Influence of Aging on Level and Layer-Specific Left Ventricular Longitudinal Strain in Subjects Without Structural Heart Disease

Values for level- (apical, mid, and basal) and layer-based (endocardial, mid-myocardial, and epicardial) left ventricular (LV) longitudinal strain across age are scarce. The present study evaluates the effect of aging on level- and layer-specific LV longitudinal strain in subjects without structural heart disease. A total of 408 subjects (mean age 58 years [range 16 to 91]; 49% men) were evaluated retrospectively. Subjects were divided into equal groups based on age and gender. Subjects with evidence of structural heart disease or arrhythmias were excluded. Mean LV ejection fraction was 62 ± 6.2%. A gradual increase in magnitude of level LV longitudinal strain was observed from basal to mid and apical levels (−16.7 ± 2.1%, −18.8 ± 2.0%, −22.6 ± 3.8%; p <0.001, respectively). Across age groups, there was a borderline significant decrease in magnitude of basal longitudinal strain in older subjects, whereas the magnitude in the apical level significantly increased. On layer-based analysis, the magnitude of longitudinal strain increased from epicardium to endocardium across all age groups. On multivariable analysis, only diabetes mellitus was associated with more impaired longitudinal strain in the endocardium, and male gender was associated with more impaired longitudinal strain at the epicardium layer. In conclusion, with increasing age, the magnitude of LV longitudinal strain at the basal level declines while the apical LV longitudinal strain increases. In contrast, layer-specific LV longitudinal strain remains unchanged with aging. The presence of diabetes mellitus modulated the effect of age on the LV endocardial layer, and male gender was associated with more impaired longitudinal strain at the epicardial layer. Values for level- (apical, mid, and basal) and layer-based (endocardial, mid-myocardial, and epicardial) left ventricular (LV) longitudinal strain across age are scarce. The present study evaluates the effect of aging on level- and layer-specific LV longitudinal strain in subjects without structural heart disease. A total of 408 subjects (mean age 58 years [range 16 to 91]; 49% men) were evaluated retrospectively. Subjects were divided into equal groups based on age and gender. Subjects with evidence of structural heart disease or arrhythmias were excluded. Mean LV ejection fraction was 62 ± 6.2%. A gradual increase in magnitude of level LV longitudinal strain was observed from basal to mid and apical levels (−16.7 ± 2.1%, −18.8 ± 2.0%, −22.6 ± 3.8%; p <0.001, respectively). Across age groups, there was a borderline significant decrease in magnitude of basal longitudinal strain in older subjects, whereas the magnitude in the apical level significantly increased. On layer-based analysis, the magnitude of longitudinal strain increased from epicardium to endocardium across all age groups. On multivariable analysis, only diabetes mellitus was associated with more impaired longitudinal strain in the endocardium, and male gender was associated with more impaired longitudinal strain at the epicardium layer. In conclusion, with increasing age, the magnitude of LV longitudinal strain at the basal level declines while the apical LV longitudinal strain increases. In contrast, layer-specific LV longitudinal strain remains unchanged with aging. The presence of diabetes mellitus modulated the effect of age on the LV endocardial layer, and male gender was associated with more impaired longitudinal strain at the epicardial layer. Regional assessment of left ventricular (LV) longitudinal strain provides incremental prognostic value in ischemic heart failure patients.1Wang N. Hung C.L. Shin S.H. Claggett B. Skali H. Thune J.J. Kober L. Shah A. McMurray J.J. Pfeffer M.A. Solomon S.D. Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction.Eur Heart J. 2016; 37: 466-472Crossref PubMed Scopus (36) Google Scholar Data from subjects without structural heart disease show a gradient in LV strain, with higher values in the apex compared with the basal segments.2Kocabay G. Muraru D. Peluso D. Cucchini U. Mihaila S. Padayattil-Jose S. Gentian D. Iliceto S. Vinereanu D. Badano L.P. Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults.Rev Esp Cardiol (Engl Ed). 2014; 67: 651-658Crossref PubMed Scopus (152) Google Scholar, 3Marwick T.H. Leano R.L. Brown J. Sun J.P. Hoffmann R. Lysyansky P. Becker M. Thomas J.D. Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range.JACC Cardiovasc Imaging. 2009; 2: 80-84Crossref PubMed Scopus (415) Google Scholar In addition, the LV myocardium can be divided in 3 different layers (endocardial, mid-myocardial, and epicardial) that have a characteristic spatial disposition.4Geyer H. Caracciolo G. Abe H. Wilansky S. Carerj S. Gentile F. Nesser H.J. Khandheria B. Narula J. Sengupta P.P. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications.J Am Soc Echocardiogr. 2010; 23: 351-369Abstract Full Text Full Text PDF PubMed Scopus (823) Google Scholar Whether the values of longitudinal strain in these different layers are similar or show variation in magnitude has not been evaluated in detail. In the present study, the influence of age on longitudinal strain (measured with 2-dimensional (2D) speckle tracking echocardiography) at 3 different LV levels (basal, mid, and apical) and 3 different LV layers (endocardium, mid-myocardium, and epicardium) was investigated in a large cohort of subjects without structural heart disease. Subjects who were clinically referred for transthoracic echocardiography at the Leiden University Medical Center (The Netherlands) between January 2005 and September 2016 were retrospectively evaluated. Subjects were referred for evaluation of dyspnea, syncope, chest pain, palpitations, preoperative screening before noncardiac surgery, or cardiac assessment due to high cardiovascular risk profile. Subjects with known history of coronary artery disease, LV wall motion abnormalities at rest, left ventricular ejection fraction (LVEF) <50%, previous cardiac surgery, pacemaker, arrhythmias or valvular heart disease (any grade of valve stenosis or more than mild valve regurgitation), congenital heart disease, or cardiomyopathies were excluded. Furthermore, subjects with suboptimal echocardiographic image quality precluding reliable speckle tracking analysis were excluded. A total of 408 subjects were included and divided into approximately equally distributed groups based on age and gender. Five age categories were defined: <45 years, 45 to 54 years, 55 to 64 years, 65 to 74 years, and >75 years.3Marwick T.H. Leano R.L. Brown J. Sun J.P. Hoffmann R. Lysyansky P. Becker M. Thomas J.D. Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range.JACC Cardiovasc Imaging. 2009; 2: 80-84Crossref PubMed Scopus (415) Google Scholar To reflect a real-world aging population, subjects with cardiovascular risk factors (hypertension, smoking status, diabetes mellitus, dyslipidemia, and family history of coronary artery disease) were not excluded. Demographics and clinical characteristics were recorded. All clinical data were stored at the departmental Cardiology Information System (EZIS chipsoft and EPD-Vision, Leiden University Medical Center, Leiden, The Netherlands) and retrospectively analyzed. The Dutch Central Committee on Human-related Research (CCMO) allows the use of anonymous data without previous approval of an institutional review board provided that the data are acquired for routine patient care. All data used for this study were acquired for clinical purposes and handled anonymously. Images were obtained with subjects at rest in the left lateral decubitus position using commercially available ultrasound systems (Vivid 7 and E9, General Electric Vingmed, Horten, Norway). Data acquisition was performed with a 3.5-MHz or M5S transducers. Standard M-mode, 2D, color, and pulsed and continuous wave Doppler images were acquired and stored digitally for subsequent offline analysis (EchoPac BT13, GE Medical Systems, Horten, Norway). LVEF was calculated using the Simpson's biplane method of discs according to current recommendations.5Lang R.M. Badano L.P. Mor-Avi V. Afilalo J. Armstrong A. Ernande L. Flachskampf F.A. Foster E. Goldstein S.A. Kuznetsova T. Lancellotti P. Muraru D. Picard M.H. Rietzschel E.R. Rudski L. Spencer K.T. Tsang W. Voigt J.U. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39Abstract Full Text Full Text PDF PubMed Scopus (7056) Google Scholar LV mass was calculated according Devereux et al, and indexed for body surface area.5Lang R.M. Badano L.P. Mor-Avi V. Afilalo J. Armstrong A. Ernande L. Flachskampf F.A. Foster E. Goldstein S.A. Kuznetsova T. Lancellotti P. Muraru D. Picard M.H. Rietzschel E.R. Rudski L. Spencer K.T. Tsang W. Voigt J.U. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39Abstract Full Text Full Text PDF PubMed Scopus (7056) Google Scholar Valvular morphology and function were assessed with 2D, color, and pulsed and continuous wave Doppler echocardiography.6Lancellotti P. Tribouilloy C. Hagendorff A. Popescu B.A. Edvardsen T. Pierard L.A. Badano L. Zamorano J.L. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging.Eur Heart J Cardiovasc Imaging. 2013; 14: 611-644Crossref PubMed Scopus (1093) Google Scholar Left ventricular diastolic function was assessed by measuring the peak early (E) and late (A) diastolic velocities on transmitral flow pulsed-wave recordings. The average of E′ septal and E′ lateral measured in the apical 4-chamber view on tissue Doppler imaging was used for this analysis.7Nagueh S.F. Smiseth O.A. Appleton C.P. Byrd 3rd, B.F. Dokainish H. Edvardsen T. Flachskampf F.A. Gillebert T.C. Klein A.L. Lancellotti P. Marino P. Oh J.K. Popescu B.A. Waggoner A.D. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2016; 29: 277-314Abstract Full Text Full Text PDF PubMed Scopus (2774) Google Scholar Right ventricular (RV) function was evaluated according to current recommendations by measuring the tricuspid annular plane systolic excursion in the apical 4-chamber view using the M-mode.8Rudski L.G. Lai W.W. Afilalo J. Hua L. Handschumacher M.D. Chandrasekaran K. Solomon S.D. Louie E.K. Schiller N.B. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23: 685-713Abstract Full Text Full Text PDF PubMed Scopus (4864) Google Scholar Systolic pulmonary artery pressure was estimated by adding the RV pressure to right atrial pressure. The RV pressure was estimated by calculating the systolic pressure gradient between the RV and right atrium by the peak velocity of the regurgitant jet of the tricuspid valve (if present) using the modified Bernoulli equation.8Rudski L.G. Lai W.W. Afilalo J. Hua L. Handschumacher M.D. Chandrasekaran K. Solomon S.D. Louie E.K. Schiller N.B. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23: 685-713Abstract Full Text Full Text PDF PubMed Scopus (4864) Google Scholar Right atrial pressure was estimated by measuring the diameter and the inspiratory collapse of the inferior vena cava.8Rudski L.G. Lai W.W. Afilalo J. Hua L. Handschumacher M.D. Chandrasekaran K. Solomon S.D. Louie E.K. Schiller N.B. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23: 685-713Abstract Full Text Full Text PDF PubMed Scopus (4864) Google Scholar From the apical 4-, 2-, and long-axis views, 2D speckle tracking echocardiography was applied to analyze longitudinal strain at 3 different LV levels (apex, mid, basal) and 3 different LV layers (endocardial, mid-myocardial, and epicardial). The endocardial border was manually traced at end-systole and the region of interest including the entire LV myocardial wall was displayed.9Negishi K. Negishi T. Kurosawa K. Hristova K. Popescu B.A. Vinereanu D. Yuda S. Marwick T.H. Practical guidance in echocardiographic assessment of global longitudinal strain.JACC Cardiovasc Imaging. 2015; 8: 489-492Crossref PubMed Scopus (102) Google Scholar The software automatically tracks and accepts segments of good tracking quality and rejects segments while the to manually based on assessment of tracking LV longitudinal strain was obtained the average of longitudinal strain of segments longitudinal strain values of the mid, and basal levels of the LV were obtained by the value of strain of the apical segments and the basal and segments the software allows for analysis of the LV longitudinal strain of the 3 different mid-myocardial, and longitudinal strain values are obtained the average of longitudinal strain of segments at The strain the average of the epicardial and endocardial strain mid, and Left ventricular longitudinal strain at the basal and apical levels are calculated the average of the image longitudinal strain The for the endocardium, mid-myocardium, and epicardium are and the global value of longitudinal strain at calculated the average of the strain values layer. image are ± for distributed and were using analysis of are and and were using the of LV longitudinal strain of the 3 myocardial levels (basal, and apical) and the 3 myocardial layers (endocardial, mid-myocardial, and epicardial) across age categories was performed using a for The age was into the the between age and LV longitudinal A was applied for The estimated and of data are were performed to between age and multivariable analysis was performed to the effect of age on layer-specific longitudinal systolic strain, for known risk factors and cardiovascular of for analysis was at p The was calculated to the and for global longitudinal strain subjects were by was whereas was to analysis was performed on for A of was and layer-specific values of LV longitudinal strain were compared between subjects with subjects without cardiovascular risk factors or were significant in LV and layer-specific longitudinal strain between groups investigated the of aging in the for subjects without with cardiovascular risk risk ± ± ± ± ± ± risk longitudinal ± ± ± ± ± ± ± ± ± ± ± ± ± ± body mass body surface are ± or was pressure or previous was total or previous mellitus was previous in a body mass body surface Data are ± or was pressure or previous was total or previous mellitus was previous The clinical characteristics of the subjects according to age categories are in was a significant increase in the of and diabetes mellitus across the age whereas family history of cardiovascular disease was more and groups The use of cardiovascular was more in older groups characteristics according to age ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± mellitus mellitus history body mass body surface cardiovascular are ± or was pressure or previous was total or previous mellitus was previous in a body mass body surface cardiovascular disease. Data are ± or was pressure or previous was