Key result
Systolic strain rate measured by 2D speckle tracking echocardiography discriminated normal from abnormal echocardiograms (1.1 vs 0.9 1/sec, P<0.001) with 82% sensitivity and 54% specificity.
Why the study?
Do 2DSTE and 3DE improve the identification of subclinical left ventricular dysfunction in patients referred for routine echocardiography?
Observational (n=81)
Do 2DSTE and 3DE improve the identification of subclinical left ventricular dysfunction in patients referred for routine echocardiography?
Absolute Event Rate: 1.1% vs 0.9%
p-value: p=<0.001
2DSTE and 3DE provide additional parameters such as strain rate that can detect subclinical left ventricular dysfunction even when standard 2D echocardiography appears normal.
May support strain rate for subclinical LV dysfunction detection; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: While speckle tracking echocardiography (2DSTE) can be used to study longitudinal, circumferential, and radial function, real time 3D echocardiography (3DE) generates dynamic time-volume curves, offering a wide array of new parameters for characterizing mechanical and volumetric properties of the left ventricle (LV). Our aim was to investigate the merit of these new techniques to separate normal from abnormal echocardiograms as well as to identify subclinical disease in reportedly normal subjects. METHODS: Eighty-one patients (mean age 61 ± 16 years) underwent standard 2D echocardiography (2DE) enhanced by 2DSTE and 3DE. The data included LV volumes and ejection fraction (EF), velocities, strain/strain rate, and peak ejection/filling rates. The patients were divided into Group 1: normal (n = 42) and Group 2: abnormal (n = 39) on the basis of an expert interpretation of the resting 2DE. RESULTS: Global longitudinal strain (%) was 17 ± 4 in Group1 and 14 ± 4 in Group2 (P < 0.002). Strain rates (SR, 1/sec) at peak systole (1.1 ± 0.2 vs 0.9 ± 0.3, P < 0.001) and early diastole (1.3 ± 0.3 vs 0.9 ± 0.3, P < 0.001) were also higher in Group1. Three-dimensional peak ejection and filling rates (EDV/sec) were significantly higher in Group1 (-2.5 ± 0.4 vs -2.1 ± 0.7, and 1.8 ± 0.2 vs 1.5 ± 0.5, P < 0.002, P < 0.001, respectively). The best discriminatory power for predicting a normal 2DE was systolic SR with a sensitivity of 82% and a specificity of 54% using a cutoff value of 1.09. Interestingly, 19/41 (46%) of Group1 patients had systolic SR < 1.09, suggesting subclinical disease. CONCLUSIONS: 2DSTE and 3DE can discriminate between normal and abnormal echocardiograms and have the potential to detect subclinical LV dysfunction.
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Saha et al. (2012) conducted an observational in Referred for routine echocardiography (n=81). Normal resting 2D echocardiogram vs. Abnormal resting 2D echocardiogram was evaluated on Systolic strain rate (1/sec) at peak systole (p=<0.001). Systolic strain rate measured by 2D speckle tracking echocardiography discriminated normal from abnormal echocardiograms (1.1 vs 0.9 1/sec, P<0.001) with 82% sensitivity and 54% specificity.
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