2D and 3D Echocardiography-Derived Indices of Left Ventricular Function and Shape

Abstract

OBJECTIVES This study hypothesized that left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) derived from 3-dimensional echocardiographic (3DE) images would better predict mortality than those obtained by 2-dimensional echocardiographic (2DE) measurements, and that 3DE-based LV shape analysis may have added prognostic value. BACKGROUND Previous studies have shown that both LVEF and GLS derived from 2DE images predict mortality. Recently, 3DE measurements of these parameters were found to be more accurate and reproducible because of independence of imaging plane and geometric assumptions. Also, 3DE analysis offers an opportunity to accurately quantify LV shape. METHODS We retrospectively studied 416 inpatients (60 18 years of age) referred for transthoracic echocardiography between 2006 and 2010, in whom good-quality 2DE and 3DE images were available. Mortality data through 2016 were collected. Both 2DE and 3DE images were analyzed to measure LVEF and GLS. Additionally, 3DE-derived LV endocardial surface information was analyzed to obtain global shape indices (sphericity and conicity) and regional curvature (anterior, septal, inferior, lateral walls). Cardiovascular (CV) mortality risks related to these indices were determined using Cox regression. RESULTS Of the 416 patients, 208 (50%) died, including 114 (27%) CV-related deaths over a mean follow-up period of 5 3 years. Cox regression revealed that age and body surface area, all 4 LV function indices (2D EF, 3D EF, 2D GLS, 3D GLS), and regional shape indices (septal and inferior wall curvatures) were independently associated with increased risk of CV mortality. GLS was the strongest prognosticator of CV mortality, superior to EF for both 2DE and 3DE analyses, and 2D EF was the weakest among the 4 functional indices. A 1% decrease in GLS magnitude was associated with an 11.3% increase in CV mortality risk. CONCLUSIONS GLS predicts mortality better than EF by both 3DE and 2DE analysis, whereas 3D EF is a better predictor than 2D EF. Also, LV shape indices provide additional risk assessment.

Intensity of Glycemic Exposure in Early Adulthood and Target Organ Damage in Middle Age: The CARDIA Study

“…In fact, identi cation of the predisposing factors for subclinical organ dysfunction provide the insight towards long-term risk of organ dysfunction. From a disease-prevention perspective, given the independent prognostic signi cance of TOD, it would make sense to establish screening strategies on IGE and implement intensive blood glucose management during young adulthood, avoiding irreversible organs damage [4][5][6].…”

“…Subclinical target organ damages of hyperglycemia, indicated by coronary artery calcium (CAC), early cardiac deformation and dysfunction as well as albuminuria in our study, are e cient markers and well precursors of adverse clinical outcomes [4][5][6]. The Coronary Artery Risk Development in Young Adults (CARDIA) Study, which only enrolled young adults aged 18-30 years at baseline and underwent 6 blood glucose monitoring over 25 years, offers the opportunity to assess the impact of IGE on subclinical indicators of organ dysfunction in life-course pattern since young adulthood.…”

A review of current trends in three-dimensional analysis of left ventricular myocardial strain

“…Several studies investigated the prognostic value of 3D strain in myocardial infarction, hemodialysis, valvular heart disease, and a diverse variety of subjects [24,26,48,86,[97][98][99][100] (Table 6). These studies all showed that 3D global strains were impaired in patients who had cardiac events, and reduction of 3D global strains was associated with poor outcomes.…”

“…Reduction of 2D and 3D strains was attributed to myocardial fibrosis or inflammation [101]. Three of eight studies directly compared prognostic values between 2D GLS and 3D GLS, and all three studies showed that 3D GLS had superior prognostic value over 2D GLS [26,99,100]. Further studies are needed to validate whether 3D GLS is distinctly superior to 2D GLS for predicting future outcomes in specific cardiovascular pathologies.…”

“…Non-segmental (e.g., coronary artery territories) analysis of deformation is one solution to overcome current problems for segmental analysis [109]. Myocardial curvature analysis or LV shape analysis is another fruitful field of research, because it will provide useful information regarding disease severity and prognosis [99]. Since 3D strain simultaneously provides multidirectional strains, extraction of shear strain components which combine deformation in two different directions is also an interesting field for research [7,110].…”