2D speckle-tracking assessment of left ventricular myocardial strain in healthy children and adolescents

Introduction.To determine the relevant indicators of strain and strain rate of the left ventricular myocardium in children and adolescents.

Materials and methods. Have been examined 67 patients form aged from 7 up to 17 years old. 1-st group – 30 children from 7 to 11 years old; 2-nd group – 37 adolescents from 12 to 17 years old. Аt an echocardiographic examination the systolic function of the left ventricle was determined: ejection and shortening fractions, in 2D-speckle-tracking mode – global and segmental longitudinal, circular and radial strain and strain rates.

Results. Have been studied the relevant indicators of global and segmental longitudinal, radial, circular deformities of the left ventricular myocardium and their rates in healthy children and adolescents. A statistically significant increase in global and segmental longitudinal strain, radial and circular strain rates in the 2-nd group compared with the 1-st group had revealed. Had found that the uniform distribution of indicators in the ranges of confidence intervals, noted in the assessment of global radial strain and circular strain rate, as well as a statistically significant predominance of strain indicators in the subendocardial layers compared with the subepicardial layers of the myocardium left ventricle.

Conclusions. 1. In adolescents 12–17 years old, compared with children 7–11 years old, there is a statistically  significant predominance of global and segmental longitudinal strain, radial and circular strain rates of the left  ventricular myocardium. Radial strain and circular strain rate of the left ventricular myocardium are the most uniform in contrast to other indicators of strain.
2. In healthy children and adolescents, had observed statistically significant higher strain and strain rate in the subendocardial layer compared to the subepicardial layer of the myocardium.
3. The obtained indicators of global and segmental myocardial strain can serve as normative for children and  adolescents in assessing the systolic function of the left ventricle.

1. Voigt J.U., Pedrizzetti G., Lysyansky P., Marwick T.H., Houle H., Baumann R. et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardizede formation imaging. Eur Heart J Cardiovasc Imaging. 2015;16(1):1–11. doi: 10.1093/ehjci/jeu184.

2. Alekhin M.N. Ultrasonic methods for assessing myocardial strain and their clinical significance. M.: Vidar-M; 2012. 88 p. (In Russ.)

3. Rybakova M.K., Mitkov V.V., Baldin D.G. Echocardiography from Rybakova M.K. M.: Vidar; 2016. 600 p. (In Russ.)

4. Bokeriya L.A., Alekhin M.N., Mashina T.A., Mrikaev D.V., Golukhova E.Z. Modern ultrasonic technologies in cardiology and cardiac surgery. M.: Bakulev Scientific Center of Cardiovascular Surgery; 2018. 140 p. (In Russ.) Doi: https://www.elibrary.ru/item.asp?id=36572533.

5. Yang H., Marwick T.H., Fukuda N., Oe H., Saito M., Thomas J.D., Negishi K. Improvement in strain concordance between two major vendors after the strain standardization initiative. J Am Soc Echocardiogr. 2015;28(6):642–648. doi: 10.1016/j.echo.2014.12.009.

6. Manovel A., Dawson D., Smith B., Nihoyannopoulos P. Assessment of left ventricular function by different speckle-tracking software. Eur J Echocardiogr. 2010;11(5):417–421. doi: 10.1093/ejechocard/jep226.

7. Yingchoncharoen T., Agarwal S. Popović Z.B., Marwick T.H. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr. 2013;26(2):185–191. doi: 10.1016/j.echo.2012.10.008.

8. Nikiforov V.S., Marsalskaya O.A., Novikov V.I. Echocardiographic assessment of myocardial strain in clinical practice. St Petersburg: KultInformPress; 2015. 28 p. (In Russ.)

9. Takigiku K., Takeuchi M., Izumi C., Yuda S., Sakata K., Ohte N. et al. Normal Range of Left Ventricular 2-Dimensional Strain. Japanese Ultrasound Speckle Tracking of the Left Ventricle Study. Circ J. 2012;76(11):2623–2632. doi: 10.1253/circj.cj-12-0264.

