1. Myocardial strain imaging : theory, current practice, and the futureOtto A. Smiseth, Oliver Rider, Marta Cvijić, Ladislav Valkovič, Espen W. Remme, Jens-Uwe Voigt, 2025, review article Abstract: Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.
Keywords: cardiac magnetic resonance, cardiomyopathy, myocardial function, myocardial work, speckle-tracking echocardiography, strain
Published in DiRROS: 08.01.2026; Views: 403; Downloads: 94
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2. Multi-modality approach to detect device-related thrombus after left atrial appendage occlusion : a case reportHamady Ibrahim Maiga, Jana Ambrožič, Borut Jug, Marta Cvijić, 2025, other scientific articles Abstract: Background: There has been a growing interest in using left atrial appendage occlusion (LAAO) for stroke prevention in patients with atrial fibrillation (AF) who are ineligible for oral anticoagulation. However, device-related thrombus (DRT) may occur after LAAO implantation and poses significant diagnostic and treatment challenges. Case summary: We describe a case of a patient who suffered an intracranial pontine haemorrhage while on anticoagulation with rivaroxaban for permanent atrial fibrillation and successfully underwent implantation of the LAAO device. Early follow-up transoesophageal echocardiography (TOE) with 3D multi-plane reconstruction revealed a large echo-dense mass on the left atrial aspect of the device. Cardiac computed tomography angiography confirmed a thrombus adherent to the LAAO device. After deciding on the treatment strategy, complete thrombus resolution was achieved at the 6 months follow-up and the patient was free of any thromboembolic and bleeding events. Discussion: Although DRT is a rare complication following LAAO procedure, an accurate diagnosis is crucial for the specific treatment. Multi-modality imaging approach with TOE and cardiac computed tomographic angiography as complementary methods is helpful to detect complications after LAAO procedure in challenging cases.
Keywords: atrial fibrillation, cardiac computer tomography, left atrial appendage occlusion, transoesophageal echocardiography
Published in DiRROS: 07.01.2026; Views: 129; Downloads: 123
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3. Accuracy of transthoracic echocardiography in diagnosis of cardiac myxoma : single center experiencePolona Kačar, Nejc Pavšič, Mojca Bervar, Zvezdana Dolenc-Stražar, Katja Prokšelj, 2025, original scientific article Abstract: Background: The differential diagnosis of cardiac myxomas (CM), the most common benign primary cardiac tumors, is broad and a thorough diagnostic workup is required to establish accurate diagnosis prior to surgical resection. Transthoracic echocardiography (TTE) is usually the first imaging modality used for diagnosis of suspected CM. In a single tertiary centre study, we sought to determine the accuracy, sensitivity, and specificity of TTE in the diagnosis of CM and to determine echocardiographic characteristics indicative of CM. Patients and methods: We retrospectively analyzed clinical, echocardiographic, and pathohistological findings of 73 patients consecutively admitted for suspected CM. Results: After diagnostic workup, 53 (73%) patients were treated surgically at our institution. Based on preoperative TTE, patients were divided into a CM group (n=45, 85%) and non-myxoma (NM) group. Of the 53 pathohistological specimens obtained during surgery, 39 (73%) were CM. The sensitivity and specificity of preoperative echocardiography were 97% and 50%, respectively. The overall accuracy was 85%. All NM tumors were found in an atypical location and 72% of CM were found in a typical position in the left atrium (p < 0.001). Tumors in NM group were significantly smaller than CM (24.3 ± 13.2 mm vs. 37.9 ± 18.3 mm, p = 0.017). Conclusions: Our study confirms very good accuracy of TTE in the diagnosis of CM. The most important echocardiographic characteristics to differentiate between CM and tumors of different etiology are tumor location and size. Smaller tumors presenting at an atypical location are less likely to be diagnosed as CM, and these require additional imaging modalities for accurate diagnosis.
