The influence of accessory pathway localization on left ventricular mechanics in adult patients with Wolff-Parkinson-White syndrome: a speckle-tracking echocardiographic investigation
Jul 2026· Quantitative Imaging in Medicine and Surgery· Vol 16, pp. 629-629· 0 citations· 26 references
Medicine
Abstract
Background Ventricular pre-excitation can cause left ventricular (LV) mechanical dyssynchrony and dysfunction. However, the specific impact of accessory pathway (AP) location on LV mechanics remains incompletely characterized. This study utilized two-dimensional speckle-tracking echocardiography (2D-STE) to quantify and compare LV deformation and synchrony across these anatomical subgroups. Methods We retrospectively analyzed 91 patients with Wolff-Parkinson-White (WPW) syndrome (age 38.2±1.4 years) and 56 matched controls using 2D-STE. Global and regional LV deformation and synchrony were compared across AP-location groups: septal (n=34), right (n=38), and left (n=19). LV deformation parameters included circumferential strain (CS), longitudinal strain (LS), and radial strain (RS). LV synchrony was assessed by peak strain dispersion (PSD) of LV segments for each strain direction. Results All patient groups (septal: −19.0%±0.7%, right: −19.3%±0.6%, and left AP: −19.2%±0.8%) had lower global CS (GCS) compared with controls (−23.1%±0.4%, all P<0.001). The septal AP group showed lower global LS (GLS) (−17.2%±0.5%), global RS (GRS) (30.1%±2.0%), and prolonged GLS-PSD (51.3±3.1 ms) than the left AP group and controls (P<0.05). The right AP group exhibited lower GLS (−17.5%±0.5%) than the left AP group (−19.6%±0.5%, P<0.05) and prolonged GLS-PSD (46.7±2.5 ms) compared with controls (31.6±1.1 ms, P<0.001). The left AP group showed GLS (−19.6%±0.5%), GRS (40.0%±2.6%), and GLS-PSD (40.1±2.3 ms) that were not significantly different from controls (all P>0.05). LV ejection fraction (LVEF) was lower in septal (59.2%±1.2%) and right AP groups (59.8%±1.0%) vs. controls (65.0%±0.3%; P<0.001). LVEF correlated negatively with GLS (r=−0.53, P<0.001) and with GLS-PSD (r=−0.41, P<0.001). Conclusions LV mechanical dysfunction in WPW syndrome varies by AP location. Septal and right APs lead to widespread strain impairment, dyssynchrony, and lower LVEF, whereas left APs mainly reduce CS. Reduced LVEF is closely associated with impaired LV mechanics and dyssynchrony.
Background:Idiopathic premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT) are associated with subclinical ventricular dysfunction despite preserved conventional systolic indices. Indeed, several studies have shown that speckle-tracking echocardiography (STE) enables sensitive assessment of longitudinal myocardial mechanics and may detect early functional recovery after catheter ablation.Methods:This pre–post observational study included 26 adults with an idiopathic RVOT PVC burden >15% who underwent catheter ablation. A STE and 24-hour Holter monitoring were performed at baseline and 3 months to assess left ventricular global longitudinal strain (LV-GLS), right ventricular free-wall longitudinal strain (RVFWLS), and right ventricular four-chamber longitudinal strain (RV4CLS). Associations between PVC burden reduction (ΔPVC%) and changes in strain were evaluated using correlation analyses, threshold-based comparisons, and exploratory multiple linear regression models adjusted for baseline strain and baseline PVC burden.Results:The study included 26 patients with a mean age of 46.7 ± 10.4 years; 23 patients (88.5%) were women. PVC burden decreased from a median of 20.5% (interquartile range [IQR] 17.8–20.5) at baseline to 1.5% (IQR 1–5.3) at 3 months. Furthermore, all strain indices improved significantly, including LV-GLS (−17.8 ± 3.4 to −20.9 ± 3.5), RVFWLS (−23.1 ± 4.3 to −28.3 ± 4.3), and RV4CLS (−18.9 ± 3.8 to −23.3 ± 3.6) (all p < 0.001). Greater ΔPVC% correlated with recovery in LV-GLS (Spearman’s rs = −0.51; p = 0.008) and RVFWLS (Spearman’s rs = −0.49; p = 0.010), but not with RV4CLS. Patients achieving a ΔPVC% ≥80% demonstrated greater improvement in LV-GLS and RVFWLS. In exploratory multiple linear regression models, ΔPVC% remained associated with recovery in LV-GLS and RVFWLS, but not with RV4CLS.Conclusions:Catheter ablation of idiopathic RVOT PVCs was associated with significant improvement in biventricular longitudinal strain at 3 months. A higher reduction in PVC burden was associated with greater improvements in LV-GLS and RVFWLS, suggesting that suppression of ectopic burden may be linked to early mechanical recovery. Given the observational pre–post design and modest sample size, these findings should be interpreted as associative and hypothesis-generating.
