Non-Doppler Two-dimensional Strain Imaging by Echocardiography–From Technical Considerations to Clinical Applications

doi:10.1016/j.echo.2006.08.023

Journal of the American Society of Echocardiography

Volume 20, Issue 3, March 2007, Pages 234-243

https://doi.org/10.1016/j.echo.2006.08.023 Get rights and content

During the past several years, strain and strain rate imaging have emerged as a quantitative technique to accurately estimate myocardial function and contractility. Non-Doppler, 2-dimensional (2D) strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements. It analyzes motion by tracking speckles in the ultrasonic image in two dimensions. Current available software allows spatial and temporal image processing with recognition and selection of such elements on ultrasound image. The geometric shift of each speckle represents local tissue movement. By tracking theses speckles, 2D tissue velocity, strain, and strain rate can be calculated. Non-Doppler 2D strain imaging is simple to perform. It requires only one cardiac cycle to be acquired; further processing and interpretation can be done after image data acquisition. Because it is not based on tissue Doppler measurements, it is angle independent. Data regarding accuracy, validity, and clinical application of non-Doppler 2D strain imaging are rapidly accumulating. This technique may prove to be of significant clinical value, enabling rapid and accurate assessment of global and segmental myocardial function.

Section snippets

General Principles

Non-Doppler 2D strain imaging is a newer technique for obtaining strain and SR measurements. It analyzes motion by tracking speckles (natural acoustic markers) in the ultrasonic image in two dimensions. These markers are statistically equally distributed throughout the myocardium. The size of these elements is 20 to 40 pixels. Each speckle can be identified and followed accurately over a number of consecutive frames. These markers, within the ultrasonic image, are tracked by calculating

Technique Substantiation

Data regarding accuracy, validity, and clinical application of non-Doppler 2D strain imaging are rapidly accumulating. In in vivo and in vitro models, non-Doppler 2D strain demonstrated good correlation and agreement with sonomicrometry values, including when measured under different contractile conditions.17, 18, 19 Intraobserver and interobserver variability were found to be low: 3.6% to 5.3% and 7% to 11.8%, respectively. In a substudy¹⁸ comparing non-Doppler 2D strain with tagged magnetic

References (30)

R. Hoffmann et al.
Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms
J Am Coll Cardiol
(1996)
J.P. Kvitting et al.
How accurate is visual assessment of synchronicity in myocardial motion?An in vitro study with computer-simulated regional delay in myocardial motion: clinical implications for rest and stress echocardiography studies
J Am Soc Echocardiogr
(1999)
G. Gilman et al.
Strain rate and strain: s step-by-step approach to image and data acquisition
J Am Soc Echocardiogr
(2004)
I. Hashimoto et al.
Myocardial strain rate is a superior method for evaluation of left ventricular subendocardial function compared with tissue Doppler imaging
J Am Coll Cardiol
(2003)
C. Pislaru et al.
Higher myocardial strain rates during isovolumetric relaxation phase than during ejection characterize acutely ischemic myocardium
J Am Coll Cardiol
(2002)
G.R. Sutherland et al.
Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function
J Am Soc Echocardiogr
(2004)
G. Yip et al.
Clinical applications of strain rate imaging
J Am Soc Echocardiogr
(2003)
T.H. Marwick
Measurement of strain and strain rate by echocardiography: ready for prime time?
J Am Coll Cardiol
(2006)
T. Kukulski et al.
Acute changes in systolic and diastolic events during clinical coronary angioplasty: a comparison of regional velocity, strain rate, and strain measurement
J Am Soc Echocardiogr
(2002)
T. Kukulski et al.
Identification of acutely ischemic myocardium using ultrasonic strain measurements
J Am Coll Cardiol
(2003)

T. Kukulski et al.

Acute changes in systolic and diastolic events during clinical coronary angioplasty: a comparison of regional velocity, strain rate and strain measurement

J Am Soc Echocardiogr

(2002)

F. Jamal et al.

Can changes in systolic longitudinal deformation quantify regional myocardial function after an acute infarction?An ultrasonic strain rate and strain study

J Am Soc Echocardiogr

(2002)

J. Korinek et al.

Two-dimensional strain–a Doppler-independent ultrasound method for quantitation of regional deformation: validation in vitro and in vivo

J Am Soc Echocardiogr

(2005)

B.H. Amundsen et al.

