Abstract:

Global longitudinal strain (GLS) is a sensitive measure of LV dysfunction and is better than EF at predicting CVD events and deaths. Recently 3D/4D/4D X strain speckle tracking echocardiography (STE) is used to analyse complex LV mechanics. Interestingly, HFpEF is related to both GLS and increased Aortic stiffness. TDI of ascending Aorta is an effective technique to assess Aortic stiffness. The aim of the present study is to establish normal values of TDI of AA by 2DE and 4D X-strain volumetric and strain parameters of LV of healthy adults. 102 subjects were enrolled, 72 assessed by 2DE-GROUP-A, and 30 were analysed by 4D X-strain echocardiography-GROUP-B. Important TDI parameters of Aortic stiffness were 3.90 ±3.79& 5.23 ± 10.55, (p = NS), in males & females respectively and Aortic strain were 10.55 ± 7.67% and 9.49 ± 5.56%, (p = NS), in males & females respectively. Volumetric data of EF were 64 ± 7.0 % & 65 ± 6.0 %, (p = NS), in males & females respectively and CO were 5.6 ± 1.5 l/min & 4.91±1.53l/min, (p = NS), in males & females respectively. Moreover, 4D X-strain STE indices of GLS being -17.29 ± 2.71 & -19.00 ± 3.51, (p = NS), in males & females, respectively GCS being -15.46 ± 7.1 & -14.12 ± 6.15, (p =NS), in males & females respectively and GRS being -24.53 ± 9.8 & -21.93 ± -8.81, (p= NS), in males & females respectively. No previous data is available, making the research a singular experience.

References:

[1] Quninones MA, Greenberg BH, Kopelen HA, Koilpillai C, Limacher MC, Shindler DM, et al. Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: Significance of left ventricular hypertrophy, Studies of left ventricular dysfunction. J Am CollCardiol2000; 35(5):1237-1244.

[2] Thune JJ. Kober L, Pfeffer MA, Skali H, Anavekar NS, Bourgoun M, et al. Comparison of regional versus global assessment of left ventricular function in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction; the valsartan in acute myocardial infarction echocardiographic study. J Am Soc Echocardiogr 2006; 19(12):1462-1465.

[3] Kocabay G, Muraru D, Peluso D, Cucchini U, Mihaila S, Padayattil-Jose Sanjay Pandey MD., et al. Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values I healthy adults. Rev Esp Cardiol (Engl Ed)2014; 67(8):651-658.

[4] Quinones MA, Douglas PS, Foster E, Gorcsan J 3rd, Lewis JF, Pearlman AS, et al.; American Society of Echocardiography; Society of Cardiovascular Anesthesiologists; Society of Pediatric Echocardiography. ACC/AHA clinical competence statement on echocardiography: A report of the American College of Cardiology/ American Heart Association/ American College of physicians-American Society of Internal Medicine Task Force on Clinical Competence. J Am Soc-Echocardiogr.2003; 16(4):379-402.

[5] Nakatani S. Left ventricular and twist: Why should we learn? J Cardiovasc Ultrasound 2011: 19(1): 1-6.

[6] Poveda F, Git D, Marti E, Andaluz A, Ballester M, Carreras F, Helical Structure of the cardiac ventricular anatomy assessed by diffusion tensor magnetic resonance imaging with multiresolution tractography. Rev Esp Cardiol (Engl Ed)2013; 66(10): 782-790.

[7] Muraru, D.; Niero, A.; Zanella, H.R.; Cherata, D.; Badano, L.P. Three-dimensional speckle-tracking echocardiography: Benefits and limitation of integrating myocardial mechanics with three-dimensional imaging. Cardiovasc. Diagn. Ther. 2018, 8, 101-117.

[8] Kang Y, Sun MM, Cui J, Chen HY, Su YG, Pan CZ, et al. Three-dimensional speckle tracking echocardiography for the assessment of left ventricular function and mechanical dyssynchrony. Acta Cardiol 2012; 67(4):423-430.

