Assessment Of Myocardial Function Research Articles

4D cardiac imaging at clinical 3.0 T provides accurate assessment of murine myocardial function and viability

ObjectivesWe validate a 4D strategy tailored for 3T clinical systems to simultaneously quantify function and infarct size in wild type mice after ischemia/reperfusion, with improved spatial and temporal resolution by comparison to previous published protocols using clinical field MRI systems. MethodsC57BL/6J mice underwent 60min ischemia/reperfusion (n=14) or were controls without surgery (n=6). Twenty-four hours after surgery mice were imaged with gadolinium injection and sacrificed for post-mortem MRI and histology with serum also taken for Troponin I levels. The double ECG- and respiratory-triggered 3D FLASH (Fast Low Angle Shot) gradient echo (GRE) cine sequence had an acquired isotropic resolution of 344μm, TR/TE of 7.8/2.9ms and acquisition time 25–35min. The conventional 2D FLASH cine sequence had the same in-plane resolution of 344μm, 1mm slice thickness and TR/TE 11/5.4ms for an acquisition time of 20–25min plus 5min for planning. Left ventricle (LV) and right ventricle (RV) volumes were measured and functional parameters compared 2D to 3D, left to right and for inter and intra observer reproducibility. MRI infarct volume was compared to histology. ResultsFor the function evaluation, the 3D cine outperformed 2D cine for spatial and temporal resolution. Protocol time for the two methods was equivalent (25–35min). Flow artifacts were reduced (p=0.008) and epi/endo-cardial delineation showed good intra and interobserver reproducibility. Paired t-test comparing ejection volume left to right showed no significant difference for 3D (p=0.37), nor 2D (p=0.30) and correlation slopes of left to right EV were 1.17 (R2=0.75) for 2D and 1.05 (R2=0.50) for 3D.Quantifiable ‘late gadolinium enhancement’ infarct volume was seen only with the 3D cine and correlated to histology (R2=0.89). Left ejection fraction and MRI-measured infarct volume correlated (R2>0.3). ConclusionsThe 4D strategy, with contrast injection, was validated in mice for function and infarct quantification from a single scan with minimal slice planning.

P5239Echocardiographic assessment of myocardial geometry and function after cardiac surgery

P5239Echocardiographic assessment of myocardial geometry and function after cardiac surgery

Myocardial Deformation in Cardiac Amyloid Light-chain Amyloidosis: Assessed with 3T Cardiovascular Magnetic Resonance Feature Tracking

Clinically, assessment of myocardial function is essential in patients with amyloid light-chain cardiac amyloidosis (AL-CA) to predict outcome and determine therapeutic approach. The aim of this study was to investigate the feasibility of cardiovascular magnetic resonance (CMR)-derived feature tracking algorithm for assessing left ventricular (LV) myocardial deformation in AL-CA, and to determine if these abnormal myocardial deformation parameters are correlated to impaired LV myocardial microvascular dysfunction. A total of 42 AL-CA patients, including 26 with preserved systolic function and 16 with impaired LVEF, and 35 healthy controls were enrolled and underwent CMR examination. Our result indicated that AL-CA patients had significantly reduced global peak strain (PS) (longitudinal, circumferential, and radial) (all P < 0.05). AL-CA patients with normal LVEF showed preserved longitudinal PS at apical and significantly reduced longitudinal PS at mid and basal segments. By Spearman’s rank correlation analysis, the LV regional radial, circumferential, and longitudinal myocardial deformation values were correlated to myocardial upslope and MaxSI in CA, regardless of LVEF. This study indicated that the abnormal LV myocardial deformation of AL-CA patients can be monitored using feature tracking CMR, even in those with preserved LVEF; and the myocardial deformation was associated with coronary microvascular dysfunction.