A. Yudha, Rille Puspitoadhi Harjoko, A. Y. B. Mochtar et al.· Heart Surgery Forum· 0 citations
Abstract Objectives This study aimed to evaluate predefined two-dimensional speckle-tracking parameters (2D-STE) to distinguish between growth-restricted fetuses (FGR) and healthy controls (FC) and to identify novel parameters using an exploratory approach. Methods The study comprised 112 fetuses, 56 in the FGR cohort and 56 gestational-age-matched healthy fetuses in the FC cohort. We analyzed global longitudinal strain (GLS), as well as segmental strain, displacement, and velocity using 2D Cardiac Performance Analysis software. Dyssynchrony (DYS) was calculated as the difference in time to peak of GLS or segmental parameters inter- and intraventricular. We also measured changes in ventricular length, diameter and area. Additionally, we tested a prototype software with a tracked M-mode approach, which measured annular displacement. Results Dyssynchrony parameters were generally higher in the FGR cohort than in the FC cohort. Particularly the GLS-DYS was noticeably higher in the FGR cohort than in the FC cohort (median 19.85 vs. 8.40 ms; p<0.001). Also strain-dyssynchrony, displacement- and velocity-dyssynchrony were increased. FGR fetuses showed right ventricular alterations with lower RV-GLS and reduced longitudinal shortening and area change (25.58 vs. 22.06; p=0.040; 0.75 vs. 0.78; p=0.015; 0.58 vs. 0.67; p=0.024), while LV-GLS and LV-geometry did not differ noticeably. The prototype software did not sufficiently discriminate between groups. Conclusions FGR was associated with higher cardiac dyssynchrony and altered right-ventricular function and geometry. GLS-based dyssynchrony may complement Doppler for risk stratification and monitoring in suspected placental insufficiency. These results should be considered in the context of the limited sample size. Prospective studies with larger cohorts should validate these parameters and establish standardized reference values.
