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Two-dimensional strain analysis of the global and regional myocardial function for the differentiation of pathologic and physiologic left ventricular hypertrophy: a study in athletes and in patients with hypertrophic cardiomyopathy

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Abstract

Two-dimensional strain (2DS) is a novel method to measure strain from standard two-dimensional echocardiographic images by speckle tracking, which is less angle dependent and more reproducible than conventional Doppler-derived strain. The objective of our study was to characterize global and regional function abnormalities using 2DS and strain rate analysis in patients (pts) with pathological left ventricular hypertrophy (LVH) caused by non-obstructive hypertrophic cardiomyopathy (HCM), in top level athletes, and in healthy controls. The hypothetical question was, if 2DS might be useful as additional tool in differentiating between pathologic and physiologic hypertrophy in top-level athletes. We consecutively studied 53 subjects, 15 pts with hypertrophic cardiomyopathy (HCM), 20 competitive top-level athletes, and a control group of 18 sedentary normal subjects by standard echocardiography according to ASE guidelines. Global longitudinal strain (GLS) and regional peak systolic strain (PSS) was assessed by 2DS in the apical four-chamber-view using a dedicated software. All components of strain were significantly reduced in pts with HCM (GLS: −8.1 ± 3.8%; P < 0.001) when compared with athletes (−15.2 ± 3.6%) and control subjects (−16.0 ± 2.8%). In general, there was no significant difference between the strain values of the athletes and the control group, but in some of the segments, the strain values of the control group were significantly higher than those in the athletes. A cut-off value of GLS less than −10% for the diagnosis of pathologic hypertrophy (HCM) resulted in a sensitivity of 80.0% and a specificity of 95.0%. The combination of TDI (averaged S′, E′) and 2DS (GLS) cut-off values for the detection of pathologic LVH in HCM demonstrated a sensitivity of 100%, and a specificity of 95%. Two-dimensional strain is a new simple and rapid method to measure GLS and PSS as components of systolic strain. This technique could offer a unique approach to quantify global as well as regional systolic dysfunction, and might be used as new additional tool for the differentiation between physiologic and pathologic LVH.

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Abbreviations

2DS:

Two-dimensional strain

A:

Late component of the transmitral inflow pattern

A′:

Late diastolic velocity of the mitral annulus (TDI)

DT:

Deceleration time of E

E:

Early component of the transmitral inflow pattern

E′:

Early diastolic velocity of the mitral annulus (TDI)

E/E′ ratio:

Ratio of the early component of the transmitral inflow pattern and the early diastolic velocity of the mitral annulus

E′/E ratio:

Ratio of the early diastolic velocity of the mitral annulus and the early component of the transmitral inflow pattern

GFI:

Global function index; GFI = (E/E′)/S′ [s × cm−1]

GLS:

Global longitudinal strain

HCM:

Hypertrophic cardiomyopathy

IVSED:

End diastolic thickness of the interventricular septum

LV:

Left ventricular

LVEDD:

Left ventricular enddiastolic diameter

LVH:

Left ventricular hypertrophy

MA:

Mitral annulus

PSS:

Regional peak systolic strain

PWED:

End diastolic thickness of the posterior wall

S′:

Systolic velocity of the mitral annulus (TDI)

TDI:

Tissue Doppler imaging

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Authors and Affiliations

  1. Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany

    T. Butz, F. van Buuren, K. P. Mellwig, C. Langer, D. Horstkotte & L. Faber

  2. Department of Cardiology and Angiology, Marienhospital Herne, Ruhr-University Bochum, Hoelkeskampring 40, 44625, Herne, Germany

    T. Butz, G. Plehn, A. Meissner & H. J. Trappe

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  1. T. Butz
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  2. F. van Buuren
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  3. K. P. Mellwig
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  9. L. Faber
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Correspondence to T. Butz.

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Butz, T., van Buuren, F., Mellwig, K.P. et al. Two-dimensional strain analysis of the global and regional myocardial function for the differentiation of pathologic and physiologic left ventricular hypertrophy: a study in athletes and in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 27, 91–100 (2011). https://doi.org/10.1007/s10554-010-9665-5

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