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Archives of cardiovascular diseases
Volume 106, n° 4
page 246 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.006

Analysis of longitudinal strain integrals during rest and effort on heart failure patients

A. Brunet-Bernard a, E. Donal b, A. Reynaud a, F. Schnell a, J.-C. Daubert b, C. Leclercq b, A. Hernandez a
a Université de Rennes 1, LTSI, Rennes, France 
b CHU de Rennes, Service de Cardiologie, Rennes, France 

Purpose .– Left ventricular mechanical dyssynchrony is based classically on the analysis of velocity or strain peak instants, which are detected manually. This method may not reflect the complexity of both contractility and timing of a dilated heart, particularly at exercise. We hypothesized that integral-based indicators of regional longitudinal strain signals, and their variation between rest and exercise, would provide additional information for the characterization of the evolution of heart failure patients.

Methods .– Forty-nine patients with NYHA II to III, ischemic (28%) or idiopathic DCM (72%), ejection fraction 29.6±7.1%, QRS width 138±35ms, were studied. All patients underwent submaximal supine bicycle exercise stress echocardiography. Thirty of 49 patients had a CRT device implantation following baseline evaluation. Patients were classified as responders (n =18) if they showed a decrease in LV end-systolic volume ≥ 15% at 6-months follow-up, non-responders (n =12) if not. Apical-4 chamber longitudinal strain was recorded manually on a dedicated software (EchoPAC PC, GE Healthcare) and then strain data was exported for a detailed analysis, based on custom-made methods and algorithms. Integrals of strain signals were calculated for each segment, from the beginning of the cardiac cycle (QRS onset), to the instant of the peak of longitudinal strain.

Results .– Concerning the global population (n =49), no significant change between rest and exercise was observed for septal and lateral peak of longitudinal strain, or intraventricular mechanical dyssynchrony, when recorded manually on the Echopac interface. Integrals to minimum of longitudinal strain decreased significantly between rest and exercise for mid septal segments (1.96±1.30 vs. 1.54±0.91, P <0.01), but no variation was observed for mid-lateral segments (1.96±1.22 vs. 2.04±1.02, P =NS). CRT responders showed an increase in integral to minimum for the mid-lateral segment (1.64±0.90 at rest vs. 2.26±1.20 at exercise; P <0.01) whereas CRT non-responders did not. The latter showed a decrease in integral to minimum for mid-septal segment during exercise (2.21±1.36 vs. 1.30±0.89; P <0.01) that was not observed on CRT responders.

Conclusion .– Integral-derived longitudinal strain curves give new insights into LV mechanics for heart failure patients during exercise, revealing different patterns between the septum and the lateral wall. These patterns may be useful to identify potential CRT responders.

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