Diagnostic utility of two-dimensional speckle tracking imaging in detecting subclinical left ventricular systolic...

Alcohol-related disorders affect 4.5-7.8% of Chinese adults and are known to precipitate alcoholic cardiomyopathy; nevertheless, conventional left ventricular ejection fraction (LVEF) often remains within the normal range in early disease, so a more sensitive marker of incipient systolic injury is needed. This study aims to quantify the diagnostic performance of two-dimensional speckle tracking imaging (2D-STI) for detecting sub-clinical left ventricular systolic dysfunction in patients with alcohol-related disorders.

Consecutive 50 in-patients (100% male, age 47.21±4.57 years) fulfilling diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria for alcohol-related disorder and 50 age- and sex-matched healthy controls were prospectively enrolled. All subjects underwent the same Philips EPIQ-7C scan (frame-rate ≥60 Hz). Global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) together with their systolic strain rates were measured off-line (using advanced cardiac mechanics quantification analysis Software, aCMQ software). Conventional Simpson-derived left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and ejection fraction were also obtained. Between-group comparisons used unpaired t-test; associations were assessed with Pearson correlation.

Compared with control group, patients with alcohol-related disorders showed higher (less negative) GLS (-13.5%±2.1% vs. -18.2%±2.5%, P<0.001), lower GCS (-17.6%±3.5% vs. -22.5%±4.0%, P<0.001), lower GRS (22.4%±5.2% vs. 30.8%±6.0%, P<0.001) and lower mean systolic strain rate (1.4±0.3 vs. 1.8±0.4 s^-1, P<0.001). LVEDV (90.5±15.2 vs. 78.0±12.5 mL, P<0.001), LVESV (58.6±12.0 vs. 35.5±10.0 mL, P<0.001) and LVEF (52.3%±5.0% vs. 60.5%±4.5%, P<0.001) all differed significantly. Within the patient cohort, LVEF correlated positively with GLS, GCS, GRS and strain rate (r=0.72, 0.68, 0.70, 0.73, all P<0.001), while LVEDV and LVESV correlated negatively with these indices (r range, -0.60 to -0.71; all P<0.001).

In males with alcohol-related disorders, 2D-STI consistently reveals multidirectional strain deficits that correlate tightly with conventional left ventricular volumes and ejection fraction, supporting its use for early detection of sub-clinical systolic dysfunction.