Eighty-one CHF patients (66 ± 9 years) underwent cardiopulmonary exercise test. Left ventricular (LV) diastolic function was evaluated by transmitral patterns and tissue Doppler. Intraventricular dyssynchrony was calculated according to time intervals between the onset of QRS and the onset of systolic velocities of basal septum and lateral wall. We divided the patients based on the mean value (40 ms) of dyssynchrony. Patients with intraventricular dyssynchrony (>40 ms) showed higher New York Heart Association class (2.7 ± 0.6 vs. 2.2 ± 0.4, P < 0.001), higher brain natriuretic peptide (BNP) (415 ± 478 vs. 194 ± 205, P = 0.014), more frequent restrictive transmitral pattern (33 vs. 7%, P = 0.013), higher E/E_a (13 ± 7 vs. 10 ± 6, P = 0.016), lower mitral annulus peak systolic velocity (4.5 ± 1.1 vs. 5.5 ± 1.5 cm/s, P = 0.01), and peak oxygen consumption (13.8 ± 3.5 vs. 18.1 ± 3.9, P < 0.001), than patients without dyssynchrony (≤40 ms). Predictors of exercise tolerance were intraventricular dyssynchrony (P = 0.035), log BNP (P = 0.003), and E/E_a (P = 0.004).

Intraventricular dyssynchrony correlates with higher LV filling pressure and lower ejection fraction and it is an independent predictor of poor aerobic capacity; it may be helpful for functional evaluation of CHF patients.

We analysed systolic myocardial function by two-dimensional strain (2D-S) and sonomicrometry (SS) in an experimental pig model of aortic banding. Both radial and longitudinal functions were analysed in six open-chest pigs under various loading conditions: baseline and graded aortic banding (subsequent increase in LV pressure of 10, 20, and 40 mmHg). Both systolic 2D-S_long and 2D-S_rad were significantly correlated with SS_long and SS_rad (r = 0.63, P < 0.001 and r = 0.65, P < 0.01, respectively). At a low increase in LV afterload, 2D-S_rad was still preserved whereas 2D-S_long significantly decreased. When LV afterload was subsequently increased, both 2D-S_rad and 2D-S_long significantly decreased. Difference in dependence to wall stress might explain these different behaviours.

2D-S shows a different response in longitudinal and radial functions to increased afterload. Longitudinal function is early impaired, whereas radial function remains preserved. This finding justifies the combined assessment of both radial and longitudinal regional myocardial functions to characterize myocardial dysfunction and might help to better identify the transition to heart failure in pressure-overload cardiomyopathy.

Nine consecutive children scheduled for surgery of CoA were intraoperatively evaluated. Intraoperative 3D data sets were taken and analysed online before resection of the coarctation, showing the cross-sectional area (CSA) of the proximal aorta, coarctation, and the distal descending aorta. After resection of the coarctation and extended end-to-end anastomosis, a 3D data set was recorded to analyse the CSA of the anastomosis. In nine out of nine consecutive procedures, intraoperative 3D echography permitted comprehensive viewing and measuring of CoA and its repair. In three out of nine surgical procedures, intraoperative 3D echography provided additional information to support surgical decision-making.

Intraoperative 3D echography is a feasible non-invasive imaging modality for intraoperative assessment of CoA and its repair, which provides useful additional information.

To determine longitudinal, radial, and circumferential function, three LV short-axis and three LV apical views were acquired in 60 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. Using 2D strain software, end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) were measured in 18 LV segments. No significant differences in LVEF were noted between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with normal subjects. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (26/60) of the diabetic patients showing abnormal global LS values (cut-off value: –17.2, mean – 2SD in control subjects). Basal RS and apical CS were also significantly lower in diabetic patients. Multivariate linear regression analysis showed that diabetic duration was the only independent confounder for the reduction of LS (t = 2.22, P = 0.0313).

In addition to diastolic dysfunction, subclinical LV longitudinal dysfunction is preferentially and frequently observed in asymptomatic diabetes patients with normal LVEF. The decrease in LS correlated with duration of diabetes. 2DSTE has the potential for detecting subclinical LV systolic dysfunction and might provide useful information of the risk stratification in an asymptomatic diabetic population.

Accordingly, a total of 89 consecutive patients undergoing contrast echocardiography and unenhanced echocardiography 7 to 10 days after AMI and reperfusion therapy were followed up for cardiac death (CD) and AMI. LV ejection fraction (LVEF), LV end-systolic volume (ESV), and LV end-diastolic volume were assessed by the two methods independently. Outcome data were obtained (mean 46 ± 16 months).There were 15 (17%) events (eight CDs and seven AMIs). LVEF and ESV with contrast echocardiography were found to be independent multivariable predictors of CD (P = 0.04 and P = 0.02, respectively) and CD or AMI (P = 0.02 and P = 0.01, respectively). Furthermore, LVEF and ESV with contrast echocardiography provided incremental information for the prediction of CD (P = 0.004 and P = 0.004, respectively) and CD or AMI (P = 0.02 and P = 0.03, respectively).

