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01-01-2020 | Echocardiography | Review Article

What is Left Ventricular Strain in Healthy Neonates? A Systematic Review and Meta-analysis

Authors: Umael Khan, Tom R. Omdal, Knut Matre, Gottfried Greve

Published in: Pediatric Cardiology | Issue 1/2020

Abstract

Reference values for left ventricular systolic strain in healthy neonates are necessary for clinical application of strain. The objectives of this systematic review were to identify echocardiographic studies that presented left ventricular strain values in healthy neonates, perform a meta-analysis for speckle tracking-derived global longitudinal strain, and identify areas that require further investigation. A structured search was applied to MEDLINE, Embase, and Cochrane Central Register of Clinical Trials in search of echocardiographic studies that presented left ventricular strain in healthy neonates. 244 studies were identified, of which 16 studies including speckle tracking and tissue Doppler strain in the longitudinal, radial, and circumferential directions passed the screening process. Out of these 16 studies, a meta-analysis was performed on the 10 studies that reported speckle tracking global longitudinal strain. Mean speckle tracking-derived global longitudinal strain was 21.0% (95% Confidence Interval 19.6–22.5%, strain given as positive values). When the studies were divided into subgroups, mean speckle tracking global longitudinal strain from the four-chamber view was 19.5% (95% Confidence Interval 18.0–21.0%) and that derived from all three apical views was 22.5% (95% CI 20.6–24.7%), indicating that global longitudinal strain from the four-chamber view is slightly lower than global longitudinal strain from all three apical views. Neonatal strain values were close to strain values in older subjects found in previous meta-analyses. Further studies are recommended that examine strain rate, segmental strain values, strain derived from short axis views, and strain in the first few hours after birth.

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El-Khuffash A, Schubert U, Levy PT, Nestaas E, de Boode WP, de Boode WP, Austin T, Bohlin K, Bravo MC, Breatnach CR, Breindahl M, Dempsey E, El-Khuffash A, Groves AM, Gupta S, Horsberg Eriksen B, Levy PT, McNamara PJ, Molnar Z, Nestaas E, Rogerson SR, Roehr CC, Savoia M, Schubert U, Schwarz CE, Sehgal A, Singh Y, Slieker MG, Tissot C, van der Lee R, van Laere D, van Overmeire B, van Wyk L (2018) Deformation imaging and rotational mechanics in neonates: a guide to image acquisition, measurement, interpretation, and reference values. Pediatr Cardiol 84(1):30–45. https://doi.org/10.1038/s41390-018-0080-2 CrossRef

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270. https://doi.org/10.1093/ehjci/jev014 CrossRefPubMed

Breatnach CR, Levy PT, James AT, Franklin O, El-Khuffash A (2016) Novel echocardiography methods in the functional assessment of the newborn heart. Neonatology 110(4):248–260. https://doi.org/10.1159/000445779 CrossRefPubMed

Nestaas E, Stoylen A, Brunvand L, Fugelseth D (2011) Longitudinal strain and strain rate by tissue Doppler are more sensitive indices than fractional shortening for assessing the reduced myocardial function in asphyxiated neonates. Cardiol Young 21(1):1–7. https://doi.org/10.1017/S1047951109991314 CrossRefPubMed

Al-Biltagi M, Tolba OA, Rowisha MA, Mahfouz Ael S, Elewa MA (2015) Speckle tracking and myocardial tissue imaging in infant of diabetic mother with gestational and pregestational diabetes. Pediatr Cardiol 36(2):445–453. https://doi.org/10.1007/s00246-014-1033-0 CrossRefPubMed

Hirose A, Khoo NS, Aziz K, Al-Rajaa N, van den Boom J, Savard W, Brooks P, Hornberger LK (2015) Evolution of left ventricular function in the preterm infant. J Am Soc Echocardiogr 28(3):302–308. https://doi.org/10.1016/j.echo.2014.10.017 CrossRefPubMed

