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Updated: Aug 15, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Prediction of Deterioration of Left Ventricular Function Using 3-Dimensional Speckle-Tracking Echocardiography in
Hyue Mee Kim1, In-Chang Hwang2, Yeonyee Elizabeth Yoon2
1Division of Cardiology Department of Internal Medicine Chung-Ang University Hospital Chung-Ang University College of Medicine Seoul South Korea.
Insights
Two-dimensional global longitudinal strain (2D-GLS) predicts preserved left ventricular ejection fraction (LVEF) in patients with left bundle-branch block. Three-dimensional global circumferential strain (3D-GCS) predicts persistent LV dysfunction in those with reduced LVEF.
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Cardiac Mechanics
Background:
- Previous studies linked 2D-GLS to cardiovascular outcomes in left bundle-branch block (LBBB) patients.
- The predictive utility of 3D speckle-tracking echocardiography in LBBB remains under-investigated.
Purpose of the Study:
- To investigate the association between 2D and 3D strain parameters and longitudinal changes in left ventricular ejection fraction (LVEF) in patients with LBBB.
- To determine the predictive value of different strain measures for maintaining or improving LVEF in LBBB patients.
Main Methods:
- Retrospective analysis of 290 LBBB patients with serial echocardiograms.
- Quantification of 2D-GLS, 3D-GLS, 3D-global circumferential strain (3D-GCS), 3D global radial strain, and 3D global area strain using speckle-tracking echocardiography.
- Analysis of associations between strain parameters and follow-up LVEF, stratified by baseline LVEF (preserved ≥40% vs. reduced <40%).
Main Results:
- In patients with preserved baseline LVEF, higher 2D-GLS was associated with maintaining LVEF (OR, 0.65; P<0.001).
- In patients with reduced baseline LVEF, lower 3D-GCS was strongly associated with persistently reduced LVEF (OR, 0.61; P<0.001).
- 14.9% of patients with preserved LVEF progressed to LV dysfunction, while 51.0% with reduced LVEF showed improved LV function.
Conclusions:
- 2D-GLS is a valuable predictor of preserved LVEF maintenance in LBBB patients.
- 3D-GCS offers significant predictive value for persistent LV dysfunction in LBBB patients with initially reduced LVEF.
- 3D strain parameters, particularly 3D-GCS, provide complementary prognostic information in LBBB management.
Abstract:
Background Previous studies have demonstrated that 2-dimensional (2D) global longitudinal strain (GLS) is associated with cardiovascular outcomes in patients with left bundle-branch block. However, the predictive value of 3-dimensional (3D) speckle-tracking echocardiography has not yet been investigated in these patients. Methods and Results The authors retrospectively identified 290 patients with left bundle-branch block who underwent echocardiography more than twice. Using speckle-tracking echocardiography, 2D-GLS, 3D-GLS, 3D-global circumferential strain, 3D global radial strain, and 3D global area strain were acquired. The association between 2D and 3D strains and the follow-up left ventricular (LV) ejection fraction (LVEF) was analyzed. The study population was divided into 2 sets: a group with preserved LVEF (baseline LVEF ≥40%) and a group with reduced LVEF (baseline LVEF <40%). After a median follow-up of 29.1 months (interquartile range, 13.1-53.0 months), 14.9% of patients progressed to LV dysfunction in the group with preserved LVEF, and 51.0% of patients showed improved LV function in the group with reduced LVEF. Multivariable analysis of 2D and 3D strains revealed that higher 2D-GLS (odds ratio [OR], 0.65 [95% CI, 0.54-0.78], P<0.001) was highly associated with maintaining LVEF in patients with preserved LVEF. However, a lower 3D-global circumferential strain (OR, 0.61 [95% CI, 0.47-0.78], P<0.001) showed a strong association with persistently reduced LVEF in patients with reduced LVEF. Conclusions Although 2D-GLS showed a powerful predictive value for the deterioration of LV function in the preserved LVEF group, 3D strain, especially 3D-global circumferential strain, can be helpful to predict consistent LV dysfunction in patients with left bundle-branch block who have reduced LVEF.
