Advances in echocardiography: global longitudinal strain, intra-cardiac multidirectional flow imaging and automated 3d volume analysis

Baysan, Oben; Ocaklı, Ezgi Polat; Saglam, Yasemin; Altuner, Tuğba Kayhan

doi:10.24969/hvt.2018.83

Cited by 6 publications

(4 citation statements)

References 45 publications

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“…Intra-observer variability has been shown to be <6% for global longitudinal and circumferential strain, and <9% for global transverse and radial strain in 2D strain imaging 4 and relative mean errors of 4.9%–7.3% for 3D. 5 In our lab, the intra-observer variation is 5.3%. For each patient, three readings were taken for all the variables by a single operator and an average of them were incorporated into the database to minimize the variability which was 4.1%.…”

Section: Methodsmentioning

confidence: 54%

To study the usefulness and comparison of myocardial strain imaging by 2D and 3D echocardiography for early detection of cardiotoxicity in patients undergoing cardiotoxic chemotherapy

Alam

Chandra

Saran

et al. 2019

Indian Heart Journal

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Background Chemotherapy-induced cardiotoxicity constitutes subclinical myocardial dysfunction, arrhythmias, pericarditis, coronary vasospasm, and significant symptomatic heart failure. Anthracyclines pose higher risk for long-term cardiac dysfunction, with increased incidences of morbidity and mortality. Hence, early detection of chemotherapy-induced cardiac dysfunction may prompt an earlier treatment modification. Aim To evaluate global, longitudinal, radial, and circumferential strain changes in adult patients undergoing anthracycline chemotherapy along with the usefulness of three-dimensional (3D) echocardiography as the new modality over two-dimensional (2D) echocardiography. Methods This was a single centre, prospective, observational study that included asymptomatic patients free from any cardiac signs and symptoms attributable to heart failure, who underwent potentially cardiotoxic chemotherapy for malignancy from December 2017 to November 2018 at a tertiary care centre in India. Baseline demographics were recorded, and 2D and 3D echocardiography was performed at baseline and after completion of four cycles of chemotherapy. Results All the 55 patients received a cumulative dose of doxorubicin of less than 550 mg/m 2 . Follow-up period from the beginning of doxorubicin therapy was 108 ± 14 days. 9 patients were excluded from the study due to poor 3D images, so data analysis was done only for 46 patients. In 2D echocardiography, only global longitudinal strain (GLS) was observed to be significantly reduced (Δ18.33%; P < 0.001). 2D ejection fraction (EF) did not show significant change (Δ0.67%; P = 0.176), while by 3D echo, EF reduced significantly (Δ3.55%; P < 0.001). 3D global longitudinal (Δ29.19%; P < 0.001), circumferential (Δ30.65%; P < 0.001), area (Δ21.61%; P < 0.001), and radial (Δ29.66%; P < 0.001) strains were observed to be significantly reduced at follow-up. Conclusion Myocardial dysfunction induced by cardiotoxic chemotherapy can be detected earlier by using 2D GLS, 3D volumetric analysis, and 3D strain analysis by calculating global, longitudinal, radial, and circumferential strain changes. 3D echocardiographic assessment seems to be more accurate in picking out small changes in left ventricular functions, but at the cost of slightly poor image quality as compared to the 2D echocardiography. These newer techniques could potentially improve the ability for early detection of subclinical abnormalities of LV function in patients undergoing cardiotoxic chemotherapy and thus early initiation of treatment could be possible.

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Section: Methodsmentioning

confidence: 54%

To study the usefulness and comparison of myocardial strain imaging by 2D and 3D echocardiography for early detection of cardiotoxicity in patients undergoing cardiotoxic chemotherapy

Alam

Chandra

Saran

et al. 2019

Indian Heart Journal

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“…More recently, three-dimensional STE is being performed that not only includes length, and height but also width (depth). One significant advantage of 3D STE is that automated images are available that have higher resolution and greater prognostic power for cardiac death, nonfatal myocardial infarction, stroke, and admission for heart failure [64, 65].…”

Section: Speckle Tracking Echocardiography (Ste)mentioning

confidence: 99%

Use of speckle tracking to assess heart failure with preserved ejection fraction

Hiebert

Vacek

Shah

et al. 2019

Journal of Cardiology

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Heart failure with preserved ejection fraction (HFpEF) currently represents approximately 50% of heart failure (HF) cases in the USA and is increasingly recognized as a leading cause of morbidity and mortality. Recent data suggest that the prevalence of HFpEF relative to HF with reduced ejection fraction (HFrEF) is increasing at a rate of 1% per year. With an aging population and increasing risk factors such as hypertension, obesity, and diabetes mellitus, HFpEF will soon be the most prevalent HF phenotype. Two-dimensional speckle-tracking echocardiography (STE) has been used to diagnose HFpEF specifically by focusing on the longitudinal systolic function of the left ventricle (LV). Yet there are many patients with HFpEF in whom there are no differences in LV global longitudinal systolic strain, but there are changes in left atrial function and structure. There are several proposed pathophysiological mechanisms for HFpEF such as endothelial dysfunction, interactions among proteins, signaling pathways, and myocardial bioenergetics. Yet only one specific therapy, mineralocorticoid receptor antagonist, spironolactone, is recommended as a treatment for patients with HFpEF. However, spironolactone does not address many of the pathophysiologic changes that occur in HFpEF, thus new novel therapeutic agents are needed. With the limited available therapies, clinicians should use STE to assess for the presence of this syndrome in their patients to provide effective diagnosis and management.

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“…Tissue Doppler data could be used for strain analysis, but nowadays, angle independent speckle-tracking based strain imaging is the preferred route for this purpose. Technical details about how to measure LV-GLS can be found elsewhere (25) (Fig. 6).…”

Section: ) Left Ventricular Global Longitudinal Strain (Lv-gls)mentioning

confidence: 99%

Looking beyond ejection fraction: what we have in echocardiography

Baysan¹,

Akyıldız²

2019

HVT

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Left ventricular ejection fraction (LVEF) is the most frequently used echocardiographic parameter. LVEF based heart failure classification, timely intervention in a patient with valvular disease (e.g. aortic stenosis, mitral regurgitation), deterioration of myocardial function in a patient treated with chemotherapy; all need a simple LVEF value for decision-making process. An echocardiographic examination also contains several parameters with invaluable importance. Measurement and evaluation of these parameters should be made in every patient suspected of having myocardial disease.

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Advances in echocardiography: global longitudinal strain, intra-cardiac multidirectional flow imaging and automated 3d volume analysis

Cited by 6 publications

References 45 publications

To study the usefulness and comparison of myocardial strain imaging by 2D and 3D echocardiography for early detection of cardiotoxicity in patients undergoing cardiotoxic chemotherapy

To study the usefulness and comparison of myocardial strain imaging by 2D and 3D echocardiography for early detection of cardiotoxicity in patients undergoing cardiotoxic chemotherapy

Use of speckle tracking to assess heart failure with preserved ejection fraction

Looking beyond ejection fraction: what we have in echocardiography

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