Tham EB, Smallhorn JF, Kaneko S, Valiani S, Myers KA, Colen TM, Kutty S, Khoo NS (2014) Insights into the evolution of myocardial dysfunction in the functionally single right ventricle between staged palliations using speckle-tracking echocardiography. J Am Soc Echocardiogr 27(3):314–322. https://doi.org/10.1016/j.echo.2013.11.012 CrossRefPubMed

Sehgal A, Doctor T, Menahem S (2014) Cyclooxygenase inhibitors in preterm infants with patent ductus arteriosus: effects on cardiac and vascular indices. Pediatr Cardiol 35(8):1429–1436. https://doi.org/10.1007/s00246-014-0947-x CrossRefPubMed

Nestaas E, Skranes JH, Stoylen A, Brunvand L, Fugelseth D (2014) The myocardial function during and after whole-body therapeutic hypothermia for hypoxic-ischemic encephalopathy, a cohort study. Early Hum Dev 90(5):247–252. https://doi.org/10.1016/j.earlhumdev.2014.01.014 CrossRefPubMed

10.

Akao M, Katsube Y, Kamisago M, Watanabe M, Abe M, Fukazawa R, Ogawa S, Itoh Y (2013) Developmental changes in left and right ventricular function evaluated with color tissue Doppler imaging and strain echocardiography. J Nippon Med Sch 80(4):260–267CrossRef

11.

Jain A, Kuipers BCW, Mohamed A, Connelly KA, McNamara PJ, Jankov RP, Mertens L (2017) Left ventricular function in healthy term neonates during the transitional period. J Pediatr 182:197–203.e192. https://doi.org/10.1016/j.jpeds.2016.11.003 CrossRefPubMed

12.

Sehgal A, Wong F, Menahem S (2013) Speckle tracking derived strain in infants with severe perinatal asphyxia: a comparative case control study. Cardiovasc 11:34. https://doi.org/10.1186/1476-7120-11-34 CrossRef

13.

Sehgal A, Doctor T, Menahem S (2014) Cardiac function and arterial indices in infants born small for gestational age: analysis by speckle tracking. Acta Paediatr 103(2):e49–e54. https://doi.org/10.1111/apa.12465 CrossRefPubMed

14.

Cantinotti M, Kutty S, Franchi E, Paterni M, Scalese M, Iervasi G, Koestenberger M (2017) Pediatric echocardiographic nomograms: What has been done and what still needs to be done. Trends Cardiovasc Med 27(5):336–349. https://doi.org/10.1016/j.tcm.2017.01.006 CrossRefPubMed

15.

Forsey J, Friedberg MK, Mertens L (2013) Speckle tracking echocardiography in pediatric and congenital heart disease. Echocardiography 30(4):447–459. https://doi.org/10.1111/echo.12131 CrossRefPubMed

16.

Kahr PC, Kahr MK, Dabral H, Agarwal R, Kothari SS, Saxena A, Ramakrishnan S (2016) Changes in myocardial contractility and electromechanical interval during the first month of life in healthy neonates. Pediatr Cardiol 37(2):409–418. https://doi.org/10.1007/s00246-015-1292-4 CrossRefPubMed

17.

Nestaas E, Støylen A, Fugelseth D (2012) Myocardial performance assessment in neonates by one-segment strain and strain rate analysis by tissue Doppler—a quality improvement cohort study. BMJ Open 2(4):e001636. https://doi.org/10.1136/bmjopen-2012-001636 CrossRefPubMedPubMedCentral

18.

Khan U, Hjertaas JJ, Greve G, Matre K (2016) Optimal acquisition settings for speckle tracking echocardiography-derived strains in infants: an in vitro study. Ultrasound Med Biol 42(7):1660–1670. https://doi.org/10.1016/j.ultrasmedbio.2016.02.015 CrossRefPubMed

19.

Yingchoncharoen T, Agarwal S, Popovic ZB, Marwick TH (2013) Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiogr 26(2):185–191. https://doi.org/10.1016/j.echo.2012.10.008 CrossRefPubMed

20.

