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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/54\\\/13\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/54\\\/13\u0022}],\u0022ac\u0022:{\u0022spmdc;14\\\/54\\\/13\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;14\\\/54\\\/13\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EEchocardiography and other multimodality imaging tools are invaluable for assessing cardiac structure and function. This technology is being used to assess cardiac mechanics in pericardial diseases, distinguish constrictive pericarditis from restrictive cardiomyopathy, and identify ischemic cardiomyopathy patients. Besides having prognostic value, these tools are useful in the management and treatment of patients with cardiovascular disease.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Etransthoracic echocardiography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiac structure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eejection fraction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epericardial disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emultimodality imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epericarditis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiomyopathy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eischemic heart disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESTICH\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT00023595\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003ETransthoracic echocardiography is now routinely used to evaluate cardiac structure and function; to measure left ventricular ejection fraction (LVEF); to diagnose, manage, and treat heart failure (HF); and to obtain prognostic information in patients with cardiovascular (CV) disease (Class I; Level of Evidence C) [McMurray JJV et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2012]. E. Donal, MD, H\u00f4pital Pontchaillou, Rennes, France, discussed how to interpret different parameters detected by imaging technology in patients with heart failure with preserved ejection fraction (HFpEF).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EHFpEF is a major and growing worldwide health problem that is diagnosed in part with the use of echocardiography. Echocardiography can detect signs of vascular stiffness, cardiac dysfunction, and atrial fibrillation (AF). Signs consistent with HFpEF include LVEF\u2009\u0026gt;\u200950%, left ventricular (LV) filling dysfunction, and increases in left atrial (LA) volume index and LV mass index. LA strain and LA stiffness are the most accurate indices in identifying patients with HFpEF [Kurt M et al. \u003Cem\u003ECirc Cardiovasc Imaging\u003C\/em\u003E. 2009]. Impaired LA function may be a marker of severity of HFpEF and is associated with a higher prevalence of prior HF hospitalization and history of AF, as well as worse LV systolic function [Santos AB et al. \u003Cem\u003EEur J Heart Fail\u003C\/em\u003E. 2014]. Pulmonary hypertension (PH) is present in 83% of patients with HFpEF and the presence of PH can distinguish HFpEF from preclinical hypertensive heart disease and is a strong predictor of mortality [Lam CS et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2009]. Right ventricular (RV) dysfunction (RV fractional area change\u2009\u0026lt;\u200935%) is present in 33% of HFpEF patients and is associated with greater severity, comorbidity, and mortality (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Melenovsky V et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022RVD in HFpEF Patients Associated With Higher MortalityFAC, fractional area change; HFpEF, heart failure with preserved ejection fraction; RV, right ventricule; RVD, right ventricular dysfunction.Reprinted from Melenovsky V et al. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014; Epub ahead of print 29 May 2014. doi:10.1093\/eurheartj\/ehu193. Accessed 12\/19\/2014. By permission of European Society of Cardiology.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1562207347\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;RVD in HFpEF Patients Associated With Higher MortalityFAC, fractional area change; HFpEF, heart failure with preserved ejection fraction; RV, right ventricule; RVD, right ventricular dysfunction.Reprinted from Melenovsky V et al. Right heart dysfunction in heart failure with preserved ejection fraction. \u0026amp;lt;em\u0026amp;gt;Eur Heart J\u0026amp;lt;\/em\u0026amp;gt;. 2014; Epub ahead of print 29 May 2014. doi:10.1093\/eurheartj\/ehu193. Accessed 12\/19\/2014. By permission of European Society of Cardiology.