Age- and sex-based reference limits and clinical correlates of myocardial strain and synchrony: the Framingham Heart Study

• Published in: Circulation. Cardiovascular imaging Vol. 6; no. 5; pp. 692 - 699
• Main Authors: Cheng, Susan, Larson, Martin G, McCabe, Elizabeth L, Osypiuk, Ewa, Lehman, Birgitta T, Stanchev, Plamen, Aragam, Jayashri, Benjamin, Emelia J, Solomon, Scott D, Vasan, Ramachandran S
• Format: Journal Article
• Language: English
• Published: United States 01-09-2013
• Subjects: Age Factors; Aged; Aged, 80 and over; Biomechanical Phenomena; Echocardiography, Doppler, Pulsed - standards; Female; Heart Ventricles - diagnostic imaging; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; Myocardial Contraction; Predictive Value of Tests; Reference Values; Sex Factors; Stress, Mechanical; Ventricular Function, Left; left ventricular function; reference values; echocardiography
• ISSN: 1941-9651; 1942-0080
• DOI: 10.1161/CIRCIMAGING.112.000627

There is rapidly growing interest in applying measures of myocardial strain and synchrony in clinical investigations and in practice; data are limited regarding their reference ranges in healthy individuals.
We performed speckle-tracking-based echocardiographic measures of left ventricular myocardial strain and synchrony in healthy adults (n=739, mean age 63 years, 64% women) without cardiovascular disease. Reference values were estimated using quantile regression. Age- and sex-based upper (97.5th quantile) limits were: -14.4% to -17.1% (women) and -14.4 to -15.2% (men) for longitudinal strain; -22.3% to -24.7% (women) and -17.9% to -23.7% (men) for circumferential strain; 121 to 165 ms (women) and 143 to 230 ms (men) for longitudinal segmental synchrony (SD of regional time-to-peak strains); and 200 to 222 ms (women) and 216 to 303 ms (men) for transverse segmental synchrony. In multivariable analyses, women had ≈1.7% greater longitudinal strain, ≈2.2% greater transverse strain, and ≈3.2% greater circumferential strain (P<0.0001 for all) compared with men. Older age and higher diastolic blood pressure, even within the normal range, were associated with worse transverse segmental synchrony (P<0.001). Overall, covariates contributed to ≤12% of the variation in myocardial strain or synchrony in this healthy sample.
We estimated age- and sex-specific reference limits for measures of left ventricular strain and synchrony in a healthy community-based sample, wherein clinical covariates contributed to only a modest proportion of the variation. These data may facilitate the interpretation of left ventricular strain-based measures obtained in future clinical research and practice.