Abstract

Background: 4-Dimensional XStrain speckle tracking echocardiography (4DXStrainSTE) is an advanced cardiac imaging technique that synthesizes Speckle Tracking Echocardiography (STE) data obtained from the apical Three-Chamber (3CH), Four-Chamber (4CH), and Two-Chamber (2CH) views, thereby enabling a comprehensive evaluation of Multiple Left Ventricular Strain Parameters (MLVSP) within a three-dimensional framework.
Methods: This study aimed to evaluate the impact of Cardiovascular Risk Factors (CVRFs) on MLVSP using 4DXStrainSTE. Nine strain parameters were analyzed: Global Circumferential Strain (GCS), Global Circumferential Strain Rate (GCSR), Global Radial Strain (GRS), and Global Radial Strain Rate (GRSR) at the Mitral Valve (mv) and papillary muscle (pap) levels, along with Global Longitudinal Strain (GLS). A total of 500 Indian adults (aged 18-60 years; both sexes) were enrolled. Participants were categorized into four CVRF Risk Categories (1, 2, 3, and 4) according to the cumulative number of risk factors. The inclusion criterion was a 4-dimensional left ventricular ejection fraction (4D-LVEF) > 50%.
Result: The effect of CVRF on strain parameters was determined using trend and linearity analyses. Trend analysis across CVRF categories revealed a significant decline in GLS, GCS at the pap level, and GCSR at the mv level. Pearson’s correlation demonstrated mild-to-moderate linear associations across MLVSP, and multivariate regression analysis identified significant associations of GLS and GCSR at the mv level with GLS across the risk categories.
Conclusion: To the best of our knowledge, this is the first study to provide a comprehensive evaluation of the impact of CVRFs on MLVSP in individuals with preserved ejection fraction.

Keywords:4DXStrain; Speckle tracking echocardiography; 4D-LVEF%; Cardiovascular risk factors; Trend analysis