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Updated: Sep 11, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Assessment of cardiac dysfunction in COVID-19 patients using layer-specific strain echocardiography in short-axis and
Mengjiao Zhang1,2,3, Jianxiong Chen3,4, Lingheng Wu3,4
1Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201803, China.
Insights
COVID-19 causes myocardial dysfunction, particularly in the inner heart layers. Global longitudinal strain (GLS) effectively identifies this dysfunction, outperforming global circumferential strain (GCS) in COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomedical Imaging
Background:
- COVID-19 frequently causes cardiac dysfunction, impacting various myocardial layers.
- Understanding layer-specific myocardial injury is crucial for assessing COVID-19's cardiac effects.
- Previous studies have not fully detailed the impact on endocardial, mid-myocardial, and epicardial layers.
Purpose of the Study:
- To evaluate myocardial dysfunction in COVID-19 patients using layer-specific strain imaging.
- To assess both long-axis and short-axis function of the left ventricle (LV).
- To correlate cardiac function with clinical and biochemical markers.
Main Methods:
- 197 COVID-19 patients were categorized into mild, moderate, and severe groups.
- Two-dimensional myocardial layer-specific strain imaging was used to assess LV function.
- Cardiac indices and biomarker levels were analyzed for correlation with global longitudinal strain (GLS) and global circumferential strain (GCS).
Main Results:
- Reduced GLS and GCS were observed in moderate and severe COVID-19 cases.
- GLS showed superior diagnostic performance (AUC 0.81-0.84) compared to GCS (AUC 0.55-0.61) in detecting myocardial dysfunction.
- Myocardial dysfunction was linked to factors including age, LVEF, cTnI, myoglobin, and BNP levels.
Conclusions:
- COVID-19 induces distinct myocardial injury across different layers, with greater impact on the inner myocardium.
- GLS is a more effective diagnostic tool than GCS for identifying COVID-19-related myocardial dysfunction.
- Myocardial dysfunction in COVID-19 correlates with blood pressure, cardiac structure, and biochemical markers.
Objectives:
Cardiac dysfunction is commonly observed in COVID-19 patients, but its impact on different myocardial layers-endocardial, mid-myocardial, and epicardial remains insufficiently understood. This study aims to evaluate myocardial dysfunction in COVID-19 patients by assessing both the long-axis and short-axis function of the left ventricle (LV) using two-dimensional myocardial layer-specific strain imaging.
Methods:
A total of 197 COVID-19 patients were enrolled and categorized into three subgroups: mild, moderate, and severe. Cardiac structural and functional indices, along with biomarker levels, were collected to analyze their correlation with global longitudinal strain (GLS) and global circumferential strain (GCS).
Results:
GLS and GCS were reduced in moderate and severe COVID-19 patients, including layer-specific GLS and GCS (both p < 0.05). E/A ratio, left ventricular ejection fraction (LVEF), and myoglobin were identified as independent factors influencing GLS (all p < 0.05). Age, LVEF, cardiac troponin I (cTnI), and myoglobin were independent factors influencing GCS (p < 0.05). Furthermore, B-type Natriuretic Peptide (BNP) and myoglobin were identified as independent predictors of both GLS in the whole wall (GLSww) and endocardial (GLSendo), with β values of -0.22, -0.21 and -0.39, -3.70, respectively (all p < 0.05). GLS, including endocardial, mid-myocardial, and epicardial myocardial layers, demonstrated superior diagnostic performance compared to GCS, with AUC values of 0.81, 0.83, and 0.84 vs. 0.61, 0.57, and 0.55, respectively (all p < 0.001).
Conclusion:
There are differences in myocardial injury caused by COVID-19 across different layers of the myocardium, both in the longitudinal and circumferential directions, with more pronounced damage observed in the inner myocardium. GLS demonstrated superior diagnostic performance compared to GCS in identifying myocardial dysfunction. Furthermore, myocardial dysfunction was correlated with blood pressure, myocardial structure, and biochemical markers.
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