Echocardiographic reference ranges for normal left ventricular layer-specific strain: results from the EACVI NORRE study

• Published in: European heart journal cardiovascular imaging Vol. 21; no. 8; pp. 896 - 905
• Main Authors: Tsugu, Toshimitsu, Postolache, Adriana, Dulgheru, Raluca, Sugimoto, Tadafumi, Tridetti, Julien, Nguyen Trung, Mai-Linh, Piette, Caroline, Moonen, Marie, Manganaro, Roberta, Ilardi, Federica, Chitroceanu, Alexandra Maria, Sperlongano, Simona, Go, Yun Yun, Kacharava, George, Athanassopoulos, George D, Barone, Daniele, Baroni, Monica, Cardim, Nuno, Hagendorff, Andreas, Hristova, Krasimira, Lopez, Teresa, de la Morena, Gonzalo, Popescu, Bogdan A, Penicka, Martin, Ozyigit, Tolga, Rodrigo Carbonero, Jose David, van de Veire, Nico, Von Bardeleben, Ralph Stephan, Vinereanu, Dragos, Zamorano, Jose Luis, Rosca, Monica, Calin, Andreea, Magne, Julien, Cosyns, Bernard, Galli, Elena, Donal, Erwan, Santoro, Ciro, Galderisi, Maurizio, Badano, Luigi P, Lang, Roberto M, Lancellotti, Patrizio
• Format: Journal Article Web Resource
• Language: English
• Published: England Oxford UP 01-08-2020; Oxford University Press
• Subjects: 2D echocardiography; adult echocardiography; Bioengineering; Cardiology and cardiovascular system; Cardiovascular & respiratory systems; deformation imaging; Human health and pathology; Human health sciences; Life Sciences; reference values; Sciences de la santé humaine; Systèmes cardiovasculaire & respiratoire; 2D echocardiography; reference values; deformation imaging; adult echocardiography
• ISSN: 2047-2404; 2047-2412; 2047-2412
• DOI: 10.1093/ehjci/jeaa050

To obtain the normal range for 2D echocardiographic (2DE) measurements of left ventricular (LV) layer-specific strain from a large group of healthy volunteers of both genders over a wide range of ages.
A total of 287 (109 men, mean age: 46 ± 14 years) healthy subjects were enrolled at 22 collaborating institutions of the EACVI Normal Reference Ranges for Echocardiography (NORRE) study. Layer-specific strain was analysed from the apical two-, three-, and four-chamber views using 2DE software. The lowest values of layer-specific strain calculated as ±1.96 standard deviations from the mean were -15.0% in men and -15.6% in women for epicardial strain, -16.8% and -17.7% for mid-myocardial strain, and -18.7% and -19.9% for endocardial strain, respectively. Basal-epicardial and mid-myocardial strain decreased with age in women (epicardial; P = 0.008, mid-myocardial; P = 0.003) and correlated with age (epicardial; r = -0.20, P = 0.007, mid-myocardial; r = -0.21, P = 0.006, endocardial; r = -0.23, P = 0.002), whereas apical-epicardial, mid-myocardial strain increased with the age in women (epicardial; P = 0.006, mid-myocardial; P = 0.03) and correlated with age (epicardial; r = 0.16, P = 0.04). End/Epi ratio at the apex was higher than at the middle and basal levels of LV in men (apex; 1.6 ± 0.2, middle; 1.2 ± 0.1, base 1.1 ± 0.1) and women (apex; 1.6 ± 0.1, middle; 1.1 ± 0.1, base 1.2 ± 0.1).
The NORRE study provides useful 2DE reference ranges for novel indices of layer-specific strain.