Keywords: cardiac mass, cardiac myxoma, cardiovascular imaging, echocardiography
Published in DiRROS: 16.12.2025; Views: 263; Downloads: 82
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4. Influence of natural variability and anatomical misalignment on the correlation between segmental myocardial edema and strain in acute myocarditisKanza Awais, Lana Kralj, Andreja Černe Čerček, Borut Kirn, 2025, original scientific article Abstract: Background: Acute myocarditis (AM) affects myocardial structure and function, assessed by cardiac magnetic resonance late gadolinium enhancement (CMR-LGE) and speckle tracking echocardiography (STE), respectively; however, the correlation between the two techniques at the segmental level is inconsistent. We studied natural heterogeneity and anatomical orientation mismatch as potential causes of correlation discrepancy. Methods: A total of 30 AM patients underwent left ventricle LGE-CMR and STE measurement, acquiring 18 segmental values depicting edema extent and peak longitudinal strain, respectively. Baseline segmental correlation was compared to average patient segmental correlation and to segmental correlation after spatial resolution reduction achieved by averaging adjacent segments in four successive iterations, where the degree of spatial resolution reduction was evaluated based on the relative decrease in segmental standard deviation. Results: Baseline segmental correlation was weak, i.e., r = 0.24 (p < 0.05) but improved in fitted SLGE and SpLS baseline correlation (r0 = 0.44, p < 0.05) and in average patient correlation (r = 0.55, p < 0.05). Iterative spatial resolution reduction increased the correlation to r1 = 0.49 and r2 = 0.51 and then decreased it to r3 = 0.11 (p < 0.05) and r4 = 0.07 (p > 0.05), with corresponding decreases in segmental standard deviation relative to baseline from σ0 = 12.87 to σ/σ0 = 0.68, 0.51, 0.38, and 0.29 in SLGE values and σ0 = 4.77 to σ/σ0 = 0.57, 0.41, 0.31, and 0.23 in SpLS. Conclusions: Improved correlation in average patients is associated with natural heterogeneity, which indicates a need to develop more robust indicators of ventricular function. The improved correlation in moderate spatial resolution reduction indicates a potential solution for anatomic orientation mismatch between CMR-LGE and STE techniques.
Keywords: acute myocarditis, anatomical orientation mismatch, cardiac magnetic resonance, late gadolinium enhancement, natural heterogeneity, segmental peak systolic strain, spatial resolution reduction, speckle tracking echocardiography
Published in DiRROS: 10.11.2025; Views: 257; Downloads: 117
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5. Long term follow-up report of cardiac toxicity in patients with multiple myeloma treated with tandem autologous hematopoietic stem cell transplantationMirta Koželj, Samo Zver, Vesna Zadnik, 2013, original scientific article Abstract: Background. Tandem autologous hematopoietic stem cell transplantation (ta-HSCT) is a standard treatment for multiple myeloma (MM). Patients receive a high-dose cyclophosphamide (CY), followed by two myeloablative cycles of melphalan (MEL). There are scarce data about long term cardiotoxicity. Patients and methods. We studied 12 patients (62.25 8.55 years) six years after the completion of MM treatment with ta-HCST. Late cardiotoxic effects were evaluated clinically and echocardiographically. Results. None of the patients developed clinical signs of heart failure, all were in sinus rhythm and NT-pro BNP concentration was elevated (778 902.76 pg/mL). The left ventricular (LV) size remained normal. The LV ejection fraction did not decrease (73.75 5.67%, 69.27 6.13%, p = NS). The LV diastolic function parameters (E, A, ratio E/A and A/a) did not change significantly. In tissue Doppler parameters we observed a nonsignificant decrease in Em (10.26 2.63 cm/s, 7.57 1.43 cm/s) and Sm velocities (8.7 0.87 cm/s, 7.14 1.17 cm/s, p = NS). The E/Em values were in an abnormal range (8.66 1.05, 10.55 2.03). Conclusions. The treatment of MM with ta-HSCT, during which patients receive a high dose CY followed by two myeloablative cycles of MEL, causes mild, chronic, partially reversible and clinically silent cardiotoxic side-effects. However, ta-HSCT in patients with MM is a safe regarding cardiotoxic side effects, but, because of increasing life expectancy needs long term attention.
Keywords: cardiotoxicity, echocardiography, myeloma
Published in DiRROS: 22.03.2024; Views: 1272; Downloads: 328
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