Assessing Global and Regional Left Ventricular Myocardial Function in Elderly Patients Using the Bidimensional Strain Method

Zghal, Fathia; Bougteb, Hanane; Réant, Patricia; Lafitte, Stéphane; Roudaut, R.

doi:10.1111/j.1540-8175.2011.01476.x

Cited by 47 publications

(38 citation statements)

References 17 publications

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“…The exclusion of hypertensive individuals in the current but not previous studies may explain this discrepancy since blood pressure strongly influences systolic function [40]. Furthermore, longitudinal deformation (strain and both systolic and diastolic SR) was impaired in older healthy males, supporting previous studies [11,41,42]. Most likely in response to the impaired longitudinal deformation, we observed compensatory increases in apical circumferential deformation and LV twist with age.…”

Section: Discussionsupporting

confidence: 79%

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Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males

Crendal

Dutheil

Naughton

et al. 2014

BMC Cardiovasc Disord

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BackgroundEvaluation of sensitive myocardial mechanics with speckle tracking echocardiography (STE) across the lifespan may reveal early indicators of cardiovascular disease (CVD) risk. Epicardial adipose tissue (EAT) and left ventricular (LV) myocardial dyssynchrony; subclinical risk-factors of CVD, are of particular clinical interest. However, the evolution of EAT and LV-dyssynchrony across the lifespan, and their influence on myocardial dysfunction remains unclear. We aimed to establish a profile of the healthy aging-heart using conventional, tissue-Doppler imaging (TDI) and speckle-tracking echocardiography (STE), while also exploring underlying contributions from EAT and LV-dyssynchrony towards LV myocardial mechanics, independent of blood biology.MethodsHealthy males aged 19–94 years were recruited through University-wide advertisements in Victoria and New-South Wales, Australia. Following strict exclusion criteria, basic clinical and comprehensive echocardiographic profiles (conventional, TDI and STE) were established. LV-dyssynchrony was calculated from the maximum-delay of time-to-peak velocity/strain in the four LV-annulus sites (TDI), and six LV-segments (STE longitudinal and circumferential axes). Epicardial fat diameter was obtained from two-dimensional grey-scale images in the parasternal long-axis. Blood biological measures included glycemia, hsCRP, triglycerides, total cholesterol, high-density and low-density lipoprotein levels.ResultsThree groups of 15 were assigned to young (<40 years), middle (40–65 years), and older (>65) aged categories. Five participants were excluded from STE analyses due to inadequate image quality. Decreased longitudinal strain, increased circumferential apical strain and LV twist were age-related. Moreover, independent of blood biology, significant increases were observed across age categories for EAT (young: 2.5 ± 0.9 mm, middle: 3.9 ± 1.0 mm, older 5.7 ± 2.4 mm; p < 0.01), longitudinal STE-dyssynchrony (young: 42 ± 7.7 ms, middle: 58.8 ± 18.9 ms, older 88.6 ± 18.2 ms; p < 0.05), and circumferential-basal STE-dyssynchrony (young: 50.2 ± 20.5 ms, middle: 75.9 ± 20.6 ms, older 97.9 ± 20.2 ms; p < 0.05). These variables collectively explained 37% and 31% (p < 0.01) of longitudinal strain and LV twist, respectively.ConclusionsThis study enabled comprehensive profiling of LV mechanics at different stages of aging using sensitive echocardiographic technology. Novel findings included increased epicardial fat, and both longitudinal and circumferential LV-dyssynchrony across the healthy age groups. These factors may be key underlying contributors to myocardial dysfunction during aging, and their recognition may promote an advanced understanding of early signs of cardiovascular disease.

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Section: Discussionsupporting

confidence: 79%

“…Previous studies of LV myocardial function and dyssynchrony in aging people have not observed individuals older than 89 years of age [8,9,11-13,17,18,28]. In the present study, our participants were aged up to 94 years.…”

Section: Discussionmentioning

confidence: 86%

Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males

Crendal

Dutheil

Naughton

et al. 2014

BMC Cardiovasc Disord

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“…Higher body surface area is associated with lower strain values, as reported in a large cohort of normal probands [50]. However, because higher body surface area and older age are associated with lower strain values [49,50], the observed lack of alteration in LVEF, stroke volume, cardiac output, LV strain and rotational parameters may be even more relevant.…”

Section: Sea Level Altitudementioning

confidence: 75%

“…Anatomical alterations in the elderly result in modifications of LV myocardial deformation with a decrease in global longitudinal strain [49]. Higher body surface area is associated with lower strain values, as reported in a large cohort of normal probands [50].…”

