The influence of pectus excavatum on cardiac kinetics and function in otherwise healthy individuals: A systematic review

The wide spectrum of determinants of false-positive results on exercise stress echocardiography

“…Another potential mechanism capable of inducing LVWM abnormalities, hence possibly yielding FP-ESE results, is represented by abnormalities of chest anatomy, particularly anterior chest wall deformity due to a narrow antero-posterior thoracic diameter or pectus excavatum 21 . The latter may cause mechanical compression of cardiac chambers and a paradoxical septal motion, defined as the movement of the interventricular septum away from the LV free wall during systole, more enhanced during physical exercise 22 .…”

“…10 586 Journal of Cardiovascular Medicine 2023, Vol 24 No 8 Another potential mechanism capable of inducing LVWM abnormalities, hence possibly yielding FP-ESE results, is represented by abnormalities of chest anatomy, particularly anterior chest wall deformity due to a narrow anteroposterior thoracic diameter or pectus excavatum. 21 The latter may cause mechanical compression of cardiac chambers and a paradoxical septal motion, defined as the movement of the interventricular septum away from the LV free wall during systole, more enhanced during physical exercise. 22 If the exercise-induced septal bounce is not appropriately put in relation to the individual's anterior chest wall deformity, it may be misinterpreted as regional myocardial hypokinesis or dyskinesis due to obstructive CAD.…”

From ejection fraction, to myocardial strain, and myocardial work in echocardiography: Clinical impact and controversies

“…Limitations : Age and load dependency 3 ; chest shape dependency 24 ; image quality‐related 3 ; accuracy 0.79 1 ; specificity 68% 1 ; intervendor and intersoftware variability 3 …”

“…When changes in GLS are larger between subsequent examinations, the interpretation is uncertain, because of the more tight scale range, variable, and uncertain cutoff value for normality 3,9,11–14 . It is very difficult to proceed to an operative clinical decision‐making process if not supported by concordant pathophysiological changes in EF and other parameters/markers, due to the variety of possible factors interfering with GLS values, 14–23 including chest shape 24 . Thus, it is unclear what LV strain parameters might concretely add in clinical practice (and to EF), mostly when applying decision‐making process to the single case, because of the great heterogeneity of the reported results, wide standard deviation overlap of GLS values when comparing different populations or subgroups, and a lack of documented and meaningful test‐retest variability assessment in extended and not (highly) selected population as well 3,9,11–23 …”

“…Finally, other GLS limitations include the important image‐quality relation, 3,5,6,14 intervendor/intersoftware variability, 3,5,6,14 age and load dependency, 3 and chest shape 24 (Table 1).…”