Classification of longitudinal strain curves measured by speckle-tracking echocardiography in normal and pathological myocardial segments

Mirea, Oana; Berceanu, Mihaela; Soldea, Sorina; Donoiu, Ionuț; Raicea, Victor

doi:10.2478/rjc-2023-0031

Abstract

Background

Two-dimensional speckle-tracking echocardiography (2D-STE) provides a quantitative tool to evaluate LV function at the regional level. The purpose of this study was to classify the types of regional longitudinal strain curves (LSC). Moreover, we propose a novel longitudinal strain curve index (LSCI) which we compared to the wall motion score index (WMSI).

Methods

We enrolled 100 healthy volunteers and 50 patients with prior myocardial infarction (MI). Each LSC was classified considering the positive peak (peak P), peak maximum strain (PMS), and time to maximum peak strain (TPMS) as follows: Type 1 (Peak P<6%, PMS>6%, TPMS before aortic valve closure [AVC]); Type 2 (Peak P<6%, PMS≥6%, TPMS after AVC); Type 3 (Peak P≥6%, PMS≥6%, TPMS before AVC); Type 4 (Peak P≥6%, PMS≥6%, TPMS after AVC); Type 5 (Peak P<6%, PMS≥6%, TPMS first third of systole); Type 6 (Peak P<6%, PMS<6%); and Type 7 (Peak P≥6%, PMS<6%). The longitudinal curve score index (LCSI) was obtained (sum of LSC type/18 segments).

Results

A total of seven types of LSC were identified. In the healthy subjects, LSC Type 1 (T1) and Type 2 (T2) were the most frequent. Type 3 (T3) and Type 4 (T4) were found in insignificant percentages while Type 5 (T5), Type 6 (T6), and Type 7 (T7) were not identified. When analyzed for the entire population, LSCI correlated strongly with WMSI (r=0.83, p<0.01).

Conclusions

Analysis of LSC may provide a substantial support to visual assessment of regional LV function and the LCSI represents an index that is highly reproducible, independent of the examiner’s experience.

References

Savage ML, Hay K, Anderson B, Scalia G, Burstow D, Murdoch D, et al. The prognostic value of echocardiographic wall motion score index in ST-segment elevation myocardial infarction. Crit Care Res Pract. 2022 Nov 10;2022:8343785. doi: 10.1155/2022/8343785.
Open DOI Search in Google Scholar Back to article
Jurado-Román A, Agudo-Quílez P, Rubio-Alonso B, Molina J, Díaz B, García-Tejada J, et al. Superiority of wall motion score index over left ventricle ejection fraction in predicting cardiovascular events after an acute myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2019 Feb;8(1):78–85.
Search in Google Scholar Back to article
Amzulescu MS, Langet H, Saloux E, Manrique A, Boileau L, Slimani A, et al. Head-to-head comparison of global and regional two-dimensional speckle tracking strain versus cardiac magnetic resonance tagging in a multicenter validation study. Circ Cardiovasc Imaging. 2017 Nov;10(11):e006530. doi: 10.1161/CIRCIMAGING.117.006530.
Open DOI Search in Google Scholar Back to article
Potter E, Marwick T. Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction. JACC Cardiovasc Imaging. 2018 Feb;11(2 Pt 1):260–274.
Search in Google Scholar Back to article
Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. European Heart Journal - Cardiovascular Imaging. 2015;16(1):1–11.
Search in Google Scholar Back to article
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–1463.
Search in Google Scholar Back to article
Carasso S, Rakowski H, Witte KK, Smith P, Carasso D, Garceau P, et al. Left ventricular strain patterns in dilated cardiomyopathy predict response to cardiac resynchronization therapy: timing is not everything. J Am Soc Echocardiogr. 2009;22(3):242–50.
Search in Google Scholar Back to article
Mirsky I, Parmley WW. Assessment of passive elastic stiffness for isolated heart muscle and the intact heart. Circ Res. 1973;33:233–43.
Search in Google Scholar Back to article
Voigt JU, Lindenmeier G, Exner B, Regenfus M, Werner D, Reulbach U, et al. Incidence and characteristics of segmental postsystolic longitudinal shortening in normal, acutely ischemic, and scarred myocardium. J Am Soc Echocardiogr. 2003 May;16(5):415–23.
Search in Google Scholar Back to article
Skulstad H, Edvardsen T, Urheim S, Rabben SI, Stugaard M, Lyseggen E, et al. Postsystolic shortening in ischemic myocardium: active contraction or passive recoil? Circulation. 2002;106(6):718–24.
Search in Google Scholar Back to article
Janse MJ, Sosunov EA, Coronel R, Opthof T, Anyukhovsky EP, de Bakker JM, et al. Repolarization gradients in the canine left ventricle before and after induction of short-term cardiac memory. Circulation. 2005 Sep 20;112(12):1711–8.
Search in Google Scholar Back to article
Sengupta PP, Khandheria BK, Korinek J, Wang J, Jahangir A, Seward JB, et al. Apex-to-base dispersion in regional timing of left ventricular shortening and lengthening. J Am Coll Cardiol. 2006 Jan 3;47(1):163–72.
Search in Google Scholar Back to article
Brown MA, Norris RM, Takayama M, White HD. Post-systolic shortening a marker of potential for early recovery of acutely ischaemic myocardium in the dog. Cardiovasc Res. 1987;21(10):703–716.
Search in Google Scholar Back to article
Hosokawa H, Sheehan FH, Suzuki T. Measurement of postsystolic shortening to assess viability and predict recovery of left ventricular function after acute myocardial infarction. J Am Coll Cardiol. 2000;35:1842–1849.
Search in Google Scholar Back to article
Zahid W, Eek CH, Remme EW, Skulstad H, Fosse E, Edvardsen T. Early systolic lengthening may identify minimal myocardial damage in patients with non-ST-elevation acute coronary syndrome. Eur Heart J Cardiovasc Imaging. 2014 May 27;pii:jeu101.
Search in Google Scholar Back to article
Smedsrud MK, Sarvari S, Haugaa KH, Gjesdal O, Ørn S, Aaberge L, et al. Duration of myocardial early systolic lengthening predicts the presence of significant coronary artery disease. J Am Coll Cardiol. 2012;60(12):1086–93.
Search in Google Scholar Back to article
Ramanathan C, Jia P, Ghanem R, Ryu K, Rudy Y. Activation and repolarization of the normal human heart under complete physiological conditions. Proc Natl Acad Sci. 2006 Apr 18;103(16):6309–14.
Search in Google Scholar Back to article
Blondheim DS, Beeri R, Feinberg MS, Vaturi M, Shimoni S, Fehske W, et al. Reliability of visual assessment of global and segmental left ventricular function: a multicenter study by the Israeli echocardiography research group. J Am Soc Echocardiogr. 2010;23(3):258–64.
Search in Google Scholar Back to article
Møller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ, Pellikka PA. Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. Am Heart J. 2006;151(2):419–25.
Search in Google Scholar Back to article
Cacciapuoti F, Arciello A, Fiandra M, Manfredi E, Cacciapuoti F, Lama D. Index of myocardial performance after early phase of myocardial infarction in relation to its location. J Am Soc Echocardiogr. 2004;17(4):345–9.
Search in Google Scholar Back to article
Zhang Y, Takagawa J, Sievers RE, Khan MF, Viswanathan MN, Springer ML, et al. Validation of the wall motion score and myocardial performance indexes as novel techniques to assess cardiac function in mice after myocardial infarction. Am J Physiol Heart Circ Physiol. 2007;292(2):H1187–92.
Search in Google Scholar Back to article