Efficacy of echocardiography for differential diagnosis of left ventricular hypertrophy: special focus on speckle-tracking longitudinal strain

Abstract

Left ventricular (LV) hypertrophy (LVH) is a frequent imaging finding in daily clinical practice, and its presence is associated with poor outcomes and ventricular arrhythmias. It is commonly detected in athletes, arterial hypertension, aortic stenosis, hypertrophic cardiomyopathy, cardiac amyloidosis, Fabry disease, or Friedreich's ataxia. Echocardiography plays an important role in detecting LVH and underlying causes in current clinical practice. While echocardiography is essential for the quantification and early detection of LV structural findings for various cardiovascular diseases, it has been reported that speckle-tracking echocardiographic parameters are also useful for the detection of early LV structural abnormalities. In particular, global longitudinal strain (GLS) assessed by two-dimensional speckle-tracking echocardiography is reportedly a sensitive marker for early subtle abnormalities of LV myocardial performance, helpful for the prediction of outcomes for various cardiac diseases, and superior to conventional echocardiographic indices. GLS is determined as the averaged peak longitudinal strain of 18 LV segments from standard apical views and can be assessed as a polar plot. This polar plot longitudinal strain mapping offers an intuitive visual overview of the global and regional LV longitudinal myocardial function status of various cardiomyopathies with LVH. This mapping is clinically practicable and the plot patterns obtainable as the result of further development of this technique for clinical practice provide clues to the etiology of cardiomyopathies. This article reviews the efficacy of echocardiography for differential diagnosis of LVH, with a special focus on the utility of speckle-tracking longitudinal strain.

Keywords: Echocardiography; Global longitudinal strain; Left ventricular hypertrophy; Speckle-tracking strain.

Fig. 1

Examples of the parasternal long-axis view and the longitudinal strain bull’s eye plot for a 71-year-old female with arterial hypertension. GLS of 19.8% is normal, but the longitudinal strain in the basal septum is reduced compared to that in other segments

Fig. 2

Examples of the parasternal long-axis view and the longitudinal strain bull’s eye plot for a 48-year-old male with HCM. GLS of 14.7% is low, and longitudinal strain in the region of the interventricular septum with its increased wall thickness is further reduced

Fig. 3

Examples of the parasternal long-axis view and the longitudinal strain bull’s eye plot for a 72-year-old male with variant transthyretin cardiac amyloidosis. GLS of 14.2% is low, while an apical sparing pattern can be observed

Fig. 4

Examples of the parasternal long-axis view and the longitudinal strain bull’s eye plot for a 72-year-old female with Fabry disease. LVEF of 65% is preserved without wall motion abnormality, but GLS of 12.3% is low. Furthermore, longitudinal strain in the basal posterior-lateral wall was further reduced compared to that in other regions

Fig. 5

Examples of the parasternal long-axis view and the longitudinal strain bull’s eye plot for an 82-year-old male with severe AS who was referred for transcatheter aortic valve implantation. GLS of 9.8% is low, but an apical sparing pattern can be observed. Moreover, the diagnosis of this patient was complicated by wild-type transthyretin cardiac amyloidosis