Title: Left Ventricular Myocardial Deformation Assessment by 4Dimensional XStrain Speckle Tracking Echocardiography: An Innovative Technology
Authors: Akhil Mehrotra, Anurag Mehrotra, Mohammed Shaban3, Sadhvi Rajawat, Shubham Kacker
DOI: https://dx.doi.org/10.18535/jmscr/v11i8.09
Abstract
Strain based imaging techniques, particularly speckle tracking echocardiography (STE) have been shown to have clinical utility in a variety of clinical settings. Currently, STE is being embraced and increasingly adopted in numerous echocardiographic laboratories worldwide. In context with contemporary non invasive cardiovascular procedures, 2Dimensional STE is most sought-after method to evaluate LV strain, rotation, twist and torsion. Two dimensional (2D), three dimensional (3D) and 4Dimensional (4D) deformation assessment by STE is inherently associated with certain limitations. For better appraisal of LV contractile properties recently introduced updated version of 4D XStrain STE has been employed to analyse the various complex multidimensional LV mechanics. This novel technology is a reliable, affordable and a simple tool for estimation of regional and global myocardial function. Furthermore, 4D XStrain STE can accurately quantify the 4D LV ejection-fraction, end-diastolic and end-systolic volumes and sphericity index (SI). However, this distinctive technology has not been widely adopted and its assessment is still limited to research applications. Hence we aimed to familiarize this innovative technology by comprehensively addressing its technique, advantages and limitations, with the intent that it may serve a more meaningful purpose in the current volatile scenario of cardio-vascular disease.
Keywords: 4Dimensional XStrain Echocardiography, LV strain, LV rotation, LVtwist, LV untwist, LV torsion.
References
- Yingchoncharoen T, Agarwal S, Popovic ZB. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr. 2013; 26:185-91.
- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. 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 2015; 28:1-39.
- Jasaityte R, Heyde B, D'Hooge J. Current state of three-dimensional myocardial strain estimation using echocardiography. J Am Soc Echocardiogr.2012; 26:15-28.
- Papademetris X, Sinusas AJ, Dione DP, Duncan JS. Estimation of 3D left ventricular deformation from echocardiography. Med Image Anal. 2001; 5: 17-28.
- Elen A, Choi HF, Loeckx D. Three-dimensional cardiac strain estimation using spatio-temporal elastic registration of ultrasound images: a feasibility study. IEEE Trans Med Imaging 2008; 27:1580-91.
- Muraru D, Niero A, Zanella HR, Cherata D, Badano LP. Three-dimensional speckle-tracking Echocardiography: Benefits and limitations of integrating myocardial mechanics with three-dimensional imaging. Cardiovasc. Diagn. Ther, 2018; 8: 101- 117.
- Van mil AC, Pearson J, Drane AL, Cockcroft JR. McDonnell B and Stoehr EJ. Interaction of LV Twist with arterial haemodynamics during localised. Exp Physiol. 2016; 101:509-520.
- Stöhr EJ, Shave RE, Baggish AL, Weiner RB. Left ventricular twist mechanics in the context of normal physiology and cardiovascular disease: a review of studies using speckle tracking echocardiography. Am J Physiol Heart Circ Physiol. 2016; 311:H177-H182.
- Carreras F, Garcia-Barnes J, Gil D, Pujadas S, Li CH, Suarez-Arias R. Leta R, Alomar X, Ballester M, Pons-Llado G. Left ventricular torsion and longitudinal shortening: two fundament components of myocardial mechanics assessed by tagged cine-MRI normal subjects. Int J Cardiovasc Imaging. 2012; 28: 273-84.
- Takahashi K, Naami GA. Thompson R, Inage A, Mackie AS, Smallhorn JF, Normal rotational, torsion and untwisting data in children, adoledcents and young adults. J Am Soc Echocardiogr.2010; 23:286-93.
- Reckefuss N, Butz T, Horstkotte D and Faber L. Evaluation of longitudinal and radial left ventricular function by two-dimensional speckle-tracking echo-cardiography in a large cohort of normal probands. Int J Cardiovasc Imaging. 2011; 27:515-526.
- Muraru D, Cucchini U, Mihăilă S, Miglioranza MH, Aruta P, Cavalli G, Cecchetto A, Padayattil-Josè S, Peluso D, Iliceto S, Badano LP. 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; 27:858-871.
- EXPERT CONSENSUS STATEMENT: Current and Evolving Echocardiographic Techniques for the Quantitative Evaluation of Cardiac Mechanics: ASE/EAE Consensus Statement on Methodology and Indications. Endorsed by the Japanese Society of Echocardiography. Mor-Avi V, J Am Soc Echocardiogr. 2011; 24:277-313.
- Voigt J-U, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr. 2015; 28:183-193.
- Di Bella G, Pedri S, Schreckenberg M, et al. Three and four dimensional quantification of left ventricular volumes and ejection fraction on the basis of feature strain echocardiography. (2011) 72 Congresso Nazio- nale della Società Italiana di Cardiologia. G Ital Cardiol. 2011; 106:12.
