Journal of the American Society of Echocardiography
Clinical InvestigationVentricular Mechanics: Strain and TwistComprehensive Evaluation of Left Ventricular Strain Using Speckle Tracking Echocardiography in Normal Adults: Comparison of Three-Dimensional and Two-Dimensional Approaches
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Study Population
This study was approved by the local ethical committee, and all subjects gave written, informed consent. Fifty-six healthy volunteers were consecutively enrolled. Ten subjects were excluded from this study because of poor image quality for analysis. Finally, 46 subjects (40 male, aged 29 ± 7 years) were studied. All studied subjects were (1) normotensive, (2) in normal sinus rhythm, and (3) without structural and functional abnormalities (including valvular heart disease) on transthoracic
Average Analysis Time
Average times for acquisition of the echocardiographic images and for the analysis per subject are shown in Table 1. The time for both the image acquisition and the analysis per subject by 3DT was significantly shorter than by 2DT (P < .0001).
Comparison between 3D and 2D Strain Values
Table 2 shows the LV volumes and left ventricular ejection fraction (LVEF) measured by 3D and 2D echocardiography. The end-diastolic volume measured by 2D echocardiography was significantly larger than by 3D echocardiography (P < .0001). However, the
Discussion
This study assessed the different components of strain (longitudinal, radial, and circumferential) values in 16 LV segments by using a newly developed 3D strain imaging and then compared the data with those measured by conventional 2D strain imaging. Our results showed that 1) the newly developed 3D myocardial tracking technique is a simple, feasible, and reproducible method to measure the strains; 2) the mean strain values of 16 segments between 3DT and 2DT showed discordant values in part;
Study Limitations
3DT has a material limitation in time and spatial resolution. However, there was no significant difference in the time to peak strain between 3DT and 2DT. In addition, equivalent reproducibilities of 3DT were demonstrated compared with 2DT. Another limitation of the present study is its small population, with only normal and relatively young individuals. Therefore, prospective studies are needed to clarify the strain values with more elderly, normal subjects and those with cardiac disease.
Conclusions
3DT is a simple, feasible, and reproducible method to measure longitudinal, circumferential, and radial strain values. The discordant results between 3DT and 2DT may be explained by the 3D cardiac motion that has been ignored in current 2DT. 3DT is a promising technique, which has the advantage of measuring real myocardial movement, including twisting motion of the heart, compared with conventional 2DT.
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