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Surgical repair of Tetralogy of Fallot (ToF) is usually performed in the first months of life with low early postoperative mortality. During long-term follow-up, however, both right (RV) and left ventricular (LV) performances may deteriorate. Tissue Doppler imaging (TDI) and speckle tracking echocardiography (ST) can unmask a diminished RV and LV performance. The objective of the current study was to assess the cardiac performance before and shortly after corrective surgery in ToF patients using conventional, TDI and ST echocardiographic techniques. Thirty-six ToF patients after surgery were included. Transthoracic echocardiography including TDI and ST techniques was performed preoperatively and at hospital discharge after surgery (10 days to 4 weeks after surgery). Median age at surgery was 7.5 months [5.5–10.9]. Regarding the LV systolic function there was a significant decrease in interventricular septum (IVS) S ′ at discharge as compared to preoperatively (pre IVS S ′ = 5.4 ± 1.4; post IVS S ′ = 3.9 ± 1.2; p  < 0.001) and in global longitudinal peak strain (GLS) (pre = − 18.3 ± 3.4; post = − 14.2 ± 4.1; p  = 0.003); but not in the fractional shortening (FS). Both conventional and TDI parameters showed a decrease in diastolic function at discharge. Tricuspid Annular Plane Systolic Excursion and RV S ′ were significantly lower before discharge. When assessing the RV diastolic performance, only the TDI demonstrated a RV impairment. There was a negative correlation between age at surgery and postoperative LV GLS ( R  = − 0.41, p  = 0.031). There seems to be an impairment in left and right ventricle performance at discharge after ToF corrective surgery compared to preoperatively. This is better determined with TDI and ST strain imaging than with conventional echocardiography.

Background Identifying patients with advanced left atrial (LA) remodeling before catheter ablation (CA) of atrial fibrillation (AF) is crucial. Hypothesis This study aimed to identify echocardiographic parameters associated with changes in anatomy and conduction properties of the left atrium (LA). Methods We examined 75 AF patients prior to CA and measured the intervals from the P‐wave‐onset to four mitral annulus sites by pulsed‐wave tissue Doppler imaging (PW‐TDI). Patients were grouped to an upward U‐pattern (delayed anterior activation) and a downward D‐pattern (earliest LA activation anterior). CT‐data were used to measure the LA volume (LAV). LAV was divided into anterior‐ (LA‐A) and posterior‐parts by a plane, parallel to the posterior wall and between the veins and the appendage, to calculate the asymmetry index (ASI = LA‐A/LAV). Results Patients with U‐pattern (n = 66) had a higher ASI (65 ± 6 vs. 61 ± 3%, p = .014), older age (61 ± 11 vs. 51 ± 11 years, p = .03) and more diastolic dysfunction (71 vs. 22%, p = .008) Multivariate regression showed that age (OR 1.1 per year, CI 1.007–1.199) and diastolic dysfunction (OR 6.36, CI 1.132–35.7, p = .036) were independent predictors of the U‐pattern. Diastolic dysfunction (B 4.49, CI 1.61–7.37, p = .003) was the only independent predictor of ASI in linear regression analysis. Conclusion AF patients with a U‐pattern have an increased LA asymmetry. Diastolic dysfunction is a common cause of this LA activation and remodeling. Therefore, detection of a U‐pattern signifies patients with advanced AF and may facilitate selection for an appropriate ablation strategy.

To analyze the epidemiological data of patients with septic cardiomyopathy and investigate the relationship between ultrasonic parameters and prognosis of patients with sepsis. In this study, we enrolled patients with sepsis who were treated at the Department of Critical Care Medicine in the Beijing Electric Power Hospital (No.1 Taipingqiao Xili, Fengtai District, Beijing) from January 2020 to June 2022. All patients received standardized treatment. Their general medical status and 28-day prognosis were recorded. Transthoracic echocardiography was performed within 24 hours after admission. We compared the ultrasound indexes between the mortality group and the survival group at the end of 28 days. We included parameters with significant difference in the logistic regression model to identify the independent risk factors for prognosis and evaluated their predictive value using receiver operating characteristic (ROC) curve. We included 100 patients with sepsis in this study; the mortality rate was 33% and the prevalence rate of septic cardiomyopathy was 49%. The peak e' velocity and right ventricular systolic tricuspid annulus velocity (RV-Sm) of the survival group were significantly higher than those of the mortality group ( < 0.05). Results of logistic regression analysis showed that the peak e' velocity and RV-Sm were independent risk factors for prognosis. The area under curve of the peak e' velocity and the RV-Sm was 0.657 and 0.668, respectively ( < 0.05). The prevalence rate of septic cardiomyopathy in septic patients is high. In this study, we found that the peak e' velocity and right ventricular systolic tricuspid annulus velocity were important predictors of short-term prognosis.

