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Diastolic wall strain: a simple marker of abnormal cardiac mechanics.

Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KY, Peng J, Lee DC, Patel A, Sha J, Irvin MR, Arnett DK, Shah SJ - Cardiovasc Ultrasound (2014)

Bottom Line: DWS decreased with increasing comorbidity burden (β-coefficient -0.013 [95% CI -0.015, -0.011]; P<0.0001).DWS was independently associated with GLS, GCS, GRS, and e' velocity (adjusted P<0.05) but not LV chamber compliance (EDV20, P=0.97).C-statistics for DWS as a diagnostic test for abnormal GLS, GCS, and GRS were: 0.78, 0.79, and 0.84, respectively.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N, St, Clair St,, Suite 600, Chicago, IL 60611, USA. sanjiv.shah@northwestern.edu.

ABSTRACT

Background: Diastolic wall strain (DWS), defined using posterior wall thickness (PWT) measurements from standard echocardiographic images (DWS = [PWT(systole)-PWT(diastole)]/PWT(systole)), has been proposed as a marker of left ventricular (LV) diastolic stiffness. However, the equation for DWS is closely related to systolic radial strain, and whether DWS is associated with abnormal cardiac mechanics (reduced systolic strains and diastolic tissue velocities) is unknown. We sought to determine the relationship between DWS and systolic and diastolic cardiac mechanics.

Methods: We calculated DWS and performed speckle-tracking analysis in a large population- and family-based study (Hypertension Genetic Epidemiology Network [HyperGEN]; N=1907 after excluding patients with ejection fraction [EF] <50% or posterior wall motion abnormalities). We measured global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS, respectively) and early diastolic (e') tissue velocities, and we determined the independent association of DWS with cardiac mechanics using linear mixed effects models to account for relatedness among study participants. We also prospectively performed receiver-operating characteristic (ROC) analysis of DWS for the detection of abnormal cardiac mechanics in a separate, prospective validation study (N=35).

Results: In HyperGEN (age 51 ± 14 years, 59% female, 45% African-American, 57% hypertensive), mean DWS was 0.38 ± 0.05. DWS decreased with increasing comorbidity burden (β-coefficient -0.013 [95% CI -0.015, -0.011]; P<0.0001). DWS was independently associated with GLS, GCS, GRS, and e' velocity (adjusted P<0.05) but not LV chamber compliance (EDV20, P=0.97). On prospective speckle-tracking analysis, DWS correlated well with GLS, GCS, and GRS (R=0.61, 0.57, and 0.73, respectively; P<0.001 for all comparisons). C-statistics for DWS as a diagnostic test for abnormal GLS, GCS, and GRS were: 0.78, 0.79, and 0.84, respectively.

Conclusions: DWS, a simple parameter than can be calculated from routine 2D echocardiography, is closely associated with systolic strain parameters and early diastolic (e') tissue velocities but not LV chamber compliance.

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Related in: MedlinePlus

Left ventricular diastolic indices versus quintiles of diastolic wall stiffness in HyperGEN. Bar graphs depict the relationship between diastolic wall strain and left ventricular e’ velocity and E/e’ ratio.
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Fig2: Left ventricular diastolic indices versus quintiles of diastolic wall stiffness in HyperGEN. Bar graphs depict the relationship between diastolic wall strain and left ventricular e’ velocity and E/e’ ratio.

Mentions: Figures 1 and2 show the relationship between DWS quintiles and LV strain parameters and diastolic indices, respectively. Table 3 demonstrates the correlation between DWS and both 2D and speckle-tracking echocardiographic systolic and diastolic indices. There was a modest but significant correlation between DWS and many systolic and diastolic indices. The strongest correlation was with midwall fractional shortening, a systolic index (R = 0.56, P < 0.001). DWS did not correlate with EF. Importantly, DWS did not correlate with measures of LV chamber compliance (EDV20 and early mitral inflow [E] deceleration time).Figure 1


Diastolic wall strain: a simple marker of abnormal cardiac mechanics.

Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KY, Peng J, Lee DC, Patel A, Sha J, Irvin MR, Arnett DK, Shah SJ - Cardiovasc Ultrasound (2014)

Left ventricular diastolic indices versus quintiles of diastolic wall stiffness in HyperGEN. Bar graphs depict the relationship between diastolic wall strain and left ventricular e’ velocity and E/e’ ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197332&req=5

Fig2: Left ventricular diastolic indices versus quintiles of diastolic wall stiffness in HyperGEN. Bar graphs depict the relationship between diastolic wall strain and left ventricular e’ velocity and E/e’ ratio.
Mentions: Figures 1 and2 show the relationship between DWS quintiles and LV strain parameters and diastolic indices, respectively. Table 3 demonstrates the correlation between DWS and both 2D and speckle-tracking echocardiographic systolic and diastolic indices. There was a modest but significant correlation between DWS and many systolic and diastolic indices. The strongest correlation was with midwall fractional shortening, a systolic index (R = 0.56, P < 0.001). DWS did not correlate with EF. Importantly, DWS did not correlate with measures of LV chamber compliance (EDV20 and early mitral inflow [E] deceleration time).Figure 1

Bottom Line: DWS decreased with increasing comorbidity burden (β-coefficient -0.013 [95% CI -0.015, -0.011]; P<0.0001).DWS was independently associated with GLS, GCS, GRS, and e' velocity (adjusted P<0.05) but not LV chamber compliance (EDV20, P=0.97).C-statistics for DWS as a diagnostic test for abnormal GLS, GCS, and GRS were: 0.78, 0.79, and 0.84, respectively.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N, St, Clair St,, Suite 600, Chicago, IL 60611, USA. sanjiv.shah@northwestern.edu.

ABSTRACT

Background: Diastolic wall strain (DWS), defined using posterior wall thickness (PWT) measurements from standard echocardiographic images (DWS = [PWT(systole)-PWT(diastole)]/PWT(systole)), has been proposed as a marker of left ventricular (LV) diastolic stiffness. However, the equation for DWS is closely related to systolic radial strain, and whether DWS is associated with abnormal cardiac mechanics (reduced systolic strains and diastolic tissue velocities) is unknown. We sought to determine the relationship between DWS and systolic and diastolic cardiac mechanics.

Methods: We calculated DWS and performed speckle-tracking analysis in a large population- and family-based study (Hypertension Genetic Epidemiology Network [HyperGEN]; N=1907 after excluding patients with ejection fraction [EF] <50% or posterior wall motion abnormalities). We measured global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS, respectively) and early diastolic (e') tissue velocities, and we determined the independent association of DWS with cardiac mechanics using linear mixed effects models to account for relatedness among study participants. We also prospectively performed receiver-operating characteristic (ROC) analysis of DWS for the detection of abnormal cardiac mechanics in a separate, prospective validation study (N=35).

Results: In HyperGEN (age 51 ± 14 years, 59% female, 45% African-American, 57% hypertensive), mean DWS was 0.38 ± 0.05. DWS decreased with increasing comorbidity burden (β-coefficient -0.013 [95% CI -0.015, -0.011]; P<0.0001). DWS was independently associated with GLS, GCS, GRS, and e' velocity (adjusted P<0.05) but not LV chamber compliance (EDV20, P=0.97). On prospective speckle-tracking analysis, DWS correlated well with GLS, GCS, and GRS (R=0.61, 0.57, and 0.73, respectively; P<0.001 for all comparisons). C-statistics for DWS as a diagnostic test for abnormal GLS, GCS, and GRS were: 0.78, 0.79, and 0.84, respectively.

Conclusions: DWS, a simple parameter than can be calculated from routine 2D echocardiography, is closely associated with systolic strain parameters and early diastolic (e') tissue velocities but not LV chamber compliance.

Show MeSH
Related in: MedlinePlus