- Email: [email protected]
THE CLINICAL USEFULNESS AND UTILIZATION OF TISSUE DOPPLER IMAGING, LONGITUDINAL AND CIRCUMFERENTIAL STRAIN AND STRAIN RATE IN THE DIAGNOSTIC ACCURACY FOR DIFFERENT PHENOTYPES OF HEART FAILURE
E1125 JACC March 12, 2013 Volume 61, Issue 10
Imaging The Clinical Usefulness and Utilization of Tissue Doppler Imaging, Longitudinal and Circumferential Strain and Strain Rate in the Diagnostic Accuracy for Different Phenotypes of Heart Failure Poster Contributions Poster Sessions, Expo North Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Multimodality Imaging in Cardiomyopathy Abstract Category: 18. Imaging: Echo Presentation Number: 1316-371 Authors: Yau-Huei Lai, Chi-In Lo, Kuo-Tzu Sung, Jen-Yuan Kuo, Yih-Jer Wu, Hung-I Yeh, Chung-Lieh Hung, Mackay Memorial Hospital, Taipei, Taiwan,ROC Background: Tissue Doppler imaging (TDI) is a sensitive tool in identifying diastolic dysfunction. Recent progresses in myocardial deformation imaging has enabled early detection of subclinical systolic dysfunction. Head-to-head comparison and optimal cut-off by these measures for different heart failure phenotypes remained elusive. Methods: We performed echocardiography on 3 groups of hospitalized patients: 64 with heart failure and preserved ejection fraction (HFpEF, defined as EF≥50%); 66 with reduced ejection fraction HF (HFrEF); 240 without HF. Mitral annulus systolic (S’) and early diastolic (E’) velocities were measured by TDI, with global longitudinal (GLS) and circumferential strain (GCS), systolic (S’ SR) and diastolic strain rate (E’ SR) obtained by a dedicated system. The diagnostic accuracy and optimal cut-off for these parameters were further compared. Results: For all HF patients, the sensitivity, specificity, and area under ROC curve (AUROC) for GLS were 77.7%, 87.9%, 0.9. For the HFpEF and HFrEF groups, they were 68.8%, 86.7%, 0.85 and 83.3%, 86.2%, 0.91 respectively. Longitudinal S’ SR had good AUROC (0.74) in HFpEF; circumferential E’ SR was most sensitive (93.7%). In HFrEF, the specificity and AUROC were best for longitudinal S’ SR (85.9%, 0.88) and fractional shortening (83.1%, 0.87). Conclusion: Deformation imaging, especially global longitudinal strain, remains a reliable indicator of subclinical systolic dysfunction, which may be more accurate than TDI in detecting HFpEF. HFpEF+HFrEF (n=130) Sensitivity (%) GLS 77.7 S’ LSR 79.1 E’ LSR 68.2 GCS 66.7 S’ CSR 46.5 E’ CSR 48.8 LFS 68.3 TDI S’ 43.1 TDI E’ 64.6 HFpEF (n=64) Sensitivity (%) GLS 68.8 S’ LSR 59.4 E’ LSR 60.9 GCS 46 S’ CSR 41.3 E’ CSR 93.7 LFS 50 TDI S’ 87.5 TDI E’ 50
Specificity (%) 87.9 73.8 67.5 69.9 86.2 72.8 73.6 87.4 72.2
PPV (%) 77.7 61.8 53 54.4 64.5 49.2 57.7 65.1 56
NPV (%) 87.9 86.8 79.8 79.5 74.9 72.5 81.5 73.8 78.8
AUROC 0.9002 0.8306 0.7172 0.7171 0.689 0.6454 0.7625 0.681 0.7142
Optimal Cut-off point -16.3 -0.99 0.88 -16.5 -0.9 0.8 16.4 4.8 -5.1
Specificity (%) 86.7 80 67.5 69.9 74.9 20.5 73.6 25.2 81
PPV (%) 57.9 44.2 33.3 28.7 30.2 23.7 33 23.9 41.6
NPV (%) 91.2 88.1 86.6 83.1 82.9 92.5 85 88.2 85.7
AUROC 0.8528 0.742 0.6507 0.5648 0.5464 0.5231 0.6322 0.5723 0.6767
Optimal Cut-off point -16.4 -0.95 0.88 -16.5 -1 1.55 16.4 7.4 -4.5
Abbreviations: GLS=global longitudinal strain, S’ LSR=systolic longitudinal strain rate, E’ LSR=diastolic longitudinal strain rate, GCS=global circumferential strain, S’ CSR=systolic circumferential strain rate, E’ CSR=diastolic circumferential strain rate, LFS=longitudinal fractional shortening, PPV: positive predictive value, NPV: negative predictive value.
