Normal ranges of left ventricular strain in children: a meta-analysis (original) (raw)
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Journal of the American Society of Echocardiography, 2014
Background: Establishment of the range of normal values and associated variations of two-dimensional (2D) speckle-tracking echocardiography (STE)-derived right ventricular (RV) strain is a prerequisite for its routine clinical application in children. The objectives of this study were to perform a meta-analysis of normal ranges of RV longitudinal strain measurements derived by 2D STE in children and to identify confounders that may contribute to differences in reported measures.
Journal of The American Society of Echocardiography, 2016
Background: In pediatric echocardiography, myocardial strain measurements are likely influenced by cardiac size and growth in healthy children. The application of this technique in clinical practice has been hampered by the lack of good normal reference values for the pediatric population. The aim of this study was to determine reference values and Z score equations for left ventricular systolic circumferential and longitudinal strain in a healthy pediatric population. Methods: Two hundred thirty-three healthy subjects 1 to 18 years of age were prospectively recruited. Left ventricular systolic longitudinal and circumferential strain measurements were recorded using two-dimensional speckle-tracking. Normalization for body size was performed using parametric nonlinear regression modeling. Several analyses were performed to detect potential residual associations with body size, residual heteroscedasticity, or departure from an adequate Z score distribution. Results: There were weak but statistically significant nonlinear associations between body size and most strain values. Body surface area was superior to adjust for body size compared with age, height, and weight. Most strain values displayed a second-order polynomial relationship with body surface area. Z score equations were computed with adequate normal distributions and without residual associations in relation to BSA for most strain parameters. Conclusions: There was a weak but significant influence of body size on most left ventricular circumferential and longitudinal systolic strain parameters used in pediatric echocardiography. Z scores are presented for strain measurements normalized to body surface area and adjusted for heteroscedasticity. The use of these normalized values may reduce the risk for misclassification caused by normal variation in myocardial strain values during growth.
Journal of Clinical Medicine
Background: Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. Methods: A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. Results: Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall ...
Review and status report of pediatric left ventricular systolic strain and strain rate nomograms
Heart failure reviews, 2015
Interest in strain (ε) and strain rate (SR) for the assessment of pediatric left ventricular (LV) myocardial function has increased. However, the strengths and limitations of published pediatric nomograms have not been critically evaluated. A literature search was conducted accessing the National Library of Medicine using the keywords myocardial velocity, strain, strain rate, pediatric, reference values, and nomograms. Adding the following keywords, the results were further refined: neonates, infants, adolescents, range/intervals, and speckle tracking. Ten published studies evaluating myocardial velocities, ε, or SR nomograms were analyzed. Sample sizes were limited in most of these studies, particularly in terms of neonates. Heterogeneous methods-tissue Doppler imaging, two- and three-dimensional speckle tracking-were used to perform and normalize measurements. Although most studies adjusted measurements for age, classification by specific age subgroups varied. Few studies addresse...
Journal of The American Society of Echocardiography, 2011
Background: The accurate evaluation of intrinsic myocardial contractility in children with or without congenital heart disease (CHD) has turned out to be a challenge. Two-dimensional strain echocardiographic (2DSTE) imaging or two-dimensional speckle-tracking echocardiographic imaging appears to hold significant promise as a tool to improve the assessment of ventricular myocardial function. The aim of this study was to estimate left ventricular myocardial systolic function using 2DSTE imaging in a large cohort consisting of healthy children and young adults to establish reference strain values.
The American Journal of Cardiology, 1990
The outcome and suitability for therapeutic interventions in children with congenital heart disease depend frequently on left ventricular function. Congenital heart disease is characterized by changes in loading conditions, making it difficult to assess ventricular contractility using conventional load-dependent indexes. Two-dimensional and M-mode echocardiography and arterial blood pressure were used to study left ventricular morphometrics and contractility in 44 normal children, aged 2 to 12 years. Left ventricular end-systolic and end-diastolic length, diameter, wall thickness, volume and mass all showed linear increases with body surface area (p less than 0.001 in all). Shortening and ejection fractions, velocity of circumferential fiber shortening, morphometric ratios and endocardial meridional and circumferential stress (mean 46 and 115 g/cm2, respectively) all remained constant. A load-independent measure of the normal resting left ventricular contractile state was determined by relating the rate-corrected velocity of circumferential fiber shortening to end-systolic endocardial meridional and circumferential stress; there was an inverse linear correlation (r = -0.641 and -0.557 respectively, p less than 0.001). These data provide a quantitative basis for assessment of myocardial hypertrophy, afterload and contractile state in childhood.
Eur J Echocardiogr, 2009
Aims This study examined the relationships between myocardial strain (1) and strain rate (SR) data, derived from both two-dimensional (2D) speckle tracking and tissue Doppler imaging (TDI), and indices of left ventricular (LV) morphology to assess size-(in)dependence of these functional parameters. Methods and results 2D speckle tracking and TDI echocardiograms were performed in 79 healthy adult male volunteers (age range: 22-76 years). 2D speckle tracking allowed the determination of myocardial 1 and peak systolic and early diastolic SR in radial, circumferential, and longitudinal planes, whereas TDI provided longitudinal 1 only. Mean circumferential and radial 1 and SR were calculated from data collected at six basal myocardial regions, whereas mean longitudinal 1 and SR derived from both 2D speckle tracking and TDI were calculated from the basal septum and basal lateral walls. Standard 2D echocardiography allowed the assessment of LV morphology including LV length, LV end-diastolic volume, LV enddiastolic diameter, mean wall thickness, and LV mass. The association of myocardial 1 and SR data with relevant LV morphology indices was determined by adoption of the general, non-linear allometric model (y ¼ ax b ). The b exponent +95% confidence intervals were reported. The relationships between the measures of LV morphology and myocardial 1 and SR were highly variable and generally weak. Only two relationships displayed at least a moderate effect size (r ! 0.30): (i) 2D circumferential peak systolic SR and LV end-diastolic dimension (b ¼ 20.92; 21.35 to 0.5, r ¼ 0.44) and (ii) TDI longitudinal peak systolic SR and LV length (b ¼ 21.39; 22.11 to 20.66, r ¼ 0.41). Conclusion The empirical relationships derived in this cohort do not support the need to scale myocardial 1 and SR derived from 2D speckle or TDI for any index of LV morphology.
Normal Ranges of Left Ventricular Strain: A Meta-Analysis
Journal of the American Society of Echocardiography, 2013
Background: The definition of normal values of left ventricular global longitudinal strain (GLS), global circumferential strain, and global radial strain is of critical importance to the clinical application of this modality. The investigators performed a meta-analysis of normal ranges and sought to identify factors that contribute to reported variations.
Normal Range of Left Ventricular 2-Dimensional Strain
Circulation Journal, 2012
Background: To determine the normal range of left ventricular (LV) 2- dimensional (2-D) strain and vendor-specific differences, a multicenter prospective 2-D strain study endorsed by the Japanese Society of Echocardiography was conducted.