Initial application of three-dimensional speckle-tracking echocardiography to detect subclinical left ventricular dysfunction and stratify cardiomyopathy associated with Duchenne muscular dystrophy in children

  • Hong-kui Yu
  • Bei XiaEmail author
  • Xiao Liu
  • Chunxi Han
  • Weiling Chen
  • Zhihui Li
Original Paper


Three-dimensional (3D) speckle-tracking echocardiography (STE) is a new imaging modality used for quantitative analysis of left ventricular (LV) function. The aim of this study is to assess the value of 3D STE in early detection of subclinical myocardial involvement in children with Duchenne muscular dystrophy (DMD). Fifty-six children with DMD (mean age, 8.8 ± 1.9 years) and 31 age-matched control subjects were studied. Patients were subdivided into two groups by age: ≤ 8 or > 8 years. Standard echocardiography examinations were performed to measure LV size and ejection fraction (EF). 3D STE was performed to assess LV 3D global strain and LV end-diastolic volume (EDV), end-systolic volume (ESV), and EF. Standard and 3D echocardiography measures were compared between children with DMD and those in the control group as well as between different patient groups. The areas under the receiver-operating characteristic (ROC) curve were calculated to determine the capability of 3D global strain indices to discriminate between patients and control subjects. No significant difference was detected in either LVEF derived from M-mode or 3D echocardiography between the two groups, and they were both within the normal range. Compared with control subjects, children with DMD had significantly reduced LV 3D global longitudinal strain (GLS; − 16.6 ± 4.7 vs. − 19.5 ± 3.7, p = 0.003), global circumferential strain (GCS; − 13.7 ± 2.9 vs. − 15.8 ± 2.6, p = 0.001), global radial strain (GRS; 42.5 ± 9.7 vs. 50.3 ± 10.4, p = 0.001), and global area strain (GAS; − 25.3 ± 4.9 vs. − 30.7 ± 4.1, p = 0.000). The older DMD children (age > 8 years) had lower GLS (− 15.1 ± 4.43 vs. − 18.6 ± 4.35, p < 0.05), GCS (− 12.8 ± 3.48 vs. − 14.8 ± 2.83, p < 0.001), GAS (− 23.8 ± 4.7 vs. − 29.0 ± 5.4, p < 0.001), and GRS (40.7 ± 8.8 vs. 47.3 ± 11.5, p < 0.05) than younger patients (age ≤ 8 years). The AUC of GAS was 0.80, and the cutoff value of − 29.5 had a sensitivity of 85.7% and a specificity of 71.0% for differentiating DMD patients from control. 3D speckle-tracking echocardiography is useful for detecting subclinical myocardial dysfunction and stratifying cardiomyopathy in children with DMD.


Three-dimensional speckle-tracking echocardiography Cardiomyopathy Duchenne muscular dystrophy Area strain Children 



This study was funded by Shenzhen Municipal Science and Technology Innovation Committee Foundation (No. JCYJ20140416141331487).

Compliance with ethical standards

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of UltrasonographyShenzhen Children’s HospitalShenzhenChina
  2. 2.Laboratory of Neuromuscular DiseaseShenzhen Children’s HospitalShenzhenChina

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