Intervendor Differences in the Accuracy of Detecting Regional Functional Abnormalities: A Report From the EACVI-ASE Strain Standardization Task Force

ObjectivesThe purpose of this study was to compare the accuracy of vendor-specific and independent strain analysis tools to detect regional myocardial function abnormality in a clinical setting. BackgroundSpeckle tracking echocardiography has been considered a promising tool for the quantitative assessment of regional myocardial function. However, the potential differences among speckle tracking software with regard to their accuracy in identifying regional abnormality has not been studied extensively. MethodsSixty-three subjects (5 healthy volunteers and 58 patients) were examined with 7 different ultrasound machines during 5 days. All patients had experienced a previous myocardial infarction, which was characterized by cardiac magnetic resonance with late gadolinium enhancement. Segmental peak systolic (PS), end-systolic (ES) and post-systolic strain (PSS) measurements were obtained with 6 vendor-specific software tools and 2 independent strain analysis tools. Strain parameters were compared between fully scarred and scar-free segments. Receiver-operating characteristic curves testing the ability of strain parameters and derived indexes to discriminate between these segments were compared among vendors. ResultsThe average strain values calculated for normal segments ranged from −15.1% to −20.7% for PS, −14.9% to −20.6% for ES, and −16.1% to −21.4% for PSS. Significantly lower values of strain (p < 0.05) were found in segments with transmural scar by all vendors, with values ranging from −7.4% to −11.1% for PS, −7.7% to −10.8% for ES, and −10.5% to −14.3% for PSS. Accuracy in identifying transmural scar ranged from acceptable to excellent (area under the curve 0.74 to 0.83 for PS and ES and 0.70 to 0.78 for PSS). Significant differences were found among vendors (p < 0.05). All vendors had a significantly lower accuracy to detect scars in the basal segments compared with scars in the apex (p < 0.05). ConclusionsThe accuracy of identifying regional abnormality differs significantly among vendors.

Postoperative Assessment of Myocardial Function and Microcirculation in Patients with Acute Coronary Syndrome by Myocardial Contrast Echocardiography.

BackgroundPostoperative myocardial function and microcirculation of acute coronary syndrome (ACS) was assessed by myocardial contrast echocardiography (MCE).Material/MethodsEighty-nine ACS patients treated with percutaneous coronary intervention (PCI) were detected by MCE and two-dimensional ultrasonography before and a month later after PCI respectively. Their myocardial perfusion was evaluated by myocardial contrast score (MSC) and contrast score index (CSI); cross-sectional area of microvessel (A), average myocardial microvascular impairment (β), and myocardial blood flow (MBF) were analyzed by cardiac ultrasound quantitative analysis (CUSQ), and fractional flow reserve (FFR) change was observed. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), and left ventricular end-systolic dimension (LVESD) were observed; the index of microcirculatory resistance (IMR), FFR, and coronary flow reserve (CFR) were detected to evaluate coronary microcirculation.ResultsNone of the 89 patients experienced no-reflow. Patients with normal myocardial perfusion mostly had normal or slightly decreased ventricular wall motion after PCI. A month after the operation, there was an increase in A, β, MBF, LVEF, E/A, IMR, FFR, and CFR (all P<0.05), while LVEDD, LVESD, diastolic gallop A peak, E/Ea, E/Ea×S, and Tei decreased (all P<0.05). LVEF and IMR were in positive correlations with A. LVEF, IMR, FFR and CFR were positively correlated with β and MBF (both r>0, P<0.05), while E/Ea×Sa and Tei were negatively correlated with β and MBF (r<0, P<0.05).ConclusionsMCE can safely assess post-PCI myocardial function and microcirculation of ASC.

New indices of left ventricular function: let's move from ejection fraction to more physiological parameters.

The assessment of myocardial function in the context of valvular heart disease (VHD) remains highly challenging. This article is protected by copyright. All rights reserved

5D whole-heart sparse MRI.