Background: Dyslipidemia is a major health problem among children and adolescents worldwide due to its significant association with cardiovascular disease. Primary dyslipidemias are commonly familial syndromes that can be completely asymptomatic.Purpose: Apart from the risk of coronary artery disease (CAD), limited data are currently available on the direct effects of dyslipidemia on myocardial function in children.Methods: We recruited 25 children with primary dyslipidemia (14 with isolated hypercholesterolemia, 4 with isolated hypertriglyceridemia, and 7 with combined dyslipidemia). Relevant clinical manifestations and laboratory and radiological investigations were evaluated. Pulsed-wave Doppler and tissue Doppler imaging echocardiography were performed for all recruited patients and the results were compared with those of 15 age- and sex-matched healthy children.Results: The median age of the dyslipidemic children was 8 years (range, 1.5–16 years). A family history was documented in 13 cases (52%), while 18 (72%) had consanguineous parents. None of the dyslipidemic children had a personal history or clinical manifestations of CAD. In contrast, echocardiographic findings differed in several diastolic function parameters of both right and left ventricles in dyslipidemic children compared to controls. Based on normalized z scores, aortic valve narrowing was detected in 7 patients (28%), while narrowing of the aortic sinus (sinus of Valsalva) was detected in 15 patients (60%).Conclusion: Different types of primary dyslipidemia produce functional myocardial abnormalities early in childhood. Biochemical and echocardiographic screening of high-risk children is advised to minimize the incidence of serious cardiovascular complications.

BackgroundAortic stiffness may be associated with an increased incidence of cardiovascular events and has been reported to be related to arterial wall motion velocities as measured by tissue Doppler imaging.ObjectiveTo investigate the potential clinical application of tissue Doppler imaging (TDI) for assessment of aortic function parameters in healthy and hypertensive adults.Methods110 hypertensive and 80 healthy adults were examined. Pulse wave velocity (PWV) and augmentation index (Aix) were measured as standard parameters of arterial stiffness by an oscillometric system. Aortic M-mode and TDI parameters were measured. Aortic distensibility (D) and aortic stiffness index (SI) were calculated using accepted formulae. Anterior wall aortic expansion velocity (SAo), acceleration time (ATAo), early (EAo) and late (AAo) diastolic retraction velocity and peak systolic radial strain (εAo) were determined. Comprehensive echocardiography was performed for the assessment of left ventricular (LV) systolic/diastolic function.ResultsSAo, EAo and eAo were significantly lower in hypertensive subjects (p<.001, p<.001, and p<.0001, respectively). Reduced D (p<.05 vs controls) and increased PWV (p<.05 vs controls) and SI (p<.01 vs controls) were consistent with evidence of increased aortic stiffness in both male and female hypertensive patients. PWV and Aix increased and D decreased with increasing age or systolic blood pressure. Multivariate analysis showed εAo to be independently related (R2 = 0.63) to pulse pressure, LV mass index and diastolic function.ConclusionAscending aorta TDI provides wall velocity and strain data differentiating hypertensive from healthy adults and reflecting aortic compliance changes related to age and sex and LV diastolic function.

Abstract Background Tissue velocity imaging (TVI) is increasingly used in small animal cardiology. Tissue velocity of the myocardial wall can be measured by pulsed wave (PW) or color Doppler (CD) imaging methods. Currently, the same reference ranges are used for PW TVI and CD TVI methods. However, if and how both methods correlate, and whether they can be used interchangeably, have not been assessed in small animals. Objectives To compare the results of PW TVI and CD TVI measurements. Animals Seventy-one healthy dogs. Methods Longitudinal myocardial velocity profiles were recorded from the 4-chamber left apical view. Peak maximal systolic (S), early (E), and late diastolic (A) velocities were measured off-line in a blinded fashion in the septal and lateral left ventricular wall by PW TVI and CD TVI. Differences between peak PW TVI and CD TVI waves were analyzed by a paired t-test. Regression analysis and Bland-Altman difference plots also were used to assess agreement between methods. Results There was a significant correlation between PW TVI and CD TVI (P < .001). However, S, E, and A waves measured by PW TVI were significantly higher than the CD TVI values (P < .001). Peak systolic and diastolic PW velocities were approximately 2.20 cm/s higher than corresponding mean CD TVI velocities. Conclusions and Clinical Importance PW TVI measurements are significantly higher compared with CD TVI measurements. Theses differences are clinically relevant. These methods should not be used interchangeably, and different reference ranges for PW TVI and CD TVI should be used.

Tissue Doppler (TDE), strain, and strain rate echocardiography are emerging real time ultrasound techniques that provide a measure of wall motion. They offer an objective means to quantify global and regional left and right ventricular function and to improve the accuracy and reproducibility of conventional echocardiography studies. Radial and longitudinal ventricular function can be assessed by the analysis of myocardial wall velocity and displacement indices, or by the analysis of wall deformation using the rate of deformation of a myocardial segment (strain rate) and its deformation over time (strain). A quick and easy assessment of left ventricular ejection fraction is obtained by mitral annular velocity measurement during a routine study, especially in patients with poor endocardial definition or abnormal septal motion. Strain rate and strain are less affected by passive myocardial motion and tend to be uniform throughout the left ventricle in normal subjects. This paper reviews the underlying principles of TDE, strain, and strain rate echocardiography and discusses currently available quantification tools and clinical applications.