- Dragulescu A, Grosse-Wortmann L, Fackoury C, Mertens L. Echocardiographic assessment of right ventricular volumes: a comparison of different techniques in children after surgical repair of tetralogy of Fallot. Eur Heart J Cardiovasc Imaging. 2012; 13:596-604.
- Mehrotra A, Kacker S, Shadab M, Chandra N, Singh AK. 4 Dimensional XStrain speckle tracking echocardiography: comprehensive evaluation of left ventricular strain and twist parameters in healthy Indian adults during COVID-19 pandemic. Am J Cardiovasc Dis. 2022; 12:192-204.
- Mehrotra A, Sharma A, Shadab M, Srivastava M,Chandra N, Singh A. Dimensional X Strain and 2Dimensional Speckle Tracking Echocardiographic Study: Normative Values of Strain Parameters of Left Ventricle and Tissue Doppler Imaging of Ascending Aorta in Healthy Adults -A Single Centre Indian Study. Texila International Journal of Academic Research. 2022; 9:120-141.
- Mehrotra A, Kacker S, Shadab M, Chandra N, Singh AK, Sharma A. 4Dimensional X-Strain Speckle Tracking Echocardiography: Assessment of Normal Values of Left Ventricular Rotation and Twist, in Healthy Indian Adults during the Covid-19 Pandemic. Texila International Journal of Public Health. 2022; 10:382-397.
- Mehrotra A, Kacker S, Shadab M, Prakash O, Singh AK, Sharma A, Four-Dimensional XStrain Echocardiography: Correlation of Aortic Stiffness with Left Ventricular Diastolic, Systolic, and Strain Parameters in Healthy Adults - A Single-center Indian Perspective. Journal of Indian College of Cardiology. 2023; 13:29-39.
- Oleynikov VE, Galimskaya VA, Kupriyanova SN, Burko NV. Use of the Speckle tracking method for determining global parameters of heart contractility in healthy individuals. Method X, 2018; 5:125-135.
- Mehrotra A, Kacker S, Patnaik A. 4Dimensional XStrain Echocardiography: M-mode and Tissue Doppler Estimation of Age and Gender Specific Normative Values of Aortic Stiffness in Healthy Adults during Covid -19 Pandemic. Clinical Cardiovascular Research. 2023; 2: 1-17.
- D’Andrea A, Mele D, Agricola E, Pezzullo E, Cameli M, Rossi A, Esposito R, Novo G, Mondillo s, Montisci R, Gallina S, Bossone E, Galderisi M. XStrain 4D analysis predicts left ventricular remodeling in patients with recent non -ST-segment elevation myocardial infarction. International Journal of Cardiology 2016; 2016:107-109.
- Eek C, Grenne B, Brunvand H, Aakhus S, Endresen K, Smiseth OA, Edvardsen T, Skulstad H. Strain echocardiography predicts acute coronary occlusion in patients with non-ST-segment elevation acute coronary syndrome. Eur J Echocardiogr. 2010; 11:501-50 8.
- D'Andrea A Cocchia R, Caso P, Riegler L, Scarafile R, Salerno G, Golia E, Di Salvo G Calabrò P, Bigazzi MC, Liccardo B, Esposito N, Cuomo S, Bossone E, Russo MG ID Calabrò R Global longitudinal speckle- tracking strain Is predictive of left ventricular remodeling after coronary angioplasty in patients with recent non - ST elevation myocardial infarction. International Journal of Cardiology, 2010; 153:185-191.
- Rostamzadeh A, Shojaeifard M, Rezaei Y, Dehghan K. Diagnostic accuracy of myocardial deformation indices for detecting high risk coronary artery disease in patients without regional wall motion abnormality. Int J Clin Exp Med. 2015; 8:9412-9420.
- D'Andrea A, Sperlongano S, Pacileo M, Venturini E, lannuzzo G, Gentile M, Sperlongano R, Vitale G, Maglione M, Cice G, Maria Sarullo F, Di Lorenzo A, 2020 Vigorito C, Giallauria F. New Ultrasound Technologies for Ischemic Heart Disease Assessment and Monitoring in Cardiac Rehabilitation. Picano E J Clin Med, 2020; 9:E3131.
- Hussein Awad Hemeda, Mahmoud Shawky Abd Elmoneum, Eman Said Al Kishk, Sayed Abd El Khaleq El Darky. Echocardiographic assessment of the left atrial function in patients with mitral valve disease by two- dimensional speckle tracking. Cardiovascular System. 2018; 6:1.
- Stefani L, Luca AD, Maffulli N, Mercuri R, Innocenti G, Sultiman I, Tonceli L, Vono MC, Cappelli B, Pedri S, Perizzetti G and Galanti G. Speckle tracking for left ventricle performance in young athletes with bicuspid aortic valve and mild aortic regurgitation. European Journal of Echocardiography. 2009; 10:527-531.
- Badran HM, Elnoamany MF, Soltan G, Ezat M, Elsedi M, Abdelfatah RA, Yacoub M. Relationship of mechanical dyssynchrony to QT interval prolongation in hypertrophic cardiomyopathy. European Heart Journal - Cardiovascular Imaging. 2012; 13:423-432.
