Myocardial Strain Imaging for Early Detection of Cardiac Involvement in Patients with Duchenne's Progressive Muscular Dystrophy

Mori, Kazuhiro; Hayabuchi, Yasunobu; Inoue, Miki; Suzuki, Mitsujiro; Sakata, Miho; Nakagawa, Ryuji; Kubo, Shoji; Tatara, Katsunori; Hirayama, Y.; Abe, Yasuhiko

doi:10.1111/j.1540-8175.2007.00437.x

Cited by 68 publications

(49 citation statements)

References 25 publications

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“…In the posterior wall, six of the DMD patients had postsystolic shortening in the inner-half; four of the DMD patients had systolic thinning in the outer-half of the posterior wall. These data of the current study was concordant with previous pathological and MRI studies [6,7] and tissue Doppler strain imaging studies [15,16].…”

Section: Discussionsupporting

confidence: 93%

“…The two-dimensional speckle tracking echocardiography might easily measure the strain of the myocardium with increased spatial and temporal resolution in comparison to MR tagging strain analysis. We already reported that myocardial strain imaging by tissue Doppler echocardiography is characterized by decreased peak systolic strain of the posterior wall despite normal standard echocardiographic findings [15]. However, as the derivative pitch tends to include structures outside the epicardium, the strain of the most outer portion of the posterior wall, just near the pericardium, cannot be measured.…”

Section: Discussionmentioning

confidence: 99%

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Segmental Myocardial Strain of the Left Ventricle in Patients With Duchenne Muscular Dystrophy Using Two-Dimensional Speckle Tracking Echocardiography

et al. 2008

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Background. Myocardial fibrosis occurs in the subepicardial myocardium of the left ventricular posterior wall in patients with Duchenne Muscular Dystrophy (DMD). The aim of this study was to clarify how these regional myocardial lesions might influence the focal cardiac movement using two-dimensional speckle tracking echocardiography and to investigate whether this new method is useful for the early detection of cardiac involvement in DMD patients. Methods and Results.Twelve DMD patients with a normal fractional shortening (FS) of the left ventricle and twelve healthy age-matched control subjects were enrolled in this study. The segmental radial strain of the left ventricle was recorded using the two-dimensional tissue tracking echocardiography, and the systolic maximal strain was measured.Thereafter, the peak systolic maximal strain was separately measured in the inner-half and outer-half of the left ventricular posterior wall. In DMD patients, the systolic maximal radial strain of the septum, posterior, and inferior walls were significantly lower than those in normal subjects. In particular, the systolic maximal radial strain of the posterior wall in the DMD patients was the most significantly decreased (P<0.0001). Six of the DMD patients had postsystolic shortening in the inner-half, and four of the DMD patients had systolic thinning in the outer-half of the posterior wall. Conclusions.Even if the FS is normal, the left ventricular posterior wall of DMD patients often showed an abnormal strain pattern. A segmental myocardial strain analysis might be useful for the early detection of cardiac involvement in DMD patients. (J Echocardiogr 2008; 4: 100-108)

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Segmental Myocardial Strain of the Left Ventricle in Patients With Duchenne Muscular Dystrophy Using Two-Dimensional Speckle Tracking Echocardiography

et al. 2008

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“…5 There are studies showing the value of strain in identifying patients with hypertensive heart disease, 6 system sclerosis, 7 heart transplant rejection, 8 chemotherapy, 9 various cardiomyopathies and systemic muscular problems. 10 There is literature indicating the superior diagnostic value of strain vs. EF inpatients with acute heart failure. 11 A large multicenter study showed that strain assessment is both feasible and reliable in patients with LV dysfunction and allows for cardiovascular risk stratification in heart failure patients, with greater accuracy than LVEF.…”

Section: Speckle Tracking 2d Strainmentioning

confidence: 99%

A Practical Approach to Using Strain Echocardiography to Evaluate the Left Ventricle

Feigenbaum

Mastouri

Sawada

2012

Circ J

100

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp valuation of left ventricular (LV) systolic function is a critical component of the practice of cardiology and a fundamental function of the echocardiographic examination. Although LV systolic function is commonly defined by ejection fraction (EF), there are numerous technical and hemodynamic limitations to EF. A qualitative "eyeball" estimate has high variability, and quantitative measurements are subject to endocardial border definition and formulas that make assumptions in geometry of the LV. The EF denotes global LV function and does not convey any regional differences in function that may exist in patients with various cardiomyopathies. Hyperkinetic segments can distort a global measurement, leading to an underestimation of the significance of regional abnormalities. There are several alternative techniques that can either supplement or replace EF, including tissue Doppler recordings of the mitral annulus and measurements such as the TEI or myocardial performance index. Doppler-Derived Strain RateThe newest technique for evaluating the LV uses the concept of strain or strain rate. This technique assesses myocardial mechanics by measuring the relationship between 2 points within the myocardium as if they were connected by a rubber band. When the 2 points move away from each other (myocardial lengthening during diastole), strain values are positive. When the 2 points move toward each other (myocardial shortening during systole), strain is decreased, generating negative strain. Strain and strain rate can be derived from either tissue Doppler or speckle tracking 2-or 3-dimensional (D) echocardiography. Using tissue Doppler, which is a form of pulsed Doppler, specific points within the myocardium can be identified. 1 Tracking these Doppler points enables measurement of strain rate. Because Doppler is velocity or distance divided by time, the initial measurement is strain rate. Integrating the strain rate gives strain.There are limitations to the Doppler-based strain rate. As with all Doppler applications, the Doppler-derived strain rate is angledependent. The Doppler strain rate sample volume is also fixed while the myocardium is moving. Thus the sample volume may not stay within the myocardium throughout the cardiac cycle. Strain rate is a derivative of strain and tends to be noisy. Figure 1 shows one way of recording strain rate using "curved M-mode". A resting normal 4-chamber view shows yellowishbrown strain rate during ventricular systole. The strain rate recording of the apex is not reliable, because the apex is perpendicular to the ultrasonic beam, so there is no Doppler signal. With exercise the systolic strain rate turns reddish brown, indicating a higher degree of negativity or contraction in the basal segments. This patient has a blockage in the left anterior descending coronary artery. With exercise, there is a delay in the onset of contraction of the apical half of the septal and lateral walls, a failur...