[9] Chen R, Wu X, Shen LJ, Wang B, Ma MM, Yang Y, et al. Left ventricular myocardial function in hemodialysis and nondialysisuremia patients: A three-dimensional speckle-tracking echocardiography study. PLoS One 2014; 9(6):e100265.

[10] Zhu M, Streiff C, Panosian J, Zhang Z, Song X, Sahn DJ, et al. Regional Strain determination and myocardial infarction detection by three-dimensional echocardiography with varied temporal resolution Echocardiography 2015; 32(2):339-348.

[11] Zhu M, Streiff C, Panosian J, Roundhill D, Lapin M, Tutschek B, et al. Evaluation of stroke volume and ventricular mass in a fetal heart model: A novel four-dimensional echocardiographic analysis. Echocardiography 2014; 31(9): 1138-1145.

[12] Jenkins C, Leano R, Chan J. Marwick TH. Reconstructed versus real-time 3-dimensional echocardiography: Comparison with magnetic resonance imaging. J Am Soc Echocardiogr 2007; 20(7): 862-868.

[13] Jenkins C, Leano R, Chan J, Marwick TH. Reconstructed versus real-time 3-dimensional echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography. J Am Coll Cardiol 2004; 44 (4):878-886.

[14] Pedrizzetti G, Mangual J and Tonti G. On the geometrical relationship between global longitudinal strain and ejection fraction in the evaluation of cardiac contraction. J Biomech. 2014 47:746-9.

[15] Stampehi MR, Mann DL, Nguyen JS, Cota F, Colmenares C, and Dokainish H. Speckle strain echocardiography predicts outcome in patients with heart failure with both depressed and preserved left ventricular ejection fraction. Echocardiography. 2015; 32:71-8.

[16] Perk G, Tunick PA and Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography from technical consideration to clinical application. J Am Soc Echocardiogr.2007; 20:234-43.

[17] Mizuguchi Y, Oishi Y, Miyoshi H, luchi A, Nagase N and Oki T. the functional role of longitudinal, circumferential, and radial myocardial deformation for early impairment of left ventricular contraction and relaxation in patients with cardiovascular risk factors: a study with two-dimensional strain imaging. J Am Soc Echocardiogr. 2008; 21:1138-44.

[18] Share BL, La Gerche A, Naughton GA, Obert P, and Kemp JG. Young Women with Abdominal Obesity Have Subclinical Myocardial Dysfunction. Can J cardiol 2015; 31:1195-201.

[19] Yingchoncharoen T, Agarwal S, Popovic ZB, and Marwick TH. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr. 2013; 26:185-91.

[20] Kleijn SA, Pandian NG, Thomas JD, Perez de Isla L, Kamp O, Zuber M, Nihoyannopoulos P, Forster T, Neser HJ, Geibel A, Gorissen W and Zamorano JL. Normal reference values of left strain using three-dimensional speckle tracking echocardiography: result from a multicenter study. Eur Heart J Cardiovasc Imaging:2015; 16:410-6.

[21] Bernard A, Addetia K, Dulgheru R, Caballero L, Sugimoto T, Akhaladze N, Athanasopoulos GD, Barone D, Baroni M, Cardim N, Hristova K, Ilardi F, Lopez T, de la Morena G, Popescu BA, Penicka M, Ozyigit T, David Rodrigo Carbonero J, van de Veire N, Stephan Von Bardeleben R, vinereanu D, Luis Zamorano J, Martinez C, Magne J, Cosyns B, Donal E, Habib G, Badano LP, Lang RM and Lancellotti P, 3D echocardiographic reference ranges for normal left ventricular and strain results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017; 18:475-483.

[22] Cheng S, Larson MG, McCabe EL, Osypiuk E, Lehman BT, Stanchev P, Aragam J, Benjamin EJ, Solomon SD and Vasan RS. Age- and sex- based reference limits and clinical correlates of myocardial strain and synchrony: the Framingham Heart study. Circ Cardiovasc Imaging 2013; 6:692-9.

