Статья
Клинические возможности и ограничения в применении современных технологий в эхокардиографии
Трансторакальная эхокардиография (ЭхоКГ) – наиболее часто используемый метод для выявления нарушений сократимости левого желудочка (ЛЖ). В большинстве случаев оценка сократимости проводится визуально, «на глаз», что увеличивает ее субъективность, зависит от опыта и квалификации исследователя и требует высокого уровня его клинической подготовки. В настоящее время в арсенале специалиста по ЭхоКГ для количественной оценки сократимости ЛЖ иногда используется тканевая допплер-ЭхоКГ, однако этот метод требует специальных настроек изображения (высокая частота смены кадров, выделение зон интереса), зависит от угла сканирования, квалификации исследователя, обладает высокой внутри- и межисследовательской вариабельностью, а также существенно увеличивает продолжительность исследования, поэтому данный метод не получил широкого клинического применения. В 2000-х годах появилась инновационная технология speckle tracking (оценка деформации по двухмерному изображению), которая в отличие от тканевой допплер-ЭхоКГ не обременяет исследователя временны´ми затратами, обладает низкой внутри- и межисследовательской вариабельностью, не зависит от угла сканирования и позволяет оценивать показатели сократимости миокарда. В последние годы эта технология активно внедряется в клиническую практику для выявления субклинических нарушений функционального состояния миокарда при различных заболеваниях и синдромах: артериальной гипертензии, ишемической болезни сердца, клапанных пороках и врожденных заболеваниях сердца, хронической сердечной недостаточности, кардиомиопатиях различной этиологии.
1. Buckberg GD, Hoffman JIE, Coghlan HC, Nanda NC. Ventricular structure–function relations in health and disease: Part I. The normal heart. European Journal of Cardio-Thoracic Surgery. 2015;47(4):587–601. DOI: 10.1093/ejcts/ezu278
2. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography. 2011;24(3):277–313. DOI: 10.1016/j.echo.2011.01.015
3. Voigt J-U, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R et al. Definitions for a Common Standard for 2D Speckle Tracking Echocardiography: Consensus Document of the EACVI/ ASE/Industry Task Force to Standardize Deformation Imaging. Journal of the American Society of Echocardiography. 2015;28(2):183–93. DOI: 10.1016/j.echo.2014.11.003
4. Pirat B, Khoury DS, Hartley CJ, Tiller L, Rao L, Schulz DG et al. A Novel Feature-Tracking Echocardiographic Method for the Quantitation of Regional Myocardial Function. Journal of the American College of Cardiology. 2008;51(6):651–9. DOI: 10.1016/j.jacc.2007.10.029
5. Marwick TH, Leano RL, Brown J, Sun J-P, Hoffmann R, Lysyansky P et al. Myocardial strain measurement with 2-dimensional speckletracking echocardiography: definition of normal range. JACC. Cardiovascular imaging. 2009;2(1):80–4. DOI: 10.1016/j.jcmg.2007.12.007
6. Manovel A, Dawson D, Smith B, Nihoyannopoulos P. Assessment of left ventricular function by different speckle-tracking software. European Journal of Echocardiography. 2010;11(5):417–21. DOI: 10.1093/ejechocard/jep226
7. Brown J, Jenkins C, Marwick TH. Use of myocardial strain to assess global left ventricular function: A comparison with cardiac magnetic resonance and 3-dimensional echocardiography. American Heart Journal. 2009;157(1):102 .e1-102. e5. DOI: 10.1016/j.ahj.2008.08.032
8. Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography. Journal of the American College of Cardiology. 2017;69(8):1043–56. DOI: 10.1016/j.jacc.2016.12.012
9. Korinek J, Kjaergaard J, Sengupta PP, Yoshifuku S, McMahon EM, Cha SS et al. High Spatial Resolution Speckle Tracking Improves Accuracy of 2-Dimensional Strain Measurements: An Update on a New Method in Functional Echocardiography. Journal of the American Society of Echocardiography. 2007;20(2):165–70. DOI: 10.1016/j.echo.2006.08.031
10. Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaum M et al. Two-dimensional strain–a novel software for real-time quantitative echocardiographic assessment of myocardial function. Journal of the American Society of Echocardiography. 2004;17(10):1021–9. DOI: 10.1016/j.echo.2004.06.019
11. Amzulescu MS, De Craene M, Langet H, Pasquet A, Vancraeynest D, Pouleur AC et al. Myocardial strain imaging: review of general principles, validation, and sources of discrepancies. European Heart Journal - Cardiovascular Imaging. 2019; pii:jez041. DOI: 10.1093/ehjci/jez041
12. Mądry W, Karolczak MA. Physiological basis in the assessment of myocardial mechanics using speckle-tracking echocardiography 2D. Part II. Journal of Ultrasonography. 2016;16(66):304–16. DOI: 10.15557/JoU.2016.0031
13. Mądry W, Karolczak MA. Physiological basis in the assessment of myocardial mechanics using speckle-tracking echocardiography 2D. Part I. Journal of Ultrasonography. 2016;16(65):135–44. DOI: 10.15557/JoU.2016.0015
14. Takigiku K, Takeuchi M, Izumi C, Yuda S, Sakata K, Ohte N et al. Normal range of left ventricular 2-dimensional strain: Japanese Ultrasound Speckle Tracking of the Left Ventricle ( JUSTICE) study. Circulation Journal: Official Journal of the Japanese Circulation Society. 2012;76(11):2623–32. PMID: 22813873
15. Edvardsen T, Helle-Valle T, Smiseth OA. Systolic Dysfunction in Heart Failure with Normal Ejection Fraction: SpeckleTracking Echocardiography. Progress in Cardiovascular Diseases. 2006;49(3):207–14. DOI: 10.1016/j.pcad.2006.08.008
16. de Simone G, Devereux RB, Roman MJ, Ganau A, Saba PS, Alderman MH et al. Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. Journal of the American College of Cardiology. 1994;23(6):1444–51. PMID: 8176105
17. Wang J, Khoury DS, Yue Y, Torre-Amione G, Nagueh SF. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. European Heart Journal. 2008;29(10):1283–9. DOI: 10.1093/eurheartj/ehn141
18. Choi J-O, Cho SW, Song YB, Cho SJ, Song BG, Lee S-C et al. Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. European Journal of Echocardiography. 2009;10(5):695–701. DOI: 10.1093/ejechocard/jep041
19. Sjøli B, Ørn S, Grenne B, Ihlen H, Edvardsen T, Brunvand H. Diagnostic Capability and Reproducibility of Strain by Doppler and by Speckle Tracking in Patients With Acute Myocardial Infarction. JACC: Cardiovascular Imaging. 2009;2(1):24–33. DOI: 10.1016/j.jcmg.2008.10.007
20. Park YH, Kang S-J, Song J-K, Lee EY, Song J-M, Kang D-H et al. Prognostic Value of Longitudinal Strain After Primary Reperfusion Therapy in Patients with Anterior-wall Acute Myocardial Infarction. Journal of the American Society of Echocardiography. 2008;21(3):262–7. DOI: 10.1016/j.echo.2007.08.026
21. Becker M, Lenzen A, Ocklenburg C, Stempel K, Kühl H, Neizel M et al. Myocardial Deformation Imaging Based on Ultrasonic Pixel Tracking to Identify Reversible Myocardial Dysfunction. Journal of the American College of Cardiology. 2008;51(15):1473–81. DOI: 10.1016/j.jacc.2007.10.066
22. Voigt J. Comparison of deformation imaging and velocity imaging for detecting regional inducible ischaemia during dobutamine stress echocardiography. European Heart Journal. 2004;25(17):1517–25. DOI: 10.1016/j.ehj.2004.05.014
23. Moonen M, Lancellotti P, Zacharakis D, Pierard L. The Value of 2D Strain Imaging during Stress Testing. Echocardiography. 2009;26(3):307–14. DOI: 10.1111/j.1540-8175.2008.00864.x
24. Lancellotti P, Cosyns B, Zacharakis D, Attena E, Van Camp G, Gach O et al. Importance of Left Ventricular Longitudinal Function and Functional Reserve in Patients With Degenerative Mitral Regurgitation: Assessment by Two-Dimensional Speckle Tracking. Journal of the American Society of Echocardiography. 2008;21(12):1331–6. DOI: 10.1016/j.echo.2008.09.023
25. Salaun E, Casalta A-C, Donal E, Bohbot Y, Galli E, Tribouilloy C et al. Apical four-chamber longitudinal left ventricular strain in patients with aortic stenosis and preserved left ventricular ejection fraction: analysis related with flow/gradient pattern and association with outcome. European Heart Journal - Cardiovascular Imaging. 2018;19(8):868–78. DOI: 10.1093/ehjci/jex203
