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Perez-Fernandez OM, Medina HM, Lopez M, Barrera M, Martinez A, Benavides J, Duran JC, Salazar G, Manrique FT. Global longitudinal strain in heart transplantation recipients using different vendors: reliability and validity in a tertiary hospital in Colombia. Int J Cardiovasc Imaging 2021; 38:279-287. [PMID: 34487311 DOI: 10.1007/s10554-021-02398-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/30/2021] [Indexed: 12/27/2022]
Abstract
Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman's limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coefficient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and specificity of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p < 0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Specificity of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips'. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.
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Affiliation(s)
- Oscar Mauricio Perez-Fernandez
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia.
| | - Hector M Medina
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Mónica Lopez
- Research Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia.,Cardiology and Heart Transplantation Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Madeleine Barrera
- Cardiology Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Azucena Martinez
- Cardiology Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Jhonattan Benavides
- Cardiology Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Juan C Duran
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Gabriel Salazar
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia
| | - Frida Tatiana Manrique
- Cardiovascular Imaging and Non-Invasive Department, Fundación Cardioinfantil - Instituto de Cardiología, 110131, Bogotá, Colombia.
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The strain and strain rate imaging paradox in echocardiography: overabundant literature in the last two decades but still uncertain clinical utility in an individual case. Arch Med Sci Atheroscler Dis 2021; 5:e297-e305. [PMID: 33644489 PMCID: PMC7885811 DOI: 10.5114/amsad.2020.103032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Almost two decades ago strain and strain rate imaging were proposed as a new, potentially more sensitive modality for quantifying both regional and global myocardial function. Until now, however, strain and strain rate imaging have been slow to be incorporated into everyday clinical practice. More recently, two dimensional strain has been claimed as of greater clinical utility, given that it is angle independent, with improved feasibility and reproducibility as compared to tissue Doppler strain. Nevertheless, speckle tracking strain is reliant on 2D image quality and frame rates. Three dimensional speckle tracking could eliminate the problem of through-plane motion inherent in 2D imaging, but 3D strain is currently limited by low frame rates. Another limitation of strain imaging is that the results are dependent on the ultrasound machine on which analyses are performed, with variability in measurements between different vendors. Despite the diagnostic and prognostic advantages of 2D strain, there is a lack of specific therapeutic interventions based on strain and a paucity of long-term large-scale randomized trial evidence on cardiovascular outcomes. After overabundant literature the same definition of normal cut-off values is controversial and not univocal. Further studies are needed, involving both manufacturers and medical professionals, on the additive contribution, possibly different case by case, of interfering and artifactual factors, aside from myocardial function per se. These artifactual determinants and motion artifacts components could be dominant in individual cases and should always be taken into account in the clinical decision making process in a single case.
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Ancedy Y, Ederhy S, Jean ML, Nhan P, Soulat-Dufour L, Adavane-Scheuble S, Chauvet-Droit M, Boccara F, Cohen A. Does layer-specific strain using speckle tracking echocardiography improve the assessment of left ventricular myocardial deformation? A review. Arch Cardiovasc Dis 2020; 113:721-735. [PMID: 32891564 DOI: 10.1016/j.acvd.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
An increasing number of studies of left ventricular myocardial deformation have been published. Layer-specific strain using speckle tracking echocardiography to evaluate left ventricular function is not recommended in clinical practice. However, evaluation of myocardial mechanics using longitudinal and circumferential layer-specific strain enables the detection of subclinical impairment of myocardial deformation in various diseases. Unfortunately, normal values for longitudinal and circumferential strain have not been clearly defined. In normal subjects, layer-specific strain decreases from the endocardial to the epicardial layer, and from the apex to the base of the left ventricle. Although various studies have tried to define normal values for each layer in healthy subjects, studies with more subjects are needed. This tool has good reproducibility in terms of intraobserver and interobserver variability, but, as with monolayer strain, it has poor intervendor variability. Efforts that aim for standardization between vendors will be required before widespread use of this technique can be advocated.
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Affiliation(s)
- Yann Ancedy
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Stephane Ederhy
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Marie-Liesse Jean
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Pascal Nhan
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Laurie Soulat-Dufour
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Saroumadi Adavane-Scheuble
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Marion Chauvet-Droit
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Franck Boccara
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France.
