Two-dimensional strain analysis of the global and regional myocardial function for the differentiation of pathologic and physiologic left ventricular hypertrophy: a study in athletes and in patients with hypertrophic cardiomyopathy

Abstract

Two-dimensional strain (2DS) is a novel method to measure strain from standard two-dimensional echocardiographic images by speckle tracking, which is less angle dependent and more reproducible than conventional Doppler-derived strain. The objective of our study was to characterize global and regional function abnormalities using 2DS and strain rate analysis in patients (pts) with pathological left ventricular hypertrophy (LVH) caused by non-obstructive hypertrophic cardiomyopathy (HCM), in top level athletes, and in healthy controls. The hypothetical question was, if 2DS might be useful as additional tool in differentiating between pathologic and physiologic hypertrophy in top-level athletes. We consecutively studied 53 subjects, 15 pts with hypertrophic cardiomyopathy (HCM), 20 competitive top-level athletes, and a control group of 18 sedentary normal subjects by standard echocardiography according to ASE guidelines. Global longitudinal strain (GLS) and regional peak systolic strain (PSS) was assessed by 2DS in the apical four-chamber-view using a dedicated software. All components of strain were significantly reduced in pts with HCM (GLS: -8.1 ± 3.8%; P < 0.001) when compared with athletes (-15.2 ± 3.6%) and control subjects (-16.0 ± 2.8%). In general, there was no significant difference between the strain values of the athletes and the control group, but in some of the segments, the strain values of the control group were significantly higher than those in the athletes. A cut-off value of GLS less than -10% for the diagnosis of pathologic hypertrophy (HCM) resulted in a sensitivity of 80.0% and a specificity of 95.0%. The combination of TDI (averaged S', E') and 2DS (GLS) cut-off values for the detection of pathologic LVH in HCM demonstrated a sensitivity of 100%, and a specificity of 95%. Two-dimensional strain is a new simple and rapid method to measure GLS and PSS as components of systolic strain. This technique could offer a unique approach to quantify global as well as regional systolic dysfunction, and might be used as new additional tool for the differentiation between physiologic and pathologic LVH.

Patterns of Left Ventricular Longitudinal Strain and Strain Rate in Olympic Athletes

“…[7][8][9][10] Most notably, GLS and derived strain rate parameters can be measured, which have been shown to provide additional and valuable information beyond EF in different clinical scenarios, such as in subjects with coronary artery disease, heart failure, and cardiomyopathies. 9,10,21,22 Specifically, Di Salvo et al 23 showed that in hypertrophic cardiomyopathy, reduction in regional myocardial strain in more than three segments might identify patients at risk for ventricular arrhythmias; additionally, and of relevance to our purpose, Butz et al 11 recently showed that GLS can distinguish the physiologic hypertrophy of athlete's heart from hypertrophic cardiomyopathy.…”

“…[7][8][9][10] Specifically, strain analysis may identify subclinical myocardial impairment (such as in incipient heart failure, ischemic heart disease, and valvular heart disease) and may be helpful in the clinical scenario of distinguishing physiologic from pathologic LV hypertrophy. [8][9][10][11][12][13] The aims of the present study were therefore to define the characteristics of LV myocardial mechanics as assessed by 2D STE in trained athletes and to derive reference values that may be implemented in the clinical assessment of ''athlete's heart. ''…”

Evaluation of longitudinal and radial left ventricular function by two-dimensional speckle-tracking echocardiography in a large cohort of normal probands

“…In experimental models and animal studies this new method has been validated against sonomicrometry and tagged MRI [7,8]. There is also some experience with STE in healthy humans and in various structural heart diseases such as hypertrophic cardiomyopathy (HCM), myocardial infarction, atrial septal defects (ASD), or LV dysfunction with conduction disorders in the context of cardiac resynchronization therapy (CRT) [4,[9][10][11][12][13][14][15][16]. However, all these reports were only based on small numbers of healthy probands or controls, had incomplete coverage of the LV, and/or focussed on specific cardiac problems.…”

The Post-Modern Era: Chronic Disease and the Onslaught of a Sedentary Lifestyle

“…In the future, a new technique that may help to differentiate physiological from pathological hypertrophy is the use of ultrasound speckle tracking; this calculates the global longitudinal strain in the ventricular muscle (Butz et al 2011). Differentiation of transient from long-term pathologies may also emerge from ultrasound and magnetic resonance imaging of right ventricular and atrial dimensions before and after endurance competition (Neilan et al 2006).…”