26. Ng ACT, Prihadi EA, Antoni ML, Bertini M, Ewe SH, Ajmone Marsan N et al. Left ventricular global longitudinal strain is predictive of all-cause mortality independent of aortic stenosis severity and ejection fraction. European Heart Journal - Cardiovascular Imaging. 2018;19(8):859–67. DOI: 10.1093/ehjci/jex189
27. Kosmala W, Plaksej R, Strotmann JM, Weigel C, Herrmann S, Niemann M et al. Progression of Left Ventricular Functional Abnormalities in Hypertensive Patients with Heart Failure: An Ultrasonic Two-Dimensional Speckle Tracking Study. Journal of the American Society of Echocardiography. 2008;21(12):1309–17. DOI: 10.1016/j.echo.2008.10.006
28. Liu Y-W, Tsai W-C, Su C-T, Lin C-C, Chen J-H. Evidence of Left Ventricular Systolic Dysfunction Detected by Automated Function Imaging in Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction. Journal of Cardiac Failure. 2009;15(9):782–9. DOI: 10.1016/j.cardfail.2009.05.006
29. Park S-J, Miyazaki C, Bruce CJ, Ommen S, Miller FA, Oh JK. Left Ventricular Torsion by Two-Dimensional Speckle Tracking Echocardiography in Patients with Diastolic Dysfunction and Normal Ejection Fraction. Journal of the American Society of Echocardiography. 2008;21(10):1129–37. DOI: 10.1016/j.echo.2008.04.002
30. Wang J, Khoury DS, Yue Y, Torre-Amione G, Nagueh SF. Left Ventricular Untwisting Rate by Speckle Tracking Echocardiography. Circulation. 2007;116(22):2580–6. DOI: 10.1161/CIRCULATIONAHA.107.706770
31. Cho G-Y, Marwick TH, Kim H-S, Kim M-K, Hong K-S, Oh D-J. Global 2-dimensional strain as a new prognosticator in patients with heart failure. Journal of the American College of Cardiology. 2009;54(7):618–24. DOI: 10.1016/j.jacc.2009.04.061
32. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circulation. Cardiovascular Imaging. 2009;2(5):356–64. DOI: 10.1161/CIRCIMAGING.109.862334
33. Wang J, Khoury DS, Thohan V, Torre-Amione G, Nagueh SF. Global Diastolic Strain Rate for the Assessment of Left Ventricular Relaxation and Filling Pressures. Circulation. 2007;115(11):1376– 83. DOI: 10.1161/CIRCULATIONAHA.106.662882
34. Sakurai D, Asanuma T, Masuda K, Koriyama H, Nakatani S. New Parameter Derived from Three-Dimensional Speckle-Tracking Echocardiography for the Estimation of Left Ventricular Filling Pressure in Nondilated Hearts. Journal of the American Society of Echocardiography. 2017;30(5):522–31. DOI: 10.1016/j.echo.2017.01.015
35. Chung ES, Leon AR, Tavazzi L, Sun J-P, Nihoyannopoulos P, Merlino J et al. Results of the Predictors of Response to CRT (PROSPECT) Trial. Circulation. 2008;117(20):2608–16. DOI: 10.1161/CIRCULATIONAHA.107.743120
36. Tanaka H, Hara H, Saba S, Gorcsan J. Prediction of Response to Cardiac Resynchronization Therapy by Speckle Tracking Echocardiography Using Different Software Approaches. Journal of the American Society of Echocardiography. 2009;22(6):677–84. DOI: 10.1016/j.echo.2009.03.007
37. Nesser H-J, Winter S. Speckle Tracking in the Evaluation of Left Ventricular Dyssynchrony. Echocardiography. 2009;26(3):324–36. DOI: 10.1111/j.1540-8175.2008.00866.x
38. Stefani L, Pedrizzetti G, De Luca A, Mercuri R, Innocenti G, Galanti G. Real-time evaluation of longitudinal peak systolic strain (speckle tracking measurement) in left and right ventricles of athletes. Cardiovascular Ultrasound. 2009;7(1):17. DOI: 10.1186/1476-7120-7-17
39. Richand V, Lafitte S, Reant P, Serri K, Lafitte M, Brette S et al. An Ultrasound Speckle Tracking (Two-Dimensional Strain) Analysis of Myocardial Deformation in Professional Soccer Players Compared With Healthy Subjects and Hypertrophic Cardiomyopathy. The American Journal of Cardiology. 2007;100(1):128–32. DOI: 10.1016/j.amjcard.2007.02.063
40. Friedberg MK, Slorach C. Relation Between Left Ventricular Regional Radial Function and Radial Wall Motion Abnormalities Using Two-Dimensional Speckle Tracking in Children With Idiopathic Dilated Cardiomyopathy. The American Journal of Cardiology. 2008;102(3):335–9. DOI: 10.1016/j.amjcard.2008.03.064
41. van Dalen BM, Caliskan K, Soliman OII, Nemes A, Vletter WB, ten Cate FJ et al. Left ventricular solid body rotation in non-compaction cardiomyopathy: A potential new objective and quantitative functional diagnostic criterion? European Journal of Heart Failure. 2008;10(11):1088–93. DOI: 10.1016/j.ejheart.2008.08.006
42. Несветов В.В., Школьник Е.Л., Васюк Ю.А. Значение глобальной продольной систолической деформации по двухмерному изображению для ранней диагностики кардиотоксического действия химиопрепаратов (предварительные результаты). Журнал Сердечная Недостаточность. 2013;14(3):127-30
43. Biswas M, Sudhakar S, Nanda NC, Buckberg G, Pradhan M, Roomi AU et al. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography (Mount Kisco, N.Y.). 2013;30(1):88–105. DOI: 10.1111/echo.12079
44. Tan TC, Scherrer-Crosbie M. Cardiac complications of chemotherapy: role of imaging. Current Treatment Options in Cardiovascular Medicine. 2014;16(4):296. DOI: 10.1007/s11936-014-0296-3
45. Tarr A, Stoebe S, Tuennemann J, Baka Z, Pfeiffer D, Varga A et al. Early detection of cardiotoxicity by 2D and 3D deformation imaging in patients receiving chemotherapy. Echo Research and Practice. 2015;2(3):81–8. DOI: 10.1530/ERP-14-0084
46. Thavendiranathan P, Poulin F, Lim K-D, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. Journal of the American College of Cardiology. 2014;63(25 Pt A):2751–68. DOI: 10.1016/j.jacc.2014.01.073
47. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA: a cancer journal for clinicians. 2011;61(4):212–36. DOI: 10.3322/caac.20121
48. Stoodley PW, Richards DAB, Meikle SR, Clarke J, Hui R, Thomas L. The potential role of echocardiographic strain imaging for evaluating cardiotoxicity due to cancer therapy. Heart, Lung & Circulation. 2011;20(1):3–9. DOI: 10.1016/j.hlc.2010.09.007
49. Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Tan TC et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circulation. Cardiovascular Imaging. 2012;5(5):596–603. DOI: 10.1161/CIRCIMAGING.112.973321
50. Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Cohen V et al. Early detection and prediction of cardiotoxicity in chemotherapy-treated patients. The American Journal of Cardiology. 2011;107(9):1375– 80. DOI: 10.1016/j.amjcard.2011.01.006
51. Negishi K, Negishi T, Hare JL, Haluska BA, Plana JC, Marwick TH. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography. 2013;26(5):493–8. DOI: 10.1016/j.echo.2013.02.008
52. Unitt C, Montazeri K, Tolaney S, Moslehi J. Cardiology patient page. Breast cancer chemotherapy and your heart. Circulation. 2014;129(25):e680-682. DOI: 10.1161/CIRCULATIONAHA.113.007181
53. Toufan M, Pourafkari L, Ghahremani Nasab L, Esfahani A, Sanaat Z, Nikanfar A et al. Two-dimensional strain echocardiography for detection of cardiotoxicity in breast cancer patients undergoing chemotherapy. Journal of Cardiovascular and Thoracic Research. 2017;9(1):29–34. DOI: 10.15171/jcvtr.2017.04
54. Boyd A, Stoodley P, Richards D, Hui R, Harnett P, Vo K et al. Anthracyclines induce early changes in left ventricular systolic and diastolic function: A single centre study. PloS One. 2017;12(4):e0175544. DOI: 10.1371/journal.pone.0175544
55. TArciniegas Calle MC, Sandhu NP, Xia H, Cha SS, Pellikka PA, Ye Z et all. Two-dimensional speckle tracking echocardiography predicts early subclinical cardiotoxicity associated with anthracycline-trastuzumab chemotherapy in patients with breast cancerBMC Cancer. 2018 Oct 25;18(1):1037. doi: 10.1186/s12885-018-4935-z
56. Kasner M, Aleksandrov A, Escher F, Al-Saadi N, Makowski M, Spillmann F et al. Multimodality imaging approach in the diagnosis of chronic myocarditis with preserved left ventricular ejection fraction (MCpEF): The role of 2D speckle-tracking echocardiography. International Journal of Cardiology. 2017;243:374–8. DOI: 10.1016/j.ijcard.2017.05.038
