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Related Experiment Video

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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
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Assessing left ventricular systolic function: from ejection fraction to strain analysis.

Brian P Halliday1,2, Roxy Senior1,3, Dudley J Pennell1,2

  • 1National Heart Lung Institute, Imperial College, Dovehouse St, London SW3 6NP, UK.

European Heart Journal
|September 25, 2020
PubMed
Summary
This summary is machine-generated.

Left ventricular ejection fraction (LVEF) is an outdated measure for heart failure prognosis. Global longitudinal strain (GLS) offers improved risk stratification for heart failure patients, especially those with preserved LVEF.

Keywords:
Cardiac performanceEjection fractionHeart failureMyocardial strainValvular heart disease

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Left ventricular ejection fraction (LVEF) is a standard metric in cardiac imaging for patient management.
  • Historically, LVEF cut-offs guided heart failure therapy selection based on prognosis.
  • Current cardiac disease prevalence necessitates improved prognostic indicators beyond LVEF.

Purpose of the Study:

  • To evaluate the utility of myocardial strain assessment, specifically global longitudinal strain (GLS), in improving cardiac patient risk stratification.
  • To highlight the limitations of LVEF in identifying myocardial dysfunction in conditions like heart failure with preserved ejection fraction (HF-PEF) and valvular heart disease.
  • To advocate for the integration of GLS into routine clinical practice for better therapy selection and patient outcomes.

Main Methods:

  • Review of existing literature and clinical trial data concerning LVEF and myocardial strain measurements.
  • Analysis of the role of GLS in risk stratification for heart failure patients.
  • Examination of GLS's effectiveness in detecting myocardial dysfunction in valvular heart disease despite normal LVEF.

Main Results:

  • LVEF is increasingly recognized as an inadequate predictor of prognosis for many heart failure patients, particularly in HF-PEF.
  • GLS has demonstrated consistent improvement in risk stratification for heart failure patients.
  • GLS effectively identifies patients with valvular heart disease and myocardial decompensation who have preserved LVEF and a higher risk of adverse events.

Conclusions:

  • LVEF alone is insufficient for comprehensive risk assessment in diverse cardiac conditions.
  • Myocardial strain, particularly GLS, shows significant promise for enhancing prognostic accuracy and guiding clinical decisions.
  • Further research is needed to confirm GLS's impact on therapy selection and patient outcomes for widespread clinical adoption.