822). Separated multivariate analysis shows that 2D GLS, 3D GLS, 3D GAS and 3D GRS all can be independent predictors of LV remodeling. However, receiver-operating characteristic curve analysis showed that the area under the curve of 3D GLS (0.82) for predicting LV remodeling was significantly higher than that of 2D GLS (0.72, p = 0.034), 3D GAS (0.68, p < 0.001) and 3D GRS (0.68, p < 0.001). In patients after STEMI, 2D GLS, 3D GLS, 3D GAS and 3D GRS but not 3D GCS measured after primary PCI are independent predictors of LV remodeling and 3D GLS is the most powerful predictor among them.