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DiNardo JA. Commentary: Understanding principal strain need not be stressful. J Thorac Cardiovasc Surg 2023; 165:1430-1431. [PMID: 33726900 DOI: 10.1016/j.jtcvs.2021.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- James A DiNardo
- Division of Cardiac Anesthesia, Harvard Medical School, and Department of Anesthesiology, Boston Children's Hospital, Boston, Mass.
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Nabeshima Y, Seo Y, Takeuchi M. A review of current trends in three-dimensional analysis of left ventricular myocardial strain. Cardiovasc Ultrasound 2020; 18:23. [PMID: 32591001 PMCID: PMC7320541 DOI: 10.1186/s12947-020-00204-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional (3D) left ventricular (LV) myocardial strain measurements using transthoracic 3D echocardiography speckle tracking analysis have several advantages over two-dimensional (2D) LV strain measurements, because 3D strain values are derived from the entire LV myocardium, yielding more accurate estimates of global and regional LV function. In this review article, we summarize the current status of 3D LV myocardial strain. Specifically, we describe how 3D LV strain analysis is performed. Next, we compare characteristics of 2D and 3D strain, and we explain validation of 3D strain measurements, feasibility and measurement differences between 2D and 3D strain, reference values of 3D strain, and its applications in several clinical scenarios. In some parts of this review, we used a meta-analysis to draw reliable conclusions. We also describe the added value of 3D over 2D strain in several specific pathologies and prognoses. Finally, we discuss novel techniques using 3D strain and suggest its future directions.
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Affiliation(s)
- Yosuke Nabeshima
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan.
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, School of Medicine, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
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Guler HS, Tulunay Kaya C, Kumru G, Kosku H, Ozyuncu N, Sengul S, Kutlay S. Acute stunning effect of hemodialysis on myocardial performance: A three-dimensional speckle tracking echocardiographic study. Artif Organs 2020; 44:1081-1089. [PMID: 32279336 DOI: 10.1111/aor.13698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/28/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
The effects of acute changes during hemodialysis (HD) on the myocardium are not yet known. The invention of three-dimensional speckle tracking echocardiography (3DSTE) has offered clinicians a new method to assess the movements of ventricular segments simultaneously in three spatial directions. The aim of this study was to evaluate the effect of first weekly standard HD process on the left ventricle (LV) and right ventricle (RV) global and regional myocardial function in patients with normal left ventricle ejection fraction using 3DSTE-derived indices. Patients (n=38) receiving maintenance HD in our clinic who have no known cardiovascular disease are examined just before and after a HD session using 3DSTE. Demographic and comorbidity data, renal replacement treatment characteristics, and laboratory test results are recorded. 3DSTE analysis is performed to calculate the LV global longitudinal, circumferential area and radial peak systolic strain, as well as RV septum and free-wall longitudinal strain and fractional area change. Patients are aged 52.8 ± 13.6 years and 52.6% of them are male. Mean dialysis duration is 56 months. The LV strain values of the patients changed markedly before and after HD (GLS: -14.2 ± 5.2, -11.1 ± 4.6 [P < .001], GCS: -14.8 ± 4.2, -12.4 ± 5.28 [P < .009]; GRS: 41.5 ± 16, 33.3 ± 16.5 [P = .003]; AREA -24.7 ± 7.2, -20.1 ± 7.6 [P = .001], respectively). We could not demonstrate any improvement in RV strain values before or after HD. LV strain values are positively correlated with blood pressure variability during the dialysis sessions. LV function is preserved better after HD in patients on beta or calcium channel blocker therapy compared to those who do not use these agents (P < .001, P < .01, respectively). HD treatment results in deterioration in all LV strain directions but not in RV. Strain assessment may improve vascular risk stratification of patients on chronic HD.
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Affiliation(s)
- Hasan Selim Guler
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Cansin Tulunay Kaya
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Gizem Kumru
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Kosku
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Nil Ozyuncu
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Sim Kutlay
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
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Sato T, Calderon RJC, Klas B, Pedrizzetti G, Banerjee A. Simultaneous Volumetric and Functional Assessment of the Right Ventricle in Hypoplastic Left Heart Syndrome After Fontan Palliation, Utilizing 3-Dimensional Speckle-Tracking Echocardiography. Circ J 2020; 84:235-244. [DOI: 10.1253/circj.cj-19-0926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomoyuki Sato
- Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia
| | - Renzo JC Calderon
- Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia
| | | | | | - Anirban Banerjee
- Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia
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Lee S, Choi S, Kim S, Jeong Y, Lee K, Hur S, Lee SR, Lee E, Sin M, Kim N, Song J. Validation of three‐dimensional echocardiographic principal strain analysis for assessing left ventricular contractility: An animal study. Med Phys 2019; 46:2137-2144. [DOI: 10.1002/mp.13509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sahmin Lee
- Division of Cardiology Department of Internal Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Seunghyun Choi
- Department of Convergence Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Sehwan Kim
- Department of Convergence Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Yeongjin Jeong
- Division of Cardiology Department of Internal Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Kyusup Lee
- Division of Cardiology Department of Internal Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Seung‐Ho Hur
- Convergence Medicine Research Center Asan Institute for Life Sciences Seoul Korea
| | - Sun Ro Lee
- Division of Cardiology Department of Internal Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Eun‐Jeong Lee
- Division of Cardiology Department of Internal Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Min‐Jung Sin
- Division of Cardiology Department of Internal Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Namkug Kim
- Department of Convergence Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jong‐Min Song
