title: Value of two-dimensional speckle tracking and real time three-dimensional echocardiography for the identification of subclinical left ventricular dysfunction in patients referred for routine echocardiography.
abstract: BACKGROUND
  While speckle tracking echocardiography (2DSTE) can be used to study longitudinal, circumferential, and radial function, real time 3D echocardiography (3DE) generates dynamic time-volume curves, offering a wide array of new parameters for characterizing mechanical and volumetric properties of the left ventricle (LV). Our aim was to investigate the merit of these new techniques to separate normal from abnormal echocardiograms as well as to identify subclinical disease in reportedly normal subjects.
  
  
  METHODS
  Eighty-one patients (mean age 61 ± 16 years) underwent standard 2D echocardiography (2DE) enhanced by 2DSTE and 3DE. The data included LV volumes and ejection fraction (EF), velocities, strain/strain rate, and peak ejection/filling rates. The patients were divided into Group 1: normal (n = 42) and Group 2: abnormal (n = 39) on the basis of an expert interpretation of the resting 2DE.
  
  
  RESULTS
  Global longitudinal strain (%) was 17 ± 4 in Group1 and 14 ± 4 in Group2 (P < 0.002). Strain rates (SR, 1/sec) at peak systole (1.1 ± 0.2 vs 0.9 ± 0.3, P < 0.001) and early diastole (1.3 ± 0.3 vs 0.9 ± 0.3, P < 0.001) were also higher in Group1. Three-dimensional peak ejection and filling rates (EDV/sec) were significantly higher in Group1 (-2.5 ± 0.4 vs -2.1 ± 0.7, and 1.8 ± 0.2 vs 1.5 ± 0.5, P < 0.002, P < 0.001, respectively). The best discriminatory power for predicting a normal 2DE was systolic SR with a sensitivity of 82% and a specificity of 54% using a cutoff value of 1.09. Interestingly, 19/41 (46%) of Group1 patients had systolic SR < 1.09, suggesting subclinical disease.
  
  
  CONCLUSIONS
  2DSTE and 3DE can discriminate between normal and abnormal echocardiograms and have the potential to detect subclinical LV dysfunction.
authors.affiliation: Karolinska Institute at Sundsvall Hospital, Sundsvall, Sweden.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Anatoli
authors.initials: A
authors.lastname: Kiotsekoglou
authors.forename: Rena S
authors.initials: RS
authors.lastname: Toole
authors.forename: James C
authors.initials: JC
authors.lastname: Moggridge
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Nichols
authors.forename: Satish
authors.initials: S
authors.lastname: Govind
authors.forename: Aasha S
authors.initials: AS
authors.lastname: Gopal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003199:Computer Systems; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D055815:Young Adult