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Echocardiographic examinations

—Echocardiographic examinations

Transthoracic examination
TEE - views
Stress echocardiography
Contrast echocardiography
Cardiac asynchrony
Strain Imaging
3D | 4D echo
Indications for echocardiography
Training in echocardiography

—Cardiac function and PA pressure

—Examples of pathological

Strain Imaging: assessment of myocardial mechanics

Guidelines and Standards
Evaluation of Cardiac Mechanics Consensus Statement, 2019

Strain: myocardial deformation (strain) can be assessed with this tool. It can be obtained based on Tissue Doppler Imaging (TDI) or on bidimensional images (speckle tracking). TDI allows better time definition and can be also used in case of poor echocardiographic windows. Analyses from bidimensional images allow assessment of radial and circumferencial strain, as well as apical and basal rotation, needed to calculate ventricular torsion. Lowest normal values of global longitudinal strain (GLS) is -17.8% in women and -16.7% in men.

Strain rate: rate of myocardial deformation in time. Units are expressed in number/second or %/second. Diastolic myocardial deformation can be assessed more clearly in this way. Normal values of longitudinal LV deformation are 1 - 1.5/s or higher.

Normal strain: values of myo- cardial deformation at systole lie here around -25 % on the lateral segments of the left ventricle. Color encoded dynamic bidimen- sional image helps to visualize strain, red stands here for -20 %.

Pathological strain: values of myocardial deformation at systole lie here around -7 %, being consequently very reduced. This case is a proven myocardial invol- vement in systemic amyloidosis.

Normal strain rate: values of diastolic myocardial deformation in this normal heart lie between 1.3 and 1.7/s.

Pathological strain rate: this former amyloidosis case shows also a severe impairment of longitudinal diastolic myocardial deformation, with values around 0.6/s.

2D Speckle-Tracking Strain

The longitudinnal strain in this case is normal.

In this case, the longitudinal strain is mildly reduced, especially septal basal.

Here is an example of a moderate reduction of the longitudinal strain, especially mediobasal, in a case of cardiac compromise by systemic light-chain amyloidosis. The apical segments show normal values (relative apical sparing).

The longitudinal strain is in this case severely diminished, especially mediobasal, in a case of cardiac compromise by systemic light-chain amyloidosis.

The longitudinal strain in this case is reduced, especially medioapical, in an apical form of hypertrophic cardiomyopathy.

Alternative methods for the assessment of longitudinal strain

Feature-Traking Strain is comparable to 2D Spekle-Tracking Strain:
Left ventricular mechanics assessed by two-dimensional echocardiography and cardiac magnetic resonance imaging: comparison of high-resolution speckle tracking and feature tracking, 2016

The longitudinal Unidimensional Strain (ULS) is comparable to 2D Speckle-Tracking Strain:
Unidimensional Longitudinal Strain: A Simple Approach for the Assessment of Longitudinal Myocardial Deformation by Echocardiography, 2018

Longitudinal LV function may be assessed by the measurement of the anterior movement of the aortic root in systolen:
Pathophysiological background and prognostic implication of systolic aortic root motion in non-ischemic dilated cardiomyopathy, 2019


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