Abstract
The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) classification, based on structural changes and symptoms, classifies stages of heart failure (HF) development as Stages A–D. This HF classification emphasizes the development and progression of the disease and can be used to describe individuals and populations. Since HF is considered a progressive disorder that can be represented as a clinical continuum, individuals at a particular HF stage require specific management with the long-term goal of avoiding HF development and progression. Although early detection of subclinical left ventricular (LV) dysfunction is essential for delaying progression to HF, the assessment of such dysfunction can be challenging. While echocardiography plays a pivotal role in the quantification and early detection of LV structural findings, two-dimensional speckle-tracking echocardiographic parameters, especially global longitudinal strain (GLS), have recently been reported to be sensitive markers of early subtle abnormalities of LV myocardial performance. They are thus helpful for prediction of outcomes for various cardiac diseases, and superior to conventional echocardiographic indices such as LV ejection fraction, mitral inflow E and mitral e′ annular velocities ratio. Strain imaging, especially GLS-guided management for patients at a particular stage of HF, may therefore have the potential to prevent progression to later HF stages and may offer new insights into the management of HF patients. This article reviews the utility of strain imaging, especially GLS in conjunction with HF stage classification, and future perspectives for HF patient management.
Similar content being viewed by others
References
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:1810–52.
Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–61.
Writing Committee, Yancy CW, Jessup M, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2016;134:e282–93.
Ammar KA, Jacobsen SJ, Mahoney DW, et al. Prevalence and prognostic significance of heart failure stages: application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community. Circulation. 2007;115:1563–70.
Biering-Sorensen T, Biering-Sorensen SR, Olsen FJ, et al. Global longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population: the Copenhagen City Heart Study. Circ Cardiovasc Imaging. 2017;10:e005521.
Gorcsan J 3rd, Tanaka H 3rd. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol. 2011;58:1401–13.
Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging. 2009;2:356–64.
Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100:1673–80.
Mignot A, Donal E, Zaroui A, et al. Global longitudinal strain as a major predictor of cardiac events in patients with depressed left ventricular function: a multicenter study. J Am Soc Echocardiogr. 2010;23:1019–24.
Russo C, Jin Z, Elkind MS, et al. Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort. Eur J Heart Fail. 2014;16:1301–9.
Cheng S, McCabe EL, Larson MG, et al. Distinct aspects of left ventricular mechanical function are differentially associated with cardiovascular outcomes and all-cause mortality in the community. J Am Heart Assoc. 2015;4:e002071.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr. 2015;28(1–39):e14.
Levy D, Larson MG, Vasan RS, et al. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557–62.
National Cholesterol Education Program Expert Panel on Detection E. Treatment of High Blood Cholesterol in A Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–421.
Soufi Taleb Bendiab N, Meziane-Tani A, Ouabdesselam S, et al. Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction. Eur J Prev Cardiol. 2017;24:1463–72.
Imbalzano E, Zito C, Carerj S, et al. Left ventricular function in hypertension: new insight by speckle tracking echocardiography. Echocardiography. 2011;28:649–57.
Chen XJ, Sun XL, Zhang Q, et al. Uncontrolled blood pressure as an independent risk factor of early impaired left ventricular systolic function in treated hypertension. Echocardiography. 2016;33:1488–94.
Vaur L, Gueret P, Lievre M, et al. Development of congestive heart failure in type 2 diabetic patients with microalbuminuria or proteinuria: observations from the DIABHYCAR (type 2 DIABetes, Hypertension, CArdiovascular Events and Ramipril) study. Diabetes Care. 2003;26:855–60.
Iribarren C, Karter AJ, Go AS, et al. Glycemic control and heart failure among adult patients with diabetes. Circulation. 2001;103:2668–73.
Nakai H, Takeuchi M, Nishikage T, et al. Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur J Echocardiogr. 2009;10:926–32.
Ng AC, Delgado V, Bertini M, et al. Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol. 2009;104:1398–401.
Zoroufian A, Razmi T, Taghavi-Shavazi M, et al. Evaluation of subclinical left ventricular dysfunction in diabetic patients: longitudinal strain velocities and left ventricular dyssynchrony by two-dimensional speckle tracking echocardiography study. Echocardiography. 2014;31:456–63.
Ernande L, Bergerot C, Girerd N, et al. Longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus. J Am Soc Echocardiogr. 2014;27:479–88.
Ernande L, Bergerot C, Rietzschel ER, et al. Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy? J Am Soc Echocardiogr. 2011;24(1268–75):e1.
Mochizuki Y, Tanaka H, Matsumoto K, et al. Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus. Cardiovasc Diabetol. 2015;14:37.
Mochizuki Y, Tanaka H, Matsumoto K, et al. Association of peripheral nerve conduction in diabetic neuropathy with subclinical left ventricular systolic dysfunction. Cardiovasc Diabetol. 2015;14:47.
Mochizuki Y, Tanaka H, Tatsumi K, et al. Easy-to-use comprehensive speckle-tracking approach for cardiac resynchronization therapy. Circ J. 2014;78:2250–8.
Mochizuki Y, Tanaka H, Matsumoto K, et al. Impaired mechanics of left ventriculo-atrial coupling in patients with diabetic nephropathy. Circ J. 2016;80:1957–64.
