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Journal of Echocardiography

, Volume 17, Issue 1, pp 17–24 | Cite as

Utility of strain imaging in conjunction with heart failure stage classification for heart failure patient management

  • Hidekazu TanakaEmail author
Review Article

Abstract

The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) classification, based on structural changes and symptoms, classifies stages of heart failure (HF) development as Stages A–D. This HF classification emphasizes the development and progression of the disease and can be used to describe individuals and populations. Since HF is considered a progressive disorder that can be represented as a clinical continuum, individuals at a particular HF stage require specific management with the long-term goal of avoiding HF development and progression. Although early detection of subclinical left ventricular (LV) dysfunction is essential for delaying progression to HF, the assessment of such dysfunction can be challenging. While echocardiography plays a pivotal role in the quantification and early detection of LV structural findings, two-dimensional speckle-tracking echocardiographic parameters, especially global longitudinal strain (GLS), have recently been reported to be sensitive markers of early subtle abnormalities of LV myocardial performance. They are thus helpful for prediction of outcomes for various cardiac diseases, and superior to conventional echocardiographic indices such as LV ejection fraction, mitral inflow E and mitral e′ annular velocities ratio. Strain imaging, especially GLS-guided management for patients at a particular stage of HF, may therefore have the potential to prevent progression to later HF stages and may offer new insights into the management of HF patients. This article reviews the utility of strain imaging, especially GLS in conjunction with HF stage classification, and future perspectives for HF patient management.

Keywords

Heart failure stage classification Speckle-tracking strain Global longitudinal strain Echocardiography 

Notes

Compliance with ethical standards

Conflict of interest

Hidekazu Tanaka declares that he has no conflict of interest.

