Interpretation of two-dimensional and tissue Doppler-derived strain (epsilon) and strain rate data: is there a need to normalize for individual variability in left ventricular morphology?

Abstract

Aims This study examined the relationships between myocardial strain ( ε ) and strain rate (SR) data, derived from both two-dimensional (2D) speckle tracking and tissue Doppler imaging (TDI), and indices of left ventricular (LV) morphology to assess size-(in)dependence of these functional parameters. Methods and results 2D speckle tracking and TDI echocardiograms were performed in 79 healthy adult male volunteers (age range: 22–76 years). 2D speckle tracking allowed the determination of myocardial ε and peak systolic and early diastolic SR in radial, circumferential, and longitudinal planes, whereas TDI provided longitudinal ε only. Mean circumferential and radial ε and SR were calculated from data collected at six basal myocardial regions, whereas mean longitudinal ε and SR derived from both 2D speckle tracking and TDI were calculated from the basal septum and basal lateral walls. Standard 2D echocardiography allowed the assessment of LV morphology including LV length, LV end-diastolic volume, LV end-diastolic diameter, mean wall thickness, and LV mass. The association of myocardial ε and SR data with relevant LV morphology indices was determined by adoption of the general, non-linear allometric model ( y = axb ). The b exponent ± 95% confidence intervals were reported. The relationships between the measures of LV morphology and myocardial ε and SR were highly variable and generally weak. Only two relationships displayed at least a moderate effect size ( r ≥ 0.30): (i) 2D circumferential peak systolic SR and LV end-diastolic dimension ( b = −0.92; −1.35 to 0.5, r = 0.44) and (ii) TDI longitudinal peak systolic SR and LV length ( b = −1.39; −2.11 to −0.66, r = 0.41). Conclusion The empirical relationships derived in this cohort do not support the need to scale myocardial ε and SR derived from 2D speckle or TDI for any index of LV morphology.