Can global longitudinal strain predict reduced left ventricular ejection fraction in daily echocardiographic practice?

Transthoracic echocardiography (TTE) is the most commonly used method for measuring left ventricular ejection fraction (LVEF), but its reproducibility remains a matter of controversy. Speckle tracking echocardiography assesses myocardial deformation and left ventricular systolic function by measuring global longitudinal strain (GLS), which is more reproducible, but is not used routinely in hospital practice. To investigate the feasibility of on-line two-dimensional GLS in predicting LVEF during routine echocardiographic practice. The analysis involved 507 unselected consecutive patients undergoing TTE between August 2012 and November 2013. Echocardiograms were performed by a single sonographer. Echogenicity was noted as good, moderate or poor. Simple linear regression was used to assess the relationship between LVEF and GLS, overall and according to quality of echogenicity. Receiver operating curve (ROC) analysis was used to identify the threshold GLS that predicts LVEF≤40%. Mean LVEF was 64±11% and GLS was -18.0±4.0%. A reasonable correlation was found between LVEF and GLS (r=-0.53; P<0.001), which was improved when echogenicity was good (r=-0.60; P<0.001). GLS explained 28.1% of the variation in LVEF, and for one unit decrease in GLS, a 1.45 unit increase in LVEF was expected. Correlations between LVEF and GLS were -0.51 for patients in sinus rhythm (n=490) and -0.86 in atrial fibrillation (n=17). Based on ROC analysis, the area under the curve was 0.97 for GLS≥-14%, allowing detection of LVEF≤40% with a sensitivity of 95% and specificity of 86%. Two-dimensional GLS is easy to obtain and accurately detects LVEF≤40% in unselected patients. GLS may be especially helpful when a suboptimal acoustic window makes LVEF measurement by Simpson's biplane method difficult and in atrial fibrillation patients with low heart rate variability.

Benyounes N ，Lang S ，Soulat-Dufour L ，Obadia M ，Gout O ，Chevalier G ，Cohen A ... -  《-》

Use of three-dimensional speckle-tracking echocardiography for quantitative assessment of global left ventricular function: a comparative study to three-dimensional echocardiography.

The aim of this study was to determine whether global strains derived from three-dimensional (3D) speckle-tracking echocardiography (STE) are as accurate as left ventricular (LV) ejection fraction (LVEF) obtained by two-dimensional (2D) and 3D echocardiography in the quantification of LV function. Two-dimensional and 3D echocardiography and 2D and 3D STE were performed in 88 patients (LVEF range, 17%-79%). Two-dimensional and 3D global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain, and global area strain were quantified and correlated with LV function determined by 2D and 3D echocardiographic LVEF. Reproducibility, feasibility, and duration of study to perform 3D STE were assessed by independent, blinded observers. A total of 78 patients (89%) underwent 3D STE. All 3D speckle-tracking echocardiographic parameters had strong correlations with assessment of LV function determined by 2D and 3D echocardiographic LVEF. Three-dimensional GCS was the best marker of LV function (r = -0.89, P < .0001). Subgroup analysis demonstrated that 3D speckle-tracking echocardiographic parameters were particularly useful in identifying LV dysfunction (LVEF < 50%). Receiver operating characteristic curve analysis demonstrated areas under the curve of 0.97 for 3D GCS, 0.96 for 3D global radial strain, 0.95 for 3D global area strain, and 0.87 for 3D GLS. An optimal 3D GCS cutoff value of magnitude < -12% predicted LV dysfunction (LVEF obtained by 2D echocardiography < 50%) with 92% sensitivity and 90% specificity. There was good correlation between 2D GLS and 3D GLS (r = 0.85, P < .001; mean difference, -1.7 ± 6.5%). Good intraobserver, interobserver, and test-retest agreements were seen with 3D STE. Time for image acquisition to postprocessing analysis was significantly reduced with 3D STE (3.7 ± 1.0 minutes) compared with 2D STE (4.6 ± 1.5 min) (P < .05). Global strain by 3D STE is a promising novel alternative to quantitatively assess LV function. Three-dimensional STE is reproducible, feasible, and time efficient.

Luis SA ，Yamada A ，Khandheria BK ，Speranza V ，Benjamin A ，Ischenko M ，Platts DG ，Hamilton-Craig CR ，Haseler L ，Burstow D ，Chan J ... -  《-》

Speckle-tracking strain echocardiography: any place in routine daily practice in 2014?

Maréchaux S 《-》

Echocardiographic prediction of postoperative atrial fibrillation after aortic valve replacement for aortic stenosis: a two-dimensional speckle tracking left ventricular longitudinal strain multicentre pilot study.

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, with increased risk of embolic events, haemodynamic instability, haemorrhagic complications and prolonged hospital stay. We sought to assess the value of preoperative left ventricular global longitudinal strain (GLS) for the prediction of POAF in a series of patients with severe symptomatic aortic stenosis who underwent aortic valve replacement (AVR). Fifty-eight consecutive patients (52% men) aged 73±9 years, with severe symptomatic aortic stenosis (aortic valve area<1cm(2) or<0.5cm(2)/m(2)), in sinus rhythm, who underwent AVR were prospectively included in three centres between 2009 and 2010. Complete preoperative echocardiography was performed in all patients, including global and segmental longitudinal strain using two-dimensional speckle tracking. The POAF incidence was 28/58 (48%). On univariate analysis, aortic valve area (P=0.04), preoperative E/e' ratio (P=0.04) and GLS (P=0.005) were associated with the occurrence of POAF. Chronic obstructive pulmonary disease (P=0.05), preoperative statin treatment (P=0.09), age≥80 years (P=0.09), left ventricular ejection fraction (P=0.09) and systolic pulmonary artery pressure (P=0.06) tended to increase the risk of POAF. The best GLS cut-off value for the prediction of POAF was -15% (82% sensitivity, 53% specificity, area under the curve 0.72). On multivariable analysis, GLS>-15% was the only independent predictor of POAF (odds ratio 7.74, 95% confidence interval [1.15-52.03]; P=0.035). Incidence of POAF is high after AVR for severe aortic stenosis. Our results suggest an additive value of the study of left ventricular myocardial deformation to classical clinical and echocardiographic variables for the prediction of POAF in this setting.

Levy F ，Debry N ，Labescat AL ，Meimoun P ，Malaquin D ，Marechaux S ，Rusinaru D ，Jeu A ，Ennezat PV ，Castel AL ，Tribouilloy C ... -  《-》

Systolic time intervals as simple echocardiographic parameters of left ventricular systolic performance: correlation with ejection fraction and longitudinal two-dimensional strain.

Reant P ，Dijos M ，Donal E ，Mignot A ，Ritter P ，Bordachar P ，Dos Santos P ，Leclercq C ，Roudaut R ，Habib G ，Lafitte S ... -  《-》