Practical tips and tricks in measuring strain, strain rate and twist for the left and right ventricles

Johnson, Christopher; Kuyt, Katherine; Oxborough, David; Stout, Martin

doi:10.1530/erp-19-0020

Cited by 41 publications

(51 citation statements)

References 41 publications

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“…The analysis of LV deformation including circumferential strain and rotation may improve the echocardiographic diagnostic approach in AM [ 24 , 27 , 28 ]. However, the use of myocardial deformation is not yet widely implemented in patients with AM [ 36 , 37 ]. Recently, the authors of the present study demonstrated the feasibility to define deformation patterns for radial and circumferential strain as well as rotation in a cohort of healthy volunteers and professional athletes [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic characteristics of patients with SARS-CoV-2 infection

et al. 2020

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Background Myocardial involvement induced by SARS-CoV-2 infection might be important for long-term prognosis. The aim of this observational study was to characterize the myocardial effects during SARS-CoV-2 infections by echocardiography. Results and methods An extended echocardiographic image acquisition protocol was performed in 18 patients with SARS-CoV-2 infection assessing LV longitudinal, radial, and circumferential deformation including rotation, twist, and untwisting. Furthermore, LV deformation was analyzed in an age-matched control group of healthy individuals ( n = 20). The most prevalent finding was a reduced longitudinal strain observed predominantly in more than one basal LV segment ( n = 10/14 patients, 71%). This pattern reminded of a “reverse tako-tsubo” morphology that is not typical for other viral myocarditis. Additional findings included a biphasic pattern with maximum post-systolic or negative regional radial strain predominantly basal ( n = 5/14 patients, 36%); the absence or dispersion of basal LV rotation ( n = 6/14 patients, 43%); a reduced or positive regional circumferential strain in more than one segment ( n = 7/14 patients, 50%); a net rotation showing late post-systolic twist or biphasic pattern ( n = 8/14 patients, 57%); a net rotation showing polyphasic pattern and/or higher maximum net values during diastole ( n = 8/14 patients, 57%). Conclusion Myocardial involvement due to SARS-CoV-2-infection was highly prevalent in the present cohort—even in patients with mild symptoms. It appears to be characterized by specific speckle tracking deformation abnormalities in the basal LV segments. These data set the stage to prospectively test whether these parameters are helpful for risk stratification and for the long-term follow-up of these patients.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic characteristics of patients with SARS-CoV-2 infection

et al. 2020

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“…RV functional reserve may be assessed by measuring TAPSE, RVS’, and RV fractional area change at rest and during stress ( 52 ). RV longitudinal strain may also be assessed during rest and stress, although this may become less reliable at heart rates > 100 bpm due to reduced frame rate ( 53 ). A failure to augment these indices suggests impaired RV functional reserve, which has been associated with worse outcomes in patients with left-sided valve disease ( 52 ).…”

Section: Stress Echocardiographymentioning

confidence: 99%

Echocardiographic assessment of the tricuspid and pulmonary valves: a practical guideline from the British Society of Echocardiography

et al. 2020

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Transthoracic echocardiography is the first-line imaging modality in the assessment of right-sided valve disease. The principle objectives of the echocardiographic study are to determine the aetiology, mechanism and severity of valvular dysfunction, as well as consequences on right heart remodelling and estimations of pulmonary artery pressure. Echocardiographic data must be integrated with symptoms, to inform optimal timing and technique of interventions. The most common tricuspid valve abnormality is regurgitation secondary to annular dilatation in the context of atrial fibrillation or left-sided heart disease. Significant pulmonary valve disease is most commonly seen in congenital heart abnormalities. The aetiology and mechanism of tricuspid and pulmonary valve disease can usually be identified by 2-dimensional assessment of leaflet morphology and motion. Colour flow and spectral Doppler are required for assessment of severity, which must integrate data from multiple imaging planes and modalities. Transoesophageal echo is used when transthoracic data is incomplete, although the anterior position of the right heart means that transthoracic imaging is often superior. Three-dimensional echocardiography is a pivotal tool for accurate quantification of right ventricular volumes and regurgitant lesion severity, anatomical characterisation of valve morphology and remodelling pattern, and procedural guidance for catheter-based interventions. Exercise echocardiography may be used to elucidate symptom status and demonstrate functional reserve. CMR and CT should be considered for complimentary data including right ventricular volume quantification, and precise cardiac and extracardiac anatomy. This BSE guideline aims to give practical advice on the standardised acquisition and interpretation of echocardiographic data relating to the pulmonary and tricuspid valves.

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“…The best single cardiac cycle was selected for analysis as validated by several studies. 15,16 After the tracing was complete, the images were played frame by frame, and the tracing was manually adjusted if necessary. This software measures the different segmental speckle strains and strain rates.…”

Section: Speckle-tracking Echocardiographymentioning

confidence: 99%

Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography

et al. 2019

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Aim:Anthracycline-associated cardiotoxicity in childhood cancer survivors may relate to global or segmental left ventricular abnormalities from associated thromboembolic events and myocardial microinfarcts. We characterized left ventricular segmental changes by two-dimensional speckle-tracking echocardiography in anthracycline-treated asymptomatic childhood cancer survivors.Methods and Results:Childhood cancer survivors’ echocardiograms with normal left ventricular fractional shortening >1 year after anthracycline chemotherapy were studied. Cancer-free control children had normal echocardiograms. Apical two-, three-, and four-chamber peak systolic left ventricular longitudinal and global longitudinal strain, and peak systolic left ventricular radial and circumferential strain at papillary muscle levels were analyzed. The mean (standard deviation) age was 12.7 (3.8) years in 41 childhood cancer survivors. The median (interquartile range) follow-up after anthracycline chemotherapy was 4.73 (2.15–8) years. The median (range) cumulative anthracycline dose was 160.2 (60–396.9) mg/m2. In childhood cancer survivors, the mean (standard deviation) left ventricular longitudinal strain was lower in two- (−18.6 [3.2] versus −21.3 [2.5], p < 0.001), three- (−16.3 [6.0] versus −21.7 [3.0], p < 0.001), and four- (−17.6 [2.7] versus −20.8 [2.0], p < 0.001) chamber views compared to controls. The left ventricular global longitudinal strain (−17.6 [2.7] versus −21.3 [2.0]) and circumferential strain (−20.8 [4.3] versus −23.5 [2.6], p < 0.001) were lower in childhood cancer survivors. Among childhood cancer survivors, 12 out of 16 left ventricular segments had significantly lower longitudinal strain than controls.Conclusions:Asymptomatic anthracycline-treated childhood cancer survivors with normal left ventricular fractional shortening had lower global longitudinal and circumferential strain. The left ventricular longitudinal strain was lower in majority of the segments, suggesting that anthracycline cardiotoxicity is more global than regional.

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Practical tips and tricks in measuring strain, strain rate and twist for the left and right ventricles

Cited by 41 publications

References 41 publications

Echocardiographic characteristics of patients with SARS-CoV-2 infection

Echocardiographic characteristics of patients with SARS-CoV-2 infection

Echocardiographic assessment of the tricuspid and pulmonary valves: a practical guideline from the British Society of Echocardiography

Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography

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