3-Dimensional Echocardiography and 2-D Strain Analysis of Left Ventricular, Left Atrial and Right Ventricular Function in Healthy Brazilian Volunteers

Saraiva, Roberto M.; Scolin, Eliza Maria B.; Pacheco, Nicole P.; Bouret, Maria Eduarda; Mediano, Mauro Felippe Felix; Holanda, Marcelo T.; Costa, Andréa R. da

doi:10.5935/abc.20190155

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Original Article • Arq. Bras. Cardiol. 113 (5) • Nov 2019 • https://doi.org/10.5935/abc.20190155 copy

3-Dimensional Echocardiography and 2-D Strain Analysis of Left Ventricular, Left Atrial and Right Ventricular Function in Healthy Brazilian Volunteers

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

New echocardiographic techniques are used in the diagnosis and prognosis of many heart diseases. However, reference values in different populations are still needed for several of these new indexes. We studied these new echocardiographic parameters in a group of Brazilians with no known cardiovascular disease.

Objective:

To study values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age.

Methods:

Cross-sectional study that included healthy individuals who underwent three-dimensional echocardiography (3DE) and two-dimensional speckle tracking echocardiography (STE) strain (e) analysis. Left atrial (LA) and left ventricular (LV) function were analyzed by 3DE and STE, and right ventricular (RV) function by STE. P values < 0.05 were considered significant.

Results:

Seventy-seven subjects (46.7% men; 40.4 ± 10.4 years) were included. Maximum, minimum and pre-atrial contraction (pre-A) LA volumes (ml/m²) were 21.2 ± 5.5, 7.8 ± 2.5, and 11.0 ± 3.1, respectively. Peak positive global LA e (LAScd), peak negative global LA e and total global LA e (LASr) were 17.4 ± 5.2%, -13.2 ± 2.0% and 30.5 ± 5.9%, respectively. LV end-diastolic and end-systolic volumes (ml/m²) measured 57 ± 12 and 24 ± 6, and 3D LV ejection fraction measured 58 ± 6%. Global LV longitudinal, circumferential and radial e were -19 ± 2%, -19 ± 3%, and 46 ± 12%, respectively. LV torsion measured 1.6 ± 0.7⁰ /cm. Global longitudinal RV e (RV-GLS) and RV free wall strain were -22 ± 3% and -24 ± 5%. Minimum LA and pre-A volumes, LV apical rotation, torsion and RV-GLS increased with age, while total and passive LA emptying fractions, LAScd, LASr, LV end-diastolic and end-systolic volumes decreased with age.

Conclusion:

Values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age are presented.

Keywords:
Cardiovascular Diseases; Echocardiography, Three-Dimensional; Reference Values; Left Ventricular Function; Right Ventricular Function; Strain; Speckle Tracking

	All n = 77	Male n = 36	Female n = 41	P value^a a Student’s t-test or contingency tables comparing men vs. women, as appropriate. n (%); mean ± SD.
Age, years	40.4 ± 10.4 (range 19–78)	39.5 ± 9.7 (range 19–62)	41.3 ± 11.0 (range 21–78)	0.45
BMI, kg/m²	25.0 ± 3.2	25.1 ± 3.0	24.9 ± 3.3	0.78
SBP, mmHg	122 ± 12	124 ± 10	121 ± 13	0.28
DBP, mmHg	76 ± 8	77 ± 7	75 ± 9	0.49
Place of origin				0.15
Southeast	32 (41.5%)	19 (52.7 %)	13 (31.7%)
Northeast	41 (53.2%)	16 (44.4%)	25 (61%)
North	4 (5.2%)	1 (2.8%)	3 (7.3%)
Ethnicity				0.13
White	42 (54.5%)	24 (66.6%)	18 (43.9%)
Afro-Brazilian	11 (14.3%)	4 (11.1%)	7 (17.1%)
Mixed/Browned skinned	24 (31.1%)	8 (22.2%)	16 (39.0%)
2D echocardiogram
LA, cm	3.4 ± 0.4	3.5 ± 0.5	3.2 ± 0.3	0.009
LVd, cm	5.0 ± 0.5	5.3 ± 0.4	4.7 ± 0.4	< 0.0001
LVs, cm	3.0 ± 0.4	3.2 ± 0.4	2.8 ± 0.4	< 0.0001
LV ejection fraction, %	68 ± 6	67 ± 5	69 ± 6	0.10
LV S’, cm/s	9.6 ± 2.0	9.8 ± 2.0	9.4 ± 2.0	0.32
LV mass, g/m²	60 ± 12	63 ± 13	58 ± 11	0.07
E/A ratio	1.6 ± 0.5	1.7 ± 0.5	1.6 ± 0.4	0.08
DT, ms	160 ± 34	161 ± 34	160 ± 35	0.81
E’, cm/s	13.6 ± 2.9	14.1 ± 2.4	13.3 ± 3.2	0.22
E/E’ ratio	6.2 ± 1.8	5.5 ± 1.0	6.9 ± 2.0	0.0003
Vp, cm/s	73 ± 23	72 ± 26	74 ± 120	0.67
E/Vp	1.2 ± 0.4	1.1 ± 0.3	1.3 ± 0.4	0.21
RV S’, cm/s	14.6 ± 2.3	14.7 ± 2.4	14.6 ± 2.2	0.93
TAPSE, mm	24 ± 4	25 ± 4	24 ± 3	0.71
RVSP, mmHg	26 ± 5	26 ± 5	25 ± 5	0.45