57. Leitman M, Vered Z, Tyomkin V, Macogon B, Moravsky G, Peleg E et al. Speckle tracking imaging in inflammatory heart diseases. The International Journal of Cardiovascular Imaging. 2018;34(5):787–92. DOI: 10.1007/s10554-017-1284-y
58. Du Toit R, Herbst PG, van Rensburg A, Snyman HW, Reuter H, Doubell AF. Speckle tracking echocardiography in acute lupus myocarditis: comparison to conventional echocardiography. Echo Research and Practice. 2017;4(2):9–19. DOI: 10.1530/ERP-17-0005
59. Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European Heart Journal. 2010;31(19):2369– 429. DOI: 10.1093/eurheartj/ehq278
60. Romero J, Cao JJ, Garcia MJ, Taub CC. Cardiac imaging for assessment of left atrial appendage stasis and thrombosis. Nature Reviews Cardiology. 2014;11(8):470–80. DOI: 10.1038/nrcardio.2014.77
61. Kirchhof P, Auricchio A, Bax J, Crijns H, Camm J, Diener H-C et al. Outcome parameters for trials in atrial fibrillation: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork and the European Heart Rhythm Association. Europace. 2007;9(11):1006–23. DOI: 10.1093/europace/eum191
62. Cianciulli TF. Two-dimensional speckle tracking echocardiography for the assessment of atrial function. World Journal of Cardiology. 2010;2(7):163–70. DOI: 10.4330/wjc.v2.i7.163
63. Kallergis EM, Goudis CA, Vardas PE. Atrial fibrillation: A progressive atrial myopathy or a distinct disease? International Journal of Cardiology. 2014;171(2):126–33. DOI: 10.1016/j.ijcard.2013.12.009
64. Nattel S, Harada M. Atrial Remodeling and Atrial Fibrillation: recent advances and translational perspectives. Journal of the American College of Cardiology. 2014;63(22):2335–45. DOI: 10.1016/j.jacc.2014.02.555
65. Karabay CY, Zehir R, Güler A, Oduncu V, Kalayci A, Aung SM et al. Left Atrial Deformation Parameters Predict Left Atrial Appendage Function and Thrombus in Patients in Sinus Rhythm with Suspected Cardioembolic Stroke: A Speckle Tracking and Transesophageal Echocardiography Study. Echocardiography. 2013;30(5):572–81. DOI: 10.1111/echo.12089
66. Miśkowiec D, Karolina K, Michalski BW, Uznańska-Loch B, Kurpesa M, Kasprzak JD et al. Left Atrial Dysfunction Assessed by Two-Dimensional Speckle Tracking Echocardiography in Patients with Impaired Left Ventricular Ejection Fraction and SleepDisordered Breathing. Echocardiography. 2016;33(1):38–45. DOI: 10.1111/echo.12987
67. Dell’Era G, Rondano E, Franchi E, Marino PN, on behalf of the Novara Atrial Fibrillation (NAIF) Study Group. Atrial asynchrony and function before and after electrical cardioversion for persistent atrial fibrillation. European Journal of Echocardiography. 2010;11(7):577–83. DOI: 10.1093/ejechocard/jeq010
68. Obokata M, Negishi K, Kurosawa K, Tateno R, Tange S, Arai M et al. Left Atrial Strain Provides Incremental Value for Embolism Risk Stratification over CHA2DS2-VASc Score and Indicates Prognostic Impact in Patients with Atrial Fibrillation. Journal of the American Society of Echocardiography. 2014;27(7):709-716.e4. DOI: 10.1016/j.echo.2014.03.010
69. Kupczynska K. Association between left atrial function assessed by speckle-tracking echocardiography and the presence of left atrial appendage thrombus in patients with atrial fibrillation. The Anatolian Journal of Cardiology. 2017;18(1):15–22. DOI: 10.14744/AnatolJCardiol.2017.7613
70. Skaarup KG, Christensen H, Høst N, Mahmoud MM, Ovesen C, Olsen FJ et al. Usefulness of left ventricular speckle tracking echocardiography and novel measures of left atrial structure and function in diagnosing paroxysmal atrial fibrillation in ischemic stroke and transient ischemic attack patients. The International Journal of Cardiovascular Imaging. 2017;33(12):1921–9. DOI: 10.1007/s10554-017-1204-1
71. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L 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. Journal of the American Society of Echocardiography. 2015;28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003