A 5D whole-heart sparse imaging framework is proposed for simultaneous assessment of myocardial function and high-resolution cardiac and respiratory motion-resolved whole-heart anatomy in a single continuous noncontrast MR scan. A non-electrocardiograph (ECG)-triggered 3D golden-angle radial balanced steady-state free precession sequence was used for data acquisition. The acquired 3D k-space data were sorted into a 5D dataset containing separated cardiac and respiratory dimensions using a self-extracted respiratory motion signal and a recorded ECG signal. Images were then reconstructed using XD-GRASP, a multidimensional compressed sensing technique exploiting correlations/sparsity along cardiac and respiratory dimensions. 5D whole-heart imaging was compared with respiratory motion-corrected 3D and 4D whole-heart imaging in nine volunteers for evaluation of the myocardium, great vessels, and coronary arteries. It was also compared with breath-held, ECG-gated 2D cardiac cine imaging for validation of cardiac function quantification. 5D whole-heart images received systematic higher quality scores in the myocardium, great vessels and coronary arteries. Quantitative coronary sharpness and length were always better for the 5D images. Good agreement was obtained for quantification of cardiac function compared with 2D cine imaging. 5D whole-heart sparse imaging represents a robust and promising framework for simplified comprehensive cardiac MRI without the need for breath-hold and motion correction. Magn Reson Med 79:826-838, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Fast left ventricle tracking using localized anatomical affine optical flow.

In daily clinical cardiology practice, left ventricle (LV) global and regional function assessment is crucial for disease diagnosis, therapy selection, and patient follow-up. Currently, this is still a time-consuming task, spending valuable human resources. In this work, a novel fast methodology for automatic LV tracking is proposed based on localized anatomically constrained affine optical flow. This novel method can be combined to previously proposed segmentation frameworks or manually delineated surfaces at an initial frame to obtain fully delineated datasets and, thus, assess both global and regional myocardial function. Its feasibility and accuracy were investigated in 3 distinct public databases, namely in realistically simulated 3D ultrasound, clinical 3D echocardiography, and clinical cine cardiac magnetic resonance images. The method showed accurate tracking results in all databases, proving its applicability and accuracy for myocardial function assessment. Moreover, when combined to previous state-of-the-art segmentation frameworks, it outperformed previous tracking strategies in both 3D ultrasound and cardiac magnetic resonance data, automatically computing relevant cardiac indices with smaller biases and narrower limits of agreement compared to reference indices. Simultaneously, the proposed localized tracking method showed to be suitable for online processing, even for 3D motion assessment. Importantly, although here evaluated for LV tracking only, this novel methodology is applicable for tracking of other target structures with minimal adaptations.

Comparison of bioreactance and echocardiographic non-invasive cardiac output monitoring and myocardial function assessment in primagravida women

BackgroundNon-invasive cardiac output monitoring (NICOM) using bioreactance (BRT) in pregnancy is gaining interest but lacks validation. We compared simultaneous cardiac output (CO) measurements obtained using the NICOM® (BRT-CO) and echocardiography (echo-CO), and assessed the relationship between maternal characteristics and myocardial performance. MethodsPaired stroke volume (SV) and CO readings were obtained using NICOM® and echocardiography, in a group of healthy nulliparous women throughout a 15 min period. Agreement between NICOM® and echocardiography was assessed using Bland–Altman analysis and the intraclass correlation coefficient (ICC). Left ventricular (LV) function was assessed using systolic strain and tissue Doppler velocities (S′, E′, and A′ waves). ResultsThirty-five women with a median [interquartile range] age, weight, and gestation of 29 [26–34] yr, 71 [64–79] kg, and 28 [21–29] weeks, respectively, were enrolled. There was good agreement between NICOM®-measured and echocardiographically measured SV [mean bias 6 ml (limits of agreement −18 to 29); ICC 0.8 (95% confidence interval 0.6–0.9), P<0.001] and CO [mean bias 0.2 litres (limits of agreement −1.3–1.7); ICC 0.8 (95% confidence interval 0.7–0.9), P<0.001; mean percentage error ±26%; coefficient of error (precision)=3.4%]. The mean (sd) LV S′ was 9.7 (2.3) cm s−1. The mean (sd) LV strain was −18.6 (2.6)%. There was a negative relationship between BMI and LV diastolic function measured using the E′:A′ ratio (r = −0.51, P<0.01). ConclusionsStroke volume and CO measurements obtained using NICOM® were comparable to those obtained using echocardiography, with acceptable limits of agreement. Increased maternal BMI negatively impacts LV diastolic function measured using tissue Doppler imaging.