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11580\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ERVD in HFpEF Patients Associated With Higher Mortality\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EFAC, fractional area change; HFpEF, heart failure with preserved ejection fraction; RV, right ventricule; RVD, right ventricular dysfunction.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EReprinted from Melenovsky V et al. Right heart dysfunction in heart failure with preserved ejection fraction. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2014; Epub ahead of print 29 May 2014. doi:10.1093\/eurheartj\/ehu193. Accessed 12\/19\/2014. By permission of European Society of Cardiology.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EReduced LV compliance, RV remodeling, and low tricuspid annular plane systolic excursion are also significant pathophysiologic predictors of adverse outcomes in HFpEF patients [Burke MA et al. \u003Cem\u003ECirc Heart Fail.\u003C\/em\u003E 2014]. Echocardiography is useful for either the diagnosis or exclusion of suspected HF (systolic and diastolic) with the measurement of LV longitudinal systolic function [Vinereanu D et al. \u003Cem\u003EEur J Heart Fail.\u003C\/em\u003E 2005]. Depressed longitudinal and radial deformation indicates diastolic HF [Wang J et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2008]. Longitudinal and circumferential strain detected by strain imaging is significantly (\u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.0001) lower in HFpEF patients (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Kraigher-Krainer E et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Longitudinal and Circumferential Strain Lower in HFpEF PatientsHFpEF, heart failure with preserved ejection fraction; HHD, hypertensive heart disease; LVEF, left ventricular ejection fraction.*P\u0026#x2009;\u0026amp;lt;\u0026#x2009;.0001 compared with controls and between HHD and HFpEF overall for longitudinal strain and circumferential strain. **LVEF-adjusted P\u0026#x2009;\u0026amp;lt;\u0026#x2009;.001 compared with controls. ***P\u0026#x2009;=\u0026#x2009;.0002 compared with controls.Adapted from Kraigher-Krainer E et al. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2014;63:447-456.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1562207347\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Longitudinal and Circumferential Strain Lower in HFpEF PatientsHFpEF, heart failure with preserved ejection fraction; HHD, hypertensive heart disease; LVEF, left ventricular ejection fraction.*\u0026amp;lt;em\u0026amp;gt;P\u0026amp;lt;\/em\u0026amp;gt;\u0026#x2009;\u0026amp;amp;lt;\u0026#x2009;.0001 compared with controls and between HHD and HFpEF overall for longitudinal strain and circumferential strain. **LVEF-adjusted \u0026amp;lt;em\u0026amp;gt;P\u0026amp;lt;\/em\u0026amp;gt;\u0026#x2009;\u0026amp;amp;lt;\u0026#x2009;.001 compared with controls. ***\u0026amp;lt;em\u0026amp;gt;P\u0026amp;lt;\/em\u0026amp;gt;\u0026#x2009;=\u0026#x2009;.0002 compared with controls.Adapted from Kraigher-Krainer E et al. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. \u0026amp;lt;em\u0026amp;gt;J Am Coll Cardiol\u0026amp;lt;\/em\u0026amp;gt;. 2014;63:447-456.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11583\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003ELongitudinal and Circumferential Strain Lower in HFpEF Patients\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EHFpEF, heart failure with preserved ejection fraction; HHD, hypertensive heart disease; LVEF, left ventricular ejection fraction.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003E*\u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.0001 compared with controls and between HHD and HFpEF overall for longitudinal strain and circumferential strain. **LVEF-adjusted \u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.001 compared with controls. ***\u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.0002 compared with controls.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EAdapted from Kraigher-Krainer E et al. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2014;63:447-456.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-12\u0022\u003EHFpEF can be difficult to identify, but exercise echocardiography can play an important role in diagnosis. During exercise, HFpEF patients display lower peak VO\u003Csub\u003E2\u003C\/sub\u003E coupled with significantly blunted increases in heart rate, stroke volume, LVEF, and LV end-systolic volume compared with controls [Abudiab MM et al. \u003Cem\u003EEur J Heart Fail.