[en] Aims
To obtain the normal ranges for 2D echocardiographic (2DE) measurements of left ventricular (LV) strain from a large group of healthy volunteers accounting for age and gender.
Methods and results
A total of 549 (mean age: 45.6 ± 13.3 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. 2DE data sets have been analysed with a vendor-independent software package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire the data sets. The lowest expected values of LV strains and twist calculated as ± 1.96 standard deviations from the mean were −16.7% in men and −17.8% in women for longitudinal strain, −22.3% and −23.6% for circumferential strain, 20.6% and 21.5% for radial strain, and 2.2 degrees and 1.9 degrees for twist, respectively. In multivariable analysis, longitudinal strain decreased with age whereas the opposite occurred with circumferential and radial strain. Male gender was associated with lower strain for longitudinal, circumferential, and radial strain. Inter-vendor differences were observed for circumferential and radial strain despite the use of vendor-independent software. Importantly, no intervendor differences were noted in longitudinal strain.
Conclusion
The NORRE study provides contemporary, applicable 2D echocardiographic reference ranges for LV longitudinal, radial, and circumferential strain. Our data highlight the importance of age- and gender-specific reference values for LV strain.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Sugimoto, T; Université de Liège - ULiège > Cardiologie
DULGHERU, Raluca Elena ; Centre Hospitalier Universitaire de Liège - CHU > Service de cardiologie
BERNARD, Anne-Catherine ; Centre Hospitalier Universitaire de Liège - CHU > Service de cardiologie
Ilardi, Federica; Université de Liège - ULiège > Cardiologie
Contu, L; Université de Liège - ULiège > Cardiologie
Addetia, K; University of Chicago > Medicine
Caballero, L; Hospital Clinico Universitario Virgen de la Arrixaca > Cardiologie
Akhaladze, N; JO ANN Medical Center > Echocardiography
Athanassopoulos, George; Onassis Cardiac Surgery Cente > Noninvasive Diagnostics
Barone, D; S. Andrea Hospital > Cardiologie
Baroni, M; Fondazione Toscana ‘G.Monasterio’—Ospedale Del Cuore > Laboratorio Di Ecocardiografia Adulti
Cardim, Nuno; Hospital da Luz > Echocardiography
Hagendorff, Andreas; University of Leipzig > Cardiology-Angiology
Hristova, K; University National Heart Hospital > Noninvasive Functional Diagnostic and Imaging
Lopez, T; La Paz University Hospital > Cardiology
de la Morena, G; Hospital Clinico Universitario Virgen de la Arrixaca > Cardiologie
Popescu, Bogdan Alexandru; Carol Davila’ University of Medicine and Pharmacy—Euroecolab, Institute of Cardiovascular Diseases
MOONEN, Marie ; Centre Hospitalier Universitaire de Liège - CHU > Service de cardiologie
Penicka, M; OLV-Clinic > Cardiovascular Center Aalst
Ozyigit, T; Kardiyoloji Bölümü > VKV Amerikan Hastanesi
Carbonero, JDR; Hospital de Cruces > Echocardiography
van de Veire, N; AZ Maria Middelares Gent > Echocardiography
von Bardeleben, RS; Universitätsmedizin of the Johannes Gutenberg-University Mainz > Cardiologie
Vinereanu, D; University of Medicine and Pharmacy Carol Davila > Cardiovascular Research
Zamorano, JL; University Alcala, Hospital Ramón y Cajal
Go, YY; Université de Liège - ULiège > Cardiology
Rosca, M; Carol Davila’ University of Medicine and Pharmacy—Euroecolab, Institute of Cardiovascular Diseases
Calin, A; Carol Davila’ University of Medicine and Pharmacy—Euroecolab, Institute of Cardiovascular Diseases
Magne, Julien; CHU Dupuytren, Limoges
Cosyns, Bernard; Universitair ziekenhuis Brussel > CHVZ (Centrum voor Hart en Vaatziekten)
MARCHETTA, Stella ; Centre Hospitalier Universitaire de Liège - CHU > Service de cardiologie
Donal, Erwan; Université Rennes 1 > Cardiologie
Habib, G; La Timone Hospital > Cardiologie
Galderisi, Maurizio; Federico II University Hospital > Advanced Biomedical Sciences
Badano, LP; University of Padova > Cardiac, Thoracic and Vascular Sciences
Lang, RM; University of Chicago > Medicine
Lancellotti, Patrizio ; Université de Liège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie
Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging 2009;2:356-64.
