Clinical significance of left ventricular longitudinal deformation in coronary heart disease and non-coronary pathology

Abstract

The values of the global longitudinal systolic deformation of the left ventricle have sufficiently high diagnostic informativeness, preceding the reduction of the left ventricular ejection fraction, local contractility and increase of troponins. Its indicators reflect the early deformation disorders not only in coronary heart disease, but can serve as a sensitive parameter of the formation of systolic dysfunction in diseases of any origin. The study of the global deformation of the left ventricle with the preservation of traditional echocardiographic parameters within the norm (ejection fraction, local contractility, wall thickness, valve status, diastolic function, etc.) allows identifying a risk group for the subsequent targeted search for signs of coronary atherosclerosis. The sensitivity and specificity of longitudinal deformation by speckle-tracking echocardiography in the verification of myocarditis and cardiomyopathies are higher than those of magnetic resonance imaging. The prognostic value of the levels of deformation in the short and long term in relation to rehospitalization and death due to the progression of heart failure is proved. Dynamic observation of the global longitudinal deformation allows revealing the side cardiotoxic effects of drugs in patients with cancer and rheumatic diseases. Numerous studies show that the values of global longitudinal deformation in healthy individuals vary from -18 to -25% depending on the calculation program used, distinguishing this parameter from a number of other ultrasonic parameters. Illustrative color marking of numerical values of segmental systolic deformation of the left ventricle in the form of a «bull's eye» is much less reproducible than the value of the officially recommended global deformation. The differences in global and segmental longitudinal strain thresholds due to ultrasound scanner software and the lack of standardized clinical observations and statistical generalizations should stimulate further research in this area.