Levy PT, Machefsky A, Sanchez AA, Patel MD, Rogal S, Fowler S, Yaeger L, Hardi A, Holland MR, Hamvas A, Singh GK (2016) Reference ranges of left ventricular strain measures by two-dimensional speckle-tracking echocardiography in children: a systematic review and meta-analysis. J Am Soc Echocardiogr 29(3):209–225.e206. https://doi.org/10.1016/j.echo.2015.11.016 CrossRefPubMed

21.

Jashari H, Rydberg A, Ibrahimi P, Bajraktari G, Kryeziu L, Jashari F, Henein MY (2015) Normal ranges of left ventricular strain in children: a meta-analysis. Cardiovasc Ultrasound 13:37. https://doi.org/10.1186/s12947-015-0029-0 CrossRefPubMedPubMedCentral

22.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentral

23.

Bax L, Yu L-M, Ikeda N, Moons KGM (2007) A systematic comparison of software dedicated to meta-analysis of causal studies. BMC Med Res Methodol 7:40. https://doi.org/10.1186/1471-2288-7-40 CrossRefPubMedPubMedCentral

24.

Lee YH (2018) An overview of meta-analysis for clinicians. Korean J Intern Med 33(2):277–283. https://doi.org/10.3904/kjim.2016.195 CrossRefPubMed

25.

Bowden J, Tierney JF, Copas AJ, Burdett S (2011) Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med Res Methodol 11:41. https://doi.org/10.1186/1471-2288-11-41 CrossRefPubMedPubMedCentral

26.

Nestaas E, Stoylen A, Brunvand L, Fugelseth D (2009) Tissue Doppler derived longitudinal strain and strain rate during the first 3 days of life in healthy term neonates. Pediatr Cardiol 65(3):357–362. https://doi.org/10.1203/PDR.0b013e318193f149 CrossRef

27.

Friede T, Röver C, Wandel S, Neuenschwander B (2017) Meta-analysis of few small studies in orphan diseases. Res Synth Methods 8(1):79–91. https://doi.org/10.1002/jrsm.1217 CrossRefPubMed

28.

Marcus KA, Mavinkurve-Groothuis AM, Barends M, van Dijk A, Feuth T, de Korte C, Kapusta L (2011) Reference values for myocardial two-dimensional strain echocardiography in a healthy pediatric and young adult cohort. J Am Soc Echocardiogr 24(6):625–636. https://doi.org/10.1016/j.echo.2011.01.021 CrossRefPubMed

29.

Zhang L, Gao J, Xie M, Yin P, Liu W, Li Y, Klas B, Sun J, Balluz R, Ge S (2013) Left ventricular three-dimensional global systolic strain by real-time three-dimensional speckle-tracking in children: feasibility, reproducibility, maturational changes, and normal ranges. J Am Soc Echocardiogr 26(8):853–859. https://doi.org/10.1016/j.echo.2013.05.002 CrossRefPubMed

30.

Lorch SM, Ludomirsky A, Singh GK (2008) Maturational and growth-related changes in left ventricular longitudinal strain and strain rate measured by two-dimensional speckle tracking echocardiography in healthy pediatric population. J Am Soc Echocardiogr 21(11):1207–1215. https://doi.org/10.1016/j.echo.2008.08.011 CrossRefPubMed

31.

Rosner A, Bijnens B, Hansen M, How OJ, Aarsaether E, Muller S, Sutherland GR, Myrmel T (2009) Left ventricular size determines tissue Doppler-derived longitudinal strain and strain rate. Eur J Echocardiogr 10(2):271–277. https://doi.org/10.1093/ejechocard/jen230 CrossRefPubMed

32.

Riley RD, Higgins JPT, Deeks JJ (2011) Interpretation of random effects meta-analyses. BMJ 342:d549. https://doi.org/10.1136/bmj.d549 CrossRefPubMed

33.

Davey J, Turner RM, Clarke MJ, Higgins JPT (2011) Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis. BMC Med Res Methodol 11(1):160. https://doi.org/10.1186/1471-2288-11-160 CrossRefPubMedPubMedCentral

34.