Noninvasive myocardial strain measurement by speckle tracking echocardiography; validation against sonomicrometry and tagged magnetic resonance imaging

J Am Coll Cardiol

(2006)

T. Toyoda et al.

Assessment of regional myocardial strain by a novel automated tracking system from digital image files

J Am Soc Echocardiogr

(2004)

Cited by (435)

Comparative effects of nebivolol and carvedilol on left ventricular diastolic function in older patients with heart failure and preserved ejection fraction
2023, International Journal of Cardiology: Cardiovascular Risk and Prevention
Although many studies have compared carvedilol and nebivolol in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF), such comparative studies for the elderly have not been reported yet. Nebivolol is known to be effective for improving diastolic function of elderly patients with HF. Thus, this study aimed to determine whether nebivolol could improve LV diastolic function to a greater extent than carvedilol in older patients aged over 70 years.
This trial was a prospective, randomized, open-label, single-center, active-controlled study that enrolled 62 patients with class II or III HF over 70 years of age with an LVEF ≥40%. Patients were randomized into a carvedilol group or a nebivolol group. Transthoracic echocardiography was performed at baseline and 12 months by the same investigator who was blinded to clinical data. The primary endpoint was E/e′ measured by echocardiographic evaluation 12 months after treatment.
The median duration of follow-up was 24 months. Baseline clinical characteristics and echocardiographic parameters, such as LV diastolic function indices, did not differ significantly between carvedilol and nebivolol groups. Twelve-month follow-up echocardiography data showed no significant difference in E/e′ or other LV diastolic function indices between the two groups. There were no significant changes in echocardiographic parameters over 12 months in either group.
There was no difference between carvedilol and nebivolol for improving diastolic function of elderly HF patients with LVEF ≥40%. This study showed no superiority of nebivolol over carvedilol in elderly patients with HF.
Two-dimensional speckle tracking-derived global longitudinal strain in healthy Doberman Pinschers: method evaluation, variability, and reference values
2023, Journal of Veterinary Cardiology
Evaluation of two-dimensional speckle tracking (2D-ST)-derived global longitudinal strain (GLS) in healthy Doberman Pinschers (DP) is essential before it can be used in diseased DP to assess systolic function. To determine feasibility and observer related measurement variability of 2D-ST-derived GLS by use of AutoSTRAIN (AUTO) and 2D Cardiac Performance Analysis (TomTec Imaging Systems GmbH, Unterschleissheim, Germany).
This prospective study included 120 healthy, client-owned DP presented for screening evaluation. Global longitudinal strain of the apical four- (GLS_A4C), two-, and three-chamber view as well as the average GLS of all three views combined (GLS_AV) were determined, compared, and reference values established. Measurement variability was assessed by using intra- and inter-observer coefficient of variation.
A small difference existed for GLS_AV (mean + 0.23%; P=0.022) between the two software programs although the determined strain values were similar and positively correlated (r = 0.84; P<0.001). No difference could be found between GLS_AV and GLS_A4C for AUTO (mean + 0.16%; P=0.228), whereas a difference existed for Cardiac Performance Analysis (mean −0.89% (end-systolic strain) and −0.56% (peak strain), P<0.0001). Software specific reference values were established for GLS_AV and GLS_A4C. Intra- and inter-observer coefficient of variation revealed very low to low measurement variability, with better results for AUTO.
Two-dimensional speckle tracking (2D-ST) derived GLS is a feasible technique to assess systolic function with low measurement variability. Whenever possible, GLS_AV should be determined, although GLS_A4C might be a potential alternative.
Echocardiographic study of cardiac structure and function in people with bipolar disorder after midlife
2022, Journal of Affective Disorders
Heart failure is the leading cause of mortality in older people with bipolar disorder (BD). Studies examining cardiac structure and function in middle-aged patients with BD by using echocardiography and cardiac strain imaging are scant.
