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Updated: Oct 6, 2025
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Pre-heart failure at 2D- and 3D-speckle tracking echocardiography: A comprehensive review
Ram B Singh1, Fabiola B Sozzi2, Jan Fedacko3
1Internal Medicine/Cardiology, TsimTsoum Institute, Krakow, Poland & Halberg Hospital, Moradabad, India.
Insights
Pre-heart failure (PHF) involves cellular changes and risk factors like obesity and hypertension. Echocardiography can detect early cardiac dysfunction and myocardial remodeling, aiding disease assessment.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Chronic heart failure (CHF) encompasses stages including pre-heart failure (PHF), characterized by high risk of myocardial dysfunction.
- Behavioral and biological risk factors (obesity, diabetes, hypertension) contribute to myocyte damage, fibrosis, and cardiac hypertrophy, initiating PHF.
- Cellular processes in PHF and heart failure (HF) involve phospholipase/protease activation, mitochondrial dysfunction, oxidative stress, and intracellular calcium overload.
Purpose of the Study:
- To explore the pathological mechanisms underlying pre-heart failure (PHF) and its transition to advanced heart failure (HF).
- To investigate the role of subcellular remodeling in the progression from cardiac hypertrophy to heart failure.
- To evaluate the utility of 2D and 3D speckle tracking echocardiography (STE) in assessing myocardial damage and sub-clinical cardiac dysfunction.
Main Methods:
- Review of pathological mechanisms in PHF and HF, including cellular damage and signaling pathways.
- Analysis of subcellular remodeling processes contributing to myocardial dysfunction.
- Application of 2D and 3D speckle tracking echocardiography (STE) to quantify regional myocardial strain alterations.
Main Results:
- Risk factors lead to myocyte damage, fibrosis, and hypertrophy, potentially causing pathological subcellular remodeling and PHF.
- PHF and HF share common pathways including oxidative stress and calcium dysregulation.
- STE effectively quantifies regional strain, identifying sub-clinical cardiac dysfunction and myocardial remodeling, with attenuated strain indicating disease progression.
Conclusions:
- Subcellular remodeling is integral to the progression from cardiac hypertrophy to heart failure.
- STE is a valuable tool for detecting early signs of cardiac dysfunction and assessing myocardial damage in PHF and HF.
- Early identification of myocardial remodeling through strain analysis can aid in disease assessment and management.
Abstract:
Chronic heart failure (CHF) has different stages and includes pre-HF (PHF), a state of high risk of developing myocardial dysfunction and advanced CHF. Some major behavioral risk factors of PHF might predispose to biological risk factors such as obesity, diabetes mellitus, dyslipidemia, hypertension, myocardial infarction, and cardiomyopathy. These risk factors damage the myocytes leading to fibrosis, apoptosis, cardiac hypertrophy, along with alterations in cardiomyocyte' size and shape. A condition of physiological subcellular remodeling resulting into a pathological state might be developed, conducting to PHF. Both PHF and heart failure (HF) are associated with the activation of phospholipases and protease, mitochondrial dysfunction, oxidative stress and development of intra-cellular free Ca2+ [Ca2+ ]i overloading to an elevation in diastolic [Ca2+ ]i . Simultaneously, cardiac gene expression is activated leading to further molecular, structural and biochemical changes of the myocardium. The sub-cellular remodeling may be intimately involved in the transition of cardiac hypertrophy to heart failure. 2D- and 3D-speckle tracking echocardiography (STE) have been used to quantify regional alterations of longitudinal strain and area strain, through their polar projection, which permits a further assessment of both sites and degrees of myocardial damage. The examination of strain can identify sub-clinical cardiac dysfunction or cardiomyocyte remodeling. During remodeling of the myocardium cardiac strain is attenuated, therefore it is an indicator of disease assessment.
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