GLS
Glutaminase kidney isoform, mitochondrial precursor (EC 3.5.1.2) (GLS) (K-glutaminase) (L-glutamine amidohydrolase) [Contains: Glutaminase kidney isoform, mitochondrial 68 kDa chain; Glutaminase kidney isoform, mitochondrial 65 kDa chain] [GLS1] [KIAA0838]
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Normal pediatric values of three-dimensional (3D) left ventricular (LV) volumes and strain are not well established; moreover, no reports exist of the stress-strain relation and the heart rate-corrected velocity of circumferential fiber shortening (VCFc) based upon 3D imaging in children. Three-dimensional LV datasets were obtained in pediatric patients (≤18 years of age) with structurally normal hearts. Ventricular volumes and strain components (longitudinal, GLS; circumferential, GCS; and 3D strain, 3DS) were analyzed using a commercial 3D speckle-tracking analysis package. LV mid-wall global average end-systolic fiber stress was calculated from 3D LV volumes. A total of 238 patients were included in the analysis with a median age of 13.1 years (range 0.4 to 17.9 years). Regression equations were derived for 3D volume parameters, permitting body surface area-based Z score calculation. Overall, 3DS values were more negative than GLS and GCS (mean ± SD = -33.8 ± 2.8; -27.8 ± 2.9; and -21.7 ± 3.1, respectively); only GLS varied significantly with age (r = 0.22; p <0.001). Both global average end-systolic fiber stress and 3D VCFc increased significantly with age (p <0.001 for both). Stress-adjusted 3DS and VCFc both varied with age (p <0.001 for both), consistent with increased contractility. In conclusion, 3D echocardiography may be used to calculate LV stress, strain, and volumes in pediatric patients with strong reproducibility. Among strain parameters, significant age-related changes were seen only in GLS. Both indexes of contractility investigated (3DS and VCFc indexed to wall stress) improved with age. Future studies of the 3D echocardiography stress-strain relation may yield new insights into maturational changes in myocardial contractility.
MeSH Terms
- Adolescent
- Aging
- Cardiac Volume
- Child
- Child, Preschool
- Echocardiography, Three-Dimensional
- Female
- Follow-Up Studies
- Heart Ventricles
- Humans
- Infant
- Male
- Myocardial Contraction
- Reference Values
- Reproducibility of Results
- Retrospective Studies
- Stroke Volume
- Ventricular Function, Left
Patients with Stage A heart failure (HF) show no HF symptoms but have related comorbid diseases with a high risk of progressing to HF. Screening for comorbid diseases warrants closer attention because of the growing interest in addressing Stage A HF as the best means of preventing eventual progression to overt HF such as Stages C and D. The identification of individuals of Stage A HF is potentially useful for the implementation of HF-prevention strategies; however, not all Stage A HF patients develop left ventricular (LV) structural heart disease or symptomatic HF, which lead to advanced HF stages. Therefore, Stage A HF requires management with the long-term goal of avoiding HF development; likewise, Stage B HF patients are ideal targets for HF prevention. Although the early detection of subclinical LV dysfunction is, thus, essential for delaying the progression to HF, the assessment of subclinical LV dysfunction can be challenging. Global longitudinal strain (GLS) as assessed by speckle-tracking echocardiography has recently been reported to be a sensitive marker of early subtle LV myocardial abnormalities, helpful for the prediction of the outcomes for various cardiac diseases, and superior to conventional echocardiographic indices. GLS reflects LV longitudinal myocardial systolic function, and can be assessed usually by means of two-dimensional speckle-tracking. This article reviews the importance of the assessment of subclinical LV dysfunction in Stage A HF patients by means of GLS, and its current potential to prevent progression to later stage HF.
