Toshimitsu Tsugu1,2, Adriana Postolache1, Raluca Dulgheru1, Tadafumi Sugimoto1,3, Julien Tridetti1, Mai-Linh Nguyen Trung1, Caroline Piette1, Marie Moonen1, Roberta Manganaro1,4, Federica Ilardi1,5, Alexandra Maria Chitroceanu1,6, Simona Sperlongano1,7, Yun Yun Go1,8, George Kacharava9, George D Athanassopoulos10, Daniele Barone11, Monica Baroni12, Nuno Cardim13, Andreas Hagendorff14, Krasimira Hristova15, Teresa Lopez16, Gonzalo de la Morena17, Bogdan A Popescu18, Martin Penicka19, Tolga Ozyigit20, Jose David Rodrigo Carbonero21, Nico van de Veire22, Ralph Stephan Von Bardeleben23, Dragos Vinereanu6, Jose Luis Zamorano24, Monica Rosca18, Andreea Calin18, Julien Magne25,26, Bernard Cosyns27, Elena Galli28, Erwan Donal28, Ciro Santoro5, Maurizio Galderisi5, Luigi P Badano29,30, Roberto M Lang31, Patrizio Lancellotti1,32,33. 1. Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, CHU Sart Tilman, 4000 Liège, Belgium. 2. Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan. 3. Clinical Laboratory, Mie University Hospital, Mie, Japan. 4. Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy. 5. Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy. 6. Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. 7. Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy. 8. National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore. 9. Department of the Cardiology, Tbilisi Institute of Medicine (TIM), 16 Tsintsadze, 0160 Tbilisi, Georgia. 10. Department of Noninvasive Diagnostics, Onassis Cardiac Surgery Center, Athens, Greece. 11. Laboratory of Cardiovascular Ecography, Department of Cardiology, S. Andrea Hospital, La Spezia, Italy. 12. Laboratorio Di Ecocardiografia Adulti, Fondazione Toscana "G.Monasterio" - Ospedale Del Cuore, Massa, Italy. 13. Hospital da Luz, Echocardiography Laboratory, Lisbon, Portugal. 14. Department of Cardiology, University of Leipzig, Leipzig, Germany. 15. Department of Noninvasive Functional Diagnostic and Imaging, University National Heart Hospital, Sofia, Bulgaria. 16. Cardiology Department, La Paz Hospital, IdiPAz, Ciber, Madrid, Spain. 17. Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain. 18. University of Medicine and Pharmacy "Carol Davila" - Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022328, Bucharest, Romania. 19. Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. 20. VKV Amerikan Hastanesi, Kardiyoloji Bölümü, Istanbul, Turkey. 21. Laboratorio de Ecocardiografia Hospital de Cruces, Barakaldo, Spain. 22. Echocardiography Unit, AZ Maria Middelares Gent, Gent, Belgium. 23. Emergency Medical Department Cardiology, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Mainz, Germany. 24. Department of Cardiology, University Alcala, Hospital Ramón y Cajal, Madrid, Spain. 25. CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042 France. 26. INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, GEIST, 2, rue Marcland, 87000 Limoges, France. 27. CHVZ (Centrum voor Hart en Vaatziekten) - Universitair ziekenhuis Brussel; and ICMI (In Vivo Cellular and Molecular Imaging) laboratory, 101 Laarbeeklaan, 1090b Brussels, Belgium. 28. Service de Cardiologie, INSERM 1414, CHU Pontchaillou - and- LTSI, Université de Rennes 1 - INSERM, UMR 1099, Rennes, France. 29. Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy. 30. Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. 31. Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA. 32. Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italy. 33. Anthea Hospital, Bari, Italy.
Abstract
AIMS: 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. METHODS AND RESULTS: 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). CONCLUSION: The NORRE study provides useful 2DE reference ranges for novel indices of layer-specific strain. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: 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. METHODS AND RESULTS: 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). CONCLUSION: The NORRE study provides useful 2DE reference ranges for novel indices of layer-specific strain. Published on behalf of the European Society of Cardiology. All rights reserved.
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