Assessment Of Left Ventricular Strain Research Articles

Four-Dimensional XStrain Echocardiographic Assessment of Left Ventricular Strain and Rotational Mechanics: Technology, Clinical Applications, Advantages and Limitations

Because of its excellent ability to non-invasively assess left ventricular (LV) systolic function, two-dimensional speckle tracking echocardiography (STE) is increasingly being used in echocardiographic laboratories worldwide. Two-dimensional STE is the most sought-after method to evaluate LV strain, rotation, twist and torsion. Two dimensional, three-dimensional and four-dimensional (4D) deformation estimation by STE has several intrinsic limitations. For better appraisal of LV contractile properties, a recently introduced updated version of 4D XStrain STE has been used to analyse the various complex multidimensional LV mechanics. This novel technology is a reliable, economical and simple tool for estimating regional and global myocardial function. Furthermore, 4D XStrain STE can accurately quantify the 4D LV ejection-fraction, LV volume and sphericity index. However, this technology has not been extensively implemented, and its assessment remains limited primarily to research applications. Hence, we aim to promote this innovative technology by comprehensively addressing its technique, advantages and limitations, so that it can be better applied in cardiovascular disease.

Contribution of TNF-R1 to reduced exercise capacity in hypertensive heart disease. Mediating role of left atrial mechanical function reserve

Abstract Background Tumor necrosis factor alpha (TNF-alpha) plays a relevant pathophysiological role in cardiovascular disorders, including hypertensive heart disease (HHD) – a clinical condition frequently contributing to the development of heart failure with preserved ejection fraction (HFpEF). TNF receptor 1 (TNF-R1) has been found to mediate proinflammatory and proapoptotic effects of TNF-alpha, and its soluble circulating form proved to be effective in predicting incident HF. Existing evidence indicates the association between TNF pathways activation and cardiac dysfunction, but exact mechanisms mediating this link are unclear. Objectives We sought to investigate the association of TNF-R1 with exercise capacity, and left ventricular (LV) and left atrial (LA) function reserve in asymptomatic patients with HHD. Methods We enrolled 80 (55±12 yo) patients with HHD and normal exercise tolerance (stage A and B HF). Echocardiography (including LA and LV strain assessment) was performed at rest and immediately post exercise test. Blood samples for TNF-R1 were drawn in fasting conditions. Exercise reserve of cardiac function parameters was calculated by subtracting resting value from exercise value. Results The study population was categorized into 2 subsets using a median value of exercise capacity (9.2 METs). Patients with higher exercise capacity were characterized by lower TNF-R1 concentrations and higher LA reservoir and LA contractile strain reserves (Table). No significant intergroup differences were found for exercise reserves in LV ejection fraction (LVEF), LV global longitudinal strain and diastolic parameters (e’ and E/e’). TNF-R1 significantly correlated with peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) reserves (r=-0.27; p<0.02 and r=-0.24; p<0.04, respectively), but not with LVEF, global longitudinal strain (GLS), e’ and E/e’ reserves. Regression-based mediation analysis revealed that the relationships between TNF-R1 and exercise capacity were mediated by PALS and PACS reserve, as evidenced by the reduction in variance of exercise capacity (METs) explained by TNF-R1 after the inclusion of PALS and PACS reserve to the models (decrease in beta coefficient from -0.24 to -0.19 for PALS, and to -0.20 for PACS, Figure). Conclusions In patients with HHD, higher TNF-R1 is associated with lower exercise capacity, and this relationship may be mediated by lower LA strain reserve. This finding may contribute to elucidating the mechanisms behind the involvement of the left atrium in HF progression.Mediation analysis

Free-Breathing Compressed Sensing Cine Cardiac MRI for Assessment of Left Ventricular Strain by Feature Tracking in Children.

Cardiac MRI feature-tracking (FT) with breath-holding (BH) cine balanced steady state free precession (bSSFP) imaging is well established. It is unclear whether FT-strain measurements can be reliably derived from free-breathing (FB) compressed sensing (CS) bSSFP imaging. To compare left ventricular (LV) strain analysis and image quality of an FB CS bSSFP cine sequence with that of a conventional BH bSSFP sequence in children. Prospective. 40 children able to perform BHs (cohort 1 [12.1 ± 2.2 years]) and 17 children unable to perform BHs (cohort 2 [5.2 ± 1.8 years]). 3T, bSSFP sequence with and without CS. Acquisition times and image quality were assessed. LV myocardial deformation parameters were compared between BH cine and FB CS cine studies in cohort 1. Strain indices and image quality of FB CS cine studies were also assessed in cohort 2. Intraobserver and interobserver variability of strain parameters was determined. Paired t-test, Wilcoxon signed-rank test, intraclass correlation coefficient (ICC), and Bland-Altman analysis. A P-value <0.05 was considered statistically significant. In cohort 1, the mean acquisition time of the FB CS cine study was significantly lower than for conventional BH cine study (15.6 s vs. 209.4 s). No significant difference were found in global circumferential strain rate (P = 0.089), global longitudinal strain rate (P = 0.366) and EuroCMR image quality scores (P = 0.128) between BH and FB sequences in cohort 1. The overall image quality score of FB CS cine in cohort 2 was 3.5 ± 0.5 with acquisition time of 14.7 ± 2.1 s. Interobserver and intraobserver variabilities were good to excellent (ICC = 0.810 to 0.943). FB CS cine imaging may be a promising alternative technique for strain assessment in pediatric patients with poor BH ability. 1 TECHNICAL EFFICACY: Stage 1.

