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Beyond left ventricular ejection fraction: Tissue Doppler Imaging and Speckle Tracking In Clinical Practice

EuroEcho-Imaging 2014 session report

Session focused on systolic LV function, but experts underline that tissue Doppler and speckle tracking can also provide substantial insights into diastolic LV function.

Non-Invasive Imaging

I was honored to co-chair this interesting session with Julien Magne, PhD, who deserves much credit for his accomplishments as EuroEcho Imaging Scientific Programme Director over the past two years. Dr. Magne now works in Limoges, FR

This session was arranged in order to focus on the relative importance of conventional LVEF compared with newer markers of LV systolic mechanics as indicators of systolic LV function. This is, and is likely to remain, an important topic in clinical cardiology in general, and for cardiovascular imagers in particular. That the conference room was overfilled at the start of this session, and even fuller at the end, speaks to the high interest in the topics discussed.

The session began with a nicely presented review by Dr. Anne Brunet Bernard (Tours, FR) of the value of LVEF for risk stratification of patients with a variety of disorders. The literature on this topic is substantial and confirms that low LVEF is an important indicator of risk of adverse outcomes.

Dr. Victoria Delgado (Leiden, NL) next discussed the incremental value of tissue Doppler imaging and speckle tracking echocardiography, noting that measures of LV systolic mechanics such as global longitudinal strain (GLS) and rotational mechanics can often provide evidence of early LV dysfunction in patients in whom LVEF is still normal. One clear example is in patients receiving anthracycline chemotherapy for various malignancies, in whom reductions in GLS are noted earlier in the course of therapy, prior to reductions in LVEF. LV strain and twist mechanics may be helpful for following such patients.

Dr. Partho P Sengupta (New York, US) was scheduled to participate as a judge in the Young Investigator Award session to follow, so he spoke third in this session, and reviewed the importance of altered loading conditions on LVEF in patients with various valvular lesions. In this circumstance it is important to recognize the limitations of EF, and to consider other factors in considering LV systolic function. It seems fair to note that RV function assessment can also be challenging, for similar reasons, in patients with valve dysfunction. Also, strain mechanics, whether by tissue Doppler or speckle tracking methods, are load-dependent themselves.

The final speaker, Dr. Tomasz Kukulski (Zabrze, PL), presented a thorough and helpful review of technical issues that pertain to the use of newer indicators of LV systolic function. He emphasized that while tissue Doppler and speckle tracking methods have different strengths and limitations, technical factors as well as physiologic variables are of great importance in acquiring and interpreting measures of systolic LV shortening.  

It seemed clear to me, as I listened to four excellent presentations, that as 2014 draws to a close, echocardiographic methods are able to provide tremendous insights into systolic LV function. However, as we develop and apply new and sophisticated methods for evaluating cardiac function, the basic importance of high quality images, and careful attention to technique, must not be forgotten. Echocardiographic methods are not feasible in every patient, and other imaging modalities, such as CMR and cardiac CT, can be of great value. While the current session focused on systolic LV function, it is worth noting that tissue Doppler and speckle tracking can also provide substantial insights into diastolic LV function, and can be used to examine all four cardiac chambers as well as the pulsatile function of the aorta.




Beyond left ventricular ejection fraction: Tissue Doppler Imaging and Speckle Tracking In Clinical Practice

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.