Left Ventricular Global Longitudinal Strain Can Reliably Be Measured from a Single Apical Four-Chamber View in Patients with Heart Failure

Alenezi, Fawaz; Ambrosy, Andrew P.; Phelan, Matthew; Chiswell, Karen; Abudaqa, Loai; Alajmi, Hasan; Kisslo, Joseph; Velázquez, Eric J.

doi:10.1016/j.echo.2018.10.009

Cited by 14 publications

(13 citation statements)

References 5 publications

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“…However, others recommend that the term global longitudinal strain should be used for measurements that also incorporate the three-chamber and two-chamber views [ 5 , 16 , 22 , 23 ]. This is further complicated by the fact that studies and meta-analyses differ in whether these different approaches have clinical implications [ 22 , 24 ]. In order to avoid confusion, we have used the term average 4ch strain rather than global longitudinal strain in this study.…”

Section: Discussionmentioning

confidence: 99%

Effect of Temporal and Spatial Smoothing on Speckle–Tracking-Derived Strain in Neonates

et al. 2021

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Clinical application of strain in neonates requires an understanding of which image acquisition and processing parameters affect strain values. Previous studies have examined frame rate, transmitting frequency, and vendor heterogeneity. However, there is a lack of human studies on how user-regulated spatial and temporal smoothing affect strain values in 36 neonates. This study examined nine different combinations of spatial and temporal smoothing on peak systolic left ventricular longitudinal strain in 36 healthy neonates. Strain values were acquired from four-chamber echocardiographic images in the software-defined epicardial, midwall, and endocardial layers in the six standard segments and average four-chamber stain. Strain values were compared using repeated measure ANOVAs. Overall, spatial smoothing had a larger impact than temporal smoothing, and segmental strain values were more sensitive to smoothing settings than average four-chamber strain. Apicoseptal strain decreased by approximately 4% with increasing spatial smoothing, corresponding to a 13–19% proportional change (depending on wall layer). Therefore, we recommend clinicians be mindful of smoothing settings when assessing segmental strain values.

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Section: Discussionmentioning

confidence: 99%

Effect of Temporal and Spatial Smoothing on Speckle–Tracking-Derived Strain in Neonates

et al. 2021

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Section: Discussionmentioning

confidence: 95%

“…The value of GLS 4ch identified <7.5%, that is very low and unusual, is expression of extremely advanced HF disease and could help to better stratify this group of patient and indicate even worse prognosis. 18 Finally, the routine use of strain echocardiography requires adequate training for physicians and sonographers. In contrast to older tissue Doppler imaging methods, newer speckle-tracking imaging has increased the ease of assessment, improved inter-observer variability, and decreased analysis times.…”

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confidence: 99%

Echocardiography to estimate high filling pressure in patients with heart failure and reduced ejection fraction

