Speckle-tracking Echocardiography-derived Strain Research Articles

Increasing region of interest width reduces neonatal circumferential strain.

There is growing interest in speckle tracking echocardiography-derived strain as a measure of left ventricular function in neonates. However, knowledge gaps remain regarding the effect of image acquisition and processing parameters on circumferential strain measurements. The aim of this study was to evaluate the effect of using different region of interest (ROI) widths on speckle tracking derived circumferential strain in healthy neonates. Thirty healthy-term-born neonates were examined with speckle-tracking echocardiography in the short-axis view. Circumferential strain values were acquired and compared using two different ROI widths. Furthermore, strain values in the different vendor-defined wall layers were also compared. Increasing ROI width led to a decrease in global circumferential strain (GCS) in the midwall and epicardial layers, the respective decreases in strain being -23.4±.6% to -22.0±1.1%, p<.0001 and 18.5±1.7% to -15.6±2.0%, p<.0001. Segmental analyses were consistent with these results, apart from two segments in the midwall. There was no statistically significant effect on strain for the endocardial layer. A gradient was seen where strain increased from the epicardial to endocardial layers. Increasing ROI width led to a decrease in GCS in the midwall and epicardium. There is an increase in circumferential strain when moving from the epicardial toward the endocardial layer. Clinicians wishing to implement circumferential strain into their practice should consider ROI width variation as a potential confounder in their measurements.

Abstract 15592: Artificial Intelligence-Derived Left Ventricular Global Longitudinal Strain is Associated More Strongly With All-Cause Mortality Than is Speckle Tracking Echocardiography-Derived Strain in a Cohort of Cardio-Oncology Patients

Introduction: Myocardial strain, a marker of heart muscle deformation, is crucial for assessing cardiac function and prognosis in cardiovascular diseases. Speckle Tracking Echocardiography (STE) is the preferred non-invasive method for strain. However, STE's accuracy can vary due to image quality, vendor-dependence, and operator inconsistency. STE-derived Global Longitudinal Strain (manual GLS) changes are key in early detection of cancer treatment-related cardiotoxicity. Hypothesis: We hypothesized that AI-derived GLS would have a stronger correlation with all-cause mortality (ACM) than STE-derived GLS. Methods: We retrospectively analyzed 1,224 echocardiograms, from 762 patients, with STE GLS values from Harrington Heart and Vascular Institute Cardio-Oncology studies performed between Jan 2021 - Jun 2022. Images were analyzed using EchoGo Core (Ultromics Ltd), a cloud-based, AI-powered software employing convolutional neural networks. Pearson's correlation coefficients and Bland-Altman analysis compared STE and AI-derived GLS (R-Studio). Both methods were evaluated using Receiver Operating Characteristic (ROC) curves. Patients were divided into tertiles based on their GLS values to assess ACM hazard ratios (HR). Results: Out of 762 patients, a moderate correlation (r=0.63, p&lt;0.001) existed between STE and AI-derived GLS. The mean difference between the two was 2.37 and the limits of agreement were -3.65 to 8.39. The Area Under the Curve (AUC) was higher for AI (0.66) than STE GLS (0.59). Over an average follow-up of 215 days (± 169 days), 26 deaths occurred. When Tertile 3 was compared to Tertile 1, AI-derived GLS showed an HR of 4.46 (p=0.023), whereas the STE GLS HR was not statistically significant (HR=2.4). Conclusions: The study showed moderate agreement between AI and manual GLS measurements. The HR for ACM was statistically significant only in AI-derived GLS in patients undergoing cardiotoxic chemotherapy.

Serial Strain Analysis Identifies Hypoplastic Left Heart Syndrome Infants at Risk for Cardiac Morbidity and Mortality: A Pilot Study

Validated, objective measures of right ventricular (RV) function assessment in hypoplastic left heart syndrome (HLHS) are needed. In other populations, speckle-tracking echocardiography-derived strain is a sensitive measure that outperforms conventional parameters of RV function. We hypothesized that speckle-tracking echocardiography-derived measures of RV function would be worse in patients with HLHS who have a poor cardiac outcome. Prospective serial echocardiography was performed in 35 infants with HLHS during the first 6months of life. Patients not undergoing staged palliation or with other variants of single RV were excluded. Traditional RV measurements and strain analysis were performed from standard apical and basal views. The primary outcome of cardiac death, heart transplantation, or persistent ≥moderate RV dysfunction was examined using Cox regression analysis, and receiver operating characteristic curve analyses were performed to derive cutoff values. At median follow-up of 10.9months (interquartile range 5.6, 15.2), eight patients reached the outcome and demonstrated worse RV strain measures compared with those without the outcome. A post-Norwood global longitudinal strain (GLS) of>-16% (area under the curve [AUC]=0.76; P=.04) and pre-Glenn GLS>-13% (AUC, 0.98; P≤.01) were highly sensitive and specific for poor outcome. Other thresholds included post-Norwood GLS rate (GLSr)>-1.15 %/s (AUC, 0.78; P=.03), pre-Glenn GLSr=-0.85%/sec (AUC, 0.89; P<.01), post-Glenn circumferential strain rate>-0.85%/sec (AUC, 0.92; P<.01), and GLSr>-0.85%/sec (AUC, 0.84; P=.02). Strain analysis may help identify at-risk HLHS infants. In this pilot study, interstage strain indices were worse in infants with HLHS who had a poor cardiac outcome.

Comparative evaluation of left ventricular function by two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography in noncompaction cardiomyopathy. Results from the MAGYAR-Path Study

Noncompaction cardiomyopathy develops due to the absence of myocardial compaction, and is associated with left ventricular dysfunction. The aim of the study was to evaluate comparatively left ventricular dysfunction in patients with noncompaction cardiomyopathy using two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography. The present study comprised of 7 patients with noncompaction cardiomyopathy (62.9±8.5 years, 3 males) and 10 age- and gender-matched healthy controls (60.7±7.7 years, 2 males). All patients were examined by two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography for the evaluation of left ventricular function. Increased left ventricular end-diastolic and end-systolic volumes and reduced left ventricular ejection fraction were detected in patients with noncompaction cardiomyopathy as compared to those measured in controls. All three-dimensional speckle-tracking echocardiography-derived strain parameters of patients with noncompaction cardiomyopathy were found to be reduced as compared to the values of controls. Three-dimensional speckle-tracking echocardiography-derived rotational parameters showed movements of the apical and basal segments in the same direction suggesting 'rigid body rotation' in all noncompaction cardiomyopathy cases. Left ventricular function and contractility are severely reduced in patients with noncompaction cardiomyopathy. Absence of left ventricular twist could be demonstrated in a series of noncompaction cardiomyopathy patients.