Mignot A, Donal E, Zaroui A, Reant P, Salem A, Hamon C et al. Global longitudinal strain as a major predictor of cardiac events in patients with depressed left ventricular function: a multicenter study. J Am Soc Echocardiogr 2010;23:1019-24.
Ersbøll M, Valeur N, Mogensen UM, Andersen MJ, Møller JE, Velazquez EJ et al Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction. J Am Coll Cardiol 2013;61:2365-73.
Haugaa KH, Grenne BL, Eek CH, Ersbøll M, Valeur N, Svendsen JH et al. Strain echocardiography improves risk prediction of ventricular arrhythmias after myocardial infarction. JACC Cardiovasc Imaging 2013;6:841-50.
Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardio-toxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol 2014;63:2751-68.
Zamorano JL, Lancellotti P, Rodriguez Munoz D, Aboyans V, Asteggiano R, Galderisi M et al 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J 2016;37:2768-801.
Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014;15:1063-93.
Yingchoncharoen T, Agarwal S, Popovic ZB, Marwick TH. Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr 2013;26:185-91.
Yang H, Marwick TH, Fukuda N, Oe H, Saito M, Thomas JD et al Improvement in strain concordance between two major vendors after the strain standardization initiative. J Am Soc Echocardiogr 2015;28:642-8.
Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G et al Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Heart J Cardiovasc Imaging 2014;15:680-90.
Caballero L, Kou S, Dulgheru R, Gonjilashvili N, Athanassopoulos GD, Barone D et al Echocardiographic reference ranges for normal cardiac Doppler data: re-sults from the NORRE Study. Eur Heart J Cardiovasc Imaging 2015;16:1031-41.
Saura D, Dulgheru R, Caballero L, Bernard A, Kou S, Gonjilashvili N et al Two-dimensional transthoracic echocardiographic normal reference ranges for proximal aorta dimensions: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017;18:167-79.
Bernard A, Addettia K, Dulgheru R, Caballero L, Sugimoto T, Akhaladze N et al 3D echocardiographic reference ranges for normal left ventricular volume and strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017;18:475-83.
Lancellotti P, Badano LP, Lang RM, Akhaladze N, Athanassopoulos GD, Barone D et al Normal Reference Ranges for Echocardiography: rationale, study design, and methodology (NORRE Study). Eur Heart J Cardiovasc Imaging 2013;14:303-8.
Cosyns B, Garbi M, Separovic J, Pasquet A, Lancellotti P. Education Committee of the European Association of Cardiovascular Imaging Association (EACVI). Update of the echocardiography core syllabus of the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2013;14:837-9.
Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, 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 standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2015;16:1-11.
Kocabay G, Muraru D, Peluso D, Cucchini U, Mihaila S, Padayattil-Jose S et al Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults. Rev Esp Cardiol (Engl Ed) 2014;67:651-8.
Dalen H, Thorstensen A, Aase SA, Ingul CB, Torp H, Vatten LJ et al Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway. Eur J Echocardiogr 2010;11:176-83.
Kleijn SA, Pandian NG, Thomas JD, 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;16:410-6.
Muraru D, Cucchini U, Mihaila S, Miglioranza MH, 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;27:858-71.
Marwick TH, Leano RL, Brown J, Sun JP, Hoffmann R, Lysyansky P et al Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range. JACC Cardiovasc Imaging 2009;2:80-4.
Risum N, Ali S, Olsen NT, Jons C, Khouri MG, Lauridsen TK et al. Variability of global left ventricular deformation analysis using vendor dependent and independent two-dimensional speckle-tracking software in adults. J Am Soc Echocardiogr 2012;25:1195-203.