Three-dimensional principal strain analysis for characterizing subclinical changes in left ventricular function

Gianni Pedrizzetti; Shantanu Sengupta; Giuseppe Caracciolo; Chan Seok Park; Makoto Amaki; Georg Goliasch; Jagat Narula; Partho P. Sengupta

doi:10.1016/j.echo.2014.05.014

Three-dimensional principal strain analysis for characterizing subclinical changes in left ventricular function

Gianni Pedrizzetti, Shantanu Sengupta, Giuseppe Caracciolo, Chan Seok Park, Makoto Amaki, Georg Goliasch, Jagat Narula, Partho P. Sengupta

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Abstract

Background Subendocardial strain analysis is currently feasible in two-dimensional and three-dimensional (3D) echocardiography; however, there is a lack of clarity regarding the most useful strain component for subclinical disease detection. The aim of this study was to test the hypothesis that strain analysis along the direction of strongest and weakest systolic compression (referred to as principal and secondary strain, respectively) circumvents the need for multidirectional strains and provides a more simplified assessment of left ventricular subendocardial function.

Methods Strain analyses were performed by using two-dimensional and 3D echocardiography in 41 consecutive subjects with normal results on electron-beam computed tomography, including 15 controls and 26 patients with systemic hypertension. The direction of principal strain referenced the myofiber geometry obtained from diffusion tensor magnetic resonance imaging of a normal autopsied human heart. The incremental value of principal strain over multidirectional two-dimensional and 3D strain was analyzed.

Conclusions Two-component principal and secondary strain analysis can be related to left ventricular myofiber geometry and may simplify the assessment of 3D left ventricular deformation by circumventing the need to assess multiple shortening and shear strain components.

Results In healthy subjects, 50 ± 3% of the subendocardial shortening occurred in the cross-fiber direction (left-handed helical); this balance was significantly altered in patients with hypertension (P =.01). The magnitude of longitudinal and circumferential strain was similar in patients with hypertension and controls. However, the alteration of the directional contraction pattern resulted in reduced secondary strain magnitude in patients with hypertension (P =.01), and the differences were further exaggerated when the secondary strain was normalized by the principal strain magnitude (P =.004).

Original language	English
Pages (from-to)	1041-1050.e1
Journal	Journal of the American Society of Echocardiography
Volume	27
Issue number	10
DOIs	https://doi.org/10.1016/j.echo.2014.05.014
State	Published - 1 Oct 2014

Keywords

Left ventricle
Mechanics
Strain
Subclinical disease

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10.1016/j.echo.2014.05.014

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title = "Three-dimensional principal strain analysis for characterizing subclinical changes in left ventricular function",

abstract = "Background Subendocardial strain analysis is currently feasible in two-dimensional and three-dimensional (3D) echocardiography; however, there is a lack of clarity regarding the most useful strain component for subclinical disease detection. The aim of this study was to test the hypothesis that strain analysis along the direction of strongest and weakest systolic compression (referred to as principal and secondary strain, respectively) circumvents the need for multidirectional strains and provides a more simplified assessment of left ventricular subendocardial function.Methods Strain analyses were performed by using two-dimensional and 3D echocardiography in 41 consecutive subjects with normal results on electron-beam computed tomography, including 15 controls and 26 patients with systemic hypertension. The direction of principal strain referenced the myofiber geometry obtained from diffusion tensor magnetic resonance imaging of a normal autopsied human heart. The incremental value of principal strain over multidirectional two-dimensional and 3D strain was analyzed.Conclusions Two-component principal and secondary strain analysis can be related to left ventricular myofiber geometry and may simplify the assessment of 3D left ventricular deformation by circumventing the need to assess multiple shortening and shear strain components.Results In healthy subjects, 50 ± 3% of the subendocardial shortening occurred in the cross-fiber direction (left-handed helical); this balance was significantly altered in patients with hypertension (P =.01). The magnitude of longitudinal and circumferential strain was similar in patients with hypertension and controls. However, the alteration of the directional contraction pattern resulted in reduced secondary strain magnitude in patients with hypertension (P =.01), and the differences were further exaggerated when the secondary strain was normalized by the principal strain magnitude (P =.004).",

keywords = "Left ventricle, Mechanics, Strain, Subclinical disease",

author = "Gianni Pedrizzetti and Shantanu Sengupta and Giuseppe Caracciolo and Park, {Chan Seok} and Makoto Amaki and Georg Goliasch and Jagat Narula and Sengupta, {Partho P.}",

note = "Publisher Copyright: {\textcopyright} 2014 by the American Society of Echocardiography.",

year = "2014",

month = oct,

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doi = "10.1016/j.echo.2014.05.014",

language = "English",

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T1 - Three-dimensional principal strain analysis for characterizing subclinical changes in left ventricular function