References

  1. 1.
    Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:1810–52.CrossRefGoogle Scholar
  2. 2.
    Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–61.CrossRefGoogle Scholar
  3. 3.
    Writing Committee, Yancy CW, Jessup M, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2016;134:e282–93.Google Scholar
  4. 4.
    Ammar KA, Jacobsen SJ, Mahoney DW, et al. Prevalence and prognostic significance of heart failure stages: application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community. Circulation. 2007;115:1563–70.CrossRefGoogle Scholar
  5. 5.
    Biering-Sorensen T, Biering-Sorensen SR, Olsen FJ, et al. Global longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population: the Copenhagen City Heart Study. Circ Cardiovasc Imaging. 2017;10:e005521.Google Scholar
  6. 6.
    Gorcsan J 3rd, Tanaka H 3rd. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol. 2011;58:1401–13.CrossRefGoogle Scholar
  7. 7.
    Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging. 2009;2:356–64.CrossRefGoogle Scholar
  8. 8.
    Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100:1673–80.CrossRefGoogle Scholar
  9. 9.
    Mignot A, Donal E, Zaroui A, et al. Global longitudinal strain as a major predictor of cardiac events in patients with depressed left ventricular function: a multicenter study. J Am Soc Echocardiogr. 2010;23:1019–24.CrossRefGoogle Scholar
  10. 10.
    Russo C, Jin Z, Elkind MS, et al. Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort. Eur J Heart Fail. 2014;16:1301–9.CrossRefGoogle Scholar
  11. 11.
    Cheng S, McCabe EL, Larson MG, et al. Distinct aspects of left ventricular mechanical function are differentially associated with cardiovascular outcomes and all-cause mortality in the community. J Am Heart Assoc. 2015;4:e002071.CrossRefGoogle Scholar
  12. 12.
    Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr. 2015;28(1–39):e14.Google Scholar
  13. 13.
    Levy D, Larson MG, Vasan RS, et al. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557–62.CrossRefGoogle Scholar
  14. 14.
    National Cholesterol Education Program Expert Panel on Detection E. Treatment of High Blood Cholesterol in A Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–421.CrossRefGoogle Scholar
  15. 15.
    Soufi Taleb Bendiab N, Meziane-Tani A, Ouabdesselam S, et al. Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction. Eur J Prev Cardiol. 2017;24:1463–72.CrossRefGoogle Scholar
  16. 16.
    Imbalzano E, Zito C, Carerj S, et al. Left ventricular function in hypertension: new insight by speckle tracking echocardiography. Echocardiography. 2011;28:649–57.CrossRefGoogle Scholar
  17. 17.
    Chen XJ, Sun XL, Zhang Q, et al. Uncontrolled blood pressure as an independent risk factor of early impaired left ventricular systolic function in treated hypertension. Echocardiography. 2016;33:1488–94.CrossRefGoogle Scholar
  18. 18.
    Vaur L, Gueret P, Lievre M, et al. Development of congestive heart failure in type 2 diabetic patients with microalbuminuria or proteinuria: observations from the DIABHYCAR (type 2 DIABetes, Hypertension, CArdiovascular Events and Ramipril) study. Diabetes Care. 2003;26:855–60.CrossRefGoogle Scholar
  19. 19.
    Iribarren C, Karter AJ, Go AS, et al. Glycemic control and heart failure among adult patients with diabetes. Circulation. 2001;103:2668–73.CrossRefGoogle Scholar
  20. 20.
    Nakai H, Takeuchi M, Nishikage T, et al. Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur J Echocardiogr. 2009;10:926–32.CrossRefGoogle Scholar
  21. 21.
    Ng AC, Delgado V, Bertini M, et al. Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol. 2009;104:1398–401.CrossRefGoogle Scholar
  22. 22.
    Zoroufian A, Razmi T, Taghavi-Shavazi M, et al. Evaluation of subclinical left ventricular dysfunction in diabetic patients: longitudinal strain velocities and left ventricular dyssynchrony by two-dimensional speckle tracking echocardiography study. Echocardiography. 2014;31:456–63.CrossRefGoogle Scholar
  23. 23.
    Ernande L, Bergerot C, Girerd N, et al. Longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus. J Am Soc Echocardiogr. 2014;27:479–88.CrossRefGoogle Scholar
  24. 24.
    Ernande L, Bergerot C, Rietzschel ER, et al. Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy? J Am Soc Echocardiogr. 2011;24(1268–75):e1.Google Scholar
  25. 25.
    Mochizuki Y, Tanaka H, Matsumoto K, et al. Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus. Cardiovasc Diabetol. 2015;14:37.CrossRefGoogle Scholar
  26. 26.
    Mochizuki Y, Tanaka H, Matsumoto K, et al. Association of peripheral nerve conduction in diabetic neuropathy with subclinical left ventricular systolic dysfunction. Cardiovasc Diabetol. 2015;14:47.CrossRefGoogle Scholar
  27. 27.
    Mochizuki Y, Tanaka H, Tatsumi K, et al. Easy-to-use comprehensive speckle-tracking approach for cardiac resynchronization therapy. Circ J. 2014;78:2250–8.CrossRefGoogle Scholar
  28. 28.
    Mochizuki Y, Tanaka H, Matsumoto K, et al. Impaired mechanics of left ventriculo-atrial coupling in patients with diabetic nephropathy. Circ J. 2016;80:1957–64.CrossRefGoogle Scholar
  29. 29.
    Holland DJ, Marwick TH, Haluska BA, et al. Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus. Heart. 2015;101:1061–6.CrossRefGoogle Scholar
  30. 30.
    Cognet T, Vervueren PL, Dercle L, et al. New concept of myocardial longitudinal strain reserve assessed by a dipyridamole infusion using 2D-strain echocardiography: the impact of diabetes and age, and the prognostic value. Cardiovasc Diabetol. 2013;12:84.CrossRefGoogle Scholar
