Normal range of myocardial layer-specific strain using two-dimensional speckle tracking echocardiography

Abstract

BackgroundNewer 2D strain software has a potential to assess layer-specific strain. However, normal reference values for layer-specific strain have not been established. We aimed to establish the normal ranges of layer-specific longitudinal and circumferential strain (endocardial global longitudinal strain (GLS), transmural GLS, epicardial GLS, endocardial global circumferential strain (GCS), transmural GCS, and epicardial GCS).Methods and resultsWe retrospectively analyzed longitudinal and circumferential strain parameters in 235 healthy subjects, with use of layer-specific 2D speckle tracking software (GE). The endocardial strain/epicardial strain (Endo/Epi) ratio was also measured to assess the strain gradient across the myocardium. The endocardial, transmural, and epicardial GLS values and the Endo/Epi ratio in the normal subjects were -23.1±2.3, -20.0±2.0, -17.6±1.9, and 1.31±0.07, respectively. The corresponding values of GCS were -28.5±3.0, -20.8±2.3, -15.3±2.0, and 1.88±0.17, respectively. The layer-specific global strain parameters exhibited no age dependency but did exhibit gender dependency except for endocardial GCS. A subgroup analysis revealed that basal and middle levels of endocardial LS was decreased in the middle and elderly aged group. However, apical endocardial LS was preserved even in the elderly subjects.ConclusionsWe proposed normal reference values for layer-specific strain based on both age and gender. This detailed strain analysis provides layer-oriented information with the potential to characterize abnormal findings in various cardiovascular diseases.

Cardiac Segmental Strain Analysis in Pediatric Left Ventricular Noncompaction Cardiomyopathy

“…The pattern of improved circumferential strain values in the endocardium compared with the epicardium has been described and attributed to larger changes in circumferential radius of curvature during systole in the endocardium than epicardium, resulting in increased strain values. 25,26 Markedly decreased shortening and ejection fractions were demonstrated on the initial echocardiograms of patients with LVNC who did not survive or required heart transplantation; those with Figure 3 NC:C ratios: graphical representation of the segments involved in LV noncompaction. Average NC:C ratios in the benign and adverse outcome groups are illustrated.…”

Normal reference values of multilayer longitudinal strain according to age decades in a healthy population: A single-centre experience

“…To the best of our knowledge, only two studies proposed normal reference values of layer-specific strain. 13,14 In the first study, prospectively performed on 119 healthy volunteers (age range = 22-76 years, 50% women), LSsubendo was substantially higher than LSsubepi, they being both influenced by gender, heart rate, and stroke volume but not by age. 13 In the second one, Nagata et al 14 retrospectively collected data on 235 healthy subjects and presented normal reference values according to four age decades (from 20 years to 59 years).…”

“…12 Conversely, little information is available on normal values of layer-specific strain. 13,14 This prospective study was designed to define normal values of both LSsubendo and LSsubepi and myocardial transmural gradient in a healthy population with a wide age range, in relation with demographic and echocardiographic variables and to propose reference values according to age decades.…”

Layer-specific speckle tracking analysis of left ventricular systolic function and synchrony in maintenance hemodialysis patients

“…Compared with traditional echocardiography, 2D-STE technology is faster, more accurate, and angle-independent; it can assess myocardial function through longitudinal, circumferential, radial, and torsional motions (10), and thus can examine the global and local left ventricular function with high sensitivity. The layer-specific speckle tracking (LST) technology, derived from 2D-STE, can analyze strain parameters of LV function in three muscular layers-the sub-endocardium, mid-myocardium, and sub-epicardium (11). Therefore, LST allows early detection of subtle ventricular systolic dysfunction (11)(12)(13).…”

“…The layer-specific speckle tracking (LST) technology, derived from 2D-STE, can analyze strain parameters of LV function in three muscular layers-the sub-endocardium, mid-myocardium, and sub-epicardium (11). Therefore, LST allows early detection of subtle ventricular systolic dysfunction (11)(12)(13). Previous studies used the LST to assess global longitudinal, circumferential, and radial myocardial strains of dialysis patients (14)(15)(16), but few studies have been performed to measure longitudinal and circumferential strains of the LV three-layer myocardium.…”