Assessing cardiac contractility in hypertension with heart failure with preserved ejection fraction: the value of left ventricular strain

Aim: Hypertension (HTN) is a major cause of heart failure but the precise pathways by which HTN leads to heart failure are not resolved. Newer echocardiographic techniques permit assessment of myocardial contraction in different orientations defining left ventricular (LV) shortening as percentage longitudinal, circumferential and radial strain. Methods: A systematic search was conducted of Medline and Embase. The search was conducted from the inception of each database on June 30, 2022. Search terms “left ventricular strain” or speckle tracking AND heart failure with preserved ejection fraction or diastolic dysfunction AND HTN. Results: Six studies were identified and subject to detailed review. LV ejection fraction (LVEF) was not significantly different in patients with heart failure with preserved ejection fraction (HFpEF) and HTN compared to individuals with or without HTN. Global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly (P &lt; 0.0001) different (lower) in patients with HFpEF and HTN compared to patients with HTN without HFpEF and control individuals without HTN or other conditions. In contrast, global radial strain (GRS) was not significantly (P &lt; 0.054) different in patients with HFpEF and HTN compared to individuals without HTN or other conditions. GRS was significantly (P &lt; 0.01) different in individuals with HFpEF and HTN compared to individuals with HTN. Conclusions: Assessment of LV strain is an important advance in the assessment of LV function in patients with HTN and HFpEF as it identifies patients with reduced LV strain while there was no difference in LVEF. GLS and GCS provide the best separation between patients with HFpEF and HTN compared to individuals with HTN without HFpEF. This study advances the possibility of redefining the classification of heart function and heart failure for patients with HTN by either classifying patients mainly by LV strain or sub-classifying patients with HTN and HFpEF by LV strain.

Relationship Between Left Ventricular Strain Assessment by Cardiac Magnetic Resonance Imaging and Response to Cardiac Resynchronization Therapy.

Although cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction, 30 to 50% patients are non-responders. In this retrospective single-centre study, 19 patients underwent cardiac MRI pre-CRT, and global left ventricular (LV) strain and late gadolinium enhancement (LGE) were measured by a blinded reader. LV reverse remodeling was independently assessed using transthoracic echocardiogram before and after CRT implant. Both LV strain and extent of LGE correlated significantly with measures of reverse LV remodeling (reduction in LV volume and improvement in LV ejection fraction). These findings suggest that CMR derived strain analysis and scar evaluation may be useful preimplant predictors of response to CRT. Larger prospective multi-center studies are needed to confirm these findings and to further evaluate the role of CMR strain imaging in guiding CRT treatment decisions.

Clinical value of left ventricular strain analysis by cardiovascular magnetic resonance in patients with coronary chronic total occlusion