Cardiovascular magnetic resonance myocardial perfusion: methods and applications in patients with coronary artery disease

Perfusion CMR is an attractive imaging modality that is becoming comparable with other clinically diagnostic tests. SPECT and PET are well clinically validated and have good accuracy for detection of significant CAD. However, these techniques have a rather low spatial resolution and are not suitable for the detection of subendocardial perfusion defect. In addition, the radiation burden, the potential for attenuation artefacts (SPECT) and the limited availability (PET) are limitations of these imaging techniques. An integrated assessment of myocardial perfusion, function and viability is feasible with CMR. In addition, compared to other clinically available imaging techniques, CMR perfusion has excellent spatial resolution and no ionising radiation exposure. However, it is not widely available and there is a need of protocol and pulse sequence standardization. Most perfusion analysis remains observer-dependent (“eyeball” analysis) or dependent on bolus dispersion (semi-quantitative analysis). Fully quantitative analysis using CMR perfusion is currently time-consuming for clinical application. Perfusion CMR is an evolving field with numerous future directions.

The role of advanced echocardiography and cardiovascular magnetic resonance in the assessment of myocardial function in Marfan syndrome-An update.

Cardiovascular assessment of patients with Marfan syndrome has normally focused on the aortic root and vascular manifestations of the disease due to the high risk of aortic dissection. Although primary myocardial impairment has long been suspected in these patients, the evidence has been controversial. Advanced echocardiography and cardiovascular magnetic resonance imaging have proven to be effective, accurate, and more sensitive in the detection of subtle cardiac dysfunction. The application of these techniques to Marfan syndrome over the last 10years has made significant progress in demonstrating the presence of primary myocardial impairment in these patients, but further work is still required to obtain confirmatory molecular, pathophysiological, and prognostic clinical data. Phenotypic expression of the disease has prognostic value, also suggesting potential effective medical therapy.

The Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

A unique and highly versatile technique, stress echocardiography (SE) is increasingly recognized for its utility in the evaluation of non-ischaemic heart disease. SE allows for simultaneous assessment of myocardial function and haemodynamics under physiological or pharmacological conditions. Due to its diagnostic and prognostic value, SE has become widely implemented to assess various conditions other than ischaemic heart disease. It has thus become essential to establish guidance for its applications and performance in the area of non-ischaemic heart disease. This paper summarizes these recommendations.

Myocardial Assessment in School-Aged Children with Past Kawasaki Disease.

Coronary artery involvement remains the most important complication with Kawasaki disease (KD). Additional myocardial injury can be caused by inflammatory response and ischemic event. However, the long-term outcome of myocardial function has not been fully known in KD. The purpose of this study is to evaluate myocardial function in school-aged children who had the past history of KD. Sixty-seven children in the second grade of elementary schools, who had the past history of KD, were included. Echocardiographic measurements of each coronary artery and myocardial function were obtained as the long-term follow-up data, and compared with the baseline data at the time of initial presentation of KD. The mean age of the subjects was 8.6 ± 2.4 years, and 4.3 ± 3.4 years have passed since the diagnosis of KD. Among the echocardiographic data, interventricular septum thickness at end-diastole (IVSd), LV internal diameters at end-systole (LVIDs), maximal velocity of late diastolic filling across mitral valve (mitral A) flow, maximal velocity of early diastolic filling across mitral valve (mitral E)/A ratio, mitral inflow E wave to peak early diastolic tissue velocity (E/E') ratio showed significant differences between the baseline and follow-up measurements. Coronary Z-score of left main artery (LMA), left anterior descending (LAD), and right coronary artery (RCA) showed no significant difference. The school-aged children with the past history of KD may have diastolic dysfunction. Therefore, appropriate assessment of myocardial function would be recommended during the follow-up period in children with KD.