Romano

Magro²,

Agnese

et al. 2020

ESC Heart Failure

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Aims Echocardiographic assessment of left ventricular filling pressures is performed using a multi-parametric algorithm. Unselected sample of patients with heart failure with reduced ejection fraction (HFrEF) patients may demonstrate an indeterminate status of diastolic indices making interpretation challenging. We sought to test improvement in the diagnostic accuracy of standard and strain echocardiography of the left ventricle and left atrium (LA) to estimate a pulmonary capillary wedge pressure (PCWP) > 15 mmHg in patients with HFrEF. Methods and results Out of 82 consecutive patients, 78 patients were included in the final analysis and right heat catheterization, and echocardiogram was performed simultaneously. According to the univariable analysis, E wave velocity, the ratio between E-wave/A-wave (E/A, area under the curve [AUC] = 0.81, respectively), isovolumic relaxation time (AUC = 0.83), pulmonary vein D wave (AUC = 0.84), pulmonary vein S/D Ratio (AUC = 0.85), early pulmonary regurgitation velocity (AUC = 0.80), and accelerationa time at right ventricular out-flow tract (RVOT AT, AUC = 0.84) identified with the highest accuracy PCWP > 15 mmHg. They were all tested in multivariate analysis, and they were not independently correlated with PCWP. Tricuspid regurgitation (TR) velocity was measurement with the highest predictive value in identifying PCWP > 15 mmHg (AUC = 0.89), compared with other established parameters such as the ratio between e-wave velocity divided by mitral annular e' velocity (E/e'), deceleration time, or LA indexed volume (LAVi), which all reached a lower accuracy level (AUC = 0.75; 0.78; 0.76). Among strain measures, global longitudinal strain in four chamber view (GLS 4ch), the ratio between e-wave velocity divided by mitral annular e' strain rate (E/e'sr), and LA longitudinal strain at the reservoir phase were helpful in estimating elevated PCWP (AUC = 0.77; 0.76; 0.75). According to multivariable analysis, the following two models had the greatest accuracy in detecting PCWP > 15 mmHg: (i) TR velocity, LAVi, and E wave velocity (receiver operating characteristic [ROC]-AUC = 0.98), (ii) AT RVOT, LAVi and GLS 4ch (ROC-AUC = 0.96). Neither E/A (ROC-AUC = 0.81) nor E/e' (ROC-AUC = 0.75) was an independent predictor when included in the model. The two MODELS were applicable to the entire population and demonstrated better agreement with the invasive reference (91% and 88%) than the guidelines algorithm (77%) regardless of the type of rhythm. Conclusions Our suggested echocardiographic approach could be used to potentially reduce the frequency of "doubtful" classification and increase the accuracy in predicting elevated left ventricular filling pressure leading to a decrease in the number of invasive assessment made by right heart catheterization.

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“…In recent years, studies on adults have begun to emerge that compare three plane GLS against 4ch GLS. One such study showed good agreement and similar prognostic value of 4ch GLS and three plane GLS in heart failure patients [ 18 ]. Another study aimed at detecting cardiotoxicity was conducted in patients undergoing chemotherapy [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Speckle tracking derived strain in neonates: planes, layers and drift

Khan

Omdal

Matre

et al. 2021

Int J Cardiovasc Imaging

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The aims of this study was to assess the effect of using a four chamber versus a three plane model on speckle tracking derived global longitudinal strain, the effects of drift compensation, the effect of assessing strain in different layers and finally the interplay between these aspects for the assessment of strain in neonates. Speckle tracking derived longitudinal strain was obtained from 22 healthy neonates. ANOVA, Bland–Altman analyses, coefficients of variation and assessment of intraclass correlation coefficients were conducted to assess the effect of the abovementioned aspects as well as assess both inter-observer and intra-observer variability. Neither the use of the three plane model versus the four chamber model nor the use of drift compensation had a substantial effect on global longitudinal strain (less than 1%, depending on which layer was being assessed). A gradient was seen with increasing strain from the epicardial to endocardial layers, similar to what is seen in older subjects. Finally, drift compensation introduced more discrepancy in segmental strain values compared to global longitudinal strain. Global longitudinal strain in healthy neonates remains reasonably consistent regardless of whether the three plane or four chamber model is used and whether drift compensation is applied. Its value increases when one moves from the endocardial to the epicardial layer. Finally, drift compensation introduces more discrepancy for regional measures of longitudinal strain compared to global longitudinal strain.

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Left Ventricular Global Longitudinal Strain Can Reliably Be Measured from a Single Apical Four-Chamber View in Patients with Heart Failure

Cited by 14 publications

References 5 publications

Effect of Temporal and Spatial Smoothing on Speckle–Tracking-Derived Strain in Neonates

Effect of Temporal and Spatial Smoothing on Speckle–Tracking-Derived Strain in Neonates

Echocardiography to estimate high filling pressure in patients with heart failure and reduced ejection fraction

Speckle tracking derived strain in neonates: planes, layers and drift

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