MeSH Terms
- Aging
- Cardiology
- Cardiotoxins
- Comorbidity
- Diagnosis, Computer-Assisted
- Disease Progression
- Echocardiography
- Heart Failure
- Heart Ventricles
- Humans
- Hypercholesterolemia
- Myocardium
- Risk Factors
- Systole
Keywords
- Global longitudinal strain
- Left ventricular longitudinal myocardial function
- Stage A heart failure
Establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE)-derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims of this study were to perform a meta-analysis of normal ranges of LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) measurements derived by 2DSTE in children and to identify confounding factors that may contribute to variance in reported measures. A systematic review was launched in MEDLINE, Embase, Scopus, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. Search hedges were created to cover the concepts of pediatrics, STE, and left-heart ventricle. Two investigators independently identified and included studies if they reported 2DSTE-derived LV GLS, GCS, or GRS. The weighted mean was estimated by using random effects models with 95% CIs, heterogeneity was assessed using the Cochran Q statistic and the inconsistency index (I(2)), and publication bias was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a metaregression. The search identified 2,325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean, -20.2%; 95% CI, -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean, -22.3%; 95% CI, -19.9% to -24.6%), and GRS varied from 33.9% to 54.5% (mean, 45.2%; 95% CI, 38.3% to 51.7%). Twenty-six studies reported longitudinal strain only from the apical four-chamber view, with a mean of -20.4% (95% CI, -19.8% to -21.7%). Twenty-three studies reported circumferential strain (mean, -20.3%; 95% CI, -19.4% to -21.2%) and radial strain (mean, 46.7%; 95% CI, 42.3% to 51.1%) from the short-axis view at the midventricular level. A significant apex-to-base segmental longitudinal strain gradient (P < .01) was observed in the LV free wall. There was significant between-study heterogeneity and inconsistency (I(2) > 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, frame rate/heart rate ratio, tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. The metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). This study defines reference values of 2DSTE-derived LV strain in children on the basis of a meta-analysis. In healthy children, mean LV GLS was -20.2% (95% CI, -19.5% to -20.8%), mean GCS was -22.3% (95% CI, -19.9% to -24.6%), and mean GRS was 45.2% (95% CI, 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturation. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor parameters, age- and vendor-specific referenced ranges were established as well.
MeSH Terms
- Adolescent
- Aging
- Child
- Child, Preschool
- Echocardiography
- Elastic Modulus
- Elasticity Imaging Techniques
- Female
- Heart Ventricles
- Humans
- Infant
- Infant, Newborn
- Internationality
- Male
- Reference Values
- Reproducibility of Results
- Sensitivity and Specificity
- Ventricular Function, Left
- Young Adult
Keywords
- Cardiac function
- Children
- Global strain
- Left ventricle
- Speckle-tracking echocardiography
A growing body of evidence indicates that cardiorespiratory fitness attenuates some age-related cerebral declines. However, little is known about the role that myocardial function plays in this relationship. Brain regions with high resting metabolic rates, such as the default mode network (DMN), may be especially vulnerable to age-related declines in myocardial functions affecting cerebral blood flow (CBF). This study explored the relationship between a measure of myocardial mechanics, global longitudinal strain (GLS), and CBF to the DMN. In addition, we explored how cardiorespiratory affects this relationship. Participants were 30 older adults between the ages of 59 and 69 (mean age=63.73years, SD=2.8). Results indicated that superior cardiorespiratory fitness and myocardial mechanics were positively associated with DMN CBF. Moreover, results of a mediation analysis revealed that the relationship between GLS and DMN CBF was accounted for by individual differences in fitness. Findings suggest that benefits of healthy heart function to brain function are modified by fitness.
MeSH Terms
- Aged
- Aging
- Blood Flow Velocity
- Brain
- Cardiorespiratory Fitness
- Cerebrovascular Circulation
- Female
- Humans
- Male
- Middle Aged
- Neuronal Plasticity
- Statistics as Topic
- Stroke Volume
- Ventricular Function, Left
Keywords
- Aging
- Arterial spin labeling
- Cardiorespiratory fitness
- Default mode network
- Global longitudinal strain
The purpose of this study was to identify traits of the left ventricular (LV) global longitudinal strain (GLS), global radial strain (GRS), global circular strain (GCS), and global area tracking (GAT) with three-dimensional speckle tracking echocardiography (3DSTE), and to determine the relationship between strain and age in healthy adults of different ages. A total of 153 volunteers were divided into young adult, middle-aged, and elderly groups, and examined with echocardiography to obtain general data and live two-dimensional (2D) images of the apical four-chamber view, which were assembled to obtain the full volume view of the LV. The images were then analyzed with 3DSTE software. Compared with the young adult and middle-aged groups, elderly adults demonstrated lower GLS, GRS, GCS, and GAT. Significant differences were not noted in GLS, GRS, and GCS between the young adult and middle-aged groups; however, the GAT of the middle-aged group was lower than that of the young adult group. The longitudinal strain (LS), radial strain (RS), and area tracking (AT) of 16 LV segments of the young adult group decreased gradually in level from the mitral valve to the apex, and increased in circular strain (CS). The LS, RS, CS, and AT of the middle-aged group also decreased gradually. The LS, RS, CS, and AT of the elderly people were highest from the mitral valve to the apex level and lowest at the papillary muscle. The results of this study demonstrated that LV GLS, GRS, GCS, and GAT decrease with age.
