PRE-HEART FAILURE IN THE LIGHT OF 2D AND 3D SPECKLE TRACKING
ECHOCARDIOGRAPHY: A COMPREHENSIVE REVIEW
Abstract
Chronic heart failure (CHF) has different stages and they include pre-HF
(PHF), a state of high risk of developing myocardial dysfunction and
subsequently, advanced CHF (ACHF). Some major behavioral risk factors of
PHF are Western diet, tobacco, alcoholism, sedentary life style and
chronic mental disorders (anxiety, depression). These insults might
predispose to biological risk factors such as obesity, diabetes mellitus
dyslipidemia hypertension, myocardial infarction and cardiomyopathy.
These risk factors damage the myocytes leading to fibrosis, apoptosis,
cardiac hypertrophy, along with alterations in cardiomyocyte’ size and
shape. A condition of physiological subcellular remodeling resulting
into a pathological or deformation state might be developed conductiong
to PHF. Both PHF and HF are associated with the activation of
phospholipases and protease, mitochondrial dysfunction, oxidative stress
and development of intracellular free Ca2+ [Ca2+]i overloading or an
elevation in diastolic [Ca2+]i. Simultaneously, cardiac gene
expression is activated leading to further molecular, structural and
biochemical changes of the myocardium. The sub-cellular remodeling may
be intimately involved in the transition of cardiac hypertrophy to heart
failure. Two-dimensional (2D) and three-dimensional (3D) speckle
tracking-echocardiography (STE) have been used to quantify regional
alterations of longitudinal strain and area strain, through their polar
projection, which permits a further assessment of both sites and degrees
of myocardial damage. The examination of strain can identify
sub-clinical cardiac dysfunction or cardiomyocyte remodeling. It is
concluded that during remodeling of the myocardium, cardiac strain is
attenuated which can be used for the assessment of disease progression
and subsequently for therapeutic interventions.