Three-Dimensional Principal Strain Analysis for Characterizing Subclinical Changes in Left Ventricular Function

Pedrizzetti, Gianni; Sengupta, Shantanu; Caracciolo, Giuseppe; Park, Chan Seok; Amaki, Makoto; Goliasch, Georg; Narula, Jagat; Sengupta, Partho P.

doi:10.1016/j.echo.2014.05.014

Cited by 71 publications

(73 citation statements)

References 26 publications

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“…3D-STE is a possible solution to this problem, and also has potential application in the assessment of myocardial principal strain ( Figure 6A), a newly developed concept of myocardial mechanics, which simultaneously integrates myocardial deformations in all directions, including torsional deformation, alleviating the need for multidirectional strain assessments. 51 However, 3D echocardiographic image acquisition is currently limited by low frame rates and reduced temporal resolution. This can be addressed with the use of the recently developed high-frequency echocardiographic systems, which represent a new platform for ultrasound-based assessment in humans with high temporal and spatial resolutions.…”

Section: Summary and Future Directionsmentioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

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105

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A 52-year-old white man visited his physician because he started experiencing shortness of breath on walking short distances at ground level. He had smoked half a packet of cigarettes daily for 40 years. Physical examination revealed a blood pressure of 147/95 mm Hg. Chest examination and chest x-ray were unremarkable, and ECG showed left atrial abnormality. The patient had normal serum electrolytes, blood sugar, and kidney function tests. A stress echocardiogram was ordered to exclude potential coronary artery disease. His resting echocardiography showed an ejection fraction (EF) of 60%, normal septal and posterior wall thickness, and mild diastolic dysfunction (septal early diastolic mitral annular velocity [e′] of 7 cm/s, early diastolic [E wave] to late diastolic [A wave] transmitral Doppler flow velocity ratio [E/A] of 1.4, E-wave deceleration time of 210 ms, E/e′ ratio of 9, and left atrial volume index of 44 mL/m 2 ; Figure 1A). There were no resting segmental wall motion abnormalities suggestive of ischemia. The patient exercised on a treadmill using Bruce protocol for 4 minutes and 43 s, and achieved 6.6 metabolic equivalent of task and maximum heart rate of 148 bpm (88% of his maximum age predicted heart rate). At peak exercise, the patient developed severe dyspnea and his blood pressure was 213/90 mm Hg. Post exercise echocardiography was acquired within 1 minute of exercise termination and showed EF of 69% and no segmental wall motion abnormalities, with Doppler recordings obtained at recovering heart rate of 125 bpm; showing a septal e′ velocity of 7.3 cm/s, E/A of 1.9, E-wave deceleration time of 110 ms, and E/e′ of 13.7, left atrial volume index of 35 mL/m 2 ( Figure 1B). Ten minutes into the recovery period, the blood pressure returned to basal level (145/80 mm Hg). Compared with resting levels, the increased E/A ratio, shortened E-wave deceleration time and relatively increased E/e′ ratio suggested post exercise worsening of diastolic function with elevation of left ventricular (LV) filling pressures. To investigate the mechanistic basis of diastolic dysfunction in this patient, LV deformation was assessed offline using speckletracking echocardiography (STE). Besides characterizing the longitudinal and circumferential shortening, and radial thickening, the LV rotational deformation, that resembles the wringing of a towel, was also measured (Figures 2 and 3). This wringing deformation, also referred to as LV twist (LVT) and the subsequent recoil that occurs in diastole, referred to as untwist, were abnormal in this patient (Figure 4). At rest, the patient had mild diastolic dysfunction, which was associated with a higher than normal LVT and untwist values, compared with the published age-related normal values, 1,2 and low global longitudinal strain. At peak exercise, there was a significant worsening of the patient's diastolic parameters, which was associated with worsening untwist values and further reduction of global longitudinal strain, whereas LVT remained same in magnitude. The following ...

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Section: Summary and Future Directionsmentioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

Self Cite

105

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“…One approach, initially developed through CMR technologies [41–43], and recently introduced in 3D echocardiography [44–46], entails identification of the principal directions of deformation. Principal directions are those orthogonal directions defined such that there is no shear across them.…”

Section: Calculations Of Deformation Parameters From Tissue Trackingmentioning

confidence: 99%

Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use

Pedrizzetti

Claus

Kilner

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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337

295

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Tissue tracking technology of routinely acquired cardiovascular magnetic resonance (CMR) cine acquisitions has increased the apparent ease and availability of non-invasive assessments of myocardial deformation in clinical research and practice. Its widespread availability thanks to the fact that this technology can in principle be applied on images that are part of every CMR or echocardiographic protocol. However, the two modalities are based on very different methods of image acquisition and reconstruction, each with their respective strengths and limitations. The image tracking methods applied are not necessarily directly comparable between the modalities, or with those based on dedicated CMR acquisitions for strain measurement such as tagging or displacement encoding. Here we describe the principles underlying the image tracking methods for CMR and echocardiography, and the translation of the resulting tracking estimates into parameters suited to describe myocardial mechanics. Technical limitations are presented with the objective of suggesting potential solutions that may allow informed and appropriate use in clinical applications.

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“…LV twist or torsion. 8 All deformational behaviors of the myocardium can be appreciated by STE. LV torsion is of particular importance for systolic ejection and recoil of torsional forces (untwist) creates negative suction pressures and thus is important for diastolic filling.…”

Section: Introductionmentioning

confidence: 99%

Worsening of left ventricular twist mechanics in isolated rheumatic mitral stenosis immediately after balloon mitral valvuloplasty

Rifaie

Abdel-Rahman

Samir

et al. 2016

The Egyptian Heart Journal

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Background: Reportedly, left ventricular (LV) mechanics are worsened in patients with mitral stenosis (MS) compared to controls. The immediate effect of balloon mitral valvuloplasty (BMV) on LV mechanics is, however, not known. Aim: To assess the immediate effect of balloon mitral valvuloplasty on the left ventricular twist mechanics. Methods and results: We studied 39 candidates for BMV. Pressures were measured invasively before and after BMV. Speckle tracking echocardiography (STE) was done for twist mechanics (basal rotation, apical rotation, and torsion) before and immediately after BMV. Twist mechanics were also measured by STE in 15 normal subjects as control group. Mean age was 30.4 ± 7.2 years, mean BMI was 24.7 ± 3.1 and 28 patients (72%) were females. All twist mechanics apical rotation and torsion were lower post-BMV compared to pre-BMV. Left ventricular end diastolic pressure was significantly higher post compared to pre-BMV while left atrial pressure (LAP) was similar between both groups. Importantly, patients who showed an increased LVEDP post compared to pre-BMV had worse LV twist mechanics than those whose LVEDP post-BMV was similar to or lower than pre-BMV. Conclusion: LV twist mechanics are worsened in MS with a further worsening, immediately after BMV probably because of failure of the LV to adapt to the sudden increased preload.

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Three-Dimensional Principal Strain Analysis for Characterizing Subclinical Changes in Left Ventricular Function

Cited by 71 publications

References 26 publications

Left Ventricular Twist and Torsion

Left Ventricular Twist and Torsion

Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use

Worsening of left ventricular twist mechanics in isolated rheumatic mitral stenosis immediately after balloon mitral valvuloplasty

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