Amzulescu MS, Langet H, Saloux E, Manrique A, Boileau L, Slimani A, Allain P, Roy C, Meester Cd, Pasquet A, Craene MD, Vancraeynest D, Pouleur A-C, Vanoverschelde J-LJ, Gerber BL (2017) Head-to-head comparison of global and regional two-dimensional speckle tracking strain versus cardiac magnetic resonance tagging in a multicenter validation study. Circ Cardiovasc Imaging 10(11):e006530. https://doi.org/10.1161/CIRCIMAGING.117.006530 CrossRefPubMed

35.

Mirea O, Pagourelias ED, Duchenne J, Bogaert J, Thomas JD, Badano LP, Voigt JU (2018) Intervendor differences in the accuracy of detecting regional functional abnormalities: a report from the EACVI-ASE strain standardization task force. JACC Cardiovasc Imaging 11(1):25–34. https://doi.org/10.1016/j.jcmg.2017.02.014 CrossRefPubMed

36.

Shiino K, Yamada A, Ischenko M, Khandheria BK, Hudaverdi M, Speranza V, Harten M, Benjamin A, Hamilton-Craig CR, Platts DG, Burstow DJ, Scalia GM, Chan J (2017) Intervendor consistency and reproducibility of left ventricular 2D global and regional strain with two different high-end ultrasound systems. Eur Heart J Cardiovasc Imaging 18(6):707–716. https://doi.org/10.1093/ehjci/jew120 CrossRefPubMed

37.

Collier P, Phelan D, Klein A (2017) A test in context: myocardial strain measured by speckle-tracking echocardiography. J Am Coll Cardiol 69(8):1043–1056. https://doi.org/10.1016/j.jacc.2016.12.012 CrossRefPubMed

38.

Evans NJ, Archer LN (1990) Postnatal circulatory adaptation in healthy term and preterm neonates. Arch Dis Childhood 65(1 Spec No):24–26.CrossRef

39.

Elkiran O, Karakurt C, Kocak G, Karadag A (2014) Tissue Doppler, strain, and strain rate measurements assessed by two-dimensional speckle-tracking echocardiography in healthy newborns and infants. Cardiol Young 24(2):201–211. https://doi.org/10.1017/S1047951112002284 CrossRefPubMed

40.

Jashari H, Lannering K, Ibrahimi P, Djekic D, Mellander M, Rydberg A, Henein MY (2016) Persistent reduced myocardial deformation in neonates after CoA repair. Int J Cardiol 221:886–891. https://doi.org/10.1016/j.ijcard.2016.07.114 CrossRefPubMed

41.

Czernik C, Rhode S, Helfer S, Schmalisch G, Buhrer C, Schmitz L (2014) Development of left ventricular longitudinal speckle tracking echocardiography in very low birth weight infants with and without bronchopulmonary dysplasia during the neonatal period. PLoS ONE 9(9):e106504. https://doi.org/10.1371/journal.pone.0106504 CrossRefPubMedPubMedCentral

42.

De Waal K, Lakkundi A, Othman F (2014) Speckle tracking echocardiography in very preterm infants: feasibility and reference values. Early Hum Dev 90(6):275–279. https://doi.org/10.1016/j.earlhumdev.2014.03.006 CrossRefPubMed

43.

Levy PT, El-Khuffash A, Patel MD, Breatnach CR, James AT, Sanchez AA, Abuchabe C, Rogal SR, Holland MR, McNamara PJ, Jain A, Franklin O, Mertens L, Hamvas A, Singh GK (2017) Maturational patterns of systolic ventricular deformation mechanics by two-dimensional speckle-tracking echocardiography in preterm infants over the first year of age. J Am Soc Echocardiogr 30(7):685–698.e681. https://doi.org/10.1016/j.echo.2017.03.003 CrossRefPubMedPubMedCentral

44.

Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S (2016) Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 37(15):1196–1207. https://doi.org/10.1093/eurheartj/ehv529 CrossRefPubMed

45.

Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, Song JH, Hamilton J, Sengupta PP, Kolias TJ, d'Hooge J, Aurigemma GP, Thomas JD, Badano LP (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr 28(2):183–193. https://doi.org/10.1016/j.echo.2014.11.003 CrossRefPubMed

46.

