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      Strain Echocardiography and Myocardial Mechanics: From Basics to Clinical Applications

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          Abstract

          The aim of this review is to summarize the recent developments in strain imaging, an evolving technique – from tissue Doppler to 3D echocardiography – for resolving the complex left ventricular mechanics. Following a brief overview of the different used technique to extract myocardial deformation data, the authors summarize the role of the technique in the assessment of cardiac mechanics and its role in the clinical arena.

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          Cardiac mechanics revisited: the relationship of cardiac architecture to ventricular function.

          Gerald D. Buckberg, Julien Hoffman, Aman Mahajan … (2008)
          The keynote to understanding cardiac function is recognizing the underlying architecture responsible for the contractile mechanisms that produce the narrowing, shortening, lengthening, widening, and twisting disclosed by echocardiographic and magnetic resonance technology. Despite background knowledge of a spiral clockwise and counterclockwise arrangement of muscle fibers, issues about the exact architecture, interrelationships, and function of the different sets of muscle fibers remain to be resolved. This report (1) details observed patterns of cardiac dynamic directional and twisting motions via multiple imaging sources; (2) summarizes the deficiencies of correlations between ventricular function and known ventricular muscle architecture; (3) correlates known cardiac motions with the functional anatomy within the helical ventricular myocardial band; and (4) defines an innovative muscular systolic mechanism that challenges the previously described concept of "isovolumic relaxation." This new knowledge may open new doors to treating heart failure due to diastolic dysfunction.
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            Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy.

            Makoto Saito, Hideki Okayama, Toyofumi Yoshii … (2012)
            Late gadolinium enhancement (LGE) on contrast-enhanced magnetic resonance imaging (MRI) in hypertrophic cardiomyopathy (HCM) has been reported to be associated with myocardial fibrosis and cardiac events. In patients with HCM, two-dimensional (2D) strain can identify subclinical global systolic dysfunction despite normal left ventricular (LV) chamber function. Therefore, this study tested the hypothesis that global 2D strain could detect subtle myocardial fibrosis and serve as a novel prognostic parameter in HCM patients. Echocardiography and MRI were performed in 48 consecutive patients with HCM and normal chamber function. We measured global longitudinal strain (GLS) in apical two-chamber, four-chamber, and long-axis views using speckle-tracking analysis. The extent of LGE (%LGE = LGE volume/total LV volume) and LV mass index were calculated by MRI using Simpson's rule and custom software. All patients were followed up for major cardiac events. Global longitudinal strain in patients with LGE was significantly lower than that without LGE (-11.8 ± 2.8 vs. -15.0 ± 1.7%, P < 0.001). Multivariate analysis showed that GLS was an independent predictor of %LGE (standard coefficient = 0.627, P < 0.001). During a mean follow-up period of 42 ± 12 months, five patients had cardiac events. When the patients were stratified based on the median level of GLS (-12.9%), all events were observed in the worse GLS group (P = 0.018). These results suggest that global 2D strain might provide useful information on myocardial fibrosis and cardiac events in HCM patients with normal chamber function.
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              Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study.

              Pio Caso, Sebastian Russo, Antonio D'Onofrio … (2005)
              Accurate echocardiographic parameters to predict maintenance of sinus rhythm in patients with atrial fibrillation (AF) are poorly defined. This study was conducted to assess the atrial myocardial properties during AF through myocardial velocity, strain rate, and strain and to compare their prognostic value in maintaining sinus rhythm in patients with lone AF with standard transthoracic (TTE) and transesophageal echocardiography (TEE). Sixty-five consecutive patients with lone AF for < or =3 months underwent TTE, TEE, and myocardial velocity and strain and strain rate imaging examinations before successful external cardioversion. Maintenance of sinus rhythm was assessed during a 9-month follow-up. Atrial myocardial velocity, strain, and strain rate values in AF patients were compared with those of age- and sex-matched referents. Moreover, clinical and echocardiographic parameters of patients with maintenance of sinus rhythm (MSR patients) over the 9-month follow-up period (n=25) were compared with those from patients with AF recurrence (AFR patients; n=40). Atrial myocardial properties assessed by myocardial velocity, strain rate, and strain were significantly reduced (P<0.0001) in patients (velocity, 3.2+/-1.4 cm/s; strain, 23.3+/-19%; strain rate, 2+/-0.9 seconds(-1)) compared with referents (velocity, 5.7+/-1.3 cm/s; strain, 92+/-26%; strain rate, 4.2+/-1.8 seconds(-1)). The individual predictors of sinus rhythm maintenance were atrial appendage flow velocity (MSR patients, 39+/-12 cm/s; AFR patients, 32+/-15 cm/s; P<0.01) assessed by TEE and atrial strain (MSR patients, 33+/-27%; AFR patients, 17+/-9%; P=0.0007) and strain rate (MSR patients, 2.7+/-1 seconds(-1); AFR patients, 1.6+/-0.6 seconds(-1); P<0.0001) peak systolic values. Atrial strain (P<0.0001; coefficient, 0.015; SE, 0.003) and strain rate (P<0.0001; coefficient, 0.372; SE, 0.075) parameters alone were confirmed as independent predictors of sinus rhythm maintenance by multivariable analysis. Patients with higher atrial strain and strain rate appear to have a greater likelihood of staying in sinus rhythm. If the current data are verified in future studies, then additional pharmacological therapy and maintenance of anticoagulants for a longer period may need to be considered in those with lower atrial strain and strain rate measurements.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Ecogr
                Journal ID (iso-abbrev): J Cardiovasc Ecogr
                Journal ID (publisher-id): JCE
                Title: Journal of Cardiovascular Echography
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2211-4122
                ISSN (Electronic): 2347-193X
                Publication date (Print): Jan-Mar 2015
                Volume: 25
                Issue: 1
                Pages: 1-8
                Affiliations
                [1] King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Saudi Arabia
                [1 ] Monaldi Hospital Cardiology, Naples, Italy
                Author notes
                Address for correspondence Prof. Giovanni Di Salvo, Director Heart Center Research Unit, Consultant Cardiology, King Faisal Specialist Hospital and Research Center, Professor Pediatric Cardiology Al Faisal University, Riyadh - 11211, Kingdom of Saudi Arabia. E-mail: giodisal@ 123456yahoo.it
                Article
                Publisher ID: JCE-25-1
                DOI: 10.4103/2211-4122.158415
                PMC ID: 5353453
                PubMed ID: 28465921
                SO-VID: 5f98d2e0-fb4b-4e40-bb1e-1a6fe57271da
                Copyright © Copyright: © 2015 Journal of Cardiovascular Echography
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Subject: Review Article

                Keywords: cardiac mechanics,clinical application,strain echocardiography,speckle tracking
                Data availability:
                Keywords: cardiac mechanics, clinical application, strain echocardiography, speckle tracking

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