Abstract
Values for level- (apical, mid, and basal) and layer-based (endocardial, mid-myocardial, and epicardial) left ventricular (LV) longitudinal strain across age are scarce. The present study evaluates the effect of aging on level- and layer-specific LV longitudinal strain in subjects without structural heart disease. A total of 408 subjects (mean age 58 years [range 16 to 91]; 49% men) were evaluated retrospectively. Subjects were divided into equal groups based on age and gender. Subjects with evidence of structural heart disease or arrhythmias were excluded. Mean LV ejection fraction was 62 ± 6.2%. A gradual increase in magnitude of level LV longitudinal strain was observed from basal to mid and apical levels (-16.7 ± 2.1%, -18.8 ± 2.0%, -22.6 ± 3.8%; p <0.001, respectively). Across age groups, there was a borderline significant decrease in magnitude of basal longitudinal strain in older subjects, whereas the magnitude in the apical level significantly increased. On layer-based analysis, the magnitude of longitudinal strain increased from epicardium to endocardium across all age groups. On multivariable analysis, only diabetes mellitus was associated with more impaired longitudinal strain in the endocardium, and male gender was associated with more impaired longitudinal strain at the epicardium layer. In conclusion, with increasing age, the magnitude of LV longitudinal strain at the basal level declines while the apical LV longitudinal strain increases. In contrast, layer-specific LV longitudinal strain remains unchanged with aging. The presence of diabetes mellitus modulated the effect of age on the LV endocardial layer, and male gender was associated with more impaired longitudinal strain at the epicardial layer.
Highlights
There were no statistically significant differences in left ventricular (LV) global longitudinal strain (GLS), level, and layer-specific longitudinal strain between groups and, we investigated the effects of aging in the overall population
There were no significant differences in left ventricular ejection fraction (LVEF) and LV GLS across the different age groups (Table 3)
Data on global LV longitudinal strain are accumulating in healthy volunteers and subjects without structural or functional heart disease, data on level- and layer-specific longitudinal strain are scarce.[2,3,10]
Summary
Rachid Abou, MDa, Melissa Leung, MBBS BSc (med), MBiostat, PhDa, Mand J.H. Khidir, MDa, Ron Wolterbeek, MDb, Martin J. MD, PhDa, and Victoria Delgado, MD, PhDa,*. Regional assessment of left ventricular (LV) longitudinal strain provides incremental prognostic value in ischemic heart failure patients.[1] Data from subjects without structural heart disease show a gradient in LV strain, with higher values in the apex compared with the basal segments.[2,3] In addition, the LV myocardium can be divided in 3 different layers (endocardial, mid-myocardial, and epicardial) that have a characteristic spatial disposition.[4] Whether the values of longitudinal strain in these different layers are similar or show variation in magnitude has not been evaluated in detail. The influence of age on longitudinal strain (measured with 2-dimensional (2D) speckle tracking echocardiography) at 3 different LV levels (basal, mid, and apical) and 3 different LV layers (endocardium, midmyocardium, and epicardium) was investigated in a large cohort of subjects without structural heart disease. Manuscript received June 15, 2017; revised manuscript received and accepted August 8, 2017
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