Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study

Sugimoto, Tadafumi; Dulgheru, Raluca; Bernard, Anne; Ilardi, Federica; Contu, Laura; Addetia, Karima; Caballero, Luis; Akhaladze, Natela; Athanassopoulos, George; Barone, Daniele; Baroni, Monica; Cardim, Nuno; Hagendorff, Andreas; Hristová, Krasimira; López, Teresa; Morena, Gonzalo de la; Popescu, Bogdan A; Moonen, Marie; Pěnička, Martin; Özyiğit, Tolga; Carbonero, D. Rodrigo; Veire, Nico Van de; Bardeleben, Ralph Stephan von; Vinereanu, Dragoş; Zamorano, José Luís; Go, Yun Yun; Roşca, Monica; Calin, A.; Magné, Julien; Cosyns, Bernard; Marchetta, Stella; Donal, Erwan; Habib, Gilbert; Galderisi, Maurizio; Badano, Luigi P.; Lang, Roberto M.; Lancellotti, Patrizio

doi:10.1093/ehjci/jex140

Cited by 261 publications

(219 citation statements)

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“…We found that about a third of screened patients had impaired GLS. In a cohort of 549 healthy European subjects, mean GLS was −23.3% (±3.1%) in females aged 40–60 years, compared to mean GLS in our total cohort of −18.3% (±3.1%): −17.9% (±2.9%) in anthracycline‐treated patients and −18.8% (±3.2%) in the no‐anthracycline group. It should be noted that part of this ∼5% difference may be explained by differences in the prevalence of cardiovascular risk factors associated with worse GLS.…”

Section: Discussioncontrasting

confidence: 61%

“…We performed sensitivity analyses excluding patients with a locoregional BC recurrence and/or second BC or clinical cardiovascular disease diagnosed after BC to establish their influence on outcome measures. For clinical interpretation of the data, we conducted multivariable logistic regression to study effects of treatment‐related risk factors on myocardial dysfunction prevalence, defined as a LVEF <54%, according to the range of normal LVEF values in the general female population, GLS >–17%, a cut‐off value indicative of impaired myocardial deformation, or NT‐proBNP >125 ng/L . Significance tests were two‐sided and P < 0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

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Myocardial dysfunction in long‐term breast cancer survivors treated at ages 40–50 years

Jacobse

Steggink

Sonke

et al. 2019

European J of Heart Fail

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Aims Anthracyclines increase heart failure (HF) risk, but the long‐term prevalence of myocardial dysfunction in young breast cancer (BC) survivors is unknown. Early measures of left ventricular myocardial dysfunction are needed to identify BC patients at risk of symptomatic HF. Methods and results Within an established cohort, we studied markers for myocardial dysfunction among 569 women, who were 5–7 years (n = 277) or 10–12 years (n = 292) after BC treatment at ages 40–50 years. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were assessed by echocardiography. N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) was measured in serum. Associations between patient‐related and treatment‐related risk factors and myocardial dysfunction were evaluated using linear and logistic regression. Median ages at BC diagnosis and cardiac assessment were 46.7 and 55.5 years, respectively. Anthracycline‐treated patients (n = 313), compared to the no‐anthracycline group (n = 256), more often had decreased LVEF (10% vs. 4%), impaired GLS (34% vs. 27%) and elevated NT‐proBNP (23% vs. 8%). GLS and LVEF declined in a linear fashion with increasing cumulative anthracycline dose (GLS: +0.23 and LVEF: −0.40 per cycle of 60 mg/m2; P < 0.001) and GLS was worse for patients with left breast irradiation. The risk of NT‐proBNP >125 ng/L was highest for patients who received 241–300 mg/m2 anthracycline dose compared to the no‐anthracycline group (odds ratio: 3.30, 95% confidence interval: 1.83–5.96). Conclusion Impaired GLS and increased NT‐proBNP levels are present in a substantial proportion of young BC survivors treated with anthracyclines. Whether this will lead to future cardiac disease needs to be evaluated by longitudinal assessment.

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Section: Discussioncontrasting

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Myocardial dysfunction in long‐term breast cancer survivors treated at ages 40–50 years

Jacobse

Steggink

Sonke

et al. 2019

European J of Heart Fail

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“…19,204,218 All strain values are dimensionless and are expressed as percentages. For ease of use in these recommendations, we suggest a cut-point of 16% in absolute values; [219][220][221][222] and a value below 16% (e.g. 14%) is recommended as a minor criterion.…”

Section: Minor Criterion∶ Gls < 16%mentioning

confidence: 99%

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Pieske

Tschöpe

Boer

et al. 2020

European J of Heart Fail

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406

643

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Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the ‘HFA–PEFF diagnostic algorithm’. Step 1 (P=Pre‐test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non‐cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e′), LV filling pressure estimated using E/e′, left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2–4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.

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“…Although we display good inter‐observer reproducibility, it may be dependent on operator skill. However, the parameters, which we measured, have been extensively studied, and the data on their reproducibility are available in the literature …”

Section: Discussionmentioning

confidence: 99%

“…However, the parameters, which we measured, have been extensively studied, and the data on their reproducibility are available in the literature. [16][17][18]…”

Section: Study Limitationsmentioning

confidence: 99%

Diagnostic utility of two‐dimensional speckle tracking echocardiography to identify ischemic etiology of left ventricular systolic dysfunction

et al. 2019

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Background The differentiation between dilated cardiomyopathy (DCM) and systolic dysfunction caused by coronary artery disease (CAD) based on clinical and echocardiographic presentation can be difficult in some cases. Aim Our study aimed to define differences in myocardial function between patients with ischemic and nonischemic etiology of reduced left ventricular ejection fraction using 2D speckle tracking echocardiography (STE). Material and methods We retrospectively analyzed 90 patients (mean age 65 ± 11 years, 70% male) with de novo diagnosed reduced left ventricular ejection fraction (≤45% as determined by the transthoracic echocardiography), who were referred for coronary angiography to determine the presence of significant CAD. On the basis of coronary angiography results, patients were divided into two subgroups as follows: 45 subjects with significant CAD (group A) and 45 subjects without CAD (group B). Acquired transthoracic echocardiographic images were assessed off‐line using 2DSTE. In each patient, we calculated arithmetic mean, median value, and standard deviation of regional longitudinal strain and strain rate of 18 left ventricular segments. Results Standard deviation of the regional peak early diastolic strain rate was significantly higher in group A than in group B (P = 0.01). The cutoff value with the highest diagnostic value was >0.37/s—its sensitivity and specificity for the diagnosis of CAD were 73% and 53%, respectively. The remaining parameters did not differ significantly between the study groups. Conclusions Patients with systolic dysfunction resulting from CAD have significantly more heterogeneous regional longitudinal early diastolic strain rate assessed by 2DSTE than patients with DCM.

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Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study

Abstract: The NORRE study provides contemporary, applicable 2D echocardiographic reference ranges for LV longitudinal, radial, and circumferential strain. Our data highlight the importance of age- and gender-speciﬁc reference values for LV strain.

Cited by 261 publications

References 20 publications

Myocardial dysfunction in long‐term breast cancer survivors treated at ages 40–50 years

Myocardial dysfunction in long‐term breast cancer survivors treated at ages 40–50 years

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Diagnostic utility of two‐dimensional speckle tracking echocardiography to identify ischemic etiology of left ventricular systolic dysfunction

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