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Walker V, Lairez O, Fondard O, Jimenez G, Camilleri J, Panh L, Broggio D, Bernier MO, Laurier D, Ferrières J, Jacob S. Myocardial deformation after radiotherapy: a layer-specific and territorial longitudinal strain analysis in a cohort of left-sided breast cancer patients (BACCARAT study). Radiat Oncol 2020; 15:201. [PMID: 32819449 PMCID: PMC7439550 DOI: 10.1186/s13014-020-01635-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
Background Radiotherapy for breast cancer (BC) and its resulting cardiac exposure are associated with subclinical left ventricular dysfunction characterized by early decrease of global longitudinal strain (LS) measurement based on 2D speckle-tracking echocardiography. Recent software allows multi-layer and segmental analysis of strain, which may be of interest to quantify and locate the impact of cardiac exposure on myocardial function and potentially increase the early detection of radiation-induced cardiotoxicity. The aim of the study was to evaluate whether decrease in LS 6 months after radiotherapy is layer-specific and if it varies according to the left ventricular regional level and the coronary arterial territories. Methods LS was measured at baseline before radiotherapy and 6 months post-radiotherapy. The LS was obtained for each myocardial layer (endocardial, mid-myocardial, epicardial), left ventricular regional level (basal, mid, apical) and coronary artery territory (left anterior descending artery (LAD), circumflex artery, right coronary artery). Results The study included 64 left-sided BC patients. Mean age was 58 years, mean doses to the heart, the left ventricle and the LAD were respectively 3.0, 6.7 and 16.4 Gy. The absolute decrease of LS was significant for the three layers (endocardial: − 20.0 ± 3.2% to − 18.8 ± 3.8%; mid-myocardial: − 16.0 ± 2.7% to − 15.0 ± 3.1%; epicardial: − 12.3 ± 2.5% to − 11.4 ± 2.8%, all p = 0.02), but only the relative decrease of LS in the endocardial layer was close to be significant (− 4.7%, p = 0.05). More precisely, the LS of the endocardial layer was significantly decreased for the most exposed parts of the left ventricle corresponding to the apical level (− 26.3 ± 6.0% vs. -24.2 ± 7.1%, p = 0.03) and LAD territory (− 22.8 ± 4.0% vs. -21.4 ± 4.8%, p = 0.03). Conclusion Six months post-radiotherapy, LS decreased predominantly in the endocardial layer of the most exposed part of the left ventricle. For precise evaluation of radiotherapy-induced cardiotoxicity and early left ventricular dysfunction, the endocardial layer-based LS might be the most sensitive parameter. Trial registration ClinicalTrials.gov: NCT02605512, Registered 6 November 2015 - Retrospectively registered.
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Affiliation(s)
- Valentin Walker
- Pôle Santé-Environnement (PSE-SANTE), Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants (SESANE), Laboratoire d'épidémiologie des rayonnements ionisants (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP17, 92262, Fontenay-aux-Roses cedex, France
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, 31059, Toulouse, France.,Cardiac Imaging Centre, Rangueil University Hospital, 31059, Toulouse, France.,Medical School of Rangueil, University Paul Sabatier, 31400, Toulouse, France
| | - Olivier Fondard
- Department of Cardiology, Clinique Pasteur, 31300, Toulouse, France
| | - Gaëlle Jimenez
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, 31300, Toulouse, France
| | - Jérémy Camilleri
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, 31300, Toulouse, France
| | - Loïc Panh
- Department of Cardiac Arrhythmia, Clinique Pasteur, 31300, Toulouse, France
| | - David Broggio
- Department of dosimetry, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Marie-Odile Bernier
- Pôle Santé-Environnement (PSE-SANTE), Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants (SESANE), Laboratoire d'épidémiologie des rayonnements ionisants (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP17, 92262, Fontenay-aux-Roses cedex, France
| | - Dominique Laurier
- Division of Health and Environment, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Jean Ferrières
- Department of Cardiology, Rangueil University Hospital, 31059, Toulouse, France.,Medical School of Purpan, University Paul Sabatier, 31000, Toulouse, France.,INSERM, UMR1027, 31000, Toulouse, France
| | - Sophie Jacob
- Pôle Santé-Environnement (PSE-SANTE), Service de recherche sur les effets biologiques et sanitaires des rayonnements ionisants (SESANE), Laboratoire d'épidémiologie des rayonnements ionisants (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP17, 92262, Fontenay-aux-Roses cedex, France.
