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      Evaluation of Left Ventricular Longitudinal, Radial, and Circumferential Strains in Subjects with Normal Variations of Coronary Dominance: A Preliminary Comparative Study

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          Abstract

          Background:

          The aim of this study was to evaluate the contractile function of the left ventricular muscles in subjects with normal coronary artery and normal variations of coronary dominance.

          Methods:

          This study was performed on 90 adult subjects with normal results of coronary arteries angiography, echocardiography, and electrocardiography. The participants were categorized into 3 groups of 30 with right-dominant, left-dominant, and codominant variations. Two-dimensional transthoracic echocardiography was performed with apical 2-, 3-, and 4-chamber views and parasternal basal, mid, and apical short-axis views. Then, images were analyzed offline using the velocity vector imaging method. In all studied groups, the mean and standard deviation of left ventricle coronary territorial longitudinal, circumferential, radial strains, and left ventricle global strains were determined. They were compared in 3 layers of sub-endocardial, myocardium, and sub-epicardial.

          Results:

          In terms of longitudinal and circumferential strains, there were significant differences in the most coronary territories and global strain among the right-dominant, left-dominant and codominant groups ( P < .05). No significant differences in terms of territorial and global radial strains were observed among the study groups ( P > .05).

          Conclusion:

          Strain level decreased from endocardium to epicardium in all studied groups. Territorial and global contractile functions (longitudinal and circumferential strains) of the left ventricle vary depending on the variations of coronary arteries.

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          Most cited references37

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          Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

          The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
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            Myocardial strain imaging: how useful is it in clinical decision making?

            Myocardial strain is a principle for quantification of left ventricular (LV) function which is now feasible with speckle-tracking echocardiography. The best evaluated strain parameter is global longitudinal strain (GLS) which is more sensitive than left ventricular ejection fraction (LVEF) as a measure of systolic function, and may be used to identify sub-clinical LV dysfunction in cardiomyopathies. Furthermore, GLS is recommended as routine measurement in patients undergoing chemotherapy to detect reduction in LV function prior to fall in LVEF. Intersegmental variability in timing of peak myocardial strain has been proposed as predictor of risk of ventricular arrhythmias. Strain imaging may be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. Strain may also be used to diagnose myocardial ischaemia, but the technology is not sufficiently standardized to be recommended as a general tool for this purpose. Peak systolic left atrial strain is a promising supplementary index of LV filling pressure. The strain imaging methodology is still undergoing development, and further clinical trials are needed to determine if clinical decisions based on strain imaging result in better outcome. With this important limitation in mind, strain may be applied clinically as a supplementary diagnostic method.
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              Normal ranges of left ventricular strain: a meta-analysis.

              The definition of normal values of left ventricular global longitudinal strain (GLS), global circumferential strain, and global radial strain is of critical importance to the clinical application of this modality. The investigators performed a meta-analysis of normal ranges and sought to identify factors that contribute to reported variations. MEDLINE, Embase, and the Cochrane Library database were searched through August 2011 using the key terms "strain," "speckle tracking," "left ventricle," and "echocardiography" and related phrases. Studies were included if the articles reported left ventricular strain using two-dimensional speckle-tracking echocardiography in healthy normal subjects, either in the control group or as a primary objective of the study. Data were combined using a random-effects model, and effects of demographic, hemodynamic, and equipment variables were sought in a meta-regression. The search identified 2,597 subjects from 24 studies. Reported normal values of GLS varied from -15.9% to -22.1% (mean, -19.7%; 95% CI, -20.4% to -18.9%). Normal global circumferential strain varied from -20.9% to -27.8% (mean, -23.3%; 95% CI, -24.6% to -22.1%). Global radial strain ranged from 35.1% to 59.0% (mean, 47.3%; 95% CI, 43.6% to 51.0%). There was significant between-study heterogeneity and inconsistency. The source of variation was sought between studies using meta-regression. Blood pressure, but not age, gender, frame rate, or equipment, was associated with variation in normal GLS values. The narrowest confidence intervals from this meta-analysis were for GLS and global circumferential strain, but individual studies have shown a broad range of strain in apparently normal subjects. Variations between different normal ranges seem to be associated with differences in systolic blood pressure, emphasizing that this should be considered in the interpretation of strain. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Anatol J Cardiol
                Anatol J Cardiol
                Anatolian Journal of Cardiology
                Turkish Society of Cardiology
                2149-2263
                2149-2271
                August 2022
                01 August 2022
                : 26
                : 8
                : 645-653
                Affiliations
                [1 ]Department of Cardiology , Healthy Heart Research Center, Guilan University of Medical Sciences, Rasht, Iran
                [2 ]Department of Anatomy , School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
                [3 ]Department of Biochemistry and Medical Physics , Healthy Heart Research Center, Guilan University of Medical Sciences, Rasht, Iran
                [4 ]Department of Anatomy , Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
                Author notes
                Corresponding author:Ebrahim Nasiri ✉ ebrahimnasiri@ 123456gmail.com

                Cite this article as: Aghajankhah MR, Hosseinpour M, Moladoust H, Rad MA, Nasiri E. Evaluation of left ventricular longitudinal, radial, and circumferential strains in subjects with normal variations of coronary dominance: A preliminary comparative study. Anatol J Cardiol. 2022; 26(8): 645-653.

                Author information
                http://orcid.org/0000-0002-0856-9483
                http://orcid.org/0000-0003-1217-5652
                http://orcid.org/0000-0003-2306-400X
                http://orcid.org/0000-0002-7769-1925
                http://orcid.org/0000-0002-5878-0148
                Article
                ajc-26-8-645
                10.5152/AnatolJCardiol.2022.1075
                9403878
                35924291
                5c79befa-aeef-41be-b31e-a19d60f9f0d5
                © Copyright 2022 authors

                Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 29 September 2021
                : 21 March 2022
                Categories
                Original Investigation

                coronary angiography,coronary dominance,echocardiography,velocity vector imaging,cardiac function

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