Reference Ranges and Regional Patterns of Left Ventricular Strain and Strain Rate Using Two-Dimensional Speckle-Tracking Echocardiography in a Healthy Middle-Aged Black and White Population: The CARDIA Study

Henrique T. Moreira, Chike C. Nwabuo, Anderson C. Armstrong, Satoru Kishi, Ola Gjesdal, Jared P. Reis, Pamela J. Schreiner, Kiang Liu, Cora E. Lewis, Stephen Sidney, Samuel S. Gidding, Joao Lima, Bharath Ambale Venkatesh

Research output: Contribution to journalArticle

Abstract

Background: Strain and strain rate are sensitive markers of left ventricular (LV) myocardial function. The aim of this study was to assess reference ranges and regional patterns of LV strain and strain rate using two-dimensional speckle-tracking echocardiography in a large population of black and white subjects. Methods: This study involved a retrospective review of prospectively collected images in 557 participants in the Coronary Artery Risk Development in Young Adults study who remained healthy at the year 25 examination. LV deformation parameters were measured in apical four-chamber, apical two-chamber, and parasternal short-axis views in 509, 391, and 521 subjects, respectively. Results: Patients' mean age was 49.6 ± 3.6 years, 61.6% were women, and 69.5% were white. White women showed the highest LV systolic and diastolic deformation values, reflected by a more negative reference range for apical four-chamber longitudinal strain (-16.4%; 95% prediction interval [PI], -20.8% to -12.0%) and a higher positive reference range for early diastolic strain rate (0.93 1/sec; 95% PI, 0.41 to 1.46 1/sec), respectively. The lowest LV systolic and diastolic deformation values were found in black men, with apical four-chamber longitudinal strain (14.7%; 95% PI, -19.1% to -10.3%) and early diastolic strain rate (0.79 1/sec; 95% PI, 0.42 to 1.16 1/sec). Absolute strain increased from the epicardium toward the endocardium. A base-to-apex gradient of longitudinal strain toward the apex was exhibited in inferior and inferoseptal regions and, in contrast, in the opposite direction in anterior and anterolateral walls. Sex had the strongest influence on LV deformation variability. Conclusions: Strain and strain rate reference values were sex and race related. White women showed the highest reference ranges for LV deformation, while the lowest values were found in black men. Significant layer- and level-specific patterns in regional LV deformation were identified.

Original languageEnglish (US)
JournalJournal of the American Society of Echocardiography
DOIs
StateAccepted/In press - 2017

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Echocardiography
Reference Values
Population
Endocardium
Pericardium
Left Ventricular Function
Young Adult
Coronary Vessels
hydroquinone

Keywords

  • Echocardiography
  • Left ventricular function
  • Myocardial contraction
  • Myocardial strain
  • Speckle-tracking echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Reference Ranges and Regional Patterns of Left Ventricular Strain and Strain Rate Using Two-Dimensional Speckle-Tracking Echocardiography in a Healthy Middle-Aged Black and White Population : The CARDIA Study. / Moreira, Henrique T.; Nwabuo, Chike C.; Armstrong, Anderson C.; Kishi, Satoru; Gjesdal, Ola; Reis, Jared P.; Schreiner, Pamela J.; Liu, Kiang; Lewis, Cora E.; Sidney, Stephen; Gidding, Samuel S.; Lima, Joao; Ambale Venkatesh, Bharath.

In: Journal of the American Society of Echocardiography, 2017.

Research output: Contribution to journalArticle

Moreira, Henrique T. ; Nwabuo, Chike C. ; Armstrong, Anderson C. ; Kishi, Satoru ; Gjesdal, Ola ; Reis, Jared P. ; Schreiner, Pamela J. ; Liu, Kiang ; Lewis, Cora E. ; Sidney, Stephen ; Gidding, Samuel S. ; Lima, Joao ; Ambale Venkatesh, Bharath. / Reference Ranges and Regional Patterns of Left Ventricular Strain and Strain Rate Using Two-Dimensional Speckle-Tracking Echocardiography in a Healthy Middle-Aged Black and White Population : The CARDIA Study. In: Journal of the American Society of Echocardiography. 2017.
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abstract = "Background: Strain and strain rate are sensitive markers of left ventricular (LV) myocardial function. The aim of this study was to assess reference ranges and regional patterns of LV strain and strain rate using two-dimensional speckle-tracking echocardiography in a large population of black and white subjects. Methods: This study involved a retrospective review of prospectively collected images in 557 participants in the Coronary Artery Risk Development in Young Adults study who remained healthy at the year 25 examination. LV deformation parameters were measured in apical four-chamber, apical two-chamber, and parasternal short-axis views in 509, 391, and 521 subjects, respectively. Results: Patients' mean age was 49.6 ± 3.6 years, 61.6{\%} were women, and 69.5{\%} were white. White women showed the highest LV systolic and diastolic deformation values, reflected by a more negative reference range for apical four-chamber longitudinal strain (-16.4{\%}; 95{\%} prediction interval [PI], -20.8{\%} to -12.0{\%}) and a higher positive reference range for early diastolic strain rate (0.93 1/sec; 95{\%} PI, 0.41 to 1.46 1/sec), respectively. The lowest LV systolic and diastolic deformation values were found in black men, with apical four-chamber longitudinal strain (14.7{\%}; 95{\%} PI, -19.1{\%} to -10.3{\%}) and early diastolic strain rate (0.79 1/sec; 95{\%} PI, 0.42 to 1.16 1/sec). Absolute strain increased from the epicardium toward the endocardium. A base-to-apex gradient of longitudinal strain toward the apex was exhibited in inferior and inferoseptal regions and, in contrast, in the opposite direction in anterior and anterolateral walls. Sex had the strongest influence on LV deformation variability. Conclusions: Strain and strain rate reference values were sex and race related. White women showed the highest reference ranges for LV deformation, while the lowest values were found in black men. Significant layer- and level-specific patterns in regional LV deformation were identified.",
keywords = "Echocardiography, Left ventricular function, Myocardial contraction, Myocardial strain, Speckle-tracking echocardiography",
author = "Moreira, {Henrique T.} and Nwabuo, {Chike C.} and Armstrong, {Anderson C.} and Satoru Kishi and Ola Gjesdal and Reis, {Jared P.} and Schreiner, {Pamela J.} and Kiang Liu and Lewis, {Cora E.} and Stephen Sidney and Gidding, {Samuel S.} and Joao Lima and {Ambale Venkatesh}, Bharath",
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T1 - Reference Ranges and Regional Patterns of Left Ventricular Strain and Strain Rate Using Two-Dimensional Speckle-Tracking Echocardiography in a Healthy Middle-Aged Black and White Population