Assessment of regional and global myocardial systolic function by 2D longitudinal speckle tracking in children with beta thalassemia major

Background: Thalassemias constitute a group of chronic, inherited anemias that are transfusion dependent. Cardiac disease as a result of transfusional iron overload remains as the principal cause of death in these patients even though there have been lots of improvements in iron chelation therapy during the past 25 years. For this reason, it is recommended that regular cardiac evaluation should be done for all patients with thalassemia major. Objective: The present study was conducted with the primary objective to investigate the left ventricular (LV) myocardial function using conventional echocardiographic measures as well as two-dimensional (2D) speckle tracking in patients with beta-thalassemia major who received regular transfusions and chelation therapy. Methodology: This prospective observational study was conducted in the Department of Paediatrics, Sir Jamshedji Jeejeebhoy Group of Hospitals, Mumbai, over a period of 6 months from February 2012 to July 2012. The study comprised 25 consecutive cases of beta-thalassemia major who were diagnosed on the basis of hemoglobin electrophoresis and 25 controls with normal hemoglobin electrophoresis pattern. Patients with any congenital or acquired heart disease and also patients with heart disease of infectious, metabolic, autoimmune etiology were excluded from the study. 2D, M-mode, Doppler, and longitudinal speckle tracking echocardiographic assessment was performed in all the study cases and controls. Results: The mean age of beta-thalassemia group was 7.02 ± 3.00 years whereas the control group was 5.06 ± 3.62 years. The mean hemoglobin was 5.54 ± 1.30 g/dl in beta-thalassemia patients and 10.96 ± 1.36 g/dl in controls (P < 0.001). The thalassemia patients had lower LV ejection fraction (EF) (62.20 ± 7.93% vs. 66.40 ± 1.19%, P < 0.001) and lower global longitudinal strain (GLS) (−21.73 ± 3.68% vs. −26.80 ± 1.29%, P < 0.001) as compared to the controls. The age of the child, hemoglobin level, and serum ferritin level correlated with the LVEF and GLS. Conclusions: LV systolic dysfunction is common in patients with beta-thalassemia major. This is likely to be a consequence of chronic anemia as well as transfusional iron load, compounded by poor compliance to chelation therapy and sometimes nonavailability of proper cardiac monitoring. These findings suggest that even in young children with beta-thalassemia major, who are asymptomatic, serial echocardiography is warranted to permit early recognition of LV systolic dysfunction and timely initiation of appropriate cardioprotective therapy.

Evaluating LV Function in Mouse Myocardial Infarction Model by Speckle Tracking Echocardiography

Mouse models of cardiovascular disease have been used to study the mechanism and various stem cell therapy strategies. Speckle tracking echocardiography (STE) has been shown to provide unique information for the quantitative assessment of global and regional myocardial function. Standard view B-mode images are recorded and measured by continuous frame-by-frame motion analysis of speckles within the myocardium. Deformation parameters including radial, longitudinal and circumferential strain can be used for a serious of myocardial remodeling indicator after infarction. In multimodality noninvasive imaging techniques, including PET, SPECT and STE are employed to monitor serially the beneficial effects of cell therapy on angiogenesis, blood perfusion, and myocardial function, respectively. These experimental data reveal the efficacy of mesenchymal stem cell therapy after MI and elucidate the mechanism cardiac repair.

Speckle-Tracking Echocardiography to Assess Global and Regional Left Ventricular Function in Acute Myocardial Infarction

Speckle tracking is a useful tool in assessing global &amp; regional myocardial function in patients with acute myocardial infarction undergoing primary PCI. Global Longitudinal Strain (GLS) is a robust parameter to assess regional and global LV function. Global longitudinal strain helps in predicting short term outcomes in these patients and has shown to be better than ejection fraction, and as good as wall motion scoring, wall motion scoring index and myocardial performance index. A Lower global longitudinal strain parallels the rise in troponin T and CPKMB in acute myocardial infarction. Global longitudinal strain may have the potential to be an echocardiographic parameter which is useful in identifying multivessel disease. Assessment of regional myocardial function by speckle tracking echocardiography, particularly GLS, can be useful in ACS patients undergoing PCI in predicting short term recovery of the affected segments. Speckle tracking echocardiography can be used independent of the conventional markers to assess regional and global LV function.