[23] Menting ME, mcGhie JS, Koopman LP, Vletter WB, Helbing WA, van de Bosch AE and Roos-Hesselink JW. Normal myocardial strain values using 2D speckle tracking echocardiography in healthy adults aged 20 to 72 years. Echocardiography .2016;33:1665-1675.

[24] Dalen H, Thorstensen A, Aase SA, Ingul CB, Trop H, Vatten LJ, and Stoylen A. Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway. Eur J Echocardiogr .2010; 11:176-83.

[25] Moreira HT, Nwabuo CC, Armstrong AC, Kishi S, Gjesdal O, Reis JP. Schreiner PJ, Liu K, Lewis CE, Sidney S, Gidding SS, Lima JAC, and Ambale-Venkatesh B. Reference Ranges and Regional Patterns of Left Ventricular Strain and Strain Rate Using Two-Dimensional Speckle-Tracking Echocardiography in a Healthy Middle-Aged Black and White Population: The CARDIA study. J Am Soc Echocardiogr.2017;30:647-658 e2.

[26] Park JH, Lee JH, Lee SY, Choi JO, Shin MS, Kim MJ, Jung HO, Park JR, Sohn IS, Kim H, Park SM, Yoo NJ, Choi JH, Kim HK, Cho GY, Lee MR, Park JS, Shim CY, Kim DH, Shin DH, Shin GJ, Shin SH, Kim KH, Kim WS, and Park SW. Normal 2-Dimensional Strain Values of the Left Ventricular: A Substudy of the Normal Echocardiographic Measurements in Korean Population Study. J Cardiovasc Ultrasound.2016;24:285-293.

[27] Kaku K, Takeuchi M, Tsang W, Takigiku K, Yasukochi S, Patel AR, Mor-Avi V, Lang RM and Otsuji Y. Age-related normal range of left ventricular strain and torsion using three-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr.2014;27:55-64.

[28] Liu CY, Lai S, Kawel-Boehm N, Chahal H, Ambale-Venkatesh B, Lima JAC and Bluemke DA. Healthy aging of the left ventricle in relationship to cardiovascular risk factors: The Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One.2017; 12: e0179947.

[29] Bjornstad P, Truong U, Pyls L, Dorosz JL, Cree-Green M, Baumgartner A, Coe G, Regensteiner JG, Reusch JE and Nadeau KJ. Youth with type 1 diabetes have worse strain and less pronounced sex differences in early echocardiographic markers of diabetic. Cardiomyopathy compared to their normoglycemic peers: A RESistance to Insulin in Type 1 ANd Type 2 diabetes (RESISTANT) Study. J Diabetes Complications. 2016; 30:1103-10.

[30] Szelenyi Z, Fazakas A, Szenasi G, Tegze N, Fekete B, Molvarec A, Hadusfalvy-Sudar S, Janosi O, Kiss M, Karadi I and Vereckei A. The mechanism of reduced longitudinal left ventricular systolic function in hypertensive patients with normal ejection fraction. J Hypertens. 2015; 33:1962-9; discussion 1969.

[31] Huang J, Yan ZN, Rui YF, Fan L, Shen D and Chen DL. Left ventricular Systolic Function Changes in Primary Hypertension Patients Detected by the Strain of Different Myocardium Layers. Medicine (Baltimore).2016;95: e2440.

[32] Almeida AL, Teixido-Tura G, Choi EY, Opdahi A, Fernandes VR, Wu CO, Bluemke DA and Lima JA. Metabolic syndrome, strain, and reduced myocardial function: multi-ethnic study of atherosclerosis. Arq Bras Cardiol. 2014; 102:327-35.

[33] Pascual M, Pascual DA, Soria F, Vicente T, Hernandez AM, Tebar FJ and Valdes M. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart. 2003; 89:1152-6.

