Speckle-Tracking Echocardiography May Help Identify LV Diastolic Function Phenotypes

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Data derived from speckle-tracking echocardiography and conventional methods and data derived solely from speckle-tracking echocardiography showed a high degree of statistical overlap.
Data derived from speckle-tracking echocardiography and conventional methods and data derived solely from speckle-tracking echocardiography showed a high degree of statistical overlap.

Variables derived from speckle-tracking echocardiography (STE) strongly correlate with variables derived from 2-dimensional (2D) and Doppler echocardiography, and allow for phenotyping of left ventricular (LV) diastolic dysfunction in patients with heart failure (HF), according to findings published in JACC Cardiovascular Imaging.1

Nearly 1 million new cases of HF are diagnosed every year, underscoring the pressing need for improved phenotypic characterization of the condition, as well as methods to help identify high-risk patients in the early stages of HF.2 Although algorithms incorporating 2D, Doppler, and tissue Doppler measurements are effective, they require extensive training.

“The newer approaches in tracking natural myocardial markers, or speckles, in 2D cardiac ultrasound images for computing myocardial deformation provide incremental characterization of myocardial functional abnormalities beyond ejection fraction,” the investigators wrote. Previous studies have suggested that speckle-tracking echocardiography should be standardized for routine clinical use.3,4 

In the present study, researchers from the Ichan School of Medicine at Mount Sinai University in New York City and Ain Shams University in Cairo, Egypt, assessed STE-derived parameters in an exploratory cohort of 130 patients with HF symptoms and compared them with variables derived from conventional 2D and Doppler echocardiography. The researchers hypothesized that measurements from the 3 methods would be similar. In addition, they used cluster analysis to develop multivariable models of LV diastolic function.

Next, in a validation group of 44 patients with HF symptoms who underwent echocardiographic examination before left and right cardiac catheterization, the  investigators tested the models to assess “Doppler-independent phenotypic characterization of the LV diastolic dysfunction and noninvasive assessment of LV filling pressures,” as reported in the study. After echocardiography, an investigator who was blinded to the data measured pulmonary capillary wedge pressure and LV end-diastolic pressure in the validation group.

The results showed a high degree of statistical overlap between the data derived from STE and conventional methods of assessing diastolic function, and the data solely derived from STE “independently clustered the patients into 3 groups with conventional measurements verify[ing] increasing severity of diastolic dysfunction and LV filling pressures,” the researchers reported. These findings could eventually lead to “new opportunities for fully automated assessment of diastolic function in clinical practice.”

Disclosures: Dr Pedrizzetti reports that he is in a research partnership with Tomtec. Dr Narula has received research support from Panasonic, Philips, and GE Healthcare, as well as an honorarium from GE Healthcare. Dr Sengupta has served as an advisor to Heart Test Laboratories and TeleHealth Robotics and as a consultant for Hitachi Aloka. He has also received grants from Forest Laboratories and Heart Test Laboratories.

References

  1. Omar AM, Narula S, Abdel Rahman MA, et al. Precision phenotyping in heart failure and pattern clustering of ultrasound data for the assessment of diastolic dysfunction [published online January 18, 2017]. JACC Cardiovasc Imag. doi: 10.1016/j.jcmg.2016.10.012
  2. The American Heart Association. Causes and risks for heart failure. Dallas, TX: American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartFailure/CausesAndRisks
    ForHeartFailure/Causes-and-Risks-for-Heart-Failure_UCM_002046_Article.jsp#
    . Accessed January 26, 2017.
  3. Voigt JU, 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(2):183-193. doi: 10.1016/j.echo.2014.11.003
  4. Knackstedt C, Bekkers SCAM, Schummers G, et al. Fully automated vs standard tracking of left ventricular ejection fraction and longitudinal strain: the FAST-EFs Multicenter Study. J Am Coll Cardiol. 2015;66(13):1456-1466. doi:10.1016/j.jacc.2015.07.052
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