title: Cardiac mechanics and ventricular twist by three-dimensional strain analysis in relation to B-type natriuretic peptide as a clinical prognosticator for heart failure patients.
abstract: BACKGROUND
  Three dimensional (3D) echocardiography-derived measurements of myocardial deformation and twist have recently advanced as novel clinical tools. However, with the exception of left ventricular ejection fraction and mass quantifications in hypertension and heart failure populations, the prognostic value of such imaging techniques remains largely unexplored.
  
  
  METHODS
  We studied 200 subjects (mean age: 60.2±16 years, 54% female, female n = 107) with known hypertension (n = 51), diastolic heart failure (n = 61), or systolic heart failure (n = 30), recruited from heart failure outpatient clinics. Fifty-eight healthy volunteers were used as a control group. All participants underwent 3D-based myocardial deformation and twist analysis (Artida, Toshiba Medical Systems, Tokyo, Japan). We further investigated associations between these measures and brain natriuretic peptide levels and clinical outcomes.
  
  
  RESULTS
  The global 3D strain measurements of the healthy, hypertension, diastolic heart failure, and systolic heart failure groups were 28.03%, 24.43%, 19.70%, and 11.95%, respectively (all p<0.001). Global twist measurements were estimated to be 9.49°, 9.77°, 8.32°, and 4.56°, respectively. We observed significant differences regarding 3D-derived longitudinal, radial, and global 3D strains between the different disease categories (p<0.05), even when age, gender, BMI and heart rate were matched. In addition, 3D-derived longitudinal, circumferential, and 3D strains were all highly correlated with brain natriuretic peptide levels (p<0.001). At a mean 567.7 days follow-up (25th-75th IQR: 197-909 days), poorer 3D-derived longitudinal, radial, and global 3D strain measurements remained independently associated with a higher risk of cardiovascular related death or hospitalization due to heart failure, after adjusting for age, gender, and left ventricular ejection fraction (all p<0.05).
  
  
  CONCLUSIONS
  3D-based strain analysis may be a feasible and useful diagnostic tool for discriminating the extent of myocardial dysfunction. Furthermore, it is able to provide a prognostic value beyond traditional echocardiographic parameters in terms of ejection fraction.
authors.affiliation: National Taiwan University College of Medicine, Graduate Institute of Clinical Medicine, Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Dou-Liu City, Taiwan.
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Yau-Huei
authors.initials: YH
authors.lastname: Lai
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chih-Hsuan
authors.initials: CH
authors.lastname: Yen
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chia-Ti
authors.initials: CT
authors.lastname: Tsai
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Dou-Liu City, Taiwan.
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.affiliation: Noninvasive Cardiovascular Research, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, 02115, United States of America.
authors.forename: Bernard E
authors.initials: BE
authors.lastname: Bulwer
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Ta-Chuan
authors.initials: TC
authors.lastname: Hung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Charles Jia-Yin
authors.initials: CJ
authors.lastname: Hou
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Jen-Yuan
authors.initials: JY
authors.lastname: Kuo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei City, Taiwan; The Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan.
authors.forename: Chung-Lieh
authors.initials: CL
authors.lastname: Hung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Juey-Jen
authors.initials: JJ
authors.lastname: Hwang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei City, Taiwan.
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Yeh
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016276:Ventricular Function
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain