Longitudinal strain

Methods and results A total of 549 (mean age: 45.6 ± 13.3 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. 2DE data sets have been analysed with a vendor-independent software package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire the data sets. The lowest expected values of LV strains and twist calculated as ± 1.96 standard deviations from the mean were −16.7% in men and −17.8% in women for longitudinal strain, −22.3% and −23.6% for circumferential strain, 20.6% and 21.5% for radial strain, and 2.2 degrees and 1.9 degrees for twist, respectively. In multivariable analysis, longitudinal strain decreased with age whereas the opposite occurred with circumferential and radial strain. Male gender was associated with lower strain for longitudinal, circumferential, and radial strain. Inter-vendor differences were observed for circumferential and radial strain despite the use of vendor-independent software. Importantly, no intervendor differences were noted in longitudinal strain. Introduction Early detection of subclinical left ventricular (LV) dysfunction using strain plays a crucial role in the evaluation of many cardiac diseases. 1–7 Longitudinal, circumferential, and radial strain have been reported to detect LV dysfunction prior to a decline in LV ejection fraction. Therefore, global longitudinal strain is recommended as a routine measur...

Article: • • • • • Basic principles Myocardial strain describes the deformation of the 1-3: ɛ = (L-L 0)/L 0 ɛ is strain, L 0 is the baseline length and L is the length in systole In strain imaging left ventricular contraction can be divided into three basic spatial orientations or directions 1-3: • longitudinal strain • radial strain • circumferential strain is the deformation of the 0) at baseline in the normal 2,3. 0 increases with contraction in systole 2,3. represents the myocardial contraction along the circular outline in the short axis. It is negative in normal individuals since the circumference of the left ventricle in a relaxed state L o decreases in systole 2,3. Left ventricular torsion is measured in degrees and is related to the clockwise twirl from apex to base and a counterclockwise rotation from the base to the apex as well as to the circumferential-longitudinal shear angle 3. Methodology Strain imaging can be conducted with echocardiography and cardiac magnetic resonance with the common principle that specific features or patterns in an image are detected and followed over a certain time course and re-identified in the subsequent images 4. The workflow for both cardiac MRI and echocardiography is similar and includes the following steps 4: • identification of end-diastole and end-systole • definition of the myocardial region of interest and dimension to be examined • definition of the points or features to be tracked (segmentation) • tissue tracking and co...

Learning objectives • To learn how to measure left ventricular global longitudinal strain (LV GLS) and the factors that may influence its measurement. • To understand why LV GLS is an earlier marker of LV systolic dysfunction as compared with LV ejection fraction. • To learn other clinical applications of the use of speckle tracking echocardiography. Introduction Non-invasive evaluation of left ventricular (LV) systolic function by echocardiography remains one of the most pivotal measures in clinical cardiology. Although conventionally quantified by means of LV ejection fraction (LVEF), it has become evident that this parameter is subject to a number of limitations. LVEF can be normal in the presence of impaired LV systolic function, since it does not reflect intrinsic myocardial contractility. 1 In addition, LVEF is highly load-dependent and suffers from significant intraobserver and interobserver variability. 2 Assessment of myocardial strain can potentially overcome many of the limitations of LVEF in assessing LV systolic function. Speckle tracking echocardiography permits assessment of myocardial strain in three spatial directions (longitudinal, radial and circumferential) independent of the angle of insonation of the ultrasound beam. Longitudinal strain is probably the most frequent type of strain used to characterise LV systolic function in clinical practice. This review article focuses on the practical aspects of measuring LV global longitudinal strain (GLS), review...

Global longitudinal strain (GLS) was measured offline by the use of the software QLAB, version 9.0.1 (Philips Healthcare). ECG indicates electrocardiogram. aOther cardiac arrhythmias comprised atrial tachycardia (n = 4), bigeminus (n = 3), frequent supraventricular extrasystoles (n = 2), and frequent ventricular (n = 1) extrasystoles. Univariate and multivariate regression analysis with GLS as the dependent variable. The multivariate model was adjusted for all covariates shown. Filled circles represent adjustment for all covariates. Open circles represent crude values. COPD indicates chronic obstructive pulmonary disease; eGFR, estimated glomerular filtration rate; and MI, myocardial infarction. aIncluded individuals with atrial fibrillation and sinus rhythm during echocardiography. Supplement. eMethods. Detailed Methods eTable 1. Inclusion and Exclusion Criteria of the Study Sample eTable 2. Clinical Characteristics of Study Participants in Sinus Rhythm Stratified for the Availability of Data on GLS eTable 3. Predictive Value of Left Ventricular Ejection Fraction and E/E′ Ratio in Addition to Global Longitudinal Strain for Survival eTable 4. C Statistics of Cox Models for Predicting All-Cause and Cardiac Death eTable 5. Cause-Specific Hazard Ratios for Global Longitudinal Strain, Left Ventricular Ejection Fraction and E/E′ Ratio For Cardiac Death eFigure 1. Distribution of Global Longitudinal Strain in the Sample eFigure 2. Relation Between Established Measures of Cardiac...

Extract This editorial refers to ‘Link between myocardial deformation phenotyping using longitudinal and circumferential strain, and risk of incident heart failure and cardiovascular death’, by K.G. Skaarup et al., https://doi:10.1093/ehjci/jead075. Some data demonstrate that subtle impairments of systolic function are independently associated with incident heart failure (HF). 1 Over the past decade, we have been focusing on showing the value of global longitudinal strain (GLS) in different clinical settings 2 with the goal of demonstrating the complementary role of GLS to left ventricular ejection fraction (LVEF). Therefore, it is important to be convinced about the reproducibility of GLS. Also, it is, and it remains, important to ensure that the measurements can be made widely available and remain independent from the echo vendors. 3 GLS is getting more and more accepted by each passing day. There is still room for improvement, and automation of the measurements will help. 4 Accumulating evidence is justifying the use of GLS in clinical practice day by day. Get help with access Institutional access Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways: IP based access Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically,...