T2 - The CARDIA Study

AU - Moreira, Henrique T.

AU - Nwabuo, Chike C.

AU - Armstrong, Anderson C.

AU - Kishi, Satoru

AU - Gjesdal, Ola

AU - Reis, Jared P.

AU - Schreiner, Pamela J.

AU - Liu, Kiang

AU - Lewis, Cora E.

AU - Sidney, Stephen

AU - Gidding, Samuel S.

AU - Lima, Joao

AU - Ambale Venkatesh, Bharath

PY - 2017

Y1 - 2017

N2 - Background: Strain and strain rate are sensitive markers of left ventricular (LV) myocardial function. The aim of this study was to assess reference ranges and regional patterns of LV strain and strain rate using two-dimensional speckle-tracking echocardiography in a large population of black and white subjects. Methods: This study involved a retrospective review of prospectively collected images in 557 participants in the Coronary Artery Risk Development in Young Adults study who remained healthy at the year 25 examination. LV deformation parameters were measured in apical four-chamber, apical two-chamber, and parasternal short-axis views in 509, 391, and 521 subjects, respectively. Results: Patients' mean age was 49.6 ± 3.6 years, 61.6% were women, and 69.5% were white. White women showed the highest LV systolic and diastolic deformation values, reflected by a more negative reference range for apical four-chamber longitudinal strain (-16.4%; 95% prediction interval [PI], -20.8% to -12.0%) and a higher positive reference range for early diastolic strain rate (0.93 1/sec; 95% PI, 0.41 to 1.46 1/sec), respectively. The lowest LV systolic and diastolic deformation values were found in black men, with apical four-chamber longitudinal strain (14.7%; 95% PI, -19.1% to -10.3%) and early diastolic strain rate (0.79 1/sec; 95% PI, 0.42 to 1.16 1/sec). Absolute strain increased from the epicardium toward the endocardium. A base-to-apex gradient of longitudinal strain toward the apex was exhibited in inferior and inferoseptal regions and, in contrast, in the opposite direction in anterior and anterolateral walls. Sex had the strongest influence on LV deformation variability. Conclusions: Strain and strain rate reference values were sex and race related. White women showed the highest reference ranges for LV deformation, while the lowest values were found in black men. Significant layer- and level-specific patterns in regional LV deformation were identified.

AB - Background: Strain and strain rate are sensitive markers of left ventricular (LV) myocardial function. The aim of this study was to assess reference ranges and regional patterns of LV strain and strain rate using two-dimensional speckle-tracking echocardiography in a large population of black and white subjects. Methods: This study involved a retrospective review of prospectively collected images in 557 participants in the Coronary Artery Risk Development in Young Adults study who remained healthy at the year 25 examination. LV deformation parameters were measured in apical four-chamber, apical two-chamber, and parasternal short-axis views in 509, 391, and 521 subjects, respectively. Results: Patients' mean age was 49.6 ± 3.6 years, 61.6% were women, and 69.5% were white. White women showed the highest LV systolic and diastolic deformation values, reflected by a more negative reference range for apical four-chamber longitudinal strain (-16.4%; 95% prediction interval [PI], -20.8% to -12.0%) and a higher positive reference range for early diastolic strain rate (0.93 1/sec; 95% PI, 0.41 to 1.46 1/sec), respectively. The lowest LV systolic and diastolic deformation values were found in black men, with apical four-chamber longitudinal strain (14.7%; 95% PI, -19.1% to -10.3%) and early diastolic strain rate (0.79 1/sec; 95% PI, 0.42 to 1.16 1/sec). Absolute strain increased from the epicardium toward the endocardium. A base-to-apex gradient of longitudinal strain toward the apex was exhibited in inferior and inferoseptal regions and, in contrast, in the opposite direction in anterior and anterolateral walls. Sex had the strongest influence on LV deformation variability. Conclusions: Strain and strain rate reference values were sex and race related. White women showed the highest reference ranges for LV deformation, while the lowest values were found in black men. Significant layer- and level-specific patterns in regional LV deformation were identified.

KW - Echocardiography

KW - Left ventricular function

KW - Myocardial contraction

KW - Myocardial strain

KW - Speckle-tracking echocardiography

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