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Updated: Apr 28, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Patterns of decrease in multidirectional myocardial deformations in patients with fluctuating left ventricular
Yong-Hyun Kim1, Jungsoon Choi, Seong-Hwan Kim
1Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital.
Insights
This study investigated how heart strain and strain rate change with left ventricular ejection fraction (LVEF) in individual patients. Findings suggest these relationships may not be linear but are not definitively proven in individual hearts.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Mechanics
Background:
- Left ventricular ejection fraction (LVEF) is a key measure of heart function.
- Longitudinal/circumferential/radial strain (LS/CS/RS) and strain rate (LSr/CSr/RSr) offer detailed insights into myocardial mechanics.
- Limited data exists on individual variations in strain parameters relative to fluctuating LVEF.
Purpose of the Study:
- To test the hypothesis that strain/strain rate and LVEF relationships exhibit non-linear, inflective patterns in individual hearts.
- To analyze the relationship between LS/CS/RS, LSr/CSr/RSr, and LVEF in patients with significant LVEF variability.
Main Methods:
- Utilized 2-D speckle tracking echocardiography data from 25 patients with fluctuating LVEF (ΔLVEF > 10%).
- Developed 'collective' and 'individual hearts' plots to model strain/strain rate versus LVEF relationships.
- Identified inflection points (IPs) and compared slope decrements above and below IPs.
Main Results:
- Collective plots showed linear LS/LSr decrease with LVEF ≥ 40% (IP at 40%) and constant values below 40%.
- Collective RS-LVEF relationship was sigmoid with IPs at 30% and 50% LVEF.
- Individual heart plots revealed no significant difference in slope decrements for LS/LSr-LVEF, and marginal difference for RS-LVEF.
Conclusions:
- While collective data suggests non-linear, inflective relationships between strain/strain rate and LVEF, this hypothesis was not confirmed in individual hearts.
- Further research with larger patient cohorts is necessary to validate the inflective nature of these relationships in individual patients.
Abstract:
Few studies have examined the variations in longitudinal/circumferential/radial strain (LS/CS/RS) and strain rate (LSr/CSr/RSr) in individual hearts when the left ventricular ejection fraction (LVEF) has changed. We hypothesized the relationships of strain/strain rate and LVEF are not linear, but vary with multiple inflection points (IPs) in individual hearts.Twenty-five patients with fluctuating LVEF (ΔLVEF > 10%) who had 2-D speckle tracking echocardiography available for analysis were enrolled. After models of best fit were obtained from the 'collective' plots to determine inflection points, the decrements of slopes above inflection points (IP) were compared with those below IPs in the 'individual hearts' plots.In the 'collective' plots, both LS and LSr linearly decreased in proportion to LVEF when LVEF ≥ 40% but remained constant regardless of LVEF when LVEF < 40% (IPs when LVEF = 40%, P < 0.0001). The RS-LVEF relationship was sigmoid with two IPs when LVEF = 30% and 50% (P < 0.0001). However, in the 'individual hearts' plots, the decrements of slopes above and below IPs were not different for LS-LVEF and LSr-LVEF, and marginally different for RS-LVEF (P = 0.049, across IP when LVEF = 50%).Collectively, the relationship of LS/LSr/RS and LVEF seemed to be not linear, but inflective, however, we could not prove the inflective relationship in individual hearts with fluctuating LVEF. Further study with more patients is needed to prove our hypothesis.
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