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Updated: Oct 10, 2025
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Comparison of Myocardial Deformation by Speckle-Tracking Echocardiography and Cardiac Magnetic Resonance in Patients
Elena Sanz Pascual1, Montserrat Bret Zurita2, Jesus Diez Sebastián3
1Department of Pediatric Cardiology, La Paz University Hospital, Madrid, Spain.
Insights
Speckle-tracking echocardiography (STE) can help detect early ventricular dysfunction in Fontan circulation patients. A new algorithm using STE parameters shows 100% sensitivity and negative predictive value for identifying dysfunction, potentially reducing the need for cardiac magnetic resonance (CMR).
Area of Science:
- Cardiology
- Pediatric Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- Patients with Fontan circulation have improved survival but often experience reduced cardiac function and exercise capacity.
- Cardiac magnetic resonance (CMR) is the gold standard for assessing ventricular function, but speckle-tracking echocardiography (STE) shows promise as a myocardial deformation technique.
- Early detection of myocardial dysfunction is crucial for managing patients with Fontan circulation.
Purpose of the Study:
- To validate STE and conventional echocardiography parameters against CMR in Fontan circulation patients.
- To compare the diagnostic accuracy of STE and conventional echocardiography with CMR.
- To develop a diagnostic algorithm using STE parameters for early detection of myocardial dysfunction.
Main Methods:
- A cross-sectional study involving 64 patients with Fontan circulation.
- Measurements included longitudinal and circumferential strain, strain rates, and conventional echocardiographic parameters.
- Ventricular volumes and ejection fraction (EF) were assessed using CMR.
Main Results:
- Seven patients (11%) showed ventricular dysfunction (EF <45% by CMR).
- No significant correlation was found between individual STE parameters or conventional echocardiography measures and CMR.
- The developed diagnostic algorithm achieved 100% sensitivity and negative predictive value for detecting ventricular dysfunction, identifying 19 patients (40.1%) without dysfunction and no false negatives.
Conclusions:
- STE is a valuable complementary tool for assessing ventricular function in Fontan patients.
- The proposed STE-based diagnostic algorithm effectively identifies early ventricular dysfunction.
- This algorithm can improve diagnostic accuracy and potentially reduce the frequency of CMR follow-up scans.
Background:
While the short- and median-term survival has improved considerably in patients with Fontan circulation, cardiac function and exercise capacity are still reduced and may deteriorate over time. Cardiac magnetic resonance (CMR) is the gold standard for the assessment of ventricular volume and function. Speckle-tracking echocardiography (STE) is a myocardial deformation technique to assess ventricular function, with promising results. The aim of our study is to validate STE and conventional echocardiography parameters and to compare them with CMR. Furthermore, we aimed to design a diagnostic algorithm applying some parameters in series for early detection of myocardial dysfunction.
Materials And Methods:
We performed a cross-sectional single-center study in 64 patients with Fontan circulation. Longitudinal and circumferential strain, strain rates, and conventional echocardiographic measurements were registered. Ventricular volumes and ejection fraction (EF) were obtained by CMR.
Results:
Seven patients presented ventricular dysfunction (EF <45% by CMR), without showing a significant correlation between STE parameters or conventional measures by echocardiography and CMR. After the application of the diagnostic algorithm with the optimal cutoff points (global longitudinal strain - 24.5%, global circumferential strain - 20%, and annular plane systolic excursion - 16.5 mm), we got a sensitivity rate and a negative predictive value of 100%. In 19 patients (40.1%), the absence of ventricular dysfunction was demonstrated without no false-negative cases.
Conclusions:
STE should be considered a complementary diagnostic tool in Fontan patients. These suggested parameters applied in series are a useful tool for identifying early ventricular dysfunction and for diagnostic tests improvement with a fewer CMRs in the follow-up of these patients.
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