Speckle Tracking – ABC CARDIOL

ABCIC

Original Article

Evaluation of Strain Parameters by Three Dimensional Speckle Tracking Echocardiography in Competitive Athletes

Edgar Daminello et al. Ana Clara Tude Rodrigues Adriana Cordovil Wércules Antônio Oliveira … Edgar Bezerra Lira Filho Rafael Bonafim Piveta Marcelo Luiz Campos Vieira Cláudio Henrique Fischer Samira S. Morhy

Summary

Introduction

Echocardiography is fundamental in the distinction between physiological adaptations promoted by physical activity and pathological abnormalities. Three-dimensional speckle tracking echocardiography (3D-STE) could prove accurate in detecting subclinical abnormalities in cardiac function.

Objectives

To determine the effect of exercise on the parameters of myocardial strain in athletes through 3D STE.

Method

Elite boxers underwent conventional three-dimensional echocardiography (3D-echo) and 3D-STE to analyze left ventricular (LV) volumes, left ventricular mass indexed to body surface area (LVMIBSA), ejection fraction (EF), longitudinal global strain (LGS), circumferential global strain (CGS), radial global strain (RGS), twist, torsion and tracking area. These data were compared with measurements performed on untrained control individuals.

Results

The analyses included 16 athletes and 14 controls with similar age (23 ± 4 vs. 21 ± 4 years; p = NS) and gender (14 vs. 12 males). LVEF was normal and similar in the 2 groups. LVMIBSA was higher in the athletes (83 ± 21 vs. 65 ± 15 g/m², p < 0.05), as well as RGS (24.7 ± 5.2 vs. 16.3 ± 7.2; p = 0.007). There was no significant difference for the other parameters, such as CGS (-26 ± 2 vs. -28 ± 6), LGS (-16 ± 2 vs. -17 ± 3), twist (3.1 ± 1.3 vs. 3.7 ± 1.9), torsion (2.0 ± 0.8 vs. 1.4 ± 0.4) and tracking area (37 ± 4 vs. 41 ± 6).

Conclusion

Athletes and untrained individuals have comparable myocardial strain parameters on 3D-STE. However, an increase in RGS was observed only in the athletes. 3D-STE could help in the early detection of subclinical cardiac issues in athletes. (Arq Bras Cardiol: Imagem cardiovasc. 2017;30(3):92-97)

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Review Article

Left Atrial Function Using Speckle Tracking: Beyond Volumetric Evaluation

Mardson de Araújo Medeiros et al. Rodrigo Pinto Pedrosa Carlos Antonio da Mota Silveira Jose Maria Del Castillo

Abstract

Evaluation of left atrial function is currently an emerging method that may be related to patient prognosis. Classically, the static measures of diameter, area and volume are the most used for this purpose. The technique known as speckle tracking is capable of providing dynamic information of the left atrium throughout the cardiac cycle, as well as detecting abnormalities in left atrial function in subclinical phases, before volumetric increases or diastolic dysfunctions occur. Normality values for speckle tracking are being proposed, but the methodological differences and techniques make it difficult to standardize them. This literature review aims to discuss progress in the analysis of left atrial function, especially via speckle tracking.

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Original Article

Software for Post-Processing Analysis of Strain Curves: The D-Station

Rafael Duarte de Sousa et al. Carlos Danilo Miranda Regis Ittalo dos Santos Silva Paulo Szewierenko … Renato de Aguiar Hortegal Henry Abensur

Abstract

Background

The use of speckle-tracking echocardiography for evaluation of cardiac function has great applicability in different scenarios. The broad use of this method requires tools that allow the extraction of relevant data from strain curves and inclusion of these data in traditionally used parameters.

Objectives

The present study aimed to present and validate a free software, called D-station, for analysis of strain curves.

Methods

From raw data files, the D-Station determines the phases of the cardiac cycle, and simultaneously exhibits the strain and strain rate curves of different cardiac chambers. Validation of the software was done by global longitudinal strain (GLS), and the analyses were performed: 1) graphical comparison of EchoPAC and D-Station paired measurements in relation to equality line; 2) by coefficient of correlation of these measurements; 3) test of hypothesis (p > 0.05); and 4) Bland-Altman analysis.

Results

The Spearman’s rho correlation coefficient indicated a strong correlation between the measurements. Results of the test of hypothesis showed a p-value = 0.6798 >> 0.05, thus also indicating an equivalence between the softwares. The Bland-Altman analysis revealed a bias ≤ 1% and dispersion ≤ 2% between the measurements. The tests showed that, for GLS values lower than 10%, there was a trend for higher percentage difference between the values, although the absolute values remained low.

