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• W54132292 abstract "In contemporary clinical cardiology practice, echocardiography plays a leading role in thediagnosis and management guidance of various forms of myocardial remodelling.Furthermore, it is the most commonly used diagnostic technique in the elucidation of theunderlying substrates and pathophysiologic mechanisms of heart failure as a consequenceof ventricular remodelling. Due to its widespread availability, non-invasiveness, userfriendlinessand relatively low cost, echocardiography is still irreplaceable by other cardiacimaging methods which should rather be seen as complementary diagnostic tools.This thesis sought to study several types of ventricular remodelling and theirconsequences on regional and global myocardial function, employing differentechocardiographic tools and dedicated signal and image analysis algorithms in the detectionof ventricular dysfunction.Recent echocardiographic techniques based on Myocardial Velocity Imaging haveprovided the possibility of a more detailed and integrated insight to cardiac (dys-) function.Based on novel understandings, we first gave an original integrated overview on ‘cardiacfunction’, distinguishing intrinsic myocyte function (often referred to as contractility) andventricular pump function as well as the main components of function, namely forcedevelopment and deformation. Additionally, the boundary conditions in which the heartfunctions, which determine the interactions between these components were defined as: a)wall properties such as tissue composition/elasticity, fibre structure and global geometry, andb) interaction between the heart and peripheral circulation, mostly described as (pressure &volume) loading conditions.Furthermore, Doppler echocardiography data were analyzed in a study addressing flowremodelling as a consequence of cellular and force remodelling in ischaemically remodelledhearts. A dedicated automated quantification of the CW outflow Doppler traces was used todefine specific trace parameters indicative of myocardial dysfunction. It was shown thatdecreased overall contractility results in a more symmetrical outflow velocity profile, whichwould suggest that the global development of contractile force has been remodelled to copewith the decreased output resulting from decreased contractility.Similar automatic quantification of the aortic instantaneous peak velocities was furtheremployed in patients with hypertrophic remodelling due to aortic stenosis. This study hasshown that the values of trace asymmetry before surgery are predictive of the change in EF112pre- and postoperatively: all of the patients with markedly symmetric preoperativeinstantaneous peak velocities showed stagnation or deterioration of EF postoperatively.Furthermore, the study has proven that the symmetry of the shape of the instantaneous peakvelocities is a more reliable predictor of functional improvement after the valve replacementprocedure as compared to mean aortic gradient and aortic valve area which are widely usedin preoperative assessment of patients with aortic stenosis.An intraoperative Doppler myocardial imaging study was performed along with standardechocardiography in an analysis of electrical remodelling in patients with LBBB during theCRT implantation procedure. In addition to confirming the septal flash as a mechanicalconsequence of the underlying electrical problem and a valid marker of intraventriculardyssynchrony, an acute contractility recruitment, resolution of the septal flash as well asreverse remodelling immediately following CRT device activation was shown in thesepatients.As opposed to remodelling induced by changes in loading conditions, evidence ofhypertrophy and hypercontractility without an additional change in afterload resulting inincreased cardiac output and inducing additional signs of vascular remodelling wasdemonstrated in patients with early stage acromegaly.Finally, a comprehensive view on the changing role of echocardiography in the diagnosisof hypertrophic myopathies is presented. Previous knowledge as well as regionaldeformation data (including deformation pattern analysis) are combined to provide anindicator toward the disease underlying hypertrophic ventricular remodelling: in hypertensiveheart disease LVH is predominantly localized in the basal septal region showing reducedsystolic strain values with post-systolic shortening; systemic diseases such as Fabry’sdisease often affect a specific region - the basal (infero)lateral segment in which post-systolicdeformation is often present. Hypertrophic cardiomyopathy is associated with regions of localfibre disarray, in which no myocardial deformation is present at all, while in the surroundingsegments (often showing similar thickness) deformation is reduced, but almost normal ascompared to undiseased hearts. The absence of deformation is mostly associated with thethickest segments. Amyloidosis seems to provide an exception in which the impairment ofsystolic function affects the myocardium globally – it is presented with global LVH anddiffuse, severe reduction of longitudinal strain, while the radial strain is still preserved, but oflow values." @default.
• W54132292 created "2016-06-24" @default.
• W54132292 creator A5065688556 @default.
• W54132292 date "2009-12-18" @default.
• W54132292 modified "2023-09-27" @default.
• W54132292 title "A study of regional and global myocardial morphology and function in various substrates of cardiac remodelling [Ispitivanje regionalne i globalne morfologije te funkcije miokarda u različitim oblicima srčanog remodeliranja]" @default.
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