The Role of Speckle Strain Echocardiography in the Diagnosis of Early Subclinical Cardiac Injury in Cancer Patients—Is There More Than Just Left Ventricle Global Longitudinal Strain?

Figures

• 

  Figure 1. Left ventricle global longitudinal strain measurement GLS was assessed in three apical views, 4 chamber, 2 chamber and 3 chamber views, with 6 segments measured per each view (presented in the different colors), with a total of 18 segments per each exam.

• 

  Figure 2. Diastolic strain time (Dst) measurement. Dst was evaluated by measuring manually the time of lengthening (ms) of the myocardium during diastole, from the point of aortic valve closure (AVC) throughout the isovolumic relaxation time and early diastolic, until the plateau of the curve. Dst was assessed in three apical views, 4 chamber (A), 2 chamber (B) and 3 chamber (C) views, with 6 segments measured per each view (presented in the different colors), with a total of 18 segments per each exam. The red arrow shows how the measurement was performed manually for the average of the 6 segments in the 4-chamber view.

• 

  Figure 3. Left atrial strain measurement. Region of interest of the left atrial endocardial border, from the mitral annulus level to the pulmonary veins and/or LA appendage orifice, up to the opposite mitral annulus side were assessed. LASr = left atrial strain during reservoir phase (yellow arrow); LASc = left atrial strain during conduit phase (blue dot arrow); LASp = left atrial strain during atrial contraction phase (green arrow).

• 

  Figure 4. Right ventricle strain measurement. Region of interest of the right ventricle (RV) was defined by the endocardial border at the lateral tricuspid annulus level to the medial tricuspid annulus level. Then, the software automatically divided the apical right chamber views in 6 segments (three separate basal, mid and septal RV free wall strain traces, and three separate basal, mid and septal RV septal wall strain traces) and mathematically calculated RV global 4-chamber contour (RV4CSL) by averaging values of equal segment strain. Peak strain was defined as the peak value during entire heart cycle that may coincide with end-systolic peak or may appear after aortic valve closure. End systole (ES) was defined by the tricuspid valve opening time or by nadir of volume curve as surrogate. Segmental longitudinal strain curves. Note, free-wall strain segments are usually higher than septal strain segments.