\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EAllan L. Klein, MD, Cleveland Clinic, Cleveland, Ohio, USA, discussed the use of multimodality imaging to assess cardiac mechanics in pericardial diseases and as well as the use of imaging to distinguish constrictive pericarditis from restrictive cardiomyopathy. Using a case example of a man, aged 47 years, with worsening exertional dyspnea and cough, findings from echocardiography and cardiac magnetic resonance imaging (CMR) revealed organizing pericardial effusion, inferior vena cava plethora, abnormal septal bounce, respiratory Doppler variation, interventricular respirophasic shift, increased pericardial thickness, and the presence of late gadolinium enhancement of pericardium. Dr Klein referred this patient for pericardiectomy and prescribed anti-inflammatory medication until the time of surgery.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003ESurgery revealed constrictive pericarditis, which is very often hard to distinguish from restrictive cardiomyopathy. Tissue Doppler echocardiography has been used successfully to distinguish between these 2 diseases [Rajagopalan N et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E. 2001]. In particular, the ratio between lateral and septal mitral annular velocity is significantly reduced in constrictive pericarditis compared with controls and restrictive cardiomyopathy patients [Choi JH et al. \u003Cem\u003EJACC Cardiovasc Imaging.\u003C\/em\u003E 2011]; moreover, reduced lateral annular velocity is correlated with pericardial thickness.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EConstrictive pericarditis is defined by epicardial tethering and pericardial constraint in fibrotic or inflamed pericardium with LV filling limited to a circumferential direction. Intrinsic myocardial disease with subendocardial dysfunction and LV filling limited to a longitudinal direction defines restrictive cardiomyopathy [Sengupta PP et al. \u003Cem\u003EJACC Cardiovasc Imaging.\u003C\/em\u003E 2008]. CMR shows depressed LV anterolateral wall strain and RV free wall longitudinal systolic strain but preserved LV septal wall systolic strain in constrictive pericarditis patients, which is improved by pericardiectomy [Kusunose K et al. \u003Cem\u003ECirc Cardiovasc Imaging.\u003C\/em\u003E 2013]. There is also a significant inverse correlation between pericardial thickness and respective ventricular strains not seen in restrictive cardiomyopathy patients (strain reverses).\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EAn echocardiography evaluation of LA mechanics in constrictive pericarditis showed impaired mechanics, presumably because of the constrictive tethering process involving the left atrium. Functional improvement in global LA strain parameters were noted following pericardiectomy (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E) [Motoki H et al. \u003Cem\u003EJ Am Soc Echocardiogr.\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Functional Improvement Before and After PericardiectomyGlobal LA longitudinal strain (\u0026#x3B5;) included peak negative strain (\u0026#x3B5;negative), peak positive strain (\u0026#x3B5;positive), and the sum of those values, total LA strain (\u0026#x3B5;total).LA, left atrial.Adapted from J Am Soc Echocardiogr. Vol 26, Motoki H et al. Changes in left atrial mechanics following pericardiectomy for pericardial constriction, 640-648. Copyright (2013), with permission from American Society of Echocardiography.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1562207347\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Functional Improvement Before and After PericardiectomyGlobal LA longitudinal strain (\u0026#x3B5;) included peak negative strain (\u0026#x3B5;\u0026amp;lt;sub\u0026amp;gt;negative\u0026amp;lt;\/sub\u0026amp;gt;), peak positive strain (\u0026#x3B5;\u0026amp;lt;sub\u0026amp;gt;positive\u0026amp;lt;\/sub\u0026amp;gt;), and the sum of those values, total LA strain (\u0026#x3B5;\u0026amp;lt;sub\u0026amp;gt;total\u0026amp;lt;\/sub\u0026amp;gt;).LA, left atrial.Adapted from \u0026amp;lt;em\u0026amp;gt;J Am Soc Echocardiogr.\u0026amp;lt;\/em\u0026amp;gt; Vol 26, Motoki H et al. Changes in left atrial mechanics following pericardiectomy for pericardial constriction, 640-648. Copyright (2013), with permission from American Society of Echocardiography.