We recruited 48 patients with bipolar I disorder (BD-I) older than 45 years to undergo conventional and tissue speckle tracking echocardiography. Data of 31 mentally healthy adults older than 45 years were randomly retrieved from the echocardiographic dataset and compared with the data of BD patients.
Patients with BD-I had significantly higher mean values of interventricular septal thickness (Cohen's d = 0.83, p = 0.001) and left ventricular internal diameter (Cohen's d = 0.90, p = 0.001) at end-diastole relative to controls. Additionally, BD-I patients exhibited significantly lower mean values of mitral valve E/A ratio (Cohen's d = 0.67, p = 0.007) and a more reduced global longitudinal strain (Cohen's d = 0.72, p = 0.029) than controls. Multiple linear regression revealed that body mass index was negatively correlated with the mitral valve E/A ratio (adjustment R² = 0.363, p = 0.043) in patients with BD-I.
A relatively small sample size may limit generalization.
After midlife, BD patients exhibit cardiac diastolic (low mitral valve E/A ratio) and systolic (reduced global longitudinal strain) dysfunction. High body mass index may play a role in the unfavorable cardiac function in aging patients with BD.
Early diastolic strain rate in relation to long term prognosis following isolated coronary artery bypass grafting
2021, International Journal of Cardiology
The ratio of early mitral inflow velocity to early diastolic strain rate (E/e'sr) is a novel echocardiographic measure to estimate early left ventricular (LV) filling pressure. We hypothesize that E/e'sr is a predictor of outcome following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e'.
Consecutive patients undergoing isolated CABG at Gentofte Hospital (n = 652) were included. The mean age of the study population was 67 ± 9 years, 84% were male, mean LVEF was 50 ± 11%. Prior to surgery, all patients underwent an extensive echocardiographic examination. The outcome was all-cause mortality. During follow-up (median 3.8 years [IQR: 2.7; 4.9 years]), a total of 73 (11.2%) died. Both E/e' and E/e'sr were significant predictors in univariable models. In a multivariable model, E/e'sr remained an independent predictor of outcome (HR:1.05 [1.01–1.10], p = 0.049, per 10 cm increase) whereas E/e' did not (HR:1.05 [0.99–1.11], p = 0.053, per 1-unit increase). The relationship between E/e'sr, and the outcome was significantly modified by GLS (p for interaction = 0.043). In the multivariable model, E/e'sr was still significantly associated with the outcome in patients with high GLS (≥13.6%) (HR:1.18 [1.02–1.36], p = 0.029) but not in patients with low GLS (HR 1.04 CI95%: [0.99–1.10], p = 0.14). E/e' was not a significant predictor of all-cause mortality after multivariable adjustment in neither of the groups. E/e'sr improved net reclassification with 33% when added to EuroSCOREII.
Following CABG, preoperative E/e'sr is an independent predictor of all-cause mortality, especially in patients with preserved systolic function and superior to E/e'.
Right Ventricular Longitudinal Strain Predicts Survival in Patients With Functional Tricuspid Regurgitation
2021, Canadian Journal of Cardiology
Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Despite general consent that right ventricular (RV) dysfunction impacts outcome of patients with TR, it is still unknown which echocardiographic parameters most accurately reflect prognosis. In this study we aimed to evaluate the prevalence of RV dysfunction and its prognostic value in patients with TR.
Data from 1089 consecutive patients were analysed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change, and right ventricular free wall longitudinal strain (RV strain) were used to define RV dysfunction. Patients were followed for 2-year all-cause mortality. For prediction of survival, reclassification and C statistics of RV functional parameters using TR grade as reference model were performed.
Among the patients studied, 13.9% showed no TR, 61.2% had mild TR, 19.6% had moderate TR, and 5.3% had severe TR. The TR grade was associated with increased mortality (log rank, P < 0.001). Impaired RV strain and TAPSE were independent predictors for mortality (RV: hazard ratio [HR], 1.130; 95% confidence interval [CI], 1.099-1.160; P < 0.001; TAPSE: HR, 1.131; 95% CI, 1.085-1.175; P < 0.001). Both RV strain and TAPSE improved the reference model for survival prediction (RV: integrated discrimination improvement [IDI], 0.184; 95% CI, 0.146-0.221; P < 0.001; TAPSE: IDI, 0.057; 95% CI, 0.037-0.077; P < 0.001).