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Ruiz‐Ortiz M, Rodriguez‐Diego S, Delgado M, Kim J, Weinsaft JW, Ortega R, Carnero L, Sánchez JJ, Carrasco F, López‐Aguilera J, López‐Granados A, Arizón JM, Paredes N, Oneto‐Fernandez J, Pan M, Mesa D. Myocardial deformation and acute cellular rejection after heart transplantation: Impact of inter‐vendor variability in diagnostic effectiveness. Echocardiography 2019; 36:2185-2194. [DOI: 10.1111/echo.14544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Mónica Delgado
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | - Jiwon Kim
- Greenberg Division of Cardiology Weill Cornell Medical College New York NY USA
| | | | - Rosa Ortega
- Pathology Department Reina Sofia University Hospital Cordoba Spain
| | - Lucía Carnero
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | - José J. Sánchez
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | | | | | | | - José M. Arizón
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | - Nick Paredes
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | | | - Manuel Pan
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | - Dolores Mesa
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
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Bhat S, Gahungu N, Thavendiranathan P, Dwivedi G. The Role of Echocardiography in Cardio-oncology Patients: Contemporary Indications and Future Directions. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9519-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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7
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Walker V, Lairez O, Fondard O, Pathak A, Pinel B, Chevelle C, Franck D, Jimenez G, Camilleri J, Panh L, Broggio D, Derreumaux S, Bernier MO, Laurier D, Ferrières J, Jacob S. Early detection of subclinical left ventricular dysfunction after breast cancer radiation therapy using speckle-tracking echocardiography: association between cardiac exposure and longitudinal strain reduction (BACCARAT study). Radiat Oncol 2019; 14:204. [PMID: 31727075 PMCID: PMC6854785 DOI: 10.1186/s13014-019-1408-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/28/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Breast cancer (BC) radiotherapy (RT) can induce cardiotoxicity, with adverse events often observed many years after BC RT. Subclinical left ventricular (LV) dysfunction can be detected early after BC RT with global longitudinal strain (GLS) measurement based on 2D speckle-tracking echocardiography. This 6-month follow-up analysis from the BACCARAT prospective study aimed to investigate the association between cardiac radiation doses and subclinical LV dysfunction based on GLS reduction. METHODS The patient study group consisted of 79 BC patients (64 left-sided BC, 15 right-sided BC) treated with RT without chemotherapy. Echocardiographic parameters, including GLS, were measured before RT and 6 months post-RT. The association between subclinical LV dysfunction, defined as GLS reduction > 10%, and radiation doses to whole heart and the LV were performed based on logistic regressions. Non-radiation factors associated with subclinical LV dysfunction including age, BMI, hypertension, hypercholesterolemia and endocrine therapy were considered for multivariate analyses. RESULTS A mean decrease of 6% in GLS was observed (- 15.1% ± 3.2% at 6 months vs. - 16.1% ± 2.7% before RT, p = 0.01). For left-sided patients, mean heart and LV doses were 3.1 ± 1.3 Gy and 6.7 ± 3.4 Gy respectively. For right-sided patients, mean heart dose was 0.7 ± 0.5 Gy and median LV dose was 0.1 Gy. Associations between GLS reduction > 10% (37 patients) and mean doses to the heart and the LV as well as the V20 were observed in univariate analysis (Odds Ratio = 1.37[1.01-1.86], p = 0.04 for Dmean Heart; OR = 1.14 [1.01-1.28], p = 0.03 for Dmean LV; OR = 1.08 [1.01-1.14], p = 0.02 for LV V20). In multivariate analysis, these associations did not remain significant after adjustment for non-radiation factors. Further exploratory analysis allowed identifying a subgroup of patients (LV V20 > 15%) for whom a significant association with subclinical LV dysfunction was found (adjusted OR = 3.97 [1.01-15.70], p = 0.048). CONCLUSIONS This analysis indicated that subclinical LV dysfunction defined as a GLS decrease > 10% is associated with cardiac doses, but adjustment for non-radiation factors such as endocrine therapy lead to no longer statistically significant relationships. However, LV dosimetry may be promising to identify high-risk subpopulations. Larger and longer follow-up studies are required to further investigate these associations. TRIAL REGISTRATION ClinicalTrials.gov: NCT02605512, Registered 6 November 2015 - Retrospectively registered.
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Affiliation(s)
- Valentin Walker
- Laboratory of Epidemiology (LEPID), PSE-SANTE, SESANE, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Olivier Lairez
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Olivier Fondard
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Atul Pathak
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Baptiste Pinel
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, France
| | - Christian Chevelle
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, France
| | - Denis Franck
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, France
| | - Gaëlle Jimenez
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, France
| | - Jérémy Camilleri
- Department of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, France
| | - Loïc Panh
- Department of Cardiac Arrhythmia, Clinique Pasteur, Toulouse, France
| | - David Broggio
- Department of Dosimetry, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Sylvie Derreumaux
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Marie-Odile Bernier
- Laboratory of Epidemiology (LEPID), PSE-SANTE, SESANE, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Jean Ferrières
- Department of Cardiology, Toulouse University Hospital, Toulouse, France.,INSERM, UMR1027, Toulouse, France
| | - Sophie Jacob
- Laboratory of Epidemiology (LEPID), PSE-SANTE, SESANE, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.
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