Objective: To explore the clinical value of quantitatively assessment of left ventricular strain in patients with coronary chronic total occlusion (CTO) by cardiac magnetic resonance imaging (CMR)-feature tracking (CMR-FT) technique. Methods: In this retrospective and observation study, patients with single CTO, who underwent CMR examination in Beijing Anzhen Hospital from November 2014 to January 2019, were selected as case group (CTO group), and those without cardiovascular diseases defined by echocardiography, electrocardiogram (ECG) and clinical history and with normal CMR results were selected as healthy control group (control group). General clinical data including age, gender, discharge diagnosis, and the examination results of echocardiography and ECG were obtained from the electronic medical record system. Two-dimensional CMR-FT was applied to measure left ventricle (LV) global peak radial, circumferential, and longitudinal strains (GPRS, GPCS and GPLS, respectively), and the regional myocardial strain in the target vessel area of CTO was analyzed. Grayscale thresholds of 5 standard deviations (SDs) were used to quantify late gadolinium enhancement (LGE). Patients with CTOs were divided into infract size>10% group and infarct size≤10% group, and left ventricular ejection fraction (LVEF)≥50% group and LVEF<50% group, respectively. The differences between various groups were compared. Results: There were 52 patients in CTO group (34 males, age (54.1±11.7) years, body mass index (BMI) (26.2±2.5)kg/m2) and 30 patients in control group (14 males, age(51.6±12.3)years, BMI (25.6±3.3)kg/m2). There was no significant difference in age, gender, and BMI between the two groups (all P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower in CTO group than in control group (all P<0.05), left ventricular volume (LVEDV) was similar between the two groups (P>0.05). Among the patients with CTO, there were 26 patients with infarct size>10% and 26 patients with infarct size≤10%. GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEF and LVEDV were similar in CTO patients with infarct size≤10% as compared to control group (both P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEDV was similar in CTO patients with infarct size>10% (P>0.05) as compared to control group. GPRS and GPCS were significantly lower (both P<0.05), while LVEF, LVEDV and GPLS were similar in CTO patients with infarct size>10% as compared to infarct size≤10% group. There were 40 subjects in LVEF≥50% group and 12 subjects in LVEF<50% group. Compared with the control group, GPCS and GPLS of CTO patients were significantly lower in LVEF≥50% group and LVEF<50% group (all P<0.01), LVEF and LVEDV was similar in CTO patients with LVEF≥50% (both P>0.05), but LVEF was lower and LVEDV was larger in LVEF<50% group (both P<0.05). The GPRS, GPCS, GPLS and LVEF of CTO patients in LVEF ≥ 50% group were higher than those in LVEF<50% group (all P<0.0l), and the myocardial infarction size was smaller than that in LVEF reduced group (P<0.0l), but there was no significant difference in LVEDV between the two groups (P=0.07). In the CTO group, there were 21 patients with left anterior descending artery (LAD) occlusion and 126 segments supplied by the target vessels. The peak radial strain (PRS), circumferential strain (PCS) and longitudinal strain (PLS) in the blood supply area were lower than those in the control group (all P<0 01). In 7 patients with left circumflex artery (LCX) occlusion, the number of myocardial segments supplied by the target vessels was 35, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0 05). In 24 patients with right coronary artery (RCA) occlusion, the number of myocardial segments supplied by the target vessels was 120, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0.01). Among the 126 segments in 21 patients with LAD CTO, 91 (72.2%) segments had infarct size≤25%, 17 (13.5%) segments had infarct size between 26%-50%, 11 segments (8.7%) had infarct size between 51%-75%, and 7 (5.6%) segments had infarct size between 76%-100%. Among the 35 segments in 7 patients with LCX CTO, 31 (88.6%) segments had infarct size≤25%, and 4 (11.4%) segments had infarct size between 26%-75%. Among the 120 segments in 24 patients with RCA CTO, 96 (80.0%) segments had infarct size≤25%, 11 (9.2%) segments had infarct size between 26%-50%, 8 (6.7%) segments had infarct size between 51%-75%, and 5 segments (4.2%) had infarct size between 76%-100%. Conclusions: In this study with single CTO, although the LVEF is preserved in the majority of the patients, the left ventricular global and regional strain values are significantly decreased. The larger the infarct size, the greater the impact on radial and circumferential motion, reflecting the early impairment of left ventricular function in these patients.

Left ventricular strain values using 3D speckle-tracking echocardiography in healthy adults aged 20 to 72\xa0years

Three dimensional speckle tracking echocardiography (3D-STE) is a novel modality for the assessment of left ventricular strain (LVS). The aim of our study is to provide single vendor normative strain values measured with 3D-STE in healthy adult caucasians. One hundred fifty-five healthy subjects aged 20 to 72 years (≥ 28 subjects per decile) were prospectively included and examined with 2D and 3D transthoracic echocardiography. In 105 both 3D and 2D-STE were feasible (71%, mean age 44 ± 14 years, 51% female). Mean 3D tangential strain (3D-TS) was − 32 ± 2.9%. 3D global longitudinal strain (3D-GLS) demonstrated a significant but not very strong correlation with 2D-GLS values (− 19.7 ± 1.8% vs − 20.4 ± 2.2%, r = 0.462, p < 0.001). No gender difference was observed in 3D strain parameters. 3D-GLS decreased with increasing age stratum (p = 0.024). LVEF was associated with 3D-TS and 3D-GLS (r = − 0.819, p ≤ 0.001 for 3D-TS, p = − 0.477, r < 0.001, p = 0.001 for 3D-GLS). In this single vendor study age and gender-specific normative LV 3D-TS values were reported for healthy adult caucasians. In a significant proportion of the subjects 3D-STE was not feasible, but when feasible, 3D-STE shows excellent association with LVEF, and is therefore a promising novel modality for the assessment of the myocardial function, provided that issues of limited feasibility and temporal resolution are addressed.

