Pre‐heart failure at 2D‐ and 3D‐speckle tracking echocardiography: A comprehensive review

Abstract

Chronic heart failure (CHF) has different stages and includes pre‐HF (PHF), a state of high risk of developing myocardial dysfunction and advanced CHF. Some major behavioral risk factors of PHF might predispose to biological risk factors such as obesity, diabetes mellitus, dyslipidemia, hypertension, myocardial infarction, and cardiomyopathy. These risk factors damage the myocytes leading to fibrosis, apoptosis, cardiac hypertrophy, along with alterations in cardiomyocyte’ size and shape. A condition of physiological subcellular remodeling resulting into a pathological state might be developed, conducting to PHF. Both PHF and heart failure (HF) are associated with the activation of phospholipases and protease, mitochondrial dysfunction, oxidative stress and development of intra‐cellular free Ca2+ [Ca2+]i overloading to an elevation in diastolic [Ca2+]i. Simultaneously, cardiac gene expression is activated leading to further molecular, structural and biochemical changes of the myocardium. The sub‐cellular remodeling may be intimately involved in the transition of cardiac hypertrophy to heart failure. 2D‐ and 3D‐speckle tracking echocardiography (STE) have been used to quantify regional alterations of longitudinal strain and area strain, through their polar projection, which permits a further assessment of both sites and degrees of myocardial damage. The examination of strain can identify sub‐clinical cardiac dysfunction or cardiomyocyte remodeling. During remodeling of the myocardium cardiac strain is attenuated, therefore it is an indicator of disease assessment.

Cardiomyocyte BRAF is a key signalling intermediate in cardiac hypertrophy in mice

“…These changes are not necessarily detected using standard M-mode or B-mode echocardiography. Since strain analysis is potentially more sensitive [ 47 ], we analysed B-mode images from the phenylephrine study using speckle-tracking software, comparing hearts from male and female mice ( Figure 8 A,B, representative images shown for 7 d only; Supplementary Tables S6 and S7). This approach detected greater baseline variation between animals, so we compared the data obtained at 7 d with baseline data for each mouse individually using paired two-way ANOVA with Holm-Sidak’s post-test.…”

Cardiomyocyte BRAF is a key signalling intermediate in cardiac hypertrophy in mice

“…These changes are not necessarily detected using standard M-mode or B-mode echocardiography. Since strain analysis is potentially more sensitive [41], we analysed B-mode images from the phenylephrine study using speckle-tracking software, comparing hearts from male and female mice ( Figure 7A,B , representative images shown for 7 d only; Supplementary Tables S5 and S6 ). This approach detected greater baseline variation between animals, so we compared the data obtained at 7 d with baseline data for each mouse individually using paired statistical testing.…”

High Exogenous Antioxidant, Restorative Treatment (Heart) for Prevention of the Six Stages of Heart Failure: The Heart Diet

“…However, in the normal heart, the base of the heart has clockwise rotation during systole and the apex of the heart has counterclockwise rotation, causing a wringing movement. The cardiologists are not able to understand the utility of the twist function in clinical practice, which may be due to the problems in the measurement of cardiac rotation and torsion in the clinic [ 3 , 18 ]. It seems that three-dimensional STE may be an alternative method to assess the twist function, during plane motion.…”

“…However, it seems that the measurement of the twist function would enhance our knowledge of physiological mechanics of the heart, such as the early diagnosis of abnormality in the rotation, indicating sub-endocardial dysfunction, the second stage of the six stages of HF, that may occur due to behavioral risk factors such as tobacco and Western diet. These risk factors may be also helpful in exploring the secrets of the diastole (a Rosetta stone), which could be a new concept in diastolic function and diastolic HF, via STE, in the light of neuro-humoral dysfunction [ 3 , 12 , 18 , 19 , 20 ]. It seems that the physician needs to have a closer look to understand the physio-pathogenesis of oxidative myocardial function and cardiac dysfunction, in particular, the LV twist and decline in myocardial strain [ 8 ].…”

“… GLS = global longitudinal strain, GCS = global circumferential strain, GRS = global radial strain, LV = left ventricle, SR = strain rate, ARNI = angiotensin receptor neprilysin inhibitor, mr EF= mild reduction in Ejection fraction (EF), r = reduction in EF, LA = left atrial (modified from the following references: [ 3 , 12 ]). …”