Section: Sea Level Altitudementioning

confidence: 94%

Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness

Dedobbeleer

Hadefi

Pichon

et al. 2015

Int J Cardiovasc Imaging

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Hypoxic exposure depresses myocardial contractility in vitro, but has been associated with indices of increased cardiac performance in intact animals and in humans, possibly related to sympathetic nervous system activation. We explored left ventricular (LV) function using speckle tracking echocardiography and sympathetic tone by spectral analysis of heart rate variability (HRV) in recently acclimatized lowlanders versus adapted or maladapted highlanders at high altitude. Twenty-six recently acclimatized lowlanders, 14 healthy highlanders and 12 highlanders with chronic mountain sickness (CMS) were studied. Control measurements at sea level were also obtained in the lowlanders. Altitude exposure in the lowlanders was associated with slightly increased blood pressure, decreased LV volumes and decreased longitudinal strain with a trend to increased prevalence of post-systolic shortening (p = 0.06), whereas the low frequency/high frequency (LF/HF) ratio increased (1.62 ± 0.81 vs. 5.08 ± 4.13, p < 0.05) indicating sympathetic activation. Highlanders had a similarly raised LF/HF ratio, but no alteration in LV deformation. Highlanders with CMS had no change in LV deformation, no significant increase in LF/HF, but decreased global HRV still suggestive of increased sympathetic tone, and lower mitral E/A ratio compared to healthy highlanders. Short-term altitude exposure in lowlanders alters indices of LV systolic function and increases sympathetic nervous system tone. Life-long altitude exposure in highlanders is associated with similar sympathetic hyperactivity, but preserved parameters of LV function, whereas diastolic function may be altered in those with CMS. Altered LV systolic function in recently acclimatized lowlanders may be explained by combined effects of hypoxia and changes in loading conditions.

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“…If we consider regional Ecc analysis, largely investigated through single modality studies (STE or MR-tagging performed separately), highest lateral absolute Ecc is constantly reported in MR-based literature [5,[16][17][18][19][20][21] and highest septal absolute Ecc is constantly reported in the STE based literature [3,4,10,11,22,23] . These results, are not influenced by the base-apex positioning and by the type of machine used [3] .…”

Section: Figure 5 Comparison Of Published Regional Ecc Values Obtainmentioning

confidence: 99%

Discrepancy between regional left ventricular regional circumferential strain assessed by MR-tagging and by speckle tracking echocardiography

Ghannudi¹,

Germain

Jeung³

et al. 2013

JBGC

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Background: In recent years, myocardial strain imaging has gained an important place for the evaluation of cardiac patients. Global longitudinal strain assessed by speckle tracking echocardiography (STE) is now commonly used but circumferential strain remains less extensively studied. MR-tagging is recognized as the reference method for circumferential strain analysis, however no validation study between regional MR-tagging and regional STE has been performed up to now. Objective:To compare segmental circumferential strain values (Ecc) obtained by speckle tracking and by MR-tagging in patient with normal systolic function in order to define if both methods are interchangeable or not.Patients and methods: patients without significant regional nor global systolic dysfunction (LVEF > 55%) were studied by MR-tagging (n=82) and by STE (n=35). Left ventricular mid-level short axis slice was obtained by both methods and paired data were available in 16 patients. Segmental Ecc values were computed in six equidistant sectors using GE EchoPac software for STE and InTag post processing software for MR-tagging. Results: 1) Comparison between regions:Overall results showed that regional peak Ecc magnitude |Eccpeak| was not uniform with both methods but in an opposite way. MR-tagging demonstrated significantly lower septal |Eccpeak| as compared with postero-lateral |Eccpeak| (-16.5±3.6 vs -23.4±4.4, p<10 -4 ). Conversely, STE showed significantly higher septal |Eccpeak| as compared with postero-lateral |Eccpeak| (-22.3±6.4 vs -13.9±6.2, p<10 -4 ). 2) Comparison between both methods: In the subgroup of patients studied by both methods, septal |Eccpeak| was 29% lower by MR-tagging as compared with STE (-14.9±2.4 vs -20.9±6.5, p<.006) and postero-lateral |Eccpeak| was 39% lower by STE as compared with MR-tagging (-12.9±5.9 vs -21.0±2.9, p<.0003). 3) Intra and interobserver coefficients of variation were homogeneous (in the range 10%-14%) for all sectors with MR-tagging but were dramatically variable with STE (15% to 20% in the anterior-septal region but three times higher, in the range 35%-40%, in the postero-lateral territory). Conclusion:Regional distributions of Ecc is not uniform but opposite results are provided by MR-tagging and by STE. This finding demonstrates that both methods cannot be considered as interchangeable. These conflicting results raise the www.sciedu.ca/jbgc Journal of Biomedical Graphics and Computing, 2013, Vol. 3, No. 4 ISSN 1925-4008 E-ISSN 1925 76 question of the validity of either MR tagging or speckle tracking for the quantification of regional circumferential strain. Some arguments, developed in the discussion would rather let believe that MR-tagging results should be more reliable.

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Assessing Global and Regional Left Ventricular Myocardial Function in Elderly Patients Using the Bidimensional Strain Method

Abstract: Aging results in a decrease in global longitudinal strain. This should be taken into account in the assessment of pathological myocardial dysfunction.

Cited by 47 publications

References 17 publications

Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males

Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males

Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness

Discrepancy between regional left ventricular regional circumferential strain assessed by MR-tagging and by speckle tracking echocardiography

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