Page 95 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

continuous wave Doppler images were acquired and stored digitally for offline analysis (EchoPac BT13; GE Medical Systems, Horten, Norway). LVEF was calculated using the Simpson’s biplane method of discs. The WMSI was defined as the total sum of the segmental scores divided by the number of segments scored.17 Valvular morphology and function were assessed with 2D, color and pulsed and continuous wave Doppler echocardiography following contemporary recommendations.18 Finally, LV diastolic function was assessed with transmitral flow pulsed-wave recordings and the peak early (E) and late (A) diastolic velocities as well as the E-wave deceleration time were measured. The measurement of E´ was performed with tissue Doppler imaging at the septal and lateral location of the mitral annulus in the apical 4-chamber view.19
Two-dimensional speckle tracking echocardiography. From the apical 4-,
2- and long-axis views of the left ventricle, 2D-STE was applied to perform a layer- 5 specific analysis (endocardial, mid-myocardial and epicardial) of GLS. The endocardial
and epicardial borders were manually traced at end-systole and the region of interest
including the entire LV myocardial wall. Mid-myocardial (which represents the full wall
strain) is obtained as an average of the endocardial and the epicardial.54 The software automatically tracks and accepts segments of good tracking quality and rejects poorly
tracked segments, while allowing the observer to manually override its decisions
based on visual assessment of tracking quality. LV GLS was obtained as the average
of longitudinal strain of 17 segments. Subsequently, the software allows for analysis
of the global and regional LV longitudinal strain of the 3 different layers: endocardial, mid-myocardial and epicardial. Layer-specific GLS values are obtained as the average
of longitudinal strain of 17 segments at each layer.
Study endpoint
Patients were followed-up for from baseline to 6 months follow-up. All patient received an echocardiogram at follow up and were evaluated for the occurrence of LV adverse remodeling which was defined as an increase of ≥20% in LV end-diastolic volume when compared to the baseline echocardiogram.6
Statistical analysis
Continuous variables were presented as mean±standard deviation for normally distributed variables, and median (interquartile range) for non-Gaussian variables. Continuous variables were compared with the unpaired Student’s t-test, analysis of variance and Wilcoxon rank sum test, as appropriate. Categorical data are summarised as frequencies and percentages, and compared using the χ2 test. Uni- and multivariable logistic regression analyses were performed to determine independent correlates of LV adverse remodeling at 6 months follow-up. Variables with p-values <0.2 on univariable
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