Longitudinal strain bull’s eye plot patterns in patients with cardiomyopathy and concentric left ventricular hypertrophy

Abstract

Despite substantial advances in the imaging techniques and pathophysiological understanding over the last decades, identification of the underlying causes of left ventricular hypertrophy by means of echocardiographic examination remains a challenge in current clinical practice. The longitudinal strain bull’s eye plot derived from 2D speckle tracking imaging offers an intuitive visual overview of the global and regional left ventricular myocardial function in a single diagram. The bull’s eye mapping is clinically feasible and the plot patterns could provide clues to the etiology of cardiomyopathies. The present review summarizes the longitudinal strain, bull’s eye plot features in patients with various cardiomyopathies and concentric left ventricular hypertrophy and the bull’s eye plot features might serve as one of the cardiac workup steps on evaluating patients with left ventricular hypertrophy.

Role of the deformation imaging in the evaluation of patients with cardiomyopathy

“…In the most common pattern of the disease (“apical sparing”), longitudinal strain is more preserved at apical segments and significantly reduced at mid and basal segments (Figure ). That finding is consistently observed by longitudinal strain bull's eye mapping and seems to be useful in the differentiation of patients with amyloidosis from patients with other causes of LVH .…”

Variability in the Assessment of Myocardial Strain Patterns: Implications for Adequate Interpretation

“…Delineations for the normal case were consistent between the beginning and the end of the course, with less outliers at the apex at the end of the course, but still substantial inter-operator variability over the lateral wall (mean inter-operator variability of 3.5 mm [before] against 3.8 mm [after], and 1.6 mm for the intra-operator measurements). Table 1), global strain is normal and most segments show normal deformation, but in both cases there is a region within the mid septum where deformation is much lower compared to both the direct proximal and distal regions (Cikes et al 2010;Liu et al 2016). This is confirmed by the strain pattern from tissue Doppler.…”

“…The course took place in 2018, and provided cases collected by the organizers during the past five years and covering a broad range of pathologies. Six representative cases with known deformation patterns were selected for this study: (1) a healthy adult individual, (2) a patient with cardiac amyloidosis (Cikes et al 2010;Liu et al 2016), (3a-3b) two athlete brothers with familial hypertrophic cardiomyopathy (Cikes et al 2010;Liu et al 2016), (4) a candidate for cardiac resynchronization therapy (CRT) with dilated cardiomyopathy and intraventricular dyssynchrony (Parsai et al 2009), and (5) an athlete that died from sudden cardiac death. All echocardiographic examinations were performed in line with current international recommendations, and were recorded with a transthoracic probe (M4S or M5S, GE Healthcare, Milwaukee, WI, USA) using a commercially available system (Vivid 7 or 9, GE Healthcare, Milwaukee, WI, USA).…”

“…Nonetheless, a finer understanding of pattern changes with disease is highly recommended (Bijnens et al 2009;Bijnens et al 2012;Cikes and Solomon 2016;Fornwalt et al 2009). The spatial distribution of myocardial motion and deformation (regionally or even locally) and their temporal evolution along the cycle provide complementary information that is missed by peak measurements (Cikes et al 2010;Duchateau et al 2011;Duchateau et al 2014;Liu et al 2016;McLeod et al 2015;Parsai et al 2009;Tabassian et al 2017).…”

The Imaging Diagnosis of Less Advanced Cases of Cardiac Amyloidosis: The Relative Apical Sparing Pattern

“…Imaging techniques based on 2-D STE could contribute to the differential diagnosis of conditions involving the thickening of the LV wall (7). For example, in patients with hypertensive heart disease, wall thickening and a significant reduction in the degree of longitudinal strain in the basal part of the septum are sometimes noted as initial signs of the disease, and such findings can even precede the reduction in the LV ejection fraction (8).…”