Page 24 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter one. General introduction and outline of the thesis
impaired in such patients and has been associated with the development of symptoms or LVEF deterioration in a group of 67 individuals with moderate to severe AR and preserved LVEF.36, 37
Cardio-oncology
The prevalence of cardiotoxicity as a result of chemotherapy may vary from 13%-42%, and is influenced by individual risk, combination chemotherapy and dosages.38, 39 At present, the mainstay of LV systolic function monitoring during chemotherapy, still remains the LVEF.38 When employing this parameter, cardiotoxicity is defined as a decrease of >10% in the LVEF, to an LVEF <53%.38 Early cardiac impairment can be demonstrated with LV GLS, i.e. when the LVEF is still within the normal range, and LV GLS values predict the subsequent decline in LVEF.40, 41 Even though the impact on management has not been validated, guidelines from the American Society of Echocardiography and the European Association of Cardiovascular Imaging recommend the routine use of LV GLS for surveillance of patients receiving potentially cardiotoxic chemotherapy regimens. A relative percentage reduction in LV GLS of >15% from baseline, has been proposed to define cardiotoxicity.38 Prospective studies are required to inform on the therapeutic role of LV GLS in cardio-oncology, i.e. if early cardioprotective therapy will translate into improved outcomes.
RESEARCH-BASED APPLICATIONS OF LV GLOBAL LONGITUDINAL STRAIN
Speckle tracking echocardiography allows for more detailed analysis of the LV, such as automated analysis of layer-specific GLS of the LV myocardial wall (endocardium, mid-myocardial, epicardium; respectively) (Figure 4). Particularly in ischaemic heart disease, layer-specific analysis is of interest since the myocardial damage after acute myocardial infarction may not be transmural. Layer-specific analysis of LV GLS can accurately discriminate between transmural and non-transmural myocardial infarction and has also been associated with outcome.42, 43 The use of layer-specific strain analysis remains experimental, due to the lack of reference values, high inter-vendor variability and suboptimal reproducibility.10
18