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Echocardiographic Longitudinal Strain Analysis in Heart Failure: Real Usefulness for Clinical Management Beyond
Giuseppe D Sanna1, Mario E Canonico2,3, Ciro Santoro3
1Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy. giuseppe.sanna@aousassari.it.
Insights
Global longitudinal strain (GLS) offers valuable insights into heart failure (HF) diagnosis and management, overcoming limitations of traditional ejection fraction measurements. This echocardiographic technique provides crucial data on systolic and diastolic functions for improved patient care.
Area of Science:
- Cardiology
- Echocardiography
- Medical Diagnostics
Background:
- Heart failure (HF) presents significant phenotypic heterogeneity, challenging traditional classification systems.
- Left ventricular ejection fraction (LVEF) has limitations in accurately assessing cardiac function across diverse clinical scenarios.
- Limitations of LVEF are evident in heart failure with preserved ejection fraction (HFpEF), valvular heart disease, subclinical HF, and athletes.
Purpose of the Study:
- To review the current role of global longitudinal strain (GLS) in the diagnosis and management of heart failure (HF).
- To critically analyze the advantages and disadvantages of GLS in various HF clinical settings.
- To elucidate how appropriate use and interpretation of GLS can offer important diagnostic and prognostic clues.
Main Methods:
- Review of current literature on strain imaging analysis, specifically global longitudinal strain (GLS).
- Critical analysis of the pros and cons of GLS application in different HF patient populations.
- Discussion of the diagnostic performance and prognostic value of GLS in HF.
Main Results:
- Global longitudinal strain (GLS) provides simultaneous information on systolic and diastolic functions, independent of preload and afterload.
- GLS has demonstrated utility in enhancing diagnostic performance and prognostic value in numerous HF studies.
- Despite its benefits, universally accepted GLS cutoff values and inter-vendor variability require further investigation for routine clinical adoption.
Conclusions:
- Global longitudinal strain (GLS) is a valuable echocardiographic tool that overcomes limitations of traditional ejection fraction (EF) measurements in heart failure (HF).
- Appropriate application and interpretation of GLS can significantly aid in the diagnosis and management of patients across various HF phenotypes.
- Further standardization of GLS measurement and interpretation is needed to facilitate its widespread routine use in clinical practice.
Abstract:
Heart failure (HF) is a highly prevalent clinical syndrome characterized by considerable phenotypic heterogeneity. The traditional classification based on left ventricular ejection fraction (LVEF) is widely accepted by the guidelines and represents the grounds for patient enrollment in clinical trials, even though it shows several limitations. Ejection fraction (EF) is affected by preload, afterload, and contractility, it being problematic to express LV function in several conditions, such as HF with preserved EF (HFpEF), valvular heart disease, and subclinical HF, and in athletes. Over the last two decades, developments in diagnostic techniques have provided useful tools to overcome EF limitations. Strain imaging analysis (particularly global longitudinal strain (GLS)) has emerged as a useful echocardiographic technique in patients with HF, as it is able to simultaneously supply information on both systolic and diastolic functions, depending on cardiac anatomy and physiology/pathophysiology. The use of GLS has proved helpful in terms of diagnostic performance and prognostic value in several HF studies. Universally accepted cutoff values and variability across vendors remain an area to be fully explored, hence limiting routine application of this technique in clinical practice. In the present review, the current role of GLS in the diagnosis and management of patients with HF will be discussed. We describe, by critical analysis of the pros and cons, various clinical settings in HF, and how the appropriate use and interpretation of GLS can provide important clues.
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