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Updated: Feb 24, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
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.
Insights
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.
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.
Background:
Preserved left ventricular (LV) ejection fraction (EF) and reduced myocardial strain are reported in patients with hypertrophic cardiomyopathy, ischemic heart disease, diabetes mellitus, and more.
Objectives:
The authors performed a combined mathematical and echocardiographic study to understand the inconsistencies between EF and strains.
Methods:
An analytical equation showing the relationship between EF and the 4 parameters, global longitudinal strain (GLS), global circumferential strain (GCS), wall thickness, and short-axis diameter, was derived from an elliptical LV model. The equation was validated by measuring the 4 parameters by echocardiography in 100 subjects with EF ranging from 16% to 72% and comparing model-predicted EF with measured EF. The effect of the different parameters on EF was explored in the model and compared with findings in the patients.
Results:
Calculated EF had very good agreement with measured EF (r = 0.95). The model showed that GCS contributes more than twice as much to EF than GLS. A significant reduction of GLS could be compensated by a small increase of GCS or wall thickness or reduced diameter. The model further demonstrated how EF can be maintained in ventricles with increased wall thickness or reduced diameter, despite reductions in both longitudinal and circumferential shortening. This was consistent with similar EF in 20 control subjects and 20 hypertrophic cardiomyopathy patients with increased wall thickness and reductions in both circumferential and longitudinal shortening (all p < 0.01).
Conclusions:
Reduced deformation despite preserved EF can be explained through geometric factors. Due to geometric confounders, strain better reflects systolic function in patients with preserved EF.
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