Features of left ventricular myocardial deformation in female patients of reproductive age with connective tissue dysplasia

Features of longitudinal left ventricular (LV) myocardial deformation in female patients of reproductive age with undifferentiated connective tissue dysplasia (UCTD) have not been specifically studied before.

Aim. To study the features of longitudinal LV myocardial deformation using speckle tracking echocardiography in female patients of reproductive age with UCTD.

Material and Methods. A noninvasive assessment of systolic LV myocardial deformation in the longitudinal direction using echocardiography was performed in 20 young adult female patients with UCTD (the average age was 23.5 ± 2.6 years). A control group composed of 34 apparently healthy women of comparable age (the average age was 24.8 ± 2.4 years) with no signs of UCTD were examined.

Results. The indices of longitudinal systolic myocardial deformation in female patients with UCTD practically did not differ from the control group. Significant differences were found only for the median segment: excessive shortening of the interventricular septum and a decrease in deformation in the lateral wall of the left ventricle. Segments 8–10 (mid anteroseptal, mid inferolateral, and mid inferior) and all apical LV segments (13–17: apical anterior, apical septal, apical inferior, and apical lateral) were subjected to maximum deformation, p < 0.05.

Conclusions. In patients of reproductive age with UCTD, a significant decrease in global longitudinal systolic LV deformity was recorded in the basal segment of the interventricular septum and the apical segment of the anterior LV wall. Segments 8–10 (median anterior-septum, median inferior-septum, and lower) and all apical LV segments (13–17: apical anterior, apical septum, apical lower, and apical lateral) were subjected to the greatest deformation in the examined patients.

1. Martynov A.I., Nechaeva G.I. National recommendations of the Russian scientific society of internal medicine for diagnostics, treatment and rehabilitation of patients with connective tissue dysplasia. Medical News of the North Caucasus. 2016;99(1):1–32. (In Russ.). DOI: 10.14300/mnnc.2018.13037.

2. Zemtsovsky E.V., Malev E.G. Small anomalies of the heart and dysplastic phenotypes. St. Petersburg: VESEP; 2012:160. (In Russ.).

3. Nechaeva G.I., Martynov A.I. Connective tissue dysplasia: cardiovascular changes, modern approaches to diagnosis and treatment. Moscow: Medical Information Agency; 2017:400. (In Russ.).

4. Drobiazko O.A., Chumakova O.S., Zateyschikov D.A., Chelombitko E.G., Alekhin M.N. Structural and functional features and indicators of deformation of the left ventricle of the heart in athletes according to speckle tracking echocardiography. The Siberian Journal of Clinical and Experimental Medicine. 2019;34(1):48–53. (In Russ.). DOI: 10.29001/2073-8552-2019-34-1-48-53.

5. Groznova O.S., Chernykh N.Yu., Tarasova A.A. Diagnostics of systolic myocardial dysfunction: Аnalysis of myocardial deformationy. Russian Bulletin of Perinatology and Pediatrics. 2018;63(2):53–57. (In Russ.). DOI: 10.21508/1027-4065-2018-63-2-53-57.

6. Ponikowski P., Voors A., Anker S.D., Bueno H., Clealand J.G.F., Coats A.J.S. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 2016;37(27):2129–2200. DOI: 10.1093/eurheartj/ehw128.

7. Mukhametgareeva A.V., Kashtalap V.V., Molchanov A.N., Vorobyev A.S., Urvantseva I.A., Romashkin V.V. . Possibilities of using ultrasound assessment of left ventricular myocardial deformity in cardiology. Ulyanovsk Medical and Biological Journal. 2020;(3):28–43. (In Russ.). DOI: 10.34014/2227-1848-2020-3-28-43.

8. Stepanova A.I., Alekhin M.N. Capabilities and limitations of speckletracking stress echocardiography. The Siberian Journal of Clinical and Experimental Medicine. 2019;34(1):10–17. (In Russ.). DOI: 10.29001/2073-8552-2019-34-1-10-17.

9. Voigt J.U., Pedrizzetti G., Lysyansky P., Marwick T.H., Houle H., Baumann R. et аl. Definitions for a common standard for 2D speckle-tracking echocardiography: Сonsensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J. Am. Soc Echocardiogr. 2015;28(2):183–193. DOI: 10.1016/j.echo.2014.11.003.

10. Takigiku K., Takeuchi M., Izumi C., Yuda S., Sakata K., Ohte N. et al. Normal range of left ventricular 2-dimensional strain: Japanese Ultrasound Speckle Tracking of the Left Ventricle (JUSTICE) Study. Circ. J. 2012;76(11):2623–2632. DOI: 10.1253/circj.cj-12-0264.

11. Muraru D., Niero A., Rodriguez-Zanella H., Cherata D., Badano L. Three-dimensional speckle-tracking echocardiography: benefits and limitations of integrating myocardial mechanics with three-dimensional imaging. Cardiovasc. Diagn. Ther. 2018;8(1):101–117. DOI: 10.21037/cdt.2017.06.01.

12. Kalinkina T.V., Lareva N.V., Chistyakova M.V. Modern methods of diagnosis of diastolic dysfunction of the left ventricle in patients with hypertension. Zabaikalsky Medical Bulletin. 2016;(2):115–120. (In Russ.).

13. Dunkan A.E., Alfirevic A., Sessler D.I., Popovic Z.B., Thomas J.D. Perioperative assessment of myocardial deformation. Anesth. Analg. 2014;118(3):525–544. DOI: 10.1213/ANE.0000000000000088.

14. Kalam K., Otahal P., Marwick T.H. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100(21):1673–1680. DOI: 10.1136/heartjnl-2014-305538.

15. Luis S.A., Yamada A., Khandheria B.K., Speranza V., Benjamin A., Ischenko M. et al. Use of three-dimensional speckle tracking echocardiography for quantitative assessment of global left ventricular function: a comparative study to three-dimensional echocardiography. J. Am. Soc. Echocardiogr. 2014;27(3):285–291. DOI: 10.1016/j.echo.2013.11.002.

16. Zhang H.J., Wang H., Sun T., Lu M.J., Xu N., Wu W.C. et al. Assessment of left ventricular twist mechanics by speckle tracking echocardiography reveals association between LV twist and myocardial fibrosis in patients with hypertrophic cardiomyopathy. Int. J. Cardiovasc. Imaging. 2014;30(8):1539–1558. DOI: 10.1007/s10554-014-0509-6.

17. Park J.H. Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field. Korean Circ. J. 2019;49(10):908–931. DOI: 10/4070/kcj.2019.0200.