Background Ejection fraction (EF) plays a prominent role in clinical decision making but remains dependent on image quality and left ventricular geometry. Using magnetic resonance imaging (MRI-EF) as the reference standard, we sought whether global longitudinal strain (GLS) could be an alternative to the measurement of EF. Methods Manual and semi-automated tracing was used to measure Simpson's biplane ejection-fraction (2D-EF) and 3D ejection fraction (3D-EF) and MRI in 62 patients with previous infarction. Global longitudinal strain was measured by 2-dimensional strain (2DS) in the apical views. Automated EF was calculated using speckle tracking to detect the end-diastolic and end-systolic endocardial border. Results Strain curves were derived in all segments, with artifactual curves being excluded. The correlation of GLS with MRI-EF (r = −0.69, P < .0001) was comparable to that between 3D-EF and MRI (r = 0.80, P < .0001), and better than that between 2D-EF (r = 0.58, P < .0001) or automated EF and MRI (r = 0.62, P < .0001). To convert GLS into an equivalent MRI-EF, linear regression was used to develop the formula EF = −4.35 * (strain + 3.9). Of the 32 patients with a normal MRI-EF (≥50%), 75% had normal systolic function by GLS, whereas 85% of patients were recognized as having a normal 3D-EF. Fewer patients were recognized as normal by 2D-EF (70%, P = .14) and automated-EF (61%, P = .04). In those with >6 abnormal segments, the correlation of GLS with MRI-EF improved significantly (r = −0.77, P < .0001) and was similar to 3D-EF (r = 0.76, P < .0001). Conclusion Global longitudinal strain is an effective method for quantifying global left ventricular function, particularly in patients with extensive wall motion abnormalities.
History
Publication title
American Heart Journal
Volume
157
Pagination
102.e1-102.e5
ISSN
0002-8703
Department/School
Menzies Institute for Medical Research
Publisher
Mosby
Place of publication
Inc, 11830 Westline Industrial Dr, St Louis, USA, Mo, 63146-3318