Deformation imaging and rotational mechanics in neonates: a guide to image acquisition, measurement, interpretation, and reference values

El-Khuffash, Afif; Schubert, Ulf; Levy, Philip; Nestaas, Eirik; Boode, Willem P. de

doi:10.1038/s41390-018-0080-2

Cited by 73 publications

(88 citation statements)

References 77 publications

(205 reference statements)

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“…using an established analysis protocol, and blinded to group allocation. STE was used to assess peak systolic strain and MD (synchrony) of ventricular segments in accordance with existing consensus recommendations [5]. …”

Section: Methodsmentioning

confidence: 99%

“…Improved understanding of cardiac function in adult pulmonary hypertension has been possible due to advances in non-invasive imaging, including speckle tracking echocardiography (STE) [4]. STE has also been demonstrated to be feasible in newborn infants, allows assessment of regional and global myocardial function, and MD (synchrony) without the limitations of traditional geometric and velocity-based measures [5]. …”

Section: Introductionmentioning

confidence: 99%

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Ventricular Dysfunction, Interdependence, and Mechanical Dispersion in Newborn Infants with Congenital Diaphragmatic Hernia

et al. 2019

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Background: Congenital diaphragmatic hernia (CDH) is an important cause of mortality and morbidity in the neonatal period. Pulmonary hypertension and pulmonary hypoplasia are key pathological findings. Cardiac function may also be an important determinant of disease severity, prognostic indicator, and therapeutic target in CDH. Objective: The aim of this study was to assess ventricular mechanics and synchrony in infants with CDH and controls using speckle tracking echocardiography (STE). Methods: Retrospective analysis was performed of echocardiograms obtained in the first 48 h of life in 27 infants with CDH and 20 controls. STE-derived longitudinal strain (LS) was measured in the right and left ventricles (RV, LV). Circumferential strain (CS) and radial strain (RS) were additionally measured in the LV. Mechanical dispersion (MD), a measure of synchrony, was assessed by calculation of the standard deviation of time to peak systolic strain in six ventricular segments. Results: RV LS and LV LS, LV CS, and LV RS were significantly reduced in CDH compared to controls. In the LV free wall, LS and RS were significantly reduced in CDH. LV LS correlated significantly with RV LS in CDH cases (r² = 0.37, p = 0.002), but not controls (r² = 0.19, p = 0.06). LV LS also correlated with LV MD in CDH (r² = 0.25, p = 0.01) but not controls (r² = 0.02, p = 0.54). Conclusions: Global impairment of RV and LV systolic function are present in newborn infants with CDH and are associated with primary left ventricular dysfunction, ventricular interdependence, and MD.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ventricular Dysfunction, Interdependence, and Mechanical Dispersion in Newborn Infants with Congenital Diaphragmatic Hernia

et al. 2019

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“…Two‐dimensional speckle tracking echocardiography (2D STE) is a novel angle‐independent modality for myocardial strain measurement that has been used to evaluate deformation and quantitatively characterize left ventricle (LV) function in neonates . 2D STE‐obtained measures of myocardial strain and strain rate provide global and regional measures of myocardial function, thus delivering quantitative information of muscle wall characteristics beyond the scope of the conventional echocardiography measures that mainly describe changes in cavity dimensions .…”

Section: Introductionmentioning

confidence: 99%

“…LV longitudinal deformation remains the most reproducible quantitative tool of the three to assess LV function in preterm infants during the transitional period and later neonatal period . In addition, reference ranges for 2D STE‐derived LV longitudinal deformation parameters now exist, and their response to common preterm morbidities are also becoming available …”

Section: Introductionmentioning

confidence: 99%

“…There has been some interest in reporting 2D STE‐derived radial thickening and circumferential shortening of the LV in the human fetus, the premature neonate, the term neonate, and healthy children . However, there is a distinct lack of robust feasibility and reproducibility data on radial and circumferential strain in extremely premature infants < 29 weeks of gestation . Recent advances in offline measurement software and neonatal‐specific recommendations for image acquisition and optimization for 2D STE‐derived deformation measurements may now facilitate the measurement of radial and circumferential deformation in this population.…”

Section: Introductionmentioning

confidence: 99%

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Circumferential and radial deformation assessment in premature infants: Ready for primetime?

