Circumferential and Longitudinal Strain in 3 Myocardial Layers in Normal Subjects and in Patients with Regional Left Ventricular Dysfunction

doi:10.1016/j.echo.2009.10.004

Journal of the American Society of Echocardiography

Volume 23, Issue 1, January 2010, Pages 64-70

https://doi.org/10.1016/j.echo.2009.10.004 Get rights and content

Background

The left ventricle is not homogenous and is composed of 3 myocardial layers. Until recently, magnetic resonance imaging has been the only noninvasive technique for detailed evaluation of the left ventricular (LV) wall. The aim of this study was to analyze strain in 3 myocardial layers using speckle-tracking echocardiography.

Methods

Twenty normal subjects and 21 patients with LV dysfunction underwent echocardiography. Short-axis (for circumferential) and apical (for longitudinal strain) views were analyzed using modified speckle-tracking software enabling the analysis of strain in 3 myocardial layers.

Results

In normal subjects, longitudinal and circumferential strain was highest in the endocardium and lowest in the epicardium. Longitudinal endocardial and mid layer strain was highest in the apex and lowest in the base. Epicardial longitudinal strain was homogenous over the left ventricle. Circumferential 3-layer strain was highest in the apex and lowest in the base. In patients with LV dysfunction, strain was lower, with late diastolic or double peak.

Conclusions

Three-layer analysis of circumferential and longitudinal strain using speckle-tracking imaging can be performed on a clinical basis and may become an important method for the assessment of real-time, quantitative global and regional LV function.

Section snippets

Methods

Twenty of 22 subjects with normal LV function and no risk factors for coronary disease (mean age, 36 years; range, 21-70 years; mean ejection fraction, 60%) and 21of 25 patients with regional LV dysfunction due to ischemic heart disease (mean age, 63 years; range, 40-93 years; mean ejection fraction, 38%; range, 25%-55%) were studied using a Vivid 7 system (GE Vingmed Ultrasound AS, Horten, Norway) and a Vivid I system (GE Healthcare, Haifa, Israel). Images were stored in digital format for

Results

Among 378 normal segments, 369 apical long-axis and 357 short-axis segments were successfully analyzed using modified speckle-tracking imaging. Among 378 cardiac segments with wall motion abnormalities, 365 long-axis and 359 short-axis segments were successfully analyzed. Wall thickness in abnormally contracting segments varied from 6 to 11 mm. Intraobserver and interobserver variability ranged up to 5%. Heart rates ranged from 42 to 100 beats/min (mean, 71 beats/min).

Discussion

As has been shown in dogs,¹³ the wall of the human heart has a well-defined distribution of fibers, with angles varying from about 60° (from the circumferential direction) at the inner surface to about −60° at the outer surface. The greatest change in angle with respect to wall thickness occurs at the two surfaces (endocardial and epicardial). The ratio of circumferentially to longitudinally oriented fibers is 10:1, increasing toward the base and decreasing toward the apex.

Myocardial strain has

Conclusions

LV strain is not uniform over the left ventricle; it varies through myocardial layers and levels with circular and longitudinal inhomogeneity.

In normal subjects, longitudinal and circumferential strains are highest in the endocardium and lowest in the epicardium. Longitudinal endocardial and midlayer strain exhibit a base-to-apical gradient that increases toward the apex. Epicardial longitudinal strain is homogenous over the left ventricle. Circumferential strain is higher than longitudinal

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The prognostic value of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) has been well-established. Although cardiac magnetic resonance (CMR) is the method of choice in its revealing as the presence of late gadolinium enhancement (LGE), this technique still has limited availability in daily clinical practice. Two-dimensional speckle tracking echocardiography (2D STE) seems to be helpful in verification which HCM patient has the highest probability of LGE presence and hence needs to be qualified to CMR. While the majority of HCM patients have a patchy pattern of myocardial fibrosis, the aim of this study was to evaluate whether segmental rather than global longitudinal strain is more accurate in the identification of the presence of LGE.
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Clinical InvestigationHeart FailureCircumferential and Longitudinal Strain in 3 Myocardial Layers in Normal Subjects and in Patients with Regional Left Ventricular Dysfunction

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

Am J Cardiol

Optimizing ventricular fibers: uniform strain or stress, but not ATP consumption, leads to high efficiency

Am J Physiol Heart Circ Physiol

Form follows function: developmental and physiological view on ventricular myocardial architecture

Eur J Cardiothorac Surg

Systolic ventricular filling

Eur J Cardiothorac Surg

Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations

Eur J Echocardiogr

Clinical Investigation
Heart Failure
Circumferential and Longitudinal Strain in 3 Myocardial Layers in Normal Subjects and in Patients with Regional Left Ventricular Dysfunction