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Related Concept Videos

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Related Experiment Video

Updated: Feb 24, 2026

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
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Geometry as a Confounder When Assessing Ventricular Systolic Function: Comparison Between Ejection Fraction and

Thomas M Stokke1, Nina E Hasselberg2, Marit K Smedsrud3

  • 1Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

Journal of the American College of Cardiology
|August 19, 2017
PubMed
Summary

Geometric factors explain preserved ejection fraction (EF) despite reduced myocardial strain. This study reveals how ventricular geometry influences EF, suggesting strain better reflects systolic function when EF is preserved.

Keywords:
left ventricular geometrymathematical modelingmyocardial strain

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Mathematical Modeling

Background:

  • Preserved left ventricular ejection fraction (EF) with reduced myocardial strain is observed in various cardiac conditions.
  • Inconsistencies between EF and myocardial strain measurements require explanation.

Purpose of the Study:

  • To investigate the relationship between EF and myocardial strain using a combined mathematical and echocardiographic approach.
  • To elucidate the impact of geometric factors on the assessment of systolic function.

Main Methods:

  • Derived an analytical equation linking EF to global longitudinal strain (GLS), global circumferential strain (GCS), wall thickness, and short-axis diameter using an elliptical left ventricular model.
  • Validated the model by comparing predicted EF with measured EF in 100 subjects via echocardiography.
  • Explored parameter effects on EF within the model and compared with clinical findings.

Main Results:

  • The derived equation showed strong agreement between calculated and measured EF (r=0.95).
  • Global circumferential strain (GCS) was found to contribute more than twice as much to EF as global longitudinal strain (GLS).
  • Reductions in GLS could be compensated by increases in GCS, wall thickness, or decreased diameter, maintaining EF.

Conclusions:

  • Geometric factors, such as increased wall thickness or reduced diameter, can explain preserved EF despite reduced myocardial deformation.
  • Strain measurements may be more indicative of true systolic function in patients with preserved EF due to geometric confounders.