Page 37 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

INTRODUCTION
Regional assessment of LV longitudinal strain provides incremental prognostic value
in ischemic heart failure patients.1 Data from individuals without structural heart 2 disease show a gradient in LV strain, with higher values in the apex as compared to
the basal segments.2,3 In addition, the LV myocardium can be divided in 3 different
layers (endocardial, mid-myocardial and epicardial) which have a characteristic spatial disposition. 4 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 speckle
tracking echocardiography, STE) at 3 different LV levels (basal, mid and apical) and 3
different LV layers (endo-, mid- and epicardium) was investigated in a large cohort of
individuals without structural heart disease.
METHODS
Individuals 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, pre-operative screening prior to non-cardiac surgery, or cardiac assessment due to high cardiovascular risk profile. Individuals with known history of coronary artery disease, LV wall motion abnormalities at rest, 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, individuals with suboptimal echocardiographic image quality precluding reliable speckle tracking analysis were excluded. A total of 408 patients were included and divided into approximately equally distributed groups based on age and gender. Five age categories were defined: <45 years, 45-54 years, 55-64 years, 65-74 years and >75 years.3 To reflect a real-world ageing population, patients with cardiovascular risk factors (hypertension, smoking status, diabetes mellitus, dyslipidaemia and family history of coronary artery disease) were not excluded.
Patient 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) and retrospectively analyzed. The Dutch Central Committee on Human-related Research (CCMO) allows the use of anonymous
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