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“…132,148 In addition to standard 2-dimensional, Mmode, and Doppler assessments, research on strain and strain-rate echocardiographic imaging could provide future insights about disease presence and progression before detection of global dysfunction by more traditional echocardiographic indices. 144,[149][150][151][152] An important limitation in the application of standard transthoracic echocardiography in the care of patients with DMD and BMD is the diminishment of imaging (acoustic) windows because of progression of scoliosis or obesity with advancing age. 153 Thus, the use of other imaging modalities, such as cardiac magnetic resonance imaging (CMR), might better fully characterize the severity of cardiac involvement in older patients.…”

Section: Cardiac Evaluation In Dmd and Bmdmentioning

confidence: 99%

Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association

Feingold¹,

Mahle²,

Auerbach³

et al. 2017

Circulation

211

195

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For many neuromuscular diseases (NMDs), cardiac disease represents a major cause of morbidity and mortality. The management of cardiac disease in NMDs is made challenging by the broad clinical heterogeneity that exists among many NMDs and by limited knowledge about disease-specific cardiovascular pathogenesis and course-modifying interventions. The overlay of compromise in peripheral muscle function and other organ systems, such as the lungs, also makes the simple application of endorsed adult or pediatric heart failure guidelines to the NMD population problematic. In this statement, we provide background on several NMDs in which there is cardiac involvement, highlighting unique features of NMD-associated myocardial disease that require clinicians to tailor their approach to prevention and treatment of heart failure. Undoubtedly, further investigations are required to best inform future guidelines on NMD-specific cardiovascular health risks, treatments, and outcomes. N euromuscular diseases (NMDs) encompass a broad spectrum of diagnoses with overlapping but distinct phenotypes. Common to many NMDs is cardiac involvement. Although the past 3 decades have seen marked advances in our understanding of many NMDs, significant gaps in knowledge remain on how best to approach cardiac care in these patients. For example, survival in Duchenne muscular dystrophy (DMD) has been extended through the use of glucocorticoid use and respiratory support, yet cardiac complications remain a significant cause of morbidity and mortality.1-3 To achieve further gains in care, we will need to improve our understanding of the pathophysiologies driving cardiac involvement in NMDs and advance treatments aimed at preventing the progression of heart failure (HF) and sudden death in NMDs. The recently published findings of an expert working group on cardiac involvement in DMD, which outlined key gaps in knowledge and made specific recommendations aimed at improving diagnosis and management, are a step toward this goal. 4 In this statement, we include a comprehensive overview of the major categories of NMDs with cardiac involvement. For each, a brief background of the gene defect(s), common clinical manifestations (particularly cardiac findings), and current therapies is summarized. Gaps in knowledge are highlighted, and where possible, clinical treatment suggestions are made by the expert writing group appointed by the American Heart Association to review the available literature. Selection of the writing group was performed in accordance with the American Heart Association's conflict-of-interest management policy. Participants volunteered to write sections relevant to their expertise and experience. CLINICAL STATEMENTS AND GUIDELINESconducted a general search of the literature, restricted to human subjects research published between 1980 and 2016. Drafts of each section were written and sent to the chair of the writing group for incorporation into a single document, which was then edited. The edited document was discussed electron...

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Myocardial Strain Imaging for Early Detection of Cardiac Involvement in Patients with Duchenne's Progressive Muscular Dystrophy

Abstract: Myocardial strain imaging in DMD patients was characterized by decreased peak systolic strain of the posterior wall despite normal standard echocardiographic findings. Strain measurement might be useful for early detection of subtle regional myocardial dysfunction.

Cited by 68 publications

References 25 publications

Segmental Myocardial Strain of the Left Ventricle in Patients With Duchenne Muscular Dystrophy Using Two-Dimensional Speckle Tracking Echocardiography

Segmental Myocardial Strain of the Left Ventricle in Patients With Duchenne Muscular Dystrophy Using Two-Dimensional Speckle Tracking Echocardiography

A Practical Approach to Using Strain Echocardiography to Evaluate the Left Ventricle

Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association

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