Usefulness of layer-specific strain for identifying complex CAD and predicting the severity of coronary lesions in patients with non-ST-segment elevation acute coronary syndrome: Compared with Syntax score

Zhang, Li; Wu, Wenzhi; Ma, Hong; Wang, Hao

doi:10.1016/j.ijcard.2016.08.277

Cited by 45 publications

(32 citation statements)

References 24 publications

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“…Mid‐myocardial GLS was shown to be an equally good predictor of CAD in patients with reversible ischemia as layer‐specific GLS in terms of AUC's (Figure ) and was significantly impaired in patients with a true‐positive SPECT (Table ). In the present study, layer‐specific GLS showed a decreasing gradient from the endocardium to the epicardium in both controls and patients with a positive SPECT, in agreement with previous studies . Endocardial GLS failed to stay independently associated with the presence of CAD after multivariable adjustment in contrast to epicardial and mid‐myocardial GLS (Table ), although the difference between GLS parameters lacked significance in terms of AUC's (Figure ).…”

Section: Discussionsupporting

confidence: 91%

“…[33][34][35][36] Endocardial GLS failed to stay independently associated with the presence of CAD after multivariable adjustment in contrast to epicardial and mid-myocardial GLS ( Table 2), although the difference between GLS parameters lacked significance in terms of AUC's ( Figure 3). The notable finding is in contrast to previous studies [34][35][36] and requires further investigation; however, our population of patients with suspected SAP (not suspected acute coronary syndrome or hypertension) differs significantly from the previous studies, [34][35][36] which might explain the different results, or it could simply be due to the better reproducibility ( Figure 6) and superior tracking of the epicardial layer as compared to the endocardial layer. A still-unpublished independent study of layer-specific GLS including 285 patients prospectively enrolled with suspected SAP, preserved LVEF, and no previous cardiac history performed by our group showed that epicardial and mid-myocardial GLS appeared superior to endocardial GLS for diagnosing CAD, indicating that the notable finding in the present study was not caused by limitations related to this study (abstr.…”

Section: Discussionmentioning

confidence: 98%

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Layer‐specific global longitudinal strain reveals impaired cardiac function in patients with reversible ischemia

et al. 2018

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Layer‐specific global longitudinal strain reveals impaired cardiac function in patients with reversible ischemia

et al. 2018

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“…As acquired myocardial disease processes often develop firstly in the endocardium and endocardial fibers [13], the endocardial longitudinal strain (LS) may be more sensitive than transmural LS in the detection of subtle abnormalities observed during the early stages of heart disease. Recent advancements in 2D strain software have provided the capability to measure layer-specific strain (e.g., endocardial strain or epicardial strain), the usefulness of which has been described in recent publications [14–17]. However, normal ranges for each type of layer-specific strain and the normal strain gradient from the endocardium to the epicardium have not been determined [15, 18].…”

Section: Introductionmentioning

confidence: 99%

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

Nagata

Otsuji

et al. 2017

PLoS ONE

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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.

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“…STE is an angle‐independent method that allows the separate evaluation of myocardial deformation within each of three myocardial layers simultaneously. Many studies have demonstrated the accuracy and effectiveness of STE in identifying subclinical myocardial impairment . In this study, we applied three‐layer GLS based on STE to assess myocardial function and to understand the process of impairment of myocardial function in patients with CSFP.…”

Section: Discussionmentioning

confidence: 99%

Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

et al. 2018

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Objective This study aimed to determine whether STE could help detect subclinical myocardial dysfunction in patients with CSFP. Methods Sixty patients with CSFP confirmed by CAG and 51 controls with normal coronary flow were prospectively enrolled. Coronary angiographic data and conventional and speckle tracking echocardiographic parameters of the LV and RV were obtained for every subject. Results Compared with controls, CSFP patients presented with higher BMI and TG levels, but lower HDL‐C levels. Conventional echocardiographic parameters of biventricular systolic and diastolic function did not differ between the two groups (all P > 0.05). The GLS of the LV and RV was significantly impaired in CSFP patients compared with that in controls (−19.03% vs −21.42%, P < 0.001 and −19.72% vs −22.96%, P = 0.001, respectively). The myocardial impairment pattern of CSFP patients was homogenous in the RV and heterogeneous in the LV, where only endo‐ and mid‐myocardial layers were affected. LV‐GLS and RV‐GLS were found to be well correlated with mTFC and HDL‐C in CSFP groups (r = 0.463 vs r = 0.439; r = −0.569 vs r = −0.552, all P < 0.05). ROC curve analysis demonstrated that LV‐GLS‐endo had the highest AUC (0.867, P < 0.001) for predicting subclinical myocardial impairment in CSFP patients. Conclusions Subclinical myocardial systolic dysfunction occurs in both ventricles, and GLS could be an effective method to detect early‐stage myocardial impairment in patients with CSFP.

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Usefulness of layer-specific strain for identifying complex CAD and predicting the severity of coronary lesions in patients with non-ST-segment elevation acute coronary syndrome: Compared with Syntax score

Cited by 45 publications

References 24 publications

Layer‐specific global longitudinal strain reveals impaired cardiac function in patients with reversible ischemia

Layer‐specific global longitudinal strain reveals impaired cardiac function in patients with reversible ischemia

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

Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

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