232Evaluation of left ventricular strain assessment cardiac magnetic resonance-feature tracking in STEMI patients at different time points during a long term follow-up

232Evaluation of left ventricular strain assessment cardiac magnetic resonance-feature tracking in STEMI patients at different time points during a long term follow-up

The Role of Left Atrium

Left atrium (LA) contributes 20-30% of cardiac output. LA volume and function measured by 2D biplane area length and real-time 3D echocardiography have been well-validated and widely used. LA function consists of 3 components, including reservoir, conduit, and active contractile phases. The most frequently used echocardiographic method for evaluation of phasic function of LA is volumetric method. LA volume measured by biplane area-length method and corrected by body surface area is a useful index for studying LA remodeling, and early LA remodeling has been proven to have prognostic significance in heart failure after myocardial infarction. Phasic changes of LA volume can be measured in different phases of cardiac cycle. Volumetric measurements are useful in evaluation of LA, however, volumetric changes can not reflect changes of the LA wall itself. Tissue Doppler imaging has been applied for the assessment of cardiac function, including atrial function. Atrial deformation evaluated by tissue Doppler derived strain or strain rate imaging can be used for assessment of LA wall directly. Newly developed speckle tracking echocardiography is useful in assessment of left ventricular strain and strain rate. This non-Doppler two-dimensional strain imaging avoids effects of Doppler angle and ventricular tethering. Speckle tracking echocardiography was recently used for assessment of LA function after resynchronization therapy. The feasibility of LA longitudinal strain and strain rate measured by speckle tracking echocardiography has been verified in healthy subjects, and adequate tracking can be performed in 94% of subjects or in 97% of segments. Early changes of LA function can be documented by speckle tracking echocardiography. We have found the phasic LA function changed in untreated hypertension subjects and correlated with left ventricular diastolic function. LA strain also has prognostic implications such in primary mitral regurgitation or in atrial fibrillation.

Velocity Vector Imaging in the Measurement of Left Ventricular Myocardial Mechanics on Cardiac Magnetic Resonance Imaging: Correlations with Echocardiographically Derived Strain Values

Regional and global function can be measured by echocardiography using speckle-tracking, a technique that has previously been validated against crystal sonomicrometry. However, the application of Velocity Vector Imaging (VVI) to images obtained from cardiac magnetic resonance (CMR) imaging has never been validated against those values derived from VVI applied to two-dimensional echocardiographic images in the same patient group. The aim of this study was to validate for the first time the application of VVI to retrospectively acquired CMR data sets for the assessment of left ventricular strain and rotation, using echocardiographic strain assessment by VVI as the reference technique. Cine steady-state free precession CMR data sets and two-dimensional echocardiographic images obtained on the same day in 36 adult patients with hypertrophic cardiomyopathy were analyzed retrospectively using VVI to quantify global longitudinal and circumferential strain and rotation parameters. The absolute differences in longitudinal strain between the two imaging modalities were -1.1 ± 3.3% (endocardial) and -2.2 ± 3.6% (full thickness). The absolute differences in circumferential strain were -4.7 ± 5.3% (endocardial) and -3.4 ± 3.8% (full thickness). CMR consistently resulted in higher strain values than echocardiography. The absolute differences in twist were -0.2 ± 5.6% (endocardial) and 0.1 ± 5.8% (full thickness). The application of VVI to CMR data sets allows a feasible and reproducible method for strain analysis in HCM, demonstrating excellent agreement with two-dimensional echocardiography-derived values. Given the superior image quality obtained with CMR in a significant proportion of patients, this technique provides a method for strain assessment without the need for dedicated CMR acquisition and analytic techniques.

Abstract 1417: Combined Assessment of Left Ventricular Strain and Rotation - A Novel Approach for Assessment of Function in Infarcted Myocardium and its Border Zones

Background : LV circumferential strain and rotation are markers of myocardial function, but the two measures dissociate in the ischemic LV. This study investigates the mechanism and clinical significance of this dissociation. Methods : In healthy subjects (n=15) and patients with LAD-related myocardial infarction (n=15), LV apical rotation and strain were measured from apical short-axis recordings by STE and MRI tagging. Infarct extent was determined by contrast MRI. To define mechanisms of the dissociation between strain and rotation we used a finite element model. Results : Mean apical rotation and strain by STE were lower in the patients than in healthy subjects (13±4 vs. 10±5° and −24±2 vs. −12±10%, respectively, P &lt;0.05). In patients, segmental strain was reduced in proportion to extent of infarction (r=0.84, P &lt;0.0001). Maximum and minimum rotation, however, were found at the infarct borders; maximum rotation at the border in direction of rotation (counter-clockwise) and minimum rotation at the opposite infarct border (Figure ). The simulation study reproduced the clinical findings and indicated that the dissociation was mainly caused by mechanical interactions between infarcted and viable myocardium transmitted along circumferentially oriented LV fibers. Conclusions : Systolic strain reflects regional myocardial function and infarct extent, while systolic rotation defines infarct borders. Strain and rotation provides complementary information in assessment of myocardial dysfunction and infarct extent.