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11586\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \u003Cp id=\u0022p-17\u0022 class=\u0022first-child\u0022\u003EFunctional Improvement Before and After Pericardiectomy\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EGlobal LA longitudinal strain (\u03b5) included peak negative strain (\u03b5\u003Csub\u003Enegative\u003C\/sub\u003E), peak positive strain (\u03b5\u003Csub\u003Epositive\u003C\/sub\u003E), and the sum of those values, total LA strain (\u03b5\u003Csub\u003Etotal\u003C\/sub\u003E).\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003ELA, left atrial.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EAdapted from \u003Cem\u003EJ Am Soc Echocardiogr.\u003C\/em\u003E Vol 26, Motoki H et al. Changes in left atrial mechanics following pericardiectomy for pericardial constriction, 640-648. Copyright (2013), with permission from American Society of Echocardiography.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-21\u0022\u003EDr Klein concluded that constrictive pericarditis is characterized by perimyocardial tethering involving both the ventricles and atria, decreased global circumferential strain, and preserved longitudinal strain. Regional longitudinal LV and LA strain is impaired in constrictive pericarditis and improves after pericardiectomy as well as with medical therapy.\u003C\/p\u003E\u003Cp id=\u0022p-22\u0022\u003EJae K. Oh, MD, Heart Vascular Stroke Institute, Samsung MC, Korea, focused his presentation on the diagnosis, treatment, and prognosis of dilated cardiomyopathy (DCM). As cardiomyopathy progresses, the LV size increases, ejection fraction (EF) decreases, and mitral regurgitation increases. Echocardiography Core Laboratory analysis of baseline echocardiographic findings from the Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease (STICH) study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00023595\u0026amp;atom=%2Fspmdc%2F14%2F54%2F13.atom\u0022\u003ENCT00023595\u003C\/a\u003E] in ischemic cardiomyopathy patients demonstrated a wide spectrum of LV shape, function, and hemodynamic impairment [Oh JK et al. \u003Cem\u003EJ Am Soc Echocardiogr.\u003C\/em\u003E 2012]. The addition of coronary artery bypass grafting (CABG) to medical therapy reduced mortality, sudden death, and fatal pump failure events. The addition of surgical ventricular reconstruction (SVR) to CABG resulted in no overall benefit, although a subgroup analysis suggested that patients with less dilated LV and better LVEF function benefit more from SVR [Oh JK et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2013]. An examination of methods for measuring LV end-systolic volume index (CMR, radionuclide imaging, and echocardiography) shows good correlation among the imaging modalities (\u003Ca id=\u0022xref-fig-4-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F4\u0022\u003EFigure 4\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F4\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F4.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Echo vs CMR vs RNCMR, cardiac magnetic resonance imaging; Echo, echocardiography; ESVI, end-systolic volume index; RN, radionuclide imaging.Reprinted from Oh JK et al. Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy. Eur Heart J. 2013;34:39-47. By permission of European Society of Cardiology.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1562207347\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Echo vs CMR vs RNCMR, cardiac magnetic resonance imaging; Echo, echocardiography; ESVI, end-systolic volume index; RN, radionuclide imaging.Reprinted from Oh JK et al. Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy. \u0026amp;lt;em\u0026amp;gt;Eur Heart J.\u0026amp;lt;\/em\u0026amp;gt; 2013;34:39-47. By permission of European Society of Cardiology.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 4.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F4.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F4.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 4.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/54\/13\/F4.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11588\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 4.\u003C\/span\u003E \u003Cp id=\u0022p-23\u0022 class=\u0022first-child\u0022\u003EEcho vs CMR vs RN\u003C\/p\u003E\u003Cp id=\u0022p-24\u0022\u003ECMR, cardiac magnetic resonance imaging; Echo, echocardiography; ESVI, end-systolic volume index; RN, radionuclide imaging.\u003C\/p\u003E\u003Cp id=\u0022p-25\u0022\u003EReprinted from Oh JK et al. Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2013;34:39-47. By permission of European Society of Cardiology.