et al. 2019

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Background Speckle tracking echocardiography (STE) is a validated method to measure longitudinal deformation in premature infants, but there is a paucity of data on STE‐derived circumferential and radial strain in this population. We assessed the feasibility and reproducibility of circumferential and radial deformation measurements in premature infants. Methods In a prospective study of 40 premature infants (<29 weeks of gestation at birth), STE‐derived circumferential and radial strain, systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) were measured on day 2 and day 8. Intra‐ and inter‐observer reproducibility analysis were performed using Bland–Altman analysis, coefficient of variation (COV), and intra‐class correlation coefficient (ICC). The impact of a persistent patent ductus arteriosus (PDA) was analyzed. Results Deformation analysis was feasible in 98% of the acquisitions. Circumferential parameters demonstrated excellent intra‐ and inter‐observer reproducibility with an ICC between 0.89 and 0.99 (all P < 0.001) and a COV between 4% and 13%. Radial parameters demonstrated acceptable intra‐ and inter‐observer reproducibility with an ICC between 0.73 and 0.96 (all P < 0.001) and a COV between 14% and 27%. Infants with a PDA on day 8 (n = 21, 53%) demonstrated higher radial strain, SRs and SRe. There were no differences in circumferential parameters with a PDA at either time point. Conclusion This study demonstrates clinical feasibility and reproducibility of circumferential and radial strain by STE in premature infants. A PDA elevates radial deformation measures, suggesting that the increased LV preload from a PDA may augment intrinsic contractility in the radial but not circumferential plane.

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Does chest wall conformation influence myocardial strain parameters in infants with pectus excavatum?

Sonaglioni

Nicolosi²,

Braga

et al. 2021

J of Clinical Ultrasound

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Purpose To investigate the possible influence of chest wall conformation on myocardial strain parameters in a consecutive population of infants with pectus excavatum (PE), noninvasively assessed by modified Haller index (MHI). Methods Sixteen consecutive PE infants (MHI >2.5) and 44 infants with normal chest shape (MHI ≤2.5) entered in this prospective case–control study. All infants underwent evaluation by neonatologist, transthoracic echocardiography implemented with two‐dimensional speckle tracking echocardiography (2D‐STE) analysis of both ventricles and MHI assessment (ratio of chest transverse diameter over the distance between sternum and spine), at two time points: within 3 days and at about 40 days of life. Results At 2.1 ± 1 days of life, compared to controls (MHI = 2.01 ± 0.2), PE infants (MHI = 2.76 ± 0.2) were diagnosed with significantly smaller cardiac chambers dimensions. Biventricular contractile function and hemodynamics were similar in both groups of infants. Left ventricular (LV) global longitudinal strain (GLS) (−16.0 ± 2.8 vs. −21.7 ± 2.2%), LV‐global circumferential strain (GCS) (−16.3 ± 2.7 vs. −24.0 ± 5.2%), LV‐global radial strain (GRS) (24.2 ± 3.0 vs. 31.5 ± 6.3%), and right ventricular free wall longitudinal strain (RVFWLS) (−16.0 ± 3.2 vs. −22.3 ± 4.4%) were significantly reduced in PE infants versus controls (all p < 0.001). A strong inverse correlation between MHI and the following parameters: LV‐GLS (r = −0.92), LV‐GCS (r = −0.88), LV‐GRS (r = −0.87), and RVFWLS (r = −0.88), was demonstrated in PE infants, but not in controls, in perinatal period (all p < 0.001). Analogous results were obtained at 36.8 ± 5.2 days after birth. Conclusions Abnormal chest anatomy progressively impairs myocardial strain parameters in PE infants. This impairment might reflect intraventricular dyssynchrony due to compressive phenomena rather than intrinsic myocardial dysfunction.

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Deformation imaging and rotational mechanics in neonates: a guide to image acquisition, measurement, interpretation, and reference values

Cited by 73 publications

References 77 publications

Ventricular Dysfunction, Interdependence, and Mechanical Dispersion in Newborn Infants with Congenital Diaphragmatic Hernia

Ventricular Dysfunction, Interdependence, and Mechanical Dispersion in Newborn Infants with Congenital Diaphragmatic Hernia

Circumferential and radial deformation assessment in premature infants: Ready for primetime?

Does chest wall conformation influence myocardial strain parameters in infants with pectus excavatum?

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