Conclusion

The D-Station software was validated as an additional tool to the EchoPAC, which uses the raw data from the strain and strain rate curves exported from a proprietary software. (Arq Bras Cardiol. 2020; 114(3):496-506)

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Original Article

Impaired Right Ventricular Function in Heart Transplant Rejection

Luciana J. B. M. Carrion et al. Alice Sperotto Raffaela Nazario Livia A. Goldraich … Nadine Clausell Luís Eduardo Rohde Angela Barreto Santiago Santos

Abstract

Background:

The practice of screening for complications has provided high survival rates among heart transplantation (HTx) recipients.

Objectives:

Our aim was to assess whether changes in left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) are associated with cellular rejection.

Methods:

Patients who underwent HTx in a single center (2015 – 2016; n = 19) were included in this retrospective analysis. A total of 170 biopsies and corresponding echocardiograms were evaluated. Comparisons were made among biopsy/echocardiogram pairs with no or mild (0R/1R) evidence of cellular rejection (n = 130 and n = 25, respectively) and those with moderate (2R) rejection episodes (n=15). P-values < 0.05 were considered statistically significant

Results:

Most patients were women (58%) with 48 ± 12.4 years of age. Compared with echocardiograms from patients with 0R/1R rejection, those of patients with 2R biopsies showed greater LV posterior wall thickness, E/e’ ratio, and E/A ratio compared to the other group. LV systolic function did not differ between groups. On the other hand, RV systolic function was more reduced in the 2R group than in the other group, when evaluated by TAPSE, S wave, and RV fractional area change (all p < 0.05). Furthermore, RV GLS (−23.0 ± 4.4% in the 0R/1R group vs. −20.6 ± 4.9% in the 2R group, p = 0.038) was more reduced in the 2R group than in the 0R/1R group.

Conclusion:

In HTx recipients, moderate acute cellular rejection is associated with RV systolic dysfunction as evaluated by RV strain, as well as by conventional echocardiographic parameters. Several echocardiographic parameters may be used to screen for cellular rejection.

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Editorial

Real-Time Three-Dimensional Echocardiography and Myocardial Strain: Ready for Use in Clinical Practice

Frederico Jose Neves Mancuso

The ability of echocardiography to quantify volumes and to evaluate the contractile function of cardiac chambers has evolved greatly in recent years, particularly due to the development of real-time three-dimensional echocardiography (echo3D) and the possibility myocardial deformation (Strain) analysis by the speckle tracking technique.^–

Unlike two-dimensional echocardiography, where geometric inferences and mathematical calculations are required, the echo3D allows direct measurement of ventricular and atrial volumes, from which function data such as left and right ventricular ejection fraction, and left atrial function, including total emptying fraction and active emptying fraction parameters.^–

[…]

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Original Article

The Use of Two-Dimensional Strain Measured by Speckle Tracking in the Identification of Incipient Ventricular Dysfunction in HIV-Infected Patients on Antiretroviral Therapy, Untreated HIV Patients and Healthy Controls

Ronaldo Campos Rodrigues et al. Katia Martins Lopes de Azevedo Samuel Datum Moscavitch Sergio Setubal Claudio Tinoco Mesquita

Abstract

Background:

Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients.

Objectives:

To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals.

Methods:

Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (> 0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS – version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis’ non-parametric test was done, followed by Dunn’s multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests.

Results:

The mean age of HIV patients was 40 ± 8.65 years and the mean age of controls was 50 ± 11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (-17.70%), PI patients (-18.27%) and NNRTIs (-18.47%) were significantly lower than that of the Ctrl group (-20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups.

Conclusion:

The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies.

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Original Article

3-Dimensional Echocardiography and 2-D Strain Analysis of Left Ventricular, Left Atrial and Right Ventricular Function in Healthy Brazilian Volunteers

Roberto M. Saraiva et al. Eliza Maria B. Scolin Nicole P. Pacheco Maria Eduarda Bouret … Mauro Felippe Felix Mediano Marcelo T. Holanda Andréa R. da Costa

Abstract

Background:

New echocardiographic techniques are used in the diagnosis and prognosis of many heart diseases. However, reference values in different populations are still needed for several of these new indexes. We studied these new echocardiographic parameters in a group of Brazilians with no known cardiovascular disease.

Objective:

To study values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age.

