الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 142 |  |  |
| | | from | 142 | | |
Abstract
Background:
The high morbidity and mortality in heart failure represents a serious
public health issue. Novel technologies have been used aiming to improve
diagnosis and the therapeutic approach. In this context, speckle tracking
echocardiography (STE) uses natural myocardial markers to analyze the
systolic deformation of the left ventricle (LV).
Objective:
The main aim of this study was to measure the longitudinal strain
(ɛ sys) and strain rate (SR) of the LV through STE in patients with HF,
comparing the results with normal individuals and with echocardiographic
parameters established for the analysis of LV systolic function, in
addition to functional status. And to correlate these results with galectin-3
level.
Methodology:
This study included a total of 66 subjects. 19 subjects formed a
control group (group CG). 47 patients with heart failure; 23 of which
were diagnosed with HFpEF (group PG) and 24 were diagnosed with
either HFrEF of HFmrEF (group RG), the mean age for group PG (HFpEF) was 55.22±10.13 years and the mean age for group RG
(HFrEF + HFmrEF) was 56.71±8.55 years. group PG included 13 males
(56.5%) and 10 females (43.5%), while group RG included 15 males
(62.5%) and 9 females (37.5% . 19 individuals were subjected as controls
(group CG) in the study with a mean of 40.37±7.27 years. This group
included 14 males (73.7%) and 5 females (26.3%). The following
variables were studied: LV ɛ sys, SR, obtained by STE. LV volumes and
ejection fraction calculated by two–dimensional echocardiography,
Doppler parameters and E/è using tissue Doppler at the mitral annulus.
Results:
Regarding Conventional 2D Echocardiography:
A highly significant difference was present between group RG,
group PG and group CG as regard IVSD, LVPWD and left atrium
dimension. Also, a highly significant difference was present between
group RG and group PG as regard LVEDD.
Moving to mitral Doppler inflow and by comparing group RG with
group CG; a highly significant difference was present as regard peak E
velocity and E/A ratio. In addition, a significant difference was observed between group PG and group RG as regard peak E velocity, peak A
velocity and E/A ratio. Also, a significant difference between group CG
and group PG was present as regard peak E velocity, peak A velocity and
E/A ratio.
Regarding Mitral Annular TDI Echocardiography:
Evaluation of systolic function:
The septal è velocity demonstrated a stepwise decrease from group
CG to group PG to group RG, the difference was statistically significant
among the three groups.
Evaluation of diastolic function:
A statistically significant differences were found among the three
groups regarding DTI-derived indices indicating abnormal LV relaxation.
Septal, Lateral and Em peak velocities demonstrated a stepwise decrease
from group CG to group PG to group RG and that difference was
statistically significant. While E/è ratio results of group CG (Controls)
were significantly lower than those of the other two groups (HF patients).
The latter two groups (PG & RG) showed E/è ratio results that were
nearly similar.
Regarding LV Deformation Analysis:
Analysis of LV peak systolic longitudinal strain (Ses):
Comparing the three groups as regard longitudinal peak systolic
strain demonstrated a stepwise decrease of cumulative peak systolic strain
of the anterior, inferior, lateral, septal, posterior and anteroseptal walls as
well as global LV strain from group CG to group PG to group RG. When matching group PG with group CG there was a highly significant
reduction of the mean value of global LV strain as well as cumulative
longitudinal peak systolic strain of septal, lateral, inferior and posterior
walls. Comparing group RG with group CG, there was a highly
significant reduction of the mean value of cumulative longitudinal peak
systolic strain of septal and posterior walls.
Analysis of LV peak systolic strain rate (SRs):
Regarding peak systolic strain rate (SRs [s-1]) between the three
groups there was a stepwise reduction of cumulative peak systolic strain
rate of the anterior, inferior, lateral, septal, posterior and anteroseptal
walls along with global LV strain rate from group CG to group PG to
group RG. Comparing group CG with group RG, there was a significant
reduction of the mean value of cumulative peak SRs (s-1) of global LV,
lateral, inferior and posterior walls. While comparing group CG with
group PG, there was a reduction of the mean value of cumulative peak
SRs (s-1) of global LV, lateral, inferior and posterior walls. But the
reduction was to a lesser extent than the comparison between group CG
and group RG.
Analysis of LV early diaststolic strain rate (SRe):
Comparing the three groups demonstrated a stepwise reduction of
the mean value of cumulative SRe (s-1) of the anterior, inferior, lateral,
septal, posterior and anteroseptal walls and global LV from group CG to group PG to group RG. When matching group CG with group RG, there
was a highly significant reduction of the mean value of cumulative SRe
(s-1) of the septal, inferior and anterior walls and global LV. In addition,
there was a significant reduction of the mean value of cumulative SRe
(s-1) of the lateral, posterior and anteroseptal walls. Comparing group CG
with group PG, there was a significant reduction of the mean value of
cumulative SRe (s-1) of posterior and anteroseptal walls as well as global
LV SRe.