Clinical Investigation
Systolic Left Ventricular Mechanics and Function
Age-Related Normal Range of Left Ventricular Strain and Torsion Using Three-Dimensional Speckle-Tracking Echocardiography

https://doi.org/10.1016/j.echo.2013.10.002Get rights and content

Background

Three-dimensional (3D) speckle-tracking echocardiography (STE) is an emerging technology used to quantify left ventricular (LV) function. However, the accuracy and normal values of LV strain and twist using 3D STE have not been established in a large group of normal subjects. The aims of this study were to (1) to evaluate the accuracy of 3D STE analysis of LV strain against a cardiac magnetic resonance (CMR) reference and (2) to establish age-related normal values of LV strain and torsion using real-time 3D echocardiographic (RT3DE) images.

Methods

In protocol 1, RT3DE data sets and CMR images were acquired on the same day in 19 patients referred for clinically indicated CMR. Global LV longitudinal, circumferential, and radial strain was compared between the two modalities. In protocol 2, global and regional strain and twist and torsion were measured in 313 healthy subjects using 3D STE.

Results

In protocol 1, good correlations for each LV strain component were noted between RT3DE imaging and CMR (r = 0.61–0.86, P < .001). In protocol 2, normal global longitudinal, circumferential, radial, and 3D strain were −20.3 ± 3.2%, −28.9 ± 4.6%, 88.0 ± 21.8%, and −37.6 ± 4.8%, respectively. A significant age dependency was observed for global longitudinal and 3D strain. Aging also affected LV torsion: the lowest values were found in children and adolescents, and values subsequently increased with age, while further aging was associated with a gradual reduction in basal rotation accompanied by an increase in apical rotation.

Conclusions

This study provides initial validation of 3D strain analysis from RT3DE images and reference values of normal 3D LV strain and torsion. The age-related differences in LV strain and torsion may reflect myocardial maturation and aging.

Section snippets

Study Subjects

In protocol 1, we studied 19 patients who underwent clinically indicated CMR examinations and agreed to undergo RT3DE studies on the same day. In protocol 2, 335 normal subjects (mean age, 36 ± 22 years; range, 1–88 years; 170 male subjects) were enrolled to obtain RT3DE data sets. Eligibility criteria included (1) normal blood pressure with no history of hypertension and (2) absence of diabetes and/or cardiovascular disease. Subjects who were primarily hospital employees, their relatives,

Results

Acquisition of RT3DE data sets was feasible in all subjects in both protocols. The time required for analysis, including endocardial initialization, correction of boundaries, and computation of LV strain, was <5 min.

Discussion

The major findings of this study were as follows: (1) longitudinal and circumferential strain measured by RT3DE imaging correlated well with strain values derived from CMR images using the feature-tracking algorithm,16 and the correlation for radial strain was only modest; (2) significant age dependency of longitudinal, radial, and 3D strain values was observed at the basal, middle, and apical levels of the left ventricle; (3) LV rotation, twist, and torsion demonstrated significant age

Conclusions

Our results provide initial validation of 3D strain analysis from RT3DE images, as well as normal reference values for the different components of LV strain and torsion. Age-related differences in strains and torsion may reflect the maturational and aging process of the myocardium.

References (36)

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Dr Michael H. Picard served as guest editor for this report.

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