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      Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training

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          Abstract

          Background

          Left ventricular ejection fraction (LVEF) is an established method for evaluation of left ventricular (LV) systolic function. Global longitudinal strain (GLS) by speckle tracking echocardiography seems to be an important additive method for evaluation of LV function with improved reproducibility compared with LVEF. Our aim was to compare reproducibility of GLS and LVEF between an expert and trainee both as echocardiographic examiner and analyst.

          Methods

          Forty-seven patients with recent Acute Coronary Syndrome (ACS) underwent echocardiographic examination by both an expert echocardiographer and a trainee. Both echocardiographers, blinded for clinical data and each other’s findings, performed image analysis for evaluation of intra- and inter- observer variability. GLS was measured using speckle tracking echocardiography. LVEF was calculated by Simpson’s biplane method.

          Results

          The trainee measured a GLS of − 19.4% (±3.5%) and expert − 18.7% (±3.2%) with an Intra class correlation coefficient (ICC) of 0.89 (0.74–0.95). LVEF by trainee was 50.3% (±8.2%) and by expert 53.6% (±8.6%), ICC coefficient was 0.63 (0.32–0.80). For GLS the systematic difference was 0.21% (− 4.58–2.64) vs. 4.08% (− 20.78–12.62) for LVEF.

          Conclusion

          GLS is a more reproducible method for evaluation of LV function than LVEF regardless of echocardiographic training.

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          Most cited references22

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          Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography.

          Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment.Several such technique shave emerged over the past decades to address the issue of reader's experience and inter measurement variability in interpretation.Some were widely embraced by echocardiographers around the world and became part of the clinical routine,whereas others remained limited to research and exploration of new clinical applications.Two such techniques have dominated the research arena of echocardiography: (1) Doppler based tissue velocity measurements,frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements.Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated backscatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses,briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.
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            Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction.

            This study sought to test the hypothesis that semiautomated calculation of left ventricular global longitudinal strain (GLS) can identify high-risk subjects among patients with myocardial infarctions (MIs) with left ventricular ejection fractions (LVEFs) >40%. LVEF is a key determinant in decision making after acute MI, yet it is relatively indiscriminant within the normal range. Novel echocardiographic deformation parameters may be of particular clinical relevance in patients with relatively preserved LVEFs. Patients with MIs and LVEFs >40% within 48 h of admission for coronary angiography were prospectively included. All patients underwent echocardiography with semiautomated measurement of GLS. The primary composite endpoint (all-cause mortality and hospitalization for heart failure) was analyzed using Cox regression analyses. The secondary endpoints were cardiac death and heart failure hospitalization. A total of 849 patients (mean age 61.9 ± 12.0 years, 73% men) were included, and 57 (6.7%) reached the primary endpoint (median follow-up 30 months). Significant prognostic value was found for GLS (hazard ratio [HR]: 1.20; 95% confidence interval [CI]: 1.10 to 1.32; p   -14% was associated with a 3-fold increase in risk for the combined endpoint (HR: 3.21; 95% CI: 1.82 to 5.67; p   -14% was significantly associated with cardiovascular death (HR: 12.7; 95% CI: 3.0 to 54.6; p  40% above and beyond traditional indexes of high-risk MI. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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              Global 2-dimensional strain as a new prognosticator in patients with heart failure.

              We sought to evaluate whether global 2-dimensional (2D) strain offers additional benefit over left ventricular ejection fraction (LVEF) to predict clinical events in heart failure. Although 2D strain based on speckle tracking has been proposed as a simple and reproducible tool to detect systolic dysfunction, the relationship of 2D strain and prognosis has not been studied. Two hundred one patients (age 63 +/- 11 years, 34% female, LVEF 34 +/- 13%) hospitalized for acute heart failure underwent clinical evaluation and conventional and tissue Doppler echocardiography. Using dedicated software, we measured the global longitudinal strain (GLS) in apical 4- and 2-chamber views and the global circumferential strain (GCS) in a parasternal short-axis view. Cardiac events were defined as readmission for heart failure or cardiac death. There were 23.4% clinical events during 39 +/- 17 months of follow-up. In univariate analysis, age, left atrial volume, left ventricular volume, LVEF, ratio of early transmitral flow to early diastolic annular velocity (E/e'), and both GLS and GCS were predictive of cardiac events. In multivariate Cox models, age (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.10, p = 0.017) and GCS (HR: 1.15, 95% CI: 1.04 to 1.28; p = 0.006) were independently associated with cardiac events. By Cox proportional hazards model, the addition of GCS markedly improved the prognostic utility of a model containing ejection fraction, E/e', and GLS. GCS is a powerful predictor of cardiac events and appears to be a better parameter than ejection fraction in patients with acute heart failure.
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                Author and article information

                Contributors
                +47 37014000 , harald.brunvand@sshf.no
                Journal
                Cardiovasc Ultrasound
                Cardiovasc Ultrasound
                Cardiovascular Ultrasound
                BioMed Central (London )
                1476-7120
                2 September 2019
                2 September 2019
                2019
                : 17
                : 18
                Affiliations
                [1 ]ISNI 0000 0004 0414 4503, GRID grid.414311.2, Sørlandet Hospital, ; Arendal, Norway
                [2 ]ISNI 0000 0004 0627 3560, GRID grid.52522.32, St. Olavs Hospital, ; Trondheim, Norway
                [3 ]ISNI 0000 0004 0389 8485, GRID grid.55325.34, Oslo University Hospital, , Rikshospitalet, ; Oslo, Norway
                Article
                168
                10.1186/s12947-019-0168-9
                6720884
                31477137
                89cd21a2-071a-49aa-a009-f77d00c1f91e
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 June 2019
                : 23 August 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100009471, EkstraStiftelsen Helse og Rehabilitering;
                Award ID: n.a
                Award Recipient :
                Funded by: Sørlandet Hospital, Arendal
                Award ID: n.a.
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Cardiovascular Medicine
                global longitudinal strain,left ventricular ejection fraction,echocardiographic training

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