total or previous mellitus was previous were significant in LVEF and LV across the different age groups Furthermore, subjects more impaired diastolic function with increasing age LV analysis (basal, and an increasing gradient in magnitude of longitudinal strain from the basal to mid and apical levels was observed for the entire the apical level the magnitude of strain ± whereas the basal level the strain (−16.7 ± The age categories the with an increasing gradient in magnitude of longitudinal strain from the basal to mid and apical levels for all a decrease in the magnitude of longitudinal strain at the basal level was observed from to older age categories an increase in the magnitude of longitudinal strain at the apical level was significant across categories in peak systolic strain at the level characteristics according to age ± ± ± ± ± ± ± ± ± ± diameter ± ± ± ± ± diameter ± ± ± ± ± wall diameter ± ± ± ± ± indexed ± ± ± ± ± diameter ± ± ± ± ± diameter ± ± ± ± ± indexed ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ejection fraction ± ± ± ± ± longitudinal strain ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± left LV Left pulmonary tricuspid annular plane systolic are ± in a peak systolic left ventricular longitudinal strain divided by age categories ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± for level outcome to are ± for level outcome to in a left LV Left pulmonary tricuspid annular plane systolic Data are ± Data are ± analysis (endocardium, mid-myocardium, and epicardium) a decrease in magnitude of longitudinal strain from endocardium to and epicardium for the and all age categories for all not across the age categories (endocardium, p mid, p p global peak systolic left ventricular longitudinal strain divided by age categories ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± for outcome to are ± for outcome to in a Data are ± On analysis, increasing age was not associated with peak systolic strain at the endocardial p p or the epicardial p In addition, heart and LV mass were not associated with longitudinal strain at all these were not into the On multivariable analysis, diabetes mellitus was associated with more impaired longitudinal strain in the endocardium p and male gender was associated with more impaired longitudinal strain at the epicardium p The effect of age on layer-specific peak systolic strain, for these diabetes in were significant in global peak systolic strain across the age categories for the endocardium and epicardium for peak systolic left ventricular longitudinal LV left in a LV left and for were with an of to and an of to data on global LV longitudinal strain are in healthy and subjects without structural or heart disease, data on level- and layer-specific longitudinal strain are G. Muraru D. Peluso D. Cucchini U. Mihaila S. Padayattil-Jose S. Gentian D. Iliceto S. Vinereanu D. Badano L.P. Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults.Rev Esp Cardiol (Engl Ed). 2014; 67: 651-658Crossref PubMed Scopus (152) Google Scholar, 3Marwick T.H. Leano R.L. Brown J. Sun J.P. Hoffmann R. Lysyansky P. Becker M. Thomas J.D. Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range.JACC Cardiovasc Imaging. 2009; 2: 80-84Crossref PubMed Scopus (415) Google Scholar, J. C. D. L. Left ventricular longitudinal and layer-specific myocardial and in healthy 2016; PubMed Scopus Google Scholar A of subjects without structural heart disease (mean age ± years, men) that the normal values of global LV longitudinal strain from to T. S. Marwick T.H. Normal of left ventricular a Am Soc Echocardiogr. 2013; Full Text Full Text PDF PubMed Scopus Google Scholar characteristics of the included subjects and the software used to analyze longitudinal strain the values of global LV longitudinal In the present study, the value of global LV longitudinal strain for the was and not significantly across the different age In of LV longitudinal strain, previous have a gradient in longitudinal strain from the to the the basal segments a magnitude of longitudinal strain compared with the apical segments.2Kocabay G. Muraru D. Peluso D. Cucchini U. Mihaila S. Padayattil-Jose S. Gentian D. Iliceto S. Vinereanu D. Badano L.P. Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults.Rev Esp Cardiol (Engl Ed). 2014; 67: 651-658Crossref PubMed Scopus (152) Google Scholar, 3Marwick T.H. Leano R.L. Brown J. Sun J.P. Hoffmann R. Lysyansky P. Becker M. Thomas J.D. Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: definition of normal range.JACC Cardiovasc Imaging. 