Contrast echocardiography provided improved prediction of outcome compared with unenhanced echocardiography following AMI.

LV tissue velocities were measured in 71 controls and 222 patients with T2DM by pulsed-wave Doppler and colour-coded tissue Doppler (TDI) during systole (S' and S_m) and diastole (early, E' and E_m, and late, A' and A_m) at the basal septum and lateral wall. Both systolic tissue velocities were higher in males than in females within controls (S': 7.3 ± 1.2 vs. 6.6 ± 1.0 cm/s; P = 0.017, S_m: 6.2 ± 1.0 vs. 5.5 ± 0.7 cm/s; P = 0.002) but only by colour-coded TDI in patients with T2DM (S_m: 5.7 ± 1.7 vs. 4.9 ± 1.7 cm/s; P = 0.025). Correction for LV length negated the difference between genders in the controls and patients with T2DM (P > 0.05 for all). In controls, LV length was the strongest predictor of S' (β = 0.393, P = 0.002), whereas height was the strongest predictor of S_m (β = 0.394, P = 0.003).

In controls, systolic tissue velocities are significantly higher in males compared with females, which may be explained by the increased chamber size of men.

Seventy-two adult unoperated MFS patients and 73 controls without significant differences in age, sex, and body surface area from the patient group were studied using two-dimensional, pulsed, and colour-Doppler and tissue-Doppler imaging (TDI). Biventricular early filling measurements were significantly decreased in MFS patients when compared with controls (P < 0.001). Pulsed TDI early filling measurements obtained from five mitral annular regions and over the lateral tricuspid valve corner were significantly reduced in the patient group (P < 0.001). Indices reflecting atrial function at the reservoir, conduit and contractile phases were also significantly decreased in MFS patients (P < 0.001).

This study demonstrated significant biventricular diastolic and biatrial systolic and diastolic dysfunction in MFS patients. Our findings suggest that MFS affects diastolic function independently. Diastolic abnormalities could be attributed to fibrillin-1 deficiency and dysregulation of transforming growth factor-β activity in the cardiac extracellular matrix.

In 50 patients scheduled for coronary angiography and with poor baseline image quality, MCE and LVO were performed during DSE. Regional wall motion was assessed and inter-observer agreement was determined for each imaging modality. The endocardial border score index was similar for both modalities. The wall motion score index (WMSCI) at peak stress using MCE was well correlated with WMSCI obtained with LVO (r² = 0.9, P < 0.001). However, WMSCI at peak stress was underestimated by MCE (1.66 ± 0.58 with DSE-LVO vs. 1.535 ± 0.50 with DSE-MCE; P < 0.001). Inter-observer agreement on the presence of WMA was 0.65 for MCE and 0.67 for LVO at peak stress.

Myocardial contrast perfusion echocardiography provides equal endocardial border delineation compared with LVO modality. Although the inter-observer agreement is slightly higher with LVO compared with MCE, it is not significantly different with MCE at peak stress. Despite the similar improvement in endocardial border delineation, LVO settings allow the detection of more WMA than MCE at peak stress, leading to a significantly higher accuracy for the detection of ischaemia in patients suspected of coronary artery disease when only wall motion is taken into account.

Fifty patients with systolic LV dysfunction underwent 2D and 3D quantitative assessment of LV function, shape, and synchronicity at rest and during symptom-limited exercise test. According to the magnitude of change in MR, patients were divided into EMR group (15 patients, 30%), if the degree of MR increased during test, and NEMR group. During exercise, the changes in LV volumes and ejection fraction were similar in both groups, whereas changes in mitral valvular deformation parameters, in LV sphericity index, and in the extent of LV dyssynchrony were more pronounced in the EMR group. At rest, only the 3D sphericity index could distinguish the two groups. By stepwise multiple regression model, dynamic changes in the systolic dyssynchrony index, sphericity index, and coaptation distance were associated with dynamic MR (r² = 0.45, P = 0.012).

Dynamic MR during exercise is related to the 3D changes in LV shape and in LV synchronicity.

Hundred consecutive patients admitted with acute new-onset decompensated HF and EF <40%, with no clinical or electrocardiographic data suggestive of CAD. The patients were classified according to the presence or absence of significant CAD (stenosis ≥70% in at least one major vessel). Twenty-one patients (21%) had significant CAD. Seventy-nine (79%) had no lesions. Eighteen of the 21 patients (85%) with CAD had subendocardial/transmural LGE. In the diagnosis of CAD, LGE has a sensitivity of 85.7% (95% CI, 80–91) and specificity of 92.4% (95% CI, 87–96), respectively, with a negative predictive value of 96% (95% CI, 90–99). It has an area under the receiver operating characteristic curve of 0.906 (95% CI, 0.814–0.998).

In patients with new-onset HF and LVSD for whom there are no clinical and exploratory data suggestive of ischaemic heart disease, CMR with LGE is an excellent means of ruling out significant CAD and is a valid alternative to angiography.