Holland DJ, Marwick TH, Haluska BA, et al. Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus. Heart. 2015;101:1061–6.
Cognet T, Vervueren PL, Dercle L, et al. New concept of myocardial longitudinal strain reserve assessed by a dipyridamole infusion using 2D-strain echocardiography: the impact of diabetes and age, and the prognostic value. Cardiovasc Diabetol. 2013;12:84.
Mochizuki Y, Tanaka H, Matsumoto K, et al. Impact of left ventricular longitudinal functional mechanics on the progression of diastolic function in diabetes mellitus. Int J Cardiovasc Imaging. 2017;33:1905–14.
Djousse L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302:394–400.
Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.
Ho JE, McCabe EL, Wang TJ, et al. Cardiometabolic traits and systolic mechanics in the community. Circ Heart Fail. 2017;10:e003536.
Suto M, Tanaka H, Mochizuki Y, et al. Impact of overweight on left ventricular function in type 2 diabetes mellitus. Cardiovasc Diabetol. 2017;16:145.
Leung M, Xie M, Durmush E, et al. Weight loss with sleeve gastrectomy in obese type 2 diabetes mellitus: impact on cardiac function. Obes Surg. 2016;26:321–6.
Hooning MJ, Botma A, Aleman BM, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst. 2007;99:365–75.
Doyle JJ, Neugut AI, Jacobson JS, et al. Chemotherapy and cardiotoxicity in older breast cancer patients: a population-based study. J Clin Oncol. 2005;23:8597–605.
Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342:1077–84.
Negishi K, Negishi T, Haluska BA, et al. Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. Eur Heart J Cardiovasc Imaging. 2014;15:324–31.
Negishi K, Negishi T, Hare JL, et al. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr. 2013;26:493–8.
Thavendiranathan P, Poulin F, Lim KD, et al. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63:2751–68.
Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27:911–39.
Hatazawa K, Tanaka H, Nonaka A, et al. Baseline global longitudinal strain as a predictor of left ventricular dysfunction and hospitalization for heart failure of patients with malignant lymphoma after anthracycline therapy. Circ J. 2018;82:2566–74.
Wang Y, Yang H, Huynh Q, et al. Diagnosis of nonischemic stage B heart failure in type 2 diabetes mellitus: optimal parameters for prediction of heart failure. JACC Cardiovasc Imaging. 2018;16:2601.
Magne J, Mahjoub H, Pierard LA, et al. Prognostic importance of brain natriuretic peptide and left ventricular longitudinal function in asymptomatic degenerative mitral regurgitation. Heart. 2012;98:584–91.
Witkowski TG, Thomas JD, Debonnaire PJ, et al. Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair. Eur Heart J Cardiovasc Imaging. 2013;14:69–76.
Yingchoncharoen T, Gibby C, Rodriguez LL, et al. Association of myocardial deformation with outcome in asymptomatic aortic stenosis with normal ejection fraction. Circ Cardiovasc Imaging. 2012;5:719–25.
Sato K, Seo Y, Ishizu T, et al. Prognostic value of global longitudinal strain in paradoxical low-flow, low-gradient severe aortic stenosis with preserved ejection fraction. Circ J. 2014;78:2750–9.
Smedsrud MK, Pettersen E, Gjesdal O, et al. Detection of left ventricular dysfunction by global longitudinal systolic strain in patients with chronic aortic regurgitation. J Am Soc Echocardiogr. 2011;24:1253–9.
Alashi A, Mentias A, Abdallah A, et al. Incremental prognostic utility of left ventricular global longitudinal strain in asymptomatic patients with significant chronic aortic regurgitation and preserved left ventricular ejection fraction. JACC Cardiovasc Imaging. 2018;11:673–82.
Kalogeropoulos AP, Samman-Tahhan A, Hedley JS, et al. Progression to stage D heart failure among outpatients with stage C heart failure and reduced ejection fraction. JACC Heart Fail. 2017;5:528–37.
Cameli M, Mondillo S, Righini FM, et al. Left ventricular deformation and myocardial fibrosis in patients with advanced heart failure requiring transplantation. J Card Fail. 2016;22:901–7.
Chimura M, Onishi T, Tsukishiro Y, et al. Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy. Heart. 2017;103:679–86.
Reant P, Mirabel M, Lloyd G, et al. Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy. Heart. 2016;102:741–7.
Haugaa KH, Goebel B, Dahlslett T, et al. Risk assessment of ventricular arrhythmias in patients with nonischemic dilated cardiomyopathy by strain echocardiography. J Am Soc Echocardiogr. 2012;25:667–73.
Debonnaire P, Thijssen J, Leong DP, et al. Global longitudinal strain and left atrial volume index improve prediction of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy patients. Int J Cardiovasc Imaging. 2014;30:549–58.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Hidekazu Tanaka declares that he has no conflict of interest.
Rights and permissions
About this article
Cite this article
Tanaka, H. Utility of strain imaging in conjunction with heart failure stage classification for heart failure patient management. J Echocardiogr 17, 17–24 (2019). https://doi.org/10.1007/s12574-018-0408-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12574-018-0408-2