10. Sun J.P., Pui-Wai Lee A., Wu C., Lam Y.Y., Hung M.J., Chen L. et al. Quantification of Left Ventricular Regional Myocardial Function Using Two-Dimensional Speckle Tracking Echocardiography in Healthy Volunteers- A Multi-Center Study. Int J Cardiol. 2013;167(2):495–501. doi: 10.1016/j.ijcard.2012.01.071.

11. Kocabay G., Muraru D., Peluso D., Cucchini U., Mihaila S., Padayattil-Jose S. et al. Normal left ventricular mechanics by two-dimensional speckletracking echocardiography. Reference values in healthy adults. Rev Esp Cardiol (Engl Ed). 2014;67(8):651–658. doi: 10.1016/j.rec.2013.12.009.

12. Muraru D., Cucchini U., Mihăilă S., Miglioranza M.H., Aruta P., Cavalli G. et al. Left ventricular myocardial strain by three-dimensional speckle-tracking echocardiography in healthy subjects: reference values and analysis of their physiologic and technical determinants. J Am Soc Echocardiogr. 2014;27(8):858–871. doi: 10.1016/j.echo.2014.05.010.

13. Maharaj N., Peters F., Khandheria B.K., Libhaber E., Essop M.R. Left ventricular twist in a normal African adult population. Eur Heart J Cardiovasc Imaging. 2013;14(6):526–533. doi: 10.1093/ehjci/jes208.

14. Kleijn S.A., Pandian N.G., Thomas J.D., Perez de Isla L., Kamp O., Zuber M. et al. Normal reference values of left ventricular strain using three-dimensional speckle tracking echocardiography: results from a multicentre study. Eur Heart J Cardiovasc Imaging. 2015;16(4):410–416. doi: 10.1093/ehjci/jeu213.

15. Jashari H., Rydberg A., Ibrahimi P., Bajraktari G., Kryeziu L., Jashari F., Henein M.Y. Normal ranges of left ventricular strain in children: a meta-analysis. Cardiovasc Ultrasound. 2015;13:37. doi: 10.1186/s12947-015-0029-0.

16. Cantinotti M., Cantinotti M., Assanta N., Crocetti M., Spadoni I., Iervasi G. Challenges in Interpreting Pediatric Normative Left Ventricular Strain Data and the Quest for Comprehensive Deformation Nomograms. J Am Soc Echocardiogr. 2016;29(6):567–568. doi: 10.1016/j.echo.2016.03.005.

17. Levy P.T., Machefsky A., Sanchez A.A., Patel M.D., Rogal S., Fowler S. et al. Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr. 2016;29(3):209–225. doi: 10.1016/j.echo.2015.11.016.

18. Ryabov V.V. (ed.) New medical technologies in prevention, diagnostics, and treatmnt of cardiological diseases. Tomsk: Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sceinces; 2018. 324 p. (In Russ.) Available at: https://www.cardio-tomsk.ru/storage/img/content/new_medical_technologies.pdf.

19. Sugak A.B., Nikolaeva G.N., Feoktistova Е.V., Lohmatova M.E., Tikhomirova E.A. Assessment of heart left ventricle function in children with β-thalassemia using the speckle-tracking method. Pediatriya = Pediatria. 2018;97(4):70–77. (In Russ.) Available at: https://pediatriajournal.ru/archive?show=365&section=5276.

20. Chernykh N.Yu., Groznova O.S., Dovgan M.I., Podolsky V.A. A change in myocardial deformity as an early marker for myocardial dysfunction in children with hypertrophic cardiomyopathy. Rossiyskiy Vestnik Perinatologii i Pediatrii = Russian Bulletin of Perinatology and Pediatrics. 2016;61(5):70–74. (In Russ.) doi: 10.21508/1027-4065-2016-61-5-70-74.