In echocardiography, simple is better

… Simple is better, or at least just as good

In our small animal echocardiography training programme, we talk a lot about longitudinal function and its importance in assessing left and right ventricular systolic function.

Cunha De Almeida et al. (2024) compared 4 methods of assessing left ventricular longitudinal function, using mortality as an end-point. The authors looked at:

• Long axis excursion as a straight line from mid-annulus to apex
• Long axis excursion as a curved line (endocardial curve)
• Long axis excursion as a straight line, normalised by diastolic length (strain)
• Long axis excursion as a curved line, normalised by diastolic length (strain)

The above described methodology is illustrated below.

Above: A straight line from the mid-annulus to the apex.

Above: Endocardial contour, traced from annular hinge point to annular hinge point.

Findings

There was no evidence that more complex measures of longitudinal function gave better prognostic information than a single long-axis excursion measurement.

Additionally (and not discussed in Cunha De Almeida et al’s publication), linear measurements are far more reproducible than manually performed myocardial or endocardial curves, as well as much more accessible to general practice veterinarians, few of whom have access to strain packages.

References

Cunha De Almeida, A., Stowell, C., Howard, J. et al (2024). Which echocardiographic measure of longitudinal function is most informative? European Heart Journal.