Methods:

Cross-sectional study that included healthy individuals who underwent three-dimensional echocardiography (3DE) and two-dimensional speckle tracking echocardiography (STE) strain (e) analysis. Left atrial (LA) and left ventricular (LV) function were analyzed by 3DE and STE, and right ventricular (RV) function by STE. P values < 0.05 were considered significant.

Results:

Seventy-seven subjects (46.7% men; 40.4 ± 10.4 years) were included. Maximum, minimum and pre-atrial contraction (pre-A) LA volumes (ml/m²) were 21.2 ± 5.5, 7.8 ± 2.5, and 11.0 ± 3.1, respectively. Peak positive global LA e (LAScd), peak negative global LA e and total global LA e (LASr) were 17.4 ± 5.2%, -13.2 ± 2.0% and 30.5 ± 5.9%, respectively. LV end-diastolic and end-systolic volumes (ml/m²) measured 57 ± 12 and 24 ± 6, and 3D LV ejection fraction measured 58 ± 6%. Global LV longitudinal, circumferential and radial e were -19 ± 2%, -19 ± 3%, and 46 ± 12%, respectively. LV torsion measured 1.6 ± 0.7⁰ /cm. Global longitudinal RV e (RV-GLS) and RV free wall strain were -22 ± 3% and -24 ± 5%. Minimum LA and pre-A volumes, LV apical rotation, torsion and RV-GLS increased with age, while total and passive LA emptying fractions, LAScd, LASr, LV end-diastolic and end-systolic volumes decreased with age.

Conclusion:

Values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age are presented.

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Image

How Echocardiographic Deformation Indices Can Distinguish Different Types of Left Ventricular Hypertrophy

José Luiz Barros Pena et al. Wander Costa Santos Stanley de Almeida Araújo Glauber Monteiro Dias Eduardo Back Sternick

We present cases of athlete’s heart, idiopathic HCM, and glycogen storage cardiomyopathy (PRKAG2).

The two non-athlete patients (Pts) underwent genetic studies and myocardial biopsies.

[…]

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Editorial

Right Ventricular Evaluation with Speckle Tracking Echocardiography in COPD after a Pulmonary Rehabilitation Program

Djair Brindeiro Filho

Chronic obstructive pulmonary disease (COPD) is a serious public health problem, and is often related to smoking. In advanced stages of COPD, the presence of PAH is a common development. PAH progression rate in COPD is usually slow (an increase of < 1 mmHg per year). However, the presence of even moderate PAH is a strong predictor of mortality. During stable periods of the disease, the increase in mean pulmonary artery pressure is usually mild to moderate. However, severe PAH may occasionally occur in COPD patients COPD.

Conventional two-dimensional (2D) echo parameters allow a reasonable assessment of RV Function. In the 1990s, the use of tissue Doppler (TD) to measure the intramyocardial velocity gradient allowed measuring the rate of myocardial strain and its percentage (strain rate and strain). About ten years ago, the speckle tracking technique, based on the tracking of the speckles which two-dimensional echo images, allowed assessing myocardial strain without limitation by the DT insonation angle. 2D-STE strain can not only quantify the overall RV function, but it can also identify discrete, localized contractile losses, providing information regarding the pathophysiological mechanisms that lead to right ventricular failure. In a heterogeneous group of patients, RV lateral wall longitudinal strain showed a strong correlation with RV ejection fraction calculated by cardiac magnetic resonance. Peak longitudinal strain is a significant prognostic determinant in PAH patients, with greater value compared to other known clinical and echocardiographic predictors of mortality.

[…]

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Original Article

Right Atrial Deformation Analysis in Cardiac Amyloidosis – Results from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study

Attila Nemes et al. Dóra Földeák Péter Domsik Anita Kalapos … Árpád Kormányos Zita Borbényi Tamás Forster

Abstract

Background:

Light-chain (AL) cardiac amyloidosis (CA) is characterized by fibril deposits, which are composed of monoclonal immunoglobulin light chains. The right ventricle is mostly involved in AL-CA and impairment of its function is a predictor of worse prognosis.

Objectives:

To characterize the volumetric and functional properties of the right atrium (RA) in AL-CA by three-dimensional speckle-tracking echocardiography (3DSTE).

Methods:

A total of 16 patients (mean age: 64.5 ± 10.1 years, 11 males) with AL-CA were examined. Their results were compared to that of 15 age- and gender-matched healthy controls (mean age: 58.9 ± 6.9 years, 8 males). All cases have undergone complete two-dimensional Doppler and 3DSTE. A two-tailed p value of less than 0.05 was considered statistically significant.