MeSH Terms
- Adolescent
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Aging
- Cohort Studies
- Echocardiography, Doppler, Pulsed
- Echocardiography, Three-Dimensional
- Female
- Healthy Volunteers
- Humans
- Image Interpretation, Computer-Assisted
- Male
- Middle Aged
- Reproducibility of Results
- Stroke Volume
- Ventricular Dysfunction, Left
- Ventricular Function, Left
- Young Adult
Keywords
- 3D
- adult
- echocardiography
- left ventricle
- speckle tracking imaging
- strain
Three-dimensional (3D) strain analysis may help overcome the limitations of Doppler and two-dimensional strain analysis for the left ventricle and become the method of choice for left ventricular (LV) systolic function. The aims of this study were to evaluate the feasibility and reproducibility of LV global 3D systolic strain by real-time 3D speckle-tracking echocardiography (STE) in children and to establish their maturational growth patterns and normal values. A prospective study was conducted in 256 consecutive healthy subjects using real-time 3D echocardiography. Full-volume 3D data were acquired using a 3D matrix-array transducer. Three-dimensional LV peak systolic global strain (GS), global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) values were determined using real-time 3D STE. A total of 228 patients (89%) met the criteria for analysis; 28 (11%) were excluded. The correlations between age and strain variables by real-time 3D STE were poor (R(2) = 0.01-0.05, P < .05). The differences in GLS and GCS among the five age groups were statistically significant but clinically irrelevant. There were no statistical differences in GRS and GS values among the age groups, nor were there statistical differences between the genders for all 3D strain parameters. Intraobserver and interobserver variability ranged from 5.0 ± 4.3% to 10.1 ± 8.5% versus 6.9 ± 6.1% to 17.0 ± 16.2% for coefficients of variation, respectively. Interclass correlation coefficients ranged from 0.78 to 0.87 and from 0.75 to 0.79 for intraobserver and interobserver measurements for GS, GLS, GCS, and GRS, respectively. LV global 3D systolic strain analysis using the new 3D STE is feasible and reproducible in the pediatric population. There are small maturational changes in GLS and GCS, but not in GRS and GS, that are statistically significant but probably clinically irrelevant. Further investigation is warranted for potential clinical application of this new technology in a pediatric population.
MeSH Terms
- Adolescent
- Age Distribution
- Aging
- Child
- Child, Preschool
- China
- Computer Systems
- Echocardiography, Three-Dimensional
- Elastic Modulus
- Elasticity Imaging Techniques
- Feasibility Studies
- Female
- Heart Ventricles
- Humans
- Infant
- Infant, Newborn
- Male
- Observer Variation
- Reference Values
- Reproducibility of Results
- Sensitivity and Specificity
- Ventricular Function, Left
Keywords
- 2D
- 3D
- CI
- CMR
- Cardiac magnetic resonance
- Confidence interval
- GCS
- GLS
- GRS
- GS
- Global circumferential strain
- Global longitudinal strain
- Global radial strain
- Global strain
- LAX
- LV
- LVEDL
- LVEF
- Left ventricular
- Left ventricular ejection fraction
- Left ventricular end-diastolic length
- Left ventricular strain
- Long-axis
- Mid right ventricular diameter
- RT
- RVD2
- Real-time
- STE
- Speckle-tracking echocardiography
- Speckle-tracking imaging
- Three-dimensional
- Three-dimensional echocardiography
- Two-dimensional