Sugimoto T, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K, Caballero L, Akhaladze N, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez T, de la Morena G, Popescu BA, Moonen M, Penicka M, Ozyigit T, Rodrigo Carbonero JD, van de Veire N, von Bardeleben RS, Vinereanu D, Zamorano JL, Go YY, Rosca M, Calin A, Magne J, Cosyns B, Marchetta S, Donal E, Habib G, Galderisi M, Badano LP, Lang RM, Lancellotti P (2017) Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 18(8):833–840. https://doi.org/10.1093/ehjci/jex140 CrossRefPubMed

47.

Farsalinos KE, Daraban AM, Unlu S, Thomas JD, Badano LP, Voigt JU (2015) Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE inter-vendor comparison study. J Am Soc Echocardiogr 28(10):1171–1181.e1172. https://doi.org/10.1016/j.echo.2015.06.011 CrossRefPubMed

48.

de Waal K, Phad N (2017) A comparison between Philips and Tomtec for left ventricular deformation and volume measurements in neonatal intensive care patients. Echocardiography 35(3):375–379. https://doi.org/10.1111/echo.13788 CrossRefPubMed

49.

Altit G, Bhombal S, Van Meurs K, Tacy TA (2018) Diminished cardiac performance and left ventricular dimensions in neonates with congenital diaphragmatic hernia. Pediatr Cardiol 39(5):993–1000. https://doi.org/10.1007/s00246-018-1850-7 CrossRefPubMed

50.

Nyrnes SA, Garnæs KK, Salvesen Ø, Timilsina AS, Moholdt T, Ingul CB (2018) Cardiac function in newborns of obese women and the effect of exercise during pregnancy. A randomized controlled trial. PLoS ONE 13(6):e0197334. https://doi.org/10.1371/journal.pone.0197334 CrossRefPubMedPubMedCentral

51.

Breatnach CR, Monteith C, McSweeney L, Tully EC, Malone FD, Kent E, Doherty A, Franklin O, El-Khuffash A (2017) The impact of maternal gestational hypertension and the use of anti-hypertensives on neonatal myocardial performance. Neonatology 113(1):21–26. https://doi.org/10.1159/000480396 CrossRefPubMed

52.

Akazawa Y, Hachiya A, Yamazaki S, Kawasaki Y, Nakamura C, Takeuchi Y, Kusakari M, Miyosawa Y, Kamiya M, Motoki N, Koike K, Nakamura T (2016) Cardiovascular remodeling and dysfunction across a range of growth restriction severity in small for gestational age infants—implications for fetal programming. Circ J 80(10):2212–2220. https://doi.org/10.1253/circj.CJ-16-0352 CrossRefPubMed

53.

Klitsie LM, Roest AA, Haak MC, Blom NA, Ten Harkel AD (2013) Longitudinal follow-up of ventricular performance in healthy neonates. Early Hum Dev 89(12):993–997. https://doi.org/10.1016/j.earlhumdev.2013.08.019 CrossRefPubMed

54.

Schubert U, Muller M, Norman M, Abdul-Khaliq H (2013) Transition from fetal to neonatal life: changes in cardiac function assessed by speckle-tracking echocardiography. Early Hum Dev 89(10):803–808. https://doi.org/10.1016/j.earlhumdev.2013.06.009 CrossRefPubMed

55.

Pena JL, da Silva MG, Faria SC, Salemi VM, Mady C, Baltabaeva A, Sutherland GR (2009) Quantification of regional left and right ventricular deformation indices in healthy neonates by using strain rate and strain imaging. J Am Soc Echocardiogr 22(4):369–375. https://doi.org/10.1016/j.echo.2008.12.007 CrossRefPubMed

Title: What is Left Ventricular Strain in Healthy Neonates? A Systematic Review and Meta-analysis
Authors: Umael Khan
Tom R. Omdal
Knut Matre
Gottfried Greve
Publication date: 01-01-2020
Publisher: Springer US
Keywords: Echocardiography
Echocardiography
Published in: Pediatric Cardiology / Issue 1/2020
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-019-02219-8

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