Speckle tracking derived reference values of myocardial deformation and impact of cardiovascular risk factors - Results from the population-based STAAB cohort study.

Caroline Morbach,Margret Breunig,Stefan Störk,Peter U Heuschmann,Dan Liu,Götz Gelbrich,Martin Wagner,Theresa Tiffe,Bettina N Walter,Vincenzo Lionetti

doi:10.1371/journal.pone.0221888

Abstract

AimsWe aimed to provide reference values for speckle-tracking derived systolic and diastolic myocardial deformation markers, and to determine their relation with age, sex, and cardiovascular risk factors.Methods and resultsThe Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study recruited a representative sample of the population of Würzburg, Germany, aged 30–79 years. In a sample of 1818 participants (52% female, mean age 54±12 years) global longitudinal peak systolic strain (GL-PSS, n = 1218), systolic (GL-SSR, n = 1506), and early (GL-EDSR, n = 1506) and late diastolic strain rates (GL-LDSR, n = 1500) were derived from 2D speckle tracking analysis. From a subgroup of 323 individuals without any cardiovascular risk factor, sex- and age-specific reference values were computed. GL-PSS, GL-SSR, and GL-EDSR were associated with sex, GL-EDSR decreased and GL-LDSR increased with age. In the total sample, dyslipidemia was associated with altered GL-PSS, GL-SSR, and GL-EDSR in women but not in men, whereas obesity was associated with less favorable GL-PSS and GL-EDSR in either sex. Hypertension impacted more adversely on systolic and diastolic myocardial deformation in women compared to men (all p<0.01).ConclusionThe female myocardium appeared more vulnerable to high blood pressure and dyslipidemia when compared to men, while obesity was associated with adverse myocardial deformation in either sex. The reference values for echocardiographic myocardial deformation provided for a non-diseased population and their here reported associations with cardiovascular risk factors will inform future observational and intervention studies regarding i) effect sizes and power calculation, ii) cross-study comparisons, and iii) categorization of myocardial deformation in specific patient groups.

Highlights

Echocardiography is the most frequently used method in the assessment of cardiac function
The female myocardium appeared more vulnerable to high blood pressure and dyslipidemia when compared to men, while obesity was associated with adverse myocardial deformation
Prevalence of diabetes mellitus, CV disease, and current pharmacotherapy was assessed by GL-SSR, Global longitudinal systolic strain rate; left ventricular (LV), Left ventricle/ventricular; STAAB, Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression cohort study; SR, Strain rate; tissue Doppler imaging (TDI), Tissue Doppler Imaging

Summary

Introduction

Echocardiography is the most frequently used method in the assessment of cardiac function. Conventional measurements like left ventricular (LV) ejection fraction are of limited utility to detect changes over time, more sensitive methods are required. Strain as a measure of myocardial deformation carries incremental information on the change of the LV shape during the cardiac cycle [1]. Strain imaging may detect subtle alterations in cardiac function [2]. Two-dimensional speckle-tracking assesses myocardial motion by tracking speckles in the ultrasonic image. This method determines strain and strain rates avoiding Doppler-associated angulation errors and tethering artifacts with a good correlation to sonomicrometry and tagged magnetic resonance imaging (r = 0.87) [3]. The impairment in longitudinal deformation precedes deterioration of radial and/or circumferential deformation [4, 5]

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Conclusion