In advanced heart failure (AHF) clinical evaluation fails to detect subclinical HF deterioration in outpatient settings. The aim of the study was to determine whether the strategy of intensive outpatient echocardiographic monitoring, followed by treatment modification, reduces mortality and re-hospitalizations at 12 months. Methods: 214 patients with ejection fraction < 30% and >1 hospitalization during the last year underwent clinical evaluation and echocardiography at discharge and were divided into intensive (IMG; N = 143) or standard monitoring group (SMG; N = 71). In IMG, volemic status and left ventricular filling pressure were assessed 14, 30, 90, 180 and 365 days after discharge. HF treatment, particularly diuretic therapy, was temporarily intensified when HF deterioration signs and E/e’ > 15 were detected. In SMG, standard outpatient monitoring without obligatory echocardiography at outpatient visits was performed. Results: We observed lower hospitalization (absolute risk reduction [ARR]-0.343, CI-95%: 0.287–0.434, p < 0.05; number needed to treat [NNT]-2.91) and mortality (ARR-0.159, CI 95%: 0.127–0.224, p < 0.05; NNT-6.29) in IMG at 12 months. One-year survival was 88.8% in IMG and 71.8% in SMG (p < 0.05). Conclusion: In AHF, outpatient monitoring of volemic status and intracardiac filling pressures to individualize treatment may potentially reduce hospitalizations and mortality at 12 months follow-up. Echocardiography-guided outpatient therapy is feasible and clinically beneficial, providing evidence for the larger application of this approach.

Background： Hypertension （HT） is associated with atrial electrophysiological abnormalities. Echocardiographic pulsed wave tissue Doppler imaging （TDI） is one of the noninvasive methods for evaluation of atrial electromechanical properties. The aims of our study were to investigate the early changes in atrial electromechanical conduction in patients with HT and to assess the parameters that affect atrial electromechanical conduction. Methods： Seventy-six patients with HT （41 males, mean age 52.6 i 9.0 years） and 41 controls （22 males, mean age 49.8 ± 7.9 years） were included in the study. Atrial electromechanical coupling at the right （PRA）, left （PLA）, interatrial septum （PIS） were measured with TDI. Intra- （right： PIS-PRA, left： PLA-PIS） and inter-atrial （PLA-PRA） electromechanical delays were calculated. Maximum P-wave duration （Pmax） was calculated from 12-lead electrocardiogram. Results： Atrial electromechanical coupling at PLA （76.6 ± 14.1 ms vs. 82.9 ±15.8 ms, P - 0.036）, left intra-atrial （10.9 ±5.0 ms vs. 14.0 ± 9.7 ms, P = 0.023）, right intra-atrial （10.6 ± 7.8 ms vs. 14.5 ± 10.1 ms, P= 0.035）, and interatrial electromechanical （21.4± 9.8 ms vs. 28.3 ± 12.7 ms, P = 0.003） delays were significantly longer in patients with HT. The linear regression analysis showed that left ventricular （LV） mass index and Pmax were significantly associated with PLA （P = 0.001 and P = 0.002, respectively）, and the LV mass index was the only related factor for interatrial delay （1~ = 0.001）. Conclusions： Intra- and interatrial electromechanical delay, PLA were significantly prolonged in hypertensive patients. LV mass index and Pmax were significantly associated with PLA, and the LV mass index was the only related factor for interatrial delay. The atrial TDI can be a valuable method to assess the early changes of atrial electromechanical conduction properties in those patients.

Background: Left ventricular non-compaction (LVNC) may manifest an undulating phenotype ranging from dilated to hypertrophic appearance. It is unknown whether tissue Doppler (TD) velocities can predict adverse clinical outcomes including death and need for transplantation in children with LVNC. Methods and results: 56 children (median age 4.5 years, median follow-up 26 months) with LVNC evaluated at one hospital from January 1999 to May 2004 were compared with 56 age/sex-matched controls. Children with LVNC had significantly decreased early diastolic TD velocities (Ea) at the lateral mitral (11.0 vs 17.0 cm/s) and septal (8.9 vs 11.0 cm/s) annuli compared with normal controls (p<0.001 for each comparison). Using receiver operator characteristic curves, the lateral mitral Ea velocity proved the most sensitive and specific predictor for meeting the primary end point (PEP) at 1 year after diagnosis (area under the curve = 0.888, SE = 0.048, 95% CI 0.775 to 0.956). A lateral mitral Ea cut-off velocity of 7.8 cm/s had a sensitivity of 87% and a specificity of 79% for the PEP. Freedom from death or transplantation was 85% at 1 year and 77% at 2 years. Conclusions: TD velocities are significantly reduced in patients with LVNC compared with normal controls. Reduced lateral mitral Ea velocity helps predict children with LVNC who are at risk of adverse clinical outcomes including death and need for cardiac transplantation.