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Understanding cardiac mechanics: what is the purpose?

EuroEcho-Imaging 2014 session report

Basic knowledge of cardiac mechanics is crucial to select suitable imaging techniques and parameters to be measured, while interpretation of results requires understanding of mechanics and awareness of limitations of imaging techniques.

This interesting symposium was organized jointly with the Saudi Heart Association.

Dr Ernande presented a comprehensive review of the basic mechanisms responsible for physiologic and pathologic changes within the myocardium. The LV presents a complex architecture resulting in a complex 4D deformation. She introduced echo techniques that have the potential to quantify regional changes in wall deformation. Deformation imaging including echo (2D , 3D, speckle/strain) and MRI techniques, is a valuable tool to assess global and regional LV function for diagnostic and prognostic purposes. She emphasized that global longitudinal strain (GLS) is the most reliable and most widely used parameter in clinical practice, but should be interpreted cautiously according to age, sex, and loading conditions. In addition, because of inter-vendor software variability, serial assessment of GLS in individual patients should be performed using the same brand of equipment and the same software. Clinically established indications for strain analysis are: detection of acute ischemia, infarct size estimation, detection of subclinical disease in diabetic patients and patients under cardiotoxic cancer therapy. The other potential areas for deformation wall analysis are: monitoring of hypertrophic remodeling in HCM, aortic stenosis, and amyloidosis. Finally, Dr Ernande pointed out that no universal normal values exist for longitudinal strain measurements, which is why serial assessment should be performed for each individual.

Dr. Gillbert very elegantly assessed the mechanisms of diastolic dysfunction, pointing out that diastolic dysfunction results from delayed myocardial relaxation and increased myocardial stiffness. Arterial stiffening and impaired vascular endothelial–dependent relaxation also contribute to the disease. When evaluating LV load, one should remember that late-systolic load results in different effects than early systolic load. Early systolic load leads to physiological hypertrophy, whereas late systolic load leads to maladaptive hypertrophy. He summarized in saying that HFpEF is a multiorgan disease with distinct risk factors.

Dr Al Zahrani introduced a very systematic description of anatomical and functional features of the right ventricle. The assessment of RV function using conventional techniques and parameters remains a challenge for echocardiographer. The complex nature of this chamber requires special attention when applying new quantitative techniques (2D, 3D strain) in daily routine practice.

Dr Omran said that assessment of cardiac mechanics by speckle tracking echocardiography provides incremental information in clinical settings. Resolving the multidirectional components of LV deformations offers important insights for detecting subclinical states that are likely to progress into either systolic or diastolic heart failure. With the advent of 3D echo, newer algorithms for tracking LV and RV deformation are very promising. As speckle tracking echocardiography becomes more common, it will be important to ensure standardization of nomenclature, steps in data acquisition, and optimal training to reduce data variability.
Basic knowledge of cardiac mechanics is crucial for proper selection of imaging techniques as well as the parameters we want to measure. Interpretation of our results again requires understanding of RV and LV mechanics and the limitations of imaging techniques.




Understanding cardiac mechanics: what is the purpose?

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.