  31. 31.
    Mochizuki Y, Tanaka H, Matsumoto K, et al. Impact of left ventricular longitudinal functional mechanics on the progression of diastolic function in diabetes mellitus. Int J Cardiovasc Imaging. 2017;33:1905–14.CrossRefGoogle Scholar
  32. 32.
    Djousse L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302:394–400.CrossRefGoogle Scholar
  33. 33.
    Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.CrossRefGoogle Scholar
  34. 34.
    Ho JE, McCabe EL, Wang TJ, et al. Cardiometabolic traits and systolic mechanics in the community. Circ Heart Fail. 2017;10:e003536.CrossRefGoogle Scholar
  35. 35.
    Suto M, Tanaka H, Mochizuki Y, et al. Impact of overweight on left ventricular function in type 2 diabetes mellitus. Cardiovasc Diabetol. 2017;16:145.CrossRefGoogle Scholar
  36. 36.
    Leung M, Xie M, Durmush E, et al. Weight loss with sleeve gastrectomy in obese type 2 diabetes mellitus: impact on cardiac function. Obes Surg. 2016;26:321–6.CrossRefGoogle Scholar
  37. 37.
    Hooning MJ, Botma A, Aleman BM, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst. 2007;99:365–75.CrossRefGoogle Scholar
  38. 38.
    Doyle JJ, Neugut AI, Jacobson JS, et al. Chemotherapy and cardiotoxicity in older breast cancer patients: a population-based study. J Clin Oncol. 2005;23:8597–605.CrossRefGoogle Scholar
  39. 39.
    Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342:1077–84.CrossRefGoogle Scholar
  40. 40.
    Negishi K, Negishi T, Haluska BA, et al. Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. Eur Heart J Cardiovasc Imaging. 2014;15:324–31.CrossRefGoogle Scholar
  41. 41.
    Negishi K, Negishi T, Hare JL, et al. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr. 2013;26:493–8.CrossRefGoogle Scholar
  42. 42.
    Thavendiranathan P, Poulin F, Lim KD, et al. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63:2751–68.CrossRefGoogle Scholar
  43. 43.
    Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27:911–39.CrossRefGoogle Scholar
  44. 44.
    Hatazawa K, Tanaka H, Nonaka A, et al. Baseline global longitudinal strain as a predictor of left ventricular dysfunction and hospitalization for heart failure of patients with malignant lymphoma after anthracycline therapy. Circ J. 2018;82:2566–74.CrossRefGoogle Scholar
  45. 45.
    Wang Y, Yang H, Huynh Q, et al. Diagnosis of nonischemic stage B heart failure in type 2 diabetes mellitus: optimal parameters for prediction of heart failure. JACC Cardiovasc Imaging. 2018;16:2601.Google Scholar
  46. 46.
    Magne J, Mahjoub H, Pierard LA, et al. Prognostic importance of brain natriuretic peptide and left ventricular longitudinal function in asymptomatic degenerative mitral regurgitation. Heart. 2012;98:584–91.CrossRefGoogle Scholar
  47. 47.
    Witkowski TG, Thomas JD, Debonnaire PJ, et al. Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair. Eur Heart J Cardiovasc Imaging. 2013;14:69–76.CrossRefGoogle Scholar
  48. 48.
    Yingchoncharoen T, Gibby C, Rodriguez LL, et al. Association of myocardial deformation with outcome in asymptomatic aortic stenosis with normal ejection fraction. Circ Cardiovasc Imaging. 2012;5:719–25.CrossRefGoogle Scholar
  49. 49.
    Sato K, Seo Y, Ishizu T, et al. Prognostic value of global longitudinal strain in paradoxical low-flow, low-gradient severe aortic stenosis with preserved ejection fraction. Circ J. 2014;78:2750–9.CrossRefGoogle Scholar
  50. 50.
    Smedsrud MK, Pettersen E, Gjesdal O, et al. Detection of left ventricular dysfunction by global longitudinal systolic strain in patients with chronic aortic regurgitation. J Am Soc Echocardiogr. 2011;24:1253–9.CrossRefGoogle Scholar
  51. 51.
    Alashi A, Mentias A, Abdallah A, et al. Incremental prognostic utility of left ventricular global longitudinal strain in asymptomatic patients with significant chronic aortic regurgitation and preserved left ventricular ejection fraction. JACC Cardiovasc Imaging. 2018;11:673–82.CrossRefGoogle Scholar
  52. 52.
    Kalogeropoulos AP, Samman-Tahhan A, Hedley JS, et al. Progression to stage D heart failure among outpatients with stage C heart failure and reduced ejection fraction. JACC Heart Fail. 2017;5:528–37.CrossRefGoogle Scholar
  53. 53.
    Cameli M, Mondillo S, Righini FM, et al. Left ventricular deformation and myocardial fibrosis in patients with advanced heart failure requiring transplantation. J Card Fail. 2016;22:901–7.CrossRefGoogle Scholar
  54. 54.
    Chimura M, Onishi T, Tsukishiro Y, et al. Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy. Heart. 2017;103:679–86.CrossRefGoogle Scholar
  55. 55.
    Reant P, Mirabel M, Lloyd G, et al. Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy. Heart. 2016;102:741–7.CrossRefGoogle Scholar
  56. 56.
    Haugaa KH, Goebel B, Dahlslett T, et al. Risk assessment of ventricular arrhythmias in patients with nonischemic dilated cardiomyopathy by strain echocardiography. J Am Soc Echocardiogr. 2012;25:667–73.CrossRefGoogle Scholar
  57. 57.
    Debonnaire P, Thijssen J, Leong DP, et al. Global longitudinal strain and left atrial volume index improve prediction of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy patients. Int J Cardiovasc Imaging. 2014;30:549–58.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Echocardiography 2018

Authors and Affiliations

  1. 1.Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan

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