- Division of Cardiology Department of Internal Medicine Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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Ahn HS, Kim YK, Song HC, Choi EJ, Kim GH, Cho JS, Ihm SH, Kim HY, Park CS, Youn HJ. The impact of preload on 3-dimensional deformation parameters: principal strain, twist and torsion. Cardiovasc Ultrasound 2017; 15:22. [PMID: 28899401 PMCID: PMC5596939 DOI: 10.1186/s12947-017-0111-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022] Open
Abstract
Background Strain analysis is feasible using three-dimensional (3D) echocardiography. This approach provides various parameters based on speckle tracking analysis from one full-volume image of the left ventricle; however, evidence for its volume independence is still lacking. Methods Fifty-eight subjects who were examined by transthoracic echocardiography immediately before and after hemodialysis (HD) were enrolled. Real-time full-volume 3D echocardiographic images were acquired and analyzed using dedicated software. Two-dimensional (2D) longitudinal strain (LS) was also measured for comparison with 3D strain values. Results Longitudinal (pre-HD: −24.57 ± 2.51, post-HD: −21.42 ± 2.15, P < 0.001); circumferential (pre-HD: −33.35 ± 3.50, post-HD: −30.90 ± 3.22, P < 0.001); and radial strain (pre-HD: 46.47 ± 4.27, post-HD: 42.90 ± 3.61, P < 0.001) values were significantly decreased after HD. The values of 3D principal strain (PS), a unique parameter of 3D images, were affected by acute preload changes (pre-HD: −38.10 ± 3.71, post-HD: −35.33 ± 3.22, P < 0.001). Twist and torsion values were decreased after HD (pre-HD: 17.69 ± 7.80, post-HD: 13.34 ± 6.92, P < 0.001; and pre-HD: 2.04 ± 0.86, post-HD:1.59 ± 0.80, respectively, P < 0.001). The 2D LS values correlated with the 3D LS and PS values. Conclusion Various parameters representing left ventricular mechanics were easily acquired from 3D echocardiographic images; however, like conventional parameters, they were affected by acute preload changes. Therefore, strain values from 3D echocardiography should be interpreted with caution while considering the preload conditions of the patients.
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Affiliation(s)
- Hyo-Suk Ahn
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong-Kyun Kim
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Ho Chul Song
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Euy Jin Choi
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Gee-Hee Kim
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jung Sun Cho
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sang-Hyun Ihm
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hee-Yeol Kim
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chan Seok Park
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Ho-Joong Youn
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
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Rajan NK, Song Z, Hoffmann KR, Belohlavek M, McMahon EM, Borazjani I. Automated Three-Dimensional Reconstruction of the Left Ventricle From Multiple-Axis Echocardiography. J Biomech Eng 2016; 138:2469751. [PMID: 26548948 DOI: 10.1115/1.4031977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Indexed: 01/08/2023]
Abstract
Two-dimensional echocardiography (echo) is the method of choice for noninvasive evaluation of the left ventricle (LV) function owing to its low cost, fast acquisition time, and high temporal resolution. However, it only provides the LV boundaries in discrete 2D planes, and the 3D LV geometry needs to be reconstructed from those planes to quantify LV wall motion, acceleration, and strain, or to carry out flow simulations. An automated method is developed for the reconstruction of the 3D LV endocardial surface using echo from a few standard cross sections, in contrast with the previous work that has used a series of 2D scans in a linear or rotational manner for 3D reconstruction. The concept is based on a generalized approach so that the number or type (long-axis (LA) or short-axis (SA)) of sectional data is not constrained. The location of the cross sections is optimized to minimize the difference between the reconstructed and measured cross sections, and the reconstructed LV surface is meshed in a standard format. Temporal smoothing is implemented to smooth the motion of the LV and the flow rate. This software tool can be used with existing clinical 2D echo systems to reconstruct the 3D LV geometry and motion to quantify the regional akinesis/dyskinesis, 3D strain, acceleration, and velocities, or to be used in ventricular flow simulations.
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Echocardiographic Deformation Imaging for the Assessment of Left Ventricular Function: Clinical Implications and Perspectives— Update 2014. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Stefani L, De Luca A, Toncelli L, Pedrizzetti G, Galanti G. 3D Strain helps relating LV function to LV and structure in athletes. Cardiovasc Ultrasound 2014; 12:33. [PMID: 25113389 PMCID: PMC4138416 DOI: 10.1186/1476-7120-12-33] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/04/2014] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The evaluation of cardiac contraction could benefit from a connection with the underlying helical structure of cardiac fibers in athletes either completely healthy or with minor common cardiopathies like Bicuspid Aortic Valve (BAV). This study aims to exploit the potential role of 3D strain to improve the physiological understanding of LV function and modification due to physical activity as a comparative model. METHODS Three age-matched groups of young (age 20.3 ± 5.4) individuals are prospectively enrolled: 15 normal healthy subjects, 15 healthy athletes, and 20 athletes with bicuspid aortic valve (BAV). All subjects underwent echocardiographic examination and both 2D and 3D strain analysis. RESULTS All echo parameters were within the normal range in the three groups. Global values of end-systolic longitudinal and circumferential strain, assesses by either 2D or 3D analysis, were not significantly different. The 3D strain analysis was extended in terms of principal and secondary strain (PS, SS). Global PS was very similar, global SS was significantly higher in athletes and displays a modified time course. The comparative analysis of strain-lines pattern suggests that the enhancement of LV function is achieved by a more synchronous recruitment of both left- and right-handed helical fibers. CONCLUSIONS 3D strain analysis allows a deeper physiological understanding of LV contraction in different types of athletes. Secondary strain, only available in 3D, identifies increase of performances due to physical activity; this appears to follow from the synergic activation of endocardial and epicardial fibers.
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Affiliation(s)
- Laura Stefani
- Sport Medicine Center, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio De Luca
- Sport Medicine Center, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Loira Toncelli
- Sport Medicine Center, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Giorgio Galanti
- Sport Medicine Center, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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