Geert Kleinnibbelink

Acute Cardiac Responses vs. Cardiac Remodelling 3 71 chamber quantification. 17 Regarding the right heart, we examined the following structural and functional indices: basal andmid-cavity end-diastolic diameters, RV end-diastolic area (RVEDA), RV end-systolic area (RVESA), RV outflow tract (RVOT) diameter at the proximal level in the parasternal long-axis (RVOT PLAX) and the proximal and distal portion in the parasternal short-axis (PSAX) view (RVOT1 and RVOT2, respectively), right atrial (RA) area, RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and tissue doppler imaging (TDI) of the tricuspid annulus (‘s, e’, a’). Regarding the left heart, the following structural and functional indices were determined: biplane LV end-diastolic volume (LVEDV), biplane LV end-systolic volume (LVESV), LV mass, relative wall thickness (RWT), LV wall thickness (IVSd, septal; PWd, posterior), LV internal diameter (LVIDd), LA diameter, LA volume, modified Simpson’s left ventricular ejection fraction (LVEF), tissue Doppler imaging (TDI) of the mitral annulus (s’, e’ and a’), trans-mitral Doppler (E, A and E/A ratio). All RV and LV structural indices were allometrically scaled to body surface area (BSA) according to the laws of geometric similarity. 18 Mechanics . Images were acquired specifically for offline speckle tracking analysis. This involved the optimization of frame rates between 40 and 90 frames s − 1 , depth to ensure adequate imaging of the chamber of interest and compression and reject to ensure endocardial delineation. The RV focused and the apical two-chamber, four-chamber and long-axis view were utilized for the RV free wall (RVFWS) and LV global longitudinal strain (LVGLS), respectively. Valve closure times were determined from the respective pulsed wave Doppler signals. For both the RV and LV the myocardium was manually traced to include the septum and adjusted so that the region of interest (ROI) incorporated all of the wall thickness, while avoiding the pericardium. 19, 20 The region of interest was divided into six myocardial segments, providing segmental strain curves. LV global longitudinal strain was obtained by averaging the 18 segments of the three separate apical LV views and global RV strain from three segments of the RV free wall. Where inappropriate tracking of segments was observed visually or detected by the system, retracing was performed until all segments were considered acceptable. RV strain-area and LV strain-volume loops . The longitudinal strain-area/volume relationship (for methodology of derivation, see Supplemental 1, Oxborough et al. 6 and Hulshof et al. 21 ) was assessed using the following parameters ( Figure 2 ): (a) early linear slope during