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-26\u0022\u003EThere was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause, but patients receiving only CABG had lower rates of death from CV causes and of death from any cause or hospitalization for CV causes compared with medical therapy alone [Velazquez EJ et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-27\u0022\u003EThe presence of 3-vessel coronary artery disease, EF below the median (27%), and end-systolic volume index above the median (79 mL\/m\u003Csup\u003E2\u003C\/sup\u003E) influenced these findings [Panza JA et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2014]. After \u2265\u20092 years, patients with 2 to 3 prognostic factors had reduced mortality with CABG compared with those who only received medical therapy. SVR added to CABG reduced LV volume but did not decrease the rate of death or hospitalization for cardiac causes, compared with CABG alone [Jones RH et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-28\u0022\u003ETwo novel imaging tools are global longitudinal strain, (GLS) CMR, cardiac magnetic resonance imaging; often used to measure LV longitudinal deformation, and speckle tracking echocardiography. GLS is a good prognostic tool for predicting major adverse cardiac events and is superior to LVEF [Kalam K et al. \u003Cem\u003EHeart.\u003C\/em\u003E 2014]. Speckle tracking echocardiography is a sensitive method for assessing ventricular function and may detect myocardial dysfunction in sepsis cases not seen with conventional echocardiography [Orde SR et al. \u003Cem\u003ECrit Care.\u003C\/em\u003E 2014]. Prof Oh concluded that echocardiography is a reliable tool for detecting DCM, as well as useful for guiding treatment.\u003C\/p\u003E\u003Cp id=\u0022p-29\u0022\u003EMyocardial function assessment in ischemic heart disease depends on a good understanding of cardiac mechanics. The complex interplay between the tissue structure\/shape, force development, cavity pressure development, ejection by wall deformation, and the potential to adapt to changing circumstances is of great importance when diagnosing CV abnormalities. B. Bijnens, MD, Instituci\u00f3 Catalana de Recerca i Estudis Avan\u00e7ats, Barcelona, Spain, reviewed the mechanics and physiology of ischemic heart disease, and discussed important points to consider when using this information for the assessment of ventricular function.\u003C\/p\u003E\u003Cp id=\u0022p-30\u0022\u003EAs an example, he noted that strain rate imaging indices (myocardial strain and strain rate) are useful in detecting the magnitude and rate of myocardial deformation in asymptomatic patients with severe mitral regurgitation. Estimation of myocardial shortening and thickening reflect the radial mechanics of the heart and provide a sensitive means for detecting regional myocardial dysfunction, including ischemia. Formulas have been developed to identify patients at risk of myocardial damage based on passive load, tissue elasticity, and regional deformation.\u003C\/p\u003E\u003Cp id=\u0022p-31\u0022\u003EAcute ischemia causes systolic deformation, which leads to postsystolic thickening. Increased afterload significantly worsens regional systolic and diastolic dysfunction, while progression of regional ischemia results in the loss of relaxation.\u003C\/p\u003E\u003Cp id=\u0022p-32\u0022\u003EIschemia followed by reperfusion results in myocardial edema (myocyte swelling and myofibrillar edema) and stunning, or contractile abnormality due to changes in force development [Bragadeesh T et al. \u003Cem\u003EHeart.\u003C\/em\u003E 2007]. The identification of an acute increase in regional wall thickness in a reperfused infarct zone by cardiac ultrasound can be useful for monitoring the presence, extent, and resolution of the edema associated with reperfusion injury [Turschner O et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2004].\u003C\/p\u003E\u003Cp id=\u0022p-33\u0022\u003EProf Bijnens concluded that deformation is linked to cardiac force, perfusion, and flow\/functional reserves. When there is a difference in force development or deformation in neighboring segments, postsystolic deformation increases. Systolic deformation decreases with decreasing flow and increased transmural fibrosis and myocardial stiffness.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/54\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzob5d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzob5d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}