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Global longitudinal strain: clinical use and prognostic implications in contemporary practice
  1. Rachid Abou,
  2. Pieter van der Bijl,
  3. Jeroen J Bax,
  4. Victoria Delgado
  1. Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Victoria Delgado, Leiden University Medical Center, Leiden 2300, The Netherlands; v.delgado{at}lumc.nl

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Learning objectives

  • To learn how to measure left ventricular global longitudinal strain (LV GLS) and the factors that may influence its measurement.

  • To understand why LV GLS is an earlier marker of LV systolic dysfunction as compared with LV ejection fraction.

  • To learn other clinical applications of the use of speckle tracking echocardiography.

Introduction

Non-invasive evaluation of left ventricular (LV) systolic function by echocardiography remains one of the most pivotal measures in clinical cardiology. Although conventionally quantified by means of LV ejection fraction (LVEF), it has become evident that this parameter is subject to a number of limitations. LVEF can be normal in the presence of impaired LV systolic function, since it does not reflect intrinsic myocardial contractility.1 In addition, LVEF is highly load-dependent and suffers from significant intraobserver and interobserver variability.2 Assessment of myocardial strain can potentially overcome many of the limitations of LVEF in assessing LV systolic function. Speckle tracking echocardiography permits assessment of myocardial strain in three spatial directions (longitudinal, radial and circumferential) independent of the angle of insonation of the ultrasound beam. Longitudinal strain is probably the most frequent type of strain used to characterise LV systolic function in clinical practice. This review article focuses on the practical aspects of measuring LV global longitudinal strain (GLS), reviews the clinical implications of impaired LV GLS strain and provides a glimpse into the future clinical applications of this technology.

Assessment of LV GLS

The LV myocardium consists of two helical, opposing layers of myocardial fibres (endocardial/right-handed and epicardial/left-handed) surrounding a circumferential, mid-ventricular layer. When these layers contract, the myocardium shortens in the longitudinal and circumferential directions and thickens in the radial direction (figure 1). The introduction of speckle tracking echocardiography has allowed for a more comprehensive analysis of LV systolic function when compared with LVEF by assessing myocardial deformation in these three directions. …

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Footnotes

  • Contributors All the authors of this review article have done the following: substantial contributions to the conception or design of the review outline, drafting the work or revising it critically for important intellectual content, final approval of the version published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The Department of Cardiology, Heart Lung Center, Leiden University Medical Center received research grants from Abbott Vascular, BioVentrix, Biotronik, Medtronic, Boston Scientific Corporation, GE Healthcare and Edwards Lifesciences. VD received speaker fees from Abbott Vascular, Edwards Lifesciences, Medtronic and GE Healthcare. JJB received speaker fees from Abbott Vascular.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references

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