[34] Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low densitylipoprotein in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18:499-502.

[35] Wagner M, Tiffe T, Morbach C, Gelbrich G, Stork S, Heuschmann PU and Consortium S. characteristics and Course of Heart Failure Stages A-B and Determinants of Progressiondesign and rationale of the STAAB cohort study. Eur J Prev Cardiol. 2017; 24:468-479.

[36] Morbach C, Gelbrich G, at al. Impact of acquisition and interpretation on total inter-observer variability in echocardiography: results from the quality assurance program of the STAAB cohort study. Int J Cardiovasc Imaging. 2018.

[37] Bia D, Aguirre I, Zocalo Y, Devera L, Cabrera Fischer E, Armentano R. [Regional differences in velocity, elasticity and wall buffering function in systemic arteries: pulse wave analysis of the arterial pressure-diameter relationship]. Rev Esp Cardiol. 2005; 58:167-74.

[38] Lehmann ED. Non invasive measurements of aortic stiffness: methodological considerations. Pathol Biol. 1999; 47:716-30.

[39] Lantelme P, Mestre C, Lievre M, Gressard A, Milon H. Heart rate AN important confounder of pulse wave velocity assessment Hypertension. 2002; 39:1083-7.

[40] Benetos A, Laurent S, Hoeks AP, Boutouyrie PH, Safar ME. Arterial alterations with ageing and high blood pressure: a non-invasive study of carotid and femoral arteries. Arterioscler Thromb. 1993; 13:90-7.

[41] Lang RM, Badano LP, Mor-Avi V et al (2015) 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 28:1-39.

[42] Ethnic-Specific Normative Reference Values for Echocardiographic LA and, size LV (2015) Mass, and systolic functions:   the EchoNoRMAL study.JACC Cardiovas Imaging 8:656-665.

[43] Chahal NS, Lim TK, Jain P, Chmabers JC, Kooner JS, Senior R (2010) Ethnicity-related differences in left ventricular functions, structure, and geometry: a population study of UK Indian Asian and European white subjects. Heart 96:466-471.

[44] Chahal NS, Lim TK, Jain P. Chmabers JC, Kooner JS, Senior R (2012) Population-based references values for 3D echocardiographic LV volumes and ejection fraction. JACC Cardiovasc Imaging 5:1191-1197.

[45] Bansal M, Mohan JC, Sengupta SP (2016) Normal echocardiographic measurements in Indian adults: how different are we from the western populations? A pilot study. Indian Heart J 68:772-775.

[46] Poppe KK, Doughty RN, Walsh HJ, Triggs CM, Whalley GA (2014) A comparison of the effects of indexation on standard echocardiography measurements of the left heart in a healthy multi-racial population. Int J Cardiovasc Imaging 30:749-758.

[47] Asch FM, Miyoshi T, Addetia K et al (2019) Similarities and differences in left ventricular size and function among races and nationalities: results of the world alliances of echocardiography normal values study. J Am Soc Echocardiogr 32:1396-1406.

[48] Chahal NS, Lim TK, Jain P, Chambers JC, Senior R. Population-based reference values for 3D echocardiographic LV volumes and ejection fraction JACC Cardiovasc Imaging. 2012; 5:1191-1197.

[49] Bansal M, Mohan JC, Sengupta SP. Normal echocardiographic measurements in Indian adults: how different are we from the western populations? A pilot study. Indian Heart J. 2016; 68:772-775.

[50] Luis SA, Yamada A, Khandheria BK, Speranza V, Benjamin A, Ischenko M, et al. Use of three-dimensional speckle-tracking echocardiography for quantitative assessment of global left ventricular function: A comparative study of three-dimensional echocardiography. J Am Soc Echocardiogr 2014;27 (3):285-291.

[51] Brown J, Jenkins C, Marwick TH, Use of myocardial strain to assess global left ventricular function: a comparison with cardiac magnetic resonance and 3-dimensional echocardiography. Am Heart J. 2009; 157(1):102. e1-e5.