Change in left ventricular global longitudinal peak strain for early diagnosis of high-risk coronary atherosclerotic heart disease in older adult patients: study protocol for a single-center diagnostic trial

Background and objective: Previous studies have demonstrated that tissue Doppler echocardiography and two-dimensional speckle tracking echocardiography are minimally invasive imaging methods used to screen for coronary atherosclerotic heart disease. However, they are not highly sensitive and specific for patients with suspected heart disease presenting with normal ventricular wall motion or for patients with early coronary heart disease. The newly emerging three-dimensional longitudinal strain imaging technology can overcome these shortcomings and has become a relatively mature technique for quantitative assessment of myocardial function. The left ventricular global longitudinal peak strain (LVGLPS) measured by three-dimensional longitudinal strain imaging technology contributes to early diagnosis of high-risk coronary atherosclerotic heart disease. Design: Single-center, open-label, diagnostic trial. Methods: Three hundred older adult patients with suspected coronary atherosclerotic heart disease receiving treatment from January 2013 to December 2017 at the Department of Ultrasound Medicine, Taihe Hospital of China, are being included in this study. These patients will be divided into three groups: low-risk group (n = 100; ≥ 70* diameter stenosis in one or two branches of the right main coronary artery and the left circumflex artery), high-risk group (n = 100; ≥ 50* diameter stenosis in the left main coronary artery or ≥ 70* diameter stenosis in the left anterior descending branch), and control group (n = 100; Outcome measures: The primary outcome measure is the sensitivity of the LVGLPS for prediction of coronary atherosclerotic heart disease. The secondary outcome measures are: (1) the specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy rate of the LVGLPS for prediction of coronary atherosclerotic heart disease; (2) change in the LVGLPS; (3) change in conventional echocardiography parameters; and (4) change in the receiver operating characteristic curve for prediction of high-risk coronary atherosclerotic heart disease using the LVGLPS. Discussion: The findings from this study will help to confirm that three-dimensional longitudinal strain imaging technology is highly sensitive and specific for patients with abnormal coronary arteries with suspected coronary heart disease but who present with normal ventricular wall motion. The change in the LVGLPS contributes to early diagnosis of high-risk coronary atherosclerotic heart disease in older adult patients. This helps clinicians to diagnose early coronary heart disease and take timely strategies to avoid serious cardiovascular events as much as possible. Ethics and dissemination: This study will be performed in accordance with the Declaration of Helsinki. All patients are informed of the study protocol and procedure and provide written informed consent. This trial was approved by Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) (approval number: ethics No. 2013(03)) in January 2013. Participant recruitment and data collection began in January 2013 and will continue through December 2017. Outcome measure analysis will be performed and the trial will be completed in January 2018. Results will be disseminated through presentations at scientific meetings and publications in peer-reviewed journals. Trial registration: This trial was registered with the Chinese the Clinical Trial Registry (registration number: ChiCTR-DDD-17012839).

Speckle tracking can detect subclinical myocardial dysfunction in rheumatoid arthritis patients.

Patients with rheumatoid arthritis (RA) have shorter life expectancy and their risk of cardiovascular death is more than 50 % higher than the rest of the population. Early myocardial dysfunction in RA patients may be detectable sooner using speckle‑tracking echocardiography. Cross-sectional study enrolled 55 patients with RA (mean age 44.1 years) without known cardiovascular disease and 31 healthy controls. All subjects underwent a standard echocardiographic examination: indexed left ventricular mass, left ventricle ejection fraction, isovolumic contraction and relaxation times (IVCT and IVRT), mitral valve inflow curve (E/A), septal mitral annular motion (e'), and E/e' ratio as well as the speckle tracking assessment of left ventricle longitudinal, radial and circular strain and strain rate. In standard echocardiographic examination RA patients exhibited higher indexed left ventricle mass (96.36±20.90 g/m2 vs 95.84±21.86 %, p=0.013), lower ejection fraction (64.84±3.87 % vs 67.10±3.87 %, p=0.011) and prolonged IVCT (61.51±9.30 ms vs 53.71±8.95 ms, p=0.001). Diastolic dysfunction was demonstrated by prolonged IVRT (81.62±9.56 ms vs 74.58±12.02 ms, p=0.007) as well as by higher E/e' ratio (8.21±1.76 vs 7.21±1.52, p=0.009). Speckle‑tracking method detected lower global longitudinal epicardial strain (-19.51 % vs -21.46 %, p=0.049). Radial, circular, and transversal strains and strain rates were same in both groups. Global longitudinal epicardial strain correlated with IVCT and IVRT, disease duration, and markers of myocardial damage NTproBNP. Standard echocardiographic assessment of myocardial function is examiner- and angle-dependent method with considerable limitations for evaluation of minimal subclinical changes. Speckle-tracking echocardiography significantly revealed incipient myocardial dysfunction in RA patients without overt cardiovascular diseases. This correlates with clinical RA characteristics and markers of cardiac damage (Tab. 4, Ref. 48).