Echocardiographic evaluation of RV function appears to useful for patients with TR. Assessment of RV strain provides additional value for prediction of 2-year mortality.
Une insuffisance tricuspide (IT) fonctionnelle est une observation fréquente en échocardiographie. Bien qu'il soit généralement admis que la dysfonction du ventricule droit (VD) a un impact sur le pronostic des patients atteints d'IT, on ne sait toujours pas quels sont les paramètres échocardiographiques qui reflètent le plus précisément ce pronostic. Dans cette étude, nous avons cherché à évaluer la prévalence de la dysfonction du VD et sa valeur pronostique chez les patients atteints d'IT.
Les données obtenues pour 1 089 patients consécutifs ont été analysées. L'excursion systolique du plan de l'anneau tricuspide (TAPSE, de l’anglais « tricuspid annular plane systolic excursion »), la fraction de raccourcissement de surface et la déformation longitudinale de la paroi libre du ventricule droit ont été utilisées pour définir la dysfonction du VD. Les patients ont été suivis pour la mortalité à deux ans toutes causes confondues. Pour la prédiction de la survie, une reclassification et des probabilités de concordance des paramètres fonctionnels du VD en utilisant le niveau d'IT comme modèle de référence ont été réalisées.
Parmi les patients étudiés, 13,9 % ne présentaient aucune IT, 61,2 % présentaient une IT légère, 19,6 % une IT modérée et 5,3% une IR sévère. Le grade d'IT était associé à une mortalité accrue (test logarithmique par rangs, P < 0,001). L'altération de la déformation du VD et du TAPSE était un facteur prédictif indépendant de mortalité (VD : rapport des risques [RR], 1,130; intervalle de confiance [IC] à 95 %, 1,099-1,160; P < 0,001; TAPSE : RR, 1,131; IC à 95 %, 1,085-1,175 ; P < 0,001). La déformation du VD et le TAPSE ont amélioré le modèle de référence pour la prédiction de la survie (déformation du VD : indice d’amélioration de la discrimination intégrée [IDI], 0,184 ; IC à 95 %, 0,146-0,221; P < 0,001; TAPSE : IDI, 0,057; IC à 95 %, 0,037-0,077 ; P < 0,001).
L'évaluation échocardiographique de la fonction du VD s’est révélée utile pour les patients atteints d'IT. L'évaluation de la déformation du VD apporte une plus-value pour la prédiction de la mortalité à 2 ans.
New mutation in Fabry disease: c.448delG, first phenotypic description
2021, Molecular Genetics and Metabolism Reports
Fabry disease (FD) (Anderson-Fabry disease, OMIM 301500) is a genetic disorder caused by a pathogenic variant in the GLA gene on chromosome Xq22 that produces a deficiency in the lysosomal enzyme alpha-galactosidase A.
It is transmitted as an X-linked trait, although de novo mutations have been described. The objective of this report is to describe the clinical characteristics of a patient with FD who is a carrier of a mutation not previously studied, in order to provide information on the genotype-phenotype correlation in this pathology.
38-year-old patient who consulted Neurology for positional vertigo. He also reported acroparesthesia, anhidrosis, heat intolerance and episodes of abdominal pain, with postprandial discomfort from 10 years of age. Physical examination showed horizonto-rotatory nystagmus in both looks, the rest of the neurological evaluation did not present abnormalities. The presence of umbilical and thighs angiokeratomas was identified. Determination of Alpha-Galactosidase in blood was requested: 0.34 μmol/l/h (2.10–10.51 μmol/l/h). Genetic analysis detected a deletion of a guanine at position 448, in exon 3 of the GLA gene (c.448delG). This mutation was considered to be pathogenic, confirming the diagnosis of FD, although it is not described in the data bases. Genetic counseling and a family pedifree study were performed without finding relatives with this variant of the GLA gene or a family history of FD, which suggests a de novo mutation.

View all citing articles on Scopus

: GE Medical Systems, Israel, provided our laboratory (on loan) with a portable Vivid I unit.

View full text

Review articleNon-Doppler Two-dimensional Strain Imaging by Echocardiography–From Technical Considerations to Clinical Applications

Section snippets

General Principles

Technique Substantiation

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

Review article
Non-Doppler Two-dimensional Strain Imaging by Echocardiography–From Technical Considerations to Clinical Applications