Jana Rarbach, Georg Schummers, A. Burgmair et al.· Journal of Perinatal Medicin...· 0 citations
Background: Cardiac amyloidosis is characterized by progressive myocardial infiltration leading to ventricular dysfunction. While left ventricular strain assessment is well established, evaluation of right ventricular (RV) mechanics remains challenging because of the ventricle’s complex geometry and limitations of conventional speckle-tracking methods. We aimed to evaluate an alternative approach for RV strain assessment based on a continuous biventricular tracking pathway within the apical four-chamber view. Methods: We retrospectively studied 32 patients with cardiac amyloidosis and 32 age-, sex-, rhythm-, and ejection fraction–matched controls. RV free-wall longitudinal strain was measured using a novel investigational biventricular tracking approach from the basal RV free wall through the apex to the basal lateral left ventricular wall and compared with conventional RV strain. Investigational biventricular strain (BVS) was also obtained automatically as a surrogate marker of global ventricular function. Reproducibility was assessed in a subset of 20 patients using intraclass correlation coefficients (ICC), coefficient of variation (CV), and Bland–Altman analysis. Results: Investigational RV free-wall strain was significantly reduced in patients with cardiac amyloidosis compared with controls (−15.3 ± 4.1% vs. −21.2 ± 5.4%, p < 0.001). Compared with conventional RV strain, the investigational biventricular tracking approach yielded more negative global RV strain values in both patients with amyloidosis (−15.3 ± 4.1% vs. −13.8 ± 4.8%, p = 0.003) and controls (−21.2 ± 5.4% vs. −17.4 ± 5.8%, p < 0.001). The greatest differences were observed at the apical RV segment. Bland–Altman analysis demonstrated a mean bias of −2.64 percentage points with 95% limits of agreement from −8.41 to +3.12 percentage points. A significant regional deformation pattern along the investigational tracking contour was observed in patients with cardiac amyloidosis (p < 0.001), whereas no significant regional variation was observed in controls. BVS correlated strongly with LV global longitudinal strain (r = 0.83 in amyloidosis; r = 0.58 in controls; r = 0.84 overall; all p < 0.001). Inter- and intra-observer reproducibility of investigational RV free-wall strain was excellent (ICC 0.976 and 0.985, respectively). Conclusions: The investigational biventricular tracking approach is a feasible and highly reproducible method for assessing ventricular longitudinal deformation using a single continuous contour. It provides complementary information while remaining an exploratory investigational technique. Further studies are required to validate its anatomical specificity, clinical applicability, and prognostic value.
M. Leitman, Vladimir Tyomkin, Shmuel Fuchs· Clinics and Practice· 0 citations
Even in the absence of cardiovascular pathology, a finely tuned interaction can be observed between regional LV deformation, especially with LV-LS and the size of the ascending aorta in healthy individuals.
A. Nemes, N. Ambrus, C. Lengyel· Medicina· 0 citations
This study used layer-specific speckle-tracking imaging (LS-STI) to investigate alterations in the left ventricular transmural contractile gradient and its correlation with septal flash (SF) parameters in patients with complete left bundle branch block (CLBBB). This study included 116 CLBBB patients (37 without SF, 79 with SF) and 40 matched controls. Using LS-STI, we measured the left ventricular global longitudinal systolic peak strain (GLS) and the longitudinal systolic peak strain of the endocardial, mid-myocardial, and epicardial layers (GLS-Endo, GLS-Mid, and GLS-Epi). The strain gradient through the left ventricular wall (transmural gradient, TG) was subsequently calculated. Spearman correlation analysis was used to determine the correlations of SF amplitude and SF duration with systolic strain parameters, particularly the TG. Compared with the non-SF group, the SF group had lower myocardial systolic longitudinal strain in all layers (GLS-Endo: -16.83 ± 4.89% vs. -20.88 ± 3.24%; GLS-Mid: -14.71 ± 4.38% vs. -18.24 ± 2.80%; GLS-Epi: -12.77 ± 3.84% vs. -15.82 ± 2.44%) and transmural gradient (TG: 4.05 ± 1.19 vs. 5.06 ± 1.09) (all P < 0.05). TG was negatively correlated with both SF amplitude and SF duration (r = -0.25, P = 0.027 for amplitude; r = -0.47, P < 0.001 for duration). In CLBBB patients with SF, the left ventricular transmural contractile gradient was more severely impaired, and SF duration was moderately correlated with layer‑specific strain and the transmural gradient. However, its independent or incremental predictive value needs to be further validated.
Jie Xiao, Hongda Su, Wanqing Hou et al.· Scientific Reports· 0 citations
There are no significant correlations between AAPSE and LV rotational parameters, but the trends observed in subgroup analyses could serve as hypothesis-generating observations for future studies.
A. Nemes, Barbara Bordács, N. Ambrus et al.· Journal of Clinical Medicine· 0 citations
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