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Should LVEF be replaced by global longitudinal strain?
  1. Catherine Szymanski1,2,
  2. Franck Lévy1,
  3. Christophe Tribouilloy1,2
  1. 1Department of Cardiology, University Hospital Amiens, Amiens Cedex 1, France
  2. 2INSERM U1088, University of Picardie, Amiens, France
  1. Correspondence to Dr Catherine Szymanski, INSERM U 1088 and University Hospital, Amiens, France, Department of Cardiology, Avenue René Laënnec, Amiens Cedex 1 80054, France; caszymanski{at}yahoo.fr

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For many years, echocardiography remained the main non-invasive bedside-imaging modality to provide reliable assessment of cardiac mechanics. Considering its major prognostic value, vigorous efforts were made to improve ultrasound determination of global left ventricular (LV) systolic function, from M-mode fractional shortening to Simpson's biplane or 3D ejection fraction (EF). However, these volumetric indices of global LV showed inherent variability, influenced by image quality, off-axis imaging or measurement errors. Direct echocardiographic assessment of myocardial fibre deformation has recently become available in routine clinical practice with the development of speckle-tracking imaging software. This relatively new technique is based on frame-to-frame tracking of acoustic markers (speckles) obtained from gray-scale echocardiographic images. However, significant variability was observed within the first generation of software products released by various manufacturers, mostly related to vendor-specific postprocessing algorithms.1 While ongoing efforts from vendors and echocardiographic societies are designed to standardise and calibrate strain measurements, a high level of agreement and reproducibility has recently been reported for global (but not segmental) longitudinal strain (GLS) obtained with the most …

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