Ünlü Serkan, Duchenne Jürgen, Mirea Oana, Pagourelias Efstathios D, Bézy Stéphanie, Cvijic Marta, Beela Ahmed Salem, Thomas James D, Badano Luigi P, Voigt Jens-Uwe
Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium.
Bluhm Cardiovascular Institute, Northwestern University, 675 N St Clair St 19th Fl, Suite 100, Chicago, IL 60611, USA.
Eur Heart J Cardiovasc Imaging. 2020 Mar 1;21(3):337-343. doi: 10.1093/ehjci/jez189.
Foreshortening of apical views is a common problem in echocardiography. It results in an abnormally thick false apex and a shortened left ventricular (LV) long axis. We sought to evaluate the impact of foreshortened (FS) on LV ejection fraction (LVEF) and layer-specific 2D speckle tracking based segmental (S) and global (G) longitudinal strain (LS) measurements.
We examined 72 participants using a GE Vivid E9 system. FS apical views were collected from an imaging window one rib-space higher than the optimal images. Ejection fraction as well as layer-specific GLS and SLS measurements were analysed by GE EchoPAC v201 and TomTec Image Arena 4.6 and compared between optimal and FS images. On average, LV long axis was 10% shorter in FS images than in optimal images. FS induced a relative change in LVEF of 3.3% and 6.9% for GE and TomTec, respectively (both, P < 0.001). Endocardial GLS was 9.0% higher with GE and 23.2% with TomTec (P < 0.001). Midwall GLS measurements were less affected (7.8% for GE and 14.1% for TomTec, respectively, both P < 0.001). Segmental strain analysis revealed that the mid-ventricular and apical segments were more affected by foreshortening, and endocardial measurements were more affected than midwall.
Optimal image geometry is crucial for accurate LV function assessment. Foreshorhening of apical views has a substantial impact on longitudinal strain measurements, predominantly in the apex and in the endocardial layer. Our data suggest that measuring midwall strain might therefore be the more robust approach for clinical routine use.
心尖视图缩短是超声心动图中的常见问题。它会导致假性心尖异常增厚以及左心室（LV）长轴缩短。我们试图评估缩短（FS）对左心室射血分数（LVEF）以及基于二维散斑追踪的节段性（S）和整体（G）纵向应变（LS）测量的影响。
我们使用GE Vivid E9系统检查了72名参与者。从比最佳图像高一个肋间隙的成像窗口采集FS心尖视图。通过GE EchoPAC v201和TomTec Image Arena 4.6分析射血分数以及特定层面的GLS和SLS测量值，并在最佳图像和FS图像之间进行比较。平均而言，FS图像中的左心室长轴比最佳图像短10%。FS导致GE和TomTec的LVEF相对变化分别为3.3%和6.9%（均P < 0.001）。GE测量的心内膜GLS高9.0%，TomTec测量的高23.2%（P < 0.001）。室壁中层GLS测量受影响较小（GE为7.8%，TomTec为14.1%，均P < 0.001）。节段应变分析显示，心室中部和心尖节段受缩短影响更大，心内膜测量比室壁中层受影响更大。
最佳图像几何形状对于准确评估左心室功能至关重要。心尖视图缩短对纵向应变测量有重大影响，主要影响心尖和心内膜层。我们的数据表明，因此测量室壁中层应变可能是临床常规使用中更可靠的方法。
