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Updated: Sep 14, 2025
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Blood speckle tracking to predict functional status in pediatric patients with dilated cardiomyopathy
Antoine Fakhry AbdelMassih1,2, Soha Emam3, Aliaa Ibrahim Mabrouk4
1Department of Pediatrics, Pediatric Cardiology Division, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Cairo University Children Hospital, Kasr Al Ainy Street, Cairo, 12411, Egypt. antoine.abdelmassih@kasralainy.edu.eg.
Insights
Advanced echocardiography revealed that post-systolic strain index (PSI) and systolic vortex formation, not global strain or ejection fraction, effectively differentiate heart failure severity in pediatric dilated cardiomyopathy patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Heart Failure Pathophysiology
Background:
- Dilated Cardiomyopathy (DCM) significantly impairs cardiac function in children.
- Current echocardiographic methods have limitations in assessing functional status in pediatric DCM.
Purpose of the Study:
- To identify echocardiographic parameters that better correlate with functional status in pediatric DCM patients.
- To compare the efficacy of advanced echocardiographic techniques in differentiating heart failure severity.
Main Methods:
- Utilized advanced echocardiography, including Tissue Doppler and 2D speckle tracking, in 28 DCM patients (NYHA class II-III) and 30 controls.
- Assessed Left Ventricular (LV) function, calculating Global Longitudinal Strain (GLS), Global Area Strain (GAS), Ejection Fraction (EF), Post-Systolic Strain Index (PSI), and LV vortex formation timing.
Main Results:
- Global strain (GLS, GAS) and Ejection Fraction (EF) did not differentiate between NYHA II and III subgroups.
- Post-Systolic Strain Index (PSI) and systolic vortex formation timing were significantly different between NYHA II and III cases.
- Systolic vortex formation was observed in 33% of NYHA II vs. 77% of NYHA III patients; a PSI cut-off >4% predicted worse outcomes with 92% sensitivity.
Conclusions:
- Cardiac dyssynchrony plays a crucial role in pediatric DCM symptom manifestation.
- Blood speckle tracking for assessing LV vortex formation is a promising bedside tool for evaluating heart failure severity.
- Further standardization of blood speckle tracking is needed for objective clinical application.
Background:
Dilated Cardiomyopathy (DCM) is an important cause of significant cardiac functional impairment in pediatric patients. There is to date debate on which echocardiographic variable correlates better with the functional status of the patient.
Methodology:
28 DCM patients (NYHA class II and III), and 30 controls were enrolled in the study, where advanced echocardiographic examination was used to assess LV (Left ventricular) function. Tissue Doppler, 2D speckle tracking for PSI (post-systolic strain index calculation), and blood speckle tracking for the timing of LV vortex formation were implemented.
Results:
Intriguingly, none of LV GLS and GAS (Global longitudinal and area strain), or EF (Ejection fraction, were able to differentiate NYHA II and III subgroups of cases. In contrast, PSI, and systolic vortex formation were significantly different between subgroups of cases; systolic vortex was seen in 33% of NYHA II patients compared to 77% of NYHA III patients, a PSI median value of 5% was seen in NYHA III cases, and a cut-off >4% was 92% sensitive in predicting worse manifestations.
Conclusion:
Dyssynchrony; seems to play a significant role in orchestrating symptoms of heart failure. In this context, blood speckle tracking study seems a promising bedside method, in its assessment. A large room for improvement and systemization of its assessment is still needed to objectivize its use.