Two-dimensional strain echocardiography for detection of cardiotoxicity in breast cancer patients undergoing chemotherapy.

Introduction: Two-dimensional (2D) strain echocardiography has emerged as a novel method for early diagnosis of myocardial dysfunction in patients receiving anthracycline chemotherapy. Certain myocardial segments might be more vulnerable for development of dysfunction. Methods: Sixty-three patients with breast cancer who were deemed amenable for anthracycline chemotherapy were prospectively studied from March 2013 to March 2015 in University Hospital settings. Global left ventricular (LV) ejection fraction (EF), fractional shortening and the strain over 17 segments of the LV were examined using 2-dimensional transthoracic echocardiography (TTE) before and after chemotherapy. More than 15% reduction in longitudinal peak systolic strain (LPSS) was considered significant. Results: The mean age of patients was 47 ± 10 years. LVEF was 59.7 ± 6.5% at baseline. Significant reduction of global LPSS was detected in 13% of patients. A significant LPSS reduction occurred in 32.4% of 1071 segments examined following chemotherapy. LPSS significantly decreased in 28% of apical segments, 31% of mid segments and 37% of basal segments. LPSS reduction occurred more frequently over the basal segments than all other segments (P = 0.031). Conclusion: Segmental pattern appears to exist in LPSS reduction following anthracycline therapy. As significant segmental decreases can be seen in the setting of unchanged global LPSS, segmental evaluation of LPSS might be a more accurate way for assessment of myocardial function.

Three-dimensional Versus Two-dimensional Strain for the Assessment of Myocardial Function: A Case Series

Introduction: Two-dimensional (2D) strain assessment is an important diagnostic and prognostic tool in various clinical conditions, particularly coronary artery disease (CAD). However, these measurements are limited in that the information is obtained in only a single plane (2D). Three-dimensional (3D) strain tracks the myocardium in all 3D, potentially overcoming the limitation of 2D strain. The objective of this study was to establish normal values for 3D strain in a population of healthy, normal controls and to compare these values with 2D strain values. In addition, we sought to evaluate the utility of 3D strain in patients with known or suspected CAD. Methods: We conducted a prospective study at a single major tertiary care center. Individuals were recruited for the study and divided into two groups: a normal control group and a CAD group. Global longitudinal strain (GLS) and global circumferential and global radial strain were calculated by both 2D and 3D strain methods. In addition, 3D was used to calculate area strain. Results: We enrolled a total of 43 individuals (20 normal control group, mean age 33 ± 2.7 years, and 23 CAD group, mean age 57 ± 2.8 years, 80% male). Values for 3D strain were consistently lower for GLS and global circumferential strain in both groups compared with 2D measurements. In the control group, the mean 2D GLS was −20 ± 1.6% versus −17.5 ± 1.5% for 3D GLS (P &lt; 0.001). Similarly, the mean 2D circumferential strain was −17.7 ± 2.3% versus −15.6 ± 2.1% for 3D circumferential strain (P &lt; 0.001). Combining both groups, the sensitivity of GLS for CAD was 80% for 2D versus 93% for 3D. Similar findings were seen for global circumferential strain (sensitivity 87% for 2D vs. 100% for 3D). However, the sensitivity of 3D global radial strain was lower (93% for 2D vs. 47% for 3D). 3D strain data were acquired in a shorter time span compared with 2D (2.2 ± 1 min vs. 3 ± 1 min). Conclusions: 3D strain assessment of longitudinal and circumferential strain is similar but mildly reduced compared with 2D techniques, with similar sensitivity for CAD. Radial strain measurements by 3D, however, are not accurate and correlate poorly with 2D.