Imaging The Clinical Usefulness and Utilization of Tissue Doppler Imaging, Longitudinal and Circumferential Strain and Strain Rate in the Diagnostic Accuracy for Different Phenotypes of Heart Failure Poster Contributions Poster Sessions, Expo North Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Multimodality Imaging in Cardiomyopathy Abstract Category: 18. Imaging: Echo Presentation Number: 1316-371 Authors: Yau-Huei Lai, Chi-In Lo, Kuo-Tzu Sung, Jen-Yuan Kuo, Yih-Jer Wu, Hung-I Yeh, Chung-Lieh Hung, Mackay Memorial Hospital, Taipei, Taiwan,ROC Background: Tissue Doppler imaging (TDI) is a sensitive tool in identifying diastolic dysfunction. Recent progresses in myocardial deformation imaging has enabled early detection of subclinical systolic dysfunction. Head-to-head comparison and optimal cut-off by these measures for different heart failure phenotypes remained elusive. Methods: We performed echocardiography on 3 groups of hospitalized patients: 64 with heart failure and preserved ejection fraction (HFpEF, defined as EF≥50%); 66 with reduced ejection fraction HF (HFrEF); 240 without HF. Mitral annulus systolic (S’) and early diastolic (E’) velocities were measured by TDI, with global longitudinal (GLS) and circumferential strain (GCS), systolic (S’ SR) and diastolic strain rate (E’ SR) obtained by a dedicated system. The diagnostic accuracy and optimal cut-off for these parameters were further compared. Results: For all HF patients, the sensitivity, specificity, and area under ROC curve (AUROC) for GLS were 77.7%, 87.9%, 0.9. For the HFpEF and HFrEF groups, they were 68.8%, 86.7%, 0.85 and 83.3%, 86.2%, 0.91 respectively. Longitudinal S’ SR had good AUROC (0.74) in HFpEF; circumferential E’ SR was most sensitive (93.7%). In HFrEF, the specificity and AUROC were best for longitudinal S’ SR (85.9%, 0.88) and fractional shortening (83.1%, 0.87). Conclusion: Deformation imaging, especially global longitudinal strain, remains a reliable indicator of subclinical systolic dysfunction, which may be more accurate than TDI in detecting HFpEF. HFpEF+HFrEF (n=130) Sensitivity (%) GLS 77.7 S’ LSR 79.1 E’ LSR 68.2 GCS 66.7 S’ CSR 46.5 E’ CSR 48.8 LFS 68.3 TDI S’ 43.1 TDI E’ 64.6 HFpEF (n=64) Sensitivity (%) GLS 68.8 S’ LSR 59.4 E’ LSR 60.9 GCS 46 S’ CSR 41.3 E’ CSR 93.7 LFS 50 TDI S’ 87.5 TDI E’ 50
Specificity (%) 87.9 73.8 67.5 69.9 86.2 72.8 73.6 87.4 72.2
PPV (%) 77.7 61.8 53 54.4 64.5 49.2 57.7 65.1 56
NPV (%) 87.9 86.8 79.8 79.5 74.9 72.5 81.5 73.8 78.8
AUROC 0.9002 0.8306 0.7172 0.7171 0.689 0.6454 0.7625 0.681 0.7142
Optimal Cut-off point -16.3 -0.99 0.88 -16.5 -0.9 0.8 16.4 4.8 -5.1
Specificity (%) 86.7 80 67.5 69.9 74.9 20.5 73.6 25.2 81
PPV (%) 57.9 44.2 33.3 28.7 30.2 23.7 33 23.9 41.6
NPV (%) 91.2 88.1 86.6 83.1 82.9 92.5 85 88.2 85.7
AUROC 0.8528 0.742 0.6507 0.5648 0.5464 0.5231 0.6322 0.5723 0.6767
Optimal Cut-off point -16.4 -0.95 0.88 -16.5 -1 1.55 16.4 7.4 -4.5
Abbreviations: GLS=global longitudinal strain, S’ LSR=systolic longitudinal strain rate, E’ LSR=diastolic longitudinal strain rate, GCS=global circumferential strain, S’ CSR=systolic circumferential strain rate, E’ CSR=diastolic circumferential strain rate, LFS=longitudinal fractional shortening, PPV: positive predictive value, NPV: negative predictive value.