- Badran HM, Soltan G, Faheem N, Enait ME, Yacoub MH. Right Ventricular Mechanical Changes after Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy: Vector Velocity Imaging Study. World Journal of Cardiovascular Diseases. 2019; 9:467-488.
- Badran HM, Ahmed NF, Ibrahim WA, Khalifa MM. Assessment of right ventricular response to exercise using vector velocity imaging in hypertrophic cardiomyopathy. Menoufia Med J 2014; 27:136-144.
- Badran HM, Sultan GM, Ahmed NF, Mohamed HA. Assessment of right atrium function in hypertrophic cardiomyopathy by speckle-tracking echocardiography. Menoufia Medical Journal. 2017; 30:823-831.
- Simonovic D, Coiro S, Deljanin-ilic M, Kobayashi M, Erberto C, Girerd N, Ambrosio G. Exercise-induced B-lines in heart failure with preserved ejection fraction occur along with diastolic function worsening. ESC Heart Failure, 2021; 8:5068-5080.
- Oleynikov VE, Averyanova EV, Oreshkina AA, Burko NV, Barmenkova YA, Golubeva AV and GalimskayaVA. A Multivariate Model to Predict Chronic Heart Failure after Acute ST-Segment Elevation Myocardial Infarction: Preliminary Study. Diagnostics 2021; 11:1925.
- Hematian MN, Torabi S, Malkan-Rad E, Zanjani K, Ziaee V, Lotfi-Tolkaldany M: Noninvasive evaluation of Myocardial Systolic Dysfunction in the early stage of Kawasaki Disease: A Speckle-Tracking Echocardiography study. Iran J Pediatr. 2015; 25:198.
- Benacka O, Benacka J, Blazicek P, Belansky M, Payer J, Killinger Z and Lietava J:A Speckle-tracking Echocardiography is More Sensitive in Detecting Subclinical Myocardial Dysfunction in Patients with Rheumatoid Arthritis. Journal of Arthritis. 2016; 5:224
- Atteritano M, Visconti L, Dattilo G, Zuppardo C, Lacquaniti A, Parato VM, Migliorato A, Conti' G and Santoro D. Non-Invasive Imaging for Evaluating Cardiovascular Involvement in Patients with Primary and Lupus Nephritis. The Open Rheumatology Journal. 2019; 13:86-93.
- Dattilo G, Imbalzano E, Casale M, et al. Psoriasis and Cardiovascular Risk: Correlation between Psoriasis and Cardiovascular Functional Indices. Angiology. 2018; 69:31-37.
- Piccione M, Zito C, Bagnaton G, Oreto G, Bella G, Bagnato G and Carerj S. Role of 2D strain in the early identification of left ventricular dysfunction and in the risk stratification of systemic sclerosis patients. Cardiovascular Ultrasound. 2013; 11:6.
- Shahryari M, Mehdizadegan N, Amoozgar H, Borzouee M, Ajami G, Cheriki S, Edraki M, Shakiba A, Mohammadi H and Keshavarz K; Efficacy of High Dose and Short Course of Deferoxamine Infusion on Cardiac Remodeling of Children with Thalassemia Major. Iran J Pediatr. 2013; 23:79684.
- Bella GD, Minutoli F, Piaggi P, Casale M, Mazzeo A, Zito C, Oreto G, Baldari S, Vita G, Pingitore A, Khandheria BK, Carerj S. Quantitative Comparison Between Amyloid Deposition Detected by 99mTc- Diphosphonate Imaging and Myocardial Deformation Evaluated by Strain Echocardiography in Transthyretin-Related Cardiac Amyloidosis. Cric J 2016; 80:1998-2003
- Bella GD, Gaeta M, Pingtore A, Oreto G, Zito C, Minutoli F, Anfuso c, Dattilo G, Lamari A, Coglitore S, Carerj S. Myocardial Deformation in Acute Myocarditis With Normal Left Ventricular Wall Motion - A Cardiac Magnetic Resonance and 2-Dimensional Strain Echocardiogrphic Study. Cric J 2010; 74:1205-1213.
- Stefani L, Pedrizzetti G and Galanti G. Clinical Application of 2D Speckle Tracking Strain for Assessing Cardio-Toxicity in Oncology. J. Funct. Morphol. Kinesiol. 2016; 1:343-354.
- D'Andrea A, Stanziola A, D'Alto M, Di Palma E, Martino M, Scarafile R, Molino A, Rea G, Maglione M, Calabrò R, Russo MG, Bossone E, Saggar R nt J Cardiol. Right ventricular strain: An independent predictor of survival idiopathic pulmonary fibrosis. Saggar R Int J Cardiol. 2016; 222:908-910.
- Badran HM, Ibrahim WA, Alaksher T and Soltan G. Impact of the left anterior descending artery wrapping around the left ventricular apex on cardiac mechanics in patients with normal coronary angiography. The Egyptian Heart Journal. 2020; 72:33.
- Luca AD, Stefani L, Pedrizzetti G, Pedri S and Galanti G. The effect of exercise trainingon left ventricular function in young elite athletes. Cardiovascular Ultrasound. 2011; 9:27.