	All n = 77	Men n = 36	Women n = 41	P value^a a Student’s test-t comparing men vs. women.
3DE
Max LA Vol, mL/m²	21.2 ± 5.5	21.6 ± 5.5	20.9 ± 5.5	0.63
Min LA Vol, mL/m²	7.8 ± 2.5	8.3 ± 2.6	7.4 ± 2.4	0.11
Pre-A LA Vol, mL/m²	11.0 ± 3.1	11.8 ± 3.1	10.4 ± 3.0	0.04
Total LA EF, %	63 ± 8	61 ± 7	64 ± 8	0.08
Active LA EF, %	29 ± 9	29 ± 9	29 ± 9	0.74
Passive LA EF, %	48 ± 10	45 ± 8	50 ± 11	0.03
LA Strain
LASct, %	-13.2 ± 2.0	-13.1 ± 2.4	-13.2 ± 1.5	0.70
LAScd, %	17.4 ± 5.2	16.8 ± 5.0	17.8 ± 5.3	0.36
LASr, %	30.5 ± 5.9	29.8 ± 6.0	31.1 ± 5.8	0.35

	All n = 77	Men n = 36	Women n = 41	P value^a a Student’s test-t comparing men vs. women.
3DE
LV end-diastolic volume, mL/m²	57 ± 12	60 ± 10	54 ± 13	0.04
LV end-systolic volume, mL/m²	24 ± 6	25 ± 5	22 ± 7	0.05
Ejection fraction, %	58 ± 6	58 ± 6	58 ± 6	0.61
LV Strain
LV-GLS, %	-19 ± 2	-19 ± 2	-20 ± 2	0.06
LV-GCS, %	-19 ± 3	-18 ± 3	-20 ± 3	0.03
LV-GRS, %	46 ± 12	44 ± 12	48 ± 12	0.19
Peak apical rotation, ⁰	8.7 ± 4.2	7.9 ± 4.1	9.3 ± 4.2	0.19
Peak basal rotation, ⁰	-5.6 ± 3.0	-5.2 ± 2.5	-5.9 ± 3.3	0.31
Peak twist, ⁰	13.5 ± 5.0	12.6 ± 4.4	14.2 ± 5.4	0.18
Peak torsion, ⁰/cm	1.6 ± 0.7	1.4 ± 0.5	1.7 ± 0.7	0.07
Untwist,⁰/s	-116 ± 32	-110 ± 34	-119 ± 31	0.26

	All n = 77	Men n = 36		Women n = 41	P value^a a Student’s test-t comparing men vs. women.
RV-GLS, %	-22 ± 3	-22 ± 3		-22 ± 3	0.86
RV-fwLS, %	-24 ± 5	-25 ± 5		-24 ± 4	0.17

	β coefficients ± standard error	P value	adjusted R²
Min LA Vol
Age	0.07 ± 0.03	0.02	0.06
Pre-A LA Vol
Age	0.10 ± 0.03	0.002	0.15
Male	1.57 ± 0.7	0.02
Total LA EF
Age	-0.21 ± 0.09	0.02	0.09
Male	-3.7 ± 1.8	0.04
Passive LA EF
Age	-0.27 ± 0.11	0.01	0.24
Male	-5.3 ± 2.0	0.01
BMI	-0.9 ± 0.3	0.01
LAScd
Age	-0.16 ± 0.05	0.003	0.29
BMI	-0.60 ± 0.17	0.0006
LASr
Age	-0.17 ± 0.06	0.0007	0.25
BMI	-0.67 ± 0.20	0.001
LV end-diastolic volume
Age	-0.36 ± 0.14	0.01	0.08
LV end-systolic volume
Age	-0.19 ± 0.07	0.007	0.10
LV-GLS
BMI	0.23 ± 0.09	0.01	0.07
LV-GCS
Male	1.6 ± 0.7	0.03	0.05
Peak apical rotation
Age	0.12 ± 0.05	0.01	0.07
Peak twist
Age	0.14 ± 0.06	0.02	0.08
Peak torsion
Age	0.02 ± 0.007	0.02	0.07
RV-GLS
BMI	0.31 ± 0.10	0.002	0.18
Ethnicity	0.71 ± 0.10	0.05
RV-fwLS
BMI	0.56 ± 0.17	0.002	0.13

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[1] Mailing Address: Roberto M. Saraiva, Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz , Av. Brasil, 4365. Postal Code 21040-900, Rio de Janeiro, RJ - Brazil. E-mail: roberto.saraiva@ini.fiocruz.br