Results:

Significant differences could be demonstrated in RA volumes respecting cardiac cycle. Total (19.2 ± 9.3% vs. 27.9 ± 10.7%, p = 0.02) and active atrial emptying fractions (12.1 ± 8.1 vs. 18.6 ± 9.8%, p = 0.05) were significantly decreased in AL-CA patients. Peak global (16.7 ± 10.3% vs. 31.2 ± 19.4%, p = 0.01) and mean segmental (24.3 ± 11.1% vs. 38.6 ± 17.6%, p =0.01) RA area strains, together with some circumferential, longitudinal and segmental area strain parameters, proved to be reduced in patients with AL-CA. Global longitudinal (4.0 ± 5.2% vs. 8.2 ± 5.5%, p = 0.02) and area (7.8 ± 8.1% vs. 15.9 ± 10.3%, p = 0.03) strains at atrial contraction and some circumferential and area strain parameters at atrial contraction were reduced in AL-CA patients.

Conclusion:

Significantly increased RA volumes and deteriorated RA functions could be demonstrated in AL-CA.

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Editorial

Speckle-Tracking Echocardiography – Ready for Use in Acute Coronary Syndrome?

Brivaldo Markman Filho

Population aging and the increase of risk factors such as arterial hypertension and diabetes, mainly associated with obesity, have greatly contributed to increased hospitalizations of patients with acute coronary syndrome (ACS).^, Patients with ACS may have different prognosis and, for this reason, risk stratification of ACS, including unstable angina (UA), is mandatory.^, In this context, anatomical definition of culprit artery using coronary cineangiography and percutaneous intervention has been the first choice for patients at moderate-to-high risk. Doppler echocardiography has a key role at the emergency room to assess left ventricle function and to rule out other conditions that may influence the diagnosis.

Recently, the use of two-dimensional speckle-tracking echocardiography (2D-STE) for measurement of myocardial strain has gained importance for its applicability in the clinical practice. Its high sensitivity to measure systolic function and identify left ventricular subclinical dysfunction, as compared with left ventricular ejection fraction, extends its applicability and makes it a test of additional value in many areas of cardiology.

[…]

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Editorial

What is the Role of Two-Dimensional Speckle Tracking Echocardiography in the Diagnosis and Management of Anthracycline-Induced Cardiotoxicity?

Isabela Bispo Santos da Silva Costa et al. Ludhmila Abrahão Hajjar

The increasing number of patients with neoplasms and survivors^, has raised the interest of the scientific community in the diagnosis and early management of the effects of neoplasms and/or their treatments on patients. In that scenario, the injury caused to the cardiovascular system belongs to a spectrum and can impair all cardiovascular system structures in a clinically variable way, ranging from asymptomatic forms to cardiovascular death. Most studies on cardiotoxicity have focused on ventricular dysfunction because of its presentation severity and because it is the major cause of late non-oncologic mortality of neoplasm survivors.

In oncologic patients, the drugs most commonly related to ventricular dysfunction are anthracyclines. Recent studies have reported that the damage related to those drugs, if not identified and treated early, evolves continuously from cell injury to ventricular dysfunction. In the past decade, several studies showed that the subclinical detection of cardiotoxicity, by use of biomarkers, such as troponin and BNP, might be an opportunity to prevent cardiovascular injury, allowing for early treatment and more appropriate individualized follow-up.^–

[…]

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Review Article

Cardiac Mechanics Evaluated by Speckle Tracking Echocardiography

Maria Cristina Donadio Abduch et al. Adriano Mesquita Alencar Wilson Mathias Jr. Marcelo Luiz de Campos Vieira

Natural myocardial markers, or speckles, originated from constructive and destructive interference of ultrasound in the tissues may provide early diagnosis of myocardial changes and be used in the prediction of some cardiac events. Due to its relatively temporal stability, speckles can be tracked by dedicated software along the cardiac cycle, enabling the analysis of the systolic and diastolic function. They are identified by either conventional 2D grey scale and by 3D echo, conferring independence of the insonation angle, thus allowing assessment of cardiac mechanics in the three spatial planes: longitudinal, circumferential, and radial. The purposes of the present paper are: to discuss the role and the meaning of cardiac strain obtained by speckle tracking during the evaluation of cardiac physiology and to discuss clinical applications of this novel echocardiographic technology.

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