title: Three-dimensional simultaneous strain-volume analysis describes left ventricular remodelling and its progression: a pilot study.
abstract: OBJECTIVE
  Three-dimensional (3D)-echocardiography speckle imaging allows the evaluation of frame-by-frame strain and volume changes simultaneously. The aim of the present investigation was to describe the strain-volume combined assessment in different patterns of cardiac remodelling.
  
  
  RESULTS
  Fifty patients received a 3D acquisition. Patients were classified as follows: healthy subjects (CNT), previous AMI, and normal ejection fraction (EF; group A); ischaemic cardiomyopathy with reduced EF (group B); hypertrophic/infiltrative cardiomyopathy (group C). Values of 3D strain were plotted vs. volume for each frame to build a strain-volume curve for each case. Peak of radial, longitudinal, and circumferential systolic strain (Rεp, Lεp, and Cεp, respectively), slopes of the curves (RεSl, LεSl, CεSl), and strain to end-diastolic volume (EDV) ratio (Rε/V, Lε/V, Cε/V) were computed for the analysis. Strain-volume curves of the CNT group were steep and clustered, whereas, due to progressive dilatation and reduction of strains, progressive flattening could be demonstrated in groups A and B. Quantitative data supported visual assessment with progressive lower slopes (P< 0.05 for RεSl, CεSl, P= 0.06 for LεSl) and significantly lower ratios (P< 0.01 for Rε/V, Lε/V, and Cε/V). Group C showed an opposite behaviour with slopes and ratios close to those of normal subjects. Correlation coefficients between EDV and slopes of the curves were significant for all the directions of strain (CεSl: r = 0.891; RєSl: r = 0.704; LєSl: r = 0.833; P< 0.0001 for all).
  
  
  CONCLUSIONS
  We measured left ventricular volumes and strain by 3D-echo and obtained strain-volume curve to evaluate their behaviour in remodelling. A distinctive and progressive pattern consistent with pathophysiology was observed. The analysis here shown could represent a new non-invasive method to assess myocardial mechanics and its relationship with volumes.
authors.affiliation: UO Cardiology, Versilia Hospital, Via Aurelia 335, Lido Di Camaiore, Italy. lilli.alessio@libero.it
authors.forename: Alessio
authors.initials: A
authors.lastname: Lilli
authors.forename: Marco Tullio
authors.initials: MT
authors.lastname: Baratto
authors.forename: Jacopo
authors.initials: J
authors.lastname: Del Meglio
authors.forename: Marco
authors.initials: M
authors.lastname: Chioccioli
authors.forename: Massimo
authors.initials: M
authors.lastname: Magnacca
authors.forename: Carla
authors.initials: C
authors.lastname: Svetlich
authors.forename: Andrea
authors.initials: A
authors.lastname: Ghidini Ottonelli
authors.forename: Rosa
authors.initials: R
authors.lastname: Poddighe
authors.forename: Alessandro
authors.initials: A
authors.lastname: Comella
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Casolo
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000473:pathology; D016009:Chi-Square Distribution; D018450:Disease Progression; D019560:Echocardiography, Three-Dimensional / Q000295:instrumentation*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left