AU - Pedrizzetti, Gianni

AU - Sengupta, Shantanu

AU - Caracciolo, Giuseppe

AU - Park, Chan Seok

AU - Amaki, Makoto

AU - Goliasch, Georg

AU - Narula, Jagat

AU - Sengupta, Partho P.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Background Subendocardial strain analysis is currently feasible in two-dimensional and three-dimensional (3D) echocardiography; however, there is a lack of clarity regarding the most useful strain component for subclinical disease detection. The aim of this study was to test the hypothesis that strain analysis along the direction of strongest and weakest systolic compression (referred to as principal and secondary strain, respectively) circumvents the need for multidirectional strains and provides a more simplified assessment of left ventricular subendocardial function.Methods Strain analyses were performed by using two-dimensional and 3D echocardiography in 41 consecutive subjects with normal results on electron-beam computed tomography, including 15 controls and 26 patients with systemic hypertension. The direction of principal strain referenced the myofiber geometry obtained from diffusion tensor magnetic resonance imaging of a normal autopsied human heart. The incremental value of principal strain over multidirectional two-dimensional and 3D strain was analyzed.Conclusions Two-component principal and secondary strain analysis can be related to left ventricular myofiber geometry and may simplify the assessment of 3D left ventricular deformation by circumventing the need to assess multiple shortening and shear strain components.Results In healthy subjects, 50 ± 3% of the subendocardial shortening occurred in the cross-fiber direction (left-handed helical); this balance was significantly altered in patients with hypertension (P =.01). The magnitude of longitudinal and circumferential strain was similar in patients with hypertension and controls. However, the alteration of the directional contraction pattern resulted in reduced secondary strain magnitude in patients with hypertension (P =.01), and the differences were further exaggerated when the secondary strain was normalized by the principal strain magnitude (P =.004).

AB - Background Subendocardial strain analysis is currently feasible in two-dimensional and three-dimensional (3D) echocardiography; however, there is a lack of clarity regarding the most useful strain component for subclinical disease detection. The aim of this study was to test the hypothesis that strain analysis along the direction of strongest and weakest systolic compression (referred to as principal and secondary strain, respectively) circumvents the need for multidirectional strains and provides a more simplified assessment of left ventricular subendocardial function.Methods Strain analyses were performed by using two-dimensional and 3D echocardiography in 41 consecutive subjects with normal results on electron-beam computed tomography, including 15 controls and 26 patients with systemic hypertension. The direction of principal strain referenced the myofiber geometry obtained from diffusion tensor magnetic resonance imaging of a normal autopsied human heart. The incremental value of principal strain over multidirectional two-dimensional and 3D strain was analyzed.Conclusions Two-component principal and secondary strain analysis can be related to left ventricular myofiber geometry and may simplify the assessment of 3D left ventricular deformation by circumventing the need to assess multiple shortening and shear strain components.Results In healthy subjects, 50 ± 3% of the subendocardial shortening occurred in the cross-fiber direction (left-handed helical); this balance was significantly altered in patients with hypertension (P =.01). The magnitude of longitudinal and circumferential strain was similar in patients with hypertension and controls. However, the alteration of the directional contraction pattern resulted in reduced secondary strain magnitude in patients with hypertension (P =.01), and the differences were further exaggerated when the secondary strain was normalized by the principal strain magnitude (P =.004).

KW - Left ventricle

KW - Mechanics

KW - Strain

KW - Subclinical disease

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JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

IS - 10

ER -

Three-dimensional principal strain analysis for characterizing subclinical changes in left ventricular function

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Keywords

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