2009; 2: 80-84Crossref PubMed Scopus (415) Google Scholar, N. T. D. L. of longitudinal and left ventricular function by two-dimensional speckle-tracking echocardiography in a large cohort of normal J Cardiovasc Imaging. PubMed Scopus Google Scholar wall the apex due to of to higher magnitude of longitudinal strain in the apex compared with the J. Regional of normal left J Heart PubMed Google Scholar Furthermore, this gradient can be by the different of the myocardium with more in the apex compared with the LV J. Regional of normal left J Heart PubMed Google Scholar in the gradient across different age categories in a real-world aging have not been The present study that the gradient in longitudinal strain from to apex across the age aging was associated with a borderline significant in LV longitudinal strain magnitude in the basal segments and significant of longitudinal strain magnitude in apical known to be associated with of the LV while function and of in the aging PubMed Scopus Google Scholar The increase of and LV mass to increased of the LV myocardium and impaired diastolic in To LV the LV an increase of the longitudinal strain in the apical segments a P.P. Chandrasekaran K. Khandheria mechanics of the left and Cardiovasc Imaging. PubMed Scopus Google Scholar To the effect of aging on LV the present study evaluated the layer-specific longitudinal strain endocardium to The magnitude of longitudinal strain in the endocardium compared with the epicardium can be by the wall in the endocardium to at and J. Regional of normal left J Heart PubMed Google Scholar longitudinal strain analysis used in the of global and LV W. B. S. L. Edvardsen T. quantification of myocardial by strain echocardiography significant in patients with coronary Cardiovasc Imaging. 2013; PubMed Scopus Google Scholar, M. M. Lysyansky P. V. T. D. R. and longitudinal strain in 3 myocardial layers in normal subjects and in patients with left ventricular Am Soc Echocardiogr. 2010; 23: Full Text Full Text PDF PubMed Scopus Google Scholar study the layer-specific values of longitudinal strain in a study including healthy to J. C. D. L. Left ventricular longitudinal and layer-specific myocardial and in healthy 2016; PubMed Scopus Google Scholar A gradient from the endocardium to the epicardium was observed with the magnitude of longitudinal strain in the endocardial ± and the in the epicardial ± with more values of longitudinal strain at all the to study, aging not influence significantly on layer-specific longitudinal strain factors influence global LV longitudinal strain in subjects without structural heart disease. and for have been associated with impaired global LV longitudinal V. M. M. G. M. A. H.J. J.J. from left ventricular strain and strain imaging in patients with diabetes J 2009; Full Text Full Text PDF PubMed Scopus Google Scholar, A. G. N. B. A. S. M. A. The of longitudinal left ventricular systolic function in patients with normal ejection 2015; PubMed Scopus Google Scholar known the of LV layer-specific have that has an influence on layer-specific longitudinal In subjects with and et that longitudinal strain was significantly in all the myocardial layers compared with S.A. Assessment of left ventricular function by layer-specific strain and to structural in patients with J 2016; Full Text Full Text PDF PubMed Scopus Google Scholar LV mass was associated with layer-specific longitudinal strain, and subjects with LV mass more impaired longitudinal strain across all the myocardial The present study that diabetes was associated with impaired longitudinal strain of the endocardial layer. in with previous that the endocardium to early by M. J. myocardial strain of in a of diabetes mellitus different 2016; PubMed Scopus Google Scholar, M. T. M. H. H. K. systolic dysfunction in J. 2015; PubMed Scopus Google Scholar In addition, impaired longitudinal strain of the endocardial has been associated with cardiovascular in patients with coronary artery W. B. S. L. Edvardsen T. quantification of myocardial by strain echocardiography significant in patients with coronary Cardiovasc Imaging. 2013; PubMed Scopus Google Scholar, S. J. Hoffmann R. E. A. M. A. N. Becker M. of in patients with ischemic by layer-specific strain echocardiography: a of Am Soc Echocardiogr. 2016; 29: Full Text Full Text PDF PubMed Scopus Google Scholar Whether this be to subjects with cardiovascular risk factors be The current study was and included subjects without structural heart disease a significantly high of cardiovascular risk factors that influence LV the values of level- and layer-specific longitudinal strain in this not be pressure values and of diabetes mellitus were not Furthermore, LV strain were performed with and the values obtained with this software not be to In conclusion, with increasing age, the magnitude of LV longitudinal strain at the basal level whereas the apical LV longitudinal strain increases. In contrast, layer-specific LV longitudinal strain remains unchanged with aging. The presence of diabetes mellitus modulated the effect of age on the LV endocardial layer, and male gender was associated with more impaired longitudinal strain at the epicardial layer. The of Cardiology of the Leiden University Medical Center from and from

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.