The Role of Strain in Cardiomyopathy (Cardiac Imaging Symposium)

The Role of Strain in Cardiomyopathy (Cardiac Imaging Symposium)

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  The Role ofStrain in Cardiomyopathies Melissa LeFevre Cardiac Sonographer BA, RDCS Duke University
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  2004
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  2025
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  Consensus Statement: Validates theutility the of strain Robust and reproducible as a complementary parameter of global LV function Guide clinical applications with clear supporting evidence Provides guidance to payers - which applications of strain are most worthy of reimbursement
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  Reporting on GLS •-18%: Normal • Normal LV strain is more negative than -18%. • -16% to -18%: Borderline • “.. lower limits of normal. As an adjunctive assessment of myocardial function, this strain value may be compatible with early or mild impairment of myocardial contractility in the setting of preserved EF.“ • -16% Abnormal • Abnormal is less negative than 16%.
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  Uses In cardiomyopathy Prognosis Diagnosis Guidetreatment Monitor treatment and disease progression
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  A Few Examples: Dilatedcardiomyopathy Hypertrophic cardiomyopathy Infiltrative cardiomyopathy
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  Prognosis Guide decision makingabout various interventions Would patient benefit from a defibrillator? Strain value is low Mechanical Dispersion – Related to arrhythmic events help identify patients at increased risk Would a patient benefit from CRT device? Dyssynchrony strain pattern
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  Prognosis Strain equal orless negative to -6.95% Worse long-term adverse events, including death, cardiac transplantation, and HF hospitalization Each 1% decrease of LVGLS was 15% increased odds for mortality in HFrEF. Strain also provides superior prognostic values than LVEF in predicting mortality in reduced EF and improved EF
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  Diagnosis Determine etiology ofLV hypertrophy Disease differentiation
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  CASE A 45 yearold male SOB
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  Case A
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  What is thispatient’s diagnosis? 1. Athlete’s heart 2. Hypertension 3. Hypertrophic cardiomyopathy 4. Amyloid cardiomyopathy
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  Case A
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  Hypertrophic cardiomyopathy
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  Case Study 60 yrold male No significant health history Echo ordered after A-fib event over weekend
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  Case B:
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  -14.9 %
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  -8.2 %
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  2023 -17.6 %
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  Monitor Treatment Serial quantificationof LV function Identify subclinical impairment