[52] Mignot A, Donal E, Zaroui A, Reant P, Saleem A, Hamon C, 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(10):1019-1024.

[53] Cho GY, Marwick TH, Kim HS, Kim MK, Hong KS, Oh DJ. Global2-dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol 2009; 54(7):618-624.

[54] Kearney LG, Lu K, Ord M, Patel SK, Profitis K, Matalanis G, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging 2012; 13(10):827-833.

[55] Dahi JS, Videbaek L, Poulsen MK, Rudbaek TR, Pellikka PA, Moller JE, Global Strain in severe aortic valve stenosis: Relation to clinical outcome after aortic valve replacement. Circ Cardiovasc Imaging 2012;5(5):613-620.

[56] Woo JS, Kim WS, Yu TK, Ha SJ, Kim SY, Bae JH et al. Prognostic value of serial global longitudinal strain measured by two-dimensional speckle tracking echocardiography in patients with ST-segment elevation myocardial infarction. Am J Cardiol 2011; 108(3):340-347.

[57] Chen X, Xie H, Erkamp R, Kim K, Jia C, Rubin JM, et al. 3-D correlation-based speckle tracking. Ultrason Imaging 2005; 27(1):21-36.

[58] Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications andorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 2011;24(3):277-313.

[59] Perez de Isla L, Balcones DC, Fernandez-Golfin C, Marcos-Alberca P, Almeria C Rodrigo JL et al. Three-dimensional-wall motion tracking; a new and faster tool for myocardial strain assessment; comparison with two-dimensional-wall motion tracking. J Am Soc Echocardiogr 2009; 22:325-30.

[60] Maffessanti F, Nesser HJ, Weinert L, Steringer-Mascherbauer R, Niel J. Gorissen W et al. Quantitative evaluation of regional left ventricular function using three-dimensional speckle Tracking echocardiography in patients with and without heart disease. Am J cardiol 2009;1041755-62.

[61] Kleijn SA, Aly MF, Terwee CB, van Rossum AC, Kamp O. Three-dimensional speckle tracking echocardiography for automatic assessment of global and regional left ventricular function based on area strain. J Am Soc Echocardiogr 2011; 24:314-21.

[62] Marwick TH, Leano RL, Brown J, Sun JP, Hoffmann R, Lysyansky P et al. Myocardial strain measurements with 2-dimensional speckle-tracking echocardiography: definition of normal range. JACC Cardiovasc Imaging 2009; 2:80-4.

[63] Maffessanti F, Nesser HJ, Weinert L, Steringer-Mascherbauer R, Niel J, Gorissen W et al. Quantitative evaluation of regional left ventricular function using three-dimensional speckle tracking echocardiography in patients with and without heart disease. Am J Cardiol 2009; 104:1755-62.

[64] Saito K, Okura H, Watanabe N, Hayashida A, Obase K, lmai K et al. Comprehensive evaluation of left ventricular strain using speckle tracking echocardiography in normal adults: comparison of three-dimensional and two-dimensional approaches. J Am Soc Echocardiogr 2009; 22:1025-30.

[65] Bernard A, Addettia K, Dulgheru R, Caballero L, Sugimoto T, Akhaladze N et al. 3D echocardiographic reference ranges for normal left ventricular volume and strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017; 18:475-83.

[66] Kocabay G, Muraru D, Peluso D, Cucchini U, Mihaila S, Padayattil-Jose S et al. Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. References values in healthy adults. Rev Esp Cardiol (Engl Ed) 2014:67:651-8.

[67] Muraru D, Cucchini U, Mihaila S, Miglioranza MH, Aruta P, Caralli G et al. Left ventricular myocardial strain by three-dimensional speckle-tracking echocardiography in healthy subjects: reference values and analysis of their physiologic and technical determinants. J Am Soc Echocardiogr 2014; 27:858-71.